The emergence of the COVID-19 pandemic imposed fundamental changes in the field of surgery. Reorganization was made in order to adequately treat the patients during the pandemic. WALANT (Wide Awake Local Anesthesia No Tourniquet) approach was found to be a very convenient method in facilitating continuity in hand surgery with limited staff. A retrospective comparative study was performed between period of April 2020 till September 2021 at our clinic to evaluate advantages of WALANT approach. This study included 136 patients, from which 72 (53%) were operated with WALANT, compared to the control group of 64 (47%) patients without WALANT. Average hospital stay for the WALANT group was 2.2 days vs. 4.7 days for the control group. Average operating room personnel were 3.8 for WALANT and 6.2 for the control non-WALANT group. Intraoperative and postoperative VAS (visual analogue scale) score was evaluated. Due to its diversity, low cost and low complication rate, we recommend WALANT approach in acute and elective hand surgery.

Background Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe. Material and Methods A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country. Results The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination. Conclusion Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe.

We present a case of a 28-year-old woman with primary lymphedema of the right leg, with tumor formations on her right foot, causing functional disabilities. Tumor formations were removed and histologically confirmed as dermatofibromas. Five years later, the patient was readmitted due to foot problems, keratosis of the heel, as well as increased edema of the dorsum of the foot and lower leg.Liposuction and excision of lymphoedematous tissue from the dorsum of the foot, release of the constrictive band at the level of the anterior surface of the ankle with "Z" plasty, as well as liposuction of lymphoedematous tissue of the lower leg and thigh were performed. The postoperative course was without complications, with a light seroma at the dorsum of the foot.During the 4-year follow-up period, the patient showed a noticeable improvement, with a slow increase in the volume of the lower leg and thigh, which did not reach the preoperative dimensions. Unfortunately, lymphedematous tissue increased again on the dorsum of the foot as prior to surgery.

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Regardless of the cause, major lower limb amputation is a life-changing event and accompanied by pain it has a great impact on patients' quality of life. Over the years many pharmacological and surgical treatments have been tried to manage residual limb pain and phantom limb pain, but they were either unsuccessful or did not apply to all patients. The aim of this review paper was to describe the current modalities of treatment of postamputation pain and the opportunity to use surgical techniques as prophylactic. More than 150 surgical interventions have been described in the literature: traction neurectomy, nerve capping, endto-end nerve coaptation, nerve transposition, etc. New and efficient techniques are regenerative peripheral nerve interface and targeted muscle reinnervation initially described for bioprosthetic control. Results from recent studies have shown that these techniques can be used for treatment, but also in a prophylactic manner, which can only be of benefit for the patient.