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Sample records for gundersen flap surgery

  1. Bilobed flap in sole surgery

    SciTech Connect

    Sanchez-Conejo-Mir, J.; Bueno Montes, J.; Moreno Gimenez, J.C.; Camacho-Martinez, F.

    1985-09-01

    The bilobed flap is a simple reconstructive technique principally used to correct substantial defects in the facial region. The authors present their experience with this local flap in the difficult plantar area, with excellent short-term functional results. They describe the special characteristics of the bilobed flap in this zone, and comment on its indications and possible complications.

  2. Forehead flap in maxillofacial surgery: Our experiences

    PubMed Central

    Ahmed, Syed S.; Ghassemi, Alireza; Rehman, Sajjad A.; Ansari, Md. Kaleem

    2015-01-01

    The forehead flap is a commonly used technique to reconstruct the deep and large nasal defects. It can be conveniently performed under local or general anesthesia and provides a very good color and texture matching to the nasal skin, which makes it a suitable graft harvesting site for nasal reconstruction. It has only single disadvantage disadvantagethat it is a two-stage procedure and “finishing” surgeries are needed occasionally for best surgical and cosmetic outcome. In this paper, we describe three different applications of forehead flaps. PMID:26668457

  3. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    PubMed

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery.

  4. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    PubMed

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery. PMID:27140865

  5. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye. PMID:27621782

  6. Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

    PubMed Central

    Romero-Diaz-de-Leon, Lorena; Serna-Ojeda, Juan Carlos; Navas, Alejandro; Graue-Hernández, Enrique O.; Ramirez-Miranda, Arturo

    2016-01-01

    Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  7. Evaluation of intraoperative anticoagulants in microvascular free-flap surgery.

    PubMed Central

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

    1996-01-01

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

  8. Effect of Tisseel on healing after periodontal flap surgery.

    PubMed

    Warrer, K; Karring, T

    1992-08-01

    The purpose of this investigation was to evaluate the effect on healing of fast and slow absorbable Tisseel in combination with periodontal flap surgery. Mucoperiosteal flaps were raised on the buccal aspect of maxillary premolars and mandibular premolars and first molars in 4 beagle dogs. The underlying buccal, interproximal and inter-radicular bone was then removed to a level of approximately 5 mm apically to the original bone crest and half way into the interdental spaces and bifurcations. The exposed root surfaces were curetted in order to remove the periodontal ligament tissue, and a notch was made in the root surface at the base of the defects. On the control teeth, the flaps were sutured immediately after creation of the defects, while on the test teeth, a layer of fast (group I) or slow (group II) absorbable Tisseel was applied between the curetted roots and the subsurface of the flaps prior to suturing. Postoperatively, the teeth were brushed 2 x weekly. The dogs were sacrificed after 4 months. Histological analysis revealed that the amounts of new attachment and bone regrowth were similar in the test and control groups, although the results tended to be most favorable for the group of teeth treated with fast absorbable Tisseel (Group I).

  9. The possibility for use of venous flaps in plastic surgery

    NASA Astrophysics Data System (ADS)

    Baytinger, V. F.; Kurochkina, O. S.; Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-01

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  10. The possibility for use of venous flaps in plastic surgery

    SciTech Connect

    Baytinger, V. F. Kurochkina, O. S. Selianinov, K. V.; Baytinger, A. V.; Dzyuman, A. N.

    2015-11-17

    The use of venous flaps is controversial. The mechanism of perfusion of venous flaps is still not fully understood. The research was conducted on 56 white rats. In our experimental work we studied two different models of venous flaps: pedicled venous flap (PVF) and pedicled arterialized venous flap (PAVF). Our results showed that postoperative congestion was present in all flaps. However 66.7% of all pedicled venous flaps and 100% of all pedicled arterialized venous flaps eventually survived. Histological examination revealed that postoperatively the blood flow in the skin of the pedicled arterialized venous flap became «re-reversed» again; there were no differences between mechanism of survival of venous flaps and other flaps. On the 7-14th day in the skin of all flaps were processes of neoangiogenesis and proliferation. Hence the best scenario for the clinical use of venous flaps unfolds when both revascularization and skin coverage are required.

  11. [The role definition of lateral arm free flap in reconstruction after head and neck cancer surgery].

    PubMed

    Li, C; Cai, Y C; Wang, W; He, Y X; Lan, X J; Li, Q L; Zhou, Y Q; Liu, J F; Zhu, G Q; Liu, K; Wang, S X; Wang, K; Fan, J C; Sun, R H

    2016-02-01

    Application of free flap is one of the important repair means in head and neck surgery. A variety of free flaps, such as anterolateral thigh flap, have showed unique advantages in repair for tissue defects after resection of head and neck tumor, and have became increasing popularity. Lateral arm flee flap is an important repair means in plastic surgery, which has developed more than 30 years, but the application of this flap for reconstruction in head and neck surgery is relatively backward, with few reports. This review focuses on the creativity and innovation, the relationship between anatomy and clinical application, and the application status and prospects for lateral arm flee flap in individual head and neck reconstruction surgery.

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

    PubMed Central

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

    2014-01-01

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

  13. The use of the pedicled supraclavicular flap in noma reconstructive surgery.

    PubMed

    Hartman, Ed H M; Van Damme, Philip A; Sauter, Hartwig; Suominen, Sinikka H H

    2006-01-01

    Three noma patients with large unilateral facial defects were reconstructed using the pedicled supraclavicular flap technique in the Noma Children Hospital in Sokoto, Nigeria. The results are-although not completely perfect-encouraging enough to report and to repeat the technique in future reconstructive noma surgery after moderate modifications. It is advised not to tunnel the pedicle in the neck, but instead to open the neck. Then, the flap can be inset in a Z-plasty fashion to close the neck without the chance of compression of the pedicle of the flap. In this way flap necrosis can be prevented, without the risk of a scar contracture of the neck. Another technique, which can prevent partial flap necrosis and loss of tissue, with the need for secondary stage interventions, is a delay procedure of the flap. Incorporation of the fascia in the pedicled supraclavicular flap can be another option to fulfil the abovementioned requirements.

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

    PubMed

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

    2013-11-01

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

  15. Fetal reconstructive surgery: experimental use of the latissimus dorsi flap to correct myelomeningocele in utero.

    PubMed

    Meuli-Simmen, C; Meuli, M; Hutchins, G M; Harrison, M R; Buncke, H J; Sullivan, K M; Adzick, N S

    1995-10-01

    A recent study in human fetuses with myelomeningocele produced evidence that nonclosure of the spine leads to progressive damage of the exposed spinal cord during pregnancy. Thus in utero coverage might spare function. We tested the use of the latissimus dorsi flap for fetal myelomeningocele repair. In seven sheep fetuses, a lumbar myelomeningocele type of lesion was created at 75 days' gestation and was covered with a "reversed" latissimus dorsi flap at 100 days. At term, the three survivors had healed cutaneous wounds and normal hindlimb function. The vascular pedicle of the latissimus dorsi flap was patent, the viable flap covered the entire lesion, and the underlying spinal cord was grossly intact. We conclude that the latissimus dorsi flap repair is suitable for fetal surgery and provides efficient coverage of the lesion. These results have clinical implications, since fetal myelomeningocele repair may be a compelling way to reduce the severe neurologic deficit in humans. PMID:7568473

  16. Postoperative bacteremia in periodontal flap surgery, with and without prophylactic antibiotic administration: A comparative study

    PubMed Central

    Asi, Kanwarjit S.; Gill, Amarjit S.; Mahajan, Sunil

    2010-01-01

    Objectives: Many a times in clinical periodontology, the decision whether to prescribe prophylactic antibiotics or not, is perplexing.The present study was conducted to compare the bacteremias induced after periodontal flap surgeries with and without prophylactic antibiotics. Materials and Methods: The occurrence of postoperative bacteremia following periodontal flap surgery was studied in 30 patients. On these patients, 30 quadrant wise flap surgeries were carried out without any preoperative prophylactic antibiotics and 30 surgeries carried out after prophylactic administration of amoxycillin preoperatively. A blood sample was taken from each patient at the time of maximum surgical trauma and was cultured for micro-organisms and antibiotic sensitivity. Results: 18 out of 60 blood samples were positive for micro-organisms. There was a significant reduction in post operative bacteremia after amoxycillin prophylaxis (x2 - 7.96 with P<0.01) as post operative bacteremia was found in 14 of the non medicated patients as compared to only 4 of the pre medicated patients. The micro-organisms encountered in the study are as follows:- 1) Staphylococcus albus coagulase negative, 2) Klebsiella, 3) Psedomonas aerugenosa, 4) Streptococcus viridans, 5) Alpha hemolytic streptococcus, 6) Neisseria catarrhalis Conclusion: On the basis of the study, it is concluded that the incidence of postoperative bacteremia following periodontal flap surgery is not as high as previously reported. The clinical results show that Amoxicillin is highly effective in reducing postoperative bacteremia in periodontal flap surgery and thus in preventing the possible sequelae (Infective Endocarditis and other systemic maladies) in susceptible patients. However, cefotaxime and cephalexin may prove to be more effective in preventing the same. PMID:20922074

  17. Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

    PubMed Central

    Lodders, Johannes N.; Parmar, Satyesh; Stienen, Niki LM.; Martin, Timothy J.; Karagozoglu, K. Hakki; Heymans, Martijn W.; Nandra, Baljeet

    2015-01-01

    Background The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods Desired data was retrieved from a computer database at the department of Oral and Maxillofacial Department, Queen Elisabeth hospital Birmingham, United Kingdom, between June 2007 and October 2012. Logistic regression was used to study relationships between preoperative variables and postoperative outcomes. Results The study population consisted 184 patients, comprising 189 composite resections with reconstruction. Complications developed in 40.2% of the patients. Three patients (1.6%) died, 11.1% returned to the operating room, 5.3% developed donor site complications and 6.9% flap complications of which 3.2% total flap failure. In the multivariable analysis systemic complications were associated with anaesthesia time and hospital stay with red cell transfusion. Conclusions A significant proportion of the patients with primary free flap reconstructions after oral cancer surgery develops postoperative complications. Prolonged anaesthesia time and red cell transfusion are possible predictors for systemic complications and hospital stay respectively. Preoperative screening for risk factors is advocated for patient selection and to have realistic information and expectations. Key words:Free flap, complications, oral cancer, risk factors, reconstruction. PMID:26116846

  18. Flap infection associated with medicinal leeches in reconstructive surgery: two new drug-resistant organisms.

    PubMed

    Bibbo, Christopher; Fritsche, Thomas; Stemper, Mary; Hall, Matthew

    2013-09-01

    The use of medicinal leeches in reconstructive surgery has proven value for the salvage of flaps with venous congestion but is associated with a risk of leech-acquired infection. The most common leech-associated organism is Aeromonas hydrophila, which antibiotic prophylaxis is typically directed against. The authors describe two new multidrug-resistant organisms acquired from medicinal leech therapy that resulted in flap infection. The evaluation of suspected leech-borne infection and management protocol for this leech-acquired resistant multi-organism infection is presented.

  19. The temporalis muscle flap in temporo-mandibular joint surgery.

    PubMed

    Brusati, R; Raffaini, M; Sesenna, E; Bozzetti, A

    1990-11-01

    In the treatment of the severely damaged TMJ structural components (ankylosis, arthrosis, tumour, perforation or degeneration of the disc), it is advisable to insert a biological interposition between bony articular surfaces. The temporal muscle, due to its anatomical, topographical, and functional properties, can be successfully employed for this purpose. Based on the experience of Tessier, Delaire and Rowe, a temporalis muscle flap, inferiorly based, is rotated downwards and medially to the zygomatic arch, interposed and then fixed to condyle and capsule. Using this surgical technique, 12 patients and 13 temporo-mandibular joints were treated with good functional results and without any complication.

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

    PubMed Central

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

    2009-01-01

    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. PMID:19881029

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. Vertical rectus abdominis myocutaneous flap for vaginal reconstruction after radical pelvic surgery for Stage II vaginal carcinoma.

    PubMed

    Tapisiz, O L; Gungor, T; Demiralp, C O; Demirseren, M E; Yalcin, H; Mollamahmutoglu, L

    2011-01-01

    Primary carcinomas of the vagina are uncommon, occurring only 2-3% of all gynecological malignancies. In women with early stage of disease, primary surgery, consisting of radical vaginectomy (plus hysterectomy in patients with tumors involving the upper vagina) and systematic dissection of lymphatic drainage of tumor, is a valid option. In these patients, a rectus abdominis myocutaneous (RAM) flap may be favorably used for vaginal reconstruction during radical pelvic surgery. Here we describe a case of Stage II vaginal carcinoma treated with radical pelvic surgery and vertical-RAM (V-RAM) flap reconstruction.

  4. Trismus Secondary Release Surgery and Microsurgical Free Flap Reconstruction After Surgical Treatment of Head and Neck Cancer.

    PubMed

    Chang, Yang-Ming; Deek, Nidal Farhan Al; Wei, Fu-Chan

    2016-10-01

    This article addresses trismus following head and neck cancer ablation and free flap reconstruction whether or not radiotherapy has been utilized. The focus is to achieve durable and favorable outcomes and avoid untoward results. To aid surgeons in fulfilling these goals, key factors, including adequate release surgery, optimal free flap selection and reconstruction, long-lasting results, and the untoward outcomes specific to trismus release and reconstruction surgery and how to avoid them have been investigated and discussed based on the authors' experience in this surgery. PMID:27601398

  5. Innovative techniques in preventing and salvaging neurovascular pedicle flaps in reconstructive foot and ankle surgery.

    PubMed

    Zgonis, Thomas; Stapleton, John J

    2008-04-01

    Pedicle flaps to cover soft tissue defects of the foot, ankle, and lower extremity are invaluable. However, venous congestion and flap necrosis, a common complication, poses greater morbidity to the patient as few remaining options for attempted limb salvage remain. The authors discuss how to prevent flap failure by allowing close observation and strict offloading of the pedicle flap through current external fixation designs. This article also discusses the role of medicinal leeches in reestablishing blood flow through the pedicle flap to prevent tissue necrosis. In addition, the use of hydrosurgery as an innovative technique offers the surgeon another option if faced with pedicle flap necrosis. PMID:19825700

  6. Computer-assisted orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct facial asymmetry and maxillary defects secondary to maxillectomy in childhood.

    PubMed

    Zhang, Lei; Sun, Hao; Yu, Hong-bo; Yuan, Hao; Shen, Guo-fang; Wang, Xu-dong

    2013-05-01

    Maxillectomy in childhood not only causes composite primary defects but also secondary malformation of the middle and lower face. In the case presented, we introduced computer-assisted planning and simulation of orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct complex craniofacial deformities. Virtual orthognathic surgery and maxillary reconstruction surgery were undertaken preoperatively. LeFort I osteotomy, with bilateral sagittal split ramus osteotomy and lower border ostectomy, was performed to correct malocclusion and facial asymmetry. Maxillary reconstruction was accomplished using a fibular osteomyocutaneous flap. The patient recovered uneventfully with an adequate aesthetic appearance on 3D computed tomography. Our experience indicates that orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction can used to correct complex facial asymmetry and maxillary defects secondary to maxillectomy. Computer-assisted simulation enables precise execution of the reconstruction. It shortens the free flap ischemia time and reduces the risks associated with microsurgery.

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

    PubMed Central

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

    2014-01-01

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

  8. Flapless versus conventional flapped dental implant surgery: a meta-analysis.

    PubMed

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

    2014-01-01

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

  9. Dynamic perfusion assessment during perforator flap surgery: an up-to-date

    PubMed Central

    MUNTEAN, MAXIMILIAN VLAD; MUNTEAN, VALENTIN; ARDELEAN, FILIP; GEORGESCU, ALEXANDRU

    2015-01-01

    Flap monitoring technology has progressed alongside flap design. The highly variable vascular anatomy and the complexity associated with modern perforator flaps demands dynamic, real-time, intraoperative information about the vessel location, perfusion patterns and flap physiology. Although most surgeons still assess flap perfusion and viability based solely on clinical experience, studies have shown that results may be highly variable and often misleading. Poor judgment of intraoperative perfusion leads to major complications. Employing dynamic perfusion imaging during flap reconstruction has led to a reduced complication rate, lower morbidity, shorter hospital stay, and an overall better result. With the emergence of multiple systems capable of intraoperative flap evaluation, the purpose of this article is to review the two systems that have been widely accepted and are currently used by plastic surgeons: Indocyanine green angiography (ICGA) and dynamic infrared thermography (DIRT). PMID:26609259

  10. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap.

    PubMed

    Nemir, Stephanie; Hunter-Ellul, Lindsey; Codrea, Vlad; Wagner, Richard

    2015-01-01

    A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm(2) of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection. PMID:26425374

  11. Reconstruction of a Large Anterior Ear Defect after Mohs Micrographic Surgery with a Cartilage Graft and Postauricular Revolving Door Flap

    PubMed Central

    Nemir, Stephanie; Hunter-Ellul, Lindsey; Codrea, Vlad; Wagner, Richard

    2015-01-01

    A novel postauricular revolving door island flap and cartilage graft combination was employed to correct a large defect on the anterior ear of an 84-year-old man who underwent Mohs micrographic surgery for an antihelical squamous cell carcinoma. The defect measured 4.6 × 2.4 cm and spanned the antihelix, scapha, a small portion of the helix, and a large segment of underlying cartilage, with loss of structural integrity and anterior folding of the ear. The repair involved harvesting 1.5 cm2 of exposed cartilage from the scaphoid fossa and then sculpting and suturing it to the remnant of the antihelical cartilage in order to recreate the antihelical crura. The skin of the posterior auricle was then incised just below the helical rim and folded anteriorly to cover the cartilage graft. The flap remained attached by a central subcutaneous pedicle, and an island designed using the full-thickness defect as a stencil template was pulled through the cartilage window anteriorly to resurface the anterior ear. This case demonstrates the use of the revolving door flap for coverage of large central ear defects with loss of cartilaginous support and illustrates how cartilage grafts may be used in combination with the flap to improve ear contour after resection. PMID:26425374

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

    PubMed

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

    2013-01-01

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

  13. Postoperative Controversies in the Management of Free Flap Surgery in the Head and Neck.

    PubMed

    Cannady, Steven B; Hatten, Kyle; Wax, Mark K

    2016-08-01

    Free tissue transfer is the gold standard for reconstructing head and neck defects. Free flap success approaches 95% in centers with experience, affording unparalleled ability to restore form and function in cancer, trauma, or other major composite tissue loss. It is critical to manage the perioperative variables that predict success; several areas of controversy have not yet reached consensus. This review focuses on postoperative anticoagulation, fluid management, and flap monitoring methods. These areas of controversy potentially influence flap survival. We review published practices considered within the standard of care, why controversy remains, and future directions to reach standardization. PMID:27400844

  14. Postoperative Controversies in the Management of Free Flap Surgery in the Head and Neck.

    PubMed

    Cannady, Steven B; Hatten, Kyle; Wax, Mark K

    2016-08-01

    Free tissue transfer is the gold standard for reconstructing head and neck defects. Free flap success approaches 95% in centers with experience, affording unparalleled ability to restore form and function in cancer, trauma, or other major composite tissue loss. It is critical to manage the perioperative variables that predict success; several areas of controversy have not yet reached consensus. This review focuses on postoperative anticoagulation, fluid management, and flap monitoring methods. These areas of controversy potentially influence flap survival. We review published practices considered within the standard of care, why controversy remains, and future directions to reach standardization.

  15. Skin flaps and grafts - self-care

    MedlinePlus

    ... Free flap - self-care; Skin autografting - self-care; Pressure ulcer skin flap self-care; Burns skin flap self- ... skin infection Surgery for skin cancer Venous ulcers , pressure ulcers , or diabetic ulcers that DO NOT heal After ...

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

    PubMed

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

    2013-04-01

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

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

    PubMed Central

    2011-01-01

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

  18. Two Cases of Single-Stage Closure of a Bronchopleural Fistula Using Latissimus Dorsi Musculocutaneous Flaps after Lung Surgery

    PubMed Central

    Akiyama, Hirohiko; Kinoshita, Hiroyasu; Inoue, Takuya; Hamahata, Atsumori; Uramoto, Hidetaka

    2015-01-01

    Two cases of successful primary closure of a bronchopleural fistula with favorable infection control using latissimus dorsi musculocutaneous flaps are reported. Case 1 was a 70-year-old man who underwent resection of the right lower pulmonary lobe due to right lung metastasis of sigmoid colon cancer. A bronchopleural fistula was found on day 28 after surgery. Infection was controlled by antibiotic administration and tube drainage. Closure of the bronchopleural stump, thoracoplasty and plombage of latissimus dorsi muscles were performed for single-stage closure without open treatment, based on a negative pleural effusion culture. Case 2 was a 64-year-old man who underwent right lower pulmonary lobe resection due to right lung cancer. A bronchopleural fistula was found on day 14 after surgery. In single-stage closure, thoracoplasty and plombage of latissimus dorsi muscles were performed due to infection control and a negative pleural effusion culture. Both cases had a good postoperative course. PMID:26004108

  19. A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix

    PubMed Central

    Bingol, Ugur A.; Cinar, Can; Arslan, Hakan; Altındas, Muzaffer

    2015-01-01

    Background. Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers. Methods. We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method. Results. None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability. Conclusion. VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients. PMID:26516626

  20. Necrosis of the Ventral Penile Skin Flap: A Complication of Hypospadias Surgery in Children

    PubMed Central

    Bakal, Ünal; Abeş, Musa; Sarac, Mehmet

    2015-01-01

    Objectives. To review cases of hypospadias that were repaired with TIPU method and consequently resulted in the necrosis of ventral penile skin flaps. Methods. Eighty-three patients with hypospadias underwent TIPU procedure by two surgeons. Neourethra in all patients was covered with dartos flap prepared from the preputium or penile shaft. In cases where ventral skin could not be covered primarily, closure was ensured by using preputial Ombredanne or Byars' flaps to repair ventral defects. Results. The median age of patients was 4 years. Twenty-five (30.12%) patients that underwent hypospadias repair had urethral opening at the coronal level, 33 (39.75%) at the distal penis, 10 (12.04%) at the midpenis, and 15 (18.07%) at the proximal penis. The ventral skin defect could not be primarily covered in 10 patients with penile shaft hypospadias. Consequently, Byars' method was used in 8 of these patients to cover the defect and the Ombredanne method was used in the remaining 2. Ventral skin flap necrosis developed in 5 patients (4 Byars and 1 Ombredanne). It was medically treated in 4 patients. Urethral fistula developed in the other patient whose necrosis was deeper. The mean hospital stay was 7 days for patients without necrosis, and 14 for those with necrosis. Conclusion. We are of the opinion that dartos flaps used in the TIPU method in order to cover neourethra and decrease the incidence of fistula development lead to necrosis in the Ombredanne or Byars' flaps by causing low blood supply to the preputium and thus extend hospital stay. PMID:25922604

  1. Correction of pincer nail deformity with dermal flap: a new technique in pincer nail deformity surgery.

    PubMed

    Altun, Serdar; Gürger, Murat; Arpacı, Enver; İnözü, Emre

    2016-01-01

    Pincer nail deformity is the extreme, transverse, proximal-to-distal overcurvature of the finger, caused by osteophyte of the distal phalanx, and causing clamp effect on soft tissues and nail ingrowth. We report a new technique consisting of removal of the osteophyte causing clamp effect. Depressed areas of both side of the nail bed (lateral nail fold) were corrected with dermal flaps prepared from the side. Depressed areas were filled by these flaps, creating a smooth surface for the nail bed, and adequate correction was obtained. PMID:27130395

  2. Speech and swallowing following tongue cancer surgery and free flap reconstruction--a systematic review.

    PubMed

    Lam, Lisetta; Samman, Nabil

    2013-06-01

    This was a systematic review of the current research on speech and swallowing outcomes and the factors affecting these outcomes after primary resection of tongue cancer and free flap reconstruction. A structured search in various electronic databases and relevant journals was performed. Retrieved articles were critically appraised in three rounds according to the level of evidence, the methodological quality, and the specific domain of speech and swallowing. A total of 21 articles were in the final review and the findings were categorized according to the area of tongue resection. For patients with resection and free flap reconstruction limited to either the oral tongue or the base of tongue (BOT), significant decline in speech and swallowing function was evident in the early postoperative phase, but the majority recovered close to preoperative level after 1 year. Poorer speech and swallowing outcomes were found following resections involving both oral and base of tongue (OBOT) regardless of the type of free flap reconstruction. Results overall were influenced by multiple factors including tumor size, area of resection, method of reconstruction and the use of adjuvant therapy. The use of free flaps in the immediate reconstruction of the tongue after tumor resection should aim at the maintenance of the mobility of the residual tongue and restoration of tongue bulk in order to optimize the recovery of speech and swallowing function. Future research in this field should employ standardized and reliable evaluation of speech and swallowing outcomes using multiple modalities in well-designed cohort studies with longer follow-up.

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

    PubMed

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

    2011-10-01

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

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

    PubMed Central

    2014-01-01

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

  5. Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

    PubMed Central

    Yu, Jea H.; Nguyen, Chuck; Gallemore, Esmeralda

    2016-01-01

    Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions. Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement. Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from 39 ± 14 mmHg to 15 ± 2 mmHg and the number of glaucoma medications was reduced from 4 ± 1 to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively. Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis. PMID:27747118

  6. Automatic 3D vascular tree construction of perforator flaps for plastic surgery planning.

    PubMed

    Gao, Jean; Wen, Quan

    2004-01-01

    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 computational framework for the automatic 3D vascular tree construction. The computational framework begins with an image segmentation algorithm, spedge-and-medge, which is an integration of Canny edge detector, edge-linking, and split-and-merge to initially segment out the vessels from the background. To deal with the possible broken vessels, a vascular cross-sectional tree repairing and interpolation algorithm is then developed based on the 3D connectivity and root-converging properties of the tree branches. Furthermore, to extract the essential characteristics of the vascular structure, 3D thinning algorithms are used to build up the skeletons of the tree. At each stage of the framework, 3D rendering results are provided for the visualization of the computed results. The proposed method achieves good performance and has been used for the 3D vascular tree construction and surgical danger zone measurements on 39 harvested cadaver perforator flaps with the types of ALTP, GAP, and TAP. PMID:17271020

  7. Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction

    PubMed Central

    Sabino, Jennifer M.; Slater, Julia; Valerio, Ian L.

    2016-01-01

    Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases. Advanced reconstructive techniques coupled with regenerative medicine applications have played a critical role in the restoration, recovery, and rehabilitation of functional limb salvage. Translational Relevance: The past 14 years of war trauma have increased our understanding of tissue transfer for extremity reconstruction in the treatment of combat casualties. Injury patterns, flap choice, and reconstruction timing are critical variables to consider for optimal outcomes. Clinical Relevance: Subacute reconstruction with specifically chosen flap tissue and donor site location based on individual injuries result in successful tissue transfer, even in critically injured patients. These considerations can be combined with regenerative therapies to optimize massive wound coverage and limb salvage form and function in previously active patients. Summary: Traditional soft tissue reconstruction is integral in the treatment of war extremity trauma. Pedicle and free flaps are a critically important part of the reconstructive ladder for salvaging extreme extremity injuries that are seen as a result of the current practice of war. PMID:27679751

  8. Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction

    PubMed Central

    Sabino, Jennifer M.; Slater, Julia; Valerio, Ian L.

    2016-01-01

    Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases. Advanced reconstructive techniques coupled with regenerative medicine applications have played a critical role in the restoration, recovery, and rehabilitation of functional limb salvage. Translational Relevance: The past 14 years of war trauma have increased our understanding of tissue transfer for extremity reconstruction in the treatment of combat casualties. Injury patterns, flap choice, and reconstruction timing are critical variables to consider for optimal outcomes. Clinical Relevance: Subacute reconstruction with specifically chosen flap tissue and donor site location based on individual injuries result in successful tissue transfer, even in critically injured patients. These considerations can be combined with regenerative therapies to optimize massive wound coverage and limb salvage form and function in previously active patients. Summary: Traditional soft tissue reconstruction is integral in the treatment of war extremity trauma. Pedicle and free flaps are a critically important part of the reconstructive ladder for salvaging extreme extremity injuries that are seen as a result of the current practice of war.

  9. Evaluation of the Ex-PRESS® P-50 implant under scleral flap in combined cataract and glaucoma surgery

    PubMed Central

    Huerva, Valentín; Soldevila, Jordi; Ascaso, Francisco J.; Lavilla, Laura; Muniesa, M. Jesús; Sánchez, M. Carmen

    2016-01-01

    AIM To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS® P-50 for combined cataract surgery and glaucoma. METHODS Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS® P-50 model placed under scleral flap was performed. RESULTS Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P<0.001). A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control (<21 mm Hg). CONCLUSION Combined surgery of phacoemulsification with ExPRESS® P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation. PMID:27162726

  10. Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma

    PubMed Central

    Raschke, Gregor-Franziskus; Guentsch, Arndt; Roshanghias, Korosh; Eichmann, Francy; Schultze-Mosgau, Stefan

    2016-01-01

    Background Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient’s perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well being. Material and Methods n this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. Results Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r=-0.488), insomnia (r=-0.416) and pain (r =-0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r=-0.438), eating in public (r=-0.420) and persistent severe speech (r=-0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. Conclusions Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment. Key words:Longterm quality of life, oral cancer, oncologic surgery, microvascular free flap reconstruction. PMID:27031070

  11. Determination of the recipient vessels in the head and neck using multislice spiral computed tomography angiography before free flap surgery: a preliminary study.

    PubMed

    Tan, Onder; Kantarci, Mecit; Parmaksizoglu, Duygu; Uyanik, Ummugulsum; Durur, Irmak

    2007-11-01

    Preoperative assessment of the recipient vessels in free flap surgery directly affects the success rate of the operation by determining the flap type, pedicle length, orientation to the recipient site, and need for a vein graft. For this purpose, conventional angiographic methods are still being used with some disadvantages. The aims of this study were to evaluate the potential success of multislice computed tomography angiography in assessment of the recipient vessels before free flap surgery and to reveal if this may be an alternative to conventional angiography. The study was bilaterally carried out in 33 outpatients using a 16-detector spiral computed tomography scanner. In images of multiplanar reconstructions, maximum intensity projections, and three-dimensional volume renderings, the external carotid artery and its main branches were evaluated in terms of availability; patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; variations involving ramification from another main vessel; and abnormal course. The superior thyroid artery was absent bilaterally in two patients (6.06%). The external carotid artery was stenotic on one side in two patients (6.06%) and on each side in one (3.03%). All the remaining vessels appeared without stenosis, occlusion, or variation. We think that multislice computed tomography angiography can provide detailed information about vascular structures and the remaining anatomic structures and their relationships with the recipient vessels. Therefore, multislice computed tomography angiography, as a less invasive vascular imaging method, can be a useful tool before planning free flap surgery. PMID:17993870

  12. Facial flap complications.

    PubMed

    Zoumalan, Richard A; Murakami, Craig S

    2012-06-01

    Knowledge of fundamental concepts can help decrease the chance of complications in plastic surgery. Local flap reconstruction for facial defects has many pitfalls. This article describes common complications in local flap reconstruction of the face and describes strategies that prevent problems.

  13. Total arm flap.

    PubMed

    Becker, D W

    1987-11-01

    The development of an unusual and rarely indicated total arm flap is described in the context of widely indicated and automatically used principles passed down by the recognized father of plastic surgery, Sir Harold G. Gillies.

  14. Changes in Transforming Growth Factor-β1 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis Following Periodontal Flap Surgery

    PubMed Central

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

    2015-01-01

    Introduction: The aim of the study was to assess changes in Transforming Growth Factor– β1 (TGF-β1) levels in gingival crevicular fluid (GCF) and examine correlation of TGF-β1 levels and periodontal parameters: probing pocket depth (PPD) and clinical attachment level (CAL) in sites with chronic periodontitis at various time intervals before and after periodontal surgery. Materials and Methods: The effects of non-surgical and surgical therapy on periodontal parameters and GCF TGF-β1 levels in 18 sites affected with chronic periodontitis were assessed upto 6 weeks post conventional flap surgery. GCF was collected and PPD, CAL recorded at Baseline. GCF was collected and PPD, CAL recorded at Pre-surgery and flap surgery performed. GCF was collected from all sites at Two Weeks Post-surgery. GCF was collected and PPD, CAL recorded at Six Weeks Post-surgery. The concentration of TGF-β1 in GCF was determined using a human TGF-β1 enzyme immunometric assay kit. Results: Mean TGF-β1 concentrations were significantly reduced at Pre-surgery, at Two Weeks Post-surgery and at Six Weeks Post-surgery (p<0.05) when compared to Baseline TGF-β1 values. There was a statistically significant reduction in PPD and gain in CAL following non-surgical and surgical therapy when compared to baseline (p<0.05). Conclusion: Results indicate that TGF-β1 may play a role in the pathogenesis and diagnosis of periodontal disease and could be considered as a disease predictive biomarker. PMID:25859517

  15. Evaluation of lower-limb arteries with multidetector computed tomography angiography prior to free flap surgery: a radioanatomic study.

    PubMed

    Tan, Onder; Yuce, Ihsan; Kantarci, Mecit; Algan, Said

    2011-03-01

    In this study, we aimed to evaluate the vascular structures of the lower limb with multidetector computed tomography (CT) angiography and to reveal the importance of this method in preoperative planning of microsurgical transplantation. In 24 patients, lower-limb arteries were bilaterally evaluated with 16-detector spiral CT scanner in terms of patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; and variations as well as length of the peroneal artery. The peroneal artery was absent unilaterally in two patients (4.3%). The mean maximal and minimal diameters were as 2.77 and 1.63, 2.92 and 1.75, and 2.72 and 1.50 mm for anterior and posterior tibial and peroneal arteries, respectively. The ranges of lengths of peroneal arteries were 50 to 117 mm. This valuable tool can provide detailed information about vascular and the remaining anatomic structures by means of its high-resolution characteristics before planning free flap surgery. PMID:21181625

  16. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap

    PubMed Central

    Alço, Gül; Igdem, Sefik; Okkan, Sait; Dincer, Maktav; Sarsenov, Dauren; Ilgun, Ahmet Serkan; Agacayak, Filiz; Elbüken, Filiz; Ercan, Tulay; Selamoglu, Derya; Ozmen, Vahit

    2016-01-01

    The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4–4.43 cm) in the x, 1.07 cm (range, 0.05–5.67 cm) in the y, and 1.12 cm (range, 0–3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction. PMID:27699027

  17. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap

    PubMed Central

    Alço, Gül; Igdem, Sefik; Okkan, Sait; Dincer, Maktav; Sarsenov, Dauren; Ilgun, Ahmet Serkan; Agacayak, Filiz; Elbüken, Filiz; Ercan, Tulay; Selamoglu, Derya; Ozmen, Vahit

    2016-01-01

    The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4–4.43 cm) in the x, 1.07 cm (range, 0.05–5.67 cm) in the y, and 1.12 cm (range, 0–3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction.

  18. The effectiveness of different root debridement modalities in open flap surgery.

    PubMed

    Huerzeler, M B; Einsele, F T; Leupolz, M; Kerkhecker, U; Strub, J R

    1998-03-01

    It is unclear what degree of roughness or smoothness result from use of hand instruments alone in comparison to the use of hand instruments in combination with other aids and how it may effect the grade of cleanliness. The aim of this study was to determine in vivo whether the combination of hand instruments with other aids can increase the effectiveness of root debridement. 11 patients with holpless 4 mandibular incisors were involved in this study. After elevating a lingual and buccal mucoperiosteal flap, the 4 incisors were randomly treated with either: (1) no treatment (control); (2) 5-min scaling (method 1); (3) 4-min scaling and 1 min instrumentation with a perio-diamond bur (15 microm) (method 2); (4) 3-min scaling, 1-min instrumentation with a perio-diamond bur (15 microm) and 1 min with an air abrasive system (method 3). The cleanliness of the surface was determined using the method of Eschler and -Rapley. The degree of roughness (Ra and Rt) were measured with a laser beam (computer supported optical surface sensor system). In addition, an SEM analysis was performed. With regard to the remaining calculus (surface cleanliness), method 3 yielded significantly better results than the other 2 methods. The roughness analyses also exhibited that method 3 is superior to methods 1 and 2. The qualitative results of the SEM investigations demonstrated the most homogeneous and smooth surfaces with method 3. Root debridement in vivo was most significant using a combination of different treatment modalities (i. e., curettes, perio-diamond bur and air abrasive system).

  19. Considerations and Protocols in Virtual Surgical Planning of Reconstructive Surgery for More Accurate and Esthetic Neomandible with Deep Circumflex Iliac Artery Free Flap

    PubMed Central

    Kim, Nam-Kyoo; Kim, Hyun Young; Kim, Hyung Jun; Cha, In-Ho; Nam, Woong

    2014-01-01

    Purpose: The reconstruction of mandibular defects poses many difficulties due to the unique, complex shape of the mandible and the temporomandibular joints. With development of microvascular anastomosis, free tissue transplantation techniques, such as deep circumflex iliac artery (DCIA) flap and fibular free flap (FFF), were developed. The DCIA offers good quality and quantity of bone tissue for mandibular segmental defect and implant for dental rehabilitation. Virtual surgical planning (VSP) and stereolithography-guided osteotomy are currently successfully applied in three-dimensional mandibular reconstruction, but most use FFF. There are only a few articles on reconstruction with the DCIA that assess the postoperative results. Methods: Three patients admitted during a five month period (April of 2013 to August of 2013) underwent resection of mandible and DCIA musculo-osseous reconstruction using a VSP and stereolithographic modeling and assessment of outcomes included technical accuracy, esthetic contour, and functional outcomes. Results: This technique yielded iliac bone segment with excellent apposition and duplication of the preoperative plan. Flap survival was 100 percent and all patients maintained preoperative occlusion and contour. Conclusion: Based on our experience, we offer considerations and logically consistent protocols by classification of mandibular defects, and demonstrate the benefits in VSP and stereolithographic modeling of mandibular reconstructive surgery with DCIA flap. PMID:27489828

  20. Musculocutaneous flaps in head and neck reconstruction.

    PubMed Central

    Leonard, A. G.

    1989-01-01

    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 PMID:2686511

  1. Flap monitoring using infrared spectroscopy

    NASA Astrophysics Data System (ADS)

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

    2006-02-01

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

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

    PubMed Central

    Anyanechi, CE; Osunde, OD; Bassey, GO

    2015-01-01

    Background: The most common complication of surgery for the release of temporomandibular joint (TMJ) ankylosis is relapse of the ankylosis. To prevent re-ankylosis, a variety of interpositional materials have been used. Aim: The aim was to compare the surgical outcome of oral mucoperiosteal flap, not hitherto used as interpositional material, with pterygo-masseteric muscles flap after surgical release of TMJ ankylosis. Subjects and Methods: This was a prospective randomized study of all consecutive patients treated for the release of complete TMJ bony ankylosis, from January 2003 to December 2012, at the Oral and Maxillofacial unit of our institution. The patients were randomized into two groups: The pterygo-masseteric group comprises 22 patients while the oral mucoperiosteal group had 23 patients. Information on demographics, clinical characteristics, and postoperative complications over a 5 year follow-up period were obtained, and analyzed using the statistical package for social sciences (Statistical Package for the Social Sciences version 13, Chicago, IL, USA). A P < 0.05 was considered significant. Results: The age of the patients ranged from 15 to 28 mean 20.3 (3.35) years while the duration of ankylosis ranged from 2 to 16 mean 5.1 (3.4) years. The baseline demographic (gender; P = 0.92; side; P = 0.58) and clinical characteristics in terms of etiology (P = 0.60) and age (P = 0.52) were comparable in both treatment groups. All the patients presented with complete bony TMJ ankylosis with a preoperative inter-incisal distance of <0.5 cm. The intraoperative mouth opening achieved ranged from 4 cm to 5 cm, mean 4.6 (0.27) cm and this was not different for either group (P = 0.51). The patients were followed up postoperatively for a period ranging from 3 to 5 years, mean 3.4 (0.62) years. The mouth opening decreased, over the period of postoperative review, from the initial range of 4–5 cm to 2.9–3.6 cm, and this was not different in both groups (P = 0

  3. Computer-Assisted Surgery for Segmental Mandibular Reconstruction with the Osteoseptocutaneous Fibula Flap: Can We Instigate Ideological and Technological Reforms?

    PubMed

    Deek, Nidal Farhan A L; Wei, Fu-Chan

    2016-03-01

    Virtual surgical planning and computer-aided design and computer-aided modeling are promising technologies with a growing trend in contemporary head and neck reconstruction. Segmental mandibular reconstruction with the osteoseptocutaneous fibula flap is one of the fields in which these technologies are increasingly used. Perceived benefits are increased surgical precision, improved operative efficiency, and overall good outcomes. Nevertheless, these programs do not cover the reconstruction picture of interest thoroughly, at least in the mind of the experienced surgeon. Based on extensive experience in segmental mandibular reconstruction and comprehensive literature review, the authors attempted to identify missing dots in computer-aided mandibular reconstruction; when possible, a problem-solution approach was taken. Of these dots, pedicle reach to the recipient vessels, multiple target soft-tissue reconstruction, anatomical variations and cross-section topography of the osteoseptocutaneous fibula flap, and intraoperative modification of the surgical plan were understated or not considered in the phases of virtual surgical planning and execution. Moreover, with the relatively small experience reported in computer-aided segmental mandibular reconstruction compared with the well-appreciated challenges, further discussion of what could be a realistic and safe indication was deemed necessary. Following in the footsteps of the iPhone developer of creating software satisfying to customers (i.e., surgeons) first and armed with the evidence from the literature and accumulation of experience, this Special Topic article aims to provoke a discussion among experts in this field to instigate ideological and technological reforms in computer-aided mandibular reconstruction. PMID:26910680

  4. Freestyle Local Perforator Flaps for Facial Reconstruction.

    PubMed

    Lee, Jun Yong; Kim, Ji Min; Kwon, Ho; Jung, Sung-No; Shim, Hyung Sup; Kim, Sang Wha

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosis underwent minor revision. We reviewed the literature on freestyle perforator flaps for facial defect reconstruction and focused on English articles published in the last five years. With the advance of knowledge regarding the vascular anatomy of pedicled perforator flaps in the face, we found that some perforator flaps can improve functional and aesthetic reconstruction for the facial defects. We suggest that freestyle facial perforator flaps can serve as alternative, safe, and versatile treatment modalities for covering small to moderate facial defects. PMID:26236734

  5. Propeller Flap Reconstruction in Post Oncological Thigh Defect: "The Move in Flap".

    PubMed

    Nambi, G I; Salunke, Abhijeet Ashok

    2015-06-01

    Reconstruction of soft tissue defects of the limb after tumor resection is challenging question for oncosurgeons. The management differs from reconstruction of post traumatic defects due to the complexity of the primary surgery and subsequent radiation. The conventional propeller flap is based on a perforator which is located close to the defect; but in present case the perforator was located far away from the defect. So we describe it as "Move in flap" as the flap rotated a large volume of soft tissue lying between the defect and the perforator. We present a case of post oncological thigh defect with reconstruction using a propeller flap based on distal anteromedial perforator.

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

    PubMed

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

    2009-01-01

    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

  7. Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap for Tongue Reconstruction Following Hemiglossectomy.

    PubMed

    Zhang, Senlin; Chen, Wei; Cao, Gang; Dong, Zhen

    2015-09-01

    This study investigated the tongue function and donor-site morbidity of patients with malignant tumors who had undergone immediate flap reconstruction surgery. Twenty-seven patients who had undergone immediate reconstruction after hemiglossectomy were observed. Twelve patients were reconstructed using the pedicled supraclavicular artery island flap (PSAIF) and 15 patients using the free radial forearm flap (FRFF). Flap survival, speech and swallowing function, and donor-site morbidity at the 6-month follow-up were evaluated. All the flaps were successfully transferred. No obvious complications were found in either the transferred flaps or donor regions. Age, sex, defect extent, speech and swallowing function were comparable between the 2 groups. Donor-site complications were less frequent with PSAIF reconstruction than FRFF reconstruction. The PSAIF is reliable and well suited for hemiglossectomy defect. It has few significant complications, and allows preservation of oral function.

  8. Complications of surgery for radiotherapy skin damage

    SciTech Connect

    Rudolph, R.

    1982-08-01

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

  9. Mucocele formation under pedicled nasoseptal flap.

    PubMed

    Vaezeafshar, Reza; Hwang, Peter H; Harsh, Griffith; Turner, Justin H

    2012-01-01

    The pedicled nasoseptal flap has become an indispensible tool for the reconstruction of skull base defects. This flap is easily harvested, provides a large surface area of vascularized tissue, and has few reported complications. We describe the case of a 60-year-old man who underwent endoscopic, endonasal transsphenoidal surgery with septal flap reconstruction who developed a sphenoid sinus mucocele postoperatively. We also have reviewed the literature for similar findings and discuss this complication in the setting of pituitary surgery and endoscopic skull base repair. Although likely a rare occurrence, mucocele formation after septal flap reconstruction should be recognized and monitored with postoperative nasal endoscopy and radiologic imaging. Reoperation or mucocele drainage may be necessary if symptomatic or in cases of rapid enlargement.

  10. The origin of the temporalis muscle flap.

    PubMed

    Speculand, B

    1992-12-01

    This paper explores the origin of the temporalis muscle flap which has been attributed to Golovine, a Moscow ophthalmic surgeon, who described a forehead skin transposition flap. Small temporalis muscle transpositions were used in surgery for TMJ ankylosis, but the use of the majority of the muscle for reconstruction of facial defects was first described by Sir Harold Gillies during the 1914-18 war.

  11. Sural Versus Perforator Flaps for Distal Medial Leg Wounds.

    PubMed

    Schannen, Andrew P; Truchan, Lisa; Goshima, Kaoru; Bentley, Roger; DeSilva, Gregory L

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. PMID:26652325

  12. Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction

    PubMed Central

    Wang, Frederick; Buonocore, Samuel; Narayan, Deepak

    2011-01-01

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

  13. Deltopectoral Flap in the Era of Microsurgery

    PubMed Central

    Chan, R. C. L.; Chan, J. Y. W.

    2014-01-01

    Background. Our study aimed to review the role of deltopectoral (DP) flap as a reconstructive option for defects in the head and neck region in the microvascular era. Methods. All patients who received DP flap reconstruction surgery at the Department of Surgery, Queen Mary Hospital, between 1999 and 2011 were recruited. Demographic data, indications for surgery, defect for reconstruction, and surgical outcomes were analyzed. Results. Fifty-four patients were included. All but two patients were operated for reconstruction after tumour resection. The remaining two patients were operated for necrotizing fasciitis and osteoradionecrosis. The majority of DP flaps were used to cover neck skin defect (63.0%). Other reconstructed defects included posterior pharyngeal wall (22.2%), facial skin defect (11.1%), and tracheal wall (3.7%). All donor sites were covered with partial thickness skin graft. Two patients developed partial flap necrosis at the tip and were managed conservatively. The overall flap survival rate was 96.3%. Conclusions. Albeit the technical advancements in microvascular surgery, DP still possesses multiple advantages (technical simplicity, reliable axial blood supply, large size, thinness, and pliability) which allows it to remain as a useful, reliable, and versatile surgical option for head and neck reconstruction. PMID:25374953

  14. Surgery

    MedlinePlus

    ... 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

  15. Incidence of flap procedures in the management of burn patients.

    PubMed

    Lineaweaver, William C; Craft-Coffman, Beretta; Oswald, Tanya M

    2015-03-01

    Increased survival of burn patients presents opportunities for reconstructive strategies to improve outcomes in management of acute and secondary burn injuries. To assess one such strategy, namely flap reconstruction, we reviewed cases performed during the first 4.5 years of the JMS Burn and Reconstruction Center. We found that flap procedures accounted for 0.8% of acute cases (23 of 2723 procedures) and 33% of secondary cases (260 of 790 procedures). This initial finding shows that in this practice flap procedures are applied to a small number of acute problems while flap procedures comprise 33% of secondary procedures. Reconstructive flap surgery plays a measurable role in burn treatment at this center. Further study of outcomes and timing could lead to better understanding of optimal strategies for flap reconstruction in burns.

  16. The racquet conjunctival flap.

    PubMed

    Cies, W A; Odeh-Nasrala, N

    1976-01-01

    In situations requiring a conjunctival flap to cover a corneal defect, the racquet flap technique is a simple relatively noninvasive method. Less conjunctiva is sacrificed and yet the flap is fully maintained by the one pedicle. The bulbar conjunctiva is maintained in an essentially normal state.

  17. Late traumatic flap displacement after laser in situ keratomileuisis.

    PubMed

    Franklin, Quentin J; Tanzer, David J

    2004-04-01

    Laser in situ keratomileusis (LASIK) has become the community standard in corneal refractive surgery and is being performed by surgeons in the Army, Navy, and Air Force. LASIK differs from photorefractive keratectomy (PRK) in that a partial-thickness corneal flap is created in the LASIK procedure before removing a microscopic amount of corneal tissue, whereas no flap creation is required in PRK. The benefits of LASIK include minimal discomfort after surgery, as well as a much faster return of visual function. PRK involves a surface ablation and therefore heals differently, involving more discomfort and a slower return of functional vision. LASIK flap integrity is a concern to anyone undergoing the procedure, as well as for those making recommendations on the best form of refractive surgery for military personnel. A case report and a review of the literature are presented on the identification and management of LASIK flap trauma.

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

    PubMed

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

    2013-01-01

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

  19. Free Flap Elevation Times in Head and Neck Reconstruction Using the Harmonic Scalpel Shears

    PubMed Central

    DeSerres, Joshua J.; Barber, Brittany R.; Seikaly, Hadi; Harris, Jeffrey R.

    2016-01-01

    Summary: Free tissue transfer has become the mainstay of head and neck cancer (HNC) reconstructive surgery. The objective of the study is to examine the efficacy of the Harmonic Scalpel (HS) Shears on free flap elevation time and complication rates after HNC reconstruction compared with traditional electrocautery. A retrospective review of 215 HNC patients undergoing surgical ablation and free flap reconstruction from January 2010 to April 2013 at the University of Alberta Hospital was undertaken. All patients requiring free flap reconstruction with radial forearm free flap or fibula free flap were included. Overall, there was no significant difference demonstrated between the HS and electrocautery groups for free flap elevation time for RFFFs (P = 0.563) or FFFs (P = 0.087). No differences were observed in donor-site complications. The HS is a reliable, safe, and alternative method of free flap elevation in HNC reconstructive surgery. PMID:27579242

  20. In situ monitoring of surgical flap viability using THz imaging (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Bajwa, Neha; Sung, Shijun; Grundfest, Warren; Taylor, Zachary

    2016-03-01

    This paper explores the utility of reflective THz imaging to assess the viability of surgical flaps. Flap surgery is a technique where tissue is harvested from a donor site and moved to a recipient while keeping the blood supply intact. This technique is common in head and neck tumor resection surgery where the reconstruction of complex and sensitive anatomic structures is routine following the resection of large and/or invasive tumors. Successful flap surgery results in tissue that is sufficiently perfused with both blood and extracellular water. If insufficient fluid levels are maintained, the flap tissue becomes necrotic and must be excised immediately to prevent infection developing and spreading to the surrounding areas. The goal of this work is to investigate the hydration of surgical flaps and correlate image features to successful graft outcomes. Advancement flaps were created on the abdomens of rat models. One rat model was labeled control and care was taken to ensure a successful flap outcome. The flap on the second rat was compromised with restricted blood flow and allowed to fail. The flaps of both rats were imaged once a day over the course of a week at which point the compromised flap had begun to show signs of necrosis. Significant differences in tissue water content were observed between rats over the experimental period. The results suggest that THz imaging may enable early assessment of flap viability.

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

    NASA Astrophysics Data System (ADS)

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

    2012-12-01

    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.

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

    PubMed Central

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

    2014-01-01

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

  3. Switch Flap for Upper Eyelid Reconstruction—How Soon Should the Flap Be Divided?

    PubMed Central

    Yanai, Tetsu; Yasuta, Masato; Kawano, Hiroshige; Ishihara, Yasuhiro; Kikuchi, Mamoru

    2016-01-01

    Background: The results of a cohort of patients treated at one institution for upper eyelid reconstruction with the switch flap method after a defect due to excision of malignant tumor were reviewed. Methods: A retrospective data file review of all patients who had undergone total upper eyelid reconstruction with the switch flap method was conducted at the Saga University Hospital between April 2000 and October 2014. The follow-up lasted for varying periods during which the preoperative and postoperative photographs were compared as well. Results: A total of 10 patients with upper eyelid tumors, that is, 7 sebaceous carcinoma, 2 squamous cell carcinoma, and 1 basal cell carcinoma, underwent reconstructive surgery. With the switch flap technique, the defects resulting from tumor excision were completely covered in all cases. The mean of defect widths after tumor excision (A) was 18.8 mm (range, 15–25 mm), the mean of widths of switch flaps (B) was 13.3 mm (range, 8–22 mm), and the mean of B/A ratios was 0.69 (range, 0.5–0.88). When the switch flap was divided at 7 to 14 days, there was no flap loss, trichiasis, or corneal ulcer. Conclusion: Our protocol managed to make flaps with a B/A ratio of 0.5–0.7, and the flaps were divided at 7 to 14 days after surgery, the timing of which was much earlier than in the conventional method, lessening the possibility of complications. PMID:27200257

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

    PubMed Central

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

    2014-01-01

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

  5. Concomitant Correction of a Soft-Tissue Fenestration with Keratinised Tissue Augmentation By Using A Rotated Double-Pedicle Flap During Second-Stage Implant Surgery- A Case Report

    PubMed Central

    Reddy, Aileni Amarender; Kumar, P. Anoop; Sailaja, Sistla; Chakravarthy, Yshs

    2015-01-01

    Soft tissue deficiencies and defects around dental implants have been observed frequently. Soft-tissue defects after implant procedures originate from the process of modelling of periimplant mucosa and often cause aesthetic disharmony, food debris accumulation and soft tissue shrinkage. Periimplant mucogingival surgery focuses on creating an optimum band of keratinized tissue resulting in soft tissue architecture similar to the gingiva around natural teeth. A 23-year-old male reported to the Department of Periodontology with a complaint of gum soreness, foul smell and food accumulation at a site where a 3.75 x 11.5mm implant was placed previously. On clinical examination, fenestration of tissue above the cover screw was observed and there appeared to be a keratinized tissue of 1mm surrounding the implant. The case was managed by use of a rotated double-pedicle flap during second-stage implant surgery to correct the soft-tissue fenestration defect and to obtain a keratinized periimplant soft tissue. A periosteal bed was prepared by giving a horizontal incision at the mucogingival junction to a depth of 4 mm. Two split-thickness keratinized pedicles were dissected from the mesial and distal interproximal tissues near the implant. After rotation, both the pedicles were sutured to each other mid-buccally and the pedicles were rigidly immobilized with sutures. At 1 month, there was a 3mm band of stable and firm keratinized tissue over the underlying tissues. The procedure resulted in an aesthetic improvement due to enhanced soft tissue architecture and optimum integration between the peri-implant soft tissue and the final prosthesis. PMID:26816998

  6. [Elimination of isolated gingival atrophy by laterally positioned flap and free mucogingival autografts in combination with coronally positioned flap].

    PubMed

    Kovaćević, K; Leković, V

    1991-01-01

    Mucogingival surgical procedures such as laterally (horizontally) positioned flap, double papillae positioned flap and free mucogingival autografts have been recommended for the prevention and treatment of isolated gingival atrophy. These procedures can bi performed either independently or in combination with coronally positioned flap. In our study, for covering of exposed tooth roots, we applied laterally positioned flap and free mucogingival autografts in combination with coronally positioned flap. The obtained therapeutic results showed that six months after the surgery the exposure of tooth necks in patients treated by laterally positioned flap, decreased by 2.54 mm. Somewhat better results were obtained in the group of patients treated by fre mucogingival autografts in combination with coronally positioned flap. Within the same time interval, the total surface area of exposed tooth roots decreased by 59.76% in the group of patients treated by laterally positioned flap, i.e. by 62.25% in the group of patients treated by free mucogingival autografts in combination with coronally positioned flap. PMID:1785128

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

    PubMed

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

    2012-01-01

    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

  8. Free deep inferior epigastric perforator flap used for management of post-pneumonectomy space empyema.

    PubMed

    Manley, Kate; Gelvez, Sandra; Meldon, Charlotte J; Levai, Irisz; Malata, Charles M; Coonar, Aman S

    2013-04-01

    Various solutions exist for management of post-pneumonectomy space empyema. We describe the use of a free deep inferior epigastric perforator (DIEP) flap to fill the space and close a pleural window. Previously, flaps involving abdominal muscle or omentum have been used for this purpose. Abdominal surgery to harvest such flaps can impair ventilatory mechanics. The DIEP flap--harvested from the abdomen, and composed primarily of skin and muscle avoids this problem, thus is a desirable technique in patients with impaired lung function. We believe this is the first report of the DIEP flap to close a postpneumonectomy empyema space.

  9. The “Reverse” Latissimus Dorsi Flap for Large Lower Lumbar Defect

    PubMed Central

    Kotti, Bouraoui; Jaidane, Olfa; Ben Hassouna, Jamel; Rahal, Khaled

    2012-01-01

    The latissimus dorsi (LD) flap is one of the most common flaps used in plastic surgery based on its dominant thoracodorsal pedicle as well as free tissue transfer. The “distally based” or “reverse” fashion design has been used to repair myelomeningoceles, congenital diaphragmatic agenesis, or thoracolumbar defects. We present a case of a large lumbar defect after cancer resection covered by a combined tegument solution starring the “reverse” LD flap in its muscular version with a cutaneous gluteal flap. This flap is a safe and reliable way to cover large distal lumbar defect. PMID:23082273

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

    PubMed

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

    2014-10-01

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

  11. Keyhole Flap Nipple Reconstruction.

    PubMed

    Chen, Joseph I; Cash, Camille G; Iman, Al-Haj; Spiegel, Aldona J; Cronin, Ernest D

    2016-05-01

    Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76). The average patient follow-up was 17 months. The design of the flap is based on a keyhole configuration. The base of the flap determines the width of the future nipple, whereas the length of the flap determines the projection. We try to match the projection of the contralateral nipple if present. The keyhole flap is simple to construct yet reliable. It provides good symmetry and projection and avoids the creation of new scars. The areola is then tattooed approximately 3 months after the nipple reconstruction. PMID:27579228

  12. Perforator flaps in hand reconstruction: the effect of blood vessel twisting

    PubMed Central

    ARDELEAN, FILIP; MUNTEAN, MAXIMILIAN; DUMITRASCU, DINU; STRILCIUC, STEFAN; GEORGESCU, ALEXANDRU VALENTIN

    2015-01-01

    Background and aims Perforator flaps increasingly find acceptance and use in hand reconstructive surgery. A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular pedicle. It is now possible to design propeller flaps based on a single perforator, so-called “perforator-based propeller flaps,” but they are more prone to vascular impairment when twisted more than 90°. Methods We present a prospective study conducted in the Plastic and Reconstructive Surgery Department of the Rehabilitation Hospital over 17 months. All perforator-based propeller flaps that were used for hand reconstruction were analyzed. The parameters studied included the size and location of the defect, the size and shape of the flap, the perforator (length and location) that was used, the degree of twisting of the perforator, the degree of perforator dissection, the management of the donor site, and flap survival area. Results In this study we investigated the circulatory impairment induced by twisting of the pedicle on a true perforator flap. All flaps survived completely with the exception of partial skin necrosis in few cases. Some of these cases required debridement and skin grafting. Conclusions Perforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be generally directly closed. PMID:26609268

  13. The Modified 3-square Flap Method for Reconstruction of Toe Syndactyly.

    PubMed

    Iida, Naoshige; Watanabe, Ayako

    2016-07-01

    Bandoh reported the 3-square-flap method as a procedure for interdigital space reconstruction in patients with minor syndactyly. We recently modified this flap design so that it could be used in the treatment of toe syndactyly involving fusion of the areas distal to the proximal interphalangeal joint. With our method, the reconstructed interdigital space consists of 4 oblong flaps (A through D). Flaps A and D are designed on the dorsal side, flap B is designed on the frontal plane of the interdigital space, and flap C is designed on the plantar side. Flaps A, B, and C are raised immediately below the dermis in a manner that allowed slight fat tissue to adhere to each flap. Flap D is freed to a degree minimally needed for dislocation, while leaving a thick subcutaneous pedicle. Flaps A, B, and C are each folded in 90 degrees; flap D is dislocated to the proximal plane of the reconstructed digit, followed by skin suturing. In this process, suturing is avoided between flaps A and C, between flaps A and D, and between flaps B and D. During the period of 2011 to 2015, we treated 8 patients of toe syndactyly involving fusion distal to the proximal interphalangeal joint. Cases of congenital syndactyly received surgery between the ages of 8 and 11 months. Using this technique, flap ischemia/necrosis was not observed. During the postoperative follow-up period, the interdigital space retained sufficient depth without developing any scar contracture. No case required additional surgery. PMID:27536472

  14. The Modified 3-square Flap Method for Reconstruction of Toe Syndactyly

    PubMed Central

    Watanabe, Ayako

    2016-01-01

    Bandoh reported the 3-square-flap method as a procedure for interdigital space reconstruction in patients with minor syndactyly. We recently modified this flap design so that it could be used in the treatment of toe syndactyly involving fusion of the areas distal to the proximal interphalangeal joint. With our method, the reconstructed interdigital space consists of 4 oblong flaps (A through D). Flaps A and D are designed on the dorsal side, flap B is designed on the frontal plane of the interdigital space, and flap C is designed on the plantar side. Flaps A, B, and C are raised immediately below the dermis in a manner that allowed slight fat tissue to adhere to each flap. Flap D is freed to a degree minimally needed for dislocation, while leaving a thick subcutaneous pedicle. Flaps A, B, and C are each folded in 90 degrees; flap D is dislocated to the proximal plane of the reconstructed digit, followed by skin suturing. In this process, suturing is avoided between flaps A and C, between flaps A and D, and between flaps B and D. During the period of 2011 to 2015, we treated 8 patients of toe syndactyly involving fusion distal to the proximal interphalangeal joint. Cases of congenital syndactyly received surgery between the ages of 8 and 11 months. Using this technique, flap ischemia/necrosis was not observed. During the postoperative follow-up period, the interdigital space retained sufficient depth without developing any scar contracture. No case required additional surgery. PMID:27536472

  15. Extracorporeal Free Flap Perfusion in Case of Prolonged Ischemia Time

    PubMed Central

    Präbst, K.; Beier, J. P.; Meyer, A.; Horch, R. E.

    2016-01-01

    Summary: In free flap surgery, a clinically established concept still has to be found for the reduction of ischemia-related cell damage in the case of prolonged ischemia. Although promising results using extracorporeal free flap perfusion in the laboratory have been published in the past, until now this concept has not yet paved its way into clinical routine. This might be due to the complexity of perfusion systems and a lack of standardized tools. Here, we want to present the results of the first extracorporeal free flap perfusion in a clinical setting using a simple approach without the application of a complex perfusion machinery. PMID:27200244

  16. Latissimus dorsi flap remains an excellent choice for breast reconstruction.

    PubMed

    Sternberg, Erez G; Perdikis, Galen; McLaughlin, Sarah A; Terkonda, Sarvam P; Waldorf, James C

    2006-01-01

    Latissimus dorsi flap has been unfairly relegated to a second option in breast reconstruction. One hundred consecutive latissimus dorsi muscle flaps (LDMF) with tissue-expander reconstruction were studied, mean follow-up 34.5 months (range, 1-175), 50 immediate, 50 delayed. With attention to a few technical details, excellent esthetic, soft reconstructions were achieved. Complications included 1 partial flap loss; 2 patients required inframammary fold revision; and 6 patients required surgery for capsular contracture. Donor-site seroma occurred in 34 patients; 6 required operative revision. Results were similar in the immediate versus the delayed groups. LDMF remains an esthetic, reliable, safe reconstructive choice.

  17. Identification of independent risk factors for flap failure: A retrospective analysis of 1530 free flaps for breast, head and neck and extremity reconstruction.

    PubMed

    Las, David E; de Jong, Tim; Zuidam, J Michiel; Verweij, Norbert M; Hovius, Steven E R; Mureau, Marc A M

    2016-07-01

    Reconstructive microsurgery is a powerful method of treating various complex defects. However, flap loss remains a possibility, leading to additional surgery, hospitalisation and costs. Consequently, it is important to know which factors lead to an increased risk of flap failure, so that measures can be undertaken to reduce this risk. Therefore, we analysed our results over a 20-year period to identify risk factors for flap failure after breast, head and neck and extremity reconstruction. The medical files of all patients treated between 1992 and 2012 were reviewed. Patient characteristics, surgical data and post-operative complications were scored, and independent risk factors for flap loss were identified. Reconstruction with a total of 1530 free flaps was performed in 1247 patients. Partial and total flap loss occurred in 5.5% and 4.4% of all free flaps, respectively. In all flaps, signs of compromised flap circulation were a risk factor for flap failure. More specifically, the risk factors for flap failure in breast reconstruction were previous radiotherapy, venous anastomosis revision, gluteal artery perforator (GAP) flap choice and post-operative bleeding. In head and neck reconstruction, pulmonary co-morbidity and anastomosis to the lingual vein or superficial temporal artery were risk factors, whereas a radial forearm flap reduced the risk. In extremity reconstruction, diabetes, prolonged anaesthesia time and post-operative wound infection were risk factors. Independent pre-, intra- and post-operative risk factors for flap failure after microvascular breast, head and neck and extremity reconstruction were identified. These results may be used to improve patient counselling and to adjust treatment algorithms to further reduce the chance of flap failure.

  18. Flow Over Swept Flaps and Flap Tips

    NASA Technical Reports Server (NTRS)

    Bradshaw, Peter; Buice, Carl U.

    1995-01-01

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

  19. Enhancement of flap survival and changes in angiogenic gene expression after AAV2-mediated VEGF gene transfer to rat ischemic flaps.

    PubMed

    Wang, Xiao Tian; Avanessian, Bella; Ma, Qiangzhong; Durfee, Heather; Tang, Yu Qing; Liu, Paul Y

    2011-01-01

    Necrosis of surgically transferred flaps due to ischemia is a serious wound problem. We evaluated the improvement of flap survival and changes in angiogenic gene expression profiles after transfer of the VEGF gene by means of adeno-associated virus type 2 (AAV2) vector to rat ischemic flaps. Thirty rats were divided into one experimental group, one AAV2-GFP group, and one saline group. AAV2-VEGF or AAV2-GFP were injected intradermally into the rat dorsum in the AAV2-VEGF or AAV2-GFP group. The saline group received saline injection. A 3 × 10 cm flap was raised in each rat two weeks post-injection. One week after surgery, flap viability was evaluated. Angiogenesis real-time PCR array was performed to analyze the expression of angiogenesis-associated genes. The AAV2-VEGF treatment significantly improved flap survival (p<0.05). Immunohistochemical staining showed increased VEGF expression in AAV2-VEGF treated flaps. The PCR array identified remarkable changes in 6 out of the 84 angiogenesis-associated genes in AAV2-VEGF treated flaps. Particularly, EGF, PDGF-A and VEGF-B genes were up-regulated in these flaps. In contrast, FGF2 gene expression was down-regulated. In conclusion, AAV2-VEGF improves flap survival and affects the expression of a series of endogenous growth factor genes, which likely play critical roles in the enhancement of ischemic flap survival. PMID:21649787

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

    SciTech Connect

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

    1985-08-01

    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.

  1. Free fibula osteocutaneous flap with soleus muscle as a chimeric flap for reconstructing mandibular segmental defect after oral cancer ablation.

    PubMed

    Kuo, Yur-Ren; Shih, Hsiang-Shun; Chen, Chien-Chang; Boca, Radovan; Hsu, Yao-Chung; Su, Chih-Ying; Jeng, Seng-Feng; Wei, Fu-Chan

    2010-06-01

    In some cases, the fibula osteocutaneous flap may not provide sufficient soft tissue for obliterating dead space after tumor ablation. This report describes a modified fibula osteocutaneous flap using a portion of soleus muscle to reduce postoperative complications. This study analyzed 20 patients who underwent ablative oral cancer surgery with mandibular segmental defect between September 2005 and June 2007. Of total, 17 cases were mandible complex defects and 3 were composite defects. Of total, 18 were men and 2 were women, respectively. Age range was 30 to 74 years, and mean age was 53 years. The procedure entailed harvest of chimeric fibula flap with skin paddle and bone segment composed of a sheet of soleus muscle (7 x 4 to 12 x 5 cm in size) originating from the perforator branch of the peroneal artery. The soleus muscle was used to obliterate the dead space of the mouth floor and cheek-neck area. All flaps survived except 1 failure due to venous insufficiency. The submandibular and chin area exhibited mild swelling at the submandibular area early postoperatively. Patients had achieved satisfactory contour without donor site morbidity at a mean 12-months of follow-up. Complications included 2 flaps requiring reoperation due to the flap pedicle compromised. One flap was successfully salvaged but the other failed. Two cases of orocutaneous fistula-induced infection recovered after conservative treatment. Donor site assessment revealed a satisfactory outcome without major donor site morbidity. This refinement in mandibular reconstructive surgery substantially reduces postoperative complications.

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

    PubMed

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

    2014-01-01

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

  3. Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession.

    PubMed

    Rath, Avita; Varma, Smrithi; Paul, Renny

    2016-01-01

    Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries. The regeneration of a new connective tissue attachment to denuded root surface is by allowing the selective coronal regrowth of periodontal ligament cells while excluding the gingival tissues from the root during wound healing by means of a barrier membrane. Case Presentation. This case reports a two-stage surgical technique for treatment of Miller's class III defect using free gingival autograft and type I absorbable collagen membrane (BioMend®, Zimmer Dental, USA)(§). Conclusions. The 6-month follow-up of the case showed a significant increase in attached gingiva suggesting it as a predictable alternative in the treatment of Millers class III defects. PMID:27525131

  4. Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession

    PubMed Central

    Paul, Renny

    2016-01-01

    Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries. The regeneration of a new connective tissue attachment to denuded root surface is by allowing the selective coronal regrowth of periodontal ligament cells while excluding the gingival tissues from the root during wound healing by means of a barrier membrane. Case Presentation. This case reports a two-stage surgical technique for treatment of Miller's class III defect using free gingival autograft and type I absorbable collagen membrane (BioMend®, Zimmer Dental, USA)§. Conclusions. The 6-month follow-up of the case showed a significant increase in attached gingiva suggesting it as a predictable alternative in the treatment of Millers class III defects. PMID:27525131

  5. Effect of intraoperative platelet-rich plasma and fibrin glue application on skin flap survival.

    PubMed

    Findikcioglu, Fulya; Findikcioglu, Kemal; Yavuzer, Reha; Lortlar, Nese; Atabay, Kenan

    2012-09-01

    The experiment was designed to compare the effect of intraoperative platelet-rich plasma (PRP) and fibrin glue application on skin flap survival. In this study, bilateral epigastric flaps were elevated in 24 rats. The right-side flaps were used as the control of the left-side flaps. Platelet-rich plasma, fibrin glue, and thrombin had been applied under the flap sites in groups 1, 2, and 3, respectively. Five days later, all flap pedicles were ligated. Necrotic area measurements, microangiography, and histologic and immunohistochemical evaluations were performed to compare the groups. Platelet-rich plasma reduced necrotic area percentages as compared with other groups. Histologically and microangiographically increased number of arterioles were observed in PRP groups. Thrombin when used alone increased flap necrosis. Vascular endothelial growth factor, platelet-derived growth factor, and transforming growth factor β3 primary antibody staining showed increased neovascularization and reepithelialization in all PRP-applied flaps. This study demonstrated that PRP, when applied intraoperatively under the skin flap, may enhance flap survival. Thrombin used alone was found to be unsuitable in flap surgery.

  6. [The abdominal drop flap].

    PubMed

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

    2015-08-01

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

  7. Flapping of Insectile Wings

    NASA Astrophysics Data System (ADS)

    Huang, Yangyang; Kanso, Eva

    2015-11-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. Yet the effects of muscle stiffness on the performance of insect wings remain unclear. Here, we construct an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring and submerged in an oscillatory flow. The wing system is free to rotate and flap. We first explore the extent to which the flyer can withstand roll perturbations, then study its flapping behavior and performance as a function of spring stiffness. We find an optimal range of spring stiffness that results in large flapping amplitudes, high force generation and good storage of elastic energy. We conclude by conjecturing that insects may select and adjust the muscle spring stiffness to achieve desired movement. These findings may have significant implications on the design principles of wings in micro air-vehicles.

  8. Versatility of the buccinator myomucosal flap in atypical palate reconstructions.

    PubMed

    Franco, Diogo; Rocha, Diógenes; Arnaut, Marcio; Freitas, Renato; Alonso, Nivaldo

    2014-10-01

    Initially described for the treatment of cleft palate, the anatomical bases of the buccinator myomucosal flap were described by Bozola et al. (1989). A meticulous search found several reports of its use for the correction of post-palatoplasty oronasal fistulas, with only a few reports of its use for other palate-related pathologies. A retrospective analysis was undertaken of patients treated by the Plastic Surgery Units at the Rio de Janeiro Federal University Hospital (HU-UFRJ) and the São Paulo University Hospital (HC-USP), suffering from palatal lesions not associated with a cleft palate and treated through the use of buccinator myomucosal flaps. The average age was 47 years, with 70% of the patients being male. Assorted aetiologies were noted for palatal defects. When there was significant damage to the soft palate, a superior base pharyngeal flap was used. Of this total, in 71% of the cases only the buccinator myomucosal flap was used. In all cases, the flaps were unilateral, adequately covering the defects in question. The buccinator myomucosal flap is a good option for reconstructing medium to large palate defects, as it is a flap with good vascularization and dimension, in addition to an ample arc of rotation, with primary closure of the donor site, without adding significant morbidity.

  9. Control of Flap Vortices

    NASA Technical Reports Server (NTRS)

    Greenblatt, David

    2005-01-01

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

  10. Blowing Flap Experiment: PIV Measurements

    NASA Technical Reports Server (NTRS)

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

    2004-01-01

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

  11. Latissimus Dorsi Flap Invasion by Ductal Breast Carcinoma after Lipofilling

    PubMed Central

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

    2013-01-01

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

  12. [Fundamentals and principles of grafts and flaps].

    PubMed

    Cruz-Navarro, Natalio; León-Dueñas, Eduardo

    2014-01-01

    Reconstructive surgery of large urethral stenosis and the management of congenital anomalies such as hypospadias and epispadias require covering large cutaneous and mucosal defects with different techniques. The objective of this work is to define the main differences between tissues to be transferred and to study the principles that must govern the management of the various flaps and grafts used for these techniques. We analyze the anatomical and physiological features that may be key to understand the success and possible failures of these procedures, and we review technical details that must accompany in every case, not only during the operation, but also during the preoperative and postoperative period. We conclude stating that grafts (mainly oral and preputial mucosa) and flaps are increasingly used for the repair of urethral stenosis. Grafts must be prepared adequately in the back table and thinned to the maximum, and also be fixed properly, to guarantee their immobility until neovascularization is assured.

  13. Flap Endonuclease 1

    PubMed Central

    Balakrishnan, Lata; Bambara, Robert A.

    2013-01-01

    First discovered as a structure-specific endonuclease that evolved to cut at the base of single-stranded flaps, flap endonuclease (FEN1) is now recognized as a central component of cellular DNA metabolism. Substrate specificity allows FEN1 to process intermediates of Okazaki fragment maturation, long-patch base excision repair, telomere maintenance, and stalled replication fork rescue. For Okazaki fragments, the RNA primer is displaced into a 5′ flap and then cleaved off. FEN1 binds to the flap base and then threads the 5′ end of the flap through its helical arch and active site to create a configuration for cleavage. The threading requirement prevents this active nuclease from cutting the single-stranded template between Okazaki fragments. FEN1 efficiency and specificity are critical to the maintenance of genome fidelity. Overall, recent advances in our knowledge of FEN1 suggest that it was an ancient protein that has been fine-tuned over eons to coordinate many essential DNA transactions. PMID:23451868

  14. Flap prefabrication and prelamination with tissue-engineered cartilage.

    PubMed

    Staudenmaier, Rainer; Hoang, T Nguyen; Kleinsasser, Norbert; Schurr, Christian; Frölich, Kathrin; Wenzel, Magdalene M; Aigner, Joachim

    2004-10-01

    In reconstructive surgery, the integration of tissue-engineered cartilage in a prefabricated free flap may make it possible to generate flaps combining a variety of tissue components, to meet the special requirements of particular defects. One aim of the present study was to investigate prefabrication of a microvascular free flap by implanting a vessel loop under a skin flap in a rabbit model. A second aim was to report on the authors' preliminary experiences in prelaminating prefabricated flaps with autologous tissue-engineered cartilage, in terms of matrix development, inflammatory reaction, and host-tissue interaction. The flap was prefabricated by implanting a vessel loop under a random-pattern abdominal skin flap. The tissue-engineered cartilage constructs were made by isolating chondrocytes from auricular biopsies. Following a period of amplification, the cells were seeded onto a non-woven scaffold made of a hyaluronic-acid derivative and cultivated for 2 weeks. One cell-biomaterial construct was placed beneath the prefabicated flap, and two additional constructs were placed subcutaneously and intramuscularly. In addition, a biomaterial sample without cells was placed subcutaneously to provide a control. All implanted specimens were left in position for 6 or 12 weeks. Neovascularization in the prefabricated flap and biomaterial construct was analyzed by angiography. After explantation, the specimens were examined by histologic and immunohistochemical methods. The prefabricated flaps showed a well-developed network of blood vessels between the implanted vessel loop and the original random-pattern blood supply. The tissue-engineered constructs remained stable in size and showed signs of tissue similar to hyaline cartilage, as evidenced by the expression of cartilage-specific collagen type II and proteoglycans. No inflammatory reactions were observed. The physiologic environment of the autologous rabbit model provided favorable conditions for matrix deposition

  15. Pectoralis major myocutaneous flap in head and neck reconstruction: An experience in 100 consecutive cases

    PubMed Central

    Tripathi, Mayank; Parshad, Sanjeev; Karwasra, Rajender Kumar; Singh, Virender

    2015-01-01

    Background: The pectoralis major myocutaneous (PMMC) flap has been used as a versatile and reliable flap since its first description by Ariyan in 1979. In India head and neck cancer patients usually present in the advanced stage making PMMC flap a viable option for reconstruction. Although free flap using microvascular technique is the standard of care, its use is limited by the availability of expertise and resources in developing world. The aim of this study is to identify the outcomes associated with PMMC flap reconstruction. Patients and Methods: After ethical approval we retrospectively analyzed 100 PMMC flap at a tertiary care hospital from 2006 to 2013. A total of 137 PMMC flap reconstructions were performed out of which follow-up data of 100 cases were available in our record. Results: A total of 100 patients were reviewed of these 86% were of oral cavity and oropharyngeal lesions, 8% were of hypopharyngeal, 3% were of laryngeal malignancies and 3 cases were of salivary gland tumor. Most tumors (83%) were advanced (T3 or T4 lesion). 95 PMMC flap reconstruction were done as a primary procedure, and 5 were salvage procedure. PMMC flap was used to cover mucosal defect in 84 patients, skin defects in 10 patient and both in 6 patients. Overall flap related complications were 40% with a major complication in 10% and minor complications in 30%. No total flap loss occurred in any patient, major flap occurred in 6% and minor flap loss in 12%. In minor flap loss patients, necrotic changes were mostly limited to skin. Orocutaneous and pharyngocutaneous fistula developed in 12 patients. 10% patients required re-surgery after developing various flap related complications Pleural empyema developed in 3 patients. Other minor complications such as neck skin dehiscence and intra-oral flap dehiscence developed in 26 patients. Conclusion: PMMC flap is a versatile flap with an excellent reach to face oral cavity and neck region. With limited expertise and resources, it is

  16. [Tumor surgery].

    PubMed

    Hausamen, J E

    2000-05-01

    Surgery is still the primary therapeutic approach in treatment of tumors in the head and neck area, dating back to the early nineteenth century. More than 150 years ago, hemimaxillectomies and mandibular resections as well as hemiglossectomies were already performed by leading surgeons. The block principle we are now following dates back to Crile, who also established the principle of cervical lymph node dissection. Ablative oncologic surgery has always been closely linked with plastic and reconstructive surgery, rendering radical surgical interventions possible without disfiguring patients. The development of facial reconstructive surgery proceeded in stages, in the first instance as secondary reconstruction using tube pedicled flaps. The change to the concept of primary reconstruction occurred via arterialized skin flaps and myocutaneous flaps to the widely accepted and performed free tissue transfer. Free bone grafting, inaugurated earlier and still representing the majority of bone grafting, has been supplemented for certain reconstructive purposes by free vascularized bone transfer from various donor sites. Although the five-year-survival rate of carcinoma of the oral cavity has remained unchanged in the past 30 years, distinctive improvements in tumor surgery can be recorded. This is primarily based on improved diagnostics such as modern imaging techniques and the refinement of surgical techniques. The DOSAK has worked out distinctive guidelines for effective ablative oncologic surgery. Surgical approaches offering wide exposure and carrying low morbidity play a decisive role in radical resections. For this reason, midfacial degloving offers an essential improvement for the resection of midface tumors, especially from an aesthetic point of view. Tumors situated deep behind the viscerocranium at the skull base can be clearly exposed either through a lateral approach following a temporary osteotomy of the mandibular ramus or a transmandibular, transmaxillar, or

  17. Total lower lip reconstruction using sensate composite radial forearm flap.

    PubMed

    Ozdemir, Ragip; Ortak, Turgut; Koçer, Uğur; Celebioğlu, Selim; Sensöz, Omer; Tiftikcioglu, Yigit Ozer

    2003-05-01

    In modern plastic and reconstructive surgery, shape and function must be considered together. These are the most important goals of any operation. There are a lot of techniques that have been reported for total lower lip reconstruction. It is believed that the radial forearm flap is the most suitable technique for lower lip and chin reconstruction after tumor excision so as to achieve better shape and functional results. The sensate radial forearm-palmaris longus free flap was used for total lower lip reconstruction in 17 patients with lower lip carcinoma with a mean age of 51 years. Two of the patients were female, and 15 were male. All the patients had squamous cell carcinoma. The patients were followed up for 1 to 3 years. Complications of these operations were partial superficial flap loss in 1 patient, partial graft loss in the donor areas of two flaps, and infection in only 1 patient. Wound dehiscence, fistula formation, suture abscesses, or sialocele was not seen in any patient. In this study, the aim was to demonstrate that the sensate radial forearm flap could produce acceptable esthetic results, good sphincteric function, and sensation in the early period after surgery. PMID:12826811

  18. Local Flaps of The Hand

    PubMed Central

    Rehim, Shady A.; Chung, Kevin C.

    2014-01-01

    Synopsis A local flap consists of skin and subcutaneous tissue that is harvested from a site nearby a given defect while maintaining its intrinsic blood supply. When a soft tissue defect of the hand is not amenable to primary closure or skin grafting, local skin flaps can be a used as a reliable source of soft tissue replacement that replaces like with like. Flaps are categorized based on their composition, method of transfer, flap design and blood supply, yet flap circulation is considered the most critical factor for the flap survival. This article reviews the classification of local skin flaps of the hand and offers a practical reconstructive approach for several soft tissue defects of the hand and digits. PMID:24731606

  19. Noise Reduction of Aircraft Flap

    NASA Technical Reports Server (NTRS)

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

    2009-01-01

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

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

    PubMed

    Jevtović, Dobrica; Dordević, Boban; Gacević, Milomir; Sijan, Goran

    2002-01-01

    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

  1. Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap

    PubMed Central

    Sawant, Ajit; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin; Bansal, Sumit; Kapadnis, Lomesh; Savalia, Abhishek

    2016-01-01

    Introduction Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss. Aim Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap. Materials and Methods Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue. Results Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation. Conclusion Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in

  2. Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap

    PubMed Central

    Sawant, Ajit; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin; Bansal, Sumit; Kapadnis, Lomesh; Savalia, Abhishek

    2016-01-01

    Introduction Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss. Aim Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap. Materials and Methods Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue. Results Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation. Conclusion Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in

  3. The Deltopectoral Flap Revisited: The Internal Mammary Artery Perforator Flap.

    PubMed

    Ibrahim, Amir; Atiyeh, Bishara; Karami, Reem; Adelman, David M; Papazian, Nazareth J

    2016-03-01

    Pharyngo-esophageal and tracheostomal defects pose a challenge in head and neck reconstruction whenever microanastomosis is extremely difficult in hostile neck that is previously dissected and irradiated. The deltopectoral (DP) flap was initially described as a pedicled flap for such reconstruction with acceptable postoperative results. A major drawback is still that the DP flap is based on 3 perforator vessels leading to a decreased arc of rotation. The DP flap also left contour deformities in the donor site. The internal mammary artery perforator flap was described as a refinement of the deltopectoral flap. It is a pedicled fasciocutaneous flap based on a single perforator, with comparable and reliable blood supply compared with the DP flap, giving it the benefit of having a wide arc of rotation. It is both thin and pliable, with good skin color match and texture. The donor site can be closed primarily with no esthetic deformity and minimal morbidity. The procedure is relatively simple and does not require microvascular expertise. In this report, the authors describe a patient in whom bilateral internal mammary artery perforator flaps were used for subtotal pharyngo-esophageal reconstruction and neck resurfacing. The flaps healed uneventfully bilaterally with no postoperative complications. PMID:26854779

  4. Periosteal Pedicle Flap Harvested during Vestibular Extension for Root Coverage.

    PubMed

    Kumar, Shubham; Gupta, Krishna Kumar; Agrawal, Rahul; Srivastava, Pratima; Soni, Shalabh

    2015-01-01

    Root exposure along with inadequate vestibular depth is a common clinical finding. Treatment option includes many techniques to treat such defects for obtaining predictable root coverage. Normally, the vestibular depth is increased first followed by a second surgery for root coverage. The present case report describes a single-stage technique for vestibular extension and root coverage in a single tooth by using the Periosteal Pedicle Flap (PPF). This technique involves no donor site morbidity and allows for reflection of sufficient amount of periosteal flap tissue with its own blood supply at the surgical site, thus increasing the chances of success of root coverage with simultaneous increase in vestibular depth. PMID:26788377

  5. Hand Allograft Saved by an Ultrathin Groin Flap

    PubMed Central

    Château, Joseph; Gazarian, Aram; Boucher, Fabien; Badet, Lionel; Braye, Fabienne; Saint-Cyr, Michel

    2016-01-01

    Summary: We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery. To our knowledge, this is the only case of an upper extremity allotransplant salvaged by a pedicled flap. PMID:27757334

  6. Nasolabial Flap in Maxillofacial Gunshot Trauma: A Case Series

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2016-01-01

    Introduction The nasolabial flap (NLF) has many advantages in oromaxillary reconstruction, but the majority of cases are reconstructions after pathologic resections. Its usage in trauma surgery, especially in the management of gunshot wounds, is rarely mentioned. Case Presentation Three cases involving gunshot injuries to the face are presented: one for reconstruction of the nasal ala, another for bone graft coverage in mandibular reconstruction, and the third for the repair of premaxillary hard and soft tissue avulsive defects. Conclusions The NLF is a thin, pliable flap and is useful for intraoral and facial reconstruction of trauma patients with small to moderate soft tissue loss. PMID:27148497

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

    PubMed Central

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

    2014-01-01

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

  8. Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State.

    PubMed

    Kang, Jin Seok; Choi, Hwan Jun; Tak, Min Sung

    2016-06-01

    Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed.

  9. Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

    PubMed Central

    Lu, Mingxing; Hu, Qingang; Tang, Enyi; Wang, Yujia

    2015-01-01

    Background To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap. Material and Methods The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery. Results Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05). Conclusions Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity. PMID:26449437

  10. Functional sensory function recovery of random-pattern abdominal skin flap in the repair of fingertip skin defects

    PubMed Central

    YU, YA-DONG; ZHANG, YING-ZE; BI, WEI-DONG; WU, TAO

    2013-01-01

    The fingertip skin defect is a common hand injury often accompanied by tendon or bone exposure, and is normally treated with flaps. The aim of this study was to evaluate the functional sensory recovery of random-pattern abdominal skin flap in the repair of fingertip cutaneous deficiency. A total of 23 patients, aged between 18 and 50 years (mean age, 31 years) with fingertip cutaneous deficiency (30 digits) were treated with random-pattern abdominal skin flaps. The post-debridement defect area measured from 0.7×1.2 to 2.5×3 cm. The flap pedicle was divided three weeks after surgery, which marked the onset of the second stage. A second surgery was performed on 2 patients after 3 months and on another set of 2 patients after 6 months to create a thinner flap. Tissue was dissected during surgery for a histological examination. All the flaps survived and the post-operative follow-up ranged from 2 weeks to 6 months. Patients were satisfied with the appearance of their fingers and the flaps. All flaps demonstrated satisfactory flexibility and texture and sensory recovery was achieved. Only 4 patients were subjected to a second surgery to make the flap thinner. The flaps for the 3-month tissue section had several low-density, free nerve endings, whereas those of the 6-month section had more intensive free nerve endings, nerve tracts, tactile cells and lamellar corpuscles. Random-pattern abdominal skin flap therefore repairs fingertip skin defects achieving sensory recovery. PMID:23403483

  11. Flexible Flapping Foils

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

    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.

  12. Acute effects of cigarette smoke exposure on experimental skin flaps

    SciTech Connect

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

    1985-04-01

    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.

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2014-10-01

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

  15. Engineered Vascularized Muscle Flap.

    PubMed

    Egozi, Dana; Shandalov, Yulia; Freiman, Alina; Rosenfeld, Dekel; Ben-Shimol, David; Levenberg, Shulamit

    2016-01-01

    One of the main factors limiting the thickness of a tissue construct and its consequential viability and applicability in vivo, is the control of oxygen supply to the cell microenvironment, as passive diffusion is limited to a very thin layer. Although various materials have been described to restore the integrity of full-thickness defects of the abdominal wall, no material has yet proved to be optimal, due to low graft vascularization, tissue rejection, infection, or inadequate mechanical properties. This protocol describes a means of engineering a fully vascularized flap, with a thickness relevant for muscle tissue reconstruction. Cell-embedded poly L-lactic acid/poly lactic-co-glycolic acid constructs are implanted around the mouse femoral artery and vein and maintained in vivo for a period of one or two weeks. The vascularized graft is then transferred as a flap towards a full thickness defect made in the abdomen. This technique replaces the need for autologous tissue sacrifications and may enable the use of in vitro engineered vascularized flaps in many surgical applications. PMID:26779840

  16. The Versatile Modiolus Perforator Flap

    PubMed Central

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    Background: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our experience using freestyle facial perforator flaps, we have located areas where perforators are consistently found. This study is focused on a particular perforator lateral to the angle of the mouth; the modiolus and the versatile modiolus perforator flap. Methods: A cohort case series of 14 modiolus perforator flap reconstructions in 14 patients and a color Doppler ultrasonography localization of the modiolus perforator in 10 volunteers. Results: All 14 flaps were successfully used to reconstruct the defects involved, and the location of the perforator was at the level of the modiolus as predicted. The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps based on it can be recommended for several indications from the reconstruction of defects in the perioral area, cheek and nose. Conclusions: The modiolus is a well-described anatomical area containing a sizeable perforator that is consistently present and readily visualized using color Doppler ultrasonography. We have used the modiolus perforator flap successfully for several indications, and it is our first choice for perioral reconstruction. PMID:27257591

  17. Flag flapping in a channel

    NASA Astrophysics Data System (ADS)

    Alben, Silas; Shoele, Kourosh; Mittal, Rajat; Jha, Sourabh; Glezer, Ari

    2015-11-01

    We study the flapping of a flag in an inviscid channel flow. We focus especially on how quantities vary with channel spacing. As the channel walls move inwards towards the flag, heavier flags become more unstable, while light flags' stability is less affected. We use a vortex sheet model to compute large-amplitude flapping, and find that the flag undergoes a series of jumps to higher flapping modes as the channel walls are moved towards the flag. Meanwhile, the drag on the flag and the energy lost to the wake first rise as the walls become closer, then drop sharply as the flag moves to a higher flapping mode.

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

    NASA Astrophysics Data System (ADS)

    Wen, Quan; Gao, Jean

    2005-04-01

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

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

    PubMed

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

    2015-02-01

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

  20. Incisions for cochlear implant flaps and superficial skin temperature. Skin temperature/blood circulation in CI flaps.

    PubMed

    Pau, Hans Wilhelm; Sievert, Uwe; Graumüller, Sylke; Wild, Ernst

    2004-01-01

    Healing and integration of a cochlear implant is largely influenced by good blood circulation in the covering skin, which, on the other hand, is closely correlated to skin temperature. Measuring superficial flap temperatures by thermography is an easy way to get some clues about the corresponding blood supply. These data should allow some implications for the design of skin flaps in cochlear implant surgery. In 15 patients thermography was carried out prior to and after cochlear implantation, using the Agema 550 Thermovision system. It was evident, that the anatomic courses of the major superficial arteries were represented by areas of increased temperature. The pattern of temperature distribution may allow some conclusions concerning site and shape of surgical incisions. From our data we concluded, that most types of incisions do not interfere too much with the arterial blood supply. However, some types like the extended retroauricular C-incision may eventually cause problems. Our data suggest, that the straight or slightly curved vertical retroauricular incision causes the least impairment of blood circulation. After surgery, directly along the incisions (and later along the scars) temperature was diminished, indicating reduced blood circulation. In our series, the thickness of the implant did not impede blood circulation significantly. So far, we could not examine patients with local circulation disorders. Probably local scars, skin atrophies, angiopathies etc. may present typical patterns of temperature distribution, which require individual design of skin flaps. Thermography is an easy method which can give impressions of local blood circulation in skin flaps. If the courses of the major arteries and their branches are respected, blood circulation within the flap should not be problematic. Thermography is likely to help designing optimal flaps in cases with impeded blood circulation e.g. by pre-existing scar formations.

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

    PubMed Central

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

    2012-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Brooks, THomas F.

    2005-01-01

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

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

    PubMed

    Batra, R K; Aseeja, Veena

    2014-04-01

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

  4. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction.

    PubMed

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-10-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps. We performed 148 reconstructions in 130 patients. Eleven facial reconstructions, 118 reconstructions in the body, 7 in the upper limbs, and 12 in the lower limbs. The propeller flap was used in 135 of 148 (91%) cases followed by the turnover design in 10 (7%) and the V to Y flap in 3 (2%) cases. The flaps were raised on 1 perforator in 98 (67%), 2 perforators in 48 (33%), and 3 perforators in 2 (1%) flaps. The reconstructive goal was achieved in 143 of 148 reconstructions (97%). In 5 cases, surgical revision was needed. No flaps were totally lost indicating a patent pedicle in all cases. We had 10 (7%) cases of major complications and 22 (15%) minor complications. The CDU-targeted perforator mapping and angiosome-based flap reconstruction are simple to perform, and we recommended its use for freestyle perforator flap reconstruction. All perforators selected by CDU was identified during surgery and used for reconstruction. The safe boundaries of angiosomes remain to be established.

  5. Color Doppler Ultrasonography-Targeted Perforator Mapping and Angiosome-Based Flap Reconstruction.

    PubMed

    Gunnarsson, Gudjon Leifur; Tei, Troels; Thomsen, Jørn Bo

    2016-10-01

    Knowledge about perforators and angiosomes has inspired new and innovative flap designs for reconstruction of defects throughout the body. The purpose of this article is to share our experience using color Doppler ultrasonography (CDU)-targeted perforator mapping and angiosome-based flap reconstruction throughout the body. The CDU was used to identify the largest and best-located perforator adjacent to the defect to target the reconstruction. The cutaneous or fasciocutaneous flaps were raised, mobilized, and designed according to the reconstructive needs as rotation, advancement, or turnover flaps. We performed 148 reconstructions in 130 patients. Eleven facial reconstructions, 118 reconstructions in the body, 7 in the upper limbs, and 12 in the lower limbs. The propeller flap was used in 135 of 148 (91%) cases followed by the turnover design in 10 (7%) and the V to Y flap in 3 (2%) cases. The flaps were raised on 1 perforator in 98 (67%), 2 perforators in 48 (33%), and 3 perforators in 2 (1%) flaps. The reconstructive goal was achieved in 143 of 148 reconstructions (97%). In 5 cases, surgical revision was needed. No flaps were totally lost indicating a patent pedicle in all cases. We had 10 (7%) cases of major complications and 22 (15%) minor complications. The CDU-targeted perforator mapping and angiosome-based flap reconstruction are simple to perform, and we recommended its use for freestyle perforator flap reconstruction. All perforators selected by CDU was identified during surgery and used for reconstruction. The safe boundaries of angiosomes remain to be established. PMID:27387469

  6. Comparison of corneal flaps created by Wavelight FS200 and Intralase FS60 femtosecond lasers

    PubMed Central

    Liu, Qian; Zhou, Yue-Hua; Zhang, Jing; Zheng, Yan; Zhai, Chang-Bin; Liu, Jing

    2016-01-01

    AIM To assess and compare the morphology of corneal flaps created by the Wavelight FS200 and Intralase FS60 femtosecond lasers in laser in situ keratomileusis (LASIK). METHODS Four hundred eyes of 200 patients were enrolled in this study and divided into Wavelight FS200 groups (200 eyes) and Intralase FS60 groups (200 eyes). Fourier-domain optical coherence tomography (RTVue OCT) was used to measure the corneal flap thickness of 36 specified measurements on each flap one week after surgery. Results were used to analyze the regularity, uniformity and accuracy of the two types of LASIK flaps. RESULTS The mean thickness of corneal flap and central flap was 105.71±4.72 µm and 105.39±4.50 µm in Wavelight FS200 group and 109.78±11.42 µm and 109.15 ±11.59 µm in Intralase FS60 group, respectively. The flaps made with the Wavelight FS200 femtosecond laser were thinner than those created by the Intralase FS60 femtosecond laser (P=0.000). Corneal flaps in the 2 groups were uniform and regular, showing an almost planar configuration. But the Wavelight FS200 group has more predictability and uniformity of flap creation. The mean deviation between achieved and attempted flap thickness was smaller in the Wavelight FS200 group than that in the Intralase FS60 group, which were 5.18±3.71 µm and 8.68±7.42 µm respectively. The deviation of more than 20 µm was 0.2% measurements in Wavelight FS200 group and 8.29% measurements in Intralase FS60 group. CONCLUSION The morphologies of flaps created by Wavelight FS200 are more uniform and thinner than those created by Intralase FS60. PMID:27500109

  7. Reconstruction of Large Defects in the Perineal Area Using Multiple Perforator Flaps

    PubMed Central

    Sung, Ki Wook; Lee, Won Jai; Yun, In Sik

    2016-01-01

    Background Perineal defects are commonly encountered during the treatment of conditions such as malignancy, infectious disease, and trauma. Covering large defects in the perineal area is challenging due to its complicated anatomy and the need for functional preservation. Methods Fourteen patients who underwent reconstructive surgery with multiple perforator flaps for defects >100 cm2 in the perineal area were included in this retrospective cohort study. Characteristics of the perforator flap operation and postoperative outcomes were reviewed. Results Reconstruction was performed using 2 perforator flaps for 13 patients and 3 perforator flaps for 1 patient. Internal pudendal artery perforator flaps were mainly used for covering the defects. The average defect size was 176.3±61.8 cm2 and the average size of each flap was 95.7±31.9 cm2. Six patients had minor complications, such as wound dehiscence and partial necrosis of the flap margin, which were corrected with simple revision procedures. Conclusions Multiple perforator flaps can be used to achieve successful reconstructions of large perineal defects that are difficult to reconstruct with other coverage methods. PMID:27689052

  8. Obesity Should Not Prevent from TRAM Flap Breast Reconstruction in Developing Countries.

    PubMed

    Alipour, Sadaf; Omranipour, Ramesh; Akrami, Rahim

    2015-12-01

    Transverse rectus abdominis musculocutaneous (TRAM) flap is the most common procedure performed for breast reconstruction after mastectomy for breast cancer. Obesity is a relative contraindication, and complex modifications have been proposed in the pedicled technique for obese patients. We studied ischemic complications in our patients to investigate the effect of body weight on the outcome of TRAM flap breast reconstruction. Pertinent data from medical records of patients receiving a TRAM flap surgery from 1986 to 2011 were extracted. Patients were divided into three groups based on the body mass index (BMI): normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (>30 kg/m(2)). Flap necrosis is defined as any visible nonviable tissue in the reconstructed breast. It was observed that 117 patients had received TRAM flap reconstruction. Fifty-eight patients were excluded. Of the remaining 59 cases, 24 had normal BMI, 21 were overweight, and 14 were obese. No patient was found to develop flap necrosis. Outcome of TRAM flap breast reconstruction in obese patients is similar to nonobese patients. No major necrosis in need of reoperation was identified in the studied obese patients. It was concluded that categorizing obesity as a relative contraindication to TRAM flap breast reconstruction should be revisited based on larger cohort studies. PMID:26730022

  9. Reconstruction of Large Defects in the Perineal Area Using Multiple Perforator Flaps

    PubMed Central

    Sung, Ki Wook; Lee, Won Jai; Yun, In Sik

    2016-01-01

    Background Perineal defects are commonly encountered during the treatment of conditions such as malignancy, infectious disease, and trauma. Covering large defects in the perineal area is challenging due to its complicated anatomy and the need for functional preservation. Methods Fourteen patients who underwent reconstructive surgery with multiple perforator flaps for defects >100 cm2 in the perineal area were included in this retrospective cohort study. Characteristics of the perforator flap operation and postoperative outcomes were reviewed. Results Reconstruction was performed using 2 perforator flaps for 13 patients and 3 perforator flaps for 1 patient. Internal pudendal artery perforator flaps were mainly used for covering the defects. The average defect size was 176.3±61.8 cm2 and the average size of each flap was 95.7±31.9 cm2. Six patients had minor complications, such as wound dehiscence and partial necrosis of the flap margin, which were corrected with simple revision procedures. Conclusions Multiple perforator flaps can be used to achieve successful reconstructions of large perineal defects that are difficult to reconstruct with other coverage methods.

  10. Flap-Edge Blowing Experiments

    NASA Technical Reports Server (NTRS)

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

    2003-01-01

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

  11. Fewer Revisions in Abdominal-based Free Flaps than Latissimus Dorsi Breast Reconstruction after Radiation

    PubMed Central

    Smith, Benjamin D.; Liu, Jun; Robb, Geoffrey L.; Kronowitz, Steven J.; Garvey, Patrick B.

    2016-01-01

    Background: The most commonly chosen flaps for delayed breast reconstruction after postmastectomy radiation therapy (PMRT) are abdominal-based free flaps (ABFFs) and pedicled latissimus dorsi (LD) musculocutaneous flaps. The short-and long-term advantages and disadvantages of delayed ABFFs versus LD flaps after PMRT remain unclear. We hypothesized that after PMRT, ABFFs would result in fewer postoperative complications and a lower incidence of revision surgery than LD flaps. Methods: We retrospectively reviewed a prospectively maintained database of consecutive patients who underwent unilateral, delayed breast reconstruction after PMRT using ABFFs or pedicled LD flaps with implants at the MD Anderson Cancer Center between January 1, 2001, and December 31, 2011. We compared outcomes and additional surgeries required between the 2 groups. Univariate and multivariate logistic regression modeling analyzed the relationships between patient and reconstruction characteristics and postoperative outcomes. Results: A total of 139 consecutive patients’ breast reconstructions were evaluated: 101 ABFFs (72.7%) versus 38 LDs (27.3%). Average follow-up was similar for ABFF and LD reconstructions. Although ABFF and LD reconstructions experienced similar rates of overall (30.7% vs 23.7%, respectively; P = 0.53), donor-site (8.91% vs 5.13%, respectively; P = 0.48), and flap (20.7% vs 17.9%, respectively; P = 0.37) complications, the LD reconstructions required more additional surgeries (92.1% vs 67.3%; P < 0.001). Furthermore, LDs required more revision surgeries more than 1 year after reconstruction (37.1% vs 14.7%; P = 0.02). Conclusion: Although early complication rates were similar for both types of reconstructions, ABFFs seem to have the advantage of providing a more durable result that required fewer revision surgeries in the long term. PMID:27757331

  12. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap interconnection. 23.701 Section 23.701... Systems § 23.701 Flap interconnection. (a) The main wing flaps and related movable surfaces as a system must— (1) Be synchronized by a mechanical interconnection between the movable flap surfaces that...

  13. Radiated noise from an externally blown flap

    NASA Technical Reports Server (NTRS)

    Reddy, N. N.; Yu, J. C.

    1975-01-01

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

  14. Flap Edge Noise Reduction Fins

    NASA Technical Reports Server (NTRS)

    Khorrami, Mehdi R. (Inventor); Choudhan, Meelan M. (Inventor)

    2015-01-01

    A flap of the type that is movably connected to an aircraft wing to provide control of an aircraft in flight includes opposite ends, wherein at least a first opposite end includes a plurality of substantially rigid, laterally extending protrusions that are spaced apart to form a plurality of fluidly interconnected passageways. The passageways have openings adjacent to upper and lower sides of the flap, and the passageways include a plurality of bends such that high pressure fluid flows from a high pressure region to a low pressure region to provide a boundary condition that inhibits noise resulting from airflow around the end of the flap.

  15. A case report of total breast reconstruction using an inframammary adipofascial flap with an implant

    PubMed Central

    Ogawa, Tomoko; Yamakawa, Tomomi

    2016-01-01

    Introduction Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap. Presentation of case The patient was a 27-year-old female with moderate ptotic breasts, who had ductal carcinoma in situ in the lower outer quadrant of her left breast. After NSM through the inframammary fold (IMF) incision, the subcutaneous fat of the intended inframammary area was undermined, and the tongue shaped adipofascial flap was pulled up in the intended area. After inserting a tissue expander under the major pectoral muscle, this adipofascial flap was reflected back to the inferior portion of the breast area. After modeling the breast mound with this flap, the inframammary skin incision was sutured. Eleven months later, the patient underwent surgery to replace the expander with a permanent implant. Eight months after the replacement with an implant, the cosmetic result is good. Discussion This procedure can be performed through the same skin incision on the IMF as NSM. Total breast reconstruction using the inframammary adipofascial flap with an implant can be an alternative approach to achieving symmetry in some patients. Conclusion This method is useful for breast reconstruction after NSM for young patients with moderate-ptotic breasts. PMID:27107500

  16. Effects of Venous Superdrainage and Arterial Supercharging on Dorsal Perforator Flap in a Rat Model

    PubMed Central

    Zheng, Jun; Xi, Shanshan; Ding, Maochao; Li, Hong; Xu, Wei; Tang, Maolin; Chen, Shixin

    2016-01-01

    Objective To comparatively assess the effects of venous superdrainage and arterial supercharging on dorsal perforator flap survival. Materials and Methods Sixty male Sprague-Dawley rats (450–550g) were randomly divided into three groups (n = 20), including control group (Control) and experimental groups A (venous superdrainage, Exp. A) and B (arterial supercharging, Exp. B). At postoperative day 7, survival areas of the flaps were evaluated and all animals underwent angiography. Laser Doppler was used to evaluate flap perfusion from 0h to 7days after surgery. Histology with hematoxylin and eosin staining was used to count microvessels. Tissue of “Choke vessels”was excised for quantification of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) by western blot assay at 6h and 7days after surgery. Results In the Exp. A group, almost all flaps survived (98.2±1.6%); in the Exp. B and control group, survival areas accounted for 78.8±8.5% and 60.3±7.8%, respectively (P <0.001). In addition, Exp. A animals showed improved anastomosis of choke vessels 2 compared with the Exp. B and Control groups. Furthermore, flap blood flow and partial pressure of oxygen in the Exp. A group were significantly higher compared with values obtained for the Exp. B and Control groups, from 6 hours to 7 days after surgery. More microvessels were found in the Exp. A group (11.65±1.33) than in Exp. B (9.25±0.34) and control (7.25±0.91) animals on POD 7. The relative expression level of HIF-1α and VEGF were significant at 6h and 7days after surgery. Conclusions Venous superdrainage in rat dorsal perforator flap is more effective than arterial supercharging in promoting flap survival, and could effectively alter hemodynamics in the microcirculation and stimulate blood vessel formation. PMID:27513520

  17. Etanercept protects myocutaneous flaps from ischaemia reperfusion injury: An experimental study in a rat tram flap model.

    PubMed

    Ersoy, Burak; Çevik, Özge; Çilingir, Özlem Tuğçe

    2016-08-01

    Background Being an inevitable component of free tissue transfer, ischemia-reperfusion injury tends to contribute to flap failure. TNF-α is an important proinflammatory cytokine and a prominent mediator of the ischemia-reperfusion injury. Etanercept, a soluble TNF-α binding protein, has shown anti-inflammatory and anti-apoptotic effects in animal models of renal and myocardial ischemia-reperfusion injury. We have designed an experimental study to investigate the effect of etanercept on myocutaneous ischemia-reperfusion injury on transverse rectus abdominis myocutaneous flap model in rats. Methods Twenty-four male Sprague-Dawley rats were divided into 3 groups: In group 1 (sham), the TRAM flap was raised and sutured back without further intervention. In group 2 (control), the flap was raised and the ischemia-reperfusion protocol was followed. In group 3, etanercept (10 mg/kg, i.v.) was administered 10 minutes before reperfusion. At the end of the reperfusion period, biochemical and histolopathological evaluations were performed on serum and tissue samples. Results In the etanercept group the IMA and 8-OHdG levels (p = 0.005 and p = 0.004, respectively) were found significantly lower, and the GSH and SOD levels (p = 0.01 and p < 0.001, respectively) significantly higher in comparison to the control group. The histopathological analysis has revealed a lower degree of hyalinization, degenerated muscle fibers and nuclear change in the etanercept group compared to the control group. Conclusion The results of our experimental study indicate that etanercept offers protection against ischemia-reperfusion injury in skeletal muscle tissue, enhancing the TRAM flap viability. The ability of etanercept to induce ischemic tolerance suggests that it may be applicable in free-flap surgery. PMID:26950289

  18. Robotic-assisted ureteral reimplantation with Boari flap and psoas hitch: a single-institution experience.

    PubMed

    Yang, Christopher; Jones, Loren; Rivera, Marcelino E; Verlee, Graham T; Deane, Leslie A

    2011-11-01

    Robotic-assisted ureteral reimplantations were performed on 3 patients at a single institution, 2 with Boari flap and psoas hitch and 1 with psoas hitch alone. These were for urothelial carcinoma of the distal ureter, ureteral obstruction caused by distal ureteral endometriosis, and ureteral transaction during gynecologic surgery. We used intraoperative ureteroscopy to confirm tumor margins as well as a simple technique for retrograde placement of transvesicle wire prior to ureteral anastomosis. Surgery and recovery were uneventful. This illustrates that robotic-assisted ureteral reimplantation with Boari flap and psoas hitch is a safe and viable approach for ureterovesicle reconstruction. PMID:21859340

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

    PubMed

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

    2004-08-01

    determined of 100 %), the vessel quantity in the prefabricated flap of the 20-day group had increased to 98.7 %. As a pre-clinical test, prefabricated flaps through arteriovenous pedicle implantation with special advantages can be a new useful method in plastic and reconstructive surgery. PMID:15368146

  20. Full scale upper surface blown flap noise

    NASA Technical Reports Server (NTRS)

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

    1975-01-01

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

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

    PubMed

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

    2014-04-22

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

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

    PubMed Central

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

    2014-01-01

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

  3. Vascularized rotational temporal bone flap for repair of anterior skull base defects: a novel operative technique.

    PubMed

    Zeiler, Frederick A; Kaufmann, Anthony M

    2015-11-01

    Repair of anterior skull base defects with vascularized grafts poses a significant challenge, given the location and small number of adequately sized vessels for free-flap anastomosis. This is particularly the case in the setting of redo surgery or in patients with preexisting soft-tissue trauma. Even more difficult is achieving a vascularized bone flap closure of such bony defects. The authors report a novel technique involving a rotational temporal bone flap with a temporalis muscle vascularized pedicle, which was used to repair an anterior fossa bony and soft-tissue defect created by recurrent malignancy. A 55-year-old man with history of scalp avulsion during a motor vehicle accident, anterior fossa/nasopharyngeal malignant neuroendocrine carcinoma postresection, and bone flap infection presented with a recurrence of his skull base malignancy. The tumor was located in the anterior fossa, extending interhemispherically and down through the cribriform plate, ethmoid air cells, and extending into the nasopharyngeal cavity. Resection of the recurrent tumor was performed. The bony defect in the anterior skull base was repaired with a novel vascularized rotational temporal bone flap, with acceptable separation of the nasopharynx from the intracranial cavity. The vascularized rotational temporal bone flap, in which a temporalis muscle pedicle is used, provides a novel and easily accessible means of vascularized bone closure of anterior skull base defects without the need for microsurgical free-flap grafting.

  4. Inverted Internal Limiting Membrane Flap For Large Traumatic Macular Holes

    PubMed Central

    Abou Shousha, Mohsen Ahmed

    2016-01-01

    Abstract The aim of the study was to assess the role of inverted internal limiting membrane flap as a treatment option for large traumatic macular holes. This is a prospective noncomparative study in which 12 eyes with large traumatic macular holes (basal diameter of 1300–2800 μm) since 3 to 6 months were subjected to standard 23-gauge vitrectomy with removal of the posterior hyaloid, brilliant blue G (BBG)-assisted internal limiting membrane peeling in a circular fashion keeping it attached to the edge of the hole to create a flap. At the end of the surgery, air fluid exchange was done with inversion of the internal limiting membrane flap inside the macular hole using the soft tipped cannula and sulfur hexafluoride 20% as tamponade. The main follow-up measures are the best corrected visual acuity and the optical coherence tomography for 6 to 9 months. All the included eyes had a closed hole from the first week postoperative and along the follow-up period (6–9 months). The best corrected visual acuity improved from 20/2000 to 20/200 with a median of 20/400 preoperatively to 20/400 to 20/50 with a median of 20/100 at the end of follow-up period. Inverted internal limiting membrane flap is a good adjuvant to standard vitrectomy in the management of large traumatic macular holes that led to the 100% closure rate and improvement of best corrected visual acuity. PMID:26817894

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

    PubMed Central

    GRANDI, C.; PACIFICI, L.

    2009-01-01

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

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

    PubMed

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

    2015-07-01

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

  7. Enhancement of venous drainage with vein stripper for reversed pedicled neurocutaneous flaps.

    PubMed

    Sonmez, Erhan; Silistireli, Özlem Karataş; Karaaslan, Önder; Kamburoğlu, Haldun Onuralp; Safak, Tunc

    2013-05-01

    The flaps based on the vascular axis of superficial sensitive cutaneous nerves had gained increased popularity in reconstructive surgery because of such major advantages as preservation of major extremity arteries and avoidance of microsurgical procedures. However, postoperative venous congestion resulting in partial or total necrosis is still a common problem for these flaps. The aim of the current study is to introduce a new method for reducing the postoperative venous congestion of neural island flap with the results of reconstruction of the soft tissue defects of foot and ankle. This method was used to treat 19 patients with various chronic soft tissue defects of the foot and ankle between 2011 and 2012. We observed that the novel method presented in this report enables effective venous drainage, solving the postoperative venous congestion problem of these flaps.

  8. Histological changes in radial forearm skin flaps in the oral cavity.

    PubMed

    Sinclair, A; Johnston, E; Badran, D H; Neilson, M; Soutar, D S; Robertson, A G; McDonald, S W

    2004-04-01

    We reported previously that skin flaps transplanted to the oral cavity in reconstructive surgery for oral cancer frequently acquired the gross appearance of buccal mucosa. The changes were shown to be reactive in nature. The "changed" flaps generally had a heavier infiltration of leukocytes in the dermis and appeared to have thicker epithelium. The present study quantifies these parameters, as well as the numbers of intraepithelial leukocytes. The flaps that had acquired the gross appearance of oral mucosa had significantly thicker epithelium, larger numbers of dermal leukocytes, and more intraepidermal inflammatory cells per unit length than flaps that retained the gross appearance of thin skin. No correlation was found between these changes and radiotherapy. PMID:15042571

  9. The Role of Muscle Flaps for Salvage of Failed Perforator Free Flaps

    PubMed Central

    2015-01-01

    Background: Despite the most heroic efforts, sometimes free flaps fail. Perforator free flaps are not invincible and can suffer the same fate. The real challenge is how to decide what is the next best choice for achieving the desired outcome. Methods: Over the past decade, 298 free perforator flaps were used in our institution. Total failure occurred in 16 patients, and partial failure requiring a second free flap occurred in an additional 6 patients for a true success rate of 93%. All failures had some form of secondary vascularized tissue transfer, which included the use of muscle flaps in 9 (41%) different patients. Results: Initial flap salvage after a failed perforator free flap was attempted with 12 perforator and 5 muscle free flaps as well as 1 perforator and 2 muscle local flaps. These were not all successful, with loss of 3 muscle free flaps and 3 perforator flaps. Tertiary free flap coverage was successful in 3 cases using 2 muscle flaps and 1 perforator free flap. Local fasciocutaneous flaps or primary wound closure was used in the remaining individuals. Conclusions: Microsurgical tissue transfers can be the most rewarding and at the same time the most challenging reconstructive endeavor. Persistence in achieving the desired outcome can require multiple steps. Perforator flaps are an important asset to obtain this goal. However, muscle flaps can still be a useful alternative, and the message is that they should not be overlooked as sometimes a viable option. PMID:26893989

  10. Wound Dehiscence after Wisdom Tooth Removal in Mandibular Mesioangular Class IB Impactions: Triangular Transposition Flap versus Envelope Flap.

    PubMed

    Rahpeyma, Amin; Khajehahmadi, Saeedeh; Ilkhani, Sina

    2015-01-01

    Background and aims. Wound dehiscence after lower third molar surgery extends the postoperative treatment period and may cause long-standing pain. The aim of this study was to compare wound dehiscence after removal of wisdom teeth in the most prevalent mandibular impaction (mesioangular class IB) by two different soft tissue flap designs. Materials and methods. Partially-erupted mandibular third molars with mesioangular class IB impaction (Pell and Gregory classification) were selected. Split mouth technique was used to compare the two flap designs (envelope vs. triangular transposition flap-TTF). The patients were recalled one week and a month later and rechecked for dehiscence, infection, and dry socket formation. Results. There were no cases of infection in either group. However, three cases of dry socket in the envelope group and four in the TTF group were recorded. In the envelope group, dehiscence occurred in 43% of cases during the first week, with 67% of cases being a large dehiscence (diameters of more than 5 mm). Extra appointments (those requested by the patient exclusively related to the problem of the hole distal to the second molar) were scheduled in 10% of cases in the envelope group. In the TTF group, dehiscence occurred during the first week for the same impaction in 19% of cases with large dehiscence cases occurring in 65% of cases and extra appointment rate at 4.1%. Conclusion. According to theresults in the evaluated operation, TTF may prevent postoperative wound dehiscence more probably than the envelope flap.

  11. PIV Measurements on a Blowing Flap

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

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

  12. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting.

    PubMed

    Ribuffo, Diego; Atzeni, Matteo; Saba, Luca; Milia, Arianna; Guerra, Maristella; Mallarini, Giorgio

    2009-04-01

    The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction. PMID:19325338

  13. Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera.

    PubMed

    Miyamoto, Shimpei

    2016-06-01

    Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon's perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon's perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection. PMID:27482504

  14. Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera

    PubMed Central

    2016-01-01

    Summary: Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon’s perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon’s perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection. PMID:27482504

  15. Video Capture of Perforator Flap Harvesting Procedure with a Full High-definition Wearable Camera.

    PubMed

    Miyamoto, Shimpei

    2016-06-01

    Recent advances in wearable recording technology have enabled high-quality video recording of several surgical procedures from the surgeon's perspective. However, the available wearable cameras are not optimal for recording the harvesting of perforator flaps because they are too heavy and cannot be attached to the surgical loupe. The Ecous is a small high-resolution camera that was specially developed for recording loupe magnification surgery. This study investigated the use of the Ecous for recording perforator flap harvesting procedures. The Ecous SC MiCron is a high-resolution camera that can be mounted directly on the surgical loupe. The camera is light (30 g) and measures only 28 × 32 × 60 mm. We recorded 23 perforator flap harvesting procedures with the Ecous connected to a laptop through a USB cable. The elevated flaps included 9 deep inferior epigastric artery perforator flaps, 7 thoracodorsal artery perforator flaps, 4 anterolateral thigh flaps, and 3 superficial inferior epigastric artery flaps. All procedures were recorded with no equipment failure. The Ecous recorded the technical details of the perforator dissection at a high-resolution level. The surgeon did not feel any extra stress or interference when wearing the Ecous. The Ecous is an ideal camera for recording perforator flap harvesting procedures. It fits onto the surgical loupe perfectly without creating additional stress on the surgeon. High-quality video from the surgeon's perspective makes accurate documentation of the procedures possible, thereby enhancing surgical education and allowing critical self-reflection.

  16. Experimental Study of Wake / Flap Interaction Noise and the Reduction of Flap Side Edge Noise

    NASA Technical Reports Server (NTRS)

    Hutcheson, Florence V.; Stead, Daniel J.; Plassman, Gerald E.

    2016-01-01

    The effects of the interaction of a wake with a half-span flap on radiated noise are examined. The incident wake is generated by bars of various widths and lengths or by a simplified landing gear model. Single microphone and phased array measurements are used to isolate the effects of the wake interaction on the noise radiating from the flap side edge and flap cove regions. The effects on noise of the wake generator's geometry and relative placement with respect to the flap are assessed. Placement of the wake generators upstream of the flap side edge is shown to lead to the reduction of flap side edge noise by introducing a velocity deficit and likely altering the instabilities in the flap side edge vortex system. Significant reduction in flap side edge noise is achieved with a bar positioned directly upstream of the flap side edge. The noise reduction benefit is seen to improve with increased bar width, length and proximity to the flap edge. Positioning of the landing gear model upstream of the flap side edge also leads to decreased flap side edge noise. In addition, flap cove noise levels are significantly lower than when the landing gear is positioned upstream of the flap mid-span. The impact of the local flow velocity on the noise radiating directly from the landing gear is discussed. The effects of the landing gear side-braces on flap side edge, flap cove and landing gear noise are shown.

  17. [1984-1994: Ten years of skin flaps. Development of transfer techniques. New methods of autoplasty described during this period].

    PubMed

    Martin, D

    1995-10-01

    Ten years of flaps represent a little and a lot. It is little compared to the 2600 years since the first flap in plastic surgery: the Susruta Indian flap, but it is a lot in view of the phenomenal acceleration of this speciality since the Second World War. In 1994 alone, more than two hundred references are listed under the heading "new flaps". As it is impossible to be exhaustive, the author has chosen to focus on two main aspects: a theoretical review of new transfer techniques, dealing successively with: the principles of reverse flow flaps, venous flaps, neurocutaneous flaps, so-called "extracorporeal" transfers, reverse flow YV technique; and practical aspects based on a review of eighteen autoplasties or donor sites selected for their surgical value, their reproductibility and their innovative nature. The author's objective is not to present a technical treatise, but rather to make the reader aware of several key points or even, in some cases, the very existence of these autoplasties. This paper is designed to be didactic, with extensive references, in order to act as a practical guide. It also demonstrates, as if there were any need, to what extent plastic surgery is able to create new solutions and the essential value of continuing research.

  18. TEMPORAL INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR A MACULAR HOLE PATIENT UNABLE TO MAINTAIN POSTOPERATIVE PRONE POSITIONING

    PubMed Central

    Tanito, Masaki; Sugihara, Kazunobu; Kodama, Tatsuo; Ohira, Akihiro

    2016-01-01

    Purpose: To report the surgical technique and efficacy of the temporal inverted internal limiting membrane (ILM) flap technique for a patient with an idiopathic macular hole (MH) who is unable to maintain postoperative prone positioning. Methods: Case report. Results: A 73-year-old man with a Stage III MH in his left eye was scheduled to undergo surgery. Owing to his inability to maintain postoperative prone positioning for continuous placement of a transdermal bladder catheter after radical cystoprostatectomy to treat urinary bladder cancer, he underwent pars plana vitrectomy combined with the temporal inverted ILM flap technique and intraocular sulfur hexafluoride gas tamponade. The technique included ILM peeling at a temporal area of the macula to create one 2-disk-diameter semicircular ILM flap and inversion of the ILM flap nasally to cover the MH. Optical coherence tomography showed that MH closure started from the top of the MH just beneath the covered ILM flap; the closure process gradually extended toward the bottom of the MH. The well-aligned fovea recovered in 5 weeks postoperatively. The visual acuity was 20/200 preoperatively and improved to 20/50 postoperatively. Conclusion: The temporal inverted ILM flap technique, a simple surgery to treat MHs, provides scaffolding for retinal gliosis and may facilitate bridge formation between the walls of the MH beneath the flap. The procedure may be a good option to achieve MH closure without postoperative prone positioning. PMID:26674274

  19. Postoperative evaluation of the folded pharyngeal flap operation for cleft palate patients with velopharyngeal insufficiency

    PubMed Central

    Yoshimasu, Hidemi; Sato, Yutaka; Mishimagi, Takashi; Negishi, Akihide

    2015-01-01

    Background: Velopharyngeal function is very important for patients with cleft palate to acquire good speech. For patients with velopharyngeal insufficiency, prosthetic speech appliances and speech therapy are applied first, and then pharyngeal flap surgery to improve velopharyngeal function is performed in our hospital. The folded pharyngeal flap operation was first reported by Isshiki and Morimoto in 1975. We usually use a modification of the original method. Purpose: The purpose of this research was to introduce our method of the folded pharyngeal flap operation and report the results. Materials and Methods: The folded pharyngeal flap operation was performed for 110 patients with velopharyngeal insufficiency from 1982 to 2010. Of these, the 97 whose postoperative speech function was evaluated are reported. The cases included 61 males and 36 females, ranging in age from 7 to 50 years. The time from surgery to speech assessment ranged from 5 months to 6 years. In order to evaluate preoperative velopharyngeal function, assessment of speech by a trained speech pathologist, nasopharyngoscopy, and cephalometric radiography with contrast media were performed before surgery, and then the appropriate surgery was selected and performed. Postoperative velopharyngeal function was assessed by a trained speech pathologist. Results: Of the 97 patients who underwent the folded pharyngeal flap operation, 85 (87.6%) showed velopharyngeal competence, 8 (8.2%) showed marginal velopharyngeal incompetence, and only 2 (2.1%) showed velopharyngeal incompetence; in 2 cases (2.1%), hyponasality was present. Approximately 95% of patients showed improved velopharyngeal function. Conclusions: The folded pharyngeal flap operation based on appropriate preoperative assessment has been shown to be an effective method for the treatment of cleft palate patients with velopharyngeal insufficiency. PMID:26389036

  20. Reconstruction of concomitant lip and cheek through-and-through defects with combined free flap and an advancement flap from the remaining lip.

    PubMed

    Jeng, Seng-Feng; Kuo, Yur-Ren; Wei, Fu-Chan; Su, Chih-Ying; Chien, Chih-Yen

    2004-02-01

    Massive facial defects involving the oral sphincter are challenging to the reconstructive surgeon. This study presents the authors' approach to simultaneous reconstruction of complex defects with an advancement flap from the remaining lip and free flaps. From January of 1997 to December of 2001, 22 patients were studied following ablative oral cancer surgery. Their ages ranged from 32 to 66 years. Nineteen patients had buccal cancer, two patients had tongue cancer, and one patient had lip cancer. In all cases, the disease was advanced squamous cell carcinoma. Nine patients underwent composite resection of tumor with segmental mandibulectomy, and seven patients underwent marginal mandibulectomy. Cheek defects ranged from 15 x 12 cm to 4 x 3 cm, and intraoral defects ranged from 14 x 8 cm to 5 x 4 cm in size. One third of the lower lip was excised in nine patients, both the upper and lower lips were excised in 10 patients, and only commissure defects were excised in three patients. An advancement flap from the remaining upper lip was used for reconstruction of the oral commissure and oral sphincter. Then, the composite through-and-through defect of the cheek was reconstructed with radial forearm flaps in 13 patients, fibula osteocutaneous flaps in five patients, double flaps in three patients, and an anterolateral thigh flap in one patient. The free flap survival rate was 96 percent, and only one flap failed. With regard to complications, there were two patients with cheek hematoma, six patients with orocutaneous fistula or neck infection, and one patient with osteomyelitis of the mandible. All but one patient had adequate oral competence. All patients had an adequate oral stoma and could eat a regular or soft diet; two patients could eat only a liquid diet. For moderate lip defects, immediate reconstruction of complex defects took place using an advancement flap from the remaining lip to obtain a normal and functional oral sphincter; the free flap can be used to

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

    PubMed

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

    2001-12-01

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

  2. Comparison of the Inverted Internal Limiting Membrane Flap Technique and the Internal Limiting Membrane Peeling for Macular Hole with Retinal Detachment

    PubMed Central

    Matsumura, Takehiro; Takamura, Yoshihiro; Tomomatsu, Takeshi; Arimura, Shogo; Gozawa, Makoto; Kobori, Akira; Inatani, Masaru

    2016-01-01

    Purpose To evaluate the efficacy of the inverted internal limiting membrane (ILM) flap technique in vitrectomy for macular hole (MH) with retinal detachment (RD) compared with vitrectomy using ILM peeling. Methods A retrospective case series study was performed. Twenty-two eyes of 22 patients who underwent vitrectomy for MH with RD and followed-up more than 12 months after the surgery were included in this study. We retrospectively reviewed the medical records of patients who underwent vitrectomy with inverted ILM flap technique or vitrectomy with ILM peeling. Ten patients who had been treated vitrectomy with inverted ILM flap technique, and 12 patients who had been treated vitrectomy with ILM peeling were analyzed. We evaluated changes in best-corrected visual acuity (BCVA) before and after surgery, closing rates of MH, and retinal reattachment rates and compared between both groups. Results MH was closed and RD was reattached postoperatively in 9 eyes (90%) in the inverted ILM flap group. In the ILM peeling group, the MH was closed in 4 eyes (33.3%) and the retinas were reattached in 6 eyes (50%) after surgery. Significant improvement in BCVA after surgery (P = 0.0017) was only found in the inverted ILM flap group. Conclusions Higher rates of closed MH and retinal reattachment, and small but significant improvement in BCVA were found in the inverted ILM flap group. Based on our data, the inverted ILM flap technique may be useful in vitrectomy for MH with RD. PMID:27764184

  3. New model of flap-gliding flight.

    PubMed

    Sachs, Gottfried

    2015-07-21

    A new modelling approach is presented for describing flap-gliding flight in birds and the associated mechanical energy cost of travelling. The new approach is based on the difference in the drag characteristics between flapping and non-flapping due to the drag increase caused by flapping. Thus, the possibility of a gliding flight phase, as it exists in flap-gliding flight, yields a performance advantage resulting from the decrease in the drag when compared with continuous flapping flight. Introducing an appropriate non-dimensionalization for the mathematical relations describing flap-gliding flight, results and findings of generally valid nature are derived. It is shown that there is an energy saving of flap-gliding flight in the entire speed range compared to continuous flapping flight. The energy saving reaches the highest level in the lower speed region. The travelling speed of flap-gliding flight is composed of the weighted average of the differing speeds in the flapping and gliding phases. Furthermore, the maximum range performance achievable with flap-gliding flight and the associated optimal travelling speed are determined.

  4. The UK National Flap Registry (UKNFR): A National Database for all pedicled and free flaps in the UK.

    PubMed

    Hazari, Anita; Walton, Peter

    2015-12-01

    The UK National Flap Registry (UKNFR) is a cross-speciality National Clinical Audit with participation by the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), British Association of Head and Neck Oncologists (BAHNO), British Association of Oral and Maxillofacial Surgeons (BAOMS) and Association of Breast Surgery (ABS). The aim of UKNFR is to collect information about all major pedicled and free flap operations carried out in the UK and through that, assess the quality of care we provide for patients. This audit will allow appropriate comparison of clinical performance with national standards and provide useful data on changing trends. Participation in audit is integral to appraisal and revalidation in the UK. PMID:26617340

  5. Efficient flapping flight of pterosaurs

    NASA Astrophysics Data System (ADS)

    Strang, Karl Axel

    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

  6. Schooling of flapping wings: Simulations

    NASA Astrophysics Data System (ADS)

    Masoud, Hassan; Becker, Alexander; Ristroph, Leif; Shelley, Michael

    2014-11-01

    We examine the locomotion of an infinite array of wings that heave vertically with a prescribed sinusoidal motion and are free to translate in the horizontal direction. To do this, we simulate the motion of a freely translating flapping airfoil in a domain with periodic horizontal boundary conditions. These simulations indicate that the wings can ``take advantage'' of their collectively generated wake flows. In agreement with our experiments in a rotational geometry, we find ranges of flapping frequency over which there are multiple stable states of locomotion, with one of these swimming states having both higher speeds and efficiencies than an isolated flapping and locomoting wing. A simple mathematical model, which emphasizes the importance of history dependence in vortical flows, explains this multi-stability. These results may be important to understanding the role of hydrodynamic interactions in fish schooling and bird flocking.

  7. Fibular free flap reconstruction for the management of advanced bilateral mandibular osteoradionecrosis.

    PubMed

    Shan, Xiao-Feng; Li, Ru-Huang; Lu, Xu-Guang; Cai, Zhi-Gang; Zhang, Jie; Zhang, Jian-Guo

    2015-03-01

    Fibular osteoseptocutaneous flap has been widely used for unilateral mandibular reconstruction. However, reports about the effects of fibular osteoseptocutaneous flap for the reconstruction of bilateral mandibular defects are limited. In this study, we used free vascularized fibular flaps to successfully manage bilateral mandibular osteoradionecrosis(ORN) in 5 patients. Functional aspects were evaluated during the reconstruction process. All 5 patients had bilateral refractory ORN of the mandible and underwent radical resection between 2003 and 2011. The reconstruction surgery was performed in 2 stages using 2 free fibular flaps in 3 patients. In the other 2 patients, reconstruction was performed in a single stage using 2 separate flaps prepared from a single fibula. All patients had a healthy mandibular symphysis and meniscus of the temporomandibular joint, and these structures were preserved during the reconstruction.Of the 10 defects involving the mandible sides, 9 were successfully reconstructed. One microvascular composite flap failed because of radiation injury to the arterial endothelium at the recipient site. After the treatments, all patients had good esthetic and functional outcomes. Preoperative clinical features such as trismus and dysphagia were also markedly improved. Our surgical method may be an effective alternative for the clinical management of advanced bilateral mandibular ORN.

  8. Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction

    PubMed Central

    Zhang, Bin; Li, Ke-Yi; Jiang, Li-Cheng; Meng, Zhen; Wang, Xiu-Mei; Cui, Fu-Zhai; Zhu, Ying-Nan; Wu, Ya-Ping

    2016-01-01

    Purpose: The purpose of this study was to present the outcome and discuss the feasibility of rib composite flap with intercostal nerve and internal thoracic vessels for reconstructing mandibular defect. Methods: Rib composite flaps have been used in 82 patients for reconstructing benign tumor-caused large mandibular defects: 66 of the 82 patients were reconstructed using rib composite flap with intercostal nerve and internal thoracic vessels, whereas the other 16 patients were reconstructed using rib composite flap with internal thoracic vessels, without intercostal nerve. After operation, clinical observation, imageological examination, and sensory detection were used to evaluate the effect of reconstruction. Results: All rib composite flaps with intercostal nerve and internal thoracic vessels were successfully harvested and transplanted. Both immediate and long-term examination showed good appearance reconstruction. All followed-up patients conveyed good satisfaction degree with function and appearance reconstruction. Postoperative panoramic x-ray examination showed new bone formation between the transplanted rib and mandibular stump. Good recoveries of mandibular nerve sensory were observed when followed up after reconstruction surgery. Conclusions: Rib composite flap with intercostal nerve and internal thoracic vessels could be a promising method for reconstruction of mandibular defects. PMID:27564074

  9. Cost analysis of 109 microsurgical reconstructions and flap monitoring with microdialysis.

    PubMed

    Setälä, Leena; Koskenvuori, Heini; Gudaviciene, Daiva; Berg, Leena; Mustonen, Paula

    2009-11-01

    Few studies have examined the cost-effectiveness of microsurgery, and little is known about the cost-effectiveness of flap monitoring. We studied the costs related to microsurgery during 2004 to 2006 in Kuopio University Hospital. A total of 99 patients were reconstructed with 109 flaps. Primary success was achieved in 64% of cases. Reoperation for anastomosis was conducted in 25% and for other surgical complications in 27%. The intended result was achieved in 94% of cases. The mean total cost of hospital care was 20,000 euro in head and neck cancer surgery, 15,500 euro in defects of the lower extremities, and 9200 euro in breast reconstruction. The costs were greatly influenced by surgical complications (i.e., if the primary reconstruction failed, then the secondary microvascular flap almost doubled the expense involved; mean expenses per case 27,900 euro). Microdialysis was used in flap monitoring with an additional cost of 535 euro per patient. We found that microdialysis provided an early diagnosis of perfusion failure and helped to save the flap. It was estimated that if one or two flaps per year are saved due to more effective monitoring, then the extra costs of using microdialysis are covered. PMID:19774503

  10. Reconstruction of low hairline microtia of Treacher Collins syndrome with a hinged mastoid fascial flap.

    PubMed

    Maeda, T; Oyama, A; Funayama, E; Yamamoto, Y

    2016-06-01

    Treacher Collins syndrome (TCS) is a rare genetic disorder leading to congenital craniofacial malformations. Although this syndrome presents with various symptoms, corrective surgery for bilateral microtia with low hairline is one of the most challenging operations given the complex contours of the external ear. In this technical note, a novel, simple procedure for dealing with the low hairline by using a hinged mastoid fascial flap simultaneously with costal cartilage grafting is described. Several techniques for the reconstruction of low hairline microtia have been reported previously, such as skin graft, skin flap, and tissue expander, but the high number of repeat operations and residual scars remain problematic. As a simultaneous procedure with framework grafting, the use of a temporoparietal flap with skin grafting is popular; however, its drawbacks include the operative scar, decreased hair growth, and hair thinning. Patients with TCS show anatomical variations of the superficial temporal vessels supplying the temporoparietal flap. In contrast, due to the high vascularity of the mastoid fascia, the mastoid fascial flap can be elevated safely and easily as an anteriorly, posteriorly, superiorly, or inferiorly based flap. PMID:26744099

  11. Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

    PubMed Central

    Guzzini, Matteo; Guidi, Marco; Civitenga, Carolina; Ferri, Germano; Ferretti, Andrea

    2016-01-01

    Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure. Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion. PMID:27064589

  12. Reconstruction of low hairline microtia of Treacher Collins syndrome with a hinged mastoid fascial flap.

    PubMed

    Maeda, T; Oyama, A; Funayama, E; Yamamoto, Y

    2016-06-01

    Treacher Collins syndrome (TCS) is a rare genetic disorder leading to congenital craniofacial malformations. Although this syndrome presents with various symptoms, corrective surgery for bilateral microtia with low hairline is one of the most challenging operations given the complex contours of the external ear. In this technical note, a novel, simple procedure for dealing with the low hairline by using a hinged mastoid fascial flap simultaneously with costal cartilage grafting is described. Several techniques for the reconstruction of low hairline microtia have been reported previously, such as skin graft, skin flap, and tissue expander, but the high number of repeat operations and residual scars remain problematic. As a simultaneous procedure with framework grafting, the use of a temporoparietal flap with skin grafting is popular; however, its drawbacks include the operative scar, decreased hair growth, and hair thinning. Patients with TCS show anatomical variations of the superficial temporal vessels supplying the temporoparietal flap. In contrast, due to the high vascularity of the mastoid fascia, the mastoid fascial flap can be elevated safely and easily as an anteriorly, posteriorly, superiorly, or inferiorly based flap.

  13. Robotic surgery

    MedlinePlus

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

  14. Delayed Cranioplasty: Outcomes Using Frozen Autologous Bone Flaps

    PubMed Central

    Hng, Daniel; Bhaskar, Ivan; Khan, Mumtaz; Budgeon, Charley; Damodaran, Omprakash; Knuckey, Neville; Lee, Gabriel

    2014-01-01

    Reconstruction of skull defects following decompressive craniectomy is associated with a high rate of complications. Implantation of autologous cryopreserved bone has been associated with infection rates of up to 33%, resulting in considerable patient morbidity. Predisposing factors for infection and other complications are poorly understood. Patients undergoing cranioplasty between 1999 and 2009 were identified from a prospectively maintained database. Records and imaging were reviewed retrospectively. Demographics, the initial craniectomy and subsequent cranioplasty surgeries, complications, and outcomes were recorded. A total of 187 patients underwent delayed cranioplasty using autologous bone flaps cryopreserved at –30°C following decompressive craniectomy. Indications for craniectomy were trauma (77.0%), stroke (16.0%), subarachnoid hemorrhage (2.67%), tumor (2.14%), and infection (2.14%). There were 64 complications overall (34.2%), the most common being infection (11.2%) and bone resorption (5.35%). After multivariate analysis, intraoperative cerebrospinal fluid (CSF) leak was significantly associated with infection, whereas longer duration of surgery and unilateral site were associated with resorption. Cranioplasty using frozen autologous bone is associated with a high rate of infective complications. Intraoperative CSF leak is a potentially modifiable risk factor. Meticulous dissection during cranioplasty surgery to minimize the chance of breaching the dural or pseudodural plane may reduce the chance of bone flap. PMID:26269726

  15. Sternocleidomastoid Muscle Flap after Parotidectomy

    PubMed Central

    Nofal, Ahmad Abdel-Fattah; Mohamed, Morsi

    2015-01-01

    Introduction Most patients after either superficial or total parotidectomy develop facial deformity and Frey syndrome, which leads to a significant degree of patient dissatisfaction. Objective Assess the functional outcome and esthetic results of the superiorly based sternocleidomastoid muscle (SCM) flap after superficial or total parotidectomy. Methods A prospective cohort study for 11 patients subjected to parotidectomy using a partial-thickness superiorly based SCM flap. The functional outcome (Frey syndrome, facial nerve involvement, and ear lobule sensation) and the esthetic results were evaluated subjectively and objectively. Results Facial nerve palsy occurred in 5 cases (45%), and all of them recovered completely within 6 months. The Minor starch iodine test was positive in 3 patients (27%), although only 1 (9%) subjectively complained of gustatory sweating. The designed visual analog score completed by the patients themselves ranged from 0 to 3 with a mean of 1.55 ± 0.93; the scores from the blinded evaluators ranged from 1 to 3 with a mean 1.64 ± 0.67. Conclusion The partial-thickness superiorly based SCM flap offers a reasonable cosmetic option for reconstruction following either superficial or total parotidectomy by improving the facial deformity. The flap also lowers the incidence of Frey syndrome objectively and subjectively with no reported hazard of the spinal accessory nerve. PMID:26491478

  16. [The Current Role of Salvage-Surgery of Recurrent Tumors in the Larynx and Pharynx].

    PubMed

    Stuck, B A; Rothmeier, N; Mattheis, S; Dominas, N; Lang, S

    2016-05-01

    Over the past 20 years, the therapeutic concepts for the treatment of head and neck cancer have evolved and non-surgical treatment strategies have gained in importance. However, despite improved organ preservation protocols and primary chemoradiation, tumor recurrence is still frequent. Under these conditions, salvage surgery if often the only remaining curative treatment option. Over the past 30 years, advancements in plastic-reconstructive surgery have broadened the surgical spectrum in the head and neck area, offering new treatment options for salvage surgery in recurrent cancer of the pharynx and larynx. Survival after salvage surgery mainly depends on the primary treatment modality as well as the localization and tumor stage at the time of initial diagnosis and local recurrence. For the reconstruction of defects after salvage surgery, pedicled flaps and microvascular free flaps may be utilized. The most frequently used flaps in these situations are the pectoralis major island- or the myocutaneous latissimus dorsi island flap. The radial forearm and the ALT-flap are potentially applicable free flaps. With the use of these flaps, vital tissue is transferred into the previously irradiated area, hereby allowing for reconstruction and functional preservation of the resected area and preventing complications such as fistulas. The expected morbidity and the likelihood of surgical success must be assessed thoroughly in every individual case prior to performing salvage surgery. This review aims to support decision making in these situations. PMID:27135424

  17. Benefit of HSP90α intervention on ischemia-reperfusion injury of venous blood-congested flaps

    PubMed Central

    HU, XIAO-YING; CHEN, ZHEN-YU; ZHANG, BIN; LENG, XIANG-FENG; FAN, XIAO-JIAN; LIU, TAO

    2016-01-01

    In order to decrease the incidence of flap necrosis after reconstructive surgeries, new approaches are required. In the present study, a model of venous congested flaps in rats was established to test the heat shock protein (HSP) 90α, ‘F-5’, protein as an intervention therapy to alleviate ischemia-reperfusion injury. A recombinant plasmid pET15b-F-5 carrying the HSP90α gene was constructed and the induced protein was purified from bacterial cell cultures. The rats in the study were divided into three different intervention groups: group A rats were treated with normal saline prior to flap establishment, group B rats were treated with HSP90α, ‘F-5’, protein prior to flap establishment, and group C rats were treated with the same ‘F-5’ protein after the surgical procedure. Additionally, the reperfusion time-points, ischemia for 6 or 8 h (5 rats each), were established in each group. After set periods of time, the flaps were observed for skin appearance, blood flow, survival rate and histological changes including neovascularization and re-epithelialization. The results showed that the flaps in the rats pre-treated with ‘F-5’ protein performed better than the flaps of rats in the other two groups: the blood flow was higher, flap survival rate was increased, inflammatory cell infiltration was decreased and angiogenesis increased, and new skin structure was better completed by the end of the experiment. The parameters examind were improved for all the groups when the ischemia time was 6 h instead of 8 h. In conclusion, HSP90α intervention prior to flap establishment was shown to be beneficial in the model of ischemia-reperfusion injury in venous-congested flaps. PMID:27347036

  18. Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Huang, Chong; Radabaugh, Jeffrey P.; Aouad, Rony K.; Lin, Yu; Gal, Thomas J.; Patel, Amit B.; Valentino, Joseph; Shang, Yu; Yu, Guoqiang

    2016-02-01

    Head and neck cancer accounts for 3 to 5% of all cancers in the United States. Primary or salvage surgeries are extensive and often lead to major head and neck defects that require complex reconstructions with local, regional, or free tissue transfer flaps. Knowledge of tissue blood flow (BF) changes after free tissue transfer may enable surgeons to predict the failure of flap thrombosis at an early stage. This study used our recently developed noncontact diffuse correlation spectroscopy to monitor dynamic BF changes in free flaps without getting in contact with the targeted tissue. Eight free flaps were elevated in patients with head and neck cancer; one of the flaps failed. Multiple BF measurements probing the transferred tissue were performed during and post the surgical operation. Postoperative BF values were normalized to the intraoperative baselines (assigning '1') for the calculation of relative BF change (rBF). The rBF changes over the seven successful flaps were 1.89 +/- 0.15, 2.26 +/- 0.13, and 2.43 +/- 0.13 (mean +/- standard error) respectively on postoperative days 2, 4, and 7. These postoperative values were significantly higher than the intraoperative baseline values (p < 0.001), indicating a gradual recovery of flap vascularity after the tissue transfer. By contrast, rBF changes observed from the unsuccessful flap were 1.14 and 1.34 respectively on postoperative days 2 and 4, indicating a less flow recovery. Measurement of BF recovery after flap anastomosis holds the potential to act early to salvage ischemic flaps.

  19. [Moderate sequelae secondary to noma: value of the nasogenal flap].

    PubMed

    Trendel, D; Martin, J P; Martins-Carvalho, C

    2009-02-01

    Noma is a gangrenous disease leading to destruction of soft and hard tissue of the face. It mainly affects young poor children with poor oral care. Without treatment noma is fatal in 70 to 90% of cases. In survivors, esthetic and functional sequelae are severe. Emergency intravenous antibiotherapy improves survival but restoration of the face requires reconstructive surgery. Different surgical techniques with various degrees of complexity and reliability have been proposed. The purpose of this article is to describe the nasogenal flap technique. This simple, single-stage technique is well suited to conditions in Africa.

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

    PubMed

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

    2015-07-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2010-02-01

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

  2. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up.

    PubMed

    Olvera-Caballero, Carlos; Ortiz-Dominguez, Abel

    2016-08-01

    A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112

  3. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up

    PubMed Central

    Ortiz-Dominguez, Abel

    2016-01-01

    Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results.

  4. Pediatric Arm Reconstruction after Shot-gun Injury Using Peroneal Free-flap and Pedicled Latissimus Dorsi Muscle Flap: Late Follow-up

    PubMed Central

    Ortiz-Dominguez, Abel

    2016-01-01

    Summary: A 15-year-old patient harmed himself upon firing a shotgun that he was carrying when he slipped and fell, causing a destructive wound in the right arm with a medial entry hole and a posterolateral exit hole. The biceps, coracobrachialis, triceps, deltoids, skin cover, and humerus were injured; however, the blood vessels and major nerves of the area were surprisingly not affected. The residual skin muscle defect after debridements was 16 × 5 cm medially and posteriorly, and the bone loss was 7 cm. The wound was reconstructed during a single surgery with a free fibula flap and a pedicled flap of latissimus dorsi. Ten years after surgery, the patient presents neither functional deficit of the injured limb (shoulder, arm, forearm, and hand) nor sequelae in the donor areas; he performs his daily activities without any limitations. This case confirms that the use of free bone flaps and pedicled muscle flaps in pediatric patients can provide excellent long-term results. PMID:27622112

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

    PubMed

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

    2016-01-01

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

  6. [Extruded cochlear implant magnet covered with a temporoparietal fascial flap. A case report].

    PubMed

    Lima Sánchez, J; Berenguer, B; Aránguez, G; González Meli, B; Marín Molina, C; de Tomás Palacios, E

    2013-01-01

    Complications are infrequent after cochlear implant surgery but they might occur despite careful preoperative planning and meticulous surgical technique. Among the most commonly encountered problems are those associated with the postauricular flap. An exposed, and therefore contaminated, device requires immediate attention and intervention. Cochlear implantation revision surgery is justified by two main reasons, the high price of these devices and the difficulty of reimplantation, due to cochlear fibrosis and ossification after its removal. There are multiple options in cochlear implantation revision surgery with infected device. However, the temporoparietal fascia flap is highly vascularized and provides some advantages over other alternatives. We report a case of a 5 year old boy with bilateral sensor neural hearing loss, who suffered a device extrusion three years after its implantation. PMID:23833928

  7. The Use of Composite Flaps in the Management of Large Full-Thickness Defects of the Lower Eyelid

    PubMed Central

    Fang, Shuo; Yang, Chao; Zhang, Yuntong; Xue, Chunyu; Bi, Hongda; Dai, Haiying; Xing, Xin

    2016-01-01

    Abstract To describe a modified surgical procedure that uses a combination of the tarsoconjunctival flap, orbicularis myocutaneous advancement flap, and paranasal-island flap to correct extensive full-thickness lower eyelid defects in functioning eyes. From May 2010 to December 2013, a total of 15 patients had reconstructive surgeries of large to giant lower eyelid defect, with an average 19-month follow-up. The musculocutaneous flaps were harvested from both orbicularis and paranasal regions and clinical outcomes were recorded and analyzed. No major complications were observed in any of the patients. All the patients showed aesthetic eyelid contour, good color, and texture match as well as no obvious scar formation. The mean Marginal Reflex Distance-2 measured 4 months after surgery was 4.9 ± 0.4 mm. Reconstruction of a large defect in the lower eyelid with a tarsoconjunctival flap and the composite neighboring musculocutaneous flaps is a reliable and reproducible method. With proper design and well-executed precision, excellent functional and aesthetic results can be achieved by this elegant procedure without any major complications. PMID:26765467

  8. Wound Dehiscence after Wisdom Tooth Removal in Mandibular Mesioangular Class IB Impactions: Triangular Transposition Flap versus Envelope Flap

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh; Ilkhani, Sina

    2015-01-01

    Background and aims. Wound dehiscence after lower third molar surgery extends the postoperative treatment period and may cause long-standing pain. The aim of this study was to compare wound dehiscence after removal of wisdom teeth in the most prevalent mandibular impaction (mesioangular class IB) by two different soft tissue flap designs. Materials and methods. Partially-erupted mandibular third molars with mesioangular class IB impaction (Pell and Gregory classification) were selected. Split mouth technique was used to compare the two flap designs (envelope vs. triangular transposition flap—TTF). The patients were recalled one week and a month later and rechecked for dehiscence, infection, and dry socket formation. Results. There were no cases of infection in either group. However, three cases of dry socket in the envelope group and four in the TTF group were recorded. In the envelope group, dehiscence occurred in 43% of cases during the first week, with 67% of cases being a large dehiscence (diameters of more than 5 mm). Extra appointments (those requested by the patient exclusively related to the problem of the hole distal to the second molar) were scheduled in 10% of cases in the envelope group. In the TTF group, dehiscence occurred during the first week for the same impaction in 19% of cases with large dehiscence cases occurring in 65% of cases and extra appointment rate at 4.1%. Conclusion. According to theresults in the evaluated operation, TTF may prevent postoperative wound dehiscence more probably than the envelope flap. PMID:26697150

  9. [Microsurgery in reanimation, lymphoedema and hand surgery].

    PubMed

    Bonde, Christian T; Jensen, Lisa Toft; Tos, Tina; Kiil, Birgitte Jul; Toft, Gete Ester; Larsen, Søren Erik; Birkeland, Peter; Sørensen, Jens Ahm

    2016-06-01

    Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s. Microsurgery in hand surgery is primarily replantation and revascularisation but also peripheral nerve surgery as well as brachial plexus surgery. Lymphoedema is being treated with super microsurgery on an experimental basis. Dynamic reconstruction of facial palsy is performed in a two-stage operation with cross-over nerve graft and a free microvascular muscle flap, typically gracilis. PMID:27292577

  10. Surgical Adhesives in Facial Plastic Surgery.

    PubMed

    Toriumi, Dean M; Chung, Victor K; Cappelle, Quintin M

    2016-06-01

    In facial plastic surgery, attaining hemostasis may require adjuncts to traditional surgical techniques. Fibrin tissue adhesives have broad applications in surgery and are particularly useful when addressing the soft tissue encountered in facial plastic surgery. Beyond hemostasis, tissue adhesion and enhanced wound healing are reported benefits associated with a decrease in operating time, necessity for drains and pressure dressings, and incidence of wound healing complications. These products are clinically accessible to most physicians who perform facial plastic surgery, including skin grafts, flaps, rhytidectomy, and endoscopic forehead lift. PMID:27267012

  11. Microsurgical reconstruction of noma-related facial defects with folded free flaps: an overview of 31 cases.

    PubMed

    Giessler, Goetz A; Fieger, Alexander; Cornelius, Carl-Peter; Schmidt, Andreas B

    2005-08-01

    Noma is primarily affecting children in underprivileged countries and results in disfiguring facial defects, loss of mandibular movement, and subsequent social disintegration. Plastic surgery in West Africa traditionally uses pedicled flaps. In large, complex, or central facial defects, though, pedicled flaps are apt to be too small or have a significant donor site morbidity. Since 1999, we have been using free microvascular flaps in Nigeria. In 5 Interplast missions, 31 patients (age 5-45 years, median 20 years, female to male ratio 18:13) underwent 31 free flap procedures in Nigeria, 27 of them for primary treatment. The operative time ranged from 3.75-8.75 hours (mean 5.5 hours). An external distractor/fixator to maintain mouth opening was mounted in 13 cases. All anastomoses were done with loupe magnification. Three flaps failed completely, 1 partly, and 4 patients showed minor wound infections. No donor-site complications occurred. Free flaps can be a suitable and safe closure for complex noma defects even in underprivileged circumstances, if patient profile and own microsurgical routine allows it. Patient disfigurement can be less than in pedicled flaps regarding the donor sites.

  12. Cosmetic Surgery

    MedlinePlus

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

  13. Reconstruction With Modified Face Lift and Orbicularis Oculi V-Y Advancement Flap for Sebaceous Carcinoma on Temple Area.

    PubMed

    Lee, Byeong Ho; Kim, Joo Hyun; Park, Seong Hoon; Ahn, Duk Kyun; Suh, In Suck; Jeong, Hii Sun

    2015-09-01

    Extraocular sebaceous carcinoma that occurs on sebaceous gland is a rare malignant cancer with unknown causes and nonspecific clinical characters, but with distinct pathology and immunohistochemical finding. In Kangnam Sacred Heart Hospital, there was a case that the result of preoperative punch biopsy was squamous cell carcinoma and malignant proliferating trichilemmal tumor, but that of postoperative permanent biopsy was sebaceous carcinoma. The type of tumor, differentiation, location, and aesthetic results are considered to get both recurrence-safe and aesthetically pleasing result. Various flaps were considered, and modified face-lift flap, forehead rotation flap, orbicularis oculi V-Y advancement flap were planned. There were no sign of recurrence of cancer or functional and aesthetical deformities 6 months after the surgery. PMID:26267581

  14. Benefits of using omental pedicle flap over muscle flap for closure of open window thoracotomy

    PubMed Central

    Chikaishi, Yasuhiro; Kuwata, Taiji; Takenaka, Masaru; Oka, Soichi; Hirai, Ayako; Imanishi, Naoko; Kuroda, Koji; Tanaka, Fumihiro

    2016-01-01

    Background Open window thoracotomy (OWT) as well as its closure are challenging. Transposition of omental pedicle and muscle flaps is often performed for OWT closure; however, the better technique among the two is unknown. The purpose of this series was to evaluate the outcomes of using both omental pedicle and muscle flaps for the aforementioned closure. Methods This was an observational retrospective cohort study on 27 consecutive patients who underwent OWT closure at a single institution between January 2005 and December 2014. The operation was performed using either omental pedicle or muscle flap with thoracoplasty. We compared both techniques in terms of the patient background [sex, age, body mass index (BMI) and C-reactive protein (CRP) before OWT and serum albumin levels before OWT closure], presence of methicillin-resistant Staphylococcus aureus (MRSA) infection, rate of bronchopleural fistula (BPF), duration of OWT, recurrence of local infection, morbidity, duration of indwelling drainage after operation, success, mortality and postoperative hospital stay. Results There were 9 (33.3%) omental pedicle flap procedures and 18 (66.7%) muscle flap procedures. The rate of local recurrence after closure of OWT was significantly higher with muscle flap than with omental pedicle flap (0% vs. 50.0%, P=0.012). The median duration of postoperative hospital stay was significantly shorter with omental pedicle flap than that with muscle flap (16.0 vs. 41.5 days, P=0.037). Mortality was observed in 2 patients (11.2%) in the muscle flap group and no patient in the omental pedicle flap group. Success rate was similar between the two groups (100% for omental pedicle flap vs. 83.3% for muscle flap). Conclusions Omental pedicle flap was superior to muscle flap in terms of reducing local recurrence and shortening postoperative hospital stay. However, mortality, morbidity and success rates were not affected by the choice of flap. PMID:27499959

  15. Davis flap: the glory still present

    PubMed Central

    El-Sabbagh, Ahmed Hassan

    2016-01-01

    Background: Upper third defects of the ear are too large to be closed primarily without distorting the auricle. Full thickness defects can be reconstructed with local flaps. In this article, Davis flap was used to fill the upper third defects of the ear with some modifications. Patients and methods: Eight patients underwent reconstruction of full thickness auricular defects with Davis flaps from July 2012 to December 2014. The posterior surface of the flap and the raw area of conchal area were covered by full thickness graft taken from posterior surface of ear. Results: All flaps survived. No congestion was noted. The donor sites and skin grafts healed uneventfully. Conclusion: Davis flap is a simple and reproducible tool for reconstruction of upper third of ear. PMID:27274439

  16. Repositioning free laser in situ keratomileusis flaps.

    PubMed

    Todani, Amit; Al-Arfaj, Khalid; Melki, Samir A

    2010-02-01

    We describe a protocol for adequate repositioning of free laser in situ keratomileusis (LASIK) corneal flaps created by a Moria M2 microkeratome even in the absence of fiduciary marks. In an enucleated porcine globe, a free flap was created by initially placing a longitudinal incision at the proposed hinge site followed by activating the forward pass of the automated microkeratome. A protocol was devised based on placement of a positioning dot on the free flap before the flap is retrieved from the microkeratome head. Preplaced surgical landmarks were used as a guide to determine the correct alignment of the free flap. Adequate orientation of the free flap to the stromal bed was achieved in 9 porcine eyes using the positioning dot method. The technique is applicable to the Moria M2 microkeratome only and must be validated for other types of keratomes.

  17. Reconstruction of the denuded nasoseptal flap donor site with a free fascia lata graft: technical note.

    PubMed

    Zeinalizadeh, Mehdi; Sadrehosseini, Seyed Mousa; Barkhoudarian, Garni; Carrau, Ricardo L

    2016-10-01

    The nasoseptal flap provides hearty vascularized tissue for the reconstruction of skull base defects subsequent to expanded endonasal approaches; however, it leads to exposure of the cartilage at the septal donor site producing crusting and discomfort while it remucosalizes. We report an alternative technique to reconstruct the denuded nasal septal donor site by means of a free fascia lata graft. Fascia lata grafting of the nasoseptal flap donor site showed evidence of revascularization 4 weeks after initial surgery. Re-epithelialization was complete 4-12 weeks postoperation. Although the nasoseptal flap provides a versatile reconstructive technique, its harvest results in significant donor site morbidity. A free fascia lata graft accelerates the rate of donor site remucosalization; thus, decreasing the nasal complications.

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

    PubMed

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

    2015-02-01

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

  19. Reconstruction of the denuded nasoseptal flap donor site with a free fascia lata graft: technical note.

    PubMed

    Zeinalizadeh, Mehdi; Sadrehosseini, Seyed Mousa; Barkhoudarian, Garni; Carrau, Ricardo L

    2016-10-01

    The nasoseptal flap provides hearty vascularized tissue for the reconstruction of skull base defects subsequent to expanded endonasal approaches; however, it leads to exposure of the cartilage at the septal donor site producing crusting and discomfort while it remucosalizes. We report an alternative technique to reconstruct the denuded nasal septal donor site by means of a free fascia lata graft. Fascia lata grafting of the nasoseptal flap donor site showed evidence of revascularization 4 weeks after initial surgery. Re-epithelialization was complete 4-12 weeks postoperation. Although the nasoseptal flap provides a versatile reconstructive technique, its harvest results in significant donor site morbidity. A free fascia lata graft accelerates the rate of donor site remucosalization; thus, decreasing the nasal complications. PMID:26951218

  20. Use of Composite Osteotemporoparietal Fascia Flap for Midface Reconstruction After En Bloc Resection of Squamous Cell Carcinoma Involving the Zygomaticomaxillary Complex

    PubMed Central

    Lee, Daniel D.; Kenning, Tyler

    2016-01-01

    Summary: The osteotemporoparietal fascia flap (OTPFF) has been used for bony defects, especially on the maxilla and orbital floor. However, there are limited reports about the reconstruction of the zygoma. We report the use of composite OTPFF for reconstruction of zygomaticomaxillary complex. The patient had undergone zygomaticomaxillary complex reconstruction with composite OTPFF because of the resection of recurrent postradiation tumor. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. Flap was successfully transferred with complete bone integration. There were no surgical complications and excellent cosmetic result. The patient is free of disease 12 months post surgery. The OTPFF seems to be a good option in zygomatic reconstruction, even in previously irradiated fields. Utilization of extratemporoparietal fascia to cover the medullary surface of the bone flap has potential to be an advantageous technique to minimize bone exposure and improve flap integration. PMID:27622103

  1. Use of Composite Osteotemporoparietal Fascia Flap for Midface Reconstruction After En Bloc Resection of Squamous Cell Carcinoma Involving the Zygomaticomaxillary Complex

    PubMed Central

    Lee, Daniel D.; Kenning, Tyler

    2016-01-01

    Summary: The osteotemporoparietal fascia flap (OTPFF) has been used for bony defects, especially on the maxilla and orbital floor. However, there are limited reports about the reconstruction of the zygoma. We report the use of composite OTPFF for reconstruction of zygomaticomaxillary complex. The patient had undergone zygomaticomaxillary complex reconstruction with composite OTPFF because of the resection of recurrent postradiation tumor. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. Flap was successfully transferred with complete bone integration. There were no surgical complications and excellent cosmetic result. The patient is free of disease 12 months post surgery. The OTPFF seems to be a good option in zygomatic reconstruction, even in previously irradiated fields. Utilization of extratemporoparietal fascia to cover the medullary surface of the bone flap has potential to be an advantageous technique to minimize bone exposure and improve flap integration.

  2. Use of Composite Osteotemporoparietal Fascia Flap for Midface Reconstruction After En Bloc Resection of Squamous Cell Carcinoma Involving the Zygomaticomaxillary Complex.

    PubMed

    Lee, Daniel D; Kenning, Tyler; Pinheiro-Neto, Carlos D

    2016-08-01

    The osteotemporoparietal fascia flap (OTPFF) has been used for bony defects, especially on the maxilla and orbital floor. However, there are limited reports about the reconstruction of the zygoma. We report the use of composite OTPFF for reconstruction of zygomaticomaxillary complex. The patient had undergone zygomaticomaxillary complex reconstruction with composite OTPFF because of the resection of recurrent postradiation tumor. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. Flap was successfully transferred with complete bone integration. There were no surgical complications and excellent cosmetic result. The patient is free of disease 12 months post surgery. The OTPFF seems to be a good option in zygomatic reconstruction, even in previously irradiated fields. Utilization of extratemporoparietal fascia to cover the medullary surface of the bone flap has potential to be an advantageous technique to minimize bone exposure and improve flap integration. PMID:27622103

  3. [Use of pedicled cutaneous groin flaps in distal reconstruction of the upper extremity].

    PubMed

    Molski, M; Potocki, K; Stańczyk, J; Komorowska, A; Murawski, M

    2000-01-01

    In the years 1981-1997 at the Department of Plastic Surgery Medical Centre for Postsgraduate Education in Warsaw 116 patients were treated surgically using groin flaps and 97 patients using a pedicled cutaneous groin flap. This paper reports the results of the later technique. Reconstructions were performed in 10 female patients aged 18-58 (mean age 37.5 years) and 87 male patients aged 15-67 (mean age 33.8 years). The tissue defects or acquired deformations were caused by: crush injuries (26 cases), scalping injuries (23 cases), rugged injuries (18 cases), avulsion trauma (15 cases), explosion injuries (8 cases) and electric burns (7 cases). Flap size depended upon extent of the tissue defect and the from flaps were 7-26 cm long and 4-12 cm wide. Flap area ranged from 35 to 260 square centimetres. Emergency procedures were performed in 59 patients (61%). Secondary reconstructions were carried out in 38 cases (39%). Operative technique was based on the rules described by McGregor and Jackson. The donor site was sutured primarily tubulizing its basis--as in tube flap. The flap pedicle was cut off during a one stage procedure in 41 patients 21-30 days (mean 23 days) after surgery or during a two-stage procedure in 56 cases. The two-stage procedure consisted of an incision of part of the pedicle after 15-45 days post-op (mean 21 days) followed by a complete dissection after a few days (mean 4 days). In 44 cases the flap required modelling i.e. excision of excessives kin and/or thinning of subcutaneous tissue. The flap healed in 96 patients (99%). Complications at different stages of the treatment were observed in 40 patients (41%). In 3 cases wound ischemia was observed because of too tight suturing. Removal of skin sutures lead to normalization of blood supply. In 7 patients cyanotic skin of the distal part with no significant consequences was observed. In 27 patients (28%) necrosis of the marginal tissues surrounding the operation wound after cutting of the pedicle

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

    PubMed

    Dunne, Jonathan A

    2014-12-01

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

  5. Optimal propulsive flapping in Stokes flows.

    PubMed

    Was, Loïc; Lauga, Eric

    2014-03-01

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

  6. Refining the intrinsic chimera flap: a review.

    PubMed

    Agarwal, Jayant P; Agarwal, Shailesh; Adler, Neta; Gottlieb, Lawrence J

    2009-10-01

    Reconstruction of complex tissue deficiencies in which each missing component is in a different spatial relationship to each other can be particularly challenging, especially in patients with limited recipient vessels. The chimera flap design is uniquely suited to reconstruct these deformities. Chimera flaps have been previously defined in many ways with 2 main categories: prefabricated or intrinsic. Herein we attempt to clarify the definition of a true intrinsic chimeric flap and provide examples of how these constructs provide a method for reconstruction of complex defects. The versatility of the intrinsic chimera flap and its procurement from 7 different vascular systems is described. A clarification of the definition of a true intrinsic chimera flap is described. In addition, construction of flaps from the lateral femoral circumflex, deep circumflex iliac, inferior gluteal, peroneal, subscapular, thoracodorsal, and radial arterial systems is described to showcase the versatility of these chimera flaps. A true intrinsic chimera flap must consist of more than a single tissue type. Each of the tissue components receives its blood flow from separate vascular branches or perforators that are connected to a single vascular source. These vascular branches must be of appropriate length to allow for insetting with 3-dimensional spatial freedom. There are a multitude of sites from which true intrinsic chimera flaps may be harvested.

  7. Optimal propulsive flapping in Stokes flows.

    PubMed

    Was, Loïc; Lauga, Eric

    2014-03-01

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

  8. Pressure Available for Cooling with Cowling Flaps

    NASA Technical Reports Server (NTRS)

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

    1941-01-01

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

  9. Basic Perforator Flap Hemodynamic Mathematical Model

    PubMed Central

    Tao, Youlun; Ding, Maochao; Wang, Aiguo; Zhuang, Yuehong; Chang, Shi-Min; Mei, Jin; Hallock, Geoffrey G.

    2016-01-01

    Background: A mathematical model to help explain the hemodynamic characteristics of perforator flaps based on blood flow resistance systems within the flap will serve as a theoretical guide for the future study and clinical applications of these flaps. Methods: There are 3 major blood flow resistance network systems of a perforator flap. These were defined as the blood flow resistance of an anastomosis between artery and artery of adjacent perforasomes, between artery and vein within a perforasome, and then between vein and vein corresponding to the outflow of that perforasome. From this, a calculation could be made of the number of such blood flow resistance network systems that must be crossed for all perforasomes within a perforator flap to predict whether that arrangement would be viable. Results: The summation of blood flow resistance networks from each perforasome in a given perforator flap could predict which portions would likely survive. This mathematical model shows how this is directly dependent on the location of the vascular pedicle to the flap and whether supercharging or superdrainage maneuvers have been added. These configurations will give an estimate of the hemodynamic characteristics for the given flap design. Conclusions: This basic mathematical model can (1) conveniently determine the degree of difficulty for each perforasome within a perforator flap to survive; (2) semiquantitatively allow the calculation of basic hemodynamic parameters; and (3) allow the assessment of the pros and cons expected for each pattern of perforasomes encountered clinically based on predictable hemodynamic observations. PMID:27579238

  10. Arterialized Venous Bone Flaps: An Experimental Investigation

    PubMed Central

    Borumandi, Farzad; Higgins, James P.; Buerger, Heinz; Vasilyeva, Anna; Benlidayi, Memmet Emre; Sencar, Leman; Gaggl, Alexander

    2016-01-01

    In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps. PMID:27558705

  11. Reconstruction after Anterior Chest Wall Keloid Resection Using Internal Mammary Artery Perforator Propeller Flaps

    PubMed Central

    Ogawa, Rei; Ono, Shimpei; Akaishi, Satoshi; Dohi, Teruyuki; Iimura, Takeshi; Nakao, Junichi

    2016-01-01

    Background: It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy. Methods: All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented. Results: There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 × 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site. Conclusions: IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence. PMID:27757357

  12. Evaluation of the Effect of Bosentan-Mediated Endothelin Receptor Blockade on Flap Survival in Rats: An Experimental Study.

    PubMed

    Görgülü, Tahsin; Guler, Ramazan; Olgun, Abdulkerim; Torun, Merve; Kargi, Eksal

    2016-08-01

    Local skin flaps are important tools for performing plastic surgery. Skin flaps are used for closure of defects after tumor excision or in tissue losses after trauma. However, problems associated with these flaps are commonly encountered, particularly in areas of marginal necrosis. Bosentan is a vasodilator that exerts its effect through endothelin receptor blockade, and has been shown to prevent ischemic tissue damage. However, no reports have addressed the effect of bosentan on skin flaps. The aim of the study was to investigate the effects of bosentan, which may be applied clinically to promote survival of ischemic skin flaps. A modified McFarlane flap was elevated in the dorsum of 20 Albino Wistar rats with a width-to-length ratio of 3 to 10 cm, respectively, with the caudal base. Perioperatively, 0.9% of physiologic NaCl and injectable distilled water of identical volume were injected into rats in Group 1 (n = 10), and 5 mg/kg bosentan was injected intraperitoneally into rats in Group 2 (n = 10). All of the rats were followed up for 7 days postoperatively. The surviving parts of the flaps were measured at the end of day 7. Acute and chronic inflammation, amount of granulation tissue, fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization present in the ischemic zones of the distal parts of the flaps were evaluated histopathologically, and results were compared statistically. The mean flap survivals were 61.1% in Group 1 and 91.1% in Group 2; the percentage of the surviving flap area in Group 2 was higher than that in Group 1 (p < 0.005). In both groups, there was significantly less acute inflammation in the ischemic zones in Group 2 than in Group 1 (p < 0.005). No significant difference was found in the amounts of chronic inflammation and granulation tissue between the two groups (p > 0.005). Fibroblast maturation, amount of collagen, and amounts of reepithelialization and neovascularization

  13. Effects of diammonium glycyrrhizinate on random skin flap survival in rats: An experimental study

    PubMed Central

    Lv, Qing-Bo; Gao, Xiang; Lin, Ding-Sheng; Chen, Yun; Cao, Bin; Zhou, Kai-Liang

    2016-01-01

    Partial necrosis of skin flaps continues to restrict the survival of local skin flaps following plastic and reconstructive surgeries. The aim of the present study was to investigate the effects of diammonium glycyrrhizinate (DG), a salt of glycyrrhetinic acid that has been widely used in the therapy of chronic hepatitis and human immunodeficiency virus infection, on random skin flap survival in rats. McFarlane flaps were established in 60 male Sprague-Dawley rats randomly divided into three groups. Group I served as the control group and was injected with saline (10 mg/kg) once per day. Group II and group III were the experimental groups, and were injected with 10 mg/kg DG once and twice per day, respectively. On day 7, the survival area of the flap was measured. Tissue samples were stained with hematoxylin and eosin and immunohistochemically evaluated. Tissue edema, neutrophil density, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were evaluated. The mean survival areas of the flaps of group II were significantly larger when compared with those of group I (P<0.05), and the rats of group III exhibited significantly higher survival areas than group II (P<0.05). Histologic and immunohistochemical evaluation showed that microvessel development and the expression level of vascular endothelial growth factor were higher in the two experimental groups than in the control group. Furthermore, SOD activity was significantly increased (P<0.05), while the neutrophil density and MDA level were significantly reduced (P<0.05) in group II when compared with group I. Significant differences between group II and group III with regard to SOD activity and MDA level were also observed (P<0.05). Thus, DG may have a dose-dependent effect on promoting the survival of random skin flaps. PMID:27588181

  14. The posterior interosseous artery flap: clinical results with special emphasis on donor site morbidity.

    PubMed

    Neuwirth, Maximilian; Hubmer, Martin; Koch, Horst

    2013-05-01

    This study evaluated the clinical results, and especially the donor site morbidity of the posterior interosseous artery flap. A retrospective study included 40 patients with defects covered with posterior interosseous flaps. Twenty-one patients were available for a follow-up examination to assess donor site morbidity by evaluating the dimensions and quality of the donor site scar and the forearm contour as well as complaints and subjective satisfaction with the aesthetic result. The flaps and related donor sites healed uneventfully in 29 cases (72.5%); healing was delayed in 11 cases (27.5%), with total flap loss in two cases. Further surgery was required in six cases. The quality of the donor site scar rated with the Vancouver Scar Scale averaged 2.4 points. Eleven patients (55%) reported impaired sensibility around the donor site and four patients (20%) had physical complaints. Subjective and objective donor site evaluation revealed significantly lower donor site morbidity for directly closed as opposed to skin grafted donor sites, although subjectively, there was a high level of satisfaction in both groups. Our data indicated that the posterior interosseous flap is a valuable option for the management of soft-tissue defects on the dorsum of the hand, due to its anatomical reliability and soft and pliable tissue, its low donor site morbidity and high patient acceptance.

  15. Modified Bilateral Neurovascular Cheek Flap: Functional Reconstruction of Extensive Lower Lip Defects

    PubMed Central

    2016-01-01

    Background: Reconstruction of extensive lower lip defects is challenging, and functional outcomes are difficult to achieve. Methods: A modified bilateral neurovascular cheek (MBNC) flap has been described. The data of patients with cancer of the lower lip treated with wide excision and reconstructed with the MBNC flap in the Plastic Surgery Unit, Srinagarind Hospital, Khon Kaen University, from 1966 to 2012 were reviewed. Results: Of the total of 143 patients included, 90.91% were women, and their age ranged from 32 to 100 years. All defects involved 70% or greater of the lower lip, which included oral commissure, buccal mucosa, or cheek skin and upper lip. All 20 patients who were followed up demonstrated good outcomes of intercommissural distance, interlabial distance, sulcus depth, and 2-point discrimination compared with normal lip parameters according to age group and satisfaction with treatment. Conclusions: Reconstruction of extensive lower lip defects with the MBNC flap provided good oral competence and functional outcomes. The flap provided adequate lip height and width, with proper position of oral commissure and vermilion reconstruction. The awareness about neurovascular anatomy of the lip and cheek and gentle dissection preserve the lip function. The flap overcomes the drawbacks of Karapandzic technique, which is microstomia, and of Bernard technique, which is a tight adynamic lower lip. It can be used in defects of more than two-thirds of the lip, extending to the cheek, commissural reconstruction, and secondary reconstruction. PMID:27579245

  16. [Functional surgery for head and neck squamous cell carcinoma].

    PubMed

    Janot, François; Julieron, Morbize

    2002-12-01

    Surgery for head and neck squamous cell carcinoma can alter speech, swallowing, and cosmoses. Recent tendency is to avoid mutilating surgery unless the tumour is aggressive or resistant to chemotherapy and or radiotherapy. Functional surgery is being widely employed, and for example it may vary between conventional partial surgery and endoscopic laser surgery for small sized vocal cord cancers. Various new reconstructive procedures have been developed to help early functional restoration. Loco-regional flaps can be used to replace gums and avoid dental extractions. Free flaps with micro-vascular anastomosis can be employed for immediate reconstruction of extensive surgical defects involving pharyngeal wall, tongue, mandible and mid-face to restore better function and cosmoses. Few recently developed techniques can be also employed in selected cases of laryngo-pharyngeal cancers to avoid permanent laryngeal mutilation. Another goal of functional surgery is to decrease the postoperative radiotherapy or chemo-radiotherapy sequelae, and obtain successful postoperative functional rehabilitation.

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

    PubMed

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

    2013-08-01

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

  18. [The super extended sub-mental flap or combo sub-mental flap].

    PubMed

    Martin, D

    2014-08-01

    The author presents a technical variation of the sub-mental flap including in a conventional pedicled flap both sub-mental axes and their anastomoses on the midline. The assessment of the first flaps raised according to this method confirms the improvement of the distal blood supply. It allows the possibility to harvest "super extended" flaps reaching the contralateral auricular lobula. This variation can be considered as an axial flap which only the tip, located beyond the mandibular angle, is at random. The evolution of the sub-mental flap from its original description to this variation called "combo sub-mental flap" is then presented. Its reliability and the technical simplification it provides will have to be assessed in the future. PMID:24840945

  19. Effects of Acellular Amniotic Membrane Matrix and Bone Marrow-Derived Mesenchymal Stem Cells in Improving Random Skin Flap Survival in Rats

    PubMed Central

    Chehelcheraghi, Farzaneh; Eimani, Hossein; Homayoonsadraie, Seyed; Torkaman, Giti; Amini, Abdollah; Alavi Majd, Hamid; Shemshadi, Hashem

    2016-01-01

    Background The necrotic skin flap represents a great challenge in plastic and reconstructive surgery. In this study, we evaluated the effect of bioscaffolds, acellular amniotic membranes (AAMs), and bone marrow-derived mesenchymal stem cells (BM-MSCs) on random skin flap (RSF) survival in rats by applying a cell-free extracellular matrix scaffold as a supportive component for the growth and proliferation of BM-MSCs on RSFs. AAM matrix scaffolds were created by incubating AMs in ethylenediaminetetraacetic acid 0.05% at 37°C, and cell scrapers were used. Objectives The aim of the present study was to assess the effect of AAM as a scaffold in TE, and combined with transplanted BM-MSCs, on the survival of RSFs and on the biomechanical parameters of the incision-wound flap margins 7 days after flap elevation. Materials and Methods BM-MSCs and AAMs were transplanted into subcutaneous tissue in the flap area. On the 7th postoperative day, the surviving flap areas were measured using digital imaging software, and the flap tissue was collected for evaluation. Forty rats were randomly divided into four groups of 10 each: group 1 received an AAM injection; group 2 underwent BM-MSC transplantation; group 3 received both AAM injection + BM-MSC transplantation; and group 4 was the control group, receiving only saline. Results The survival area in the AAM/BM-MSC group was significantly higher than in the control group (18.49 ± 1.58 versus 7.51 ± 2.42, P < 0.05). The biomechanical assessment showed no significant differences between the experimental groups and the control group (P > 0.05), and there was no correlation with flap survival. Conclusions Our findings showed that the treatment of flaps with BM-MSC and AAM transplantations significantly promoted flap survival compared to a control group. The viability of the flap was improved by combining BM-MSCs with AAM matrix scaffolds.

  20. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....

  1. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....

  2. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....

  3. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....

  4. 14 CFR 25.457 - Wing flaps.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Wing flaps. 25.457 Section 25.457 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Structure Control Surface and System Loads § 25.457 Wing flaps....

  5. First dorsal metacarpal artery adiposofascial flap for venous conduit and soft tissue cover in an avulsed thumb: case report.

    PubMed

    Dodakundi, Chaitanya; Hattori, Yasunori; Doi, Kazuteru

    2012-06-01

    Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit. PMID:22517573

  6. Piezoelectrically actuated insect scale flapping wing

    NASA Astrophysics Data System (ADS)

    Mukherjee, Sujoy; Ganguli, Ranjan

    2010-04-01

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

  7. Scrubbing noise of externally blown flaps

    NASA Technical Reports Server (NTRS)

    Fink, M. R.

    1975-01-01

    An experimental study was conducted to examine the aeroacoustic mechanism that produces externally blown flap (EBF) scrubbing noise, i.e. a surface-radiated noise which is generally strongest normal to UTW deflected flaps. Scrubbing noise was not radiated from portions of the surface adjacent to strong, locally coherent turbulent eddies. Instead, scrubbing noise seemed to come from weak loading fluctuations that were coherent along the scrubbed span. These loading fluctuations probably were induced by the convected large-scale vortex structure of the attached exhaust jet. Deflecting a UTW flap would reduce the distance between the vortex trajectory and the flap surface, increasing the resulting dipole noise and rotating its directivity. In contrast, deflecting a USB flap would increase this distance, so that observable scrubbing noise would be radiated only from the undeflected forward portion of the wing.

  8. Facial artery flaps in facial oncoplastic reconstruction.

    PubMed

    Fabrizio, Tommaso

    2013-10-01

    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.

  9. Cataract Surgery

    MedlinePlus

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics ...

  10. Local Measurement of Flap Oxygen Saturation: An Application of Visible Light Spectroscopy.

    PubMed

    Nasseri, Nassim; Kleiser, Stefan; Reidt, Sascha; Wolf, Martin

    2016-01-01

    The aim was to develop and test a new device (OxyVLS) to measure tissue oxygen saturation by visible light spectroscopy independently of the optical pathlength and scattering. Its local applicability provides the possibility of real time application in flap reconstruction surgery. We tested OxyVLS in a liquid phantom with optical properties similar to human tissue. Our results were in good agreement with a conventional near infrared spectroscopy device.

  11. Hydrodynamic schooling of flapping swimmers

    DOE PAGES

    Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif

    2015-10-06

    Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in amore » group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. Lastly, these results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.« less

  12. Hydrodynamic schooling of flapping swimmers

    SciTech Connect

    Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif

    2015-10-06

    Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. Lastly, these results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.

  13. Hydrodynamic schooling of flapping swimmers

    PubMed Central

    Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif

    2015-01-01

    Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing–wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups. PMID:26439509

  14. Hydrodynamic schooling of flapping swimmers

    NASA Astrophysics Data System (ADS)

    Becker, Alexander D.; Masoud, Hassan; Newbolt, Joel W.; Shelley, Michael; Ristroph, Leif

    2015-10-01

    Fish schools and bird flocks are fascinating examples of collective behaviours in which many individuals generate and interact with complex flows. Motivated by animal groups on the move, here we explore how the locomotion of many bodies emerges from their flow-mediated interactions. Through experiments and simulations of arrays of flapping wings that propel within a collective wake, we discover distinct modes characterized by the group swimming speed and the spatial phase shift between trajectories of neighbouring wings. For identical flapping motions, slow and fast modes coexist and correspond to constructive and destructive wing-wake interactions. Simulations show that swimming in a group can enhance speed and save power, and we capture the key phenomena in a mathematical model based on memory or the storage and recollection of information in the flow field. These results also show that fluid dynamic interactions alone are sufficient to generate coherent collective locomotion, and thus might suggest new ways to characterize the role of flows in animal groups.

  15. Current trends in robotic surgery for otolaryngology

    PubMed Central

    Byrd, J. Kenneth; Duvvuri, Umamaheswar

    2013-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Platt, Robert C

    1936-01-01

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

  17. Posterior Thigh Flap Pedicled on the Cutaneous Vessels Arising From the Popliteo-posterior Intermediate Artery: A Report of 5 Cases.

    PubMed

    Sun, Xi-Guang; Gong, Xu; Song, Liang-Song; Cui, Jian-Li; Yu, Xin; Liu, Bin; Lu, Lai-Jin

    2016-08-01

    Surgical repair of soft tissue defects of the knee and leg remains challenging. Using a case study approach, the anatomy of the popliteo-posterior intermediate cutaneous artery was examined, and a reverse island flap method was developed and implemented. After obtaining informed consent, 5 patients (1 woman, 4 men, age range 31 to 57 years) underwent the experimental use of a reverse island flap with a posterior thigh flap pedicled on the cutaneous vessels arising from the popliteo-posterior intermediate artery to repair soft-tissue defects of the knee and leg. The defects were caused by burned skin below the knee (n = 1), progressive skin necrosis in the knee after fracture surgery (n = 2), and skin infections associated with diabetes mellitus (n = 2). Skin defect sizes ranged from 15 cm x 5 cm to 30 cm x 12 cm. These large defects did not heal spontaneously; wound duration ranged from 1 week to 1 year, and all patients had refused defect repair with free flaps. Patients received posterior thigh flaps pedicled on the popliteo-posterior intermediate artery with areas ranging from 17 cm x 6 cm to 25 cm x 12 cm. All patients were treated with antibiotics and local dressings (iodoform and alcohol) changed daily post surgery, and blood supply was monitored by assessing the texture and color of the flap and venous regurgitation (ie, vein drainage disturbance). Four (4) of the five flaps survived completely. In 1 patient, partial survival of the flap, which had a good blood supply despite a venous circulation disorder, occurred: in this case, complete survival was achieved after treatment with a retrograde fascial flap and skin grafting. The appearance and texture of all flaps were satisfactory (ie, patients underwent only 1 operation, healing time was approximately 2 weeks, flap quality was close to normal skin, the donor site closed directly, and the shape and function of the knee and leg recovered well). No donor site abnormality was observed, and no postsurgical

  18. Outcomes following V-Y advancement flap reconstruction of large upper lip defects

    PubMed Central

    Griffin, Garrett R.; Weber, Stephen; Baker, Shan R.

    2016-01-01

    Objective To characterize revision surgery following V-Y subcutaneous tissue pedicle advancement flap repair of large upper lip skin defects. Methods Retrospective review of upper lip skin defects ≥3.0 cm2 that were reconstructed with a V-Y subcutaneous tissue pedicle advancement flap at an academic tertiary care center. Depth and area of the defect, as well as involvement of the vermilion and nasal ala, were recorded as independent variables. Revision techniques were analyzed to identify patterns. Results Thirty patients were identified with upper lip skin defects ranging from 3.0 to 14.0 cm2 (mean 7.0 cm2, median 6.25 cm2). The defect involved the nasal ala in four cases and the vermilion in three cases. At least one revision surgery was performed in 14/30 (47%) patients. Alar or vermilion involvement was a significant factor in revision by chi-square analysis (p=0.026). Larger defect size did not predict a need for revision, even among cases where the defect did not involve the ala or vermilion (p=0.68). Conclusion Reconstruction of large upper lip skin defects with a V-Y subcutaneous tissue pedicle advancement flap is associated with a 47% revision rate, and when the defect involves the ala or vermilion, the revision rate is increased. Defect size alone cannot be used to predict the need for revision surgery. Revision techniques are demonstrated. PMID:22801764

  19. TRAM flap breast reconstruction after radiation treatment.

    PubMed Central

    Williams, J K; Bostwick, J; Bried, J T; Mackay, G; Landry, J; Benton, J

    1995-01-01

    OBJECTIVE: Patients with and without radiation treatment before their breast reconstruction were compared to study the relationship of radiation to flap-related complications. SUMMARY BACKGROUND DATA: The transverse rectus abdominis muscle (TRAM) flap for breast reconstruction involves a a vascular pedicle and recipient bed, both included in the radiated field of patients undergoing adjunctive therapy. Detailed reviews of flap-related complications in this subgroup of patients have been limited. METHODS: One hundred eight patients with radiation treatment who subsequently underwent a TRAM flap breast reconstruction were compared with 572 patients with no radiation treatment before similar reconstruction. Flap-related complications, radiation dosage, time, fields, relationships between risk factors, and complications were studied. RESULTS: Overall complication rates were comparable between the two groups. Only fat necrosis (> 10% of total reconstruction) was found to be statistically significant (17.6% vs. 10.1%, p = 0.03228). No difference was found for fat necrosis in unipedicled vs. bipedicled flaps controlled for radiation (17.7% vs. 17.4%). Obesity and radiation therapy were associated with fat necrosis and major infection in a logistic regression. Significant abdominal scarring was also associated with major infection (p = 0.0044). CONCLUSIONS: In this, the largest reported series, radiation therapy was associated with increased fat necrosis and major infection. The use of the TRAM flap was not found to be prohibitive in radiated patients and should still be the first choice in this subgroup of patients. Images Figure 1. Figure 2. PMID:7794079

  20. Preputial flaps to correct buried penis.

    PubMed

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

    2007-11-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1946-01-01

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

  2. An Island Flap Technique for Laryngeal Intracordal Mucous Retention Cysts

    PubMed Central

    Izadi, Farzad; Ghanbari, Hadi; Zahedi, Sahar; Pousti, Behzad; Maleki Delarestaghi, Mojtaba; Salehi, Abolfazl

    2015-01-01

    Introduction: Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. Materials and Methods: In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. Results: There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. Conclusion: The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods. PMID:26568936

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

    NASA Technical Reports Server (NTRS)

    Howe, M. S.

    1981-01-01

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

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

    PubMed

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

    2012-05-01

    Skin flaps are still a matter of concern among surgeons, as failures can occur leading to flap necrosis. However, low-level laser irradiation has been reported as an effective tool to improve the viability of ischemic flaps, yet its mechanisms of action remain unclear. We investigated the effect of low-level laser irradiation on the viability of random skin flaps in rats and determined COX-2 expression in the flap pedicle. The study animals comprised 24 EPM-1 Wistar rats which were randomly allocated into three equal groups. A cranially based dorsal random skin flap measuring 10 × 4 cm was created in all the animals. In one group, laser irradiation was simulated (sham group), and in the other two groups the animals were irradiated at 12 points with 0.29 J at 20 mW (energy density 10.36 J/cm(2), irradiance 0.71 W/cm(2)), or with 7.3 J at 100 mW (energy density 260.7 J/cm(2), irradiance 3.57 W/cm(2)). These procedures were applied to the cranial half of the flap immediately after surgery and were repeated on days 2 and 5 after surgery. The percentage necrotic area was determined on day 7 after surgery by the paper template method. The immunohistochemical expression of COX-2 in the samples was given scores from 0 to 3. The necrotic area was smaller in group irradiated at 7.3 J compared to sham-treated group and to the group irradiated at 0.29 J (P < 0.05); there was no difference between the sham-treated group and group irradiated at 0.29 J. COX-2 expression was lower in the group irradiated at 7.3 J than in the sham-treated group and the group irradiated at 0.29 J (P < 0.001). Low-level laser therapy was effective in decreasing random skin flap necrosis in rats using a laser energy of 7.30 J per point. Laser irradiation also decreased the expression of COX-2 in the flap pedicle.

  5. A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?

    PubMed

    Nelson, Jonas A; Fischer, John P; Brazio, Philip S; Kovach, Stephen J; Rosson, Gedge D; Rad, Ariel N

    2013-10-01

    Soft tissue coverage in the distal lower extremity remains a significant challenge. While free flaps are often utilized for larger defects, local perforator-based propeller flaps may be ideal for smaller wounds requiring coverage. Propeller flaps can provide excellent form and function for both traumatic and atraumatic defects with minimal donor site morbidity but can have concerning rates of flap loss. We reviewed the literature, identifying 21 studies presenting 310 propeller flaps for distal lower extremity reconstruction. Total flap necrosis was noted in 5.5% of flaps, with partial necrosis in 11.6%. While these flaps do enable transfer of local, healthy tissue to the defect site without the need for a microsurgical anastomosis, this rate of flap loss is concerning and appropriate patient selection is crucial. This review provides a brief history and overview of the clinical application and research into distal lower extremity perforator propeller flaps to place this technique into a clinical context.

  6. Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator

    PubMed Central

    Wei, Peng; Chen, Weiwei; Mei, Jin; Ding, Maochao; Yu, Yaling; Xi, Shanshan; Zhou, Renpeng

    2016-01-01

    Background: The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect. Methods: Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees. Results: The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good. Conclusions: The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity. PMID:27482478

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

    PubMed

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

    2012-12-01

    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.

  8. Limb salvage surgery.

    PubMed

    Kadam, Dinesh

    2013-05-01

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

  9. Limb salvage surgery

    PubMed Central

    Kadam, Dinesh

    2013-01-01

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

  10. The plane problem of the flapping wing

    NASA Technical Reports Server (NTRS)

    Birnbaum, Walter

    1954-01-01

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

  11. Flap-augmented shrouds for aerogenerators

    NASA Technical Reports Server (NTRS)

    Seginer, A.

    1976-01-01

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

  12. Dynamic response of a piezoelectric flapping wing

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  13. An endoscopic approach to longitudinal structures including muscle flaps and vein, tendon, and nerve grafts.

    PubMed

    Hallock, Geoffrey G; Rice, David C

    2008-02-01

    Anatomically favorable structures that have a longitudinal orientation are particularly amenable to endoscopic harvest. Typically, only a single portal is necessary for access, and an optical cavity can be maintained using a mechanical retraction device. As with all minimal invasive surgery, this can still allow rapid and often a safer tissue harvest with diminished morbidity, especially with respect to wound healing and non-aesthetic scar formation. Many plastic surgery applications have already been described facilitated by the endoscopic harvest of vein, tendon, and nerve grafts, as well as certain local or free muscle flaps.

  14. Foot and ankle reconstruction: an experience on the use of 14 different flaps in 226 cases.

    PubMed

    Zhu, Yue-Liang; Wang, Yi; He, Xiao-Qing; Zhu, Min; Li, Fu-Bin; Xu, Yong-Qing

    2013-11-01

    The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap. The free flaps were latissimus musculocutaneous flap, anterolateral thigh musculocutaneous flap, groin flap, lateral arm flap, anterolateral thigh perforator flap, peroneal artery perforator flap, thoracdorsal artery perforator flap, medial arm perforator flap. The sensory nerve coaptation was not performed for all of flaps. One hundred and ninety-four cases were combined with open fractures. One hundred and sixty-two cases had tendon. Among 164 free flaps, 8 flaps were completely lost, in which the defects were managed by the secondary procedures. Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps), ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing, and infection was found in 14 flaps. The donor site complications were seen in 3 cases with the free anterolateral thigh perforator flap transfer. All of limbs were preserved and the patients regained walking and daily activities. All of patients except for one regained protective sensation from 3 to 12 months postoperatively. Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus, dorsal hindfoot and midfoot. Plantar foot, forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap. For the infected wounds with dead spce, the free latissimus dorsi musculocutaneous flap remained to

  15. Route Flap Damping Made Usable

    NASA Astrophysics Data System (ADS)

    Pelsser, Cristel; Maennel, Olaf; Mohapatra, Pradosh; Bush, Randy; Patel, Keyur

    The Border Gateway Protocol (BGP), the de facto inter-domain routing protocol of the Internet, is known to be noisy. The protocol has two main mechanisms to ameliorate this, MinRouteAdvertisementInterval (MRAI), and Route Flap Damping (RFD). MRAI deals with very short bursts on the order of a few to 30 seconds. RFD deals with longer bursts, minutes to hours. Unfortunately, RFD was found to severely penalize sites for being well-connected because topological richness amplifies the number of update messages exchanged. So most operators have disabled it. Through measurement, this paper explores the avenue of absolutely minimal change to code, and shows that a few RFD algorithmic constants and limits can be trivially modified, with the result being damping a non-trivial amount of long term churn without penalizing well-behaved prefixes' normal convergence process.

  16. Postirradiation flap infection about the oral cavity

    SciTech Connect

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

    1983-06-01

    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.

  17. A dynamical system for interacting flapping swimmers

    NASA Astrophysics Data System (ADS)

    Oza, Anand; Ramananarivo, Sophie; Ristroph, Leif; Shelley, Michael

    2015-11-01

    We present the results of a theoretical investigation into the dynamics of interacting flapping swimmers. Our study is motivated by the recent experiments of Becker et al., who studied a one-dimensional array of self-propelled flapping wings that swim within each other's wakes in a water tank. They discovered that the system adopts certain ``schooling modes'' characterized by specific spatial phase relationships between swimmers. To rationalize these phenomena, we develop a discrete dynamical system in which the swimmers are modeled as heaving airfoils that shed point vortices during each flapping cycle. We then apply our model to recent experiments in the Applied Math Lab, in which two tandem flapping airfoils are free to choose both their speed and relative positions. We expect that our model may be used to understand how schooling behavior is influenced by hydrodynamics in more general contexts. Thanks to the NSF for its support.

  18. Interpreting laser Doppler recordings from free flaps.

    PubMed

    Svensson, H; Holmberg, J; Svedman, P

    1993-01-01

    Although the transfer of free flaps is nowadays accomplished with an increasing degree of safety, thrombosis of the microvascular anastomoses is still a problem. In order to avoid delay in re-operating, various methods for objective blood flow monitoring have been tried, among them Laser Doppler Flowmetry (LDF). When one reviews the literature, it is apparent that opinions differ about whether or not LDF is a reliable technique for this purpose. To focus on the need to interpret continuous recordings, this paper reports our findings in six latissimus dorsi free flaps chosen from our series of LDF monitoring procedures. One uneventful flap, no. 1, had an immediate postoperative LDF value of 4.5 perfusion units (PU). LDF values improved during the recovery period and the graphic recording showed fluctuations due to normal physiological variations of the blood flow in the flap. Another uneventful flap, no. 4, showed the same pattern, though at an appreciably lower level, 2 PU, on average. Flap no. 2 had an acceptably high value of 3.5 PU despite suffering a venous thrombosis. However, the LDF recording showed no fluctuations and the value declined gradually. Another flap, no. 3, showed fluctuations and blood flow was normal although the value decreased to 2.5 PU. In flap no. 5, any value between 2 and 3.5 PU could be obtained merely by adjusting the position of the probe in the holder. In no. 6, the LDF value suddenly dropped, accompanied by a decrease in the total amount of backscattered light, indicating venous obstruction which was confirmed at re-operation.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Extending the extended V-Y flap.

    PubMed

    Prowse, Phoebe; Morton, Jonathan

    2012-06-01

    This case report demonstrates a modification of the so-called 'Extended V-Y Flap' used to simultaneously reconstruct a defect involving the upper lip, floor of nose and alar rim following tumour excision. We hope that this case serves as a reminder of the versatility of the V-Y flap in the nasolabial region, and its considerable capacity for augmentation. PMID:22018837

  20. Aerodynamic effects of flexibility in flapping wings.

    PubMed

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

    2010-03-01

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

  1. Aerodynamic effects of flexibility in flapping wings

    PubMed Central

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

    2010-01-01

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

  2. Long-term follow-up study of radial forearm free flap reconstruction after hemiglossectomy.

    PubMed

    Akashi, Masaya; Hashikawa, Kazunobu; Sakakibara, Akiko; Komori, Takahide; Terashi, Hiroto

    2015-01-01

    Previous studies on postoperative long-term results in patients who underwent reconstructive free flap transfer following hemiglossectomy had some issues, including the heterogeneity of the patient population and the observation period. The present study aimed to evaluate changes of reconstructed tongues in patients who underwent radial forearm free flap (RFFF) after hemiglossectomy with long-term follow-up. We enrolled 23 patients who underwent RFFF after hemiglossectomy with a postoperative follow-up of 5 years or more. Postoperative status (eating, speech, sensation function) was assessed by concise medical inquiries. Morphological changes of flaps were evaluated by reviewing clinical photographs. Hemiglossectomy involving the base of the tongue was performed in 4 cases (17.4%) and was limited to the mobile tongue in 19 cases (82.6%). The mean follow-up was 85.4 months (range, 60-122 months). All patients experienced gradually improved postoperative status. The most significant improvement was found between 1 and 5 years after surgery (P = 0.007), but not between 1 and 3 years (P = 0.075) or between 3 and 5 years (P = 0.530). In almost all of the flaps, there were few morphological changes throughout the follow-up period. Postoperative status in patients who underwent reconstructive RFFF following hemiglossectomy improved sequentially.

  3. [Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].

    PubMed

    Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F

    2015-06-01

    We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations. PMID:25069828

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

    PubMed

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

    2014-03-01

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

  5. Salient Points in Reconstruction of Nasal Skin after Tumor Ablation with Local Flaps

    PubMed Central

    Ebrahimi, Ali; Motamedi, Mohammad Hosein Kalantar; Nejadsarvari, Nasrin; Ebrahimi, Azin; Rasouli, Hamid Reza

    2016-01-01

    Objective: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation. Patients and Methods: From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected. Results: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications. Conclusion: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate. PMID:27761088

  6. Investigation of Energy Harvesting Using Flapping Foils

    NASA Astrophysics Data System (ADS)

    Mivehchi, Amin; Persichetti, Amanda; Dunham, Brandon; Dahl, Jason M.

    2013-11-01

    When harvesting kinetic energy using a flapping foil, the separation of coherent structures in the wake is crucial for determining forces on the body. Applications for utilizing energy harvesting with a flapping foil include powering of local, low power equipment and recharging AUV batteries that use flapping foils for propulsion and maneuvering. In each of these cases, it is critical to accurately predict the physical behavior and location of vortices in relation to the motion of the body in order to maximize energy output. A two-dimensional open source boundary data immersion method (LilyPad) is used for simulating the flapping motion of a foil for energy harvesting in a current. Forced motion of the flapping body indicates theoretical efficiencies for energy harvesting near 43 percent under specific flapping conditions. A simple control scheme based on pressure sensing on the surface of the foil is developed to control pitch of the foil while energy harvesting occurs in the heave direction. The control scheme is tested through real time numerical simulation. Comparisons are made with physical laboratory experiments, demonstrating high efficiencies in energy harvesting.

  7. Plastic Surgery

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  8. Lung surgery

    MedlinePlus

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

  9. Foot Surgery

    MedlinePlus

    ... About Feet » Foot Health Information Surgery When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Fusions: Fusions are usually performed to treat ...

  10. Effect of femtosecond and microkeratome flaps creation on the cornea biomechanics during laser in situ keratomileusis: one year follow-up

    PubMed Central

    Sun, Qian; Deng, Zheng-Zheng; Zhou, Yue-Hua; Zhang, Jing; Peng, Xiao-Yan

    2016-01-01

    AIM To compare the corneal biomechanical outcomes at one year after laser in situ keratomileusis (LASIK) with the flaps created by Ziemer and Moria M2 microkeratome with 110 head and -20 blade. METHODS Totally 100 eyes of 50 consecutive patients were enrolled in this prospective study and divided into two groups for corneal flaps created by ZiemerFemto LDV and Moria M2 microkeratome with 110 head and -20 blade. Corneal biomechanical properties including cornea resistance factor (CRF) and cornea hysteresis (CH) were measured before and 1, 3, 6, 12mo after surgery by ocular response analyzer. Central cornea thickness and corneal flap thickness were measured by optical coherence tomography. RESULTS The ablation depth (P=0.693), residual corneal thickness (P=0.453), and postoperative corneal curvature (P=0.264) were not significant different between Ziemer group and Moria 110-20 group after surgery. The residual stromal bed thickness, corneal flap thickness, CH and CRF at 12mo after surgery were significant different between Ziemer group and Moria 110-20 group (P<0.01);Ziemer group gained better corneal biomechanical results. The CRF and CH increased gradually from 1 to 12mo after surgery in Ziemer group, increased from 1 to 6mo but decreased from 6 to 12mo in Moria 110-20 group. Both CRF and CH at one year after surgery increased with the increasing of residual cornea thickness; pre-LASIK CRF, CRF also increased with residual stromal bed thickness, while CH decreased with the increasing of pre-LASIK intraocular pressure and cornea flap thickness (P<0.01). CONCLUSION In one year follow-up, femtosecond laser can provide better cornea flaps with stable cornea biomechanics than mechanical microkeratome. PMID:27803856

  11. Hairline aesthetics and styling in hair replacement surgery.

    PubMed

    Mayer, T G; Fleming, R W

    1985-01-01

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

  12. The dog-ear flap as an alternative for breast reconstruction in patients who have already undergone a DIEAP flap.

    PubMed

    Colebunders, Britt; Depypere, Bernard; Van Landuyt, Koenraad

    2016-05-01

    Breast reconstruction in patients who have previously undergone deep inferior epigastric artery perforator flap (DIEAP) reconstruction or abdominoplasty is often challenging. Depending on patients' body habitus, several second-choice flaps have been described such as the transverse upper gracilis (TUG) flap, profundus femoris artery perforator (PFAP) flap, superior gluteal artery perforator (SGAP) flap, and lumbar artery perforator (LAP) flap. Patients who have undergone a DIEAP flap reconstruction or abdominoplasty occasionally present with dog ears on both sides of the abdominal scar. The adipose tissue and skin of these dog ears are supplied by perforators of the deep circumflex iliac artery (DCIA). The DCIA flap was first described in 1979 by Taylor. We introduce this abdominal "dog-ear" flap for autologous breast reconstruction. PMID:26951847

  13. Accidental burns during surgery.

    PubMed

    Demir, Erhan; O'Dey, Dan Mon; Pallua, Norbert

    2006-01-01

    The purpose of this report is to increase awareness of intraoperative burns during standard procedures, to discuss their possible causes and warning signs and to provide recommendations for prevention and procedures to follow after their occurrence. A total of 19 patients associated with intraoperative burn accidents were treated surgically and analyzed after a mean follow-up of 5 +/- 3.5 months. Review included retrospective patient chart analysis, clinical examination, and technical device and equipment testing. A total of 15 patients recently underwent cardiac surgery, and 4 pediatric patients recovered after standard surgical procedures. A total of 15 patients had superficial and 4 presented with deep dermal or full-thickness burns. The average injured TBSA was 2.1 +/- 1% (range, 0.5-4%). Delay between primary surgery and consultation of plastic surgeons was 4.5 +/- 3.4 days. A total of 44% required surgery, including débridment, skin grafting or musculocutaneous gluteus maximus flaps, and the remaining patients were treated conservatively. Successful durable soft-tissue coverage of the burn region was achieved in 18 patients, and 1 patient died after a course of pneumonia. Technical analysis demonstrated one malfunctioning electrosurgical device, one incorrect positioned neutral electrode, three incidents occurred after moisture under the negative electrode, eight burns occurred during surgery while fluid or blood created alternate current pathways, five accidents were chemical burns after skin preparation with Betadine solution, and in one case, the cause was not clear. The surgical team should pay more attention to the probability of burns during surgery. Early patient examination and immediate involvement of plastic and burn surgeons may prevent further complications or ease handling after the occurrence.

  14. Toward noninvasive assessment of flap viability with time-resolved diffuse optical tomography: a preclinical test on rats.

    PubMed

    Di Sieno, Laura; Bettega, Georges; Berger, Michel; Hamou, Cynthia; Aribert, Marion; Mora, Alberto Dalla; Puszka, Agathe; Grateau, Henri; Contini, Davide; Hervé, Lionel; Coll, Jean-Luc; Dinten, Jean-Marc; Pifferi, Antonio; Planat-Chrétien, Anne

    2016-02-01

    The noninvasive assessment of flap viability in autologous reconstruction surgery is still an unmet clinical need. To cope with this problem, we developed a proof-of-principle fully automatized setup for fast time-gated diffuse optical tomography exploiting Mellin-Laplace transform to obtain three-dimensional tomographic reconstructions of oxy- and deoxy-hemoglobin concentrations. We applied this method to perform preclinical tests on rats inducing total venous occlusion in the cutaneous abdominal flaps. Notwithstanding the use of just four source-detector couples, we could detect a spatially localized increase of deoxyhemoglobin following the occlusion (up to 550 μM in 54 min). Such capability to image spatio-temporal evolution of blood perfusion is a key issue for the noninvasive monitoring of flap viability.

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

    PubMed Central

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

    2014-01-01

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

  16. Toward noninvasive assessment of flap viability with time-resolved diffuse optical tomography: a preclinical test on rats

    NASA Astrophysics Data System (ADS)

    Di Sieno, Laura; Bettega, Georges; Berger, Michel; Hamou, Cynthia; Aribert, Marion; Mora, Alberto Dalla; Puszka, Agathe; Grateau, Henri; Contini, Davide; Hervé, Lionel; Coll, Jean-Luc; Dinten, Jean-Marc; Pifferi, Antonio; Planat-Chrétien, Anne

    2016-02-01

    The noninvasive assessment of flap viability in autologous reconstruction surgery is still an unmet clinical need. To cope with this problem, we developed a proof-of-principle fully automatized setup for fast time-gated diffuse optical tomography exploiting Mellin-Laplace transform to obtain three-dimensional tomographic reconstructions of oxy- and deoxy-hemoglobin concentrations. We applied this method to perform preclinical tests on rats inducing total venous occlusion in the cutaneous abdominal flaps. Notwithstanding the use of just four source-detector couples, we could detect a spatially localized increase of deoxyhemoglobin following the occlusion (up to 550 μM in 54 min). Such capability to image spatio-temporal evolution of blood perfusion is a key issue for the noninvasive monitoring of flap viability.

  17. Comparing semilunar coronally positioned flap to standard coronally positioned flap using periodontal clinical parameters.

    PubMed

    Nassar, Carlos Augusto; da Silva, Wilson Aparecido Dias; Tonet, Karine; Secundes, Mayron Barros; Nassar, Patricia Oehlmeyer

    2014-01-01

    This study compared the effectiveness of 2 surgical root coverage techniques--semilunar coronally positioned flap and coronally advanced flap--using the clinical parameters of periodontal tissues from patients with Miller Class I gingival recession. Twenty patients (20-50 years of age) were selected. Basic periodontal treatment was performed, and plaque index, gingival index, probing depth, clinical attachment level, and height of the attached gingiva were determined. Each patient was placed into 1 of 2 groups: Group 1 patients underwent the semilunar coronally positioned flap technique, and Group 2 patients underwent the coronally advanced flap technique. Patients were assessed for 180 days. Both groups showed significant reduction of plaque and gingival indices and an improvement in clinical attachment levels and probing depth. However, results showed the standard coronally positioned flap technique was deemed more effective due to significant clinical attachment level gains. PMID:24598495

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

    PubMed

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

    2012-08-01

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

  19. Extended thoracodorsal artery perforator flap for breast reconstruction.

    PubMed

    Angrigiani, Claudio; Rancati, Alberto; Escudero, Ezequiel; Artero, Guillermo

    2015-12-01

    A total of 45 patients underwent partial or total autologous breast reconstruction after skin-sparing mastectomy, skin-reducing mastectomy, and quadrantectomy using a thoracodorsal artery perforator (TDAP) flap. The detailed surgical technique with its variations is explained in this report. The propeller, flip-over, conventional perforator, and muscle-sparing flaps have been described and evaluated. The flaps were partially or completely de-epithelialized. The conventional TDAP can be enlarged or "extended" as the traditional latissimus dorsi musculocutaneous (LD-MC) flap by incorporating the superior and inferior fat compartments. It can be referred to as the "extended TDAP flap". This technique augments the flap volume. In addition, this flap can serve as a scaffold for lipofilling to obtain autologous breast reconstruction in medium to large cases. There were two complete failures due to technical errors during flap elevation. Distal partial tissue suffering was observed in four flaps. These flaps were longer than usual; they reached the midline of the back. It is advisable to discard the distal medial quarter of the flap when it is designed up to the midline to avoid steatonecrosis or fibrosis. A retrospective analysis of the 39 flaps that survived completely revealed a satisfactory result in 82% of the cases. The main disadvantage of this procedure is the final scar. The TDAP flap is a reliable and safe method for partial or total breast autologous reconstruction. PMID:26645006

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

    PubMed

    Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

    2015-01-01

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

  1. A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry.

    PubMed

    Lohman, Robert F; Langevin, Claude-Jean; Bozkurt, Mehmet; Kundu, Neilendu; Djohan, Risal

    2013-01-01

    No universally accepted method of flap monitoring exists, and several techniques are in use. Repeated physical examination is most popular and is often supplemented with a handheld, external Doppler, and/or implantable Doppler probes; near-infrared spectroscopy is less commonly used. We investigated the nursing and resident house staff's experience and confidence with physical exam for flap monitoring. Also, a consecutive series of 38 patients with free flaps were monitored using physical examination, external Doppler, implantable arterial and venous Doppler probes, and near-infrared spectroscopy. Five patients developed signs of microvascular complications within 3 days of surgery; all were explored and salvaged. Neither the residents nor the nursing staff were universally trained or experienced in flap monitoring by physical exam. In all patients, changes in the appearance of the flap suggestive of a microvascular complication lagged 30 to 60 minutes after the adjunctive monitoring methods indicated that a problem had occurred. Near-infrared spectroscopy was the first warning sign in four of the five patients. Two patients were explored before thrombosis of the anastomoses occurred. Near-infrared spectroscopy may identify early microvascular complications more reliably than physical examination, external Doppler, or implantable Doppler.

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

    PubMed

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

    2015-06-01

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

  3. [Treatment of nasal saddle-back deformities using a median naso-frontal five-point star flap].

    PubMed

    Dupuis, A; Hainsdorf, F

    1983-01-01

    Severe saddle-back deformities of the nose require reconstructive surgery using bone grafts, often in association with tegmental tissue when the point of the nose is retracted. To diminish the inconveniences of the multiple techniques proposed, the procedure employed involves the use of a mesiofrontal, inter-eyebrow sliding graft with its superior point in VY, and with a pedicle consisting of the remaining tissue of the nasal ridge. Four triangular flaps arise from the edges of this flap, their apices being external and supra- or infra-eyebrow in position. They are transposed downwards for one stage, into two infra-eyebrow and infra-canthal zones. These will fill the raw surfaces to allow the bone graft to be applied. Loss of frontal substance is compensated by a VY above and by apposition of the edges laterally. The lateral flaps replace the two peri-orbital losses of substance, and give a sufficient amount of tissue on either side of the nasal ridge to enable the bone graft to be covered without excessive tension. This technique presents the advantages of being performed as a one-stage operation and of producing less scarring. The flap has the shape of a star with five branches and is termed a christmas tree flap; the pedicle is situated below and forms the roots of the tree.

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

    SciTech Connect

    Kroll, S.S.; Schusterman, M.A.; Larson, D.L.; Fender, A. )

    1990-10-01

    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.

  5. Flow field of flexible flapping wings

    NASA Astrophysics Data System (ADS)

    Sallstrom, Erik

    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

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

    PubMed Central

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

    2014-01-01

    Background: Treatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon’s skill and experience. Methods: Two hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months. Results: The preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques. Conclusions: In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques. PMID:25426383

  7. Bifurcated Superficial Temporal Artery Island Flap for the Reconstruction of a Periorbital Burn: An Innovation

    PubMed Central

    Elbatawy, Amr; Aly, Gaber M.; Ayad, Wael; Helmy, Yasser; Helmy, Emad; Sholkamy, Khallad; Dahshan, Hazem; Al-Hady, Abdallah

    2016-01-01

    Background: Facial burns represent between one-fourth and one-third of all burns. The long-term sequelae of periorbital burns include significant ectropion and lagophthalmos as a result of secondary burn contractures in the lower and upper eyelids, in addition to complete or incomplete alopecia of the eyebrows. Methods: A retrospective study of 14 reconstructive procedures for 12 postburn faces was conducted with all procedures performed since 2010 at the Department of Plastic Surgery, Al-Hussein University Hospital, and at the Craniofacial Unit, Nasser Institute Hospital. Four patients experienced chemical burns, and 8 patients experienced thermal burns. All patients underwent periorbital reconstruction using a bifurcated superficial temporal artery island flap to reconstruct the eyebrows, correct the lagophthalmos, and release the ectropion in both the upper and the lower eyelids. Two patients underwent bilateral periorbital flap reconstruction. The mean age of patients was 29 years, and the study was conducted on 8 males and 4 females. Patient satisfaction was assessed using a questionnaire completed by all patients postoperatively. Results: The complete release of both the upper and the lower eyelids was achieved in all cases, together with ideal replacement of brow hair; no complications were noted, apart from one case in which a loss of hair density in the new eyebrow was observed, combined with the partial loss of the flap in the lower eyelid. Patient satisfaction results were collected and assembled in a table. Conclusion: A bifurcated superficial temporal artery island flap is an innovative flap for reconstructing both burned eyebrows and eyelids. PMID:27482487

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

    PubMed Central

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

    2013-01-01

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

  9. Relationship between BMI and Postoperative Complications with Free Flap in Anterolateral Craniofacial Reconstruction

    PubMed Central

    Yagi, Shunjiro; Toriyama, Kazuhiro; Takanari, Keisuke; Fujimoto, Yasushi; Nishio, Naoki; Fujii, Masazumi; Saito, Kiyoshi; Takahashi, Masakatsu; Kamei, Yuzuru

    2016-01-01

    Background: Although we have seen tremendous advancement in microsurgery over the last 2 decades and free tissue transfer has become standard for head and neck reconstruction, surgeons still struggle to prevent postoperative complications. We examined the relationship between body mass index (BMI) and postoperative complications in patients undergoing rectus abdominis free flap transfer after anterolateral craniofacial resection. Methods: This was a retrospective review of reconstructive surgery using rectus abdominis musculocutaneous free flap in patients with locally advanced maxillary sinus carcinoma from 2003 to 2014 (n = 35, 27 men and 8 women; average age, 60.9 ± 7.8 years). All patients underwent craniofacial reconstruction after anterior and middle cranial fossa skull base resection and maxillectomy (class IV, subtype a) with palatal resection. Patients were categorized based on sex, BMI, and other parameters. Results: Recipient-site infection occurred in 11 patients (31.4%), cerebrospinal fluid leakage in 6 (17.1%), partial flap necrosis in 2 (5.7%), total flap necrosis in 1 (2.9%), and facial fistula in 4 (11.4%). Women showed partial flap necrosis significantly more frequently (P = 0.047), probably owing to poor vascular supply of the subcutaneous fat layer. Patients with low BMI (<20 kg/m2) showed recipient-site infection (P = 0.02) and facial fistula (P = 0.01) significantly more frequently owing to insufficient tissue volume and poor vascular supply. Conclusion: Postoperative recipient-site infection and facial fistula occurred mainly in low-BMI patients. Surgeons should take care to achieve sufficient donor tissue on low-BMI patients. Using a prosthetic obturator in low-BMI patients for craniofacial reconstruction can be a good alternative option to reduce postoperative complications due to insufficient donor tissue volume. PMID:27257566

  10. [Self-closing flaps in the treatment of scalp burns due to high-voltage electricity].

    PubMed

    Hafidi, J; El Mazouz, S; El Mejatti, H; Fejjal, N; Gharib, N E; Abbassi, A; Belmahi, A M

    2011-06-30

    Electrical burns caused by high voltage are responsible for extensive tissue damage. This damage continues in the days following the accident because of the heat deriving from the Joule effect and vascular microthrombosis. In such cases of destruction of the periostum and the calvarium we use coverage flaps. From June 1997 to June 2008, 15 patients were treated for loss of scalp substance due to high-voltage electric burns. The loss, in the tonsural region and varying in size from 9 to 11 cm, was reliably covered per primam in the first week following the accident using axial and multiple coverage flaps. We report the experience of the Division of Plastic Surgery, Ibn-Sina, Rabat, Morocco. PMID:22262963

  11. [Vascularised osteocutaneous scapular flap in the reconstruction of mandibular defects after war wounding].

    PubMed

    Stosić, S; Jović, N; Stosić-Opinca, T; Kozomara, R; Panajotović, Lj

    2005-01-01

    Vascularized osteocutaneous scapular flaps belong into the most convenient ones in reconstruction of mandibular defects followed by massive loss of adjacent skin and mucous membrane due to its vascular supply, bulkiness, suitability and mobility of cutaneous component of the flap. In seven wounded patients such defects of the mandible and adjacent soft tissues after war wounding have been reconstructed at the Clinic for Maxillofacial Surgery of the Military Medical Academy - Belgrade during the six years period with vascularized osteocutaneous scapular grafts. Here we present localization and structure of the defect, features of harvested compound graft, the procedure of reestablishment of mandibular continuity, immediate and late complications during the consolidation period, as well as the analysis of the success rate.

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

    PubMed

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

    2013-01-01

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

  13. The anterolateral thigh flap for complicated abdominal wall reconstruction after giant incisional hernia repair.

    PubMed

    Berrevoet, F; Martens, T; Van Landuyt, K; de Hemptinne, B

    2010-01-01

    In the management of giant incisional hernias with loss of domain several surgical obstacles have to be addressed. Adequate coverage of the defect using mesh, sufficient local tissue advancement and prevention of wound and mesh infections are prerequisites for success. We present a case of a complicated giant incisional hernia repair after oncologic surgery, in which we chose for an intraabdominal mesh repair using a composite mesh. The patient developed a wound dehiscence and mesh infection, successfully treated with negative pressure therapy followed by a free ALT perforator flap. Several surgical techniques are discussed to manage these complicated hernias, such as progressive pneumoperitoneum, the component separation technique and the importance of soft tissue coverage (e.g. anterolateral thigh flap). In cases of wound complications, negative pressure therapy and new soft tissue coverage are discussed.

  14. 14 CFR 25.1511 - Flap extended speed.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap extended speed. 25.1511 Section 25... Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it does not exceed the design flap speed V F chosen under §§ 25.335(e) and 25.345, for...

  15. 14 CFR 25.1511 - Flap extended speed.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flap extended speed. 25.1511 Section 25... Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it does not exceed the design flap speed V F chosen under §§ 25.335(e) and 25.345, for...

  16. 14 CFR 25.1511 - Flap extended speed.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Flap extended speed. 25.1511 Section 25... Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it does not exceed the design flap speed V F chosen under §§ 25.335(e) and 25.345, for...

  17. 14 CFR 25.1511 - Flap extended speed.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Flap extended speed. 25.1511 Section 25... Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it does not exceed the design flap speed V F chosen under §§ 25.335(e) and 25.345, for...

  18. 14 CFR 25.1511 - Flap extended speed.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flap extended speed. 25.1511 Section 25... Limitations § 25.1511 Flap extended speed. The established flap extended speed V FE must be established so that it does not exceed the design flap speed V F chosen under §§ 25.335(e) and 25.345, for...

  19. Calculation of the longitudinal aerodynamic characteristics of wing-flap configurations with externally blown flaps

    NASA Technical Reports Server (NTRS)

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

    1976-01-01

    A theoretical investigation was carried out to extend and improve an existing method for predicting the longitudinal characteristics of wing flap configurations with externally blown flaps (EBF). Two potential flow models were incorporated into the prediction method: a wing and flap lifting-surface model and a turbofan engine wake model. The wing-flap model uses a vortex-lattice approach to represent the wing and flaps. The jet wake model consists of a series of closely spaced vortex rings normal to a centerline which may have vertical and lateral curvature to conform to the local flow field beneath the wing and flaps. Comparisons of measured and predicted pressure distributions, span load distributions on each lifting surface, and total lift and pitching moment coefficients on swept and unswept EBF configurations are included. A wide range of thrust coefficients and flap deflection angles is considered at angles of attack up to the onset of stall. Results indicate that overall lift and pitching-moment coefficients are predicted reasonably well over the entire range. The predicted detailed load distributions are qualitatively correct and show the peaked loads at the jet impingement points, but the widths and heights of the load peaks are not consistently predicted.

  20. Reconstruction of eyelids with Washio flap in anophthalmia.

    PubMed

    Tvrdek, M; Kozák, J

    2014-01-01

    The authors present a case report of a patient with anophthalmia in whom retroauriculo-temporal flap (Washio flap) was used for reconstruction of eyelids. This flap, which is mostly used for reconstructions of nasal defects, was not used in this way according to available literature.

  1. Flap Thickness in Eyes with Ectasia after LASIK

    PubMed Central

    Randleman, J. Bradley; Hebson, Carolyn B.; Larson, Paul M.

    2015-01-01

    Purpose To measure central flap thickness in eyes with ectasia after LASIK and to compare these values with estimated anticipated flap thickness based on average published values for each device used for flap creation. Setting Emory Vision at Emory University, Atlanta GA, USA Methods Confocal microscopic analysis using the Confoscan 3 (Nidek technologies) to measure central flap thickness in eyes with ectasia after LASIK, and evaluation of pre-LASIK records, including basic patient demographics, preoperative corneal topographies, estimated anticipated flap thickness based on published average thickness values, and residual stromal bed thickness (RSB) calculations using both measured and estimated flap thicknesses. Results Fifty eyes from 29 patients were evaluated. Average measured flap thickness was (138 ± 26 μ, range 90 to 220 μ). There were no significant differences between measured and estimated flap thicknesses (138 vs. 135 μ, p = 0.5) or RSB (329 vs. 332 μ, p = 0.7), nor were there any differences in flap thickness between eyes with normal or abnormal corneal topographies. Only one eye had a measured flap resulting in unintended RSB < 250 microns; this occurred in an eye with abnormal topography. Conclusions Measured central flap thickness was not thicker than estimated for the vast majority of eyes developing ectasia after LASIK. Thus, excessively thick flaps do not appear to be a major contributing factor to the pathogenesis of ectasia after LASIK. PMID:22424807

  2. The distally based forearm island flap in hand reconstruction.

    PubMed

    Jeng, S F; Wei, F C

    1998-08-01

    The distally based forearm island flap is vascularized by the perforators of the distal radial artery. The skin flap is along the axis of the radial artery, and the pivot point of its subcutaneous pedicle is about 2 to 4 cm above the radial styloid process. We have treated 12 patients with 12 flaps for soft-tissue defects of the hand. Of these recipient sites, seven were in dorsal hands, two were in thumbs, two were in forearms, and one was in the palmar area. The donor-tissue variants included eight skin flaps, two adipofascial flaps, and two sensate flaps. The sizes of the flaps ranged from 6 x 4 cm to 14 x 6 cm. The donor site wound could be closed primarily in five patients. Two sensate flaps, innervated by the lateral antebrachial cutaneous nerve, could provide sensation for thumb reconstruction. The advantage of this flap is its constant and reliable blood supply without sacrifice of the main radial artery. The elevation of the flap is simple and rapid. There is the potential that this flap can be used as an innervated flap, and there is no need of microsurgical technique.

  3. 14 CFR 23.1511 - Flap extended speed.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it...

  4. 14 CFR 23.1511 - Flap extended speed.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it...

  5. 14 CFR 23.1511 - Flap extended speed.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it...

  6. 14 CFR 23.1511 - Flap extended speed.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it...

  7. 14 CFR 23.1511 - Flap extended speed.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Flap extended speed. 23.1511 Section 23.1511 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT... Information § 23.1511 Flap extended speed. (a) The flap extended speed V FE must be established so that it...

  8. Posttraumatic eyebrow reconstruction with hair-bearing temporoparietal fascia flap.

    PubMed

    Denadai, Rafael; Raposo-Amaral, Cassio Eduardo; Marques, Frederico Figueiredo; Raposo-Amaral, Cesar Augusto

    2015-01-01

    The temporoparietal fascia flap has been extensively used in craniofacial reconstructions. However, its use for eyebrow reconstruction has been sporadically reported. We describe a successfully repaired hair-bearing temporoparietal fascia flap after traumatic avulsion of eyebrow. Temporoparietal fascia flap is a versatile tool and should be considered as a therapeutic option by all plastic surgeons.

  9. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Wing flap position indicator. 23.699 Section 23.699 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap...

  10. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Wing flap position indicator. 23.699 Section 23.699 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap...

  11. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Wing flap position indicator. 23.699 Section 23.699 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap...

  12. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Wing flap position indicator. 23.699 Section 23.699 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap...

  13. 14 CFR 23.699 - Wing flap position indicator.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Wing flap position indicator. 23.699 Section 23.699 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... Construction Control Systems § 23.699 Wing flap position indicator. There must be a wing flap...

  14. Numerical linearized MHD model of flapping oscillations

    NASA Astrophysics Data System (ADS)

    Korovinskiy, D. B.; Ivanov, I. B.; Semenov, V. S.; Erkaev, N. V.; Kiehas, S. A.

    2016-06-01

    Kink-like magnetotail flapping oscillations in a Harris-like current sheet with earthward growing normal magnetic field component Bz are studied by means of time-dependent 2D linearized MHD numerical simulations. The dispersion relation and two-dimensional eigenfunctions are obtained. The results are compared with analytical estimates of the double-gradient model, which are found to be reliable for configurations with small Bz up to values ˜ 0.05 of the lobe magnetic field. Coupled with previous results, present simulations confirm that the earthward/tailward growth direction of the Bz component acts as a switch between stable/unstable regimes of the flapping mode, while the mode dispersion curve is the same in both cases. It is confirmed that flapping oscillations may be triggered by a simple Gaussian initial perturbation of the Vz velocity.

  15. 50 CFR Figure 16 to Part 223 - Escape Opening and Flap Dimensions for the Double Cover Flap TED

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE... AND ANADROMOUS SPECIES Pt. 223, Fig. 16 Figure 16 to Part 223—Escape Opening and Flap Dimensions...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE... AND ANADROMOUS SPECIES Pt. 223, Fig. 16 Figure 16 to Part 223—Escape Opening and Flap Dimensions...

  17. 50 CFR Figure 16 to Part 223 - Escape Opening and Flap Dimensions for the Double Cover Flap TED

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 50 Wildlife and Fisheries 10 2014-10-01 2014-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES... for the Double Cover Flap TED ER02JN04.003...

  18. 50 CFR Figure 16 to Part 223 - Escape Opening and Flap Dimensions for the Double Cover Flap TED

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 50 Wildlife and Fisheries 10 2013-10-01 2013-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES... for the Double Cover Flap TED ER02JN04.003...

  19. Airplane wing leading edge variable camber flap

    NASA Technical Reports Server (NTRS)

    Cole, J. B.

    1980-01-01

    The invention and design of an aerodynamic high lift device which provided a solution to an aircraft performance problem are described. The performance problem of converting a high speed cruise airfoil into a low speed aerodynamic shape that would provide landing and take-off characteristics superior to those available with contemporary high lift devices are addressed. The need for an improved wing leading edge device that would complement the high lift performance of a triple slotted trailing edge flap is examined. The mechanical and structural aspects of the variable camber flap are discussed and the aerodynamic performance aspects only as they relate to the invention and design of the device are presented.

  20. Flap Edge Aeroacoustic Measurements and Predictions

    NASA Technical Reports Server (NTRS)

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

    2000-01-01

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

  1. [Aseptic bone flap osteonecrosis following cranioplasty after decompressive cranietomy].

    PubMed

    Smoll, Nicolas R; Stienen, Martin N; Schaller, Karl; Gautschi, Oliver P

    2013-06-19

    This case report discusses a case of aseptic osteonecrosis in a cranioplasty bone flap after decompressive craniectomy, which is a known, but rare complication after autologous cranioplasty. We suggest that the pathophysiology of cranial bone flap necrosis may have a similar pathophysiology to free flap necrosis/failure. The key suggested problem causing the osteonecrosis is vessel thrombosis within the smaller vessels of the bone flap due to the prothrombotic effects of the factors released during drilling of the bone flap. Suspicious local findings like wound dehiscence or fluid leakage should lead to a head computed tomography in order to discuss a prophylactic artificial second cranioplasty if necessary. PMID:23773942

  2. After Surgery

    MedlinePlus

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

  3. Turbinate surgery

    MedlinePlus

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

  4. Results and Complications of 1104 Surgeries for Velopharyngeal Insufficiency

    PubMed Central

    Hirschberg, Jenő

    2012-01-01

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

  5. Review of Skull Base Reconstruction Using Locoregional Flaps and Free Flaps in Children and Adolescents

    PubMed Central

    Yano, Tomoyuki; Tanaka, Kentarou; Kishimoto, Seiji; Iida, Hideo; Okazaki, Mutsumi

    2011-01-01

    Tumors of the skull base are rare in children, and reconstruction in such patients has rarely been reported. We reviewed 16 cases of skull base reconstruction in patients under 18 years. The study group consisted of 10 boys and 6 girls, whose ages ranged from 2 to 17 years. Of the 16 cases, eight tumors were benign and eight were malignant. Defects were anterior in six cases, lateral in eight cases, and anterolateral in two cases. Reconstruction was performed with locoregional flaps in 11 cases and with free flaps in 5 cases. No significant difference was found between locoregional flaps and free flaps in total operative time, intraoperative blood loss, or postoperative hospital stay. However, in some cases, total operative time, reconstruction time, and blood loss increased to a degree unacceptable for pediatrics. Minor complications occurred in three patients and a major complication occurred in one case. Of four patients, three patients with postoperative complications had undergone chemoradiotherapy. Because of the physical weakness of pediatric patients, complicated reconstructive procedure should be avoided. We believe locoregional flaps will become the first choice for reconstruction. However, if patients have large, complex defects and have received radiotherapy, appropriate free flaps should be used to avoid postoperative complications. PMID:22547961

  6. Flapping wing aerodynamics: from insects to vertebrates.

    PubMed

    Chin, Diana D; Lentink, David

    2016-04-01

    More than a million insects and approximately 11,000 vertebrates utilize flapping wings to fly. However, flapping flight has only been studied in a few of these species, so many challenges remain in understanding this form of locomotion. Five key aerodynamic mechanisms have been identified for insect flight. Among these is the leading edge vortex, which is a convergent solution to avoid stall for insects, bats and birds. The roles of the other mechanisms - added mass, clap and fling, rotational circulation and wing-wake interactions - have not yet been thoroughly studied in the context of vertebrate flight. Further challenges to understanding bat and bird flight are posed by the complex, dynamic wing morphologies of these species and the more turbulent airflow generated by their wings compared with that observed during insect flight. Nevertheless, three dimensionless numbers that combine key flow, morphological and kinematic parameters - the Reynolds number, Rossby number and advance ratio - govern flapping wing aerodynamics for both insects and vertebrates. These numbers can thus be used to organize an integrative framework for studying and comparing animal flapping flight. Here, we provide a roadmap for developing such a framework, highlighting the aerodynamic mechanisms that remain to be quantified and compared across species. Ultimately, incorporating complex flight maneuvers, environmental effects and developmental stages into this framework will also be essential to advancing our understanding of the biomechanics, movement ecology and evolution of animal flight. PMID:27030773

  7. Flapping wing aerodynamics: from insects to vertebrates.

    PubMed

    Chin, Diana D; Lentink, David

    2016-04-01

    More than a million insects and approximately 11,000 vertebrates utilize flapping wings to fly. However, flapping flight has only been studied in a few of these species, so many challenges remain in understanding this form of locomotion. Five key aerodynamic mechanisms have been identified for insect flight. Among these is the leading edge vortex, which is a convergent solution to avoid stall for insects, bats and birds. The roles of the other mechanisms - added mass, clap and fling, rotational circulation and wing-wake interactions - have not yet been thoroughly studied in the context of vertebrate flight. Further challenges to understanding bat and bird flight are posed by the complex, dynamic wing morphologies of these species and the more turbulent airflow generated by their wings compared with that observed during insect flight. Nevertheless, three dimensionless numbers that combine key flow, morphological and kinematic parameters - the Reynolds number, Rossby number and advance ratio - govern flapping wing aerodynamics for both insects and vertebrates. These numbers can thus be used to organize an integrative framework for studying and comparing animal flapping flight. Here, we provide a roadmap for developing such a framework, highlighting the aerodynamic mechanisms that remain to be quantified and compared across species. Ultimately, incorporating complex flight maneuvers, environmental effects and developmental stages into this framework will also be essential to advancing our understanding of the biomechanics, movement ecology and evolution of animal flight.

  8. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control... airplanes, it must be designed to account for the unsummetrical loads resulting from flight with the engines... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  9. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control... airplanes, it must be designed to account for the unsummetrical loads resulting from flight with the engines... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  10. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control... airplanes, it must be designed to account for the unsummetrical loads resulting from flight with the engines... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  11. 14 CFR 23.701 - Flap interconnection.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control... airplanes, it must be designed to account for the unsummetrical loads resulting from flight with the engines... independent of the flap drive system; or by an approved equivalent means; or (2) Be designed so that...

  12. Enhanced Correlation of SMART Active Flap Rotor Loads

    NASA Technical Reports Server (NTRS)

    Kottapalli, Sesi

    2011-01-01

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

  13. A Miniature Controllable Flapping Wing Robot

    NASA Astrophysics Data System (ADS)

    Arabagi, Veaceslav Gheorghe

    The agility and miniature size of nature's flapping wing fliers has long baffled researchers, inspiring biological studies, aerodynamic simulations, and attempts to engineer their robotic replicas. Flapping wing flight is characterized by complex reciprocating wing kinematics, transient aerodynamic effects, and very small body lengths. These characteristics render robotic flapping wing aerial vehicles ideal for surveillance and defense applications, search and rescue missions, and environment monitoring, where their ability to hover and high maneuverability is immensely beneficial. One of the many difficulties in creating flapping wing based miniature robotic aerial vehicles lies in generating a proper wing trajectory that would result in sufficient lift forces for hovering and maneuvering. Since design of a flapping wing system is a balance between overall weight and the number of actuated inputs, we take the approach of having minimal controlled inputs, allowing passive behavior wherever possible. Hence, we propose a completely passive wing pitch reversal design that relies on wing inertial dynamics, an elastic energy storage mechanism, and low Reynolds number aerodynamic effects. Theoretical models, compiling previous research on piezoelectric actuators, four-bar transmissions, and aerodynamics effects, are developed and used as basis for a complete numerical simulation. Limitations of the model are discussed in comparison to experimental results obtained from a working prototype of the proposed passive pitch reversal flapping wing mechanism. Given that the mechanism is under-actuated, methods to control lift force generation by actively varying system parameters are proposed, discussed, and tested experimentally. A dual wing aerial platform is developed based on the passive pitch reversal wing concept. Design considerations are presented, favoring controllability and structural rigidity of the final platform. Finite element analysis and experimental

  14. Effect of adrenergic stimulation on cutaneous microcirculation immediately after surgical adventitiectomy in a rat skin flap model.

    PubMed

    Lecoq, Jean-Pierre H; Joris, Jean L; Nelissen, Xavier P; Lamy, Maurice L; Heymans, Olivier Y

    2008-01-01

    Chronic sympathetic denervation leads to the development of supersentivity to adrenergic agents. Free flap surgery results in the disruption of the autonomic nerve fibers running along the anastomosed vessels. We therefore investigated the early effect of surgical sympathectomy on the reactivity of cutaneous microcirculation challenged to adrenergic agents. Two epigastric flaps were elevated and exposed in 15 rats. On the right flap (Side A), a circular adventitiectomy of the feeder vessels was realized to provide surgical sympathectomy. On the left flap (Side N), vessels were kept intact. The following drugs were then given intravenously successively: phenylephrine (10 and 15 microg kg(-1)), norepinephrine (10 microg kg(-1)), prazocin (1 mg kg(-1)) followed by norepinephrine (10 microg kg(-1)). Cutaneous microcirculation was assessed using Laser-Doppler Flowmeters simultaneously on the two flaps after each drug administration. Mean arterial pressure was also measured. On side N, phenylephrine and norepinephrine resulted in a transient increase in cutaneous microcirculation followed by a more prolonged reduction. On side A, only the initial increase was observed, which was greater and longer as compared with side N, and paralleled the increase in mean arterial pressure. After prazocin pre-treatment, norepinephrine produced a transient increase in cutaneous microcirculation similar on both sides, and parallel to the changes in arterial pressure. No decrease in cutaneous microcirculation was observed. Immediately after surgical adventitiectomy, the vasoconstriction produced by alpha-adrenergic agents is prevented. No denervation-induced hypersentivity is observed. Surgical sympathectomy might protect cutaneous flaps from vasoconstriction induced by endogenous catecholamines release. PMID:18623150

  15. Stein’s Double Cross-Lip Flaps Combined with Johanson’s Step Technique for Subtotal Lower Lip Reconstruction

    PubMed Central

    Roldán, J. Camilo

    2016-01-01

    Background: In a previous study, a single cross-lip flap (Abbe flap) combined with Johanson’s step technique for repair of defects of more than 2/3 of the lower lip was superior, in terms of aesthetic and functional outcome, compared with Bernard Webster–related techniques (cheek advancement). Herewith, a double cross-lip flap (Stein procedure) is proposed for repair of subtotal lower lip defects. A systematic review of the Stein procedure is provided. Methods: Two patients underwent a paramedian double cross-lip flap, preserving the aesthetic subunit philtrum column combined with the Johanson’s step technique. The aesthetic and functional outcomes and the surgical steps are demonstrated in the videos. An electromyographic study was performed 6 months and 4 years after surgery. A PubMed and a Google Scholar search were performed for the Stein procedure published in 1848. Results: Lip competence was achieved directly after sectioning of the cross-lip pedicles in both patients. Lips progressivity expanded in the first 6 months. No microstomia was observed. Electromyography showed successful reinnervation of the transplanted muscles at 6 months. Four years after surgery, the electromyographic findings were consolidated. Since 1975, 7 articles on the double cross-lip procedure have been published: 4 in English, 1 in French, and 2 in Japanese. None of those articles reported on any supplemental lower lip advancement or on any electromyographic study. Conclusions: The rationale of using 2 cross-lip flaps and a lip-cheek advancement according to Johanson seems to achieve functionally and aesthetically superior results compared with other techniques described for subtotal lower lip reconstruction. PMID:27014544

  16. [Minimally invasive breast surgery].

    PubMed

    Mátrai, Zoltán; Gulyás, Gusztáv; Kunos, Csaba; Sávolt, Akos; Farkas, Emil; Szollár, András; Kásler, Miklós

    2014-02-01

    Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil

  17. Perforator arteries of the medial upper arm: anatomical basis of a new flap donor site.

    PubMed

    Perignon, D; Havet, E; Sinna, R

    2013-01-01

    The development of perforator flaps' concept based on knowledge on vascular anatomy of the skin represents a major improvement in reconstructive surgery. Succeeding description about vascular territories and anatomical basics of the main donor sites, the study of hidden donor sites, such as medial upper arm, constitutes a new step and an additional refinement. 20 upper limbs of 10 fresh adult cadavers were studied with colored latex injections. The origin and distribution of the perforator arteries of the superior ulnar collateral artery and the brachial artery were investigated. We have noted constant perforator arteries and described the limits of vascular territories of the medial upper arm.

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

    PubMed Central

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

    2013-01-01

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

  19. Combined V-Y Fasciocutaneous Advancement and Gluteus Maximus Muscle Rotational Flaps for Treating Sacral Sores

    PubMed Central

    Choi, Eun Jeong; Moon, Suk Ho; Lee, Yoon Jae

    2016-01-01

    The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients' age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%). Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p = 0.087). Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity. PMID:27366755

  20. Microcirculatory Evaluation of the Abdominal Skin in Breast Reconstruction with Deep Inferior Epigastric Artery Perforator Flap

    PubMed Central

    Tønseth, Kim Alexander; Pripp, Are Hugo; Tindholdt, Tyge Tind

    2016-01-01

    Background: No studies have assessed the perfusion of the undermined abdominal skin in breast reconstruction with deep inferior epigastric artery perforator flap. A greater understanding of the procedure’s impact on the perfusion of the abdominal skin can be valuable in predicting areas susceptible to necrosis. Methods: Microcirculatory changes were monitored in the abdominal skin of 20 consecutive patients undergoing breast reconstruction with a deep inferior epigastric artery perforator flap. Quantitative mapping was performed with laser Doppler perfusion imaging at 7 set intervals. Measurements were taken and recorded within 4 standardized zones covering the skin between the xiphoid process and the upper incisional boundary of the flap (zones 1–4; cranial to caudal). Results: Before commencing surgery, a significantly higher perfusion was registered in zones 3 and 4 when compared with zone 1. After undermining the abdominal skin, the perfusion in zones 1–3 increased significantly. After the abdominal closure, the perfusion dropped in all 4 zones and only the perfusion level in zone 1 remained significantly higher than preoperative mean. Postoperatively, the perfusion of each zone stabilized at a significantly higher level compared with preoperative values. No tissue necrosis was observed in any of the zones. Conclusions: Although perforators are divided during undermining of the abdominal skin, there seems to be a reactive hyperemia that exceeds the blood supply delivered by the perforators. Thus, due to microcirculatory mechanisms, the undermining of the abdomen during the procedure does not seem to present any great risk of tissue necrosis. PMID:27014545

  1. Penile reconstruction: combined use of an innervated forearm osteocutaneous flap and big toe pulp.

    PubMed

    Sasaki, K; Nozaki, M; Morioka, K; Huang, T T

    1999-09-01

    The use of a radial forearm flap has become the most popular method to reconstruct a phallus in recent years. This method of reconstruction, however, is plagued with problems such as urethral fistula and loss of phallic girth as a result of tissue atrophy, rendering a phallic contour that is cosmetically unsatisfactory. We had the opportunity of modifying the technique of penile reconstruction using a forearm osteocutaneous flap to minimize these problems. Specifically, a segment of the big toe pulp is used to reconstruct a glans penis. Sensory restoration in the "glans" and "penile shaft" is restored by coapting the digital and the antebrachial nerves to the penile nerve remnants. A segment of flexor carpi radialis muscle is included in the design of a forearm flap to reinforce the coaptation site of the urethral tract. An arteriovenous shunt is incorporated in the shaft as a mechanism to elicit erection of the penis by compressing the root of the neophallus. We had used these technical modifications in a 51-year-old man who had undergone penile amputation because of cancer. The cosmetic appearance and erotic and tactile sensation in the shaft and glans were proper and satisfactory at the end of fourth year after the surgery. The coital function was also satisfactory. PMID:10654748

  2. Pharmacologic partial salvage of a failing free flap with recombinant tissue plasminogen activator (rt-PA).

    PubMed

    Atiyeh, B S; Fuleihan, N S; Musharafieh, R S

    1999-11-01

    Despite all the technical improvements in microvascular surgery and the experience gained in clinical practice, thrombosis at the site of microanastomosis remains a significant problem and a continuous source of frustration to most microsurgeons. Early recognition of vascular complications and prompt reexploration with vascular revision remain an essential and standard conduct for salvage. However, in situations where conditions for no-reflow have been established due to severe vasospasm or prolonged ischemia time, it becomes obvious that surgical reexploration alone is not enough to salvage a failing flap or a replanted limb. In such situations, the loss of the revascularized tissues seems to be inevitable. The authors describe their experience in partially salvaging a failing free flap with recombinant tissue plasminogen activator (rt-PA), reversing an established state of no-reflow. Pharmacologic manipulation of the complex and variable factors influencing anastomotic patency in microvascular tissue transfer seems to offer a new hope for preventing failures, as well as for salvaging failing flaps. It appears also that free-tissue transfer failure is not an all-or-none phenomenon.

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

    PubMed

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

    2015-11-01

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

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

    PubMed

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

    2014-09-01

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

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

    PubMed

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

    2014-02-01

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

  6. The innervated anterolateral thigh flap: anatomical study and clinical implications.

    PubMed

    Ribuffo, Diego; Cigna, Emanuele; Gargano, Francesco; Spalvieri, Cristina; Scuderi, Nicolò

    2005-02-01

    During the past 20 years, the neural anatomy of many flaps has been investigated, although no extensive studies have been reported yet on the anterolateral thigh flap. The goal of this study was to describe the sensory territories of the nerves supplying the anterolateral thigh flap with dissections on fresh cadavers and with local anesthetic injections in living subjects. The sensate anterolateral thigh flap is typically described as innervated by the lateral cutaneous femoral nerve. Two other well-known nerves, the superior perforator nerve and the median perforator nerve, which enter the flap at its medial border, might have a role in anterolateral thigh flap innervation. Twenty-nine anterolateral thigh flaps were elevated in 15 cadavers, and the lateral cutaneous femoral nerve, the superior perforator nerve, and median perforator nerve were dissected. In the injection study, the lateral cutaneous femoral nerve, superior perforator nerve, and median perforator nerve in 16 thighs of eight subjects were sequentially blocked. The resulting sensory deficit from each injection was mapped on the skin and superimposed on the marked anterolateral thigh flap territory. The study shows that the sensate anterolateral thigh flap is basically innervated by all three nerves. The lateral cutaneous femoral nerve was present in 29 of 29 thighs, whereas the superior perforator nerve was present in 25 of 29 and the median perforator nerve in 24 of 29 thighs. Furthermore, in the proximal half of the flap, the lateral cutaneous femoral nerve lies deep, whereas the superior perforator nerve and median perforator nerve lie more superficially. Whereas the lateral cutaneous femoral nerve innervates the entire flap, the superior perforator nerve innervates 25 percent of the flap and the median perforator nerve innervates 60 percent of the flap. Clinically, a small anterolateral thigh flap (7 x 5 cm) can be raised sparing the lateral cutaneous femoral nerve and using only the selective

  7. Effects of Acellular Amniotic Membrane Matrix and Bone Marrow-Derived Mesenchymal Stem Cells in Improving Random Skin Flap Survival in Rats

    PubMed Central

    Chehelcheraghi, Farzaneh; Eimani, Hossein; Homayoonsadraie, Seyed; Torkaman, Giti; Amini, Abdollah; Alavi Majd, Hamid; Shemshadi, Hashem

    2016-01-01

    Background The necrotic skin flap represents a great challenge in plastic and reconstructive surgery. In this study, we evaluated the effect of bioscaffolds, acellular amniotic membranes (AAMs), and bone marrow-derived mesenchymal stem cells (BM-MSCs) on random skin flap (RSF) survival in rats by applying a cell-free extracellular matrix scaffold as a supportive component for the growth and proliferation of BM-MSCs on RSFs. AAM matrix scaffolds were created by incubating AMs in ethylenediaminetetraacetic acid 0.05% at 37°C, and cell scrapers were used. Objectives The aim of the present study was to assess the effect of AAM as a scaffold in TE, and combined with transplanted BM-MSCs, on the survival of RSFs and on the biomechanical parameters of the incision-wound flap margins 7 days after flap elevation. Materials and Methods BM-MSCs and AAMs were transplanted into subcutaneous tissue in the flap area. On the 7th postoperative day, the surviving flap areas were measured using digital imaging software, and the flap tissue was collected for evaluation. Forty rats were randomly divided into four groups of 10 each: group 1 received an AAM injection; group 2 underwent BM-MSC transplantation; group 3 received both AAM injection + BM-MSC transplantation; and group 4 was the control group, receiving only saline. Results The survival area in the AAM/BM-MSC group was significantly higher than in the control group (18.49 ± 1.58 versus 7.51 ± 2.42, P < 0.05). The biomechanical assessment showed no significant differences between the experimental groups and the control group (P > 0.05), and there was no correlation with flap survival. Conclusions Our findings showed that the treatment of flaps with BM-MSC and AAM transplantations significantly promoted flap survival compared to a control group. The viability of the flap was improved by combining BM-MSCs with AAM matrix scaffolds. PMID:27621924

  8. Reconstruction of pressure sores with perforator-based propeller flaps.

    PubMed

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

    2011-03-01

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

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

    PubMed Central

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

    2013-01-01

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

  10. Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

    PubMed Central

    Unukovych, Dmytro; Gallego, Camilo Hernandez; Aineskog, Helena; Rodriguez-Lorenzo, Andres

    2016-01-01

    Background: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure. Patients and Methods: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins. Results: In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023). Conclusions: The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in

  11. Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

    PubMed Central

    Unukovych, Dmytro; Gallego, Camilo Hernandez; Aineskog, Helena; Rodriguez-Lorenzo, Andres

    2016-01-01

    Background: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure. Patients and Methods: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins. Results: In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023). Conclusions: The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in

  12. Unilobed Rotational Flap for Plantar Hallux Interphalangeal Joint Ulceration Complicated by Osteomyelitis.

    PubMed

    Boffeli, Troy J; Hyllengren, Shelby B

    2015-01-01

    Diabetes-related neuropathic ulcers located at the plantar aspect of the hallux interphalangeal joint are often chronic or recurrent and frequently become complicated by osteomyelitis. Once infected, treatment will typically involve hallux amputation. Although intended as a definitive procedure, amputation of the first toe is not desirable from a cosmetic or functional standpoint and often leads to transfer ulcers at adjacent locations of the foot. Reconstructive wound surgery, combined with limited bone resection, is possible if the infection is caught early before the local tissue and bone have become necrotic. In addition to neuropathy, biomechanical issues, including ankle equinus, hallux limitus, hallux extensus, and hallux valgus, predispose patients with diabetes mellitus to developing plantar hallux ulcers. We commonly employ a proximal based unilobed plantar rotational flap combined with hallux interphalangeal joint arthroplasty as an alternative to hallux amputation. We present a typical case with long-term follow-up to highlight our flap protocol, including patient selection criteria, flap design, surgical technique, bone resection and biopsy pearls, staging timeline, and a typical postoperative course. Periodic follow-up during the next 72 months for unrelated conditions allowed long-term monitoring with no recurrence of osteomyelitis or subsequent amputation. The foot remained ulcer free 6 years later. The benefits of this surgical approach include complete excision of the ulcer, adequate exposure for bone resection, early bone biopsy before the spread of infection or necrosis of local tissue, flap coverage with viable soft tissue, and partial offloading of mechanical pressure at the plantar interphalangeal joint.

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

    PubMed

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

    2012-08-01

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

  14. Power performance optimization and loads alleviation with active flaps using individual flap control

    NASA Astrophysics Data System (ADS)

    Pettas, Vasilis; Barlas, Thanasis; Gertz, Drew; Madsen, Helge A.

    2016-09-01

    The present article investigates the potential of Active Trailing Edge Flaps (ATEF) in terms of increase in annual energy production (AEP) as well as reduction of fatigue loads. The basis for this study is the DTU 10 MW Reference Wind Turbine (RWT) simulated using the aeroelastic code HAWC2. In an industrial-oriented manner the baseline rotor is upscaled by 5% and the ATEFs are implemented in the outer 30% of the blades. The flap system is kept simple and robust with a single flap section and control with wind speed, rotor azimuth, root bending moments and angle of attack in flap's mid-section being the sensor inputs. The AEP is increased due to the upscaling but also further due to the flap system while the fatigue loads in components of interest (blade, tower, nacelle and main bearing) are reduced close to the level of the original turbine. The aim of this study is to demonstrate a simple and applicable method that can be a technology enabler for rotor upscaling and lowering cost of energy.

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

    PubMed

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

    2006-04-01

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

  16. Changes in quantitative norepinephrine levels in delayed pig flank flaps.

    PubMed

    Cutting, C; Bumsted, R; Bardach, J; Mooney, M; Johnson, S

    1982-04-01

    A quantitative norepinephrine assay was used to follow tissue norepinephrine concentrations serially in bipedicle delayed pig flank flaps. In contrast to a previous study by Palmer, norepinephrine concentration decreased significantly after 24 hr, but then gradually returned to normal at 10 days. This suggests that the pig flank flap maintains much of its adrenergic innervation following bipedicle delay. It appears unlikely that adrenergic denervation explains the delay phenomenon in this model. The combined results of this study and others suggest that the degree of adrenergic denervation of a flap is determined by the anatomic layout of the flap with respect to the underlying cutaneous adrenergic neural anatomy. This experiment suggests that the effectiveness of adrenergic blocking agents in improving flap survival is dependent on the degree of adrenergic denervation of the flap.

  17. Versatility of V-Y Flap in Gluteal Area

    PubMed Central

    El-Sabbagh, Ahmed

    2016-01-01

    BACKGROUND Lesions in perineal area are common. The usual treatment is coverage by skin graft and flaps which may be local, pedicled or free types. In this paper V-Y flaps were used to cover the defects. METHODS V-Y flaps were used in the gluteal area in 15 patients. Lesions were due to different causes. RESULTS Of 15 patients, 11 were males and 4 were females. Their ages ranged from 3 weeks to 52 years old. Two cases were due to myelomeningocele, necrotizing fasciitis (2 cases) and the rest were due to bed sores (11 cases). The flaps were located over the trochanter (3 cases), ischial (6 cases) and sacral (6 cases). Good healing and durable coverage were obtained in all cases except one case. CONCLUSION V-Y flap as a working horse flap is recommended in the gluteal area. PMID:27579271

  18. Strabismus Surgery

    MedlinePlus

    ... used. Some surgeons prescribe an antibiotic or combination antibiotic/steroid drop or ointment after surgery. More technical ... Screening Recommendations Loading... Most Common Searches Adult ...

  19. Forward speed effects on blown flap noise

    NASA Technical Reports Server (NTRS)

    Pennock, A. P.

    1977-01-01

    The effects of forward speed on the noise of under-the-wing (externally blown flaps, EBF) and over-the-wing (upper surface blown, USB) blown flap configurations were measured in wind tunnel model tests with cold jets. The results are presented without correction for the effects (e.g., signal convection, shear layer refraction) associated with flight simulation in a wind tunnel or free jet facility. Noise decreases were generally observed at microphones forward of the wing. The reductions were larger at the low frequencies (below peak SPL) than at the high (above peak SPL). Noise increases of 10 dB or more were observed at the aft microphones, especially in the high frequency range.

  20. Aerosound from corner flow and flap flow

    NASA Technical Reports Server (NTRS)

    Meecham, W. C.

    1982-01-01

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

  1. [Pedicled versus free TRAM flap for breast reconstruction].

    PubMed

    Galla, T J; Lukas, B; Feller, A M

    1999-03-01

    In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

  2. USB noise reduction by nozzle and flap modifications

    NASA Technical Reports Server (NTRS)

    Hayden, R. E.

    1976-01-01

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

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

    NASA Technical Reports Server (NTRS)

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

    1977-01-01

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

  4. Flapping instability of a liquid jet

    NASA Astrophysics Data System (ADS)

    Matas, Jean-Philippe; Cartellier, Alain

    2013-01-01

    We study the flapping instability observed when a liquid jet is incompletely atomized by a fast parallel gas stream: the remaining liquid jet is destabilized over a scale large compared with its radius, and breaks into liquid fragments. We characterize the symmetry of this instability and its frequency. The intact liquid length is measured as a function of gas and liquid velocity, and turns out to be longer than the one predicted by Raynal (1997) for a planar mixing layer. The frequency of the instability is measured with a spectral method, and is in agreement with the frequency observed for the planar shear instability, though slightly smaller. The planar, and not helical, symmetry of the instability makes it akin to a flapping instability, observed when a planar liquid sheet is atomized by two planar gas streams. We next measure drop sizes when the flapping instability is present, with a method based on image processing. Measured size distributions are in agreement with distributions observed in a mixing layer geometry for low gas velocities (long tail distribution). The mean drop diameter depends weakly on liquid velocity, and decreases as d10˜Ug0.9. On the contrary, Sauter diameter depends strongly on liquid velocity.

  5. Evaluation of flexible flapping wing concept

    NASA Astrophysics Data System (ADS)

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

    2009-03-01

    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.

  6. Flapping inertia for selected rotor blades

    NASA Technical Reports Server (NTRS)

    Berry, John D.; May, Matthew J.

    1991-01-01

    Aerodynamics of helicopter rotor systems cannot be investigated without consideration for the dynamics of the rotor. One of the principal properties of the rotor which affects the rotor dynamics is the inertia of the rotor blade about its root attachment. Previous aerodynamic investigation have been performed on rotor blades with a variety of planforms to determine the performance differences due to blade planform. The blades tested for this investigation have been tested on the U.S. Army 2 meter rotor test system (2MRTS) in the NASA Langley 14 by 22 foot subsonic tunnel for hover performance. This investigation was intended to provide fundamental information on the flapping inertia of five rotor blades with differing planforms. The inertia of the bare cuff and the cuff with a blade extension were also measured for comparison with the inertia of the blades. Inertia was determined using a swing testing technique, using the period of oscillation to determine the effective flapping inertia. The effect of damping in the swing test was measured and described. A comparison of the flapping inertials for rectangular and tapered planform blades of approximately the same mass showed the tapered blades to have a lower inertia, as expected.

  7. Managing Flap Vortices via Separation Control

    NASA Technical Reports Server (NTRS)

    Greenblatt, David

    2006-01-01

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

  8. Aerodynamics of high frequency flapping wings

    NASA Astrophysics Data System (ADS)

    Hu, Zheng; Roll, Jesse; Cheng, Bo; Deng, Xinyan

    2010-11-01

    We investigated the aerodynamic performance of high frequency flapping wings using a 2.5 gram robotic insect mechanism developed in our lab. The mechanism flaps up to 65Hz with a pair of man-made wing mounted with 10cm wingtip-to-wingtip span. The mean aerodynamic lift force was measured by a lever platform, and the flow velocity and vorticity were measured using a stereo DPIV system in the frontal, parasagittal, and horizontal planes. Both near field (leading edge vortex) and far field flow (induced flow) were measured with instantaneous and phase-averaged results. Systematic experiments were performed on the man-made wings, cicada and hawk moth wings due to their similar size, frequency and Reynolds number. For insect wings, we used both dry and freshly-cut wings. The aerodynamic force increase with flapping frequency and the man-made wing generates more than 4 grams of lift at 35Hz with 3 volt input. Here we present the experimental results and the major differences in their aerodynamic performances.

  9. Vortex leading edge flap assembly for supersonic airplanes

    NASA Technical Reports Server (NTRS)

    Rudolph, Peter K. C. (Inventor)

    1997-01-01

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

  10. Monocortical Deep Circumflex Iliac Artery Flap in Jaw Reconstruction.

    PubMed

    Moon, Seong-Yong

    2015-06-01

    Conventionally deep circumflex iliac artery (DCIA) flap had been harvested as bicortical form. However, several complications and adverse effects occurred such as abnormal hip contour, hernia, severe bleeding tendency, gait disturbance, and hypoesthesia. All the 9 patients required reconstruction of the jaw with microvascular free flaps after radical resection. Monocortical bone segment was harvested from the anterior iliac crest, and the amount of bone harvested was from 47 to 90 mm (mean, 63 ± 14.6). Monocortical deep circumflex iliac artery flap has sufficient advantages in donor-site morbidity, which is one of the factors to choose flap.

  11. A novel animal model for skin flap prelamination with biomaterials

    PubMed Central

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-01-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible. PMID:27659066

  12. Numerical analysis of the V-Y shaped advancement flap.

    PubMed

    Remache, D; Chambert, J; Pauchot, J; Jacquet, E

    2015-10-01

    The V-Y advancement flap is a usual technique for the closure of skin defects. A triangular flap is incised adjacent to a skin defect of rectangular shape. As the flap is advanced to close the initial defect, two smaller defects in the shape of a parallelogram are formed with respect to a reflection symmetry. The height of the defects depends on the apex angle of the flap and the closure efforts are related to the defects height. Andrades et al. 2005 have performed a geometrical analysis of the V-Y flap technique in order to reach a compromise between the flap size and the defects width. However, the geometrical approach does not consider the mechanical properties of the skin. The present analysis based on the finite element method is proposed as a complement to the geometrical one. This analysis aims to highlight the major role of the skin elasticity for a full analysis of the V-Y advancement flap. Furthermore, the study of this technique shows that closing at the flap apex seems mechanically the most interesting step. Thus different strategies of defect closure at the flap apex stemming from surgeon's know-how have been tested by numerical simulations. PMID:26342442

  13. Lower extremity reconstruction with the anterolateral thigh flap.

    PubMed

    Nosrati, Naveed; Chao, Albert H; Chang, David W; Yu, Peirong

    2012-05-01

    The versatility and location of the anterolateral thigh (ALT) flap make it well suited for lower extremity reconstruction. The purpose of this study was to evaluate surgical and functional outcomes by specific anatomic regions in the lower extremity to better define the role of the ALT flap in lower extremity reconstruction. A retrospective review of patients undergoing lower extremity reconstruction with an ALT flap between July 2002 and December 2010 was performed. Total 46 patients underwent lower extremity reconstruction with an ALT flap, of whom 29 (63%) had a pedicled flap and 17 (37%) a microvascular free flap. Defects were located in the hip/buttocks (n = 8), groin (n = 13), thigh (n = 8), knee (n = 5), leg (n = 6), and foot/ankle (n = 6). The mean postoperative follow-up was 4 months. Total flap loss occurred in two patients (4%). There were 11 recipient site complications (24%). The most common complication was recipient site seroma, which occurred in five patients (11%), all of whom had hip/buttock or groin defects. Overall, 38 patients (83%) returned to their preoperative functional status. The ALT flap is an effective method of lower extremity reconstruction. It can be performed as a pedicled or free flap, with good surgical and functional outcomes. PMID:22399252

  14. Clinical Experiences with the Scapular Fascial Free Flap

    PubMed Central

    Park, Il Ho; Chang, Yong Joon; Kim, Jae Hyun

    2016-01-01

    Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from 3×12 to 13×23 cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation. PMID:27689051

  15. Clinical Experiences with the Scapular Fascial Free Flap

    PubMed Central

    Park, Il Ho; Chang, Yong Joon; Kim, Jae Hyun

    2016-01-01

    Background The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissue for optimal restoration of form and function. Here, we present our clinical experience with the use of the scapular fascial free flap to correct facial asymmetry and to reconstruct soft tissue defects of the extremities. Methods We used a scapular fascial free flap in 12 cases for soft tissue coverage of the extremities or facial soft tissue augmentation. Results The flaps ranged in size from 3×12 to 13×23 cm. No cases of total loss of the flap occurred. Partial loss of the flap occurred in 1 patient, who was treated with a turnover flap using the adjacent scapular fascial flap and a skin graft. Partial loss of the skin graft occurred in 4 patients due to infection or hematoma beneath the graft, and these patients underwent another skin graft. Four cases of seroma at the donor site occurred, and these cases were treated with conservative management or capsulectomy and quilting sutures. Conclusions The scapular fascial free flap has many advantages, including a durable surface for restoration of form and contours, a large size with a constant pedicle, adequate surface for tendon gliding, and minimal donor-site scarring. We conclude that despite the occurrence of a small number of complications, the scapular fascial free flap should be considered to be a viable option for soft tissue coverage of the extremities and facial soft tissue augmentation.

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

    PubMed

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

    2006-01-01

    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

  17. Monitoring flap for buried free tissue transfer: its importance and reliability.

    PubMed

    Cho, Byung Chae; Shin, Dong Pill; Byun, Jin Suk; Park, Jae Woo; Baik, Bong Soo

    2002-10-01

    To improve the success rate of microsurgical flap transfers into a buried area, it is important to monitor the circulation of the flap during the early stage. A monitoring flap includes such advantages as simplicity, reliability, noninvasiveness, and the ability to continuously monitor the vascular status of various buried flaps. This article describes experiences related to the importance and reliability of a monitoring flap. A total of 109 flaps in 99 patients were treated with buried free flaps, including a monitoring flap, between 1990 and 1999. Forty-nine patients received a tubed free radial forearm flap with a skin-monitoring flap, and six received a free jejunal flap with a jejunal segment monitoring flap for the reconstruction of the esophagus. Vascularized fibular grafts with a skin monitoring flap or peroneus longus muscle monitoring flap were used for reconstructing the mandible in six patients and for treating osteonecrosis of the femoral head in 48 flaps in 38 patients. Monitoring flap abnormalities were indicated in 14 flaps; therefore, immediate revisions were performed on the pedicle of the monitoring flap and microanastomosis site. Among these 14 flaps, nine showed true thrombosis and five showed false-positive thrombosis. Among the nine flaps that showed true thrombosis, five were salvaged and four were finally lost. The false-positive thrombosis in the five flaps was attributed to torsion or tension of the perforator of the monitoring flap in three flaps, an unclear determination in one flap because the monitoring flap size was too small, and damage to the perforator in the last flap. The total thrombosis rate was 8.3 percent (nine of 109), and the failure rate of the free tissue transfer was 3.7 percent (four of 109). The overall sensitivity of the monitoring flap was 100 percent, the predictive value of a positive test was 64 percent (nine of 14), and false-positive results occurred in 36 percent (five of 14). The salvage rate was 55.6 percent

  18. Outcomes following pharyngolaryngectomy reconstruction with the anterolateral thigh (ALT) free flap.

    PubMed

    Ho, M W; Houghton, L; Gillmartin, E; Jackson, S R; Lancaster, J; Jones, T M; Blackburn, T K; Homer, J J; Loughran, S; Ascott, F M; Shaw, R J

    2012-01-01

    We retrospectively reviewed 15 cases of pharyngolaryngectomy for advanced laryngeal carcinoma reconstructed with the anterolateral thigh (ALT) free flap. Thirteen patients had primary surgery and adjuvant treatment (radiotherapy or chemoradiotherapy), and two had salvage surgery. Thirteen had stage III or IV disease, and eight had cervical nodal extracapsular spread. In this series all the flaps survived, and at median follow-up of 14.5 months (range 3.7-31.2), 12 of the 15 patients were alive. One patient developed a chronic pharyngocutaneous fistula, and five required repeat balloon dilatations for late pharyngeal strictures. Six patients enjoyed restoration of full oral intake, seven were able to take a soft diet, and two were dependent on feeding by percutaneous endoscopic gastrostomy. Four patients developed adequate tracheo-oesophageal speech, and one successfully developed oesophageal speech. In this series many of the surgical problems associated with pharyngolaryngectomy reconstruction were addressed successfully by the ALT, but late dysphagia remained troublesome in an appreciable minority. While adjuvant radiotherapy could have contributed to this, future innovations will focus on the reduction of late strictures. PMID:21055852

  19. [A Case of Tongue Carcinoma Resection and Reconstruction with Microsurgical Free Flap during Pregnancy].

    PubMed

    Terada, Tomonori; Uwa, Nobuhiro; Sagawa, Kosuke; Mohri, Takeshi; Kida, Kota; Saeki, Nobuo; Sakagami, Masafumi

    2015-01-01

    Malignant tumors during pregnancy are rarely seen by otolaryngologists, and they cause various problems which require special treatment with careful consideration of both the mother and fetus. Cases of tongue carcinoma resection and reconstruction with a microsurgical free flap during pregnancy have not previously been reported in Japan. We report herein on a case, in which the mother and her child made satisfactory progress after surgery. A-33-year-old female at 25 weeks and 4 days of pregnancy was referred to our department for the treatment of a tumor on the right edge of her tongue. Examinations including biopsy revealed SCC (T2N0M0). We performed an operation to remove the tongue carcinoma with the pull-through method and reconstruct the tongue with an ALT flap at just 28 weeks of pregnancy. The postoperative recovery was favorable, and she gave natural birth to a girl safely at 38 weeks and 6 days of pregnancy. She is currently free of disease and her child is growing normally, at 2 years and 10 months after surgery. PMID:26333272

  20. Tunica vaginalis flap following ‘Tubularised Incised Plate’ urethroplasty to prevent urethrocutaneous fistulaa

    PubMed Central

    Hamid, Raashid; Baba, Aejaz A.; Shera, Altaf; Ahmad, Sarfaraz

    2015-01-01

    Introduction: Surgery for hypospadias has been continuously evolving, implying thereby that no single technique is perfect and suitable for all types of hypospadias. Snodgrass technique is presently the most common surgical procedure performed for hypospadias. Materials and Methods: We analysed the results of tunica vaginalis flap (TVF) as an additional cover to the tubularised incised plate (TIP) repair. Results: A total of 35 patients of hypospadias were repaired using TIP urethroplasty and TVF as a second layer. Mean age at the time of presentation was 6.63 ± 3.4 years. Post-operative complications namely wound infection, flap necrosis, scrotal haematoma, scrotal abscess, urethral fistula, meatal stenosis were recorded and analysed during follow-up period. Need for re-do surgery was considered as failure of the operative procedure. Out of 35 patients, 8 (22.85%) patients had proximal penile hypospadias and 27 (77.14%) patients had distal penile hypospadias. Mean post-operative follow-up was 24.53 months. During the follow-up complications noticed included wound infection (n = 2), urethrocutaneous fistula (n = 1) and meatal stenosis (n = 1). Wound infection was managed with appropriate antibiotics as per hospital policy/culture and sensitivity reports. Meatal stenosis responded to bougie dilatation/calibration during follow-up. Conclusion: To conclude, TVF as an additional cover is associated with an acceptable complication rate and good cosmetic results if performed with meticulous tissue handling PMID:26424985

  1. Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients.

    PubMed

    Mongon, Mauricio Leal; Piva, Felipe Alberto; Mistro Neto, Sylvio; Carvalho, Jose Andre; Belangero, William Dias; Livani, Bruno

    2013-04-01

    Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl's technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18-41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783-785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands. PMID:23371841

  2. Rhabdomyosarcoma: Surgery

    MedlinePlus

    ... is and what type of operation is done. Physical changes after surgery can range from little more than a scar to changes in appearance or in how some parts of the body function, which may require physical rehabilitation. For more on surgery as a treatment ...

  3. Unnecessary surgery.

    PubMed Central

    Leape, L L

    1989-01-01

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

  4. The radix nasi island flap: a versatile musculocutaneous flap for defects of the eyelids, nose, and malar region.

    PubMed

    Seyhan, Tamer

    2009-03-01

    A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness. PMID:19305249

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

    NASA Technical Reports Server (NTRS)

    Boyd, D. Douglas, Jr.

    2005-01-01

    A computational study of a generic wing with a half span flap shows the mean flow effects of several blown flap configurations. The effort compares and contrasts the thin-layer, Reynolds averaged, Navier-Stokes solutions of a baseline wing-flap configuration with configurations that have blowing normal to the flap surface through small slits near the flap side edge. Vorticity contours reveal a dual vortex structure at the flap side edge for all cases. The dual vortex merges into a single vortex at approximately the mid-flap chord location. Upper surface blowing reduces the strength of the merged vortex and moves the vortex away from the upper edge. Lower surface blowing thickens the lower shear layer and weakens the merged vortex, but not as much as upper surface blowing. Side surface blowing forces the lower surface vortex farther outboard of the flap edge by effectively increasing the aerodynamic span of the flap. It is seen that there is no global aerodynamic penalty or benefit from the particular blowing configurations examined.

  6. Propeller Flap for Complex Distal Leg Reconstruction: A Versatile Alternative when Reverse Sural Artery Flap is Not Feasible.

    PubMed

    Ademola, Samuel A; Michael, Afieharo I; Oladeji, Femi J; Mbaya, Kefas M; Oyewole, O

    2015-01-01

    Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator-based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained Gustilo 3B injuries from gunshot. The donor area for reversed sural artery flap was involved in the injuries. They had early debridement, external fixation, and wound coverage with perforator-based propeller flaps. The donor sites were covered with skin graft. All flaps survived. There were minor wound edge ulcers due to the pressure of positioning that did not affect flap survival and the ulcers healed with conservative management. Perforator-based propeller flap is a versatile armamentarium for reconstruction of soft tissue defects of the distal leg in resource-constrained settings, especially when the donor area for a reverse flow sural flap artery is involved in the injury.

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

    NASA Astrophysics Data System (ADS)

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

    2002-04-01

    In recent studies, near-infrared spectroscopy (NIRS) has been considered as a potentially ideal noninvasive technique for the postoperative monitoring of plastic surgery. In this study, free flaps were raised on rhesus monkeys' forearms and oxygen delivery to these flaps was monitored following vascular occlusions and inhalation of pure oxygen. Optical fibers were adopted in the probe of the oximeter so that the detection could be performed in reflectance mode. The distance between emitter and detector can be adjusted easily to achieve the best efficacy. Different and repeatable patterns of changes were measured following vascular occlusions (arterial occlusion, venous occlusion and total occlusion) on flaps. It is clear that the near-infrared spectroscopy is capable of postoperatively monitoring vascular problems in flaps. NIRS showed high sensitivity to detect the dynamic changes in flaps induced by inhalation of pure oxygen in this study. The experimental results indicated that it was potential to assess tissue viability utilizing the dynamic changes induced by a noninvasive stimulation. It may be a new assessing method that is rapid, little influenced by other factors and brings less discomfort to patients.

  8. [Fasciocutaneous forearm flaps in the management of the catastrophic hand].

    PubMed

    Herrera-Tenorio, J G; Gómez-Cansino, E

    2014-01-01

    This paper describes a series of cases with severe hand injury that required antebrachial flaps as part of treatment, and their functional results. The clinical records of patients with a diagnosis of traumatic hand injury and major skin cover losses, reconstructed with a reverse-flow forearm flap, were reviewed. The following variables were studied: type of flap, sex, age, mechanism of injury, receiver site, size, adjacent injuries and their treatment, vascular integrity test prior to flap placement, operative time, follow-up and complications. A total of 25 patients were included, with 25 reverse-flow fasciocutaneous forearm flaps; in 15 of them the blood supply was based on the radial artery and in 10 in the posterior interosseous artery. The Allen test was used in 13 cases of radial flaps (RF) to check the integrity of the superficial palmar arch; Doppler ultrasound was used in the remaining two cases. Sixteen cases (64%) underwent bone and tendon reconstruction, four cases (16%) isolated tenorrhaphy of one or several tendons, two cases (8%) isolated osteosynthesis, one case due to electrical burn underwent Littler opponensplasty with a radial flap in the anterior aspect of the wrist (4%), and in two cases (8%) an isolated flap was used. In one 67 year-old patient (4%) there was congestion and total loss of the posterior interosseous flap. The recommended indications for this type of flap are: coverage of the distal forearm, hand dorsum and fingers, first interdigital space, palmar region of the wrist and hand. Only two cases required coverage of the palmar region of the wrist and hand, and they were both treated with radial flaps, probably for reasons of anatomical convenience. PMID:26016286

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

    PubMed

    Stowers, Amanda K; Lentink, David

    2015-04-01

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

  10. Reconstruction of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma by vascular anastomosed free dorsalis pedis flaps' transplantation.

    PubMed

    Bi, Xiaoping; Fan, Xianqun; Zhou, Huifang; Shi, Wodong; Xiao, Caiwen; Lin, Min; Li, Zhenkang

    2011-05-01

    Retinoblastoma is a common malignant intraocular tumor in childhood, and most patients require enucleation or exenteration even with irradiation. Severe anophthalmic orbits and atresic eye sockets are not rare. We conducted a retrospective study to evaluate the results of surgical management of reconstruction of severe anophthalmic orbits and atresic eye sockets with vascular anastomosed free dorsalis pedis flap transplantation. There were 5 patients (5 eyes) who underwent reconstructive surgery of severe anophthalmic orbits and atresic eye sockets after enucleation and irradiation of retinoblastoma in our hospital during the 3 years. All patients had enucleation and irradiation immediately after the retinoblastoma was diagnosed and had never worn artificial eyes because of the atresic eye sockets. Vascular anastomosed free dorsalis pedis flaps, whose dimensions were typically 6.5 × 5.5 cm(2), were transplanted to reconstruct the severe anophthalmic orbits and atresic eye sockets. The donor sites were covered by free abdominal skin flaps. All the vascular anastomosed free dorsalis pedis flaps were valid after more than 6 months of follow-up. And then all the 5 patients underwent secondary autogenous dermal fat implantation to augment the supraorbital area depression. After the 2-stage reconstruction surgery, the dimensions of the eye sockets were adequate, and all patients were able to wear their prosthesis and had a satisfactory cosmetic result. Implantation of alloplastic materials is not recommended because of insufficient blood supply of the irradiated orbital area.

  11. Cornea surgery with nanojoule femtosecond laser pulses

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

    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.

  12. Reconstructive Surgery for Head and Neck Cancer Patients

    PubMed Central

    Hanasono, Matthew M.

    2014-01-01

    The field of head and neck surgery has gone through numerous changes in the past two decades. Microvascular free flap reconstructions largely replaced other techniques. More importantly, there has been a paradigm shift toward seeking not only to achieve reliable wound closure to protect vital structures, but also to reestablish normal function and appearance. The present paper will present an algorithmic approach to head and neck reconstruction of various subsites, using an evidence-based approach wherever possible. PMID:26556426

  13. The gust-mitigating potential of flapping wings.

    PubMed

    Fisher, Alex; Ravi, Sridhar; Watkins, Simon; Watmuff, Jon; Wang, Chun; Liu, Hao; Petersen, Phred

    2016-01-01

    Nature's flapping-wing flyers are adept at negotiating highly turbulent flows across a wide range of scales. This is in part due to their ability to quickly detect and counterract disturbances to their flight path, but may also be assisted by an inherent aerodynamic property of flapping wings. In this study, we subject a mechanical flapping wing to replicated atmospheric turbulence across a range of flapping frequencies and turbulence intensities. By means of flow visualization and surface pressure measurements, we determine the salient effects of large-scale freestream turbulence on the flow field, and on the phase-average and fluctuating components of pressure and lift. It is shown that at lower flapping frequencies, turbulence dominates the instantaneous flow field, and the random fluctuating component of lift contributes significantly to the total lift. At higher flapping frequencies, kinematic forcing begins to dominate and the flow field becomes more consistent from cycle to cycle. Turbulence still modulates the flapping-induced flow field, as evidenced in particular by a variation in the timing and extent of leading edge vortex formation during the early downstroke. The random fluctuating component of lift contributes less to the total lift at these frequencies, providing evidence that flapping wings do indeed provide some inherent gust mitigation.

  14. The gust-mitigating potential of flapping wings.

    PubMed

    Fisher, Alex; Ravi, Sridhar; Watkins, Simon; Watmuff, Jon; Wang, Chun; Liu, Hao; Petersen, Phred

    2016-01-01

    Nature's flapping-wing flyers are adept at negotiating highly turbulent flows across a wide range of scales. This is in part due to their ability to quickly detect and counterract disturbances to their flight path, but may also be assisted by an inherent aerodynamic property of flapping wings. In this study, we subject a mechanical flapping wing to replicated atmospheric turbulence across a range of flapping frequencies and turbulence intensities. By means of flow visualization and surface pressure measurements, we determine the salient effects of large-scale freestream turbulence on the flow field, and on the phase-average and fluctuating components of pressure and lift. It is shown that at lower flapping frequencies, turbulence dominates the instantaneous flow field, and the random fluctuating component of lift contributes significantly to the total lift. At higher flapping frequencies, kinematic forcing begins to dominate and the flow field becomes more consistent from cycle to cycle. Turbulence still modulates the flapping-induced flow field, as evidenced in particular by a variation in the timing and extent of leading edge vortex formation during the early downstroke. The random fluctuating component of lift contributes less to the total lift at these frequencies, providing evidence that flapping wings do indeed provide some inherent gust mitigation. PMID:27481211

  15. Breast ptosis managed by mastopexy using the triple flaps procedure.

    PubMed

    Gheita, Alaa; Moftah, Ali

    2011-02-01

    Breast ptosis is a highly unattractive appearance of the breast. In the mind, it is associated with aging, multiple pregnancies, lactation, and senile changes. Its correction by mastopexy presents one of the greatest challenges to the breast surgeon aiming at a pleasant full conical shape and stability of the results. The authors present their mastopexy procedure using a triple-flap method based on the principle of a superior pedicle flap mammaplasty. The technique, presented in detail, basically consists of a superior pedicle dermaglandular flap that carries the nipple-areola complex between outer and inner flaps. The outer flap is rotated inward and upward behind the main superior pedicle to give fullness to the breast and fixed to the chest wall. The inner flap is double-breasted on top or superficial to outer flap, and both are sutured to each other resembling a hammock or a cradle that carries the main superior pedicle middle flap. The results are presented and advantages discussed. This method, besides its simplicity, gives good projection with a pleasant and attractive conical shape to the breast and upper fullness, frequently negating the need for an implant. In addition, the results were stable in the long term, with no need for a mesh or any other foreign material.

  16. The use of free flaps in skull base reconstruction.

    PubMed

    Macía, G; Picón, M; Nuñez, J; Almeida, F; Alvarez, I; Acero, J

    2016-02-01

    Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored.

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

    PubMed Central

    Kaçaniku, Gazmend; Begolli, Ilir

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2000-01-01

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

  19. Outcome after free flap reconstruction of the heel.

    PubMed

    Durham, J W; Saltzman, C L; Steyers, C M; Miller, B A

    1994-05-01

    We reviewed six free flap reconstructions of the weight-bearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7-6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers. All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.

  20. Pectoralis myocutaneous flap for salvage of necrotic wounds

    SciTech Connect

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

    1985-02-01

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

  1. [The dorsoradial flap: a new flap for hand reconstruction. Anatomical study and clinical applications].

    PubMed

    Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

    2006-02-01

    The authors report a new cutaneous flap harvested from the dorsal and distal quarter of the forearm: the dorsoradial flap. The vascularisation type of the cutaneous paddle belongs this flap to the anterograde and axial family flaps. The anatomical study carried out on thirty six fresh cadaver upper arms showed a constant and a consistent cutaneous collateral branch of the radial artery which arises at the apex of the first intermetacarpal space. Two anatomical types were recorded according to the origin of the dorsoradial artery: type I (84% of cases), the vessel arises directly from the radial artery; type II (16% of cases), it arises from a common trunk with the first dorsal intermetacarpal artery. Those anatomical findings does not influence the flap operative technique, the flap design and the location of the pedicle pivot point. The dorsoradial artery emerges vertically from the apex of the first intermetacarpal space, crosses the angle between the extensor pollicis longus tendon laterally and the extensor carpi radialis longus tendon medially and turns proximally towards the distal radio-ulnar joint. Over the dorsal aspect of the wrist, the dorsoradial artery enters the subcutaneous tissue, runs parallel to the extensor pollicis longus tendon at three millimeters in a medial position, passes over the medial collateral branch of the superficial radial nerve and irrigates all the distal and dorsal quarter of the forearm. The artery is consistently accompanied by two comitantes veins, which assume the venous drainage of the cutaneous territory. The flap paddle is designed over the distal dorsal forearm quarter, between the dorsal crease of the wrist distally, the ulnar crest medially and the radial crest laterally. All this skin territory can be harvested and supplied by the dorsoradial pedicle, but we always should deal with the needs of the defects reconstruction and the morbidity of the donor site. The vascular pedicle is outlined between the distal radio

  2. Double-pedicle abdominal perforator free flaps for unilateral breast reconstruction: new horizons in microsurgical tissue transfer to the breast.

    PubMed

    Hamdi, Moustapha; Khuthaila, Dana K; Van Landuyt, Koenraad; Roche, Nathalie; Monstrey, Stan

    2007-01-01

    The DIEAP (deep inferior epigastric artery perforator) flap is a suitable option for breast reconstruction resulting in excellent aesthetic outcome, and minimal donor site morbidity. Contraindications for use of the DIEAP flap may include previous abdominal liposuction and/or surgery, or lack of abdominal tissue. The purpose of this paper is to describe options of using abdominal perforator flaps, based on double-pedicle techniques, despite these contraindications. A retrospective evaluation was carried out on a series of 16 patients who required abdominal double-pedicle free perforator flaps for unilateral breast reconstruction since June 2002. The indications were multiple abdominal scars, previous abdominal liposuction and thin patients in five, three and eight cases, respectively. Preoperative mapping of the vascular network was done using Duplex and/or multi-detector CT scan imaging. Clinical evaluation of medical charts was done regarding patients' characteristics, surgical techniques, ischaemia/total operative time and complications. A clinical evaluation was done on all patients with average follow up of 15 months. Fat necrosis was investigated clinically and by mammogram examination. Different microsurgical techniques were performed to provide enough blood supply to the requested flaps: Perforator (P) to contralateral Deep Inferior Epigastric (DIE) anastomosis (P/DIEAP), in two patients; bilateral DIE vessels (DIEAP/DIEAP) in seven patients; and DIE with SIE (superficial inferior epigastric) vessels in seven patients (DIEAP/SIEA). One pedicle was always anastomosed to the internal mammary vessels. The second pedicle was anastomosed end-to-end to a side branch of the DIE or end-to-side with the DIE pedicle in 13 cases. The thoracodorsal vessels were used as recipient vessels for the second pedicle in three cases. Average operative time was 6h 30min (range 5h 30min-8h). All 16 flaps survived and fat necrosis occurred in one case. The harvesting of perforator

  3. Prophylaxis against Frey's syndrome in parotid surgery.

    PubMed

    Bonanno, P C; Palaia, D; Rosenberg, M; Casson, P

    2000-05-01

    In 1990 the authors reported their preliminary study of the prevention of Frey's syndrome in 55 patients utilizing a superficial musculoaponeurotic system (SMAS) flap in parotid gland surgery. During the past 10 years, numerous studies have supported their original thesis that interposition of living tissue between the resected gland bed and the skin could prevent the development of this complication. The authors have expanded their own patient population and now consider this a definitive study on the prevention of Frey's syndrome. A total of 160 patients are presented with a follow-up period of 5 to 22 years. All patients underwent subtotal or total parotidectomy performed by one of the authors. A history was acquired and testing for Frey's syndrome (Minor's starch iodine test) was performed. As a result of this approach, and in spite of the intensive search for it, no cases of Frey's syndrome were encountered. The hoped-for secondary benefit of preventing the postparotidectomy retromandibular depression was somewhat less satisfactory, although most patients remain satisfied with their appearance. The debilitating symptoms in Frey's syndrome, which is reported to have an incidence of 5% to 50% in the typical parotidectomy patient, can be avoided with thoughtful preoperative planning. The authors favor an aesthetic incision followed by the development of an SMAS flap. The parotidectomy is then performed using the surgeon's preferred technique. The SMAS flap is then placed into the bed of the resected parotid gland. This institutes a protective tissue barrier guarding against the aberrant anastomotic communication between the postganglionic secretomotor fibers intended for the parotid gland, and the now adjacent sweat glands. Their patient population is large enough to provide significant evidence that Frey's syndrome can be prevented, compared with a meta-analysis of parotid patients in multiple other studies in the literature. Assuming the patient's history and

  4. Brain surgery

    MedlinePlus

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

  5. Thyroid Surgery

    MedlinePlus

    ... thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure ). This is especially true if you had ... Nodules Goiter Graves’ Disease Hashimoto’s Thyroiditis Hyperthyroidism (Overactive) Hypothyroidism (Underactive) Iodine Deficiency Low Iodine Diet Radioactive Iodine ...

  6. Cosmetic Surgery

    MedlinePlus

    ... defect or cosmetic flaw that has diminished their self-esteem over time. It's important to remember that cosmetic ... can create both physical changes and changes in self-esteem. But if you are seeking surgery with the ...

  7. Rodding Surgery

    MedlinePlus

    ... Rods can be made of stainless steel or titanium. Regular rods do not expand. They have many ... v regular), the rod materials (stainless steel v titanium) and the age for a first rodding surgery. ...

  8. Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle.

    PubMed

    Chen, Z; Chen, C; Chen, M; Zhang, J; Wu, N; Wang, J

    1991-03-01

    A technique of vaginal reconstruction using bilateral, perineal-thigh flaps with subcutaneous pedicle is described. In this procedure, the flaps were raised bilaterally and introduced into an artificial space between the urinary bladder and rectum. The blood supply for the flaps flows from the perineal artery through anastomotic branches to the external pudendal artery. The authors used the technique on four patients, and all the flaps survived entirely. There was no complication. According to a more than two-year follow-up survey, the reconstructed vaginas are expansible and contract little. No stent is needed. There is good sensitivity in the wall of the artificial vagina because sensory nerves run through the flaps.

  9. A method for calculating externally blown flap noise

    NASA Technical Reports Server (NTRS)

    Fink, M. R.

    1978-01-01

    Several basic noise components were described. These components are: (1) compact lift dipoles associated with the wing and flaps; (2) trailing edge noise associated with the last trailing edge; and (3) quadrupole noise associated with the undeflected exhaust jet and the free jet located downstream of the trailing edge. These noise components were combined to allow prediction of directivity and spectra for under the wing (UTW) slotted flaps with conventional or mixer nozzles, UTW slotless flaps, upper surface blowing (USB) slotless flaps, and engine in front of the wing slotted flaps. A digital computer program listing was given for this calculation method. Directivities and spectra calculated by this method were compared with free field data for UTW and USB configurations. The UTRC method best predicted the details of the measured noise emission, but the ANOP method best estimated the noise levels directly below these configurations.

  10. Study of Flapping Flight Using Discrete Vortex Method Based Simulations

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

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

    PubMed

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

    2014-01-01

    In the last years, propeller flaps have become an appealing option for coverage of a large range of defects. Besides having a more reliable vascular pedicle than traditional flap, propeller flaps allow for great freedom in design and for wide mobilization that extend the possibility of reconstructing difficult wounds with local tissues and minimal donor-site morbidity. They also allow one-stage reconstruction of defects that usually require multiple procedures. Harvesting of a propeller flap requires accurate patient selection, preoperative planning, and dissection technique. Complication rate can be kept low, provided that potential problems are prevented, promptly recognized, and adequately treated. This paper reviews current knowledge on propeller flaps. Definition, classification, and indications in the different body regions are discussed based on a review of the literature and on the authors' experience. Details about surgical technique are provided, together with tips to avoid and manage complications.

  12. Experimental investigation of a flapping wing model

    NASA Astrophysics Data System (ADS)

    Hubel, Tatjana Y.; Tropea, Cameron

    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.

  13. Experimental investigation of a flapping wing model

    NASA Astrophysics Data System (ADS)

    Hubel, Tatjana Y.; Tropea, Cameron

    2009-05-01

    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.

  14. [Robotic surgery].

    PubMed

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

    2014-12-01

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

  15. [Robotic surgery].

    PubMed

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

    2014-12-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 50 Wildlife and Fisheries 10 2012-10-01 2012-10-01 false Escape Opening and Flap Dimensions for the Double Cover Flap TED 16 Figure 16 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS...

  17. Corrective Jaw Surgery

    MedlinePlus

    ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  18. [BIOMECHANICAL SUBSTANTIATION OF ONE-AXIS DEFORMITY OF ADIPOSE-CUTANEOUS FLAPS OF TEMPORAL AND ZYGOMATIC AREAS WHILE PERFORMANCE OF UPPER RHYTIDOPLASTY].

    PubMed

    Avetikov, D S; Gutnik, A A; Boyko, I V; Ivanytskaya, O S; Tsvetkova, N V

    2015-05-01

    The urgency of the problem of determining the biomechanical features adipose-cutaneous grafts due to a significant increase in the frequency of performing cosmetic surgery and the lack of a unified concept for such interventions. In 32 women aged 35 to 65 years, which will eliminate the excess soft tissues in the implementation ritidectomy and other surgical interventions, isolated patches of adipose-cutaneous flaps to determine the mechanisms of its plastic deformation. Based on the analysis of biomechanical research targeted the optimal stretching the boundaries of adipose-cutaneous flaps zygomatic--to (0.45 ± 0.021) cm and temporal--by (0.0165 ± 0.002) cm refer to areas that allowed to perform surgery with preservation of natural topographoanatomic relations persons in the performance of the upper ritidectomy. PMID:26419037

  19. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly.

    PubMed

    Schonauer, Fabrizio; Di Martino, Annalena; Nele, Gisella; Santoro, Mariangela; Dell'Aversana Orabona, Giovanni; Califano, Luigi

    2016-09-01

    Oral and oropharyngeal squamous cell carcinoma (Scc) occur most commonly in middle-aged and elderly individuals. Free flaps are commonly used for reconstruction of extensive tumor resection defects in the oral cavity. Age alone is not an independent variable for increased risk in microvascular reconstruction; however operative time and ASA risk score correlated with medical complications but not with surgical complications. The submental island flap has proven to be a reliable alternative in reconstruction of composite oral cavity defects for its thinness, pliability and versatility in design, shared by the radial forearm free flap, and its advantageous donor site. The submental flap can be easily raised and involves shorter operative time and hospital stay compared to the free-flap procedure. It can be an excellent choice in patients with a high ASA risk score, moreover in elderly patients, where the potential complications linked to microsurgical procedures are avoided. PMID:27255573

  20. Pressure Distributions for the GA(W)-2 Airfoil with 20% Aileron, 25% Slotted Flap and 30% Fowler Flap

    NASA Technical Reports Server (NTRS)

    Wentz, W. H., Jr.; Fiscko, K. A.

    1978-01-01

    Surface pressure distributions were measured for the 13% thick GA(W)-2 airfoil section fitted with 20% aileron, 25% slotted flap and 30% Fowler flap. All tests were conducted at a Reynolds number of 2.2 x 10 to the 6th power and a Mach number of 0.13. Pressure distribution and force and moment coefficient measurements are compared with theoretical results for a number of cases. Agreement between theory and experiment is generally good for low angles of attack and small flap deflections. For high angles and large flap deflections where regions of separation are present, the theory is inadequate. Theoretical drag predictions are poor for all flap-extended cases.

  1. Aeroacoustic Measurements of a Wing-Flap Configuration

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

    Aeroacoustic measurements are being conducted to investigate the mechanisms of sound generation in high-lift wing configurations, and initial results are presented. The model is approximately 6 percent of a full scale configuration, and consists of a main element NACA 63(sub 2) - 215 wing section and a 30 percent chord half-span flap. Flow speeds up to Mach 0.17 are tested at Reynolds number up to approximately 1.7 million. Results are presented for a main element at a 16 degree angle of attack, and flap deflection angles of 29 and 39 degrees. The measurement systems developed for this test include two directional arrays used to localize and characterize the noise sources, and an array of unsteady surface pressure transducers used to characterize wave number spectra and correlate with acoustic measurements. Sound source localization maps show that locally dominant noise sources exist on the flap-side edge. The spectral distribution of the noise sources along the flap-side edge shows a decrease in frequency of the locally dominant noise source with increasing distance downstream of the flap leading edge. Spectra are presented which show general spectral characteristics of Strouhal dependent flow-surface interaction noise. However, the appearance of multiple broadband tonal features at high frequency indicates the presence of aeroacoustic phenomenon following different scaling characteristics. The scaling of the high frequency aeroacoustic phenomenon is found to be different for the two flap deflection angles tested. Unsteady surface pressure measurements in the vicinity of the flap edge show high coherence levels between adjacent sensors on the flap-side edge and on the flap edge upper surface in a region which corresponds closely to where the flap-side edge vortex begins to spill over to the flap upper surface. The frequency ranges where these high levels of coherence occur on the flap surface are consistent with the frequency ranges in which dominant features

  2. Analysis of Non-symmetrical Flapping Airfoils

    NASA Astrophysics Data System (ADS)

    Beng Tay, Wee; Lim, Kah Bin

    2007-11-01

    Simulations have been done to assess the performance of different types of non-symmetrical airfoils on lift, thrust and propulsive efficiency under different flapping configurations at a Reynolds number of 10,000. The variables studied include the Stroudal number, reduced frequency, pitch angle and phase angle difference. In order to analyze the variables more efficiently, the Design of Experiments using the response surface methodology is applied. The simulation results show that besides the flapping configuration, airfoil shape also has a profound effect on the efficiency, thrust and lift production. The 4 factors have different levels of significance on the responses, indicating the shape of the airfoil plays a part as well. Thrust production depends more heavily on these parameters, rather than the shape of the airfoil. On the other hand, lift production is primarily dominated by its airfoil shape. Efficiency falls somewhere in between. Two-factor interactions among the variables also exist in efficiency and thrust production. Vorticity plots are analyzed to explain some of the results. Overall, the s1020 airfoil is able to provide relatively good efficiency and at the same time generate high thrust and lift force. These results can be used to help in the design of a better ornithopter's wing.

  3. Flapping flight: effect of asymmetric kinematics

    NASA Astrophysics Data System (ADS)

    Pande, Nakul; Krithivasan, Siddharth; K. R., Sreenivas

    2014-11-01

    Flapping flight has received considerable attention in the past with its relevance in the design of micro-air vehicles. In this regard, asymmetric flapping of wings offers simple kinematics. Nevertheless, it leads to symmetry-breaking in the flow field and generation of sustained lift. It has been observed previously with flow visualization experiments and Discrete Vortex Method (DVM) simulations that if the down-stroke time period is lesser than the up-stroke time, there is a net downward momentum imparted to the fluid. This is seen as a switching the flow field from a four-jet (symmetric) to a two-jet (asymmetric) configuration when the stroke-time ratio is progressively varied. This symmetry breaking has been studied experimentally using Particle Image Velocimetry (PIV) across a range of Reynolds Numbers and asymmetry ratios. Results are also corroborated with results from 3-D numerical simulations. Study helps in shedding light on the effectiveness of asymmetric kinematics as a lift generation mechanism.

  4. Uncertainty Analysis for a Jet Flap Airfoil

    NASA Technical Reports Server (NTRS)

    Green, Lawrence L.; Cruz, Josue

    2006-01-01

    An analysis of variance (ANOVA) study was performed to quantify the potential uncertainties of lift and pitching moment coefficient calculations from a computational fluid dynamics code, relative to an experiment, for a jet flap airfoil configuration. Uncertainties due to a number of factors including grid density, angle of attack and jet flap blowing coefficient were examined. The ANOVA software produced a numerical model of the input coefficient data, as functions of the selected factors, to a user-specified order (linear, 2-factor interference, quadratic, or cubic). Residuals between the model and actual data were also produced at each of the input conditions, and uncertainty confidence intervals (in the form of Least Significant Differences or LSD) for experimental, computational, and combined experimental / computational data sets were computed. The LSD bars indicate the smallest resolvable differences in the functional values (lift or pitching moment coefficient) attributable solely to changes in independent variable, given just the input data points from selected data sets. The software also provided a collection of diagnostics which evaluate the suitability of the input data set for use within the ANOVA process, and which examine the behavior of the resultant data, possibly suggesting transformations which should be applied to the data to reduce the LSD. The results illustrate some of the key features of, and results from, the uncertainty analysis studies, including the use of both numerical (continuous) and categorical (discrete) factors, the effects of the number and range of the input data points, and the effects of the number of factors considered simultaneously.

  5. Incidence and time course of dentinal hypersensitivity after periodontal surgery.

    PubMed

    Al-Sabbagh, Mohanad; Beneduce, Carla; Andreana, Sebastiano; Ciancio, Sebastian G

    2010-01-01

    This study sought to characterize the incidence and clinical progression of dentinal hypersensitivity after periodontal surgery. Fourteen patients scheduled for open-flap periodontal debridement participated in the study. Ten subjects completed the study and were evaluated for six consecutive weeks after periodontal surgery. Tactile hypersensitivity was assessed using the Yeaple probe; thermal hypersensitivity measurements were obtained using a blast of air from the air/water syringe; and subjective hypersensitivity measurements were obtained using a visual analog scale (VAS). Measurements were taken preoperatively, one week postoperatively, and once a week for the next five consecutive weeks, for a total of six measurements after periodontal surgery. Depending on the stimuli used, dentinal hypersensitivity at one week after periodontal surgery ranged from 67 to 76%. Preoperative tactile and thermal hypersensitivity incidence combined was 30% at baseline. One week after periodontal surgery, the combined incidence had increased to 79%; at six weeks postsurgery, it had decreased to 45%. This study shows that postoperative dentinal hypersensitivity increases at one and three weeks after open-flap periodontal debridement before spontaneously and gradually decreasing to levels similar to those presurgery, even in the absence of desensitizing therapy. PMID:20129876

  6. Surgery of the nasal septum and turbinates

    PubMed Central

    Matthias, Christoph

    2008-01-01

    The following article presents nasal septum and turbinate surgery. First an overview with special consideration of the anatomical and physiological background is given followed by indications for surgical procedures. Key steps of the gold standard procedure first described by Cottle and common variations are presented. Furthermore, some techniques dealing with special problems of the septumplasty are discussed followed by an overview on complications and long term results. However, it should be mentioned that studies on surgical procedures of the nasal septum are still not sufficient as higher evidence levels are very rare. Within a separated chapter techniques for closure of septum perforations are presented and indications particularly in the background of the standard procedure of bridge flaps forwarded by Schultz-Coulon are discussed. The second part focusses on turbinate surgery. Accordingly, anatomical and physiological basics are presented followed by indications for surgical procedures and the surgical steps of different procedures as well as postsurgical treatment and long term results. PMID:22073086

  7. Lasers in oral surgery and implantology

    NASA Astrophysics Data System (ADS)

    Vescovi, Paolo

    2016-03-01

    The usefulness of laser for oral hard tissue procedure such as caries treatment, impacted teeth extraction, periodontal therapy, peri-implantitis management, sinus lifting is reported by several Authors [1]. Conventionally, mechanical rotary instruments and hand instruments are employed for bone surgery. Rotary instruments have better accessibility and cutting efficiency, but there is a risk of excessive heating of bone tissue and caution must be exercised to avoid the bur becoming entangled with surrounding soft tissues and the reflected flap. The main clinical advantages of the lasers are represented by minimal patient discomfort, good recovery with decreased or absent post-operative pain. In the last ten years are described in the international literature great advantages of Laser Surgery and Low Level Laser Therapy (LLLT) performed with different wavelength in addition to traditional surgical techniques to improve bone and soft tissue healing and for pain and infection control.

  8. [Perforator flaps--the evolution of a reconstructive surgical technique].

    PubMed

    Klein, S; Hage, J J; de Weerd, L

    2005-10-22

    Trauma, oncological resections and pressure sores can cause major soft tissue defects. The evolution of cutaneous, myocutaneous, and fasciocutaneous flaps currently makes possible the restoration of contour and, in many cases, function. This evolution was closely related to the increased understanding of the vascular anatomy of the skin and subcutis and has led to the development of perforator flaps. A perforator flap is a large flap of skin that survives on a single vascular stalk that perforates the muscle, referred to in briefas a 'perforator'. This has its origin in a larger vascular stalk that runs beneath the muscle. The vascular stalk of such a perforator flap can be lengthened by dissecting the perforator from the muscle in continuity with the vessels running beneath the muscle. Moreover, the larger diameter of these vessels facilitates the creation of a vascular anastomosis in the receptor area. By the use of such perforator flaps, proper innervation and a good blood supply to the flap can be combined with less morbidity at the donor site. Important possibilities include the filling of a dorsal (decubitus) defect and breast reconstruction.

  9. [Postoperative monitoring of microvascular flap repair with pulse oximetry--initial experience].

    PubMed

    Strauss, J M; Neukam, F W; Krohn, S; Schmelzeisen, R; Borchard, F

    1994-03-01

    The surgical success of microvascular free flaps or pedicled flaps depends on the function of the nutritive vessels. Complications such as thrombosis or vessel kinking, are dangerous and may result in flap loss. During the last decade, different methods were tested for their capability of monitoring flap perfusion. We report our preliminary experience with the continuous and non-invasive pulse oximetry by using a special reflection sensor positioned on the surface of the flap. PMID:8020852

  10. Design and Performance of Insect-Scale Flapping-Wing Vehicles

    NASA Astrophysics Data System (ADS)

    Whitney, John Peter

    Micro-air vehicles (MAVs)---small versions of full-scale aircraft---are the product of a continued path of miniaturization which extends across many fields of engineering. Increasingly, MAVs approach the scale of small birds, and most recently, their sizes have dipped into the realm of hummingbirds and flying insects. However, these non-traditional biologically-inspired designs are without well-established design methods, and manufacturing complex devices at these tiny scales is not feasible using conventional manufacturing methods. This thesis presents a comprehensive investigation of new MAV design and manufacturing methods, as applicable to insect-scale hovering flight. New design methods combine an energy-based accounting of propulsion and aerodynamics with a one degree-of-freedom dynamic flapping model. Important results include analytical expressions for maximum flight endurance and range, and predictions for maximum feasible wing size and body mass. To meet manufacturing constraints, the use of passive wing dynamics to simplify vehicle design and control was investigated; supporting tests included the first synchronized measurements of real-time forces and three-dimensional kinematics generated by insect-scale flapping wings. These experimental methods were then expanded to study optimal wing shapes and high-efficiency flapping kinematics. To support the development of high-fidelity test devices and fully-functional flight hardware, a new class of manufacturing methods was developed, combining elements of rigid-flex printed circuit board fabrication with "pop-up book" folding mechanisms. In addition to their current and future support of insect-scale MAV development, these new manufacturing techniques are likely to prove an essential element to future advances in micro-optomechanics, micro-surgery, and many other fields.

  11. Conservative mastectomies and Immediate-DElayed AutoLogous (IDEAL) breast reconstruction: the DIEP flap

    PubMed Central

    Nestle-Krämling, Carolin; Fertsch, Sonia; Hagouan, Mazen; Munder, Beatrix; Richrath, Philip; Stambera, Peter; Abu-Ghazaleh, Alina; Andree, Christoph

    2016-01-01

    Background With the development of conservative mastectomies, there are an increasing number of women seeking immediate implant based and autologous breast reconstruction. Despite the oncologic safety of the procedures, the focus will be on the timing of reconstruction. Methods Our plastic surgery unit is focused primarily on autologous breast reconstruction and is part of an interdisciplinary breast center. We offer immediate breast reconstruction (IBR) with autologous tissue for patients with positive BRCA 1 and 2, ductal carcinoma in situ (DCIS), invasive cancer without margin problems to the skin, as well as to correct poor oncologic and aesthetic breast conserving therapy (BCT) outcomes. In the majority of cases we prefer an Immediate-DElayed AutoLogous (IDEAL) breast reconstruction concept with a two-stage procedure. Results Over the last 10 years we performed more than 1,600 breast reconstructions with free flaps, performing the deep inferior epigastric perforator (DIEP) flap as our first choice for autologous tissue. We recommend IDEAL breast reconstruction, however approximately 15% of our cases are immediate one stage conservative mastectomies and breast reconstruction with the DIEP flap. Conclusions For immediate reconstruction, the aesthetic outcome should not take precedence over oncologic considerations. Immediate one-stage, breast reconstruction with autologous tissue can be offered to the suitable patients which is most likely a healthy women with a small-to-medium sized non ptotic breast receiving a conservative mastectomy. In all other cases, we recommend an IDEAL breast reconstruction approach in order to achieve a final result that is both satisfyingly pleasing and oncologically safe. PMID:26855905

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

    PubMed Central

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

    2012-01-01

    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

  13. Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

    PubMed Central

    Brodbeck, Rebekka; Horch, Raymund E.; Arkudas, Andreas; Beier, Justus P.

    2015-01-01

    Defects of the perineum may result from ablative procedures of different malignancies. The evolution of more radical excisional surgery techniques resulted in an increase in large defects of the perineum. The perineogenital region per se has many different functions for urination, bowel evacuation, sexuality, and reproduction. Up-to-date individual and interdisciplinary surgical treatment concepts are necessary to provide optimum oncological as well as quality of life outcome. Not only the reconstructive method but also the timing of the reconstruction is crucial. In cases of postresectional exposition of e.g., pelvic or femoral vessels or intrapelvic and intra-abdominal organs, simultaneous flap procedure is mandatory. In particular, the reconstructive armamentarium of the plastic surgeon should include not only pedicled flaps but also free microsurgical flaps so that no compromise in terms of the extent of the oncological resection has to be accepted. For intra-abdominally and/or pelvic tumors of the rectum, the anus, or the female reproductive system, which were resected through an abdominally and a sacrally surgical access, simultaneous vertical rectus abdominis myocutaneous (VRAM) flap reconstruction is recommendable. In terms of soft tissue sarcoma of the pelvic/caudal abdomen/proximal thigh region, two-stage reconstructions are possible. This review focuses on the treatment of perineum, genitals, and pelvic floor defects after resection of malignant tumors, giving a distinct overview of the different types of defects faced in this region and describing a number of reconstructive techniques, especially VRAM flap and pedicled flaps like antero-lateral thigh flap or free flaps. Finally, this review outlines some considerations concerning timing of the different operative steps. PMID:26500887

  14. Pharyngocutaneous fistula after anterior cervical spine surgery

    PubMed Central

    Sansur, Charles A.; Early, Stephen; Reibel, James

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap. PMID:19330360

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

    PubMed

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

    2009-02-01

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

  16. Aeroelastically deflecting flaps for shock/boundary-layer interaction control

    NASA Astrophysics Data System (ADS)

    Gefroh, D.; Loth, E.; Dutton, C.; Hafenrichter, E.

    2003-06-01

    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.

  17. Inverted Internal Limiting Membrane Flap Technique for Repair of Large Macular Holes: A Short-term Follow-up of Anatomical and Functional Outcomes

    PubMed Central

    Chen, Zhe; Zhao, Chan; Ye, Jun-Jie; Wang, Xu-Qian; Sui, Rui-Fang

    2016-01-01

    Background: Inverted internal limiting membrane (ILM) flap technique has recently been reported in a limited number of studies as an effective surgical technique for the management of large macular holes (MHs) with fair MH closure rates as well as gains in visual acuity. In the current study, longitudinal changes in multi-focal electroretinogram (mfERG) responses, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated in eyes with large MHs managed by this technique. Methods: A prospective noncontrolled interventional study of eight patients (eight eyes) with large MHs (minimum diameter >400 μm) was conducted. All MHs were treated with pars plana vitrectomy and indocyanine green-assisted inverted ILM flap technique. SD-OCT images were used to assess the anatomical outcomes of surgery while BCVA and mfERG were used to evaluate the functional outcomes during a 3-month follow-up. Results: All patients underwent successful intended manipulation and translocation of the ILM flap without flap dislocation and achieved complete anatomical closure. Partial microstructural reconstruction, demonstrated on SD-OCT as restoration of the external limiting membrane and the ellipsoid zone, was observed in all cases as early as 1 month after surgery. Functionally, as compared to baseline, all patients showed improvements in BCVA and all but one in mfERG response during follow-up. However, Pearson's test revealed no significant correlations between BCVA and mfERG responses of the fovea and of the macular area at each evaluation time point. Conclusions: Inverted ILM flap technique appeares to be a safe and effective approach for the management of large idiopathic MHs with favorable short-term anatomical and functional results. Postoperative reconstruction of the microstructure generally shows good consistency with improvements in both BCVA and mfERG response, of which the latter might be a supplement for the former in

  18. The flap by flap dissection in terminal ballistic applied to less lethal weapons.

    PubMed

    de Freminville, Humbert; Rongieras, Fréderic; Prat, Nicolas; Voiglio, Eric J

    2011-06-01

    Medical examiners often have to solve questions such as firing distance and bullet trajectory for lethal weapons. Knowledge in the field of terminal ballistics has increased during the last 30 years and layer by layer dissection reveals superficial wounds that can be linked with the permanent cavity. At the end of the 1990s, terminal ballistics also focused on less lethal weapons and their wounds. Here, 2 different less lethal weapons with single bullets were tested on nonembalmed and undressed cadavers (N = 26) at different ranges and speeds. We have developed a technique for dissection which we call flap by flap dissection that reveals the advantage of the bullet-skin-bone entity, the absence of wounds linking its components and range of less lethal weapons.

  19. Does body mass index matter while selecting the flap type for pharyngeal reconstructions?

    PubMed

    Calli, Caglar; Teknos, Theodoros N; Agrawal, Amit; Schuller, David E; Ozer, Enver; Songu, Murat

    2014-05-01

    The aim of our study was to investigate the effect of patient-related factors, such as the body mass index (BMI) and tumor size, in selecting the flap type for the reconstruction of pharyngeal defects. This retrospective review included 182 patients with pharyngeal defect reconstructions with free and pedicled flaps at the Ohio State University from January 2005 to December 2008. We conducted a retrospective comparison of variety of different flap reconstruction techniques. We compared different flap reconstruction with BMI and tumor size without functional outcome such as swallowing and speech data. Although there was no statistically significant correlation (P > 0.05) when comparing the free flaps with pedicled flaps according to the BMI and tumor size, there was an obvious tendency to prefer radial forearm free flap over anterolateral thigh free flap in patients who are overweight and those with obesity with a ratio of 32:3. In the same group of patients, a similar tendency was observed to prefer fibular free flap over iliac crest free flap with a ratio of 14:5, whereas the ratio was becoming 3:5 in favor of iliac crest free flap over fibular free flap in patients with BMI of 24 or lower. Despite the fact that surgeons' experience with a certain flap type is one of the most important factors while determining which flap to reconstruct, BMI might have a significant impact while selecting the free flap types for the reconstruction of pharyngeal defects.

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

    PubMed

    Deganello, Alberto; Leemans, C René

    2014-08-01

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

  1. Bilateral anterolateral thigh flaps for large-volume breast reconstruction.

    PubMed

    Rosenberg, Jason J; Chandawarkar, Rajiv; Ross, Merrick I; Chevray, Pierre M

    2004-01-01

    Autologous tissue reconstruction of a large breast in patients who are not candidates for a TRAM flap is a difficult problem. We present a case report of the use of bilateral free anterolateral thigh (ALT) flaps for immediate reconstruction of a unilateral large breast in a patient who had a previous abdominoplasty. Use of ALT flaps allows two or three surgical teams to work simultaneously, does not require intraoperative patient repositioning, has minimal donor-site morbidity, and can provide ample malleable soft tissue for breast reconstruction. These are advantages compared to the use of gluteal donor sites. The disadvantages include more conspicuous donor-site scarring on the anterior thighs.

  2. Spectacles under Pedicles: Eyewear Modification with the Paramedian Forehead Flap

    PubMed Central

    Qu, Linda T.; Kelpin, John P.; Komorowska-Timek, Ewa

    2016-01-01

    Summary: The paramedian forehead flap is a widely used method of nasal reconstruction. The flap requires a bridge of tissue from forehead to the nose, for a period of 2 to 3 weeks, before it can be divided at a second procedure. During this time, patients often have difficulty positioning and wearing their eyewear underneath the pedicle of the flap. Here we present a novel approach to the problem. It requires only a simple modification to the patient’s eyewear and greatly facilitates wear and removal.

  3. Spectacles under Pedicles: Eyewear Modification with the Paramedian Forehead Flap.

    PubMed

    Qu, Linda T; Kelpin, John P; Eichhorn, Mitchell G; Komorowska-Timek, Ewa

    2016-08-01

    The paramedian forehead flap is a widely used method of nasal reconstruction. The flap requires a bridge of tissue from forehead to the nose, for a period of 2 to 3 weeks, before it can be divided at a second procedure. During this time, patients often have difficulty positioning and wearing their eyewear underneath the pedicle of the flap. Here we present a novel approach to the problem. It requires only a simple modification to the patient's eyewear and greatly facilitates wear and removal. PMID:27622084

  4. Spectacles under Pedicles: Eyewear Modification with the Paramedian Forehead Flap

    PubMed Central

    Qu, Linda T.; Kelpin, John P.; Komorowska-Timek, Ewa

    2016-01-01

    Summary: The paramedian forehead flap is a widely used method of nasal reconstruction. The flap requires a bridge of tissue from forehead to the nose, for a period of 2 to 3 weeks, before it can be divided at a second procedure. During this time, patients often have difficulty positioning and wearing their eyewear underneath the pedicle of the flap. Here we present a novel approach to the problem. It requires only a simple modification to the patient’s eyewear and greatly facilitates wear and removal. PMID:27622084

  5. Medicinal leeches used to salvage a traumatic nasal flap.

    PubMed

    Mortenson, B W; Dawson, K H; Murakami, C

    1998-12-01

    We report a case in which medicinal leeches (Hirudo medicinalis) were used to rescue a traumatic nasal flap from venous congestion and loss. A healthy 18-year-old had a bicycling accident and, in addition to other facial injuries, presented with a complex full thickness nasal laceration. After he had been resuscitated and the flap sutured, he was treated with two leeches four times a day for 48 h. His recovery was satisfactory and uncomplicated. Oral and maxillofacial surgeons should be familiar with the use of leeches, as they have a small but occasionally important role in the management of both traumatic and reconstructive flaps.

  6. Tolerance of gastric mucosal flap to postoperative irradiation

    SciTech Connect

    Devineni, V.R.; Hayden, R.; Fredrickson, J.; Sicard, G. )

    1991-05-01

    When malignant lesions of the oral cavity, base of tongue, and oropharynx are treated with radical resection, adequate reconstruction is required. The free gastric mucosal flap with microvascular transfer is being used with increasing frequency at Washington University Medical Center. Because of the advanced nature of the primary lesions, most patients also require postoperative radiation therapy. In this paper the tolerance of the gastric mucosal flap to postoperative radiation therapy is reviewed. The changes resulting from radiation therapy in the mucosal flap were found to be acceptable, and no major complications were encountered.

  7. Vertical extended hemi crico-laryngectomy and reconstruction with a prefabricated tracheal free flap--initial results.

    PubMed

    Cox, G J; Goodacre, T E; Corbridge, R

    2000-01-01

    We describe our experiences of treating three patients with recurrent T3 squamous cell carcinoma of the larynx, following initial treatment with radiotherapy; using the technique of partial crico-laryngectomy and autologous pre-fabricated tracheal flap reconstruction as described in 1998 by Delaere (1). We have found the technique to be technically challenging. The patients require extensive speech and swallowing rehabilitation following surgery, but the functional result offers significant advantages over the other surgical salvage procedures of total or near-total laryngectomy. We describe our early results of three patients that we have treated using this technique. PMID:10865483

  8. Dental restoration with endosseous implants after mandibular reconstruction using a fibula free flap and TMJ prosthesis: a patient report.

    PubMed

    Infante-Cossio, Pedro; Torres-Lagares, Daniel; Martinez-de-Fuentes, Rafael; Garcia-Perla-Garcia, Alberto; Gutierrez-Perez, Jose-Luis

    2006-01-01

    This patient report describes the secondary reconstruction of a hemimandibular and condylar defect and the dental restoration of a 56-year-old woman who had been subjected to radical ablative surgery 30 years earlier to remove a tumor. In the first phase, a fibula free flap was used in combination with a total TMJ prosthesis for the reconstruction of the hemimandible and condyle. Secondly, 3 endosseous implants were placed in the residual mandible. These implants were used to support an overdenture prosthesis that has remained in continuous function for a period of 2 years.

  9. Knee extensor loss and proximal tibial soft tissue defect managed successfully with simultaneous medial gastrocnemius flap, saphenous fasciocutaneous flap and medial hemisoleus flap: a case report

    PubMed Central

    2013-01-01

    Introduction Open fractures of the proximal tibia often pose serious challenges to the treating orthopedic surgeon. Management of these complex injuries becomes difficult if they are associated with damage to the extensor mechanism and an exposed knee joint. The scenario becomes more difficult to manage when the soft tissue defect extends to the middle third of the leg. We report a case where we used an extended medial gastrocnemius flap in combination with a saphenous artery fasciocutaneous flap and a medial hemisoleus flap for treatment of an infected proximal tibia fracture with loss of the extensor mechanism and soft tissue defect. To the best of our knowledge, combined use of these three flaps for the management of such injuries has not been reported elsewhere to date. Case presentation A 28-year-old Indian man presented to our Out-patient Department with complaints of pain and pus discharge from his left proximal leg for four weeks. He had sustained an open fracture of his left proximal tibia in a road traffic accident five weeks ago and had been operated on elsewhere. He had a stiff, painful knee with an infected wound of 4×4cm over the proximal third of his leg exposing infected, necrotic patellar tendon. He was successfully managed with debridement and simultaneously elevated flaps as described. Conclusions This procedure avoids the donor site morbidity associated with free flaps harvested from sites distant from the site of injury, and also does not need the expertise of microvascular reconstruction. To the best of our knowledge, this is also the first report of the combined use of three local flaps for knee extensor reconstruction and soft tissue coverage around the knee. PMID:23506268

  10. Carotid artery surgery

    MedlinePlus

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  11. Autologous sclera-muscle flaps technique in evisceration with hydroxyapatite implantation

    PubMed Central

    Zhu, Ying; Zhang, Hong; Song, Yin-Wei; Guo, Jing-Min; Xu, Xiao-Lan; Wang, Jun-Ming

    2015-01-01

    AIM To provide superior cosmetic results and reduce complications, unlike traditional evisceration coupled with implant insertion technique and its modifications, we have developed a novel and simple technique for anophthalmic patients. METHODS All patients who underwent the scleral-muscle flaps procedure in evisceration with the placement of hydroxyapatite implant were included in the study. Main outcome measures were complications such as exposure, infection, chemosis, conjunctival inclusion cysts, granulomas. Meanwhile, implant motility was indirectly measured and the results were collected and analyzed. RESULTS A total of twenty-eight patients were enrolled in the study. Eighteen were men (64.29%) and ten were women (35.71%). Ages ranged from 18 to 65y (mean age, 32 years old). Mean follow-up was 12.32mo (range, 9-16mo). All patients received a hydroxyapatite implant. The average diameter of the implant was 19.29±1.36 mm (range, 18-22 mm). Minor complications occurred in 3 patients, and a major complication was observed in 1 patient. Mean motility were 11.04±1.45 mm horizontally (range, 7-14 mm) and 8.57±1.50 mm vertically (range, 5-12 mm). CONCLUSION The sclera-muscle flaps technique in evisceration with hydroxyapatite implantation is simple and practical that eases the surgical procedure, enables a proper size hydroxyapatite implantation, distinctively reduces complications and provides superior surgery results, especially the motility of the implant. PMID:26309868

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Summary: Breast implant exposure due to poor tissue coverage or previous irradiation represents a surgical challenge both in the reconstructive and aesthetic plastic surgery practice. In case of implant extrusion or incipient exposure, the commonly suggested strategies, such as targeted antibiotic therapy, drainage and lavage of the cavity, fistulectomy, and primary closure, may be ineffective leading the surgeon to an unwanted implant removal or to adopt more invasive flap coverage procedures. Breast implant capsule, in its physiological clinical behavior, can be considered as a new reliable source of tissue, which can be used in a wide range of clinical situations. In our hands, capsular flaps proved to be a versatile solution not only to treat breast contour deformities or inframammary fold malpositions but also to salvage exposed breast implants. In this scenario, the use of more invasive surgical techniques can be avoided or simply saved and delayed for future recurrences.(Plast Reconstr Surg Glob Open 2015;3:e340; doi:10.1097/GOX.0000000000000307; Published online 30 March 2015.) PMID:26034647

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

    PubMed Central

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

    2015-01-01

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

  15. The Lateral Port Control Pharyngeal Flap: A Thirty-Year Evolution and Followup

    PubMed Central

    Boutros, Sean; Cutting, Court

    2013-01-01

    In 1971, Micheal Hogan introduced the Lateral Port Control Pharyngeal Flap (LPCPF) which obtained good results with elimination of VPI. However, there was a high incidence of hyponasality and OSA. We hypothesized that preoperative assessment with videofluoroscopy and nasal endoscopy would enable modification and customization of the LPCPF and result in improvement in the result in both hyponasality and obstructive apnea while still maintaining results in VPI. Thirty consecutive patients underwent customized LPCPF. All patients had preoperative diagnosis of VPI resulting from cleft palate. Patient underwent either videofluoroscopy or nasal endoscopy prior to the planning of surgery. Based on preoperative velar and pharyngeal movement, patients were assigned to wide, medium, or narrow port designs. Patients with significant lateral motion were given wide ports while patients with minimal movement were given narrow ports. There was a 96.66% success rate in the treatment of VPI with one patient with persistent VPI (3.33%). Six patients had mild hyponasality (20 %). Two patients had initial OSA (6.67%), one of which had OSA which lasted longer than six months (3.33%). The modifications of the original flap description have allowed for success in treatment of VPI along with an acceptably low rate of hyponasality and OSA. PMID:23365734

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

    PubMed

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

    2014-11-17

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

  17. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

  18. Fetal Surgery

    PubMed Central

    Laberge, Jean-Martin

    1986-01-01

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

  19. Robotic surgery.

    PubMed

    Oleynikov, Dmitry

    2008-10-01

    This article discusses the developments that led up to robotic surgical systems as well as what is on the horizon for new robotic technology. Topics include how robotics is enabling new types of procedures, including natural orifice endoscopic translumenal surgery in which one cannot reach by hand under any circumstances, and how these developments will drive the next generation of robots. PMID:18790158

  20. Cardiac Surgery

    PubMed Central

    Weisse, Allen B.

    2011-01-01

    Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of coronary artery bypass grafting greatly aided the treatment of coronary heart disease. Cardiac transplantation, attempts to use the total artificial heart, and the application of ventricular assist devices have brought us to the present day. Although progress in the field of cardiovascular surgery appears to have slowed when compared with the halcyon times of the past, substantial challenges still face cardiac surgeons. It can only be hoped that sufficient resources and incentive can carry the triumphs of the 20th century into the 21st. This review covers past developments and future opportunities in cardiac surgery. PMID:22163121

  1. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

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

  2. [Laparoscopic surgery in day surgery].

    PubMed

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

    1998-06-01

    Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have

  3. Soap Films Burst Like Flapping Flags

    NASA Astrophysics Data System (ADS)

    Lhuissier, Henri; Villermaux, Emmanuel

    2009-07-01

    When punctured, a flat soap film bursts by opening a hole driven by liquid surface tension. The hole rim does not, however, remain smooth but soon develops indentations at the tip of which ligaments form, ultimately breaking and leaving the initially connex film into a mist of disjointed drops. We report on original observations showing that these indentations result from a flaglike instability between the film and the surrounding atmosphere inducing an oscillatory motion out of its plane. Just like a flag edge flaps in the wind, the film is successively accelerated on both sides perpendicularly to its plane, inducing film thickness modulations and centrifuging liquid ligaments that finally pinch off to form the observed spray. This effect exemplifies how the dynamics of fragile objects such as thin liquid films is sensitive to their embedding medium.

  4. Oblique waves lift the flapping flag.

    PubMed

    Hœpffner, Jérôme; Naka, Yoshitsugu

    2011-11-01

    The flapping of the flag is a classical model problem for the understanding of fluid-structure interaction: How does the flat state lose stability? Why do the nonlinear effects induce hysteretic behavior? We show in this Letter that, in contrast with the commonly studied model, the full three-dimensional flag with gravity has no stationary state whose stability can be formally studied: The waves are oblique and must immediately be of large amplitude. The remarkable structure of these waves results from the interplay of weight, geometry, and aerodynamic forces. This pattern is a key element in the force balance which allows the flag to hold and fly in the wind: Large amplitude oblique waves are responsible for lift. PMID:22181612

  5. Sinking skin flap syndrome in glioblastoma.

    PubMed

    Kamiya-Matsuoka, Carlos; Shroff, Sheetal; Tatsui, Claudio E; Tremont-Lukats, Ivo W; Gilbert, Mark R

    2014-01-01

    Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. Hallmark of SSFS is the sinking of the scalp to a plane lower than the edges of the skull defect in the setting of neurological deterioration. Our objective is to report that SSFS can present after small craniotomy without cerebral cortex compression and to share our diagnostic/therapeutic approach. A 62-year-old woman with a glioblastoma developed SSFS after a small craniectomy and tumour resection without cerebral cortex compression but a decrease in the surgical cavity volume. Brain MRI showed decreased size of the surgical cavity. Interestingly, the patient also developed posterior reversible encephalopathy syndrome (PRES). This case highlights an atypical presentation of SSFS and the possible association with PRES. It also illustrates how an early cranioplasty can successfully reverse SSFS. PMID:25398923

  6. Oblique waves lift the flapping flag.

    PubMed

    Hœpffner, Jérôme; Naka, Yoshitsugu

    2011-11-01

    The flapping of the flag is a classical model problem for the understanding of fluid-structure interaction: How does the flat state lose stability? Why do the nonlinear effects induce hysteretic behavior? We show in this Letter that, in contrast with the commonly studied model, the full three-dimensional flag with gravity has no stationary state whose stability can be formally studied: The waves are oblique and must immediately be of large amplitude. The remarkable structure of these waves results from the interplay of weight, geometry, and aerodynamic forces. This pattern is a key element in the force balance which allows the flag to hold and fly in the wind: Large amplitude oblique waves are responsible for lift.

  7. Vortex Flap Technology: a Stability and Control Assessment

    NASA Technical Reports Server (NTRS)

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

    1984-01-01

    A comprehensive low-speed wind tunnel investigation was performed of leading edge vortex flaps applied to representative aircraft configurations. A determination was made of the effects of analytically- and empirically-designed vortex flaps on the static longitudinal and lateral-directional aerodynamics, stability, and control characteristics of fighter wings having leading-edge sweep angles of 45 to 76.5 degrees. The sensitivity to several configuration modifications was assessed, which included the effects of flap planform, leading- and trailing-edge flap deflection angles, wing location on the fuselage, forebody strakes, canards, and centerline and outboard vertical tails. Six-component forces and moments, wing surface static pressure distributions, and surface flow patterns were obtained using the Northrop 21- by 30-inch low-speed wind tunnel.

  8. Optimization of Kinematics of a Flapping Wing Mechanism

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

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

  9. Buccinator Myomucosal Flap for Treatment of Osteoradionecrosis of the Mandible.

    PubMed

    Woo, Seung Hoon

    2016-03-01

    The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.

  10. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond...

  11. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond...

  12. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond...

  13. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond...

  14. 14 CFR 23.697 - Wing flap controls.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... wing flap control lever settings corresponding to those positions must be positively located such that a definite change of direction of movement of the lever is necessary to select settings beyond...

  15. Splash jet and slamming generated by a rotating flap

    NASA Astrophysics Data System (ADS)

    Sun, S. Y.; Sun, S. L.; Ren, H. L.; Wu, G. X.

    2015-09-01

    The hydrodynamic problem of slamming generated by a rotating flap, commonly known as Oyster in the wave energy sector, plunging into water, is analysed based on the incompressible velocity potential theory. The problem is solved through the boundary element method in the time domain. Two typical case studies are undertaken. One is the flap plunging into calm water and the other into an incoming wave. The splash jet formed during the flap plunging is included in the simulation. When the jet meets the main flow, it is treated through the domain decomposition method without taking account the secondary impact, which is similar to the mathematical method of Riemann's second sheet in the complex plane. The problem is solved in each non-overlapping subdomain, and the velocity and pressure continuity condition is imposed on the interface of the subdomains. Detailed results for the flap plunging into water with different velocities or accelerations are provided. The gravity and wave effects are also investigated.

  16. Transfer of free fillet lateral arm flap for facial reconstruction.

    PubMed

    Bayram, Fazli Cengiz; Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep

    2014-07-01

    We describe a 16-year-old male patient who had a major right facial degloving injury resulting in a soft-tissue defect with exposed zygoma as well as temporal and frontal bones. Multiple operations were undertaken in a staged manner for reconstruction. Lateral arm free fillet flap transfer was initially performed with fixation of bones with miniplates, which is followed by flap debulking, lateral canthopexy, scalp tissue expansion for hairline reconstruction, as well as ear reconstruction with costal cartilage and local flap techniques. After a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures after a successful free fillet flap transfer from an amputated part. PMID:25006958

  17. Flap motion of helicopter rotors with novel, dynamic stall model

    NASA Astrophysics Data System (ADS)

    Han, Wei; Liu, Jie; Liu, Chun; Chen, Lei; Su, Xichao; Zhao, Peng

    2016-07-01

    In this paper, a nonlinear flapping equation for large inflow angles and flap angles is established by analyzing the aerodynamics of helicopter blade elements. In order to obtain a generalized flap equation, the Snel stall model was first applied to determine the lift coefficient of the helicopter rotor. A simulation experiment for specific airfoils was then conducted to verify the effectiveness of the Snel stall model as it applies to helicopters. Results show that the model requires no extraneous parameters compared to the traditional stall model and is highly accurate and practically applicable. Based on the model, the relationship between the flapping angle and the angle of attack was analyzed, as well as the advance ratio under the dynamic stall state.

  18. Wing compliance in self-propelled flapping flyers

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

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

  19. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    PubMed Central

    Liu, Yuan Fang; Vuong, Christopher; Walker, Paul Charles; Peterson, Nathaniel Ray; Inman, Jared Christian; Filho, Pedro Alcantara Andrade; Lee, Steve Choon-Sung

    2016-01-01

    Eulerian Video Magnification (EVM) can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free. PMID:27092284

  20. Post-facelift flap necrosis treatment using charged polystyrene microspheres

    PubMed Central

    Weissman, Oren; Farber, Nimrod; Remer, Eric; Tessone, Ariel; Trivizki, Omer; Bank, Jonathan; Winkler, Eyal; Zilinsky, Isaac; Haik, Josef

    2013-01-01

    BACKGROUND: Flap necrosis following facial rhytidectomy constitutes a vexing and grievous complication to the patient and the surgeon. Treatment modalities that can expedite wound healing and re-epithelialization rates are highly desired. OBJECTIVES: To assess wound healing and re-epithelialization rates of open wounds following postrhytidectomy flap necrosis treated with commercially available charged polystyrene microspheres (Polyheal-1, Polyheal Ltd, Israel). METHODS: Flap necrosis following rhytidectomy with open wounds in three female patients were treated using dressings soaked with Polyheal-1. Wound closure rates were documented. RESULTS: The wounds demonstrated both accelerated granulation tissue formation and rapid re-epithelialization rates. No complications or side effects were encountered. CONCLUSIONS: Charged polystyrene microspheres may offer a new and efficacious way to treat open wounds due to flap necrosis following facial rhytidectomy. Further research with larger patient numbers is still needed to verify these findings. PMID:24431937