Reconstruction of the Scalp, Forehead, Calvarium, Skull Base, and Midface

Question 1

How many regional flaps are in the calvarial?

Answer 1

only three regional flaps (pericranium, temporoparietal fascia, and temporalis muscle)

Question 2

The blood supply of the forehead and scalp

Answer 2

supraorbital, supratrochlear, superficial temporal (ST),
posterior auricular, and occipital vessels.

Question 3

The sensory nerves

Answer 3

the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, lesser occipital, and greater occipital
nerves.

Question 4

defect up to 5 cam can closed primarly

Answer 4

F No greater than 3 cm in diameter

Question 5

Techniques that can utilise to facilitates primary closure

Answer 5

First, the resection
can be designed so that the closure is oriented perpendicular to the
relaxed skin tension lines; this tends to be in a sagittal direction on
the scalp and in a transverse direction on the forehead. Second, wide
undermining in the subgaleal layer along the circumference of the
defect can reduce tension. Finally, galeal scoring is an adjunctive
technique that can increase scalp pliability and reduce closure tension.

Question 6

Scores deeper than the galea will disrupt the random pattern
blood supply of the scalp

Answer 6

T

Question 7

After burring the outer table the skin graft should put in delayed fashion

Answer 7

F This can be performed
immediately or with an intermediate stage using a dermal substitute

Question 8

areas of the scalp with laxity

Answer 8

the parietal and temporal regions

Question 9

What is the back grafting

Answer 9

Reconstruction of larger defects may require
elevating the local flap in the subgaleal plane and maintaining the
pericranium so that the donor site can then be closed with a skin graft

Question 10

The draw back of the Orticochea flap?

Answer 10

unpopular because of the
high rate of partial flap necrosis

Question 11

The aesthetic subunit principle
should be followed to make the reconstruction as inconspicuous as
possible. in forehead reconstruction

Answer 11

T

Question 12

The most suitable donor site for skin graft to forhead

Answer 12

skin grafts should be harvested from a
location above the clavicles to achieve a good color match

Question 13

Contraindications in using tissue expansion in forehead and scalp surgery

Answer 13

It is less germane in the oncologic setting when there is typically an urgent need for resection,
a history of radiation therapy or the anticipated need for adjuvant radiation precludes the use of tissue expansion,

Question 14

tissue expansion provide hair-bearing tissue of a similar thickness

Answer 14

T

Question 15

The temporoparietal fascia! flap and temporalis muscle flap can
be used for defects within or adjacent to the temporal area or lateral
forehead

Answer 15

T

Question 16

Recipient vessels should have a similar caliber in free flap

Answer 16

T

Question 17

the anastomosis should be
performed above the tragal notch where the vessels emerge
from the parotid.

Answer 17

F the anastomosis should be
performed at the level of the tragal notch where the vessels emerge
from the parotid.

Question 18

pedicle length required to travel from the neck to the scalp almost
always necessitates the use ofa vein graft

Answer 18

T

Question 19

age is not a contraindication
to microsurgical scalp reconstruction

Answer 19

T

Question 20

The atrophy of the muscle flap will accelerate with radiotherapy

Answer 20

T

Question 21

Flaps with a skin paddle may be preferred in situations where the flap is covering a cranioplasty.

Answer 21

T

Question 22

Calvarial reconstruction is usually recommended for any full-thickness defect greater than 10 cm

Answer 22

F Calvarial reconstruction is usually recommended for any full-thickness defect greater than 6 cm

Question 23

The type of alloplastic material used was not found to be
an independent risk factor for complications

Answer 23

T

Question 24

What is the thickest bone in the skull ?

Answer 24

he parietal bone

Question 25

The pariental graft site should not extend any further medially than 2 cm lateral to midline

Answer 25

F 1.5

Question 26

the extracranial technique is usually performed by a neurosurgeon

Answer 26

T

Question 27

larger defects can be repaired using rib.

Answer 27

T 7TH & 8 TH

Question 28

The maximum number of ribs that can be harvested?

Answer 28

more than two or three ribs

Question 29

Vascularized bone flaps are useful for larger calvarial defects

Answer 29

F Vascularized bone flaps are useful for smaller calvarial defects

Question 30

Options of vascularised free bone graft

Answer 30

chimeric latissimus-serratus anterior flap can be designed with vascularized rib chimeric scapular/parascapular flap has also been described for this purpose, but with using a segment of scapula free fibula flap has -specifically for replacing the anterior table of the frontal sinus in the setting of a chronic mucocele.

Question 31

Radial forearm flap Similar thickness as native scalp

Answer 31

T

Question 32

Omentum Usually atrophies significantly over time

Answer 32

T

Question 33

Calcium phosphate as alloplastic is britle and used for small defect and high risk of infection

Answer 33

T

Question 34

Muscle flap with skin reconstruction of the scalp need debulking later-on

Answer 34

T

Question 35

The skin of the scalp is among the thickest in the body, measuring 3 to 8 mm

Answer 35

T

Question 36

The scores should be designed in parallel with the leading edge of the flap, be spaced no closer than 1 cm apart, and only divide the galea in galea scoring

Answer 36

T

Question 37

Each galeal incision increases the length of the scalp 1.67 mm

Answer 37

T

Question 38

skin graft and is not recommended as a long-term solution or in the context of radiation. In any situation,

Answer 38

T

Question 39

once healed, the graft will not bear hair. Additionally, because of the difference in thickness between the native scalp and a skin graft, a noticeable contour deformity will be present

Answer 39

T

Question 40

Most local flaps are designed using the rotation-advancement principle and should be oriented to recruit tissue from areas of the scalp with laxity, such as the parietal and temporal regions.

Answer 40

T

Question 41

healing by secondary intention can have a better cosmetic outcome than skin grafting, as can be frequently seen in the treatment of donor defects for forehead flaps

Answer 41

T

Question 42

The incision used to place the expander should be designed in the area of scalp that will be excised and should be oriented perpendicular to the axis of expansion to help prevent incisional dehiscence and exposure of the device

Answer 42

T

Question 43

In large defects, multiple expanders can be placed; ports are typically remote.

Answer 43

T

Question 44

The trapezius muscle can be designed as either a muscle or myocutaneous flap and can be used to reconstruct the occipital scalp

Answer 44

T

Question 45

The superficial temporal artery tends to be more superficial and posterior, whereas the vein may exist in a slightly deeper plane and more anterior

Answer 45

T

Question 46

If the ST vessels are not available or insufficient, the neck provides a multitude of options: facial, lingual, superior thyroid

Answer 46

T

Question 47

The vein grafts should be placed beneath a widely undermined cutaneous tunnel, and the patient should be prevented from wearing eyeglasses during the immediate postoperative period to avoid compression

Answer 47

T

Question 48

The incidence of cutaneous malignancies located on the scalp is higher in elderly patients and continues to rise after age 65 years.

Answer 48

T

Question 49

Muscle flaps are bulky initially, but will atrophy over time; this effect is accelerated if postoperative radiation is given . Once the flap atrophies, it contours nicely along the underlying skull.

Answer 49

T

Question 50

Flaps with a skin paddle are thought to be more durable and may be preferred in situations where the flap is covering a cranioplasty

Answer 50

T

Question 51

The disadvantage to a skin paddle is that it may require a secondary debulking procedure to improve the contour, as these flaps are less likely to atrophy

Answer 51

T

Question 52

Calvarial reconstruction is most commonly performed using autologous reconstruction

Answer 52

F Calvarial reconstruction is most commonly performed using alloplastic materials

Question 53

Calvarial bone can be harvested using an in situ technique or an extracranial approach

Answer 53

T

Question 54

The advantage of in situ techniqueis that it avoids accessing the intracranial space

Answer 54

T

Question 55

Disadvantages include the creation of a depression contour deformity along the skull; additionally, the size of the graft is limited

Answer 55

T

Question 56

In the extracranial approach, a craniotomy is performed and a full-thickness section of the calvarium is removed.

Answer 56

T

Question 57

in men, rib graft is harvested through an incision directly over the rib, whereas in women, an inframammary fold incision is better camouflaged.

Answer 57

T

Question 58

Gaps between the rib grafts can be filled with either particulate cadaveric allograft bone, calcium phosphate bone cement, or hydroxyapatite putty

Answer 58

T

Question 59

Serratus anterior can be used all muscle for MICROSURGICAL SCALP RECONSTRUCTION

Answer 59

F Only inferior 3 or 4 slips are harvested to prevent winging of the scapula

Question 60

Pedicle is on posterior surfase of the serratus muscle surface of the muscle; care must be taken during exposure

Answer 60

F Pedicle is on anterior surface of the muscle; care must be taken during exposure

Question 61

Omentum flap has Variable skin graft take

Answer 61

T

Question 62

infection is fortunately uncommon in the scalp and calvarium.

Answer 62

T

Question 63

Calcium phosphate Brittle Use limited to smaller defects

Answer 63

T