Plastic and Reconstructive Surgery
What the exam tests
This domain covers wound healing, burns, skin cancer, hand injuries, flaps and microsurgery, and the reconstructive ladder.
Core rules
- Burns: estimate total body surface area, assess inhalation injury and start fluid resuscitation. Parkland formula is 4 mL/kg/%TBSA crystalloid in 24 hours, with half in the first eight hours from injury.
- Monitor urine output, typically 0.5 mL/kg/hour in adults, and avoid over-resuscitation.
- Circumferential full-thickness burns or limb compromise may require escharotomy.
- Skin cancer excision margins depend on tumour type and thickness; melanoma generally requires wider margins than basal cell carcinoma.
- Free flaps require monitoring of colour, capillary refill, temperature and Doppler signal; venous congestion and arterial insufficiency need urgent review.
Worked example
A 30-year-old weighing 70 kg has 30% TBSA deep partial-thickness burns. Parkland calculation gives 4 × 70 × 30 = 8,400 mL in 24 hours, with 4,200 mL in the first eight hours. Urine output and haemodynamics guide titration, and analgesia, warming and wound cover are provided.
Traps
Over-resuscitating burns and causing compartment syndrome; missing inhalation injury because the chest X-ray is initially normal; failing to document neurovascular status in hand injuries; and delaying review of a congested flap.