Zusammenfassung Hintergrund Im Rahmen des ELF der ESPRAS wurde die Notwendigkeit standardisierter Richtlinien zur Brustrekonstruktion auf europäischer Ebene definiert. Ziel dieser Studie ist es, zunächst einen Überblick über den aktuellen Status, Entwicklungen und mögliche regionale Unterschiede der Brustrekonstruktion in Europa zu geben, wobei ein Schwerpunkt auf dem Angebot, der Verteilung und dem Zugang zur Brustrekonstruktion liegt. Materialien und Methoden Es erfolgte eine internetbasierte Befragung von in der Brustrekonstruktion spezialisierten Plastischen Chirurgen, welche zusätzlich die nationalen Versorgungsstrukturen ihrer jeweiligen Länder überblicken. Geeignete Teilnehmer wurden über das ExCo der ESPRAS und nationale Delegierte von ESPRAS identifiziert. Die Ergebnisse wurden mit aktueller evidenzbasierter Literatur verglichen. Ergebnisse 33 Teilnehmer aus 29 europäischen Ländern nahmen an der Studie teil. Im Vergleich zur Gesamtzahl durchgeführter Mastektomien war die Inzidenz der Brustrekonstruktionen in Europa relativ gering, vergleichbar mit anderen großen geografischen Regionen, wie z. B. Nordamerika. Die Verfügbarkeit und der Zugang zur Brustrekonstruktion war innerhalb Europas gleichmäßig verteilt, allerdings kann die geografische Region das Verfahren der Brustrekonstruktion (Eigengewebe vs. Implantat) beeinflussen. Deutliche Differenzen zeigten sich bezüglich Brustrekonstruktionen bei bestrahlten Patientinnen. Schlussfolgerung Die Studie identifizierte ein ausgeprägtes Maß an Inkohärenz in den internationalen Standards zwischen den europäischen Ländern. Es besteht großer Bedarf für kohärente europäische Leitlinien. Europäische, multizentrische klinische Studien sollten initiiert werden, um eine evidenzbasierte Grundlage zu schaffen.

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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.

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Abstract:Objectives: Majority of patients that undergo total or partial removal of the hypopharynx and cervical oesophagus are oncologic patients. Optimal management of head and neck malignancies requires multimodal therapy including surgical ablation, reconstruction, and adjuvant oncologic therapy. Despite aggressive surgical and adjuvant therapy, a fi ve-year survival rate is achieved only in 25-35 %. Methods: In the presented retrospective study, the choice of reconstructive method was infl uenced by type, length and extent of the defect, and condition of patient. The fl ap was indicated when the defect not allowed for primary suture of the hypopharynx and/or cervical oesophagus. Two-team approach was used. Results: The study was based on the data of ten patients. Radial forearm fl ap was used in 8 cases; pectoralis major myocutaneous fl ap was used in 3 patients, and ALT perforator free fl ap in 1 case. A total of 12 fl aps were used for 10 patients. Two patients developed free fl ap necrosis. These necrotic fl aps were substituted with pedicled pectoralis major myocutaneous fl aps. Conclusions:The primary reconstruction of the pharyngo-oesophageal defects could be the method of choice. For the partial defects, the best choice could be a radial forearm free fl ap. For circumferential defects, jejunal fl ap could be the best. The pectoralis major pedicled fl ap could be a safe procedure for elderly patients with multiple medical problems ( Tab. 6, Fig. 2, Ref. 34). Full Text in PDF www.elis.sk. Key words: pharynx reconstruction, pharyngo-oesophageal reconstruction, ALT perforator fl ap, free radial forearm fl ap, pectoralis major fl ap. Surgical resection of the hypopharynx and cervical oesophagus may lead to severe functional defi cits, and it may prevent the patient's peroral intake of solid food and liquids. This usually applies to patients with locally advanced laryngeal or hypopharyngeal malignancy. The treatment of these patients involves resection and reconstruction followed by radiotherapy. Surgical resection and reconstruction of the hypopharynx in patients suffering from advanced oncological disease is a challenge for surgeons, anaesthesiologists, nurses, and represents serious stress for patient.Resection of a small part of the hypopharynx or cervical oesophagus allows for primary suture of the defect, and it results in only minimal and temporary changes. Extensive resections require diffi cult reconstructions, often associated with free transfer of tissues. Despite the extensive surgical therapy and aggressive adjuvant therapy, fi ve-year survival of patients in stage III or IV of head and neck malignancies is only 25-35 % (1-3).Nowadays, the most favoured method is that of one-stage reconstruction of gastrointestinal tract continuity. The reconstructions of hypopharynx and cervical oesophagus have progressed from multiple-stage procedures using pedicle skin fl aps (4-8) to the use of pedicle fasciocutaneous, myocutaneous and visceral fl aps (9-15). The advent of microsurgical free fl aps has allo...