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Plastic Surgery( Grabb)Ali jasim > Breast Reconstruction: Autologous Flap Techniques > Flashcards

Breast Reconstruction: Autologous Flap Techniques Flashcards

1
Q

Clinical exam remains the standard for postoperative flap
monitoring.

A

T

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2
Q

using autologous tissue, one may obviate the postoperative risks of
morbidity associated with implants including infection, rupture,
capsular contracture, and malposition.

A

T

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3
Q

autologous tissue is generally preferred in patients expecting to receive radiation or with a history of radiation therapy including radiation
previously delivered as part of breast conservation therapy (BCT)

A

T

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4
Q

quality of life in patients undergoing autologous tissue reconstructions is maintained at a high level over time after the completion of
reconstruction

A

T

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5
Q

The need for PMRT, an
absolute contraindication to immediate reconstruction,

A

F The need for PMRT, though not an
absolute contraindication to immediate reconstruction, tends to be
the predominant reason to consider delayed reconstruction

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6
Q

Delayed
reconstruction is typically advocated for multiple reasons including

A

Avoidance of untoward effects of radiation on the results of an
immediate reconstruction and the potential for delaying oncologic
treatment because of complications from reconstruction

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7
Q

A known history of hypercoagulable conditions would be a contraindication to performing a free tissue transfer with an increased risk for vessel thrombosis;

A

T pedicled flap options would be possible in this
context.

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8
Q

Active smoking would be an absolute contraindication for performing any autologous flap procedure with increased risk for wound
dehiscence and delayed wound healing.

A

F Active smoking would be a relative contraindication for performing any autologous flap procedure with increased risk for wound
dehiscence and delayed wound healing.

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9
Q

Patients are typically counseled to quit smoking for a minimum of 4 weeks before surgery and
often preoperatively evaluated with a urine cotinine test

A

T

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10
Q

Patient preferences for postreconstruction breast size is also
important for operative planning

A

T

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11
Q

The need for PMRT, though not an
absolute contraindication to immediate reconstruction, tends to be
the predominant reason to consider delayed reconstruction

A

T

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12
Q

Imaging is absolutely needed in patients planned for autologous reconstraction

A

F imaging is not absolutely needed in patients without a surgical history that raises concerns about pedicle compromise

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13
Q

The latissimus dorsi (LD) myocutaneous flap is a well-established pedicled flap option for breast reconstruction.

A

T

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14
Q

Part of LD flap can be used ?

A

Within the latissimus the thoracodorsal branches into a
medial or transverse and a lateral or descending branch, which
allow for muscle-sparing procedures with use of part of the LD for
reconstruction

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15
Q

The muscle harvested with the skin paddle provides sufficient volume for breast reconstruction

A

the muscle harvested with a skin paddle
typically does not provide sufficient volume for breast reconstruction

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16
Q

The LD may also
be used in setting of salvage procedures to replace compromised
mastectomy skin flaps over implants or in cases of failed free-flap
breast reconstructions.

A

T

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17
Q

TRAM Flap based on the superior epigastric artery

A

T

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18
Q

Always requires mesh placement for closure of the donor site in TRAM flap

A

F often requires mesh placement
for closure of the donor site

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19
Q

the deep inferior epigastric
artery system is the more dominant blood supply to the abdominal skin and fat

A

T

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20
Q

a delay procedure, which is often performed 2
or 3 weeks before the pedicled TRAM procedure, when the ipsilateral deep inferior epigastric artery is ligated to facilitate the
recruitment of choke vessels with perfusion from the superior epigastric vessels

A

T

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21
Q

Abdomen-based breast reconstruction is the mainstay of autologous
microvascular breast reconstruction

A

T

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22
Q

The benefit of Abdomen-Based Flaps

A

reliable vascular anatomy,
extensive reported clinical experience,
reduced donor site morbidity with muscle-sparing/perforator flap options, a long pedicle with similar caliber to recipient vessels, and typically, the presence of sufficient soft tissue for reconstruction.

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23
Q

The free TRAM,
free ms-TRAM, flaps are based on the deep inferior epigastric vessels

A

T

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24
Q

The SIEA flap is based on the superficial inferior epigastric
vessels, which are branches from the external iliac vessels

A

F The SIEA flap is based on the superficial inferior epigastric
vessels, which are branches from the femoral vessels

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25
Q

violation of the anterior rectus fascia is avoided with the SIEA flap

A

T

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26
Q

violation of the anterior rectus fascia is avoided with this flap why?

A

the superficial inferior epigastric vessels, which are branches from the femoral vessels, run superficial to the abdominal wall fascia

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27
Q

A small
percentage of flaps (less than I0%) are reported to be superficially
dominant

A

T

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28
Q

within 5 to IO cm lateral from
the midline, is explored for the SIEA and SIEV

A

T

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29
Q

SIEA/V vessels that can be used are reported to be present in 50%
of patients

A

F SIEA/V vessels that can be used are reported to be present in 30%
of patients

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30
Q

dissection of the SIEA and SIEV are carried to the femoral vessels. 29 Once adequate perfusion based on the superficial vessels is
confirmed, all other perforators from the deep inferior epigastric
system are divided

A

T

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31
Q

Perfusion of flaps based on the SIEA/SIEV is
not reliable across the midline

A

T

32
Q

Most of the perforators required for DIEP flap elevation are
located within a 10 cm radius from the umbilicus

A

T

33
Q

In the DIEAP flap The superior abdominal flap is elevated from the superior incision for closure with the inferior incision, which is not undermined

A

T

34
Q

in cases where the SIEA is
absent or too small to rely upon, the SIEV if present is dissected
out to a length (5-7 cm) for potential use as an alternate flap outflow option

A

T

35
Q

primary closure without mesh is
often possible with DIEP flap and free ms-TRAM flap harvests.

A

T

36
Q

Free
TRAM harvests tend to include wide sections of anterior rectus
fascia and may require mesh placement, particularly in cases with
bilateral flaps.

A

T

37
Q

the pedicle to the gracilis muscle

A

The medial circumflex femoral artery, a branch of the profunda femoris artery, serves as the pedicle to the gracilis muscle to
support the overlying fat and skin

38
Q

The skin may be
oriented transversely (transverse upper gracilis (TUG) flap), vertically (vertical upper gracilis (VUG) flap) or designed as a combination of both with a bipedicled skin paddle

A

T

39
Q

Although the TUG
does not provide as much skin or fat as the VUG,

A

T

40
Q

skin paddle. is more reliable in VUG muscle flap

A

F In transverse upper gracilis (TUG)

41
Q

The transverse upper thigh scar is better hidden than the vertical scar

A

T

42
Q

excessive tension from
closure of the transverse skin paddle donor site may cause labial
spreading.

A

T

43
Q

Medial thigh flaps are ideal for patients with small- to
moderate-sized breast who desire similar-sized reconstruction

A

T

44
Q

Draw back of medial thigh flap

A

labial spreading.
overall availability of sufficient tissue

45
Q

One advantage of this form of
reconstruction is that flap harvest and breast reconstruction can
be performed in one position with the patient supine and the hip
externally rotated (thigh frog legged) for flap harvest

A

t

46
Q

the length of the vascular pedicle of gracilis flap is good and matches the caliber of the recipient’s vessels

A

F, the length of the vascular pedicle is relatively short, measuring approximately 7 cm and the flap artery is often smaller than recipient
arteries used for breast reconstruction (e.g., internal mammary or
thoracodorsal vessels).

47
Q

Posterior Thigh Flaps or the profunda artery perforator (PAP) flap pedicle length is 5 CM.

A

F 10.6 CM

48
Q

Perforators from the pedicle
are located roughly 5 to 6 cm below the gluteal crease, both medial and
lateral to the midline of the posterior thigh

A

T

49
Q

The flap is designed as
a horizontal ellipse with a superior incision at gluteal crease always

A

F The flap is designed as
a horiwntal ellipse with superior incision at or immediately below
the gluteal crease

50
Q

The superior or inferior gluteal artery perforator (SGAP or !GAP)
flaps are autologous alternatives to abdominal-based flaps

A

t

51
Q

The superior gluteal artery exits the
pelvis superior to the piriformis muscle at approximately the point
marking the junction of the upper and middle third of a line drawn
from the posterior superior iliac spine (PSIS) to the greater trochanter

A

T

52
Q

The inferior gluteal artery exits the pelvis inferior to the piriformis muscle, at approximately the point marking the junction of the upper
and middle third of a line drawn from the PSIS to the ischial tuberosity.

A

T

53
Q

Gluteal artery perforator flap at least need two perforator to survive

A

F One perforator is many times sufficient to
support the GAP flap

54
Q

The most suitable flap for patients with lower BMI

A

One advantage provided by use of gluteal flap is the
presence of a good amount of adipose tissue for reconstruction even in
patients with lower BMls.

55
Q

The pedicles length of the gluteal flap

A

5.6cm

56
Q

the thoracodorsal artery and vein. are the most common utilized recipient vessels for free flap

A

The IMA and internal mammary vein (IMV) are the more commonly
utilized recipient vessels for free flap breast reconstruction; alternatives are the thoracodorsal artery and vein

57
Q

The internal mammary vessels can be accessed by
removal ofthe third or fourth rib cartilage;

A

T

58
Q

At the level of the third rib, the IMA generally
lies lateral to the IMV.

A

T

59
Q

The right and left IMAs are of similar diameter (1.9-2.1 mm) at third and fourth intercostal spaces

A

T

60
Q

The left IMV
bifurcates at a higher level than the right IMV (third rib on the left
vs. fourth rib on the right)

A

T

61
Q

At the level of the third intercostal space,
the left IMV is on average smaller than the right (2.5 mm vs. 3 mm)

A

T

62
Q

The identification of venous congestion without obvious
mechanical obstructions within the pedicle and perforators may
lead the surgeon to consider augmenting venous outflow through
use of the superficial inferior epigastric vein (SIEV

A

T

63
Q

Anticoagulation with an antiplatelet agent (Aspirin) and venous thromboembolism (VTE) prophylaxis (subcutaneous heparin or enoxaparin)
is typical.

A

T

64
Q

Donor site complications

A

infection, hematoma, seroma, wound dehiscence, skin flap necrosis, umbilical necrosis, abdominal wall hernias and bulges, medial thigh lymphatic leaks,
and unfavorable scars

65
Q

Studies have shown that CTA may reduce operative time for abdominal-based reconstruction

A

T

66
Q

In pedicle TRAM flap we did not take the facia of the muscle

A

F Flap harvest includes fascia overlying the rectus muscle and often requires mesh placement
for closure of the donor site.

67
Q

Free Flap types

A

the free transverse rectus abdominis musculocutaneous (TRAM), free muscle-sparing TRAM (ms-TRAM),
deep inferior epigastric perforator (DIEP), and the superficial
inferior epigastric artery (SIEA) perforator flaps

68
Q

The free TRAM,
free ms-TRAM, and DIEP flaps are based on the deep inferior epigastric vessels

A

T

69
Q

superficial to the Scarpa fascia and within 5 to IO cm lateral from
the midline, is explored for the SIEA and SIEV

A

T

70
Q

the intervening segment of muscle between the two rows may be
harvested with the flap as a muscle-sparing TRAM flap, obviating
perforator dissection through the muscle.

A

T

71
Q

TUG provide a
more reliable skin paddle.

A

T

72
Q

the horizontally designed PAP flap offers mean weight of 220 g, larger flaps are
possible with the PAP designed as a fleur-de-lis

A

T

73
Q

The thoracodorsal vessels are typically identified at the lateral border of a mastectomy defect on the deep surface of the latissimus muscle.

A

T

74
Q

The PAP flap can provide sufficient tissue in patients
with B or C-cup breasts

A

T

75
Q

The DIEP flap is no longer an option in
patients who have had an abdominoplasty

A

T

76
Q

The latissimus dorsi
musculocutaneous flap is not likely to provide sufficient tissue to
reconstruct B-cup breasts in this patient

A

T

77
Q

IMV on the
left side can be substantially smaller at ribs 4 and 5.

A

T

Plastic Surgery( Grabb)Ali jasim (92 decks)

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