IntroductionMastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.MethodsA MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance.ResultsMSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.ConclusionMSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.

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Objectives Historically, burns have formed a significant proportion of the casualties of war. The management of burns in recent conflict has been found to be a resourceheavy undertaking, though its impact on both personnel and resources in current conflicts is unclear. A case analysis has been carried out in order to quantify the logistical impact of the management of burns on Role 3 Medical Treatment Facility (MTF) infrastructure and to examine if and how the cause and management of burns have evolved in early 21st century conflict. Methods All casualties treated for burns at a Role 3 MTF over one calendar year were identified and scanned copies of their notes obtained from the UK Joint Theatre Trauma Registry and retrospectively analysed. Results 88 of the 1461 (6.0%) trauma patients presenting to the Role 3 MTF over the year were treated for burns of whom 52.3% were combat troops and 45.4% civilians. Half of the burns were caused by non-conflict related mechanisms; the two commonest mechanisms were flame burns in 38/88 mostly non-conflict related cases and blast in 30/88 cases most of which were conflict related. Conclusions The management of burns at war is a complex process. It is further confounded by the management of civilians with non-conflict related burns, which places a predictable strain on Role 3 MTF resources: theatre time, nursing time, dressing resources and bed space. This must be planned for in current and future deployed operations.

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