Plastic Surgery Q 35-45

Questions in Plastic Surgery 35-45


Questions 1-5 (free)          Questions 6-1    Questions 11-14    15-24   Q 25-34   Burns (6 questions)


Q 35 ) Angles in rhomboid flap
a)60,120
b)45,45
c)45,90
d)90,90

Ans a
Rhomboid (Limberg) flap
Defect made into rhombic shape (equilateral parallelogram) with 60 and 120 degree angles.

First side of flap is a short diagonal of rhombus extended at an equal length.

Second side of flap is a line parallel to and same length as nearest limb of flap.

Four flaps can be designed around sides of the defect, flap design chosen with best skin mobility and scar placement


36) Groin flap perforator according to mathes nahai classification is a
a) Direct cutaneous perforator
b) septocutaneous perforaror
c) musculocutaneous perforator
d) none of the above

ans A
Blood supply/Mathes and Nahai classification
1. Type A: Direct cutaneous perforator; pedicle courses beneath deep
fascia on its way to skin (e.g., temporoparietal fascia flap, groin flap).
2. Type B: Septocutaneous perforator; pedicle travels within intermuscular
septa (e.g., radial forearm flap)
3. Type C: Musculocutaneous perforator; pedicle based on
musculocutaneous perforators that travel through muscle to supply deep
fascia and overlying skin (e.g.,anterolateral thigh flap)


37) Tensor fascia lata blood supply is?
a) Type 1
b) Type 2
c) Type 3
d) Type 5

ans a
Blood supply/Mathes and Nahai classification
1. Type I: (D)Single vascular pedicle (e.g., gastrocnemius, tensor fascia lata)
2. Type II: (D+M) Single dominant pedicle and one or more minor pedicles;
flap cannot survive on minor pedicles alone; most common type of muscle in
body (e.g., soleus, gracilis, rectus femoris, biceps femoris)
3. Type III: (D+D) Two dominant pedicles; flap can survive on either
pedicle alone (e.g., rectus abdominis, gluteus maximus)
4. Type IV: (SSS)Segmental pedicles; multiple pedicles enter along course
of muscle, each supplies a portion of the flap; least reliable type (e.g.,
sartorius, tibialis anterior)
5. Type V: (D+S)One dominant pedicle and secondary segmental pedicles;
flap can survive on segmental pedicles alone (e.g., latissimus dorsi, pectoralis
major)


38) Physiological changes that occur in flap delay
a) Decrease in sympathetic tone
b) Dilatation of choked vessels
c) Angiogenesis
d) All of the above

ans D
Flap delay causes:
a. Decrease in sympathetic tone from transection of sympathetic fibers.
b. Dilation of previously closed choke vessels increases the area of tissue supplied by the dominant pedicle.
c. Relative tissue ischemia stimulates angiogenesis, increasing flap vascularity before transfer


39) Enhancing blood supply of a pedicled flap by performing microvascular anastomosis to a secondary pedicle of the flap is:
a) Delaying of flap
b) Advanvancement of flap
c) Crane principle
d) Super charging

ans d
1)Flap delay
Flap is partially elevated and entirely elevated, or selected pedicles are
divided into one or more procedures; flap is brought back to in situ position
in staged procedure before definitive flap elevation and transfer
2)Crane principle
Pedicled flap used to lift, transport, and deposit subcutaneous tissue to
recipient bed.
Flap is raised and transferred to recipient bed.
3)Supercharging
Enhancing blood supply of a pedicled flap by performing microvascular
anastomosis to a secondary pedicle of the flap.


40) Introduction of additional tissue layers into flap prior to transfer to create multilayer composite flap is termed as
a) Prelamination
b) Prefabrication
c) Supercharging
d) Crane principle


ans a
1)Prelamination
Introduction of additional tissue layers into flap prior to transfer to create multilayer composite flap; allows tissue to have time to mature before transfer.

2. Indication: Allows custom-made flaps for specialized areas of the body with 3D structure (e.g., central face, penis).
2)Prefabrication
1. Introduction of new vascular pedicle into tissue
2. Indication: When desired donor tissue has required qualities but does not
have reliable axial blood supply.
3)Supercharging
Enhancing blood supply of a pedicled flap by performing microvascular anastomosis to a secondary pedicle of the flap.

4)Crane principle
Pedicled flap used to lift, transport, and deposit subcutaneous tissue to
recipient bed. Flap is raised and transferred to recipient bed.


41 )Example for sensate flap
A) Gracilis flap
b) Lattismus dorsi flap
c)  Dorsalis Pedis flap
d) Pectoralis major flap

ans c
Innervated flaps
Motor nerve and/or sensory nerves are preserved or coapted to appropriate nerve near the recipient site.

Common functional muscle flap transfers and motor nerve
i. Gracilis with obturator nerve
ii. Latissimus with thoracodorsal nerve
iii. Serratus with long thoracic nerve
iv. Pectoralis minor with medial and lateral pectoral nerves

Common sensory flaps and sensory nerves
i. Lateral arm flap with posterior brachial cutaneous nerve
ii. Radial forearm flap with medial and/or lateral antebrachial cutaneous nerves
iii. Dorsalis pedis flap with deep peroneal nerve and/or superficial peroneal nerve


42 ) Flap with multiple territories, each with independent vascular supply, but territories remain connected is called as.
a) Chimeric flap
b) Conjoined flap
c) Pedicled flap
d) Rotational flap


ans b
Chimeric versus conjoined (Siamese) flap
1. Chimeric flap: Has multiple territories, each with independent vascular
supply (perforators or named branches), but territories are NOT connected
except by connection to common source vessel.
2. Conjoined flap: Has multiple territories, each with independent vascular
supply, but territories remain connected


43) Gold standard method of flap assessment is
a)Flourescein dye
b)pulse oximetry
c)clinical evaluation
d)implanted Doppler


ans c
Clinical evaluation: Gold standard method of flap assessment
a. Temperature: Should be body temperature
b. Color: Should be pink
c. Capillary refill: Should be approximately 2 seconds
d. Bleeding: Upon introduction of fine-gauge needle, bright-red bleeding
should be
present
e. Firmness: Should be soft, with some appreciable turgo
(ref Michigan manual)