Soft Tissue Reconstruction of the Upper Extremity and Management of Fingertip and Nail Bed Injuries

Question 1

A functional hand should possess a stable wrist and at least two opposing, sensate, and painless digits. One finger should be mobile and opposed with another stable finger, with a space between the digits

Answer 1

T

Question 2

An acceptable hand consists of a thumb and at least three fingers
that have supple interphalangeal joint motion,adequate length, and
preserved sensibility.

Answer 2

T

Question 3

prolonged application of NPWT can lead to scaring

Answer 3

because granulation tissue may form over the wound bed and cause scarring over time.

Question 4

prolonged use of NPWT in
the hand causes contracture and stiffness

Answer 4

T

Question 5

If the patient has vital structures that are exposed in the hand , the surgeon must consider an immediate flap
coverage

Answer 5

T

Question 6

The most effective way to preserve the vital components is to consider
early soft tissue coverage as the first step in the management

Answer 6

T

Question 7

surgeons
prefer the use of a fasciocutaneous flap over a muscle flap

Answer 7

T

Question 8

A fasciocutaneous flap is more pliable and has greater gliding capacity, which
facilitates tendon gliding without impairment during motion

Answer 8

T

Question 9

Distantflap in the hand almost always requires two stages for harvest and inset

Answer 9

T

Question 10

A free flap is advantageous because permits earlier rehabilitation

Answer 10

T

Question 11

FTSG
can restore more durability and sensibility, while it can minimize the
risk of contracture

Answer 11

T

Question 12

. The thick dermal layer of the glabrous skin is
rich in exocrine sweat glands, blood vessels, and sensory nerve endings

Answer 12

T

Question 13

STSGs are typically used for the reconstruction of defects
of the palm of the hand

Answer 13

F Dorsum of the hand

Question 14

Dermal substitutes require a noninfected and well-vascularized wound bed

Answer 14

T

Question 15

Dermal substitutes are used for the
reconstruction of acute and chronic burns of the hand

Answer 15

T

Question 16

dermal substitutes are a good alternative if the patient cannot tolerate a prolonged operation or needs a shorter period of immobilization

Answer 16

T

Question 17

dermal substitute templates lack many essential components of normal skin, such as hair follicles, sweat glands, or other
skin appendages. Furthermore, sensory recovery is unsatisfactory

Answer 17

T

Question 18

Reconstruction of soft tissue defects via dermal substitutes typically requires STSG in single stage

Answer 18

F In a two-stage reconstruction,

Question 19

split-thickness
skin grafting can be done 2 to 3 weeks after dermal substitute placement

Answer 19

T

Question 20

Full-thickness skin grafting with a dermal substitute
is not recommended

Answer 20

T

Question 21

Small fingertip defects that are less than 2 cm’ with minimal bony
exposure or nail matrix involvement should be healed by secondary
intention.

Answer 21

F Small fingertip defects that are less than I cm’

Question 22

Secondary intention can restore sensation

Answer 22

T

Question 23

Secondary intention achieve comparable functionality to skin grafts

Answer 23

T

Question 24

Less than 1 cm may indicate reconstruction using local tissue coverage,
such as V-Y volar or lateral advancement flaps

Answer 24

T

Question 25

The V-Y advancement flap is most suitable for coverage of transverse or dorsal oblique fingertip amputations that have exposed bones

Answer 25

T

Question 26

> 1cm larger or composite defects will require more soft tissue, suggesting homodigital, heterodigital, locoregional, or free tissue transfers

Answer 26

T

Question 27

if the defect of the pulp covers two-thirds of the digital pulp of the first three fingers we should do the microvascular toe pulp or the glabrous skin of the foot transfers

Answer 27

T

Question 28

A defect without any bony exposure that affects less than half of the finger pulp can heal by secondary intention.

Answer 28

T

Question 29

the Moberg flap used to reconstruct the volar defect only

Answer 29

Volar or ulnar side defects

Question 30

A Moberg flap can advance distally by 1.5 to 2 cm without causing flexor contracture

Answer 30

t

Question 31

In case of large pulp defect of the thump

Answer 31

reconstructed with the first dorsal metacarpal artery (DMCA) flap because it provides more soft tissue and can immediately restore sensation by including a branch of the superficial radial nerve

Question 32

The drawback of innervated heterodigital island flap

Answer 32

-Requires more vascular pedicle dissection into the palm -Loss of sensation in the donor finger - Higher rate of venous congestion than with a first DMCA flap.

Question 33

Option of free flap for thump bulb?

Answer 33

Toe thump transfer and medial planter flap

Question 34

Toe pulp transfers are preferred over medial plantar flaps because they can provide a sensate flap

Answer 34

T

Question 35

Amputation is usually a the midportion of the nail bed of the any finger what is the options

Answer 35

V* Y advancement flap

Question 36

Amputation injury proximal to the lanula can reconstract with v-y

Answer 36

F

Question 37

Thenar flap the index, middle, or ring finger. a near-total or total distal phalangeal pulp loss

Answer 37

T

Question 38

Heterodigital island flap on the dorsal or volar surface of the finger up to 3.5 cm long

Answer 38

T

Question 39

Dorsal metacarpal artery flap contraindication

Answer 39

Injury to the dorsal carpal circulation

Question 40

heavy smoking is contraindicatin for Neurovascular heterodigital island flap

Answer 40

T

Question 41

reverse homodigital dorsal ulnar or dorsal radial flap,used for In the dorsal or radial areas of the thumb

Answer 41

T

Question 42

The reversed dorsal ulnar artery flap provides soft tissue from the ulnar side of the thumb over the metacarpophalangeal area and first webspace.

Answer 42

T

Question 43

This flap should only use less than 2 cm of skin. if more , causing contracture of the webspace

Answer 43

T

Question 44

reversed dorsal radial artery flap provides a larger skin paddle that can measure up to 4 x 3 cm in dimension

Answer 44

T

Question 45

Locoregional fasciocutaneous flaps can reconstruct medium-sized defects in dorsum of the hand that are less than 6 to 7 cm in width

Answer 45

T

Question 46

free fasciocutaneous flaps are used to reconstruct defects that are larger or more complex

Answer 46

T

Question 47

radial forearm flaps, posterior interosseous flaps, dorsal ulnar artery flaps, and forearm perforator flaps used to reconstract Medium-sized defects of the hand

Answer 47

T

Question 48

Ulnar perforator flap can used for reconstruction of cubital fossa

Answer 48

T

Question 49

Free thenar flap measures up to 2 cm x 10 cm

Answer 49

T

Question 50

VThe medial plantar flap a maximum of 8 cm x 6 cm of skin

Answer 50

T

Question 51

distant pedicle flaps are preferred in mutilated hand injuries

Answer 51

T

Question 52

ALT flaps are advantageous over the other free fasciocutaneous flaps because the length of the pedicle reaches up to 16 cm

Answer 52

T

Question 53

ALT flaps provide a large surface area of skin that enables composite tissue reconstruction to include the nerve, tendon, or muscle within the same vascular axis.

Answer 53

T

Question 54

Lateral arm flaps are thick and pliable with variable blood supply

Answer 54

F Lateral arm flaps are thin and pliable with consistent blood supply

Question 55

the donor side of the lateral arm flap should closed with skin graft

Answer 55

F If the flap that is harvested is less than 6 to 7 cm in width, the donor site can be closed primarily

Question 56

The pedicle of the flap is dissected toward the spiral groove, which varies in length by 7 to 11 cm

Answer 56

T

Question 57

Lateral arm flap can provide a vascularized nerve graft of the posterior brachia! cutaneous of the forearm

Answer 57

T

Question 58

Lateral arm flap not used for composed reconstruction

Answer 58

F posterior radial collateral artery extends branches to supply the lateral epicondyle of the humerus and the tricep tendon. Thus, the lateral arm flap can be used for composite reconstruction of the bone and tendons

Question 59

SCIP flaps and medial sural artery perforator flaps are not used as frequently as the other free fasciocutaneous flaps

Answer 59

T

Question 60

The drawback of SCIP flap

Answer 60

short pedicle length 5 cm

Question 61

medial sural artery flaps have limited amount of skin, which makes the flap only suitable for small-to-medium-sized defects.

Answer 61

T

Question 62

Free or pedicle fascia! flaps with skin grafting is another option for reconstructing a dorsal defect of the hand

Answer 62

T

Question 63

Advantages

Answer 63

fascia! flaps is not having to use a skin graft to cover the donor area, unusual that there will be late scar contracture over the fascia! flap after skin grafting on the dorsum of the hand

Question 64

Free thenar flaps can be raised up to 2 cm in width and 10 cm in length

Answer 64

T

Question 65

Thenar flaps can be a sensate flap

Answer 65

by including a small cutaneous nerve originating from the palmar cutaneous branch of the median nerve

Question 66

Medial plantar flaps can provide glabrous skin up to 8 cm x 6 cm in dimension

Answer 66

T

Question 67

These flaps can be harvested as a sensate flap by including the medial plantar nerve with the fla

Answer 67

T

Question 68

Posterior interosseous artery (PIA) flaps are considered as the work-horse flap for reconstruction of defects on the dorsum and volar area of the first webspace and the radial palm

Answer 68

T

Question 69

using fascia! flaps and skin grafts are not suitable in the palmar area because scar contracture is likely to occur

Answer 69

T

Question 70

the lost or deformation of the nail can affect both the appearance and function of the hand

Answer 70

T

Question 71

In Subungual Hematoma If the patient is asymptomatic or the hematoma affects less than half of the nail bed, the patient can be treated conservatively, including warm compression and the administration of analgesics

Answer 71

T

Question 72

In children, if the nail and perionychium are intact, there is no need for an exploration and removal of the nail plate

Answer 72

T

Question 73

the patient's outcome is similar regardless of method. 5

Answer 73

T

Question 74

If there is fracture of the distal phalanx, the nail plate should be removed

Answer 74

T

Question 75

a nail bed graft can be harvested from the big toe for reconstruction

Answer 75

T