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1

Fibrin glue for Gundersen flap surgery  

PubMed Central

Purpose To evaluate the feasibility of fibrin glue in Gundersen flap surgery. Design Prospective case series. Study subjects Seven eyes of seven subjects who had undergone Gundersen flap surgery from 2009 to 2011 at the Singapore National Eye Centre, Singapore. Methods Review of case records for outcomes after Gundersen flap surgery. Main outcome measures Surgical success was defined as achieving a stable ocular surface. Complications to be noted included flap retraction or exposure of underlying corneal surface. Results Surgical success was achieved in all eyes with significant reduction in ocular surface inflammation. No retractions were noted and recovery was uncomplicated. Conclusion Fibrin glue application is a viable alternative to sutures in Gundersen flap surgery. It reduces surgical downtime, gives faster ocular surface rehabilitation, and offers similar outcomes to conventional conjunctival flap surgery. PMID:23493670

Chung, Hsi-Wei; Mehta, Jodhbir S

2013-01-01

2

Flap complications associated with lamellar refractive surgery  

Microsoft Academic Search

PURPOSE: Corneal lamellar refractive surgery for myopia reduces the risk of corneal haze but adds to the risk of flap complications. We retrospectively determined the incidence of flap complications in the initial series of eyes undergoing lamellar refractive surgery by one surgeon. We assessed the incidence of flap complications overall, the trend in these complications during the surgeon’s learning curve,

Robert T Lin; Robert K Maloney

1999-01-01

3

[Applicability of skin flaps and myocutaneous flaps for esophageal surgery].  

PubMed

Stomach and colon are always used to reconstruct esophagus after esophagectomy. However, alternative procedures to reconstruct or repair esophagus are required if the patients suffered from gastric or colonic diseases, underwent gastric colonic operations or had severe local esophageal stricture. More than ten kinds of skin flaps and myocutaneous flaps, which are classified into free or pedicled ones, are used to reconstruct or repair esophagus. Microvascular anastomosis is required while using free flaps. Necrosis of the free flaps is prone to developing once the vascular occlusion occurs. The pectoralis major myocutaneous and latissimus dorsi pedicled flaps have sufficient blood supplies. However, both are bulky and difficult to reconstruct a circumferential esophagus through contouring a tube. Platysma myocutaneous flaps have a large surface area and are supplied from multiple vessels. Single lateral and bilateral platysma myocutaenous flap can be applied to repair the cervical esophageal defect and circumferential cervical esophagus, respectively. The use of platysma myocutaneous to repair and reconstruct cervical esophagus is a procedure easy to perform and confer excellent outcomes. There is no development of ulcer and hair growth after long-term follow-up and resistance to radiotherapy. PMID:25273650

Wang, Ruwen; Zhou, Jinghai; Deng, Bo

2014-09-01

4

Non-invasive vascular imaging in perforator flap surgery.  

PubMed

Preoperative imaging using a range of imaging modalities has become increasingly popular for preoperative planning in plastic surgery, in particular in perforator flap surgery. Modalities in this role include ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA). The evidence for the use of these techniques has been reported in only a handful of studies. In this paper we conducted a non-systematic review of the literature to establish the role for each of these modalities. The role of state-of-the-art vascular imaging as an application in perforator flap surgery is thus offered. PMID:23125392

Saba, Luca; Atzeni, Matteo; Rozen, Warren Matthew; Alonso-Burgos, Alberto; Bura, Raffaella; Piga, Mario; Ribuffo, Diego

2013-02-01

5

A Longitudinal Study: Phonological Changes Associated with Pharyngeal Flap Surgery.  

ERIC Educational Resources Information Center

The longitudinal study compared the speech of two children (beginning at age 3) with cleft palate and inadequate velopharyngeal closure in an attempt to identify the patterns of production observed prior to surgery and the course and rate of change in production following surgery. Subjects' speech samples were evaluated prior to pharyngeal flap

Letcher, Lisa M.; And Others

6

[Renaissance of pedicled flaps in oral and maxillofacial surgery].  

PubMed

A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction. PMID:24449079

Twieg, M; Reich, W; Dempf, R; Eckert, A W

2014-06-01

7

Evaluation of intraoperative anticoagulants in microvascular free-flap surgery.  

PubMed Central

This retrospective study evaluated anticoagulants used during surgery to determine efficacy and associated complications. The patient population was comprised of 15 patients who underwent microvascular free-flap surgery for wound coverage of the lower one third of the leg. Results indicated that the use of heparin in conjunction with other anticoagulants was associated with the development of more hematomas compared with the use of aspirin and dextran, both separately and together. PMID:8918071

Pugh, C. M.; Dennis, R. H.; Massac, E. A.

1996-01-01

8

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

E-print Network

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

Liblit, Ben

9

Comparison of gracilis and rectus abdominis myocutaneous flap neovaginal reconstruction performed during radical pelvic surgery: flap-specific morbidity.  

PubMed

To compare flap-specific complications of gracilis myocutaneous (GM) and rectus abdominis myocutaneous (RAM) flap neovaginal reconstructions after radical pelvic surgery. The study was a single-institution retrospective review of patients undergoing concurrent radical pelvic surgery with GM or RAM neovaginal reconstructions performed on a gynecological oncology service, 1978-2003. Flap-specific complications were compared between the techniques. Forty-four GM and 32 RAM neovaginal reconstructions were analyzed: plastic surgeons developed 12 (27%) GM and 4 (13%) RAM flaps, with all other flaps performed by gynecological oncologists. Primary procedures included 54 (71%) total pelvic exenterations, with partial exenterations or radical vulvovaginectomies in 16 (21%) and 6 (8%) patients, respectively. Forty (53%) patients had received radiation and 28 (36%) received chemoradiation before radical surgery. There were no significant differences in patient characteristics, other than more frequent use of continent urinary conduits (P < 0.001) and a trend for more frequent sidewall radiation (P < 0.1) in the RAM group, reflecting use in more recent patients (P < 0.001). Median follow-up is 28 months (range: 2 weeks to 216 months), with 5% acute operative mortality. Flap-specific complications were significantly increased in GM patients (P < 0.03). Overall flap loss was significantly increased in GM patients (P < 0.02). Thirty (59%) of 51 patients surviving for more than 12 months reported coitus, with no significant difference between the groups. Because of lower overall incidence of flap-specific complications and significantly lower incidence of flap loss compared with GM flap, RAM flap has become our technique of choice for neovaginal reconstruction concurrent with radical pelvic surgery. PMID:17291272

Soper, J T; Secord, A A; Havrilesky, L J; Berchuck, A; Clarke-Pearson, D L

2007-01-01

10

[Radial fascio-cutaneous flap of the forearm and myocutaneous gracilis muscle flap in urologic surgery: surgical anatomy and techniques].  

PubMed

All the concepts and principles commonly espoused in plastic surgery are very useful in urologic reconstructive operations too. Hypospadia's repair, neo-bladder reconstruction, microsurgery of the seminal way require as certain rules as an absolute respect for anatomy, sparing of the finest tissue vascularization and tension free sutures. Pedicled skin flaps harvesting and utilisation are techniques typical of plastic surgery but are also largely used in urologic adult and paediatric surgery. They are adopted for urethral, penile and corpora cavernosa reconstruction. Pedicled flaps are utilised for the closure of large skin defect in case of complicated wound or when an urinary fistula is present, especially after radiotherapy. A perfect knowledge of the flap nourishment and of the method of harvesting is crucial if the best results must be obtained. In our work we describe the surgical technique for the utilisation of gracilis muscle and forearm flap. Special care is taken to the anatomical description. PMID:10953388

de Stefani, S; Liguori, G; Ciampalini, S; Trombetta, C; Pascone, M; Bertolotto, M; Belgrano, E

2000-06-01

11

Cryptogenic stroke following abdominal free flap breast reconstruction surgery  

PubMed Central

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

Xie, Huizhuang; Malata, Charles M.

2014-01-01

12

Infective Left Atrial Dissecting Flap after Cardiac Surgery  

PubMed Central

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

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

2014-01-01

13

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

PubMed Central

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

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

2014-01-01

14

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

PubMed

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

Liu, Jian-Feng; Zhao, Li-Rong; Lu, Lai-Jin; Chen, Lei; Liu, Zhi-Gang; Gong, Xu; Liu, Bin

2014-11-01

15

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

PubMed Central

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

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

2014-01-01

16

ARTERIOVENOUS FISTULAE AFTER FREE FLAP SURGERY IN A REPLANTED HAND  

Microsoft Academic Search

AV fistulae are extremely rare complications after hand replantation. In the case presented, the formation of an AV fistula did not occur immediately after the replantation, but after the insertion of the free lateral arm flap to the extensor surface of the replanted hand.This paper discusses the mechanisms responsible for the formation of AV fistulae.

M. NINKOVI?; D. SU?UR; B. STAROVI?; S. MARKOVI?

1992-01-01

17

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

PubMed Central

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.

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

2015-01-01

18

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

PubMed Central

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

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

2012-01-01

19

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

PubMed Central

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

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

20

Surgery for complex perineal fistula following rectal cancer treatment using biological mesh combined with gluteal perforator flap.  

PubMed

Three patients with complex perineal fistula after extensive pelvic surgery and radiotherapy underwent surgical treatment combining a biological mesh for pelvic floor reconstruction and a unilateral superior gluteal artery perforator (SGAP) flap for filling of the perineal defect. All patients had both fecal and urinary diversion. Two fistulas originated from the small bowel, necessitating parenteral feeding, and one from the bladder. Symptoms included severe sacral pain and skin maceration. After laparotomy with complete debridement of the pelvic cavity, the pelvic floor was reconstructed by stitching a biological mesh at the level of the pelvic outlet. Subsequently, patients were turned to prone position, and perineal reconstruction was completed by rotating a SGAP flap into the defect between the biomesh and the perineal skin. Operating time ranged from 10 to 12.5 h, and hospital stay lasted from 9 to 23 days. The postoperative course was uneventful in all three patients. Reconstruction of large pelvic defects with a combination of biological mesh and SGAP flap is a viable alternative to a rectus abdominis musculocutaneous flap and may be preferable after extensive pelvic surgery with ostomy. PMID:24913972

Musters, G D; Lapid, O; Bemelman, W A; Tanis, P J

2014-10-01

21

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

PubMed Central

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

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

2014-01-01

22

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

PubMed

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

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

2013-12-01

23

Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.  

PubMed

The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery) board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill) protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL) group had superior performance as confirmed by checklist scores (p<0.002), overall global assessment (p?=?0.017) and post-test results (p<0.001). All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method. PMID:23935818

de Sena, David P; Fabricio, Daniela D; Lopes, Maria Helena I; da Silva, Vinicius D

2013-01-01

24

[Complications in plastic surgery breast reconstruction with TRAM flap. Preventive methods and treatment modalities].  

PubMed

The breast reconstruction with the TRAM-flap is sophisticated and demanding procedure, requiring careful planning and technical proficiency. Despite these efforts, the outcome of the breast reconstruction can be compromised by factors such as vascular insufficiency, scar contraction, errors in planning of the flap, or in the technique of building the new breast. Preventing the problems and complications in breast reconstruction require careful preoperative study, proper patient selection, accurate analysis of the results and immaculate technical performance. PMID:11194654

Tepavicharova, P

1999-01-01

25

Perforator Based Propeller Flaps in Limb Reconstructive Surgery: Clinical Application and Literature Review  

PubMed Central

The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs. PMID:25250327

Artiaco, Stefano; Bianchi, Pasquale; Boux, Elena; Tos, Pierluigi

2014-01-01

26

Perforator based propeller flaps in limb reconstructive surgery: clinical application and literature review.  

PubMed

The reconstruction of loss of substance due to trauma or oncological excision may have relevant functional and aesthetic implications. We report our experience in twenty-one cases of propeller flaps for the treatment of loss of substance of the upper and lower limbs. The etiology of defect was tumor excision in nine cases, trauma in seven cases, surgical wound complications in four cases, and chronic osteomyelitis in one case. Clinical results were favorable in most cases and eighteen flaps survived. We observed an overall complication rate of 33% with four cases of superficial epidermolysis that spontaneously healed and three cases of partial flap loss ranging from 10 to 50% that required surgical revision by means of skin graft (two cases) or ALT free flap (one case). Propeller flap harvesting requires great care and experience, and potential complications may occur even in expert hands. When indicated by the characteristic of the defect, these flaps can be a useful surgical option for the treatment of loss of substance of upper and lower limbs. PMID:25250327

Artiaco, Stefano; Battiston, Bruno; Colzani, Giulia; Bianchi, Pasquale; Scaravilli, Gabriele; Boux, Elena; Tos, Pierluigi

2014-01-01

27

Determination of a perfusion threshold in experimental perforator flap surgery using indocyanine green angiography.  

PubMed

Indocyanine green (ICG) angiography has been used in the evaluation of flap perfusion but the viability threshold has not been elucidated. In this study, we determined the threshold by comparing perfusion, using ICG imaging (SPY imaging system, LifeCell Corporation), to clinical evidence of nonviability in rat abdominal perforator flaps. Abdominal flaps, based on a single perforator, were elevated and re-inset in Sprague-Dawley rats. ICG imaging and clinical assessments were conducted preoperatively, as well as 0, 24, and 48 hours postoperatively. SPY-Q software allowed standardization of the perforator's perfusion for comparison purposes. A total of 278 random percentage measurements were made from postoperative day 0 giving a mean (SE) percentage perfusion of 26.8% (1.6%) and 59.1% (1.3%), respectively, for necrosis and survival (P<0.05). We demonstrate that ICG angiography can be readily analyzed in a perforator flap environment allowing a determination of the perfusion threshold. PMID:24625512

Monahan, John; Hwang, Brian H; Kennedy, James M; Chen, Wen; Nguyen, Gerard K; Schooler, Wesley G; Wong, Alex K

2014-11-01

28

[Experience in the use of frontal flap for reconstructive surgery of eyelids].  

PubMed

Results of the use of classic Indian and petalous frontal flaps for surgical treatment of 52 patients of the age from 11 till 58 years with congenital and acquired eyelid defects were presented. In all cases eyelid form and function it was possible to restore, reduce the number of operations and achieve maximal esthetic rehabilitation in the terms to 1 year from the patient addressing to clinic and in patients with congenital oblique face clefts - before achieving the age of 14-16 years. Frontal flap use on medial, paramedical and lateral pedicles considerably widened reconstructive blepharoplastics possibilities and increased efficacy of treatment of the patients with congenital and acquired limited total and subtotal eyelid defects. PMID:21983613

Vissarionov, V A; Kulakov, A A; Grishchenko, S V; Malitskaia, O A

2011-01-01

29

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

PubMed

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

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

1992-01-01

30

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

PubMed Central

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

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

2012-01-01

31

Breast surgery under local anesthesia: second-stage implant exchange, nipple flap reconstruction, and breast augmentation.  

PubMed

Breast reconstruction can be performed safely with local anesthesia. Utilization of the star flap method in conjunction with tattooing successfully provides optimal aesthetic results without the need for an additional donor site. When tissue expander to silicon implant exchange is part of the operative plan, use of triple antibiotic irrigation as well as the Keller Funnel is recommended. Breast augmentation and breast augmentation-mastopexy can also be performed with good results under local anesthetic in a private operating room setting. All other operative conditions, including sterility and sound operative surgical techniques, should be the mainstay of any practice. PMID:24093654

Koumanis, Dimitri J; Colque, Alex; Eisemann, Michael L; Smith, Jenna

2013-10-01

32

Midurethral autologous fascial sling surgery with reconstruction of the lower abdominal wall using the tensor fascia lata muscle flap for post-hemipelvectomy stress urinary incontinence.  

PubMed

Hemipelvectomy is surgery for pelvic bone neoplasms. In the case of pubic bone osteosarcoma, the distal end of the rectus abdominis muscle is severed from the pubic and ischium bones, and the pelvic floor muscles are resected en bloc with the bone, which leads to stress urinary incontinence. Cancer control is prioritized over complications, and stress urinary incontinence is generally disregarded. A 25-year-old woman presented with stress urinary incontinence. She had undergone a hemipelvectomy for left pubic bone osteosarcoma, and stress urinary incontinence appeared and persisted since the surgery. We carried out a reconstruction of the tissue deficit of the rectus abdominis using the tensor fascia lata muscle flap simultaneously with a midurethral autologous fascial sling anchoring to the tensor fascia lata flap. Stress incontinence was successfully improved without morbidity. This is the first reported case of midurethral suspension with reconstruction of the lower abdominal wall with the tensor fascia lata flap for post-hemipelvectomy stress urinary incontinence. PMID:24954425

Niimi, Aya; Igawa, Yasuhiko; Fujimura, Tetsuya; Suzuki, Motofumi; Mihara, Makoto; Koshima, Isao; Homma, Yukio

2014-09-01

33

Gingival Flap Surgery  

MedlinePLUS

... days later. Your periodontist also may cover the surgical site with a bandage. This is called a periodontal ... your mouth as clean as possible while the surgical site is healing. This means you should brush and ...

34

Pedicled Extranasal Flaps in Skull Base Reconstruction  

PubMed Central

Cerebrospinal fluid (CSF) leaks most commonly arise during or after skull base surgery, although they occasionally present spontaneously. Recent advances in the repair of CSF leaks have enabled endoscopic endonasal surgery to become the preferred option for management of skull base pathology. Small defects (<1cm) can be repaired by multilayered free grafts. For large defects (>3cm), pedicled vascular flaps are the repair method of choice, resulting in much lower rates of postoperative CSF leaks. The pedicled nasoseptal flap (NSF) constitutes the primary reconstructive option for the vast majority of skull base defects. It has a large area of potential coverage and high rates of success. However, preoperative planning is required to avoid sacrificing the NSF during resection. In cases where the NSF is unavailable, often due to tumor involvement of the septum or previous resection removing or compromising the flap, other flaps may be considered. These flaps include intranasal options—inferior turbinate (IT) or middle turbinate (MT) flaps—as well as regional pedicled flaps: pericranial flap (PCF), temporoparietal fascial flap (TPFF), or palatal flap (PF). More recently, novel alternatives such as the pedicled facial buccinator flap (FAB) and the pedicled occipital galeopericranial flap (OGP) have been added to the arsenal of options for skull base reconstruction. Characteristics of and appropriate uses for each flap are described. PMID:23257554

Kim, Grace G.; Hang, Anna X.; Mitchell, Candace; Zanation, Adam M.

2013-01-01

35

Perforator Flaps in Head and Neck Reconstruction  

PubMed Central

Free tissue transfer has revolutionized the management of complex head and neck defects. Perforator flaps represent the most recent advance in the development of free flap surgery. These flaps are based on perforating vessels and can be harvested without significant damage to associated muscles, thereby reducing the postoperative morbidity associated with muscle-based flaps. Elevation of perforator flaps requires meticulous technique and can be more challenging than raising muscle-based flaps. Use of a Doppler device enables reliable identification of the perforating vessels and aids in the design of free-style free flaps, where the flaps are designed purely according to the perforator located. The major advantage of free-style free flaps is that an unlimited number of flaps can potentially be designed on much shorter pedicles. The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction. Its use is described in detail, as is use of other less common perforator flaps. This article also describes head and neck reconstruction in a region-specific manner and gives a short-list of suitable flaps based on the location of the defect. PMID:22550446

Chana, Jagdeep S.; Odili, Joy

2010-01-01

36

Flap monitoring using infrared spectroscopy  

NASA Astrophysics Data System (ADS)

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.

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

2006-02-01

37

The galeo pericranial flap in oropharyngeal reconstruction.  

PubMed

Flap reconstruction of the oropharyngeal region using a galeo pericranial flap was performed in 26 patients. This paper describes the anatomy, technique and discusses the outcome of the surgery showing that all flaps but one had good long term vascularity. Good access to all areas of the oropharynx was possible, the flap length was up to 20 cm and width up to 15 cm. Complications were minimal but included a tendency to form intra oral fibrous bands, patchy alopecia of the composite using outer plate of calvarium. The galeo pericranial flap is a valuable technique and can be used successfully in suitable cases. PMID:8645683

Ilankovan, V; Adcock, S D

1996-02-01

38

Flag flap - Kite flap Dorsal metacarpal flap  

Microsoft Academic Search

The flag flap is a pedicled dorsal digital flap, combining a skin paddle (the “flag”) and a vascular pedicle (the flag “pole”).\\u000a Its vascularisation depends on the dorsal metacarpal arteries (DMCA). It has been described in 1963, by Holevitch [1] with\\u000a harvest of a cutaneovascular pole; it has been brilliantly modified in 1979 by Foucher et al. [2–4] under the

J.-P. Deleuze; A. Carlier; P. Massagé; C. Lambermont

2007-01-01

39

[Eponychial flap].  

PubMed

The author describes an original and new method to lengthen the fingernail plate in distal digital amputation. After digital amputation, the loss of substance concerns the pulp tissue and fingernail apparatus. Generally, most palmar falp techniques can restore functional and aesthetic pulp. The fingernail defect is obviously not tolerated by the patient and needs to be corrected. The eponychial flap is a backward cutaneous translation flap. This flap lengthens the nail plate and restores normal dimensions of the nail apparatus. Two clinical cases are reported. This technique should be reserved for reconstruction of stage I and II distal digital amputations. PMID:9768069

Bakhach, J

1998-06-01

40

Secret scar free gracilis flap.  

PubMed

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

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

2012-06-01

41

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

Microsoft Academic Search

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

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

1997-01-01

42

The anatomic basis of perforator flaps.  

PubMed

The recent enthusiasm for perforator flaps underlines the need for a detailed understanding of the cutaneous vasculature. The principle determinant of success in perforator flap surgery is the inclusion of an adequately sized cutaneous perforator in the flap. Therefore, the size, distribution, and variability of cutaneous perforators of the human body are crucial to the design and execution of successful perforator flap surgery. Based on numerous anatomic studies, the authors have found that the main source arteries supplying the skin are fairly constant but the individual cutaneous perforators are quite variable. Knowledge of the overall architecture of the vasculature and an awareness of the variability, combined with a flexible operative plan, will enable the perforator flap surgeon to take advantage of the most appropriate perforators to execute a successful operative plan. PMID:20816512

Morris, Steven F; Tang, Maolin; Almutari, Khalid; Geddes, Christopher; Yang, Daping

2010-10-01

43

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 ...

44

Microsurgical free flaps: Controversies in maxillofacial reconstruction  

PubMed Central

Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps. PMID:23662264

George, Rinku K.; Krishnamurthy, Arvind

2013-01-01

45

The fleur-de-lis upper gracilis flap for breast reconstruction: flap design and outcome.  

PubMed

We evaluated a fleur-de-lis design for the gracilis myocutaneous flap to improve flap volume for breast reconstruction. Thirty-one flaps were used in 17 consecutive patients undergoing the procedure for either thin body habitus (23 flaps) or prior abdominal surgery (8 flaps). The flap success rate was 100%. The fleur-de-lis flap provided proportionate breast reconstructions in all patients. Complications included 6 (19.3%) donor-site dehiscence and 4 (12.9%) episodes of cellulitis. Applying a negative pressure dressing to the donor site (n=26) significantly reduced the initially high dehiscence rate to 7.7% (P<0.01). There was no incidence of lower extremity edema or sensory loss. The fleur-de-lis gracilis flap can be performed with a low flap related complication rate and acceptable donor-site morbidity. Because of its standardized flap design, improved volume, and favorable breast shaping, it may allow autologous breast reconstruction to be offered to a greater number of patients. PMID:22868308

McKane, Brice W; Korn, Peter T

2012-10-01

46

Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction.  

PubMed

This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata (TFL) myofascial flaps. TFL flaps were elevated and delayed for 4 weeks in both cases. In the second case, Parietex Composite mesh was positioned underneath the TFL flap and allowed to incorporate. After a delay of 4 weeks, the flaps were harvested and tunnelled subcutaneously to repair the abdominal wall defect. Both patients have stable repairs but had donor site seromas requiring drainage. Cadaver dissection was also performed to identify structures related to TFL flap harvest. We identified a variant of lateral femoral cutaneous nerve that traversed the TFL flap, necessitating meticulous dissection during surgery. In summary, we describe a new technique of incorporating mesh into the TFL prior to flap harvest for reconstruction of complex abdominal wall. PMID:22707661

Wang, Frederick; Buonocore, Samuel; Narayan, Deepak

2011-01-01

47

Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction  

PubMed Central

This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata (TFL) myofascial flaps. TFL flaps were elevated and delayed for 4 weeks in both cases. In the second case, Parietex Composite mesh was positioned underneath the TFL flap and allowed to incorporate. After a delay of 4 weeks, the flaps were harvested and tunnelled subcutaneously to repair the abdominal wall defect. Both patients have stable repairs but had donor site seromas requiring drainage. Cadaver dissection was also performed to identify structures related to TFL flap harvest. We identified a variant of lateral femoral cutaneous nerve that traversed the TFL flap, necessitating meticulous dissection during surgery. In summary, we describe a new technique of incorporating mesh into the TFL prior to flap harvest for reconstruction of complex abdominal wall. PMID:22707661

Wang, Frederick; Buonocore, Samuel; Narayan, Deepak

2011-01-01

48

Forehead flag flap  

Microsoft Academic Search

We present a modification of the Okada and Maruyama's flap for forehead reconstruction, based solely on the supratrochlear vessels. The flap is raised extra-periosteally but in the area of the pedicle the periosteum is included in the flap to protect the vessels. The flap is advanced and rotated to cover full thickness defects on the contralateral hemi-forehead, like a flag

J Benito-Ruiz; J Monner; J Fontdevila; J. M Serra-Renom

2004-01-01

49

Muscle Flaps and Their Role in Limb Salvage  

PubMed Central

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

Klebuc, Michael; Menn, Zachary

2013-01-01

50

Rescue of Primary Incomplete Microkeratome Flap with Secondary Femtosecond Laser Flap in LASIK  

PubMed Central

For laser-assisted in situ keratomileusis (LASIK) retreatments with a previous unsuccessful mechanical microkeratome-assisted surgery, some surgical protocols have been described as feasible, such as relifting of the flap or the creation of a new flap and even the change to a surface ablation procedure (photorefractive keratectomy (PRK)). This case shows the use of femtosecond technology for the creation of a secondary flap to perform LASIK in a cornea with a primary incomplete flap obtained with a mechanical microkeratome. As we were unable to characterize the interface of the first partial lamellar cut, a thick flap was planned and created using a femtosecond laser platform. As the primary cut was very thick in the nasal quadrant, a piece of loose corneal tissue appeared during flap lifting which was fitted in its position and not removed. Despite this condition and considering the regularity of the new femtosecond laser cut, the treatment was uneventful. This case report shows the relevance of a detailed corneal analysis with an advanced imaging technique before performing a secondary flap in a cornea with a primary incomplete flap. The femtosecond laser technology seems to be an excellent tool to manage such cases successfully. PMID:25506449

Razgulyaeva, E. A.

2014-01-01

51

Lower Extremity Reconstruction Using Vastus Lateralis Myocutaneous Flap versus Anterolateral Thigh Fasciocutaneous Flap  

PubMed Central

Background The anterolateral thigh (ALT) perforator flap has become a popular option for treating soft tissue defects of lower extremity reconstruction and can be combined with a segment of the vastus lateralis muscle. We present a comparison of the use of the ALT fasciocutaneous (ALT-FC) and myocutaneous flaps. Methods We retrospectively reviewed patients in whom free-tissue transfer was performed between 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twenty-four patients were divided into two groups: reconstruction using an ALT-FC flap (12 cases) and reconstruction using a vastus lateralis myocutaneous (VL-MC) flap (12 cases). Postoperative complications, functional results, cosmetic results, and donor-site morbidities were studied. Results Complete flap survival was 100% in both groups. A flap complication was noted in one case (marginal dehiscence) of the ALT-FC group, and no complications were noted in the VL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site, and debulking surgeries were needed for two cases. There were no significant differences in the mean scores for either functional or cosmetic outcomes in either group. Conclusions The VL-MC flap is able to fill occasional dead space and has comparable survival rates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevated without myocutaneous perforator injury. PMID:22872841

Lee, Min Jae; Yun, In Sik; Rah, Dong Kyun

2012-01-01

52

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

PubMed Central

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

Gunnarsson, Gudjon Leifur

2014-01-01

53

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

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

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

2014-01-01

54

[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

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

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

2013-01-01

55

Robot-Assisted Free Flap in Head and Neck Reconstruction  

PubMed Central

Background Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction. Methods We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated. Results Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur. Conclusions This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method. PMID:23898431

Song, Han Gyeol; Yun, In Sik; Lee, Won Jai; Rah, Dong Kyun

2013-01-01

56

Traumatic flap dislocation 10 years after LASIK. Case report and literature review.  

PubMed

We report a case of traumatic partial flap dislocation 10 years after uneventful laser in situ keratomileusis (LASIK). The patient was treated bilaterally for hyperopia and astigmatism with LASIK. A superior-hinged corneal flap was created using the Moria M2 microkeratome (Moria SA, Antony, France) and the surgery was uneventful. Ten years later, partial flap dislocation was diagnosed after mild trauma. This case suggests that flap dislocations can occur during recreational activities up to 10 years after surgery. Full visual recovery is achievable if the case is managed promptly. Further studies should evaluate the potential protective role of an inferior hinge during LASIK. PMID:23219507

Khoueir, Z; Haddad, N M; Saad, A; Chelala, E; Warrak, E

2013-01-01

57

Multi-staged flap reconstruction for complex radiation thoracic ulcer  

PubMed Central

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

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

2014-01-01

58

Hardware Removal after Osseous Free Flap Reconstruction  

PubMed Central

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

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

2015-01-01

59

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

PubMed Central

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

2014-01-01

60

Flow Over Swept Flaps and Flap Tips  

NASA Technical Reports Server (NTRS)

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.

Bradshaw, Peter; Buice, Carl U.

1995-01-01

61

Second free radial forearm flap for urethral reconstruction after partial flap necrosis of tube-in-tube phalloplasty with radial forearm flap: a report of two cases.  

PubMed

We present a salvage procedure to reconstruct the neo-urethra after partial flap necrosis occurring in free radial forearm flap (RFF) phalloplasty for sex reassignment surgery. Two cases of tube-in-tube phalloplasty using a free sensate RFF are described in which partial flap necrosis occurred involving the complete length of the neo-urethra and a strip of the outer lining of the neo-phallus. Neo-urethra-reconstruction was performed with a second RFF from the contralateral side providing well-vascularized tissue. No flap-related complications were observed. Twelve months postoperatively, both patients were able to void while standing. A satisfactory aesthetic appearance of the neo-phallus could be preserved with an excellent tactile and erogenous sensitivity. Using this technique, we successfully salvaged the neo-urethra and reconstructed the outer lining of the neo-phallus PMID:24038531

Tchang, Laurent A H; Largo, René D; Babst, Doris; Wettstein, Reto; Haug, Martin D; Kalbermatten, Daniel F; Schaefer, Dirk J

2014-01-01

62

[Vestibularly displaced flap with bone augmentation].  

PubMed

The aim of this study is to achieve esthetic gingival contours with the help of less traumatic mucogingival surgeries. 9 Patients were operated with horizontal deficiencies in 9 edentulous sites, planned to be restored with fixed partial dentures. In all cases there was lack of keratinized tissues. Temporary bridges were fabricated to all patients. Before surgery the bridges were removed and the abutment teeth were additionally cleaned with ultrasonic device. A horizontal incision was made from lingual (palatal) side between the abutment teeth, which was connected with two vertical releasing incisions to the mucogingival junction from the vestibular side. The horizontal incision was made on a distance 6-10 mm from the crest of the alveolar ridge. A partial thickness flap in the beginning 3-5 mm, then a full thickness flap up to the mucogingival junction, then a partial thickness flap was made. The flap was mobilized and displaced vestibularly. In the apical part the cortical bone was perforated, graft material was put and the flap was sutured. In all 9 cases the horizontal defect was partially or fully eliminated. The width of the keratinized tissues was also augmented in all cases. The postoperative healing was without complications, discomfort and painless. The donor sites also healed without complications. The application of Solcoseryl Dental Adhesive Paste 3 times a day for 7-10 days helped for painless healing of the donor site. The offered method of soft tissue and bone augmentation is effective in the treatment of horizontal defects of edentulous alveolar ridges of not big sizes. It makes possible to achieve esthetic results without traumatizing an additional donor-site. PMID:19644187

Bakalian, V L

2009-01-01

63

Flap reconstruction following gynaecological tumour resection for advanced and recurrent disease--a 12 year experience.  

PubMed

We have reviewed all the cases of flap reconstruction following resection of a gynaecological malignancy at the Royal Marsden Hospital over 12 years from 1993 until 2005. Forty-six patients were identified who required 53 flaps. The predominant site of the primary tumour was vulva, accounting for 83% of the cases, with cervix, ovary, vagina and endometrium making up the remainder. Squamous cell carcinoma was the most common histological type, accounting for 71% of cases, with adenocarcinoma, Paget disease, leiomyosarcoma, melanoma and basosquamous carcinoma making up the remainder. Most patients (73%) had recurrent disease at the time of reconstruction and most patients (80%) had been treated with radiotherapy either before and/or after surgery. Local flaps accounted for 49% of the reconstructions performed, with 16 rhomboid flaps, five lotus petal flaps and five advancement flaps. Of the pedicled myocutaneous flaps, there were 21 rectus abdominis flaps, four gracilis flaps and one tensor fascia lata flap. There was one free flap. The complication rate was 53%, with wound breakdown predominating. The 5 year survival was 14%, with 67% of patients surviving 1 year. This group of patients often have advanced disease and a limited life span. The complications associated with performing a major reconstructive procedure need to be balanced against the potential wound problems associated with leaving these advanced tumours untreated surgically. PMID:18784004

Staiano, Jonathan J; Wong, Lisa; Butler, John; Searle, Adam E; Barton, Desmond P J; Harris, Paul A

2009-03-01

64

Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap - a randomised prospective trial  

PubMed Central

Background Oral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap. Methods This study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed. Results Average increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with ‘P’ value?>?0.05. Conclusion Based on this study radial forearm free flap is a superior method compared to transposition of nasolabial flap to cover the surgical wound of oral submucous fibrosis. PMID:23915701

2013-01-01

65

The longitudinal gracilis myocutaneous flap: broadening options in breast reconstruction.  

PubMed

Many patients who present for autogenous breast reconstruction are not suitable candidates for abdominal wall flaps, either because of previous abdominal surgery (most commonly transverse rectus abdominis myocutaneous flap for prior breast reconstruction) or because of the lack of enough adipose tissue. Another donor site option is the medial thigh that has more recently been recognized as a source of tissue for breast reconstruction. Prior reports have described the harvest of a gracilis myocutaneous flap through a transverse incision. From August 2004 to April 2007, 12 patients underwent autogenous breast reconstruction of 15 breasts with the longitudinal gracilis myocutaneous microvascular flap. The patients' ages ranged from 41 to 60 years (average, 48 years). In all patients the longitudinal gracilis flap was chosen because of a desire for autogenous reconstruction and a lack of available abdominal wall tissue. Mean follow-up of the 12 patients was 16.8 months (range, 5-36 months). There was no microvascular thrombosis or free-flap failure in this series. Donor sites were well tolerated by all patients. Three patients underwent suction-assisted lipectomy of 5 donor site areas to improve contour and/or symmetry. The longitudinal gracilis myocutaneous flap is a useful alternative for breast reconstruction in properly selected patients. PMID:18948778

Kind, Gabriel M; Foster, Robert D

2008-11-01

66

Blown flap noise  

E-print Network

This report is concerned with the noise generated by blown flaps of the type currently being developed for the short take off and landing aircraft. The majority of the report is an experimental study of the sound-radiation ...

Haas Martin

1972-01-01

67

[Hypogastric abdominal wall reconstruction with a pedicled anterolateral thigh flap].  

PubMed

Looking at a full-thickness abdominal wall defect, it is necessary to use reconstructive surgery techniques. The authors present an original case of reconstruction of the abdominal wall, using an anterolateral thigh flap (ALT) harvested with vascularised fascia lata. We describe the advantages of this technique, which has rarely been used for this indication. An 80-year-old woman presenting a full-thickness abdominal wall defect of 15×18cm was reconstructed by a pedicled ALT flap. Skin wound healing was obtained within 15 days, with no complication. There was no donor site sequela. The pedicled ALT flap appears to be a good solution for hypogastric abdominal wall defect in a one step procedure. Vacularised fascia lata bring with the cutaneous flap is useful to reconstruct the abdominal fascia. PMID:23182334

Moullot, P; Philandrianos, C; Gonnelli, D; Casanova, D

2014-10-01

68

Tongue reconstruction with the gracilis myocutaneous free flap.  

PubMed

We describe our experience in tongue reconstruction using the transverse gracilis myocutaneous (TMG) free flap after major demolitive surgery for advanced cancer. This technique was used in 10 patients: seven underwent total glossectomy and three partial glossectomy. In eight patients we performed motor reinnervation attempting to maintain muscular trophism and gain long-term volumetric stability. The follow-up period ranged from 6 to 28 months. The overall flap survival was 100%. Nine out of 10 patients resumed oral intake. Our preliminary experience shows that this flap is a good reconstructive option for total glossectomy patients, whereas it is less suited for reconstruction of hemiglossectomy defects. Functional and objective evaluation of the tongue reconstructed with TMG free flap requires further and standardized evaluation. PMID:21503974

Calabrese, Luca; Saito, Akira; Navach, Valeria; Bruschini, Roberto; Saito, Noriko; Zurlo, Valeria; Ostuni, Angelo; Garusi, Cristina

2011-07-01

69

Control of Flap Vortices  

NASA Technical Reports Server (NTRS)

A wind tunnel investigation was carried out on a semi-span wing model to assess the feasibility of controlling vortices emanating from outboard flaps and tip-flaps by actively varying the degree of boundary layer separation. Separation was varied by means of perturbations produced from segmented zero-efflux oscillatory blowing slots, while estimates of span loadings and vortex sheet strengths were obtained by integrating wing surface pressures. These estimates were used as input to inviscid rollup relations as a means of predicting changes to the vortex characteristics resulting from the perturbations. Surveys of flow in the wake of the outboard and tip-flaps were made using a seven-hole probe, from which the vortex characteristics were directly deduced. Varying the degree of separation had a marked effect on vortex location, strength, tangential velocity, axial velocity and size for both outboard and tip-flaps. Qualitative changes in vortex characteristics were well predicted by the inviscid rollup relations, while the failure to account for viscosity was presumed to be the main reason for observed discrepancies. Introducing perturbations near the outboard flap-edges or on the tip-flap exerted significant control over vortices while producing negligible lift excursions.

Greenblatt, David

2005-01-01

70

Latissimus Dorsi Flap Invasion by Ductal Breast Carcinoma after Lipofilling  

PubMed Central

Summary: Autologous fat grafting is commonly performed in reconstructive breast surgery but also increasingly in breast augmentation surgery. On the international level, we are witnessing an important increased confidence for this procedure. Nevertheless, it continues to raise questions on the risks of cancer. A 66-year-old patient benefited from a lipofilling to improve a latissimus dorsi flap breast reconstruction, 7 years after initial cancer management. Two years later, constant pain in the flap leads to reoperation. The flap showed a major retraction with histologically massive infiltration of the muscle by an undifferentiated carcinoma of breast origin. The tumor cells were displayed directly in contact with lipofilling inside the muscle. Without establishing any causal link between these 2 events, this case raises the question once more of the risks of breast cancer and encourages us to continue being careful. PMID:25289263

Alharbi, Muhannad; Garrido, Ignacio; Vaysse, Charlotte; Chavoin, Jean Pierre; Grolleau, Jean Louis

2013-01-01

71

Blowing Flap Experiment: PIV Measurements  

NASA Technical Reports Server (NTRS)

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.

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

2004-01-01

72

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

PubMed

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

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

2014-08-01

73

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

PubMed

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

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

2012-08-01

74

Externally blown flap impingement noise  

NASA Technical Reports Server (NTRS)

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.

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

1972-01-01

75

The subaxillary pedicled flap.  

PubMed

The subaxillary fasciocutaneous flap is a new pedicled flap designed and developed by us for resurfacing defects on the dorsum of the hand, thumb, fingers and web-spaces. The lack of mobility and inability of the patient to dress properly during transfer of a groin or hypogastric flap prompted us to develop this flap which is based on the direct cutaneous branch of the subscapular-thoracodorsal arterial axis to the lateral thoracic region. It consists of skin, subcutaneous tissue and the underlying fascia. It is located in the region of the lower half of the lateral chest wall extending from 5th to 10th rib to the mid-axillary line and can be raised without any delay. The donor defect can be closed primarily or skin grafted if necessary and can be very easily taken care of during hospitalisation. It can be nicely concealed later on in life. The subaxillary fasciocutaneous flap has been tried by us in 10 cases and the results are presented in this paper. PMID:3349221

Chandra, R; Kumar, P; Abdi, S H

1988-03-01

76

Externally blown flap impingement noise.  

NASA Technical Reports Server (NTRS)

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.

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

1972-01-01

77

Noise Reduction of Aircraft Flap  

NASA Technical Reports Server (NTRS)

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.

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

2009-01-01

78

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

PubMed Central

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

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

2014-01-01

79

Radiated noise from an externally blown flap  

Microsoft Academic Search

The far field noise from subsonic jet impingement on a wing-flap with a 45 deg bend was experimentally investigated. The test parameters are jet Mach number and flap length. For long flaps, the primary source mechanisms are found to be turbulent mixing and flow impingement. For short flaps, the interaction of turbulent flow with the flap trailing edge appears to

N. N. Reddy; J. C. Yu

1975-01-01

80

Uncommon Flaps for Chest Wall Reconstruction  

PubMed Central

The omentum, external oblique musculocutaneous, and thoracoepigastric flaps are uncommonly used for chest wall reconstruction. Nevertheless, awareness and knowledge of these flaps is essential for reconstructive surgeons because they fill specific niche indications or serve as lifeboats when workhorse flaps are unavailable. The current report describes the anatomic basis, technical aspects of flap elevation, and indications for these unusual flaps. PMID:22294943

Matros, Evan; Disa, Joseph J.

2011-01-01

81

Innervated thenar pedicle flap with the palmar cutaneous branch of the median nerve for treating a thumb pulp defect: a case report.  

PubMed

A 51-year-old male plumber with a thumb pulp defect was treated with a reversed innervated thenar pedicle flap. The flap was based on the radial digital artery originating from the princeps pollicis artery with the palmar cutaneous branch of the median nerve. The flap survived and achieved good innervation with a moving 2-point discrimination of 6 mm at 12 months after surgery. This flap is indicated for patients who hesitate to have tissue taken from the foot. We believe that this flap is a feasible option for reconstructing thumb pulp defects. PMID:24399693

Kanaya, Kohei; Wada, Takuro; Iba, Kosuke; Yamashita, Toshihiko

2014-06-01

82

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

PubMed

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

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

2014-07-01

83

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

PubMed Central

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

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

2012-01-01

84

[Reconstruction of an abdominal wall defect with a superior epigastric perforator propeller flap: case report].  

PubMed

Perforators flaps take a special place in reconstructive surgery. These flaps can be dissected and turned as a propeller blade on its pedicule axis. We report the case of a 54-year-old man presenting a recurrence of a dermatofibrosarcoma in the right hypochondrium. Tumor resection caused a large abdominal wall defect taking the anterior aponeurosis of the rectus abdominis. An angioscanner was realized in preoperative to locate the perforators of the deep superior epigastric artery. We realized a propeller flap based on a perforator of the left superior epigastric artery who allowed to cover the wall defect. We set up a patch of Vicryl® to reconstruct the aponeurosis plan at the same operative time. We didn't note any necrosis and complete healing occurred in 2 weeks. The margins were healthy. The cosmetic result and the low morbidity make this flap a good therapeutic option. This flap seems reliable, arteries perforators are constant with good diameter. PMID:24908629

Lepivert, J-C; Alet, J-M; Michot, A; Pélissier, P; Pinsolle, V

2014-10-01

85

The Efficiacy of Sternocleidomastoid Muscle Flap on Frey's Syndrome via a Novel Test: Galvanic Skin Response.  

PubMed

The aim of this study was to evaluate the effects of sternocleidomastoid (SCM) muscle flap on preventing Frey's syndrome by using, Galvanic skin responses (GSR). Fourty-three patients who underwent superficial parotidectomy were randomly divided into two groups and their GSR were recorded. SCM muscle flap was applied over the surgical area only in one group. Six months after the surgery, GSRs were remeasured. In addition, the patients completed a questionnaire regarding their complaints about clinical Frey's syndrome. Four patients had symptoms of clinical Frey's syndrome. Postoperative GSR measurements revealed no significant difference between two sides in flap group (p = 0.426) but higher in without flap group (p = 0.003). The patients with clinical Frey syndrome had significantly higher GSR values than the remaining patients. The SCM muscle flap was an effective method in preventing Frey's syndrome. Moreover, GSR test was highly sensitive and specific for diagnosis. PMID:24533401

Demirci, Ugur; Basut, Oguz; Noyan, Behzat; Demir, Uygar Levent; Afsin Ozmen, O; Kasapoglu, Fikret; Hakan Coskun, H; Onart, Selcuk

2014-01-01

86

[Thin perforator flaps elevated in the plane of the superficial fascia: Principle and surgical procedure.  

PubMed

Perforator flaps have an ever growing place in reconstructive surgery and classical surgical procedures describe sub or supra-fascial plane elevation. In some indications, defatting of perforator flaps may be necessary and different methods have been described, primary or secondary, but may expose to partial loss of the flap or to another operation. Recently, a new method of perforator flap elevation in the plane of the superficial fascia has been described. This method permits to obtain a thin and reliable flap in the same procedure without the need of debulking and while decreasing donor site morbidity. We present the principle and the surgical procedure of this new method. Advantages and drawbacks are discussed with the help of clinical cases. PMID:25201098

Qassemyar, Q; Delobaux, A

2014-09-01

87

14 CFR 23.701 - Flap interconnection.  

Code of Federal Regulations, 2010 CFR

...1 2010-01-01 2010-01-01 false Flap interconnection. 23.701 Section 23.701...Construction Control Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system...

2010-01-01

88

Improved Survival of Ischemic Cutaneous and Musculocutaneous Flaps after Vascular Endothelial Growth Factor Gene Transfer Using Adeno-Associated Virus Vectors  

PubMed Central

A major challenge in reconstructive surgery is flap ischemia, which might benefit from induction of therapeutic angiogenesis. Here we demonstrate the effect of an adeno-associated virus (AAV) vector delivering vascular endothelial growth factor (VEGF)165 in two widely recognized in vivo flap models. For the epigastric flap model, animals were injected subcutaneously with 1.5 × 1011 particles of AAV-VEGF at day 0, 7, or 14 before flap dissection. In the transverse rectus abdominis musculocutaneous flap model, AAV-VEGF was injected intramuscularly. The delivery of AAV-VEGF significantly improved flap survival in both models, reducing necrosis in all treatment groups compared to controls. The most notable results were obtained by administering the vector 14 days before flap dissection. In the transverse rectus abdominis musculocutaneous flap model, AAV-VEGF reduced the necrotic area by >50% at 1 week after surgery, with a highly significant improvement in the healing process throughout the following 2 weeks. The therapeutic effect of AAV-VEGF on flap survival was confirmed by histological evidence of neoangiogenesis in the formation of large numbers of CD31-positive capillaries and ?-smooth muscle actin-positive arteriolae, particularly evident at the border between viable and necrotic tissue. These results underscore the efficacy of VEGF-induced neovascularization for the prevention of tissue ischemia and the improvement of flap survival in reconstructive surgery. PMID:16192634

Zacchigna, Serena; Papa, Giovanni; Antonini, Andrea; Novati, Federico; Moimas, Silvia; Carrer, Alessandro; Arsic, Nikola; Zentilin, Lorena; Visintini, Valentina; Pascone, Michele; Giacca, Mauro

2005-01-01

89

Shape-based 3D vascular tree extraction for perforator flaps  

NASA Astrophysics Data System (ADS)

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.

Wen, Quan; Gao, Jean

2005-04-01

90

[Evaluation of surgical flaps used for creation of an artificial penis in female-male type transsexuals].  

PubMed

In the years 1983-1997, 252 female to male transsexuals were treated in the Department of Plastic Surgery of University Medical School in ?ód?. In 209 patients surgical penis construction was performed. The paper presents operative techniques and results of penis construction with the use of four kinds of flaps: a bipedicled abdominal tube flap, a single pedicled infraumblical flap, a pedicled myocutaneous flap with gracilis muscle and a pedicled lateral groin flap. Overall estimation of early results of penis construction with the use of the four methods applied in the Department showed that we obtained good results in 69.8% of operated transsexuals, satisfactory effects in 24.4% of patients and poor outcome in 5.8% of cases. The best results were achieved with the technique involving a lateral groin flap. PMID:11320547

Zieli?ski, T

2001-01-01

91

Comparison of corneal flap thickness using a FS200 femtosecond laser and a moria SBK microkeratome  

PubMed Central

AIM To evaluate differences in flap thickness resulting from use of an Alcon Wavelight FS200 femtosecond laser and a MORIA SBK microkeratome when making a 110-µm-thick corneal flap and to identify the potential factors that affect corneal flap thickness. METHODS A prospective case study was performed on 120 eyes of 60 patients who were divided into two groups for LASIK, each group consisting of 60 eyes (30 patients). The corneal flaps were created using an Alcon Wavelight FS200 femtosecond laser or a MORIA SBK microkeratome. The central corneal flap thickness was calculated by subtraction pachymetry. Age, central corneal thickness (CCT), spherical equivalent refraction, mean keratometry, and corneal diameter were recorded preoperatively for analysis. RESULTS Cutting of all flaps was easily performed without intraoperative complications. In the Alcon Wavelight FS200 femtosecond laser group, the mean right and left corneal flap thicknesses were 114.0±6.6 µm (range: 98-126) and 111.4±7.6 µm (range: 98-122), respectively. The difference (2.6±9.1 µm) in the corneal flap thickness between the right and left eyes was not significant (t=1.59, P=0.12). Stepwise regression analysis indicated that the resulting corneal flap thickness was unrelated to the patient's age, preoperative CCT, spherical equivalent refraction, mean keratometry, or corneal diameter. In the MORIA SBK microkeratome group, the mean right and left corneal flap thicknesses were 110.6±7.4 µm (range: 97-125 µm) and 108.2±6.1 µm (range: 78-123 µm), respectively. The difference in the corneal flap thickness between the right and left eyes (2.4±6.5µm) was not significant (t=2.039, P=0.0506). The corneal flap thickness was positively correlated with the preoperative CCT through stepwise regression analysis (r=0.297, P=0.021). The corneal flap thickness was not related to age, spherical equivalent refraction, mean keratometry, or corneal diameter. The corneal flap thickness was estimated using the following equation: Tflap=67.77+0.076 CCT (F=5.63, P=0.021). CONCLUSION Both the Alcon Wavelight FS200 femtosecond laser and the MORIA SBK microkeratome produced 110-µm-thick corneal flaps. The central corneal flap thickness was positively correlated with the preoperative CCT in MORIA SBK microkeratome surgery. PMID:24790869

Zhang, Jing; Zhang, Shi-Sheng; Yu, Qing; Wu, Jiang-Xiu; Lian, Jing-Cai

2014-01-01

92

Nose Defects Reconstruction with Forehead Flap – Case Report  

PubMed Central

ABSTRACT Objectives: Nasal reconstruction has be one of the most challenging procedures in reconstructive plastic surgery. Small nasal defects may be closed by primary suture or covered by small local flaps or skin graft. But in large nasal defects, we need to find a bigger source of color and texture matching tissue that will ensure functional and aesthetical outcomes. Material and Methods: We chose a case report of one patient admitted in our clinic in 2012, who represented a daring task for us. Best suited for paramedian forehead flap reconstruction, the patient underwent a procedure in 2 steps, which led to a very satisfying nose both for the patient and for the surgeon. Conclusions: In order to achieve a good coverage with the smallest donor site defect, we used a flap based only on the left supratrocheal artery, which gave us the possibility to rotate the flap without distorting the vessels. In such cases, the best option, aesthetically and functionally, for the patient still remains the paramedian flap, modified from the original version, and adapted to every case. PMID:25553131

CHIOARU, Bogdan; DRAGU, Elena; LASCAR, Ioan

2014-01-01

93

[Submental island flap: A review of the literature.  

PubMed

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

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

2014-09-01

94

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

PubMed Central

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

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

2014-01-01

95

Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole  

PubMed Central

We are presenting the initial results of inverted internal limiting membrane (ILM) flap technique for large macular hole. Five eyes of five patients with large diameter macular hole (>700 ?m) were selected. All patients underwent inverted ILM flap technique for macular hole. Anatomical closure and functional success were achieved in all patients. There was no loss of best-corrected visual acuity in any of the patients. Inverted ILM flap technique in macular hole surgery seems to have a better hole closure rates, especially in large diameter macular holes. Larger case series is required to assess the efficacy and safety of this technique. PMID:24212316

Mahalingam, Prabhushanker; Sambhav, Kumar

2013-01-01

96

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

PubMed

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

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

2014-08-01

97

Microdialysis: characterisation of haematomas in myocutaneous flaps by use of biochemical agents.  

PubMed

Metabolic markers are measured by microdialysis to detect postoperative ischaemia after reconstructive surgery with myocutaneous flaps. If a haematoma develops around the microdialysis catheter, it can result in misinterpretation of the measurements. The aim of the present study was to investigate whether a haematoma in a flap can be identified and dissociated from ischaemia, or a well-perfused flap, by a characteristic chemical profile. In 7 pigs, the pedicled rectus abdominal muscle flap was mobilised on both sides. A haematoma was made in each flap and two microdialysis catheters were placed, one in the haematoma, and the other in normal tissue. One flap was made ischaemic by ligation of the pedicle. For 6 hours, the metabolism was monitored by measurement every half-an-hour of the concentrations of glucose, lactate, pyruvate, and glycerol from all 4 catheters. After 3 hours of monitoring, intravenous glucose was given as a challenge test to identify ischaemia. The non-ischaemic flap could be differentiated from the ischaemic flap by low glucose, and high lactate, concentrations. It was possible to identify a catheter surrounded by a haematoma in ischaemic as well as non-ischaemic muscle from a low or decreasing concentration of glucose together with a low concentration of lactate. All four sites could be completely dissociated when the concentrations of glucose and lactate were evaluated and combined with the lactate:glucose ratio and a flow chart. The challenge test was useful for differentiating between haematomas in ischaemic and non-ischaemic tissue. PMID:22521587

Kristensen, Danja Lykke; Ladefoged, Sřren A; Sloth, Erik; Aagaard, Rasmus; Birke-Sřrensen, Hanne

2013-03-01

98

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

PubMed

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

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

99

Reduction of Flap Side Edge Noise - the Blowing Flap  

NASA Technical Reports Server (NTRS)

A technique to reduce the noise radiating from a wing-flap side edge is being developed. As an airplane wing with an extended flap is exposed to a subsonic airflow, air is blown outward through thin rectangular chord-wise slots at various locations along the side edges and side surface of the flap to weaken and push away the vortices that originate in that region of the flap and are responsible for important noise emissions. Air is blown through the slots at up to twice the local flow velocity. The blowing is done using one or multiple slots, where a slot is located along the top, bottom or side surface of the flap along the side edge, or also along the intersection of the bottom (or top) and side surfaces.

Hutcheson, Florence V.; Brooks, THomas F.

2005-01-01

100

Flap-Edge Blowing Experiments  

NASA Technical Reports Server (NTRS)

This Appendix documents the salient results from an effort to mitigate the so-called flap-edge noise generated at the split between a flap edge that is deployed and the undeployed flap. Utilizing a Coanda surface installed at the flap edge, steady blowing was used in an attempt to diminish the vortex strength resulting from the uneven lift distribution. The strength of this lifting vortex was augmented by steady blowing over the deployed flap. The test article for this study was the same 2D airfoil used in the steady blowing program reported earlier (also used in pulsed blowing tests, see Appendix G), however its trailing edge geometry was modified. An exact duplicate of the airfoil shape was made out of fiberglass with no flap, and in the clean configuration. It was attached to the existing airfoil to make an airfoil that has half of its flap deployed and half un-deployed. Figure 1 shows a schematic of the planform showing the two areas where steady blowing was introduced. The flap-edge blowing or the auxiliary blowing was in the direction normal to the freestream velocity vector. Slot heights for the blowing chambers were on the order of 0.0 14 inches.

Gaeta, R. J.; Englar, R. J.; Ahuja, K. K.

2003-01-01

101

Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases.  

PubMed

We have transferred 74 free or pedicled anterolateral thigh flaps, including those combined with other flaps, for reconstruction of various types of defects. We report several anatomic variations of the lateral circumflex arterial system and discuss some technical problems with this flap. Septocutaneous perforators were found in 28 of 74 cases (37.8 percent), and no perforators were found in 4 cases (5.4 percent). In the 70 cases with perforators, 171 tiny cutaneous perforators (an average of 2.31 per case) were found. Musculocutaneous perforators (81.9 percent) were much more common than septocutaneous perforators (18.1 percent). Perforators were concentrated near the midpoint of the lateral thigh, and the selection of perforators as nutrient vessels for the anterolateral thigh flap was related to the length of the pedicle and the thickness of the skin flap. Anatomic variations of the branching pattern of perforators were classified into eight types. Flaps with perforators that arise directly from the profunda femoris artery are difficult to combine with other free flaps. Because the perforators are extremely small and tend to thrombose soon after congestion develops, these flaps are difficult to salvage with recirculation surgery. Therefore, several perforators should be included with the flap, if possible. The descending artery of the lateral circumflex femoral artery was always accompanied by two veins with different back-flow strengths. Therefore, veins for microsurgical anastomosis must be chosen carefully. Because it is nourished by several perforators arising from the descending artery, the vastus lateralis muscle can be combined with the anterolateral thigh flap. However, splitting the muscle longitudinally without harvesting its blood supply is complicated because its fibers are oblique. The rectus femoris muscle can also be combined with the anterolateral thigh flap, but its pedicle is short and its origin is very near the site of anastomosis. When the anterolateral thigh flap is combined with the tensor fasciae latae musculocutaneous flap, the large skin area of the lateral part of thigh can be transferred to repair the massive defects. The anterolateral thigh flap has many advantages and can be used to reconstruct many types of defect. However, anatomic variations must be considered if the flap is to be used safely and reliably. PMID:9774005

Kimata, Y; Uchiyama, K; Ebihara, S; Nakatsuka, T; Harii, K

1998-10-01

102

Anthelix-conchal reconstruction with postauricular "revolving door" island flap.  

PubMed

The postauricular "revolving door" island flap is commonly used to reconstruct the conchal area after ablative surgery. This procedure may also be used to reconstruct the anthelix-conchal area after surgical removal of a squamous cell carcinoma of the external ear. The technique is simple and safe, and it can be performed as a one-stage procedure; moreover, excellent aesthetic results can be achieved. PMID:8627097

Politi, M; Robiony, M

1995-10-01

103

A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement  

Microsoft Academic Search

Background: Flapless implant surgery is considered to offer advantages over the traditional flap access approach. There may be minimized bleeding, decreased surgical times and minimal patient discomfort. Controlled studies comparing patient outcome variables to support these assumptions, however, are lacking. Aim: The objective of this clinical study was to compare patient outcome variables using flapless and flapped implant surgical techniques.

Jerome A. Lindeboom; Wijk van A. J

2010-01-01

104

Endothelin receptor blockade improves oxygenation in contralateral TRAM flap tissue in pigs.  

PubMed

Partial skin and fat necrosis is the most common complication occurring in TRAM flaps. It is related to disturbances of the microcirculation and oxygenation in the contralateral part of the flap. It may be hypothesised that the development of necrosis is promoted by the vasoconstrictor endothelin, the production of which is enhanced in ischaemic flap tissues. The purpose of this study was to evaluate the effect of tezosentan, a new endothelin receptor blocker, on microcirculation and oxygenation in experimental TRAM flaps. The administration of tezosentan began preoperatively (3 mg/kg body weight) and then continued at a rate of 1.5 mg/kg/h. A TRAM flap with a skin island measuring 16 x 8 cm was raised in the middle of the epigastrium in minipigs. The flap was pedicled on the right superior epigastric vessels. Microcirculatory blood flow was measured with laser Doppler flowmetry and tissue oxygen tension was measured with a Clark-type microprobe. Dominant subcutaneous veins were cannulated in both the ipsilateral and the contralateral parts of the flap. Subdermal tissue oxygen tension in the contralateral part of the flap was significantly reduced 4h after surgery to 5 mmHg (ca. 48 mmHg in normal tissue) in the control group, but to only 12 mmHg in the group that had been administered tezosentan (P< 0.05). Furthermore, tezosentan significantly attenuated venous hypertension (14 mmHg versus 24 mmHg), as well as lactate (4.0 mmol/l versus 5.6 mmol/l) and haemoglobin (10.2 g/dl versus 11.4 g/dl) concentrations in the venous effluent of the contralateral part of the flap, although microcirculatory blood flow remained virtually unchanged. Our findings suggest that tezosentan improves oxygenation and metabolism in the jeopardised contralateral flap tissue, probably as a result of a decrease in venous vascular resistance and fluid extravasation. PMID:11428773

Erni, D; Wessendorf, R; Wettstein, R; Schilling, M K; Banic, A

2001-07-01

105

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

PubMed

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

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

2009-10-01

106

An engineered muscle flap for reconstruction of large soft tissue defects  

PubMed Central

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

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

2014-01-01

107

Dual-dermal-barrier fashion flaps for the treatment of sacral pressure sores.  

PubMed

Abstract The sacral region is one of the most vulnerable sites for the development of pressure sores. Even when surgical reconstruction is performed, there is a high chance of recurrence. Therefore, the concept of dual-dermal-barrier fashion flaps for sacral pressure sore reconstruction was proposed. From September 2007 to June 2010, nine patients with grade IV sacral pressures were enrolled. Four patients received bilateral myocutaneous V-Y flaps, four patients received bilateral fasciocutaneous V-Y flaps, and one patient received bilateral rotation-advanced flaps for sacral pressure reconstruction. The flaps were designed based on the perforators of the superior gluteal artery in one patient's reconstructive procedure. All flaps' designs were based on dual-dermal-barrier fashion. The mean follow-up time was 16 months (range = 12-25). No recurrence was noted. Only one patient had a complication of mild dehiscence at the middle suture line, occurring 2 weeks after the reconstructive surgery. The dual-dermal fashion flaps are easily duplicated and versatile. The study has shown minimal morbidity and a reasonable outcome. PMID:25420912

Hsiao, Yen-Chang; Chuang, Shiow-Shuh

2015-02-01

108

Pedicled Latissimus Dorsi Muscle Flap  

E-print Network

wall muscles may lead to substantial functional loss ormuscle for use as a transposition flap will result in the lossloss, blood transfusion re- quirements, duration of intubation, pulmonary complications, systemic complications Pedicled Latissimus Dorsi Muscle

Abolhoda, Amir; Bui, Trung D.; Milliken, Jeffrey C.; Wirth, Garrett A.

2009-01-01

109

The ratio in choosing access flap for surgical endodontics: a review  

PubMed Central

SUMMARY In Surgical Endodontics we face complex situations that require the knowlflap and application of both principles of endodontics (cleansing shaping and filling) in the root management, and the principles of surgery (asepsis, non harmfulness and hemostasis) in the phase of access to the root. Among the factors of surgical relevance that for which have been proposed with the largest number of alternatives is the design of access flap. That clearly indicates that not only one flap design can be ideal in all clinical situations. In this article all proposed access flap designs are evaluated in the light of their degree of compliance with ideal requirements in different circumstances. A clear pattern in the decision-making criteria for the selection of access flaps is proposed. PMID:23285356

GRANDI, C.; PACIFICI, L.

2009-01-01

110

Free flap salvage with subcutaneous injection of tissue plasminogen activator in head and neck patients.  

PubMed

In this report, we present our experience with subcutaneous rt-PA injection for salvage of free radial forearm flaps with vascular compromise. Three patients underwent reconstruction of defects of the soft palate or the lateral tongue with a free radial forearm flap. Patients underwent on average two attempted operative revisions with thrombectomy and intravenous heparin injections. After recurrent venous thrombosis 3-6 days after surgery, rt-PA (Alteplase 2 mg; 1,160,000 IE) was injected subcutaneously at multiple sites into the compromised flap as final attempt. In all three patients, successful thrombolysis with no or only partial soft tissue loss was achieved after subcutaneous injection of rt-PA. We therefore suggest subcutaneous rt-PA injection as an additional tool in managing difficult and recurrent cases of venous thrombosis in free flap head and neck reconstruction. PMID:23843292

Ihler, Friedrich; Matthias, Christoph; Canis, Martin

2013-09-01

111

Full scale upper surface blown flap noise  

NASA Technical Reports Server (NTRS)

A highly noise suppressed TF 34 engine was used to investigate the noise of several powered lift configurations involving upper surface blown (USB) flaps. The configuration variables were nozzle type (i.e. slot and circular with deflector), flap chord length, and flap angle. The results of velocity surveys at both the nozzle exit and the flap trailing edge are also presented and used for correlation of the noise data. Configurations using a long flap design were 4 db quieter than a short flap typical of current trends in USB flap design. The lower noise for the long flap is attributed primarily to the greater velocity decay of the jet at the flap trailing edge. The full-scale data revealed substantially more quadrupole noise in the region near the deflected jet than observed in previous sub-scale tests.

Heidelberg, L. J.; Homyak, L.; Jones, W. L.

1975-01-01

112

Modified osteomyocutaneous iliac crest flaps transplantation.  

PubMed

Abstract 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

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

2014-07-01

113

14 CFR 23.699 - Wing flap position indicator.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 2010-01-01 false Wing flap position indicator. 23.699 Section 23...Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap position indicator for— (a) Flap...

2010-01-01

114

14 CFR 23.697 - Wing flap controls.  

Code of Federal Regulations, 2014 CFR

...2014-01-01 false Wing flap controls. 23.697 Section 23...Design and Construction Control Systems § 23.697 Wing flap controls. (a) Each wing flap...adjusted or is moved by the automatic operation of a flap...

2014-01-01

115

The Versatility of the Tongue Flap in the Closure of Palatal Fistula  

PubMed Central

Aims?Tongue flaps were introduced for intraoral reconstruction by Lexer in 1909. A retrospective study was performed in the Department of Oral and Maxillofacial Surgery, S.D.M. College of Dental Sciences (Dharwad, India), to assess the use of tongue flap in closure of palatal fistula. Material and Methods?A total of 40 patients treated for palatal fistulas were included in this study from the period of January 1, 2000, to January 1, 2007; fistulas present in anterior and midpalate were considered. Patients' preoperative photographs, clinical records, and preoperative speech analysis were recorded. Following completion of fistula closure, patients were assessed over 6 months to check flap viability, fistula closure, residual tongue function, aesthetics, and speech impediment. Results?A total of 40 (24 male and 16 female) patients with palatal fistulas were treated with tongue flap in our study. Six patients were 4 to 6 years old, three were 7 to 10 years old, and 22 were 11 to 20 years old, which accounts for 68% of study subjects. There were nine patients 21 to 30 years old. In the early postoperative period, we encountered bleeding in one patient and sloughing in one patient. There are three recurrences, and two flaps were detached; all remaining cases showed satisfactory healing, and donor site morbidity was minimal. No speech deficits were evident. Conclusion?Tongue flaps are used in cleft palate surgery because of their excellent vascularity, and the large amount of tissue that they provide has made tongue flaps particularly appropriate for the repair of large fistulas in palates scarred by previous surgery. PMID:23997859

Vasishta, Sathish M.S.; Krishnan, Gopal; Rai, Y.S.; Desai, Anil

2012-01-01

116

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

PubMed Central

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

Huang, Chenyu

2014-01-01

117

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

PubMed

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

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

2014-05-01

118

Evaluation of Flap Tissue Viability by F-18 FDG PET/CT.  

PubMed

A 60-year-old man underwent vertical rectus abdominis myocutaneous flap to reconstruct a left lateral chest wall defect. For assessment of viability of muscle flap, F-18 fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed 15 days after surgery. The FDG PET/CT showed a small metabolic defect in the left lateral chest wall. During follow-up, necrotic change of the graft was observed, and the site was in accordance with the area where the metabolic defect was observed in the FDG PET/CT. As a result, debridement and wound closure was performed. This case suggested that the FDG PET/CT should be a useful method for the monitoring of muscle viability after flap surgery. PMID:25177384

Lee, Inki; Kang, Seo Young; Heo, Chan-Yeong; Lee, Ho-Young; Kim, Sang Eun

2014-09-01

119

PIV Measurements on a Blowing Flap  

NASA Technical Reports Server (NTRS)

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.

Hutcheson, Florence V.; Stead, Daniel J.

2004-01-01

120

The extended latissimus dorsi flap option in autologous breast reconstruction: A report of 14 cases and review of the literature  

PubMed Central

Background: Autologous breast reconstruction using the extended latissimus dorsi flap has been infrequently reported. In the current study, the authors are reporting their own clinical experience with this method. A review of the literature is also discussed. Materials and Methods: Over a three year period, 14 patients underwent breast reconstruction using the extended latissimus dorsi (LD) flap. Patients with small to medium sized breasts were selected. The age of the patients ranged from 29 to 42 years with a follow-up period ranging from six to 18 months. The indications, flap-related complications and donor site morbidity and aesthetic results were evaluated. Results: The main indication to use the flap was dorsal donor site preference by patients. The remaining patients were either not suitable for a flap from the abdomen or wished to get pregnant and were offered the dorsal donor site. Neither total nor partial flap loss was recorded but donor site morbidity was mainly due to seroma, which was treated conservatively in all patients, except for one who required surgery. Another two patients suffered from wound breakdown and distal necrosis of the back flaps. Mild contour deformity was also noted on the back of all patients but caused no major concern. Indeed, the overall patient satisfaction was very high. Conclusion: The extended LD flap proved to be a good option for autologous breast reconstruction in selected patients. Patients should be warned of the potential for seroma and mild contour back deformity. PMID:19753197

Rifaat, Mohammed A.; Amin, Ayman A.; Bassiouny, Mahmoud; Nabawi, Ayman; Monib, Sherif

2008-01-01

121

Design and evaluation of LIPCA-actuated flapping device  

NASA Astrophysics Data System (ADS)

In this paper, we present our recent progress in LIPCA (Lightweight Piezo-Composite Actuator) application for actuation of flapping wing device. The flapping device uses linkage system that can amplify the actuation displacement of LIPCA. The feathering mechanism is also designed and implemented such that the wing can rotate during flapping. The natural flapping-frequency of the device was 9 Hz, where the maximum flapping angle was reached. The flapping test under 4 Hz to 15 Hz flapping frequency was performed to investigate the flapping performance by measuring the produced lift and thrust. Maximum lift and thrust produced when the flapping device was actuated near the natural flapping-frequency.

Syaifuddin, Moh.; Park, Hoon C.; Yoon, Kwang J.; Goo, Nam S.

2005-05-01

122

Considering Surgery?  

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... to happen before, during, and after surgery. Outpatient Surgery Outpatient surgery, sometimes called same-day surgery, is ... outpatient surgery is right for you. Planning for Surgery There are many steps you can take to ...

123

Development of insect thorax based flapping mechanism  

Microsoft Academic Search

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

Zaeem Khan; Kyle Steelman; Sunil Agrawal

2009-01-01

124

Efficient flapping flight of pterosaurs  

NASA Astrophysics Data System (ADS)

In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains and propels an animal in the air. Because pterosaurs were so large with wingspans up to eleven meters, if they could have sustained flapping flight, they would have had to achieve high propulsive efficiencies. Identifying the wing motions that contribute the most to propulsive efficiency is key to understanding pterosaur flight, and therefore to shedding light on flapping flight in general and the design of efficient ornithopters. This study is based on published results for a very well-preserved specimen of Coloborhynchus robustus, for which the joints are well-known and thoroughly described in the literature. Simplifying assumptions are made to estimate the characteristics that can not be inferred directly from the fossil remains. For a given animal, maximizing efficiency is equivalent to minimizing power at a given thrust and speed. We therefore aim at finding the flapping gait, that is the joint motions, that minimize the required flapping power. The power is computed from the aerodynamic forces created during a given wing motion. We develop an unsteady three-dimensional code based on the vortex-lattice method, which correlates well with published results for unsteady motions of rectangular wings. In the aerodynamic model, the rigid pterosaur wing is defined by the position of the bones. In the aeroelastic model, we add the flexibility of the bones and of the wing membrane. The nonlinear structural behavior of the membrane is reduced to a linear modal decomposition, assuming small deflections about the reference wing geometry. The reference wing geometry is computed for the membrane subject to glide loads and pretension from the wing joint positions. The flapping gait is optimized in a two-stage procedure. First the design space is explored using a binary genetic algorithm. The best design points are then used as starting points in a sequential quadratic programming optimization algorithm. This algorithm is used to refine the solutions by precisely satisfying the constraints. The refined solutions are found in generally less than twenty major iterations and constraints are violated generally by less than 0.1%. We find that the optimal motions are in agreement with previous results for simple wing motions. By adding joint motions, the required flapping power is reduced by 7% to 17%. Because of the large uncertainties for some estimates, we investigate the sensitivity of the optimized flapping gait. We find that the optimal motions are sensitive mainly to flight speed, body accelerations, and to the material properties of the wing membrane. The optimal flight speed found correlates well with other studies of pterosaur flapping flight, and is 31% to 37% faster than previous estimates based on glide performance. Accounting for the body accelerations yields an increase of 10% to 16% in required flapping power. When including the aeroelastic effects, the optimal flapping gait is only slightly modified to accommodate for the deflections of stiff membranes. For a flexible membrane, the motion is significantly modified and the power increased by up to 57%. Finally, the flapping gait and required power compare well with published results for similar wing motions. Some published estimates of required power assumed a propulsive efficiency of 100%, whereas the propulsive efficiency computed for Coloborhynchus robustus ranges between 54% and 87%.

Strang, Karl Axel

125

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

PubMed

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

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

2014-09-01

126

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

PubMed Central

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

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

2014-01-01

127

Advanced carcinoma of the hypopharynx: functional results after circumferential pharyngolaryngectomy with flap reconstruction.  

PubMed

Surgical treatment of advanced cancers of the hypopharynx inevitably impairs swallowing, respiration and phonation. The purpose of this study was to analyze the functional results after circumferential pharyngolaryngectomy (CPL) and flap reconstruction, in order to offer decisional guidelines for the choice of the most effective reconstructive method. We performed a retrospective analysis on the medical records of patients submitted to reconstructive surgery after CPL from July 1991 to November 2011. 75% of the 94 patients underwent reconstruction with a free flap (group A), while 25% underwent reconstruction with a pedicled flap (group B); 80% of patients in group A and none in group B were discharged with a free diet; 14% of patients in group A and 26% in group B were unable to resume oral feeding and were discharged with NG-tube or PEG. None of the patients acquired a satisfactory oesophageal voice; 17% of patients in group A and 7% in group B underwent voice restoration with tracheo-oesophageal voice-prosthesis. In conclusion, free flaps should be considered the first choice for reconstruction of the hypopharynx after CPL because of the better functional results obtained. Pedicled flaps represent a valid alternative in patients with contraindications to microvascular surgery. PMID:22767979

Mura, F; Bertino, G; Occhini, A; Mevio, N; Scelsi, D; Benazzo, M

2012-06-01

128

Tunneled modified lotus petal flap for surgical reconstruction of severe introital stenosis after radical vulvectomy  

PubMed Central

INTRODUCTION We presented the anatomical, functional and aesthetic results achieved with lotus petal flap in case of introital stenosis as a results of inadequate primary plastic reconstruction. We discussed the potential advantages of lotus petal flap compared to others vulvar reconstructive techniques. PRESENTATION OF CASE We report a case of a 44-years old woman presenting a severe introital stenosis following radical surgery for vulvar cancer. She could not have a normal sexual activity life because the narrow scarred introitus resulting after primary closure of a large vulvar defect. The patient comes to our attention after three years from primary surgery. Once the scar was removed we performed a vulvoperineal reconstruction with bilateral tunneled lotus petal flaps. DISCUSSION Lotus petal flap is a safe, easy and quick technique, has a good functional and cosmetic results in this young woman, and represents an optimal alternative solution for plastic reconstruction in case of severe introital stenosis after primary closure of large vulvoperineal defect. CONCLUSION Tunneled lotus petal flaps represents a feasible, attractive and versatile surgical reconstructive technique that can be easily performed after surgical treatment of vulvoperineal neoplasms. PMID:22534648

Buda, Alessandro; Confalonieri, Pier Luigi; Rovati, Luca Carlo Vittorio; Signorelli, Mauro; Del Bene, Massimo

2012-01-01

129

Changes in the subgingival biofilm composition after coronally positioned flap  

PubMed Central

Objectives This study evaluated the effects of coronally positioned flap (CPF) on the subgingival biofilm composition. Material and Methods Twenty-two subjects with gingival recessions were treated with CPF. Clinical parameters were assessed before and at 6 months after surgery. Subgingival biofilms were analyzed by checkerboard DNADNA hybridization technique for 40 bacterial species. Results Recession height, clinical attachment level and bleeding on probing improved significantly (p<0.05) at 6 months post- CPF. The proportions of 10 periodontal pathogens and the proportions of red and orange complexes decreased at 6 months. Conclusion In conclusion, CPF can induce beneficial effects on the composition of the subgingival microbiota after 6 months. PMID:21437473

LIMA, Jadson Almeida; SANTOS, Vanessa Renata; FERES, Magda; de FIGUEIREDO, Luciene Cristina; DUARTE, Poliana Mendes

2011-01-01

130

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

PubMed Central

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

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

2014-01-01

131

A Bilateral Pediculated Palatal Periosteal Connective Tissue Flap for Coverage of Large Bone Grafts in the Anterior Maxillary Region  

PubMed Central

Introduction: Coverage of bone grafts is very important in reconstructive surgery. In edentulous alveolar ridges this coverage is particularly important for supporting dental prostheses. Here we present the case of a patient with a large deficient maxillary anterior region that was reconstructed with a bilateral palatal submucosal periosteal connective tissue flap: a soft tissue reserve for upper jaw reconstructive surgeries. The bilateral pediculated palatal periosteal connective tissue flap was used for coverage of a large bone graft in the anterior maxillary region. Conclusion: Palatal submucosa can be used as a soft tissue reserve in upper jaw reconstructions. PMID:24303400

Rahpeyma, Amin; khajeh Ahmadi, Saeedeh; Reza Hosseini, Vahid; Azimi, Hamidreza

2012-01-01

132

Coupled states of flapping flags  

Microsoft Academic Search

Experiments concerning the oscillatory motion of thin flexible filaments lying in flowing soap films have shown particularly interesting phenomena. For example, when two such ``flapping'' filaments were introduced to the flowing soap film the filaments oscillated in-phase (asymmetry) or in anti-phase (symmetry) depending only on their mutual separation. We have been able to numerically simulate these experiments and provide some

D. J. J. Farnell; T. David; D. C. Barton

2004-01-01

133

Coupled states of flapping flags  

Microsoft Academic Search

Experiments concerning the oscillatory motion of thin flexible filaments lying in flowing soap films have shown particularly interesting phenomena. For example, when two such “flapping” filaments were introduced to the flowing soap film the filaments oscillated in-phase (asymmetry) or in anti-phase (symmetry) depending only on their mutual separation. We have been able to numerically simulate these experiments and provide some

D. J. J. Farnell; T. David; D. C. Barton

2004-01-01

134

Efficient flapping flight of pterosaurs  

Microsoft Academic Search

In the late eighteenth century, humans discovered the first pterosaur fossil remains and have been fascinated by their existence ever since. Pterosaurs exploited their membrane wings in a sophisticated manner for flight control and propulsion, and were likely the most efficient and effective flyers ever to inhabit our planet. The flapping gait is a complex combination of motions that sustains

Karl Axel Strang

2009-01-01

135

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

PubMed

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

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

2013-01-14

136

Recurrent cervical esophageal stenosis after colon conduit failure: Use of myocutaneous flap  

PubMed Central

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

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

2013-01-01

137

Femoral nerve palsy after mandibular reconstruction with microvascular iliac flap: a complication under anticoagulation therapy.  

PubMed

Pharmacological prophylaxis and intervention are used extensively in head and neck reconstructions with microvascular flaps. There is no universally accepted protocol, but the microvascular surgery literature recommends intraoperative anticoagulation with heparin. Here is reported a case of iliacus haematoma with subsequent femoral nerve palsy after the harvest of a microvascular iliac flap for mandibular reconstruction in a patient who had been treated with heparin. The association between femoral nerve palsy and anticoagulant therapy has been well described. It remains unclear as to why the iliacus muscle is particularly vulnerable to intramuscular haemorrhage. Femoral nerve neuropathy is also an uncommon but recognized complication after abdominopelvic surgery. Iliacus haematoma secondary to microvascular surgery has not been previously reported. This case illustrates the need to be aware of this type of complication and its clinical manifestations for patients under anticoagulant therapy in the perioperative period during microvascular reconstructions. PMID:17079115

Toro, C; Millesi, W; Zerman, N; Robiony, M; Politi, M

2007-03-01

138

The lateral scalp flap for anterior hairline reconstruction.  

PubMed

The lateral scalp flap is a valuable addition to the armamentarium of the trained surgeon who manages the problem of male pattern baldness. With careful patient selection and frank counselling, the quality of reconstruction of the anterior hairline can be enhanced for some patients. The transfer of a large number of hair follicles in their normal pattern of density is an obvious advantage over free graft techniques. The disadvantages of a posterior direction of hair growth in the transposed flap, although readily overcome by careful grooming in most patients, may provide a stimulation for microvascular free flap acceptance in the future. At the present time, the magnitude of the latter procedure and the associated expense preclude consideration of this approach for the usual patient, and it is beyond the capability of many surgeons. Only with accurate reporting of complications and long-term results can one ultimately determine the rightful place of this technique. It is our continuing responsibility to inform patients of the changing options and guide them to a proper treatment based on their individual desire and need. The future generation of physicians and surgeons will undoubtedly dwarf our best effort with their accomplishments. I hope and trust that some day patients with male pattern baldness will no longer require surgery for relief. The ideal hope of the future is discovery of a safe method for prevention or medical treatment. PMID:7128016

Elliott, R A

1982-04-01

139

Endoscopic ICG perfusion imaging for flap transplants: technical development  

NASA Astrophysics Data System (ADS)

Objective: Following tumour surgery in the head and neck region, skin flap transplants are usually required to cover the resection area. The purpose of the development was to provide a simple and reliable means to assess whether the transplanted flap is sufficiently perfused. Methods: Fluorescence of intravenously injected Indocyanine green (ICG) was detected with a slightly modified 3-chip CCD camera. Appropriately coated optical filters allow for excitation of ICG with NIR light and detection of NIR ICGfluorescence with the blue channel of the camera. In addition, low intensities of white light can be transmitted to allow for simultaneous display of a remission image in the green and red channels of the camera. Further processing was performed with a LabVIEW program. Results: A satisfactory white light image (red, green and blue display (RGB)) could be calculated from the remission images recorded with the green and red channels of the camera via a look-up table. The look-up table was programmed to provide an optimized blue intensity value for each combination of red and green values. This was generated using a reference image. Implementation of image tracking and intensity measurements in regions of interest (ROIs) in the images is useful to reliably monitor perfusion kinetics of flap and adjacent normal tissue.

Stepp, Herbert; Schachenmayr, Hilmar; Ehrhardt, André; Göbel, Werner; Zhorzel, Sven; Betz, Christian Stephan

2010-02-01

140

Vascularisation of Urethral Repairs with the Gracilis Muscle Flap  

PubMed Central

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

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

2013-01-01

141

Biologic Collagen Cylinder with Skate Flap Technique for Nipple Reconstruction  

PubMed Central

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

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

2014-01-01

142

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

PubMed

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

Simman, Richard; Craft, Chris; McKinney, Bart

2005-05-01

143

Cosmetic Surgery  

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... Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

144

Predicting the need for muscle flap salvage after open groin vascular procedures: A clinical assessment tool.  

PubMed

Abstract Groin wound complications after open vascular surgery procedures are common, morbid, and costly. The purpose of this study was to generate a simple, validated, clinically usable risk assessment tool for predicting groin wound morbidity after infra-inguinal vascular surgery. A retrospective review of consecutive patients undergoing groin cutdowns for femoral access between 2005-2011 was performed. Patients necessitating salvage flaps were compared to those who did not, and a stepwise logistic regression was performed and validated using a bootstrap technique. Utilising this analysis, a simplified risk score was developed to predict the risk of developing a wound which would necessitate salvage. A total of 925 patients were included in the study. The salvage flap rate was 11.2% (n = 104). Predictors determined by logistic regression included prior groin surgery (OR = 4.0, p < 0.001), prosthetic graft (OR = 2.7, p < 0.001), coronary artery disease (OR = 1.8, p = 0.019), peripheral arterial disease (OR = 5.0, p < 0.001), and obesity (OR = 1.7, p = 0.039). Based upon the respective logistic coefficients, a simplified scoring system was developed to enable the preoperative risk stratification regarding the likelihood of a significant complication which would require a salvage muscle flap. The c-statistic for the regression demonstrated excellent discrimination at 0.89. This study presents a simple, internally validated risk assessment tool that accurately predicts wound morbidity requiring flap salvage in open groin vascular surgery patients. The preoperatively high-risk patient can be identified and selectively targeted as a candidate for a prophylactic muscle flap. PMID:24666001

Fischer, John P; Nelson, Jonas A; Shang, Eric K; Wink, Jason D; Wingate, Nicholas A; Woo, Edward Y; Jackson, Benjamin M; Kovach, Stephen J; Kanchwala, Suhail

2014-12-01

145

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

PubMed Central

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

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

2014-01-01

146

Comprehensive Evaluation of Risk Factors and Management of Impending Flap Loss in 2138 Breast Free Flaps.  

PubMed

Loss of a breast free flap is a relatively rare but catastrophic occurrence. Our study aims to identify risk factors for flap loss and to assess whether different salvage techniques affect flap salvage. We performed a retrospective review of all breast free flaps performed at a single institution from 2000 to 2010. Overall, 2138 flaps were performed in 1608 patients (unilateral, 1120 and bilateral, 488) with 44 flap losses (2.1%). Age, body mass index, smoking, radiation, chemotherapy, and surgeon experience did not affect flap loss. Abdominal flaps based on a single perforator were at significantly higher risk for flap loss compared with flaps based on multiple perforators (P = 0.0007). Subgroup analysis of the subset of 166 compromised free flaps (flaps requiring a return to the operating room, an intraoperative anastomotic revision, or loss/partial loss of a free flap) demonstrated deep inferior epigastric perforator, and other flaps (superficial inferior epigastric artery and superior gluteal artery perforator) were significantly associated with flap loss [odds ratio (OR) 5.20; P = 0.03 and OR 6.91; P = 0.0004, respectively] compared with transverse rectus abdominis myocutaneous and muscle-sparing transverse rectus abdominis myocutaneous flaps. Although an intraoperative complication was not associated with a flap loss, the need for a reoperation was strongly predictive (P < 0.0001). Flap salvage was the highest within the first 24 hours (83.7%) and significantly less between days 1 and 3 (38.6%; P < 0.0001) and beyond 4 days (29.4%; P < 0.0001). Longer ischemia time was significantly associated with flap loss (P = 0.04). Salvage techniques (aspirin, heparinzation, thrombectomy, and thrombolytic) had no impact on flap salvage rates. Heparinization and thrombolytics were associated with higher loss rates (OR 3.40; P = 0.003 and OR 10.36; P < 0.0001, respectively). Free flap loss following breast reconstruction is multifactorial with higher losses in superficial inferior epigastric artery and gluteal flaps, single-perforator abdominal flaps, and longer ischemia times. Salvage rates are most successful within the first 24 hours, and the use of heparinization, aspirin, and thrombolytics does not improve salvage rates. PMID:25003429

Chang, Edward I; Chang, Eric I; Soto-Miranda, Miguel A; Zhang, Hong; Nosrati, Naveed; Crosby, Melissa A; Reece, Gregory P; Robb, Geoffrey L; Chang, David W

2014-07-01

147

Reconstruction of an enterocutaneous fistula using a superior gluteal artery perforator flap.  

PubMed

Enterocutaneous fistula is an uncommon complication of surgery for colorectal cancer. However, once a fistula has developed, treatment is complicated by previous treatments. Here, we describe an enterocutaneous fistula that developed after multiple treatments for rectal cancer in a 62-year-old woman. The woman had previously undergone several colorectal surgeries, radiation therapy and five courses of chemotherapy. Four years after the final surgery, an enterocutaneous fistula developed between the small intestine and the sacral skin. The fistula was resected, and the resulting defect was successfully reconstructed with a superior gluteal artery perforator flap. PMID:17959426

Sakuraba, M; Asano, T; Yano, T; Yamamoto, S; Moriya, Y

2009-01-01

148

The Expansion of RPE Atrophy after the Inverted ILM Flap Technique for a Chronic Large Macular Hole  

PubMed Central

Purpose To report a case of the expansion of submacular retinal pigment epithelium (RPE) atrophy after using the inverted internal limiting membrane (ILM) flap technique for a persisting, large, stage IV macular hole (MH). Case Report A 79-year-old woman presented with a chronic large MH that remained open despite pars plana vitrectomy (PPV). The surgery was performed twice for the MH closure 14 years earlier. ILM peeling was not performed during the previous surgeries. The best-corrected visual acuity (BCVA) with the Landolt ring chart was 0.08 at her visit. The minimum MH diameter was 1,240 ?m. Inverted ILM flap technique with 20% SF6 gas tamponade was performed for the MH closure. For the inverted ILM flap technique, 25-gauge PPV and ILM staining with indocyanine green were used. The ILM was peeled off for 2 disc diameters around the MH, but the ILM was not removed completely. The ILM was then inverted and covered the MH. Results One month after surgery, the MH was closed, accompanied by glial cell proliferation spreading from the inverted ILM flap (as reported before). On the other hand, the area of the submacular RPE atrophy, which was already observed 1 week after surgery, gradually increased in size. BCVA improved to 0.3 six months after the surgery. Conclusions The inverted ILM flap technique may be promising even for persisting large MH which were not closed in previous surgeries, but long-term observation is needed because the detailed behavior of the inverted ILM and the Müller cells after surgery is not yet known. PMID:24707278

Imai, Hisanori; Azumi, Atsushi

2014-01-01

149

Vesicovaginal fistula repair with genito-gluteal fold fat pad flap.  

PubMed

We report our experience of supratrigonal vesicovaginal fistula (VVF) repair cases developed after gynaecologic surgery. Two patients presented with urinary incontinence after hysterectomy and adjuvant radiation therapy for cervical carcinoma. Cystoscopy findings showed vesicovaginal fistula near the bladder neck area. In a transvaginal approach, we excised the fistulous tract and transferred the genito-gluteal fold fat pad flap for interpositioning. Postoperative cystography showed no evidence of leakage and no recurrence was found after a 1 year follow-up period. This flap technique is particularly useful for a vaginal cuff area fistula in terms of ease of dissection, lower donor site morbidity and large flap dimension. Also the fat pad provides neovascularity and lymphatic drainage, fills dead space, and enhances granulation tissue formation. PMID:18024252

Heo, Chanyeong; Eun, Seokchan; Baek, Rongmin; Minn, Kyungwon

2008-01-01

150

Surgical management of traumatic LASIK flap dislocation with macrostriae and epithelial ingrowth 14 years postoperatively.  

PubMed

Fourteen years after uneventful laser in situ keratomileusis (LASIK), a 59-year-old woman presented after suffering blunt trauma to her left eye 5 weeks earlier. The injury resulted in traumatic flap dislocation, epithelial ingrowth, and significant macrostriae. Following epithelial removal, the flap was hydrated with sterile water, facilitating reduction of the macrostriae and reapproximation without the need for suture placement. The postoperative course was uneventful, and at 1 month, the epithelial ingrowth and macrostriae had resolved and the uncorrected distance visual acuity was 20/30. This case represents the longest documented interval from LASIK surgery to traumatic flap dislocation. We describe our surgical approach to the management of this type of injury and present a video illustrating the technique. PMID:22112789

Holt, Derick G; Sikder, Shameema; Mifflin, Mark D

2012-02-01

151

Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities?  

PubMed Central

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves “untreated”. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

Sinis, Nektarios; Lamia, Androniki; Gudrun, Helml; Schoeller, Thomas; Werdin, Frank

2012-01-01

152

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

PubMed

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

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

2014-01-01

153

14 CFR 25.1511 - Flap extended speed.  

Code of Federal Regulations, 2010 CFR

... 1 2010-01-01 2010-01-01 false Flap extended speed. 25.1511 Section 25.1511...Information Operating Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established...

2010-01-01

154

Course review: the 4th bob huffstadt upper and lower limb flap dissection course.  

PubMed

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

Dunne, Jonathan A

2014-12-01

155

Pressure Distribution Over Airfoils with Fowler Flaps  

NASA Technical Reports Server (NTRS)

Report presents the results of tests made of a Clark y airfoil with a Clark y Fowler flap and of an NACA 23012 airfoil with NACA Fowler flaps. Some of the tests were made in the 7 by 10-foot wind tunnel and others in the 5-foot vertical wind tunnel. The pressures were measured on the upper and lower surfaces at one chord section both on the main airfoils and on the flaps for several angles of attack with the flaps located at the maximum-lift settings. A test installation was used in which the model was mounted in the wind tunnel between large end planes so that two-dimensional flow was approximated. The data are given in the form of pressure-distribution diagrams and as plots of calculated coefficients for the airfoil-and-flap combinations and for the flaps alone.

Wenzinger, Carl J; Anderson, Walter B

1938-01-01

156

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

PubMed

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

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

2014-01-19

157

Our Experiences in Nipple Reconstruction Using the Hammond flap  

PubMed Central

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

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

158

Pressure Available for Cooling with Cowling Flaps  

NASA Technical Reports Server (NTRS)

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.

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

1941-01-01

159

Vascular Waveform Analysis of Flap-Feeding Vessels Using Color Doppler Ultrasonography  

PubMed Central

We performed vascular waveform analysis of flap-feeding vessels using color Doppler ultrasonography and evaluated the blood flow in the flaps prior to surgery. Vascular waveform analysis was performed in 19 patients. The analyzed parameters included the vascular diameter, flow volume, flow velocity, resistance index, pulsatility index, and acceleration time. The arterial waveform was classified into 5 types based on the partially modified blood flow waveform classification reported by Hirai et al.; in particular, D-1a, D-1b, and D-2 were considered as normal waveforms. They were 4 patients which observed abnormal vascular waveform among 19 patients (D-4?:?1, D-3?:?1, and Poor detect?:?2). The case which presented D-4 waveform changed the surgical procedure, and a favorable outcome was achieved. Muscle flap of the case which presented D-3 waveform was partially necrosed. The case which detected blood flow poorly was judged to be the vascular obstruction of the internal thoracic artery. In the evaluation of blood flow in flaps using color Doppler ultrasonography, determination of not only basic blood flow information, such as the vascular distribution and diameter and flow velocity, but also the flow volume, vascular resistance, and arterial waveform is essential to elucidate the hemodynamics of the flap. PMID:24804093

Onishi, Kiyoshi

2014-01-01

160

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

PubMed Central

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

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

2014-01-01

161

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

PubMed

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

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

2015-02-01

162

Effects of perforated flap surfaces and screens on acoustics of a large externally blown flap model  

NASA Technical Reports Server (NTRS)

Various model geometries and combinations of perforated flap surfaces and screens mounted close to the flap surfaces were studied for application to jet-flap noise attenuation for externally blown flap, under-the-wing aircraft. The efforts to reduce jet-flap interaction noise were marginally successful. Maximum attenuations of less than 4 db in overall sound pressure level were obtained in the flyover plane. Noise reductions obtained in the low-to-middle-frequency ranges (up to 7 db) were generally offset by large increases in high-frequency noise (up to 20 db).

Burns, R. J.; Mckinzie, D. J., Jr.; Wagner, J. M.

1976-01-01

163

Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes  

Microsoft Academic Search

Purpose: To measure and compare the changes in objective wavefront aberration and subjective manifest refraction after laser in situ keratomileusis (LASIK) flap creation with a mechanical microkeratome and a femtosecond laser. Setting: Private practice refractive surgery center, Irvine, California, USA. Methods: This randomized prospective study comprised 9 patients (18 eyes) treated with a 2-step LASIK procedure: lamellar keratectomy with a

Dan B. Tran; Melvin A. Sarayba; Zsolt Bor; Carrie Garufis; Yi-Jing Duh; Charles R. Soltes; Tibor Juhasz; Ron M. Kurtz

2005-01-01

164

Lung surgery  

MedlinePLUS

... Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... do surgery on your lungs are thoracotomy and video-assisted thoracoscopic surgery (VATS). Lung surgery using a ...

165

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 ...

166

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 ...

167

Cataract Surgery  

MedlinePLUS

... Cataract Vision Simulator Pre-operative tests for cataract surgery Before surgery, the length of your eye will ... calculate the correct IOL power. Medications and cataract surgery If you are having cataract surgery, be sure ...

168

The Foreign Language Assistance Program (FLAP)  

ERIC Educational Resources Information Center

This article features the Foreign Language Assistance Program, also known as FLAP, which holds the distinction as the only federally funded program that exclusively targets foreign language instruction in elementary and secondary schools. Funded under Title V of No Child Left Behind, FLAP provides 3-year grants to states and local school districts…

Richey, Rebecca

2007-01-01

169

Vortex shedding model of a flapping flag  

Microsoft Academic Search

A two-dimensional model for the flapping of an elastic flag under axial flow is described. The vortical wake is accounted for by the shedding of discrete point vortices with unsteady intensity, enforcing the regularity condition at the flag's trailing edge. The stability of the flat state of rest as well as the characteristics of the flapping modes in the periodic

EBASTIEN MICHELIN; STEFAN G. LLEWELLYN SMITH; BEVERLEY J. GLOVER

2008-01-01

170

Smart flapping wing using macrofiber composite actuators  

Microsoft Academic Search

In the present study, we have developed a smart flapping wing with a MFC (macro-fiber composites) actuator. To mimic the flying mechanisms of nature's flyers such as birds or insects, the aerodynamic characteristics related to the birds and ornithopters are investigated. To measure the aerodynamic forces of flapping devices, a test stand consisting of two loadcells is manufactured, and the

Dae-Kwan Kim; Jae-Hung Han

2006-01-01

171

Camber-adjustable flapping wing air vehicles  

Microsoft Academic Search

This paper introduces the implementation of adjustable camber of flapping wing and tail of a typical artificial flapping vehicle using a flexible piezoelectric actuator, called macro-fiber composites (MFC). When MFC is applied to the main wing of an ornithopter, the induced camber greatly affects aerodynamic characteristics such as mean lift and thrust. The tail wing actuation can be useful to

Jun-Seong Lee; Jae-Hung Han; Dae-Kwan Kim

2011-01-01

172

Local flap reconstruction of large scalp defects.  

PubMed

Scalp defects can have a number of origins, and their repair is dependent upon their location, size and depth. In the case of the scalp, the repair of even small defects is complicated. Local flaps are the reference for the reconstruction of such defects. Knowledge of scalp anatomy is essential for preparing these flaps, which must be based on one or two vascular pedicles to afford a large rotation angle--thereby facilitating closure of the defect. The parietal zone is the location offering the greatest flap mobilization possibilities. We present a case involving the repair of a major pericranial frontoparietal scalp defect. A local transverse posterior transpositioning scalp flap was raised with the posterior auricular and occipital arteries as vascular pedicle. Following repositioning of the flap, a free partial-thickness skin graft from the thigh was used to cover the donor zone. A review is provided of the different techniques for the reconstruction of large scalp defects. PMID:18830178

García del Campo, José Antonio; García de Marcos, José Antonio; del Castillo Pardo de Vera, José Luis; García de Marcos, María Jesús

2008-10-01

173

Subcutaneous pedicle hypothenar island flap.  

PubMed

The status of the blood supply to the hypothenar skin was investigated by anatomical and radiological studies. The investigation revealed that the hypothenar skin receives a rich blood supply from the arterial network by branches from the palmar ulnar artery of the little finger and the hypothenar branches. By making use of this abundance of vascular networking, a subcutaneous pedicle flap was obtained from this site. This method was clinically applied to 7 patients, and the procedures and advantages of the method are described. PMID:1793236

Kinoshita, Y; Kojima, T; Hirase, Y; Kim, H; Endo, T

1991-12-01

174

A comparison between proximal lateral leg flap and radial forearm flap for intraoral reconstruction.  

PubMed

Free flaps have become a popular option for the reconstruction of intraoral defects. The radial forearm flap used to be the workhorse flap for small and thin defects, but was associated with numerous donor-site morbidities. The proximal lateral leg flap can provide a thin and pliable tissue similar to the radial forearm flap but without the related donor-site morbidities. We compared the differences between these 2 flaps. Thirty-four patients with intraoral defects from September 2005 to October 2011 were reconstructed, using the radial forearm flap in 23 cases, and the proximal lateral leg flap in 11 cases. The radial forearm flap group had a success rate of 95.6%. The flap survival rate was 100% in the proximal lateral leg flap group. However, the difference was statistically insignificant. Skin graft was required in 22 of the 23 cases for the donor site of the radial forearm flap. Partial loss of the skin graft occurred in 5/22 (23%) of the patients, with exposure of tendons in 3/22 (14%). Delay in healing of the donor sites occurred in 6/23 (26%) of the patients. The donor sites of the proximal lateral leg flap were all closed primarily. One case developed wound dehiscence and this healed by conservative treatment. Long-term follow-up showed functional impairment of the donor forearm (reduced extension or grip strength) in 17% of the patients. Thirty percent of the patients developed sensory disturbance and 48% complained of poor outcome of the donor forearms. In the proximal lateral leg flap group, no motor or sensory functional deficits were seen. No patients complained of poor outcome of the donor legs. Primary closure of the donor site of the proximal lateral leg flap could be performed if the flap width was less than 6 cm. This flap is useful for patients with small and thin intraoral defects and is associated with minimal donor-site morbidity when compared to the radial forearm flap. PMID:24284740

Lee, Jiunn-Tat; Chen, Peir-Rong; Cheng, Li-Fu; Wang, Chien-Hsing; Wu, Meng-Si; Huang, Chieh-Chi; Chien, Sou-Hsin; Hsu, Honda

2013-12-01

175

Modeling Helicopter Rotor Blade Flapping Motion Considering Nonlinear Aerodynamics  

Microsoft Academic Search

The flapping equation for a rotating rigid helicopter blade is typically derived by con- sidering 1) small flap angle, 2) small induced an- gle of attack and 3) linear aerodynamics. How- ever, the use of nonlinear aerodynamics can make the assumptions of small angles suspect. A gen- eral equation describing helicopter blade flap dy- namics for large flap angle and

Jyoti Ranjan Majhi; Ranjan Ganguli

2008-01-01

176

50 CFR Figure 16 to Part 223 - Escape Opening and Flap Dimensions for the Double Cover Flap TED  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and...16 Figure 16 to Part 223—Escape Opening and Flap Dimensions for the Double Cover Flap TED...

2010-10-01

177

Limb salvage surgery  

PubMed Central

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

Kadam, Dinesh

2013-01-01

178

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

PubMed Central

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.

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

2015-01-01

179

New experimental flap model in the rat: free flow-through epigastric flap.  

PubMed

This study describes a free flow-through flap model in the rat for use in the evaluation of the physiologic and hemodynamic characteristics of this type of flap in clinical practice. The rat is a preferred animal model because it is inexpensive, readily available, and reliable. There is no free flow-through flap model available for laboratory animals, although this model gained popularity in clinical use recently. Twenty Wistar rats weighing 200-250 g were used in our experiment. In 5 rats, the vascular anatomy of the groin and proximal thigh region was determined by anatomic dissection. The experimental design consisted of two groups. In the experimental group (N = 5), a flow-through epigastric skin flap was harvested based on the femoral artery, preparing both its proximal and distal stumps. The flap was transferred to the contralateral groin, and end-to-end vascular anastomosis was performed between a proximal and distal stump of the femoral arteries of the flap and recipient site. The proximal stump of the femoral vein of the flap was anastomosed to the femoral vein of the recipient site. The control group was divided into two subgroups. In all control group rats (N = 10), the flap was harvested in the same manner, and transferred to the contralateral groin, but standard free-flap procedure with one artery and one vein anastomosis was performed in 5 rats (conventional free-flap subgroup), and anastomosis was not performed between the flap and the recipient site in the remaining 5 rats (graft subgroup). Survival of the flap was evaluated on postoperative day 7 by direct observation, and microangiography was performed to delineate the vascularity of the flow-through flap. The results showed that all flaps survived in the experimental group and the conventional free-flap subgroup of the control group, whereas in the graft subgroup, all flaps underwent total necrosis. The authors conclude that the flow-through epigastric flap for the rat is a simple and reliable model for future physiologic and pharmacologic studies. PMID:15499551

Ozkan, Omer; Co?kunfirat, O Koray; Ozgenta?, H Ege; Dikici, M Bahadir

2004-01-01

180

Critical Mach Numbers of Thin Airfoil Sections with Plain Flaps  

NASA Technical Reports Server (NTRS)

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.

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

1946-01-01

181

On the generation of side-edge flap noise. [part span trailing edge flaps  

NASA Technical Reports Server (NTRS)

A theory is proposed for estimating the noise generated at the side edges of part span trailing edge flaps in terms of pressure fluctuations measured just in-board of the side edge of the upper surface of the flap. Asymptotic formulae are developed in the opposite extremes of Lorentz contracted acoustic wavelength large/small compared with the chord of the flap. Interpolation between these limiting results enables the field shape and its dependence on subsonic forward flight speed to be predicted over the whole frequency range. It is shown that the mean width of the side edge gap between the flap and the undeflected portion of the airfoil has a significant influence on the intensity of the radiated sound. It is estimated that the noise generated at a single side edge of a full scale part span flap can exceed that produced along the whole of the trailing edge of the flap by 3 dB or more.

Howe, M. S.

1981-01-01

182

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

PubMed Central

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

Classen, Dale A

2005-01-01

183

Autonomization of epigastric flaps in rats.  

PubMed

The question of how long a flap depends on its pedicle cannot be answered clearly from the available literature. To address this, we investigated the time to flap autonomization in the wound bed and the length of time to the point when flap necrosis is reduced to a clinically negligible level. The superficial epigastric flap was raised in 24 rats. After 3, 5, 7, or 10 days of wound healing, the pedicle was again exposed, ligated, and divided. Values of blood flow (flow), velocity (velocity), hemoglobin level (Hb), and oxygen saturation (SO(2) ) were noninvasively measured using Laser spectrophotometry. The area of necrosis of the flap was 62.77 ± 1.71% after 3 days, 16.26 ± 0.86% after 5 days, 2.88 ± 0.14% after 7 days, and 1.64 ± 0.16% after 10 days (P < 0.001). Hb, flow, and velocity were found to be significant factors on developing flap necrosis at the preoperative and postoperative time point (P < 0.0001), whereas SO(2) and flow were significant predictors of necrosis at the time of pedicle ligation (P < 0.0001). The percentage changes of SO(2) (P < 0.0001), flow (P < 0.0001), and velocity (P = 0.001) between the different time points were significant predictors of flap necrosis. The time needed for the complete autonomization of vascularized free flaps in their wound beds has been found as completed between the 5th and 7th day postoperatively in this rat model. The area of flap necrosis depends on the present value of SO(2) , Hb, flow, and velocity at different time points, but, more importantly, also on the perioperative change of these parameters. PMID:21503975

Mücke, Thomas; Borgmann, Anna; Wagenpfeil, Stefan; Günzinger, Ralf; Nöbauer, Christian; Lange, Rüdiger; Slotta-Huspenina, Julia; Hölzle, Frank; Wolff, Klaus-Dietrich

2011-09-01

184

The plane problem of the flapping wing  

NASA Technical Reports Server (NTRS)

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.

Birnbaum, Walter

1954-01-01

185

Robotic surgery  

MedlinePLUS

Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

186

14 CFR 23.701 - Flap interconnection.  

Code of Federal Regulations, 2013 CFR

14 Aeronautics and Space 1 2013-01-01 2013-01-01...701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT...surfaces that is independent of the flap drive system; or by an approved...

2013-01-01

187

14 CFR 23.701 - Flap interconnection.  

Code of Federal Regulations, 2012 CFR

14 Aeronautics and Space 1 2012-01-01 2012-01-01...701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT...surfaces that is independent of the flap drive system; or by an approved...

2012-01-01

188

14 CFR 23.701 - Flap interconnection.  

Code of Federal Regulations, 2011 CFR

14 Aeronautics and Space 1 2011-01-01 2011-01-01...701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT...surfaces that is independent of the flap drive system; or by an approved...

2011-01-01

189

14 CFR 23.701 - Flap interconnection.  

Code of Federal Regulations, 2014 CFR

14 Aeronautics and Space 1 2014-01-01 2014-01-01...701 Section 23.701 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT...surfaces that is independent of the flap drive system; or by an approved...

2014-01-01

190

Performance of biologically inspired flapping foils  

E-print Network

Flapping foil propulsion is thought to provide AUVs with greater maneuverability than propellers. This thesis seeks to simplify the design process for this type of propulsion system by identifying thrust and wake characteristics ...

Read, Melissa B. (Melissa Beth), 1982-

2006-01-01

191

Propulsive device of the flapping wing type  

NASA Astrophysics Data System (ADS)

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.

Gorelov, D. N.

2014-11-01

192

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

PubMed Central

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

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

2014-01-01

193

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

PubMed Central

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

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

2010-01-01

194

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition.  

PubMed

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection (DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males (73.7%) and 5 females (26.3%), aged 55±13 (18-78) years. According to the Pairolero classification of infected median sternotomies, 3 (15.8%) patients were type II, and the other 16 (84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients (78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients (21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients (10.5%) presented with subcutaneous infection, and 3 patients (15.8%) had hematoma. They recovered following local debridement and medication. 17 patients (89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition. PMID:25429744

Wu, Song; Wan, Feng; Gao, Yong-Shun; Zhang, Zhe; Zhao, Hong; Cui, Zhong-Qi; Ji-Yan Xie, And

2014-11-28

195

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

NASA Technical Reports Server (NTRS)

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.

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

1973-01-01

196

V-Y fasciocutaneous flap of the medial thigh including the long saphenous vein for reconstruction of intrapelvic dead space.  

PubMed

Some patients develop an intrapelvic infection and fistula caused by the presence of intrapelvic dead space after the resection of rectal cancer, and the treatment is sometimes quite difficult. We have developed a new surgical technique for the treatment and prevention of such fistulas that uses a fasciocutaneous flap from the medial thigh. A V-shaped fasciocutaneous flap with a pedicle on the anterior side of the thigh is designed on the medial thigh and gluteal region. After raising the fasciocutaneous flap that contains the long saphenous vein, the gluteal section including a thick layer of fatty tissue is de-epithelialised, and the flap is rotated and advanced towards the dead space to fill it. Four patients were operated on using our technique. One was a secondary reconstruction: the patient had developed a small fistula after reconstructive surgery, but it healed with conservative treatment. As a result, all four patients achieved satisfactory outcomes. The advantages of our technique include: no change in the position of the body is required for reconstruction; operations are simple; sufficient volume of tissue is obtained from the thick fatty tissues of the gluteal region; and the fasciocutaneous flap contains the long saphenous vein and has good venous circulation. We consider this technique useful for the reconstruction of intrapelvic dead space. PMID:19401944

Yamauchi, Toshihiko; Kiyokawa, Kensuke; Inoue, Yojiro; Rikimaru, Hideaki

2009-01-01

197

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

PubMed Central

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

Butler, Daniel; Grobbelaar, Adriaan

2015-01-01

198

[Reconstruction of large tissue loss of the anus and perineum with bilateral inferior gluteal and right gracilis myocutaneous flaps].  

PubMed

The authors present a case of locally advanced anal squamous cell carcinoma which, due to infiltration of deep structures, caused anal incontinence, serious pain, exulceration, and bleeding. Neoadjuvant radiotherapy made the tumour operable and abdominoperineal extirpation was performed. The large tissue loss of the anal and perineal region was covered by bilateral gluteus maximus myocutaneous flaps, and the loss of the pelvic musculature and the remaining pelvic skin loss were replaced by a right gracilis myocutaneous flap. The patient was discharged on the 36th postoperative day. There was no flap necrosis noted and an incomplete lesion of the proximal urethra healed after direct suturing. The patient was allowed to lye on the flap in the second postoperative month and sitting on the third month. Unfortunately, an inoperable infiltrative lymph node metastasis occurred in the right inguinal region after six months, and the patient died 10 months after the surgery. We believe that in cases of large, ulcerating anal tumours, when direct closure would be impossible due to massive tissue loss after resection, quality of life can be significantly improved by resection and closure with myocutaneous flaps. PMID:21997531

Hamvas, Balázs; Mucs, Mihály; Varga, István; Szilágyi, Anna; Altorjay, Aron

2011-10-01

199

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

PubMed Central

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

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

2014-01-01

200

Anchoring galeal flaps for scalp reduction procedures.  

PubMed

This article describes an operative technique, based on the use of three anchoring galeal flaps, aimed at reducing the percentage of "stretch-back" that occurs after performing scalp reduction procedures. In 12 male patients undergoing a midline scalp reduction procedure, three rectangular (2 x 3 cm) galeal flaps in direct continuity with the longitudinal margin of the left scalp flap were sutured individually to the galeal undersurface of the right scalp flap to draw the two scalp flaps toward the midline of the scalp and to relieve the wound margins of closing tension. Tattoo marks were placed on the patient's scalp at the level of the vertical lines drawn through the external auditory meatuses (A1-A2) and 6 cm more posterior (B1-B2) to measure the movement and stretching of the scalp. The results were compared with those obtained from a control group of 13 male patients who underwent the same surgical procedure but without the use of the anchoring galeal flaps. Mean stretch-back (as measured 4 weeks postoperatively) at level A1-A2 was 8.3 mm in the control group and 1.6 mm in the experimental group. The mean stretch-back at level B1-B2 was 7.7 mm in the control group and 0.9 mm in the experimental group. A statistically significant difference (p < 0.005) was found between data from the control and experimental groups regarding the above-reported stretch-back values at both levels. The use of the described galeal flaps allowed us to obtain an 80.93-percent and an 88.09-percent stretch-back reduction at levels A1-A2 and B1-B2, respectively, 1 month postoperatively. PMID:9858186

Raposio, E; Cella, A; Panarese, P; Nordström, R E; Santi, P

1998-12-01

201

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

PubMed

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

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

2013-12-01

202

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

PubMed

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

Grossman, J; Baltzer, W

2012-05-01

203

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

PubMed

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

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

2013-01-01

204

Flapping wing PIV and force measurements  

NASA Astrophysics Data System (ADS)

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.

Cameron, Benjamin H.

205

Vascular basis of the retroauricular flap.  

PubMed

The aims of this study were to investigate the vascular communication between the superficial temporal artery (STA) and the posterior auricular artery (PAA) and to determine the vascular territory of various retroauricular flaps for flap design. A series of eight adult fresh cadavers were perfused with a mixture of lead oxide, gelatin, and water through the common carotid and femoral arteries. The full thickness of scalp and facial skin was removed with the STA and the PAA. A radiograph was taken of each specimen. After the retroauricular flap with the PAA from the posterior auricular and mastoid regions was elevated, another radiograph was taken of the specimen. Our radiographic assessment revealed two patterns of vascular anastomosis between the STA and PAA. The auricular anastomoses were found at the upper portion of the posterior surface of the ear, where some reticular anastomoses occurred between auricular branches derived from the STA and the PAA. The scalp anastomoses were located in the scalp superior to the ear, where some reduced caliber choke anastomoses or true anastomoses existed between the parietal branch and the terminal branches of the PAA. The results of this study will be helpful for better understanding of the vascular communication between the STA and the PAA and the vascular territory of retroauricular flaps. Our findings will also provide anatomic information and guidance for the design of reliable flaps. PMID:9464692

Yang, D; Morris, S F

1998-01-01

206

The Effects of Botulinum Toxin A on Survival of Rat TRAM Flap With Vertical Midline Scar.  

PubMed

The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used in various reconstructive surgeries. Recently, there have been reports regarding the positive effect of botulinum toxin A (BoTA) on flap survival. We hypothesized that pretreatment with BoTA could augment the survival of pedicled TRAM flaps with a vertical midline scar.Twenty-four Sprague-Dawley rats were randomly divided into 2 groups, namely, control group and BoTA group. Five days after a vertical midline incision, the BoTA group was pretreated with BoTA, whereas the control group was pretreated with normal saline. Ten days after the initial incision, the TRAM flap was harvested.We evaluated the gross flap survival and analyzed the overall histologic change, lumen area of pedicle, and microvessel density with immunohistochemistry. Reverse transcription polymerase chain reaction was performed for the evaluation of angiogenesis-related factors.In the BoTA group, the gross flap survival rate was significantly higher than that in the control group on both ipsilateral and contralateral sides (P < 0.001). In the BoTA group, a significant increase in pedicle lumen area was observed (P < 0.001). In the control group, mild to moderate epidermal necrosis was seen; microvessels were relatively small compared with those of the BoTA group. According to immunohistochemistry, the number of CD31 positively stained vessels was significantly higher on the contralateral side in the control group compared to that in the BoTA group (P < 0.001).The relative messenger RNA (mRNA) expression of CD31 was significantly lower in the BoTA group than that in the control group on both ipsilateral and contralateral sides (P < 0.001). Meanwhile, the relative mRNA expression of VEGF was significantly higher in the BoTA group than in the control group on both ipsilateral and contralateral sides (P < 0.001).We believe that preoperative BoTA therapy is a feasible method to improve circulation of the rat TRAM flap with a vertical midline incision scar. PMID:23817458

Park, Tae Hwan; Rah, Dong Kyun; Chong, Yosep; Kim, June-Kyu

2015-01-01

207

Perforator flaps--how many perforators are necessary to keep a flap alive?  

PubMed

Perforator flaps are becoming increasingly important in reconstructive microsurgery because of their reduced donor-site morbidity. However, one drawback is partial necrosis caused by vasospasm or inconsistency of delicate perforator vessels. In this study we have evaluated the number and capacity of perforator vessels with respect to the size of a flap, and the influence of vascular endothelial growth factor (VEGF) on the capacity of perforators in a standard animal model. We realised an epigastric perforator flap 4cm×7cm in 36 rats. In 3 control groups (n=6 in each), flaps were raised based on 4, 2, or 1 perforator vessel(s), while all other perforators as well as the epigastric vessels were ligated. In three study groups (n=6 in each), set up in the same way as the control groups, we also injected a single dose of VEGF into the wound area. After one week, all areas of necrosis were assessed planimetrically. We also evaluated the wounds by laser Doppler flowmetry preoperatively and after one week, and by histological and immunohistochemical examination. An increased number of perforators, together with VEGF, was associated with a significant reduction in the areas of necrosis. This observation was particularly true in flaps based on only one perforator. The inclusion of additional perforators has a more important role in the success of a flap than theoretical models suggest. Proangiogenetic factors may improve the viability of perforator flaps. PMID:24629454

Fichter, Andreas M; Borgmann, Anna; Ritschl, Lucas M; Mitchell, David A; Wagenpfeil, Stefan; Dornseifer, Ulf; Wolff, Klaus-Dietrich; Mücke, Thomas

2014-05-01

208

14 CFR 23.1511 - Flap extended speed.  

Code of Federal Regulations, 2010 CFR

... 1 2010-01-01 2010-01-01 false Flap extended speed. 23.1511 Section 23.1511...Operating Limitations and Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so...

2010-01-01

209

14 CFR 25.701 - Flap and slat interconnection.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 2010-01-01 false Flap and slat interconnection. 25.701...Construction Control Systems § 25.701 Flap and slat interconnection. (a) Unless...has safe flight characteristics with the flaps or slats retracted on one side and...

2010-01-01

210

Aerodynamics and flight performance of flapping wing micro air vehicles  

Microsoft Academic Search

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

Dmytro Silin

2010-01-01

211

The "duck" modification of the tensor fascia lata flap.  

PubMed

Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure. PMID:15900151

Aslan, Gurcan; Tuncali, Dogan; Bingul, Ferruh; Ates, Levent; Yavuz, Nurten

2005-06-01

212

Clinical outcomes of epi-LASIK: 1-year results of on- and off-flap procedures with and without mitomycin-C.  

PubMed

AIM To evaluate and compare the clinical outcomes of epi-laser in situ keratomileusis (LASIK) performed either on-flap or off-flap with or without 0.02% mitomycin-C (MMC) in terms of corneal haziness, pain scores and satisfaction scores. METHODS In this non-randomised comparative retrospective study, the charts of 198 patients (394 eyes) who had undergone an epi-LASIK procedure for myopia (-1.5 D to -8.0 D spherical equivalent) correction were reviewed. Patients were classified into four groups: Group I, on-flap without MMC, 181 eyes; Group II, on-flap with MMC, 52 eyes; Group III, off-flap without MMC, 93 eyes; Group IV, off-flap with MMC, 68 eyes. We compared the group outcomes on the first day, 1, 3 and 6 months and 1 year after the operation. RESULTS The mean uncorrected visual acuity was significantly better in the off-flap groups (III and IV) than in the on-flap groups (I and II) on day 1 (p=0.002). There was no significant difference in the spherical equivalent among all groups at 1 year (p=0.305). Some degree of haziness was present in 10 eyes (Grade II: 2; Grade I: 8), but the haziness level was not significantly different among groups at 1 year (p=0.533). Pain scores (0-10) were lower in the off-flap groups (III and IV) (p=0.010). Satisfaction scores (0-10) were higher in the off-flap groups (III and IV), but the difference was not statistically significant (p=0.248). CONCLUSIONS Myopic correction by epi-LASIK surgery with all four methods showed stable visual results in terms of the 1-year postoperative clinical outcomes. Haziness levels revealed that treatment with 0.02% MMC was less effective than expected. Overall, the off-flap method offered faster visual recovery and less postoperative pain than the on-flap method. PMID:19955194

Kim, Seong Taeck; Koh, Jae Woong; Yoon, Gil Joong; Yang, Seong Won

2010-05-01

213

Combined cremaster muscle and inner thigh skin composite flap: a novel experimental flap model in the rat.  

PubMed

Unlike the composite musculocutaneous flap models, the combined composite muscle-skin flap model allows evaluating muscle and skin viability independently, because it has an independent blood supply to the muscle and skin component. However, to our knowledge, only two combined muscle-skin flaps have been reported to date. During our cremaster dissection in our laboratory, we perceived a new vessel as a terminal continuation of the pudic-epigastric artery (PEA) on which the cremaster muscle flap is raised. Therefore, we designed this study to determine whether the scrotal and inner thigh skin can be harvested with the cremaster muscle as a combined cremaster muscle-skin composite flap. Thirty male Sprague-Dawley rats were used in this experiment. In five rats, ink study selective to the PEA marked a skin territory. In 15 rats, cremaster muscle and 4 x 3 cm ipsilateral scrotal and medial thigh skin flap was raised on the PEA. Fluorescein study after 4 hours showed fluorescein stain in the skin island. On postoperative day 7, both muscle and skin components of the flaps were viable. Microangiographic study after the flap elevation revealed the vascularity of all components of the flap and clearly identified the branch to the skin island. To the best of our knowledge, this is the first report describing the combined flap model including the cremaster muscle. Our flap seems to have an important advantage over the other combined muscle-skin flap models in terms of the cremaster muscle being suitable for the intravital microscopy. Additionally, the two components of the flap have separate nutrient vessels with adequate length, which gives the flap flexibility in the placement of the skin component in a location distant from the muscle component. The flap may be also be raised as a skin flap without the cremaster muscle. It can be used for different applications, including microcirculatory, pharmacological, physiological, biochemical, and immunological studies as well as for transplantation studies. PMID:18548374

Cinar, Can; Ogur, Simin; Ozturk, Can

2008-01-01

214

New developments in blown flap noise technology  

NASA Technical Reports Server (NTRS)

The noise technology relating to blown-flap systems is reviewed. There are three general sources of noise: turbomachinery, airframe, and the interaction noise of the jet blowing on the flaps. The latter noise-source area is the most critical and the main subject dicussed. Characteristics of lower surface blown and upper surface blown systems are described, including noise spectra, directivity, jet velocity characteristics, aircraft geometric variation effects, and aircraft forward speed effects. Noise reduction concepts are described, including slowing down the jet flow field by devices and engine cycle modifications, structural geometry and shielding modifications, local flow field modifications of the passive and active type, and the absorption of noise. It is concluded that, while there has been considerable progress in the past several years, low noise characteristics in blown flap aircraft must be largely built in by better application of low noise principles during the design.

Gibson, J. S.

1976-01-01

215

Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging  

Microsoft Academic Search

Radical pelvic surgery is often required in patients with advanced, persistent or recurrent gynaecological and anorectal malignancies.\\u000a In the last decade, pedicled flap reconstructions have been increasingly used for pelvic floor and neovaginal reconstruction,\\u000a introducing well-vascularised non-irradiated tissue into the wound cavity and hence reducing wound complications. The aim\\u000a of this pictorial review is to describe the normal post-operative cross-sectional

Nyree Griffin; Jeremy Rabouhans; Lee A. Grant; Roy L. H. Ng; David Ross; Paul Roblin; Mark L. George

2011-01-01

216

Prelaminated calvarial osteofascial flap for palatal reconstruction.  

PubMed

Reconstruction of the hard palate defects is among the most challenging problems for plastic surgeons. Prosthetic obturations and local flaps for small defects have been used, whereas numerous regional and free flaps have been described for larger defects. The search for the ideal method offering a natural palatal structure is still ongoing. Five male patients with a mean age of 30.4 years experiencing hard palate defects due to congenital cleft palate or tumor excisions were repaired by prelaminated calvarial osteofascial flap. The mean defect size was 3.14 × 2.48 cm. Both of the surfaces of the calvarial bone elevated with superficial temporal fascia were wrapped with fascia and covered with split-thickness skin graft. The interval between the 2 sessions ranged from 3 to 6 weeks. In the second session, triple layered reconstruction involving the bony layer as well as the oral and nasal mucosa was performed. In 1 case, partial skin loss on the oral surface of the flap was seen in the second session but epithelialized spontaneously. The mean follow-up period was 21.8 months, and no complication such as wound detachment, infection, flap loss, as well as fistula or nasal regurgitation was encountered. A hard palatal reconstruction was performed, offering a natural anatomy in terms of structure and shape. This reliable technique, which is convenient for the three-dimensional reconstruction of the hard palate defects offering a near-normal anatomy owing to its triple layered structure, thickness, and the compatible shape of the calvarial bone to the palate, can be a good alternative against other regional and free flaps. PMID:24531246

Kilinc, Hidir; Aytekin, Ahmet Hamdi

2014-07-01

217

V-Y fasciocutaneous pudendal thigh flap for repair of perineum and genital region after necrotizing fasciitis: modification and new indication.  

PubMed

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of the overlying skin, and it is a toxin-mediated disease. The aim of this study was to review 13 cases of necrotizing fasciitis of the perineum and the external genitalia region with regard to the diagnosis, treatment, and methods of reconstruction of secondary defects. The study was performed from June 1997 to May 2001 and involved 11 men and 2 women who ranged in age from 35 to 67 years (mean age, 53 years). All patients presented to the plastic surgery unit with huge secondary defects of the urogenital region, upper thigh, and lower abdomen after being excised initially by general surgeons. Eight patients were treated with bilateral flaps, and the unilateral flap was used in 2 patients. The V-Y island fasciocutaneous flap, used to resurface the urogenital region after necrotizing fasciitis, is considered a new indication. The V-Y axial-pattern design of the flap is also considered a new modification, which enabled the flap to be advanced and tailored nicely in the midline. The idea of using the V-Y-plasty design is raised because the perineum has a pair of symmetrical anatomic structures. In addition, this procedure conserves tissue and the flap donor site is closed primarily without tension. Both aesthetic and functional results were satisfactory. PMID:12068218

El-Khatib, Hamdy A

2002-04-01

218

Rodding Surgery  

MedlinePLUS

... and After Their Child is in the Hospital.” Potential Complications Rodding is major surgery, and as with any major surgical procedure, there are potential complications. Complications from surgery include risks related to ...

219

Sinus Surgery  

MedlinePLUS

... evaluation of chronic sinusitis. Sinus Surgical Options Include: Functional endoscopic sinus surgery (FESS): Developed in the 1950s, ... altered anatomical landmarks, or where a patient?s sinus anatomy is very unusual, making typical surgery difficult. Image ...

220

Plastic Surgery  

MedlinePLUS

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

221

Brain surgery  

MedlinePLUS

Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Before surgery, the hair on part of the scalp is shaved and the area is cleaned. The doctor makes ...

222

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 ...

223

Hemorrhoid Surgery  

MedlinePLUS Videos and Cool Tools

Hemorrhoid Surgery Introduction Swollen hemorrhoids are a common condition that affects millions of people. Your doctor may recommend a ... months later. Hemorrhoids could come back. After the Surgery Most patients go home the same day of ...

224

After Surgery  

MedlinePLUS

... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

225

Flap Edge Aeroacoustic Measurements and Predictions  

NASA Technical Reports Server (NTRS)

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 methods developed herein.

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

2000-01-01

226

Flap Edge Aeroacoustic Measurements and Predictions  

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

227

Combined use of gastric pull-up and pectoralis major flaps for massive defects after total laryngopharyngoesophagectomy in patients with advanced hypopharyngeal carcinoma.  

PubMed

Reconstruction for patients with advanced squamous cell carcinoma of the hypopharynx (SCCHP) after radical surgery is a challenge for head and neck surgeons, especially when one flap alone cannot entirely cover the defects. In this report, we describe the successful use of gastric pull-up combined with pectoralis major flaps for single-stage reconstruction after total laryngopharyngoesophagectomy in patients with SCCHP. We retrospectively reviewed the records of 23 patients with stage IV SCCHP who underwent this reconstructive procedure. Surgical details and perioperative morbidity were described, and functional and oncologic outcomes were evaluated. We used the gastric pull-up and pectoralis major flap procedure to reconstruct the defects for all 23 patients. In 13 patients the combined flaps were used to restore intestinal continuity, and in 10 patients the defects were repaired using gastric pull-up alone and covered by the pectoralis major flap. All the combined flaps worked well, and patients recovered normal swallowing function a mean 19.6 days after surgery. After an overall mean follow-up time of 25.3 months, six patients were still alive at the time of this analysis with no evidence of disease. Our results indicate that for patients with advanced SCCHP after total laryngopharyngoesophagectomy, using a pectoralis major flap combined with gastric pull-up enables one-stage reconstruction even when gastric pull-up alone cannot restore intestinal continuity. Furthermore, the functional and oncologic outcomes from this study suggest that this reconstructive procedure is safe and reliable, and more patients with advanced disease could be considered. PMID:25488278

Zhang, Caiyun; Chen, Shicai; Zhu, Minhui; Chen, Donghui; Chen, Hezhong; Zheng, Hongliang

2014-12-01

228

Femtosecond laser versus mechanical microkeratome-assisted flap creation for LASIK: a prospective, randomized, paired-eye study  

PubMed Central

Purpose To compare a femtosecond laser with a microkeratome for flap creation during laser in situ keratomileusis (LASIK) in terms of flap thickness predictability and visual outcomes. Patients and methods This was a prospective, randomized, masked, paired-eye study. Forty-four patients (34 females) who received bilateral LASIK were included. Patients were stratified by ocular dominance, and they then underwent randomization of flap creation using the femtosecond laser on one eye and undergoing the microkeratome procedure on the other one. The visual outcome differences between the corrected distance visual acuity (CDVA) at baseline and the uncorrected distance visual acuity (UDVA) on the first day postoperatively were set as the efficiency index for both groups. All visual acuity outcome results and the deviation of flap thickness were evaluated. P-values <0.05 were considered statistically significant. Results The index of efficiency regarding the postoperative visual outcomes in the microkeratome group was lower (P<0.0001). This result was correlated with the difference between intended and achieved flap thickness (P=0.038; r=0.28), and a negative relationship in the regression analysis was confirmed (P<0.04; R2=0.1428). The UDVA in the microkeratome group improved significantly by the end of the first month (P<0.0271) in comparison to the baseline CDVA. The deviation between intended and postoperative flap thickness using either optical coherence pachymetry or Heidelberg Retinal Tomography II confocal microscopy was statistically significant (paired t-test; P<0.001) between the groups. The flap thickness deviation in the microkeratome group was higher. In the femtosecond laser group, the efficiency index was stable postoperatively (P=0.64) The UDVA improved significantly by the end of the first postoperative week (P=0.0043) in comparison to the baseline CDVA. Six months after surgery, improvement in the UDVA was significant in both groups (all P<0.001; one way analysis of variance). Conclusion Femtosecond laser was superior to microkeratome-assisted LASIK in terms of flap thickness predictability and the speed of visual acuity recovery. A negative relationship in the regression analysis between increasing flap thickness deviation and visual acuity recovery was confirmed. PMID:25284975

Pajic, Bojan; Vastardis, Iraklis; Pajic-Eggspuehler, Brigitte; Gatzioufas, Zisis; Hafezi, Farhad

2014-01-01

229

Urethroplasty by Use of Turnover Flaps (Modified Mathieu Procedure) for Distal Hypospadias Repair in Adolescents: Comparison With the Tubularized Incised Plate Procedure  

PubMed Central

Purpose The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery. Materials and Methods Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively. Results The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030). Conclusions The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP. PMID:25405018

Bae, Seong Ho; Lee, Jun Nyung; Kim, Hyun Tae

2014-01-01

230

Gurney flap—Lift enhancement, mechanisms and applications  

NASA Astrophysics Data System (ADS)

Since its invention by a race car driver Dan Gurney in 1960s, the Gurney flap has been used to enhance the aerodynamics performance of subsonic and supercritical airfoils, high-lift devices and delta wings. In order to take stock of recent research and development of Gurney flap, we have carried out a review of the characteristics and mechanisms of lift enhancement by the Gurney flap and its applications. Optimum design of the Gurney flap is also summarized in this paper. For the Gurney flap to be effective, it should be mounted at the trailing edge perpendicular to the chord line of airfoil or wing. The flap height must be of the order of local boundary layer thickness. For subsonic airfoils, an additional Gurney flap increases the pressure on the upstream surface of the Gurney flap, which increases the total pressure of the lower surface. At the same time, a long wake downstream of the flap containing a pair of counter-rotating vortices can delay or eliminate the flow separation near the trailing edge on the upper surface. Correspondingly, the total suction on the airfoil is increased. For supercritical airfoils, the lift enhancement of the Gurney flap mainly comes from its ability to shift the shock on the upper surface in the downstream. Applications of the Gurney flap to modern aircraft design are also discussed in this review.

Wang, J. J.; Li, Y. C.; Choi, K.-S.

2008-01-01

231

Precaution against postoperative venous complications after major hepatectomy using the pedicled omental transposition flap: Report of two cases  

PubMed Central

INTRODUCTION Vascular complications following hepato-pancreatic biliary surgery can be devastating, and therefore precaution of them must be critical. We report two cases in which the pedicled omental transposition flap might be effective to avoid postoperative venous complications following major hepatectomy. PRESENTATION OF CASE Case 1 is a 80-year-old male who required to perform re-laparotomy at postoperative day 1 following major hepatectomy due to acute portal venous thrombosis (PVT). In the second surgery, the main trunk of PV was occluded by thrombus resulted from its redundancy and kinking. PV was resected with an adequate length and reconstructed. The omental flap was placed between PV and inferior vena cava (IVC) to fill in the dead space, resulting in favorable intrahepatic portal blood flow. Case 2 is a 64-year-old male who underwent left trisectionectomy because of giant hepatocellular carcinoma located close to the trunk of right hepatic vein (RHV) and IVC. After removal of the specimens, the dead space developed between the RHV and IVC. In order to prevent outflow block caused by kinking of the RHV, the omental flap was placed between the RHV and IVC, and the right triangle ligament of the liver was fixed to the diaphragm. RHV patency was confirmed by postoperative imaging. DISCUSSION The omental flap is a simple procedure and useful to fill the dead space developed in the area surrounding major vessels. CONCLUSIONS We experienced two cases in which vascular complications might be avoided by filling the dead space surrounding major vessels using the omental flap. PMID:25194595

Narita, Masato; Matsusue, Ryo; Hata, Hiroaki; Yamaguchi, Takashi; Otani, Tetsushi; Ikai, Iwao

2014-01-01

232

Enhanced Correlation of SMART Active Flap Rotor Loads  

NASA Technical Reports Server (NTRS)

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.

Kottapalli, Sesi

2011-01-01

233

Correlation of Smart Active Flap Rotor Loads  

NASA Technical Reports Server (NTRS)

The ability to predict SMART active trailing edge flap rotor loads is explored in this study. Full-scale wind tunnel data recently acquired in the NASA Ames 40- by 80- Foot Wind Tunnel are compared with analytical results from CAMRAD II. For the 5-bladed rotor, two high-speed forward flight cases are considered, namely, a 0 deg flap deflection case and a 5P, 2 deg flap deflection case. Overall, the correlation is reasonable, with the following exceptions: the torsion moment frequency and the chordwise bending moment are under predicted. In general, the effect of the 5P, 2 deg flap motion is captured by the analysis, though there is over prediction in the neighborhood of the 105 deg and 120 deg azimuthal locations. Changes to the flexbeam torsion stiffness are also briefly considered in this study, as this stiffness will be updated in the future. Finally, the indication is that compressibility effects are important, and this suggests that computational fluid dynamics might improve the current correlation.

Kottapalli, Sesi; Straub, Friedrich

2009-01-01

234

The Flexible Learning Approach to Physics: FLAP  

NASA Astrophysics Data System (ADS)

Major changes in the teaching of physics at university are already underway and more are imminent. These are driven by the need to accommodate changes in schools and to effect the planned general expansion of the higher education sector. The Flexible Learning Approach to Physics (FLAP) is one major response to this situation.

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

1993-09-01

235

Anomalous Hydrodynamic Drafting of Interacting Flapping Flags  

Microsoft Academic Search

In aggregates of objects moving through a fluid, bodies downstream of a leader generally experience reduced drag force. This conventional drafting holds for objects of fixed shape, but interactions of deformable bodies in a flow are poorly understood, as in schools of fish. In our experiments on ``schooling'' flapping flags, we find that it is the leader of a group

Leif Ristroph; Jun Zhang

2008-01-01

236

Dynamics of Flapping Flag in Axial Flow  

Microsoft Academic Search

We investigate experimentally the phenomenon of the flapping of a flag, placed within a low turbulent axial flow inside a small scale wind tunnel test section. Flags of different sizes and flexural rigidities were used. Image processing technique was used and the time series of a given point on the edge of the flag was analyzed. The stability condition of

Hamid Ait Abderrahmane; Mohamed Fayed; Amy-Lee Gunter; Michael P. Paidoussis; Hoi Dick Ng

2010-01-01

237

Analysis of non-symmetrical flapping airfoils  

Microsoft Academic Search

Simulations have been done to assess the lift, thrust and propulsive efficiency of different types of non-symmetrical airfoils under different flapping configurations. The variables involved are reduced frequency, Strouhal number, pitch amplitude and phase angle. In order to analyze the variables more efficiently, the design of experiments using the response surface methodology is applied. Results show that both the variables

W. B. Tay; K. B. Lim

2009-01-01

238

Optical flow on a flapping wing robot  

Microsoft Academic Search

Optical flow sensing techniques are promising for obstacle avoidance, distance regulation, and moving target tracking, particularly for small mobile robots with limited power and payload constraints. Most optical flow sensing experimental work has been done on mobile platforms which are relatively steady in rotation, unlike the pitching motion expected on flapping wing flyers. In order to assess the feasibility of

Fernando Garcia Bermudez; Ronald S. Fearing

2009-01-01

239

Analysis of Non-symmetrical Flapping Airfoils  

Microsoft Academic Search

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

Wee Beng Tay; Kah Bin Lim

2007-01-01

240

Computation of Lifting Wing-Flap Configurations  

NASA Technical Reports Server (NTRS)

Research has been carried out on the computation of lifting wing-flap configurations. The long term goal of the research is to develop improved computational tools for the analysis and design of high lift systems. Results show that state-of-the-art computational methods are sufficient to predict time-averaged lift and overall flow field characteristics on simple high-lift configurations. Recently there has been an increased interest in the problem of airframe generated noise and experiments carried out in the 7 x 10 wind tunnel at NASA Ames have identified the flap edge as an important source of noise. A follow-on set of experiments will be conducted toward the end of 1995. The computations being carried out under this project are coordinated with these experiments. In particular, the model geometry being used in the computations is the same as that in the experiments. The geometry consists of a NACA 63-215 Mod B airfoil section which spans the 7 x lO tunnel. The wing is unswept and has an aspect ratio of two. A 30% chord Fowler flap is deployed modifications of the flap edge geometry have been shown to be effective in reducing noise and the existing code is currently being used to compute the effect of a modified geometry on the edge flow.

Cantwell, Brian; Kwak, Dochan

1996-01-01

241

A Miniature Controllable Flapping Wing Robot  

NASA Astrophysics Data System (ADS)

The agility and miniature size of nature's flapping wing fliers has long baffled researchers, inspiring biological studies, aerodynamic simulations, and attempts to engineer their robotic replicas. Flapping wing flight is characterized by complex reciprocating wing kinematics, transient aerodynamic effects, and very small body lengths. These characteristics render robotic flapping wing aerial vehicles ideal for surveillance and defense applications, search and rescue missions, and environment monitoring, where their ability to hover and high maneuverability is immensely beneficial. One of the many difficulties in creating flapping wing based miniature robotic aerial vehicles lies in generating a proper wing trajectory that would result in sufficient lift forces for hovering and maneuvering. Since design of a flapping wing system is a balance between overall weight and the number of actuated inputs, we take the approach of having minimal controlled inputs, allowing passive behavior wherever possible. Hence, we propose a completely passive wing pitch reversal design that relies on wing inertial dynamics, an elastic energy storage mechanism, and low Reynolds number aerodynamic effects. Theoretical models, compiling previous research on piezoelectric actuators, four-bar transmissions, and aerodynamics effects, are developed and used as basis for a complete numerical simulation. Limitations of the model are discussed in comparison to experimental results obtained from a working prototype of the proposed passive pitch reversal flapping wing mechanism. Given that the mechanism is under-actuated, methods to control lift force generation by actively varying system parameters are proposed, discussed, and tested experimentally. A dual wing aerial platform is developed based on the passive pitch reversal wing concept. Design considerations are presented, favoring controllability and structural rigidity of the final platform. Finite element analysis and experimental characterization is performed on the proposed design, yielding acceptable coupling and rigidity characteristics. A working prototype is manufactured from carbon composites and characterized for its lift production capabilities. A scaling law based on momentum flow theory and design scaling arguments is developed, predicting an increase of lift-to-weight ratio of the robot with decreasing size. Per the theoretical considerations, a scaled down prototype of the robot is manufactured and experimentally characterized. System geometry and parameters were optimized based on the developed full system theoretical model to yield maximum lift force. Finally, preliminary control is attempted on the flapping platform employing a decoupled methodology for the roll and pitch direction. A simple Proportional Integral Derivative controller is implemented on the experimental prototype mounted on a motion constraining rig, yielding acceptable trajectory tracking characteristics.

Arabagi, Veaceslav Gheorghe

242

Partial auricular reconstruction with porous polyethylene frameworks and superficial temporoparietal fascia flap.  

PubMed

Untreated acquired auricular damage can be a psychological burden, especially for younger patients. The significance of auricular reconstruction in patients with microtia in terms of quality of life has already been demonstrated. In these patients the use of porous polyethylene combined with a temporoparietal fascia flap has proven to be a suitable method for achieving good cosmetic results. Here, we describe how to use porous polyethylene combined with an endoscopically harvested temporoparietal fascia flap and autologous skin grafts for the reconstruction of acquired partial auricle defects and present outcomes and patient benefit. Ten consecutive patients were asked to answer validated questionnaires [modified Glasgow Benefit Inventory (GBI)] determining the effects of partial ear reconstruction on their health-related quality of life. These patients were seen regularly in our outpatient clinic for documentation and postoperative counseling. All patients returned a valid questionnaire; 80% were satisfied with the esthetic result. In retrospect, all patients would again decide to undergo surgery. The mean total GBI score was 27.8 (median 29.2, p < 0.05) reflecting an improvement of the health-related quality of life due to the operation. Odd feeling, numbness and the formation of scar tissue were the main complaints. Partial auricular reconstruction using porous polyethylene combined with an endoscopically harvested temporoparietal fascia flap and autologous skin grafts yields good esthetic results and can significantly increase patient's health-related quality of life. PMID:24213274

Hempel, John-Martin; Braun, Thomas; Patscheider, Martin; Berghaus, Alexander; Kisser, Ulrich

2014-10-01

243

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

PubMed

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

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

2014-09-01

244

Reconstruction of the Lower Extremity Using Free Flaps  

PubMed Central

Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes and sites of defects, types of flaps, recipient vessels, types of anastomosis, survival rate, and complications. Results There were 42 men and 10 women with a mean age of 32.7 years (range, 3-72 years). The sites of defects included the dorsum of the foot (19), pretibial area (17), ankle (7), heel (5) and other sites (4). The types of free flap included latissimus dorsi muscle flap (10), scapular fascial flap (6), anterolateral thigh flap (6), and other flaps (30). There were four cases of vascular complications, out of which two flaps survived after intervention. The overall survival of the flaps was 96.2% (50/52). There were 19 cases of other complications at recipient sites such as partial graft loss (8), partial flap necrosis (6) and infection (5). However, these complications were not notable and were resolved with skin grafts. Conclusions The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site. PMID:24086813

Kang, Min Jo; Chang, Yong Joon; Kim, Kyul Hee

2013-01-01

245

A new flap alternative for trochanteric pressure sore coverage: distal gluteus maximus musculocutaneous advancement flap.  

PubMed

Management of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap. PMID:24051465

Nisanci, Mustafa; Sahin, Ismail; Eski, Muhitdin; Alhan, Dogan

2015-02-01

246

Autologous breast reconstruction: preoperative magnetic resonance angiography for perforator flap vessel mapping.  

PubMed

Background?Selection of a vascular pedicle for autologous breast reconstruction is time consuming and depends on visual evaluation during the surgery. Preoperative imaging of donor site for mapping the perforator artery anatomy greatly improves the efficiency of perforator selection and significantly reduces the operative time. In this article, we present our experience with magnetic resonance angiography (MRA) for perforator vessel mapping including MRA technique and interpretation. Methods?We have performed over 400 MRA examinations from August 2008 to August 2013 at our institution for preoperative imaging of donor site for mapping the perforator vessel anatomy. Using our optimized imaging protocol with blood pool magnetic resonance imaging contrast agents, multiple donor sites can be imaged in a single MRA examination. Following imaging using the postprocessing and reporting tool, we estimated incidence of commonly used perforators for autologous breast reconstruction. Results?In our practice, anterior abdominal wall tissue is the most commonly used donor site for perforator flap breast reconstruction and deep inferior epigastric artery perforators are the most commonly used vascular pedicle. A thigh flap, based on the profunda femoral artery perforator has become the second most used flap at our institution. In addition, MRA imaging also showed evidence of metastatic disease in 4% of our patient subset. Conclusion?Our MRA technique allows the surgeons to confidently assess multiple donor sites for the best perforator and flap design. In conclusion, a well-performed MRA with specific postprocessing provides an accurate method for mapping perforator vessel, at the same time avoiding ionizing radiation. PMID:24875438

Agrawal, Mukta D; Thimmappa, Nanda Deepa; Vasile, Julie V; Levine, Joshua L; Allen, Robert J; Greenspun, David T; Ahn, Christina Y; Chen, Constance M; Hedgire, Sandeep S; Prince, Martin R

2015-01-01

247

Use of Extraocular Muscle Flaps in the Correction of Orbital Implant Exposure  

PubMed Central

Purposes The study is to describe a new surgical technique for correcting large orbital implant exposure with extraocular muscle flaps and to propose a treatment algorithm for orbital implant exposure. Methods In a retrospective study, seven patients with orbital implant exposure were treated with extraocular muscle flaps. All data were collected from patients in Chang Gung Memorial Hospital, Taiwan during 2007–2012. All surgeries were performed by one surgeon (Y.J.T). Patient demographics, the original etiology, details of surgical procedures, implant types, and follow-up interval were recorded. Small exposure, defined as exposure area smaller than 3 mm in diameter, was treated conservatively first with topical lubricant and prophylactic antibiotics. Larger defects were managed surgically. Results Seven patients consisting of two males and five females were successfully treated for orbital implant exposure with extraocular muscle flaps. The average age was 36.4 (range, 3–55) years old. Five patients were referred from other hospitals. One eye was enucleated for retinoblastoma. The other six eyes were eviscerated, including one for endophthalmitis and five for trauma. Mean follow-up time of all seven patients was 19.5 (range, 2–60) months. No patient developed recurrence of exposure during follow-up. All patients were fitted with an acceptable prosthesis and had satisfactory cosmetic and functional results. Conclusions The most common complication of orbital implant is exposure, caused by breakdown of the covering layers, leading to extrusion. Several methods were reported to manage the exposed implants. We report our experience of treating implant exposure with extraocular muscle flaps to establish a well-vascularized environment that supplies both the wrapping material and the overlying ocular surface tissue. We believe it can work as a good strategy to manage or to prevent orbital implant exposure. PMID:24086260

Chu, Hsueh-Yen; Liao, Yi-Lin; Tsai, Yueh-Ju; Chu, Yen-Chang; Wu, Shu-Ya; Ma, Lih

2013-01-01

248

Intraoperative template-molded bone flap reconstruction for patient-specific cranioplasty.  

PubMed

Cranioplasty is a common neurosurgical procedure. Free-hand molding of polymethyl methacrylate (PMMA) cement into complex three-dimensional shapes is often time-consuming and may result in disappointing cosmetic outcomes. Computer-assisted patient-specific implants address these disadvantages but are associated with long production times and high costs. In this study, we evaluated the clinical, radiological, and cosmetic outcomes of a time-saving and inexpensive intraoperative method to mold custom-made implants for immediate single-stage or delayed cranioplasty. Data were collected from patients in whom cranioplasty became necessary after removal of bone flaps affected by intracranial infection, tumor invasion, or trauma. A PMMA replica was cast between a negative form of the patient's own bone flap and the original bone flap with exactly the same shape, thickness, and dimensions. Clinical and radiological follow-up was performed 2 months post-surgery. Patient satisfaction (Odom criteria) and cosmesis (visual analogue scale for cosmesis) were evaluated 1 to 3 years after cranioplasty. Twenty-seven patients underwent intraoperative template-molded patient-specific cranioplasty with PMMA. The indications for cranioplasty included bone flap infection (56%, n?=?15), calvarian tumor resection (37%, n?=?10), and defect after trauma (7%, n?=?2). The mean duration of the molding procedure was 19?±?7 min. Excellent radiological implant alignment was achieved in 94% of the cases. All (n?=?23) but one patient rated the cosmetic outcome (mean 1.4 years after cranioplasty) as excellent (70%, n?=?16) or good (26%, n?=?6). Intraoperative cast-molded reconstructive cranioplasty is a feasible, accurate, fast, and cost-efficient technique that results in excellent cosmetic outcomes, even with large and complex skull defects. PMID:22391771

Marbacher, Serge; Andereggen, Lukas; Erhardt, Salome; Fathi, Ali-Reza; Fandino, Javier; Raabe, Andreas; Beck, Jürgen

2012-10-01

249

Application of Advancement Flap After Loose Seton Placement: A Modified Two-Stage Surgical Repair of a Transsphincteric Anal Fistula  

PubMed Central

Purpose A number of techniques have been described for the treatment of a transsphincteric anal fistula. In this report, we aimed to introduce a relatively new two-stage technique, application of advancement flap after loose seton placement, to present its technical aspects and to document our results. Methods Included in this retrospective study were 13 patients (10 males, 3 females) with a mean age of 42 years who underwent a two-stage seton and advancement flap surgery for transsphincteric anal fistula between June 2008 and June 2013. In the first stage, a loose seton was placed in the fistula tract, and in the second stage, which was performed three months later, the internal and external orifices were closed with advancement flaps. Results All the patients were discharged on the first postoperative day. The mean follow-up period was 34 months. Only one patient reported anal rigidity and intermittent pain, which was eventually resolved with conservative measures. The mean postoperative Wexner incontinence score was 1. No recurrence or complications were observed, and no further surgical intervention was required during follow-up. Conclusion The two-stage seton and advancement flap technique is very efficient and seems to be a good alternative for the treatment of a transsphincteric anal fistula. PMID:25210689

Ertem, Metin; Gok, Hakan; Ozveri, Emel

2014-01-01

250

Health-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap  

PubMed Central

Objectives: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Mandibular resection has been associated with a poor health-related quality of life (HRQOL), particularly before free fibula flap to reconstruct the defect. The aim of this study was to evaluate health-related quality of life in patients who have had mandibular resections of oral cancer and reconstruction with free fibula flap. Study Designs: There were 115 consecutive patients between 2008 and 2011 who were treated by primary surgery for oral squamous cell carcinoma, 34 patients had a mandibular resection. HRQOL was assessed by means of the 14-item Oral Health Impact Profile (OHIP-14) and University of Washington Quality of Life (UW-QOL) questionnaires after 12 months postoperatively. Results: In the UW-QOL the best-scoring domain was mood, whereas the lowest scores were for chewing and saliva. In the OHIP-14 the lowest-scoring domain was social disability, followed by handicap, and psychological disability. Conclusions: Mandible reconstruction with free fibula flap would have significantly influenced on patients’quality of life and oral functions. The socio-cultural data show a fairly low level of education for the majority of patients. Key words:Health-related quality of life, free fibula flap, mandibulectomy, UW-QOL, OHIP-14. PMID:24608209

Yang, Wenli; Liu, Fei; Sun, Minglei

2014-01-01

251

[Lid Reconstruction for Large Lower Eyelid Defects (Extending into Canthus) with Hughes Flap and Skin Graft - Possibilities and Limitations.  

PubMed

Purpose: The aim of lid reconstruction is restoration of function, comfort and cosmesis. Large defects of the lower eyelid especially with extension into the canthus are a surgical challenge. A Hughes flap combined with a skin graft is a good option not only for central defects of the lower eyelid. Methods: This article presents the surgical outcome in a series of 45 patients with large full-thickness lower eyelid defects partially extended into the canthus after tumour excision. These patients underwent reconstructive eyelid surgery using a Hughes flap, autogenous skin graft, partially combined with other surgical techniques. Results after division, possibilities and limitations are shown in this article. The analysis was based on photo documentation, surgery reports and patient statements. In all cases surgery was performed by the same surgeon. Results: 45 patients were identified during a 3-year interval. The average age at the time of eyelid reconstruction was 70.6 years (range 38-94 years). Lid defects extending into the canthus were observed in 20 patients (9 inner/11 outer canthal region). The average size of lid defect was 17?mm and ranged from 9 to 28?mm horizontally. 26 patients showed defects ??15?mm; 16 of them were identified with an extension into the canthus (8 inner/8 outer). Flap complications occurred in 14 patients after flap division; 8 with primary canthal involvement. After Hughes procedure, flap division and correction of complications (epilation, debulking, resuturing) 44 patients showed a very good lower lid position with good functional and cosmetic results. Due to incomplete lid closure 1 patient developed severe complications of corneal surface. Follow-up time ranged from 5 to 10 months (on average 6 months). In 6 patients the Hughes procedure was combined with other reconstructive techniques. Conclusions: In cases of large lower lid defects (even with extension into the canthus) the Hughes flap combined with skin graft and other reconstructive procedures leads to a well tightened lid position, shows a high grade of patient satisfaction although the complete blepharorrhaphy is necessary for 6 weeks and complications occur. For one-eyed patients a one step surgical procedure should be preferred. PMID:25275792

Sommer, F; Wozniak, K

2014-10-01

252

Applications of a semitendinosus muscle flap in two dogs.  

PubMed

The proximal half of the semitendinosus muscle can be used as a versatile vascularized local transposition flap to reconstruct anatomic faults in the adjacent perineum in dogs. The flap is easy to dissect, and the arc of rotation is considerably beyond the midline. The location, size, and direction of the major vascular pedicle from the caudal gluteal artery is conducive to dependable flap perfusion. PMID:1885335

Chambers, J N; Rawlings, C A

1991-07-01

253

A combined flap technique for earlobe reconstruction in one stage.  

PubMed

Many of the techniques available for earlobe reconstruction require that the rest of the ear is in continuity with retroauricular skin and they usually need two stages; in some cases a graft is also required. We present a method to create an earlobe in one stage and without grafts, illustrated by one case report. The technique is a combination of the flap techniques of Davis and Zenteno Alanis, using an extended retroauricular flap together with an anterior ear flap. PMID:8757675

Alconchel, M D; Rodrigo, J; Cimorra, G A

1996-06-01

254

Sepsis of the cheek over a subcutaneous forehead flap.  

PubMed

In two cases, a temporal flap was folded medially and passed through a subcutaneous tunnel superficial to the parotid gland. In both cases sepsis developed at the point at which the flap entered the mouth. In one case a spontaneous perforation occurred and the other required drainage. If one elects to fold the flap medially and pass it superficial to the zygomatic arch, the route described by Lewis and Remensnyder, i.e., deep to the masseter, is preferable. PMID:7355171

Cohen, D J; Jones, R F; Engrav, L H

1980-03-01

255

Aerosound from corner flow and flap flow  

NASA Astrophysics Data System (ADS)

Noise generation at the edge of a wing flap is analyzed. The phenomenon as a single vortex moving around a corner in an incompressible, potential flow is modelled. Vortex image retarding effects are proposed as an explanation for small Strouhal numbers. The model surface pressures, sound pressures (using Curle's theory), and Mach number dependencies agree with wind tunnel experiments. A double pressure peak is found in the model (credited to image action) which is qualitatively similar to measured sound correlations. Incompressible flow aerosound calculations are discussed. The effects of a series of vortices moving in the same idealized potential flow are also studied. The vortices are assumed to be statistically independent so their intensities can be added. The frequency of appearance of the vortices are determined from measurements. Diffraction effects caused by the presence of the wing near the dipole sound radiators on the flap surfaces are included.

Meecham, W. C.

1982-07-01

256

Aerosound from corner flow and flap flow  

NASA Technical Reports Server (NTRS)

Noise generation at the edge of a wing flap is analyzed. The phenomenon as a single vortex moving around a corner in an incompressible, potential flow is modelled. Vortex image retarding effects are proposed as an explanation for small Strouhal numbers. The model surface pressures, sound pressures (using Curle's theory), and Mach number dependencies agree with wind tunnel experiments. A double pressure peak is found in the model (credited to image action) which is qualitatively similar to measured sound correlations. Incompressible flow aerosound calculations are discussed. The effects of a series of vortices moving in the same idealized potential flow are also studied. The vortices are assumed to be statistically independent so their intensities can be added. The frequency of appearance of the vortices are determined from measurements. Diffraction effects caused by the presence of the wing near the dipole sound radiators on the flap surfaces are included.

Meecham, W. C.

1982-01-01

257

Dynamics of Flapping Flag in Axial Flow  

NASA Astrophysics Data System (ADS)

We investigate experimentally the phenomenon of the flapping of a flag, placed within a low turbulent axial flow inside a small scale wind tunnel test section. Flags of different sizes and flexural rigidities were used. Image processing technique was used and the time series of a given point on the edge of the flag was analyzed. The stability condition of the flag was obtained and compared to the recent theoretical models and numerical simulations. Afterwards, the nonlinear dynamics of the flapping was investigated using nonlinear time series method. The nonlinear dynamics is depicted in phase space and the correlation dimension of the attractors is determined. On the basis of observations made in this study, some conclusions on the existing models were drawn.

Abderrahmane, Hamid Ait; Fayed, Mohamed; Gunter, Amy-Lee; Paidoussis, Michael P.; Ng, Hoi Dick

2010-11-01

258

Segmental masseteric flap for dynamic reanimation of facial palsy.  

PubMed

The masseter muscle is one of the major chewing muscles and contributes to define facial contour. It is an important landmark for aesthetic and functional surgery and has been used for facial palsy reanimation or as source of donor motor nerve. We present an anatomic study to evaluate the possibility of using a muscle subunit for dynamic eye reanimation. Sixteen head halves were dissected under magnification to study the neurovascular distribution and determine safe muscle subunits; areas of safe/dangerous dissection were investigated. Once isolated, the arc of rotation of the muscular subunit was measured on fresh body to verify the reach to the lateral canthus. The patterns of neurovascular distribution and areas of safe dissection were identified; the anterior third of the muscle represents an ideal subunit with constant nerve and artery distribution. The muscle is too short to reach the lateral canthus; a fascia graft extension is needed. The information provided identified the main neurovascular branches and confirms the feasibility of a dynamic segmental flap. The need of efficient motor units for facial reanimation demands for different surgical options. A detailed anatomic description of the neurovascular bundle is mandatory to safely raise a functional motor subunit. PMID:24621710

Romeo, Marco; Lim, Yee Jun; Fogg, Quentin; Morley, Stephen

2014-03-01

259

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

PubMed

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

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

2014-10-01

260

Dental implant placement after mandibular reconstruction by microvascular free fibula flap: current knowledge and remaining questions.  

PubMed

Mandibular reconstruction by microvascular free fibula flap has dramatically improved the quality of life of patients treated by interruptive surgery. A simple prosthesis can be used for dental rehabilitation but in many cases, these prostheses remain nonfunctional. The use of osseointegrated implants restores both function and aesthetics. The technique for implantation in fibula flap is very similar to the technique in native mandible but access to the bone is the most difficult step of the surgery. The success rate for osteointegration ranges from 86% to 99% but the success rate of the prosthesis is much lower. This difference could be explained by the vertical discrepancy between the graft and the remaining mandible, which leads to an unfavourable implant-crown ratio. The quality of soft tissues is also a limiting factor for the prosthesis, and hypertrophy often appears after the placement of the abutments. The type of the prosthesis (fixed or removable) should also be discussed. Occlusal considerations should be highlighted as occlusion remains abnormal in many cases. Three-dimensional imaging might help in the planning of these complex reconstructions. A close collaboration between the maxillo-facial surgeon, the oral surgeon and the prosthodontist is necessary to obtain good results. PMID:21873106

Anne-Gaëlle, Bodard; Samuel, Salino; Julie, Bémer; Renaud, Lucas; Pierre, Breton

2011-12-01

261

Locomotory Advantages to Flapping Out of Phase  

Microsoft Academic Search

The interactions between two fish swimming side by side are examined. An inviscid fluid model is employed to argue that flapping\\u000a out of phase can lead to locomotory advantages for both fish. Two effects are examined: (a) the effect of the cooperation\\u000a between the wakes of the two fish in increasing their forward swimming velocities and (b) the effect of

E. Kanso; P. K. Newton

2010-01-01

262

Analysis of non-symmetrical flapping airfoils  

Microsoft Academic Search

Simulations have been done to assess the lift, thrust and propulsive efficiency of different types of non-symmetrical airfoils\\u000a under different flapping configurations. The variables involved are reduced frequency, Strouhal number, pitch amplitude and\\u000a phase angle. In order to analyze the variables more efficiently, the design of experiments using the response surface methodology\\u000a is applied. Results show that both the variables

W. B. Tay; K. B. Lim

2009-01-01

263

Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.  

PubMed

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

Lu, Shengdi; Chai, Yimin; Wang, Chunyang; Wen, Gen

2014-02-01

264

Moustache reconstruction using an extended midline forehead flap.  

PubMed

A new method for reconstruction of the upper lip and moustache is presented. An extended midline forehead flap is described, which is a modification of the classical midline forehead flap in which the flap is extended into the hair-bearing scalp. Simultaneously, a nasal alar defect was reconstructed using the non-hair-bearing forehead skin in a patient with cancrum oris. The flap is reliable, technically easy to raise, does not require any special expertise and causes minimal donor site deformity. However, it is a multistage procedure and hence causes prolonged morbidity. PMID:11207129

Agrawal, K; Panda, K N

2001-03-01

265

Breast reconstruction using the lateral femoral circumflex artery perforator flap.  

PubMed

The development of microsurgical breast reconstruction has resulted in not only the lower abdomen as a source of donor site tissue but also interest in alternative donor sites. These have included perforator-based flaps at the sites of previously described myocutaneous flaps (e.g., superior or inferior gluteal arteries) and the use of myocutaneous flaps not previously used for breast reconstruction (e.g., gracilis or transverse upper gracilis). We present our experience with a unique form of the tensor fascia lata flap and describe the first reported use of the lateral femoral circumflex artery (LFCA) perforator flap for breast reconstruction. A patient with minimal abdominal fat but lipodystrophy of the upper lateral thighs presented for breast reconstruction. Perforator flaps based on the lateral femoral circumflex vessels were designed. The LFCA perforator flap from one side was successfully used for breast reconstruction. The flap on the contralateral side did not have a suitable perforator. The LFCA perforator flap offers another option for women seeking autogenous breast reconstruction. Advances in preoperative imaging will likely make this a more reliable option. PMID:21766271

Kind, Gabriel M; Foster, Robert D

2011-09-01

266

The propeller flap concept used in vaginal wall reconstruction.  

PubMed

Most posterior vaginal wall defects are due to abdominoperineal resection for colorectal carcinoma involving the posterior vaginal wall or resection of local malignancies. The rectus abdominis myocutaneous flap, the modified Singapore flap and the gracilis myocutaneous flap remain workhorse solutions for this type of vaginal reconstruction. The introduction of the perforator concept has introduced new therapeutic options using the gluteal donor site region. Recently, perforator-based gluteal flaps have been described as a reliable solution for reconstruction of posterior vaginal wall defects, with low donor site morbidity. Here, we present a new technique to optimise results and minimise morbidity to the patient. PMID:22133384

Smeets, L; Hendrickx, B; Teo, T C

2012-05-01

267

Theoretical and experimental study on the ejector augmented jet flap  

NASA Technical Reports Server (NTRS)

The analytical concept used in determining the characteristics of jet flap or related propulsive systems suitable for VTOL and STOL applications was examined. The configuration chosen was a two dimensional wing with a biplane flap, having a jet injected on the upper surface of the wing at the flap hinge axis and discharging into the channel between the two elements of the flap. The experimental work was conducted in a two dimensional test installation in a subsonic wind tunnel. The model description, the test conditions, and a summary of the experimental results are presented.

Stewart, H. J.

1974-01-01

268

Development of a morphing flap using shape memory alloy actuators: the aerodynamic characteristics of a morphing flap  

NASA Astrophysics Data System (ADS)

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.

Ko, Seung-Hee; Bae, Jae-Sung; Rho, Jin-Ho

2014-07-01

269

Managing Flap Vortices via Separation Control  

NASA Technical Reports Server (NTRS)

A pilot study was conducted on a flapped semi-span model to investigate the concept and viability of near-wake vortex management by means of boundary layer separation control. Passive control was achieved using a simple fairing and active control was achieved via zero mass-flux blowing slots. Vortex sheet strength, estimated by integrating surface pressures, was used to predict vortex characteristics based on inviscid rollup relations and vortices trailing the flaps were mapped using a seven-hole probe. Separation control was found to have a marked effect on vortex location, strength, tangential velocity, axial velocity and size over a wide range of angles of attack and control conditions. In general, the vortex trends were well predicted by the inviscid rollup relations. Manipulation of the separated flow near the flap edges exerted significant control over either outboard or inboard edge vortices while producing small lift and moment excursions. Unsteady surface pressures indicated that dynamic separation and attachment control can be exploited to perturb vortices at wavelengths shorter than a typical wingspan. In summary, separation control has the potential for application to time-independent or time-dependent wake alleviation schemes, where the latter can be deployed to minimize adverse effects on ride-quality and dynamic structural loading.

Greenblatt, David

2006-01-01

270

Locomotion of a flapping flexible plate  

NASA Astrophysics Data System (ADS)

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.

Hua, Ru-Nan; Zhu, Luoding; Lu, Xi-Yun

2013-12-01

271

Scintigraphic evaluation of lymphatic draining pathways in patients treated with pectoralis major (PM) and deltopectoralis (DP) myocutaneous flaps for oropharyngeal cancer  

SciTech Connect

Oropharyngeal tumors are routinely treated with extensive surgical resection and radiotherapy followed by PM and DP myocutaneous flaps performed for reconstruction purposes. The lymph vessels are the main pathways of oropharyngeal tumor dissemination and play an important role in the development of local recurrences and regional tumor invasion. To evaluate the local and regional residual pathways of lymphatic drainage after flap reconstruction, 25 pts (pts) were imaged 2-3 hours post-administration of .5 mCi of Tc-99m antimony colloid in the flaps. All pts had extensive tumor resection and PM (21 pts) or DP (4 pts) flaps. Fifteen pts had neck radiotherapy prior to the scintigrams. Following are the scintigraphic findings: 1) eight pts showed no visualization of lymph nodes although 4 of these had radiocolloid accumulation within the liver; 2) contralateral or ipsilateral cervical lymph nodes were seen in 16 pts; 3) xyphoid or internal mammary nodes were seen in 4 pts; 4) axillary nodes were seen in 5 pts; 5) liver visualization was present in 12 pts. Findings indicate that pathways of lymph drainage re-establish following head and neck surgery and flap reconstruction in most pts. These pathways are variable and unpredictable and lymphoscintigraphy may therefore play a major role to predict sites of future metastases and in planning therapy.

Fernandez-Ulloa, M.; Silver, F.M.; Vasavada, P.J.

1984-01-01

272

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)

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.

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

2002-04-01

273

Analysis of functional results and quality of life following free jejunal flaps for reconstruction after upper aerodigestive neoplastic resection: the St James's experience.  

PubMed

Surgical treatment of hypopharyngeal cancers with extension to the postcricoid region generally requires a circumferential pharyngolaryngoesphagectomy followed by reconstruction of the upper aerodigestive tract. Many techniques have been described in order to achieve a safe and functional reconstruction. Interposition of the jejunal free flap (JFF) is a well-established technique and is the flap of choice in our unit. This is a retrospective review of all patients who required a JFF following pharyngolaryngoesphagectomy over an 9-year period. We studied medical charts, histological reports, and speech and language therapy assessments. Eight of the nine surviving patients completed a quality of life questionnaire. Analysis was carried out on patient demographics, flap survival, patient survival and quality of life including swallow function and speech restoration. A total of 23 patients had 24 jejunal free flaps. There were four perioperative deaths. Two flaps failed, and were salvaged with a second JFF in one case and a gastric pull-up in the second. Functioning swallow was established in 74% of patients with four patients complaining of dysphagia. Speech was restored using an electrolarynx or Blom Singer valve in 70% of patients. Most patients required radiotherapy as part of their adjuvant treatment. In our hands the JFF for reconstruction following pharyngolaryngoesophageal resection allows restoration of function following major ablative surgery. PMID:17485043

Hanson, R P; Chow, T K; Feehan, E; Eadie, P A; Timon, C T; Keogh, S

2007-01-01

274

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

Microsoft Academic Search

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

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

2001-01-01

275

Aerodynamic characteristics of wings with cambered external airfoil flaps, including lateral control, with a full-span flap  

NASA Technical Reports Server (NTRS)

The results of a wind-tunnel investigation of the NACA 23012, the NACA 23021, and the Clark Y airfoils, each equipped with a cambered external-airfoil flap, are presented in this report. The purpose of the research was to determine the relative merit of the various airfoils in combination with the cambered flap and to investigate the use of the flap as a combined lateral-control and high-lift device.

Platt, Robert C

1936-01-01

276

Navier-Stokes Computations of a Wing-Flap Model With Blowing Normal to the Flap Surface  

NASA Technical Reports Server (NTRS)

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.

Boyd, D. Douglas, Jr.

2005-01-01

277

Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications  

PubMed Central

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours. PMID:25396184

Mok, Wan Loong James; Por, Yong Chen

2014-01-01

278

Trends in head and neck microvascular reconstructive surgery in Liverpool (1992–2001)  

Microsoft Academic Search

Microvascular reconstructive techniques in head and neck surgery are well established, but we are now entering an era of modification exemplified by perforator and free style free flaps. We present a review of the database introduced into the unit in 1992 over a 10-year period, during which time 977 patients with malignant disease were operated on and 620 defects were

J. S. Brown; P. Magennis; S. N. Rogers; J. I. Cawood; R. Howell; E. D. Vaughan

2006-01-01

279

Practical Considerations for Perforator Flap Thinning Procedures Revisited  

PubMed Central

Background A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. Methods We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution. The second study was done on four cadavers independently from the first study. Last, a clinical series was performed on 15 patients. Results The areolar fat lobules of 10 anterolateral thigh perforator (ALT), seven deep inferior epigastric artery perforator (DIEAP), and six thoracodorsal artery perforator (TAP) flaps were dissected to reduce the flap thickness guided by the colored vascular pattern. On average, the ALT, DIEAP, and TAP flaps were reduced to 32.76%±9.76%, 37.01%±9.21%, and 35.42%±9.41%, respectively. In the second study, the areolar fat lobules were directly dissected in six ALT, six TAP, and four MSAP flaps, and an average reduction in flap thickness of 53.41%±5.64%, 52.30%±2.88%, and 47.87%±6.41%, respectively, was found. In the clinical series, 13 out of the 15 cases yielded satisfactory outcomes with an average thickness reduction of 37.91%±7.15%. Conclusions These multiple studies showed that the deep fat layer could be safely removed to obtain a thin yet viable perforator flap. This evidence suggests that the macroscopic flap thinning technique can achieve thin flaps. Surgeons should consider this technique before embracing the latest technique of supermicrosurgery. PMID:25396182

Bangun, Kristaninta; Buchari, Frank B; Rezkini, Putri

2014-01-01

280

Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study  

PubMed Central

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

Pennington, David G.

2014-01-01

281

Bariatric Surgery  

MedlinePLUS

... to monitor the effects of surgery. How are postoperative nutritional deficiencies managed? Because your body absorbs fewer ... Vomiting occurs most commonly during the first few postoperative months, when you are adapting to a small ...

282

Thyroid Surgery  

MedlinePLUS

... especially true if you had surgery for thyroid cancer. Thyroid hormone replacement therapy may be delayed for several ... you are to receive radioactive iodine therapy (see Thyroid Cancer brochure ). Further Information Further details on this and ...

283

Osseous Surgery  

MedlinePLUS

... Before your surgery, you need to have basic periodontal treatment called scaling and root planing. You also ... be covered with a bandage known as a periodontal pack or dressing. Follow-Up You may get ...

284

Thyroid surgery.  

PubMed

Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel(®) (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery. PMID:22192610

Cheng, Leo H-H; Hutchison, Iain L

2012-10-01

285

Oculoplastic surgery.  

PubMed

Esthetic and functional surgery in the periocular region falls into the domain of oculoplastic surgeons, as well as plastic surgeons and otorhinolaryngologists with training in facial plastic surgery. This article provides a description of 8 common eyelid procedures that are routinely performed under local anesthesia, with or without mild intravenous sedation. Serious complications are rare. The rate of postoperative infection in the highly vascularized eyelid tissues is less than 1% in our experience. PMID:24093658

Mehta, Sonul; Belliveau, Michel J; Oestreicher, James H

2013-10-01

286

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

E-print Network

IMU 5 Degrees of Freedom ] Controller unit [ Mini 2-Axes Motor Drive ] Tail rotor Main motor Li - Po), the controller unit (the micro- computer and the 2D motor driver), our flapping-wing robot, and Li-Po battery for measuring the robot's attitude an- gles and the controller unit composed of the microcom- puter and the 2D

Kimura, Hiroshi

287

External Dacryocystorhinostomy with and Without Suturing the Posterior Mucosal Flaps  

PubMed Central

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

Kaçaniku, Gazmend; Begolli, Ilir

2014-01-01

288

Active Flap Control of the SMART Rotor for Vibration Reduction  

NASA Technical Reports Server (NTRS)

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.

Hall, Steven R.; Anand, R. Vaidyanathan; Straub, Friedrich K.; Lau, Benton H.

2009-01-01

289

Perforator propeller flaps for sacral and ischial soft tissue reconstruction  

PubMed Central

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications. PMID:21217972

Korambayil, Pradeoth M.; Allalasundaram, KV; Balakrishnan, TM

2010-01-01

290

Segmentals and Global Foreign Accent: The Japanese Flap in EFL.  

ERIC Educational Resources Information Center

Reports the results of research on the extent to which global foreign accent in English is related to a discrete segmental feature of pronunciation, substitution of the Japanese flap for /l/ and /r/ in two phonological environments. Results showed a strong negative correlation between a nativelike accent and flap substitution. (Author/VWL)

Riney, Timothy J.; Takada, Mari; Ota, Mitsuhiko

2000-01-01

291

Interaction of Two Flapping Flags in Axial Flow  

Microsoft Academic Search

The flapping of two parallel flags in axial low turbulence flow is investigated experimentally inside a small scale wind tunnel test section. The variables of the problem are the size and flexural rigidity of the flags, and the distance that separates the two flags. The flow velocity represents the control parameter that governs the coupling and flapping mode of the

Amy-Lee Gunter; Mohamed Fayed; Hamid Ait Abderrahmane; Michael P. Paidoussis; Hoi Dick Ng

2010-01-01

292

Search for Chaotic Behavior in a Flapping Flag  

Microsoft Academic Search

As part of an undergraduate physics lab, a flapping flag was investigated to see if chaotic behavior is present. An experiment was carried out to search for correlation of the times between successive flaps of the flag for a variety of wind speeds. We find no evidence of chaotic behavior in the return maps of such times, but instead see

J. O. McCaslin; P. R. Broussard

2007-01-01

293

Flapping and Bending Bodies Interacting with Fluid Flows  

Microsoft Academic Search

The flapping or bending of a flexible planar structure in a surrounding fluid flow, which includes the flapping of flags and the self-streamlining of flexible bodies, constitutes a central problem in the field of fluid-body interactions. Here we review recent, highly detailed experiments that reveal new nonlinear phenomena in these systems, as well as advances in theoretical understanding, resulting in

Michael J. Shelley; Jun Zhang

2011-01-01

294

Wing and gliding dynamics of a flapping winged ornithopter  

Microsoft Academic Search

The Great Albatross, having the largest wingspan of any extant bird, is a highly efficient flier, using unique flapping and gliding techniques to cover great distances with little exertion. The main issue in the development of an Albatross robot is overcoming the problem of needing to use a significant amount of material in order to simulate its flapping motion. This

GARY PARKER; JOHNNY BORBONE

2010-01-01

295

Flapping Flight for Biomimetic Robotic Insects Part I: System Modeling  

E-print Network

of independent flapping wings and are capable of sustained autonomous flight, and therefore mimic real flying and bigger size constraints. On the other hand, flapping flying insects, such as fruit flies and house flies). These vehicles, called Micromechanical Flying Insects (MFIs), are elec- tromechanical devices propelled by a pair

Sastry, S. Shankar

296

Homodigital Neurovascular Island Flaps for Digital Pulp Loss  

Microsoft Academic Search

Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981–1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the

G. FOUCHER; D. SMITH; C. PEMPINELLO; F. M. BRAUN; N. CITRON

1989-01-01

297

On Flow Separation Control by Means of Flapping Wings  

Microsoft Academic Search

Experimental and computational results for two configurations which benefit from flow separation control are presented. Both configurations operate at low Reynolds numbers, on the order of , characterized by laminar flow , often where separation is unavoidable. The first, a flapping-wing propelled micro air vehicle (MAV), consists of a biplane pair of wings flap- ping in counterphase located downstream of

Kevin D. Jones; Motomu Nakashima; Chris J. Bradshaw; Jason Papadopoulos; Max F. Platzer

298

Efficiency of an auto-propelled flapping airfoil  

Microsoft Academic Search

The present study deals with an investigation of the flow aerodynamic characteristics and the propulsive velocity of a system equipped with a nature inspired propulsion system. In particular, the study is aimed at studying the effect of the flapping frequency on the flow behavior. We consider a NACA0014 airfoil undergoing a vertical sinusoidal flapping motion. In contrast to nearly all

T. Benkherouf; M. Mekadem; H. Oualli; S. Hanchi; L. Keirsbulck; L. Labraga

2011-01-01

299

Experience with 24 Cases of Reconstructive Anterior Skull Base Surgery  

PubMed Central

This article details our experience with 24 cases of anterior skull base reconstruction after tumor resection. They were classified into four types according to the resected region. In 11 cases of type I resection, the orbital part of frontal bone and/or cribriform plate of ethmoid bone were resected. In two cases of type II resection, the orbital contents and partial orbital bone were resected with the addition of type I. In five cases of type III resection, the maxillary bone was resected with the addition of type II. In six cases of type IV resection, the zygomatic bone and/or facial skin were resected with the addition of type III. The tumor originating from intracranial region was 25% of this series and all of them belonged to type I. The tumor originating from extracranial region tumor was 75% and its resected region was more extensive. In type I and II resections, the cranial flap, radial forearm free flap, or a combination of the two was used for reconstruction. The rectus abdominis myocutaneous/muscle free flap was used for reconstruction of massive defects in type III and IV defects. Total incidence of postoperative complications was 16.7%. Donor site deformity of the cranial flap at the frontal and temporal region in types I and II resections and facial contour deformity in zygomatic region and defect of upper and/or lower palpebra in type IV resection were major problems with postoperative facial appearance. Although use of the rectus abdominis myocutaneous free flap combined with costal cartilages improved the midfacial contour, palpebral reconstruction remained an unsolved problem in reconstructive skull base surgery. The reconstructive goals in skull base surgery are not only to obtain safe and reliable skull base reconstruction but also to restore the facial appearance postoperatively. ImagesFigure 1Figure 2Figure 3p69-bFigure 4 PMID:17171103

Yamamoto, Yuhei; Minakawa, Hidehiko; Kawashima, Kunihiro; Sugihara, Tsuneki; Fukuda, Satoshi; Sawamura, Yutaka; Watanabe, Akihito; Nohira, Kunihiko

2000-01-01

300

[Special indications for negative pressure wound therapy in dermatologic surgery].  

PubMed

In recent years negative pressure wound therapy (NPWT) has gained more and more supporters in dermatologic surgery. NPWT has become one of the standard therapeutic options, especially for non-healing diabetic, venous and arterial ulcers of the legs. When managing large wounds after tumor surgery, NPWT is frequently used to induce granulation tissue and reduce wound size before the wound is closed with split- or full-thickness skin grafts or local flaps. In addition to these well-established uses, NPWT can be also employed for a variety of "new" or rare indications, some of which are presented in this review. PMID:23896694

Valesky, E M; Kaufmann, R; Meissner, M

2013-08-01

301

Propeller Flaps: A Review of Indications, Technique, and Results  

PubMed Central

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

D'Arpa, Salvatore; Toia, Francesca; Pirrello, Roberto; Moschella, Francesco; Cordova, Adriana

2014-01-01

302

Mechanisms of viability in rabbit flank venous flaps.  

PubMed

Venous flaps may become more versatile in reconstruction and offer different opportunities to reconstructive surgeons if the mechanisms of their viability is clarified. In this study, axial pattern flank flaps in rabbits were converted into venous flaps by dividing the cutaneous pedicles and ligating the artery. Fluorescein and radioactive tracer studies were performed to elucidate the mechanisms of possible circulation. It is hypothesized that the venous flaps do not have a capillary circulation, but veins transport the fluid out, which is drawn into the capillaries from the interstitium, and that the nutrients and oxygen for flap viability diffuse from the wound bed. Venous drainage plays an important role by draining the metabolites away until revascularization offers a more direct supply. PMID:8333688

Gençosmano?lu, R; Ulgen, O; Yaman, C; Songür, E; Akin, Y; Ca?das, A

1993-01-01

303

Versatile Use of Rhomboid Flaps for Closure of Skin Defects  

PubMed Central

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.

Aydin, Osman Enver; Tan, Onder; Algan, Said; Kuduban, Selma Denktas; Cinal, Hakan; Barin, Ensar Zafer

2011-01-01

304

Study of Flapping Flight Using Discrete Vortex Method Based Simulations  

NASA Astrophysics Data System (ADS)

In recent times, research in the area of flapping flight has attracted renewed interest with an endeavor to use this mechanism in Micro Air vehicles (MAVs). For a sustained and high-endurance flight, having larger payload carrying capacity we need to identify a simple and efficient flapping-kinematics. In this paper, we have used flow visualizations and Discrete Vortex Method (DVM) based simulations for the study of flapping flight. Our results highlight that simple flapping kinematics with down-stroke period (tD) shorter than the upstroke period (tU) would produce a sustained lift. We have identified optimal asymmetry ratio (Ar = tD/tU), for which flapping-wings will produce maximum lift and find that introducing optimal wing flexibility will further enhances the lift.

Devranjan, S.; Jalikop, Shreyas V.; Sreenivas, K. R.

2013-12-01

305

Experimental investigation of a flapping wing model  

NASA Astrophysics Data System (ADS)

The main objective of this research study was to investigate the aerodynamic forces of an avian flapping wing model system. The model size and the flow conditions were chosen to approximate the flight of a goose. Direct force measurements, using a three-component balance, and PIV flow field measurements parallel and perpendicular to the oncoming flow, were performed in a wind tunnel at Reynolds numbers between 28,000 and 141,000 (3-15 m/s), throughout a range of reduced frequencies between 0.04 and 0.20. The appropriateness of quasi-steady assumptions used to compare 2D, time-averaged particle image velocimetry (PIV) measurements in the wake with direct force measurements was evaluated. The vertical force coefficient for flapping wings was typically significantly higher than the maximum coefficient of the fixed wing, implying the influence of unsteady effects, such as delayed stall, even at low reduced frequencies. This puts the validity of the quasi-steady assumption into question. The (local) change in circulation over the wing beat cycle and the circulation distribution along the wingspan were obtained from the measurements in the tip and transverse vortex planes. Flow separation could be observed in the distribution of the circulation, and while the circulation derived from the wake measurements failed to agree exactly with the absolute value of the circulation, the change in circulation over the wing beat cycle was in excellent agreement for low and moderate reduced frequencies. The comparison between the PIV measurements in the two perpendicular planes and the direct force balance measurements, show that within certain limitations the wake visualization is a powerful tool to gain insight into force generation and the flow behavior on flapping wings over the wing beat cycle.

Hubel, Tatjana Y.; Tropea, Cameron

2009-05-01

306

Experimental investigation of a flapping wing model  

NASA Astrophysics Data System (ADS)

The main objective of this research study was to investigate the aerodynamic forces of an avian flapping wing model system. The model size and the flow conditions were chosen to approximate the flight of a goose. Direct force measurements, using a three-component balance, and PIV flow field measurements parallel and perpendicular to the oncoming flow, were performed in a wind tunnel at Reynolds numbers between 28,000 and 141,000 (3-15 m/s), throughout a range of reduced frequencies between 0.04 and 0.20. The appropriateness of quasi-steady assumptions used to compare 2D, time-averaged particle image velocimetry (PIV) measurements in the wake with direct force measurements was evaluated. The vertical force coefficient for flapping wings was typically significantly higher than the maximum coefficient of the fixed wing, implying the influence of unsteady effects, such as delayed stall, even at low reduced frequencies. This puts the validity of the quasi-steady assumption into question. The (local) change in circulation over the wing beat cycle and the circulation distribution along the wingspan were obtained from the measurements in the tip and transverse vortex planes. Flow separation could be observed in the distribution of the circulation, and while the circulation derived from the wake measurements failed to agree exactly with the absolute value of the circulation, the change in circulation over the wing beat cycle was in excellent agreement for low and moderate reduced frequencies. The comparison between the PIV measurements in the two perpendicular planes and the direct force balance measurements, show that within certain limitations the wake visualization is a powerful tool to gain insight into force generation and the flow behavior on flapping wings over the wing beat cycle.

Hubel, Tatjana Y.; Tropea, Cameron

307

What Is Heart Valve Surgery?  

MedlinePLUS

... your heart are made of thin (but strong) flaps of tissue that open and close as your ... called incompetence, insufficiency or regurgitation. • Prolapse — mitral valve flaps don’t close properly (more common in women). ...

308

The failure mode analysis of motion mechanism for airbus A320 flap  

Microsoft Academic Search

Flap plays an important role in the process of the plane flying, once the flap failure may cause serious flight accidents. Based on FMEA of the A320 flap, this article summarizes the main failure modes of motion mechanism for A320 flaps, and analyzes the failure mechanism from the point view of design, tooling, use and maintenance. According to the failure

Fei Xiang; Weimin Cui; Yunlong Zhong

2011-01-01

309

Nonlinear dynamic analysis of dragonfly-inspired piezoelectric unimorph actuated flapping and twisting wing  

Microsoft Academic Search

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

Sujoy Mukherjee; Ranjan Ganguli

2012-01-01

310

Robotic Surgery  

PubMed Central

Objective: To review the history, development, and current applications of robotics in surgery. Background: Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving. Methods: A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications. Results: Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques. Conclusions: Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedures. PMID:14685095

Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C.

2004-01-01

311

DEHN SURGERY 1. Introduction  

E-print Network

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

Hachimori, Masahiro

312

Design and construction of pre-stressed piezoelectric unimorph for trailing edge flap actuation  

NASA Astrophysics Data System (ADS)

This paper presents a trailing edge flap actuation mechanism using a novel pre-stressed piezoelectric unimorph, PUMPS (Piezoelectric Unimorph with Mechanically Pre-stressed Substrate). Experimental evaluation of actuation performance such as force-displacement characteristics of PUMPS actuators showed that the performance of PUMPS satisfied the requirements for trailing edge flap actuation. Subsequently, flap actuation mechanisms were designed and constructed with several slot types in the flaps, and stacked PUMPS actuators were applied to the flap actuation mechanisms. Experimental study of the test wing models with four flaps was accomplished, and the flap angle was achieved up to +/-5.5° within 15Hz under maximum applicable voltage.

Kang, Lae-Hyong; Lee, Jong-Won; Han, Jae-Hung

2009-07-01

313

Aeroacoustic Measurements of a Wing-Flap Configuration  

NASA Technical Reports Server (NTRS)

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.

Meadows, Kristine R.; Brooks, Thomas F.; Humphreys, William M.; Hunter, William H.; Gerhold, Carl H.

1997-01-01

314

Wound surgery.  

PubMed

The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

Caldwell, Michael D

2010-12-01

315

Craniopharyngioma surgery.  

PubMed

Ideal surgical treatment of craniopharyngiomas remains a major challenge for neurosurgeons. Craniopharyngiomas grow in the deep-seated hypothalamic area that is paramount for vegetative, emotional and endocrine function, and for maintaining worthwhile life. The benign histological nature of craniopharyngiomas belies their biological behavior and the propensity to recur is a major threat. Surgical treatment has to weigh the risk of hypothalamic damage against the risk of tumor recurrence or progression. Both aggressive surgery and conservative minor surgery followed by radiotherapy has been proclaimed by the proponents of different schools. During the past decade, the pendulum has swung back to surgery with the attempt at radical removal. Refined neurosurgical techniques and innovative approaches yielded improved surgical results. The contemporary neurosurgical strategy of treating craniopharyngiomas with early and late outcome data is presented. Neurosurgical therapy is only beneficial in the context of an interdisciplinary treatment concept as discussed here. PMID:18636330

Honegger, Jürgen; Tatagiba, Marcos

2008-01-01

316

Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations  

PubMed Central

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

Schirmer, Steffen; Ritter, Ralf-Gerhard; Fansa, Hisham

2013-01-01

317

Uncertainty Analysis for a Jet Flap Airfoil  

NASA Technical Reports Server (NTRS)

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.

Green, Lawrence L.; Cruz, Josue

2006-01-01

318

Analysis of Non-symmetrical Flapping Airfoils  

NASA Astrophysics Data System (ADS)

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.

Beng Tay, Wee; Lim, Kah Bin

2007-11-01

319

[Metabolic surgery].  

PubMed

The prevalence of obesity and diabetes mellitus type 2 is constantly rising worldwide and is one of the most threatening global health and health economic problems. Whereas bariatric surgery is well established in the treatment of morbid obesity, the surgical treatment options for type 2 diabetes mellitus alone are still under discussion (metabolic surgery). Bariatric procedures differ considering weight loss and influencing associated comorbidities. Detailed knowledge of available surgical treatment options for morbid obesity, the risks and requirements of laparoscopic skills, effectiveness and, as far as already known, mechanisms of action are crucial for appropriate implementation. PMID:22695815

Jurowich, C; Germer, C T; Seyfried, F; Thalheimer, A

2012-06-01

320

Reduction of Donor Site Morbidity of Free Radial Forearm Flaps: What Level of Evidence Is Available?  

PubMed Central

Background: The radial forearm free flap (RFFF) is the most commonly used free flap in head and neck reconstructive surgery. However, despite excellent results with respect to the site of reconstruction, donor site morbidity cannot be neglected. This review summarizes the current state of knowledge and analyzes the level of evidence with regard to perioperative management of the reduction of RFFF donor site morbidity. Methods: The medical Internet source PubMed was screened for relevant articles. All relevant articles were tabulated according to the levels of scientific evidence, and the available methods for reduction of donor site morbidity are discussed. Results: Classification into levels of evidence reveals 3 publications (1.5%) with level I (randomized controlled trials), 29 (14.0%) with level II (experimental studies with no randomization, cohort studies, or outcome research), 3 (1.5%) with level III (systematic review of case-control studies or individual case-control studies), 121 (58.7%) with level IV (nonexperimental studies, such as cross-sectional trials, case series, case reports), and 15 (7.3%) with level V (narrative review or expert opinion without explicit critical appraisal). Thirty-five (17.0%) articles could not be classified, because they focused on a topic other than donor site morbidity of the RFFF. Conclusions: Although great interest has been expressed with regard to reducing the donor site morbidity of the workhorse flap in microvascular reconstruction procedures, most publications fail to provide the hard facts and solid evidence characteristic of high-quality research. PMID:22331991

Loeffelbein, Denys J.; Al-Benna, Sammy; Steinsträßer, Lars; Satanovskij, Robin M.; Rohleder, Nils H.; Mücke, Thomas; Wolff, Klaus-Dietrich; Kesting, Marco R.

2012-01-01

321

The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women  

PubMed Central

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

Kim, Byung Jun; Choi, Jun Ho; Kim, Tae Hoon; Jin, Ung Sik; Minn, Kyung Won

2014-01-01

322

Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft  

PubMed Central

Background Vascularized medial femoral condyle (MFC) corticoperiosteal bone-flap is a well-accepted technique when dealing with tissue defects or infection. Its role in refractory conditions and in the possible use for options concerning modifications of this bone-flap compared to a conventional iliac bone graft (conventional-graft) are rarely discussed. Methods We reviewed 21 consecutive cases concerning alternatives with some modifications of original MFC bone-flap surgery used to treat refractory conditions with bone defects, necrosis, or infection in the extremities. We present our devised approaches for this boneflap, and especially modifications of the grafted bone (including strut bone, perforator to the vastus medialis muscle, and the use of one vascular pedicle for some bone flaps) as well as the combined use of artificial bone as hybrid bone transplantation. We also compared the clinical results of 21 cases that received a conventional-graft. Results and Conclusions Following flap placement, 100% of the nonunion sites healed in an average of 2 months, which was significantly shorter than 5.5 months for the conventional-graft. The results showed the expanding possibility for options with regard to the form and options of this bone-flap as well as the shortening the duration of treatment, especially at the site of an infected distal tibia, insertion of the Achilles tendon on the posterior aspect of calcaneal osteomyelitis, distal end of the clavicle, clavicle or forearm with a bone defect, small bones with refractory conditions, and a femur without implant failure. However, it was not efficient for treating a forearm without bone defect.

Hamada, Yoshitaka; Hibino, Naohito; Kobayashi, Anna

2014-01-01

323

Scar flap for extension of the nasal and lip soft tissue shell in secondary cleft deformities: final aesthetic touches in clefts-part iii.  

PubMed

A scar flap is formed with the pedicle at the lateral part of the columella base at the cleft side, that is, in the center of the affected region. It enables flap placement according to individual need. A prospective evaluation was performed in a group of 76 patients with cleft lip and palate, all operated on by the same plastic surgeon. The flap was used to improve the height of the columella and the extent of nasal mucosa on the frontal septum and on the nostril base in the vestibule. In the lip, the flap raised its height and improved proportionality. The average area of flap used in a unilateral deformity was 42 mm. Both flaps in a bilateral deformity were 77 mm. The average follow-up was 22.4 months. Neither local nor general complications were noted apart from a recurrence of the deformity of the nasal septum in 7.9% of patients. The nasal passage was improved in 59.9% of patients and normalized in 19.6% upon follow-up rhinomanometry, but nevertheless, only one third of patients overcame their dynamic stereotype of breathing by the mouth. Anthropometric measurements showed an absence of statistically significant differences between patients after surgery and healthy individuals in crucial parameters (nasal tip projection, length of columella, nasolabial angle, nasal angle, and lip angle). The loss of the stigmatizing deformity is based on rotation of the nasolabial angle in relation to the aesthetic axis of the face. Direct examination proved aesthetic and functional improvement as statistically significant in 92.1% of patients. PMID:17003611

Duskova, Marketa; Smahel, Zbynek; Hronkova, Klara

2006-09-01

324

Intraoperative and Postoperative Complications of Laser in situ Keratomileusis Flap Creation Using IntraLase Femtosecond Laser and Mechanical Microkeratomes  

PubMed Central

An essential step of laser in situ keratomileusis surgery is corneal flap creation, Femtosecond (FS)-assisted or mechanical microkeratome. Each type has rare intraoperative and postoperative complication rates. Several recent studies have identified risk factors and guidelines to help manage these complications. Fortunately, studies have shown no loss of best-corrected visual acuity (BCVA) after the management of intraoperative and postoperative complications in IntraLase FS and mechanical microkeratome. Refractive surgeons need to be aware of the types of complications that can occur, how to avoid them and how to manage them to ensure the best possible outcomes. PMID:20543937

Espandar, Ladan; Meyer, Jay

2010-01-01

325

Superior epigastric artery perforator flap for sternal osteomyelitis defect reconstruction.  

PubMed

Sternal osteomyelitis after median sternotomy is associated with considerable morbidity and mortality. Combined with radical debridement, muscle and less frequently omentum flaps are used to reconstruct the resulting defects. In this study, we present our experience with the fasciocutaneous superior epigastric artery perforator (SEAP) flap for defect closure. After resection of the entire sternum, including the costochondral arches and the sternoclavicular joints, the repair of the defect was performed with the perforator flap without any re-stabilisation of the thoracic wall. A consecutive series of nine patients with a mean age of 69 ± 6 years were reconstructed with the SEAP flap. The mortality rate was zero. One patient developed a mediastinal haematoma and required five re-interventions by the cardiothoracic surgeons and thereafter a revision to close a small-wound dehiscence at the tip of the flap. Another two patients developed partial necrosis of the flap that could be managed conservatively. One patient had a revision for a seroma on the donor site, resulting in a 100% closure rate of the defect; there were revisions in two out of nine patients. The underlying infection was controlled by debridement, antibiotic therapy and flap closure in all cases. The overall success of the procedure was satisfactory; however, the local complication rate was relatively high with three out of nine patients on the flap side and one of nine on the donor site. Major advantages of the perforator flap in this highly morbid patient cohort are that the operation is relatively quick, muscle tissue is spared and re-education facilitated. PMID:24560800

Wettstein, R; Weisser, M; Schaefer, D J; Kalbermatten, D F

2014-05-01

326

Fetal Surgery  

PubMed Central

Fetal surgery has come of age. For decades experimental fetal surgery proved essential in studying normal fetal physiology and development, and pathophysiology of congenital defects. Clinical fetal surgery started in the 1960s with intrauterine transfusions. In the 1970s, the advent of ultrasonography revolutionized fetal diagnosis and created a therapeutic vacuum. Fetal treatment, medical and surgical, is slowly trying to fill the gap. Most defects detected are best treated after birth, some requiring a modification in the time, mode and place of delivery for optimal obstetrical and neonatal care. Surgical intervention in utero should be considered for malformations that cause progressive damage to the fetus, leading to death or severe morbidity; that can be corrected or palliated in utero with a reasonable expectation of normal postnatal development; that cannot wait to be corrected after birth, even considering pre-term delivery; that are not accompanied by chromosomal or other major anomalies. At present, congenital hydronephrosis is the most common indication for fetal surgery, followed by obstructive hydrocephalus. Congenital diaphragmatic hernia also fulfills the criteria, but its correction poses more problems, and no clinical attempts have been reported so far. In the future many other malformations or diseases may become best treated in utero. The ethical and moral issues are complex and need to be discussed as clinical and experimental progress is made. PMID:21267309

Laberge, Jean-Martin

1986-01-01

327

Arthroscopic Surgery.  

ERIC Educational Resources Information Center

Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

Connors, G. Patrick

328

Robotic surgery  

Microsoft Academic Search

The application of an active surgical robot, the Surgical Assistant Robot for Prostatectomy (SARP), to transurethral resection of the prostate is discussed. SARP performs surgery under the supervision of a surgeon. The mechanical construction computing system, software, motion controller and image system of SARP are discussed

W. S. Ng; B. L. Davies; R. D. Hibberd; A. G. Timoney

1993-01-01

329

The infrahyoid flap: a comprehensive review of an often overlooked reconstructive method.  

PubMed

The infrahyoid flap is a myocutaneous pedicled flap mainly nourished by the superior thyroid vessels through the perforators of the infrahyoid muscles. This thin and pliable flap provides a skin island of about 7 by 4 cm from the central part of the anterior neck. The flap can be transferred on its pedicle of superior thyroid artery and vein to reconstruct medium sized head and neck defects created after cancer ablation. We have successfully used this flap in a series of 40 cases with no total flap loss and with 1 case of superficial skin necrosis. The aim of this review is to highlight the clinical usefulness of this pedicled flap even in the microvascular free flap era. A comprehensive review of the available literature reporting on the infrahyoid flap has been carried out using a web search. The history of the infrahyoid flap, the surgical technique with technical innovations, the clinical utility and limitations of this flap, are reported and discussed. Among the 7 larger series (cohort larger than 50 cases) a total of 956 flaps were performed, and the global success rate was 91.7%, with failures being mainly related to partial skin necrosis, as the rate of total (skin and muscle) flap necrosis was only 1%. This flap is reliable, easy to harvest during neck dissection, oncologically safe, it does carry a negligible donor site morbidity. This paper highlights how the infrahyoid flap can represent an excellent reconstructive solution in selected patients and head and neck sites. PMID:24856306

Deganello, Alberto; Leemans, C René

2014-08-01

330

Ischemic tissue injury in the dorsal skinfold chamber of the mouse: a skin flap model to investigate acute persistent ischemia.  

PubMed

Despite profound expertise and advanced surgical techniques, ischemia-induced complications ranging from wound breakdown to extensive tissue necrosis are still occurring, particularly in reconstructive flap surgery. Multiple experimental flap models have been developed to analyze underlying causes and mechanisms and to investigate treatment strategies to prevent ischemic complications. The limiting factor of most models is the lacking possibility to directly and repetitively visualize microvascular architecture and hemodynamics. The goal of the protocol was to present a well-established mouse model affiliating these before mentioned lacking elements. Harder et al. have developed a model of a musculocutaneous flap with a random perfusion pattern that undergoes acute persistent ischemia and results in ~50% necrosis after 10 days if kept untreated. With the aid of intravital epi-fluorescence microscopy, this chamber model allows repetitive visualization of morphology and hemodynamics in different regions of interest over time. Associated processes such as apoptosis, inflammation, microvascular leakage and angiogenesis can be investigated and correlated to immunohistochemical and molecular protein assays. To date, the model has proven feasibility and reproducibility in several published experimental studies investigating the effect of pre-, peri- and postconditioning of ischemically challenged tissue. PMID:25489743

Harder, Yves; Schmauss, Daniel; Wettstein, Reto; Egańa, José T; Weiss, Fabian; Weinzierl, Andrea; Schuldt, Anna; Machens, Hans-Günther; Menger, Michael D; Rezaeian, Farid

2014-01-01

331

Successful femtosecond LASIK flap creation despite multiple suction losses  

PubMed Central

Summary We present a case of successful completion of a laser in situ keratomileusis (LASIK) procedure despite 5 episodes of suction loss during femtosecond flap creation in a 30-year-old man with no risk factors. The patient had an uncorrected distance visual acuity of 20/20 in both eyes at his 2-month follow-up visit. Our experience in this case shows that multiple suction losses during femtosecond LASIK flap creation do not preclude completion of a successful procedure with excellent visual outcomes. Caution and technique modification are advised if multiple laser passes are applied to avoid creating multiplanar flaps. PMID:25097457

Syed, Zeba A.; Melki, Samir A.

2014-01-01

332

Stimulation of angiogenesis to improve the viability of prefabricated flaps.  

PubMed

The cutaneous area in a prefabricated myocutaneous flap surviving after elevation is dependent on the rate and amount of vascular ingrowth that occurs from the underlying muscle. Two modalities, basic fibroblast growth factor and hyperbaric oxygen, were used separately and together in a prefabricated myocutaneous flap animal model to improve flap survival. The semimembranous muscle, based on the saphenous vessels of 40 female Wistar rats weighing between 250 and 325 grams, was tunneled under the ipsilateral abdominal skin and sutured in place. A 3 x 5-cm silicone sheet was placed beneath the muscle flap, and the ipsilateral epigastric vessels were ligated. Four groups of 10 animals each received one of the following treatment regimes: a 1-ml normal saline infusion into the saphenous arterial pedicle, a 1-ml infusion of basic fibroblast growth factor (1.0 microg/gm of muscle), a 1-ml normal saline infusion and 14 hyperbaric oxygen treatments, or a 1-ml basic fibroblast growth factor infusion and 14 hyperbaric oxygen treatments. After 1 week, the muscle, still based on the saphenous vessels, was elevated with a 3 x 5-cm abdominal skin paddle. The flap was sutured back in place, leaving the silicone sheet intact. The surviving area of each flap was measured 1 week later after it had demarcated into viable and necrotic regions. Laser Doppler skin perfusion measurements were taken before and after flap elevation and before animal euthanasia. Sixteen flaps, 4 in each group, were examined histologically for vascularity by means of hematoxylin and eosin staining. There was a statistically significant increase in flap survival area when either basic fibroblast growth factor or hyperbaric oxygen was used alone. Further improvement was noted with combination therapy. Histology confirmed improved vascularity in the basic fibroblast growth factor and hyperbaric oxygen-treated flaps. This study shows a significant and reliable increase in the area of prefabricated myocutaneous flap survival using either basic fibroblast growth factor or hyperbaric oxygen. There is a further complementary effect when these two modalities are combined, leading to near complete flap survival through improved vascularity. PMID:9529215

Bayati, S; Russell, R C; Roth, A C

1998-04-01

333

Surgical Excision of Multiple Penile Syringomas With Scrotal Flap Reconstruction  

PubMed Central

Objective: Penile syringomas are rare lesions usually occurring in isolation. We report the excision and reconstruction of multiple synchronous penile shaft syringomas with local scrotal flaps. Methods: We report a rare case of excision of multiple penile syringomas and reconstruction with scrotal flaps in a 29-year-old man. Results: Penile syringomas were excised and reconstructed with scrotal flaps in a single-stage procedure. Conclusions: In addition to providing wound coverage, this reconstructive option allowed for excellent functional results with regard to shaft alignment and erectile function, and it should be considered in the reconstructive armamentarium for penile shaft lesions. PMID:24966995

Vaca, Elbert E.; Mundinger, Gerhard S.; Zelken, Jonathan A.; Erdag, Gulsun

2014-01-01

334

[Laparoscopic surgery in day surgery].  

PubMed

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

Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

1998-06-01

335

Gallbladder Cancer: Surgery  

MedlinePLUS

... treated? Next Topic Radiation therapy for gallbladder cancer Surgery for gallbladder cancer There are 2 general types ... gallbladder: Potentially curative surgery Palliative surgery Potentially curative surgery is done when imaging tests or the results ...

336

Ear Plastic Surgery  

MedlinePLUS

Ear Plastic Surgery Ear Plastic Surgery Patient Health Information News media interested in covering the latest from AAO-HNS/F can ... weight earrings. Does Insurance Pay for Cosmetic Ear Surgery? Insurance usually does not cover surgery solely for ...

337

Pediatric heart surgery  

MedlinePLUS

Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... outside the heart. Some heart defects may need surgery right after the baby is born. For others, ...

338

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

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

2013-01-01

339

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Shoulder Instability Surgery Work? Rev. 2/13 1 Table of Contents · Introduction to Shoulder Instability Surgery (Page 1) · Shoulder Instability Surgery Illustrations (Page 2) · Preparing for Shoulder Surgery (Pages 3-4) · General Post Surgery (Pages

Kim, Duck O.

340

Computational Investigation of Flap-Edges  

NASA Technical Reports Server (NTRS)

The current study expands the application of computational fluid dynamics to three-dimensional multi-element high-lift systems by investigating the flow dynamics created by a slat edge. Flow is computed over a three-element high-lift configuration using an incompressible Navier-Stokes solver with structured, overset grids processed assuming full turbulence with the one-equation Baldwin-Barth turbulence model. The geometry consists of an unswept wing, which spans the wind tunnel test section, a single element half-span Fowler flap, and a three-quarter span slat. Results are presented for the wing configured for landing with a chord based Reynolds number of 3.7 million. Results for the three-quarter span slat case are compared to the full-span slat and two-dimensional investigations.

Cummings, Russell M.

1997-01-01

341

Oblique waves lift the flapping flag.  

PubMed

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

Hśpffner, Jérôme; Naka, Yoshitsugu

2011-11-01

342

Oblique Waves Lift the Flapping Flag  

NASA Astrophysics Data System (ADS)

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.

Hśpffner, Jérôme; Naka, Yoshitsugu

2011-11-01

343

Vortex Flap Technology: a Stability and Control Assessment  

NASA Technical Reports Server (NTRS)

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.

Carey, K. M.; Erickson, G. E.

1984-01-01

344

Development of Variable Camber Continuous Trailing Edge Flap System  

NASA Technical Reports Server (NTRS)

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.

Urnes, Jim, Sr.; Nguyen, Nhan T.; Dykman, John

2012-01-01

345

Gracilis musculocutaneous flap scrotal reconstruction after Fournier gangrene.  

PubMed

We present a case of complete scrotal destruction secondary to acute necrotizing fasciitis. Full scrotal reconstruction utilizing bilateral gracilis musculocutaneous flaps was achieved with excellent results. This technique is described. PMID:3765234

Banks, D W; O'Brien, D P; Amerson, J R; Hester, T R

1986-10-01

346

Optimization of Kinematics of a Flapping Wing Mechanism  

NASA Astrophysics Data System (ADS)

Flapping flight offers several potential advantages over conventional fixed wing flight, such as agility and maneuverability in confined spaces, potentially decreased noise and detectability, and hovering capability. In this presentation, a water tunnel-based flapping wing apparatus is introduced that allows for arbitrary wing trajectories in three rotational degrees of freedom and simultaneous measurements of lift and thrust production. An optimal flapping trajectory for takeoff is found using hardware-in-the-loop optimization methodology. Wing motion derived from high-speed imaging of a ladybug during takeoff is used as a first iteration of the hardware-in-the-loop optimization. Using real-time force measurements and a gradient-based optimization approach, the algorithm searches for the optimal trajectory for a variety of parameters such as lift or efficiency. Hardware performance is assessed. Results from the optimization routine, including the final flapping trajectory are reported for both rigid and compliant wings.

George, Ryan; Thomson, Scott; Mattson, Christopher; Colton, Mark; Tree, Mike

2010-11-01

347

Propulsion through wake synchronization using a flapping foil  

E-print Network

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 ...

Beal, David Nelson, 1973-

2003-01-01

348

Free posterior tibial flap reconstruction for hypopharyngeal squamous cell carcinoma  

PubMed Central

Objectives The aim of this article was to determine outcomes in patients with squamous cell carcinoma of the hypopharynx (SCCHP) in whom the free posterior tibial flap was used for primary reconstruction of hypopharynx defects after cancer resection. Subjects and methods Between August 2009 and February 2012, 10 patients with SCCHP underwent posterior tibial flap reconstruction for hypopharynx defects. The corresponding clinical data were retrospectively collected and analyzed. Results Despite the multistep and time-consuming procedure, the posterior tibial flap survival rate was 100%. Operation-induced complications did not occur in four patients. Six patients developed postoperative hypoproteinemia, four patients developed postoperative pulmonary infections, and four patients developed pharyngeal fistula. The pharyngeal and laryngeal functions of all patients were preserved. Conclusion Our experience demonstrates that the posterior tibial flap is a safe and reliable choice for the reconstruction of hypopharynx defects. PMID:24884631

2014-01-01

349

Pressure distribution over NACA 23012 airfoil with a slotted and a split flap  

NASA Technical Reports Server (NTRS)

A pressure-distribution investigation has been conducted in the NACA 4 by 6-foot vertical wind tunnel to determine the air loads on an NACA 23012 airfoil in combination with a 25.66-percent-chord slotted flap and a 20-percent-chord split flap. Pressures were measured on both the upper and the lower surfaces of the main airfoil and the flaps for several angles of attack and at several flap settings. The data, presented as pressure diagrams and as graphs of the section coefficients for the flap alone and for the airfoil-flap combinations, are applicable to rib and flap design for a combination of a thick airfoil and a slotted or a split flap. The results of previous tests of a NACA 23012 airfoil with a slotted flap are compared with the present results.

Harris, Thomas A; Lowry, John G

1941-01-01

350

Lateral Arm Free Flap With Preservation of the Posterior Antebrachial Cutaneous Nerve.  

PubMed

The lateral arm free flap offers many advantages in reconstruction of soft tissue defect and reconstruction of extremities. However, this free flap is associated with sensory loss at the posterior forearm due to injury of the posterior antebrachial cutaneous nerve (PABCN).The PABCN-sparing lateral arm free flaps were performed in 19 patients with various soft tissue defects of the extremity, and the outcomes of free flap reconstructions using this modification are evaluated. All flaps survived without partial necrosis. Three patients experienced transient sensory loss in the posterior area of the forearm after flap harvest.In this study, lateral arm free flaps can be elevated without necessarily sacrificing the PABCN. This nerve-sparing modification decreases the donor-site morbidity of lateral arm free flaps and further increases the overall usefulness of this flap in soft tissue reconstructions of the extremities. PMID:25046679

Ki, Sae Hwi

2014-07-17

351

Use of rotation flap in repair of cleft palate and velopharyngeal insufficiency.  

PubMed

Although cleft palate anomaly is frequent, the criterion standards in surgical treatment have not been determined yet. There are a few techniques described for cleft palate repair owing to the limited tissue in the palatal mucosa, the rigid structure of the palatal mucosa, and the limited vascularity of the hard palate. In this study, a novel cleft palate repair technique based on separating the soft palate from the hard palate as a musculomucosal flap and using it as a rotation flap has been described. The operation is evaluated individually for each anomaly because variations occur in the surgical technique according to the extension of the cleft toward the teeth in the palate. This operation was performed on a total of 28 patients (17 girls and 11 boys) aged between 1.5 and 16 years and presented to our clinic. Patients were assessed for speech analysis outcomes, tympanogram values, hearing functions, magnitude of palatal lengthening during the operation, and rate of fistulae. Statistically significant differences in values of the speech analysis and the audiometric assessment were determined between before and 6 months after surgery. Complete recovery of otitis was observed 1 month after surgery without another treatment in 9 (42.8%) of 21 patients who were detected to have serous otitis media preoperatively. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all types of cleft palate, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this technique. PMID:21772216

Isik, Daghan; Durucu, Cengiz; Isik, Yasemin; Atik, Bekir; Kocak, Omer Faruk; Karatas, Erkan; Bekerecioglu, Mehmet

2011-07-01

352

Replantation surgery  

Microsoft Academic Search

Summary  \\u000a In the early days of replantation surgery, if viability was restored the operation was judged a success. Nowadays restoration\\u000a of viability alone is not sufficient to fulfill the criteria of successful replantation, which are as follows: Lack of severe\\u000a systemic disturbances due to the replantation, a “functional extremity” according to the definition of Chen et al. (1978),\\u000a no or

A. Berger; R. Hierner; M. H.-J. Becker; B. Rieck; F. Lassner

1997-01-01

353

Wind-tunnel investigation of an NACA 23030 airfoil with various arrangements of slotted flaps  

NASA Technical Reports Server (NTRS)

AN investigation was made of a large-chord NACA 23030 airfoil with a 40- and a 25.66 percent-chord slotted flap to determine the section aerodynamic characteristics of the airfoil affected by flap chord, slot shape, flap position, and flap deflection. The flap positions for maximum lift, the position for minimum drag at moderate and high lift coefficients, and the complete section aerodynamic characteristics of selected optimum arrangements are given. Envelope polar of various flap arrangements are included. The relative merits of slotted flaps of different chords on the NACA 23030 airfoil are discussed, and a comparison is made of each flap size with a corresponding flap size on the NACA 23021 and 23012 airfoils. The lowest profile drags at moderate lift coefficients were obtained with an easy entrance to the slot. The 25.66-percent-chord slotted flap gave lower drag than the 40-percent-chord flap for lift coefficients less than 1.8, but the 40-percent-chord flap gave considerably lower drag for lift coefficients. The drag coefficients at moderate and high lift coefficients were greater with both sizes of flap on the NACA 23030 airfoil than on either the NACA 23021 or the NACA 23012 airfoil. The maximum lift coefficient for the deflections tested with either flap was practically independent of airfoil.

Recant, I G

1940-01-01

354

Basic fibroblast growth factor induced angiogenesis and prefabricated flap survival.  

PubMed

Prefabrication of a latissimus dorsi myocutaneous flap was performed in adult male Landrace pigs. Gelfoam sponges were used as a delivery system for basic fibroblast growth factor (bFGF) at the muscle-subcutaneous tissue interface. Skin survival and angiogenesis were augmented in the growth-factor-treated animals. These data support the use of basic fibroblast growth factor to enhance flap prefabrication. PMID:11316283

Haws, M J; Erdman, D; Bayati, S; Brown, R E; Russell, R C

2001-01-01

355

Wind Tunnel Test of the SMART Active Flap Rotor  

NASA Technical Reports Server (NTRS)

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.

Straub, Friedrich K.; Anand, Vaidyanthan R.; Birchette, Terrence S.; Lau, Benton H.

2009-01-01

356

Relief of Headache by Cranioplasty After Skull Base Surgery  

PubMed Central

Headache after skull base surgery can cause profound morbidity in certain patients, resulting in significant impairment of their quality of life. Several methods to prevent postoperative headache have been described, including a modification of the skin/muscle incision replacing the craniotomy bone flap replacing the bone flap and filling in the residual defect with methyl methacrylate, using hydroxyapatite cement (HAC) to fill the craniectomy defect, and wiring hardened methyl methacrylate (MMA) into the defect. Ten patients with severe headache following craniectomy for a posterior fossa lesion underwent cranioplasty with MMA, which was placed exactly within the craniectomy defect and secured rigidly with miniplates and screws. The headache decreased in severity in all patients and resolved completely in 90%. Also, 78% of patients with dizziness improved. The procedure and its effect on headache and dizziness will be described. PMID:17171000

Fetterman, Bruce L.; Lanman, Todd H.; House, John W.

1997-01-01

357

The Supraclavicular Flap for Reconstruction of Post-Burn Mentosternal Contractures  

PubMed Central

Background The thin and pliable skin of the neck is a region with multidirectional activity, and postburn scar contractures tend to form there easily. The supraclavicular flap is used to correct neck scar contractures. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicle flap or an island flap (vascular pedicle flap). Objective In this article, a total of 41 flaps are studied retrospectively and their efficacy in reconstruction of post-burn neck scar contractures is discussed. Also donor-site morbidity, patient satisfaction, and complications were evaluated. Patients and Methods Between November of 2004 and January of 2009, 41 supraclavicular flaps were used for reconstructions in 32 patients at the authors’ hospital. Twenty-four of these flaps were skin pedicle flaps, and 17 were island flaps. The range of flap size was 18 ± 6 cm in length, and 9 ± 3 cm in width. Pre-expansion was performed in 14 flaps. Primary closure of donor site was performed in 35 flaps. Results Thirty-seven of the 41 flaps survived completely, but there were three cases of distal necrosis (10-30%), and one case of complete flap necrosis. Twenty-nine of the 32 patients were satisfied with both the functional and aesthetic results. Conclusions Scarring of the neck produces problems with function, and appearance. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. This flap is easy to harvest, with good functional and aesthetic results. PMID:24083000

Loghmani, Shahriar; Eidy, Mohammad; Mohammadzadeh, Mahdi; Loghmani, Alireza; Raigan, Fahimeh

2013-01-01

358

A triceps musculocutaneous flap for chest-wall defects  

SciTech Connect

A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. (Emory Univ. School of Medicine, Atlanta, GA (USA))

1990-09-01

359

Flap Conformations in HIV-1 Protease are Altered by Mutations  

NASA Astrophysics Data System (ADS)

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.

Fanucci, Gail; Blackburn, Mandy; Veloro, Angelo; Galiano, Luis; Fangu, Ding; Simmerling, Carlos

2009-03-01

360

Aerodynamics and flight performance of flapping wing micro air vehicles  

NASA Astrophysics Data System (ADS)

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.

Silin, Dmytro

361

Flap pedicle vena comitant as a vein graft donor source.  

PubMed

A vena comitant segment harvested from a flap's pedicle can be used as an interpositional vein graft in selected microvascular cases. When a vascular pedicle includes paired venae comitantes, one of these can prove suitable for use as a vein graft while still allowing for venous outflow of the flap. An additional operative site and procedure to harvest a vein graft can be avoided if a vena comitant segment can be used. We present eight cases in which pedicle vena comitant segments were used as interpositional vein grafts. In six cases, vena comitant grafts were used to supercharge or augment venous outflow in transverse rectus abdominis myocutaneous (TRAM) flaps used for breast reconstruction. A vena comitant graft was used to revise the venous anastomosis in one deep inferior epigastric perforator (DIEP) flap. The arterial anastomosis was revised with a vena comitant graft in a gracilis muscle free flap. Our experience demonstrates the viability and utility of using the flap pedicle's vena comitant as a source of vein graft in selected cases. PMID:18946884

Stewart, Daniel; Liau, James; Vasconez, Henry

2009-01-01

362

Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage  

PubMed Central

Objective: Multiple large decubitus ulcers present a reconstructive challenge to the plastic surgeon. When stage IV pressure sores become recurrent or extensive, traditional flaps either have already been exhausted or would not be sufficient to cover the defect. Methods: A retrospective review was performed on all paraplegic patients who had chronic, extensive, and stage IV decubitus ulcers, and underwent reconstruction using a pedicled continuous musculocutaneous flap of the entire leg between 1998 and 2007. The extent and size of the debrided pressure sores, number of previous flap reconstructions, intraoperative blood loss, postoperative complications, and years of follow-up were all recorded. A description of the operative technique is also given. Results: Four patients underwent a total leg fillet flap in the study period, with follow-up ranging from 2 to 7 years. Indications included extensive and bilateral trochanteric, sacral, and ischial pressure sores. Complications included intraoperative blood loss and postoperative heterotopic calcification. Conclusions: The total leg fillet flap is a very large and robust flap that offers paraplegic patients coverage of extensive stage IV pressure sores of the trochanteric, sacral, and ischial areas. PMID:19946358

Jandali, Shareef; Low, David W.

2009-01-01

363

Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------  

E-print Network

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

Miyashita, Yasushi

364

Partially de-epithelialized preputial flap (triangular soft tissue flap): an aid to prevent coronal urethrocutaneous fistulae.  

PubMed

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 1-year of follow-up. PMID:12898163

Singh, R B; Pavithran, Nevil M

2003-09-01

365

The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps.  

PubMed

Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74?±?2.47. The mean postoperative PI value was 12.52?±?2.34. The mean difference between the preoperative and postoperative PI values was -1.78±0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P?=?0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014. PMID:25256771

Temiz, Gökhan; Bilkay, Ufuk; Tiftikçio?lu, Yi?it Özer; Mezili, Candan Tevfik; Songür, Ecmel

2014-09-25

366

Simulating flapping insect wings using an aerodynamic panel method: Towards the development of flapping-wing technology  

Microsoft Academic Search

In response to the general trend in aeronautics towards the design of multifunctional aircraft with versatile flight capabilities, this dissertation asserts the integrity of re-instating inquiry into mechanized flapping-wing flight and the ultimate utility of ornithopters. Prevailing arguments against the viability and utility of flapping-wing aircraft are summarized and challenged, ornithopter designs from the fifteenth century to the present are

Michael John Clarke Smith

1995-01-01

367

The combined tensor fasciae latae/rectus femoris musculocutaneous flap: a possibility for major soft tissue reconstruction in the groin, hip, gluteal, perineal, and lower abdominal regions.  

PubMed

A 57-year-old man, with a long-lasting multiple hereditary cartilaginous exostoses, presented with a progressive tumor growth in the left iliac wing and in the gluteus maximus muscle. An open biopsy revealed a secondary chondrosarcoma, which had developed from an osteochondroma. A wide surgical resection, sparing the inferior limb, was the option for treatment. The fairly constant and reliable vascular anatomy of the lateral circumflex femoral artery, as confirmed by 27 previous anatomical dissections, gave us the opportunity to repair the wide postoperative defect by means of a single, very large flap, combining the vascular territories of the tensor fasciae latae and rectus femoris musculocutaneous flaps. The postoperative period was uneventful, and 1 year after surgery the man had no sign of local recurrence or metastases, and the flap was fully viable without sign of local complication. A functional evaluation was performed on a Kin-Com II dynamometer, showing major impairment of the limb that had undergone surgery. Despite the severe functional disturbance, the man prefers the impaired status to an amputation after a hemipelvectomy. PMID:8215135

Santanelli, F; Berlin, O; Fogdestam, I

1993-08-01

368

Preoperative Identification of a Perforator Using Computed Tomography Angiography and Metal Clip Marking in Perforator Flap Reconstruction  

PubMed Central

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

Lee, Jung Woo; Kim, Han Kyeol; Kim, Sin Rak; Han, Yea Sik

2015-01-01

369

Le Fort I osteotomy to correct malocclusion after reconstruction of the maxilla with the free fibula flap.  

PubMed

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

Nocini, Pier Francesco; Chiarini, Luigi; Fior, Andrea; Bedogni, Alberto

2009-09-01

370

Macular Hole Surgery in a Patient Who Cannot Maintain Facedown Positioning  

PubMed Central

Aim To present macular hole surgery in a patient who had previously undergone thyroid removal surgery. Material and Methods During thyroid gland removal surgery, the recurrent laryngeal nerves were cut by the surgeon. Therefore, the patient had to have a tracheotomy and because of this unusual situation, the patient could not breathe if lying ‘upside-down’. Complete ophthalmic examination and spectral optical coherence tomography was performed in a 77-year-old woman before and after macular hole surgery. Results The patient was treated by the ‘inverted internal limiting membrane (ILM) flap technique’ with air tamponade for macular hole closure. This technique was described to have very high success rates in large, stage IV macular holes. Postoperatively, lying on her opposite side was advised. However, the macular hole remained open after this approach. Because of this, another approach was undertaken. The ILM flap technique and silicone oil were applied, and the patient was positioned on her opposite side. Silicone oil was removed after 3 months. Eighteen months later, the macular hole remained closed. Visual acuity improved from 10/200 to 20/50. Conclusion This case demonstrates that in an extremely select group of patients, silicone oil combined with the inverted flap technique may be considered for treatment of macular hole. PMID:23467189

Michalewska, Zofia; Nawrocki, Jerzy

2013-01-01

371

[Robotic surgery].  

PubMed

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

Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

2013-10-01

372

Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern via Intraoperative Fluorescence Angiography.  

PubMed

Background?Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. Methods?A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. Results?Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. Conclusions?Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications. PMID:25469765

Valerio, Ian; Green, J Marshall; Sacks, Justin M; Thomas, Shane; Sabino, Jennifer; Acarturk, T Oguz

2015-01-01

373

Piloted simulation study of two tilt-wing flap control concepts, phase 2  

NASA Technical Reports Server (NTRS)

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.

Birckelbaw, Lourdes G.; Corliss, Lloyd D.; Hindson, William S.; Churchill, Gary B.

1994-01-01

374

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2 Surgical Illustrations (Pages 2-4) · Preparing for Rotator Cuff Surgery (Pages 5-6) · General Post Surgery to embark on the arthroscopic rotator cuff repair journey. The goal of rotator cuff repair surgery is create

Kim, Duck O.

375

DEHN SURGERY SIDDHARTHA GADGIL  

E-print Network

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

Gadgil, Siddhartha

376

Pedicled full-thickness abdominal flap combined with skin grafting for the reconstruction of anterior chest wall defect following major electrical burn.  

PubMed

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

Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

2015-02-01

377

The FLARE™ Intraoperative Near-Infrared Fluorescence Imaging System: A First-in-Human Clinical Trial in Perforator Flap Breast Reconstruction  

PubMed Central

Background The ability to determine flap perfusion in reconstructive surgery is still primarily based on clinical examination. In this study, we demonstrate the use of an intraoperative, near infrared (NIR) fluorescence imaging system for evaluation of perforator location and flap perfusion. Methods Indocyanine green (ICG) was injected intravenously in six breast cancer patients undergoing a deep inferior epigastric perforator (DIEP) flap breast reconstruction after mastectomy. Three dose levels of ICG were assessed using the Fluorescence-Assisted Resection and Exploration (FLARE™) imaging system. This system uses light emitting diodes (LED) for fluorescence excitation; different from current commercially available systems. In this pilot study, the operating surgeons were blinded to the imaging results. Results Use of the FLARE™ system was successful in all six study subjects with no complications or sequelae. Among the three dose levels, 4 mg per injection resulted in the highest observed contrast-to-background ratio (CBR), signal-to-background ratio, and signal-to-noise ratio. However, due to small sample size, we did not have sufficient power to detect statistical significance for these pairwise comparisons at the multiple-comparison adjusted type-I error of 0.017. Six mg per injection provided a similar CBR, but also a higher residual background signal. Conclusions Based on this pilot study, we conclude that NIR assessment of perforator flap breast reconstruction is feasible with an LED based system, and that a dose of 4 mg of ICG per injection yields the best observed CBR compared to a dose of 2 or 6 mg for assessment of flap perfusion. PMID:21042103

Lee, Bernard T.; Hutteman, Merlijn; Gioux, Sylvain; Stockdale, Alan; Lin, Samuel J.; Ngo, Long H.; Frangioni, John V.

2010-01-01

378

Analysis and Control of Flapping Flight: from Biological to Robotic Insects  

E-print Network

Analysis and Control of Flapping Flight: from Biological to Robotic Insects Luca Schenato Robotics Insects Overview and motivations True insect flight (Biomimetics) Averaging theory Flapping flight control #12;Micromechanical Flight Insect Project* (MFI) Objective: 10-25mm (wingtip

Schenato, Luca

379

Force and hydrodynamic efficiency measurements of a three-dimensional flapping foil  

E-print Network

Investigations into unsteady flapping foil propulsion have shown that it is an efficient and high thrust means of propulsion. Extensive work has been done to optimize the efficiency of two-dimensional flapping foils, varying ...

McLetchie, Karl-Magnus Weidmann

2004-01-01

380

Pressure distribution over an NACA 23012 airfoil with a slotted and a plain flap  

NASA Technical Reports Server (NTRS)

Report presents the results of pressure-distribution of an NACA 23012 airfoil equipped with a slotted flap and with a plain flap conducted in the 7 by 10-foot wind tunnel. A test installation was used in which the 7-foot-span airfoil was mounted vertically between the upper and lower sides of the closed test section so that two-dimensional flow was approximated. The pressures were measured on the upper and lower surfaces at one chord section both on the main airfoil and on the flaps for several different flap deflections and at several angles of attack. The data are presented in the form of pressure-distribution diagrams and as graphs of calculated section coefficients for the airfoil-and-flap combinations and also for the flaps alone. The results are useful for application to rib and flap structural design; in addition, the plain-flap data furnish considerable information applicable to the structural design of plain ailerons.

Wenzinger, Carl J; Delano, James B

1938-01-01

381

Analysis of Aeroelastic Flapping-Wing Signals for Micro Air-Vehicles.  

E-print Network

??Flapping-wing micro air-vehicles are being investigated for their potential to provide enhanced aerodynamic efficiency, maneuverability and gust tolerance. The flight dynamics of flapping-wing micro air-vehicles… (more)

Love, Robert

2009-01-01

382

Rotor Flapping Response to Active Control  

NASA Technical Reports Server (NTRS)

Rotor active control using higher harmonic blade pitch has been proposed as a means to reduce both rotor radiated noise and airframe vibration and to enhance rotor performance. The higher harmonic input, however, can affect rotor thrust and cyclic flapping - the basic trim characteristics of the rotor. Some of the trim changes can negate the active control benefits. For example, wind tunnel test results of a full scale BO-105 rotor with individual-blade control indicate some rotor performance improvements, accompanied with changes in rotor trim, using two-per-rev blade pitch input. The observed performance benefits could therefore be a simple manifestation of the trim change rather than an efficient redistribution of the rotor airloads. More recently, the flight test of the BO-105 helicopter equip,ped with individual-blade-control actuators also reported trim changes whenever the two-per-rev blade pitch for noise reduction was activated. The pilot had to adjust the trim control to maintain the aircraft under a constant flight path. These two cases highlight the, importance of trim considerations in the application of active control to rotorcraft.

Nguyen, Khanh; Johnson, Wayne

2004-01-01

383

Theoretical studies on flapped delta wings  

NASA Technical Reports Server (NTRS)

The effects of leading edge flaps on the aerodynamic characteristics of a low aspect-ratio delta wing are studied theoretically. As an extension of the classical crossflow plane analysis and in order to include separated shear layers, an analogy between three dimensional steady conical and two dimensional unsteady self-similar flows is explored. This analogy provides a simple steady-unsteady relationship. The criteria for the validity of the steady-unsteady analogy are also examined. Two different theoretical techniques are used to represent the separated shear layers based on the steady-unsteady analogy, neglecting the trailing edge effect. In the first approach, each vortex system is represented by a pair of concentrated vortices connected to the separation points by straight feeding sheets. In the second approach, the vortex cloud method is adopted for simulating the flow field in the crossflow plane. The separated shear layers are replaced with a cloud of discrete vortices and the boundary element method is employed to represent the wing trace by a vorticity distribution. A simple merging scheme is used to model the core region of the vortical flow as a single vortex by imposing a restriction on the shear layer rotation angle. The results are compared with experiments and with results from 3-D panel calculations.

Oh, S.; Tavella, D.; Roberts, L.

1988-01-01

384

Analysis of non-symmetrical flapping airfoils  

NASA Astrophysics Data System (ADS)

Simulations have been done to assess the lift, thrust and propulsive efficiency of different types of non-symmetrical airfoils under different flapping configurations. The variables involved are reduced frequency, Strouhal number, pitch amplitude and phase angle. In order to analyze the variables more efficiently, the design of experiments using the response surface methodology is applied. Results show that both the variables and shape of the airfoil have a profound effect on the lift, thrust, and efficiency. By using non-symmetrical airfoils, average lift coefficient as high as 2.23 can be obtained. The average thrust coefficient and efficiency also reach high values of 2.53 and 0.61, respectively. The lift production is highly dependent on the airfoil’s shape while thrust production is influenced more heavily by the variables. Efficiency falls somewhere in between. Two-factor interactions are found to exist among the variables. This shows that it is not sufficient to analyze each variable individually. Vorticity diagrams are analyzed to explain the results obtained. Overall, the S1020 airfoil is able to provide relatively good efficiency and at the same time generate high thrust and lift force. These results aid in the design of a better ornithopter’s wing.

Tay, W. B.; Lim, K. B.

2009-08-01

385

Why Do Elephants Flap Their Ears?  

NASA Astrophysics Data System (ADS)

It is estimated that a 4200 kg elephant generates as much as 5.12 kW of heat. How the elephant dissipates its metabolic heat and regulates its body temperature has been investigated during the past seven decades. Findings and conclusions differ sharply. The high rate of metabolic heat coupled with low surface area to volume ratio and the absence of sweat glands eliminate surface convection as the primary mechanism for heat removal. Noting that the elephant ears have high surface area to volume ratio and an extensive vascular network, ear flapping is thought to be the principal thermoregulatory mechanism. A computational and experimental program is carried out to examine flow and heat transfer characteristics. The ear is modeled as a uniformly heated oscillating rectangular plate. Our computational work involves a three-dimensional time dependent CFD code with heat transfer capabilities to obtain predictions of the flow field and surface temperature distributions. This information was used to design an experimental setup with a uniformly heated plate of size 0.2m x 0.3m oscillating at 1.6 cycles per second. Results show that surface temperature increases and reaches a steady periodic oscillation after a period of transient oscillation. The role of the vortices shed off the plate in heat transfer enhancement will be discussed.

Koffi, Moise; Jiji, Latif; Andreopoulos, Yiannis

2009-11-01

386

The Impact of Perforator Number on Deep Inferior Epigastric Perforator Flap Breast Reconstruction  

PubMed Central

Background Perforator flaps minimize abdominal site morbidity during autologous breast reconstruction. The purpose of this study was to assess whether the number of perforators harvested influences the overall deep inferior epigastric perforator (DIEP) flap survival and flap-related complications. Methods A retrospective review was performed of all DIEP flaps performed at the Hospital of the University of Pennsylvania from 2006 to 2011. The outcomes assessed included flap loss and major complications. We compared flaps by the number of total perforators (1-4) and then carried out a subgroup analysis comparing flaps with one perforator to flaps with multiple perforators. Lastly, we conducted a post-hoc analysis based on body mass index (BMI) categorization. Results Three hundred thirty-three patients underwent 395 DIEP flaps. No significant differences were noted in the flap loss rate or the overall complications across perforator groups. However, the subgroup analysis revealed significantly higher rates of fat necrosis in the case of one-perforator flaps than in the case of multiple-perforator flaps (10.2% vs. 3.1%, P=0.009). The post-hoc analysis revealed a significant increase in the flap loss rate with increasing BMI (<30=2.0%, 30-34.9=3.1%, 35-39.9=3.1%, >40=42.9%, P<0.001) in the DIEP flaps, but no increase in fat necrosis. Conclusions This study demonstrates that the number of perforators does not impact the rate of flap survival. However, the rate of fat necrosis may be significantly higher in DIEP flaps based on a single perforator. Multiple perforators should be utilized if possible to decrease the risk of fat necrosis. PMID:24511497

Grover, Ritwik; Nelson, Jonas A; Fischer, John P; Kovach, Stephen J; Serletti, Joseph M

2014-01-01

387

The body as a living bioreactor: a feasibility study of pedicle flaps for tracheal transplantation.  

PubMed

Reconstruction of long-segment tracheal stenosis remains problematic. Ex vivo transplantation of stem cell-derived tracheas has been established in humans using external tissue bioreactors. These bioreactors, however, are not widely accessible. Thus, we are developing a rotational flap-based "internal bioreactor" to allow in vivo stem cell engraftment in a pre-vascularized recipient bed. This muscle will also then serve as a carrier for the transplanted trachea during rotation into position for airway reconstruction. Herein, we present a study investigating the feasibility of two pedicle muscle flaps for implantation and subsequent tracheal transplantation. Trapezius and latissimus flaps were raised using established surgical techniques. The length and width of each flap, along with the distance from the pedicle takeoff to the trachea, were measured. The overall ability of the flaps to reach the trachea was assessed. Twelve flaps were raised in 5 fresh adult human cadavers. For the trapezius flap, averages were: flap length of 16.4 cm, flap width of 5.95 cm at the tip, and distance from the pedicle takeoff to the trachea of 11.1 cm. For the latissimus dorsi flap, averages were: flap length of 35.4 cm, flap width of 7.25 cm at the tip, and distance from the pedicle takeoff to the trachea of 27.3 cm. All flaps showed sufficient durability and rotational ability. Our results show that both trapezius and latissimus dorsi flaps can be transposed into the neck to allow tension-free closure of tracheal defects. For cervical tracheal transplantation, both flaps are equally adequate. We believe that trapezius and latissimus dorsi muscle flaps are potential tracheal implantation beds in terms of vascular supply, durability, and rotational ability. PMID:22829157

Jana, Tanima; Khabbaz, Eyad; Bush, Carrie M; Prosser, J Drew; Birchall, Martin A; Nichols, Carol A; Postma, Gregory N; Weinberger, Paul M

2013-01-01

388

Rotation flaps for coverage after total knee arthroplasty  

PubMed Central

OBJECTIVE: To evaluate the results obtained using local myocutaneous rotation flaps in cases of wound dehiscence after total knee arthroplasty. METHODS: Patients undergoing these surgical procedures were selected in the 2000-2012 period. The nine selected cases during this period were subjected to flap coverage due to skin dehiscence associated with infection. In eight cases we used rotation flaps of the medial gastrocnemius, and in one case we used advancing skin. RESULTS: Eighty nine percent of the cases were successful in the coverage of the prosthesis and the viability of the flaps. In four cases it was possible to maintain or review the prosthesis. Four other cases progressed to amputation due to failure on treatment of infections, and one case remained without the prosthesis. The functional evaluation showed an unsatisfactory outcome in 89% of cases. CONCLUSION: Coverage flaps are a good option for the treatment of cases of dehiscence with exposure of the prosthesis and the functional failure was associated with the inability to control the infection and the damage it caused. Level of Evidence IV, Case Series. PMID:24453672

Pozzobon, Leonardo Rafael; Helito, Camilo Partezani; Guimarăes, Tales Mollica; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis

2013-01-01

389

Orbital Floor Reconstruction with Free Flaps after Maxillectomy  

PubMed Central

Background The purpose of this study is to evaluate the outcome of orbital floor reconstruction with free flaps after maxillectomy. Methods This was a retrospective analysis of 34 consecutive patients who underwent maxillectomy with orbital floor removal for malignancies, reconstructed with free flaps. A cross-sectional survey to assess the functional and esthetic outcome was done in 28 patients who were alive and disease-free, with a minimum of 6 months of follow-up. Results Twenty-six patients had bony reconstruction, and eight had soft tissue reconstruction. Free fibula flap was the commonest flap used (n = 14). Visual acuity was normal in 86%. Eye movements were normal in 92%. Abnormal globe position resulted in nine patients. Esthetic satisfaction was good in 19 patients (68%). Though there was no statistically significant difference in outcome of visual acuity, eye movement, and patient esthetic satisfaction between patients with bony and soft tissue reconstruction, more patients without bony reconstruction had abnormal globe position (p = 0.040). Conclusion Free tissue transfer has improved the results of orbital floor reconstruction after total maxillectomy, preserving the eye. Good functional and esthetic outcome was achieved. Though our study favors a bony orbital reconstruction, a larger study with adequate power and equal distribution of patients among the groups would be needed to determine this. Free fibula flap remains the commonest choice when a bony reconstruction is contemplated. PMID:24436744

Sampathirao, Leela Mohan C. S. R.; Thankappan, Krishnakumar; Duraisamy, Sriprakash; Hedne, Naveen; Sharma, Mohit; Mathew, Jimmy; Iyer, Subramania

2013-01-01

390

A Large Scale PIV Investigation of a Flap Edge Vortex  

NASA Astrophysics Data System (ADS)

A recent experiment at NASA/Ames Research Center demonstrated the application of a large scale 'on-line' Particle Image Velocimetry, (PIV), in a 7' x 10' wind tunnel. Data was collected for freestream velocities in the range from approximately 40 m/sec to 100 m/sec. The flow field of interest for this investigation was a vortex that was generated by a flap edge. The model was an unswept wing, having a span of 5 ft and a chord, (c), of 2.5 ft., fitted with a half-span Fowler flap. The flap had a chord of 9 inches. Cross plane flow field velocity measurements were made at 0.6 c, (18 inches), downstream of the trailing edge of the flap. The baseline model was also tested with a three quarter-span slat, and a flap edge fence. The fence is designed to reduce noise from high-lift devices. The area of the flow encompassed within this investigation was 40 cm by 40 cm. A high resolution CCD Camera, (2048 pixels x 2048 pixels), was used to capture the double exposure images. The light source used in this experiment was a Spectra Physics PIV-400 Nd:Yag double pulsed laser, and the particle seeding was generated from a Roscoe 4500 fog machine. The velocity data obtained from the experiment was used to determine both the vorticity and the circulation.

Walker, Stephen M.; Alkislar, M. B.; Lourenco, L.; Krothapalli, A.

1996-11-01

391

How to make a flag flap in water.  

NASA Astrophysics Data System (ADS)

The motion of a flag in the wind is a classical example of the interaction of a elastic membrane with a moving fluid. Above a critical fluid velocity, the elastic membrane experiences an instability resulting from the competition between the bending rigidity and the inertial forces of both the flag and the surrounding fluid. This linear instability has been studied both experimentally in wind-tunnels, and theoretically. Theoretical studies assume an inviscid fluid and predict a stability threshold close to the one observed in experiments. However when one tries to make a flag flap in flowing water, even in the limit of a very flexible flag where the inviscid theory predicts flapping, instability is not observed. The drag of the fluid is an important stabilizing force and the instability involves now a competition between drag and inertia. To reach the instability threshold, it is necessary to increase dramatically the inertia of the flag. In our experimental work, we use of a flag made of metal to investigate the transition to flapping in a water tunnel. We explore the effect of the flag inertia and determine the critical flapping speed. We also discuss the influence of inertia on the flapping frequency and on the waveform.

Shelley, Michael; Vandenberghe, Nicolas; Zhang, Jun

2003-11-01

392

Anterolateral Thigh Flow-Through Flap in Hand Salvage  

PubMed Central

Objective: Hand salvage and reconstruction following trauma and oncologic resection often dictates the use of innovative reconstructive techniques. Preservation of functional anatomy is paramount to success in this clinical setting. Further constraints are placed on the reconstructive surgeon in the setting of the aging US population. We report a case of successful hand salvage in an elderly patient using a free anterolateral thigh flow-through flap. Methods: A retrospective chart review was performed on prospectively entered data to examine the case in detail. Indications, radiographs, and follow-up visits were reviewed. A free anterolateral thigh flap was harvested and used to provide soft tissue coverage as well as reconstruction of the palmar arch. Results: The free anterolateral thigh flap not only reconstructed the unique soft tissue envelope of the hand but also restored functional vascular anatomy by reconstituting the interrupted superficial palmar arch. The patient had an uneventful hospital course and was discharged without complications. Conclusions: The free anterolateral thigh flap is a versatile flap that can be used as an innovative solution for hand salvage where vascular anatomy and soft tissue need to be restored. PMID:23641298

Kells, Amy F.; Broyles, Justin M.; Simoa, Antonio F.; Lewis, Valerae O.; Sacks, Justin M.

2013-01-01

393

Minimally Invasive Surgery  

MedlinePLUS

... incisions made. Benefits of minimally invasive surgery Fewer scars on the outside Scars from minimally invasive surgery ... womb) from the vagina into the uterus. Fewer scars on the inside In general, all surgery can ...

394

Scoliosis surgery - child  

MedlinePLUS

Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... may also do the procedure using a special video camera. A surgical cut in the back is ...

395

Surgery for Testicular Cancer  

MedlinePLUS

... treated? Next Topic Radiation therapy for testicular cancer Surgery for testicular cancer Surgery is typically the first ... very experienced. Possible risks and side effects of surgery The short-term risks of any type of ...

396

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 ...

397

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 ...

398

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 ...

399

Cavus Foot Surgery  

MedlinePLUS

... the Smaller Toes AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

400

Endodontic surgery.  

PubMed

Conventional endodontic therapy is successful approximately 80-85% of the time. Many of these failures will occur after one year. The presence of continued pain, drainage, mobility or an increasing size of a radiolucent area are some of the indications to treat the case surgically. Since many of these cases may have had final restorations placed by the dentist, the salvage of these cases is of importance to the patient. Advances in periapical surgery have included the use of ultrasonic root end preparation. With the use of these piezoelectric devices, a more controlled apical preparation can be achieved. Additionally, isthmus areas between canals can be appropriately prepared and sealed. The precision afforded with these devices reduces the chances for a malpositioned fill and a more successful outcome. PMID:22117946

Lieblich, Stuart E

2012-01-01

401

Robotic Surgery  

NASA Technical Reports Server (NTRS)

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.

2000-01-01

402

Microbial keratitis after corneal laser refractive surgery.  

PubMed

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

Sharma, Daya Papalkar; Sharma, Shanel; Wilkins, Mark R

2011-07-01

403

Energetics of Flapping-Wing Robotic Insects: Towards Autonomous Hovering Flight  

E-print Network

Energetics of Flapping-Wing Robotic Insects: Towards Autonomous Hovering Flight Michael Karpelson-- Flapping-wing mechanisms inspired by biological insects have the potential to enable a new class of small of flapping-wing robotic insects with the goal of selecting design parameters that enable power autonomy

Wood, Robert

404

Effects of dextran-40 on flap viability after modified radical mastectomy  

PubMed Central

BACKGROUND: Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40. OBJECTIVE: To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy. METHODS: Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed. RESULTS: Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement. CONCLUSIONS: Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment. PMID:24431947

Yildiz, Baris Dogu; Sulu, Barlas

2013-01-01

405

All in a Flap About Reading: Catherine Morland, Spot, and Mister Wolf.  

ERIC Educational Resources Information Center

Considers how lift-the-flap books attract very little critical attention. Attempts to redress this imbalance by suggesting that lift-the-flap books provide useful lessons in reading both literature and pictures for the young reader, that a grammar of lift-the-flap books can be postulated to facilitate their description and discussion, and that the…

Smith, Vivienne

2001-01-01

406

Interaction of two flapping filaments in a flowing soap film Luoding Zhua)  

E-print Network

the two-dimensional analog of a flag flapping in the wind has much to teach us about biological swimming2Interaction of two flapping filaments in a flowing soap film Luoding Zhua) and Charles S. Peskin of sustained oscillation of the two filaments: parallel flapping and mirror-image clapping, depending

Peskin, Charles S.

407

FL43CH19-Shelley ARI 10 September 2010 19:30 Flapping and Bending Bodies  

E-print Network

planar structure in a surrounding fluid flow, which includes the flapping of flags and the self is the flapping of a flag in a steady wind, and the mutual motion of wind and fabric has long begged the question are a coupled system with their motions jointly determined. The flapping of flags is a subset of a more general

Shelley, Michael

408

A motor-driven flapping-wing system mimicking beetle flight  

Microsoft Academic Search

In this work, we present an insect-inspired design of a motor-driven flapping wing system that mimics beetle in terms of beetle's dimension, flapping frequency and wing kinematics. In the design, we used a combination of a Scotch yoke mechanism and a linkage system to transform the rotary motion of a motor into a large flapping motion. A passive wing rotation

Quoc Viet Nguyen; Quang Tri Truong; Hoon Cheol Park; Nam Seo Goo; Doyoung Byun

2009-01-01

409

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 ...

410

Angiomyxoma of the nasal dorsum treated by Mohs surgery.  

PubMed

Cutaneous angiomyxomas are myofibroblastic neoplasms with locally aggressive behaviour and a high risk of recurrence. We describe a case of a solitary cutaneous angiomyxoma presenting on the nasal dorsum of a 28-year-old man, excised with Mohs surgery using permanent section control and repaired with an advancement flap. Histology showed myxoid nests of bland CD34-positive and vimentin-positive stellate and spindled cells in the deep dermis and abundant thin-walled blood vessels. An echocardiogram, performed to rule out the possibility of a cardiac myxoma with cutaneous embolisation, was normal. PMID:25333656

Kahn, Steven L; Juhl, Mark E; Sidiropoulos, Michael; Guitart, Joan; Antonijevic, Sasha; Krunic, Aleksandar L

2014-10-21

411

Successful management of esophagoparaprosthetic fistula after aortic surgery.  

PubMed

Aortoesophageal fistula is a relatively rare but highly fatal condition, especially in the case of secondary aortoesophageal fistulas after previous thoracic aortic surgery in which the aortic prosthetic graft itself may be involved in the infection, resulting in an esophagoparaprosthetic fistula. In this report, we describe a complicated case of esophagoparaprosthetic fistula arising after descending thoracic aortic replacement and endovascular pseudoaneurysm repair that was successfully treated by surgical resection and in situ aortic graft replacement using a homograft completely covered with an omental flap, combined with subtotal esophagectomy and staged reconstruction of the alimentary tract. The patient has been doing well for 24 months without signs of recurrent infection. PMID:18355554

Kawamoto, Shunsuke; Saiki, Yoshikatsu; Oda, Katsuhiko; Nitta, Yoshio; Akasaka, Jun-etsu; Miyazaki, Shukichi; Tabayashi, Koichi

2008-04-01

412

Gluteal thigh flap repair of chronic perineal wounds.  

PubMed

Since the introduction of the gluteal thigh flap in 1979, we have had the opportunity to study and modify this reconstructive technique in over 40 patients. Our successful experience with the gluteal thigh flap in six consecutive patients with difficult, nonhealing perineal pelvic sinuses has increased our confidence with this modality and led to a modified technique. Bilateral deepithelialized and well-vascularized flaps are harvested from the posterior thighs and transferred to the perineal wounds on pliable musculofascial pedicles through the ischiorectal space. Proper filling of the pelvic space requires adequate debridement, which may include release of a bottleneck narrowing of the sacral promontory. Donor site morbidity is minimal and temporary. Follow-up periods of 8 months to 5 years have revealed no wound recurrence. PMID:4037203

Hurwitz, D J; Zwiebel, P C

1985-09-01

413

Aeroelastic Analysis of Bearingless Rotor Systems with Trailing Edge Flaps  

NASA Astrophysics Data System (ADS)

An aeroelastic analysis of bearingless rotor systems with trailing edge flaps was conducted using large deflection-type beam theory for forward flight conditions with a focus on reducing vibration while minimizing control effort. The aerodynamic forces of the rotor blade were calculated using two-dimensional quasi-steady strip theory. For the analysis of forward flight, the nonlinear periodic blade steady response was obtained by integrating the full finite element equation in time through a coupled trim procedure with a vehicle trim. The objective function, which includes vibratory hub loads and active flap control inputs, was minimized by an optimal control process. Numerical simulations were performed for the steady-state forward flight of various advance ratios. Numerical results of the steady blade and flap deflections as well as the vibratory hub loads were also presented for various advance ratios and were compared with previously published analysis results obtained from modal analyses based on a moderate deflection-type beam theory.

Lim, In-Gyu; Lee, In

414

Aeroelastic analysis of rotor systems using trailing edge flaps  

NASA Astrophysics Data System (ADS)

An aeroelastic analysis of rotor blades with trailing edge flaps was conducted using large deflection-type beam theory for forward flight conditions with a focus on reducing vibration while minimizing control effort. The aerodynamic forces of the rotor blade were calculated using two-dimensional quasi-steady strip theory. For the analysis of forward flight, the nonlinear periodic blade steady response was obtained by integrating the full finite element equation in time through a coupled trim procedure with a vehicle trim. The objective function, which includes vibratory hub loads and active flap control inputs, was minimized by an optimal control process. Numerical simulations were performed for the steady-state forward flight of various advance ratios. Numerical results of the steady blade and flap deflections as well as the vibratory hub loads were also presented for various advance ratios and were compared with previously published analysis results obtained from modal analyses based on a moderate deflection-type beam theory.

Lim, In-Gyu; Lee, In

2009-04-01

415

Four-winged flapping flyer in forward flight  

E-print Network

We study experimentally a four-winged flapping flyer with chord-wise flexible wings in a self-propelled setup. For a given physical configuration of the flyer (i.e. fixed distance between the forewing and hindwing pairs and fixed wing flexibility), we explore the kinematic parameter space constituted by the flapping frequency and the forewing-hindwing phase lag. Cruising speed and consumed electric power measurements are performed for each point in the $(f,\\varphi)$ parameter space and allow us to discuss the problem of performance and efficiency in four-winged flapping flight. We show that different phase-lags are needed for the system to be optimised for fastest flight or lowest energy consumption. A conjecture of the underlying mechanism is proposed in terms of the coupled dynamics of the forewing-hindwing phase lag and the deformation kinematics of the flexible wings.

Godoy-Diana, Ramiro; Centeno, Mariana; Weinreb, Alexis; Thiria, Benjamin

2015-01-01

416

Earlobe reconstruction by the Gavello technique and bilobed flap*  

PubMed Central

The earlobe is an anatomical structure that has a significant aesthetic role. Its surgical repair places a challenge due to the difficulty of obtaining a natural appearing and durable outcome. The authors present two options: the Gavello technique and the bilobed flap, after the excision of malign neoplasms of the earlobe. The Gavello technique makes use of a bilobed flap with an anterior base to mold the new earlobe. D'Hooghe's bilobed flap with a pre and post-auricular lobe allows the reconstruction of small earlobes. Both techniques, although old, acquire an important and current interest in earlobe reconstruction, by reason of the moderate degree of difficulty, the use of a single time surgical act and under local anesthesia, with a proper aesthetic result. PMID:23739705

Cabral, Ana Rita; Alonso, Neide; Brinca, Ana; Vieira, Ricardo; Figueiredo, Américo

2013-01-01

417

Passive Porous Treatment for Reducing Flap Side-Edge Noise  

NASA Technical Reports Server (NTRS)

A passive porous treatment has been proposed as a means of suppressing noise generated by the airflow around the side edges of partial-span flaps on airplane wings when the flaps are extended in a high-lift configuration. The treatment proposed here does not incur any aerodynamic penalties and could easily be retrofit to existing airplanes. The treatment could also be applied to reduce noise generated by turbomachinery, including wind turbines. Innovative aspects of the proposed treatment include a minimum treatment area and physics-based procedure for treatment design. The efficacy of the treatment was confirmed during wind-tunnel experiments at NASA Ames, wherein the porous treatment was applied to a minute surface area in the vicinity of a flap edge on a 26-percent model of Boeing 777-200 wing.

Choudhari, Meelan M.; Khorrami, Mehdi R.

2008-01-01

418

Wide-Open Flaps are Key to Urease Activity  

PubMed Central

Substrate ingress and product egress from the active site of urease is tightly controlled by an active site flap. Molecular dynamics simulations of urease reveal a previously unobserved, wide-open flap state that, unlike the well-characterized closed and open states, allows ready access to the metal cluster in the active site. This state is easily reached, via low free energy barriers, from the closed and open states. Additionally, we find that even when the flap is closed, a region of the binding pocket is solvent exposed leading to the hypothesis that it may act as a substrate/product reservoir. The newly identified wide-open state offers further opportunities for small molecule drug discovery by defining a more extensive active site pocket than has been previously described. PMID:22670767

Roberts, Benjamin P.; Miller, Bill R.; Roitberg, Adrian E.; Merz, Kenneth M.

2012-01-01

419

Aircraft wake-vortex minimization by use of flaps  

NASA Technical Reports Server (NTRS)

A survey was made of research on the alleviation of the trailing vortex hazard by altering span loading with flaps on the generator airplane. Flap configurations of the generator that shed multiple vortices were found to have wakes that dispersed by vortex merging and sinusoidal instability. Reductions of approximately 50 percent in both the wake rolling moment imposed on a following aircraft and the aircraft separation requirement were achieved in the ground based and flight test experiments by deflecting the trailing edge flaps more inboard than outboard. Significantly, this configuration did not increase the drag or vibration on the generating aircraft compared to the conventional landing configuration. Ground based results of rolling moment measurement and flow visualization are shown, using a water tow facility, an air tow facility, and a wind tunnel. Flight test results are also shown, using a full scale B-747 airplane. General agreement was found among the results of the various ground based facilities and the flight tests.

Corsiglia, V. R.; Dunham, R. E., Jr.

1977-01-01

420

Finite element analysis of aeroacoustic jet-flap flows  

NASA Technical Reports Server (NTRS)

A computational analysis was performed on the steady, turbulent aerodynamic flowfields associated with a jet-blown flap. For regions devoid of flow separation, a parabolic approximation to the governing time-averaged Navier-Stokes equations was applied. Numerical results are presented for the symmetry plane flow of a slot-nozzle planar jet flap geometry, including prediction of flowfield evolution within the secondary mixing region immediately downstream of the trailing edge. Using a two equation turbulence kinetic energy closure model, rapid generation and decay of large spatial gradients in mean and correlated fluctuating velocity components within the immediate wake region were predicted. Modifications to the turbulent flow structure, as induced by porous surface treatment of the flap, were evaluated. The recirculating flow within a representative discrete slot in the surface was evaluated, using the two dimensional, time-averaged Navier-Stokes equations.

Baker, A. J.; Manhardt, P. D.

1977-01-01

421

The role of flaps and grafts in modern hypospadiology  

PubMed Central

The modern hypospadiologist must be proficient in the use of both vascularized flaps and free grafts. When choosing a repair for any given patient with hypospadias, one must consider the length of the urethroplasty, the presence and degree of ventral curvature and perhaps most importantly, the surgeon’s own experience. Not all repairs are created equally and different complication rates and cosmetic outcomes can be seen among different surgeons utilizing the same technique. Each surgeon tends to infuse their own modifications to any given technique and many of these modifications go unreported. It is incumbent upon each surgeon to be familiar with a wide variety of techniques, which invariably includes the use of flaps and grafts. We present a spectrum of the uses of flaps and grafts in modern hypospadiology. PMID:19468398

Wallis, M. Chad; Braga, Luis; Khoury, Antoine

2008-01-01

422

Is open surgery for head and neck cancers truly declining?  

PubMed

In the past two decades, major modifications in the way we treat head and neck cancers, due to advances in technology and medical oncology, have led to a decline in the use of open surgery as first-line treatment of cancers arising from several primary tumor sites. The incidence of tobacco- and alcohol-related squamous cell carcinoma of the pharynx and larynx has been steadily decreasing, with a rise in the incidence of human papillomavirus-related oropharyngeal tumors and the use of minimally invasive endoscopic surgery and non-surgical treatment modalities has increased in the treatment of all of these tumors. However, open surgery remains the initial definitive treatment modality for other tumors, including tumors of the skin, oral cavity, sinonasal cavities and skull base, salivary glands, thyroid and sarcomas. Selected group of nasal, paranasal, base of the skull and thyroid tumors are also candidates for minimally invasive procedures. For some indications, the rate of open surgery has actually increased in the past decade, with an increase in the incidence of oral cavity, thyroid and skin cancer, an increase in the number of neck dissections performed, and an increase in salvage surgery and free flap reconstruction. The use of minimally invasive, technology-based surgery-with the use of lasers, operating microscopes, endoscopes, robots and image guidance-has increased. Technology, epidemiology and advances in other domains such as tissue engineering and allotransplantations may further change the domains of competencies for future head and neck surgeons. PMID:23283241

Hartl, Dana M; Brasnu, Daniel F; Shah, Jatin P; Hinni, Michael L; Takes, Robert P; Olsen, Kerry D; Kowalski, Luiz P; Rodrigo, Juan P; Strojan, Primož; Wolf, Gregory T; Rinaldo, Alessandra; Suárez, Carlos; Mendenhall, William M; Paleri, Vinidh; Forastiere, Arlene A; Werner, Jochen A; Ferlito, Alfio

2013-11-01

423

New mucosal flap modification for endonasal endoscopic dacryocystorhinostomy in Asians  

PubMed Central

AIM To describe a simple modification of fashioning the mucosal flap for endonasal endoscopic dacryocystorhinostomy (EES-DCR) in Asians and investigate its efficacy. METHODS A total of 120 patients with unilateral primary chronic dacryocystitis (PCD) were randomized into two groups: the new shaped nasal mucosal flap group (group A) and the removed nasal mucosal flap group (group B). All patients underwent standard EES-DCR. Patients in group A were performed a new shaped nasal mucosal flap covering the bared bone around the opened sac and those in group B was removed the nasal mucosal flap uncovering the bared bone. Patients were followed up for one year. The occurrence of granulation tissue, the proliferation of scar tissue and success rate of EES-DCR was compared. RESULTS In the present study, complete postoperative data were acquired from 54 patients in group A and from 57 patients in group B. During process of review, the occurrence of granulation tissue was at the ostium margins account for 15% (8/54) in group A and 39% (22/57) in group B (P<0.05). At the one-year review, scar tissue was present in 5 patients in group A compared with 18 in group B (P<0.05). The success rate of EES-DCR was 98% (53/54) in group A and 84% (48/57) in group B (P<0.05). CONCLUSION The simple modification of fashioning nasal mucosal flap can effectively cover the bared bone around the opened sac and reduce formation of granulation tissue, lessen the risk of scar tissue formation and closure of ostium, thus improve the success rate of EES-DCR in Asians. PMID:23275904

Ji, Qing-Shan; Zhong, Jing-Xiang; Tu, Yun-Hai; Wu, Wen-Can

2012-01-01

424

Paradoxical effects of heme arginate on survival of myocutaneous flaps  

PubMed Central

Ischemia reperfusion injury (IRI) contributes to partial flap and solid organ transplant failure. Heme-oxygenase 1 (HO-1) is an inducible, cytoprotective enzyme which protects against IRI in solid organ transplant models. Heme arginate (HA), a HO-1 inducer, is a promising, translatable, preconditioning agent. This study investigated the effects of preconditioning with HA on the clinical outcome of a myocutaneous IRI model. Forty male Lewis rats were randomized to intravenously receive 1) Control-NaCl, 2) HA, 3) HA and tin mesoporphyrin (SnMP), a HO-1 inhibitor; and 4) SnMP alone. Twenty-four hours later, an in situ transverse rectus abdominis myocutaneous flap was performed under isoflurane anesthesia. Viability of flaps was measured clinically and by laser-Doppler perfusion scanning. In vitro work on human epidermal keratinocytes (HEKa) assessed the effects of HA, SnMP, and the iron chelator desferrioxamine on 1) cytotoxicity, 2) intracellular reactive oxygen species (ROS) concentration, and 3) ROS-mediated DNA damage. In contrast to our hypothesis, HA preconditioning produced over 30% more flap necrosis at 48 h compared with controls (P = 0.02). HA-containing treatments produced significantly worse flap perfusion at all postoperative time points. In vitro work showed that HA is cytotoxic to keratinocytes. This cytotoxicity was independent of HO-1 and was mediated by the generation of ROS by free heme. In contrast to solid organ data, pharmacological preconditioning with HA significantly worsened clinical outcome, thus indicating that this is not a viable approach in free flap research. PMID:24089372

Czopek, Alicja; Wigmore, Stephen J.; Kluth, David C.

2013-01-01

425

Paradoxical effects of heme arginate on survival of myocutaneous flaps.  

PubMed

Ischemia reperfusion injury (IRI) contributes to partial flap and solid organ transplant failure. Heme-oxygenase 1 (HO-1) is an inducible, cytoprotective enzyme which protects against IRI in solid organ transplant models. Heme arginate (HA), a HO-1 inducer, is a promising, translatable, preconditioning agent. This study investigated the effects of preconditioning with HA on the clinical outcome of a myocutaneous IRI model. Forty male Lewis rats were randomized to intravenously receive 1) Control-NaCl, 2) HA, 3) HA and tin mesoporphyrin (SnMP), a HO-1 inhibitor; and 4) SnMP alone. Twenty-four hours later, an in situ transverse rectus abdominis myocutaneous flap was performed under isoflurane anesthesia. Viability of flaps was measured clinically and by laser-Doppler perfusion scanning. In vitro work on human epidermal keratinocytes (HEKa) assessed the effects of HA, SnMP, and the iron chelator desferrioxamine on 1) cytotoxicity, 2) intracellular reactive oxygen species (ROS) concentration, and 3) ROS-mediated DNA damage. In contrast to our hypothesis, HA preconditioning produced over 30% more flap necrosis at 48 h compared with controls (P = 0.02). HA-containing treatments produced significantly worse flap perfusion at all postoperative time points. In vitro work showed that HA is cytotoxic to keratinocytes. This cytotoxicity was independent of HO-1 and was mediated by the generation of ROS by free heme. In contrast to solid organ data, pharmacological preconditioning with HA significantly worsened clinical outcome, thus indicating that this is not a viable approach in free flap research. PMID:24089372

Edmunds, Marie-Claire; Czopek, Alicja; Wigmore, Stephen J; Kluth, David C

2014-01-01

426

Free Fibula Reconstruction of Distal Tibial Defects After Sarcoma Surgery.  

PubMed

Distal tibial tumor ablation results in combined soft tissue and bone defect that involves the ankle joint. This area is unique and problematic because it combines low caliber limb size, relatively soft tissue deficiency, suboptimal bone and soft tissue healing ability, and the need to sustain increased mechanical loads. The management is difficult, controversial, and traditionally was treated by primary amputation. We present our experience with a limb sparing surgery using biological reconstruction.Between 2004 and 2007, 5 patients with malignant bone tumors of the distal tibia underwent tumor resection and reconstruction with free vascularized osteoseptocutaneous fibula flap. The average age was 33.2 years (range, 11-62 years). In all cases, a skin island was harvested and used for wound closure. Arthrodesis of the ankle joint was preformed in all patients. Double fixation system was used to provide stability and avoid flap rotation.All flaps survived. There were no major complications. One patient had partial loss of the skin paddle that was treated conservatively. Callous formation was documented after an average time of 4 months, partial weight bearing after an average time of 4 months, and full weight bearing after an average time of 11.5 months. All patients regained almost normal ambulation within a year. PMID:24343357

Scaglioni, Mario Francesco Carlo; Arzi, Ravit Yanko; Gur, Eyal; Amotz, Oded Ben; Barnea, Yoav; Kollender, Yheuda; Meller, Isaak; Bickels, Jacob; Dadia, Shlomo; Zaretski, Arik

2013-12-13

427

Spreader flaps for middle vault contour and stabilization.  

PubMed

Nasal hump excision is common during septorhinoplasty. Without appropriate restoration of the middle nasal vault, cosmetic and functional problems may ensue. Recently, spreader flaps have become an established alternative to traditional spreader grafts. Typical indications include primary rhinoplasty patients with hump noses, hump/tension noses, and moderately hooked or crooked noses. When suitable patients are selected, spreader flaps and their modifications represent a reliable alternative to the standard spreader graft, and when all of the necessary prerequisites are met, this technique obviates the need for additional cartilage grafting in most cases. PMID:25430925

Kovacevic, Milos; Wurm, Jochen

2015-02-01

428

Reinnervation after nerve suture in rat groin flaps.  

PubMed

Regeneration of sensory and adrenergic nerves in the skin was studied in rats. The aim was to investigate the effect of reanastomosing the cut nerve ends of the nerve trunk leading to the microvascular groin flap. Reinnervation was demonstrated immunohistochemically using calcitonin gene-related peptide (CGRP) as marker for sensory nerves, neuropeptide Y (NPY) and tyrosine hydroxylase (TH) as markers for adrenergic nerves and Protein Gene Product 9.5 (PGP 9.5) as general neuronal marker. It was demonstrated that reanastomosing of the nerve trunk was favourable for both the sensory and sympathetic reinnervation of microsurgical flaps. PMID:9635785

Ranne, J O; Lähteenmäki, P T; Vaalasti, A; Waris, T H; Lindholm, T S

1998-01-01

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Dipyrone Increases the Blood Flow of Arterial Dorsal Skin Flaps  

Microsoft Academic Search

Background  Findings have shown that dipyrone has a beneficial effect on