Plastic Surgery 46-60

Ans c Its Hypotelorism

Ref Bailey Table 43.6

Trigonocephaly  is a type of craniosyntosis. Craniosynostosis is the premature fusion of one (simple craniosynostosis) or more (complex craniosynostosis) cranial sutures, preventing growth perpendicular to the suture. 

In Trigonocephaly, Metopic suture is involved and clinically there is triangle shaped head.

Syndromic craniosynostosis, often associated with abnormalities of the fibroblast growth factor receptor genes, is accompanied by developmental delay and other abnormalities.

Patients often have hypotelorism, strabismus, and upslanting palpebral fissures (this is sometimes referred to as the trigonocephalic "sequence").

Ref G& S page 226

Q 49 which of the following are muscles of Second extensor compartment?

1. APL & EPB
2. ECRL & ECRB
3. EPL
4. EIP

Answer 49 B. (REF Grabb and smith 8th edition. Fig 77.1)

Extensor compartment -

I - APL & EPB

II - ECRL ECRB

III - EPL

IV - EDC & EIP

V - EDM

VI - ECU

Q 50  - A patient presented with laceration to the thumb just proximal to the IP joint dorsal. Patient is unable to extend the IP joint. On local exploration, the tendon seems to have retracted. The surgeon should look for the tendon in which extensor compartment?

a) I

b) II

c) III

d) IV

answer -50  C (ref grabb and smith 8th edition, Fig 77.1)

The clinical picture is suggestive of injury to the EPL tendon. If retracted, an incision is given in the wrist corresponding to the Third extensor compartment to locate the tendon.

Q 51Skin expansion was first described by

1. Codvilla
2. Neumann
3. Radovan
4. Austad and Rose

Ans 51 B-  page 365

• The foundation for tissue expansion technique actually has its derivation from distraction osteogenesis. At the turn of the 20th century, Codvilla applied the principles of external distraction directly to bones. One of the earliest descriptions of skin expansion came several years later in 1957 when Neumann became the pioneering surgeon to first use gradual distention of a rubber balloon through an externally exposed tube with a stopcock to expand local skin and subcutaneous tissue to reconstruct a partial ear defect. More than two decades later, Radovan reinvigorated the concept of expansion through the use of an internally placed port. Further work by Austad and Rose elucidated much of the physiology behind tissue expansion through the use of an osmotically driven, self-inflating expander in a guinea pig model.

Q 52)  All are changes in skin and soft tissue after expansion, except?

• Epidermis – increased mitotic activity
• Dermis – dermal thinning
• Muscle – Increased size and number of mitochondria
• Fat – temporary decrease in fat cells and thickness

ans 52 D- 366 (table 11.1)

• Epidermis - Increased mitotic activity. No significant decrease in thickness
• Dermis- Dermal thinning. Collagen synthesis markedly increased. Increase fibroblasts and myofibroblasts. Realignment of collagen fibers. Decreased hair follicle density
• Muscle - Increased thinning. Function unchanged. Myofibril and myofilament disorganized arrangement. Increased size and number of mitochondria

Fat Permanent decrease in fat cells and thickness. Fat necrosis and fibrosis may occur with aggressive expansion

Q 53 Which of the following is false regarding tissue expanders?

a) Distal ports have the advantage of minimizing risk of iatrogenic rupture by accidental puncture.

b)  Integrated ports have the advantage of not having the need to make a separate dissection for the port.

c) Tubing between expander and port gets obstructed in case of integrated ports.

d) The Food and Drug Administration had cleared for the use of carbon dioxide–filled, remote-controlled tissue expanders

Ans 53 C- 368

The port can also be distal to the expander itself or integrated within the apparatus itself.

Distal ports have the advantage of minimizing risk of iatrogenic rupture by accidental puncture. However, they have their own faults such as manipulation of the port itself (e.g., flipping, migration) if not placed into a proper pocket as well as obstruction of the tubing in between the port and the expander.

Integrated ports have the obvious advantage of not having the need to make a separate dissection for the port along with any mechanical issues one would find with the distant ports. tissue.

More recently, the Food and Drug Administration had cleared for the use of carbon dioxide–filled, remote-controlled tissue expanders for further convenience of home expansion and obviating the need for percutaneous saline injections in breast reconstruction.

A-

• 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, but the incision must take into account that the direction of movement will be perpendicular to the incision placed to maximize flap coverage and minimize tension during expansion. The injectable port should be superficial enough to be palpable, not be in an area of pressure or sensitivity, and not be in the line of a healing incision.