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How I Operate

The Plastics Fella

The Plastics Fella talks to leading expert in Plastic Surgery. How I Operate takes you behind the scenes of plastic and reconstructive surgery, exploring the stories, expertise, and decisions behind the work. Each episode features candid conversations with people shaping the industry, from their clinical process to the lessons they’ve learned along the way.

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  • 15 episodes
  • monthly
  • Avg 41 min
  • English

Episodes 15

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  • S2 · E5
    August 31 · 45 min

    At the Limits of Reconstruction, How far is too far? With Dr Pedro Cavadas

    📩 Subscribe to The Plastics Fella Newsletter: https://www.theplasticsfella.com In this episode of How I Operate, Ryan Sugrue is joined by Pedro Cavadas, a reconstructive microsurgeon known for tackling complex limb salvage and replantation cases where conventional reconstructive options can begin to run out. Beginning with the medial sural artery perforator (MSAP) flap, Cavadas gives a characteristically direct account of where the flap is useful, where it is not, and why anatomy and surgical efficiency matter more than novelty. The conversation then moves into the practical details of microsurgery: intramuscular dissection, perforator selection, venous anastomosis, vessel geometry and the sequence of repair in digital replantation. Along the way, he challenges established dogma, explains the small technical habits he believes improve patency, and shares why de-airing an arterial anastomosis may be critical to avoiding unexplained flap failure. Key Takeaways When the MSAP flap is a useful regional free flap and why Cavadas does not consider it a universal workhorse. How high-setting, non-stick bipolar dissection can make intramuscular perforator dissection faster and more controlled. Why Cavadas usually wants a single perforator and believes one perfect venous anastomosis can be better than two suboptimal ones. The microsurgical habits he uses to protect the endothelium, optimise vessel geometry, and improve anastomotic reliability. How changing the sequence of repair can make digital replantation faster, cleaner, and more reproducible under tourniquet. Why air bubbles in an arterial anastomosis may contribute to apparent “no-reflow” and unexplained flap failure. Chapters 00:00 – Reconstructing the “Impossible” 01:50 – The Rise of Perforator Flaps and the MSAP Flap 04:15 – What the MSAP Flap Is Really Good For 08:40 – Choosing the Right Flap for Complex Limb Reconstruction 10:20 – Raising the MSAP Flap and Intramuscular Dissection 16:30 – Flap Design, Doppler and Perforator Selection 18:20 – Why One Vein Can Be Better Than Two 21:10 – Anastomosis Tricks and Avoiding Endothelial Injury 28:20 – Replantation Strategy, Bone Shortening and Repair Sequence 39:40 – Air Embolism, “No-Reflow” and Flap Failure Thank you for listening to How I Operate. Brought to you by ThePlasticsFella. If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released bi-weekly, featuring the surgeons, innovators, and ideas that continue to shape modern plastic surgery.

  • S2 · E4
    August 10 · 1 hr 6 min

    Deconstructing Breast Reduction, with Dr. Elizabeth Hall-Findlay

    📩 Subscribe to The Plastics Fella Newsletter: https://www.theplasticsfella.com In this episode of How I Operate, Ryan Sugrue is joined by Dr Elizabeth Hall-Findlay, whose work has helped reshape the way plastic surgeons think about breast reduction. Dr Hall-Findlay traces the evolution of her approach from the traditional inverted T inferior pedicle technique to vertical reduction and the true superomedial pedicle. She explores the importance of separating skin design, blood supply and parenchymal reshaping, explaining why the skin shouldn't be relied upon as a "brassiere". From nipple position and pedicle selection to markings, tissue resection and managing complications, she shares the lessons and surgical principles developed throughout her career. Key Takeaways: How Dr Hall-Findlay transitioned from the inverted T technique to vertical breast reduction. Why understanding the superficial blood supply is fundamental to pedicle design and nipple viability. The principles behind the true superomedial pedicle and its advantages for blood supply, sensation and breast shape. Why surgeons should "remove the excess where it is" rather than relying solely on predetermined patterns. How parenchymal reshaping, rather than skin tension, can create more predictable long-term results. The importance of the upper breast border, breast meridian and individual anatomy when determining nipple position. When a horizontal scar may still be required and why the vertical incision shouldn't be cinched. How honest reflection, photography and long-term follow-up can help surgeons continually refine their technique. Chapters: 00:15 – The Evolution of Breast Reduction 03:24 – Moving Away from the Inverted T 06:29 – Transitioning to Vertical Reduction 09:49 – Understanding the True Superomedial Pedicle 14:33 – Sensation, Shape and Parenchymal Reshaping 24:52 – Remove the Excess Where It Is 31:03 – Gravity, Weight and the Inframammary Fold 36:47 – Marking the Breast and Choosing Nipple Position 47:00 – Inside the Hall-Findlay Technique 53:56 – The Pucker, the T and Surgical Judgement 58:59 – Managing Complications and Nipple Necrosis 62:26 – A Career Built on Surgical Evolution Thank you for listening to How I Operate. If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released monthly, featuring the surgeons, innovators and ideas that continue to shape modern plastic surgery.

  • S2 · E3
    July 27 · 55 min

    Designing the Perfect PIA Flap, with Prof. Claudio Angrigiani

    📩 Subscribe to The Plastics Fella Newsletter: https://www.theplasticsfella.com In this episode of How I Operate, Ryan Sugrue is joined by Professor Claudio Angrigiani, the creator of the Posterior Interosseous Artery (PIA) flap and one of the pioneers of perforator flap surgery. Looking back over four decades of innovation, Professor Angrigiani shares the story behind the development of the PIA flap, from cadaveric anatomy studies in Argentina to its adoption as a reliable reconstructive option for hand and wrist defects around the world. Along the way, he explores the importance of anatomy, surgical simplicity, and why understanding vascular territories remains fundamental to flap design today. Key Takeaways: How the PIA flap was developed as an alternative to traditional reconstructive options for the hand. The role of anatomical research and cadaveric studies in creating dependable surgical techniques. Why the middle perforators are key to the reliability of the PIA flap. Common technical mistakes that can lead to complications or flap failure. The importance of simplifying flap surgery through a deep understanding of anatomy. Professor Angrigiani's approach to innovation, research, and developing new surgical techniques. Chapters: 00:00 – Introducing the PIA Flap 04:10 – Hand Reconstruction in the 1980s 09:25 – The Origins of the PIA Flap 16:40 – Early Anatomical Research and Cadaver Studies 24:15 – Understanding Perforators and Vascular Territories 33:50 – The Physiology Behind the PIA Flap 43:20 – Flap Design, Landmarks, and Planning 54:35 – Raising the PIA Flap Step by Step 01:06:10 – Common Mistakes and Avoiding Complications 01:15:45 – Innovation, Anatomy and Surgical Thinking Thank you for listening to How I Operate. Brought to you by ThePlasticsFella. If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released bi-weekly, featuring the surgeons, innovators, and ideas that continue to shape modern plastic surgery.

  • S2 · E2
    July 13 · 42 min

    Inside the Creation of the Mathes & Nahai Classification, With Dr. Foad Nahai

    📩 Subscribe to The Plastics Paper Newsletter: www.theplasticsfella.com/theplasticspaper-newsletter/ In the second episode of How I Operate, Ryan Sugrue (ThePlasticsFella) sits down with Professor Foad Nahai, co-creator of the Mathes & Nahai classification, one of the most influential frameworks in reconstructive surgery. More than four decades after its publication, the classification remains a cornerstone of plastic surgery training and clinical practice. Professor Nahai reflects on the anatomy lab discoveries, clinical challenges, and collaborative work with Dr. Stephen Mathes that led to the development of a system that transformed how surgeons understand muscle flaps. Together, they explore the origins of the classification, its lasting relevance, and the principles that continue to shape reconstructive surgery today. Key Takeaways: How the Mathes & Nahai classification was developed from anatomical research. Why understanding vascular anatomy changed the reliability of muscle flaps. The role of anatomy in advancing reconstructive and microsurgical techniques. Lessons learned from creating a framework that has remained relevant for over 40 years. Why simplicity, clinical relevance, and practicality are key to lasting surgical innovation. Chapters: 00:00 – Introducing the Mathes & Nahai Classification 04:09 – Muscle Flaps Before the Classification 09:04 – Reconstruction, Microsurgery, and a Changing Specialty 13:13 – Why Anatomy Still Matters 17:06 – Discovering the Pattern in the Anatomy Lab 22:40 – Publishing the Research and Early Reception 24:40 – Building a Framework That Lasted 31:16 – Seeing the Classification Adopted Worldwide 34:18 – Clinical Impact Beyond the Classification 38:48 – Advice for the Next Generation of Surgeons Thank you for listening to How I Operate. Brought to you by ThePlasticsFella. If you enjoyed this episode, please follow the show, leave a rating, and share it with colleagues. New episodes are released bi-weekly, exploring the ideas, techniques, and innovations that continue to shape modern plastic surgery.

  • S2 · E1
    June 29 · 1 hr 1 min

    The SCIP Flap in Practice: Lessons from Dr. JP Hong

    📩 Read more on thePlasticsFella.com and subscribe to The Plastics Paper Newsletter: www.theplasticsfella.com/theplasticspaper-newsletter/ In the first episode of How I Operate, Ryan Sugrue is joined by Professor JP Hong, one of the leading innovators in modern reconstructive microsurgery and a pioneer of the SCIP flap. From its origins as a modification of the traditional groin flap to its evolution into one of the most versatile perforator flaps in reconstructive surgery, Professor Hong shares the anatomical discoveries, technical refinements, and clinical insights that transformed the SCIP flap into a global workhorse. Along the way, he discusses the importance of continuous innovation, the role of ultrasound in modern flap surgery, and the principles that guide his approach to surgical problem-solving. Key Takeaways: How the SCIP flap evolved from the traditional groin flap. The anatomical principles that improved flap reliability and reduced complications. Why understanding perforator anatomy remains fundamental to successful reconstruction. The growing role of ultrasound in flap planning and surgical decision-making. How incremental improvements can transform a good operation into a great one. Professor Hong's philosophy on innovation, teaching, and building a lasting surgical legacy. Chapters: 00:00 – Introducing the SCIP Flap 03:20 – The Evolution of the Groin Flap 09:15 – Early Modifications and the Work of Dr Kashima 16:30 – Understanding Perforator Anatomy 24:45 – Improving Reliability Through Anatomical Research 34:20 – The Role of Veins and Flap Design 45:10 – When to Use (and Not Use) the SCIP Flap 55:35 – Ultrasound as a Microsurgical Tool 01:06:30 – SCIP Flap Design and Surgical Technique 01:25:40 – Innovation, Legacy, and Lessons for Future Surgeons Thank you for listening to How I Operate. Brought to you by ThePlasticsFella. If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released bi-weekly, featuring the surgeons, innovators, and ideas that continue to shape modern plastic surgery.

  • June 7 · 1 min

    Trailer - How I Operate

    We’re excited to announce the upcoming release of our new podcast series, “How I Operate”, featuring discussions with leading experts in plastic and reconstructive surgery. Here’s a teaser from an upcoming episode where Professor JP Hong explores the SCI

  • S1 · E8
    Oct 27, 2024 · 39 min

    28 Days in Gaza with Ms Victoria Rose: Surgery, Logistics & How to Help

    In this episode of Behind the 'Fella Podcast for The PlasticsFella, Ryan speaks with Ms. Victoria Rose, a plastic surgeon who shares her experience working in Gaza with the charity Ideals. Victoria discusses her role training local surgeons amidst challen

  • S1 · E7
    Oct 17, 2024 · 39 min

    The Oral Exam Playbook: 3 Tips with Prof Andy Hart

    Summary This conversation focuses on the viva oral exam for plastic surgery trainees, discussing preparation strategies, understanding the exam process, and the dynamics between examiners and candidates. There is a strong focus on the FRCS exam. The spea

  • S1 · E6
    Sep 23, 2024 · 40 min

    5 Surgical Techniques Every Plastic Surgeon Should Master

    Behind the 'Fella by thePlasticFella. In this conversation with the Plastics Fella team, the speakers delve into essential techniques and skills required in plastic surgery, focusing on wound management, suturing, flap surgery, and advanced techniques li

  • S1 · E5
    Sep 8, 2024 · 44 min

    Underrated Plastic Surgery Resources Every Surgeon Needs

    Episode Summary: In this episode of Behind the 'Fella, Ryan, Kurt, and Suzanne take a deep dive into the most underrated resources for learning plastic surgery. From top journals like JPRAS and BSH to essential textbooks such as Essentials of Plastic Surg

  • S1 · E2
    Jun 13, 2024 · 39 min

    Flexor Teno Unpacked, Suture Controversy, & Anki Insights

    Welcome to another episode of Behind the 'Fella. A podcast by thePlasticsFella where we discuss all things plastic surgery. The team meeting begins with introductions and welcomes from team members located in different parts of the world. The meeting cov

  • S1 · E1
    May 15, 2024 · 2 min

    Behind The 'Fella Teaser

    Welcome to Behind the Fella, where we dive deep into the world of plastic surgery. In this trailer, I'll share the inspiration behind the podcast, introduce you to our passionate team, and give you a sneak peek of the compelling stories and expert intervi

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