Q 46) First stage of healing in a skin graft is
d. None of the above
Imbibtion is the 1st stage in 24-48 hrs. It involves fibrin formation between the graft and bed
After 48 hours - Inosculation by which time new capillary buds develop
3rd stage is revasularization
Q 47) Primary symptom in De Quervain’s tenosynovitis is pain in the:
a. Radial wrist
b. Ulnar wrist
c. Dorsal wrist
d. Volar wrist
Radial wrist pain
DE Quervain's disease is tenosynovitis of Abductor Pollicis Longus and Extensor pollicis bravis in the 1st dorsal wrist extensor compartment
It is characterized by radial wrist pain, tenderness, swelling and positive Finklestein test
Q 48) True about Trigonocephaly is all except:
a. Premature fusion of metopic suture
b. Triangle shape head
d. Developmental delay
Q 54) Regarding expander placement false statement is:
- Direction of movement of flap will be parallel to the incision placed for expander
- Incisions are typically made at the border of the defect needing coverage or lesion needing excision
- Flaps can be of any type such as advancement, rotation, or interpositional flaps
- The injectable port should not be in an area of pressure or sensitivity
- After final serial expansion, second staged reconstruction is delayed by
- <1 week
- 1-2 weels
- 2-3 weeks
- 3-4 weeks
- D- 369
- Once the tissue expander has been placed and wounds have healed for 3 weeks, serial expansion can begin. Once the goal is met, it is best to wait 3 to 4 weeks before the second-staged reconstruction. The second stage may be for permanent implant exchange or flap placement and to take advantage of the stress-relaxation effect from prolonged positioning after the final serial expansion.
- Tissue expansion for scalp can be used for defects upto
- C- 370
- Tissue expansion has been widely accepted and used by plastic surgeons in reconstruction of these medium to large scalp defects. One can use this technique to cover large defects involving up to 50% of the scalp without significant thinning of the hair-bearing areas. The robust vascular nature of the scalp along with incorporation of a dominant vessel in the flap design will ensure a durable flap of good hairbearing quality. Even though expansion brings upon a decrease in hair density, this is usually unnoticeable. The expander is typically placed in the subgaleal plane under hair-bearing area.
- Breast augmentation in transgender females is done after how many years (at least) of estrogen therapy?
- B- 376
- Male-to-female transgender patients desiring breast augmentation may need tissue expanders to expand their skin and soft tissues to fit the size of implant they desire. The Endocrine Society recommends transgender females to delay breast augmentation until at least 2 years of estrogen therapy, as the breasts continue to grow during that time period.
- False statement regarding tissue expanders in trunk:
- They are uncomfortable and can interfere with daily activities of living
- Tissue expansion of the trunk is associated with high rates of morbidity and mortality
- High rates of primary fascial closure
- Hernia recurrences rates appear to be low
- B- 377
- Subcutaneously placed expanders are used for defects with minimal fascial tension, whereas intermuscularly placed expanders can close large defects involving the fascia and abdominal musculature. Although they are uncomfortable and can interfere with daily activities of living, tissue expansion of the trunk is associated with low rates of morbidity and mortality and high rates of primary fascial closure and incisions, while hernia recurrences rates appear to be low.
- Complication rate from tissue expansion is:
- C- 379
- Several factors play a role in complications from tissue expansion. These factors depend on patient characteristics, technique, site of expansion, and the aggressiveness of expansion schedule and volume. One study showed complications necessitating some form of revision to the original treatment plan in as high as 39% of cases. However, enough tissue was generated from the expansion itself to complete the reconstructive plan without affecting final outcomes. Fortunately, most complications from tissue expansion are minor, consisting of things such as seroma formation, widened scar, discomfort from the expansion itself, bone resorption, neuropraxia, remnant excessive soft tissue, and other aesthetic concerns.
- For forehead defects, expansion can be used to reconstruct defects of
- C- 373
- Expansion with direct advancement of tissues can be used to reconstruct 25% to 70% of forehead defects. Anything less may just require serial excisions, and anything more may require going up the reconstructive ladder to an expanded full-thickness skin graft or even a free flap.