Test on Principles of Microvascular and Free-Flap Surgery

Question 1: The interrupted suturing technique is commonly used and is appropriate for most arterial and venous end-to-end anastomoses.

A. Ano

B. Ne

Explanation: Interrupted suturing is described as the most common method used for end-to-end anastomosis, being simple and appropriate for most arterial and venous anastomoses.

Question 2: Which of the following statements accurately describe the purpose or methods of adventitial stripping in microvascular surgery, according to the provided text?

A. Its main purpose is to improve visualization of the vessel ends and prevent the adventitia from falling into the lumen while tying the knot.

B. Overly aggressive stripping should be avoided as it may cause necrosis of the vessel wall and false aneurysms.

C. It is advisable to remove only the adventitia that overhangs the vessel ends in smaller veins with thin tunica media.

D. Sharp dissection is shown to completely remove all the adventitia and cause less damage to the vessel.

Explanation: The text states that the main purpose of adventitial stripping is 'to improve visualization of the vessel ends and prevent the adventitia from falling into the lumen while tying the knot.' It also advises to 'Avoid overly aggressive adventitial stripping as this may cause necrosis of the vessel wall at the anastomotic site with resultant false aneurysms.' For smaller veins, it mentions, 'In smaller veins with thin tunica media, it is advisable to remove only the adventitia that overhangs the vessel ends.' However, the text explicitly states 'neither method completely removes all the adventitia and that sharp dissection appears to cause less damage to the vessel,' making the fourth option incorrect.

Question 3: The empty-and-refill test is considered a non-traumatic method for routinely assessing vessel patency.

A. Ano

B. Ne

Explanation: The study materials state that the empty-and-refill test is 'slightly more traumatic and should only be performed when needed', indicating it is not non-traumatic nor routinely performed.

Question 4: According to the study materials, what is recommended regarding the placement of the anastomosis in relation to irradiated areas during free-flap surgery?

A. The anastomosis should always be performed within the irradiated area to encourage tissue integration.

B. It is recommended to site the anastomosis outside the area of irradiation, where possible.

C. Irradiation has been definitively shown to significantly improve the quality of vessels for anastomosis.

D. Irradiation has no effect whatsoever on the quality of local tissues or vessels for anastomosis.

Explanation: The study materials state that 'Where possible, however, site the anastomosis outside the area of irradiation' and that 'Ideally they should be away from zones of trauma and sites of irradiation.' It also notes that 'Irradiation impairs the quality of local tissues and vessels and may predispose to complications at the recipient site.'

Question 5: Supramicrosurgery, which involves the dissection and anastomosis of vessels, commonly yields a long pedicle for the flap.

A. Ano

B. Ne

Explanation: Supramicrosurgery yields a very short pedicle because it involves the dissection and anastomosis of vessels with diameters of less than 1 mm, harvested without breaching the deep fascia.