Hyperbaric Oxygen Therapy in Upper Limb Crush Injury: Why and When?

Introduction In 2016, the European Committee for Hyperbaric Medicine strongly recommended hyperbaric oxygen therapy (HBOT) adjunctive to surgery in post-traumatic crush injuries, initiating as rapidly as possible. For the last 30 years, HBOT has been used in crush injury, but in most cases as a last resort, after skin flaps necrosis or wound bed infection, diminishing its potential benefits as a complementary treatment. It is, therefore, essential to understand how HBOT modulates the outcome of crush injury, and when to use it, since this can be a significant and underused therapeutic weapon that may alter the natural course of these patients. Methods Nineteen (n=19) adult patients with upper limb crush injuries underwent adjunctive HBOT, after the initial surgical approach. The measured outcomes included trauma-related acute complications (tissue necrosis and local infection), and late complications (pseudarthrosis and late deep infection). Results Only six (n=6) patients started HBOT in the first 24 hours. Four (n=4) patients presented acute complications; in half of those cases (n=2), HBOT was initiated more than 24 hours post-injury. Late complications were observed in three patients, none of which had initiated HBOT in the first 24 hours post-injury. Conclusions Either lack of awareness or logistic difficulties, preclude initiating timely HBOT, limiting its potential benefits. It is important to alert all practitioners to the right timing to initiate HBOT in order to improve these patients' outcomes.

Surgical Management of Severe Mandibular Actinomycosis: Segmental Mandibulectomy and Fibula Free Flap for Optimal Outcomes.

Actinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.

Impact of polyurethane versus acellular dermal matrix coating on prepectoral reconstruction outcomes: Interface does matter.

BACKGROUND: Interfaces continue to be used in prepectoral breast reconstruction to refine breast appearance, but more clinical data are required to assess their effectiveness. This study compares the rates of capsular contracture, breast esthetics, and patient satisfaction between two commonly used interface materials, acellular dermal matrix (ADM) and polyurethane (PU) foam. METHODS: A cross-sectional assessment was conducted on all patients who underwent prepectoral direct-to-implant reconstruction with an interface material between June 2018 and June 2022. We compared capsular contracture rates (assessed in-person), esthetic outcomes (evaluated by a three-member panel using a specially designed scale), and patient satisfaction (measured using the Breast-Q questionnaire) among the members of the interface groups. RESULTS: Among the 79 reconstructed breasts (20 bilateral cases), 35 were reconstructed using ADM and 44 using PU implants. The ADM group had a significantly higher frequency of Baker III/IV capsular contracture compared with the PU group (14.3% vs. 0%, p = 0.014) and lower ratings from the panel in terms of capsular contracture (median 3.7 vs. 4.0, p < 0.001). PU reconstructions scored worse in implant visibility (median 2.3 vs. 3.3, p < 0.001) and rippling (median 3.0 vs. 3.7, p < 0.001). However, after appropriate adjustment for confounders, no significant differences in overall appearance and patient satisfaction were found. CONCLUSIONS: ADM reconstructions are prone to capsular contracture with all their related esthetic issues, but PU implants have certain cosmetic flaws, such as implant visibility and malposition. Since each technique has its own limitations, neither the experienced surgeons nor patients exhibited a clear preference for either approach.

Refining reconstructive arsenal: Free omental flap with autologous bone graft for complex craniofacial defects after tumor resection and frontal osteoradionecrosis.

Skull osteoradionecrosis may happen after radiation therapy for head and neck cancer. Here in, the authors present a case of intracranial carcinoma with osteoradionecrosis and exposure of frontal bone with a large communication between nasal cavity and anterior fossa associated. The patient was successfully treated with resection of the tumor and reconstruction omentum free flap wrapped around autologous bone graft.

Heterotopic ossification - A rare donor site complication after iliac crest free flap.

Iliac crest free flap is still essential as a source of vascularized bone tissue, having a definite role in osseous reconstruction of the face and other small bone defects. Some of its drawbacks include laborious dissection and donor site morbidity. We report a case of a patient that presented to our follow-up consultation ten years after iliac crest free flap harvest with new complaints of pain, gait disturbance and swelling in the right hip. Imaging exams revealed a heterotopic bone formation and helped with the diagnosis of heterotopic ossification (HO) of the right iliacus bone. Surgical intervention was needed for debridement of the heterotopic bone, with resolution of the symptoms. To our knowledge, this is the first report of HO after iliac crest free flap harvest. This rare condition adds to an already well-known number of donor zone complications of this flap. Plastic surgeons should be aware of this complication, as it can cause disability many years after the original surgery.

Primary care doctor's perception about the scope of plastic surgeons: A national survey.

BACKGROUND: Plastic surgery is characterized by a broad spectrum of aesthetic and reconstructive surgical expertise that is not defined by an anatomic area. The authors sought to identify primary care doctors' perceptions of different fields of plastic surgery. METHODS: A short, anonymous, web-based survey was administered to primary care doctors in Portugal. Respondents were asked to choose the specialist they perceived to be an expert for 29 specific clinical areas, including 20 that are the core of plastic surgery practice. Specialists for selection included the following choices: dermatologist, general surgeon, maxillofacial surgeon, vascular surgeon, neurosurgeon, orthopedic surgeon, otolaryngologist, and plastic surgeon. RESULTS: A total of 430 complete answers to the survey were collected. Out of the 20 clinical cases related to plastic surgery, only nine were attributed to plastic surgery in the majority of the answers: thumb reimplantation (64,2%), abdominoplasty (93%), breast reduction (94%), otoplasty (62,3%), skin graft for a burn (97,7%), breast reconstruction (94,9%), complex open wound (57,2%), facial reanimation (36,7%) and first web space contracture of the hand (78,6%). CONCLUSIONS: There is a clear underestimation of the role of plastic surgery in a wide range of conditions, which may lead to the downsizing of plastic surgery departments in the national health system. It is of utmost importance to educate primary care doctors so that patients are referred correctly and in a timely manner.

Opioid-Free Anaesthesia Reduces Complications in Head and Neck Microvascular Free-Flap Reconstruction.

Head and neck free-flap microvascular surgeries are complex and resource-intensive procedures where proper conduct of anaesthesia plays a crucial role in the outcome. Flap failure and postoperative complications can be attributed to multiple factors, whether surgical- or anaesthesia-related. The anesthesiologist should ensure optimised physiological conditions to guarantee the survival of the flap and simultaneously decrease perioperative morbidity. Institutions employ different anaesthetic techniques and results vary across centres. In our institution, two different total intravenous approaches have been in use: a remifentanil-based approach and a multimodal opioid-sparing approach, which is further divided into an opioid-free anaesthesia (OFA) subgroup. We studied every consecutive case performed between 2015 and 2022, including 107 patients. Our results show a significant reduction in overall complications (53.3 vs. 78.9%, p = 0.012), length of stay in the intensive care unit (3.43 ± 5.51 vs. 5.16 ± 4.23 days, p = 0.046), duration of postoperative mechanical ventilation (67 ± 107 vs. 9 ± 38 h, p = 0.029), and the need for postoperative vasopressors (10% vs. 46.6%, p = 0.001) in the OFA group (vs. all other patients). The multimodal and OFA strategies have multiple differences regarding the fluid therapy, intraoperative type of vasopressor used, perioperative pathways, and various drug choices compared to the opioid-based technique. Due to the small number of cases in our study, we could not isolate any attitude, as an independent factor, from the success of the OFA strategy as a whole. Large randomised controlled trials are needed to improve knowledge and help define the ideal anaesthetic management of these patients.

Effects of a Physical Exercise Program on Quality of Life and Physical Fitness of Breast Cancer Survivors: the MAMA_MOVE Gaia After Treatment Trial.

To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.

Stylomandibular False Ankylosis: An Unusual Complication After Vascularized Iliac Crest Flap for Mandibular Reconstruction.

Stylomandibular fusion is a poorly documented and rare complication of maxillofacial surgical procedures. This case report describes a patient presenting with stylomandibular false ankylosis following mandibular reconstruction. A 59-year-old female patient underwent segmental mandibular resection and reconstruction for a defect resulting from ameloblastoma surgery using an iliac crest free flap. A styloid fracture was detected postoperatively, and the patient was managed conservatively. In the third postoperative year, the patient presented with marked limitation of oral gape. A diagnosis of stylomandibular false ankylosis was made, and the patient underwent an ostectomy of the aberrant bone, with improved mouth opening. The abnormal union between the styloid process and the mandible is a previously unreported complication in the use of iliac crest free flaps. This case report emphasizes the importance of being vigilant for stylomandibular false ankylosis, especially when there is a restriction of oral aperture postoperatively following reconstructive procedures involving bone flaps.

Comparing Polyurethane and Acellular Dermal Matrix Implant Cover in Prepectoral Breast Reconstruction: Short-term Complications.

Implant covering with an interface material is the standard in prepectoral breast reconstruction. Acellular dermal matrix (ADM) is frequently used, but it is expensive and associated with complications. Alternatively, we have been using integrated devices consisting of a silicone implant coated with polyurethane (PU) foam. We aimed to compare both techniques in terms of acute complications. Methods: The authors retrospectively reviewed patients undergoing prepectoral direct-to-implant reconstruction from June 2018 to January 2022. Two cohorts were defined based on the interface material used: ADM versus PU. Total drainage volume, time to drain removal, and acute complications (hematoma, seroma, infection, and explantation) were analyzed. Results: Forty-four breast reconstructions were performed in 35 patients (10 bilateral); implants were covered with ADM in 23 cases and with PU foam in 21. Median total drainage volume (500 versus 515 cc for ADM and PU, respectively) and time to drain removal (9 versus 8 days) were not affected by the interface material used, but seromas and infections occurred exclusively in the ADM cohort (seromas in four of 23 of cases, P = 0.109; infections in three of 23 cases, P = 0.234). Overall complications occurred more often in cases reconstructed with ADM, but the difference was nonsignificant (P = 0.245). Conclusions: The use of interface materials is generally considered a prerequisite for state-of-the-art prepectoral breast reconstruction for a variety of reasons, including the prevention of capsular contracture. In this study, PU coating tended to be associated with fewer short-term complications than ADM, including seroma and infection.

Therapeutic Reduction Mammoplasty: Experience of a Single Institute.

INTRODUCTION: Breast cancer is the most common malignancy in women worldwide as reported by the World Health Organization. The concept of oncoplastic breast surgery appeared as an extension of breast-conserving surgery, applying breast reduction techniques with more acceptable aesthetic and functional outcomes. The purpose of the present study was to describe the breast cancer population of a single institute submitted to lumpectomy and bilateral immediate breast reduction or mastopexy and its complications. MATERIAL AND METHODS: This is a retrospective observational study including patients submitted to lumpectomy and immediate bilateral breast reduction or mastopexy. Patients and tumour characteristics, surgical technique, complications, follow-up period, and recurrence data were obtained and analyzed. RESULTS: A total of 49 patients were submitted to lumpectomy and bilateral breast therapeutic reduction/mastopexy, with a mean age of 56.47 ±8.58 years and a mean body mass index of 28.68kg/m2 ±3.94 kg/m² between January 2019 and December 2021. Invasive tumours of no specific type, associated or not, with carcinoma intraductal in situ were the most common histological type corresponding to almost 80% of the cases with T1 stage corresponding to more than half of the cases. Sixteen percent of the patients had early minor complications with wound dehiscence associated with wound delayed healing, corresponding to 75% of the cases. Body mass index had a statistical difference between groups (p=0,006, t-test). CONCLUSIONS: The low rates of minor and major complications show that immediate therapeutic breast reduction can be a suitable approach in selected cases.

ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe.

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. HINTERGRUND: Die Facharzt-Weiterbildung für Plastische und Ästhetische Chirurgie ist eine Grundvoraussetzung für sichere und effektive Patientenversorgung. Ziel der vorliegenden Studie war die Darstellung von Gemeinsamkeiten und Unterschieden in der Weiterbildung für Plastische Chirurgie innerhalb von Europa. MATERIALIEN UND METHODEN: Ein internetbasierter Fragebogen wurde mit Hilfe eines kostenlosen Formularerstellungstools erstellt und verteilt. Die Fragen betrafen Kernpunkte der Weiterbildung für Plastische Chirurgie in Europa. Die Teilnehmer wurden direkt über das European Leadership Forum (ELF) der European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) kontaktiert. Alle Teilnehmer hatten weitreichende Kenntnisse über die Organisation und Struktur der plastisch-chirurgischen Weiterbildung in ihrem jeweiligen Land. ERGEBNISSE: 29 Teilnehmer*innen aus 23 europäischen Ländern nahmen an der Umfrage teil. Die Weiterbildung für Plastische Chirurgie beinhaltet grundlegende Prinzipien und Techniken zur Wiederherstellung von Form und Funktion innerhalb der verschiedenen Säulen der Plastischen Chirurgie, sowie in allen Körperregionen. In den meisten europäischen Ländern ist eine Rotation in der Intensiv- und Notfallmedizin und die Behandlung kritisch kranker Patienten obligatorisch. Voraussetzung für die Facharztbezeichnung ist die mehrjährige, national organisierte Weiterbildung, der Nachweis einer festgelegten Anzahl selbstständig durchgeführter Operationen, sowie die mündliche und/oder schriftliche Abschlussprüfung. SCHLUSSFOLGERUNG: Fachärzte für Plastische und Ästhetische Chirurgie sind hochqualifiziert und auch im Umgang mit Komplikationen geschult. Der Standard der Weiterbildung der europäischen Plastischen Chirurgen ist hoch, so dass innerhalb Europas eine hohe Qualität plastisch-chirurgischer Versorgung gewährleistet ist.

Acute Impact of Cancer Treatment on Head and Neck Cancer Patients: FIT4TREATMENT.

Head and neck cancer (HNC) treatment's toxicities impact several health domains. Exercise training (ET) may be beneficial. This prospective observational study (NCT04996147) aimed to analyse the acute impact of HNC curative multimodal treatment on health-related quality of life (HRQoL), nutritional status, physical and cognitive functions, and ET preferences. Eighteen patients with stage III/IV HNC were evaluated at baseline (T0), and 10 patients were evaluated at the end of treatment (T1), 7 of them after radical chemoradiotherapy (rCRT). At T0, the majority referred a good HRQoL on the EORTC QLQ-C30 questionnaire (median score: 70.8), were moderately malnourished or at risk of malnutrition (78%), recognized the benefits of an ET program, and were willing to participate (78%). After rCRT, there was worsening in HRQoL (75 vs. 50 score, p = 0.014), dysphagia severity (Eating Assessment Tool: 7 vs. 31, p = 0.027; Functional Oral Intake Scale: 6 vs. 4, p = 0.041), handgrip strength (dominant: 40.9 vs. 35.8 kgf, p = 0.027; nondominant: 37.2 vs. 33.9 kgf, p = 0.043), and nutritional status (Patient-Generated Subjective Global Assessment: 7 vs. 18, p = 0.028). HNC patients subjected to radical treatment represent a vulnerable population that might benefit from multimodal supportive care strategies including an ET program.

A new pattern of cranial nerve injuries caused by unfavorable fractures during Le Fort I osteotomy.

Cranial nerve injury is a described complication of Le Fort I osteotomy technique. The authors present the case of a 45-year-old patient that underwent bimaxillary orthognathic surgery and suffered unfavorable skull base fractures, which resulted in cranial nerve injury of the II, III, IV, V, and VI nerves on the left side and of the V nerve on the right side, through different mechanisms. One of the mechanisms was cavernous sinus thrombosis, which was never described following Le Fort I technique in a non-cleft patient. The fracture pattern involved the foramen ovale and Meckel's cave, which was also never described after this technique. The resolution of the deficits at the final follow-up at 14 months was incomplete. Le Fort I osteotomy technique is considered a safe technique to correct dentofacial deformities, but serious complications can occur. Pterygomaxillary disjunction and down-fracture must be performed with the utmost care to avoid it.

Colgajo sural medial en la reconstrucción de miembro inferior / Medial sural artery perforator flap in lower extremity reconstruction

Introducción y objetivo: El colgajo de perforante de arterial medial sural (MSAP- medial sural artery perforator) fue descrito con un refinamiento del colgajo gastrocnemio medial. A pesar de su reciente historia, demuestra ventajas e indicaciones, principalmente en la reconstrucción de miembro inferior.Presentamos una serie retrospectiva de pacientes con defectos de tejidos blandos de miembro inferior reconstruidos con colgajo MSAP.Material y método.Presentamos 10 pacientes operados entre 2013 y 2018, 6 hombres y 4 mujeres, con edades entre los 27 y los 86 años.La principal etiología de los defectos fue traumática. Los defectos localizados entre el tercio distal del muslo y el tercio proximal de la pierna fueron cubiertos con colgajos pediculados, y los defectos distales con colgajos libres.Resultados.Las dimensiones medias de los colgajos fueron 6.35 cm de anchura por 10.9 cm de longitude y 9.9 cm de longitude del pedículo. Todos los colgajos menos 1 fueron elevados con una sola perforante.Excepto 1 caso de pérdida parcial del colgajo, no hubo complicaciones a corto plazo. Dos pacientes precisaron cobertura con injerto del área donante y el resto fueron cerrados directamente.El seguimiento medio fue de 22.8 meses y no hubo complicaciones en el área donante. Obtuvimos un cierre estable y estéticamente acceptable en todos los casos.Conclusiones.El colgajo MSAP es un colgajo fasciocutaneo fino y plegable que provee tejido similar al área del defecto con minima morbilidad del área donante.Sus características menos positivas incluyen una potencialmente laboriosa disección intramuscular y la posibilidad de congestion venosa ocasional. A pesar de ello, los buenos resultados y la satisfacción de los pacientes lo convierte en una elección apropiada en casos seleccionados de reconstrucción del miembro inferior. (AU)

Background and objective: The medial sural artery perforator (MSAP) flap was first described as a refinement of the medial gastrocnemius flap. Despite its recent history, it has already proven to have several advantages and indications, namely in lower extremity reconstruction.The authors present a retrospective case series with lower limb soft-tissue defects which were reconstructed with the MSAP flap.Methods.Between 2013 and 2018, 10 patients were operated on: 6 men and 4 women, ranging in age from 27 to 86 years.The main etiology of the defects was traumatic injury. The defects located between the distal third of the thigh and the proximal third of the leg were covered with pediculated flaps while the distal defects were covered with free flaps.Results.The mean flap dimensions were 6.35 cm width, 10.9 cm length, and 9.9 cm pedicle length. All flaps except 1 were raised with a single perforator.Apart from 1 case of partial free-flap loss, there were no short-term complications. Two patients required skin grafting of the donor site while the remaining were closed directly.The mean follow-up time was 22.8 months and there were no donor site complaints. A stable and aesthetically satisfactory coverage was obtained in all cases.Conclusions.The MSAP flap is a thin and pliable fasciocutaneous flap that can provide “like-with-like” tissue with minor donor site morbidity in lower limb reconstruction. Less positive characteristics include a potential laborious intramuscular dissection and occasional venous congestion. Still, the good results and satisfaction of the patients make this a wise choice in selected cases. (AU)

ESPRAS Survey on Breast Reconstruction in Europe.

BACKGROUND: The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access. MATERIALS AND METHODS: A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature. RESULTS: A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported. CONCLUSION: This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures.

Strengthening Plastic Surgery in Europe - ESPRAS Survey at ESPRAS European Leadership Forum (ELF).

BACKGROUND: The Executive Committee (ExCo) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) organized a first ESPRAS European Leadership Forum (ELF) to facilitate international exchange and to provide a platform for international leaders and delegates of national societies of Plastic Surgery to discuss common challenges. The presented manuscript presents key findings in a first effort of international harmonization and cooperation. MATERIALS AND METHODS: Members of the executive (presidents, vice-presidents, secretary generals) and national delegates of Plastic Surgery national societies discussed hot topics in Plastic Surgery via the Zoom virtual conferencing system (Zoom Video Communications, Inc.). Attending participants responded to a virtual question & answer session with questions being displayed throughout the webinar. RESULTS: The challenges associated with Aesthetic Surgery performed by doctors who are not board-certified Plastic Surgeons and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) were perceived as major hot topics within most national societies. Both topics were discussed vividly. Education in plastic surgery and a European fellowship program for young Plastic Surgeons was favored by a large majority of participants. The implementation of European registries for free flaps, implants and for breast reconstruction were supported by the majority of respondents. CONCLUSION: The ESPRAS ELF provides a platform to propel international exchange and alliance, communication, education, research and future projects. A further virtual webinar with the topic "Strategies for Strengthening and Defending Plastic Surgery against Others" was suggested to be conducted in spring 2021.

The COVID-19 Pandemic and its Impact on Plastic Surgery in Europe - An ESPRAS Survey.

The present article provides an overview of the current and expected effects of plastic surgery in Europe. It presents the experience of departments for plastic and reconstructive surgery, as evaluated by interviews with members of the Executive Committee (ExCo) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). The objective of this overview is to summmarise current information in our area of work and to make this accessible to a broad group of readers. As our knowledge is rapidly increasing during the current pandemic, it is evident that we can only provide a snapshot and this will inevitably be incomplete.

EASAPS/ESPRAS Considerations in getting back to work in Plastic Surgery with the COVID-19 Pandemic - A European point of view.

The aim of this paper is to summarize the results of a consensus process and a European webinar of the two societies, European Association of Societies of Aesthetic Surgery (EASAPS) and the European Society of Plastic, Reconstructive and Aesthetic Societies (ESPRAS) on what is considered safe practice based on the scientific knowledge we have today. This review of the current situations gives considerations which have to be taken into account when getting back to work in plastic surgery with COVID-19 in Europe. At all times, one should be familiar the local and regional infection rates in the community, with particular emphasis on the emergence of second and third waves of the pandemic. Due to the fast-evolving nature of the COVID-19 pandemic the recommendations aim to be rather considerations than fixed guidelines and might need to be revised in near future.