Plastic and Reconstructive Surgery Board Review Pearls of Wisdom 3th

CHAPTER 93 High-Yield opics
917

What syndrome has brachycephaly, hypertelorism, bregmatic prominence, maxillary hypoplasia, and bony
syndactyly o toes and hands?
Apert.

Members o a amily with rontal recession, maxillary retrusion, proptosis, and exorbitism without extremity
anomalies have what syndrome?
Crouzon.

What ndings are seen in Carpenter syndrome?
Brachydactyly, syndactyly, polydactyly, cardiac disease, obesity, GU anomalies; AR.

What is seen in Nager syndrome?
Acro acial dysostosis; AR; cle t palate, orbital, zygomatic, maxillo-mandibular hypoplasia, preaxial hypoplasia or
agenesis; auricular de ects, mental retardation; syndactyly o the second web space.

What is seen in P ei er syndrome?
Synostosis, acrocephalosyndactyly, broad thumbs, mid ace hypoplasia.

What procedure is done or horizontal de ciency and vertical excess o the chin?
Jumping genioplasty.

What embryologic anomaly is responsible or primary cle t palate?
Failed lateral and median palatine process usion.

What causes secondary cle t palate?
Failed lateral palatine process usion to each other and the nasal septum.

What causes cle t lip?
Fusion o the medial nasal prominence and maxillary prominence.

What causes macrostomia?
Failed usion o the maxillary and mandibular prominences.

In a maxillary advancement or 1 cm o negative overjet, what primary actor is the most signi cant risk or
VPI?
Mid ace hypoplasia due to cle t palate repair (higher risk than other cranio acial syndromes such as microsomia or
Crouzon).

What is the most common essier acial cle t?
No. 7 (macrostomia, zygomatic arch absence).

Which essier cle t includes the same position as a unilateral cle t lip?
No. 3; also extends to a ect nasal ala and medial canthus.

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Plastic & Reconstructive Surgery Board Review

What is the appropriate management o Romberg hemi acial atrophy?
Parascapular ap; deepithelialized and placed under skin ap.

What is the most common cause o late enophthalmos ollowing ORIF o an orbital oor and zygomatic
arch racture?
Inadequate reduction.

Where does a rontonasal encephalocele communicate intracranially?
Foramen cecum.

What is the metachronous incidence o squamous cell carcinoma in a patient who continues to smoke?
40%; those who stop tobacco have an incidence o 6%.

What is the normal latency period in mandibular distraction in a 6-year-old child?
1 week.

What are the symptoms o MJ internal derangement?
Anterior excursion o the meniscus with posterior and superior positioning o the condyle; jaw clicking;
preauricular pain.

What is the relationship o the condyle during an acute MJ dislocation?
Anterior excursion o the condyle past the eminence.

What is the sa est landmark or identi ying the acial nerve during parotid surgery?
Using the tympanomastoid suture line.

Following a Le Fort I, what provides vascularity to the maxillary segment?
T e ascending pharyngeal artery and ascending palatine artery (o the acial artery).

What does the greater palatine artery supply?
Palate and roo o mouth.

What does the lesser palatine artery supply?
So t palate and palatine tonsils.

What is cryptotia?
Absence o the superior auriculocephalic sulcus; upper pole is buried beneath the scalp.

What normally supplies blood to the maxilla?
Internal maxillary artery by descending palatine, posterior superior alveolar, and in raorbital arteries.

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919

What is cup ear?
Hooding o the scapha and helix and antihelical attening.

What is lop ear?
Auricular protrusion and superior helical olding.

What are the characteristics o mandibular prognathism?
Angle class III, lower acial third prominence.

What are the characteristics o mandibular retrognathism?
Anterior teeth protrusion, lip incompetence, deep labiomental crease.

What treatment should be undertaken or an anterior rontal sinus racture with a nondisplaced posterior
wall racture and patency o the naso rontal duct?
Repair o the anterior wall alone.

What approach is undertaken i the naso rontal duct is obstructed?
Obliteration o the rontal sinus.

What situation necessitates cranialization?
Comminution o the posterior wall; concomitant CSF leak.

What clinical symptoms de ne superior orbital ssure syndrome?
Fracture a ecting III, IV, V1, and VI; extraocular muscle paralysis, levator palpebrae weakness, numbness o the
orehead, eyebrow, upper eyelid.

What is orbital apex syndrome?
Superior orbital ssure syndrome with blindness ( rom optic nerve involvement).

When do the permanent canine teeth erupt?
Between 10 and 11 years o age.

When do the permanent rst molars erupt?
Between 6 and 7 years o age.

What nerve is the cause o Frey syndrome?
Aberrant regeneration o the auriculotemporal nerve.

What is the mechanism o Frey syndrome?
Aberrant regeneration o the auriculotemporal nerve to sweat glands; test with Minor starch-iodine test.

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Plastic & Reconstructive Surgery Board Review

What is the treatment o Frey syndrome?
ympanic neurectomy, topical glycopyrrolate, and/or Prantal (diphemanil methylsul ate) to control gustatory
sweating.

Where does the great auricular nerve travel within the neck?
Exists on top o the SCM, 9 cm rom the caudal EAC and 6.5 cm in erior to the tragus.

What type o mandible racture is seen in a patient with chin deviation to the le t, upward mandibular cant
to the le t, and right-sided open-bite de ormity?
Le t condylar racture; also with loss o posterior ramus height on le t, chin deviated to le t due to right lateral
pterygoid.

What growth actor has been associated with craniosynostosis in the animal model?
GF-beta in the posterior rontal suture line.

When does the anterior ontanelle close?
24 months.

When does the posterior ontanelle close?
2 months.

What is the treatment or bilateral subcondylar ractures?
ORIF through preauricular incisions.

What is the most common cranio acial anomaly?
Hemi acial microsomia.

Fractures o what part o the mandible are most signi cant or growth in the child?
Fractures o the condyle.

What are late complications o rontal sinus ractures?
Orbital abscess, mucocele, osteomyelitis.

What are complications o rontal sinus ractures occurring within the rst ew weeks?
Meningitis, mucocele, rontal sinusitis.

What does the rst branchial groove develop into?
T e EAC.

What is the most common site o squamous cell carcinoma o the paranasal sinuses?
T e maxillary sinus (chronic exposure to nickel and wood working materials).

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921

What is most common cause o MJ ankylosis?
rauma.

What permanent tooth erupts rst?
T e rst molar (6–7 years o age).

What are the commonly used cranial base planes?
Frank ort horizontal, basion-nasion, sella-nasion.

What are the common maxillary planes used?
Axis o the maxillary incisor, nasion to A point, occlusal, and palatal.

What bones orm the lateral orbital wall?
Zygoma, greater wing o the sphenoid.

What bones orm the orbit?
Greater wing o sphenoid, lacrimal, palatine, maxilla, ethmoid, rontal, lesser wing o the sphenoid.

What structures drain into the middle meatus?
T e anterior ethmoid, maxillary, and rontal sinuses.

What drains into the in erior meatus?
T e nasolacrimal duct.

What is the primary action o the superior oblique?
Depression; also abduction and intorsion; innervated by the trochlear nerve.

What is the percentage o coexisting spine injuries with pan acial MVC trauma?
10%.

What muscle is used in sphincter pharyngoplasty or reconstruction?
Palatopharyngeus.

What is the blood supply to the sternocleidomastoid muscle?
Occipital, superior thyroid, and thyrocervical trunk.

What metal on C scan exhibits the greatest amount o scatter?
Stainless steel; titanium and vitallium have the least scatter.

What suture line is broken in Le Fort III but not monobloc advancement?
Frontozygomatic suture and naso rontal junction.

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Plastic & Reconstructive Surgery Board Review

What muscles are important or closure o the velum?
Levator veli palatini, uvulus, palatopharyngeus, and superior pharyngeal constrictors (NO the tensor veli
palatini).

What is the mechanism o velopharyngeal insuf ciency with the levator veli palatini in cle t palate?
T e levator inserts on the posterior hard palate; repair reproduces the sling required or closure.

What is the role o the tensor veli palatini?
enses the so t palate; important or eustachian tube unction.

What attaches to Whitnall tubercle?
Lateral rectus ascial extension, lateral check ligament, lateral levator aponeurosis horn, and lateral palpebral
ligaments.

What is the suspensor ligament o Lockwood composed o ?
Fascia rom the in erior rectus and in erior oblique.

What is the most requent site o mandible ractures?
Angle (35%), parasymphysial region (24%), and body (18%).

What mandible racture location is most commonly associated with anterior open bite?
Subcondylar/condylar.

What premature usion causes brachycephaly?
Bilateral coronal synostosis, cranial vault is shortening in A-P dimension, rontal skull is at and wide.

What is lambdoid synostosis known as?
Occipital or posterior plagiocephaly; oblique and posterior attening.

What is the condition present with a normal SNA and decreased SNB?
Mandibular retrusion.

What is the Landes angle?
Frank ort horizontal and N-A plane; normal value 88 degrees.

What is the likely cause o a gradual bony enlargement o the le t ronto-orbital region in a 9-year-old child?
Fibrous dysplasia.

What is McCune Albright syndrome?
Polyostotic brous dysplasia, hyperthyroidism, abnormal pigmentation, sexual precocity.

CHAPTER 93 High-Yield opics
923

In a patient with mandibular prognathism and maxillary hypoplasia, what is the required treatment?
Le Fort I with sagittal split osteotomy.

What is the likely cause o enophthalmos a ter trauma?
Bony orbital volume increase.

What is the next course o treatment ollowing a Le Fort I with a unilateral posterior open-bite de ormity?
Removal o hardware and disimpaction o the maxillary racture.

What is Binder syndrome?
Mid ace hypoplasia, at nasal dorsum, retracted columella, anterior nasal spine absence; Angle class III occlusion.

What do the rst three hillocks give rise to?
T e tragus, root o the helix, and superior helix.

What do the second three hillocks give rise to?
T e antihelix, antitragus, and lobule.

What does Meckel cartilage orm?
Malleus, incus, mandible, sphenomandibular ligament.

What does Reichert cartilage orm?
Stapes, styloid process, stylohyoid ligament, lesser cornu o the hyoid, part o the hyoid body.

What is the rst structure to be released during treatment o a retrobulbar hematoma?
T e lateral canthal tendon.

Where is enon capsule located?
It covers the globe and extraocular muscles; lower portion constitutes Lockwood ligament.

What is the study o choice in patients with painless jaw clicking a ter trauma?
MRI to rule out internal derangement.

What essier cle t is associated with macrostomia?
No. 7.

Which cle t is associated with absence o the zygomatic arch?
Also No. 7.

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Plastic & Reconstructive Surgery Board Review

What is the likelihood o malignant trans ormation in acinic cell carcinoma o the parotid?
In requent, bilateral, or multicentric lesion.

What is the most common malignant tumor o the parotid?
Mucoepidermoid carcinoma.

What is the layer underneath which is used or the Gillies approach to a zygomatic arch racture?
Deep layer o the deep temporal ascia.

What is the mechanism o action o the MJ during the last portion o jaw opening?
Upper joint space translation.

What is the sequence o events in MJ opening?
Rotation (condyle in lower joint space), rotation/translation, translation within the joint (condyle in upper joint
space).

What innervates the tensor veli palatini?
Cranial nerve V.

What innervates the levator veli palatini?
T e superior laryngeal branch o CN X.

What innervates the stylopharyngeus?
CN IX.

What innervates the palatopharyngeus?
CN X.

What supplies vascularity to the trapezius ap?
T e transverse cervical artery, secondary source occipital artery, type II muscle ap.

What supplies sensation to the lobule and posterior two-thirds o the ear?
T e great auricular nerve.

What supplies sensation to the posterior ear and EAC?
Arnold nerve (branch o X).

What supplies sensation to the anterior superior helix and tragus?
Auriculotemporal nerve (branch o V).

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925

What supplies sensation to the posterior auricle and concha?
Posterior auricular nerve, lesser occipital nerve.

What is the rate o distraction osteogenesis in the pediatric mandible?
1 mm/day.

What process causes the changing o recipient mesenchymal cells into osteoprogenitor cells rom BMP
stimulation?
Osteoinduction.

What is osteoconduction?
Bone ingrowth into gra ted material.

What structures should be inspected ollowing nasal trauma regarding septal deviation?
Septal cartilage, perpendicular plate o the ethmoid, vomer.

What is the rst-line treatment or nasopharyngeal carcinoma?
Radiation therapy.

What is the likely response to a 2-cm squamous cell carcinoma o the lower lip to radiotherapy?
90% complete response.

What permanent teeth have the longest roots?
T e cuspids (canines); 27 mm height.

What bone mainly comprises the medial orbital wall?
Ethmoid bone.

T e lingual nerve is a branch o what nerve?
T e mandibular branch o CN V.

What are the main branches o the mandibular division o CN V?
Lingual nerve, in erior alveolar nerve, long buccal branch, mental nerve, auriculotemporal branch.

What does the auriculotemporal nerve innervate?
Sensation to the anterior auricle, temporal region, and portion o EAC and MJ.

What are the main branches o the maxillary division o CN V?
In raorbital nerve, nasopalatine nerve, posterosuperior alveolar nerve, posterosuperior nasal nerve.

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Plastic & Reconstructive Surgery Board Review

What structure is the likely cause o ectropion ollowing an orbital oor racture reduction through a
subciliary incision?
Scarring o the orbital septum.

What structure is avoided when making an incision into the rst lower eyelid crease during an orbital oor
racture case?
T is incision preserves the innervation o the pretarsal portion o the orbicularis oculi; normal lid tone is
preserved.

T e mental nerve located in relation to what tooth o the mandible?
T e second bicuspid.

Where is Stensen duct located relative the maxillary teeth?
Opposite the second molar.

What muscle contributes to medial displacement o the condyle ollowing a racture?
Lateral pterygoid.

T e Frank ort horizontal passes through which points?
T e porion and orbitale.

What is the treatment or a unilateral nondisplaced coronoid racture?
Short-term mandibulomaxillary xation.

What is the treatment or a mandibular osteogenic sarcoma?
Wide excision, ollowed by radiation/chemotherapy.

Where do the most minor salivary gland tumors arise in the mouth?
T e palate.

What is the histological subtype o most minor salivary gland tumors?
Adenoid cystic carcinoma.

In an edentulous patient, what can be used or MMF?
Intraoral splints that are custom made; xed to the maxilla or mandible using wires/screws.

What is advocated or rst-line treatment or a chylous stula in the neck?
Medium chain triglyceride diet with closed drainage on suction.

Which side is a chylous stula usually associated on?
Injury to the thoracic duct on the le t.

CHAPTER 93 High-Yield opics
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What are the physical ndings associated with a unilateral cle t lip?
Rotation o the premaxilla and outward projection; collapsed lateral maxillary segment; shortened columella,
attenuation o the lower lateral cartilage; alar base rotated outward; shortened philtrum.

What direction are the septum and cartilage deviated toward in a unilateral cle t lip?
oward the noncle t side.
HAND AND EXTREMITIES

What is the Gustilo classi cation?
Classi cation o open lower extremity ractures.
Type I
Low energy, so t-tissue de ect < 1 cm
Type II
So t-tissue de ect > 1 cm with moderate so t-tissue damage
Type III
So t-tissue de ect > 1 cm with extensive so t-tissue damage
IIIa

Local so t-tissue coverage possible
IIIb

Local so t-tissue coverage not possible
IIIc

Vascular injuries that require repair

What management option should be considered with Gustilo IIIC injuries with an insensate oot?
Below-knee amputation.

What is lymphedema praecox? Lymphedema arda?
It is the most likely orm o hereditary lymphedema—typically mani ests at puberty and has a chronic course.
It is usually seen bilaterally. Lymphedema tarda arises in middle age by de nition. It is another orm o primary
lymphedema.

What is in antile digital bromatosis? reatment?
Rapidly growing brous lesions appearing on the lateral or dorsal aspects o ngers o children. Pathology shows
intracytoplasmic inclusion bodies. reatment is wide excision.

What is the initial management o lymphedema?
Elevation and compression, also consider intermittent pneumatic compression therapy.

At what age should thumb reconstruction be per ormed in the complete absence o the thumb?
1 year o age.

What structures need to be divided with release o the ulnar tunnel?
Pisohamate ligament, volar carpal ligament.

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Plastic & Reconstructive Surgery Board Review

What is Osborne ligament?
T e band o ascia bridging between the two heads o the FCU and the medial epicondyle, a common site o ulnar
nerve compression.

What nerve may be injured with harvest o the lateral gastrocnemius ap?
Common peroneal nerve (approximately 8%).

How can you distinguish a preganglionic rom a postganglionic nerve injury?
Preganglionic lesions are associated with nerve root avulsions and are not reconstructable by nerve repair or nerve
gra ts. Sensory nerve conduction is intact but with the absence o somatosensory-evoked potentials.

A manual laborer presents with avulsion amputation o the index nger, what is the best treatment?
Revision amputation.

What is the initial management o epithelioid sarcoma?
Preoperative radiation.

A patient presents with delayed rupture o a exor tendon repair, what is the best treatment option?
Staged tendon reconstruction with initial placement o Hunter rods.

Patient presents a ter mastectomy and radiation or breast cancer with ipsilateral hand swelling, numbness,
and generalized weakness without pain, what is the diagnosis?
Radiation-induced plexopathy, most common in the C5–6 distribution.

What is the emoral triangle? What is its importance in medial thigh li t?
T e emoral triangle is ormed by the inguinal ligament, the sartorius muscle, and the adductor longus muscle.
Avoiding the lymphatics in this area during thigh li t reduces seroma rate.

What is melanonychia?
Benign pigmented streaks in the nail plate, commonly seen in A rican Americans.

What is the initial management o a pigmented lesion under the nail?
Shave biopsy ( ull-thickness biopsy is unnecessarily morbid).

A patient has burn scar over hal o his nail bed and requests cosmetic improvement, what is the best
treatment?
Excision o scar, eponychial ap, and nail bed gra t rom a toe.

What is the Wassel classi cation o duplicated thumb? Which is most common?
I: bi d distal phalanx; II: duplicated distal phalanx; III: bi d proximal phalanx; IV: duplicated proximal phalanx;
V: bi d metacarpal; VI: duplicated metacarpal; VII: triphalangism.
* ype IV is most common.

CHAPTER 93 High-Yield opics
929

An FDP tendon ruptures with a large piece o bone, the tendon will get caught on what structure?
A4 pulley.

Polydactyly alls under what category o congenital anomalies?
Duplication.

Syndactyly alls under what category o congenital anomalies?
Failure o di erentiation.

What are the innervations o the exor pollicis brevis muscle?
Deep head: ulnar nerve; super cial head: median nerve.

What nerve trans er can restore intrinsic unction a ter high ulnar nerve injury?
Anterior interosseous nerve to the pronator quadratus trans erred to the ulnar motor branch.

What is the reverse cross- nger ap?
T e ap trans ers only the subcutaneous tissue o the dorsum o the donor nger to the recipient nger providing
an adequate bed or skin gra ting.

What is a DISI de ormity in the wrist?
Dorsal intercalated segmental instability (DISI) is when the scaphoid and lunate are dissociated rom an injury to
the scapholunate ligament (indicated by widened scapholunate interval). T e lunate goes into dorsi exion and the
scaphoid goes into volar exion.

In Klippel– renaunay syndrome (K S), what are the major health risks?
DV , pulmonary embolism.

At the level o the wrist, where are the motor bers o the median nerve in relation to the sensory bers?
Volar and radial.

What is the Blauth classi cation o hypoplastic thumb?
I

Minor generalized hypoplasia
II
Absence o thenar muscles, rst webspace narrowing, ulnar collateral ligament insu ciency
III Extrinsic muscle abnormalities, skeletal de ciency (A: stable CMC; B: unstable CMC)
IV Pouce f ottant o f oating thumb (rudimentary thumb)
V
Absent thumb

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Plastic & Reconstructive Surgery Board Review

What is the main arterial supply to the reverse sural ap?
T e ap is based on the sural artery via per orators rom the peroneal artery. T e main per orator arises
approximately 5 cm superior to the malleolus.

A patient can still ex her DIP joint a ter cutting her FDP, why?
Preservation o the vincula.

A patient can still extend the DIP joint a ter cutting the extensor tendon at the middle phalanx, why?
Oblique retinacular ligament.

On nerve conduction studies, what is the signi cance o increased latency?
Latency measures the time or nerve conduction, nerve compression, and subsequent demyelination result in
increased latency.

On EMG, what changes signi y denervation?
Fibrillations and positive sharp waves.

rue/False: Biodegradable materials are pre erable or use as spacers in CMC arthroplasty?
rue.

What is the most important structure providing stabilization to the CMC joint?
Dorsal ligament complex.

What is the management o perilunate dislocations?
Open reduction and internal xation.

What is the treatment or loss o the thumb at the level o the MCP joint?
oe-to-thumb trans er.

rue/False: At the level o the wrist, the FDS tendons o the index and small ngers are dorsal to the long
and ring ngers.
rue.

What tendon trans er is most appropriate in a child with spastic cerebral palsy with mental retardation and
a clenched st with ulnar palmar maceration?
FDS to FDP; this will lengthen and weaken the nger exors; may also arthrodese wrist rather than trans erring to
wrist extensors.

When is texture discrimination appropriate or children with CP?
Age 2 to 3 years.

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931

rauma to the dorsalis pedis artery in the lower leg is most likely associated with what neuropraxia?
Decreased deep peroneal nerve unction; rst webspace decreased sensation.

What innervates the dorsal aspect o the oot?
Super cial peroneal nerve.

What innervates the lateral oot?
Sural nerve.

Medial?
Saphenous nerve.

Which o these nerves travels with an artery?
Deep peroneal nerve.

What innervates the plantar sur ace?
ibial nerve; travels with P .

What is the immediate treatment or hydro uoric acid burns?
Calcium gluconate gel application (prevention o hypocalcemia, hypomagnesemia, hyperkalemia).

What is given or phenol burns?
Mineral oil.

What is given or creosol burns?
Polyethylene glycol.

What is the most common primary benign tumor o the hand?
Enchondroma (benign cartilaginous tumor).

What signi es pain in the absence o racture with enchondroma?
Malignant degeneration.

What is the radiographic nding in enchondroma?
Scalloped, lytic lesion within the medullary canal.

What is Ollier disease?
Multiple enchondromatosis.

What is Ma ucci syndrome?
Multiple enchondromas with subcutaneous hemangiomas.

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Plastic & Reconstructive Surgery Board Review

How o ten do chondromyxoid bromas occur in the upper extremity?
Rarely.

How o ten do giant cell tumors occur in the distal upper extremity?
Only 2% to 5% in hand; radius is the third most commonly a ected site.

How o ten do osteoid osteomas cause pain?
Frequently, at night, give NSAIDs.

What de nes the midpalmar space?
Flexor tendons, metacarpal bone and interosseous ascia, septum rom the third metacarpal to FDP, super cial
aponeurosis (deep to the exor tendon to ascia over second/third volar interossei and third/ ourth metacarpals).

What is the thenar space?
Radial to vertical septum between the third MC and FDP o long nger; extends to radial edge o abductor
pollicis brevis.

What tendons are ruptured most commonly in RA?
EPL (treat with ECRL trans er) and EDQ.

How do extensor tendon ruptures progress in the RA patient?
Ulnar to radial progression (Vaughn–Jackson progression); EDQ then EDC to small, ring, then long ngers.

What is a Manner elt lesion?
Rupture o FPL over a scaphoid spur ( exor ruptures ar less requently, usually a ecting radial digits).

What prevents closed reduction o the little nger in a volar dislocation o the PIP joint?
Extensor tendon; when condyle has pushed through the extensor tendon and acts as sling.

What is more common—volar or dorsal dislocations o the PIP?
Dorsal.

What may prevent dorsal dislocations o the PIP rom adequate closed reduction?
Volar plate and exor tendons, though rarely.

What is the most common primary blood supply to the great toe in toe-to-thumb trans er?
First dorsal metatarsal artery rom DP; may travel dorsal or plantar to interosseous muscle.

What hand tumor has an af nity or immunosuppressed patients?
Keratoacanthoma (thought to be a variant o SCCa); appears as red papule, expands rapidly over several weeks.

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What is the likelihood or uture siblings to be a ected with constriction band syndrome?
No genetic transmission; ourth most common congenital hand anomaly.

What are the three most common congenital hand anomalies?
Polydactyly, syndactyly, and trigger thumb.

What other anomalies are seen with amniotic band syndrome?
Club oot, cle t lip/palate, cranio acial de ects, hemangioma, meningocele.

What is the most appropriate treatment or radial nerve palsy a ter a humeral ORIF 6 months later?
endon trans ers.

What trans ers are per ormed or radial nerve palsy?
Pronator teres to ECRB or wrist extension.

What trans ers are per ormed or nger extension?
FCR, FCU, FDS(3, 4) to EDC.

What trans ers are per ormed or thumb extension?
PL or FCR to EPL.

What is the best option or reconstruction o volar skin o the index when dorsal skin o the long nger is
not available?
T enar ap ( or tips o index/long ngers); these ngers ex easily into the thenar crease.

What option is there or ring and small nger volar skin de ects?
Hypothenar aps.

What procedure may be used or volar pad de ects o the thumb?
Moberg ap; volar advancement ap; composed completely o palmar thumb skin.

With an SLAC wrist what procedure is most appropriate in a dockworker?
SLAC wrist, with DISI and radioscaphoid arthrosis, is best treated with scaphoid excision and our-corner
arthrodesis (lunate, capitate, hamate, triquetrum) in a dockworker.

How is SLAC wrist classi ed?
Stage I: radioscaphoid
Stage II: radial midcarpal
Stage III: ulnar midcarpal
Stage IV: pancarpal

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Plastic & Reconstructive Surgery Board Review

What structure de nes the growth and di erentiation o the new limb during embryologic development?
Apical ectodermal ridge (which arises rom the Wol an ridge, protruding rom the main trunk).

What structure de nes anterior–posterior morphology o the limb?
Zone o polarizing activity.

When do the upper extremities begin to develop?
At 4 weeks; by the th week, the hand is recognizable; the apical ectodermal ridge becomes attened; hand
appears initially as paddle.

When are the ngernails identi able?
At the 17th week o gestation.

What is the rst step in a patient with a 2-cm gap in the ulnar nerve ollowing trauma?
Ulnar nerve transposition (provides up to 4 cm o length; 2 cm o length at distal orearm and wrist).

PIP contractures in th nger Dupuytren is most likely caused by what structures?
Central, lateral, and spiral cords.

What other ascial structures may contribute to exion contractures?
Grayson, Cleland, lateral digital sheath, natatory ligament, pretendinous and spiral bands, super cial transverse
ligament.

What does the central cord arise rom?
T e pretendinous band.

What is the lateral cord rom?
Central digital sheath.

What is the spiral cord composed o ?
Pretendinous and spiral bands, lateral digital sheath, and Grayson ligament.

Contraction o the spiral cord has what e ect on the neurovascular bundle?
Medial and super cial displacement o the bundle.

What causes contracture o the MP joint?
Action rom the pretendinous cord (which does not contribute to PIP contracture).

What does the natatory cord cause?
Adduction contractures o the digits (passes transversely across palm at level o webspaces).

CHAPTER 93 High-Yield opics
935

What is the most common organism causing septic arthritis o the hand/wrist?
Staphylococcus aureus. Streptococcus is next.

What organism will likely be cultured rom a human bite wound?
Eikenella corrodens.

What is the best option or a distal third de ect ollowing trauma with exposed bone?
Fasciocutaneous ap.

What de ects will a gastrocnemius ap cover in the leg?
Upper, some middle third o the leg de ects.

How is onychomycosis treated?
6 weeks o terbina ne or itraconazole.

Is terbina ne associated with any side e ects?
Stevens–Johnson, neutropenia, hepatic ailure.

What is lumbrical plus de ormity?
Extension o the PIP on attempting to make a st (occurs ollowing repair; secondary to release o FDP o index).

How is lumbrical plus treated?
Division o the lumbrical (with attempted exion lumbrical exerts tension through lateral band).

When is trans er o the interosseous muscle per ormed?
Correction o rheumatoid ulnar dri t.

What is the acceptable limit o be ore surgical correction is necessary in a pediatric patient with
camptodactyly?
30 degrees o extension o the PIP.

How are minimal extension de cits corrected in camptodactyly?
rans er lumbrical tendon into central slip.

How are extension de cits greater than 30 degrees treated?
Release o abnormal lumbrical and super cialis tendons; release o accessory collateral ligaments to volar plate;
F SG.

What is the Zancolli lasso procedure?
Portions o FDS brought through A2 pulley; or the correction o ulnar palsy digital clawing.

936
Plastic & Reconstructive Surgery Board Review

What are Kanavel signs?
Fusi orm swelling, partial exed posturing o nger, tenderness over exor tendon sheath, pain with passive
extension; open and irrigate exor sheath.

Where are the incisions made or exor tenosynovitis?
Palm incision to inspect proximal A1 pulley and distal incision to visualize A4, A5 at minimum.

What is the best postoperative dressing or an in ant ollowing simple complete syndactyly release o the
third webspace?
Long arm cast.

What zone o exor tendon repair is associated with the best prognosis?
Zone 5.

Which nger has the most lacerations o the nail bed?
T e long nger.

How are nail bed lacerations classi ed?
Simple, stellate, crush, amputated, avulsion.

Following a ring avulsion replantation ailure, what is the next step in management?
Ray amputation with most or all o the metacarpal.

What is the Littler ap?
A neurovascular island ap based on the digital nerve/vascular bundle o long or ring.

What is the Shaw ap?
Super cial in erior epigastric artery (SIEA) ap; can be used or coverage o hand/ orearm.

Where are the landmarks o the SIEA?
Intersection o inguinal ligament and emoral artery; travels superiorly and laterally toward anterior axilla.

What is the arterial supply o the groin ap?
SCIA.

What are landmarks or the SCIA?
Originates rom emoral artery, travels parallel to inguinal ligament, 1 cm deep to the ligament.

What is the best treatment o trapeziometacarpal DJD in actory worker?
Arthrodesis.

CHAPTER 93 High-Yield opics
937

When is reconstruction o the palmar (oblique) ligament per ormed?
Situations o prearthritic instability with pain o CMC joint.

How are lunate dislocations classi ed?
Midcarpal lunocapitate, complete lunate, and perilunate.

How is a complete lunate injury di erentiated rom a perilunate injury?
Presence o radiolunate joint dislocation concurrently.

What other bony structures are involved in greater arc injury?
High-energy trauma; radial styloid, scaphoid, capitate, hamate, triquetrum, ulnar styloid ractures.

What structures are involved in lesser arc injury?
SL, L , lunocapitate intervals.

What is a collar button abscess?
Pus communicating rom volar webspace to dorsal hand by palmar ascia or lumbrical canal.

What is a characteristic nding o a collar button abscess?
Finger abduction.

Where is Parona space?
Between pronator quadratus and FDP tendons; communicates with radial and ulnar palmar bursa and midpalmar
space.

What area o swelling is associated with Parona space in ection?
Volar wrist proximal to distal exion crease.

How is the scaphoid vascularized?
Per orators enter distally and supply most proximal part last; high risk o avascular necrosis o proximal pole
ractures.

What nerve is typically decompressed during Volkmann contracture reconstruction with a muscle ree ap?
Median nerve at all points o compression.

What orearm muscles are a ected most o ten in compartment syndrome?
FPL, FDP; in severe cases, FDS, FCU, FCR.

What areas o compression are important in decompressing the median nerve?
Lacertus brosus, two heads o pronator teres, proximal arch o FDS, carpal canal; ligament o Struthers (band
between supracondylar humeral process and medial epicondyle).

938
Plastic & Reconstructive Surgery Board Review

Does Volkmann’s ischemic contracture involve the anterior interosseous nerve?
No.

What is ectrodactyly?
Partial or total absence o ngers suggesting central hand de ciency.

What is typical central hand de ciency?
Absence o third ray; usually bilateral, cle t lip/palate, congenital heart disease, syndactyly and oot involvement
common.

What is camptodactyly?
Nontraumatic exion de ormity o PIP; usually bilateral; involves small nger.

What is hypothenar hammer syndrome?
Ulnar artery thrombosis; symptoms include pain, paresthesia, temperature decrease, numbness o ulnar digits.

What is the treatment o a neuroma in continuity in the extremity?
Neuroma excision and nerve gra ting (e.g., with sural nerve).

What in uences the success o a replanted digit?
Most importantly, mechanism o injury (crush, avulsion lower success rates); cooling o amputated part improves
success.

What di erentiates complex and simple syndactyly?
Complex: skin and bones are used.

When do in ants with syndactyly undergo release?
ypically by 18 months.

What is the best diagnostic study or a high- ow vascular mal ormation in the extremity?
MRA.

What symptoms accompany ulnar nerve compression at Guyon canal?
Weakness o grip, limited abduction/adduction o ngers, di culty in crossing ngers, decreased sensation over
ulnar-sided digits.

What is the signi cance o dorsoulnar sensation o the hand?
Sensation to this area is supplied by ulnar nerve bers arising 6 cm PROXIMAL to Guyon canal.

What are the most common sites o compression o the ulnar nerve?
Band o Osborne (cubital tunnel), Guyon canal, arcade o Struthers (thin aponeurotic band rom medial triceps
head to medial intermuscular septum), origin o the FCU.

CHAPTER 93 High-Yield opics
939

What describes the arcade o Struthers?
Fascial bands extending rom the medial intermuscular septum that can compress the ulnar nerve.

What is another name or the deep branch o the radial nerve?
Posterior interosseous nerve.

What are compression sites o the radial nerve?
Arcade o Frohse (band over supinator), vascular leash o Henry (radial recurrent vessels that cross the nerve),
ECRB, proximal supinator, distal supinator.

What is the most appropriate treatment or split nail de ormity?
Full-thickness nail gra ting rom the toe; injured nail bed does not carry growth o new nail plate.

What are the likely anatomic causes o ailed closed reduction o a dorsal dislocation o the MP joint o the
index nger?
Lumbrical muscle, volar plate, FDP.

What is the mechanism o ailed closed reduction in this case?
MC head protrudes volar between lumbrical and exor tendons; volar plate is olded within the joint.

What are symptoms o complex regional pain syndrome (CRPS) I?
Otherwise known as RSD; pain, sti ness, vasomotor instability; hyperhidrosis, osteoporosis may occur.

How is RSD diagnosed?
Stellate ganglion blocks; thermography has also been used.

How is CRPS characterized?
Chronic pain that persists in the absence o ongoing cellular damage and is characterized by autonomic
dys unction, trophic changes, and impaired unction. T is contributes to or creates one or more o the
ollowing: clinically signi cant osteopenia, delayed bony healing or nonunion, joint sti ness, tendon adhesions,
arthro brosis, pseudo-Dupuytren palmar brosis, swelling, and atrophy.

What is the incidence o CRPS?
5.5 to 26.2 per 100,000 person-years, and the prevalence is reported as 20.7 per 100,000 person-years. Women
are more requently a ected than men, with a ratio o 3:1 to 4:1; the upper extremity is involved more requently
than the lower extremity; and racture is the most common causative event. Incidence o CRPS a ter distal radius
racture has been reported to be between 22% and 39%.

What drug is associated with a decreased incidence o CRPS?
Ascorbic acid.

What is causalgia?
Otherwise known as CRPS II; persistent pain ollowing trauma with a known nerve injury.

940
Plastic & Reconstructive Surgery Board Review

What is most appropriate treatment ollowing transverse nonhealing ractures o the ourth and th
metacarpal sha ts?
Open reduction, miniplate xation.

What is the most common mode o inheritance in typical cle t hand?
Autosomal dominant.

What are the characteristics o typical cle t hand?
V-shaped cle t, absence o central digit, syndactyly o ulnar-sided digits; associated with syndromes (EEC:
ectrodactyly, ectodermal dysplasia, cle t lip/palate); cle t oot.

What are the characteristics o atypical cle t hand?
U-shaped hand that is broad; sometimes termed symbrachydactyly.

What is the common cause o swan neck de ormities in rheumatoid arthritis?
Intrinsic tendon tightness.

What procedures are recommended or swan neck de ormities?
MP arthroplasty, intrinsic releases, centralizing extrinsic extensor tendons; Zancolli-FDS reconstruction.

What muscle harvested with a distally based posterior interosseous ap will maintain blood supply o the
ulna?
Muscle to the EPL.

What ascial structures normally surround the neurovascular bundle in the nger?
Cleland, Grayson ligaments, lateral digital sheet, retrovascular band.

Where do EDC ruptures occur in RA?
At the level o distal ulna; must di erentiate rom extensor subluxation.

Can FDS ruptures cause swan neck de ormities in RA?
Yes, less commonly.

What is Cleland ligament?
Fascial structure lying deep and dorsal to neurovascular bundle; originates rom side o phalanges and travels
obliquely to skin.

What is Grayson ligament?
Super cial to neurovascular bundle; arises rom tendon sheath and goes to the skin; travel volar to the
neurovascular bundle; thought to be involved in Dupuytren’s.

CHAPTER 93 High-Yield opics
941

What is the lateral digital sheath?
Composed o super cial ascia on both sides o the phalanges; bers rom the natatory ligament and spiral band
contribute as well.

What is the most appropriate time or correction o syndactyly?
12 to 18 months or third webspace; earlier or rst or ourth webspace syndactyly.

What de nes complete syndactyly?
Inclusion o the entire webspace.

What supplies the sartorius muscle ap?
T e super cial circum ex iliac (SCIA) and super cial emoral arteries.

What potential aps are supplied by the lateral circum ex emoral artery?
Rectus emoris, FL, vastus lateralis.

What is a pincer nail de ormity?
Otherwise known as trumpet nail de ormity; excess transverse nail curvature; pinching o the so t tissue o the
ngertip.

How is trumpet nail de ormity treated?
Lateral nail matrix elevation and dermal gra ting.

In neonatal brachial plexus palsy, complete recovery is likely i activity is seen in the deltoid and biceps by
what week?
Week 8.

What is Dupuytren diathesis?
An early, aggressive orm o Dupuytren involving knuckles, plantar ascia, and Peyronie disease.

What digits are involved in Dupuytren disease? In Dupuytren diathesis?
In Dupuytren the ulnar digits; in diathesis the radial digits.

What distinguishes the location o Heberden and Bouchard nodes?
Both seen in OA; Heberden a ect the DIP; Bouchard a ect the PIP.

What response is sometimes seen ollowing surgery or Dupuytren disease?
A are response (type o localized RSD).

What is hypothenar hammer syndrome?
rauma to hand causing crushing o the ulnar artery at Guyon canal resulting in a true aneurysm sending emboli
to the digits.

942
Plastic & Reconstructive Surgery Board Review

What upper extremity ndings are seen in thoracic outlet syndrome?
Sensorimotor ndings in C8– 1; numbness in ngers (particularly small nger); test with Roos, Adson tests.

What patient population is Buerger disease seen in?
Middle-aged smokers.

What incision is used or compartment syndrome o the hand in releasing the adductor pollicis and
interossei?
Dorsal incision over the second metacarpal.

What compartments are released in a hand compartment syndrome?
Four dorsal, three volar interossei, adductor pollicis, and thenar/hypothenar eminences.

What incisions are made or releasing all o the hand compartments?
All dorsal incisions over the second and ourth metacarpals; ulnar th metacarpal, radial rst metacarpal.

What is the best means o reducing a dorsal dislocation o the MP joint o the index?
Wrist exion with placing pressure distally and volarly; traction places the volar plate more dorsally preventing the
MP joint rom being reducible and tightens lumbricals and exor tendons.

What is the likely cause o point tenderness o the base o the nail that is sensitive to cold and pain ul on
palpation?
Glomus tumor; bright lesion on 2 MRI.

What are the two most common tumors o the hand?
Ganglions, ollowed by giant cell tumors.

Where are giant cell tumors usually ound?
Palmar sur aces o the wrist and hand.

What is Vaughn–Jackson progression?
Extensor tendon rupture rom ulnar to radial-sided digits.

What is caput ulna?
Prominence and dorsal subluxation o the ulna causing tendon ruptures.

What is done or extensor tendon ruptures in RA?
rans er to radial extensors; centralized over MP joints.

What comprises tendon trans ers or radial nerve palsy?
Pronator teres to ECRB, FCU to EDC, palmaris longus to EPL.

CHAPTER 93 High-Yield opics
943

What is done in the Boyes sublimis trans er?
FDS(3) trans erred to the EDC(3,4,5); FDS(4) to EIP and EPL; and FCR to adductor longus and EPB.

What is seen on radiographs o the hand in scleroderma?
Calcium deposits in the so t tissue; treat with calcium channel antagonists, NSAIDs, penicillamine.

What is clinically seen in the hands in hypoparathyroidism?
Carotenemia on the palms and soles.

What is pronator syndrome?
Compression proximally o the median nerve; sensory symptoms in the median nerve distribution; decreased palm
sensation.

What maneuvers reproduce pronator syndrome?
Elbow exion with elbow in pronation, resisted elbow exion, resisted pronation with wrist exion.

What are compression points o the median nerve?
T e supracondylar process and ligament o Struthers ( rom supracondylar humeral process and medial epicondyle,
lacertus brosis ( ascia o aponeurosis rom biceps tendon to exor mass), pronator teres, FDS arch.

What is anterior interosseous syndrome?
Pain in proximal orearm; weakness/paralysis o FDP o index and long, FPL, and pronator quadratus.

Where is the anterior interosseous nerve compressed potentially?
Deep head o the pronator teres, FDS(4) tendinous origin, origin o FCU, accessory FPL, palmaris pro undus.

What is cubital tunnel syndrome?
Compression o the ulnar nerve at the elbow; pain over proximal orearm; weakness o FDP o ring and small and
rst dorsal interosseous and abductor digiti minimi; numbness/tingling o ring/small ngers; sensory de cit o
ring/small.

What is posterior interosseous syndrome?
Motor de cits without sensory de cits; weakness o wrist/thumb/thumb abduction/digit extensors; radial
deviation o the wrist (ECRL innervated proximally); initially weakness and pain in orearm.

What likely is the site o compression o the posterior interosseous nerve?
Arcade o Frohse.

Where do most patients have compression with radial tunnel syndrome?
At the arcade o Frohse (band over deep radial nerve entering supinator); also vascular leash, ECRB tendon.

944
Plastic & Reconstructive Surgery Board Review

What is the primary symptom seen in radial tunnel?
Pain rather than numbness or weakness over the mobile wad with extension, resisted supination, or passive
exion/pronation o the wrist.

What motor or sensory loss is seen with radial tunnel syndrome?
None.

What is the most appropriate step or avascular necrosis o the proximal pole o the scaphoid ollowing
ORIF?
Bone pedicle ap; based on per orators rom neighboring extensor compartments.

What percentage o nondisplaced scaphoid ractures heal by casting alone?
90%.

What is the incidence o complete healing in scaphoid ractures displaced by more than 1 mm?
55% have nonunion; 50% have eventual avascular necrosis.

What is Kienböck disease?
Avascular necrosis o the lunate.

What most likely prevents closed reduction in PIP dislocations?
FDP tendon ( exion causes entrapment o the proximal phalangeal condyles); volar plate also is a potential cause
o ailed reduction.

What is the treatment or extrinsic tendon tightness o the PIP ollowing an old burn injury?
Central slip release.

What is the treatment or intrinsic tendon tightness?
Release o the lateral bands.

What is the sequence o replantation or a ve- nger amputation?
T umb, ollowed by long or ring, with index least in order o importance.

What is the sequence o reconstructing the structures o an amputated digit?
First bone/tendon, then vein/artery, then nerves last.

What position on the metacarpal is most appropriate or an index to long nger transposition?
At the level o the metacarpal base.

What is the likely e ect on power grip and key pinch ollowing a ray resection o the index nger?
20% decrease; loss o supination strength.

CHAPTER 93 High-Yield opics
945

What is the treatment or an acute scapholunate tear?
Open repair through a dorsal incision; Blatt capsulodesis urther secures the repair.

What are May eld classi cation o perilunate instability patterns?
I: SL instability or tearing o SL and volar radioscaphoid ligaments
II: dislocation o the capitate
III: L separation
IV: lunate dislocation

What encompasses greater arc injuries in the setting o perilunate dislocations?
Fractures o the radial styloid, capitate, triquetrum, ulnar styloid.

When is scaphoidectomy recommended?
In scaphoid nonunion advanced collapse; progressive chronic arthritis in conjunction with a proximal row
carpectomy or our corner arthrodesis.

What artery courses through the triangular space?
T e circum ex scapular.

What are the boundaries o the triangular space?
T e long head o the triceps, teres major and teres minor.

Where is the quadrangular space in relation to the triangular space?
Immediately lateral.

What comprises the quadrangular space?
Surgical humeral neck, lateral head o the triceps, teres major, teres minor.

What passes through the quadrangular space?
T e axillary nerve and posterior humeral circum ex artery.

What is the period o immobilization or a nondisplaced scaphoid waist racture?
10 to 14 weeks in a thumb spica cast.

What is the lumbrical plus de ormity?
Occurs ollowing transection o the FDP tendon; in exion, the lumbrical through the radial lateral band causes
paradoxical PIP extension.

What is the treatment o lumbrical plus de ormity?
Division o the lumbrical tendon or releasing the radial lateral band.

946
Plastic & Reconstructive Surgery Board Review

What exor tendon ruptures are seen most requently in RA?
FPL and FDP o the index because o bony spurs over the distal scaphoid.

What is intersection syndrome?
Second dorsal compartment tenosynovitis; near intersection o rst and second extensor compartments; pain and
swelling 4 cm proximal to wrist; proximal to Lister tubercle.

What is Wartenberg syndrome?
Compression o the dorsal sensory branch o the radial nerve between the brachioradialis and ECRL tendons;
pain, numbness o dorsoradial wrist ollowing wearing a bracelet.

What length o bone is provided by the bula ree ap?
More than 20 cm.

What procedure may be done or a 1.5-cm diameter de ect o the volar distal thumb?
Moberg ap (palmar advancement ap).

What is the most appropriate treatment or a ull-thickness burn o the orearm?
Early tangential excision to punctate bleeding and coverage with split-thickness skin gra ts.

What joints are a ected in osteoarthritis o the thumb?
CMC, S , radiocarpal joints; initially, there is volar beak ligament ailure.

What are elons?
In ections o the pulp space usually caused by S. aureus.

What is the mechanism in congenital clasp thumb?
Absence o the EPB and/or EPL; MP exion and thumb adduction.

Where does the rst dorsal metacarpal artery travel in relation to the rst dorsal interosseous muscle?
Within the ascia o the muscle; communicates with per orators rom the super cial arch near the MP joint.

What is a Stener lesion?
Palpable mass on the ulnar metacarpal head; composed o adductor pollicis ascia interposed between torn ulnar
collateral ligament and MP joint o thumb.

What muscle may cause carpal tunnel syndrome in a heavy laborer?
Lumbrical. T e lumbrical inserts into radial sagittal band and aids in extension o the interphalangeal joints as well
as exion o MP joints.

What is the appropriate treatment o a chronic paronychia o the nger?
Usually due to Candida; i topical/oral anti ungals are not success ul, eponychial marsupialization.

CHAPTER 93 High-Yield opics
947

What are the associated syndromes o radial club hand?
VA ER, Holt-Oram, Fanconi anemia, AR syndrome (thrombocytopenia-absent radius syndrome).

What test is per ormed to detect Fanconi anemia?
Mitomycin testing to prevent pancytopenia complications.

What structures are involved in Dupuytren contractures o the PIP joint?
Central, lateral, retrovascular, and spiral cord (pretendinous band, vertical band, spiral band, Grayson ligaments,
lateral digital sheath contribute to the spiral cord).

What are the subtypes o the thumb-in-palm de ormity in cerebral palsy?
ype I: simple adduction contracture.
ype II: type I with MP exion de ormity.
ype III: adduction with hyperextension de ormity and/or MP instability.
ype IV: type I with FPL spasticity.

What level o amputation should be done or a subungual melanoma?
At the DIP joint.

What manipulations o the upper extremity will increase median and ulnar nerve length during repair?
Shoulder abduction and elbow exion.

What is the best treatment or a 30-year-old steelworker with CMC arthritis?
rapeziometacarpal arthrodesis.

What are the characteristics o juvenile RA?
Exhibit wrist exion with loss o wrist extension; carpal bone and metacarpals are deviated ulnarly, loss o IP
exion, loss o MP exion, and radial deviation o MP joints.

How common are tendon ruptures seen in juvenile RA?
Rare.

In adult RA, what direction does the carpus tend toward?
Radial deviation and supination.

What is the guiding principle in zone II exor tendon repairs to ensure greatest motion?
Immediate early active exion to prevent adhesions.

What spatial relation does the ulnar motor group have with respect to the sensory group in the wrist?
Ulnar and dorsal to the sensory group; at Guyon’s the motor ascicles become dorsal and radial.

948
Plastic & Reconstructive Surgery Board Review

What is the treatment or a type IV mallet injury?
Closed reduction and pin xation; 30% o the articular sur ace o the phalanx has been avulsed.

What is the treatment or a type I mallet injury?
Stack splinting; immobilizes DIP joint in extension.

What is the quadriga e ect?
Excessive distal pull by one FDP tendon; leaves other digits with decreased exion.

What is the treatment or a CMC dislocation o the thumb?
Closed reduction by axial traction and pronation with application o pressure to the metacarpal base and pinning.

What is normal total active motion or an index nger?
90 (MP) + 110 (PIP) + 70 (DIP) = 270 degrees.

What is the appropriate treatment or the third MP joint o a piano player with severe OA?
Silicone implant arthroplasty.

What is the best way to correct a supination de ect in a quadriplegic?
Redirection o the biceps tendon through the interosseous membrane.

What is a Moberg ap used or?
Volar de ects o the thumb; two arteries and two nerves are included; may be advanced 1 to 1.5 cm.

What are common causes o the lumbrical plus de ormity?
Distal amputations, lengthy FDP interposition gra ts; excessive pro undus lengthening procedures.

What is the local muscle ap used or antecubital ossa wounds?
Brachioradialis ap; based on the radial recurrent artery.

What is the lateral arm ap based on?
Per orating branches o the pro unda brachii artery.

What nerve palsy is occasionally seen in tourniquet usage during hand surgery?
Radial nerve palsy.

What is arthrogryposis?
Multiple joint contractures seen at birth.

What is Madelung de ormity?
Radial shortening, palmar subluxation o the carpus, ulnar head prominence; slowed growth o the ulnar distal radius.

CHAPTER 93 High-Yield opics
949

What is the treatment o most Salter ractures?
Closed reduction with pin xation.

What is the rst step in managing an above-elbow amputation 5 hours later?
Arterial shunting.

What is a longitudinally bracketed epiphysis?
Causes angular de ormity o the nger; longitudinal growth is delayed on one side while the other side o the
phalanx grows normally; associated with delta phalanx.

What is Secrétan disorder?
Peritendinous brosis ollowing minor work-related trauma; may be associated with lymphedema.

Where do the per orators arise to supply the osteocutaneous radial orearm ap?
Between the brachioradialis and exor carpi radialis.

What is the appearance o an enchondroma on plain lms?
Radiolucent neoplasm; thinning and expansion o the bony cortex.

What is the risk o multiple enchondromas?
Degeneration to chondrosarcomas.

Following a Gustilo IIIB injury, what pulse lavage agent is likely to preserve cellular unction while cleaning
the wound?
1% surgical soap.

What is the earliest clinical sign o upper extremity compartment syndrome?
Worsening pain with passive muscle stretching.

What organism is associated with medicinal leech therapy during antibiotic prophylaxis?
Aeromonas hydrophila.

What sensation is detected by Pacinian corpuscles?
Vibration.

What skin component detects burning pain?
Free endings o C bers.

What detects moving two-point discrimination?
Meissner corpuscles.

950
Plastic & Reconstructive Surgery Board Review

What detects static two-point discrimination?
Merkel cells.

What webspace is most requently a ected in syndactyly?
T e third webspace.

What is the inheritance o syndactyly?
Sporadic.

What is Carpenter syndrome?
Simple syndactyly, brachydactyly, broad thumbs, craniosynostosis.

What is P ei er syndrome?
Partial syndactyly, broad thumbs, mid ace hypoplasia.

What is a traumatic boutonniere de ormity?
Central slip disruption at the PIP joint with volar migration o the lateral bands; PIP exion causes DIP extension.

What causes PIP contractures in Dupuytren?
Central cord most likely cause contractures; lateral and spiral cords can also cause contractures.

What is the clinical nding o a natatory cord?
Loss o nger abduction.

What cord causes contractures o the DIP joint?
T e retrovascular cord; dorsal to the neurovascular bundle and palmar to Cleland ligament.

What contractures do pretendinous cords cause?
MP contractures.

What can be used or coverage or a dorsal exposed IP joint o the thumb?
Kite ap.

What is the kite ap based on?
First or second dorsal metacarpal artery; dorsal skin o the respective proximal phalanx is taken with the ap;
super cial radial sensory nerve branch may be used or sensation.

Where is the origin o the rst dorsal metacarpal artery located?
Just proximal to the bi urcation o the dorsal radial artery into the princeps pollicis and deep palmar arch.

What congenital de ormity is seen with a delta phalanx?
Clinodactyly.

CHAPTER 93 High-Yield opics
951

What causes camptodactyly?
Skin de cit, volar plate shortening, central slip de ciency, shortening o the sublimis tendon.

What is the most requent nding in late Volkmann contractures?
Flexor muscle brosis.

In what population o patients do Volkmann contractures occur?
Children who have supracondylar ractures (brachial artery compromise).

What nerve is most commonly involved in Volkmann contracture?
Median nerve neuropathy most common.

What is the typical clinical appearance o the hand in Volkmann contracture?
Wrist exion, exion/adduction o the thumb, MP extension, PIP/DIP exion.

What characterizes intrinsic plus de ormities?
Intrinsic muscle contracture; MP exion, PIP extension.

What is a Stener lesion?
T e ulnar collateral ligament o the thumb MP joint tears and retracts proximally; the adductor aponeurosis
intercedes the space and prevents healing.

What treatment is done or a Stener lesion?
Open reduction, internal xation.

What is the treatment principle behind patients with RA regarding order o progression?
Proximal to distal sequence (i.e., elbow arthroplasty be ore wrist arthrodesis be ore MP joint arthroplasties).

What diagnosis should be considered with rapid onset o psoriatic arthritis or Reiter syndrome (arthritis,
conjunctivitis, uveitis)?
HIV in ection.

What orearm muscles lie the deepest when considering sequelae o compartment syndrome?
T e FDP and FPL.

What are known as the super cial exors o the orearm?
FDS, FCR, FCU, pronator teres.

What are the deep extensors?
EPL, EPB, APL, EIP.

What are the super cial extensors?
Brachioradialis, ECRL, ECRB, EDC, ECU.

952
Plastic & Reconstructive Surgery Board Review

What are the more aggressive subtypes o BCC?
In ltrative, ulcerative, sclerosing, morphea orm.

For a subungual melanoma o the thumb, what is the most appropriate level o amputation?
T e diaphysis o the proximal phalanx.

What prevents a Clark level rom being assigned in subungual melanomas?
Absence o subcutaneous tissue in the nail bed.

What maneuvers are done to preserve webspace and unction ollowing a proximal phalanx amputation o
the thumb?
Z-plasty, rst dorsal interosseous tendon detachment, more proximally reattaching the adductor pollicis.

What structures may be released to improve PIP motion ollowing a severe pilon racture?
Collateral ligaments, volar plate, capsule, check rein ligaments; capsulectomy to improve nger motion.

What borders the lunula o the nail bed?
Sterile matrix distally and germinal matrix proximally.

What percentage o people do not have a plantaris muscle on one side?
15%.

What clinical nding may be seen with a glomus tumor o the nail bed?
Blue discoloration o the nail bed and distal phalanx erosion.

Where are giant cell tumors o the hand ound?
Palmar wrists, hands, ngers.

Where are mucous cysts typically located in the hand?
T ey are ganglions o the DIP joint; Heberden nodes associated.

What study is typically done or evaluating osteomyelitis o the calcaneus?
MRI.

What procedure may be done or osteomyelitis o the proximal phalanx o the thumb ollowing EPL repair?
Decortication and removal o all a ected bone; IV antibiotics.

What is next appropriate step or a 2-year-old child with a unctional thumb but adactyly o the other digits
at the level o the MP joint?
Second toe-to-hand trans er.

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953

What is Kienböck disease?
Avascular necrosis o the lunate.

What is the end-stage result o scapholunate dissociation?
SLAC wrist.

What does the lunate appear like with perilunate dislocation?
riangular on A-P.

What are the characteristics o scleroderma o the hand?
Joint sti ness, “shiny” edema o the hands; may also be associated with dysphagia.

What components orm CRES syndrome?
Calcinosis, Raynaud’s, esophageal dys unction, sclerodactyly, telangiectasias.

A laceration over the MP joint o the thumb is likely in what extensor zone?
V; EPL likely injured.

What is the role o the intrinsics in thumb extension?
Able to extend thumb IP joint to a neutral position.

What is the treatment or a volar dislocation o the PIP joint with middle phalanx volarly subluxed?
Lateral band and central slip repair; classically described as irreducible by closed means.

What structures are injured in a volar dislocation o the PIP joint?
Volar plate, collateral ligament, accessory collateral ligament; may attempt reduction by exing the MP and PIP
joints.

What is the treatment or unstable dorsal dislocations o the PIP joint?
Volar plate arthroplasty.

What are the borders o the anatomic snu box?
Volar (APL and EPB) and dorsal border (EPL).

How does C7 nerve compression present?
Weakness in the muscles supplied by the radial nerve (including triceps) and muscles in median nerve distribution
(pronator teres, FCR, FDS, FPL).

What is the next step in treating gangrene o the distal tip in a patient with severe peripheral vasculitis?
Venous bypass; amputation only as a last resort.

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Plastic & Reconstructive Surgery Board Review

What tendon trans er may be done or severe carpal tunnel syndrome with dif culty opposing the thumb in
all positions?
Palmaris longus (Camitz) to aid the abductor pollicis longus; this is an abductorplasty.

What is done or a pit viper bite to the hand?
Fasciotomy, IV antibiotics, antivenin.

What is the recommended treatment or asymptomatic pediatric carpal ganglions?
Observation and splinting.

What does the Bunnell opponensplasty involve?
rans er o the ring FDS.

What does a Huber opponensplasty involve?
Abductor digiti minimi.

A Phalen–Miller?
rans er o the ECU tendon.

A Burkhalter opponensplasty?
rans er o the EIP tendon.

What is the treatment principle o the ulna in radial club hand surgery?
Centralization o the ulna.

What is the status o the thumb in type IV radial club hand?
Absence o the thumb with the absence o the radius; scaphoid and trapezium usually absent; index pollicization
may be per ormed.

What other common syndromes are associated with radial club hand?
VA ER, Holt-Oram, AR.

What is a ag ap used or?
De ects o the proximal or MP joints o the digits; not used or the thumb.

Following a distal radius racture ORIF, thumb pain and numbness may be due to what?
Acute carpal tunnel syndrome; release the carpal tunnel.

What procedure may be done or severe ischemic peripheral vascular disease be ore amputation?
Distal venous arterialization bypass.

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955

What is the mechanism o a boutonniere de ormity o the PIP joint?
Extensor mechanism (central slip, transverse and oblique retinacular ligaments, lateral bands) becomes
imbalanced; central slip injured.

What is the management or a stage I boutonniere de ormity?
Splinting the PIP joint at 0 degrees.

What is the likely cause o recurrent paronychia?
Candida albicans.

What do radiographs show in giant cell tumors o the hand?
Radiolucent expansile lesions o the epiphysis; multi ocal tumor.

What nerve gra t may be used or a 2.7-cm de ect o a digital nerve?
erminal branch o the posterior interosseous nerve.

Where is the posterior interosseous nerve located?
Deep to the extensors at the wrist; lies in the oor o the ourth compartment radially; ulnar and deep to the EPL.

What ndings on radiographs are seen in pantrapezial arthritis?
CMC and S joint narrowing and arthritic changes.

What is the length o advancement that is able to be accomplished using a Moberg ap?
1.5 cm.

What prevents being able to use a Moberg-type advancement ap in the digits?
T e digits do not have a dual arterial supply like the thumb.

What are the earliest carpal bones visible on radiographs?
T e capitate and hamate; appositional growth occurs in the carpal bones.

What is the last carpal bone to be seen on x-ray?
T e pisi orm, at 6.5 years.

What nonoperative management exists or Dupuytren?
Collagenase, cortisone, skeletal traction, extension splinting.

What is a thenar ap used or?
Coverage o de ects o the index and middle nger tips.

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Plastic & Reconstructive Surgery Board Review
COMPREHENSIVE

Which is essential to have in the operative suite according to the Guidelines or Of ce-Based Anesthesia?
Materials and equipment necessary to provide anesthesia, recovery ministration, cardiopulmonary resuscitation,
and provisions or potential emergencies. T is includes: suctioning apparatus, appropriately sized airway
equipment, including laryngoscope blades, means o positive-pressure ventilation, intravenous equipment,
pharmacologic antagonists, basic resuscitative medications, and de brillator equipment.

What e ect might garlic supplements have on surgery?
Increased risk o bleeding.

When does the physician–patient relationship begin?
It begins when a doctor has any pro essional contact with a patient (not necessarily in person).

I you excise a lesion and per orm an adjacent tissue trans er closure at the same time, can you code or both?
No, code only or the ap closure.

What is the most common genetic mutation increasing risk o V E?
Factor V Leiden (activated protein C resistance) present in 3% to 7% o the Caucasian population.

What is the genetic transmission o male pattern alopecia?
X-linked autosomal inheritance.

What is the result o increased 5-alpha reductase activity?
Alopecia.

Regarding hair growth phases, what characterizes male pattern alopecia?
Lengthened telogen phase; shortened anagen phase.

What growth phase o hair is active growth in?
T e anagen phase; lasts 3 years.

What is the pattern o hair growth ollowing hair transplant?
1 month o hair growth, loss o hair, and normal growth ollowing 3 months; 6 months required or permanent
hair growth into area.

What is the most appropriate procedure or a patient with Hamilton class VI alopecia?
Scalp reduction; ollowed by recreating the anterior hairline.

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957

What period o time should be told to the smoking patient undergoing surgery?
Discontinue smoking 4 to 8 weeks be ore surgery and 4 weeks a ter surgery.

Reanimation o the lower ace 3 years ollowing Bell palsy with resultant good eye coverage is best treated in
what manner?
Neurotized ree muscle trans er using cross- acial gra ts; acial muscle atrophy occurs a ter 18 months o absent
innervation.

What initiates the process o epithelial migration in healing incisions?
T e loss o contact inhibition between cells.

In the setting o an electrical injury to an extremity, what concerning diagnosis should be ruled out? How is
it treated?
Suspect compartment syndrome. reat with asciotomy.

What is the most common worldwide cause o secondary (i.e., acquired) lymphedema?
Filariasis, in estation o lymph nodes by the parasite Wuchereria bancro ti. Other causes are prior surgery, radiation,
in ection, and tumor invasion.

What is Charles procedure?
A classic procedure used to treat lower extremity lymphedema consisting o excision o skin down to ascia and
immediate autogra ting using the excised skin. Rarely used.

Which anesthetic induction agent should be avoided in the setting o signi cant burns?
Succinylcholine, which can cause hyperkalemia because o massive release o potassium rom skeletal muscle.

How large o an abdominal wall ascial de ect can be closed with a component separation technique?
Epigastric region: 10 cm, mid abdomen: 20 cm, low abdomen: 6 cm.

What actors increase complication rates o hydroxyapatite use in cranioplasty?
Radiation, pediatric patients, de ects in the rontal region, de ects greater than 25 cm2.

What are the classic eatures o BCC?
Shiny, pearly nodule; telangiectasias; nonhealing ulcer.

What is the pre erred treatment modality or BCC o the ace?
Mohs micrographic surgery.

958
Plastic & Reconstructive Surgery Board Review

What is the Mathes and Nahai ap classi cation? Name two muscles o each type.
I

One dominant pedicle (gastrocnemius, rectus emoris, tensor ascia lata)
II One dominant pedicle and one minor pedicle (gracilis, trapezius, vastus lateralis)
III Two dominant pedicles (rectus abdominus, gluteus maximus, serratus)
IV Multiple segmental pedicles (sartorius, tibialis anterior)
V One dominant pedicle and minor segmental (pectoralis major, latissimus)

What is the pre erred ap or mid-thoracic spinal de ects?
Latissimus dorsi ap.

What is Apligra ?
A biomaterial containing two types o cells: cultured oreskin-derived human keratinocytes and broblasts on a
matrix o bovine collagen. Used or di cult wounds.

What is Biobrane?
A biomaterial consisting o silicone lm with embedded nylon abric coated with porcine collagen.

What is Integra?
A bilayer membrane system or skin replacement. It consists o a porous matrix layer o bovine collagen and
glycosaminoglycans covered by a thin layer o silicone. Aids in the development o a granulation bed or skin
gra ting di cult wounds.

What is AlloDerm?
Acellular dermal matrix derived rom human cadaveric donors without epidermal and cellular components.

What is Surgisis?
A biosynthetic matrix consisting o collagen and other proteins derived rom porcine small intestine.

What is the most common bacteria in cat bite in ections?
Pasteurella species.

What is antibiotic prophylaxis or cat bites?
Amoxicillin-clavulanate (penicillin allergy: moxi oxacin or cipro oxacin/clindamycin).

What is the treatment or doxorubicin extravasation?
opical dimethyl sul oxide.

What is the biochemical mechanism o vitamin C de ciency (scurvy)?
Vitamin C is essential or cross-linking collagen through the hydroxylation o proline and lysine.

CHAPTER 93 High-Yield opics
959

What are the pathologic characteristics o radiated skin?
Decreased acute in ammatory response, decreased broblast proli eration, decreased neutrophil unction,
decreased tissue oxygenation, increased vessel thrombosis.

What is the blood supply to the lateral arm ap? Reverse lateral arm ap?
Posterior radial collateral artery. Radial recurrent artery.

How do you reverse epinephrine-induced vasoconstriction?
Injection o phentolamine.

In cases o accidental digital sel -injection o epinephrine with an EpiPen, what is the appropriate
management?
Observation. T ere have been no documented cases o digital necrosis ollowing injection, and observation is
indicated. Vasoconstriction lasts 90 minutes and resolves on its own.

What is the best measure o uid status in burn patients?
Urine output, ideally 0.5 mL/kg/hr in adults.

What is the most important actor in the development o decubitus ulcers?
Prolonged pressure above end-capillary pressure (32 mm Hg).

What is the treatment or eyelid ectropion secondary to burns?
Release and gra ting.

What is the most common adverse outcome a ter labioplasty?
Incomplete correction.

What should be suspected when thrombotic events occur a ter heparin therapy?
Heparin-induced thrombocytopenia (HI ), check the platelet count rst.

What is a dermato broma?
Benign skin lesion presenting as a small (< 1 cm), rm, symmetric, and regular-appearing nodule. Occurs
anywhere on the body, but most commonly anterior thighs and legs. reat with excision i bothersome or
uncertain diagnosis.

What is the Fitzpatrick sign?
Skin dimples downward with lateral compression o a skin lesion. T is nding is associated with dermato bromas.

What is the most carcinogenic component o sunlight?
Ultraviolet B (290–320-nm wavelength), which is more carcinogenic than ultraviolet A (320–400-nm wavelength).

What dermal structure is implicated in hidradenitis suppurativa?
Apocrine sweat glands.

960
Plastic & Reconstructive Surgery Board Review

HIV-positive male with pain ul, erythematous vesicles on the ngertip. Diagnosis? reatment?
Herpes simplex in ection. Diagnose with zanck smear showing giant cells or intranuclear inclusions. reat with
antiviral such as acyclovir.

What is the transmission rate ollowing an HIV needle stick?
0.3%.

What is the risk reduction o using AZ within 2 hours ollowing an HIV needle stick?
80%.

What is the initial treatment o rostbite?
Rapid rewarming in a water bath (104–108°F). Avoid radiant heat source.

What medications can be use ul in the initial management o rostbite?
NSAIDs (i.e., ibupro en) provide antiprostaglandin activity that can limit secondary damage.

What is the vascular risk o microsurgery in the sickle cell patient?
Sludging leading to compromised ap per usion.

What is the mechanism o action o topical imiquimod?
O ten used or actinic keratoses and nonmelanoma skin cancers, imiquimod is thought to act by stimulating host
cytokine production and induction o tumor apoptosis.

What is the mechanism o action o topical 5-FU?
Direct inhibition o DNA synthesis.

What are the characteristics o body dysmorphic disorder (BDD)?
Excessive preoccupation with a perceived physical aw that causes signi cant distress and behavioral impairment.
Cosmetic surgery unlikely to bene t BDD.

What are the three most common pathogens o burn wound in ections?
MRSA, Pseudomonas, Klebsiella.

T e area between which two muscle layers o the abdominal wall is preserved in a component separation?
Internal oblique and transversus abdominis (contains intercostals nerves and vessels).

What type o anticoagulation has been proven to increase microsurgical anastomotic patency rate?
What type o suture technique?
No orm o anticoagulation or suture technique has been consistently proven superior in improving patency rates
or ree ap survival.

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961

90% o all thrombotic complications in microsurgery occur in what time period?
First 24 hours.

What is the most appropriate initial treatment o calcinosis cutis in CRES syndrome?
Debridement o calci c deposits.

Which abdominal ap used in breast reconstruction has the greatest unctional morbidity? T e lowest
morbidity?
Greatest: bilateral pedicled RAM ap. Lowest: SIEA ree ap.

When is vascular compromise most likely to occur ollowing ree ap reconstruction?
1 to 2 days.

A patient has a Mohs de ect on the nasal sidewall subunit. What is the appropriate ap or a de ect 10 to
15 mm? Greater than 15 mm?
Bilobed ap. Paramedian orehead ap.

What is xeroderma pigmentosum (XP)?
Autosomal recessive de ect resulting in abnormal DNA repair mechanism. Patients are prone to skin malignancies
rom UV exposure. reatment is avoidance o sun exposure.

A portion o what muscle may need to be taken with an AL ap?
Vastus lateralis.

For each ap, name the arterial supply.
ALT

Descending branch o the lateral emoral circumf ex
Gracilis

Medial emoral circumf ex
Tensor ascia lata

Ascending branch o the lateral emoral circumf ex

What is the adverse e ect o nicotine on wound healing?
Microvascular vasoconstriction.

What is cutis laxa?
A rare disorder in which abnormal elastin bers cause hypoblastic skin. T e skin o these patients does not spring
back when stretched. T ere is an increased risk o hernia ormation.

What is Ehlers–Danlos syndrome?
Also known as cutis hyperelastica, it is characterized by skin and joint laxity due to an inherited de ect in collagen.
Results in greater incidence o wound complications, hernia ormation, and wide and thin scars.

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Plastic & Reconstructive Surgery Board Review

What is the recurrence rate o keloids ollowing simple excision?
At least 55% and reported even higher.

What is the most likely result o axillary silicone granulomas ollowing breast augmentation?
T ey are a known tissue response to the presence o oreign material and should be resected when present.

What is the optimal treatment or carbonaceous material embedded in the ace?
ND:YAG laser treatment (also used or road asphalt, amateur tattoo ink).

What artery does the saphenous artery arise rom?
Descending genicular artery.

What does the super cial emoral artery become at the knee?
Popliteal artery.

What does the lateral circum ex emoral artery arise rom?
T e pro unda emoris artery.

What medication is most appropriate to treat heterotopic ossi cation?
Etidronate.

How o ten may heterotopic ossi cation occur in spinal cord injury patients?
40%.

What agent most readily decreases the depth o a phenol peel?
Liquid soap.

What e ects do antibiotic ointment and taping have on phenol peel?
Increasing the depth.

What is the most appropriate treatment or a patient exhibiting a dark bluish discoloration o a RAM ap
ollowing ree RAM reconstruction with signs o venous congestion?
Operative intervention.

What clinical appearance characterizes the end point o dermabrasion at the level o the super cial reticular
dermis?
Con uent bleeding with a coarse tissue background.

When does reepithelialization begin ollowing dermabrasion?
7 to 10 days.

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963

What clinical appearance occurs with dermabrasion to the super cial papillary dermis?
Sparse punctate bleeding.

What theoretical gain in length is achieved with a Z-plasty angle o 60 degrees?
75%.
Z-plasty Length Gain (%)
30

25
45

50
60

75
75

100

What is the mechanism o Botox?
Inhibition o acetylcholine release at the neuromuscular junction.

What age group characterizes keratoacanthomas?
Men older than 50 years.

What clinical appearance describes keratoacanthomas?
Umbilicated center with a keratin plug.

Where do cylindromas orm?
T ey are ound rm, eshy tumors o the scalp, rarely solitary.

What cutaneous lesion is characteristically ound on the lower extremities o young adults?
Dermato broma ( brous popular lesion).

Where do syringomas orm?
In emales during adolescence occurring only on the lower eyelids.

For the treatment o a sacral pressure sore, what is the highest level at which bony debridement may be done
without entering the dural space?
S2–3.

At what level does the conus medullaris lie?
L2.

What organisms are typically isolated in patients with hidradenitis?
S. aureus and Streptococcus viridans.

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Plastic & Reconstructive Surgery Board Review

Which sweat glands are a ected in hidradenitis?
T e apocrine sweat glands.

Lesions around the nostrils that are culture negative but demonstrate noncaseating granulomas are
indicative o what likely process?
Sarcoidosis.

What systemic process is lupus pernio associated with?
Sarcoidosis.

What is the appropriate treatment o sarcoidosis?
Intralesional steroids, oral hydroxychloroquine, or methotrexate.

What is rhinosporidiosis?
A chronic ungal condition o the nose caused by Rhinosporidium seeberi bacteria; cultures may be negative.

What is Apligra composed o ?
Bilayer o neonatal epidermal keratinocytes and dermal broblasts within a matrix o bovine collagen.

What is AlloDerm composed o ?
Lyophilized cellular cadaveric dermis.

What is Biobrane composed o ?
Nylon and silicone abric coated with porcine collagen.

Integra?
Dermal matrix o bovine collagen and shark-derived chondroitin sul ate covered by bilayer o silastic epidermis;
silicone layer is removed and skin gra t is placed on underlying dermal matrix.

ransCyte?
Neonatal dermal broblasts cultured onto a thin membrane o silicone bonded to nylon mesh and bovine
collagen.

What are the common characteristics o von Hippel–Lindau disease?
Hemangiomas a ecting the retina and hemangioblastomas o the cerebellum/visceral organs; seizures/mental
retardation.

What are the common characteristics o Klippel– renaunay syndrome?
Port-wine stain (usually over one extremity) and overlying venous/lymphatic mal ormations; limb
hemihypertrophy (usually the leg).

CHAPTER 93 High-Yield opics
965

What is Parkes–Weber syndrome?
Similar to Klippel– renaunay syndrome but distinguished by the presence o A-V stulas; also hypertrophy o
upper extremity.

What is Osler–Weber–Rendu syndrome?
Hereditary hemorrhagic telangiectasia; AD; multiple ecstatic vessels; epistaxis, hematuria, hematemesis.

What is Sturge–Weber syndrome?
Port-wine stain in distribution o V1 and V2; may be associated with seizures, intracranial calci cations,
hemiparesis, glaucoma; leptomeningeal venous mal ormations.

What blood level is increased in calciphylaxis?
Parathyroid hormone; protein C is decreased.

What surgical interventions may be bene cial in patients with calciphylaxis?
Debridement, skin gra ting, subtotal thyroidectomy.

What nding is more likely to occur in patients undergoing with the Erbium:YAG laser than with the
CO2 laser?
ransudative wound.

What laser currently is elt to be the treatment o choice or ablative resur acing o the skin?
Er:YAG laser (absorbs water within the epidermis a minimum o 10 times more e ciently than the CO2 laser);
photomechanical rather than photothermal process.

How requent is permanent hypopigmentation with Er:YAG versus CO2?
Less than 5% with Er:YAG and as much as 40% in CO2.

What physiologic changes occur in acute burn injury?
Decreased cardiac output, decreased plasma volume, increased systemic vascular resistance, decreased capillary
pressure.

What characterizes the anagen and telogen phases in male pattern alopecia?
Decreased anagen (active phase o hair ollicle), increased telogen phase (resting phase).

Follicles changing rom terminal to villous bers are seen in what process?
Male pattern alopecia.

How is the Parkland ormula administered?
Lactated Ringer solution (4 mL/kg/% BSA [second and third degree only]) administered during the rst 24 hours.
T e rst hal administered during the rst 8 hours and the second hal administered during the remaining 16 hours.