Q) True about Beger procedure for chronic pancreatitis
a) Posterior branch of gastro duodenal artery is preserved.
b) Beger procedure is a pancreatic head mass resection that can be done for small pancreatic tumors.
c)Intra pancreatic, choledochal and ampullary structures are removed.
d) Neck of the pancreas is not transacted
Answer a) Posterior branch of GDA is preserved
Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.
The difference from similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted where as in Frey, neck of the pancreas is not cut.
This procedure is not recommended if there is suspicion of carcinoma head of pancreas and Whipple is the procedure for that.
Posterior branch of GDA is preserved in Beger Procedure.
Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.
Q) For a 3 X 4 cm defect on weight bearing heel, the ideal flap would be
a) Gracilis and skin
b) Radial forearm
c) Dorsalis Pedis
d) Medial Plantar Island flap
Sensate pedicled medial plantar island
This area of the heel is a sensitive area and would be under tremendous gravitational and shearing force. It will require a resilient flap in the form of choice d. This island flap is sensate, hairless and tough.
All other are muscle flaps which do not provide enough strength and are unstable. They also do not have a sensory supply.