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Question 5#

In relation to free tissue transfer, which one is true?

a. The anterolateral thigh free flap, by definition, is based on the descending branch of the lateral circumflex femoral artery
b. The superficial inferior epigastric artery pedicle is absent in approximately 5% of cases
c. The skin paddle of the fibula osteoseptocutaneous free flap is an unreliable indicator of the blood supply to the fibula bone
d. Some surgeons are capable of performing microsurgery without the aid of a surgical microscope
e. None of the above is true

Correct Answer is E

Comment:

None of the above is true. The skin of the anterolateral thigh can be based on any appropriate underlying pedicle, which may or may not arise from the descending branch of the lateral circumflex femoral artery. The superficial inferior epigastric artery was absent in 35% of cadaveric dissections and in 40% of patients in a clinical study. Although the skin paddle of the fibula osteoseptocutaneous free flap was widely believed to be unreliable during the 1970s and 1980s, this has been refuted by several clinical studies from different centres. Microsurgery is, by definition, performed with the aid of a surgical microscope.

References:

  1. Semple JL. Retrograde microvascular augmentation (turbocharging) of a singlepedicle TRAM flap through a deep inferior epigastric arterial and venous loop. Plast Reconstr Surg 1994; 93(1): 109-17.
  2. Taylor GI, Caddy CM, Watterson Paul A, Crock JG. The venous territories (venosomes) of the human body: experimental study and clinical implications. Plast Reconstr Surg 1990; 86(2): 185-213.
  3. Wei FC, Chen HC, Chuang CC, Noordhoff MS. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 1986; 78: 191.
  4. Hidalgo DA. Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg 1989; 84: 71.