ASPS Anatomy, Physiology & Surgical Planning 2 — Questions and Answers
Question 1: Which perforator artery is the primary basis for the DIEP flap used in breast reconstruction?
- Superior epigastric artery
- Deep inferior epigastric artery (Correct answer)
- Superficial inferior epigastric artery
- Internal mammary artery
Correct answer: Deep inferior epigastric artery
The DIEP flap is based on perforators from the deep inferior epigastric artery, sparing the rectus abdominis muscle.
Question 2: In rhinoplasty planning, the nasofrontal angle in a female patient ideally measures approximately:
- 115–120°
- 130–135° (Correct answer)
- 105–110°
- 140–145°
Correct answer: 130–135°
The ideal nasofrontal angle in women is approximately 130–135°, slightly more open than the male ideal of 120–130°.
Question 3: The thoracodorsal nerve, if injured during axillary dissection, causes weakness in which muscle?
- Serratus anterior
- Pectoralis minor
- Latissimus dorsi (Correct answer)
- Subscapularis
Correct answer: Latissimus dorsi
The thoracodorsal nerve innervates the latissimus dorsi; injury results in weakness of arm adduction and internal rotation.
Question 4: During abdominoplasty, preservation of which nerve prevents sensory loss to the lateral thigh?
- Genitofemoral nerve
- Lateral femoral cutaneous nerve (Correct answer)
- Ilioinguinal nerve
- Femoral nerve
Correct answer: Lateral femoral cutaneous nerve
The lateral femoral cutaneous nerve crosses near the ASIS and can be injured during abdominoplasty, causing meralgia paresthetica.
Question 5: Which zone of the breast, according to the Würinger ligament anatomy, provides the primary neurovascular supply to the nipple-areola complex?
- Superior pedicle zone
- Medial pedicle zone
- Inferior pedicle zone
- Central horizontal septum zone (Correct answer)
Correct answer: Central horizontal septum zone
The Würinger septum (central horizontal septum) carries the primary neurovascular supply to the NAC and is preserved in superomedial pedicle techniques.
Question 6: In free flap surgery, a vessel with a diameter less than 1 mm presents increased risk of thrombosis primarily due to which hemodynamic principle?
- Increased turbulent flow
- Elevated transmural pressure
- Increased flow resistance per Poiseuille's law (Correct answer)
- Reduced platelet aggregation
Correct answer: Increased flow resistance per Poiseuille's law
Poiseuille's law states resistance is inversely proportional to the fourth power of radius, making very small vessels extremely high-resistance and thrombosis-prone.
Question 7: The sentinel lymph node for the breast most commonly drains to which nodal basin?
- Internal mammary chain
- Interpectoral (Rotter's) nodes
- Axillary level I nodes (Correct answer)
- Supraclavicular nodes
Correct answer: Axillary level I nodes
The sentinel lymph node most frequently maps to axillary level I nodes, lateral to the pectoralis minor muscle.
ASPS Anatomy, Physiology & Surgical Planning 2
Which perforator artery is the primary basis for the DIEP flap used in breast reconstruction?