Plastic and Reconstructive Surgery Practice Questions

Q: A patient was brought to the emergency department following a road traffic accident. Skin grafting was done wherein the graft was taken from the same person. Which type of graft is it?

Autograft. ***Autograft*** - An **autograft** is a type of graft where tissue is transplanted from one site to another on the **same individual**, which matches the clinical scenario described. - This is the most common type of skin graft because there is no risk of an **immunological rejection** by the recipient's body, as the tissue is genetically identical. *Xenograft* - A **xenograft** (or heterograft) involves the transplantation of tissue between individuals of **different species**, such as using pig skin for a temporary burn dressing on a human. - This is incorrect as the graft was taken from the patient themselves, not from an animal source. *Allograft* - An **allograft** (or homograft) is a graft of tissue between two genetically **non-identical individuals** of the **same species**, such as a cadaveric skin graft. - This is not the correct answer because the donor and recipient are the same person, not two different people. *Isograft* - An **isograft** (or syngeneic graft) is a tissue transplant between two genetically **identical individuals**, specifically **identical twins**. - While isografts also avoid immune rejection, this is incorrect because the graft was from the patient's own body, not from their identical twin.

Q: Cleft lip primary muscle repair is required in which of the following muscles?

Orbicularis oris. ***Orbicularis oris*** - The **orbicularis oris** muscle forms the main sphincter of the mouth and is interrupted in a cleft lip. Repair involves meticulous anatomical realignment of this muscle for correct function and appearance. - Dysfunction of this muscle in unrepaired cleft lip leads to **vermilion deficiency**, **cupid's bow distortion**, and poor feeding/speech. *Orbicularis oculi* - This muscle surrounds the eye and is responsible for blinking and closing the eyelid; it is not primarily affected in a standard cleft lip. - Though part of the facial musculature, its involvement is secondary, mainly due to potential nerve injury during extensive **craniofacial procedures**, not cleft lip repair. *Levator palpebrae superioris* - This muscle elevates the upper eyelid and is innervated by the **oculomotor nerve (CN III)**. It is not involved in cleft lip pathology or repair. - Its function is essential for vision, and damage results in **ptosis**, a concern unrelated to primary lip closure. *Masseter* - The masseter is a powerful muscle of mastication, innervated by the **trigeminal nerve (CN V)**. It is located in the cheek and is not part of the required functional repair for a cleft lip. - Its primary role is in **jaw closure (chewing)**, and its integrity is preserved during standard cleft lip repair procedures.

Q: Identify the procedure shown in the image.

Dog ear excision. ### **Explanation: Dog Ear Excision** **1. Why the Correct Answer is Right:** A **"Dog ear"** (also known as a cone or cutaneous redundancy) occurs during the closure of a circular or elliptical wound when one side of the wound is longer than the other, or when the closure angle is too obtuse. This results in a **puckered elevation of skin** at the ends of the suture line. * **The Procedure:** To correct this, the surgeon extends the incision slightly, creates a small triangular flap of the redundant tissue, and excises it to allow the skin to lie flat. This converts the wound into a slightly longer, but aesthetically pleasing, linear scar. **2. Why the Other Options are Wrong:** * **Keloid Excision:** Keloids are firm, rubbery lesions that extend beyond the boundaries of the original wound. Excision involves removing the entire bulk of hypertrophic tissue, often followed by adjuvant therapy (like intralesional steroids) to prevent recurrence. * **Z-plasty:** This is a transposition flap technique used to **lengthen a scar** or change its direction to align with Relaxed Skin Tension Lines (RSTLs). It involves creating two triangular flaps that are transposed. * **Transposition Flap:** This involves moving a flap of skin and subcutaneous tissue over an incomplete bridge of intact skin to a nearby defect (e.g., Limberg flap). It does not specifically address the puckering seen at the ends of a simple closure. **3. High-Yield Clinical Pearls for INI-CET:** * **Prevention:** To avoid dog ears, the length of an elliptical incision should ideally be **3 times its width**, and the apical angle should be **less than 30 degrees**. * **Rule of Halves:** When suturing, always start at the center of the wound and bisect the remaining segments to distribute tension evenly and minimize the risk of dog ears. * **Mnemonic:** Dog ears are most common in **convex surfaces** (like the scalp or nose) where skin tension is non-uniform.

Q: A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:

Painless scar. ***Painless scar*** - Marjolin's ulcer, which develops on a chronic wound or scar, is typically associated with **pain**, tenderness, and rapid growth after latency. - A painless scar is characteristic of a **benign healed wound**, not a malignant transformation like Marjolin's ulcer. *Cured by surgery* - **Surgical excision** with wide margins is the primary and most effective treatment for Marjolin's ulcer. - This procedure aims to remove all cancerous tissue and achieve clear margins, leading to a potential cure. *Lymphatic metastasis* - Marjolin's ulcer, being a type of **squamous cell carcinoma**, has a significant propensity for **lymphatic spread**. - Regional lymph node involvement is common and impacts both staging and prognosis. *Represents malignant transformation* - The description of an **ulcer at a previous burn site** is the classic presentation of a Marjolin's ulcer. - This represents **malignant transformation** of chronic wounds, scars, or ulcers, most commonly squamous cell carcinoma.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - A **hand-held dermatome** with a long flat blade and an **adjustable calibrated roller/guard** that controls the thickness of the harvested graft. - Specifically designed for **freehand harvesting** of split-thickness skin grafts with precise depth control, making it the primary instrument for this procedure. *Mesher* - A **skin meshing device** used **after graft harvesting** to create perforations and expand the graft for better coverage. - Does not harvest skin grafts but rather processes already harvested grafts to create a mesh pattern. *Eschmann blade* - A type of **dermatome blade** used in powered dermatomes, not a standalone instrument for split skin grafting. - Requires a **motorized dermatome system** to function, unlike the hand-held Humby's knife. *Down's blade* - Another type of **dermatome blade** designed for use with specific dermatome systems. - Like the Eschmann blade, it is a **component blade** rather than a complete harvesting instrument like Humby's knife.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - The image clearly depicts a **Humby's knife**, which is a type of **manual dermatome** used to harvest split-thickness skin grafts. - This instrument is characterized by its adjustable blade and roller, allowing for collection of skin grafts of varying thicknesses. *Mesher* - A **mesher** is an instrument used to create fenestrations or small slits in a skin graft, allowing it to stretch and cover a larger wound area. - The instrument in the image is designed for harvesting, not for meshing. *Watson's knife* - **Watson's knife** is another type of manual dermatome used for harvesting split-thickness skin grafts. - While similar in purpose to Humby's knife, Watson's knife has distinct design features and the instrument shown in the image is specifically a Humby's knife. *Blair knife* - **Blair knife** is a different type of skin grafting knife, typically used for full-thickness skin graft harvesting. - The instrument in the image has the characteristic roller and adjustable blade design of a Humby's knife, not a Blair knife.

Q: A Wolfe graft is a

Large full thickness skin graft. ***Large full thickness skin graft*** - A **Wolfe graft** is a type of **large full-thickness skin graft** that includes the epidermis and entire dermis. - Due to its full thickness, it provides better cosmetic results and less contracture compared to split-thickness grafts, but requires optimal **vascularization** at the recipient site. - The term "Wolfe graft" specifically refers to the **large size** of the full-thickness graft, distinguishing it from smaller grafts. *Partial thickness skin graft* - A **partial-thickness skin graft** (also known as a split-thickness skin graft) includes the epidermis and only a portion of the dermis. - While easier to harvest and more likely to **take** in less ideal recipient beds, they are known for more contraction and a less cosmetic appearance. *Pinch skin graft* - A **pinch graft** is a small, conical piece of skin, including the epidermis and dermis, taken by pinching the skin. - These grafts are generally less aesthetically pleasing, have limited applications, and are often used for small, non-cosmetic defects. *Pedicle graft* - A **pedicle graft** (or flap) is a section of tissue that remains attached to its original site at one or more points, maintaining its own **blood supply**. - Unlike a free graft, it is not completely detached from the donor site, allowing for transfer of more complex tissues like muscle or bone.

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

Deltopectoral flap. ***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.

Q: The best cure rates for keloids are achieved by:

Intralesional excision followed by radiotherapy. ***Intralesional excision followed by radiotherapy*** - This combined approach offers the **highest cure rates** for keloids by removing the bulk of the lesion and then inhibiting fibroblast proliferation and collagen synthesis using radiation. - **Postoperative radiotherapy** significantly reduces the recurrence rate compared to excision alone, as keloids have a high tendency to recur. *Intralesional injection of triamcinolone* - While effective for some keloids, particularly smaller or flatter ones, **corticosteroid injections alone** have a lower long-term cure rate and are more often used for primary treatment or to reduce inflammation. - This method targets inflammation and fibroblast activity but may not fully prevent recurrence or completely flatten larger, more established keloids. *Surgical excision* - **Surgical excision alone** has a very high recurrence rate (up to 45-100%) for keloids because the removal of the keloid can itself trigger an exaggerated healing response. - It is rarely recommended as a monotherapy due to the significant risk of creating a larger or more aggressive keloid. *Localised irradiation* - **Radiotherapy alone** can be effective in some cases, particularly for preventing recurrence after excision, but it is generally not considered the primary treatment for an existing, bulky keloid. - Using radiation without prior excision might lead to incomplete regression and can be associated with side effects if the keloid is large.

Question 1

A patient was brought to the emergency department following a road traffic accident. Skin grafting was done wherein the graft was taken from the same person. Which type of graft is it?

Accepted Answer

Autograft

Answer

Isograft

Answer

Xenograft

Answer

Allograft

Question 2

Cleft lip primary muscle repair is required in which of the following muscles?

Accepted Answer

Orbicularis oris

Answer

Levator palpebrae superioris

Answer

Orbicularis oculi

Answer

Masseter

Question 3

Identify the procedure shown in the image.

Accepted Answer

Dog ear excision

Answer

Keloid excision

Answer

Z plasty

Answer

Transposition flap

Question 4

What is a true statement about Z plasty?

Accepted Answer

To increase length

Answer

It is a type of split-thickness skin graft

Answer

Zigzag suturing

Answer

Flap turning

Question 5

A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:

Accepted Answer

Painless scar

Answer

Cured by surgery

Answer

Lymphatic metastasis

Answer

Represents malignant transformation

Question 6

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Eschmann blade

Answer

Down's blade

Question 7

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Watson's knife

Answer

Blair knife

Question 8

A Wolfe graft is a

Accepted Answer

Large full thickness skin graft

Answer

Partial thickness skin graft

Answer

Pinch skin graft

Answer

Pedicle graft

Question 9

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

Accepted Answer

Deltopectoral flap

Answer

Silicone implants

Answer

Transversus abdominis muscle flap (TRAM flap)

Answer

Latissimus dorsi flap (LD flap)

Question 10

The best cure rates for keloids are achieved by:

Accepted Answer

Intralesional excision followed by radiotherapy

Answer

Intralesional injection of triamcinolone

Answer

Surgical excision

Answer

Localised irradiation

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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