Plastic and Reconstructive Surgery — MCQs

A Young Male complained of intermittent pain, swelling and discharge at the base of spine. He also had episodes of fever and repeated abscesses that had burst spontaneously. By occupation, he is a jeep driver. Physical examination showed pilonidal sinus. Which flap-based procedure is used for pilonidal sinus surgery?

Plastic and Reconstructive Surgery Indian Medical PG Practice Questions and MCQs

Question 191: An autograft of a burn victim is best described by which one of the following?

A. Transplant from one person to another person
B. Transplant from one person to a genetically identical person
C. Transplant from one species to another species
D. Transplant from one region of a person to another region (Correct Answer)

Explanation: ***Transplant from one region of a person to another region*** - An **autograft** involves transferring tissue from one site to another within the **same individual**. - This type of graft is immunologically optimal as it avoids **immune rejection**. *Transplant from one person to another person* - This describes an **allograft**, where tissue is transplanted between genetically distinct individuals of the **same species**. - **Allografts** carry a risk of rejection and require immunosuppression. *Transplant from one person to a genetically identical person* - This is an **isograft** (or syngraft), occurring between **monozygotic twins** or highly inbred animals. - While genetically identical, it is a specific type of **allograft** and not an autograft. *Transplant from one species to another species* - This describes a **xenograft**, where tissue is transferred between individuals of **different species**. - **Xenografts** face significant immune rejection and ethical considerations, making them less common in standard practice.

Question 192: Wound contraction can be most effectively minimized by:

A. Allowing secondary granulation
B. Full thickness grafting (Correct Answer)
C. Split skin graft
D. Dressing with placenta

Explanation: ***Full thickness grafting*** - **Full-thickness skin grafts** include the epidermis and full dermis, which contains **fewer myofibroblasts** than split-thickness grafts, thus minimizing contraction. - The greater amount of dermal tissue acts as a **mechanical barrier** to prevent excessive wound contraction, providing a more stable and aesthetically pleasing result. *Allowing secondary granulation* - Healing by **secondary intention** involves substantial granulation tissue formation, which is rich in **myofibroblasts** and leads to significant wound contraction. - This method of healing is often used for infected or contaminated wounds but results in the **most contraction**. *Split skin graft* - **Split-thickness skin grafts** contain only a portion of the dermis, making them prone to **moderate to significant wound contraction**. - While better than secondary intention, the thin dermal layer provides less resistance to the contractile forces of the **myofibroblasts**. *Dressing with placenta* - **Placental tissue dressings** can promote wound healing by providing growth factors and a scaffold for regeneration. - However, they do not inherently prevent or minimize **wound contraction** in the same way that a full-thickness graft mechanically does, as they do not replace the entire dermal layer.

Question 193: Best procedure for an injury to the leg with exposed bone and skin loss:

A. Full thickness grafting
B. Skin flap
C. Split skin grafting
D. Pedicle flap (Correct Answer)

Explanation: ***Pedicle flap*** - A pedicle flap provides **vascularized tissue** that can cover exposed bone, which requires a robust blood supply for healing and protection. - This method ensures good **tissue viability** and bulk, crucial for areas with high functional demands and potential for infection like the lower leg. *Full thickness grafting* - **Full-thickness skin grafts** are generally too thin to adequately cover exposed bone and do not provide sufficient vascularity or padding. - They rely entirely on the recipient bed for vascularization, which is poor over exposed bone, leading to a high risk of **graft failure**. *Skin flap* - While a generic "skin flap" implies a vascularized tissue transfer, it is less specific than a pedicle flap, which ensures continuous blood supply from the donor site until full integration. - The term "skin flap" alone doesn't specify if it's a local, regional, or free flap, and **pedicle flaps** are often the most direct and reliable solution for lower leg bone exposure. *Split skin grafting* - **Split-thickness skin grafts** are very thin and contain only a portion of the dermis, making them unsuitable for covering exposed bone or tendons. - They would likely **fail to take** due to lack of a vascular bed and offer no padding or protection against further injury.

Question 194: Skin grafts stored at 4°C can survive up to?

A. 1 week
B. 4 weeks
C. 2 weeks (Correct Answer)
D. 3 weeks

Explanation: ***2 weeks*** - Skin grafts stored at 4°C, a standard method for preserving graft viability, can typically survive and be successfully transplanted for **up to 2 weeks**. - This storage temperature helps to slow down cellular metabolic processes, preserving cell integrity and reducing degradation. *1 week* - While skin grafts can certainly survive for 1 week at 4°C, this option does not represent the **maximum storage duration** under optimal conditions. - Selecting 2 weeks indicates a more complete understanding of the potential longevity of stored grafts. *4 weeks* - Storing skin grafts for **4 weeks** at 4°C generally leads to a significant decrease in cell viability and graft success rates. - Prolonged storage beyond 2 weeks increases the risk of cellular damage, necrosis, and reduced integration into the recipient site. *3 weeks* - Although some cellular activity might persist at 3 weeks, the viability and successful integration of skin grafts begin to significantly decline around the **2-week mark**. - Survival rates for storage beyond 2 weeks are often considerably lower, making 3 weeks less reliably successful for optimal graft outcomes.

Question 195: Thiersch graft consists of

A. Only epidermis
B. Epidermis and variable portion of dermis (Correct Answer)
C. Epidermis and entire dermis
D. Dermis and subcutaneous tissue

Explanation: ***Epidermis and variable portion of dermis*** - A **Thiersch graft** is another name for a **split-thickness skin graft (STSG)**. - It includes the entire epidermis and only a portion of the dermis, allowing the donor site to heal spontaneously from adnexal structures like hair follicles and sweat glands. *Only epidermis* - This describes an **epidermal graft** which is much thinner and less commonly used for reconstructive purposes compared to split-thickness grafts. - Pure epidermal grafts have very limited structural integrity and are primarily used for cell delivery or very superficial wounds. *Epidermis and entire dermis* - This composition describes a **full-thickness skin graft (FTSG)**. - A full-thickness graft provides excellent cosmetic results and minimal contracture but requires primary closure of the donor site, which limits the size of the graft. *Dermis and subcutaneous tissue* - This combination is characteristic of a **dermo-fat graft** or a **composite graft** if other tissue types are included. - These are typically used for tissue augmentation or specific reconstructive needs, not for resurfacing large wounds.

Question 196: Kanavel's sign is diagnosed in

A. Acute paronychia
B. Flexor tendon sheath infection (Correct Answer)
C. Web space infection
D. Mid palmar infection

Explanation: ***Flexor tendon sheath infection*** - **Kanavel's signs** are a classic set of four criteria used to diagnose **flexor tenosynovitis**, which is an infection of the flexor tendon sheath. - The four signs are **uniform swelling** of the digit, **flexed posture** of the digit, **tenderness along the course of the flexor sheath**, and **pain on passive extension** of the digit. *Acute paronychia* - This is an **infection of the nail fold**, typically presenting with localized redness, swelling, and pain around the nail. - It does not involve the flexor tendon sheath and therefore does not exhibit Kanavel's signs. *Web space infection* - A web space infection, also known as a **collar button abscess**, occurs in the subcutaneous tissue of the interdigital space. - While painful, it presents with swelling between the digits and does not involve the flexor tendon sheath. *Mid palmar infection* - This refers to an infection in the **mid palmar space**, a deep fascial space in the palm of the hand. - It would present with diffuse palmar swelling and tenderness but would not typically involve the specific signs related to flexor tendon sheath inflammation.

Question 197: Kraissl's lines are:

A. Relaxed tension lines in skin (Correct Answer)
B. Collagen and elastin lines in stab wounds
C. Point of maximum tension in a fracture
D. Point of tension in hanging

Explanation: ***Relaxed tension lines in skin*** - **Kraissl's lines** represent the orientation of **relaxed skin tension lines (RSTL)**, which are natural lines of tension in the skin. - Making surgical incisions parallel to these lines results in **better cosmetic outcomes** and **less prominent scarring** due to reduced tension on the wound. *Collagen and elastin lines in stab wounds* - While collagen and elastin are fundamental components of skin, **Kraissl's lines** refer to the macroscopic tension patterns, not microscopic collagen/elastin orientation in the context of stab wounds. - The lines described by Kraissl are primarily used for **surgical planning** to minimize scar formation, rather than analyzing stab wound characteristics. *Point of maximum tension in a fracture* - This option incorrectly relates Kraissl's lines to fractures; they are concerned with **skin tension**, not bone mechanics. - The point of maximum tension in a fracture is related to **biomechanical stress** on bone, which is a different concept. *Point of tension in hanging* - This option is unrelated to Kraissl's lines, which describe the natural tension patterns in the skin. - The 'point of tension in hanging' refers to forces applied to the neck during strangulation, a concept entirely distinct from skin tension lines.

Question 198: The best skin graft for open wounds is -

A. Isograft (tissue from a genetically identical individual)
B. Allograft (tissue from a donor of the same species)
C. Autograft (tissue from the patient's own body) (Correct Answer)
D. Xenograft (tissue from a different species)

Explanation: ***Autograft (tissue from the patient's own body)*** - **Autografts are the gold standard** for permanent wound closure because they are derived from the patient's own body, eliminating the risk of immunologic rejection - They provide the **best cosmetic and functional results**, as the transplanted tissue is genetically identical to the recipient's unaffected skin - Permanent solution with optimal healing and integration *Isograft (tissue from a genetically identical individual)* - While an isograft (from an identical twin) would also avoid immune rejection due to genetic identity, it is rarely a practical option as most patients do not have an identical twin - Isografts are essentially a specialized form of autograft but with a donor other than the patient themselves - Not the "best" choice since it requires an identical twin donor *Allograft (tissue from a donor of the same species)* - Allografts (from another human donor) are used as **temporary biological dressing** for large burns or wounds when autograft sites are limited, but they are eventually rejected by the recipient's immune system - Helpful for providing temporary wound coverage, reducing fluid loss, and preventing infection, but they **do not provide permanent closure** - Used as a bridge until autograft is available *Xenograft (tissue from a different species)* - Xenografts (from a different species, e.g., pig skin) are used as **temporary biological dressing**, primarily for burn wounds, to close the wound and provide a barrier against infection and fluid loss - Always rejected by the immune system within a few weeks and cannot provide permanent coverage due to significant antigenic differences - Only a temporary measure for wound protection

Question 199: Reduction rhinoplasty is done for

A. Saddle nose
B. Crooked nose
C. Narrow nose
D. Hump nose (Correct Answer)

Explanation: ***Hump nose*** - **Reduction rhinoplasty** aims to decrease the size of specific nasal structures, making it the appropriate procedure for a **hump nose** where the dorsal hump needs to be reduced. - This involves removing excess bone and cartilage to achieve a smoother, straighter nasal profile. *Saddle nose* - **Saddle nose** is characterized by a depressed nasal dorsum and requires **augmentation rhinoplasty** to build up the bridge, often using grafts, rather than reduction. - The goal is to add tissue, not remove it, to correct the concavity. *Crooked nose* - A **crooked nose** involves deviation of the nasal pyramid and septum, requiring a septorhinoplasty or reconstructive techniques to straighten the nose, which is a complex reshaping process, not just reduction. - The focus is on realigning structures rather than simply making them smaller. *Narrow nose* - A **narrow nose** typically requires **augmentation or spreader grafts** to widen the nasal passages or define the dorsum, which would involve adding tissue, not removing it. - Reduction rhinoplasty would further narrow the nose, which is counterproductive for this condition.

Question 200: A Young Male complained of intermittent pain, swelling and discharge at the base of spine. He also had episodes of fever and repeated abscesses that had burst spontaneously. By occupation, he is a jeep driver. Physical examination showed pilonidal sinus. Which flap-based procedure is used for pilonidal sinus surgery?

A. Rhomboid flap (Correct Answer)
B. Free flap
C. Rotational flap
D. Circular flap

Explanation: ***Rhomboid flap*** - The **rhomboid flap** (**Limberg flap**) is a common and effective surgical technique for pilonidal sinus, offering good wound closure and reduced recurrence rates. - It involves excising the sinus tract *en bloc* and closing the defect with a **rhomboid-shaped skin flap**, which distributes tension evenly. - This is a **transposition flap** that moves tissue laterally into the defect while maintaining blood supply. *Free flap* - **Free flaps** involve transplanting tissue with its own blood supply from one part of the body to another using microsurgery. - This method is overly complex and unnecessary for a typical pilonidal sinus repair, which usually only requires local tissue rearrangement. *Rotational flap* - A **rotational flap** is a type of local flap where tissue is rotated on a pivot point to cover a defect. - While rotational flaps (such as the **Karydakis flap**) can be used for pilonidal sinus surgery, the **rhomboid flap** is more commonly referenced as the standard flap-based technique due to its reliable outcomes and specific geometric design. - The rhomboid flap is technically a **transposition flap**, not a rotational flap, though both are local tissue rearrangement techniques. *Circular flap* - **Circular flaps** are generally not a standard design for closing excisional defects, especially in areas like the sacrococcygeal region where linear tension and dead space management are crucial. - Such a flap would likely create dog-ears and poor cosmetic outcomes, making it unsuitable for pilonidal sinus surgery.

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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