Question 1

A 35-year-old man undergoes coverage of a soft-tissue defect on the posterior right elbow with a reverse lateral arm flap. He does not have a history of serious illness and has never smoked cigarettes. Vascular examination shows no abnormalities. Arterial blood to the flap is provided primarily by which of the following arteries?

Accepted Answer

Radial recurrent

Answer

Posterior radial collateral

Answer

Inferior cubital

Answer

Artery to the biceps muscle

Answer

Musculocutaneous perforating branches from the brachioradialis muscle

Question 2

A 52-year-old man is brought to the emergency department after sustaining injuries in a motor vehicle collision. Physical examination shows a traumatic degloving injury to the dorsum of the right hand with exposed, intact extensor tendons. Reconstruction with a fascial free flap and full-thickness skin grafting are planned. Which of the following arteries supplies blood to the most appropriate choice of flap?

Accepted Answer

Superficial temporal

Answer

Supratrochlear

Answer

Superior thyroid

Answer

Posterior auricular

Answer

Transverse facial

Question 3

A 55-year-old woman is scheduled to undergo surgery for soft-tissue coverage of an open joint elbow wound. The vascular pedicle of the flap in the photograph shown passes between which of the following tendons?

Accepted Answer

Brachioradialis and flexor carpi radialis

Answer

Brachioradialis and pronator teres

Answer

Brachioradialis and flexor pollicis longus

Answer

Brachioradialis and abductor pollicis longus

Question 4

A 45-year-old woman is brought to the emergency department after sustaining a shotgun injury to the nondominant left forearm. A preoperative x-ray study is shown. Bone stabilization is performed. The ulnar nerve, multiple flexor tendons, and the ulnar artery are repaired during surgery and are left exposed. A photograph taken following the repair is shown. The wound was covered with allograft skin while viability of the hand was confirmed for 2 days. Which of the following is the most appropriate definitive coverage for the wound?

Accepted Answer

Free anterolateral thigh flap

Answer

Pedicled groin flap

Answer

Reverse lateral arm flap

Answer

Split-thickness skin grafting from the thigh

Answer

Full-thickness skin grafting from the groin

Question 5

A 24-year-old right-hand-dominant male construction worker is evaluated because of a right dorsal thumb abscess that is treated with debridement and administration of antibiotics. A photograph of the residual defect is shown. Which of the following is the most appropriate method for reconstruction in this patient?

Accepted Answer

Coverage with a skin flap

Answer

Full-thickness skin grafting

Answer

Split-thickness skin grafting

Answer

Coverage with a muscle flap

Answer

Negative pressure wound therapy

Question 6

A healthy 40-year-old man comes to the office because of an injury to his finger. Examination shows a 4 × 3-cm, full-thickness defect over the proximal interphalangeal (PIP) joint of the right index finger. The joint capsule and extensor tendons are exposed. No sign of infection is noted. Coverage with an arterialized venous free flap from the forearm is planned. Which of the following is the main disadvantage of using this flap in reconstruction?

Accepted Answer

Difficult flap monitoring

Answer

Inability to transfer flap with nerve and/or tendon

Answer

Limited supply of donor sites

Answer

Technically demanding flap harvest

Answer

High incidence of total flap failure

Question 7

An 18-year-old man undergoes open reduction with tension band wiring to treat a fracture of the olecranon he sustained in a bicycle collision. Postoperatively, he develops a wound infection, resulting in an open wound over the elbow. Coverage with a posterior interosseous fasciocutaneous flap is planned. Which of the following best describes the anatomical location of the dominant pedicle of this flap?

Accepted Answer

Between the extensor carpi ulnaris and the extensor digiti minimi

Answer

Between the flexor digitorum profundus and flexor pollicis longus

Answer

Superficial to the anconeus and extensor digitorum muscle

Answer

Deep to the brachioradialis and lateral to the flexor carpi radialis

Answer

Anterior to the pronator teres and deep to the brachioradialis

Question 8

A 48-year-old man is brought to the emergency department after being involved in a high-speed motorcycle collision. Physical examination shows comminuted fractures of the left radius and ulna. A photograph of his wounds is shown. After debridement of the necrotic tissue, the brachial vessels and median nerve are exposed. Microsurgical techniques are not available. Which of the following is the most appropriate choice for tissue coverage in this patient?

Accepted Answer

Lateral arm flap

Answer

Radial forearm flap

Answer

Posterior interosseous artery flap

Answer

Split-thickness skin graft

Answer

Groin flap

Question 9

A 28-year-old man is evaluated in the emergency department because of a soft-tissue defect of the dorsum of the hand with exposed extensor tendons. Reconstruction is planned with a fasciocutaneous free flap that is centered on the axis between the anterior superior iliac spine and patella. Which of the following arteries is the most likely pedicle of this flap?

Accepted Answer

Descending branch of lateral femoral circumflex

Answer

Ascending branch of medial femoral circumflex

Answer

Descending branch of medial femoral circumflex

Answer

Superficial femoral

Answer

Ascending branch of lateral femoral circumflex

Question 10

A 24-year-old man is brought to the emergency department after sustaining a degloving injury of the long, ring, and little fingers of the dorsal, nondominant left hand in a high-speed, rollover motor vehicle collision. Following debridement, the patient has obvious open proximal interphalangeal (PIP) joints of each of these fingers. Which of the following is the most appropriate management of these defects?

Accepted Answer

Reverse radial forearm flap coverage

Answer

Split-thickness skin grafting from the thigh

Answer

Full-thickness skin grafting from the groin

Answer

Cross-finger flap coverage

Answer

Pedicle lateral arm flap coverage

Question 11

A 43-year-old electrician sustains a high-voltage electrical injury and undergoes multiple debridement procedures of the right upper extremity. The hand, ulnar aspect of the forearm, and medial upper arm are spared. Two weeks following the injury, a final debridement is performed leaving a 6-cm segment of the brachial artery and median nerve exposed in the proximal forearm. Which of the following is the most appropriate method for wound coverage?

Accepted Answer

Local tissue flap

Answer

Free tissue transfer

Answer

Dermal substitute followed by skin graft

Answer

Split-thickness skin graft

Answer

Above-elbow amputation

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