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, butterritories 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)