Clinical decision support that reasons like a plastic surgeon: resuscitate the burn, climb the reconstructive ladder, monitor the flap, keep the aesthetic case safe — with the decision rule and exactly what would change it. Built for verified plastic surgeons.
Two real plastic-surgery questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Adult, 30% total-body-surface-area flame burn, 80 kg — the initial fluid resuscitation?
Estimate the burn with the rule of nines (about 30% here), then resuscitate by the Parkland formula: roughly 4 mL × 80 kg × 30 = 9,600 mL of lactated Ringer over 24 hours, half in the first 8 hours from the time of injury. Titrate to a urine output of 0.5 mL/kg/h, not to the formula, and reassess for inhalation injury and referral to a burn center.
Decision ruleParkland ≈ 4 mL × kg × %TBSA of lactated Ringer, half in the first 8 h; titrate to urine output 0.5 mL/kg/h; refer major burns.
Not established from this alone — exact TBSA and depth, inhalation injury, age and comorbidity change volume and disposition.
Scalp defect with exposed skull after tumor resection — how should I reconstruct it?
Work the reconstructive ladder to the rung the defect needs. Exposed bone without periosteum will not take a graft, so simple closure or grafting is out; a local scalp flap covers a small defect, and a large or irradiated defect with exposed skull is best served by free tissue transfer (a free flap) with a skin graft over the muscle. Choose the simplest option that reliably reconstructs — but go straight to a free flap when the wound demands it.
Decision ruleMatch the defect to the ladder: primary → graft → local flap → free flap; exposed bone/hardware or a large, irradiated defect → free tissue transfer.
Not established from this alone — defect size, exposed structures, radiation, vessels and patient fitness change the choice.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Estimate the burned area with the rule of nines (or a Lund–Browder chart) counting partial- and full-thickness only. Resuscitate with the Parkland formula — about 4 mL of lactated Ringer per kilogram per %TBSA over 24 hours, half in the first 8 hours from the burn — and then titrate to a urine output of 0.5 mL/kg/h. Escharotomy relieves a circumferential full-thickness burn that compromises perfusion or ventilation.ABLS · Parkland
Decision ruleRule of nines → Parkland (≈4 mL/kg/%TBSA, half in 8 h) → titrate to urine output 0.5 mL/kg/h; escharotomy for circumferential full-thickness burns.
Missing data: depth, inhalation injury, age, and the time from injury change the volume and the plan.
Climb from simplest to most complex until the rung matches the wound: primary closure, then healing by secondary intention, then a skin graft, then a local or regional flap, then free tissue transfer. A well-vascularized bed takes a graft; exposed bone, tendon, hardware or an irradiated field needs a flap. Modern practice favors the option that gives the best result, not merely the simplest — the "reconstructive elevator".guideline synthesis
Decision rulePick the lowest rung that reliably covers the defect; exposed bone/tendon/hardware or irradiation → flap; a healthy bed → graft.
Missing data: the bed, exposed structures, defect size and patient factors decide the rung.
Fatal fat embolism follows injection into or beneath the gluteal muscle, where large veins can be breached. Inject only into the subcutaneous plane — never intramuscular or submuscular — keep the cannula angled parallel or upward, avoid deep passes, use a larger-bore rigid cannula, and inject while moving. Intraoperative ultrasound guidance to confirm the subcutaneous plane further lowers the risk.Gluteal Fat Grafting Task Force
Decision ruleSubcutaneous plane only, never intramuscular; cannula parallel/upward, no deep passes; inject in motion; consider ultrasound guidance.
Missing data: anatomy, cannula control, volume and image guidance change the safety margin.
Monitor color, temperature, capillary refill, turgor, a Doppler signal and pinprick bleeding. Venous congestion looks blue and swollen with brisk refill and dark, rapid bleeding; arterial insufficiency looks pale and cool with sluggish or absent refill and no bleeding. Either is a surgical emergency — return early to the operating room, because salvage falls sharply with delay.guideline synthesis
Decision ruleCongested (blue, brisk refill, dark bleeding) or ischemic (pale, cool, no bleeding) → emergent re-exploration; earlier return means higher salvage.
Missing data: the trend, flap type, pedicle geometry and time since surgery change the response.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist plastic-surgery colleague across burns, reconstruction, hand, aesthetic and wound care — cited, non-directive, always with the decision rule.
Deep specialist agents for reconstructive & microsurgery, aesthetic, hand and burns — each its own soul and knowledge base — plus your own uploaded materials.
In reconstruction and the burn unit the margin is thin. Only one of these reasons like a plastic-surgery colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the plastic surgery build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment plastic surgery opens — with your Founding Plastic Surgeon offer.
One email at launch. No spam, ever.
It reasons in the tools you use — the rule of nines, the Parkland formula and titration to urine output — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in the burn unit and before reconstruction. Access is gated to verified physicians.
Reconstructive & microsurgery, aesthetic, hand, and burns each have their own deep specialist agent on the Pro plan, on top of the full plastic-surgery scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited plastic-surgery knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
HeyHippocrates