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UKNFR Reports

December 2022

Report from Peter Kalu:

From a registry perspective, there seems to be some well-placed optimism that flap activity is on a continuing upward trend since the summer cut off for the second UKNFR report - long may this continue as there is undoubtedly much to catch up on.

With respect to the second report, the initial analysis of data is complete and the relevant sections are being prepared for review by the various associations. Please feel free to email me if there are any specific questions or investigations you think would be of interest in the upcoming report or the registry.

The UKNFR report for December 2022 is available here.


October 2022

Report from Peter Kalu:

With summer a faded memory and the weather turning decidedly autumnal I write with an update on flap activity over the past four months.

I send my gratitude to all UKNFR users who were able to update their accounts with all flap activity generated in the three years up to 8th August 2022. This additional reporting is reflected in the marked increase in recorded cases numbers over the summer.  

I am now beginning the process of reviewing the data and with input from each association I am hoping to disseminate the second report in early 2023

The UKNFR report for October 2022 is available here.


1st July 2022 - Letter from Peter Kalu, UKNFR Audit Lead:

Building on the fantastic work of Anita Hazari, the second UKNFR report is due for publication based upon the last three years of data. The UKNFR is a collaboration between 5 surgical speciality associations: BAPRAS, BAOMS, ABS, BAHNO and BSSH.

Like the first report, we will aggregate national data on all flaps without units and surgeons names specified. It will have national averages for key performance indicators: case mix, age, demographics, flap success, unplanned return to theatre and length of stay. These will be listed broadly according to anatomically reconstructed areas: 

  • Breast
  • Head & Neck
  • Upper limb
  • Lower limb
  • Trunk
  • Perineum

Participating units will be listed in the report, however specific data on each unit's performance will not be in the report. 

 The final cut of UKNFR data will be taken on 8th August 2022 the time period covered will by 31st July 2019 to 8th August 2022.  

If you are a UKNFR user, please check your data for completion and accuracy. 

If you perform flaps for reconstruction, and you have not registered or entered data, please register and enter data retrospectively from 31st July 2019.

If there are any issues with submitting data then please contact the UKNFR helpdesk team ( or call +44 1491 411 288). I am also happy to be contacted directly for any issues.



Mr Peter Kalu

Consultant Plastic & Reconstructive Surgeon, Oxford University Hospitals



June 2022

Report from Peter Kalu:

Flap activity continues at a relatively steady pace with the usual variations seen prior to the onset of the COVID-19 pandemic. It is therefore an opportune time to review the data collated since the last report was published in 2019. The arrival of COVID-19 in March 2020 has seen major upheavals and challenges in the delivery of flap surgery in the UK. I would ask all Speciality Association leads to encourage their members to ensure all data covering the period 9th August 2019 – 8th August 2022 is submitted for inclusion in the 2nd UKNFR report by midnight 8th August.

Data is power and I have no doubt that the findings of the 2nd UKNFR report will be of value to all involved with UK flap surgery.

The UKNFR report for June 2022 is available here.


April 2022

The UKNFR report for April 2022 is available here.


February 2022

UKNFR report for February 2022 is available here.


December 2021

Report from Peter Kalu:

In short, this UKNFR update confirms recorded reconstructive flap activity continued at the post-pandemic steady state in the final few months of 2021.

We wait to see the effect of the omicron wave of COVID-19 as well as the all too familiar ‘winter pressures’ in the coming months.

The UKNFR report for December 2021 is available here.


October 2021

Report from Peter Kalu:

As autumn marches on, winter pressures will gradually once again come to bear upon the NHS and in turn the ability to perform flap surgery. I hope that fears regarding the resurgence in COVID-19 do not come to pass as we have yet to return to pre-pandemic levels of flap activity. Reported flap cases have plateaued over the course of the last few months and I suspect further recovery maybe limited over the winter.


Once again, I encourage all societies to remind their members and particularly trainees that the UKNFR remains an excellent tool for GMC directed audit of practice, appraisal and revalidation. Beyond personal metrics, the high-quality data submitted to the UKNFR has been of assistance to units struggling to justify re-commencing local services.

The UKNFR report for October is available here.


August 2021

Report from Peter Kalu:

Flap activity continued on it’s upward trajectory as we moved into the summer period. Numbers were approaching levels seen in pre-pandemic years. 

As flap activity moves back to normality can I encourage all societies to remind their members and particularly trainees that the UKNFR remains an excellent tool for GMC directed audit of practice, appraisal and revalidation. Trainers can facilitate trainee engagement by supervising data entry on their behalf as a ‘delegate’.

The UKNFR report for August 2021 is available here.


June 2021

Report from Peter Kalu:

Here is  the latest United Kingdom National Flap Registry (UKNFR) update. It would seem that we are still struggling to reestablish prior levels of reconstructive flap activity. 

I am appreciative of the time spent by UKNFR users to submit data and I would ask that we also try to encourage trainees to participate as Delegates, that enter data into the UKNFR for registered users. 

The UKNFR report for June 2021 is available here.


April 2021

Report from Peter Kalu:

I am pleased to say that the latest United Kingdom National Flap Registry (UKNFR) update seems to suggest that reconstructive flap activity is returning to levels seen prior to the first UK national lockdown.  

As we all appreciate, COVID-19 has had a significant impact upon the number of flap cases performed and our attention is becoming increasingly focused on how we address the backlog. I’m hopeful that solutions and plans will be put in place to expand capacity so we see recorded case number exceed normal levels.

The UKNFR report for April 2021 is available here


February 2021

Report from Peter Kalu:

The latest United Kingdom National Flap Registry (UKNFR) update comes as we begin to look forward to Spring. 

The successful rollout of the COVID-19 vaccination programme during the midst of the third national lockdown should hopefully give some confidence to flap surgeons as they consider how to once again ‘unlock’ reconstructive services. 

This report shows evidence of the effects of a resurgent COVID-19 and the reconfiguration of healthcare services to deal with the unfolding medical emergency. 

The next report in April will be issued after we have past the one year mark since the first national lockdown began in March 2020. We shall then begin to issue summary details on the year-on-year activity since the emergence of COVID-19. 

The UKNFR February 2021 report available here.


December 2020

Report from Peter Kalu:

The UKNFR is likely to be a good barometer of surgical activity in the NHS. 

In October 2020 there were signs of a dramatic increase in reconstructive capacity. These gains were short-lived as registered case numbers rapidly tailed-off in November and December most likely due to the arrival of the second wave of COVID-19. We shall see what effect the annual round of ‘winter pressures’ has on further registry numbers.

The UKNFRDecember 2020 report is available here


October 2020

Report from Peter Kalu:

Since my last update in August, we have quite rapidly found ourselves in the midst of a second wave of COVID-19. For many units, this may prove to be a further unwelcome challenge for major reconstructive procedures. 

The UKNFR October 2020 report is available here.


August 2020

Report from Peter Kalu:

The nationally reported levelling-off in COVID case numbers is welcome news and has allowed minds to focus upon the restoration of reconstructive services. 

An expansion in flap reconstruction capacity is evidenced by an increase in UKNFR case numbers. I am hopeful that this trend will continue as we head into the autumn and that all opportunities are taken to address the inevitable backlog in cases.  

The report of UKNFR August 2020 is available here.


June 2020

Message from Peter Kalu:

I have now taken up post as the UKNFR Audit Lead from Anita - thank you for a wonderful handover and the last 5 years of service in making the UKNFR what it is today.

I know that COVID-19 has been particularly challenging to all flap surgeons on so many levels and I hope that over the coming weeks and months we see a steady resumption of surgical services. 

I would ask you all to encourage your fellow colleagues to see this as an opportunity to “build back better” and start to enter data into what is becoming an increasingly useful tool to demonstrate the utility of flap surgery In surgical care.

The report of UKNFR End of June 2020 is available here.


May 2020

Latest UKNFR Report - from Anita Hazari

The impact of Covid19

As expected with Covid19, the numbers have fallen significantly, as breast reconstruction was halted in March. The flaps currently being performed are for H&N oncology reconstruction (priority 2) and Lower/ upper limb trauma (priority 1).

Covid related data entries have also been added into UKNFR in the last few days, so we will get data regarding swab positivity prior to surgery, at discharge and development of Covid19 in the postopertaive period. This should help us to monitor if peri-operative outcomes are more adversely affected in the Covid negative and positive groups.

Full report available here.