Facial Plastic and Reconstructive Surgery

Facial Plastic and Reconstructive Surgery Indian Medical PG Question 1: Which of the following statements about mesh skin grafts is not correct?

• A. They allow egress of fluid collections under the graft.
• B. They permit coverage of large areas.
• C. They “take” satisfactorily on granulating bed.
• D. They contract to the same degree as a grafted sheet of skin. (Correct Answer)

Facial Plastic and Reconstructive Surgery Explanation: ***They contract to the same degree as a grafted sheet of skin.*** - This statement is incorrect because **meshed skin grafts** undergo **greater primary and secondary contraction** compared to unmeshed, full-thickness sheet grafts. - The fenestrations in the meshed graft allow for stretching and expansion, but this also contributes to increased contraction as the graft heals and remodels. *They allow egress of fluid collections under the graft.* - The **fenestrations** created by the meshing process provide small openings that facilitate the **drainage of seroma or hematoma** from beneath the graft. - This feature is crucial for graft survival as fluid accumulation can lift the graft, impairing nutrient diffusion and leading to graft failure. *They permit coverage of large areas.* - Meshing a skin graft allows it to be **expanded to cover an area up to 1.5 to 9 times larger** than the original harvested skin. - This is particularly useful in managing **large burn wounds** or extensive skin defects where donor sites are limited. *They “take” satisfactorily on granulating bed.* - Meshed grafts tend to tolerate **less ideal recipient beds**, such as those with some granulation tissue or minor contamination, better than sheet grafts. - The fenestrations allow for drainage and better adherence, which can compensate for a suboptimal underlying bed.

Facial Plastic and Reconstructive Surgery Indian Medical PG Question 2: Abbe-Estlander flap is used for:

• A. Reconstruction of the tongue
• B. Reconstruction of the eyelid
• C. Reconstruction of the ears
• D. Reconstruction of the lip (Correct Answer)

Facial Plastic and Reconstructive Surgery Explanation: ***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.

Facial Plastic and Reconstructive Surgery Indian Medical PG Question 3: When osseous defects amenable to reconstruction are present, technique of choice is?

• A. Sulcular flap
• B. Modified Widman flap
• C. Apically displaced flap
• D. Papilla preservation flap (Correct Answer)

Facial Plastic and Reconstructive Surgery Explanation: ***Papilla preservation flap*** - This technique is specifically designed to **preserve the interdental papilla**, which is critical for covering and protecting regenerative materials placed in osseous defects. - By maintaining the integrity of the papilla, it facilitates primary wound closure over the defect, enhancing the predictability of **guided tissue regeneration (GTR)** and bone grafting procedures. *Sulcular flap* - A sulcular flap involves an incision within the sulcus, which typically provides limited access and does not allow for adequate coverage of large **osseous defects**. - It does not offer the tissue volume needed for the stable primary closure essential for regenerative procedures. *Modified Widman flap* - While providing excellent access for debridement in periodontal pockets, the modified Widman flap's incisions often **transect the interdental papilla**, making primary closure over a regenerative defect less ideal. - Its primary goal is root debridement and pocket reduction, not necessarily **papilla preservation** for regenerative purposes. *Apically displaced flap* - An apically displaced flap is designed to **increase the zone of attached gingiva** or reduce pocket depths, by positioning the flap apically to its original position. - This flap design is not suitable for covering osseous defects amenable to reconstruction because it often exposes more root surface and does not provide the necessary coronal coverage for regenerative materials.

Facial Plastic and Reconstructive Surgery Indian Medical PG Question 4: For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?

• A. Mohs surgery (Correct Answer)
• B. Superficial laser surgery
• C. Curettage and electrodesiccation
• D. Wide local excision

Facial Plastic and Reconstructive Surgery Explanation: ***Mohs surgery*** - **Mohs micrographic surgery** is the most popular and highly effective procedure specifically designed for **basal cell carcinoma (BCC)**, especially on the face and other cosmetically sensitive areas. - It involves the **progressive removal** of thin layers of skin, which are immediately examined under a microscope, allowing for complete tumor removal while preserving maximum healthy tissue. - Mohs surgery has the **highest cure rate** (95-99%) for BCC and is particularly preferred for high-risk locations, recurrent tumors, and poorly defined borders. *Superficial laser surgery* - While lasers can sometimes be used for very superficial skin lesions, **superficial laser surgery** is generally not the primary treatment for established **BCC** due to the risk of incomplete removal and recurrence. - It lacks the **histological margin control** provided by Mohs surgery, which is crucial for ensuring complete eradication of BCC. *Curettage and electrodesiccation* - **Curettage and electrodesiccation** is an alternative surgical treatment for small, low-risk BCCs in non-critical areas. - However, it has **lower cure rates** (85-95%) compared to Mohs surgery and does not provide histological margin assessment. - It is less preferred for facial BCCs where cosmetic outcome and complete removal are critical. *Wide local excision* - **Wide local excision** is a standard surgical approach that removes the tumor with predetermined margins (typically 4-5 mm for BCC). - While effective, it requires **larger tissue removal** compared to Mohs surgery and lacks the real-time microscopic margin control. - Mohs surgery remains more popular due to its tissue-sparing nature and higher cure rates, especially in cosmetically sensitive areas.

Facial Plastic and Reconstructive Surgery Indian Medical PG Question 5: Which of the following bone defects offers the best chance for bone fill?

• A. 3 Walled defect (Correct Answer)
• B. Hemisepta
• C. Osseous crater
• D. 2 Walled defect

Facial Plastic and Reconstructive Surgery Explanation: ***3 Walled defect*** - A **3-walled defect** provides the best prognosis for bone fill because it retains the most natural bone structure, enhancing the ability to contain bone graft material effectively. - The presence of three bony walls offers **excellent support and blood supply** for graft survival and successful bone regeneration. *Hemisepta* - A **hemisepta** refers to a one-walled defect, which offers very limited containment for graft materials. - It has a **poor prognosis** for bone fill due to insufficient support and rapid loss of grafting material. *Osseous crater* - An **osseous crater** is a two-walled defect where the buccal and lingual walls are present, but the interproximal walls are missing. - While better than a one-walled defect, it still presents challenges in graft containment and has a **less predictable outcome** compared to a 3-walled defect. *2 Walled defect* - A **2-walled defect** offers less containment and support for bone graft materials compared to a 3-walled defect. - The reduced number of walls means there is a **higher chance of graft material displacement** and a slower healing process.

Facial Plastic and Reconstructive Surgery Flashcard 1 of 4

Question: In a _____ nose, there is depressed nasal dorsum.

Answer: saddle

Facial Plastic and Reconstructive Surgery Flashcard 2 of 4

Question: House Brackmann score is used for grading _____

Answer: facial nerve palsy

Facial Plastic and Reconstructive Surgery Flashcard 3 of 4

Question: If immediate reconstruction is not possible for an avulsed pinna, then delayed repair can be done by preserving the _____ but not the skin

Answer: cartilage

Facial Plastic and Reconstructive Surgery Flashcard 4 of 4

Question: Surgeries for congenital malformations of the pinna (auricle) are usually performed around the ages of _____ years.

Answer: 5 or 6