ABPS Surgical Anatomy & Reconstructive Techniques 3 — Questions and Answers
Question 1: Which perforator flap is based on perforators from the profunda femoris artery and is used for breast reconstruction?
- DIEP flap
- SIEA flap
- PAP flap (Correct answer)
- TUG flap
Correct answer: PAP flap
The profunda artery perforator (PAP) flap is harvested from the posterior thigh and based on perforators from the profunda femoris artery.
Question 2: The marginal mandibular branch of the facial nerve is most vulnerable during which reconstructive procedure?
- Rhytidectomy at the zygomatic arch
- Neck dissection below the mandibular border (Correct answer)
- Parotidectomy near the stylomastoid foramen
- Brow lift at the temporal hairline
Correct answer: Neck dissection below the mandibular border
The marginal mandibular branch, which has limited redundancy, is at greatest risk during dissection below the lower border of the mandible during neck dissection.
Question 3: During a fibula free flap harvest, what is the minimum segment of fibula that must be preserved proximally and distally to protect joint stability?
- 3 cm proximal and 3 cm distal
- 6 cm proximal and 6 cm distal (Correct answer)
- 4 cm proximal and 8 cm distal
- 6 cm proximal and 8 cm distal
Correct answer: 6 cm proximal and 6 cm distal
At least 6 cm of fibula must be preserved proximally to protect the peroneal nerve and knee, and 6 cm distally to maintain ankle stability.
Question 4: The reverse sural artery flap is perfused in retrograde fashion via which anastomotic connection?
- Peroneal communicating branch to the sural artery (Correct answer)
- Anterior tibial artery perforators
- Greater saphenous vein tributaries
- Popliteal artery directly
Correct answer: Peroneal communicating branch to the sural artery
The reverse sural flap relies on the peroneal communicating branch connecting the peroneal artery to the sural artery for retrograde perfusion.
Question 5: In cleft palate repair using the Furlow double-opposing Z-plasty, the primary goal of the technique is to:
- Widen the hard palate
- Lengthen the soft palate and reorient the levator veli palatini muscle (Correct answer)
- Close the alveolar cleft simultaneously
- Advance the posterior pharyngeal wall
Correct answer: Lengthen the soft palate and reorient the levator veli palatini muscle
The Furlow Z-plasty lengthens the soft palate and repositions the levator veli palatini muscle into its correct transverse orientation to improve velopharyngeal function.
Question 6: The Allen test assesses patency of which two arteries before radial forearm flap harvest?
- Radial and ulnar arteries (Correct answer)
- Radial and brachial arteries
- Ulnar and interosseous arteries
- Brachial and axillary arteries
Correct answer: Radial and ulnar arteries
The Allen test evaluates the patency of both the radial and ulnar arteries to ensure adequate hand perfusion from the ulnar side after radial artery sacrifice.
Question 7: Which layer of the scalp contains the neurovascular supply to the overlying skin?
- Skin (epidermis/dermis)
- Dense connective tissue layer (Correct answer)
- Epicranial aponeurosis (galea)
- Loose areolar tissue
Correct answer: Dense connective tissue layer
The dense connective tissue layer (second layer of SCALP) contains the blood vessels, lymphatics, and nerves supplying the scalp skin.
ABPS Surgical Anatomy & Reconstructive Techniques 3
Which perforator flap is based on perforators from the profunda femoris artery and is used for breast reconstruction?