Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients.

BACKGROUND: Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. METHODS: Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type. RESULTS: Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9-20 days). Patients were followed-up for a median of 344 days (range: 142-594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type. CONCLUSION: TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.

Undergraduate plastic surgery in the United Kingdom: The students' perspective.

Plastic Surgery is consistently ranked as one of the most competitive for higher surgical training in the United Kingdom. With falling rates of undergraduate Plastic Surgery education there is a danger that potentially excellent candidates will be deterred from applying for training positions. We sought to investigate a cohort of UK medical students with an established interest in Plastic Surgery regarding the factors that influence their interest in the specialty. A cross-sectional study design was used with questionnaires distributed to medical students attending the BAPRAS Undergraduate Day in London and Glasgow University Plastics Undergraduate National Conference in 2019. The questionnaire included factors attracting and deterring them from a career in Plastic Surgery, alongside their undergraduate exposure to the specialty and suggestions on how it could be improved. The most common factors attracting students to a career in Plastic Surgery were variety (25%), surgical intricacy (15%) and immediate effect on patient quality of life (12%). The most common factors deterring students from a Plastic Surgery career were a competitive national selection process (41%), work-life balance (15%) and length of training (12%). As 47% of students had not received undergraduate education in Plastic Surgery, their perceptions of the specialty will be likely be influenced from external, often negative, sources such as television and other media. To safeguard the future Plastic Surgery workforce, universities should collaborate with local departments and professional bodies to meet the needs of medical students for undergraduate exposure through mentorship, workshops, taster days and clinical placements.