Plastic and Reconstructive Surgery Practice Questions

Q: Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?

Latissimus dorsi. ***Latissimus dorsi*** - The **latissimus dorsi** muscle is commonly used in **autologous breast reconstruction** due to its rich blood supply and ample tissue volume which can be transferred as a **pedicled flap** to the chest. - This flap includes muscle, skin, and subcutaneous fat, providing a good aesthetic outcome for **breast mound reconstruction** after mastectomy. *Deltopectoral* - The **deltopectoral flap** is primarily used for **head and neck reconstruction**, specifically for oral cavity and pharyngeal defects. - It involves muscle and skin from the **chest and shoulder region**, but its size and location make it less suitable for comprehensive breast reconstruction. *Serratus anterior* - The **serratus anterior** muscle is occasionally used as a **free flap** for small soft tissue defects, but it is not typically the first choice for large-volume breast reconstruction. - Its primary role is in **shoulder movement** and it does not provide sufficient tissue bulk for a complete breast mound. *Trapezius* - The **trapezius flap** is more commonly employed in **head and neck reconstruction** or for covering defects in the posterior shoulder region. - While it offers a good blood supply, its bulk and orientation are not ideal for **breast reconstruction**, which requires a more anterior and hemispheric shape.

Q: What is the most common complication associated with carpal tunnel release surgery?

Finger stiffness. ***Finger stiffness*** - Among the options listed, **finger stiffness** is the most recognized complication of carpal tunnel release surgery. - **Post-operative pain, swelling, and scar tissue formation** can lead to reduced range of motion in the digits. - Patients may develop stiffness due to **immobilization**, **scar adhesions**, or apprehension in mobilizing the hand after surgery. - **Note:** In clinical practice, **pillar pain** (pain at the thenar and hypothenar eminences) is actually the most common complication (10-30% of cases), but it is not among the options provided. *Malunion* - **Malunion** refers to improper healing of a fractured bone. - Carpal tunnel release involves dividing the **transverse carpal ligament** (flexor retinaculum), which is a **soft tissue procedure**. - No bone is cut or fractured, so malunion is not relevant to this surgery. *Avascular necrosis* - **Avascular necrosis (AVN)** is bone death due to interrupted blood supply. - AVN affects bones with precarious blood supply (femoral head, scaphoid, lunate in Kienböck's disease). - Carpal tunnel release does not involve bone manipulation and **AVN is not a recognized complication** of this procedure. *Rupture of EPL tendon* - **Extensor Pollicis Longus (EPL) tendon rupture** is classically associated with **distal radius fractures** or inflammatory arthritis. - EPL runs through the **third dorsal compartment** and is anatomically distant from the carpal tunnel (volar wrist). - While median nerve injury is a rare but serious complication of carpal tunnel release, **EPL rupture is not associated** with this surgery.

Q: How much length is increased in Z-plasty when it is done at 60 degrees?

75%. ***75%*** - A **60-degree Z-plasty** lengthens the central limb by approximately **75%** of its original length. This configuration provides a balance between length gain and flap viability. - The greater the angle of the Z-plasty limbs, the greater the theoretical lengthening, but also the larger the flaps and the increased risk of complications. *25%* - A **30-degree Z-plasty** typically provides about **25% lengthening** of the central limb. This angle offers less lengthening but is useful for smaller scars or when skin mobility is limited. - While it provides some lengthening, it falls significantly short of the length achieved with a 60-degree Z-plasty. *50%* - A **45-degree Z-plasty** generally results in approximately **50% lengthening**. This is an intermediate option, providing moderate lengthening. - This option does not match the significant lengthening associated with the larger 60-degree angle. *100%* - To achieve approximately **100% length gain**, larger angles such as **75 or 90-degree Z-plasty** might be considered. However, these angles are less commonly used due to increased flap size and tension at the base. - A standard 60-degree Z-plasty does not provide a 100% increase in length.

Q: Unilateral cleft lip is repaired at what age?

3-6 months. ***3-6 months*** - Unilateral cleft lip repair is typically performed between **3 and 6 months of age**, following the rule of **10s** (10 pounds weight, 10 weeks old, 10 g/dL hemoglobin). - This timing allows for adequate **growth of facial structures** while still completing the repair before the child develops significant speech patterns. *1-3 months* - While some surgeons might consider earlier repair, this window is generally considered a bit **too early** given the child's small size and potential for respiratory compromise during anesthesia. - The **rule of 10s** is often not fully met by 1-3 months, which can increase surgical risks. *6-9 months* - This period is generally considered **too late** for initial cleft lip repair, as waiting longer can lead to more pronounced **psychosocial impact** and may interfere with early speech development. - Early muscle activity in an uncorrected cleft can also lead to more significant **nasal deformity**. *9-12 months* - Performing cleft lip repair this late is **not recommended** as it can negatively impact feeding, speech, and potential **social interaction** and bonding. - The optimal window for **cleft palate repair** is typically between 9 and 12 months, not cleft lip.

Q: At what age, in years, is rhinoplasty usually done once the nose is fully grown?

16 years. ***16 years*** - Rhinoplasty is typically performed once the **nose is fully grown**, which generally occurs in the mid to late teen years, around **15-16 years old for girls** and slightly later for boys. - Performing the surgery earlier risks altering nasal structures that are still developing, potentially leading to undesired aesthetic and functional outcomes as the nose continues to grow. *6 years* - At this age, the nose is still in its **early developmental stages** and is far from being fully grown. - Performing rhinoplasty at this age would likely disrupt normal nasal growth and lead to **severe deformities** as the child matures. *12 years* - While closer to maturity than 6 years, the nose is still undergoing significant development, especially in **boys**. - Surgical intervention at this age could still interfere with the **natural growth trajectory** of the nose, leading to suboptimal results. *25 years* - By this age, the nose has been fully grown for several years, and while rhinoplasty can certainly be done, it is not the typical age limit for when the nose is "fully grown." - This age is well past the point where growth concerns dictate the timing of the surgery; rather, patient desire and cosmetic concerns would be the primary drivers.

Q: What is true about keloids?

It appears weeks to months after surgery.. ***It appears weeks to months after surgery.*** - Keloids typically develop **weeks to months** after the initial injury or surgery, reflecting their nature as a **delayed abnormal healing response**. - Their delayed appearance is due to the **overgrowth of collagen** during the prolonged healing process. - This distinguishes them from normal wound healing and even hypertrophic scars. *It appears immediately after surgery.* - Keloids are a form of **abnormal wound healing** that occurs long after the initial injury, not immediately. - The immediate post-surgical period involves normal wound closure and initial inflammatory responses, not keloid formation. *It is limited in its distribution.* - Keloids are characterized by their tendency to **grow beyond the original wound margins**, unlike hypertrophic scars which remain confined to the wound site. - They can occur in various locations on the body, especially common in areas like the **chest, shoulders, earlobes, and upper back**. *It is common in older people.* - Keloids are more prevalent in **younger individuals**, typically between **10 and 30 years of age**. - The incidence decreases with age, and they are **rarely seen in very young children** or the elderly.

Q: Which of the following is NOT a characteristic of a youthful feminine smile?

Open incisor embrasure. ***Open incisor embrasure*** - An **open incisor embrasure** is typically associated with an aging smile or dental wear, where the interdental papilla may recede, or teeth become more rectangular. - A youthful feminine smile is characterized by well-defined, closed embrasures, contributing to a sense of **fullness and vitality**. *Softened facial line angles* - A **softened facial line angle** is a characteristic of a youthful feminine smile, contributing to a more rounded and gentle appearance. - This feature helps create harmony between the facial contours and the smile. *Golden proportion is followed* - The **golden proportion** is a mathematical ratio often associated with aesthetic beauty and is commonly observed in youthful and aesthetically pleasing smiles. - It relates to the visual harmony of individual tooth dimensions and their relationship within the overall smile. *Rounding of incisal line angles* - **Rounding of incisal line angles** contributes to a soft, feminine, and youthful appearance of the teeth. - This contrasts with sharp, angular incisal edges, which can appear more masculine or aged.

Q: What is the primary mechanism responsible for skin graft survival within the first 48 hours after transplantation?

Plasma imbibition. ***Correct: Plasma imbibition*** - **Plasma imbibition** is the initial process where the transplanted graft absorbs nutrients and oxygen from the recipient bed through diffusion. - This fluid uptake is crucial for the survival of the graft cells before revascularization occurs, typically within the first **24-48 hours**. - The graft acts like a sponge, absorbing serum and plasma from the vascular bed through capillary action and osmosis. *Incorrect: Amount of saline in graft* - While sterile saline is often used to keep donor tissue moist during harvesting and transport, its presence in the graft itself is not the primary mechanism for survival post-transplantation. - Excessive saline could even lead to **edema** and compromise graft take if not properly drained or if it prevents good contact with the recipient bed. *Incorrect: New vessels growing from the donor tissue* - Grafts themselves do not spontaneously grow new vessels; new blood vessels are formed by **angiogenesis** from the recipient bed into the graft over several days. - This process, called **inosculation** and subsequent neovascularization, provides long-term blood supply but is not the primary mechanism of survival within the *first 48 hours*. *Incorrect: Connection between donor and recipient capillaries* - The direct connection of donor and recipient capillaries (inosculation) is a later stage of graft vascularization, typically beginning after **3-5 days**, not within the first 48 hours. - Within the initial 48 hours, the graft relies on diffusion because a complete vascular connection has not yet been established.

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.

Question 1

Which muscle flap is commonly used for autologous breast reconstruction after mastectomy?

Accepted Answer

Latissimus dorsi

Answer

Deltopectoral

Answer

Serratus anterior

Answer

Trapezius

Question 2

What is the most common complication associated with carpal tunnel release surgery?

Accepted Answer

Finger stiffness

Answer

Malunion

Answer

Avascular necrosis

Answer

Rupture of EPL tendon

Question 3

How much length is increased in Z-plasty when it is done at 60 degrees?

Accepted Answer

75%

Answer

50%

Answer

25%

Answer

100%

Question 4

Unilateral cleft lip is repaired at what age?

Accepted Answer

3-6 months

Answer

1-3 months

Answer

6-9 months

Answer

9-12 months

Question 5

At what age, in years, is rhinoplasty usually done once the nose is fully grown?

Accepted Answer

16 years

Answer

6 years

Answer

12 years

Answer

25 years

Question 6

What is true about keloids?

Accepted Answer

It appears weeks to months after surgery.

Answer

It appears immediately after surgery.

Answer

It is limited in its distribution.

Answer

It is common in older people.

Question 7

Which of the following is NOT a characteristic of a youthful feminine smile?

Accepted Answer

Open incisor embrasure

Answer

Softened facial line angles

Answer

Golden proportion is followed

Answer

Rounding of incisal line angles

Question 8

What is the primary mechanism responsible for skin graft survival within the first 48 hours after transplantation?

Accepted Answer

Plasma imbibition

Answer

Amount of saline in graft

Answer

New vessels growing from the donor tissue

Answer

Connection between donor and recipient capillaries

Question 9

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 10

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

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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