Question 6#

According to Mathes and Nahai:

A. The posterior interosseous artery flap is a Type C fasciocutaneous flap

The deltopectoral flap is a Type C fasciocutaneous flap. The others are Type B fasciocutaneous flaps. Type A flaps are supplied by direct cutaneous vessels, Type B are septocutaneous and Type C are musculocutaneous. Cormack and Lamberty also classified fasciocutaneous flaps. Type A flaps are supplied by un-named vessels entering at the base of the flap, Type B flaps have an axial vessel, and Type C have segmental perforators from a deeper source vessel.

Question 7#

With regards to toe-to-hand transfer:

A. The dominant blood supply to the great toe is the first plantar metatarsal artery in 25% of cases and the first dorsal metatarsal artery in 75% of cases

When reconstructing a Type IIC metacarpal hand by toe-to-hand transplantations, finger reconstruction should usually precede thumb reconstruction. In approximately 10% of cases, the first dorsal and plantar metatarsal arteries are co-dominant. A metacarpal hand results when all fingers have been amputated proximal to the middle of the proximal phalanx, with (Type II) or without (Type I) thumb involvement. Types I and II metacarpal hands are subdivided further according to the levels of finger and thumb amputations, respectively. Type IIC metacarpal hands additionally have inadequate thenar muscular function; finger reconstruction by toe transfer(s) should therefore precede thumb reconstruction to ensure restoration of accurate digital prehension. The toe extensor tendon repairs in the hand during toe-to-hand transfer should be performed under tension and before flexor tendon repair in order to reduce the risk of neo-digit clawing thereafter. Nicoladoni reported pedicled second toe-to-hand transfer.

Question 8#

Regarding free tissue transfer:

A. According to Koshima, supramicrosurgery (or supermicrosurgery) is defined as microvascular dissection and anastomosis of vessels measuring less than 0.5mm

The first successful free tissue transfer in humans was performed in America. The first successful free tissue transfer in humans was performed without a surgical microscope by Seidenberg et al in 1957 in Montefiore Hospital, New York City, and reported 2 years later. Supermicrosurgery is defined as microvascular dissection and anastomosis of small-calibre vessels measuring 0.5 to 0.8mm in diameter. Jacobson and Suarez reported successful microvascular anastomoses in vessels down to 1.4mm in diameter. Taylor is credited with the first description of the free fibula osseous flap without a skin paddle, and he also described the deep circumflex iliac artery (DCIA) flap.

References:

1. Koshima I. Superficial circumflex iliac artery perforator flap. In: Perforator flaps: anatomy, technique, & clinical applications. Blondeel PN, Morris SF, Hallock GG, Neligan PC, Eds. St. Louis, USA: Quality Medical Publishing, 2006: 977.
2. Seidenberg B, Rosenak SS, Hurwitt ES, Som ML. Immediate reconstruction of the cervical esophagus by a revascularized isolated jejunal segment. Ann Surg 1959; 149(2): 162-71.

Question 9#

The dominant type of collagen in tendon is:

A. Type I

Question 10#

The dorsal artery of the penis is immediately deep to which anatomical layer?

A. Skin

Buck fascia. Anatomical layers of the dorsal penile shaft, from external inwards, are: skin, dartos fascia, Buck (deep) fascia and tunica albuginea. The superficial arterial plexus lies within dartos fascia and supplies the skin and prepuce but the dorsal artery of the penis lies beneath Buck (deep) fascia. The tunica vaginalis is in the scrotum.