FPRS microvascular free flaps

Question 1

What are vessels leaving the axial blood supply of a
free flap and passing through muscle on their way
to supply the skin called?

Answer 1

Musculocutaneous perforators

Question 2

Review the clinical findings of acute arterial
thrombosis of a free flap in the early postoperative
period.

Answer 2

Loss of implanted Doppler signal (if placed); the flap is cool, pale, and without capillary refill, and there is no bleeding
after pinprick.

Question 3

A free-flap arterial anastomosis is revised within
the first 24 hours after surgery for presumed
arterial thrombosis. Despite good blood flow through the artery after the revision, the flap’s
appearance at the skin level does not improve; subsequently, it undergoes necrosis. What is the most likely reason for failure after revision surgery
despite good blood flow through the artery?

Answer 3

No-reflow phenomenon: Despite restoration of blood flow through the major artery, the prior occlusion and ischemia have detrimental effects on the microvasculature, which caused subsequent necrosis.

Question 4

Review the clinical findings of venous congestion

of a free flap in the early postoperative period.

Answer 4

Congestion and edema, violaceous color with brisk bleeding

of dark blood on pinprick, loss of venous Doppler signal

Question 5

What is the most common reason for venous

occlusion of a free-flap vascular pedicle?

Answer 5

Mechanical obstruction from compression, twisting, or

kinking

Question 6

What nonsurgical therapy can be used to treat venous congestion after free-flap reconstruction?

Answer 6

Leech therapy

Question 7

What is the most common free flap used for reconstruction of hemi-glossectomy defects?

Answer 7

Radial forearm free flap

Question 8

Describe the Allen test.

Answer 8

The patient makes a fist and elevates the hand. The radial
and ulnar arteries are compressed. The hand is then opened
and should appear blanched. Pressure is released from the
ulnar artery. The hand should have capillary refill and return
to a normal color in 5 to 7 seconds, indicating a patent
ulnar artery and palmar arches.

Question 9

What is the vascular supply to an osteocutaneous

radial forearm free flap?

Answer 9

Perforators from the radial artery

Question 10

What nerves provide sensory innervation to the fasciocutaneous paddle of the osteocutaneous
radial forearm free flap?

Answer 10

The medial and lateral antebrachial cutaneous nerves

Question 11

What added complication can occur when using an osteocutaneous radial forearm free flap as opposed to a fasciocutaneous radial forearm free flap?

Answer 11

Pathologic fracture of the radius

Question 12

What are some of the potential donor site

complications of an osteocutaneous radial forearm free flap?

Answer 12

Incomplete skin graft take, radius fracture, hand and forearm weakness and contracture, numbness, and hematoma

Question 13

What are some potential donor sites for osseocutaneous free tissue transfer for reconstruction of segmental mandibular defects?

Answer 13

Fibula, radius, scapula, iliac crest

Question 14

Which osteocutaneous free flaps can accept dental implants?

Answer 14

Iliac crest and fibula. The scapula has a variable ability to accept dental implants.

Question 15

Review relative candidacy requirements for osseointegrated dental implant placement?

Answer 15

Absence of poorly controlled autoimmune or all vessel disease, which could impair healing; no trismus; good tongue mobility; adequate bone stock

Question 16

Describe the difference between segmental and marginal mandibulectomy.

Answer 16

In a segmental mandibulectomy, the entire vertical height of a portion of the mandible is removed. In a marginal mandibulectomy, at least 1 cm of the inferior border remains in continuity.

Question 17

Review the general options for segmental mandibular defect reconstruction?

Answer 17

Reconstruction with hardware alone (large reconstruction
bar for lateral defects), hardware combined with a local flap (large reconstruction bar with pectoralis muscle), hardware
combined with free tissue transfer

Question 18

What are the reconstructive goals when repairing

a segmental mandibulectomy defect?

Answer 18

Maintenance of occlusion, restoration of bone continuity, oral competence, maintenance of facial symmetry, and ability to place a dental prosthesis

Question 19

What are the major disadvantages to the use of a reconstruction plate alone for reconstruction of a segmental mandibulectomy defect?

Answer 19

Plate extrusion, plate fracture, development of mandible osteomyelitis

Question 20

What is the vascular supply to the osteocutaneous

fibular free flap?

Answer 20

The peroneal artery and the paired venae comitantes

Question 21

What is the most effective test to evaluate the lower extremities for adequate vasculature prior to fibula free flap harvest?

Answer 21

CT angiogram with three-vessel runoff of the lower extremities. Angiography is probably the gold standard but has largely been replaced by CT angiography.

Question 22

What are some of the potential donor site

complications of an osteocutaneous fibular free flap?

Answer 22

Compartment syndrome, peroneal nerve weakness, hematoma, decreased range of motion, ankle instability, and foot ischemia

Question 23

What is the vascular supply to the osteocutaneous

scapular free flap?

Answer 23

Circumflex scapular branch of the subscapular artery

Question 24

What are some of the potential complications of an osteocutaneous scapular free flap?

Answer 24

Potential donor-site complications include long thoracic nerve injury, winged scapula, uppe-extremity weakness
and decreased range of motion, wound dehiscence,
hematoma, and seroma. Potential recipient-site defects include hematoma and flap necrosis.

Question 25

What is the most common type of perforating vessels encountered in the anterolateral thigh free flap?

Answer 25

Myocutaneous perforators

Question 26

The anterolateral thigh free flap is based on what

artery?

Answer 26

Descending branch of the lateral femoral circumflex artery

Question 27

The rectus abdominis free flap is based on what artery?

Answer 27

Deep inferior epigastric artery

Question 28

The latissimus dorsi free flap is based on what artery?

Answer 28

Thoracodorsal artery from the subscapular system

Question 29

What donor site nerve is used for neurorrhaphy
when the gracilis free flap is used for facial
reanimation?

Answer 29

The obturator nerve