ABPS Surgical Anatomy & Reconstructive Techniques 2 — Questions and Answers
Question 1: Which nerve is at greatest risk during elevation of a radial forearm free flap?
- Median nerve
- Lateral antebrachial cutaneous nerve
- Radial nerve superficial branch (Correct answer)
- Ulnar nerve
Correct answer: Radial nerve superficial branch
The superficial branch of the radial nerve runs in proximity to the radial artery and is at risk when elevating the radial forearm flap.
Question 2: The deep inferior epigastric artery (DIEA) originates from which vessel?
- Femoral artery
- External iliac artery (Correct answer)
- Internal iliac artery
- Common iliac artery
Correct answer: External iliac artery
The deep inferior epigastric artery arises from the external iliac artery just above the inguinal ligament.
Question 3: In a TRAM flap reconstruction, Zone IV refers to which area of the flap?
- Ipsilateral central zone with most reliable perfusion
- Contralateral zone farthest from the pedicle with least reliable perfusion (Correct answer)
- Periumbilical zone
- Ipsilateral lateral zone
Correct answer: Contralateral zone farthest from the pedicle with least reliable perfusion
Zone IV of the TRAM flap is the contralateral lateral zone, most distant from the pedicle and least reliably perfused, often discarded.
Question 4: The thoracodorsal nerve innervates which muscle used in reconstructive surgery?
- Pectoralis major
- Serratus anterior
- Latissimus dorsi (Correct answer)
- Trapezius
Correct answer: Latissimus dorsi
The thoracodorsal nerve, a branch of the posterior cord of the brachial plexus, innervates the latissimus dorsi muscle.
Question 5: Which anatomical landmark defines the superior border of the femoral triangle?
- Inguinal ligament (Correct answer)
- Sartorius muscle
- Adductor longus
- Iliopsoas muscle
Correct answer: Inguinal ligament
The inguinal ligament forms the superior border of the femoral triangle, with sartorius laterally and adductor longus medially.
Question 6: In V-Y advancement flap design, tissue movement is primarily achieved by which mechanism?
- Tissue expansion prior to incision
- Geometric redistribution of tension along the flap limbs
- Secondary movement of surrounding skin after flap advancement (Correct answer)
- Random-pattern blood supply elongation
Correct answer: Secondary movement of surrounding skin after flap advancement
V-Y advancement relies on secondary movement of the surrounding skin, which advances into the defect as the triangular flap is advanced.
Question 7: The sentinel lymph node in melanoma of the upper extremity typically drains to which basin first?
- Inguinal nodes
- Axillary nodes (Correct answer)
- Supraclavicular nodes
- Cervical nodes
Correct answer: Axillary nodes
Melanoma of the upper extremity drains primarily to the axillary lymph node basin as the first echelon of lymphatic drainage.
ABPS Surgical Anatomy & Reconstructive Techniques 2
Which nerve is at greatest risk during elevation of a radial forearm free flap?