Plastic and Reconstructive Surgery Practice Questions

Q: An adolescent boy presents with bilateral prominence of breasts and requests removal of the breasts. Which one of the following incisions would be ideal?

Incision along the areolar margin. ***Incision along the areolar margin*** - An incision along the **areolar margin** (specifically, a periareolar incision) is ideal because it allows for the removal of glandular tissue with a **minimally visible scar**, blending well with the natural color changes and texture of the areola. - This approach offers good exposure to the underlying tissue while maintaining the **cosmetic integrity** of the chest, which is particularly important for an adolescent boy with **gynecomastia**. *Radial incision* - A **radial incision** would extend outwards from the areola, creating a more conspicuous and less aesthetically pleasing scar that would be harder to conceal. - This type of incision is generally not favored for gynecomastia surgery due to its **poor cosmetic outcome**. *Submammary incision* - A **submammary incision** is typically placed in the inframammary fold, which is often less defined in males, especially adolescents. - This incision may result in a more noticeable scar on the lower chest and may not provide optimal access for the removal of all glandular tissue in the upper breast area. *Vertical incision* - A **vertical incision** extends vertically through the chest and would result in a highly visible and cosmetically unfavorable scar on the anterior chest wall. - This approach is not typically used for gynecomastia as it offers no advantage in tissue access while significantly compromising **aesthetic outcomes**.

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: For tendon transfer, the most common tendon used is

Palmaris longus tendon. ***Palmaris longus tendon*** - The **palmaris longus tendon** is the **most commonly used donor tendon** for tendon transfers due to multiple advantages: - **Dispensability**: Absent in 10-15% of the population without causing functional deficit, making it expendable - **Ideal dimensions**: Adequate length (12-15 cm) and appropriate diameter for various reconstructive procedures - **Easy access**: Superficial location with straightforward surgical harvest - **Minimal donor site morbidity**: Its removal causes virtually no functional impairment - Commonly used for tendon grafts in hand surgery, wrist reconstruction, and even ligament repairs (e.g., UCL reconstruction in elbow) *Achilles tendon* - The **Achilles tendon** is a large, critical tendon for ankle plantarflexion and is **not used as a donor** for tendon transfers due to its essential function - It is the strongest tendon in the body and its harvest would cause severe functional disability - May be involved in major reconstructive procedures of the ankle and foot, but not as a donor graft *Flexor carpi ulnaris tendon* - The **flexor carpi ulnaris tendon** is sometimes used for specific wrist transfers (e.g., in cerebral palsy or radial nerve palsy), but it is **not the most common donor tendon** overall - It plays an important role in wrist flexion and ulnar deviation, making its harvest potentially more impactful than the palmaris longus - More commonly used as a recipient rather than donor in transfer procedures *Tibialis posterior tendon* - The **tibialis posterior tendon** is commonly used as a **transfer** (not harvest) for specific conditions like foot drop or posterior tibial tendon dysfunction - It is an important stabilizer of the medial longitudinal arch and inversion of the foot - For general tendon grafting across various anatomical sites, it is not as frequently used as the palmaris longus

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: 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.

Q: Which of the following is an example of a composite material?

A filled resin. ***A filled resin*** - A **filled resin** consists of a resin matrix (polymer) reinforced with inorganic filler particles, combining the properties of both materials. - This combination creates a material with enhanced strength, wear resistance, and reduced polymerization shrinkage, characteristic of a **composite material**. *Colloidal silica* - **Colloidal silica** is a suspension of fine, amorphous silicon dioxide particles in a liquid, primarily used as an abrasive or polishing agent. - While it can be a component of a composite (as a filler), it is not a composite material in itself; it is a **single-phase** material or a dispersion. *Gold alloy* - A **gold alloy** is a metallic material formed by mixing gold with one or more other metallic elements, such as copper, silver, or palladium. - It is an example of an **alloy**, which is a mixture of metals, not a composite material that combines distinct materials at a macroscopic level. *Wax* - **Wax** is a single organic material characterized by its plasticity, low melting point, and hydrophobic nature. - It does not consist of two or more distinct constituent materials with significantly different physical or chemical properties, making it a **simple material**, not a composite.

Question 1

An adolescent boy presents with bilateral prominence of breasts and requests removal of the breasts. Which one of the following incisions would be ideal?

Accepted Answer

Incision along the areolar margin

Answer

Radial incision

Answer

Submammary incision

Answer

Vertical incision

Question 2

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 3

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 4

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 5

For tendon transfer, the most common tendon used is

Accepted Answer

Palmaris longus tendon

Answer

Achilles tendon

Answer

Flexor carpi ulnaris tendon

Answer

Tibialis posterior tendon

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

Repair of cleft lip should be undertaken at:

Accepted Answer

10 weeks

Answer

4 weeks

Answer

6 weeks

Answer

8 weeks

Question 9

Which of the following is an example of a composite material?

Accepted Answer

A filled resin

Answer

Colloidal silica

Answer

Gold alloy

Answer

Wax

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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