FRCS (Plast) revision topics

01

General principles

9 topics · 177 questions in the bank

General principles is the scaffolding for the whole paper. It covers the basics of surgical practice — sutures and needles, local anaesthesia and its toxicity, antisepsis, tourniquets and diathermy — alongside embryology and wound healing, including abnormal scarring, chronic wounds, negative pressure therapy and dressings. The reconstructive core sits here: skin grafts and graft take, flap classification, random-pattern and local flaps, muscle, fasciocutaneous and perforator flaps, angiosomes and delay, and Z-plasty geometry. Microsurgery covers anastomosis, flap monitoring and failure, and replantation, and the category closes with tissue expansion, biomaterials and implants, and lasers. These principles reappear inside regional questions: a lower-limb or head and neck stem is often really asking about blood supply, the reconstructive ladder or why a graft failed.

• General surgical principles

  Sutures & needles · Local anaesthesia & LAST · Antiseptics & asepsis · Tourniquets & diathermy

  29

• Embryology

  10

• Wound healing

  Phases of healing · Hypertrophic & keloid scars · Chronic wounds & NPWT · Dressings & skin substitutes

  29

• Skin grafts

  Graft take & failure · SSG vs FTSG · Donor sites

  21

• Flaps

  Flap classification · Random-pattern & local flaps · Muscle & musculocutaneous flaps · Fasciocutaneous flaps · Perforator flaps · Angiosomes & delay · Z-plasty & local flap geometry

  40

• Microsurgery

  Microvascular anastomosis · Flap monitoring & failure · Replantation

  25

• Tissue expansion

  8

• Biomaterials & implants

  8

• Lasers & energy devices

  7

02

Skin & soft tissue

6 topics · 166 questions in the bank

Skin and soft tissue covers the cutaneous malignancies and the lumps a plastic surgeon is asked to diagnose and treat. Basal cell carcinoma, cutaneous squamous cell carcinoma and melanoma form the core: risk stratification, excision margins, Mohs surgery, and when to involve the specialist skin cancer multidisciplinary team. Melanoma questions span diagnosis, Breslow thickness and staging, and sentinel lymph node biopsy. Vascular anomalies are classified by ISSVA into tumours, chiefly infantile haemangioma, and malformations, and that distinction drives management. The category also covers soft tissue tumours and sarcoma, where the safe answer is often to image and refer before any biopsy, and benign and premalignant lesions such as actinic keratosis, Bowen’s disease and naevi. Thresholds here are precise and guideline-based, so they make natural discriminators.

• Basal cell carcinoma

  25

• Squamous cell carcinoma

  26

• Melanoma

  Diagnosis & staging (Breslow) · Sentinel node & management

  45

• Vascular anomalies

  Infantile haemangioma · Vascular malformations

  20

• Soft tissue tumours & sarcoma

  25

• Benign & premalignant lesions

  25

03

Head & neck

10 topics · 220 questions in the bank

Head, neck and craniofacial is one of the broadest categories on the paper. Facial trauma covers soft tissue injury and mandibular, midface and Le Fort, orbital and zygomatic fractures. The facial nerve section runs from anatomy and grading of palsy to static and dynamic reanimation. Reconstruction spans the scalp and calvarium, lip, nose, eyelid and ear — including prominent ear and microtia — and the mandible and intraoral cavity, alongside head and neck oncology. The craniofacial and cleft components cover craniosynostosis, craniofacial syndromes, orthognathic surgery, cleft lip, and cleft palate with velopharyngeal insufficiency. Questions reward working anatomy, because the right reconstruction or the right emergency step usually follows from exactly which structure is involved.

• Facial trauma

  Facial soft tissue injury · Mandibular fractures · Midface & Le Fort fractures · Orbital & zygomatic fractures

  45

• Facial nerve & reanimation

  18

• Head & neck reconstruction

  Scalp & calvarial reconstruction · Lip reconstruction · Mandible & intraoral reconstruction

  35

• Head & neck oncology

  20

• Ear (prominent ear, microtia)

  15

• Nasal reconstruction

  15

• Eyelid & periorbital

  15

• Craniofacial

  Craniosynostosis · Craniofacial syndromes · Orthognathic surgery

  30

• Cleft lip

  13

• Cleft palate & VPI

  14

04

Breast

6 topics · 135 questions in the bank

Breast covers aesthetic and reconstructive surgery of the breast. Augmentation includes implant choice, pocket plane and complications, including capsular contracture and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Reduction and mastopexy cover pedicle design, skin patterns and nipple viability. Reconstruction is split between implant-based techniques, with or without acellular dermal matrix, and autologous options such as the DIEP and latissimus dorsi flaps, with the timing of reconstruction around radiotherapy a recurring theme. The category also covers oncoplastic surgery, gynaecomastia, and congenital anomalies such as tuberous breast and Poland syndrome. Questions usually present a patient with a defined oncological plan and ask which reconstructive option, or which management of a complication, is most appropriate for her.

• Breast augmentation

  25

• Breast reduction & mastopexy

  25

• Breast reconstruction

  Implant-based reconstruction · Autologous (DIEP/LD) reconstruction

  40

• Oncoplastic surgery

  20

• Gynaecomastia

  12

• Congenital breast (tuberous, Poland)

  13

05

Trunk & perineum

4 topics · 70 questions in the bank

Chest, trunk and perineum covers reconstruction of the torso. Chest wall reconstruction includes infected median sternotomy wounds, skeletal and soft tissue defects after tumour resection, and the choice between pectoralis major, rectus abdominis, latissimus dorsi and omental flaps. Abdominal wall reconstruction covers complex hernia and full-thickness defects, component separation and mesh position. Back and spinal wounds are reconstructed with paraspinous muscle, trapezius and latissimus dorsi flaps. Perineal and pelvic reconstruction follows abdominoperineal resection and pelvic exenteration, often in an irradiated field, and uses the vertical rectus abdominis myocutaneous (VRAM) flap and thigh-based flaps. Questions in this category are usually about choosing the right flap for a defined defect once prior surgery, stomas, radiotherapy and pedicles that may already have been used are taken into account.

• Chest wall reconstruction

  20

• Abdominal wall reconstruction

  18

• Back & spinal wound reconstruction

  12

• Perineal & pelvic reconstruction

  20

06

Hand

10 topics · 233 questions in the bank

Hand is the category where examination findings and anatomy carry the most weight. It covers hand anatomy and examination, fingertip and nailbed injuries, fractures and dislocations, and flexor and extensor tendon injuries by zone, with repair technique and rehabilitation. Nerve compression covers carpal and cubital tunnel syndromes. Dupuytren’s disease, scaphoid fractures and carpal instability, osteoarthritis and rheumatoid arthritis, hand infection and congenital hand differences complete the syllabus. Most questions describe a patient with a precise mechanism and a precise examination finding, and the best answer depends on identifying exactly which structure is injured and what current UK practice offers for it. Options that are standard abroad or historically, but not in the UK today, are deliberate distractors.

• Hand anatomy & examination

  20

• Hand trauma

  Fingertip & nailbed injuries · Hand fractures & dislocations

  40

• Flexor tendon injuries

  25

• Extensor tendon injuries

  20

• Nerve compression syndromes

  Carpal tunnel syndrome · Cubital tunnel syndrome

  23

• Dupuytren's disease

  18

• Scaphoid & carpal instability

  20

• Hand arthritis (OA/RA)

  18

• Hand infection

  20

• Congenital hand

  29

07

Upper limb & nerve

3 topics · 77 questions in the bank

Upper limb and peripheral nerve covers injury and reconstruction of the nerves that drive the arm and hand. Brachial plexus injury is split into obstetric palsy, where questions turn on natural history and the timing of exploration, and adult traction injury, where the level of injury — preganglionic or postganglionic — and the time since injury decide what can be reconstructed. Peripheral nerve injury and repair covers the Seddon and Sunderland classifications, degeneration and regeneration, primary repair, nerve grafts and conduits. Nerve transfers, such as the Oberlin transfer for elbow flexion or the anterior interosseous to ulnar motor branch transfer, are tested as a principle: using an expendable donor close to the target muscle. Expect overlap with the hand category, particularly in examination findings and compression neuropathy.

• Brachial plexus

  Obstetric brachial plexus injury · Adult brachial plexus injury

  30

• Peripheral nerve injury & repair

  29

• Nerve transfers

  18

08

Lower limb

4 topics · 116 questions in the bank

Lower limb and trauma covers soft tissue reconstruction of the leg and foot and the chronic wounds that bring patients to a plastic surgeon. Open fractures are managed by combined orthoplastic teams under BOAST and NICE standards, with Gustilo–Anderson classification, timing of debridement and definitive soft tissue cover, and the choice of local or free flap by the part of the leg involved. Pressure sores cover staging, the optimisation that must come before surgery, and flap reconstruction of sacral, ischial and trochanteric sores. Diabetic foot disease brings together vascular assessment, infection, offloading and amputation level. Lymphoedema covers diagnosis and staging, decongestive therapy, and surgical options from lymphaticovenular anastomosis and vascularised lymph node transfer to liposuction for fat-dominant disease.

• Lower limb trauma

  Open fractures (Gustilo/orthoplastics) · Lower limb soft tissue coverage

  50

• Pressure sores

  21

• Diabetic foot

  20

• Lymphoedema

  25

09

Burns

6 topics · 134 questions in the bank

Burns follows the patient from the scene to reconstruction. Assessment covers burn depth and estimation of total body surface area (TBSA), and referral to a specialised burn service under the National Burn Care Referral Guidance. Resuscitation covers formula-based fluid calculation, titration to urine output and the harms of over-resuscitation. Critical care covers inhalation injury, carbon monoxide and cyanide toxicity, and escharotomy. Burn surgery covers early excision, grafting, skin substitutes and donor sites, and burn reconstruction covers contractures and hypertrophic scarring. Chemical and electrical burns each have their own priorities, from calcium gluconate for hydrofluoric acid to cardiac monitoring and rhabdomyolysis after high-voltage injury. Many questions hinge on a number — a percentage, a time from injury, a urine output — so precise working matters.

• Burn assessment (depth & TBSA)

  19

• Burn resuscitation

  19

• Burns critical care & inhalation

  24

• Burn surgery (debridement/grafting)

  24

• Burn reconstruction

  23

• Chemical & electrical burns

  25

10

Paediatric

4 topics · 67 questions in the bank

Paediatric covers conditions in which the child’s age, growth and safeguarding change the answer. Paediatric burns bring different fluid needs, including maintenance fluid with glucose alongside resuscitation, toxic shock syndrome after small burns, and recognition of non-accidental injury. Congenital melanocytic naevi raise questions of melanoma risk by size, neurocutaneous melanosis, and the timing and method of treatment. Hypospadias and genital anomalies cover classification by meatal position, associated anomalies and the timing of repair. Paediatric vascular anomalies revisit infantile haemangioma and vascular malformations, with emphasis on natural history, propranolol and when to intervene. Expect the best answer to depend on the child’s age and on spotting the one finding in the stem that changes the plan, such as a burn pattern that does not fit the history.

• Paediatric burns

  22

• Congenital naevi

  12

• Hypospadias & genitalia

  18

• Paediatric vascular anomalies

  15

11

Aesthetic

8 topics · 65 questions in the bank

Aesthetic covers cosmetic surgery of the face and body and the non-surgical treatments that now make up much of aesthetic practice. Facial surgery includes facelift, blepharoplasty and brow lift, and aesthetic rhinoplasty, built on the anatomy of the SMAS, the facial nerve branches and the eyelid support structures. Body surgery includes abdominoplasty, liposuction and fat grafting, and body contouring after massive weight loss. Non-surgical treatments cover botulinum toxin, dermal fillers and chemical peels, including the management of their complications. Gender-affirming surgery is also part of this category. Questions usually test patient selection, safe technique and the recognition of complications rather than aesthetic taste: the best answer is generally the one that keeps the patient safe.

• Facelift (rhytidectomy)

  10

• Blepharoplasty & brow lift

  10

• Rhinoplasty (aesthetic)

  10

• Abdominoplasty

  8

• Body contouring & post-bariatric

  7

• Liposuction & fat grafting

  8

• Non-surgical (toxin, fillers, peels)

  7

• Gender-affirming surgery

  5

12

Professional & statistics

5 topics · 40 questions in the bank

Professional, ethics and statistics covers the non-technical knowledge every consultant needs. Consent is examined through the Montgomery judgment and GMC guidance on decision making and consent, including capacity and consent in children and young people. Ethics covers the core principles, confidentiality and the duty of candour. Medical law covers negligence and capacity legislation, which differs between England and Wales, Scotland and Northern Ireland. Statistics and evidence cover study design, levels of evidence, hypothesis testing, choice of statistical test, sensitivity and specificity, and measures of effect such as number needed to treat. Clinical governance and leadership cover audit, research and service evaluation, incident reporting and Never Events. These questions are short and precise, and a modest amount of focused revision secures them.

• Consent

  10

• Ethics

  6

• Medical law

  6

• Statistics & evidence

  12

• Clinical governance & leadership

  6