Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

Background: The deep inferior epigastric perforator (DIEP) flap is widely regarded as the Gold Standard in autologous breast reconstruction. Although drain-free abdominoplasty is performed in many centres, there is a paucity of evidence comparing outcomes when applied to DIEP breast reconstruction. Method: A retrospective review of patients who underwent DIEP breast reconstruction without abdominal drain insertion at Royal Free Hospital between Jan 2012-Nov 2016 was undertaken. Results were compared to previously published data from our centre on patients undergoing DIEP breast reconstruction with abdominal drains between Jan 2011-Jul 2012. Results: Thirty-five patients underwent abdominal drain-free reconstruction (GroupA). Of 74 patients who previously underwent reconstruction with abdominal drains, 33 patients underwent drain removal by postoperative day (POD)3 regardless of output (GroupB) and 41 underwent drain removal after POD3 following instructions on drainage volume/24 h (GroupC). There was no significant difference in the length of stay between patients in Group A and B (3.6 vs. 3.9 days; p = 0.204). Length of stay in Group C was significantly higher than Group A and B (p = 0.001, p = 0.001). There were no statistically significant differences in total (11.43% vs. 12.12% vs 17.07%, p = 0.780) or specific complications: Seroma: 2.86% vs. 0% vs. 4.88% (p = 0.774); Wound dehiscence: 8.57% vs. 9.09% vs. 4.88% (p = 0.728); Haematoma: 0% vs. 3.00% vs. 7.32% (p = 0.316) between Groups A, B and C, respectively. Conclusion: Our data suggests that drain-free abdominal closure in DIEP reconstruction can be safely achieved without increased postoperative complications. These conclusions support existing evidence on the use of a drain-free approach in cosmetic abdominoplasty

The Role of Emotional Intelligence in Predicting a Successful Career for Plastic Surgeons: A Systematic Review

The definition of a successful career in plastic surgery is both a highly variable and personal one. Career success is underpinned by a combination of skills and is often multifactorial in nature. Although clinical and academic factors have long been key determinants of success, modern medical practice is now underlining the previously understated non-clinical skills as a major contributory element. Emotional intelligence (EI) has shown clear benefits in a successful career in the business world, where it was originally popularized. As a successful career in surgery also requires proficient understanding of human emotions, the clear similarities drawn with corporate success have resulted in a growing interest in EI in the medical domain. Despite such interest, the role of EI as a predictor of career success in plastic surgery has been poorly defined. This systematic review aims to define EI, to explore its role in medical and nonmedical fields, and to investigate its impact on a successful career in plastic surgery

Wide awake local anaesthetic no tourniquet (WALANT) in hand and wrist surgery: current concepts, indications and considerations

Background: Traditionally, hand surgery has necessitated the use of a pneumatic arterial tourniquet in order to preserve a bloodless field and allow adequate visibility for efficient and safe surgery; this has necessitated regional anaesthesia with or without sedation or general anaesthesia. However, hand surgeons are increasingly using a novel technique - Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in both elective and emergency settings. WALANT relies on the infiltration of a tumescent adrenaline-containing local anaesthetic (ACLA) into the operative field for both its anaesthetic and haemostatatic effects. We present a comprehensive review for the hand surgeon beginning their practice with WALANT. Methods: Literature published on the safety of adrenaline use in the hand, the indications for WALANT based surgery, key advantages of WALANT including dynamic intraoperative assessment, cost, efficiency, patient satisfaction, waste production and role during the COVID-19 pandemic is reviewed. Conclusion: WALANT surgery is increasing in popularity as evidenced by the variety of surgical indications reported in the literature. Published data on functional outcomes in hand surgery exhibit significant disparity and heterogeneity with a paucity of agreed outcome measures. Clear benefits are demonstrated regarding patient comfort, cost and resource savings compared to conventional anaesthetic techniques. Use of WALANT provides an excellent opportunity to redesign and optimise surgical pathways towards providing safe and efficient surgery in the hand and wrist