Reconstruction in plastic surgery comprises a vast field, with varying levels of demand. The vascular territories (angiosomes) oft the body define the options of micro-or macro tissue transplantation. Differential challenges arise from supermicrosurgical approaches with reformation of aesthetic units over smart and effective solutions for medium size defects by perforator flaps up to complex approaches with arterialized flaps and their vascular extension by loops in case of tremendous trauma

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... large size defects. Whereas supermicrosurgical reconstructions requires miniture skill in anastomosing fine vessles. Experience and fantasy of the surgeon achieves effective coverage of medium size defects by perforator flap approaches. The resurrection from large defects, however, as in polytrauma patients, requires many prerequisits to lead to success. First and foremost thourough planning, e.g. loop-and flap preformation, awarness of caveats that comes with experience and importantly high end interdisciplinarity and intesive care excellence to achieve survival and durable results. Materials and methods: We investigated the defects and surgical strategies of a series of patients with different degrees of defects ranging from facial defects over smaller size defects with smart perforator flap solutions up to coverage of extreme defects of trauma which are considered mutually exclusive with life. Next to the surgical approach and conduct we put emphasis on the blood supply situation, severity of accompanying disease, such as organ transplant and immunosupression, metabolic disease and excessive and life-threatening trauma that compromize the vascular tree. Results: We present a case of a patient with facial recosntruction using a miniaturized ALT-flap under the aggravating circumstances of pharmacological immunosupression und therapeutic anticoagulation with problems of wound healing and bleeding. We introduce our solution to cover small pretibial defects by differential positioning of both rotor blades of a propeller-flap of the lower extremity to cover the involved defects simultanously. Finally we demonstrate the stepwise approach to coverage of a tremendous 40 x 50 cm life threatening defect oft the back with osteosynthetic exposure following severe pressure trauma. Conclusion: The differential challenges in plastic surgery arise from the location and size oft the defect but also from limitations oft the vascular territories as well as the medical circumstances and condition of a patient. With our case series we demonstrate plastic surgical solutions to defect coverage from supermicrosurgical, aesthetically relevant approaches over durable solutions of medium size problems up to excessively large and life-threatening defects of severe trauma. 3 Bundeswehrkrankenkenhaus Koblenz 4 FH Aachen, Aachen Background: Not only that current imaging modalities (CBCT, CT, MRI) are becoming more precise in capturing data, also the demonstration and interpretation of the acquired images is no longer limited to conventional display screens or projectors. The so-called Virtual Reality (VR) glasses have the potential to engage the viewer in a three-dimensional (3D) space and ultimately evaluating the reconstructed anatomical structures from a novel new perspective. Materials and methods: For the first time in the field of Oral and Maxillofacial Surgery (OMFS), a 3-dimensional imaging data set (CBCT, CT, MRI) is evaluated by using VR glasses. A medical student, an OMFS resident and an OMFS consultant rated the preoperative usability of VR glasses to improve the operative understanding for three patient cases, namely a deeply impacted wisdom tooth, a midfacial fracture, and an oncological resection case. Results: VR glasses seem to help in simplify operations and give the surgeon a good preoperative overview of the intraoperative findings especially in the evaluation of impacted teeth and hard tissue structures. In addition, this technique represents a promising innovative modality for training of surgical residents in addition to student teaching. The more experienced the surgeon is, the lower is the additional value of VR glasses is. Conclusion: The preoperative examination using VR glasses can aid in a better understanding and planning of the surgical site in the future, and represents an innovative advanced technology for displaying CT, CBCT, and MRI anatomical data sets.