What is the condition commonly known as jumper's knee?

Patellar tendonitis due to overuse of the patellar tendon.

Inflammation of the patellar tendon at its insertion on the patella.

Tendinopathy of the quadriceps tendon.

Injury to the hamstring tendon.

The best material for below-inguinal arterial graft is:

Saphenous vein graft (upside-down)

Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.

Statements 1 & 2 are correct, 2 is not explaining 1

Statements 1 and 2 are correct and 2 is the correct explanation for 1

Statements 1 and 2 are incorrect

Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

Transversus abdominis muscle flap (TRAM flap)

Latissimus dorsi flap (LD flap)

Which flap is commonly used in breast reconstruction?

DIEP based on deep inferior epigastric perforator vessels

Gluteal flap based on superior gluteal artery

Latissimus dorsi flap based on thoracodorsal artery

TRAM based on transverse rectus abdominis muscle

Breast Reconstruction for INI-CET: High-Yield Surgery Lessons

Indications & Timing - Recon Roadmap

Indications:
- Post-mastectomy (cancer, prophylactic)
- Congenital (e.g., Poland syndrome)
- Severe trauma/burns
Timing Options:
- Immediate: With mastectomy.
  - Pros: Single surgery, ↑psychological well-being.
  - Cons: Longer operation, potential delay to adjuvant therapy.
- Delayed: After mastectomy & adjuvant therapy.
  - Pros: Oncologically safer (high-risk), patient choice.
  - Cons: Multiple stages, tissue changes (fibrosis).
- Delayed-Immediate: Expander at mastectomy; final recon later.
  - Balances benefits of immediate/delayed; staged approach.

⭐ Immediate reconstruction is generally preferred for eligible patients due to superior aesthetic and psychological outcomes, provided oncologic safety is not compromised.

Autologous Flaps - Flap Fantasia

Uses patient's own tissue (skin, fat, +/- muscle).
Types:
- Pedicled: Blood supply remains attached.
- Free: Blood supply detached & re-anastomosed (microsurgery).

Autologous flap donor sites for breast reconstruction

Flap	Pedicle(s)	Type (P/F)	Key Pro(s)	Key Con(s)
TRAM	Sup/Deep Inf. Epigastric	P/F	Good volume, robust	Abd. wall weakness, muscle sacrifice
DIEP	DIEA Perforators	F	Muscle-sparing, ↓ abd. morbidity	Technically demanding, longer OR
LD	Thoracodorsal A.	P/F	Reliable, salvage, good for thin pts	Back scar/seroma, often needs implant for vol.
SIEA	Superficial Inf. Epigastric A.	F	Muscle-sparing, ↓ donor pain	Vessel often small/absent, less reliable
SGAP	Sup. Gluteal A. Perf.	F	Alternative donor, good projection	Buttock contour issues, difficult positioning
IGAP	Inf. Gluteal A. Perf.	F	Hidden scar (IMF), good for thin pts	Sciatic nerve risk, shorter pedicle

Implant-Based Methods - Silicone & Saline Stories

Subglandular vs Submuscular Breast Implant Placement

Overview: Uses silicone or saline implants. Shorter surgery, faster recovery vs. autologous.
Implant Types:
- Silicone Gel: Cohesive gel, natural feel. MRI for rupture detection.
- Saline: Sterile saltwater-filled. Rupture causes visible deflation. Firmer.
Placement:
- Subglandular (prepectoral).
- Submuscular (retropectoral, often dual-plane for better coverage).
Procedure:
- Two-Stage (Common): Tissue expander placed, gradually inflated, then exchanged for permanent implant.
- Direct-to-Implant (DTI): Single stage; requires good skin/soft tissue.

Complications:
- Capsular Contracture (Baker I-IV).
- Implant Rupture/Deflation, Infection, Seroma.
- ⚠️ BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) - higher with textured surfaces.

⭐ Capsular contracture is the most frequent complication; Baker grades III and IV are clinically significant and often require surgical correction.

NAC, Complications, Adjuncts - Finessing & Fixes

Nipple-Areola Complex (NAC) Reconstruction:
- Timing: 3-6 months post-mound creation.
- Nipple: Local flaps (skate, C-V), composite grafts, nipple sharing.
- Areola: Full-thickness skin grafts (FTSG) (contralateral NAC, inner thigh), medical tattooing (3D).
Complications:
- General: Hematoma, seroma, infection, dehiscence, pain, asymmetry.
- Implant-Based:
  - Capsular contracture (Baker I-IV); 📌 Mnemonic: "BAKER makes implants HARD".
  - Rupture, malposition, rippling, animation deformity.
  ⭐ Capsular contracture is the most common long-term complication of implant-based breast reconstruction. Baker Grade III/IV often requires surgical intervention.
- Autologous Flap: Partial/total flap loss, fat necrosis, donor site morbidity (hernia, seroma).
Adjuncts & Finessing:
- Lipofilling: Contour, volume, skin quality.
- Symmetrization: Contralateral mastopexy, reduction, augmentation.
- Minor revisions: Dog-ear correction, scar revision_._

High‑Yield Points - ⚡ Biggest Takeaways

Immediate reconstruction is common; delayed if inflammatory cancer or PMRT planned.

Choose between autologous flaps (patient's tissue) or implant-based reconstruction.

DIEP flap: Muscle-sparing abdominal flap, preferred for lower morbidity.

TRAM flap: Abdominal flap with rectus muscle harvest, risks hernia/weakness.

LD flap: Back flap, often requires an implant for volume projection.

Implant risks: Capsular contracture, rupture, infection, and BIA-ALCL.

Nipple-areola complex (NAC) reconstruction is a separate, staged procedure.

Continue reading on Oncourse

CONTINUE READING — FREE

or get the app

App Store|Google Play