Principles of Microsurgery

Question 1

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)

Answer 1

T

Question 2

Routine use of antithrombotic agents in the postoperative
period is mandatory

Answer 2

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

Question 3

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

Answer 3

T

Question 4

Platelets do not adhere to undamaged endothelium

Answer 4

T

Question 5

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

Answer 5

T

Question 6

Dextran has been shown to have no
effect on flap survival

Answer 6

T

Question 7

Heparin and aspirin continue to be commonly used

Answer 7

T

Question 8

Cooling prolongs tolerance to ischemia for all types
of tissues

Answer 8

T

Question 9

Skin and subcutaneous tissue remain viable for approximately 6 hours.

Answer 9

F 24 hours

Question 10

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

Answer 10

T

Question 11

What is the no-reflow phenomenon

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

T

Question 14

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

Answer 14

T

Question 15

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

Answer 15

T

Question 16

Loupes-only microsurgery reduces operative time

Answer 16

T microscope setup is eliminated

Question 17

couplers Patency rates are lower than hand sewn anastomoses

Answer 17

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

Question 18

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

Answer 18

T

Question 19

Coupler should not be used on irradiated vessels

Answer 19

T

Question 20

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

Answer 20

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

Question 21

Age alone is not a contraindication for microsurgical reconstruction.

Answer 21

T

Question 22

Macrovascular and ,microvascular considred contraindications for the microsurgery

Answer 22

F no difference in the rate of flap failur

Question 23

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

Answer 23

T

Question 24

Free flaps in obese patients are twice as likely to fail

Answer 24

T

Question 25

Smoking effect the anastomosis patency

Answer 25

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

Question 26

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

Answer 26

T

Question 27

Interrupted sutures are preferred when there is significant vessel size discrepancy

Answer 27

T

Question 28

Continuous sutures require less knot tying and are more time efficient

Answer 28

T

Question 29

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

Answer 29

T

Question 30

The proximal arterial clamp is removed last

Answer 30

T

Question 31

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

Answer 31

T

Question 32

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

Answer 32

T

Question 33

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

Answer 33

T

Question 34

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

Answer 34

T

Question 35

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

Answer 35

T

Question 36

vasopressors are avoided in microsurgery

Answer 36

T

Question 37

Anesthesia Benefits

Answer 37

supporting circulatory volume avoiding peripheral vasoconstriction maintaining normal body temperature

Question 38

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

Answer 38

T

Question 39

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

Answer 39

T

Question 40

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

Answer 40

T

Question 41

Thrombosis is most common within 24 hours ofsurgery

Answer 41

T

Question 42

Early failure is often related to venous thrombosis

Answer 42

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

Question 43

approximately 50% of failing free flaps can be salvaged

Answer 43

T

Question 44

Doppler signals may persist for several hours despite venous thrombosis.

Answer 44

T

Question 45

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

Answer 45

t

Question 46

There is no indication for routine anticoagulation when conditions are optimal

Answer 46

T

Question 47

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

Answer 47

T

Question 48

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

Answer 48

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

Question 49

Prophylaxis against Aeromonas hydrophila is necessary why?

Answer 49

because this organism routinely inhabits the digestive tract of leeches

Question 50

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

Answer 50

T

Question 51

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

Answer 51

T

Question 52

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

Answer 52

T

Question 53

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

Answer 53

T

Question 54

Synthetic grafts are not common in microsurgery

Answer 54

T

Question 55

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

Answer 55

T