A patient has an isolated right-sided chest wall defect 4cm in diameter involving two ribs with adequate soft tissues. Which reconstruction is the most appropriate treatment?
None of the above. None of these options is appropriate. In general, chest wall reconstruction is only indicated in large defects where more than four ribs are missing.
In relation to penile reconstruction, which one is true?
An ulnar forearm free flap reconstruction has significant advantages over a radial forearm flap reconstruction. The ulnar forearm flap provides a longer pedicle than the radial flap, good sensation, and most importantly the urethra is cited along a less hair-bearing area of the flap (Lovie 1984, popularised by Gilbert 1995). Pudendal nerve to antebrachial nerve anastomoses can provide good sensory recovery. Vascularised bone flaps have been described. Penile nerve supply is from the pudendal, ilioinguinal and genitofemoral nerves.
1. Mathes SJ, Hentz VR. Plastic surgery. St. Louis, USA: Saunders-Elsevier, 2006.
Which of the following statements is true?
The vascularity of a free DIEP flap is better than a pedicled TRAM flap. The DIEP flap is based on one or several perforators that directly fill some of the ipsilateral zone 1, and flow though adjacent choke zones to the adjacent abdominal wall zones. The free TRAM captures this zone 1 territory more completely by including all perforators (A and B are false). The pedicled TRAM is based on the deep superior epigastric artery and thus flow is across a choke zone to reach zone 1, and two major choke zones to reach zones 2 and 3 (E is true). The SIEA angiosome is different to the DIEA angiosome. The DIEP flap spares rectus muscle fibres, unlike the TRAM flap.
Which of the following is not an advantage of immediate breast reconstruction after skinsparing mastectomy?
Improved oncologic outcome. There is no diminished oncologic outcome in selected immediate breast reconstruction; however, there is no actual benefit.
Which of the following is not an advantage of a free TRAM?
It has a higher partial flap loss rate in smokers and diabetics. Options A, B and D are all advantages of the free TRAM over the pedicled TRAM. Option C is true of a pedicled TRAM - a free TRAM has a lower partial flap loss rate.
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