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Egyptian Board Plastic Surgery study materials
Egyptian Board Plastic Surgery study resources

Egyptian Board Plastic Surgery practice questions

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Question 1Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which collagen type predominates in the normal dermis and provides most of the skin's tensile strength?

  1. Type IV
  2. Type I Correct answer.
  3. Type III
  4. Type VII

Explanation

Type I collagen accounts for roughly 80-85% of dermal collagen and forms thick, mature fibrils that resist tensile loading. Type III is present in smaller amounts in adult dermis and predominates only in fetal skin and early granulation tissue.

Question 2Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

During a radial forearm free flap harvest, which structure must be preserved to maintain venous drainage of the hand if the superficial palmar arch is incomplete?

  1. The cephalic vein
  2. The palmaris longus tendon
  3. The median nerve
  4. The basilic vein Correct answer.

Explanation

When the superficial palmar arch is incomplete, the basilic vein and its deep connections become important for venous return from the hand. Sacrificing the basilic vein in such anatomy risks hand congestion, so it should be spared.

Question 3Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which phase of wound healing is characterised by the highest density of macrophages and by fibroblast-mediated collagen deposition?

  1. Proliferation Correct answer.
  2. Haemostasis
  3. Remodelling
  4. Inflammation

Explanation

The proliferative phase features granulation tissue formation, angiogenesis, and active collagen synthesis by fibroblasts, with macrophages remaining abundant to orchestrate repair. Remodelling involves collagen maturation and turnover with declining cellularity rather than peak deposition.

Question 4Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

A patient sustains a full-thickness burn to 30% of total body surface area. Which systemic physiological change occurs earliest?

  1. Hypermetabolic state with doubling of resting energy expenditure
  2. Marked catabolism of skeletal muscle protein
  3. Suppression of cell-mediated immunity
  4. Increased capillary permeability with plasma extravasation Correct answer.

Explanation

Increased capillary permeability leading to plasma leak into the interstitium is the earliest systemic event after major burns, beginning within minutes to hours. Hypermetabolism, catabolism, and immune suppression develop over subsequent hours to days.

Question 5Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which nerve is most at risk during elevation of a subgaleal flap in the temporal region?

  1. The supraorbital nerve
  2. The auriculotemporal nerve
  3. The temporal branch of the facial nerve Correct answer.
  4. The greater occipital nerve

Explanation

The temporal branch of the facial nerve runs superficially within the temporoparietal fascia, making it vulnerable during temporal dissection. Dissection deep to the superficial layer of the deep temporal fascia protects it.

Question 6Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

In a split-thickness skin graft, which dermal structure is retained at the donor site to allow re-epithelialisation?

  1. The deep dermal appendages and adnexal epithelium Correct answer.
  2. The entire reticular dermis
  3. The dermoepidermal junction
  4. The subcutaneous fat layer

Explanation

Split-thickness grafts leave behind deep dermal adnexal structures such as hair follicles and sweat glands, whose epithelium migrates to resurface the donor site. This allows donor sites to heal by re-epithelialisation rather than scarring.

Question 7Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which cytokine is considered the principal driver of fibroblast proliferation and collagen synthesis during wound repair?

  1. Interleukin-1
  2. Interferon gamma
  3. Transforming growth factor beta Correct answer.
  4. Tumour necrosis factor alpha

Explanation

Transforming growth factor beta is the key profibrotic cytokine, stimulating fibroblast proliferation, collagen production, and myofibroblast differentiation. Interleukin-1, TNF-alpha, and interferon gamma are primarily proinflammatory or inhibitory to collagen synthesis.

Question 8Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

A keloid differs from a hypertrophic scar in which fundamental way?

  1. Keloids occur only after burn injury
  2. Keloids remain confined to the original wound margins
  3. Hypertrophic scars show excessive collagen synthesis while keloids do not
  4. Keloids extend beyond the original wound margins and rarely regress Correct answer.

Explanation

Keloids grow beyond the boundaries of the original wound and tend not to regress spontaneously, whereas hypertrophic scars stay within the wound margins and often improve over time. Both involve excessive collagen deposition.

Question 9Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which anatomical layer must be incised to enter the subplatysmal plane during a neck dissection?

  1. The investing layer of deep cervical fascia Correct answer.
  2. The prevertebral fascia
  3. The superficial cervical fascia
  4. The pretracheal fascia

Explanation

The investing layer of deep cervical fascia encloses the sternocleidomastoid and trapezius and forms the roof of the anterior triangle. Dividing it exposes the subplatysmal plane containing the cervical lymph node levels.

Question 10Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which factor most strongly impairs wound healing by reducing tissue oxygen delivery?

  1. Cigarette smoking Correct answer.
  2. Mild obesity
  3. Topical antibiotic use
  4. Moderate sun exposure

Explanation

Smoking causes vasoconstriction and carbon monoxide-mediated reduction in oxygen delivery, impairing fibroblast function and collagen synthesis. Obesity, topical antibiotics, and sun exposure do not primarily compromise tissue oxygenation.

Question 11Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

In the hand, which structure passes through the carpal tunnel along with the flexor tendons?

  1. The ulnar nerve
  2. The ulnar artery
  3. The radial artery
  4. The median nerve Correct answer.

Explanation

The median nerve is the only nerve passing through the carpal tunnel, accompanied by the flexor digitorum tendons and flexor pollicis longus. The ulnar nerve and artery travel in Guyon's canal, and the radial artery passes on the radial side of the wrist.

Question 12Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which statement best describes the physiological basis of the delay phenomenon in flap surgery?

  1. It increases the number of random perforating vessels within the flap
  2. It conditions the flap to ischaemia by promoting vascular remodelling and dilation Correct answer.
  3. It reduces the metabolic demand of the flap to zero
  4. It eliminates the need for a vascular pedicle

Explanation

The delay phenomenon improves flap survival by subjecting tissue to controlled ischaemia, which promotes vasodilation and remodelling of the vascular network. It does not create new perforators or remove the need for a blood supply.

Question 13Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which component of the extracellular matrix provides the immediate scaffold for cell migration during granulation tissue formation?

  1. Hyaluronic acid
  2. Elastin
  3. Keratin
  4. Fibronectin Correct answer.

Explanation

Fibronectin is an adhesive glycoprotein that forms a provisional matrix supporting fibroblast and endothelial cell migration during granulation tissue formation. Elastin provides recoil, hyaluronic acid contributes to hydration, and keratin is an epithelial structural protein.

Question 14Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which vascular territory supplies the skin of the anterior abdominal wall in a deep inferior epigastric perforator flap?

  1. The superficial inferior epigastric artery only
  2. The superficial circumflex iliac artery
  3. The deep inferior epigastric artery perforators Correct answer.
  4. The internal thoracic artery directly

Explanation

The DIEP flap is based on perforating branches of the deep inferior epigastric artery, which supply the lower abdominal skin and fat. The superficial inferior epigastric artery supplies a separate superficial territory.

Question 15Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which histological finding is characteristic of a mature hypertrophic scar?

  1. Complete replacement of dermis by adipose tissue
  2. Predominantly type IV collagen deposition
  3. Absence of collagen deposition
  4. Nodular myofibroblastic proliferation with thick eosinophilic collagen bundles Correct answer.

Explanation

Hypertrophic scars show nodular proliferations of myofibroblasts and thick, eosinophilic collagen bundles aligned in a disorganised pattern. This contrasts with normal scar, which has finer, more parallel collagen fibres.

Question 16Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which best explains why a random-pattern flap has a length-to-width ratio limit of approximately 1:1 in the trunk?

  1. Lymphatic drainage is inadequate at the tip
  2. The flap lacks a dermal blood supply
  3. Arterial inflow exceeds venous outflow at the base
  4. Perfusion pressure falls below the threshold needed to sustain the distal tip Correct answer.

Explanation

In random flaps, perfusion pressure declines along the flap length, and beyond a critical distance the distal tissue cannot be adequately perfused, leading to necrosis. The ratio limit reflects this pressure gradient rather than lymphatic or dermal factors.

Question 17Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which vitamin deficiency most specifically impairs collagen cross-linking and causes poor wound healing with capillary fragility?

  1. Vitamin C Correct answer.
  2. Vitamin D
  3. Vitamin K
  4. Vitamin A

Explanation

Vitamin C is a cofactor for prolyl and lysyl hydroxylase, enzymes required for collagen hydroxylation and stable cross-linking. Deficiency impairs collagen maturation and produces capillary fragility.

Question 18Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which anatomical feature distinguishes the facial nerve from the trigeminal nerve in the parotid region?

  1. The facial nerve exits through the foramen ovale
  2. The facial nerve carries only sensory fibres in the face
  3. The facial nerve emerges from the stylomastoid foramen and divides within the parotid gland Correct answer.
  4. The facial nerve lies deep to the parotid fascia in the infratemporal fossa

Explanation

The facial nerve exits the skull through the stylomastoid foramen and then divides within the substance of the parotid gland into its temporal, zygomatic, buccal, marginal mandibular, and cervical branches. The trigeminal nerve exits through different foramina and provides facial sensation.

Question 19Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which of the following best explains the increased risk of wound dehiscence in a patient on long-term corticosteroids?

  1. Excessive collagen cross-linking
  2. Enhanced angiogenesis at the wound edge
  3. Suppression of inflammatory and fibroblast-mediated repair Correct answer.
  4. Increased neutrophil migration into the wound

Explanation

Corticosteroids suppress the inflammatory response and inhibit fibroblast proliferation and collagen synthesis, weakening the tensile strength of the healing wound. They do not enhance angiogenesis or neutrophil migration; they blunt these processes.

Question 20Basic Sciences Relevant to Plastic Surgery (anatomy, physiology, wound healing, pathology)

Which structure forms the medial boundary of the femoral triangle relevant to harvesting a superficial circumflex iliac artery flap?

  1. The inguinal ligament
  2. The adductor longus muscle Correct answer.
  3. The sartorius muscle
  4. The rectus femoris muscle

Explanation

The femoral triangle is bounded medially by the adductor longus, laterally by the sartorius, and superiorly by the inguinal ligament. This anatomy guides dissection around the femoral vessels and the superficial circumflex iliac pedicle.

Question 21Principles of Plastic Surgery and Surgical Techniques

During elevation of a random-pattern skin flap, which manoeuvre most directly preserves the subdermal plexus that supplies the distal flap?

  1. Dissecting in the loose areolar plane superficial to the deep fascia
  2. Dissecting in the plane immediately deep to the dermis Correct answer.
  3. Dividing the deep fascia at the flap base
  4. Undermining widely beneath the flap bed

Explanation

Random-pattern flaps derive their blood supply from the subdermal plexus, a network of vessels running in the immediate subdermal plane. Elevating the flap just deep to the dermis keeps this plexus within the flap. Dissection that leaves the plexus behind on the bed risks distal necrosis.

Question 22Principles of Plastic Surgery and Surgical Techniques

Which suture material is most appropriate for closure of a facial skin wound where minimal tissue reaction and good handling are priorities?

  1. Poliglecaprone 25 Correct answer.
  2. Polypropylene
  3. Silk
  4. Chromic catgut

Explanation

Poliglecaprone 25 is a monofilament absorbable suture with low tissue reactivity and excellent handling, making it well suited to fine facial skin closure. Its absorption avoids the need for removal in paediatric or uncooperative patients.

Question 23Principles of Plastic Surgery and Surgical Techniques

A patient requires a local anaesthetic for a 3-hour procedure on the ear. Which agent provides the longest duration of action?

  1. Bupivacaine 0.5% with adrenaline Correct answer.
  2. Lidocaine 1% with adrenaline
  3. Prilocaine 2%
  4. Mepivacaine 1%

Explanation

Bupivacaine is the longest-acting amide local anaesthetic, with duration of action of several hours, prolonged further by adrenaline. It is therefore suited to longer procedures and provides extended postoperative analgesia.

Question 24Principles of Plastic Surgery and Surgical Techniques

Which of the following best describes the Z-plasty principle used to correct a linear scar contracture?

  1. Replacing the scar with a full-thickness graft
  2. Redistributing tension by transposing two triangular flaps Correct answer.
  3. Lengthening the scar by serial excision
  4. Excising the scar and closing under tension

Explanation

Z-plasty works by transposing two triangular flaps so that the central limb is reoriented and the scar is lengthened along its axis. This redistributes tension away from the contracture line and breaks up the linear scar.

Question 25Principles of Plastic Surgery and Surgical Techniques

Which of the following is the most important factor in achieving an inconspicuous scar in elective facial surgery?

  1. Closing under maximal tension
  2. Performing the procedure under general anaesthesia
  3. Placing incisions parallel to relaxed skin tension lines Correct answer.
  4. Using the thickest suture available

Explanation

Incisions placed parallel to relaxed skin tension lines (RSTLs) heal with the least spreading and the finest scar. The lines reflect the orientation of dermal collagen bundles, so parallel incisions are subjected to minimal distracting force.

Question 26Principles of Plastic Surgery and Surgical Techniques

A patient with a full-thickness burn to 25% of the total body surface area is being resuscitated. Which formula is most commonly used to estimate initial crystalloid requirements?

  1. Rule of nines
  2. Parkland formula Correct answer.
  3. Wallace rule
  4. Lund-Browder chart

Explanation

The Parkland formula estimates 24-hour crystalloid needs as 4 mL/kg per percentage of total body surface area burned, with half given in the first 8 hours. The other options estimate burn surface area rather than fluid volume.

Question 27Principles of Plastic Surgery and Surgical Techniques

Which of the following is a recognised advantage of a full-thickness skin graft over a split-thickness graft at a facial defect?

  1. Greater resistance to secondary contraction Correct answer.
  2. Higher take rate on poorly vascularised beds
  3. Less donor site morbidity
  4. Ability to cover very large defects

Explanation

Full-thickness grafts contain the entire dermis and therefore contract much less than split-thickness grafts, giving better colour and texture match on the face. Their intact dermal architecture limits secondary contraction.

Question 28Principles of Plastic Surgery and Surgical Techniques

A patient presents with a defect on the nasal ala. Which local flap is best suited to reconstruct a full-thickness alar defect while maintaining a cartilage framework?

  1. V-Y advancement flap
  2. Bilobed flap
  3. Nasolabial flap Correct answer.
  4. Rhomboid flap

Explanation

The nasolabial flap provides well-vascularised skin with a good colour match for alar reconstruction and can be used as an interpolated flap to resurface a full-thickness defect over a cartilage graft. It is the workhorse for alar defects too large for local hinge flaps.

Question 29Principles of Plastic Surgery and Surgical Techniques

During a cleft lip repair, which structure is primarily responsible for nasal tip projection and should be repositioned to correct the cleft nasal deformity?

  1. Lower lateral cartilage Correct answer.
  2. Septal cartilage
  3. Upper lateral cartilage
  4. Alar cartilage of the non-cleft side

Explanation

The cleft nasal deformity involves displacement of the lower lateral cartilage on the cleft side, which is flattened and splayed. Repositioning and suspension of this cartilage restores tip projection and symmetry.

Question 30Principles of Plastic Surgery and Surgical Techniques

Which of the following best describes the vascular basis of the anterolateral thigh flap?

  1. Branches from the thoracodorsal artery
  2. Perforators from the deep inferior epigastric artery
  3. Perforators from the descending branch of the lateral circumflex femoral artery Correct answer.
  4. Direct branches from the superficial femoral artery

Explanation

The anterolateral thigh flap is supplied by musculocutaneous or septocutaneous perforators arising from the descending branch of the lateral circumflex femoral artery. This reliable pedicle allows it to be used as a free or pedicled flap.

Question 31Principles of Plastic Surgery and Surgical Techniques

Which technique is most appropriate for managing a hypertrophic scar that has failed conservative treatment?

  1. Observation for 12 months
  2. Simple excision with primary closure
  3. Application of silicone gel alone
  4. Intralesional corticosteroid injection Correct answer.

Explanation

Intralesional triamcinolone is a first-line treatment for hypertrophic scars, reducing fibroblast activity and collagen synthesis. It is used when silicone sheeting and pressure therapy have failed.

Question 32Principles of Plastic Surgery and Surgical Techniques

Which of the following is the primary indication for a skin graft rather than a flap?

  1. A defect with exposed tendon lacking paratenon
  2. A defect with an adequate vascularised bed and no exposed bone or tendon Correct answer.
  3. A defect with exposed bone lacking periosteum
  4. A defect requiring restoration of bulk

Explanation

A skin graft survives by plasmatic imbibition and requires a well-vascularised bed to take. When bone, tendon or cartilage lacks periosteum, paratenon or perichondrium, a flap is required to bring its own blood supply.

Question 33Principles of Plastic Surgery and Surgical Techniques

Which of the following is a recognised disadvantage of using a pedicled latissimus dorsi flap for chest wall reconstruction?

  1. Limited arc of rotation to the anterior chest
  2. High donor site morbidity from seroma formation Correct answer.
  3. Inability to cover large defects
  4. Requirement for microvascular anastomosis

Explanation

The latissimus dorsi flap is reliable and can cover large defects, but donor site seroma is a common complication, reported in a significant proportion of patients. Meticulous closure and drain placement reduce but do not eliminate this risk.

Question 34Principles of Plastic Surgery and Surgical Techniques

A patient undergoing abdominoplasty is assessed for risk of wound dehiscence. Which factor most increases this risk?

  1. Use of a drain
  2. Preoperative marking in standing position
  3. Use of absorbable sutures
  4. Excessive tension on the closure Correct answer.

Explanation

Excessive tension on the abdominal closure compromises perfusion and predisposes to wound dehiscence and widened scars. Adequate undermining and tension-free closure are essential to reduce this risk.

Question 35Principles of Plastic Surgery and Surgical Techniques

Which of the following best describes the principle of the delay phenomenon in flap surgery?

  1. Ischaemic preconditioning increases flap survival after a staged procedure Correct answer.
  2. The flap is tunnelled beneath the skin
  3. The flap is designed with a random pattern
  4. The flap is raised and immediately inset

Explanation

The delay phenomenon involves partially devascularising a flap in a staged procedure, which conditions the tissue to ischaemia and improves survival after the definitive raise. It is thought to involve ischaemic preconditioning and vascular remodelling.

Question 36Principles of Plastic Surgery and Surgical Techniques

Which of the following is the most appropriate first-line management for a patient with a simple lacerated wound of the forearm presenting 10 hours after injury?

  1. Immediate skin grafting
  2. Irrigation, debridement and primary closure Correct answer.
  3. Delayed primary closure after 5 days
  4. Healing by secondary intention

Explanation

A clean forearm laceration presenting within the golden period can be managed by thorough irrigation, debridement and primary closure. The low bacterial load and good vascularity of the forearm support primary healing.

Question 37Principles of Plastic Surgery and Surgical Techniques

Which of the following is a recognised complication of a radial forearm free flap donor site?

  1. Facial nerve palsy
  2. Tendon exposure and delayed healing Correct answer.
  3. Mandibular non-union
  4. Flap necrosis from venous congestion

Explanation

The radial forearm donor site is prone to tendon exposure and delayed healing, particularly if a skin graft is used over the flexor tendons. Careful graft placement and immobilisation reduce this risk.

Question 38Principles of Plastic Surgery and Surgical Techniques

Which of the following best explains why a random-pattern flap has a length-to-width ratio limit?

  1. The flap lacks any blood supply
  2. The flap is always based on a named artery
  3. The flap requires microvascular anastomosis
  4. Perfusion depends on the subdermal plexus with limited axial input Correct answer.

Explanation

Random-pattern flaps rely on the subdermal plexus, which provides only limited perfusion pressure over distance. Beyond a certain length-to-width ratio the distal portion becomes ischaemic, hence the traditional limits.

Question 39Principles of Plastic Surgery and Surgical Techniques

A patient with a deep burn to the dorsum of the hand has exposed extensor tendons without paratenon. Which coverage option is most appropriate?

  1. A split-thickness skin graft
  2. Healing by secondary intention
  3. A full-thickness skin graft
  4. A fascial or fasciocutaneous flap Correct answer.

Explanation

Tendon without paratenon cannot support a skin graft, so a flap is required to provide vascularised cover. A fascial or fasciocutaneous flap restores a gliding surface and protects the tendons.

Question 40Principles of Plastic Surgery and Surgical Techniques

Which of the following statements about the blood supply of the transverse rectus abdominis myocutaneous (TRAM) flap is correct?

  1. It is based on the superficial inferior epigastric artery
  2. It is based on the internal thoracic artery directly
  3. It is based on the thoracodorsal artery
  4. It is based on the superior or inferior deep epigastric vessels Correct answer.

Explanation

The TRAM flap is supplied by the deep superior epigastric artery when pedicled and by the deep inferior epigastric artery when used as a free flap. These are the dominant pedicles of the rectus abdominis muscle.

Question 41Reconstructive Surgery (flaps, grafts, microsurgery)

A 34-year-old man has a 6 × 4 cm full-thickness scalp defect with exposed bare calvaria after tumour excision. Pericranium is absent over the defect. Which reconstructive option provides the most reliable durable coverage?

  1. Free latissimus dorsi muscle flap with split-thickness skin graft Correct answer.
  2. Secondary healing with regular dressings and bone trephination alone
  3. Full-thickness skin graft placed on the exposed outer table
  4. Split-thickness skin graft applied directly to the denuded bone

Explanation

Skin grafts cannot survive on bare cortical bone because there is no vascularized bed; they require periosteum, fascia, or granulation tissue. A well-vascularized flap, either free or pedicled, provides durable coverage and a bed for grafting over exposed calvaria. Trephination to encourage granulation is a temporizing measure and is slower and less durable than flap coverage for a defect of this size.

Question 42Reconstructive Surgery (flaps, grafts, microsurgery)

Which flap is the workhorse pedicled option for reconstructing a large full-thickness cheek and intraoral lining defect after resection of a buccal squamous cell carcinoma?

  1. Radial forearm free flap
  2. Deltopectoral flap
  3. Pectoralis major myocutaneous flap Correct answer.
  4. Temporoparietal fascia flap

Explanation

The pectoralis major myocutaneous flap is a bulky, reliably vascularized pedicled flap based on the thoracoacromial axis and is widely used for large composite oromandibular and cheek defects. It can provide both skin cover and intraoral lining in one stage without microsurgery. The radial forearm flap is a free flap requiring recipient vessels and is thinner than needed for bulk replacement, while the deltopectoral and temporoparietal flaps have limited reach and volume for this defect.

Question 43Reconstructive Surgery (flaps, grafts, microsurgery)

In a radial forearm free flap, which vessel supplies the flap and is anastomosed as the arterial pedicle?

  1. Radial artery Correct answer.
  2. Posterior interosseous artery
  3. Brachial artery
  4. Ulnar artery

Explanation

The radial forearm fasciocutaneous flap is supplied by the radial artery through septocutaneous perforators in the distal forearm. The radial artery is harvested with the flap and anastomosed to a recipient artery in the neck. The ulnar and posterior interosseous arteries do not supply this flap, and the brachial artery is a proximal source vessel, not the flap pedicle.

Question 44Reconstructive Surgery (flaps, grafts, microsurgery)

A patient requires reconstruction of a full-thickness defect of the lower eyelid involving more than 75% of the eyelid margin. Which approach is most appropriate?

  1. Full-thickness skin graft alone to the anterior lamella
  2. Primary healing by secondary intention
  3. Tarsoconjunctival (Hughes) flap from the upper eyelid Correct answer.
  4. Direct layered closure after minimal undermining

Explanation

Defects involving most of the lower eyelid margin require a composite reconstruction that replaces both the posterior lamella (tarsus and conjunctiva) and the anterior lamella. The tarsoconjunctival Hughes flap supplies vascularized posterior lamella from the upper eyelid and is combined with an anterior lamella graft or flap. Direct closure is impossible for such a large defect, and a skin graft alone cannot restore the tarsal support or conjunctival lining.

Question 45Reconstructive Surgery (flaps, grafts, microsurgery)

Which statement best describes the blood supply of a random-pattern skin flap?

  1. It is based on a named direct cutaneous artery identified by Doppler
  2. It relies on the dermal and subdermal plexus without a named axial vessel Correct answer.
  3. It is supplied solely by musculocutaneous perforators from an underlying muscle
  4. It depends on reverse flow through a distant named artery

Explanation

A random-pattern flap derives its blood supply from the dermal and subdermal vascular plexus rather than a single named axial artery. Its length-to-width ratio is therefore limited by the perfusion pressure of that plexus. Axial flaps, perforator flaps, and reverse-flow flaps depend on named vessels and are distinct categories.

Question 46Reconstructive Surgery (flaps, grafts, microsurgery)

Which graft is most appropriate for reconstructing a full-thickness defect of the nasal ala with intact underlying vascular bed after Mohs excision?

  1. Split-thickness skin graft
  2. Composite auricular chondrocutaneous graft
  3. Full-thickness skin graft from the preauricular region Correct answer.
  4. Fascial graft without skin cover

Explanation

A full-thickness skin graft from a colour- and texture-matched donor site such as the preauricular or nasolabial region provides good contour and minimizes contracture for a full-thickness nasal alar defect with a vascularized bed. Split-thickness grafts contract and give poor colour match on the face. Composite chondrocutaneous grafts are reserved for defects needing structural support, and a fascial graft alone provides no epithelial cover.

Question 47Reconstructive Surgery (flaps, grafts, microsurgery)

Which monitoring method is the most sensitive early indicator of arterial thrombosis in a buried free flap?

  1. Daily clinical inspection of the skin paddle colour
  2. Routine postoperative haematocrit trending
  3. Measurement of flap surface temperature alone
  4. Implantable Doppler probe on the venous pedicle Correct answer.

Explanation

An implantable Doppler probe placed on the pedicle, particularly the vein, detects changes in flow signal and is among the most sensitive bedside monitors for early flap compromise, including in buried flaps where the skin paddle is not visible. Clinical inspection, surface temperature, and haematocrit are indirect and change later. Early detection allows timely re-exploration and salvage.

Question 48Reconstructive Surgery (flaps, grafts, microsurgery)

A patient sustains a Gustilo grade IIIC open tibial fracture with a segmental bone defect and overlying soft-tissue loss. Which reconstructive principle is most appropriate?

  1. Early radical debridement followed by vascularized soft-tissue coverage and later bone reconstruction Correct answer.
  2. Prolonged external fixation alone until spontaneous bone union
  3. Delayed split-thickness grafting over exposed bone without debridement
  4. Immediate amputation in all grade IIIC injuries

Explanation

Grade IIIC open fractures involve arterial injury requiring repair and carry high infection and nonunion risk. Modern limb salvage follows radical debridement, skeletal stabilization, vascular repair, and early vascularized soft-tissue coverage, with bone reconstruction staged later. Immediate amputation is reserved for non-salvageable limbs, and grafting over undebrided exposed bone predictably fails.

Question 49Reconstructive Surgery (flaps, grafts, microsurgery)

Which nerve is most commonly used as a donor for cable grafting of a 4 cm gap in the median nerve at the wrist?

  1. Sural nerve Correct answer.
  2. Phrenic nerve
  3. Long thoracic nerve
  4. Recurrent laryngeal nerve

Explanation

The sural nerve is the most commonly used donor for peripheral nerve cable grafting because it provides a long length of usable nerve with predictable anatomy and acceptable donor-site sensory loss on the lateral foot. Multiple strands can be used to match the calibre of the median nerve. The phrenic, recurrent laryngeal, and long thoracic nerves are critical motor nerves and are not used as graft donors.

Question 50Reconstructive Surgery (flaps, grafts, microsurgery)

A 58-year-old woman has a 3 cm full-thickness defect of the mid-helix with exposed cartilage after excision of a basal cell carcinoma. Which reconstruction best restores contour with acceptable donor morbidity?

  1. Healing by secondary intention
  2. Primary closure with wide undermining
  3. Chondrocutaneous advancement (Antia-Buch) flap Correct answer.
  4. Split-thickness skin graft directly on cartilage

Explanation

The Antia-Buch chondrocutaneous advancement flap mobilizes the remaining auricular tissue with its cartilage and skin to close moderate helical defects while preserving the cartilaginous framework and ear contour. Skin grafts placed directly on cartilage have poor take, and primary closure of a 3 cm full-thickness defect would distort the ear. Secondary intention healing risks chondritis and deformity.