Plastic Surgery (Prometric)

A 25-year-old woman requests correction of breast asymmetry present since puberty. She has no previous breast surgery, pregnancy, or major weight change. The clinical appearance is shown. Examination confirms soft mobile tissue, no palpable mass, and adequate skin elasticity. Ultrasonography is normal. The smaller breast has a constricted base and elevated inframammary fold, while the patient desires improved lower-pole fullness and reduced areolar prominence in one operation. Which operative plan best addresses the underlying deformity?

A 62-year-old man with diabetes and sensory neuropathy has a 4-cm plantar-medial heel ulcer present for 5 months. Glycemic control has improved, osteomyelitis has been excluded, and cultures are now negative after debridement. The calcaneal cortex remains exposed, ankle motion is preserved, and ankle-brachial index is 0.95. He needs durable protective sensation because he will resume weight bearing with custom footwear. The defect is within the territory of a reliable medial plantar artery perforator. Which coverage is most appropriate?

A 59-year-old woman is 10 hours after an anterolateral thigh free flap for lower-leg reconstruction. The flap was normal during the first six checks, but it is now swollen, dusky, and has brisk capillary refill. The arterial Doppler remains audible, while the venous Doppler has disappeared. The drain has produced little output, blood pressure is stable, and the dressing is loose. There is no obvious external compression. Which management is most appropriate?

A 37-year-old woman has progressive unilateral lower-leg swelling three years after pelvic lymph-node dissection. Six months of compression and supervised decongestive therapy improve heaviness but not recurrent ankle swelling. The limb remains soft and pitting, with minimal adipose enlargement and no venous obstruction. Indocyanine-green mapping identifies several linear functioning lymphatic collectors. The image illustrates the clinical stage most closely matching her examination. Which operation is most appropriate?

A 24-year-old man requests correction of bilateral ear prominence. The supplied photographs show the external ear contour. Examination identifies excessive conchal depth, a weak antihelical fold, and mild superior-pole overprojection. Hearing is normal, the cartilage is mature, and he has no previous otoplasty or keloid history. He understands that symmetry will be approximate and wants a natural contour rather than maximal pinning. Which operative plan is most appropriate?

A 56-year-old woman requests correction of an obtuse cervicomental angle and visible neck bands. She has mild skin laxity, stable weight, and minimal submental fullness despite two previous nonsurgical fat-reduction treatments. Examination reveals prominent platysmal bands during animation without submandibular-gland enlargement. Upright high-frequency ultrasound is shown. She wants a durable single-stage result and accepts standard facelift incisions. Which operative plan best addresses the principal anatomical cause?

A 62-year-old man has permanent facial paralysis after parotid cancer treatment and radiotherapy. Lower facial tone has been restored with static suspension, but he has persistent exposure keratopathy. Examination shows 4 mm of lagophthalmos, paralytic lower-lid ectropion, weak Bell phenomenon, and intact corneal sensation. The eyelid image supplies the decisive mechanical abnormalities. Which combined procedure best protects the eye while preserving vision?

A 33-year-old woman requests correction of mild bilateral breast ptosis after pregnancy. She has stable weight, no breast symptoms, minimal upper-pole volume, and a desire for a modest increase. Examination shows adequate soft-tissue coverage and a small amount of excess skin. She understands that an implant alone may leave residual ptosis, while a large combined operation increases wound-healing risk. Which plan is most appropriate?

A 34-year-old paraplegic man develops recurrent drainage from an ischial wound despite six weeks of pressure relief and nutritional optimization. The photograph is obtained after removal of superficial slough. MRI shows inflammatory change around the ischial tuberosity, and bone biopsy confirms chronic osteomyelitis. Albumin is 3.7 g/dL, smoking has stopped, and his rehabilitation team has arranged a long-term pressure-redistribution program. Which definitive reconstructive plan is most appropriate?

A 32-year-old woman with a 40% TBSA burn is day 10 after injury. Despite enteral feeding, she has lost 6% of body weight, serum prealbumin is falling, and nitrogen balance is markedly negative. She is afebrile, hemodynamically stable, and tolerating gastric feeds without ileus. Her grafts are mostly viable, but wound healing is delayed. Indirect calorimetry shows energy expenditure well above predictive equations. Which nutritional plan is most appropriate?