Comprehensive Integument

Question 1

Which of the following physiologic changes is most likely to occur in tissue that has undergone tissue expansion?

A. Decrease in melanocyte activity
B. Decrease in vascularity
C. Epidermal hypertrophy
D. Increased hair density
E. Net decrease in collagen formation

Answer 1

C

Tissue expansion causes an increase in epidermal thickness. During expansion, the dermis thins, hair density decreases, melanocyte activity increases, and hyperpigmentation occurs. There is increased angiogenesis and increased vascularity. There is also a net accumulation of collagen in expanded skin.

Question 2

A 57-year-old woman who was recently diagnosed with advanced rectal cancer is referred to the office for preoperative evaluation. History includes abdominoplasty and bilateral medial thigh lift. The patient is status post neoadjuvant chemotherapy and radiation. The colorectal surgery team plans abdominoperineal resection with posterior vaginectomy. Reconstruction with which of the following flaps is most appropriate for this patient?

A. Anterolateral thigh
B. Fasciocutaneous pudendal
C. Profunda artery perforator
D. Transverse upper gracilis
E. Vertical rectus abdominis myocutaneous

Answer 2

A

Question 3

A 55-year-old woman undergoes excision of a high-grade sarcoma from the middle third pretibial area of her right leg. Prior to the procedure, she received neoadjuvant radiation therapy to the area. The underlying bone is exposed. The defect measures 5 × 5 cm. The patient has palpable peripheral pulses. Which of the following is the main indication for coverage with a flap rather than a graft in this clinical scenario?
A.
Dimension of wound
B.
Exposed bone with intact periosteum
C.
History of radiation
D.
Location of wound

Answer 3

C The main indication for coverage with a flap rather than a graft in this case is the history of radiation therapy.

Flap placement and skin grafting are methods by which wounds are covered for ultimate healing. Skin grafts do not have intrinsic blood flow and, as such, rely on the wound bed for ultimate survival initially through mechanisms of imbibition and inosculation. Therefore, wounds that do not have conducive wound beds to nourish a graft need to be flapped, such as exposed bone without periosteum, radiated wounds, or wounds with hardware or other foreign materials in their base. It is not the mere presence of bone that makes it nongraftable; it is the absence of a vascularized covering (periosteum) that does. In this case, it is the history of radiation that makes a skin graft over the exposed bone an inferior choice, necessitating the use of a flap for coverage.