Plastic and Reconstructive Surgery — MCQs
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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?
Cleft lip primary muscle repair is required in which of the following muscles?
Identify the procedure shown in the image.
What is a true statement about Z plasty?
A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:
The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)
The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)
A Wolfe graft is a
Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except
The best cure rates for keloids are achieved by:
Plastic and Reconstructive Surgery Indian Medical PG Practice Questions and MCQs
Question 161: 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?
- A. Isograft
- B. Autograft (Correct Answer)
- C. Xenograft
- D. Allograft
Explanation: ***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.
Question 162: Cleft lip primary muscle repair is required in which of the following muscles?
- A. Levator palpebrae superioris
- B. Orbicularis oris (Correct Answer)
- C. Orbicularis oculi
- D. Masseter
Explanation: ***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.
Question 163: Identify the procedure shown in the image.
- A. Dog ear excision (Correct Answer)
- B. Keloid excision
- C. Z plasty
- D. Transposition flap
Explanation: ### **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.
Question 164: What is a true statement about Z plasty?
- A. To increase length (Correct Answer)
- B. It is a type of split-thickness skin graft
- C. Zigzag suturing
- D. Flap turning
Explanation: ### **Explanation: Z-Plasty** **Z-plasty** is a versatile transposition flap technique used extensively in reconstructive surgery. It involves the creation of two triangular flaps of equal size that are transposed (swapped) to change the direction of a scar and gain length. #### **Why Option A is Correct** The primary biomechanical goal of a Z-plasty is **lengthening in the direction of the central limb**. When the two triangular flaps are transposed, the central limb of the "Z" rotates 90 degrees. This results in: * **Gain in length** along the axis of the original central limb. * **Contraction (shortening)** in the perpendicular axis. This makes it the gold standard for **releasing linear scar contractures** (e.g., across a joint or a burn web). #### **Why Other Options are Incorrect** * **Option B:** Z-plasty is a **local transposition flap**, not a skin graft. Flaps maintain their own blood supply, whereas grafts (split or full-thickness) rely on the recipient bed for nutrition. * **Option C:** While the final scar has a "zigzag" appearance, "zigzag suturing" is a vague descriptive term. The fundamental surgical principle is **transposition**, not just the suturing pattern. * **Option D:** "Flap turning" is imprecise. The specific movement is **transposition** (moving a flap across a bridge of intact skin to a new position). --- ### **High-Yield Clinical Pearls for INI-CET** * **The 60° Rule:** The standard Z-plasty uses **60° angles**. This provides a theoretical **75% increase in length**. * 30° angle $\rightarrow$ 25% length gain. * 45° angle $\rightarrow$ 50% length gain. * 75°+ angles are rarely used due to excessive tension and risk of tip necrosis. * **Indications:** Realigning scars with **Langer’s lines** (Relaxed Skin Tension Lines), breaking up linear scars to make them less visible, and releasing webbed contractures. * **Prerequisite:** There must be adequate **lateral skin laxity** to allow for the transposition.
Question 165: A patient presents with an ulcer at the site of a previous burn site. All are true about the lesion except:
- A. Painless scar (Correct Answer)
- B. Cured by surgery
- C. Lymphatic metastasis
- D. Represents malignant transformation
Explanation: ***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.
Question 166: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)
- A. Humby's knife
- B. Mesher (Correct Answer)
- C. Eschmann blade
- D. Down's blade
Explanation: ***Mesher*** - The image depicts a **skin mesher** with a harvested split-thickness skin graft being passed through it, resulting in the characteristic mesh pattern seen below. - A mesher creates perforations in the skin graft, which allows for expansion (covering a larger area), drainage of exudate, and improved graft take. *Humby's knife* - A **Humby's knife** is a type of dermatome (skin grafting knife) used to harvest freehand split-thickness skin grafts. - It does not produce the characteristic mesh pattern seen in the image. *Eschmann blade* - An **Eschmann blade** is a type of surgical blade, often used in specific dermatomes, but it is not the meshing machine itself. - It is used for harvesting, not for perforating skin grafts into a mesh. *Down's blade* - Similar to the Eschmann blade, a **Down's blade** is a type of dermatome blade used for harvesting skin grafts. - It does not perform the meshing function shown in the image.
Question 167: The following instrument used in split skin grafting is called: (Recent NEET Pattern 2016-17)
- A. Humby's knife (Correct Answer)
- B. Mesher
- C. Watson's knife
- D. Blair knife
Explanation: ***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.
Question 168: A Wolfe graft is a
- A. Partial thickness skin graft
- B. Pinch skin graft
- C. Pedicle graft
- D. Large full thickness skin graft (Correct Answer)
Explanation: ***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 169: Following radical surgery for the carcinoma of breast, reconstruction of the breast can be performed by using the following procedures except
- A. Silicone implants
- B. Transversus abdominis muscle flap (TRAM flap)
- C. Latissimus dorsi flap (LD flap)
- D. Deltopectoral flap (Correct Answer)
Explanation: ***Deltopectoral flap*** - The **deltopectoral flap**, also known as the Bakamjian flap, is primarily used for **head and neck reconstruction**, particularly for defects in the pharynx, esophagus, or oral cavity. - It involves tissue from the shoulder and chest wall, but its design and vascular supply make it unsuitable for **breast reconstruction** after radical mastectomy, which requires significantly more volume and different tissue characteristics. *Silicone implants* - **Silicone implants** are a common method for breast reconstruction, offering a less invasive option than flap procedures. - They are placed either beneath the pectoral muscle or subcutaneously to restore breast volume and shape. *Transversus abdominis muscle flap (TRAM flap)* - The **TRAM flap** is a widely used and versatile autologous tissue reconstruction method, utilizing tissue from the lower abdomen to create a new breast mound. - It can be either pedicled (retaining its original blood supply) or free (requiring microvascular anastomosis), providing a natural-feeling and long-lasting reconstruction. *Latissimus dorsi flap (LD flap)* - The **latissimus dorsi (LD) flap** involves transferring muscle, fat, and skin from the back to the chest to reconstruct the breast. - It is particularly useful for smaller breasts or when combined with an implant, and it can provide good aesthetic results with reliable blood supply.
Question 170: The best cure rates for keloids are achieved by:
- A. Intralesional excision followed by radiotherapy (Correct Answer)
- B. Intralesional injection of triamcinolone
- C. Surgical excision
- D. Localised irradiation
Explanation: ***Intralesional excision followed by radiotherapy*** - This combined approach offers the **highest cure rates** for keloids by removing the bulk of the lesion and then inhibiting fibroblast proliferation and collagen synthesis using radiation. - **Postoperative radiotherapy** significantly reduces the recurrence rate compared to excision alone, as keloids have a high tendency to recur. *Intralesional injection of triamcinolone* - While effective for some keloids, particularly smaller or flatter ones, **corticosteroid injections alone** have a lower long-term cure rate and are more often used for primary treatment or to reduce inflammation. - This method targets inflammation and fibroblast activity but may not fully prevent recurrence or completely flatten larger, more established keloids. *Surgical excision* - **Surgical excision alone** has a very high recurrence rate (up to 45-100%) for keloids because the removal of the keloid can itself trigger an exaggerated healing response. - It is rarely recommended as a monotherapy due to the significant risk of creating a larger or more aggressive keloid. *Localised irradiation* - **Radiotherapy alone** can be effective in some cases, particularly for preventing recurrence after excision, but it is generally not considered the primary treatment for an existing, bulky keloid. - Using radiation without prior excision might lead to incomplete regression and can be associated with side effects if the keloid is large.
Practice by Chapter
Wound Healing
Practice Questions
Skin Grafts
Practice Questions
Flap Surgery Principles
Practice Questions
Local Flaps
Practice Questions
Regional Flaps
Practice Questions
Microsurgical Techniques
Practice Questions
Tissue Expansion
Practice Questions
Breast Reconstruction
Practice Questions
Hand Surgery Basics
Practice Questions
Craniofacial Surgery Principles
Practice Questions
Aesthetic Surgery Concepts
Practice Questions
Body Contouring
Practice Questions
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