Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery Indian Medical PG Practice Questions and MCQs

Question 171: Which of the following statements about mesh skin grafts is not correct?

A. They allow egress of fluid collections under the graft.
B. They permit coverage of large areas.
C. They “take” satisfactorily on granulating bed.
D. They contract to the same degree as a grafted sheet of skin. (Correct Answer)

Explanation: ***They contract to the same degree as a grafted sheet of skin.*** - This statement is incorrect because **meshed skin grafts** undergo **greater primary and secondary contraction** compared to unmeshed, full-thickness sheet grafts. - The fenestrations in the meshed graft allow for stretching and expansion, but this also contributes to increased contraction as the graft heals and remodels. *They allow egress of fluid collections under the graft.* - The **fenestrations** created by the meshing process provide small openings that facilitate the **drainage of seroma or hematoma** from beneath the graft. - This feature is crucial for graft survival as fluid accumulation can lift the graft, impairing nutrient diffusion and leading to graft failure. *They permit coverage of large areas.* - Meshing a skin graft allows it to be **expanded to cover an area up to 1.5 to 9 times larger** than the original harvested skin. - This is particularly useful in managing **large burn wounds** or extensive skin defects where donor sites are limited. *They “take” satisfactorily on granulating bed.* - Meshed grafts tend to tolerate **less ideal recipient beds**, such as those with some granulation tissue or minor contamination, better than sheet grafts. - The fenestrations allow for drainage and better adherence, which can compensate for a suboptimal underlying bed.

Question 172: In Split thickness graft, which part of the skin is/are included?

A. Epidermis and dermis
B. Epidermis only
C. Epidermis and part of dermis (Correct Answer)
D. Epidermis, dermis and part of subcutaneous tissue

Explanation: ***Epidermis and part of dermis*** - A **split-thickness skin graft** includes the entire **epidermis** and only a **portion of the dermis**. - This allows for easier engraftment and donor site healing due to less deep tissue removal. *Epidermis and dermis* - This describes a **full-thickness skin graft**, which includes the entire epidermis and the entire dermis. - While it provides better cosmetic results and less contraction, it requires a more complex donor site closure. *Epidermis only* - A graft consisting only of the epidermis would be too thin to be clinically useful and would likely not survive. - The dermis provides structural support and a blood supply critical for graft viability. *Epidermis, dermis and part of subcutaneous tissue* - This typically refers to a **composite graft** or a **flap**, not a split-thickness skin graft. - These grafts include deeper tissues, such as subcutaneous fat, to provide bulk and specialized structures.

Question 173: Which of the following is NOT true about Dupuytren's Contracture?

A. Autosomal dominant
B. Associated with alcoholism, smoking and hypothyroidism
C. Occurs in elderly men
D. Not familial (Correct Answer)

Explanation: ***Not familial*** - This is the **CORRECT answer** because this statement is **FALSE** - Dupuytren's contracture **IS familial** and has a strong genetic predisposition. - The condition often runs in families, exhibiting an **autosomal dominant inheritance pattern**. - Its familial nature is a well-established risk factor, making "not familial" the incorrect statement about Dupuytren's contracture. *Autosomal dominant* - This statement is **TRUE** about Dupuytren's contracture, which is frequently inherited in an **autosomal dominant pattern**. - A single copy of an altered gene is sufficient to cause the condition. - This genetic link explains why it often runs in families and is more prevalent in certain populations (especially Northern Europeans). *Associated with alcoholism, smoking and hypothyroidism* - This statement is **TRUE**; Dupuytren's contracture has known associations with several risk factors including **alcoholism**, **smoking**, and **hypothyroidism**. - Other risk factors include diabetes mellitus and epilepsy. - These conditions are thought to influence cellular processes that contribute to the proliferation of fibroblasts and collagen deposition in the palmar fascia. *Occurs in elderly men* - This statement is **TRUE**; Dupuytren's contracture is more common in **males** and typically presents in **middle-aged to elderly individuals**. - While it can occur in women, it is more prevalent (male:female ratio ~7:1) and often more severe in men. - Peak incidence is in the 5th to 7th decades of life.

Question 174: A nasal surgery was carried out with the incision shown in the image. What was the procedure likely carried out?

A. Submucosal resection (SMR)
B. FESS (Functional Endoscopic Sinus Surgery)
C. Open rhinoplasty (Correct Answer)
D. Caldwell-Luc's procedure

Explanation: ***Open rhinoplasty*** - The image displays a **transcolumellar incision** (typically inverted V or W-shaped), which is the hallmark approach for **open rhinoplasty**. - This incision allows for direct visualization of the underlying nasal cartilages and bones, enabling precise reshaping of the nose. *Submucosal resection (SMR)* - SMR is a procedure to correct a **deviated nasal septum** by removing cartilage or bone from beneath the mucoperichondrial flaps. - It involves an **intranasal incision**, usually along the septal mucosa, not an external transcolumellar incision. *FESS (Functional Endoscopic Sinus Surgery)* - FESS is a minimally invasive procedure used to treat **chronic sinusitis** and other sinus conditions. - It is performed entirely **endoscopically through the nostrils**, with no external incisions on the nasal columella. *Caldwell-Luc's procedure* - This procedure accesses the **maxillary sinus** through an incision in the upper gum beneath the lip. - It is used for drainage of the maxillary sinus or removal of foreign bodies/tumors, and does not involve an external nasal incision.

Question 175: How does a skin graft receive nutrition on day 3 after transplantation?

A. Imbibition
B. Inosculation (Correct Answer)
C. Neovascularization
D. A & B

Explanation: ***Inosculation*** - **Inosculation** is the process where host capillaries directly connect with the graft's existing vessels (or newly formed ones) around day 2-3 post-transplantation. - This establishes blood flow and is the primary mechanism for **nutrient delivery** and waste removal by day 3. *Imbibition* - **Imbibition** is the initial phase (first 24-48 hours) where the graft passively absorbs nutrients from the recipient bed through diffusion. - While essential for initial survival, it is typically insufficient for sustained graft viability by day 3. *Neovascularization* - **Neovascularization** involves the formation of entirely new blood vessels into the graft, a process that typically begins after inosculation and continues for several days to weeks. - On day 3, while *initiation* of new vessel formation may be occurring, the main nutritional support is primarily from established connections through inosculation. *A & B* - While **imbibition** plays a role in the initial survival of the graft, by day 3, **inosculation** is the dominant and more effective mechanism for nutrient supply. - Therefore, selecting both A and B would be incorrect as imbibition's role diminishes significantly as inosculation progresses.

Question 176: What type of graft or dressing is used to cover the post-burn wound shown in the image?

A. Split thickness skin graft (Correct Answer)
B. Full thickness skin graft
C. VAC dressing
D. Normal saline dressing

Explanation: ***Split thickness skin graft*** - The image shows a **meshed pattern** on the skin graft, which is characteristic of a **split-thickness skin graft** that has been expanded to cover a larger area. - This type of graft consists of the epidermis and a portion of the dermis, making it more flexible and able to **"take" more reliably** on various wound beds, commonly used for burn wounds. *Full thickness skin graft* - A **full-thickness skin graft** includes the entire epidermis and dermis and typically does not have a meshed appearance. - They are used for smaller defects where cosmesis is a priority, but have a **lower take rate** than split-thickness grafts, making them less suitable for large burn wounds. *VAC dressing* - A **VAC (Vacuum-Assisted Closure) dressing** is a system that applies negative pressure to a wound to promote healing and is not a skin graft itself. - It involves a foam or gauze dressing sealed with an adhesive film, connected to a vacuum pump, which is not what is depicted in the image. *Normal saline dressing* - A **normal saline dressing** is a simple wet-to-dry or wet-to-wet dressing for wound care, involving gauze soaked in normal saline. - This is a basic wound management technique and does not involve grafting or have the characteristic meshed appearance seen in the image.

Question 177: During reconstruction of an amputated limb which of the following is done first?

A. Arterial repair
B. Venous repair
C. Fixation of the bone (Correct Answer)
D. Nerve anastomoses

Explanation: ***Fixation of the bone*** - **Bone stabilization** is the crucial first step to create a rigid framework, allowing for subsequent precise vascular and nerve repairs. - This prevents movement and tension on delicate repairs, which could lead to failure of the reconnected vessels and nerves. *Arterial repair* - While critical for blood supply, arterial repair is performed *after* bone fixation to ensure the vessels are not disrupted by later bone manipulation. - It's typically done before venous repair to establish arterial flow and identify any potential venous back pressure that needs addressing. *Venous repair* - Venous repair is usually performed after arterial repair, as establishing arterial inflow can help distend the veins, making them easier to identify and repair. - Repairing veins first without establishing arterial flow immediately is less effective and may lead to congestion once arterial flow is restored. *Nerve anastomoses* - Nerve repair is typically the last major step in an amputation reconstruction, following bone stabilization and full vascular repair. - Nerves are fragile and require a stable, well-perfused environment to optimize the chances of successful regeneration.

Question 178: When osseous defects amenable to reconstruction are present, technique of choice is?

A. Sulcular flap
B. Modified Widman flap
C. Apically displaced flap
D. Papilla preservation flap (Correct Answer)

Explanation: ***Papilla preservation flap*** - This technique is specifically designed to **preserve the interdental papilla**, which is critical for covering and protecting regenerative materials placed in osseous defects. - By maintaining the integrity of the papilla, it facilitates primary wound closure over the defect, enhancing the predictability of **guided tissue regeneration (GTR)** and bone grafting procedures. *Sulcular flap* - A sulcular flap involves an incision within the sulcus, which typically provides limited access and does not allow for adequate coverage of large **osseous defects**. - It does not offer the tissue volume needed for the stable primary closure essential for regenerative procedures. *Modified Widman flap* - While providing excellent access for debridement in periodontal pockets, the modified Widman flap's incisions often **transect the interdental papilla**, making primary closure over a regenerative defect less ideal. - Its primary goal is root debridement and pocket reduction, not necessarily **papilla preservation** for regenerative purposes. *Apically displaced flap* - An apically displaced flap is designed to **increase the zone of attached gingiva** or reduce pocket depths, by positioning the flap apically to its original position. - This flap design is not suitable for covering osseous defects amenable to reconstruction because it often exposes more root surface and does not provide the necessary coronal coverage for regenerative materials.

Question 179: Which of the following nerves has the best prognosis for repair after injury ?

A. Radial (Correct Answer)
B. Median
C. Ulnar
D. Lateral popliteal

Explanation: ***Correct: Radial*** - The **radial nerve has the best prognosis** for repair among peripheral nerves after injury - It is predominantly a **motor nerve** with a relatively simple sensory distribution (posterior arm, forearm, and dorsal hand) - **Motor recovery is more predictable** compared to complex mixed nerves - Its **anatomical course** and branching pattern allow for better surgical access and repair outcomes - Literature consistently shows **better functional recovery rates** following radial nerve repair *Incorrect: Median* - The **median nerve** is a **complex mixed nerve** with extensive sensory and motor components - Injury results in loss of **thenar muscle function** and critical sensory loss in palmar digits - While recovery can be good, it is **not superior to radial nerve** due to the complexity of reinnervation required - Recovery of fine motor control and discriminative sensation is often incomplete *Incorrect: Lateral popliteal (Common peroneal)* - The **common peroneal nerve** has one of the **poorest prognoses** among peripheral nerves - Its **superficial location** around the fibular head makes it highly vulnerable to injury - **Long regeneration distances** from injury site to target muscles (foot dorsiflexors and evertors) - Frequently results in **persistent foot drop** even after repair *Incorrect: Ulnar* - The **ulnar nerve** has a **less favorable prognosis**, especially with proximal injuries at the elbow - Supplies **intrinsic hand muscles** requiring precise reinnervation for functional recovery - Injuries often result in **persistent claw hand deformity** and loss of fine motor coordination - **Delayed muscle atrophy** and long distances for regeneration contribute to poor outcomes

Question 180: In below-elbow amputation the length of stump should be

A. 15 - 20 cm (Correct Answer)
B. 5 - 10 cm
C. 20 - 25 cm
D. 10-15 cm

Explanation: ***15 - 20 cm*** - For a **below-elbow amputation** to be functional, the **stump length** should be approximately **15 to 20 cm** from the olecranon to allow for optimal prosthetic fitting and control. - This length provides sufficient leverage and preserves enough forearm musculature for effective **prosthetic operation**. *5 - 10 cm* - A stump length of **5-10 cm** from the olecranon would be considered too short for a below-elbow amputation, making it difficult to achieve **adequate prosthetic suspension** and control of the artificial limb. - Such a short stump might be classified as a **very short below-elbow amputation**, which often requires specialized prosthetic designs and can limit functionality. *20 - 25 cm* - A stump length of **20-25 cm** from the olecranon would be considered too long for a below-elbow amputation, encroaching on the wrist and hand area. - An excessively long stump can make it challenging to fit a standard **transradial prosthesis** comfortably and effectively, and might even be classified as a **wrist disarticulation** if extending too far distally. *10 -15 cm* - While **10-15 cm** from the olecranon can sometimes be functional, it is often considered on the shorter end of the ideal range for a below-elbow amputation, potentially limiting the effectiveness of certain **prosthetic designs** and control mechanisms. - A stump in this range might work, but the **15-20 cm range** generally offers superior functional outcomes and easier prosthetic fitting.

Practice by Chapter

Wound Healing

Practice Questions

Skin Grafts

Practice Questions

Flap Surgery Principles

Practice Questions

Local Flaps

Practice Questions

Regional Flaps

Practice Questions

Microsurgical Techniques

Practice Questions

Tissue Expansion

Practice Questions

Breast Reconstruction

Practice Questions

Hand Surgery Basics

Practice Questions

Craniofacial Surgery Principles

Practice Questions

Aesthetic Surgery Concepts

Practice Questions

Body Contouring

Practice Questions

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