Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Frostbite following cryolipolysis: a case report

Cryolipolysis is a non-invasive body contouring procedure that aims to achieve focal clearance of subcutaneous fat by means of confined areas of cold exposure. Cryolipolysis is currently gaining popularity as an alternative to traditional liposuction due to its high efficacy and low incidence and duration of side effects. Common side effects include erythema, bruising, oedema, pain and diminished sensation, all of which are usually transient. Frostbite injuries following cryolipolysis are exceedingly rare. We report a case of severe frostbite following a cryolipolysis session that required surgical intervention with resultant permanent scarring

Postoperative management of lower limb split-thickness skin grafts in Australia

**Background**: Evidence for postoperative management of split-thickness skin grafts (SSGs) to lower leg wounds has shown early mobilisation to have no adverse effects on graft take, while improving patient outcomes and significantly reducing hospitalisation costs. The development of negative-pressure wound therapy (NPWT) for SSGs has led to new options for bolster dressings. This study aimed to determine the current postoperative mobilisation and dressing choices of Australian plastic surgeons and to assess whether the evidence has induced change in clinical practice. **Methods**: Australian plastic surgeons were invited electronically to participate in a questionnaire regarding their postoperative regimens for lower limb SSG in 2013, and again in 2018. A literature review was performed to establish whether surgeon-reported practice was in line with current evidence for early mobilisation of lower limb SSGs and also for NPWT on SSGs. **Results**: In 2013, 119 responses were received and in 2018, 110 responses were received. Survey responses showed a significant reduction in the numbers of patients kept immobilised for more than five days (30% to 9%, p=0.001) between 2013 and 2018. Surgeons reported immobilising their patients longer with standard dressings than with NPWT dressings (p=0.003 by multinomial logistic regression). More than two-thirds of surgeons reported NPWT use in both 2013 (66%) and 2018 (70%). **Conclusion**: Between 2013 and 2018, NPWT use increased slightly and the percentage of surgeons mobilising their patients early significantly increased, in accordance with evidence in the literature. A link was noted between NPWT use and an increased tendency to early mobilisation. However, a large proportion of surgeons continued to prescribe bed rest postoperatively