Useful flaps for orthopaedic surgeons: Review of the 2017 EFORT Anatomical Course
The EFORT Anatomical Flap Course for orthopaedic surgeons chaired by Prof. Dr. Thierry Bégué was held in Paris 23 to 25 January. For this third edition, the main goal was to offer lectures and workshops on the usual flaps that any orthopaedic or trauma surgeon may need during procedures.
The main ones were fasciocutaneous flaps, such as the groin flap, saphenous flap, supra-malleolar flap, suralis flap, lateral arm flap and Chinese flap; or muscular flaps, such as medial gastrocnemius, lateral gastrocnemius, soleus and hemisoleus flaps, brachioradialis and latissimus flaps. Some difficult ones were explained with active demonstration, such as the lateral thigh flap, posterior interosseous flap and free fibula transfer.
For each flap, the sequence was the same: a keynote done by an expert in the field was followed by a demonstration done by the lecturer on a specific cadaver. Then, participants had to apply the same flap elevation based on the technique presented by the expert. During the workshop, faculty members gave additional details to the participants so they could raise the flap securely. The cadaver dissection was the last simulation before performing the procedure on a living patient.
Two phases, case discussions
For progressive training, the easiest flap was done at the beginning so that the raising technique could be well understood by the participants. During the entire course, flaps that are more difficult were done in a second phase.
Case discussions were added to the course to illustrate when to use each type of flap in the clinical practice. By the end of the entire procedure for each flap, participants had learned the technique of flap elevation, tips and tricks for each one, and a specific case in which this flap could be used.
The goal of this course was clear: to give orthopaedic surgeons sufficient knowledge on the usual flaps they can use, either to proceed with the procedures themselves or to have an adequate discussion with any plastic surgeons they refer to for help.
In addition, basic lectures were done on the vascular supply of the skin and vascular anatomy of different types of muscular or cutaneous flaps, so some difficult flaps were quickly described for a complete knowledge. Nevertheless, the difficulty of raising the flap or use of microvascular surgery for anastomosis were pointed, so those flaps were just mentioned for a complete training program.
Attendance was high this year. The exchanges between the participants and faculty were on specific details about technique and indications, and were based on case discussions. Because the surgeons who attended the course were so experienced in this area, it was a pleasure for the lecturers to share challenging situations — and their solutions — with the attendees. At the end of this 3-day course, all surgeons could raise the most frequent flaps needed to cover wound defects, in either trauma, reconstruction or tumor resection. Of course, if the professional objective of the surgeon was to limit his or her activity to a specific type of surgery, only some of the flaps he or she was trained on will be of value in clinical practice.
Based on the success of each flap course done since 2013, another session is scheduled to be held in January 2019.
Course participants commented
“I am happy I had the chance to join the course. It was so compact, but also all-embracing and included everything an orthopedic surgeon needs to know for using flaps.
For all areas of the entire body, you showed different solutions and different flaps to use. The allocation of the course was excellent. First, a theoretical lesson with explanations, drawings and videos on how to do it; then, a demonstration at one cadaver; and by the end, two participants practicing on one cadaver practicing what was just seen. Already 1 week later, I did one of those learned flaps with success. Thank you.”
— Dr. Heiko Baumgartner
“Theoretical lectures, followed by immediate cadaver works by faculty members, then practice on cadavers by ourselves are effective for learning. I am satisfied with the course, and I applied some flaps on my patients after that. Thanks to EFORT and to all faculty members, especially Prof. Dr. Bégué.”
— Ass. Prof. Dr. Bülent KILIÇ
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