Plastic & Reconstructive Surgery
Core concepts
Understand wound healing, flap physiology, and reconstructive decision-making. Know the difference between skin grafts and flaps, the angiosome concept, and the blood supply of common flaps. Recognize the reconstructive ladder and when free tissue transfer is justified.
Key topics
- Grafts versus flaps: grafts need a vascularized bed; flaps bring their own blood supply.
- Flap monitoring: color, capillary refill, Doppler, and signs of venous versus arterial compromise.
- Burns: airway assessment, fluid resuscitation formulas, and escharotomy indications.
- Hand and soft tissue infections: timing of debridement.
Traps
- Choosing a graft over a flap for exposed bone or tendon.
- Missing compartment syndrome in a hand injury.
- Misjudging burn depth and fluid needs.
- Ignoring flap venous congestion as a reversible emergency.
Worked example
A wound with exposed tendon and no vascularized bed: a skin graft will fail - choose a flap. Rule of thumb: if the bed cannot support a graft, bring blood supply to the wound.
Study strategy
Compare graft and flap indications with a table. Practice recognizing flap compromise early and the burn resuscitation approach.