Plastic & Reconstructive Surgery

Shared operative foundations taught once, the room they happen in, the instruments on the tray, and the anaesthetic that makes it possible.

• The reconstructive ladder

  The specialty's operating system: for any defect, the simplest reliable reconstruction first, escalating only as the defect demands. Taught once here; the graft and flap pages assume it.

  1. 01The rungs. Healing by secondary intention, direct closure, skin graft, local flap, regional pedicled flap, free tissue transfer: each rung adds capability and cost.
  2. 02Grafts need a bed. A graft arrives with no blood supply and survives by imbibition then inosculation: it takes on vascular beds and fails on bare bone, bare tendon and irradiated fields.
  3. 03Flaps bring their supply. A flap's tissue stays alive on its pedicle throughout: it can cover what grafts cannot, and its survival question is the pedicle's patency, not the bed's generosity.
  4. 04Choosing honestly. Analyse the defect (missing, exposed, required function), then choose the lowest rung that truly serves, taking the elevator to a free flap when only that restores function: the discipline is in the reasons, not the altitude.
  5. 05The donor site. Every reconstruction is two wounds: what the donor site costs in scar, function and pain is part of the arithmetic, and the patient consents to both.

  Used bySplit-thickness skin graftLocal flap reconstruction

• Flap physiology & the failing flap

  Flaps live on plumbing, and rescuing a failing flap is a race measured in hours: the physiology every ward covering a flap patient must speak.

  1. 01The pedicle. One artery in, one vein out (sometimes two): everything the flap is depends on those vessels staying open, unkinked and uncompressed.
  2. 02Arterial failure. Pale, cool, slow refill, no bleeding on pinprick: the inflow has stopped. Rarer, and read as an immediate return to theatre.
  3. 03Venous failure. Congested, dark, brisk refill, dark ooze on pinprick: outflow has failed and the flap is drowning in its own blood. Commoner, faster, and equally a theatre problem.
  4. 04The ward's job. Keep the physiology flap-friendly: warm, well-filled, pain-controlled, dressings loose, position unkinked, and the escalation call made on concern rather than on certainty. Salvage rates track the clock.

  Used byLocal flap reconstruction

• Watch

  Split-thickness skin graft

  Harvest with the dermatome, meshing and fixing the graft, and the donor site.

  Watch for

  • Dermatome depth and the donor bleeding pattern
  • Why the graft is meshed
  • What kills a graft: haematoma, shear, infection

  Source: Children's Hospital Colorado · Watch on YouTube
• Watch

  Flexor tendon repair techniques

  Core suture configurations and the epitendinous stitch, drawn and compared.

  Watch for

  • Four-strand core repair
  • The epitendinous suture and gliding
  • The pulleys you must not sacrifice

  Source: Hand, Plastic, Reconstructive and Nerve Surgery · Watch on YouTube
• Watch

  Flexor tendon rehabilitation

  The hand therapy that decides the result: early active motion protocol.

  Source: University Hospitals Birmingham · Watch on YouTube
• Watch

  How to design a Limberg rhomboid flap

  The geometry of the transposition flap that closes a rhomboid defect.

  Watch for

  • Drawing the defect as a rhombus with 60 and 120 degree angles
  • Choosing the flap along the line of maximum extensibility
  • Where the donor site closes

  Source: Hand, Plastic, Reconstructive and Nerve Surgery · Watch on YouTube
• Watch

  How to design a bilobed local flap

  The two-lobed rotation flap for nasal tip defects.

  Source: Hand, Plastic, Reconstructive and Nerve Surgery · Watch on YouTube

Embedded videos are curated and attributed. The search doors are labeled searches for reviewers to source candidates from, not endorsements; nothing plays here until it has been reviewed.