ASPS Reconstructive Surgery Principles & Techniques 2 — Questions and Answers
Question 1: Which flap classification describes tissue that retains its original blood supply throughout transfer?
- Free flap
- Pedicled flap (Correct answer)
- Interpolation flap
- Advancement flap
Correct answer: Pedicled flap
A pedicled flap maintains its native vascular pedicle during transfer, unlike a free flap which requires microvascular anastomosis.
Question 2: In the reconstructive ladder, which option represents the most complex level of reconstruction?
- Primary closure
- Skin graft
- Local flap
- Free tissue transfer (Correct answer)
Correct answer: Free tissue transfer
Free tissue transfer sits at the top of the reconstructive ladder, requiring microvascular anastomosis and offering the greatest versatility.
Question 3: What is the primary advantage of a musculocutaneous flap over a fasciocutaneous flap for infected wounds?
- Greater aesthetic outcome
- Superior bulk for obliteration of dead space and infection control (Correct answer)
- Faster donor site healing
- Lower risk of flap necrosis
Correct answer: Superior bulk for obliteration of dead space and infection control
Muscle has robust vascularity that enhances antibiotic delivery and host defense, making it superior for infected or contaminated wounds.
Question 4: The 'zone of injury' concept in trauma reconstruction refers to:
- The geometric area of skin loss
- Tissue surrounding the wound that may have compromised vascularity (Correct answer)
- The depth of injury through tissue layers
- The dermatomal distribution of nerve injury
Correct answer: Tissue surrounding the wound that may have compromised vascularity
The zone of injury extends beyond visible wound edges and may contain traumatized tissue with impaired perfusion that can compromise flap survival.
Question 5: Which nerve coaptation technique involves trimming nerve ends to healthy fascicles and using fibrin glue or sutures without tension?
- Nerve grafting
- Neurorrhaphy (Correct answer)
- Nerve conduit repair
- Neurolysis
Correct answer: Neurorrhaphy
Neurorrhaphy is direct nerve repair by coaptation of nerve ends, requiring tension-free alignment of fascicles for optimal axon regeneration.
Question 6: In perforator flap surgery, the perforator vessel most commonly arises from which source?
- Superficial venous system
- Musculocutaneous or septocutaneous branches of named deep arteries (Correct answer)
- Subdermal plexus only
- Lymphatic channels
Correct answer: Musculocutaneous or septocutaneous branches of named deep arteries
Perforators are vessels that pierce the deep fascia from underlying named source arteries, traveling through or between muscles to supply the skin.
Question 7: What is the recommended timing for replantation of a completely amputated digit to maximize viability?
- Within 2 hours warm ischemia or 6 hours cold ischemia
- Within 6 hours warm ischemia or 12 hours cold ischemia (Correct answer)
- Within 12 hours warm ischemia or 24 hours cold ischemia
- Timing is not critical if cooled properly
Correct answer: Within 6 hours warm ischemia or 12 hours cold ischemia
Digits tolerate approximately 6 hours of warm ischemia and up to 12 hours of cold ischemia before irreversible muscle and nerve damage occurs.
ASPS Reconstructive Surgery Principles & Techniques 2
Which flap classification describes tissue that retains its original blood supply throughout transfer?