Intended for healthcare professionals


The north east flap course

BMJ 2010; 340 doi: (Published 26 May 2010) Cite this as: BMJ 2010;340:c2669
  1. Niroshan Sivathasan, specialist registrar in plastic surgery
  1. 1Queen Victoria Hospital, East Grinstead
  1. niroshan.s{at}

Flaps are a method of covering defects and are part of the standard reconstructive armamentarium of plastic and maxillofacial surgeons. There are two main courses in the United Kingdom covering flap surgery: the north east flap course, based in Newcastle; and the Canniesburn practical course on the use of flaps in reconstructive microsurgery, based in Glasgow.

What is it?

The north east flap course is run by the Department of Anatomy at the University of Newcastle in conjunction with surgeons from the University Hospital of North Durham and the James Cook University Hospital, Middlesbrough. The course director is Matt Erdmann, a consultant hand and plastic surgeon, and the faculty consists of other senior plastic surgeons.

When did you do it?

I attended the 2009 course at the Department of Anatomy and Clinical Skills Centre in the University of Newcastle Medical School, adjacent to the Royal Victoria Infirmary.

Who is it for?

I feel that one must have adequate operating experience to benefit fully from this course—that is, be at registrar level or above. When I attended, however, participants varied in seniority from senior house officers to consultants and most were in plastic surgery, but there were maxillofacial and orthopaedic trainees too. There was an appreciable international element with participants from Holland, Italy, Japan, Poland, and Spain.

How was it structured?

It is a one week course concentrating on the practical anatomy of flaps for all the regions of the body and is based wholly in the dissecting rooms, where delegates get first hand experience in raising flaps. Practicals are preceded by lectures, which serve to provide a clinical perspective and go over the anatomy and approach required for the subsequent dissections. Places on the course are limited to 28, so that there are four people per cadaver. This ratio permits good experience with raising flaps and distinguishes the course from others, which, for instance, tend to have six people per dissection table. I found the course a sociable experience too, with numerous organised evenings out.

What was the timetable like?

The course covers a variety of reconstructive techniques including skin flaps, fascial flaps, muscle flaps, musculocutaneous flaps, and free tissue transfer.

This is the schedule in brief, giving a few examples of the flaps covered.

  • Monday

    • Morning—Head and neck: temporal, forehead, scalping, Karapandzic

    • Afternoon—Anterior superior trunk: trapezius, pectoral major and minor, deltopectoral

  • Tuesday

    • Morning—Posterior superior trunk: lateral dorsi, serratus anterior, scapular, parascapular

    • Afternoon—Posterior inferior trunk: superior gluteal artery perforator (SGAP), inferior gluteal artery perforator (IGAP)

    • —Anterior inferior trunk: transverse rectus abdominis myocutaneous (TRAM), vertical rectus abdominis myocutaneous (VRAM), deep inferior epigastric perforators (DIEP)

  • Wednesday

    • Morning—Upper limb: deltoid, lateral arm, posterior interosseous

    • Afternoon—Upper limb: radial forearm, Quaba, Foucher, Maruyama, cross finger

  • Thursday

    • Morning—General: groin, deep circumflex iliac artery (DCIA), fibular

    • Afternoon—Lower limb: dorsalis pedis, free toe, anterolateral thigh

  • Friday

    • Morning—Lower limb: posterior thigh, gastrocnemius, medial plantar, biceps femoris

    • Afternoon—Consolidation and coverage of anything not done

Is there an exam?

There are no formal assessments, but a course that is structured like this works on the basis of self driven learning. Essentially, each participant should know what principles and technical aspects they need to accomplish, and spoon feeding should not be required. The relaxed atmosphere is conducive to learning regardless of seniority, and a certificate of attendance is provided at the end of the week.

How much does it cost?

The course fee is £900. Registration and payment can be made online at Because of the relatively high demand, early booking is advised.

Was it worth it?

At a time when study budgets are almost non-existent and study leave is difficult to organise and get approved, the correct choice of course is ever more critical. I feel that the north east flap course has met my learning objectives and I certainly feel more au fait with harvesting and using flaps.

Pros and cons

  • Well organised course with good exposure to flaps and the techniques

  • Unpressured environment and friendly faculty

  • Competitive price, inclusive of good lunches and refreshments

  • The course does not use fresh frozen cadavers; however, this is being addressed for future courses. There will naturally be a modest increase in the course fees, but this would be worth it

  • If one has limited operative exposure to flaps, then having a DVD to complement the course would be ideal

Top tips

  • Read the course manual

  • Aim to have a good grasp of anatomy

  • Aim to get to the university early as the layout is somewhat haphazard, and most of the people who had not previously been affiliated with the university/hospital probably got lost at some point

  • Try to book city centre hotels as early as possible to get competitive prices. The course organisers are aiming to tackle this with two different fees from next year: one to include a block booking at a single hotel and the other for those who want to book their own accommodation

Further information

Department of Plastic Surgery, University Hospital of North Durham, North Road, Durham DH1 5TW; tel: +44(0)191 333 6989;


  • Competing interests: None declared.