Plastic and Reconstructive Surgery Practice Questions

Q: Which of the following cannot accept a split-thickness skin graft?

Skull bone. **Explanation:** The success of a skin graft depends on **"take,"** a process where the graft survives via diffusion (plasmatic imbibition) and subsequent revascularization (inosculation) from the underlying recipient bed. For a graft to survive, the recipient bed must be **vascularized.** **Why Skull Bone is the Correct Answer:** Cortical bone, such as the outer table of the **skull bone** (when denuded of its periosteum), is a **relatively avascular surface.** It lacks a sufficient capillary network to provide the necessary nutrients for the graft to survive. To graft over bone, one must either ensure the **periosteum** is intact or drill holes into the outer cortex to allow granulation tissue to grow from the diploe. **Analysis of Incorrect Options:** * **Fat (Subcutaneous tissue):** While less vascular than muscle, healthy adipose tissue has enough capillary supply to support a split-thickness skin graft (STSG). * **Muscle:** This is a highly vascular bed and is considered one of the best surfaces for graft uptake. * **Deep Fascia:** Fascia is a vascularized connective tissue layer that provides an excellent bed for STSGs, often used in reconstructive procedures following debridement. **High-Yield Clinical Pearls for NEET-PG:** * **Avascular beds** that cannot accept a graft include: Bare bone (without periosteum), bare tendon (without paratenon), bare cartilage (without perichondrium), and infected/necrotic tissue. * **Stages of Graft Take:** 1. **Plasmatic Imbibition (0–48 hours):** Graft "drinks" nutrients via diffusion. 2. **Inosculation (48–72 hours):** Alignment of donor and recipient capillaries. 3. **Revascularization (Day 3–5):** Actual blood flow established. * **STSG vs. FTSG:** Split-thickness grafts have a higher "take" rate on less-than-ideal beds compared to Full-thickness grafts (FTSG) because they have lower metabolic demands.

Q: A full-thickness skin graft is also known as:

Wolfe graft. **Explanation:** A **Full-Thickness Skin Graft (FTSG)**, also known as a **Wolfe graft**, consists of the entire epidermis and the complete thickness of the dermis. Unlike split-thickness grafts, FTSGs include adnexal structures like hair follicles and sweat glands. They are preferred for aesthetically sensitive areas (like the face or eyelids) because they undergo less secondary contraction, provide better color match, and offer superior durability. **Analysis of Options:** * **A. Wolfe graft (Correct):** Named after John Reissberg Wolfe, it refers to the transplantation of the full depth of the skin. * **B. Thiersch graft:** This refers to a **Split-Thickness Skin Graft (STSG)**. It involves the epidermis and only a portion of the dermis. It is easier to "take" but prone to significant secondary contraction. * **C. Thieme graft:** This is a distractor. While "Thieme" is a well-known medical publisher, it is not a recognized eponym for a specific skin graft type. * **D. Fernandez graft:** This is not a standard term in skin grafting nomenclature. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Contraction:** FTSGs (Wolfe) have **high primary contraction** (immediate recoil due to elastin in the dermis) but **low secondary contraction** (shrinkage during healing). * **Vascularization:** FTSGs require a highly vascular recipient bed because they are thicker and take longer to revascularize via *inosculation* and *capillary ingrowth*. * **Donor Site:** The donor site of a Wolfe graft must be closed primarily (sutured) because no dermal elements remain to allow for spontaneous epithelialization. Common sites include post-auricular and supraclavicular areas.

Q: Which of the following is NOT a feature of a meshed skin graft?

Better cosmetic appearance. **Explanation:** A **meshed skin graft** is a split-thickness skin graft (STSG) that has been passed through a mesher to create multiple small incisions (fenestrations). This allows the graft to be expanded to cover a larger surface area. **Why "Better cosmetic appearance" is the correct answer (NOT a feature):** Meshed grafts result in a characteristic **"fish-net" or "checkerboard" appearance** once healed. Because the gaps between the skin bridges heal by secondary intention (epithelialization), the texture and color match are inferior compared to sheet grafts. Therefore, they are generally avoided on aesthetically sensitive areas like the face or hands. **Analysis of Incorrect Options:** * **A. Fenestrations allow for egress of wound fluid:** This is a primary advantage. The holes prevent the accumulation of blood (hematoma) or serum (seroma) under the graft, which are the most common causes of graft failure. * **C. Good contour matching:** Because the mesh is flexible and "stretchy," it conforms better to irregular, concave, or convex wound beds compared to a stiff sheet graft. * **D. Large surface area can be covered:** Meshing allows expansion ratios (e.g., 1.5:1, 3:1, or even 6:1), making it ideal for massive burns where donor skin is limited. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Burns:** Meshed STSG is the preferred method for extensive burn injuries. * **Graft Take:** The most critical factor for graft survival is **vascularization** (plasmatic imbibition → inosculation → capillary ingrowth). * **Sheet Grafts:** These provide the best cosmetic results and are used for the face, neck, and hands but carry a higher risk of seroma formation. * **Storage:** Skin grafts can be stored in saline-soaked gauze at **4°C** for up to 2 weeks.

Q: A full-thickness skin graft is indicated in which of the following situations?

Fascial regions for cosmetic effect. ### Explanation **1. Why Option C is Correct:** A **Full-Thickness Skin Graft (FTSG)**, also known as a Wolfe graft, includes the entire epidermis and the complete thickness of the dermis. Because it contains a higher density of dermal collagen and elastic fibers, it undergoes **minimal secondary contraction** (shrinkage after healing). This makes it the gold standard for reconstructive surgery in aesthetically and functionally sensitive areas, such as the **face (facial regions)**, eyelids, and hands. It provides a better color match, texture, and contour compared to split-thickness grafts. **2. Why the Other Options are Incorrect:** * **Options A & B (Deep/Large Area Burns):** These require **Split-Thickness Skin Grafts (STSG)**. STSGs are preferred for large surfaces because the donor site heals spontaneously (re-epithelialization from skin appendages), allowing for "re-harvesting." FTSG donor sites must be closed primarily, limiting the amount of tissue available. * **Option D (Over the Back):** The skin on the back is exceptionally thick. Using an FTSG here is impractical due to the large surface area and the fact that cosmetic requirements are lower. STSGs are typically used for large trunk defects. **3. High-Yield Clinical Pearls for NEET-PG:** * **Primary Contraction:** Immediate recoil after harvesting (Greater in **FTSG** due to more elastin). * **Secondary Contraction:** Shrinkage during healing (Greater in **STSG**; minimal in **FTSG**). * **Graft Take:** FTSGs are more "demanding" and have a higher failure rate than STSGs because they require more robust vascularization (revascularization takes longer). * **Ideal Donor Sites for FTSG:** Post-auricular (best color match for face), supraclavicular, and groin crease.

Q: Which of the following is the ideal time for the repair of cleft palate?

9-12 months. **Explanation:** The primary goal of cleft palate repair (Palatoplasty) is to facilitate **normal speech development**. The timing is a delicate balance between allowing for maxillary growth and intervening before the child begins to develop complex speech patterns. **1. Why 9-12 months is correct:** Speech development typically begins around 12 months of age. Repairing the palate between **9 and 12 months** ensures a functional velopharyngeal mechanism is in place before the child starts articulating sounds. This prevents compensatory speech habits (like glottal stops) that are difficult to correct later. Modern surgical techniques and anesthesia safety have shifted the standard toward this earlier window. **2. Why the other options are incorrect:** * **18-24 months (Option D):** While previously common, this is now considered late. Delaying surgery beyond 18 months significantly increases the risk of permanent speech defects and hypernasality. * **2-3 years & 5-6 years (Options B & C):** These are far too late for primary repair. At these ages, the child has already established speech patterns, and surgery would likely require extensive secondary speech therapy. However, 5-6 years is often the age for secondary procedures like alveolar bone grafting. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 10s:** Used for **Cleft Lip** repair (10 weeks old, 10 lbs weight, 10 g/dL Hemoglobin). * **Cleft Lip Repair Timing:** Usually 3–6 months. * **Cleft Palate Repair Timing:** Usually 9–12 months (latest by 18 months). * **Most Common Type:** Isolated cleft palate is more common in females; cleft lip (with or without palate) is more common in males. * **Feeding:** Use specialized bottles (e.g., Haberman feeder); breastfeeding is often difficult due to the inability to create negative pressure.

Q: What type of transplant involves organs transferred between genetically identical individuals?

Isograft. ### Explanation The classification of transplants (grafts) is based on the genetic relationship between the donor and the recipient. **Correct Answer: A. Isograft (Syngeneic graft)** An **isograft** refers to the transfer of tissue or organs between individuals who are **genetically identical**. In humans, this occurs exclusively between **monozygotic (identical) twins**. Because the Major Histocompatibility Complex (MHC) molecules are identical, there is no immune recognition of "non-self" antigens, and the graft is accepted without the need for long-term immunosuppression. **Incorrect Options:** * **B. Allograft (Homograft):** This is the most common clinical transplant type. It involves transfer between genetically different members of the **same species** (e.g., human to human). These require immunosuppression to prevent rejection. * **C. Autograft:** This involves moving tissue from **one site to another on the same individual** (e.g., Split-thickness skin graft from the thigh to the arm). There is no risk of rejection. * **D. Xenograft (Heterograft):** This involves transfer between members of **different species** (e.g., porcine heart valve to a human). These carry the highest risk of hyperacute rejection. **High-Yield Clinical Pearls for NEET-PG:** * **Order of Immunogenicity:** Xenograft > Allograft > Isograft = Autograft. * **First Successful Human Kidney Transplant (1954):** Performed by Joseph Murray between identical twins (Isograft), which bypassed the then-unsolved problem of immune rejection. * **Orthotopic vs. Heterotopic:** An *orthotopic* graft is placed in its normal anatomical position (e.g., Liver), while a *heterotopic* graft is placed in a different site (e.g., Kidney transplant in the iliac fossa).

Q: Potts puffy tumor occurs as a complication of which sinusitis?

Frontal. **Explanation:** **Pott’s Puffy Tumor** is a rare but serious clinical entity characterized by **subperiosteal abscess** of the frontal bone associated with **osteomyelitis**. **Why Frontal Sinus is the Correct Answer:** The condition occurs as a direct complication of **acute or chronic frontal sinusitis**. The infection spreads from the frontal sinus to the frontal bone through two primary mechanisms: 1. **Venous Spread:** Through the thrombophlebitis of the diploic veins (Breschet’s veins) that drain the sinus mucosa. 2. **Direct Extension:** Through the thin posterior or anterior table of the frontal sinus. This leads to a localized, fluctuant, "puffy" swelling on the forehead, which is the hallmark of the disease. **Why Other Options are Incorrect:** * **Sphenoid Sinus:** Infections here typically lead to cavernous sinus thrombosis or orbital apex syndrome due to its deep anatomical location, rather than a forehead swelling. * **Ethmoid Sinus:** Complications usually involve the orbit (e.g., orbital cellulitis or subperiosteal abscess of the lamina papyracea) rather than the frontal bone. **High-Yield Clinical Pearls for NEET-PG:** * **Eponym:** Named after Sir Percivall Pott (1760). * **Clinical Presentation:** Forehead swelling, headache, fever, and rhinorrhea. * **Imaging of Choice:** **Contrast-enhanced CT** (to see bone destruction) and **MRI** (to rule out intracranial complications like epidural abscess or meningitis). * **Management:** Requires emergency IV antibiotics and surgical drainage (often via Frontal Sinotomy or FESS). * **Most Common Organism:** *Streptococcus* species, *Staphylococcus*, and anaerobes.

Question 1

Which of the following cannot accept a split-thickness skin graft?

Accepted Answer

Skull bone

Answer

Fat

Answer

Muscle

Answer

Deep fascia

Question 2

A full-thickness skin graft is also known as:

Accepted Answer

Wolfe graft

Answer

Thiersch graft

Answer

Thieme graft

Answer

Fernandez graft

Question 3

Which of the following is NOT a feature of a meshed skin graft?

Accepted Answer

Better cosmetic appearance

Answer

Fenestrations allow for egress of wound fluid

Answer

Good contour matching of the wound bed by the graft

Answer

Large surface area can be covered

Question 4

A full-thickness skin graft is indicated in which of the following situations?

Accepted Answer

Fascial regions for cosmetic effect

Answer

Deep burns

Answer

Burns over large areas

Answer

Over the back

Question 5

During breast reconstruction surgery, which of the following structures is preserved?

Accepted Answer

Pectoralis major

Answer

Pectoralis minor

Answer

Serratus anterior

Answer

Nipple areola complex

Question 6

Which of the following is the ideal time for the repair of cleft palate?

Accepted Answer

9-12 months

Answer

2-3 years

Answer

5-6 years

Answer

18-24 months

Question 7

Which of the following is NOT true regarding split-thickness skin grafts?

Accepted Answer

They are cosmetically superior.

Answer

They do not sweat.

Answer

They do not adhere to exposed bone.

Answer

They are hairless.

Question 8

Split skin grafts in young children should be harvested from which anatomical location?

Accepted Answer

Thigh

Answer

Buttocks

Answer

Trunk

Answer

Upper limb

Question 9

What type of transplant involves organs transferred between genetically identical individuals?

Accepted Answer

Isograft

Answer

Allograft

Answer

Autograft

Answer

Xenograft

Question 10

Potts puffy tumor occurs as a complication of which sinusitis?

Accepted Answer

Frontal

Answer

Sphenoid

Answer

Ethmoid

Answer

None of the above

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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