ABPlSurg Plastic Surgery cheat sheet
ABPlSurg Plastic Surgery · Keep the key ideas within reach.
Written Examination: Core Plastic Surgery Facts and Decision Rules
Burn resuscitation: Parkland formula = 4 mL lactated Ringer's × body weight (kg) × %TBSA burned in 24 h; give half in the first 8 h from the time of injury and the remainder over the next 16 h.
Rule of Nines in adults: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%. The Lund-Browder chart adjusts for age in children.
Basal cell carcinoma: most common skin cancer; arises from basal keratinocytes; subtypes include nodular, superficial, morpheaform, and basosquamous.
Melanoma Breslow thickness drives management: in situ requires excision with margins of 0.5–1 cm; invasive lesions require margins of 1–2 cm based on thickness, with sentinel lymph node biopsy offered for tumors of 0.8 mm or greater (or thinner with ulceration).
Squamous cell carcinoma risk factors include cumulative UV exposure, chronic wounds (Marjolin ulcer), and immunosuppression; high-risk features include perineural invasion, depth greater than 2 mm, and poor differentiation.
Carpal tunnel syndrome: median nerve compression beneath the transverse carpal ligament; sensory loss in the thumb, index, middle, and radial half of the ring finger; thenar atrophy in advanced disease.
Dupuytren contracture involves the palmar fascia and most commonly affects the ring and small fingers; treatment options include collagenase injection, needle aponeurotomy, and fasciectomy.
Flexor tendon zones: Zone II (fibro-osseous canal, 'no man's land') carries the highest risk of adhesion formation and poorest outcomes after repair.
Cleft lip repair typically occurs at 3–6 months of age (rule of 10s: weight 10 lb, hemoglobin 10 g/dL, age 10 weeks); cleft palate repair typically occurs at 9–12 months.
Oral Examination: Case-Based Reasoning and Communication
Structure case answers as: problem list, differential diagnosis, diagnostic workup, operative plan, and postoperative management with complications.
Breast reconstruction timing: immediate reconstruction is generally preferred for early-stage disease; delayed reconstruction is used when postmastectomy radiation is planned, because radiation adversely affects reconstructed tissue.
Abdominal wall reconstruction: components separation (anterior or posterior/transversus abdominis release) restores midline continuity; mesh reinforcement is placed in the retrorectus or preperitoneal plane.
Pressure ulcer staging: Stage I is intact skin with nonblanchable erythema; Stage II is partial-thickness loss; Stage III is full-thickness loss to fascia; Stage IV extends to muscle, bone, or tendon.
Free flap monitoring relies on clinical assessment (color, capillary refill, temperature, turgor, bleeding) with adjuncts such as implantable Doppler or near-infrared spectroscopy; venous congestion presents as a congested, purple flap with brisk dark bleeding.
Craniosynostosis: sagittal synostosis produces scaphocephaly; coronal synostosis produces anterior plagiocephaly; metopic synostosis produces trigonocephaly; lambdoid synostosis produces posterior plagiocephaly.
Hand infection emergencies: flexor tenosynovitis (Kanavel signs: fusiform swelling, tenderness along the sheath, finger held in slight flexion, pain with passive extension) and necrotizing fasciitis both require urgent operative drainage.
When discussing complications in an oral exam, state the incidence, mechanism, prevention, recognition, and management for each complication, and address informed consent and documentation.