ABPS Surgical Anatomy & Reconstructive Techniques 4 — Questions and Answers
Question 1: The blood supply to a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is based on which vessels?
- Deep inferior epigastric vessels
- Superior epigastric vessels (Correct answer)
- Superficial inferior epigastric vessels
- Internal mammary perforators
Correct answer: Superior epigastric vessels
The pedicled TRAM flap is based on the superior epigastric vessels, which are the terminal continuation of the internal mammary artery.
Question 2: Which anatomical structure passes through the carpal tunnel along with the nine flexor tendons?
- Ulnar nerve
- Radial nerve
- Median nerve (Correct answer)
- Palmar cutaneous branch of the median nerve
Correct answer: Median nerve
The median nerve passes through the carpal tunnel along with the four tendons of flexor digitorum superficialis and four of flexor digitorum profundus and the flexor pollicis longus.
Question 3: A Z-plasty with limbs at 60-degree angles theoretically increases the length of the central limb by approximately:
- 25%
- 50%
- 75% (Correct answer)
- 100%
Correct answer: 75%
A 60-degree Z-plasty provides approximately 75% lengthening of the central limb and is the most commonly used angle in clinical practice.
Question 4: During parotidectomy, the facial nerve is most reliably identified at which landmark?
- Tragal pointer (tragal cartilage pointer) (Correct answer)
- Posterior belly of the digastric muscle
- Tympanomastoid suture line
- Stylomastoid foramen directly
Correct answer: Tragal pointer (tragal cartilage pointer)
The tragal pointer is a reliable landmark where the main trunk of the facial nerve lies approximately 1 cm deep and inferior to the tip of the tragal cartilage.
Question 5: In hand surgery, the Camper chiasm refers to the anatomical arrangement of which tendons at the level of the proximal phalanx?
- Extensor digitorum splitting around the lateral bands
- Flexor digitorum superficialis splitting to allow passage of flexor digitorum profundus (Correct answer)
- Lumbrical tendons joining the extensor expansion
- Interosseous tendons merging at the base of the proximal phalanx
Correct answer: Flexor digitorum superficialis splitting to allow passage of flexor digitorum profundus
Camper's chiasm is the decussation where the flexor digitorum superficialis splits into two slips around the FDP tendon at the level of the proximal phalanx.
Question 6: The superior gluteal artery perforator (SGAP) flap is particularly advantageous over the DIEP flap in which patient population?
- Obese patients with large pannus
- Thin patients with insufficient abdominal tissue (Correct answer)
- Patients with prior C-section scars
- Smokers requiring delayed reconstruction
Correct answer: Thin patients with insufficient abdominal tissue
The SGAP flap is preferred in thin patients who lack sufficient abdominal tissue for a DIEP flap, as the gluteal region provides an alternative fat source.
Question 7: What is the primary advantage of a keystone island perforator flap over a standard random-pattern advancement flap?
- It requires no skin incisions
- Named perforators provide reliable axial blood supply allowing larger flap dimensions (Correct answer)
- It can be used without subcutaneous tissue
- It does not require a donor site closure
Correct answer: Named perforators provide reliable axial blood supply allowing larger flap dimensions
The keystone flap is designed around named perforators, providing an axial blood supply that allows larger flap dimensions compared to random-pattern flaps limited by length-to-width ratios.
ABPS Surgical Anatomy & Reconstructive Techniques 4
The blood supply to a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is based on which vessels?