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Trunk & perineum for FRCS (Plast)

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.

70 questions in the bank · 4 topics Updated 4 October 2026
Practise trunk & perineum questions Try a free question

Topics in this domain

  • Chest wall reconstruction20
  • Abdominal wall reconstruction18
  • Back & spinal wound reconstruction12
  • Perineal & pelvic reconstruction20

What the paper tends to test

  • Expect flap selection for a defined defect: a sternal wound, an anterior abdominal wall defect, a lumbosacral wound or a perineal defect after radiotherapy.
  • The paper tends to test the reasoning behind component separation and the choice of mesh position in abdominal wall reconstruction.
  • Expect questions on how previous surgery, stomas, radiotherapy and harvested vessels change the options available.
  • Sternal wound questions usually start with debridement and source control before reconstruction.

Classic traps and discriminators

  • After abdominoperineal resection with an end colostomy, the VRAM flap is usually raised from the rectus on the side opposite the stoma.
  • The pectoralis major turnover flap depends on internal mammary perforators, so it is unreliable on the side where the internal mammary artery was used for coronary grafting; an advancement flap or another option is safer.
  • Anterior component separation releases the external oblique lateral to the linea semilunaris; posterior component separation releases transversus abdominis. Know which layer each divides.
  • Fournier’s gangrene is a clinical diagnosis; scoring systems such as LRINEC can support it but must not delay urgent radical debridement.

Free trunk & perineum practice question

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09Trunk & perineum·Abdominal wall reconstruction
medium

During an open anterior component separation for a large midline incisional hernia, the surgeon makes a longitudinal release 1–2 cm lateral to the linea semilunaris and develops an avascular plane deep to the released layer to allow the rectus complex to advance medially.

Which structure is divided in this release?

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Interactive 3D: Omental flap

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Free revision notes

Flap classification: blood supply, tissue and movement

Flap classification for FRCS (Plast): random vs axial, Mathes–Nahai types I–V, Cormack–Lamberty A–D, Nakajima, movement and Gent perforator nomenclature.

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Trunk & perineum questions, answered

Which flap is used for perineal reconstruction after abdominoperineal resection?

The vertical rectus abdominis myocutaneous (VRAM) flap is the classic choice, bringing well-vascularised muscle into an irradiated pelvic dead space. Thigh-based options such as gracilis or anterolateral thigh flaps are used when the rectus is unavailable.

How are infected sternotomy wounds managed?

Debridement and control of infection first, then cover, usually with pectoralis major advancement or turnover flaps, and rectus abdominis or omentum for lower-third defects or when pectoralis is inadequate.

What is component separation?

A technique for closing large midline abdominal defects by releasing layers of the lateral abdominal wall so the rectus muscles can be advanced medially. Anterior separation divides the external oblique; posterior separation releases transversus abdominis.

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