Sample records for gundersen flap surgery

  1. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    PubMed Central

    Xie, Huizhuang; Malata, Charles M.

    2014-01-01

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

  2. Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

    PubMed Central

    Lumen, N.; Monstrey, S.; Ceulemans, P.; van Laecke, E.; Hoebeke, P.

    2008-01-01

    Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF) or the pedicled anterolateral thigh flap (ALTF) has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years) were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months). Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula). Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps. PMID:19009034

  3. The flow-through free flap in replantation surgery: a new concept

    Microsoft Academic Search

    H. Costa; C. Cunha; A. Conde; A. Barsdley; D. A. McGrouther

    1997-01-01

    The concept of flow-through circulation in free flaps was previously described as a one-staged technique for cover and revascularisation of ischaemic traumatized extremities. This paper describes the practical use of the concept in replantation surgery. Two clinical cases of hand replants are presented in which an uninterrupted flow was established through the selected free flap.

  4. A New Biaxial Epilated Scrotal Flap for Reconstructive Urethral Surgery

    Microsoft Academic Search

    Josemaria Gil-Vernet; Octavio Arango; Alfredo Gil-Vernet; Antoni Gelabert-Mas

    1997-01-01

    PurposeWe describe a new type of perineum based scrotal flap with biaxial vascularization supplied by both superficial perineal arteries. Flap length of up to 20 cm. may be attained for urethral reconstruction.

  5. Results of Free Flap Reconstruction After Ablative Surgery in the Head and Neck

    PubMed Central

    Kim, Heejin; Jeong, Woo-Jin

    2015-01-01

    Objectives Due to the complex anatomy and function of the head and neck region, the reconstruction of ablative defects in this area is challenging. In addition, an increasing interest in improving the quality of life of patients and achieving good functional results has highlighted the importance of free flaps. The aim of this study was to summarize the results of free flap reconstruction and salvage of free flaps in a single institute, and to analyze differences in the results by the flap donor site, recipient site, and learning curve. Methods The medical records of patients who underwent free flap reconstruction from 2004-2012 were reviewed retrospectively. One hundred and fifty free flaps were used in 134 patients, who had an average age of 57.7 years. The types of flaps applied, primary defect sites, success rates, results of salvage operations for compromised flap, and the learning curve were analyzed. Results The anterolateral thigh flap was preferred for the reconstruction of head and neck defects. The overall success rate was 90.7%, with 14 cases of failure. A total of 19 salvage operations (12.7%) for compromised flap were performed, and 12 flaps (63.2%) were salvaged successfully. Dependency on the facial vessels as recipient vessels was statistically different when oral and oropharyngeal defects were compared to hypopharyngeal and laryngeal defects. The learning curve for microvascular surgery showed decrease in the failure rate after 50 cases. Conclusion The free flap technique is safe but involves a significant learning period and requires careful postoperative monitoring of the patient. Early intervention is important for the salvage of free flaps and for lowering the failure rate.

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

    PubMed Central

    Tupikina, Nataliya; Pushkar, Dmitry

    2014-01-01

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

  7. Previous Multiple Abdominal Surgeries: A Valid Contraindication to Abdominal Free Flap Breast Reconstruction?

    PubMed Central

    Di Candia, Michele; Asfoor, Ahmed Al; Jessop, Zita M.; Kumiponjera, Devor; Hsieh, Frank; Malata, Charles M.

    2012-01-01

    Presented in part at the following Academic Meetings: 57th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery, September 24-27, 2008, Naples, Italy.45th Congress of the European Society for Surgical Research (ESSR), June 9-12, 2010, Geneva, Switzerland.British Association of Plastic Reconstructive and Aesthetic Surgeons Summer Scientific Meeting, June 30-July 2, 2010, Sheffield Hallam University, Sheffield, UK. Background: Patients with previous multiple abdominal surgeries are often denied abdominal free flap breast reconstruction because of concerns about flap viability and abdominal wall integrity. We therefore studied their flap and donor site outcomes and compared them to patients with no previous abdominal surgery to find out whether this is a valid contraindication to the use of abdominal tissue. Patients and Methods: Twenty patients with multiple previous abdominal operations who underwent abdominal free flap breast reconstruction by a single surgeon (C.M.M., 2000-2009) were identified and retrospectively compared with a cohort of similar patients without previous abdominal surgery (sequential allocation control group, n = 20). Results: The index and control groups were comparable in age, body mass index, comorbidities, previous chemotherapy, and RT exposure. The index patients had a mean age of 54 years (r, 42-63) and an average body mass index of 27.5 kg/m2 (r, 22-38). The main previous surgeries were Caesarean sections (19), hysterectomies (8), and cholecystectomies (6). They underwent immediate (n = 9) or delayed (n = 11) reconstructions either unilaterally (n = 18) or bilaterally (n = 2) and comprising 9 muscle-sparing free transverse rectus abdominis muscle and 13 deep inferior epigastric perforator flaps. All flaps were successful, and there were no significant differences in flap and donor site outcomes between the 2 groups after an average follow up of 26 months (r, 10-36). Conclusion: Multiple previous abdominal surgeries did not predispose to increased flap or donor site morbidity. On the basis of our experience, we have proposed some recommendations for successful abdominal free flap breast reconstruction in patients with previous multiple scars. Careful preoperative planning and the use of some intraoperative adaptations can allow abdominal free flap breast reconstruction to be reliably undertaken in such patients. PMID:22848775

  8. Application of Lateral Arm Free Flap in Oral and Maxillofacial Reconstruction following Tumor Surgery

    Microsoft Academic Search

    Xiao-meng Song; Ye Yuan; Zhen-jiang Tao; He-ming Wu; Hua Yuan; Yu-nong Wu

    2007-01-01

    Objective: To describe the application of lateral arm free flap (LAFF) in reconstruction of defects in the oral and maxillofacial regions following ablative oncological surgery. Subjects and Methods: The study included 16 patients (13 male, 3 female, mean age 56, range 35–69 years). Sixteen LAFF were harvested to reconstruct defects caused by the dissection of malignant tumors of the oral

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Introduction: The aim of the study was to assess changes in Transforming Growth Factor– ?1 (TGF-?1) levels in gingival crevicular fluid (GCF) and examine correlation of TGF-?1 levels and periodontal parameters: probing pocket depth (PPD) and clinical attachment level (CAL) in sites with chronic periodontitis at various time intervals before and after periodontal surgery. Materials and Methods: The effects of non-surgical and surgical therapy on periodontal parameters and GCF TGF-?1 levels in 18 sites affected with chronic periodontitis were assessed upto 6 weeks post conventional flap surgery. GCF was collected and PPD, CAL recorded at Baseline. GCF was collected and PPD, CAL recorded at Pre-surgery and flap surgery performed. GCF was collected from all sites at Two Weeks Post-surgery. GCF was collected and PPD, CAL recorded at Six Weeks Post-surgery. The concentration of TGF-?1 in GCF was determined using a human TGF-?1 enzyme immunometric assay kit. Results: Mean TGF-?1 concentrations were significantly reduced at Pre-surgery, at Two Weeks Post-surgery and at Six Weeks Post-surgery (p<0.05) when compared to Baseline TGF-?1 values. There was a statistically significant reduction in PPD and gain in CAL following non-surgical and surgical therapy when compared to baseline (p<0.05). Conclusion: Results indicate that TGF-?1 may play a role in the pathogenesis and diagnosis of periodontal disease and could be considered as a disease predictive biomarker. PMID:25859517

  11. Effect of Periodontal Dressing on Wound Healing and Patient Satisfaction Following Periodontal Flap Surgery

    PubMed Central

    Soheilifar, Sara; Bidgoli, Mohsen; Faradmal, Javad; Soheilifar, Sanaz

    2015-01-01

    Objectives: It has been claimed that periodontal dressing reduces the risk of wound infection, bleeding and granulation tissue formation and improves tissue healing. This study sought to assess the effect of periodontal dressing on wound healing and patient satisfaction following periodontal flap surgery. Materials and Methods: This clinical trial was conducted on 33 patients presenting to Hamadan University, School of Dentistry in 2012 whose treatment plan included two periodontal surgical procedures on both quadrants of the maxilla or mandible. The variables evaluated were severity of pain, bleeding, facial swelling and ease of nutrition experienced by patient during the first 3 days after surgery and inflammation, granulation tissue formation and gingival color at 7 and 14 days. Obtained data were analyzed using SPSS version 16.0 and R software and chi-square and t-tests. Results: The mean (±SD) pain score was 1.73±1.153 and 2.79±1.933 in surgical sites with and without periodontal dressing, respectively and this difference was statistically significant (P=0.005). No significant difference was noted between sites with and without periodontal dressing in terms of swelling, bleeding, gingival consistency, granulation tissue formation, gingival color and ease of nutrition (P>0.05). Conclusion: According to the results of the present study, patients did not experience more bleeding, facial swelling or nutritional problems without periodontal dressing; however, the level of pain experienced was lower after surgeries with the use of periodontal dressing.

  12. Lateral tarsal artery flap: an option for hypopharyngeal reconstruction in patients with hypopharyngeal carcinomas after surgery

    PubMed Central

    Wang, Chengyuan; Wang, Qiang; Wang, Zengtao; Li, Guojun; Yang, Dazhang

    2015-01-01

    Background: Hypopharyngeal reconstruction following resection of hypopharyngeal carcinoma has utilized local, regional and free tissue transfer flap options. No single surgical technique is currently in use for hypopharyngeal reconstruction that is applicable to all patients. In this article, we introduce the application of the lateral tarsal artery flap (LTA flap) as a reconstructive option following hypopharyngeal oncologic ablation. Methods: From June 2010 to January 2012, four patients of hypopharyngeal carcinomas underwent total laryngectomy and partial pharyngectomy followed by single-stage reconstruction with LTA flaps. After operation, patients were treated with radical radiotherapy within four weeks. All the patients were followed up. Results: All flaps survived, with an average size of 7.5 cm × 5.8 cm (range of 8.0-7.0 cm × 6.0-5.0 cm). There were no complications or contractures during the follow-up. Normal diets were adopted two weeks after operation. The follow-up ranged from 12-20 months (mean: 15 months). There were no distal stenosis or pharyngocutaneous fistula nor were there any donor-site complications. Conclusion: The LTA flap could be a viable option for hypopharyngeal reconstruction following head and neck oncologic resection. It seems that LTA flap would be a promising flap deserving extensively research.

  13. [Plastic surgery coverage of osteocutaneous defects of the sternum area with the vertical and transversal rectus abdominis muscle (VRAM/TRAM) flap].

    PubMed

    Erdmann, D; Küntscher, M; Petracic, A; Sauerbier, M; Menke, H; Schirren, J; Dienemann, H; Germann, G

    2000-09-01

    Longitudinal osteocutaneous defects of the sternal region including the caudal third were reconstructed in 15 patients during a 3-year period by using the "vertical (VRAM)- and transverse rectus abdominis muscle" (TRAM) flap. The majority of the defects resulted from chronic osteomyelitis after previous cardiothoracic surgery or were due to former therapy of breast cancer. Three VRAM/TRAM flaps were primarily transferred as free flaps with microvascular anastomosis in the axilla region. Nine out of 12 pedicled VRAM or TRAM flaps required an additional microvascular anastomosis because of imminent venous or arterial insufficiency ("supercharging"). Therefore, operative technique and operating time of the pedicled and free flap for reconstruction of longitudinal sternal defects are comparable. Adequate reconstruction and rehabilitation was achieved in 11 cases. In 2 patients revision and partial secondary defect coverage was required. Two male patients died postoperatively due to their preexisting condition. PMID:11043136

  14. Co-operative radical pelvic surgery: a role for the gynecologist in vaginal reconstruction using a uterine myoserosal flap in urological and anorectal cancer surgery.

    PubMed

    Saadeh, Feras Abu; Cheema, Iwad; McCormick, Paul; Gleeson, Noreen

    2015-06-01

    This study describes a new technique for reconstructing the vagina and vestibule after radical extirpative surgery for urological and anorectal malignancy. The uterus is always excised when exenterative surgery is performed for gynecological cancer. The use of the uterus as a graft gives the gynecologic oncologist/reconstructive surgeon a role in the multidisciplinary team with urologists when the anterior vaginal wall and vestibule are excised and with the anorectal surgeons when the posterior vaginal wall and perineum are excised for nongynecological cancers. In some such cases, only the anterior or posterior wall of the vagina may be excised, leaving a healthy full-length, one-third, or half-circumference vaginal sleeve. A myoserosal flap is raised from the in situ uterus. The ectocervix is excised, and the adnexa are detached or excised. The uterus is opened to generate a hexagonal flap. The endometrium and endocervix are excised/ablated with electrocautery. The flap is advanced to the edge of the remaining anterior vestibule or reconstituted perineum. The serosal surface of the uterus forms the new wall of the vagina and undergoes metaplastic transformation to squamous epithelium within 3 months. The very satisfactory anatomical and functional outcome means that this technique merits further evaluation. PMID:24987923

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

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  17. Recurrent venous thrombosis following free flap surgery: The role of heparin-induced thrombocytopenia

    PubMed Central

    Nikolis, Andreas; Christopoulos, Apostolos; Saint-Cyr, Michel; Cordoba, Carlos; Guertin, Louis; Harris, Patrick G

    2003-01-01

    Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption. PMID:24115848

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

    PubMed

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

    2013-03-01

    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

  19. A case of nonisland pedicled foot fillet flap for below-knee amputation stump wound: treatment option for compartment syndrome after fibular free flap surgery.

    PubMed

    Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong

    2014-02-01

    Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation. PMID:24550664

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

    PubMed

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

    2014-11-01

    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

  1. [Plastic surgery using cutaneous arterialized flaps in patients with sequelae of burns].

    PubMed

    Sizov, V M; Galich, S P; Zhernov, A A; Kovalenko, O N

    1991-01-01

    The experience with performing operations in 17 patients with contracture of the neck, face, trunk with the use of composite cutaneous arterialized flaps from the lateral surface of the thoracic wall and inclusion of the latissimus dorsi has been analysed. It is established that such a plasty is attended by the lesser risk of circulatory impairement in the transferred tissues as compared with the available methods of non-free plasty. PMID:2067270

  2. Cardiac output monitoring to guide fluid replacement in head and neck microvascular free flap surgery-what is current practice in the UK?

    PubMed

    Chalmers, Alison; Turner, Matthew W H; Anand, Rajiv; Puxeddu, Roberto; Brennan, Peter A

    2012-09-01

    Appropriate fluid balance is an important factor in the survival of free flaps, and recently there has been a shift towards more conservative fluid regimens. Several surgical specialties have made extensive use of the relatively non-invasive method of measuring cardiac output (CO) to optimise fluid balance during and after surgery, which has resulted in a shorter hospital stay, but little has been published in head and neck surgery. To ascertain its use in the head and neck we sent a postal questionnaire to the anaesthetic departments of 40 major head and neck units identified from the 2010 database of the British Association of Oral and Maxillofacial Surgeons (BAOMS). Questions were asked about the number of free flaps done in the unit each year, the monitoring of central venous and arterial blood pressure (and inotrope protocols), optimal target variables, and whether CO was monitored (with type of device). Thirty-two units responded (80%). While 26 units (81%) routinely monitored central venous pressure (CVP), CO was monitored in only 3 units (9%). There was a wide range of responses in relation to optimal variables and use of inotropes. As with other specialties, it is likely that CO monitoring will become widely used in head and neck reconstructive surgery. Not only does it enhance fluid optimisation, but it may also reduce hospital stay and morbidity. Appropriate clinical studies are urgently needed to evaluate its use in our specialty. PMID:21940078

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

    PubMed

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

    2014-09-01

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

  4. Flap noise

    NASA Technical Reports Server (NTRS)

    Dorsch, R. G.; Lasagna, P. L.; Maglieri, D. J.; Olsen, W. A.

    1972-01-01

    Externally-blown-flap noise research can be summarized by the following remarks: With lower-surface blowing, the sources of the flap noise are begining to be understood and the noise scaling laws have been established. Further, progress has been made on suppressing the flap interaction noise at the large flap deflections used during landing. Recent small-scale noise tests of configurations using external upper-surface blowing indicate that engine-over-the-wing configurations may be promising.

  5. Perforator Flaps in Head and Neck Reconstruction

    PubMed Central

    Chana, Jagdeep S.; Odili, Joy

    2010-01-01

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

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

    PubMed Central

    Anyanechi, CE; Osunde, OD; Bassey, GO

    2015-01-01

    Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0.18). Conclusion: This study suggests that oral mucoperiosteal flap could be an option in the choice of interpositional materials in surgery of TMJ ankylosis. PMID:25745573

  7. Venous flaps.

    PubMed

    Thatte, M R; Thatte, R L

    1993-04-01

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

  8. Image-guided, stereotactic perforator flap surgery: a prospective comparison of current techniques and review of the literature

    Microsoft Academic Search

    W. M. Rozen; A. Buckland; M. W. Ashton; D. L. Stella; T. J. Phillips; G. I. Taylor

    2009-01-01

    Background  Image-guided stereotaxy is a recent advancement in imaging technology, allowing computer guidance to aid surgical planning\\u000a and accuracy. Despite the use of multiple techniques for patient registration in several surgical specialities, only fiducial\\u000a marker registration has been described for use in soft tissue reconstructive surgery. The current study comprises an evaluation\\u000a of the current techniques available for this purpose.\\u000a \\u000a \\u000a \\u000a Methods  A

  9. Adipofascial flap harvest using endoscopic assistance.

    PubMed

    Hallock, G G

    1997-06-01

    Minimally invasive plastic surgery has expanded beyond the original confines of aesthetic applications to encompass all our endeavors in an attempt to restrict the size of surgical scars, limit postoperative discomfort, and hasten recovery of function. This evolution has already delineated methods to raise our workhorse muscle flaps and has negated the risks of laparotomy for various visceral flaps. It is then only a logical progression to use these endoscopic techniques to harvest fascial flaps so as to avoid the notorious donor site morbidity of the fasciocutaneous flap, which has certainly hindered the rapid acceptance of these otherwise valuable flaps. Endoscopic-facilitated elevation of a local adipofascial flap is described for which little or no additional skin incisions need ever be made. PMID:9188984

  10. Marking of tumor resection borders for improved radiation planning facilitates reduction of radiation dose to free flap reconstruction in head and neck cancer surgery.

    PubMed

    Bittermann, Gido; Wiedenmann, Nicole; Voss, Pit; Zimmerer, Ruediger; Duttenhoefer, Fabian; Metzger, Marc C

    2015-05-01

    Accurate localization of tumor resection borders is crucial for adjuvant radiotherapy. An improvement to adjuvant radiotherapy with the reduction of radiation doses to free flap reconstruction by virtual navigation procedures and titanium clips was evaluated. Thirty-three patients with oral cancer were prospectively included in the study. Following complete local excision of the primary tumor, resection borders were marked virtually using a navigation pointer and with titanium ligature clips. Postoperative delineation of tumor resection borders was examined. In five patients with microvascular free flap reconstruction a reduction of the radiation dose to the free flap reconstruction was achieved. The tumor resection borders in 30 patients were marked with titanium ligature clips. Surgical clip insertion was successful in 91%. We demonstrate a significant relationship between the reconstruction volume and the part of the target volume which will receive a reduced radiation dose. A cumulative dose of 60 Gy was administered to the target volume and a significant reduction of the administered radiation dose to the center of the flap could be demonstrated. We demonstrate an accurate delineation of the tumor resection margins. These improvements in tumor resection margin delineation allow for increased accuracy in adjuvant treatment and a reduction of radiation dose to the vascular free flap reconstruction. PMID:25841307

  11. Osteogaleal flaps in pediatric cranioplasty.

    PubMed

    Ozerdem, Omer Refik; Sen, Orhan; Anlatici, Recep; Erdo?an, Bülent; Aydin, Volkan

    2002-08-01

    Reconstruction of cranial defects larger than 2 to 3 cm in diameter and frontal defects of any size is indicated for mechanical protection and cosmetic reasons. The authors used osteogaleal flaps for cranioplasty in 2 pediatric patients with the aim of decreasing infection risk and maximizing bone healing. In the first patient, bone was harvested from the diploë. Children's cranial bones are thin, and in the second patient the authors used full-thickness grafts of adjacent bone, splitting this into three pieces to cover the recipient and donor sites. The postoperative period was uneventful for both children. Scintigraphic studies performed the first week after surgery revealed uptake in the flaps. Computed tomography demonstrated rapid bone healing with good contouring. The scintigraphic findings and rapid bone healing suggest that the bone component of the osteogaleal flap nourishes the graft site with blood from the galea and the periosteum. These flaps are an ideal choice for reconstruction of cranial defects because of their membranous origin, ease of harvest, applicability to any part of the calvarium, and reliable vascularity. PMID:12187338

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

    PubMed Central

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

    2012-01-01

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

  13. Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap.

    PubMed

    Gore, Sinclair M; Akhavani, Mohammed A; Kang, Norbert; Chana, Jagdeep S

    2008-01-01

    Extremely large chest wall defects may result following salvage oncological surgery. Typically these defects involve a large skin defect combined with a variable resected area of underlying muscle and ribs. In situations where the skin defect is very large the use of a large latissimus dorsi flap may require skin grafting to the donor site if a myocutaneous flap is used or to the recipient defect if a muscle-only flap is used. Alternatively a transverse rectus abdominis flap is a second option but in certain cases this may not be available. We describe the use of a free anterolateral thigh flap to reconstruct a chest wall defect and demonstrate the principle of side-to-side stacking of separate skin paddles to achieve skin closure of a massive defect whilst permitting primary closure of the donor site. The principle of turbocharging components of a chimaeric flap is also described. PMID:17392046

  14. Bilobed transposition flap.

    PubMed

    Aasi, Sumaira Z; Leffell, David J

    2005-01-01

    This article reviews the indications and techniques for performing a bilobed flap for reconstruction of surgical wounds. Various examples of surgical defects where a bilobed flap can be used are shown. Possible complications and pitfalls are also reviewed. PMID:15620619

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

    PubMed Central

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

    2014-01-01

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

  16. Columella reconstruction with the Washio flap

    Microsoft Academic Search

    S Motamed; A. J Kalantar-Hormozi

    2003-01-01

    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.

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

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2015-03-01

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

  19. Extended Reverse Sural Artery Flap’s Safety, Success and Efficacy - A Prospective Study

    PubMed Central

    MN, Prakashkumar; M, Shankarappa

    2014-01-01

    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

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

    PubMed Central

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

    2014-01-01

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

  1. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    PubMed

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas. PMID:25785382

  2. Versatility of the supraclavicular pedicle flap in head and neck reconstruction.

    PubMed

    Giordano, L; Bondi, S; Toma, S; Biafora, M

    2014-12-01

    Head and neck surgery has witnessed an increase in microvascular reconstructive procedures with free flaps over the last 20 years as they offer efficient functional recovery. Nevertheless, under certain circumstances they may be contraindicated or cannot be used. We present the use of supraclavicular pedicled flap in three patients with different recipient sites. All patients had acceptable functional and aesthetic outcomes. Donor-site morbidity was satisfactory. Supraclavicular pedicled flap is not only an alternative to free flap reconstruction, but also a first-choice option in head and neck reconstructive surgery. PMID:25762831

  3. Laparoscopic assisted adenomyomectomy using double flap method

    PubMed Central

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

    2014-01-01

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

  4. Free Flap Reconstruction of Head and Neck Defects after Oncologic Ablation: One Surgeon's Outcomes in 42 Cases

    PubMed Central

    Lim, Yun Sub; Kim, Nam Gyun; Lee, Kyung Suk; Choi, Jae Hoon; Park, Sang Woo

    2014-01-01

    Background Free flap surgery for head and neck defects has gained popularity as an advanced microvascular surgical technique. The aims of this study are first, to determine whether the known risk factors such as comorbidity, tobacco use, obesity, and radiation increase the complications of a free flap transfer, and second, to identify the incidence of complications in a radial forearm free flap and an anterolateral thigh perforator flap. Methods We reviewed the medical records of patients with head and neck cancer who underwent reconstruction with free flap between May 1994 and May 2012 at our department of plastic and reconstructive surgery. Results The patients included 36 men and 6 women, with a mean age of 59.38 years. The most common primary tumor site was the tongue (38%). The most commonly used free flap was the radial forearm free flap (57%), followed by the anterolateral thigh perforator free flap (22%). There was no occurrence of free flap failure. In this study, risk factors of the patients did not increase the occurrence of complications. In addition, no statistically significant differences in complications were observed between the radial forearm free flap and anterolateral thigh perforator free flap. Conclusions We could conclude that the risk factors of the patient did not increase the complications of a free flap transfer. Therefore, the risk factors of patients are no longer a negative factor for a free flap transfer. PMID:24665423

  5. Flow Over Swept Flaps and Flap Tips

    NASA Technical Reports Server (NTRS)

    Bradshaw, Peter; Buice, Carl U.

    1995-01-01

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

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

    PubMed Central

    2014-01-01

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

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

    PubMed Central

    Panse, Nikhil; Sahasrabudhe, Parag

    2014-01-01

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

  8. Anteriorly based pedicled flaps for skull base reconstruction.

    PubMed

    Meier, Joshua C; Bleier, Benjamin S

    2013-01-01

    The expansion of endoscopic skull base surgery has resulted in the creation of large defects that must be repaired to ensure separation of the cranial vault from the nasal cavity. The workhorse of anterior skull base reconstruction remains the nasoseptal or Hadad-Bassagasteguy flap. Despite its success, the nasoseptal flap is limited in its ability to reach extremely anterior defects including those involving the frontal break, posterior frontal table, and anterior cribiform plate. Alternative approaches utilizing anteriorly pedicled flaps have been described which exploit the vascular supply to the anterior septum and lateral nasal wall. The diminutive nature of the anterior septal blood supply has led to the elaboration of a bipedicled anterior septal flap which is capable of reliable reconstruction of both the frontal beak as well as posterior frontal table defects. Similarly anteriorly based inferior turbinate flaps pedicled largely on anterior ethmoid arborizations have been used successfully to reconstruct anterior defects. In light of the limitations of the nasoseptal flap, the addition of anteriorly pedicled flaps to the clinical armamentarium offers the opportunity to provide vascularized mucosal coverage of virtually any region of the skull base which can be reached endoscopically. PMID:23257553

  9. Heel reconstruction with free instep flap: a case report

    PubMed Central

    2014-01-01

    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

  10. [The abdominal drop flap].

    PubMed

    Bodin, F; Liverneaux, P; Seigle-Murandi, F; Facca, S; Bruant-Rodier, C; Dissaux, C; Chaput, B

    2015-08-01

    The skin between the mastectomy scar and the future infra-mammary fold may be managed in different ways in delayed breast reconstruction using a DIEP (deep inferior epigastric perforator). Conserving this skin and positioning the flap skin paddle in the middle of the breast usually highlights skin color disparity because of two visible transition zones. Resection of the entire skin under the scar may be more aesthetic but limits direct closure possibility in case of flap failure. In order to benefit from both aesthetic result and safe surgical method, we propose the abdominal drop flap. The inferior thoracic skin flap is detached from the thoracic wall beyond the future infra-mammary fold, preserved and pushed under the breast. PMID:25896871

  11. Blown flap noise

    E-print Network

    Haas Martin

    1972-01-01

    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 ...

  12. Intraoral Reconstruction Using Local and Regional Flaps

    PubMed Central

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

    2010-01-01

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

  13. Salvage of a free radial forearm flap by creation of an arteriovenous fistula at the distal arterial pedicle.

    PubMed

    Eweida, Ahmad M; Lang, Werner; Schmitz, Marweh; Horch, Raymund E

    2013-07-01

    Interdisciplinary approaches with infrainguinal bypass grafts and free flaps between the plastic and vascular surgery may well offer an opportunity for diabetic patients with peripheral vascular disease to salvage their critically affected limbs. A free flap transfer combined with an autologous vein graft can cover large tissue defects and simultaneously improve distal perfusion even in patients with arterial occlusive disease. We are presenting a case of bypass-free radial forearm flap used to cover a foot defect in an old diabetic patient with peripheral arterial disease. The flap perfusion deteriorated significantly during the early postoperative period. The patient was brought back to the operating room with acute thrombosis of the popliteal-radial venous graft and the arterial pedicle of the flap. The flap was salvaged by thrombectomy and creation of an additional arteriovenous fistula at the distal arterial pedicle. The procedure improved the flap perfusion and decreased the high internal resistance that was noticed in the flap when trying to flush the radial artery during the revision surgery and was evident by continuous wave -Doppler sonography. The successful salvage of the flap in the presented case and the convenient long-term follow up suggest that this technique may be safe and helpful as a last effort to salvage a bypass-free flap with a suspected high internal resistance. PMID:23640844

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

    PubMed Central

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

    2012-01-01

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

  15. Lower-Extremity Local Flaps.

    PubMed

    Bos; Buehler

    1994-11-01

    Some soft-tissue defects of the lower extremities can be covered reliably with local flaps. Five such flaps--the tensor fascia lata, gastrocnemius, soleus, posterior tibial artery fasciocutaneous, and dorsalis pedis flaps--are described. If the indications for each flap are understood and the vascular pedicle is carefully preserved, these flaps can be used to provide relatively simple and reliable coverage of selected soft-tissue defects on the lower extremities. However, the indications must not be overextended in an attempt to avoid a free-tissue transfer. The gastrocnemius flap is most often used. It reliably covers common defects about the knee and the proximal tibia. A skin graft is required for the gastrocnemius flap, as well as the soleus flap, which covers the midportion of the tibia. The soleus requires deeper dissection of the calf for elevation. The tensor fascia lata flap and the more recently described posterior tibial artery fasciocutaneous flap are relatively easy to raise, but there are fewer orthopaedic indications for their use. The dorsalis pedis cutaneous flap is technically more demanding, but it can be used to cover difficult defects around the ankle. PMID:10709027

  16. Comparison of Modifications in Flap Anastomosis Patterns and Skin Incision Types for External Dacryocystorhinostomy: Anterior-Only Flap Anastomosis with W Skin Incision versus Anterior and Posterior Flap Anastomosis with Linear Skin Incision

    PubMed Central

    Dirim, Burcu; Sendul, Selam Yekta; Demir, Mehmet; Ergen, Erdem; Acar, Zeynep; Olgun, Ali; Tiryaki, Semra; Sensoz, Hakan; Guven, Dilek

    2015-01-01

    Purpose. To compare the outcomes of external dacryocystorhinostomy (E-DCR) by using two different flap anastomosis patterns and skin incision types. Methods. This study included 79 patients (88 eyes) with lacrimal drainage system disorders who underwent E-DCR surgery. Fifty eyes of 44 patients (group A) underwent E-DCR by suturing anterior and posterior flaps (H-flap) of the lacrimal sac with curvilinear skin incision whereas in 38 eyes of 35 patients (group B) DCR was performed by suturing only anterior flaps (U-flap) with W skin incision. Results. The success rate was evaluated according to lacrimal patency and scar assessment scores. Patency was achieved in 78 patients (88.6%). In terms of groups, patency was 44 eyes (88.0%) in group A and 34 eyes (89.5%) in group B. There was no statistically significant difference in the success rates of lacrimal patency between the two groups. Further, there was no statistically significant difference concerning cutaneous scar scores. Conclusion. Our study suggests that anastomoses of only anterior flaps or both anterior and posterior flaps have similar success rates; suturing only anterior flaps is easier to perform and shortens the operative time. In addition, W skin incision is a reasonable alternative to curvilinear incision for reducing scar formation. PMID:26185781

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

    PubMed

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

    2012-05-01

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

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

    PubMed

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

    2015-08-01

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

  19. Novel flaps for head and neck reconstruction.

    PubMed

    Ahmad, Quazi Ghazwan; Shankhdhar, Vinay Kant

    2010-04-01

    The head and neck region is important both functionally and aesthetically and its reconstruction poses a formidable challenge for plastic surgeons. A perforator flap is a flap of skin or subcutaneous tissue supplied by a vessel that perforates the deep fascia to gain access to flap. With improvement in our knowledge of the anatomy of blood supply to the skin, the perforator flaps have opened a whole new horizon for the plastic surgeon to choose flaps with better function and cosmesis. The locally available perforators enable flaps to be designed with excellent match in tissue characteristics. Perforator flaps limit donor site morbidity and as they are islanded complete insetting is possible in a single stage. The principal perforator flaps such as facial artery perforator flap, platysma flap and its variant the submental flap and supra-clavicular artery flap used in the head and neck reconstruction are discussed. The more commonly used flaps are the free radial artery forearm flap and the anterolateral thigh flap while the novel ones are the thoracodorsal artery perforator flap, medial sural artery perforator flap and the toe-web flap for commissure reconstruction. The indications, reach and drawbacks of these flaps have been discussed in this review. PMID:22930626

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

    PubMed

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

    2014-07-01

    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

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

    PubMed

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

    2015-03-01

    Recent advances in 3-dimensional (3D) surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP) flaps (5 immediate, 6 delayed) using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast. PMID:25878927

  2. Long head of biceps femoris flap in anal fistula treatment : anatomical study and case report.

    PubMed

    Terryn, F X; Leonard, D; Chateau, F

    2015-01-01

    In case of complex anal fistulae, the treatment can include muscular flaps. The gracilis transposition flap is the gold-standard in perineal reconstructive surgery, with wide use during the past decades. However, in some cases, this flap is too short to reach difficult locations such as the posterior perineum. The long head of the biceps femoris, which has already been studied in the electrically stimulated neosphincter formation, could be more appropriate in such clinical situations. Furthermore, its potential advantages, amongst which an excellent functional outcome, would be to allow persistent prone position, during both treatment and reconstruction, as well as a more favorable intramuscular vascularisation. We report the case of a 39-year-old man with a complex recurrent transphincteric posterior anal fistula with an external orifice in the right buttock and complicated with a severe cellulitis, treated with an endo-anal flap combined with a long head of biceps femoris pediculised flap. PMID:26021955

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

    PubMed

    Qassemyar, Q; Delobaux, A

    2015-06-01

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

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

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

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

  5. Successful twin pregnancy and delivery following free rectus abdominis muscle flap at 15 weeks gestational age.

    PubMed

    Johnson, P J; Bentz, M L

    1998-01-01

    Although a vertical rectus abdominis flap would not have been selected for reconstruction of the patient's defect had her pregnancy been detected preoperatively, the present case does demonstrate the remarkable resiliency and integrity of the anterior abdominal wall after rectus abdominis muscle flap surgery. Meticulous closure of the abdominal wall is of utmost importance in maintaining abdominal wall competence. Although the merits of muscle splitting techniques and the use of mesh are beyond the scope of this report, there is no evidence that modification of technique should be performed in the patient considering future pregnancy. Our case supports other reports that rectus abdominis flap surgery is not a contraindication to future pregnancy. Intuitively waiting at least 1 year, as recommended by Chen et al., seems reasonable, although the present case demonstrated a successful pregnancy and delivery of twins after a vertical rectus abdominis flap was harvested during pregnancy. PMID:9427929

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

    PubMed Central

    Bhat, Satish P.

    2013-01-01

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

  7. Effects of different vascular patterns and the delay phenomenon on rat ventral island flap viability.

    PubMed

    Adanali, Gokhan; Seyhan, Tamer; Turegun, Murat; Senen, Dilek; Sensoz, Omer

    2002-06-01

    The objective of the current study was to investigate flap viability and to determine optimal delay time by designing various blood flow patterns in the superficial inferior epigastric (SIE) artery (A) and vein (V) flap model. Flaps measuring 7 x 7 cm were created in 42 Sprague-Dawley rats, which were divided into six groups. In group I rats (AV-AV), the flap was elevated based on the bilateral SIE vessels. In group II rats (AV-A), the flap was elevated based on the right SIE vessels and the left artery. In group III rats (V-AV), the flap was elevated based on the left-side vein whereas the SIE artery and vein were the pedicle on the right side. In group IV rats (V-A), the flap was elevated as a venous flap on the left side and was SIE artery based on the right side. In group V rats (AV-) the flap was elevated based on the right SIE artery and vein. In group VI rats (delay), the SIA artery and vein on the left side were ligated without elevation during the first session. The flap was elevated on the right SIE artery and vein 7 days after the delay procedure. Percentages of viable flap surface area were measured in millimeters with acetate paper on day 5 after surgery. The highest viability was seen in group I rats (96.14%), and the delay group had the second highest viable area (88.56%). The area that remained viable in group II was larger than that of group III (87.41% vs. 72.84%; p < 0.05). The least viable areas were observed in group IV. The percentage of viable flap area was significantly higher in the delay group when compared with group V rats (88.56 +/- 1.06% vs. 60.01 2.58%; p < 0.05). In conclusion, if the contralateral pedicle is ligated 7 days before SIE vessel-based island flap elevation, the flap can be used safely in a manner that crosses the median. Artery inflow of the flap is more important than venous outflow for improvement of flap viability on the contralateral side. PMID:12055438

  8. Near infrared spectroscopy for monitoring flap viability following breast reconstruction.

    PubMed

    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

    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

  9. [Submental island flap: a review of the literature].

    PubMed

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

    2015-02-01

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

  10. Effects of Buflomedil and Pentoxifylline on Hamster Skin-Flap Microcirculation: Prediction of Flap Viability Using Orthogonal Polarization Spectral Imaging

    PubMed Central

    Coelho da Mota, Denise Salles; Furtado, Eliane; Bottino, Daniel Alexandre; Bouskela, Eliete

    2009-01-01

    OBJECTIVE This study investigated the effects of buflomedil and pentoxifylline, both of which are used in reconstructive surgery of hamster skin flap microcirculation, and evaluated the skin flap survival rate by orthogonal polarization spectral imaging. METHOD Twenty-four adult male Syrian golden hamsters were divided into three groups: a control (C, 0.1 ml 0.9% saline), buflomedil (B, 3 mg/kg/day), and pentoxifylline group (P, 14.5 mg/kg/day). Treatments administered intraperitoneally were initiated 1 hour before skin flap preparation and continued for 7 days post-operatively at 12-hour intervals. Preparations (skin flaps) were divided into 12 fields, which were organized into six bands. Functional capillary density (FCD, in mm/mm2), distance from the skin flap base to blood flow cessation (Distwith flow, in cm), percentage of viable skin (VA, in%), and qualitative analysis of blood flow by orthogonal polarization spectral imaging were performed at 1 and 24 hours and on the seventh post-operative day. RESULT Bands IV, V, and VI presented no flow independent of time. The functional capillary density group B was higher than that of groups C and P, primarily after 24 hours. All groups showed an increase in D with time but reached similar final distances (C = 2.73, B = 2.78 and P = 2.70 cm). Moreover, the percentage of viable areas remained at approximately 50%. The orthogonal polarization spectral imaging was useful to assess viability by counting fields with and without blood flow. CONCLUSIONS Functional capillary density values were higher in the buflomedil group compared to the control and pentoxifylline groups in this model. Functional capillary density did not influence D or the percentage of VA, and the technique showed favorable potential to assess/predict the viability of skin flaps within 1 h after surgery. PMID:19690666

  11. Aortic aneurysm following subclavian flap repair: diagnosis by magnetic resonance imaging.

    PubMed

    Scholz, T D; Sato, Y; Bolinger, L

    2001-01-01

    Aortic aneurysm following subclavian flap repair of coarctation of the aorta is thought to occur infrequently. We present a case in which aneurysm of the subclavian flap was found 10 years after the original surgery. The location and extent of the aneurysm was clearly defined using cardiac magnetic resonance imaging (MRI). This report adds further support to recent recommendations to make cardiac MRI a routine imaging study for all postoperative patients from coarctation of the aorta repair. PMID:11178675

  12. Ultrasound visualization of aortic dissection by right parasternal scanning, including systolic flutter of the intimal flap.

    PubMed

    D'Cruz, I A; Jain, M; Campbell, C; Goldbarg, A N

    1981-08-01

    Dilation of the ascending aorta and an intimal flap within it (indicating dissecting aneurysm) were visualized by M-mode and cross-sectional echocardiography, from the right but not from the left parasternal area. The diagnosis was confirmed by aortography and at surgery. Systolic flutter of the intimal flap, seen on M-mode echocardiography, was attributable to the jet from a mildly stenotic aortic valve impinging on it. PMID:7249777

  13. The radial free forearm flap--prelaminated versus non-prelaminated: a comparison of two methods.

    PubMed

    Poeschl, P W; Kermer, C; Wagner, A; Klug, C; Ziya-Ghazvini, F; Poeschl, E

    2003-04-01

    In the present work two methods of harvesting the RFFF (radial free forearm flap) are compared: the prelaminated fasciomucosal and the non-prelaminated fasciocutaneous version. The flaps were employed for intraoral reconstruction after radical oncological surgery of the oral cavity. In most cases a squamous cell carcinoma was the present malignant tumour. A total of 32 patients were included in the study, 16 in each group. The design was retrospective. Data were obtained by clinical follow up, chart review and compiled database. Analysis included the amount of shrinkage of the flaps during the follow-up period, early postoperative complications, following function improving operations and early and late donor site difficulties. Prelaminated fasciomucosal flaps showed a higher shrinkage rate than fasciocutaneous non-prelaminated flaps. Due to this circumstance the number of following function improving operations was higher in the prelaminated flap group. Early wound healing difficulties were also seen more often in the prelaminated flap group, whereas donor site problems occurred more frequently in the non-prelaminated group. Mucosal prelamination of the RFFF is a promising method for a most physiological reconstruction of intraoral defects resulting from tumour surgery. Postoperative shrinkage is a problem in prelaminated RFFF. Our aim is to improve the prelamination technique in order to prevent shrinkage. The almost complete absence of donor site difficulties in prelaminated RFFF may represent a solution to this common and yet unsolved problem. PMID:12729776

  14. The Effect of Enoxaparin and Clopidogrel on Survival of Random Skin Flap in Rat Animal Model

    PubMed Central

    Fatemi, Mohammad Javad; S Forootan, Kamal; S Jalali, Seyed Ziaaddin; Mousavi, Seyed Jaber; Pedram, Mir Sepehr

    2012-01-01

    BACKGROUND Necrosis of skin flaps is considered as an important complication in reconstructive surgery. We conducted an experimental study to investigate the efficacy of low-molecular weight heparin, clopidogrel and their combination to improve the flap survival. METHODS Forty male, adult Sprague-Dawlay rats were divided randomly into 4 groups. Standard rectangular, distally based dorsal random pattern skin flap was elevated. To prevent the graft effect, a sterile sheet was put under the flap. No pharmacological agent was administered for the control group. In group 2, single subcutaneous dose of enoxaparin (3.2 mg/kg) was immediately administrated after surgery. In group 3, clopidogrel (25 mg/kg) was given orally for 7 days. In group 4, both enoxaparin and clopidogrel were administrated. The rats were evaluated on post-operative day 7 for viable and necrotic portions of flaps. RESULTS The mean and SD of necrosis was 17.79+2.5 cm in the control group, 16.20±3.1 cm in low-molecular weight heparin, 15.25+3.8 cm in combined therapy group and 13.69+2.7 cm in clopidogrel group. Clopidogrel was the only pharmaceutical agent that produced a significant increase in the flap survival area. CONCLUSION Clopidogrel may be an effective pharmaceutical agent that significantly increases viability of random skin flaps in rats, but low-molecular weight heparin and their combination did not have any significant beneficial effects. PMID:25734046

  15. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

    PubMed Central

    Bali, ?lhan; Aziret, Mehmet; Sözen, Selim; Emir, Seyfi; Erdem, Hasan; Çetinkünar, Süleyman; ?rkörücü, Oktay

    2015-01-01

    OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus. PMID:26039952

  16. Reduction of Flap Side Edge Noise - the Blowing Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Brooks, THomas F.

    2005-01-01

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

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

    PubMed

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

    2012-01-01

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

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

    PubMed

    Politi, M; Robiony, M

    1995-10-01

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

  19. Free perivascular tissue flap transfer.

    PubMed

    Matsuda, Ken; Kubo, Tateki; Fukai, Megumi; Kikuchi, Mamoru; Hikasa, Hisashi; Nakajima, Yoriko; Tomita, Koichi; Shibata, Minoru; Hosokawa, Ko

    2015-07-01

    Local flaps and composite grafting are the procedures of choice for reconstructing relatively small soft tissue defects. However, despite their limited conveyable volume, local flaps sometimes require a wide dissection area and long new incisions. Composite grafts also have serious limitations and require a well-vascularized recipient bed. To overcome these limitations, we used a free vascularized perivascular tissue flap based on the descending branch of the lateral femoral circumflex artery. Using this method, we performed reconstructions for seven patients (four cases in head and neck region and three cases in lower limb) with various soft tissue defects (ranged from 4.0 cm(3) to 40.0 cm(3)). This flap was easily elevated, without the need for precise preoperative flap design, and the flap volume was adjustable regardless of whether deep fascia and muscle were included. The flap has a rich vascular supply, which allows bone and cartilage tissue to be combined with the transfer of soft tissue, and satisfactorily treats chronic wounds with poor blood supply. PMID:25824197

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

    PubMed

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

    2015-04-01

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

  1. The sternocleidomastoid myoperiosteal flap for esophagopharyngeal reconstruction and fistula repair: clinical and experimental study.

    PubMed

    Friedman, M; Toriumi, D M; Strorigl, T; Chilis, T; Skolnik, E

    1988-10-01

    Despite advances in head and neck surgery, reconstruction of the pharynx and cervical esophagus continues to be troublesome. Classic pedicled flaps are often too bulky and difficult to position for repair of pharyngeal and esophageal fistulas. An ideal flap would be local, well-vascularized, compact, and capable of being sutured into a tension-free, water-tight seal. In selected cases, the sternocleidomastoid myoperiosteal flap can meet these requirements in a single-stage procedure for repair of fistulas as well as selected cases of primary pharyngeal reconstruction. The use of this flap is described in five patients. Two patients underwent laryngectomy with partial pharyngectomy that left inadequate mucosa for primary closure. A sternocleidomastoid myoperiosteal flap was used to add width to the remaining mucosa. Both patients healed within 3 weeks and remained stricture free. Three other patients who underwent radiation followed by tumor resection and standard primary closure of the pharynx developed fistulas. Two fistulas were repaired successfully with the sternocleidomastoid myoperiosteal flap, and both patients were able to eat a general diet on the eighth postoperative day. Reconstruction was also performed in dogs to histologically evaluate the epithelialization capacity of the periosteum. There was total epithelialization of the flap at 4 weeks after reconstruction. PMID:3172955

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

    PubMed

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

    2014-04-22

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

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

    PubMed Central

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

    2014-01-01

    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

  4. Supraclavicular artery island flap reconstruction of a contralateral partial laryngopharyngeal defect.

    PubMed

    Kucur, C; Durmus, K; Ozer, E

    2015-04-01

    Oncologic resection of head and neck cancers often results in complex reconstructive problems that can require local, regional, or free flaps. Herein, we present a case of a 67-year-old female with a history of floor of mouth cancer who had a second primary carcinoma in the left side of pharynx, 9 years after initial therapy. She underwent a wide oncologic resection requiring laryngopharyngeal reconstruction. Significant scar formation on the left side, due to previous surgery and radiotherapy, prevented us from harvesting an ipsilateral flap. Therefore, we used a right sided supraclavicular artery island flap for reconstruction of the contralateral defect. The patient healed completely with hyperbaric oxygen therapy and conservative local wound care. Supraclavicular artery island flap is a viable option for poor microvascular surgical candidates. It is easy and quick to harvest, and significantly decreases operative times. It is thus a versatile option for contralateral laryngopharyngeal reconstruction. PMID:26019397

  5. Sectioned Images and Surface Models of a Cadaver for Understanding the Dorsalis Pedis Flap.

    PubMed

    Shin, Dong Sun; Kim, Hyung Jun; Kim, Bong Chul

    2015-07-01

    The aim of this study was to represent the dorsalis pedis (DP) flap on sectioned images and surface models using Visible Korean for medical education and clinical training in the field of maxillofacial reconstructive surgery. Serially sectioned images of the foot were obtained from a cadaver. The important structures in the sectioned images were outlined and stacked to create a surface model. The PDF file (53?MB) of the assembled models is accessible for free download on the Department of Anatomy at Ajou University School of Medicine Web site (http://anatomy.co.kr). In this file, the significant anatomic structures of the DP flap can be inspected in the sectioned images. All surface models and stereoscopic structures of the DP flap are described in real time. We hope that these state-of-the-art sectioned images, outlined images, and surface models will help students and trainees gain a better understanding of the DP flap anatomy. PMID:26079120

  6. Successfully treated descending necrotizing mediastinitis through thoracotomy using a pedicled muscular serratus anterior flap.

    PubMed

    Haremza, Céline; De Dominicis, Florence; Merlusca, Geoni; Berna, Pascal

    2011-10-01

    Descending necrotizing mediastinitis (DNM) is rare and aggressive. A 68-year-old female with no medical history, was admitted to our institution for cervical cellulitis. After a conventional medical treatment, multiple abscesses of the upper mediastinum appeared on computed tomography (CT) findings. Although two cervicotomies were performed, a new necrotic abscess appeared in the anterior upper and middle mediastinum. An extensive debridement of cellulitis and abscess extended to the pericardium was made by thoracotomy. Middle mediastinum and pericardium were covered and reconstructed by a right pedicled serratus anterior flap. After radical surgery, follow-up was uneventful. Early extensive and complete debridement of cervical and mediastinal collections and irrigation with broad-spectrum intravenous antibiotics is essential. Combined surgery is the best approach in DNM. The use of a pedicled muscular flap helps control the sepsis. In such cases, serratus anterior flap is a flap of choice because it is reliable and always available even in a skinny patient, contrary to omentum. In this life-threatening disease, an early aggressive combined surgery with debridement of all necrotic tissues extended to the pericardium if necessary associated with a pedicled flap is mandatory. PMID:21791516

  7. In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

    PubMed Central

    Edmunds, Marie-Claire; Wigmore, Stephen; Kluth, David

    2013-01-01

    Free tissue transfer is the gold standard of reconstructive surgery to repair complex defects not amenable to local options or those requiring composite tissue. Ischemia reperfusion injury (IRI) is a known cause of partial free flap failure and has no effective treatment. Establishing a laboratory model of this injury can prove costly both financially as larger mammals are conventionally used and in the expertise required by the technical difficulty of these procedures typically requires employing an experienced microsurgeon. This publication and video demonstrate the effective use of a model of IRI in rats which does not require microsurgical expertise. This procedure is an in situ model of a transverse abdominis myocutaneous (TRAM) flap where atraumatic clamps are utilized to reproduce the ischemia-reperfusion injury associated with this surgery. A laser Doppler Imaging (LDI) scanner is employed to assess flap perfusion and the image processing software, Image J to assess percentage area skin survival as a primary outcome measure of injury. PMID:23770929

  8. Use of a caudal auricular axial pattern flap in three cats and one dog following orbital exenteration.

    PubMed

    Stiles, Jean; Townsend, Wendy; Willis, Michelle; Moore, Phillip A; Smith, Eric

    2003-06-01

    Orbital exenteration accompanied by wide eyelid excision in the cat and dog may leave a defect that cannot be closed in a primary fashion. This report describes the use of a caudal auricular axial pattern flap to effect closure following orbital exenteration in three cats and one dog. The most common complication was distal flap necrosis, which necessitated a second surgery in two patients. PMID:12753612

  9. Double cheek-cervical rotation flap for repair of facial defects.

    PubMed

    Lim, R Y; Strickland, S A; Lim, J W

    1993-01-01

    Repair of extensive facial defects due to cancer surgery or trauma is a challenge to restore form, function, and facade. This article studies the advantages of using the double cheek-cervical rotation flap for immediate reconstruction of 10 patients with huge facial defects. PMID:8421911

  10. Refractive Surgery Survey 2001.

    PubMed

    Solomon, Kerry D; Holzer, Mike P; Sandoval, Helga P; Vargas, Luis G; Werner, Liliana; Vroman, David T; Kasper, Terrance J; Apple, David J

    2002-02-01

    In February 2001, a questionnaire on the practice of refractive surgery was sent worldwide to all 8196 members of the American Society of Cataract and Refractive Surgery; 1511 responses (18.4%) were received. Although laser in situ keratomileusis (LASIK) was the most common refractive procedure reported, phakic intraocular lenses, clear lens extraction, and photorefractive keratectomy were also widespread. Nineteen percent of the respondents said they had had refractive surgery, and that group reported performing significantly more procedures than those who had not had a refractive procedure (P < .0001). The most common complication of LASIK was dry eyes, occurring in more than half of the cases in one fourth of the practices; however, only 30% of surgeons said they perform a Schirmer test before surgery. High-volume surgeons reported seeing fewer cases of flap striae (P = .002) and slipped flaps (P = .02) than low-volume surgeons. Seventy-seven percent said that wavefront LASIK ablation will increase the quality of vision and of those already performing wavefront ablation, 92% stated they believe it will improve outcomes. PMID:11821220

  11. Nasal reconstruction by modified bilobed forehead flap.

    PubMed

    Akbay, Ercan; Cokkeser, Ya?ar; Karao?lu, Emre

    2012-01-01

    Paramedian forehead flaps, which are supplied by supratrochlear artery and have structural compatibility with nasal skin, have been successfully used for nasal reconstruction for many years. However, removing this flap from midline as perpendicular to natural lines of forehead may lead to marked scar. A flap extending to lateral in parallel to natural lines of forehead results in ipsilateral elevation of eyebrow. In this article, we aimed to demonstrate a flap technique called as "modified bilobed forehead flap technique". In this technique, pedicle of the flap is supplied by supratrochlear artery at one side and the flap is removed at the contralateral side of the lesion using parallel incision to natural lines of forehead. Another flap with a half thickness of the original flap is removed from contralateral frontal region and interpolated to the site where the original flap is removed to prevent the asymmetrical elevation of eyebrow ipsilateral to flap removal. The aim of this technique is to utilize masking effect of natural lines of forehead, while the basic method is bilobed flap technique. Secondary benefits of this technique include forehead lifting and bilateral eyebrow lifting. PMID:23176701

  12. O to Z flaps in facial reconstructions*

    PubMed Central

    Luna, Sara Alcántara; Cejudo, Manuel Perea; Mendonça, Francisco Manuel Ildefonso; Martínez, Francisco M. Camacho

    2015-01-01

    Local flaps are the standard procedure to reconstruct facial defects. As it occurs in any surgical procedure, the incision should be planned so that scars are located in the minimum skin tension lines. We report two cases of O to Z flaps in the supra and infraciliary regions. One of them is a hatchet flap. PMID:25831001

  13. Regional anesthesia alone for pediatric free flaps.

    PubMed

    Bjorklund, Kim A; Venkatramani, Hari; Venkateshwaran, Govindaswamy; Boopathi, Vadivel; Raja Sabapathy, S

    2015-05-01

    Microvascular surgery plays an important reconstructive role in the pediatric population. Successful outcomes rely on surgical technique as well as anesthesia. Regional anesthesia contributes to successful free tissue transfer through sympathetic blockade, postoperative pain control, and elimination of risks and costs associated with general anesthesia. While regional anesthesia in microsurgery is discussed in the literature for adult and elderly patients, no studies focus on the pediatric population. Accordingly, this paper reviews 20 pediatric patients undergoing microvascular surgery (anterolateral thigh, n = 9; gracilis, n = 3; toe transfer, n = 6; and fibula, n = 2) with regional anesthesia and sedation. All patients underwent spinal epidural anesthesia, and seven also received brachial plexus blocks. The average duration of anesthesia was 3-4 h (anterolateral thigh (ALT) and gracilis) and 6-8 h (toe transfer and fibula). No anesthesia-related complications or flap failures occurred. We conclude that regional anesthesia has important benefits in pediatric microsurgery and it is a safe and cost-effective alternative to general anesthesia. PMID:25858275

  14. Flap noise generation and control

    NASA Technical Reports Server (NTRS)

    Chestnutt, D.; Maglieri, D. J.; Hayden, R. E.

    1972-01-01

    The characteristics of aerodynamic noise generated by the interaction of an airstream with a flap surface are discussed. The location and behavior of various noise sources were investigated to determine optimal quieting techniques. A schematic diagram of the jet-flap concepts being considered for integrated-powered-lift systems for short takeoff aircraft is shown. Each of the concepts has in common high velocity turbulent air flowing over relatively rigid surfaces with resultant production of interaction noise. The nature, location, and control of noise sources which involve the interactions of air flows with airfoil surfaces are examined.

  15. Use of Postoperative Palatal Obturator After Total Palatal Reconstruction With Radial Forearm Fasciocutaneous Free Flap.

    PubMed

    Jeong, Euicheol C; Jung, Young Ho; Shin, Jin-Yong

    2015-07-01

    A 67-year-old-male patient visited our hospital for a mass on the soft palate of approximately 5.0 × 6.0?cm in size. He was diagnosed with adenoid cystic carcinoma and reconstruction after total palate resection was planned. After ablative surgery, a radial forearm free flap procedure was successfully performed to cover the hard and soft palates. However, wound disruption occurred twice during the postoperative period.When a palate defect is reconstructed using a soft tissue free flap, flap drooping by gravitation and the flap itself can generate irregularity in the lower contour of the palate and, in the long-term, insufficiencies of velopharyngeal function, speech, and mastication. To complement such functional and aesthetic problems caused by flap drooping, conventional prosthetics and new operative techniques have been discussed. However, overcoming wound disruption caused by flap drooping in the acute postoperative period has not been discussed.In this case, the temporary use of a palatal obturator during the postoperative period was beneficial after soft tissue reconstruction of the palate. PMID:26114541

  16. Four-flap Breast Reconstruction: Bilateral Stacked DIEP and PAP Flaps

    PubMed Central

    Mayo, James L.; Allen, Robert J.

    2015-01-01

    Background: In cases of bilateral breast reconstruction when the deep inferior epigastric perforator (DIEP) free flap alone does not provide sufficient volume for body-specific reconstruction, stacking each DIEP flap with a second free flap will deliver added volume and maintain a purely autologous reconstruction. Stacking the profunda artery perforator (PAP) flap with the DIEP flap offers favorable aesthetics and ideal operative efficiency. We present the indications, technique, and outcomes of our experience with 4-flap breast reconstruction using stacked DIEP/PAP flaps. Methods: The authors performed 4-flap DIEP/PAP breast reconstruction in 20 patients who required bilateral reconstruction without adequate single donor flap volume. The timing of reconstruction, average mastectomy/flap weights, and operative time are reported. Complications reviewed include fat necrosis, dehiscence, hematoma, seroma, mastectomy flap necrosis, and flap loss. Results: Twenty patients underwent 4-flap DIEP/PAP breast reconstruction. Surgical time averaged 7 hours and 20 minutes. The primary recipient vessels were the antegrade and retrograde internal mammary vessels. No flap losses occurred. Complications included 1 hematoma, 1 incidence of arterial and venous thrombosis successfully treated with anastomotic revision, 1 incidence of thigh donor site dehiscence, and 3 episodes of minor mastectomy skin flap necrosis. Conclusions: Four-flap breast reconstruction is a favorable autologous reconstructive option for patients requiring bilateral reconstruction without adequate single donor flap volume. Stacking DIEP/PAP flaps as described is both safe and efficient. Furthermore, this combination provides superior aesthetics mirroring the natural geometry of the breast. Bilateral stacked DIEP/PAP flaps represent our first choice for breast reconstruction in this patient population.

  17. Innervated boomerang flap for finger pulp reconstruction.

    PubMed

    Chen, Shao-Liang; Chiou, Tai-Fung

    2007-11-01

    The boomerang flap originates from the dorsolateral aspect of the proximal phalanx of an adjacent digit and is supplied by the retrograde blood flow through the vascular arcades between the dorsal and palmar digital arteries. To provide sensation of the boomerang flap for finger pulp reconstruction, the dorsal sensory branch of the proper digital nerve and the superficial sensory branch of the corresponding radial or ulnar nerve are included within the skin flap. After transfer of the flap to the injured site, epineural neurorrhaphies are done between the digital nerves of the pulp and the sensory branches of the flap. We used this sensory flap in five patients, with more than 1 year follow-up, and all patients achieved measurable two-points discrimination. The boomerang flap not only preserves the proper palmar digital artery but also provides an extended and innervated skin paddle. It seems to be an alternative choice for one-stage reconstruction of major pulp defect. PMID:17597624

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

    PubMed

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

    2013-07-01

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

  19. Respiratory failure after superior-based pharyngeal flap for velopharyngeal insufficiency: A rare complication.

    PubMed

    Lawlor, Claire M; Riley, Charles A; Hildrew, Douglas M; Guarisco, J Lindhe

    2015-07-01

    Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented. To date, there have been no published cases of respiratory failure secondary to pneumomediastinum, pneumopericardium, and bilateral pneumothoraces with associated subcutaneous emphysema after superior-based pharyngeal flap. We present the first case in the literature. Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation. PMID:25953454

  20. Total nasal reconstruction using a prelaminated free radial forearm flap and porous polyethylene implants.

    PubMed

    Tsiliboti, D; Antonopoulos, D; Spyropoulos, K; Naxakis, S; Goumas, P

    2008-08-01

    Reconstruction of total nasal defects remains one of the most difficult problems in plastic surgery as the nose combines aesthetics and function. Standard techniques using either forehead or nasolabial flaps do not have a place in the case of extensive scarring on the face or areas with high risk of cancer recurrence on the face. In these cases, microsurgical free tissue transfer for the soft tissue reconstruction in combination with bone grafts or implants for the nasal skeleton are ideal. We report the use of prelaminated radial forearm flap with porous polyethylene implants for total nasal reconstruction. PMID:18688765

  1. Keystone Design Sliding Skin Flap for the Management of Small Full Thickness Burns

    PubMed Central

    Al-Busaidi, Azher A.; Semalesan, Nirannanilathu; Al-Busaidi, Said S.

    2011-01-01

    Deep dermal burns and full thickness burns are generally managed by excision and split thickness skin grafting. The skin graft may lead to unacceptable colour changes and be aesthetically unacceptable. Also, there may be a contour defect and, furthermore, it is followed by varying degrees of contracture. The keystone design sliding flap, first described in 2003, avoids the need for grafting and is not associated with any skin graft problems. We report two cases of the use of this flap as the primary surgery in reconstruction of small full thickness burn defects. PMID:22087386

  2. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants

    PubMed Central

    Gunnarsson, Gudjon L.; Břrsen-Koch, Mikkel; Nielsen, Henrik T.; Salzberg, Andrew

    2015-01-01

    Summary: We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes (200–330), and the average implant size used was 350 cm3 (195–650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for single-stage bilateral breast reconstruction. PMID:26180736

  3. Endoscopic ICG perfusion imaging for flap transplants: technical development

    NASA Astrophysics Data System (ADS)

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

    2010-02-01

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

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

    PubMed

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

    2007-03-01

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

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

    PubMed

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

    2013-01-14

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

  6. Refinements of medial plantar flap used for covering nonweightbearing ankle and posterior heel defects requiring thin flaps.

    PubMed

    Ulkür, Ersin; Açikel, Cengiz; Karagöz, Hüseyin; Celiköz, Bahattin

    2005-10-01

    We present our clinical experiences with the refinements that we applied to avoid circular flap contraction and achieve thin flap coverage in the reconstruction of posterior heel and tendocalcaneal skin defects with medial plantar flap. Eight male patients, aged 18 to 35 (mean 24 years), with nonweightbearing skin defects, were treated with refined medial plantar flaps. All flaps survived and no circulation problem was encountered. The flaps adapted well to the recipient area, and thin and well-contoured skin coverage was achieved by postoperative month 6. As a conclusion, it is possible to reconstruct the nonweightbearing defects needing thin flap by medial plantar flap with adding refinements: (1) adding triangles around the flap, (2) harvesting a thin flap by excluding the thick plantar fascia, (3) harvesting a further thin flap by defatting of the flap, (4) application of pressure to the flap. PMID:16186701

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

    PubMed Central

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

    2014-01-01

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

  8. Aerodynamics of jet flap and rotating cylinder flap STOL concepts

    NASA Technical Reports Server (NTRS)

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

    1974-01-01

    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.

  9. The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect.

    PubMed

    Momeni, A; Krischak, S; Bannasch, H

    2006-01-01

    High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury. PMID:17001635

  10. Pressure Distribution Over Airfoils with Fowler Flaps

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Anderson, Walter B

    1938-01-01

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

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

    PubMed

    Dunne, Jonathan A

    2014-12-01

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

  12. Clinical results of TRAM flap delay by selective embolization of the deep inferior epigastric arteries.

    PubMed

    Scheufler, O; Andresen, R; Kirsch, A; Banzer, D; Vaubel, E

    2000-04-01

    Preoperative selective embolization of the deep inferior epigastric arteries constitutes a new technique in TRAM flap delay. Whereas surgical ligation of these vessels has proved to be an effective delay procedure in experimental and clinical settings, it requires an additional operative step under general anesthesia. Despite the introduction of the free TRAM leading to improved flap perfusion, this microsurgical technique is not always available because of the requirements of specialized equipment and staff, longer operating hours, and subsequently higher expenses. The search for a minimally invasive, easy, and inexpensive technique to improve perfusion of the pedicled TRAM flap led us to selective embolization of the deep inferior epigastric arteries by an angiographic procedure. After 4 years of experience with this technique, we now present the first clinical results. Breast reconstruction by a delayed pedicled TRAM flap was performed in 40 patients with a mean age of 48.4 years (range, 31 to 66 years). The mean interval between embolization and surgery was 3.6 months. Postoperative data concerning flap survival and complications were available for all patients. Embolization of the deep inferior epigastric arteries was performed bilaterally in 35 patients (87.5 percent) and unilaterally in 5 patients (12.5 percent). Radiotherapy had been applied in 21 patients (52.5 percent) before surgery. Postoperative flap complications consisted of partial necrosis in three (7.5 percent), fat necrosis in one (2.5 percent), impaired wound healing in five (12.5 percent), and postoperative bleeding in two patients (5 percent). Abdominal wound healing complications occurred in six patients (15 percent), abdominal wall weakness in eight (20 percent), and hernia formation in four (10 percent). Surgical corrections were performed at the breast (TRAM flap) in 22 patients (55 percent) and at the abdomen (donor site) in 9 (22.5 percent). Preoperative selective embolization of the deep inferior epigastric arteries constitutes an alternative delay procedure for the pedicled TRAM flap. It is superior to the conventional procedure without delay, offers several advantages compared with surgical ligation of these vessels, and represents an alternative to the free TRAM flap in selected cases. PMID:10744221

  13. [Digestive flaps and facial microsurgery].

    PubMed

    Devauchelle, B; Testelin, S; Verhaeghe, P

    1997-01-01

    Abdominal wall and contents can be used out of the coeliac cavity, as tissues donors site, for filling up or covering defects. Microsurgical technology mastery can extend their use in all the human body parts, especially in the craniofacial area. More than 110 digestive free transplants have been used during a 8 year period in head and neck surgical repairs. The report shows how to exploit at their best the anatomical and physiological properties of diverse abdominal tissues. Beyond this, the possible association of these transplants with other repair techniques opens new therapeutical perspectives, such as chimerical flaps whose pedicle distributes to heterogenous (or heteroclite) components, double flaps with a single or a double pedicle, replacing, at one single operative time, each missing tissue by the most adequate transplant. In consideration of this, abdominal tissues are an inexhaustible source of transplants, even through some imperfections must be managed. PMID:9588061

  14. Craniotomy flap osteomyelitis: a diagnostic approach

    SciTech Connect

    Blumenkopf, B.; Hartshorne, M.F.; Bauman, J.M.; Cawthon, M.A.; Patton, J.A.; Friedman, A.H.

    1987-01-01

    Nine cases of suspected craniotomy flap osteomyelitis evaluated by combined bone and gallium scanning are presented. In six cases, the clinical data were inconclusive and evaluation by radionuclide imaging provided an accurate negative diagnosis. The other three cases considered positive by this technique were proven infected at subsequent exploration and flap removal. The use of radionuclide bone and gallium imaging should be considered in cases of possible craniotomy flap osteomyelitis.

  15. Gurney Flaps in Transonic Flows

    Microsoft Academic Search

    Henning Rosemann; Kai Richter

    \\u000a The application of Gurney flaps to airfoils, high aspect ratio wings and delta wings in transonic flow is being investigated\\u000a at the Institute of Aerodynamics and Flow Technology of DLR. The present paper gives an overview over these studies explaining\\u000a the basic working principles and advantages of these trailing edge devices at transonic Mach numbers. Numerical studies confirmed\\u000a by wind

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

    PubMed

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

    2015-03-01

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

  17. Distally based dorsal forearm fasciosubcutaneous flap.

    PubMed

    Kim, Kwang Seog

    2004-08-01

    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 reconstruct skin defects on the dorsum of the hand in nine patients at Chonnam National University Medical School. The sizes of these flaps ranged from 10 to 14 cm in length and from 5 to 7 cm in width. The flaps survived in all patients. Marginal loss over the distal edge of the flap was noted in one patient. Three flaps that developed minimal skin-graft loss were treated successfully with a subsequent split-thickness skin graft. The long-term follow-up showed good flap durability and elasticity. The distally based dorsal forearm fasciosubcutaneous flap is a convenient and reliable alternative for reconstructing skin defects of the dorsum of the hand involving vital structure exposure. It obviates the need for more complicated and time-consuming procedures. PMID:15277804

  18. A water tunnel study of Gurney flaps

    NASA Technical Reports Server (NTRS)

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

    1988-01-01

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

  19. New Refinements in Greater Omentum Free Flap Transfer for Severe Secondary Lymphedema Surgical Treatment

    PubMed Central

    Pinilla, Carmen; Castellano, Michele

    2015-01-01

    Summary: Lymphedema is a chronic debilitating disease, affecting a considerable part of the population; it results from impairment of the lymphatic system. It is highly prevalent among patients subjected to axillary and groin nodal dissection after surgery for breast cancer, abdominopelvic surgery, and lymphadenectomy after melanoma surgery. Interestingly, among the surgical treatment options for lymphedema, groin lymph node transfer is gaining popularity; however, in some cases, dissection at this site can cause significant morbidity, including possible development of iatrogenic lymphedema. To avoid these complications, new donor nodal groups are being proposed (eg, submental or supraclavicular). We have used the greater omentum as a lymph node and lymph vessel donor site. Dissection of the omentum is easy to perform and can even be done in patients who have undergone previous abdominal surgeries. We present refinements in the surgical technique for free omentum transfer in the management of secondary lymphedema: the first free omental flap dissection performed laparoscopically and the use of a primary flap as the recipient pedicle of a free greater omentum flap for anatomical repair after chest osteoradionecrosis and simultaneous functional repair of chronic lymphedema.

  20. Inferior-based pharyngeal flap for correction of stress velopharyngeal incompetence in musicians: case reports and review of the literature.

    PubMed

    Visser, A; van der Biezen, J J

    2012-07-01

    Stress velopharyngeal incompetence (SVPI) is a special form of velopharyngeal incompetence observed in musicians who play wind and brass instruments. Due to high intraoral pressures generated while playing, the velopharyngeal structures fail to seal off the nasopharynx properly, resulting in unwanted nasal air leakage or noises. We present two young female professional clarinetists who experience symptoms of SVPI that preclude the development of their professional career. Both musicians underwent an inferior based pharyngeal flap, a well-known flap frequently used in cleft palate surgery. Both musicians were symptom-free after surgery and remain free of nasal noises while playing the clarinet after 2 and 4 years of follow-up. We present a review of literature of management of SVPI and show that the inferior-based pharyngeal flap is a feasible option for management of these potentially career ending symptoms. PMID:22212382

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

    PubMed Central

    Varghese, Don; Datta, Shubharanjan; Varghese, Annie

    2015-01-01

    Background: The purpose of this review was to assess the effectiveness of the buccal myomucosal flap in secondary repairs of cleft palate in 20 patients. Patients and Methods: Totally, 20 patients, who underwent secondary palatoplasty between 5 years and 8 years in which a buccal myomucosal flap was used, were reviewed retrospectively. All patients had undergone at least one previous attempted repair at other institutions. Indications for the secondary repair included velopharyngeal incompetence and/or oronasal fistula. Patients were evaluated preoperatively for oronasal fistula status, velopharyngeal competence, nasal resonance, speech quality, and nasal escape. Results: The buccal myomucosal flap was used in all 20 patients, and there was marked increase in the quality of speech as well as nasal regurgitation decreased. In patients with levator dysfunction due to poor primary surgery and glottal speech the results were inconclusive Conclusion: Palate re-repair combined with a buccal myomucosal flap, occasionally in conjunction with other techniques, is an effective method for correcting failed cleft palate repairs. Minimum donor site morbidity and complication makes the buccal flap a useful armamentarium of a cleft surgeon. PMID:25821372

  2. Factors predicting fistula following radial forearm free flap reconstruction for head and neck cancer.

    PubMed

    Joo, Young-Hoon; Sun, Dong-Il; Park, Jun-Ook; Cho, Kwang-Jae; Kim, Min-Sik

    2010-09-01

    The goal of this study was to evaluate the relationship between postoperative fistula formation and perioperative risk factors after radial forearm free flap (RFFF) reconstruction for head and neck cancer. A total of 180 patients underwent RFFF reconstruction after head and neck ablative surgery from October 1993 to July 2009. Age, gender, systemic disease, smoking status, tumor stage, preoperative radiotherapy, reconstruction site, concurrent neck dissection, flap shape and size, and partial or complete flap necrosis were recorded as potential prognostic variables. Twenty-one (11.7%) of the 180 patients developed a fistula. Significant correlations were found between fistula formation and diabetes mellitus (p=0.015) and preoperative radiotherapy (p=0.029). Reconstruction of the hypopharynx influenced fistula formation with borderline significance (p=0.057). The multivariate analysis showed a significant association between fistula formation and diabetes mellitus (odds ratio=5.4 [95% CI, 1.0-27.6]) and preoperative radiotherapy (odds ratio=5.9 [95% CI, 1.1-32.6]). Spontaneous fistula closure occurred in 10 patients, but surgical closure with a local flap or pectoralis major myocutaneous flap was necessary in the other 11 patients. Diabetes mellitus and preoperative radiotherapy were found to be risk factors for fistula formation in patients that underwent RFFF reconstruction for head and neck cancer. PMID:20729137

  3. The postauricular fascial flap as an adjunct to Mustardé and Furnas type otoplasty.

    PubMed

    Horlock, N; Misra, A; Gault, D T

    2001-11-01

    Anterior riberation methods of otoplasty have been criticized because of the risk of anterior hematoma that can cause anterior skin necrosis, scarring, and even cartilage destruction caused by infection. As a result, cartilage-sparing otoplasty such as the Mustardé and Furnas types has been increasingly popular. However, postauricular suture extrusion may result, and recurrence rates of up to 25 percent have been recorded. In this study, cartilage-sparing otoplasty is refined by the addition of a postauricular fascial flap to reduce suture extrusion and recurrence rates. Fifty-one patients underwent otoplasty (45 bilateral, six unilateral). This technique involves the elevation of a fascial flap from the postauricular region. A new antihelical fold is then created by Mustardé sutures, and the conchal bowl is rotated by Furnas-type concha-mastoid sutures. The fascial flap is then advanced to cover the sutures with a supplementary vascularized layer to prevent suture extrusion. In addition, the advancement of the flap acts as a postauricular support to prevent recurrence. A natural-looking antihelical fold and helical rim is created by this technique. There were no hematomas. There was recurrence in eight ears (8 percent) in six patients. Two patients requested further surgery. No patients developed suture extrusion or granuloma. This is a simple and intrinsically safe procedure and does not cause irreparable complications such as anterior scarring or skin necrosis. The postauricular fascial flap seems to prevent suture extrusion. It may also help to reduce recurrence rates to acceptable levels. PMID:11711914

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

    PubMed Central

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

    2014-01-01

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

  5. Is distal fibular fracture an absolute contraindication to free fibular flap harvesting? A review of evidence in the literature and illustration by a successful case.

    PubMed

    Chan, Richie Chiu-Lung; Wei, Fu-Chan; Wong, Jason Kin Fai; Wu, Chao-Min

    2015-01-01

    Despite the advantages of a fibula flap, many surgeons would often be hesitant in its use in patients with a history of distal fibular fracture. The chief concern is the potential vascular damage sustained during the injury. From our experience, however, we noticed that the blood supply of various components of a fibula flap rarely relies on its distal part alone. Avoiding the use of this flap may unnecessarily forgo the optimal reconstructive option in many patients. Free fibula flap was harvested from a 41-year-old man who had a history of left fibula fracture 10 years before surgery. The fracture was treated with open reduction with internal fixation. The plate was removed 1 year after the trauma surgery. We used this fractured and healed fibula to reconstruct the intraoral and mandibular defect after tumor extirpation. The harvesting process was straight-forward and the flap survived uneventfully. On the basis of our experience and current evidence in the literature, we believe that a history of previous fibular fracture should not be considered as an absolute contraindication for free fibular flap harvesting. With a good knowledge of the lower limb anatomy and appropriate patient selection, the fibular flap can still be a safe option that incurs no additional risk. PMID:24677116

  6. Prelaminating the fascial radial forearm flap by using tissue-engineered mucosa: improvement of donor and recipient sites.

    PubMed

    Lauer, G; Schimming, R; Gellrich, N C; Schmelzeisen, R

    2001-11-01

    In reconstructive surgery, prelamination of free flaps using split-thickness skin is an established technique to avoid the creation of a considerable defect at the donor site, for example, in the case of a radial forearm flap. For oral and maxillofacial surgery, this technique is less than optimal for the recipient site because the transferred skin is inadequate to form a lining in the oral cavity. To create mucosa-lined free flaps, prelamination using pieces of split-thickness mucosa has been performed. However, the availability of donor sites for harvesting mucosa is limited. The present study combines a tissue-engineering technique with free flap surgery to create mucosa-lined flaps with the intention of improving the tissue quality at the recipient site and decreasing donor-site morbidity. On five patients undergoing resection of squamous cell carcinoma of the oral cavity, the radial forearm flap was prelaminated with a tissue-engineered mucosa graft to reconstruct intraoral defects. Using 10 x 5 mm biopsies of healthy mucosa, keratinocytes were cultured for 12 days and seeded onto collagen membranes (4.5 x 9 cm). After 3 days, the mucosal keratinocyte collagen membrane was implanted subcutaneously at the left or right lower forearm to prelaminate the fascial radial forearm flap. One week later, resection of the squamous cell carcinoma was performed, and the free fascial radial forearm flap pre- laminated with tissue-engineered mucosa was transplanted into the defect and was microvascularly anastomosed. Resection defects up to a size of 5 x 8 cm were covered. In four patients, the graft healed without complications. In one patient, an abscess developed in the resection cavity without jeopardizing the flap. During the postoperative healing period, the membrane detached and a vulnerable pale-pink, glassy hyperproliferative wound surface was observed. This surface developed into normal-appearing healthy mucosa after 3 to 4 weeks. In the postoperative follow-up period, such functions as mouth opening and closing and speech attested to the success of the tissue-engineering technique for flap prelamination. PMID:11711928

  7. Effects of nebivolol on skin flap survival: A randomized experimental study in rats

    PubMed Central

    Gideroglu, Kaan; Alagoz, Sahin; Uygur, Fatih; Evinc, Rahmi; Celikoz, Bahattin; Bugdayci, Guler

    2008-01-01

    Background: Skin flaps are among the basic treatment options in the reconstruction of soft tissue defects. To improve skin flap survival, a variety of methods, including pharmacologic agents, have been investigated. The effectiveness of anticoagulants, antioxidants, anti-inflammatory drugs, and vasodilatory drugs in improving flap survival has been studied. Nebivolol is a new-generation selective ?1-adrenoreceptor blocking agent that has vasodilatory, antithrombotic, antioxidative, and anti- inflammatory effects. Objective: The aim of this experimental study was to investigate the effects of nebivolol (50 mg/kg/d) on random pattern skin flap survival in rats. Methods: Male Wistar rats weighing 290 to 310 g were randomly divided into 2 groups—the nebivolol group and the control group. Random patterned, caudally-based, ~3 × 10-cm skin flaps were elevated on the back of each rat. In the nebivolol group, nebivolol 50 mg/kg/d (1 mL, of a racemic solution of nebivolol) was administered orally 2 days before surgery to reach steady-state drug blood concentrations and was continued for 6 days. In the control group, 1 mL/d of sterile saline solution was orally administered 2 days before surgery and was continued for 6 days. To observe the effects of nebivolol, cutaneous blood flow was examined using a laser Doppler flow-meter before and after surgery on days 1, 3, 5, and 7, and flap tissue, malondialdehyde (MDA) and glutathione (GSH) concentrations, and superoxide dismutase (SOD) activity were measured 7 days postsurgery. Flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area. Results: All 20 rats (nebivolol group, n = 10; control group, n = 10) survived throughout the study period. Mean (SD) MDA concentration was significantly lower in the nebivolol group than in the control group (69.25 [5.82] vs 77.67 [6.87] nmol/g tissue; P = 0.009). GSH concentration was significantly higher in the nebivolol group than in the control group (2.14 [0.15] vs 1.88 [0.22] nmol/mg tissue; P = 0.004). SOD activity was significantly greater in the nebivolol group than in the control group (49.28 [5.49] vs 42.09 [4.95] U/g tissue; P = 0.007). The percentage of the flap that was necrotic was significantly lower in the nebivolol group than in the control group (40.27 [4.08] vs 48.87 [6.35]; P = 0.007). Conclusions: This small, experimental, in vivo animal study found that nebivolol was associated with reduced necrotic random pattern skin flap area. Further studies are needed to clarify these findings. PMID:24692819

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

    Microsoft Academic Search

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

    2005-01-01

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

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

    Microsoft Academic Search

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

    2002-01-01

    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

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

    Microsoft Academic Search

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

    2011-01-01

    A variety of the flaps used to reconstruct defects of the head and neck region following surgery for malignant disease contain hair follicles that may result in unwanted hair growth. This can cause significant distress to the patients in a variety of ways. We report 5 cases of significant intraoral hair growth of which 4 cases were successfully managed with

  11. Supercharged reverse-flow sural flap: a new modification increasing the reliability of the flap.

    PubMed

    Tan, Onder; Atik, Bekir; Bekerecioglu, Mehmet

    2005-01-01

    The management of soft-tissue defects in the lower third of the leg and foot presents a considerable problem because of composite tissue defects, inadequate and tight local tissue for reconstruction, and poor circulation. Although the reverse sural flap is frequently preferred and is fairly reliable, some complications arising from the circulation may be encountered in large flaps or in diabetic patients. In the present study, we developed a new modification by supercharging the sural flap to reduce venous congestion and edema and to increase the reliability of the flap. We treated 3 patients (2 men and 1 woman) by utilizing a supercharged reverse sural flap. All flaps survived and healed uneventfully. We also suggest a new and more distinctive classification for supercharging and turbocharging, which defines the vessel type to be anastomosed and the relationship of the vessel to be anastomosed with the main vessel to the flap. PMID:15481044

  12. A surgical approach for earlobe keloid: keloid fillet flap.

    PubMed

    Kim, Dae Young; Kim, Eui Sik; Eo, Su Rak; Kim, Kwang Seog; Lee, Sam Yong; Cho, Bek Hyun

    2004-05-01

    Earlobe keloid can form after cosmetic ear piercing, trauma, or burns, and it poses several difficulties in treatment and distinctive cosmetic implications. Treatment methods for earlobe keloids include both surgical and nonsurgical methods. After excision of the earlobe keloid, healing by secondary intention, primary suture, skin graft, or local flap has revealed some disadvantages. The authors approached this problem with a new excision and covering method. The surgery was performed under local anesthesia. Skin over the keloid was dissected from the keloid mass as a flap, which they termed a "keloid fillet flap," and the keloid mass was completely removed. Subcutaneous sutures were not used, and the keloid fillet flaps were closed with 6-0 nylon sutures after trimming. Other intraoperative or postoperative preventive procedures, such as steroid injection, pressure device, or irradiation, were not applied primarily. In the period from May of 1999 to October of 2000, nine earlobe keloids in eight patients were treated with this protocol. One patient had bilateral keloids. Of the eight patients, there were six women and two men, ranging in age from 21 to 61 years (mean age, 28.5 years). The causes of keloids were ear piercing in six cases and trauma in three cases. The largest lesion was 3 cm in its greatest dimension, and the smallest was 1.5 cm (mean, 2.3 cm). All flaps survived completely. There were four cases of recurrence. Seven cases, including two recurrences, showed good results. The authors believe the recurrence of earlobe keloid was closely related to the method for coverage of the defect after its surgical excision, and the "5 As and one B" (Asepsis, Atraumatic technique, Absence of raw surface, Avoidance of tension, Accurate approximation of wound margin, and complete Bleeding control) are important factors in reducing the recurrence rate of earlobe keloids in surgical excision. The authors' protocol is very effective in closing the defect after surgical excision of earlobe keloids and offers many advantages over other surgical approaches. The recurrence rate of earlobe keloid may be lower than in their results if other intraoperative and postoperative treatment procedures are combined with their protocol. PMID:15114128

  13. Neurobiologically Inspired Control of Engineered Flapping Flight

    E-print Network

    Chung, Soon-Jo

    Neurobiologically Inspired Control of Engineered Flapping Flight Soon-Jo Chung , Jeremiah R. Stoner of neurobiologically inspired control systems in the form of Central Pattern Generators (CPG) to generate wing of the proposed neurobiologically inspired control approach. Nomenclature w, w, w Flapping, lead-lag, and pitch

  14. Results with sphincter pharyngoplasty and pharyngeal flap

    Microsoft Academic Search

    Lianne M. de Serres; Frederic W.-B. Deleyiannis; Linda E. Eblen; Joseph S. Gruss; Mark A. Richardson; Kathleen C. Y. Sie

    1999-01-01

    Objective: To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI). Design: Case series. Setting: Tertiary care children’s hospital. Patients: All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995. Methods: Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality

  15. A Split Forehead Flap for the Treatment of Resistant Bilateral Upper and Lower Eyelid Ectropion Postburn Injury

    PubMed Central

    Wetton, Lara; Wijewardena, Aruna; Miroshnik, Michael; Vandervord, John

    2012-01-01

    Objective: The aim of this surgical procedure was to definitively correct severe recurrent upper and lower bilateral eyelid ectropion after 2 attempts with full-thickness skin grafts. It was necessary to repair all 4 eyelids with forehead skin. Middle lamella support was required. Methods: Bilateral median forehead flaps, which were well vascularized by the supratrochlear vessels, were chosen for this procedure to utilize the readily available forehead tissue. The median forehead flap can be easily positioned to cover the entire eyelid. Furthermore, the flap could be split in half, without the risk of vascular compromise. Middle lamella support was provided with a cartilage graft from the nasal septum. Results: At 4 months, the patient no longer suffered from exposure keratopathy and both forehead flaps had healed well. At 12 months, the functional and cosmetic outcomes of this procedure were acceptable. Conclusions: This method of surgery can be effective in the young, in whom the Mustarde cheek advancement fails, or when there is little available unburnt tissue. It can be used as an alternative to a forehead flap when both upper and lower eyelids are damaged bilaterally. The split forehead flap definitively corrected the ectropion in this case. PMID:22461952

  16. Short interposed pedicle of flow-through anterolateral thigh flap for reliable reconstruction of damaged upper extremity.

    PubMed

    Yokota, Kazunori; Sunagawa, Toru; Suzuki, Osami; Nakanishi, Misa; Ochi, Mitsuo

    2011-02-01

    In microvascular reconstructive surgery, the recipient vessel in free flap transfer is often sacrificed to provide the vascular pedicle anastomosis. As the recipient vessel is likely to be necessary for distal circulation in the damaged upper extremity, preserving its patency is critical. Flow-through anastomosis is one method that preserves the recipient vessel's patency. We present here eight patients who underwent upper-extremity reconstructions with a free flow-through anterolateral thigh flap. The flap's short vascular pedicle was interposed into a division of the radial artery and anastomosed on both sides of the pedicle's T-shaped arterial segment. The flow-through flap has various advantages, not only making it possible to reconstruct both vessels and soft tissues but also preserving recipient vessels and balancing the blood supply or pressure in the flap. In clinical situations that do not require reconstruction of the artery, the short interposed pedicle of the free anterolateral thigh flow-through flap offers a versatile and reliable option for microsurgical reconstruction of defects in the upper extremities. PMID:20976665

  17. Lotus petal flaps in vulvo-vaginal reconstruction

    Microsoft Academic Search

    N. W. Yii; N. S. Niranjan

    1996-01-01

    The perineum is an area of rich blood supply with multiple arterial anastomoses. Flaps raised on perforators around the perineum resemble the petals of the lotus and can be used to reconstruct a variety of vulvo-vaginal defects. Thirteen such flaps have been used successfully without any loss of flaps in eight patients. Eight flaps in four patients were used for

  18. Current trends in robotic surgery for otolaryngology

    PubMed Central

    Byrd, J. Kenneth; Duvvuri, Umamaheswar

    2013-01-01

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

  19. Low-level laser irradiation, cyclooxygenase-2 (COX-2) expression and necrosis of random skin flaps in rats.

    PubMed

    Esteves Junior, Ivaldo; Masson, Igor B; Oshima, Celina T F; Paiotti, Ana Paula R; Liebano, Richard E; Plapler, Helio

    2012-05-01

    Skin flaps are still a matter of concern among surgeons, as failures can occur leading to flap necrosis. However, low-level laser irradiation has been reported as an effective tool to improve the viability of ischemic flaps, yet its mechanisms of action remain unclear. We investigated the effect of low-level laser irradiation on the viability of random skin flaps in rats and determined COX-2 expression in the flap pedicle. The study animals comprised 24 EPM-1 Wistar rats which were randomly allocated into three equal groups. A cranially based dorsal random skin flap measuring 10?×?4 cm was created in all the animals. In one group, laser irradiation was simulated (sham group), and in the other two groups the animals were irradiated at 12 points with 0.29 J at 20 mW (energy density 10.36 J/cm(2), irradiance 0.71 W/cm(2)), or with 7.3 J at 100 mW (energy density 260.7 J/cm(2), irradiance 3.57 W/cm(2)). These procedures were applied to the cranial half of the flap immediately after surgery and were repeated on days 2 and 5 after surgery. The percentage necrotic area was determined on day 7 after surgery by the paper template method. The immunohistochemical expression of COX-2 in the samples was given scores from 0 to 3. The necrotic area was smaller in group irradiated at 7.3 J compared to sham-treated group and to the group irradiated at 0.29 J (P?flap necrosis in rats using a laser energy of 7.30 J per point. Laser irradiation also decreased the expression of COX-2 in the flap pedicle. PMID:22016040

  20. [Upper nasolabial flap: improving the surgical technique].

    PubMed

    Abbou, R; Meningaud, J-P; Bosc, R; Hersant, B; Zemirline, A; Baratte, A

    2014-12-01

    The upper nasolabial flap was initially described by Kilner in 1937, and popularized by Préaux in 1994. It is an interesting solution for the reconstruction of the ala thanks to its simplicity and reliability. Nevertheless, the results obtained with the original technique could be improved because of scars on the side of the nose and the absence of nostril groove. That is why we propose a modification of the surgical technique. We present the case of an 82-year-old female patient who presented with a basal cell carcinoma of the right nasal wing rebuilt by a modified upper nasolabial flap. The skin triangle above the defect, which separated it from the flap pedicle, was not sacrificed but dissected forward from behind, to the junction between the nasal dorsum and the lateral side of the nose. The next step, key step of our technique, was removing the epidermis from the flap pedicle. The nasolabial flap was thus slid forward to the alar loss of substance, thereby recreating a nostril groove nose with a single scar. The scar was thus more discrete than with the conventional technique. The other steps did not differ from the conventional technique. The immediate postoperative course was uneventful. Rebuilding a loss of transfixing matter of the ala with a modified Préaux flap technique allows obtaining a simple, reliable, and elegant reconstruction. It presents all the advantages of the conventional upper nasolabial flap with particular care given to the cosmetic appearance of nasal reconstruction. PMID:25052304

  1. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    PubMed Central

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative. PMID:23197233

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

    NASA Technical Reports Server (NTRS)

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

    1946-01-01

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

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

    PubMed

    Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

    2014-01-01

    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

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

    NASA Technical Reports Server (NTRS)

    Howe, M. S.

    1981-01-01

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

  5. The plantar marginal septum cutaneous island flap: a new flap in forefoot reconstruction.

    PubMed

    Bertelli, J A; Duarte, H E

    1997-04-01

    Soft-tissue reconstruction of the foot very often requires flap coverage to preserve exposed structures such as bone, joint, tendons, and weight-bearing areas. However, forefoot coverage remains a challenge, since the alternatives for flap coverage are very limited. The vascularization of the medial side of the foot was studied in 25 injected limbs. Based on this anatomic knowledge, the plantar marginal septum cutaneous island flap is described. The plantar marginal septum cutaneous island flap is a reversed-flow flap based on the superficial branch of the medial division of the medial plantar artery and its distal anastomosis with the lateral plantar artery, first dorsal metatarsal artery, and lateral branch of the medial plantar artery. The venous drainage is ensured by the accompanying veins. The flap arc of rotation includes the forefoot plantar and dorsal region and the first and second toes. Eight cases have been operated on and are reported. PMID:9105367

  6. Dynamic response of a piezoelectric flapping wing

    NASA Astrophysics Data System (ADS)

    Kumar, Alok; Khandwekar, Gaurang; Venkatesh, S.; Mahapatra, D. R.; Dutta, S.

    2015-03-01

    Piezo-composite membranes have advantages over motorized flapping where frequencies are high and certain coupling between bending and twisting is useful to generate lift and forward flight. We draw examples of fruit fly and bumble bee. Wings with Piezo ceramic PZT coating are realized. The passive mechanical response of the wing is characterized experimentally and validated using finite element simulation. Piezoelectric actuation with uniform electrode coating is characterized and optimal frequencies for flapping are identified. The experimental data are used in an empirical model and advanced ratio for a flapping insect like condition for various angular orientations is estimated.

  7. Flap-augmented shrouds for aerogenerators

    NASA Technical Reports Server (NTRS)

    Seginer, A.

    1976-01-01

    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.

  8. Boomerang flap reconstruction for the breast.

    PubMed

    Baumholtz, Michael A; Al-Shunnar, Buthainah M; Dabb, Richard W

    2002-07-01

    The boomerang-shaped latissimus dorsi musculocutaneous flap for breast reconstruction offers a stable platform for breast reconstruction. It allows for maximal aesthetic results with minimal complications. The authors describe a skin paddle to obtain a larger volume than either the traditional elliptical skin paddle or the extended latissimus flap. There are three specific advantages to the boomerang design: large volume, conical shape (often lacking in the traditional skin paddle), and an acceptable donor scar. Thirty-eight flaps were performed. No reconstruction interfered with patient's ongoing oncological regimen. The most common complication was seroma, which is consistent with other latissimus reconstructions. PMID:12142594

  9. The plane problem of the flapping wing

    NASA Technical Reports Server (NTRS)

    Birnbaum, Walter

    1954-01-01

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

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

    Microsoft Academic Search

    T. Lee; Y. Y. Su

    2011-01-01

    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

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

    NASA Technical Reports Server (NTRS)

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

    2014-01-01

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

  12. Limb salvage surgery

    PubMed Central

    Kadam, Dinesh

    2013-01-01

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

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

    PubMed

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

    2014-03-01

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

  14. Buttock reconstruction using a pedicled deep inferior epigastric perforator flap.

    PubMed

    Kim, Kwang Seog; Kim, Eui Sik; Hwang, Jae Ha; Lee, Sam Yong

    2011-03-01

    Although deep inferior epigastric perforator (DIEP) flaps are mainly used for breast reconstruction as free flaps, they are also useful as pedicled island flaps. However, DIEP flaps have seldom been used for reconstructions in the lateral hip region. Furthermore, to the best of our knowledge, no report has been issued on the use of this flap for buttock reconstruction. The authors describe the successful use of a pedicled oblique DIEP flap for the reconstruction of a severe scar contracture in the buttock. The pedicled DIEP flap can be a useful option for the reconstruction of large buttock defects, and if a transverse DIEP flap is unavailable, an oblique DIEP flap should be considered an alternative. PMID:21400579

  15. Propulsive device of the flapping wing type

    NASA Astrophysics Data System (ADS)

    Gorelov, D. N.

    2014-11-01

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

  16. Flap-edge aeroacoustic measurements and predictions

    Microsoft Academic Search

    Thomas F. Brooks; William M. Humphreys

    2003-01-01

    An aeroacoustic model test has been conducted to investigate the mechanisms of sound generation on high-lift wing configurations. This paper presents an analysis of flap side-edge noise, which is often the most dominant source. A model of a main element wing section with a half-span flap was tested at low speeds of up to a Mach number of 0.17, corresponding

  17. Aerodynamic effects of flexibility in flapping wings

    PubMed Central

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

    2010-01-01

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

  18. Reconstruction of Digital Skin Defects with the Free Wrist Crease Flap.

    PubMed

    Zhang, Gan-Lin; Meng, Hong; Huang, Jian-Hua; Hong, Xiao-Fang; Zhang, Hua-Sheng; Liu, Xiao-Tao; Luo, He-Yuan; Liu, Wei-Yong

    2015-07-01

    Background?Soft-tissue digital defects frequently need to be covered by a flap rather than a skin graft. In hand surgery, functional preservation and aesthetic appearance are often as important as procedural efficacy. Objective?We present our clinical experience with reconstruction of digital skin defects with the free wrist crease flap. Methods?From January 2012 to September 2013, 14 digits of 14 patients (10 males, 4 females) were included for evaluation. The procedure was performed with brachial plexus block anesthesia. The superficial palmar branch of the radial artery, a subcutaneous superficial vein, and the palmar cutaneous branch of the median nerve were included in the free wrist crease flap. The flaps were used to reconstruct the skin defect of injured digits through microvascular anastomosis, and donor sites were closed primarily. Results?Postoperative follow-up time ranged from 3 to 25 months. All digital deformities were corrected, all flaps survived completely without ischemia, and none were aesthetically bulky. The area of free wrist crease flaps ranged from 2.5 to 5.0 cm by 2.0 to 3.1 cm. Slight wound infections appeared in two cases. Venous crisis occurred in one case, but it was successfully addressed after vascular exploration and reanastomosis. Sensation determined by static two-point discrimination measured in these flaps 2 months postsurgery was "good" at a mean 9.7?±?2.1?mm (range, 6-14 mm). The mean motion range of the distal interphalangeal joint and proximal interphalangeal joint was 23.4?±?6.9 degrees (0-42 degrees) and 75.8?±?22.1 degrees (0-98 degrees) preoperatively. The mean motion range of the distal interphalangeal joint recovered to 40.3?±?5.7 degrees (36-42 degrees), and that of the proximal interphalangeal joint was 90.3?±?15.3 degrees (85-98 degrees) postoperatively. Both joints reached normal motion angle and difference was statistically significant preoperatively and postoperatively (p?flap to be an ideal solution for reconstruction of skin defects of digits. PMID:25938933

  19. Reverse Dorsoradial Flaps for Thumb Coverage Show Increased Sensory Recovery with Smaller Flap Sizes.

    PubMed

    Sun, Y C; Chen, Q Z; Chen, J; Gong, Y P; Gu, J H

    2015-07-01

    Background?Reverse homodigital dorsoradial (RHD) flap has been developed to repair soft-tissue defects of the thumb. However, few articles have reported this flap with long-term follow-up. This retrospective study was designed to evaluate the RHD flap and investigate factors affecting sensory recovery. Methods?From February 2010 to February 2011, 19 patients were treated consecutively with RHD flap without neurorrhaphy. At final follow-up, flap sensibility was assessed by Semmes-Weinstein (SW) monofilament, moving two-point discrimination (M-2PD), and static two-point discrimination (S-2PD) tests. Patient satisfaction, active range-of-motion of the joints, patient complications, and cold intolerance severity score questionnaire were sequentially evaluated. The patients were divided into two groups based on the S-2PD results and another two groups based on flap size. Results?The mean SW monofilament sensitivity and M-2PD and S-2PD scores on the flap were 4.01?g and 9.26?mm, and 10.63?mm, respectively. Highly positive correlations existed between the flap size and the M-2PD and S-2PD scores. Moreover, in the respective groups based on S-2PD scores and flap size, no statistical difference was found among age, sex, and follow-up time, but the flap size and S-2PD scores were statistically different. Conclusions?RHD flap without neurorrhaphy is a recommendable technique for relatively small-sized thumb-defect reconstruction, which can achieve a satisfactory sensory recovery. PMID:25803410

  20. Hairline aesthetics and styling in hair replacement surgery.

    PubMed

    Mayer, T G; Fleming, R W

    1985-01-01

    Punch grafting and flap surgery are proven methods of correcting baldness. Using either method, the location and shape of a new hairline on the frontal and temporal scalp is one of the most important aspects of hair replacement surgery. If the hairline is not aesthetic, the results can be unacceptable or even devastating for the patient and surgeon alike. The principles of planning the frontal and temporal hairline are presented using punch grafts as well as flaps. Postoperative styling of the "new" hair will vary depending upon the method used to transfer the hair (flaps or grafts), the local factors involved (texture, direction, density, tufting, etc.), as well as the patient's preference. The various advantages and disadvantages of styling possibilities with each method are presented. These factors should be discussed with the patient preoperatively. PMID:3988533

  1. Cosmetic Surgery

    MedlinePLUS

    ... risks of cosmetic surgery? top People who have cosmetic surgery face many of the same risks as anyone having surgery. These include: Infection Not healing well Damage to nerves Bleeding Not being happy with the results Risks ...

  2. 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- ...

  3. Autologous Advanced Tenon Grafting Combined with Conjunctival Flap in Scleromalacia after Pterygium Excision

    PubMed Central

    Lee, Jong Soo; Shin, Min Kyu; Park, Jong Ho; Park, Young Min; Song, Margaret

    2015-01-01

    Purpose. To evaluate the efficacy of autologous tenon grafting combined with conjunctival flap as a treatment for scleromalacia or scleral thinning after pterygium excision without any additional donor graft tissue. Methods. Twenty-six cases underwent autologous advanced tenon grafting combined with sliding or rotating conjunctival flap for scleromalacia after pterygium surgery ranging from 2 years to 30 years. The extent of scleral defect measured from 2.0?mm to 6.8?mm in diameter. The cosmetic outcome was defined as complete resolution of scleromalacia or completely conjunctival reepithelialization and firm adhesion between subtenon and scleral tissue over scleral thinning without significant complications. Results. All cases achieved the covering of conjunctival and tenon or subtenon tissue over scleromalacia or scleral thinning with this procedure. Preoperative pain, inflammation, and choroidal exposure disappeared after surgery. Immediate postoperative complications, such as large wound dehiscence or reopening of the scleral wound, did not occur in any of the patients. There were no significant clinical complications during the mean postoperative follow-up period of 14.17 months in all cases. Conclusions. We obtained excellent outcome with fewer complications after autologous advanced tenon graft and conjunctival flap, without an additional donor graft, in scleromalacia or scleral thinning caused by previous pterygium excision. PMID:25984368

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

    NASA Technical Reports Server (NTRS)

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

    1973-01-01

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

  5. Reconstruction of the penis after surgery.

    PubMed

    Salgado, Christopher J; Monstrey, Stan; Hoebeke, Piet; Lumen, Nicolaas; Dwyer, Moira; Mardini, Samir

    2010-08-01

    This article describes penile reconstruction after surgery. Patient considerations in reconstruction, reconstruction of varied urethral defects, general principles of urethroplasty, surgical techniques of urethral reconstruction, reconstruction of scrotal and testicular defects, reconstruction of the penile shaft, and timing of reconstruction are discussed. The use of local pedicled flaps in penile reconstruction, distant free tissue transfer in penile reconstruction, varied forms of prostheses, management of complications following penile reconstruction, postoperative care in penile reconstruction patient, and penile transplantation are described. PMID:20674694

  6. Heinrich von Pfalzpaint, Pioneer of Arm Flap Nasal Reconstruction in 1460, More Than a Century Before Tagliacozzi.

    PubMed

    Greig, Aina; Gohritz, Andreas; Geishauser, Max; Mühlbauer, Wolfgang

    2015-06-01

    Heinrich von Pfalzpaint (circa 1415-1465) was a Bavarian military surgeon of the Teutonic Order who treated more than 4000 casualties during the siege of Marienberg Fortress (1454-1457). In 1460, he reported "How to create a new nose if it has been chopped off and the dogs have eaten it" in his treatise on wound care Bündt-Ertznei. He used opium-soaked sponges for anesthesia, described the surgical extraction of bullets and cleft lip repair. Pfalzpaint would have been the first author to describe nasal reconstruction in Europe if his treatise had not been lost. Only 5 copies of his manuscript existed. One was rediscovered and printed in 1868. Pfalzpaint's technique for nasal reconstruction was performed in 2 stages using an undelayed skin flap from the upper arm, which was sutured to the nasal defect and the arm was bandaged to the head. After 8 to 10 days, he divided the pedicle; inset the flap; and fashioned the nasal dorsum, alae, and columella. Tagliacozzi described arm flap nasal reconstruction more than a century later in 1597. He used delayed skin flaps, with at least 6 operative stages over 4 months. Pfalzpaint was ahead of his time regarding his knowledge of wounds, insistence on surgical cleanliness, and his technically easier arm flap rhinoplasty, compared with Tagliacozzi. Pfalzpaint, who is rarely referenced in the literature, should be remembered as a great pioneer of reconstructive surgery in Europe. PMID:26080150

  7. Surgical Technique Refinements in Head and Neck Oncologic Surgery

    PubMed Central

    Liu, Jeffrey C.; Shah, Jatin P.

    2010-01-01

    The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction. PMID:20512941

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-12-01

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

  11. Flapping wing PIV and force measurements

    NASA Astrophysics Data System (ADS)

    Cameron, Benjamin H.

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

  12. Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck

    Microsoft Academic Search

    J. F. Hönig

    2005-01-01

    To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision.Nine patients (3 male and 6 female) ranging

  13. Digital Fillet Flaps: A Systematic Review.

    PubMed

    Schade, Valerie L

    2014-11-26

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

  14. [Boomerang flap. A true single-stage pedicled cross finger flap].

    PubMed

    Legaillard, P; Grangier, Y; Casoli, V; Martin, D; Baudet, J

    1996-06-01

    The indications for cover of long fingers have been considerably modified over recent years as a result of the concept of retrograde flow flaps. However, in some cases in which the dorsal digital networks cannot be used, cross-finger flaps are still indicated for cover of long fingers beyond the PIP joint. The authors present a new flap eliminating the need for this rather complicated procedure. The donor site takes advantage of the rich dorsal collateral arterial network of P1 of an adjacent healthy finger. The flap can be raised due to the constant existence of a bifurcation between the collateral dorsal digital arterial networks and the anastomoses situated at various levels between the dorsal and palmar collateral networks of the long fingers, which are constant as far as the PIP joint. A dorsolateral flap can therefore be raised from a healthy finger and transferred to the injured finger by raising the fatty connective tissue, including the dorsal collateral pedicles, in the shape of a boomerang. This flap covers distal defects from the PIP joint to the fingertip. The authors describe the anatomical basis for raising of the flap, the operative technique and report six clinical cases with a mean follow-up of 11 months. PMID:8949504

  15. CHARACTERISTICS OF FLAP GATES AT THE END OF DRAIN PIPES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Flap gates are commonly used at the end of pipe drains and pump outlets to prevent back flows of water and entry of small animals. Flap gates are relatively inexpensive, with low maintenance costs, but can trap debris in their hinge systems. Many texts refer to studies performed on flap gates at t...

  16. Conformal mapping for potential flow about airfoils with attached flap.

    NASA Technical Reports Server (NTRS)

    Rossow, V. J.

    1973-01-01

    The conformal mapping sequence presented transforms the potential flow about a circle into that about an airfoil with an attached flap or spoiler. It is found that adequate versatility of the flap shape for a given airfoil can usually be obtained with the indicated functions, although other transformations would expand the variety of possible flap shapes.

  17. WAKE VORTEX ALLEVIATION USING RAPIDLY ACTUATED SEGMENTED GURNEY FLAPS

    E-print Network

    Stanford University

    WAKE VORTEX ALLEVIATION USING RAPIDLY ACTUATED SEGMENTED GURNEY FLAPS by Claude G. Matalanis significantly degrading aircraft performance. Rapidly actuated segmented Gurney flaps, also known as Miniature: the spanwise actuating Gurney flap. A prototype of this device was designed and tested. The tests showed

  18. Propulsion in viscoelastic fluids: waving, flapping

    NASA Astrophysics Data System (ADS)

    Lauga, Eric

    2008-03-01

    In this talk, we present recent results on low-Reynolds number locomotion in non-Newtonian fluids. We first consider waving motion, the prototypical biological situation arising e.g. in ciliary transport of mucus, or spermatozoa swimming in complex fluids. We use asymptotic methods to estimate the effect of viscoelastic stresses on the kinematics and energetics of locomotion and transport in complex fluids. In our second problem, we consider simple flapping motion. Because of Purcell's scallop theorem, reciprocal motion such as flapping is known to be ineffective in a Newtonian fluid. We show here instead that a fluid with normal stress differences - such as Oldroyd B - can be used to rectify flapping motion and generate non-zero average forces and flows.

  19. Deep inferior epigastric perforator flap in breast reconstruction: experience with the first 50 flaps.

    PubMed

    Hamdi, M; Weiler-Mithoff, E M; Webster, M H

    1999-01-01

    Abdominal wall function is a major concern for plastic surgeons performing breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore, preserves adequate abdominal wall competence. Between January of 1995 and May of 1997, a total of 50 breast reconstructions in 42 patients were performed by using the DIEP flap. Eight patients had bilateral procedures. Five breast reconstructions were immediate and 45 were delayed. All patients were collected prospectively and no patients were excluded from this study. The average age of patients was 47 years (range, 22 to 59 years) and the average weight was 65 kg (range, 51 to 103 kg). Seventy percent of patients had one or more risk factors for TRAM flap reconstruction. The mean postoperative follow-up period was 13 months (range, 3 to 30 months). Twenty consecutive patients (17 single and 3 bilateral DIEP flap breast reconstructions) within this group underwent evaluation of their abdominal wall function preoperatively and then 3 and 6 months postoperatively by using Lacote's muscle grading system. Average flap harvesting time was 120 minutes and average blood loss was 420 cc. Total flap loss and partial necrosis occurred in one (2 percent) and three flaps (6 percent), respectively. Abdominal wound infection occurred in seven patients (17 percent). Unfortunately, one patient died of adult respiratory distress syndrome on the seventh postoperative day. Fat necrosis was found in three flaps (6 percent). Postoperative abdominal wall examination did not reveal any hernia, but bulging was found in two patients (5 percent). All patients were able to resume their daily activities. Abdominal wall function tests in the series of 20 patients showed that all patients had reached or even improved their preoperative level of upper and lower rectus muscle function 6 months after the operation. The external oblique muscles were the most affected by the procedure of flap harvesting, but only two patients (10 percent) were found to have a measurable impairment after 6 months. Patient satisfaction with the reconstructed breast and the donor site was rated high. The free DIEP flap is, therefore, a reliable and valuable method of breast reconstruction. The donor site morbidity was decreased, and the more tedious flap dissection did not affect the overall outcome. PMID:9915167

  20. The Flexible Learning Approach to Physics (FLAP)

    NASA Astrophysics Data System (ADS)

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

    1997-03-01

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

  1. Effects of jet flap on AV8-B 'Harrier' performance

    NASA Technical Reports Server (NTRS)

    Hahn, A. S.; Wilson, S. B., III

    1985-01-01

    This paper examines the effects of fitting various jet-flap configurations to an AV8-'Harrier II' Baseline aircraft using two NASA developed computer codes. The first code predicts the ground roll of an AV8-B with a partial span jet-flap, a full span jet-flap, a partial span internally blown-flap, and a full span internally blown-flap as well as the Baseline configuration. The second code used was a mission performance estimation routine called ACSYNT (Aircraft Synthesis). This code models each configuration on a standard mission so that the relative merits may be determined.

  2. Gurney flap—Lift enhancement, mechanisms and applications

    NASA Astrophysics Data System (ADS)

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

    2008-01-01

    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.

  3. Plantar reconstruction using the medial sural artery perforator free flap.

    PubMed

    Kim, Eui Sik; Hwang, Jae Ha; Kim, Kwang Seog; Lee, Sam Yong

    2009-06-01

    Free flaps are usually required rather than local flaps for large plantar defects, due to a lack of locally available tissue. The medial sural artery perforator free flap, recently introduced clinically by several authors, is a noticeable option for soft tissue coverage, but it has still not been widely used for the reconstruction of various large plantar defects. Between 2005 and 2007, medial sural artery perforator free flaps were used to reconstruct soft tissue defects in plantar areas in 11 patients at our institute. Patient ages ranged from 10 to 68 years (mean, 43 years), and follow-up periods ranged from 7 to 22 months (mean, 13 months). Flap sizes ranged from 10 to 14 cm in length and from 5 to 7 cm in width. Flaps survived in all patients. Marginal loss over the distal flap region was noted in 1 patient, and this was treated successfully with a subsequent split-thickness skin graft. In another one case, venous insufficiency developed, but salvage was successful with leech application. Long-term follow-up showed good flap durability with a protective sensation. The medial sural artery perforator flap provides sufficient durability for weight-bearing areas, even though it is a thin cutaneous flap. The authors recommend that this flap be considered as a reliable alternative for the reconstruction of large plantar defects. PMID:19461285

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

    PubMed Central

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Lee, T.; Su, Y. Y.

    2011-06-01

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

  6. Computational Aerodynamics of Insects' Flapping Flight

    NASA Astrophysics Data System (ADS)

    Yang, Kyung Dong; Kyung, Richard

    2011-11-01

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

  7. FRONTBACKRIGHT FLAP Reconnecting People and Politics

    E-print Network

    Su, Xiao

    FRONTBACKRIGHT FLAP Reconnecting People and Politics at San José State University Reconnecting People and Politics CIVICEDUCATION Born and raised in San José, Les Francis earned his Bachelor's from for CIVIC EDUCATION LES C. FRANCIS #12;HIGH SCHOOL TEACHERS: EDUCATING TOMORROW'S LEADERS Les Francis

  8. Anocutaneous advancement flap repair of transsphincteric fistulas

    Microsoft Academic Search

    David D. E. Zimmerman; John W. Briel; Martijn P. Gosselink; W. Rudolf Schouten

    2001-01-01

    PURPOSE: The purpose of this study was to evaluate the healing rate of transsphincteric perianal fistulas after anocutaneous advancement flap repair and to examine the impact of this procedure on fecal continence. METHODS: Between January 1997 and June 1999, 26 consecutive patients with a transsphincteric perianal fistual passing through the middle or upper third of the external anal sphincter underwent

  9. Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks.

    PubMed

    Gunaratne, Dakshika Abeydeera; Singh, Narinder Pal

    2015-01-01

    Spontaneous cerebrospinal fluid (CSF) leaks in the sphenoid sinus are an uncommon but potentially significant condition associated with thin pneumatised bone, obesity and raised intracranial pressure. Despite advances in endoscopic sinus surgery, successful repair remains problematic due to limitations in visualisation, access and management of underlying aetiological factors. Utilisation of vascularised tissue in the primary repair process of sphenoid CSF leaks is yet to be well explored in the literature. In this series, we describe our surgical approach and explore related clinical, pathological and operative factors in three cases of spontaneous sphenoid sinus CSF leaks, successfully repaired on first attempt with the use of a vascularised nasoseptal flap. PMID:25926586

  10. Wind-tunnel Investigation of Two Airfoils with 25-percent-chord Gwinn and Plain Flaps

    NASA Technical Reports Server (NTRS)

    Ames, Milton B , Jr

    1940-01-01

    Aerodynamic force tests of an NACA 23018 airfoil with a Gwinn flap having a chord 25 percent of the overall chord and of an NACA 23015 airfoil with a plain flap having a 25-percent chord were conducted to determine the relative merits of the Gwinn and the plain flaps. The tests indicated that, based on speed-range ratios, the plain flap was more effective than the Gwinn flap. At small flap deflections, the plain flap had lower drag coefficients at lift-coefficient values less than 0.70. For lift coefficients greater than 0.70, however, the Gwinn flap at all downward flap deflections had the lower drag coefficients.

  11. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps.

    PubMed

    Kim, Kwang Seog; Kim, Eui Sik; Kim, Dae Young; Lee, Sam Yong; Cho, Bek Hyun

    2003-01-01

    Resurfacing after a total degloving injury to the hand is one of the most difficult management problems in hand surgery. Although there are many methods of managing this type of injury that preserve functions and lessen deformities, none provides a satisfactory solution to this problem. The authors resurfaced a totally degloved hand using extremely thin and broad perforator-based cutaneous free flaps, and the donor defects were covered with split-thickness skin grafts. The postoperative course was uneventful, the flaps survived completely, and the grafts took without loss. Several minor operations, including interdigitation, defatting, and the formation of palmar and digital creases, were required to obtain the final appearance and function of the hand. Eighteen months after the initial operation, the patient could pick up a bean with a pair of chopsticks. Sensation was satisfactory in the palm 20 months after the initial operation, as evidenced by 10 mm of static two-point discrimination. To reconstruct a total and complete skin defect of the hand, the authors recommend that thin perforator-based cutaneous free flaps be an initial consideration. PMID:12545113

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

    PubMed

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

    2014-09-01

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

  13. Ex Vivo Prefabricated Rat Skin Flap Using Cell Sheets and an Arteriovenous Vascular Bundle

    PubMed Central

    Fujisawa, Daisuke; Sekine, Hidekazu; Okano, Teruo; Sakurai, Hiroyuki

    2015-01-01

    Background: Recently, research on tissue-engineered skin substitutes have been active in plastic surgery, and significant development has been made in this area over the past several decades. However, a regenerative skin flap has not been developed that could provide immediate blood flow after transplantation. Here, we make a regenerative skin flap ex vivo that is potentially suitable for microsurgical transplantation in future clinical applications. Methods: In rats, for preparing a stable vascular carrier, a femoral vascular pedicle was sandwiched between collagen sponges and inserted into a porous chamber in the abdomen. The vascular bed was harvested 3 weeks later, and extracorporeal perfusion was performed. A green fluorescent protein positive epidermal cell sheet was placed on the vascular bed. After perfusion culture, the whole construct was harvested and fixed for morphological analyses. Results: After approximately 10 days perfusion, the epidermal cell sheet cornified sufficiently. The desquamated corneum was positive for filaggrin. The basement membrane protein laminin 332 and type 4 collagen were deposited on the interface area between the vascular bed and the epidermal cell sheet. Moreover, an electron microscopic image showed anchoring junctions and keratohyalin granules. These results show that we were able to produce native-like skin. Conclusions: We have succeeded in creating regenerative skin flap ex vivo that is similar to native skin, and this technique could be applied to create various tissues in the future. PMID:26180725

  14. A novel procedure combining transoral resection and set-back tongue flap for oropharyngeal cancer.

    PubMed

    Sakai, Mizuno; Yokoyama, Junkichi; Tashiro, Masatugu; Ishikawa, Tooru

    2015-07-01

    Seven patients with advanced lateral oropharyngeal cancer (T3N2bM0, or T4N2bM0) underwent transoral lateral oropharyngectomy (TLO) with reconstruction performed through set-back tongue flap and polyglycolic acid (PGA) sheet. TLO was performed following en bloc resection of tumors using endoscopy. To cover the resulting defect in the lateral oropharyngeal wall, the set-back tongue flap was moved posteriorly and laterally to the area of the tongue base and lateral pharyngeal wall. The tip of the set-back tongue flap was sutured to the lateral pharynx to reconstruct the elevated tongue base and altered anterior pillar. The defect on the floor of the mouth was reconstructed using a PGA sheet. Following surgery, the mean observation period was 24 months. The mean operating time was 4 h and 2 min, with an average blood loss of 68.1 ml. All oral intake resumed on the first postoperative day via gastric tube. The mean gastric tube removal time was 1.6 postoperative days as a result of sufficient oral intake. None of the patients received postoperative radiotherapy or displayed evidence of tumor recurrence. We conclude that this novel procedure is highly effective for treating advanced oropharyngeal cancer as it demonstrates good prognostic and functional outcomes. PMID:25761449

  15. Intraoperative prediction of postoperative flap outcome using the near-infrared fluorophore methylene blue.

    PubMed

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

    2013-03-01

    Methylene blue (MB) is a near-infrared 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 hours. 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 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 hours. 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 near-infrared measurement can predict submental flap outcome at 72 hours. PMID:22395044

  16. Hypopharynx and larynx defect repair after resection for pyriform fossa cancer with a platysma skin flap.

    PubMed

    Cai, Qian; Liang, Faya; Huang, Xiaoming; Han, Ping; Pan, Yong; Zheng, Yiqing

    2015-02-01

    We used a platysma skin flap to repair larynx and hypopharynx defects to improve postoperative laryngeal function in patients with pyriform fossa cancer. Larynx-sparing surgery and postoperative radiotherapy were used in 10 patients with pyriform fossa cancer. The surgical approaches of lymph node dissection of the neck, vertical partial laryngectomy, and pyriform fossa resection were adopted, and a platysma skin flap was used to repair the resulting defects. In this group, the overall 3-year survival rate was 75% according to the Kaplan-Meier analysis, and the local control rate was 90%. Additionally, all patients were able to speak fluently with mild-to-moderate hoarseness. The tracheal tube was removed in all cases. Laryngeal fistulas were observed in 1 patient during radiotherapy. In conclusion, a platysma skin flap can be used to rebuild the larynx and hypopharynx in larynx-sparing resection for pyriform fossa cancer. These patients can obtain good postoperative function in swallowing, breathing, and pronunciation. PMID:25428776

  17. Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: types and reconstruction algorithm.

    PubMed

    Laporta, Rosaria; Longo, Benedetto; Pagnoni, Marco; Catta, Federico; Garbarino, Giovanni Maria; Santanelli, Fabio

    2014-01-01

    The intra-operative latissimus dorsi (LD) pedicle damage during axillary lymph-node dissection by the general surgeon is a rare complication leading to flap failure and poor outcomes. The authors present their experience on this topic and develop a classification of the thoracodorsal (TD) pedicle injuries and reconstruction algorithm. Pedicle damage of LD occurred in five cases, three of which were experienced during immediate breast reconstruction and two observed in patients who underwent prior surgery. In two cases the thoracodorsal vein (TDV) was damaged in its proximal segment, thus end-to-end anastomosis was performed between distal stump of TDV and circumflex scapular vein (CSV). In one case the TDV required simple microsurgical repair while in other two cases the severe damage of vein and artery required more complex surgical strategies in attempt to salvage the flap. Four cases completely survived with one case of rippling phenomenon. One case had partial flap necrosis that required subtotal muscle resection. Based on these cases, the authors have developed a reconstruction algorithm in attempt to repair LD pedicle damage while preserving breast reconstruction. Taking into account its anatomical conformation, TD pedicle injuries are classified in four different types and available options are suggested for all of them according to the anatomical site and to the mechanism and timing of injury. PMID:23836695

  18. Orthopedic surgery.

    PubMed

    Gehrig, Laura M B

    2011-09-01

    Orthopedic surgery is a specialty of surgery dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups. Careers in orthopedic surgery span the spectrum from general orthopedics to those of subspecialty expertise in orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology to name a few. PMID:21871990

  19. Eyelid Surgery

    Microsoft Academic Search

    C. Neoh; A. Eckstein

    2010-01-01

    Eyelid lengthening with or without blepharoplasty (dermatochalasis correction) is usually the final step of surgical rehabilitation. A pleasing outcome after orbital decompression and squint surgery, if indicated, is very much dependent on correcting any remaining lid deformity satisfactorily. This is often more challenging than the preceding surgery. The most common indication for lid surgery is upper lid retraction with poor

  20. The effect of hyperbaric oxygen on compromised grafts and flaps.

    PubMed

    Baynosa, Richard C; Zamboni, William A

    2012-01-01

    The use of grafts and flaps serves as an integral tool in the armamentarium of the reconstructive surgeon. Proper planning and surgical judgment are critical in the ultimate success of these procedures. However, there are situations when grafts and/or flaps can become compromised and require urgent intervention for salvage. These instances can include irradiated or otherwise hypoxic wound beds, excessively large harvested grafts, random flap ischemia, venous or arterial insufficiency and ischemia-reperfusion injury. Alternatively, compromised grafts and flaps can be inadvertently created secondary to trauma. It is in these types of cases that hyperbaric oxygen therapy (HBO2T) can serve as a useful adjunct in the salvage of compromised flaps and grafts. This review outlines the extensive basic science and clinical evidence available in support of the use of HBO2T for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO2T for multiple types of grafts and flaps with various etiologies of compromise. HBO2T can enhance graft and flap survival by several methods including decreasing the hypoxic insult, enhancing fibroblast function and collagen synthesis, stimulating angiogenesis and inhibiting ischemia-reperfusion injury. The expedient initiation of hyperbaric oxygen therapy as soon as flap or graft compromise is identified maximizes tissue viability and ultimately graft/flap salvage. PMID:22908842

  1. The superior trapezius myocutaneous flap in head and neck reconstruction.

    PubMed

    Aviv, J E; Urken, M L; Lawson, W; Biller, H F

    1992-07-01

    The superior trapezius myocutaneous flap, based on the paraspinous perforating branches of the intercostal vessels, is generally not a first-line choice for reconstruction of head and neck defects. However, after wound breakdown following radical neck dissection and radiation therapy, the superior trapezius flap is extremely reliable for coverage of exposed major neck vessels. The flap was used in 30 patients undergoing lateral neck reconstruction. All 30 patients had undergone prior neck dissection and all but two had undergone prior radiation therapy. There were no flap failures. The superior trapezius flap is unique among other regional myocutaneous flaps presently in use in that it has a superiorly based pedicle, which reduces the problem of gravitational pull on the suture lines of severely unfavorable recipient beds. Another advantage of using the denervated muscle of this flap is that it imposes no additional functional loss. The deficiencies of this flap are primarily related to its limited arc of rotation, thereby precluding its use when resurfacing defects that extend beyond the midline of the neck. The reliability of the superior trapezius flap after neck dissection can be explained by the angiosome concept. Based on that concept, previous ligation of the transverse cervical vessels during a neck dissection serves to simultaneously stage this flap, thereby improving its reliability and potential surface area available. PMID:1627289

  2. Reconstruction of the Lower Extremity Using Free Flaps

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

    Ertem, Metin; Gok, Hakan; Ozveri, Emel

    2014-01-01

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

  5. Aerodynamic flight performance in flap-gliding birds and bats.

    PubMed

    Muijres, Florian T; Henningsson, Per; Stuiver, Melanie; Hedenström, Anders

    2012-08-01

    Many birds use a flight mode called undulating or flap-gliding flight, where they alternate between flapping and gliding phases, while only a few bats make use of such a flight mode. Among birds, flap-gliding is commonly used by medium to large species, where it is regarded to have a lower energetic cost than continuously flapping flight. Here, we introduce a novel model for estimating the energetic flight economy of flap-gliding animals, by determining the lift-to-drag ratio for flap-gliding based on empirical lift-to-drag ratio estimates for continuous flapping flight and for continuous gliding flight, respectively. We apply the model to flight performance data of the common swift (Apus apus) and of the lesser long-nosed bat (Leptonycteris yerbabuenae). The common swift is a typical flap-glider while-to the best of our knowledge-the lesser long-nosed bat does not use flap-gliding. The results show that, according to the model, the flap-gliding common swift saves up to 15% energy compared to a continuous flapping swift, and that this is primarily due to the exceptionally high lift-to-drag ratio in gliding flight relative to that in flapping flight for common swifts. The lesser long-nosed bat, on the other hand, seems not to be able to reduce energetic costs by flap-gliding. The difference in relative costs of flap-gliding flight between the common swift and the lesser long-nosed bat can be explained by differences in morphology, flight style and wake dynamics. The model presented here proves to be a valuable tool for estimating energetic flight economy in flap-gliding animals. The results show that flap-gliding flight that is naturally used by common swifts is indeed the most economic one of the two flight modes, while this is not the case for the non-flap-gliding lesser long-nosed bat. PMID:22726811

  6. The posterosuperiorly based platysmal myocutaneous flap: the underutilized reconstructive option.

    PubMed

    Thakkur, Rahul K; Pandya, Shrey R

    2015-06-01

    The platysmal myocutaneous flap has shown promising results for the reconstruction of defects in the head and neck region. It has been successfully used for the reconstruction of the defects over the cheek, floor of the mouth, buccal mucosa, tongue, lower lip, mandibular alveolus, hypopharnx and supraglotic larynx. The posteriorly and the superiorly based platysmal flaps have a wide range of applicability in the reconstruction of intraoral defects. In the present series we have used a posterosuperiorly based platysmal flap which has shown encouraging results. It was also found that leaving the base of the mandible intact helps in maintaining the periosteal blood supply which further contributes to the survival of the flap. The thinness, arc of rotation, pliability and ease of availability of the platysmal myocutaneous flap gives the reconstructive surgeon an additional option, especially when a microvascular flap is not feasible. PMID:26028879

  7. PIV investigation of flowfield behind perforated Gurney-type flaps

    NASA Astrophysics Data System (ADS)

    Lee, Tim; Ko, L. S.

    2009-06-01

    The flow behind perforated Gurney-type flaps was investigated by using particle image velocimetry (PIV) at Re = 5.3 × 104. The PIV measurements were supplemented by force balance and surface pressure data. The near wake was disrupted and narrowed, indicative of a reduced drag, with increasing flap perforation and had a drastically suppressed fluctuating intensity. Depending on the strength of the perforation-generated jet, the vortex shedding process behind the flap could be eliminated. The flap porosity also led to reduced positive camber effects and the decompression of the cavity flow (upstream of the flap), as well as decreased upper and lower surface pressures, compared to the solid flap. The reduction in the drag, however, outweighed the loss in lift and rendered an improved lift-to-drag ratio.

  8. Could flapping foil propulsion become a commercial shipping reality?

    NASA Astrophysics Data System (ADS)

    Epps, Brenden

    2013-11-01

    Since the 1990s, fluid dynamicists have made great strides towards understanding the physics of flapping foil propulsion. However, to date, few commercial shipping vessels employ this technology. Why? How does the efficiency of a flapping hydrofoil compare to that of a conventional screw propeller? What technical challenges exist, and how might we overcome them in order to make flapping foil propulsion a reality for commercial shipping vessels? Since the 1990s, fluid dynamicists have made great strides towards understanding the physics of flapping foil propulsion. However, to date, few commercial shipping vessels employ this technology. Why? How does the efficiency of a flapping hydrofoil compare to that of a conventional screw propeller? What technical challenges exist, and how might we overcome them in order to make flapping foil propulsion a reality for commercial shipping vessels? This work is supported by Walvisstaart Exploitatie BV.

  9. First web-space reconstruction by the anterolateral thigh flap.

    PubMed

    Adani, Roberto; Tarallo, Luigi; Marcoccio, Ignazio; Fregni, Umberto

    2006-04-01

    Four patients with severe contracture of the first web space were treated with an anterolateral thigh perforator flap. The flap size ranged from 10 to 13 cm in length and from 7 to 8 cm in width. The donor site was closed directly and thinning of the flap was performed in all cases. All flaps survived and there were no re-explorations. Web space opening was maintained over the follow-up period. There was an average postoperative increase of the angle of the first web space of 61 degrees. The thinned anterolateral thigh flap provides a pliable vascularized tissue for resurfacing the skin after release of severe contracture of the first web space and represents a reliable alternative to other flaps. PMID:16632060

  10. Flap Coverage of Anterior Abdominal Wall Defects

    PubMed Central

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

    2012-01-01

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

  11. Chimeric Upper Eyelid--Supraorbital Flap Reconstruction

    PubMed Central

    Schechter, Eyal Mordechai Meir

    2015-01-01

    Summary: Wide local excision of a lesion that encompasses several facial subunits including medial canthus, nasal sidewall, and cheek provides multiple aesthetic and reconstructive challenges to restore both orbital function as well as appearance. We report the first successful use of a chimeric upper eyelid--supraorbital flap to reconstruct a facial defect, secondary to a wide local excision of the lower eyelid, entire nasal sidewall, and infraorbital cheek in a patient with a biopsy-proven diagnosis of malignant melanoma. Chimeric upper eyelid--supraorbital flap provides simultaneous reconstruction of lower eyelid, nasal sidewall, and infraorbital areas, therefore replacing multiple facial aesthetic subunits at the same time providing unparalleled tissue quality match to all areas as well as excellent functional and aesthetic outcomes. PMID:26090289

  12. Abdominal wall competence in transverse abdominal island flap operations.

    PubMed

    Hartrampf, C R

    1984-02-01

    This study critically evaluates the abdominal wall in 82 patients following breast and chest wall reconstruction using the transverse abdominal island flap operation. Experience with these patients led to an awareness of the important muscle and ligamentous structures in the anterior abdominal wall. An operative procedure is presented for selective harvesting of the transverse abdominal island flap in a manner that preserves viability of the flap and at the same time reestablishes abdominal competence. PMID:6230981

  13. USB noise reduction by nozzle and flap modifications

    NASA Technical Reports Server (NTRS)

    Hayden, R. E.

    1976-01-01

    The development of concepts for reducing upper surface blown flap noise at the source through flap modifications and special nozzles is reviewed. In particular, recent results obtained on the aerodynamic and acoustic performance of flaps with porous surfaces near the trailing edge and multi-slotted nozzles are reviewed. Considerable reduction (6-10 db) of the characteristic low frequency peak is shown. The aerodynamic performance is compared with conventional systems, and prospects for future improvements are discussed.

  14. Visualization of flapping wing of the drone beetle

    Microsoft Academic Search

    Kazutaka Kitagawa; Mitsutoshi Sakakibara; Michiru Yasuhara

    2009-01-01

    Investigation of flapping wings of insect are focused on low Reynolds number effect and the unsteady aerodynamic properties.\\u000a Interaction between flapping wing of insects and the air flow became one of important and fundamental research topics in micro\\u000a air vehicle. The present work is aim to investigate the flow behavior of flapping wings of tethered scarab beetle. The generation\\u000a mechanisms

  15. Wake Vortex Control using Segmented Rapidly Actuated Gurney Flaps

    Microsoft Academic Search

    Claude Matalanis; John Eaton

    2004-01-01

    Gurney flaps are small flaps oriented perpendicular to the freestream at the trailing edge of a wing, which can increase the lift considerably with little drag penalty. Meso-scale trailing edge effectors (MiTEs) are segmented, rapidly actuated, independent Gurney flaps that have an analogous effect local to their spanwise position. MiTEs show great potential in helping to alleviate the wake vortex

  16. Scrotal reconstruction using thigh pedicle flaps.

    PubMed

    McDougal, W S

    1983-04-01

    A technique is described for reconstructing the scrotum in patients who have sustained massive loss of the skin overlying the scrotum and perineum. Scrotal reconstruction with superior and laterally based thigh flaps was done in 3 patients and all 3 had an acceptable cosmetic result. The procedure has the advantage of simplicity, early closure of the wound, excellent cosmetic appearance and maintenance of testicular function. PMID:6842695

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

    PubMed

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

    2014-10-01

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

  18. Global optimization of actively morphing flapping wings

    NASA Astrophysics Data System (ADS)

    Ghommem, Mehdi; Hajj, Muhammad R.; Mook, Dean T.; Stanford, Bret K.; Beran, Philip S.; Snyder, Richard D.; Watson, Layne T.

    2012-08-01

    We consider active shape morphing to optimize the flight performance of flapping wings. To this end, we combine a three-dimensional version of the unsteady vortex lattice method (UVLM) with a deterministic global optimization algorithm to identify the optimal kinematics that maximize the propulsive efficiency under lift and thrust constraints. The UVLM applies only to incompressible, inviscid flows where the separation lines are known a priori. Two types of morphing parameterization are investigated here—trigonometric and spline-based. The results show that the spline-based morphing, which requires specification of more design variables, yields a significant improvement in terms of propulsive efficiency. Furthermore, we remark that the average value of the lift coefficient in the optimized kinematics remained equal to the value in the baseline case (without morphing). This indicates that morphing is most efficiently used to generate thrust and not to increase lift beyond the basic value obtained by flapping only. Besides, our study gives comparable optimal efficiencies to those obtained from previous studies based on gradient-based optimization, but completely different design points (especially for the spline-based morphing), which would indicate that the design space associated with the flapping kinematics is very complex.

  19. Flow Field of Flexible Flapping Wings

    NASA Astrophysics Data System (ADS)

    S"{A}Llstr"{O}M, Erik; Ukeiley, Lawrence

    2009-11-01

    The flow field around several flexible flapping Zimmerman planform wings of aspect ratio 7.65 and a semispan of 75 mm is investigated using particle image velocimetry (PIV) in a quiescent environment. The wings are made from carbon fiber skeletons and covered with a thin layer of Capran. The skeletons consist of reinforced leading edges and chordwise battens in an attempt to decouple chordwise and spanwise flexibility as much as possible. The flow field from several phases throughout the flapping cycle will be presented. These flow fields consist of the phase averaged velocities in multiple PIV planes. These planes will include both those orientated in the streamwise and spanwise directions to build up a three dimensional representation of the flow in the vicinity of the wing and calculate the resultant vorticity field. The vortical features of these flow fields will be identified and discussed through the use of vortex identification methods. The discussion of the flow measurements will be coupled with force measurements and wing deflection data for a detailed view of mechanisms related to flapping flight and study how the formation of vorticity relates to the generation of aerodynamic forces.

  20. Prelaminated free flap reconstruction of complex central facial defects.

    PubMed

    Pribaz, J J; Weiss, D D; Mulliken, J B; Eriksson, E

    1999-08-01

    This article is a review of five patients who underwent reconstruction of nasal and paranasal facial defects with prelaminated forearm free flaps. The defects resulted from thermal injury, gunshot wound, excision of tumor, and arteriovenous malformation (n = 2). The forearm flaps were based on the radial artery (n = 4) and ulnar artery (n = 1) and were prelaminated with grafts of skin and cartilage. All flaps were successfully transferred to the face, but revisions were needed to separate the subunits and improve appearance. A prelaminated free flap should be considered for a patient requiring reconstruction of a complex central facial defect. PMID:10654678

  1. The Evolution of the Pedicled Radial Forearm Flap

    PubMed Central

    Sauerbier, Michael; Germann, Günter

    2009-01-01

    Because of the thin skin envelope of the hand, especially at the dorsum, flaps are frequently required for defect reconstruction in the hand. The pedicled radial forearm flap is a time proven procedure that offers reliable coverage in this area without the need of advanced microsurgical expertise. Despite several alternatives and an increasing acceptance of free tissue transfers, the pedicled radial forearm flap can still be the procedure of choice under special circumstances. Variations of the original technique address the two main disadvantages, the conspicuous donor site and the sacrifice of the radial artery. Indications, anatomy, surgical technique, and limitations of this classic workhorse flap are presented. PMID:19826879

  2. The Effect of Polydeoxyribonucleotide on Ischemic Rat Skin Flap Survival.

    PubMed

    Lee, Dong Won; Hong, Hyun Joon; Roh, Huyn; Lee, Won Jai

    2015-07-01

    Polydeoxyribonucleotide (PDRN) has multiple vascular actions such as angiogenesis and production of a vascular endothelial growth factor (VEGF) through the adenosine A2 receptor stimulation. We applied PDRN on the ischemic flap of rat back and investigated whether it enhances the skin flap survival. A total of 28 Sprague-Dawley rats were divided into 3 groups, namely, PDRN group, control group 1 (no treatment), and group 2 (phosphate-buffered saline injection). On the distally based flap of 3 × 9 cm in size, it was subdermally injected with PDRN or phosphate-buffered saline, which were administered 48 hours prior and immediately after flap elevation. The PDRN group was daily maintained by intraperitoneal administration of PDRN from the postoperative 1st day to 10th day. The mean survival rates of flap in PDRN group [79.5% (6.3%)] are significantly larger than control groups [1, 53.0% (6.9%); 2, 51.7% (6.7%)]. Serial measurements of blood perfusion also showed that the blood flux was significantly increased in almost part of the flap on the 10 days after PDRN injection. The number of CD31 positively stained vessels and expression of VEGF protein were significantly higher in the PDRN group. We propose that administration of PDRN into the ischemic skin flaps increased blood flux to the flap, VEGF expression, and number of capillaries, thereby improving the rat skin flap survival. PMID:25954843

  3. Vortex leading edge flap assembly for supersonic airplanes

    NASA Technical Reports Server (NTRS)

    Rudolph, Peter K. C. (Inventor)

    1997-01-01

    A leading edge flap (16) for supersonic transport airplanes is disclosed. In its stowed position, the leading edge flap forms the lower surface of the wing leading edge up to the horizontal center of the leading edge radius. For low speed operation, the vortex leading edge flap moves forward and rotates down. The upward curve of the flap leading edge triggers flow separation on the flap and rotational flow on the upper surface of the flap (vortex). The rounded shape of the upper fixed leading edge provides the conditions for a controlled reattachment of the flow on the upper wing surface and therefore a stable vortex. The vortex generates lift and a nose-up pitching moment. This improves maximum lift at low speed, reduces attitude for a given lift coefficient and improves lift to drag ratio. The mechanism (27) to move the vortex flap consists of two spanwise supports (24) with two diverging straight tracks (64 and 68) each and a screw drive mechanism (62) in the center of the flap panel (29). The flap motion is essentially normal to the airloads and therefore requires only low actuation forces.

  4. V-y advancement flap technique in resurfacing postexcisional defect in cases with pilonidal sinus disease-study of 25 cases.

    PubMed

    Sahasrabudhe, Parag; Panse, Nikhil; Waghmare, Chandrashekhar; Waykole, Pankaj

    2012-10-01

    We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21-30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan. PMID:24082587

  5. Tennis elbow surgery - discharge

    MedlinePLUS

    ... surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... had surgery to repair a tendon in your elbow . The surgeon made a cut (incision) over the ...

  6. Effect of wing aspect ratio and flap span on aerodynamic characteristics of an externally blown jet-flap STOL model

    NASA Technical Reports Server (NTRS)

    Smith, C. C., Jr.

    1973-01-01

    An investigation has been conducted to determine the effects of flap span and wing aspect ratio on the static longitudinal aerodynamic characteristics and chordwise and spanwise pressure distributions on the wing and trailing-edge flap of a straight-wing STOL model having an externally blown jet flap without vertical and horizontal tail surfaces. The force tests were made over an angle-of-attack range for several thrust coefficients and two flap deflections. The pressure data are presented as tabulated and plotted chordwise pressure-distribution coefficients for angles of attack of 1 and 16. Pressure-distribution measurements were made at several spanwise stations.

  7. Folding in and out: passive morphing in flapping wings.

    PubMed

    Stowers, Amanda K; Lentink, David

    2015-04-01

    We present a new mechanism for passive wing morphing of flapping wings inspired by bat and bird wing morphology. The mechanism consists of an unactuated hand wing connected to the arm wing with a wrist joint. Flapping motion generates centrifugal accelerations in the hand wing, forcing it to unfold passively. Using a robotic model in hover, we made kinematic measurements of unfolding kinematics as functions of the non-dimensional wingspan fold ratio (2-2.5) and flapping frequency (5-17 Hz) using stereo high-speed cameras. We find that the wings unfold passively within one to two flaps and remain unfolded with only small amplitude oscillations. To better understand the passive dynamics, we constructed a computer model of the unfolding process based on rigid body dynamics, contact models, and aerodynamic correlations. This model predicts the measured passive unfolding within about one flap and shows that unfolding is driven by centrifugal acceleration induced by flapping. The simulations also predict that relative unfolding time only weakly depends on flapping frequency and can be reduced to less than half a wingbeat by increasing flapping amplitude. Subsequent dimensional analysis shows that the time required to unfold passively is of the same order of magnitude as the flapping period. This suggests that centrifugal acceleration can drive passive unfolding within approximately one wingbeat in small and large wings. Finally, we show experimentally that passive unfolding wings can withstand impact with a branch, by first folding and then unfolding passively. This mechanism enables flapping robots to squeeze through clutter without sophisticated control. Passive unfolding also provides a new avenue in morphing wing design that makes future flapping morphing wings possibly more energy efficient and light-weight. Simultaneously these results point to possible inertia driven, and therefore metabolically efficient, control strategies in bats and birds to morph or recover within a beat. PMID:25807583

  8. Practical Considerations for Perforator Flap Thinning Procedures Revisited

    PubMed Central

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

    2014-01-01

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

  9. Pathology of warm ischaemia and reperfusion injury in adipomusculocutaneous flaps.

    PubMed Central

    Nishikawa, H.; Manek, S.; Barnett, S. S.; Charlett, A.; Green, C. J.

    1993-01-01

    In-vivo assessment and histological analysis after 168 hours of reperfusion were used to determine the normothermic (37 degrees C) ischaemic tolerance of adipomusculocutaneous, free flap, isotransplants in inbred AS rats. Flaps stored for up to 2 hours under normothermic conditions survived; flaps stored for 4 hours partially survived but those which had been stored for more than 6 hours became totally necrotic. Neither treatment with the iron chelator desferrioxamine (DFX) nor hypertonic citrate (HCA) flush increased the ischaemic tolerance of flaps which had been stored for 4 hours since neither diminished the amount of necrosis. Treated and untreated flaps stored for 4 hours were also assessed 0, 0.5, 24, 48, 96 and 168 hours after isotransplantation. They were compared to control flaps which had not been stored prior to reperfusion and negative control flaps which were not stored but isotransplanted without a blood supply. Oedema reached a peak at 24 hours and there was progressive increase in general severe necrosis, reaching a plateau by 48 hours. Suture line epidermalization and thickening was established by 48 hours. Among flaps stored for 4 hours, those treated with DFX had the most necrosis. Adipose tissue and striated muscle proved the least tolerant to warm ischaemic stress. These experiments suggest reperfusion injury contributes to eventual flap necrosis, but the role of free radicals has not been established. The 4-hour stored flap is a useful model to study the effects of ischaemia both in flap tissue and at the suture line. Images Figure 1 Figure 3 Figure 6 Figure 7 PMID:7682434

  10. Sushruta: father of plastic surgery.

    PubMed

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

    2014-07-01

    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

  11. Free Boomerang-shaped Extended Rectus Abdominis Myocutaneous flap: The longest possible skin/myocutaneous free flap for soft tissue reconstruction of extremities

    PubMed Central

    Koul, Ashok R.; Nahar, Sushil; Prabhu, Jagdish; Kale, Subhash M.; Kumar, Praveen H. P.

    2011-01-01

    Background: A soft tissue defect requiring flap cover which is longer than that provided by the conventional “long” free flaps like latissimus dorsi (LD) and anterolateral thigh (ALT) flap is a challenging problem. Often, in such a situation, a combination of flaps is required. Over the last 3 years, we have managed nine such defects successfully with a free “Boomerang-shaped” Extended Rectus Abdominis Myocutaneous (BERAM) flap. This flap is the slightly modified and “free” version of a similar flap described by Ian Taylor in 1983. Materials and Methods: This is a retrospective study of patients who underwent free BERAM flap reconstruction of soft tissue defects of extremity over the last 3 years. We also did a clinical study on 30 volunteers to compare the length of flap available using our design of BERAM flap with the maximum available flap length of LD and ALT flaps, using standard markings. Results: Our clinical experience of nine cases combined with the results of our clinical study has confirmed that our design of BERAM flap consistently provides a flap length which is 32.6% longer than the standard LD flap and 42.2% longer than the standard ALT flap in adults. The difference is even more marked in children. The BERAM flap is consistently reliable as long as the distal end is not extended beyond the mid-axillary line. Conclusion: BERAM flap is simple in design, easy to harvest, reliable and provides the longest possible free skin/myocutaneous flap in the body. It is a useful new alternative for covering long soft tissue defects in the limbs. PMID:22279271

  12. Repair of nostril stenosis using a triple flap combination: boomerang, nasolabial, and vestibular rotation flaps.

    PubMed

    Bozkurt, Mehmet; Kapi, Emin; Kuvat, Samet Vasfi; Selçuk, Caferi Tayyar

    2012-11-01

    Tissue losses within the nose due to various reasons result in the loss of normal anatomy and function. The external nasal valve area is one of the most important functional components of the nose. The columella, lobule, nostril, and alar region are among the components forming the external nasal valve area. Deformities of the nostrils are among the most frequently observed features that interfere with the functional anatomy of the nose. Malformations of the nostrils often emerge subsequent to cleft lip repairs. Stenoses are a common type of pathology among nostril deformities. In cases where a stenosis has formed, breathing problems and developmental anomalies may occur. In the patient with nostril stenosis presented in this report, there was a serious alar collapse and contracture subsequent to a cleft lip repair. In order to repair the nostril stenosis, a "boomerang flap" was chosen. This boomerang flap was used in combination with a nasolabial flap, a vestibular rotation flap, and a conchal cartilage graft to achieve a satisfactory repair. PMID:21951167

  13. External Dacryocystorhinostomy with and Without Suturing the Posterior Mucosal Flaps

    PubMed Central

    Kaçaniku, Gazmend; Begolli, Ilir

    2014-01-01

    ABSTRACT Purpose: To evaluate the outcome of the external dacryocystorhinostomy with and without suturing the posterior mucosal flaps. Methods: This study included 106 patients with lacrimal drainage system disorders who underwent the external dacryocystorhinostomy. Fifty four patients (Group A) underwent external dacryocystorhinostomy with suturing anterior and posterior flaps of the lacrimal sac and nasal mucosa, and the results obtained were compared with those of another series of 52 patients (Group B) where dacryocystorhinostomy was performed with suturing only the anterior flaps, whereas posterior mucosal flaps were excised. Results: The success rate was evaluated by lacrimal patency to irrigation and relief of epiphora. Patency achieved in groups A and B was 94.4% and 96.2%, respectively. There was no statistically significant difference in success rate between the groups. Conclusion: Our study suggests that external dacryocystorhinostomy with suturing anterior and posterior flaps have no advantage over dacryocystorhinostomy with suturing only anterior flaps. Anastomosis by suturing only anterior flaps and excision of the posterior flaps is easier to perform and may improve the success rate of external dacryocystorhinostomy. PMID:24783915

  14. Modeling of Flap Endonuclease Interactions with DNA Substrate

    E-print Network

    Onufriev, Alexey

    processing15 ­ 17 and repair of DNA damage caused by alkylating agents or UV radiation.9,18,19 In OkazakiModeling of Flap Endonuclease Interactions with DNA Substrate Hatim T. Allawi1 *, Michael W. Kaiser play an important role in DNA replication and repair uniquely recognizing an overlap flap DNA substrate

  15. OVMI - Towards a 3D-space flapping flight parametrization

    Microsoft Academic Search

    Hala RIFAI; Nicolas MARCHAND; Guylaine POULIN

    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

  16. Eyebrow island flap for reconstruction of a partial eyebrow defect.

    PubMed

    Kim, Kwang Seog; Hwang, Jae Ha; Kim, Dae Young; Lee, Sam Yong; Cho, Bek Hyun

    2002-03-01

    A diverse variety of methods for reconstructing eyebrow defects has been described previously, and each procedure has inherent advantages and disadvantages. The authors present a case of reconstruction of a partial eyebrow defect using two eyebrow island flaps, which are modifications of the subcutaneous pedicle flap. PMID:11862039

  17. Active Flap Control of the SMART Rotor for Vibration Reduction

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

    Active control methodologies were applied to a full-scale active flap rotor obtained during a joint Boeing/ DARPA/NASA/Army test in the Air Force National Full-Scale Aerodynamic Complex 40- by 80-foot anechoic wind tunnel. The active flap rotor is a full-scale MD 900 helicopter main rotor with each of its five blades modified to include an on-blade piezoelectric actuator-driven flap with a span of 18% of radius, 25% of chord, and located at 83% radius. Vibration control demonstrated the potential of active flaps for effective control of vibratory loads, especially normal force loads. Active control of normal force vibratory loads using active flaps and a continuous-time higher harmonic control algorithm was very effective, reducing harmonic (1-5P) normal force vibratory loads by 95% in both cruise and approach conditions. Control of vibratory roll and pitch moments was also demonstrated, although moment control was less effective than normal force control. Finally, active control was used to precisely control blade flap position for correlation with pretest predictions of rotor aeroacoustics. Flap displacements were commanded to follow specific harmonic profiles of 2 deg or more in amplitude, and the flap deflection errors obtained were less than 0.2 deg r.m.s.

  18. Homodigital Neurovascular Island Flaps for Digital Pulp Loss

    Microsoft Academic Search

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

    1989-01-01

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

  19. An investigation into the aerodynamics of Gurney flaps

    Microsoft Academic Search

    David Robert Michael Jeffrey

    1998-01-01

    The Gurney flap is a simple device for increasing the normal force (lift or downforce) generated by a wing. This thesis presents results from different experimental and computational techniques, which are used to examine the aerodynamics of the Gurney flap. Time-averaged off-surface velocities, obtained using Laser Doppler Anemometry, confirm the hypothesis that the dominant features directly downstream of the Gurney

  20. Gurney flap—Lift enhancement, mechanisms and applications

    Microsoft Academic Search

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

    2008-01-01

    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

  1. Flight Control of a Rotary wing UAV including Flapping Dynamics

    E-print Network

    Pota, Himanshu Roy

    Flight Control of a Rotary wing UAV including Flapping Dynamics Bilal Ahmed and Hemanshu R. Pota.bilal@gmail.com). School of Engineering and Information Technology The University of New South Wales at the Australian control of a Rotary wing Unmanned Aerial Vehicle (RUAV). Flapping and servo dynamics, important from

  2. Anomalous Hydrodynamic Drafting of Interacting Flapping Flags Leif Ristroph1

    E-print Network

    Zhang, Jun

    Anomalous Hydrodynamic Drafting of Interacting Flapping Flags Leif Ristroph1 and Jun Zhang2,* 1'' flapping flags, we find that it is the leader of a group who enjoys a significant drag reduction (of up to 50%), while the downstream flag suffers a drag increase. This counterintuitive inverted drag

  3. Bounded attitude control of a biomimetic flapping robot

    Microsoft Academic Search

    H. Rifai; Nicolas Marchand; Guylaine Poulin

    2007-01-01

    Flapping micro Unmanned Air Vehicles (UAVs) can be considered as high frequency periodic systems. Based on the averaging theory, only the mean aerodynamic forces and torques over a wingbeat affect the movement of the body. Therefore, a nonlinear bounded state feedback control law is calculated upon the averaged model and applied to the time varying system represented by the flapping

  4. Pectoralis myocutaneous flap for salvage of necrotic wounds

    SciTech Connect

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

    1985-02-01

    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.

  5. Prelaminated free radial forearm flap for a total nasal reconstruction.

    PubMed

    Sinha, M; Scott, J R; Watson, S B

    2008-08-01

    A prelaminated osteocutaneous radial forearm flap has previously been described for total nasal reconstruction, but achieving good aesthetics at the dorsum and tip tends to be difficult with a flap that can be too bulky. We present a case of total nasal reconstruction in a burns patient where a tight adherent scar at the forehead precluded the use of a forehead flap, ideal for such reconstructions. We successfully used a prelaminated free radial forearm flap, with a non-vascularised bone graft. The existing scarred skin at the dorsum was turned down as pedicled flaps for the lining. We were able to achieve a successful total nasal reconstruction which was aesthetically pleasing and made a tremendous impact on the quality of life of the patient. PMID:18455974

  6. Mucosal prelamination of a radial forearm flap for intraoral reconstruction.

    PubMed

    Rath, T; Millesi, W; Millesi-Schobel, G; Lang, S

    1997-10-01

    For reconstruction of intraoral soft-tissue defects after radical resection of squamous-cell carcinomas, the microvascular jejunal patch has been a reconstructive graft option of first choice. in addition to other advantages, these jejunal grafts are able to produce mucus. In cases in which the use of jejunal grafts is contraindicated, the fasciocutaneous radial forearm flap has enlarged the spectrum of reconstructive options. A disadvantage is that mucus production will be absent, because mucosal and lining reconstruction is performed with tissue lacking mucus-providing qualities. The authors successfully prelaminated a distal radial forearm flap with buccal mucosa in five patients. Mucosal prelamination of the distal radial forearm flap enables a physiologic reconstruction with resultant mucus production, in combination with the provision of thin, pliable, and resistant flaps. The technique lowers donor-site morbidity because of the preservation of skin and subcutaneous tissue. Reconstruction with fasciomucosal, osteomyomucosal, and myomucosal flaps by this method seems feasible. PMID:9353703

  7. Preservation of Hand Function Using Muscle Perforator Flaps

    PubMed Central

    2008-01-01

    Adequate soft tissue coverage is imperative after any interventions performed to maximize or preserve hand function. Although this can most simply be achieved by primary closure or a skin graft if possible, often a vascularized flap will be preferable, especially if a later secondary procedure is planned. Even moderately sized skin deficits of the upper extremity, and especially if involving the hand itself, can be better covered using a free tissue transfer. Many reasonable options in this regard are available. Muscle perforator flaps, as a relatively new variant of a fasciocutaneous flap, have unique attributes, including availability, diversity, accessibility, large size, and lengthy vascular pedicle, and since no muscle need be included, donor site function is preserved. As is shown here in a series of nine muscle perforator flaps in eight patients, these represent yet another alternative that should be considered if selection of a free flap is indicated to maintain hand function. PMID:18780005

  8. Distally based perforator sural flaps for foot and ankle reconstruction

    PubMed Central

    Chang, Shi-Min; Li, Xiao-Hua; Gu, Yu-Dong

    2015-01-01

    Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chain-linked adipofascial neurovascular axis around the sural/saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage. PMID:25893175

  9. Comparison of quality-of-life in tongue cancer patients undergoing tongue reconstruction with lateral upper arm free flap and radial forearm free flap

    PubMed Central

    Liang, Yujie; Cui, Yaqi; Liao, Guiqing

    2015-01-01

    Surgery entails radical resection, neck dissection and tongue reconstruction has been commonly used in treatment of T2 and T3 tongue squamous cell carcinoma. Although lateral upper arm free flap (LUFF) and radial forearm free flap (RFFF) are similar in texture and thickness, significant differences can be noticed in the donor-site function and surgical demands. In the treatment of T2 and T3 tongue cancer, the choice of either LUFF or RFFF is still not defined.We aim to investigatethe long-term QOL of patients with moderate tongue defect and reconstruction with LUFF or RFFF, based on which to provide clinical suggestion for tongue reconstructions.Sixty-five patients (T2 or T3 stage, 42 underwent tongue reconstruction with RFFF and 23 with LUFF) treated at the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sun Yat-Sen University from January 2005 to June 2009 were included. The QOL of each patient was determined using the questionnaire designed based on the University of Washington Quality-of-Life (UW-QOL, version 4). The questionnaire was accomplished by a qualified medical staff blinded to the study after telephone communication with each patient. Statistical analysis showed that no significant difference was noticed in the long-term QOL of patients with tongue cancer after tongue reconstruction using LUFF or RFFF, respectively, indicating that similar QOLs were obtained in the long-term follow-up of patients with tongue cancer (T2 or T3 stages) using LUFF and RFFF for reconstruction.

  10. Salvage of Intraoperative Deep Inferior Epigastric Perforator Flap Venous Congestion with Augmentation of Venous Outflow: Flap Morbidity and Review of the Literature

    PubMed Central

    Pisano, Steven; Chrysopoulo, Minas; Ledoux, Peter; Arishita, Gary; Nastala, Chet

    2013-01-01

    Background: Breast reconstruction with deep inferior epigastric perforator (DIEP) flaps has gained considerable popularity due to reduced donor-site morbidity. Previous studies have identified the superficial venous system as the dominant outflow to DIEP flaps. DIEP flap venous congestion occurs if superficial venous outflow via the deep venous system is insufficient for effective flap drainage. Although augmentation of venous outflow through a second venous anastomosis may relieve venous congestion, effects on flap morbidity remain ill defined. Methods: A retrospective analysis of 1616 patients who underwent 2618 DIEP flap breast reconstructions between March 2005 and January 2012 was performed. Patients with intraoperative venous congestion underwent a second venous anastomosis. Preoperative demographic data and methods used to relieve venous congestion were recorded. Incidence of flap morbidity was calculated and compared with a group of 418 controls having 639 DIEP flap breast reconstructions with no venous congestion. Results: Venous augmentation was required to relieve venous congestion in 87 (3.3%) DIEP flaps on 81 patients. The superficial inferior epigastric vein or accompanying deep inferior epigastric venae comitantes was used to augment venous outflow. Preoperative comorbidities were similar between both groups. Patients requiring a second venous anastomosis had a longer operative time and length of hospital stay. Overall, flap morbidity, delayed wound healing, fat necrosis, and flap loss were similar to controls. Conclusions: Arterial and venous anatomies play unique roles in flap reliability. DIEP flap venous congestion must be treated expeditiously with venous augmentation to relieve venous congestion and mitigate flap morbidity. PMID:25289247

  11. Oxytocin increases the survival of musculocutaneous flaps

    Microsoft Academic Search

    Maria Petersson; Thomas Lundeberg; Annica Sohlström; Ursula Wiberg; Kerstin Uvnäs-Moberg

    1998-01-01

    The aim of the present study was to evaluate the effect of oxytocin on survival of musculocutaneous flaps in male Sprague-Dawley\\u000a rats. For this purpose oxytocin (0.1 or 1.0 mg\\/kg), an oxytocin antagonist (1-deamino-2-D-Tyr-(OEt)-4-Thr-8-Orn-oxytocin)\\u000a (1.0 mg\\/kg) alone or in combination with oxytocin (1.0 mg\\/kg) or saline was given subcutaneously (s.c.), 24 hours and 1 hour\\u000a before and 24 hours after

  12. Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue

    Microsoft Academic Search

    Wan-Fu Su; Yi-Jan Hsia; Yen-Chine Chang; Shyi-Gen Chen; Hwa Sheng

    2003-01-01

    Objective: Numerous patients in Taiwan with tongue carcinoma require tongue reconstruction. We compared the abilities of 2 methods of tongue reconstruction to reserve tongue function.Study Design and Setting: Sixty patients underwent resection of the tumors and reconstruction with a pectoralis major flap or a radial forearm flap. The Chinese articulation test was used to evaluate the place and manner of

  13. Corrective Jaw Surgery

    MedlinePLUS Videos and Cool Tools

    ... find out more. Dental and Soft Tissue Surgery Dental and Soft Tissue Surgery Oral and facial surgeons ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ...

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

    Microsoft Academic Search

    Sujoy Mukherjee; Ranjan Ganguli

    2012-01-01

    The nonlinear equations for coupled elastic flapping–twisting motion of a dragonfly-inspired smart flapping wing are used for a flapping wing actuated from the root by a PZT unimorph in the piezofan configuration. Excitation by the piezoelectric harmonic force generates only the flap bending motion, which, in turn, induces the elastic twist motion due to interaction between flexural and torsional vibration

  15. Mohs Surgery

    MedlinePLUS Videos and Cool Tools

    ... contact Share | Mohs Surgery A A A Mohs Learning Series Mohs for Melanoma Ninety percent of nonmelanoma ... Cell Carcinoma (BCC) Squamous Cell Carcinoma (SCC) Mohs Learning Series Insight from Dr. Sherrif Ibrahim Why Isn’ ...

  16. Periodontology: a clinical approach. 4. Periodontal surgery.

    PubMed

    Palmer, R M; Floyd, P D

    1995-04-22

    Results from comparative surgical studies have shown small differences between methods when evaluated over a few years post-surgically. Early interim results suggest that apical repositioning is more effective at reducing probing depth, replaced flaps (such as the modified Widman technique) offer slight advantages in terms of gain in clinical attachment, and procedures which involve extensive bone removal or exposure result in more bone loss and loss of attachment. The replaced flaps should in theory produce better aesthetics than the apical repositioned flap. In the long term however, the former tend to recede slightly whilst there is some coronal rebound in the latter, thereby producing relatively little difference between them when good plaque control is maintained. In all procedures there is loss in height of the interdental tissues, even if the labial tissue is maintained, and this can be aesthetically displeasing to some individuals. However it should also be remembered that effective non-surgical treatment can result in similar changes in tissue height and contour, and there is no guarantee of preservation of pre-existing dentogingival aesthetics. All routine periodontal treatment results in gingival shrinkage to some degree. In many cases periodontal surgery will, in reality, involve a combination of replacement, apical repositioning and resection due to the uneven pattern of disease and different anatomical constraints of the palate, tuberosities and retromolar regions. This is shown in figure 12. In summary the surgical procedures should: 1. Produce well contoured flaps of even thickness which are tailored to the shape of the tooth surfaces and permit good coverage of the alveolar bone and any bone defects.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7742105

  17. Mastoid surgery

    Microsoft Academic Search

    S. G. Joshi

    1950-01-01

    Summary  562 cases of mastoiditis admitted to the King Edward VII Memorial Hospital in the last 12 years have been reviewed. Though\\u000a the incidence of mastoiditis has been lowered and there are reports of recoveries of cases of acute mastoiditis now and then\\u000a with sulpha and penicillin therapy, the place of surgery in mastoiditis is unchanged. These drugs supplement surgery but

  18. Effect of Heparin on Prevention of Flap Loss in Microsurgical Free Flap Transfer: A Meta-Analysis

    PubMed Central

    Pan, Xuan-liang; Chen, Guo-xian; Shao, Hua-wei; Han, Chun-mao; Zhang, Li-ping; Zhi, Li-zhu

    2014-01-01

    The effectiveness of heparin for thromboprophylaxis during microvascular free flap transfer is uncertain. The purpose of this meta-analysis was to determine the effect of heparin on the prevention of flap loss in microsurgical free flap transfer.A search of PubMed, Cochrane databases, and Google Scholar using combinations of the search terms heparin, free flap, flap loss, free tissue transfer was conducted on March 15, 2013. Inclusion criteria were: 1) Prospective randomized trials. 2) Retrospective, non-randomized studies. 3) Patients received free tissue transfer. Flap loss rate was used to evaluate treatment efficacy. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated and compared between therapies. Four studies meet the criteria for analysis and were included. Two studiescompared aspirin and heparin, and the ORs of the 2 studies were 1.688 and 2.087. The combined OR of 2.003 (95% CI 0.976–4.109, p?=?0.058) did not indicate any significant difference between heparin and aspirin therapies. Two studiescompared high and low doses of dalteparin/heparin therapies, and the ORs of the 2 studies were 4.691 and 11.00. The combined OR of 7.810 (95% CI 1.859–32.808, p?=?0.005) revealed a significant difference indicating that high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy. Heparin and aspirin prophylaxis are associated with similar flap loss rates after free flap transfer, and high dose dalteparin or heparin therapy is associated with a greater flap loss rate than low dose therapy. PMID:24751924

  19. [Robotic surgery].

    PubMed

    Moreno-Portillo, Mucio; Valenzuela-Salazar, Carlos; Quiroz-Guadarrama, César David; Pachecho-Gahbler, Carlos; Rojano-Rodríguez, Martín

    2014-12-01

    Medicine has experienced greater scientific and technological advances in the last 50 years than in the rest of human history. The article describes relevant events, revises concepts and advantages and clinical applications, summarizes published clinical results, and presents some personal reflections without giving dogmatic conclusions about robotic surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) defines robotic surgery as a surgical procedure using technology to aid the interaction between surgeon and patient. The objective of the surgical robot is to correct human deficiencies and improve surgical skills. The capacity of repeating tasks with precision and reproducibility has been the base of the robot´s success. Robotic technology offers objective and measurable advantages: -?Improving maneuverability and physical capacity during surgery. -?Correcting bad postural habits and tremor. -?Allowing depth perception (3D images). -?Magnifying strength and movement limits. -?Offering a platform for sensors, cameras, and instruments. Endoscopic surgery transformed conceptually the way of practicing surgery. Nevertheless in the last decade, robotic assisted surgery has become the next paradigm of our era. PMID:25643879

  20. [Approaches to sella turcica in endoscopic pituitary surgery].

    PubMed

    Nakagawa, T; Takashima, T; Tomiyama, K; Asada, M

    2001-01-01

    Recent advances in endoscopic sinus surgery suggested the potential for its surgical application to pituitary surgery. A number of institutions have reported the advantage of endoscope use in pituitary surgery, which is now widely accepted, but approaches to the sella vary in the literature. We retrospectively studied sella approaches in endoscopic pituitary surgery as rhinologists. Subjects included 6 cases of pituitary adenoma and 2 cases of Rathke's cleft cyst. A both-nostril transnasal transsphenoidal approach, our standard technique, was used in 6 cases. This approach consisted of elevation of mucoperiosteal flaps, resection of the vomer and sphenoid anterior wall, and opening of the sellar floor. Elevated mucoperiosteal flaps were used to close of the sella after tumor resection. All tumors were removed and no significant postoperative complications occurred. We found the both-nostril transnasal approach to be easy and time-saving and provided surgeon with a broad surgical field necessary to treat large tumors and accidental cases. Postoperative observation of the sella was easy for wide opening of the anterior wall of the sphenoid sinus. In our experience with reoperation, we quickly accessed the sella and easily removed tumors in the second operation. Our technique therefore has an advance in treatment of recurrence. The both-nostril transnasal approach involves the same procedures as median drainage of the sphenoid sinus, so our technique may have advantages in preventing mucocele of the sphenoid sinus as a late complication of transsphenoidal surgery. The transnasal transsphenoidal approach via both nostrils is preferable rhinologically. PMID:11218736

  1. Correction of inverted nipple: an alternative method using two triangular areolar dermal flaps.

    PubMed

    Kim, Dae Young; Jeong, Eui Cheol; Eo, Su Rak; Kim, Kwang Seog; Lee, Sam Yong; Cho, Bek Hyun

    2003-12-01

    Inverted nipple, which is defined as a nipple located on a plane lower than the areola, presents both functional and cosmetic problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. Inverted nipples are congenital or acquired, and are classified as the umbilicated and invaginated types or divided into 3 groups (grades 1, 2, and 3). With consideration of its underlying pathophysiologic components and severity, various surgical procedures have been proposed. For correcting the inverted nipple, the authors introduce an alternative, simple method using 2 triangular areolar dermal flaps. Compared with other methods using triangular areolar dermal flaps, each triangle is approximately 1 mm shorter than the diameter of the nipple, and the deepithelialized areolar dermal flaps are lodged at the slit in the bundle of the lactiferous ducts in the grade 2 inverted nipple. From August 2000 to December 2001, 11 patients (16 nipples) were treated. Five patients had bilateral inverted nipples. Patient age at operation ranged from 18 to 31 years (mean age, 27 years). All nipples were congenital and they had no previous operation. Thirteen nipples were grade 2 and 3 were grade 3 according to the classification of inverted nipple by Han and Hong. The mean follow-up period was 8.7 months (range, 3-12 months). Follow-up examinations revealed no evidence of recurrence of inversion. There was no complication associated with surgery, such as infection, hematoma, permanent sensory disturbance, or nipple necrosis. The resulting scars were minimal. All patients were satisfied with their results. The authors conclude that their procedure is reliable, preserves the lactiferous ducts in grade 2 inverted nipple, requires no special postoperative care, and leaves minimal scars and no recurrence of inversion. This technique can be applied to any type of inverted nipple as a primary surgical procedure. PMID:14646667

  2. Improved outcome of surgical flaps treated with topical dimethylsulfoxide.

    PubMed Central

    Rand-Luby, L; Pommier, R F; Williams, S T; Woltering, E A; Small, K A; Fletcher, W S

    1996-01-01

    OBJECTIVE: The objective of this study was to analyze the effect of dimethylsulfoxide (DMSO) on skin flap viability. BACKGROUND: Dimethylsulfoxide has been shown to decrease necrosis of random skin flaps in the rat model, but no human studies have been performed. The authors performed a randomized, prospective study on the effect of DMSO on skin flap viability in patients undergoing mastectomy and inguinal lymphadenectomy. METHODS: Twenty-four patients had topical 60% DMSO applied to their flaps every 4 hours x 10 days after operation and 27 patients had operation alone. The maximum area of flap ischemia was traced by a masked observer and measured by cut and weigh technique. Significance of differences between the treatment and control group was determined by Student's test. RESULTS: The mean area of ischemia for the DMSO group was 16.33 U versus 44.93 U for the control group. This difference was statistically significant (p = 0.01). CONCLUSIONS: The authors conclude that topical application of DMSO reduces skin flap ischemia in humans and recommend its use after operation in which skin flaps are created. PMID:8857862

  3. Principles of definitive soft tissue coverage with flaps.

    PubMed

    Levin, L Scott

    2008-01-01

    Despite the emergence of negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) for orthopaedic trauma, vascularized tissue transfer whether it be pedicle, free, or tissue transfer using the operating microscope or as an island, remains the mainstay of soft tissue reconstruction for orthopaedic traumatology. The critisism of microvascular procedures has been that they are lengthy, costly, and required technical expertise to perform. While technical skills are required, microsurgical care has evolved into a routine operation with high degrees of success in experienced hand. The problem that still remains is access to surgeons who are interested in soft tissue reconstruction and can perform definitive coverage with flaps. There is a need in the orthopaedic community to solve the problem of lack of flap surgeons and as a result, NPWT/ROCF has been touted as the answer to flap reconstruction. NPWT/ROCF is an important addition to soft tissue reconstruction but it serves as a bridge rather than definitive coverage in many hands. Just as wound technology is evolving with tissue substitutes, growth factors and NPWT/ROCF flaps technology continues to advance with new perforator flaps and local regional flaps, particularly the sural flap, coming on line as mainstays of soft tissue reconstruction. PMID:19034164

  4. Comparison of depression, anxiety and long-term quality of health in patients with a history of either primary closure or Limberg flap reconstruction for pilonidal sinus

    PubMed Central

    Duman, Kazim; Ozdemir, Yavuz; Yucel, Ergun; Akin, Mehmet L

    2014-01-01

    OBJECT?VE: Pilonidal sinus is characterized by high operative morbidity mainly due to wound problems. We aimed to compare the quality of health, comfort and psychological status in patients who underwent surgery for pilonidal sinus. METHODS: A total of 205 pilonidal sinus patients operated on with either primary closure or Limberg flap reconstruction were compared in terms of depression, anxiety, and long-term quality of health by using Short Form 36, Beck Depression Inventory, and Beck Anxiety Inventory scales. RESULTS: There were 107 patients in the primary closure group with a mean follow-up of 29.6±7.7 months and 98 patients in the Limberg flap group with a mean follow-up of 34.1±7.3 months. In the SF-36 analysis, the mental health and bodily pain scores (59±6 and 56±11 in the primary closure group and 62±8 and 61±10 in the Limberg flap group) were significantly higher in the Limberg flap group (p?=?0.014 and p?=?0.002, respectively). The mean Beck Depression Inventory (19±6.13 vs. 16±4.90 p<0.001) and Beck Anxiety Inventory (19±6.27 vs. 16±4.90 p<0.001) scores were lower in the Limberg flap group. CONCLUSION: Limberg flap reconstruction produced better quality of health scores according to the SF 36, especially in terms of mental health and bodily pain. There was a higher tendency towards anxiety and depression in the primary closure group. PMID:24964301

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

    PubMed

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

    2014-07-01

    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

  6. Preoperative color Doppler assessment in planning of gluteal perforator flaps.

    PubMed

    Isken, Tonguc; Alagoz, M Sahin; Onyedi, Murat; Izmirli, Hakki; Isil, Eda; Yurtseven, Nagehan

    2009-02-01

    Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores. PMID:19158526

  7. Microdialysis detects postoperative perfusion failure in microvascular flaps.

    PubMed

    Setälä, Leena; Papp, Anthony; Romppanen, Eeva-Liisa; Mustonen, Paula; Berg, Leena; Härmä, Markku

    2006-02-01

    In microvascular tissue transfers, it is essential postoperatively to follow-up on the perfusion of the transferred flap because of the risk of anastomotic failure. The diagnosis of pedicle obstruction is usually made by clinical observation, but some techniques have been reported as more reliable than clinical observation in detecting perfusion failure. The authors used microdialysis (MD), a method developed to assess in situ tissue metabolism, in the follow-up of 80 consecutive microvascular flaps from October, 2001 to October, 2003. Of the 78 flaps with postoperative data, 58 flaps were uneventful clinically and using MD, and served as the reference material for normal postoperative metabolism. Twenty flaps showed some abnormality in the clinical course or with MD. Of these, 13 flaps were reoperated for anastomosis thrombosis (9 arterial, 4 venous). All thromboses were clearly recognized by MD via a decrease in the glucose concentration in the tissue (< 2.7 mmol/l) and an increase in the lactate concentrations (> 5.7 mmol/l). In some cases, MD indicated a pathological trend in glucose and lactate concentrations hours before there were any clinical signs. A system of alarm levels was developed for the staff: when the limits were reached, a critical evaluation of the situation was undertaken, and the need for reoperation was considered. In the series, the salvage rate of all thrombosed flaps was 77 percent, with a final success rate in microvascular reconstruction of 95 percent. No flap was lost due to a delay in the diagnosis of secondary ischemia, if on-line MD monitoring was available. Microdialysis is a clinically feasible and sensitive monitoring method for all kinds of microvascular flaps, especially for those in which clinical observation is difficult or impossible. The performance of the analysis is easy and can be done by even less experienced nursing staff working in institutes with a low frequency of microsurgery. PMID:16456768

  8. Teaching Pediatric Hand Surgery in Vietnam

    PubMed Central

    Kotsis, Sandra V.

    2007-01-01

    Background International volunteering missions are becoming an important focus of plastic surgeons in the United States. The purpose of this paper is to describe the teaching of pediatric hand surgery in Vietnam to share the lessons learned from this project. Methods Two medical education trips were conducted to the no. 1 Children’s Hospital in Ho Chi Minh city (Saigon) to teach pediatric hand and burn reconstructive surgery to the surgeons and therapists. This is the main referral children’s hospital for the country, and pediatric hand surgery expertise is not available. Results Structured education programs were conducted over two trips to introduce congenital hand surgery and burn reconstructive procedures using flap techniques. The education programs included lectures and surgical demonstrations of selected procedures. Their proficiency was verified by supervised conduct of these operations. Conclusions A well-conceived medical education program can introduce complex surgical discipline to a country. Through two trips, the surgeons at this referral center will have the capability to take care of many children requiring reconstructive hand surgery. PMID:18780043

  9. Surgical Excision of Multiple Penile Syringomas With Scrotal Flap Reconstruction

    PubMed Central

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

    2014-01-01

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

  10. DEHN SURGERY 1. Introduction

    E-print Network

    Hachimori, Masahiro

    DEHN SURGERY 1. Introduction Dehn surgery hyperbolic knot exceptional surgery (§2) link Dehn surgery (§3) 2. Exceptional surgery and boundary slopes hyperbolic knot exceptional surgery ? S3 ( S3 homotopy S3 ) Dehn surgery K S3 knot E(K) = S3 -intN(K) exterior prim- itive class H1(E(K); Z) ( ) m K

  11. Treatment of Oroantral Communication Using the Lateral Palatal Sliding Flap Technique

    PubMed Central

    Ribeiro, Fernando Salimon; de Toledo, Cassio Torres; Aleixo, Michele Romero; Durigan, Maria Cristina; da Silva, Willian Corręa; Bueno, Samanta Kelen; Pontes, Ana Emília Farias

    2015-01-01

    Herein, we present a case of oroantral communication that was to be treated with clinical examination, tomography, and prototyping. A patient presented with oroantral communication with purulent exudation for 4 months, since the displacement of the dental implant and O-ring component to the maxillary sinus. Tomographic examination and prototyping revealed a 5?mm bone gap. The patient underwent local washes and antibiotic therapy. After local palpation, a bone defect detected by prototyping was suspected to be greater than that observed. For the surgery, a communication tunnel was made, and the bone defect was found to be 12?mm in diameter. A pedicle flap was raised on the palate, followed by sliding and suturing. No complications were observed during the postoperative period, and the suture was removed after a week. Four months later, communication did not resume, and the patient did not complain of pain, foul smelling, or purulent discharge and was satisfied with the outcome. The findings of this case suggest that the lateral sliding flap can be used as an efficient technique for closing oroantral communications. An accurate clinical examination is a critical tool that can be used instead of tomography and prototyping, which can be misleading. PMID:26113864

  12. Versatility of Capsular Flaps in the Salvage of Exposed Breast Implants

    PubMed Central

    Tenna, Stefania; Cagli, Barbara; Pallara, Tiziano; Campa, Stefano; Persichetti, Paolo

    2015-01-01

    Summary: Breast implant exposure due to poor tissue coverage or previous irradiation represents a surgical challenge both in the reconstructive and aesthetic plastic surgery practice. In case of implant extrusion or incipient exposure, the commonly suggested strategies, such as targeted antibiotic therapy, drainage and lavage of the cavity, fistulectomy, and primary closure, may be ineffective leading the surgeon to an unwanted implant removal or to adopt more invasive flap coverage procedures. Breast implant capsule, in its physiological clinical behavior, can be considered as a new reliable source of tissue, which can be used in a wide range of clinical situations. In our hands, capsular flaps proved to be a versatile solution not only to treat breast contour deformities or inframammary fold malpositions but also to salvage exposed breast implants. In this scenario, the use of more invasive surgical techniques can be avoided or simply saved and delayed for future recurrences.(Plast Reconstr Surg Glob Open 2015;3:e340; doi:10.1097/GOX.0000000000000307; Published online 30 March 2015.)

  13. Oncoplastic volume replacement technique for the upper inner quadrant using the omental flap

    PubMed Central

    2015-01-01

    Background In breast-conserving surgery (BCS), a large defects in the upper inner quadrant (UIQ) named the no man’s land of the breast will cause shift the nipple in an unnatural upward or medial fashion. We have developed oncoplastic volume replacement techniques using a laparoscopically harvested omental flap (OF). This paper presents our experiences performing partial breast reconstruction for the defect in the UIQ using the OF. Methods A wide excision (>20% of the breast tissue) was performed mainly through a periareolar incision. The pedicled OF was harvested laparoscopically. A small incision was made along the medical inframammary fold and a subcutaneous tunnel was created towards the xyphoid process. The OF was extracted through the tunnel, and used to fill the defect in the UIQ. Results Thirty patients were included in this study. The median resected breast volume was 142 g. A donor-site complication was only one ventral hernia. The surgical margins were positive in one patient (3.3%), and neither local nor systemic recurrence has occurred during medial follow-up periods of 64 months. Cosmetic outcomes were mostly satisfactory with negligible donor-site scars, and more than 80% of the patients scored excellent or good. Conclusions The OF is a useful volume replacement technique for the UIQ which is the most difficult quadrant for the other distant flaps. PMID:26161311

  14. Karydakis flap repair for sacrococcygeal pilonidal sinus disease: how important is technique?

    PubMed

    Keshava, Anil; Young, Christopher J; Rickard, Matthew J F X; Sinclair, Gael

    2007-03-01

    Numerous operative and conservative treatments have been described in the published work for the management of sacrococcygeal pilonidal sinus; yet there remains considerable debate over its ideal treatment. This report is an audit of our results using the Karydakis flap repair in the management of this condition. We analysed prospective data on 70 patients who had had a Karydakis procedure. The length of follow up ranged from 1 to 79 months (median 36 months). Seventy-one operations were carried out in 70 patients. This included 12 patients (17%) who had previously undergone between one and four procedures (median 2) for recurrent disease. Superficial wound breakdown occurred in 27 patients (38%) and complete wound breakdown occurred in six patients (8.4%). These wounds were allowed to heal by secondary intent. The median time to complete healing for superficial and complete wound breakdown was 80 and 84 days, respectively. Disease recurrence occurred in three patients (4.2%) -- two of whom had recurrent disease at the time of this presentation. Of the three patients who had a recurrence after our surgery, two had a superficial breakdown and one had a complete wound breakdown. Sacrococcygeal pilonidal disease has a low recurrence rate when treated by the Karydakis operation involving flattening of the midline cleft. This procedure avoids the need for more complicated flap repairs. PMID:17305997

  15. [Presbyopia surgery].

    PubMed

    Gatinel, Damien

    2008-05-31

    Presbyopia surgery is a compensation option which aims at creating an increased depth of field. Monovision preserves a good close-vision quality for myopes. Multifocality is well tolerated by hyperopes if it is compatible with good far-vision quality. Conductive keratoplasty and Lasik multifocal ablation patterns are newly emerging methods. Monovision and multifocality can be applied to surgery by using corneal or intraocular implantation techniques. Multifocal intraocular lenses (IOLs) are growing in popularity among patients and surgeons, and opened the way to refractive lens exchange. Still they are not used routinely in cataract surgery, for reasons probably connected to the frequently observed reduction in contrast sensitivity. Accommodative IOL provides new method to compensate accommodation of presbyopes. Indications depend on preoperative ametropia, patient age and visual needs. PMID:18652400

  16. Bariatric surgery.

    PubMed

    2014-08-26

    Essential facts: Type 2 diabetes is linked closely to obesity. Bariatric surgery can lead to dramatic improvements in the management of the condition, according to the National Institute for Health and Care Excellence (NICE). There are two main types of bariatric surgery. A gastric band procedure uses a band to reduce the size of the stomach so a smaller amount of food is required to make the patient feel full. A gastric bypass is where the digestive system is re-routed past most of the stomach so less food is digested. PMID:25138853

  17. Acne Surgery

    PubMed Central

    Dilworth, G. R.

    1983-01-01

    Acne surgery consists of comedone extraction of non-inflamed lesions, triamcinolone acetate injections of some inflamed lesions, and extraction of milia. Prevention is a very important part of comedone treatment, especially avoidance of picking, moisturizers and harsh soaps. Instruments are also very important: even the finest may be too thick and may have to be filed down. Acne surgery is only an adjunct of good medical therapy. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:21283373

  18. Simultaneous bilateral breast reconstruction using latissimus dorsi myocutaneous flaps: a retrospective review of an institutional experience.

    PubMed

    Smith, B K; Cohen, B E; Biggs, T M; Suber, J

    2001-10-01

    A single institution's experience in the simultaneous reconstruction of both breasts using bilateral latissimus dorsi myocutaneous flaps is presented. The procedure was performed on 24 patients by the attending staff of the department of plastic surgery at St. Joseph Hospital in Houston, Texas, between 1979 and 1999. Of the 24 patients reviewed, six had immediate reconstructions, 13 had delayed primary reconstructions, and five had secondary reconstructions of failed or unsatisfactory primary procedures. In the group with delayed reconstructions, the average time between mastectomy and reconstruction was 46.4 months, with a range from 7 days to 21 years. The operative method, results, and outcomes of our experience in these patients is presented. PMID:11604615

  19. Reconstruction of a Severely Crushed Leg with Interpositional Vessel Grafts and Latissimus Dorsi Flap

    PubMed Central

    Park, Chan Woo; Hwang, Kyu Tae; Kim, Jeong Tae

    2012-01-01

    We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time. PMID:22872848

  20. Lift Enhancement by Dynamically Changing Wingspan in Forward Flapping Flight

    E-print Network

    Wang, Shizhao; He, Guowei; Liu, Tianshu

    2013-01-01

    Stretching and retracting wingspan has been widely observed in the flight of birds and bats, and its effects on the aerodynamic performance particularly lift generation are intriguing. The rectangular flat-plate flapping wing with a sinusoidally stretching and retracting wingspan is proposed as a simple model of biologically-inspired dynamic morphing wings. Direct numerical simulations of the low-Reynolds-number flows around the flapping morphing wing in a parametric space are conducted by using immersed boundary method. It is found that the instantaneous and time-averaged lift coefficients of the wing can be significantly enhanced by dynamically changing wingspan in a flapping cycle. The lift enhancement is caused not only by changing the lifting surface area, but also manipulating the flow structures that are responsible to the generation of the vortex lift. The physical mechanisms behind the lift enhancement are explored by examining the three-dimensional flow structures around the flapping wing.

  1. Pedicled anterolateral thigh flap for contralateral groin composite defect

    PubMed Central

    Bharath, S. P.; Madhusudan, G.; Manjunath, Suraj

    2010-01-01

    Pedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described. PMID:20924463

  2. Propulsion through wake synchronization using a flapping foil

    E-print Network

    Beal, David Nelson, 1973-

    2003-01-01

    The design issues associated with underwater vehicles operating in the surf zone or other high-energy environments are likely to have viable biomimetic solutions. The flapping fin is capable of producing high instantaneous ...

  3. Computer study of a jet flap ASTVOL 'Harrier'

    NASA Technical Reports Server (NTRS)

    Wilson, S. B., III; Liperra, L. D.

    1984-01-01

    A study of the costs/benefits trade-off was conducted for an Advanced Supersonic Short Takeoff and Vertical Landing (ASTOVL) aircraft incorporating a jet flap. The data used were the theory of jet flaps and high aspect ratio nozzles, experience with a V/STOL aircraft study performed for NASA Ames Research Center in February 1982, and a high performance aircraft-synthesis program (ACSYNT). The methodology was to accurately model the supersonic Harrier V/STOL aircraft design on ACSYNT, and then modify the design by both adding high aspect-ratio nozzles in place of the rear (core-flow) nozzles on the Pegasus-type turbofan engine, and integrating these nozzles on each wing's trailing edge, thus creating a jet flap. The predicted performance advantages (increase in maximum lift coefficient with flap deflection and horizontal thrust recovery) were traded off against the disadvantages (additional weight and thrust loss due to ducting) on two representative missions.

  4. Wing compliance in self-propelled flapping flyers

    NASA Astrophysics Data System (ADS)

    Ramananarivo, Sophie; Thiria, Benjamin; Godoy-Diana, Ramiro

    2010-11-01

    Wing flexibility governs the flying performance of flapping wing flyers. Here we use the self-propelled flapping-wing model mounted on a "merry-go-round" described by Thiria and Godoy-Diana (Phys. Rev. E 82, 015303, 2010) to investigate the effect of chord-wise wing compliance on the propulsive performance of the system. The bending of the wings, which is driven mainly by wing inertia in the present experiments, redistributes the aerodynamic forces engendered by the flapping motion and improves the efficiency of the system for a wide range of wing flexibilities and flapping frequencies. A detailed analysis of the phase dynamics between the leading and trailing edges of the wings allows us to pinpoint the mechanisms that limit the beneficial effect of wing compliance.

  5. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...positions that are not fully retracted, the wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond those settings....

  6. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...positions that are not fully retracted, the wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond those settings....

  7. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...positions that are not fully retracted, the wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond those settings....

  8. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...positions that are not fully retracted, the wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond those settings....

  9. Impact of Timing of Admission and Microvascular Reconstruction on Free Flap Success Rates in Traumatic Upper Extremity Defects.

    PubMed

    Kolbenschlag, Jonas; Klinkenberg, Marek; Hellmich, Susanne; Germann, Günter; Megerle, Kai

    2015-07-01

    Background?Despite a growing body of knowledge, the timing of microsurgical reconstruction for the upper extremity remains a controversial topic. Most of the available literature deals with lower extremity reconstruction and the few reports on microsurgical reconstruction of the upper extremity are mostly concerned with infection rates and rarely consider thrombosis and changes in coagulation parameters. Methods?We performed a retrospective review of all free flaps performed for upper extremity reconstruction at our institution from 2000 to 2010. Only acute, isolated traumatic defects of the upper extremity requiring a free flap for reconstruction were included in this study. A review of medical records was performed to assess, among others, comorbidities, timing of reconstruction, and platelet levels. Results?A total of 41 patients were included in this study, 70% of whom were male. Mean age at the time of surgery was 40.8?±?15.4 years. Patients who were directly referred to our hospital underwent reconstruction significantly faster than those who were transferred secondarily (p?=?0.0001). The number of surgical revisions as well as the flap loss rate was higher in patients undergoing reconstruction more than 1?week after trauma (p?=?0.09 and 0.033, respectively). A significantly higher platelet count was seen in the patients undergoing delayed reconstruction (p?=?0.002). Conclusion?In our study, early microsurgical reconstruction of the upper extremity yielded better results in terms of lower rates of surgical revisions and flap loss. This might be partly because of a trauma-induced thrombocythemia, with a maximum level of platelets in the 2nd week post trauma. We, therefore, advocate a timely coverage of these defects along with an anticoagulatory regimen including some form of platelet inhibition. PMID:25803409

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

    NASA Technical Reports Server (NTRS)

    Harris, Thomas A; Lowry, John G

    1941-01-01

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

  11. Hyperbaric oxygen (HBO2) treatment for a failing facial flap

    Microsoft Academic Search

    Brian F McCrary

    2007-01-01

    Hyperbaric oxygen (HBO2) is an approved treatment for 13 pathological entities. One of these indications—a failing facial flap—is presented in this case report of a traumatic wound to the face and right axilla after an unprovoked pit bull attack on a 4 year old girl. Surgical repair was started acutely but the facial flap became congested and ischaemic, indicating deterioration

  12. Animal flight dynamics II. Longitudinal stability in flapping flight.

    PubMed

    Taylor, G K; Thomas, A L R

    2002-02-01

    Stability is essential to flying and is usually assumed to be especially problematic in flapping flight. If so, problems of stability may have presented a particular hurdle to the evolution of flapping flight. In spite of this, the stability of flapping flight has never been properly analysed. Here we use quasi-static and blade element approaches to analyse the stability provided by a flapping wing. By using reduced order approximations to the natural modes of motion, we show that wing beat frequencies are generally high enough compared to the natural frequencies of motion for a quasi-static approach to be valid as a first approximation. Contrary to expectations, we find that there is noting inherently destabilizing about flapping: beating the wings faster simply amplifies any existing stability or instability, and flapping can even enhance stability compared to gliding at the same air speed. This suggests that aerodynamic stability may not have been a particular hurdle in the evolution of flapping flight. Hovering animals, like hovering helicopters, are predicted to possess neutral static stability. Flapping animals, like fixed wing aircraft, are predicted to be stable in forward flight if the mean flight force acts above and/or behind the centre of gravity. In this case, the downstroke will always be stabilizing. The stabilizing contribution may be diminished by an active upstroke with a low advance ratio and more horizontal stroke plane; other forms of the upstroke may make a small positive contribution to stability. An active upstroke could, therefore, be used to lower stability and enhance manoeuvrability. Translatory mechanisms of unsteady lift production are predicted to amplify the stability predicted by a quasi-static analysis. Non-translatory mechanisms will make little or no contribution to stability. This may be one reason why flies, and other animals which rely upon non-translatory aerodynamic mechanisms, often appear inherently unstable. PMID:11846595

  13. Wind Tunnel Test of the SMART Active Flap Rotor

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

    Boeing and a team from Air Force, NASA, Army, DARPA, MIT, UCLA, and U. of Maryland have successfully completed a wind-tunnel test of the smart material actuated rotor technology (SMART) rotor in the 40- by 80-foot wind-tunnel of the National Full-Scale Aerodynamic Complex at NASA Ames Research Center. The Boeing SMART rotor is a full-scale, five-bladed bearingless MD 900 helicopter rotor modified with a piezoelectric-actuated trailing edge flap on each blade. The eleven-week test program evaluated the forward flight characteristics of the active-flap rotor at speeds up to 155 knots, gathered data to validate state-of-the-art codes for rotor aero-acoustic analysis, and quantified the effects of open and closed loop active flap control on rotor loads, noise, and performance. The test demonstrated on-blade smart material control of flaps on a full-scale rotor for the first time in a wind tunnel. The effectiveness of the active flap control on noise and vibration was conclusively demonstrated. Results showed significant reductions up to 6dB in blade-vortex-interaction and in-plane noise, as well as reductions in vibratory hub loads up to 80%. Trailing-edge flap deflections were controlled within 0.1 degrees of the commanded value. The impact of the active flap on control power, rotor smoothing, and performance was also demonstrated. Finally, the reliability of the flap actuation system was successfully proven in more than 60 hours of wind-tunnel testing.

  14. Solder-assembled large MEMS flaps for fluid mixing

    Microsoft Academic Search

    Zhichun Ma; Elizabeth Bradley; Thomas Peacock; Jean R. Hertzberg; Yung-Cheng Lee

    2003-01-01

    We describe surface-micromachined thermal actuator-based micro-electro-mechanical systems (MEMS) flaps with a length scale of 1,000 ?m. These flaps were developed for the enhancement of fluid mixing in an experimental study of a planar air jet. The scales of the flow physics required the actuators to be much larger than the typical MEMS scales, and the experiment required an array of

  15. PIV investigation of flowfield behind perforated Gurney-type flaps

    Microsoft Academic Search

    Tim Lee; L. S. Ko

    2009-01-01

    The flow behind perforated Gurney-type flaps was investigated by using particle image velocimetry (PIV) at Re = 5.3 × 104. The PIV measurements were supplemented by force balance and surface pressure data. The near wake was disrupted and narrowed,\\u000a indicative of a reduced drag, with increasing flap perforation and had a drastically suppressed fluctuating intensity. Depending\\u000a on the strength of the perforation-generated jet, the

  16. Effect of the Gurney flap on a NACA 23012 airfoil

    Microsoft Academic Search

    Neung-Soo Yoo

    2000-01-01

    A numerical investigation was performed to determine the effect of the Gurney flap on a NACA 23012 airfoil. A Navier-Stokes\\u000a code, RAMPANT, was used to calculate the flow field about the airfoil. Fully-turbulent results were obtained using the standardk-? two-equation turbulence model. The numerical solutions showed that the Gurney flap increased both lift and drag. These\\u000a results suggested that the

  17. Flap Side Edge Liners for Airframe Noise Reduction

    NASA Technical Reports Server (NTRS)

    Jones, Michael G. (Inventor); Khorrami, Mehdi R. (Inventor); Choudhari, Meelan M. (Inventor); Howerton, Brian M. (Inventor)

    2014-01-01

    One or more acoustic liners comprising internal chambers or passageways that absorb energy from a noise source on the aircraft are disclosed. The acoustic liners may be positioned at the ends of flaps of an aircraft wing to provide broadband noise absorption and/or dampen the noise producing unsteady flow features, and to reduce the amount of noise generated due to unsteady flow at the inboard and/or outboard end edges of a flap.

  18. Abdominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.

    PubMed

    Suominen, S; Asko-Seljavaara, S; Kinnunen, J; Sainio, P; Alaranta, H

    1997-09-01

    A prospective study was designed to evaluate the possible changes in abdominal wall strength following free transverse rectus abdominis musculocutaneous (TRAM) flap surgery for breast reconstruction. Twenty-two patients were examined 1 day before surgery, and at 3, 6, and 12 months postoperatively. Trunk muscle strength was measured by the same physiotherapist using an isokinetic dynamometer (Lido Multi Joint II, Loredan Biomedical Inc., Davies, CA). The peak torque and average torque for both flexion and extension at 60 degrees per second angular velocity were recorded from the curves obtained. There was a significant reduction in trunk flexion strength at 3 months postoperatively (peak torque mean, 92% of the preoperative value; p = 0.04), but this was corrected by 6 months (mean, 96%), and improved to 98% by 12 months. The patient's ability to do curled trunk sit-ups was evaluated by the same physiotherapist and graded on a scale from 1 to 6. In 9 of 19 patients the operation had no effect on sit-up performance during follow-up. In 10 of 19 patients there was a reduction of one or two grades at 3 months that did not improve by 12 months. Magnetic resonance imaging of the abdominal wall was performed on 9 patients. The mean area of the upper third of both rectus muscles was measured on the axial images. At 3 months postoperatively the mean area of the upper third of the donor muscle was significantly larger than the contralateral (p = 0.03). There was no difference in size at 6 months, and by 12 months the donor side was smaller. This prospective study shows that harvesting of a free TRAM flap can cause a subclinical reduction in abdominal strength, although this was not noticed by the patients themselves. PMID:9326701

  19. Bariatric Surgery

    Microsoft Academic Search

    M. Schweitzer; A. Lidor; T. Magnuson

    2006-01-01

    Bariatric surgery is currently the only effective long-term treatment of morbid obesity and its related co-morbidities. Gastric bypass, adjustable gastric banding, and duodenal switch with biliopancreatic diversion are the three most common operations performed in the United States to induce sustained weight loss. Patient selection is important since compliance postoperatively leads to a successful outcome in over 80% of patients.

  20. After Surgery

    MedlinePLUS

    ... or accidental injury. Some people have a greater risk of complications because of other medical conditions. Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  1. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

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

  2. "Reposition-flap": A therapeutic alternative in fingertips amputations.

    PubMed

    Robert, N; Chassat, R; Couturier, C; Delpit, X; Masmejean, E

    2015-08-01

    After trans-phalanx fingertips amputations, there is usually a therapeutic problem related to the distal fragment quality. Replantation is not always possible. The aim of this study was to propose the "reposition-flap" surgical procedure as an alternative solution to various surgical strategies for distal stump coverage. It consisted in the association of a bone fragment osteosyntesis and a pedicular local flap implementation. Between 2001 and 2011, the reposition-flap surgical procedure was retrospectively tested in two hand trauma centers. We reviewed a cohort of 51 patients divided in two groups. The first one (20 patients) was the "reposition-flap" group, the second (31 patients) had a coverage with an other surgical procedure (simple regularisation or local flap). Sensibility, pulp trophicity, fingers mobility, digital length, nail appearance and radiologic consolidation of each patient were reviewed. "Reposition-flap" allowed 80% length of phalanx conservation. In comparison with regularisation, the aesthetic aspects of the nail's finger (no claw) were improved with this surgical procedure. However, the Quick DASH average revealed significant statistical differences instead of the statistics obtained with the mobility of the IPD and the sensitivity of the pulp. This procedure gave best aesthetic and functional results. PMID:25001417

  3. An investigation into the aerodynamics of Gurney flaps

    NASA Astrophysics Data System (ADS)

    Jeffrey, David Robert Michael

    The Gurney flap is a simple device for increasing the normal force (lift or downforce) generated by a wing. This thesis presents results from different experimental and computational techniques, which are used to examine the aerodynamics of the Gurney flap. Time-averaged off-surface velocities, obtained using Laser Doppler Anemometry, confirm the hypothesis that the dominant features directly downstream of the Gurney flap are two counter-rotating vortices. The instantaneous flow structure actually consists of a wake of alternately shed vortices, which form a von Kármán vortex street. The vortex shedding and the deceleration of the flow caused by the upstream face of the Gurney flap create a pressure difference acting across the trailing edge, and it is this that generates the increase in circulation. Arguments are put forward that explain the observed variations in shedding frequency, trailing-edge pressures and suctions, lift and drag with Gurney flap height, incidence and sectional properties. The effect of the Gurney flap on chordwise pressures can be simulated in a three-dimensional panel method by extending the trailing edge of the aerofoil.

  4. Compliant topology optimization for planar passive flap micro valve.

    PubMed

    Yoon, Gil Ho

    2014-10-01

    This paper reports the compliant topology optimization for planar passive flap micro valve considering fluid-structure interaction with a monolithic approach. Although flap valve type check valve is easy to manufacture and use for the applications for Bio/Nano/MEMS, its structural optimization has been seldom conducted so far. The size of the Bio/Nano/MEMS devices becomes smaller and the simple straight type micro valve structure is required to be optimized considering fluid speed. To address this optimization problem, the structural topology optimization scheme which designs optimal topologies is applied for a flap type check valve structure. To consider the coupling effects of fluid domain and structural domain, the monolithic finite element approach is employed. In the new analysis approach, solid domain is simulated by introducing the inverse permeability in the Navier-Stokes equation and the fluid stress filter in the linear elasticity equation. Also it is a new idea that fluid domain is simulated by finite elements with a weak Young's modulus in the linear elasticity equation. The mutual couplings between fluid and structure are considered by the introduction of the deformation tensor which is one of the basic concepts of the continuum mechanism. By distributing material properties inside a design domain for compliant flap, optimal flap structures can be constructed with different fluid speeds. By investigating the optimal layouts of several passive flap designs, we prove that the structural topology optimization can provide optimal layouts for Bio, Nano, and MEMS applications. PMID:25942830

  5. Abdominal wall surgery

    MedlinePLUS

    Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It ... tummy tuck" to more complicated, extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...

  6. Latissimus dorsi muscle and its short perforator-based skin compound free flap.

    PubMed

    Hwang, Jae Ha; Kim, Eui Sik; Kim, Kwang Seog; Kim, Dae Young; Lee, Sam Yong

    2007-04-01

    Some authors have described the latissimus dorsi muscle and its short perforator-based skin compound flap based on the same thoracodorsal vessels. This flap procedure involves separating the skin island from the underlying latissimus dorsi muscle and rotating the skin island over the musculocutaneous perforator emerging from the latissimus dorsi muscle. As with all surgical procedures, there are various advantages and disadvantages. However, to the best of the authors' knowledge, there are no reports on the use of the flap in a consecutive series. Between 1997 and 2005, the flap was used to reconstruct below-knee structures in 26 patients (23 males and 3 females) by the 2 senior authors at the Chonnam National University Medical School. The clinical outcomes of this procedure were evaluated. Satisfactory results were obtained in most patients. However, there were 2 marginal necroses in the excessively large skin flaps, 1 partial necrosis over the distal edge of a skin flap, and 1 total flap failure caused by infection. The marginally and partially necrotized skin flaps were treated successfully with split-thickness skin grafts. However, another flap procedure was required to cover the defect in the case of flap failure. The donor sites were closed primarily in all patients, and the skin flaps were rotated between 40 degrees and 180 degrees. This flap allows the surface of the latissimus dorsi musculocutaneous flap to be expanded without additional donor morbidity. In addition, the flap procedure is safe and easy to perform. Moreover, the flap provides sufficient flexibility, even though it has less independent flap mobility than the chimeric flap. Therefore, the flap may be a convenient and reliable alternative for the reconstruction of large and irregular-shaped wounds. PMID:17413879

  7. Porcine cadaver iris model for iris heating during corneal surgery with a femtosecond laser

    NASA Astrophysics Data System (ADS)

    Sun, Hui; Fan, Zhongwei; Wang, Jiang; Yan, Ying; Juhasz, Tibor; Kurtz, Ron

    2015-03-01

    Multiple femtosecond lasers have now been cleared for use for ophthalmic surgery, including for creation of corneal flaps in LASIK surgery. Preliminary study indicated that during typical surgical use, laser energy may pass beyond the cornea with potential effects on the iris. As a model for laser exposure of the iris during femtosecond corneal surgery, we simulated the temperature rise in porcine cadaver iris during direct illumination by the femtosecond laser. Additionally, ex-vivo iris heating due to femtosecond laser irradiation was measured with an infrared thermal camera (Fluke corp. Everett, WA) as a validation of the simulation.

  8. Management of heel ulcers in insensate foot by using free prefabricated radial fascial flap — a new flap

    Microsoft Academic Search

    Vishwa Prakash

    2010-01-01

    Heel ulcers are common in insensate foot. The management of such ulcers require tissue not only to resurface the skin defect,\\u000a which is small in most of the cases; but also well vascularised tissue to fill the cavity which results after excision of\\u000a the ulcer. We have described a new flap prefabricated radial fascial flap, by which both aims are

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

    PubMed

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

    2015-05-01

    Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74?±?2.47. The mean postoperative PI value was 12.52?±?2.34. The mean difference between the preoperative and postoperative PI values was -1.78±0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P?=?0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results. © 2014 Wiley Periodicals, Inc. Microsurgery 35:253-261, 2015. PMID:25256771

  10. Tests of an N.A.C.A. 23012 Airfoil with a slotted deflector flap

    NASA Technical Reports Server (NTRS)

    House, R O

    1939-01-01

    Section aerodynamic characteristics of a large-chord N.A.C.A. 23012 airfoil with a slotted deflector flap were obtained in the N.A.C.A. 7- by 10-foot wind tunnel. The characteristics of an N.A.C.A. slotted flap and of a simple split flap are included for comparison. The slotted deflector flap was found to have a somewhat lower maximum lift coefficient and somewhat higher drag at high lift coefficients than the N.A.C.A. slotted flap. The high drag of the open slot with the deflector flap neutral indicates that the slot should be closed for this condition.

  11. A computer program to calculate the longitudinal aerodynamic characteristics of wing-flap configurations with externally blown flaps

    NASA Technical Reports Server (NTRS)

    Mendenhall, M. R.; Goodwin, F. K.; Spangler, S. B.

    1976-01-01

    A vortex lattice lifting-surface method is used to model the wing and multiple flaps. Each lifting surface may be of arbitrary planform having camber and twist, and the multiple-slotted trailing-edge flap system may consist of up to ten flaps with different spans and deflection angles. The engine wakes model consists of a series of closely spaced vortex rings with circular or elliptic cross sections. The rings are normal to a wake centerline which is free to move vertically and laterally to accommodate the local flow field beneath the wing and flaps. The two potential flow models are used in an iterative fashion to calculate the wing-flap loading distribution including the influence of the waves from up to two turbofan engines on the semispan. The method is limited to the condition where the flow and geometry of the configurations are symmetric about the vertical plane containing the wing root chord. The calculation procedure starts with arbitrarily positioned wake centerlines and the iterative calculation continues until the total configuration loading converges within a prescribed tolerance. Program results include total configuration forces and moments, individual lifting-surface load distributions, including pressure distributions, individual flap hinge moments, and flow field calculation at arbitrary field points.

  12. Turn-over orbital septal flap and levator recession for upper-eyelid retraction secondary to thyroid eye disease

    PubMed Central

    Watanabe, A; Shams, P N; Katori, N; Kinoshita, S; Selva, D

    2013-01-01

    Background A turn-over septal flap has been reported as a spacer for levator lengthening in a single case report. This study reports the preliminary outcomes of this technique in a series of patients with upper-lid retraction (ULR) associated with thyroid eye disease (TED) causing symptomatic exposure keratopathy (EK). Methods Retrospective, multicenter study of 12 eyelids of 10 patients with TED undergoing a transcutaneous levator-lengthening technique using the reflected orbital septum (OS) as a spacer. Change in palpebral aperture (PA) and contour, position of the skin crease (SC), symptoms of EK, and complications were recorded. Results The average age was 47.5 years. Two patients were excluded, as their septa were found to be very thin at surgery. At an average of 13 months postoperatively, the PA was reduced by 2.5?mm on average (P<0.001) and was within 1?mm of the contralateral eyelid in 11 cases (92%); the position of the SC was within 1?mm of the desired position in all cases. EK resolved in all cases. Complications included one case of overcorrection and one case of recurrent lateral flare. Conclusions The turn-over orbital septal flap technique may be a viable option as an autogenous spacer for the treatment of ULR in TED. This technique may be possible in cases where the OS has been opened by previous surgery but may not be feasible in patients in whom the septum is very thin. PMID:23907627

  13. Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.

    PubMed

    Zang, Mengqing; Yu, Shengji; Xu, Libin; Zhao, Zhenguo; Zhu, Shan; Ding, Qiang; Liu, Yuanbo

    2015-06-01

    Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. Our purpose is to use various intercostal artery perforator propeller flaps for trunk oncologic reconstruction. Between November 2013 and July 2014, nine intercostal artery perforator propeller flaps were performed in seven patients to reconstruct the defects following sarcoma resection in different regions of the trunk, including the back, lumbar, chest, and abdomen. Two perforators from intercostal arteries were identified for each flap using Doppler ultrasound probe adjacent to the defect. The perforator with visible pulsation was chosen as the pedicle vessel. An elliptical flap was raised and rotated in a propeller fashion to repair the defects. There were one dorsal intercostal artery perforator flap, four dorsolateral intercostal artery perforator flaps, three lateral intercostal artery perforator flaps, and one anterior intercostal artery perforator flap. The mean skin paddle dimension was 9.38 cm in width (range 6-14 cm) and 21.22 cm in length (range 13-28 cm). All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps. PMID:25801799

  14. Theoretical studies on flapped delta wings

    NASA Technical Reports Server (NTRS)

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

    1988-01-01

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

  15. Open loop performance of a biomimetic flapping foil autonomous underwater vehicle

    E-print Network

    Wolf, Malima Isabelle, 1981-

    2006-01-01

    Flapping foil propulsion is emerging as an alternative to conventional propulsion for underwater vehicles. MIT's Biomimetic Flapping Foil Autonomous Underwater Vehicle is a prototype vehicle that uses four three-dimensional ...

  16. [Comments on article "Scalp flap pedicled on posterior auricular artery. Anatomical study and clinical application"].

    PubMed

    Oufkir, A A; Kajout, M; Chadli, R; Alami, M N

    2015-06-01

    The authors comment on the reliability of the scalp flap pedicled on auricular posterior artery, arguing with the conclusions of anatomic studies published in this issue and their little experience in reconstructing scalp defects by local flaps. PMID:25841768

  17. The modified cross finger flap for finger pulp and nail bed reconstruction

    Microsoft Academic Search

    S. Spokevicius; A. Gupta

    1997-01-01

    We describe a modification of the cross finger flap procedure. The modification enhances the amount of soft tissue under the flap, permitting reconstruction of the nail bed where necessary. We present two clinical cases.

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

    E-print Network

    McLetchie, Karl-Magnus Weidmann

    2004-01-01

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

  19. An experimental study of pressures on 60 deg Delta wings with leading edge vortex flaps

    NASA Technical Reports Server (NTRS)

    Marchman, J. F., III; Terry, J. E.; Donatelli, D. A.

    1983-01-01

    An experimental study was conducted in the Virginia Tech Stability Wind Tunnel to determine surface pressures over a 60 deg sweep delta wing with three vortex flap designs. Extensive pressure data was collected to provide a base data set for comparison with computational design codes and to allow a better understanding of the flow over vortex flaps. The results indicated that vortex flaps can be designed which will contain the leading edge vortex with no spillage onto the wing upper surface. However, the tests also showed that flaps designed without accounting for flap thickness will not be optimum and the result can be oversized flaps, early flap vortex reattachment and a second separation and vortex at the wing/flap hinge line.

  20. Hydrodynamic performance and vortex shedding of a biologically inspired three-dimensional flapping foil

    E-print Network

    Lim, Keith, K. L

    2005-01-01

    The dynamics of flapping remains a subject a great theoretical and practical interest. Propulsion and maneuvering by flapping, optimized through years of evolution, is ubiquitous in nature, yet marine pulsars inspired by ...

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

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Delano, James B

    1938-01-01

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

  2. Reduction of flaps: Speech style, phonological environment, and variability

    NASA Astrophysics Data System (ADS)

    Warner, Natasha L.

    2005-09-01

    Normal connected speech contains a tremendous amount of variability in how a given sound is realized. The current work examines American English /t/ and /d/ in flapping environments. Flaps can be reduced to an approximant or even deleted in connected speech, and this study compares reduction of flaps to reduction of other stops (/p, b, k, g/) in the same environments. The effects of segmental environment (target followed by /l/, syllabic /r/, /?/, word boundary, etc.), stress (target following stressed syllable versus between two unstressed syllables), and speech style (casual conversation, reading connected text, and word list reading) are analyzed. Target segments are analyzed for presence/absence of a burst and of formants during closure, for duration of the segment and of closure voicing, and for amplitude during the closure or constriction. This project documents the degree of variability in reduction both within and across speakers. Preliminary results show that flaps are reduced to approximants surprisingly often, even in the most careful speech style. The results also suggest that flaps are far more likely to reduce than /p/ or /k/, suggesting that there is a categorical, phonological process at work as well as gradient variability.

  3. Increased survival of skin flaps by scavengers of superoxide radical

    SciTech Connect

    Huang, L.; Privalle, C.T.; Serafin, D.; Klitzman, B.

    1987-08-01

    Elevation of rat abdominal skin flaps, followed by ligation and division of the left inferior neurovascular pedicle, resulted in only a 40% survival of the area normally perfused by the ligated artery and vein. Superoxide dismutase (SOD) (EC1.15.1.1) administered v (20,000 U/kg) 30 min before flap elevation increased survival to 52%. SOD derivatized with polyethylene gycol, which increases circulating half-life, was more effective, increasing survival to 80%. This protective effect resulted from the catalytic activity of the derivatized enzyme because inactivation by treatment with H/sub 2/O/sub 2/ eliminated its effect on skin flap survival. An equimolar mixture of Desferal and MnCl/sub 2/, which catalyzes the dismutation of O/sub 2//sup -/ in vitro, improved survival to 72%. Desferal-Fe/sup 3 +/, which lacks in vitro SOD activity, or Mn/sup 2 +/ alone did not affect the survival of skin flaps, but Desferal alone was nearly as effective as the Desferal-Mn/sup 2 +/ mixture. This effect of Desferal may result from acquisition of and subsequent removal of iron in vivo. These results support the view that the superoxide radical or a product derived from it plays a role in limiting the survival of island skin flaps.

  4. Latissimus dorsi flap closure of the irradiated clavicular wound.

    PubMed

    Hartzell, Tristan L; Hornicek, Francis J; Austen, William G

    2008-01-01

    Partial or total resection of a previously irradiated clavicle and surrounding soft tissues is a difficult clinical problem. Attempts to close the defect with local tissue often result in wound breakdown and exposure of any remaining clavicle. Furthermore, the most appealing local muscle flap, the pectoralis major, is often unsuitable for reconstruction because of previous resection or radiation damage. Over a 3-year period, 8 patients had resection of a previously irradiated clavicle and surrounding soft tissues. Four underwent excision for sarcoma and four for osteoradionecrosis complicated by chronic wounds. All defects were reconstructed with a pedicled latissimus dorsi muscle flap. No patient had a flap failure, and all had closed wounds at a minimum 18-month follow-up. Our series demonstrates the success of latissimus dorsi flap coverage for post-claviculectomy defects in an irradiated field. To our knowledge, this is the first described series of such patients. The latissimus dorsi muscle flap should be considered for all difficult wounds involving the clavicle and surrounding soft tissues. PMID:18760634

  5. Computational evaluation of an airfoil with a Gurney flap

    NASA Technical Reports Server (NTRS)

    Jang, Cory S.; Ross, James C.; Cummings, Russell M.

    1992-01-01

    A 2D numerical investigation was performed to determine the effect of a Gurney flap on a NACA 4412 airfoil. A Gurney flap is a flat plate on the order of 1 to 3 percent of the airfoil chord length, oriented perpendicular to the airfoil chord line and located at the trailing edge of the airfoil. An incompressible Navier Stokes code, INS2D, was used to calculate the flow field about the airfoil. The fully turbulent results were obtained using the Baldwin-Barth one-equation turbulence model. Gurney flap sizes of 0.5 , 1, 1.25, 1.5, 2, and 3 percent of the airfoil chord were studied. Computational results were compared with experimental results where possible. The numerical solutions show that the Gurney flap increases airfoil lift coefficient with only a slight increase in drag coefficient. Use of a 1.5 percent chord Gurney flap increases the maximum lift coefficient by approximately 0.3 and decreases the angle of attack for a given lift coefficient by more than 3 deg. The numerical solutions exhibit detailed flow structures at the trialing edge and provide a possible explanation for the increased aerodynamic performance.

  6. The physics of modeling unsteady flaps with gaps

    NASA Astrophysics Data System (ADS)

    Liggett, Nicholas; Smith, Marilyn J.

    2013-04-01

    Research indicates that active control concepts have promise in mitigating numerous adverse phenomena associated with the aeromechanics of lifting surfaces. These techniques are being applied to delay stall of fixed wing aircraft, as well as to eliminate or mitigate vibratory loads, blade-vortex interaction, and dynamic stall of the flow about rotorcraft and wind turbine blades. These phenomena are nonlinear and unsteady for dynamic systems, which add yet another layer of complexity on the physics of the flow. While a plethora of different active control techniques is being explored, the use of trailing edge flaps appears to be one of the more viable and cost-effective concepts. Static multi-element airfoils and wings have been analyzed computationally, but little exists on the ability to model these when the airfoil and flap are dynamic. The costs associated with modeling the gap between the airfoil and flap have led to approximations where the flap is modeled only as a morphed tip of the airfoil (no gap). Using a hybrid Reynolds-Averaged Navier-Stokes/Large-Eddy-Simulation turbulence technique, an oscillating flapped airfoil has been studied to determine the influence of modeling the gap on the performance and acoustic signature of the airfoil. Results are compared with the experimental data to confirm the validity of the computational approach. Both attached and separated (dynamic stall) oscillating flows are examined. The physics within the gap are found to be important for the airfoil performance when stall is encountered, as well as when acoustic signatures are required.

  7. The estimation of pressure on the surface of a flapping rigid plate by stereo PIV

    Microsoft Academic Search

    Alexandre Suryadi; Shinnosuke Obi

    The method to estimate the dynamic load of a flapping wing by the integration of pressure on the wing’s surface is discussed.\\u000a The flapping wing was modeled as a plate flapping sinusoidally in hovering condition. The flow around the flapping plate was\\u000a measured using stereo PIV on multiple measurement planes along the out-of-plane direction. The phase-averaged velocity field\\u000a of each

  8. Flow visualization and wall shear stress of a flapping model hummingbird wing

    Microsoft Academic Search

    Erik W. M. Swanton; Blake A. Vanier; Kamran Mohseni

    2010-01-01

    The unsteady low Reynolds number aerodynamics of flapping flight was investigated experimentally through flow visualization\\u000a by suspended particle imagery and wall shear stress measurement from micro-array hot-film anemometry. In conjunction, a mechanism\\u000a was developed to create a flapping motion with three degrees of freedom and adjustable flapping frequency. The flapping kinematics\\u000a and wing shape were selected for dynamic similarity to

  9. Author: Joachim Christian Heinz Title: Investigation of Piezoelectric Flaps for Load Alleviation Using

    E-print Network

    and Measurements 21 5.1 Fixed AOA / Fixed flap angle 21 5.2 Harmonic motion of AOA / Fixed flap angle 25 5.3 Fixed AOA / Harmonic motion of flap angle 28 5.4 Harmonic motion of AOA / Harmonic motion of flap angle 33 6.1.2 Comment on the translatoric motion: 11 2.2 Morphing the grid 11 3 Generation of Airfoil Shape 12 3

  10. [Robotic surgery].

    PubMed

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

    2013-10-01

    Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures. PMID:24144815

  11. Development of a value-added product using channel catfish belly flap meat

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The shank fillet of channel catfish is a primary product form produced during processing and is formed by trimming the belly flap or nugget section from a boneless fillet. Belly flap meat comprises around 20 percent of the fillet weight. Belly flap meat has a fat content of about 15 percent compared...

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

    E-print Network

    Wood, Robert

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

  13. Sural flap vascularization in arteritic patients: an anatomic study of 24 amputation specimens

    Microsoft Academic Search

    S. Malokov; D. Casanova; G. Magalon; A. Branchereau

    2003-01-01

    Obliterating arteriopathy of the lower limbs is a classic contraindication for neurocutaneous islands flaps, particularly the sural flap. But recent literature reports examples of its successful application in arteritic patients. The aim of this work was to study the vascular anatomy of the sural flap in patients suffering from arteriopathy and its possible clinical application. Twenty-four specimens of leg amputation

  14. Study on improvement in aerodynamic performance of Vertical Axis Wind Turbine using Gurney flap

    Microsoft Academic Search

    Zhang Xu; Qian Wang; Geng Dai; Hongfei Tan; Yingjie Zhong

    2011-01-01

    Based on Spalart-Allmaras turbulence model, numerical simulation on NACA0015 airfoil with Gurney flap is carried out in this paper. Then the double Disks multiple stream- tube model is introduced to predict aerodynamic performance of VAWT of NACA0015 airfoil with Gurney flap. Results show that the Gurney flap can improve the lift coefficient of the airfoil and the height of the

  15. The Use of Negative Pressure Wound Therapy for Random Local Flaps at the Ankle Region

    Microsoft Academic Search

    Jesse A. Goldstein; Matthew L. Iorio; Benjamin Brown; Christopher E. Attinger

    2010-01-01

    Local random flaps are seldom used for reconstruction of complex ankle wounds because of concern for flap failure attributable to vascular compromise and tissue edema. Negative pressure wound therapy has been shown to improve perfusion and limit tissue edema. The objective of this study was to demonstrate the utility of negative pressure wound therapy in improving outcomes for local flaps

  16. Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study

    PubMed Central

    Sinha, Rajeev; Malhotra, Vivek; Sikarwar, Prashant

    2015-01-01

    BACKGROUND: Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure. PATIENTS AND METHODS: All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded. RESULTS: All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period. CONCLUSIONS: SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly. PMID:25883454

  17. DEHN SURGERY SIDDHARTHA GADGIL

    E-print Network

    Gadgil, Siddhartha

    DEHN SURGERY SIDDHARTHA GADGIL Contents 1. Introduction 1 2. Co-ordinates for surgery 1 3. Some algebraic topology 2 4. The theorem of Lickorish and Wallace 3 5. Surgeries and Cobordisms 4 6. The Kirby Calculus 5 7. Constructing knots using surgery 5 8. Surgeries about knots 5 References 6 1. Introduction

  18. Passive Porous Treatment for Reducing Flap Side-Edge Noise

    NASA Technical Reports Server (NTRS)

    Choudhari, Meelan M.; Khorrami, Mehdi R.

    2008-01-01

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

  19. Abdominal perforator vs. muscle sparing flaps for breast reconstruction

    PubMed Central

    Wu, Liza C.

    2015-01-01

    Abdominally based free flaps have become the mainstay for women that desire to use their own tissue as a means of breast reconstruction after mastectomy. As the techniques have evolved, significant effort has been invested in finding the best means of minimizing morbidity to the abdominal donor site while ensuring a viable reconstructed breast that is aesthetically pleasing. This manuscript reviews and compares the muscle sparing free transverse rectus abdominis myocutaneous (MsfTRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps, regarding flap success rate, operative times, abdominal donor site morbidity and residual functionality, hospital lengths of stay and associated costs, impact of co-morbid conditions, and resilience after adjuvant radiation treatment. PMID:26161306

  20. Flap Side-Edge Noise: Acoustic Analysis of Sen's Model

    NASA Technical Reports Server (NTRS)

    Hardin, Jay C.; Martin, James E.

    1996-01-01

    The two-dimensional flap side-edge flow model developed by Sen is analyzed to reveal the noise production potential of the proposed mechanism. The model assumes that a vortex will form at the equilibrium position off the side edge of the flap. The vortex is then perturbed away from the equilibrium position by incoming turbulence causing it to oscillate and thus radiate sound. The noise field is calculated three-dimensionally by taking the flap to have a finite chord. Spectra and directivity of the farfield sound are presented. In addition, the effect of retarded time differences is evaluated. The parameters in the model are related to typical aircraft parameters and noise reduction possibilities are proposed.

  1. Aeroelastic analysis of rotor systems using trailing edge flaps

    NASA Astrophysics Data System (ADS)

    Lim, In-Gyu; Lee, In

    2009-04-01

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

  2. Aeroelastic Analysis of Bearingless Rotor Systems with Trailing Edge Flaps

    NASA Astrophysics Data System (ADS)

    Lim, In-Gyu; Lee, In

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

  3. Interactions between butterfly scales and unsteady flows during flapping flight

    NASA Astrophysics Data System (ADS)

    Jones, Robert; Lang, Amy

    2008-11-01

    Recent research has shown that the highly flexible wings of butterflies in flapping flight develop vortices along their leading and trailing edges. Butterfly scales (approximately 100 microns) have a shingled pattern and extend into the boundary layer. These scales could play a part in controlling separation in this 3-dimensional complex flow field. Biomimetic applications of butterfly scales may aid in the development of flapping wing micro air vehicles. In this study, we observed that the orientation of the scales may relate to the local flow field, and might move or shift during flight. Monarch butterflies were trained to fly in a low speed smoke tunnel for visualization. Scales were removed from the leading and trailing edges and specimens were photographed at 500 frames per second. Variation in flapping pattern and flight fitness are discussed.

  4. Future prospects for reconstructive surgery in breast cancer.

    PubMed

    Gabka, C J; Bohmert, H

    1996-01-01

    Reconstructive surgery has become an integral part of primary breast cancer therapy in patients requiring total mastectomy. State-of-the-art reconstructions with autogenous tissue are transverse rectus abdominis (TRAM) flap procedures. Superior aesthetic results in terms of both appearance and consistency, seem to outweigh the disadvantages of impaired abdominal wall competence and donor site scars. The "free," microvascular TRAM flap may be the way to minimize abdominal wall weakness, since only a little portion of the rectus abdominis muscle must be sacrificed. Despite all discussions, breast reconstruction using silicone (gel) implants is a safe and reliable method and will be in the future. However, not every patient may be the right candidate for silicone reconstruction. Advantages of using silicone implants include (relatively) simple technique, short operation time, and no donor site morbidity. In patients suffering from breast-conserving therapy failures, plastic surgery has to address skin and parenchymal loss in an irradiated environment. Oncoplastic surgery, such as volume shrinking or volume replacement techniques, are useful for immediate reconstruction in breast-conserving therapy. PMID:8821412

  5. Resume of air-load data on slats and flaps

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Rogallo, Francis M

    1939-01-01

    A resume of the generally available test data regarding air loads on slats and flaps is presented and data attained up to the fall of 1938 are included. The data are given in the form of N.A.C.A. standard coefficients of air forces and moments on the lift-increasing device and, when available, the aerodynamic characteristics of the combined wing and high-lift device are included. Slats of the Handley Page type, fixed auxiliary airfoils, and flaps of several different types are covered.

  6. The use of flaps in the treatment of fingertip injuries.

    PubMed

    Foucher, G; Boulas, H J; Braga Da Silva, J

    1991-01-01

    Fingertip injuries constitute a large portion of the traumatic injuries sustained to the hand and are frequently associated with significant disability for the patient. While many methods are available for the treatment of such injuries, quite often only certain procedures are appropriate for a particular digit in any given patient. The use of flaps in such instances provides an important tool for coverage of the exposed fingertip bone when more simple measures are inadequate. Herein follows a discussion of the indications and potential pitfalls for a variety of flaps which may be employed in the treatment of fingertip injuries. PMID:1891930

  7. Clinical outcome after pedicled segmental pectoralis major island flaps for head and neck reconstruction.

    PubMed

    Corten, Eveline M L; Schellekens, Pascal P A; Hage, Joris J; Kon, Moshe

    2009-09-01

    The pectoralis major is reliable for reconstruction of large defects in the head and neck area. In 2001, we introduced a muscle-sparing technique with preservation of the clavicular part of the muscle. So far, we did not report on its reliability and clinical outcome at the receptor site.Fifty-four pedicled segmental pectoralis major island flaps were used in 53 patients, from 2001 through 2006. As outcome measures, we studied the overall rate of complications, the rate of major complications, and the final outcome at the receptor sites. We differentiated for the types of complications and assessed operation indication (primary vs. salvage procedure), site of reconstruction, previous radiotherapy, and completeness of tumor excision as possible risk factors for complications. We compared our findings to those of a meta-analysis of 16 other studies.Complications at the receptor site were observed after 21 of the 54 operations (0.39). Eleven of these cases (0.52) required repeated surgery that was successful in 8 cases (0.72). Conservative treatment was successful in 8 cases (0.80). Final outcome was successful in 49 of the 54 operations (0.91). Previous radiotherapy was a significant risk factor for persisting complications. Salvage procedures were a significant risk factor for developing clinical fistulas and the risk of partial flap loss was significantly correlated with nonhypopharyngeal reconstructions. Our results were comparable with those found in the meta-analysis.Our muscle-sparing technique proved to be reliable with clinical results comparable with conventional techniques in addition to function preservation at the donor site. PMID:19602950

  8. Preparing for Surgery

    MedlinePLUS

    Preparing for Surgery If you are preparing for surgery, there are some critical steps you can take to help ensure the ... eat or drink anything after midnight before your surgery. Under some circumstances, your physician anesthesiologist may give ...

  9. Cosmetic breast surgery

    MedlinePLUS

    Cosmetic breast surgery is done at an outpatient surgery clinic or in a hospital. Most women receive general anesthesia ... with a plastic surgeon if you are considering cosmetic breast surgery. Discuss how you expect to look and feel ...

  10. Comparison of Onlay and Tubularized Island Flaps of Inner Preputial Skin for the Repair of Proximal Hypospadias

    Microsoft Academic Search

    John S. Wiener; Richard W. Sutherland; David R. Roth; Edmond T. Jr. Gonzales

    1997-01-01

    PurposeTransverse island flaps of inner preputial skin have provided a reliable technique for the repair of proximal hypospadias. The flap may be used to create a neourethra by tubularizing the flap after urethral transection or applying the flap as an onlay patch onto an intact urethral plate. We retrospectively analyzed our experience with these 2 techniques to compare outcomes.

  11. Numerical investigation of flow control on performance enhancing by mounting gurney flaps of a large horizontal wind turbines

    Microsoft Academic Search

    W. L. Zhao; P. Q. Liu; J. Y. Zhu; Q. L. Qu

    2011-01-01

    Numerical investigation of large thick and low Reynolds airfoil of wind turbines by mounting Gurney flaps was carried out. The influenced rules of the height of Gurney flaps on the aerodynamic performance of airfoil under different height of flaps were achieved, and the optimal height of Gurney flap was presented. At last, the mechanism of wind turbine performance controlled by

  12. Study of external dynamic flap loads on a 6 percent B-1B model

    NASA Technical Reports Server (NTRS)

    Seiner, John M.; Manning, James C.; Capone, Francis J.; Pendergraft, Odis C., Jr.

    1991-01-01

    The origin of dynamic pressure loads on external divergent engine nozzle flaps of the B-1B aircraft was investigated in the NASA/LaRC 16 foot transonic tunnel using a 6 percent full span model with powered engine nacelles. External flap dynamic loads and afterbody drag associated with flap removal were measured using this model. Both dry and max. A/B power nozzles were evaluated in this study. As a result of this study, the principal mechanisms responsible for high dynamic external flap loads were determined along with performance penalty associated with flap removal.

  13. Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction

    PubMed Central

    Thankappan, Krishnakumar; Trivedi, Nirav P.; Sharma, Mohit; Kuriakose, Moni A.; Iyer, Subramania

    2009-01-01

    A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome. PMID:19881028

  14. Vein/Arterial Grafts Harvested within the Incision for a Free Groin Flap

    PubMed Central

    Tomita, Koichi; Fukai, Megumi; Kubo, Tateki; Hayashi, Akiteru; Shibata, Minoru; Hosokawa, Ko

    2015-01-01

    Summary: The free groin flap results in less donor-site morbidity than other skin flaps and is suitable for use in children and adolescents. However, the vascular pedicle is relatively short and vessel diameter is small, which makes vascular anastomosis technically difficult. To overcome this limitation, we harvested vein and arterial grafts from the flap elevation area without placing additional skin incisions. Use of short (2–3 cm) vein/arterial grafts greatly simplified flap insetting and vascular anastomosis. This procedure may expand the indications for free groin flap transfer.

  15. Span load distribution for tapered wings with partial-span flaps

    NASA Technical Reports Server (NTRS)

    Pearson, H A

    1937-01-01

    Tables are given for determining the load distribution of tapered wings with partial-span flaps placed either at the center or at the wing tips. Seventy-two wing-flap combinations, including two aspect ratios, four taper ratios, and nine flap lengths, are included. The distributions for the flapped wing are divided into two parts, one a zero lift distribution due primarily to the flaps and the other an additional lift distribution due to an angle of attack of the wing as a whole. Comparison between theoretical and experimental results for wings indicate that the theory may be used to predict the load distribution with sufficient accuracy for structural purposes.

  16. Multiple valve surgery for a patient with presternal oesophageal reconstruction.

    PubMed

    Hamamoto, Masaki; Kobayashi, Taira; Ozawa, Masamichi

    2015-08-01

    A 73-year old woman presented with progressive exertional dyspnoea. Echocardiography revealed severe regurgitation of the aortic, mitral and tricuspid valves, indicating the need for multiple valve surgery. The patient had a past history of oesophageal cancer that had been treated with chemoradiotherapy followed by oesophagectomy with presternal reconstruction using a gastric tube and a pedicled jejunum covered by the rectus abdominal muscle flap. She underwent aortic and mitral valve replacement with prostheses and tricuspid ring annuloplasty through a lower partial median sternotomy to avoid injury to the cervical oesophagus and a pedicled jejunum placed on the sternal manubrium. PMID:26059876

  17. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    MedlinePLUS

    ... Loss Surgery: Stacie's Story (Video) Weight and Diabetes Metabolic Syndrome Healthy Eating Preparing Your Child for Surgery Body ... Mass Index (BMI) Staying at a Healthy Weight Metabolic Syndrome How Can I Lose Weight Safely? When Being ...

  18. Is open surgery for head and neck cancers truly declining?

    PubMed

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

    2013-11-01

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

  19. Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage.

    PubMed

    Wright, Thomas C; Mossaad, Bassem M; Chummun, Shaheel; Khan, Umraz; Chapman, Thomas W L

    2013-07-01

    The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible. PMID:23587679

  20. Sensory recovery with innervated and noninnervated flaps after total lower lip reconstruction: a comparative study.

    PubMed

    Ayhan Oral, Meltem; Zeynep Sevim, Kamuran; Görgü, Metin; Yücel Öztan, Hasan

    2013-01-01

    This study compares sensory recovery after total lower lip reconstruction in a wide variety of flaps including bilateral depressor anguli oris flap, submental island flap, bilateral fan flaps, radial forearm flap, and pectoralis major myocutaneous flaps in a large number of patients. Spontaneous return of flap sensation was documented by clinical testing in the majority (3%) of patients who underwent total lower lip reconstruction. Sensory recovery occurred more often in patients with fasciocutaneous free flaps than in those with musculocutaneous flaps. Flap sensation to touch, two-point discrimination, and temperature perception was correlated with age, smoking, and radiation treated patients. We conclude that reasonable sensory recovery may be expected in noninnervated flaps, provided that the major regional sensorial nerve has not been sacrificed, and also provided that the patients age is relatively young and that enough surface contact area of the recipient bed is present without marked scarring. This trial was regestered with Chinese Clinical Trial Registry (Chi CTR) with ChiCTR-ONC-13003656. PMID:24381755

  1. Sensory recovery of innervated and non-innervated radial forearm free flaps: functional implications.

    PubMed

    Netscher, D; Armenta, A H; Meade, R A; Alford, E L

    2000-04-01

    Findings reported in the literature on the sensation provided by intraorally applied innervated vs. non-innervated radial forearm free flaps differ. In an effort to understand these differences in sensory recovery, the authors carried out sensory evaluations in 12 patients who had undergone radial forearm free flaps. Seven patients had innervated flaps for defects of the tongue and floor of mouth; five had non-innervated flaps to various sites. Flap sensitivity to temperature, light touch, dull touch, and sharpness and two-point discrimination was assessed at the donor site and contralaterally, and at the recipient site and contralateral mirror-image oral mucosa. Patients subjectively rated post-reconstruction sensation and provided quality of life (QOOL) data. The innervated flaps demonstrated better sensory recovery than the non-innervated flaps, although the latter did restore reasonable sensation. This paper describes the results, compares the study to other similar studies, and discusses various factors in the sensory recovery of both innervated and non-innervated intraoral radial forearm free flaps. The authors conclude that, although the trend in this study is toward improved function with the innervated flaps, these flaps do not appear to offer major intraoral functional advantage over the non-innervated flaps, which attain reasonably effective sensory recovery from neural ingrowth, if the lingual nerve is intact. PMID:10803620

  2. Successful pregnancy “during” pedicled transverse rectus abdominis musculocutaneous flap for breast reconstruction with normal vaginal delivery

    PubMed Central

    Chai, Siew Cheng; Umayaal, Shahlini; Saad, Arman Zaharil Mat

    2015-01-01

    A transverse rectus abdominis myocutaneous (TRAM) flap is a popular choice for breast reconstruction. Pregnancies in women following a TRAM flap present concerns regarding both safety and the integrity of the abdominal wall. We report a case of a patient who was pregnant during immediate breast reconstruction with pedicled TRAM flap and had a successful spontaneous vaginal delivery. We also conducted a literature review using PubMed on pregnancy post TRAM flap, type of reconstruction, timing of pregnancy after TRAM flap, complication, and mode of delivery, which are summarised in this report. We concluded that patients may have safe pregnancies and normal deliveries following TRAM flap breast reconstruction regardless of the time frame of pregnancy after the procedure. Therefore, TRAM flaps can continue to be a reconstruction option, even in women of childbearing age. PMID:25991893

  3. Distally based posterior interosseous flap: primary role in soft-tissue reconstruction of the hand.

    PubMed

    Agir, Hakan; Sen, Cenk; Alagöz, Sahin; Onyedi, Murat; Isil, Eda

    2007-09-01

    A series of 15 consecutive patients with various hand defects requiring flap coverage was reviewed in this study. The defects were all covered with the distally based posterior interosseous flap. Its main indications were in complex hand trauma, severe burn injury, or skin cancer ablation, either acute or postprimary. In 12 of the patients, flaps survived completely. In 3 patients, there was partial necrosis of the distal part of the flap, which did not require additional surgical procedure. Radial nerve palsy was noted in one of the cases, with a complete recovery after 3 months. Donor site was closed directly in up to 4-cm-wide flaps, while larger flaps required skin grafting. No major anatomic variation was observed. Distally based posterior interosseous flap is a reliable choice for various types and areas of hand defects, with very low donor-site morbidity, and should be more commonly considered in clinical practice. PMID:17721217

  4. Wind-tunnel investigation of NACA 23012 airfoil with various arrangements of slotted flaps

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Harris, Thomas A

    1939-01-01

    An investigation was made in the NACA 7 by 10-foot wind tunnel of a large-chord NACA 23012 airfoil with several arrangements of 25.66 percent chord slotted flaps to determine the section aerodynamic characteristics as affected by slot shape, flap shape, flap location, and flap deflection. The flap position for maximum lift, the polars for arrangements considered favorable for take-off and climb, and the complete section aerodynamic characteristics for selected optimum arrangements were determined. A discussion is given of the relative merits of the various arrangement for certain selected criterions. A comparison is made of a slotted flap on the NACA 23021 airfoil with a corresponding slotted flap previously developed for the NACA 23012 airfoil.

  5. Long-term functional donor site morbidity of the free radial forearm flap in head and neck cancer survivors

    PubMed Central

    2014-01-01

    Background To assess the functional donor site morbidity of the forearm free flap in patients surviving at least 2 years after ablative head and neck cancer surgery in a tertiary care centre. Methods This study involved nine long-term survivors (2 year post-operative) who had forearm free flaps to reconstruct head and neck defects. All flaps were raised from the non-dominant arm. The non-donor side acted as a control for all patients. Objective measurements were as follows: grip, tip pinch and key pinch strength measured with dynamometers; flexion, extension, radial and ulnar deviation and pronation and supination range of motion at the wrist measured with goniometry; A timed manual dexterity task was performed with a grooved pegboard test, and sensation of the radial nerve was tested with Semmes Weinstein monofilaments. Subjective measurements included a validated patient questionnaire of hand function and opinions of scar appearance as well as a validated scar assessment from two different observers. Results Pronation at the wrist, manual dexterity and sensation were found to be significantly reduced in the donor side compared to the non-donor side. Inter-rater agreement between the two observers was found to be poor, except for an acceptable correlation between overall scar opinions. No correlations were found between any subjective or objective items or between the patient’s and the observers’ subjective evaluations. Conclusions Donor site morbidity can be demonstrated with objective testing however this is accepted and well tolerated by head and neck cancer patients. PMID:24418459

  6. A phase-change type micropump with aluminum flap valves

    Microsoft Academic Search

    Woo Young; Hyeun Sim; Joong Yoon; Ok Chan Jeong

    2003-01-01

    In this paper, a phase-change type micropump is presented. This micropump consists of a pair of aluminum flap valves and a phase-change type actuator. The actuator is composed of a heater, a silicone rubber diaphragm and a working flui dc hamber. The diaphragm is actuated by the vaporization and the condensation of the working fluid. The micropump is fabricated by

  7. Probabilistic Analysis of Space Shuttle Body Flap Actuator Ball Bearings

    Microsoft Academic Search

    Fred B. Oswald; Timothy R. Jett; Roamer E. Predmore; Erwin V. Zaretsky

    2008-01-01

    A probabilistic analysis, using the two-parameter Weibull-Johnson method, was performed on experimental life test data from space shuttle actuator bearings. Experiments were performed on a test rig under simulated conditions to determine the life and failure mechanism of the grease lubricated bearings that support the input shaft of the space shuttle body flap actuators. The failure mechanism was wear that

  8. Anatomical basis of latissimus dorsi myocutaneous flap: clinical applications

    Microsoft Academic Search

    S. H. El-Maasarany; E. Sharaf; F. Moustafa; A. Borhan; A. Abdel-Fattah; A. Hamza

    1989-01-01

    The anatomical study was carried out using 40 preserved cadaveric specimens of latissimus dorsi myocutaneous flaps. It included dissections, angiographies and tissue clearing after arterial injection with latex. The results proved that the dominant vascular supply, the thoracodorsal a., has an almost constant pattern of intramuscular distribution. In addition, there are two sets of segmental pedicles, from the intercostal and

  9. 6. CLOSEUP VIEW OF THE PUMP DISCHARGE CHANNEL, THE FLAP ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. CLOSEUP VIEW OF THE PUMP DISCHARGE CHANNEL, THE FLAP VALVES OF THE PUMPING UNITS 8, 6, AND 7 (L TO R) AND PART OF THE DISCHARGE WEIR OF THE INDIVIDUAL DISCHARGE CHAMBER OF PUMP NO. 5, LOOKING NORTHEAST. - Wyoming Valley Flood Control System, Woodward Pumping Station, East of Toby Creek crossing by Erie-Lackawanna Railroad, Edwardsville, Luzerne County, PA

  10. Effects of vinpocetine on random skin flap survival in rats.

    PubMed

    Xiao-Xiao, Tao; Sen-Min, Wu; Ding-Sheng, Lin

    2013-07-01

    The effect of vinpocetine on flap survival, vascular endothelial growth factor (VEGF) expression, and superoxide dismutase (SOD) and malondialdehyde (MDA) contents were evaluated in this study. The McFarlane flap model was established in 20 rats and evaluated within two groups. Postoperative celiac injection was given for 7 days in the two groups: vinpocetine was applied in Group 1, and the same volume of saline was applied in Group 2. Flap necrosis was measured on day 7 by cellophane in all groups. VEGF expression was determined using immunohistochemical methods on tissue samples taken after 7 days of injections. SOD and MDA contents were examined according to the Kit (reagent instructions). Vinpocetine significantly reduced necrosis area in Group 1 (p < 0.05). VEGF expression and SOD contents were significantly increased in Group 1 compared with Group 2 (p < 0.01), whereas MDA level was reduced (p < 0.05). This experimental study demonstrates that vinpocetine improves survival of random skin flaps, promotes neovascularization, and increases VEGF expression. Meanwhile, vinpocetine has a protective effect against ischemia-reperfusion injury by improving SOD vitality and decreasing MDA value. PMID:23588551

  11. Forward flight of swallowtail butterfly with simple flapping motion.

    PubMed

    Tanaka, Hiroto; Shimoyama, Isao

    2010-06-01

    Unlike other flying insects, the wing motion of swallowtail butterflies is basically limited to flapping because their fore wings partly overlap their hind wings, structurally restricting the feathering needed for active control of aerodynamic force. Hence, it can be hypothesized that the flight of swallowtail butterflies is realized with simple flapping, requiring little feedback control of the feathering angle. To verify this hypothesis, we fabricated an artificial butterfly mimicking the wing motion and wing shape of a swallowtail butterfly and analyzed its flights using images taken with a high-speed video camera. The results demonstrated that stable forward flight could be realized without active feathering or feedback control of the wing motion. During the flights, the artificial butterfly's body moved up and down passively in synchronization with the flapping, and the artificial butterfly followed an undulating flight trajectory like an actual swallowtail butterfly. Without feedback control of the wing motion, the body movement is directly affected by change of aerodynamic force due to the wing deformation; the degree of deformation was determined by the wing venation. Unlike a veinless wing, a mimic wing with veins generated a much higher lift coefficient during the flapping flight than in a steady flow due to the large body motion. PMID:20484782

  12. Optimization of a Fully-Passive Flapping-Airfoil Turbine

    E-print Network

    Optimization of a Fully-Passive Flapping-Airfoil Turbine Mémoire Jean-Christophe Veilleux Maîtrise. De telles oscillations pourraient ^etre utilis´ees afin de d´evelopper un nouveau type de turbine Reynolds de 500 000, ce type de turbine est optimis´e et amplement ´etudi´e afin de d´evelopper une

  13. Free skin flap reconstruction after partial hypopharyngectomy with laryngeal preservation.

    PubMed

    Ishida, Katsuhiro; Kato, Takakuni; Seino, Youichi; Uchida, Mitsuru

    2014-10-01

    Surgical resection of hypopharyngeal cancer often affects laryngeal function. The aim of this study is to assess the reliability and efficacy of free skin flap transfer after partial hypopharyngectomy with laryngeal preservation. This study designs a retrospective analysis. The subjects were 54 patients who underwent free skin flap reconstruction immediately after partial pharyngolaryngectomy or hypopharyngectomy with laryngeal preservation. The defects were classified into four types based on the location of the hypopharyngeal defect. Functional results were evaluated by routine physical examination findings and parameters related to swallowing function and X-ray barium deglutition examination. Perioperative mortalities and morbidities were reviewed. There were no perioperative mortalities and 98% of the flaps survived. Forty-three patients (80%) were able to eat an unrestricted diet and experienced no aspiration. Restriction of the diet was significantly associated with the extent of oesophageal mucosal resection. In conclusion, free skin flap reconstruction is confirmed to be a safe and effective strategy to maintain laryngeal function and good quality-of-life. PMID:24443773

  14. The use of flaps in the treatment of fingertip injuries

    Microsoft Academic Search

    Guy Foucher; H. Jay Boulas; Jefferson Braga Da Silva

    1991-01-01

    Fingertip injuries constitute a large portion of the traumatic injuries sustained to the hand and are frequently associated with significant disability for the patient. While many methods are available for the treatment of such injuries, quite often only certain procedures are appropriate for a particular digit in any given patient. The use of flaps in such instances provides an important

  15. Radioimmunoguided surgery.

    PubMed

    Veroux, G; Nicosia, A S; Veroux, P; Cardillo, P; Veroux, M; Amodeo, C

    1999-01-01

    Although clinical staging of neoplastic diseases has long remained the only approach to prognosis and treatment, parameters for stage determination, such as tumor size (T) and lymph-node involvement (N), do not always provide effective indication of optimal treatment. Molecular medicine has also provided useful indications as to an alternative and/or integration to clinical staging. Despite the numerous possibilities afforded by pre-operative staging techniques, failures in defining the real spread of neoplasias into surrounding structures have remained a very important diagnostic problem. The labeling of monoclonal antibodies binding with neoplastic target cells by way of radioactive isotopes introduced the techniques known as immunoscintigraphy and SPECT, which then evolved into radioimmunoguided surgery. Fourty patients suffering from colorectal cancer whose age ranged between 42-82 years were singled out for this study. Before undergoing surgery, they were administered pancoloscopy and macrobiopsies, AP-LL chest x-rays, hepatobiliary ECT, echoendoscopy, abdomen and pelvis CT with nephrostographic phase, and total body bone scintigraphy. They were treated with 125I-B72.3 and 125I-FO23C5 (5% and 95% of patients, respectively). Thyrosuppression was achieved by Lugol solution (15 drops x 3/die) from the 6th day before infusion and until the day of surgical operation. Radioimmunoguided surgery (RIGS) has also been tested on staging and second-look of ovarian tumors. Five years after surgical operation the survival rate of Dukes A patients (15%) was confirmed to amount to 100%, whereas for Dukes B patients (50%) having undergone RIGS-guided exeresis on single unrecognized metastases (2 patients) and on unrecognized n+ (5 patients) the survival rate was found to be 85% after 5 years; 2 patients deceased due to relapse; 1 patient deceased due to e.p.a. Finally, for Dukes C patients; (35%) having undergone RIGS-guided exeresis on unrecognized liver micrometastases (1 patient), on single isolated metastases (2 patients) and in the occurrence of multicentric lymph-node positivity (9 patients), the survival rate after 5 years was found to amount to 64%; 5 patients deceased due to relapse. Out of 19 patients without pre-operative evidence of ovarian tumor as opposed to just 1 patient suspected of pelvic recurrence, after intra-operative surgical radicalization (45%), 1 patient was diagnosed fibrosis (suspicious lesion on CT) and 1 other patient peritoneal MTS (negative CT) by means of RIGS. RIGS has made it possible: to localize primary and/or metastatic lesions; to determine tumor-free margins, loco-regional disease spread; to differentiate suspicious foci on inspection and palpation (biotopic sampling); to detect invisible and impalpable tumor foci (occult sites); to verify radical exeresis; to evaluate lymphatic drainage stations; to enable guided exeresis of liver metastases. PMID:10626169

  16. Traditional transcutaneous approaches in head and neck surgery

    PubMed Central

    Goessler, Ulrich R.

    2012-01-01

    The treatment of laryngeal and hypopharyngeal malignancies remains a challenging task for the head and neck surgeon as the chosen treatment modality often has to bridge the gap between oncologically sound radicality and preservation of function. Due to the increase in transoral laser surgery in early tumor stages and chemoradiation in advanced stages, the usage of traditional transcutaneous approaches has decreased over the recent past. In addition, the need for a function-sparing surgical approach as well as highest possible quality of life has become evident. In view of these facts, rationale and importance of traditional transcutaneous approaches to the treatment of laryngeal and hypopharyngeal malignancies are discussed in a contemporary background. The transcutaneous open partial laryngectomies remain a valuable tool in the surgeon's armamentarium for the treatment of early and advanced laryngeal carcinomas, especially in cases of impossible laryngeal overview using the rigid laryngoscope. Open partial laryngetomies offer superior overview and oncologic safety at the anterior commissure, especially in recurrencies. In select advanced cases and salvage settings, the supracricoid laryngectomy offers a valuable tool for function-preserving but oncologically safe surgical therapy at the cost of high postoperative morbidity and a very demanding rehabilitation of swallowing. In hypopharyngeal malignancies, the increasing use of transoral laser surgery has led to a decline in transcutaneous resections via partial pharyngectomy with partial laryngectomy in early tumor stages. In advanced stages of tumors of the piriform sinus and the postcricoid area with involvement of the larynx, total laryngectomy with partial pharyngectomy is an oncologically safe approach. The radical surgical approach using circumferent laryngopharyngectomy with/without esophagectomy is indicated in salvage cases with advanced recurrences or as a primary surgical approach in patients where chemoradiation does not offer sufficient oncologic control or preservation of function. In cases with impending reconstruction, fasciocutaneous free flaps (anterolateral thigh flap, radial forearm flap) seem to offer superior results to enteric flaps in cases where the cervical esophagus is not involved leading to better voice rehabilitation with fewer complications and postoperative morbidity. In salvage situations, the Gastroomental Free Flap has proven to be a valuable tool. In conclusion, the choice of a surgical treatment modality is influenced by the patient's anatomy, tumor size and location as well as the surgeon's personal expertise. PMID:23320058

  17. Local Vascularized Flaps for Augmentation of Reinke’s Space

    PubMed Central

    Dailey, Seth H.; Gunderson, McLean; Chan, Roger; Torrealba, Jose; Kimura, Miwako; Welham, Nathan V.

    2011-01-01

    Objectives/Hypothesis The purpose of this study is to describe and test a novel surgical strategy for augmentation of Reinke’s space using vascularized flaps: a thyroid ala perichondrium flap (TAP) and a composite thyroid ala perichondrium flap (CTAP) from the anterior larynx. We hypothesized that these specially designed vascularized flaps would remain viable once inset into the lamina propria, and that they would not disrupt rheologic, biomechanical, and histologic properties of the native vocal fold. Study Design Experimental. In vivo canine model. Methods The length and volume of test flaps harvested in six adult human cadaveric larynges were analyzed to determine suitability for use in augmentation in the lamina propria. Also, 12 beagles randomly underwent unilateral placement of either TAP or CTAP, which were designed in accordance with the human adult cadaveric experiments. Flap perfusion was measured before and after harvest with laser Doppler. After 1 month, the beagles were humanely sacrificed and their larynges subjected to aerodynamic and acoustic evaluation using an excised larynx apparatus. The vocal fold lamina propria of four larynges—two TAP and two CTAP—underwent rheologic evaluation using a simple-shear rheometer. The remaining eight larynges underwent quantitative histologic and immunohistochemical evaluation. The survival and complication (swallowing, airway, local wound) rates of all dogs were noted. Results Initial studies with adult human cadaveric larynges established that TAP and CTAP possessed length and volume greater than native lamina propria. In the canine experiments, the perfusion change in the flaps was similar between flap groups. The damping ratio (?), dynamic viscosity (??), elastic shear modulus (G?), and viscous shear modulus (G?) of treated and untreated native vocal folds were not statistically different. The glottic function measures of vocal efficiency, laryngeal resistance, jitter, shimmer, and harmonics-to-noise ratio (HNR) of treated and normal larynges were not statistically different. Similarly, the values for collagen, elastin, and glycosaminoglycans (GAGs) in treated and untreated vocal folds were not statistically different. Also, neither neochrondrogenesis nor neoosteogenesis was detected in any treated vocal fold. The values for vascular and cellular proliferation in treated and untreated vocal folds were not statistically different. All test dogs survived and had no complications related to swallowing, airway distress, or the local wound. Conclusions The test flaps described and tested in this study appear to have conceptually attractive features for augmentation of Reinke’s space. When placed in an in vivo setting TAP and CTAP did not reveal unfavorable vascular, rheologic, aerodynamic, acoustic, or histologic characteristics. There was no unanticipated morbidity or mortality to the test animals. Long-term viability of these flaps is unknown. TAP and CTAP may open novel pathways for correction of glottic defects and may offer crossover opportunities with tissue engineering techniques. Level of Evidence None. PMID:21271606

  18. Orandi flap for penile urethral stricture: Polishing the gold standard

    PubMed Central

    Goel, Apul; Kumar, Manoj; Singh, Manmeet

    2015-01-01

    Introduction: We describe the combined use of the Orandi flap and the scrotal skin advancement flap to reduce complications for pendulous urethral stricture in men >40 years old. Methods: Over the last 40 months, 10 men underwent urethroplasty for pendulous stricture by the modified Orandi urethroplasty. In this, additionally, a midline hairless scrotal skin flap of the size of the ventral skin defect on the pendulous portion was raised based on the dartos fascia. This flap was mobilized so that it reached the pendulous portion without tension and covered the penile defect. The catheter was removed after 4 weeks. Patients were followed every 3 months using uroflowmetry and the American Urological Association (AUA) symptom score. Results: The mean age was 55.5. Of the 10 patients, the etiology was post-catheterization in 5 and idiopathic in the remaining 5. Three men also had stricture extending into the bulbous urethra (repaired using buccal graft). The mean additional time needed for the flap coverage was 36.2 minutes (range: 30–45). The median follow-up was 12 months (range: 3–40). The mean postoperative symptom score was 5.2 and the mean flow rate was 20.1 mL/sec. In 2 men, the meatus got retracted to the distal penile part (probably due to downward traction by scrotal skin). No patient complained of disfigurement. Two men reported recurrence (1 each in bulbous and penile urethra). The limitations are small number of patients and the observational nature of this study. Conclusions: The intermediate-term results show that the modified Orandi urethroplasty is an acceptable treatment option with acceptable cosmetic results. PMID:26085873

  19. Flexible flapping wings with self-organized microwrinkles.

    PubMed

    Tanaka, Hiroto; Okada, Hiroyuki; Shimasue, Yosuke; Liu, Hao

    2015-01-01

    Bio-inspired flapping wings with a wrinkled wing membrane were designed and fabricated. The wings consist of carbon fibre-reinforced plastic frames and a polymer film with microscale wrinkles inspired by bird feathers and the corrugations of insect wings. The flexural and tensile stiffness of the wrinkled film can be controlled by modifying the orientations and waveforms of the wrinkles, thereby expanding the design space of flexible wings for micro flapping-wing aerial robots. A self-organization phenomenon was exploited in the fabrication of the microwrinkles such that microscale wrinkles spanning a broad wing area were spontaneously created. The wavy shape of these self-organized wrinkles was used as a mould, and a Parylene film was deposited onto the mould to form a wrinkled wing film. The effect of the waveforms of the wrinkles on the film stiffness was investigated theoretically, computationally and experimentally. Compared with a flat film, the flexural stiffness was increased by two orders of magnitude, and the tensile stiffness was reduced by two orders of magnitude. To demonstrate the effect of the wrinkles on the actual deformation of the flapping wings and the resulting aerodynamic forces, the fabricated wrinkled wings were tested using a tethered electric flapping mechanism. Chordwise unidirectional wrinkles were found to prevent fluttering near the trailing edge and to produce a greater aerodynamic lift compared with a flat wing or a wing with spanwise wrinkles. Our results suggest that the fine stiffness control of the wing film that can be achieved by tuning the microwrinkles can improve the aerodynamic performance of future flapping-wing aerial robots. PMID:26119657

  20. Bariatric Surgery

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ? 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight. The actual number of Ontario adults who are overweight or obese may be higher. Diet, exercise, and behavioural therapy are used to help people lose weight. The goals of behavioural therapy are to identify, monitor, and alter behaviour that does not help weight loss. Techniques include self-monitoring of eating habits and physical activity, stress management, stimulus control, problem solving, cognitive restructuring, contingency management, and identifying and using social support. Relapse, when people resume old, unhealthy behaviour and then regain the weight, can be problematic. Drugs (including gastrointestinal lipase inhibitors, serotonin norepinephrine reuptake inhibitors, and appetite suppressants) may be used if behavioural interventions fail. However, estimates of efficacy may be confounded by high rates of noncompliance, in part owing to the side effects of the drugs. In addition, the drugs have not been approved for indefinite use, despite the chronic nature of obesity. The Technology Morbidly obese people may be eligible for bariatric surgery. Bariatric surgery for morbid obesity is considered an intervention of last resort for patients who have attempted first-line forms of medical management, such as diet, increased physical activity, behavioural modification, and drugs. There are various bariatric surgical procedures and several different variations for each of these procedures. The surgical interventions can be divided into 2 general types: malabsorptive (bypassing parts of the gastrointestinal tract to limit the absorption of food), and restrictive (decreasing the size of the stomach so that the patient is satiated with less food). All of these may be performed as either open surgery or laparoscopically. An example of a malabsorptive technique is Roux-en-Y gastric bypass (RYGB). Examples of restrictive techniques are vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). The Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services includ

  1. Possibilities of application of composite bone-soft tissue complex in reconstructive surgery.

    PubMed

    Peradze, I; Peradze, T

    2005-09-01

    Hereby the method of formation of bone-soft tissue complex with its future application in reconstructive surgery is presented. Treatment of spacious defects of human body with soft tissue lost as well as with bone injury is considered as critical problem in contemporary surgery. Even today, there is no final reference regarding the particular sort of flat to be applied in each specific case. Method of formation and flap taking is one of the most complicated and crucial stages of the operation. Operation of free transplantation of compound composite flaps of soft tissues, muscles and bones, including microvascular anastomosis, was done for 66 patients; in total 68 transplantations were carried out. the patients were provided with clinic-laboratory analysis; identification of deficient tissues, X-ray, dopplerography, determination of various sorts of sensitivity, biomechanical examinations and tests, and bacteriological tests. 66 patients with grave injuries of bones and soft tissues were operated. In 86,8% of total good functional and esthetical effect was reached, and in 11,8%--the outcomes were estimated as satisfactory. While observance of all technical rules for flap formation precision during formation of vascular pedicle, accurate selections of form and flap dimension are of significant importance. During solution of this very problem, auto-transplantation of tissue flaps is deemed to be highly effective method of treatment. It is worthy to note, that value of micro-surgical transplantation, such as lack of lingering immobilization of extremities, is of crucial importance for children and adolescent as far as it prevents development of hard mobility of joints and saves from obligatory lingering confinement to bed during treatment with traditional methods (Italian plastics, Phylatov's stalk, etc.) The offered method of formation of bone-soft tissue complex facilitates technical sides of transplantation and monitoring. In case of serious bone-soft tissue defects, transplantation of rib-thoracodorsial complex is considered as method of choice. PMID:16234584

  2. A comparison of the donor-site morbidity after using the prelaminated fasciomucosal flap and the fasciocutaneous radial forearm flap for intraoral reconstruction.

    PubMed

    Nehrer-Tairych, G V; Millesi, W; Schuhfried, O; Rath, T

    2002-04-01

    Since 1996 we have performed mucosal prelamination of the distal radial forearm flap for functional reconstruction of defects of the intraoral lining. This study was undertaken to demonstrate that the prelaminated fasciomucosal radial forearm flap can provide physiological oropharyngeal reconstruction with mucus-producing tissue, while avoiding the donor-site complications of the fasciocutaneous radial forearm flap. We examined the donor hand at least 6 months postoperatively in 20 patients after using a prelaminated fasciomucosal radial forearm flap and in 15 patients after harvesting a classical fasciocutaneous radial forearm flap. The evaluation of hand function included range of motion, grip power, pinch power, sensibility and vascular analysis in both hands. The patients were asked about cold intolerance, pain and any restrictions in daily life, and the cosmetic appearance of the donor hand was noted. In the prelaminated-flap group (n 20), two patients had decreased wrist extension, and one of these patients also had reduced strength and mild hypaesthesia in the donor hand. In the classical-fasciocutaneous-flap group (n 15), six patients had decreased wrist extension, five patients had reduced strength and four patients had diminished sensibility in the donor hand. Painful neuromas were found only after fasciocutaneous flaps (three cases). Subjective assessment revealed restricted hand function in one patient in the prelaminated-flap group, and in five patients who had undergone fasciocutaneous flap transfer. The results of this study show that using the prelaminated fasciomucosal radial forearm flap minimises the donor-site morbidity. Furthermore, we were able to improve the cosmetic appearance of this very exposed region. PMID:12041971

  3. Calculation of the longitudinal aerodynamic characteristics of upper-surface-blown wing-flap configurations

    NASA Technical Reports Server (NTRS)

    Mendenhall, M. R.; Spangler, S. B.

    1978-01-01

    An engineering method for predicting the longitudinal aerodynamic characteristics of wing-flap configurations with upper surface blowing (USB) was developed. Potential flow models were incorporated into the prediction method: a wing and flap lifting surface model and a jet wake model. The wing-flap model used a vortex-lattice to represent the wing and flaps. The wing had an arbitrary planform and camber and twist, and the flap system was made up of a Coanda flap and other flap segments of arbitrary size. The jet wake model consisted of a series of closely spaced rectangular vortex rings. The wake was positioned such that it was tangent to the upper surface of the wing and flap between the exhaust nozzle and the flap trailing edge. It was specified such that the mass, momentum, and spreading rates were similar to actual USB jet wakes. Comparisons of measured and predicted pressure distributions, span load distributions, and total lift and pitching-moment coefficients on swept and unswept USB configurations are included. A wide range of thrust coefficients and flap deflection angles were considered at angles of attack up to the onset of stall.

  4. PIV study of near-field tip vortex behind perforated Gurney flaps

    NASA Astrophysics Data System (ADS)

    Lee, T.

    2011-02-01

    The impact of Gurney flaps, of different heights and perforations, on the growth and development of a tip vortex, both along the tip and in the near field of a finite NACA 0012 wing, at Re = 1.05 × 105 was investigated by using particle image velocimetry (PIV). Wind-tunnel force balance measurements were also made to supplement the PIV results. This study is a continuation of the work of Lee and Ko (Exp Fluids 46(6):1005-1019, 2009) on the near-wake measurements behind perforated Gurney flaps. The present results show that along the tip, the overall behavior of the secondary vortices and their interaction with the primary, or tip, vortex remained basically unchanged, regardless of flap height and perforation. The peak vorticity of the tip vortex, however, increased with flap height and always exhibited a local maximum at x/ c = 0.8 (from the leading edge). In the near field, the strength and structure of the near-field tip vortex were found to vary greatly with the flap height and perforation. The small flaps produced a more concentrated tip vortex with an increased circulation, while the large Gurney flaps caused a disruption of the tip vortex. The disrupted vortex can, however, be re-established by the addition of flap perforation. The larger the flap perforation the more organized the tip vortex. The Gurney flaps have the potential to serve as an alternative off-design wake vortex control device.

  5. Distally based adipofascial flaps for dorsal foot and ankle soft tissue defects.

    PubMed

    Suliman, M Taifour

    2007-01-01

    Soft tissue defects of the dorsal foot and ankle are difficult to reconstruct because the contour of the foot must be maintained for shoe fitting. The adipofascial flap, covered with a skin graft, is a suitable method of reconstruction that fulfills this important requirement. Twelve patients with soft tissue defects of the dorsal foot and at the ankle were treated in our unit with this method. Ten (83%) were children, 2 (17%) were adults. All defects were due to road traffic accidents. Three (25%) patients were women; 9 (75%) were men. The right foot was affected in 10 (83.4%) patients, with 2 (16.6%) patients having the left foot involved. The flaps used were the peroneal artery perforator flap (distally based lateral adipofascial flap) in 9 (75%) patients, the superficial sural artery flap in 2 patients (17%), and the posterior tibial artery perforator flap (distally based medial adipofascial flap) in 1 patient (8%). All flaps were successful, providing adequate contour of the foot for wearing ordinary shoes. There were 2 partial skin graft necroses, and, in 1 patient, the tips of the donor site skin flaps were necrosed. In conclusion, the distally based adipofascial flap, covered with skin graft, is a suitable method for reconstruction of soft tissue loss of the dorsal foot and ankle and provides optimum functional and aesthetic outcome with minimum donor site morbidity. PMID:17980844

  6. Combination of microvascular medial femoral condyle and iliac crest flap for hemi-midface reconstruction.

    PubMed

    Brandtner, C; Hachleitner, J; Buerger, H; Gaggl, A

    2015-06-01

    In midface defects including the orbit (Brown class III and IV), no single flap can provide adequate reconstruction. In this technical note, the combination of vascularized iliac crest flap and vascularized medial femoral condyle flap (MFC) is described. The vascularized iliac crest flap is reported to be the gold standard for maxilla reconstruction. There is, however, no consensus on the best method for orbital and nasal wall reconstruction. The MFC flap can be harvested as a thin corticoperiosteal flap or as an osteomyocutaneous flap. Due to the periosteal blood supply, this flap can be customized for an individual defect of the upper hemi-midface. It is therefore of great benefit in orbital and nasal wall reconstruction. By combining the deep circumflex iliac artery (DCIA) bone flap and the MFC flap, the best standard reconstruction technique of the hemi-maxilla can be combined with a new anatomical precise microvascular reconstruction technique of the orbit. A nearly symmetric midface appearance can be achieved. PMID:25835757

  7. Tolerance of prefabricated skin flaps to ischaemia and reperfusion: experimental study.

    PubMed

    Serel, Sava?; Çavu?o?lu, Tar?k; Uluç, Ars?n; Ayva, ?ebnem; Saray, Ayd?n; Özbek, Mustafa R?za

    2011-03-01

    Custom prefabrication of tissues allows the surgeon to build what is required for the reconstruction and has enabled the surgeon to reinforce new blood supply into selected blocks of tissue without vessel anastomosis. However, prefabricated flaps have several drawbacks and characteristics that differentiate them from conventional flaps. The objective of this study was to test the tolerance of prefabricated flaps to ischaemia/reperfusion injury in rats. In the first stage, the unilateral-inferior-epigastric pedicle was ligated and divided, and then a skin flap was fabricated by implantation of distally ligated femoral arteriovenous pedicle beneath the abdominal skin. The femoral vessels were implanted either in skeletonised or in muscle-cuffed fashion beneath the abdominal skin, a portion of which was raised as an island flap, based on these vessels. Prefabricated flaps (3×6 cm) were raised 6 weeks after, and were subjected to 10 h ischaemia and followed by 12 h reperfusion. Flap survival and histological changes at the pedicle-skin junction were evaluated at 7 days. Flap necrosis in the sham group was 0%, whereas the control group (conventional) had 47.27±13.50% necrosis. Flaps prefabricated with skeletonised femoral pedicle demonstrated an insignificant pattern with 63.74±10.62% necrosis when compared with prefabricated flaps with muscle-cuffed pedicle with the percentage of necrosis of 64.51±11.24. The area of necrosis was significantly increased when both the prefabricated flaps were compared with the control group or with the sham-prefabricated group (p<0.05). Skin flaps prefabricated with either pedicle-alone or pedicles with muscle cuff are more susceptible to ischaemia and following reperfusion in comparison with the normal flaps. PMID:20542482

  8. Reconstruction of a transmetatarsal amputation stump using a salvaged peroneal artery fasciocutaneous flap from the opposite leg: A case report

    PubMed Central

    Balakrishnan, Chenicheri; Altman, Gil; Khalil, Abdullah J

    2005-01-01

    During lower extremity amputation, the objective is to provide a functional residual limb that permits maximum patient mobility and independence. Preservation of length of the fore part of the foot using salvageable tissue from the amputated part in young patients prevents equines deformity and revision of amputation to a higher level. This can be achieved using tissue available from the amputated part. The spare part concept in reconstructive surgery should be integrated into the trauma algorithm to avoid additional donor site morbidity. Reported here is a young adult patient with crush injuries to both feet, which resulted in amputations. A fasciocutaneous flap raised from one extremity was used to facilitate transmetatarsal amputation stump length preservation of the other extremity. PMID:24227936

  9. Total ear reconstruction in the devascularized temporoparietal region: I. Use of the contralateral temporoparietal fascial free flap.

    PubMed

    Park, C; Suk Roh, T

    2001-10-01

    Total ear reconstruction by the use of contralateral temporoparietal fascial free flap and autogenous costal cartilage was performed in 16 patients presenting with a devascularized temporoparietal region resulting from trauma or prior surgery. The microsurgical success rate was 87.5 percent (14 of 16 transplants). On evaluation of the final aesthetic result in 11 patients followed up for more than 3 years, nine patients were graded good-to-excellent and two patients exhibited fair-to-poor results. Despite the relatively long operating hours and the comparatively low microsurgical success rate, ear reconstruction by autogenous tissue transplantation has proved to be an encouraging and worthwhile experience. This article presents the clinical cases and discusses the technical details. PMID:11604610

  10. Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: the role of local muscle flaps revisited.

    PubMed

    Pu, Lee L Q

    2010-08-01

    The proper soft-tissue management for an extensive mid-tibial wound of the leg with a less aggressive surgical approach has rarely been discussed in the literature and the reliability and the usefulness of such an approach to this challenging clinical problem remains uncertain. In this series, four patients with an extensive mid-tibial wound (12x3 to 22x6 cm) of the leg underwent the combined medial gastrocnemius and medial hemisoleus muscle flaps for soft-tissue reconstruction. Both muscle flaps were elevated with emphasis on the preservation of the critical perforators from the posterior tibial vessels to the medial hemisoleus muscle flap as possible and on the possible preservation of foot planter flexion by reconstruction of the proximal Achilles tendon to minimise functional loss. All patients except one had primary healing of their tibial wounds. One patient developed insignificant distal flap necrosis of the medial soleus flap and was treated with debridement and flap re-advancement. Three patients with tibial fracture also had evidenced healing of their tibial fractures. Limb salvage was achieved in all four patients during follow-up. Thus, the combined medial gastrocnemius and medial hemisoleus muscle flaps can be a valid option for soft-tissue coverage of an extensive mid-tibial wound of the leg when both local muscle flaps are not traumatised. Such an approach offers relatively simple but more cost-effective way to manage this complex clinical problem and should be revisited by reconstructive surgeons. PMID:20627760

  11. Turbulence Measurements on a Flap-Edge Model

    NASA Technical Reports Server (NTRS)

    Moriarty, Patrick; Bradshaw, Peter; Cantwell, Brian; Ross, James

    1998-01-01

    Turbulence measurements have been made on a flap-edge and leading-edge slat model using hot-wire anemometry, and, later, particle image velocimetry. The properties of hot-wire anemometry were studied using facilities at NASA Ames Research Center. Hot-film probes were used because of their durability, but cross-films were limited by non-linear end effects. As a warm-up exercise, hot-film probes were used to measure velocities in the farfield wake of a cylinder with an airfoil in the near-field wake. The airfoil reduced the drag coefficient of the system by 10%. A single-wire hot-film probe was used to measure velocity profiles over the top of a NACA 63(sub 2)-215 Mod. B wing with a Fowler flap and leading,-edge slat. Results showed the size of slat wake was dependent upon the slat deflection angle. Velocity increased through the slat gap with increased deflection. The acoustically modified slat decreased the chance of separation. Measurements were taken at the flap edge with a single hot-film. Trends in the data indicate velocity and turbulence levels increase at the flap edge. The acoustically modified flap modifies the mean flow near the flap edge. Correlations were made between the hot-film signal and the unsteady pressure transducers on the wing which were published in a NASA CDTM. The principles of Particle Image Velocimetry (PIV) were studied at Florida State University. Spectral PIV was used to measure the spectra of a subsonic jet. Measured frequencies were close to the predicted frequency of jet shedding. Spectral PIV will be used to measure the spectra of the slat flow in the second 7 x lO-ft. wind tunnel test. PIV has an advantage that it can measure velocity and spectra of the entire flowfield instantaneously. However, problems arise when trying, to store this massive amount of PIV data. Support for this research has continued through a NASA Graduate Student Program Fellowship which will end in June 1999. The thesis should be completed by this time.

  12. Localized, Non-Harmonic Active Flap Motions for Low Frequency In-Plane Rotor Noise Reduction

    NASA Technical Reports Server (NTRS)

    Sim, Ben W.; Potsdam, Mark; Kitaplioglu, Cahit; LeMasurier, Philip; Lorber, Peter; Andrews, Joseph

    2012-01-01

    A first-of-its-kind demonstration of the use of localized, non-harmonic active flap motions, for suppressing low frequency, in-plane rotor noise, is reported in this paper. Operational feasibility is verified via testing of the full-scale AATD/Sikorsky/UTRC active flap demonstration rotor in the NFAC's 40- by 80-Foot anechoic wind tunnel. Effectiveness of using localized, non-harmonic active flap motions are compared to conventional four-per-rev harmonic flap motions, and also active flap motions derived from closed-loop acoustics implementations. All three approaches resulted in approximately the same noise reductions over an in-plane three-by-three microphone array installed forward and near in-plane of the rotor in the nearfield. It is also reported that using an active flap in this localized, non-harmonic manner, resulted in no more that 2% rotor performance penalty, but had the tendency to incur higher hub vibration levels.

  13. Flap survey test of a combined surface blowing model: Flow measurements at static flow conditions

    NASA Technical Reports Server (NTRS)

    Fukushima, T.

    1978-01-01

    The Combined Surface Blowing (CSB) V/STOL lift/propulsion system consists of a blown flap system which deflects the exhaust from a turbojet engine over a system of flaps deployed at the trailing edge of the wing. Flow measurements consisting of velocity measurements using split film probes and total measure surveys using a miniature Kiel probe were made at control stations along the flap systems at two spanwise stations, the centerline of the nozzle and 60 percent of the nozzle span outboard of the centerline. Surface pressure measurements were made in the wing cove and the upper surface of the first flap element. The test showed a significant flow separation in the wing cove. The extent of the separation is so large that the flow into the first flap takes place only at the leading edge of the flap. The velocity profile measurements indicate that large spanwise (3 dimensional) flow may exist.

  14. Microvascular tissue transfer in cleft palate patients: advocacy of the prelaminated radial free forearm flap.

    PubMed

    Zemann, Wolfgang; Kruse, Astrid Loni; Lüebbers, Heinz Theo; Jacobsen, Christine; Metzler, Philipp; Obwegeser, Joachim Anton

    2011-11-01

    The closure of wide palatal clefts and recurrent oronasal fistulae may be challenging. After repeated failure of conventional techniques, microvascular tissue transfer may be indicated in the closure of such fistulae. Depending on the location and the size of the palatal fistula, different tissues are required to sufficiently close the palatal gaps. A subdivision of common flaps into mucosa, muscular, bony, skin, and fascia flaps was carried out to analyze their suitability for alveolar, hard, and soft palate reconstruction. Furthermore, the bulk of flaps and the length of the vascular pedicle were analyzed to rate the suitability of different flaps for palatal closure. Based on a new classification of oronasal fistulae, all these factors were taken into consideration to introduce a decision guidance of what microvascular flap fits a particular clinical situation. The radial free forearm flap was found to be sufficient in the closure of all classes of oronasal fistulae. PMID:22067854

  15. Analysis of a Multi-Flap Control System for a Swashplateless Rotor

    NASA Technical Reports Server (NTRS)

    Sekula, Martin K.; Wilbur, Matthew L.

    2011-01-01

    An analytical study was conducted examining the feasibility of a swashplateless rotor controlled through two trailing edge flaps (TEF), where the cyclic and collective controls were provided by separate TEFs. This analysis included a parametric study examining the impact of various design parameters on TEF deflections. Blade pitch bearing stiffness; blade pitch index; and flap chord, span, location, and control function of the inboard and outboard flaps were systematically varied on a utility-class rotorcraft trimmed in steady level flight. Gradient-based optimizations minimizing flap deflections were performed to identify single- and two-TEF swashplateless rotor designs. Steady, forward and turning flight analyses suggest that a two-TEF swashplateless rotor where the outboard flap provides cyclic control and inboard flap provides collective control can reduce TEF deflection requirements without a significant impact on power, compared to a single-TEF swashplateless rotor design.

  16. Covering implantable left ventricular assist device (DuraHeart(®)) with free flap.

    PubMed

    Matsuda, Ken; Nishibayashi, Akimitsu; Toda, Koichi; Fujiwara, Takashi; Fukai, Megumi; Yoshioka, Daisuke; Sawa, Yoshiki; Hosokawa, Ko

    2015-06-01

    Severe donor shortage in Japan makes the waiting period for heart transplantation extremely long and the left ventricular assist devices (LVADs) are often used for bridge-to-transplant. We present three cases of infected and exposed DuraHeart(®) LVAD system treated with free flaps. Four free flaps (two latissimus flaps and two anterolateral thigh flaps) were transferred using the right internal thoracic vessels or left deep inferior epigastric vessels as recipients. The potential significance of the continuous low pressure blood flow generated by the LVAD system on microvascular patency has not been previously reported. All flaps survived and worked efficiently to control the infection and cover the devices. Heart transplantation was conducted in the two of three patients. Free flap transfer is an efficient treatment for the patients with infected and exposed implantable LVAD. PMID:25535105

  17. Perioperative factors that influence the outcome of microsurgical reconstructions in craniomaxillofacial surgery.

    PubMed

    Preidl, R H M; Wehrhan, F; Schlittenbauer, T; Neukam, F W; Stockmann, P

    2015-07-01

    Microsurgical tissue transfer is a well-established way of reconstructing the head and neck, but there are still many postoperative complications that require revision. The aim of this study was to clarify perioperative factors and characteristics of patients that influence the success of the flap and the need for revision. We retrospectively studied 368 patients who were treated with microsurgical free tissue transfer in the head and neck area at the Department of Oral and Maxillofacial Surgery at the University Medical Centre, Erlangen, between 2004 and 2009. Investigations concentrated on patients' characteristics and operative factors. Free scapular or parascapular flaps (n=161, 44%) and radial forearm flaps (n=119, 32%) were predominantly used for the reconstruction of major defects in the mandible and the floor of the mouth. In 39 patients (11%) revision was required, which resulted in a success rate of 96%. There was a significant association between preoperative American Society of Anesthesiologists (ASA) grade and postoperative survival of the flap (p=0.04). Patients previously treated by irradiation required significantly more revisions than those not so treated (p=0.04). The use of vein grafts was also significantly associated with the need for revision (p=0.02). The ASA grade influenced the success rate but was not associated with the number of revisions. These factors must be taken into consideration when intervention is planned to reduce the number of postoperative complications and interventions further. PMID:25863435

  18. Tests in the variable-density wind tunnel of the NACA 23012 airfoil with plain and split flaps

    NASA Technical Reports Server (NTRS)

    Abbott, Ira H; Greenberg, Harry

    1939-01-01

    Section characteristics for use in wing design are presented for the NACA 23012 airfoil with plain and split flaps of 20 percent wing chord at a value of the effective Reynolds number of about 8,000,000. The flap deflections covered a range from 60 degrees upward to 75 degrees downward for the plain flap and from neutral to 90 degrees downward for the split flap. The split flap was aerodynamically superior to the plain flap in producing high maximum lift coefficients and in having lower profile-drag coefficients at high lift coefficients.

  19. Numerical simulation for hydrodynamic characteristics of a bionic flapping hydrofoil

    NASA Astrophysics Data System (ADS)

    Su, Yu-min; Wang, Zhao-li; Zhang, Xi; Guo, Bing-jie

    2012-06-01

    In order to study the propulsion mechanism of the bionic flapping hydrofoil (BFH), a 2-DoF (heave and pitch) motion model is formulated. The hydrodynamic performance of BFH with a series of kinematical parameters is explored via numerical simulation based on FLUENT. The calculated result is compared with the experimental value of MIT and that by the panel method. Moreover, the effect of inlet velocity, the angle of attack, the heave amplitude, the pitch amplitude, the phase difference, the heave biased angle, the pitch biased angle and the oscillating frequency are investigated. The study is useful for guiding the design of bionic underwater vehicle based on flapping propulsion. It is indicated that the optimal parameters combination is v = 0.5 m/s, ? 0 = 40°, ? 0 = 30°, ? = 90°, ? bias = 0°, ? bias = 0° and f = 0.5 Hz.

  20. Ontogeny of aerial righting and wing flapping in juvenile birds.

    PubMed

    Evangelista, Dennis; Cam, Sharlene; Huynh, Tony; Krivitskiy, Igor; Dudley, Robert

    2014-08-01

    Mechanisms of aerial righting in juvenile chukar partridge (Alectoris chukar) were studied from hatching to 14 days-post-hatching (dph). Asymmetric movements of the wings were used from 1 to 8 dph to effect progressively more successful righting behaviour via body roll. Following 8 dph, wing motions transitioned to bilaterally symmetric flapping that yielded aerial righting via nose-down pitch, along with substantial increases in vertical force production during descent. Ontogenetically, the use of such wing motions to effect aerial righting precedes both symmetric flapping and a previously documented behaviour in chukar (i.e. wing-assisted incline running) hypothesized to be relevant to incipient flight evolution in birds. These findings highlight the importance of asymmetric wing activation and controlled aerial manoeuvres during bird development and are potentially relevant to understanding the origins of avian flight. PMID:25165451

  1. The X-38 V-201 Flap Actuator Mechanism

    NASA Technical Reports Server (NTRS)

    Hagen, Jeff; Moore, Landon; Estes, Jay; Layer, Chris

    2004-01-01

    The X-38 Crew Rescue Vehicle V-201 space flight test article was designed to achieve an aerodynamically controlled re-entry from orbit in part through the use of two body mounted flaps on the lower rear side. These flaps are actuated by an electromechanical system that is partially exposed to the re-entry environment. These actuators are of a novel configuration and are unique in their requirement to function while exposed to re-entry conditions. The authors are not aware of any other vehicle in which a major actuator system was required to function throughout the complete re-entry profile while parts of the actuator were directly exposed to the ambient environment.

  2. Experimental investigations on the effects of divergent trailing edge and Gurney flaps on a supercritical airfoil

    Microsoft Academic Search

    Y. C. Li; J. J. Wang; J. Hua

    2007-01-01

    Wind tunnel experiments were conducted to investigate the effects of divergent trailing edges and Gurney flaps on a supercritical airfoil at a Mach number M=0.7 and a Reynolds number Re=3.15×105 based on the airfoil chord length. The effects of Gurney flaps on a divergent trailing edge airfoil were also studied. Four Gurney flaps with heights h=0.5%, 1.0%, 1.5% and 2.0%

  3. Resume of Present Data on Load Distribution on Slots and Flaps, Special Report

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J.

    1934-01-01

    This report covers a study of the generally available data on load distribution on slots and flaps. The study was made by the National Advisory Committee for Aeronautics at the request of the Material Division, Army Air Corps to furnish information applicable to design criteria for slots and flaps of various types. The data are presented in three main sections: slots (Handley page type), auxiliary airfoils (fixed), and flaps.

  4. Microvascular reconstruction of the columella using a small radial forearm free flap: a case report

    Microsoft Academic Search

    Rossella Sgarzani; Luca Negosanti; Claudio Marchetti; Riccardo Cipriani

    2009-01-01

    Columellar defects can result from various causes, a number of methods have been described for the reconstruction using local,\\u000a regional, or free flaps. When local tissues are not available due to the presence of scars, free flaps become the treatment\\u000a of choice. We present the case of a columellar defect resulting from a distal necrosis of a forehead flap in

  5. Pressure distribution over a Clark Y-H airfoil section with a split flap

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J

    1937-01-01

    An investigation was made in the N.A.C.A. 7 by 10 foot wind tunnel of the distribution of air pressure over one chord section of a Clark Y-H airfoil with a split flap. The results obtained are given in the form of diagrams showing the chordwise distribution of pressure on both airfoil and flap as plots of calculated aerodynamic coefficients for both airfoil and flap.

  6. Wind tunnel testing of a Mach-scaled rotor model with trailing-edge flaps

    Microsoft Academic Search

    Nikhil A. Koratkar; Inderjit Chopra

    2001-01-01

    This paper presents the wind tunnel testing of a four-bladed Mach-scaled rotor model with piezoelectric bender actuated trailing-edge flaps. Correctly phased, this flap motion can be used for the active suppression of vibratory hub loads. First, the University of Maryland Advanced Rotorcraft Code was used to conduct a parametric study to determine the optimal flap sizing and location as well

  7. Inferiorly based thigh flap for reconstruction of defects around the knee joint

    PubMed Central

    Akhtar, Md. Sohaib; Khan, Arshad Hafeez; Khurram, Mohammed Fahud; Ahmad, Imran

    2014-01-01

    Background: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. Aims and Objectives: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. Materials and Methods: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Results: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. Conclusions: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh. PMID:25190918

  8. Feasibility of Use of a Barbed Suture (V-Loc 180) for Quilting the Donor Site in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction

    PubMed Central

    Hussain, Tasadooq; Mahapatra, Tapan Kumar; McManus, Penelope Louise; Kneeshaw, Peter John

    2013-01-01

    Background Latissimus dorsi (LD) myocutaneous flap is a popular method of breast reconstruction which can be associated with high incidence of seroma formation. Quilting sutures at the harvest site are used to reduce this. Barbed sutures are self anchoring sutures which avoid multiple knotting and can be useful in quilting. Methods A retrospective analysis of prospectively maintained database of patients who underwent LD flap breast reconstruction between January 2009 and January 2011 was carried out. Seroma formation at the harvest site, wound related complications, inpatient stay and duration of surgery were analysed and a comparison was made between two groups where quilting was done with barbed (V-Loc) suture and conventional polydioxanone (PDS) II sutures. Results Fifty-seven patients were included of which 33 had quilting by V-Loc sutures and in 24 patients PDS II suture was used. Median age in the PDS group was 55 years (interquartile range [IQR)], 45 to 61 years) which was comparable to the V-Loc group (53 years [IQR, 48 to 59 years]; P-value 0.948). Sixteen patients (28%) had significant seroma formation and 5 (9%) patients developed superficial wound dehiscence. Incidences of seroma or wound complications were comparable (P-value 0.378 and 1.00, respectively). Secondary outcomes such as total duration of surgery, total inpatient stay, total amount of drain at the donor site were also similar in two groups. Conclusions Use of barbed sutures for quilting the donor site in LD flap reconstruction is a feasible option and the associated seroma formation and wound complications are comparable with conventional sutures. PMID:23532830

  9. Management of chronic expanding haematoma using triamcinolone after latissimus dorsi flap harvesting.

    PubMed

    Hamada, Mariko; Shimizu, Yusuke; Aramaki-Hattori, Noriko; Kato, Tatsuya; Takada, Keiko; Aoki, Marie; Kishi, Kazuo; Nagasao, Tomohisa

    2015-03-01

    Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH. PMID:25798395

  10. Oblique triangular neurovascular osteocutaneous flap for hook nail deformity correction.

    PubMed

    García-López, Antonio; Laredo, Carlos; Rojas, Adaly

    2014-07-01

    Hook nail deformity results in aesthetic and functional problems after fingertip amputations. Previously described techniques do not correct the osseous defect, which may be the principle cause of the problem. We present a surgical technique based on a compound homodigital advancement flap combining bone of the distal phalanx, finger pulp, and skin. We describe this technique, report a case, and discuss the advantages over former techniques. PMID:24969498

  11. Redefining the vascular anatomy of the peroneus brevis muscle flap.

    PubMed

    Ensat, Florian; Weitgasser, Laurenz; Hladik, Michaela; Larcher, Lorenz; Heinrich, Klemens; Skreiner, Anna; Russe, Elisabeth; Fuerntrath, Frank; Kamp, Jonas; Cotofana, Sebastian; Wechselberger, Gottfried

    2015-01-01

    The peroneus brevis flap can be used as either proximally or distally based flap for coverage of small to medium-sized defects in the lower leg. The purpose of this study was to clarify the vascular anatomy of the peroneus brevis muscle. An anatomical dissection was performed on 17 fixed adult cadaver lower legs. Altogether, 87 segmental branches (mean 5.1?±?1.6 per leg) either from the fibular or anterior tibial artery to the muscle were identified. Sixty-two were branches from the fibular artery (mean 3.4?±?1.1 per fibular artery), whereas 25 (mean 1.4?±?0.9 per anterior tibial artery) originated from the anterior tibial artery. The distance between the most distal vascular branch and the malleolar tip averaged 4.3?±?0.6 cm. An axial vascular bundle to the muscle could be identified in all cadavers; in one leg two axial supplying vessels were found. Their average length was 5.5?±?2.4 cm and the average arterial diameter was 1.1?±?0.5 mm, the average venous diameter was 1.54?±?0.7 mm. The constant blood supply to the peroneus brevis muscle by segmental branches from the fibular and tibial artery make this muscle a viable option for proximally or distally pedicled flap transfer. The location of the most proximal and distal branches to the muscle and conclusively the pivot points for flap transfer could be determined. Furthermore, a constant proximal axial vascular pedicle to the muscle may enlarge the clinical applications. Perfusion studies should be conducted to confirm these findings. PMID:25046821

  12. Wake Vortex Alleviation Using Rapidly Actuated Segmented Gurney Flaps

    Microsoft Academic Search

    Claude Matalanis; John Eaton

    2006-01-01

    A study to assess the potential for using rapidly actuated segmented Gurney flaps, also known as Miniature Trailing Edge Effectors (MiTEs), for active wake vortex alleviation is conducted using a half-span model wing with NACA 0012 shape and an aspect ratio of 4.1. All tests are performed with the wing at an 8.9 degree angle of attack and chord based

  13. Jet-Engine Exhaust Nozzle With Thrust-Directing Flaps

    NASA Technical Reports Server (NTRS)

    Wing, David J.

    1996-01-01

    Convergent/divergent jet-engine exhaust nozzle has cruciform divergent passage containing flaps that move to deflect flow of exhaust in either or both planes perpendicular to main fore-and-aft axis of undeflected flow. Prototype of thrust-vector-control nozzles installed in advanced, high-performance airplanes to provide large pitching (usually, vertical) and yawing (usually, horizontal) attitude-control forces independent of attitude-control forces produced by usual aerodynamic control surfaces.

  14. Search for Chaotic Behavior in a Flapping Flag

    E-print Network

    J. O. McCaslin; P. R. Broussard

    2007-08-29

    We measured the correlation of the times between successive flaps of a flag for a variety of wind speeds and found no evidence of low dimensional chaotic behavior in the return maps of these times. We instead observed what is best modeled as random times determined by an exponential distribution. This study was done as an undergraduate experiment and illustrates the differences between low dimensional chaotic and possibly higher dimensional chaotic systems.

  15. A pigeon-inspired design for a biomimetic flapping wing

    NASA Astrophysics Data System (ADS)

    Mahardika, Nanang; Nguyen, Quoc Viet; Park, Hoon Cheol

    2010-04-01

    As an effort to explore the potential implementation of wing feather separation and lead-lagging motion to a flapping wing, a biomimetic flapper with separable outer wings has been designed and demonstrated. The artificial wing feather separation is implemented to the biomimetic wing by dividing the wing into inner and outer wings. The features of flapping, lead-lagging and feather separation of the flapper are captured by a high-speed camera for evaluation. The performance of the biomimetic flapper with separable outer wings is compared with that of a flapper with inseparable outer wings in terms of lift and thrust production. For low flapping frequency ranging from 2.47 Hz to 3.90 Hz, the biomimetic flapper shows higher thrust and lift generation capability, which is demonstrated from a series of experiments. The experiments show that the outer parts of the separable wing are able to deform largely resulting smaller amount of drag production during upstroke, while still producing relatively larger lift and thrust during downstroke.

  16. Wake Vortex Control using Segmented Rapidly Actuated Gurney Flaps

    NASA Astrophysics Data System (ADS)

    Matalanis, Claude; Eaton, John

    2004-11-01

    Gurney flaps are small flaps oriented perpendicular to the freestream at the trailing edge of a wing, which can increase the lift considerably with little drag penalty. Meso-scale trailing edge effectors (MiTEs) are segmented, rapidly actuated, independent Gurney flaps that have an analogous effect local to their spanwise position. MiTEs show great potential in helping to alleviate the wake vortex hazard. By periodically varying the loading distribution across the span of a wing, it may be possible to excite natural instabilities that accelerate vortex destruction. The problem is to introduce large enough disturbances while holding the total lift of the wing nearly constant. The purpose of this work is to assess how different MiTE actuation patterns can alter the strength and position of the trailing vortex. Our experimental apparatus consists of an untapered NACA 0012 wing with a 30 cm chord length and an aspect ratio of 2 mounted in a wind tunnel. Reynolds numbers based on the chord are of order 105. The wing is equipped with an array of 14 MiTEs. PIV is used to measure tangential velocities of the trailing vortex roughly five chord lengths behind the wing. Data from static MiTE configurations show that the vortex core can be displaced by at least 0.01 chord lengths.

  17. The inner prepuce flap for penile scald burns.

    PubMed

    Fuller, Sam M; Roughton, Michelle C; Gottlieb, Lawrence J

    2014-01-01

    Preputial skin has similar color, texture, and composition to the skin of the penile shaft. The inner preputial skin may be transferred as a flap based upon Dartos fascia to resurface full-thickness burns of the penile shaft, providing a gliding and stretchable surface cover unique to the penis. The advantages of using the inner prepuce skin to resurface full-thickness burns of the penile shaft will be elucidated and the technique will be described. A retrospective chart review was performed of three patients whose penile shaft was resurfaced with inner prepuce flaps after tangential excision of their full-thickness scald burns. Patient 1 was a 9-year-old boy who sustained an 8% TBSA scald burn resulting in a full-thickness burn to the dorsum of his penis. Patient 2 was a 3-year-old boy who sustained a 60% TBSA immersion scald burn as a victim of child abuse, resulting in a circumferential penile burn. Patient 3 was an 8- year-old boy who sustained a 3% TBSA grease burn to the dorsum of his penis. The inner surface of the prepuce of the patients was intact. They were treated with an inner preputial flap. Full-thickness scald burns to the penis are unusual and challenging for the patient, family, and burn surgeon. It is advantageous that inner preputial skin is commonly spared. This specialized thin skin is ideal for resurfacing the penile shaft and should be used when available. PMID:24823339

  18. FLAP (Force and Loads Analysis Program) code development and validation

    SciTech Connect

    Wright, A.D.; Buhl, M.L.; Thresher, R.W.

    1988-01-01

    The Force and Loads Analysis Program (FLAP) has been refined to include the teetering degree of freedom (without delta-3). This report describes these refinements, as well as comparisons of predicted blade-bending moments to tet measurements. Wind-tunnel data for a 1/20-scale model of the Boeing MOD-2 machine were used to compare FLAP predictions for the cyclic flap-bending moments at the 33% spanwise station for three different wind speeds. The comparisons were made for both rigid- and teetering-hub cases. The code was written in Fortran 77 to be especially useful on the IBM PC family of computers. A special effort was made to make the program ''user friendly'' and readable. This report can be used as a user's guide; it includes a program description, a method of preparing input files, and information on the correct method of executing the code. A method of correctly preparing blade input data from a structural-dynamics viewpoint is also described. The code and this report are now available for public use. 10 refs., 28 figs., 22 tabs.

  19. Flapping-wing mechanical butterfly on a wheel

    NASA Astrophysics Data System (ADS)

    Godoy-Diana, Ramiro; Thiria, Benjamin; Pradal, Daniel

    2009-11-01

    We examine the propulsive performance of a flapping-wing device turning on a ``merry-go-round'' type base. The two-wing flapper is attached to a mast that is ball-bearing mounted to a central shaft in such a way that the thrust force produced by the wings makes the flapper turn around this shaft. The oscillating lift force produced by the flapping wings is aligned with the mast to avoid vibration of the system. A turning contact allows to power the motor that drives the wings. We measure power consumption and cruising speed as a function of flapping frequency and amplitude as well as wing flexibility. The design of the wings permits to change independently their flexibility in the span-wise and chord-wise directions and PIV measurements in various planes let us examine the vorticity field around the device. A complete study of the effect of wing flexibility on the propulsive performance of the system will be presented at the conference.

  20. Comparison of heaving buoy and oscillating flap wave energy converters

    NASA Astrophysics Data System (ADS)

    Abu Bakar, Mohd Aftar; Green, David A.; Metcalfe, Andrew V.; Najafian, G.

    2013-04-01

    Waves offer an attractive source of renewable energy, with relatively low environmental impact, for communities reasonably close to the sea. Two types of simple wave energy converters (WEC), the heaving buoy WEC and the oscillating flap WEC, are studied. Both WECs are considered as simple energy converters because they can be modelled, to a first approximation, as single degree of freedom linear dynamic systems. In this study, we estimate the response of both WECs to typical wave inputs; wave height for the buoy and corresponding wave surge for the flap, using spectral methods. A nonlinear model of the oscillating flap WEC that includes the drag force, modelled by the Morison equation is also considered. The response to a surge input is estimated by discrete time simulation (DTS), using central difference approximations to derivatives. This is compared with the response of the linear model obtained by DTS and also validated using the spectral method. Bendat's nonlinear system identification (BNLSI) technique was used to analyze the nonlinear dynamic system since the spectral analysis was only suitable for linear dynamic system. The effects of including the nonlinear term are quantified.

  1. The faciocervicopectoral flap for non-oncological cases of cheek reconstruction

    PubMed Central

    2013-01-01

    Introduction Major facial defect has been a challenging case for plastic surgeons in terms of wound healing and covering technique for a long time. Methods Eight faciocervicopectoral (FCP) flaps were performed for reconstruction of major cheek defects due to handmade explosive and gun injuries. They were evaluated perioperatively and postoperatively with regard to operative time and operative blood loss as well as the function and cosmetic appearance. Results The technique showed marvellous cosmetic results but encountered minor postoperative flap complications. Conclusions The FCP flap is one of the best solutions for coverage of a simple or complex cheek defect. Application of the FCP flap is easy and rapid. PMID:24025286

  2. Unsteady Vortex Structures in the Wake of a Piezoelectric Flapping Wing

    NASA Astrophysics Data System (ADS)

    Clemons, Lucas; Igarashi, Hirofumi; Hu, Hui

    2009-11-01

    An experimental study was conducted to characterize the behavior of Unsteady Vortex Structures in the Wake of a piezoelectric flapping wing with miniaturized size (about 10mm in chord length), large flapping amplitude (up to 2.0 times of chord length) and high flapping frequency (60Hz) to explore the potential application of piezofans as the compact, gearless flapping-wings for the development of novel piezoelectric-flapping-wing-based Nano-Air-Vehicles (NAVs). The experimental investigation was performed in a low-speed wind tunnel. A digital particle image velocimetry (PIV) system was used to achieve phased-locked flow field measurements to quantify the transient behavior of the unsteady vortex structures in wake of the piezoelectric flapping wing. The effects of important parameters such as incoming flow velocity (i.e., forward flight speed), the flapping amplitude, and the incline angle of the flapping wing in relation to the incoming flow direction (i.e. the angle of attack) on the wake vortex shedding processes were examined to elucidate underlying physics in order to explore/optimize design paradigms for the development of novel piezoelectric-flapping-wing-based NAVs.

  3. Flap Reconstruction for Esophageal Perforation Complicating Anterior Cervical Spinal Fusion: An 18-year Experience

    PubMed Central

    Hanwright, Philip J.; Purnell, Chad A.

    2015-01-01

    Background: Esophageal injury following anterior cervical discectomy and fusion (ACDF) poses a significant reconstructive challenge. Buttressing flap repairs have proven beneficial; however, there remains a paucity of evidence to guide optimal flap selection. Methods: A retrospective chart review was performed for patients who presented to the senior author with esophageal perforations after ACDF from 1995 until present. Demographic, clinical, and postoperative details were collected. Outcomes of omental flap reconstructions were compared against other flap reconstructions. Results: A total of 13 flap reconstructions were performed in 11 patients with the following distribution: 7 free omental, 1 anterolateral thigh, 1 osteomuscular fibula, 2 radial forearm, and 2 pedicled pectoralis flaps. Patients receiving omental flap reconstructions demonstrated a significantly faster resolution of leak on contrast swallow imaging and earlier return to oral feeding compared with all other flap reconstructions (22.5 versus 268 days, respectively; P < 0.05). This relationship remained evident even when calculations excluded an outlying patient from the nonomental cohort (22.5 versus 111 days, respectively; P < 0.05). Length of hospital stay, complications, and success rates were also more favorable in the omental cohort but failed to reach statistical significance. Conclusions: Esophageal perforation after ACDF is an uncommon but devastating complication. The use of free omentum flap reconstruction is associated with a more rapid functional recovery and may prove beneficial in the management of these challenging cases. PMID:26090290

  4. Reconstruction of the Medial Canthus Using an Ipsilateral Paramedian Forehead Flap

    PubMed Central

    Kim, Jin Hyung; Kim, Jeong Min; Park, Jang Wan; Hwang, Jae Ha; Kim, Kwang Seog

    2013-01-01

    Background The medial canthus is an important area in determining the impression of a person's facial appearance. It is composed of various structures, including canthal tendons, lacrimal canaliculi, conjunctiva, the tarsal plate, and skin tissues. Due to its complexity, medial canthal defect reconstruction has been a challenging procedure to perform. The contralateral paramedian forehead flap is usually used for large defects; however, the bulkiness of the glabella and splitting at the distal end of the flap are factors that can reduce the rate of flap survival. We reconstructed medial canthal defects using ipsilateral paramedian forehead flaps, minimizing glabellar bulkiness. Methods This study included 10 patients who underwent medial canthal reconstruction using ipsilateral paramedian forehead flaps between 2010 and 2012. To avoid an acute curve of the pedicle, which can cause venous congestion, we attempted to make the arc of the pedicle rounder. Additionally, the pedicle was skeletonized from the nasal root to the glabella to reduce the bulkiness. Results All patients had basal cell carcinoma, and 3 of them had recurrent basal cell carcinoma. All of the flaps were successful without total or partial flap loss. Two patients developed venous congestion of the flap, which was healed using medicinal leeches. Four patients developed epiphora, and 2 patients developed telecanthus. Conclusions Large defects of the medial canthus can be successfully reconstructed using ipsilateral paramedian forehead flaps. In addition, any accompanying venous congestion can be healed using medicinal leeches. PMID:24286048

  5. Pressure Distribution Over a Rectangular Airfoil with a Partial-Span Split Flap

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Harris, Thomas A

    1937-01-01

    This report presents the results of pressure-distribution tests of a Clark y wing model with a partial-span split flap made to determine the distribution of air loads over both the wing and the flap. The model was used in conjunction with a reflection plane in the NACA 7 by 10 foot wind tunnel. The 20-percent-chord split flap extended over the inboard 60 percent of the semispan. The tests were made at various flap deflections up to 45 degrees and covered a range of angles of attack from zero lift to approximately maximum lift for each deflection.

  6. Inferior Turbinate Flap for Nasal-side Closure of Palatal Fistula in Cleft Patients: Technical Note

    PubMed Central

    Rahpeyma, Amin

    2014-01-01

    Summary: Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this purpose. Under general anesthesia with nasotracheal intubation, inferior turbinate was released from posterior attachment. After removing the inferior conchal bone, mucoperiosteal flap was used for nasal-side closure of anterior palatal fistula in patients with cleft. Anteriorly based inferior turbinate flap was used for nasal-side closure of residual palatal fistula in 3 patients with cleft. Age of the patients was 14, 16, and 18, and recurrence of palatal fistula has not occurred. Anteriorly based inferior turbinate flap is an axial pattern flap with appropriate surface of the paddle and vicinity to the oral cavity roof. It can be used in large anterior, palatal fistula for reconstruction of nasal floor. Considering appropriate another flap for oral side coverage of such fistula is mandatory. PMID:25587499

  7. The pedicled lateral arm flap for oncologic reconstruction near the shoulder.

    PubMed

    Jordan, Sumanas W; Wayne, Jeffrey D; Dumanian, Gregory A

    2015-01-01

    Oncologic resections near the shoulder create challenging reconstructive problems. In addition to severe contour defects and the risk for functional deficits resulting from contractures, there may be exposed bone and peripheral nerves rendering simple skin graft closures suboptimal long term. The lateral arm flap is a versatile septofasciocutaneous flap based on the posterior branch of the radial collateral artery in the lateral intermuscular septum of the upper arm. This paper details our experience with 3 patients who underwent wide local excision or radical resection of soft tissue tumors of the upper arm and closure with pedicled lateral arm fasciocutaneous flaps. Flap size ranged from 6 × 10 cm to 5 × 15 cm. Two flaps were transferred as 180-degree pivotal flaps; 1 flap was transferred as an advancement flap. There were no immediate postoperative complications or long-term functional deficits. The pedicled lateral arm flap is a safe and reliable option for soft tissue coverage of anterolateral shoulder defects. The vascular pedicle lies deep within the mid-upper arm and is rarely at risk during extensive tumor extirpation. The adjacent donor site allows for a single operative field without the need for repositioning and furthermore results in a skin paddle requirement that is one half the width of the original defect. PMID:23759966

  8. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps.

    PubMed

    Zelken, Jonathan A; AlDeek, Nidal F; Hsu, Chung-Chen; Chang, Nai-Jen; Lin, Chih-Hung; Lin, Cheng-Hung

    2014-12-01

    Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014. PMID:25487137

  9. Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap

    SciTech Connect

    Mathes, S.J.; Stevenson, T.R.

    1988-10-01

    The vertical trapezius musculocutaneous flap has been successfully utilized for reconstruction in 13 patients with complex posterior skull and neck defects. This flap based on its vascular pedicle, the descending branch of the transverse cervical artery, provides well-vascularized tissue for coverage of defects related to chronic osteomyelitis, tumor extirpation, osteoradionecrosis, and dehisced cervical laminectomy wounds. Emphasis on flap design, including the location of the skin island, allows adequate wound coverage, direct donor site closure, and muscle function preservation. With its large size and wide arc of rotation, the vertical trapezius musculocutaneous flap provides reliable coverage for posterior trunk, cervical, and skull defects.

  10. T-shaped Pectoralis Major Musculocutaneous Flap for Reconstruction of an Extensive Circumferential Pharyngeal Defect

    PubMed Central

    Fukunaga, Yutaka; Shinozaki, Takeshi; Yasunaga, Yoshichika; Hayashi, Ryuichi; Sakuraba, Minoru

    2014-01-01

    Summary: In the era of free-flap transfer, the pectoralis major musculocutaneous flap still plays a unique role in head and neck reconstruction. We report on a patient with a recurrent hypopharyngeal carcinoma after total pharyngolaryngectomy and adjuvant chemoradiotherapy in whom defects included a circumferential defect of the oropharynx and the entire tongue. The defects were successfully reconstructed with a T-shaped pectoralis major musculocutaneous flap whose skin island included multiple intercostal perforators from the internal mammary vessels. This flap design is effective for reconstructing circumferential pharyngeal defects in vessel-depleted neck. PMID:25289322

  11. Septoplasty and Turbinate Surgery

    MedlinePLUS

    ... may be asked to use saline sprays or irrigations after your surgery. Please check with your surgeon ... may be asked to use saline sprays or irrigations after your surgery. Please check with your surgeon ...

  12. Complications of TMJ surgery.

    PubMed

    Hoffman, David; Puig, Leann

    2015-02-01

    Temporomandibular joint (TMJ) surgery can be divided into 3 types of surgery: Arthroscopy, arthroplasty, and total joint replacement. The complications associated with these procedures increase with complexity. They all include injury to adjacent structures, infections, and bleeding problems. PMID:25483447

  13. Diabetic Vitrectomy Surgery

    MedlinePLUS Videos and Cool Tools

    ... Magwire, who is a registered nurse and certified diabetes educator. 00:01:06 MELISSA MAGWIRE, RN, CDE: ... questions you may have during the surgery about diabetes or the surgery. You can e-mail these ...

  14. Wind-Tunnel Investigation of the Effect of Angle of Attack and Flapping-Hinge Offset on Periodic Bending Moments and Flapping of a Small Rotor

    NASA Technical Reports Server (NTRS)

    McCarty, John Locke; Brooks, George W.; Maglieri, Domenic J.

    1959-01-01

    A two-blade rotor having a diameter of 4 feet and a solidity of 0.037 was tested in the Langley 300-MPH 7- by 10-foot tunnel to obtain information on the effect of certain rotor variables on the blade periodic bending moments and flapping angles during the various stages of transformation between the helicopter and autogiro configuration. Variables studied included collective pitch angle, flapping-hinge offset, rotor angle of attack, and tip-speed ratio. The results show that the blade periodic bending moments generally increase with tip-speed ratio up into the transition region, diminish over a certain range of tip-speed ratio, and increase again at higher tip-speed ratios. Above the transition region, the bending moments increase with collective pitch angle and rotor angle of attack. The absence of a flapping hinge results in a significant amplification of the periodic bending moments, the magnitudes of which increase with tip-speed ratio. When the flapping hinge is used, an increase in flapping-hinge offset results in reduced period bending moments. The aforementioned trends exhibited by the bending moments for changes in the variables are essentially duplicated by the periodic flapping motions. The existence of substantial amounts of blade stall increased both the periodic bending moments and the flapping angles. Harmonic analysis of the bending moments shows significant contributions of the higher harmonics, particularly in the transition region.

  15. Robotic liver surgery.

    PubMed

    Leung, Universe; Fong, Yuman

    2014-10-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  16. Trinucleotide repeat deletion via a unique hairpin bypass by DNA polymerase ? and alternate flap cleavage by flap endonuclease 1

    PubMed Central

    Xu, Meng; Gabison, Jonathan; Liu, Yuan

    2013-01-01

    Trinucleotide repeat (TNR) expansions and deletions are associated with human neurodegenerative diseases and prostate cancer. Recent studies have pointed to a linkage between oxidative DNA damage, base excision repair (BER) and TNR expansion, which is demonstrated by the observation that DNA polymerase ? (pol ?) gap-filling synthesis acts in concert with alternate flap cleavage by flap endonuclease 1 (FEN1) to mediate CAG repeat expansions. In this study, we provide the first evidence that the repair of a DNA base lesion can also contribute to CAG repeat deletions that were initiated by the formation of hairpins on both the template and the damaged strand of a continuous run of (CAG)20 or (CAG)25 repeats. Most important, we found that pol ? not only bypassed one part of the large template hairpin but also managed to pass through almost the entire length of small hairpin. The unique hairpin bypass of pol ? resulted in large and small deletions in coordination with FEN1 alternate flap cleavage. Our results provide new insight into the role of BER in modulating genome stability that is associated with human diseases. PMID:23258707

  17. Staged Surgery with Total Excision and Lamellar Reconstructive for Medium-sized Divided Nevus of the Eyelids

    PubMed Central

    Li, Qian; Quan, Yadan; Li, Kang; Liu, Jinling

    2015-01-01

    Background: To explore a prior treatment strategy for medium-sized (1.5–20 cm) divided nevus of the eyelids. Methods: Six patients who suffered from divided nevus of eyelids were recruited to this prospective, case series study between July 2008 and January 2014 (4 male and 2 female patients). The patients’ ages ranged from 14 to 29 years, with an average age of 24.5 years. All lesions were medium-sized (1.5–20 cm in diameter) and invaded eyelid margins and the posterior lamella of eyelids. Staged surgery involved total excision of lesions and then repair of the defects with advanced skin flaps and tarsoconjunctival flaps. Two staged surgeries were completed at intervals of at least 3 months. Results: All of the patients were followed up at least 3 months after the second surgery. Malignant transformation and recurrence were not observed. All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring. The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication. Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites. Conclusions: A staged surgery approach with the total excision of lesions and lamellar reconstructive procedures to repair the defect is a reasonable treatment strategy and can achieve satisfactory cosmetic results for medium-sized (1.5–20 cm in diameter) divided nevus of eyelid. PMID:26180739

  18. Simulation of Endoscopic Surgery

    E-print Network

    Boyer, Edmond

    Simulation of Endoscopic Surgery Nicholas AYACHE 1 - Stéphane COTIN 1 - Hervé DELINGETTE 1 Jean of therapy. This is particularly true for video-surgery, where the use of video-images during, in order to rehearse a difficult surgical procedure. In the future, we believe that surgery simulators

  19. Pediatric Surgery Gallengangatresie

    E-print Network

    Manstein, Dietmar J.

    1 Pediatric Surgery Gallengangatresie: eine seltene Erkrankung fällt durch die Maschen eines Versorgungsnetzes C. Petersen, B. M. Ure Pediatric Surgery Warum machen wir so viel Wirbel um eine seltene Surgery Die Gallengangatresie ist ein Problem! Seltene Erkrankung: ca. 1: 18.000 In Deutschland ca. 40

  20. Wrong site surgery

    Microsoft Academic Search

    D. García-Germán Vázquez; J. Sanz-Martín; F. Canillas del Rey; J. Sanjurjo-Navarro

    2009-01-01

    The term “wrong site surgery” refers to surgery carried out on the wrong side, in the wrong anatomical area or in the wrong patient. It can also indicate that the surgical procedure employed was not the one intended. In spite of being a rather neglected topic, wrong site surgery is a fairly usual complication in a surgeon's professional life -

  1. Pediatric heart surgery

    MedlinePLUS

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  2. Reconstructive Surgery of Extensive Face and Neck Burn Scars Using Tissue Expanders

    PubMed Central

    Ashab Yamin, Mohammad Reza; Mozafari, Naser; Mozafari, Mohadase; Razi, Zahra

    2015-01-01

    BACKGROUND Neck reconstruction is considered as one of the most important surgeries in cosmetic and reconstructive surgery. The present study aimed to assess the results of reconstructive surgery of extensive face and neck burning scars using tissue expanders. METHODS This descriptive prospective study was conducted on 36 patients with extensive burning scars on the neck and face. Operation for tissue expander insertion was performed and tissue distension started two or three weeks later, depending on the patients’ incisions. After sufficient time for tissue expansion, while removing the expander and excision of the lesion, the expanded flap was used to cover the lesion. Overall, 43 cosmetic surgeries were done. RESULTS Rectangular expanders were employed in most patients (73.81%) and were located in the neck in most of them (60.78%). Complications were detected in five patients (13.89%), with exposure of the prosthesis being the most common one. Scar tissues at the reconstruction site and the flap donor site were acceptable in 94.44% and 98.18% of the cases, respectively. Overall, most of the patients (77.78%) were satisfied with the operation results.  CONCLUSION Using tissue expanders in tissue reconstruction of extensive neck and facial burning scars results in highly desirable outcomes. PMID:25606476

  3. The extensor digitorum brevis muscle flap for the reconstruction of soft tissue defects in the lower limb

    Microsoft Academic Search

    A. D. Mandrekas; G. J. Zambacos; T. M. Grivas

    1995-01-01

    The use of the extensor digitorum brevis muscle as a local muscle island flap for the cover of soft tissue defects in the lower extremity is presented. The anatomy of the muscle, the blood supply, the elevation, and use of the extensor digitorum brevis muscle flap in the lower extremity are discussed. This flap offers a mean area of 27

  4. Flapping States of a Flag in an Inviscid Fluid: Bistability and the Transition to Chaos Silas Alben*

    E-print Network

    Shelley, Michael

    Flapping States of a Flag in an Inviscid Fluid: Bistability and the Transition to Chaos Silas Alben (Received 26 October 2007; published 21 February 2008) We investigate the ``flapping flag'' instability of elastic bodies and high-speed flows is the instability underlying the flapping of flags. One

  5. The 2006–2007 Food Label and Package Survey (FLAPS): Nutrition labeling, trans fat labeling

    Microsoft Academic Search

    Mary Brandt; Julie Moss; Martine Ferguson

    2009-01-01

    Since the 1970s, the Center for Food Safety and Applied Nutrition at the United States (US) Food and Drug Administration (FDA) has studied product labels from the US food supply through the Food Label and Package Survey (FLAPS). The sampling frame for the latest survey, FLAPS 2006–2007, was the ACNielsen Strategic Planner food sales database. As the newest addition to

  6. Optimization of the aerodynamics of small-scale flapping aircraft in hover

    Microsoft Academic Search

    Sidney Lebental

    2008-01-01

    Flapping flight is one of the most widespread mean of transportation. It is a complex unsteady aerodynamic problem that has been studied extensively in the past century. Nevertheless, by its complex nature, flapping flight remains a challenging subject. With the development of micro air vehicles, researchers need new computational methods to design these aircrafts efficiently. In this dissertation, I will

  7. Coherent locomotion as an attracting state for a free flapping body

    E-print Network

    Shelley, Michael

    Coherent locomotion as an attracting state for a free flapping body Silas Alben* and Michael the dynamics of a simple body, flapped up and down within a viscous fluid and free to move horizontally. We as an attracting state for an initially nonlocomoting body. Loco- motion is generated in two stages: first

  8. Reconstruction of adult auricular defect with thin titanium mesh and prelaminated free radial forearm flap.

    PubMed

    Kubo, Tateki; Tomita, Koichi; Takada, Akiyoshi; Yano, Kenji; Hosokawa, Ko

    2009-01-01

    We used a thin titanium mesh combined with a prelaminated free radial forearm flap to construct a framework to reconstruct a traumatic defect in an adult ear. The prelaminated forearm flap covered both the anterior and posterior aspects of the titanium framework. A raised ear could therefore be created. PMID:19153884

  9. Repair of Minor Tissue Defect in Hand by Transfer of Free Tissue Flap from the Toe

    PubMed Central

    Tan, Haitao; Luo, Xiang; Yang, Keqin; Jiang, Jianzhong; Wei, Pingou; Zhao, Jinming

    2014-01-01

    Background: To introduce our experience of using the free neurovascular flap from great and second toe. Methods: Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institution between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, the treatment was carried out for the pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, the treatment was carried out for the defect of distal middle with composite flap with distal digital bone of second toe. Results: All flaps survived. The average subjective satisfaction score was 8.08 (range 4-10). Nine patients (69%) experienced cold intolerance, and 2 patients (15%) dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range 4-12). Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Conclusions: Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand. PMID:25207307

  10. Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery.

    PubMed

    Kim, K S; Yoo, S I; Kim, D Y; Lee, S Y; Cho, B H

    2001-09-01

    A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. Light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects. PMID:11562030

  11. Advances in the development of an intelligent helicopter rotor employing smart trailing-edge flaps

    NASA Astrophysics Data System (ADS)

    Ben-Zeev, Oren; Chopra, Inderjit

    1996-02-01

    Significant advances in the development of a Froude scaled helicopter rotor model featuring a trailing-edge flap driven by piezoceramic bimorph actuators for active vibration suppression are discussed. A quasisteady aerodynamic analysis used to determine flap size and actuator requirements is presented. The block force and stroke of the current actuators are evaluated using two theories and compared with experimental results. The dynamic performance of the actuator as well as the actuator - flap assembly is examined. Earlier hover tests showed severe degradation in flap deflections with increasing rotor speed, and flap deflections were too small to be effectively utilized for significant vibration control. To investigate the causes of the performance degradation, new blades are constructed and tested in vacuo to isolate the effects of centrifugal loading on the actuator - flap system. A beam model of the piezo bimorph including propeller moment effects is formulated to better illustrate the physical mechanisms affecting the system in a rotating environment. The cause of the reduced deflections is traced to frictional forces created at the junction where the flap is supported during rotation of the blades. The use of a thrust bearing was found to alleviate this problem and subsequent hover tests showed a dramatic increase in flap deflection at high excitation frequencies.

  12. Design and Fabrication of Ultralight High-Voltage Power Circuits for Flapping-Wing Robotic Insects

    E-print Network

    Wood, Robert

    Design and Fabrication of Ultralight High-Voltage Power Circuits for Flapping-Wing Robotic Insects@seas.harvard.edu Abstract-- Flapping-wing robotic insects are small, highly ma- neuverable flying robots inspired by biological insects and useful for a wide range of tasks, including exploration, environmen- tal monitoring

  13. Computational Study of Porous Treatment for Altering Flap Side-Edge Flowfield

    NASA Technical Reports Server (NTRS)

    Choudhari, Meelan; Khorrami, Mehdi R.

    2003-01-01

    Reynolds-averaged Navier-Stokes calculations are used to investigate porous side-edge treatment as a passive means for flap noise reduction. Steady-state simulations are used to infer effects of the treatment on acoustically relevant features of the mean flow near the flap side edge. Application of the porous treatment over a miniscule fraction of the wetted flap area (scaling with the flap thickness) results in significantly weaker side-edge vortex structures via modification of the vortex initiation and roll-up processes. At high flap deflections, the region of axial flow reversal associated with the breakdown of the side-edge vortex is also eliminated, indicating an absence of vortex bursting in the presence of the treatment. Potential ramifications of the mean-flow modifications for flap-noise reduction are examined in the light of lessons learned from recent studies on flap noise. Computations confirm that any noise reduction benefit via the porous treatment would be achieved without compromising the aerodynamic effectiveness of the flap. Results of the parameter study contribute additional insight into the measured data from the 7x10 wind tunnel at NASA Ames and provide preliminary guidance for specifying optimal treatment characteristics in terms of treatment location, spatial extent, and flow resistance of the porous skin.

  14. Meta-analysis of the effect of posterior mucosal flap anastomosis in primary external dacryocystorhinostomy

    PubMed Central

    Bukhari, Amal A

    2013-01-01

    Purpose We aimed to compare the outcomes of primary external dacryocystorhinostomy and silicone tube with anterior and posterior mucosal flap anastomosis, versus dacryocystorhinostomy and silicone intubation with anterior mucosal flap anastomosis. Methods We utilized the electronic databases PubMed, EMBASE, Ovid, Cochrane Central Register of Controlled Trials, and MEDLINE® to find articles related to external dacryocystorhinostomy. For inclusion in this meta-analysis, we isolated prospective and retrospective comparative studies of adult patients with acquired nasolacrimal duct obstruction, or chronic dacryocystitis, who had undergone primary external dacryocystorhinostomy and silicone intubation with anterior and posterior flap anastomosis; versus primary dacryocystorhinostomy and silicone intubation with anterior flap anastomosis. The minimum follow-up period for each study was 4 months. Results We identified and analyzed seven studies. Overall, dacryocystorhinostomy with anterior and posterior flap anastomosis was performed on 368 eyes, while primary external dacryocystorhinostomy with anterior flap anastomosis was performed on 397 eyes. There was no significant difference in the success rates of both techniques (risk ratio: 0.987; 95% confidence interval 0.946–1.030). Conclusion For patients with acquired nasolacrimal duct obstruction or chronic dacryocystitis, there was no significant difference in the resolution of epiphora, and patency of the lacrimal system, between those who underwent external dacryocystorhinostomy with anterior and posterior mucosal flap anastomosis, and those who had dacryocystorhinostomy with anterior flap anastomosis. PMID:24363551

  15. Indocyanine Green Near-Infrared Laser Angiography Predicts Timing for the Division of a Forehead Flap

    PubMed Central

    Christensen, Joani M.; Baumann, Donald P.; Myers, Jeffrey N.; Buretta, Kate; Sacks, Justin M.

    2012-01-01

    Introduction: Reconstruction with flaps requiring delayed division remains common, even with increasing use of free tissue transfer. Patient quality of life and function are significantly decreased during the delay period. Delay could be minimized by developing methods to reliably determine when the flap has developed sufficient vascular supply to undergo successful division. We report the use of laser angiography to determine the appropriate time for division of a forehead flap pedicle. Methods: The patient who had risk factors for microvascular disease underwent near-infrared laser angiography using indocyanine green on postoperative day 21 to assess vascular perfusion of the flap. Although traditional clinical examination indicated the flap was not adequately perfused, laser angiography revealed perfusion to all areas of the flap, so the pedicle was divided. Results: Pedicle division was successful, with no epidermolysis or necrosis. Conclusion: Near-infrared laser angiography with indocyanine green can assess perfusion status of the entire flap and inform the decision to divide the flap in an objective manner. PMID:22977676

  16. Optimum Gurney flap height determination for “lost-lift” recovery in compressible dynamic stall control

    Microsoft Academic Search

    M. S. Chandrasekhara

    2010-01-01

    A variable droop leading edge (VDLE) airfoil was successfully used to control compressible dynamic stall and its associated adverse pitching moment variations. But, the price for this success was a 10% loss of lift. A Gurney flap was then attached normally to the airfoil pressure surface at its trailing edge to recover this “lost-lift”. Gurney flaps are seldom used in

  17. Effects of Gurney flaps on the lift enhancement of a cropped nonslender delta wing

    NASA Astrophysics Data System (ADS)

    Li, Y. C.; Wang, J. J.; Tan, G. K.; Zhang, P. F.

    An experimental wind-tunnel investigation was undertaken to determine the effects of Gurney flaps on a 40-deg cropped nonslender delta wing at a chord Reynolds number of 250,000. In the experiment, the height of the Gurney flaps was varied from 0.01C to 0.05C, and the sideslip angle of the model was selected as 0, 5, 10 and 20deg. In addition, the 0.05C Gurney flap was serrated with different heights of 0.01C to 0.05C separately. In comparison with the baseline clean configuration results, it was found that the model with plate Gurney flaps can indeed increase the lift-to-drag ratio at moderate-to-high lift coefficients for the wing, and the greatest increment was obtained for the 0.01C Gurney flap. The effect of Gurney flap on the increment of lift-to-drag ratio tends to be not significant with the increase of sideslip angle. Moreover, the 0.05C serrated Gurney flap provides the best performance among the serrated Gurney flaps.

  18. Synchronous penile urethra onlay patch and scrotal reconstruction after Fournier's gangrene using medial thigh flaps

    Microsoft Academic Search

    G. G. Hallock

    1996-01-01

    Massive penoscrotal skin loss, frequently a sequela of Fournier's gangrene, can sometimes be successfully treated using skin grafts alone. If the urological debridement has been extensive with a concomitant disruption of the urethra, a regional vascularized flap must be introduced. A superiorly based fasciocutaneous flap can be constructed on the medial thigh to provide scrotal reconstruction. The underlying gracilis muscle

  19. Dermal flap advancement combined with conservative sphincterotomy in the treatment of chronic anal fissure.

    PubMed

    Theodoropoulos, George E; Spiropoulos, Vasileios; Bramis, Konstantinos; Plastiras, Aris; Zografos, George

    2015-02-01

    Lateral internal sphincterotomy (LIS) is considered the surgical treatment of choice for chronic anal fissure (CAF). Flap techniques for fissure coverage have the advantage of primary wound healing, potentially providing better functional results and faster pain relief. The standard surgical strategy for CAF consisting of conventional LIS (CLIS) up to the dentate line was modified by "tailoring" the LIS to the apex of the CAF, but never greater than 1 cm, and by advancing a dermal flap for coverage of the CAF (LIS + flap) after fissurectomy. Thirty consecutive patients who underwent "LIS + flap" were compared with 32 patients who had been previously treated by CLIS. A modified, trapezoid-like Y-V flap from perianal skin was advanced into the CAF base. Pain at the first postoperative day, pain at defecation during the first week, postoperative use of analgesics, and time for patients' pain relief were significantly less at the "LIS + flap" group (P < 0.01). Objective healing was achieved faster (P < 0.01) and soiling episodes were less (P < 0.05) after "LIS + flap." The addition of a dermal flap after "conservative" LIS resulted in better healing and significantly less postoperative discomfort than the isolated application of CLIS. PMID:25642874

  20. Liftoff of a 60mg flapping-wing MAV School of Engineering & Applied Sciences

    E-print Network

    Wood, Robert

    Liftoff of a 60mg flapping-wing MAV R.J. Wood School of Engineering & Applied Sciences Harvard: flapping-wing and rotary-wing. Researchers at U.C. Berkeley have made tremendous progress in generating, a group at the University of Delaware has constructed a small ornithopter using rotary and parallel

  1. A numerical study of the propulsive efficiency of a flapping hydrofoil

    Microsoft Academic Search

    G. Pedro; A. Suleman; N. Djilali

    2003-01-01

    A computational fluid dynamics study of the swimming efficiency of a two-dimensional flapping hydrofoil at a Reynolds number of 1100 is presented. The model accounts fully for viscous effects that are particularly important when flow separation occurs. The model uses an arbitrary Lagrangian-Eulerian (ALE) method to track the moving boundaries of oscillatory and flapping bodies. A parametric analysis is presented

  2. Thoracodorsal artery perforator - scapular flap in oromandibular reconstruction with associated large facial skin defects.

    PubMed

    Shaw, R J; Ho, M W; Brown, J S

    2015-07-01

    The reconstruction of oromandibular defects associated with extensive loss of external skin is surgically challenging. We describe 2 cases where such defects were reconstructed with a chimeric thoracodorsal artery perforator and scapular (TDAP-Scap) free flap based on the subscapular system. The flap is a reliable option in the reconstruction of through-and-through oromandibular defects. PMID:25857251

  3. Subcutaneous Nasolabial Flap for Eliminating Depressed Nasal Floor in Adult Cleft Rhinoplasty: Technical Note

    PubMed Central

    Rahpeyma, Amin; Torabizadeh Siraji, Arman

    2015-01-01

    Summary: Depressed nasal floor extension into the nostril in cleft patients is difficult to solve. Suggested ways for solving this problem need skin incisions other than routine open rhinoplasty incisions. Nasolabia subcutaneous flap makes the infrastructure in depressed nasal floor in cleft patients. Alar advancement and medial nasal floor triangular flap cover it.

  4. Nasal-skin-fold transposition flap for upper lip reconstruction in a French bulldog.

    PubMed

    Benlloch-Gonzalez, Manuel; Lafarge, Stéphanie; Bouvy, Bernard; Poncet, Cyrill

    2013-10-01

    Upper-lip reconstruction after mast-cell tumor-resection in a French bulldog was achieved by using a transposition flap from the nasal-skin-fold and an oral mucosal flap. The new technique is an alternative for reconstruction of extensive upper-lip defects in brachycephalic dogs and achieves satisfactory functional and cosmetic results. PMID:24155421

  5. Active Control of Wall Turbulence with an Array of Flush Mounted Flaps

    NASA Astrophysics Data System (ADS)

    Suzuki, Yuji; Kasagi, Nobuhide

    1997-11-01

    An array of twelve sets of wall-mounted flaps was developed for controlling a turbulent plane channel flow. The flaps were designed and fabricated so as to manipulate the near-wall quasi-streamwise vortical structures. The width and height of the flap were respectively chosen as 3 and 4.8 mm, which correspond to the half of the mean diameter of near-wall vortices and their mean elevation from the wall. Since spanwise asymmetry of the near-wall vortical structures should be of main dynamical significance, the flap was sharpened to be a right triangle, which is also asymmetric in the spanwise direction. A set of flaps are mirror-symmetric each other in the spanwise direction, and they can be activated independently by a solenoid. The movement of the whole system is controlled by a parallel processing unit. In the present work, the effect of periodic motion of the flaps on the turbulent statistics was examined with the aid of a two-component laser-doppler anemometer. The time period of the flap motion was chosen as 200, 400, and 800 ? / u_?^2, respectively. The spanwise velocity component is substantially affected even 590 ? / u_? downstream of the flaps; a non-zero mean spanwise velocity component exists near the wall, whilst its fluctuation is appreciably increased. More detailed discussion on the flow behavior will be presented at the time of presentation.

  6. Flapping flight for biomimetic robotic insects: part I-system modeling

    Microsoft Academic Search

    Xinyan Deng; Luca Schenato; Wei Chung Wu; S. Shankar Sastry

    2006-01-01

    This paper presents the mathematical modeling of flapping flight inch-size micro aerial vehicles (MAVs), namely micromechanical flying insects (MFIs). The target robotic insects are electromechanical devices propelled by a pair of independent flapping wings to achieve sustained autonomous flight, thereby mimicking real insects. In this paper, we describe the system dynamic models which include several elements that are substantially different

  7. Method and apparatus for controlling pitch and flap angles of a wind turbine

    DOEpatents

    Deering, Kenneth J. (Seattle, WA); Wohlwend, Keith P. (Issaquah, WA)

    2009-05-12

    A wind turbine with improved response to wind conditions is provided. Blade flap angle motion is accompanied by a change in pitch angle by an amount defining a pitch/flap coupling ratio. The coupling ratio is non-constant as a function of a flap angle and is preferably a substantially continuous, non-linear function of flap angle. The non-constant coupling ratio can be provided by mechanical systems such as a series of linkages or by configuring electronic or other control systems and/or angle sensors. A link with a movable proximal end advantageously is part of the mechanical system. The system can provide relatively large coupling ratios and relatively large rates of coupling ratio changes especially for near-feather pitches and low flap angles.

  8. Factor V Leiden associated with flap loss in microsurgical breast reconstruction.

    PubMed

    Khansa, Ibrahim; Colakoglu, Salih; Tomich, David C; Nguyen, Minh-Doan; Lee, Bernard T

    2011-07-01

    Two cases are reported of flap loss following microsurgical perforator flap breast reconstruction in patients diagnosed with a factor V Leiden mutation. Factor V Leiden is the most common inherited cause of hypercoagulability, leading to an increased risk of thrombotic events. The first patient underwent a deep inferior epigastric artery perforator flap and then had recurrent arterial thrombosis both intraoperatively and postoperatively. This patient was subsequently diagnosed with a factor V Leiden mutation. The second patient had a known factor V Leiden mutation and underwent a superior gluteal artery perforator flap, which developed thrombosis and flap loss 2 days later. Preoperative assessment of a personal or family history of unexplained venous or arterial thrombosis should prompt suspicion of a factor V Leiden mutation. This mutation places patients at high risk for thromboembolic events in microvascular breast reconstruction, particularly when oral contraceptives or tamoxifen are used in conjunction. PMID:21503971

  9. Calculation of the longitudinal aerodynamic characteristics of upper-surface-blown wing-flap configurations

    NASA Technical Reports Server (NTRS)

    Mendenhall, M. R.; Spangler, S. B.

    1979-01-01

    An investigation has been carried out to develop an engineering method for predicting the longitudinal aerodynamic characteristics of wing-flap configurations with upper surface blown (USB) high lift devices. Potential flow models of the lifting surfaces and the jet wakes are combined to calculate the induced interference of the engine wakes on the wing and flaps. The wing may have an arbitrary planform with camber and twist and multiple trailing edge flaps. The jet wake model has a rectangular cross section over its entire length and it is positioned such that the wake is tangent to the upper surfaces of the wing and flaps. Comparisons of measured and predicted pressure distributions, spanload distributions, and total lift and pitching-moment coefficients on swept and unswept USB configurations are presented for a wide range of thrust coefficients and flap deflection angles.

  10. "Boomerang" rectus abdominis musculocutaneous free flap in head and neck reconstruction.

    PubMed

    Yamamoto, Y; Nohira, K; Minakawa, H; Sasaki, S; Yoshida, T; Sugihara, T; Shintomi, Y; Yamashita, T; Hosokawa, M; Ohura, T

    1995-01-01

    Immediate head and neck reconstruction after cancer resection using the "boomerang" rectus abdominis musculocutaneous (RAM) free flap was performed in 13 patients over the past 2 years. The skin paddle of the flap is designed as a boomerang shape based on the anatomical construction of the dominant perforators from the inferior epigastric vascular system. A versatile technique of the boomerang RAM flap provides effective use for reconstruction of the complex defects at the skull base, orbital, nasal cavity, paranasal sinuses, oropharynx, palate, buccal mucosa, tongue, floor of mouth, and neck. It also allows a reconstructive surgical team to elevate the flap simultaneously with a head and neck surgical team before the size and location of the defect are exactly determined and greatly reduces operating time. This flap will be a routine technique for immediate head and neck reconstruction after cancer resection. PMID:7702301

  11. Wind-Tunnel Investigation of an NACA 23012 Airfoil with Various Arrangements of Slotted Flaps

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J; Harris , Thomas A

    1939-01-01

    An investigation was made in the 7 by 10-foot wind tunnel and in the variable-density wind tunnel of the NACA 23012 airfoil with various slotted-flap arrangements. The purpose of the investigation in the 7 by 10-foot wind tunnel was to determine the airfoil section aerodynamic characteristics as affected by flap shape, slot shape, and flap location. The flap position for maximum lift; polars for arrangements favorable for take-off and climb; and complete lift, drag, and pitching-moment characteristics for selected optimum arrangements were determined. The best arrangements were tested in the variable-density tunnel at an effective Reynolds number of 8,000,000. In addition, data from both wind tunnels are included for plain, split, external-airfoil, and Fowler flaps for purposes of comparison.

  12. Pressure distribution over an NACA 23012 airfoil with an NACA 23012 external-airfoil flap

    NASA Technical Reports Server (NTRS)

    Wenzinger, Carl J

    1938-01-01

    Report presents the results of pressure-distribution tests of an NACA 23012 airfoil with an NACA 23012 external airfoil flap made in the 7 by 10-foot wind tunnel. The pressures were measured on the upper and lower surfaces at one chord section on both the main airfoil and on the flap for several different flap deflections and at several angles of attack. A test installation was used in which the airfoil was mounted horizontally in the wind tunnel between vertical end planes so that two-dimensional flow was approximated. The data are presented in the form of pressure-distribution diagrams and as graphs of calculated coefficients for the airfoil-and-flap combination and for the flap alone.

  13. Diffuse lamellar keratitis in the femtosecond-assisted LASIK flap tunnel

    PubMed Central

    Kymionis, George D; Tsoulnaras, Konstantinos I; Tsakalis, Nikolaos G; Grentzelos, Michael A

    2014-01-01

    Here we report a case of a 29-year-old myopic female who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) and, on the first postoperative day slit-lamp examination revealed a dense, white, granular reaction with the presence of some blood droplets (stage I diffuse lamellar keratitis [DLK]) in her left eye, specifically localized into the femtosecond LASIK flap tunnel (not extended to the flap interface). The patient received intensive treatment with topical corticosteroids and 5 days later the granular reaction had completely resolved. A new site of DLK, ie, the flap tunnel, in femtosecond-assisted LASIK is presented. DLK into the flap tunnel could be managed with corticosteroids if detected early, without affecting the flap interface. PMID:24940043

  14. Change of weight-bearing pattern before and after plantar reconstruction with free anterolateral thigh flap.

    PubMed

    Sekido, Mitsuru; Yamamoto, Yuhei; Furukawa, Hiroshi; Sugihara, Tsuneki

    2004-01-01

    We reconstructed a large-sized defect at the weight-bearing plantar region by a free anterolateral thigh flap successfully. This is the first case report of using the anterolateral thigh flap for reconstruction of the plantar foot. Based on the preoperative and postoperative pedogram examinations, the pressure distribution on the weight-bearing area reconstructed by the transferred flap was obviously improved and demonstrated a nearly normal pattern. No previous report has compared the weight-bearing pattern before and after large plantar reconstruction with a free flap. The anterolateral thigh free flap, which provides adequate bulk and contour of the foot, and which withstands weight pressure and shearing force and has the ability to provide recovery of sensation, is considered a good alternative in covering a large weight-bearing plantar defect. PMID:15274185

  15. Reconstruction of the extremity with the dorsal thoracic fascia free flap.

    PubMed

    Colen, L B; Pessa, J E; Potparic, Z; Reus, W F

    1998-03-01

    The dorsal thoracic fascia is the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. The cutaneous vascular territory of the circumflex scapular artery and its parascapular branches is well known. During the past 8 years, the authors have employed the dorsal thoracic fascia free flap for extremity reconstruction in 17 patients (upper extremity, n = 9; lower extremity, n = 8). The indications for using this free flap included primary coverage after trauma (n = 10), resurfacing of "unstable" scar (n = 3), coverage of plantar foot ulceration (n = 3), and coverage of an exposed lower extremity distal arterial bypass graft (n = 1). The large anatomic boundaries of this flap, the consistent vascular anatomy, and the thin yet durable quality of the tissue make this flap an excellent choice for the reconstruction of upper and lower extremity defects. PMID:9500391

  16. Wind-tunnel studies of advanced cargo aircraft concepts. [leading edge vortex flaps for drag reduction

    NASA Technical Reports Server (NTRS)

    Rao, D. M.; Goglia, G. L.

    1981-01-01

    Accomplishments in vortex flap research are summarized. A singular feature of the vortex flap is that, throughout the range of angle of attack range, the flow type remains qualitatively unchanged. Accordingly, no large or sudden change in the aerodynamic characteristics, as happens when forcibly maintained attached flow suddenly reverts to separation, will occur with the vortex flap. Typical wind tunnel test data are presented which show the drag reduction potential of the vortex flap concept applied to a supersonic cruise airplane configuration. The new technology offers a means of aerodynamically augmenting roll-control effectiveness on slender wings at higher angles of attack by manipulating the vortex flow generated from leading edge separation. The proposed manipulator takes the form of a flap hinged at or close to the leading edge, normally retracted flush with the wing upper surface to conform to the airfoil shape.

  17. Topology optimization of pressure adaptive honeycomb for a morphing flap

    NASA Astrophysics Data System (ADS)

    Vos, Roelof; Scheepstra, Jan; Barrett, Ron

    2011-03-01

    The paper begins with a brief historical overview of pressure adaptive materials and structures. By examining avian anatomy, it is seen that pressure-adaptive structures have been used successfully in the Natural world to hold structural positions for extended periods of time and yet allow for dynamic shape changes from one flight state to the next. More modern pneumatic actuators, including FAA certified autopilot servoactuators are frequently used by aircraft around the world. Pneumatic artificial muscles (PAM) show good promise as aircraft actuators, but follow the traditional model of load concentration and distribution commonly found in aircraft. A new system is proposed which leaves distributed loads distributed and manipulates structures through a distributed actuator. By using Pressure Adaptive Honeycomb (PAH), it is shown that large structural deformations in excess of 50% strains can be achieved while maintaining full structural integrity and enabling secondary flight control mechanisms like flaps. The successful implementation of pressure-adaptive honeycomb in the trailing edge of a wing section sparked the motivation for subsequent research into the optimal topology of the pressure adaptive honeycomb within the trailing edge of a morphing flap. As an input for the optimization two known shapes are required: a desired shape in cruise configuration and a desired shape in landing configuration. In addition, the boundary conditions and load cases (including aerodynamic loads and internal pressure loads) should be specified for each condition. Finally, a set of six design variables is specified relating to the honeycomb and upper skin topology of the morphing flap. A finite-element model of the pressure-adaptive honeycomb structure is developed specifically tailored to generate fast but reliable results for a given combination of external loading, input variables, and boundary conditions. Based on two bench tests it is shown that this model correlates well to experimental results. The optimization process finds the skin and honeycomb topology that minimizes the error between the acquired shape and the desired shape in each configuration.

  18. Results of instrumental and operative implementation of T-Flap

    NASA Astrophysics Data System (ADS)

    Marcelli, M.; Madonia, A.; Piermattei, V.; Mainardi, U.

    2012-04-01

    The development of new technologies for the study of the ocean processes is one of the most innovative aspects of oceanographic research that increasingly requires a large amount of data for an integrated approach to in situ observations, forecasting models and remotely sensed data. At now the marine measurement technologies are too expensive for an extensive utilization. The T-Flap technology (Temperature-Fluorescence LAunchable Probe) meets these needs by providing low cost and user-friendly in situ measuring of physical and bio-optical variables of water bodies, as opposed to traditional methods. Many experimental laboratory tests were carried out in order to increase the instrumental sensitivity of the fluorimetric sensor for the detection of chlorophyll a concentration. To test the selected components (LEDs, diodes, filters) and their new configurations, an optical circuit has been realized consisting on three prototypes of the measuring cell. Fluorescence excitation and detection efficiency of the new electro-optical assemblages were also tested by the comparison between the voltage output signals and spectroscopic in vivo fluorescence measures both of natural seawater samples and marine cultures at different concentrations. The upgraded sensors were tested during different oceanographic surveys performed in the last years both in the Tyrrhenian Sea and Adriatic Sea. The technological achievements were applied in different operative conditions: profiler along the water column (not expendable) and stand alone (in continuous surface acquisitions along tracks, in continuous acquisition on a buoy). In this work we present the results of the latest research activities on T-Flap evolution. In addition preliminary results about new sensors currently under development are shown, such as CDOM (Cromophoric Dissolved Organic Matter) fluorimetric sensor, based on T-Flap fluorescence technology, and conductivity sensor.

  19. TiAl Scramjet Inlet Flap Subelement Designed and Fabricated

    NASA Technical Reports Server (NTRS)

    Draper, Susan L.

    2004-01-01

    Next-generation launch vehicles are being designed with turbine-based combined cycle (TBCC) propulsion systems having very aggressive thrust/weight targets and long lives. Achievement of these goals requires advanced materials in a wide spectrum of components. TiAl has been identified as a potential backstructure material for maintainable composite panel heat exchangers (HEX) in the inlet, combustor, and nozzle section of a TBCC propulsion system. Weight reduction is the primary objective of this technology. Design tradeoff studies have assessed that a TiAl structure, utilizing a high-strength, hightemperature TiAl alloy called Gamma MET PX,1 reduce weight by 41 to 48 percent in comparison to the baseline Inconel 718 configuration for the TBCC propulsion system inlet, combustor, and nozzle. A collaborative effort between the NASA Glenn Research Center, Pratt & Whitney, Engineering Evaluation & Design, PLANSEE AG (Austria), and the Austrian Space Agency was undertaken to design, manufacture, and validate a Gamma-MET PX TiAl structure for scramjet applications. The TiAl inlet flap was designed with segmented flaps to improve manufacturability, to better control thermal distortion and thermal stresses, and to allow for maintainable HEX segments. The design philosophy was to avoid excessively complicated shapes, to minimize the number of stress concentrations, to keep the part sizes reasonable to match processing capabilities, and to avoid risky processes such as welding. The conceptual design used a standard HEX approach with a double-pass coolant concept for centrally located manifolds. The flowpath side was actively cooled, and an insulation package was placed on the external side to save weight. The inlet flap was analyzed structurally, and local high-stress regions were addressed with local reinforcements.

  20. BATMAV: a 2-DOF bio-inspired flapping flight platform

    NASA Astrophysics Data System (ADS)

    Bunget, Gheorghe; Seelecke, Stefan

    2010-04-01

    Due to the availability of small sensors, Micro-Aerial Vehicles (MAVs) can be used for detection missions of biological, chemical and nuclear agents. Traditionally these devices used fixed or rotary wings, actuated with electric DC motortransmission, a system which brings the disadvantage of a heavier platform. The overall objective of the BATMAV project is to develop a biologically inspired bat-like MAV with flexible and foldable wings for flapping flight. This paper presents a flight platform that features bat-inspired wings which are able to actively fold their elbow joints. A previous analysis of the flight physics for small birds, bats and large insects, revealed that the mammalian flight anatomy represents a suitable flight platform that can be actuated efficiently using Shape Memory Alloy (SMA) artificial-muscles. A previous study of the flight styles in bats based on the data collected by Norberg [1] helped to identify the required joint angles as relevant degrees of freedom for wing actuation. Using the engineering theory of robotic manipulators, engineering kinematic models of wings with 2 and 3-DOFs were designed to mimic the wing trajectories of the natural flier Plecotus auritus. Solid models of the bat-like skeleton were designed based on the linear and angular dimensions resulted from the kinematic models. This structure of the flight platform was fabricated using rapid prototyping technologies and assembled to form a desktop prototype with 2-DOFs wings. Preliminary flapping test showed suitable trajectories for wrist and wingtip that mimic the flapping cycle of the natural flyer.

  1. Modeling the Thin Flapping Wing with Leading Edge Separation

    NASA Astrophysics Data System (ADS)

    Butoescu, Valentin

    2007-09-01

    A vortex model of a flapping aerofoil with LE detached vortex sheet is presented. A system of equations, one integral that imposes the boundary condition and other describing the motion of the wakes and vorticity conservation are written. To these one must add the Kutta-like condition and the initial conditions for the wakes. A numerical solution was given that consists of a modified Glauert method in connection with vortex range wake models with finite cores. Mathcad worksheets were written to obtain numerical values and diagrams.

  2. Supersonic Jet Noise Reduction Using Flapping Injection and Pulsed Injection

    NASA Astrophysics Data System (ADS)

    Hafsteinsson, Haukur; Eriksson, Lars-Erik; Cuppoletti, Daniel; Gutmark, Ephraim; Department of Applied Mechanics, Chalmers University of Technology Team; Department of Aerospace Engineering, University of Cincinatti Team; Swedish Defence Material Administration, Sweden Team

    2013-11-01

    Aircraft are in general noisy and there is a high demand for reducing their noise levels. The jet exhaust is in most cases the main noise source of the aircraft, especially for low bypass ratio jet engines. Fluidic injection affecting the shear layer close to the nozzle exit is a promising noise reduction technique as it can be turned of while not needed and thus the negative effect on the engine performance will be minimized. In the presented work, LES is used to compare steady-state mass flow injection with steady-state mass flow flapping jet injection. The work is a direct continuation of a previous LES study on pulsed injection which showed that the pulsed injection induced pressure pulses in the jet which caused increased tonal noise in the downstream directions. The injection system considered in the presented work consists of eight evenly distributed injectors at the nozzle exit plane with a 90° injection angle relative to the flow direction. Flapping jet injection is believed to minimize the creation of these pressure pulses since it provides steady-state mass flow. Aircraft are in general noisy and there is a high demand for reducing their noise levels. The jet exhaust is in most cases the main noise source of the aircraft, especially for low bypass ratio jet engines. Fluidic injection affecting the shear layer close to the nozzle exit is a promising noise reduction technique as it can be turned of while not needed and thus the negative effect on the engine performance will be minimized. In the presented work, LES is used to compare steady-state mass flow injection with steady-state mass flow flapping jet injection. The work is a direct continuation of a previous LES study on pulsed injection which showed that the pulsed injection induced pressure pulses in the jet which caused increased tonal noise in the downstream directions. The injection system considered in the presented work consists of eight evenly distributed injectors at the nozzle exit plane with a 90° injection angle relative to the flow direction. Flapping jet injection is believed to minimize the creation of these pressure pulses since it provides steady-state mass flow. This work is funded by Swedish Defense Material Administration (FMV).

  3. The Wing Apparatus and Flapping Behavior of Hymenoptera

    NASA Astrophysics Data System (ADS)

    Sudo, Seiichi; Tsuyuki, Koji; Ito, Yoshiyasu; Tani, Junji

    The wing apparatus of Hymenoptera was observed with a scanning electron microscope, and the structure and function of insect wings were studied. The measurements of displacement of extrinsic skeleton vibration produced by wing flapping of a wasp were made by an optical displacement detector system. The free flight of the wasp was analyzed by a three dimensional motion analysis system. The results of a series of measurements revealed the flight characteristics of Hymenoptera, such as the wing tip velocity, wing path, wave form of extrinsic skeleton vibration, and so forth.

  4. Interim prediction method for externally blown flap noise

    NASA Technical Reports Server (NTRS)

    Dorsch, R. G.; Clark, B. J.; Reshotko, M.

    1975-01-01

    An interim procedure for predicting externally blown flap (EBF) noise spectra anywhere below a powered lift aircraft is presented. Both engine-under-the-wing and engine-over-the-wing EBF systems are included. The method uses data correlations for the overall sound pressure level based on nozzle exit area and exhaust velocity along with OASPL directivity curves and normalized one-third-octave spectra. Aircraft motion effects are included by taking into account the relative motion of the source with respect to the observer and the relative velocity effects on source strength.

  5. A comprehensive aeroelastic analysis of helicopter main rotors with trailing edge flaps for vibration reduction

    NASA Astrophysics Data System (ADS)

    Milgram, Judah Henry

    1997-08-01

    A comprehensive analysis is developed to evaluate main rotor blade trailing edge flap systems for helicopter vibration reduction. The analysis incorporates a nonlinear aeroelastic rotor model, response calculations via finite element in time method, coupled wind tunnel trim to prescribed operating conditions, unsteady compressible aerodynamics of the flap, and a multicyclic flap controller. An extensive validation study was performed using experimental wind tunnel data. Correlation between predicted and measured blade natural frequencies was generally fair. Results for hover thrust and power agreed well with the experimental data. Some discrepancy was observed near the low thrust conditions. In forward flight, fair correlation was observed for the power required and trim controls. For the rotor with no trailing edge flap motion, overall correlation of blade loads was fair good, although significant descrepancies were observed in individual cases. A parametric study was conducted for a four-bladed Sikorsky S-76 main rotor. The combination of trailing edge flap and multicyclic controller is predicted to provide significant reductions in fixed system 4/rev hub loads. The flap motions could be optimized to reduce either hub shears or hub moments through variation of a single scalar weighting parameter in the control algorithm. The effects of parametric variations of design parameters such as flap length, span-wise location, and chord could largely be offset by compensating adjustments to the flap motions as determined by the multicyclic algorithm, provided the flap motions did not become too large. The results suggest that a flap with the smallest possible chord and largest possible deflections is preferred.

  6. Surgical Site Infections after Free Flap Breast Reconstruction: An Analysis of 2,899 Patients from the ACS-NSQIP Datasets.

    PubMed

    Chung, Cyndi U; Wink, Jason D; Nelson, Jonas A; Fischer, John P; Serletti, Joseph M; Kanchwala, Suhail K

    2015-07-01

    Background?Surgical site infections (SSIs) are a costly complication, resulting in lower patient satisfaction and higher health care expenditures. Incidence varies widely in the literature by surgery type, yet few studies focus exclusively on autologous breast reconstruction, an increasingly common surgery. The aim of this study is to identify risk factors for SSIs in free flap breast reconstruction using the National Surgical Quality Improvement Program Database (NSQIP). Methods?Patients undergoing breast reconstruction with any flap type were identified by Current Procedural Terminology codes in the NSQIP database. Patients with superficial or deep SSIs within 30 days of surgery were compared with controls by univariate analysis and multivariate logistic regression across various characteristics. Results?Overall, 2,899 patients undergoing autologous reconstruction were identified. Of these, 143 (4.9%) patients developed SSIs. Those who developed wound complications were more likely smokers (18.2 vs. 8.4%, p?

  7. Wind-tunnel investigation of NACA 23012, 23021, and 23030 airfoils equipped with 40-percent-chord double slotted flaps

    NASA Technical Reports Server (NTRS)

    Harris, Thomas A; Recant, Isidore G

    1941-01-01

    Report presents the results of an investigation conducted in the NACA 7 by 10-foot win tunnel to determine the effect of the deflection of main and auxiliary slotted flaps on the aerodynamic section characteristics of large-chord NACA 23012, 23021, 23030 airfoils equipped with 40-percent-chord double slotted flaps. The complete aerodynamic section characteristics and envelope polar curves are given for each airfoil-flap combination. The effect of airfoil thickness is shown, and comparisons are made of single slotted flaps with double slotted flaps on each of the airfoils.

  8. General surgery career resource.

    PubMed

    Parsee, Ana M; Ross, Sharona B; Gantt, Nancy L; Kichler, Kandace; Hollands, Celeste

    2013-11-01

    General surgery residency training can lead to a rewarding career in general surgery and serve as the foundation for careers in several surgical subspecialties. It offers broad-based training with exposure to the cognitive and technical aspects of several surgical specialties and prepares graduating residents for a wide range of career paths. This career development resource discusses the training aspects of general surgery. PMID:24157351

  9. Hyperoxaluria and Bariatric Surgery

    NASA Astrophysics Data System (ADS)

    Asplin, John R.

    2007-04-01

    Bariatric surgery as a means to treat obesity is becoming increasingly common in the United States. An early form of bariatric surgery, the jejunoileal bypass, had to be abandoned in 1980 due to numerous complications, including hyperoxaluria and kidney stones. Current bariatric procedures have not been systematically evaluated to determine if they cause hyperoxaluria. Presented here are data showing that hyperoxaluria is the major metabolic abnormality in patients with bariatric surgery who form kidney stones. Further studies are needed to assess the prevalence of hyperoxaluria in all patients with bariatric surgery.

  10. Anesthesia for colorectal surgery.

    PubMed

    Baldini, Gabriele; Fawcett, William J

    2015-03-01

    Anesthesiologists play a pivotal role in facilitating recovery of patients undergoing colorectal surgery, as many Enhanced Recovery After Surgery (ERAS) elements are under their direct control. Successful implementation of ERAS programs requires that anesthesiologists become more involved in perioperative care and more aware of the impact of anesthetic techniques on surgical outcomes and recovery. Key to achieving success is strict adherence to the principle of aggregation of marginal gains. This article reviews anesthetic and analgesic care of patients undergoing elective colorectal surgery in the context of an ERAS program, and also discusses anesthesia considerations for emergency colorectal surgery. PMID:25701931

  11. F119 Nozzle Flaps Tested at Lewis' CE-22 Facility

    NASA Technical Reports Server (NTRS)

    2005-01-01

    The next generation of aircraft fighters requires higher engine performance and enhanced stealth characteristics for air superiority. A Lockheed-Martin/Boeing aircraft with a Pratt & Whitney F119 engine was selected by the Air Force for the next advanced tactical fighter (ATF). As part of this program, the NASA Lewis Research Center entered into a cooperative test program with Pratt & Whitney along with the Air Force to study the performance for various advanced nozzle concepts for the F119 engine. The area of interest was to measure the internal performance (both thrust and flow coefficients) of nozzle flaps redesigned for low observability with minimal performance loss. The experimental program was successfully completed May 1995 in Lewis' CE-22 facility. The models were tested over a wide range of geometric variations and nozzle pressure ratios. Results confirmed that the redesigned nozzle flaps had an insignificant effect on the thrust performance and that the resulting flow patterns should not be a problem in the cooling flow design. The results also agreed well with Pratt & Whitney's computational fluid dynamics analysis. The data obtained from this test were added to the current data base to help validate other performance prediction methodology.

  12. A low-cost simulation platform for flapping wing MAVs

    NASA Astrophysics Data System (ADS)

    Kok, J. M.; Chahl, J. S.

    2015-03-01

    This paper describes the design of a flight simulator for analysing the systems level performance of a Dragonfly-Inspired Micro Air Vehicle (DIMAV). A quasi-steady blade element model is used to analyse the aerodynamic forces. Aerodynamic and environmental forces are then incorporated into a real world flight dynamics model to determine the dynamics of the DIMAV system. The paper also discusses the implementation of the flight simulator for analysing the manoeuvrability of a DIMAV, specifically several modes of flight commonly found in dragonflies. This includes take-off, roll turns and yaw turns. Our findings with the simulator are consistent with results from wind tunnel studies and slow motion cinematography of dragonflies. In the take-off mode of flight, we see a strong dependence of take-off accelerations with flapping frequency. An increase in wing-beat frequency of 10% causes the maximum vertical acceleration to increase by 2g which is similar to that of dragonflies in nature. For the roll and yaw modes of manoeuvring, asymmetrical inputs are applied between the left and right set of wings. The flapping amplitude is increased on the left pair of wings which causes a time averaged roll rate to the right of 1.76rad/s within two wing beats. In the yaw mode, the stroke plane angle is reduced in the left pair of wings to initiate the yaw manoeuvre. In two wing beats, the time averaged yaw rate is 2.54rad/s.

  13. Probabilistic Analysis of Space Shuttle Body Flap Actuator Ball Bearings

    NASA Technical Reports Server (NTRS)

    Oswald, Fred B.; Jett, Timothy R.; Predmore, Roamer E.; Zaretsky, Erin V.

    2007-01-01

    A probabilistic analysis, using the 2-parameter Weibull-Johnson method, was performed on experimental life test data from space shuttle actuator bearings. Experiments were performed on a test rig under simulated conditions to determine the life and failure mechanism of the grease lubricated bearings that support the input shaft of the space shuttle body flap actuators. The failure mechanism was wear that can cause loss of bearing preload. These tests established life and reliability data for both shuttle flight and ground operation. Test data were used to estimate the failure rate and reliability as a function of the number of shuttle missions flown. The Weibull analysis of the test data for a 2-bearing shaft assembly in each body flap actuator established a reliability level of 99.6 percent for a life of 12 missions. A probabilistic system analysis for four shuttles, each of which has four actuators, predicts a single bearing failure in one actuator of one shuttle after 22 missions (a total of 88 missions for a 4-shuttle fleet). This prediction is comparable with actual shuttle flight history in which a single actuator bearing was found to have failed by wear at 20 missions.

  14. Wake Vortex Alleviation Using Rapidly Actuated Segmented Gurney Flaps

    NASA Astrophysics Data System (ADS)

    Matalanis, Claude; Eaton, John

    2006-11-01

    A study to assess the potential for using rapidly actuated segmented Gurney flaps, also known as Miniature Trailing Edge Effectors (MiTEs), for active wake vortex alleviation is conducted using a half-span model wing with NACA 0012 shape and an aspect ratio of 4.1. All tests are performed with the wing at an 8.9 degree angle of attack and chord based Reynolds number around 350,000. The wing is equipped with an array of 13 MiTE pairs. Each MiTE has a flap that in the neutral position rests behind the blunt trailing edge of the wing, and in the down position extends 0.015 chord lengths perpendicular to the freestream on the pressure side of the wing. Dynamic PIV is used to measure the time dependent response of the vortex in the intermediate wake to various MiTE actuation schemes that deflect the vortex in both the spanwise and liftwise directions. A maximum spanwise deflection of 0.041 chord lengths is possible while nearly conserving lift. These intermediate wake results as well as pressure profile, five-hole probe, and static PIV measurements are used to form complete, experimentally-based initial conditions for vortex filament computations that are used to compute the far wake evolution. Results from these computations show that the perturbations created by MiTEs can be used to excite vortex instability.

  15. Flapping motion and force generation in a viscoelastic fluid

    NASA Astrophysics Data System (ADS)

    Normand, Thibaud; Lauga, Eric

    2008-12-01

    In a variety of biological situations, swimming cells have to move through complex fluids. Similarly, mucociliary clearance involves the transport of polymeric fluids by beating cilia. Here, we consider the extent to which complex fluids could be exploited for force generation on small scales. We consider a prototypical reciprocal motion (i.e., identical under time-reversal symmetry): the periodic flapping of a tethered semi-infinite plane. In the Newtonian limit, such motion cannot be used for force generation according to Purcell’s scallop theorem. In a polymeric fluid (Oldroyd-B, and its generalization), we show that this is not the case and calculate explicitly the forces on the flapper for small-amplitude sinusoidal motion. Three setups are considered: a flapper near a wall, a flapper in a wedge, and a two-dimensional scalloplike flapper. In all cases, we show that at quadratic order in the oscillation amplitude, the tethered flapping motion induces net forces, but no average flow. Our results demonstrate therefore that the scallop theorem is not valid in polymeric fluids. The reciprocal component of the movement of biological appendages such as cilia can thus generate nontrivial forces in polymeric fluid such as mucus, and normal-stress differences can be exploited as a pure viscoelastic force generation and propulsion method.

  16. Safe Osteocutaneous Radial Forearm Flap Harvest with Prophylactic Internal Fixation

    PubMed Central

    Shnayder, Yelizaveta; Tsue, Terance T.; Toby, E. Bruce; Werle, Andreas H.; Girod, Douglas A.

    2011-01-01

    We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction. PMID:22942941

  17. Safe osteocutaneous radial forearm flap harvest with prophylactic internal fixation.

    PubMed

    Shnayder, Yelizaveta; Tsue, Terance T; Toby, E Bruce; Werle, Andreas H; Girod, Douglas A

    2011-09-01

    We studied the efficacy of prophylactic plate fixation technique and a modified harvest of the osteocutaneous radial forearm free flap (OCRFFF) to minimize the incidence of postoperative donor radius pathological fracture. We retrospectively studied of the first 70 consecutive patients undergoing OCRFFF harvest by the University of Kansas Head and Neck Microvascular Reconstruction Team. Mean follow-up was 13 months. One of two patients undergoing OCRFFF harvest without prophylactic fixation developed a pathological radius fracture. The 68 subsequent OCRFFF patients underwent prophylactic fixation of the donor radius, and none developed a symptomatic radius fracture. Five of 68 patients did have a radiographically visible fracture requiring no intervention. The plate fixation technique was further modified to exclude monocortical screws in the radius bone donor defect (subsequent 39 patients), without any further fractures detected. One patient required forearm hardware removal for an attritional extensor tendon tear. The described modified OCRFFF harvest and prophylactic plate fixation technique may eliminate postoperative pathological fracture of the donor radius. Donor morbidity is similar to that of the fasciocutaneous radial forearm free flap , affording safe use of OCRFFF in head and neck reconstruction. PMID:22942941

  18. Aerodynamic forces and vortical structures in flapping butterfly's forward flight

    NASA Astrophysics Data System (ADS)

    Yokoyama, Naoto; Senda, Kei; Iima, Makoto; Hirai, Norio

    2013-02-01

    Forward flights of a bilaterally symmetrically flapping butterfly modeled as a four-link rigid-body system consisting of a thorax, an abdomen, and left and right wings are numerically simulated. The joint motions of the butterflies are adopted from experimental observations. Three kinds of the simulations, distinguished by ways to determine the position and attitude of the thorax, are carried out: a tethered simulation, a prescribed simulation, and free-flight simulations. The upward and streamwise forces as well as the wake structures in the tethered simulation, where the thorax of the butterfly is fixed, reasonably agree with those in the corresponding tethered experiment. In the prescribed simulation, where the thoracic trajectories as well as the joint angles are given by those observed in a free-flight experiment, it is confirmed that the butterfly can produce enough forces to achieve the flapping flights. Moreover, coherent vortical structures in the wake and those on the wings are identified. The generation of the aerodynamic forces due to the vortical structures are also clarified. In the free-flight simulation, where only the joint angles are given as periodic functions of time, it is found that the free flight is longitudinally unstable because the butterfly cannot maintain the attitude in a proper range. Focusing on the abdominal mass, which largely varies owing to feeding and metabolizing, we have shown that the abdominal motion plays an important role in periodic flights. The necessity of control of the thoracic attitude for periodic flights and maneuverability is also discussed.

  19. Immediate autologous breast reconstruction using muscle-sparing TRAM flaps with superficial epigastric system turbocharging: a salvage option.

    PubMed

    Cohn, Al B; Walton, Robert L

    2006-04-01

    Current breast reconstruction trends favor the use of muscle-sparing abdominal flaps to minimize abdominal morbidity. When compared to the transverse rectus abdominis myocutaneous (TRAM) flap, the muscle-sparing deep inferior epigastric perforator (DIEP) flap and the superficial inferior epigastric artery (SIEA) flap are common options that minimize donor-site morbidity. For patients with inadequate flap perfusion via either system, alternative surgical options that permit preservation of the abdominal musculature are limited. Using both the DIEP and SIEA systems, the authors describe a turbocharged construct that also facilitates flap perfusion without the need for violation of the anterior rectus sheath. This turbocharged system can provide adequate blood supply in a flap with questionable DIEP or SIEA perfusion alone. PMID:16780043

  20. Distally-based peroneus brevis muscle flap: a successful way of reconstructing lateral soft tissue defects of the ankle.

    PubMed

    Koski, E Antti; Kuokkanen, Hannu O M; Tukiainen, Erkki J

    2005-01-01

    Sixteen distally-based peroneus brevis muscle flaps were used to cover soft tissue defects in the lateral side of the ankle. The defect in 13 cases was on the lateral malleolus, in two on the lateral side of the calcaneus, and in one case in the Achilles tendon. The patients were all followed up until full recovery (mean 7.6 months, range 1.5-22 months). One flap failed to cover the defect and was replaced with a microvascular latissimus dorsi flap. In three cases minor revision and new skin grafting of the distal end of the flap was necessary. In 15 of the 16 patients the distally-based peroneus brevis muscle was successful in covering the lateral defect in the ankle. The technique of harvesting a flap is reliable, fast, and the overall success of the flap is good. The flap is particularly suitable for covering small or moderate sized defects on the lateral malleolus. PMID:16320407