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Fibrin glue for Gundersen flap surgery  

PubMed Central

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

Chung, Hsi-Wei; Mehta, Jodhbir S



Conjunctival flaps for pterygium surgery.  


The literature reveals that pterygium surgery focuses on adjunctive therapy such as mitomycin C and 5-fluorouracil, and beta irradiation with bare sclera technique to decrease recurrence. The following description of the basic surgical technique of conjunctival flaps shows that it is simple, easier to perform, has faster healing time, and is more effective in preventing recurrence than any of the others. PMID:17416957

Anduze, Alfred L



Breast Reconstruction with Flap Surgery  


... flap). Another type of abdominal procedure is the deep inferior epigastric perforator (DIEP) flap. This newer procedure is almost the same as a muscle-sparing free TRAM flap, but skin and fat are the ...


Flap removal or flap preservation during LASEK surgery.  


The objective of this study was to evaluate the effectiveness of corneal epithelial flap removal or flap preservation during LASEK operation on myopia and to determine whether there was any accrual of benefit in either approach. From March 2006 to March 2008, some 582 patients (1,164 eyes) who presented with myopia and myopic astigmatism were treated with corrective LASEK operations. They were divided into two groups: one group underwent corneal flap-preservation while the other had the corneal flap removed. Each group comprised 582 eyes, and the data accumulated were retrospectively analyzed. Each patient was examined after 1, 3, 5, and 7 days; 2 weeks; and 1, 2, 3, 6, and 12 months after LASEK surgery to determine their post-operative visual acuity and check for complications. All eyes achieved pre-operative corrected vision 16 weeks after LASEK surgery, with no difference being observed between the two groups. However, there was a significant difference in the ophthalmalgia observed 3 days after LASEK surgery, with the flap-removal group experiencing less post-operative pain than those who had the corneal flap preserved. Furthermore, by 3 days post-operation, the observed corneal epithelial healing was significantly different: again the eyes of those who had the corneal flap removed having a faster recovery than those belonging to the corneal preservation group. In conclusion, the patients who had a flap-removal LASEK operation recorded faster recovery and suffered less ophthalmalgia, but there was no significant difference in the overall outcome in terms of post-operative optimally corrected vision or complications such as haze formation. PMID:20373049

Liu, Xiang-Qiong; Xu, Li; Yi, Cun-Jian



Microsurgery flap in endodontic surgery: case report  

PubMed Central

SUMMARY In periodontal plastic surgery it is increasingly more evident the relavance of the protection of the gingival marginal anatomy through the realization of a conservative flap. Minimizing the recession of the treated tissue. A correct healing always needs to take into account the diameter and type of the suture and the time of removal from the wound.




Flap Removal or Flap Preservation During LASEK Surgery  

Microsoft Academic Search

The objective of this study was to evaluate the effectiveness of corneal epithelial flap removal or flap preservation during\\u000a LASEK operation on myopia and to determine whether there was any accrual of benefit in either approach. From March 2006 to\\u000a March 2008, some 582 patients (1,164 eyes) who presented with myopia and myopic astigmatism were treated with corrective LASEK\\u000a operations.

Xiang-Qiong LiuLi; Li Xu; Cun-Jian Yi



A transparent dressing in free-flap surgery.  


The authors have developed a technique for postoperative monitoring of transferred free flaps, making the removal of gauze dressings unnecessary. Their technique involves the transparent, hydrogel wound dressing, Clear Site. A Doppler probe can also be directly applied over this material, to examine the patency of the vascular pedicle. An adhesive border on the sheeted material keeps the flap aseptic, thus providing fewer opportunities for wound infection. A wider use of this transparent dressing technique in free-flap surgery is expected. PMID:7965997

Yamamoto, Y; Minakawa, H; Yoshida, T



Regional accelerated phenomenon in the mandible following mucoperiosteal flap surgery.  


Striking remodeling activity occurs adjacent to the site of injury in orthopedic surgery. This reaction has been described as regional accelerated phenomenon (RAP), as it speeds up the healing stage. The phenomenon is a transient burst of localized remodeling process following surgical wounding of cortical bone. We explored whether RAP occurs following mucoperiosteal flap surgery in the jaw bone. Mucoperiosteal flaps were performed on 60 Wistar rats, either only on the buccal aspect or both on buccal and lingual aspects of the mandible. The surgical procedure lasted an average of 30 seconds and the flap was readapted without sutures. The rats were sacrificed at 3, 7, 10, 14, 21, and 120 days. High resolution x-ray microradiography of 1 to 1.5 mm thick ground sections between premolar and molar regions of the mandible were analyzed and revealed large areas of radiolucency which correlated to massive resorption of the alveolar bone, as well as areas in the bone proper. The RAP was observed as early as 10 days in the treated side group. Striking resorption of the cortical bone, both on the surface and the bone proper, occurred on the periodontal aspect of the crestal bone leading to widening of the periodontal ligament space, where a mucoperiosteal flap was performed on the buccal aspect. The resorption was more prominent when a mucoperiosteal flap was performed both on the lingual and buccal aspect. The alveolar bone recovered almost to control levels 120 days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8133418

Yaffe, A; Fine, N; Binderman, I



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

Microsoft Academic Search

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

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



Evaluation of the pectoralis major flap for reconstructive head and neck surgery  

Microsoft Academic Search

Purpose  The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature,\\u000a the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study\\u000a is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Patients

Astrid L Kruse; Heinz T Luebbers; Joachim A Obwegeser; Marius Bredell; Klaus W Grätz



Delay techniques for local flaps in dermatologic surgery.  


Local flaps may be required to reconstruct defects on the face, neck, and scalp. Occasionally, delay techniques are indicated to reduce the risk for flap ischemia and subsequent necrosis. Delay may be employed before the flap is raised, as done to improve blood supply to a random flap when length to breadth proportions are not ideal, or after the flap is raised and before separation of the pedicle in the final reconstructive step to improve vascularity in the distal end of an interpolation flap. We present our techniques and results of delay procedures for interpolation and similar flaps. PMID:23135656

Farber, Nimrod; Haik, Josef; Weissman, Oren; Israeli, Hadar; Winkler, Eyal; Zilinsky, Isaac



The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery  

PubMed Central

Background The large defects resulting from head and neck tumour surgeries present a reconstructive challenge to surgeons. Although numerous methods can be used, they all have their own limitations. In this paper, we present our experience with cervicofacial and cervicothoracic rotation flaps to help expand the awareness and application of this useful system of flaps. Methods Twenty-one consecutive patients who underwent repair of a variety of defects of the head and neck with cervicofacial or cervicothoracic flaps in our hospital from 2006 to 2009 were retrospectively analysed. Statistics pertaining to the patients' clinical factors were gathered. Results Cheek neoplasms are the most common indication for cervicofacial and cervicothoracic rotation flaps, followed by parotid tumours. Among the 12 patients with medical comorbidities, the most common was hypertension. Defects ranging from 1.5 cm × 1.5 cm to 7 cm × 6 cm were reconstructed by cervicofacial flap, and defects from 3 cm × 2 cm to 16 cm × 7 cm were reconstructed by cervicothoracic flap. The two flaps also exhibited versatility in these reconstructions. When combined with the pectoralis major myocutaneous flap, the cervicothoracic flap could repair through-and-through cheek defects, and in combination with a temporalis myofacial flap, the cervicofacial flap was able to cover orbital defects. Additionally, 95% patients were satisfied with their resulting contour results. Conclusions Cervicofacial and cervicothoracic flaps provide a technically simple, reliable, safe, efficient and cosmetic means to reconstruct defects of the head and neck.



Airway Management in A Case of Tongue Flap Division Surgery: A Case Report  

PubMed Central

Summary This article sums up successful airway management in an 18-year-old male presented for tongue flap division surgery constructed before for a palatal fistula in our hospital. After induction of general anaesthesia, we performed laryngoscopy with right molar approach using miller straight blade, intubated from right side of flap and throat packing done using left molar approach. Tongue flap was divided without any ties and hemostasis checked.

Sahoo, Tapas Kumar; Ambardekar, Manasi; Patel, R D; Pandya, S H



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

Microsoft Academic Search

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

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



Outcome of second surgery in LASIK cases aborted due to flap complications  

Microsoft Academic Search

Purpose: To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome.Setting: Outpatient ambulatory laser vision correction centers.Methods: This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a

Nada S Jabbur; Elliott Myrowitz; Jeffrey L Wexler; Terrence P O'Brien



Evaluation of the pectoralis major flap for reconstructive head and neck surgery  

PubMed Central

Purpose The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. Patients and methods The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. Results The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. Conclusion The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy.



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


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

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



The versatility of the pectoralis major flap in reconstructive surgery  

Microsoft Academic Search

Background The pectoralis major flap is frequently being applied as a pedicled flap for head and neck reconstruction. To reduce donor-site morbidity, muscle-preserving methods using only a segment of this muscle for transplantation, were described. The nerve supply to the clavicular part of the pectoralis major muscle was investigated in order to maintain its function at the donor site. This

E. M. L. Corten



Mucosal flap approximation in microlaryngeal surgery: Fibrin glue as a viable alternative  

Microsoft Academic Search

Objectives: Fibrin glue is a biodegradable tissue adhesive that mimics the final step of the coagulation cascade through the activation of fibrinogen by thrombin, leading to the formation of a fibrin clot. Fibrin glue can be used to hold tissue edges in approximation. During microlaryngeal surgery, atraumatic reapproximation of mucosal flaps is beneficial in achieving an acceptable functional result. In

Shepherd Green Pryor; Eric J. Moore; Nicolas E. Maragos; Kofi Derek Owusu Boahene



Indications and Complications of Latissimus Dorsi Myocutaneous Flaps in Oncologic Breast Surgery  

Microsoft Academic Search

  The use of the latissimus dorsi myocutaneous flap (LDMF) in reconstructive breast surgery is well documented. Few reports\\u000a exist of its use in oncologic breast surgery. This series describes indications and complications of the LDMF in locally advanced\\u000a cancer. The records of 83 patients were analysed for age and sex, menstrual status, stage, indication, margins of resection,\\u000a chemotherapy, radiotherapy, complications,

J. Apffelstaedt



The prefabricated superficial temporal fascia flap in noma surgery  

Microsoft Academic Search

In a series of 15 patients with facial deformity due to noma, the authors report their experience with a prefabricated superficial\\u000a temporal fascia (PTF) flap performed in an African hospital. The operative method has been simplified as compared with methods\\u000a described by others. In the first stage, the temporal fascia is skin grafted and the wound is closed over the

K. W. Marck; B. van der Lei; F. K. L. Spijkervet; S. A. Adeniyi; J. Meixner; H. P. de Bruijn



Effect of Flap Removal in Myopic Epi-LASIK Surgery on Visual Rehabilitation and Postoperative Pain: A Prospective Intraindividual Study  

Microsoft Academic Search

Purpose: A prospective intraindividual study to evaluate the effect of flap removal in myopic epi-LASIK surgery on visual rehabilitation and postoperative pain. Methods: Ninety eyes of 45 patients were treated for myopia with epi-LASIK. In each patient, the epithelial flap was repositioned in one eye after epi-LASIK (group 1) while the flap was removed in the other (group 2). Uncorrected

Kyung-Sun Na; Kyung-Min Lee; Shin-Hae Park; Hyun-Soo Lee; Choun-Ki Joo



Salvage surgery of recurrence after laryngectomy - when should the alt free flap be modified?  

PubMed Central

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

Maciejewski, Adam; Krakowczyk, Lukasz; Szymczyk, Cezary; Wierzgon, Janusz; Grajek, Maciej; Dobrut, Miroslaw; Szumniak, Ryszard; Jedrzejewski, Piotr; Ulczok, Rafal; Poltorak, Stanislaw



Delayed buccal fat pad herniation: An unusual complication of buccal flap in cleft surgery  

PubMed Central

Buccal musculomucosal flap is commonly used in cleft palate surgery for providing additional lining when nasal mucosa is inadequate. We report an unusual complication of progressively increasing fat herniation from the sutured donor site which started appearing on the third postoperative day. This necessitated excision of the protruding fat pad on the seventh postoperative day. The possible mechanism and precautions for prevention of this complication are discussed.

Tuli, Puneet; Parashar, Atul; Nanda, Vipul; Sharma, Ramesh K.



Free flap transfer in cranio-maxillofacial surgery: a review of the current data  

Microsoft Academic Search

Background  The advances of cranio-maxillofacilal surgery are considerably driven by the evolution of microsurgical techniques. At present,\\u000a these methods continue to provide new therapeutic options to the field. Especially, free flap transfer has evolved to become\\u000a an integral part of current treatment protocols for head and neck malignancies. It ensures uneventful wound healing even after\\u000a previous radiotherapy and can often preserve

M. Thorwarth; C. Eulzer; R. Bader; C. Wolf; M. Schmidt; S. Schultze-Mosgau



Conjunctival flap in manual sutureless small-incision cataract surgery: a necessity or dogmatic.  


To compare the surgical outcomes of manual sutureless small-incision extracapsular cataract surgery (MSICS) with versus without a conjunctival flap for the treatment of cataracts. Prospective, randomized comparison of 220 consecutive patients with visually significant cataracts. Tertiary level eye clinic. 220 consecutive patients with cataracts. Patients assigned randomly to receive either SICS with a conjunctival flap or without one. Operative time, surgical complications, surgically induced astigmatism. Both surgical techniques achieved comparable surgical outcomes with comparable complication rates. The operative time was markedly less in group without flap (mean duration of 7.67 ± 1.45 min) than in group with flap (mean duration of 11.46 ± 1.69 min) (p value <0.001). In the group without a flap intraoperative pupillary miosis was significantly greater (p value 0.039) and on postoperative day 1, there were greater patients with a subconjunctival bleed involving greater than one quadrant of the bulbar conjunctiva (p value <0.0001). Also, post operative conjunctival retraction and consequent wound exposure was also significantly higher in this group (p value 0.026). However, the rate of other serious complications like any postop hyphaema, conjunctival bleb formation, iris prolapse, tunnel stability, shallow anterior chamber, post operative uveitis, malpositioned IOL, retinal detachment, cystoid macular edema, endophthalmitis were comparable in both. Both MSICS with and without a conjunctival flap achieved good surgical outcomes with comparable complication rates. But flapless MSICS is significantly faster. However it may be associated with higher intraoperative miosis and greater postoperative wound exposure. PMID:22638922

Singh, Punitkumar; Singh, Subhadra; Bhargav, Gajesh; Singh, Manju



The use of near-infrared spectroscopy for assessing flap viability during reconstructive surgery.  


The ability to assess viability of tissues by monitoring changes in oxygenation and perfusion during harvesting and following transfer of free and pedicled flaps is potentially important in reconstructive surgery. Rapid detection of a critical change in tissue oxygenation could enable earlier and more successful surgical intervention when such problems arise. In this study near infra-red spectroscopy (NIRS) was used to assess changes in tissue oxygenation, haemoglobin oxygenation and blood volume in a porcine prefabricated myocutaneous flap model in response to pedicle manipulations. As far as we are aware this is the first usage of a NIRS instrument to assess changes in oxygenation in a flap model which closely simulates the clinical situation. A myocutaneous flap was raised (n = 9 pigs), tubed and the flap circulation allowed to readjust for periods between 7 and 9 days. The pedicle vessels were then subjected to arterial (n = 9), venous (n = 12) and total occlusion (n = 6). Repeatable and reproducible patterns of change were measured in each case. Comparison of mean values indicated that the differences between arterial and venous, and venous and total occlusions were significant for all NIRS parameters. The monitor was easily able to detect two additional features: (i) the presence of venous congestion indicated by raised levels of deoxygenated haemoglobin and an increase in blood volume; and (ii) the presence and magnitude of reactive hyperaemia. In two flaps release of arterial or total occlusion did not result in the expected reactive hyperaemia associated with an increase in blood volume (oxygenated haemoglobin) suggestive of possible damage to the vascular bed. NIRS proved able to detect and distinguish between microcirculatory changes occurring as a result of arterial, venous or total vascular occlusion. We believe that NIRS provides a sensitive and reliable postoperative monitor of tissue viability following transfer of free and pedicled flaps. It can accurately identify different types of problems with the pedicle vessels. In addition its predictive capabilities would allow assessment of flaps buried deep to the skin. This monitor is excellent for surgical and intensive care unit monitoring since it is unaffected by light, portable and is extremely easy to use. PMID:9664881

Thorniley, M S; Sinclair, J S; Barnett, N J; Shurey, C B; Green, C J



Improvisations in classic and modified techniques of flap surgery to improve the success rate for pressure ulcer healing in patients with spinal cord injury.  


The recurrence of pressure ulcers (PrUs) and dehiscence of reconstructive flap have always been a problem. The present study aimed to evaluate the results of reconstructive flap surgeries in patients with spinal cord injury (SCI) having PrUs, using classic and modified flaps with improvisations to decrease wound dehiscence, flap necrosis and tension in flap. This is a prospective clinical study. The setting was a tertiary care centre in northern India. Thirty-five patients with SCI having 37 stage III and IV PrUs. PrUs were treated using classic and modified flaps with improvisations. The outcome was evaluated using criteria of wound dehiscence, flap necrosis and recurrence. The results of flap surgery were excellent in 32 (86·48%) patients, good in 4 (10·81%) patients and poor in 1 (2·7%) patient. Partial flap necrosis (2·7%), low incidence of PrU recurrence rate at flap site (5·4%) and overall PrU recurrence (11·4%) were the complications observed. Improvisation of classic and modified techniques of flap surgeries along with reinforcement of general care principles of paraplegia can be effective in minimising complications often associated with PrU reconstructive surgery thus improving the ultimate outcome. PMID:22697785

Singh, Roop; Singh, Raghubir; Rohilla, Rajesh K; Magu, Narender K; Goel, Rakesh; Kaur, Kiranpreet



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

PubMed Central

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

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



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

PubMed Central

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



Infrahyoid muscle flap for pharyngeal fistulae after cervical spine surgery: a novel approach--Report of six cases  

PubMed Central

A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5–12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1–5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus.

Niedeggen, Andreas; Todt, Ingo; Westhofen, Martin; Ernst, Arne



Accidental self-removal of a flap—a rare complication of laser in situ keratomileusis surgery  

Microsoft Academic Search

PURPOSE: To report a rare complication in which the patient accidentally removed the laser in situ keratomileusis corneal flap.METHODS: Interventional case report. A 35-year-old woman underwent uncomplicated laser in situ keratomileusis surgery. Ten days after surgery, she inserted a soft contact lens into the right eye to improve her vision. She tried to remove the contact lens, but had pain

M. S. Sridhar; Christopher J. Rapuano; Elisabeth J. Cohen



[Experience with 38 deltopectoral flaps in reconstructive surgery of the head and neck (author's transl)].  


The deltopectoral flap was described by Bakamjian in 1965 for pharyngo-oesophageal reconstruction. Since then, the indications of this excellent flap have been extended and the versatility of the flap has allowed extensive skin and mucous membrane resections in cancerology. The authors have used 38 deltopectoral flaps in 36 patients with difficult reconstructive problems. The results have been good in 31 cases. There were 7 failures. PMID:327736

Lejour, M; Dor, P; Jortay, A; Mendes da Costa, P; el-Hafed, A


Automatic 3D Vascular Tree Construction of Perforator Flaps for Plastic Surgery Planning  

Microsoft Academic Search

Perforator flaps have been increasingly used in the past few years for trauma and reconstructive surgical cases. With the thinned flap design, greater survivability and a 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. In this paper, we will propose a

Jean Gao; Quan Wen



Cornerstones in reconstructive plastic surgery: Argentinian development of muscular, myocutaneous, and fasciocutaneous flaps  

Microsoft Academic Search

This article pays tribute to two Argentinian surgeons whose work has been published in their local journals but is unknown internationally. Goldtraj's pioneering work on the treatment of vascular ulcers of the leg using a muscular flap, presented in 1954, and Spadafora's work on the treatment of tissue defects with myocutaneous and fasciocutaneous flaps, presented in 1964, are discussed. Both

A. S. Kostianovsky; N. M. Sostaric



Lateral palatal flap approach to the nasopharynx and parapharyngeal space for transoral robotic surgery: a cadaveric study.  


The da Vinci surgical robot has been used for minimally invasive surgery of the head and neck region including resection of tumors in the nasopharynx. Access to and vision of the nasopharynx with the robot are difficult. A pure transoral approach and midline palatal split approach have been described. The disadvantage of these approaches is the limited lateral access to the parapharyngeal space. The objective of this study was to investigate the feasibility of accessing the nasopharynx and parapharyngeal space with a lateral palatal flap. Two complete nasopharyngectomies with resection of the parapharyngeal space and exposure of the internal carotid artery and branches of the mandibular nerves were performed on two fresh cadavers with the da Vinci surgical robot. The set up of the robot, the surgical procedure of elevating the lateral palatal flap, and robotic resection of the nasopharynx and parapharyngeal space are described. PMID:23704859

Tsang, Raymond K; Mohr, Catherine



Combination Flap Surgery with Resin-Modified Glass Ionomer for the Treatment of Radicular Lesions: A Long-Term Follow-up.  


This retrospective study evaluated the long-term clinical success of combination therapy using resin-modified glass ionomer (RMGI) with flap surgery in treating subgingival radicular defects. The study population consisted of 142 patients with 188 radicular defects. Clinical parameters (pocket depth, recession, clinical attachment level [CAL], and bleeding on probing) were evaluated. Statistically significant CAL gain was observed from baseline to follow-up in successful cases (4.3 ± 0.1 mm to 4.1 ± 0.1 mm, respectively; P < .01). RMGI with flap surgery demonstrated an overall success rate of 86.7% (77.7% with open flap debridement and 94.4% with coronally advanced flap with or without connective tissue graft), with favorable and stable clinical results over a mean period of 4.2 years (longest follow-up, 13 years). PMID:24116366

Perez, Luis A; Lee, Angie; Medina, Gioconda; Eber, Robert; Wang, Hom-Lay; Oh, Tae-Ju


[Preoperative angiographic CT-scan for perforator flap transfer. Clinical applications in an emergency unit of reconstructive surgery: four clinical cases].  


Our experience of the deep inferior epigastric artery perforator flap has led us to perform systematically an abdominal CT-scan for the pretherapeutic checking. This exam gives us a precise vascular mapping of musculocutaneous and septocutaneous perforators artery of the flap, may enable a better orientation in the dissection and reduce the surgery time. We have enlarged the indication of this exam to the members flaps who needs the dissection of a musculocutaneous or a septocutaneous perforators vessels: Nakajima's et al. classification [1]. The mapping of perforating vessels on 3D reconstruction pictures helps us to planify the vascular cutaneous autologous grafts. PMID:20705211

Bosc, R; Hivelin, M; Benjoar, M-D; Pigneur, F; Lantieri, L



Local flap coverage following posteromedial release in clubfoot surgery in older children  

Microsoft Academic Search

We present our experience of avoiding skin problems in older children with severe clubfoot deformity. We used a local transpositional flap coverage during wound closure following posteromedial release. We present our experience in five cases.

B. Jagannath Kamath; Praveen Bhardwaj



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

Microsoft Academic Search

Background  Deep sternal wound infection after cardiac surgery carries high morbidity and mortality. Our strategy for deep sternal wound\\u000a infection is aggressive strenal debridement followed by vacuum-assisted closure (VAC) therapy and omental-muscle flap reconstrucion.\\u000a We describe this strategy and examine the outcome and long-term quality of life (QOL) it achieves.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively examined 16 patients treated for deep sternal wound infection

Toshiro Kobayashi; Akihito Mikamo; Hiroshi Kurazumi; Ryo Suzuki; Bungo Shirasawa; Kimikazu Hamano



The effect of pharyngeal flap surgery on the movements of the lateral pharyngeal walls.  


Observations of prepharyngeal and postpharyngeal flap degrees of lateral pharyngeal wall movement seem to indicate that some individuals have the ability to alter patterns of lateral pharyngeal wall motion. However, most of the subjects did not show changes in lateral pharyngeal wall motion, and in those who did show changes, the effects of speech therapy could not be excluded. Therefore, the suggestion that pharyngeal flaps should be "tailored" to the size of the gap in the velopharyngeal sphincter seems valid. Or, to put it differently, it seems likely that in many individuals, if the pharyngeal flap constructed is not as broad as the velopharyngeal gap, velopharyngeal insufficiency and hypernasality are likely to persist because most often the lateral pharyngeal wall movement will not adapt to the presence of a new structure in the pharynx. PMID:7208670

Shprintzen, R J; McCall, G N; Skolnick, M L



[Vastus lateralis flap--an ideal procedure for definitive surgery of infected cavities of the hip].  


Between January 1994 and August 1998, 12 patients with 13 chronic infections after resection arthroplasty were treated successfully with vastus lateralis muscleflap. One patient was suffering from chronic infection on both sides. In all cases we found the infected cavity to be the origin of the persistent infection. The average duration of infection was 8.3 months. The patients had undergone an average of 3.8 operations. Up to now there was no recurrent infection, controlled by clinical investigation, ultrasound and laboratory findings in all 13 cases. Follow up investigation occurred 2.5 years (1.5-4.7) after flap transfer. The flap is easy to harvest. He has a very constant pattern of vascular pedicle and a wide arc of rotation. The functional deficits of donor side morbidity are minimal. That vastus lateralis flap seems to be an ideal procedure to stop draining infections due to infected cavities in the hip region. PMID:11142881

Heppert, V; Kessler, T; Malze, K; Wentzensen, A



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


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

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



[Mediastinal tracheotomy in cervicofacial oncologic surgery. Contribution of the pectoralis major myocutaneous flap].  


Four cases of anterior mediastinal tracheostomy with myocutaneous Pectoralis Major flap are described. Resection of the manubrium, clavicular heads and the cartilages of the first and second ribs is necessary. The use of myocutaneous Pectoralis Major flap give good functional results. No infection or hemorrhage of mediastinal great vessels occurred. The indications of Anterior mediastinal tracheostomy are discussed. Stomal and peristomal recurrences following laryngectomy for carcinoma represents the indication of choice. Stomal recurrences are difficult to treat and the prognostic is poor. Prevention of the stomal recurrences is discussed. PMID:4014936

Hamoir, M; Calteux, N; Robillard, T; Remacle, M; De Coninck, A; Van Den Eeckhaut, J



[Gracilis muscle flaps for covering losses of perineal substance in cancer surgery].  


Myocutaneous or purely muscular flaps were used in 14 patients after extended surgical excision in the perineal region. When taking out the flap, its one-pedicle and relatively weak blood supply must be taken into account. With this precaution, this technics can always be used for perineal resurfacing, particularly after total vulvectomy. In pelvic exenteration and amputation for anorectal cancer, it enables surgeons to fill the muscular gap, which seems to improve the post-operative course. It can also be used for vaginal, penile or sphincteric reconstruction. PMID:2933710

de Ranieri, J; Crouet, H; André, M; Ollivier, J M; Desdoits, J M; Bouvet, A; Souloy, J



The inferiorly based masseter muscle flap: anatomical basis for its use in head and neck reconstructive surgery.  


The aim of this study was to investigate and elucidate the anatomical basis for the use of the inferiorly based masseter muscle flap in the reconstruction of oropharyngeal defects after ablative surgery. The anatomy of the masseter muscle, with particular emphasis on its blood supply, was studied using plain and coloured resin injected dissections and a series of digital subtraction angiograms and external carotid arteriograms. Both techniques were demonstrated to be reliable and effective means of anatomical investigation of blood vessels. The vascular anatomy of the masseter muscle and the anatomical and angiological results as well as a case report are described. The masseter muscle, when used as an inferiorly based flap, provides the necessary bulk for reconstruction of moderate size defects in the lateral border of the tongue, posterior floor of the mouth, retromolar trigone, anterior tonsillar pillars and lateral pharyngeal wall. Although the masseter muscle has small dimensions, it offers a reliable method of reconstruction in selected defects without the disadvantages of cosmetic and functional loss. PMID:2051046

Marinho, L H; Shanahan, D A; Langdon, J D; Sinnatamby, C S



Breast Surgery Under Local Anesthesia: Second-stage Implant Exchange, Nipple Flap Reconstruction, and Breast Augmentation.  


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

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



A New Approach for the Surgery of Large Renal Masses: Abdominal Wall Flap Incision  

Microsoft Academic Search

Introduction: The type of skin incision affects the course of surgery during radical nephrectomy. We investigated the efficacy of a new type of incision for the surgical approach to large renal masses. Patients and Methods: Fourty patients (23 males and 17 females, mean age 63 years) who underwent radical nephrectomy in our department between 2002 and 2004 were evaluated. The

Levent N. Türkeri; Yusuf Temiz; Abdurrahman Özgur; Fikret Fatih Önol



Musculocutaneous flaps in head and neck reconstruction.  

PubMed Central

The introduction of musculocutaneous flaps to head and neck reconstructive surgery is described. The flaps available are listed, and the most important ones described and illustrated. Both the latissimus dorsi and pectoralis major flaps are felt to have a role in head and neck reconstruction, though they have largely been superseded by microvascular free flaps such as the radial forearm flap. Images fig. 1 fig. 2 fig. 3 fig. 4 fig. 5 fig. 6 fig. 7 fig. 8

Leonard, A. G.



Flap and incision design in implant surgery: clinical and anatomical study  

Microsoft Academic Search

Objectives  The protection of microcircular support which is essential for healing gains importance if implant surgery is considered to\\u000a affect the blood flow. The aim of the study is to establish the artery territories supplying the blood into the oral mucosa\\u000a in the cadavers and to demonstrate the mucosal delivery pattern and to evaluate the effects of different incision types on

Ramazan Koymen; Umit Karacayli; Nuket Gocmen-Mas; Cevlan Ertugrul-Koymen; Kerim Ortakoglu; Yilmaz Gunaydin; Orhan Magden



The pros and cons of distant pedicled flaps for upper extremity trauma reconstruction in the era of microvascular surgery  

Microsoft Academic Search

Nineteen distant pedicled flaps, performed during 1989 for posttraumatic upper extremity soft tissue defect cover were reviewed. The pros and cons of distant pedicled flaps were examined with respect to the alternative treatment; namely, free microvascular tissue transfer. The main points considered were the traumatic defect, the donor site and particular problems of each patient. The conclusion was that pedicled

P. Graft; H. U. Steinau; G. Ingianni; E. Biemer



A selective laser sintering guide for transferring a virtual plan to real time surgery in composite mandibular reconstruction with free fibula osseous flaps.  


The free fibular flap is the standard procedure for reconstructing mandibular defects. The graft has to be contoured to fit the defect so preoperative planning is required. The systems used previously do not allow transfer of the surgical plan to the operation room in an optimal way. The authors present a method to bring the virtual plan to real time surgery using a rapid prototyping guide. Planning was conducted using the Surgicase CMF software simulating surgery on a workstation. The osteotomies were translated into a rapid prototyping guide, sterilised and applied during surgery on the fibula allowing for the osteotomies and osteosynthesis to be performed with intact circulation. During reconstruction the authors were able to choose the best site for the osteotomies regarding circulation and as a result increased the precision and speed of treatment. PMID:19179046

Leiggener, C; Messo, E; Thor, A; Zeilhofer, H-F; Hirsch, J-M



Peculiar indications for the pedicled or free rectus abdominis flap in reconstructive surgery. A review of our experience.  


Among all known flaps, the rectus abdominis muscle flap possesses an unique diversity in flap designs due to the special vascular supply of the abdominal wall. The axial vascularization of the rectus abdominis muscle gives ofF several musculocutaneous perforators, which are mainly located in the periumbilical region. Abdominal wall skin perfusion is guaranteed by spoke-wheel like vessels arising from these perforators. Subsequently several designs (muscle, myocutaneous and myosubcutaneous) are possible, by varying the included tissue and the position of the skin island. We described 7 cases where the rectus abdominis muscle was used as a muscle or myocutaneous flap for reconstruction of large defects. In most cases a pedicled transfer was necessary, possible and sufficient to reconstruct the difficult defects in various body regions. Great amounts of well perfused tissue can be transferred with still possible primary closure of the donor site. Due to its rich perfusion and constancy of vascular pattern, it represents an excellent and safe pedicled reconstructive procedure for large defects of the thorax, the abdomen, the forearm or the hip and pelvis where free tissue transfers are impossible or contraindicated. No other local transposition would have achieved this goal, due to the lack of volume and mobility. Moreover the flap is ideal for reconstruction of contour deficiencies due to the abundance of fat, as for example in breast or buttock reconstruction. However the flap is not the first choice for traumatic and infected wounds where fat tissue is not desired. PMID:8571724

Sinsel, N K; Guelinckx, P J


[Perineal giant cell fibroblastoma in a five years old boy managed with micrographic surgery and local reconstruction with a posterior perforator thigh flap].  


A report of a five-year-old male child diagnosed as a recurrent perineal giant cell fibroblasoma is described. Complete tumour removal was obtained with micrographic surgery and complete pathological analysis of the limits of the tumour with the "technique verticale modifiée" developed in our institution. The closure of the operative wound was performed with a posterior perforator thigh flap based on the descending branch of the inferior gluteal vessels. Thanks to these new surgical and pathological approaches, the complete removal of this recurring tumour was achieved with acceptable oncologic, fonctionnal and cosmetic results in this young child. PMID:19223102

Pachet, C; Fournier, E; Robert, C; Duvillard, P; Kolb, F



Multiple toe transfer and sensory free flap use after a traumatic amputation of multiple digits. Surgery done in a single setting: a case study.  


Crush avulsion injuries to the hand with concomitant traumatic amputation of multiple digits can be a devastating injury to the patient. These injuries have multiple issues occurring under emergency conditions. When feasible, replantation of the multiple digits is optimal, but in many cases, it is not possible. Because of the crushing force on the digits, they are not viable candidates for replantation. The usual course of treatment for these patients is a two stage procedure, usually involving a groin flap. Here, we present the case of a patient who had a left hand skin avulsion of the whole palm and P1 of index, long, ring and small fingers. The left index finger had a complete amputation at the P2 level, the long, ring and small fingers all had complete amputations at the P1 level. This injury was dealt with by a left foot second and third toe transplant, a sensory free flap from the left big toe and a fourth toe microvascular free transfer to the left hand. The remainder of the defect was managed with a 10 × 14 cm reversed radial forearm flap and a combination of full and split thickness skin grafts. The procedure was performed in a single operation, obviating the need for a second surgery. This procedure optimized the patient's outcome during a single setting, making it an ideal choice in an emergency setting. PMID:21766329

Galpern, David W; Tsai, Tsu-Min



Advances in refractive surgery: microkeratome and femtosecond laser flap creation in relation to safety, efficacy, predictability, and biomechanical stability  

Microsoft Academic Search

Purpose of review Methods of flap creation have changed over the years from the evolution of the mechanical microkeratome to the introduction of the IntraLase femtosecond laser keratome, both of which have different mechanisms of action to create corneal resections. Previous studies report the advantages and disadvantages of the mechanical microkeratome and the IntraLase femtosecond laser. The critical components in

Karl Stonecipher; Teresa S. Ignacio; Megan Stonecipher



The use of a retroauricular fascioperichondrial flap in the recreation of the antihelical fold in prominent ear surgery.  


The surgical treatments for prominent ears are on the basis of the approach over the basics of the deformity decrease the concha-mastoid angle and create a new antihelical fold. The author describes a new retroauricular flap to be used in the recreation of the antihelical fold and critically analyzes the cosmetic results and complications. A skin ellipse is outlined on the posterior surface of the ear. After hydrodissection with anesthetic solution in the outlined area, the skin is removed as thin as possible over the superior mid ear, preserving the underlying connective tissue and perichondrium. A triangular flap is created in the superior third of the raw area and elevated in the subperichondrial plane. The fixation of the flap posteriorly allows the medialization of the upper pole, resulting in a natural antihelical fold. One hundred sixty-one otoplasties were performed in 82 patients (3 unilateral), 53 women and 29 men. Mean age was 19.2 years and mean follow-up time was 3.4 years. Loss of correction at the upper pole led to secondary correction in 12 ears (7.45%). Suture extrusion was observed in 7 ears (4.34%). Hypertrophic scarring developed in 3 ears (1.86%). The accumulated risk of reoperation was of 10.85% in 9 years. The retroauricular fascioperichondrial flap combined with other techniques may be used as a standard procedure in the surgical treatment of prominent ears. PMID:19806040

Frascino, Luiz Fernando



Anterolateral thigh cutaneous flap vs. radial forearm free-flap in oral and oropharyngeal reconstruction: an analysis of 48 flaps  

PubMed Central

Summary Microvascular free-flaps have been in clinical use for nearly 3 decades becoming the gold standard in oral and oropharyngeal reconstruction. In this study, a comparison has been made between the radial forearm fasciocutaneous flap with the thinned anterolateral thigh cutaneous flap (tALT), showing the advantage of the anterolateral thigh cutaneous flap in oral and oropharyngeal reconstruction. Between January 2003 and January 2007, 48 reconstructions were performed in patients submitted to surgery for oral and oropharyngeal carcinoma using, in 17 cases, a radial forearm fasciocutaneous flap and, in 31, an anterolateral thigh cutaneous flap. In patients treated with the radial forearm fasciocutaneous flap, results showed 94.1% flap survival; in cases treated with the anterolateral thigh cutaneous flap, 93.5% flap survival (p < 0.9). Functional results, at receiving site, were comparable in both groups. Functional results, at donor site, were less successful in the radial forearm fasciocutaneous flap group, with permanent forearm movement impairment in 35.3% of cases; in the anterolateral thigh cutaneous flap group, only transitory gait impairment occurred in 12.9% of patients. In conclusion, in our experience, the thinned anterolateral thigh cutaneous flap is comparable to radial forearm fasciocutaneous flap in terms of functional results at receiving site, but, having no limitation in availability of donor tissue, it allows a more extended resection of the tumour. Moreover, the donor site can be closed primarily with only an inconspicuous curvilinear scar left over the thigh and with significantly reduced functional impairment.

Camaioni, A; Loreti, A; Damiani, V; Bellioni, M; Passali, FM; Viti, C



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


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

Dawood, Andrew; Tanner, Susan; Hutchison, Iain



Pseudomonas aeruginosa Necrotizing Infection of the Abdominal Flap in a Post-Bariatric Patient Undergoing Body Contouring Surgery  

Microsoft Academic Search

Pseudomonas aeruginosa infections may involve any organ or body district and may give serious clinical sequelae. We report the case of an infection\\u000a of the abdominoplasty flap that compromised wound closure and jeopardized the aesthetic outcome. To the best of our knowledge,\\u000a this is the first such case reported in the literature for this group of patients. We have presented

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



CASE REPORT Persistent Seromas in Abdominal Free Flap Donor Sites After Postmastectomy Breast Reconstruction Surgery: Case Reports and Literature Review  

PubMed Central

Objectives: Donor site seroma formation is a common occurrence following abdominal free flap breast reconstructions. Although such seromas usually resolve spontaneously after a few weeks or months, we recently encountered 3 patients with abdominal seromas persisting for up to 2 years postoperatively. We therefore investigated possible predisposing factors in our patient group. Methods: Patients with persistent abdominal seromas, arbitrarily defined as present after 3 months following abdominal free flap harvest were identified. Their demographic characteristics, comorbidities, reconstruction details, frequency, and volume of abdominal aspirations were documented. Results: Three obese patients (Mean body mass index = 35) with an average age of 49 years bilaterally reconstructed with superior inferior epigastric artery or deep inferior epigastric artery flaps fitted the aforementioned criteria. Seroma aspirations commenced at 3 weeks and continued for a maximum of 26 months postoperatively. The average number of aspirations was 11 with a mean volume of 338 mL (range: 100-864 mL) per visit. The patients were aspirated either weekly or fortnightly depending on the speed of seroma reaccumulation and symptoms. All the 3 patients needed excision of the seroma sac to achieve permanent resolution. Discussion and Conclusion: In addition to their nuisance value (notably frequent aspirations and outpatient clinic visits), persistent seromas can cause significant morbidity and eventually require surgical excision. Possible predisposing factors in our patients included obesity, bilateral reconstructions, and superior inferior epigastric artery flap harvest. Such “high risk” patients should be warned about the likelihood of persistent seromas needing repeated aspirations and possible surgical interventions for ultimate resolution.

Sadeghi, Abtin; Malata, Charles



Fasciocutaneous free flaps for hypopharyngeal reconstruction.  


Considerable controversy persists regarding the optimal technique for hypopharyngeal reconstruction. The ideal procedure should provide low mortality and morbidity, short hospitalization, a high success rate, few complications, and the greatest potential for neopharyngeal speech and deglutition. In this study, a variety of fasciocutaneous free flaps were used for reconstruction of the hypopharynx. Over a two-year period, fasciocutaneous flaps were used for reconstruction of pharyngoesophageal segments following total laryngopharyngectomies in 16 patients at The National Cancer Institute, Cairo University, Cairo, Egypt. Flap survival, recipient vessels used, and complications were examined. The ultimate functional and cosmetic outcomes of free flaps were compared. Of the 16 patients included in this study, nine were males, and seven were females. Free flaps used for reconstruction included the radial forearm (8), lateral arm (2), anterolateral thigh (3), and posterolateral thigh (3) flaps. Free flaps were successful in 15 patients. One patient had total flap loss. Salvage surgery was successful for one flap that developed venous congestion. Eleven patients received adjuvant radiation therapy. The commonly used recipient vessels were the small arteries of the neck and the external jugular vein. Five patients developed minor pharyngocutaneous fistulas that healed spontaneously. Six patients developed anastomotic line stricture. Donor-site morbidity was more significant with the radial forearm flap, compared to other flaps. Fasciocutaneous free flaps have a definite place in pharyngoesophageal reconstruction. The flap should be selected with reference to the type of the defect and patient obesity; however, donor-site morbidity should also be considered. PMID:11917950

Amin, Ayman Abdel-Wahab; Bassiouny, Mahmoud; Elsebai, Hesham; Riffat, Mohammed; Fakhry, Sherif; Hewidi, Sobhi; Khafagy, Medhat



Propeller flaps for leg reconstruction.  


Leg soft tissue defects with bone or tendon exposure need to be covered with a flap. Various local and free flaps with more or less consistent donor site defects have been described in the past. After the introduction of the perforator-based flap concept, new flaps have also been described for the leg. An evolution and simplification of the perforator flap concept, together with the 'free style' flap harvesting method, are the propeller flaps, i.e. local flaps, based on a perforator vessel, which becomes the pivot point for the skin island that can, therefore, be rotated up to 180 degrees . In this prospective study, six consecutive patients, having post-traumatic soft tissue defects of the leg or knee prosthesis infection, with bone or tendon exposure, were treated with propeller flaps. Complete and stable coverage of the soft tissue losses was obtained in all cases with an inconspicuous, only cosmetic, donor site defect. No flap necrosis was observed, with the exception of a small superficial necrosis of the tip of one flap, due to the inclusion in the design of scarred tissue. In two cases, transient venous congestion was observed and resolved spontaneously. Mean operative time was 2 h (ranging from 60 min to 6 h when an orthopaedic procedure was also needed) and mean hospital stay after surgery was 10 days. Propeller flaps allow the coverage of wide defects, can be raised with a relatively simple surgical technique, have a high success rate and good cosmetic results without functional impairment. In the light of this they can be considered among the first surgical choices to resurface complex soft tissue defects of the leg. PMID:18450531

Pignatti, Marco; Pasqualini, Monica; Governa, Maurizio; Bruti, Massimiliano; Rigotti, Gino



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

PubMed Central

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



Free flap neovascularization: myth or reality?  


The blood supply of 17 free flaps was studied several months after surgery. The aim was to see whether or not the free flaps acquired blood flow through vessels across the flap inset independently of the main vascular anastomoses. A color Doppler flowmeter was used to identify the original arterial and venous anastomoses, the vessels in the margin of the flap, and also across the flap inset. The main vascular pedicle was then manually compressed for 2 min and blood flow was again examined in the vessels at the margin of the flap. The flap vessels (post-anastomotic), the anastomoses, and the recipient vessels (pre-anastomotic) could be identified in every case. There was no evidence of anastomotic stenosis. No vessels (neo-vascularization) greater than 0.5 mm could be identified across the flap inset. Small arteries could be identified in the flap near the inset. These vessels emptied completely on manual compression of the vascular pedicle for 2 min and did not refill until the compression was released. This evidence suggests that the free flaps do not receive significant blood flow through vessels across the flap inset, and are therefore significantly dependent for vascularity on the original anastomoses even 1 year after surgery. PMID:14973773

Kumar, Krishna; Jaffe, Wayne; London, N J M; Varma, Sanjay Kumar



Venous flaps.  


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

Thatte, M R; Thatte, R L



Iloprost and salvage of a free flap  

Microsoft Academic Search

Despite the alluring pharmacological properties of prostacyclin and its stable analogue (iloprost), these substances are little used in plastic surgery. A case is presented in which iloprost resulted in persistent patency of the vessels supplying a free flap. A patient who had had failure of a free flap because of thrombosis distal to the arterial anastomosis had a second free

F. Renaud; E. Succo; M. C. Alessi; R. Legre; I. Juhan-Vague



The use of the latissimus dorsi musculocutaneous flap for immediate correction of the deformity resulting from breast conservation surgery  

Microsoft Academic Search

Breast conservation surgery is now widely accepted as the treatment of choice in early breast cancer. Randomised controlled trials have shown comparable recurrence and survival rates following breast conservation when compared to mastectomy, with the perceived advantage that it should leave a cosmetically acceptable result without reconstruction. It is our experience that an adequate local excision may result in a

C. C. Kat; C. M. Darcy; J. M. O’Donoghue; A. R. Taylor; P. J. Regan



Short-term and long-term results of speech improvement after surgery for velopharyngeal insufficiency with pharyngeal flaps in patients younger and older than 6 years old: 10-year experience.  


Velopharyngeal insufficiency (VPI) is a well-known cause for hypernasality. To overcome this problem, the authors use a static surgical technique: a cranially or caudally based flap. In 93 patients, the results of this technique on speech (hypernasality, nasal air escape, articulation) and velopharyngeal function were evaluated over a period of at least 1 year. In 53 patients, pharyngoplasty flaps were based caudally. In 40 patients, pharyngoplasty flaps were based cranially. The patients were age 2.5 to 24.5 years, with a mean of 5.5 years (SD: 4 years and 2 months). Improvement was found in almost all patients. The patients who underwent surgery when they were younger than age 6 significantly improved better then the patients who were treated when they were older than age 6. There were no differences in outcome between cranially based and caudally based flaps. There were also no differences between patients with plain VPI and patients with VPI (e.g., Pierre Robin sequence and Shprintzen). PMID:12545103

Meek, Marcel F; Coert, J Henk; Hofer, Stefan O P; Goorhuis-Brouwer, Sieneke M; Nicolai, Jean-Philipe A



[From Tansini to Angrigiani: improvement and refinement of the thoracodorsal flap].  


Flap surgery is the art of transposing an autonomous vascularised tissue, from a donor site to a distant recipient site. It was born 2000 years ago in India, evolving from random flaps to microsurgical flaps with a skeletonised vascular pedicle. This evolution was possible through the knowledge of cutaneous vascularisation and allows today the spreading field of perforator flaps. Writing the story of any particular flap is, in fact, looking back to understand the global concept and evolution of flaps surgery. Therefore the authors detail every step of the development and technical improvement of the thoracodorsal flap from the classical musculocutaneous latissimus dorsi flap to one of its latest achievement, the thoracodorsal perforator flap. This story helps us to appreciate the armamentarium of thin and low donor site morbidity flap that perforator flaps offer to us. PMID:21035937

Perignon, D; Qassemyar, Q; Benhaim, T; Robbe, M; Delay, E; Sinna, R



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


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

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



Late-onset traumatic laser in situ keratomileusis (LASIK) flap dehiscence  

Microsoft Academic Search

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) flap dehiscence following focal trauma six months after uneventful refractive surgery.METHODS: Case report. A 37 year old man was seen one day after a tree branch snapped tangentially against his left cornea causing a dehiscence of his LASIK flap.RESULTS: The flap was repositioned after treating the exposed flap stroma

Harry S. Geggel; Mary P. Coday



Comparative evaluation of ‘flap on’ and ‘flap off’ techniques of Epi-LASIK in low-to-moderate myopia  

Microsoft Academic Search

PurposeComparative evaluation of ‘flap on’ and ‘flap off’ techniques of Epi-LASIK in low-to-moderate myopia.MethodsSixteen eyes of eight consecutive patients with myopia ?6 D were selected for this prospective, randomized, comparative, interventional case series. Epi-LASIK surgery was performed in all eyes. In one eye of each patient, the epithelial flap was retained after excimer laser ablation (flap on). In the fellow

N Sharma; S Kaushal; V Jhanji; J S Titiyal; R B Vajpayee



Differences in blood flow volume and vascular resistance between free flaps: assessment in 58 cases.  


In free-flap transfer, blood flow in the transferred flap contributes to wound healing and to resistance against infection in the recipient site. Successful reconstructions using free tissue transfers may be required to define and choose flaps with abundant blood flow in necessary cases. We investigated blood flow in the flap by transit-time ultrasound flowmeter in 58 free-flap transfers. Flow volume was compared between flap tissues as vascular resistance in the flap was calculated. Fasciocutaneous and osteocutaneous flaps had relatively low blood flow volume, myocutaneous flaps had more, and intraperitoneal flaps had still higher blood flow volume. These differences were statistically significant. Vascular resistance significantly decreased in the same order of comparison. Our findings will help in selecting the most suitable flaps for reconstructive surgery. PMID:18942044

Takanari, Keisuke; Kamei, Yuzuru; Toriyama, Kazuhiro; Yagi, Shunjiro; Torii, Shuhei



Outcomes of wound closure with the reading man flap technique.  


Background:In dermatologic surgery, numerous flap types have been described for wound closure after skin cancer surgery. The reading man flap was first published in 2008 for the closure of skin defects of the face, trunk, and extremities. Technically, this flap is based on an asymmetrical Z-plasty.Objective:To investigate the feasibility, clinical outcomes, and postoperative complications for wound closure with the reading man flap technique.Methods:We treated seven patients (facial and extremity defects) after microscopically controlled surgery using the reading man flap technique. The median defect size was 491.71 mm2. All of the patients were treated under tumescent local anesthesia.Results:A tension-free defect closure was created in all patients. One minor complication, a wound infection on one leg, was observed.Conclusion:The described technique is an easy and safe dermatologic surgery procedure that can be performed under local anesthesia. PMID:24138973

Wagner, Justinus A; Simon, Jan C; Wetzig, Tino; Kendler, Michael


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

PubMed Central

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

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



Complications of surgery for radiotherapy skin damage  

SciTech Connect

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

Rudolph, R.



Flow Over Swept Flaps and Flap Tips.  

National Technical Information Service (NTIS)

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...

C. U. Buice P. Bradshaw



Free flaps in reconstructive surgery.  

PubMed Central

Advances in technique, training and instrumentation have improved the patency rates for small vessel anastomosis. This, together with the introduction of more reliable donor sites for free tissue transfer, have resulted in success rates in excess of 90%. The technique is not associated with an increase in mortality or morbidity; on the contrary there is the advantage of primary reconstruction with a wide choice of donor sites offering the correct amount and type of tissue required. Single-stage, effective reconstruction, aimed at primary wound healing remains the aim of the reconstructive surgeon and free tissue transfer offers the most versatile and reliable method currently available. Images fig. 1 fig. 2 fig. 3 fig. 4

Soutar, D. S.



Computed tomography-guided implant surgery for dental rehabilitation in mandible reconstructed with a fibular free flap: description of the technique  

Microsoft Academic Search

The fibular free flap, with or without a cutaneous component, is the gold standard for reconstructing mandibular defects. Dental prosthetic rehabilitation is possible this way, even if the prosthesis-based implant is still a challenge because of the many anatomical and prosthetic problems. We think that complications can be overcome or reduced by adopting the new methods of computed tomography (CT)-assisted

Giacomo De Riu; Silvio Mario Meloni; Milena Pisano; Olindo Massarelli; Antonio Tullio


Application of a carbon dioxide laser for early closure of gingival flaps  

Microsoft Academic Search

The aim of this study was to evaluate the applicability of a carbon dioxide (CO2) laser as a means of achieving early closure of gingival flaps after periodontal surgery. In this study, an incision was made from the maxillary premolar to the canine tooth in dogs. Full thickness flaps were raised, and mucoperiosteal flaps were created. After repositioning the mucoperiosteal

Soh Sato; Hisahiro Kamoi; Yoshiko Wasaki; Kyuichi Kamoi



Perforator flap breast reconstruction.  


A perforator flap consists of skin and fat harvested from a donor site nourished by myocutaneous perforators while sparing the donor muscle for function and strength. This flap type has revolutionized microvascular free tissue transfer and the technique has been successfully applied to well-established donor sites for autologous breast reconstruction namely the lower abdomen, upper and lower buttock, the upper back, and the lateral thigh. Although these flaps are technically more demanding than conventional myocutaneous free flaps, their minimal impact on the donor site muscle function significantly reduces local morbidity, postoperative pain and hospital stay. Perforator flap breast reconstruction has an increased operating time because of the meticulous dissection of the perforators, the possible anatomical variation in their location and, once these are located, the difficulty in selecting suitable perforator(s) to base the flap on. Although it has been suggested that perforator flaps may have a higher incidence of fat necrosis and partial flap loss than conventional free myocutaneous flaps, this has not been borne out by clinical results. There is, however, a learning curve and careful patient selection is important. The role of perforator flap technique in breast reconstruction is evolving. While its indications are similar to those of free TRAM and gluteal flaps, it is clearly a better alternative to these. The choice of perforator flap depends on where the patient has the most abundant donor tissue and the surgeon's experience. These flaps may in the future become the standard of care in free flap breast reconstruction. PMID:15687662

Weiler-Mithoff, Eva; Hodgson, Elaine L B; Malata, Charles M





... After surgery there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery. Agency for Healthcare Research and Quality




... how pain will be treated Preparing for the Day of Surgery Various preparations are made in the ... Then, this device can perform more accurately. The Day of Surgery Before most operations, a person removes ...


Enhanced reliability and renewed applications of the deltopectoral flap in head and neck reconstruction.  


Bakamjian introduced the deltopectoral skin flap in 1965, and thereafter it was used extensively for reconstructive surgery of the head and neck. Flap failure rates of 10% to 25% were reported, necessitating the development of alternative methods of reconstruction and eventually relegating the flap to historical references. Since 1991, we have used the deltopectoral flap in 24 patients for reconstruction after head and neck tumor surgery. Simple technical modifications have been used to enhance the reliability of this flap, with no observed failures or even partial flap loss. The deltopectoral flap remains a versatile and reliable tissue source that can be used simultaneously with the pectoralis major myocutaneous flap for a variety of complex head and neck reconstructions. PMID:8849791

Kingdom, T T; Singer, M I



Undulatory Flap Pair Propulsion  

NASA Astrophysics Data System (ADS)

We study thrust-producing flap pairs in series and in parallel. The flaps produce thrust by a combination of pitch and heave motion in a high Reynolds number flow. We use singularity elements that allow us to investigate finite thickness flaps. The unsteady wake is modeled by a time-stepping vortex lattice method with a regularized Birkhoff-Rott kernel. The problems we analyze are two flaps swimming out of phase side by side in close proximity and one flap trailing another with strong wake-flap interaction. Our results include thrust, efficiency, and coefficient of lost power

Howle, Laurens



[1984-1994: Ten years of skin flaps. Prefabricated flaps].  


The term prefabrication of flaps corresponds to completely different technical modalities, often complementary and associated, which share the common feature of extending the indications and potential of pedicle or free flaps. Current methods of prefabrication of flaps can be considered to be based on one or several basic principles of reconstructive surgery. The authors discuss and analyse various modalities: a free flap can be made autonomous or can be expanded prior to transfer. A transfer can be initially prefabricated at its donor site by performing several operative steps in situ. A free transfer can be performed on the main vascular axis of a flap which is subsequently transferred, for example: free scalp transfer to reconstruct an eyebrow on a donor site reconstructing half of the face, but the first in situ operative phase usually consists of performing cutaneous, bone, cartilaginous or even alloplastic material transplants. The transfer is only performed after a sufficiently satisfactory complex anatomical, functional or esthetic unit has been achieved, in order to avoid difficult or dangerous remodeling operations after transfer. The most revolutionary appearance in the area of prefabrications is certainly induction of a pedicle or free neoflap in a so-called random territory. The addition of an arteriovenous pedicle associated with fascia underneath a muscle, underneath a skin cover, in contact with an osteoperiosteal segment allows a perfectly transferable neovascularized unit to be obtained after several weeks. All of the procedures described: autonomization before transfer, expansion before transfer, in situ prefabrication of a complex unit by addition of several tissue units (autologous or alloplastic) in one or several stages and finally vascular induction of a muscular, cutaneous or bone unit, etc. by transfer of a vascular axis in contact with this anatomical structure and combinations of these various modalities obviously open up a new approach which will considerably extend the already remarkable possibilities offered by free tissue transfers. PMID:8579303

Baudet, J; Pelissier, P; Casoli, V



Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report  

PubMed Central

INTRODUCTION Tracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications. PRESENTATION OF CASE An 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months. DISCUSSION Our technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence. CONCLUSION This technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.

Tatekawa, Yukihiro; Yamanaka, Hiroaki; Hasegawa, Toshimichi



Secondary extremity reconstruction with free perforator flaps for aesthetic purposes.  


Perforator flap surgery enables surgeons to tailor flaps to individual requirements with reduced donor-site morbidity. The technique allows better aesthetic results to be achieved in various fields of microsurgical reconstruction, but reports on aesthetic resurfacing and contour restoration of extremity deformities are sparse. The authors present their experience of elective reconstructions of established deformities in the extremities for aesthetic purposes using free perforator flaps. Aesthetic results were evaluated using a questionnaire and by photographic grading. From March 2006 to June 2010, 15 free flaps were transferred in 14 patients for aesthetic purposes to restore established skin and soft-tissue deformities in the extremities. Twelve flaps were transferred to lower extremities and three to upper extremities. After recreating tissue deficiencies, flaps were precisely designed and elevated with elaborate flap insetting and thickness control. Patient-assessment questionnaires were administered after surgery, and aesthetic results were evaluated using photographs by independent observers. Photographic gradings were assessed statistically using the generalised estimating equation. Eight deep inferior epigastric artery perforator free flaps and seven thoracodorsal artery perforator free flaps were used in the 14 patients. Flap sizes ranged from 8 × 14 to 14 × 38 cm, and all flaps survived well. The patient satisfaction rate was high, and aesthetic improvements were confirmed by conducting objective photographic evaluations. Statistically significant changes were detected during the photographic evaluation (p < 0.05). Secondary reconstruction using a customised free perforator flap to achieve aesthetic improvements is a valuable option for the restoration of established skin and soft-tissue deformities in the extremities. PMID:21768004

Jeon, Byung-Joon; Lim, So-Young; Pyon, Jai-Kyong; Bang, Sa-Ik; Oh, Kap Sung; Mun, Goo-Hyun



Paraspinous muscle flaps.  


Coverage of midline posterior wounds presents a challenge to the reconstructive surgeon, especially when spinal stabilization hardware has been present and exposed in the wound. Most commonly those wounds that involve the mid to upper thoracic spine have been covered by latissimus dorsi muscle or musculocutaneous flaps. Lower midline wounds, especially in the thoracolumbar region, have needed more complex means of coverage. These have included reversed latissimus dorsi flaps, free flaps, extended intercostal flaps, or fasciocutaneous rotation flaps. We have utilized a far simpler and effective muscle flap: the paraspinous muscle flap. We have raised paraspinous muscle flaps bilaterally and have been able to cover a number of difficult wounds. The wounds were presented by 8 patients with exposed Harrington rods, 3 patients with cerebrospinal fluid leaks, and 1 patient with exposed spinous processes. The wounds in 5 of these 12 patients were in the upper thoracic region, where a latissimus flap was utilized as an additional layer of muscle coverage. The other seven patients had wounds in the lower midline region below the potential reach of the latissimus dorsi. In the latter patients the only flaps employed were paraspinous muscle flaps. We had only one failure in all patients, which involved a recurrent cerebrospinal fluid leak in which there was no decompression of the cerebrospinal fluid pressure utilized in the immediate postoperative period to protect the dural repair. In that instance, a leak recurred. This paper presents the method of flap elevation and the results of our series. PMID:9600427

Manstein, M E; Manstein, C H; Manstein, G



Paramuscular Perforators in DIEAP Flap for Breast Reconstruction.  


: One of the main steps in perforator flap surgery is to identify the dominant perforator. Using multidetector row computed tomography (MDCT) for the preoperative planning of deep inferior epigastric artery perforator (DIEAP) flap surgery, we identified a perforator with a large caliber, an excellent location in the middle abdominal region, and a totally extramuscular trajectory in a significant number of patients. We describe the frequency of this perforator and determine its characteristics. PATIENTS AND METHODS: We conducted a retrospective study of 482 patients who underwent 526 DIEAP flaps for breast reconstruction from October 2003 to October 2011. Mean age at surgery was 51.3 years old. A preoperative MDCT of abdominal vascularization was performed in all patients. RESULTS: MDCT identified a dominant perforator with a paramuscular course in 12.4% of abdominal walls. In all cases, it was located in the midline and emerged directly from the deep inferior epigastric system. Its mean caliber was 1.9 mm. The flap was harvested based on this perforator in all these patients, and mean harvest time was 51 minutes. The characteristics of this perforator made dissection easier and reduced morbidity at the donor site. There were no flap losses and the only complications were minor. CONCLUSION: We located a paramuscular perforator in 12.4% of patients undergoing breast reconstruction with abdominal perforator flaps. Its morphological features and extramuscular course make it the perforator of choice in DIEAP flap surgery. PMID:23728240

Pons, Gemma; Masia, Jaume; Sanchez-Porro, Lídia; Larrańaga, Jose; Clavero, Juan Angel





... candidate for lung surgery. Lung Volume Reduction Surgery (LVRS) is a procedure to help people with severe COPD. LVRS is not a cure for COPD but can ... that the remaining healthier portion can perform better. LVRS can also allow the diaphragm to return to ...


The changing role of pectoralis major flap in head and neck reconstruction.  


Although pectoralis major flap (PM flap) has been used as the workhorse flap in head and neck reconstruction, its use in head and neck defects seems to fall out of favour in the era of free tissue transfer. The aim of this review is to find out the role of PM flap in modern head and neck surgery. Medical records of patients who underwent PM flap reconstruction for head and neck defect in our division were reviewed. The age, gender, flap type, indication and complication rate were described. Between January 1998 and December 2008, 202 PM flaps were used for head and neck reconstruction in 192 patients. In the early study period (1998-June 2003), out of the 119 PM flap reconstructions, 106 (89%) were performed for immediate reconstruction after resection of head and neck tumour, while 10 (8%) were performed as salvage procedures for complication after tumour resection e.g. failure of free flap, pharyngocutaneous fistula. In the late study period (July 2003-2008), out of the 83 PM flap reconstructions, 58 (70%) were performed for immediate reconstruction, while 24 (29%) were performed as salvage procedures. For immediate reconstruction after tumour extirpation, 51 flaps (48%) were performed for reconstruction of the tongue in the early study period, while only 14 (24%) were performed in the late study period. The number of PM flap used for immediate reconstruction for other head and neck defects remained relatively static throughout the two study periods. Over the study period, there were 10 (5%) cases of partial flap necrosis and 2 (1%) total flap loss, making the overall flap necrosis rate 6%. In the era of free tissue transfer, the role of PM flap in head and neck surgery has shifted from immediate reconstruction to salvage operation. However, PM flap still has an unique role in the repair of certain head and neck defects. PMID:20461392

Liu, Hin-Lun; Chan, Jimmy Yu-Wai; Wei, William Ignace



Cervicothoracic reconstruction with an anteromedial thigh flap: a novel flap concept.  


The anteromedial thigh region is more popular as a donor site for skin graft than for flap. It is an extended area whose limits are poorly defined. This explains why flaps vascularised by different source arteries but described under the same name can be found in the literature introducing confusion and misunderstanding. This confusion was introduced since the primary descriptions as Baek presented in 1983 an anteromedial skin flap whose source artery was the superficial femoral artery and Song published a year later, under the same name, a flap vascularised by the innominate descending branch of the lateral circumflex femoral artery. Whatever the name and the source artery, the anteromedial thigh region is an under-exploited region which can be useful in the case of composite and complex defects. Anteromedial thigh flaps, either as pedicled or as a microvascular free-tissue transfer, were used in reconstructive surgery. We here describe a chimeric flap of the anteromedial thigh region and used as a flow-through flap. PMID:23168095

Leduey, Alexandre; Leymarie, Nicolas; Bidault, François; Fadel, Elie; Dartevelle, Philippe; Kolb, Frédéric



Free iliac flap for treating multiple skin defects of the hand and digits.  


A total of eight cases with multiple skin defects of the hand and digits were resurfaced using a free iliac flap. The lesions involved both the hand and multiple digits in five patients and multiple digits in three patients. The average skin flap size was 89.3 cm(2). In three, a piece of of vascularized iliac bone was included. There was no flap loss. Flap debulking was performed in five patients at 10-12 weeks post-surgery during the operation for flap separation and inset. Secondary flap debulking was performed in one patient at 6 months post-surgery. The average static 2-point discrimination was 15.4 mm in five patients, whereas the remaining patients only exhibited sensation to pressure. This procedure may require additional refinement; however, the free iliac flap with technical refinements is a viable option for the treatment of multiple skin defects of the hand and digits. PMID:23677961

Pan, Z-H; Jiang, P-P; Xue, S





... be treated with radiation or chemotherapy. Enable direct access for chemotherapy, radiation implants, or genetic treatment of malignant tumors. Relieve seizures (due to a brain tumor) that are hard to control. Types The most common types of surgery for ...


Assessment of skin flap viability using visible diffuse reflectance spectroscopy and auto-fluorescence spectroscopy  

NASA Astrophysics Data System (ADS)

The accurate assessment of skin flap viability is vitally important in reconstructive surgery. Early identification of vascular compromise increases the change of successful flap salvage. The ability to determine tissue viability intraoperatively is also extremely useful when the reconstructive surgeon must decide how to inset the flap and whether any tissue must be discarded. Visible diffuse reflectance and auto-fluorescence spectroscopy, which yield different sets of biochemical information, have not been used in the characterization of skin flap viability simultaneously to our best knowledge. We performed both diffuse reflectance and fluorescence measurements on a reverse MacFarlane rat dorsal skin flap model to identify the additional value of auto-fluorescence spectroscopy to the assessment of flap viability. Our result suggests that auto-fluorescence spectroscopy appears to be more sensitive to early biochemical changes in a failed flap than diffuse reflectance spectroscopy, which could be a valuable complement to diffuse reflectance spectroscopy for the assessment of flap viability.

Zhu, Caigang; Chen, Shuo; Chui, Christopher Hoe-Kong; Liu, Quan



A simple method for predicting survival of pedicled skin flaps before completely raising them  

PubMed Central

Background: Pedicled skin and fasciocutaneous flaps are commonly used in plastic surgery. Once such a flap is completely raised on its pedicle it becomes defenceless against any possible necrosis. Aim: To use a simple method for raising such a flap in a manner that can predict the vascularity better, offering additional protection against necrosis. Materials and Methods: A total of 30 skin and fasciocutaneous flaps were raised in 27 patients. They were raised as bipedicle flaps; and the vascularity of the flap was tested by occluding the additional pedicle with a pedicle occlusion clamp. If the vascularity was found to be satisfactory the flap was primarily transferred; if found unsatisfactory it was either delayed or abandoned. The delayed flaps were again tested during transfer. Results: Nineteen (63.3%) flaps were primarily transferred, 11 (36.7%) flaps were delayed, and two (6.7%) delayed flaps displayed an unsatisfactory pattern during transfer. Twenty-two (73.3%) flaps fully survived and seven (23.3%) underwent partial thickness necrosis at the tip, which healed without any further surgical intervention, making 29 (96.7%) flaps clinically successful. There was major necrosis of one flap. All the flaps with a scar at the base survived. Discussion: The clinical success of 96.7% indicated a high-degree of predictability of flap survival through this method. Also, this method could safely assess the vascularity of flaps during primary transfer, during delayed transfer, and also those with a scar at the base. Conclusions: This technique is recommended in all major pedicled skin and fasciocutaneous flaps.

Mishra, S.



Two modifications of pectoralis major myocutaneous flap (PMMF).  


Pectoralis major myocutaneous flap is the most commonly used versatile flap in head and neck reconstructive surgery. The use of entirely tubed pectoralis major myocutaneous flap for reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy has a disadvantage of bulkiness of the flap and poor postoperative deglutition. One-stage reconstruction of the entire hypopharynx utilizing a combination of pectoralis major myocutaneous flap and dermal graft minimizes bulkiness, thus achieving satisfactory to excellent functional results. The operation has been performed on four patients with excellent deglutition. The pectoralis major myocutaneous flap is utilized to reconstruct the anterior and lateral walls of the hypopharynx, the dermal graft for the posterior wall as far superior as the vault of the nasopharynx. The operative procedure is described. Pectoralis major myocutaneous flap usually provides enough length to reach the distant site of the surgical defect. On occasion, however, additional length is desirable to avoid tension along the suture line. This becomes apparent when a random portion of elevated pectoralis major myocutaneous flap presents questionable viability which may require further trimming. Resection of the medial half of the clavicle can provide additional length of this flap by 2 cm to 2.5 cm. PMID:3515080

Lee, K Y; Loré, J M



Optical spectroscopic assessment of free flap circulatory impairment  

NASA Astrophysics Data System (ADS)

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

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



Total lower eyelid reconstruction with superficial temporal fascia flap and porous polyethylene implant: a case report.  


Total reconstruction of the eyelid after serious periorbital injury is a challenging procedure for plastic and reconstructive surgery. Although several methods have been used for reconstructing the eyelids, such as advancement flap with fascia lata sling, island mucochrondrocutaneous flap, prefabricated temporal island flap, porous polyethylene and superficial temporal fascia flap, creating a supportive eyelid for housing an artificial eye without complication is still an ongoing problem. In the case presented, superficial temporal fascia flap with porous polyethylene was used for the reconstruction of total lower eyelid. PMID:21778127

Sahin, Ismail; Aykan, Andac; Acikel, Cengiz; Alhan, Dogan; Isik, Selcuk



Effects of hyperbaric oxygen and irradiation on experimental skin flaps in rats  

SciTech Connect

This study investigated the effects of hyperbaric oxygen (HBO) and irradiation (RT) on experimental skin flaps in rats under varying conditions. Animals were assigned at random to 1 of 15 groups that represented all possible ordering effects of HBO, RT, and flap, as well as controls that included flap-only, RT-only, and HBO-only groups. Cranially based skin flaps measuring 3 x 9 cm were elevated on the dorsum. The surviving length was evaluated with fluorescein dye 7 days after the operation. Depending on the treatment condition, HBO was given either 48 hours or 24 hours before flap elevation, or within 4 hours or 48 hours after flap elevation. Rats receiving RT (WCo) were given a single dose of 1000 rads to the dorsum. Results showed that all groups receiving HBO within 4 hours after flap elevation had significantly greater flap survival length, with as much as a 22% greater length of surviving flap. HBO given 48 hours before flap elevation also significantly improved flap survival over controls. RT appeared to have no immediate significant effect on flap survival. However, rats receiving RT, regardless of other factors, gained significantly less weight than did controls. Findings clearly indicate that, to be effective, HBO needs to be given as soon after surgery as possible.

Nemiroff, P.M.; Merwin, G.E.; Brant, T.; Cassisi, N.J.



High-energy war wounds: flap reconstruction.  


In this article, we emphasize that knowledge of terminal ballistics is essential for understanding the pathophysiology of war wounds. We present our own experiences in treatment of high-energy war wounds in 75 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. Patients were divided into three groups with regard to the time of definite reconstruction, using local or free microvascular flaps. About 12% of patients underwent flap reconstruction in the acute phase, associated with low complication rate and the shortest hospital stay. Group II was comprised by 18% of the patients and, considering the number of complications, presented the most unfavorable time for reconstruction. Flap reconstruction in the chronic phase resulted in a substantial prolongation of the hospital stay in 82% of patients. Therefore, we advocate proper primary treatment of wounds aimed at early flap closure. This type of management results in a significantly shorter hospitalization and leads to more effective rehabilitation and recovery of patients. PMID:8215140

Stanec, Z; Skrbi?, S; Dzepina, I; Hulina, D; Ivrlac, R; Unusi?, J; Montani, D; Prpi?, I



Hemi-tongue flaps.  


We describe a design for tongue flaps that utilizes the full thickness of the hemi-mobile tongue that provides mucosal lining, muscle bulk, and a long, supple, nonrestricting pedicle. The method was used in six children who had large palatal defects and allowed complete and permanent closure without any of the complications previously associated with lingual flaps. PMID:7208671

Carlesso, J; Mondolfi, P; Flicki, E



[Medial sural artery perforator fasciocutaneous flap for the reconstruction of tongue and mouth base].  


Background: Despite the well-known high donor site morbidity of the radial forarm flap, it has still remained the first option for the reconstruction of the tongue and the floor of mouth. However, a desire for an alternative, thin fasciocutaneous flap has led to the use of the median sural artery perforator flap. Methods: Three patients had reconstructive surgery used MSAP flaps, after radical tumor excision. Results: The flap was based in all cases on a dominant perforator vessel. The size of the skin paddles ranged between 20-32 cm2, and the length of the vascular pedicle between 8.2-11 cm. The mean thickness of the flap was 6.5 mm. Conclusion: MSAP flap is an ideal solution for surgical reconstruction in the oral cavity. PMID:23955954

Lóderer, Zoltán; Bognár, Gábor; Novák, András; Berki, Csaba; Sándor, Gábor; Bognár, Gábor; Ondrejka, Pál



Rotational pectoral musculocutaneous flap for the repair of gastric conduit necrosis in cervical esophagogastrostomy  

PubMed Central

We experienced a case of wide necrosis of the cervical gastric conduit during esophageal cancer surgery. We attempted to repair this defect with various methods including conservative care, stents two times, and sternocleidomastoid muscle flap without successful results. Finally, we were able to reconstruct the gastric conduit defect with rotational pectoralis major musculocutaneous (PMM) flap. PMM flap is thought to be a reconstruction method applicable to the intractable gastric conduit defect.

Kim, Jae Jun; Hwang, Sun Jin; Moon, Seok Whan



Reconstruction of scalp defects with the radial forearm free flap  

PubMed Central

Background Advanced and recurrent cutaneous squamous cell carcinoma of the scalp and forehead require aggressive surgical excision often resulting in complex defects requiring reconstruction. This study evaluates various microvascular free flap reconstructions in this patient population, including the rarely utilized radial forearm free flap. Patients and methods A retrospective review of patients undergoing free flap surgeries (n = 47) of the scalp between 1997 and 2011 were included. Patients were divided primarily into two cohorts: a new primary lesion (n = 21) or recurrence (n = 26). Factors examined include patient demographics, indication for surgery, defect, type of flap used, complications (major and minor), and outcomes. Results The patients were primarily male (n = 34), with a mean age of 67 years (25–91). A total of 58 microvascular free flap reconstructions were performed (radial forearm free flap: n = 28, latissimus dorsi: n = 20, rectus abdominis: n = 9, scapula: n = 1). Following reconstruction with a radial forearm free flap, duration of hospitalization was shorter (P = 0.04) and complications rates were similar (P = 0.46). Donor site selection correlated with defect area (P < 0.001), but not with the extent of skull defect (P = 0.70). Larger defect areas correlated with higher complications rates (P = 0.03) and longer hospitalization (P = 0.003). Patients were more likely to require multiple reconstructions if referred for a recurrent lesions (P = 0.01) or received prior radiation therapy (P = 0.02). Conclusion Advanced and recurrent malignancies of the scalp are aggressive and challenging to treat. The radial forearm free flap is an underutilized free flap in the reconstruction of complex scalp defects.



Anteromedial thigh perforator-assisted closure of the anterolateral thigh free flap donor site.  


Primary closure of the anterolateral thigh free flap donor site is advisable as skin grafting can be associated with higher morbidity. However, this is not possible when anterolateral thigh free flap width is over 8-9 cm with a corresponding flap width-to-thigh circumference ratio over 16%. The authors report their experience and technique with the anteromedial thigh perforator dissection during anterolateral thigh free flap donor-site closure that, on demand, can be used to design a local perforator flap to achieve primary closure of the donor site. Between July and December 2012, 20 consecutive patients underwent elective anterolateral thigh free flap reconstruction for head and neck oncologic surgery. Attempts to close directly the anterolateral thigh free flap donor site failed in two patients with large flaps and V-Y anteromedial thigh perforator flaps were advanced to close the defect. Flaps healed uneventfully. Except two patients, at least one>1-mm perforator was found in all the remaining thighs. Further investigation is needed to establish the maximum anterolateral thigh free flap donor-site width that can be served by this reconstruction. This represents an ideal model for residents to start training on perforator dissection. PMID:23523166

Visconti, Giuseppe; Salgarello, Marzia



Split pectoralis major flaps for mediastinal wound coverage: a 12-year experience.  


Poststernotomy mediastinitis is an infrequent but highly dangerous complication following median sternotomy. Typically, such wounds are debrided aggressively of necrotic and foreign materials with subsequent flap reconstruction. Between December 1989 and January 2002, 69 patients were referred to the University of Maryland division of plastic surgery for mediastinal wound coverage. A total of 105 flaps of various types were used. Fifty-eight percent of the patients received a single flap. Ninety percent of the flaps used were pectoralis major flaps, whereas only 10% of the flaps were rectus abdominis, latissimus dorsi, or omentum flaps. Ten patients (14.5%) required reoperation. The most common comorbidity was diabetes mellitus. Those patients with diabetes mellitus were 9.1 times more likely to require reoperation after their sternal reconstruction compared with nondiabetic patients (95% confidence interval, 2.1-40.4). Four patients (5.8%) died less than 30 days from their flap procedure. The flap of first choice used in this series is the pectoralis major turnover flap, which is harvested in its entirety and split in the direction of its muscle fibers. Taking the entire muscle allows better coverage of the lower portion of the incision, resulting in far less frequent need for abdominal flaps and their associated morbidity. PMID:15385766

Li, Edward N; Goldberg, Nelson H; Slezak, Sheri; Silverman, Ronald P



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

PubMed Central

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



Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap  

Microsoft Academic Search

Objective: To report our experience using two staged bilateral pectoralis major flap as the sole treatment modality for sternal wound infection. Methods: A retrospective study of 9417 open-heart surgery cases performed between 1998 and 2003 at The Prince Charles Hospital. Sixty-eight patients were referred to the plastic surgical team for consideration of bilateral pectoralis major flap as the sole treatment

Clement H. K. Wong; Shireen Senewiratne; Bruce Garlick; Daniel Mullany



Predictive Capability of Near-Infrared Fluorescence Angiography in Submental Perforator Flap Survival  

PubMed Central

Background Perforator flaps have become increasingly popular in reconstructive surgery as patients experience less donor-site morbidity than with conventional musculocutaneous flaps. Previously, our laboratory described the intraoperative use of near-infrared (NIR) fluorescence angiography for patient-specific perforator-flap design. This study evaluates the predictive capability of NIR fluorescence angiography for flap survival in submental flap reconstruction. Methods NIR angiography was performed using indocyanine green at 0, 0.5, 24, 48, and 72 h post-surgery after flap creation in 12 pigs. A single perforator artery was preserved during flap creation based on location (central or non-central) and dominance (dominant or non-dominant). Venous drainage, arterial perfusion, and perfused area as percentage of total flap were analyzed. Clinical assessments of perfusion were compared with those made using NIR imaging and histology. Results Use of NIR fluorescence angiography immediately after flap creation accurately predicted areas of perfusion at 72 h (p = 0.0013), compared to the initial clinical assessment (p = 0.3085). Identification of necrosis by histology at 72 h correlated with NIR findings of insufficient arterial perfusion immediately after flap creation. No statistically significant differences in perfusion metrics were detected based on location or dominance of the preserved perforator; however, flaps containing central perforators had a higher percent perfused area than those with non-central perforators. Conclusions The use of NIR angiography immediately after flap creation can predict areas of perfusion at 72 h. This predictive capability may permit intraoperative revision of compromised flaps that have a high likelihood of failure.

Matsui, Aya; Lee, Bernard T.; Winer, Joshua H.; Laurence, Rita G.; Frangioni, John V.



Lateral deltopectoral flap: a new and extended flap.  


Tissues of the pectoral area such as skin and pectoralis major muscle are used in safe and extended flaps for cervical and neck reconstructions. As blood supply is derived from medial vessels (internal mammary artery) or lateral (thoracodorsal and lateral thoracic arteries), 2 different flaps can be constructed: medial and lateral deltopectoral flaps. Medial deltopectoral flap was developed by Bakamjian as an axial-pattern skin flap, and its blood supply depends on perforating branches from the internal mammary artery. When either parasternal skin or pectoralis major muscle must be resected, this flap obviously cannot be used. In this article, a new lateral deltopectoral flap based on lateral pedicles (from axilla and lateral thoracic area) is described. The successful use of this lateral deltopectoral flap in an extended cervical and thoracic reconstruction after resection of a giant basal cell carcinoma demonstrates that it must be considered as an alternative technique. PMID:19387360

Güerrissi, Jorge Orlando



Vastus lateralis muscle flaps for monitoring buried anterolateral thigh flaps.  


Postoperative monitoring of buried anterolateral thigh flaps is difficult with standard methods. Although a monitoring skin flap based on a second cutaneous perforator is often used, it requires tedious dissection of 2 sets of perforators and cannot be used when a second perforator is absent. We present 2 patients who underwent head and neck reconstruction with buried anterolateral thigh flaps, which were monitored with a small, externalized segment of the vastus lateralis muscle accompanying the main skin island. Both flaps survived, and the monitoring muscle flaps remained pink throughout the postoperative period until removal. For monitoring, a vastus lateralis muscle flap has several advantages over a skin flap. This method obviates the need for dissecting a second cutaneous perforator and allows reliable monitoring regardless of the number of available cutaneous perforators. We believe this method is a versatile option for monitoring buried anterolateral thigh flaps. PMID:24036768

Miyamoto, Shimpei; Kayano, Shuji; Umezawa, Hiroki; Fujiki, Masahide; Sakuraba, Minoru



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

SciTech Connect

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

Young, C.M.



Levels of gingival tissue platelet activating factor after conventional and regenerative periodontal surgery  

Microsoft Academic Search

The hypothesis, a relationship between gingival tissue platelet activating factor (PAF) levels and healing after periodontal\\u000a surgery, was tested by measuring PAF levels in gingival tissues collected from sites that had undergone flap surgery and guided\\u000a tissue regeneration (GTR) or flap surgery alone. Using a split-mouth design, 20 intrabony defects were randomly assigned to\\u000a treatment with flap surgery and GTR

Gonca Cayir Keles; Burcu Ozkan Cetinkaya; Bulent Ayas; Ibrahim Isildak; Emine Diraman; Hulya Koprulu; Gokhan Acikgoz



Rotor Blade Flapping Criteria Investigation.  

National Technical Information Service (NTIS)

The objective of this study was to identify helicopter characteristics critical to main rotor flapping and to attempt to establish flapping design criteria. Three helicopter types and three rotor systems were simulated in steady flight an maneuvers using ...

L. W. Dooley



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


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

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



Advances in Plastic Surgery  

PubMed Central

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

McDonald, Harold D.; Vasconez, Luis O.



The viability of skin flaps.  

PubMed Central

The historical development of skin flaps is outlined, and in particular their division into two types: random, which are supplied by small musculocutaneous vessels; and axial flaps, which are supplied by named cutaneous vessels running within the flap. Experiments are described into the viability of random skin flaps, using the pig as an experimental model. These experiments confirm that random flaps should not be designed longer than their base and probably should not exceed 12.5 cm (5 in) in length. Images Fig. 1

Stell, P. M.



Invited discussion: Harvesting of forearm perforator flaps based on intraoperative vascular exploration: clinical experiences and literature review.  


Advancements in microsurgery and a better understanding of vascular anatomy has allowed for expanding indications for perforators flaps in reconstructive surgery. The use of perforator flaps in the forearm has not become widespread, yet the benefit of sparing a major peripheral artery such as the ulnar or radial is certainly worth considering. The authors present their experience with perforator flaps in the forearm. PMID:18537175

Lee, Gordon K



Flap size/flow rate relationship in perforator flaps and its importance in DIEAP flap drainage.  


The vascular architecture within a perforator flap is different from a conventional muscle or myocutaneous flap. The purpose of this paper is to understand the correlation between flow rate and flap size in perforator flaps. With extrapolation of these data, we have provided an indirect analysis of the venous drainage and its correlation with flap size. A prospective study was planned. Twenty-five patients were enrolled in this study: six patients were operated on using an anterolateral thigh (ALT) flap and 19 using a deep inferior epigastric artery perforator (DIEAP) flap. One month postoperatively, echo-colour-Doppler measurements were performed on pedicle and perforator arteries to calculate blood flow rate in the flaps. A correlation between weight and flow rate was analysed. Spearman rho statistic was calculated. A linear regression model was made from patient data of flow rate/flap weight and predicted values of flow per flap weight were calculated. Then, flow rate values of veins of various diameters were estimated using Hagen-Poiseuille's formula. Our data show that flow rate measured postoperatively on flap arteries is significantly correlated with flap weight [rho(23 d.f.)=0.725, P<0.01 (two-tailed)]. Moreover, we have calculated the minimum size of veins able to drain flaps of increasing weights with different patterns, i.e. our data show that veins of 1.30, 1.50 and 1.75 mm diameter could safely drain flaps of, respectively, 300, 500 and 900 g in weight. This can be useful preoperatively to estimate the risk of flap congestion and in planning additional drainage. PMID:18851934

Rubino, C; Ramakrishnan, V; Figus, A; Bulla, A; Coscia, V; Cavazzuti, M A



[Reconstruction of the thumb using a forearm osseofasciocutaneous reverse flap].  


This paper presents the experiences of the thumb reconstruction with osteofasciocutaneous reverse flap (OFCR flap). In the period between 1987 and 2000 the OFCR flap was used in 15 patients. The youngest of them was 18 and the oldest was 38 years of age. The average age was 25.4. All the patients had posttraumatic amputations. Defects on proximal phalangae and a part of metacarpal bone occurred in two cases. In one case there was an amputation on the base level of proximal phalanx and the metacarpophalangeal (MPH) joint was preserved. In all cases of reconstruction the OFCR flap was used, which included antebrachial skin nervs that were anastomosed with digital nerv. The flap nutrition was carried out through the reverse circulation of a. radialis, and the venous drainage through the comitant vein of a. radialis. Superficial veins were not anastomosed. Secondary defects were covered with a free skin graft. All the flaps survived. The bone graft was healed in the period of eight weeks. The sensibility of this flap was regained in the period of three to six months after the surgery. The distance of two-point discrimination (TPD) was increased for 30% compared to the same region on the other hand after six months. The opposition of the reconstructed thumb to the other fingers was possible, as well as abduction, adduction and normal grasp. The method of reconstruction of the amputated thumb with the OFCR flap was better than other classical methods because it allowed the reconstruction of all the structures in one surgical operation. The sensibility that was regained represented good protection from injuries. There were no functional damages on the secondary defect. The esthetic result was not good due to the lack of a fingernail. PMID:12557617

Jevtovi?, Dobrica; Dordevi?, Boban; Gacevi?, Milomir; Sijan, Goran


Jet Flap Diffuser Ejector.  

National Technical Information Service (NTIS)

The use of a jet flap diffuser for recovery of ejector jet kinetic energy has been investigated in a two-dimensional experiment, utilizing an ejector which employs a Coanda inlet for ninety degree rotation of the primary flow. Performance is compared to a...

G. L. Marlotte M. Alperin



The effect of platelet rich plasma on angiogenesis in ischemic flaps in VEGFR2-luc mice.  


To improve skin flap healing, one promising strategy in reconstructive surgery might be to optimize platelet rich plasma (PRP) bioactivity and the ischemia-altered expression of genes. We studied both the effect of PRP on ischemic flaps, and whether in vivo bioluminescence imaging (BLI) is a suitable method for the longitudinal monitoring of angiogenesis in surgical wounds. Axial murine skin flaps were created in four experimental groups. In vivo measurements of VEGFR2 expression levels were made every other day until the 14th day. The local VEGF level and microvessel density were quantified on the 14th day via ELISA and immunohistochemistry, and flap survival rates were measured. We demonstrated that PRP and induced ischemia have a beneficial influence on angiogenesis and flap healing. Combining the two resulted in a significantly robust increase in angiogenesis and flap survival rate that was corroborated by bioluminescence imaging of VEGFR2 activity. This study shows that angiogenic effects of PRP may be potentialized by the stimulus of induced ischemia during free flap harvesting, and thus the two procedures appear to have a synergistic effect on flap healing. This study further demonstrates that BLI of modulated genes in reconstructive surgery is a valuable model for longitudinal in vivo evaluation of angiogenesis. PMID:23352038

Sönmez, Tolga Taha; Vinogradov, Alexandra; Zor, Fatih; Kweider, Nisreen; Lippross, Sebastian; Liehn, Elisa Anamaria; Naziroglu, Mustafa; Hölzle, Frank; Wruck, Christoph; Pufe, Thomas; Tohidnezhad, Mersedeh



Uncommon flaps for chest wall reconstruction.  


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

Matros, Evan; Disa, Joseph J



Craniofacial and head and neck applications of the transaxillary latissimus dorsi flap.  


The use of a transaxillary latissimus dorsi musculocutaneous flap is suitable whenever a large volume of tissue is required for head and neck reconstruction. Our series of 63 transaxillary latissimus dorsi musculocutaneous flap reconstructions included three cases of complete flap necrosis and ten cases of partial flap necrosis. When used in reconstructive head and neck surgery, the latissimus dorsi vascular pedicle is separate from the radiated field. The pedicled latissimus dorsi flap provides coverage of the orbitocranium, including the supraorbital region and central portion of the upper face. In the event that the pedicle muscle flap does not reach far enough cephalad, the nutrient vessels can be separated from the axillary artery and anastomosed to vessels in the neck. Combined defects of the esophagus, the mandibulofacial region, and the neck may be reconstructed with a single large latissimus dorsi flap. In our experience, aesthetic and functional deficits have been well tolerated by patients after latissimus dorsi reconstruction. Disadvantages of the latissimus dorsi flap include repositioning of the patient, increased blood loss, and longer operating time. Permanent brachial plexus injury can also occur. In general, the transaxillary latissimus dorsi musculocutaneous flap should not be used when defects can be reconstructed using simpler methods. PMID:1582368

Sabatier, R E; Bakamjian, V Y; Carter, W L



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


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

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



Supercharged pectoralis major musculocutaneous flap.  


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

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



Hypnosis in Plastic Surgery  

Microsoft Academic Search

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

David L. Scott



Use of “House” Advancement Flap in Anorectal Diseases  

Microsoft Academic Search

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

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



Novel flaps for head and neck reconstruction.  


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

Ahmad, Quazi Ghazwan; Shankhdhar, Vinay Kant



Flexible Flapping Foils  

NASA Astrophysics Data System (ADS)

Hydrodynamic tunnel experiments with flexible flapping foils of 4:1 span-to-chord aspect ratio are used in the present work to study the effect of foil compliance in the dynamical features of a propulsive wake. The average thrust force produced by the foil is estimated from 2D PIV measurements and the regime transitions in the wake are characterized according to a flapping frequency-amplitude phase diagram as in Godoy-Diana et al. (Phys. Rev. E 77, 016308, 2008). We show that the thrust production regime occurs on a broader region of the parameter space for flexible foils, with propulsive forces up to 3 times greater than for the rigid case. We examine in detail the vortex generation at the trailing edge of the foils, and propose a mechanism to explain how foil deformation leads to an optimization of propulsion.

Marais, Catherine; Godoy-Diana, Ramiro; Wesfreid, José. Eduardo



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


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

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



The vortex flap  

NASA Astrophysics Data System (ADS)

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

Buerge, Brandon T.


Role of platysma muscle flap in depressed scars of neck  

PubMed Central

Background: Depressed scars in the neck pose a cosmetic problem. There is a need to fill the lost tissue volume defect between the surface and deeper tissues. It is preferable that the filling is done by autologous tissue which is available in substantial amount in the adjoining area. There should be no donor site morbidity. Platysma muscle flap meets these criteria. Materials and Methods: Platysma muscle flap was advanced into the defect after excision of depressed scar. The procedure was done under local anesthetic in two patients. Result: The result was a ‘good scar’ with scar lying in the transversely oriented neck lines. Conclusions: Platysma muscle flap has a definitive role in revision surgery of depressed scars in neck as it provides an ideal tissue for lost tissue volume.

Sandhir, Rakesh K.; Jindal, Bharat R.; Sandhir, Shivanjali



Acute effects of cigarette smoke exposure on experimental skin flaps  

SciTech Connect

Random vascular patterned caudally based McFarlane-type skin flaps were elevated in groups of Fischer 344 rats. Groups of rats were then acutely exposed on an intermittent basis to smoke generated from well-characterized research filter cigarettes. Previously developed smoke inhalation exposure protocols were employed using a Maddox-ORNL inhalation exposure system. Rats that continued smoke exposure following surgery showed a significantly greater mean percent area of flap necrosis compared with sham-exposed groups or control groups not exposed. The possible pathogenesis of this observation as well as considerations and correlations with chronic human smokers are discussed. Increased risks of flap necrosis by smoking in the perioperative period are suggested by this study.

Nolan, J.; Jenkins, R.A.; Kurihara, K.; Schultz, R.C.



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

PubMed Central

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

Bhat, Satish P.



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

PubMed Central

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

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



The gluteal fold fascio-cutaneous flap for reconstruction after radical excision of primary vulvar cancers  

Microsoft Academic Search

ObjectivesReconstructive surgery plays an important role in cosmetic and functional results of major excisional surgery performed as a treatment for invasive vulvar cancer. Traditional techniques – gracilis myocutaneous o rectus abdominis flaps – have several limits. We describe here a different surgical approach that we have used since 1998 in an effort to obtain better results in vulvar reconstruction.

S. Franchelli; M. S. Leone; M. Bruzzone; M. Muggianu; A. Puppo; C. Gustavino; E. Di Capua; M. G. Centurioni



Reconstruction of Nasal Skin Cancer Defects with Local Flaps  

PubMed Central

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

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



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

PubMed Central

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.

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



Factors Influencing Corneal Flap Thickness in Laser In Situ Keratomileusis with a Femtosecond Laser  

PubMed Central

Purpose To evaluate factors responsible for the variability between intended and achieved corneal-flap thickness during femtosecond laser-assisted laser in situ keratomileusis (LASIK). Methods A prospective, nonrandomized, case study was performed on 35 eyes of 18 consecutive patients who underwent LASIK surgery using the 60 kHz femtosecond laser microkeratome. Eyes were assigned to three different thickness groups, with 110-, 120-, or 130-µm cut depths. Anterior segment optical coherence tomography was used to assess the morphology of 35 LASIK flaps at postoperative one week postoperatively. The flap thickness was assessed at seven measuring points across each flap. Patient age, preoperative spherical equivalent, manual keratometry, preoperative central pachymetry, and regional variability of the cornea were evaluated to determine where they influenced the achieved corneal flap thickness. Results Cuttings of all flaps were easily performed without any intraoperative complications. Flap-thickness measurements had a mean of 115.21 ± 4.98 µm (intended thickness, 110 µm), 121.90 ± 5.79 µm (intended, 120 µm), and 134.38 ± 5.04 µm (intended, 130 µm), respectively. There was no significant difference between the 110-µm and 120-µm groups when compared with the 130-µm group (one-way analysis of variance test, p > 0.05). Patients' age, preoperative spherical equivalent, manual keratometry, and preoperative central pachymetry did not affect the achieved flap thickness (Pearson correlations test, p > 0.05). The reproducibility of flap thickness in the central 1.5-mm radius area was more accurate than that in the peripheral 3.0 to 4.0-mm radius area (paired samples t-test, p < 0.05). Conclusions Femtosecond laser-assisted LASIK is likely to reproduce a reliable thickness of the corneal flap, which is independent of corneal shape factors or refractive status. Future studies should focus on variations in corneal biomechanical factors, which may also play an important role in determining flap thickness.

Kim, Chan Young; Song, Ji Hye; Na, Kyoung Sun; Chung, So-Hyang



Island flaps in the repair of medial canthus: Report of 8 cases.  


Reconstruction of the medial canthus following skin cancer excision is often challenging because of the complex anatomy and the cosmetic relevance of that region. The island pedicle advancement flap is an extremely versatile flap, which is commonly used to close defects in different body areas, including face, trunk, and extremities. We report our favourable experience with the use of island flaps, mobilized from the nasal saddle or lateral nasal side wall in 8 patients who had skin defects on the medial canthus region after Mohs micrographic surgery for basal cell carcinomas. PMID:24011325

Cecchi, Roberto; Fancelli, Laura; Troiano, Michela



Heparin-soaked gauze to salvage congested flaps: the poor man’s leech  

Microsoft Academic Search

An important and broad area of plastic surgery entails the cover of defects by pedicled or free flaps and the revascularisation\\u000a of amputated parts of the body. Failure of perfusion in flaps and replants, due to venous congestion, presents a problem even\\u000a to the most experienced surgeon. Many bleeding techniques have been used to relieve venous congestion after replantation and

A. Y. Goedkoop; R. B. Karim; J. J. Hage



A New Technique of Upper Eyelid Blepharoplasty Using the Orbicularis Muscle Flap  

Microsoft Academic Search

Background  Blepharoplasty of the upper eyelids is one of the most commonly performed procedures in aesthetic plastic surgery. The orbicularis\\u000a muscle flap technique provides good results for patients with atonic skin and an atonic orbicularis muscle when there is excessive\\u000a fullness in the lateral aspect of the upper lid. This flap also can be used to contain a prominent lacrimal gland

Manfredi Greco; Tiziana Vitagliano; Maria Antonia Fiorillo; Antonio Greto Ciriaco


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


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

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



Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction  

Microsoft Academic Search

Objective. To evaluate the impact of TRAM flap delayed breast reconstruction on health related quality of life in patients who had undergone mastectomy.Methods. Twenty-five patients following mastectomy were selected consecutively from the Plastic Surgery\\/Mastology Units of two university hospitals. All subjects underwent breast reconstruction with the use of pedicled TRAM flap. The patients' health related quality of life was assessed

D. F Veiga; M Sabino Neto; L. M Ferreira; E. B Garcia; J Veiga Filho; N. F Novo; J. L. B. S Rocha



Two-stage management of sternal wound infection using bilateral pectoralis major advancement flap  

Microsoft Academic Search

Objective:Toreportourexperienceusingtwostagedbilateralpectoralismajorflapasthesoletreatmentmodalityforsternalwoundinfection. Methods: A retrospective study of 9417 open-heart surgery cases performed between 1998 and 2003 at The Prince Charles Hospital. Sixty-eight patients were referred to the plastic surgical team for consideration of bilateral pectoralis major flap as the sole treatment modality for sternal wound infection. Results: There was a trend for early referral for flap operation (median 10 days) (p

Clement H. K. Wong; Shireen Senewiratne; Bruce Garlick; Daniel Mullany



Changes in airflow dynamics after creation of pharyngeal flaps in nonsyndromic children.  


Velopharyngeal insufficiency is a common problem in the cleft palate population that may require a pharyngeal flap. Sleep disordered breathing is a common complication of this surgery and a baseline sleep study is often performed before undergoing the procedure. Few postoperative sleep studies are ever done and little is known about the effects that pharyngeal flaps have on airflow dynamics.Preoperative and postoperative nasometry and polysomnographic data were reviewed and compared from nonsyndromic children requiring pharyngeal flap since 2009. Eighteen children having undergone pharyngeal flap were identified. Of those 18, Nadir oxygen saturations were worsened in 10, improved in 7, and remained the same in 1. Snoring was caused or made worse in 8. Sleep efficiency was worse in 11, improved in 6, and remained the same in 1. Apnea/hypopnea events increased in 9 and decreased in the other 9. Hypernasality was improved in varying degrees in 17 patients, but all required additional speech therapy. Diagnosed preoperative sleep apnea remained in 1 patient. No patient's postpharyngeal flap had any significant sleep disturbance that would warrant continuous positive airway pressure. No flaps required division or takedown.This preliminary study suggests that pharyngeal flaps may increase snoring and apnea/hypopnea events without causing diagnosable sleep disordered breathing and the resultant clinical sequelae. Nasometry shows evidence of nasal airway diversion without complete obstruction. Speech improves more subjectively than nasometry would predict after pharyngeal flap. PMID:23542857

Griner, Devan; Sargent, Larry A; Overmeyer, Claire Lee



Tissue engineered prefabricated vascularized flaps  

Microsoft Academic Search

Background. Microvascular free tissue transfer has become increasingly popular in the reconstruction of head and neck defects, but it also has its disadvantages. Tissue engineer- ing allows the generation of neo-tissue for implantation, but these tissues are often avascular. We propose to combine tissue-engi- neering techniques together with flap prefabrication techniques to generate a prefabricated vascularized soft tissue flap. Methods.

Kenneth Kian Kwan Oo; Wei Chen Ong; Annette Hui Chi Ang; Dietmar W. Hutmacher; Luke Kim Siang Tan



The use of a latissimus dorsi muscle flap for scapular reconstruction in a cat following fibrosarcoma excision.  


A latissimus dorsi muscle flap was used to reconstruct a proximal scapular defect in a cat after excision of a fibrosarcoma that had recurred after eight surgeries, radiation therapy, and chemotherapy. To obtain appropriate surgical margins, infraspinatus and supraspinatus myectomy and scapular spinous ostectomy were performed. The latissimus dorsi muscle flap was rotated into the defect and anchored to four holes placed in the cranial border of the scapula. The cat showed no lameness at 6, 21, 42, and 147 days after surgery. The latissimus dorsi muscle flap was successful for proximal scapular reconstruction in this cat. PMID:11361122

Canapp, S O; Mann, F A; Henry, C J; Lattimer, J C


Experience with the forearm septofascial flap  

Microsoft Academic Search

Fascia has a well vascularized surface, and when it is covered with a split skin graft, it provides the thinnest possible flap. The authors present their own experience with the use of the forearm septofascial flap in 23 patients. A free septofascial flap was used in 15 patients and an island flap in 8 patients. Seven days later, only 25%

Z. Stance; R. Ivrlac; J. Unusic; D. Hulina; I. Dzepina; D. Montani; I. Prpic



Reconstruction of gluteal defects using free flaps.  


The TRAM flap, DIEP flap, and gluteal free flaps are routinely used for breast reconstruction. However, these have seldom been described for reconstruction of buttock deformities. We present three cases of free flaps used to restore significant buttock contour deformities. They introduce vascularised bulky tissue and provide adequate cushioning for future sitting, as well as correction of the aesthetic defect. PMID:23294832

Aggarwal, Shagun; Pennington, David



Muscle flaps or omental flap in the management of deep sternal wound infection.  


The primary question addressed was whether muscle flaps (MFs) offer a significant advantage over an omental flap (OF) in the management of deep sternal wound infection (DSWI) following cardiovascular surgery in terms of outcome (morbidity and mortality). Altogether, 333 citations (from PubMed and EMBASE and using a manual search, without language restriction) were identified using the reported strategy. Focusing on publications from single institutions with experience with both types of flap in the treatment of DSWI, 16 studies represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. These 16 observational studies covered 1046 patients, and all reported mortality rates. Unadjusted data from five of six studies investigating a possible association between mortality and flap type suggested a higher mortality rate following reconstruction with MFs. A meta-analysis of all six studies indicates a slight, but not significant, survival advantage for reconstruction with an OF [overall relative risk 1.29 (95% confidence interval 0.58-2.88)]. Thirteen studies reported on the number of individual postoperative complications for a total of 964 patients. Data, unadjusted for potentially confounding surgical factors, on complications following flap closure, such as complete or partial flap loss, haematoma, arm or shoulder weakness and chronic chest wall pain, suggested that these complications were more common following MF reconstruction. Four studies evaluated patients with recurrent sternal wound infection (n=521). Two of these were associated with a high incidence (>17.5%) of re-exploration for recurrent sternal infection following MF reconstruction. The most commonly reported complications following an OF were abdominal or diaphragmatic hernias, with an incidence of <5%. We conclude that the weight of current evidence is insufficient to prove the superiority of reconstruction with MFs to a laparotomy-harvested, OF in the treatment of DSWI. The results suggest that use of the omentum may be associated with lower mortality and fewer complications. PMID:21543366

van Wingerden, Jan J; Lapid, Oren; Boonstra, Piet W; de Mol, Bas A J M



The reverse sural artery neurocutaneous flap under combined sciatic and femoral nerve block for lower limb defects: a series of ten cases  

Microsoft Academic Search

The case of reverse sural artery neurocutaneous flap done for lower leg defects under combined sciatic and femoral nerve block\\u000a is presented. Doing the flap using this method of anesthesia makes the positioning changes necessary during surgery easy.\\u000a All flaps survived. Nine out of the ten blocks acted satisfactorily. The technique of giving the combined block is described\\u000a in brief.

Aswin Appukuttan; Jimmy Mathew; Saramma Varghese; S. Jagadeesh



Repairing the high-riding nipple with reciprocal transposition flaps.  


The high-riding nipple-areola complex is a clinical problem that can be encountered following cosmetic and reconstructive breast surgery. Because of the desire to avoid scars on the superior aspect of the breast and the limited availability of superior breast skin, it can be technically challenging to place the nipple-areola complex in a lower position. Multiple surgical strategies have attempted to lower it, and each has its advantages and disadvantages. Reciprocal rotation flaps have been used by the authors with success. They describe the surgical technique and outcomes in five breasts. The medical records of all patients who had reciprocal rotation flaps for high-riding nipple-areola complexes performed by the senior author (S.L.S.) were reviewed. The institutional review board-approved review included preoperative history and examination, surgical findings, surgical technique, and postoperative course. Five reciprocal rotation flap procedures were performed on four patients between 2005 and 2012 for high-riding nipple-areola complexes. The high-riding nipple-areola complexes were all iatrogenic, following reconstruction for nipple-sparing mastectomy or mastopexy. All nipple-areola complexes were successfully lowered with an average follow-up duration of 2.1 years. One breast that had undergone previous radiation therapy had a nipple-areola complex flap that appeared ischemic; the patient underwent hyperbaric oxygen therapy and the flap fully survived. Reciprocal rotation flaps are an effective strategy for management of the high-riding nipple-areola complex and can be safely performed with thoughtful planning and careful surgical technique. This technique is riskier in the irradiated breast but may be facilitated with hyperbaric oxygen therapy. PMID:23542242

Spear, Scott L; Albino, Frank P; Al-Attar, Ali



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


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

Shinya, K



Pectoralis major and other myofascial\\/myocutaneous flaps in head and neck cancer reconstruction: Experience with 437 cases at a single institution  

Microsoft Academic Search

Background. Pectoralis major and other myofas- cial\\/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers. Methods. We retrospectively analyzed the records of pa- tients with head and neck cancer who underwent an immediate reconstruction with pectoralis

Solange Maria T. Carvalho; Lia Mizobe; Luiz Paulo Kowalski



Effects of Primary Rotor Parameters on Flapping Dynamics.  

National Technical Information Service (NTIS)

The effects of flapping dynamics of four main rotor design features that influence the agility, stability, and operational safety of helicopters are studied. The parameters include flapping hinge offset, flapping hinge restraint, pitch-flap coupling, and ...

R. T. N. Chen



The role of the anterolateral thigh flap in complex defects of the scalp and cranium.  


In this study, we introduced scalp reconstruction using free anterolateral thigh (ALT) flaps and evaluated postoperative outcomes in nine patients between March 2000 and April 2012. Five patients had problems of exposed prosthesis, three required reconstruction after resection of scalp tumor and one patient presented with third degree flame burns of the scalp. All flaps survived without re-exploration, except three flaps with tip necrosis requiring secondary procedures of debridement and small Z-plasty reconstructions. The superficial temporal artery and its concomitant vein were used as recipient vessels, apart from two cases where previous surgery and flame burns excluded these choices, for which facial arteries and veins were used instead. Primary closure of the donor-site was possible in six cases; with skin grafting performed for the other three patients. All donor sites healed without complications. The ALT flap offers the advantage of customizable size, option of fascia lata as vascularized dural replacement, and minimal flap atrophy typical of muscle flaps. Indications include very large defects, defects with exposed prosthesis, or defects with bone or dural loss. Our experience lends credible support to the use of customized free ALT flaps to achieve functional and cosmetically superior result for the reconstruction of large scalp defects, especially with bone exposure. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013. PMID:23640870

Lin, Pao-Yuan; Miguel, Ros; Chew, Khong-Yik; Kuo, Yur-Ren; Chia-Shen Yang, Johnson



Palate lengthening by buccinator myomucosal flaps for velopharyngeal insufficiency.  


Objective : To assess the outcome of palate lengthening by myomucosal buccinator flaps for velopharyngeal insufficiency both in terms of speech and changes in palate length. Design : Thirty-two consecutive patients who underwent the buccinator flap procedure were reviewed retrospectively. Palate length and the presence or absence of a velopharyngeal gap were assessed on pre- and postoperative videofluoroscopic recordings using a calibrated image analysis system. Hypernasality, nasal emission, nasal turbulence, and passive cleft type articulation errors were evaluated blindly by a speech-language pathologist external to the team using pre- and postoperative speech recordings. Setting : Multidisciplinary cleft team based in a tertiary referral center. Results : In 81% of patients, speech outcome was such that no further velopharyngeal surgery was considered necessary at the time of follow-up. The buccinator flap procedure resulted in a mean palate lengthening of 7.5 mm (±5.5 SD). After the operation, there was a complete elimination of the velopharyngeal gap on lateral videofluoroscopy in 77% of patients. There were significant decreases in hypernasality ratings and passive cleft type articulation errors postoperatively. Conclusion : Palatal lengthening with myomucosal buccinator flaps in patients with velopharyngeal insufficiency is effective and safe. It has become one of our routinely practiced procedures for velopharyngeal insufficiency. PMID:23237471

Hens, G; Sell, D; Pinkstone, M; Birch, M J; Hay, N; Sommerlad, B C; Kangesu, L



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

Microsoft Academic Search

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

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



Propeller flaps: classification and clinical applications.  


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

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



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


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

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



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


In this report, we present our experience with subcutaneous rt-PA injection for salvage of free radial forearm flaps with vascular compromise. Three patients underwent reconstruction of defects of the soft palate or the lateral tongue with a free radial forearm flap. Patients underwent on average two attempted operative revisions with thrombectomy and intravenous heparin injections. After recurrent venous thrombosis 3-6 days after surgery, rt-PA (Alteplase 2 mg; 1,160,000 IE) was injected subcutaneously at multiple sites into the compromised flap as final attempt. In all three patients, successful thrombolysis with no or only partial soft tissue loss was achieved after subcutaneous injection of rt-PA. We therefore suggest subcutaneous rt-PA injection as an additional tool in managing difficult and recurrent cases of venous thrombosis in free flap head and neck reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery 33:478-481, 2013. PMID:23843292

Ihler, Friedrich; Matthias, Christoph; Canis, Martin



[Modern filtration surgery. An update].  


Preoperative treatment with steroids and nonsteroidal anti-inflammatory drugs increases the success of filtration surgery. Surgery with the patient under subconjunctival anesthesia is safe. Intraoperative application of mitomycin C is state of the art and enhances success rates. Perioperative use of bevacizumab seems to attenuate postoperative fibrosis. Postoperative hypotension is avoided by stable fixation of the scleral flap followed by stepwise controlled suturelysis or release. Transconjunctival flap suturing allows fast and simple treatment of overfiltration. The shorter the time lag between trabeculectomy and subsequent cataract surgery the higher the probability of bleb failure will be. The number of antiglaucomatous drugs and severity of glaucomatous damage before surgery correlate with the probability of failure and blindness. PMID:23519498

Klink, T; Grehn, F



DMSO: Applications in plastic surgery  

Microsoft Academic Search

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

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



Comparisons of morphologic characteristics between thin-flap LASIK and SBK  

PubMed Central

AIM To compare the morphologic characteristics between thin-flap laser in situ keratomileusis (LASIK) and Sub-Bowman keratomileusis (SBK), and to evaluate the uniformity of flap and to explore the correlative factors of corneal flap thickness. METHODS A prospective, randomized, comparative clinical study was performed in Department of Ophthalmology, West Hospital of China, Chengdu, Sichuan Province, China. Totally 59 patients 114 eyes underwent LASIK or SBK to correct myopia, 29 patients 57 eyes underwent SBK, 30 patients 57 eyes underwent LASIK. Anterior optical coherence tomography(OCT) was used to measure corneal flap thickness in all the patients 1 week after surgeries, 16 positions were set to be measured in each eye. Comparisons of flap thickness in each group and between 2 groups were evaluated. Correlative factors of flap thickness were evaluated. RESULTS Coefficient of variation (CV, s/×%) in SBK group were lesser than that in LASIK group, t test showed there was significant statistical difference between 2 groups(P=0.000). Comparisons of the difference of 2 paired positions(temporal-nasal; superior-inferior) showed there were no significant differences in each group, but between 2 groups, there were statistical significance of value of difference (D-value) of superior and inferior positions between SBK and LASIK group(P=0.036). Linear regression analysis of correlative factors of flap thickness showed there were no statistic significances related to central corneal thickness(CCT)(P=0.060, t=1.921) and corneal curvature(P=0.083, t=1.766). CONCLUSION SBK is better than LASIK in creating much uniform corneal flap. There was no evidence showing correlations between flap thickness and CCT or corneal curvature.

Sun, Yi; Deng, Ying-Ping; Wang, Lin; Huang, Yong-Zhi; Qiu, Le-Mei



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

PubMed Central

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

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



[The thoracodorsal flap in facial reconstruction].  


Seventy autotransplantations of thoracodorsal flaps were carried out to repair defects on the head, face, and neck. Variants of such flaps are described. An extensive defect of any localization is an indication for the use of such grafts. PMID:7502304

Malakhovskaia, V I; Nerobeev, A I; Osipov, G I



The propeller flap for postburn elbow contractures.  


Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release. PMID:16384651

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



Dorsalis pedis free flap in oromandibular reconstruction  

Microsoft Academic Search

This paper reports the free dorsalis pedis flap as a fasciocutaneous and osteocutaneous flap in oromandibular reconstruction.\\u000a The authors present a 7-year series of nine patients with squamous cell carcinoma of oral cavity with extensive soft tissue\\/soft\\u000a tissue and bone defect in whom this flap was used for intraoral reconstruction. The free fasciocutaneous flap (two neurosensate)\\u000a was used in eight

Luis Filipe Lamas Azevedo; Horacio Zenha; Leonor Rios; Cristina Cunha; Horácio Costa



Reconstructive indications of simultaneous double free flaps in the head and neck: a case series and literature review.  


Extensive and complex defects of the head and neck involving multiple anatomical and functional subunits are a reconstructive challenge. The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery. This is a retrospective review of 21 consecutive cases of head and neck malignancies treated surgically with resection and reconstruction with simultaneous use of double free flaps. Nineteen of 21 patients had T4 primary tumor stage. Eleven patients had prior history of radiotherapy or chemo-radiotherapy. Forty-two free flaps were used in these patients. The predominant combination was that of free fibula osteo-cutaneous flap with free anterolateral thigh (ALT) fascio-cutaneous flap. The indications of the simultaneous use of double free flaps can be broadly classified as: (a) large oro-mandibular bone and soft tissue defects (n = 13), (b) large oro-mandibular soft tissue defects (n = 4), (c) complex skull-base defects (n = 2), and (d) dynamic total tongue reconstruction (n = 2). Flap survival rate was 95%. Median follow-up period was 11 months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of flap combination for the appropriate indications is proposed. PMID:22438175

Balasubramanian, Deepak; Thankappan, Krishnakumar; Kuriakose, Moni Abraham; Duraisamy, Sriprakash; Sharan, Rajeev; Mathew, Jimmy; Sharma, Mohit; Iyer, Subramania



In situ transverse rectus abdominis myocutaneous flap: a rat model of myocutaneous ischemia reperfusion injury.  


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

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



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


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

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



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

PubMed Central

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

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



Development of insect thorax based flapping mechanism  

Microsoft Academic Search

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

Zaeem Khan; Kyle Steelman; Sunil Agrawal



Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage?  

PubMed Central

Backgrounds and aim In recent decades, fibrin glue has appeared as an alternative treatment for high perianal fistulas. Early results seemed promising, with high success rates being reported. However, with increasing follow-up, the enthusiasm was tempered because of disappointing results. The aim of this retrospective study was to assess the additional value of fibrin glue in combination with transanal advancement flap, compared to advancement flap alone, for the treatment of high transsphincteric fistulas of cryptoglandular origin. Materials and methods Between January 1995 and January 2006, 127 patients were operated for high perianal fistulas with an advancement flap. After exclusion of patients with inflammatory bowel disease or HIV, 80 patients remained. A consecutive series of 26 patients had an advancement flap combined with obliteration of the fistula tract with fibrin glue. Patients were matched for prior fistula surgery, and the advancement was performed identically in all patients. In the fibrin glue group, glue was installed retrogradely in the fistula tract after the advancement was completed and the fistula tract had been curetted. Results Minimal follow-up after surgery was 13 months [median of 67 months (range, 13–127)]. The overall recurrence rate was 26% (n = 21). Recurrence rates for advancement flap alone vs the combination with glue were 13% vs 56% (p = 0.014) in the group without previous fistula surgery and 23% vs 41% (p = 0.216) in the group with previous fistula surgery. Conclusion Obliterating the fistula tract with fibrin glue was associated with worse outcome after rectal advancement flap for high perianal fistulas.

van Koperen, Paul J.; Wind, Jan; Bemelman, Willem A.



Efficient flapping flight of pterosaurs  

NASA Astrophysics Data System (ADS)

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

Strang, Karl Axel


A Novel Reconstructive Technique After Endoscopic Expanded Endonasal Approaches: Vascular Pedicle Nasoseptal Flap  

Microsoft Academic Search

Background: In patients with large dural defects of the anterior and ventral skull base after endo- nasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after re- construction. Reconstruction with vascularized tis- sue is desirable to facilitate rapid healing, espe- cially in irradiated patients. Methods: We developed a neurovascular pedicled flap of the nasal

Gustavo Hadad; Luis Bassagasteguy; Ricardo L. Carrau; Juan C. Mataza; Amin Kassam; Carl H. Snyderman; Arlan Mintz



Retrospective analysis of actual LASIK flap diameter compared with microkeratome ring size performed by different surgeons  

Microsoft Academic Search

Purpose: To evaluate the difference in the diameter between microkeratome ring and actual laser in situ keratomileusis (LASIK) flap size by 4 different surgeons using 3 different microkeratomes in comparison to preoperative keratometry.Setting: Gimbel Eye Centre, Calgary, Alberta, Canada.Methods: A retrospective analysis of 6667 consecutive LASIK surgeries performed at the Gimbel Eye Centre between 1998 and 2002 was conducted. The

Ori Mahler; Sandra J Sofinski; Howard V Gimbel; Jacinthe Kassab; Ellen E. Anderson Penno; John A van Westenbrugge



Perforator flaps of the facial artery angiosome.  


For small to moderate-sized defects in the head and neck region, local flaps have been the mainstay of reconstruction for years. However, in certain instances, additional flap translation is required be it advancement, transposition or rotation. In such cases, the local flap concept is combined with perforator flap know-how, allowing larger loco-regional flaps to be raised to reconstruct relatively larger defects, even in cosmetically-expensive areas. In our cohort of fifteen patients', we have utilised detailed microanatomy of the facial artery perforators to reconstruct such defects with good results. PMID:23219748

Kannan, R Y; Mathur, B S



[Donor site morbidity after free gracilis muscle flap. Report of 32 cases.  


BACKGROUND: Coverage of tissue defects of the lower limbs is a complex problem. Free gracilis muscle flap is a reliable surgical technique and the morbidity of its donor site is considered as minimal. Our retrospective study involved all patients who underwent a free gracilis muscle flap in a reconstructive surgery of the lower limb. To the best of our knowledge, this is the first study to assess comprehensively the aesthetic and functional morbidity of the free gracilis flap donor site. PATIENTS AND METHODS: Thirty-two patients underwent a gracilis muscle free flap in our plastic surgery department, between January 2009 and April 2012, as part of a reconstructive surgery of the lower limb. All medical datas were carried out using computerized records. Aesthetic and functional assessments of the donor site were done by the patient using questionnaires and by a plastic surgeon and a physiotherapist using a clinical evaluation, 6months after surgery. A comparative study between both limbs including the thigh perimeter analysis, an isokinetic study of the knee, a study of the range of motion of hip and knee, and an assessment of the strength of adduction of the hip were conducted. RESULTS: Concerning the aesthetic outcomes, the clinical and subjective scores were satisfactory with a Vancouver score under 1. Five patients had a decrease in the volume of the thigh after surgery. Concerning the functional outcomes, no motor or sensory defects were reported. No statistically significant difference was demonstrated for the range of motion of the hip and knee between both limbs. The strength of hip adduction was not altered by the removal of the gracilis muscle. CONCLUSION: This study confirms the low aesthetic and functional donor site morbidity of the free gracilis muscle flap. The aftermath of the donor area of the flap are very well accepted by patients, which is a sign of good acceptance of the whole reconstruction. Because of these findings and the suitability of the flap at the recipient site, the gracilis muscle free flap should be part of the armamentarium of any reconstructive surgeon. PMID:23707083

Besset, M; Penaud, A; Quignon, R; Bahe, L; Brilhault, J; Fouquet, B



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

PubMed Central

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

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



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

PubMed Central

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

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



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


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

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



Dynamic Flaps Electronic Scan Antenna.  

National Technical Information Service (NTIS)

A dynamic FLAPS(TM) electronic scan antenna was the focus of this research. The novelty S of this SBIR resides in the use of plasma as the main component of this dynamic X-Band phased S array antenna. The plasma introduces a hysteresis property to the pha...

D. G. Gonzalez



Force Generation by Flapping Foils  

NASA Astrophysics Data System (ADS)

Aquatic animals like fish use flapping caudal fins to produce axial and cross-stream forces. During WW2, German scientists had built and tested an underwater vehicle powered by similar flapping foils. We have examined the forces produced by a pair of flapping foils. We have examined the forced produced by a pair of flapping foils attached to the tail end of a small axisymmetric cylinder. The foils operate in-phase (called waving), or in anti-phase (called clapping). In a low-speed water tunnel, we have undertaken time-dependent measurements of axial and cross-stream forces and moments that are exerted by the vortex shedding process over the entire body. Phase-matched LDV measurements of vorticity-velocity vectors, as well as limited flow visualization of the periodic vortex shedding process have also been carried out. The direction of the induced velocity within a pair of shed vortices determines the nature of the forces produced, viz., thrust or drag or cross-stream forces. The clapping mode produces a widely dispersed symmetric array of vortices which results in axial forces only (thrust and rag). On the other hand, the vortex array is staggered in the waving mode and cross-stream (maneuvering) forces are then generated.

Bandyopadhyay, P. R.; Donnelly, M.



Efficient flapping flight of pterosaurs  

Microsoft Academic Search

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

Karl Axel Strang



Biomimetic flapping wing aerial vehicle  

Microsoft Academic Search

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

M. A. A. Fenelon



Reduction meatoplasty with a post-auricular island flap.  


The importance of an adequate meatoplasty is often emphasised in mastoid surgery. However, bigger is not always better, as an excessively widened external meatus can be cosmetically unacceptable, provide little extra benefit for cleaning, be an obstacle to the good fitting of hearing aids and expose the mastoid cavity to exaggerated caloric effect. The problems created by an overly large meatus can occasionally be difficult to manage, prompting consideration of reduction of the meatus. We describe the use of a pedicled, post-auricular skin flap to achieve reduction of an excessively large meatus. PMID:17112396

Harvey, R J; Fagan, P; Baldwin, M



Fluorescence angiography in the assessment of flap perfusion and vitality.  


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

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



Study of flapping actuator modules using IPMC  

NASA Astrophysics Data System (ADS)

The Ionic Polymer Metal Composite (IPMC), an electro-active polymer, has many advantages including bending actuation, low weight, low power consumption, and flexibility. These advantages coincide with the requirements of flapping-wing motion. Thus, IPMC can be an adequate smart material for the generation of the flapping-wing motions. In this research, a flapping actuator module operated at the resonant frequency is developed using an IPMC actuator. First, IPMC actuators are fabricated to investigate the mechanical characteristics of IPMC as an actuator. The performances of the IPMC actuators, including the deformation, blocking force and natural frequency, are then obtained according to the input voltage and IPMC dimensions. Second, the empirical performance model and the equivalent stiffness model of the IPMC actuator are established. Third, flapping actuator modules using the first resonance frequency are developed, and their flapping frequency and stroke characteristics are investigated. Fourth, adequate flapping models for a flapping actuator module are selected, and dimensional data such as wing area and wing mass are obtained. Finally, the flapping actuator module is designed and manufactured to adjust the flapping models and its performance is tested. Experimental results demonstrate the potential IPMC has for use as a flapping actuator.

Kim, Hong-Il; Kim, Dae-Kwan; Han, Jae-Hung



Vascularisation of Urethral Repairs with the Gracilis Muscle Flap  

PubMed Central

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

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



Thumb salvage with skin grafted medial femoral corticoperiosteal free flap.  


A 23-year-old man suffered a severe crush injury with fracture of his left thumb base phalanx and destruction of his extensor pollicis longus tendon. Immediate plate stabilisation and soft tissue coverage was performed; however, a recalcitrant pseudarthrosis developed in this compliant non-smoker despite three revisions with avascular iliac crest grafts for interphalangeal joint arthrodesis, corticocancellous bone application and hardware exchange. An attempt to improve thumb vascularity and soft tissue cover with a pedicled Foucher flap as well as through extracorporeal shock wave therapy failed. Bone healing and subsequent thumb salvage were finally achieved with a free vascularised medial femoral condyle (MFC) bone flap, which was covered directly with a full-thickness skin graft. Both bony and soft tissue healing went well and after 3 months the patient returned to work. This case demonstrates that skin grafting the periosteal surface of the MFC flap is safe and results in a thin skin-bone compositae transplant which also might be very useful for indications other than hand surgery. PMID:21624854

Giessler, Goetz A; Schmidt, Andreas B



Combined use of free jejunum and pectoralis major muscle flap with skin graft for reconstruction after salvage total pharyngolaryngectomy.  


Salvage total pharyngolaryngectomy after failed organ-preserving therapy often results in composite defects involving the alimentary tract, trachea, and neck skin. This retrospective study examined combined use of the free jejunum flap and the pectoralis major muscle flap with skin graft for such a complex reconstruction. We reviewed 11 patients who underwent free jejunum transfer for alimentary reconstruction and pedicled pectoralis major muscle flap transfer with a skin graft on the muscle for simultaneous neck skin resurfacing after salvage total pharyngolaryngectomy from 2005 through 2010. The operative morbidity rate was 27.3%. No pharyngocutaneous fistula developed in this series. Oral intake could be resumed within 3 weeks after surgery in all patients. Seven of 11 patients had a functional tracheostoma with adequate stomal patency. Combined use of free jejunum and pectoralis major muscle flap with skin graft provided secure wound closure even for complicated cases. PMID:22821761

Miyamoto, Shimpei; Sakuraba, Minoru; Nagamatsu, Shogo; Kamizono, Kenichi; Fujiki, Masahide; Hayashi, Ryuichi



The transverse abdominal island flap —What you should do when the flap turns blue  

Microsoft Academic Search

Transverse abdominal island flaps often turn blue in the operating room when transferred to the chest wall. Acute blue flaps are caused by venous congestion. In most cases this resolves spontaneously. Persistent venous congestion of the flap, however, is dangerous and must be corrected promptly. This is done by keeping the patient warm, by appropriate dissection around the rib cage

M. Scheflan



Optimal Flight of a Symmetric Flapping Wing  

NASA Astrophysics Data System (ADS)

We study the unidirectional locomotion that results from symmetry-breaking of fluid response to a wing that is flapped vertically. We seek the optimal parameters of such locomotion. In particular, we investigate (1) at what flapping amplitude the forward flight speed is highest (minimum Strouhal number), and (2) at what amplitude the flapping wing has the lowest threshold to forward flight. We discuss other factors affecting the forward flight performance, such as the chord of the wing and its flexibility.

Rosellini, Lionel; Zhang, Jun



A novel technique for ventral orbital stabilization: the masseter muscle flap.  


Loss of the caudal maxilla and ventral orbit after tumor resections can have negative functional and esthetic influences on the eye involved. This article reports on a case of a caudal maxillary acanthomatous ameloblastoma involving the ventral orbit that was resected and stabilized with a masseter muscle flap. The masseter muscle flap was generated from the superficial belly of the masseter muscle in order to close a defect in the orbital rim, created by a caudal maxillectomy. None of the published complications such as enophthalmos, excessive lacrimation, globe deviation, or strabismus were noted, 8 months following the procedure. The only clinical sign present at the time of re-evaluation was mild lacrimation. The authors propose the use of a masseter muscle flap as a viable technique in stabilizing the ventral orbit after caudal maxillectomy and ventral orbitectomy, preventing the complications associated with this surgery. PMID:23710820

Sivagurunathan, Amilan; Boy, Sonja C; Steenkamp, Gerhard



[Case report: squamous cell carcinoma, radial forearm flap and Huriez syndrome. Focus on a rare pathology].  


Huriez disease is a rare autosomal dominant pathology characterized by the triad hypoplastic nail, hyperkeratosis and scleroatrophy of distal extremities. One of its most principal complications is the development of an aggressive squamous cell carcinoma. We present a case of a 62-year old patient who had an acute two hands scleroatrophy associated with recurrent squamous cell carcinoma treated by large excision and covered by trophic and thick radial forearm flap. This flap allowed us to treat the wound and the sclerosis shrinkage with aim to give back the functional benefit to the patient. It also gave the patient an oncological treatment despite aggressive management in one step surgery. Furthermore, one year later we did not observe cutaneous flap histological modification that could have degenerated into cancer. A multidisciplinary approach with dermatologists, geneticists and plastic surgeons is essential in addition with close medical supervision because of high cancer risks. PMID:21885179

Dumont, L A; Gahagnon, T; Martinot-Duquennoy, V; Mortier, L; Guerreschi, P



Moist heat postconditioning to increase flap survival.  


One of the areas of interest within the discipline of reconstructive microsurgery is increasing the amount of tissue harvested along with a given pedicle and sustaining it. The aim of this study is to introduce moist heat postconditioning as a means to increase skin flap survival and evaluate its effectiveness. Eight white New Zealand rabbits weighing 2500 to 3000 g were separated into two groups. In both groups, the truncal flaps spanning four consecutive angiosomes were elevated bilaterally. Flaps were inset back afterwards, and to the flaps in the trial group moist heat was applied for 30 minutes. After 2 weeks, the flaps were photographed and flap survival ratios were calculated via ImageTool© software (University of Texas Health Science Center, San Antonio, Texas, USA). With an average necrosis ratio of 4.91% versus 37.31%, the flaps treated with moist heat displayed a significantly better survival rate (p = 0.000). This study presenting our new method demonstrates that application of moderate moist heat right after the flap inset provides a significant increase in flap survival and introduces a noninvasive, cost-effective, and safe method for clinical use. PMID:23100086

Engin, Murat Sinan; Demirta?, Yener; Ya?mur, Caglayan; Oztürk, Nuray; Karacalar, Ahmet



Flapping metal actuator in electric field  

NASA Astrophysics Data System (ADS)

Electrically induced flapping motion of aluminum foil with a high frequency is demonstrated. The flapping motion was recorded by using a high speed camera and characterized by analyzing the tip displacement of the foil. It is found that a critical voltage presents to induce the flapping motion and the vibration frequency depends on the dimensions of the foils as well as the dielectric properties of the supporters for the foil. Induced directional airflow by the flapping motion was also demonstrated here. This study may provide a simple way to realize the two-dimensional flying vehicle in the future.

Xu, Chengyi; Xu, Chunye; Zheng, Jianming



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

PubMed Central

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

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



Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap  

PubMed Central

Purpose To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. Methods We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. Results Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 ± 10.1 months in the graft group versus 50.9 ± 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). Conclusions In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Lee, Ho Young; Park, Jong Seok; Choy, Yoon Jung



Diagnostic and prognostic value of 99mTc-tetrofosmin scintigraphy in maxillofacial flaps.  


In oro-maxillofacial malignancies, new therapeutic approaches are placing changing demands on the diverse diagnostic modalities. In contradistinction to mandibular reconstruction of former years, the transplants (microvascular anastomosed pedicled flaps, "flaps") now consist of one or more arteries feeding a soft tissue component attached to a piece of bone suitably fitted to fill the defect. We addressed the diagnostic value of technetium-99m tetrofosmin scintigraphy in differentiating between viability and non-viability of the soft tissue portion of flaps in the immediate postoperative assessment. A total of 60 patients who had received flaps for reconstruction of the mandible after partial resection were investigated with (99m)Tc-tetrofosmin 3-5 days after surgery. Scintigraphy consisted of (a) radionuclide angiography, (b) static planar imaging in four projections starting at 10 min post injection, and (c) single-photon emission tomography (SPET) performed immediately after the planar imaging. Normal perfusion associated with no defects throughout the soft tissue portion of the transplant was observed in 46/60 patients. This scintigraphic pattern was identical to viability and normal postoperative follow-up. Hypoperfusion and small defects on planar and SPET images indicated viability and uncomplicated postoperative healing in 6/60 patients, but non-viability/inadequate healing of the flap in 4/60 patients. Absence of perfusion combined with a large defect on static planar and SPET images definitively showed the non-viability of the flap (4/60 patients). It is concluded that (99m)Tc-tetrofosmin scintigraphy is a sensitive diagnostic tool for the immediate postoperative assessment of the viability and the adequacy of implantation of the soft tissue portion of flaps. Therefore tetrofosmin scintigraphy is an important modality in order (a) to define the optimal therapeutic regimen in the immediate postoperative period and (b) to provide better prognosis. PMID:12552336

Aigner, Reingard M; Schultes, Guenter; Sorantin, Erich



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


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

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



Advanced Nail Surgery  

PubMed Central

Six techniques not yet widely known or used in the dermatologic surgery of the nails are briefly described. Small-to-medium-sized tumours of the proximal nail fold (PNF) can be excised and the defect repaired with advancement or rotation flaps. A superficial biopsy technique of the matrix for the diagnosis of longitudinal brown streaks in the nail, which allows rapid histological diagnosis of the melanocyte focus to be performed, is described here. Because the excision is very shallow and leaves the morphogenetic connective tissue of the matrix intact, the defect heals without scarring. Laterally positioned nail tumours can be excised in the manner of a wide lateral longitudinal nail biopsy. The defect repair is performed with a bipedicled flap from the lateral aspect of the distal phalanx. Malignant tumours of the nail organ often require its complete ablation. These defects can be covered by a full-thickness skin graft, reversed dermal graft, or cross-finger flap. The surgical correction of a split nail is often difficult. The cicatricial tissue of the matrix and PNF have to be excised and the re-attachment of these wounds prevented. The matrix defect has to be excised and sutured or covered with a free matrix graft taken either from the neighbouring area or from the big toe nail.

Haneke, Eckart



The Effect of New Technologies on Plastic Surgery  

Microsoft Academic Search

lastic surgery has always been a technique- and technology-driven surgical discipline, given that there is no regional anatomic focus. There has been a remarkable evolution in tech- nique over the last 25 years with an increased understanding of anatomy leading to a whole host of new and more reliable flaps, which has transformed reconstructive surgery, breast reconstruction being one notable

Thomas A. Mustoe; Hongshik Han



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

PubMed Central

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

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



Surgical Correction of Whistle Deformity Using Cross-Muscle Flap in Secondary Cleft Lip  

PubMed Central

Background The whistle deformity is one of the common sequelae of secondary cleft lip deformities. Santos reported using a crossed-denuded flap for primary cleft lip repair to prevent a vermilion notching. The authors modified this technique to correct the whistle deformity, calling their version the cross-muscle flap. Methods From May 2005 to January 2011, 14 secondary unilateral cleft lip patients were treated. All suffered from a whistle deformity, which is characterized by the deficiency of the central tubercle, notching in the upper lip, and bulging on the lateral segment. The mean age of the patients was 13.8 years and the mean follow-up period was 21.8 weeks. After elevation from the lateral vermilion and medial tubercle, two muscle flaps were crossed and turned over. The authors measured the three vertical heights and compared the two height ratios before and after surgery for evaluation of the postoperative results. Results None of the patients had any notable complications and the whistle deformity was corrected in all cases. The vertical height ratios at the midline on the upper lip and the affected Cupid's bow point were increased (P<0.05). The motion of the upper lip was acceptable. Conclusions A cross muscle flap is simple and it leaves a minimal scar on the lip. We were able to reconstruct the whistle deformity in secondary unilateral cleft lip patients with a single state procedure using a cross-muscle flap.

Choi, Woo Young; Kim, Gyu Bo; Han, Yun Ju



Involutional Entropion Surgery: A Modified Technique  

Microsoft Academic Search

Purpose: A study to evaluate the effectiveness of a modified procedure to correct involutional entropion. Methods: Seventeen cases of involutional entropion underwent surgery and had a postoperative follow-up of 18 months. The authors describe a technique of vertically shortening the anterior lamella (skin and orbicularis muscle), using a blepharoplasty incision and reflection of a skin muscle flap. Results: In 16

Andrea Marabotti; Andrea Bedei; Gustavo Lanza; Anna Cariello; Iacopo Giannecchini



Robot-Assisted Laparoscopic Distal Ureteral Surgery  

PubMed Central

Background: The use of robotic assistance in adult genitourinary surgery has been successful in many operations, leading surgeons to test its use in other applications as well. Methods: Based on our use during prostatectomy, we have applied robotic surgery to complex distal ureteral surgeries since 2004 with successful outcomes. Results: A series of 11 patients who underwent robot-assisted laparoscopic distal ureteral surgery is presented. These surgeries include distal ureterectomy for ureteral cancer with reimplantation, as well as reimplantation with and without Boari flap or psoas hitch for benign conditions. Conclusions: Robot-assisted laparoscopic surgery can be successfully applied to patients requiring distal ureteral surgery. Maintenance of the principles of open surgery is paramount.

Wagner, Joseph R.



Use of free flaps in burn trauma.  


The present currently used method of treating and reconstructing injuries caused by electric current and deep thermal injuries is compared with the method of early reconstruction using free flaps. Brief summary of present experience substantiating this method is presented. The three presented clinical cases show subacute reconstruction in this type of injury by free flaps transfer. PMID:7618395

Tvrdek, M; Nejedlý, A; Kletenský, J; Pros, Z; Broz, L



Free flap pulse oximetry utilizing reflectance photoplethysmography.  


The successful salvage of a free flap is dependent on the continuous monitoring of perfusion. To date there is no widely accepted and readily available post-operative monitoring technique to reliably assess the viability of free flaps by continuously monitoring free flap blood oxygen saturation. In an attempt to overcome the limitations of the current techniques a reflectance photoplethysmographic (PPG) processing system has been developed with the capability of real-time estimation of arterial oxygen saturation (SpO2) levels implemented in LabVIEW. This system was evaluated in clinical measurements on five patients undergoing breast reconstruction using Deep Inferior Epigastric Perforator (DIEP) flap. Good quality PPG signals were obtained from the flaps and fingers simultaneously. The estimated free flap SpO2 values were in broad agreement with the oxygen saturation readings from the commercial pulse oximeter. The results suggest that reflectance free flap photoplethysmography can be used as a continuous monitoring technique to non-invasively monitor the perfusion of free flaps. PMID:24110620

Zaman, T; Kyriacou, P A; Pal, S K



Flapping wing PIV and force measurements  

Microsoft Academic Search

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.

Benjamin H. Cameron



Design of a flapping foil underwater vehicle  

Microsoft Academic Search

The design, construction and testing of a biomimetic flapping foil autonomous underwater vehicle are detailed. The project is a proof of concept for the use of flapping foils as the sole source of propulsion for an underwater vehicle. We intend to use the vehicle in several physical arrangements to compare the swimming performance of different shapes and foil arrangements. The

Stephen Licht; Franz Hover; Michael S. Triantafyllou



Why and when to delay TFL flaps  

Microsoft Academic Search

Sensory TFL flaps have to be extended to the ischial and perianal region of patients suffering from a low spinal cord lesion if they are to provide optimal sensitivity as well as adequate length. A sensory TFL flap which extends to the perianal area may also help such patient to control his bowel function. In order to mobilize a large

S. Krupp; A. C. Milliet



Divergent Flap for a Gas Turbine Engine.  

National Technical Information Service (NTIS)

A divergent flap assembly of a gas turbine engine includes a hotsheet, a backbone structure for supporting the hotsheet, and a plow portion secured to the backbone structure to bridge a gap between the hotsheet and an external flap. The plow portion is fa...

J. A. Arbona



Coanda Inlet/Jet Flap Diffuser Ejector.  

National Technical Information Service (NTIS)

The combination of a Coanda inlet and jet flap diffusion, for the achievement of high performance, low volume, thrust augmentation, has been investigated in a two-dimesnional experiment. The use of jet flap diffusion provides a mechanism for the achieveme...

M. Alperin



Perineal reconstruction with local flaps: technique and results.  


BACKGROUND: Wide excision of perineal lesions, often including the entire anal canal, may be necessary for benign and malignant conditions. Closure of these large defects is challenging, especially when continence is a goal. The aim of this study was to assess our experience with local flap closure of large perineal defects. METHODS: From 1994 to 2009, 20 patients underwent wide perineal and/or anal canal excisions and reconstruction using local flaps. Mean age was 45 years (range 20-65 years), 13 were male, and 8 (40 %) were immunocompromised. Primary indications included anal or perineal squamous cell carcinoma-(n = 12), Buschke-Lowenstein tumor (n = 3), and anal intraepithelial neoplasia (n = 3), hidradenitis, stenosis, ectropion, and traumatic cloaca repair (n = 1 each). Primary procedures included wide local excision of large neoplastic lesions-(n = 15) (mean size 10 cm, range 5-18 cm), abdominoperineal resection (APR) (n = 2), perineoplasty with sphincteroplasty-(n = 1), and others-(n = 2). All were reconstructed with bilateral local flaps (V-Y 18, S 2). Thirteen had complete excision of the anal canal to the anorectal ring preserving the sphincters. Six (30 %) had ostomies; 2 with APR and 4 temporary. RESULTS: There were no perioperative deaths. Mean hospital stay was 4.2 days. Follow-up averaged 35 months (range 3-87 months) in survivors. Five patients died during follow-up; 2 of complications of acquired immune deficiency syndrome (AIDS) and 3 of cancer (2 treated palliatively). Wound dehiscence occurred in 6 (30 %) patients: in 3 cases, this was minor dehiscence and healed quickly; in 3 cases, it was major dehiscence and occurred in the 2 radiation/APR patients and in one patient with advanced AIDS. Radiation was the only significant risk factor (P < .05). Twelve of 14 eligible patients with long-term follow-up and an intact anal canal are fully continent, and 2 are partially continent (1 traumatic cloaca; 1 the same as before surgery). CONCLUSION: Local flap reconstruction of the perineum and anal canal is an excellent method of managing large perineal defects. Most heal primarily, even in immunocompromised patients, and continence may be preserved. Local flaps should be avoided in irradiated patients. PMID:23430348

Orkin, B A



Facial artery flaps in facial oncoplastic reconstruction.  


The face is one of the common sites for cutaneous cancer localization. It is well known that the face is the localization of more than 50% of skin cancers. Nowadays, the principles of modern "oncoplasty" recommend the complete excision of the cancer and the reconstruction with respect to cosmetic features of the face in terms of good color, good softness, and good texture of the flaps, utilized in cancer repair. The oncological and cosmetic results of facial reconstruction are strictly linked and the modern plastic and reconstructive surgeon must respect both oncological and cosmetic aspects. For that reason the best solution in facial cancer repair is the utilization of locoregional flaps based on the tributary vessels of the facial artery. In consideration of the dimension of recipient area to repair, the retroangular flap (RAF) or the submental flap could be used. This article is voted to illustrate a very large and long-term casuistry dedicated to these flaps. PMID:24037925

Fabrizio, Tommaso



Piezoelectrically actuated insect scale flapping wing  

NASA Astrophysics Data System (ADS)

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

Mukherjee, Sujoy; Ganguli, Ranjan



Benign soft tissue neoplasm of a myocutaneous flap masquerading as recurrent squamous cell carcinoma of parotid gland.  


Development of a lipoma within the subcutaneous tissues of a trapezius myocutaneous flap is very rare. This is more so when it occurs after surgery for a head and neck cancer. In the case report described, it masqueraded as tumour recurrence causing significant anxiety. To the best of our knowledge this is a previously unreported 'complication'. PMID:15712578

Andrews, A; Harris, R; Williamson, P



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

Microsoft Academic Search

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

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



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

NASA Astrophysics Data System (ADS)

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

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



Reconstruction of large defect of foot with extensive bone loss exclusively using a latissimus dorsi muscle free flap: a potential new indication for this flap.  


In cases of extensive damage to the foot, with significant bone loss, it is generally accepted that reconstruction must include bone flaps or grafts either in the emergency setting or subsequently. In this report, we describe the case of an 18-year-old student with an avulsion injury of the dorsum of his right foot. Consequently, he lost most of the soft tissue over the dorsum of the foot and the cuboid, navicular, and cuneiform bones. A latissimus dorsi free flap was used to reconstruct the defect. A functional pseudoarthrosis developed between the remaining bones of the foot, and the patient experienced satisfactory foot function after rehabilitation. For this reason, no additional reconstructive procedure was undertaken. This case suggests that it might be adequate to use the latissimus dorsi muscle flap more liberally than previously reported in the reconstruction of extensive defects of the dorsum of the foot, including cases with significant bone loss. This option could avoid the morbidity and inconvenience of a second surgery and the need to harvest a bone flap or graft. PMID:21945400

Gomez, Manuel Macemino; Casal, Diogo



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


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

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



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

PubMed Central

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.

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



CASE REPORT Laser-Assisted Indocyanine Green Evaluation of Paramedian Forehead Flap Perfusion Prior to Pedicle Division  

PubMed Central

Objective: To present the use of indocyanine green and the LifeCell SpyElite System to confirm perfusion and viability of a forehead flap prior to division and inset, thereby eliminating the question of flap survival based on clinical judgment alone. Methods: A case report of a 67-year-old man with a forehead flap reconstruction following an acquired nasal defect due to resection of an adenoid cystic carcinoma is presented. LifeCell SpyElite System was used to confirm perfusion prior to pedicle division. Results: The LifeCell SpyElite System was used to confirm perfusion to the forehead flap prior to pedicle division during the second stage of the procedure. After confirming perfusion, the pedicle was divided and the flap was inset. The remainder of the patient's operative and postoperative course was uneventful, and he healed without incident. Conclusions: Indocyanine green and the LifeCell SpyElite System is a reliable method to confirm perfusion and viability of staged reconstructive procedures prior to division and inset, thereby eliminating the question of flap survival based on clinical judgment alone. This is a practical application of this technology that has not been previously described in the plastic surgery literature.

Shah, Ajul; Au, Alexander



Safety and efficacy of low molecular weight dextran (dextran 40) in head and neck free flap reconstruction.  


Background Antithrombotic agents have been used in microvascular surgeries. Low molecular weight dextran (dextran 40), though used, is not without complications.Methods Retrospective analysis of 172 consecutive flaps. A comparison was made between two groups of patients (86 flaps each) with and without the use of dextran 40, in terms of safety and efficacy.Results The free flap survival rate was 95.9%. The flap survival rates were comparable between the groups. Total flap loss in Group A (patients who received dextran 40) was 3.5% compared with 2.3% in Group B (patients who did not receive dextran 40) (p = 1.00). There was no statistically significant difference in the incidence of thrombotic flap complications between the groups. None of the patients developed acute respiratory distress syndrome or required prolonged ventilator support. No patient had dextran-related anaphylactoid reactions. Thirty-eight patients (43.7%) in Group A had postoperative atelectasis and 21 (25.6%) patients in Group B had this complication (p = 0.01). Six patients in Group A developed postoperative pneumonia, and five patients in Group B developed this complication (p = 0.93).Conclusions Though dextran 40 did not result in any significant adverse local or systemic complications, it is not useful as a postoperative antithrombotic agent in head and neck oncologic reconstruction with free tissue transfer. PMID:23609045

Jayaprasad, Kiran; Mathew, Jimmy; Thankappan, Krishnakumar; Sharma, Mohit; Duraisamy, Sriprakash; Rajan, Sunil; Paul, Jerry; Iyer, Subramania



Breast reduction with dermoglandular flaps: Tessier's "total dermo-mastopexy" and the "yin-yang technique".  


The use of dermoglandular flaps in reduction mastopexy was advocated by Paul Tessier, who never published his method, but had actually almost finished the following article before his death in June 2008. Dr. Tessier is acknowledged as the "father" of craniofacial surgery, but he had interest in aesthetic surgery, and was quite proud of the technique he had developed using dermoglandular flaps in reduction mammoplasty. He had literally hundreds of techniques and methods that he had developed but which never found their way into print, both because of his enormous surgical schedule, and perhaps his self-imposed standards for anything that he published, which were almost impossibly high. The technique proposed by Dr. Gargano is similar in some ways to Dr. Tessier, it seemed good that they will be published together. PMID:22123549

Gargano, Francesco; Tessier, Paul; Wolfe, S Anthony



Stability and response to gravity of the flap lag motion for a rigid rotor blade with flap-pitch coupling  

Microsoft Academic Search

The coupled flap lag motion of a single, rigid rotor blade of a wind energy converter with flap and lag hinges and a coupling of the angle of attack with the flap motion is investigated. The equations of motion are developed under the assumption of linearized quasi-stationary aerodynamic forces. Static and dynamic stability of the coupled flap and lag motion

J. H. Argyris; B. Kirchgaessner



Dynamic stall in flapping flight  

NASA Astrophysics Data System (ADS)

We report on experiments concerning unsteady effects in flapping flight, conducted in the low-speed wind tunnel of the TU Darmstadt using a mechanical flapping-wing model. Particle Image Velocimetry (PIV) was used for qualitative and quantitative analysis parallel and perpendicular to the flow field. A sensitivity analysis of the main flight parameters has been performed, with specific attention to the flight envelope of 26,500 < Re < 135,000 and 0.029 < k < 0.29 (k=?f c / U?). The phase-averaged reconstructions of the flow field are then used to calculate the phase-resolved forces acting on the model and were compared with the results from an internal three component balance. The existence of the dynamic stall effect could be verified by the direct force measurement as well as the flow visualization. The observation of the leading-edge vortex for typical bird flight reduced frequencies shows that this flow cannot be approximated as being quasi- steady. This in effect proves that adaptive wings are necessary to fully control these unsteady flow features, such as dynamic stall.

Hubel, Tatjana; Tropea, Cameron



Periosteo-Temporofascial flap for cavity obliteration - first Indian study.  


Healing of the mastoid cavtiycompletely is the desired result after a mastoid surgery. Even after the Sade's principles' of the complete disease clearance, adequate lowering of the facial ridge, good meatoplasty and closure of the perforation of the tympanic membrane are fallowed, the complete healing of tike mastoid cavity is sometimes net the end result. According to various surgeons, the incidence of discharging mastoid cavity after a open cavity mastoid surgery is between /0-60%-H The usual techniques of obliteration of the mastoid cavity to decrease the size of the mastoid cavity, unusually has good healing results due to good vascularity. The failure ta the early detectmn 0/disease recurrence and risk of sudden appearance of intra-cranial complications are the most important disadvantages of the technique. We undertook a study in SO randomly chosen patients of Unsafe CSOM. Twenty five underwent obliteration of the mastoid cavity with Periosteo-Temporofascial flap, which is based on branches of posterior auricular artery and rest twenty five underwent non-obliteration of the mastoid cavity. Tfie results between the two groups were compared in terms of healing of the mastoid cavity and hearing gain after operation. Very good results in terms of healing of the cavity were seen after obliteration surgery. The rate of healing of the cavity was much faster after obliteration. The additional advantage with the flap is the see-through character of the cavity lining, which would lead to early detection of the disease recurrence. No significant increase in the hearing was seen in the obliterated patients as compared to non-obliterated cases. PMID:23119970

Wadhwa, Vikram; Anand, T S; Kumar, Sandeep; Kathuria, Geeta; Rana, Indu



Clavicular reconstruction with free fibula flap: A report of four cases and review of the literature.  


Midclavicular fracture is one of the most common injuries of the skeleton, representing 3-5% of all fractures and 45% of all shoulder injuries. The recurrent failure of clavicular fracture treatment, whether conservative or surgical, could give rise to multiple surgeries, ultimately leading to a painful nonunion. The aim of the article is to address the indications, surgical technique and results of clavicular reconstruction using vascularised fibular flaps based on 4 cases reports. PMID:23352678

Abarca, J; Valle, P; Valenti, Ph



Simplified Wake Model of a Flapping Wing  

NASA Astrophysics Data System (ADS)

A vortex wake model consisting of two parts, a strong leading-edge vortex that is shed during the flapping cycle and a continuously attached vortex line determined by quasi-steady lifting line theory was developed. The leading edge vortex is essentially an expression of the Magnus effect, while the strength of the wing-tip vortex is determined by unsteady lifting line theory. Combined, these produce the ``ladder vortex" pattern seen downstream of root-flapping wings with fixed span, such as insects and most man-made flapping wing vehicles. A small flapping wing experimental setup in still air was used to provide experimental comparison to the model. Measurements include flow visualization and velocity obtained using a stereo PIV system. The flapping mechanism was mounted on a two-component force balance to obtain time-resolved lift and thrust. Data were ensemble averaged with the flapping phase cycle and used to calculate vorticity. These were then reconstructed to show the space-time development of vorticity shed from the wing during the flapping motion to compare to the model predictions.

Apker, Thomas; Corke, Thomas



The Deep Inferior Epigastric Perforator and Pedicled Transverse Rectus Abdominis Myocutaneous Flap in Breast Reconstruction: A Comparative Study  

PubMed Central

Background Our objective was to compare the complication rates of two common breast reconstruction techniques performed at our hospital and the cost-effectiveness for each test group. Methods All patients who underwent deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis myocutaneous (TRAM) flap by the same surgeon were selected and matched according to age and mastectomy with or without axillary clearance. Patients from each resultant group were selected, with the patients matched chronologically. The remainder were matched for by co-morbidities. Sixteen patients who underwent immediate breast reconstruction with pedicled TRAM flaps and 16 patients with DIEP flaps from 1999 to 2006 were accrued. The average total hospitalisation cost, length of hospitalisation, and complications in the 2 year duration after surgery for each group were compared. Results Complications arising from both the pedicled TRAM flaps and DIEP flaps included fat necrosis (TRAM, 3/16; DIEP, 4/16) and other minor complications (TRAM, 3/16; DIEP, 1/16). The mean hospital stay was 7.13 days (range, 4 to 12 days) for the pedicled TRAM group and 7.56 (range, 5 to 10 days) for the DIEP group. Neither the difference in complication rates nor in hospital stay duration were statistically significant. The total hospitalisation cost for the DIEP group was significantly higher than that of the pedicled TRAM group (P<0.001). Conclusions Based on our study, the pedicled TRAM flap remains a cost-effective technique in breast reconstruction when compared to the newer, more expensive and tedious DIEP flap.

Tan, Shane; Yek, Jacklyn; Ong, Wei Chen; Hing, Chor Hoong; Lim, Thiam Chye



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

PubMed Central

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.

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



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

Microsoft Academic Search

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

T. Lee; Y. Y. Su



Combined Fascial Flap and Expanded Skin Flap for Enveloping Medpor Framework in Microtia Reconstruction  

Microsoft Academic Search

The Medpor implant is another choice for a new auricular framework besides autogenous costal cartilage. However, its relatively\\u000a frequent exposure and less-matching skin coverage discourage surgeons from using it. In this article, we present a new two-flap\\u000a method, a combination of the temporoparietal fascial flap and the expanded skin flap, for wrapping the Medpor implant in microtia\\u000a reconstruction. A staged

Song-Lin Yang; Jiang-Hong Zheng; Zhi Ding; Qing-Yang Liu; Guang-Yu Mao; Yi-Ping Jin



Patterns of flap recurrence following mastectomy.  


Flap recurrence after mastectomy is divisible into three distinct entities: spot recurrence, multiple spot recurrence and field change. Spot recurrence and multiple spot recurrence are usually controlled by local measures and are not associated with any particular characteristics of the primary tumour. The field change type of flap recurrence is difficult to control and is associated with aggressive primary tumours (grade III, node positive, oestrogen receptor negative) and a very poor prognosis. The appearance of field change type of flap recurrence is an indication for systemic therapy. PMID:4041733

Blacklay, P F; Campbell, F C; Hinton, C P; Blamey, R W; Morgan, D A; Elston, C W; Haybittle, J L



Optimum Flapping Wing Motions of Dragonfly  

NASA Astrophysics Data System (ADS)

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

Kamisawa, Yuichi; Isogai, Koji


[Successful treatment of subglottic tracheal stenosis with a mucosa-lined radial forearm fascia flap].  


Short-segment tracheal stenosis is often treated by segmental resection and end-to-end anastomosis. Longer-segment stenosis can sometimes be treated using dilation, laser therapy, bronchoscopic stent insertion and segmental resection and reconstruction. Long-segment restenosis with a buildup of scar tissue due to successful resection surgery in the past represents a particular therapeutic challenge and a sufficiently vascularized transplant may be the only option. We describe the case of a 37-year-old patient who underwent a tracheal reconstruction using a mucosa-lined radial forearm flap. Subsequent to a traumatic laryngotracheal fracture, long-term ventilation and multiple surgical interventions, the patient had developed a functionally relevant subglottic stenosis (5.5 cm). Following longitudinal anterior resection of the trachea 1 cm above and below the stenosis, a Dumon® stent was inserted. Simultaneously, a radial forearm fascia flap was harvested, as were two full-thickness buccal mucosa grafts, which were sutured onto the subcutaneous tissue and fascia of the forearm flap. Beginning caudally, the mucosa-lined flap was then sutured, air-tight, into the anterior tracheal defect with the mucosa facing the lumen. Finally, end-to-end anastomosis connected the blood vessels of the radial forearm flap to the recipient blood vessels in the neck. The patient was successfully extubated after 24 h and discharged after 5 days. A postoperative CT scan revealed optimal placement of the stent and the patient's speech and breathing were sufficiently re-established. The stent was removed bronchoscopically 6 weeks after surgery. Examinations during the 6-month follow-up period showed that the diameter of the reconstructed airway was retained and the patient remained symptom-free. PMID:23202872

Mandapathil, M; Hoffmann, T K; Freitag, L; Reddy, N; Lang, S; Delaere, P



Latissimus Dorsi Myocutaneous Flap for Breast Reconstruction: Bad Rap or Good Flap?  

PubMed Central

Objective: This article serves to review latissimus dorsi myocutaneous flap as an option for breast reconstruction postmastectomy. Since the introduction of the latissimus dorsi myocutaneous flap in the late 1970s, its use has always been as a secondary technique, particularly after the development of the transverse rectus abdominus myocutaneous flap in the 1980s. Methods: A literature review of the history of latissimus dorsi myocutaneous flap utilized for breast reconstruction as well as a review of our institution's experience with latissimus dorsi myocutaneous flap and tissue expander placement was performed. Results: There remains a paucity of published studies investigating latissimus dorsi myocutaneous flap for breast reconstruction. Most studies have small numbers and do not utilize tissue expanders. More recently several small studies have been published that show acceptably low complication rates with aesthetically pleasing outcomes when latissimus dorsi myocutaneous flap is employed with a tissue expander. At our institution, we have employed latissimus dorsi myocutaneous flap with tissue expander placement for both delayed and immediate reconstruction with subsequent replacement with a permanent implant with a capsular contraction rate of 10.5%. Our data and others more recently published demonstrate very acceptable capsular contracture rates and aesthetic outcomes, particularly when an expander is utilized. Conclusion: The latissimus dorsi myocutaneous flap remains an excellent choice for breast reconstruction with a low risk of complications.

Perdikis, Galen; Koonce, Stephanie; Collis, George; Eck, Dustin



The "Jacobsen flap" technique: a safe, simple surgical procedure to treat Dupuytren disease of the little finger in advanced stage.  


The surgery for advanced stages of Dupuytren disease of the little finger is controversial. In the literature, several techniques have been described with variable reported results and postoperative complications. Percutaneous needle fasciotomy, McCash technique, and dermofasciectomy are often performed for surgical treatment but they present significant complications and limits. This study reviews our experience of using the Jacobsen flap technique, a modification of the McCash procedure. We found that the Jacobsen flap technique for the significant correction of the contracture, the low rate of complications, and the relatively simple surgical approach is an excellent alternative to percutaneous needle fasciotomy, dermofasciectomy, or amputation. PMID:20818219

Tripoli, Massimiliano; Cordova, Adriana; Moschella, Francesco



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


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

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



Reconstruction techniques in skull base surgery.  


One of the major challenges of cranial base surgery is reconstruction of basal dural defects. Ineffective reconstruction may result in potentially life-threatening complications such as cerebrospinal fluid leak, meningitis, and tension pneumocephalus. Goals of reconstructive procedures are to repair the dural defect and to separate intracranial contents from bacteria-laden secretion of the mouth, nose, and sinus. Different reconstructive techniques have been reported. Multiple factors may influence the surgical choice of reconstructive technique and its outcome. Regional pedicled flap and vascular free flaps represent the best reconstructive options because vascularized tissues promote fast and complete healing. A variety of endoscopic pedicled mucosal flaps within the nasal cavity have also been described. The different reconstruction techniques are described and discussed in terms of indications, advantages, and drawbacks. PMID:21558901

Gagliardi, Filippo; Boari, Nicola; Mortini, Pietro



The Versatile Use of Temporoparietal Fascial Flap  

PubMed Central

Background: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin. Objective: The aim of this study is to report our experience in versatile use of temporoparietal fascial flap (TPFF) and discuss the surgical anatomy and technique. Patients and Methods: A total number of 57 TPFFs have been used in periorbital, mid-facial, auricular, and tracheal reconstruction due to tumor resection, trauma, and congenital ear deformities. Results: All the flaps were successfully transferred without any major complication. The cosmetic results were quite satisfactory to all patients. Conclusion: The advantages and minimal donor site morbidity of TPPF makes this flap a good choice in many reconstructive procedures.

Demirdover, Cenk; Sahin, Baris; Vayvada, Haluk; Oztan, Hasan Yucel



Postirradiation flap infection about the oral cavity  

SciTech Connect

Postirradiation alteration of oral flora is well documented in the literature. Infection as a complication leading to partial or complete loss of a flap used to reconstruct a defect in the oral cavity is a worrisome outcome. We describe how a flap that was judged clinically to be viable became overwhelmingly infected with the Klebsiella oxytoca, an oral cavity pathogen encountered in this patient following irradiation. Local and systemic changes led to detachment of the flap. This complication may be explained, in view of the absence of venous congestion or arterial ischemia both clinically and pathologically, by the proven contamination of the flap by the Klebsiella pathogen. Local factors resulted in lower resistance and subsequent overwhelming infection. Discussion of the case, review of pertinent literature, and proposed solutions are presented.

Cabbabe, E.B.; Herbold, D.R.; Sunwoo, Y.C.; Baroudi, I.F.



Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps  

SciTech Connect

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

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



Smart flapping wing using macrofiber composite actuators  

NASA Astrophysics Data System (ADS)

In the present study, we have developed a smart flapping wing with a MFC (macro-fiber composites) actuator. To mimic the flying mechanisms of nature's flyers such as birds or insects, the aerodynamic characteristics related to the birds and ornithopters are investigated. To measure the aerodynamic forces of flapping devices, a test stand consisting of two loadcells is manufactured, and the dynamic tests are performed for an onithopter. The smart flapping wing is designed and manufactured using composite materials and MFC actuators. The camber of the wing can be changed by using the surface actuators to enhance the aerodynamic performance of the wing. Finally, aerodynamic tests are performed in a subsonic wind tunnel to evaluate the dynamic characteristics of the smart flapping wing. Experimental results show that unsteady flow effects are increased with low velocity in high flapping frequency regions, and that the deformation of the wing surface generated by the MFC is enough to control the lift and thrust. The lift generated by the smart flapping wing can be increased by 20% when the MFC is actuated.

Kim, Dae-Kwan; Han, Jae-Hung



Upper-lip vermilion reconstruction with a modified cross-lip vermilion flap in hemifacial atrophy.  


Lip-vermilion reconstruction is part of the comprehensive treatment of progressive hemifacial atrophy. In this study, we described a two-stage reconstruction procedure to address the defect of the upper lip in patients with hemifacial atrophy, using a modified cross-lip vermilion flap with the pedicle specifically positioned at the commissure for functional and aesthetic purposes. During the first stage of surgery, a pre-determined mucosal flap from the lower lip with a vascular pedicle containing an inferior labial artery and the surrounding orbicularis oris muscle cuff were raised and transposed to reconstruct the upper-vermilion defect. Additional manoeuvres include simultaneous creation of the central tubercle of the upper lip with a segment of de-epithelised vermilion flap. At the second stage, the pedicle was divided 10-14 days later to complete the reconstruction. The patients achieved satisfactory results without compromising the shape of the commissure and the donor-site scar was inconspicuous. During the period prior to the division of the pedicle, this technique also overcomes the discomfort and pain during eating and speaking that could occur with the traditional cross-lip vermilion-flap transfer whereby the pedicle is centrally located. To the best of our knowledge, this is the first report of such a technique specifically applied to address the unilateral upper-lip vermilion defect in patients with hemifacial atrophy. PMID:23410844

Jin, Xiaolei; Teng, Li; Lu, Jianjian; Xu, Jiajie; Zhang, Chao; Xu, Meibang; Zhao, Jingyi



Successful upper alveolar reconstruction for gingival cancer using a fibular osteoadipofascial flap without osseointegrated implants.  


An upper alveolar skeletal reconstruction with closure of the palatal fistula using an osteocutaneous free flap is considered an ideal reconstructive strategy after curative surgery for cancer of the lower maxilla. Although installation of osseointegrated implants into the bone has advantages for utilizing a dental prosthesis, it is often time and cost prohibitive. In the case of 1 patient, we reconstructed and fit the patient with a conventional denture, eliminating the need for installation of osseointegrated implants. The patient underwent upper alveolar reconstruction using a fibular osteoadipofascial flap, followed by a skin graft for creation of an alveololabial sulcus. It was then possible for the patient to wear a conventional denture without implants. One explanation for this success is that the regenerated mucosa on the adipofascial flap and skin graft was immobile, which allowed it to serve as a base for the dental prosthesis. The alveololabial sulcus that had been constructed kept the denture in place. This reconstruction confirmed that a fibular osteoadipofascial flap might be a useful choice in restoring a natural upper alveolar osseous and soft tissue structure. PMID:15725845

Nakayama, Bin; Ikuo, Hyodo; Kamei, Yuzuru; Hachiya, Hiroshi; Torii, Shuhei



Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions.  


Despite the refinement of microsurgical techniques, microsurgical free flap transfer in patients with a history of previous radiotherapy, neck dissection or free flaps remains a challenge in oncologic reconstructive surgery. Previous studies on the prognostic factors for postoperative complications have been largely retrospective and shown conflicting results. Our aim was to design a prospective study to identify negative outcome predictors of free flap surgery in previously treated oral cancer patients. Prospective study including all patients who required microsurgical free flap transfer for reconstruction of the oral cavity between July of 2007 and June of 2010 with subset analysis of those cases in whom previous surgical or nonsurgical oncological treatment for head and neck cancer had been carried out. A total of 360 free flaps were performed in 358 patients, of whom 61 had previous neck dissection and 58 had undergone radiation therapy. Operation time was significantly found to be longer in irradiated patients. The need for microsurgical revision, postoperative wound infection and free flap loss were significantly associated with the ASA score and a previous neck dissection. Wound infection was seen significantly more often after radiotherapy. Previous neck dissections and radiotherapy as well as the ASA score are significant negative predictors for success in free flap transfer. For patients with prior oncologic treatments in their medical history, we recommend detailed preoperative assessment of the vascular status and an intensified postoperative care to reduce complication rates to improve outcome in oncologic reconstructive surgery. PMID:22155256

Mücke, Thomas; Rau, Andrea; Weitz, Jochen; Ljubic, Andreas; Rohleder, Nils; Wolff, Klaus-Dietrich; Mitchell, David A; Kesting, Marco R



The versatility of pectoralis major muscle and musculocutaneous flaps in the reconstruction of the oral cavity and of the anterior chest wall.  


Musculocutaneous flaps, allowing one stage reconstructions and reducing the stay in hospital and rehabilitation period, have revolutionised modern plastic surgery. Muscle flaps are a good alternative to provide adequate coverage of tissue losses but with limited scarring. The authors report their 5 year clinical experience in the reconstruction of oral cavity and chest wall defects using the pectoralis major as muscle or musculocutaneous flap. The preliminary data of an angiographic study, confirming the segmentation of the pectoralis major muscle into two subunits, each provided with its own vascular supply (mainly the clavicular and the sternocostal segment), are also presented. The short and long-term results confirm the excellent viability and versatility of the pectoralis major musculocutaneous and muscle flap. In particular the complications rate is so low that this procedure can be considered safe and reliable. PMID:7928147

Candiani, P; Campiglio, G L; Saccheri, S; Roviaro, G C


Primary closure with a filleted hallux flap after transmetatarsal amputation of the big toe for osteomyelitis in the diabetic foot: a short series of four cases.  


In the diabetic foot, osteomyelitis of the first metatarsal head adjacent to a malum perforans may require resection of the metatarsophalangeal joint. This results in a dysfunctional great toe and large tissue defects that take a long time to heal. The authors postulated that transmetatarsal amputation followed by primary closure with a filleted hallux flap would be feasible in selected cases. Patients that required surgery for diffuse bone destruction of the first metatarsal head were included in the study. Transmetatarsal amputation was performed only if tissue removal rendered the hallux functionless. Primary closure with a filleted hallux flap was attempted in four out of sixteen patients. The developed skin flaps invariably were long enough to cover the plantar tissue defect; no flap necrosis or recurrent infection was noted. Mean healing time was 44 days (range 9-69). Long-term results were disappointing due to ulcer recurrences under the remaining metatarsal heads. PMID:22561521

Aerden, Dimitri; Vanmierlo, Bert; Denecker, Nathalie; Brasseur, Lutgart; Keymeulen, Bart; Van den Brande, Pierre



Neophalloplasty using a rectus abdominis muscle flap and a radial forearm free flap  

Microsoft Academic Search

A method for construction of a neopenis in female-to-male transsexual patients is described. The method consisted of inferior transposition of a rectus abdominis island muscle flap with resurfacing using a radial forearm free flap. Excellent internal support and a natural looking appearance was achieved. This technique was considered to be better than any other previously used method of neophalloplasty.

P. Santi; M. Adami; P. Berrino; A. Galli; M. Muggianu; J. Vesely



Single flap reconstruction for complex oro-facial defects using chimeric free fibular flap variants.  


In this article, we describe the use of chimeric free fibular flaps to reconstruct three-dimensional spatial defects in the orofacial region. Recent insights into permutations possible with the chimeric fibular flap have allowed us to achieve our reconstructive objectives with a single chimeric flap and minimise donor-site morbidity as well as operating time. In an overall series of 34 free fibular flaps from 2009 to 2012, we performed twelve cases of free chimeric fibular flaps with osseo-myo-cutaneous/OMC (n=7), multi-pedicled osseo-musculo-cutaneous/Mp-OMC (n=4) and multi-pedicled osseo-cutaneous/Mp-OC (n=1) variants for either post-excisional defects or osteo-radionecroses. We had an overall flap survival rate of 100% with one partial flap loss due to the 'puppeteer' effect. Based on our experiences, we find the chimeric fibular flap to be an excellent addition to our reconstructive arsenal for complex orofacial defects. PMID:23177211

Kannan, R Y; Mathur, B S; Tzafetta, K



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

Microsoft Academic Search

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




The distally based superficial sural flap for reconstruction of the lower leg and foot  

Microsoft Academic Search

We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and

N. Rajacic; M. Darweesh; K. Jayakrishnan; R. K. Gang; S. Kojic



Efficacy of postoperative steroids on ischemic skin flap survival in rats  

Microsoft Academic Search

Necrosis of skin flaps remains a significant clinical problem. This study examined whether steroids improve skin flap survival in rats. Random skin flaps were raised in 30 male Sprague-Dawley rats. Intramuscular methylprednisolone (n=15) or saline solution (n=15) were administered 1, 24, and 48 h after flap elevation. Surviving flap areas were measured after 7 days. The mean surviving flap area

Bekir Kuru; Soykan Dinç; Mithat Çamlibel; Engin Durmu?; Haluk Alagöl



The pedicled inferior paraumbilical perforator (I-PUP) flap for a volar wrist defect: A reconstructive solution across the ages.  


Full-thickness soft-tissue defects overlying vital forearm or wrist structures frequently result from acute trauma or tumor ablation. These defects present reconstructive challenges, due to the thin pliable skin to be replaced and the non-graftable bed beneath. The authors discuss a case of a renal-transplant patient with a volar wrist SCC, in whom local vascular anatomy deemed microvascular free tissue transfer inappropriate. The authors present a successful novel reconstructive solution; the pedicled inferior paraumbilical perforator flap (I-PUP), a two-staged procedure that incorporates principles of distant flaps - which pre-date microsurgery - combined with techniques and lessons learned in the era of perforator flap surgery. PMID:23473676

Shukla, L; Taylor, G I; Shayan, R



Experimental comparison of bone revascularization by musculocutaneous and cutaneous flaps  

SciTech Connect

Revascularization, one of the major components of bone healing, was examined in an experimental model. The radioactive microsphere technique demonstrated that after 4 weeks beneath a musculocutaneous flap, isolated bone segments had significant blood flow, whereas bone beneath a cutaneous flap did not. The muscle flap bone had a blood flow approximately half that of normal control bone. The muscle of the musculocutaneous flap had a blood flow three times that of the skin of the cutaneous flap. The bipedicle cutaneous flap used was designed to have a healthy blood supply, and at 4 weeks it had a blood flow twice that of control skin. Despite this, there was essentially no demonstrable blood flow in the cutaneous flap bone segments at 4 weeks. Only 3 of 17 bone segments underneath cutaneous flaps showed medullary vascularization, whereas 10 of 11 muscle flap bones did. All bone segments underneath muscle flaps showed osteoblasts and osteoclasts at 4 weeks; neither were seen in the cutaneous bone segments. The process of revascularization occurred through an intact cortex and penetrated into the cancellous bone. Because the bone segments were surrounded by an impervious barrier except for one cortical surface, the cellular activity seen is attributed to revascularization by the overlying flap. In this model, a muscle flap was superior to a cutaneous flap in revascularizing isolated bone segments at 4 weeks. This was documented by blood flow measured by the radioactive microsphere technique and by bone histology.

Fisher, J.; Wood, M.B.



Omental free-tissue transfer for coverage of complex upper extremity and hand defects--the forgotten flap.  


Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm(2) with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity. PMID:19319608

Seitz, Iris A; Williams, Craig S; Wiedrich, Thomas A; Henry, Ginard; Seiler, John G; Schechter, Loren S



The clavipectoral osteomyocutaneous free flap.  


Microvascular free tissue transfer has revolutionized head and neck reconstruction and currently is considered the most successful and reliable method of primary oromandibular reconstruction. This study was designed to assess the feasibility of full thickness free vascularized transfer of the clavicle based on the clavicular branch of the thoracoacromial artery and the soft tissue component associated with the thoracoacromial axis. Forty dissections of the pectoral region were performed on 26 cadavers. The anatomic relations of the region and the thoracoacromial arterial and venous systems were documented in detail. Selective ink injections of the thoracoacromial arterial branches were also performed on fresh cadavers. The clavicle was supplied mainly by the clavicular artery (medial three quarters), with minor contribution from the deltoid artery (lateral quarter). An average of 16.1 cm (range of 12 to 20 cm) was obtained with total clavicular harvest and the clavicle had sufficient width and height to support dental implants. Two soft tissue donor sites were associated with the thoracoacromial artery: the sternocostal head of the pectoralis major muscle, with the overlying skin supplied by the pectoral artery, and the clavicular head of the pectoralis major muscle, with the overlying skin supplied by the deltoid and clavicular arteries. Sensory innervation of the upper chest was supplied through the supraclavicular nerves, whereas the lateral pectoral nerve supplied motor innervation to both heads of the pectoralis major muscle. The anatomy of the clavipectoral donor site and the first case of full thickness free clavicular transfer for mandibular reconstruction in the English literature are presented. The donor site is an excellent source of well vascularized, thin, pliable, hairless, potentially innervated (motor and sensory) soft tissue, along with up to 20 cm of clavicular bone. The surgical anatomy is familiar to the head and neck surgeon. The harvesting does not require repositioning of the patient and is amenable to a two-team, simultaneous approach. The functional and cosmetic donor site morbidity is minimal even with clavicular harvest. The major disadvantage of this flap is the relatively short pedicle. The authors conclude that the thoracoacromial system provides a free flap with osseous and soft tissue components that are well suited for oromandibular reconstruction. PMID:9374182

Seikaly, H; Calhoun, K; Rassekh, C H; Slaughter, D



Early Postoperative Outcomes Associated With the Anterolateral Thigh Flap in Gustilo IIIB Fractures of the Lower Extremity.  


PURPOSE: A core concept in plastic surgery has been the replacement of "like-with-like" tissue. Applying this concept to the lower extremity, the anterolateral thigh (ALT) perforator flap has become a frequently used free flap for restoration of soft tissue defects involving the distal lower extremity. The objective of this study was to evaluate the rate of early postoperative complications associated with the ALT perforator free flap for coverage of high-energy traumatic open fractures of the lower extremity (Gustilo IIIB) and explore related patient risk factors. METHODS: A retrospective chart review of 74 patients undergoing free tissue transfer for lower extremity limb coverage was performed. Early postoperative complications were defined as any 1 or more of the following having occurred within 6 months from surgical reconstruction: hematoma, wound infection, deep venous thrombosis, thromboembolism, partial flap loss, complete flap loss, continued osteomyelitis, and progression to amputation occurring within the first 6 months after the injury. Statistical analyses were performed using GraphPad software. Fisher exact test was performed to identify risk factors associated with greater morbidity. RESULTS: Of all patients, 26 (35%) were identified as those habitually using tobacco product and 48 (64%) were identified as nonusers of tobacco product. Moreover, 10 patients (14%) had other risk factors for atherosclerotic disease and 64 patients (86%) did not have other risk factors for atherosclerosis. Mean (SD) time to reconstruction was 4.74 (1.3) days (range, 3-8 days). Of all defects, 34 (46%) were reconstructed using adipocutaneous flaps and 40 (54%) were reconstructed using fasciocutaneous flaps. The most frequent complication was partial flap loss or superficial epidermolysis 4 (5.4%). Fisher exact test was performed, showing that patients who used tobacco product (cigarette smokers) and had other risk factors for atherosclerosis were significantly more at risk for complications (P < 0.001). CONCLUSIONS: In this retrospective review, those patients who had a positive history of tobacco use at the time of injury and those with risk factors for atherosclerosis had a significantly increased risk of flap complications. Although this is not surprising given the vasoconstrictive effects of nicotine and the impaired blood flow to the lower extremity in patients with atherosclerosis, this study will allow the surgeon to better counsel patients who have a history of tobacco use through complex reconstruction of the lower extremity. This analysis is a preliminary investigation into the safety and efficacy of the ALT fasciocutaneous or adipocutaneous flap to reconstruct high-energy open fractures of the lower extremity. PMID:22868329

Christy, Michael R; Lipschitz, Avron; Rodriguez, Eduardo; Chopra, Karan; Yuan, Nance



Swallowing after free-flap reconstruction in patients with oral and pharyngeal cancer.  


Swallowing and intraoral sensation outcome were investigated prospectively after microvascular free-flap reconstruction. Forty-one patients with a large oral or oropharyngeal carcinoma underwent free-flap surgery usually combined with radiotherapy. The patients completed modified barium swallow, self-rating of swallowing, and 2-point moving discrimination preoperatively and at four time points during the 12-month follow-up period, and a plain chest X-ray one year after operation. Swallowing was impaired with respect to an objective and subjective measure after therapy. Rates for nonsilent and silent aspiration increased during the follow-up. Intraoral sensation deteriorated. Swallowing outcome was not related to sensation. One year after surgery, 86% of the patients ate regular masticated or soft food. Microvascular transfers offer a reasonable option for oral reconstruction. This study does not support the need for sensate flaps. Swallowing problems should be routinely sought and patients rehabilitated during a sufficiently long follow-up with videofluorography regardless of the patient's perception of swallowing. PMID:16376135

Markkanen-Leppänen, Mari; Isotalo, Elina; Mäkitie, Antti A; Rorarius, Eija; Asko-Seljavaara, Sirpa; Pessi, Timo; Suominen, Erkki; Haapanen, Marja-Leena



Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap.  


Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy. PMID:15975135

Mukohyama, H; Haraguchi, M; Sumita, Y I; Iida, H; Hata, Y; Kishimoto, S; Taniguchi, H



Mandibular reconstruction in Goldenhar syndrome using temporalis muscle osteofascial flap.  


Goldenhar syndrome is a well-known developmental anomaly of the maxillofacial skeleton and hemifacial soft tissue. Maxillofacial anomalies of that syndrome can be managed by a variety of means such as inlay- or onlay-applied nonvascularized bone grafts, vascularized osteocutaneous/osseous flaps, or distraction osteogenesis. Vascularized full-thickness calvarial bone grafting is an important option for mandibular reconstruction for cases in which, for one reason or another, other techniques are not available, not applicable, or have failed. A mandibular defect of a 6-year-old boy presenting with bilateral preauricular skin tags, right microtia, right mandibular hypoplasia (with missing right condylar head and ascending ramus of the mandible) was reconstructed with right vascularized full-thickness calvarial bone grafting. Preoperative three-dimensional computed tomographic scans were used to acquire the stereolithographic biomodeling of the patient for assessing the amount of bone defect and precise planning of the surgery. Panoramic, anteroposterior, and lateral cephalograms and three-dimensional computed tomographic scans were obtained before and after the surgery and in the follow-up period for the evaluation of amount of relapse in the follow-up period. Clinical follow up and bone scintigraphy were used to assess the viability of transferred vascularized calvarial bone graft in the postoperative period. Plain radiographic evaluation with anteroposterior radiographs showed that mandibular symmetry increased and normooclusive closure of incisive teeth was achieved after surgery and retained in the postoperative period. Radiographs taken 1 year after surgery demonstrated that there was a slight relapse (1 mm) to the right side in the mandible when the results were compared with early postoperative ones. Postoperative three-dimensional computed tomographic evaluation of bony structures 3 months after operation showed that the transferred bone retained its volume. Sequential bone scintigraphies, performed to assess the vascularity of the grafts 1 week, 1 month, and 1 year after the operation, demonstrated the viability of transferred vascularized bone graft. The temporalis muscle osteofascial flap is a reliable method for mandibular reconstruction. It lessens the operative time, lessens surgical team labor, minimizes postoperative morbidity and discomfort, minimizes the hospital stay period, and minimizes financial expenses without renouncing the bone-healing capacity and increases aesthetic outcome by camouflaging the donor site scar in scalp and minimizing the facial scarring. PMID:18216683

Canter, Halil Ibrahim; Kayikcioglu, Aycan; Saglam-Aydinatay, Banu; Kiratli, Pinar Ozgen; Benli, Kemal; Taner, Tulin; Erk, Yucel



Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations.  


In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 x 5 to 6 x 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect. PMID:20143299

Pelzer, Michael; Reichenberger, Matthias; Germann, Günter



14 CFR 23.697 - Wing flap controls.  

Code of Federal Regulations, 2010 CFR

...limiting device. (b) The rate of movement of the flaps in response to...retracted, the wing flap control lever settings corresponding to those...definite change of direction of movement of the lever is necessary to select...



Flow field of flexible flapping wings  

NASA Astrophysics Data System (ADS)

The agility and maneuverability of natural fliers would be desirable to incorporate into engineered micro air vehicles (MAVs). However, there is still much for engineers to learn about flapping flight in order to understand how such vehicles can be built for efficient flying. The goal of this study is to develop a methodology for capturing high quality flow field data around flexible flapping wings in a hover environment and to interpret it to gain a better understanding of how aerodynamic forces are generated. The flow field data was captured using particle image velocimetry (PIV) and required that measurements be taken around a repeatable flapping motion to obtain phase-averaged data that could be studied throughout the flapping cycle. Therefore, the study includes the development of flapping devices with a simple repeatable single degree of freedom flapping motion. The acquired flow field data has been examined qualitatively and quantitatively to investigate the mechanisms behind force production in hovering flight and to relate it to observations in previous research. Specifically, the flow fields have been investigated around a rigid wing and several carbon fiber reinforced flexible membrane wings. Throughout the whole study the wings were actuated with either a sinusoidal or a semi-linear flapping motion. The semi-linear flapping motion holds the commanded angular velocity nearly constant through half of each half-stroke while the sinusoidal motion is always either accelerating or decelerating. The flow fields were investigated by examining vorticity and vortex structures, using the Q criterion as the definition for the latter, in two and three dimensions. The measurements were combined with wing deflection measurements to demonstrate some of the key links in how the fluid-structure interactions generated aerodynamic forces. The flow fields were also used to calculate the forces generated by the flapping wings using momentum balance methods which yielded details of where along the wing the forces were generated. As expected, these results indicated that the spanwise location of where the forces were generated depended upon the wings membrane material and reinforcement pattern, but in general it was in the outer third of the wing. (Full text of this dissertation may be available via the University of Florida Libraries web site. Please check

Sallstrom, Erik


Complications in circulation hamper the reinnervation of rat groin flaps  

Microsoft Academic Search

The reinnervation of rat groin island flaps and microneurovascular flaps was investigated. The nerve trunk leading to the\\u000a flap was transsected in all rats and the nerve ends were either resutured or ligated. Sensory and adrenergic reinnervation\\u000a of the flaps was studied semiquantitatively after 20 weeks using specific antisera for calcitonin gene-related peptide (CGRP)\\u000a as a marker for sensory nerves,

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



Effect of flapping trajectories on the dragonfly aerodynamics  

Microsoft Academic Search

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

Jinliang Xu; Chuangxin Zhao; Yongli Zhang; Yang Zhang



Perforator plus flaps: Optimizing results while preserving function and esthesis  

PubMed Central

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

Mehrotra, Sandeep



The forked flap repair for hypospadias  

PubMed Central

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

Chadha, Anil; Singh, Amitabh



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

PubMed Central

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

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



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

SciTech Connect

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

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



Digital coverage with flaps from the same or neighboring digits.  


Objective: Several flaps can be dissected from the same or neighboring digits for the reconstruction of relatively large soft tissue digital defects.Material and Methods: In a 6-year period, 106 large soft tissue digital defects were reconstructed with the use of flaps in 101 patients. For the reconstruction of 75 fingertip defects 73 neurovascular, island or advancement flaps (42 homodigital, 18 heterodigital, 13 advancement) and 2 thenar flaps were used. The 31 defects of the proximal and middle phalanges were reconstructed with 3 intermetacarpal and 28 cross-finger flaps (17 de-epithelialized and 11 classic for dorsal and palmar defects respectively).Results: All flaps survived. Subjectively, the results were rated as good or excellent in 69 of 73 distal defects reconstructed with neurovascular island or advancement flaps and in 29 of 31 proximal defects treated with cross-finger and intermetacarpal flaps. The mean DASH score was 4.1 and 3.34 for the neurovascular island/advancement flaps and the cross-finger flaps respectively.Conclusions: This study elucidates the indications and presents the advantages and disadvantages of flaps used for reconstruction of proximal and distal digital defects. Good results can be obtained with appropriate flap selection and meticulous surgical technique. PMID:22110298

Papatheodorou, L K; Dailiana, Z H; Varitimidi, S E; Hantes, M E; Basdekis, G K; Malizos, K N



Digital coverage with flaps from the same or neighboring digits  

PubMed Central

Objective: Several flaps can be dissected from the same or neighboring digits for the reconstruction of relatively large soft tissue digital defects. Material and Methods: In a 6-year period, 106 large soft tissue digital defects were reconstructed with the use of flaps in 101 patients. For the reconstruction of 75 fingertip defects 73 neurovascular, island or advancement flaps (42 homodigital, 18 heterodigital, 13 advancement) and 2 thenar flaps were used. The 31 defects of the proximal and middle phalanges were reconstructed with 3 intermetacarpal and 28 cross-finger flaps (17 de-epithelialized and 11 classic for dorsal and palmar defects respectively). Results: All flaps survived. Subjectively, the results were rated as good or excellent in 69 of 73 distal defects reconstructed with neurovascular island or advancement flaps and in 29 of 31 proximal defects treated with cross-finger and intermetacarpal flaps. The mean DASH score was 4.1 and 3.34 for the neurovascular island/advancement flaps and the cross-finger flaps respectively. Conclusions: This study elucidates the indications and presents the advantages and disadvantages of flaps used for reconstruction of proximal and distal digital defects. Good results can be obtained with appropriate flap selection and meticulous surgical technique.

Papatheodorou, L K; Dailiana, Z H; Varitimidi, S E; Hantes, M E; Basdekis, G K; Malizos, K N



Outcomes of flap salvage with medicinal leech therapy.  


Medicinal leech therapy (MLT) to salvage venous congestion in native skin and local flaps is commonly practiced. However, the role of MLT in compromised regional and free flaps remains unclear. Leeches were used in 39 patients to treat venous congestion in native skin (n = 5), local flaps (n = 6), regional flaps (n = 14), and free flaps (n = 14). There were no total losses in patients with compromised native skin or local flaps. One patient who had received a radial forearm free flap expired before flap outcome could be assessed, and was excluded from analysis. Of the remaining 27 regional and free flaps, 33.3% were salvaged, 33.3% were partially salvaged, and 33.3% were lost. Means of 38.3 ± 34.0, 101.0 ± 11.2, and 157.9 ± 224.4 leeches and 1.7 ± 3.6, 3.2 ± 4.4, and 5.6 ± 5.2 units of blood were required for the salvaged, partially salvaged, and lost groups, respectively. Twenty-two patients required blood transfusion (57.9%). No patients developed wound infection with Aeromonas hydrophilia. Two patients developed donor site hematomas, and four patients developed recipient site hematomas. MLT is efficacious in congested native skin and local flaps. Some regional and free flaps can be totally or partially salvaged. However, the morbidity of MLT must be weighed against the risks of flap loss. PMID:22473683

Nguyen, Marilyn Q; Crosby, Melissa A; Skoracki, Roman J; Hanasono, Matthew M



Experimental tracheal reconstruction with free prefabricated arterialized venous flap  

Microsoft Academic Search

A technique of tracheal reconstruction in the rat model has been developed using the microvascular transfer of a prefabricated compound flap. This flap consists of a tubed cartilage graft incorporated within an arterialized venous flap created in the abdominal skin. Twenty-five Wistar male rats were operated on in three stages. First, the subcutaneous venous network was arterialized by doing an

P. C. Cavadas; P. Baena-Montilla; F. Vera



Application of Floquet Theory to Helicopter Blade Flapping Stability.  

National Technical Information Service (NTIS)

The purpose of this thesis was to explore the flapping stability of a helicopter rotor blade in forward flight. The equations of motion for the flapping motion for the flapping motion of the blade were converted from nonlinear differential equations with ...

J. K. March



On the generation of side-edge flap noise  

Microsoft Academic Search

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 on the upper surface of the flap. Asymptotic formulas are developed in the opposite extremes of Lorentz contracted acoustic wavelength large\\/small compared with the chord of the flap. Interpolation

M. S. Howe



On the generation of side-edge flap noise  

Microsoft Academic Search

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

M. S. Howe



Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction  

Microsoft Academic Search

This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata (TFL) myofascial flaps. TFL flaps were elevated and delayed for 4 weeks in both cases. In the second case, Parietex Composite mesh was positioned underneath the TFL flap and allowed to incorporate. After a delay of 4

Frederick Wang; Samuel Buonocore; Deepak Narayan



Temporalis myo-osseous flap: an experimental study  

Microsoft Academic Search

The present paper investigates the anatomy and vascularization of the temporalis myo-osseous flap. This is a calvarial bone flap that employs temporalis muscle and its distal pericranial extension as a pedicle. In six human cadavers the flap was raised as an island on the anterior deep temporal artery after transecting the zygomatic arch and coronoid process. Maximal mobilization was thus

O. Antonyshyn; R. G. Colcleugh; L. N. Hurst; C. Anderson



Microvascular reconstruction of the mouth, face and jaws. Oromandibular reconstruction - free fibula flap.  


Dental surgeons may encounter in their clinical practice patients who present with aggressive pathologies that require early diagnosis and prompt treatment. This action may limit the extent of tissue damage and, where relevant, improve survival outcome. Clinicians should therefore be aware of the range of resective, reconstructive and rehabilitative options that are available in the management of these patients. We present our experience with the free fibula flap used for oromandibular reconstruction; this was undertaken in 21 patients following resective surgery for malignant pathology, cytologically benign but biologically aggressive odontogenic pathology and radiation induced osteonecrosis. We also review the history, surgical anatomy, surgical assessment and potential complications that are relevant to the free fibula flap. PMID:22924365

Hoffman, G R; Islam, S; Eisenberg, R L



Asynchronous osteoradionecrosis of the mandible treated with sequential fibula osteoseptocutaneous flaps: a report of two cases.  


Osteroradionecrosis of the mandible is one of the most serious complications of radiotherapy in head and neck cancer. Once osteoradionecrosis of the mandible has been established, conservative therapy is often useless. Two cases of asynchronous bilateral osteoradionecrosis of the mandible are presented. In both cases, successful reconstruction was performed with 2 free fibula osteoseptocutaneous flap transfers from both legs. We believe that adequate debridement, with removal of dead or hypovascular bone and surrounding soft tissue, followed by vascularized composite bone grafts, is the key for a successful outcome. In our cases, the oral function after 2 reconstructive surgeries with the fibula osteoseptocutaneous flap was acceptable. Furthermore, the patient could walk without difficulty. PMID:21811150

Shimizu, Fumiaki; Kato, Aiko; Taneda, Hiroko; Masuda, Daisuke; Sato, Seiichi; Uehara, Miyuki; Matsuda, Kaho; Kawano, Kenji; Takahashi, Yoshihiro; Yamaguchi, Kenji; Fujiwara, Sakuhei



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

PubMed Central

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

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



Neurotized Free Muscle Flaps can Produce MRI Changes Mimicking Tumour Recurrence  

PubMed Central

Soft tissue sarcomas are investigated by magnetic resonance imaging (MRI) both for initial staging and follow-up. We describe the presence of increased signal on T2-weighted images caused by a neurotized muscle flap following reconstructive surgery. This raised concern about possible sarcoma recurrence that was not clinically evident. On post-operative imaging of sarcomas the presence of recurrent tumour is indicated by a mass and high signal intensity on T2-weighted images. However, high signal changes in skeletal muscle on T2-weighted images are not specific. In this case, the free functioning muscle transfer with neurotization of the flap mimicked recurrence on MR scan. High signal intensity on T2-weighted images in muscle is an indication of either a physiological change or a pathological condition and must be taken in context of the clinical picture.

Barrett, J. A.; Cobley, T.; Devaraj, V.; Silver, D. A. T.



Neurotized Free Muscle Flaps can Produce MRI Changes Mimicking Tumour Recurrence.  


Soft tissue sarcomas are investigated by magnetic resonance imaging (MRI) both for initial staging and follow-up. We describe the presence of increased signal on T2-weighted images caused by a neurotized muscle flap following reconstructive surgery. This raised concern about possible sarcoma recurrence that was not clinically evident. On post-operative imaging of sarcomas the presence of recurrent tumour is indicated by a mass and high signal intensity on T2-weighted images. However, high signal changes in skeletal muscle on T2-weighted images are not specific. In this case, the free functioning muscle transfer with neurotization of the flap mimicked recurrence on MR scan. High signal intensity on T2-weighted images in muscle is an indication of either a physiological change or a pathological condition and must be taken in context of the clinical picture. PMID:18521420

O'Neill, J K; Barrett, J A; Cobley, T; Devaraj, V; Silver, D A T



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


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

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



Pedicled Lingual flap to provide keratinized tissue regeneration over dental implants: A description of the technique and a case report.  


Abstract Aim of this study is to report the efficacy of a lingual pedicle flap for soft tissue pre-prosthetic surgery in implant rehabilitation. While it has been demonstrated that keratinized gingiva is an important factor for implant success, there remains a dearth of case reports concerning the use of a lingual pedicle flap to achieve this desired outcome in such a large reconstructive effort. For this case report, the patient underwent an anterior mandibular resection of an ameloblastoma, and subsequent reconstruction resulting in soft tissue loss. To both functionally and esthetically satisfy the patient's desires, a bilateral rotated pedicled lingual flap was performed to augment keratinized tissue on the anterior mandibular ridge. An additional vestibuloplasty with two collagen matrices was also performed and an acrylic splint was then applied to achieve better stabilization. The primary outcome was to evaluate the efficacy of this technique, which, until now, was only used for exposed root coverage.The site demonstrated excellent healing over time, even resulting in an excess of healthy and pink soft tissue, which later had to be corrected with a small gingivectomy. Although the patient reported slight discomfort for a few days after surgery, she was nonetheless pleased both with her ability to function and her appearance. The results of this study show that the bilateral rotated pedicled lingual flap is a viable technique for the correction of soft tissue defects in implant dentistry, providing a good amount of keratinized gingiva. PMID:23425252

Herford, Alan S; Tandon, Rahul; Pivetti, Luca; Cicciů, Marco



Bovine surgery of the skin.  


Occasionally, the bovine practitioner is presented situations requiring application of techniques regarding wound repair and healing. Less commonly encountered in bovine practice than equine practice for example, principles and management of traumatic wound healing should be regarded as similar. Frequently, bovine practitioners need to apply knowledge of healing principles when wounds are surgically induced during horn and mass removal. Consideration of surgical approach, tension-relieving techniques, and dermal transposition flaps (see the ocular surgery article by Schulz in this issue) can be applied effectively in bovine practice. PMID:18929958

Miesner, Matt D



Smoking as a risk factor for wound healing and infection in breast cancer surgery  

Microsoft Academic Search

Aim: Clinical studies suggest that smoking is associated with wound necrosis after breast cancer surgery. However, the significance of smoking as a risk factor for wound infection, skin flap necrosis, and epidermolysis when adjusting for other potential risk factors remains to be studied.Methods: From June 1994 through August 1996, 425 patients underwent breast cancer surgery as simple mastectomy, modified radical

L. T. Sřrensen; J. Hřrby; E. Friis; B. Pilsgaard; T. Jřrgensen



Propulsion in viscoelastic fluids: waving, flapping  

NASA Astrophysics Data System (ADS)

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.

Lauga, Eric



Flapping dynamics of a flexible filament  

NASA Astrophysics Data System (ADS)

This paper investigates the dynamics of the flapping regime of a filament placed in a two-dimensional soap-film flow for different filament lengths and flow speeds. It was found that the onset of flapping is quasiperiodic, with the main flapping amplitude and frequency modulated by low-amplitude, low-frequency oscillation. At higher flow velocities, the oscillation becomes chaotic. The transition to chaos occurs via the quasiperiodic route to chaos. A new bistability phenomenon was discovered in which the system alternates between the stretched-straight and oscillatory states, which is here referred to as “switching oscillation.” Unlike some previously reported forms of bistability, in this case the system alternates between the two states continuously, without any external perturbation.

Ait Abderrahmane, H.; Paidoussis, M. P.; Fayed, M.; Ng, H. D.



Merest sclera technique for primary pterygium surgery.  


Over a 5-year period, 800 patients with primary pterygium underwent "merest sclera" surgery, a procedure in which the injured limbo-conjunctival area is covered completely with superior and inferior conjunctival flaps so that the tear film can be reestablished. After a 1-year follow-up, 17 recurrences were found (2.1%). All these resulted from premature wound dehiscence and/or postoperative infection. PMID:2630971

Anduze, A L



Maxillary Reconstruction using Chimeric Flaps of the Subscapular Artery System without Vein Grafts and the Novel Usage of Chimeric Flaps.  


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

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



The Flexible Learning Approach to Physics (FLAP)  

NASA Astrophysics Data System (ADS)

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.

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



Complications with homologous fat grafts in breast augmentation surgery  

Microsoft Academic Search

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

Peter Pohl; Carlos Oscar Uebel




Microsoft Academic Search

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




The use of an angularis oris axial pattern flap in a dog after resection of a multilobular osteochondroma of the hard palate  

PubMed Central

An 11-year-old neutered male boxer was presented for treatment of a multilobular osteochondroma of the hard palate. The mass was surgically resected and the hard palate defect was reconstructed using an angularis oris axial pattern buccal mucosal flap. No local recurrence was reported 6 mo after surgery.

Dicks, Naomi; Boston, Sarah



Flap-edge aeroacoustic measurements and predictions  

NASA Astrophysics Data System (ADS)

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

Brooks, Thomas F.; Humphreys, William M.



The clavicular head of pectoralis major musculocutaneous free flap.  


A new free flap is described based on the deltoid vessels of the acromiothoracic axis. The flap is comprised of the clavicular head of pectoralis major muscle with overlying skin. It is also possible to harvest vascularised clavicular bone with the flap. The vascular anatomy is reviewed and the technique of raising the flap described. Its clinical application is illustrated with five cases. Four of these were intra-oral reconstructions and the fifth a composite osteo-musculocutaneous flap to a lower limb following trauma. PMID:3511998

Reid, C D; Taylor, G I; Waterhouse, N



The use of prefabrication technique in microvascular reconstructive surgery  

PubMed Central

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

Maciejewski, Adam; Szymczyk, Cezary; Wierzgon, Janusz; Szumniak, Ryszard; Jedrzejewski, Piotr; Grajek, Maciej; Dobrut, Miroslaw; Ulczok, Rafal; Poltorak, Stanislaw



Bilateral small radial forearm flaps for the reconstruction of buccal mucosa after surgical release of submucosal fibrosis: a new, reliable approach.  


Oral submucous fibrosis is a collagen disorder affecting the submucosal layer and often severely limiting mouth opening. Previous surgical treatments have been disappointing. This article introduces a new surgical approach: reconstructing the bilateral buccal mucosa with two small radial forearm flaps. The surgical method includes the complete surgical release of fibrotic buccal mucosa and, if necessary, a bilateral coronoidectomy and temporalis muscle myotomy. From 1997 to 1999, 15 patients with moderate-to-severe trismus received reconstructive surgery, for a total of 30 small radial forearm flaps after surgical release. The flap size was between 1.5 x 5 and 2.5 x 7 cm. All donor sites were directly closed, and all flaps survived completely, except for one with partial necrosis. Six flaps required minor revisions because of size redundancy. Two patients developed buccal cancer in the area of reconstruction. At an average of 12 months' follow-up, the inter-incisal distance averaged 33 mm, an increase of 17 mm compared with the preoperative value. The donor-site morbidity was minimal, except in one heavy smoker who developed dry gangrene of his fingertips. The use of two small free forearm flaps for buccal mucosa reconstruction allows more radical release of fibrotic tissue. Coronoidectomy and temporal muscle myotomy further contribute to the effect of trismus release. The combined effects of this approach have consistently given good results. An aggressive approach toward surgical treatment of this precancerous lesion also facilitates the detection of cancer at an early stage. PMID:11391185

Wei, F C; Chang, Y M; Kildal, M; Tsang, W S; Chen, H C



Repositioning of Cranial Bone Flaps Cut with a Diamond-Coated Threadwire Saw: 5-Year Experience with Cosmetic Cranioplasty without Fixation Devices  

PubMed Central

Artificial fixation systems for cranial bone flaps have problems related to their materials and designs. We developed an alternative technique for supratentorial craniotomy that employs a diamond-coated threadwire saw (diamond T-saw), originally developed for spinal surgery, and reduces the bone gap for fitted bone flap fixation. The study subjects were 77 adults undergoing elective supratentorial craniotomy. After placing a burr hole at each corner of the craniotomy, we performed osteotomy between adjacent burr holes to approximately one-third of the length of the osteotomy with a craniotome; this leaves a bony bridge at each corner. The diamond T-saw was introduced between adjacent burr holes through the epidural space and a bridge was cut with reciprocating strokes. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. Successful bone flap fixation was obtained in all followed-up cases. There were no technique-related complications such as dural laceration, flap displacement, or resorption. Our method is ideal for bone cuts in cosmetic cranioplasty; it is easy, safe, and inexpensive and avoids the need for flap fixation with artificial devices.

Shimizu, Satoru; Kondo, Koji; Yamazaki, Tomoya; Nakayama, Kenji; Yamamoto, Isao; Fujii, Kiyotaka



The creation of new rotation arc to the rat latissimus dorsi musculo-cutaneous flap with delay procedures  

PubMed Central

Background Latissimus dorsi musculocutaneous flap is one of the most frequently performed reconstructive techniques in surgery. Latissimus dorsi muscle has two arcs of rotation. It is classified as type V muscle. This muscle can be elevated on the thoracodorsal artery to cover large defects in the anterior chest and also, the muscle can be elevated on the segmental vessels to cover midline defects posteriorly. The aim of this study was to create a new arc of rotation on a vertical axis for the muscle and investigate effectiveness of vascular and chemical delays on the latissimus dorsi muscle flap with an inferior pedicle in an experimental rat model. We hypothesized that the latissimus dorsi muscle would be based on inferior pedicle by delay procedures. Methods We tested two different types of delay: vascular and combination of vascular and chemical. We also tried to determine how many days of "delay" can elicit beneficial effects of vascular and combination delays in an inferior pedicled latissimus dorsi musculocutaneous flap. To accomplish this, 48 male Sprague-Dawley rats were randomly subjected to vascular or combination delay (vascular and chemical). In addition, one ear of each rat was assigned into a delay procedure and the other ear was used as a control. Results were evaluated macroscopically, and micro-angiography and histological examinations were also performed. As a result, there was a significant difference in viable flap areas between vascular delay alone and control groups (p < 0.05). Results The higher rate of flap viability was obtained in seven-day vascular delay alone. However, there was no significant difference in the viability between seven-day vascular delay and five-day vascular delay (p < 0.05), so the earliest time when the flap viability could be obtained was at five days. The rate of flap viability was significantly higher in the vascular delay combined with chemical delay than the control group (p < 0.05). Conclusion The combination of vascular and chemical delays increased the rate of viability. Nevertheless, there was no significant difference between vascular delay alone and combination of vascular and chemical delays. Chemical delay did not significantly decrease the delay period. Better histological and microangiographical results were achieved in delay groups compared to control groups. We concluded that the arch of the latissimus dorsi musculocutaneous flap can be changed and the flap can be used for various purposes with the delay procedures.

Copcu, Eray; Sivrioglu, Nazan; Aktas, Alper; Oztan, Yucel



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


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

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



Comparison studies of different flaps for reconstruction of buccal defects.  


Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation. PMID:24036811

Fang, Qi-Gen; Safdar, Jawad; Shi, Shuang; Zhang, Xu; Li, Zhen-Ning; Liu, Fa-Yu; Sun, Chang-Fu



Herpes Simplex Virus 1 Infection on a Reconstructive Free Flap  

PubMed Central

Objective: Herpes simplex virus 1 (HSV1) is a widespread virus that primarily causes orofacial infection. Methods: We present a case of HSV1 infection on a free radial forearm flap used to reconstruct a palate defect. Initially, the free flap appeared healthy; however, after 48 hours the free flap appeared in distress, with dark red colour and fast capillary refill. Venous congestion was suspected, and the patient underwent a second operation where no vascular compromise was found. Vesicles were noted on the free flap; swabs revealed HSV1 infection. Results: Complete recovery of the free flap was achieved with acyclovir. Discussion: To the best of our knowledge, this is the first report of HSV1 infection on a free flap that was found to be responsible for the free flap appearing distressed.

Parys, Simon P.; Leman, Thea; Gurfinkel, Reuven



Unsteady airfoil with a harmonically deflected trailing-edge flap  

NASA Astrophysics Data System (ADS)

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

Lee, T.; Su, Y. Y.



Superficial musculoaponeurotic system flap for reconstruction of the intraoral defects.  


Intraoral tumors are the main causes of the intraoral and maxillofacial defects. Skin grafts and several soft tissue flaps can be used to reconstruct the intraoral defects including local, regional, and free flaps. Here we present a case of intraoral adenocystic carcinoma treated with segmental maxillectomy, resection of the parotid gland, and the buccal mucosa leaving a full-thickness intraoral defect. The defect was covered with a superficial musculoaponeurotic system (SMAS) flap elevated using the preauricular incision. Reconstruction with SMAS flap for temporal defects and parotidectomy defects has been described in the literature. To our knowledge, the use of this flap for intraoral defects has not been reported. The proximity of the flap to the defect and ease of harvest in cases including total parotidectomy are few of the reasons we use and recommend this flap in reconstruction of intraoral defects. PMID:24037938

Kocaaslan, Nihal Durmus; Akdeniz, Zeynep Deniz; Celebiler, Ozhan; Numanoglu, Ayhan



The Split Radial Forearm Flap for Lower Leg Defects.  


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

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



[Fasciocutaneous flap--a simple alternative to the musculocutaneous or free, microvascular flap of the lower extremity?].  


Fasciocutaneous flaps demonstrate, in comparison to subcutaneous transposition flaps, far better local hemodynamic circulation and the length to width ratio can be increased to 3:1 or 5:1 so that they provide a simple method of closure in soft tissue defects. Fasciocutaneous flaps can be prepared rapidly and simply, due to the subfascial dissection, so that traumatic soft tissue defects can be closed directly. The donor site is closed with a split skin graft. Free musculocutaneous flaps and regional musculocutaneous island flaps are far more useful in large muscular defects, degloving injuries and osteomyelitis. PMID:1793967

Heinrich, M; Falter, E; Herndl, E; Mühlbauer, W



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

NASA Astrophysics Data System (ADS)

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.

Lee, T.; Su, Y. Y.



Blood glucose measurement for flap monitoring to salvage flaps from venous thrombosis.  


Early detection and rapid re-exploration are important for flap salvage, and for this, a reliable monitoring method is required. The purpose of the current study was to evaluate blood glucose measurement (BGM) for flap monitoring and to establish a simple method that can be used widely to decrease the flap loss rate after tissue transplantation. We noted the BGM in 33 free or pedicled tissue transfers (57 BGM points) over time postoperatively. Skin punctures and blood glucose measurements were made using a Medisafe-finetouch needle and Medisafe-Mini (Terumo, Japan), which are commonly used by diabetic patients. Partial necrosis of the vascular territory was found at 5 points (9%), and blood flow disorder due to a venous thrombus was found at 5 points (9%). The mean blood glucose level in the congestive flaps was significantly lower than that in healthy flaps. ROC curve analysis was used to determine a cutoff value for BGM of 62 mg/dL, at which the sensitivity and specificity were 88% and 82%, respectively (p < 0.0001). In conclusion, BGM is an easy and accessible adjunct to flap monitoring, and the combination of BGM and previously established methods is likely to reduce postoperative complications caused by the development of a venous thrombus after free tissue transplantation. PMID:22153849

Hara, Hisako; Mihara, M; Iida, T; Narushima, M; Todokoro, T; Yamamoto, T; Koshima, I



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

PubMed Central

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

Lee, Byung Kwon



[The Foucher's "kite-flap" (12 cases)].  


The "kite-flap" is a cutaneous island flap containing a triple pedicle. It is harvested from the dorsum of the index and is intended to cover skin-loss on the thumb. The purpose of our study was to evaluate 12 "kite-flaps" performed over the course of 11 years. The skin defects were on the dorsum of the distal phalanx of the thumb in 3 cases, on the dorsum of both the distal and proximal phalanges in 4 cases and on the volar aspect of the thumb in 5 cases. The associated lesions consisted of combined bone and skin in one case treated by bone graft with external fixation, and one case of septic arthritis of the interphalangeal joint treated by arthrodesis. The results of our series are very good after an average of 2 years follow-up. We have however had 4 cases of cold intolerance, 2 cases of superficial sepsis and one case of shrinkage of the first commissure. It appears that the "kite-flap" is the best solution for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover. PMID:17418767

El Andaloussi, Y; Fnini, S; Labsaili, A; Garch, A; Ouarab, M; Largab, A



Calculation of Vortex-Flap Aerodynamic Characteristics.  

National Technical Information Service (NTIS)

The lateral-directional characteristics for configurations with vortex flaps were calculated by the VORSTAB code. In view of the poor correlation between the VORSTABL results and the data, it was decided to examine in detail the reasons behind the discrep...

C. E. Lan C. C. Hsing



Computational Aerodynamics of Insects' Flapping Flight  

NASA Astrophysics Data System (ADS)

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.

Yang, Kyung Dong; Kyung, Richard



[Myocutaneous and fasciocutaneous free flap for covering the lower leg and foot--a comparative study].  


A comparison is presented of free myocutaneous flaps, e.g. latissimus dorsi flap, gracilis flap and the inferior gluteal flap, with fasciocutaneous flaps, especially the scapular/parascapular flap, for covering defects of the lower leg and the foot. Myocutaneous flaps are especially suited to cover deep defects with loss of bone and provide a good basis for free bone grafting. Fasciocutaneous flaps are better suited to cover plain defects, having a good blood supply due to the rich epifascial vascular network. They are thinner than the myocutaneous flaps and in extensive defects they do not need additional free skin transplantation in the recipient area. PMID:1686568

Baumeister, R G; Frick, A



Transoral robotic-assisted free flap reconstruction after radiation therapy in hypopharyngeal carcinoma: report of two cases.  


The objective was to assess the feasibility and safety of transoral robotic surgery (TORS)-assisted free flap reconstruction for hypopharyngeal carcinoma after radiation therapy. The study evaluated the feasibility, surgical margins, the need for a tracheotomy, a nasogastric tube as well as surgery-related complications. Two patients underwent TORS-assisted free flap reconstruction after radiation therapy. The resection margins were free of tumor in both patients. A tracheotomy was performed in one patient who had been decannulated on the sixth postoperative day. One patient resumed satisfactory oral feeding in the fourth postoperative month and the second patient on postoperative day 7. No intraoperative complication and one postoperative complication (neck hematoma) were reported. After a follow-up period of 24 and 30 months, no local recurrence was observed. TORS is feasible for hypopharyngeal resection and assisted free flap reconstruction after radiation therapy. It represents a further step in the development of minimally invasive surgery for the treatment of head and neck cancers with laryngeal preservation. PMID:23712763

Hans, Stéphane; Jouffroy, Thomas; Veivers, David; Hoffman, Caroline; Girod, Angélique; Badoual, Cécile; Rodriguez, Jose; Brasnu, Daniel



Scanning electron microscopy of irradiated recipient blood vessels in head and neck free flaps  

SciTech Connect

Irradiated and control recipient blood vessels in a similar patient population were studied with scanning electron microscopy. The vessels that were biopsied were then anastomosed to a free flap. Irradiated arteries display a significantly greater wall thickness and higher incidence of intimal dehiscence compared with control arteries. Fibrin deposition, microthrombi, and endothelium cell dehiscence are present more frequently in irradiated vessels than in control vessels. Details of the preparation and anastomotic technique for irradiated blood vessels are discussed. Microvascular surgery in irradiated human blood vessels carries with it a higher risk of thrombosis due to preexisting vessel wall damage. This risk can be minimized by experience and attention to detail.

Guelinckx, P.J.; Boeckx, W.D.; Fossion, E.; Gruwez, J.A.



Open mastoidectomy and temporalis flap in the control of chronic otorrhoea.  


Open mastoid surgery still remains a principal operative treatment for chronic discharging ear. The indications for this procedure still abound in the tropics although it is rarely done in the developed countries nowadays. This series re-emphasize the control of chronic otorrhoea and operative wound infection as benefiting from a combined open mastoidectomy and reconstruction with deep temporalis fascia flap in children. The operative technique is further discussed. It is our hope that repopularising this procedure will help in the control of highly prevalent chronic ear in the tropical environment. PMID:21977847

Lasisi, O A; Olatoke, F; Sandabe, M B; Kondiya, S B


Reconstruction of a facial defect using the ear pinna as a composite flap.  


A four-month-old, female pit bull was evaluated for multiple, resolving, second- and third-degree burn wounds. The convex surface of the left pinna was severely burned and distorted. Contraction of a large (6 cm by 4 cm), facial cutaneous defect had resulted in contracture of surrounding normal skin and dorsal displacement of both upper eyelids. Decreased ability to blink predisposed the puppy to exposure keratitis. The cutaneous facial defect was repaired using the left pinna as a composite skin flap. Surgery resulted in a successful repair of the defect and immediate return of normal eyelid function. PMID:9728471

Swainson, S W; Goring, R L; deHaan, J J; Priehs, D R; Pavletic, M M


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


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

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



The superior trapezius myocutaneous flap in head and neck reconstruction.  


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

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



Reconstruction of the Lower Extremity Using Free Flaps  

PubMed Central

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

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



Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency  

PubMed Central

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

Hirschberg, Jeno



Free vascularized flaps for reconstruction of the mandible – complications, success and dental rehabilitation  

Microsoft Academic Search

PurposeTo evaluate complications and success of mandibular reconstruction with free fibula flaps, iliac crest flaps and forearm flaps with reconstruction plates. To evaluate dental rehabilitation after these reconstructions.

Johannes T. M. van Gemert; Robert J. J. van Es; Antoine J. W. P. Rosenberg; Andries van der Bilt; Ron Koole; Ellen M. Van Cann


Risk factors and blood flow in the free transverse rectus abdominis (TRAM) flap: smoking and high flap weight impair the free TRAM flap microcirculation.  


Mastectomy patients may have significant psychologic-related problems. Breast reconstruction provides in these cases substantial benefits in restoring body image and health-related quality of live. Autologous free tissue transfer is the treatment of choice due to excellent outcome. The purpose of this study was to elucidate the effect of the risk factors on the microcirculation and clinical outcome. In this prospective study, 21 patients with a free transverse rectus abdominis (TRAM) flap breast reconstruction were included. Patient demographics and flap characteristics were recorded. Blood flow was recorded in the central part (zone I) and the distal part (zone IV) of the flap with the laser Doppler flowmetry (LDF; Perimed). In this study, increased flap complications were seen in smokers when compared with nonsmokers (P < 0.000). LDF was higher in the older patient population (P = 0.008) in zone IV. Smoking, especially in combination with a high flap weight (HFW), revealed lower blood-flow values (P = 0.020) in zone IV. Other possible influencing risk factors such as a HFW and history of radio- and chemotherapy did not alter the microcirculation. Patients with smoking and a HFW did also show decreased blood flow but also more severe flap complications.Smoking, especially in patients with a HFW, impairs the free TRAM flap microcirculation in zone IV. In our opinion, these patients can still be included for reconstruction. However, extra care has to be taken during flap design to minimize disturbed wound healing. PMID:17901724

Booi, Darren I; Debats, Iris B J G; Boeckx, Willy D; van der Hulst, Rene R W J



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

PubMed Central

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

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



Reconstruction of extensive abdominal wall defect using an eccentric perforator-based pedicled anterolateral thigh flap: a case report.  


Reconstruction of extensive abdominal wall defects is a challenge for reconstructive surgeons. In this report, a case of reconstruction of a large abdominal wall defect using an eccentric perforator-based pedicled anterolateral thigh (ALT) flap is presented. A 30-year-old man presented with recurrent desmoid-type fibromatosis in the abdominal wall. The recurrent tumor was radically excised, and the en bloc excision resulted in a full-thickness, large abdominal wall defect (25 cm × 20 cm). An eccentric perforator-based pedicled ALT flap, including wide fascial extension, was transferred to the abdominal defect; fascial portions were sutured to the remnant abdominal fascia. Plication of the fascia along the sutured portion was performed to relieve the skin tension between the flap and the marginal skin of the abdominal defect. Eight months after surgery, the reconstructed abdomen had an acceptable esthetic appearance without tumor recurrence or hernia. The use of an eccentric perforator-based pedicled ALT flap may be an alternative method for the reconstruction of extensive abdominal wall defects. PMID:23836365

Jang, Joonchul; Jeong, Seong-Ho; Han, Seung-Kyu; Kim, Woo-Kyung



Supraclavicular artery flap: a new option for pharyngeal reconstruction.  


Laryngopharyngeal oncologic resections produce complex reconstructive problems, requiring dependable robust flaps to restore form and function. Current options include morbid local-regional flaps or free tissue transfers. The supraclavicular artery flap (SAF) offers a great new option. Partial pharyngeal oncologic defects were reconstructed with pedicled SAFs. Handheld Doppler probes marked the pedicle preoperatively. Flaps were design based upon the dopplered vascular anatomy. Complications and functional outcomes were assessed. All flaps (n = 6) were harvested in under 1 hour with uneventful postoperative recoveries. Ablative wounds and donor sites were closed primarily. Two patients had small controlled leaks because of preoperative radiation and overly aggressive oral intakes, that subsequently resolved. There were no functional donor site morbidities. We describe a novel application of the SAF for pharyngeal reconstructions after laryngopharyngeal cancer ablation. This thin, reliable, easy to harvest, low morbidity flap is an excellent reconstructive option for pharyngeal reconstructions. PMID:19387148

Liu, Perry H; Chiu, Ernest S



Free vascularized fascial flap in oral cavity reconstruction.  


Our experience with the free vascularized fascial flap based on the radial artery used for intraoral reconstruction is described. Thirteen patients underwent primary or secondary reconstruction following major resections for malignant disease. The osseofascial flap incorporating radial bone proved to be ideal when reconstruction of composite mandibular or maxillary defects was undertaken. The flaps rapidly underwent surface epithelialization, and submucosal fibrosis provided the ideal attached mucosal lining for prosthetic rehabilitation. PMID:8125787

Martin, I C; Brown, A E


Wake Vortex Control using Segmented Rapidly Actuated Gurney Flaps  

Microsoft Academic Search

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

Claude Matalanis; John Eaton



Visualization of flapping wing of the drone beetle  

Microsoft Academic Search

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

Kazutaka Kitagawa; Mitsutoshi Sakakibara; Michiru Yasuhara



Pumping by flapping in a viscoelastic fluid  

NASA Astrophysics Data System (ADS)

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

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



Reconstruction of mandible with fibula free flap.  


The fibula can be used as a donor for a free flap for mandible reconstruction. It has the advantages of low donor site morbidity, consistent shape, ample length, and distant location to enable a two-team approach, allowing multiple osteotomies because of its periosteal circulation. It can be raised with a skin island for composite tissue reconstruction. Eight segmental mandibular defects (average 11.62 cm) were reconstructed following resection for tumour. Six defects consisted of bone alone and the other two had only a small amount of associated intraoral soft-tissue loss. Two patients underwent primary reconstruction. We performed two or three osteotomies on each graft and used miniplates and wires for bone fixation. The flaps survived in all patients. All osteotomy sites healed primarily. The aesthetic result of reconstruction was satisfactory. PMID:9727925

Celebioglu, S; Unlü, R E; Koçer, U; Sensöz, O; Mengi, A S



Comparison of rectus abdominis muscle and musculoperitoneal flap in closure of urinary bladder defects in a rat model  

Microsoft Academic Search

To study the histological differences between a muscle flap and a musculoperitoneal flap used as a urinary bladder wall substitute, we prospectively studied these flaps in 24 Wistar albino rats. In 12 rats a rectus abdominis muscle flap including the overlying peritoneum (RAMP flap) was sutured into a surgical defect of the bladder wall. The rectus abdominis muscle flap was

Pien S. A. Schwencke-König; J. Joris Hage; Moshe Kon



Aerodynamic characteristics of flapping motion in hover  

Microsoft Academic Search

The aim of the present work is to understand the aerodynamic phenomena and the vortex topology of an unsteady flapping motion\\u000a by means of numerical and experimental methods. Instead of the use of real insect\\/bird wing geometries and kinematics which\\u000a are highly complex and difficult to imitate by an exact modeling, a simplified model is used in order to understand

D. Funda Kurtulus; Laurent David; Alain Farcy; Nafiz Alemdaroglu



Augmentation cheiloplasty by using mucomuscular flaps  

Microsoft Academic Search

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

Giovanni Botti; Renč Villedieu



Experimental investigation of a flapping wing model  

Microsoft Academic Search

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

Tatjana Y. Hubel; Cameron Tropea



Total scalp reconstruction with bilateral anterolateral thigh flaps.  


Large scalp defects can require complicated options for reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large scalp defects, and report a unique case in which total scalp reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The reconstruction was achieved as a single-stage reconstruction and involved wide resection of cranium and overlying soft-tissues and reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for scalp resurfacing and may be the largest reported scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the reconstruction of large and/or complicated scalp defects. PMID:22438113

Kwee, Melissa M; Rozen, Warren M; Ting, Jeannette W C; Mirkazemi, Mansoor; Leong, James; Baillieu, Charles



Medial circumflex femoral artery flap for ischial pressure sore.  


A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap. PMID:19881020

Palanivelu, S


Surgical flap amputation for central flap necrosis after laser in situ keratomileusis.  


A 52-year-old man had uneventful bilateral myopic laser in situ keratomileusis (LASIK) with planned monovision. Three months later, the left eye was retreated to improve the near vision. On postoperative day 1, the uncorrected distance visual acuity (UDVA) was 0.95 and the patient reported mild ocular pain. Stage 2 diffuse lamellar keratitis was observed. Despite hourly prednisolone instillation, the UDVA decreased to 0.1 and central flap necrosis syndrome was diagnosed. The flap was lifted and stromal bed irrigation performed. One month later, the UDVA was 0.05 with a hyperopic shift of +3.25 diopters and the flap, which had central haze and several striae, was amputated. Four months later, the UDVA was 0.05 with residual irregular astigmatism. Customized transepithelial photorefractive keratectomy (PRK) was performed; there were no postoperative complications. Three months after PRK, the UDVA was 0.8 with no refractive defect. PMID:19878838

Garcia-Gonzalez, Montserrat; Gil-Cazorla, Raquel; Teus, Miguel A



Flow Field of Flexible Flapping Wings  

NASA Astrophysics Data System (ADS)

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.

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



Evaluation of flexible flapping wing concept  

NASA Astrophysics Data System (ADS)

ONERA - The French Aerospace Lab - has launched an internal program on biologically-inspired Micro Air Vehicles (MAVs), covering many research topics such as unsteady aerodynamics, actuation, structural dynamics or control. The aim is to better understand the flapping flight performed in nature by insects, and to control state of the art technologies and applications in this field. For that purpose, a flight-dynamics oriented simulation model of a flapping-wing concept has been developed. This model, called OSCAB, features a body and two wings along which the aerodynamics efforts are integrated, so as to determine the global motion of the MAV. The model has been improved by taking into account the flexibility of the wings (flexion of the leading edge and passive torsion of the wings, induced by the flapping motion itself under wing inertia). Thus, it becomes possible to estimate the coupling between flexibility and the aerodynamic forces. Furthermore, the model shows that using elastic properties of the wings allows a diminution of the mechanical energy needed for wings motion, and a reduction of the number of actuators to be implanted into the MAV.

Rakotomamonjy, Thomas; Le Moing, Thierry; Danet, Brieuc; Gadoullet, Xavier; Osmont, Daniel; Dupont, Marc



A novel flap for the reconstruction of midcheek defects: "rabbit ear flap".  


Cheek defects generally occur because of reasons such as trauma, burn, and tumor excisions. In the reconstruction of cheek defects, it is essential to cover the defects using the tissues with compatible color and similar texture. Although many techniques have been described for this purpose, local flaps are more likely to be used.In this study, we describe a new technique named "rabbit ear flap," which we used for the reconstruction of a 4.5 × 7-cm cheek defect due to basal cell carcinoma excision in a 71-year-old male patient. Two separate flaps on the extension of right facial artery with an inferior pedicle on the nasolabial region (hairless skin) and a superior pedicle flap that extended from right oral commissure to the submandibular region (hairy skin) were used. The hairy skin part of the defect was closed via the hairy skin flap, whereas the hairless region was closed with the hairless skin flap. The donor sites were closed primarily.No complication was encountered in the early or long-term follow-ups. In the 28-month follow-up of the patient, it was observed that the color and texture compatibility was fine, the natural beard integrity was obtained, the donor site scarring was minimal, and the scarring was camouflaged well in the anatomical lines.This technique is supposed to be an alternative method for reconstruction of medium-sized cheek defects because it is a simple, reliable, and single-session procedure, and because of its similar color and texture, it offers satisfactory aesthetic and functional outcomes due to natural beard restoration. PMID:24036812

Kilinc, Hidir; Erbatur, Serkan; Aytekin, Ahmet Hamdi



Multidetector-row computed tomography in the planning of abdominal perforator flaps.  


An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is extremely valuable in improving the surgical strategy in abdominal perforator flaps. The multidetector-row computer tomography offers thin slice coverage of extended volumes with an extremely high spatial resolution. From October 2003 to December 2004, 66 female patients had breast reconstruction surgery in our department using the deep inferior epigastric artery perforator flap. Our multidetector-row computer tomography studies were performed using a 16-detector-row computer tomography scanner. The image assessment was carried out using the following protocol: we first identified the best three perforators from each side of the abdomen. Then we conducted a three-dimensional reconstruction of the abdomen by identifying exactly where the three best perforators emerged from the rectus abdominis fascia. We then transferred the data obtained from the image to the patient using a coordinate system. In addition, we also placed the dominant perforators in the patient by using a conventional hand-held Doppler. During the operation we compared intra-operative findings, Doppler results and computer tomography outcomes. Neither false positive nor false negative results were found in the computer tomography outcome. Multidetector-row computer tomography provides us with an easy method of interpreting the virtual anatomic dissection in three dimensions. It has high sensitivity and specificity and provides a good quality evaluation of the perforator vessels. This information allows reduction of operating time and safer performance of surgery. The multidetector-row computer tomography is a highly effective tool in the preoperative study of abdominal perforator flaps. PMID:16716952

Masia, J; Clavero, J A; Larrańaga, J R; Alomar, X; Pons, G; Serret, P



Breast Surgery  


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Surgical Techniques for Personalized Oncoplastic Surgery in Breast Cancer Patients with Small- to Moderate-Sized Breasts (Part 2): Volume Replacement  

PubMed Central

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.

Yang, Jung Dug; Lee, Jeong Woo; Cho, Young Kyoo; Kim, Wan Wook; Hwang, Seung Ook; Jung, Jin Hyang





Abstract Ameloblastomas are benign odontogenic tumors that develop from the epithelial rests of Malassez. This case reports the multi-disciplinary treatment of an extensive ameloblastoma including reconstruction with free bone flaps and dental implants and acellular dermal matrix graft. Segmental mandibular resection followed by reconstruction with free iliac crest bone flap was performed. Following six months of healing, 7 dental implants were performed. After six months, clinical examinations revealed existence of a mucogingival problem associated with lack of keratinized tissue at the peri-implant region and acellular dermal matrix graft was performed prior to second stage surgery. Following healing of 3 months, second stage surgery was performed and dental implant supported fixed prosthesis was delivered.The patient tolerated the procedures well. At 3rd month and 6th month follow-ups, clinical and radiographic examinations revealed favorable soft tissue and bone health. Following delivery of prosthesis, the patient was competent about the aesthetic and functional results achieved. Multidisciplinary treatment of extensive ameloblastomas with radical resection, free iliac crest bone flap and dental implants increase the quality of life for patients at both aesthetic and functional aspects. Frequent maintenance procedures and increasing the keratinized tissue at the peri-implant region are suggested for long term success of dental implants placed in reconstructed sites. PMID:23506101

Buyukozdemir Askin, Sezen; Aksu, Ali Emre; Cal?s, Mert; Tulunoglu, Ibrahim; Safak, Tunc; Tozum, Tolga Fikret



Vestibular deepening by periosteal fenestration and its use as a periosteal pedicle flap for root coverage  

PubMed Central

Gingival recession along with reduced width of attached gingiva and inadequate vestibular depth is a very common finding. Multiple techniques have been developed to obtain predictable root coverage and to increase the width of attached gingiva. Usually, the width of gingiva is first increased and then the second surgery is caried out for root coverage. The newer methods of root coverage are needed, not only to reconstruct the lost periodontal tissues but also to increase predictability, reduce the number of surgical sites, reduce the number of surgeries and improve patient comfort. Hence, this paper describes a single stage technique for increasing the width of attached gingiva and root coverage by using the periosteal pedicle flap.

Rajpal, Jaisika; Gupta, Krishna K.; Srivastava, Ruchi; Arora, Aakash



Stereoscopic lithography: customized titanium implants in orofacial reconstruction. A new surgical technique without flap cover.  


Head and neck surgery may involve complex methods of composite reconstruction that do not replicate the volume and contour of the normal anatomy. 'Functional' reconstruction implies replication of the normal volume and contour of both hard and soft tissues to produce normal form and function of the face, mouth and jaws. Techniques such as stereoscopic lithography and computer-assisted design, and-manufacture (CAD-CAM) have been successfully used with computer-numerized control (CNC) milling to manufacture customized titanium implants for single-stage reconstruction of the maxilla, hemimandible and dentition without the use of composite flap cover after the removal of tumours. Reduction in theatre time and personnel, less need for intensive care, and earlier discharge from hospital, indicate possible savings of Pound Sterling 17,000-Pound Sterling 19,000 per patient. There are implications for surgery in general, and further research and development is advocated. PMID:10577749

Peckitt, N S



Proangiogenic soluble factors from amniotic fluid stem cells mediate the recruitment of endothelial progenitors in a model of ischemic fasciocutaneous flap.  


Skin flaps are routinely used in surgery for the functional and cosmetic repair of wounds or disfiguring scars. The recent concept of therapeutic angiogenesis has emerged as an attractive approach to overcome the problem of blood supply deficiency, often resulting in the flap grafting failure. In the present study, we embedded a gelatin membrane with amniotic fluid stem cells (AFSC) derived conditioned media (ACM) to topically deliver angiogenic growth factors and cytokines into a rat model of ischemic full-thickness skin flap elevated in the epigastric region. AFSC secretome triggered the endogenous repair by the recruitment of endothelial progenitor cells. We studied the vascular perfusion rate, the vessel distribution, and the survival of ACM-treated flaps. In detail, the ischemic sectors of ACM-treated flaps showed at day 7 a perfusion level 50% higher than the preoperation baseline. The ensuing necrosis development was delayed and the histology analysis showed a normal arrangement of epidermal and dermal structures and a high density of vessels in subcutaneous tissues. Further, we found that ACM recruited CD31?/VEGFR2? and CD31?/CD34? cells into the ischemic subcutaneous tissues and that the isolated progenitors were capable to form clusters of von Willebrand factor-positive cells in culture. We propose ACM as a cell-free cocktail of chemokines and growth factors to be adopted for clinical applications. PMID:22225409

Mirabella, Teodelinda; Hartinger, Joachim; Lorandi, Christian; Gentili, Chiara; van Griensven, Martijn; Cancedda, Ranieri



Novel irradiated axial rotational flap model in the rodent.  


IMPORTANCE Patients who require extensive surgical resection of head and neck tumors often have a history of treatment with radiation and chemotherapy. Chemoradiation-induced damage to the skin and soft tissues can cause complications following surgical reconstruction. OBJECTIVE To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation exposure on flap viability. DESIGN AND SETTING Ten rats at a tertiary university medical center received 40-Gy irradiation to the abdominal wall. Following a recovery period of 1 month, a 3?×?8-cm fasciocutaneous flap based axially on the inferior epigastric vessel was raised and rotated 60° into a contralateral deficit. Five nonirradiated rats underwent the identical procedure as a control. Animals were killed 7 days postoperatively, areas of flap necrosis were documented by an observer blinded to the grouping, and histological specimens were taken to compare flap viability and vessel density. MAIN OUTCOMES AND MEASURES Flap revascularization and microvascular density. RESULTS Six of 10 rats in the irradiated group had necrosis of the distal flap ranging from 1 to 6 cm from the distal edge, whereas none of the animals in the control group exhibited necrosis (P?flaps; P?=?.004, .03, and .01 in the distal, middle, and proximal segments of the flap, respectively. CONCLUSIONS AND RELEVANCE This novel rat axial rotational flap model demonstrates increased flap necrosis and a decrease in vascular density due to the effects of radiation exposure. With use of a linear electron accelerator, a dose of 40 Gy can be delivered to the skin without resulting in devastating gastrointestinal adverse effects. LEVEL OF EVIDENCE NA. PMID:23787778

Luginbuhl, Adam; Modest, Mara; Yan, Kaiguo; Curry, Joseph; Heffelfinger, Ryan



Frontalis Muscle Flap Suspension for the Correction of Congenital Blepharoptosis in Early Age Children  

PubMed Central

Background We aimed to report our successful use of frontalis muscle flap suspension for the correction of congenital blepharoptosis in early age children. Methods This retrospective study included 61 early age children (41 boys, 20 girls) with an average age of 6 years (range, 3–10 years) with congenital blepharoptosis who received surgery during the period from March 2007 to January 2011. There were 39 cases of unilateral blepharoptosis and 22 cases of bilateral blepharoptosis, thus a total of 83 eyes were affected. If patient had bilateral blepharoptosis, both eyes were operated on in the same surgery. Patients were followed for 3 months to 5 years. The procedure was performed without complications in all cases. Results The postoperative healing grade was good in 81 eyes (97.6%); the correction of blepharoptosis was satisfactory, the double eyelid folds were natural and aesthetic, the eyelid position and the curvature were ideal, and the eyes were bilaterally symmetrical. The postoperative healing grade was fair in 2 eyes (2.4%); blepharoptosis was improved compared with that before surgery. At discharge, lagophthalmos was noted in 10 eyes of which 4 cases resolved by the last follow-up. The remaining 6 cases were mild. Eleven eyes received reoperation for residual ptosis after the first surgery. The curvature of the palpebral margin was not natural in 4 eyes. These unnatural curvature possibly was caused by an excessively low lateral fixation point or postoperative avulsion. Conclusion Frontalis muscle flap suspension under general anesthesia for the correction of congenital blepharoptosis in early age children can achieve good surgical results.

Hou, Dianju; Li, Gehong; Fang, Lin; Li, Bing



Fibrin sealant as an alternative for sutures in periodontal surgery.  


The trial compared wound healing clinically, histologically and morphometrically after the use of fibrin sealant and sutures for periodontal flap closure. Ten patients were selected for this split-mouth randomized controlled clinical trial. On the test site fibrin sealant (F) was applied for flap closure after periodontal flap surgery (n = 10) and on the control site sutures (S) were used (n = 10). Clinically wound healing was observed at 7, 14 and 21 days and biopsy was taken on the 8th day. At seventh day better healing was observed in fibrin sealant site. Histologically mature epithelium and connective tissue formation was seen in fibrin sealant site with increased density of fibroblasts (F = 70.45 ± 7.22; S = 42.95 ± 4.34, p < 0.001) and mature collagen fibers. The suture site had more number of inflammatory cells (S = 32.58 ± 4.29; F = 20.91 ± 4.46, p < 0.001) and more number of blood vessels (S = 11.89 ± 3.64; F = 5.74 ± 2.41, p = 0.005). Fibrin sealant can form a better alternative to sutures for periodontal flap surgery. PMID:23374528

Pulikkotil, Shaju Jacob; Nath, Sonia



Surprising behaviors in flapping locomotion with passive pitching  

NASA Astrophysics Data System (ADS)

To better understand the role of wing and fin flexibility in flapping locomotion, we study through experiment and numerical simulation a freely moving wing that can ``pitch'' passively as it is actively heaved in a fluid. We observe a range of flapping frequencies corresponding to large horizontal velocities, a regime of underperformance relative to a clamped (nonpitching) flapping wing, and a surprising, hysteretic regime in which the flapping wing can move horizontally in either direction (despite left/right symmetry being broken by the specific mode of pitching). The horizontal velocity is shown to peak when the flapping frequency is near the immersed system's resonant frequency. Unlike for the clamped wing, we find that locomotion is achieved by vertically flapped symmetric wings with even the slightest pitching flexibility, and the system exhibits a continuous departure from the Stokesian regime. The phase difference between the vertical heaving motion and consequent pitching changes continuously with the flapping frequency, and the direction reversal is found to correspond to a critical phase relationship. Finally, we show a transition from coherent to chaotic motion by increasing the wing's aspect ratio, and then a return to coherence for flapping bodies with circular cross section.

Spagnolie, Saverio E.; Moret, Lionel; Shelley, Michael J.; Zhang, Jun



One hundred free DIEP flap breast reconstructions: a personal experience  

Microsoft Academic Search

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

P. N. Blondeel



Urethral reconstruction using a prefabricated pedicled gracilis flap.  


This case study describes a patient who experienced an iatrogenic urethral injury because of a Fournier gangrene debridement. Because of the extent of the debridement, which resected all penile and scrotal dartos tissue, no local flaps that would typically be used to reconstruct a urethral disruption were possible. The authors chose to use a prefabricated pedicled gracilis flap to restore urethral continuity. PMID:22791063

Crane, Curtis; Cornejo, Agustin; Lyons, Robert; Alter, Gary J



Noise Characteristics of Jet Flap Type Exhaust Flows.  

National Technical Information Service (NTIS)

An experimental investigation of the aerodynamic noise and flow field characteristics of internal-flow jet-augmented flap configurations (abbreviated by the term jet flap throughout the study) is presented. The first part is a parametric study of the infl...

G. O. Schrecker J. R. Maus



Pectoralis myocutaneous flap for salvage of necrotic wounds  

SciTech Connect

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

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



Management of osteoradionecrosis of the mandible with myocutaneous flaps  

Microsoft Academic Search

Involvement of large areas of the mandible or the entire mandible with osteoradionecrosis may result in severe functional disability and cosmetic deformity. The use of a well-vascularized pectoralis major myocutaneous flap from outside the original field of irradiation has been successful in obtaining functional and cosmetic goals. Myocutaneous flaps provide bulk for contour and tissue support, and their rich vascular

Shan R. Baker



On Flow Separation Control by Means of Flapping Wings  

Microsoft Academic Search

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

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


Anatomic basis of tracheobronchial reconstruction by intercostal flap  

Microsoft Academic Search

Summary A feasibility study was carried out to standardise the use of the intercostal muscle flap (ICF) for reconstruction of the posterior wall of the trachea and bronchi. The program consisted of two stages. Morphologically, in anatomic specimens, intercostal muscle flaps were dissected that could be used whatever the morphotype of the subject. Ten human cadavers were dissected after a

D Philippi; D Valleix; B Descottes; M Caix



Aerodynamics of flapping wings with fluttering trailing edges  

Microsoft Academic Search

Our previous work on the aerodynamics of passive flexible flapping wings showed that there is a strong relationship between the dynamics of trailing edge and the size of the leading edge vortex, therefore aerodynamic forces. Here we investigated the aerodynamic effects of active trailing edges. The experiments were conducted on a model flapping wing in an oil tank. During static

Liang Zhao; Zheng Hu; Jesse Roll; Xinyan Deng



Extended nasolabial flaps in the management of oral submucous fibrosis  

Microsoft Academic Search

We evaluated the use of extended nasolabial flaps and coronoidectomy in the management of 47 randomly selected patients with histologically confirmed oral submucous fibrosis. They all had interincisal opening of less than 25mm and were treated by bilateral release of fibrous bands, coronoidectomy or coronoidotomy, and extended grafting with a nasolabial flap. All patients had postoperative physiotherapy, and were followed

R. M. Borle; P. V. Nimonkar; R. Rajan



Gurney flap—Lift enhancement, mechanisms and applications  

Microsoft Academic Search

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

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



A pigeon-inspired design for a biomimetic flapping wing  

Microsoft Academic Search

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

Nanang Mahardika; Quoc Viet Nguyen; Hoon Cheol Park



Distally based sural flap in treatment of chronic venous ulcers.  


The treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipodermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 x 3 to 11 x 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only 1 patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recurrent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect. PMID:16034246

Top, Husamettin; Benlier, Erol; Aygit, A Cemal; Kiyak, Medeni



Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction  

SciTech Connect

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

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



Clinical study of dorsal ulnar artery flap in hand reconstruction  

PubMed Central

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Khan, Manal M.; Yaseen, Mohd.; Bariar, L. M.; Khan, Sheeraz M.



Aesthetic Improvements in Poland's Syndrome Treatment with Omentum Flap  

PubMed Central

Background There are many techniques that can be used to reconstruct anomalous breast volume in Poland’s syndrome, but repair of the stigmatizing deformities such as the transverse skin fold in the anterior axillary pillar, infraclavicular depression, and anomalous breast contours continues to be a challenge. This study aimed to demonstrate the superior results of laparoscopically harvested omentum flap to achieve these aesthetic improvements. Methods Patients with Poland’s syndrome from a clinical database were identified and their outcomes were studied. Results In 15 consecutive patients with Poland’s syndrome, the breast contour, the anterior axillary pillar, and the infraclavicular depression were treated with omentum flap and evaluated. Silicone implants were used beneath the flap in 80% of cases to improve symmetry. Flap consistency was similar to that of the natural breast and only a small incision in the breast fold was needed. The flap is extremely malleable, adapts to irregular surfaces, and has a long vascular pedicle. It does not leave a scar at the donor site as muscular flaps do. The omentum can repair small irregularities in breast contour, achieving a natural result different from all other flaps. Due to its malleability, it is possible to reconstruct even the extension to the axillary pillar, which is impossible with all other techniques. Conclusions The omentum flap technique is a means of repairing the deformities caused by Poland’s syndrome and improves the aesthetic result with outcomes that seem superior to any other reconstructive option.

Blotta, Rosa Maria; Mariano, Mirandolino Batista; Meurer, Luise; Edelweiss, Maria Isabel Albano



Improvement of the SERN nozzle performance by aerodynamic flap design  

Microsoft Academic Search

As continuation of the former study [P. Gruhn et al., Aerospace Science and Technology 4 (2000) 555–565], we examine the flow at a SERN nozzle for a future hypersonic cruise vehicle with help of a nozzle\\/afterbody wind tunnel model. Main focus is on the flow at the nozzle flap and the separation of the boundary layer at the flap cowl.

Patrick Gruhn; Andreas Henckels; Gero Sieberger



Subsonic and Transonic Similarity Rules for Jet-Flapped Wings.  

National Technical Information Service (NTIS)

Linear-subsonic and nonlinear-transonic similarity rules are derived for a finite-span jet-flapped wing with partial or full-span blowing. Although some subsonic rules previously have been published for jet-flapped wings, those presented herein are more g...

H. W. Woolard



Efficiency of an auto-propelled flapping airfoil  

Microsoft Academic Search

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

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



Work in progress report - Cardiac general Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers  

Microsoft Academic Search

There are various primary treatment modalities of managing deep sternal wound infection (DSWI) following cardiac surgery, namely surgical debridement with primary reclosure in conjunction with irrigation, Vacuum-assisted closure (V.A.C. ) therapy, and primary or delayed flap closure. The purpose of this study was to assess whether there is consensus of the primary management of DSWI using one method as a

Christoph Schimmer; Sebastian-Patrick Sommer; Marc Bensch; Rainer Leyh


The thigh as a model for free style free flaps.  


Following a set of principles, free style free flaps may be harvested from any region of the body where a Doppler signal is heard. By using a retrograde dissection technique, the skin vessel is traced through its subfascial course (intramuscular or septocutaneous), until adequate length or vessel size is achieved. If a "free style free flap" is not originally planned, this approach can be usedwhen anatomic variations or unexpected events are encountered. The thigh, a region that is familiar to the surgical team at Chang Gung Memorial Hospital, was chosen as the site to begin exploring this style of flap harvest. Nine flaps were harvested as free style free flaps from the thigh and were used successfully for the reconstruction of complex defects. PMID:12916602

Mardini, Samir; Tsai, Feng-Chou; Wei, Fu-Chan



Experimental investigation of a flapping wing model  

NASA Astrophysics Data System (ADS)

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

Hubel, Tatjana Y.; Tropea, Cameron



Experimental investigation of a flapping wing model  

NASA Astrophysics Data System (ADS)

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

Hubel, Tatjana Y.; Tropea, Cameron


Tensor fascia latae perforator flap: An alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available  

PubMed Central

Introduction: The anterolateral thigh flap (ALT) is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL) perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.

Contedini, Federico; Negosanti, Luca; Pinto, Valentina; Tavaniello, Beatrice; Fabbri, Erich; Sgarzani, Rossella; Tassone, Daniela; Cipriani, Riccardo



Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap  

Microsoft Academic Search

Swallowing, speech, and morbidity were assessed postoperatively in 25 patients, 18 of whom had had intraoral defects reconstructed by lateral upper arm free flaps (LUFF) and 7 by radial forearm free flaps (RFFF). Video fluoroscopy was used to assess swallowing, the Freiburger audiometric test to assess speech; and measurement of arm circumference to assess donor site morbidity. A questionnaire was

I Hara; N.-C Gellrich; J Duker; R Schön; O Fakler; R Smelzeisen; T Honda; O Satoru



Endoscopic, assisted, modified turbinoplasty with mucosal flap.  


A variety of surgical methods have been developed to reduce the volume of the inferior turbinates, in order to create a more patent nasal airway. We describe a technique used in our department since February 2002 for all patients undergoing inferior turbinectomy. We resect with endoscopic assistance the lateral mucosa and bony inferior turbinate. This technique can reduce a large volume of the turbinate while preserving the mucosal continuity and the submucosa by covering the raw surface with a mucosal flap. We believe our method minimises post-operative side effects and complications such as dryness, infection, bleeding and pain. PMID:22380635

Puterman, M M; Segal, N; Joshua, B-Z



Tongue flap in oral submucous fibrosis  

Microsoft Academic Search

A perspective study of role of lateral tongue flap operation in cases with trismus due to oral submucous fibrosis has been\\u000a carried out. This study includes pre and post-operative evaluation of 21 cases. The results of this procedure have been discussed.\\u000a The findings of the present study can be summarised as follows :\\u000a \\u000a \\u000a 1. \\u000a \\u000a In all 21 cases have been

S. Golhar; M. N. Mahore; S. Narkhede



The microcirculation and survival of experimental flow-through venous flaps  

Microsoft Academic Search

The subject of venous flaps is controversial. The purpose of this study was to investigate the haemodynamic changes and the survival process of venous flow-through flaps. Venous flaps and composite grafts were elevated along the axis of the thoracoepigastric veins in rabbits. The microcirculation was studied by capillaroscopy and injection studies. For the first 72 h, the flaps were nourished

Z.-F. Xiu; Z.-J. Chen



Application of lateral thoracic flap in maxillofacial defect reconstruction: Experience with 28 cases.  


Lateral thoracic (LT) flaps are primarily used as pedicle flaps for reconstructing limb and chest wall defects and have rarely been applied for head and neck reconstruction. We aimed to present our surgical techniques and experience using free LT cutaneous, myocutaneous and conjoint flaps for oral and maxillofacial reconstruction. From 2006 to 2010, we reconstructed 28 cases of oral and maxillofacial soft tissue defects using LT flaps. Controls were 54 cases reconstructed with anterior forearm flaps during same period. Flap size and pedicle length were recorded intraoperatively. Patients were monitored for flap survival in hospital until discharge and then followed regularly for 3-38 months, assessing for tumor recurrence, flap appearance, donor site function and cosmesis. All patients had free flaps except for one LT pedicle flap. LT flap patients were significantly younger than controls (45.5 vs. 54.8 years, p = 0.004) and had greater flap size than controls (55.2 cm(2) vs. 40.3 cm(2), p = 0.001). Of 28 LT flaps transferred, 26 survived completely; 1 failed (total necrosis due to venous insufficiency), and 1 suffered tip necrosis. No significant differences were observed in flap survival between groups. Follow-up was shorter in LT flap patients than in controls (20.3 months vs. 26.9 months, p = 0.02). Application of the LT flap is a reliable technique for reconstruction of maxillofacial defects with minimal donor site morbidity and favorable aesthetic outcomes. PMID:23764321

Shi, Jun; Xu, Bing; Shen, Guo-Fang; Wang, Xu-Dong



Effect of outer wing separation on lift and thrust generation in a flapping wing system  

Microsoft Academic Search

We explore the implementation of wing feather separation and lead-lagging motion to a flapping wing. A biomimetic flapping wing system with separated outer wings is designed and demonstrated. The artificial wing feather separation is implemented in the biomimetic wing by dividing the wing into inner and outer wings. The features of flapping, lead-lagging, and outer wing separation of the flapping

Nanang Mahardika; Nguyen Quoc Viet; Hoon Cheol Park



‘Distally based dorsal hand flaps’: clinical experience, cadaveric studies and an update  

Microsoft Academic Search

Many developments have taken place in the area of distally based dorsal hand flaps since 1988. This paper reported these developments as well as our clinical experience and cadaveric studies. Thirty-three reverse dorsal metacarpal artery (RDMA) flaps, 11 reverse dorsal digital artery (RDDA) flaps and five extended RDMA flaps done in the Institute for Research and Rehabilitation of Hand, Stanley

Gunasekar Vuppalapati; C. Oberlin; G. Balakrishnan



The bottom-up approach to the suprafascial harvest of the radial forearm flap  

Microsoft Academic Search

Suprafascial radial forearm flaps cause far less donor morbidity compared with the conventional method of including the deep fascia. Here we describe our technique of harvesting the flap with a bottom-up approach, which simplifies flap elevation and is safe and expedient. The radial artery pedicle is ligated distally and secured to the flap. Gentle traction on the pedicle presents the

Chin-Ho Wong; Jeng-Yee Lin; Fu-Chan Wei



"The Practical Perforator Flap": the sural artery flap for lower extremity soft tissue reconstruction in wounds of war.  


BACKGROUND: Sural artery perforator flaps have been described for use as both local flaps and in free tissue transfer. We present the use of this flap for compound soft tissue defects of the lower limb in civilian casualties of armed conflict in Afghanistan. METHODS/RESULTS: Detailed description of the management of blast and high-velocity projectile wounds of the lower extremity with the use of local sural perforator flaps and a review of literature. CONCLUSIONS: Sural artery perforator flaps may be harvested to cover complex lower limb defects. The use of this technique is not limited to centers with complex surgical armamentarium per se, but is feasible for surgeons with good understanding of the local anatomy. PMID:23412258

van Waes, Oscar J F; Halm, Jens A; Vermeulen, Jefrey; Ashford, Bruce G



Lower Energy to Make a Corneal Flap with a 60 kHz Femtosecond Laser Reduces Flap Inflammation and Corneal Stromal Cell Death But Weakens Flap Adhesion  

PubMed Central

Purpose To compare corneal flaps created in rabbits with a 60 kHz femtosecond (FS) laser using different levels of raster energy and to measure early inflammation, corneal stromal cell death, and late postoperative adhesion strength. Methods Sixty rabbits were divided into three groups of 20 each. A flap 110 µm thick and 9.0 mm in diameter was made in one eye of each rabbit at raster energies of 0.7 µJ, 1.1 µJ, and 2.4 µJ. Histopathological evaluation for inflammation and apoptosis using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed at 4 and 24 hours after flap creation. The adhesion strength of the flaps was measured with a tension meter at 1 and 3 months. Results Twenty four hours after flap creation, the 2.4 µJ group had more inflammatory and CD11b-positive cells than the 0.7 and 1.1 µJ groups. The number of TUNEL-positive cells increased with raster energy at 4 and 24 hours. The grams of force (gf) needed to detach the flaps at 3 months was significantly higher in 2.4 µJ group (170 gf) than in 0.7 µJ group (97.5 gf) and 1.1 µJ group (100 gf, p = 0.03). Conclusions Using raster energy lower than 1.1 µJ to make a flap with a 60 kHz FS laser decreases inflammatory cell infiltration and corneal stromal cell death in the central cornea but may result in a weaker flap than using higher raster energy (2.4 µJ).

Kim, Jae Yong; Joo, Sung-Woo; Sunwoo, Jung Hae; Kim, Eun-Soon; Kim, Myoung Joon



Taste disturbance after palatopharyngeal surgery for obstructive sleep apnea.  


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

Hsiao, Han-Ren; Li, Hsueh-Yu



Rotational lamellar scleral flap for the management of posttrabeculectomy bleb leak.  


We describe a technique of rotational lamellar scleral flap for surgical repair in cases of posttrabeculectomy aqueous leak in patients with button holing or necrosis of the trabeculectomy flap. A rotational scleral flap is marked out from the sclera adjacent to the trabeculectomy site followed by a lamellar dissection to fashion the flap. Relaxing cuts are made at the base of the flap so as to ensure that the rotation flap adequately covers the site of aqueous leak. This flap is then secured to the underlying sclera and the cornea at the limbus. PMID:22858983

Kumar, Dhivya A; Agarwal, Amar; Nair, Vidya; Jacob, Soosan; Prakash, Gaurav; Agarwal, Athiya



[Development of DRGs in reconstructive breast surgery].  


Diagnosis-Related Groups (DRG) were introduced in Germany in 2004 as a medico-economic classification system. In this analysis, we looked at reconstructive surgery after breast cancer, focusing on changes of the fee-per-case system in the last 6 years. Immediate, delayed, pedicle and free flaps as well as alloplastic reconstructive methods were analysed using data from German reference hospitals. We analysed the length of stay, reimbursements, costs and profits. The biggest profit margin was found in free perforator flaps. These were up to 3 times higher than in alloplastic reconstruction and pedicle flaps. Due to the fact that the underlying costs for the calculation of reimbursement are always retrospective, we accounted for the rate of price increase. In spite of increasing mean profits, foregone profits of up to €574 per case due to inflation were not taken into consideration. Contrary to actual guidelines, neither the immediate reconstruction of the breast by autologous tissue, nor the bilateral reconstruction is taken into account economically. Although a more differentiated reimbursement of breast reconstruction by DRG has taken place in the last years, the subject still remains a classical example for insufficient mapping of new medical standards in our DRG system. As the choice of surgical therapy is increasingly influenced by free market mechanisms, the risk for economic selection in contradiction to clinical recommendations becomes a real problem. Even 9 years after its introduction, the German DRG system is far from being a learning or quick adapting system. PMID:22495963

Lotter, O; Amr, A; Jaminet, P; Hoefert, S; Schaller, H-E; Stahl, S



Cornea surgery with nanojoule femtosecond laser pulses  

NASA Astrophysics Data System (ADS)

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

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



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

Microsoft Academic Search

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

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



Modeling flexible flapping wings oscillating at resonance  

NASA Astrophysics Data System (ADS)

Using a hybrid approach for fluid-structure interactions that integrates the lattice Boltzmann and lattice spring models, we study the three-dimensional aerodynamics of flexible flapping wings at hovering. The wings are a pair of flat elastic plates tilted from the horizontal and driven to oscillate according to the sinusoidal law. Our simulations reveal that resonance oscillations of flexible wings dramatically increase aerodynamic lift at low Reynolds number. Comparing to otherwise identical rigid wings, flexible wings at resonance generate up to two orders of magnitude greater lift. Within the resonance band, we identify two operation regimes leading to the maximum lift and the maximum efficiency, respectively. The maximum lift occurs when the wing tip and root move with a phase lag of 90 degrees, whereas the maximum efficiency occurs at the frequency where the wing tip and root oscillate in counterphase. Our results suggest that the resonance regimes would be optimal for the design of microscale flying machines using flexible flapping wings driven by simple kinematic strokes.

Alexeev, Alexander; Masoud, Hassan



Experimental Investigation on the Aerodynamic Characteristics of a Biomimetic Flapping Wing with Macro-fiber Composites  

Microsoft Academic Search

This study describes the development of a bio-mimetic flapping wing and the aerodynamic characteristics of a flexible flapping wing. First, the flapping wing is designed to produce flapping, twisting, and camber motions by using a bio-mimetic design approach. A structural model for a macro-fiber composite (MFC) actuator is established, and structural analysis of a smart flapping wing with the actuator

Dae-Kwan Kim; Hong-Il Kim; Jae-Hung Han; Ki-Jung Kwon



Ischemic preconditioning of free muscle flaps: an experimental study.  


The aim of this study was to apply the hypothesis of ischemic preconditioning (IP) on free skeletal muscle (rat thigh flap). Five groups of Sprague-Dawley rats (n = 6) were used. In group A (control group), standard free autologous flap transfers were performed. Flaps in groups B and C underwent 4 and 6 h, respectively, of ischemia before transfer. In groups D and E, muscle flaps were preconditioned (3 x 10 min ischemia interrupted by 10 min of reperfusion, clip applied on the dissected artery of the flap) and subjected to 4 and 6 h, respectively, of ischemia before transfer. After 48 h of reperfusion, the muscle flaps were evaluated macroscopically as well as by histological and immunohystochemical staining. In group A, the viability was 100%, whereas in groups D and E the viability was 83.3% and 100%, respectively. Groups B and C had undergone macroscopically parceled to total necrosis, further confirmed by histological findings (fragmentation and disappearance of muscle striations, combined with tissue necrosis and intravascular thrombosis). The beneficial effect of IP demonstrated in the heart, liver, and small bowel extends to skeletal muscle, which can be used in free-flap transfers, if the transfer includes a long period of predictable ischemia. PMID:16184525

Marian, Claudiu F; Jiga, Lucian P; Ionac, Mihai



Correction of hemifacial atrophy using free anterolateral thigh adipofascial flap.  


Treatment of hemifacial atrophy presents a challenge for reconstructive surgeons. Previous studies have described numerous methods for the correction of facial asymmetry. We present our experience with treatment of hemifacial atrophy using a microsurgical anterolateral thigh adipofascial flap procedure and other adjunctive measures. This method is similar to that used for the free anterolateral thigh flap, but only the deep fascia of the anterolateral thigh and subcutaneous fatty tissue above the fascia were harvested. This flap procedure was used in 32 patients with moderate or severe hemifacial atrophy. In the first stage, the anterolateral thigh adipofascial flap procedure was used in all the patients, of whom eight accepted a porous polyethylene implant along with the anterolateral thigh adipofascial flap to reconstruct the skeleton. In the second stage, ancillary procedures including porous polyethylene implantation, liposuction debulking, fat injection and flap re-suspension were performed to refine the outcome in 28 patients. The anterolateral thigh adipofascial flap is advantageous in that it can provide a reliable vascular pedicle with relatively thin, pliable soft tissue and direct primary closure of the donor site. PMID:19616490

Teng, Li; Jin, Xiaolei; Wu, Guoping; Zhang, Zhiyong; Ji, Ying; Xu, Jiajie; Lu, Jianjian; Zhang, Bo; Zhou, Gang



Islanded perforator flaps in the reconstruction of hidradenitis suppurativa defects.  


Hidradenitis suppurativa is a recurrent, chronic, and suppurative cutaneous disease of unknown etiology. Radical excision of all affected skin followed by flap coverage of the defect is the treatment method of choice in severe and recurrent cases. This study discusses the use of local islanded perforator flaps in the reconstruction of defects following excision of hidradenitis suppurativa lesions in axillary, gluteal, and inguinal regions. Eleven male patients (mean age of 39.3 years) underwent reconstruction of hidradenitis suppurativa defects with 13 local islanded perforator flaps. Three patients (one being bilateral) had gluteal, two patients (one being bilateral) had inguinal, and six patients had axillary involvement. The defects in the gluteal region were repaired with superior gluteal artery perforator flaps, inguinal defects were repaired with medial circumflex femoral artery perforator flaps, and the axillary defects were repaired with thoracodorsal artery perforator flaps. There was no total flap loss in the postoperative period, but one marginal necrosis and two wound infections occurred. There was no recurrence of hidradenitis suppurativa or revision requirement during the mean follow-up period of 11.5 months. PMID:23303517

Egemen, Onur; Özkaya, Özay; Bingöl, Derya; Orman, Ça?da?; Akan, Mithat



The Problematic Inguinal Wound in Vascular Surgery–What is the Optimal Treatment?  

Microsoft Academic Search

Purpose: Problems of wound healing following vascular surgery through inguinal incisions include hematoma formation, infection, lymphocele and lymph fistula, and occur in up to 20% of the cases. Closure of chronic wounds is sometimes obtained only after plastic reconstructions such as muscle flaps. We have examined if the use of the less invasive method of vacuum-assisted closure (VAC) may be

Hannu Savolainen; Matthias K. Widmer; Georg Heller; Vladimir Makaloski; Thierry Carrel; Juerg Schmidli



Aeroelastically deflecting flaps for shock/boundary-layer interaction control  

NASA Astrophysics Data System (ADS)

An aeroelastic mesoflap system has been developed to improve the downstream flow properties of an oblique shock/boundary-layer interaction. The mesoflap system employs a set of small flaps over a cavity, whereby the flaps downstream of the interaction bend downward aeroelastically to bleed the flow and the upstream flaps bend upward to re-inject this same mass flow upstream. This recirculating system requires no net mass bleed and therefore has advantages for boundary layer control in external or mixed-compression supersonic aircraft inlets. In addition, the system may be applicable in other aerospace applications where boundary-layer control can help remedy the adverse effects of shock interactions. Several mesoflap systems have been fabricated and examined experimentally to investigate their aerodynamic and structural performance. Each mesoflap is rigidly attached to a spar on its upstream end while the remainder of the flap is free to deflect aeroelastically. The flap length is nominally a few boundary-layer thicknesses in dimension, while the flap thickness is small enough to allow tip deflections that are of the order of the boundary-layer momentum thickness. Experiments were conducted for a Mach 2.41 impinging oblique shock wave interaction with a turbulent boundary layer. Spanwise-centered laser Doppler velocimeter measurements indicate that certain mesoflap designs can show significant flow improvement as compared to the solid-wall case, including increased stagnation pressure recovery and a 7% reduction in boundary layer thickness and sonic thickness. However, one drawback of the mesoflap system is the potential for fatigue, which in some cases led to microcracking followed by flap failure. Structural design improvements to alleviate and avoid this problem included a lower profile spar design, substitution of Nitinol for aluminum as the flap material, and use of stress-relieving holes at the ends of the flap cut-outs.

Gefroh, D.; Loth, E.; Dutton, C.; Hafenrichter, E.



Effects of Systemic Tadalafil on Skin Flap Survival in Rats  

PubMed Central

Objective: Phosphodiesterase-5 inhibitors, used to increase penile blood flow in erectile dysfunction patients, have recently been postulated to increase blood flow and flap survival in cutaneous flaps based on random blood supply. This study aims to investigate the phosphodiesterase-5 inhibitor tadalafil, administered orally, on random flap survival. Methods: Modified McFarlane flaps measuring 8 cm × 2.5 cm were raised on the backs of 37 male Sprague-Dawley rats. Rats received were divided into a control group, a low-dose group (10 mg/kg tadalafil), and a high-dose group (20 mg/kg tadalafil). Treatment doses were administered once preoperatively and every 24 hours postoperatively for a total of 7 doses. On postoperative day 7 and 14, the area of flap survival was calculated and compared. Results: All rats survived and thrived throughout the experimental period. Control group rats showed an average flap survival of 77% ± 11% at 7 days and 77% ± 9% at 14 days. Low-dose-group rats showed an average flap survival of 82% ± 10% at 7 days (P=0.21), and 81% ± 12% at 14 days (P=0.41). High-dose group rats showed an average flap survival of 81% ± 11% at 7 days (P = 0.45) and 80% ± 12% at 14 days (P = 0.53). Statistical analysis was performed using the Mann-Whitney test. Conclusions: Our results indicate a trend toward increased random-pattern flap survival with both high- and low-dose oral tadalafil in a rat model. Because this trend did not achieve statistical significance, further studies are warranted.

Brewer, Michael B.; Stump, Amy L.; Holton, Luther H.; Janes, Lindsay E.; Silverman, Ronald P.; Singh, Devinder P.



Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications  

PubMed Central

Background A thinned anterolateral thigh (ALT) flap is often harvested to achieve optimal skin resurfacing. Several techniques have been described to thin an ALT flap including an adipocutaneous flap, an adipofascial flap and delayed debulking. Methods By systematically reviewing all of the available literature in English and French, the present manuscript attempts to identify the common surgical indications, complications and donor site morbidity of the adipofascial variant of the ALT flap. The studies were identified by performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database of Systematic Reviews, Current Contents, PubMed, Google, and Google Scholar. Results The study selection process was adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and 15 articles were identified using the study inclusion criteria. These articles were then reviewed for author name(s), year of publication, flap dimensions and thickness following defatting, perforator type, type of transfer, complications, thinning technique, number of cases with a particular area of application and donor site morbidity. Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects and improve pliability. Its strong and safe blood supply permits adequate immediate or delayed debulking without vascular complications. The presence of the deep fascia makes it possible to prevent sagging by suspending and fixing the flap for functional reconstructive purposes (e.g., the intraoral cavity). Donor site morbidity is minimal, and thigh deformities can be reduced through immediate direct closure or liposuction and direct closure. A safe blood supply was confirmed by the rate of secondary flap debulking.

Agostini, Tommaso; Russo, Giulia Lo; Spinelli, Giuseppe; Lazzeri, Davide



The Importance of Early Flap Coverage in Deep Sternal Wounds.  


BACKGROUND: Chronic or persistent wound infection is one of the key outcome measures after flap reconstruction in deep sternal wound infection (DSWI). This study aimed to assess potentially modifiable factors associated with chronic infection in patients undergoing flap reconstruction. MATERIALS AND METHODS: An analysis of a prospective database of 5239 median sternotomies performed during a 5-year period was carried out. Seventy-seven cases of DSWI were recorded, of which 23 cases proceeded to flap reconstruction. The flap-reconstructed patients were placed into groups according to the primary outcome measure of those who experienced chronic infection and those who remained infection free. RESULTS: Of the flap-reconstructed patients, 22% experienced subsequent chronic infection, whereas 78% remained infection free. The only 2 variables that were associated with chronic infection were the timing of flap reconstruction; median time 29.5 days (vs 12 days in the infection-free group), P = 0.011 and time taken from diagnosis of wound infection/dehiscence to referral to the plastic surgical team; median 21 days (vs median 8 days in the infection free group), P = 0.02.Each day of delay from the diagnosis of clinical infection to flap cover equated to an increase in risk of chronic infection of 1.2 times per day (OR = 1.205, P = 0.039). CONCLUSIONS: This study suggests that chronic infection after flap reconstruction in DSWI is associated with late flap cover. We suggest the need for a consensus agreement on the combined care and early management of DSWI. PMID:23728246

Lo, Steven; Hutson, Kristian; Hallam, Marc-James; Soldin, Mark



Osseous Surgery  


... their teeth. Osseous surgery reshapes the bone to get rid of the defects. This procedure is often used ... surgery. You can reduce swelling by applying an ice pack to the outside of your face in the treated area. In some situations, you may get a prescription for antibiotics to prevent an infection. ...


[Traditional transcutaneous approaches in head & neck surgery].  


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:22456920

Gößler, U R



Tennis elbow surgery - discharge  


... 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 ...


Design and Performance of Insect-Scale Flapping-Wing Vehicles  

NASA Astrophysics Data System (ADS)

Micro-air vehicles (MAVs)---small versions of full-scale aircraft---are the product of a continued path of miniaturization which extends across many fields of engineering. Increasingly, MAVs approach the scale of small birds, and most recently, their sizes have dipped into the realm of hummingbirds and flying insects. However, these non-traditional biologically-inspired designs are without well-established design methods, and manufacturing complex devices at these tiny scales is not feasible using conventional manufacturing methods. This thesis presents a comprehensive investigation of new MAV design and manufacturing methods, as applicable to insect-scale hovering flight. New design methods combine an energy-based accounting of propulsion and aerodynamics with a one degree-of-freedom dynamic flapping model. Important results include analytical expressions for maximum flight endurance and range, and predictions for maximum feasible wing size and body mass. To meet manufacturing constraints, the use of passive wing dynamics to simplify vehicle design and control was investigated; supporting tests included the first synchronized measurements of real-time forces and three-dimensional kinematics generated by insect-scale flapping wings. These experimental methods were then expanded to study optimal wing shapes and high-efficiency flapping kinematics. To support the development of high-fidelity test devices and fully-functional flight hardware, a new class of manufacturing methods was developed, combining elements of rigid-flex printed circuit board fabrication with "pop-up book" folding mechanisms. In addition to their current and future support of insect-scale MAV development, these new manufacturing techniques are likely to prove an essential element to future advances in micro-optomechanics, micro-surgery, and many other fields.

Whitney, John Peter


Reduction of donor site morbidity of free radial forearm flaps: what level of evidence is available?  


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

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



Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps.  


The propeller-type flap design is increasingly used in reconstructive surgery for various regions of the body. To date, determinants of perforator patency when subjected to twisting have not been elucidated. We propose a simulation model to study parameters affecting perforator patency under such conditions. Nonlinear finite element procedure was used to simulate a perforator consisting of an artery and a vein with both ends fixed. A rigid body was attached to the top of the perforator for applying prescribed angular displacement. The effect of the following parameters on the pedicle patency was determined: (1) increasing angle of twist, (2) vessel stiffness, (3) vessel length, (4) diameter, (5) intraluminal pressure, and (6) the presence or absence of blood flow during twisting. Simulation results were reported in effective stress and strain on the twisted pedicle. In the context of perforator patency, effective strain, which is a measure of vessel deformation or collapse, is the more relevant outcome. The vein was more prone to occlusion because of its weaker wall and lower intraluminal pressure. Four factors that affected perforator patency were identified: angle of twist, intraluminal blood pressure, and perforator diameter and length. There was no significant difference whether twisting was performed prior to or after restoration of blood flow (P > 0.05). Therefore, to optimize condition for maintaining perforator patency, the angle of twist should be kept <180 degrees, perioperative blood pressure should be kept stable (avoiding periods of hypotension), and the selected perforator should be approximately 1 mm in diameter and >30 mm in length. We found that the propeller flap is a feasible design. This study defined the determinants of perforator patency and will serve as a useful guide when performing such flaps. PMID:18046151

Wong, Chin-Ho; Cui, Fangsen; Tan, Bien-Keem; Liu, Zhuangjian; Lee, Heow-Pueh; Lu, C; Foo, Chee-Liam; Song, Colin



Intraoral flap depilation using the long-pulsed alexandrite laser.  


A multitude of skin flaps are used to reconstruct defects following the surgical resection of head and neck cancers. Skin imported from distant sites to provide intraoral coverage often contains hair-bearing skin, which can create a problem following reconstruction of the oropharynx. Patients with hairy intraoral flaps often present with irritation, pooling of saliva and trapping of food. In this article, we report, for the first time, a treatment for the removal of hair from intraoral flaps using a long-pulsed alexandrite laser. PMID:18773876

Conroy, F J; Mahaffey, P J



Osteoradionecrosis of the olecranon: treatment by radial forearm flap  

SciTech Connect

Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.

Thornton, J.W.; Stevenson, T.R.; VanderKolk, C.A.