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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.
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A 41-year-old woman had an abdominoplasty closed with buried braided absorbable dermal sutures. Over the following three months she developed six small sterile abscesses along the scar, each discharging a fragment of suture before settling. She now requests revision of the widened scar.
Which suture is most appropriate for the dermal layer?
A 34-year-old woman is having extensive perianal viral warts ablated with a carbon dioxide laser under general anaesthesia. The scrub team ask what protection is required for the staff in theatre during the procedure.
What is the most appropriate arrangement?
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Also in this domain: Anterolateral thigh (ALT) flap, DIEP flap, Omental flap, Bilobed flap (Zitelli), Z-plasty (coming soon), Rhomboid (Limberg) flap (coming soon), Rotation flap (coming soon), Keystone perforator island flap (coming soon)
Flap classification for FRCS (Plast): random vs axial, Mathes–Nahai types I–V, Cormack–Lamberty A–D, Nakajima, movement and Gent perforator nomenclature.
Read · 6 minLocal flap design for FRCS (Plast): Z-plasty angles and gains, Limberg and Dufourmentel rhomboids, Zitelli bilobed, rotation, V–Y, keystone and forehead flaps.
Read · 6 minTaylor's angiosomes, choke vessels, Saint-Cyr's perforasomes, direct and indirect perforators, delay, supercharging and flap monitoring for FRCS (Plast).
Read · 5 minSkin grafts for FRCS (Plast): split vs full thickness, contraction, phases of take, recipient beds, causes of failure, meshing ratios, bolsters and NPWT.
Read · 6 minMathes–Nahai for muscle and musculocutaneous flaps (types I–V by vascular pattern) and Cormack–Lamberty for fasciocutaneous flaps (types A–D), plus perforator flaps and angiosomes. Questions usually apply them to a reconstructive choice rather than ask for the list.
The figures usually quoted in the UK are 3 mg/kg plain and 7 mg/kg with adrenaline. Expect questions on recognising local anaesthetic systemic toxicity and treating it with 20% lipid emulsion as well as on the dose itself.
Most often because haematoma, seroma, shear or infection separates the graft from its bed and stops plasmatic imbibition and revascularisation. A poorly vascularised bed, such as bare cortical bone or tendon stripped of paratenon, is the other classic cause.
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