ABPS Surgical Anatomy & Reconstructive Techniques 5 — Questions and Answers
Question 1: The nasolabial flap used for oral cavity reconstruction is supplied by perforators from which artery?
- Angular artery
- Transverse facial artery
- Facial artery (Correct answer)
- Infraorbital artery
Correct answer: Facial artery
The nasolabial flap is supplied by perforators from the facial artery, which provide a reliable axial blood supply to the nasolabial fold skin.
Question 2: Which of the following best describes the anatomical basis of the 'safe zone' for deep plane facelift dissection?
- Dissection superficial to the SMAS avoids all facial nerve branches
- Dissection deep to the SMAS but above the parotid-masseteric fascia protects facial nerve branches (Correct answer)
- Dissection below the zygomaticus major avoids the frontal branch of the facial nerve
- Subcutaneous dissection in all zones eliminates nerve injury risk
Correct answer: Dissection deep to the SMAS but above the parotid-masseteric fascia protects facial nerve branches
In the deep plane, dissection deep to SMAS but superficial to the parotid-masseteric fascia keeps the facial nerve protected beneath the fascia while mobilizing the SMAS-platysma unit.
Question 3: The pectoralis major myocutaneous flap used in head and neck reconstruction is based on the pectoral branch of which artery?
- Lateral thoracic artery
- Thoracoacromial artery (Correct answer)
- Internal mammary artery perforators
- Subscapular artery
Correct answer: Thoracoacromial artery
The pectoralis major myocutaneous flap is reliably based on the pectoral branch of the thoracoacromial artery, a branch of the axillary artery.
Question 4: In lower extremity reconstruction using the anterolateral thigh (ALT) flap, the perforators most commonly arise from which source vessel?
- Medial circumflex femoral artery
- Lateral circumflex femoral artery descending branch (Correct answer)
- Profunda femoris artery directly
- Superficial femoral artery
Correct answer: Lateral circumflex femoral artery descending branch
ALT flap perforators most commonly arise from the descending branch of the lateral circumflex femoral artery, located in the septum between the rectus femoris and vastus lateralis.
Question 5: Reconstruction of a full-thickness lower eyelid defect involving more than 50% of the lid length typically requires which technique?
- Simple primary closure with canthotomy
- Hughes tarsoconjunctival flap with a skin graft (Correct answer)
- Mustardé cheek rotation flap alone
- Full-thickness skin graft without structural support
Correct answer: Hughes tarsoconjunctival flap with a skin graft
Defects exceeding 50% of lower lid length require both posterior lamellar reconstruction (Hughes flap for tarsoconjunctiva) and anterior lamellar coverage, typically with a skin graft.
Question 6: The 'golden period' for primary nerve repair following sharp laceration is generally considered to be within:
- 6 hours of injury
- 24 hours of injury (Correct answer)
- 72 hours of injury
- 7 days of injury
Correct answer: 24 hours of injury
Primary nerve repair is ideally performed within 24 hours of a sharp, clean laceration when tissue planes are well-defined and ends are not yet retracted or fibrotic.
Question 7: A fasciotomy of the lower leg for compartment syndrome must release which four compartments?
- Anterior, lateral, deep posterior, superficial posterior (Correct answer)
- Anterior, medial, lateral, deep posterior
- Anterior, lateral, medial, superficial posterior
- Anterior, deep posterior, medial, peroneal
Correct answer: Anterior, lateral, deep posterior, superficial posterior
Complete lower leg fasciotomy requires release of all four compartments: anterior, lateral, deep posterior, and superficial posterior, typically via two incisions.
ABPS Surgical Anatomy & Reconstructive Techniques 5
The nasolabial flap used for oral cavity reconstruction is supplied by perforators from which artery?