Wound Healing, Plastic and Reconstructive Surgery MCQs

Surgery · 68 free questions with answers & explanations.

1. A patient sustains a laceration that is primarily closed. Wound healing by primary intention proceeds through the proliferative phase. Which cell type is primarily responsible for collagen synthesis during this phase?
2. A patient undergoes split-thickness skin grafting (STSG) for a large burn wound. The STSG fails to take in one area with underlying granulation tissue appearing unhealthy. Wound swab grows >10^5 organisms/gram of tissue. The most likely reason for graft failure is:
3. A 35-year-old woman develops a raised, pruritic, erythematous scar that remains confined to the original wound boundaries after a Caesarean section. This is best classified as a hypertrophic scar. How does it differ pathologically from a keloid?
4. A 45-year-old woman with a chronic non-healing venous ulcer on the medial aspect of the lower leg undergoes split-thickness skin grafting. At 72 hours post-graft, the graft appears white and does not blanche on pressure. The mechanism responsible for the early graft survival before revascularization is:
5. The reconstructive ladder in plastic surgery describes escalating complexity of closure options. Which technique represents the correct principle of a 'perforator flap' that has revolutionised reconstructive surgery?
6. A hypertrophic scar develops 3 months after a forearm laceration. Which statement correctly distinguishes it from a keloid scar?
7. A diabetic patient develops a chronic non-healing lower limb wound with a peri-wound biofilm. Which of the following wound care strategies directly targets biofilm disruption in chronic wounds?
8. A patient develops a hypertrophic scar 3 months after a chest burn injury. Which of the following best distinguishes a hypertrophic scar from a keloid?
9. The 'reconstructive ladder' concept in plastic surgery arranges reconstructive options from simplest to most complex. Which of the following correctly represents the ascending order?
10. In the reconstructive ladder, a 6 × 8 cm full-thickness wound over the Achilles tendon with exposed tendon is to be reconstructed. Which reconstructive option is most appropriate when the wound cannot be skin grafted due to exposed avascular tendon?
11. A patient undergoes a split-thickness skin graft (STSG) for a large leg defect. At 5 days post-graft, the graft appears white and non-adherent with a seroma beneath. Which mechanism best explains early graft failure in this specific scenario?
12. A 35-year-old man develops a hypertrophic scar 3 months after a burn injury. Comparing hypertrophic scar versus keloid, which statement is CORRECT?
13. A 45-year-old diabetic woman with a 6 cm sacral pressure ulcer (Stage IV — full-thickness tissue loss exposing bone) has failed 3 months of conservative management. The wound bed is clean with healthy granulation tissue. The reconstructive ladder principle and best option is:
14. A 35-year-old patient presents 6 months after a laparotomy with a raised, firm, erythematous scar that extends well beyond the boundaries of the original incision onto the chest wall. He has no personal or family history of keloid. The most likely diagnosis and its distinguishing molecular mechanism compared to hypertrophic scar is:
15. In the reconstructive ladder for wound closure, which option represents the highest 'rung' (most complex) and is used when all simpler options are inadequate?
16. A split-thickness skin graft (STSG) harvested from the thigh contains which layers of skin?
17. A 45-year-old woman develops a hypertrophic scar over her anterior chest wall 4 months after median sternotomy. Histologically, the collagen fibers in hypertrophic scars compared to keloids show which distinctive pattern?
18. A 40-year-old patient with a chronic diabetic foot ulcer (5 cm, Wagner Grade 2) undergoes negative pressure wound therapy (NPWT). Which cellular and molecular mechanism best explains the therapeutic effect of NPWT on wound healing?
19. A surgeon plans a free flap reconstruction following oncological resection of the floor of mouth. The reconstructive ladder principle defines an hierarchy of reconstruction. Where does microsurgical free tissue transfer sit in this hierarchy?
20. A 45-year-old man develops a hypertrophic scar 3 months after a burn wound on the anterior chest. Which of the following correctly distinguishes a hypertrophic scar from a keloid, and which patient characteristic increases the risk of keloid formation?
21. The reconstructive ladder principle guides flap selection. A patient with a 4 × 6 cm defect over the mid-tibia following trauma with exposed hardware and compromised local tissue has failed split-skin grafting. Which single flap is the workhorse muscle flap for mid-tibial defects in reconstructive surgery?
22. In the process of wound healing, matrix metalloproteinases (MMPs) play a key role in remodeling. During the remodeling phase, type III collagen is replaced by type I collagen, and wound tensile strength at 6 weeks is approximately what percentage of normal unwounded skin?
23. Negative pressure wound therapy (NPWT/VAC therapy) promotes wound healing via which primary mechanisms?
24. In the classification of flaps for reconstructive surgery, a perforator flap harvests skin and subcutaneous tissue based on which vascular principle, and what is the reconstructive advantage over a myocutaneous flap?
25. In the reconstructive ladder for complex wounds, which principle guides the choice between a local flap and a free tissue transfer (microsurgical flap)?
26. In split-thickness skin grafting, which graft characteristic primarily determines the probability of primary graft take at a recipient wound bed?
27. A 40-year-old man sustains a full-thickness skin loss over the anterior tibia following a motorcycle injury. The tibial bone is exposed without periosteum. According to the reconstructive ladder, the most appropriate reconstruction is:
28. A keloid scar has extended beyond the original wound margin. The patient requests treatment. Which of the following describes a keloid scar as distinct from a hypertrophic scar?
29. The 'reconstructive ladder' prioritises wound closure from simplest to most complex. For a 6 cm × 4 cm wound on the dorsum of the foot in a 50-year-old diabetic patient after debridement, with exposed but viable extensor tendons, which level of the reconstructive ladder is MOST appropriate as the first-line option?
30. In wound healing, the process of contraction is mediated primarily by which cell type, and during which phase does it predominantly occur?
31. Negative pressure wound therapy (NPWT/VAC) promotes wound healing through multiple mechanisms. Which of the following is NOT a recognised mechanism of NPWT?
32. Which type of skin graft has the highest chance of survival (take) but leaves the worst donor-site morbidity?
33. A 40-year-old man develops a hypertrophic scar 6 months after a burn injury. What is the pathological distinction between a hypertrophic scar and a keloid?
34. A 25-year-old woman undergoes reconstruction after mastectomy using a TRAM flap (transverse rectus abdominis myocutaneous flap). Which of the following complications is specifically associated with the TRAM flap donor site?
35. A 45-year-old construction worker sustains full-thickness burns over 35% TBSA. Parkland formula for fluid resuscitation in the first 24 hours after a burn injury requires calculation of 4 mL × weight (kg) × %TBSA burned. For a 70 kg patient with 35% TBSA burn, how much Ringer's lactate should be given in the first 8 hours?
36. The Reconstructive Ladder for wound closure is, from simplest to most complex:
37. A keloid scar differs from a hypertrophic scar primarily in that:
38. Which growth factor is primarily responsible for the proliferative phase of wound healing and stimulates angiogenesis and fibroblast migration?
39. A 30-year-old woman develops a raised, pruritic, erythematous scar extending beyond the original wound boundaries 6 months after a median sternotomy. This is best described as:
40. Negative pressure wound therapy (NPWT) facilitates wound healing through all of the following mechanisms EXCEPT:
41. In the reconstructive ladder for wound closure, the principle of using the simplest effective method first means that after considering direct closure, the next rung is:
42. A 30-year-old woman develops a raised, itchy, erythematous scar that extends BEYOND the boundaries of the original wound on her shoulder 6 months after a minor surgical excision. This is MOST consistent with:
43. The reconstructive ladder for wound coverage proceeds from simple to complex. In managing a large tibial wound with exposed bone and tendons after trauma, the reconstructive option at the apex of the ladder is:
44. The 'reconstructive ladder' in plastic surgery guides selection of wound closure technique in ascending order of complexity. Which technique is at the TOP of the traditional reconstructive ladder?
45. TGF-β1 is the most important cytokine in wound healing scar formation and fibrosis. In keloid scars, TGF-β1 signaling is characteristically altered. Which cell type is primarily responsible for excessive collagen deposition in keloids?
46. The reconstructive ladder guides selection of wound closure technique from simplest to most complex. A patient has a complex lower leg wound with exposed bone following road traffic injury. Split-skin grafting has failed. What is the MOST appropriate next step on the reconstructive ladder?
47. Keloid scars differ from hypertrophic scars in a key clinically important way. Which statement is MOST accurate?
48. A 45-year-old patient has a 6 cm × 4 cm full-thickness skin defect over the anterior tibia following debridement of an infected wound. There is exposed bone with viable periosteum. The most appropriate reconstruction using the reconstructive ladder is:
49. A raised, firm, irregular scar extending beyond the original wound margins in a 25-year-old develops 3 months after a sternal wound. It continues to grow 2 years later. Histologically, it shows whorled collagen bundles extending into surrounding dermis. This is best classified as:
50. In negative pressure wound therapy (NPWT/VAC), the standard recommended pressure setting for most chronic wounds is:
51. A 35-year-old patient has a full-thickness defect of the anterior leg following debridement of necrotising fasciitis. The tibia is exposed with viable periosteum present. The reconstructive approach following the 'reconstructive ladder' that is most appropriate at this stage is:
52. A 25-year-old patient develops a 3 cm hypertrophic scar 8 months after an abdominal surgical incision. On examination, the scar is raised, erythematous, and pruritic but confined within the original wound boundaries. The management of choice for a symptomatic hypertrophic scar is:
53. A diabetic patient on long-term corticosteroids undergoes abdominal surgery. Six days post-operatively, clear pink fluid ('salmon-coloured fluid') soaks the wound dressings and the wound edges separate. What is the most likely diagnosis and immediate management?
54. A reconstruction ladder guides selection of wound coverage techniques in plastic surgery. The reconstructive ladder places which technique at the highest rung (most complex)?
55. Negative pressure wound therapy (NPWT/VAC therapy) accelerates wound healing primarily by which mechanism?
56. The reconstructive ladder principle prioritises which approach as the first option before escalating to complex reconstruction?
57. Hypertrophic scars differ from keloids in several important ways. Which statement correctly distinguishes them?
58. In the reconstructive ladder, a local random-pattern flap differs from an axial-pattern flap in which fundamental way?
59. Negative pressure wound therapy (NPWT) promotes wound healing through which primary mechanism?
60. Negative pressure wound therapy (NPWT) promotes wound healing primarily by which mechanism?
61. A fasciocutaneous flap based on the radial forearm (Chinese flap) is classified by the Mathes and Nahai classification as which type?
62. A 40-year-old man has a large keloid on the chest wall after a previous sternotomy. Which of the following treatment approaches is MOST effective for preventing recurrence after keloid excision?
63. A 55-year-old diabetic man has a chronic non-healing wound on the plantar surface of the foot. Wound care has failed. Negative pressure wound therapy (NPWT/VAC) is initiated. What is the PRIMARY mechanism by which NPWT promotes wound healing?
64. A 40-year-old man with a 4 cm full-thickness burn on the dorsum of the hand requires skin grafting. Which graft type would provide SUPERIOR long-term functional and cosmetic outcome for this site?
65. A patient undergoes reconstruction after mastectomy using a TRAM (Transverse Rectus Abdominis Myocutaneous) flap. Which of the following is the PRIMARY blood supply to a pedicled TRAM flap?
66. The reconstructive ladder (elevator) concept ranks reconstructive options from simplest to most complex. Which option, when added as 'rungs' in the reconstructive elevator concept, represents the most recent additions beyond free flap transfer?
67. Negative pressure wound therapy (NPWT/VAC therapy) accelerates wound healing through which primary mechanism?
68. Negative pressure wound therapy (NPWT/VAC therapy) promotes wound healing through all of the following mechanisms EXCEPT: