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1

Treatment of symptomatic bullous keratopathy with poor visual prognosis using a modified Gundersen conjunctival flap and amniotic membrane.  

PubMed

A modified Gundersen conjunctival flap combined with amniotic membrane to treat symptomatic bullous keratopathy and poor visual prognosis is described. A 360° conjunctival peritomy was performed 2 mm from the limbus. After complete epithelial removal of the corneo-conjunctival surface, an amniotic membrane graft was sutured at the peripheral cornea with a running 10-0 nylon suture. Single 9-0 polyglactin sutures attached the edges of the amniotic membrane with the peritomized conjunctiva, which lay over the amniotic membrane. Five eyes were treated. Epithelialization, resolution of the pain, presence of ocular surface inflammation, and reinterventions were assessed. All eyes showed immediate resolution of the pain and minimal inflammation. In 1 eye, the amniotic membrane was reabsorbed before complete epithelialization. No reinterventions were required. All eyes were asymptomatic for at least 16 months. This technique provided sustained relief of symptomatic bullous keratopathy while significantly reducing the conjunctival manipulation and the anatomical distortion associated with classic sliding conjunctival flaps. PMID:22956637

Güell, Jose L; Morral, Merce; Gris, Oscar; Elies, Daniel; Manero, Felicidad

2012-01-01

2

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

3

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

4

Predictive risk factors of free flap thrombosis in breast reconstruction surgery.  

PubMed

Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage. © 2014 Wiley Periodicals, Inc. Microsurgery 34:589-594, 2014. PMID:24665051

Masoomi, Hossein; Clark, Emily G; Paydar, Keyianoosh Z; Evans, Gregory R D; Nguyen, Audrey; Kobayashi, Mark R; Wirth, Garrett A

2014-11-01

5

An audit of Bjork flap tracheostomies in head and neck plastic surgery  

Microsoft Academic Search

Patients undergoing head and neck surgery for malignancy especially resection of parts of the upper aerodigestive tracts need a secure airway intra- and postoperatively. A tracheostomy is an effective method of achieving this objective. In our unit the Bjork flap technique' has been the preferred type of tracheostomy. Ninety-five consecutive Bjork flap tracheostomies performed by one surgeon preceding major head

C. M. Malata; I. T. H. Foo; K. H. Simpson; A. G. Batchelor

1996-01-01

6

Effect of Cerebrospinal Fluid Leakage on Wound Healing in Flap Surgery: Histological Evaluation  

Microsoft Academic Search

The aim of this study was to find out the effect of CSF leakage on wound healing after flap surgery. Sixteen male Wistar rats were used. The superiorly based rectangular dorsal skin flap 3 × 3 cm was elevated at the interscapular region. Through this opening, paraspinal muscle dissection and three-level bilateral laminectomy were done. Finally, a dura defect with

Orhan Babuccu; Irfan Peksoy; Ferda Cagavi

2004-01-01

7

Revisional surgery following the superiorly based posterior pharyngeal wall flap. Historical perspectives and current considerations.  

PubMed

The aim of this study was to describe the surgical and functional complications following superiorly based posterior pharyngeal wall (SBPP) flap surgery. Records of 130 patients with velopharyngeal insufficiency (VPI) who had undergone SBPP flap surgery as a secondary procedure to reduce nasal resonance in speech were reviewed. Complications were defined as the incidence of revisional surgery required to obtain a more satisfactory result. 20 patients (15%) required revisional surgery. In 4 patients (3%) early revisional surgery was indicated to treat surgical complications (1 postoperative bleeding, 3 flap dehiscences). In 16 patients (12%) late revisional surgery was indicated to achieve a better functional result with regard to nasal resonance in speech. The low incidence of surgical complications indicates that SBPP flap surgery is a safe procedure. After SBPP flap surgery, a satisfactory functional result with respect to nasal resonance was obtained in 88% of patients. This result was improved after revisional surgery. The hypothesis that the patients of an experienced surgeon have fewer complications and better functional results than those of a less experienced one was tested. The individual skill of the surgeon rather than their experience led to a better functional result. PMID:19632094

Keuning, K H D M; Meijer, G J; van der Bilt, A; Koole, R

2009-11-01

8

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

PubMed Central

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

2014-01-01

9

Speech Outcome regarding Overall Intelligibility, Articulation, Resonance and Voice in Flemish Children a Year after Pharyngeal Flap Surgery  

Microsoft Academic Search

Objective: The main purpose of this study is to determine the treatment effectiveness of pharyngeal flap surgery by measuring speech outcome 1 year after surgery. The authors hypothesized that flap surgery is an effective technique for velopharyngeal inadequacy resulting in improved intelligibility, decreased hypernasality and nasalance scores and normal voice characteristics. Patients and Methods: Objective (Nasometer, Dysphonia Severity Index) as

Kristiane M. Van Lierde; Katrien Bonte; Nele Baudonck; P. Van Cauwenberge; Els M. R. De Leenheer

2008-01-01

10

Use of Martius flap in the complex female urethral surgery  

PubMed Central

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

Tupikina, Nataliya; Pushkar, Dmitry

2014-01-01

11

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

12

Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps  

Microsoft Academic Search

Objective: Severe sternum necrosis requiring extended resection necessitates plastic reconstruction of the resulting defect and stabilization of the chest. We analyzed the outcome of patients undergoing bilateral pectoralis major flap repair on functional and cosmetic results, chest stabilization and pulmonary function. Methods: Twelve patients undergoing cardiac surgery between 1997 and 2001 suffered from a deep mediastinal wound infection and sternum

Armin Alex Klesius; Omer Dzemali; Andreas Simon; Peter Kleine; Ulf Abdel-Rahman; Christopher Herzog; Gerhard Wimmer-Greinecker; Anton Moritz

2004-01-01

13

Successful treatment of deep sternal infections following open heart surgery by bilateral pectoralis major flaps  

Microsoft Academic Search

Objective: Severe sternum necrosis requiring extended resection necessitates plastic reconstruction of the resulting defect and stabilization of the chest. We analyzed the outcome of patients undergoing bilateral pectoralis major flap repair on functional and cosmetic results, chest stabilization and pulmonary function. Methods: Twelve patients undergoing cardiac surgery between 1997 and 2001 suffered from a deep mediastinal wound infection and sternum

Armin Alex Klesius; Omer Dzemali; Andreas Simon; Peter Kleine; Ulf Abdel-Rahman; Christopher Herzog; Gerhard Wimmer-Greinecker; Anton Moritz

2010-01-01

14

Late-onset laser in situ keratomileusis (LASIK) flap dehiscence during retinal detachment surgery  

Microsoft Academic Search

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) flap dehiscence during retinal detachment surgery 7 months after uneventful refractive surgery.DESIGN: Interventional case report.METHODS: A 47-year-old man noticed a defect of the upper visual field in his right eye 7 months after a LASIK procedure. The fundus showed rhegmatogenous retinal detachment, and a scleral buckling procedure was performed.

Eiji Sakurai; Masatoshi Okuda; Miho Nozaki; Yuichiro Ogura

2002-01-01

15

Radial forearm flap surgery—evaluation of donor site morbidity  

Microsoft Academic Search

The free radial forearm flap is an excellent method for reconstruction of defects in the head and neck region. In the literature,\\u000a there is still disagreement about the best surgical treatment of the forearm defect to avoid functional and cosmetic drawbacks.\\u000a There is a debate about using full-thickness skin graft or better split thickness skin graft. To evaluate our own

A. Thiele; C. Wulke; E. Roepke; S. Knipping

2008-01-01

16

[Surgery guided by customized devices: reconstruction with a free fibula flap].  

PubMed

The reconstruction of jaws with a free fibula flap can be anticipated virtually. The simulation can be transferred to the operating theater using customized devices obtained from computer-assisted design and manufacturing in a complete digital workflow. Several alternatives are available, from cutting guides to customized titanium osteosynthesis plates, to obtain the best accuracy and reproducibility of reconstruction. Moreover, these new processes allow integrating prosthetic planning concomitantly with reconstruction. We present the virtual three-dimensional planning method for jaw reconstruction with a free fibula flap and the various alternatives of surgery guided by customized devices provided by this planning. PMID:24412037

Schouman, T; Bertolus, C; Chaine, C; Ceccaldi, J; Goudot, P

2014-02-01

17

ExPRESS Miniature Glaucoma Device Implanted Under a Scleral Flap Alone or Combined With Phacoemulsification Cataract Surgery  

Microsoft Academic Search

Purpose: Our purpose was to evaluate the clinical outcomes of the Ex-PRESS miniature glaucoma device placed under a partial- thickness scleral flap as a single procedure or combined with phacoemulsification cataract surgery. Methods: This was a comparative consecutive case series of 345 eyes: 231 eyes treated with Ex-PRESS implant under scleral flap alone and 114 eyes treated with Ex-PRESS implant

Elliott M. Kanner; Peter A. Netland; Steven R. Sarkisian; Haiming Du

2009-01-01

18

Technical Changes in Paraspinous Muscle Flap Surgery Have Increased Salvage Rates of Infected Spinal Wounds  

PubMed Central

Objectives: The objective of this study is to introduce modifications in paraspinous muscle flap surgery and compare this new variation's ability to salvage infected hardware with the classic technique. Infected posterior spine wounds are a difficult problem for reconstructive surgeons. As per experience, hardware retention in infected wounds maintains spinal stability, decreases length of stay, and decreases the wound healing complication rate. Methods: An 11-year retrospective office and hospital chart review was conducted between July 1996 and August 2007. All patients who underwent paraspinous muscle flap reconstruction for postspine surgery wound infections during this time period were included. There were 51 patients in the study representing the largest reported series, to date, for this procedure. Twenty-two patients underwent treatment using the modified technique and 29 patients were treated using the classic technique. Results: There was no statistical difference between the 2 groups in demographics, medical history, or reason for initial spine surgery. The hardware salvage rate associated with the modified technique was greater than the rate associated with the classic technique (95.4% vs 75.8%; P = .03). There were fewer postreconstruction wound healing complications requiring hospital readmission in the modified technique group than the classic group (13.6% vs 44.8%; P = .04). Patients in the modified technique group demonstrated a shorter mean length of stay than the patients in the classic group (23.7 days vs 29.7; P = .25). Conclusions: The modified paraspinous muscle flap technique is an excellent option for spinal wound reconstruction, preservation of spinal hardware, and local infection control. PMID:19011678

Mericli, Alexander F.; Moore, John H.; Copit, Steven E.; Fox, James W.; Tuma, Gary A.

2008-01-01

19

Short-term effect of Keyes' approach to periodontal therapy compared with modified Widman flap surgery.  

PubMed

Keyes' method of non-surgical therapy was compared with modified Widman flap surgery in 9 patients with symmetrical periodontal disease. Following an initial oral hygiene programme, baseline measurements were recorded and paired contralateral areas were subjected randomly to the 2 techniques. 42 teeth receiving surgery were compared with 40 treated by Keyes' method. 6 sites per tooth were scored immediately prior to therapy and 3 months later, using a constant force probe with onlays. Consistent data were recorded for the 6 separate sites, which showed no baseline difference between treatments, slightly greater recession with surgery at 3 months, but no difference between treatments in probing depth and attachment levels. Mean data for individual patients showed similar consistency. Probing depth in deep sites was reduced slightly more with surgery, and there were no differences in bleeding on probing at 3 months. Both techniques gave marked improvements in health. Surprisingly, only 2 subjects preferred Keyes' technique of mechanical therapy, 6 preferred surgery, and 1 had no preference. PMID:2826548

Whitehead, S P; Watts, T L

1987-11-01

20

Tunnelled lateral fasciocutaneous thoracodorsal flap with a skin island in breast reconstruction in oncoplastic breast surgery.  

PubMed

The technique and results of a tunnelled lateral fasciocutaneous flap with a skin island is described in immediate partial breast reconstruction in a subpopulation in oncoplastic breast surgery. Fifteen patients were operated on from January 2008 to January 2011. The subpopulation consisted of patients with small or medium-sized breasts. All patients had invasive ductal carcinomas, located in the lateral or central parts of the breast, of which the lumpectomy in three cases included the nipple areola complex. Eleven patients had axillary lymph node dissection because of positive sentinel node biopsy. In four patients a re-resection was performed due to insufficient primary resection margins. No primary or secondary mastectomies were performed. One haematoma at the site of reconstruction was registered as the only postoperative complication. No patient developed wound infection, delayed wound healing, seroma, or any flap complications. All patients had adjuvant chemotherapy and radiation therapy according to the guidelines of The Danish Breast Cancer Group. The patients were seen at follow-up visits at 14 days, 3, 12, and 24 months. No recurrences were seen during the observation time except for one patient, who had recurrence with dissemination of the disease and died 19 months postoperatively. PMID:23157501

Rose, Michael; Svensson, Henry

2012-12-01

21

Breast cancer in the lower jaw after reconstructive surgery with a pectoralis major myocutaneous flap (PMMC) - A case report  

PubMed Central

For head and neck as well as for oromaxillofacial surgery, the use of the pectoralis major myocutaneous (PMMC) flap is a standard reconstructive technique after radical surgery for cancers in this region. We report to our knowledge for the first development of breast cancer in the PMMC flap in a 79 year old patient, who had undergone several operations in the past for recurring squamous cell carcinoma of the jaw. The occurrence of a secondary malignancy within the donor tissue after flap transfer is rare, but especially in the case of transferred breast tissue and the currently high incidence of breast cancer theoretically possible. Therefore preoperative screening mammography seems advisable to exclude a preexisting breast cancer in female patients undergoing such reconstruction surgery. Therapy for breast cancer under these circumstances is individual and consists of radical tumor resection followed by radiation if applicable and a standard systemic therapeutic regimen on the background of the patients individual prognosis due to the primary cancer. PMID:22112363

2011-01-01

22

Computer-Assisted Teaching of Skin Flap Surgery: Validation of a Mobile Platform Software for Medical Students  

PubMed Central

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

23

Image fusion of thallium-201 SPECT and MR imaging for the assessment of recurrent head and neck tumors following flap reconstructive surgery  

Microsoft Academic Search

The aim of this study was to assess the value of fused MR and Tl-201 single photon emission computed tomography (SPECT) images in the diagnosis of recurrent head and neck tumors in patients after flap reconstruction surgery. Twenty-four patients after resection of primary head and neck tumors with flap reconstruction were suspected of having recurrent tumor by follow-up MR examination.

Noriaki Tomura; Osamu Watanabe; Koichi Omachi; Ikuo Sakuma; Satoshi Takahashi; Takahiro Otani; Hiroyuki Kidani; Jiro Watarai

2004-01-01

24

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

25

Fascia redefined: anatomical features and technical relevance in fascial flap surgery.  

PubMed

Fascia has traditionally been thought of as a passive structure that envelops muscles, and the term "fascia" was misused and confusing. However, it is now evident that fascia is a dynamic tissue with complex vasculature and innervation. A definition of fascia as an integral tissue has been provided here, highlighting the main features of the superficial and deep fasciae. Wide anatomic variations and site-specific differences in fascial structure are described, coupled with results of our extensive investigations of fascial anatomy. This will enable surgeons to make better decisions on selecting the appropriate fascia in the construction of fascial flaps. The use of the superficial or deep fasciae in the creation of a fascial flap cannot be selected at random, but must be guided by the anatomical features of the different types of fasciae. In particular, we suggest the use of the superficial fascia, such as the parascapular fascio-cutaneous free flap or any cutaneous flap, when a well-vascularized elastic flap, with the capacity to adhere to underlying tissues, is required, and a fascio-cutaneous flap formed by aponeurotic fascia to resurface any tendon or joints exposures. Moreover, the aponeurotic fascia, such as the fascia lata, can be used as a surgical patch if the plastic surgeon requires strong resistance to stress and/or the capacity to glide freely. Finally, the epimysial fascia, such as in the latissimus dorsi flap, can be used with success when used together with the underlying muscles. Clearly, extensive clinical experience and judgment are necessary for assessment of their potential use. PMID:23266871

Stecco, Carla; Tiengo, Cesare; Stecco, Antonio; Porzionato, Andrea; Macchi, Veronica; Stern, Robert; De Caro, Raffaele

2013-07-01

26

Online rapid sampling microdialysis (rsMD) using enzyme-based electroanalysis for dynamic detection of ischaemia during free flap reconstructive surgery.  

PubMed

We describe an enzyme-based electroanalysis system for real-time analysis of a clinical microdialysis sampling stream during surgery. Free flap tissue transfer is used widely in reconstructive surgery after resection of tumours or in other situations such as following major trauma. However, there is a risk of flap failure, due to thrombosis in the flap pedicle, leading to tissue ischaemia. Conventional clinical assessment is particularly difficult in such 'buried' flaps where access to the tissue is limited. Rapid sampling microdialysis (rsMD) is an enzyme-based electrochemical detection method, which is particularly suited to monitoring metabolism. This online flow injection system analyses a dialysate flow stream from an implanted microdialysis probe every 30 s for levels of glucose and lactate. Here, we report its first use in the monitoring of free flap reconstructive surgery, from flap detachment to re-vascularisation and overnight in the intensive care unit. The on-set of ischaemia by both arterial clamping and failure of venous drainage was seen as an increase in lactate and decrease in glucose levels. Glucose levels returned to normal within 10 min of successful arterial anastomosis, whilst lactate took longer to clear. The use of the lactate/glucose ratio provides a clear predictor of ischaemia on-set and subsequent recovery, as it is insensitive to changes in blood flow such as those caused by topical vasodilators, like papaverine. The use of storage tubing to preserve the time course of dialysate, when technical difficulties arise, until offline analysis can occur, is also shown. The potential use of rsMD in free flap surgery and tissue monitoring is highly promising. PMID:23435450

Rogers, M L; Brennan, P A; Leong, C L; Gowers, S A N; Aldridge, T; Mellor, T K; Boutelle, M G

2013-04-01

27

A difficult case: omental transposition flap reconstruction of a large radionecrotic axillary ulcer in a patient with extensive previous abdominal surgery.  

PubMed

Radionecrotic ulcers due to breast cancer treatment is a highly morbid and disabling condition, causing pain, malodour, need for frequent dressings, reduced range of shoulder movements and an unacceptable cosmetic appearance. In patients with radiotherapy to the chest and/or axilla and general poor health the usual reconstructive options may not be suitable due to regional tissue damage and inappropriate long anaesthetic time, respectively. Described procedures include the pedicled latisimus dorsi flap, transverse rectus abdominal flap (TRAM) and omental transposition flap, as well as free tissue transfer (e.g. free TRAM, DIEP). We report a case of a morbidly obese female patient presenting with a large radionecrotic ulcer in her left axilla, following mastectomy, axillary clearance and local radiotherapy to left chest and axilla for breast cancer. She underwent reconstruction using an omental transposition flap, despite previous abdominal surgery. PMID:22871429

Hartmann, Christoph E A; Ko, Loretta W L; Ion, Lucion; Jemec, Barbara

2013-03-01

28

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

PubMed

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

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

2011-10-01

29

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

30

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

PubMed Central

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

2014-01-01

31

Use of the Hadad-Bassagasteguy flap for repair of recurrent cerebrospinal fluid leak after prior transsphenoidal surgery  

PubMed Central

The Hadad-Bassagasteguy vascularized nasoseptal pedicled flap (HBF) is an effective technique for reconstruction of skull base defects with low incidence of postoperative cerebrospinal fluid (CSF) leak. Advanced planning is required as posterior septectomy during transsphenoidal surgery can preclude its use due to destruction of the vascular pedicle. We present four cases in which the HBF was successfully used to repair recurrent CSF leaks despite prior posterior septectomy and transsphenoidal surgery. A retrospective chart review was performed on all patients who developed recurrent CSF leak after transsphenoidal surgery over a 7-year period (2006–2013). Data were collected regarding demographics, clinical presentation, intraoperative findings, and surgical outcomes. Four patients who developed recurrent CSF drainage after transsphenoidal surgery were managed with HBF reconstruction during the study period. Two were men and two were women with a mean age of 37 years (range, 24–48 years). All had previously undergone resection of a pituitary macroadenoma via a transsphenoidal approach, with intraoperative CSF leaks repaired using multilayered free grafts. Recurrent CSF rhinorrhea arose 0.37–12 months (mean, 2.98 months) after the initial pituitary surgery. Active CSF drainage could be visualized intraoperatively with posterior septal perforations present. The HBF was successfully used in all cases, with no evidence of recurrent CSF leak after a mean follow-up of 2.35 years. The HBF may be salvaged for repair of recurrent CSF leaks even in the context of prior posterior septectomy and transsphenoidal surgery. However, longer follow-up is necessary to determine the long-term efficacy of this procedure in such revision cases. PMID:24498521

Brunworth, Joseph; Lin, Tina; Keschner, David B.; Garg, Rohit

2013-01-01

32

Bone flap management in neurosurgery  

Microsoft Academic Search

SUMMARY Bone flap removal procedure is growing in frequency in neuro- surgical practice. Decompressive craniotomy has gained more scientifical evidences of its therapeutical value in post-traumatic brain swelling, in cerebrovascular diseases and in brain edema non-responding to clinical treatment after elective surgeries. Bone flap destination after craniotomy has many possible fates. We present a literature review of bone flap management

Andrei Fernandes Joaquim; João Paulo Mattos; Feres Chaddad Neto; Armando Lopes; Evandro de Oliveira

33

Effects of an air-powder abrasive device used during periodontal flap surgery in dogs.  

PubMed

An air-powder abrasive system, the Prophy-Jet, is a commercially available product product intended for use during dental prophylaxis procedures. The purpose of this investigation was to assess the effects on periodontal tissues when the device is used as an adjunct to hand instrumentation in root preparation during periodontal surgery. The degree of tissue injury was assessed by evaluating clinical healing and by histometric analysis of the intensity of the inflammatory response at selected healing times. Surgical sites subjected to Prophy-Jet treatment tended to have slightly lower histometric inflammation scores than control sites treated by hand instrumentation alone. As judged by the inflammatory response and clinical healing, additional effects to surgical exposure of tissues of the periodontium were benign. Use of the Prophy-Jet instrument during periodontal surgery is effective and well tolerated. PMID:2846817

Pippin, D J; Crooks, W E; Barker, B F; Walters, P L; Killoy, W J

1988-09-01

34

Medial Thigh Lift Free Flap for Autologous Breast Augmentation after Bariatric Surgery  

Microsoft Academic Search

Background: Massive weight loss following bariatric surgery frequently results in body contour deformities like ptotic and\\u000a hypoplastic breasts, redundant abdominal tissue and loose skin especially in the medial thigh area.This redundant tissue can\\u000a be used for breast augmentation in the case of hypertrophic ptotic breasts. Method: In 3 patients who underwent a vertical\\u000a banded gastroplasty and consecutively lost more than

Thomas Schoeller; Romed Meirer; Angela Otto-Schoeller; Gottfried Wechselberger; Hildegunde Piza-Katzer

2002-01-01

35

[Use of cutaneo-fascial flaps in reconstructive surgery of the lower extremities].  

PubMed

Defects in the soft tissues of the lower extremities after burns and traumas in 10 patients were managed by plastic surgery using ++cutaneo-fascial grafts formed from the leg of the same or contralateral side. The operation was performed in two or three stages. ++Cutaneo-fascial grafts formed on the posteromedial or posterolateral surface of the leg may have a width:length ratio of 1:3. In cross plastics the proximal one third of the graft is folded like a tube. Inclusion of the vena saphena magna in the graft and measures aimed at prevention of separation of the fascia from the layer of fat increase the viability of the graft. Secondary deformity is significantly reduced by modelling the edges of the donor wound and closing it with an unperforated graft of split skin. PMID:2273843

Grishkevich, V M; Moroz, V Iu; Trutiak, I R; Salikhbaev, B S; Iudenich, A A; Kurbanov, Sh A; Shishkov, A L

1990-09-01

36

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

PubMed

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

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

2014-09-01

37

Reconstruction of porcine critical-sized mandibular defects with free fibular flaps: the development of a craniomaxillofacial surgery model.  

PubMed

Vascularized bone flaps are the well-known standards of care for reconstruction of segmental mandibular defects ? 6 cm. We developed a large animal critical-sized mandibular defect model in which osseous free fibula flaps were used for reconstruction.In this study a total of eight 3-month-old Yorkshire pigs underwent 6 cm full-thickness resection of the left hemimandible. An osseous free fibula flap from the left leg was harvested and contoured to the mandibular defect. Bone placement and plate position was confirmed with fluoroscopy. Animals were followed with serial radiographs and clinical evaluations.Free fibulas were transferred successfully in all eight animals. The average operative time was 346 minutes, and the average flap ischemia time was 86 minutes. The average volume ratio of reconstructed hemimandibles to nonoperated control hemimandibles was 0.72 ± 0.33. The average maximum fracture load was 689 ± 262 N, and the average ratio of biomechanical fracture load for these samples compared with contralateral control hemimandibles was 0.88 ± 0.25.It is concluded that the porcine osseous free fibula flaps can be reliably harvested and viably transferred to critical-sized posterior mandibular defects with acceptable long-term results. The described microsurgical large animal model is acceptable for use in craniomaxillofacial experimentation. PMID:24590323

Dorafshar, Amir H; Mohan, Raja; Mundinger, Gerhard S; Brown, Emile N; Kelamis, Alex J; Bojovic, Branko; Christy, Michael R; Rodriguez, Eduardo D

2014-05-01

38

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 ...

39

Skin flaps and grafts - self-care  

MedlinePLUS

... skin infection Surgery for skin cancer Venous ulcers , pressure ulcers , or diabetic ulcers that do not heal After mastectomy or amputation Donor sites for grafts and flaps are chosen ... surgery than the wound due to newly exposed nerve endings.

40

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

41

Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function  

PubMed Central

Background Surgery after (chemo)radiation (RCTX/RTX) is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemo)radiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS) was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female) for salvage (10/21), palliation (4/21), or functional rehabilitation (7/21). Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19%) (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas) and major donor site complications in 1 pt (wound dehiscence). Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%). A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemo)radiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used. PMID:21896171

2011-01-01

42

Pseudomonas aeruginosa necrotizing infection of the abdominal flap in a post-bariatric patient undergoing body contouring surgery.  

PubMed

Pseudomonas aeruginosa infections may involve any organ or body district and may give serious clinical sequelae. We report the case of an infection of the abdominoplasty flap that compromised wound closure and jeopardized the aesthetic outcome. To the best of our knowledge, this is the first such case reported in the literature for this group of patients. We have presented this case in order to alert plastic and general surgeons who may encounter this complication in future, such that they may be aware of the need to adopt an aggressive approach to manage these patients. This consisted of the accurate monitoring of the patient's clinical condition, prescribing appropriate antibiotics, and performing serial debridement of necrotic tissue. PMID:18953619

Araco, Antonino; Araco, Francesco; Abdullah, Parveen; Overton, John; Gravante, Gianpiero

2009-06-01

43

Venous flaps.  

PubMed

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

Thatte, M R; Thatte, R L

1993-04-01

44

Metatarsal artery perforator-based propeller flap.  

PubMed

Soft-tissue defects of the distal foot that involve an exposed tendon and bone demonstrate a reconstructive challenge for plastic surgeons. This report investigates the feasibility and reliability of metatarsal artery perforator (MAP)-based propeller flap for reconstruction of the distal foot soft-tissue defects. Between July 2011 and June 2012, six patients underwent distal foot reconstruction with seven MAP-based propeller flaps. Five flaps were based on the third metatarsal artery and two flaps were based on the first metatarsal artery. The flap size ranged from 4 × 2 cm to 8 × 4 cm. All flaps completely survived. Two patients developed transient distal venous congestion, which subsided spontaneously without complications. There were no donor site complications. All patients were ambulating without difficulty within the first month of surgery. MAP-based propeller flaps can be used to repair the distal foot soft-tissue defects, providing sufficient skin territory and excellent esthetic and functional recovery. PMID:24822254

Cinpolat, Ani; Bektas, Gamze; Ozkan, Ozlenen; Rizvanovic, Zumreta; Seyhan, Tamer; Coskunfirat, O Koray; Ozkan, Omer

2014-05-01

45

ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX SOFT TISSUE HAND RECONSTRUCTIONS  

Microsoft Academic Search

The anterolateral thigh free flap is described in terms of its surgical anatomy, techniques of elevation and its application in seven cases of trauma to the hand. The particular advantages of this free flap for reconstructing a variety of hand defects are demonstrated. Flap refinements that have potential applications for hand surgery are described.

M JAVAID; G. C CORMACK

2003-01-01

46

Sensory recovery in melolabial flaps used for oral cavity reconstruction  

Microsoft Academic Search

Current literature advocates the use of complex reinnervated free flaps to re-establish oral sensation after resection of oral cavity cancers. It has been demonstrated that noninnervated flaps can also re-establish sensation. We assessed the return of sensation in local melolabial flaps used in oral reconstruction. Seven patients underwent sensory testing at intervals from 12 to 18 months after surgery. The

FRANCISCO J. CIVANTOS; JEFFREY ROTH; W. JARRARD GOODWIN; DONALD T. WEED

2000-01-01

47

Analysis of inflammatory periimplant lesions during a 12-week period of undisturbed plaque accumulation--a comparison between flapless and flap surgery in the mini-pig.  

PubMed

This study's aim was to clarify the influence of soft tissue management on the development of periimplant infection. Four weeks after removal of all maxillary premolars in 12 mini-pigs, four BEGO Semados RI implants were inserted in each maxillary quadrant. Employing a split-mouth design, one quadrant was randomized to flapless insertion while the contralateral side was chosen for flap surgery. Following 1, 2, 4 and 12 weeks of transmucosal implant, healing biopsies were retrieved from the periimplant soft tissue and subjected to further analysis. Histomorphometrically, a significant reduction of transmigration of polymorphonuclear neutrophils (week 1, p?=?0.007; week 2, p?=?0.021; week 4, p?=?0.023; week 12, p?=?0.013) as well as the density of the subepithelial inflammatory infiltrates (week 1, p?=?0.007; week 2, p?=?0.046; week 4, p?=?0.003; week 12, p?=?0.032) was verified following flapless surgery. Quantification of inducible nitric oxide synthase showed significantly reduced expression in the flapless group 2 (p?=?0.027), 4 (p?=?0.005) and 12 (p?=?0.004)?weeks post-insertion. Analysis of CD31 and collagen I immunostained sections revealed more regular capillary distribution as well as higher vessel and collagen density in the flapless group. The data of the present study indicate that flapless placement reduces the incidence of inflammatory periimplant soft tissue lesions during a 12-week period. Considering the beneficial effects of flapless placement on early soft tissue healing and stability, the technique might be preferred in case of an uncomplicated locoregional anatomy with sufficient hard and soft tissue. However, this positive effect might disappear after manipulation of the implant and soft tissue during impression taking or try in of the prosthodontic supraconstruction. PMID:22186942

Mueller, Cornelia K; Thorwarth, Michael; Schultze-Mosgau, Stefan

2012-04-01

48

Functional outcome in patients with advanced head and neck cancer: surgery and reconstruction with free flaps versus primary radiochemotherapy.  

PubMed

The objective was to compare functional outcome in patients with advanced head and neck cancer (HNC) treated with (a) surgical resection and reconstruction with microvascular free flaps (MVFF) followed by radiochemotherapy versus (b) primary radiochemotherapy (RCT) on the basis of the International Classification of Functioning, Disability and Health (ICF) from WHO. This was a cross-sectional, multi-institutional study. The outcome measures included ICF Core Sets for HNC, the EORTC-QLQ, modules c30 + hn35 and the University of Washington-Quality of life Questionnaire (UW-QOL). Analyses included descriptive statistics, ranking exercises, and regression analyses in a cumulative logit model; 27 patients were treated with MVFF and 22 with RCT. Global Quality of life scores suggested a slightly better functional outcome for the surgical approach. The majority of ICF categories (81/93, 87%) did not show a difference in functional outcome between the two treatment approaches. In the remaining 12 ICF categories, n = 3 body structures were more affected in the MVFF group, while n = 3 body functions, and n = 6 activities/participations were more problematic in the RCT group. This included oral swallowing and weight maintenance functions as well as social relationships, acquiring a job, and economic self-sufficiency. In addition, nine contextual environmental factors were more relevant to the RCT group. Both treatment approaches seemed appropriate to advanced HNC from the perspective of functional outcome. The influence of treatment modalities on the social and economic lives of cancer survivors needs to be explored further. In order to guide rehabilitation according to patients' needs, the ICF offers a multidimensional view comprising body structures, body functions, and activities and participation in life. PMID:21643935

Tschiesner, Uta; Schuster, Lena; Strieth, Sebastian; Harréus, Ulrich

2012-02-01

49

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

50

Central axis flap methods  

Microsoft Academic Search

Extensively burned patients often lack ample healthy skin for autotransplantation. Scar contractures are then frequent. Here, we reconstructed contractures using flaps of remaining healthy skin around the recipient sites. In this report, we present four original scar contracture repair methods using subcutaneous pedicled flaps: (1) Propeller flap, (2) multilobed propeller flap, (3) scar-band rotation flap and (4) pin–wheel flap. The

Hiko Hyakusoku; Itaru Iwakiri; Masahiro Murakami; Rei Ogawa

2006-01-01

51

Karapandzic flap  

PubMed Central

For full-thickness lip defects, the choice of reconstructive option depends on the size of the defect. Defects of one-quarter to one-third of the upper lip can be closed primarily. Largerdefects measuring one-third to two-thirds of the lower lip width may be closed with the Karapandzic, Abbe or Estlander flaps. If the commissure is involved, both the Karapandzic and Estlander flaps may be used; however, the Karapandzic is probably the better choice because it is better at maintaining oral competence. In the case of larger lower lip defects (more than two-thirds of the lip), if there is sufficient adjacent cheek tissue, the surgeon may employ the Karapandzic (for defects up to three-fourths of the lower lip width) or the Bernard-Burow's techniques (to reconstruct the entire lower lip). A case of post-traumatic, lower lip defect, reconstructed with a bilateral karapandzic flap is presented here.

Khan, Abdul Ahad Ghaffar; Kulkarni, Jyoti V

2014-01-01

52

The hinged-door composite septal flap as structural support and lining of nasal reconstruction by a forehead flap.  

PubMed

In this paper we describe four patients who underwent extensive nasal surgery for carcinoma in the nasal vestibule. Two patients underwent salvage surgery after radiotherapy, whereas the other two patients were treated with primary surgery. In all cases the nasal defect was reconstructed using a composite hinged-door septal flap for structural support and internal lining combined with a paramedian forehead flap which supplied the skin coverage. All patients had a pleasing aesthetic and good functional result. The combination of a paramedian forehead flap with a composite hinged-door septal flap is an excellent reconstruction procedure for defects of the lateral nasal wall and alar region. PMID:11340698

Westerveld, G J; Middelweerd, R J; Leemans, C R

2001-03-01

53

Innervated island flaps in morphofunctional vulvar reconstruction.  

PubMed

In this article, the authors present their own experience in vulvar reconstruction following vulvectomy using two different innervated island flaps according to the size and site of the defect. Island-flap mobilization is possible thanks to the rich blood supply of the perineal region. The methods described are a "V-Y amplified sliding flap from the pubis" and a "fasciocutaneous island flap" raised from one or both gluteal folds. The V-Y amplified sliding flap from the pubis is indicated when the defect is symmetric and located anteriorly. This flap is harvested from the pubis and vascularized by the deep arterial network of the pubis. Sensory innervation is provided by branches of the ileo-inguinal nerve. The fasciocutaneous island flap, raised from one or both gluteal folds, can be used following hemivulvectomy or radical vulvectomy, respectively, to cover posteriorly located defects. Vascularization is provided by the musculocutaneous perforating branches of the pudendal artery, whereas sensory innervation is maintained through the perineal branches of the pudendal nerve. Twenty-two patients have undergone reconstructive surgery of the vulvar region from 1989 to date. On 14 patients, a V-Y amplified sliding flap was used; on 7 patients, reconstruction was carried out by island flaps raised from the gluteal fold. Both techniques are compatible with inguino-femoral lymphadenectomy, and they allow for a correct morphofunctional reconstruction and provide good local sensibility. The final result is aesthetically satisfactory, as all final scars are hidden in natural folds. PMID:10809093

Moschella, F; Cordova, A

2000-04-01

54

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 ...

55

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

PubMed Central

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

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

2013-01-01

56

Complications of surgery for radiotherapy skin damage  

SciTech Connect

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

Rudolph, R.

1982-08-01

57

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

58

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

59

[Perforator propeller flap for cutaneous coverage of the knee].  

PubMed

Previous pedicled techniques for coverage of the knee use muscular flaps and/or local fascio-cutaneous flaps limited to rotate until 90° on their cutaneous base. Freestyle perforator flaps match the patient's anatomy to fill a defect. Propeller perforator flaps have been used to treat three patients presenting with a skin loss over the knee. The surgery is based on the Echo-Doppler tracing the good perforator vessels around the wound. We performed two supero-medial flaps with a self-closing donor site and one supero-lateral flap where a graft was needed. All the patients healed in less than six weeks, with satisfying functional and esthetical results. We think freestyle perforator flaps are a reliable and predictable technique with a low morbidity rate and they are well adapted to cover skin defects over the knee. PMID:21719180

Gobel, F; Pélissier, P; Casoli, V

2011-08-01

60

Perforator Pedicled Propeller Flaps  

Microsoft Academic Search

\\u000a Hyakusoku et al. [1] presented a propeller flap for reconstruction of axilla and cubitus in 1991. The original propeller flap\\u000a has been used for intact fossa and was elevated as a subcutaneous pedicled island flap. Nowadays, this propeller flap has\\u000a been refined and various types of propeller flaps have been reported [2–11]. The represented one is the perforator pedicled\\u000a propeller

Hiko Hyakusoku; Musa A. Mateev; T. C. Teo

61

Reproducibility of LASIK flap thickness using the Hansatome microkeratome  

Microsoft Academic Search

Purpose: To evaluate the actual versus the expected thickness of laser in situ keratomileusis (LASIK) flaps and to determine the factors that affect flap thickness.Setting: Centre For Sight, Queen Victoria Hospital, East Grinstead, United Kingdom.Methods: A retrospective analysis of LASIK procedures in 757 consecutive eyes was done. The surgery was performed by a single surgeon using 2 Hansatome® microkeratomes (Bausch

Osama Giledi; Mark G Mulhern; Marcela Espinosa; Andrea Kerr; Sheraz M Daya

2004-01-01

62

Inverted periosteal flap: an alternative to the buccal advancement flap for tension-free, watertight closure.  

PubMed

The buccal advancement flap has been universally used in oral and maxillofacial surgery for closure of alveolar ridge incisions. It involves scoring of the buccal periosteum to enhance flap mobility and then stretching the buccal tissues medially (palatally or lingually) to obtain tension-free, watertight closure of a wound. Its applications have included, but have not been limited to, alveolar ridge augmentation procedures and closure of oral-antral communications. However, the buccal advancement flap technique has several major disadvantages. First, because the buccal flap is advanced crestally and medially, this technique invariably results in a significant reduction in vestibular depth. This can cause patients discomfort, such that they have described a sensation that their buccal mucosa has been sutured to their alveolar mucosa. In addition to being uncomfortable, this vestibular shortening can adversely affect patients' options for future prosthetic rehabilitation. Second, because the buccal flap is advanced medially, the mucogingival junction will be obliged to follow; therefore, the width of the keratinized tissue on the buccal aspect of the alveolus will be diminished. Third, if the buccal flap has been advanced a large distance, even with aggressive periosteal scoring and release, true tension-free closure can be very difficult to achieve, increasing the risk of wound dehiscence. The inverted periosteal flap is a new technique for flap design and closure that has several advantages over the buccal advancement flap. In my experience, the inverted periosteal flap will preserve the vestibular depth, maintain the keratinized gingival dimensions, and provide true tension-free closure. Thus, this flap could be ideal for any oral and maxillofacial surgical procedure in which tension-free, watertight closure is desired. PMID:24768423

Rosenfeld, Elisheva A

2014-07-01

63

Propeller Flap and Central Axis Flap Methods  

Microsoft Academic Search

\\u000a Extensively burned patients often lack ample healthy skin for skin grafts. We have developed a method for using several novel\\u000a flaps composed of healthy skin left around recipient sites. In 1991, Hyakusoku et al. [1] presented a propeller flap with\\u000a a subcutaneous pedicle. The original propeller flap has been used in intact fossa to reconstruct the axilla or cubitus. The

Hiko Hyakusoku; Masahiro Murakami

64

Surgery  

MedlinePLUS

... a symptom of a problem or improve some body function. Some surgeries are done to find a problem. For example, ... that once needed large incisions (cuts in the body) can now be done using much smaller cuts. This is called laparoscopic surgery. Surgeons insert a thin tube with a camera ...

65

Propeller TAP flap: is it usable for breast reconstruction?  

PubMed

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

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

2013-10-01

66

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

67

Columella reconstruction with the Washio flap  

Microsoft Academic Search

Satisfactory reconstruction of the columella area is always challenging. An 8-year-old girl underwent columellar reconstruction 7 years after bilateral cleft lip surgery using a temporo-parieto-auricular flap. This method was found to be useful for columellar reconstruction with good colour and aesthetic result.

S Motamed; A. J Kalantar-Hormozi

2003-01-01

68

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

PubMed

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

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

2011-01-01

69

Reconstruction of Various Perinasal Defects Using Facial Artery Perforator-Based Nasolabial Island Flaps  

PubMed Central

Background Classical flaps for perinasal defect reconstruction, such as forehead or nasolabial flaps, have some disadvantages involving limitations of the arc of rotation and two stages of surgery. However, a perforator-based flap is more versatile and allows freedom in flap design. We introduced our experience with reconstruction using a facial artery perforator-based propeller flap on the perinasal area. We describe the surgical differences between different defect subtypes. Methods Between December 2005 and August 2013, 10 patients underwent perinasal reconstruction in which a facial artery perforator-based flap was used. We divided the perinasal defects into types A and B, according to location. The operative results, including flap size, arc of rotation, complications, and characteristics of the perforator were evaluated by retrospective chart review and photographic evaluation. Results Eight patients were male and 2 patients were female. Their mean age was 61 years (range, 35-75 years). The size of the flap ranged from 1 cm×1.5 cm to 3 cm×6 cm. Eight patients healed uneventfully, but 2 patients presented with mild flap congestion. However, these 2 patients healed by conservative management without any additional surgery. All of the flaps survived completely with aesthetically pleasing results. Conclusions The facial artery perforator-based flap allowed for versatile customized flaps, and the donor site scar was concealed using the natural nasolabial fold. PMID:24286050

Yoon, Tae Ho; Yun, In Sik; Rha, Dong Kyun

2013-01-01

70

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

PubMed Central

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

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

2014-01-01

71

Optical spectroscopic assessment of free flap circulatory impairment  

NASA Astrophysics Data System (ADS)

Free flaps are used to reconstruct tissue damaged by injury. Circulatory impairment of the free flap is the leading cause of a failed flap surgery. This study demonstrates that optical spectroscopy can detect early signs of circulatory impairment and distinguish between arterial or venous blockage. An epigastric flap model is used to mimic conditions of both arterial and venous circulatory impairment. Animals were divided into three groups 1.) arterial occlusion (n=5), 2.) venous occlusion (n=4), and 3.) control (n=5). A classifier was applied to the reflectance data to determine whether there were consistent differences between the three study groups. The classifier was able to distinguish between arterial occlusion, venous occlusion and healthy flaps with a 95% accuracy. Measures of hemoglobin oxygen saturation and blood volume were derived from the same reflectance data. Oxygenation of the flap was significantly lower during venous or arterial occlusion compared to control flaps. Blood volume of the free flap went up significantly following venous blockage while blockage of the artery cause a significant drop in blood volume. Combining the predictions of the classifier and examining the oxygenation and blood volume parameters reliably detected circulatory impairment of the free flap.

Sowa, Michael G.; Payette, Jeri R.; Kohlenberg, Elicia; Leonardi, Lorenzo; Pabbies, Arone; Kerr, Paul

2004-10-01

72

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

PubMed Central

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

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

2014-01-01

73

Reinnervated radial forearm free flaps in head and neck reconstruction.  

PubMed

The radial forearm flap has proved to be a reliable free flap for intraoral reconstruction after major head and neck ablative surgery for cancer. In contrast to the myocutaneous flap, it is thin and flexible, and as a result, it is better suited to conforming to the irregular surface which remains over an intact or restored mandible. A criticism of both techniques however, is that while the flap effectively fills the defect, it serves as an insensate reservoir in which food and saliva can collect. A modification of the reinnervated radial forearm free flap is presented, with discussion of its use in three patients, following extensive resection of the floor of the mouth and tongue. PMID:1453373

Dubner, S; Heller, K S

1992-11-01

74

Mechanical endonasal dacryocystorhinostomy with mucosal flaps  

PubMed Central

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

Tsirbas, A; Wormald, P J

2003-01-01

75

The effects of hypotension and norepinephrine on microvascular flap perfusion.  

PubMed

Microvascular flap surgery is a common technique in reconstructive surgery. The wide indications and variable patients provide challenge also for anesthesiologist. Both hypotension and hypoperfusion can be harmful to the flap. Hypotensive patients are treated with fluid resuscitation and vasopressors (e.g., norepinephrine), if needed. As vasoconstrictors, vasopressors might impair microvascular flap perfusion. In this experimental pig model we studied the effect of sevoflurane-induced hypotension on the perfusion of microvascular and superiorly pedicled rectus abdominis myocutaneous flaps. In addition, we evaluated the effect of norepinephrine on flap perfusion when it was used for correction of hypotension. Microdialysis (MD) was used to detect metabolic changes, as it is a sensitive method to detect early changes of tissue metabolism and ischemia in different tissue components of soft tissue flaps. The main finding of this study was that moderate degree of normovolemic hypotension or the use of norepinephrine for the correction of this hypotension did not affect flap perfusion as assessed by MD. More studies are clearly needed to confirm the safety of norepinephrine in clinical use in microsurgery. PMID:21717396

Hiltunen, Pamela; Palve, Johanna; Setälä, Leena; Mustonen, Paula K; Berg, Leena; Ruokonen, Esko; Uusaro, Ari

2011-09-01

76

Fasciocutaneous flap in esophageal stricture with ventriculoperitoneal shunt.  

PubMed

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

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

2014-01-01

77

Management of a traumatic flap dislocation seven years after LASIK.  

PubMed

Seven years after uneventful laser in situ keratomileusis (LASIK), a 48-year-old woman presented one week after being hit with an iron cord with blurry vision, pain, and irritation. The injury resulted in traumatic flap dislocation, epithelial ingrowth, and macrostriae. Following epithelial removal, the flap was refloated and repositioned. Nine interrupted sutures were used to secure the flap. Three-weeks after surgery with no sutures remaining, the epithelial ingrowth and macrostriae had resolved with a visual acuity of 20/20. PMID:22606465

Moshirfar, Majid; Anderson, Erik; Taylor, Nathan; Hsu, Maylon

2011-01-01

78

Management of a Traumatic Flap Dislocation Seven Years after LASIK  

PubMed Central

Seven years after uneventful laser in situ keratomileusis (LASIK), a 48-year-old woman presented one week after being hit with an iron cord with blurry vision, pain, and irritation. The injury resulted in traumatic flap dislocation, epithelial ingrowth, and macrostriae. Following epithelial removal, the flap was refloated and repositioned. Nine interrupted sutures were used to secure the flap. Three-weeks after surgery with no sutures remaining, the epithelial ingrowth and macrostriae had resolved with a visual acuity of 20/20. PMID:22606465

Moshirfar, Majid; Anderson, Erik; Taylor, Nathan; Hsu, Maylon

2011-01-01

79

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

PubMed Central

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

2013-01-01

80

Use of vertical median forehead flap in the reconstruction of the anterior skull base  

Microsoft Academic Search

Improvements in reconstruction of the skull base have made craniofacial surgery safe. Reconstruction of the anterior skull base must provide a seal between the cranial cavity and upper respiratory tract, as well as offer structural support for the brain. A wide variety of local flaps have been designed. The choice of flap in individual cases depends on the location and

Mitsuhiro Kawaura; Hideo Nameki; Masato Fujii; Jin Kanzaki

1997-01-01

81

Microdialysis monitoring of a craniofacial microvascular free flap reconstruction detected critical brain swelling.  

PubMed

Microdialysis is one of several methods described for monitoring the anastomosis and blood flow to the donor tissue in microvascular-free tissue transfer for craniofacial reconstructive surgery. A case is presented where a microdialysis free flap monitoring system detected metabolic aberrations within the free flap secondary to a rise in intracranial pressure, which the intracranial pressure monitor had failed to detect. PMID:23705579

Allen, William N; King, Andrew; Blackburn, Tim K

2013-10-01

82

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

PubMed Central

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

Panse, Nikhil; Sahasrabudhe, Parag

2014-01-01

83

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

84

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

85

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

86

Heel reconstruction with free instep flap: a case report  

PubMed Central

Introduction Reconstruction of weight-bearing heel defects remains a challenge because of the unique characteristics of the plantar skin. Though numerous surgical reconstructive options have been reported, the instep flap represents an ideal option and seems to be more acceptable to patients than others. However, when the heel defect expands to the instep area, the ipsilateral instep is not available for flap elevation. A free instep flap harvested from the contralateral foot can be a good solution, but this method has been scarcely reported. Case presentation A 41-year-old Asian man presented to our institution with a soft-tissue lesion in the weight-bearing heel and instep area. His heel was reconstructed with a free instep flap from the other foot, end-to-side anastomosis of its medial plantar artery to the recipient posterior tibial artery and end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve. Conclusion The flap survived successfully, and no ulceration occurred in the flap. At the last follow-up appointment at 30 months post-surgery, a very good functional and aesthetic outcome was verified, indicating that the suggested approach may prove to be the treatment of choice in selected cases of weight-bearing heel reconstruction. PMID:25260532

2014-01-01

87

[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

88

Quantitative assessment of partial vascular occlusions in a swine pedicle flap model using  

E-print Network

. East, Irvine, CA 92617, USA 3 Department of Plastic Surgery, University of California Irvine Medical%), the failure rate of tissue flaps that require additional surgery is significantly higher (40-60%). The reason for this is largely due to the absence of a technique for objectively assessing tissue health after surgery. Here we

Chen, Zhongping

89

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.

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

2013-01-01

90

Urethral placement through a bilateral myocutaneous gracilis flap neovagina.  

PubMed

Malignant melanoma of the vagina is an uncommon genital tumor. When the lesion arises in the distal vagina, radical surgery has been the only treatment to produce long-term survivors. A total vaginectomy, vulvectomy, and bilateral groin node dissection is recommended to assure adequate margins. Sexual function is lost unless reconstruction is performed. The bilateral myocutaneous gracilis flap neovagina has been a successful plastic procedure after exenterative procedures that result in loss of bladder and/or rectum. The authors present a technique in which bladder function was preserved after creation of a gracilis flap neovagina in a patient with Stage I melanoma of the distal vagina. Placement of the distal urethra through the reconstructed gracilis flap neovagina resulted in preservation of urinary function and continence, primary closure of the vulvar defect, and satisfactory sexual function. Two and one-half years after surgery the patient has good bladder and vaginal function without significant sequel. PMID:2909455

Wheelock, J B; Hancock, K

1989-01-01

91

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

92

Changes of perfusion of microvascular free flaps in the head and neck: a prospective clinical study.  

PubMed

Reconstruction with a free flap is routine in head and neck surgery. However, reliable assessment of perfusion can be difficult, so we prospectively evaluated it in 4 types of microvascular free flaps in the oral cavity (n=196) and assessed differences in blood flow by non-invasive monitoring with a laser Doppler flowmetry unit. We measured oxygen saturation, haemoglobin concentration, and velocity on the surface of the flap preoperatively at the donor site, and on the flap on the first, second, and seventh postoperative days, and after 4 weeks in 186/196 patients, mean (SD) age of 60 (13) years. We studied the radial forearm (n=76, 41%), fibular (n=45, 24%), anterolateral thigh (n=53, 28%), and soleus perforator (n=12, 7%) flaps. The values for the radial forearm flap differed significantly from the others. There were significant differences in haemoglobin concentrations between the fibular and soleus perforator flaps, and between the anterolateral thigh and soleus perforator flaps (p=0.002 each). Free flaps are unique in the way that perfusion develops after microvascular anastomoses. Knowledge of how each flap is perfused may indicate different patterns of healing that could potentially influence long term rehabilitation and detection of future deficits in perfusion. PMID:25149324

Mücke, Thomas; Rau, Andrea; Merezas, Andreas; Kanatas, Anastasios; Mitchell, David A; Wagenpfeil, Stefan; Wolff, Klaus-Dietrich; Steiner, Timm

2014-11-01

93

Cornea surgery with nanojoule femtosecond laser pulses  

Microsoft Academic Search

We report on a novel optical method for (i) flap-generation in LASIK procedures as well as (ii) for flap-free intrastromal refractive surgery based on nanojoule femtosecond laser pulses. The near infrared 200 fs pulses for multiphoton ablation have been provided by ultracompact turn-key MHz laser resonators. LASIK flaps and intracorneal cavities have been realized with high precision within living New

Karsten Koenig; Bagui Wang; Iris Riemann; Jens Kobow

2005-01-01

94

Advances in Plastic Surgery  

PubMed Central

Recent progress in plastic surgery has been rapid and many new techniques have been developed. Reconstructive procedures have been advanced by a better understanding of the anatomy of the blood supply to skin and muscle, with the subsequent development of the use of axial flaps, musculocutaneous flaps and neurosensory flaps. Burn treatment has advanced greatly, making it possible to successfully treat larger and more complicated burns. The development of microsurgery has made possible free-flap transfer and replantation of amputated parts. Advances in surgical procedures on the hands include a realization that primary repair of lacerated tendons and nerves will give good results. Replacement joints have been developed that can be used in hands for joints destroyed by arthritis or trauma. Craniofacial surgery is a new field of endeavor in plastic surgery, involving new techniques that can be used to treat exophthalmos of Graves' disease and the facial deformities resulting from gigantism and acromegaly. Head and neck procedures have advanced, with the emphasis on immediate reconstruction using new flaps. Techniques for treating cleft lip and palate have been refined. Encouraging results have been reported in the treatment of nevus flammeus with argon lasers. In aesthetic surgical procedures, the aim is for safety and consistent long-lasting results. Improved understanding of the physiology and treatment of radionecrosis has evolved. PMID:7072237

McDonald, Harold D.; Vasconez, Luis O.

1982-01-01

95

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

96

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

PubMed Central

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

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

2012-01-01

97

Propeller Flaps and Its Outcomes - A Prospective Study of 15 Cases Over Two-years  

PubMed Central

Introduction: Cover flaps are needed in management of any bodily defect involving bone, tendon, nerve & vessels. The major objective of a plastic surgeon, facing a complex soft-tissue defect, is to replace “like with like” tissues at minimal donor site “cost” and with maximal accuracy & efficacy. Aims: To study the “Propeller Flaps” utility in reconstructive surgeries, evaluate its planning and complications involving donor site morbidity. Methodology: The prospective study was conducted on 15 cases (11 males/4 females) of propeller flaps during the period of two years (2010-12) in Department of Plastic Surgery and Burns, Bangalore Medical College and Research Institute (BMCRI), Karnataka, India. The propeller flaps were performed in cases with defects due to any cause. Exclusion criteria: Cases with Peripheral Vascular Disease (PVD). Flaps were performed and details recorded. Results: Overall results revealed problem resolution in 87% cases (13 cases). Comprehensive description of each flap type and its related cases are given in the table. It has been categorically found that there were 2 flap partial losses. Partial necrosis has been reported in heavy-smoker patients. Conclusion: This current study clearly justifies that careful application, optimal designing & judicious scientific application of local perforator flaps for lower-limb wounds including rest of the body is successful in many aspects providing high-quality reconstruction ensuring minimal morbidity. It is cost-effective as well as time-saving. PMID:24596732

K.T., Ramesha; J., Vijay; M., Shankarappa

2014-01-01

98

Hypnosis in Plastic Surgery  

Microsoft Academic Search

This paper reports on three years experience of the use of hypnosis at the Plastic Surgical Unit of Whiston Hospital in Lancashire, England. This therapy has primarily been used as a psychotherapeutic support for 13 patients undergoing pedicle and flap graft surgery; this resulted in a greatly improved morale and marked reduction in the total drug requirement. Ego-strengthening has been

David L. Scott

1975-01-01

99

Supercharged pectoralis major musculocutaneous flap.  

PubMed

The pectoralis major musculocutaneous (PMMC) flap was once considered the workhorse for head and neck reconstruction; however, because of the proliferation of free tissue transfer, it has rightly taken on a secondary role. Nevertheless, in certain head and neck reconstructions, the PMMC flap remains the last-line treatment and the only salvage option in do-or-die scenarios. The conventional harvesting method of the PMMC flap cuts the lateral thoracic artery and all intercostals branches from the internal mammary vessel to avoid compromising pedicle length. Nonetheless, the dissection of these 2 dominant sources of blood supply to skin islands overlying the lower PMMC flap poses a potentially high risk of distal flap necrosis.To preserve the lateral thoracic vessels, the PMMC flap is a very valid choice from the viewpoint of blood supply. In a novel surgical procedure named "Supercharged Pectoral Major Musculocutaneous Flap"-"SUP-PMMC flap"-devised by us, the lateral thoracic vessels near the bifurcation of subclavian vessels are cut and then anastomosed to the cervical vessels. The procedure causes no vascular insufficiency of skin islands and no compromise to the length of the pedicle and is valid from the viewpoint of blood supply to the lower part of PMMC flaps. The author used this technique in 4 head and neck cancer reconstructions, and no partial flap necrosis or fistula formation was observed. PMID:23524830

Makiguchi, Takaya; Yokoo, Satoshi; Miyazaki, Hidetaka; Takayama, Yu; Ogawa, Masaru; Hashikawa, Kazunobu; Terashi, Hiroto

2013-03-01

100

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

PubMed Central

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

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

2014-01-01

101

The vortex flap  

NASA Astrophysics Data System (ADS)

The Vortex Flap is a new type of mechanically driven high-lift device consisting of a rotating cylinder placed underneath and near the trailing edge of an airfoil. Wind tunnel tests were designed and conducted in the Washington University Low-Speed Wind Tunnel. Wind tunnel tests indicate that the Vortex Flap produces notable lift coefficient increments and increases maximum lift coefficients, particularly for the low Reynolds number range tested. The best configurations of the configurations investigated (not necessarily optimal) produce lift increments of 300-900% at low-to-moderate angles of attack, and increase the maximum lift coefficient on the order of 200%. The large lift increments found, particularly at low angles of attack, underscore the ability to drive the airfoil to high lift coefficients even at low angles of attack, a potentially useful characteristic for certain flight maneuvers. Regions of fairly high L/D (on the order of 10) as well as low L/D performance were identified. The nondimensional cylinder rotation speed was found to be the most important experimental parameter. Methods for correcting wind tunnel data were developed and outlined, and a Response Surface Method was applied to the corrected data for ease of interpretation. Performance comparisons between the Vortex Flap and other trailing-edge high-lift devices are included. To demonstrate the potential of the device, a Navy mission specification for a VTOL ship-borne UAV, currently filled by a rotary-wing aircraft, is analyzed using a hypothetical fixed wing aircraft and the Vortex Flap. It is demonstrated that, under certain reasonable wind-over-deck conditions, such an aircraft could hypothetically fill a VTOL mission.

Buerge, Brandon T.

102

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

PubMed Central

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

Bhat, Satish P.

2013-01-01

103

Development of the clinical use of distant flaps for head and neck reconstruction.  

PubMed

The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon. PMID:23522831

Thiele, Oliver C; Seeberger, Robin; Engel, Michael; Freier, Kolja; Hoffmann, Jürgen

2014-01-01

104

[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

105

Squamous cell carcinoma of the pectoralis major myocutaneous flap donor site.  

PubMed

The pectoralis major myocutaneous flap is considered a workhorse flap in the reconstruction of head and neck defects after cancer ablative surgeries and remains one of the most widely used reconstructive options. Complications at the donor site after the use of this flap, although rare, do occur and are usually restricted to minor infections, hematoma, and seroma formation. Metastasis to the flap donor site is a rare complication with limited documentation. Metastasis at the donor site usually follows local recurrence at the primary site, supporting the probable hypothesis of re-establishment of lymphatic drainage to the primary site by the flap pedicle. Tumor implantation, although a probable cause for metastasis at the donor site, cannot be confidently distinguished from other mechanisms, such as hematogenous spread or lymphogenous metastasis. This report describes a case that supports a seeding or tumor implantation mechanism of metastasis exclusively. PMID:24560174

Mohan, A Mathan; Balaguhan, B; Krishna, Vinod; Nagarjuna, Muralidhara

2014-07-01

106

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

PubMed

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

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

2014-07-01

107

Bone Flap Perfusion Assessment using Near-Infrared Fluorescence Imaging  

PubMed Central

Background Microsurgical vascularized bone flaps are a versatile technique for reconstructing large bone defects. However, assessment of perfusion is challenging, as clinical examination is difficult intra-operatively and often not possible post-operatively. Therefore, it is important to develop techniques to assess perfusion of vascularized bone flaps, and potentially improve surgical outcomes. Near-infrared (NIR) fluorescence imaging has been previously shown to provide real-time, intra-operative evaluation of vascular perfusion. This pilot study investigates the ability of NIR imaging to assess perfusion of vascularized bone flaps. Materials and Methods Vascularized bone flaps were created on female Yorkshire pigs using well-established models for porcine forelimb osteomyocutaneous flap allotransplantation (N = 8) and hindlimb fibula flaps (N = 8). Imaging of the bone flaps was performed during harvest using the FLARE™ intraoperative fluorescence imaging system following systemic injection of indocyanine green (ICG). Perfusion was also assessed using standard of care by clinical observation and Doppler. NIR fluorescence perfusion assessment was confirmed by intermittent clamping of the vascular pedicle. Results NIR fluorescence imaging can identify bone perfusion at the cut end of the osteotomy site. When the vascular pedicle is clamped or ligated, NIR imaging demonstrates no fluorescence when injected with ICG. With clamp removal, the osteotomy site emits fluorescence indicating bone perfusion. Results using fluorescence imaging show 100% agreement with clinical observation and Doppler. Conclusion Vascularized bone transfers have become an important tool in reconstructive surgery; however, no established techniques adequately assess perfusion. Our pilot study indicates that NIR imaging can provide real-time, intra-operative assessment of bone perfusion. PMID:22664132

Nguyen, John T.; Ashitate, Yoshitomo; Buchanan, Ian A.; Ibrahim, Ahmed M.S.; Gioux, Sylvain; Patel, Priti P.; Frangioni, John V.; Lee, Bernard T.

2012-01-01

108

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

109

Near infrared spectroscopy for monitoring flap viability following breast reconstruction.  

PubMed

Free flap monitoring is essential to the early detection of compromise thereby increasing the chance of successful salvage surgery. Many alternatives to classical clinical monitoring have been proposed. This study seeks to investigate a relatively new monitoring technology: near infrared spectroscopy (NIRS). Patients were recruited prospectively to the study from a single center. During the research period, 10 patients underwent reconstruction with a free deep inferior epigastric perforator flap (DIEP). Measurements of flap perfusion were taken using NIRS in the preoperative and intraoperative phases and postoperatively for 72 hours. NIRS showed characteristic changes in all cases which returned to theater for pedicle compromise. In these cases, NIRS identified pedicle compromise prior to clinical identification. There were no false-positives. NIRS accurately identified all compromised flaps in our study. In most cases, there was an evidence of changes in oxygen saturation on NIRS prior to clinical observation. Further research, ideally double blind randomized control trials with large sample groups would be required to definitively establish NIRS as an ideal flap monitoring modality. PMID:22131106

Whitaker, Iain S; Pratt, George F; Rozen, Warren Matthew; Cairns, Scott A; Barrett, Matthew David; Hiew, Leong Yoon; Cooper, Mark Acs; Leaper, David J

2012-03-01

110

The Abbé flap in cleft lip and palate repair.  

PubMed

The Abbé flap is a procedure where the volume of the upper lip is increased at the expense of the lower lip. This study reviewed the Abbé flaps done at Skåne University Hospital during the years 1991-2006 and identified 14 patients. Data was collected from medical records. Eleven patients were deemed fit for interviews and were called to the hospital by standard mail. Six patients responded and were interviewed, examined, and photographed. One patient was interviewed over the telephone. Median age at surgery was 14 years (range = 6-22). The operation time was 152 minutes (range = 90-215). The Abbé flap was divided after 12 days (range = 11-16). All 14 flaps survived and no complications were noted. Secondary corrections were done in nine patients. Three patients experienced having their lips sutured together as difficult, and four patients described this period as easy. All patients described their lips as having better appearance after the operation and, in three of four cases, where a simultaneous columella lengthening was done, the patients described their noses as having better appearance. The scar on the lower lip was negative but also a prerequisite for the operation. All seven patients said the operation was worth all the effort and would recommend it to patients in similar situations. This data supports that the Abbé flap is a safe technique that effectively improves the appearance of the upper lip and satisfies the cleft lip and palate patients. PMID:23627564

Larsson, Jens; Becker, Magnus; Svensson, Henry

2013-12-01

111

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

112

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

PubMed

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

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

2014-07-01

113

Robotic-assisted implantation of ventricular assist device after sternectomy and pectoralis muscle flap.  

PubMed

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

114

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

115

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

Microsoft Academic Search

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

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

2011-01-01

116

Scaling in Flexible Flapping Wings  

NASA Astrophysics Data System (ADS)

The role of flexibility on the aerodynamic performance of a flapping wing is investigated. We consider chordwise, spanwise, and isotropic flexibility. Overall, the aerodynamic force is determined by the Reynolds number, reduced frequency (k), and Strouhal number (St). In particular, at the Reynolds number regime of O(10^3-10^4) and the reduced frequency of O(1), the added mass force, related to the acceleration of the wing, is important. Based on the order of magnitude and energy balance arguments, a relationship between the propulsive force and the maximum relative wing tip deformation parameter is established. The parameter depends on the density ratio, St, k, natural and flapping frequency ratio, and flapping amplitude. It seems that the maximum propulsive force is obtained when flapping near the resonance, whereas the optimal propulsive efficiency is reached when flapping at about half of the natural frequency; both are supported by the reported studies.

Kang, Chang-Kwon; Aono, Hikaru; Shyy, Wei

2011-11-01

117

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

118

Superiority of medial circumflex femoral artery perforator flap in scrotal reconstruction.  

PubMed

Scrotal skin has unique cosmetic and functional features that make its reconstruction difficult. Coverage of the testicles and constituting a good cosmetic appearance are major expectations from a successful reconstruction. Usually flaps are the choice for scrotal reconstruction, but every single flap has its own characteristics. In our series, between January 2006 and January 2010, the medial circumflex femoral artery perforator flap was used in 7 male patients for scrotal coverage after Fournier gangrene. Six flaps were raised based on a single perforator from the gracilis muscle; however in one flap 2 perforators were used. Flaps were carried to the defect either by transposition or by V-Y advancement. Donor areas were closed directly in all patients, and stable scrotal coverage was achieved with an acceptable scrotal contour and cosmesis. No major complication was seen due the perforator flap surgery, in 2 patients wound dehiscence were noted and they healed by secondary intention or by secondary suturing. For scrotal reconstruction, the medial circumflex femoral artery perforator flap is a good option with its good mobility, thinness for scrotal contour, possibility for muscle preservation, and direct closure of the donor site. All these advantages can be accomplished in 1 procedure. PMID:21346527

Coskunfirat, O Koray; Uslu, Asim; Cinpolat, Ani; Bektas, Gamze

2011-11-01

119

Standing equine sinus surgery.  

PubMed

Trephination of the equine sinuses is a common surgical procedure in sedated standing horses. Standing sinus flap surgery has become increasingly popular in equine referral hospitals and offers several advantages over sinusotomy performed under general anesthesia, including reduced patient-associated risks and costs; less intraoperative hemorrhage, allowing better visualization of the operative site; and allows surgeons to take their time. Other minimally invasive surgical procedures include sinoscopic surgery, balloon sinuplasty, and transnasal laser sinonasal fenestration. Despite the procedure used, appropriate indications for surgery, good patient selection, and familiarity with regional anatomy and surgical techniques are imperative for good results. PMID:24680206

Barakzai, Safia Z; Dixon, Padraic M

2014-04-01

120

Reconstruction of a Columellar Defect With a Nasolabial Island Flap  

PubMed Central

Columellar skin defects may be caused by excision of cutaneous malignancy, trauma, or tissue necrosis associated with surgery. Although columellar skin necrosis rarely occurs following rhinoplasty, this condition might be more common when using an external approach than a closed approach. Columellar skin incision performed with exaggerated tip augmentation may cause columellar necrosis. The nasolabial island flap, used unilaterally to cover columellar skin defects, is used for a single-stage reconstruction procedure and is generally not associated with the need for secondary surgeries. This technique is well suited for repairing columellar skin defects. We experienced a patient with columellar skin necrosis occurring after rhinoplasty which was reconstructed using a unilateral single-stage nasolabial island flap. PMID:24917913

Kang, IL Gyu; Jung, Joo Hyun; Kim, Seon Tae

2014-01-01

121

Pectoralis major myocutaneous flap: analysis of complications in difficult patients  

Microsoft Academic Search

The purpose of this study was to assess and discuss the effects of old age and systemic diseases on complications related\\u000a to the use of a pectoralis major myocutaneous flap (PMMF) for reconstruction in head and neck surgery. Eighty-four consecutive\\u000a patients, operated on between January 1992 and December 1998, were included in the study. Of these patients, 47 were in

Marco Luigi Castelli; Giancarlo Pecorari; Giovanni Succo; Antonella Bena; M. Andreis A Sartoris

2001-01-01

122

Open wound healing of the osseocutaneous fibula flap donor site.  

PubMed

Split skin grafts are the predominant method of closure for fibular flap donor sites. We present a novel approach to manage the donor site using the inter-related components of secondary intention healing: creation of a lattice to aid partial closure and compression dressings. The technique, which is widely used in dermatological surgery to manage cutaneous defects after operations for skin cancer, avoids the morbidity associated with the use of split skin grafts and enables early postoperative mobilisation. PMID:24894710

Fry, A M; Patterson, A; Orr, R L; Colver, G B

2014-11-01

123

The propeller flap for postburn elbow contractures  

Microsoft Academic Search

Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture.

Gurcan Aslan; Dogan Tuncali; Bulent Cigsar; Ayse Yuksel Barutcu; Ahmet Terzioglu

2006-01-01

124

Dancing girl flap: a new flap suitable for web release.  

PubMed

To create a deep web, a flap must be designed to have a high elongation effect in one direction along the mid-lateral line of the finger and also to have a shortening effect in the other direction, crossing at a right angle to the mid-lateral line. The dancing girl flap is a modification of a four-flap Z-plasty with two additional Z-plasties. It has a high elongation effect in one direction (>550%) and a shortening effect in the other direction at a right angle (<33%), creating a deep, U-shaped surface. This new flap can be used to release severe scar contracture with a web, and is most suitable for incomplete syndactyly with webs as high as the proximal interphalangeal joint. PMID:10597822

Shinya, K

1999-12-01

125

Dermal flaps in breast reduction: prospective study in 100 breasts.  

PubMed

The most common complication of breast reduction with inverted T-scar technique is wound dehiscence at the junction of the vertical and horizontal sutures. In this study, a technique involving three triangular dermal flaps is presented with the results for healing in the junctional T zone. Fifty women were included in a comparative, single-center randomized double-blind prospective study to evaluate the efficiency of the three-triangular dermal-flap technique in healing in the junctional T zone. All patients were seen for follow-up at 7 days, 14 days, 21 days, 28 days, 35 days, 42 days, and 49 days after surgery to evaluate primary healing in the T zone. Average healing time was 19.7 days in the triangular-skin-flap series and 25.48 days in the control series, with a statistically significant difference (p < 0.01). One patient in the triangular-skin-flap series experienced dehiscence in the T zone (2%) versus eight patients (16%) in the control series. A statistically significant difference was noted (p = 0.012). This technique is based on the association of two principles. First, ischemia on the edges as well as skin necrosis is limited by suturing the two superior skin flaps rather than directly suturing the cutaneous angles. In addition, this technique brings an underlying dermal support. Second, the inferior flap width allows fixing two sutures laterally to limit the central tension. This easy technique does not lengthen total operative time and significantly improves healing time. It is applicable to all breast reductions with inverted T scars. PMID:24662153

Domergue, Sophie; Ziade, Makram; Lefevre, Marine; Prud'homme, Alexandre; Yachouh, Jacques

2014-06-01

126

Use of Deepithelialized Flap in Mammoplasties: Simple Method With Excellent Results  

Microsoft Academic Search

Background  A deepithelialized flap is used in almost all surgical fields, particularly in plastic, reconstructive, and aesthetic surgery.\\u000a This article describes several operating techniques using deepithelialized flaps that in specific cases can improve silicone\\u000a breast implant coverage.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All the patients underwent surgery in our department. The operations described are subcutaneous mastectomies with immediate\\u000a reconstruction using silicone implants, mastopexy with immediate augmentation

Jan MestakAndrej SukopOndrej Mestak; Andrej Sukop; Ondrej Mestak

127

[Experimental investigation of neovascularisation in large prefabricated flaps after arteriovenous pedicle implantation].  

PubMed

The principle of prefabricated flaps is based on the transformation of a formerly random-pattern vascularized flap, through implantation of a vascular pedicle, into a newly neovascularized axial flap, which can be transferred after a period of neovascularisation from the prepared donor site to the recipient site by using microvascular techniques. In 30 Chinchilla Bastard rabbits weighing from 3700 to 4200 g, a skeletonized arteriovenous pedicle with distal ligation harvested from the femoral and saphena magna artery and vein was implanted beneath an 8 x 15 cm abdominal skin flap to investigate the neovascularisation process in the flap over the course of time. In order to prevent neovascularisation occurring from the underlying vascular bed into the flap, a silicon sheet measuring 8 x 15 cm x 0.25 mm was placed and fixed on the abdominal wall. Flap vitality and neovascularisation process in prefabricated flaps were evaluated by macroscopic observation, blood analysis, selective microangiography, histology and scintigraphy at the various time intervals of 4, 8, 12, 16 and 20 days. The study results showed that newly formed vessels sprouting from the implanted pedicle were seen four days after pedicle implantation. With the retention time of pedicle in the flaps, they continued to grow, became meander and more dense. Respective connections between newly formed vessels and the originally available vasculature of the abdominal flap were markedly observed in the 12- and 16-day groups. Twenty days after prefabrication, the abdominal flap was completely perfused by the blood flow supplied from the newly implanted arteriovenous pedicle through newly formed vessels arising from the implanted pedicle and their rich vascular communications. The neovascularisation in the prefabricated flap consisted of the implanted pedicle, newly formed vessels, the originally available vasculature and their vascular connections. In comparison to the control group (the quantification was determined of 100 %), the vessel quantity in the prefabricated flap of the 20-day group had increased to 98.7 %. As a pre-clinical test, prefabricated flaps through arteriovenous pedicle implantation with special advantages can be a new useful method in plastic and reconstructive surgery. PMID:15368146

Nguyen, The H; Klöppel, M; Staudenmaier, R; Biemer, E

2004-08-01

128

The "sliding door" technique for closure of abdominal wall defects after rectus abdominis musculocutaneous flap transposition.  

PubMed

Radical surgery is often necessary in patients with local recurrence of rectal cancer or in those with carcinoma associated with an anal fistula. The surgery may include extended excision of the perineal area and can create a large dead space in the pelvis and a large skin defect, often necessitating reconstruction of the pelvic floor using rectus abdominis musculocutaneous (RAM) flap transposition. Wound dehiscence and incisional hernia are common complications of RAM flap transposition. We report herein our encounter with 3 patients in whom we used a "sliding door" technique for reconstruction of the abdominal wall after the creation of a RAM flap. One patient underwent abdominoperineal resection with sacrectomy and RAM flap transposition; he experienced a postoperative surgical site infection and wound dehiscence, which we urgently repaired by reconstructing the abdominal wall using the sliding door technique. Two other patients underwent posterior pelvic exenteration with sacrectomy and RAM flap transposition. These patients underwent simultaneous abdominal wall reconstruction using the sliding door technique. No patient experienced postoperative pelvic sepsis, wound dehiscence, or incisional hernia. The sliding door technique might be useful for preventing wound dehiscence and incisional hernia in patients undergoing RAM flap transposition. PMID:24394135

Nakamoto, Takayuki; Koyama, Fumikazu; Kobata, Yasunori; Nagao, Mitsuo; Nakagawa, Tadashi; Nakamura, Shinji; Ueda, Takeshi; Nishigori, Naoto; Inoue, Takashi; Kawasaki, Keijiro; Obara, Shinsaku; Fujii, Hisao; Kido, Akira; Koizumi, Munehisa; Tanaka, Yasuhito; Nakajima, Yoshiyuki

2013-11-01

129

Minocycline inhibits apoptotic cell death in a murine model of partial flap loss.  

PubMed

For breast reconstruction, the deep inferior epigastric perforator (DIEP) flap has become standard therapy. A feared complication is partial or even total flap loss. In a novel murine model of partial DIEP flap loss, the contribution of apoptotis to flap loss was investigated. The clinically available apoptosis-inhibiting compound minocycline was tested for its ability to reduce cell death. The effect of minocycline on cell proliferation was studied in cell cultures of breast carcinoma. In 12 mice, pedicled DIEP flaps were raised, which were subjected to 15 minutes of ischemia and 4 days of reperfusion. Six mice were treated with minocycline 2 hours before surgery and every 24 hours for 4 days. Apoptosis was revealed by injecting annexin A5 30 minutes before sacrifice. Annexin A5 binds to phosphatidylserines, which are expressed on the cell membrane during apoptotis. Prior to sacrifice, necrosis was measured using planimetry. Minocycline reduced cell death after 4 days from 35.9% (standard deviation = 10.6) to 13.9% (standard deviation = 8.0; P < 0.05). Apoptosis, as shown by annexin A5 binding in nontreated animals, was abundant. Minocycline did not influence tumor growth in cell cultures of human breast cancer. Minocycline treatment leads to increased DIEP flap viability in mice. This study widens the perspective in the improvement of free flap survival in patients. PMID:20648419

Dumont, Ewald A W J; Lutgens, Suzanne P M; Reutelingsperger, Christopher P M; Bos, Gerard M J; Hofstra, Lenoard

2010-10-01

130

The use of bipaddled submental flap for reconstructing composite buccal defect.  

PubMed

Reconstruction of full-thickness buccal defect is challenging as two linings need to be addressed. Either two different flaps or double-paddle for one free flaps are necessary for this defect. The prolonged operation might not be tolerated by patients because of advanced age or medical comorbidity. A 77-year-old gentleman, with significant medical comorbidity, presented with a 4.0 × 4.5 cm ulcerative mass due to squamous cell carcinoma arising from the left buccal mucosa. The tumor extended to the left cheek skin. There was no palpable neck node. CT scan did not show any bony erosion or suspicious neck node. Full-thickness resection of the tumour was undertaken. For the full-thickness buccal defect, a bi-paddled pedicled submental flap after de-epithelialization of the flap skin was used for both the cutaneous and mucosal resurfacing. The flap survived completely and patient recovered smoothly. The surgery is simple and operation time is much shorter than free flap reconstruction. This modified utilization of submental flap simplifies the closure of complicated oro-facial wound. PMID:24644402

Chow, Tam-Lin; Choi, Chi-Yee; Ho, Lai-In; Fung, Siu-Chung

2014-03-01

131

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

132

Effects of vascular endothelial growth factor on survival of surgical flaps: a review of experimental studies.  

PubMed

Partial or complete necrosis of skin flaps remains a significant problem in plastic and reconstructive surgery. Growth factors have shown promise in improving flap survival through increased angiogenesis and blood supply to the flap. Vascular endothelial growth factor (VEGF) is the most widely investigated and successful one. But the mechanisms of the effects are still not very clear. In the course of a series of experiments, we indicated that tissue survival of surgical flaps could be improved by both preoperative (sustained phase effect) and intraoperative (acute phase effect) application of VEGF. We reviewed both experimental and clinical investigations on the use of VEGF with surgical flaps to summarize the evidence of both phases of VEGF activity in promotion of flaps survival in detail. With the combinations of acute and sustained phases of effects, VEGF protein and gene, VEGF morphologic actions, and VEGF histochemical modulations suggest a pattern of VEGF activity that can be superimposed on classic descriptive mechanisms of tissue survival of flaps. PMID:23716189

Fang, Taolin; Lineaweaver, William C; Chen, Michael B; Kisner, Carson; Zhang, Feng

2014-01-01

133

DMSO: Applications in plastic surgery  

Microsoft Academic Search

The authors point out that dimethyl sulfoxide (DMSO) increases tissue perfusion and may effectively treat or prevent ischemia in flaps. They recommend application of topical DMSO every 4 to 6 hours, until blood flow improves, to areas that show signs of ischemia or less than adequate perfusion. Other potential cosmetic surgery uses of DMSO include areas of skin care, pain

V. Leroy Young; C. B. Boswell; Robert F. Centeno; Marla E. Watson

2005-01-01

134

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

135

Propeller flaps: classification and clinical applications.  

PubMed

Propeller flaps feature a highly reliable reconstructive method, based on a perforator vessel. Since their introduction in 1991, a great variety of propeller flaps have been described, according to their shape and their potential of coverage. Indeed, these flaps have progressively been refined and modified, concerning their vascularity and space design. The authors present a classification of propeller flaps. This anatomical classification is necessary to understand the dissection procedure and the differences between the numerous types of propeller flaps nowadays described. It is the international classification, which should be used for the description and conception of these flaps. PMID:21236544

Ayestaray, B; Ogawa, R; Ono, S; Hyakusoku, H

2011-04-01

136

Extended Reverse Sural Artery Flap's Safety, Success and Efficacy - A Prospective Study  

PubMed Central

Background: One of the challenges in reconstructive surgeries, faced by a majority of surgeons, is the soft tissue defect management around the lower-third of the leg, plantar and dorsal feet. Due to the sensitive location and other related difficulties, only limited options are available in this region. A durable flap is the preferred option for coverage of such defects. Objective: To evaluate the safety, success and efficacy of the extended reverse sural artery flap which was harvested, with extension to proximal-third of the leg. Methodology: This prospective study was conducted at Department of Plastic Surgery, on 18 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested medium to large sized reverse sural artery flaps with extensions to the upper third of the calf, to cover the defects found in the distal tibia, ankle, heel, foot, and sole. Results: A majority of flaps provided a good coverage for defects. Two cases developed marginal necrosis of flaps in the distal border, which was treated with use of secondary skin grafts. Four flaps developed venous congestions. In other patients, minor complications such as rupture of suture inset, development of ulcer over insensate flap, since only one patient developed ulcer and another one patient developed inset rupture and graft loss occurred. In 16 cases, the final outcome was unaffected by any complications. Conclusions: Extension of reverse sural artery flap to the proximal third of the leg was safe and reliable and it was efficiently used to treat patients with large and far wounds of distal leg, foot and sole. PMID:24995209

MN, Prakashkumar; M, Shankarappa

2014-01-01

137

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

138

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

139

Proximally based sural adipose-cutaneous/scar flap in elimination of ulcerous scar soft-tissue defect over the achilles tendon and posterior heel region: a new approach.  

PubMed

Scar ulcers that spread over the Achilles tendon and posterior heel disturb patients by causing pain, impeding hygiene, and creating difficulty in finding appropriate shoe wear. As this region undergoes pressure, effective reconstruction is based on the flap use. The most popular flaps currently used are distally based sural fasciocutaneous flap, calcaneal artery skin flap, and free flaps. These flaps, however, are insensate, can create soft-tissue excess, and cause donor site morbidity. Ulcerous soft-tissue defects over Achilles tendon and posterior heel after burns, frost, and trauma were studied and reconstructed in 16 patients, using proximally based sural adipose-cutaneous flap, the anatomy of which was studied on lower extremities of 27 cadavers. Ulcerous soft-tissue defect consists of two parts: ulcer and surrounding pathologic scars that should be excised in one block. Resulting soft-tissue defects with exposed tendon and calcaneal bone varied from 6 to 20 cm in length and 6 cm in width. For such wound resurfacing a flap was developed that was sensate, thin, large, and having steady blood circulation. The flap was harvested from the lower third of the leg and lateral foot, consisting of skin and subcutaneous fat layer (without fascia), including the sural nerve and lesser vein. The blood supply was ensured through peroneal and anterior tibial artery perforators, which formed a vascular net in the flap. In 14 of 16 cases excellent and stable functional and good cosmetic results with acceptable donor site morbidity were achieved. In two patients the distal flap loss took place because of arteriitis obliterans (one case) and because of the cross-cutting of the sural nerve and vessels during previous surgeries (another case). Proximally based sural adipose-cutaneous/scar flap is the only flap that satisfies all requirements for Achilles tendon and posterior heel region resurfacing. The author believes that this technique, based on this flap use, is anatomically justified, clinically profitable, and should be considered as the first choice operation. PMID:24043244

Grishkevich, Viktor M

2014-01-01

140

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

141

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

142

Reconstruction with a 180-degree Rotationally Divided Latissimus-dorsi-musculocutaneous Flap after the Removal of Locally Advanced Breast Cancer  

PubMed Central

Summary: This study described a technique for reconstruction of a large lateral thoracic region defect after locally advanced breast cancer resection that allows for full coverage of the defect and primary closure of the flap donor site. The authors performed reconstruction using the newly designed 180-degree rotationally-divided latissimus-dorsi-musculocutaneous flap in a 42-year-old woman for coverage of a large skin defect (18 × 15 cm) following extensive tissue resection for locally advanced breast cancer. The latissimus-dorsi-musculocutaneous flap, consisting of two rotated skin islands (18 × 7.5 cm each) that were sutured to form a large skin island, was used for coverage of the defect. The flap was sutured without causing excessive tension in the recipient region and the donor site was closed with simple reefing. No skin grafting was necessary. The flap survived completely, shoulder joint function was intact, and esthetic outcome was satisfactory. Quick wound closure allowed postoperative irradiation to be started 1 month after surgery. The technique offered advantages over the conventional pedicled latissimus-dorsi-musculocutaneous flap, but the flap was unable to be used, when the thoracodorsal artery and vein were damaged during extensive tissue removal. Detailed planning before surgery with breast surgeons would be essential.

Kirita, Miho; Sakurai, Hiroyuki

2014-01-01

143

21 year follow up of a DIEP (deep inferior epigastric perforator) flap: A tale of a "nulltiple".  

PubMed

Since the first description of "The free abdominoplasty flap for breast reconstruction" by Hans Holmstrom in 1979, [see Ref. 1] the use of lower abdominal tissue has revolutionised reconstruction of the breast. DIEP (deep inferior epigastric perforator) free flap offers an abundance of reconstructive material, aesthetically-pleasing results and limited donor site morbidity. We report our first case of breast reconstruction with what presently is known as DIEP flap, performed in 1991 at St. Andrew's Centre for Plastic Surgery and Burns in Essex, The United Kingdom and the recent follow up results. We also discuss the historical events surrounding the evolution of this unpublished case and other documented cases. PMID:24874613

Arya, Reza; Healy, Claragh; Frame, James D; Ramakrishnan, Venkat

2014-10-01

144

Distally Based Dorsal Forearm Fasciosubcutaneous Flap  

Microsoft Academic Search

Use of a local flap is often required for the reconstruction of a skin defect on the dorsum of the hand. For this purpose, a distally based dorsal forearm fasciosubcutaneous flap based on the perforators of the posterior interosseous artery was developed. From 1997 until 2002, this flap was used to re- construct skin defects on the dorsum of the

Kwang Seog Kim

2004-01-01

145

The versatility of the anterolateral thigh flap.  

PubMed

In the last two decades, the anterolateral thigh flap has emerged as one of the most popular reconstructive options for multiple body sites. Based on a perforator flap harvest concept, the flap encompasses the advantages of versatility, pliability, and potential for composite tissue replacement. Although numerous anatomical variations exist, these are well-described, and flap safety remains uncompromised if certain anatomical boundaries are respected. Careful preoperative planning and identification of perforators remain the cornerstone of successful flap harvest. Once perforators are identified, variations in skin paddle design allow for multiple skin paddle configurations, central or eccentric orientations, and custom-made flaps tailored to fit almost any defect. A suprafascial dissection allows for "ultra-thin" flaps ideal for folding, tubing, or packing purposes. The versatility of the lateral circumflex femoral artery branches can be exploited to include muscle, iliac bone, tendon, fascia, or nerve in extended designs. The anterolateral thigh flap is currently the frontline choice for head and neck reconstruction, including intraoral, mandibular-maxillary, tongue, and facial defects, and is gaining popularity in abdominal and pelvis reconstruction. It can also be used as a pedicled flap in phallus or perineum reconstruction. More recently, the flap has proved to be extremely useful in skin resurfacing and even functional reconstruction in traumatic wounds. This review summarizes the anatomy, planning, flap harvest, donor morbidity, and clinical applications of the anterolateral thigh flap. An algorithm is proposed that facilitates a clear, problem-based approach for the use of this versatile reconstructive option. PMID:19952707

Ali, Rozina S; Bluebond-Langner, Rachel; Rodriguez, Eduardo D; Cheng, Ming-Huei

2009-12-01

146

Facial reconstruction using the visor scalp flap  

Microsoft Academic Search

In male burn victims, scar may cause grotesque disfigurement to the upper lip and lower face. There are many ways to address the problem, for simple skin grafting to complex flaps. Bipedicle scalp flaps are used sporadically for reconstruction of the upper lip. In this article, the use of bitemporal artery hair-bearing flap for reconstruction of the moustache and beard

Farhad Hafezi; Bjjan Naghibzadeh; AmirHossein Nouhi

2002-01-01

147

Numerical Analysis of Flapping Wing Aerodynamics  

Microsoft Academic Search

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

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

148

Health-related quality of life, surgical and aesthetic outcomes following microvascular free flap reconstructions: an 8-year institutional review  

PubMed Central

INTRODUCTION Microvascular free flap reconstruction has revolutionised the reconstruction of complex defects of traumatic, oncological, congenital and infectious aetiologies. Complications of microvascular free flap procedures impact negatively on patient post-operative course and outcome. METHODS We performed a retrospective analysis of 102 consecutive patients undergoing 108 free flap procedures at a tertiary referral centre over an 8-year period. Logistic regression analysis was used to identify factors pRedictive of free flap complications. Health-related quality of life (HRQoL) and aesthetic outcomes were assessed using the Short Form 36 questionnaire and a satisfaction visual analogue scale respectively. RESULTS In total, 108 free tissue transfers were performed; 23% were fasciocutaneous free flaps, 69% musculocutaneous and 8% osteoseptocutaneous. The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss. ASA (American Society of Anesthesiologists) grade ?2 (OR: 16.9, 95% CI: 15.3–18.1, p<0.009), history of smoking (OR: 6.1, 95% CI: 5.5–7.2, p<0.049), body mass index ?25kg/ m2 (OR: 21.3, 95% CI: 20.8–22.1, p<0.003), low albumin (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.2–3.9, p<0.003) and peripheral vascular disease (OR: 6.9, 95% CI: 5.9–7.5, p<0.036) were identified as factors independently predictive of free flap complications. CONCLUSIONS Patients undergoing uncomplicated free flap surgery and those reporting superior post-operative flap aesthesis have higher HRQoL scores. Microvascular free tissue transfer has revolutionised our approach to the reconstruction of complex defects, providing a safe, reliable procedure to restore functionality and quality of life for patients. PMID:22524928

Dolan, RT; Butler, JS; Murphy, SM; Cronin, KJ

2012-01-01

149

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

150

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

151

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

PubMed Central

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

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

2011-01-01

152

The prefabricated scapula flap consists of syngeneic bone, connective tissue, and a self-assembled epithelial coating.  

PubMed

The reconstruction of maxillary defects is a challenge in plastic surgery. The so-called prefabricated scapula flap consists of syngeneic bone covered with syngeneic dermis and is used to reconstruct maxillary defects. After placing these flaps into the oral cavity, they are reepithelialized within a short time period, raising the question of the cellular origin of the "neomucosa." We therefore obtained sequential biopsy samples of the prefabricated flap and of the flap after being placed into the oral cavity and analyzed the keratin expression profile of epithelial cells. We expected that after placing the prefabricated flap into the oral cavity, keratinocytes from adnexal structures of the dermal component of the graft would migrate onto the surface and reepithelialize the flap. Unexpectedly, reepithelialization occurred earlier. The flap had acquired a mucosa-like epithelium at the interface between the Gore-Tex coating and the dermis while still being positioned within the scapular region. The keratin expression profile of this epithelium was very similar to that of mucosal epithelium. Thus, the prefabricated scapula flap not only consisted of bone covered with connective tissue, but was also covered with epithelial cells derived from adnexal structures of the dermal graft. This seems to be the reason for the rapid restoration of an intact mucosa and the excellent outcome achieved with this surgical technique. PMID:11743375

Kunstfeld, R; Petzelbauer, P; Wickenhauser, G; Schlenz, I; Korak, K; Vinzenz, K; Holle, J

2001-12-01

153

Reconstruction of foot dorsiflexion using lateral arm free flap with vascularized triceps tendon  

Microsoft Academic Search

A lateral arm free flap including vascularized triceps tendon was transferred to reconstruct the tibialis anterior tendon and skin defects over the anterior distal third of the left cruris of a patient who was injured by gunshot. Four months after surgery, the patient walked and ran well, and dorsiflexed his ankle joint actively to 10°. Considering cosmetic appearance, it was

S. Akin; M. Özcan

1996-01-01

154

Treatment of traumatic radioulnar synostosis by excision, with interposition of a posterior interosseous island forearm flap  

Microsoft Academic Search

A 21-year-old man had proximal radioulnar synostosis 10 months after fracture of the proximal radius and the ulna. The bony bridge was excised and a direct posterior interosseous island flap was interposed as a biological barrier. One year after surgery, the range of forearm rotation was 65?. There was no radiographic evidence of recurrence.

M. Sugimoto; K. Masada; H. Ohno; T. Hosoya

1996-01-01

155

Treatment of radioulnar synostosis by radical excision and interposition of a radial forearm adipofascial flap.  

PubMed

A patient had radical excision of type II diaphyseal radioulnar synostosis and interposition of a radial forearm adipofascial flap. Neither adjuvant nonsteroidal anti-inflammatory medications nor radiation therapy were used. Three years after surgery the patient showed 90 degrees of pronation and 90 degrees of supination without any evidence of recurrence. PMID:15576229

Jones, Neil F; Esmail, Adil; Shin, Eon K

2004-11-01

156

Comparative study on sensory recovery after oral cavity reconstruction by free flaps: preliminary results  

Microsoft Academic Search

Anatomical restoration was once the only goal of reconstructive surgery, but now it represents only one step in the complete functional recovery process to allow resumption of physiological activity. Soft tissue and nerves play important roles in functional recovery, but the potential of these structures is not yet well known. Rehabilitation after oral cavity reconstruction by free flaps needs an

Andrea Cicconetti; Claudio Matteini; Giorgio Cruccu; Antonietta Romaniello

2000-01-01

157

[New modification of autoconjunctival plastic surgery in urgent corneal surgery].  

PubMed

A new modification of plastic repair of deep defects of the cornea was performed: autoconjunctival plasty of the cornea with a flap on a pedicle with its rigid fixation in the corneal bed. The operation was carried out in 30 patients with infectious, trophic, and autoimmune involvement of the cornea, 24 of these with perforation of the cornea. The patients were observed for 1 year after the operation. The conjunctival-corneal complex formed in 24 cases, dislocation of the flap without its necrosis occurred in 2 cases, and necrosis of the flap in 4 cases. This modification of conjunctival plasty of the cornea can serve as the operation of choice in urgent ophthalmic surgery in cases when transplantation material is unavailable. PMID:11898353

Oganesian, O G; Gundorova, R A; Ma?chuk, Iu F; Makarov, P V; Khoroshilova-Maslova, I P; Ilatovskaia, L V

2002-01-01

158

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

159

Predictors of blood transfusion in deep inferior epigastric artery perforator flap breast reconstruction.  

PubMed

Perioperative blood loss during and following breast reconstruction surgery can have substantial impact on free flap survival and patient morbidity. Transfusion rates of up to 95% have been reported following transverse rectus abdominis myocutaneous flap breast reconstruction, with blood loss described as significant in most cases. However, there has been little reported of such requirements in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. We present the transfusion requirements of 152 consecutive patients who underwent DIEP flap breast reconstruction, with a view to quantifying transfusion requirements and identifying risk factors for such loss. In this cohort, 80.3% of patients required blood transfusion, with a mean volume of 3.9 U per patient. There was a statistically significant correlation for increased transfusion requirement in patients with preoperative anemia ( P < 0.001) and in bilateral cases ( P < 0.001), but not for cases of immediate reconstruction ( P = 0.72). Although blood loss in breast reconstructive surgery is rarely large enough to be life-threatening, relative anemia does have significant effect on flap survival and patient morbidity. With risk factors for increased transfusion requirements identified in the current study, high-risk patients can be predicted preoperatively. PMID:21452109

Ting, Jeannette; Rozen, Warren M; Le Roux, Cara Michelle; Ashton, Mark W; Garcia-Tutor, Emilio

2011-05-01

160

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

161

Long-term morphometric and immunohistochemical findings in human free microvascular muscle flaps.  

PubMed

Reinnervation, muscle regeneration, density of microvessels, and muscle-type specific atrophy were studied 3-4 years after surgery in surgically nonreinnervated free microvascular muscle flaps to 13 patients transplanted to the upper or lower extremities. Routine histology and immunohistochemistry for PGP 9.5 and S-100 (neuronal markers), Ki-67 (cell proliferation), myosin (muscle fiber types), and CD-31 (endothelium) were carried out, and results were analyzed morphometrically. Three to 4 years after surgery, severe atrophy of predominantly slow-type fibers was seen in 9 cases. In 4 cases, muscle-fiber diameter and fiber-type distribution were close to normal. Long intraoperative muscle ischemia and postoperative immobilization were associated with poor muscle bulk in flaps. The density of microvessels in flaps did not differ from control muscles. PGP 9.5 and S-100 immunopositive nerve fibers were detected in 7 patients. Reinnervation was associated with good muscle bulk. In 4 patients, activation of satellite cells was evident. The results suggest that in some cases, spontaneous reinnervation may occur in free muscle flaps, and that several years after microvascular free flap transfer, the muscle still attempts to regenerate. PMID:14748022

Kauhanen, M Susanna C; Lorenzetti, Fulvio; Leivo, Ilmo V V; Tukiainen, Erkki; Asko-Seljavaara, Sirpa L

2004-01-01

162

A prospective, contralateral comparison of photorefractive keratectomy (PRK) versus thin-flap LASIK: assessment of visual function  

PubMed Central

Purpose: To compare differences in visual acuity, contrast sensitivity, complications, and higher-order ocular aberrations (HOAs) in eyes with stable myopia undergoing either photo-refractive keratectomy (PRK) or thin-flap laser in situ keratomileusis (LASIK) (intended flap thickness of 90 ?m) using the VISX Star S4 CustomVue excimer laser and the IntraLase FS60 femtosecond laser at 1, 3, and 6 months postoperatively. Methods: In this prospective, masked, and randomized pilot study, refractive surgery was performed contralaterally on 52 eyes: 26 with PRK and 26 with thin-flap LASIK. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and complications. Results: At 6 months, mean values for UDVA (logMAR) were ?0.043 ± 0.668 and ?0.061 ± 0.099 in the PRK and thin-flap LASIK groups, respectively (n = 25, P = 0.466). UDVA of 20/20 or better was achieved in 96% of eyes undergoing PRK and 92% of eyes undergoing thin-flap LASIK, whereas 20/15 vision or better was achieved in 73% of eyes undergoing PRK and 72% of eyes undergoing thin-flap LASIK (P > 0.600). Significant differences were not found between treatment groups in contrast sensitivity (P ? 0.156) or CDVA (P = 0.800) at postoperative 6 months. Types of complications differed between groups, notably 35% of eyes in the thin-flap LASIK group experiencing complications, including microstriae and 2 flap tears. Conclusion: Under well-controlled surgical conditions, PRK and thin-flap LASIK refractive surgeries achieve similar results in visual acuity, contrast sensitivity, and induction of HOAs, with differences in experienced complications. PMID:21573091

Hatch, Bryndon B; Moshirfar, Majid; Ollerton, Andrew J; Sikder, Shameema; Mifflin, Mark D

2011-01-01

163

Femtosecond refractive eye surgery: study of laser parameters for even more efficiency and safety  

NASA Astrophysics Data System (ADS)

Studies on corneal surgery and flap processing on enucleated porcine eyes have been performed using a dedicated 100 kHz femtosecond laser source based on Ytterbium technology. IR (1035 nm) and green (517 nm) flap processing have been studied. Comparisons for ocular femtosecond laser surgery are discussed in terms of process efficiency and safety aspects. Flaps with a typical diameter of 6 mm and 150 ?m thick have been performed in less than 2 min with both wavelengths. The transmittances of femtosecond laser pulses through the ocular media of porcine eyes have been measured for a collimated beam and during flap processing. More than 25% of energy is transmitted through the whole eye at the retina during IR pulses flap processing. Concerning green pulses, if less energy is necessary to perform the flap which is of prime interest, the transmission of green light is very high and could be an undeniable obstacle for the safety.

Le Harzic, Ronan; Wüllner, Christian; Bruneel, D.; Donitzky, Christof; König, Karsten

2007-07-01

164

Cost analysis in oral cavity and oropharyngeal reconstructions with microvascular and pedicled flaps.  

PubMed

Reconstructive surgery of the head and neck region has undergone tremendous advancement over the past three decades, and the success rate of free tissue transfers has risen to greater than 95%. It must always be considered that not all patients are ideal candidates for free flap reconstruction, and also that not every defect strictly requires a free flap transfer to achieve good functional results. At our institution, free flap reconstruction is first choice, although we use pedicled alternative flaps for most weak patients suffering from severe comorbidities, and for pretreated patients presenting a second primary or a recurrent cancer. From July 2006 to May 2010, 54 consecutive patients underwent soft tissue reconstruction of oral cavity and oropharyngeal defects. We divided the cohort in three groups: Group 1 (G1): 16 patients in good general conditions that received free radial forearm flap reconstruction; Group 2 (G2): 18 high-risk patients that received a reconstruction with infrahyoid flap; Group 3 (G3): 20 patients that received temporal flap (10 cases) or pectoral flap (10 cases) reconstruction. We must highlight that pedicled alternative flaps were used in elderly, unfavourable and weak patients, where usually the medical costs tend to rise rather than decrease. We compared the healthcare costs of the three groups, calculating real costs in each group from review of medical records and operating room registers, and calculating the corresponding DRG system reimbursement. For real costs, we found a statistically significant difference among groups: in G1 the average total cost per patient was € 22,924, in G2 it was € 18,037 and in G3 was € 19,872 (p = 0.043). The amount of the refund, based on the DRG system, was € 7,650 per patient, independently of the type of surgery. Our analysis shows that the use of alternative non-microvascular techniques, in high-risk patients, is functionally and oncologically sound, and can even produce a cost savings. In particular, the infrahyoid flap (G2) ensures excellent functional results, accompanied by the best economic savings in the worst group of patients. Our data reflect a large disconnection between the DRG system and actual treatment costs. PMID:24376293

Deganello, A; Gitti, G; Parrinello, G; Muratori, E; Larotonda, G; Gallo, O

2013-12-01

165

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

166

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

167

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

PubMed

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

168

The effects of resveratrol on flap survival in diabetic rats.  

PubMed

Resveratrol is an antioxidant agent with multiple positive impacts on the body. It is known to have anti-diabetic, anti-inflammatory, anti-carcinogenic, and neuroprotective effects. The goal of this study is to demonstrate the antioxidant and anti-diabetic effects of resveratrol on flap survival in diabetic rats. Streptozotocin-induced diabetic Sprague-Dawley albino rats were treated with 10 mg/kg resveratrol following a flap surgery. Histological findings regarding polymorphonuclear leukocyte (PMNL) density, vascular proliferation, fibroblast density, and tissue necrosis were compared between resveratrol-treated and control rats. Significantly higher PMNL density was found in the control group (p = 0.005); while vascular proliferation and the fibroblast density were higher in the resveratrol group (p = 0.004 and p = 0.021, respectively). Collagen density was also higher in the resveratrol group and the difference has statistical significance (p = 0.024). Lymphocyte density was not significantly different between groups (p = 0.061). When the necrosis in the distal areas was evaluated histologically, 20% of the resveratrol group had epidermal tissue necrosis, thus 90% of the control group had epidermal or full-layer necrosis. Resveratrol improved flap survival significantly in diabetic rats. Therefore, diabetic patients requiring complex reconstructive procedures may benefit from resveratrol; so, clinical trials are required to support this study. PMID:24308328

Ciloglu, N Sinem; Zeytin, Kayhan; Aker, Fugen

2014-08-01

169

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

170

Aerodynamics of jet flap and rotating cylinder flap STOL concepts  

NASA Technical Reports Server (NTRS)

The aerodynamic effectiveness of various propulsive lift concepts to provide for the low speed performance and control required for short takeoff and landing aircraft is discussed. The importance of the interrelationship between the propulsion system and aerodynamic components of the aircraft is stressed. The relative effectiveness of different lift concepts was evaluated through static and wind tunnel tests of various aerodynamic models and propulsion components, simulations of aircraft, and in some cases, flight testing of research aircraft incorporating the concepts under study. Results of large scale tests of lift augmentation devices are presented. The results of flight tests of STOL research aircraft with augmented jet flaps and rotating cylinder flaps are presented to show the steeper approach flight paths at low forward speeds.

Cook, W. L.; Hickey, D. H.; Quigley, H. C.

1974-01-01

171

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

PubMed Central

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

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

2013-01-01

172

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

173

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

PubMed Central

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

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

2014-01-01

174

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

PubMed

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

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

2014-06-01

175

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.

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

2014-01-01

176

Design and evaluation of a LIPCA-actuated flapping device  

NASA Astrophysics Data System (ADS)

In this paper, we have introduced a flapping wing mechanism actuated by a unimorph piezoceramic actuator, LIPCA (lightweight piezo-composite actuator). In the flapping system, the limited actuation displacement produced by bending motion of the simply supported actuator was transformed into a large flapping angle by using a four-bar linkage system. A wing rotation mechanism was also designed and implemented such that the wing can be passively rotated due to the resultant aerodynamic force during flapping motion. The natural flapping frequency of the device was about 9 Hz, where the maximum flapping angle was achieved. Flapping tests under 4-15 Hz flapping frequencies were performed to investigate the flapping performance by measuring the vertical force and forward force produced. The maximum forces were produced when the flapping device was actuated near the natural flapping frequency. The measured force data indicated that the present flapping system could produce positive average forces in the vertical and forward directions.

Syaifuddin, Moh; Park, Hoon Cheol; Goo, Nam Seo

2006-10-01

177

Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer.  

PubMed

Lymph node transfer is a novel technique in lymphedema surgery. In this study, we present our experience in harvesting lymph nodes flap based on the right transverse cervical artery. In a period of 7 months, we harvested 11 cervical lymph node flaps based on the right transverse cervical artery (TCA). The reliable anatomy of the TCA and the low complication rate of the donor site make this lymph node flap ideal for transfer in the treatment of lymphedema. Knowledge of the regional anatomy and the anatomic variations of the TCA are mandatory for safe dissection of this flap. We also present the preliminary results of our first 2 cases in which we performed cervical lymph node transfer for secondary lower extremity lymphedema. PMID:23759964

Sapountzis, Stamatis; Singhal, Dhruv; Rashid, Abid; Ciudad, Pedro; Meo, Domenico; Chen, Hung-Chi

2014-10-01

178

Expanded Uses for the Nasolabial Flap  

PubMed Central

The nasolabial flap is an excellent choice for use in reconstruction of the nasal alar subunit due to its inherent properties that match skin tone and the convexity of the nose. Often overlooked as an option to use in nasal reconstruction, the nasolabial flap can be very advantageous. Indications for the nasolabial flap can be expanded to include reconstruction of the nasal tip, dorsum, soft triangle, and partial alar defects. PMID:24872750

Weathers, William M.; Wolfswinkel, Erik M.; Nguyen, Huy; Thornton, James F.

2013-01-01

179

Cranioplasty with an autoclaved bone flap, with special reference to tumour infiltration of the flap  

Microsoft Academic Search

Summary The results of a total of 25 cranioplasties are reported. In 10 patients, a reinforced acrylic prosthesis was utilized. In the remaining 15 cases, the patient's own autoclaved bone flap was re-implanted. Six of these bone flaps were autoclaved to kill tumour cells, and was re-implanted during the same surgical procedure. In the remaining 9 patients, the flaps were

K. Wester

1994-01-01

180

Breast reconstruction with a turbocharged transverse rectus abdominis myocutaneous flap on the contralateral perforator.  

PubMed

Seventeen patients were submitted to delayed unilateral breast reconstruction using pedicled, muscle-sparing turbocharged transverse rectus abdominis myocutaneous flap based on the contralateral perforator vessels. The lateral portion of the rectus abdominis muscle on the pedicled side was preserved in 12 patients. Zones II and IV were included in the flap in all cases. Mean duration of surgery was 7 hours and 15 minutes. Four complications developed in the abdominal donor site: contralateral abdominal bulging (n = 1), minor suture dehiscence (n = 2), and epidermolysis at the border of the abdominal flap and umbilical scar (n = 1). Three partial losses (10%-30%) occurred in the reconstructed breast (17.64% of cases), whereas 2 cases of fat necrosis were associated with partial losses. One patient developed deep vein thrombosis with pulmonary embolism; however, outcome was favorable. This proved a viable alternative for breast reconstruction, with satisfactory results in most patients and acceptable morbidity and surgical time. PMID:24625511

Sbalchiero, Juliano Carlos; de Albuquerque Leal, Paulo Roberto; Dos Santos, César Cabello

2014-11-01

181

Optimal propulsive flapping in Stokes flows.  

PubMed

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

Was, Loïc; Lauga, Eric

2014-03-01

182

A water tunnel study of Gurney flaps  

NASA Technical Reports Server (NTRS)

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

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

1988-01-01

183

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

184

Optimal propulsive flapping in Stokes flows  

E-print Network

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

Was, Loic

2014-01-01

185

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

186

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

187

Extended Hair-bearing Lateral Orbital Flap for Simultaneous Reconstruction of Eyebrow and Eyelid  

PubMed Central

Background: When a tumor in the lateral eyebrow region is resected, reconstruction of the eyebrow and upper eyelid defects is necessary. We perform simultaneous reconstruction of such defects; sideburn hair is included on an extended lateral orbital flap. We describe our method and results of a retrospective evaluation. Methods: We treated 6 patients with partial eyebrow and upper eyelid defects. An extended lateral orbital flap was designed on the lateral region of the lateral canthus including sideburn hair and was elevated with a pedicle of the orbicularis oculi muscle. Flap size, surgical outcomes, and reconstructed eyebrow morphology were evaluated. Results: Mean flap size was 2.7?×?4.1?cm, with a maximum width and length of 3.5 and 5.1?cm, respectively. The mean hair-bearing region was 1.4?×?0.9?cm, with a maximum width and length of 1.8 and 1.3?cm, respectively. Total flap survival and hair growth were confirmed in all patients. The reconstructed eyebrow and eyelid were aesthetically satisfactory. The new eyebrow hair grew long and was directed upward but considered acceptable. No additional surgery was performed for any patient. The donor site scar was acceptable because it followed the wrinkles of the lateral eyelid. No paralysis of the temporal branch of the facial nerve resulted. Conclusions: The procedure for raising an extended hair-bearing lateral orbital flap is relatively easy, although attention must be paid to the temporal facial nerve. This flap is useful for simultaneously reconstructing defects of the upper eyelid and lateral eyebrow.

Matsuo, Shinji; Seike, Takuya; Abe, Yoshiro; Ishida, Soshi; Nakanishi, Hideki

2014-01-01

188

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

189

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

PubMed Central

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

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

2013-01-01

190

Surgical Approach for Repair of Rectovaginal Fistula by Modified Martius Flap  

PubMed Central

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

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

2014-01-01

191

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

192

Application of the inner arm perforator flap in the management of axillary hidradenitis suppurativa.  

PubMed

Axillary hidradenitis suppurativa is a chronic and debilitating disease that primarily affects the axillae, perineum, and inframammary areas. Surgical removal of all the diseased skin constitutes the only efficient treatment. Covering an axillary fossa defect is challenging, due to the range of shoulder movement required. Indeed, shoulder movement may be compromised by scar contraction after inadequate surgery. The present study is the first to apply an inner arm perforator flap to the treatment of twelve axillary skin defects in 10 patients. The defect originated from extensive excision of recurrent hidradenitis suppurativa in the axilla. The technique used to cover the defect is a V-Y advancement flap or a propeller flap from the inner arm based on one to three perforators arising from the brachial artery or the superior ulnar collateral artery. The flap provides a tensionless wound closure and a generally unremarkable postoperative course in a short hospital stay. No major complications occurred. Two patients had minor delayed wound healing. Outcomes (including donor site morbidity, function and the cosmetic outcome) were very satisfactory in all cases. We consider that the inner arm perforator flap is a valuable new option for the reconstruction of axillary defects. PMID:24290491

Alharbi, M; Perignon, D; Assaf, N; Qassemyar, Q; Elsamad, Y; Sinna, R

2014-02-01

193

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

194

The effect of scrotal reconstruction with skin flaps and skin grafts on testicular function.  

PubMed

Due to its unique composition, the reconstruction of scrotal skin defects is a major clinical challenge. This study was designed to evaluate the effects of scrotal reconstruction, using skin grafts and skin flaps, on spermatogenesis. In Group 1, the rats did not undergo surgery and were used as controls. In Group 2, after removal of all of the scrotal skin to expose the testicles, the defect was repaired using a skin flap from the right groin region. In Group 3, the reconstruction was achieved using skin grafts. All the rats were killed at 2 months postoperatively and evaluated. The mean wet weights of the testicles in the control group were significantly higher compared with that of the graft group. The mean height of the germinal epithelium was significantly greater in the control and flap groups compared with that of the graft group. The Johnsen score for spermatogenesis in the control group was higher than that in the graft group. The use of flaps resulted in testicular function that was comparable to that of the control group, whereas the use of grafts resulted in diminished testicular function. Therefore, we suggest that flaps may be the first choice for scrotal reconstruction. PMID:21629096

Demir, Yavuz; Aktepe, Fatma; Kandal, Sebahattin; Sancaktar, Nazli; Turhan-Haktanir, Nurten

2012-03-01

195

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

PubMed

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

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

2003-08-01

196

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

E-print Network

a corneal flap in refractive surgery a part of LASIK procedure , replacing less precise mechanical micro demonstrated, including single neuron dissection in a living organism 4 and excision of brain tissue from

Palanker, Daniel

197

Increased concentrations of calcitonin gene-related peptide-like immunoreactivity in rat brain and peripheral tissue after ischaemia: correlation to flap survival  

Microsoft Academic Search

The effects of experimentally induced ischaemia after free-flap surgery on concentrations of neuropeptide Y (NPY), neurokinin A (NKA), substance P (SP) and calcitonin gene-related peptide (CGRP)-like immunoreactivity (-LI) were studied in flap tissue and in different regions of the rat brain (striatum, hippocampus, pituitary, hypothalamus, frontal and occipital cortex). Ten days after the operation, CGRP-LI and NKA-LI were decreased in

V Bucinskaite; G Brodda-Jansen; C Stenfors; E Theodorsson; T Lundeberg

1998-01-01

198

Fillet flap: a successful procedure to preserve the optimum length of below-the knee-amputation stump in congenital constriction band of the leg.  

PubMed

The use of 'spare part' tissue from an amputated segment to cover a stump with soft tissue deficiency is a viable option for augmenting the shape of the stump and preserving functional length of the stump without additional donor morbidity. The procedure requires no microsurgical skill if the tissues are used as pedicle fillet flaps transfer. This concept of fillet flap makes the amputation distal to an unfavourable definitive amputation site such as in congenital constriction band possible. We report herein a case of amputation distal to constriction ring to illustrate the application of fillet flap in reconstruction surgery. PMID:16381298

Sulaiman, A R; Sallehudin, A Y; Shahidan, Y; Iskandar, M A; Halim, A S

2005-07-01

199

The Flexible Learning Approach to Physics (FLAP)  

Microsoft Academic Search

The Flexible Learning Approach to Physics (FLAP) is an extensive, high quality, supported self-study teaching resource, developed on behalf of the whole UK university sector. FLAP addresses the twin problems of an increasing diversity of intake into physics degree courses and their decreasing familiarity with the use of mathematics in a physical context. It has been developed over a three

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

1997-01-01

200

On Hydrodynamics of Bionic Flapping Hydrofoil Propeller  

Microsoft Academic Search

The bionic flapping hydrofoil propulsion, as a new propulsion mode, is different with the traditionary screw propeller, and it has attract the interest of the technologist in the aeronautics, astronautics and marine field. The underwater bionic flapping hydrofoil propeller is a system which can produce the thrust and can also produce the control force. This paper describes a hydrodynamics model

Du Xiao-xu; Song Bao-wei; Pan Guang

2010-01-01

201

Nose Surgery  

MedlinePLUS

... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ... Cover Nasal Surgery? Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, ...

202

Piezoelectrically actuated insect scale flapping wing  

NASA Astrophysics Data System (ADS)

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

Mukherjee, Sujoy; Ganguli, Ranjan

2010-04-01

203

Energy management - The delayed flap approach  

NASA Technical Reports Server (NTRS)

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

Bull, J. S.

1976-01-01

204

The Clinical Application of Anterolateral Thigh Flap  

PubMed Central

The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. PMID:22567234

Lee, Yao-Chou; Chiu, Haw-Yen; Shieh, Shyh-Jou

2011-01-01

205

Reconstruction of the upper lip, columella and premaxilla with an extended Abbé flap: report of a case  

Microsoft Academic Search

The resection of malignant tumours affecting the upper lip, columella, premaxilla and\\/or caudal septum requires reconstructive surgery, which does not always produce satisfactory results—either aesthetic or functional. We have designed a modification of the Abbé flap consisting of the extension of the distal portion of the latter over the chin, and the inclusion of a fragment of rib cartilage in

Enrique Zapater; Eduardo Simón; Eduardo Ferrandis; Juan Bosco Vendrell

2002-01-01

206

Kinking of pedicle vessels and its effect on blood flow and patency in free flaps: an experimental study in rats  

Microsoft Academic Search

Aim: Head rotation may significantly alter the initial position of the vascular pedicle of free flaps in reconstructive surgery of the oral cavity. This may lead to kinking of venous and\\/or arterial vessels. In spite of some precautions as rotating the head contralaterally for the first few days postoperatively or shortening the pedicle, the problem is still not well understood

Federico Biglioli; Marco Rabagliati; Stefano Gatti; Roberto Brusati

2004-01-01

207

In vivo animal follow-up studies on intrastromal surgery with near-infrared nanojoule femtosecond laser pulses  

NASA Astrophysics Data System (ADS)

We report on the histological results of in-vivo animal follow-up studies on refractive femtosecond laser surgery. Non-invasive flap-free intrastromal ablation as well as flap generation has been performed with MHz nanojoule near infrared femtosecond laser pulses. In particular, the dynamics of corneal wound healing have been studied. Wound-healing effects could be detected up to 90 days post-operation in the case of lasermediated flap generation. The flap-free intrastromal cavity was identified until the 28th day post-treatment. Interestingly, eosinophil granulocytes were observed. The follow-up studies confirmed that the near infrared femtosecond laser at near-nanojoule pulse energy is a highly precise and an attractive tool for intraocular refractive surgery, especially for flap-free intrastromal surgery.

Wang, Baogui; Riemann, Iris; Halbhuber, Karl-Juergen; Schubert, Harald; Kirste, Sigrun; Koenig, Karsten

2005-04-01

208

Dynamic reconstruction of full-thickness abdominal wall defects using free innervated vastus lateralis muscle flap combined with free anterolateral thigh flap.  

PubMed

Reconstruction of full-thickness abdominal wall defects remains a difficult surgical challenge. Although various reconstructive methods, including artificial mesh, pedicled and free flaps, have been reported, most reported reconstruction of only the fascia layer, leaving the resected rectus abdominis muscle unreconstructed. However, recent studies suggested the importance of dynamic reconstruction with functional muscle in preventing abdominal hernia in the long-term. According to the principle of reconstructive surgery, "replace lost tissue with similar tissue," a functionally and aesthetically ideal reconstruction is to reconstruct all components of the abdominal wall structure, including skin, subcutaneous fat, fascia, and muscle. We present 2 cases with full-thickness abdominal wall defects in the upper abdominal region, which we reconstructed with a free innervated vastus lateralis muscle flap combined with a free anterolateral thigh flap. The motor nerve of the vastus lateralis muscle was sutured with the intercostal nerve, and reinnervation was confirmed by electromyography. This method allows reconstruction of all components of the abdominal wall with a single flap, and dynamic reconstruction is achieved which will reduce the risk of postoperative hernia. We believe this method can be a good option for reconstruction of full-thickness abdominal wall defects with long-term stability. PMID:22214798

Iida, Takuya; Mihara, Makoto; Narushima, Mitsunaga; Todokoro, Takeshi; Hara, Hisako; Yoshimatu, Hidehiko; Koshima, Isao; Kadono, Takafumi

2013-03-01

209

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

PubMed

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

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

2011-05-01

210

The 3?-Flap Pocket of Human Flap Endonuclease 1 Is Critical for Substrate Binding and Catalysis*  

PubMed Central

Flap endonuclease 1 (FEN1) proteins, which are present in all kingdoms of life, catalyze the sequence-independent hydrolysis of the bifurcated nucleic acid intermediates formed during DNA replication and repair. How FEN1s have evolved to preferentially cleave flap structures is of great interest especially in light of studies wherein mice carrying a catalytically deficient FEN1 were predisposed to cancer. Structural studies of FEN1s from phage to human have shown that, although they share similar folds, the FEN1s of higher organisms contain a 3?-extrahelical nucleotide (3?-flap) binding pocket. When presented with 5?-flap substrates having a 3?-flap, archaeal and eukaryotic FEN1s display enhanced reaction rates and cleavage site specificity. To investigate the role of this interaction, a kinetic study of human FEN1 (hFEN1) employing well defined DNA substrates was conducted. The presence of a 3?-flap on substrates reduced Km and increased multiple- and single turnover rates of endonucleolytic hydrolysis at near physiological salt concentrations. Exonucleolytic and fork-gap-endonucleolytic reactions were also stimulated by the presence of a 3?-flap, and the absence of a 3?-flap from a 5?-flap substrate was more detrimental to hFEN1 activity than removal of the 5?-flap or introduction of a hairpin into the 5?-flap structure. hFEN1 reactions were predominantly rate-limited by product release regardless of the presence or absence of a 3?-flap. Furthermore, the identity of the stable enzyme product species was deduced from inhibition studies to be the 5?-phosphorylated product. Together the results indicate that the presence of a 3?-flap is the critical feature for efficient hFEN1 substrate recognition and catalysis. PMID:19525235

David Finger, L.; Blanchard, M. Suzette; Theimer, Carla A.; Sengerova, Blanka; Singh, Purnima; Chavez, Valerie; Liu, Fei; Grasby, Jane A.; Shen, Binghui

2009-01-01

211

Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak.  

PubMed

Endoscopic skull base surgery continues to rapidly evolve, requiring comparable advances in reconstructive techniques. While smaller skull base defects with low intraoperative CSF flow have been successfully managed with a variety of avascular and/or noncellular techniques, larger defects with high CSF flow require more robust repairs often in the form of vascularized flaps, which confer excellent success rates in this setting. Despite these successful outcomes, a paucity of data describing specific patient and operative characteristics and their effects on repair exist. Therefore, a retrospective, consecutive chart review was performed on patients who underwent endoscopic skull base reconstruction with a vascularized flap in the setting of intraoperative CSF leaks. In this series, 151 patients with a mean age of 51 years underwent 152 vascularized flap skull base reconstructions for an array of benign and malignant pathologies. These vascularized flaps included 144 nasoseptal flaps, 6 endoscopic-assisted pericranial flaps, 1 facial artery buccinator flap, and 1 inferior turbinate flap that were used throughout all regions of the skull base. Perioperative (< 3 months) and postoperative (> 3 months) flap complications were assessed and revealed 3 perioperative flap defects (2.0%) defined as a visualized defect within the substrate of the flap and a total of 5 perioperative CSF leaks (3.3%). No patient experienced flap death/complete flap loss in the cohort. Assessed postoperative flap complications included 1 case (0.7%) of mucocele formation, 8 cases (5.3%) of prolonged skull base crusting, and 2 cases (1.3%) of donor-site complication, specifically septal perforation secondary to nasoseptal flap harvest. Among the 152 cases identified, 37 patients received radiation therapy while 114 patients did not undergo radiation therapy as part of the treatment profile. No significant association was found between perioperative complication rates and radiation therapy (p = 0.634). However, a significant association was found between postoperative complication rates and radiation therapy, primarily accounted for by an increased risk for prolonged (> 6 months) skull base crusting (p = 0.025). It is clear that larger skull base defects with high intraoperative CSF flow require thoughtful approach and strong consideration for vascularized repair. PMID:25270144

Thorp, Brian D; Sreenath, Satyan B; Ebert, Charles S; M P H; Zanation, Adam M

2014-10-01

212

New developments in femtosecond laser corneal refractive surgery  

NASA Astrophysics Data System (ADS)

Studies on corneal surgery and flap processing on enucleated porcine eyes have been performed using a dedicated femtosecond laser source based on Ytterbium technology. The influence of several laser parameters such as wavelength, energy, repetition rate and numerical aperture has been studied. Best parameters for ocular femtosecond laser surgery are discussed in terms of process efficiency and safety aspects. The 100 KHz laser system is a promising tool for corneal surgery

Le Harzic, Ronan; Wüllner, Christian; Donitzky, Christof; König, Karsten

2007-02-01

213

Delineation of LASIK Flaps with Prednisolone Acetate Eyedrops  

PubMed Central

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

Fahd, Daoud C; Fahed, Sharbel D

2014-01-01

214

Clinical applications of venous flaps in the reconstruction of hands and fingers  

Microsoft Academic Search

In recent years, the venous flap has been highly regarded in microsurgical and reconstructive surgeries, especially in the\\u000a reconstruction of hand and digit injuries. It is easily designed and harvested with good quality. It is thin and pliable,\\u000a without the need of sacrificing a major artery at the donor site, and has no limitation on the donor site. It can

Hede Yan; Feng Zhang; Ovunc Akdemir; Somjade Songcharoen; Nicholas I. Jones; Michael Angel; Darrell Brook

2011-01-01

215

The sternocleidomastoid myoperiosteal flap for the reconstruction of a tracheal defect.  

PubMed

The sternocleidomastoid (SCM) myoperiosteal flap offers a relatively simple, single-stage reconstruction of a tracheal defect after conservative resection of an invasive papillary cancer of the thyroid with intraluminal involvement. Vascularised clavicular periosteum provides a viable, pliant, airtight, composite autologous graft with minimal vocal disturbance and a low risk to the parathyroid glands. The operation is not difficult to perform and has an acceptable long-term result even for the occasional operator in the specialised field of tracheal surgery. PMID:17674563

Becker, J H R; Franz, R C

2007-05-01

216

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

Code of Federal Regulations, 2013 CFR

... Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL...Escape Opening and Flap Dimensions for the Double Cover Flap TED ER02JN04.003 [69 FR 31037, June 2,...

2013-10-01

217

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

Code of Federal Regulations, 2012 CFR

... Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL...Escape Opening and Flap Dimensions for the Double Cover Flap TED ER02JN04.003 [69 FR 31037, June 2,...

2012-10-01

218

Aerodynamic characteristics of a wing with Fowler flaps including flap loads, downwash, and calculated effect on take-off  

NASA Technical Reports Server (NTRS)

This report presents the results of wind tunnel tests of a wing in combination with each of three sizes of Fowler flap. The purpose of the investigation was to determine the aerodynamic characteristics as affected by flap chord and position, the air loads on the flaps, and the effect of flaps on the downwash.

Platt, Robert C

1936-01-01

219

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223...Fig. 16 Figure 16 to Part 223—Escape Opening and Flap Dimensions for the Double Cover Flap TED ER02JN04.003 [69...

2011-10-01

220

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...Fig. 16 Figure 16 to Part 223—Escape Opening and Flap Dimensions for the Double Cover Flap TED ER02JN04.003 [69...

2010-10-01

221

Flap endonuclease of bacteriophage T7  

PubMed Central

Gene 6 protein of bacteriophage T7 has 5?-3?-exonuclease activity specific for duplex DNA. We have found that gene 6 protein also has flap endonuclease activity. The flap endonuclease activity is considerably weaker than the exonuclease activity. Unlike the human homolog of gene 6 protein, the flap endonuclease activity of gene 6 protein is dependent on the length of the 5?-flap. This dependency of activity on the length of the 5?-flap may result from the structured helical gateway region of gene 6 protein which differs from that of human flap endonuclease 1. The flap endonuclease activity provides a mechanism by which RNA-terminated Okazaki fragments, displaced by the lagging strand DNA polymerase, are processed. 3?-extensions generated during degradation of duplex DNA by the exonuclease activity of gene 6 protein are inhibitory to further degradation of the 5?-terminus by the exonuclease activity of gene 6 protein. The single-stranded DNA binding protein of T7 overcomes this inhibition. PMID:25105057

Mitsunobu, Hitoshi; Zhu, Bin; Lee, Seung-Joo; Tabor, Stanley; Richardson, Charles C

2014-01-01

222

Reconstruction of lateral forefoot using reversed medial plantar flap with free anterolateral thigh flap.  

PubMed

Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects. PMID:24534560

Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

2014-01-01

223

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

PubMed Central

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

Panse, Nikhil; Sahasrabudhe, Parag

2010-01-01

224

Optimum Flapping Wing Motions of Dragonfly  

NASA Astrophysics Data System (ADS)

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

Kamisawa, Yuichi; Isogai, Koji

225

Flap-augmented shrouds for aerogenerators  

NASA Technical Reports Server (NTRS)

Axisymmetrical shrouds for windmills are augmented by ring-shaped 'flaps' and their performance is studied experimentally. The concept of the shroud as an annular 'wing' is justified, leading to the conclusion that high-lift techniques should be used in shroud design, and that high-lift devices, such as flaps, would increase the power output of the windmill. It is shown experimentally that the ideal power output of a flap-augmented shrouded turbine can be more than 4 times the power of unshrouded turbines of the same diameter.

Seginer, A.

1976-01-01

226

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

Microsoft Academic Search

The impact of Gurney flaps (GF), of different heights and perforations, on the aerodynamic and wake characteristics of a NACA\\u000a 0015 airfoil equipped with a trailing-edge flap (TEF) was investigated experimentally at Re = 2.54 × 105. The addition of the Gurney flap to the TEF produced a further increase in the downward turning of the mean flow (increased\\u000a aft camber), leading to a

T. Lee; Y. Y. Su

2011-01-01

227

The effects of tretinoin on random skin flap survival in the swine model.  

PubMed

Tretinoin is currently marketed for topical treatment of acne vulgaris and has also been used in the rejuvenation of aging skin. After topical application, it has been shown to stimulate mitotic activity and increase vascularity in skin. In this study a porcine model was used to test the hypothesis that presurgical treatment with topical tretinoin would increase the surviving area of random full-thickness skin flaps. Four hybrid barrows, 40 to 60 lb, were treated with tretinoin and 4 similar animals were treated with placebo (carrier vehicle) for 2 weeks before raising four dorsally based full-thickness skin flaps (4 x 12 cm) on each animal. Biopsies were taken from tretinoin-treated, placebo-treated, and untreated skin at the time the flaps were initially raised and 1 week later before killing the animals. All tissue was processed for light and electron microscopy. One week after surgery, the pigs were killed. Photographs were taken at the termination of the experiment and the negatives were digitized and analyzed using a high-speed graphics workstation supported by SGITrace software. The percentage of skin flap survival was determined using this method of image analysis. Using repeated-measures analysis of variance, there was no significant difference in the mean flap survival between the tretinoin (mean = 46.75; SEM = 7.05) and placebo (mean = 65.80; SEM = 7.05) treated groups at the 0.05 significance level. Pretreatment with tretinoin did not enhance skin flap survival under the conditions of this study. Rationale for this finding and possible modifications of future studies are discussed. PMID:8192369

Canady, J W; Thompson, S A

1994-02-01

228

Heart Surgery  

MedlinePLUS

... heart with a healthy heart from a donor Traditional heart surgery, often called open-heart surgery, is ... off-pump, or beating heart, surgery. It's like traditional open-heart surgery because the chest bone is ...

229

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 ...

230

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 ...

231

Dorsal metacarpal island flap in syndactyly treatment.  

PubMed

Web space reconstruction is an important component of syndactyly treatment. There are several methods for a skin graft-free reconstruction. Previously, the dorsal metacarpal island flap based on a direct cutaneous branch of the dorsal metacarpal artery has been used as an island V-Y advancement for web defects in syndactyly. In this study, dorsal metacarpal artery flap was raised similarly as an island but was used instead as a transposition flap in a series of 19 web defects. Early results of a median (range) follow-up of 3 (1-5) years reveal neither recurrence of the deformity nor web creeping. Such utilization of the flap enables a better use of the skin territory proximal to the pedicle and a more comfortable reconstruction of the web space. PMID:14676698

Aydin, Atakan; Ozden, Burcu Celet

2004-01-01

232

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

233

Behind the performance of flapping flyers  

E-print Network

Saving energy and enhancing performance are secular preoccupations shared by both nature and human beings. In animal locomotion, flapping flyers or swimmers rely on the flexibility of their wings or body to passively increase their efficiency using an appropriate cycle of storing and releasing elastic energy. Despite the convergence of many observations pointing out this feature, the underlying mechanisms explaining how the elastic nature of the wings is related to propulsive efficiency remain unclear. Here we use an experiment with a self-propelled simplified insect model allowing to show how wing compliance governs the performance of flapping flyers. Reducing the description of the flapping wing to a forced oscillator model, we pinpoint different nonlinear effects that can account for the observed behavior ---in particular a set of cubic nonlinearities coming from the clamped-free beam equation used to model the wing and a quadratic damping term representing the fluid drag associated to the fast flapping mo...

Ramananarivo, Sophie; Thiria, Benjamin

2010-01-01

234

Current trends in robotic surgery for otolaryngology  

PubMed Central

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

Byrd, J. Kenneth; Duvvuri, Umamaheswar

2013-01-01

235

Anaesthesia for reconstructive surgery  

Microsoft Academic Search

Skin or tissue defects that cannot be closed primarily with simple suturing may need skin grafts, tissue expanders or flaps to maintain skin integrity and prevent infection. Flaps may be local, pedicled or free and may involve skin, muscle, bone, bowel or a combination. Local and pedicled flaps keep their primary vascular supply while free flaps have their circulation detached

Jane Quinlan; Omer Lodi

2009-01-01

236

Recycling delayed perforator flap: deep inferior epigastric artery perforator-based propeller flap from a prior vertical rectus abdominis musculocutaneous flap.  

PubMed

This article reports a case of re-elevating a prior vertical rectus abdominis musculocutaneous flap as a deep inferior epigastric artery perforator-based propeller flap to cover a recurrent chest wall defect. This case demonstrates that a conventional musculocutaneous flap tissue with a preserved perforator can be recycled as a perforator flap. Furthermore, this technique can be a promising new surgical option for recurring abdominal and chest defects. PMID:21354884

Go, Ju Young; Lim, So Young; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung; Pyon, Jai Kyong

2011-09-01

237

Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps  

SciTech Connect

Myosseous-cutaneous flaps were used for mandibular reconstruction in 16 irradiated patients. Three of six sternomastoid-clavicle flaps failed (all in conjunction with a neck dissection), as did one of 10 pectoralis major-anterior-fifth rib flaps. One trapezius-scapular flap was used and it succeeded. We found the blood supply of the sternomastoid-clavicle flap too tenuous for use in conjunction with a neck dissection. The trapezius-scapular flap had too short an arc of rotation to be used for defects other than those in the horizontal ramus. In addition, this flap required a change of position and created an undesirable functional deformity. The pectoralis major-fifth rib flap, in contrast, could be used for a variety of defects, in conjunction with a neck dissection, and did not require a change of position during operation. We found it to be the most versatile and dependable of the flaps employed in this series.

Pearlman, N.W.; Albin, R.E.; O'Donnell, R.S.

1983-10-01

238

Ventral tongue myomucosal flap: a suitable choice for shaved lower vermilion border reconstruction.  

PubMed

Squamous cell carcinoma (SCC) or verrocous carcinoma (VC) occurs frequently on the border of the lower lip and surgical excision is the mainstay of treatment. The vermilion border area is difficult to reconstruct and is very complex both morphologically and anatomically. Various reconstructive approaches for defects of the vermilion border have been described. However, for esthetics, reconstruction of the vermilion border defect by tissue of normal texture and color is paramount.We used a ventral myomucosal tongue flap for reconstruction of the vermilion border after radical excision of squamous cell carcinomas of the lip in 15 patients with labial carcinoma. The tumor was resected with a safe margin (1 cm in SCC and 0.5 cm in VC) in an approximately rectangular shape. Free-border confirmation was done using frozen section. A longitudinal strip of the free border of the tongue nonkeratinized mucosal layer with submucosal muscular layers of the tongue including the terminal branch of the lingual artery was raised. This strip extended to the angles of the mouth to cover the defect. The mucosal or myomucosal flap of the ventral tongue is designed according to the shape and size of a vermilion defect. The vermilion and subcutaneous tissue are incised, and the specimen is sent for histopathological free-border confirmation by frozen section. The flap is sutured in 2 layers, joining the mucosal border of the tongue and the upper border of the skin. The tongue flap pedicle was cut off after 3 weeks, and the oral side of the vermilion was sutured. The donor site of the tongue was closed primarily. Application of moisturizing cream for at least 2 months after surgery would be continued. In all 15 cases, the reconstructed vermilion with a tongue flap was ideal and with almost no disturbance in the patients' speaking, swallowing or taste with satisfactory cosmetic results. The ventral tongue flap is a suitable choice for vermilion border reconstruction. This flap is useful because the procedure does not require complicated surgery, and preservation of the orbicularis oris muscle and mental artery and nerve is possible. PMID:23524802

Kheradmand, Ali A; Garajei, Ata

2013-03-01

239

Flap valved closure of ventricular septal defects with increased pulmonary vascular resistance.  

PubMed

Closure of ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality with pulmonary hypertensive (PH) episodes being a major postoperative problem. Flap valved closure of VSD is reported to decrease morbidity and mortality. We report our experience of closure of a VSDs in patients with severe PH, using a valved patch in an effort to reduce the risk of operation. Eighteen consecutive patients with a large VSD with severe PH (mean PVR>8 Wood units) underwent flap valved closure (as described by Novick et al.) of VSD during a one-year study period. The mean age at surgery was 8.3±3.9 years (range: 3-13 years). Mean PVRI was 13.02±4.05 Wood units. In-hospital 30-day mortality was 5.6% (1/18). Mechanical ventilation time averaged 11.6±8.1 hours. Postoperative pulmonary artery pressures were significantly reduced. Four patients had PH crisis postoperatively. Obvious opening and closing of the flap valve was detected by echocardiography in eight patients. There were no late deaths due to cardiac causes. Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a flap valve patch was used. PMID:20724425

Rao, Prasanna Simha Mohan; Raju, Varadaraju; Narayana, Madhusudana

2010-11-01

240

Pedicled lower lid-sharing flap for full-thickness reconstruction of the upper eyelid.  

PubMed

PurposeTo explore the clinical effect of the pedicled lower lid-sharing flap for full-thickness reconstruction of the upper eyelid.MethodsFrom 2009 to 2013, 13 upper eyelids with meibomian gland carcinoma (13 patients, age range 52-78 years) were excised, and immediately reconstructed with a pedicled lower lid-sharing flap used for full-thickness upper eyelid defects (up to two-thirds of the eyelid width). Traditionally, the flap is divided after 3 to 4 weeks, and the recipient site closed directly.ResultsDuring a 1-18-month follow-up period, no recurrence, lagophthalmos, hypertrophic scar, or bulky appearance was noted in any of the patients. Aesthetic results for the upper eyelid were obtained for all patients.ConclusionsWe conclude that the pedicled lower lid-sharing flap is a safe and reliable method for reconstruction of full-thickness upper eyelid defects. This procedure not only enables eyelid closure for eye protection, but also directly improves the aesthetic appearance of the face. After second-stage surgery, a stable eyelid margin and lashes with good blood supply and an acceptable cosmetic appearance with regard to symmetry of eyelid height, contour, tarsal show, and skin fold were achieved. PMID:25104746

Wang, Y C; Dai, H Y; Xing, X; Lv, C; Zhu, J; Xue, C Y

2014-11-01

241

Vascularized temporalis muscle flap for the treatment of otorrhea. Technical note.  

PubMed

The surgical treatment for cerebral spinal fluid (CSF) fistulas provides closure of the bone and dural defects and prevents the recurrence of brain herniation and CSF fistula. The two main approaches used are the transmastoid and middle fossa ones. The authors review the results of performing a modified middle fossa approach with a vascularized temporalis muscle flap to create a barrier between the repaired dural and bone defects. Fifteen consecutive cases of CSF fistulas treated at the authors' institution were retrospectively reviewed. All patients presented with otorrhea. Eleven patients had previously undergone ear surgery. A middle fossa approach was followed in all cases. The authors used a thin but watertight and vascularly preserved temporalis muscle flap that had been dissected from the medial side of the temporalis muscle and was laid intracranially on the floor of the middle fossa, between the repaired dura mater and petrous bone. The median follow-up period was 2.5 years. None of the patients experienced recurrence of otorrhea or meningitis. There was no complication related to the intracranial temporalis muscle flap (for example, seizures or increased intracranial pressure caused by muscle swelling). One patient developed hydrocephalus, which resolved after the placement of a ventriculoperitoneal shunt 2 months later. The thin, vascularized muscle flap created an excellent barrier against the recurrence of CSF fistulas and also avoided the risk of increased intracranial pressure caused by muscle swelling. This technique is particularly useful in refractory cases. PMID:12744378

Tender, Gabriel C; Kutz, Scott; Awasthi, Deepak; Rigby, Peter

2003-05-01

242

Serratus anterior venous tributary as a second outflow vein in latissimus dorsi free flaps.  

PubMed

The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (N = 1), the long saphenous vein (N = 2), a deep vein (N= 1), and to a deep vein via a vein graft (N = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm(2) (10 × 15 cm) to 260 cm(2) (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat. PMID:21796583

Goh, Terence; Tan, Bien-Keem; Ong, Yee-Siang; Chew, Winston

2011-10-01

243

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

PubMed

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

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

2014-03-01

244

Finger reconstruction with a free neurovascular wrap-around flap from the big toe.  

PubMed

From 1983 to 1998, 16 cases of finger reconstruction with a free neurovascular wrap-around flap from the big toe were treated. Fourteen cases were successful, and two cases failed. The authors reviewed these cases on the average of about 38 months after surgery. Pinch power was 51 percent of the unaffected normal hand, and two-point discrimination was 7.6 mm. The mean resorption of the grafted bone was 13 percent in width and 9 percent in length. There were no complications such as fracture of the grafted bone, nonunion, and pulp dislodgement. This procedure provided length, stability, and adequate sensibility for a functional pinch and grasp. Sensory return to the wrap-around flap on the thumb was often greater than for the same area on the opposite foot. The donor site of the wrap-around flap was acceptable, both aesthetically and functionally, and allowed the wearing of open-toed shoes by young women. Finger reconstruction with a wrap-around flap from the big toe yielded excellent cosmetic and functional results in cases involving amputation at the level of the metacarpophalangealjoints or distal to it. In addition, this procedure was an excellent choice for treatment in cases involving avulsion injuries of the fingers and reconstruction of soft-tissue defects after tumor excision. PMID:11499464

Hahn, S B; Park, H J; Kang, H J; Kang, E S

2001-07-01

245

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

PubMed Central

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

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

1997-01-01

246

Reusing of the Failing Free Flap "Nutrient Flap" as Salvage Procedure  

PubMed Central

Summary: A 26-year-old woman sustained a traffic accident injury to her left medial malleolus. A soft-tissue defect 15?×?7?cm with exposure of bone was found and underwent free anterolateral thigh flap to cover it. On the second postoperative day, venous congestion occurred and re-exploration was performed. Re-anastomosis of the vein was done after the thrombectomy; unfortunately, the flap did not recover. We found there was a good granulation bed under the failing flap and thinned the failing flap and used it as a full-thickness skin graft. The graft survived completely; 9 months later, the graft site was softer and of good texture. The patient can wear the same size shoes without a debulking procedure. The free flap provided nutrients to the raw surface and nurtured a good granulation bed while it survived for 50 hours; as a result, it was used as “the nutrient flap.” Reuse of the failing free flap as “the nutrient flap” is useful as an alternative backup procedure.

Takahashi, Koji; Hsieh, Ching-Hua

2014-01-01

247

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

E-print Network

for a flapping-wing robot. Measured values by the rate gyro sensor and the acceleration sensor mounted-pass filtered output of the acceleration sensor. And a flapping-wing robot is controlled using the estimated-wing robot and mounted de- vices. This robot has the 2D rate gyro sensor, the 3D acceleration sensor

Kimura, Hiroshi

248

Revascularized composite grafts with inserted implants for reconstructing the maxilla — improved flap design and flap prefabrication  

Microsoft Academic Search

We present a new technique including prefabrication of a revascularized composite scapular flap that will fit a maxillary defect exactly. The method is based on careful preoperative planning using three-dimensional reconstructions of data obtained from computed tomograms and stereolithographic models. A pedicled scapular flap with a split skin graft envelope that has endosteal implants already inserted is prepared and covered

H. Plenk; J HOLLE; E WURINGER; K KULENKAMPFF

1998-01-01

249

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

250

Combined use of an anterolateral thigh flap and rapid prototype modeling to reconstruct maxillary oncologic resections and midface defects.  

PubMed

The most complex area for reconstruction of the head and the neck is the maxilla and the midface because of the difficult anatomy of this region. This article aimed to describe our design for the reconstruction of the zygomaticomaxillary complex using an anterolateral thigh (ALT) flap combined with a rapid prototyping technology. Seven patients were involved in this study. All free ALT flaps survived, and the patients were satisfied with the results both esthetically and functionally 8 months after surgery. The free ALT flap with a titanium mesh made by rapid prototyping technology is a reliable option for the treatment of oncologic resections of the maxilla and other midface defects. This technique has a significantly shorter surgical time than conventional procedures, with good and predictable postoperative outcomes. PMID:25006885

Shengwei, Han; Zhiyong, Wang; Qingang, Hu; Wei, Han

2014-07-01

251

Vulvo-perineal reconstruction with a reverse sensitive rectus abdominis salvage flap in a multirecurrent anal carcinoma.  

PubMed

Reconstructive options after vulvectomy is preferably performed using fasciocutaneous flaps. If the defect is very large, the use of vertical rectus abdominis myocutaneous (VRAM) flap is recommended. We report a case of a patient affected by multirecurrent anal carcinoma, treated by chemotherapy, radiotherapy and surgery several times, until an extended abdominoperineal resection of Miles was performed. Since other surgical options were no more available, a primary reverse VRAM flap reconstruction was harvested, together with an end-to-end nerve anastomosis between the cutaneous ramus of the 8th intercostal nerve and the superior branch of the pudendal nerve to achieve sensibility. Encouraging results, without actual recurrence of the disease, were obtained. PMID:19631598

Di Benedetto, Giovanni; Siquini, Walter; Bertani, Aldo; Grassetti, Luca

2010-02-01

252

Propeller flaps in the closure of free fibula flap donor site skin defects.  

PubMed

The free fibula is a versatile and commonly used free flap in microvascular reconstruction. It allows for reconstruction of both bone and soft tissue defects. In head and neck reconstruction, the skin paddle harvested along with the flap allows for the reconstruction of skin or oral mucosal defects. After skin paddle harvest, the donor site can be closed primarily or with skin grafts. Grafting the donor area is the common method used. However, this could lead to delayed healing because of the poor graft over the area of peroneal tendons. Propeller flaps have been extensively reported for closure of leg skin defects. We report a series of 10 patients in whom we used a local propeller flap for the closure of the fibula flap skin donor site. The donor defects could be satisfactorily closed without the need of a skin graft in 9 patients. This method is simple, reliable, and suitable for closing small to medium defects. PMID:23364675

Sharma, Mohit; Balasubramanian, Deepak; Thankappan, Krishnakumar; Sampathirao, Chandrasekhararao Leelamohan; Mathew, Jimmy; Chavre, Sachin; Iyer, Subramania

2013-07-01

253

Reconstruction of syndactyly and polysyndactyly of the toes with a dorsal pentagonal island flap: a technique that allows primary skin closure without the use of skin grafting.  

PubMed

Syndactyly and polysyndactyly are common congenital conditions involving the foot, and surgery to reconstruct the toes may be indicated for cosmetic, psychological, and practical reasons. A dorsal flap is traditionally used for web space reconstruction, with skin grafts for the bases of the toes. Skin grafting has associated morbidity and can result in pigmentation mismatch. Single-stage direct closure with a specially designed flap has advantages including a reduction of morbidity from avoidance of skin grafting and shorter surgery. Four patients (6 feet) were included in the study. There were 2 cases of syndactyly and 2 cases of polysyndactyly. Bilateral involvement occurred in 2 patients. The average age was 18 months at time of first surgery. Direct closure was achieved with a dorsal pentagonal island flap with dorsal and plantar triangular flaps. The average duration of follow-up was 19.8 months. At final follow-up, all patients had acceptable web depth and pulp contour. The distance between the proximal interphalangeal joints of adjacent toes and the web slope of the reconstructed web space were acceptable. Complications included partial synechiae, cellulitis, and keloid formation. The dorsal pentagonal island flap is an acceptable technique in providing another means for single-stage reconstruction of the web space in syndactyly and polysyndactyly. Good functional and cosmetic outcomes can be expected. However, the potential complication of keloid formation can affect cosmesis and overall outcome, and must be understood by patients and parents. PMID:17331867

Lim, Yi-Jia; Teoh, Lam Chuan; Lee, Eng Hin

2007-01-01

254

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

255

A 3-dimensional model for teaching local flaps using porcine skin.  

PubMed

The European Working Time Directive and streamlined training has led to reduced training time. Surgery, as an experience-dependent craft specialty is affected more than other medical specialties. Trainees want to maximize all training opportunities in the clinical setting, and having predeveloped basic skills acquired on a simulated model can facilitate this.Here we describe the use of a novel model to design and raise local flaps in the face and scalp regions. The model consists of mannequin heads draped with porcine skin which is skewered with pins at strategic points to give a 3-dimensional model which closely resembles a cadaveric head.The advantages of this model are that it is life size and incorporates all the relevant anatomical features, which can be drawn on if required.This model was used on a recent course, Intermediate Skills in Plastic Surgery: Flaps Around the Face, at the Royal College of Surgeons England. The trainees found that practicing on the porcine skin gave them an opportunity to master the basics of flap design and implementation.In summary, this innovative 3-dimensional training model has received high levels of satisfaction and is currently as close as we can get to cadaveric dissection without the constraints and cost of using human tissue. PMID:23797025

Hassan, Zahid; Hogg, Fiona; Graham, Ken

2014-10-01

256

Long-term survival after chest-wall reconstruction with musculocutaneous flaps  

SciTech Connect

Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures.

Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. (Univ. of Texas M. D. Anderson Cancer Center, Houston (USA))

1990-10-01

257

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.

258

Analytical study of vortex flaps on highly swept delta wings  

NASA Technical Reports Server (NTRS)

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

Frink, N. T.

1982-01-01

259

The use of the fat-cutaneous neck flap in reconstruction of the face injured by burns.  

PubMed

The face is a part of the body that is frequently affected by burn injury. Post-burn scar sequelae in this area often result in invalidity and psychological upsets for the patients. The methods of plastic surgery widely employed have their drawbacks. In particular, it is very important for surgical reconstruction of the face to find plastic material with the same properties: texture, colour, thickness, and natural elasticity. For this purpose, at the Division of Plastic and Reconstructive Surgery, A.V. Vishnevsky Institute of Surgery, Russian Academy of Medical Science, we use the fat-cutaneous neck flap mobilized according to the anatomical distribution of the vessels. We describe some typical clinical situations and possible variants of plastic surgery using the neck flap, based on the experience of surgical treatment in 248 patients. It is our opinion that application of the neck flap is preferable to other reconstructive techniques in the lower part of the face in patients with preserved skin in the neck and anterior surface of the chest. PMID:21991016

Sarygin, P V; Moroz, V Y; Yudenich, A A; Popov, S V

2006-03-31

260

Sural flap for coverage of a soft-tissue defect of a leg with an occluded fibular artery: a case report.  

PubMed

Coverage of soft-tissue defects of the leg has improved with the discovery of new flaps. However, surgeons now have to deal with new lesions on top of previous reconstructive surgeries. We present a case of soft-tissue defect of the anterior lower third of the leg presenting 20 years after reconstructive surgery for an open fracture and its management. The anterior tibial and fibular arteries were occluded with a retrograde vascularisation of the fibular artery; this provided a perforator artery that we used as a pivot point for an atypical sural island flap with a good result at 6 months. This case challenges the classic contraindication of this flap in case of occluded arteries. PMID:24476703

Kermarrec, Gwénolé; Masquelet, Alain-Charles

2014-05-01

261

Comparison of Blepharoptosis Correction Using Müller-aponeurosis Composite Flap Advancement and Frontalis Muscle Transfer  

PubMed Central

Background: Treatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon’s skill and experience. Methods: Two hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months. Results: The preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques. Conclusions: In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.

Ramadhan, Anwar; Han, Dong Gil; Shim, Jeong Su; Lee, Yong Jig; Ha, Won Ho; Lee, Byung Kwon

2014-01-01

262

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

PubMed Central

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

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

2013-01-01

263

The use of propeller perforator flaps for diabetic limb salvage: a retrospective review of 25 cases  

PubMed Central

Background Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds. PMID:23050066

Georgescu, Alexandru V.; Matei, Ileana R.; Capota, Irina M.

2012-01-01

264

Perforator plus flaps: Optimizing results while preserving function and esthesis  

PubMed Central

Background: The tenuous blood supply of traditional flaps for wound cover combined with collateral damage by sacrifice of functional muscle, truncal vessels, or nerves has been the bane of reconstructive procedures. The concept of perforator plus flaps employs dual vascular supply to flaps. By safeguarding perforators along with supply from its base, robust flaps can be raised in diverse situations. This is achieved while limiting collateral damage and preserving nerves, vessels, and functioning muscle with better function and aesthesis. Materials and Methods: The perforator plus concept was applied in seven different clinical situations. Functional muscle and fasciocutaneous flaps were employed in five and adipofascial flaps in two cases, primarily involving lower extremity defects and back. Adipofascial perforator plus flaps were employed to provide cover for tibial fracture in one patients and chronic venous ulcer in another. Results: All flaps survived without any loss and provided long-term stable cover, both over soft tissue and bone. Functional preservation was achieved in all cases where muscle flaps were employed with no clinical evidence of loss of power. There was no sensory loss or significant oedema in or distal to the flap in both cases where neurovascular continuity was preserved during flap elevation. Fracture union and consolidation were satisfactory. One patient had minimal graft loss over fascia which required application of stored grafts with subsequent take. No patient required re-operation. Conclusions: Perforator plus concept is holistic and applicable to most flap types in varied situations. It permits the exercise of many locoregional flap options while limiting collateral functional damage. Aesthetic considerations are also addressed while raising adipofascial flaps because of no appreciable donor defects. With quick operating times and low failure risk, these flaps can be a better substitute to traditional flaps and at times even free tissue transfers. PMID:21217970

Mehrotra, Sandeep

2010-01-01

265

Anatomy and physiology of perforator flaps of the upper limb.  

PubMed

Perforator flaps are an excellent reconstructive option for a functional upper limb reconstruction. This article explores the physiology and general principles of perforator flaps and their indications for use in reconstruction of the upper extremity. Workhorse perforator flaps of the upper extremity, such as the radial artery perforator, ulnar artery perforator, lateral arm perforator, posterior interosseous artery, first dorsal metacarpal artery perforator and perforator-based propeller flaps, are discussed in greater detail. PMID:24731605

Appleton, Sarah E; Morris, Steven F

2014-05-01

266

[The modified Lamberty and Cormack's flap for neuropathies of the ulnar nerve at the elbow].  

PubMed

Surgical treatment of ulnar nerve syndrome at the elbow gives good results in the majority of cases but there are sometimes incomplete results or recurrences that can lead to iterative procedures. This iterative surgery is responsible for painful neurological sequelae often resistant to pharmacological treatments. In these selected resistant cases, we made the choice of a surgical treatment associating a neurolysis of the ulnar nerve and wrapping with a vascularized flap modified from Lamberty and Cormack. This retrospective study focused on six cases with an average follow-up of 30 months. The results showed an improvement in all patients, especially for the two criteria which best reflect the neuropathic pain: DN4 questionnaire and the visual analog scale of pain. Even if it is a short study, it commits us to continue to apply the principle of covering ulnar neuropathy at the elbow by a vascularized flap. PMID:24200947

Haloua, J-P; Claise, J-M; Guigal, V

2013-12-01

267

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

PubMed Central

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

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

2013-01-01

268

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

269

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

PubMed Central

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

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

2013-01-01

270

Plastic Surgery  

MedlinePLUS

... significant defects or problems. But what about having cosmetic surgery just to change your appearance? Is it a ... are right and wrong reasons to have surgery. Cosmetic surgery is unlikely to change your life. Most board- ...

271

Foot Surgery  

MedlinePLUS

... on crutches after the surgery or in a cast. Hammer Toe Surgery: Hammer toe surgery may involve ... other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone ...

272

Free arterialised venous forearm flaps for intraoral reconstruction  

Microsoft Academic Search

In 29 patients, the intraoral defect after excision of an oral squamous cell carcinoma was repaired with an arterialised venous forearm flap. In all cases, a flap of skin and fat with a superficial vein passing through it was raised from the flexor surface of the right forearm. After the flap had been sutured into the intraoral defect, the original

C. Klein; A. Kovacs; T. Stuckensen

1997-01-01

273

DORSAL ADIPOFASCIAL TURN-OVER FLAP FOR FINGERTIP AMPUTATIONS  

Microsoft Academic Search

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered

R. E ÜNLÜ; A. S MENGI; U KOÇER; Ö SENSÖZ

1999-01-01

274

Dorsal Adipofascial Turn-Ovesr Flap for Fingertip Amputations  

Microsoft Academic Search

We designed a dorsal adipofascial pedicled flap to cover amputations of the tip of the same digit. This flap includes all the adipofascial tissues from the dermis to the paratenon of the extensor tendons. After elevation of the skin, the adipofascial tissues are raised as a flap and turned over to resurface the exposed bone or joint and then covered

A. S. MENGI

1999-01-01

275

Onlay urethroplasty with parameatal foreskin flap for distal hypospadias.  

PubMed

A new technique of onlay flap urethroplasty is described. The cosmetic and functional results of this logical extension of our one-stage urethroplasty with parameatal foreskin-flap have been good. The onlay urethroplasty with parameatal foreskin flap was recommended for the repair of distal hypospadias without chordee. PMID:1855528

Koyanagi, T; Nonomura, K; Asano, Y; Gotoh, T; Togashi, M

1991-01-01

276

Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction  

Microsoft Academic Search

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

Frederick Wang; Samuel Buonocore; Deepak Narayan

2011-01-01

277

Introduction Flapping birds and insects are often likened to revolving  

E-print Network

32 Introduction Flapping birds and insects are often likened to revolving propeller blades of flapping wings using the conceptual abstraction of a pulsed actuator disk, albeit with appropriate-field features due to flapping wings (e.g. vortex gaits) and stroke-averaged parameters such as power, efficiency

Daniel, Tom

278

Introduction Like rotating propeller blades, flapping wings of an insect  

E-print Network

43 Introduction Like rotating propeller blades, flapping wings of an insect draw air from above flapping activity is an induced airflow along the body of the insect. This flow envelops the flying insect-appreciated. For example, we know very little about how entrainment of the upwind fluid due to flapping activity affects

Daniel, Tom

279

14 CFR 25.1511 - Flap extended speed.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 2010-01-01 false Flap extended speed. 25.1511 Section 25.1511 Aeronautics...Operating Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it...

2010-01-01

280

14 CFR 23.1511 - Flap extended speed.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 2010-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics...Limitations and Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it is—...

2010-01-01

281

14 CFR 25.1511 - Flap extended speed.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 2011-01-01 false Flap extended speed. 25.1511 Section 25.1511 Aeronautics...Operating Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it...

2011-01-01

282

14 CFR 23.1511 - Flap extended speed.  

Code of Federal Regulations, 2011 CFR

...2011-01-01 2011-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics...Limitations and Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it is—...

2011-01-01

283

Evaluation of cutaneous flap survival by IR thermography  

Microsoft Academic Search

There are plenty of recent studies showing the influence of different drugs on the survival of the cutaneous flap. The effects of a topically applied capsaicin, methylprednisolon, mitomycin and gastric pentadecapeptide BPC-157 in improving skin vitality and preventing distal flap necrosis were tested in a random-pattern dorsal skin flap model. Wistar rats were randomized into five groups, four experimental groups

Petar Drvis; Drazen Shejbal; Srecko Svaic; Ivanka Boras; Igor Sundov; Mirela Sus; Vladimir Bedekovic; Livije Kalogjera; Igor Petrovi; Predrag Sikiric

284

Regional Medical Center (The MED) Plastic Surgery Rotation  

E-print Network

to perform the following plastic surgery procedures including but not limited to: � Skin grafting and flap closure of soft tissue defects of the upper extremity � Specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites, and care of graft recipient sites

Cui, Yan

285

Veteran's Administration Medical Center General Plastic Surgery Rotation  

E-print Network

Biannually With assistance from faculty, refine skills to perform the following plastic surgery procedures Biannually #12;� Skin grafting and flap closure of soft tissue defects of the upper extremity � Specific grafting techniques including the operation of various types of dermatomes, management of graft donor sites

Cui, Yan

286

Complications with homologous fat grafts in breast augmentation surgery  

Microsoft Academic Search

The most common complications in breast augmentation surgery with homologous fat grafts obtained from fresh cadavers are presented, showing subsequent surgical procedures to reconstruct the breasts of such patients through use of silicone prostheses and muscle flaps from the latissimus dorsi.

Peter Pohl; Carlos Oscar Uebel

1985-01-01

287

Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap.  

PubMed

Reoperation for malignant disease of the cervicothoracic spine can lead to compromised wound healing secondary to poor tissue quality from previous operations, heavily irradiated beds, and concomitant steroid therapy. Other complicating factors include exposed dura and spinal implants. Introducing well-vascularized soft tissue to obliterate dead space is critical to reliable wound healing. The purpose of this study was to determine the efficacy of the trapezius turnover flap in the management of these complex wounds. This study is a retrospective review of all patients undergoing trapezius muscle turnover flaps for closure of complex cervicothoracic wounds after spinal operations for metastatic or primary tumors. Six patients (3 male/3 female) were operated over an 18-month period (mean patient age, 43 years). Primary pathologies included radiation-induced peripheral nerve sheath tumor (N = 2), chondrosarcoma (N = 1), nonsmall-cell lung cancer (N = 1), paraganglioma (N = 1), and spindle cell sarcoma (N = 1). Trapezius muscle turnover flaps were unilateral and based on the transverse cervical artery in every patient. Indication for flap closure included inability to perform primary layered closure (N = 3), open wound with infection (N = 2), and exposed hardware (N = 1). All patients had previous operations of the cervicothoracic spine (mean, 5.8 months; range 2-9 months) for malignant disease and prior radiation therapy. Exposed dura was present in all patients, and 2 patients had dural repairs with bovine pericardial patches. Spinal stabilization hardware was present in 4 patients. All patients underwent perioperative treatment with systemic corticosteroids. All flaps survived, and primary wound healing was achieved in each patient. The only wound complication was a malignant pleural effusion communicating with the back wound, which was controlled with a closed suction drain. All wounds remained healed during the follow-up period. Four patients died from progression of disease within 10 months of surgery. The trapezius turnover flap has been used successfully when local tissue conditions prevent primary closure, or in the setting of open, infected wounds with exposed dura and hardware. The ease of flap elevation and minimal donor site morbidity make it a useful, single-stage reconstructive option in these difficult wounds. PMID:11601574

Disa, J J; Smith, A W; Bilsky, M H

2001-10-01

288

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

289

Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection  

PubMed Central

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

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

2014-01-01

290

Biomechanical Analysis of the Pharyngeal Swallow in Postsurgical Patients With Anterior Tongue and Floor of Mouth Resection and Distal Flap Reconstruction  

Microsoft Academic Search

The purpose of this study was to examine changes in the biomechanics of pharyngeal swallow after surgery in eight patients (six men and two women) with anterior tongue and floor of mouth resections with distal flap reconstruction. Eight normal age-matched subjects were also studied. Swallowing performance was assessed following a standardized protocol with videofluoroscopy preoperatively and at 1 and 3

Barbara Roa Pauloski; Jeri A. Logemann; Joan Cheng Fox; Laura A. Colangelo

291

RADIATION NECROSIS OF THE CHEST WALL: FULL-THICKNESS RECONSTRUCTION WITH PEDICLE FLAP AND DICED HOMOLOGOUS CARTILAGE OVER THE PERICARDIUM COMPLICATED BY CARDIAC ARREST  

Microsoft Academic Search

Successful repair by plastic surgery of nonhealing ulceration of the ; chest wall, induced by radiotherapy for breast cancer, is described. ; Reconstruction of the chest wali defect by pedicle flap coverage was carried out. ; Radiation injury extended through the entire thickness of the chest wall and ; osteoradionecrosis of the ribs was present. Reconstruction with thoracoabdominal ; tube

Rees

1961-01-01

292

Preoperative color-doppler assessment of vascularisation of the rectus abdominis: anatomic basis of breast reconstruction with a transverse rectus abdominis myocutaneous flap A prospective study  

Microsoft Academic Search

The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and optimise patient selection. We performed a prospective study

B. Meunier; E. Watier; J. Leveque; G. Roche; Y. Rolland; J. P. Pailheret

1997-01-01

293

Preoperative color-doppler assessment of vascularisation of the rectus abdominis: anatomic basis of breast reconstruction with a transverse rectus abdominis myocutaneous flap — A prospective study  

Microsoft Academic Search

Summary The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and optimise patient selection. We performed a prospective

B Meunier; E Watier; J Leveque; G Roche; Y Rolland; JP Pailheret

1997-01-01

294

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

295

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

296

Maxillary reconstruction using chimeric flaps of the subscapular artery system without vein grafts and the novel usage of chimeric flaps.  

PubMed

The purpose of this study was to overcome the disadvantages associated with the shortness of the vascular pedicle of subscapular system combined flaps when performing the maxillary reconstruction procedure. Combined flaps of the subscapular artery system were used for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next, the circumflex scapular artery (CS) and vein were cut off from the combined flaps and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps. Then, maxillary reconstruction was performed using these flaps. We encountered two patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements in facial shape were obtained in both cases. In cases in which combined flaps of the subscapular artery system are used for maxillary reconstruction, the biggest problem is that the vascular pedicle does not reach the recipient vessel in the neck due to the shortness of the CS. Therefore, vein grafts are generally performed to extend the flaps to the maxilla. Our novel procedure has the great advantages of long vascular pedicles and high flexibility in setting the flaps without the use of vein grafts. PMID:24022603

Watanabe, Koichi; Takahashi, Nagahiro; Morihisa, Yoichiro; Ikejiri, Mitsuhiro; Koga, Noriyuki; Rikimaru, Hideaki; Kiyokawa, Kensuke

2013-11-01

297

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

298

Effects of verapamil, nifedipine, and daflon on the viability of reverse-flow island flaps in rats.  

PubMed

Reverse-flow flaps are preferable in reconstructive surgery due to their several advantages. However, they may have venous insufficiency and poor blood flow. In this study, effects of various pharmacological agents on the viability of reverse-flow flaps were investigated. Forty Sprague-Dawley rats were used. Superficial epigastric artery- and superficial epigastric vein-based reverse-flow island flaps were preferred. The rats were divided into 4 groups. Group 1 was considered as the control group. Group 2 was given verapamil 0.3 mg/kg per day, group 3 nifedipine 0.5 mg/kg per day, and group 4 Daflon 80 mg/kg per day for 7 days. On day 7, viable flap areas were measured, angiography was performed, serum nitric oxide levels were evaluated, and histopathological examination was done.The mean flap viability rate was 67.59% (±13.12259) in group 1, 77.38% (±4.12506) in group 2, 74.57% (±3.44780) in group 3, and 85.39% (±4.36125) in group 4 (P = 0.001). The mean nitric oxide level was 31.66 ?mol/dL (±2.42212) in group 1, 51.00 ?mol/dL (±2.96648) in group 2, 34.00 ?mol/dL (±2.96648) in group 3, and 47.66 ?mol/dL (±2.80476) in group 4 (P = 0.001). On angiography, there were vessel dilations and convolutions in group 2; capillaries became noticeable, and anastomotic vessels extended toward the more distal part of the flaps in group 4. Histological examinations showed severe inflammation in group 3 and minimal inflammation and venous vasodilatation in group 2.Verapamil and Daflon in therapeutic doses significantly increased the viability of reverse-flow island flaps. However, nifedipine did not make a significant contribution to the flap viability. The results of this study will contribute to the literature about the hemodynamics of reverse-flow island flaps and guide further studies on the issue. PMID:23407246

Kilinc, Hidir; Aslan, Suleyman Serkan; Bilen, Bilge Turk; Eren, Ahmet Tuna; Karadag, Nese; Karabulut, Aysun Bay

2013-11-01

299

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

300

The split radial forearm flap for lower leg defects.  

PubMed

The conventional free radial forearm flap is a very reliable, long-pedicled flap with thin, pliable skin. These properties make it an excellent choice for high-risk reconstructions or defects requiring only a thin cover. The split radial forearm flap allows primary closure of the donor site and has a large variability in shape and size. In this report, the cutaneous perforators of the radial artery were investigated in fresh cadavers and we present our clinical experience with the split radial artery flap in 9 patients with lower leg defects.Sufficient perforators exist to safely divide the flap proximally and distally into segments. In all clinical cases, the donor site could be closed primarily. All flaps remained viable and 8 of 9 patients obtained an esthetically pleasing result. The split radial forearm free flap is an elegant option for reconstruction of small- to moderate-sized soft tissue defects in the lower extremity. PMID:23657049

van Kampen, Robert J; Corten, Eveline M L; Schellekens, Pascal P A

2014-11-01

301

Unsteady airfoil with a harmonically deflected trailing-edge flap  

NASA Astrophysics Data System (ADS)

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

Lee, T.; Su, Y. Y.

2011-11-01

302

Experimental investigation of a flapping wing model  

Microsoft Academic Search

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

Tatjana Y. Hubel; Cameron Tropea

2010-01-01

303

The dorsal metatarsal artery perforator flap.  

PubMed

Few options exist for the resurfacing of web-space and small soft tissue defects of the dorsum of the distal foot. The study examines the anatomy of the second to fourth dorsal metatarsal arteries in 16 fresh frozen cadavers to determine if the anatomy correlates to that in the hand, permitting the design of local flaps based on perforators of these vessels. A clinical case is also presented, illustrating the efficacy of such a perforator-based flap.Sixteen Asian cadaveric lower limbs were used for this study. The specimens were prepared with latex dye injection. Dissection under loupe magnification was carried out to determine the position and caliber of the cutaneous perforators from the dorsal metatarsal arteries, and the spread of the latex dye in the skin from these cutaneous perforators. One clinical case illustration of this perforator-based flap for distal foot defect resurfacing is presented.In our cadaveric study, each second to fourth dorsal metatarsal artery had between 2 and 5 cutaneous perforators with calibers of 0.5 to 0.7 mm in diameter. The most distal cutaneous perforator was present consistently, always arising between the heads of the respective metatarsals.In conclusion, the vascular anatomy of the second to fourth dorsal metatarsal arteries is similar to that in the hand, thus allowing for the design of reliable perforator-based flaps for distal foot resurfacing. PMID:23722578

Yeo, Chong Jin; Sebastin, Sandeep J; Ho, Samuel Y M; Tay, Shian Chao; Puhaindran, Mark E; Lim, Aymeric Y T

2014-10-01

304

Propulsion of a flapping and oscillating airfoil  

NASA Technical Reports Server (NTRS)

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

Garrick, I E

1937-01-01

305

The "open book" flap: a heterodigital cross-finger skin flap and adipofascial flap for coverage of a circumferential soft tissue defect of a digit.  

PubMed

A case of circumferential digital skin loss with exposed tendons from the proximal phalanx to the distal interphalangeal joint is presented. This was treated with a two-layer heterodigital cross-finger ("open book") flap from the adjacent digit, utilising a skin-only cross-finger flap to cover the palmar defect and an adipofascial flap to cover the dorsal defect. PMID:19129359

Tadiparthi, S; Akali, A; Felberg, L

2009-02-01

306

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

307

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

308

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.

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

2014-01-01

309

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

310

Microscopic evaluation of femtosecond laser intrastromal surgery  

NASA Astrophysics Data System (ADS)

Diode pumped Nd:glass all-solid-state femtosecond laser is promising for next generation refractive surgery, with the advantages of excellent surgical precision, minimal tissue damage and improved system stability and compactness. The microscopic evaluation of the outcome of femtosecond laser surgery is crucial before clinical applications. By two-photon laser scanning microscopy and non-invasive second harmonic imaging, the three dimensional ultrastructure of the porcine cornea is visualized without requiring slicing or staining. The minimal-invasive corneal flap cutting and non-invasive intrastromal surgery are investigated. Femtosecond laser intrastromal surgery demonstrated high ablation precision and mimimal side effects. However, there are elongated filaments/streaks observed in the cornea stroma, most likely due to the focusing optics and self-focusing.

Han, Meng; Zickler, Leander; Walter, Matthias; Giese, Guenter; Loesel, Frieder; Bille, Josef F.

2003-10-01

311

FaceLift Incision Combined With Sternomastoid Muscular Flap in Parotidectomy  

Microsoft Academic Search

Background  To improve the aesthetic outcome of a traditional parotidectomy, this study used a face-lift incision combined with a sternomastoid\\u000a muscular (SCM) flap and compared the classical method with these techniques from the patient’s perspective.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Between 2005 and 2007, 38 patients with benign parotid disease underwent surgery. The patients were retrospectively assigned\\u000a to two groups according to the surgical technique used.

Keqian ZhiWenhao; Wenhao Ren; Ling Gao; Lu Zhao; Shuo Huang; Jingwei Li; Fang Guo

312

One-stage reconstruction of a tracheal defect with a free radial forearm flap and free costal cartilage grafts.  

PubMed

Reconstructing the trachea is challenging because of its multilayer structure and airway function; multiple procedures are often required. We report a case of one-stage reconstruction for a tracheal defect. The surgery was performed with a free radial forearm flap and free costal cartilage grafts. Air leakage occurred postoperatively but healed without additional surgery. The reconstructed trachea has retained its shape, diameter and airway function for 14 months despite the patient's history of radiotherapy. This one-stage procedure with well-vascularised tissue was successfully used to reconstruct a stable, well-functioning trachea. PMID:24476705

Fukunaga, Yutaka; Sakuraba, Minoru; Miyamoto, Shimpei; Kayano, Shuji; Kurosawa, Koreyuki; Fujiki, Masahide; Sakisaka, Masanobu; Yoshimoto, Seiichi

2014-06-01

313

Reconstruction following radical maxillectomy with flaps supplied by the subscapular artery  

Microsoft Academic Search

The authors present their experience of 27 cases with repairs of defects following radical maxillectomies with free flaps. A total of 28 flaps were used (five latissimus dorsi, six scapula, 16 combination flaps of scapula and latissimus dorsi and one combination of scapula, latissimus dorsi and serratus anterior flap). Only one scapula flap was completely lost and in three cases

Vedran Ugleši?; Mišo Virag; Siniša Varga; Predrag Kneževi?; Aleksandar Milenovi?

2000-01-01

314

Chest wall reconstruction with perforator flaps after wide full-thickness resection  

Microsoft Academic Search

ioneering work by Koshima and colleagues1 and Kroll and Rosenfield2 in the late 1980s introduced perforator flaps, a new type of surgical flap based on musculocu- taneous perforator arteries with exclusion of the passive muscle carrier. Perforator flaps combine the reliable blood supply of musculocutaneous flaps with the reduced donor site morbidity of a skin flap. We report the successful

Hideki Itano; Akio Andou; Isao Koshima; Nobuyoshi Shimizu

315

RISK OF SEVERE AND REFRACTORY POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING DIEP FLAP BREAST RECONSTRUCTION  

PubMed Central

Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients. PMID:24038427

MANAHAN, MICHELE A.; BASDAG, BASAK; KALMAR, CHRISTOPHER L.; SHRIDHARANI, SACHIN M.; MAGARAKIS, MICHAEL; JACOBS, LISA K.; THOMSEN, ROBERT W.; ROSSON, GEDGE D.

2014-01-01

316

Assessment of mucocele formation after endoscopic nasoseptal flap reconstruction of skull base defects.  

PubMed

Advances in endoscopic skull base (SB) surgery have led to the resection of increasingly larger cranial base lesions, resulting in large SB defects. These defects have initially led to increased postoperative cerebrospinal fluid (CSF) leaks. The development of the vascularized pedicled nasoseptal flap (PNSF) has successfully reduced postoperative CSF leaks. Mucocele formation, however, has been reported as a complication of this technique. In this study, we analyze the incidence of mucocele formation after repair of SB defects using a PNSF. A retrospective review was performed from December 2008 to December 2011 to identify patients who underwent PNSF reconstruction for large ventral SB defects. Demographic data, defect site, incidence of postoperative CSF leaks, and rate of mucocele formation were collected. Seventy patients undergoing PNSF repair of SB defects were identified. No postoperative mucocele formation was noted at an average radiological follow-up of 11.7 months (range, 3-36.9 months) and clinical follow-up of 13.8 months (range, 3-38.9 months), making the overall mucocele rate 0%. The postoperative CSF leak rate was 2.9%. Proper closure of SB defects is crucial to prevent CSF leaks. The PNSF is an efficient technique for these repairs. Although this flap may carry an inherent risk of mucocele formation when placed over mucosalized bone during repair, we found that meticulous and strategic removal of mucosa from the site of flap placement resulted in a 0% incidence of postoperative mucocele formation in our cohort. PMID:23772323

Husain, Qasim; Sanghvi, Saurin; Kovalerchik, Olga; Shukla, Pratik A; Choudhry, Osamah J; Liu, James K; Eloy, Jean Anderson

2013-01-01

317

Intraoperative Prediction of Post-Operative Flap Outcome using the Near-Infrared Fluorophore Methylene Blue  

PubMed Central

Methylene blue (MB) is a near-infrared (NIR) fluorophore that provides a stable visual map of skin perfusion after intravenous injection. We explored the capability of MB to predict submental flap postoperative outcome using a single intraoperative measurement. Submental flaps were created in N = 15 pigs and imaged using the FLARE ™ imaging system immediately after surgery and at 72 h. Using the first 3 pigs, optimal MB dosing was found to be 2.0 mg/kg. Training and validation sets of 6 pigs each were then used for receiver operating characteristic (ROC) analysis. In the training set, a contrast-to-background ratio (CBR) threshold of 1.24 provided the highest sensitivity and specificity to predict tissue necrosis at 72 h. In the validation set, this threshold provided a prediction sensitivity of 95.3% and a specificity of 98.0%. We demonstrate that a single intraoperative NIR measurement can predict submental flap outcome at 72 h. PMID:22395044

Ashitate, Yoshitomo; Lee, Bernard T.; Laurence, Rita G.; Lunsford, Elaine; Hutteman, Merlijn; Oketokoun, Rafiou; Choi, Hak Soo; Frangioni, John V.

2011-01-01

318

Multiple Marginal Tissue Recession Treated with a Simplified Lateral Sliding Flap Technique  

PubMed Central

Marginal tissue recession is a common esthetic problem that is usually accompanied by dentin sensitivity, and patients frequently report a fear of dental loss. Lateral sliding flaps have been used for localized recession, but they are rarely used for multiple recessions. The aim of this paper was to report a case of coverage of multiple marginal tissue recessions by means of a lateral sliding flap associated with a connective tissue graft. This was a modification of Nelson's technique, which was originally described as the combination of the double papilla technique, lateral sliding flap, and connective tissue graft. In the present case, double papilla was not performed, rendering the maneuver less complicated. After surgery on teeth #23 to #25, total root coverage, decreased dentin sensitivity, and increased keratinized tissue band and gingival thickness were achieved. In the present case, modified Nelson technique proved to be a more simple procedure for the treatment of multiple recessions in one session, resulting in adequate healing, predictable root coverage, and, more importantly, esthetic and functional success.

Ribeiro, Fernando Salimon; de Morais-Camillo, Juliana Aparecida Najarro Dearo; Fernandes, Jose Marcos Alves; Pires, Juliana Rico; Zuza, Elizangela Partata; Pontes, Ana Emilia Farias

2014-01-01

319

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

320

Assessment of mucocele formation after endoscopic nasoseptal flap reconstruction of skull base defects  

PubMed Central

Advances in endoscopic skull base (SB) surgery have led to the resection of increasingly larger cranial base lesions, resulting in large SB defects. These defects have initially led to increased postoperative cerebrospinal fluid (CSF) leaks. The development of the vascularized pedicled nasoseptal flap (PNSF) has successfully reduced postoperative CSF leaks. Mucocele formation, however, has been reported as a complication of this technique. In this study, we analyze the incidence of mucocele formation after repair of SB defects using a PNSF. A retrospective review was performed from December 2008 to December 2011 to identify patients who underwent PNSF reconstruction for large ventral SB defects. Demographic data, defect site, incidence of postoperative CSF leaks, and rate of mucocele formation were collected. Seventy patients undergoing PNSF repair of SB defects were identified. No postoperative mucocele formation was noted at an average radiological follow-up of 11.7 months (range, 3–36.9 months) and clinical follow-up of 13.8 months (range, 3–38.9 months), making the overall mucocele rate 0%. The postoperative CSF leak rate was 2.9%. Proper closure of SB defects is crucial to prevent CSF leaks. The PNSF is an efficient technique for these repairs. Although this flap may carry an inherent risk of mucocele formation when placed over mucosalized bone during repair, we found that meticulous and strategic removal of mucosa from the site of flap placement resulted in a 0% incidence of postoperative mucocele formation in our cohort. PMID:23772323

Husain, Qasim; Sanghvi, Saurin; Kovalerchik, Olga; Shukla, Pratik A.; Choudhry, Osamah J.; Liu, James K.

2013-01-01

321

Reconstruction of pressure sores with perforator-based propeller flaps.  

PubMed

Perforator flaps have been successfully used for reconstruction of pressure sores. Although V-Y advancement flaps approximate debrided wound edges, perforator-based propeller flaps allow rotation of healthy tissue into the defect. Perforator-based propeller flaps were planned in 13 patients. Seven pressure sores were over the sacrum, five over the ischial tuberosity, and one on the tip of the scapula. Three patients were paraplegic, six were bedridden, and five were ambulatory. In three patients, no perforators were found. In 10 patients, propeller flaps were transferred. In two patients, total flap necrosis occurred, which was reconstructed with local advancement flaps. In two cases, a wound dehiscence occurred and had to be revised. One hematoma required evacuation. No further complications were noted. No recurrence at the flap site occurred. Local perforator flaps allow closure of pressure sores without harvesting muscle. The propeller version has the added benefit of transferring tissue from a distant site, avoiding reapproximation of original wound edges. Twisting of the pedicle may cause torsion and venous obstruction. This can be avoided by dissecting a pedicle of at least 3 cm. Propeller flaps are a safe option for soft tissue reconstruction of pressure sores. PMID:21184385

Jakubietz, Rafael G; Jakubietz, Danni F; Zahn, Robert; Schmidt, Karsten; Meffert, Rainer H; Jakubietz, Michael G

2011-03-01

322

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

PubMed

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

Boffeli, Troy J; Reinking, Ryan

2014-01-01

323

The ultra-thin, fascia-only anterolateral thigh flap.  

PubMed

Background?While many potential donor sites have been described for fascial (fascia-only) flaps, a fascial flap harvested from the anterolateral thigh (ALT) donor site has not gained popularity, likely because of concerns regarding inadequate perfusion of the deep fascia. However, recent clinical experience demonstrates that the ALT fascia-only flap is a suitable option for reconstructions necessitating thin and pliable coverage. Methods?In this study a retrospective chart review was performed examining the clinical experience of two plastic surgeons with the fascia-only ALT perforator flap from 2008 to 2012. Each flap was initially raised as a standard ALT flap, but all the overlying skin and adipose tissue was excised off the deep fascia before the inset, resulting in the creation of a fascia-only ALT flap. Immediate split- or full-thickness skin grafts were used to cover the flap. The results are reported in this article. Results?Overall seven patients underwent reconstruction of wounds using either free (six) or pedicled (one) fascia-only ALT flaps (length, 10-20 cm, width, 5-10 cm). The following regions were successfully reconstructed using a fascia-only ALT flap: occipital scalp, lower extremity, upper extremity, and groin. All patients were followed for at least 6 months postoperatively. Conclusions?The fascia-only ALT flap was successfully used to reconstruct a variety of defects in seven patients. The authors experience demonstrates the viability of the fascia-only version of the ALT flap for reconstructions requiring thin coverage with good contour, and further adds to the versatility of the ALT as a donor site for flaps. PMID:24554570

Bhadkamkar, Mohin A; Wolfswinkel, Erik M; Hatef, Daniel A; Albright, Steven B; Echo, Anthony; Hsu, Patrick W; Izaddoost, Shayan A

2014-11-01

324

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

325

Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency  

PubMed Central

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

Hirschberg, Jeno

2012-01-01

326

The effectiveness of the air-powder abrasive device for root planing during periodontal surgery.  

PubMed

The efficacy of the air-powder abrasive device (APAD) in root planing during flap surgery was assessed in vitro and in vivo. Two teeth on which full-thickness flaps were raised underwent root planing by hand-scaling alone and hand-scaling combined with APAD. One tooth extracted prior to surgery underwent unrestricted hand-scaling under a binocular microscope (control). The two teeth root planed in situ and the tooth root planed in vitro were observed by scanning electron microscopy (SEM). Then, 10 patients with periodontitis requiring flap surgery were selected for a clinical study. After raising full-thickness flaps, 29 sites from five patients underwent root planing using hand-scaling combined with APAD, whereas 22 sites from six patients underwent root planing by hand scalers only. SEM revealed that root surfaces planed in situ by hand-scaling combined with APAD were smoother than those root-planed using hand scalers alone. The control tooth surface was as smooth as those submitted to combined root planing. The clinical study showed that sites submitted to combined root planing displayed enhanced attachment level gain and pocket reduction. These results, associated with the shortened instrumentation time, suggest APAD as a useful instrument for root planing during flap surgery. PMID:1327330

Satoh, E; Wu, C H; Suzuki, T; Hara, K; Amizuka, N; Ozawa, H

1992-01-01

327

Effects of 8-Gy radiation on the microcirculation of muscle flaps in the rat.  

PubMed

Combination of radical excision and radiation has been used as a treatment modality for cancer patients. As a result, in reconstructive surgery there is often a need to harvest flaps in the vicinity of previously irradiated tissues. Radiation has been shown to cause progressive injury to the macrocirculation and microcirculation, often jeopardizing flap survival. The purpose of this study was to examine whether radiation significantly affects the sequence of leukocyte-endothelial interactions or the hemodynamics of the muscle flap in both acute and chronic situations. Male Sprague-Dawley rats (n = 42) were divided into seven groups of six rats each. Rats in group I were not irradiated. Groups II through VII received 8-Gy radiation to the right groin and scrotum. Groups II, III, and IV were examined at 4, 24 and 72 hours, respectively, and groups V, VI, and VII were examined at 1, 2 and 12 weeks. For intravital microscopy, the cremaster muscle was dissected on its neurovascular pedicle. Vessel diameters and red blood cell velocities were measured in the central cremasteric branches and branch arterioles. Capillary perfusion was evaluated in 27 visual fields of each flap. Leukocyte-endothelial interactions were evaluated by numbers of rolling, adhering, and transmigrating leukocytes in post-capillary venules. In the same postcapillary venule, we measured the endothelial edema index (constriction index). The hemodynamics of irradiated flaps did not differ significantly from those of controls. Diameter and red blood cell velocity were increased in the first- and second-order arterioles and were highest at 72 hours and 1 week. After irradiation, third-order arterioles were constricted. Radiation reduced capillary perfusion by 4.3, percent. None of the differences were statistically significant. Neither leukocyte behavior nor the constriction indices differed among the groups. In conclusion, low-dose radiation of 8 Gy does not affect hemodynamics or leukocyte-endothelial interactions of muscle flaps in the rat. Muscle tissue with intact microvasculature can be harvested for reconstructive procedures after low-dose radiation. PMID:10513920

Siemionow, M; Mee, J; Porvasnik, S; Krapohl, B D; Ozer, K; Piza, P; Zins, J E

1999-10-01

328

Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap.  

PubMed

Several microvascular free flaps are available for reconstruction of the osseous components after resections for head and neck cancer. We have prospectively evaluated patients treated by bony microsurgical reconstruction to identify predictors of adverse outcomes for delayed wound healing and failure of free flaps. All patients from July 2007 to June 2011 who had reconstructions with microvascular fibular or iliac crest flaps immediately after resection of the tumour were evaluated. There were a total of 156 bony free flaps: 120 (77%) fibular and 36 (23%) iliac crest flaps. A total of 133 (85%) were successful. Delayed wound healing was more common with the iliac crest flap (p=0.01) at the intraoral site (p=0.04). Significantly more iliac crest free flaps failed (p=0.02). Anastomosis to the facial artery (p=0.05) and facial vein (p=0.04), and duration of overall operating time were associated with a significantly higher risk of failure of the flap. Patients with cancer of the head and neck who require microsurgical bony reconstruction are at increased risk of postoperative complications. Significantly more complications were found with the iliac crest flap, whereas the fibular flap was associated with a significantly longer operating time. PMID:23399107

Mücke, Thomas; Loeffelbein, Denys J; Kolk, Andreas; Wagenpfeil, Stefan; Kanatas, Anastasios; Wolff, Klaus-Dietrich; Mitchell, David A; Kesting, Marco R

2013-09-01

329

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

PubMed Central

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

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

2014-01-01

330

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

331

Hyperbaric oxygen preconditioning promotes neovascularization of transplanted skin flaps in rats  

PubMed Central

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

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

2014-01-01

332

Cataract Surgery  

MedlinePLUS Videos and Cool Tools

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

333

Repositioning template for mandibular reconstruction with fibular free flaps: an alternative technique to pre-plating and virtual surgical planning.  

PubMed

Oral malignancies involving the mandibular bone require a complex reconstructive plan. Mandibular reconstruction with a fibular free flap is currently considered the best choice for functional and aesthetic rehabilitation after oncological surgery. This flap can be modelled with multiple osteotomies and can provide bone, muscle and skin for composite reconstruction. One of the most delicate aspects of mandibular reconstruction is the technique of bone modelling; the risk of prolonging the period of ischaemia and not restoring the correct maxillomandibular and occlusal relationships can ultimately lead to a higher rate of complications as well as poor aesthetic and functional results. Recently, there has been rising interest in virtual surgical planning and computer-assisted mandibular reconstruction in pre-operative planning; however, this is not always possible because of the costs involved and the set-up time for the entire procedure. In this paper, we present a simple and inexpensive technique for fibular free flap modelling and repositioning after segmental resection of the mandible; the technique entails the pre-operative preparation of a resin repositioning template on a stereolithographic model. This technique has been successfully applied in four cases: two cases underwent resection involving only the mandibular body, one case involving the mandibular body and symphysis and one case in which a ramus to ramus resection was performed. In this preliminary report, we show that the resin repositioning template is an easy, safe and useful tool for mandibular reconstruction with a fibular free flap. PMID:25210223

Berrone, M; Crosetti, E; Succo, G

2014-08-01

334

Reconstruction of trunk defects with bilobed myocutaneous flap.  

PubMed

This study describes the use of the bilobed myocutaneous (MC) flap for reconstruction of trunk defect. The authors employ this flap because it offers a greater flexibility in the use of available tissue than many other local conventional flaps, is easy to design, safe to elevate, and causes minimal donor-site morbidity. The bilobed MC flaps are based on their main muscular pedicle. The standard bilobed flaps are generally based on a random pattern blood supply, which were restricted to rigid length-to-width ratios to ensure viability. They are usually indicated in the repair of small defects of the nose, and scalp. When we want to apply to reconstruct on the larger trunk defect, especially for the potential to cause life-threatening complications, the bilobed M-C flap might be considered for reconstruction to decrease the potential risk of the complications. PMID:15925346

Cheng, Li-Fu; Lee, Jiunn-Tat; Sun, Tzong-Bor; Wang, Chien-Hsing; Chien, Sou-Hsin; Chang, Bee-Song

2005-07-01

335

Effect of configuration variation on externally blown flap noise  

NASA Technical Reports Server (NTRS)

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

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

1974-01-01

336

Perforator-based chimaeric thoracodorsal flap for foot reconstruction.  

PubMed

The reconstruction of severe defects of the ankle and foot is a challenge. The ideal solution should combine a thin skin flap on the dorsum to allow shoe fitting and a muscle flap with a split-thickness skin graft on the weight-bearing area. Perforator-based thoracodorsal chimaeric flaps allow us to achieve these two goals with minimal donor-site morbidity. We present a reconstruction of an extended circumferential defect of the ankle with an exposed heel using a chimaeric thoracodorsal perforator flap with a serratus muscle flap. The skin flap was transferred on the dorsal foot, whereas the serratus anterior muscle was transferred on the exposed heel. Postoperative recovery was uneventful and the patient began full weight bearing after 3 months. Twelve months after reconstruction, natural shape and walking function were successfully achieved. PMID:23800463

Rausky, Jonathan; Binder, Jean-Philippe; Mazouz-Dorval, Sarra; Hamou, Cynthia; Revol, Marc

2013-12-01

337

Bone propeller flap: a staged procedure.  

PubMed

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

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

2014-01-01

338

High fidelity numerical simulation of airfoil thickness and kinematics effects on flapping airfoil propulsion  

E-print Network

High fidelity numerical simulation of airfoil thickness and kinematics effects on flapping airfoil online 17 July 2013 Keywords: Flapping airfoil Airfoil thickness Kinematics High order Navier-digit airfoils. Airfoil thickness and kinematics effects on the flapping airfoil propulsion

Hu, Hui

339

Experimental investigation of a flapping wing model  

Microsoft Academic Search

The main objective of this research study was to investigate the aerodynamic forces of an avian flapping wing model system.\\u000a The model size and the flow conditions were chosen to approximate the flight of a goose. Direct force measurements, using\\u000a a three-component balance, and PIV flow field measurements parallel and perpendicular to the oncoming flow, were performed\\u000a in a wind

Tatjana Y. Hubel; Cameron Tropea

2009-01-01

340

Complex intimal flaps in acute aortic dissection  

Microsoft Academic Search

A 43-year-old man was emergently admitted and diagnosed as acute aortic dissection (Stanford type A). While being prepared\\u000a for emergent operation he fell into hemodynamic hazard with repeated ventricular fibrillation and loss of consciousness. Massive\\u000a aortic regurgitation and coronary disturbance due to a back-and-forth movement of an intimal flap through the aortic valve\\u000a were the causes of the cardiogenic catastrophy.

Shinji Akishima; Junichi Sakurai; Tomoaki Jikuya

2003-01-01

341

Behind the performance of flapping flyers  

Microsoft Academic Search

Saving energy and enhancing performance are secular preoccupations shared by\\u000aboth nature and human beings. In animal locomotion, flapping flyers or swimmers\\u000arely on the flexibility of their wings or body to passively increase their\\u000aefficiency using an appropriate cycle of storing and releasing elastic energy.\\u000aDespite the convergence of many observations pointing out this feature, the\\u000aunderlying mechanisms explaining

Sophie Ramananarivo; Ramiro Godoy-Diana; Benjamin Thiria

2010-01-01

342

Augmentation cheiloplasty by using mucomuscular flaps  

Microsoft Academic Search

If one excludes the controversial use of silicone injections and the not fully researched new biomaterials for implant (e.g., Gore-Tex), there are no lip augmentation techniques that give stable and lasting results. Collagen and dermal or fascial grafts are almost always reabsorbed. Local flaps (either W or V\\/Y) give only a slight outward protrusion of the lips and do not

Giovanni Botti; Renè Villedieu

1995-01-01

343

Microdialysis – a new technique for free flap surveillance: methodological description  

Microsoft Academic Search

Early detection of impaired circulation in free flaps is vital for their survival. In the present investigation metabolic\\u000a changes, known to occur in various tissues during ischemia, were studied using microdialysis. Five patients provided with\\u000a free flaps, were included in the study. Microdialysis catheters were placed in the flap and in normal control tissue. Laser\\u000a Doppler flowmetry was used postoperatively

J. Röjdmark; P. Hedén; U. Ungerstedt

1998-01-01

344

Monitoring microvascular free flaps with tissue oxygen measurement and pet  

Microsoft Academic Search

Tissue oxygen measurement and positron emission tomography (PET) were evaluated as methods for predicting ischemia in microvascular\\u000a free flaps of the head and neck. Ten patients with head and neck squamous cell cancer underwent resection of the tumour followed\\u000a by microvascular reconstruction with a free flap. Tissue oxygenation of the flap (PtiO2) was continuously monitored for three postoperative (POP) days

Aleksi R. Schrey; Ilpo A. J. Kinnunen; Reidar A. Grénman; Heikki R. I. Minn; Kalle M. J. Aitasalo

2008-01-01

345

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

346

Flapping oscillations of the bended current sheet  

NASA Astrophysics Data System (ADS)

Flapping oscillations observed in the current sheet of the Earth’s magnetotail, represent rather slow waves propagating from the center to the flanks with a typical speed 20-60 km/s, amplitude 1-2Re and quasiperiod 2-10 minutes. Besides observations, this type of oscillations was also investigated theoretically for the symmetrical configurations of the magnetotail current sheet. Here we propose some theoretical modeling of the flapping mode for the asymmetric current sheet. A lot of models were elaborated to describe the flapping oscillations, both kinetic and magnetohydrodynamical (MHD). The relevant model is MHD and based on the double gradient of magnetic field: gradient of tangential (B _{x}) component along the normal (z _{GSM}) direction and gradient of the normal component (B _{z}) along the x-direction. The dispersion curve obtained with this model for symmetric case agrees very well with the experimental one. We solve the MHD equations numerically for the asymmetric magnetic field configuration, which was obtained from generalization of the Kan’s current sheet model for the case of inclined Earth’s dipole. This generalization was constructed by the parameter varying (we suppose one of them to be imaginary). In current study we obtain the dispersion relations for different angles of dipole inclination (i.e. for the different levels of asymmetry) and investigate it’s difference from the symmetric case.

Kubyshkina, Daria; Erkaev, Nikolay; Korovinskiy, Daniil; Ivanov, Ivan; Semenov, Vladimir

347

Bilateral scrotal flap: pedicle and dimension of flap in cadaveric dissections.  

PubMed

Penile paraffinoma is not uncommon among Thai males. The definite treatment involves the complete removal of skin and subcutaneous tissue infiltrated by the foreign material and resurfacing in the penile shaft with skin graft or scrotal flap in severe cases. In the present study the authors undertook an anatomical investigation of external pudendal vessels and scrotal skin in 5 soft cadavers. The authors found that the anterior scrotal artery branching from the external pudendal artery at the point 2-2.7 cms. from midline at pubic symphysis level and running in the internal spermatic plane. Anterior scrotal artery supplied scrotal skin 62.5-100% (mean 75.9%) in anteroposterior dimension and 66-100% (mean 88%) in superoinferior dimension. The authors recommended that this flap must elevate deep to the internal spermatic plane, just close to tunica vaginalis and the dimension of flap should not be more than 62.5% in anteroposterior and 66% in superoinferior dimension. PMID:19845239

Angspatt, Apichai; Pungrasmi, Pornthep; Jindarak, Sirachai; Tunsatit, Thunwa

2009-10-01

348

Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap.  

PubMed

Major scrotal defects may result from infection due to Fournier's gangrene, excision of scrotal skin diseases, traumatic avulsion of scrotal and penile skin, and genital burns. The wide spectrum of bacterial flora of the perineum, difficulty in providing immobilisation, and obtaining a natural contour of the testes make testicular cover very difficult. Various methods have been reported to cover the penoscrotal area, including skin grafting, transposing them to medial thigh skin, and use of local fasciocutaneous or musculocutaneous flaps. In this report, reconstruction using six local medial circumflex femoral artery perforator (MCFAP) flaps was undertaken in five male patients (mean age, 47 years) with complex penoscrotal or perineal wounds. The cause of the wounds in four patients was Fournier's gangrene, and was a wide papillomateous lesion in the other patient. Flap width was 6-10 cm and flap length was 10-18 cm. The results showed that a MCFAP flap provided the testes with a pliable local flap without being bulky and also protected the testicle without increasing the temperature. The other advantage of the MCFAP flap was that the donor-site scar could be concealed in the gluteal crease. Our results demonstrated that the MCFAP flap is an ideal local flap for covering penoscrotal defects. PMID:21268105

Karsidag, Semra; Akcal, Arzu; Sirvan, Selami Serhat; Guney, Soner; Ugurlu, Kemal

2011-02-01

349

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

350

Reconstruction of Pretibial Defect Using Pedicled Perforator Flaps  

PubMed Central

Background Coverage of defects of the pretibial area remains a challenge for surgeons. The difficulty comes from the limited mobility and availability of the overlying skin and soft tissue. We applied variable pedicled perforator flaps to overcome the disadvantages of local flaps and free flaps on the pretibial area. Methods Eight patients who had the defects in the anterior tibial area were enrolled. Retrospective data were obtained on patient demographics, cause, defect location, defect size, flap dimension, originating artery, pedicle length, pedicle rotation, complication, and postoperative result. The raw surface created following the flap elevation was covered with a split thickness skin graft. Results Posterior tibial artery-based perforator flaps were used in five cases and peroneal artery-based perforator flaps in three cases. The mean age was 54.3 and the mean period of follow-up was 6 months. The average size of the flaps was 63.8 cm2, with a range of 18 to 135 cm2. There were no major complications. No patients had any newly developed functional deficit of the lower leg. Conclusions We suggest that pedicled perforator flaps can be an alternative treatment modality for covering pretibial defects as a simple, safe and versatile procedure. PMID:22872840

Shin, In Soo; Lee, Dong Won; Rah, Dong Kyun

2012-01-01

351

Microsurgical penile reconstruction with a sensitive radial forearm free flap.  

PubMed

A series of six consecutive cases of total penile reconstruction with a sensitive forearm free flap based on the radial artery is presented. A simple, reliable, and easily reproducible technique with an acceptable aesthetic appearance is described. No partial or complete flap losses were found. The only complication found in three patients was a urinary fistula on the distal third of the flap, which was repaired successfully with a secondary surgical procedure. The aesthetic and functional outcome was satisfactory to the patient and surgical team in all cases. A sensitive radial forearm free flap is a good choice of treatment for total penile reconstruction. PMID:10980518

García de Alba, A; de la Peña-Salcedo, J A; López-Monjardin, H; Clifton, J F; Palacio-López, E

2000-01-01

352

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

353

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

354

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

355

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

356

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

357

Comparative study of visual acuity and aberrations after intralase femtosecond LASIK: small corneal flap versus big corneal flap  

PubMed Central

AIM To study the effect of different flap sizes on visual acuity, refractive outcomes, and aberrations after femtosecond laser for laser in situ keratomileusis (LASIK). METHODS In each of the forty patients enrolled, 1 eye was randomly assigned to receive treatment with a 8.1mm diameter corneal flap, defined as the small flap, while the other eye was treated with a 8.6mm diameter corneal flap, defined as the big flap. Refractive errors, visual acuity, and higher-order aberrations were compared between the two groups at week 1, month 1 and 3 postoperatively. RESULTS The postoperative refractive errors and visual acuity all conformed to the intended goal. Postoperative higher-order aberrations were increased, especially in spherical aberration (Z12) and vertical coma (Z7). There were no statistically significant differences between the two groups in terms of postoperative refractive errors, visual acuity, root mean square of total HOAs (HO-RMS), trefoil 30° (Z6), vertical coma (Z7), horizontal coma (Z8), trefoil 0° (Z9), and spherical aberration (Z12) at any point during the postoperative follow-up. CONCLUSION Both the small and big flaps are safe and effective procedures to correct myopia, provided the exposure stroma meets the excimer laser ablations. The personalized size corneal flap is feasible, as we can design the size of corneal flap based on the principle that the corneal flap diameter should be equal to or greater than the sum of the maximum ablation diameter and apparatus error. PMID:24195040

Zhang, Ya-Li; Liu, Lei; Cui, Chang-Xia; Hu, Ming; Li, Zhao-Na; Cao, Li-Jun; Jing, Xiu-Hua; Mu, Guo-Ying

2013-01-01

358

A propeller flap for single-stage nose reconstruction in selected patients: supratrochlear artery axial propeller flap.  

PubMed

The paramedian forehead flap is the gold standard technique for nose reconstruction. It requires two different surgical operations which prolonged the postoperative dressing and care. We present our 5-year experience with a propeller flap based on the supratrochlear artery, which allows one-stage transfer of the forehead skin to the nose without the need for pedicle division. This technique is indicated in a selected group of patients who are not suitable for multiple-stage reconstructions because they have concurrent medical conditions, reduced mobility, or live far away from specialized medical centers. We have renamed this procedure as supratrochlear artery axial propeller flap, from the acronym STAAP flap, to stress the axial, well known and constant, vascularization of the flap. In the past 5 years, we have been performing 25 STAAP flaps; full-thickness nasal reconstruction was performed in 11 cases. The patients were 16 males and 9 females, with a mean age of 79.5 years. All patients had multiple comorbidities. Complete flap survival was observed in 23 cases and healing was complete in 7 days. In two cases, there was a partial distal necrosis of the flap treated conservatively. Cosmetic results were good and the patient's satisfaction was significant. These results indicate that the STAAP flap is a reliable and useful technique in selected cases, as old or noncompliant patients who benefit from a one-stage technique of nose reconstruction. PMID:24918712

Cordova, Adriana; D'Arpa, Salvatore; Massimiliano, Tripoli; Toia, Francesca; Moschella, Francesco

2014-06-01

359

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.

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

2014-01-01

360

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.

Pennington, David G.

2014-01-01

361

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

362

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

363

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.

Mok, Wan Loong James; Por, Yong Chen

2014-01-01

364

Temporal fascial flap: a versatile free flap for coverage of complex skin defects  

Microsoft Academic Search

The use of temporal fascial flap (TFF) as a microsurgical option permits the covering of skin defects which expose bones, nerves and vessels; it also provides a gliding surface which facilitates tendon excursion. Other advantages of the TFF are a reasonably constant surgical anatomy, minimal donor-site morbidity, and a thin and pliable surface which results in good cosmetic contour. In

M. Stella; A. Clemente; D. Bollero; D. Risso; L. Arturi

2005-01-01

365

The medial plantar flap vascularized by the reverse flow lateral plantar artery: a novel variation through the case of aggressive digital papillary adenocarcinoma of the sole.  

PubMed

Aggressive digital papillary adenocarcinoma (ADPA) is a rare neoplasm of eccrine sweat gland origin that typically presents as a mass on the distal extremities. It is associated with high rates of local recurrence and distal metastasis. Presented here is the case of a 61-year-old male who developed ADPA on his distal sole just above the head of the first metatarsal bone. Wide excision of the tumor involving a 3-cm skin margin from previous surgical scar of biopsy was performed, and sentinel lymph node biopsies were taken from the popliteal fossa and inguinal regions. During this wide excision surgery, the pedicle for the reverse medial plantar flap had to be removed along with the tumor. Reconstructive surgery was performed with a medial plantar flap that was vascularized with a lateral plantar artery in a reverse fashion. This flap successfully covered the defect and the patient can walk without any problems. However, the pedicle crossed the donor site somewhat tightly and the flap became congested for a while. Therefore, it is important to ensure careful handling of the donor site when performing this procedure. PMID:22711199

Hayashi, Ayato; Matsumura, Takashi; Horiguchi, Masatoshi; Komuro, Yuzo; Itoh, Munenari; Idezuki, Takeo; Igarashi, Atsuyuki; Mizuno, Hiroshi

2012-07-01

366

OVMI - Towards a 3D-space flapping flight parametrization  

Microsoft Academic Search

Combining the energy advantages related to the fixed airfoils and the maneuverability of the rotary airfoils, the flapping flight presents a promising potential for the micro UAVs (Unmanned Air Vehicles). In this paper, a model and its mean behavior are given for a simple wingbeat parametrization. The use of time averaged kinematic parameters to describe flapping flight seems to be

Hala RIFAI; Nicolas MARCHAND; Guylaine POULIN

367

Pectoralis myocutaneous flap for salvage of necrotic wounds  

SciTech Connect

The authors have utilized six pectoralis major myocutaneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull-up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis. These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means. This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. The authors conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.

Price, J.C.; Davis, R.K.; Koltai, P.J.

1985-02-01

368

Axial pattern upper eyelid myocutaneous flap for medial canthal reconstruction  

Microsoft Academic Search

The medial canthal area has many functional and cosmetic peculiarities which provide challenges for surgeons. One of the best reconstructive options in this area is the Tripier flap. As originally described, it is a bipedicled flap. If unipedicled, the viability of each pedicle decreases as the length past the midline of the upper lid increases. In addition, many factors such

A. Okumu?; A. Bilgin-Karabulut; H. Ayd?n

2003-01-01

369

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction  

SciTech Connect

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

Peled, I.J.; Kaplan, H.Y.; Herson, M.; Wexler, M.R.

1983-08-01

370

Ethylene oxide sterilization of autologous bone flaps following decompressive craniectomy  

Microsoft Academic Search

Summary ¶ Introduction. In patients undergoing decompressive craniectomy, the bone flap is temporarily preserved either in the subcutaneous tissue of the patient or frozen. However, there are some drawbacks related to these methods. Material and methods. In 16 patients in whom the bone flap was removed for decompressive craniectomy, the bone was firstly washed in hydrogen peroxide and then placed

P. Missori; F. M. Polli; E. Rastelli; P. Baiocchi; S. Artizzu; G. Rocchi; M. Salvati; S. Paolini; R. Delfini

2003-01-01

371

Pericranial flap for closure of paramedian anterior skull base defects  

Microsoft Academic Search

Objective: We sought to examine the position of a pericranial flap reconstruction of anterior skull base defects with respect to the original floor of the anterior cranial fossa. Study design: A retrospective chart and radiology review of 17 patients (1993-2001) with pericranial flap reconstruction for anterior skull base defects and 17 controls was performed. Results: At 6 or more months

Michael C. Noone; J. David Osguthorpe; Sunil Patel

2002-01-01

372

Cranioplasty with bone flaps preserved under the scalp  

Microsoft Academic Search

Cranial bone defects in 27 patients were repaired with bone flaps preserved under the scalp. Head trauma (thirteen patients), cerebrovascular disorder (five patients), postoperative brain swelling (seven patients), and cerebral infective disease (two patients) accounted for the cranial defects. The bone flaps are reimplanted after 14–98 days. The follow-up period was 6 to 26 months. We have encountered no complications

Aydin Pa?ao?lu; Ali Kurtsoy; R. Kemal Ko?; Olgun Konta?; Hidayet Akdemir; I. Suat Öktem; Ahmet Selçuklu; I. Argun Kavuncu

1996-01-01

373

Bulbocavernosus Muscle Flap for the Repair of Vesicovaginal Fistula  

Microsoft Academic Search

Introduction: Anatomical studies on the bulbocavernosus muscle (BCM) and its supporting blood vessels were performed to explore the clinical roles of BCM flaps in the repair of complicated vesicovaginal fistulas. Methods: BCM and the supporting blood vessels of 15 female adult cadavers were anatomized. Pedicled BCM flaps were transposed to repair complicated vesicovaginal fistulas in 11 patients. Results: The left

Qiang Fu; Wei Bian; Jiajv Lv

2009-01-01

374

Auto flow-through technique for anterolateral thigh flaps.  

PubMed

IMPORTANCE The vascular supply of anterolateral thigh (ALT) free flaps is variable, and the pedicle length and ability to capture perforators to the flap may be limited by the anatomic configuration. We describe the reasoning behind performing the auto flow-through procedure, as well as the steps to carry this procedure out. OBSERVATIONS A retrospective medical chart review was performed within our health care system database to identify patients in whom the auto flow-through technique was used during reconstruction with an ALT free flap. The auto flow-through technique was applied to 3 separate ALT free flaps to incorporate perforators from 2 separate vascular systems. This technique allowed for more robust vascularity of the flap and/or optimized pedicle length that would have otherwise necessitated vein grafts. All patients had successful ALT free flap reconstruction and went on to have good functional results. CONCLUSIONS AND RELEVANCE The auto flow-through technique is an adaptation of the flow-through flap, which allows for capture of vascular perforators from separate sources when this configuration is present in the ALT free flap. This technique is especially useful when operating in a vessel-depleted neck or when maximizing pedicle reach is necessary. This technique allows the ALT to be used in challenging reconstruction cases regardless of the vascular branching pattern of the pedicle. LEVEL OF EVIDENCE 4. PMID:24384810

Haffey, Timothy M; Lamarre, Eric D; Fritz, Michael A

2014-01-01

375

Neurotized distally based sural flap for heel reconstruction.  

PubMed

The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap. PMID:23757153

Mendieta, Mauricio J; Roblero, Carlos; Vega, Juan C

2013-10-01

376

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

377

Reversed saphenous fasciocutaneous island flap in marjolin's ulcers  

Microsoft Academic Search

BackgroundThe reconstruction of the heel represents a challenge due to the limited local soft tissue availability and also due to the special structural and functional characteristics of this region. A great number of possibilities have been described; we represent a new flap for heel reconstruction which is a modified form of sural fasciocutaneous flap.

A. Kheradmand; R. Omranipour; M. R. Farahmand

2006-01-01

378

Flapping Flight for Biomimetic Robotic Insects Part I: System Modeling  

E-print Network

1 Flapping Flight for Biomimetic Robotic Insects Part I: System Modeling Xinyan Deng, Luca Schenato presents the mathematical modeling of flapping flight for inch-size micro aerial vehicles (MAVs). These vehicles, called Micromechanical Flying Insects (MFIs), are elec- tromechanical devices propelled by a pair

Sastry, S. Shankar

379

Optimal control of flapping wing accounting for nonsteady effects  

Microsoft Academic Search

The optimization of flapping wing trajectory for the minimization energy consumed by the wing and associated with induced power losses is considered in this paper. An aircraft with such a wing is assumed to move in a horizontal direction at constant velocity. The flapping wing moves up and down at constant velocity. Unsteady vortex wake influence is analyzed. Comparison of

Diana Kravchenko

2010-01-01

380

Initial development of a flapping propelled unmanned underwater vehicle (UUV)  

Microsoft Academic Search

This paper studied the swimming modes of aquatic animals, then the development and experiment of a flapping propelled, radio-controlled UUV are described. The vehicle consists of a pair of flexible flapping wings as propeller; a pare of elevators and a rudder at the end of the shell provide the hydro-kinetic force for attitude control. The UUV prototype has a 70

Yicun Xu; Guanghua Zong; Shusheng Bi; Jun Gao

2007-01-01

381

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

382

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

383

One hundred free DIEP flap breast reconstructions: a personal experience  

Microsoft Academic Search

The Transverse Rectus Abdominis Myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Not only autologous but also immediate reconstructions are now preferred to offer the patient a natural and cosmetically acceptable result.This study summarises the prospectively gathered data of 100 free DIEP flaps used for breast reconstruction in 87 patients. Primary reconstructions were done in

P. N. Blondeel

1999-01-01

384

Value of magnetic resonance imaging in the evaluation of sex-reassignment surgery in male-to-female transsexuals  

Microsoft Academic Search

Background: We investigated the value of magnetic resonance imaging (MRI) in the evaluation of sex-reassignment surgery in male-to-female transsexual patients. Methods: Ten male-to-female transsexual patients who underwent sex-reassignment surgery with inversion of combined penile and scrotal skin flaps for vaginoplasty were examined after surgery with MRI. Turbo spin-echo T2-weighted and spin-echo T1-weighted images were obtained in sagittal, coronal, and axial

M. Cova; E. Mosconi; G. Liguori; S. Bucci; C. Trombetta; E. Belgrano; R. Pozzi-Mucelli

2003-01-01

385

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

386

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

387

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

388

Propeller flaps: a review of indications, technique, and results.  

PubMed

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

389

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

390

Sushruta: father of plastic surgery.  

PubMed

Sushruta is considered the "Father of Plastic Surgery." He lived in India sometime between 1000 and 800 BC, and is responsible for the advancement of medicine in ancient India. His teaching of anatomy, pathophysiology, and therapeutic strategies were of unparalleled luminosity, especially considering his time in the historical record. He is notably famous for nasal reconstruction, which can be traced throughout the literature from his depiction within the Vedic period of Hindu medicine to the era of Tagliacozzi during Renaissance Italy to modern-day surgical practices. The primary focus of this historical review is centered on Sushruta's anatomical and surgical knowledge and his creation of the cheek flap for nasal reconstruction and its transition to the "Indian method." The influential nature of the Sushruta Samhita, the compendium documenting Sushruta's theories about medicine, is supported not only by anatomical knowledge and surgical procedural descriptions contained within its pages, but by the creative approaches that still hold true today. PMID:23788147

Champaneria, Manish C; Workman, Adrienne D; Gupta, Subhas C

2014-07-01

391

Use of progressive tension sutures in components separation: merging cosmetic surgery techniques with reconstructive surgery outcomes.  

PubMed

Components separation is a widely used technique for defect size reduction in abdominal wall reconstruction, and ultimately helps achieve gold standard primary fascial reapproximation in many cases. Even with perforator-sparing techniques, oftentimes there are undermined skin flaps to varying degrees that can lead to complications such as seromas. In this article, the author describes the previously published technique of "progressive tension sutures" reported in the cosmetic literature and extrapolates it to reconstructive abdominal surgery with statistically significant decreases in drain output. This technique also enables recruitment of skin to the midline to afford tension-free reapproximation and excision of redundancy, thereby discarding the most random portion of the skin flaps. PMID:23018696

Janis, Jeffrey E

2012-10-01

392

Hepatobiliary surgery  

Microsoft Academic Search

The transformation of liver and biliary tract surgery into a full speciality began with the application of functional anatomy to segmental surgery in the 1950's, reinforced by ultrasound and new imaging techniques. The spectrum of gall-stone disease encountered by the hepatobiliary surgeon has changed with the laparoscopic approach to cholecystectomy. There is increased need for conservation techniques to repair the

Henri Bismuth; Pietro E. Majno

2000-01-01

393

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

394

Unnecessary surgery.  

PubMed Central

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

Leape, L L

1989-01-01

395

Reverse-flow peroneal island flap for the reconstruction of leg and foot  

Microsoft Academic Search

Sixteen cases of reconstruction of leg and foot defects were performed in our clinic using the reverse-flow peroneal island flap. Complete survival was obtained in thirteen cases. This flap can be transferred more distally than the conventional island flap. Operation requires only a one-stage procedure and microsurgical skill is not necessary. It is a thin flap and cosmetically acceptable. No

S. Torii; Y. Namiki; Y. Hayashi; A. C. W. Wong

1988-01-01

396

THRUST GENERATION DUE TO AIRFOIL FLAPPING Ismail H. Tuncer \\Lambda and Max F. Platzer y  

E-print Network

THRUST GENERATION DUE TO AIRFOIL FLAPPING Ismail H. Tuncer \\Lambda and Max F. Platzer y Department on a single flapping airfoil and a flapping/stationary airfoil combination in tandem is studied parametrically around a single flapping airfoil is also computed by an unsteady potential flow code and a Navier

Tuncer, Ismail H.

397

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

398

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

399

Cornea surgery with nanojoule femtosecond laser pulses  

NASA Astrophysics Data System (ADS)

We report on a novel optical method for (i) flap-generation in LASIK procedures as well as (ii) for flap-free intrastromal refractive surgery based on nanojoule femtosecond laser pulses. The near infrared 200 fs pulses for multiphoton ablation have been provided by ultracompact turn-key MHz laser resonators. LASIK flaps and intracorneal cavities have been realized with high precision within living New Zealand rabbits using the system FemtoCutO (JenLab GmbH, Jena, Germany) at 800 nm laser wavelength. Using low-energy sub-2 nJ laser pulses, collateral damage due to photodisruptive and self-focusing effects was avoided. The laser ablation system consists of fast galvoscanners, focusing optics of high numerical aperture as well as a sensitive imaging system and provides also the possibility of 3D multiphoton imaging of fluorescent cellular organelles and SHG signals from collagen. Multiphoton tomography of the cornea was used to determine the exact intratissue beam position and to visualize intraocular post-laser effects. The wound healing process has been investigated up to 90 days after instrastromal laser ablation by histological analysis. Regeneration of damaged collagen structures and the migration of inflammation cells have been detected.

Koenig, Karsten; Wang, Bagui; Riemann, Iris; Kobow, Jens

2005-04-01

400

Bilateral sinus cysts in a filly treated by endoscopic sinus surgery  

PubMed Central

Bilateral cysts in the frontal and caudal maxillary sinuses in a filly treated by endoscopic sinus surgery (sinoscopy) and triangulation technique are described. Sinoscopy has the advantage of being a minimally invasive technique and permits a complete inspection of the frontal and maxillary sinuses, which is not possible through flap sinusotomy. PMID:19436452

Silva, Luis C.L.C.; Zoppa, André L.V.; Fernandes, Wilson R.; Baccarin, Raquel Y.A.; Machado, Thaís S.L.

2009-01-01

401

Laser safety aspects for refractive eye surgery with femtosecond laser pulses  

Microsoft Academic Search

We report on laser safety aspects for near infrared femtosecond laser refractive surgery. In particular, the transmittance of microjoule laser pulses at 1040nm through the cornea during flap procedures based on femtosecond laser induced multiphoton ionization and photodisruption has been determined. When using focusing optics with a numerical aperture of 0.3, more than 20% of the incident NIR photons are

Ronan Le Harzic; Rainer Bückle; Christian Wüllner; Christof Donitzky; Karsten König

2005-01-01

402

Temporal muscle flap in reconstruction of maxillo-facial tissues  

PubMed Central

Aim of the study Presents our experience in reconstruction of postsurgical defects with use of temporal muscle flap. Material and methods In the years 1996–2010 we treated 10 patients with malignant neoplasms of maxillo-facial region. Following tumor removal the fascia-muscle flaps of temporal muscle were used for reconstruction. Temporal muscle flaps were applied in 5 cases for reconstructing the defect of eye socket tissue after extensive resections and in the other 5 patients was used for reconstructing the defect of palate following maxillary resections. Results All the flaps of temporal muscle that were used for reconstructing eye sockets incorporated with no local reaction. In one case of flap applied into the oral cavity for tightly separate from nasal, partial necrosis of flap's edge and oro-nasal fistula occurred. Conclusions Fascia-muscular flap of temporal muscle is a simple, easy and effective method of tissue reconstruction in maxillo-facial region following extensive oncologic procedures. PMID:23788888

Krzymanski, Grzegorz; Dabrowski, Jaroslaw; Przybysz, Jan; Domanski, Wojciech; Biernacka, Barbara

2012-01-01

403

Dr. J. F. S. Esser and his influence on the development of plastic and reconstructive surgery  

Microsoft Academic Search

Jan F.S. Esser (1877-1946) was a remarkable and gifled Dutch surgeon\\u000awhose contributions to plastic and reconstructive surgery, made long befare\\u000athis specialty was recognised as a branch of surgery, are part of our surgical\\u000aheritage. His interest in the bloodsupply of skin flaps was the !are-runner of\\u000athe clinical and anatomical research that lead to the defînîtion of the

Haeseker B

1983-01-01

404

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

405

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.

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

2014-01-01

406

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

407

Identification of perioperative risk factor by laser-doppler spectroscopy after free flap perfusion in the head and neck: a prospective clinical study.  

PubMed

The aim of this study was to evaluate perioperative flap perfusion using noninvasive monitoring with a laser-Doppler flowmetry and spectrophotometry unit (O2C) and identify whether perioperative blood flow, velocity, hemoglobin level (Hb), and oxygen saturation (SO2 ) measured could be used as indicators of free flap success. Measurements of blood flow, velocity, Hb, and SO2 were performed in 196 microvascular flaps, which had been transferred into the oral cavity to reconstruct ablative defects after surgery for oral cancer. The values were calculated superficially on the skin surface and at a depth of 8 mm. The results showed that perioperative absolute values measured were not associated with an increased rate of microvascular revisions or free flap failure. Independent predictors of microvascular revisions at the first postoperative day were the development of a falling trend in superficial and deep blood flow, and velocity in comparison with baseline values of variables measured. On day 2, all superficial and deep values of Hb, flow, and velocity were independent prognostic factors (P?flap failure. This is the first clinical study to demonstrate that during early free flap integration to the recipient site different parameters of perfusion and oxygenation play an important role at different points of time. Within the first two postoperative days, changes in these parameters can help influence the decision to revise microvascular anastomoses. PMID:24995717

Mücke, Thomas; Rau, Andrea; Merezas, Andreas; Loeffelbein, Denys J; Wagenpfeil, Stefan; Mitchell, David A; Wolff, Klaus-Dietrich; Steiner, Timm

2014-07-01