Consenting for a Free Flap in the ST3 Plastics Interview
How to approach the free flap consent station in the ST3 Plastic Surgery interview: explaining microsurgery in lay terms, the risks that matter, and flap monitoring.
On this page
The consent station hands you a patient, not an examiner — often facing a radial forearm free flap for head-and-neck reconstruction — and marks how you translate a six-hour microsurgical operation into words a frightened person can hold onto.
How the station tends to run
You consent a patient (played by the examiner) for reconstruction after cancer resection — classically a radial forearm free flap for the floor of the mouth. After your explanation, the patient asks the questions real patients ask: how long is the operation, what if the flap fails, will my arm still work, will I eat normally, how long in hospital?
The approach that scores
Open like a clinician, not a script: confirm identity and the planned procedure, build rapport, check what they already understand, and acknowledge the weight of a cancer diagnosis before explaining anything.
Then explain the operation in genuinely lay terms, in two halves: the head-and-neck team removes the cancer; the plastics team borrows a patch of skin and its blood vessels from the forearm to fill the gap, joining those vessels to vessels in the neck under a microscope so the patch stays alive. The Allen test becomes: we first check the other artery at your wrist can supply your hand on its own.
- Set expectations concretely: roughly six to ten hours with two teams working simultaneously; the first night on intensive care or HDU; possibly a temporary tracheostomy (explained in lay terms) and a feeding tube while the mouth heals; a skin graft from the thigh to close the forearm; seven to fourteen days in hospital.
- Cover the risks that matter without burying the patient: flap failure (partial or total — around 2–5% — meaning urgent return to theatre or an alternative reconstruction), neck haematoma threatening the airway, infection, wound breakdown, scarring at three sites, forearm numbness and usually-temporary grip weakness, changes to speech and swallowing, DVT/PE, and nerve injury in the neck.
- Explain monitoring as reassurance: the flap is checked every hour or two for the first two to three days — colour, warmth, blood flow — and a problem means going back to theatre promptly to save it.
- Close the loop: speech and language therapy and dietetics in recovery, diet progressing from liquid to normal over weeks, and follow-up that watches both the cancer and the reconstruction.
Where candidates lose marks
Jargon is the station’s quiet killer — "anastomosis", "pedicle", and "fasciocutaneous" all need translating or dropping. So is a risk recital delivered as a list with no pauses: the station rewards dialogue, checking understanding, and honesty about uncertainty. And when the patient asks the feared question — what if it fails? — the strong answer is calm and concrete: it happens rarely, we watch closely, and if it does we return to theatre and have back-up options.
Rehearse it
Reading about consenting for a free flap is the easy half. Rehearse this exact scenario out loud, on the clock, with an AI examiner — this scenario is in Reviva’s library, with feedback marked the way the panel marks. Or start with the wider format in the st3 plastics consent station guide.
Frequently asked questions
- How do you explain microsurgery to a patient in lay terms?
- Something like: "we move a patch of skin with its own blood vessels from your forearm to your mouth, and re-join those tiny vessels to ones in your neck under a microscope, so the patch keeps its own blood supply and stays alive."
- What flap failure rate should be quoted for a free flap?
- Total failure is around 2–5%. Pair the number with the plan: intensive early monitoring, urgent return to theatre if the blood supply falters, and alternative reconstruction as the back-up.
- What is the Allen test and why mention it in consent?
- It checks that the ulnar artery alone can perfuse the hand before the radial artery is taken with the flap. In lay terms: "we make sure the other pipe to your hand is strong enough before borrowing this one."
Sources. Grounded in standard radial forearm free flap consent practice (two-team head-and-neck reconstruction, Allen test, flap monitoring, recognised complication profile) as rehearsed in Reviva’s ST3 plastics consent scenario. Educational only.