Mathes and Nahai described muscle flaps. Within this same classification, they also described a number of non-muscle flaps. Which of these flaps is correctly attributed?
All of the above. The fibula has a dominant supply from the peroneal artery with additional multiple segmental vessels along its length. Classic Type V muscle flaps include latissimus dorsi and pectoralis major. The omentum has a dual blood supply from the left and right gastro-epiploic artery. Classic Type III muscle flaps include gluteus maximus and rectus abdominis. The jejunum is supplied by the superior mesenteric artery. Classic Type I muscle flaps include gastrocnemius and tensor fascia lata. Taylor classified flaps according to their nerve supply, and Mathes and Nahai, as well as Cormack and Lamberty, classified fasciocutaneous flaps.
The following landmark paper or author is not appropriately attributed:
Boca (1906) - radical neck dissection. This is incorrect; Crile first described the radical neck dissection, and Boca the functional neck dissection. Huger described the abdominal wall vascularity, which in simple terms comprises inferior, central and lateral zones. Winter showed that moist wounds heal better in a classic article in Nature, although this has been challenged. Penn objectively scrutinised the breast aesthetic.
The following is the appropriate treatment postoperatively for patients with split skin grafts to the lower limb:
None of the above. Early discharge is preferred. Many surgeons have different postoperative regimes for such patients. However, 10 days of bed rest has not been shown to improve graft take rates 1. This prospective randomised controlled trial was conducted to compare the time to complete healing of patients mobilised early (the first postoperative day) against those who mobilised late (the tenth postoperative day). There was no difference in time to complete healing. Other problems with a bedrest strategy includes the increased risk to patients of deep venous thrombosis and pulmonary embolism - or instigation of prophylactic interventions such as heparin, as well as the risk of hospital-acquired infections with organisms such as MRSA. The actual and manpower costs are not justifiable. There is no benefit in checking a wound on the next postoperative day after grafting. Some advocate early dressing changes at 48 hours in case a haematoma is present which can be evacuated while the graft remains viable. Analgesia is usually required, in particular for the donor site, but opioids should not be required.
References: 1. Wood SH, Lees VC. A prospective investigation of the healing of grafted pretibial wounds with early and late mobilisation. Br J Plast Surg 1994; 47(2): 127-31.
Name the flap which is not a part of the subscapular vascular axis:
The subscapular artery divides into the circumflex scapula (parascapular) and the thoracodorsal arteries (latissimus dorsi and TAP flaps), which gives the serratus branch.
Following tissue expansion:
The thickness of the epidermis tends to increase. The dermis and fat often thin.
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