Plastic and Reconstructive Surgery Practice Questions

Q: Theirsch graft is also known as?

Partial thickness graft. **Explanation:** Skin grafts are classified based on the thickness of the skin harvested. A **Thiersch graft** is another name for a **Thin Partial-Thickness Skin Graft (STSG)**. 1. **Why Option B is correct:** A Thiersch graft involves harvesting the entire epidermis and a very thin layer of the underlying dermis (usually the papillary dermis). Because it contains less dermal tissue, it has a higher "take" rate (easier revascularization) but is more prone to secondary contraction and provides less cosmetic/functional durability compared to thicker grafts. 2. **Why other options are incorrect:** * **Option A & C:** A **Full-thickness skin graft (FTSG)** is also known as a **Wolfe’s graft**. It includes the epidermis and the entire thickness of the dermis. These grafts have a lower "take" rate but offer superior cosmetic results and minimal secondary contraction. * **Option D:** "Plastic graft" is not a standard medical classification for skin grafting techniques. **High-Yield Clinical Pearls for NEET-PG:** * **Components:** STSG (Thiersch) = Epidermis + part of Dermis; FTSG (Wolfe) = Epidermis + entire Dermis. * **Donor Site Healing:** The donor site of a Thiersch graft heals spontaneously via **re-epithelialization** from skin appendages (hair follicles, sebaceous glands). The donor site of a Wolfe’s graft must be closed primarily or with another STSG. * **Contraction:** STSG has more **secondary contraction** (shrinking after healing), while FTSG has more **primary contraction** (immediate recoil upon harvesting due to elastin fibers). * **Instrument:** A **Humby’s knife** or a dermatome is typically used to harvest Thiersch grafts.

Q: At what age is a cleft lip typically repaired?

10 weeks. **Explanation:** The timing for cleft lip repair is traditionally guided by the **"Rule of Tens,"** established by Wilhelmmesen and Musgrave. This rule ensures the infant is physiologically mature enough to undergo general anesthesia and has sufficient tissue bulk for a meticulous surgical repair. **The Rule of Tens includes:** 1. **Age:** At least **10 weeks** (approx. 3 months). 2. **Weight:** At least **10 pounds** (approx. 4.5 kg). 3. **Hemoglobin:** At least **10 g/dL**. 4. **WBC Count:** Less than **10,000/mm³** (to ensure no active infection). **Analysis of Options:** * **A. 1 month:** Too early; the infant’s metabolic systems are immature, and the risk of anesthesia is higher. Tissue landmarks are also less defined. * **B. 6 months:** While surgery can be performed at this age, it is unnecessarily late. Repairing at 10 weeks allows for better parental bonding and earlier functional improvement. * **D. 1 year:** This is the typical age for **Cleft Palate** repair (usually 9–12 months), not cleft lip. Palate repair is delayed to allow for maxillary growth but performed before significant speech development begins. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type:** Left-sided unilateral cleft lip is the most common presentation. * **Surgical Technique:** The most widely used procedure for unilateral cleft lip is the **Millard Rotation-Advancement Flap**. * **Cleft Palate Timing:** Repaired at 9–12 months to prevent speech defects (velopharyngeal insufficiency). * **Sequence of Management:** Lip repair (3 months) → Palate repair (9–12 months) → Alveolar bone grafting (9–11 years, during mixed dentition).

Q: In cleft lip operations, when are all the stitches typically removed?

4th day. **Explanation:** The primary goal of suture removal in facial plastic surgery, particularly in pediatric cases like cleft lip repair, is to balance **wound tensile strength** against the risk of **permanent suture marks** (railroad scarring). **1. Why the 4th day is correct:** The facial skin has an excellent blood supply, which promotes rapid healing. In cleft lip surgery (e.g., Millard’s rotation-advancement flap), skin sutures are typically removed between the **3rd and 5th postoperative days** (average 4th day). Removing them early prevents the epithelialization of the suture tracts, which causes permanent scarring. By day 4, the wound has sufficient initial fibrin glue and early collagen deposition to remain apposed, provided the deeper muscle layers (Orbicularis oris) were repaired securely. **2. Analysis of Incorrect Options:** * **2nd day (Option A):** This is too early. The wound has not gained enough tensile strength to withstand the tension of facial expressions or crying, leading to a high risk of wound dehiscence. * **10th and 14th days (Options C & D):** These are standard timings for sutures on the trunk or limbs where healing is slower. On the face, leaving sutures for more than 7 days leads to "cross-hatching" or "railroad track" scars, which are aesthetically unacceptable in reconstructive surgery. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 10s:** Criteria for cleft lip surgery: 10 weeks of age, 10 lbs weight, and 10 g/dL Hemoglobin. * **Muscle Repair:** The most critical step in cleft lip repair is the reconstruction of the **Orbicularis oris** muscle to restore function and philtrum shape. * **Suture Material:** Usually, 6-0 or 7-0 non-absorbable monofilament (like Prolene) is used for the skin and removed early, or fast-absorbing gut is used to avoid the trauma of suture removal in infants.

Q: A full thickness graft can be obtained from all of the following sites, EXCEPT:

Knee. **Explanation:** The core principle of selecting a donor site for a **Full Thickness Skin Graft (FTSG)** is to choose areas with thin, mobile skin and minimal subcutaneous fat, which allows for better "take" (revascularization) and primary closure of the donor site. **Why "Knee" is the correct answer:** The skin over the knee is thick, subjected to constant mechanical stress, and lacks the necessary laxity for primary closure after harvesting a full-thickness piece. Furthermore, the knee is a common site for **Split Thickness Skin Grafts (STSG)**, where only the epidermis and a portion of the dermis are harvested using a dermatome. FTSGs are rarely, if ever, taken from weight-bearing or high-friction joint surfaces like the knee. **Analysis of incorrect options:** * **Eyelids:** This is the thinnest skin in the body. It is an ideal donor site for FTSG when repairing defects in the contralateral eyelid or delicate facial areas. * **Postauricular skin:** This is the **most common** donor site for FTSGs used in facial reconstruction because the color match is excellent, the skin is thin, and the scar is hidden in the sulcus. * **Supraclavicular skin:** This site provides a large surface area of thin skin with a good color match for head and neck defects. **High-Yield Clinical Pearls for NEET-PG:** * **FTSG (Wolfe’s Graft):** Includes epidermis and the *entire* dermis. It undergoes less secondary contraction than STSG, making it superior for cosmetic areas. * **Primary Closure:** Unlike STSG donor sites (which heal by epithelialization), FTSG donor sites **must** be closed primarily with sutures. * **Common Donor Sites:** Postauricular (best for face), Supraclavicular, Inguinal crease (for large grafts), and Prepuce. * **Take of Graft:** FTSGs are more demanding; they require a well-vascularized bed and are more prone to failure than STSGs.

Q: A Z-plasty is performed in which of the following conditions?

High frenal attachment. **Explanation:** **Z-plasty** is a versatile plastic surgery technique involving the transposition of two triangular flaps. Its primary functions are to **increase the length of a scar/tissue** in a specific direction and to change the direction of a scar to align with relaxed skin tension lines. **1. Why "High Frenal Attachment" is correct:** A high labial frenum attachment (where the frenum is attached near the crest of the alveolar ridge or interdental papilla) can cause a diastema, gingival recession, or interfere with denture stability. A **Frenectomy** or **Frenoplasty** is required to reposition it. Z-plasty is the preferred technique for frenoplasty because it effectively **increases the vertical length** of the frenum, thereby "lowering" the attachment point and relieving the tension that was pulling on the gingival margin. **2. Why the other options are incorrect:** * **Shallow/Deep Sulcus:** These conditions relate to the depth of the vestibule. Management usually involves **Vestibuloplasty** (e.g., Clark’s or Kazanjian’s technique) to increase the depth for denture retention, rather than a Z-plasty which is designed for linear lengthening and tension release. * **Low Frenal Attachment:** This is considered a normal anatomical position where the frenum is attached well away from the gingival margin. It does not require surgical intervention. **Clinical Pearls for NEET-PG:** * **The "60-degree" Rule:** The standard Z-plasty uses 60° angles, which results in a theoretical **75% increase in length**. * **Gain in Length:** Larger angles provide more length (e.g., 90° gives 120% gain), but the flaps become harder to transpose. * **Other Indications:** Z-plasty is high-yield for treating **linear burn contractures**, releasing webbed necks (Turner syndrome), and correcting "trap-door" deformities.

Q: Rhytidectomy is:

Removal of skin wrinkles. **Explanation:** **Rhytidectomy**, commonly known as a **facelift**, is a cosmetic surgical procedure designed to eliminate visible signs of aging in the face and neck. The term is derived from the Greek words *rhytis* (wrinkle) and *ektome* (excision). The procedure involves the removal of excess facial skin, often combined with the tightening of underlying tissues (such as the SMAS—Superficial Musculoaponeurotic System) to reduce sagging and smooth out deep wrinkles. **Analysis of Options:** * **Option A (Correct):** Rhytidectomy specifically targets the excision of redundant skin to treat **rhytids (wrinkles)**. * **Option B (Incorrect):** Correction of the nasal septum is termed **Septoplasty**. * **Option C (Incorrect):** Excision of a salivary gland is called a **Sialadenectomy** (e.g., Parotidectomy). * **Option D (Incorrect):** Cheek augmentation is known as **Malar augmentation**, often performed using implants or fat grafting. **High-Yield Clinical Pearls for NEET-PG:** * **SMAS Layer:** The most critical anatomical structure in modern rhytidectomy is the **SMAS (Superficial Musculoaponeurotic System)**. Tightening this layer provides a more natural and long-lasting result than skin tension alone. * **Nerve Injury:** The most common nerve injured during a facelift is the **Great Auricular Nerve** (sensory). The most serious motor nerve injury involves the **Marginal Mandibular branch** of the Facial Nerve. * **Hematoma:** The most common complication following rhytidectomy is a **postoperative hematoma**, which requires urgent evacuation to prevent skin flap necrosis. * **Blepharoplasty:** Often performed alongside rhytidectomy, this refers specifically to the surgical repair or reconstruction of the eyelids.

Question 1

Theirsch graft is also known as?

Accepted Answer

Partial thickness graft

Answer

Full thickness graft

Answer

Wolfe's graft

Answer

Plastic graft

Question 2

At what age is a cleft lip typically repaired?

Accepted Answer

10 weeks

Answer

1 month

Answer

6 months

Answer

1 year

Question 3

In cleft lip operations, when are all the stitches typically removed?

Accepted Answer

4th day

Answer

2nd day

Answer

10th day

Answer

14th day

Question 4

A full thickness graft can be obtained from all of the following sites, EXCEPT:

Accepted Answer

Knee

Answer

Eyelids

Answer

Postauricular skin

Answer

Supraclavicular skin

Question 5

Which of the following grafts is more resistant to infection and trauma?

Accepted Answer

Wolfe graft

Answer

Thiersch graft

Answer

Partial thickness graft

Answer

Both Partial thickness graft and Wolfe graft

Question 6

A Z-plasty is performed in which of the following conditions?

Accepted Answer

High frenal attachment

Answer

Shallow sulcus

Answer

Deep sulcus

Answer

Low frenal attachment

Question 7

Which of the following pathologies is etiologically different?

Accepted Answer

Cleft lip and palate

Answer

Isolated cleft palate

Answer

All are the same

Answer

None of the above

Question 8

Which of the following findings is seen on examining a child with a 3rd-degree cleft palate?

Accepted Answer

Presence of a united palatal process and a cleft on one side of the premaxilla

Answer

Presence of an ununited palatal process

Answer

Presence of a united palatal process with a cleft on both sides of the palatal process

Answer

Bilateral cleft lip and jaw

Question 9

In a complete cleft palate, the hard palate is totally separated from which structure?

Accepted Answer

Vomer

Answer

Maxilla

Answer

Soft palate

Answer

All of the above

Question 10

Rhytidectomy is:

Accepted Answer

Removal of skin wrinkles

Answer

Correction of nasal septum position

Answer

Salivary gland excision

Answer

Cheek augmentation

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?