Sample records for gundersen flap surgery

  1. [The radial (Chinese) flap in hand surgery].

    PubMed

    Stamate, T; Budurc?, A R; Laz?r, A N

    2004-01-01

    The radial (Chinese) flap is an fascio-cutaneous flap raised on the volar aspect of the forearm based on the radial pedicle axis which can be used either pedicled or by microsurgical free transfer. In hand and thumb reconstruction, it is used as an island flap vascularized by a reverse flow from the ulnar artery via the palmar arch, keeping the pivot point at the snuff box level. The possibility to raise a composite flap with vascularized bone or tendons make the chinese flap very useful in hand reconstruction. Of the 35 cases presented, there were 30 pedicled and 5 free flaps from the opposite forearm. The island flaps were reverse flow in 30 cases and with proximal pedicle in 5. In 4 cases the flap contained flexor carpi radialis longus tendon, and in 2 cases a bone graft from the radius. The five free radial flaps transferred from the contralateral side were used as flow-through flap. There were no vascular complications. The advantages and disadvantages of the methods are discussed. PMID:15688768

  2. The Institute of Surgery and Innovation Trunk Flap Dissection Course.

    PubMed

    Rossi, Sabrina Helena; Mestak, Ondrej; Stampolidis, Nektarios; Vasconcelos, Inês

    2014-07-01

    The Institute of Surgery and Innovation Trunk Flap Dissection Course is a biannual two day course, which covers dissection of flaps in the anterior and posterior trunk on fresh-frozen cadavers. The event is run by the Institute of Surgery and Innovation, and it was held for the first time in November 2013, at the Nottingham City Hospital Training Centre. The course was taught in English by senior faculty from the Department of Plastic Surgery of Nottingham University.The first day was dedicated to raising 8 flaps in the anterior chest and abdomen, while the second day was dedicated to 6 flaps in the posterior trunk and buttocks.There were 3 participants per dissection table and the faculty to participant ratio was 2:1, allowing close supervision and one-on-one teaching. Each flap was briefly introduced by a 10-minute presentation, followed by a live demonstration of how to raise the flap by one of the faculty. The main advantage of this course is that the focus is on practical dissection, rather than lectures. The presentations that were given had a very personal feel, describing real cases encountered in the faculty's previous experience. This served as a platform to discuss dissection tips, tricks, and common pitfalls. Flaps represent the basis of reconstructive surgery; however, they are often taught late in the professional course of a residency as they are technically challenging. This course offers the opportunity to practice skills and receive very comprehensive feedback from experienced faculty.The event is open to trainees of all levels, and it attracted very junior as well as senior trainees from across Europe, thus offering an international prospective.The course's affordability is a luring feature and the excellent content and quality of teaching makes it a highly valuable experience, which I would widely recommend to trainees of all levels. PMID:25003434

  3. Influence of anesthetics on pharyngeal flap surgery: a 23-year study

    Microsoft Academic Search

    C. M. M. A. Schwerdtfeger; A. M. Almeida; I. E. K. Trindade; A. S. Trindade Jr.

    2009-01-01

    This study assessed the influence of anesthetics on early complications after pharyngeal flap surgery. A 23-year retrospective chart review was carried out of all patients at the authors’ institution who underwent superiorly based pharyngeal flap surgery. Variables analyzed were gender, age at the time of surgery, cleft type, anesthesia procedure used and complications in the early postoperative period. 2299 patients

  4. Local Flaps: A Real-Time Finite Element Based Solution to the Plastic Surgery

    E-print Network

    Liblit, Ben

    Local Flaps: A Real-Time Finite Element Based Solution to the Plastic Surgery Defect Puzzle fundamental challenges in plastic surgery is the alter- ation of the geometry and topology of the skin the fundamental building blocks of plastic surgery procedures on a localized tissue flap, and pro- vides a proof

  5. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    PubMed Central

    Xie, Huizhuang; Malata, Charles M.

    2014-01-01

    INTRODUCTION Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction. PRESENTATION OF CASE A 54-year old female with a pre-existing PFO developed a stroke following bilateral mastectomies and immediate free flap breast reconstruction on postoperative day 5. This was attributed to an air embolus caused by central venous pressure line removal. After uneventful intra and early postoperative periods, the patient had collapsed suddenly on day 5 and become unresponsive immediately following the removal of a central venous line. Brain magnetic resonance imaging confirmed a cerebrovascular accident. This resolved within 48 h following therapeutic heparinisation. A clinical diagnosis of paradoxical embolism was made and she was subsequently referred to the cardiologists for angiographic closure of the PFO. DISCUSSION The case study herein reported gives an account that PFO can have considerable health implications in the early postoperative period and conceivably intraoperatively in patients undergoing major reconstructive surgeries. CONCLUSION Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration. PMID:25437687

  6. Infective Left Atrial Dissecting Flap after Cardiac Surgery

    PubMed Central

    Tabiban, Sasan; Ghaemian, Ali; Bagheri, Babak; Shokri, Mojtaba

    2014-01-01

    Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography. PMID:25309695

  7. Predictable dental rehabilitation in maxillomandibular reconstruction with free flaps. The role of implant guided surgery

    PubMed Central

    Cebrian-Carretero, José L.; Sobrino, José A.; Yu, Tomás; Burgueño-García, Miguel

    2014-01-01

    The reconstruction of maxillomandibular defects secondary to oral cancer surgery, represent a great challenge for Maxillofacial surgeons. During the last decades the reconstructive surgery has experimented a big advance due to the development of the microsurgical techniques. At present, we are able to reconstruct complex defects using free flaps that provide both soft and bone tissue. Fibula, iliac crest and scapula free flaps have been the three classic options for the maxillomandibular reconstruction owing to the amount of bone that this flaps provide, allowing the posterior dental rehabilitation with implants. Today, our objective it is not only the aesthetic reconstruction, but also the functional reconstruction of the patients enhancing their life quality. Guided implant surgery in free flap reconstructed patients has become an essential tool, helping to define the exact position of the dental implant in the flap. In this way it is possible to look for the areas with better bone conditions, avoiding the osteosynthesis material used to fixate the flap with the native bone and deciding the best biomechanical option, in terms of number and situation of the implants, for the future dental prostheses. In summary, using the guided implant surgery, it is possible to design an exact and predictable dental implant rehabilitation in patients with oral cancer who are reconstructed with free microvascular flap, resulting in an optimal aesthetic and functional result. Key words:Oral cancer, mandibulectomy, maxillectomy, microvascular reconstruction, fibula flap, dental implant, guided surgery. PMID:25129241

  8. The reverse ulnar artery forearm island flap in hand surgery: 54 cases.

    PubMed

    Guimberteau, J C; Goin, J L; Panconi, B; Schuhmacher, B

    1988-06-01

    The authors discuss their experience with the ulnar artery forearm island flap in 54 cases of hand surgery. They discuss its advantages over the radial island forearm flap and examine further technical possibilities in hand reconstruction, such as the compound flap. Although these reconstructive techniques do not have any sequelae, they involve the sacrifice of a major artery and should thus be used only in complex cases with very clear indications and as a last resort. PMID:3375354

  9. Limb salvage surgery following resection of a melanoma: Foot and ankle reconstruction using cutaneous flaps

    PubMed Central

    LIU, JIAN-FENG; ZHAO, LI-RONG; LU, LAI-JIN; CHEN, LEI; LIU, ZHI-GANG; GONG, XU; LIU, BIN

    2014-01-01

    Melanomas affect the foot and ankle region and are associated with a poor prognosis. The aim of the current study was to evaluate the functional and oncological outcomes of salvage surgery using cutaneous flaps for soft tissue reconstruction of the foot and ankle following the extended resection of a melanoma. A retrospective review was conducted to evaluate patients who presented with foot melanoma and underwent salvage surgery and defect reconstruction using three types of cutaneous flap (group S) or amputation (group A) between January 1999 and December 2010 at the First Hospital of Jilin University (Changchun, China). The postoperative mortality, surgical complications, functional outcomes and oncological outcomes were evaluated. Of the 21 patients, 11 were enrolled into group S and 10 were enrolled into group A. The median follow-up time of the patients was 58 months (range, 6–92 months). In group S, a reverse sural neurocutaneous island flap was used in six patients to perform the foot reconstruction, medial plantar flaps were used in four patients and lateral malleolus flaps were used in one patient. All 11 cutaneous flaps survived and provided satisfactory coverage. Only one cutaneous flap showed partial necrosis and required treatment comprising of debridement and regular changes to the wound dressing. The overall survival rate of patients was 65.0% and patients in the two groups experienced similar oncological outcomes. Salvage surgery with cutaneous flap reconstruction was found to be a reliable option for patients presenting with malignant melanoma of the foot and ankle. PMID:25295080

  10. Usefulness of a Lateral Thoracodorsal Flap after Breast Conserving Surgery in Laterally Located Breast Cancer

    PubMed Central

    Ryu, Dong Wan; Lee, Jeong Woo; Choi, Kang Young; Chung, Ho Yun; Cho, Byung Chae; Park, Ho Yong; Byun, Jin Suk

    2013-01-01

    Background Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer. Methods From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons. Results The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes. Conclusions Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer. PMID:23898433

  11. The Role of Latissimus Dorsi Myocutaneous Flaps in Secondary Breast Reconstruction After Breast-Conserving Surgery

    PubMed Central

    Tomita, Koichi; Yano, Kenji; Nishibayashi, Akimitsu; Fukai, Megumi; Miyasaka, Miwako; Hosokawa, Ko

    2013-01-01

    Objective: Secondary reconstruction after breast-conserving surgery is generally challenging because of the nature of irradiated tissue. The aim of this study was to validate the use of latissimus dorsi myocutaneous (LDM) flaps for secondary breast reconstruction after breast-conserving surgery. Methods: Fifteen consecutive patients who underwent secondary reconstruction with an LDM flap after breast-conserving surgery were included in the study. The esthetic outcome in comparison with the contralateral breast was evaluated by observer assessments consisting of 7 criteria. In addition to comparing pre- and postoperative scores for each criterion, factors affecting overall esthetic outcome were analyzed. Results: There was no major recipient- or donor-related complication. In 13 patients, the skin paddle of the LDM flap was exposed to the skin surface. In all patients, overall esthetic scores increased postoperatively. Age, period between breast-conserving surgery and LDM flap, body mass index, or preoperative breast size did not affect the overall esthetic outcome. Tumors in the lower quadrants tended to result in poorer esthetic scores, especially in breast shape and scar (P = .04 and .02, respectively). Conclusions: Given their high vascularity and moderate flap volume, LDM flaps could be a reliable option for secondary breast reconstruction after breast-conserving surgery. Although exposure of skin paddle to the skin surface is inevitable in most cases, esthetic improvement could be achieved, including the breast scar. On the contrary, immediate reconstruction would certainly be more desirable, especially in cases of tumors in the lower quadrants. PMID:23837111

  12. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery.

    PubMed

    Izumi, Ken; Fujikawa, Masakazu; Tashima, Hiroki; Saito, Takuya; Sotsuka, Yohei; Tomita, Koichi; Hosokawa, Ko

    2013-11-01

    Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery. PMID:23896164

  13. Use of Martius flap in the complex female urethral surgery

    PubMed Central

    Tupikina, Nataliya; Pushkar, Dmitry

    2014-01-01

    Introduction Objectives were to evaluate safety and patient reported perception of the Martius fibroadipose flap for complex female urethra reconstruction. Material and methods Patients operated with a Martius flap were contacted again via telephone to rate their self–perception on cosmetic appearance, pain or numbness of the flap harvest site. Results 37 women (mean age of 46.8 yrs.) were operated with Martius flaps. Complications were limited to bleeding from the flap bed in 19% (7/37); hematomas – 5.4% (2/37); and lymphorrhea from the labial incision in 13.5% (5/37) and labial wound infection in 5.4% of cases (2/37). For self–perception 65% of patients (24/37) were phone interviewed (mean follow up – 54.2 months). Only 17% of women (4/24) complained to cosmetic problems. Two patients (8%) complained to a periodical mild pain. And 12.5% (3/24) of the women had decreased sensation or numbness at the labia. Conclusions Martius flap is safe and it is not causing significant complications during female urethral reconstruction. However, an informed consent for decreased sensation and numbness at the flap harvesting area should be obtained. PMID:25140241

  14. Breast Reconstruction following Breast-conserving Surgery with a Subcutaneous Tissue Expander and Latissimus Dorsi Flap

    PubMed Central

    Yano, Kenji; Sugio, Yuta; Ishihara, Takayoshi; Nishibayashi, Akimitsu; Matsuda, Ken; Hosokawa, Ko

    2014-01-01

    Summary: Corrective surgery following breast-conserving surgery is generally challenging due to severe fibrosis induced by postoperative radiotherapy. Although use of the latissimus dorsi myocutaneous flap offers a safe and reliable option, exposure of the skin paddle to the skin surface is often inevitable to achieve correction of nipple-areola complex malposition, leaving conspicuous, patchwork-like scars on the breast. In this report, we describe a 2-stage procedure using a subcutaneous tissue expander and the latissimus dorsi myocutaneous flap for the correction of both nipple-areola complex malposition and breast volume without skin paddle exposure. Although careful observation is necessary during skin expansion, this technique could offer an alternative option for patients undergoing corrective surgery following breast-conserving surgery. PMID:25426348

  15. Salvage surgery of recurrence after laryngectomy – when should the alt free flap be modified?

    PubMed Central

    Maciejewski, Adam; Krakowczyk, ?ukasz; Szymczyk, Cezary; Wierzgo?, Janusz; Grajek, Maciej; Dobrut, Miros?aw; Szumniak, Ryszard; J?drzejewski, Piotr; Ulczok, Rafa?; Pó?torak, Stanis?aw

    2012-01-01

    Summary Background Reconstruction of the pharynx and cervical esophagus has significantly progressed in the last 2 decades. A revolution in microvascular surgery has provided numerous choices for primary restoration, or in secondary reconstructions necessary for recurrences or complications of primary surgery. The goals of reconstruction after laryngopharyngoesophagectomy are to provide continuity of the alimentary tract, to protect major blood vessels, to heal the primary wound, and to restore the swallowing and breathing functions with minimal donor site and neck morbidity and deformation. Case Report We present 3 cases with complex defects of the laryngopharynx, cervical esophagus and trachea and anterior neck skin following central neck exenteration safely reconstructed with a single anterolateral thigh flap. No postoperative complications occurred in any of the 3 cases of reconstructions, each using a single anterolateral thigh flap. Conclusions This approach significantly simplified the reconstruction, with quick recovery, short hospital stay and excellent functional and aesthetic results. PMID:22460099

  16. A large frontonasal bone flap for sinus surgery in the horse.

    PubMed

    Freeman, D E; Orsini, P G; Ross, M W; Madison, J B

    1990-01-01

    A large frontonasal bone flap was created to treat diseases of the paranasal sinuses in 14 horses. The bone flap was made as wide as possible within the confines of the nasolacrimal duct so the floor of the frontal sinus and the dorsal and ventral conchae could be opened. These openings exposed the nasal passages, maxillary sinuses, and ventral conchal sinus thereby facilitating removal of diffuse and localized lesions from these sites. Diseases treated were ethmoid hematomas (4 horses), sinus cysts (5 horses), cryptococcal granuloma, osteoma, hemangiosarcoma, pus in the ventral conchal sinus, and periapical infection of a second molar. Four horses were euthanatized during or after surgery, one because of postsurgical pleuritis and pneumonia (horse with osteoma) and three because of their primary problems (cryptococcal granuloma, hemangiosarcoma, pus in the ventral conchal sinus). Skin suture abscesses that responded to treatment developed in four horses. Ten horses returned to their intended uses, the sinus flaps healed without blemish, and the original problems did not recur. The frontonasal flap technique provided greater access to all paranasal sinuses than methods described previously. PMID:2333683

  17. MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity.

    PubMed

    Magerkurth, Olaf; Girish, Gandikota; Jacobson, Jon A; Kim, Sung Moon; Brigido, Monica K; Dong, Qian; Jamadar, David A

    2015-01-01

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence. PMID:25598685

  18. MR Imaging Appearances of Soft Tissue Flaps Following Reconstructive Surgery of the Lower Extremity

    PubMed Central

    Girish, Gandikota; Jacobson, Jon A; Kim, Sung Moon; Brigido, Monica K; Dong, Qian; Jamadar, David A

    2015-01-01

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence. PMID:25598685

  19. Soft tissue covers in hypospadias surgery: Is tunica vaginalis better than dartos flap?

    PubMed Central

    Dhua, Anjan Kumar; Aggarwal, Satish Kumar; Sinha, Shandip; Ratan, Simmi K.

    2012-01-01

    Aim: To compare tunica vaginalis with dartos flap as soft tissue cover in primary hypospadias repair. Materials and Methods: 25 cases (age range: 12-132 months; all fresh cases) of primary hypospadias were prospectively repaired by tubularized incised plate (TIP)/TIP + graft urethroplasty using tunica vaginalis flap (TVF) as soft tissue cover to urethroplasty (group A). Their results were compared with another set (group B) of age- and anatomy-matched controls (25 patients operated during the previous 3 years) who had undergone TIP repair using dartos flap as soft tissue cover. Statistical analysis of results was done with Fischer's exact test. Results: Group A: No fistula, skin necrosis, meatal stenosis, urethral stricture. One case had partial wound dehiscence that resolved on conservative treatment with no sequelae. One case required catheter removal on 3rd day because of severe bladder spasm. There was no testicular atrophy/ascent. Group B: 3 fistulae – all required surgery. There were three cases of superficial skin necrosis that healed spontaneously without sequel. There was no meatal stenosis/urethral stricture. The difference in fistula rate between both the groups, however, was not statistically significant (P = 0.4). Conclusion: TVF may have an edge over dartos fascia for soft tissue coverage of the neourethra. PMID:22279358

  20. A Novel Pilot Study Using Spatial Frequency Domain Imaging to Assess Oxygenation of Perforator Flaps During Reconstructive Breast Surgery

    PubMed Central

    Nguyen, John T.; Lin, Samuel J.; Tobias, Adam M.; Gioux, Sylvain; Mazhar, Amaan; Cuccia, David J.; Ashitate, Yoshitomo; Stockdale, Alan; Oketokoun, Rafiou; Durr, Nicholas J.; Moffitt, Lorissa A.; Durkin, Anthony J.; Tromberg, Bruce J.; Frangioni, John V.; Lee, Bernard T.

    2013-01-01

    Introduction Although various methods exist for monitoring flaps during reconstructive surgery, surgeons primarily rely on assessment of clinical judgment. Early detection of vascular complications improves rate of flap salvage. Spatial frequency domain imaging (SFDI) is a promising new technology that provides oxygenation images over a large field of view. The goal of this clinical pilot study is to use SFDI in perforator flap breast reconstruction. Methods Three women undergoing unilateral breast reconstruction after mastectomy were enrolled for our study. The SFDI system was deployed in the operating room, and images acquired over the course of the operation. Time points included images of each hemiabdominal skin flap before elevation, the selected flap after perforator dissection, and after microsurgical transfer. Results Spatial frequency domain imaging was able to measure tissue oxy-hemoglobin concentration (ctO2Hb), tissue deoxyhemoglobin concentration, and tissue oxygen saturation (stO2). Images were created for each metric to monitor flap status and the results quantified throughout the various time points of the procedure. For 2 of 3 patients, the chosen flap had a higher ctO2Hb and stO2. For 1 patient, the chosen flap had lower ctO2Hb and stO2. There were no perfusion deficits observed based on SFDI and clinical follow-up. Conclusions The results of our initial human pilot study suggest that SFDI has the potential to provide intraoperative oxygenation images in real-time during surgery. With the use of this technology, surgeons can obtain tissue oxygenation and hemoglobin concentration maps to assist in intraoperative planning; this can potentially prevent complications and improve clinical outcome. PMID:23945533

  1. Changes in Transforming Growth Factor-?1 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis Following Periodontal Flap Surgery

    PubMed Central

    Ramakrishnan, T.; Anilkumar, K.; Ambalavanan, N.

    2015-01-01

    Introduction: The aim of the study was to assess changes in Transforming Growth Factor– ?1 (TGF-?1) levels in gingival crevicular fluid (GCF) and examine correlation of TGF-?1 levels and periodontal parameters: probing pocket depth (PPD) and clinical attachment level (CAL) in sites with chronic periodontitis at various time intervals before and after periodontal surgery. Materials and Methods: The effects of non-surgical and surgical therapy on periodontal parameters and GCF TGF-?1 levels in 18 sites affected with chronic periodontitis were assessed upto 6 weeks post conventional flap surgery. GCF was collected and PPD, CAL recorded at Baseline. GCF was collected and PPD, CAL recorded at Pre-surgery and flap surgery performed. GCF was collected from all sites at Two Weeks Post-surgery. GCF was collected and PPD, CAL recorded at Six Weeks Post-surgery. The concentration of TGF-?1 in GCF was determined using a human TGF-?1 enzyme immunometric assay kit. Results: Mean TGF-?1 concentrations were significantly reduced at Pre-surgery, at Two Weeks Post-surgery and at Six Weeks Post-surgery (p<0.05) when compared to Baseline TGF-?1 values. There was a statistically significant reduction in PPD and gain in CAL following non-surgical and surgical therapy when compared to baseline (p<0.05). Conclusion: Results indicate that TGF-?1 may play a role in the pathogenesis and diagnosis of periodontal disease and could be considered as a disease predictive biomarker.

  2. Postoperative irradiation after reconstructive surgery: comparative study of radiosensitivity between free-skin grafts and skin flaps

    SciTech Connect

    Sumi, Y.; Ueda, M.; Kaneda, T.; Oka, T.; Torii, S.; Sakuma, S.

    1984-09-01

    Radiation effects after reconstructive surgery (free-skin grafts and skin flaps) were studied in the rat, and the optimum time for irradiation was determined. The radiosensitivity of both free-skin grafts and skin flaps showed the same trend depending on time of irradiation after operation. The grafts or flaps irradiated in the hypervascular stage showed severe reactions to irradiation, whereas those irradiated in the hypovascular stage showed milder reactions in gross and microangiographic observation. Vascular damage should be given primary consideration when deciding the proper time for irradiation after reconstructive surgery. In general, free-skin grafts showed more severe reactions than skin flaps, especially in the grafts irradiated in the early stage after operation. The experimental results of this study cannot be readily transferred to a clinical setting, but they suggest that postoperative irradiation could be begun 3 to 4 weeks after operation with respect to graft or flap survival, and the results of the clinical cases almost coincide with these experimental results.

  3. An overview of skin flap surgery in the mainland China: 20 years' achievements (1981 to 2000).

    PubMed

    Chang, Shi-Min; Hou, Chun-Lin; Xu, Da-Chuan

    2009-07-01

    Microsurgical anatomy and clinical applications have been widely and extensively practiced throughout the mainland of China since late 1970s. During the 1980s to 1990s, Chinese surgeons and anatomists developed many new flap donor sites and modifications, most of which were published in Chinese literature. These achievements were not fully realized by the Western surgeons. In this overview, we attempt to give a brief introduction of these contributions made by the Chinese authors in the mainland. Of the new flaps first or independently described by the Chinese, most were in the limbs. These flaps can be classified into three categories. First are free flaps with a main artery trunk, such as the radial forearm flap with radial artery, the medial leg flap with posterior tibial artery, and lateral leg flap with peroneal artery. Second are reverse-flow island flaps based on distal main vascular bundles (e.g., the radial artery and venae comitantes, the ulnar, the posterior tibial, and the peroneal arteries). Third are septocutaneous perforator flaps that avoid sacrifice of the main artery trunk, which include the anterolateral thigh flap, lateral lower-leg flap, dorsoulnar flap, distally adipofascial pedicled radial forearm flap, and so on. PMID:19288409

  4. Flapless versus Conventional Flapped Dental Implant Surgery: A Meta-Analysis

    PubMed Central

    Chrcanovic, Bruno Ramos; Albrektsson, Tomas; Wennerberg, Ann

    2014-01-01

    The aim of this study was to test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants being inserted by a flapless surgical procedure versus the open flap technique, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomized or not. The search strategy resulted in 23 publications. The I2 statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used for random-effects model or fixed-effects model, when indicated. The estimates of relative effect were expressed in risk ratio (RR) and mean difference (MD) in millimeters. Sixteen studies were judged to be at high risk of bias, whereas two studies were considered of moderate risk of bias, and five studies of low risk of bias. The funnel plots indicated absence of publication bias for the three outcomes analyzed. The test for overall effect showed that the difference between the procedures (flapless vs. open flap surgery) significantly affect the implant failure rates (P?=?0.03), with a RR of 1.75 (95% CI 1.07–2.86). However, a sensitivity analysis revealed differences when studies of high and low risk of bias were pooled separately. Thus, the results must be interpreted carefully. No apparent significant effects of flapless technique on the occurrence of postoperative infection (P?=?0.96; RR 0.96, 95% CI 0.23–4.03) or on the marginal bone loss (P?=?0.16; MD ?0.07 mm, 95% CI ?0.16–0.03) were observed. PMID:24950053

  5. Use of the versatile sternocleidomastoid flap in oral and maxillofacial surgery: our experience.

    PubMed

    Wei, Dong; Liu, Jian-hua; Zhao, Wen-quan; Zhu, Hui-yong; Li, Zhi-yong; Wang, Hui-ming

    2013-12-01

    Our aim was to evaluate the reliability of sternocleidomastoid (SCM) flaps in the reconstruction of defects after oral and maxillofacial resections, and summarise the ways in which morbidity can be reduced. We retrospectively enrolled 65 patients who had malignant tumours resected, and assessed the postoperative viability of the SCM flap. All complications were recorded during a follow up period of 1-64 months. We also investigated the relation between recurrence in regional lymph nodes and their preoperative histological state. The conventional SCM flap, the split SCM flap with only the sternal head, and the SCM flap with a half-thickness clavicular graft, were used to repair different defects. No flaps necrosed completely, and in only 5 cases was there partial loss of the skin paddle. The skin paddle avulsed in 2 cases 2 patients developed wound infections. Only 9 patients developed complications (14%, 9/65). Use of the split SCM flap overcomes the problem of bulk. The combination of the SCM flap and clavicular bone enables early dental implantation. The SCM flap is convenient, reliable, and technically easy for the reconstruction of intraoral or mandibular tissue loss. Preservation of the branch of the superior thyroid artery and precise surgical technique contribute to a higher success rate. PMID:23701831

  6. A clinical study of various buccinator musculomucosal flaps for palatal fistulae closure after cleft palate surgery.

    PubMed

    Fang, Lin; Yang, Mingyong; Wang, Chunyan; Ma, Tingting; Zhao, Zhenmin; Yin, Ningbei; Wei, Liu; Yin, Jiapeng

    2014-01-01

    This retrospective study describes various buccinator musculomucosal flaps for the repair of palatal fistulae. Twenty-two palatal fistulae were repaired at our institution between 2002 and 2012 by buccinator musculomucosal flaps with superior-anterior or posterior pedicles. Seventeen patients were treated with posteriorly pedicled flaps, 7 of whom had lengthening of the soft palate and 10 of whom had simultaneously repaired severe lateral palatal scarring. Five patients with anterior or midpalatal fistulae were treated with superior-anteriorly pedicled flaps. All but 4 of the 22 patients had satisfactory results. Four patients had recurrent fistulae, 2 resulting from flap tip necrosis and 2 from wound dehiscence. Follow-up was from 5 to 72 months. None of the patients had facial nerve injury, limited mouth opening, or difficulty chewing. We evaluated the factors that could cause complications, such as flap pattern, location of fistula, and size of palate defect. No statistically significant differences were found in the complication rates among different groups. In conclusion, the buccinator musculomucosal flap is reliable and versatile, with rich vascularity and flexible design. The flap is a good option for fistula repair, especially for larger fistulae at the anterior portion of the hard palate or at the junction of hard and soft palate, where surrounding soft tissues are stiff, scarred, and difficult to mobilize. PMID:24469368

  7. Oncoplastic breast surgery combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap for Paget's disease.

    PubMed

    Kijima, Yuko; Yoshinaka, Heiji; Hirata, Munetsugu; Nakajo, Akihiro; Arima, Hideo; Okumura, Hiroshi; Arigami, Takaaki; Ishigami, Sumiya; Natsugoe, Shoji

    2014-09-01

    Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We herein report the results of OBS in Japanese patients with Paget's disease. We performed OBS combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap in two patients. In these two patients, who were diagnosed as having Paget's disease with a restricted intraductal component in the central area of their non-ptotic breast, we performed oncoplastic surgery combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap. Neither of the two patients received contralateral surgery to produce symmetrical breasts. The observation period ranged from 6 to 12 months, and the bilateral breast volumes and inframammary lines were symmetric. OBS combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap was successfully performed in two patients with Paget's disease. PMID:23925716

  8. Secondary omental and pectoralis major double flap reconstruction following aggressive sternectomy for deep sternal wound infections after cardiac surgery

    PubMed Central

    2011-01-01

    Background Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion. We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves. Methods We retrospectively examined 16 patients treated for deep sternal wound infection between 2001 and 2007. The most recent nine patients were treated with total sternal resection followed by VAC therapy and secondary closure with omental-muscle flap reconstruction (recent group); whereas the former seven patients were treated with sternal preservation if possible, without VAC therapy, and four of these patients underwent primary closure (former group). We assessed long-term quality of life after DSWI by using the Short Form 36-Item Health Survey, Version 2 (SF36v2). Results One patient died and four required further surgery for recurrence of deep sternal wound infection in the former group. The duration of treatment for deep sternal wound infection in the recent group was significantly shorter than that in previous group (63.4 ± 54.1 days vs. 120.0 ± 31.8 days, respectively; p = 0.039). Despite aggressive sternal resection, the QOL of patients treated for DSWI was only minimally compromised compared with age-, sex-, surgical procedures-matched patients without deep sternal wound infection. Conclusions Aggressive sternal debridement followed by VAC therapy and secondary closure with an omental-muscle flap is effective for deep sternal wound infection. In this series, it resulted in a lower incidence of recurrent infection, shorter hospitalization, and it did not compromise long-term QOL greatly. PMID:21501461

  9. Deep-planes lift associated with free flap surgery for facial reanimation.

    PubMed

    Biglioli, Federico; Frigerio, Alice; Autelitano, Luca; Colletti, Giacomo; Rabbiosi, Dimitri; Brusati, Roberto

    2011-10-01

    Between April 1999 and April 2008, 37 patients with long-standing facial paralysis underwent a one-stage facial reanimation with neuromuscular free flaps: 28 patients (group A) underwent flap transposition only; 9 patients (group B) underwent a deep-planes lift (DPL) composed of the superficial muscoloaponeurotic system + parotid fascia at the time of facial reanimation. The postoperative and final results were compared between groups A and B, following the classification of Terzis and Noah (1997). Before the onset of contraction, only group B patients (100%) showed good or moderate symmetry at rest, while none of the patients of group A had a symmetric face. The respective final results for patients in groups A and B who already showed the onset of flap contraction were excellent in 28.6% and 44.5%, good in 42.9% and 33.3%, moderate in 10.7% and 22.2%, and fair or poor and fair in 17.8% and 0% of patients, respectively. The DPL allows immediate symmetry of the face at rest and contributes to upgrading the final static and dynamic results in facial reanimation with free muscular flaps. PMID:21145243

  10. Oncoplastic breast surgery with latissimus dorsi myocutaneous flap for large defect in patients with ptotic breasts: is it feasible when combined with local flaps?

    PubMed Central

    2014-01-01

    Background The latissimus dorsi myocutaneous flap (LDMCF) is frequently applied to breast cancer patients for breast reconstruction. However, the LDMCF is considered inappropriate for patients with ptotic breast. The authors investigated combining LDMCF and two local flaps for large defects of the breast after partial mastectomy in patients with ptosis. Methods Nineteen patients with breast cancer underwent a partial mastectomy with immediate reconstruction. Reconstruction methods consisted of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, referred to as a combined pedicle flap. The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system. Results Ptosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3. The mean tumor size was 2.7 cm and multifocality was identified in 11 patients (57.9%). The mean excised volume was 468.5 cm3 and the percentage of excised volume was 46.2%. The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient. Conclusion The combined pedicle flap, consisting of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, allows good cosmesis in breast cancer patients with large breasts or ptosis despite a wide excision. PMID:24669908

  11. Location of the mucogingival junction 18 years after apically repositioned flap surgery.

    PubMed

    Ainamo, A; Bergenholtz, A; Hugoson, A; Ainamo, J

    1992-01-01

    The apically repositioned flap procedure, by definition, implies that the mucogingival junction (MGJ) is shifted into an apical location. That this actually would be the case has never been shown in long-term studies. The 13 subjects in the present study had during the years 1964-1965 received treatment of moderately advanced periodontal disease (probing pocket depths less than or equal to 5 mm) in the lower jaw. An apically repositioned flap (ARF) procedure was applied in the left or right half of the mandible and a gingivectomy (GE) was performed in the contralateral side. Starting in December 1981, the patients were recalled for clinical and radiographic determination of long-term results. The width of the band of keratinized gingiva was measured clinically and the distance from the MGJ to the lower border of the mandible (LBM) was measured from orthopantomograms. Slightly less keratinized gingiva was observed on the sides where GE had been used. There was no statistically significant difference in the orthopantomographic distance from the MGJ to the LBM between ARF and GE operations. The results indicate that the apically repositioned flap procedure does not result in a permanent apical shift of the MGJ. PMID:1732309

  12. Evaluation of the use of a 940 nm diode laser as an adjunct in flap surgery for treatment of chronic periodontitis

    PubMed Central

    Lobo, Tanya Marguerite; Pol, Dilip Ganpat

    2015-01-01

    Background: Lasers have several potential benefits such as antibacterial effect and stimulation of wound healing. In addition, hemostasis and delaying epithelial migration may facilitate the outcome of flap surgery. There is a minimal research and evidence currently available for the optimum method of use of a diode laser in flap surgery and its benefit and safety. Hence, this study aimed to investigate the adjunctive effect of diode laser irradiation in open flap debridement (OFD), while treating chronic periodontitis. Materials and Methods: A total of 30 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ?5 mm post - Phase I therapy were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, clinical attachment level, gingival recession, plaque index, gingival index and tooth mobility were recorded at baseline, 3 months and 6 months following treatment. In addition, patients’ rating of procedural pain as well as the development of complications postoperatively was assessed. Results: All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The exception was a significantly greater reduction in gingival inflammation in the laser treated group. The laser treatment was acceptable to the patient and did not cause any complications. Conclusion: The diode laser can be safely and effectively used as an adjunct to the treatment of chronic periodontitis with the advantage of decreased gingival inflammation.

  13. Neurotrophins and Nerve Regeneration-associated genes are expressed in the Cornea after Lamellar Flap Surgery

    PubMed Central

    Namavari, Abed; Chaudhary, Shweta; Yco, Lisette; Chang, Jin-Hong; Sonawane, Snehal; Khanolkar, Vishakha; Sarkar, Joy; Jain, Sandeep

    2012-01-01

    Purpose To determine the in vivo expression of neurotrophins (NTs) and nerve regeneration-associated genes (RAGs) after surgically creating a hinged lamellar corneal flap in thy1-YFP mice. Methods Lamellar corneal flaps with multiple hinges were created in thy1-YFP mice. Mice were sacrificed weeks 2, 4, and 8. Quantitative PCR was performed to determine the expression of NTs and RAGs in the corneas following lamellar transection. Nerve growth factor (Ngf), Brain-derived neurotrophic factor (Bdnf), Glial cell-derived neurotrophic factor (Gdnf), Neurotrophin-3 (Ntf3), Neurotrophin 5 (Ntf5), Small proline-rich repeat protein 1A (Sprr1a), Growth-associated protein 43 (Gap43) and Beta III tubulin (Tubb3) gene expressions were analyzed. Whole-mount confocal immunofluorescence and Western analyses were performed for localization and abundance of robustly expressed genes. Results Sprouts of fine YFP positive fronds emanating from transected (injured) nerve bundles were seen in the flap area at 2 weeks onwards. Bdnf and Sprr1a were robustly and significantly expressed at 2 weeks postoperatively (> 2 folds increase in expression and p < 0.05). Bdnf localized to thy1-YFP+ cells in operated corneas. Sprr1a localized to corneal epithelial cell membranes. At 8 weeks, none of the NTs and RAGs had increased expression. Bdnf (? = 0.73, p = 0.001) and Sprr1a (? = 0.76, p = 0.001) showed a significant positive correlation with Tubb3. Conclusion The neurotrophin Bdnf and regeneration-associated gene Sprr1a are robustly and significantly expressed during corneal nerve regeneration in vivo. PMID:22673847

  14. Free flaps for type III complex pharyngoesophageal defects after enlarged ablative surgery for advanced cancer of larynx and hypopharynx.

    PubMed

    Antohi, Nicolae; Tibirna, Gheorghe; Suharski, Ilie; Bejan, Anatol; Marina, Sergiu; Pogonet, Vadim; Stan, Vitalie

    2003-01-01

    Free tissue transfer has become a useful technique for reconstruction of type III complex pharyngoesophageal defects after enlarged laryngectomy and partial or total pharyngoesophageal resection. We present a retrospective analysis of our experience with 36 patients who received free flaps for reconstruction of complex pharyngoesophageal defects associated with skin and soft-tissue defects. Free fasciocutaneous flaps and jejunum combined with a deltopectoral flap and musculocutaneous pectoralis major flap, gastro-omental flap, and combined latissimus dorsi musculocutaneous and cutaneous scapular flaps were used for reconstruction. Adjuvant therapy included preoperative or postoperative radiotherapy. Free flap failure occurred in 2 of 36 patients. Twenty-eight patients had good swallowing function. Better results with fewer complications in reconstruction of type III complex pharyngoesophageal defects were obtained with the use of a combined latissimus dorsi and scapular flap. PMID:12833318

  15. Management of thyroid cancer of follicular cell origin: Gundersen\\/Lutheran Medical Center, 1969–1995

    Microsoft Academic Search

    Renato G Martins; Robert H Caplan; Pamela J Lambert; Brenda Rooney; William A Kisken

    1997-01-01

    Background:Most reports regarding the treatment of thyroid cancer originate from university referral centers. In this article, we report our experience in managing thyroid cancer of follicular cell origin at a nonuniversity institution over a 26-year period.Study Design:We reviewed the medical records of all patients treated for thyroid cancer at the Gundersen\\/Lutheran Medical Center from 1969 to 1995. Histologic types, demographic

  16. Glans-reconstruction with preputial flap is superior to primary closure for post-surgical restoration of male sexual function in glans-preserving surgery.

    PubMed

    Yang, J; Chen, J; Wu, X-F; Song, N-J; Li, Q; Qiao, D; Zhang, J-Y; Song, N-H

    2014-09-01

    We conducted this study to investigate whether glans-reconstruction with preputial flap would be more helpful for post-operative restoration of patients' sexual potency than primary closure. From 2007 to 2013 at four centres, 46 cases reconstructed with preputial flap and 59 with primary closure were selected for the investigation from 142 consecutive cases of superficial glans cancer, with the largest diameter of lesion ?2.5 cm, who undergoing glans-preserving surgery (GPS). Subjective evaluation for patients' sexual performance was investigated using the International Index of Erectile Function-15. Objective evaluation was carried out by the Audio Visual Sexual Stimulation test with RigiScan-Plus. The degree of satisfaction for penile appearance and patients' confidence and partners' acceptability for intercourse were evaluated by 5-point scales. Patients with preputial flap reconstruction showed significant better performance in three domains (orgasmic function, intercourse satisfaction and overall satisfaction, all p < 0.05) and significantly higher ratios of appearance satisfaction (78.3% vs. 57.6%, p = 0.026) and intercourse confidence (69.6% vs. 49.2%, p = 0.035) compared with those undergoing primary closure at post-operative month 6 ends. Their sexual partners in the preputial flap group also exhibited significantly higher ratios of appearance satisfaction than in the primary closure group (67.4% vs. 42.4%, p = 0.011). Reconstruction with preputial flap contributes to a more acceptable cosmetic appearance of the penis and minimizes post-operative negative psychological impediments. Patients can benefit more from reconstruction with preputial flap than primary closure. Glans-reconstruction with preputial flap should be considered the primary reconstruction technique in GPS. PMID:24923484

  17. Neurovascular distribution within the abdominal head of the pectoralis major muscle: Application to breast and flap surgery.

    PubMed

    Kim, Dong-Min; Jeon, Anna; Kim, Kyung-Yong; Lee, Je-Hun; Kim, Deog-Im; Kim, Yi-Suk; Han, Seung-Ho

    2015-05-01

    The abdominal head of the pectoralis major (AHPM) is important in cosmetic and flap surgeries. Few studies have reported on its neurovascular entry points and distribution patterns. We aimed to determine the entry points and distribution patterns of the neurovascular structures within the AHPM. Thirty-two hemithoraxes were dissected, and the distribution patterns of the neurovascular structures were classified into several categories. The neurovascular entry points were measured at the horizontal line passing through the jugular notch (x-axis) and the midclavicular line (y-axis). The AHPM was innervated by the communication branches of the medial pectoral nerve (MPN) and the lateral pectoral nerve (LPN) in 78.1% of the specimens and of the MPN without the communication branches in 21.9%. All the LPNs had communication branches, which could be classified as independent in 46.9% of the samples, with the MPN in 21.9%, and with the LPN in 9.3%. The blood supply of the AHPM was composed of branches from the lateral thoracic artery (LTA) in 62.5% of the specimens, the thoracoacromial artery (TA) in 15.6%, and the LTA with the TA in 21.9%. The mean distance of the entry point was 6.3 cm?±?1.3 cm lateral to the y-axis, 8.1 cm?±?3.3 cm below the x-axis in the nerves, 6.5 cm?±?1.2 cm lateral to the y-axis, and 8.6 cm?±?3.0 cm below the x-axis in the arteries. This study defined the average neurovascular entry point and distribution pattern in detail using standard lines to enable the AHPM to be better understood. Clin. Anat. 28:520-526, 2015. © 2015 Wiley Periodicals, Inc. PMID:25693862

  18. Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery.

    PubMed

    Ogawa, Tomoko; Hanamura, Noriko; Yamashita, Masako; Kimura, Hiroko; Kashikura, Yumi

    2014-09-01

    We have used an inframammary adipofascial flap for breast-conserving reconstruction in the inferior portion of the breast since 2005. The aim herein is to report this oncoplastic procedure in detail, including the long-term results. The surgical procedure was as follows: A skin incision is made at the inframammary line. After partial resection of the breast, a tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle are pulled up in the inframammary area. The flap is then inserted into the breast area where the tumor was removed, and it is secured with absorbable sutures to the surrounding breast tissue. When making the flap, it is very important to preserve several intercostal perforators around the inframammary line. Cosmetic results at more than 5 years after the operation in the 5 patients were assessed using photographs. The results were found to be good in 4 cases (80%) and poor in 1 case. The poor outcome was a case with 100% fat necrosis of the flap. This surgical procedure is easy to perform, and the long-term cosmetic outcomes were good, without complications. We consider this procedure to be useful for breast-conserving reconstruction after breast cancer occurring in the inferior portion of the breast. PMID:21710196

  19. Computer guided surgery for implant placement and dental rehabilitation in a patient undergoing sub-total mandibulectomy and microvascular free flap reconstruction.

    PubMed

    Dawood, Andrew; Tanner, Susan; Hutchison, Iain

    2013-08-01

    A 58-year-old patient presented with an extensive, destructive, recurrent pleomorphic adenoma occupying the mandibular body and the soft tissues of the mouth and neck. Resection of the mandible from right ramus to left condylar process, and implant rehabilitation in both jaws with fixed bridgework was planned. Comprehensive presurgical prosthetic work up was carried out to record the existing dental relationship and guide all stages of the reconstruction. The jaw was first grafted with a segmented, fibular microvascular free-flap, which was fixed in place with a fixation plate prebent on a Rapid Prototype Anatomical Model of the jaw. Reconstruction with implant supported fixed partial dentures took place to the dental scheme planned preresection, using a computer guided approach to implant placement in the complex and unfamiliar anatomy of the extensively grafted mandible. This approach facilitated and expedited implant surgery such that treatment could take place using a minimally invasive approach relatively soon after surgery, prior to commencement of radiotherapy, and highlights the importance of a multidisciplinary approach to treatment for patients having extensive surgery to the jaws. The patient's personal assessment 2 years post surgery was recorded using 1999 University of Washington Quality of Life Questionnaire. PMID:21995588

  20. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap.

    PubMed

    Healy, Claragh; Allen, Robert J

    2014-02-01

    It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed between August 1992 and August 2012. Indication for surgery; mastectomy pattern in primary reconstruction; flap type, whether unilateral or bilateral; recipient vessels; and adjunctive procedures were recorded. The DIEP was the most commonly performed flap (66%), followed by the superior gluteal artery perforator flap (12%), superficial inferior epigastric artery perforator flap (9%), inferior gluteal artery perforator flap (6%), profunda artery perforator flap (3%), and transverse upper gracilis flap (3%). Primary reconstruction accounted for 1,430 flaps (50%), secondary 992 (35%), and tertiary 425 (15%). As simultaneous bilateral reconstructions, 59% flaps were performed. With each flap, there typically ensues a period of enthusiasm which translated into surge in flap numbers. However, each flap has its own nuances and characteristics that influence patient and physician choice. Of note, each newly introduced flap, either buttock or thigh, results in a sharp decline in its predecessor. In this practice, the DIEP flap has remained the first choice in autologous breast reconstruction. PMID:24163223

  1. Use of Oral Mucoperiosteal and Pterygo-Masseteric Muscle Flaps as Interposition Material in Surgery of Temporomandibular Joint Ankylosis: A Comparative Study

    PubMed Central

    Anyanechi, CE; Osunde, OD; Bassey, GO

    2015-01-01

    Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0.18). Conclusion: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis.

  2. Flap monitoring using infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Keller, Alex; Wright, Leigh P.; Elmandjra, Mohamed; Mao, Jian-min

    2006-02-01

    We report results of clinical trials on flap monitoring in 65 plastic surgeries. Hemoglobin oxygen saturation of flap tissue (StO II) was monitored non-invasively by using ODISsey TM tissue oximeter, an infrared spectroscopic device. StO II measurements were conducted both intra-operatively and post-operatively. From the intra-operative measurements, we observed that StO II values dropped when the main blood vessels supplying the flap were clamped in surgery, and that StO II jumped after anastomosis to a value close to its pre-operative value. From post-operative monitoring measurements for the 65 flap cases, each lasted two days or so, we found that the StO II values approach to a level close to the baseline if the surgery was successful, and that the StO II value dropped to a value below 30% if there is a perfusion compromise, such as vascular thrombosis.

  3. Treatment of localized gingival recession using the free rotated papilla autograft combined with coronally advanced flap by conventional (macrosurgery) and surgery under magnification (microsurgical) technique: A comparative clinical study

    PubMed Central

    Pandey, Suraj; Mehta, D. S.

    2013-01-01

    Background: The aim of the present study was to evaluate and compare the conventional (macro-surgical) and microsurgical approach in performing the free rotated papilla autograft combined with coronally advanced flap surgery in treatment of localized gingival recession. Materials and Methods: A total of 20 sites from 10 systemically healthy patients were selected for the study. The selected sites were randomly divided into experimental site A and experimental site B by using the spilt mouth design. Conventional (macro-surgical) approach for site A and micro-surgery for site B was applied in performing the free rotated papilla autograft combined with coronally advanced flap. Recession depth (RD), recession width (RW) clinical attachment level (CAL.) and width of keratinized tissue (WKT.) were recorded at baseline, 3 months and 6 months post-operatively. Results: Both (macro- and microsurgery) groups showed significant clinical improvement in all the parameters (RD, RW, CAL and WKT). However, on comparing both the groups, these parameters did not reach statistical significance. Conclusion: Both the surgical procedures were equally effective in treatment of localized gingival recession by the free rotated papilla autograft technique combined with coronally advanced flap. However, surgery under magnification (microsurgery) may be clinically better than conventional surgery in terms of less post-operative pain and discomfort experienced by patients at the microsurgical site. PMID:24554888

  4. Surgery for Partial Anomalous Pulmonary Venous Connections: Modification of the Warden Procedure with a Right Atrial Appendage Flap

    PubMed Central

    Kim, Chilsung; Cho, Yang Hyun; Lee, Mina; Yang, Ji-Hyuk; Song, Jin Young; Huh, June; Kang, I-seok

    2014-01-01

    Background Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications. Methods Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials. Results No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months). Conclusion Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction. PMID:24782956

  5. Varioscope M5: a new type of magnification system in anterolateral thigh perforator free-flap surgery.

    PubMed

    Chiummariello, Stefano; Monarca, Cristiano; Dessy, Luca Andrea; Alfano, Carmine; Scuderi, Nicolò

    2009-05-01

    Free microvascular tissue transfer has become a key procedure for the surgical treatment of large tissue defects that requires specialized practitioners and magnification instruments. The operating microscope traditionally has filled this requirement. A study was performed focusing on the evaluation of a new magnification system, the Varioscope M5 (Life Optics, Vienna, Austria), in reconstructive procedures with a perforator free flap. The device was employed by the same operator during dissection and microvascular anastomosis of 12 anterolateral thigh perforator flaps in head and neck reconstruction. The need to operate in a different way, not provided by an operating microscope, gave us the idea of exploring an alternative to the classical visualization systems. Specific advantages such as reduced cost, freedom of movement, auto focus, minimal upkeep, and a variable range of magnification are some of the reasons that convinced us to try this new type of magnification system. Increasing interest in microsurgery magnification highlights the need for further technical developments in this field. We consider the Varioscope M5 an alternative option for surgical magnification in most free tissue transfers, especially when an operating microscope is not supplied. PMID:19065499

  6. Postoperative complications after major head and neck surgery with free flap repair--prevalence, patterns, and determinants: a prospective cohort study.

    PubMed

    McMahon, Jeremy D; MacIver, Colin; Smith, Miller; Stathopoulos, Panos; Wales, Craig; McNulty, Richard; Handley, Thomas P B; Devine, John C

    2013-12-01

    This study aims to give a better understanding of the prevalence, patterns, and determinants of postoperative complications, to evaluate the Clavien-Dindo classification of surgical complications, and to set out a protocol to improve postoperative recovery. Over a period of 27 months we studied 192 patients who had had major head and neck operations with free flaps. Data on complications were gathered prospectively along with patients' details, comorbidities, factors indicative of the magnitude of the surgical insult, and variations in perioperative care. Complications were classified according to the Clavien-Dindo system. Outcomes analysed comprised any complication, major complications (Clavien-Dindo III and above), wound complications, and pulmonary complications. A total of 64% of patients had complications, and in around one third they were serious; wound and pulmonary complications were the most common. Factors significantly associated with complications reflected an interaction between coexisting conditions of the patient at operation and the magnitude of the surgery. Perioperative interventions to ensure preoperative optimisation of patients, and to lessen the systemic inflammatory response that results from operation offer the best prospect of reducing the burden of surgical complications. A protocol to improve recovery after operation would be appropriate. The Clavien-Dindo classification of surgical complications is useful in this group. PMID:23727043

  7. Venous flaps.

    PubMed

    Thatte, M R; Thatte, R L

    1993-04-01

    One of the earliest postulates concerning the physiological basis of flap survival is attributed to Sushruta, who, in his inimitable style, very succinctly noted in Sanskrit verse the following words: "through continuity survives." Sanskrit being a very telegraphic language, what derives from these words is as follows: Through (the flap's) continuity (with its original location) (it) survives. The principle of continuity has survived through the ages, though continuity has come to imply vascular continuity based on the Harvesian model of circulation. No matter how we classify flaps, i.e., random or axial, the Harvesian model of circulation is the key to the mechanism of survival. Lately, however, a new category of flaps, that is, "venous flaps," have been reported by a number of investigators where the classical Harvesian model is not in evidence, at least apparently. The following effort is directed toward presenting the existing data on this subject for future guidance in research and clinical applications. PMID:8446733

  8. Surgery

    MedlinePLUS

    ... for ENews Home > Lung Disease > COPD > Treating COPD Surgery Some COPD patients with very severe symptoms may ... lung surgery. Are You a Candidate for Lung Surgery? Some people with COPD have improved lung function ...

  9. Secret scar free gracilis flap.

    PubMed

    Tremp, Mathias; Wettstein, Reto; Raffoul, Wassim; Schaefer, Dirk J; Kalbermatten, Daniel F

    2012-06-01

    The gracilis free flap is a workhorse in plastic surgery. We present a modified technique that relies on a single horizontal thigh-lift-type approach, which (1) gives wide pedicle exposure, (2) provides material for skin grafting, and (3) allows for distal flap transection without an additional incision. Eighteen gracilis free flaps were performed from 2007 to 2009 for lower extremity reconstruction. Complete flap survival was observed in 17 patients with one partial necrosis distally. Our approach allowed access to divide the distal gracilis tendon without a second incision in all cases. The mean scar length was 16 ± 3 cm and no hypertrophic scars were observed. In 15 patients, no visible scar was observed in the upright position, and in three patients, the scar was visible dorsally (2 ± 1 cm). No sensory deficits were observed 6 months postoperatively. In addition, the split-thickness skin graft harvested from the skin paddle was sufficient to cover all defects. PMID:22588799

  10. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction

    Microsoft Academic Search

    Ph. N. Blondeel; G. G. Vanderstraeten; S. J. Monstrey; K. Van Landuyt; P. Tonnard; R. Lysens; W. D. Boeckx; G. Matton

    1997-01-01

    This study was undertaken to demonstrate that the deep inferior epigastric perforator (DIEP) flap can provide the well-known advantages of autologous breast reconstruction with lower abdominal tissue while avoiding the abdominal wall complications of the transverse rectus abdominis myocutaneous (TRAM) flap.Eighteen unilateral free DIEP flap breast reconstruction patients were assessed 12–30 months (mean 17.8 months) after surgery. Clinical examination, physical

  11. Complications of surgery for radiotherapy skin damage

    SciTech Connect

    Rudolph, R.

    1982-08-01

    Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design.

  12. Development of a Mouse Model of Abdominal Cutaneous Flaps for Breast Reconstruction

    PubMed Central

    Womac, Daniel John; Palanisamy, Arun Prathap; Eslick, Rene; Schimpf, Dennis Kenneth; Chavin, Kenneth David

    2013-01-01

    Autologous tissue transfer, in addition to replacing tissue that was lost during injury or surgery, offers women an excellent option to improve cosmetic appearance and self-confidence following mastectomy due to breast cancer. However, flap necrosis is a complication in obese patients undergoing this procedure. We created a mouse model to study the flap-related complications that leads to decreased flap survival in autologous breast reconstruction. Methods Left superficial inferior epigastric (SIE) pedicle abdominal-cutaneous flaps were elevated in 8 week-old, obese ob/ob male mice and their lean littermates. Flaps were followed by serial photography. Area of flap necrosis was measured at 7 days. Statistical analysis was performed. Results Necrosis was observed at the distal margin of the flaps, in both lean and obese groups. Lean left SIE flaps (n?=?8) had a total area flap necrosis of 9.1% at 7 days whereas obese left SIE flaps (n?=?8) had a total area flap necrosis of 45.5% at 7 days. Obese flaps had a statistically significant increase in necrosis compared to the lean flaps, p?=?0.001. Conclusions There was a significant difference between flap survival in lean and obese SIE pedicle flaps in our mouse model. We have developed the first flap model of obesity utilizing the superficial epigastric pedicle in the mouse. This model is optimal for future studies to dissect out mechanisms that lead to the complications related to flap survival for breast reconstruction, especially in obese subjects. PMID:23308122

  13. Recurrent Carpal Tunnel Syndrome––Analysis of the Impact of Patient Personality in Altering Functional Outcome Following a Vascularised Hypothenar Fat Pad Flap Surgery

    Microsoft Academic Search

    K. Karthik; Rajesh Nanda; John Stothard

    We retrospectively analysed 25 patients (27 hands) who had both clinical and electrophysiological confirmation of true recurrent\\u000a carpal tunnel syndrome from January 2004 to December 2009. In all the patients, after releasing the nerve a vascularised fat\\u000a pad flap was mobilised from the hypothenar region and sutured to the lateral cut end of flexor retinaculum. The patient characteristics,\\u000a co-morbidities, duration

  14. [Huge tumor resection defects on the parotid region repaired by lateral thoracic flap: a case report].

    PubMed

    Haibin, Sun; Bo, Li; Chunjie, Li; Yi, Men; Hui, Xia; Longliang, Li

    2014-12-01

    Lateral thoracic flap is a free flap for the reconstruction of soft tissue defects and has been previously used in oral and maxillofacial surgeries. We reported a case involving a huge soft tissue defect on the parotid region caused by the resection of parotid epithelial myoepithelial carcinoma. We discussed the anatomy and application of the lateral thoracic flap. PMID:25665434

  15. Diep flap sentinel skin paddle positioning algorithm.

    PubMed

    Laporta, Rosaria; Longo, Benedetto; Sorotos, Michail; Pagnoni, Marco; Santanelli Di Pompeo, Fabio

    2015-02-01

    Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P?=?0.108), and time until take-back (P?=?0.521) and flap salvage rate (P?=?0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests. PMID:24771292

  16. Muscle Flaps and Their Role in Limb Salvage

    PubMed Central

    Klebuc, Michael; Menn, Zachary

    2013-01-01

    Muscle flaps have proved to be a valuable and versatile tool in the surgical treatment of the severely compromised lower extremity. Utilized as both local pedicle flaps and free tissue transfers, muscles have been successfully employed to cover complex wounds, manage osteomyelitis, salvage infected vascular grafts, treat recalcitrant venous stasis ulcers, preserve amputation levels, and restore motion following compartment syndrome. Free flap pedicles have also been used in a flow-through fashion to create a distal arterial bypass. This article explores the multipurpose role of muscle flaps in limb salvage surgery and their beneficial physiologic characteristics in hostile wound environments. PMID:23805342

  17. The evolving breast reconstruction: from latissimus dorsi musculocutaneous flap to a propeller thoracodorsal fasciocutaneous flap.

    PubMed

    Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur

    2014-08-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized for morbidity and complications. The TAP-flap does not seem to impair the function of the shoulder or arm and the morbidity appears to be scarce. However, an implant is often needed in combination with the TAP-flap, which results in implant related morbidity over time. The TAP-flap seems to be a promising tool for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods. PMID:25207206

  18. The evolving breast reconstruction: from latissimus dorsi musculocutaneous flap to a propeller thoracodorsal fasciocutaneous flap

    PubMed Central

    Gunnarsson, Gudjon Leifur

    2014-01-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized for morbidity and complications. The TAP-flap does not seem to impair the function of the shoulder or arm and the morbidity appears to be scarce. However, an implant is often needed in combination with the TAP-flap, which results in implant related morbidity over time. The TAP-flap seems to be a promising tool for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods. PMID:25207206

  19. Prospective Randomized Trial on Postoperative Administration of Diet Containing Eicosapentaenoic Acid, Docosahexaenoic Acid, Gamma-linolenic Acid, and Antioxidants in Head and Neck Cancer Surgery Patients with Free-flap Reconstruction

    PubMed Central

    Tsukahara, Kiyoaki; Motohashi, Ray; Sato, Hiroki; Endo, Minoru; Ueda, Yuri; Nakamura, Kazuhiro

    2014-01-01

    OBJECTIVES The purpose of this prospective, randomized study was to evaluate the effects of a diet containing eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), gamma-linolenic acid (GLA), and antioxidants in head and neck cancer surgery patients with free-flap reconstruction. METHODS In this randomized, prospective study, 62 patients with head and neck cancers were assigned to receive a general control diet (Ensure® H; Abbott Japan, Tokyo, Japan) or the study diet (Oxepa®; Abbott Japan) containing EPA, DHA, GLA, and antioxidants (eg vitamins A, E, and C). The primary assessment item was the degree of postoperative inflammation, as assessed by measuring maximum body temperature and levels of C-reactive protein (CRP) and procalcitonin from the day of surgery to postoperative day 8. Secondary assessment items were lengths of stays in the intensive care unit (ICU) and hospital. RESULTS The control diet group (n = 32) and study diet group (n = 30) showed no significant difference in energy administered through diet. No significant differences in the parameters of the primary assessment item were noted. Length of stay in the ICU was significantly shorter for the control diet group than for the study diet group (P = 0.011). No significant difference in duration of hospitalization was seen between groups. CONCLUSION No usefulness of a diet containing EPA, DHA, GLA, and antioxidants was demonstrated. PMID:25368541

  20. Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps

    PubMed Central

    Muto, Mayu; Ogawa, Marina; Shibuya, Mai; Yasumura, Kazunori; Kobayashi, Shinji; Ishikawa, Takashi; Maegawa, Jiro

    2015-01-01

    Background: For reconstructing moderate-to-high projection breasts in nulliparous patients with insufficient abdominal tissue or prior abdominal surgeries, a unilateral inferior gluteal artery perforator (IGAP) flap is an alternative procedure. In patients with slim hips, however, unilateral gluteal tissue is insufficient and inferior gluteal crease displacement may develop postoperatively. Donor-site asymmetry is also a major disadvantage. In these circumstances, bilateral IGAP flaps provide sufficient tissue without significant gluteal deformity. Methods: We retrospectively reviewed 20 patients who underwent unilateral breast reconstruction using bilateral IGAP flaps by a single surgeon between November 2007 and December 2012. A quantitative outcome assessment was performed and compared with that of 22 unilateral IGAP flap patients operated on by the same surgeon. Results: Twenty patients underwent reconstruction with 40 IGAP flaps. Of the 40 flaps, 39 survived and 1 developed total necrosis due to repeated venous thrombosis. In 15 of 20 patients, the size of reconstructed breast was comparable to that of the contralateral breast. Final inset flap weight was 462.3 g for bilateral flaps and 244.3 g for unilateral flaps. Total operating time was 671.1 minutes (bilateral flaps) and 486.8 minutes (unilateral flaps). Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative. PMID:25878925

  1. Propeller TAP flap: is it usable for breast reconstruction?

    PubMed

    Thomsen, Jørn Bo; Bille, Camilla; Wamberg, Peter; Jakobsen, Erik H; Arffmann, Susanne

    2013-10-01

    The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around the perforator to ensure a sufficient venous return. PMID:23710792

  2. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction.

    PubMed

    Ogawa, Rei; Akaishi, Satoshi; Huang, Chenyu; Dohi, Teruyuki; Aoki, Masayo; Omori, Yasutaka; Koike, Sachiko; Kobe, Kyoko; Akimoto, Masataka; Hyakusoku, Hiko

    2011-01-01

    We use evidence-based algorithms to treat abnormal scarring, including keloids and hypertrophic scars (HSs). This involves a multimodal approach that employs traditional methods such as surgical removal, postoperative radiotherapy, corticosteroid injection, laser, and silicone gel sheets. As a result, the rate of abnormal scarring recurrence has decreased dramatically over the past 10 years. However, several problems remain to be solved. First, despite the optimization of a radiotherapy protocol, over 10% of cases who are treated with surgery and postoperative radiotherapy still recur in our facility. Second, the treatment options for cases with huge keloids are very limited. To address these problems, we performed basic research on the mechanisms that drive the formation of keloids and HSs. Extrapolation of these research observations to the clinic has led to the development of two treatment strategies that have reduced the rate of abnormal scar recurrence further and provided a means to remove large scars. Our finite element analysis of the mechanical force distribution around keloids revealed high skin tension at the keloid edges and lower tension in the keloid center. Moreover, when a sophisticated servo-controlled device was used to stretch wounded murine dorsal skin, it was observed that the stretched samples exhibited upregulated epidermal proliferation and angiogenesis, which are also observed in keloids and HSs. Real-time RT-PCR also revealed that growth factors and neuropeptides are more strongly expressed in cyclically stretched skin than in statically stretched skin. These findings support the well-established notion that mechanical forces on the skin strongly influence the cellular behavior that leads to scarring. These observations led us to focus on the importance of reducing skin tension when keloids/HSs are surgically removed to prevent their recurrence. Clinical trials revealed that subcutaneous/fascial tensile reduction sutures, which apply minimal tension on the dermis, are more effective in reducing recurrence than the three-layered sutures used by plastic surgeons. Moreover, we have found that by using skin flaps (e.g., perforator flaps and propeller flaps), which release tension on the wound, in combination with postoperative radiotherapy, huge keloids can be successfully treated. PMID:21551963

  3. Systemic and flap inflammatory response associates with thrombosis in flap venous crisis.

    PubMed

    Du, Wei; Wu, Pan-Feng; Qing, Li-Ming; Wang, Cong-Yang; Liang, Jie-Yu; Yu, Fang; Tang, Ju-Yu

    2015-02-01

    Venous crisis represents the most common complication in flap surgery and often results in flap failure. The gold standard for free flap monitoring is frequent clinical examination. The current study examined the systemic inflammatory response during the immediate post-operative period following flap venous crisis. Superficial epigastric artery perforator flap transplantation was performed in a total of 30 rabbits. Fifteen animals received venous obstruction by vein ligation (venous crisis group, n?=?15) and others were sham treated (control group, n?=?15). Venous thrombosis was examined by immunohistochemistry staining. Plasma levels of inflammatory response markers (IL-6, IL-8, TNF-?, and C-reactive protein) and thrombosis biomarkers (von Willebrand factor and tissue factor) were measured at 0, 2, and 4 h post-operation by enzyme-linked immunosorbent assay. The mRNA levels of relevant biomarkers in the flap were analyzed with quantitative real-time PCR. Flap histopathological examination showed erythrocyte and neutrophil aggregations in venous lumen and erythrocyte diapedesis. At 8 h post-operation, serious edema and fibrinoid necrosis were observed and the venous lumen was almost blocked by thrombus. The venous crisis group had higher plasma levels of IL-8, TNF-?, and thrombosis biomarkers. Vein ligation also increased the mRNA levels of IL-8, TNF-?, C-reactive protein, von Willebrand factor, and tissue factor in the flap. No significant change in IL-6 levels was observed between the control group and the venous crisis group. Flap venous crisis was accompanied by the increase in a number of inflammatory and thrombosis markers, both in the peripheral blood and the flaps. PMID:25448261

  4. [Smile "forced" smile versus "spontaneous": comparison of 3 techniques of reconstructive surgery of the face. Myoplasty temporal muscle, hypoglossal facial anastomosis and gracilis muscle free flap].

    PubMed

    Lheureux-Portmann, A; Lapalus-Curtoud, Q; Robert, M; Tankéré, F; Disant, F; Pasche, P; Lamas, G; Gatignol, P

    2013-01-01

    The facial palsy cause serious consequences for patients. Studies have also shown that in these patients, the inability to produce an appropriate and spontaneous smile would be a key factor of depression. When facial palsy is considered complete and the nerve cannot be repaired, the patient can benefit from palliative surgery to regain a better quality of life in the aesthetic, functional, and psychological aspects. The hypoglossal-facial anastomosis (AHF), temporal myoplasty (MAT) and gracilis transposition (TG) are the major surgeries currently used for this purpose. The aim of our study is to assess quantitatively and qualitatively the effects of each of these surgeries on the lip mobility and production of smile. From this perspective, we proposed a protocol of an evaluation of facial motricity, of quality of life, and more particularly on the quality and the analysis of the smile. The results underline that there is no significant difference in the recovery of the facial motricity according to the surgery. Only the slower, deferred deadline of recovery at the patients AHF and TG who have to wait several months, it is for the same levels as that of the patients' MAT. A premature and intensive rehabilitation such as the patients of our protocol benefited from it what is nevertheless essential to a good recovery whatever is the surgery. PMID:25252585

  5. Complications of surgery for radiotherapy skin damage

    Microsoft Academic Search

    Ross Rudolph

    1982-01-01

    Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with

  6. Homodigital artery flap reconstruction for fingertip amputation: a comparative study of the oblique triangular neurovascular advancement flap and the reverse digital artery island flap.

    PubMed

    Usami, S; Kawahara, S; Yamaguchi, Y; Hirase, T

    2015-03-01

    This fingertip reconstruction study retrospectively compared sensory recovery and active range of motion outcomes in neurovascular island advancement and reverse digital artery island flaps. Seventeen oblique triangular flaps and 14 reverse digital artery island flaps were performed for nail bed level fingertip amputations (Ishikawa subzone II). There was no significant difference between the two procedures in the Semmes-Weinstein monofilament test and range of motion results. For static and moving two-point discrimination tests, however, those with a reverse digital artery island flap required a longer period for sensory recovery compared to those with an oblique triangular advancement flap. This trend equilibrated at 12 months after surgery showing no significant difference in both static and moving two-point discrimination tests between the procedures. PMID:24300507

  7. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

    PubMed Central

    Zhu, Lei; Xu, Qingjia; Kou, Wei; Ning, Bin; Jia, Tanghong

    2014-01-01

    Background: Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip. Materials and Methods: Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site. Results: Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm. Conclusion: Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve. PMID:25404772

  8. Treatment of Ischial Pressure Sores with Both Profunda Femoris Artery Perforator Flaps and Muscle Flaps

    PubMed Central

    Kim, Chae Min; Yun, In Sik; Lee, Dong Won; Lew, Dae Hyun; Rah, Dong Kyun

    2014-01-01

    Background Reconstruction of ischial pressure sore defects is challenging due to extensive bursas and high recurrence rates. In this study, we simultaneously applied a muscle flap that covered the exposed ischium and large bursa with sufficient muscular volume and a profunda femoris artery perforator fasciocutaneous flap for the management of ischial pressure sores. Methods We retrospectively analyzed data from 14 patients (16 ischial sores) whose ischial defects had been reconstructed using both a profunda femoris artery perforator flap and a muscle flap between January 2006 and February 2014. We compared patient characteristics, operative procedure, and clinical course. Results All flaps survived the entire follow-up period. Seven patients (50%) had a history of surgery at the site of the ischial pressure sore. The mean age of the patients included was 52.8 years (range, 18-85 years). The mean follow-up period was 27.9 months (range, 3-57 months). In two patients, a biceps femoris muscle flap was used, while a gracilis muscle flap was used in the remaining patients. In four cases (25%), wound dehiscence occurred, but healed without further complication after resuturing. Additionally, congestion occurred in one case (6%), but resolved with conservative treatment. Among 16 cases, there was only one (6%) recurrence at 34 months. Conclusions The combination of a profunda femoris artery perforator fasciocutaneous flap and muscle flap for the treatment of ischial pressure sores provided pliability, adequate bulkiness and few long-term complications. Therefore, this may be used as an alternative treatment method for ischial pressure sores. PMID:25075362

  9. Improved technique for evaluating oral free flaps by pinprick testing assisted by indocyanine green near-infrared fluorescence angiography.

    PubMed

    Nagata, Tetsuji; Masumoto, Kazuma; Uchiyama, Yoshiyuki; Watanabe, Yoshiko; Azuma, Ryuichi; Morimoto, Yuji; Katou, Fuminori

    2014-10-01

    In head and neck surgery, free-flap reconstruction using a microvascular anastomosis is an indispensable option after tumor ablation. Because the success of free-flap reconstruction is enhanced by rapid identification and salvage of failing flaps, postoperative monitoring of free flaps is essential. We describe a new technique using indocyanine green (ICG) near-infrared angiography and pinprick testing to monitor intraoral free flaps. A solution of ICG (Diagnogreen, 5 ml) was intravenously injected, and scanning was performed with a near-infrared video camera system. Thirty seconds after ICG injection, a pinprick test was performed by placing a 24-gage needle through the dermis to the subcutaneous fat of the flap. Pinprick testing during ICG fluorescence imaging was performed in 30 patients. Flap perfusion was confirmed in all patients, and all flaps survived postoperatively. ICG fluorescence imaging demonstrated that flap perfusion was maintained. PMID:24530073

  10. Multi-staged flap reconstruction for complex radiation thoracic ulcer

    PubMed Central

    Valença-Filipe, Rita; Horta, Ricardo; Costa, Joana; Carvalho, Jorge; Martins, Apolino; Silva, Álvaro

    2014-01-01

    INTRODUCTION Chest wall reconstruction due to previous radiation therapy can be challenging and complex, requiring a multidisciplinary approach. PRESENTATION OF CASE The authors present the case of a 84-year-old woman with a right chest wall radionecrosis ulcer, that was submitted to an ablative surgery resulting in a full-thickness defect of 224 cm2, firstly reconstructed with a pedicled omental flap. Due to partial flap necrosis, other debridements and chest wall multi-staged flap reconstruction were performed. DISCUSSION This case highlights that the reconstructive choice should be individualized and dependent on patient and local factors. The authors advise that surgical team should work closely and be well versed in chest wall reconstruction with a variety of pedicled flaps, when a complication occurs. CONCLUSION A multi-staged flap reconstruction could be a salvage procedure for the coverage of complex, great and complicated chest wall defects due to previous radiation therapy. PMID:25437678

  11. Reestablished circulation after free radial forearm flap transfer.

    PubMed

    Ichinose, Akihiro; Tahara, Shinya; Terashi, Hiroto; Yokoo, Satoshi

    2004-04-01

    New circulation in the free flap reestablished at the recipient site is the key to successful microvascular reconstructive surgery. This study is the first evaluation of long-term circulatory changes in nine free radial forearm flap transfers. Postoperatively, color Doppler studies revealed that the flow volume through the arterial pedicle increased rapidly during the first 3 days, gradually increased until day 14 (exceeding flow volume through the facial artery of the unoperated contralateral side), then decreased slightly until the sixth month. The pulsatility index, representing vascular resistance downstream, decreased successively. Ohm's law explains that this flow increase is caused by reduced vascular resistance downstream, attributed to changes in the vascularity of the transferred flap and in the recipient bed. The authors believe the circulatory changes are determinants of the clinical properties of the flap. This study addresses the importance of clarifying the events that transpire at the macroscopic circulatory level in the transferred free flap. PMID:15088205

  12. Laparoscopic assisted adenomyomectomy using double flap method

    PubMed Central

    Kim, Jang-Kew; Shin, Chang-Soo; Ko, Young-Bok; Nam, Sang-Yun; Yim, Hyun-Sun

    2014-01-01

    Objective The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method. Methods The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap. Results From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery. Conclusion Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients. PMID:24678486

  13. Mechanical endonasal dacryocystorhinostomy with mucosal flaps

    PubMed Central

    Tsirbas, A; Wormald, P J

    2003-01-01

    Aims: To describe and assess the efficacy of mechanical endonasal dacryocystorhinostomy (MENDCR). This is a new technique that involves creation of a large rhinostomy and mucosal flaps. The study involved a prospective non-randomised interventional case series with short perioperative follow up. Method: A prospective series of 104 consecutive endonasal DCRs performed from January 1999 to December 2001 were entered into the study. Patients included in the study had nasolacrimal duct obstruction and had not had previous lacrimal surgery. The technique involved anastomosis of nasal mucosal and lacrimal sac flaps and a large bony ostium. Surgery was performed by two surgeons (AT/PJW). Follow up assessment included nasoendoscopy as well as symptom evaluation. Success was defined as anatomical patency with fluorescein flow on nasoendoscopy and patency to lacrimal syringing. The average follow up time was 9.7 months (range 2–28, SD 6.7 months). Results: There were 104 DCRs performed on 86 patients (30 male, 56 female). The average age of the patients was 59 years (range 3–89, SD 24.1 years). Common presentations were epiphora (77%) and/or mucocele (19%). Septoplasty (SMR) was required in 48 DCRs (46%) and 13 DCRs (12.5%) needed other endoscopic surgery in conjunction with the lacrimal surgery. The surgery was successful in 93 cases (89%). Of the 11 cases that were classified as a failure six patients was anatomically patent but still symptomatic and another two had preoperative canalicular problems. The anatomical patency with this new technique was thus 95% (99 of 104 DCRs). Conclusion: MENDCR involves creation of a large ostium and mucosal preservation for the construction of flaps. The anatomical success is 95% and is similar to external DCR and better then other endonasal approaches. The authors suggest that creation of a large ostium as well as mucosal flaps improves the efficacy of this endonasal technique. PMID:12488261

  14. Fasciocutaneous flap in esophageal stricture with ventriculoperitoneal shunt.

    PubMed

    Seong, Yong Won; Kang, Chang Hyun; Chang, Hak; Park, In Kyu; Kim, Young Tae

    2014-01-01

    Abdominal surgery in a patient with ventriculoperitoneal shunt may increase the risk of shunt malfunction and infection. We present a successful case of resection and reconstruction of the cervical esophagus by rolled lateral thoracic artery fasciocutaneous flap in a patient with corrosive esophageal stricture and preexisting ventriculoperitoneal shunt. Follow-up esophagogastroscopy after 3 months revealed wide patent graft. Rolled fasciocutaneous flap may be a safe alternative treatment without risk of shunt-associated complications in a patient with ventriculoperitoneal shunt. PMID:24384193

  15. Hardware Removal after Osseous Free Flap Reconstruction

    PubMed Central

    Day, Kristine E.; Desmond, Renee; Magnuson, J. Scott; Carroll, William R.; Rosenthal, Eben L.

    2015-01-01

    Objective Identifying risk factors for hardware removal in patients undergoing mandibular reconstruction with vascularized osseous free flaps remains a challenge. The purpose of this study is to identify potential risk factors, including osteocutaneous radial forearm versus fibular flap, for need for removal and to describe the fate of implanted hardware. Study Design Case series with chart review. Setting Academic tertiary care medical center. Subjects and Methods Two hundred thirteen patients undergoing 227 vascularized osseous mandibular reconstructions between the years 2004 and 2012. Data were compiled through a manual chart review, and patients incurring hardware removals were identified. Results Thirty-four of 213 evaluable vascularized osseous free flaps (16%) underwent surgical removal of hardware. The average length of time to removal was 16.2 months (median 10 months), with the majority of removals occurring within the first year. Osteocutaneous radial forearm free flaps (OCRFFF) incurred a slightly higher percentage of hardware removals (9.9%) compared to fibula flaps (6.1%). Partial removal was performed in 8 of 34 cases, and approximately 38% of these required additional surgery for removal. Conclusion Hardware removal was associated with continued tobacco use after mandibular reconstruction (P = .03). Removal of the supporting hardware most commonly occurs from infection or exposure in the first year. In the majority of cases the bone is well healed and the problem resolves with removal. PMID:24201061

  16. Functional tongue reconstruction with the anterolateral thigh flap

    PubMed Central

    2013-01-01

    Background A retrospective study was conducted to evaluate the advantages of anterolateral thigh (ALT) flap in tongue reconstruction. Method From September 2008 to February 2012, patients receiving ALT flap tongue reconstruction were included in the study. Patients undergoing ALT flap were compared with those undergoing similar surgery with radial forearm flap (RFF). The medical records of the included patients were reviewed, and a questionnaire was used to assess acceptability of the surgery. Results All flaps (both ALT and RFF) were successful In the ALT group, most patients were satisfied with the appearance of the reconstructed tongue and the intelligibility of their speech, and there were fewer complications with this technique compared with the RFF. Conclusion The ALT flap is an ideal method for tongue reconstruction. The thickness and volume of the ALT flap can be adjusted based on the individual extent of the defect, and it can not only provide bulk but also ensure mobility, and it has other advantages also, including a long pedicle and low donor site morbidity. PMID:24274671

  17. Regional Medical Center (The MED) Plastic Surgery Rotation

    E-print Network

    Cui, Yan

    to perform the following plastic surgery procedures including but not limited to: · Skin grafting and flap · Operations incorporating the full spectrum of flaps and grafts including skin grafts, local flaps, fascial closure of soft tissue defects of the upper extremity · Specific grafting techniques including

  18. My First 100 Consecutive Microvascular Free Flaps: Pearls and Lessons Learned in First Year of Practice

    PubMed Central

    2013-01-01

    Background: Microvascular reconstruction for oncologic defects is a challenging and rewarding endeavor, and successful outcomes are dependent on a multitude of factors. This study represents lessons learned from a personal prospective experience with 100 consecutive free flaps. Methods: All patients’ medical records were reviewed for demographics, operative notes, and complications. Results: Overall 100 flaps were performed in 84 consecutive patients for reconstruction of breast, head and neck, trunk, and extremity defects. Nineteen patients underwent free flap breast reconstruction with 10 patients undergoing bilateral reconstruction and 2 patients receiving a bipedicle flap for reconstruction of a unilateral breast defect. Sixty-five free flaps were performed in 61 patients with 3 patients receiving 2 free flaps for reconstruction of extensive head and neck defects and 1 patient who required a second flap for partial flap loss. Trunk and extremity reconstruction was less common with 2 free flaps performed in each group. Overall, 19 patients (22.6%) developed complications and 14 required a return to the operating room. There were no flap losses in this cohort. Thorough preoperative evaluation and workup, meticulous surgical technique and intraoperative planning, and diligent postoperative monitoring and prompt intervention are critical for flap success. Conclusions: As a young plastic surgeon embarking in reconstructive plastic surgery at an academic institution, the challenges and dilemmas presented in the first year of practice have been daunting but also represent opportunities for learning and improvement. Skills and knowledge acquired from time, experience, and mentors are invaluable in optimizing outcomes in microvascular free flap reconstruction. PMID:25289221

  19. Exclusion of Musculature from the Submental Flap: A Contingency Plan for Facial Nerve Palsy

    PubMed Central

    2014-01-01

    Summary: Submental flap surgery is a useful and versatile reconstructive procedure. Currently, disagreement exists regarding the need to include the anterior belly of the digastric muscle or mylohyoid in the submental flap. The report outlines the value of excluding normal and variant anterior digastric and mylohyoid musculature from the submental flap as a contingency plan for marginal mandibular branch of facial nerve palsy. Also, the article addresses variant anterior digastric musculature, a common anatomical finding, as it relates to the submental flap. The question of whether or not to include the anterior digastric musculature does not necessitate an all-or-none decision. In the case of multiple anterior digastric bellies, some bellies may be included in the flap, whereas others are not. The location of the submental vessels and the desired bulk or contour of the flap should guide the decision of which anterior digastric bellies, if any, are included in the flap. PMID:25587500

  20. Flow Over Swept Flaps and Flap Tips

    NASA Technical Reports Server (NTRS)

    Bradshaw, Peter; Buice, Carl U.

    1995-01-01

    Preliminary measurements have been made of the flow over the tip of an unswept wing flap. To achieve an acceptable Reynolds number based on flap chord, the flap chord was chosen equal to the chord of the main airfoil (c = 19 in. approx. 0.48 m). The model was mounted in a 30 in. x 30 in. wind tunnel running at up to 100 ft/sec. (30 m/s): severe wind-tunnel interference was accepted, and any computations would be done using the tunnel walls as the boundaries of the computational domain. Maximum Reynolds number based on flap chord and tunnel speed was about 1.O x lO(exp 6). The grant ended before a full set of measurements could be made, but the work done so far yields a useful picture of the flow. The vortex originates at about mid-chord on the flap and rises rapidly above the chord line. It has a concentrated core, with total pressure lower than the ambient static pressure, and there is no evidence of large-scale wandering. A simple method of model construction, giving light weight and excellent surface finish, was developed.

  1. Free transverse rectus abdominis myocutaneous flap reconstruction of a massive lumbosacral defect using superior gluteal artery perforator vessels.

    PubMed

    Gaster, Richard S; Bhatt, Kirit A; Shelton, Andrew A; Lee, Gordon K

    2012-07-01

    Despite significant advances in reconstructive surgery, the repair of massive lumbosacral defects poses significant challenges. When the extent of soft tissue loss, tumor resection, and/or radiation therapy preclude the use of traditional local options, such as gluteal advancement flaps or pedicled thigh flaps, then distant flaps are required. We report a case of a 64-year-old male who presented with a large sacral Marjolin's ulcer secondary to recurrent pilonidal cysts and ulcerations. The patient underwent wide local composite resection, which resulted in a wound measuring 450 cm(2) with exposed rectum and sacrum. The massive defect was successfully covered with a free transverse rectus abdominis myocutaneous flap, providing a well-vascularized skin paddle and obviating the need for a latissimus flap with skin graft. The free-TRAM flap proved to be a very robust flap in this situation and would be one of our flaps of choice for similar defects. PMID:22473859

  2. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction!

    PubMed Central

    Panse, Nikhil; Sahasrabudhe, Parag

    2014-01-01

    Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV. PMID:24987209

  3. The need for a complete platysma component for platysma myocutaneous flaps?--an introduction of the expanded cutaneous-dominant platysma flap for facial defect reconstruction.

    PubMed

    Chen, Wen; Li, Yangqun; Wang, Naili

    2010-12-01

    Platysma flaps have been successfully used for the reconstruction of variety of facial defects as musculocutaneous. This concept had been changed by a recent anatomical investigation revealing the inherently fasciocutanous nature of the platysma flap. In the study, it was observed that all of the arterial branches furnishing the anterlateral neck skin penetrate the platysma but do not run along in the platysma layer. The switch made it possible for us to design cervical skin flaps with limited participation of muscular platysma composition in clinical practice. The platysma flap is considered to be an ideal donor source due to its thin, pliable and sufficient colour matched skin nature. When combined with the tissue expansion technique, this flap can provide adequate donor tissue that is particularly valuable for large facial defect repairs without leaving any modalities on the neck donor site. In our report, we designed and used the expanded platysma myocutaneous flap as a cutaneous-dominant skin flap for large facial defect repairs. In operation, the cervical flap is elevated at the intermediate layer between the platysma and the superficial adipofascia. A small amount platysma muscular tissue is recruited only in the area surrounding these facial artery perforators at the flap peddle region. As anticipated, the result was successful. We conclude that the expanded cutaneous-dominant platysma flap peddled by facial artery perforators provides a useful alternative for the reconstruction of facial defects and should be a valuable addition to facial reconstructive surgery. PMID:20403736

  4. Flap Donor Site Size Reduction with Substratum Horizontal Mattress Suture

    PubMed Central

    Jalilimanesh, Mohammad

    2013-01-01

    BACKGROUND Closure of donor site of the flap has special problems. Reduction of this site will decrease the morbidity of operation. In this study, we present our experience in donor site size reduction. METHODS Between 2006 and 2008, 15 patients with skin and soft tissue defects underwent operation. In all patients, coverage of defect was performed with various flaps. Substratum horizontal mattress suture was used to reduce donor site dimensions. In all 15 patients, size of the flaps, the defect after the flap elevation and the scar size were measured. RESULTS The mean size of the flap, the defect after flap elevation, and the scar after 3 months were 43.9 cm2, 69.4 cm2, and 32.2 cm2, respectively. There was 46.5% reduction in the donor site after using this suture. CONCLUSION The substratum horizontal mattress suture was shown to de- crease the donor site dimensions and also its scar size in flap surgery. This suture is highly recommend in order to reduce donor site dimensions. PMID:25489499

  5. The revascularization of pedicle skin flaps in pigs: a functional and morphologic study

    SciTech Connect

    Young, C.M.

    1982-10-01

    Functional and morphologic changes occurring during the revascularization of pedicle flaps have been investigated in the skin of pigs. The skin flaps, 16 cm long by 4 cm wide, were based on a row of segmental vessels arising from the internal mammary artery. Comparative measurements were made in flapped and normal skin. The inherent blood supply in the pedicle of the flap was unable to maintain the whole of the flap in a viable state. Flap viability was ascertained at surgery by the use of the intravital dye Disulphine blue. Injections of the dye after surgery gave a less accurate prediction of viability than when dye was injected prior to surgery. Revascularization between the flap and surrounding skin was evident 3 to 4 days postoperatively at the distal, most hypoxic part of the viable flap. The whole flap had a collateral vascular supply 7 to 10 days after surgery. Isotope clearance studies showed that the greatest functional changes occurred in the distal third of the viable flap, where, after initially slowing, the clearance rate became faster than in normal skin (day 5). Potassium extraction studies indicated similar changes. However, an increase in the red-cell volume on day 1 suggested that vascular shunting was occurring. The results of the morphologic studies indicated a correlation between the number of blood vessels per unit area, the thickness of the dermis, and the recorded functional changes. Seven days after surgery, when isotope clearance rates were very rapid, there was a significant increase in the vascular density and dermal thickness.

  6. Oral reconstruction with submental flap

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2013-01-01

    Background: Submental flap is a useful technique for reconstruction of medium to large oral cavity defects. Hair bearing nature of this flap in men makes it less appropriate. Therefore, deepithelialized variant is introduced to overcome the problem of hair with this flap. Recently, application of this flap has been introduced in maxillofacial trauma patients. Materials and Methods: Deepithelialized orthograde submental flap is used for the reconstruction of oral cavity mucosal defects. Results: Four cases including two trauma patients and two squamous cell carcinomas (SCCs) of oral cavity were treated using deepithelialized orthograde submental flap. There were no complications in all four patients and secondary epithelialization occurred in raw surface of the flap which was exposed to oral cavity. Conclusion: Deepithelialized orthograde submental flap is very effective in reconstruction of oral cavity in men. The problem of hair is readily solved using this technique without jeopardizing flap blood supply. PMID:24205473

  7. Blowing Flap Experiment: PIV Measurements

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.; Bremmer, David M.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the flap vortex system. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  8. The median forehead flap reviewed: a histologic study on vascular anatomy.

    PubMed

    Skaria, A M

    2015-05-01

    Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose. PMID:24756613

  9. Defect reconstruction over the olecranon with the distally extended lateral arm flap.

    PubMed

    Wettstein, R; Helmy, N; Kalbermatten, D F

    2014-08-01

    Defect reconstruction over the olecranon should be reliable, quick, relatively simple and with minimal complications. More recently, perforator flaps have been described with the benefit of minimal donor site morbidity when compared with muscle flaps or flaps relying on the major arteries of the upper extremity. So far, most of these flaps were harvested on the upper arm and rotated 180° into the defect. The aim of the present study was to analyse the results with the proximally based, distally extended lateral arm flap for soft-tissue reconstruction over the olecranon. The subcutaneous tissue layer in this area is thinner than in the upper arm, and less rotation of the pedicle is necessary. The location of the perforator just proximal to the lateral epicondyle and the precise territory of the flap are well known. Nine consecutive male patients with a mean age of 57±27 years presenting with soft-tissue defects after surgical treatment of bursitis (eight cases) or a pressure sore (one case) were operated on. The mean operation time was 60±15 min. In eight of the nine cases, the flap healed uneventfully or with a minor complication (fistula). One patient underwent revision surgery due to marginal flap necrosis. The defect was closed with a local advancement flap. In conclusion, the flap was reliable, relatively simple and quick to harvest, and yielded acceptable aesthetic results with minimal bulging over the olecranon. Postoperative recovery was relatively painless and short. PMID:24927859

  10. Tug 'O' war: challenges of transverse upper gracilis (TUG) myocutaneous free flap breast reconstruction.

    PubMed

    Locke, Michelle B; Zhong, Toni; Mureau, Marc A M; Hofer, Stefan O P

    2012-08-01

    Autologous tissue microsurgical breast reconstruction is increasingly requested by women following mastectomy. While the abdomen is the most frequently used donor site, not all women have enough abdominal tissue excess for a unilateral or bilateral breast reconstruction. A secondary choice in such women may be the transverse upper gracilis (TUG) myocutaneous flap. This study reviews our experience with TUG flap breast reconstruction looking specifically at reconstructive success rate and the requirement for secondary surgery. A total of 16 free TUG flaps were performed to reconstruct 15 breasts in eight patients over a period of five years. Data were collected retrospectively by chart review. Follow up ranged from 14 to 41 months. During the follow up period, there was one (6.3%) complete flap loss in an immediate breast reconstruction patient. Four further flaps (25%) failed in their primary aim of breast reconstruction, as they required additional significant reconstruction with either deep inferior epigastric perforator (DIEP) flaps (two flaps (12.5%), one patient) or augmentation with silicone breast implants (two flaps (12.5%), one patient), giving a successful breast reconstruction rate with the TUG flap of only 66.7%. In all of the remaining reconstructed breasts, deficient flap volume or breast contour was seen. Eight flaps were augmented by lipofilling. A total of 62.5% of the donor sites had complications, namely sensory disturbance of the medial thigh (25%) and poor scar (37.5%) requiring revision. This series demonstrates a high rate of reconstructive failure and unsatisfactory outcomes from TUG flap breast reconstruction. We feel this reinforces the necessity of adequate pre-operative patient assessment and counselling, including discussion regarding the likelihood of subsequent revisional surgery, before embarking on this form of autologous breast reconstruction. PMID:22410285

  11. Externally blown flap impingement noise

    NASA Technical Reports Server (NTRS)

    Lasagna, P. L.; Putnam, T. W.

    1972-01-01

    Tests of the noise produced by the impingement of the jet exhaust on the wing and flap for an externally blown flap system were conducted with a CF700 turbofan engine and an F-111B wing panel. The noise produced with a daisy nozzle installed on the engine was greater than that produced by a conical nozzle at the same thrust. The presence of the wing next to the test nozzles increased the noise, as did increasing the flap deflection angle. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested. Tests showed that the single-slotted flap deflected 60 deg, produced less noise than the double-slotted flaps. Also, maintaining the maximum distance between the exit nozzle and flap system resulted in a minor reduction in noise.

  12. Soft Palate Reconstruction Using Bilateral Palatal Mucomuscular Flap and Pharyngeal Flap after Resection of Squamous Cell Carcinoma

    PubMed Central

    Jo, Hyeon Jong; Kim, Nam Gyun; Lee, Kyung Suk

    2012-01-01

    Squamous cell carcinoma infrequently occurs at the soft palate. Although various methods can be used for reconstruction of soft palate defects that occur after resecting squamous cell carcinoma, it is difficult to obtain satisfactory results from the perspective of the functional restoration of the soft palate. A combination of bilateral palatal mucomuscular flap for the oral side and superiorly based posterior pharyngeal flap for the nasal side were performed on two patients who were diagnosed with squamous cell carcinoma of the soft palate in order to reconstruct the soft palate defects after surgical resection. After surgery, the patients were followed-up for a mean period of 11 months. The flaps were well maintained in both patients. The donor site defects were epithelialized and completely recovered. Additionally, no recurrence of the primary sites was shown. Slight hyponasality was observed in the voice assessments that were conducted 6 months after surgery. No food regurgitation or aspiration was observed in the swallowing tests. We used a combination of bilateral palatal mucomuscular flap and superiorly based posterior pharyngeal flap to reconstruct the soft palate defects that occurred after resecting the squamous cell carcinomas. We reduced the donor site complications and achieved functionally satisfactory outcomes. PMID:23233893

  13. Intraoral Reconstruction Using Local and Regional Flaps

    PubMed Central

    Squaquara, Roberto; Kim Evans, Karen F.; Spanio di Spilimbergo, Stefano; Mardini, Samir

    2010-01-01

    Choosing a pedicled flap to reconstruct an intraoral defect depends on the size and the anatomic position of the tissue defect. The goals are to restore form and function and minimize donor site morbidity. Regional pedicled flaps available for intraoral reconstruction are the buccal fat pad flap, facial artery musculomucosal flap, platysma, pectoralis major, temporalis muscle flap, and trapezius flaps. We give a concise illustration of anatomy, our harvesting technique, indications, and eventual pitfalls for each of the six flaps. PMID:22550440

  14. Externally blown flap impingement noise.

    NASA Technical Reports Server (NTRS)

    Putnam, T. W.; Lasagna, P. L.

    1972-01-01

    An investigation of externally blown flap impingement noise was conducted using a full-scale turbofan engine and aircraft wing. The noise produced with a daisy nozzle installed on the engine exhaust system was greater than that produced by a conical nozzle at the same thrust. The daisy nozzle caused the jet velocity to decay about 35 percent at the flap. The presence of the wing next to the conical nozzle increased the noise, as did increasing the flap deflection. Compared with the conical nozzle, the daisy nozzle produced slightly less noise at a flap deflection of 60 deg but produced more noise at the lower flap deflections tested.

  15. Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence

    PubMed Central

    Ozsutcu, Mustafa; Ayintap, Emre; Akkan, Julide C U; Koytak, Arif; Aras, Cengiz

    2014-01-01

    Aims: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. Materials and Methods: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. Results: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P =0.1806). The recurrence rates were similar in Group B and C (P > 0.05). Conclusions: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study. PMID:24178405

  16. Noise Reduction of Aircraft Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V. (Inventor); Brooks, Thomas F. (Inventor)

    2009-01-01

    A reduction in noise radiating from a side of a deployed aircraft flap is achieved by locating a slot adjacent the side of the flap, and then forcing air out through the slot with a suitable mechanism. One, two or even three or more slots are possible, where the slot is located at one;or more locations selected from a group of locations comprising a top surface of the flap, a bottom surface of the flap, an intersection of the top and side surface of the flap, an intersection of the bottom and side surfaces of the flap, and a side surface of the flap. In at least one embodiment the slot is substantially rectangular. A device for adjusting a rate of the air forced out through the slot can also be provided.

  17. Use of “House” Advancement Flap in Anorectal Diseases

    Microsoft Academic Search

    Olcay Alver; Yeliz Emine Ersoy; Ismail Aydemir; Sabri Erguney; Serkan Teksoz; Berat Apaydin; Metin Ertem

    2008-01-01

    Background  A retrospective review of 28 patients who had “house flap” anoplasty was carried out to evaluate the therapeutic effectiveness\\u000a of the procedure.\\u000a \\u000a \\u000a \\u000a Methods  House flap anoplasty was performed at Istanbul University Cerrahpasa Medical School, General Surgery Department, in 28 patients\\u000a over 4 years. Indications were chronic anal fissure, anal stenosis, high transsphincteric fistula, low rectovaginal fistula,\\u000a anal neoplasia, and obstetric third-degree perineal

  18. Multipaddled Anterolateral Thigh Chimeric Flap for Reconstruction of Complex Defects in Head and Neck

    PubMed Central

    Li, Ning; Liu, Wen; Su, Tong; Chen, Xinqun; Zheng, Lian; Jian, Xinchun

    2014-01-01

    The anterolateral thigh flap has been the workhouse flap for coverage of soft-tissue defects in head and neck for decades. However, the reconstruction of multiple and complex soft-tissue defects in head and neck with multipaddled anterolateral thigh chimeric flaps is still a challenge for reconstructive surgeries. Here, a clinical series of 12 cases is reported in which multipaddled anterolateral thigh chimeric flaps were used for complex soft-tissue defects with several separately anatomic locations in head and neck. Of the 12 cases, 7 patients presented with trismus were diagnosed as advanced buccal cancer with oral submucous fibrosis, 2 tongue cancer cases were found accompanied with multiple oral mucosa lesions or buccal cancer, and 3 were hypopharyngeal cancer with anterior neck skin invaded. All soft-tissue defects were reconstructed by multipaddled anterolateral thigh chimeric flaps, including 9 tripaddled anterolateral thigh flaps and 3 bipaddled flaps. The mean length of skin paddle was 19.2 (range: 14–23) cm and the mean width was 4.9 (range: 2.5–7) cm. All flaps survived and all donor sites were closed primarily. After a mean follow-up time of 9.1 months, there were no problems with the donor or recipient sites. This study supports that the multipaddled anterolateral thigh chimeric flap is a reliable and good alternative for complex and multiple soft-tissue defects of the head and neck. PMID:25180680

  19. Use of the thoracodorsal artery perforator flap for bronchial reinforcement in patients with previous posterolateral thoracotomy.

    PubMed

    Berna, Pascal; Sinna, Raphael; De Dominicis, Florence

    2012-05-01

    The thoracodorsal artery perforator flap (TDAP flap) allows raising the same cutaneous island as in the classical latissimus dorsi musculocutaneous flap without its muscular part. All patients who underwent a completion pneumonectomy with reinforcement of bronchial stump with a TDAP flap from December 2009 to October 2010 were followed prospectively. The 30-day mortality and the procedure-related morbidity as well as bronchial fistula and TDAP flap were analyzed. The TDAP flap was used in 6 cases without failure or fistula formation. At 1 month, all patients were alive, and there was no morbidity (seroma, hematoma, fistula, or shoulder dysfunction). Computed tomography scans were performed at 1 month and 3 months postoperatively and showed viable nonatrophic flap. This type of flap has been described in the field of plastic surgery, and this is the first description of its use in the chest. Deepithelialized fasciocutaneous TDAP flap is safe and reliable. It is available even if the latissimus dorsi has been previously divided. It is now our first-line option to reinforce the bronchial stump. PMID:22541220

  20. Long-Term Outcomes of Simultaneous Skin and Bowel Flaps for Esophageal Reconstruction.

    PubMed

    Imaizumi, Atsushi; Liem, Anita A; Yang, Chun-Fan; Chen, Wency; Chen, Shih-Heng; Chen, Hung-Chi

    2014-07-01

    Esophageal reconstruction can be performed with skin or bowel flaps. The choice of flap remains controversial, as the long-term outcomes of skin flaps cannot always be assessed in patients with limited life expectancies due to advanced malignancy, unlike the pediatric and benign cases which have had esophageal reconstruction using bowel flaps. We report the long-term clinical and histopathological outcomes in a series of 45 cases repaired with combined skin and bowel flaps.Four patients developed symptomatic strictures after corrosive esophageal injuries were repaired with a combination of a tubed free radial forearm fasciocutaneous flap and a pedicled bowel flap. On average, 24 years had passed since uneventful initial esophageal reconstructions. Barium esophagograms were obtained in all cases and pathological examination was performed upon all surgical specimens.The cutaneous portions of the reconstructed esophagus exhibited a variety of findings on barium examination. Each of the 4 cases developed an esophagocutaneous fistula after revision; an average of 4 surgeries was required to close these fistulae. The inner surfaces of the portion of esophagus repaired with skin flaps showed extensive ulceration, polypoid lesions, and fibrosis. Pathology specimens from skin flaps showed extensive acute and chronic inflammation, microabscesses, fibrosis, and acanthosis, with depletion and degeneration of the pilosebaceous units. By contrast, adjacent parts of the esophagus repaired with bowel were widely patent with normal appearing mucosa.Our findings indicate that a bowel flap is durable with good tolerance to gastrointestinal content over long periods, whereas skin flaps often developed morphological changes and could not maintain long-term esophageal function without eventual stricture and dysphagia. We therefore recommend use of bowel flaps for esophageal reconstruction in patients with long life expectancy. PMID:25003411

  1. Venous free flaps for the treatment of skin cancers of the digits.

    PubMed

    Park, Ji Ung; Kim, Kiwan; Kwon, Sung Tack

    2015-05-01

    Microvascular reconstruction using distant free flaps is often required after excision of skin cancers of the digits. The delivered flaps should be chosen with many factors taken into consideration, especially in the digits, in which a very thin, pliable, and durable flap is required to maintain both function and cosmetic appearance. Free flaps, such as perforator flaps, however, for distal or small defects of the hand after excision of skin cancer, require the sacrifices of the main arterial pedicle with deep dissection and exhibit potential limitations regarding flap size and location of the defect. Instead, arterialized venous free flap could be used as an alternative reconstructive method for skin cancers of the digits. Twelve soft tissue defects of the digits after excision of skin cancers (5 cases of malignant melanoma and 7 cases of squamous cell carcinoma) were reconstructed using arterialized venous free flaps from January 2009 to May 2011. The flaps ranged in size from 1 × 1.5 cm to 5 × 7 cm. The flaps completely survived in 9 cases. Partial necrosis developed in 3 cases; however, skin graft was necessary only for 1 case. There were no recurrences or metastases for at least 20 months after the last case. Recently in cases of noninvasive or low-grade skin cancer of the hand, the concept of "preservative surgery" has been a higher priority compared with functional and esthetic aspects. Particularly in cases of reconstruction of a small-sized fingertip defect as 1 functional unit, arterialized venous free flaps offer several advantages, such as thinness and color similar to the hand, technical ease with a short operative time, long vascular pedicle, less donor site morbidity with no sacrifice of a major vessel, applicable to any site, and modifiable to the appropriate size and shape. Arterialized venous free flap could serve as a useful and reliable method for soft tissue reconstruction after excision of skin cancers in the digits. PMID:25003463

  2. Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

    PubMed Central

    Hou, Ruixing; Ju, Jihui; Zhao, Qiang; Liu, Yuefei

    2012-01-01

    The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n ?=? 765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4–36 months). The wider pedicled fascial flap (1.0–1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds. PMID:23294073

  3. Versatile use of the muscle and nerve sparing latissimus dorsi flap.

    PubMed

    Tan, Onder; Algan, Said; Denktas Kuduban, Selma; Cinal, Hakan; Zafer Barin, Ensar; Ulvi, Hizir

    2012-02-01

    In this report, we describe the technique of muscle and nerve sparing latissimus dorsi (LD) flap and evaluate the outcomes of reconstruction of various defects with 12 free and 2 pedicled muscle and nerve sparing LD flaps in 14 patients. The LD muscle functions at operated and nonoperated muscles were evaluated clinically and with electroneuromyography. All flaps survived completely but one which had a partial necrosis. The mean follow-up time was 12.3 months. Adduction and extention ranges of the shoulders were the same bilaterally in all patients. In electroneuromyography, no significant difference was available statistically between the sides. This muscle and nerve sparing latissimus dorsi flap has advantages of thinness, muscle preservation and reliability, and thus can be a good option to other fasciocutaneous flaps in reconstruction surgery. PMID:22113922

  4. DIEP Flap Breast Reconstruction Using 3-dimensional Surface Imaging and a Printed Mold

    PubMed Central

    Yano, Kenji; Hata, Yuki; Nishibayashi, Akimitsu; Hosokawa, Ko

    2015-01-01

    Summary: Recent advances in 3-dimensional (3D) surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP) flaps (5 immediate, 6 delayed) using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast.

  5. Supermicrosurgical free sensate intercostal artery perforator flap based on the lateral cutaneous branch for plantar reconstruction.

    PubMed

    Iida, Takuya; Narushima, Mitsunaga; Hara, Hisako; Yamamoto, Takumi; Yoshimatsu, Hidehiko; Morizaki, Yutaka; Uehara, Kosuke; Koshima, Isao

    2014-07-01

    The use of an intercostal artery perforator (ICAP) flap has recently become popular in reconstructive surgery. We have developed a novel free sensate ICAP flap based on the lateral cutaneous branch (LCB) and applied it to a case with a plantar defect. To the best of our knowledge, this case is the first to describe a free sensate ICAP flap based on the LCB. This method has several advantages: (1) a sensate flap is possible because the LCB neurovascular bundle is consistently available; (2) the long neurovascular pedicle can be harvested in the supine position without the risk of pneumothorax; (3) the donor-site morbidity is low; and (4) conversion or combination with a superficial circumflex iliac artery perforator (SCIP) or a superficial inferior epigastric artery (SIEA) flap is readily possible. We believe that this method represents a new option for soft-tissue reconstruction. PMID:24491457

  6. Shape-based 3D vascular tree extraction for perforator flaps

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

    Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned perforated flaps, greater survivability and decrease in donor site morbidity have been reported. Knowledge of the 3D vascular tree will provide insight information about the dissection region, vascular territory, and fascia levels. This paper presents a scheme of shape-based 3D vascular tree reconstruction of perforator flaps for plastic surgery planning, which overcomes the deficiencies of current existing shape-based interpolation methods by applying rotation and 3D repairing. The scheme has the ability to restore the broken parts of the perforator vascular tree by using a probability-based adaptive connection point search (PACPS) algorithm with minimum human intervention. The experimental results evaluated by both synthetic and 39 harvested cadaver perforator flaps show the promise and potential of proposed scheme for plastic surgery planning.

  7. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Wing flaps. 25.457 Section 25...AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating...

  8. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Wing flaps. 25.457 Section 25...AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating...

  9. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Wing flaps. 25.457 Section 25...AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating...

  10. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Wing flaps. 25.457 Section 25...AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating...

  11. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Wing flaps. 25.457 Section 25...AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps. Wing flaps, their operating...

  12. Superficial ulnar artery perforator flap.

    PubMed

    Schonauer, Fabrizio; Marlino, Sergio; Turrà, Francesco; Graziano, Pasquale; Dell'Aversana Orabona, Giovanni

    2014-09-01

    Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region. We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected. Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions. PMID:25102397

  13. Externally blown flap noise research

    NASA Technical Reports Server (NTRS)

    Dorsch, R. G.

    1974-01-01

    The Lewis Research Center cold-flow model externally blown flap (EBF) noise research test program is summarized. Both engine under-the-wing and over-the-wing EBF wing section configurations were studied. Ten large scale and nineteen small scale EBF models were tested. A limited number of forward airspeed effect and flap noise suppression tests were also run. The key results and conclusions drawn from the flap noise tests are summarized and discussed.

  14. Considerations on 100 cases of free microsurgical flaps in the reconstruction of the soft tissues of the lower limb.

    PubMed

    Fasano, D; Montanari, F M; Zarabini, A G; Merelli, S; Mingozzi, M

    2002-01-01

    The authors evaluate the results for 100 cases of severe loss of substance of the lower limb treated by microvascular free flaps at the Division of Plastic Surgery, Bellaria Hospital in Bologna, between 1994 and 2001. The cases involved recent traumatic loss of substance in 48 cases, post-traumatic defects such as osteomyelitis, ulcers, unstable scarring, sequelae of burns in 40, and neoplasms in 12. Muscular flaps were used in 89 cases, skin flaps in 9, a flap of the omentum in 1; the latissumus dorsi flap was that most frequently used (50 cases). A total of 87 cases had favorable results, while in 13 cases there was failure of the flap. Based on the results obtained, and experience, current indications and causes of failure are discussed. PMID:12508706

  15. VAC Therapy in Large Infected Sacral Pressure Ulcer Grade IV-Can Be an Alternative to Flap Reconstruction?

    PubMed

    Batra, R K; Aseeja, Veena

    2014-04-01

    Vacuum-assisted closure (VAC) therapy is a new entrant in wound care after growth factors and alginate or hydrocolloid dressing, in the treatment of pressure ulcers. We have been using this technique for diabetic foot ulcers. A young nondiabetic man presented with a large sacral bed sore after high doses of ionotropes in an intensive care unit for treating severe hypotension. His wound was debrided, and instead of flap surgery in such infected wound, he was treated with VAC therapy. The complete wound healing was achieved in 6 weeks and at half the cost of flap surgery. Moreover, the chances of flap failure and its related complications were eliminated. PMID:24891788

  16. Perforator-based propeller flaps treating loss of substance in the lower limb

    Microsoft Academic Search

    Pierluigi Tos; Marco Innocenti; Stefano Artiaco; Andrea Antonini; Luca Delcroix; Stefano Geuna; Bruno Battiston

    2011-01-01

    Background  Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. These flaps allow efficient\\u000a coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular\\u000a anastomosis and allows reconstruction of soft tissue defects using nearby similar tissues. The aim of this study was to evaluate\\u000a the

  17. Extended vertical lower trapezius island myocutaneous flap for reconstruction of cranio-maxillofacial defects

    Microsoft Academic Search

    W.-l. Chen; Y.-f. Deng; G.-g. Peng; J.-s. Li; Z.-h. Yang; Z.-b. Bai; Z.-q. Huang; J.-g. Wang; B. Zhang

    2007-01-01

    This study explored an effective method for repairing cranio-maxillofacial soft-tissue defects following radical craniofacial surgery in four patients with malignant tumours involving the skull base and frontal region. The large cranio-maxillofacial soft-tissue defects were reconstructed using an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery. The flap was 8–12cm long and 5–7cm wide. No major

  18. Acute compartment syndrome following fibula flap harvest for mandibular reconstruction

    Microsoft Academic Search

    Siham Kerrary; Thomas Schouman; Amanda Cox; Chloe Bertolus; Guillaume Febrer; Jacques Charles Bertrand

    2011-01-01

    Donor site morbidity for free fibula osteofasciocutaneous flaps has rarely been reported in the literature. We report on a case of acute compartment syndrome (ACS) in a 22-year-old male, following fibula flap harvest for mandibular reconstruction and arising after post-ischemic reperfusion damage. Dissection during this patient’s surgery was unusually difficult. The skin defect was covered with a loose dressing while

  19. Robotic Assisted Implantation of Ventricular Assist Device after Sternectomy & Pectoralis Muscle Flap

    PubMed Central

    Khalpey, Zain; Sydow, Nicole; Paidy, Samata; Slepian, Marvin J.; Friedman, Mark; Cooper, Anthony; Marsh, Katherine M.; Schmitto, Jan D; Poston, Robert

    2014-01-01

    Left ventricular assist devices are increasingly important in the management of advanced heart failure. Most patients who benefit from these devices have had some prior cardiac surgery, making implantation of higher risk. This is especially true in patients who have had prior pectoralis flap reconstruction after sternectomy for mediastinitis. We outline the course of such a patient, in whom the use of robotic assistance allowed for a less invasive device implantation approach with preservation of the flap for transplantation. PMID:25072555

  20. [Submental island flap: A review of the literature].

    PubMed

    Bertrand, B; Foletti, J-M; Noël, W; Duron, J-B; Bardot, J

    2015-02-01

    The sub mental island flap is a precious tool in reconstructive surgery. It was described by Martin in 1993, inspired by platysma flaps. In our days, we can find many reliable techniques for this procedure. We reviewed the main studies of the literature that described a total of 528 patients. The rate of partial necrosis was 5.1%, complete necrosis 1.7%, and reversible lesions of the marginal mandibular branch of the facial nerve 1.1%. His versatility makes this flap appropriate for the reconstruction of every part of the face: cheeks, nose, forehead, moustache, beard, and hairs. It can also be used de-epidermised with very good results, for the reconstruction of the buccal cavity, the tongue, the roof of the mouth, the larynx, and the proximal part of the esophagus. The SMAP (Submentalis Artery Perforator flap) is an alternative flap that provides even better cosmetic results. The development of indocyanine green and infrared cameras will allow in a close future to decrease the postoperative complications. PMID:25213485

  1. Reconstruction of Nasal Skin Cancer Defects with Local Flaps

    PubMed Central

    Salgarelli, A. C.; Bellini, P.; Multinu, A.; Magnoni, C.; Francomano, M.; Fantini, F.; Consolo, U.; Seidenari, S.

    2011-01-01

    Reconstruction of nasal defects must preserve the integrity of complex facial functions and expressions, as well as facial symmetry and a pleasing aesthetic outcome. The reconstructive modality of choice will depend largely on the location, size, and depth of the surgical defect. Individualized therapy is the best course, and numerous flaps have been designed to provide coverage of a variety of nasal-specific defects. We describe our experience in the aesthetic reconstruction of nasal skin defects following oncological surgery. The use of different local flaps for nasal skin cancer defects is reported in 286 patients. Complications in this series were one partial flap dehiscence that healed by secondary intention, two forehead flaps, and one bilobed flap with minimal rim necrosis that resulted in an irregular scar requiring revision. Aesthetic results were deemed satisfactory by all patients and the operating surgeons. The color and texture matches were aesthetically good, and the nasal contour was distinct in all patients. All scars were inconspicuous and symmetrical. No patient had tenting or a flat nose. PMID:21773033

  2. Fascial flaps for hand reconstruction.

    PubMed

    Taghinia, Amir H; Carty, Matthew; Upton, Joseph

    2010-08-01

    Free or pedicled fascial flaps to the hand provide an excellent reconstructive option in cases of exposed tendon, joint, or bone where soft tissue coverage is needed. They provide thin, broad, well-vascularized coverage and a gliding surface for tendons and joints. A fascial flap also avoids an unsightly donor site that results from a fasciocutaneous flap. Because of these characteristics, mobilization can be started early to avoid or minimize tendon adhesions and joint and soft tissue contractures. In this report, we discuss the technique for harvesting and insetting a pedicled reverse radial forearm adipofascial flap for a dorsal thumb defect. PMID:20684934

  3. Keystone flaps in coloured skin: Flap technology for the masses?

    PubMed Central

    Bhat, Satish P.

    2013-01-01

    Introduction: Viscoelastic properties of skin in coloured ethnic groups are less favourable compared to Caucasians for executing Keystone flaps. Keystone flaps have so far been evaluated and reported only in Caucasians. The potential of Keystone flaps in a coloured ethnic group is yet unknown. Aim: This article reviews the experience to reconstruct skin defects presenting in a coloured ethnic group, by using Keystone flaps, with a review of existing literature. Design: Uncontrolled case series. Materials and Methods: This retrospective review involves 55 consecutive Keystone flaps used from 2009 to 2012, for skin defects in various locations. Patient demographic data, medical history, co-morbidity, surgical indication, defect features, complications, and clinical outcomes are evaluated and presented. Results: In this population group with Fitzpatrick type 4 and 5 skin, the average patient age was 35.73. Though 60% of flaps (33/55) in the series involved specific risk factors, only two flaps failed. Though seven flaps had complications, sound healing was achieved by suitable intervention giving a success rate of 96.36%. Skin grafts were needed in only four cases. Conclusions: Keystone flaps achieve primary wound healing for a wide spectrum of defects with an acceptable success rate in a coloured skin population with unfavorable biophysical properties. By avoiding conventional local flaps and at times even microsurgical flaps, good aesthetic outcome is achieved without additional skin grafts or extensive operative time. All advantages seen in previous studies were verified. These benefits can be most appreciated in coloured populations, with limited resources and higher proportion of younger patients and unfavorable defects. PMID:23960304

  4. Comparison of pedicled buccal fat pad flap with buccal flap for closure of oro-antral communication.

    PubMed

    Nezafati, S; Vafaii, A; Ghojazadeh, M

    2012-05-01

    The aim of this study was to compare the clinical results of pedicled buccal fat pad flap (PBFPF) with the standard buccal flap in the closure of oro-antral fistula (OAF). Twenty-two patients aged 25-56 years with oro-antral communication were randomly divided into two groups using Rand List 1.2 software. In group 1, OAF was treated with the classic buccal sliding flap and in group 2 a pedicled buccal fat pad was used. All patients were visited 48 h, 1 week and 1 month after surgery for assessment of primary (success of surgery) and secondary outcomes (pain, swelling, maximum mouth opening (MMO) reduction). Both methods were equally successful for the closure of OAF. The pain score was statistically greater in the experimental group (U=9, P=0.001). MMO was statistically less in the experimental group 2 and 7 days after surgery (P<0.001). 1 month after surgery, no statistically significant difference was found in MMO between the two groups (P=0.09). In general, the PBFPF group had more pronounced swelling than the control group. Despite the statistical evidence, none of the patients complained of pain and swelling following the PBFPF procedure. PMID:22192386

  5. Clinical applications of free arterialized venous flaps.

    PubMed

    Kayalar, Murat; Kucuk, Levent; Sugun, Tahir Sadik; Gurbuz, Yusuf; Savran, Ahmet; Kaplan, Ibrahim

    2014-11-01

    Venous flaps are flaps by which tissue perfusion is accessed through the venous network. Despite originally being questioned due to potential perfusion problems, as the dynamics of tissue perfusion have been more fully comprehended, venous flaps appear to have a far wider range of application than first thought. In our study, we analyzed the clinical results of the applications of free arterialized venous flaps along with the factors that can affect flap survival. Forty-one flaps were assessed retrospectively. Type of the trauma, traumatized area, the time duration between trauma and application of the flap, donor area, type and count of the anastomosis, encountered complications, and flap survival rates were analyzed. Regression and classification trees were used to study the relationship between flap surface area, anastomosis count, and flap survival. Circulatory abnormalities such as early congestion and edema were seen in 53.6% of the applied flaps. A total of four flaps (9.7%) developed necrosis which presented as full thickness in three flaps and partial thickness in one flap. It can be said that there was a weak but positive correlation between the size of the flap area and the number of anastomosis. Although the results of arterialized venous flaps are inconsistent in the literature, those flaps can be preferred as an alternative treatment option in single finger defects where tissue compatibility and cosmetic results are quite impressive. In the meantime, syndactylized venous flaps are the preferred method regarding multiple finger soft-tissue defects. PMID:24961162

  6. BCL-2 and Bax Expression in Skin Flaps Treated with Finasteride or Azelaic Acid.

    PubMed

    Ayatollahi, Seyyed Abdulmajid; Ajami, Marjan; Reyhanfard, Hamed; Asadi, Yasin; Nassiri-Kashani, Mansour; Rashighi Firoozabadi, Mehdi; Davoodi, Sayed Hossein; Habibi, Esmaeil; Pazoki-Toroudi, Hamidreza

    2012-01-01

    Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between - to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein (p < 0.05) and decrease the expression of bax protein (p < 0.05). These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult. PMID:24250563

  7. Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap.

    PubMed

    Yeo, In Sung; Kim, Se-Hyuk; Park, Myong Chul; Lim, Hyoseob; Kim, Joo Hyoung; Lee, Il Jae

    2014-07-01

    Skull base reconstruction presents a challenging therapeutic problem requiring a multispecialty surgical approach and close cooperation between the neurosurgeon, head and neck surgeon, as well as plastic and reconstructive surgeon during all stages of treatment. The principal goal of skull base reconstruction is to separate the intracranial space from the nasopharyngeal and oropharyngeal cavities, creating support for the brain and providing a water-tight barrier against cerebrospinal fluid leakage and ascending infection. We present a case involving a 58-year-old man with anterior skull base defects (2.5 cm × 3 cm) secondary to the removal of olfactory neuroblastoma. The patient received conventional radiation therapy at 6000 cGy in 30 fractions approximately a month before tumor removal. The patient had radiation therapy before surgery and was planned to have postoperative radiation therapy, which would lead to a higher complication rate of reconstruction. Artificial dura was used for the packing of the dural defect, which was also suspected to increase the complication rate of reconstruction. For these reasons, we chose to apply the dual flap technique, which uses both local pericranial flap and de-epithelized radial forearm free flap for anterior skull base defect to promote wound healing. During 28 months of follow-up after coverage of the anterior skull base defect, the dual flap survived completely, as confirmed through follow-up magnetic resonance imaging. The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and there was minimal donor-site morbidity of the radial forearm free flap. Reconstruction of anterior skull base defects using the dual flap technique is safe, reliable, and associated with low morbidity, and it is ideal for irradiated wounds and low-volume defects. PMID:24902109

  8. Optimal administration routes for adipose-derived stem cells therapy in ischaemic flaps.

    PubMed

    Lee, Dong Won; Jeon, Yeo Reum; Cho, Eul Je; Kang, Jong Hwa; Lew, Dae Hyun

    2014-08-01

    Improvement of flap survival represents an ongoing challenge in reconstructive surgery. The angiogenic potential of adipose-derived stem cells (ASCs) offers a promising approach to improve the viability of random pattern flaps. Recently, to maximize the therapeutic effects of ASCs, increasing focus is being placed on how to deliver the stem cells to target lesions. The purpose of the present study was to compare the effectiveness of different administration routes of ASCs to improve the viability of the random pattern skin flap. ASCs labelled with PKH26 were applied via four methods to the cranially-based random pattern skin flaps of rats: (a) intravenous injection; (b) subcutaneous injection; (c) application with collagen sponge seeding; and (d) application with fibrin glue seeding. ASCs led to a significant increase in flap viability in the subcutaneous injection group and the collagen sponge group. Cutaneous blood flow was increased in the intravenous injection, subcutaneous injection and collagen sponge groups. Capillary density in the intravenous injection group and collagen sponge group was significantly greater than in the control group (no treatment). PKH26-positive cells via the collagen sponge were distributed more densely within the flap than in other groups. This study demonstrated that the collagen sponge method delivered ASCs most effectively within the flap and increased flap vascularity. The clinical therapeutic effects of ASCs can therefore be maximized when the optimal delivery route is chosen. PMID:22782932

  9. Reconstruction of the dynamic velopharyngeal function by combined radial forearm-palmaris longus tenocutaneous free flap, and superiorly based pharyngeal flap in postoncologic total palatal defect.

    PubMed

    Nuri, Takashi; Ueda, Koichi; Yamada, Akira; Okada, Masashi; Hara, Mai

    2015-04-01

    We attempted to reconstruct dynamic palatal function using a radial forearm-palmaris longus tenocutaneous free flap in conjunction with a pharyngeal flap for a postoncologic total-palate defect in a 67-year-old male patient. This reconstruction involved 3 important tasks, namely, separating the oral and nasal cavities, preserving the velopharyngeal space to avoid sleep apnea, and maintaining velopharyngeal closure to avoid nasal regurgitation during swallowing. In our technique, the radial forearm flap separates the oral and nasal cavities with an open rhinopharyngeal space, and a superiorly based pharyngeal flap, which is sutured to the posterior end of the forearm flap, limits the rhinopharyngeal space, and forms the bilateral velopharyngeal port. Furthermore, the palmaris longus tendon, which is attached to the forearm flap, is secured to the superior constrictor muscle to create a horizontal muscle sling. Contraction of the superior constrictor muscle leads to shrinkage of the sling, resulting in velopharyngeal closure. Swallowing therapy was started 4 weeks after the surgery. The patient could resume oral intake without any difficulties 6 months after the surgery. Speech intelligibility changed from severe to minimal hypernasality. PMID:25749212

  10. Theory of flapping flight

    NASA Technical Reports Server (NTRS)

    Lippisch, Alexander

    1925-01-01

    Before attempting to construct a human-powered aircraft, the aviator will first try to post himself theoretically on the possible method of operating the flapping wings. This report will present a graphic and mathematical method, which renders it possible to determine the power required, so far as it can be done on the basis of the wing dimensions. We will first consider the form of the flight path through the air. The simplest form is probably the curve of ordinary wave motion. After finding the flight curve, we must next determine the change in the angle of attack while passing through the different phases of the wave.

  11. Near-infrared spectroscopic assessment of oxygen delivery to free flaps on monkeys following vascular occlusions and inhalation of pure oxygen

    Microsoft Academic Search

    Fenghua Tian; Haishu Ding; Zhigang Cai; Guangzhi Wang; Fuyun Zhao

    2002-01-01

    In recent studies, near-infrared spectroscopy (NIRS) has been considered as a potentially ideal noninvasive technique for the postoperative monitoring of plastic surgery. In this study, free flaps were raised on rhesus monkeys' forearms and oxygen delivery to these flaps was monitored following vascular occlusions and inhalation of pure oxygen. Optical fibers were adopted in the probe of the oximeter so

  12. Effects of Rosmarinus officinalis on the survivability of random-patterned skin flaps: An experimental study.

    PubMed

    Ince, Bilsev; Yildirim, Alpagan Mustafa; Okur, Mehmet Ihsan; Dadaci, Mehmet; Yoruk, Ebru

    2015-04-01

    Improving survival of skin flaps used in soft-tissue reconstruction is clinically an important goal, and several systemic and local agents have been used for this purpose. However, a substance that prevents the flap necrosis has not yet been defined. This study aimed to investigate whether a Rosmarinus officinalis extract could improve the skin flap survival. In this study, 21 Wistar albino rats were divided into three groups. Rectangular 8 × 2 cm random-pattern flaps were elevated from the back of the rats. Group I was considered the control group. In Group II, a 0.5-cc of Rosmarinus officinalis oil was applied with an ear bud to the flap area 30 minutes before the flap elevation. After suturing the flaps to their location, the oil was administered twice a day for a week. In Group III, 0.5 cc of the oil was applied twice a day to the area that was elevated for a week until surgery. At the end of the week, the flaps were sutured to their location, and wiped postoperatively twice a day for a week with the oil. Mean percentage of these areas was found to be 29.81%, 58.99%, and 67.68% in Group I, Group II, and Group III, respectively. The mean percentage of the flap survival areas and vessel diameters were significantly greater in the Groups II and III than in the control group (p < 0.05). The results revealed that the topical use of the Rosmarinus officinalis extract can increase the flap survivability. PMID:24702647

  13. Surgical Outcome of Urethroplasty Using Penile Circular Fasciocutaneous Flap for Anterior Urethral Stricture

    PubMed Central

    Kim, Kyoung Rok; Suh, Jun-Gyo; Paick, Jae-Seung

    2014-01-01

    Purpose Penile circular fasciocutaneous flap urethroplasty is a useful technique for a long anterior urethral stricture due to the flap's hairless nature and ample length. We investigated the surgical outcomes of urethroplasty for a complex anterior urethral stricture, performed using a penile circular fasciocutaneous flap. Materials and Methods Between 2008 and 2013, we performed a retrospective review of 29 patients who underwent urethroplasty using a penile circular fasciocutaneous flap and had at least 6 months of follow-up. A total of 20 cases utilized only a fasciocutaneous flap, while 9 cases combined a fasciocutaneous flap with other surgery. Success was defined as no requirement of additional urethral instrumentation. Results The overall success rate was 68.9% (20 out of 29 cases) at a median follow-up of 19 months. Furthermore, fasciocutaneous flap urethroplasty rendered the actual stricture-free rate of 79.3%. The location of recurrence was mostly at the junction of the flap. Among 9 surgical failures, 5 cases were treated successfully by using an additional surgical procedure. Fistula repair was needed in 1 case 4 months later. Further, periodic urethral dilation was performed in the remaining 3 cases. The failure rate was significantly higher in patients with suprapubic cystostomy than in patients without suprapubic cystostomy. The most common complication was post-micturition dribbling. Conclusions Penile circular fasciocutaneous flap urethroplasty is a useful method for the reconstruction of a long anterior urethral stricture. A sufficient healthy margin should be acquired for better surgical results due to the fact that most recurrence occurs at the junction of the flap. PMID:25237658

  14. Feasibility of a deepithelialized superior gluteal artery perforator propeller flap for various lumbosacral defects.

    PubMed

    Moon, Suk-Ho; Choi, Jang-Youn; Lee, Jung-Ho; Oh, Deuk-Young; Rhie, Jong-Won; Ahn, Sang-Tae

    2015-05-01

    Skin and soft tissue defects in the lumbosacral area are commonly encountered in the field of reconstructive surgery, and it is well documented that the superior gluteal artery perforator (SGAP) flap provides excellent coverage of these defects. In this article, we describe our experience using a modified version of the SGAP propeller flap, in which the distal redundant portion of an elevated SGAP flap is deepithelialized, thereby maximizing the effect of the soft tissue augmentation. Thirteen patients with lumbosacral soft tissue defects treated between May 2010 and June 2012 were included in this study. The wound causes were pressure ulcer (n = 9), pseudomeningocele (n = 2), and hardware exposure (n = 2). In all patients, an elevated SGAP flap was rotated 180 degrees over the defect area and the extra distal portion of the flap was deepithelialized and used as a soft tissue filler or tamponade. During the follow-up period (mean, 26 months), 12 of 13 flaps survived completely. One flap was totally necrosed due to progressive venous congestion and was reconstructed with local advancement flaps. No further complications were noted. Because of the redundancy and pliability of the tissue in the gluteal area, a flap relatively wider or longer than the defect can be elevated safely. Hence, the redundant tissue volume can be tucked inside to facilitate soft tissue augmentation of the area. We propose that the deepithelialized version of the SGAP propeller flap is an effective option for the reconstruction of various lumbosacral soft tissue defects because it offers thick and healthy soft tissue from a distant site to the defect areas. PMID:24149404

  15. Inferior gluteal artery perforator flap: a viable alternative for ischial pressure sores.

    PubMed

    Kim, Young Seok; Lew, Dae Hyun; Roh, Tai Suk; Yoo, Won Min; Lee, Won Jai; Tark, Kwan Chul

    2009-10-01

    The ischial area is by far the most common site for pressure sores in wheelchair-bound paraplegic patients, because most of the pressure of the body is exerted on this area in the seated position. Even after a series of successful pressure sore treatments, the site is very prone to relapse from the simplest everyday tasks. Therefore, it is crucial to preserve the main pedicle during primary surgery. Several surgical procedures, such as myocutaneous flap and perforator flap, have been introduced for the treatment of pressure sores. During a 4-year time period at our institute, we found favourable clinical results using the inferior gluteal artery perforator (IGAP) procedure for ischial sore treatment. A total of 23 patients (20 males and three females) received IGAP flap surgery in our hospital from January 2003 to January 2007. Surgery was performed on the same site again in 10 (43%) patients who had originally relapsed after undergoing the conventional method of pressure sore surgery. The average age of patients was 47.4 years (range 26-71 years). Most of the patients were paraplegic (16 cases, 70%) and others were either quadriplegic (four cases, 17%) or ambulatory (three cases, 13%). Based on hospital records and clinical photographs, we attempted to assess the feasibility and practicability of the IGAP flap procedure through comparative analysis of several parameters including the size of the defective area, treatment modalities, relapses, complications, and postoperative treatments. The average follow-up duration for 23 subjects was 25.4 months (range 5-42 months). All flaps survived without major complications. Partial flap necrosis developed in one case but secondary healing was achieved and the final outcome was not impaired. Most of the cases healed well during the follow-up period. Postoperative complications such as wound dehiscence and fistula developed in some subjects, but all healed well with a secondary treatment. A total of five cases relapsed after surgery due to tissue deficit and these were treated with bursectomy and muscle transposition flap to fill the dead space. We propose that the IGAP flap should be considered a viable alternative to other methods of ischial pressure sore surgery owing to its many advantages, which include the ability to preserve peripheral muscle tissue, the variability of flap designs, relatively good durability, and the low donor site morbidity rate. PMID:18799379

  16. Comparative evaluation in the treatment of chronic post-traumatic osteomyelitis of the lower leg: free flaps compared with local flaps

    Microsoft Academic Search

    Christian Windhofer; A. H. Schwabegger; M. M. Ninkovic

    2001-01-01

    Forty-nine out of 101 patients treated for post-traumatic chronic osteomyelitis of the lower leg at the Innsbruck University Hospital for Plastic and Reconstructive Surgery in Austria between 1979 and 1996 were included in this retrospective study. The following parameters were covered in the statistic evaluation: postoperative complications, rates of flap survival, recurrence and revision, nosocomial infections, duration of hospitalisation, chronic

  17. Breast reconstruction with perforator-based inframammary de-epithelized flap: a case report.

    PubMed

    Masuoka, Takeshi; Sugita, Ayanori; Sekiya, Shuichi; Ohmori, Kitaro

    2002-01-01

    Patients with silicon gel-injected breasts sometimes appear even now, demanding removal of this foreign body. These requests are often challenging for us-the removal leaves distortion of the breast contour. Musclocutaneous flap transfer is a good method for reconstruction, but scar formation for flap harvest is a problem. Most patients are reluctant to accept these scars. Reconstruction with prostheses has been another method. But the absence of subcutaneous tissue and degenerated muscle make implantation difficult. For one of these patients, the authors applied a method for breast reconstruction with perforator-based inframammary flap. After the removal of the siliconoma with surrounding degenerated tissues, a crescent-shaped skin flap was designed on the inframammary area. Preserving perforators into the flap, it was elevated with adipose tissue. After the skin was de-epthelized, the adipose tissue and skin flap were turned over to make the breast protrusion. The donor site is closed primarily. Ten months after the operation, there was little atrophy of the reconstructed breast, and the patient is satisfied with the result, especially with the softness of the reconstructed breast. Although this method has limitation for volume, less morbidity for donor site and volume reduction in inframammary area are advantageous. In conclusion, this inframammary flap seems to be a good tool for breast surgery. PMID:12140702

  18. An engineered muscle flap for reconstruction of large soft tissue defects.

    PubMed

    Shandalov, Yulia; Egozi, Dana; Koffler, Jacob; Dado-Rosenfeld, Dekel; Ben-Shimol, David; Freiman, Alina; Shor, Erez; Kabala, Aviva; Levenberg, Shulamit

    2014-04-22

    Large soft tissue defects involve significant tissue loss, requiring surgical reconstruction. Autologous flaps are occasionally scant, demand prolonged transfer surgery, and induce donor site morbidity. The present work set out to fabricate an engineered muscle flap bearing its own functional vascular pedicle for repair of a large soft tissue defect in mice. Full-thickness abdominal wall defect was reconstructed using this engineered vascular muscle flap. A 3D engineered tissue constructed of a porous, biodegradable polymer scaffold embedded with endothelial cells, fibroblasts, and/or myoblasts was cultured in vitro and then implanted around the femoral artery and veins before being transferred, as an axial flap, with its vascular pedicle to reconstruct a full-thickness abdominal wall defect in the same mouse. Within 1 wk of implantation, scaffolds showed extensive functional vascular density and perfusion and anastomosis with host vessels. At 1 wk posttransfer, the engineered muscle flaps were highly vascularized, were well-integrated within the surrounding tissue, and featured sufficient mechanical strength to support the abdominal viscera. Thus, the described engineered muscle flap, equipped with an autologous vascular pedicle, constitutes an effective tool for reconstruction of large defects, thereby circumventing the need for both harvesting autologous flaps and postoperative scarification. PMID:24711414

  19. Facial artery myomucosal free flap for cheek mucosa reconstruction: a case report.

    PubMed

    Massarelli, Olindo; Gobbi, Roberta; Biglio, Andrea; Tullio, Antonio

    2013-07-01

    Squamous cell carcinoma (SCC) of the buccal mucosa is an aggressive form of oral cancer. It tends to spread to adjacent tissues and often metastasizes to occult cervical node. There are multiple techniques for cheek reconstruction after tumor removal, including temporalis myocutaneous and temporoparietal fascial pedicled flaps and a forearm free flap. In this report, a case of a 76-year-old man with SCC of the left cheek mucosa and extending to the posterolateral superior alveolar ridge is presented. The patient underwent radical excision of the tumor, omolateral modified radical neck dissection (MRND-III), and contralateral selective neck dissection (levels I-III). Reconstruction was performed with a facial artery myomucosal free flap. The flap was transplanted successfully, and there were no donor or recipient site complications. This technique is a good reconstructive option because of its adherence to the plastic surgery principle of "replacing like with like" and its minimal donor-site morbidity. PMID:23712929

  20. Use of a mechanical leech in a reverse-flow radial forearm flap: case report.

    PubMed

    La Scala, G C; Carroll, S M; Forrest, C R; Zuker, R M

    2001-07-01

    The reverse-flow radial forearm flap provides excellent coverage for distal upper-limb defects. It is simply raised and does not require microsurgical skills. However, since its vascular pedicle is reversed, its venous outflow can be significantly diminished because of the venous valves. The authors present the case of a 16-year-old patient with a sagittal amputation of the radial aspect of the right thumb, who manifested at the time of surgery marked venous engorgement of a reverse-flow radial forearm flap. This was successfully relieved by the placement of a mechanical leech consisting of a Silastic rubber catheter--of the kind used to gain central vascular access in newborns--introduced in the lumen of the reversed vein at the extremity of the flap. This permitted intermittent evacuation of blood from the flap postoperatively, contributing to the success of this procedure. The technique used is detailed and pertinent literature is reviewed. PMID:11499467

  1. Modified osteomyocutaneous iliac crest flaps transplantation.

    PubMed

    Liu, Jun; Song, Dajiang; Li, Jinsong; Xu, Jian; Lv, Hongbin

    2015-04-01

    The paper aims to improve the operative technique of osteomyocutaneous iliac crest flap harvesting, further minimise morbidity of donor site, and improve the effect of recipient site reconstruction. From March 2005 to March 2011, 55 cases of osteomyocutaneous iliac crest flap harvested by different methods were performed to reconstruct the defects of the extremities. Twenty-nine cases were reconstructed with a traditional deep circumflex iliac artery osteomusculocutaneous flap. Twenty-six cases were repaired with modified osteomyocutaneous iliac crest flaps. In 29 cases with a traditional DCIA osteomusculocutaneous flap, two cases showed the injured lateral femoral cutaneous nerve. Flapnecrosis was significant in two cases. Arterial compromise occurred in one case 5 days after operation completion and led to flap failure. Three flaps developed postoperative venous congestion, but only one flap received re-exploration. In the other two cases, some stitches were removed for decompression. All three flaps survived. In two cases, marginal flap necrosis occurred, but no secondary skin grafting was required. In 26 cases with modified flap transplantation, one case showed the injured lateral femoral cutaneous nerve. All flaps survived totally. Osseous integration was achieved in all 55 cases in 3 ? 9 months after operation. The modified osteomyocutaneous iliac crest flap technique enhances flap safety, provides the additional advantages of reducing donor-site morbidity, and improves the recipient-site contour. PMID:25001367

  2. Robotic surgery

    MedlinePLUS

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  3. Three-dimensional Reconstruction of Scar Contracture-bearing Axilla and Digital Webs Using the Square Flap Method

    PubMed Central

    Huang, Chenyu

    2014-01-01

    Background: Joint scar contractures are characterized by tight bands of soft tissue that bridge the 2 ends of the joint like a web. Classical treatment methods such as Z-plasties are mainly based on 2-dimensional designs. Our square flap method is an alternative surgical method that restores the span of the web in a stereometric fashion, thereby reconstructing joint function. Methods: In total, 20 Japanese patients with joint scar contractures on the axillary (n = 10) or first digital web (n = 10) underwent square flap surgery. The maximum range of motion and commissure length were measured before and after surgery. A theoretical stereometric geometrical model of the square flap was established to compare it to the classical single (60 degree), 4-flap (45 degree), and 5-flap (60 degree) Z-plasties in terms of theoretical web reconstruction efficacy. Results: All cases achieved 100% contracture release. The maximum range of motion and web space improved after square flap surgery (P = 0.001). Stereometric geometrical modeling revealed that the standard square flap (? = 45 degree; ? = 90 degree) yields a larger flap area, length/width ratio, and postsurgical commissure length than the Z-plasties. It can also be adapted by varying angles ? and ?, although certain angle thresholds must be met to obtain the stereometric advantages of this method. Conclusions: When used to treat joint scar contractures, the square flap method can fully span the web space in a stereometric manner, thus yielding a close-to-original shape and function. Compared with the classical Z-plasties, it also provides sufficient anatomical blood supply while imposing the least physiological tension on the adjacent skin. PMID:25289342

  4. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit.

    PubMed

    Avery, C M E; Gandhi, N; Peel, D; Neal, C P

    2014-05-01

    There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure. PMID:24220666

  5. PIV Measurements on a Blowing Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

    PIV measurements of the flow in the region of a flap side edge are presented for several blowing flap configurations. The test model is a NACA 63(sub 2)-215 Hicks Mod-B main-element airfoil with a half-span Fowler flap. Air is blown from small slots located along the flap side edge on either the top, bottom or side surfaces. The test set up is described and flow measurements for a baseline and three blowing flap configurations are presented. The effects that the flap tip jets have on the structure of the flap side edge flow are discussed for each of the flap configurations tested. The results indicate that blowing air from a slot located along the top surface of the flap greatly weakened the top vortex system and pushed it further off the top surface. Blowing from the bottom flap surface kept the strong side vortex further outboard while blowing from the side surface only strengthened the vortex system or accelerated the merging of the side vortex to the flap top surface. It is concluded that blowing from the top or bottom surfaces of the flap may lead to a reduction of flap side edge noise.

  6. Pitch Angle Control using Flapping Frequency for a Flapping-Wing Robot Yoshiyuki Higashi1

    E-print Network

    Kimura, Hiroshi

    Pitch Angle Control using Flapping Frequency for a Flapping-Wing Robot Yoshiyuki Higashi1 , Tatsuya@kit.ac.jp) Abstract: This paper presents methods of estimating and controlling the pitch angle. For controlling a flapping-wing robot using values of internal sensors, we estimate the pitch angle of a flapping

  7. Rectus abdominis myocutaneous flaps for perineal reconstruction: modifications to the technique based on a large single-centre experience

    PubMed Central

    McMenamin, DM; Clements, D; Edwards, TJ; Fitton, AR; Douie, WJP

    2011-01-01

    INTRODUCTION Perineal wound breakdown with delayed wound healing represents a significant cause of morbidity following surgery and radiotherapy to the perineum. The rectus abdominis myocutaneous (RAM) flap has been used increasingly to reconstruct the perineum with good effect. We describe our six-year experience of reconstruction of the perineum with the RAM flap and share some surgical adjuncts we believe are useful. METHODS We conducted a retrospective case note review of all patients who underwent a reconstruction of the perineum using the RAM flap between August 2003 and October 2009. Indications for the flap, complication rates and outcomes were all observed. RESULTS We conducted 16 RAM flap procedures, 15 of which (94%) were primary repairs and 1 (6%) a secondary repair. Three (19%) developed donor site hernias, two (12.5%) developed minor perineal wound infections, eight (50%) developed minor perineal wound breakdown and in one (6%) flap failure was observed. No perineal hernias were observed. There were no surgical mortalities. CONCLUSIONS The RAM flap has a high success rate and an acceptable morbidity rate and is a useful tool in the reconstruction of complex perineal wounds. Modifications to the standard surgical technique may reduce complications and improve the versatility of this flap. PMID:21943461

  8. Buccal fat pad - a simple, underutilised flap.

    PubMed

    Meyer, E; Liebenberg, S J R; Fagan, J J

    2012-05-01

    The pedicled buccal fat pad is a reliable flap for the repair of small oral defects. It is durable, easy to harvest and should be considered in settings where access to free flaps is limited and in cases where previous flaps have failed. We discuss a case where this flap was used successfully for closure of an oro-antral fistula. The indications, anatomy and techniques of successful harvest are discussed. PMID:22622104

  9. Piezoelectrically actuated insect scale flapping wing

    Microsoft Academic Search

    Sujoy Mukherjee; Ranjan Ganguli

    2010-01-01

    An energy method is used in order to derive the non-linear equations of motion of a smart flapping wing. Flapping wing is actuated from the root by a PZT unimorph in the piezofan configuration. Dynamic characteristics of the wing, having the same size as dragonfly Aeshna Multicolor, are analyzed using numerical simulations. It is shown that flapping angle variations of

  10. Development of insect thorax based flapping mechanism

    Microsoft Academic Search

    Zaeem Khan; Kyle Steelman; Sunil Agrawal

    2009-01-01

    Design of a flapping mechanism for flapping wing micro air vehicles (FWMAV) is presented based on a mathematical model of insect thorax. This model also includes an aerodynamic model of flapping wings. Using experiments on dynamically scaled wings and numerical optimization, the mechanism is tuned for peak aerodynamic performance. The thorax model is used to understand the mechanics of the

  11. Numerical Analysis of Flapping Wing Aerodynamics

    Microsoft Academic Search

    M. A. Ashraf; J. C. S. Lai; J. Young

    Flapping-wing aerodynamics recently has generated a great deal of interest and increasing research effort because of the potential application in micro-air vehicles. The objective of this study is to critically review the recent progress of CFD analysis of flapping- wing aerodynamics. Critical parameters like flapping modes, frequency and amplitude for optimal thrust generation and propulsive efficiency are identified. Current gaps

  12. Treatment of a Recurrent Rectourethral Fistula by Using Transanal Rectal Flap Advancement and Fibrin Glue: A Case Report

    PubMed Central

    Lee, Taek-Gu; Park, Sung-Su

    2012-01-01

    Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence. PMID:22816061

  13. Treatment of a recurrent rectourethral fistula by using transanal rectal flap advancement and fibrin glue: a case report.

    PubMed

    Lee, Taek-Gu; Park, Sung-Su; Lee, Sang-Jeon

    2012-06-01

    Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence. PMID:22816061

  14. Lumbosacral reconstruction for intractable pyogenic spondylitis using a total leg flap with a vascularized tibia graft.

    PubMed

    Iwakiri, Kentaro; Miyauchi, Akira; Okuda, Shinya; Matsuda, Ken; Yamamoto, Tomio; Iwasaki, Motoki

    2008-05-01

    This report describes an effective technique of using a total leg flap for treating a 57-year-old male paraplegic patient with intractable sacral pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus. Spondylitis was accompanied by severe instability of the lumbosacral area, a large lumbosacral ulcer, and a large bone and muscle defect, which made it difficult for the patient to maintain a sitting position. A total leg flap procedure, a modification of the total thigh flap procedure, was performed as a 1-stage salvage surgery. The vascularized tibia and fibula were grafted between the lumbar and sacral vertebrae, and a musculocutaneous flap was used to cover the extensive ulceration in the lumbosacral skin defect. The intractable lesion of the lumbosacral spine, which had not been cured for more than 2 years despite repeated debridement, intravenous antibiotic injections, sugar treatment, pyoktanin treatment, and hyperbaric O(2) treatment, subsided and stabilized within 1 year of surgery. The patient returned to activities of daily living using a wheelchair, and was very satisfied with the results. Use of a total leg flap with a vascularized tibia graft is an effective treatment for intractable pyogenic spondylitis accompanied by a large bone defect and large lumbosacral ulcers. PMID:18447694

  15. Secondary reconstruction for mandibular osteoradionecrosis defect with fibula osteomyocutaneous flap flowthrough from radial forearm flap using stereolithographic 3-dimensional printing modeling technology.

    PubMed

    Man, Qi-Wen; Jia, Jun; Liu, Ke; Chen, Gang; Liu, Bing

    2015-03-01

    Osteoradionecrosis (ORN) is one of the most serious complications of oral and nasopharyngeal malignant neoplasms after radiotherapy. The incidence of mandibular ORN is significantly higher than that of maxilla. A radical surgical intervention such as mandibulectomy for advanced ORN is appropriate and effective to relieve pain and control infection. However, recovery of functionality and aesthetics is usually not the primary purpose of the one-stage radical surgery. Some patients often need a 2-stage operation owing to the bone defect, scar contracture, or recurrence. Although free flap has been proven as a reliable way to repair the complex maxillofacial defects, it is still a great challenge for surgeons to reconstruct the secondary complex mandibular ORN defects. Here, we report a case of secondary composite mandibular ORN reconstruction using the preoperative 3-dimensional biomodel planning and flowthrough radial forearm flap for free fibula osteocutaneous flap. PMID:25748942

  16. Cholecystectomy after breast reconstruction with a pedicled autologous tram flap. Types of surgical access

    PubMed Central

    Kostro, Justyna; Jankau, Jerzy; Bigda, Justyna; Skorek, Andrzej

    2014-01-01

    The number of breast reconstruction procedures has been increasing in recent years. One of the suggested treatment methods is breast reconstruction with a pedicled skin and muscle TRAM flap (transverse rectus abdominis muscle – TRAM). Surgical incisions performed during a cholecystectomy procedure may be located in the areas significant for flap survival. The aim of this paper is to present anatomical changes in abdominal walls secondary to pedicled skin and muscle (TRAM) flap breast reconstruction, which influence the planned access in cholecystectomy procedures. The authors present 2 cases of cholecystectomy performed due to cholelithiasis in female patients with a history of TRAM flap breast reconstruction procedures. The first patient underwent a traditional method of surgery 14 days after the reconstruction due to acute cholecystitis. The second patient underwent a laparoscopy due to cholelithiasis 7 years after the TRAM procedure. In both cases an abdominal ultrasound scan was performed prior to the operation, and surgical access was determined following consultation with a plastic surgeon. The patient who had undergone traditional cholecystectomy developed an infection of the postoperative wound. The wound was treated with antibiotics, vacuum therapy and skin grafting. After 7 weeks complete postoperative wound healing and correct healing of the TRAM flap were achieved. The patient who had undergone laparoscopy was discharged home on the second postoperative day without any complications. In order to plan a safe surgical access, it is necessary to know the changes in the anatomy of abdominal walls following a pedicled TRAM flap breast reconstruction procedure. PMID:25337177

  17. Mucociliary transport and histopathological changes in rotation flaps of the nasal mucosa.

    PubMed

    Ate?pare, Altay; Üstünda?, Emre; Dalç?k, Hakk?; Çelik, Öner

    2015-05-01

    Normal mucociliary transport in the mucoperichondrium of the nasal septum is from a distal (anterior) to proximal (posterior) direction. This study was to determine the direction of mucociliary transport and histopathological changes in nasal mucosal rotation flaps when their transport directions were anatomically reversed. Thirty-two rabbits were divided into four groups. Surgical septal rotational flaps were prepared in the experimental groups. Group I was the control group. The distal aspect of the flap was sutured through a large septal window to the other side of the nasal septum, thus changing the direction of the flap. Evaluation was performed 1 week, 1 month and 9 months later with each of these groups named as groups II, III, and IV, respectively. The rate and direction of the mucociliary transport was determined and histopathological investigations were performed from the flaps. The direction of mucociliary transport was observed to continue as distal to proximal direction in the rotated segments. The mucociliary transport rate was found to be decreased in group II, nearly normal in group III, and in normal limits in group IV after surgery. Intense inflammation and decreased number of cilia were present in group II. The inflammation was milder in group III and the epithelium was found to be nearly normal in group IV. The originally programmed direction of mucociliary transport in the nasal rotation flaps is maintained and is not altered or reprogrammed. Histopathological changes revert back to normal from an inflammatory state to reach pre-surgical status over time. PMID:25022717

  18. The reconstruction of the spheno-orbital region using latissimus dorsi flap and costal graft.

    PubMed

    Biglioli, Federico; Mortini, Pietro; Pedrazzoli, Marco; D'Alessandro, Luca; Bardazzi, Alessandro; Colletti, Giacomo

    2013-07-01

    To minimize complications in skull base surgery, it is necessary to separate intracranial structures from the upper aerodigestive tract with well-vascularized tissue. The majority of defects can be reconstructed using local flaps using pericranium, galea, or temporalis muscle. However, there are conditions that affect the suitability of the previously mentioned flaps, for example, previous surgical procedures or radiotherapy. Local flaps may also be inadequate to reconstruct particularly large defects. Extensive bony demolitions produce aesthetic deformities that need accurate reconstructions. Orbital wall defects have to be reconstructed to avoid complications such as the transmission of cerebral pulsation, bulbar dystopias, diplopia, and ophthalmoplegia. The microvascular latissimus dorsi flap is ideal in all these cases, and the use of a costal graft allows simultaneous reconstruction of bony defects. From January 2000 to January 2008, 17 patients have undergone surgical ablation of the spheno-orbital region and reconstruction with latissimus dorsi flap and costal grafts. The flap survival rate was 100%. One patient required revision of the venous anastomosis. No cerebrospinal fluid leak or intracranial infections have been detected. The only complications registered were dystopias in 6 patients and diplopia in 4; all of these spontaneously resolved within 2 months. The microvascular latissimus dorsi flap with costal graft is an effective method for the reconstruction of the spheno-orbital region when local flaps are not indicated. It has a negligible donor-site morbidity, an ideal vascular pedicle, and an easy harvesting technique. The costal graft allows the simultaneous reconstruction of the orbital walls, giving good results. PMID:23851876

  19. Fluorescence angiography in the assessment of flap perfusion and vitality.

    PubMed

    Yeoh, Melvyn S; Kim, D David; Ghali, G E

    2013-02-01

    Indocyanine green angiography is increasingly being adopted by reconstructive surgeons for use in pedicle tissue flaps and microvascular free-tissue transfer procedures. With the increasing adoption of this technology, the postoperative complication rate and the need for reoperation can be decreased, making these reconstructive procedures more predictable. The main disadvantage of this technology is its cost; with time and greater adoption of this technology, the cost will eventually decrease. Decreased postoperative complications and reduced need for revision surgery with the use of this technology will play a significant role in decreasing the overall health care costs for these complex reconstructive procedures. PMID:23399396

  20. Multifocal laser surgery: Cutting enhancement by hydrodynamic interactions between cavitation bubbles

    E-print Network

    Palanker, Daniel

    been recently demon- strated in cataract surgery 2 . An anterior lens capsule was cut in a spiralMultifocal laser surgery: Cutting enhancement by hydrodynamic interactions between cavitation a corneal flap in refractive surgery a part of LASIK procedure , replacing less precise mechanical micro

  1. Tanshinone IIA Pretreatment Renders Free Flaps against Hypoxic Injury through Activating Wnt Signaling and Upregulating Stem Cell-Related Biomarkers

    PubMed Central

    Xu, Zihan; Zhang, Zhenxin; Wu, Lijun; Sun, Yaowen; Guo, Yadong; Qin, Gaoping; Mu, Shengzhi; Fan, Ronghui; Wang, Benfeng; Gao, Wenjie

    2014-01-01

    Partial or total flap necrosis after flap transplantation is sometimes clinically encountered in reconstructive surgery, often as a result of a period of hypoxia that exceeds the tolerance of the flap tissue. In this study, we determine whether tanshinone IIA (TSA) pretreatment can protect flap tissue against hypoxic injury and improve its viability. Primary epithelial cells isolated from the dorsal skin of mice were pretreated with TSA for two weeks. Cell counting kit-8 and Trypan Blue assays were carried out to examine the proliferation of TSA-pretreated cells after exposure to cobalt chloride. Then, Polymerase chain reaction and Western blot analysis were used to determine the expression of ?-catenin, GSK-3?, SOX2, and OCT4 in TSA-treated cells. In vivo, after mice were pretreated with TSA for two weeks, a reproducible ischemic flap model was implemented, and the area of surviving tissue in the transplanted flaps was measured. Immunohistochemistry was also conducted to examine the related biomarkers mentioned above. Results show that epidermal cells, pretreated with TSA, showed enhanced resistance to hypoxia. Activation of the Wnt signaling pathway in TSA-pretreated cells was characterized by the upregulation of ?-catenin and the downregulation of GSK-3?. The expression of SOX2 and OCT4 controlled by Wnt signaling were also found higher in TSA pretreated epithelial cells. In the reproducible ischaemic flap model, pretreatment with TSA enhanced resistance to hypoxia and increased the area of surviving tissue in transplanted flaps. The expression of Wnt signaling pathway components, stem-cell related biomarkers, and CD34, which are involved in the regeneration of blood vessels, was also upregulated in TSA-pretreated flap tissue. The results show that TSA pretreatment protects free flaps against hypoxic injury and increases the area of surviving tissue by activating Wnt signaling and upregulating stem cell-related biomarkers. PMID:25302618

  2. The partial myocutaneous gluteal flap reconstruction of extralevator abdominoperineal defects in irradiated patients.

    PubMed

    Saleh, Daniel Bernard; Callear, Jacqueline A; Basheer, Mohamed; Mohammed, Paul

    2015-04-01

    Reconstruction of the irradiated perineum has posed a consistent reconstructive challenge historically. The evolution of reconstructive techniques must mirror advances in neoadjuvant treatment and surgery for low rectal cancer. The purpose of this study was to evaluate the perineal healing in a cohort of patients, of whom a majority had laparoscopic tumor excision and partial myocutaneous gluteal flap reconstruction. There were 11 patients in this cohort; 8 primary reconstructions and 3 salvage cases. Complete healing was measured as the cessation of all dressings. There were no returns to theater for flap-related surgery. Mean postreconstruction inpatient stay was 16.5 days. All patients healed completely. Mean time to healing was 42 days. This method has been successful for primary and salvage reconstruction in patients having laparoscopic or open surgery; thus, averting the major morbidity associated with failed reconstruction as reported for most of other reconstructive modalities in these patients. PMID:24051461

  3. Recurrent cervical esophageal stenosis after colon conduit failure: use of myocutaneous flap.

    PubMed

    Sa, Young Jo; Kim, Young Du; Kim, Chi Kyung; Park, Jong Kyung; Moon, Seok Whan

    2013-01-14

    A 53-year-old male developed cervical esophageal stenosis after esophageal bypass surgery using a right colon conduit. The esophageal bypass surgery was performed to treat multiple esophageal strictures resulting from corrosive ingestion three years prior to presentation. Although the patient underwent several endoscopic stricture dilatations after surgery, he continued to suffer from recurrent esophageal stenosis. We planned cervical patch esophagoplasty with a pedicled skin flap of sternocleidomastoid (SCM) muscle. Postoperative recovery was successful, and the patient could eat a solid meal without difficulty and has been well for 18 mo. SCM flap esophagoplasty is an easier and safer method of managing complicated and recurrent cervical esophageal strictures than other operations. PMID:23345956

  4. Reconstruction of chest wall chondrosarcoma with an anterolateral thigh free flap: An illustration of decision-making in chest wall reconstruction

    PubMed Central

    Shahzad, F.; Wong, K.Y.; Maraka, J.; Di Candia, M.; Coonar, A.S.; Malata, C.M.

    2013-01-01

    INTRODUCTION Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is radical resection, which often requires chest wall reconstruction. This presents numerous challenges and more extensive defects mandate the use of microvascular free flaps. Selecting the most appropriate flap is important to the outcome of the surgery. PRESENTATION OF CASE A 71-year-old male presented with a large chondrocarcoma of the chest wall. The planned resection excluded use of the ipsilateral and contralateral pectoralis major flap because of size and reach limitations. The latissimus dorsi flap was deemed inappropriate on logistical grounds as well as potential vascular compromise. The patient was too thin for reconstruction using an abdominal flap. Therefore, following radical tumour resection, the defect was reconstructed with a methyl methacrylate polypropylene mesh plate for chest wall stability and an anterolateral thigh free flap in a single-stage joint cardiothoracic and plastic surgical procedure. The flap was anastomosed to the contralateral internal mammary vessels as the ipsilateral mammary vessels had been resected. DISCUSSION The outcome was complete resection of the tumour, no significant impact on ventilation and acceptable cosmesis. CONCLUSION This case demonstrates the complex decision making process required in chest wall reconstruction and the versatility of the ALT free flap. The ALT free flap ensured adequate skin cover, subsequent bulk, provided an excellent operative position, produced little loss of donor site function, and provided an acceptable cosmetic result. PMID:23849801

  5. Performance of flapping foil propulsion

    Microsoft Academic Search

    L. Schouveiler; F. S. Hover; M. S. Triantafyllou

    2005-01-01

    The performance of an aquatic propulsion system inspired from the thunniform swimming mode is experimentally studied. This consists of generating the propulsive force with a foil undergoing a harmonic flapping which is a combination of a heave translation and a pitch rotation. Experiments are performed at a fixed value of the Reynolds number and of the heave amplitude. The effects

  6. Biomimetic flapping wing aerial vehicle

    Microsoft Academic Search

    M. A. A. Fenelon

    2009-01-01

    This paper presents a vertical take-off and hover capable flapping wing aerial vehicle using a biomimetic approach; replicating the hovering patterns of dragonflies and hummingbirds. The prototype uses a spatial mechanism driven by a rotary actuator which generates an angle of attack during each wing stroke. A 98 g, 380 mm span two wing prototype capable of vertical take-off and

  7. [Presentation of a flap web space laterodigital in cleft foot].

    PubMed

    Szwebel, J; Haddad, R; Mitrofanoff, M

    2012-08-01

    Cleft foot deformity is characterized by the absence of one or more median rays of the foot. This rare polymorphous congenital anomaly occurs more frequently in males, with a frequent autosomal dominant type of transmission. The purpose of surgical treatment is to narrow the width of the foot, but also to improve its global aesthetic look. Toe reparation, and more specifically web space reconstruction, provide the main technical challenges. We present an adaptation to the foot of a laterodigital cutaneous flap published by Barsky in 1964 for commissural reconstruction in cleft hand syndroms. The anatomical structure of fingers and toes commisures being different, this flap seems more adapted to the surgery of the foot. We gathered seven patients' files treated for ectrodactyly of the foot with this technique by the same surgeon from 2005 to 2008. No particular postoperative complications were noted, and the patients all expressed their satisfaction regarding the improvement of the appearance of their foot. We recommend to add the use of this flap in the "tool box" of the surgeon in charge of the management of foot deformities. PMID:20947236

  8. Vascularisation of Urethral Repairs with the Gracilis Muscle Flap

    PubMed Central

    Kua, Ee Hsiang Jonah; Leo, Kah Woon; Ong, Yee Siang; Cheng, Christopher

    2013-01-01

    Background The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. Methods We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. Results After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. Conclusions Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs. PMID:24086814

  9. Biologic Collagen Cylinder with Skate Flap Technique for Nipple Reconstruction

    PubMed Central

    Tierney, Brian P.; Hodde, Jason P.; Changkuon, Daniela I.

    2014-01-01

    A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7?mm and average projection at 6 months was 3–5?mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging. PMID:25114802

  10. Comparison of dartos flap and dartos flap plus spongioplasty to prevent the formation of fistulae in the snodgrass technique

    Microsoft Academic Search

    Salim Bilici; Tamer Sekmenli; Mustafa Gunes; Ilhan Gecit; Vedat Bakan; Daghan Isik

    Objective  The aim of our study was to evaluate the role of paraurethral spongial tissue plus dartos flap using an additional urethral\\u000a cover to prevent fistula formation in patients who underwent surgery with the Snodgrass technique.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and methods  A retrospective study was performed on 161 patients aged 10 months to 15 years who underwent midpenile and distal hypospadias\\u000a repair using the Snodgrass technique.

  11. Improved survival of ischemic random skin flaps through the use of bone marrow nonhematopoietic stem cells and angiogenic growth factors.

    PubMed

    Simman, Richard; Craft, Chris; McKinney, Bart

    2005-05-01

    Surgical skin flaps are frequently used in plastic and reconstructive surgery to repair acquired or congenital defects. Necrosis is a common complication associated with these flaps postoperatively as a result of inadequate blood supply. Stem cells are precursor cells with the potential to differentiate into more specialized cells. Angiogenic factors act to direct cellular differentiation and organization to form new vascular elements. Our theory was that the combination of angiogenic growth factors with stem cells derived from the subject preoperatively would augment neovascularization, thereby increasing blood supply to the flap, which may ultimately improve flap survival. In phase I, 40 Lewis rats were randomized into 4 groups of 10. Random dorsal skin flaps were elevated and treated at the same time. The first group was injected with only medium, the second with stem cells, the third with stem cells and angiogenic factors, and the fourth with angiogenic growth factors. Millimetric measurements of flap viability at 7 and 14 days did not show any statistically significant differences between the studied groups. In phase II, 24 rats were also randomized into 4 groups of 6, but this time were treated 1 week before flap elevation. The viability measurements showed an increased rate of viability in the group in which stem cells and the angiogenic factors were administered simultaneously (84.5% +/- 3.2%) as compared with the unmodified control group (62.6% +/- 7.3%) or to the groups in which only precursor cells (60.4% +/- 7.9%) or angiogenic factors (62.3%+/- 10.1%). Increased blood supply brought by these manipulations is believed translated to increased tissue flap survival. Punch biopsies showed that "green fluorescent protein"-labeled precursor cells was noted to form luminal structures in the treated flaps. The vascular cast of all flaps was filled with Mercox plastic resin. After euthanasia, the soft tissues of the harvested flaps were dissolved and the remaining vascular cast was weighted. The weight-based ratio of the vascular composition was determined. The flaps injected with both stem cells and angiogenic factors showed higher values. We conclude that the administration of bone marrow stem cells with angiogenic factors 1 week before flap creation improves the survival of ischemic random skin flaps. PMID:15838218

  12. Preconditioned hyperbaric oxygenation protects skin flap grafts in rats against ischemia/reperfusion injury.

    PubMed

    Kang, Nan; Hai, Yong; Liang, Fang; Gao, Chun-Jin; Liu, Xue-Hua

    2014-06-01

    Hyperbaric oxygen (HBO) therapy is an effective therapy for ischemia/reperfusion (I/R) injury of the brain, small intestine, testes and liver. However, the detailed molecular mechanisms underlying the effect of HBO therapy remain undetermined. In the current study, the hypothesis that preconditioning rats with HBO protects grafted skin flaps against subsequent I/R injury was investigated. In addition, the molecular mechanisms underlying HBO therapy were characterized by analyzing the roles of the following important inflammatory factors: High mobility group protein 1 (HMGB1) and nuclear factor-? B (NF-?B). A total of 40 rats were randomly divided into the following five groups: (i) Sham surgery (SH); (ii) ischemia followed by reperfusion 3 days following surgery (I/R3d); (iii) ischemia followed by reperfusion 5 days following surgery (I/R5d); (iv) HBO preconditioning (HBO-PC) and ischemia followed by reperfusion 3 days following surgery (HBO-PC+3d); and (v) HBO-PC and ischemia followed by reperfusion 5 days following surgery (HBO-PC+5d). For the surgical procedure, all pedicled skin flaps were first measured and elevated (9x6 cm). The feeding vessels of the skin flaps were subsequently clamped for 3 h and released to restore blood flow. The rats in the HBO-PC+3d and HBO-PC+5d groups received 1 h HBO for 3 and 5 consecutive days, respectively, prior to surgery. Following surgery, the rats were euthanized, and grafted tissues were collected for western blotting and immunohistochemistry. HBO-PC increased blood perfusion in epigastric skin flaps and attenuated I/R injury following skin flap graft. Additionally, the elevated expression of HMGB1 and NF-?B proteins during I/R injury was attenuated by HBO-PC treatment. HBO-PC may therefore be applied to reduce I/R injury and improve the survival rate of grafted skin flaps. The molecular mechanisms underlying the effect of HBO therapy are associated with the attenuation of inflammatory responses. PMID:24676940

  13. Preconditioned hyperbaric oxygenation protects skin flap grafts in rats against ischemia/reperfusion injury

    PubMed Central

    KANG, NAN; HAI, YONG; LIANG, FANG; GAO, CHUN-JIN; LIU, XUE-HUA

    2014-01-01

    Hyperbaric oxygen (HBO) therapy is an effective therapy for ischemia/reperfusion (I/R) injury of the brain, small intestine, testes and liver. However, the detailed molecular mechanisms underlying the effect of HBO therapy remain undetermined. In the current study, the hypothesis that preconditioning rats with HBO protects grafted skin flaps against subsequent I/R injury was investigated. In addition, the molecular mechanisms underlying HBO therapy were characterized by analyzing the roles of the following important inflammatory factors: High mobility group protein 1 (HMGB1) and nuclear factor-? B (NF-?B). A total of 40 rats were randomly divided into the following five groups: (i) Sham surgery (SH); (ii) ischemia followed by reperfusion 3 days following surgery (I/R3d); (iii) ischemia followed by reperfusion 5 days following surgery (I/R5d); (iv) HBO preconditioning (HBO-PC) and ischemia followed by reperfusion 3 days following surgery (HBO-PC+3d); and (v) HBO-PC and ischemia followed by reperfusion 5 days following surgery (HBO-PC+5d). For the surgical procedure, all pedicled skin flaps were first measured and elevated (9×6 cm). The feeding vessels of the skin flaps were subsequently clamped for 3 h and released to restore blood flow. The rats in the HBO-PC+3d and HBO-PC+5d groups received 1 h HBO for 3 and 5 consecutive days, respectively, prior to surgery. Following surgery, the rats were euthanized, and grafted tissues were collected for western blotting and immunohistochemistry. HBO-PC increased blood perfusion in epigastric skin flaps and attenuated I/R injury following skin flap graft. Additionally, the elevated expression of HMGB1 and NF-?B proteins during I/R injury was attenuated by HBO-PC treatment. HBO-PC may therefore be applied to reduce I/R injury and improve the survival rate of grafted skin flaps. The molecular mechanisms underlying the effect of HBO therapy are associated with the attenuation of inflammatory responses. PMID:24676940

  14. Principles of Head and Neck Reconstruction: An Algorithm to Guide Flap Selection

    PubMed Central

    Chim, Harvey; Salgado, Christopher J.; Seselgyte, Rimante; Wei, Fu-Chan; Mardini, Samir

    2010-01-01

    Advances in head and neck reconstruction have resulted in improved outcomes with single-stage repair of defects ranging from intraoral to pharyngoesophageal to skull base defects. Key to success of surgery is choosing an appropriate reconstructive option based on the patient's wishes and fitness for major surgery. Where possible, free tissue transfer provides the best functional and aesthetic outcomes for the vast majority of defects. In this article, we present an algorithm to guide choice of flap selection and review principles of reconstruction and secondary surgery for head and neck defects. PMID:22550435

  15. Comparison of the Complications in Vertical Rectus Abdominis Musculocutaneous Flap with Non-Reconstructed Cases after Pelvic Exenteration

    PubMed Central

    Jeon, Heechang; You, Hi-Jin; Kim, Hyon-Surk; Lee, Byung-Il; Park, Seung Ha

    2014-01-01

    Background Perineal reconstruction following pelvic exenteration is a challenging area in plastic surgery. Its advantages include preventing complications by obliterating the pelvic dead space and minimizing the scar by using the previous abdominal incision and a vertical rectus abdominis musculocutaneous (VRAM) flap. However, only a few studies have compared the complications and the outcomes following pelvic exenteration between cases with and without a VRAM flap. In this study, we aimed to compare the complications and the outcomes following pelvic exenteration with or without VRAM flap coverage. Methods We retrospectively reviewed the cases of nine patients for whom transpelvic VRAM flaps were created following pelvic exenteration due to pelvic malignancy. The complications and outcomes in these patients were compared with those of another nine patients who did not undergo such reconstruction. Results Flap reconstruction was successful in eight cases, with minor complications such as wound infection and dehiscence. In all cases in the reconstructed group (n=9), structural integrity was maintained and major complications including bowel obstruction and infection were prevented by obliterating the pelvic dead space. In contrast, in the control group (n=9), peritonitis and bowel obstruction occurred in 1 case (11%). Conclusions Despite the possibility of flap failure and minor complications, a VRAM flap can result in adequate perineal reconstruction to prevent major complications of pelvic exenteration. PMID:25396186

  16. "Naked microvascular bone flap" in oral reconstruction.

    PubMed

    Gennaro, Paolo; Della Monaca, Marco; Aboh, Ikenna Valentine; Priore, Paolo; Facchini, Arianna; Valentini, Valentino

    2014-08-01

    Since the 1980s, bone free flaps have been used to reconstruct the maxilla and the mandible. The vascular pedicle, through the supply of nutritional substances and drugs from the bloodstream, ensures the vitality of the flap, rapid bone integration, and reduced risk of infection.However, due to many surgeons' concerns about orocervical and orosinusal fistulas and infections, bone flaps are usually buried and protected by mucosal flaps or a second skin flap whenever it is not possible to harvest a skin paddle together with the bone flap.The authors, convinced that naked bone free flaps, if well vascularized, are capable of healing and repairing the osteomucosal deficit on their own, with no risk of infection or fistulas, began to harvest, for oral reconstructions, naked bone flaps, that is, bone flaps covered only by a muscle layer 5 to 20 mm thick.In this study, the authors present a review of their experience in oral cavity reconstructions by harvesting naked and covered bone free flaps, retrospectively evaluating the occurrence of major and minor, early and late complications, associated with the different reconstructive technique. PMID:24691338

  17. [Postoperative complications in plastic surgery].

    PubMed

    Vogt, P M

    2009-09-01

    Plastic surgery covers a broad spectrum of diseases and conditions in the areas of reconstructive surgery, hand, burn and aesthetic surgery. Besides acquired defects or malformations an increasing number of patients are being treated for surgical or multimodal complications. In a considerable number of patients plastic and reconstructive surgery remains the only therapeutic alternative after other therapy has failed. Therefore complication management in plastic surgery is of utmost importance for a successful outcome. In addition patient expectations in the results of plastic surgery as a discipline of invention and problem solving are steadily increasing. This challenge is reflected in clinical patient management by intensive research in tissue engineering and regenerative medicine. Patients in plastic surgery are recruited from all age groups of either gender, involving traumatic and oncologic as well as congenital and aesthetic disorders. The demographics of aging, multimorbidity and obesity pose new challenges to plastic surgery. Although age over 70 years is not an independent risk factor per se for complications in plastic surgery, e.g. for complex free flap transfer, medical problems are present at a higher rate, which is to be expected in this age group. Risk factors such as alcoholism and coronary heart diseases seem to be independent predictors of perioperative complications. Therefore older patients can also benefit from plastic surgery and recurrent operations by the corresponding risk and complication management. Complication management necessitates careful patient selection, estimation of operative risks and patient-adapted selection of procedures. In addition to expertise in plastic surgery a thorough knowledge of non-surgical and surgical back-up procedures for technical incidents as well as vascular circulatory and wound healing disorders is required to deal successfully with complications in plastic surgery. This article presents these specific aspects of postoperative complication management in plastic surgery. PMID:19669715

  18. Rhabdomyosarcoma: Surgery

    MedlinePLUS

    ... is rhabdomyosarcoma treated? Next Topic Chemotherapy for rhabdomyosarcoma Surgery for rhabdomyosarcoma Surgery is an important part of ... be done at all. What to expect with surgery The type and extent of surgery can vary ...

  19. Neuroblastoma: Surgery

    MedlinePLUS

    ... neuroblastoma treated? Next Topic Chemotherapy for neuroblastoma Neuroblastoma surgery Surgery can be used both to help diagnose ... long, thin instruments and remove pieces of tumor. Surgery as treatment After neuroblastoma is diagnosed, surgery is ...

  20. Resorbable synthetic mesh supported with omentum flap in the treatment of giant hiatal hernia.

    PubMed

    Pérez Lara, F J; Marín, R; Del Rey, A; Oliva, H

    2014-01-01

    Abstract Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary. PMID:25216419

  1. Course review: the 4th Bob Huffstadt upper and lower limb flap dissection course.

    PubMed

    Dunne, Jonathan A

    2014-12-01

    The Bob Huffstadt course is a 2-day upper and lower limb flap dissection course held in Groningen, the Netherlands. The course is in English, with an international faculty of senior consultants from the Netherlands, Belgium, and United Kingdom. Faculty to participant ratio is 2:1, with 2 participants at each dissection table. The course is aimed at trainees in plastic surgery of all levels, and a comprehensive DVD is provided before the course, which demonstrates dissection of 35 flaps, ensuring those with little experience to have an understanding before dissection.This course offered a comprehensive overview with plenty of practical application. The course can greatly develop operative and theoretical knowledge, while also demonstrating a commitment for those wishing to pursue a career in plastic surgery. Longer courses are available; however, the 2-day course can already provide an excellent introduction for junior trainees. There are few flap courses in the United Kingdom and senior trainees may have difficulty acquiring a place as they book up well in advance. With reductions in operating time, trainees may welcome further experience and development of techniques in the dissection room.Most of both days were spent in the dissection room, raising flaps and receiving teaching from the faculty. Dissections included Foucher, Moberg, Becker, radial forearm, anterolateral thigh, and fibula flaps. Dissection specimens were fresh-frozen preparation, and 9 upper limb flaps were raised on the first day and 5 lower limb flaps on the second day. The faculty provided live demonstrations of perforator dissection, use of the hand-held Doppler, and tips and tricks. The last 2 hours of each day were spent with 2 lectures, including topics from the history of flaps and developments to challenging cases and reconstructive options.The course fee was 1000 euros, including a 5-course dinner, lunch on both days, and a drinks reception on the final evening. I would recommend this course unreservedly to trainees new to flaps, or those with greater experience. The course was supportive, friendly, and provided an excellent basis to develop reconstructive skills. There is a world-class faculty who can improve the knowledge and techniques of any trainee in attendance. PMID:24135639

  2. Extensive cranioplasty for sagittal synostosis in young children by preserving cranial bone flaps adhered to the dura mater.

    PubMed

    Nan, Bao; Bo, Yang; Yun-Hai, Song; Cheng, Chen; Xiong-Zheng, Mu

    2015-03-01

    This study aimed to evaluate extensive cranioplasty involving the frontal, parietal, occipital, and temporal bones without removing the floating bone flaps in the treatment of sagittal synostosis. Sixty-three children with sagittal synostosis, aged 5 months to 3 years, were included in the study. The frontal bone flap was removed using an air drill. The occipital and bilateral temporal bone flaps were cut open but not detached from the dura mater or fixed to produce floating bone flaps. The skull bone was cut into palisade-like structures. Brain compression from both sides and the base of the skull was released and the brain expanded bilaterally through the enlarged space. Only a long strip-shaped bone bridge remained in the central parietal bone. Subsequently, the frontal bone flaps and occipital bone flap were pushed towards the midline and fixed with the parietal bone bridge to shorten the anteroposterior diameter of the cranial cavity and allow the brain to expand bilaterally to correct scaphocephaly. Patients were followed up 1-5 years. Skull growth was excellent in all patients, the anteroposterior diameter was shortened, the transverse diameter was increased, the prominent forehead was corrected, and scaphocephaly improved significantly. There were no complications such as death and skull necrosis. Surgery without removing bone flaps is less traumatic and results in no massive bleeding. It can effectively relieve brain compression and promotes transversal expansion of the brain during surgery and subsequent normal brain development. The skull of young children is relatively thin and early surgery can easily achieve satisfactory bone reshaping. Our surgical technique is not only safe and effective but also can avoid subsequent psychological disorders caused by skull deformity. PMID:25668119

  3. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2013-01-01 false Wing flap position indicator...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator...

  4. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Wing flap controls. 23.697...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap control must...

  5. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Wing flap controls. 23.697...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap control must...

  6. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Wing flap controls. 23.697...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap control must...

  7. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2014-01-01 false Wing flap position indicator...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator...

  8. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 2012-01-01 false Wing flap position indicator...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator...

  9. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Wing flap controls. 23.697...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap control must...

  10. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Wing flap controls. 23.697...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap control must...

  11. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 2011-01-01 false Wing flap position indicator...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator...

  12. Our Experiences in Nipple Reconstruction Using the Hammond flap

    PubMed Central

    Ryu, Jeong Yeop; Ryu, Dong Wan; Kwon, O Hyun; Bae, Sung Gun; Lee, Jeong Woo; Choi, Kang Young; Chung, Ho Yun; Cho, Byung Chae

    2014-01-01

    Background Nipple reconstruction following breast mound reconstruction is the final step in breast reconstruction. Although nipple reconstruction is a simple surgery, the psychological aspects of nipple reconstruction are thought to be important. Nipple projection is a key factor in determining patient satisfaction with the surgery. In the present study, the Hammond flap technique was introduced for nipple reconstruction. Methods Twenty-six patients who had undergone breast reconstruction from February 2008 to March 2012 were enrolled in this prospective study. All patients were evaluated based on preoperative photos, and their nipple diameters and heights were measured. Postoperative evaluation was conducted 3, 6, 9, and 12 months following nipple reconstruction. A questionnaire on patient satisfaction with the nipple reconstruction was administered 12 months after nipple reconstruction. Moreover, the same plastic surgeon scored nipple projection and overall cosmetic result of the new nipple. Results The mean projection was 4.4 mm (range, 3-6 mm), and it well matched the contralateral nipple. Twelve months following nipple reconstruction, the mean reduction rate in the nipple projection was 43.6%. Patients were satisfied or very satisfied with the nipple projection and the overall cosmetic result in 80.7% cases. Conclusions In the present study, compared with other techniques, the use of the Hammond flap technique in nipple reconstruction showed competitive results with regard to nipple projection and patient satisfaction. PMID:25276648

  13. [Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting].

    PubMed

    Mátrai, Zoltán; Kunos, Csaba; Pukancsik, Dávid; Sávolt, Akos; Gulyás, Gusztáv; Kásler, Miklós

    2014-01-19

    Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian. PMID:24412949

  14. The blood supply of dorsal tongue flaps.

    PubMed

    Bracka, A

    1981-10-01

    Current advice on the design of dorsal tongue flaps is conflicting because of insufficient understanding of the blood supply. A detailed study of the vascular anatomy shows that the dorsal mucosa has a distinctive vascular pattern that commends the choice of a posteriorly-based midline flap for closure of defects in the soft palate and posterior part of the hard palate. More anterior defects are more easily closed with an anteriorly-based midline flap. PMID:7296138

  15. Upper limb reconstruction with reverse flaps: a review of 52 patients with emphasis on flap selection.

    PubMed

    Kostako?lu, N; Keçik, A

    1997-10-01

    Reverse flaps lend themselves to transposition from proximal to distal locations in the extremities. This series comprised 18 radial forearm flaps, 17 digital artery flaps, 13 posterior interosseous flaps, 3 lateral arm flaps, 2 dorsal digital flaps, and 1 dorsal metacarpal flap, all of which were utilized in a reverse pattern. The radial forearm flap was mainly chosen for defects involving part of the palm and the palmar aspect of the first web space. The posterior interosseous flap was more commonly utilized for resurfacing the dorsum, dorsal aspect of the first web space, and especially the hypothenar aspect of the hand. The lateral arm flap was used to reconstruct antecubital fossa and proximal forearm defects. All posterior interosseous and lateral arm donor areas were closed primarily. Sensate digital artery flaps yielded 5 mm on average static two-point discrimination in 6 to 18 months of follow-up. Functional and cosmetic results concerning the recipient and donor areas were found to be satisfactory. It was concluded that reverse flaps are versatile tools in the coverage of all kind of defects in the upper limb and should be thought of in the first place. PMID:9339281

  16. Role of the NO/cGMP Pathway in Postoperative Vasodilation in Perforator Flaps.

    PubMed

    Gao, Z M; Lin, D M; Wang, Y; Li, J J; Chen, S; Gao, W Y

    2015-02-01

    Background?The nitric oxide (NO)/cyclic guanylyl monophosphate (cGMP) pathway is one of the most important regulators of tissue perfusion. Here, we sought to elucidate the protective effects of the NO/cGMP pathway on the microcirculation of axial pattern skin flaps. Material and Methods?Overall 40 rats were divided into four groups (n?=?10 each): group A, sildenafil was administered orally at 10 mg/kg daily; group B, sildenafil citrate (10 mg/kg, oral) and nitro-amino-methyl-L-arginine (L-NAME, intraperitoneal injection), a nitric oxide synthase inhibitor, were administered daily; group C, L-NAME was administered alone; and group D, no drugs were administered. After surgery, the surviving flap area was calculated as a percentage of total flap dimensions using the paper template technique. Angiography and imaging were performed to compare the macrovascular changes of the choke zones in the flaps. Histological examinations were performed to compare the differences in microvascular changes between the two choke zones. Results?A significant improvement of flap survival area and a significant dilation of vessels in both choke zones were found after administration of sildenafil. We also found that the postoperative vasodilation of choke vessels could be altered by inhibition of NO synthase (NOS). Moreover, the vasodilatory effect prolonged by the phosphodiesterase 5 inhibitor sildenafil was attenuated after administration of L-NAME. L-NAME significantly reversed the protection afforded by sildenafil. Conclusions?Targeting the NO/cGMP pathway can dilate vessels along the axis of the flap, including the choke vessels, thus augmenting flap viability. Therefore, targeting of this pathway may have therapeutic applications. PMID:25602485

  17. Bipedicled flap for the reconstruction of soft tissue defects of the achilles tendon.

    PubMed

    Lin, Chin-Ta; Chen, Shyi-Gen; Chen, Tim-Mo; Dai, Niann-Tzyy; Chang, Shun-Cheng

    2015-04-01

    Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. The purpose of this article was to present our experience of 11 patients who underwent reconstruction of soft tissue defects of the Achilles tendon using bipedicled fasciocutaneous flaps. Between August 2008 and August 2012, 11 patients were admitted to our hospital, presenting with soft tissue defects overlying the Achilles tendon. After adequate debridement, the 11 patients underwent bipedicled fasciocutaneous flap placement to resurface the complex soft tissue defects and provide a gliding surface for the exposed Achilles tendon. The patients' age, comorbidity, etiology, defect size and location, wound culture, skin graft size, complications, surgery duration, and follow-up period were reviewed. The 11 fasciocutaneous bipedicled flaps survived completely, and the wounds healed satisfactorily at a mean follow-up period of 20.9 months (range, 6-48 months). Only 1 flap was complicated with wound dehiscence and superficial necrosis of its lateral edge, which healed conservatively. The donor sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or elderly patients. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. Thus, the bipedicled fasciocutaneous flap can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically. PMID:25760483

  18. Cosmetic closure of pilonidal sinus defects with bilateral transpositional adipofascial flaps.

    PubMed

    Yazar, Memet; Kurt Yazar, Sevgi; Celet Ozden, Burcu; Guven, Erdem; Basaran, Karaca; Alyanak, Alper; Aydin, Atakan

    2013-09-01

    The optimal treatment of the pilonidal sinus has not currently been defined. This study described the use of a modified bilateral transpositional adipofascial flap technique that effectively serves to flatten the deep natal cleft while keeping the scar limited to the intergluteal fold for good cosmesis. Between June 2007 and September 2011, 83 patients (61 men, 22 women) were included in the study. Duration of pilonidal sinus symptoms ranged from 1-15 (median 5) years; 15 patients had recurrent disease. Before the operation, perforating branches of the four pairs of lateral sacral arteries were identified with a Doppler audioscope. After complete excision of the sinus cavity and adequate undermining of the skin, bilateral adipofascial flaps were raised in order to realise a Yin-Yang pattern, with the lateral sacral artery perforators at the base of each flap. Complementary flaps were then transposed into the defect and inset to completely obliterate dead space. Skin was closed primarily in two layers. The median (range) defect size after total excision of the sinus cavity was 38 (19-60) cm2. All flaps survived. There was no wound infection or dehiscense. Median (range) follow-up was 26 (6-52) months. No recurrences were observed. Extensive scarring or asymmetry in the gluteal prominences was not observed. Transient paraesthesia over the flap donor region occurred in 14 cases (16%) and resolved completely within 6 months. The bilateral adipofascial transpositional flap method is an alternative to previously described treatment options in pilonidal sinus surgery. It is a safe, reliable, and easily applicable method, which provides cosmetically acceptable coverage of pilonidal sinus defects of moderate size. PMID:23731131

  19. Wing flapping with minimum energy

    NASA Technical Reports Server (NTRS)

    Jones, R. T.

    1980-01-01

    A technique employed by Prandtl and Munk is adapted for the case of a wing in flapping motion to determine its lift distribution. The problem may be reduced to one of minimizing induced drag for a specified and periodically varying bending moment at the wing root. It is concluded that two wings in close tandem arrangement, moving in opposite phase, would eliminate the induced aerodynamic losses calculated

  20. Foot and ankle reconstruction using the radial forearm flap: a review of 25 cases.

    PubMed

    Weinzweig, N; Davies, B W

    1998-11-01

    Twenty-five patients underwent soft-tissue reconstruction of the different anatomic regions of the foot and ankle using the microvascular radial forearm free flap. The patients, 19 men and 6 women, ranged in age from 3 to 80 years (mean, 48.4 years). Indications for the surgery included diabetes and/or vascular insufficiency (10 patients), trauma (9 patients), tumor (3 patients), gunshot wound (2 patients), and burn (1 patient). Osteomyelitis occurred in patients with traumatic (3 patients) and diabetic (3 patients) wounds. The weight-bearing surface of the foot was involved in eight patients. Defects ranged in size from 45 to 210 cm2 (mean, 100.4 cm2). The radial forearm flap was successful in 23 of 25 cases (92 percent). Flap complications included flap loss (two patients), infection (three patients), and minor wound dehiscence at the flap-leg skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor site complications included partial skin graft loss with tendon exposure in two patients; both healed with conservative management. Recurrent or persistent osteomyelitis was not seen in any of the patients. Of the eight patients with weight-bearing flaps, four were ambulatory, one had limited ambulation, one was nonambulatory, one had too short a follow-up, and one suffered flap loss. Two patients required modified shoes. Debulking was performed in one patient. Follow-up ranged from 2 to 72 months (mean, 24.9 months). The radial forearm flap meets most of the anatomic prerequisites for the ideal foot flap. It facilitates the restoration of normal foot contour by replacing "like-with-like," allowing patients to use normal shoes without the need for debulking (except in one patient); it provides a durable and stable weight-bearing plantar surface during ambulation; it achieves excellent aesthetic results without the dryness or cracking of the hypertrophied skin-grafted muscle; and it permits sensory reinnervation. We have found it especially useful for resurfacing the dorsum, ankle, and forefoot, moderate-sized defects, weight-bearing surfaces, and osteomyelitic wounds. PMID:9810997

  1. Low level laser therapy increases angiogenesis in a model of ischemic skin flap in rats mediated by VEGF, HIF-1? and MMP-2*

    PubMed Central

    Cury, Vivian; Moretti, Ana Iochabel Soares; Assis, Lívia; Bossini, Paulo; de Souza Crusca, Jaqueline; Neto, Carlos Benatti; Fangel, Renan; de Souza, Heraldo Possolo; Hamblin, Michael R; Parizotto, Nivaldo Antonio

    2013-01-01

    It is known that low level laser therapy is able to improve skin flap viability by increasing angiogenesis. However, the mechanism for new blood vessel formation is not completely understood. Here, we investigated the effects of 660 nm and 780 nm lasers at fluences of 30 and 40 J/cm2 on three important mediators activated during angiogenesis. Sixty male Wistar rats were used and randomly divided into five groups with twelve animals each. Groups were distributed as follows: skin flap surgery non-irradiated group as a control; skin flap surgery irradiated with 660 nm laser at a fluence of 30 or 40 J/cm2 and skin flap surgery irradiated with 780 nm laser at a fluence of 30 or 40 J/cm2. The random skin flap was performed measuring 10 × 4 cm, with a plastic sheet interposed between the flap and the donor site. Laser irradiation was performed on 24 points covering the flap and surrounding skin immediately after the surgery and for 7 consecutive days thereafter. Tissues were collected, and the number of vessels, angiogenesis markers (vascular endothelial growth factor, VEGF and hypoxia inducible factor, HIF-1?) and a tissue remodeling marker (matrix metalloproteinase, MMP-2) were analyzed. LLLT increased an angiogenesis, HIF-1? and VEGF expression and decrease MMP-2 activity. These phenomena were dependent on the fluences, and wavelengths used. In this study we showed that LLLT may improve the healing of skin flaps by enhancing the amount of new vessels formed in the tissue. Both 660 nm and 780 nm lasers were able to modulate VEGF secretion, MMP-2 activity and HIF-1? expression in a dose dependent manner. PMID:23831843

  2. Protective effect of hydrogen-rich saline on ischemia/reperfusion injury in rat skin flap*

    PubMed Central

    Zhao, Ling; Wang, You-bin; Qin, Shi-rui; Ma, Xue-mei; Sun, Xue-jun; Wang, Ming-lian; Zhong, Ru-gang

    2013-01-01

    Objective: Skin damage induced by ischemia/reperfusion (I/R) is a multifactorial process that often occurs in plastic surgery. The mechanisms of I/R injury include hypoxia, inflammation, and oxidative damage. Hydrogen gas has been reported to alleviate cerebral I/R injury by acting as a free radical scavenger. Here, we assessed the protective effect of hydrogen-rich saline (HRS) on skin flap I/R injury. Methods: Abdominal skin flaps of rats were elevated and ischemia was induced for 3 h; subsequently, HRS or physiological saline was administered intraperitoneally 10 min before reperfusion. On postoperative Day 5, flap survival, blood perfusion, the accumulation of reactive oxygen species (ROS), and levels of cytokines were evaluated. Histological examinations were performed to assess inflammatory cell infiltration. Results: Skin flap survival and blood flow perfusion were improved by HRS relative to the controls. The production of malondialdehyde (MDA), an indicator of lipid peroxidation, was markedly reduced. A multiplex cytokine assay revealed that HRS reduced the elevation in the levels of inflammatory cytokines, chemokines and growth factors, with the exception of RANTES (regulated on activation, normal T-cell expressed and secreted) growth factor. HRS treatment also reduced inflammatory cell infiltration induced by I/R injury. Conclusions: Our findings suggest that HRS mitigates I/R injury by decreasing inflammation and, therefore, has the potential for application as a therapy for improving skin flap survival. PMID:23645175

  3. Scars and perforator-based flaps in the abdominal region: A contraindication?

    PubMed Central

    Dragu, Adrian; Unglaub, Frank; Wolf, Maya B.; Beier, Justus P.; Schnabl, Saskia M.K.; Kneser, Ulrich; Leffler, Mareike; Horch, Raymund E.

    2010-01-01

    Background Although multiple strategies for autologous breast reconstruction exist, a vertical midline scar in the abdominal wall as a result of previous laparatomy or abdominoplasty represents a major surgical challenge. To date, little research has been conducted on the regeneration potential of the abdominal wall’s superficial vascular, perforator and choke vessel system after surgery using a vertical approache. Methods We present the cases of 8 patients, of whom 7 underwent autologous breast reconstruction. One patient received a thigh reconstruction. All patients had a vertical abdominal midline scar as a result of a previous surgical intervention. In 3 of the 7 patients, the breast was reconstructed using an MS-2-vertical rectus abdominis myocutaneous (VRAM) free flap. In 4 of these patients, an MS-2-transverse rectus abdominis myocutaneous (TRAM) free flap was performed. The thigh reconstruction used a transverse deep inferior epigastric perforator (DIEP) free flap. Clinical follow-up was done 12 months after operation. Results All 3 patients who received an MS-2-VRAM had good aesthetic results. Vertical midline scars had no negative effect on surgical outcomes, perfusion and tissue viability of the 4 MS-2-TRAM and transverse DIEP free flaps. Conclusion These clinical findings indicate that the regeneration potential of the abdominal wall’s superficial vascular system in the presence of vertical surgical scars has been greatly underestimated. Use of MS-2-VRAM free flaps in patients with vertical abdominal scars seems to be a suitable and successful alternative in the reconstruction algorithm. PMID:20334747

  4. The free deltoid flap: microscopic anatomy studies and clinical application to oral cavity reconstruction.

    PubMed

    Wang, Zuolin; Sano, Kazuo; Inokuchi, Tsugio; Li, Ji; Lan, Xingjian; Sekine, Joji; Ikeda, Hisazumi

    2003-08-01

    The deltoid free flap is a fasciocutaneous flap that should be thin, hairless, of an adequate size, and capable of sensory reinnervation. Because of its excellent color-matching and texture-matching characteristics, it has recently been widely used for the reconstruction of soft-tissue defects during oral and maxillofacial surgery. Furthermore, a characteristic of oral and maxillofacial soft-tissue defects is that they are not large; therefore, flap size will be small, allowing the donor site to be directly closed. Because of natural variation in parts of the anatomy, there has sometimes been great difficulty in clinical application. The authors decided to study this by performing anatomical studies of the deltoid region on 21 cadavers. The result indicates that the pedicle of the deltoid free flap penetrates the "quadrangular space" in 90 percent of cases but passes and does not penetrate the quadrangular space in the remaining cases. The authors also confirmed that the skin has a vascular network comprising five layers and, furthermore, that the vascular network of the deep fascia is dense. The authors also report six cases of its clinical use complicated by anatomic variation and local infection in which the deltoid flap showed a completely successful outcome. PMID:12900597

  5. Surgical Approach for Repair of Rectovaginal Fistula by Modified Martius Flap

    PubMed Central

    Reichert, M.; Schwandner, T.; Hecker, A.; Behnk, A.; Baumgart-Vogt, E.; Wagenlehner, F.; Padberg, W.

    2014-01-01

    Rectovaginal fistulas (RVF) are rare but represent a challenge for both patients and surgeons. The most common cause of RVF is obstetric trauma, and treatment is based on fistula classification and localization of the fistula in relation to the vagina and rectum. Conventional therapy frequently fails, making surgery the most viable approach for fistula repair. One surgical procedure which offers adequate repair of lower and middle rectovaginal fistulas consists of interposition of a bulbocavernosus fat flap also called modified Martius flap. First described by Heinrich Martius in 1928, this approach has been continuously modified and adjusted over time and is used in the repair of various pelvic floor disorders. Overall success rates reported in the literature of the interposition of a Martius flap as an adjunct procedure in the surgical management of RVF are 65–100?%. We present a detailed description of the operation technique together with a discussion of the use of a dorsal-flapped modified Martius flap in the treatment of RVF. PMID:25364031

  6. Use of buccal myomucosal flap for palatal lengthening in cleft palate patient: Experience of 20 cases

    PubMed Central

    Varghese, Don; Datta, Shubharanjan; Varghese, Annie

    2015-01-01

    Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients. Patients and Methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape. Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon.

  7. Salvage of Failed Local and Regional Flaps with Porcine Urinary Bladder Extracellular Matrix Aided Tissue Regeneration

    PubMed Central

    Kruper, Gregory J.; VandeGriend, Zachary P.; Lin, Ho-Sheng; Zuliani, Giancarlo F.

    2013-01-01

    Local and regional flap failure can be a major complication in head and neck surgery, which continue to be prevalent for a number of reasons including poor flap design, improper surgical technique, and poor tissue vascularity. Dealing with these failures can be quite difficult. Surgical debridement, flap revisions, and complex wound regimens are necessitated to reestablish appropriate tissue coverage. Traditional use of wet to dry dressing to enable proper wound granulation and possible closure with additional flaps or skin grafts is a laborious process. Such treatments place great time burdens on the patient, physicians, and nurses. Because the face and neck possess a complex three-dimensional topography, wound dressings are inherently complex to design and change. Many patients also require postoperative treatments such as radiation and chemotherapy to treat aggressive malignancies, and delay in wound healing leads to a delay in adjuvant treatment. Recently, advances in regenerative medicine, specifically xenogeneic extracellular matrix compounds, have been shown to promote tissue growth while limiting scar tissue formation (Badylak 2004). To our knowledge, this paper is the first case series using the porcine extracellular matrix bioscaffold (MatriStem ACell, Columbia, MD, USA) to salvage flaps with extensive wound breakdown on the face and neck. PMID:24191216

  8. Effective Use of a Silicone-induced Capsular Flap in Secondary Asian Rhinoplasty

    PubMed Central

    Oh, Sang-Ha; Suh, Man Koon; Kim, Chang Kyung; Kim, Kenneth K.

    2014-01-01

    Summary: Performing secondary rhinoplasty in patients who underwent primary rhinoplasty using a silicone implant is difficult due to thinning of nasal skin and formation of a capsule. Excess capsule formation can cause capsular contracture, resulting in short nose deformity or implant deviation, migration, or implant demarcation. Revision rhinoplasty using a capsular flap, dorsal silicone implant, and tip plasty was performed in 95 Korean patients (91 women and 4 men; mean age, 27 years) who previously underwent primary augmentation rhinoplasty using silicone implants. The capsular flap was composed by creating a dual plane above the anterior capsule and below the posterior capsule. The existing silicone implant was removed, and a new silicone implant was placed under the posterior capsule. The patients were followed up for 6 months to 4 years (mean, 31.7 months). Of the 95 patients who underwent secondary augmentation rhinoplasty using a capsular flap, 88 patients (92.6%) showed satisfactory results. There was no hematoma or nasal skin vascular compromise. There was no visible or palpable capsule resorption or recurrent capsular contracture. Early implant malpositioning (within 30 days postoperatively) was observed in 4 patients, and tip shape dissatisfaction (within 60 days postoperatively) was reported by 3 patients. Four patients underwent revision surgery and had successful outcomes. Nasal augmentation using a silicone implant and capsular flap in secondary rhinoplasty avoids complications caused by removal of the capsule. Recurrent capsule formation or clinically noticeable resorption of the capsular flap was not observed in this study. PMID:25289365

  9. Obesity alters rat abdominal flap survival.

    PubMed

    Reyna, Ronald E; Feldmann, Mark E; Evans, Zachary P; Seung-Jun, O; Chavin, Kenneth D

    2006-09-01

    Obesity presents a risk factor for flap-related complications in autologous tissue breast reconstruction. In this study, an animal model was developed to examine this phenomenon. Abdominal flaps based on a superficial inferior epigastric pedicle were elevated in an experimental group of obese Zucker (fa/fa) rats (n = 8; mean weight, 413 g) and in their lean littermates (n = 9; mean weight, 276 g). Flap tissue was harvested from a subset of both groups for baseline characterization, including histology, and assays for ATP and oxidative phosphorylation uncoupler, UCP-2. Flaps were then evaluated for survival by planimetry at 4 and 7 days postprocedure. Flap survival 7 days postoperatively was reduced in obese (42.0% +/- 8.6%) versus lean (70.3% +/- 6.7%) rats (P < 0.05). At baseline, flap tissue of obese animals had decreased ATP content relative to lean counterparts (0.12 +/- 0.12 nM/microg vs 0.36 +/- 0.23 nM/microg protein, P < 0.05), whereas UCP2 mRNA was higher in obese flap tissue versus lean. Reduced viability of obese flaps may be attributable to decreased baseline energy stores due to oxidative phosphorylation uncoupling by UCP-2. This study is the first to introduce a promising animal model for examining the effect of obesity on increased flap-related complications in breast reconstruction using autologous tissue. PMID:16986384

  10. Pressure Available for Cooling with Cowling Flaps

    NASA Technical Reports Server (NTRS)

    Stickle, George W; Naiman, Irven; Crigler, John L

    1941-01-01

    Report presents the results of a full-scale investigation conducted in the NACA 20-foot tunnel to determine the pressure difference available for cooling with cowling flaps. The flaps were applied to an exit slot of smooth contour at 0 degree flap angle. Flap angles of 0 degree, 15 degrees, and 30 degrees were tested. Two propellers were used; propeller c which has conventional round blade shanks and propeller f which has airfoil sections extending closer to the hub. The pressure available for cooling is shown to be a direct function of the thrust disk-loading coefficient of the propeller.

  11. Optimal propulsive flapping in Stokes flows

    E-print Network

    Was, Loic

    2014-01-01

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds number, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propul...

  12. Optimal propulsive flapping in Stokes flows.

    PubMed

    Was, Loïc; Lauga, Eric

    2014-03-01

    Swimming fish and flying insects use the flapping of fins and wings to generate thrust. In contrast, microscopic organisms typically deform their appendages in a wavelike fashion. Since a flapping motion with two degrees of freedom is able, in theory, to produce net forces from a time-periodic actuation at all Reynolds numbers, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propulsion mechanism valid across the whole range of Reynolds numbers. PMID:24343130

  13. A water tunnel study of Gurney flaps

    NASA Technical Reports Server (NTRS)

    Neuhart, Dan H.; Pendergraft, Odis C., Jr.

    1988-01-01

    Several Gurney flap configurations were tested in the NASA Langley 16 x 24 inch Water Tunnel. These devices provided an increased region of attached flow on a wing upper surface relative to the wing without the flaps. The recirculation region behind the flap was visualized and shown to be consistent with hypotheses stated in previous research. Although the test Reynolds number for this study was several orders of magnitude below those in previous investigations, the effect of the Gurney flaps is in qualitative agreement with them. This is as would be expected from first order effects for high lift devices.

  14. Current trends in robotic surgery for otolaryngology

    PubMed Central

    Byrd, J. Kenneth; Duvvuri, Umamaheswar

    2013-01-01

    As minimally invasive surgery has become common in head and neck surgery, the role of robotic surgery has expanded from thyroid surgery and transoral robotic surgery (TORS) of the oropharynx and supraglottic to other areas. Surgeons have advanced the limits of TORS, adapting lasers to the Da Vinci robot for glottic cancer, and combining existing techniques for transoral supraglottic laryngectomy and hypopharyngectomy to perform transoral total laryngectomy. Skull base approaches have been reported with some success in case reports and cadaver models, but the current instrument size and configuration limit the applicability of the current robotic system. Surgeons have reported reconstruction of the head and neck via local and free flaps. Using the previously reported approaches for thyroidectomy via modified facelift incision, neck dissection has also been reported. Future applications of robotic surgery in otolaryngology may be additionally expanded, as several new robotic technologies are under development for endolaryngeal work and neurotology. PMID:24069577

  15. Modified autospreader flap for nasal valve support: utilizing the spring effect of the upper lateral cartilage.

    PubMed

    Hussein, Wael Khamis; Elwany, Samy; Montaser, Motaz

    2015-02-01

    Nasal valve dysfunction has a role in up to 13% of adults complaining of chronic nasal obstruction yet it is overlooked by many physicians. In rhinoplasty and other nasal surgeries, preserving nasal function is the most significant issue. The autospreader flap has proved to be an effective spreader graft alternative. Adding the spring effect proposed in this study to the autospreader flap increases the width of the internal nasal valve, thus gaining two factors supporting the internal nasal valve. The modified autospreader flap technique is described in detail. Patients in this study were classified into two groups. The first group had no obstructive complaints and the second group had nasal obstructive complaints. Quantitative analysis of NOSE scale scores, endoscopic evaluation, and tomographic evaluation before and after the surgery were performed using statistical analysis. Survey responses were received from 22 patients. Significant improvement in the nasal valve angle width was found in both groups by the endoscopic and tomographic evaluation. Subjective evaluation using NOSE scale scores showed improvement in both groups. The greatest advantage of this technique is that it adds to the autospreader flap a spring action that widens the valve area. We found this technique to be reliable and simple to be performed with fairly good results and patient satisfaction. Level of evidence V Evidence from systematic reviews of descriptive and qualitative studies. PMID:25266940

  16. Reconstruction with different free flaps in oro-facial cancer patients.

    PubMed

    Bhathena, H M; Savant, D N; Kavarana, N M; Parikh, D M; Sanghvi, V D

    1996-01-01

    In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary. PMID:8908729

  17. Secondary onlay free flap reconstruction of glossectomy defects following initial successful flap restoration.

    PubMed

    Rihani, Jordan; Lee, Thomas; Ducic, Yadranko

    2013-08-01

    Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy. PMID:23625797

  18. Reverse-flow posterior tibial island flap: preliminary report of a new fasciocutaneous flap.

    PubMed

    Chuenkongkaew, T; Chayakula, N; Srirojanakul, S

    1990-10-01

    Septocutaneous vessels constitute an important source of skin circulation in the leg and form the basis of various fasciocutaneous flaps that have useful clinical applications. In 1978, Goufan and Baogui described a flap from the forearm based on the radial artery (Chinese forearm flap). With this in mind, the reverse-flow posterior tibial fasciocutaneous flap (Thai leg flap, or TLF) was designed and successfully transferred clinically to cover lower leg and foot defects in 2 patients. The factors that permit a distally based flap to be raised in the lower leg against the direction of the venous valves, and the backflow of arterial blood, are also described. The versatility, advantages, and disadvantages of this new flap in the reconstruction of defects of the lower leg and foot are discussed. PMID:2244742

  19. Mediastinitis and sternal prosthesis infection successfully treated by minimally invasive omental flap transposition

    PubMed Central

    2013-01-01

    Purulent mediastinitis is a possible serious complication after mediastinal surgery. We report the case of a localized sternal plasmocytoma treated by sternectomy and prosthetic repair, who needed a second surgery for a fistulizing mediastinitis. Five months earlier, in another Hospital, the patient underwent sternal resection and reconstruction with a “sandwich” prosthesis (Methyl-methacrylate and Marlex mesh). Suppurative mediastinitis occurred and septic shock resolution was observed after the spontaneous opening of a mediastinal cutaneous fistula. After referring to our Unit the patient underwent extensive local and systemic preparation and nutritional support; the infected prosthesis was then removed and the gap filled by a laparoscopically-prepared omental flap. Adequate preoperative management, removal of any infected material and minimally invasive omental flap transposition allowed the successful treatment of this life-threatening condition. PMID:23442807

  20. Limb salvage surgery

    PubMed Central

    Kadam, Dinesh

    2013-01-01

    The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy. PMID:24501463

  1. Limb salvage surgery.

    PubMed

    Kadam, Dinesh

    2013-05-01

    The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy. PMID:24501463

  2. Preoperative computed tomography angiogram to predict patients with favorable anatomy for superficial inferior epigastric artery flap breast reconstruction.

    PubMed

    Piorkowski, James R; DeRosier, Leo C; Nickerson, Paul; Fix, R Jobe

    2011-05-01

    Superficial inferior epigastric artery (SIEA) flap breast reconstruction has advantages over deep inferior epigastric perforator flap (DIEP) and muscle sparing transverse rectus abdominus myocutaneous flap (TRAM) reconstructions with less donor site morbidity and less complicated flap dissection. Not all patients have an adequate SIEA and superficial inferior epigastric vein (SIEV) to support free tissue breast reconstruction, and dissection of the SIEA in all patients can be time consuming. Preoperative computed tomography (CT) angiograms can be used to identify the SIEA and SIEV in patients planning to undergo free abdominal tissue breast reconstruction and direct more efficient dissection in patients with a large SIEA. Retrospective analysis of free abdominal tissue flap breast reconstruction from a single plastic surgeon was performed. All patients undergoing free abdominal tissue breast reconstruction had a preoperative CT angiogram using a protocol for the evaluation of the abdominal wall perforating arteries. CT scans were reviewed by the surgeon preoperatively and evaluated for the presence, caliber, and image quality of the SIEA and SIEV. All patients, regardless of CT angiogram findings, had operative dissection and evaluation of the SIEA and SIEV. A total of 177 free flaps were performed on 113 patients who underwent preoperative CT angiogram and free abdominal tissue breast reconstruction. Of them, 64 patients had bilateral breast reconstruction. Twelve SIEA flaps (10.6%) were performed on 12 patients. During preoperative CT angiographic evaluation, 49 patients (43%) were noted to have at least one visible SIEA, whereas only 24 of those patients (21%) were felt to have an SIEA of adequate caliber. No flaps were lost during the postoperative period. All 12 SIEA flaps performed had an adequate SIEA when observed on preoperative CT angiogram. Overall, 50% of patients found to have at least one adequate SIEA on CT angiogram had a single breast reconstructed with an SIEA flap. If the SIEA was not visualized on CT angiogram, no usable SIEA was found during surgery. Preoperative CT angiogram of the abdominal wall perforating arteries can help predict which patients may have adequate anatomy for an SIEA-based free flap. This information may help direct more efficient dissection of the abdominal flaps by selecting out patients who do not have an adequate SIEA. PMID:21407054

  3. Frontal sinus obliteration with the pericranial flap

    Microsoft Academic Search

    Afshin Parhiscar; Gady Har-El

    2001-01-01

    Background: Frontal sinus obliteration is often accomplished by autologous grafts such as fat, muscle, or bone. These avascular grafts carry an increased risk of resorption and infection as well as donor site morbidity. Vascular regional flaps may be used to obliterate small sinuses with less morbidity. Objectives: To review our experience with the use of the pericranial flap for obliteration

  4. Flapping wing PIV and force measurements

    Microsoft Academic Search

    Benjamin H. Cameron

    2007-01-01

    Flapping wing aerodynamics has been of interest to engineers recently due in part to the DARPA (Defense Advanced Research Projects Agency) MAV (Micro-Aerial Vehicle) initiative. MAVs are small unmanned aerial vehicles with length scales similar to birds and insects. Flapping wing MAVs would serve as mobile and stealthy sensing platforms capable of gathering intelligence in hazardous and physically inaccessible locations.

  5. Massive tears of the rotator cuff treated with a deltoid flap

    Microsoft Academic Search

    Eric Vandenbussche; Moncef Bensaïda; Céline Mutschler; Thierry Dart; Bernard Augereau

    2004-01-01

    We retrospectively reviewed the charts of 29 patients younger than 65 years at surgery treated with deltoid flap reconstruction for massive postero-superior rotator cuff tears. All tears involved supraspinatus and infraspinatus tendons and were associated with tendon stump retraction to the glenoid rim, a preservable long biceps tendon, and an intact subscapularis tendon. Mean follow-up was 10.5 years. Patient satisfaction

  6. First dorsal metacarpal artery flap for thumb reconstruction: a retrospective clinical study

    PubMed Central

    Muyldermans, Thomas

    2009-01-01

    Extensive pulp (zone 4) defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. The first dorsal metacarpal artery flap has been used successfully for defects of the thumb. The innerved first dorsal metacarpal artery flap from the dorsum of the index finger was first described by Hilgenfeldt and refined by Holevich. An island flap carried on a neurovascular pedicle consisting of the first dorsal metacarpal artery was first demonstrated by Foucher and Braun. Seven innervated FDMCA island flaps were performed from May 2005 until July 2007 for thumb reconstruction. There were three women and four men with an average age of 54.9 years (range 28–89 years). The mean follow-up period was 15.4 months (range 4–29 months). The dominant hand was involved in six (85.7%) patients. In a retrospective clinical study, the following criteria were evaluated: (1) etiology of the defect, (2) time of reconstruction (primary vs. delayed), (3) survival rate of flap, (4) sensory function (Semmes–Weinstein monofilaments, static 2-PD, pain, cortical reorientation), (5) TAM measured with the Kapandji index, and (6) subjective patient satisfaction (SF 36). Four patients presented with trauma, two patients with defects after tumor resection and one with infection of the thumb. The flap was used for immediate reconstruction in three (42.9%) patients and for delayed reconstruction in four (57.1%) patients. Delayed reconstruction was performed 4.75 (1–12) months after initial trauma or first surgery. The donor area was grafted with full-thickness skin grafts in all cases. All flaps survived. The mean SWMF was 3.31 g and average statis 2-PD over the flap was 10.57 mm. Pain at the flap scored 3.71 over 10 and at the donor site 2.17 over 10. Paresthesia at the flap scored 0.57 over 4 and at the donor site 0.33 over 4. Complete cortical reorientation was only seen in one patient. The mean Kapandji score of the reconstructed thumb was 7.43 over 10. Using the SF-36, mean physical health of the patients scored 66.88% and mean mental health scored 70.55%. Disturbing pain and paresthesia of the flap are exceptional. The static 2-PD is more than 10 mm, and is clinically over the limit. Cortical reorientation was incomplete in all but one patient. Touch on thumb is felt on the dorsum of the index finger; however, sensation is not disturbing or interfering with the patient’s activities. Foucher described the technique débranchement–rébranchement in order to improve this problem. The postoperative total amount of motion of the reconstructed thumb was very good. The results demonstrated that the FDMCA flap has a constant anatomy and easy dissection. It has a low donor site morbidity if FTSG is used. It also shows good functional and aesthetic results. Therefore, the FDMCA flap is a first treatment of choice for defects of the proximal phalanx and proximal part of the distal phalanx of the thumb. PMID:19340522

  7. The temporo-parietal fascial flap in extended transnasal endoscopic procedures: cadaver dissection and personal clinical experience.

    PubMed

    Bolzoni Villaret, Andrea; Nicolai, Piero; Schreiber, Alberto; Bizzoni, Andrea; Farina, Davide; Tschabitscher, Manfred

    2013-03-01

    Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections. PMID:22996083

  8. Piezoelectrically actuated insect scale flapping wing

    NASA Astrophysics Data System (ADS)

    Mukherjee, Sujoy; Ganguli, Ranjan

    2010-04-01

    An energy method is used in order to derive the non-linear equations of motion of a smart flapping wing. Flapping wing is actuated from the root by a PZT unimorph in the piezofan configuration. Dynamic characteristics of the wing, having the same size as dragonfly Aeshna Multicolor, are analyzed using numerical simulations. It is shown that flapping angle variations of the smart flapping wing are similar to the actual dragonfly wing for a specific feasible voltage. An unsteady aerodynamic model based on modified strip theory is used to obtain the aerodynamic forces. It is found that the smart wing generates sufficient lift to support its own weight and carry a small payload. It is therefore a potential candidate for flapping wing of micro air vehicles.

  9. Energy management - The delayed flap approach

    NASA Technical Reports Server (NTRS)

    Bull, J. S.

    1976-01-01

    Flight test evaluation of a Delayed Flap approach procedure intended to provide reductions in noise and fuel consumption is underway using the NASA CV-990 test aircraft. Approach is initiated at a high airspeed (240 kt) and in a drag configuration that allows for low thrust. The aircraft is flown along the conventional ILS glide slope. A Fast/Slow message display signals the pilot when to extend approach flaps, landing gear, and land flaps. Implementation of the procedure in commercial service may require the addition of a DME navigation aid co-located with the ILS glide slope transmitter. The Delayed Flap approach saves 250 lb of fuel over the Reduced Flap approach, with a 95 EPNdB noise contour only 43% as large.

  10. Lung surgery

    MedlinePLUS

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  11. Umbilical reconstruction using a modified inverted C-V flap with conjoint flaps.

    PubMed

    Lee, Yoonho; Lee, San Ha; Woo, Kevin Volt

    2013-09-01

    The umbilicus is an important aesthetic feature of the abdomen. Because of its location, the umbilicus can be injured after abdominal surgical procedures. Various methods have been devised to reconstruct the umbilicus by using local flaps, purse-string sutures, or a cartilage graft, but there are no ideal methods. The authors have created a modified inverted C-V flap with conjoint flaps. A 10-year-old boy presented with deformed umbilicus because he had undergone surgical correction of an omphalocele. The drawback of the traditional C-V flap method is the transverse long abdominal scar because of the long length of the V flap. However, by using two conjoint flaps at the superior part of the C-V flap, the length of V flap can be more short and the umbilical wall can be reconstructed by rotation of two conjoint flaps. It is also good for making a sinusoidal pocket and it makes the umbilicus deeper and more natural-looking. After the operation, there were no complications like flap necrosis, infection, haematoma, and so on. The patient was satisfied with the results The patient had a more attractive umbilicus than the one with the other previous technique. This new method makes a natural-looking umbilicus with less of a transverse scar and an adequate sinusoidal pocket and umbilical wall. PMID:23829506

  12. Analysis of 22 Posterior Ulnar Recurrent Artery Perforator Flaps: A Type of Proximal Ulnar Perforator Flap

    PubMed Central

    Mateev, Musa A.; Trunov, Leonid; Hyakusoku, Hiko; Ogawa, Rei

    2010-01-01

    Background: The proximal ulnar artery has several branches, including perforators that are directly derived from the ulnar artery and anterior/posterior recurrent arteries. There are only a few reports of flaps that use the anterior/posterior recurrent arteries, and flaps employing their perforators as a main pedicle are yet to be reported. In this study, posterior ulnar recurrent artery perforator (PURAP) flaps were employed for elbow and forearm reconstruction. Methods: The 22 cases of reconstruction by PURAP flaps were analyzed in terms of the cause of injury, the recipient site, the vascular pedicle of the flap, flap size and survival, and the quality of the outcome. Donor-site morbidity, including the development of scars and numbness, was also evaluated. Results: All flaps were vascular pedicled island flaps. The perforator used was the medial and posterior perforator in 14 (63.6%) and 8 (36.4%) cases, respectively. The average flap size was 10 × 5 cm. Six months after the operation, the outcomes were judged to be excellent in 15 cases (68.2%), good in 6 cases (27.3%), and poor in 1 case (4.5%) because of partial necrosis of the distal part of the flap. Conclusions: PURAP flaps can be harvested with 2 types of perforator pedicles (the medial or posterior perforator) and offer greater safety and flexibility, and less donor-site morbidity, than existing flaps used for elbow and forearm reconstruction. The ability to close the donor site primarily is a significant benefit of this flap. PMID:20076784

  13. Transdermally administered nitric oxide by application of acidified nitrite increases blood flow in rat epigastric island skin flaps.

    PubMed

    Gribbe, Orjan; Gustafsson, Lars E; Wiklund, N Peter

    2008-01-01

    Surgical flaps are commonly used in the reconstruction of tissue defects after tumour surgery and trauma. Flap failure continues to be a clinical problem and the underlying causes are not fully understood. In the present study a system that generates nitric oxide (NO) in a non-enzymatic fashion was created through the acidification with vitamin C of a cream containing increasing concentrations (0.125%, 0.25%, 0.5%, 1.25% and 2.5%) of nitrite (NO(2)(-)). The cream was applied for 30 min to a modified epigastric island skin flap in the rat. Blood flow in the supplying artery was measured by transit-time ultrasound flowmetry throughout the experiment and superficial skin blood flow was measured by laser Doppler perfusion imaging before and after treatment. Mean arterial blood pressure was also monitored. NO and the gas nitrogen dioxide (NO(2)), which is formed when NO reacts with atmospheric oxygen, were measured above the cream using chemiluminescence. In flaps treated with the NO generating cream, a concentration-dependent increase in blood flow in the supplying artery and flap skin of up to 130% was observed. Cream base alone or cream base acidified with vitamin C had no effect on blood flow. Also, concentration-dependent formation of both NO and NO(2) was seen. NO increases both supplying artery blood flow and superficial cutaneous blood flow in an epigastric island skin flap model in the rat indicating that NO is of importance in flap physiology and possibly also for flap survival. PMID:17976572

  14. Delineation of LASIK Flaps with Prednisolone Acetate Eyedrops

    PubMed Central

    Fahd, Daoud C; Fahed, Sharbel D

    2014-01-01

    We describe the use and safety of prednisolone acetate eyedrops at the end of laser in situ keratomileusis (LASIK) to aid proper positioning of the corneal flap. The LASIK flap is created using the preferred technique. Following laser ablation and flap repositioning, one drop of prednisolone acetate is instilled on the eye. This delineates the flap “gutters” and allows perfect flap positioning and centration. We used this technique in 425 eyes undergoing LASIK for correction of spherocylindrical refractive errors. Flap margins were adequately delineated intraoperatively. The only complication related to the use of the steroid suspension was crystal deposition under the flap in one case which resolved completely in 48 hours. PMID:24982743

  15. External carotid artery pseudoaneurysm following microvascular free flap reconstruction. The role of endovascular thrombin injection in embolization: a case report and review.

    PubMed

    Islam, S; Ali, M; Avery, C; Hayter, J P

    2014-09-01

    Pseudoaneurysm at the anastomosis of the free flap following ablative head and neck surgery is uncommon. We present a case of external carotid artery pseudoaneurysm in a patient who had previously undergone a subtotal glossectomy, neck dissection, and radial forearm free flap reconstruction. The traditional treatment for pseudoaneurysm has been open surgical repair. Our patient underwent successful treatment with an endovascular embolization utilizing thrombin injection of the aneurysmal sac. This case highlights the role of interventional radiology in the management of this rare but important complication of microvascular reconstructive surgery. PMID:24951176

  16. Histopathological study of corneal flap striae following laser in situ keratomileusis in rabbits

    PubMed Central

    LIU, LI; SONG, FANG-ZHOU; BAO, LIAN-YUN

    2015-01-01

    The aim of the present study was to investigate the histopathological changes and wound healing process of rabbit corneas following conventional laser in situ keratomileusis (LASIK) with and without the complication of flap macrostriae. The right eyes of 14 rabbits underwent LASIK with the formation of flap striae (macrostriae group) and the left underwent LASIK alone (control group). Two rabbits were selected at random for sacrifice on days 1, 3, 7 and 14, and at 1, 3 and 6 months postoperatively. The histopathological characters of the corneas were compared by hematoxylin and eosin (H&E), periodic acid-Schiff (PAS) and Masson staining. In the control group, the epithelial basement membrane of the cornea exhibited microstriae and the arrangement of stromal collagen fibers was regular. The width of the microstriae in the flap was 20–40 ?m one week after surgery and the microstriae were no longer visible two weeks postoperatively. In the macrostriae group, infiltration of polymorphonuclear cells occurred around the incision and irregular hyperplasia of the epithelium was observed due to undulation of the epithelial basement membrane on the first postoperative day. The collagen fibers and striae of the corneal stroma exhibited irregular undulation one month postoperatively. The area between the corneal flap and stromal bed was distinctly stained by PAS and Masson stains. Macrostriae with a width of 80–120 ?m affecting two-thirds of the entire cornea remained visible six months postoperatively. In conclusion, the inflammatory reactions and clinical impact of flap macrostriae were severe. Macrostriae involving two-thirds of the entire cornea remained visible six months postoperatively. Longer-term studies are required to further elucidate the issues associated with corneal flap striae. PMID:25667649

  17. The outcome of our modified double-flap technique for cochlear implantation: A case series of 342 consecutive patients.

    PubMed

    Alzoubi, Firas; Odat, Haitham; Al Omari, Ahmad; Al-Zuraiqi, Bassam

    2015-03-01

    Objectives A lazy S-shaped postauricular incision with a modified double-flap technique has been used for cochlear implant surgery at our institution for the past 10 years. The postoperative surgical complications, morbidity, and outcome of this technique were evaluated. Methods A retrospective case review was conducted in a tertiary referral teaching center. A total of 342 patients with profound sensory hearing loss (173 female and 169 male subjects; age range, 11 months to 52 years) who underwent cochlear implantation using the double-flap postauricular transmastoid surgical approach during a 5-year period (2005 through 2009) with at least 5 years' follow-up were retrospectively evaluated. Postoperative wound complications were identified. Major complications included flap necrosis, wound infection requiring surgical intervention, and wound dehiscence with or without implant exposure. Swelling over the implant and superficial wound infections treated medically were considered minor complications. Other non-wound-related complications, surgical time, and number of electrodes inserted were also recorded. Results The surgical approach was accomplished in all the patients with four minor wound complications. The mean surgical time was 1.4 hours, and the mean time between surgery and the programming process was 2 weeks. Conclusion This modified double-flap technique was easy to perform and appeared to reduce the incidence of wound complications in cochlear implant surgery. It allowed programming of the implant after a shorter period of time. PMID:25029104

  18. Hairy intraoral flap--an unusual indication for laser epilation: a series of 5 cases and review of the literature.

    PubMed

    Shim, Tang Ngee; Abdullah, Anthony; Lanigan, Sean; Avery, Christopher

    2011-10-01

    A variety of the flaps used to reconstruct defects of the head and neck region following surgery for malignant disease contain hair follicles that may result in unwanted hair growth. This can cause significant distress to the patients in a variety of ways. We report 5 cases of significant intraoral hair growth of which 4 cases were successfully managed with long-pulsed alexandrite laser. One patient was not treated due to technical difficulties. We review the literature on the management of hair growth on intraoral flaps. PMID:21306803

  19. Long-term vocal outcomes of refined nerve-muscle pedicle flap implantation combined with arytenoid adduction.

    PubMed

    Kodama, Narihiro; Sanuki, Tetsuji; Kumai, Yoshihiko; Yumoto, Eiji

    2015-03-01

    The objective of this study is to evaluate long-term efficacy of refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) for treatment of unilateral vocal fold paralysis (UVFP). The authors retrospectively reviewed 33 patients with UVFP who received refined NMP flap implantation with AA and were followed up over a 1-year period. Evaluation of vocal fold vibration (regularity, amplitude, and glottal gap), aerodynamic analysis (maximum phonation time [MPT] and mean airflow rate [MFR]), and perceptual evaluation (Grade and Breathiness) were performed preoperatively and at five different time points (1, 3, 6, 12, and 24 months) postoperatively. All voice parameters improved significantly postoperatively. All parameters except MFR also continued to improve over the course of 24 months. In the videostroboscopic analysis, the parameter for regularity 24 months after surgery was significantly improved compared with that at 1, 3, and 6 months after surgery. There were also significant improvements in amplitude and the glottal gap 24 months after surgery in comparison with values at 3 and 6 months after surgery and 3 months after surgery, respectively. Significant improvement in aerodynamic and perceptual measurements during the follow-up period together with near-normal vocal fold vibration was achieved by delayed reinnervation with refined NMP flap implantation and AA. The combined surgical technique is effective in the treatment of severe breathy dysphonia due to UVFP. Level of evidence 4. PMID:25502739

  20. Critical Mach Numbers of Thin Airfoil Sections with Plain Flaps

    NASA Technical Reports Server (NTRS)

    Pardee, Otway O'm.; Heaslet, Max A.

    1946-01-01

    Critical Mach number as function of lift coefficient is determined for certain moderately thick NACA low-drag airfoils. Results, given graphically, included calculations on same airfoil sections with plain flaps for small flap deflections. Curves indicate optimum critical conditions for airfoils with flaps in such form that they can be compared with corresponding results for zero flap deflections. Plain flaps increase life-coefficient range for which critical Mach number is in region of high values characteristic of low-drag airfoils.

  1. Preputial flaps to correct buried penis.

    PubMed

    Chu, Chih-Chun; Chen, Yi-Hsin; Diau, Guan-Yeu; Loh, Ih-Wei; Chen, Ke-Chi

    2007-11-01

    The authors developed a preputial skin flap technique to correct the buried penis which was simple and practical. This simple procedure can be applied to most boys with buried penis. In the last 3 years, we have seen 12 boys with buried penis and have been treated by using preputial flaps. The mean age is about 5.1 (from 3 to 12). By making a longitudinal incision on the ventral side of penis, the tightness of the foreskin is released and leave a diamond-shaped skin defect. It allows the penile shaft to extend out. A circumferential incision is made about 5 mm proximal to the coronal sulcus. Pedicled preputial flaps are obtained leaving optimal penile skin on the dorsal side. The preputial skin flaps are rotated onto the ventral side and tailored to cover the defect. All patients are followed for at least 3 months. Edema and swelling on the flaps are common, but improves with time. None of our patients need a second operation. The preputial flaps technique is a simple technique which allows surgeons to deal with most cases of buried penis by tailoring the flaps providing good cosmetic and functional results. PMID:17828406

  2. Oblique radial forearm reverse-flow flap.

    PubMed

    Akyürek, Mustafa; Safak, Tunç; Keçik, Abdullah

    2003-01-01

    A modifed design for the distally-based radial forearm flap is presented, in an oblique direction rather than longitudinally, based on the existence of skin laxity in the proximal forearm region. The skin paddle of the flap is designed in an oblique fashion pedicled on one of the proximal-row septocutaneous perforators, and elevated in the usual manner supplied by the distal radial artery. The oblique radial forearm flap thus created was successfully utilized for reconstruction of seven dorsal hand defects. Results showed that all the flaps could easily be transposed to the defect through a wide arc of rotation and all survived totally, with direct closure of the donor site in five cases, and significant reduction in size in the remaining two cases. It was concluded that the oblique design for the skin island of the reverse radial forearm flap could allow creation of a flap that has a smaller donor defect and yet presents a longer pedicle length, with a wider arc of rotation and better adaptation to a dorsal hand defect, than a conventional longitudinal-design radial forearm flap. PMID:12582958

  3. [Microscope-integrated intraoperative indocyanine green angiography in plastic surgery].

    PubMed

    Holzbach, T; Artunian, N; Spanholtz, T A; Volkmer, E; Engelhardt, T O; Giunta, R E

    2012-04-01

    The knowledge of tissue perfusion has not only a prognostic value in microvascular surgery but also the intraoperative detection of malperfusion can lead to a quick surgical intervention. Indocyanine green (ICG) angiography allows a topographic analysis of perfusion and is used to assess lymphatic drainage pathways and to analyse the depth of burn injuries. Integrating the technique into an operating microscope enables visualisation of the flow over microanastomoses and allows the assessment of the transit time of blood flow between arterial and venous anastomosis. Using this method we analysed 11 microsurgical free flaps (3 latissimus dorsi, 3 rectus abdominis, 1 gracilis muscle, 2 radial forearm, 1 ALT, and 1 DIEP flap). The topographic analysis was performed after the assessment of the microanastomoses. We observed no flap loss or partial flap necrosis. The transit time between arterial inflow and venous outflow was 32.8 s on average. Here we observed distinct differences between muscle flaps (27.7 s) on the one hand and fasciocutaneous and perforator flaps (47.5 s) on the other hand. We detected one venous thrombosis by ICG angiography in a case where the clinical patency test was not distinct. Revision was performed immediately. Particularly for intraoperative assessment, ICG angiography is a useful, reliable and safe technique. The integration into the operating microscope allows an "angiographic patency test" and the analysis of the transit time allows the evaluation of blood flow within the flap. Especially when planning perforator flaps the method of ICG angiography provides a new level of safety in flap design by quickly demonstrating the borders of perfusion. PMID:22495959

  4. Alternative techniques for pedicle transfer of an island flap and a free flap.

    PubMed

    Classen, Dale A

    2005-01-01

    Alternative techniques for pedicle transfer of a reverse radial forearm flap for hand coverage, and a latissimus dorsi myocutaneous free flap for pelvic wound coverage, are illustrated. Exteriorization of the vascular pedicle of a reverse radial forearm flap allows a greater arc of movement of the flap for more distal coverage, and avoids the potential vascular compromise of tunnelling under a tight skin bridge. Two-stage transfer of a latissimus dorsi myocutaneous free flap on a wrist carrier pedicle may be useful in circumstances when local recipient vessels are inadequate for free flap transfer. Although both of these vascular pedicle modifications have drawbacks, they may be of value in limited circumstances. Their advantages and limitations are discussed. PMID:24223010

  5. The ulnar digital artery perforator flap: A new flap for little finger reconstruction - A preliminary report

    PubMed Central

    Panse, Nikhil; Sahasrabudhe, Parag

    2010-01-01

    An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute. PMID:21217979

  6. Optimum Flapping Wing Motions of Dragonfly

    NASA Astrophysics Data System (ADS)

    Kamisawa, Yuichi; Isogai, Koji

    We studied the optimum flapping wing motions of a dragonfly (Anax parthenope julius) from hovering to cruising flight at various speeds, using a 3D Navier-Stokes code coupled with an optimization algorithm. The minimum necessary power curve and optimum flapping wing motions for the various flight velocities were determined using the optimization algorithm. The minimum power curve shows the typical U-shape. The optimum flapping wing motions were evaluated by comparison with experimental data. Examining the flow patterns showed that the large-scale flow separation around the wings is suppressed at these optimum conditions, except for very low flight speeds including hovering.

  7. The plane problem of the flapping wing

    NASA Technical Reports Server (NTRS)

    Birnbaum, Walter

    1954-01-01

    In connection with an earlier report on the lifting vortex sheet which forms the basis of the following investigations this will show how the methods developed there are also suitable for dealing with the air forces for a wing with a circulation variable with time. The theory of a propulsive wing flapping up and down periodically in the manner of a bird's wing is developed. This study shows how the lift and its moment result as a function of the flapping motion, what thrust is attainable, and how high is the degree of efficiency of this flapping propulsion unit if the air friction is disregarded.

  8. Blended Cutout Flap for Reduction of Jet-Flap Interaction Noise

    NASA Technical Reports Server (NTRS)

    Czech, Michael J (Inventor); Thomas, Russell H. (Inventor)

    2014-01-01

    An aircraft system includes a wing and a trailing edge device coupled to the wing. The trailing edge device is movable relative to the wing, and includes a leading edge and a trailing edge having a center flap portion and a plurality of outer edge portions integrally combined with the center flap portion such that the center flap portion is shorter in width than that of outer edge portions.

  9. Locoregional use of lateral thoracic artery perforator flap as a propeller flap.

    PubMed

    Baghaki, Semih; Cevirme, Mirza; Diyarbakirli, Murat; Tatar, Cihad; Aydin, Yagmur

    2015-05-01

    Although thoracodorsal system is a fundamental source of various flaps, lateral thoracic region has not been a popular flap donor area. There is limited data on the use of lateral intercostal artery perforator flap and lateral thoracic artery perforator flap. In this case series, lateral thoracic artery perforator flap has been used in locoregional (axilla, pectoral region, and arm) reconstruction as an island or propeller flap.Eighteen patients have been operated on between September 2010 and January 2013. The age of the patients ranged between 16 and 68 years with a median of 38 years. A thorough chart review has been performed with preoperative and postoperative photographs. Duration of hospitalization, complication rate and long term results have been documented.Nine patients had severe burn contracture of axilla, 7 patients had axillary hidradenitis suppurativa, 1 patient had giant neurofibroma of arm, and 1 patient had malignant peripheral nerve sheath tumor of pectoral area. Seventeen flaps survived totally, and in 1 flap, distal superficial slough of skin has been observed. No recurrence in hidradenitis or peripheral nerve sheath tumor has been observed. Donor site scar is well hidden in anatomical position. The range of motion of affected extremities returned to normal after reconstruction.Lateral thoracic area provides a reliable flap option with a wide arc of rotation when lateral thoracic artery perforators are used. PMID:25875722

  10. Sectioned images and surface models of a cadaver for understanding the deep circumflex iliac artery flap.

    PubMed

    Kim, Bong Chul; Chung, Min Suk; Kim, Hyung Jun; Park, Jin Seo; Shin, Dong Sun

    2014-03-01

    The aim of this study was to describe the deep circumflex iliac artery (DCIA) flap from sectioned images and stereoscopic anatomic models using Visible Korean, for the benefit of medical education and clinical training in the field of oromandibular reconstructive surgery. Serially sectioned images of the pelvic area were obtained from a cadaver. Outlines of significant structures in the sectioned images were drawn and stacked to build surface models. The PDF (portable document format) file (size, 30 MB) of the constructed models is available for free download on the Web site of the Department of Anatomy at Ajou University School of Medicine (http://anatomy.co.kr). In the PDF file, the relevant structures of the DCIA flap can be seen in the sectioned images. All surface models and stereoscopic structures associated with the DCIA flap are displayed in real time. We hope that these state-of-the-art sectioned images, outlined images, and surface models will help students and trainees better understand the anatomy associated with DCIA flap. PMID:24621709

  11. Simultaneous bilateral breast reconstruction with the transverse rectus abdominus musculocutaneous free flap.

    PubMed Central

    Khouri, R K; Ahn, C Y; Salzhauer, M A; Scherff, D; Shaw, W W

    1997-01-01

    OBJECTIVE: The purpose of the study was to assess the results and morbidity associated with simultaneous bilateral TRAM free flap breast reconstruction and describe refinements in its surgical technique. SUMMARY BACKGROUND DATA: Bilateral prophylactic total mastectomies might be an agreeable option for those patients at highest risk for breast cancer if autogenous tissue breast reconstruction could be performed with reasonable technical ease and acceptable morbidity. However, some surgeons harbor reservations regarding the extensiveness of the surgery, the associated morbidity, and the aesthetic quality of the resulting outcome. METHODS: A multicenter retrospective review of clinical experience with 120 consecutive patients who underwent 240 simultaneous bilateral TRAM free flap breast reconstructions was developed. RESULTS: The average operating time, including the time required for the breast ablative portion of the procedures, was 8.6 hours. The average length of hospitalization was 7.6 days. However, for the last 40 patients, these figures were reduced to 7.1 hours and 6.1 days, respectively. Nonautologous blood transfusions were needed in 33 cases (28%), but only 1 was required in the last 40 patients. Thromboses developed in six of 240 flaps (2.5%): 4 were arterial and 2 were venous. Re-exploration allowed us to restore circulation in five flaps, whereas one flap was unsalvageable and was replaced successfully with an alternate flap. An uncomplicated deep vein thromboses developed in one patient with a history of recurrent deep vein thromboses that had no adverse effect on her outcome. Minor complications developed in 18 patients (15%) (e.g., hematoma, partial wound necrosis, wound infection, or prolonged postoperative ileus) that did not affect the long-term outcome. Fourteen patients (11.6%) had abdominal wall weakness or hernias. Follow-up time averaged 37.2 months (range, 14-62 months). On last follow-up, patients' self-reported overall satisfaction with the procedure was 56% excellent, 40% good, and 4% fair.CONCLUSIONS: Simultaneous bilateral free flap reconstruction is technically feasible with a high rate of success and an acceptable morbidity. When performed by experienced surgeons, bilateral prophylactic total mastectomies combined with simultaneous bilateral TRAM free flap reconstruction may provide an adequate surgical option with aesthetically acceptable results for patients at high risk for breast cancer. Images Figure 1. Figure 4. Figure 5. Figure 6. PMID:9242334

  12. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction...interconnection. (a) The main wing flaps and related movable...flight characteristic of the airplane is extremely improbable; or (b) The airplane must be shown to...

  13. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction...interconnection. (a) The main wing flaps and related movable...flight characteristic of the airplane is extremely improbable; or (b) The airplane must be shown to...

  14. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction...interconnection. (a) The main wing flaps and related movable...flight characteristic of the airplane is extremely improbable; or (b) The airplane must be shown to...

  15. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction...interconnection. (a) The main wing flaps and related movable...flight characteristic of the airplane is extremely improbable; or (b) The airplane must be shown to...

  16. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction...interconnection. (a) The main wing flaps and related movable...flight characteristic of the airplane is extremely improbable; or (b) The airplane must be shown to...

  17. Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection

    PubMed Central

    Takaku, Mitsuru; Matsuo, Shinji; Abe, Yoshiro; Harada, Hiroshi; Nagae, Hiroaki; Fujioka, Yusuke; Anraku, Kuniaki; Inagawa, Kiichi; Nakanishi, Hideki

    2014-01-01

    Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study. PMID:24883276

  18. Tandem Rhomboid Flap Repair: A New Technique in Treatment of Extensive Pilonidal Disease of the Natal Cleft

    PubMed Central

    Kumar M, Kamal; Babu K, Ramesh; Dhanraj, Prema

    2014-01-01

    Pilonidal sinus is an annoying chronic benign disease causing disability in young adults, mainly affecting the intergluteal furrow. Treatment of this condition remains controversial and is represented by a myriad of techniques available. Most of the techniques are judged against open excision and secondary healing in terms of minimizing disease recurrence and patient discomfort. More recently superiority of flap reconstruction to non-flap techniques is accepted. An ideal operation should be simple, associated with minimal pain and wound care after surgery, minimize hospital stay and have a low recurrence rate. We hereby present a new type of rhomboid flap technique for an extensive pilonidal sinus disease. This technique has given good results in our hands considering the aforementioned factors of an ideal operation. The following case report is of our first stint with the procedure. PMID:25386481

  19. Lower extremity free flaps: a review

    PubMed Central

    Wells, Mark D.; Bowen, C. Vaughan; Manktelow, Ralph T.; Graham, John; Boyd, J. Brian

    1996-01-01

    Objective To identify factors related to free-flap coverage of lower extremity fractures that are linked to a negative outcome. Design A chart review. Setting A large microsurgical referral centre. Patients From 1981 to 1989, the records of all patients who underwent free-tissue transfer to the lower extremity with more than 1 year of follow-up were selected. From this was drawn a subgroup of 49 patients (mean age, 36 years) who had tibial fractures (55% were motor vehicle injuries) and in almost all cases established soft-tissue or bony defects. They formed the study group. Intervention Free-flap transfer. Outcome Measures Factors that might be associated with free-flap failure: mechanism of injury, grade of tibial fracture, history of smoking, diabetes, peripheral vascular disease, ischemic heart disease, vascular compromise in the leg preoperatively, recipient artery used, type of anastomosis, and hypertension or hypotension intraoperatively. Results Type IIIB tibial fractures were the most frequent (67%) and carried a significantly (p = 0.02) higher risk of free-flap failure than other types of fracture. Patients underwent a mean of four procedures before referral for free-tissue transfer. The mean time from injury to flap coverage was 1006 days. Stable, long-term coverage of the free flaps was achieved in 78% of patients. Wound breakdown was most often caused by recurrent osteomyelitis (65%). Seventy-four percent of the fractures healed. The amputation rate was 10%. Four patients required repeat free-flap transfer for limb salvage. Conclusion Only the grade of tibial fracture could be significantly related to postoperative free-flap failure. PMID:8640624

  20. Aerodynamic effects of flexibility in flapping wings

    PubMed Central

    Zhao, Liang; Huang, Qingfeng; Deng, Xinyan; Sane, Sanjay P.

    2010-01-01

    Recent work on the aerodynamics of flapping flight reveals fundamental differences in the mechanisms of aerodynamic force generation between fixed and flapping wings. When fixed wings translate at high angles of attack, they periodically generate and shed leading and trailing edge vortices as reflected in their fluctuating aerodynamic force traces and associated flow visualization. In contrast, wings flapping at high angles of attack generate stable leading edge vorticity, which persists throughout the duration of the stroke and enhances mean aerodynamic forces. Here, we show that aerodynamic forces can be controlled by altering the trailing edge flexibility of a flapping wing. We used a dynamically scaled mechanical model of flapping flight (Re ? 2000) to measure the aerodynamic forces on flapping wings of variable flexural stiffness (EI). For low to medium angles of attack, as flexibility of the wing increases, its ability to generate aerodynamic forces decreases monotonically but its lift-to-drag ratios remain approximately constant. The instantaneous force traces reveal no major differences in the underlying modes of force generation for flexible and rigid wings, but the magnitude of force, the angle of net force vector and centre of pressure all vary systematically with wing flexibility. Even a rudimentary framework of wing veins is sufficient to restore the ability of flexible wings to generate forces at near-rigid values. Thus, the magnitude of force generation can be controlled by modulating the trailing edge flexibility and thereby controlling the magnitude of the leading edge vorticity. To characterize this, we have generated a detailed database of aerodynamic forces as a function of several variables including material properties, kinematics, aerodynamic forces and centre of pressure, which can also be used to help validate computational models of aeroelastic flapping wings. These experiments will also be useful for wing design for small robotic insects and, to a limited extent, in understanding the aerodynamics of flapping insect wings. PMID:19692394

  1. Preputial flaps to correct buried penis

    Microsoft Academic Search

    Chih-Chun Chu; Yi-Hsin Chen; Guan-Yeu Diau; Ih-Wei Loh; Ke-Chi Chen

    2007-01-01

    The authors developed a preputial skin flap technique to correct the buried penis which was simple and practical. This simple\\u000a procedure can be applied to most boys with buried penis. In the last 3 years, we have seen 12 boys with buried penis and have\\u000a been treated by using preputial flaps. The mean age is about 5.1 (from 3 to 12).

  2. Propulsive device of the flapping wing type

    NASA Astrophysics Data System (ADS)

    Gorelov, D. N.

    2014-11-01

    Problems associated with the development of a propulsive device of the flapping wing type are discussed. Specific features of an unsteady flow around such a wing and the influence of its geometric parameters and the law of wing flapping on the thrust force and hydrodynamic efficiency are analyzed. Formulas for calculating the thrust force at high Strouhal numbers are derived. Some configurations of propulsive devices and possible applications are considered.

  3. The use of prefabrication technique in microvascular reconstructive surgery

    PubMed Central

    Maciejewski, Adam; Szymczyk, Cezary; Wierzgo?, Janusz; Szumniak, Ryszard; J?drzejewski, Piotr; Grajek, Maciej; Dobrut, Miros?aw; Ulczok, Rafa?; Pó?torak, Stanis?aw

    2013-01-01

    Aim of the study The aim of the study was to develop standards for the prefabrication of free microvascular flaps in an animal model, followed by their application in clinical practice, and quantitative/qualitative microscopic assessment of the extent of development of a new microvascular network. Material and methods The study was carried out in 10 experimental pigs. As the first stage, a total of 20 prefabricated flaps were created using polytetrafluoroethylene (PTFE) as a support material, placed horizontally over an isolated and distally closed vascular pedicle based on superficial abdominal vessels. After completing the animal model study, one patient was selected for the grafting of the prefabricated free flap. Results All 20 free flaps prefabricated in the animal model were analyzed microscopically, exhibiting connective tissue rich in fibroblasts and small blood vessels in the porous areas across the entire thickness of the PTFE element. Conclusions Flap prefabrication is a new and fast developing reconstruction technique. The usefulness of prefabrication techniques and their status in reconstructive surgery still needs to be investigated experimentally and clinically. The method based on prefabricated free flaps is the first step towards anatomical bioengineering that will make it possible to replace missing organs with their anatomically perfect equivalents. PMID:23788942

  4. Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy

    PubMed Central

    Deka, Amarendra; Saikia, S. P.; Bhuyan, S. K.

    2010-01-01

    Background: External dacryocystorhinostomy (DCR) remains a reliable surgical technique for the treatment of obstruction of lacrimal drainage system beyond the common canalicular opening. Aim: To describe a simple modified double flap external DCR technique. Materials and Methods: Ninety six consecutive cases of chronic dacryocystitis with or without mucocele were selected irrespective of age and sex. In a modification to routine external DCR, a modified technique was followed, where both anterior and posterior flaps of lacrimal sac and nasal mucosa are created and sutured. Two double armed sutures were used to join the edges of anterior flaps, and elevate them anteriorly to avoid adhesion or apposition with underlying sutured posterior flaps, and to approximate the deep plane of the wound. Results: At the end of average follow-up period of 13 months, we observed 98.9% objective and 96.8% subjective success rates. The average operation time was 45 minutes. No significant intraoperative or postoperative complications were noticed. Conclusion: We believe that combined posterior flap and anterior suspended flap DCR technique is simple to perform and has the advantage of both double flap DCR and anterior suspension of anterior flaps. The results of the study showed the efficacy of this simple modification. PMID:20606867

  5. The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

    PubMed

    Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

    2015-01-01

    The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time. PMID:25606493

  6. An alternative approach in the treatment of Dupuytren's contracture skin defects: first dorsal metacarpal artery island flap.

    PubMed

    Ozdemir, Oguz; Coskunol, E; Ozalp, T

    2004-03-01

    Skin defects are often present following surgery for Dupuytren's contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytren's contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger. PMID:16518236

  7. The Axillary Approach to Raising the Latissimus Dorsi Free Flap for Facial Re-Animation: A Descriptive Surgical Technique

    PubMed Central

    Butler, Daniel; Grobbelaar, Adriaan

    2015-01-01

    The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time. PMID:25606493

  8. Design and experimental results for a turbine with jet flap stator and jet flap

    NASA Technical Reports Server (NTRS)

    Bettner, J. L.; Blessing, J. O.

    1973-01-01

    The overall performance and detailed stator performance of a negative hub reaction turbine design featuring a moderately low solidity jet flap stator and a jet flap rotor were determined. Testing was conducted over a range of turbine expansion ratios at design speed. At each expansion ratio, the stator jet flow and rotor jet flow ranged up to about 7 and 8 percent, respectively, of the turbine inlet flow. The performance of the jet flap stator/jet flap rotor turbine was compared with that of a turbine which used the same jet flap rotor and a conventional, high solidity plan stator. The effect on performance of increased axial spacing between the jet stator and rotor was also investigated.

  9. Cosmetic Surgery

    MedlinePLUS

    ... keep in mind if you are thinking about plastic surgery: Talk to your parents or guardians about any ... and is certified by the American Board of Plastic Surgery. Some doctors won’t perform certain procedures if ...

  10. Plastic Surgery

    MedlinePLUS

    ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ... two such treatments. Continue Why Do Teens Get Plastic Surgery? Most teens don't, of course. But ...

  11. Cataract Surgery

    MedlinePLUS Videos and Cool Tools

    ... truck driver from Chandler, Arizona, is having cataract surgery today on his left eye. A month ago ... anesthesia to numb the eye area. With microscopic surgery the surgeon can make a very small incision, ...

  12. Turbinate surgery

    MedlinePLUS

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  13. The free sartorius flap: clinical cases and anatomical study.

    PubMed

    Ng, Darren; Vesely, Martin

    2012-12-01

    The thigh is a rich source of tissue for free flap harvest. The anterolateral thigh and gracilis flaps are most commonly used. The sartorius flap is an easily harvested flap that can be raised with the leg in the anatomically extended position without rotation. The cutaneous landmarks are readily identified and so the relevant perforators can be quickly found. Pedicle dissection is quick and easy, allowing the flap to be raised in a short time. We report our experience of using this flap both as a free muscle-only flap and as a free fasciocutaneous perforator flap for soft-tissue reconstruction in the lower limb. An anatomical study was also carried out to examine the vascular anatomy of the sartorius muscle flap and the cutaneous perforator flap. Twenty limbs from soft fixed adult cadavers were dissected and the position, length, diameter and cutaneous extension of all segmental pedicles, from the anterior superior iliac spine (ASIS) to the medial femoral condyle, were measured. Fourteen out of 20 (70%) sartorius muscles had at least one musculocutaneous perforator and, of these muscles, 13 (93%) had at least one musculocutaneous perforator that was found at 20±3cm from the ASIS. The free sartorius flap is a useful addition to flap choice from the thigh and carries a predictable cutaneous perforator in the majority of cases, allowing a fasciocutaneous perforator flap to be quickly and reliably raised with minimal donor-site morbidity. PMID:22771162

  14. Quantitative assessment of partial vascular occlusions in a swine pedicle flap model using spatial frequency domain imaging

    PubMed Central

    Ponticorvo, Adrien; Taydas, Eren; Mazhar, Amaan; Scholz, Thomas; Kim, Hak-Su; Rimler, Jonathan; Evans, Gregory R. D.; Cuccia, David J.; Durkin, Anthony J.

    2013-01-01

    The use of tissue transfer flaps has become a common and effective technique for reconstructing or replacing damaged tissue. While the overall failure rate associated with these procedures is relatively low (5-10%), the failure rate of tissue flaps that require additional surgery is significantly higher (40-60%). The reason for this is largely due to the absence of a technique for objectively assessing tissue health after surgery. Here we have investigated spatial frequency domain imaging (SFDI) as a potential tool to do this. By projecting wide-field patterned illumination at multiple wavelengths onto a tissue surface, SFDI is able to quantify absolute concentrations of oxygenated and deoxygenated hemoglobin over a large field of view. We have assessed the sensitivity of SFDI in a swine pedicle flap model by using a controlled vascular occlusion system that reduced blood flow by 25%, 50%, 75%, or 100% of the baseline values in either the vein or artery. SFDI was able to detect significant changes for oxygenated hemoglobin, deoxygenated hemoglobin, or tissue oxygen saturation in partial arterial occlusions of at least 50% and partial venous occlusions of at least 25%. This shows SFDI is sensitive enough to quantify changes in the tissue hemoglobin state during partial occlusions and thus has the potential to be a powerful tool for the early prediction of tissue flap failure. PMID:23412357

  15. Reconstruction of a circular defect of the hypopharynx and cervical part of esophagus by a free jejunal flap (case report).

    PubMed

    Palencár, D; Hedera, J; Fedeles, J; Dolezal, J; Pind'ák, D

    2005-01-01

    Patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx closure in an oncology patient with a larynx carcinoma. The patient is a 60-year-old male diagnosed in 2002 with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy and chemotherapy. In 2003 the patient underwent pharyngo - laryngectomy for relapse of the larynx carcinoma. Postoperatively the patient developed pharyngo - cutaneous fistula, which was reconstructed at the otorhinolaryngology department by a muscle - cutaneous flap from the pectoralis major muscle. During the course of healing the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended. The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to restart peroral intake. PMID:16035154

  16. Advancement flap as a novel treatment for a pododermatitis lesion in a red-tailed hawk (Buteo jamaicensis).

    PubMed

    Sander, Samantha; Whittington, Julia K; Bennett, Avery; Burgdorf-Moisuk, Anne; Mitchell, Mark A

    2013-12-01

    Pododermatitis is a pathologic condition commonly reported in captive raptors and characterized by swelling, excoriation, ulceration, cellulitis, or abscessation of the plantar aspect of the foot. Its cause can be multifactorial, often involving abnormal weight bearing or poor sanitation, and medical and surgical techniques, in addition to environmental alterations, are hallmarks of treatment. In this case, a single pedicle advancement flap was used to treat chronic, nonresponsive grade V/VII pododermatitis of the right metatarsal pad in a red-tailed hawk (Buteo jamaicensis). The advancement flap was formed by using the interdigital skin between digits 3 and 4. The double layer of skin was incised and separated, and the leading edge of the flap was then advanced over the defect and secured with simple interrupted subcutaneous and skin sutures. The foot was bandaged after surgery to take pressure off the surgical site. At 58 days after the surgery, the hawk was deemed medically sound with no signs of pododermatitis and was released to a wildlife rehabilitator. The use of a single pedicle advancement flap has not previously been reported for the treatment of pododermatitis. PMID:24640931

  17. The Internal Pudendal Artery Perforator Thigh Flap: A New Freestyle Pedicle Flap for the Ischial Region

    PubMed Central

    Goishi, Keiichi; Abe, Yoshiro; Takaku, Mitsuru; Seike, Takuya; Harada, Hiroshi; Nakanishi, Hideki

    2014-01-01

    Background: Recurrence and complication rates of pressure sores are highest in the ischial region, and other donor sites are needed for recurrent pressure sores. The potential of a new freestyle pedicle flap for ischial lesions, an internal pudendal artery perforator (iPap) thigh flap, was examined through anatomical and theoretical analyses and a case series using computed tomography angiography. Methods: The skin flap was designed in the thigh region based on an iPap. The skin perforators were marked with a Doppler probe. One patient underwent computed tomography angiography with fistulography to identify the damage to or effects on the pedicle vessels of the flap. Debridement of ischial lesions and flap elevation were performed in the jackknife position. Results: The iPap thigh flaps were performed in 5 patients, 4 with ischial pressure sores and 1 with calcinosis cutis of the ischial region. The width and length of the flaps ranged from 5 to 8?cm (mean, 6.6?cm) and 10 to 17?cm (mean, 12.6?cm), respectively. Three patients underwent partial osteotomy of the ischial bone. No complications, including flap necrosis or wound dehiscence of the donor and reconstructed sites, were observed. Conclusions: The perforator vessels of the internal pudendal artery are very close to the ischial tuberosity. Blood flow to the flap is reliable when careful debridement of the pressure sore is performed. The iPap thigh flap is a new option for soft-tissue defects in the ischial region, including ischial pressure sores. PMID:25289335

  18. Use of a preputial circumferential mucosal flap for hypospadias management in a Boston terrier.

    PubMed

    Grossman, J; Baltzer, W

    2012-05-01

    An eight-week-old male Boston terrier presented for penile desiccation and urine pooling in the prepuce due to congenital hypospadias. An advancement flap was created from the dorsal mucosa of the incompletely formed prepuce and sutured circumferentially to construct a longer distal preputial mucosa. V- to Y-plasty of the ventral abdominal skin was utilised to create the preputial skin overlying the mucosal flap. Urethrostomy and partial penile amputation were also performed. Following surgery, the clinical signs of penile desiccation and preputial urine pooling resolved and acceptable cosmetic appearance was achieved. This technique may be considered for glandular or penile hypospadias or following resection of the ventral aspect of the distal prepuce when inadequate tissue is present for a simple two-layer closure of the preputial mucosa and skin. PMID:22276748

  19. The use of bone anchors for autologous flap fixation in perineal reconstruction: a case report

    PubMed Central

    Saad, Adam; Cece, John A.; Arvanitis, Michael L.; Elkwood, Andrew I.

    2013-01-01

    The purpose of this case report is to demonstrate the use of bone anchors with an autologous flap in perineal reconstruction. This technique has not been reported before. A 64-year-old female presented to our office with a chief complaint of perineal hernia 1.5 years after abdominoperineal resection. She had a history of recurrent rectal cancer for which she received chemotherapy, radiation and surgery. To repair the hernia, a standard vertical rectus abdominismyocutaneous was harvested and de-epithelialized. It was secured into place in the pelvis utilizing several bone anchors. Mesh was used to repair the donor site defect. At 18 month follow-up, there was good healing of all the wounds and no recurrence of the hernia. She was pain free and able to resume her activities of daily living. Bone anchor fixation is a viable technique for fixation of autologous flaps in perineal reconstruction. PMID:24964462

  20. Hemimandibulectomy and vascularized fibula flap in bisphosphonate-induced mandibular osteonecrosis with polycythaemia rubra vera.

    PubMed

    Ghazali, N; Collyer, J C; Tighe, J V

    2013-01-01

    This report presents the successful management of an advanced and refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) by hemimandibulectomy and an osteocutaneous fibula flap reconstruction in a patient with polycythaemia rubra vera, a rare haematological condition in which there is increased risk of thrombosis and haemorrhage. Union of the vascularized bone with the mandible depends on obtaining a BRONJ-free margin and rigid fixation of the bony ends. Magnetic resonance imaging can provide accurate delineation of necrotic bone and area of osteomyelitis. Placement of a 1cm margin beyond this can envisage a BRONJ-free margin. Aggressive medical management of polycythaemia rubra vera by venesection, asprin and cytoreduction therapy along with anticoagulant prophylaxis against thromboembolic events in the first 2 weeks following major surgery can provide the basis of a good surgical and flap outcome. Nevertheless, the possibility of unpredictable haemorrhage must be considered throughout. PMID:22520725

  1. Indications, Outcomes, and Complications of Pedicled Propeller Perforator Flaps for Upper Body Defects: A Systematic Review

    PubMed Central

    Lazzeri, Davide; Huemer, Georg M.; Nicoli, Fabio; Larcher, Lorenz; Dashti, Talal; Grassetti, Luca; Li, Qingfeng; Spinelli, Giuseppe; Agostini, Tommaso

    2013-01-01

    Background The aim of this investigation was to systematically review the current literature to provide the best data for indications, outcomes, survival, and complication rates of pedicled propeller perforator flaps for upper body defects. Methods A comprehensive literature review for articles published from January 1991 to December 2011 was performed using the PubMed, Medline, and Cochrane Databases. Articles without available full-text, single case reports or papers with excessive missing data were excluded. Papers reporting pedicle-perforator (propeller) flaps used for lower extremity reconstruction were excluded from meta-analysis. Results From the initial 1,736 studies our search yielded, 343 studies qualified for the second stage of selection. Of 117 full-text reports screened, 41 studies, met the definitive inclusion and exclusion criteria. Of the selected 41 articles, 26 were case series, original papers or retrospective reviews and were included, whereas 15 were case report papers and therefore were excluded. Two hundred ninety-five propeller flaps were reported to have been used in a total of 283 patients. Indications include repair of trauma-induced injuries, post-trauma revision surgery, cancer resection, chronic infection, pressure sores, and chronic ulcers with a major complication rate (3.3%) comparable to that of free flaps. No specific exclusion criteria for the procedure were presented in the studies reviewed. Conclusions Pedicled propeller flaps are a versatile and safe reconstructive option that are easy and quick to raise and that provide unlimited clinical solutions because of the theoretical possibility of harvesting them based on any perforator chosen among those classified in the body. PMID:23362479

  2. Muscle-Sparing TRAM Flap Does Not Protect Breast Reconstruction from Post-Mastectomy Radiation Damage Compared to DIEP Flap

    PubMed Central

    Garvey, Patrick B.; Clemens, Mark W.; Hoy, Austin E.; Smith, Benjamin; Zhang, Hong; Kronowitz, Steven J.; Butler, Charles E.

    2014-01-01

    BACKGROUND Radiation to free flaps following immediate breast reconstruction has been shown to compromise outcomes. We hypothesized that irradiated muscle-sparing free transverse rectus abdominis musculocutaneous (MS FTRAM) flaps experience less fat necrosis than irradiated deep inferior epigastric perforator (DIEP) flaps. METHODS We performed a retrospective study of all consecutive patients undergoing immediate, autologous, abdominal-based free flap breast reconstruction with MS FTRAM or DIEP flaps over a 10-year period at The University of Texas MD Anderson Cancer Center. Irradiated flaps (external-beam radiation therapy) after immediate breast reconstruction were compared to non-irradiated flaps. Logistic regression analysis was used to identify potential associations between patient, tumor, and reconstructive characteristics and surgical outcomes. RESULTS A total of 625 flaps were included in the analysis: 40 (6.4%) irradiated vs. 585 (93.6%) non-irradiated. Mean follow-up for the irradiated vs. non-irradiated flaps was 60.0 months and 48.5 months, respectively (p=0.02). Overall complication rates were similar for both the irradiated and non-irradiated flaps. Irradiated flaps (i.e., both DIEP and MS FTRAM flaps) developed fat necrosis at a significantly higher rate (22.5%) than the non-irradiated flaps (9.2%; p=0.009). There were no differences in fat necrosis rates between the DIEP and MS FTRAM flaps in both the irradiated and non-irradiated groups. CONCLUSIONS Both DIEP and MS FTRAM flap reconstructions had much higher rates of fat necrosis when irradiated. Contrary to our hypothesis, we found that immediate breast reconstruction with an MS FTRAM flap does not result in a lower rate of fat necrosis than reconstruction with a DIEP flap. PMID:24469158

  3. Treatment of unfavourable results of flexor tendon surgery: Skin deficiencies

    PubMed Central

    Elliot, David; Giesen, Thomas

    2013-01-01

    We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled ‘What is secondary flexor tendon surgery’? This study concluded that ‘secondary flexor tendon surgery’ was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that ‘any flap will do’ provided the flexors are adequately covered. PMID:24501469

  4. Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

    PubMed Central

    Hirschberg, Jen?

    2012-01-01

    Velopharyngeal insufficiency (VPI) means that the velopharyngeal closure is inadequate or disturbed. VPI may be organic or functional, congenital or acquired and is caused by structural alterations or paresis. The symptoms are primarily to be found in speech (hypernasality), more rarely in swallowing and hearing. The management types are as follows: speech therapy, surgery, speech bulb, and others. Surgery is indicated if the symptoms of VPI cannot be improved by speech therapy. Among the operative methods, velopharyngoplasty constitutes the basis of the surgery. The pharyngeal flap was incorporated and survived in 98.1% of the cases, hyperrhinophony disappeared or became minimal in 90% after surgery in our material (1104 cases). The speech results seemed to be the same with superiorly or inferiorly based pharyngeal flap. The Furlow technique, push-back procedure, the sphincteroplasty, and the augmentation were indicated by us if the VP gap was less than 7?mm; these methods may also be used as secondary operation. We observed among 1104 various surgeries severe hemorrhage in 5 cases, aspiration in 2 cases, significant nasal obstruction in 68 patients, OSAS in 5 cases; tracheotomy was necessary in 2 cases. Although the complication rate is rare, it must always be considered that this is not a life-saving but a speech-correcting operation. A tailor-made superiorly based pharyngeal flap is suggested today, possibly in the age of 5 years. PMID:23724266

  5. Reconstruction of complex defects with composite calvarial flaps

    Microsoft Academic Search

    A. T. Tellio?lu; S. Çelebio?lu; C. Baran; U. Koçer; O. ?ensöz

    1996-01-01

    Over the past four years, composite calvarial flaps have been used to reconstruct complex defects in 14 patients. In three of the patients they were free flaps for hand reconstruction. Clinical application (technical details) and complications are also discussed.

  6. Analytical study of vortex flaps on highly swept delta wings

    NASA Technical Reports Server (NTRS)

    Frink, N. T.

    1982-01-01

    This paper highlights some current results from ongoing analytical studies of vortex flaps on highly swept delta wings. A brief discussion of the vortex flow analysis tools is given along with comparisons of the theories to vortex flap force and pressure data. Theoretical trends in surface pressure distribution for both angle-of-attack variation and flap deflection are correctly predicted by Free Vortex Sheet theory. Also shown are some interesting calculations for attached-flow and vortex-flow flap hinge moments that indicate flaps utilizing vortex flow may generate less hinge moment than attached flow flaps. Finally, trailing-edge flap effects on leading-edge flap thrust potential are investigated and theory-experiment comparisons made.

  7. Flapping wing PIV and force measurements

    NASA Astrophysics Data System (ADS)

    Cameron, Benjamin H.

    Flapping wing aerodynamics has been of interest to engineers recently due in part to the DARPA (Defense Advanced Research Projects Agency) MAV (Micro-Aerial Vehicle) initiative. MAVs are small unmanned aerial vehicles with length scales similar to birds and insects. Flapping wing MAVs would serve as mobile and stealthy sensing platforms capable of gathering intelligence in hazardous and physically inaccessible locations. Traditional means of lift and thrust generation become inefficient when scaled to these sizes, therefore a flapping wing propulsion system will be necessary. The design of a flapping wing MAV requires the ability to measure forces and velocities around the wing. Three components of velocity were measured in the wake of a two dimensional (2D) flapping airfoil model using a novel application of stereoscopic DPIV (Digital Particle Image Velocimetry). One component of force was measured using a newly proposed method outlined in the dissertation. The force measurement technique relies on a specific sequence of data acquisition, which has the benefit of reducing measurement uncertainty and noise. No experiments of this type have been conducted, and no direct aerodynamic force data exists for the low Reynolds numbers applicable to flapping wing MAVs. The well-established stereoscopic DPIV technique produces relatively low uncertainties while the new force measurement technique has not been previously tested. Theoretical analysis and experimental results show that aerodynamic forces are attainable for chord Reynolds numbers as low as 1,000, which is significantly lower than previous studies. PIV measurements reveal symmetric and asymmetric wake topologies for a NACA 0012 and flat plate airfoil. A sinusoidally heaving flat plate airfoil produces highly deflected wakes for a wider range of flapping conditions than a NACA 0012 airfoil. Deflected wakes are of potentially interest since both lift and thrust components of force are developed. The flat plate also produces larger aerodynamic forces as measured perpendicularly to the free stream velocity. Experimental data for the NACA airfoil compares favorably with a computational fluid dynamics model of a 2D flapping airfoil at similar flapping conditions. Qualitative flow topologies and quantitative velocity and force magnitudes agree with a high degree of certainty.

  8. Effect of flapping trajectories on the dragonfly aerodynamics

    Microsoft Academic Search

    Jinliang Xu; Chuangxin Zhao; Yongli Zhang; Yang Zhang

    2006-01-01

    The effects of translational, figure-eight and double-figure-eight flapping trajectories on the dragonfly aerodynamics were\\u000a numerically studied by solving the Navier-Stokes equations. There is a common characteristic regarding the lift\\/drag force\\u000a coefficients that the downstroke flapping provides the lift forces while the upstroke flapping creates the thrust forces for\\u000a different flapping trajectories. The maximum lift force coefficient exceeds five for the

  9. Hypospadias repair using a double onlay preputial flap

    Microsoft Academic Search

    T. W. Chin; C. S. Liu; C. F. Wei

    2001-01-01

    From an anatomical view, a more reasonable blood supply can be achieved in hypospadias repair using a double-faced onlay\\u000a flap. A urethroplasty was performed in 15 patients with middle or posterior hypospadias using a double-faced onlay preputial\\u000a flap (DOPF). In this method, the urethral plate is preserved and a double-faced preputial flap is developed. The inner face\\u000a of the flap

  10. Free groin flap in hemifacial volume reconstruction.

    PubMed

    Cobb, Alistair R M; Koudstaal, Maarten J; Bulstrode, Neil W; Lloyd, Timothy W; Dunaway, David J

    2013-06-01

    Use of the free groin flap, one of the first microvascular free flaps described, has been neglected recently because it has a short pedicle and varies anatomically. However, we have found its anatomical features and type of tissue ideal for volumetric enhancement in severe hemifacial asymmetry. We present a retrospective review of a consecutive series of 14 patients who had hemifacial augmentation with a free groin flap (mean age at operation 17 years, range 10-42) since 2001, and discuss the surgical technique. The most common cause of asymmetry was hemifacial microsomia (n=6). Anatomical variation of the vessels in the groin did not cause problems. Arterial anastomosis was to the facial artery in 13 patients; 12 patients had simultaneous hard tissue procedures. No flaps failed. The free groin flap is a useful adjunct in the management of hemifacial deficits in volume when free fat grafts will not provide enough bulk. Although the operation can take longer than non-vascularised grafts, little tissue is lost so long-term results may be more predictable. We have found the anatomy fairly consistent and the short pedicle caused no problems. PMID:23036834

  11. Digital Fillet Flaps: A Systematic Review.

    PubMed

    Schade, Valerie L

    2014-11-26

    Digital fillet flaps have a consistent vascular supply and provide durable soft-tissue coverage. Despite their readily available nature, their use in the foot remains limited. This systematic review was undertaken to determine the size defect that could be covered, the potential postoperative complications, and the durability of a digital fillet flap. Studies were eligible for inclusion if they involved use of the entire digit for soft-tissue coverage of defects of any etiology, reported complications, and had any length of follow-up time. A total of 9 studies met all the inclusion criteria, for a total of 34 patients with a combined mean age of 47.1 years and a combined mean follow-up time of 9.3 months. Complications consisted of continued infection and partial or total necrosis of the flap. Digital fillet flaps were able to cover defects up to a combined mean size of 15.6 cm(2). Coverage was found to be best for forefoot ulcerations. The flaps had limited donor site morbidity and provided full coverage of exposed vital and osseous structures that was able to withstand forces applied during weight bearing, The procedure is simple and straightforward, reducing operating time and the need for more complex soft-tissue reconstructive procedures. PMID:25428181

  12. The forked flap repair for hypospadias

    PubMed Central

    Chadha, Anil; Singh, Amitabh

    2012-01-01

    Context: Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve. Aim: Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described. Materials and Methods: The study has been done in 70 cases over the past 11 years. The “Forked-Flap” repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip–flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit's prepucial tissue transfer completes the one stage procedure. Statistical Analysis: An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented. Results and Conclusion: The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed. PMID:23449992

  13. 14 CFR 25.701 - Flap and slat interconnection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...interconnection. (a) Unless the airplane has safe flight characteristics...equivalent means. (b) If a wing flap or slat interconnection...takeoff power. (c) For airplanes with flaps or slats that...loads imposed when the wing flaps or slats on...

  14. Robust control of a shape memory alloy wire actuated flap

    Microsoft Academic Search

    Gangbing Song; Ning Ma

    2007-01-01

    In this paper, shape memory alloy (SMA) wire actuators are used to control the flap movement of a model airplane wing. Conventionally, the flap of an aircraft wing is driven by electric motors or hydraulic actuators. The use of SMA actuators has the advantage of significant weight reduction. Two SMA actuators are used: one to move the flap up and

  15. 14 CFR 25.701 - Flap and slat interconnection.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...interconnection. (a) Unless the airplane has safe flight characteristics...equivalent means. (b) If a wing flap or slat interconnection...takeoff power. (c) For airplanes with flaps or slats that...loads imposed when the wing flaps or slats on...

  16. 14 CFR 25.701 - Flap and slat interconnection.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...interconnection. (a) Unless the airplane has safe flight characteristics...equivalent means. (b) If a wing flap or slat interconnection...takeoff power. (c) For airplanes with flaps or slats that...loads imposed when the wing flaps or slats on...

  17. 14 CFR 25.701 - Flap and slat interconnection.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...interconnection. (a) Unless the airplane has safe flight characteristics...equivalent means. (b) If a wing flap or slat interconnection...takeoff power. (c) For airplanes with flaps or slats that...loads imposed when the wing flaps or slats on...

  18. 14 CFR 25.701 - Flap and slat interconnection.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...interconnection. (a) Unless the airplane has safe flight characteristics...equivalent means. (b) If a wing flap or slat interconnection...takeoff power. (c) For airplanes with flaps or slats that...loads imposed when the wing flaps or slats on...

  19. Preputial island flap in extensive urethral stricture repair

    Microsoft Academic Search

    A. I. Mitre; S. Arap; A. M. Lucon

    1992-01-01

    Seven patients with extensive urethral strictures were treated with a preputial island flap applied as a tubularised neourethra or as a patch covering the longitudinally incised urethra. This flap enables the correction of strictures as long as 9 cm. In two subjects, a double preputial island flap was employed, with the outer layer being used to replace the lacking skin.

  20. Double Onlay Preputial Flap for Proximal Hypospadias Repair

    Microsoft Academic Search

    Ricardo Gonzalez; Craig Smith; Enrique D. Denes

    1996-01-01

    PurposeWe describe a new technique for primary repair of proximal hypospadias. The double onlay preputial flap combines the principles of onlay urethroplasty and the double face preputial flap, namely preservation of the urethral plate and use of a total preputial flap.

  1. Passive torque regulation in an underactuated flapping wing robotic insect

    E-print Network

    Wood, Robert

    Passive torque regulation in an underactuated flapping wing robotic insect P. S. Sreetharan and R to rapid progress towards creating airborne flapping wing robots based on Dipteran (two-winged) insects the intervention of an active controller. This paper describes an insect-scale flapping wing aerome- chanical

  2. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot).

    PubMed

    Bista, N; Shrestha, K M; Bhattachan, C L

    2013-03-01

    Soft tissue defect of the lower extremities especially over the distal third leg, ankle region, tendo achilies area, heel and foot has always been challenging for the Plastic surgeon. Though with introduction of Microsurgery, the expertise and its advances, free flap surgery to cover the defect is not possible in every center due to the sophisticated instruments, equipments and lengthy procedures. The reverse sural fasciocutaneous flap is a viable option for the soft tissue coverage of distal third leg and foot. Between Nov 2008 till Nov 2010, 11 patients with moderate size soft tissue defect (5-15 cm defect) with exposed bone, tendons and hardware of ankle joint, posterior aspect of heel, and dorsum of the hind foot and mid foot were treated with reverse sural artery fasciocutaneous flap. Out of 11 cases, 10 cases had uneventful postoperative course. In one case, we encountered complete necrosis of the flap due to venous congestion that occurred in 3rd post op day. In all other cases, the flap survived completely without any marginal necrosis. Split thickness skin graft was well taken in donor site in all other cases. The sural artery fasciocutaneous flap is versatile and reliable procedure, easy and quick to elevate, due to the long pedicle, distalization up to the dorsum of the mid foot can be achieved and also a good alternative to microsurgical procedures where such facilities are not available and the surgeon is not well familiar with the procedure. PMID:24592796

  3. The Flexible Learning Approach to Physics (FLAP)

    NASA Astrophysics Data System (ADS)

    Lambourne, R. J.; Tinker, M. H.; Windsor, S. A.

    1997-03-01

    The Flexible Learning Approach to Physics (FLAP) is an extensive, high quality, supported self-study teaching resource, developed on behalf of the whole UK university sector. FLAP addresses the twin problems of an increasing diversity of intake into physics degree courses and their decreasing familiarity with the use of mathematics in a physical context. It has been developed over a three year period, funded (1M) by the UK Higher Education Funding Councils. It offers a new approach to the teaching of physics and its associated mathematics. FLAP includes 83 free-standing modules of physics and mathematics, ranging from pre-university level to some point within the first or second year of a physics or engineering degree course. Its range also makes it useful at upper high school level. It presents an integrated approach to physics and mathematics, introducing mathematics within a physical context, where possible, and sharing a common notation with the physics. FLAP includes about 2500 pages of text, with video, audio and CAL support and has a Tutor Guide with an electronic question bank of about 1700 questions and solutions. A feature of the resource is that the modular text is photocopiable by departments for their own students, giving maximum flexibility of use. Physics departments can use this as they choose, to support their present courses or to create new courses of their own design. The FLAP self-study teaching style encourages active learning and gives students more ownership of this learning. Field trials show that it can increase student self-motivation and its style is welcomed. It offers gains in the quality and efficiency of teaching and learning and is expected to make a considerable impact wherever teaching quality has to be maintained or improved, particularly with reducing staff resources. FLAP is now being made available world-wide.

  4. Flap Edge Aeroacoustic Measurements and Predictions

    NASA Technical Reports Server (NTRS)

    Brooks, Thomas F.; Humphreys, William M., Jr.

    2000-01-01

    An aeroacoustic model test has been conducted to investigate the mechanisms of sound generation on high-lift wing configurations. This paper presents an analysis of flap side-edge noise, which is often the most dominant source. A model of a main element wing section with a half-span flap was tested at low speeds of up to a Mach number of 0.17, corresponding to a wing chord Reynolds number of approximately 1.7 million. Results are presented for flat (or blunt), flanged, and round flap-edge geometries, with and without boundary-layer tripping, deployed at both moderate and high flap angles. The acoustic database is obtained from a Small Aperture Directional Array (SADA) of microphones, which was constructed to electronically steer to different regions of the model and to obtain farfield noise spectra and directivity from these regions. The basic flap-edge aerodynamics is established by static surface pressure data, as well as by Computational Fluid Dynamics (CFD) calculations and simplified edge flow analyses. Distributions of unsteady pressure sensors over the flap allow the noise source regions to be defined and quantified via cross-spectral diagnostics using the SADA output. It is found that shear layer instability and related pressure scatter is the primary noise mechanism. For the flat edge flap, two noise prediction methods based on unsteady-surface-pressure measurements are evaluated and compared to measured noise. One is a new causality spectral approach developed here. The other is a new application of an edge-noise scatter prediction method. The good comparisons for both approaches suggest that much of the physics is captured by the prediction models. Areas of disagreement appear to reveal when the assumed edge noise mechanism does not fully define, the noise production. For the different edge conditions, extensive spectra and directivity are presented. Significantly, for each edge configuration, the spectra for different flow speeds, flap angles, and surface roughness were successfully scaled by utilizing aerodynamic performance and boundary layer scaling method developed herein.

  5. The total pectoralis major muscle myocutaneous free flap.

    PubMed

    Hallock, Geoffrey G

    2013-09-01

    Even though the pectoralis major muscle has many similarities to the latissimus dorsi muscle, only the latter has a reputation as a "workhorse" free flap. Nevertheless, the former in special circumstances can provide a muscle flap of comparable surface area when used in its totality along with a skin paddle, with a consistent pedicle of large caliber, that causes minimal functional disturbance. However, the pedicle is very short, and vein grafts may be necessary to reach any recipient site. Nevertheless, the total pectoralis major muscle myocutaneous flap may be the largest free flap available when the patient must be kept in a supine position and no perforator flaps are reasonably available. PMID:23616253

  6. Thin cutaneous flap for intra oral reconstruction: the dorsalis pedis free flap revisited.

    PubMed

    Banis, J C

    1988-01-01

    The dorsalis pedis flap provides thin, hairless tissue for a variety of intra oral defects. Due to concerns for the donor site, reconstructive surgeons have largely overlooked this flap, despite its numerous desirable qualities. The paper focuses on the anatomy of the first dorsal metatarsal artery and techniques which insure the preservation of adequate flap vascularity. The prevention of donor site complications centers around meticulous attention to the placement of skin grafts, with a secure tie-over dressing and the use of a posterior splint. Patients are allowed to ambulate in the early postoperative period only when venous compression is provided with an ace bandage. Vigorous attention to detail on reconstructing the foot has minimized donor site complications. The dorsalis pedis flap continues to be an important method of reconstruction in our armamentarium of free tissue donor sites. PMID:3173079

  7. The "jigsaw puzzle" advancement flap for reconstruction of a retroauricular surgical defect.

    PubMed

    Alkalay, Ronen; Alcalay, Joseph

    2013-01-01

    Repairing retroauricular defects is quite challenging. Although direct observation of the repaired defect is not possible, choosing the wrong reconstruction might result in serious deformity of the auricle that will be easily noticed. An 89-year-old man presented with a large basal cell carcinoma tumor on his right retroauricular area adjacent to the mastoid-auricle border. The clinical tumor size was 17 × 17 mm. The tumor was excised in one stage, using the Mohs micrographic surgery technique. The final defect size was 20 × 20 mm. The surgical defect was reconstructed by a "jigsaw puzzle"-like flap. PMID:23377339

  8. A new option for autologous anterior chest wall reconstruction: the composite thoracodorsal artery perforator flap.

    PubMed

    Dast, Sandy; Berna, Pascal; Qassemyar, Quentin; Sinna, Raphael

    2012-03-01

    Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy. The authors describe the case of a 70-year-old man with sternoclavicular joint chondrosarcoma who underwent subtotal sternectomy with partial resection of the two clavicles and anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs vascularized on serratus muscle. The postoperative course was uneventful. Seven months after surgery, the patient was doing well. This surgical procedure is a new option for autologous reconstruction without prosthetic material after extensive sternectomy. PMID:22365019

  9. Propeller thoracodorsal artery perforator flap for breast reconstruction

    PubMed Central

    Angrigiani, Claudio; Escudero, Ezequiel; Artero, Guillermo; Gercovich, Gustavo; Deza, Ernesto Gil

    2014-01-01

    Background The thoracodorsal artery perforator (TDAP) flap has been described for breast reconstruction. This flap requires intramuscular dissection of the pedicle. A modification of the conventional TDAP surgical technique for breast reconstruction is described, utilizing instead a propeller TDAP flap. The authors present their clinical experience with the propeller TDAP flap in breast reconstruction alone or in combination with expanders or permanent implants. Methods From January 2009 to February 2013, sixteen patients had breast reconstruction utilizing a propeller TDAP flap. Retrospective analysis of patient characteristics, clinical indications, procedure and outcomes were performed. The follow-up period ranged from 4 to 48 months. Results Sixteen patients had breast reconstruction using a TDAP flap with or without simultaneous insertion of an expander or implant. All flaps survived, while two cases required minimal resection due to distal flap necrosis, healing by second intention. There were not donor-site seromas, while minimal wound dehiscence was detected in two cases. Conclusions The propeller TDAP flap appears to be safe and effective for breast reconstruction, resulting in minimal donor site morbidity. The use of this propeller flap emerges as a true alternative to the traditional TDAP flap. PMID:25207210

  10. Choice of Flap Affects Fistula Rate after Salvage Laryngopharyngectomy

    PubMed Central

    Kao, Huang-Kai; Abdelrahman, Mohamed; Chang, Kai-Ping; Wu, Chao-Min; Hung, Shao-Yu; Shyu, Victor Bong-Hang

    2015-01-01

    Due to the significant morbidity and mortality associated with pharyngocutaneous fistula in pharyngoesophageal reconstruction following cancer resection, the purpose of this retrospective study is to examine the selection of tubed skin flaps that impact anastomotic integrity. The flaps evaluated included radial forearm flap versus anterolateral thigh flap, and fasciocutaneous anterolateral thigh flap versus chimeric anterolateral thigh flap. The outcome of interest is the incidence of pharyngocutaneous fistula. The radial forearm group had a significantly higher rate of fistula than the anterolateral thigh group (56.6% vs. 30.2%, p = 0.03). No significant difference in the incidence of fistula was demonstrated between fasciocutaneous and chimeric anterolateral thigh flap (36.8% vs. 25%, p = 0.51). The anastomotic integrity in pharyngoesopharyngeal reconstruction is affected by choice of skin flaps. Anterolateral thigh flap appears to be a viable option for pharyngoesophageal reconstruction. The more technical demand of the anterolateral thigh flap must be weighed against an easily harvested radial forearm flap. PMID:25776941

  11. Unsteady airfoil with a harmonically deflected trailing-edge flap

    NASA Astrophysics Data System (ADS)

    Lee, T.; Su, Y. Y.

    2011-11-01

    The effects of a harmonically deflected trailing-edge flap, actuated at different start times and amplitudes but with frequency different from the airfoil motion, on the aerodynamic loads of an oscillating NACA 0015 airfoil were investigated experimentally at Re=2.51×105. Both in-phase and 180° out-of-phase flap deflections, relative to the airfoil motion, were tested. The results show that there was a large change in the hysteretic behavior of the dynamic load loops, and that the formation and detachment of the leading-edge vortex (LEV) were not affected by the flap motion, while the low pressure signature of the vortex was affected by the flap actuation start time. The later the flap actuation the larger the change in the strength of the LEV. The present flap control scheme was also found to be as effective as that achieved by a pulsed ramp flap motion, but with a reduced number of control parameters.

  12. Innervated radial thenar flap for sensory reconstruction of fingers.

    PubMed

    Omokawa, S; Mizumoto, S; Iwai, M; Tamai, S; Fukui, A

    1996-05-01

    A radial thenar flap, which is supplied by the superficial palmar branch of the radial artery and innervated by the superficial branch of the radial nerve, was used in four patients for sensory reconstruction of the fingers. Two patients had degloving injuries of the hand and two had amputation injuries of the thumb. Three of the cases underwent free-flap transfers, and one case underwent a reverse-flow island flap. The size of these flaps was about 3 x 5 cm except in one case, where a 15 x 5 cm flap combined with a radial forearm flap was used. Sensory reinnervation was excellent and donor site morbidity was minimal in all four cases. An innervated radial thenar flap from the ipsilateral hand offers an alternative choice to reconstruct large palmar defects of the fingers. PMID:8724464

  13. Prevention of hair growth in myocutaneous flap reconstruction.

    PubMed

    Eliachar, I; Kraus, D H; Bergfeld, W F; Tucker, H M

    1990-08-01

    Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncologic procedures in the head and neck. Transfer of hair-bearing skin into the reconstructed upper digestive tract can be a major disadvantage associated with the pectoralis major flap. De-epithelialization of skin to the dermal level, removing the majority of skin appendages, can convert a myocutaneous flap to a "myodermal" flap. Platysma myocutaneous and myodermal flaps were grafted into the oral cavity of 13 dogs. Gross and histologic evaluation confirmed decreased hair growth in the experimental myodermal flap. Wound complications and graft survival were similar for both techniques. Diminished hair growth further supports the utility of myodermal flaps in hairy male patients undergoing upper digestive tract reconstruction. PMID:2378719

  14. Plantar rotational flap technique for panmetatarsal head resection and transmetatarsal amputation: a revision approach for second metatarsal head transfer ulcers in patients with previous partial first ray amputation.

    PubMed

    Boffeli, Troy J; Reinking, Ryan

    2014-01-01

    Transfer ulcers beneath the second metatarsal head are common after diabetes-related partial first ray amputation. Subsequent osteomyelitis of the second ray can further complicate this difficult situation. We present 2 cases depicting our plantar rotational flap technique for revision surgery involving conversion to either panmetatarsal head resection or transmetatarsal amputation (TMA). These cases are presented to demonstrate our indications, procedure selection criteria, flap technique, operative pearls, and staging protocol. The goals of this surgical approach are to excise and close the plantar ulcer beneath the second metatarsal head, remove any infected bone, allow staged surgery if needed, remove all remaining metatarsal heads to decrease the likelihood of repeat transfer ulcers, preserve the toes when practical, avoid excessive shortening of the foot, avoid multiple longitudinal dorsal incisions, and create a functional and cosmetically appealing foot. The flap is equally suited for either panmetatarsal head resection or TMA. The decision to pursue panmetatarsal head resection versus TMA largely depends on the condition of the remaining toes. Involvement of osteomyelitis in the base of the second proximal phalanx, the soft tissue viability of the remaining toes, the presence of a preoperative digital deformity, and the likelihood that saving the lesser toes will be beneficial from a cosmetic or footwear standpoint are factors we consider when deciding between panmetatarsal head resection and TMA. Retrospective chart review identified prompt healing of the flap in both patients. Neither patient experienced recurrent ulcers or required subsequent surgery within the first 12 months postoperatively. PMID:23910736

  15. Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction

    PubMed Central

    Stathas, Theodoros; Tsiliboti, Dimitra; Tsiros, Aris; Mastronikolis, Nicholas; Goumas, Panos

    2014-01-01

    Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integrated excellently and on the followup the patient was free of disease and fully satisfied with the aesthetic and functional result. PMID:24803937

  16. Tubularized penile-flap urethroplasty using a fasciocutaneous random pedicled flap for recurrent anterior urethral stricture.

    PubMed

    Lee, Yong Jig; Lee, Byung Kwon

    2012-05-01

    This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique. PMID:22783537

  17. Lift enhancement and flow structure of airfoil with joint trailing-edge flap and Gurney flap

    NASA Astrophysics Data System (ADS)

    Lee, T.; Su, Y. Y.

    2011-06-01

    The impact of Gurney flaps (GF), of different heights and perforations, on the aerodynamic and wake characteristics of a NACA 0015 airfoil equipped with a trailing-edge flap (TEF) was investigated experimentally at Re = 2.54 × 105. The addition of the Gurney flap to the TEF produced a further increase in the downward turning of the mean flow (increased aft camber), leading to a significant increase in the lift, drag, and pitching moment compared to that produced by independently deployed TEF or GF. The maximum lift increased with flap height, with the maximum lift-enhancement effectiveness exhibited at the smallest flap height. The near wake behind the joint TEF and GF became wider and had a larger velocity deficit and fluctuations compared to independent GF and TEF deployment. The Gurney flap perforation had only a minor impact on the wake and aerodynamics characteristics compared to TEF with a solid GF. The rapid rise in lift generation of the joint TEF and GF application, compared to conventional TEF deployment, could provide an improved off-design high-lift device during landing and takeoff.

  18. Tubularized Penile-Flap Urethroplasty Using a Fasciocutaneous Random Pedicled Flap for Recurrent Anterior Urethral Stricture

    PubMed Central

    Lee, Byung Kwon

    2012-01-01

    This report describes the use of a tubularized random flap for the curative treatment of recurrent anterior urethral stricture. Under the condition of pendulous lithotomy and suprapubic cystostomy, the urethral stricture was removed via a midline ventral penile incision followed by elevation of the flap and insertion of an 18-Fr catheter. Subcutaneous buried interrupted sutures were used to reapproximate the waterproof tubularized neourethra and to coapt with the neourethra and each stump of the urethra, first proximally and then distally. The defect of the penile shaft was covered by advancement of the surrounding scrotal flap. The indwelling catheter was maintained for 21 days. A 9 month postoperative cystoscopy showed no flap necrosis, no mechanical stricture, and no hair growth on the lumen of the neourethra. The patient showed no voiding discomfort 6 months after the operation. The advantages of this procedure are the lack of need for microsurgery, shortening of admission, the use of only spinal anesthesia (no general anesthesia), and a relatively short operative time. The tubularized unilateral penile fasciocutaneous flap should be considered an option for initial flap urethroplasty as a curative technique. PMID:22783537

  19. Enhanced Correlation of SMART Active Flap Rotor Loads

    NASA Technical Reports Server (NTRS)

    Kottapalli, Sesi

    2011-01-01

    This is a follow-on study to a 2010 correlation effort. Measured data from the SMART rotor test in the NASA Ames 40- by 80- Foot Wind Tunnel are compared with CAMRAD II calculations. As background, during the wind tunnel test, unexpectedly high inboard loads were encountered, and it was hypothesized at that time that due to changes in the flexbeams over the years, the flexbeam properties used in the analysis needed updating. Boeing Mesa, recently updated these properties. This correlation study uses the updated flexbeam properties. Compared to earlier studies, the following two enhancements are implemented: i) the inboard loads (pitchcase and flexbeam loads) correlation is included for the first time (reliable prediction of the inboard loads is a prerequisite for any future anticipated flight-testing); ii) the number of blade modes is increased to better capture the flap dynamics and the pitchcase-flexbeam dynamics. Also, aerodynamically, both the rolled-up wake model and the more complex, multiple trailer wake model are used, with the latter slightly improving the blade chordwise moment correlation. This sensitivity to the wake model indicates that CFD is needed. Three high-speed experimental cases, one uncontrolled free flap case and two commanded flap cases, are considered. The two commanded flap cases include a 2o flap deflection at 5P case and a 0o flap deflection case. For the free flap case, selected modifications to the HH-06 section flap airfoil pitching moment table are implemented. For the commanded 2o flap case, the experimental flap variation is approximately matched by increasing the analytical flap hinge stiffness. This increased flap hinge stiffness is retained for the commanded 0o flap case also, which is treated as a free flap case, but with larger flap hinge stiffness. The change in the mid-span and outboard loads correlation due to the updating of the flexbeam properties is not significant. Increasing the number of blade modes results in an effective, commanded flap hinge stiffness of 4X baseline, not 3X as reported earlier. The inboard loads correlation is reasonable, but needs further study. Overall, the free flap case correlation is reasonable, thus confirming the basic correctness of the current semi-empirical modifications; the correlation for the commanded 2o flap at 5P case and the 0o flap case is also reasonable.

  20. Technical Notes Hovering Hinge-Connected Flapping

    E-print Network

    Technical Notes Hovering Hinge-Connected Flapping Plate with Passive Deflection Hui Wan, Haibo Dong of hovering flat plates with a free-to-pivot hinge at the leading edge. They found that the plate produces a motion akin to normal­hover, but with delayed rotation. However, there has been very limited study

  1. Propulsion of a flapping and oscillating airfoil

    NASA Technical Reports Server (NTRS)

    Garrick, I E

    1937-01-01

    Formulas are given for the propelling or drag force experience in a uniform air stream by an airfoil or an airfoil-aileron combination, oscillating in any of three degrees of freedom; vertical flapping, torsional oscillations about a fixed axis parallel to the span, and angular oscillations of the aileron about a hinge.

  2. [Use of the forearm island flap].

    PubMed

    Goth, D

    1986-01-01

    The forearm island flap is an excellent procedure for closing all deep soft tissue defects in the hand. Good and reliable circulation results in healing without problems and elimination of infection. Reverse blood flow occurs in the radial artery and its concomitant veins. Branches of the cutaneous nerves provide sensory supply. Four cases are described. PMID:3949260

  3. Computational Aerodynamics of Insects' Flapping Flight

    NASA Astrophysics Data System (ADS)

    Yang, Kyung Dong; Kyung, Richard

    2011-11-01

    The kinematics of the Insects' flapping flight is modeled through mathematical and computational observations with commercial software. Recently, study on the insects' flapping flight became one of the challenging research subjects in the field of aeronautics because of its potential applicability to intelligent micro-robots capable of autonomous flight and the next generation aerial-vehicles. In order to uncover its curious unsteady characteristics, many researchers have conducted experimental and computational studies on the unsteady aerodynamics of insects' flapping flight. In the present paper, the unsteady flow physics around insect wings is carried out by utilizing computer software e-AIRS. The e-AIRS (e-Science Aerospace Integrated Research System) analyzes and models the results of computational and experimental aerodynamics, along with integrated research process of these two research activities. Stroke angles and phase angles, the important two factors in producing lift of the airfoils are set as main parameters to determine aerodynamic characteristics of the insects' flapping flight. As a result, the optimal phase angle to minimize the drag and to maximize the lift are found. Various simulations indicate that using proper value of variables produce greater thrust due to an optimal angle of attack at the initial position during down stroke motion.

  4. Foot ischemia after a free fibula flap harvest: immediate salvage with an interpositional sapheneous vein graft.

    PubMed

    Saydam, Funda Akoz; Basaran, Karaca; Ceran, Fatih; Mert, Bulent

    2014-09-01

    The most dreaded major donor-site complication of free fibula flap is a foot ischemia, which is fortunately rare. Various authors have discussed the efficacy of the use of preoperative imaging methods including color Doppler, magnetic resonance angiography, and conventional angiography. A 25-year-old man presented with a 10-cm mandibular defect after a facial gunshot injury. Lower extremity color Doppler revealed triphasic peroneal, tibialis anterior, and posterior artery flows. A fibula osteocutaneous flap was harvested, and the mandible was reconstructed. However, the suture sites at the donor site began to demonstrate signs of necrosis, abscess formation, and widespread cellulitis beginning from postoperative day 9. Angiogram of the lower extremity on the 13th day demonstrated no flow in the right posterior tibial artery distal to the popliteal artery, whereas the anterior tibial artery had weak flow with collateral filling distally. An emergency bypass with a saphenous vein graft between the popliteal artery and the distal posterior tibial artery was performed. Repeated debridements, local wound care, and vacuum-assisted closure were applied. A skin graft was placed eventually. The extremity healed without severe functional disability. In conclusion, although the arterial anatomy is completely normal in preoperative evaluation, vascular complications may still ocur at the donor fibula free flap site. In addition, emergency cardiovascular bypass surgery, as we experienced, may be necessary for limb perfusion. PMID:25119400

  5. Long-term viability of the temporalis muscle/fascia flap used for temporomandibular joint reconstruction.

    PubMed

    Umeda, H; Kaban, L B; Pogrel, M A; Stern, M

    1993-05-01

    Temporalis muscle/fascia axial flaps (TFs) were used in 115 temporomandibular joints (TMJs) in 81 patients to correct ankylosis (n = 25 joints), traumatic defects (n = 8), congenital anomalies (n = 4), defects resulting from tumor resection (n = 2), degenerative joint disease (n = 52), autoimmune arthritides (n = 21), and lateral capsule flaccidity (n = 3). The follow-up period ranged from 6 months to 5.5 years. Seven patients (8.6% of the group; 10 TMJs) were reevaluated for recurrent symptoms (pain and decreased motion), with a mean of 1.7 years (range = 1 to 3 years) postoperatively. Four of these patients (seven TMJs) had magnetic resonance imaging (MRI) as part of their diagnostic workup and four patients (five TMJs) required a second operative procedure. This study reports the results of the MRI, intraoperative, and histologic evaluations of the TFs in these seven patients. The MRIs showed vascularized tissue between the condyle and roof of the glenoid fossa in all seven joints examined. The signal was consistent with muscle and/or fat as opposed to scar tissue. All flaps examined at the time of surgery (arthroscopy, n = 1; arthrotomy, n = 4) were in place and had the gross appearance of normal muscle. Histologic examination of biopsies of four flaps indicated the presence of viable muscle with normal-appearing nuclei. The results of this study indicate that the TF does survive when it is carefully dissected and inferiorly based to preserve blood supply. PMID:8478760

  6. Laparoscopic Harvest of Omental Flaps for Reconstruction of Complex Mediastinal Wounds

    PubMed Central

    Salameh, Jihad R.; Chock, Deborah A.; Gonzalez, John J.; Koneru, Suresh; Glass, Jeffrey L.

    2003-01-01

    Background: Omental harvest for complex poststernotomy mediastinal wounds has traditionally required a formal laparotomy in often high-risk patients, thus making it the procedure of last resort. Methods: The charts of all patients who underwent a laparoscopic omental harvest at the Texas Endosurgery Institute were retrospectively reviewed. Results: Seven patients, 4 males and 3 females with an average age of 65.1±6.3 years, with complex mediastinal wounds following coronary artery bypass grafting were studied. All patients underwent laparoscopic harvest of omental flaps based on the right gastroepiploic artery (3), the left gastroepiploic artery (1) or both (3), along with pectoralis major myocutaneous advancement flaps in 5 patients and partial-thickness skin graft and a vacuum-assisted closure device in 2 patients. The average operative time for the entire procedure was 196±54 minutes. Enteric feedings could be tolerated early postoperatively with a mean of 3.8 days. One death (14.2%) occurred. All surviving patients had excellent wound healing results at a mean follow-up of 19.1 months. Conclusion: Laparoscopic harvest of omental flaps for the reconstruction of complex mediastinal wounds is a valid and potentially less morbid alternative for the treatment of this infrequent but disastrous complication of open heart surgery. PMID:14626397

  7. Xenogeneic acellular dermal matrix in combination with pectoralis major myocutaneous flap reconstructs hypopharynx and cervical esophagus.

    PubMed

    Yin, Danhui; Tang, Qinglai; Wang, Shuang; Li, Shisheng; He, Xiangbo; Liu, Jiajia; Liu, Bingbing; Yang, Mi; Yang, Xinming

    2014-10-31

    The aim of this study was to explore xenogeneic acellular dermal matrix (ADM) in combination with pectoralis major myocutaneous flap in hypopharynx and cervical esophagus reconstruction. A total of five patients were treated with this surgical method to reconstruct hypopharynx and cervical esophagus in Second Xiangya Hospital between January 2012 and April 2013. Four of them had hypopharyngeal carcinoma with laryngeal and cervical esophageal invasion, while the fifth patient with hypopharyngeal cancer had developed scars and atresia after postoperative radiotherapy. The defect length after hypopharyngeal and cervical esophageal resection was 6-8 cm, and was repaired by a combination of ADM and pectoralis major myocutaneous flap by our team. Interestingly, the four patients had primary healing and regained their eating function about 2-3 weeks after surgery, the fifth individual suffered from pharyngeal fistula, but recovered after dressing change about 2 months. Postoperative esophageal barium meals revealed that the pharynx and esophagus were unobstructed in all five patients. Xenogeneic ADM in combination with pectoralis major myocutaneous flap for hypopharynx and cervical esophagus reconstruction is a simple, safe and effective method with fewer complications. Nevertheless, according to the defect length of the cervical esophagus, the patients need to strictly follow the medical advice. PMID:25355034

  8. Antioxidant support in composite musculo-adipose-fasciocutaneous flap applications: an experimental study.

    PubMed

    Bozkurt, Mehmet; Kapi, Emin; Kulahci, Yalcin; Gedik, Ercan; Ozekinci, Selver; Isik, Fatma Birgul; Celik, Yusuf; Selcuk, Caferi Tayyar; Kuvat, Samet Vasfi

    2014-02-01

    Free radicals are chemicals that play roles in the etio-pathogenesis of ischaemia-reperfusion injury. Various antioxidants have been used in an attempt to mitigate the damage induced by these chemicals. In the present study, the antioxidative effects of grape seed extract (proanthocyanidin), tomato extract (lycopene), and vitamin C (ascorbic acid) on a composite re-established-flow inferior epigastric artery based rectus abdominis muscle-skin flap model on which experimental ischaemia was induced were investigated. The rats have been administered antioxidants for 2 weeks prior to the surgery and for 2 more weeks thereafter. Macroscopic, histopathological, and biochemical analyses were carried out at the decision of the experiment. It was found that flap skin island necrosis was significantly reduced in the proanthocyanidin, lycopene, vitamin C groups (p < 0.001). Statistical analyses showed significant decreases in inflammation, oedema, congestion, and granulation tissue in the proanthocyanidin and lycopene groups compared to the vitamin C and control groups (p < 0.001). When the viability rates of fat and muscle tissues were examined, significant improvements were found in the proanthocyanidin and lycopene groups in comparison to the other groups (p < 0.001). Serum antioxidant capacity measurements revealed significant differences in the lycopene group compared to all other groups (p < 0.001). It is concluded that lycopene and proanthocyanidin are protective antioxidants in rat composite muscle-skin flap ischaemia-reperfusion models. PMID:23731129

  9. Sinus Surgery

    MedlinePLUS

    ... surgery: The sinuses are physically close to the brain, the eye, and major arteries, always areas of concern when a fiber optic tube is inserted into the sinus region. The growing use of a new technology, image guided endoscopic surgery, is alleviating that concern. ...

  10. Unnecessary surgery.

    PubMed Central

    Leape, L L

    1989-01-01

    The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Most evidence of the existence of unnecessary surgery, such as information from studies of geographic variations and the results of second surgical opinion programs, is circumstantial. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 30 percent. Most unnecessary surgery results from physician uncertainty about the effectiveness of an operation. Elimination of this uncertainty requires more efficient production and dissemination of scientific information about clinical effectiveness. In the absence of adequate data from scientific studies, the use of a consensus of expert opinion, disseminated by means of comprehensive practice guidelines, offers the best opportunity to identify and eliminate unnecessary surgery. PMID:2668237

  11. Design of Flapping Mechanisms based on Transverse Bending Phenomena in Insects

    Microsoft Academic Search

    Zaeem A. Khan; Sunil Kumar Agrawal

    2006-01-01

    In this paper, we investigate designs of flapping mechanisms that allow high amplitude and high frequency of flapping. The mechanism utilizes springs and passive flapping, a concept motivated from the study of wing motion of insects and hummingbirds. The mechanisms simulate transverse bending effect of insect wings to achieve high flapping amplitudes. Different configurations of flapping mechanism are studied using

  12. Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------

    E-print Network

    Miyashita, Yasushi

    38 Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------ http://ctstokyo.umin.ne.jp/ We are leading in Japan by annual surgery case volume of 700. New knowledge. ·Clinical research · Brain and spinal cord protection in thoracic aortic surgery · Minimally invasive

  13. Lip and oral commissure reconstruction with the radial forearm flap

    PubMed Central

    Sasidaran, Ramesh; Zain, Mohd Ali Mat; Basiron, Normala HJ

    2012-01-01

    Introduction: The radial forearm free flap has been a workhorse flap for lip reconstruction due to its pliability, color match, and ability to incorporate the palmaris longus tendon for support. We report our experience with the use of the radial forearm free flap in three patients post-tumor resection. Materials and Methods: Between 2009 and 2010, three patients had undergone resection of squammous cell carcinoma of the oral region and simultaneous reconstruction with the radial forearm free flap. The average patient age was 51 years and the average defect size was 4 × 3 cm2. In two patients, anterograde radial forearm free flap was used with a fascia lata free tendon graft for support and in one patient, a retrograde radial forearm flap was used without the use of tendon as support. Results: All three patients were satisfied with the initial management of tumor clearance. All three surgical margins were clear. Out of three, two patients complained that the flap was unsightly and were dissatisfied with the appearance and bulk of the flap. Conclusion: Although the radial forearm flap is recognized as a gold standard for lip reconstruction, there always appears to be a need for secondary revision procedures to further improve both the functional as well as esthetic appearance of the lip reconstruction procedure. As a primary reconstructive procedure, the flap does not satisfy patient expectations. A comprehensive questionnaire as well as objective assessment follow-up study is warranted. PMID:23251053

  14. Reverse flow flap use in upper extremity burn contractures.

    PubMed

    Uygur, Fatih; Sever, Celalettin; Evinç, Rahmi; Ulkür, Ersin; Duman, Haluk

    2008-12-01

    Upper extremity contractures still happen and constitute one of the most trying challenges in burn patients. This series comprised of 4 radial forearm flaps, 14 dorsoulnar artery flaps, and 4 medial arm flaps, all of which were used in a reverse pattern for upper extremity postburn contractures. The reverse flow radial forearm flap (RRFF) was chosen for reconstruction of extensive palmar contractures after burn. The reverse flow dorsoulnar flap (RDUF) was used particularly for reconstruction of the hypothenar aspect of the hand which requires moderate size tissue transfer. The reverse medial arm flap (RMAF) was used for elbow contractures after burn. In the first RMAF, venous congestion occurred and was finaly resolved with minimal flap loss, which was managed with STSG later. In the following 3 cases the flap was supercharged with anastomosis of the brachial vein into the antebrachial vein. Both RRFF and RDUF may provide a smooth and efficient solution. However, RMAF has a significant venous problem, which may result in flap loss, therefore, this flap should not be considered as a first option in the elbow area. PMID:18804917

  15. Treatment of the Secondary Defect on the First Metatarsophalangeal Joint Using the Medial Plantar Hallucal Artery Dorsal Perforator Flap.

    PubMed

    Zhang, Xu; Bai, Guangqi; Zhang, Zhihong; Chen, Chao; Yu, Yadong; Shao, Xinzhong

    2014-09-30

    Injuries or burns to the dorsum of the first metatarsophalangeal (MTP) joint may develop scar formation, resulting in hyperextension contracture. Surgical correction of the deformity often produces a secondary defect. The purpose of this study is to report on the use of the medial plantar hallucal artery dorsal perforator flap for the treatment of such defect. From February 2010 to June 2011, 16 patients were treated. The mean preoperative hyperextension of the first MTP joint was 48 degrees. The mean size of the defects was 3.6 × 6 cm. The mean flap size was 4 × 6.5 cm. The mean pedicle length was 4 cm. All flaps survived completely. Patient follow-up lasted a mean of 14 months. At the final follow-up, the mean hyperextension of the first MTP joint was 9 degrees. After surgery, the mean Foot Function Index improved from 62 to 7. Almost all patients were satisfied with the results. Transferring the medial plantar hallucal artery dorsal perforator flap is a useful and reliable technique for the reconstruction of the secondary defect on the first MTP joint. PMID:25275474

  16. Hyperbaric oxygen preconditioning promotes neovascularization of transplanted skin flaps in rats

    PubMed Central

    Liu, Xuehua; Yang, Jing; Li, Zhuo; Yang, Lin; Wang, Cong; Gao, Chunjin; Liang, Fang

    2014-01-01

    To determine whether Hyperbaric oxygen preconditioning (HBO-PC) promotes neovascularization by increasing Stromal cell derived factor-1 (SDF-1) and CXC chemokine receptor 4 (CXCR4) in transplanted skin flaps of rats. The epigastric pedicle skin flap was established in a rat model. Rats were randomly assigned to the following five groups: 1) sham-operated group (SH); 2) ischemia followed by reperfusion 3 days postoperatively group (IR3d); 3) ischemia followed by reperfusion 5 days postoperatively group (IR5d); 4) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 3 days postoperatively group (HBO-PC3d); and 5) hyperbaric oxygen preconditioning and ischemia followed by reperfusion 5 days postoperatively group(HBO-PC5d). For the groups receiving HBO-PC, animals underwent 1 hour of HBO at 2.0 ATA in 100% O2 twice per day for 3 days consecutively prior to surgery. After perfusion, Laser Doppler perfusion imaging (LDPI) was performed, and skin flap tissue samples were harvested for histological evaluation and western blot analysis. Perfusion was significantly improved in the HBO-PC groups compared with the IR groups on postoperative 3 and 5. Microvessel density (MVD) was significantly increased by HBO-PC compared with IR groups postoperatively. Western blot analysis revealed that SDF-1 and CXCR4 expression in the HBO-PC groups was significantly increased compared with IR groups. HBO-PC promoted neovascularization via increasing expression levels of SDF-1 and CXCR4 in transplanted skin flaps of rats. PMID:25197344

  17. Fat Grafting as a Vehicle for the Delivery of Recombinant Adeno-Associated Viral Vectors to Achieve Gene-Modification of Muscle Flaps*

    PubMed Central

    Carruthers, Katherine H.; During, Matthew J.; Muravlev, Alexander; Wang, Chuansong; Kocak, Ergun

    2013-01-01

    Background The combination of gene therapy and plastic surgery may have the potential to improve the specificity that is needed to achieve clinically applicable treatment regimens. Our goal was to develop a method for gene-modification that would yield sustainable production of gene products but would be less time consuming than existing protocols. Methods An adeno-associated virus (AAV) was used to deliver gene products to pectoralis muscle flaps. Gene-modification was accomplished via either direct injection or novel fat grafting techniques. Results Gene product production was observable by both in vivo imaging and immunohistochemical staining. Gene products were not detected in tissues that were not in contact with the fat grafts that were incubated with the viral vector, indicating that the transduction stayed local to the flap. Conclusions Using novel recombinant AAV vectors, we have developed a method for gene delivery that is highly efficient and applicable to muscle flaps. PMID:23403543

  18. Taste disturbance after palatopharyngeal surgery for obstructive sleep apnea.

    PubMed

    Hsiao, Han-Ren; Li, Hsueh-Yu

    2007-04-01

    Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51-year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function. PMID:17395567

  19. Use of the Anterolateral Thigh and Vertical Rectus Abdominis Musculocutaneous Flaps as Utility Flaps in Reconstructing Large Groin Defects

    PubMed Central

    Aslim, Edwin Jonathan; Rasheed, Mohamed Zulfikar; Lin, Fangbo; Ong, Yee-Siang

    2014-01-01

    Background Groin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds. Methods Groin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum) defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. Results Twenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap) was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series. Conclusions The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover. PMID:25276649

  20. The Use of Autologous Platelet-Rich Plasma (Platelet Gel) and Autologous Platelet-Poor Plasma (Fibrin Glue) in Cosmetic Surgery

    Microsoft Academic Search

    Daniel Man; Harvey Plosker; Jill E. Winland-Brown

    2001-01-01

    The purpose of this study was to evaluate a new tech- nique of harvesting and preparing autologous platelet gel and autologous fibrin glue (body glue) and to evaluate their effectiveness in stopping capillary bleeding in the surgical flaps of patients undergoing cosmetic surgery. A convenience sample of 20 patients ranging from 25 to 76 years of age undergoing cosmetic surgery

  1. Strabismus Surgery

    MedlinePLUS

    ... surgery? The type of anesthesia depends on age/health and patient preference. Most children undergo general anesthesia. Adults typically have general anesthesia, conscious sedation or local anesthesia. The procedure is usually ...

  2. Brain surgery

    MedlinePLUS

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  3. Maze Surgery

    MedlinePLUS

    ... some cases, on the morning of surgery. Small metal disks called electrodes will be attached to your ... throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so ...

  4. Heart Surgery

    MedlinePLUS

    ... surgery for adults is coronary artery bypass grafting (CABG). During CABG, a healthy artery or vein from the body ... rich blood to flow to the heart muscle. CABG can relieve chest pain and may lower your ...

  5. Effect of configuration variation on externally blown flap noise

    NASA Technical Reports Server (NTRS)

    Dorsch, R. G.; Goodykoontz, J. H.; Sargent, N. B.

    1974-01-01

    The sensitivity of flap interaction noise to variations in engine-under-the-wing externally blown flap geometry was investigated with a large cold-flow model. Both 2- and 3-flap wing sections (7-ft chord) with trailing flap angles up to 60 deg were employed. Exhaust nozzles included coaxial, plug, and 8- and 13-inch diameter conical configurations. These nozzles were tested at two positions below the wing. The effects of these geometry variations on noise level, directivity, and spectral shape are summarized in terms of exhaust flow parameters evaluated at the nozzle exit and at the flap impingement station. The results are also compared with limited flap noise data available from tests using real engines.

  6. Distally based sural island flap for foot and ankle reconstruction.

    PubMed

    Jeng, S F; Wei, F C

    1997-03-01

    The distally based sural island flap is vascularized by the cutaneous perforating branches of the peroneal artery. Three variants of this flap were used for reconstruction of 19 patients with defects in the ankle and in both dorsal and plantar surfaces of the foot. Four adipofascial sural flaps were used to cover the exposed Achilles tendons. Twelve fasciocutaneous sural flaps were used to resurface defects in the ankle region as well as in the non-weight-bearing area of the heel. Another four sural flaps, innervated by the lateral sural cutaneous nerve, were used to resurface the weight-bearing areas of the heel. The advantage of this flap is a constant and reliable blood supply without sacrifice of major arteries or sensory nerves. It also has the potential for reinnervation and can be performed in a single stage without microsurgery. PMID:9047194

  7. The radial forearm skin graft-fascial flap.

    PubMed

    Cherup, L L; Zachary, L S; Gottlieb, L J; Petti, C A

    1990-06-01

    The radial forearm flap has become a versatile flap for upper extremity reconstruction. The use of the forearm flap for hand reconstruction in the patient with previously burned forearms has not been widely appreciated. In those patients whose forearms have been previously split-thickness skin-grafted on fascia, we have employed the reverse radial forearm flap as a skin graft-fascial flap for hand reconstruction and have obtained excellent functional results. Three patients at various intervals postburn are presented to demonstrate use of this flap for wrist contracture release, coverage of arthroplasties, first web space contracture release, and acute salvage of phalanges and tendons. Assessment of the hand's vascular anatomy and careful treatment of the donor area have contributed to no added morbidity and an excellent aesthetic result at the donor site. PMID:2349295

  8. The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

    PubMed Central

    Mat Saad, A. Z.; Khoo, T. L.; Dorai, A. A.; Halim, A. S.

    2009-01-01

    Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome. PMID:19881027

  9. Successful use of a gastrocnemius flap for an exposed PTFE femorodistal graft: a case report.

    PubMed

    Nabulyato, W M; Alsahiem, H; Szepelak, K; Boyle, J R; Malata, C M

    2014-10-01

    Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the associated increased morbidity and mortality. Femoro-distal bypass grafting is used in patients with extensive occlusion affecting the crural arteries and poor limb function, but is associated with infection, wound dehiscence and graft exposure. We report a case of a 73-year-old male with history of PVD and occluded ipsilateral femoro-distal bypass graft who underwent limb salvage surgery with a left 6 mm heparin-bonded polytetrafluoroethylene femoro-distal bypass graft in September 2011. He later presented with exposure of the graft over the lateral aspect of the knee following wound dehiscence. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft. Minor donor site healing problems were noted, but he otherwise made an excellent recovery. While gastrocnemius muscle flaps have been used to cover soft tissue tibial defects secondary to sarcoma and exposed knee joint prostheses, our case adds to the limited literature demonstrating successful salvage of an exposed synthetic graft as a viable alternative to amputation. We therefore recommend prompt referral to plastic services for the management of these complex wounds. PMID:25289653

  10. [Complications of refractive excimer laser surgery].

    PubMed

    Knorz, M C

    2006-03-01

    In surface ablation, haze is the most frequent complication. After LASIK, microkeratome-related complications are rare today and usually resolve without sequelae, provided no ablation was done. Postoperative flap complications such as flap slippage usually occur during the first few days after surgery and should be treated as early whenever present. Interface complications are a new diagnostic entity as the interface between flap and stroma presents a space where fluid or cells can accumulate. Diffuse lamellar keratitis usually occurs within the first few postoperative days and should be treated aggressively to avoid scarring. Epithelial ingrowth is another rare complication usually requiring treatment. Corneal hydrops with fluid accumulation in the interface is a very rare but important phenomenon related to steroid-induced glaucoma but presenting with false low tonometry readings. Corneal ectasia is extremely rare and in most cases related to thin stromal beds. However, its pathogenesis is not yet completely understood, and it may occur in "normal" eyes, too. Dry eye syndrome is the most frequent complication after LASIK. It is usually benign but may cause significant visual impairment in rare cases. PMID:16465507

  11. Bariatric surgery

    PubMed Central

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  12. The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach

    Microsoft Academic Search

    Panduranga Yenumula; Erick F. Rivas; Keith M. Cavaness; Ed Kang; Edward Lanigan

    2011-01-01

    Introduction  Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction\\u000a (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus\\u000a decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for\\u000a ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT)

  13. Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction

    Microsoft Academic Search

    Kelly K. Hunt; Bonnie J. Baldwin; Eric A. Strom; Frederick C. Ames; Marsha D. McNeese; Stephen S. Kroll; S. Eva Singletary

    1997-01-01

    Background: Postoperative radiotherapy (PORT) has been shown to decrease locoregional failure rates in high-risk breast cancer patients\\u000a following modified radical mastectomy. However, there had not been a study evaluating the effect of PORT in patients after\\u000a transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. Therefore, we evaluated flap viability, cosmetic\\u000a results, and locoregional recurrence in patients who underwent TRAM flap

  14. Flight test pilot evaluation of a delayed flap approach procedure

    NASA Technical Reports Server (NTRS)

    Bull, J. S.; Edwards, F. G.; Foster, J. D.; Hegarty, D. M.; Drinkwater, F. J., III

    1977-01-01

    Using NASA's CV-990 aircraft, a delayed flap approach procedure was demonstrated to nine guest pilots from the air transport industry. Four demonstration flights and 37 approaches were conducted under VFR weather conditions. A limited pilot evaluation of the delayed flap procedure was obtained from pilot comments and from questionaires they completed. Pilot acceptability, pilot workload, and ATC compatibility were quantitatively rated. The delayed flap procedure was shown to be feasible, and suggestions for further development work were obtained.

  15. Flap Coverage of Anterior Abdominal Wall Defects

    PubMed Central

    Sacks, Justin M.; Broyles, Justin M.; Baumann, Donald P.

    2012-01-01

    Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen. PMID:23372457

  16. Bone propeller flap: a staged procedure.

    PubMed

    Tremp, Mathias; Largo, René D; Borens, Olivier; Schaefer, Dirk J; Kalbermatten, Daniel F

    2014-01-01

    The ideal reconstruction technique for complex defects of the lower limb consists of replacing tissue with similar tissue in an attempt to achieve a good functional result. A 23-year-old white male sustained a crush injury with a grade IIIB open ankle dislocation. After open reduction and fixation, the patient developed severe osteomyelitis at the tibiotalar joint requiring a staged and radical debridement with a substantial combined soft tissue and bony defect over the distal tibia, fibula, and talus area. The reconstructive approach consisted of a modified model of the propeller flap, implementing the spare part concept in a 2-stage procedure using a prefabricated and vascularized "double-barrel" fibular graft. At 17 months postoperatively, a plain radiograph showed bony union with complete and stable coverage of the soft tissue defect. The patient was fully weightbearing. In conclusion, there is evidence to suggest that the established concept of a soft tissue propeller flap can be implemented on bone. PMID:23876983

  17. Pumping by flapping in a viscoelastic fluid

    E-print Network

    Pak, On Shun

    2010-01-01

    In a world without inertia, Purcell's scallop theorem states that in a Newtonian fluid a time-reversible motion cannot produce any net force or net flow. Here we consider the extent to which the nonlinear rheological behavior of viscoelastic fluids can be exploited to break the constraints of the scallop theorem in the context of fluid pumping. By building on previous work focusing on force generation, we consider a simple, biologically-inspired geometrical example of a flapper in a polymeric (Oldroyd-B) fluid, and calculate asymptotically the time-average net fluid flow produced by the reciprocal flapping motion. The net flow occurs at fourth order in the flapping amplitude, and suggests the possibility of transporting polymeric fluids using reciprocal motion in simple geometries even in the absence of inertia. The induced flow field and pumping performance are characterized and optimized analytically. Our results may be useful in the design of micro-pumps handling complex fluids.

  18. Maximising the use of tissue expanded flaps.

    PubMed

    Hudson, Donald A

    2003-12-01

    Tissue expansion offers the advantages of supplying tissue similar in texture and colour to the defect to be covered. However, to maximise the result, the expanded tissue must be used in the most efficient way possible. Rectangular expanders have been shown to yield the most available tissue. A technique to maximise the use of expanded tissue with a rectangular tissue expander is described. The technique is one of an advancement flap that maximises the use of expanded tissue in both a vertical and horizontal direction by adding backcuts to the sides (and interposing triangles of local tissue into these backcuts) as well as the base of the flap. This technique has been successfully applied to 11 children (17 expanders) undergoing tissue expansion during a 19 month period. PMID:14615253

  19. Pumping by flapping in a viscoelastic fluid

    NASA Astrophysics Data System (ADS)

    Pak, On Shun; Normand, Thibaud; Lauga, Eric

    2010-03-01

    In a world without inertia, Purcell’s scallop theorem states that in a Newtonian fluid a time-reversible motion cannot produce any net force or net flow. Here we consider the extent to which the nonlinear rheological behavior of viscoelastic fluids can be exploited to break the constraints of the scallop theorem in the context of fluid pumping. By building on previous work focusing on force generation, we consider a simple, biologically inspired geometrical example of a flapper in a polymeric (Oldroyd-B) fluid, and calculate asymptotically the time-average net fluid flow produced by the reciprocal flapping motion. The net flow occurs at fourth order in the flapping amplitude, and suggests the possibility of transporting polymeric fluids using reciprocal motion in simple geometries even in the absence of inertia. The induced flow field and pumping performance are characterized and optimized analytically. Our results may be useful in the design of micropumps handling complex fluids.

  20. Pumping by flapping in a viscoelastic fluid.

    PubMed

    Pak, On Shun; Normand, Thibaud; Lauga, Eric

    2010-03-01

    In a world without inertia, Purcell's scallop theorem states that in a Newtonian fluid a time-reversible motion cannot produce any net force or net flow. Here we consider the extent to which the nonlinear rheological behavior of viscoelastic fluids can be exploited to break the constraints of the scallop theorem in the context of fluid pumping. By building on previous work focusing on force generation, we consider a simple, biologically inspired geometrical example of a flapper in a polymeric (Oldroyd-B) fluid, and calculate asymptotically the time-average net fluid flow produced by the reciprocal flapping motion. The net flow occurs at fourth order in the flapping amplitude, and suggests the possibility of transporting polymeric fluids using reciprocal motion in simple geometries even in the absence of inertia. The induced flow field and pumping performance are characterized and optimized analytically. Our results may be useful in the design of micropumps handling complex fluids. PMID:20365859

  1. Laser safety aspects for refractive eye surgery with femtosecond laser pulses

    Microsoft Academic Search

    Ronan Le Harzic; Rainer Bückle; Christian Wüllner; Christof Donitzky; Karsten König

    2005-01-01

    We report on laser safety aspects for near infrared femtosecond laser refractive surgery. In particular, the transmittance of microjoule laser pulses at 1040nm through the cornea during flap procedures based on femtosecond laser induced multiphoton ionization and photodisruption has been determined. When using focusing optics with a numerical aperture of 0.3, more than 20% of the incident NIR photons are

  2. Experimental investigation of a flapping wing model

    Microsoft Academic Search

    Tatjana Y. Hubel; Cameron Tropea

    2009-01-01

    The main objective of this research study was to investigate the aerodynamic forces of an avian flapping wing model system.\\u000a The model size and the flow conditions were chosen to approximate the flight of a goose. Direct force measurements, using\\u000a a three-component balance, and PIV flow field measurements parallel and perpendicular to the oncoming flow, were performed\\u000a in a wind

  3. Prepatterned, Sculpted Free Flaps for Facial Burns

    Microsoft Academic Search

    Elliott H. Rose

    \\u000a The demands of the twenty-first century dictate aesthetic excellence as well as functional correction in complex burn reconstructions.\\u000a The severely disfigured burned face is marred by corrugated external scarring, distortion of facial features, and restricted\\u000a facial movement. Z-plasties, local flaps, and full thickness skin grafts are useful in addressing more limited functional\\u000a needs of ectropion release, nasal stenosis, perioral contractures,

  4. Aerodynamic characteristics of flapping motion in hover

    Microsoft Academic Search

    D. Funda Kurtulus; Laurent David; Alain Farcy; Nafiz Alemdaroglu

    2008-01-01

    The aim of the present work is to understand the aerodynamic phenomena and the vortex topology of an unsteady flapping motion\\u000a by means of numerical and experimental methods. Instead of the use of real insect\\/bird wing geometries and kinematics which\\u000a are highly complex and difficult to imitate by an exact modeling, a simplified model is used in order to understand

  5. Gluteal necrosis following pelvic fracture and bilateral internal iliac embolization: Reconstruction using a transposition flap based on the lumbar artery perforators

    PubMed Central

    Gilleard, Onur; Stammers, John; Ali, Farida

    2011-01-01

    INTRODUCTION The use of bilateral internal iliac artery embolization to control hemorrhage associated with pelvic fractures is a life saving intervention. Gluteal necrosis is a rare but potentially fatal complication of this procedure. Following debridement, reconstruction can present a considerable challenge due to the compromised vascularity of local tissue. PRESENTATION OF CASE A 17 year old girl suffered an open book pelvic fracture following a road traffic accident. In order to stop profuse bleeding, bilateral internal iliac artery embolization was performed. This procedure was complicated by the development of right sided gluteal necrosis. Following extensive debridement, a transposition flap based on the lumbar artery perforators was performed to cover the soft tissue defect. DISCUSSION Gluteal necrosis occurs in approximately 3% of cases following internal iliac artery embolization. Following complete excision of the devitalised tissue reconstructive surgery is necessary. Local flaps are suboptimal options when the integument supplied by branches of the internal iliac arteries has been compromised following embolization. Furthermore, the use of a free flap is restricted by the lack of a readily accessible undamaged recipient vessel. In the present case a transposition flap based on the lumbar artery perforators facilitated robust reconstruction of the buttock region. CONCLUSION To avoid sepsis, it is imperative that gluteal necrosis following internal iliac artery embolization is recognized and promptly debrided. A transposition flap based on the lumbar artery perforators is a good option for subsequent soft tissue coverage, which avoids use of tissue supplied by the branches of the internal iliac arteries. PMID:22288054

  6. Near-infrared spectroscopic assessment of oxygen delivery to free flaps on monkeys following vascular occlusions and inhalation of pure oxygen

    NASA Astrophysics Data System (ADS)

    Tian, Fenghua; Ding, Haishu; Cai, Zhigang; Wang, Guangzhi; Zhao, Fuyun

    2002-04-01

    In recent studies, near-infrared spectroscopy (NIRS) has been considered as a potentially ideal noninvasive technique for the postoperative monitoring of plastic surgery. In this study, free flaps were raised on rhesus monkeys' forearms and oxygen delivery to these flaps was monitored following vascular occlusions and inhalation of pure oxygen. Optical fibers were adopted in the probe of the oximeter so that the detection could be performed in reflectance mode. The distance between emitter and detector can be adjusted easily to achieve the best efficacy. Different and repeatable patterns of changes were measured following vascular occlusions (arterial occlusion, venous occlusion and total occlusion) on flaps. It is clear that the near-infrared spectroscopy is capable of postoperatively monitoring vascular problems in flaps. NIRS showed high sensitivity to detect the dynamic changes in flaps induced by inhalation of pure oxygen in this study. The experimental results indicated that it was potential to assess tissue viability utilizing the dynamic changes induced by a noninvasive stimulation. It may be a new assessing method that is rapid, little influenced by other factors and brings less discomfort to patients.

  7. Vortex leading edge flap assembly for supersonic airplanes

    NASA Technical Reports Server (NTRS)

    Rudolph, Peter K. C. (Inventor)

    1997-01-01

    A leading edge flap (16) for supersonic transport airplanes is disclosed. In its stowed position, the leading edge flap forms the lower surface of the wing leading edge up to the horizontal center of the leading edge radius. For low speed operation, the vortex leading edge flap moves forward and rotates down. The upward curve of the flap leading edge triggers flow separation on the flap and rotational flow on the upper surface of the flap (vortex). The rounded shape of the upper fixed leading edge provides the conditions for a controlled reattachment of the flow on the upper wing surface and therefore a stable vortex. The vortex generates lift and a nose-up pitching moment. This improves maximum lift at low speed, reduces attitude for a given lift coefficient and improves lift to drag ratio. The mechanism (27) to move the vortex flap consists of two spanwise supports (24) with two diverging straight tracks (64 and 68) each and a screw drive mechanism (62) in the center of the flap panel (29). The flap motion is essentially normal to the airloads and therefore requires only low actuation forces.

  8. Total scalp reconstruction with bilateral anterolateral thigh flaps.

    PubMed

    Kwee, Melissa M; Rozen, Warren M; Ting, Jeannette W C; Mirkazemi, Mansoor; Leong, James; Baillieu, Charles

    2012-07-01

    Large scalp defects can require complicated options for reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large scalp defects, and report a unique case in which total scalp reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The reconstruction was achieved as a single-stage reconstruction and involved wide resection of cranium and overlying soft-tissues and reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for scalp resurfacing and may be the largest reported scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the reconstruction of large and/or complicated scalp defects. PMID:22438113

  9. Effects of primary rotor parameters on flapping dynamics

    NASA Technical Reports Server (NTRS)

    Chen, R. T. N.

    1980-01-01

    The effects of flapping dynamics of four main rotor design features that influence the agility, stability, and operational safety of helicopters are studied. The parameters include flapping hinge offset, flapping hinge restraint, pitch-flap coupling, and blade lock number. First, the flapping equations of motion are derived that explicitly contain the design parameters. The dynamic equations are then developed for the tip-path plane, and the influence of individual and combined variations in the design parameters determined. The steady state flapping response is examined with respect to control input and aircraft angular rate which leads to a feedforward control law for control decoupling through cross feed, and a feedback control law to decouple the steady state flapping response. The condition for achieving perfect decoupling of the flapping response due to aircraft pitch and roll rates without using feedback control is also found for the hover case. It is indicated that the frequency of the regressing flapping mode of the rotor system can become low enough to require consideration in the assessment of handling characteristics.

  10. Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.

    PubMed

    Lu, Shengdi; Chai, Yimin; Wang, Chunyang; Wen, Gen

    2014-02-01

    Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap. PMID:24163225

  11. "Impossible" reversed radial forearm free flap in microsurgical reconstruction.

    PubMed

    Bauland, C G; van Twisk, R; Bos, M Y; Nicolai, J P

    1993-01-01

    The reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed. PMID:8289645

  12. Development of a morphing flap using shape memory alloy actuators: the aerodynamic characteristics of a morphing flap

    NASA Astrophysics Data System (ADS)

    Ko, Seung-Hee; Bae, Jae-Sung; Rho, Jin-Ho

    2014-07-01

    The discontinuous contour of a wing with conventional flaps diminishes the aerodynamic performance of an aircraft. A wing with a continuous contour does not experience extreme flow stream fluctuations during flight, and consequently has good aerodynamic characteristics. In this study, a morphing flap using shape memory alloy actuators is proposed, designed and fabricated, and its aerodynamic characteristics are investigated using aerodynamic analyses and wind tunnel tests. The ribs of the morphing flap are designed and fabricated with multiple elements joined together in a way that allows relative rotations of adjacent elements and forms a smooth contour of the morphing flap. The aerodynamic analyses of this multiple-element morphing-flap wing are performed using XFLR pro; its aerodynamic performance is compared with that of a mechanical-flap wing, and is measured through wind-tunnel tests.

  13. Flapping instability of a liquid jet

    NASA Astrophysics Data System (ADS)

    Matas, Jean-Philippe; Cartellier, Alain

    2013-01-01

    We study the flapping instability observed when a liquid jet is incompletely atomized by a fast parallel gas stream: the remaining liquid jet is destabilized over a scale large compared with its radius, and breaks into liquid fragments. We characterize the symmetry of this instability and its frequency. The intact liquid length is measured as a function of gas and liquid velocity, and turns out to be longer than the one predicted by Raynal (1997) for a planar mixing layer. The frequency of the instability is measured with a spectral method, and is in agreement with the frequency observed for the planar shear instability, though slightly smaller. The planar, and not helical, symmetry of the instability makes it akin to a flapping instability, observed when a planar liquid sheet is atomized by two planar gas streams. We next measure drop sizes when the flapping instability is present, with a method based on image processing. Measured size distributions are in agreement with distributions observed in a mixing layer geometry for low gas velocities (long tail distribution). The mean drop diameter depends weakly on liquid velocity, and decreases as d10˜Ug0.9. On the contrary, Sauter diameter depends strongly on liquid velocity.

  14. Locomotion of a flapping flexible plate

    NASA Astrophysics Data System (ADS)

    Hua, Ru-Nan; Zhu, Luoding; Lu, Xi-Yun

    2013-12-01

    The locomotion of a flapping flexible plate in a viscous incompressible stationary fluid is numerically studied by an immersed boundary-lattice Boltzmann method for the fluid and a finite element method for the plate. When the leading-edge of the flexible plate is forced to heave sinusoidally, the entire plate starts to move freely as a result of the fluid-structure interaction. Mechanisms underlying the dynamics of the plate are elucidated. Three distinct states of the plate motion are identified and can be described as forward, backward, and irregular. Which state to occur depends mainly on the heaving amplitude and the bending rigidity of the plate. In the forward motion regime, analysis of the dynamic behaviors of the flapping flexible plate indicates that a suitable degree of flexibility can improve the propulsive performance. Moreover, there exist two kinds of vortex streets in the downstream of the plate which are normal and deflected wake. Further the forward motion is compared with the flapping-based locomotion of swimming and flying animals. The results obtained in the present study are found to be consistent with the relevant observations and measurements and can provide some physical insights into the understanding of the propulsive mechanisms of swimming and flying animals.

  15. Flapping oscillations of the bended current sheet

    NASA Astrophysics Data System (ADS)

    Kubyshkina, Daria; Erkaev, Nikolay; Korovinskiy, Daniil; Ivanov, Ivan; Semenov, Vladimir

    Flapping oscillations observed in the current sheet of the Earth’s magnetotail, represent rather slow waves propagating from the center to the flanks with a typical speed 20-60 km/s, amplitude 1-2Re and quasiperiod 2-10 minutes. Besides observations, this type of oscillations was also investigated theoretically for the symmetrical configurations of the magnetotail current sheet. Here we propose some theoretical modeling of the flapping mode for the asymmetric current sheet. A lot of models were elaborated to describe the flapping oscillations, both kinetic and magnetohydrodynamical (MHD). The relevant model is MHD and based on the double gradient of magnetic field: gradient of tangential (B _{x}) component along the normal (z _{GSM}) direction and gradient of the normal component (B _{z}) along the x-direction. The dispersion curve obtained with this model for symmetric case agrees very well with the experimental one. We solve the MHD equations numerically for the asymmetric magnetic field configuration, which was obtained from generalization of the Kan’s current sheet model for the case of inclined Earth’s dipole. This generalization was constructed by the parameter varying (we suppose one of them to be imaginary). In current study we obtain the dispersion relations for different angles of dipole inclination (i.e. for the different levels of asymmetry) and investigate it’s difference from the symmetric case.

  16. Navier-Stokes Computations of a Wing-Flap Model With Blowing Normal to the Flap Surface

    NASA Technical Reports Server (NTRS)

    Boyd, D. Douglas, Jr.

    2005-01-01

    A computational study of a generic wing with a half span flap shows the mean flow effects of several blown flap configurations. The effort compares and contrasts the thin-layer, Reynolds averaged, Navier-Stokes solutions of a baseline wing-flap configuration with configurations that have blowing normal to the flap surface through small slits near the flap side edge. Vorticity contours reveal a dual vortex structure at the flap side edge for all cases. The dual vortex merges into a single vortex at approximately the mid-flap chord location. Upper surface blowing reduces the strength of the merged vortex and moves the vortex away from the upper edge. Lower surface blowing thickens the lower shear layer and weakens the merged vortex, but not as much as upper surface blowing. Side surface blowing forces the lower surface vortex farther outboard of the flap edge by effectively increasing the aerodynamic span of the flap. It is seen that there is no global aerodynamic penalty or benefit from the particular blowing configurations examined.

  17. Comparative study of visual acuity and aberrations after intralase femtosecond LASIK: small corneal flap versus big corneal flap

    PubMed Central

    Zhang, Ya-Li; Liu, Lei; Cui, Chang-Xia; Hu, Ming; Li, Zhao-Na; Cao, Li-Jun; Jing, Xiu-Hua; Mu, Guo-Ying

    2013-01-01

    AIM To study the effect of different flap sizes on visual acuity, refractive outcomes, and aberrations after femtosecond laser for laser in situ keratomileusis (LASIK). METHODS In each of the forty patients enrolled, 1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap, defined as the small flap, while the other eye was treated with a 8.6mm diameter corneal flap, defined as the big flap. Refractive errors, visual acuity, and higher-order aberrations were compared between the two groups at week 1, month 1 and 3 postoperatively. RESULTS The postoperative refractive errors and visual acuity all conformed to the intended goal. Postoperative higher-order aberrations were increased, especially in spherical aberration (Z12) and vertical coma (Z7). There were no statistically significant differences between the two groups in terms of postoperative refractive errors, visual acuity, root mean square of total HOAs (HO-RMS), trefoil 30° (Z6), vertical coma (Z7), horizontal coma (Z8), trefoil 0° (Z9), and spherical aberration (Z12) at any point during the postoperative follow-up. CONCLUSION Both the small and big flaps are safe and effective procedures to correct myopia, provided the exposure stroma meets the excimer laser ablations. The personalized size corneal flap is feasible, as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error. PMID:24195040

  18. DEHN SURGERY 1. Introduction

    E-print Network

    Hachimori, Masahiro

    DEHN SURGERY 1. Introduction Dehn surgery hyperbolic knot exceptional surgery (§2) link Dehn surgery (§3) 2. Exceptional surgery and boundary slopes hyperbolic knot exceptional surgery ? S3 ( S3 homotopy S3 ) Dehn surgery K S3 knot E(K) = S3 -intN(K) exterior prim- itive class H1(E(K); Z) ( ) m K

  19. Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study

    PubMed Central

    Pennington, David G.

    2014-01-01

    Background: The maximum weight of tissue that a single perforator can perfuse remains an important question in reconstructive microsurgery. An empirically based equation, known as the flap viability index (FVI), has been established to determine what weight of tissue will survive on one or more perforators. The equation is FVI = Sum d(n)^4/W, where d is the internal diameter of each perforator and W is the final weight of the flap. It has been shown that if FVI exceeds 10, total flap survival is likely, but if under 10, partial flap necrosis is probable. The aim of this study was to measure absolute flow rates in deep inferior epigastric perforator (DIEP) flap pedicles and assess correlation with the determinants of the FVI, perforator diameter and flap weight. Methods: Color Doppler ultrasound was used to quantify arterial flow in 10 consecutive DIEP flap pedicles 24 hours after anastomosis. Results: In single-perforator DIEP flaps, flow rate was highly correlated with perforator diameter (r = 0.82, P = 0.01). Mean arterial flow rate was significantly reduced in DIEP flaps with 2 or more perforators (6 vs 38 cm3/min; P < 0.05). Conclusions: This study confirms that perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival. PMID:25426345

  20. Folding in and out: passive morphing in flapping wings.

    PubMed

    Stowers, Amanda K; Lentink, David

    2015-04-01

    We present a new mechanism for passive wing morphing of flapping wings inspired by bat and bird wing morphology. The mechanism consists of an unactuated hand wing connected to the arm wing with a wrist joint. Flapping motion generates centrifugal accelerations in the hand wing, forcing it to unfold passively. Using a robotic model in hover, we made kinematic measurements of unfolding kinematics as functions of the non-dimensional wingspan fold ratio (2-2.5) and flapping frequency (5-17 Hz) using stereo high-speed cameras. We find that the wings unfold passively within one to two flaps and remain unfolded with only small amplitude oscillations. To better understand the passive dynamics, we constructed a computer model of the unfolding process based on rigid body dynamics, contact models, and aerodynamic correlations. This model predicts the measured passive unfolding within about one flap and shows that unfolding is driven by centrifugal acceleration induced by flapping. The simulations also predict that relative unfolding time only weakly depends on flapping frequency and can be reduced to less than half a wingbeat by increasing flapping amplitude. Subsequent dimensional analysis shows that the time required to unfold passively is of the same order of magnitude as the flapping period. This suggests that centrifugal acceleration can drive passive unfolding within approximately one wingbeat in small and large wings. Finally, we show experimentally that passive unfolding wings can withstand impact with a branch, by first folding and then unfolding passively. This mechanism enables flapping robots to squeeze through clutter without sophisticated control. Passive unfolding also provides a new avenue in morphing wing design that makes future flapping morphing wings possibly more energy efficient and light-weight. Simultaneously these results point to possible inertia driven, and therefore metabolically efficient, control strategies in bats and birds to morph or recover within a beat. PMID:25807583

  1. Endoscopic endonasal pituitary and skull base surgery.

    PubMed

    Saeki, Naokatsu; Horiguchi, Kentaro; Murai, Hisayuki; Hasegawa, Yuzo; Hanazawa, Toyoyuki; Okamoto, Yoshitaka

    2010-01-01

    Here we describe the procedures of endoscopic pituitary and skull base surgery in our institute. We also review the literature to reveal recent advances in this field. Endonasal approach via the sphenoid ostium was carried out for pituitary lesions without the nasal speculum. Postoperative nasal packing was basically not needed in such cases. For meningiomas, craniopharyngiomas, and giant pituitary adenomas, which required intra-dural procedures, nasal procedures such as middle nasal conchotomy and posterior ethmoidectomy, and skull base techniques such as optic canal decompression and removal of the planum sphenoidale were carried out to gain a wider operative field. Navigation and ultrasonic Doppler ultrasonography were essential. Angled endoscopes allowed more successful removal of tumors under direct visualization extending into the cavernous sinus and lower clivus. If cerebrospinal fluid (CSF) leakage occurred during operation, the dural opening was covered with a vascularized mucoseptal flap obtained from the nasal septum. Lumbar drainage system to prevent postoperative CSF rhinorrhea was frequently not required. Angled suction tips, single-shaft coagulation tools, and slim and longer holding forceps, all of which were newly designed for endoscopic surgery, were essential for smoother procedures. Endonasal endoscopic pituitary surgery allows less invasive transsphenoidal surgery since no postoperative nasal packing and less dependence on lumbar drainage are needed. Endoscopic pituitary surgery will be more common and become a standard procedure. Endoscopic skull base surgery has enabled more aggressive removal of extrasellar tumors with the aid of nasal and skull base techniques. Postoperative CSF leakage is now under control due to novel methods which have been proposed to close the dural defect in a water-tight manner. Endoscopic skull base surgery is more highly specialized, so needs special techniques and surgical training. Patient selection is also important, which needs collaboration with ear, nose, and throat specialists. As a safe and successful procedure in skull base surgery, this complex procedure should be carried out only in specialized hospitals, which deal with many patients with skull base lesions. PMID:20885110

  2. Anatomical study of perforator arteries in the distally based radial forearm fasciosubcutaneous flap.

    PubMed

    Tiengo, Cesare; Macchi, Veronica; Porzionato, Andrea; Bassetto, Francesco; Mazzoleni, Franco; De Caro, Raffaele

    2004-11-01

    We investigated the anatomical vascular basis of the forearm fasciosubcutaneous flap (FSC-F), fed by the distal perforator arteries of the fascia. This type of flap was proposed, in hand reconstructive surgery, to avoid the disadvantages caused by axial-pattern reverse radial forearm fasciocutaneous flap, based on ligation and rotation of the radial artery (RA). In eight fresh cadaveric forearms, the RA was injected slowly with acrylic resin and the superficial flexor compartment was dissected. Then the FSC-F was raised from the lateral margins of the sample to the median RA axis, and the collaterals of the RA (number, interval of origin, and caliber) were evaluated. The fascial branches of RA (mean number +/- SD: 20 +/- 3) originated mainly from the radial and ulnar sides of the RA. In the distal forearm the vessels were more numerous (mean value = 11.3 vs. 8.9; Student's t-test, P < 0.05) but smaller in diameter (mean value = 0.45 mm vs. 0.63 mm; Student's t-test, P < 0.05). The perforator arteries forked in a T-shape following the main axis of the forearm and anastomosed in the fascial plane, forming longitudinal fan-shaped arterial chains giving rise to the vascular epifascial network. Histological (hematoxylin-eosin, azan-Mallory, Weigert) and immunohistochemical (anti-von Willebrand factor) study of the FSC-F at different levels of sampling was also carried out. The epifascial branches of distal sections were smaller in diameter (78.3 +/- 35.5 microm) than those of intermediate (105.7 +/- 28.7 microm; Newman-Keuls test, P < 0.01) and proximal (116.8 +/- 31.2 microm; Newman-Keuls test, P < 0.001) sections. Our findings indicate that the perforator arteries and epifascial branches are smaller in the distal forearm, so that during surgical dissection, the safety distance from the radial styloid should take into account that also in the presence of a sufficient number of vessels in the distal forearm their caliber could be inadequate to the hemodynamic request of the flap. Thus, rather than on a theoretic distance from the radial styloid, the length of the flap should be based on an accurate evaluation of the individual vascularization of the forearm case by case. PMID:15495170

  3. Laparoscopic surgery - series (image)

    MedlinePLUS

    ... of different procedures can be performed laparoscopically, including gallbladder removal (laparoscopic cholecystectomy), esophageal surgery (laparoscopic fundoplication), colon surgery (lapraoscopic colectomy), and surgery ...

  4. Considerations of glaucoma in patients undergoing corneal refractive surgery.

    PubMed

    Bashford, Kent P; Shafranov, George; Tauber, Shachar; Shields, M Bruce

    2005-01-01

    Glaucoma patients present a unique set of challenges to physicians performing corneal refractive surgery. Corneal thickness, which is modified during corneal refractive surgery, plays an important role in monitoring glaucoma patients because of its effect on the measured intraocular pressure. Patients undergo a transient but significant rise in intraocular pressure during the laser-assisted in situ keratomileusis (LASIK) procedure with risk of further optic nerve damage or retinal vein occlusion. Glaucoma patients with filtering blebs are also at risk of damage to the bleb by the suction ring. Steroids, typically used after refractive surgery, can increase intraocular pressure in steroid responders, which is more prevalent among glaucoma patients. Flap interface fluid after LASIK, causing an artificially low pressure reading and masking an elevated pressure has been reported. The refractive surgeon's awareness of these potential complications and challenges will better prepare them for proper management of glaucoma patients who request corneal refractive surgery. PMID:15850813

  5. An alternative flap choice in penis skin defects: preputial mucosal flap.

    PubMed

    Bozkurt, Mehmet; Zor, Fatih; Kulahci, Yalcin; Kapi, Emin; Karakol, Percin

    2009-12-01

    In this study, the authors present their experience with preputial mucosal flap usage for reconstruction of full-thickness skin loss of the penis in a patient with scald injury and discuss the possible treatment modalities in penile skin defects. During the 2-year follow-up period, no complication was encountered, and the patient healed uneventfully. PMID:19643464

  6. [Aesthetic gluteal region reconstruction with a perforator artery flap].

    PubMed

    Ho Quoc, C; Boucher, F; Meeus, P; Boespflug, A; Neidhart, E M; Delay, E

    2013-08-01

    The gluteal region is an important pressure zone in every day life. Defects associated with bone exposure in the sacral region are more frequent among pressure sores. The gold standard treatment consists in a musculocutaneous gluteal flap; it can have as side effects functional deficits for walking and an important scar. In order to diminish the donor site morbidity muscle sparing flaps, as perforator flaps, have been described. The purpose of this article is to report the case of a 29-year-old patient with a median sacral defect with bone exposure after oncological resection, covered by a perforator gluteal flap. A superior gluteal artery perforator was researched using a Doppler flowmetry. The role of the perforator was to make the flap more reliable and to obtain a higher degree of mobilization of the flap devoid of tension or flap morbidity, without interfering with the gluteus maximus muscle integrity. Also, the aesthetic units of the gluteal region have been considered in order to obtain a better scar quality. At the 4 months follow-up, the result was stable with a discrete scar and no walking difficulties. In conclusion, the median defects associating bone exposure in the sacral region are difficult to treat, especially in young patients. The treatment should consist in a stable soft tissue coverage with minimal functional and aesthetic sequela. The perforator gluteal flap respects the aesthetic units and can be considered as an elegant and efficient solution to treat this type of defects. PMID:23182675

  7. Active Flap Control of the SMART Rotor for Vibration Reduction

    NASA Technical Reports Server (NTRS)

    Hall, Steven R.; Anand, R. Vaidyanathan; Straub, Friedrich K.; Lau, Benton H.

    2009-01-01

    Active control methodologies were applied to a full-scale active flap rotor obtained during a joint Boeing/ DARPA/NASA/Army test in the Air Force National Full-Scale Aerodynamic Complex 40- by 80-foot anechoic wind tunnel. The active flap rotor is a full-scale MD 900 helicopter main rotor with each of its five blades modified to include an on-blade piezoelectric actuator-driven flap with a span of 18% of radius, 25% of chord, and located at 83% radius. Vibration control demonstrated the potential of active flaps for effective control of vibratory loads, especially normal force loads. Active control of normal force vibratory loads using active flaps and a continuous-time higher harmonic control algorithm was very effective, reducing harmonic (1-5P) normal force vibratory loads by 95% in both cruise and approach conditions. Control of vibratory roll and pitch moments was also demonstrated, although moment control was less effective than normal force control. Finally, active control was used to precisely control blade flap position for correlation with pretest predictions of rotor aeroacoustics. Flap displacements were commanded to follow specific harmonic profiles of 2 deg or more in amplitude, and the flap deflection errors obtained were less than 0.2 deg r.m.s.

  8. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    SciTech Connect

    Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

    1983-08-01

    We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

  9. Numerical Study of Flexible Flapping Wing Propulsion , Mingjun Wei

    E-print Network

    Wei, Mingjun

    regime, conventional fixed-wing airplane suffers with low flight efficiency and small stall angleNumerical Study of Flexible Flapping Wing Propulsion Tao Yang , Mingjun Wei New Mexico State In this study, we apply a strong-coupling approach to simulate highly flexible flapping wings interacting

  10. Numerical Study of Flexible Flapping Wing Propulsion and Mingjun Wei

    E-print Network

    Wei, Mingjun

    of immersed boundary method, while the rest of the wing moves passively through elasticity and fluid­structure interest in the flapping wing design. At low Reynolds number, conventional fixed- wing airplanes sufferNumerical Study of Flexible Flapping Wing Propulsion Tao Yang and Mingjun Wei New Mexico State

  11. External Dacryocystorhinostomy with and Without Suturing the Posterior Mucosal Flaps

    PubMed Central

    Kaçaniku, Gazmend; Begolli, Ilir

    2014-01-01

    ABSTRACT Purpose: To evaluate the outcome of the external dacryocystorhinostomy with and without suturing the posterior mucosal flaps. Methods: This study included 106 patients with lacrimal drainage system disorders who underwent the external dacryocystorhinostomy. Fifty four patients (Group A) underwent external dacryocystorhinostomy with suturing anterior and posterior flaps of the lacrimal sac and nasal mucosa, and the results obtained were compared with those of another series of 52 patients (Group B) where dacryocystorhinostomy was performed with suturing only the anterior flaps, whereas posterior mucosal flaps were excised. Results: The success rate was evaluated by lacrimal patency to irrigation and relief of epiphora. Patency achieved in groups A and B was 94.4% and 96.2%, respectively. There was no statistically significant difference in success rate between the groups. Conclusion: Our study suggests that external dacryocystorhinostomy with suturing anterior and posterior flaps have no advantage over dacryocystorhinostomy with suturing only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and may improve the success rate of external dacryocystorhinostomy. PMID:24783915

  12. No more shoulders: Technical modification of Byars' flaps

    PubMed Central

    Kurzrock, Eric A.; Hellenthal, Nicholas

    2008-01-01

    The repair of midshaft or more proximal hypospadias generally leads to a deficiency of ventral penile skin. Transposition of dorsal/lateral skin flaps may lead to redundant skin folds or shoulders. In most cases, redundant skin can be avoided by appropriate tailoring and positioning of the flaps. We describe a simple method to correct these folds when they are unavoidable. PMID:19468411

  13. Innervated free flaps for foot reconstruction: a review.

    PubMed

    Ducic, Ivica; Hung, Virginia; Dellon, A Lee

    2006-08-01

    Whether to provide a sensate plantar weight-bearing flap to reconstruct the foot remains an unanswered, but frequently asked, question. It has been more than a decade since Graham and Dellon reviewed this subject. Increasing emphasis on outcome analysis of microsurgical reconstruction has prompted this new review. All published peer-reviewed literature related to reconstruction of the plantar surface of the foot was reviewed to identify whether the flaps were 1) local, regional or distant; 2) innervated or non-innervated and, if innervated, then 3) identified as to the donor and the recipient peripheral nerves. Outcome measures included direct measurement of sensibility, development of ulceration, and activities of daily living. It was concluded that it is still not possible to determine that innervated flap reconstruction of the weight-bearing portion of the foot is critical for either durability or ambulation. It is recommended that the original nerves that innervate the flap be blocked prior to harvest to improve flap design, i.e., that the flap actually contains the intended nerve. It is recommended that appropriate donor nerves are selected to innervate the flaps, e.g., the calcaneal nerve should be used to reinnervate heel reconstructions (rather than the sural nerve), and medial/lateral plantar branches be used to reinnervate the arch and the forefoot. Reinnervating a muscle flap with a sensory nerve will permit reinnervation of the muscle and the overlying skin, but whether this provides a superior result in durability and gait remains to be seen. PMID:16894488

  14. Flapping Flight for Biomimetic Robotic Insects Part I: System Modeling

    E-print Network

    Sastry, S. Shankar

    1 Flapping Flight for Biomimetic Robotic Insects Part I: System Modeling Xinyan Deng, Luca Schenato-thorax dynamics, the flapping flight aerodynamics at a low Reynolds number regime, and the biomimetic sensory, biomimetic, modeling, low Reynolds number, flying insects. I. INTRODUCTION Micro aerial vehicles (MAVs) have

  15. Clinical study of dorsal ulnar artery flap in hand reconstruction

    PubMed Central

    Khan, Manal M.; Yaseen, Mohd.; Bariar, L. M.; Khan, Sheeraz M.

    2009-01-01

    Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft. PMID:19881021

  16. Reverse forearm flap based on an "exteriorized" pedicle.

    PubMed

    Olding, M

    1991-01-01

    Soft tissue coverage after multiple digital amputations was achieved with a reverse forearm flap based on an "exteriorized" vascular pedicle. The length of exposed radial artery pedicle was calculated to permit full range of motion of the involved digits before flap division and inset. No complications of the exposed vascular pedicle were noted. PMID:1995675

  17. Turning dynamics and passive damping in flapping flight

    Microsoft Academic Search

    Bo Cheng; Steven N. Fry; Qingfeng Huang; William B. Dickson; Michael H. Dickinson; Xinyan Deng

    2009-01-01

    we investigated whether flapping flight has an inherent stability by analyzing the inertial and aerodynamic effects of flapping wings on body dynamics. Based on wing and body kinematics of free flying fruit flies during rapid maneuvers, we found a passive counter torque due to body rotation. It is indentified both in simulation through quasi-steady state aerodynamic model and through experiments

  18. Neurotized distally based sural flap for heel reconstruction.

    PubMed

    Mendieta, Mauricio J; Roblero, Carlos; Vega, Juan C

    2013-10-01

    The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap. PMID:23757153

  19. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

  20. Varicocele Surgery

    MedlinePLUS

    Varicocele Surgery Beth Israel Medical Center, New York, NY February 24, 2009 Welcome to this "OR Live" Webcast presentation premiering from Beth Israel ... allowed to shower within three days of the operation and resumes activities usually ... broadcast from the Beth Israel Medical Center in New York City. I hope you’ve ...

  1. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  2. Versatile Use of Rhomboid Flaps for Closure of Skin Defects

    PubMed Central

    Aydin, Osman Enver; Tan, Onder; Algan, Said; Kuduban, Selma Denktas; Cinal, Hakan; Barin, Ensar Zafer

    2011-01-01

    Objective: The aim of this study is to present our clinical experience with rhomboid flaps. Materials and Methods: Twenty-four patients who were operated on between January 2006 and October 2010 were included in the study. All defects were reconstructed using rhomboid flaps. Results: Twenty-four patients were operated on for various reasons, and 26 rhomboid flaps were performed. Eleven of the 24 cases were male, and the median age of participants was 47.5 years. Eight cases were operated on under general anesthesia, and 13 were locally anesthetized; the remaining cases were operated on under regional anesthesia. In 17 cases, the defect was due to a benign or malignant tumor excision, and five cases were operated on due to burn contracture. There were no occurrences of partial or total flap necrosis or hematoma in our series. Conclusion: Our series indicates that rhomboid flaps can be safely used to reconstruct small to moderately sized skin defects. PMID:25610151

  3. A method for calculating externally blown flap noise

    NASA Technical Reports Server (NTRS)

    Fink, M. R.

    1978-01-01

    Several basic noise components were described. These components are: (1) compact lift dipoles associated with the wing and flaps; (2) trailing edge noise associated with the last trailing edge; and (3) quadrupole noise associated with the undeflected exhaust jet and the free jet located downstream of the trailing edge. These noise components were combined to allow prediction of directivity and spectra for under the wing (UTW) slotted flaps with conventional or mixer nozzles, UTW slotless flaps, upper surface blowing (USB) slotless flaps, and engine in front of the wing slotted flaps. A digital computer program listing was given for this calculation method. Directivities and spectra calculated by this method were compared with free field data for UTW and USB configurations. The UTRC method best predicted the details of the measured noise emission, but the ANOP method best estimated the noise levels directly below these configurations.

  4. Distally based perforator sural flaps for foot and ankle reconstruction

    PubMed Central

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-01-01

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

  5. Works on theory of flapping wing. [considering boundary layer

    NASA Technical Reports Server (NTRS)

    Golubev, V. V.

    1980-01-01

    It is shown mathematically that taking account of the boundary layer is the only way to develop a theory of flapping wings without violating the basic observations and mathematics of hydromechanics. A theory of thrust generation by flapping wings can be developed if the conventional downstream velocity discontinuity surface is replaced with the observed Karman type vortex streets behind a flapping wing. Experiments show that the direction of such vortices is the reverse of that of conventional Karman streets. The streets form by breakdown of the boundary layer. Detailed analysis of the movements of certain birds and insects during flight 'in place' is fully consistent with this theory of the lift, thrust and drag of flapping wings. Further directions for research into flight with flapping wings are indicated.

  6. Distally based perforator sural flaps for foot and ankle reconstruction.

    PubMed

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-04-18

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage. PMID:25893175

  7. Posterior Interosseous Forearm Flap in Reconstruction of First Web Space

    PubMed Central

    Kola, N.; Isaraj, S.; Xhepa, G.; Belba, M.; Belba, G.

    2009-01-01

    Summary Use of a fascial flap is often required for reconstruction of a skin defect on the dorsum of the hand. For this purpose, a distally based dorsal forearm fasciosubcutaneous flap based on the perforators of the posterior interosseous artery was developed. The distally based dorsal forearm fasciosubcutaneous flap and especially the posterior interosseous artery flap are a convenient and reliable alternative for reconstructing skin defects of the hand after the release of post-burn adduction contracture of web space I involving vital structure exposure. Although the posterior interosseous artery flap is suitable for covering dorsal skin defects of the hand and avoids interference with the forearm's two main arteries, the dissection of the vascular pedicle is frequently quite complex and tedious. PMID:21991164

  8. Propeller Flaps: A Review of Indications, Technique, and Results

    PubMed Central

    D'Arpa, Salvatore; Toia, Francesca; Pirrello, Roberto; Moschella, Francesco; Cordova, Adriana

    2014-01-01

    In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors' experience. Details about surgical technique are provided, together with tips to avoid and manage complications. PMID:24971367

  9. The vascular basis of the radial forearm flap.

    PubMed

    Timmons, M J

    1986-01-01

    The radial forearm flap is one of several valuable fasciocutaneous flaps. Therefore, its arterial and venous supply has been studied by dissection of 56 cadavers using various techniques, such as ink, latex, and barium sulfate injections. The relevant arterial branches tend to be in three groups with three associated and anastomosing perfusion zones. The blood supply of the distal radius is shown by latex injections. The vessels to tendons and nerves are briefly discussed. The flap is drained by superficial veins or radial artery venae comitantes or both. Each arterial perforator has one or two associated veins through which blood can pass into the venae comitantes. It is confirmed that the veins have valves, through which reverse flow has to occur in the pedicle of distally based island flaps. An explanation of how this is possible is given. The relevance of the findings to fasciocutaneous flaps in general is discussed. PMID:3941853

  10. Acoustic characteristics of externally blown flap systems with mixer nozzles

    NASA Technical Reports Server (NTRS)

    Goodykoontz, J. H.; Dorsch, R. G.; Wagner, J. M.

    1974-01-01

    Noise tests were conducted on a large scale, cold flow model of an engine-under-the-wing externally blown flap lift augmentation system employing a mixer nozzle. The mixer nozzle was used to reduce the flap impingement velocity and, consequently, try to attenuate the additional noise caused by the interaction between the jet exhaust and the wing flap. Results from the mixer nozzle tests are summarized and compared with the results for a conical nozzle. The comparison showed that with the mixer nozzle, less noise was generated when the trailing flap was in a typical landing setting (e.g., 60 deg). However, for a takeoff flap setting (20 deg), there was little or no difference in the acoustic characteristics when either the mixer or conical nozzle was used.

  11. [Laparoscopic surgery in day surgery].

    PubMed

    Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

    1998-06-01

    Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have previously been reported. 3) Diagnostic procedures on abdominal testis. The procedure is brief only superficial general anesthesia is needed and only one trocar is required. Conclusions. One-day laparoscopic surgery will require in the future a more and more strict cooperation between urologists and anesthetists in order to tailor the correct anesthesiological and laparoscopic technique to the procedure required and the features of the patient. PMID:9707775

  12. Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

    PubMed Central

    Schirmer, Steffen; Ritter, Ralf-Gerhard; Fansa, Hisham

    2013-01-01

    Introduction Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot. There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity. Patients and Methods 41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used. Results There were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated. Discussion Large defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure. Amputation means reduction of quality of life and can lead to an increased mortality postoperatively. PMID:24058622

  13. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    MedlinePLUS

    ... Weight Loss Surgery: Stacie's Story (Video) Preparing Your Child for Surgery Keeping Portions Under Control Healthy Eating Overweight and Obesity Weight and Diabetes Metabolic Syndrome Is Dieting OK ...

  14. Response of random skin flaps to rapid expansion.

    PubMed

    Marks, M W; Mackenzie, J R; Burney, R E; Knight, P R; Anderson, S H

    1985-10-01

    We studied the physiologic accommodation of tissues to 5-day expansion in a porcine random flap model to assess the time taken to expand skin to provide early coverage of traumatic defects. Three 6 X 20 cm random flaps were outlined but not elevated on the backs of 12 small (20-kg) pigs. One flap was not manipulated (control). A 450-ml expander was inserted at the base of the second flap and left in place (sham). At the base of the third flap a 450-ml expander was inserted and sequentially filled to the limits of skin viability each day for 5 days (expanded). Skin tension produced by the pressure of expansion and tissue oxygen (TpO2) in each flap were measured before and after each manipulation. Flaps were raised on day 8, and survival determined on day 15. Creation of the pocket reduced TpO2 to 55% of control values, expansion to 17.5% of control. Within 24 hours both sham and expanded had recovered to 80% of control values. After the second expansion, recovery from hypoxia was again almost complete after 24 hours. Recovery after subsequent expansions was less complete, but 3 days after the final expansion there was no statistical difference between TpO2 values in expanded, sham, and control groups. High pressures generated in the flap by expansion also returned to near normal within 24 hours. Flaps utilizing expanded skin survived to greater length (14.2 cm) than did sham (11.6 cm) or control (7.2 cm) flaps (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4046083

  15. Closure of Large Meningomyelocele Wound Defects with Subcutaneous Based Pedicle Flap with Bilateral V-Y Advancement: Our Experience and Review of Literature.

    PubMed

    Kesan, Krushnakumar; Kothari, Paras; Gupta, Rahul; Gupta, Abhaya; Karkera, Parag; Ranjan, Ritesh; Mutkhedkar, Kedar; Sandlas, Gurusev

    2014-03-28

    Background?Meningomyelocele is a defect of the spinal cord, vertebrae, and the overlying skin and is the most common form of open spinal dysraphism. Rapid closure of the back defect in the early postnatal period is mandatory to reduce the frequency of infection-related complications of the central nervous system. Majority of the cases present with small defects, which can be closed primarily, with or without subcutaneous dissection. However, direct closure is not possible in 25% of the cases. Different types of local flaps (skin or muscle flaps) are widely used for covering the skin defects; and with varying results. Patients and Methods?A prospective nonrandomized study was conducted in the department of pediatric surgery at a tertiary hospital, from September 2007 to October 2011. Overall 35 patients with large meningomyelocele defects that could not be closed primarily were included in the study. All patients were treated using subcutaneous tissue based pedicle flap with bilateral V-Y advancement. Results?There were 27 neonates, 7 infants, and 1 child, with a male:female ratio of 1.19:1. There were 3 thoracolumbar, 14 lumbar, 14 lumbosacral, 3 sacral, and 1 multiple meningomyelocele defects with an average size of 8.5 cm (range 6.5-11 cm). Average intraoperative blood loss was 8 mL (range 6-10.5 mL). Average operative time which included flap reconstruction time, after closure of dura, was 38.6 min. Total seven patients had wound complications viz. fat necrosis (n?=?2), flap necrosis (n?=?2), hematoma (n?=?1), cerebrospinal fluid leak followed by wound dehiscence (n?=?1), wound infection which led to meningitis (n?=?1). Average healing time for flap repair was 7.52 days. Overall 80% (n?=?28) of the patients had good flap texture and contour with satisfactory cosmesis. Conclusion?Closure of large meningomyelocele wound defects with subcutaneous based pedicle flap with bilateral V-Y advancement is an effective technique. The main advantages of this technique are its simplicity, short operative time, good tolerance, early healing, and good cosmetic outcome with an excellent flap texture and contour match with minimal complications. PMID:24683103

  16. Spine surgery - discharge

    MedlinePLUS

    ... Intervertebral foramina - discharge; Spine surgery - foraminotomy - discharge; Lumbar decompression - discharge; Decompressive laminectomy - discharge; Spine surgery - laminectomy - discharge; ...

  17. Nonlinear dynamic analysis of dragonfly-inspired piezoelectric unimorph actuated flapping and twisting wing

    Microsoft Academic Search

    Sujoy Mukherjee; Ranjan Ganguli

    2012-01-01

    The nonlinear equations for coupled elastic flapping–twisting motion of a dragonfly-inspired smart flapping wing are used for a flapping wing actuated from the root by a PZT unimorph in the piezofan configuration. Excitation by the piezoelectric harmonic force generates only the flap bending motion, which, in turn, induces the elastic twist motion due to interaction between flexural and torsional vibration

  18. Application of lateral thoracic flap in maxillofacial defect reconstruction: experience with 28 cases.

    PubMed

    Shi, Jun; Xu, Bing; Shen, Guo-fang; Wang, Xu-dong

    2013-10-01

    Lateral thoracic (LT) flaps are primarily used as pedicle flaps for reconstructing limb and chest wall defects and have rarely been applied for head and neck reconstruction. We aimed to present our surgical techniques and experience using free LT cutaneous, myocutaneous and conjoint flaps for oral and maxillofacial reconstruction. From 2006 to 2010, we reconstructed 28 cases of oral and maxillofacial soft tissue defects using LT flaps. Controls were 54 cases reconstructed with anterior forearm flaps during same period. Flap size and pedicle length were recorded intraoperatively. Patients were monitored for flap survival in hospital until discharge and then followed regularly for 3-38 months, assessing for tumor recurrence, flap appearance, donor site function and cosmesis. All patients had free flaps except for one LT pedicle flap. LT flap patients were significantly younger than controls (45.5 vs. 54.8 years, p=0.004) and had greater flap size than controls (55.2 cm2 vs. 40.3 cm2, p=0.001). Of 28 LT flaps transferred, 26 survived completely; 1 failed (total necrosis due to venous insufficiency), and 1 suffered tip necrosis. No significant differences were observed in flap survival between groups. Follow-up was shorter in LT flap patients than in controls (20.3 months vs. 26.9 months, p=0.02). Application of the LT flap is a reliable technique for reconstruction of maxillofacial defects with minimal donor site morbidity and favorable aesthetic outcomes. PMID:23764321

  19. Efficacy of the Lateral Advanced Flap in Root-coverage Procedures for Mandibular Central Incisors: A 5-Year Clinical Study.

    PubMed

    De Angelis, Nicola; Yumang, Catherine; Benedicenti, Stefano

    2015-01-01

    The aim of this study was to determine the efficacy of the lateral advanced flap in root-coverage procedures for mandibular incisors and to evaluate pain after treatment. A total of 15 patients who required treatment for gingival recessions were selected from the University of Genoa Laser and Restorative Dentistry Department. The inclusion criteria were the presence of at least one 3-mm gingival recession defect of a mandibular incisor and 3 mm or more of keratinized tissue width on the immediately adjacent tooth. One calibrated masked examiner performed the clinical measurements, including recession depth and width, probing depth, clinical attachment level, and keratinized tissue width. Patients were checked 7, 14, and 30 days after surgery and were included in supportive periodontal maintenance every 4 months. Further follow-ups were done at the first, third, and fifth year postsurgery when the same baseline assessment parameters were recorded according to the root-coverage esthetic score (RES). Numeric score recorded pain evaluations showed a mean of 3 at the day of the surgery, 2 in the first day after the surgery, and no significant scores were referred in the following days. Mean recession depth was 3.2 ± 1.3 mm at baseline; at 5 years, RES showed a positive increase of all scores. The laterally coronally advanced surgical technique was very effective in treating isolated gingival recessions. It combined the esthetic and root-coverage advantages of the coronally advanced flap with the increased gingival thickness and keratinized tissue associated with the lateral gingival flap. PMID:25734716

  20. Aeroacoustic Measurements of a Wing-Flap Configuration

    NASA Technical Reports Server (NTRS)

    Meadows, Kristine R.; Brooks, Thomas F.; Humphreys, William M.; Hunter, William H.; Gerhold, Carl H.

    1997-01-01

    Aeroacoustic measurements are being conducted to investigate the mechanisms of sound generation in high-lift wing configurations, and initial results are presented. The model is approximately 6 percent of a full scale configuration, and consists of a main element NACA 63(sub 2) - 215 wing section and a 30 percent chord half-span flap. Flow speeds up to Mach 0.17 are tested at Reynolds number up to approximately 1.7 million. Results are presented for a main element at a 16 degree angle of attack, and flap deflection angles of 29 and 39 degrees. The measurement systems developed for this test include two directional arrays used to localize and characterize the noise sources, and an array of unsteady surface pressure transducers used to characterize wave number spectra and correlate with acoustic measurements. Sound source localization maps show that locally dominant noise sources exist on the flap-side edge. The spectral distribution of the noise sources along the flap-side edge shows a decrease in frequency of the locally dominant noise source with increasing distance downstream of the flap leading edge. Spectra are presented which show general spectral characteristics of Strouhal dependent flow-surface interaction noise. However, the appearance of multiple broadband tonal features at high frequency indicates the presence of aeroacoustic phenomenon following different scaling characteristics. The scaling of the high frequency aeroacoustic phenomenon is found to be different for the two flap deflection angles tested. Unsteady surface pressure measurements in the vicinity of the flap edge show high coherence levels between adjacent sensors on the flap-side edge and on the flap edge upper surface in a region which corresponds closely to where the flap-side edge vortex begins to spill over to the flap upper surface. The frequency ranges where these high levels of coherence occur on the flap surface are consistent with the frequency ranges in which dominant features appear in far field acoustic spectra. The consistency of strongly correlated unsteady surface pressures and far field pressure fluctuations suggests the importance of regions on the flap edge in generating sound.

  1. Delayed healing of rhytidectomy flap resurfaced with CO2 laser.

    PubMed

    Guyuron, B; Michelow, B; Schmelzer, R; Thomas, T; Ellison, M A

    1998-03-01

    Combining facial rhytidectomy with laser resurfacing, theoretically, provides the best opportunity for achieving an optimal facial rejuvenation result. Previous studies have demonstrated the pernicious effect of a deep peel on a skin flap, but the safety of treating the rhytidectomy flap with laser has not been investigated. This study was conducted to investigate the safety of using these techniques concomitantly. Sixty sites were selected on three Yucatan minipigs, a species of swine chosen because of its hairless nature and opportunity to raise a true skin flap (without the panniculus carnosus). The healing time of 20 laser-treated sites without flap elevation was compared with that of 20 areas treated with laser following flap elevation, shortening (to emulate a more realistic rhytidectomy process), and repair. Twenty flaps were elevated and shortened without laser treatment to serve as a control. The CO2 laser parameters were set at 500 mJ, 50 watts, and a density of 5. Two passes were made to penetrate the upper dermis. The mean healing time for areas treated with laser alone was 12.05 days, ranging from 11 to 14 days. In comparison, the healing time for the laser-treated areas subsequent to flap elevation averaged 17.95 days, with a range of 14 to 24 days (p < 0.05). Two flaps treated with laser (10 percent) failed to heal completely in 24 days. At the time that all 20 of the areas treated solely with laser had re-epithelialized completely, only one of the flaps treated with laser had re-epithelialized completely (p < 0.001). A delay in healing, as well as return of pigment, was demonstrated in the distal portions of all flaps receiving laser treatment. The control flaps all healed normally except for a 5-percent superficial loss on a single flap. It was concluded from this study, and from clinical observation of delayed healing on six of seven patients who underwent concomitant rhytidectomy and laser resurfacing at a conservative laser setting, that laser resurfacing of the rhytidectomy flap is unsafe and results in delayed re-epithelialization. This combination should be avoided altogether or performed with extreme prudence on patients undergoing a deeper plane facial rhytidectomy or by using very low laser settings. PMID:9500404

  2. Endoscopy-Assisted Total Mastectomy Followed by Immediate Pedicled Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap Reconstruction: Preliminary Results of 48 Patients.

    PubMed

    Lai, Hung-Wen; Wu, Hurng-Sheng; Chuang, Kun-Lin; Chen, Dar-Ren; Chang, Tsai-Wang; Kuo, Shou-Jen; Chen, Shou-Tung; Kuo, Yao-Lung

    2014-08-12

    Background. Endoscopy-assisted breast surgery performed through minimal axillary and/or periareolar incisions is a viable option for patients with breast cancer. In this study, we report the preliminary results of patients with breast cancer who underwent endoscopy-assisted total mastectomy (EATM) followed immediately by pedicled transverse abdominis musculocutaneous (TRAM) flap reconstruction. Methods. Patients in this study comprised women with breast cancer who received EATM and pedicled TRAM flap reconstruction. Clinicopathologic characteristics, type of surgery, complications, and rate of recurrence were recorded. The cosmetic outcomes were evaluated objectively by the surgeons and subjectively by the patients at 3-month postoperative follow-up. Results. A total of 48 patients underwent 49 EATM procedures followed by pedicled TRAM flap reconstruction. Of them, 79.6% underwent endoscopic-assisted nipple-sparing mastectomy and 20.4% received endoscopic-assisted skin-sparing mastectomy. The types of cancer among these patients included ductal carcinoma in situ in 34.7%, stage I cancer in 36.7%, stage II cancer in 24.5%, and stage IIIa cancer in 4.1% patients. Mean tumor size was 2.1 ± 1.4 cm. There were no cases of flap failure. Partial nipple areolar complex ischemia/necrosis occurred in 4 (10.3%) patients; however, all cases resolved after conservative treatment. In the aesthetic outcome evaluation, EATM + TRAM were associated with 89.8% good, 8.2% fair, and 2% unsatisfactory result. No local recurrence was observed during the follow-up period. Conclusion. EATM followed immediately by pedicled TRAM flap reconstruction is a safe procedure and results in good cosmetic outcome in women with early-stage breast cancer. PMID:25118202

  3. The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women

    PubMed Central

    Kim, Byung Jun; Choi, Jun Ho; Kim, Tae Hoon; Jin, Ung Sik; Minn, Kyung Won

    2014-01-01

    Background Lower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery. Methods The vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level. Results SIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (±12.87) mm, and -8.14 (±15.24) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (±0.39) mm and 1.37 (±0.33) mm, and they were found at a mean depth of 9.75 (±2.67) mm and 8.33 (±2.65) mm, respectively. Conclusions The SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps. PMID:25396183

  4. Design and Performance of Insect-Scale Flapping-Wing Vehicles

    NASA Astrophysics Data System (ADS)

    Whitney, John Peter

    Micro-air vehicles (MAVs)---small versions of full-scale aircraft---are the product of a continued path of miniaturization which extends across many fields of engineering. Increasingly, MAVs approach the scale of small birds, and most recently, their sizes have dipped into the realm of hummingbirds and flying insects. However, these non-traditional biologically-inspired designs are without well-established design methods, and manufacturing complex devices at these tiny scales is not feasible using conventional manufacturing methods. This thesis presents a comprehensive investigation of new MAV design and manufacturing methods, as applicable to insect-scale hovering flight. New design methods combine an energy-based accounting of propulsion and aerodynamics with a one degree-of-freedom dynamic flapping model. Important results include analytical expressions for maximum flight endurance and range, and predictions for maximum feasible wing size and body mass. To meet manufacturing constraints, the use of passive wing dynamics to simplify vehicle design and control was investigated; supporting tests included the first synchronized measurements of real-time forces and three-dimensional kinematics generated by insect-scale flapping wings. These experimental methods were then expanded to study optimal wing shapes and high-efficiency flapping kinematics. To support the development of high-fidelity test devices and fully-functional flight hardware, a new class of manufacturing methods was developed, combining elements of rigid-flex printed circuit board fabrication with "pop-up book" folding mechanisms. In addition to their current and future support of insect-scale MAV development, these new manufacturing techniques are likely to prove an essential element to future advances in micro-optomechanics, micro-surgery, and many other fields.

  5. Distally based sural fasciomyocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel.

    PubMed

    Chang, Shi-Min; Zhang, Kai; Li, Hai-Feng; Huang, Yi-Gang; Zhou, Jia-Qian; Yuan, Feng; Yu, Guang-Rong

    2009-01-01

    The reconstruction of the distal third leg and weight-bearing heel, especially when complicated with infection and/or dead space, remains a challenge in reconstructive surgery. The distally based sural neurofasciomyocutaneous flap has been proved a valuable tool in repair of the soft tissue defects of those areas. In this report, we present the results of the anatomical study on vascular communication between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle and a modified technique in clinical applications for reconstruction of the soft tissue defects in the distal lower leg and heel. Six lower limbs of fresh cadavers were injected with red gelatin and dissected. A constant vascular connection with average four musculo-fasciocutaneous perforators with diameter 0.2-0.5 mm was identified in the overlapping area between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle. Based on these findings, a modified distally based sural neurofasciomyocutaneous flap including the distal gastrocnemius muscle component was designed and used for repairs of the soft tissue defects in the distal lower limb and plantar heel pad in six patients. The blood supplies of flaps comprised either the peroneal perforator and adipofascial pedicle or the peroneal perforator only. The average size of the fasciocutaneous flap was 51 cm(2), and the muscle component 17.7 cm(2). All flaps survived uneventfully. Our results suggest that this technical modification could provide wider range for applications of the distally based sural neurofasciomyocutaneous flap in repair of the soft tissue defects of the lower extremity and heel. PMID:19031395

  6. Analysis of Non-symmetrical Flapping Airfoils

    NASA Astrophysics Data System (ADS)

    Beng Tay, Wee; Lim, Kah Bin

    2007-11-01

    Simulations have been done to assess the performance of different types of non-symmetrical airfoils on lift, thrust and propulsive efficiency under different flapping configurations at a Reynolds number of 10,000. The variables studied include the Stroudal number, reduced frequency, pitch angle and phase angle difference. In order to analyze the variables more efficiently, the Design of Experiments using the response surface methodology is applied. The simulation results show that besides the flapping configuration, airfoil shape also has a profound effect on the efficiency, thrust and lift production. The 4 factors have different levels of significance on the responses, indicating the shape of the airfoil plays a part as well. Thrust production depends more heavily on these parameters, rather than the shape of the airfoil. On the other hand, lift production is primarily dominated by its airfoil shape. Efficiency falls somewhere in between. Two-factor interactions among the variables also exist in efficiency and thrust production. Vorticity plots are analyzed to explain some of the results. Overall, the s1020 airfoil is able to provide relatively good efficiency and at the same time generate high thrust and lift force. These results can be used to help in the design of a better ornithopter's wing.

  7. Uncertainty Analysis for a Jet Flap Airfoil

    NASA Technical Reports Server (NTRS)

    Green, Lawrence L.; Cruz, Josue

    2006-01-01

    An analysis of variance (ANOVA) study was performed to quantify the potential uncertainties of lift and pitching moment coefficient calculations from a computational fluid dynamics code, relative to an experiment, for a jet flap airfoil configuration. Uncertainties due to a number of factors including grid density, angle of attack and jet flap blowing coefficient were examined. The ANOVA software produced a numerical model of the input coefficient data, as functions of the selected factors, to a user-specified order (linear, 2-factor interference, quadratic, or cubic). Residuals between the model and actual data were also produced at each of the input conditions, and uncertainty confidence intervals (in the form of Least Significant Differences or LSD) for experimental, computational, and combined experimental / computational data sets were computed. The LSD bars indicate the smallest resolvable differences in the functional values (lift or pitching moment coefficient) attributable solely to changes in independent variable, given just the input data points from selected data sets. The software also provided a collection of diagnostics which evaluate the suitability of the input data set for use within the ANOVA process, and which examine the behavior of the resultant data, possibly suggesting transformations which should be applied to the data to reduce the LSD. The results illustrate some of the key features of, and results from, the uncertainty analysis studies, including the use of both numerical (continuous) and categorical (discrete) factors, the effects of the number and range of the input data points, and the effects of the number of factors considered simultaneously.

  8. Titanium Plate Fixation for Sternal Dehiscence in Major Cardiac Surgery

    PubMed Central

    Kim, Wan Kee; Kim, Gwan Sic; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2013-01-01

    Background Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Treatment failure and consequent lethal outcomes are very common. The aim of this study was to evaluate titanium plate fixation as a treatment for sternal dehiscence following major cardiac surgery. Materials and Methods Between 2010 and 2012, 17 patients underwent sternal reconstruction using horizontal titanium plating for the treatment of post-cardiac-surgery sternal dehiscence. The plates were cut and shaped, and then were fixed to corresponding costal segments using 2-3 titanium screws per each side. Results The median age of our patients was 66 years (range, 50 to 78 years) and 9 were female. Indications for sternal reconstruction included aseptic sternal dehiscence in 3 patients and osteomyelitis in 14 patients including 6 patients who were diagnosed with mediastinitis. During the operation, sternal resection and autologous flap interposition were combined in 11 patients. One patient died due to sepsis. Two patients required additional soft tissue wound revisions. Another patient presented with a tuberculous wound infection which was resolved using anti-tuberculosis medications. The postoperative course was uncomplicated in the other 13 patients. Conclusion Titanium plate fixation that combines appropriate debridement and flap interposition is very effective for the treatment of sternal dehiscence following major cardiac surgery. PMID:24003409

  9. Effects of clopidogrel on survival of rat skin flaps.

    PubMed

    Ersoy, Atilla; Sevin, Kutlu; Sevin, Asuman; Serel, Sava?

    2007-01-01

    Clopidogrel is a thienopyridine derivative that is chemically related to ticlopidine, which irreversibly inhibits platelet aggregation by selectively binding to adenylate cyclase-coupled adenosine diphosphate receptors on the platelet's surface. In animal models, clopidogrel has been shown to reduce the incidence of both arterial and venous thrombi. In the present study the effects of clopidogrel on the survival of rat epigastric island flaps was researched. Epigastric island flaps of 7x7cm were raised from symphisis pubis to arcus costa with the panniculus carnosus. The experimental group received seven doses of 25mg/kg clopidogrel postoperatively, the first dose given immediately after the suturing of the flaps. The rats were anaesthetised on postoperative day 7 to assess the survival of flaps. The difference between the clopidogrel and the control group was significant (P<0.005). The full-thickness skin samples obtained after the calculation of survival percentages revealed thinning of the epidermis layer and active chronic inflammation in both groups. However, diffuse dilated vessels, extravasated eritrocytes were seen in the clopidogrel group flaps. The results indicated a significant increase in flap survival in rats given clopidogrel. Further research is needed to assess the critical doses of clopidogrel to create optimal flap survival improvement. PMID:17418655

  10. Cryopreservation of composite tissue flaps: experimental studies in the rat.

    PubMed

    Rinker, Brian; Cui, Xiangdong D; Fink, Betsy F; Gao, Dayong Y; Vasconez, Henry C

    2007-06-01

    Cryopreservation has the potential to improve availability of donor parts for composite tissue allotransplantation and may reduce their antigenicity. This study investigates whether the component tissues of composite flaps remain viable after cryopreservation. Forty-one epigastric flaps were harvested from Lewis rats. Twenty-one flaps were perfused with DMSO/trehalose, frozen by controlled cooling to -140 degrees C, and stored in liquid nitrogen for 2 weeks. Ten fresh and 10 cryopreserved/thawed flaps were examined histologically with hematoxylin & eosin and factor VIII staining. An epithelial viability index was calculated for 10 fresh and 11 cryopreserved flaps using the MTT assay. In all cryopreserved samples, hematoxylin & eosin, and factor VIII staining revealed a well-preserved cellular architecture, which was indistinguishable from fresh specimens. The viability index for the cryopreserved samples was 10.90 +/- 2.09 compared with 12.15 +/- 1.32 for fresh flaps (P = 0.123). Results suggest that the skin, adipose, and vascular endothelial cells of composite tissue flaps retain their viability after cryopreservation and thawing. PMID:17522490

  11. Chondrosarcoma from the sternum: Reconstruction with titanium mesh and a transverse rectus abdominis myocutaneous flap after subtotal sternal excision

    PubMed Central

    Koto, Kazutaka; Sakabe, Tomoya; Horie, Naoyuki; Ryu, Kazuteru; Murata, Hiroaki; Nakamura, Shinichiro; Ishida, Toshihiro; Konishi, Eiichi; Kubo, Toshikazu

    2012-01-01

    Summary Background Chondrosarcoma arising from the sternum is extremely rare and is often untreatable. Removal of the sternum for malignant tumor results in large defects in bone and soft tissue, causing deformity and paradoxical movement of the chest wall and making subsequent repair of the thorax very important. We report a very rare patient with a chondrosarcoma of the sternum who underwent case chest wall resection, followed by reconstruction using a titanium mesh covered with a transverse rectus abdominis myocutaneous (TRAM) flap. Case Report A 63-year-old man was referred to our hospital with progressively enlarged swelling of his anterior chest wall. Physical examination showed a 2.5×2.0 cm mass fixed to the sternum, which was diagnosed as a chondrosarcoma based on clinical findings, imaging characteristics and incision biopsy results. The patient underwent a subtotal sternal and chest wall resection to remove the tumor, followed by reconstruction with a titanium mesh and a TRAM flap. There were no complications associated with surgery. Conclusions We report an extremely rare case of a patient who underwent subtotal sternal resection, followed by reconstruction, for a large chondrosarcoma. The elasticity and rigidity provided by the titanium mesh and the complete coverage of the surgical wound by a TRAM flap suggest that these procedures may be useful in reconstructing large defects in the chest wall. PMID:23018358

  12. Elec 331 -Minimally Invasive Surgery Minimally Invasive Surgery

    E-print Network

    Pulfrey, David L.

    Elec 331 - Minimally Invasive Surgery 1 Minimally Invasive Surgery · Small incision ­ Low risk surgery ­ Laparoscopic surgery ­ Arthroscopic surgery Instruments Laparoscope / Arthroscope Trocar Forceps / Scissors Elevator / Retractor Stapler #12;Elec 331 - Minimally Invasive Surgery 2 Instrument Types · Trocar

  13. Comparison of calculated and measured helicopter rotor lateral flapping angles

    NASA Technical Reports Server (NTRS)

    Johnson, W.

    1980-01-01

    Calculated and measured values of helicopter rotor flapping angles in forward flight are compared for a model rotor in a wind tunnel and an autogiro in gliding flight. The lateral flapping angles can be accurately predicted when a calculation of the nonuniform wake-induced velocity is used. At low advance ratios, it is also necessary to use a free wake geometry calculation. For the cases considered, the tip vortices in the rotor wake remain very close to the tip-path plane, so the calculated values of the flapping motion are sensitive to the fine details of the wake structure, specifically the viscous core radius of the tip vortices.

  14. Workhorse Flaps in Chest Wall Reconstruction: The Pectoralis Major, Latissimus Dorsi, and Rectus Abdominis Flaps

    PubMed Central

    Bakri, Karim; Mardini, Samir; Evans, Karen K.; Carlsen, Brian T.; Arnold, Phillip G.

    2011-01-01

    Large and life-threatening thoracic cage defects can result from the treatment of traumatic injuries, tumors, infection, congenital anomalies, and radiation injury and require prompt reconstruction to restore respiratory function and soft tissue closure. Important factors for consideration are coverage with healthy tissue to heal a wound, the potential alteration in respiratory mechanics created by large extirpations or nonhealing thoracic wounds, and the need for immediate coverage for vital structures. The choice of technique depends on the size and extent of the defect, its location, and donor site availability with consideration to previous thoracic or abdominal operations. The focus of this article is specifically to describe the use of the pectoralis major, latissimus dorsi, and rectus abdominis muscle flaps for reconstruction of thoracic defects, as these are the workhorse flaps commonly used for chest wall reconstruction. PMID:22294942

  15. Preputial flap as an adjunct to groin flap for the coverage of electrical burns in the hand.

    PubMed

    Tiwari, Vinay Kumar; Sarabahi, Sujata; Chauhan, Shashank

    2014-02-01

    High voltage electrical contact to hand result in injuries at multiple levels that may require more than a single flap for effective coverage. We present here a simple technique to utilise preputial flap as an adjunct to groin flap in cases where simultaneous coverage was required at more than one site in hands. In the past two years, 15 patients with unilateral involvement of hands due to electrical contact injury underwent this procedure. In addition to a comfortable position of the hand, stable and purposeful coverage at the wrist and various areas of hands was achieved in all the patients and none had flap failure. Minor complications related to penile erection were encountered that resulted in partial wound dehiscence that was managed with resuturing, pain relief and temporary suppression of erection. In our opinion, preputial flap is a good addition in our armamentarium to be used alongside groin flap for effective coverage of more than a single site requiring flap cover in electric injuries of the hand. PMID:24035578

  16. Knee extensor loss and proximal tibial soft tissue defect managed successfully with simultaneous medial gastrocnemius flap, saphenous fasciocutaneous flap and medial hemisoleus flap: a case report

    PubMed Central

    2013-01-01

    Introduction Open fractures of the proximal tibia often pose serious challenges to the treating orthopedic surgeon. Management of these complex injuries becomes difficult if they are associated with damage to the extensor mechanism and an exposed knee joint. The scenario becomes more difficult to manage when the soft tissue defect extends to the middle third of the leg. We report a case where we used an extended medial gastrocnemius flap in combination with a saphenous artery fasciocutaneous flap and a medial hemisoleus flap for treatment of an infected proximal tibia fracture with loss of the extensor mechanism and soft tissue defect. To the best of our knowledge, combined use of these three flaps for the management of such injuries has not been reported elsewhere to date. Case presentation A 28-year-old Indian man presented to our Out-patient Department with complaints of pain and pus discharge from his left proximal leg for four weeks. He had sustained an open fracture of his left proximal tibia in a road traffic accident five weeks ago and had been operated on elsewhere. He had a stiff, painful knee with an infected wound of 4×4cm over the proximal third of his leg exposing infected, necrotic patellar tendon. He was successfully managed with debridement and simultaneously elevated flaps as described. Conclusions This procedure avoids the donor site morbidity associated with free flaps harvested from sites distant from the site of injury, and also does not need the expertise of microvascular reconstruction. To the best of our knowledge, this is also the first report of the combined use of three local flaps for knee extensor reconstruction and soft tissue coverage around the knee. PMID:23506268

  17. Use of a composite pedicled muscle flap and rhBMP-7 for mandibular reconstruction.

    PubMed

    Ayoub, A; Challa, S R R; Abu-Serriah, M; McMahon, J; Moos, K; Creanor, S; Odell, E

    2007-12-01

    The aim of this study was to investigate the feasibility of reconstructing critical size continuity osteoperiosteal defects of the mandible using a composite of recombinant BMP-7 contained in a bovine type-1 collagen carrier wrapped in a pedicled sterno-occipitalis muscle flap. At 3 months following surgery, bridging of the surgical defect was noted in three subjects (60%). Histologically, the induced bone regenerate showed maturation from woven to lamellar bone. Islands of cartilage were distributed throughout the defect. Replacement ossification of the degenerated muscle was a common feature in all specimens. Microradiography showed a gradual increase in the calcification of mineralized tissue from the margin to the centre of the newly generated bone. This research represents a proof of the concept that bone can be satisfactorily formed within a muscular scaffolding at the site of the created defect in a one-stage procedure. PMID:17822878

  18. Surgical site infections after gracilis free flap reconstruction for facial paralysis.

    PubMed

    Lee, Linda N; Susarla, Srinivas M; Henstrom, Douglas K; Hohman, Marc H; Durand, Marlene L; Cheney, Mack L; Hadlock, Tessa A

    2012-08-01

    Compared with other free tissue transfer procedures, the gracilis free muscle transfer (GFMT) for facial reanimation is unique in that the recipient site is typically uninvolved by malignancy or infection. In this study, the authors examined the incidence, bacteriology, and outcomes of surgical site infection (SSI) after gracilis free muscle transfer for facial reanimation. From 2003 to 2011, 105 patients underwent 107 GFMT operations, with 6 SSIs. All cases of infection occurred in patients receiving clindamycin, levofloxacin, and/or cefazolin perioperatively. None of the patients who received ampicillin-sulbactam developed an SSI. Surgical site cultures grew oral flora, including ?-hemolytic streptococci, Haemophilus parainfluenzae, Fusobacterium and Neisseria species, and coagulase-negative staphylococci. Notably, there were no methicillin-resistant Staphylococcus aureus (MRSA) infections. These data may have implications for the optimal perioperative antibiotic choice in facial reanimation cases. Further study is needed to determine the ideal antibiotic regimen for this category of free flap surgeries. PMID:22496103

  19. Hemorrhoid Surgery

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program explains what hemorrhoids are, symptoms, alternative treatments, as well as the benefits and risks of surgery. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  20. Sinus Surgery

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program explains the benefits and risks of sinus surgery. It reviews sinus anatomy, causes, diagnosis, and treatments for sinus problems. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  1. Thyroid Surgery

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program explains the most common diseases that can affect the thyroid gland. It also explains treatment options including medications and surgery. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  2. [Robotic surgery].

    PubMed

    Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

    2013-10-01

    Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures. PMID:24144815

  3. Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx.

    PubMed

    Zhang, X; Shao, X; Zhu, M; Jiang, R; Feng, Y; Ren, C

    2013-05-01

    This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2-9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8-1.4 cm). All flaps completely survived. At final follow-up from 24-29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75-91°), 86° (range 65-100°) and 54° (range 32-80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint. PMID:22170242

  4. Abdominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.

    PubMed

    Suominen, S; Asko-Seljavaara, S; Kinnunen, J; Sainio, P; Alaranta, H

    1997-09-01

    A prospective study was designed to evaluate the possible changes in abdominal wall strength following free transverse rectus abdominis musculocutaneous (TRAM) flap surgery for breast reconstruction. Twenty-two patients were examined 1 day before surgery, and at 3, 6, and 12 months postoperatively. Trunk muscle strength was measured by the same physiotherapist using an isokinetic dynamometer (Lido Multi Joint II, Loredan Biomedical Inc., Davies, CA). The peak torque and average torque for both flexion and extension at 60 degrees per second angular velocity were recorded from the curves obtained. There was a significant reduction in trunk flexion strength at 3 months postoperatively (peak torque mean, 92% of the preoperative value; p = 0.04), but this was corrected by 6 months (mean, 96%), and improved to 98% by 12 months. The patient's ability to do curled trunk sit-ups was evaluated by the same physiotherapist and graded on a scale from 1 to 6. In 9 of 19 patients the operation had no effect on sit-up performance during follow-up. In 10 of 19 patients there was a reduction of one or two grades at 3 months that did not improve by 12 months. Magnetic resonance imaging of the abdominal wall was performed on 9 patients. The mean area of the upper third of both rectus muscles was measured on the axial images. At 3 months postoperatively the mean area of the upper third of the donor muscle was significantly larger than the contralateral (p = 0.03). There was no difference in size at 6 months, and by 12 months the donor side was smaller. This prospective study shows that harvesting of a free TRAM flap can cause a subclinical reduction in abdominal strength, although this was not noticed by the patients themselves. PMID:9326701

  5. Oblique waves lift the flapping flag.

    PubMed

    Hœpffner, Jérôme; Naka, Yoshitsugu

    2011-11-01

    The flapping of the flag is a classical model problem for the understanding of fluid-structure interaction: How does the flat state lose stability? Why do the nonlinear effects induce hysteretic behavior? We show in this Letter that, in contrast with the commonly studied model, the full three-dimensional flag with gravity has no stationary state whose stability can be formally studied: The waves are oblique and must immediately be of large amplitude. The remarkable structure of these waves results from the interplay of weight, geometry, and aerodynamic forces. This pattern is a key element in the force balance which allows the flag to hold and fly in the wind: Large amplitude oblique waves are responsible for lift. PMID:22181612

  6. Development of Variable Camber Continuous Trailing Edge Flap System

    NASA Technical Reports Server (NTRS)

    Urnes, Jim, Sr.; Nguyen, Nhan T.; Dykman, John

    2012-01-01

    This presentation describes the current status of the joint NASA/Boeing collaboration on the development of a variable camber continuous trailing edge flap system for use in wing shaping control for cruise drag reduction.

  7. Effect of delay on flap survival in an irradiated field

    SciTech Connect

    Fisher, J.C.; Hurn, I.; Rudolph, R.; Utley, J.; Arganese, T.

    1984-01-01

    Chronic radiation skin injury without ulceration was induced in rats by administering either 3000 or 5000 rads in staged doses. Either 4 or 8 months later, McFarlane et al. dorsal flaps were elevated, with half being delayed and half non-delayed. Measurements showed that flap survival in irradiated skin was significantly increased by delay (approximately two of four experimental groups (4 months, 5000 rads; and 8 months, 3000 rads)); flap survival was increased with borderline significance in a third experimental group (8 months, 5000 rads). These data indicate that flap survival can be increased by delay in an irradiated field. The presence of the vascular delay phenomenon suggests that microvascular occlusion alone cannot account for radiation-induced complications in skin.

  8. Wing compliance in self-propelled flapping flyers

    NASA Astrophysics Data System (ADS)

    Ramananarivo, Sophie; Thiria, Benjamin; Godoy-Diana, Ramiro

    2010-11-01

    Wing flexibility governs the flying performance of flapping wing flyers. Here we use the self-propelled flapping-wing model mounted on a "merry-go-round" described by Thiria and Godoy-Diana (Phys. Rev. E 82, 015303, 2010) to investigate the effect of chord-wise wing compliance on the propulsive performance of the system. The bending of the wings, which is driven mainly by wing inertia in the present experiments, redistributes the aerodynamic forces engendered by the flapping motion and improves the efficiency of the system for a wide range of wing flexibilities and flapping frequencies. A detailed analysis of the phase dynamics between the leading and trailing edges of the wings allows us to pinpoint the mechanisms that limit the beneficial effect of wing compliance.

  9. Wing flap reconstruction for large defects of the lower lip.

    PubMed

    Uchikawa, Yumiko; Yazawa, Masaki; Takayama, Masayoshi; Kishi, Kazuo

    2012-12-01

    Full-thickness lower lip defects most often occur due to tumour resection or injury. Because the lower lip is important for both eating and speaking, reconstruction of the region must restore the structure and function of the tissue. Here, we describe a new procedure to reconstruct the lower lip, using a 'wing flap': a mental V-Y rotational advancement flap that contains the mental nerve. This flap can preserve the sensory innervation of the lower lip, and it allows effective reconstruction of the muscle sling. We have employed this method twice and have obtained good aesthetic and functional outcomes. No special technique is required to reconstruct the lip using this flap, and it yields a satisfactory outcome. Thus, we recommend it as an effective method for reconstruction in wide lower lip defects. PMID:22607737

  10. Vortex Flap Technology: a Stability and Control Assessment

    NASA Technical Reports Server (NTRS)

    Carey, K. M.; Erickson, G. E.

    1984-01-01

    A comprehensive low-speed wind tunnel investigation was performed of leading edge vortex flaps applied to representative aircraft configurations. A determination was made of the effects of analytically- and empirically-designed vortex flaps on the static longitudinal and lateral-directional aerodynamics, stability, and control characteristics of fighter wings having leading-edge sweep angles of 45 to 76.5 degrees. The sensitivity to several configuration modifications was assessed, which included the effects of flap planform, leading- and trailing-edge flap deflection angles, wing location on the fuselage, forebody strakes, canards, and centerline and outboard vertical tails. Six-component forces and moments, wing surface static pressure distributions, and surface flow patterns were obtained using the Northrop 21- by 30-inch low-speed wind tunnel.

  11. Lift enhancement by dynamically changing wingspan in forward flapping flight

    NASA Astrophysics Data System (ADS)

    Wang, Shizhao; Zhang, Xing; He, Guowei; Liu, Tianshu

    2014-06-01

    Dynamically stretching and retracting wingspan has been widely observed in the flight of birds and bats, and its effects on the aerodynamic performance particularly lift generation are intriguing. The rectangular flat-plate flapping wing with a sinusoidally stretching and retracting wingspan is proposed as a simple model for biologically inspired dynamic morphing wings. Numerical simulations of the low-Reynolds-number flows around the flapping morphing wing are conducted in a parametric space by using the immersed boundary method. It is found that the instantaneous and time-averaged lift coefficients of the wing can be significantly enhanced by dynamically changing wingspan in a flapping cycle. The lift enhancement is caused by both changing the lifting surface area and manipulating the flow structures responsible to the vortex lift generation. The physical mechanisms behind the lift enhancement are explored by examining the three-dimensional flow structures around the flapping wing.

  12. Propulsion through wake synchronization using a flapping foil

    E-print Network

    Beal, David Nelson, 1973-

    2003-01-01

    The design issues associated with underwater vehicles operating in the surf zone or other high-energy environments are likely to have viable biomimetic solutions. The flapping fin is capable of producing high instantaneous ...

  13. Bilateral, Bipedicled DIEP Flap for Staged Reconstruction of Cranial Deformity.

    PubMed

    Slater, Julia C; Sosin, Michael; Rodriguez, Eduardo D; Bojovic, Branko

    2014-12-01

    The deep inferior epigastric perforator (DIEP) adipocutaneous flap is a versatile flap that has been most popularly used in breast reconstruction. However, it has been applied to many other anatomic areas and circumstances that require free-tissue transfer. We present a case report of the use of the DIEP flap for the reconstruction of severe craniomaxillofacial deformity complicated by indolent infection in a gentleman with infected hardware and methyl methacrylate overlay used in previous repair of traumatic injuries suffered from a motor vehicle collision. The reconstruction was done in a staged, two-step fashion that allowed for adequate infection eradication and treatment using a bilateral, bipedicled DIEP flap for tissue coverage and intravenous antibiotics before the delayed insertion of a polyetheretherketone cranioplasty for reconstruction of the cranial defect. PMID:25383155

  14. Reverse radial forearm flap peforator used in digital revascularization.

    PubMed

    Lo, Steven; Sebastin, Sandeep; Tsai, Larry; Pin, Peng Yeong

    2007-09-01

    There are very few reports in the literature of using pedicled flaps to revascularize distant tissue. Here, we describe the first description of using a radial artery perforator from a reverse radial forearm flap to revascularize a digit. Complex hand trauma presents multifaceted problems for the surgeon. This is illustrated by a recent case we treated of a severe hand crush injury, in which the two main problems were finger devascularization and a palmar defect. This required vein graft revascularization and local flap reconstruction. The initial management failed, and instead of repeating the same procedures, a single elegant solution was found. A reversed radial forearm flap was used for soft tissue defect coverage of the palmar defect, while a radial artery perforator was isolated for digital revascularization. This technique may seem excessive for digital revascularization, but in the correct context it overcomes "zone of injury" issues in major hand trauma and allows simultaneous revascularization with soft tissue defect cover. PMID:18780078

  15. SIDE DETAIL OF LEFT ENGINE MAINTENANCE. FLAPS ARE RESTRAINED WITH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    SIDE DETAIL OF LEFT ENGINE MAINTENANCE. FLAPS ARE RESTRAINED WITH LOCKS TO FACILITATE LUBRICATION. ENGINE IDENTIFIED AS #709075, PRATT & WHITNEY 200 JT 8 MODEL. - Greater Buffalo International Airport, Maintenance Hangar, Buffalo, Erie County, NY

  16. Orthopaedic Surgery Sports Medicine

    E-print Network

    Kim, Duck O.

    Orthopaedic Surgery Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2 Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2/13 2 Rotator Cuff;Orthopaedic Surgery Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2/13 3 Figure

  17. DEHN SURGERY SIDDHARTHA GADGIL

    E-print Network

    Gadgil, Siddhartha

    DEHN SURGERY SIDDHARTHA GADGIL Contents 1. Introduction 1 2. Co-ordinates for surgery 1 3. Some algebraic topology 2 4. The theorem of Lickorish and Wallace 3 5. Surgeries and Cobordisms 4 6. The Kirby Calculus 5 7. Constructing knots using surgery 5 8. Surgeries about knots 5 References 6 1. Introduction

  18. Simultaneous cheek and lower eyelid reconstruction with combinations of local flaps.

    PubMed

    Eroglu, Lutfi; Simsek, Tekin; Gumus, Murat; Aydogdu, Ilhami Oguzhan; Kurt, Alper; Yildirim, Kamil

    2013-01-01

    Cheek defects are common facial defects, especially after tumor ablation. Although primary repair yields the best aesthetic outcome, wide defects require flap resurfacing. Among the flap techniques, the cervicofacial rotation/advancement flap is one of the most common. In cases with eyelid involvement, it is very unlikely that a local flap would single-handedly resurface the defect and additional flaps must be used.This article presents our clinical experience with 14 patients with cheek defects for whom cervicofacial rotation/advancement flaps were used. In 3 of the 14 patients, local flaps that include the laterally based Tripier flap, the Fricke flap, the nasojugal flap, and the median forehead flap were combined with the cervicofacial flap to reconstruct the lower eyelid defects in accordance with the principle of individually reconstructing different anatomic subunits. All infraorbital defects were resurfaced with residual cheek and cervical skin with a good color and texture match. In patients whose eyelids were intact, no malposition was observed.Posteriorly based cervicofacial rotation/advancement flaps offer a very reliable and convenient method for resurfacing infraorbital and medial cheek defects. When a lower eyelid defect is also present, its individual reconstruction as a separate facial subunit needs to be considered using a combination of smaller local flaps. PMID:24036783

  19. Free skin flap coverage of the upper extremity.

    PubMed

    King, Elizabeth A; Ozer, Kagan

    2014-05-01

    Successful soft tissue reconstruction of the upper extremity must provide stable coverage and restore function to the injured hand. To ensure the best possible outcome after traumatic upper extremity injuries, early radical debridement and early flap coverage that restores all missing tissue components is critical to allow early mobilization. Free flaps provide extraordinary versatility in reconstructing defects of soft tissue, muscle, tendon, and bone. PMID:24731610

  20. Wind Tunnel Test of the SMART Active Flap Rotor

    NASA Technical Reports Server (NTRS)

    Straub, Friedrich K.; Anand, Vaidyanthan R.; Birchette, Terrence S.; Lau, Benton H.

    2009-01-01

    Boeing and a team from Air Force, NASA, Army, DARPA, MIT, UCLA, and U. of Maryland have successfully completed a wind-tunnel test of the smart material actuated rotor technology (SMART) rotor in the 40- by 80-foot wind-tunnel of the National Full-Scale Aerodynamic Complex at NASA Ames Research Center. The Boeing SMART rotor is a full-scale, five-bladed bearingless MD 900 helicopter rotor modified with a piezoelectric-actuated trailing edge flap on each blade. The eleven-week test program evaluated the forward flight characteristics of the active-flap rotor at speeds up to 155 knots, gathered data to validate state-of-the-art codes for rotor aero-acoustic analysis, and quantified the effects of open and closed loop active flap control on rotor loads, noise, and performance. The test demonstrated on-blade smart material control of flaps on a full-scale rotor for the first time in a wind tunnel. The effectiveness of the active flap control on noise and vibration was conclusively demonstrated. Results showed significant reductions up to 6dB in blade-vortex-interaction and in-plane noise, as well as reductions in vibratory hub loads up to 80%. Trailing-edge flap deflections were controlled within 0.1 degrees of the commanded value. The impact of the active flap on control power, rotor smoothing, and performance was also demonstrated. Finally, the reliability of the flap actuation system was successfully proven in more than 60 hours of wind-tunnel testing.

  1. The arterial anatomy of the saphenous flap: a cadaveric study.

    PubMed

    Gocmen-Mas, N; Aksu, F; Edizer, M; Magden, O; Tayfur, V; Seyhan, T

    2012-02-01

    The saphenous flap is a fasciocutaneous flap generally used for knee and upper third of the leg coverage. Due to various descriptions of the saphenous flap, such as venous, sensory, and free flap, the origin and distributing characteristics of the saphenous artery are important for plastic surgeons. The aim of this cadaveric study was to evaluate the anatomical features of the saphenous flap. The pedicles of the saphenous flap were dissected under 4 x loop magnification in thirty-two legs of 16 formalin-fixed adult cadavers. The findings of this anatomic study were as follows: Descending genicular artery originated from the femoral artery in all of the cases. The first musculoarticular branch, which arose from descending genicular, to the vastus medialis muscle existed in all dissections. The second branch was the saphenous artery which separately originated from the descending genicular artery in all of the cases. At the level of origin the mean diameter of the saphenous artery was found to be 1.61 mm. The muscular branches to the anterior or posterior sides of the sartorious muscle existed in all of the dissections. Two vena comitantes and a saphenous nerve were accompanying the saphenous artery in all cadavers. The mean distance between the origin of the artery and interepicondylar line of tibia was 115 mm. The muscular branches of the saphenous artery to the gracilis muscle were encountered 6.66% of the cases. The cutaneous branches numbered between one and four, and arose 3.5 to 9.5 cm from the site of origin of the saphenous artery. The distal end of the saphenous artery reached approximately 122 mm distally to the knee joint in all cases. Due to variations of the arterial anatomy and limited number of anatomic studies of the saphenous flap, we studied the topography and anatomy of the saphenous artery for increasing reliability of the saphenous flap. PMID:22532178

  2. Toe transfer to the vessels of the reversed forearm flap.

    PubMed

    Mahoney, J; Naiberg, J

    1987-01-01

    A 23-year-old man had a severe degloving injury of his hand, amputation of multiple fingers, and devascularization of the thumb. Primary care consisted of successful revascularization of the thumb and skin grafting of the hand. Secondary soft tissue reconstruction of the hand was done with a reverse forearm flap. This was followed by second-toe transfer to the hand, with the recipient vessels, the radial artery, and the venae comitantes of the reverse forearm flap. PMID:3543106

  3. Flap Side Edge Liners for Airframe Noise Reduction

    NASA Technical Reports Server (NTRS)

    Jones, Michael G. (Inventor); Khorrami, Mehdi R. (Inventor); Choudhari, Meelan M. (Inventor); Howerton, Brian M. (Inventor)

    2014-01-01

    One or more acoustic liners comprising internal chambers or passageways that absorb energy from a noise source on the aircraft are disclosed. The acoustic liners may be positioned at the ends of flaps of an aircraft wing to provide broadband noise absorption and/or dampen the noise producing unsteady flow features, and to reduce the amount of noise generated due to unsteady flow at the inboard and/or outboard end edges of a flap.

  4. Latissimus dorsi flap harvest with a short incision.

    PubMed

    Tan, Onder; Aydin, Osman Enver; Cinal, Hakan; Zafer Barin, Ensar; Algan, Said; Denktas Kuduban, Selma; Kara, Murat; Inaloz, Akin

    2013-03-01

    Latissimus dorsi (LD) flap is one of the most common options utilized in reconstructive armamentarium. In this report, we present our experience on harvest of the full LD muscle flap through a short incision. Twelve free and two pedicled full LD muscle flaps were raised in 14 patients (9 males and 5 females). In this technique, an oblique incision was placed 5-7 cm caudal to axillary apex, beginning from the posterior axillary line, so as to center the neurovascular hilus. The length of incision was 10 cm in adults and 8 cm in children. Mean dissection time was 45 min. All flaps survived totally. Seroma formation developed in two cases and treated with syringe aspiration and compressive dressing. In late postoperative period, donor site scars became inconspicuous and patient satisfaction was high. Short incision technique may be a good option to overcome scar problems in donor site of the LD flap. The technique reduces the dissection time and does not require sophisticated surgical devices and skill, when compared to endoscopic LD flap harvesting from the literature. PMID:23255352

  5. The inferior turbinate flap in skull base reconstruction

    PubMed Central

    2013-01-01

    Background As the indications for expanded endonasal approaches continue to evolve, alternative reconstructive techniques are needed to address increasingly complex surgical skull base defects. In the absence of the nasoseptal flap, we describe our experience with the posterior pedicle inferior turbinate flap (PPITF) in skull base reconstruction. Design Case series. Setting Academic tertiary care centre. Methods Patients who underwent reconstruction of the skull base with the PPITF were identified. Medical records were reviewed for demographic, presentation, treatment, follow-up, surgical and outcomes data. Main outcome measures Flap survival, adequacy of seal, and complications. Results Two patients with residual/recurrent pituitary adenomas met the inclusion criteria. The nasoseptal flap was unavailable in each case due to a prior septectomy. Salvage of the original nasoseptal flap was not possible, as it did not provide adequate coverage of the resultant defect due to contraction from healing. All PPITFs healed uneventfully and covered the entire defect. No complications were observed in the early post-operative period. Endoscopic techniques and limitations of the PPITF are also discussed. Conclusions Our clinical experience supports the PPITF to be a viable alternative for reconstruction of the skull base in the absence of the nasoseptal flap. PMID:23663897

  6. FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis

    PubMed Central

    Nangole, Ferdinand Wanjala; Khainga, Stanley Ominde

    2014-01-01

    Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx. PMID:25328699

  7. Global properties of magnetotail current sheet flapping: THEMIS perspectives

    NASA Astrophysics Data System (ADS)

    Runov, A.; Angelopoulos, V.; Sergeev, V. A.; Glassmeier, K.-H.; Auster, U.; McFadden, J.; Larson, D.; Mann, I.

    2009-01-01

    A sequence of magnetic field oscillations with an amplitude of up to 30 nT and a time scale of 30 min was detected by four of the five THEMIS spacecraft in the magnetotail plasma sheet. The probes P1 and P2 were at X=-15.2 and -12.7 RE and P3 and P4 were at X=-7.9 RE. All four probes were at -6.5>Y>-7.5 RE (major conjunction). Multi-point timing analysis of the magnetic field variations shows that fronts of the oscillations propagated flankward (dawnward and Earthward) nearly perpendicular to the direction of the magnetic maximum variation (B1) at velocities of 20-30 km/s. These are typical characteristics of current sheet flapping motion. The observed anti-correlation between ?B1/?t and the Z-component of the bulk velocity make it possible to estimate a flapping amplitude of 1 to 3 RE. The cross-tail scale wave-length was found to be about 5 RE. Thus the flapping waves are steep tail-aligned structures with a lengthwise scale of >10 RE. The intermittent plasma motion with the cross-tail velocity component changing its sign, observed during flapping, indicates that the flapping waves were propagating through the ambient plasma. Simultaneous observations of the magnetic field variations by THEMIS ground-based magnetometers show that the flapping oscillations were observed during the growth phase of a substorm.

  8. Aerodynamics and flight performance of flapping wing micro air vehicles

    NASA Astrophysics Data System (ADS)

    Silin, Dmytro

    Research efforts in this dissertation address aerodynamics and flight performance of flapping wing aircraft (ornithopters). Flapping wing aerodynamics was studied for various wing sizes, flapping frequencies, airspeeds, and angles of attack. Tested wings possessed both camber and dihedral. Experimental results were analyzed in the framework of momentum theory. Aerodynamic coefficients and Reynolds number are defined using a reference velocity as a vector sum of a freestream velocity and a strokeaveraged wingtip velocity. No abrupt stall was observed in flapping wings for the angle of attack up to vertical. If was found that in the presence of a freestream lift of a flapping wing in vertical position is higher than the propulsive thrust. Camber and dihedral increased both lift and thrust. Lift-curve slope, and maximum lift coefficient increased with Reynolds number. Performance model of an ornithopter was developed. Parametric studies of steady level flight of ornithopters with, and without a tail were performed. A model was proposed to account for wing-sizing effects during hover. Three micro ornithopter designs were presented. Ornithopter flight testing and data-logging was performed using a telemetry acquisition system, as well as motion capture technology. The ability of ornithopter for a sustained flight and a presence of passive aerodynamic stability were shown. Flight data were compared with performance simulations. Close agreement in terms of airspeed and flapping frequency was observed.

  9. Flap Conformations in HIV-1 Protease are Altered by Mutations

    NASA Astrophysics Data System (ADS)

    Fanucci, Gail; Blackburn, Mandy; Veloro, Angelo; Galiano, Luis; Fangu, Ding; Simmerling, Carlos

    2009-03-01

    HIV-1 protease (PR) is an enzyme that is a major drug target in the treatment of AIDS. Although the structure and function of HIV-1 PR have been studied for over 20 years, questions remain regarding the conformations and dynamics of the ?-hairpin turns (flaps) that cover the active site cavity. Distance measurements with pulsed EPR spectroscopy of spin labeled constructs of HIV-1 PR have been used to characterize the flap conformations in the apo and inhibitor bound states. From the most probably distances and the breadth of the distance distribution profiles from analysis of the EPR data, insights regarding the flap conformations and flexibility are gained. The EPR results clearly show how drug pressure selected mutations alter the average conformation of the flaps and the degree of opening of the flaps. Molecular dynamics simulations successfully regenerate the experimentally determined distance distribution profiles, and more importantly, provide structural models for full interpretation of the EPR results. By combining experiment and theory to understand the role that altered flap flexibility/conformations play in the mechanism of drug resistance, key insights are gained toward the rational development of new inhibitors of this important enzyme.

  10. Reverse radial forearm fascial flap with radial artery preservation.

    PubMed

    Hansen, Adam J; Duncan, Scott F M; Smith, Anthony A; Shin, Alexander Y; Moran, Steven L; Bishop, Allen T

    2007-09-01

    The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct the radial artery. A simpler alternative approach for hand reconstruction in such patients is a distally based RRFF flap based on radial artery perforators, which preserves the radial artery. We used RRFF flaps based on radial artery perforators in five patients who had palmar or dorsal soft-tissue loss. All five recovered full hand function, and only one had any complications (full-thickness skin graft loss at recipient site). The RRFF flap based on distal radial artery perforators is suitable for thin coverage of soft-tissue defects in hands with either a complete or an incomplete palmar arch. PMID:18780079

  11. Wind tunnel test of a tailless aircraft with a belly-flap control surface used in combination with wing flaps

    NASA Astrophysics Data System (ADS)

    Dougherty, Daniel A.

    A wind tunnel tat of a tailless aircraft configuration that has been quipped with a belly-flap control surface, was conducted with the goal of improving the trimmed maximum-lift coefficient. Tailless aircraft have aerodynamic and structural efficiencies that are superior to those of a traditionally configured wing/body/tail aircraft. However, tailless aircraft have a low maximum-lift coefficient such that; when sized for equivalent takeoff performance, the tailless aircraft suffers a large reduction in aerodynamic and structural efficiencies. A Belly-Flap control surface used in combination with wing trailing edge flaps was tested in a wind tunnel with the goal of achieving a longitudinally trimmed solution at a higher maximum lift coefficient. It was determined that, though the Belly-Flap increases the trimmed lift of the tailless configuration at low angles of attack, the maximum lift coefficient is slightly reduced in relation to the controls neutral configuration.

  12. A New Modification of C-V Flap Technique in Nipple Reconstruction: Rolled Triangular Dermal-Fat Flaps.

    PubMed

    Temiz, Gökhan; Ye?ilo?lu, Nebil; Sirino?lu, Hakan; Sarici, Murat

    2014-11-27

    In this study, a simple modification of the C-V flap technique designed to maintain the neo-nipple projection performed as the last stage of breast reconstruction is described. The technique was used in seventeen patients who were treated with breast reconstruction using the transverse rectus abdominis flap. Except for one patient with a 2.3 mm decrease in nipple projection, the projection of all neo-nipples was preserved at the end of the mean follow-up period of 19.4 months. According to the results of our study, modifying the C-V flap technique by adding rolled triangular dermal-fat flaps improves the long-term maintenance of neo-nipple projection. PMID:25428272

  13. Preoperative identification of a perforator using computed tomography angiography and metal clip marking in perforator flap reconstruction.

    PubMed

    Lee, Jung Woo; Kim, Han Kyeol; Kim, Sin Rak; Han, Yea Sik; Park, Jin Hyung

    2015-01-01

    In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3±3.9 mm, and the mean distance that was measured during surgery was 0.8±0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface. PMID:25606494

  14. Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease

    PubMed Central

    Watanabe, A; Shams, P N; Katori, N; Kinoshita, S; Selva, D

    2013-01-01

    Background A turn-over septal flap has been reported as a spacer for levator lengthening in a single case report. This study reports the preliminary outcomes of this technique in a series of patients with upper-lid retraction (ULR) associated with thyroid eye disease (TED) causing symptomatic exposure keratopathy (EK). Methods Retrospective, multicenter study of 12 eyelids of 10 patients with TED undergoing a transcutaneous levator-lengthening technique using the reflected orbital septum (OS) as a spacer. Change in palpebral aperture (PA) and contour, position of the skin crease (SC), symptoms of EK, and complications were recorded. Results The average age was 47.5 years. Two patients were excluded, as their septa were found to be very thin at surgery. At an average of 13 months postoperatively, the PA was reduced by 2.5?mm on average (P<0.001) and was within 1?mm of the contralateral eyelid in 11 cases (92%); the position of the SC was within 1?mm of the desired position in all cases. EK resolved in all cases. Complications included one case of overcorrection and one case of recurrent lateral flare. Conclusions The turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. This technique may be possible in cases where the OS has been opened by previous surgery but may not be feasible in patients in whom the septum is very thin. PMID:23907627

  15. Preoperative Identification of a Perforator Using Computed Tomography Angiography and Metal Clip Marking in Perforator Flap Reconstruction

    PubMed Central

    Lee, Jung Woo; Kim, Han Kyeol; Kim, Sin Rak; Han, Yea Sik

    2015-01-01

    In perforator flap reconstruction, vascular mapping using preoperative computed tomography (CT) angiography is widely used to confirm the existence and location of an appropriate perforator. This study proposes a rapid, accurate, and convenient method for marking the perforator location on the skin surface. For 12 patients who underwent perforator flap reconstruction between November 2011 and November 2013, metal clips were fixed on the skin surface at the anticipated perforator locations, which were decided using a handheld Doppler. CT angiography was used to compare the location between the metal clip and the actual perforator. The metal clip was moved and repositioned, if needed, on the basis of the CT images. The locations of the appropriate perforator and the metal clip, which were observed during the surgery, were then compared. In CT angiography, the mean distance between the metal clip and the perforator was 3±3.9 mm, and the mean distance that was measured during surgery was 0.8±0.8 mm. In conclusion, we report a simple, rapid, and precise technique to indicate the accurate location of the appropriate perforator on the skin surface. PMID:25606494

  16. Le Fort I osteotomy to correct malocclusion after reconstruction of the maxilla with the free fibula flap.

    PubMed

    Nocini, Pier Francesco; Chiarini, Luigi; Fior, Andrea; Bedogni, Alberto

    2009-09-01

    Malocclusion and facial asymmetry may follow microsurgical jawbone reconstruction. We describe the use of a Le Fort I osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. A 49-year-old patient with an extremely atrophied maxilla underwent alveolar crest augmentation by free fibula transfer. Bone healing was uneventful, but gross asymmetry of the reconstructed maxilla was apparent 3 months after surgery, with canting of the alveolar bone on the right side and residual skeletal discrepancy in the sagittal plane. A Le Fort I osteotomy was planned to correct malocclusion 6 months after fibula transfer. The maxilla was moved downward and forward and impacted in the right molar region. There were no postoperative complications. Solid bone union was achieved between the mobilized maxilla and the buttresses 3 months after surgery. At that time, osteointegrated implants were inserted, and an implant-supported prosthesis was completed. Neither bone resorption nor implant failure was encountered after 12 months of masticatory loading. Surgical correction of malocclusion after maxillary bone augmentation with the fibula flap is possible. Le Fort I osteotomy represents a reasonable option after microvascular alveolar bone reconstruction of the maxilla, when additional movements are required to restore facial symmetry and occlusion. PMID:19816271

  17. Who Needs Heart Surgery?

    MedlinePLUS

    ... from the NHLBI on Twitter. Who Needs Heart Surgery? Heart surgery is used to treat many heart problems. For ... t worked or can't be used, heart surgery might be an option. Specialists Involved Your primary ...

  18. Preparing for Surgery

    MedlinePLUS

    Preparing for Surgery If you are preparing for surgery, there are some critical steps you can take to help ensure the ... eat or drink anything after midnight before your surgery. Under some circumstances, your physician anesthesiologist may give ...

  19. Open heart surgery

    MedlinePLUS

    ... and a camera to perform the surgery. During robot-assisted valve surgery, the surgeon makes two to ... results than traditional surgery methods. You will not need to be on a heart-lung machine for ...

  20. Cosmetic breast surgery

    MedlinePLUS

    Cosmetic breast surgery is done at an outpatient surgery clinic or in a hospital. Most women receive ... with a plastic surgeon if you are considering cosmetic breast surgery. Discuss how you expect to look ...

  1. Orthopaedic Surgery Sports Medicine

    E-print Network

    Oliver, Douglas L.

    Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear Postoperative Rehabilitation Protocol Conditioning: Stationary bike Treadmill #12;Orthopaedic Surgery Sports Medicine Hip Arthroscopy for Labral Tear

  2. Pancreatic Cancer: Surgery

    MedlinePLUS

    ... Topic Ablation or embolization treatments for pancreatic cancer Surgery for pancreatic cancer There are 2 general types ... and risks of such surgery carefully. Potentially curative surgery Fewer than 1 in 5 pancreatic cancers appear ...

  3. Coronary Artery Bypass Surgery

    MedlinePLUS

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  4. Laser surgery - skin

    MedlinePLUS

    Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

  5. Robotic Surgery

    NASA Technical Reports Server (NTRS)

    2000-01-01

    The Automated Endoscopic System for Optimal Positioning, or AESOP, was developed by Computer Motion, Inc. under a SBIR contract from the Jet Propulsion Lab. AESOP is a robotic endoscopic positioning system used to control the motion of a camera during endoscopic surgery. The camera, which is mounted at the end of a robotic arm, previously had to be held in place by the surgical staff. With AESOP the robotic arm can make more precise and consistent movements. AESOP is also voice controlled by the surgeon. It is hoped that this technology can be used in space repair missions which require precision beyond human dexterity. A new generation of the same technology entitled the ZEUS Robotic Surgical System can make endoscopic procedures even more successful. ZEUS allows the surgeon control various instruments in its robotic arms, allowing for the precision the procedure requires.

  6. Repair of nasal septal perforation using middle turbinate flap (monopedicled superiory based bone included conchal flap): a new unilateral middle turbinate mucosal flap technique.

    PubMed

    Hanci, Deniz; Altun, Huseyin

    2014-09-01

    The purpose of this study is to present a new approach for treatment of nasal septal perforation using middle turbinate flap. A consecutive study with follow-up of 31 patients with nasal septal perforation treated using middle turbinate flap. All patients underwent an endoscopic repair of nasal septal perforation using middle turbinate flap. All patients were followed for 18-24 months. Complete closure of the perforation was achieved in 29 of the 31 patients. Complete failure of the repair was observed in two patients. All patients showed nasal crusting in varying degrees for a period of 2-4 weeks. None of the patients showed nasal obstruction or atrophic rhinitis symptoms (stuffy nose, purulent postnasal drip, nasal crusting, epistaxis and anosmia) in postoperative follow-up. This technique provides a new method with many advantages compared to other techniques for closure of septal perforations. LEVEL OF EVIDENCE: IV. PMID:25190253

  7. Combination of Tubularized Island Flap and Ventral Skin Flap Techniques in Single-Stage Correction of Severe Proximal Hypospadias

    Microsoft Academic Search

    Tugrul Tiryaki

    2010-01-01

    Objectives: To evaluate the success of the combined tubularized island flap (Duckett technique) and Thiersch-Duplay techniques in one-stage correction of proximal hypospadias. Methods: Thirty-four patients underwent surgical treatment for penoscrotal hypospadias in the last 9 years. Combined tubularized island flap (Duckett technique) and tubularized ventral skin (Thiersch-Duplay) procedures were performed in each case. The proximal urethra was repaired by the

  8. Partially de-epithelialized preputial flap (triangular soft tissue flap): an aid to prevent coronal urethrocutaneous fistulae

    Microsoft Academic Search

    R. B. Singh; Nevil M. Pavithran

    2003-01-01

    A technique is described to fashion a partially de-epithelialized preputial flap, also called triangular soft tissue flap (TSTF), to cover the neourethra in the region of glans, corona and subcorona. This highly vascular TSTF acted as a mechanical barrier against coronal fistula formation in 16 subcoronal hypospadiacs aged 3–12 years who underwent Snodgrass tubularized incised plate urethroplasty. None had complications at

  9. Endoscopic Surgery of Skull Base Chordomas

    PubMed Central

    Tan, Neil C-W; Naidoo, Yuresh; Oue, Sakiko; Alexander, Hamish; Robinson, Simon; Wickremesekera, Agadha; Floreani, Steve; Vrodos, Nick; Santoreneos, Steve; Ooi, Eng; Mcdonald, Matthew; Wormald, Peter-John

    2012-01-01

    Objective?To assess our clinical experience in treating midline intracranial pathology using minimally invasive surgical techniques. Design?Retrospective chart review of patients undergoing endoscopic endonasal resection of clival chordomas. Setting?Two tertiary referral centers in Australia and New Zealand. Main Outcome Measures?Patients were assessed by intraoperative findings (macroscopic resection rate, tumor size, and operative complications) and clinical outcomes (residual disease, postoperative complications, recurrence rate, and mortality). Results?Fourteen patients underwent endoscopic resection of clival chordomas (seven primary, seven revision) with a mean follow-up of 41.45 months (3 to 104 months). Macroscopic resection rates were 71% and 29%, respectively. Mean operative time was 386 minutes. Overall cerebrospinal fluid (CSF) leak rate was 3/14 (21%) and, using the nasoseptal flap, it was 0/5 (0%). Two patients developed late recurrence; one died of disease and one was treated with intensity modulated radiation therapy. Overall mortality was 2/14 (14%). Conclusion?Endoscopic resection of clival chordomas is a safe and viable alternative to the traditional open approach. The nasoseptal flap is an excellent method of obtaining a watertight skull base closure. Furthermore, this series highlighted the fact that the primary attempt at surgery offers the best chance to achieve a total resection. PMID:24294554

  10. Algorithm of hair restoration surgery in children.

    PubMed

    Kolasiñski, Jerzy; Kolenda, Ma?gorzata

    2003-08-01

    Hair is an inseparable element of external appearance of every human being. Although various fashion trends come and go, the lack of hair is for many a major aesthetic and psychological problem. Even if men's balding can be accepted as a natural phenomenon, hair loss in children is considered to be a condition demanding correction. During an 18-year period, 8440 hair restoration operations were performed at the Hair Clinic Poznan, in Poznan, Poland. Most patients were men treated for androgenic alopecia. Among the patients were 57 children in whom hair loss resulted from hereditary factors, perinatal traumas, radiotherapy, and mechanical, thermal, and chemical damage. Methods of restoration were adjusted to type of hair loss, patient age, and ability to cooperate with the surgeon. In cases of single massive scars, skin flap correction was usually used. The flaps were prepared with the use of expanders. In cases of numerous scattered defects or considerable thinning of the scalp, the method of choice was hair transplantation. The "four-hand stick-and-place" technique developed by the authors enabled the surgeon to quickly and precisely carry out the procedure. Application of varied surgery techniques in scalp reconstruction procedures in children gave very good aesthetic results with a minimal complication rate. PMID:12900598

  11. Hip fracture surgery

    MedlinePLUS

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

  12. Microbial keratitis after corneal laser refractive surgery.

    PubMed

    Sharma, Daya Papalkar; Sharma, Shanel; Wilkins, Mark R

    2011-07-01

    Corneal laser refractive surgery is increasingly being performed on patients with the aim of improving unaided vision. Most candidates for surgery have excellent spectacle- or contact lens-corrected vision. Although microbial keratitis following refractive surgery is a rare complication, and usually has a good visual outcome, it can be sight-threatening. The spectrum of pathogens differs to other causes of microbial keratitis, such as contact lens-associated keratitis, and a different management approach is required. Postoperatively, patients are prescribed topical steroids and broad-spectrum topical antibiotics, typically fluoroquinolones. These do not cover unusual organisms, such as fungi, Nocardia, Acanthamoeba and some atypical mycobacteria. In post-laser-assisted in situ keratomileusis microbial keratitis, the lamellar flap should be lifted to acquire samples for specific microbiological examination, including these atypical organisms. Confocal microscopy is a noninvasive test that provides morphological information, and is operator dependent, but may assist in the rapid diagnosis of fungal, Acanthamoeba or Norcardia keratitis. PCR is not in widespread use, but has high sensitivity and specificity, and may facilitate early diagnosis and specific treatment of the causative organism, which is critical in obtaining the best clinical outcome. PMID:21797693

  13. Organ-Preserving Surgery for Penile Carcinoma

    PubMed Central

    Martins, Francisco E.; Rodrigues, Raul N.; Lopes, Tomé M.

    2008-01-01

    Introduction. Penile carcinoma has traditionally been treated by either surgical amputation or radical radiotherapy, both associated with devastating anatomical, functional, and psychological impact on the patient's life. Innovative surgical techniques have focused on penile preservation in well-selected patients to minimize physical disfigurement and consequently maximize quality of life. The objective of this article is to define the current status of these organ-preserving surgical options for penile carcinoma. Materials and Methods. An extensive review of the Pubmed literature was performed to find articles discussing only reconstructive surgery which have contributed significantly to change traditional, frequently mutilating treatments, to develop less disfiguring surgery, and to improve patients' quality of life over the last two decades. Results. Several articles were included in this analysis in which a major contribution to the change in therapy was thought to have occurred and was documented as beneficial. Some articles reported novel techniques of less-mutilating surgery involving different forms of glans reconstruction with the use of flaps or grafts. The issue of safe surgical margins was also addressed. Conclusion. The development of less-disfiguring techniques allowing phallus preservation has reduced the negative impact on functional and cosmetic outcomes of amputation without sacrificing oncological objectives in appropriately selected patients based on stage, grade, and location of the tumour. Until more prospective studies are available and solid evidence is documented, organ preservation should be offered with caution. PMID:19009032

  14. One hundred fascia-sparing myocutaneous rectus abdominis flaps: An update.

    PubMed

    Rufer, Mirjam; Plock, Jan A; Erni, Dominique

    2011-02-01

    Major efforts have been undertaken to reduce donor-site morbidity after abdominal flaps, which eventually culminated in the introduction of the deep inferior epigastric perforator (DIEP) flap. However, due to anatomical variations (absence of dominant perforators) and the risk of ischaemic complications, the selection of patients qualifying for a DIEP flap is limited. Furthermore, DIEP flaps can only be used as free flaps. We present our long-term experience with a dissection technique of rectus abdominis myocutaneous (RAM) flaps that was developed to circumvent these drawbacks. The dissection is characterised by preventing to sacrifice any perforators nourishing the flap and by fully preserving the anterior rectus sheath, but not the muscle. The study comprises a consecutive series of prospectively assessed patients, treated between February 2000 and April 2008. A total of 100 fascia-sparing RAM flaps were operated on 97 patients (age 22-84 years, median 64 years). Free flaps were mainly used for breast reconstruction (47 flaps/24 patients), and cranially (34) or caudally (19) pedicled flaps for soft-tissue coverage after sternectomy, urogenital tumour resection or rectum amputation. Eighty patients had a total of 213 risk factors, such as cardiovascular diseases, obesity, hyperlipidaemia, diabetes mellitus, smoking or steroid medication. Partial tissue loss (skin or fat necrosis) occurred in 13 flaps, out of which seven required surgical revision. The ischaemic complications were evenly distributed between the patient subsets. At a follow-up of 2-89 months (median 20 months), one patient showed a flap harvest-related abdominal bulge after bilateral-free transverse rectus abdominis myocutaneous (TRAM) flap. We conclude that the present dissection technique provides maximal perforator-related perfusion and minimal donor-site morbidity even in pedicled flaps and high-risk patients. In free flaps, it may, therefore, be recommended as an alternative to the DIEP flap. PMID:20554489

  15. Piloted simulation study of two tilt-wing flap control concepts, phase 2

    NASA Technical Reports Server (NTRS)

    Birckelbaw, Lourdes G.; Corliss, Lloyd D.; Hindson, William S.; Churchill, Gary B.

    1994-01-01

    A two phase piloted simulation study has been conducted in the Ames Vertical Motion Simulator to investigate alternative wing and flap controls for tilt-wing aircraft. This report documents the flying qualities results and findings of the second phase of the piloted simulation study and describes the simulated tilt-wing aircraft, the flap control concepts, the experiment design and the evaluation tasks. The initial phase of the study compared the flying qualities of both a conventional programmed flap and an innovative geared flap. The second phase of the study introduced an alternate method of pilot control for the geared flap and further studied the flying qualities of the programmed flap and two geared flap configurations. In general, the pilot ratings showed little variation between the programmed flap and the geared flap control concepts. Some differences between the two control concepts were noticed and are discussed in this report. The geared flap configurations had very similar results. Although the geared flap concept has the potential to reduce or eliminate the pitch control power requirements from a tail rotor or a tail thruster at low speeds and in hover, the results did not show reduced tail thruster pitch control power usage with the geared flap configurations compared to the programmed flap configuration. The addition of pitch attitude stabilization in the second phase of simulation study greatly enhanced the aircraft flying qualities compared to the first phase.

  16. Sharing the radial forearm flap in reconstruction of two separate defects in the same patient.

    PubMed

    Safak, T; Kayikcioglu, A; Ozcan, G; Kecik, A

    1996-03-01

    The radial forearm flap is used extensively to cover defects for which a thin skin flap is needed. It can be used either as a pedicle or a free flap in various designs. In this case report, a new application of this flap is presented in which two flaps were created out of a single radial forearm flap to cover two separate defects. One of the flaps was a distally based reverse island flap. We used this flap to cover a defect developed by releasing a burn contracture on the flexor surface of the thumb. The other flap consisted of the proximal portion of the forearm flap and was transferred to the neck region as a free flap to cover a defect resulting from the release of a burn contracture. The radial artery allows sharing the fasciocutaneous unit of the forearm into two different flaps and transferring them to separate areas. Thus, donor site morbidity is reduced when there is more than one defect to be reconstructed. PMID:8659958

  17. Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn.

    PubMed

    Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

    2015-02-01

    Successful reconstruction of extensive anterior chest wall defect following major electrical burn represents a very challenging surgery. Herein we report the first case using pedicled full-thickness abdominal flap combined with skin grafting to treat this injury with severe infection and exposure of pericardium and ribs in a Chinese patient. Following the performance of chest debridement to remove necrotic and infected tissues and the injection of broad-spectrum antibiotics to reduce infection, a pedicled full-thickness abdominal flap was used to cover the exposed pericardium and ribs, and skin grafting from the right leg of the patient was done to cover the exposed vital tissues. The patient was followed up for a total of 3·5 years, and satisfactory cosmetic and functional outcomes were obtained without complications. This report provides an effective method for the surgeons who encounter similar cases where reconstruction of extensive anterior chest wall is required. PMID:23490336

  18. Nonmicrosurgical use of the radial forearm flap for penile reconstruction.

    PubMed

    Mutaf, M

    2001-01-01

    Although the era of microsurgical techniques has greatly expanded the number of possible solutions for penile reconstruction, additional options are still needed for some unusual situations when microsurgery is not available or not desired. This article describes the first nonmicrosurgical use of the radial forearm flap for penile reconstruction. With this technique, an osteocutaneous radial forearm flap 15 x 20 cm in size is elevated as a reverse-flow island flap and used to create a neopenis in the classic "tube within a tube" fashion. The neopenis is then transferred to the recipient site as a distant flap, without dividing its vascular connection with the forearm. Once a complete healing is ensured after the following 2 to 3 weeks, the pedicle is cut and the penile reconstruction is completed. Since 1995, this technique was used for total penile reconstruction in four patients: two with congenital penile agenesis, one with penile amputation as a result of a high-voltage electrical injury, and one with total loss of the external genitalia as a result of a shotgun injury. The patients have been followed up for 1 to 4 years. Good results were achieved in all patients. In conclusion, non-microsurgical use of the radial forearm flap seems to be a useful alternative to create an innervated functionally and aesthetically acceptable neopenis when microsurgery is not available or not desired. Although it is a multistage procedure, it is easy to perform. Moreover, this technique provides all well-known advantages of the radial forearm flap in penile reconstruction but does not require the sophisticated equipment and expertise of microsurgery. This is a great advantage that enables surgeons without microsurgical skill to use the radial forearm flap for phallic reconstruction. The author believes that the described technique will be extremely useful in developing countries that have limited resources and where microsurgery is difficult to obtain. PMID:11176605

  19. Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps

    PubMed Central

    Nguyen, Gerard K.; Monahan, John F. W.; Davis, Gabrielle B.; Lee, Yong Suk; Ragina, Neli P.; Wang, Charles; Zhou, Zhao Y.; Hong, Young Kwon; Spivak, Ryan M.; Wong, Alex K.

    2013-01-01

    The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and allow clinicians to both diagnose and successfully treat microvascular complications before irreversible tissue damage and flap loss occurs. PMID:23977093

  20. Versatility of nasolabial flaps in oral cavity reconstructions

    PubMed Central

    Cebrián-Carretero, José L.; Morán-Soto, María J.; Burgueño-García, Miguel

    2014-01-01

    Objectives: Describe the techniques involved and the results obtained witn nasolabial flaps in small and medium-sized defects of the oral cavity. The procedure is an easy resconstructive option with a high success rate and with very good aesthetic and functional outcomes. Study Design: A retrospective analysis of 16 nasolabial flap reconstructions in 15 oncological patients with oral cavity defects undergoing single-stage surgical interventions. We evaluate the tumor type, its location, size, the resective and reconstructive techniques involved, as well as any complications. Results: Out of 15 patients, 9 were male and 6 female, with ages ranging from 60-85 years. The primary tumor was located in the mandibular or maxillary gingiva in 7 patients, the lateral margin of the tongue in 5, the floor of the mouth in 3 and the mandibular symphysis in a single patient. The tumors were of a small to medium size. All patients underwent intraoral resections. In most cases, a cervical dissection was performed. All flaps were completed as single-stage surgical interventions, with 14 unilateral and 2 bilateral procedures. Five patients had received radiotherapy treatment for previous tumors. During the follow up period, which ranged from 4 months to 8 years, only one patient required their flap to be thinned, there were two incidents of surgical wound dehiscence, two hematomas and one orocutaneous fistula, none of which affected the survival of the flap. Conclusions: The nasolabial flap proves highly versatile in oral cavity reconstructions, coupled with a minimal morbidity of the donor region and good aesthetic and functional results. Its high vascularity allows for cervical dissections to be carried out or even for radiotherapy to be administered prior to it. It is straightforward, safe, and carrying it out as a single-stage intervention makes it the ideal surgical option for small to medium intraoral defects in edentulous patients with other comorbidities. Key words:Nasolabial flap, oral cavity reconstruction, oral cavity defects.