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Plastic Surgery( Grabb)Ali jasim > Principles of Microsurgery > Flashcards

Principles of Microsurgery Flashcards

1
Q

There is no difference in patency rate based on suture technique (simple interrupted versus continuous) or anastomotic technique (end-to-end versus end-to-side)

A

T

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2
Q

Routine use of antithrombotic agents in the postoperative
period is mandatory

A

F Routine use of antithrombotic agents in the postoperative
period is optional.

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3
Q

Routine use of antithrombotic agents in the postoperative
period is optional.

A

T

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4
Q

Platelets do not adhere to undamaged endothelium

A

T

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5
Q

collagen within the subendothelium is highly thrombogenic.
If the intima is damaged, exposed collagen within the media triggers platelet adhesion to the vessel wall

A

T

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6
Q

Dextran has been shown to have no
effect on flap survival

A

T

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7
Q

Heparin and aspirin continue to be commonly used

A

T

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8
Q

Cooling prolongs tolerance to ischemia for all types
of tissues

A

T

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9
Q

Skin and subcutaneous tissue remain viable for approximately 6 hours.

A

F 24 hours

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10
Q

Muscle is less tolerant; irreversible damage to the microcirculation occurs at
approximately 6 hours without blood flow.

A

T

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11
Q

What is the no-reflow phenomenon

A

The low flow state triggers
intravascular thrombosis and flap ischemia. The process is termed
the no-reflow phenomenon

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12
Q

Low magnification (6-12x)
may be used for suture placement

A

F Low magnification (6-12x)
may be used for vessel preparation and suture tying;

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13
Q

medium magnification (I0-15x) is used for suture placement

A

T

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14
Q

high magnification (>15x) is helpful in performing small-caliber anastomosis and for careful inspection at the completion of the procedure.

A

T

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15
Q

Generally, 3.Sx or higher
magnification is recommended for microsurgery

A

T

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16
Q

Loupes-only microsurgery reduces operative time

A

T microscope setup is eliminated

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17
Q

couplers Patency rates are lower than hand sewn anastomoses

A

F Patency rates of couplers are equivalent
to hand-sewn anastomoses.

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18
Q

Cou[pler can be used when vessel size mismatch is present and used on soft-walled arteries over 1 mm in diameter

A

T

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19
Q

Coupler should not be used on irradiated vessels

A

T

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20
Q

Preoperative angiography (traditional or image-based) is mandatory at the defect or donor site

A

F Preoperative angiography (traditional or image-based) is sometimes required at the defect or donor site

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21
Q

Age alone is not a contraindication for microsurgical reconstruction.

A

T

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22
Q

Macrovascular and ,microvascular considred contraindications for the microsurgery

A

F no difference in the rate of flap failur

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23
Q

Obesity is a known risk factor for flap and donor site complications

A

T

24
Q

Free flaps in obese patients are twice as likely to fail

A

T

25
Q

Smoking effect the anastomosis patency

A

F smoking does not reduce anastomotic
patency but does affect wound healing, skin graft take over flaps,
infection risk, flap necrosis, hernia formation, and length of hospital
stay

26
Q

Adventitia and periadventitial tissue is
sharply excised to prevent it from becoming interposed between the
donor and recipient vessels, which is highly thrombogenic

A

T

27
Q

Interrupted sutures are preferred when there is significant vessel
size discrepancy

A

T

28
Q

Continuous sutures require less knot tying and are
more time efficient

A

T

29
Q

End-to-side anastomosis may be necessary in
limb reconstruction to maintain distal perfusion, or when significant
size mismatch exists

A

T

30
Q

The proximal arterial clamp is removed last

A

T

31
Q

The saphenous veins are often used when
large-diameter vessels are required

A

T

32
Q

Vien Grafts should be harvested at
least 35% longer than the measured gap to accommodate for contraction

A

T

33
Q

Long-term patency
rates for vein grafts approach 100%, regardless of the length of
the graft required

A

T

34
Q

Bisecting interrupted sutures are placed 180° apart,
useful when there is a vessel size mismatch

A

T

35
Q

Triangulating interrupted sutures are placed 120° apart, dividing the vessel circumference into thirds. This technique helps prevent inadvertent inclusion ofthe opposite wall ofthe vessel in the remaining suture

A

T

36
Q

vasopressors are avoided in microsurgery

A

T

37
Q

Anesthesia Benefits

A

supporting circulatory volume
avoiding peripheral vasoconstriction
maintaining normal body temperature

38
Q

It is thought that the rise in blood pressure overcomes
any vasospastic effect of the medication

A

T

39
Q

postoperative antithrombotic use of any type offers no protection from microvascular
thrombosis and increases complication rates

A

T

40
Q

The most common antithrombotic
agents used in routine postoperative care are aspirin and heparin.

A

T

41
Q

Thrombosis is most common within 24 hours ofsurgery

A

T

42
Q

Early failure
is often related to venous thrombosis

A

F Early failure
is often related to anastomotic imperfections or pedicle positioning.

43
Q

approximately 50% of failing free flaps can
be salvaged

A

T

44
Q

Doppler signals may
persist for several hours despite venous thrombosis.

A

T

45
Q

A thrombolytic agent (streptokinase, urokinase, or tissue plasminogen activator) is infused while the flap is occluded from
systemic circulation

A

t

46
Q

There is no indication for routine anticoagulation when conditions are optimal

A

T

47
Q

ocal fibrinolytic therapy and postoperative anticoagulation may be indicated in situations where mechanical and vascular
factors are unfavorable

A

T

48
Q

Leeches are a useful adjunct for flaps with signs of venous congestion
in case of venous anastomosis is not patent

A

F Leeches are a useful adjunct for flaps with signs of venous congestion
despite a patent venous anastomosis

49
Q

Prophylaxis against
Aeromonas hydrophila is necessary why?

A

because this organism routinely
inhabits the digestive tract of leeches

50
Q

Skin and fascia flaps can be derived from any perforating blood
vessel using the angiosome concept

A

T

51
Q

Vascularized bone autografts are superior to nonvascularized bone graft in defects over 5 centimeters in regard to early
incorporation, bone hypertrophy, mechanical strength, and osseous
mass retention

A

T

52
Q

Dissipation of platelets in the vessel lumen and
formation of the pseudointima correlates clinically with the critical
period of thrombus formation within the first 3 to 5 days

A

T

53
Q

Continuous sutures have the added advantage
of equally distributing tension along the suture line, providing less
opportunity for leakage

A

T

54
Q

Synthetic grafts are not common in microsurgery

A

T

55
Q

fibrous polyurethane (PU) and microporous polytetrafluoroethylene (PTFE) grafts show adequate early patency in high-flow,43
short segment conduits, but long-term anastomotic narrowing due to
neointimal hyperplasia.” Significant thrombosis and occlusion occur
early in low-flow flaps

A

T

Plastic Surgery( Grabb)Ali jasim (92 decks)

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