Fat necrosis within a deep inferior epigastric artery perforator flap reconstructed breast is considered a minor complication from reconstructive point of view, but one that can induce anxiety, inconvenience and concerns about cancer recurrence to the oncologist and the patient. A series of 100 consecutive unilateral deep inferior epigastric artery perforator flap breast reconstructions were reviewed to identify the institutional incidence as well as potential risk and predictor factors of fat necrosis. Examination revealed 37 reconstructed breasts with palpable firmnesses (described as clinical fat necrosis) and ultrasonography and mammography confirmed signs of fat necrosis in 30 reconstructed breasts. Flaps harvested on a single perforator, obese patients with body mass index > or = 30 and revision operations were all statistically significant predictors in our statistical model. Postoperative radiotherapy, a reconstructed breast volume over 500 mL and a pedicle raised on a single row of perforators were statistically significant only after univariate analysis and their statistical strength was lost after introducing them with multivariate model. This study helped us to further clarify criteria for selection of patients undergoing breast reconstruction with flaps from the abdomen.

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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Burn injuries are a major cause of morbidity and mortality. Next to the inhalation injury, total body surface area and age are strong predictors of mortality in burn victims. The novel coronavirus disease (COVID-19) pandemic is associated with a fatality rate of around 3,5%. We present a case of burn victim with full thickness burn to face, scalp, both upper extremities (27% of total body surface area), inhalation injury and active SARS-CoV-2 infection with concomitant pneumonia. The inhalation injury in COVID-19 positive patient was severe. A bronchoscopy revealed a diffuse erythema of the trachea and both main bronchi, the whole bronchial tree up to the distal segments was covered with carbonaceous material which could not be removed. We decided to treat the inhalation injury according to the guidelines for burns and acute respiratory distress syndrome. Accordingly, the patient did not receive any antiviral drugs or corticosteroids. The reconstruction of a full-thickness scalp defect after burn presents a challenge in large size defects and in patients with comorbidities. Double layer Integra Dermal Regeneration Template (Integra LifeSciences, Plainsboro, New Jersey) was the reconstruction method of choice. The take of dermal template and split thickness skin graft was 100% and good scalp contour was achieved. To our knowledge this is the first case report presenting a successful treatment outcome in a burn victim with inhalation injury, active SARS-CoV-2 infection and concomitant pneumonia with full thickness burn of 27% of total body surface area.

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