ABOS Part I Comprehensive Review - Batch 73

Question 1

A 38-year-old right-hand dominant carpenter sustains a severe crush injury to his left dorsal hand, resulting in a 6x8 cm soft tissue defect with exposed extensor tendons and metacarpal bone. Local tissue options are insufficient. Preoperative assess

Accepted Answer

The flap is perfused by retrograde flow through the radial artery, primarily via collateral circulation from the ulnar artery around the elbow.

Question 2

A 55-year-old diabetic patient presents with a chronic non-healing ulcer over the dorsal aspect of his right wrist, exposing the extensor retinaculum. He has a history of peripheral vascular disease. Prior to considering a reverse radial forearm flap

Accepted Answer

A thorough Allen's test on the right hand to assess ulnar artery collateral circulation.

Question 3

A 28-year-old male presents with a complex soft tissue defect on the dorsal aspect of his left hand following a motorcycle accident, exposing the extensor tendons and metacarpal heads. A reverse radial forearm flap is planned. The image below shows t

Accepted Answer

To preserve distal perforators that contribute to the blood supply of the hand and minimize donor site morbidity.

Question 4

A 42-year-old patient undergoes a reverse radial forearm flap for coverage of a complex wrist defect. During the postoperative period, the patient complains of persistent pain and numbness over the dorsum of the thumb and index finger of the donor ha

Accepted Answer

Injury or entrapment of the superficial radial nerve in the donor site scar.

Question 5

A surgeon is preparing to elevate a reverse radial forearm flap for a large dorsal hand defect. The patient has undergone all necessary preoperative assessments, including a positive Allen's test. Which of the following steps is most consistent with

Accepted Answer

Making an incision along the ulnar border of the skin paddle, dissecting subfascially, ligating the proximal radial artery, and proceeding distally.

Question 6

A 60-year-old patient requires reconstruction of a thumb pulp defect with a sensate reverse radial forearm flap. During the flap harvest, which nerve is specifically identified and included with the flap to provide sensation to the reconstructed area

Accepted Answer

The superficial radial nerve; expected trade-off is sensory deficit in its native distribution on the dorsum of the donor hand.

Question 7

A 70-year-old patient with a history of diabetes and smoking undergoes a reverse radial forearm flap for coverage of an exposed distal radius fracture plate. On the first postoperative day, the flap appears dusky, swollen, and has sluggish capillary

Accepted Answer

Venous congestion; elevate the extremity, release tight sutures, and consider leeches.

Question 8

A 25-year-old patient presents with a 4x5 cm full-thickness skin defect over the dorsal aspect of the proximal phalanx of the index finger, exposing the extensor tendon. The defect is too large for primary closure or a local flap. Considering the rec

Accepted Answer

Anterolateral thigh (ALT) free flap.

Question 9

Following the successful harvest and transposition of a reverse radial forearm flap, the donor site defect is 5 cm wide. The surgeon plans to close the donor site. Which of the following is the most appropriate method for donor site closure in this s

Accepted Answer

Application of a split-thickness skin graft, ensuring preservation of the paratenon of the flexor tendons.

Question 10

A 32-year-old patient undergoes a reverse radial forearm flap for a complex hand injury. On the second postoperative day, the flap appears pale, cool to touch, and has absent capillary refill, with no audible Doppler signals over the pedicle. The pat

Accepted Answer

Urgent re-exploration of the flap to assess for pedicle compromise.

Anatomy and Surgical Approaches of the Forearm, Wrist, and Hand

Reverse Radial Forearm Flap: Comprehensive Review, Techniques & Complications | Part 22162

Key Takeaway