ABPS Preoperative Assessment & Postoperative Care 5

Question 1

Which finding on a preoperative EKG would most likely require cardiology clearance before elective flap reconstruction?

Accepted Answer

New left bundle branch block (LBBB)

Answer

A new LBBB may indicate acute cardiac pathology such as ischemia or cardiomyopathy and requires cardiology evaluation before elective surgery.

Question 2

What is the most appropriate postoperative drain management following modified radical mastectomy with immediate reconstruction?

Accepted Answer

Remove drains when output is <30 mL per day for 2 consecutive days

Answer

Standard protocol is to remove closed-suction drains when output falls below 30 mL/day for two consecutive days to reduce infection risk while preventing seroma.

Question 3

Which factor is most predictive of flap failure in free tissue transfer for breast reconstruction?

Accepted Answer

Prior radiation to the chest wall

Answer

Prior radiation causes microvascular damage and tissue fibrosis, significantly increasing the risk of anastomotic failure and fat necrosis in free flap reconstruction.

Question 4

A patient presents with erythema, warmth, and fluctuance over a breast implant site 10 days postoperatively. After aspiration reveals purulent fluid, what is the next step?

Accepted Answer

IV antibiotics and implant removal with washout

Answer

Established periprosthetic infection with purulent fluid requires implant removal, pocket washout, and IV antibiotics to eliminate the biofilm-colonized foreign body.

Question 5

What is the primary role of preoperative nutritional assessment in free flap surgery candidates?

Accepted Answer

Identifying hypoalbuminemia and malnutrition that impairs wound healing

Answer

Hypoalbuminemia (<3.5 g/dL) and malnutrition are associated with impaired immunity, poor wound healing, and increased flap complication rates in reconstructive surgery.

(ABPS) Certified American Board of Plastic Surgery Practice Test

(ABPS) Certified American Board of Plastic Surgery Practice Test

ABPS Preoperative Assessment & Postoperative Care 5