Plastic and Reconstructive Surgery

Plastic and Reconstructive Surgery Indian Medical PG Question 1: Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except

• A. Silicone implants
• B. Transversus abdominis muscle flap (TRAM flap)
• C. Latissimus dorsi flap (LD flap)
• D. Deltopectoral flap (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***Deltopectoral flap*** - The **deltopectoral flap**, also known as the Bakamjian flap, is primarily used for **head and neck reconstruction**, particularly for defects in the pharynx, esophagus, or oral cavity. - It involves tissue from the shoulder and chest wall, but its design and vascular supply make it unsuitable for **breast reconstruction** after radical mastectomy, which requires significantly more volume and different tissue characteristics. *Silicone implants* - **Silicone implants** are a common method for breast reconstruction, offering a less invasive option than flap procedures. - They are placed either beneath the pectoral muscle or subcutaneously to restore breast volume and shape. *Transversus abdominis muscle flap (TRAM flap)* - The **TRAM flap** is a widely used and versatile autologous tissue reconstruction method, utilizing tissue from the lower abdomen to create a new breast mound. - It can be either pedicled (retaining its original blood supply) or free (requiring microvascular anastomosis), providing a natural-feeling and long-lasting reconstruction. *Latissimus dorsi flap (LD flap)* - The **latissimus dorsi (LD) flap** involves transferring muscle, fat, and skin from the back to the chest to reconstruct the breast. - It is particularly useful for smaller breasts or when combined with an implant, and it can provide good aesthetic results with reliable blood supply.

Plastic and Reconstructive Surgery Indian Medical PG Question 2: What is the classification of intelligence corresponding to an IQ score of 90-109?

• A. Below average
• B. Average (Correct Answer)
• C. Slightly below average
• D. Above average

Plastic and Reconstructive Surgery Explanation: ***Average*** - An **IQ score** range of **90-109** is traditionally classified as **Average** intelligence. - This range represents the **mean** and surrounding **standard deviation** of IQ scores in the general population. *Below average* - This classification usually corresponds to IQ scores in the range of **70-79** or **80-89**, depending on the specific scale. - It does not represent the central tendency of the population's intelligence. *Slightly below average* - This category typically corresponds to IQ scores in the range of **80-89**. - It falls just below the average range but is not as low as the "below average" classification. *Above average* - This classification is typically assigned to IQ scores that are in the range of **110-119** or higher. - It signifies cognitive abilities that are greater than the majority of the population.

Plastic and Reconstructive Surgery Indian Medical PG Question 3: What is the baseline platelet count required for surgery?

• A. 50,000/µL (50 × 10^9/L) (Correct Answer)
• B. 40,000/µL (40 × 10^9/L)
• C. 20,000/µL (20 × 10^9/L)
• D. 30,000/µL (30 × 10^9/L)

Plastic and Reconstructive Surgery Explanation: ***50,000/µL (50 × 10^9/L)*** - A platelet count of **50,000/µL** is considered the **minimum threshold** for safe surgical procedures. - This level is generally sufficient to achieve **adequate primary hemostasis** and minimize the risk of significant perioperative bleeding. *20,000/µL (20 × 10^9/L)* - A platelet count of **20,000/µL** is generally **too low** for most surgical interventions, as it significantly increases the risk of serious bleeding. - This level is often associated with a risk of **spontaneous bleeding**, particularly in mucous membranes. *40,000/µL (40 × 10^9/L)* - While closer to the safe threshold, a platelet count of **40,000/µL** might still be considered **suboptimal** for major surgeries, especially those with a high risk of blood loss. - Some surgeons and anesthesiologists may prefer a slightly higher count to ensure a wider **safety margin**. *30,000/µL (30 × 10^9/L)* - A platelet count of **30,000/µL** is generally **insufficient** for most surgical procedures and would likely necessitate **platelet transfusion** preoperatively. - Patients at this level are at an **increased risk of bleeding** during and after surgery.

Plastic and Reconstructive Surgery Indian Medical PG Question 4: Match List-I with List-II and select the correct answer using the code given below the Lists:

• A. A→4 B→3 C→2 D→1 (Correct Answer)
• B. A→1 B→3 C→2 D→4
• C. A→1 B→2 C→3 D→4
• D. A→4 B→2 C→3 D→1

Plastic and Reconstructive Surgery Explanation: ***A→4 B→3 C→2 D→1*** - A **symposium** (A) is characterized by a "discussion among the speakers" (4), where experts present different aspects of a topic, followed by interaction. - A **panel discussion** (B) involves a "series of speeches on a selected subject" (3) by panel members in front of an audience, often with interaction moderated by a chairperson. - A **workshop** (C) typically focuses on "arriving at a plan of action to solve the problem" (2) through practical, hands-on activities and collaborative problem-solving. - **Role-play** (D) is a technique where a "situation is dramatized" (1) by participants acting out roles to understand different perspectives or practice new skills. *A→1 B→3 C→2 D→4* - This option incorrectly matches "Symposium" with "Situation is dramatized" and "Role-play" with "Discussion among the speakers". - Role-play is about dramatizing a situation, while a symposium involves discussion among speakers. *A→1 B→2 C→3 D→4* - This option misaligns multiple matches, particularly with "Symposium" (A) and "Workshop" (C). - A workshop is about action plans, and a symposium is about discussions among speakers, not the other way around. *A→4 B→2 C→3 D→1* - This option incorrectly matches "Panel discussion" with "Arriving at a plan of action to solve the problem" and "Workshop" with "Series of speeches on a selected subject". - Workshops focus on action plans, and panel discussions involve a series of speeches.

Plastic and Reconstructive Surgery Indian Medical PG Question 5: Which of the following are correct regarding Blood substitutes ? 1. They are biomimetic. 2. They are extensively used in war injuries. 3. They are made of perfluorocarbon emulsions. 4. They are haemoglobin-based. Select the correct answer using the code given below :

• A. 2, 3 and 4
• B. 1 and 3 only
• C. 1, 2 and 3
• D. 1, 3 and 4 (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***1, 3 and 4*** - **Blood substitutes are biomimetic** - they are artificially engineered to mimic the oxygen-carrying capacity of natural red blood cells. - Blood substitutes fall into **two main categories**: perfluorocarbon (PFC) emulsions and hemoglobin-based oxygen carriers (HBOCs). Statement 3 and 4 correctly identify these two major types. - **PFC emulsions** can dissolve large amounts of oxygen and carbon dioxide, transporting gases to tissues through physical dissolution. - **Hemoglobin-based oxygen carriers** use modified hemoglobin (human, bovine, or recombinant) to bind and transport oxygen similar to natural red blood cells. *1, 2 and 3* - While statements 1 and 3 are correct, **statement 2 is incorrect**. - Blood substitutes are **NOT extensively used in war injuries** - most remain experimental or have very limited clinical approval. - Despite theoretical advantages (extended shelf life, no cross-matching needed), practical deployment has been minimal due to safety concerns and regulatory limitations. *2, 3 and 4* - This option incorrectly includes statement 2 about extensive use in war injuries, which is **factually inaccurate**. - Most blood substitutes have failed to gain widespread approval due to adverse effects including vasoconstriction, hypertension, and increased mortality in some trials. - It also incorrectly excludes statement 1 - the **biomimetic nature** is a fundamental defining characteristic of blood substitutes. *1 and 3 only* - While statements 1 and 3 are correct, this option is **incomplete**. - It fails to recognize that blood substitutes include **both perfluorocarbon-based AND hemoglobin-based** types - the two major categories in development. - Statement 4 about hemoglobin-based carriers is equally important and correct.

Plastic and Reconstructive Surgery Indian Medical PG Question 6: Closure for clean wounds within 6 hours of injury is called.

• A. Primary closure (Correct Answer)
• B. Delayed primary closure
• C. Secondary closure
• D. Tertiary closure

Plastic and Reconstructive Surgery Explanation: ***Primary closure*** - **Primary closure** is the immediate closure of a wound, typically within **6 hours** of injury, for **clean wounds** at low risk of infection. - This method promotes direct apposition of wound edges, leading to **faster healing** and **minimal scarring**. *Delayed primary closure* - This involves leaving a wound open for **4-6 days** to monitor for infection or edema, then closing it if conditions are favorable. - It is often used for **contaminated wounds** or those with a higher risk of infection, where immediate closure is not safe. - Also known as **tertiary closure**. *Secondary closure* - **Secondary closure**, or healing by secondary intention, occurs when a wound is left open and allowed to **heal naturally by granulation, contraction, and epithelialization**. - This method is used for **heavily contaminated** or **infected wounds** and results in a larger scar and a longer healing time. *Tertiary closure* - **Tertiary closure** is another term for **delayed primary closure**. - It involves leaving a wound open initially, then closing it after several days (typically 4-6 days) once the risk of infection has decreased. - This option is incorrect because the question asks about closure **within 6 hours**, not delayed closure.

Plastic and Reconstructive Surgery Indian Medical PG Question 7: The best cosmetic result following breast reconstruction is achieved with :

• A. Latissimus dorsi flap
• B. Silicone gel implant with reconstruction
• C. Acellular dermal matrix flap
• D. Transverse rectus abdominis myocutaneous flap (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***Transverse rectus abdominis myocutaneous flap*** - The **TRAM flap** offers excellent aesthetic outcomes by utilizing the patient's own **abdominal tissue**, providing a natural look and feel that mimics breast tissue. - This method results in a soft, pliable breast mound with good long-term stability and can provide a **simultaneous abdominoplasty** effect. *Latissimus dorsi flap* - While a viable option, the **latissimus dorsi flap** is typically smaller and may require an **implant** to achieve adequate breast volume, potentially leading to a less natural result than a TRAM flap. - It uses tissue from the back, which can leave a noticeable scar and may cause **weakness in the shoulder** or back. *Silicone gel implant with reconstruction* - Implants can provide good cosmetic results but carry risks such as **capsular contracture**, rupture, and the need for future revisions, which can affect long-term satisfaction. - They do not offer the same **natural feel or warmth** as autologous tissue reconstruction, as the reconstructed breast is not made of living tissue. *Acellular dermal matrix flap* - **Acellular dermal matrix (ADM)** is often used as an adjunct in implant-based reconstruction to support and reinforce the breast tissue, rather than as a primary reconstructive flap for optimal cosmetic results. - While it aids in tissue expansion and support, it does not provide the **volume or natural contour** that an autologous flap like the TRAM can achieve on its own.

Plastic and Reconstructive Surgery Indian Medical PG Question 8: A 43-year-old window cleaner fell off a scaffold. He sustained an open wound on the right leg. Debridement was carried out in the emergency department, and the edges of the wound were left open. Which factor is least likely to inhibit wound contraction?

• A. Radiation
• B. Transforming growth factor β (Correct Answer)
• C. Full-thickness skin graft
• D. Cytolytic drug

Plastic and Reconstructive Surgery Explanation: ***Transforming growth factor β*** - **TGF-β** is a potent **pro-fibrotic cytokine** that plays a crucial role in promoting wound contraction and fibrosis by stimulating **fibroblast proliferation**, **myofibroblast differentiation**, and **collagen synthesis**. - Its presence and activity would *enhance* rather than inhibit wound contraction, making it the **least likely factor to inhibit** this process. - In wound healing, TGF-β is essential for the contraction phase and tissue remodeling. *Radiation* - **Ionizing radiation** can damage cells, including **fibroblasts** and **myofibroblasts**, which are essential for wound contraction. - This cellular damage and reduction in viable cells can significantly **impair** the contractile forces within the wound. - Radiation therapy is a known factor that inhibits wound healing and contraction. *Full-thickness skin graft* - A **full-thickness skin graft** introduces a complete layer of skin, including the dermis, into the wound. - The presence of the **dermis** within the graft provides a structural barrier and helps to **anchor the wound edges**, thereby reducing the tendency for contraction. - In contrast, **split-thickness grafts** allow more wound contraction due to less dermal tissue. *Cytolytic drug* - **Cytolytic drugs** are designed to kill cells, and if applied to a wound, they would destroy **fibroblasts** and **myofibroblasts**. - The destruction of these critical cells would directly **inhibit** the cellular machinery responsible for pulling the wound edges together, hence preventing contraction. - These drugs impair the proliferative phase of wound healing.

Plastic and Reconstructive Surgery Indian Medical PG Question 9: What is the best procedure to control external hemorrhage in an event of accidental injury?

• A. Proximal tourniquet
• B. Artery forceps
• C. Elevation
• D. Direct pressure (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***Direct pressure*** - **Direct pressure** is the most immediate and effective first-aid measure for controlling external bleeding by compressing the injured vessel. - Applying firm, direct pressure with a clean cloth or hand helps to promote **hemostasis** and allow for clot formation at the site of injury. *Proximal tourniquet* - A **tourniquet** is a last resort for severe, life-threatening hemorrhage that cannot be controlled by direct pressure, as it can cause **tissue damage** and ischemia. - It should be applied proximal to the injury, but its prolonged use carries risks of **nerve damage** and limb loss. *Artery forceps* - **Artery forceps** are surgical instruments used to clamp individual blood vessels during a surgical procedure, not for initial control of external hemorrhage in an emergency. - Their use requires expertise and carries risks of further injury if not applied correctly by trained medical personnel. *Elevation* - **Elevation** of the injured limb above the level of the heart can help reduce blood flow and venous pressure, which may aid in controlling minor bleeding. - However, elevation alone is usually insufficient for significant hemorrhage and should be used in conjunction with **direct pressure**.

Plastic and Reconstructive Surgery Indian Medical PG Question 10: What is the treatment of choice in a patient with Crohn’s disease, where inflamed appendix was found on exploration?

• A. Appendectomy
• B. Closing the abdomen and starting medical treatment
• C. Right hemicolectomy
• D. Ileo–colic resection and anastomosis (Correct Answer)

Plastic and Reconstructive Surgery Explanation: ***Ileo-colic resection and anastomosis*** - This is the treatment of choice when an inflamed appendix is found during exploration in a patient with Crohn's disease, as the disease typically affects the **terminal ileum** and **right colon**. - The inflamed appendix is often a manifestation of Crohn's disease involving the **cecal base** and surrounding bowel. - **Ileo-colic resection** ensures removal of the diseased segment, including the inflamed appendix and involved bowel, thereby preventing future complications such as **fistulas** (risk up to 65% with simple appendectomy) and **strictures**. - If the cecal base is involved with Crohn's disease, simple appendectomy is contraindicated due to poor healing and high fistula risk. *Appendectomy* - Performing a simple appendectomy in the context of Crohn's disease carries a high risk of **fistula formation** and **poor wound healing** due to the underlying inflammatory process. - When the disease involves the **base of the appendix** and surrounding **cecum** (which is common), appendectomy alone is insufficient and dangerous. - Appendectomy may only be considered safe if the cecal base is completely **normal and uninvolved**, which is uncommon in this clinical scenario. *Closing the abdomen and starting medical treatment* - While medical treatment is crucial for managing Crohn's disease, an **inflamed appendix** found during exploration suggests an acute process that requires **surgical intervention**. - Delaying surgery by closing the abdomen could lead to complications such as **perforation** and **peritonitis**, especially if inflammation is severe. - Medical therapy alone is insufficient for acute complications requiring exploration. *Right hemicolectomy* - Right hemicolectomy is a more extensive resection than necessary for most cases of ileocecal Crohn's disease with appendiceal involvement. - **Ileo-colic resection** (removing terminal ileum, cecum, and ascending colon up to the hepatic flexure) is adequate and preferred as it is less extensive while addressing the pathology. - Right hemicolectomy would be reserved for more extensive colonic involvement beyond the typical ileocecal distribution.

Plastic and Reconstructive Surgery Flashcard 1 of 10

Question: _____ flaps often skin with bone or muscle is transferred with the flap (osseocutaneous or myocutaneous flaps, respectively)

Answer: Composite

Plastic and Reconstructive Surgery Flashcard 2 of 10

Question: Midpalmar space is drained by incision in medial _____ web spaces

Answer: 2

Plastic and Reconstructive Surgery Flashcard 3 of 10

Question: _____ flaps are local flaps that ignore blood vessel paths

Answer: Random transposition

Plastic and Reconstructive Surgery Flashcard 4 of 10

Question: DIEP is a variant of TRAM flap where a microvascular technique is used and is based on _____ artery

Answer: deep inferior epigastric

Plastic and Reconstructive Surgery Flashcard 5 of 10

Question: The given image shows the pectoralis major flap, which is based on the _____ artery.

Answer: thoracoacromial

Plastic and Reconstructive Surgery Flashcard 6 of 10

Question: _____ knife is used to harvest a split skin aka Thiersch graft

Answer: Humbys

Plastic and Reconstructive Surgery Flashcard 7 of 10

Question: _____ is a synthetic non-absorbable monofilament suture material used in plastic surgery and exhibits a degree of plasticity

Answer: Polybutester

Plastic and Reconstructive Surgery Flashcard 8 of 10

Question: _____ is a type of laceration where a large area of skin and subcutaneous tissue is rolled off the scalp.

Answer: Scalping

Plastic and Reconstructive Surgery Flashcard 9 of 10

Question: Thenar flap is a type of transposition flap which is _____ for regional reconstruction

Answer: interposed

Plastic and Reconstructive Surgery Flashcard 10 of 10

Question: Thenar space is drained by incision on the webspace of _____

Answer: thumb