Which one of the following is true?
A hemi-soleus muscle flap can be raised on the same vascular axis as the fibula flap. The fibula flap is based on the peroneal artery, which gives a large branch to the lateral soleus just after dividing at the tibioperoneal trunk; this vessel is the major blood supply to the hemi-soleus but the skin perforators to the fibula can also provide an additional pedicle. The surface marking of the anterior tibial artery is a line between the anterior border of the head of the fibula to a midpoint between the two malleoli and the vessels can be exposed anywhere along this line. In the proximal third, the vascular bundle lies between tibialis anterior and extensor digitorum longus. Lower down, it lies between tibialis anterior and extensor hallucis longus. The surface marking for the posterior tibial artery is a line between the medial condyle of the tibia to a point 1cm posterior to the medial malleolus. The first dorsal metatarsal artery arises from the dorsalis pedis /anterior tibial artery.
For a 4cm x 4cm defect on the weight-bearing surface of the heel, the ideal reconstruction would be:
Sensate pedicled medial plantar island flap. Heel reconstruction needs to be resistant to stress and shear forces. The sensate, hairless, glabrous skin of the sole of the foot provides the ideal reconstruction for the weight bearing heel but its disadvantage is the skin graft on the sole of the foot. Muscle flaps require skin grafts and these are usually unstable and mostly insensate.
Large fasciocutaneous flaps include all except:
The first dorsal metacarpal artery flap is not large.
Which one of the following organs or tissues is considered to be the most immunogenic following allograft transplantation?
Skin has long been regarded as a major barrier in composite tissue transplantation due to its high antigenicity. This strong immunogenicity is believed to be due to the presence of antigen presenting cells (Langerhans cells), whose function is to present foreign antigens to the body’s immune system.
Whose research work challenged the ‘length vs breadth’ principle for flap dimensions popularised by Gillies?
Milton did much of his work in Oxford and his famous paper on flaps on the flank of the pig was published in the Brtish Journal of Plastic Surgery in 1970.
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