Example FRCS Plast questions
Trunk & Urogenital: FRCS(Plast) example questions
Our coverage spans the whole JCST curriculum for this area, from perineal reconstruction and hypospadias, to genital reconstruction, with illustrated questions and referenced explanations throughout.
Perineal & pelvic reconstruction
Hypospadias
Genital reconstruction
Gender-affirming surgery
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Obesity, diabetes and recent smoking place this patient at high risk of wound-healing failure and skin-flap necrosis, so the technique chosen must minimise soft-tissue dissection whilst still delivering a durable, mesh-reinforced closure.
Anterior component separation (Ramirez) releases the external oblique aponeurosis, but requires extensive subcutaneous lateral dissection that divides the periumbilical perforators and is associated with midline skin-edge ischaemia, dehiscence, infection and seroma. In this comorbid patient, that morbidity is predictable, making A hazardous here even though the operation itself is valid.
Posterior component separation with transversus abdominis release (TAR) works entirely in the retromuscular plane, extending laterally as far as the retroperitoneum and psoas, and avoids the wound morbidity of skin flaps while placing a wide visceral-sparing sublay mesh - ideal in this clean field.
Bridging (C) and intraperitoneal mesh carry adhesion and fistula risk and leave a non-functional repair; onlay mesh (D) does not address the retraction and creates a seroma-prone subcutaneous dead space. A 13 cm defect with retracted recti cannot be approximated without component separation, so primary repair (E) fails.
The parascapular flap is supplied by the descending branch of the circumflex scapular artery, a branch of the subscapular artery.
The vessel reaches the back through the triangular space (C), bounded:
Above by teres minor
Below by teres major
Laterally by the long head of triceps
Emerging just lateral to the lateral border of the scapula roughly at its midpoint. From there the descending branch runs towards the inferior angle, giving the flap its oblique axis, whilst the transverse branch supplies the scapular flap.
Other answers:
Point A - is the suprascapular notch, where the suprascapular nerve passes beneath the transverse scapular ligament.
Point B - is the quadrangular space, lateral to the long head of triceps, transmitting the axillary nerve and posterior circumflex humeral vessels.
Point D - lies over the dorsal scapular vessels along the medial border.
Point E - marks the inferior angle, the landmark for the angular branch used with scapular tip bone flaps.
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