The following is true regarding vaginal agenesis:
Can be treated with a split skin graft. McIndoe’s technique of a reversed split skin graft over a stent was presented as a Hunterian Oration in the 1940s. It requires persistent stent usage, and often contracts, but can result in an acceptable reconstruction. Urinary abnormalities are commonly found in vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome), and should be excluded. Vascularised bowel is a reasonable option, although they can bleed and secrete excessive mucus. Early reconstruction is preferred before sexual awareness of the child, minimising psychological trauma. The defect is of the paramesonephric duct (Mullerian duct).
Which of the following arteries does not provide blood supply to the nipple-areola complex (NAC)?
Superior thoracic artery. The superior thoracic artery does not nourish the NAC. The main blood supply to the nipple-areola complex is provided by branches from the internal mammary and the lateral thoracic arteries, which run in the subcutaneous tissue and communicate with each other above and below the areola. The dermal and subdermal vascular plexus has less importance in NAC blood supply. A medial or lateral pedicle provides the best blood supply to the NAC intercostal perforators and the branches from thoraco-acromial artery also contribute to the blood supply of breast tissue. Branches from the thoracodorsal artery may supply the lateral part of the breast.
In 1906, the first myocutaneus flap was described when used to cover a chest wall defect created by a wide mastectomy. His paper was missed until the early 1970s. Who was he?
Tansini. Tansini described the latissimus dorsi flap which he undertook in 1897 and published in 1906.
Which of the following nerves provide the main innervation to the NAC?
The 4th lateral intercostal nerve. The breast is innervated by lateral and anterior cutaneous branches of the second to the sixth intercostal nerves. The NAC is always innervated by both the anterior and lateral 3th-5th intercostal nerves. The deep branches of the lateral nerves run below or within the pectoralis fascia. At the mid-clavicular line, they turn 90° and continue through the glandular tissue towards the posterior surface of the nipple. The 4th lateral cutaneous branch is the most constant nerve to the nipple, observed in 93% of breasts. The anterior cutaneous branches of the intercostal nerves travel superficially to reach the medial edge of the areola.
1. Schlenz I, Kuzbari R, Gruber H, Holle J. The sensitivity of the nipple-areola complex: an anatomic study. Plast Reconstr Surg 2000; 105(3): 905-9.
Which of the following factors is the most important in choosing a suitable breast reduction technique?
Surgeon’s experience. Several techniques in breast reduction are available. Choosing the appropriate procedure depends on many factors. The amount of breast resection, which is obviously related to breast size, is considered one of the most important factors. However, training of the surgeon in a specific technique may make it suitable for use on any breast size. Degree of ptosis and the distance of the nipple to the IMF will determine the length of the pedicle which is needed to carry the NAC. Master plastic surgeons may be able to produce safe techniques in breast reduction; however, free nipple techniques should be considered in inexperienced hands in situations such as elderly patients in poor medical health or with resections more than 2500g per side. There is no best method of breast reduction. The ideal technique may be the one which the surgeon has mastered with the most confidence.
© 2010-2030 Your Doctor - Dr.Khalil Al-Yousifi - Kuwait - Contact Us