Plastic and Reconstructive Surgery Practice Questions

Q: Abbe-Estlander flap is used for:

Reconstruction of the lip. ***Reconstruction of the lip*** - The **Abbe-Estlander flap** is a **cross-lip flap** used specifically for reconstructing defects of the **upper or lower lip**. - It involves transferring tissue from the opposite lip to reconstruct the defect, maintaining **oral competence** and aesthetic balance. *Reconstruction of the tongue* - Tongue reconstruction typically involves **free tissue transfer**, such as **radial forearm flaps** or **anterolateral thigh flaps**, due to the need for bulk and mobility. - The Abbe-Estlander flap is primarily designed for the **mucocutaneous structure** of the lip and is unsuitable for the complex muscular architecture of the tongue. *Reconstruction of the eyelid* - Eyelid reconstruction often utilizes **Tenzel flaps**, **Mustardé flaps**, or **Hughes flaps**, which are designed to recreate the delicate structure and function of the eyelid. - The Abbe-Estlander flap's design is specific to the lip and would not provide the necessary tissue characteristics or mobility for eyelid reconstruction. *Reconstruction of the ears* - Ear reconstruction commonly employs **costal cartilage grafts** covered with local flaps (e.g., **temporoparietal fascia flap**) to create the intricate cartilaginous framework and skin coverage. - The Abbe-Estlander flap is not suitable for ear reconstruction due to its donor site and tissue composition.

Q: Longitudinal incision with Z-plasty closure is used in which of the following?

Hand surgery. ***Hand surgery*** - **Z-plasty** is frequently employed in hand surgery to **lengthen constricted scars** or to **reorient tension lines**, especially across joints or creases. - This technique helps to improve **range of motion** and prevent contractures that can severely impair hand function following injury or surgery. *Breast reconstruction surgery* - While various flap techniques are used in breast reconstruction, the primary incision or closure does not typically involve a **longitudinal incision with Z-plasty**. - Procedures often focus on re-shaping and volume replacement using **tissue flaps** or implants, or linear scar realignment for aesthetic purposes. *Thyroid surgery* - Thyroidectomy typically involves a **transverse incision** in the neck (a **Kocher collar incision**) to minimize visible scarring and follow natural skin folds. - **Z-plasty** is not a standard technique for closing the primary incision in thyroid surgery. *Hernia repair surgery* - Hernia repair usually involves a **linear or curvilinear incision** in the groin or abdominal wall, followed by direct closure or mesh placement. - The goal is strong tissue repair, and **Z-plasty** is not used as a closure method for the primary incision in hernia repair.

Q: Which of the following statements about Dupuytren's contracture is false?

Autosomal recessive inheritance. ***Autosomal recessive inheritance*** - This statement is false because Dupuytren's contracture is typically associated with an **autosomal dominant inheritance pattern**, not autosomal recessive. - While genetics play a role, the dominant inheritance means only one copy of the mutated gene is needed for the condition to manifest. *Alcoholic cirrhosis may predispose* - **Alcoholic cirrhosis** is a recognized risk factor for Dupuytren's contracture, particularly in severe cases. - Chronic alcohol use and liver disease can lead to changes in connective tissue, increasing susceptibility to fibrosis. *More common in male than female* - Dupuytren's contracture is indeed **more prevalent in males** than in females, with a higher incidence and often more severe presentation. - The male-to-female ratio can vary, but the male predominance is well-documented in epidemiological studies. *The ring finger is most commonly affected* - The **ring finger (fourth digit)** is the most frequently affected digit, followed by the little finger (fifth digit). - The contracture often involves the **metacarpophalangeal (MCP)** and **proximal interphalangeal (PIP)** joints of these fingers.

Q: Which one of the following is not a wound closure technique?

Vascular graft. ***Vascular graft*** - A **vascular graft** is a tube-like structure used to bypass or replace a diseased or damaged blood vessel. - Its primary purpose is to **restore blood flow**, not to close a wound on the body surface or replace missing tissue. *Partial thickness skin graft* - A **partial thickness skin graft** involves transplanting the epidermis and a portion of the dermis to cover a wound. - This is a common and effective technique for **wound closure**, particularly for large surface area wounds or burns. *Composite graft* - A **composite graft** is a graft consisting of multiple tissue types, such as skin, cartilage, and fat, often used for reconstruction. - This is a direct method of **wound closure** and tissue replacement, particularly in areas requiring structural support and soft tissue coverage. *Musculocutaneous flap* - A **musculocutaneous flap** involves the transfer of skin, subcutaneous tissue, and an underlying muscle to cover a wound. - This is a versatile **wound closure technique** that provides robust soft tissue coverage and blood supply to complex defects.

Q: What is the eponymous term for a full-thickness skin graft?

Wolfe's graft. ***Wolfe's graft*** - A **Wolfe's graft** is the eponymous term for a **full-thickness skin graft**, which includes the epidermis and entire dermis. - This type of graft provides superior cosmetic results and contracts less than split-thickness grafts, making it ideal for facial reconstruction. *Thiersch graft* - A **Thiersch graft** refers to a **split-thickness skin graft**, which only includes the epidermis and a portion of the dermis. - These grafts are easier to harvest and take better in less vascularized beds but are prone to greater contraction and can have a less aesthetic outcome. *Fernandez graft* - **Fernandez graft** is not a recognized eponymous term for a type of skin graft in common medical literature. - This term does not correspond to a standard full-thickness or split-thickness skin grafting technique. *Reverdin graft* - A **Reverdin graft** refers to very small, partial-thickness pieces of skin, essentially tiny bits of epithelium transplanted to promote epithelialization. - This is a **split-thickness** technique, not a full-thickness graft, and is used primarily for small granulating wounds.

Q: Pedicle TRAM flap derives its blood supply from?

Superior epigastric vessels. ***Superior epigastric vessels*** - The **pedicle TRAM (Transverse Rectus Abdominis Myocutaneous) flap** preserves the connection of the rectus abdominis muscle and its overlying skin and fat to its original blood supply. - For a pedicle TRAM flap, this primary blood supply comes from the **superior epigastric artery and vein**, which are branches of the internal mammary (internal thoracic) vessels. *Inferior epigastric vessels* - The **inferior epigastric vessels** are the primary blood supply for a **free TRAM flap**, where the flap is completely detached and then reconnected microscopically to recipient vessels in the chest. - While they contribute to the blood supply of the rectus abdominis muscle, they are not the primary pedicle for a **pedicle TRAM flap** to the breast. *Circumflex* - **Circumflex vessels** (e.g., deep inferior epigastric perforator branches, superficial circumflex iliac vessels) are typically associated with other types of flaps, such as DIEP flaps or groin flaps. - They do not represent the primary pedicle of a TRAM flap. *Internal pudendal vessels* - The **internal pudendal vessels** supply structures in the perineum and external genitalia. - They are not involved in the vascular supply of breast reconstruction flaps like the TRAM flap.

Q: The Abbe-Estlander flap is primarily based on which artery?

Labial artery. ***Labial artery*** - The **Abbe-Estlander flap** is a **lip switch flap** used in lip reconstruction, and it relies primarily on the **labial artery** for its vascular supply. - This **axial pattern flap** ensures robust blood flow, which is crucial for the flap's viability when transferring tissue from one lip to the other. *Lingual artery* - The **lingual artery** primarily supplies the **tongue** and floor of the mouth, not the lips directly. - While it originates from the **external carotid artery** like the labial artery, its branching pattern does not typically contribute to the primary blood supply of lip flaps. *Facial artery* - The **facial artery** is the main artery of the face, giving rise to the **superior and inferior labial arteries** that directly supply the lips. - Although the labial arteries are branches of the facial artery, explicitly stating the "labial artery" is more precise for the direct blood supply of this specific flap. *Internal maxillary artery* - The **internal maxillary artery** (part of the larger maxillary artery) supplies deep structures of the face, nasal cavity, and palate. - It does not directly supply the lips or contribute to the primary vascular basis of the **Abbe-Estlander flap**.

Q: Repair of cleft lip should be undertaken at:

10 weeks. ***10 weeks*** - The "rule of 10s" is a widely accepted guideline for cleft lip repair, recommending surgery when the infant is at least **10 weeks old**. - This guideline also states that the infant should weigh at least **10 pounds** and have a **hemoglobin of 10 g/dL** to ensure adequate physiological maturity and reduced surgical risk. *4 weeks* - Repair at 4 weeks is generally considered **too early** as the infant's physiological systems are still immature, increasing surgical risks. - Complications such as anesthetic risks and poor tissue healing are higher in very young infants. *6 weeks* - While closer to the recommended timing, 6 weeks still generally falls short of the **"rule of 10s" guidelines** for optimal surgical safety. - Operating significantly before 10 weeks may not allow sufficient **growth and development** to mitigate surgical risks. *8 weeks* - At 8 weeks, the infant is typically still below the recommended age criterion of **10 weeks** for cleft lip repair according to the "rule of 10s." - Delaying until 10 weeks allows for further **weight gain**, cardiopulmonary maturation, and a more robust immune system, reducing operative risks.

Question 1

Abbe-Estlander flap is used for:

Accepted Answer

Reconstruction of the lip

Answer

Reconstruction of the tongue

Answer

Reconstruction of the eyelid

Answer

Reconstruction of the ears

Question 2

Longitudinal incision with Z-plasty closure is used in which of the following?

Accepted Answer

Hand surgery

Answer

Thyroid surgery

Answer

Breast reconstruction surgery

Answer

Hernia repair surgery

Question 3

Which of the following statements about Dupuytren's contracture is false?

Accepted Answer

Autosomal recessive inheritance

Answer

More common in male than female

Answer

Alcoholic cirrhosis may predispose

Answer

The ring finger is most commonly affected

Question 4

Which one of the following is not a wound closure technique?

Accepted Answer

Vascular graft

Answer

Composite graft

Answer

Partial thickness skin graft

Answer

Musculocutaneous flap

Question 5

What is the eponymous term for a full-thickness skin graft?

Accepted Answer

Wolfe's graft

Answer

Thiersch graft

Answer

Fernandez graft

Answer

Reverdin graft

Question 6

Pedicle TRAM flap derives its blood supply from?

Accepted Answer

Superior epigastric vessels

Answer

Circumflex

Answer

Inferior epigastric vessels

Answer

Internal pudendal vessels

Question 7

Genioplasty procedure is used for:

Accepted Answer

To modify the position of the chin

Answer

To change the attachment of genioglossus muscle in pre-prosthetic procedure

Answer

To change the position of genial tubercles

Answer

To modify the attachment of anterior belly of digastric

Question 8

The Abbe-Estlander flap is primarily based on which artery?

Accepted Answer

Labial artery

Answer

Lingual artery

Answer

Facial artery

Answer

Internal maxillary artery

Question 9

Repair of cleft lip should be undertaken at:

Accepted Answer

10 weeks

Answer

4 weeks

Answer

6 weeks

Answer

8 weeks

Question 10

Which statement is true regarding secondary contraction of skin grafts?

Accepted Answer

Thinner grafts are associated with more secondary contracture.

Answer

Thicker grafts are associated with more primary contracture.

Answer

Thinner grafts are associated with more primary contracture.

Answer

Thicker grafts are associated with both primary and secondary contracture.

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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