Plastic and Reconstructive Surgery Practice Questions

Q: A patient was brought to the emergency department following a road traffic accident. Skin grafting was done wherein the graft was taken from the same person. Which type of graft is it?

Autograft. ***Autograft*** - An **autograft** is a type of graft where tissue is transplanted from one site to another on the **same individual**, which matches the clinical scenario described. - This is the most common type of skin graft because there is no risk of an **immunological rejection** by the recipient's body, as the tissue is genetically identical. *Xenograft* - A **xenograft** (or heterograft) involves the transplantation of tissue between individuals of **different species**, such as using pig skin for a temporary burn dressing on a human. - This is incorrect as the graft was taken from the patient themselves, not from an animal source. *Allograft* - An **allograft** (or homograft) is a graft of tissue between two genetically **non-identical individuals** of the **same species**, such as a cadaveric skin graft. - This is not the correct answer because the donor and recipient are the same person, not two different people. *Isograft* - An **isograft** (or syngeneic graft) is a tissue transplant between two genetically **identical individuals**, specifically **identical twins**. - While isografts also avoid immune rejection, this is incorrect because the graft was from the patient's own body, not from their identical twin.

Q: Cleft lip primary muscle repair is required in which of the following muscles?

Orbicularis oris. ***Orbicularis oris*** - The **orbicularis oris** muscle forms the main sphincter of the mouth and is interrupted in a cleft lip. Repair involves meticulous anatomical realignment of this muscle for correct function and appearance. - Dysfunction of this muscle in unrepaired cleft lip leads to **vermilion deficiency**, **cupid's bow distortion**, and poor feeding/speech. *Orbicularis oculi* - This muscle surrounds the eye and is responsible for blinking and closing the eyelid; it is not primarily affected in a standard cleft lip. - Though part of the facial musculature, its involvement is secondary, mainly due to potential nerve injury during extensive **craniofacial procedures**, not cleft lip repair. *Levator palpebrae superioris* - This muscle elevates the upper eyelid and is innervated by the **oculomotor nerve (CN III)**. It is not involved in cleft lip pathology or repair. - Its function is essential for vision, and damage results in **ptosis**, a concern unrelated to primary lip closure. *Masseter* - The masseter is a powerful muscle of mastication, innervated by the **trigeminal nerve (CN V)**. It is located in the cheek and is not part of the required functional repair for a cleft lip. - Its primary role is in **jaw closure (chewing)**, and its integrity is preserved during standard cleft lip repair procedures.

Q: Identify the procedure shown in the image.

Dog ear excision. ### **Explanation: Dog Ear Excision** **1. Why the Correct Answer is Right:** A **"Dog ear"** (also known as a cone or cutaneous redundancy) occurs during the closure of a circular or elliptical wound when one side of the wound is longer than the other, or when the closure angle is too obtuse. This results in a **puckered elevation of skin** at the ends of the suture line. * **The Procedure:** To correct this, the surgeon extends the incision slightly, creates a small triangular flap of the redundant tissue, and excises it to allow the skin to lie flat. This converts the wound into a slightly longer, but aesthetically pleasing, linear scar. **2. Why the Other Options are Wrong:** * **Keloid Excision:** Keloids are firm, rubbery lesions that extend beyond the boundaries of the original wound. Excision involves removing the entire bulk of hypertrophic tissue, often followed by adjuvant therapy (like intralesional steroids) to prevent recurrence. * **Z-plasty:** This is a transposition flap technique used to **lengthen a scar** or change its direction to align with Relaxed Skin Tension Lines (RSTLs). It involves creating two triangular flaps that are transposed. * **Transposition Flap:** This involves moving a flap of skin and subcutaneous tissue over an incomplete bridge of intact skin to a nearby defect (e.g., Limberg flap). It does not specifically address the puckering seen at the ends of a simple closure. **3. High-Yield Clinical Pearls for INI-CET:** * **Prevention:** To avoid dog ears, the length of an elliptical incision should ideally be **3 times its width**, and the apical angle should be **less than 30 degrees**. * **Rule of Halves:** When suturing, always start at the center of the wound and bisect the remaining segments to distribute tension evenly and minimize the risk of dog ears. * **Mnemonic:** Dog ears are most common in **convex surfaces** (like the scalp or nose) where skin tension is non-uniform.

Q: A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:

Painless scar. ***Painless scar*** - Marjolin's ulcer, which develops on a chronic wound or scar, is typically associated with **pain**, tenderness, and rapid growth after latency. - A painless scar is characteristic of a **benign healed wound**, not a malignant transformation like Marjolin's ulcer. *Cured by surgery* - **Surgical excision** with wide margins is the primary and most effective treatment for Marjolin's ulcer. - This procedure aims to remove all cancerous tissue and achieve clear margins, leading to a potential cure. *Lymphatic metastasis* - Marjolin's ulcer, being a type of **squamous cell carcinoma**, has a significant propensity for **lymphatic spread**. - Regional lymph node involvement is common and impacts both staging and prognosis. *Represents malignant transformation* - The description of an **ulcer at a previous burn site** is the classic presentation of a Marjolin's ulcer. - This represents **malignant transformation** of chronic wounds, scars, or ulcers, most commonly squamous cell carcinoma.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - A **hand-held dermatome** with a long flat blade and an **adjustable calibrated roller/guard** that controls the thickness of the harvested graft. - Specifically designed for **freehand harvesting** of split-thickness skin grafts with precise depth control, making it the primary instrument for this procedure. *Mesher* - A **skin meshing device** used **after graft harvesting** to create perforations and expand the graft for better coverage. - Does not harvest skin grafts but rather processes already harvested grafts to create a mesh pattern. *Eschmann blade* - A type of **dermatome blade** used in powered dermatomes, not a standalone instrument for split skin grafting. - Requires a **motorized dermatome system** to function, unlike the hand-held Humby's knife. *Down's blade* - Another type of **dermatome blade** designed for use with specific dermatome systems. - Like the Eschmann blade, it is a **component blade** rather than a complete harvesting instrument like Humby's knife.

Q: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Humby's knife. ***Humby's knife*** - The image clearly depicts a **Humby's knife**, which is a type of **manual dermatome** used to harvest split-thickness skin grafts. - This instrument is characterized by its adjustable blade and roller, allowing for collection of skin grafts of varying thicknesses. *Mesher* - A **mesher** is an instrument used to create fenestrations or small slits in a skin graft, allowing it to stretch and cover a larger wound area. - The instrument in the image is designed for harvesting, not for meshing. *Watson's knife* - **Watson's knife** is another type of manual dermatome used for harvesting split-thickness skin grafts. - While similar in purpose to Humby's knife, Watson's knife has distinct design features and the instrument shown in the image is specifically a Humby's knife. *Blair knife* - **Blair knife** is a different type of skin grafting knife, typically used for full-thickness skin graft harvesting. - The instrument in the image has the characteristic roller and adjustable blade design of a Humby's knife, not a Blair knife.

Q: Identify this instrument which is used for harvesting graft from a healthy area in split skin grafting:

Humby's knife. ***Humby's knife*** - The image shown is a **Humby's knife**, which is a type of **hand-held dermatome** used for harvesting split-thickness skin grafts. - It utilizes an adjustable roller to control the thickness of the graft. *Brown's dermatome* - **Brown's dermatome** (also known as a **drum dermatome**) is a mechanical, hand-held, electrically-powered dermatome. - It uses an oscillating blade and is more precise for very thin grafts but is not the instrument pictured. *Catlin amputating knife* - A **Catlin amputating knife** is a long, narrow knife primarily used for **amputations**, designed for cutting through tissue and muscle, not for skin grafting. - It has a distinct shape and purpose different from the instrument in the image. *Silver's knife* - **Silver's knife** is another type of blade used in surgery, often associated with a specific cutting technique or for specialized tissue dissection. - It is not a dermatome used for harvesting large split-thickness skin grafts.

Q: A Wolfe graft is a

Large full thickness skin graft. ***Large full thickness skin graft*** - A **Wolfe graft** is a type of **large full-thickness skin graft** that includes the epidermis and entire dermis. - Due to its full thickness, it provides better cosmetic results and less contracture compared to split-thickness grafts, but requires optimal **vascularization** at the recipient site. - The term "Wolfe graft" specifically refers to the **large size** of the full-thickness graft, distinguishing it from smaller grafts. *Partial thickness skin graft* - A **partial-thickness skin graft** (also known as a split-thickness skin graft) includes the epidermis and only a portion of the dermis. - While easier to harvest and more likely to **take** in less ideal recipient beds, they are known for more contraction and a less cosmetic appearance. *Pinch skin graft* - A **pinch graft** is a small, conical piece of skin, including the epidermis and dermis, taken by pinching the skin. - These grafts are generally less aesthetically pleasing, have limited applications, and are often used for small, non-cosmetic defects. *Pedicle graft* - A **pedicle graft** (or flap) is a section of tissue that remains attached to its original site at one or more points, maintaining its own **blood supply**. - Unlike a free graft, it is not completely detached from the donor site, allowing for transfer of more complex tissues like muscle or bone.

Question 1

A patient underwent split-thickness skin grafting for a burn injury on the arm. On post-operative day 6, he develops stiffness of the arm during physiotherapy. What is the most appropriate next step in management?

Accepted Answer

Passive extension of the joint under direct visualization of the graft

Answer

Continue physiotherapy without intervention

Answer

Surgical excision of contracture

Answer

Remove the graft and regraft the area

Question 2

A patient was brought to the emergency department following a road traffic accident. Skin grafting was done wherein the graft was taken from the same person. Which type of graft is it?

Accepted Answer

Autograft

Answer

Isograft

Answer

Xenograft

Answer

Allograft

Question 3

Cleft lip primary muscle repair is required in which of the following muscles?

Accepted Answer

Orbicularis oris

Answer

Levator palpebrae superioris

Answer

Orbicularis oculi

Answer

Masseter

Question 4

Identify the procedure shown in the image.

Accepted Answer

Dog ear excision

Answer

Keloid excision

Answer

Z plasty

Answer

Transposition flap

Question 5

What is a true statement about Z plasty?

Accepted Answer

To increase length

Answer

It is a type of split-thickness skin graft

Answer

Zigzag suturing

Answer

Flap turning

Question 6

A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:

Accepted Answer

Painless scar

Answer

Cured by surgery

Answer

Lymphatic metastasis

Answer

Represents malignant transformation

Question 7

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Eschmann blade

Answer

Down's blade

Question 8

The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)

Accepted Answer

Humby's knife

Answer

Mesher

Answer

Watson's knife

Answer

Blair knife

Question 9

Identify this instrument which is used for harvesting graft from a healthy area in split skin grafting:

Accepted Answer

Humby's knife

Answer

Brown's dermatome

Answer

Catlin amputating knife

Answer

Silver's knife

Question 10

A Wolfe graft is a

Accepted Answer

Large full thickness skin graft

Answer

Partial thickness skin graft

Answer

Pinch skin graft

Answer

Pedicle graft

Plastic and Reconstructive Surgery — MCQs

Plastic and Reconstructive Surgery — MCQs

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