ABPS Surgical Anatomy & Reconstructive Techniques — Questions and Answers

Question 1: Which artery supplies the majority of blood to the latissimus dorsi muscle?

Subscapular artery
Thoracodorsal artery (Correct answer)
Axillary artery
Circumflex scapular artery

Correct answer: Thoracodorsal artery

The thoracodorsal artery is the dominant vascular supply to the latissimus dorsi muscle, branching off the subscapular artery. This robust blood supply makes the latissimus dorsi a highly reliable muscle for pedicled or free flap reconstruction in plastic surgery. Its consistent anatomy is crucial for successful tissue transfer.

Question 2: What is the most important landmark when planning a TRAM flap?

Linea alba
Inguinal ligament
Rectus abdominis muscle (Correct answer)
External oblique muscle

Correct answer: Rectus abdominis muscle

When planning a Transverse Rectus Abdominis Myocutaneous (TRAM) flap for breast reconstruction, the rectus abdominis muscle is the most important landmark because the flap is based on perforator vessels that run through this muscle. The integrity and vascular supply of the rectus abdominis are critical for the viability of the transferred tissue. Careful dissection around this muscle ensures adequate blood flow to the flap while minimizing abdominal wall morbidity.

Question 3: What nerve must be preserved during a facelift to prevent lip droop?

Buccal branch
Zygomatic branch
Marginal mandibular branch (Correct answer)
Temporal branch

Correct answer: Marginal mandibular branch

The marginal mandibular branch of the facial nerve innervates the depressor anguli oris and depressor labii inferioris muscles, which are responsible for depressing the corner of the mouth and the lower lip. Injury to this nerve during a facelift can lead to an asymmetrical smile or lip droop on the affected side. Surgeons must meticulously identify and preserve this nerve to avoid such complications.

Question 4: Which muscle is typically used in pedicled flap breast reconstruction?

Pectoralis major
Latissimus dorsi (Correct answer)
Deltoid
Serratus anterior

Correct answer: Latissimus dorsi

The latissimus dorsi muscle is commonly used in pedicled flap breast reconstruction due to its reliable blood supply (thoracodorsal artery) and sufficient tissue volume. It can be rotated from the back to the chest to create a new breast mound, either alone or in combination with an implant. This flap provides a natural-feeling reconstruction with good aesthetic outcomes.

Question 5: What is the key structural difference between full-thickness and split-thickness skin grafts?

Inclusion of subcutaneous fat
Presence of epidermis only
Thickness of the dermal component (Correct answer)
Presence of fascia

Correct answer: Thickness of the dermal component

The key structural difference between full-thickness and split-thickness skin grafts lies in the amount of dermis included. A split-thickness graft contains the epidermis and only a portion of the dermis, making it thinner and more fragile but easier to harvest and take. A full-thickness graft includes the entire epidermis and dermis, providing better cosmetic results, less contraction, and more durability, but it requires a more precise donor site closure.

Question 6: What structure should be carefully avoided during rhinoplasty?

Upper lateral cartilages (Correct answer)
Nasal spine
Maxillary crest
Anterior nasal aperture

Correct answer: Upper lateral cartilages

During rhinoplasty, the upper lateral cartilages are crucial for maintaining the structural integrity of the middle vault of the nose and ensuring proper airflow. Over-resection or damage to these cartilages can lead to an inverted V deformity, nasal valve collapse, and breathing difficulties. Surgeons must carefully preserve or reconstruct these structures to achieve both aesthetic and functional success.

Question 7: Which flap is most commonly used in head and neck reconstruction?

Pectoralis major flap
Radial forearm free flap (Correct answer)
Latissimus dorsi flap
Gracilis flap

Correct answer: Radial forearm free flap

The radial forearm free flap is widely considered the workhorse flap for head and neck reconstruction due to its versatility, thin and pliable tissue, and reliable vascular pedicle. It provides excellent tissue for lining defects, covering external wounds, and reconstructing complex three-dimensional structures. Its consistent anatomy and ease of harvest make it a preferred choice for many reconstructive challenges in this region.

Question 8: What type of graft is best for fingertip reconstruction with bone exposure?

Z-plasty
Cross-finger flap (Correct answer)
Split-thickness skin graft
Full-thickness skin graft

Correct answer: Cross-finger flap

For fingertip reconstruction with bone exposure, a cross-finger flap is often the preferred choice because it provides well-vascularized, sensate skin from an adjacent finger. This flap offers durable coverage, protects the exposed bone, and can restore some sensation to the injured fingertip. Split-thickness and full-thickness grafts are generally not sufficient when bone is exposed due to their lack of bulk and poor vascularity.

Question 9: Which anatomical structure forms the base of the anatomical snuffbox?

Trapezium
Lunate
Scaphoid (Correct answer)
Capitate

Correct answer: Scaphoid

The anatomical snuffbox is a triangular depression on the radial side of the wrist, visible when the thumb is extended. Its floor is formed primarily by the scaphoid bone, along with the trapezium distally. The scaphoid is a critical carpal bone, and its location within the snuffbox makes it palpable, which is clinically significant for diagnosing scaphoid fractures.

ABPS Surgical Anatomy & Reconstructive Techniques

Which artery supplies the majority of blood to the latissimus dorsi muscle?