Background Plastic surgery training in the UK continues to evolve towards an outcome-based rather than time-served curriculum. UK plastic surgery trainees are appointed nationally, and are assessed according to national standards, but training is delivered regionally. This study sought opinion from current UK plastic surgery trainees in order to highlight strengths and shortcomings of the higher surgical training programme. Method A cross-sectional study was designed and administered by the UK Plastic Surgery Trainees Association (PLASTA). A questionnaire was distributed to all UK plastic surgery trainees holding a National Training Number, using the REDCap web-based application. Results Of the 320 UK plastic surgery trainees, 131 (41%) participated in this survey, with responses from all 12 UK training regions. The most common subspecialty career aspirations for trainees were hand surgery, cleft lip and palate, lower limb and oncoplastic breast reconstruction. The survey highlighted regional variation in teaching programmes, the ability to achieve indicative operative logbook numbers, and training in aesthetic surgery. Of the trainees, 82% expressed a desire to undertake a fellowship within their training, but most did not know whether their deanery would support this. Fifteen per cent of the respondents were currently training flexibly and the majority of these had experienced negative behaviours towards their less than full time working status. Of the respondents, 44% reported stress, 25% reported a lack of autonomy and 17% reported feeling burnt out at work at least once a week. A total of 85% perceived that they did not have access to a mentoring service. Conclusions Plastic surgery remains a popular and highly competitive surgical speciality in the UK, and many trainees reported high levels of satisfaction during their training. Aspects of training that could be improved have been highlighted and recommendations made accordingly.

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Background: The submental flap is a pedicled island flap with excellent colour match for facial reconstruction. The flap can be raised with muscle, submandibular gland or bone and can be transposed to reach defects up to two thirds of the face. We report the primary author's experience of 25 years using the submental flap from its original description to most recent technical evolutions in both Europe and Africa. Methods: This is a retrospective study including all patients with facial defects reconstructed using a submental flap between 1991 and 2016. This study included the use of all four variations of the submental flap: "platysmal', "digastric", "extended" and "super extended". We report technical adaptations and complications encountered. Results: We performed 311 facial reconstructions using submental flaps: 32 "platysmal", 133 "digastric", 91 "extended" and 45 "super extended" variations. In conjunction with these reconstructions, we performed 10 osteocutanous submental flaps and 2 free flaps. We report 2 cases of total flap necrosis (0.6%) and 28 minor complications including: 23 cases of distal skin necrosis (7%), 1 reversible mandibular facial nerve palsy (0.3%) and 3 hematomas (1%). Conclusions: The submental flap has proven to be a reliable flap for head and neck reconstruction. The four technical modifications described employ varying amounts of soft tissue to replace tissue lost and can include vascularized bone from the mandibular margin. This flap exemplifies Gillies' principle of "replacing like with like" and should be discussed as an alternative to free tissue transfer in facial reconstruction, especially in settings where resources are limited.