TY - JOUR T1 - Tips for GP trainees working in plastic surgery JF - British Journal of General Practice JO - Br J Gen Pract SP - 667 LP - 669 DO - 10.3399/bjgp13X675629 VL - 63 IS - 617 AU - Jeremy Neil Rodrigues AU - Nigel Tapiwa Mabvuure AU - Dariush Nikkhah Y1 - 2013/12/01 UR - http://bjgp.org/content/63/617/667.abstract N2 - Plastic surgery is often misrepresented in the popular media, and as a predominantly postgraduate specialty, many doctors also misunderstand it. Unlike other surgical specialties, it is defined by the application of technical skills throughout the body, rather than by a distinct anatomical area. GP trainees can easily find themselves cross covering plastics on-calls out of hours. Combined with limited previous experience and the varied case-mix, this can be daunting. However, plastic surgery provides an abundance of very relevant learning opportunities.Box 1. The reconstructive ladderThis is one way of conceptualising the options available for reconstructing a soft tissue defect. In general, start at the lowest rung of the ladder, and ‘climb’ until the simplest solution for the problem is identified: Heal by secondary intentionNot just the ‘easy option’. This can be labour-intensive, and require frequent attendances for dressing changes.Primary closureSuturing appropriate, clean, debrided wounds.Delayed primary closureSometimes a wound is initially cleaned, debrided, and dressed, and only closed at a later stage (typically to reduce the chance of infection). This is sometimes performed for bite wounds.GraftsGrafts are pieces of tissue moved from one site on the body to another, but without maintaining any intrinsic circulation. They then have to gradually derive a blood supply from the recipient site. They can comprise different tissues, for example skin or bone.Local flapsFlaps are pieces of tissue moved with their own capillary network intact. Again, these can involve different tissues, such as skin or muscle. Local flaps use geometry to reorganise nearby tissue laxity and close a defect.Regional flapsHere the tissue is moved from a different region of the body, but without detaching its blood supply. An example is detaching the origin of latissimus dorsi from the central back and swinging it through the axilla (where it … ER -