1
GENERAL PRINCIPLES / WOUND HEALING & FLAPS (Q1–20)
1. The primary blood supply to the nipple-areolar complex in reduction mammoplasty is
derived from which artery?
A. Thoracoacromial artery
B. Lateral thoracic artery
C. Internal mammary perforators
D. Subclavian artery
Answer: C — Internal mammary perforators provide the dominant vascular supply,
particularly in superior and medial pedicle techniques.
2. A full-thickness skin graft "takes" best on which type of recipient bed?
A. Exposed bone without periosteum
B. Well-vascularized muscle
C. Infected granulation tissue
D. Irradiated tissue
Answer: B — Adequate recipient bed vascularity is essential for graft survival through
plasmatic imbibition and inoculation.
3. The most common cause of early free flap failure is:
A. Arterial thrombosis
B. Venous thrombosis
C. Hematoma
D. Infection
Answer: B — Venous thrombosis is the leading cause of early flap compromise due to low-
pressure venous outflow obstruction.
4. Which suture material is preferred for microvascular anastomosis?
A. 3-0 Vicryl
B. 5-0 Prolene
C. 8-0 Nylon
D. 6-0 Chromic
Answer: C — 8-0 nylon provides optimal strength and minimal tissue reaction for
microsurgical vessel repair.
5. In the burn zone of stasis, the tissue:
A. Is irreversibly necrotic
B. Has reversible injury and may recover with resuscitation
C. Is completely normal
D. Requires immediate excision
Answer: B — The zone of stasis has impaired perfusion and may progress to necrosis but can
recover with appropriate resuscitation.
, 2
6. Which factor most strongly predicts poor wound healing?
A. Age over 60
B. Smoking
C. Male gender
D. Diabetes
Answer: B — Nicotine impairs microvascular perfusion and oxygen delivery, significantly
increasing wound complication risk.
7. The key advantage of perforator flaps is:
A. Shorter operative time
B. Reduced donor-site morbidity
C. Greater bulk than muscle flaps
D. No need for microsurgery
Answer: B — Perforator flaps spare underlying muscle, significantly reducing donor-site
morbidity.
8. Which flap is most commonly used for autologous breast reconstruction while
minimizing abdominal muscle morbidity?
A. Latissimus dorsi flap
B. TRAM flap
C. DIEP flap
D. Free fibula flap
Answer: C — The DIEP flap spares the rectus abdominis muscle, reducing donor site
morbidity while providing adequate tissue.
9. A key advantage of the DIEP flap over the TRAM flap is:
A. Inclusion of rectus muscle
B. Sparing the rectus abdominis muscle
C. Use of implant as adjunct
D. Being pedicled rather than free
Answer: B — DIEP uses perforators through the rectus without sacrificing muscle, reducing
donor-site morbidity.
10. For a full-thickness skin graft, what factor most strongly predicts graft "take"?
A. Donor site color match
B. Graft thickness >1.5 mm
C. Vascularity of the recipient bed
D. Suture technique
Answer: C — Adequate recipient bed vascularity is essential for graft survival.
11. Which is the most reliable flap for fingertip reconstruction?
A. Cross-finger flap
B. Thenar flap
, 3
C. V-Y advancement flap
D. Full-thickness skin graft
Answer: C — The V-Y flap allows direct closure with preservation of length, sensation, and
soft tissue coverage.
12. The primary goal of cleft lip repair is restoration of:
A. Skin coverage
B. Orbicularis oris continuity
C. Vermilion color
D. Nasal symmetry
Answer: B — Reestablishing orbicularis oris muscle continuity is essential for function and
aesthetic balance.
13. The "Rule of 10s" for primary cleft lip repair includes:
A. 2 kg weight, 8 weeks, Hb >9 g/dL
B. 5 kg weight, 3 weeks, Hb >10 g/dL
C. 10 weeks of age, 10 pounds (~4.5 kg), Hb >10 g/dL
D. 6 months of age only
Answer: C — The "Rule of 10s" (10 weeks, 10 pounds, Hb 10 g/dL) is the classic guideline for
timing primary cleft lip repair.
14. Which nerve is most commonly injured during rhytidectomy?
A. Marginal mandibular nerve
B. Buccal branch of facial nerve
C. Zygomatic branch
D. Temporal branch
Answer: A — The marginal mandibular nerve is vulnerable due to its superficial and variable
course near the mandible.
15. When performing a forehead lift, which nerve must be carefully preserved to prevent
brow paralysis?
A. Frontal branch of the facial nerve
B. Temporal branch of the facial nerve
C. Zygomatic branch of the facial nerve
D. Marginal mandibular branch
Answer: B — The temporal branch controls frontalis and brow elevation; injury can lead to
brow asymmetry and functional deficits.
16. The main advantage of using an endoscopic brow lift over a traditional open approach
is:
A. Longer-lasting results
B. Smaller incisions and faster recovery
C. Lower risk of hematoma
GENERAL PRINCIPLES / WOUND HEALING & FLAPS (Q1–20)
1. The primary blood supply to the nipple-areolar complex in reduction mammoplasty is
derived from which artery?
A. Thoracoacromial artery
B. Lateral thoracic artery
C. Internal mammary perforators
D. Subclavian artery
Answer: C — Internal mammary perforators provide the dominant vascular supply,
particularly in superior and medial pedicle techniques.
2. A full-thickness skin graft "takes" best on which type of recipient bed?
A. Exposed bone without periosteum
B. Well-vascularized muscle
C. Infected granulation tissue
D. Irradiated tissue
Answer: B — Adequate recipient bed vascularity is essential for graft survival through
plasmatic imbibition and inoculation.
3. The most common cause of early free flap failure is:
A. Arterial thrombosis
B. Venous thrombosis
C. Hematoma
D. Infection
Answer: B — Venous thrombosis is the leading cause of early flap compromise due to low-
pressure venous outflow obstruction.
4. Which suture material is preferred for microvascular anastomosis?
A. 3-0 Vicryl
B. 5-0 Prolene
C. 8-0 Nylon
D. 6-0 Chromic
Answer: C — 8-0 nylon provides optimal strength and minimal tissue reaction for
microsurgical vessel repair.
5. In the burn zone of stasis, the tissue:
A. Is irreversibly necrotic
B. Has reversible injury and may recover with resuscitation
C. Is completely normal
D. Requires immediate excision
Answer: B — The zone of stasis has impaired perfusion and may progress to necrosis but can
recover with appropriate resuscitation.
, 2
6. Which factor most strongly predicts poor wound healing?
A. Age over 60
B. Smoking
C. Male gender
D. Diabetes
Answer: B — Nicotine impairs microvascular perfusion and oxygen delivery, significantly
increasing wound complication risk.
7. The key advantage of perforator flaps is:
A. Shorter operative time
B. Reduced donor-site morbidity
C. Greater bulk than muscle flaps
D. No need for microsurgery
Answer: B — Perforator flaps spare underlying muscle, significantly reducing donor-site
morbidity.
8. Which flap is most commonly used for autologous breast reconstruction while
minimizing abdominal muscle morbidity?
A. Latissimus dorsi flap
B. TRAM flap
C. DIEP flap
D. Free fibula flap
Answer: C — The DIEP flap spares the rectus abdominis muscle, reducing donor site
morbidity while providing adequate tissue.
9. A key advantage of the DIEP flap over the TRAM flap is:
A. Inclusion of rectus muscle
B. Sparing the rectus abdominis muscle
C. Use of implant as adjunct
D. Being pedicled rather than free
Answer: B — DIEP uses perforators through the rectus without sacrificing muscle, reducing
donor-site morbidity.
10. For a full-thickness skin graft, what factor most strongly predicts graft "take"?
A. Donor site color match
B. Graft thickness >1.5 mm
C. Vascularity of the recipient bed
D. Suture technique
Answer: C — Adequate recipient bed vascularity is essential for graft survival.
11. Which is the most reliable flap for fingertip reconstruction?
A. Cross-finger flap
B. Thenar flap
, 3
C. V-Y advancement flap
D. Full-thickness skin graft
Answer: C — The V-Y flap allows direct closure with preservation of length, sensation, and
soft tissue coverage.
12. The primary goal of cleft lip repair is restoration of:
A. Skin coverage
B. Orbicularis oris continuity
C. Vermilion color
D. Nasal symmetry
Answer: B — Reestablishing orbicularis oris muscle continuity is essential for function and
aesthetic balance.
13. The "Rule of 10s" for primary cleft lip repair includes:
A. 2 kg weight, 8 weeks, Hb >9 g/dL
B. 5 kg weight, 3 weeks, Hb >10 g/dL
C. 10 weeks of age, 10 pounds (~4.5 kg), Hb >10 g/dL
D. 6 months of age only
Answer: C — The "Rule of 10s" (10 weeks, 10 pounds, Hb 10 g/dL) is the classic guideline for
timing primary cleft lip repair.
14. Which nerve is most commonly injured during rhytidectomy?
A. Marginal mandibular nerve
B. Buccal branch of facial nerve
C. Zygomatic branch
D. Temporal branch
Answer: A — The marginal mandibular nerve is vulnerable due to its superficial and variable
course near the mandible.
15. When performing a forehead lift, which nerve must be carefully preserved to prevent
brow paralysis?
A. Frontal branch of the facial nerve
B. Temporal branch of the facial nerve
C. Zygomatic branch of the facial nerve
D. Marginal mandibular branch
Answer: B — The temporal branch controls frontalis and brow elevation; injury can lead to
brow asymmetry and functional deficits.
16. The main advantage of using an endoscopic brow lift over a traditional open approach
is:
A. Longer-lasting results
B. Smaller incisions and faster recovery
C. Lower risk of hematoma
