Reconstructive

1304)  Which of following statements regarding the submental flap is TRUE?

A. The submental flap is based in the facial artery and vein
B. The submental flap can be harvested as fascio-cutaneous or musculo-cutaneous design only - no osteo-cutaneous design possible.
C. The cutaneous paddle can be designed up to 5 cm wide
D. The submental flap can include strips of mylohyoid and anterior digastric muscle.
E. The cervical defect is closed by secondary intention healing.

REFERENCES & ANSWER





Revenaugh P.C., Shipchandler T. Z., Burkey B.B., Microvascular and Regional Flaps in Head and Neck Reconstruction chapter 51 in Facial Plastic and Reconstructive Surgery (Papel Ira D.,editor), Fourth Edition, Thieme, 2016, pp. 650-677





1304) D    The submental flap can include strips of mylohyoid and anterior digastric muscle.

Reconstructive

1301) Which of the following statements regarding the submental flap used for oncological oral cavity reconstruction  is TRUE?

A. The submental flap is contraindicated in patients with clinical or radiological evidence of Level I metastatic disease.
B. It is based with the facial artery and vein
C. the donor site rarely can be closed primarily
D. The submental flap is associated with a similar length of operation than a radial free flap.
E. The survival of the flap is approximately 80%




REFERENCES & ANSWER





Howard B. E., Nagel T. H., Donald C. B., Hinni M. L., Hayden R. E.: Oncologic Safety of the Submental Flap for Reconstruction in Oral Cavity Malignancies, Otolaryngology-Head and Neck Surgery 2014, Vol. 150 (4)558-562




1301) A     The submental flap is contraindicated in patients with clinical or radiological evidence of Level I metastatic disease.

Reconstructive

1287) The supraclavicular artery island flap is MOST commonly used in the repair of defects related to

A. Lip reconstruction.
B. Esophagus
C. Temporal bone resection
D. Floor of the mouth oral cavity reconstruction
E. Cervico-facial cutaneous reconstruction




REFERENCES & ANSWER




1287) E     Cervico-facial cutaneous reconstruction


Reference: Kokot N., Mazhar K, Reder L. S., Peng G. L. , Sinha U. K.: Use of Supraclavicular Artery Island Flap for Reconstruction of Cervicofacial Defects, Otolaryngology-Head and Neck Surgery 2014, Vol. 150(2), 222-228

Kokot N, Mazhar K, Reder LS, Peng GL, Sinha UK: The supraclavicular artery island flap in head and neck reconstruction: applications and limitations, JAMA Otolaryngol Head Neck Surg. 2013 Nov;139(11):1247-55.

Reconstructive

1285) Which of following statements regarding the Infrahyoid Myocutaneous Flap (IHMCF) is TRUE?

A. It is ideal for intraoral "large-sized" defects following oncological resection.
B. Its major blood supply is from the inferior thyroid artery
C. Microvascular anatomosis is required.
D. Total flap necrosis, marginal skin paddle necrosis, and total skin paddle loss are as high as 20%.
D. The surgical defect can usually be closed primarily.





REFERENCES & ANSWER





1285) E     The surgical defect can usually be closed primarily.


Peng Hanwei, Wang S. J.,  Yang Xihong, Guo Haipeng, Liu Muyuan: Infrahyoid Myocutaneous Flap for Medium-Sized Head and Neck Defects: Surgical Outcome and Technique Modification Diode, Otolaryngology-Head and Neck Surg., 2013, Vol. 148 (1), pp.47-53

Reconstructive

950) Which of the following events is MOST commonly associated with the Superior Trapezius Flap?

A. Infection
B. Necrosis
C. Dehiscence
D. Venous Congestion
E. Limited Arc of Rotation






REFERENCES & ANSWERS






Aviv J. E., Urken M. L., Lawson W., Biller H. F.: The Superior Trapezius Myocutaneous Flap in Head and Neck Reconstruction, Arch. Otolaryngology-Head and Neck Surgery, July 1992, Vo. 118, pp. 702-706

Annino Jr. D. J., Shu R. S.: Musculocutaneous Flaps in Chapter 46 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D. ,editor), 2002, pp. 560-566




950) E     Limited Arc of Rotation

Reconstructive

978) Which of the following represents an INCORRECT relationship between flap and blood supply?

A. Rectus Myocutaneous Free Flap / Deep Superior Epigastric Vessels
B. Forehead Flap / Supraorbital and Supratrochlear Arteries
C. Latissimus Dorsi Flap / Thoracodorsal Artery
D. Deltopectoral Flap / Internal Mammary Arteries
E. Lateral Arm Free Flap / Posterior Radial Collateral Artery




REFERENCES & ANSWER



Burkey B.B., Coleman Jr., J. R.: Microvascular Flaps, Chapter 47 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, pp.578-560, 2002

Burkey B. B., Schmalbach C. E., Coleman Jr. J. R.: Microvascular Flaps, Chapter 57 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, pp. 765-793, 2009





978) A         Rectus Myocutaneous Free Flap / Deep Superior Epigastric Vessels

Reconstructive

935) Which of the following flaps is the MOST USEFUL for reconstruction after Total Glossectomy?

A. Lateral Trapezius Island Myocutaneous Flap
B. Latissimus Dorsi Free Flap
C. Pectoralis Major Musculocutaneous Flap
D. Radial Forearm Free Flap
E. Superficial Temporal Parietal Fascia flap




REFERENCES & ANSWER




Haughey B. H.: Tongue Reconstruction: Concepts and Practice, Laryngoscope 103, Oct. 1993, pp. 1132-1141

Burkey B. B., Coleman Jr. J. R.: Microvascular Flaps, Chapter 47 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), 2002, pp. 567-590

Burkey B. B., Schmalbach C. E, Coleman Jr. J. R.: Microvascular Flaps, Chapter 57 in Facial Plastic and Reconstructive Surgery, (Papel I. D., editor), 2009, pp. 765-793




935) B             Latissimus Dorsi Free Flap

Reconstructive

933) Which of the following reconstructive flaps is THE BEST CHOICE after wound breakdown with exposed major neck vessels post radical neck dissection and radiation therapy?

A. Deltopectoral flap
B. Lateral trapezius flap
C. Lower trapezius flap
D. Superior trapezius flap
E. Temporalis muscle flap




REFERENCES & ANSWER




Aviv J. E., Urken M. L., Lawson W., Biller H. F.: The Superior Trapezius Myocutaneous Flap in Head and Neck Reconstruction, Arch. Otolaryngology-Head and Neck Surgery, July 1992, Vo. 118, pp. 702-706

Annino Jr. D. J., Shu R. S.: Musculocutaneous Flaps in Chapter 46 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D. ,editor), 2002, pp. 560-566

Annino Jr. D. J., Shu R. S., Gold D. R.: Musculocutaneous Flaps in Chapter 56 in Facial Plastic and Reconstructive Surgery, Second Edition, (Papel I. D. ,editor), 2009, pp. 757-764




933) D               Superior trapezius flap

Reconstructive

911) Which of the following statements regarding the flap below is FALSE?

A. It is based on branches of the Internal Mamary Arterial System.
B. It is perfused predominately by the first Internal Mamary Artery.
C. 2/3 of the medial aspect is an Axial Flap, and the distal third is a Random Flap.
D. The Deltoid and Pectoralis fascias are included in the flap.
E. It is designed with a length/width ratio of 2.5:1 to be used without delay.




REFERENCES & ANSWER



Sessions D. G., Cummings C.W., Weymuller E. A.Jr , Makielski K. H., Wood P.: Atlas of Access & Reconstruction in Head & Neck Surgery, 1992, pp.230-232

Baker S. R.: Malignant Neoplasms of the Oral Cavity, Chapter 73 in Otolaryngology-Head and Neck Surgery, (Cummings, Fredrickson, Harker, Krause, Schuller, editors), Second Edition, 1993, pp. 1248-1305



911) B              It is perfused predominately by the first Internal Mamary Artery.

Reconstructive

881) Which of the following statements about the Musculocutaneous Flap Technique shown below is TRUE?

A. Its blood supply is based on the transverse cervical and dorsal scapular arteries.
B. It is the most reliable of three flap designs.
C. Its blood supply can be compromised by a previous neck dissection.
D. It is usually designed as an island musculocutenous Flap.
E. It is always closed primarily, but will require wide undermining.




REFERENCES & ANSWER


Annino Jr. D. J. , Shu R. S.: Musculocutaneous Flaps, Chapter 46 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, 2002, p. 560-566

Annino Jr. D. J. , Shu R. S. Gold D. R.: Musculocutaneous Flaps, Chapter 56 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, 2009, p. 757-764


881) B           It is the most reliable of three flap designs.

Reconstructive

786) Which of the following techniques use a semicircular rotational myocutaneous flap from the lateral canthal region to repair a lower or upper eyelid defect of up to 50% of the eyelid margin?

A. Primary closure associated with Lateral Canthotomy and Inferior Cantholysis
B. Tenzel Technique
C. Hughes Technique
D. Cutler-Beard Technique
E. Leone Technique




REFERENCES & ANSWER


Kaltreider S. A.: Periocular Reconstruction, Chapter 52 in Facial Plastic and Reconstructive Surgery (Papel I, editor), second edition, 2002, pp. 646-659

Kaltreider S. A.: Periocular Reconstruction, Chapter 62 in Facial Plastic and Reconstructive Surgery (Papel I, editor), Third edition, 2009, pp. 855-867


786) B       Tenzel Technique

Reconstructive

700) Which of the following statements about the Lower Trapezius Island Musculocutaneous Flap is TRUE?

A. It is a large flap but the arc of rotation is limited.
B. It is supplied by the occipital artery and the posterior intercostal vessels.
C. An arteriogram to evaluate vascular patency is mandatory prior to its execution.
D. It is used for the lateral skull, anterior and lateral neck and oral cavity and face.
E. Usually skin grafting or a local flap is necessary for closing the donor site.




REFERENCES & ANSWER


Urken M.L, Naidu R. K., Lawson W., Biller H.F.: The Lower Trapezius Island Musculocutaneous Flap Revisited, Report of 45 Cases and a Unifying Concept of the Vascular Supply, Arch. Otolaryngology Head Neck Surgery, Vol. 117, May 1991, pp.502-511



700) D         It is used for the lateral skull, anterior and lateral neck and oral cavity and face.

Reconstructive

666) Which of the following statements about the Sternocleidomastoid Muscle Flap is FALSE?

A. It can be used for repair of cheek defects.
B. Superiorly it is perfused by branches of the Occipital Artery.
C. It is critical to include at least two vessels to have a reliable axial-patterned flap
D. It is innervated by the Spinal Accessory Nerve.
E. It can only be used if it is superiorly based.




REFERENCES & ANSWER


Shindo M. L., Sullivan M. J.: Muscular and Myocutaneous Pedicled Flaps, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, no. 1, February 1994, pp. 161-172


666) E        It can only be used if it is superiorly based.

Reconstructive

665) Which of the following represents THE PERCENTAGE of a muscle atrophy occurring after muscular flap transfer?

A. 5%
B. 10%
C. 20%
D. 30%
E. 40%




REFERENCES & ANSWER



Shindo M. L., Sullivan M. J.: Muscular and Myocutaneous Pedicled Flaps, Soft Tissue Augmentation and Reconstruction in the Head and Neck, Otolaryngologic Clinics of North America, Vol. 27, no. 1, February 1994, pp. 161-172



665) E          40%

Reconstructive

657) Which of the following statements about the superior trapezius flap is TRUE?

A. It is the least reliable of the three trapezius flaps.
B. Its blood supply is from the transverse and dorsal scapular arteries.
C. Its blood supply is compromised by a previous neck dissection.
D. It is a reliable flap for coverage of exposed major neck vessels after radiation therapy.
E. It is not a reliable flap to be used when neck wounds are infected.




REFERENCES & ANSWER



Annino Jr. D.J., Shu R. S.: Chapter 46 Musculocutaneous Flaps, Facial Plastic and Reconstructive Surgery, (Papel I.D., editor), 2002, pp. 560-566

Annino Jr. D.J., Shu R. S., Gold D. R.: Chapter 56 Musculocutaneous Flaps, Facial Plastic and Reconstructive Surgery, (Papel I.D., editor), 2009, pp. 757-764

Aviv J. E., Urken M. L., Lawson W.. Biller H. F.: The Superior Trapezius Myocutaneos Flap in Head and Neck Reconstruction, Arch. Otolaryngology Head Neck Surgery, Vol. 118, July 1992, pp. 702-706



657) D       It is a reliable flap for coverage of exposed major neck vessels after radiation therapy.

Reconstructive

283) Which statement regarding the Latissimus Dorsi Musculocutaneous Flap is FALSE?

A. Lateral decubitus position is necessary for harvesting.
B. It has an axial blood supply from the thoracodorsal artery.
C. The thoracodorsal nerve innervates the latissimus dorsi muscle.
D. The skin paddle width can reach more than 10 cm.
E. Primary closure is always possible even in large skin paddle defects.




REFERENCES & ANSWER



Annino Jr. D. J., Shu R.S.: Musculocutaneous Flaps, Chapter 46 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p.p. 564-565, 2002

Annino Jr. D. J., Shu R.S., Gold D. R.: Musculocutaneous Flaps, Chapter 56 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p.p. 757-764, 2009



283) E      Primary closure is always possible even in large skin paddle defects.

Reconstructive

282) Which of the following Pedicle Flaps has the LARGEST AREA of tissue transfer and the GREATEST REACH of any regional flap?

A. Pectoralis Major Flap
B. Bakamjian Flap
C. Temporalis Muscle Flap
D. Trapezius Flap
E. Latissimus Dorsi Flap




REFERENCES & ANSWER



Annino Jr. D. J., Shu R.S.: Musculocutaneous Flaps, Chapter 46 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p.p. 564-565, 2002

Annino Jr. D. J., Shu R.S., Gold D. R.: Musculocutaneous Flaps, Chapter 56 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p.p. 757-764, 2009


282) E        Latissimus Dorsi Flap

Reconstructive

279) Which is the following statements regarding the Trapezius Myocutaneous Flap is TRUE?

A. The lateral trapezius island myocutaneous flap is the most reliable of the three trapezius flaps.
B. The superior trapezius myocutaneous flap is the least reliable of the three trapezius flaps.
C. The superior trapezius myocutaneous flap is not compromised by neck dissection.
D. The lateral trapezius island is based on the paraspinous perforator arteries.
E. The lower trapezius island myocutaneous flap will require skin grafting for closure of the donor site.




RECONSTRUCTIVE & ANSWER



Annino Jr. D. J., Shu R.S.: Musculocutaneous Flaps, Chapter 46 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Second Edition, p.p. 562-563, 2002

Annino Jr. D. J., Shu R.S., Gold D. R.: Musculocutaneous Flaps, Chapter 56 in Facial Plastic and Reconstructive Surgery (Papel, editor), Thieme, Third Edition, p.p. 757-764, 2009



279) C        The superior trapezius myocutaneous flap is not compromised by neck dissection.