ASPS Reconstructive Surgery Principles & Techniques 3 — Questions and Answers
Question 1: Which type of skin graft provides the best color and texture match for facial reconstruction?
- Split-thickness graft from thigh
- Full-thickness graft from post-auricular or supraclavicular region (Correct answer)
- Meshed split-thickness graft
- Dermal substitute alone
Correct answer: Full-thickness graft from post-auricular or supraclavicular region
Full-thickness grafts from facial-adjacent donor sites like post-auricular or supraclavicular skin best replicate facial skin characteristics.
Question 2: The 'delay phenomenon' in flap surgery works by:
- Allowing scar maturation before definitive repair
- Inducing sympathetic denervation and adrenergic receptor upregulation to improve perfusion (Correct answer)
- Reducing patient anxiety before complex surgery
- Allowing edema to resolve before flap inset
Correct answer: Inducing sympathetic denervation and adrenergic receptor upregulation to improve perfusion
Surgical delay triggers ischemic preconditioning, causes sympathetic denervation, and redirects blood flow along the flap axis, extending the zone of reliable perfusion.
Question 3: In lower extremity reconstruction, which anatomical zone is considered most challenging due to poor local tissue availability and high infection risk?
- Proximal thigh
- Distal third of the leg (Correct answer)
- Knee
- Foot dorsum
Correct answer: Distal third of the leg
The distal third of the leg has sparse local soft tissue, poor vascularity, and proximity to the distal tibial bone, making free flap transfer often necessary.
Question 4: Which outcome measure is most specific for assessing functional recovery after peripheral nerve repair?
- Visual analogue pain scale
- Static two-point discrimination (Correct answer)
- Range of motion goniometry
- Grip strength dynamometry
Correct answer: Static two-point discrimination
Static two-point discrimination specifically measures cutaneous sensory reinnervation density, the most direct functional outcome after digital nerve repair.
Question 5: When performing a V-Y advancement flap, the flap advances because:
- The flap is stretched under tension
- Subcutaneous tissue attachments allow forward movement when the triangular skin island is advanced (Correct answer)
- The flap is rotated along an arc
- Adjacent tissue is excised to allow movement
Correct answer: Subcutaneous tissue attachments allow forward movement when the triangular skin island is advanced
The V-Y flap advances on its subcutaneous pedicle; cutting the skin in a V and advancing the island forward closes the defect, converting the donor site to a Y.
Question 6: The most reliable recipient vessels for free flap anastomosis in head and neck reconstruction are typically:
- Temporal superficial vessels
- Facial artery and external jugular vein or internal jugular tributaries (Correct answer)
- Occipital vessels
- Lingual vessels
Correct answer: Facial artery and external jugular vein or internal jugular tributaries
The facial artery and venous tributaries of the external or internal jugular system provide consistent caliber and accessibility for microsurgical anastomosis in the head and neck.
Question 7: Tissue expansion works primarily through which biological mechanism to generate new skin?
- Stretching existing collagen without cell division
- Mechanical creep initially followed by biological tissue growth (mitosis) with sustained expansion (Correct answer)
- Migration of keratinocytes from wound edges
- Increased dermal thickness due to edema
Correct answer: Mechanical creep initially followed by biological tissue growth (mitosis) with sustained expansion
Initial expansion relies on mechanical creep and stress relaxation, but sustained expansion stimulates epidermal mitosis and dermal collagen remodeling to generate true new tissue.
ASPS Reconstructive Surgery Principles & Techniques 3
Which type of skin graft provides the best color and texture match for facial reconstruction?