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Sample records for anterolateral thigh flap

  1. The clinical application of anterolateral thigh flap.

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

    2011-01-01

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

  2. Neural Anatomy of the Anterolateral Thigh Flap

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    Luenam, Suriya; Prugsawan, Krit; Kosiyatrakul, Arkaphat; Chotanaphuti, Thanainit; Sriya, Piyanee

    2015-01-01

    The anterolateral thigh (ALT) flap is one of the commonly used sensate flaps for intra-oral, hand, and foot reconstruction. The objective of this study was to describe the anatomic location of the sensory nerves supplying the ALT flap in relation to the surface landmarks and with the vascular pedicles. The dissections were carried out in 28 embalmed specimens. An axial line from the anterior superior iliac spine to the superolateral border of the patella and two circles with radii of 5 and 10...

  3. Neural Anatomy of the Anterolateral Thigh Flap.

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    Luenam, Suriya; Prugsawan, Krit; Kosiyatrakul, Arkaphat; Chotanaphuti, Thanainit; Sriya, Piyanee

    2015-06-01

    The anterolateral thigh (ALT) flap is one of the commonly used sensate flaps for intra-oral, hand, and foot reconstruction. The objective of this study was to describe the anatomic location of the sensory nerves supplying the ALT flap in relation to the surface landmarks and with the vascular pedicles. The dissections were carried out in 28 embalmed specimens. An axial line from the anterior superior iliac spine to the superolateral border of the patella and two circles with radii of 5 and 10 cm centered on the midpoint of the former line were used for the surface landmarks. At the intersection point of the axial line and the 10-cm circle, the main lateral femoral cutaneous nerve (LFCN) and its anterior branch were located within 1 and 2.4 cm, respectively. At the intersection point of the axial line and the 5-cm circle, the anterior branch of the LFCN was located within 2.8 cm. The anterior branch of the LFCN can be detected within 3 cm from the central perforator pedicle in all specimens. The posterior branch of the LFCN, superior perforator nerve, and median perforator nerve were found in more variable locations. The findings from our study provide additional information for clinical use in the planning of sensate ALT flap harvest. PMID:26078503

  4. Free anterolateral thigh flaps for upper extremity soft tissue reconstruction

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    Spindler, Nick

    2015-02-01

    Full Text Available Introduction: Limb-threatening wounds of the upper extremity pose a challenge to the micro vascular surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction.Methods: A retrospective review of patients undergoing this procedure from 2005 to 2012 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes.Results: Thirty-two patients with a mean age of 53 years (9–84 yrs underwent upper extremity reconstruction with an anterolateral thigh (ALT flap. There were 24 (75% males and 8 (25% females. The etiology of the soft tissue defects was: infection (44.6%; post-tumor ablation (40%; and trauma (15.6%. The defect site was most commonly in the forearm (53.1%, followed by the elbow (12.5 %, arm (12.5% and hand (21.9%. The mean timing of free flap transfer was 6.8 days after admission to our institution (minimum 1 days, maximum 9 days. Mean operative time of surgery was 4 h 39 min (minimum 3 h 2 min, maximum 20 min. The mean hospitalization was 24.8 days (minimum 5, maximum 85. The ALT success rate was at 92.3%. Partial flap necrosis was documented in five cases (15.6%. Complete flap loss occurred in two post-traumatic cases who both lost their limbs.Discussion: This flap, in the hands of experienced surgeons, provides reliable coverage of upper extremity defects.

  5. Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

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    Tommaso Agostini

    2013-03-01

    Full Text Available Background A thinned anterolateral thigh (ALT flap is often harvested to achieve optimalskin resurfacing. Several techniques have been described to thin an ALT flap including anadipocutaneous flap, an adipofascial flap and delayed debulking.Methods By systematically reviewing all of the available literature in English and French, thepresent manuscript attempts to identify the common surgical indications, complications anddonor site morbidity of the adipofascial variant of the ALT flap. The studies were identifiedby performing a systematic search on Medline, Ovid, EMBASE, the Cochrane Database ofSystematic Reviews, Current Contents, PubMed, Google, and Google Scholar.Results The study selection process was adapted from the Preferred Reporting Items forSystematic Reviews and Meta-Analyses statement, and 15 articles were identified usingthe study inclusion criteria. These articles were then reviewed for author name(s, year ofpublication, flap dimensions and thickness following defatting, perforator type, type of transfer,complications, thinning technique, number of cases with a particular area of application anddonor site morbidity.Conclusions The adipofascial variant of the ALT flap provides tissue to fill large defects andimprove pliability. Its strong and safe blood supply permits adequate immediate or delayeddebulking without vascular complications. The presence of the deep fascia makes it possibleto prevent sagging by suspending and fixing the flap for functional reconstructive purposes(e.g., the intraoral cavity. Donor site morbidity is minimal, and thigh deformities can bereduced through immediate direct closure or liposuction and direct closure. A safe bloodsupply was confirmed by the rate of secondary flap debulking.

  6. Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome.

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    Changchien, Chih-Hsuan; Chen, Wei-Chen; Su, Yu-Min

    2016-01-01

    We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate. PMID:27583272

  7. Knee and Ankle Reconstruction With Reverse Anterolateral Thigh and Free Anterolateral Thigh Flap From One Donor Site.

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    Choi, KyeongBeom; Cho, JaeHo; Park, MyongChul; Park, Dong Ha; Lee, Il Jae

    2016-09-01

    Traditionally, the anterolateral thigh (ALT) free flap is used in distal lower extremity reconstruction. Reverse ALT flap has become one of the most popular choices for knee joint soft tissue defects. A 53-year-old man sustained a degloving injury in the right lateral side of the lower extremity from the lateral malleolar area to the knee joint area. The contamination was severe, necessitating serial debridement and negative pressure wound therapy. After 4 weeks, no more soft tissue necrosis was evident. No more microorganism growth was confirmed by swab culture. ALT free flap using proximal perforator was planned for lateral malleolar area reconstruction and reverse ALT flap using distal perforator was planned to cover knee joint after confirming the pedicle length was sufficient for simultaneous knee and lateral malleolar area reconstruction. PMID:27317019

  8. Reconstruction of Wide-apart Double Defect Using a Branch-based Chimeric Anterolateral Thigh Flap

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    Wei Wei Liu, MD

    2014-01-01

    Full Text Available Summary: Wide-apart double defect in head and neck region is rare and difficult to reconstruct at one time. Double free flaps are normally used for this scenario and often tedious and technically complicated. This study presented a technique using branch-based anterolateral thigh free flap to simultaneously reconstruct the 2 defects separated wide apart. The concept, indications, surgical technique, and anatomical variations are discussed. Branch-based anterolateral thigh flap is a safe technique and the dissection will be easy when the oblique branch is present.

  9. Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

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    Yadav Prabha

    2010-01-01

    Full Text Available Background: The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage. Materials and Methods: From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft. Result: All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance. Conclusion: Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.

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

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    Min Jae Lee

    2012-07-01

    Full Text Available Background The anterolateral thigh (ALT perforator flap has become a popular option fortreating soft tissue defects of lower extremity reconstruction and can be combined witha segment of the vastus lateralis muscle. We present a comparison of the use of the ALTfasciocutaneous (ALT-FC and myocutaneous flaps.Methods We retrospectively reviewed patients in whom free-tissue transfer was performedbetween 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twentyfourpatients were divided into two groups: reconstruction using an ALT-FC flap (12 cases andreconstruction using a vastus lateralis myocutaneous (VL-MC flap (12 cases. Postoperativecomplications, functional results, cosmetic results, and donor-site morbidities were studied.Results Complete flap survival was 100% in both groups. A flap complication was noted inone case (marginal dehiscence of the ALT-FC group, and no complications were noted in theVL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site,and debulking surgeries were needed for two cases. There were no significant differences inthe mean scores for either functional or cosmetic outcomes in either group.Conclusions The VL-MC flap is able to fill occasional dead space and has comparable survivalrates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevatedwithout myocutaneous perforator injury.

  11. Groin reconstruction by anterolateral thigh flap: A review of 16 cases

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    Ahmad Quazi

    2004-01-01

    Full Text Available We present our experience of pedicled Anterolateral thigh flap for reconstruction of groin defects in cancer patients. Total of 17 flaps in 16 patients were performed between January 2001 to May 2003. 15 flaps were used for groin defects after node dissection for carcinoma of Penis (bilateral groin defects in one patient, 1 case of Squamous Cell Carcinoma of groin and 1 case of Soft Tissue Sarcoma of groin. All patients were male. 16 were myocutaneous variety and 1 was fasciocutaneous flap based on the septocutaneous perforator. Complications were few and all patients achieved durable long-term coverage. We found the flap to be technically easy and reliable.

  12. [Coverage of anterior knee defect by reverse flow anterolateral thigh flap: About two cases].

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    Montoya-Faivre, D; Pineau, V; Colson, T; Brix, M; Simon, E

    2016-08-01

    The coverage of soft-tissue defects concerning the front of the knee and the proximal lower leg is a complex procedure. The reverse flow anterolateral thigh flap represents a good solution for this defects, especially when the coverage surface is large-sized and a free flap is not appropriate regarding the difficulty of the process. Flap retrograde vascularization is based on the anastomosis between the descending branch of the circumflex femoral artery and lateral superior genicular artery. It is an easy solution with low morbidity. The authors have chosen this flap to cover soft-tissue defect of anterior knee from two patients with total knee prothesis. PMID:26169962

  13. Free anterolateral thigh perforator flap for sacroiliac defect: First case report in pediatric population

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    Alejandro E. Ramirez

    2016-08-01

    Full Text Available Soft tissue defects of the sacroiliac area, usually can be covered by local flaps. However, for more complex defects, free flap transfers became necessary. We report a case of reconstruction with a free anterolateral thigh (ALT perforator flap for coverage of a sacroiliac bone exposure in a child. A six-years-old boy, suffered a car accident, resulting in pelvic and sacral fractures, as well as degloving injuries of the left thigh, buttocks, and trunk. The patient evolved with an unstable scar over the sacroiliac region with bone exposure. ALT free flap was performed. Left superior gluteal vessels were used as the recipient vessels. A stable coverage was achieved without complications. This is the first case reported of a free ALT perforator flap for sacroiliac coverage in the pediatric population. In cases of complex reconstruction in children, free perforator flap is a safe choice and should be considered in the algorithm of treatment.

  14. Pedicle Anterolateral Thigh Flap Reconstruction after Pelvic Tumor Resection: A Case Report

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    Robert M. Whitfield

    2010-01-01

    Full Text Available A 47-year-old female with a locally advanced urologic malignancy previously managed with resection, diversion, and postoperative radiation therapy presented for management of her recurrent cancer that had eroded through the soft tissues of the left inner thigh and vulva. On all staging studies the tumor involved the left common femoral artery, and vein, both above and below the inguinal ligament. The difficulty with such tumors is the availability of tissue to reconstruct the defect. The patient had a history of deep venous thrombosis in the femoral venous system. A local flap was the most logical type of reconstruction. The patient had a right lower quadrant ureterostomy with a large parastomal hernia which further limited the local flap options. An anterolateral thigh flap from the opposite thigh was used to reconstruct the soft tissue deficit in this patient. This resurfaced the defect and provided coverage for the vascular reconstruction.

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

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    N. Lumen

    2008-01-01

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

  16. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps.

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    Zelken, Jonathan A; AlDeek, Nidal F; Hsu, Chung-Chen; Chang, Nai-Jen; Lin, Chih-Hung; Lin, Cheng-Hung

    2016-02-01

    Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making. © 2014 Wiley Periodicals, Inc. Microsurgery 36:104-114, 2016. PMID:25487137

  17. Treatment of degloving injury of three fingers with an anterolateral thigh flap

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    YU Guang; LEI Hong-yu; GUO Shuang; YU Hao; HUANG Jian-hua

    2011-01-01

    The degloving injuries of the digits and palm remain a persistent challenge. We used an anterolateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring fingers. The flap was designated to wrap the entire circumference of three fingers sustaining degloving injury and to form mitten-hand. The total lengths of the distal phalanxes of three fingers were retained almost complete. The donor defect was covered with split-thickness skin graft. Three months after the first operation, roentgenograms revealed terminal phalanxex resorption in three injured fingers, and the surgical syndactyly between the middle and ring finger was separated at the same time. One month later, the syndactyly between the index and middle fingers was also separated. Good coverage of the soft tissue defects with good function and appearance was achieved. Therefore,we considered that the length of the degloved finger could be preserved using free flap.

  18. Secondary reconstruction of below knee amputation stump with free anterolateral thigh flap

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    Kadam Dinesh

    2010-01-01

    Full Text Available Below knee stump preservation reduces ambulatory energy expenditure and improves the quality of life. Reconstruction of soft tissue loss around the stump is a challenging task. Below knee stump reconstruction demands stable skin with sufficient soft tissue to allow weigh bearing. Microsurgical tissue transfer is increasingly being used as a salvage option. Anterolateral thigh flap with additional vastus lateralis muscle provides extra cushioning effect. We report two cases of amputation below knee successfully salvaged. The anterolteral flap with abundant tissue and stable skin offers a reliable option for cover. Two patients with below knee amputation were reconstructed secondarily. After 6 to 20 months of follow -up, stumps showed no signs of pressure effects. Patients are able to bear 50-70 hours of weight per week.

  19. Individual design of the anterolateral thigh flap for functional reconstruction after hemiglossectomy: experience with 238 patients.

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    Wang, L; Liu, K; Shao, Z; Shang, Z-J

    2016-06-01

    The aim of this study was to evaluate tongue function in patients with oral cancer treated surgically and reconstructed with anterolateral thigh free flaps (ALTFs). Patients (N=238) underwent primary reconstruction after hemiglossectomy between September 2012 and October 2014. Patients were divided into two groups according to the flap design: 'individual design' (ABC flap) and 'common design'. Patients were followed postoperatively and assessed after 6 months for the following functional outcomes: speech, deglutition, tongue mobility, and donor site morbidity. Intelligibility and deglutition were each scored by an independent investigator. Data were analyzed using SPSS version 16.0 software. No differences in mean speech intelligibility scores were observed between the two groups (good: P=0.908; acceptable: P=0.881). However, the ABC flap offered recovery advantages for swallowing capacity compared to the common design flap (MTF classification good: P=0.028; acceptable: P=0.001). The individualized ABC flap not only provides volume but also preserves mobility, speech intelligibility, and swallowing capacity. ALTFs require further improvement for the individualized functional reconstruction of the tongue after hemiglossectomy, but this work lays the foundation for these improvements. PMID:26826782

  20. Combined index finger pollicization with an anterolateral thigh flap for thumb reconstruction

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    Yu Guang; Xu Hongyan; Lei Hongyu; Guo Shuang; Huang Jianhua; Li Dibin

    2014-01-01

    A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.

  1. Tensor fascia latae perforator flap: An alternative reconstructive choice for anterolateral thigh flap when no sizable skin perforator is available

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    Federico Contedini

    2013-01-01

    Full Text Available Introduction: The anterolateral thigh flap (ALT is a versatile flap and very useful for the reconstruction of different anatomical districts. The main disadvantage of this flap is the anatomical variability in number and location of perforators. In general, absence of perforators is extremely rare. In literature, it is reported to be from 0.89% to 5.4%. If no sizable perforators are found, an alternative reconstructive strategy must be considered. Tensor fascia lata (TFL perforator flap can be a good alternative in these cases: Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost the same indications of the ALT flap. Materials and Methods: We report 11 cases of reconstruction firstly planned with the ALT flap, then converted into TFL perforator flap. Results and Conclusion: The result was always satisfactory in terms of the donor site morbidity and reconstructive outcome.

  2. Clinical applications of preoperative perforator planning using CT angiography in the anterolateral thigh perforator flap transplantation

    International Nuclear Information System (INIS)

    Aim: To evaluate the reliability and utility of preoperative perforator planning using computed tomography angiography (CTA) in anterolateral thigh perforator flap (ALTPF) transplantation. Materials and methods: Thirty-two consecutive patients who underwent extremity reconstruction using the ALTPF were retrospectively reviewed from 2008 to 2012. These patients were divided into two groups. In group I (n = 16), suitable perforators were designed based on four criteria using CTA. These were used for the operation and compared with the intraoperative findings. In group II (n = 16), all patients underwent operation using conventional methods without preoperative perforator planning. The surgical results of all patients were evaluated for flap complications, alteration of the donor site, donor site morbidity, and the incidence of reoperation. Results: In group I, there were no statistically significant differences between the parameters, including the calibre and location of the origin (perpendicular and horizontal distance from the origin of the perforator to both the superior lateral border of the patella and the lateral region of the thigh) of all planning perforators and the operative measurement results (p-values were 0.3, 0.422, and 0.129, respectively). The types were consistent with the operative findings; the rate of the septocutaneous type was 31.25% (5/16), and the rate of the musculocutaneous type was 68.75% (11/16). The use of preoperative perforator planning in group I was associated with a significant reduction in flap complications (p = 0.009) compared with group II. There was no difference between the two groups in alteration of the donor site, donor site morbidity, or the incidence of reoperation (p-values were 0.225, 0.225, and 0.33, respectively). Conclusion: Preoperative perforator planning using CTA in ALTPF transplantation is a reliable and useful method resulting in safer operation with optimal outcome

  3. Use of the Fix and Flap Approach to Complex Open Elbow Injury: The Role of the Free Anterolateral Thigh Flap

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    Christopher Hoe-Kong Chui

    2012-03-01

    Full Text Available Background Complex elbow injuries with associated nerve, muscle, or joint injury commonlydevelop post-inury stiffness. In order to preserve function, joint congruency, elbow stabilityand durable wound coverage must be achieved in a timely manner.Methods A retrospective review of patients who underwent orthopaedic fixation followedby free anterolateral thigh (ALT flap soft tissue coverage was performed. Five patients wereidentified and included in this study.Results We present a series of 5 cases managed with this principle. Soft tissue defects rangedin size from 4×9 cm (36 cm2 to 15×30 cm (450 cm2 and were located either posteriorly(n=4 or anteriorly (n=1. Associated injuries included open fractures (n=3 and motor nervetransection (n=2. Wound coverage was achieved in a mean duration of 18.8 days (range, 11to 42 day. There were no flap failures and no major complications. The mean postoperativeactive elbow motion was 102° (range, 45° to 140°.Conclusions In our small series we have highlighted the safety and utility of using the freeALT flap in complex elbow injuries. The ALT flap has many advantages which include abundantskin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our seriesto obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and,access to fascia lata grafts for reconstruction of the triceps tendon.

  4. Extended anterolateral thigh pedicled flap for reconstruction of trochanteric and gluteal defects: A new & innovative approach for reconstruction

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    G.I.Nambi; Abhijeet Ashok Salunke; Szeryn Chung; K.S.Raj Kumar; Vikram Anil Chaudhari; Anant Dattaray Dhanwate

    2016-01-01

    Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for anterolateral thigh (ALT) flap.Oblique branch of LCFA is an alternative pedicle that can be used in microvascular surgery.According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction.Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident,who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.

  5. Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

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    Carlos Alberto Torres-Ortíz Zermeño

    2014-01-01

    Full Text Available Background. The anterolateral thigh (ALT flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

  6. Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

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    ZHANG Gong-lin; Chen, Ke-Ming; Zhang, Jun-Hua; Wang, Shi-Yong

    2012-01-01

    【Abstract】A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transp...

  7. A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect

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    Aditya Aggarwal

    2016-01-01

    Full Text Available Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males, eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

  8. Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

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    ZHANG Gong-lin; CHEN Ke-ming; ZHANG Jun-hua; WANG Shi-yong

    2012-01-01

    A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg.It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm.Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis.The anterior tibial artery was patent.Three weeks after injury,the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect,and an end-to-side anastomosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap's vascular pedicle.A split thickness free skin graft was used to cover the muscle flap and around the flap's vascular pedicle.The vascular pedicle was cut off after 28 days and the muscle flap survived completely.After 3-year follow-up postoperatively,the right tibia and fibula fractures were confirmed healing radiologically.The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations.This technique can be used to preserve the flow and patency of recipient arteries.

  9. Repair of a soft tissue defect of medial malleolus with cross-leg bridge free transfer of anterolateral thigh muscle flap: a case report

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    ZHANG Gong-lin

    2012-11-01

    Full Text Available 【Abstract】A 38-year-old man sustained a traffic accident injury to his right medial malleolus and leg. It was an open fracture of the right tibia and fibula accompanied by a large soft tissue defect of the right medial malleolus sized 12 cm×4 cm. Doppler examination revealed that the tibialis posterior vessel was occluded due to thrombosis. The anterior tibial artery was patent. Three weeks after injury, the left anterolateral thigh muscle flap was harvested and transplanted to the right medial malleolus defect area for repair of the soft tissue defect, and an end-to-side anasto-mosis was performed between the posterior tibial vessel of the contralateral leg and the muscle flap’s vascular pedicle. A split thickness free skin graft was used to cover the muscle flap and around the flap’s vascular pedicle. The vascular pedicle was cut off after 28 days and the muscle flap sur-vived completely. After 3-year follow-up postoperatively, the right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was patent by clinical and Doppler examinations. This tech-nique can be used to preserve the flow and patency of re-cipient arteries. Key words: Surgical flaps; Soft tissue injuries; Leg injuries; Wound healing

  10. 带髂胫束的股前外侧皮瓣修复前臂复杂创面%Anterolateral thigh flap transferred with iliotibial tract for coverage of complicated forearm wounds

    Institute of Scientific and Technical Information of China (English)

    任义军; 裴国献; 任高宏; 金丹; 刘勇; 陈滨; 魏宽海; 王钢

    2008-01-01

    Objective To introduce the transfer of anterolateral thigh flap with iliotibial tract in repair of massive skin and soft tissue defects of the forearm and reconstruction of extension or flexion of the forearm. Methods Eight cases of complicated raw wounds of the forearm were repaired with transfer of anterolateral thigh flap with iliotibial tract. Flexor tendons of 3 cases and extensor tendons of 5 cases were repaired with iliotibial tract. The axial vessel of the flap was used to rebuild blood supply of the hand. Results All the flaps survived completely. A follow-up ranging from 3 months to 2.5 years re- vealed that the reconstructed forearms were good in appearance and soft in texture and restored protective sensation. Affected limbs could perform extension or flexion. Total range of motion (TRM) of the hands was excellent in 6 cases and poor in 2. Conclusion Anterolateral thigh flap with iliotibial tract can not only repair soft tissue defects of the forearm, but also reconstruct the main extension or flexion of the forearm simultaneously.%目的 介绍应用带髂胫束的股前外侧皮瓣移植修复前臂大面积皮肤软组织缺损并重建前臂的主要伸屈功能.方法 切取带髂胫束的股前外侧皮瓣修复前臂复杂创面8例,髂胫束修复前臂屈肌腱缺损3例,伸肌腱缺损5例,同时用皮瓣轴型血管修复手部血供.结果 本组患者皮瓣全部成活,随访3个月~2.5年,前臂外形满意,皮肤质地柔软,皮瓣恢复保护性感觉,患肢能完成主要的伸屈功能,手腕指关节总活动度(TAM)评价:优良6例,差2例.结论 带髂胫柬的股前外侧皮瓣在修复前臂软组织缺损同时可Ⅰ期重建前臂主要伸或屈功能,是一种简单、理想的手术方法.

  11. Three-dimensional visualization of the human face using DICOM data and its application to facial contouring surgery using free anterolateral thigh flap transfer.

    Science.gov (United States)

    Shimizu, Fumiaki; Uehara, Miyuki; Oatari, Miwako; Kusatsu, Manami

    2016-01-01

    One of the main challenges faced by surgeons performing reconstructive surgery in cases of facial asymmetry due to hemifacial atrophy or tumor surgery is the restoration of the natural contour of the face. Soft-tissue augmentation using free-flap transfer is one of the most commonly used methods for facial reconstruction. The most important part of a successful reconstruction is the preoperative assessment of the volume, position, and shape of the flap to be transplanted. This study focuses on three cases of facial deformity due to hemifacial progressive atrophy or tumor excision. For the preoperative assessment, digital imaging and communications in medicine (DICOM) data obtained from computed tomography was used and applied to a three-dimensional (3D) picture software program (ZedView, LEXI, Tokyo, Japan). Using computer simulation, a mirror image of the unaffected side of the face was applied to the affected side, and 3D visualization was performed. Using this procedure, a postoperative image of the face and precise shape, position, and amount of the flap that was going to be transferred was simulated preoperatively. In all cases, the postoperative shape of the face was acceptable, and a natural shape of the face could be obtained. Preoperative 3D visualization using computer simulation was helpful for estimating the reconstructive procedure and postoperative shape of the face. Using free-flap transfer, this procedure facilitates the natural shape after reconstruction of the face in facial contouring surgery. PMID:26319058

  12. 股前外侧脂肪筋膜瓣经和血管吻合游离移植修复面部凹陷畸形%Application of free anterolateral thigh adipofascial flap in the correction of facial depression

    Institute of Scientific and Technical Information of China (English)

    高寿松; 滕利; 张智勇; 靳小雷; 卢建建

    2010-01-01

    目的 探讨应用股前外侧脂肪筋膜瓣经血管吻合游离移植修复面部凹陷畸形的手术方法及临床效果.方法 1996年10月至2007年1月,根据面部凹陷的范围及深度,应用相应大小和厚度的股前外侧脂肪筋膜瓣游离移植修复32例面部凹陷畸形,其中8例伴有骨骼缺损的患者同期行Medpor骨膜下植入修复骨骼缺损.结果 修复32例面部凹陷畸形共应用33块股前外侧脂肪筋膜瓣,单侧应用31例,双侧应用1例.股前外侧脂肪筋膜瓣的大小为12 cm×8 cm~20 cm×11 cm(平均16.5 cm×10.5 cm).30块股前外侧脂肪筋膜瓣完全存活,另3块于术后半年内出现了边缘的吸收.32例中有23例经一期修复即获得满意效果,其余9例于术后半年行二期修整,其中6例因面部臃肿行脂肪抽吸修薄术矫正,另3例因周边吸收行自体脂肪移植术修复.术后随访6个月至2年半,所有患者面部凹陷畸形均得到显著改善,双侧面部接近对称.供区切口一期愈合,瘢痕隐蔽,未出现功能障碍.结论 股前外侧脂肪筋膜瓣町利用的面积大,可修剪成合适厚度用于三维重建,解剖较恒定、切取安全等,必要时可辅以骨骼支架的重建,能使面部凹陷得到较满意的修复.%Objective To investigate the operative technique and therapeutic effect of free anterolateral thigh adipofascial flap in the correction of facial depression. Methods From Oct. 1996 to Jan. 2007, 32 patients with facial depression deformities were treated with free anterolateral thigh adipofascial flaps. The bone defects in 8 cases were corrected with Medpor implants at the same stage. Results 33 free anterolateral thigh adipofascial flaps were used in 32 patients. 2 flaps were used bilaterally in one patient. The size of the flaps ranged from 12 cm × 8 cm to 20 cm × 11 cm(average, 16. 5 cm × 10. 5 cm). 30 flaps survived completely. Flap edge resorption happened in 3 flaps within half a year postoperatively

  13. Pudendal thigh flap for repair of rectovaginal fistula.

    Science.gov (United States)

    Sathappan, S; Rica, M A I

    2006-08-01

    The pudendal thigh flap or the Singapore flap is a versatile flap that can be used in the repair of recto-vaginal fistulae. Apart from the potential problem of hair growth, this neurovascular flap proves to be surprisingly simple in technique, robust and has a high potential for normal or near-normal function. PMID:17240589

  14. 高频彩色多普勒超声检测穿支血管在股前外侧皮瓣手术中的应用%APPLICATION OF HIGH FREQUENCY COLOR DOPPLER ULTRASOUND IN ANTEROLATERAL THIGH FLAP SURGERY

    Institute of Scientific and Technical Information of China (English)

    肖海涛; 时莹瑜; 王怀胜; 刘勇; 张艳阁; 岑瑛

    2013-01-01

    Objective To investigate the effectiveness of high frequency color Doppler ultrasound for detecting perforators in the anterolateral thigh (ALT) flap surgery. Methods Between February 2011 and July 2012, 8 patients underwent high frequency color Doppler ultrasound to detect the perforator anatomy before ALT flap surgery. There were 5 males and 3 females, aged 21-46 years (mean, 34 years). Defects were caused by excision of squamous cell carcinoma in 2 cases, by scalp avulsion in 2 cases, by soft tissue necrosis after neck trauma in 1 case, by excision of groin fibrosarcoma in 1 case, by excision of groin melanoma in 1 case, and by malformation of the face in 1 case. The defect size varied from 12 cm × 7 cm to 22 cm × 18 cm. The perforator with wider caliber, faster flow speed, and shorter intramuscular trajectory was selected, and the flap was designed according to the observed results, which size varied from 14 cm × 9 cm to 25 cm × 20 cm. The donnor sites were repaired by free skin graft. Results Totally, 19 perforators in the flap area were detected by high frequency color Doppler ultrasound, and 18 were identified during operation, with an accuracy rate of 94.7%. The point going out muscle, the travel and direction of perforators observed during operation were basically in accordance with those detected by high frequency color Doppler ultrasound. The other flaps survived, and obtained healing by first intention except 1 flap which had partial fat necrosis with healing by second intention. The skin graft at donor site survived. All patients followed up 4-16 months (mean, 8 months). The flaps had good color and texture. Conclusion High frequency color Doppler ultrasound is a valuable imaging modality for the preoperative assessment of the vascular supply for ALT flap.%目的 探讨术前采用高频彩色多普勒超声检测穿支血管在股前外侧(anterolateral thigh,ALT)皮瓣手术中的应用价值. 方法 2011年2月-2012年7月,收治8例拟行ALT

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

    Directory of Open Access Journals (Sweden)

    Ichiro Hashimoto, MD

    2014-05-01

    Conclusions: The perforator vessels of the internal pudendal artery are very close to the ischial tuberosity. Blood flow to the flap is reliable when careful debridement of the pressure sore is performed. The iPap thigh flap is a new option for soft-tissue defects in the ischial region, including ischial pressure sores.

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

    Science.gov (United States)

    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. PMID:26405422

  17. Recurrent squamous cell carcinoma of the scalp treated with serial free flaps

    DEFF Research Database (Denmark)

    Ikander, Peder; Sørensen, Jens Ahm

    2015-01-01

    dorsi flaps and one anterolateral thigh flap. No total flap loss was seen, but partial flap necrosis called for secondarily reconstruction. The final result was cosmetically acceptable and the patient is of good health. In conclusion, serial free microvascular flaps may be used with good results when...

  18. EXPERIENCE WITH VAGINAL RECONSTRUCTION USING PUDENDAL- THIGH FLAPS--REPORT OF 9 CASES

    Institute of Scientific and Technical Information of China (English)

    李发成; 陆军昌; 关文祥

    2000-01-01

    Objective To review our experience of vaginal reconstruction using pudendal-thigh flap.Methods In the past 4 years, 9 patients suffering from the congenital vaginal agenesis underwent vaginal reconstruction using the pudendal-thigh flaps. The modifications of the surgical technique were detailed. Results All patients recovered satisfactorily from surgery and have been followed- up for a mean of 1.5years. There were no instances of flap loss, penetration of rectum and urethra. On final examination, all patients were recorded as having a satisfactory result, complete flap take, adequate dimensions and depth of neovagina and the external appearance of the perineum and vagina was satisfactory. All married patients reported a satisfactory intercourse. Conclusion The result proves that neurovascular pudendal- thigh flaps provide excellent tissue for vaginal reconstruction with low complication rate and good results. This operation does not cause an ugly donor site scar and can be completed in single stage, without need of laparotomy and postoperative daily dilation. It is believed that this method can serve as a reliable alternative in vaginal reconstruction, which is one of the most challenging subjects of plastic surgery.

  19. Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report.

    Science.gov (United States)

    Scaglioni, Mario F; Chen, Yen-Chou; Yang, Johnson Chia-Shen

    2015-10-01

    Fournier's gangrene can lead to extensive defects of the perineoscrotal area with exposure of the testes. Such defect poses challenging tasks for both functional and cosmetic reconstruction. Due to its proximity, medial thigh skin appeared to be the most versatile donor site for perineoscrotal reconstruction. In this report, we present a case of reconstruction of a large perineoscrotal defect because of Fournier's gangrene using a posteromedial thigh (PMT) perforator propeller flap. A 58 year-old male who suffered from Fournier's gangrene resulted in a scrotal defect of 10 × 12 cm(2) with a large dead space. A pedicled PMT propeller flap measuring 9 × 23 cm(2) with two perforators that originated from the profunda femoris artery (PFA) was harvested for scrotal defect reconstruction and dead space obliteration. The flap survived completely, with no recipient or donor site morbidity. The length of followup was 3 months and was uneventful. The pedicled PMT propeller flap may be considered as a valid option for perineoscrotal reconstruction. PMID:26314393

  20. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle.

    Science.gov (United States)

    Koshima, I; Yamamoto, H; Hosoda, M; Moriguchi, T; Orita, Y; Nagayama, H

    1993-09-01

    Chimeric composite flaps combined using microanastomoses consist of two or more flaps or tissues, each with an isolated pedicle and a single vascular source. Free combined chimeric flaps using the lateral circumflex femoral system were used to treat massive composite defects of the head and neck in 10 cases. A combined anterolateral thigh flap and vascularized iliac bone graft based on the lateral circumflex femoral system and the deep circumflex iliac system was the most commonly used combination. An anteromedial thigh flap and a paraumbilical perforator-based flap were also combined with this principal combination. The advantages of this chimeric flap over other osteocutaneous flaps are: (1) The flap is relatively thin and the pedicle vessels are up to 10 cm longer and are wider than those of other flaps for easier harvesting of the flap. (2) It is unnecessary to reposition the patient. (3) The vascular pedicle to the skin can be separated from that of the bone. (4) The donor site is not close to the recipient site. (5) The donor scar is in an unexposed area. (6) The skin territory of this flap is extremely wide. (7) A combined anterolateral and anteromedial thigh flap and vascularized iliac bone graft can be easily obtained as an extended combined osteocutaneous flap. (8) Other neighboring skin flaps, such as a groin flap, a paraumbilical perforator-based flap, or a medial thigh flap, can be combined with this chimeric flap because several major muscle branches to be anastomosed derive from the lateral circumflex femoral system. Chimeric composite flaps using the lateral circumflex femoral system are considered suitable for the repair of massive composite defects of the head and neck. PMID:8341739

  1. Bilateral pudendal thigh flaps transfer for viginoplasty%阴股沟皮瓣阴道再造

    Institute of Scientific and Technical Information of China (English)

    陈能彬; 胡静

    2012-01-01

    Objective To explore the methods and effect of viginoplasty with bilateral pudendal thigh flaps transfer. Methods From December 2001 to February 2012, twelve patients of congenital absence of vagina were performed viginoplasty of bilateral pudendal thigh flaps transfer pedicled with perineal arteries. Then the clinical experience was summarized and analyzed. Results All flaps in 12 cases survived well, and the reconstructed vagina all gained satisfactory function and appearance without severe complications or scars after 6 to 12 months follow-up. Conclusion It is a safe and effective approach of bilateral pudendal thigh flaps transfer for the reconstruction of congenital absence of vagina.%目的 探讨阴股沟皮瓣阴道再造术的方法 和疗效.方法 自2001年12月至2012年2月,共对12例先天性无阴道患者以双侧会阴动脉为蒂的阴股沟皮瓣,行阴道再造术,并对临床经验作以总结.结果 本组12例患者,皮瓣全部成活,再造阴道功能、外观良好,随访6~12个月,无严重并发症及瘢痕增生,效果满意.结论 阴股沟皮瓣再造阴道,效果可靠,是一种安全、有效的治疗先天性无阴道畸形的整复方法.

  2. Venous-supercharged freestyle posterior thigh flap without a descending branch of the inferior gluteal artery for reconstruction in the infragluteal region.

    Science.gov (United States)

    Fukunaga, Yutaka; Miyamoto, Shimpei; Kobayashi, Eisuke; Sakuraba, Minoru

    2014-12-01

    The posterior thigh flap is a workhorse flap for reconstruction in the gluteal region. The main vascular pedicle of the flap is commonly the descending branch of the inferior gluteal artery, although it is at risk for transection during sarcoma resection. We report successful reconstruction of an infragluteal defect resulting from sarcoma resection with a venous-supercharged freestyle posterior thigh flap in the absence of the descending branch of the inferior gluteal artery. A 77-year-old man underwent sarcoma resection in the infragluteal region. The descending branch of the inferior gluteal artery was sacrificed. We found a sizable perforator through the long head of the biceps femoris and harvested a posterior thigh flap on the basis of that perforator with a freestyle approach. The flap gradually developed a congestive appearance after transfer. We therefore anastomosed the vein of the second perforator to an accompanying vein of the sciatic nerve at the recipient site. The complete flap survived, and the postoperative course was uneventful. We believe that combined use of the freestyle approach and the perforator-supercharging technique can enhance the versatility and the safety of pedicled perforator flap transfer. PMID:25193397

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

    Science.gov (United States)

    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

  4. Donor-Site Morbidity Following Free Tissue Harvest from the Thigh: A Systematic Review and Pooled Analysis of Complications.

    Science.gov (United States)

    Lakhiani, Chrisovalantis; DeFazio, Michael V; Han, Kevin; Falola, Reuben; Evans, Karen

    2016-06-01

    Background Donor-site morbidity significantly influences patient satisfaction and quality of life following reconstructive surgery. The relevant donor-site morbidities associated with more commonly utilized thigh-based flaps are reviewed. Methods A systematic search of the MEDLINE and Cochrane databases from 1994 to 2014 was conducted to identify all reports of "anterolateral thigh (ALT)," "vastus lateralis (VL)," "anteromedial thigh (AMT)," "transverse upper gracilis (TUG)," tensor fascia latae (TFL)," "gracilis," and "rectus femoris (RF)," flaps. Only studies that investigated donor-site outcomes related to pain, paresthesia, wound dehiscence, infection, hematoma, seroma, contour deformity, and/or objective functional performance were included. Case series or anecdotal reports with less than five flaps, non-English, and animal studies were excluded. Results A total of 116 articles representing 4,554 flaps were reviewed, including 2,922 ALT/VL, 148 AMT, 436 TUG, 278 TFL, 527 gracilis, and 243 RF flaps. The most frequently cited donor-site complication was paresthesia (range: 0-36.4%), followed by wound dehiscence (range: 0.9-8.3%), contour deformity (range: 0-5.2%), pain (range: 0-6.3%), and seroma (range: 0.4-2.0%). Despite mixed results regarding functional performance, pooled-analysis of dynamometric studies demonstrated a significant reduction in strength only after RF flap harvest (21%). Conclusions Donor-site morbidity for thigh-flaps is minimal and appears to be well-tolerated by the majority of patients. Nevertheless, the appropriate flap selection is highly individualized, and patients must be informed of potential complications and morbidities specific to each flap. We have established the most current review of donor-site morbidity for thigh-based flaps to aid the surgeon in this important discussion. PMID:27144952

  5. Double free-flap for a bimalleolar defect of lower leg and ankle

    Directory of Open Access Journals (Sweden)

    Naren Shetty

    2016-01-01

    Full Text Available Double free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.

  6. Flap raising on pulsatile perfused cadaveric tissue: a novel method for surgical teaching and exercise.

    Science.gov (United States)

    Wolff, Klaus-Dietrich; Fichter, Andreas; Braun, Christian; Bauer, Florian; Humbs, Martin

    2014-10-01

    Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons. PMID:24938642

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

    Science.gov (United States)

    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. PMID:26898882

  8. Robot-Assisted Free Flap in Head and Neck Reconstruction

    Directory of Open Access Journals (Sweden)

    Han Gyeol Song

    2013-07-01

    Full Text Available Background  Robots have allowed head and neck surgeons to extirpate oropharyngealtumors safely without the need for lip-split incision or mandibulotomy. Using robots inoropharyngealreconstruction is newbut essentialfor oropharyngeal defectsthatresultfromrobotic tumor excision. We report our experience with robotic free-flap reconstruction ofhead and neck defectsto exemplify the necessity forrobotic reconstruction.Methods  We investigated head and neck cancer patients who underwent ablation surgeryand free-flap reconstruction by robot. Between July 1, 2011 andMarch 31, 2012, 5 caseswereperformed and patient demographics, location of tumor, pathologic stage, reconstructionmethods, flap size, recipient vessel, necessary pedicle length, and operation time wereinvestigated.Results  Among five free-flap reconstructions, four were radial forearm free flaps and onewas an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and oneflap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flapinsetting and microanastomosis were achieved using a specially manufactured roboticinstrument. The total operation timewas 1,041.0 minutes(range, 814 to 1,132 minutes, andcomplicationsincluding flap necrosis, hematoma, andwound dehiscence did not occur.Conclusions  Thisstudy demonstratesthe clinically applicable use ofrobotsin oropharyngealreconstruction, especially using a free flap. A robot can assist the operator in insettingthe flap at a deep portion of the oropharynx without the need to perform a traditionalmandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methodsand is accepted asthemost up-to-datemethod.

  9. The Flap Sandwich Technique for a Safe and Aesthetic Skull Base Reconstruction.

    Science.gov (United States)

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

    2016-02-01

    For safe and reliable skull base reconstruction combined with repair of cranial bone defects, we introduce the flap sandwich technique in this study. A titanium mesh is often used to repair structural cranial bone defects because it has less donor site morbidity and is easy to handle. However, titanium mesh has disadvantages of exposure and infection postoperatively. To improve surgical outcomes, we applied the flap sandwich technique to 3 cases of skull base reconstruction combined with cranial bone defect repair. Two anterior skull base defects and 1 middle skull base defect were included in this study. The subjects were all women, aged 30, 58, and 62 years. One patient had former multiple craniotomies and another patient had preoperative radiotherapy. The flap sandwich technique involves structural cranial bone reconstruction with a titanium mesh and soft tissue reconstruction with a chimeric anterolateral thigh free flap. First, the dead space between the repaired dura and the titanium mesh is filled with vastus lateralis muscle, and then structural reconstruction is performed with a titanium mesh. Finally, the titanium mesh is totally covered with the adiposal flap of the anterolateral thigh free flap. The muscle flap protects the dead space from infection, and the adiposal flap covers the titanium mesh to reduce mechanical stress on the covered skin and thus prevent the exposure of the titanium mesh through the scalp. By applying this technique, there was no intracranial infection or titanium mesh exposure in these 3 cases postoperatively, even though 2 patients had postoperative radiotherapy. Additionally, the adiposal flap could provide a soft and natural contour to the scalp and forehead region, and this gives patients a better facial appearance even though they have had skull base surgery. PMID:25954846

  10. Reconstruction of the Lower Extremity Using Free Flaps

    Directory of Open Access Journals (Sweden)

    Min Jo Kang

    2013-09-01

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

  11. Microvascular free flap reconstruction for head and neck cancer in a resource-constrained environment in rural India

    Directory of Open Access Journals (Sweden)

    Nirav P Trivedi

    2013-01-01

    Full Text Available Introduction: Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialised procedure and is not routinely performed in the resource-constrained environment of certain developing parts of India. Materials and Methods: This article focuses on the practice environment in a cancer clinic in rural India. Availability of infrastructure, selection of the case, choice of flap, estimation of cost and complications associated with treatment are evaluated and the merits and demerits of such an approach are discussed. Results: We performed 22 cases of free flaps in a six-month period (2008-2009. Majority (17 of the patients had oral cancer. Seven were related to the tongue and eight to the buccal mucosa. Radial forearm free flap (RFF: 9 and anterolateral thigh flap (ALT: 9 were the most commonly used flaps. A fibula flap (1 was done for an anterior mandible defect, whereas a jejunum free flap (1 was done for a laryngopharyngectomy defect. There were six complications with two re-explorations but no loss of flaps. Conclusion: Reconstruction with microvascular free flaps is feasible in a resource-constrained setup with motivation and careful planning.

  12. Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

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    Mehrotra Sandeep

    2009-01-01

    Full Text Available Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.

  13. Facial contour deformity correction with microvascular flaps based on the 3-dimentional template and facial moulage

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available Introduction: Facial contour deformities presents with varied aetiology and degrees severity. Accurate assessment, selecting a suitable tissue and sculpturing it to fill the defect is challenging and largely subjective. Objective assessment with imaging and software is not always feasible and preparing a template is complicated. A three-dimensional (3D wax template pre-fabricated over the facial moulage aids surgeons to fulfil these tasks. Severe deformities demand a stable vascular tissue for an acceptable outcome. Materials and Methods: We present review of eight consecutive patients who underwent augmentation of facial contour defects with free flaps between June 2005 and January 2011. De-epithelialised free anterolateral thigh (ALT flap in three, radial artery forearm flap and fibula osteocutaneous flap in two each and groin flap was used in one patient. A 3D wax template was fabricated by augmenting the deformity on facial moulage. It was utilised to select the flap, to determine the exact dimensions and to sculpture intraoperatively. Ancillary procedures such as genioplasty, rhinoplasty and coloboma correction were performed. Results: The average age at the presentation was 25 years and average disease free interval was 5.5 years and all flaps survived. Mean follow-up period was 21.75 months. The correction was aesthetically acceptable and was maintained without any recurrence or atrophy. Conclusion: The 3D wax template on facial moulage is simple, inexpensive and precise objective tool. It provides accurate guide for the planning and execution of the flap reconstruction. The selection of the flap is based on the type and extent of the defect. Superiority of vascularised free tissue is well-known and the ALT flap offers a versatile option for correcting varying degrees of the deformities. Ancillary procedures improve the overall aesthetic outcomes and minor flap touch-up procedures are generally required.

  14. Role of 99mTc-methylene diphosphonate bone scan in the evaluation of the viability of the bone flap in mandibular reconstruction in patients with oromaxillofacial malignancies

    International Nuclear Information System (INIS)

    Osteo-cutaneous flap are commonly used for reconstruction of bone defect after oncology surgery. The success of surgery depends on the viability of the bone flap. Bone scan is a known, but less performed method, to look for viability of bone flaps. We describe a case of 50-year-old lady, presenting with squamous cell carcinoma of left buccal mucosa (cT4N1M0) involving the skin and mandible. She underwent left segmental mandibulectomy and upper alveolectomy with neck dissection, followed by reconstruction using a fibular osteo-cutaneous flap and anterolateral thigh free flap. On postoperative day 10, the intraoral flap showed signs of nonviability. The patient was sent to nuclear medicine for assessment of viability of the free fibula flap. The patient underwent three phase 99mTc-methylene diphosphonate (MDP) bone scan and single-photon emission computerized tomography. Computerized tomography showing good tracer uptake in fibula confirming viability. The case reflects the use of 99mTc-MDP in viability assessment of the bone flap

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

    Science.gov (United States)

    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

  16. Reconstruction of large maxillary defect with the use of vastus lateralis (VL free flap. Case report

    Directory of Open Access Journals (Sweden)

    Nikolaos Papadogeorgakis, Vlasios Oktseloglou, Eleni Pappa, Petros Spyriounis

    2010-08-01

    Full Text Available Large defects of the maxilla, following ablative surgery, significantly affect functions such as chewing, swallowing, speech and also the aesthetics. Reconstruction of soft tissues and bone defects can be achieved, either with the use of an obturator, or with free flaps. In the literature there is no sufficient evidence on the primacy of the one or the other method. The choice depends on the judgment, the experience and the ability of the surgical team. In recent years, the use of anterolateral thigh (ALTfree flap for reconstruction of large defects of the maxillary region, has gained a lot of popularity. The vastuslateralis free flap (VL is a variation of ALT. VL’s advantages include long pedicle, easier harvesting, and fewer anatomical variations. We present a case of a 75 year old male with recurrent squamous cell carcinoma of the medial canthal region, invading the maxillary bone, the medial wall and the floor of the orbit. The patient underwent a total maxillectomy, orbital exenteration, and reconstruction with vastus lateralis free flap.

  17. Esthetic Craniofacial Bony and Skull Base Reconstruction Using Flap Wrapping Technique.

    Science.gov (United States)

    Yano, Tomoyuki; Suesada, Nobuko; Usami, Satoshi

    2016-07-01

    For a safe and esthetic skull base reconstruction combined with repair of craniofacial bone defects, the authors introduce the flap wrapping technique in this study. This technique consists of skull base reconstruction using the vastus lateralis muscle of an anterolateral thigh (ALT) free flap, and structural craniofacial bony reconstruction using an autologous calvarial bone graft. The key to this technique is that all of the grafted autologous bone is wrapped with the vascularized fascia of the ALT free flap to protect the grafted bone from infection and exposure. Two anterior skull base tumors combined with craniofacial bony defects were included in this study. The subjects were a man and a woman, aged 18 and 64. Both patients had preoperative proton beam therapy. First, the skull base defect was filled with vastus lateralis muscle, and then structural reconstruction was performed with an autologous bone graft and a fabricated inner layer of calvarial bone, and then the grafted bone was completely wrapped in the vascularized fascia of the ALT free flap. By applying this technique, there was no intracranial infection or grafted bone exposure in these 2 patients postoperatively, even though both patients had preoperative proton beam therapy. Additionally, the vascularized fascia wrapped bone graft could provide a natural contour and prevent collapse of the craniofacial region, and this gives patients a better facial appearance even though they have had skull base surgery. PMID:27300454

  18. Fasciocutaneous flap for vaginal and perineal reconstruction

    International Nuclear Information System (INIS)

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction

  19. Fasciocutaneous flap for vaginal and perineal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

    1987-07-01

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

  20. Transverse tensor fascia lata myocutaneous flap for microvascular breast reconstruction: case report and review of the literature.

    Science.gov (United States)

    Zeidler, Kamakshi R; Son, Ji H; Carey, Joseph N; Watt, Andrew J; Ho, Oscar H; Lee, Gordon K

    2013-04-01

    The transverse tensor fascia lata (TTFL) flap is an important alternative flap for autologous breast reconstruction. It is a horizontal variant of the tensor fascia lata myocutaneous flap and contains fat from the prominence of the upper lateral thigh (saddle bag). We present the surgical management of a woman with trochanteric lipodystrophy, who underwent staged bilateral mastectomy and autologous breast reconstruction with TTFL flaps. We discuss technical points in TTFL flap design and harvest. Breast reconstruction was successful and the thigh donor sites had excellent aesthetic contour. There were no complications at either recipient or donor sites. The TTFL flap is an important alternative flap for autologous breast reconstruction when other options are less optimal, and has a secondary benefit of thigh donor site closure with lateral thigh lift techniques. The TTFL flap should be presented as an option for autologous breast reconstruction in women with prominent trochanteric lipodystrophy of the upper lateral thighs. PMID:23486142

  1. Medial circumflex femoral artery flap for ischial pressure sore

    OpenAIRE

    Palanivelu S

    2009-01-01

    A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The s...

  2. PINZAMIENTO ANTEROLATERAL DEL TOBILLO: EVALUACION ECOTOMOGRAFICA

    OpenAIRE

    Alonso Inzulza C; Winston Robertson C

    2002-01-01

    Se realizó una evaluación de la anatomía ultrasonográfica de los ligamentos normales y patológicos de la región lateral del tobillo, con el objeto de determinar su utilidad en pacientes con clínica sugerente de pinzamiento anterolateral. Se estudiaron ambos lados en 15 pacientes sanos y en 14 pacientes referidos por traumatólogo con clínica sugerente. Los ligamentos evaluados fueron los: tibioperoneo anterior (TPA), peroneoastragalino (PA) y peroneocalcáneo. (PC) En pacientes sanos se observa...

  3. Medial circumflex femoral artery flap for ischial pressure sore

    Directory of Open Access Journals (Sweden)

    Palanivelu S

    2009-01-01

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

  4. Research progress in reconstruction of lower extremity soft-tissue defects using perforator flaps%穿支皮瓣在下肢创面修复中的临床应用研究进展

    Institute of Scientific and Technical Information of China (English)

    冯仕明; 王爱国

    2015-01-01

    Objective To review the progress in reconstruction of lower extremity soft-tissue defects using perforator flaps. Methods Articles about perforator flaps using for the lower-limb wound reconstruction from January 1980 to April 2014 from databases such as PubMed, EMbase, CNKI and Cochrane Library were manually searched. The 264 articles were selected after they were inspected by the excluded and included standards. The safety, anatomical basis, advantages and disadvantages for the flaps were analysed. Results Perforator flaps, like musculocutaneous flaps, have a direct axial blood supply, and are just as effective as muscle flaps in the setting of radiation, hardware infection, or osteomyelitis. The major perforator flaps for the lower extremity reconstruction including anterolateral thigh flap, deep inferior epigastric perforator flap, thoracodorsal artery perforator flap, gluteal artery perforator flap and lower leg perforator flap. All these perforator flaps have each advantage, and can be selected according to the defect feature and the requirement of reconstruction. Conclusions Reconstruction the lower extremity soft-tissue defect using perforator flap is an effective method with low donor site morbidity. It is a new technology for lower extremity soft-tissue defect reconstruction, and the newest trend of development in flap surgery.%目的:探讨穿支皮瓣在下肢创面修复中的应用价值。方法计算机检索 PubMed、EMbase、中国知网以及Cochrane数据库于1980年1月—2014年4月期间公开发表的应用穿支皮瓣治疗下肢创面的文献,语种限定为中文和英文。经筛选有264篇文献入选。对皮瓣的安全性、解剖学基础及优缺点进行分析总结。结果目前应用于下肢创面修复的穿支皮瓣主要有股前外侧皮瓣、腹壁下深动脉穿支皮瓣、胸背动脉穿支皮瓣、臀动脉穿支皮瓣以及小腿穿支皮瓣等。不同皮瓣各有其特点,临床应根据其特点和创面

  5. Rescate articular con colgajo anterolateral del muslo

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    F.J. García-Bernal

    2015-06-01

    Full Text Available La preservación del nivel de amputación tanto de la extremidad superior como de la inferior, puede mejorar la función residual y el proceso de rehabilitación protésica de la misma. Ambas van a estar condicionadas por la longitud restante de la extremidad, la presencia o no de articulaciones operativas y la calidad de la cobertura del muñón. Presentamos 2 casos de amputaciones. El primero es un caso agudo de amputación traumática de extremidad superior a la altura del tercio proximal de antebrazo, que asocia avulsión cutánea circular desde el tercio medio del brazo y con articulación de codo conservada. El segundo, es la secuela de una amputación infracondílea de extremidad inferior por osteosarcoma que presenta fístulas cutáneas con drenaje supurativo por osteomielitis en el muñón tibial. En ambos pacientes realizamos cobertura con colgajo anterolateral de muslo anastomosado a la arteria radial en el caso de la extremidad superior, y a la arteria genicular descendente en la extremidad inferior. En los dos casos el postoperatorio transcurrió sin complicaciones, logrando preservar las articulaciones del codo y de la rodilla respectivamente, así como la posterior rehabilitación protésica. Consideramos que el colgajo anterolateral del muslo permite aportar tejido de buena calidad como cobertura del muñón de amputación. Dadas las características del tejido aportado y su volumen, es idóneo tanto para cobertura de defectos agudos como de déficits de almohadillado en casos crónicos.

  6. 穿支皮瓣移植修复四肢软组织缺损108例%Transplantation of perforator flaps: Systematic review of 108 case series

    Institute of Scientific and Technical Information of China (English)

    唐举玉; 李康华; 廖前德; 何洪波; 林涨源; 梁捷予; 罗令; 吴攀峰; 宋达疆

    2010-01-01

    Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.%目的 探讨应用穿支皮瓣修复四肢皮肤软组织缺损的临床效果. 方法2007年7月至2009年5月,分别采用腹壁下动脉穿支皮瓣、股前外侧穿支皮瓣、

  7. Three-dimensional Superficial Liposculpture of the Hips, Flank, and Thighs

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    Yi Xin Zhang, MD

    2015-01-01

    Conclusions: If performed correctly, 3-dimensional superficial liposuction of the trunk, hips, and thighs can yield very satisfying outcomes because of the excellent contour and the enhanced skin retraction provided by the thin cutaneous adipose flap. Three-dimensional liposuction is a reliable method with proven results. A careful application of the technique combined with accurate surgical planning, a thorough preoperative explanation of real expectations, and postoperative care is crucial.

  8. Congenital anterolateral tibial bowing and polydactyly: a case report

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    Lemire Edmond G

    2007-07-01

    Full Text Available Abstract Congenital anterolateral bowing of the tibia is a rare deformity that may lead to pseudarthrosis and risk of fracture. This is commonly associated with neurofibromatosis type 1. In this report, we describe a 15-month old male with congenital anterolateral bowing of the right tibia and associated hallux duplication. This is a distinct entity with a generally favourable prognosis that should not be confused with other conditions such as neurofibromatosis type 1. Previously published cases are reviewed.

  9. Extradigital Glomus Tumor of Thigh

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    Kemal Beksaç

    2015-01-01

    Full Text Available Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies. They represent around 1–5% of all soft-tissue tumors. High temperature, sensitivity, and pain and localized tenderness are the classical triad of symptoms. Most glomus tumors represent in the subungual area of digits. Extradigital glomus tumors are a very rare entity. There are rare cases of these tumors reported to be in shoulder, elbow, knee, wrist, even stomach, colon, and larynx. We are reporting a case of a glomus tumor on thigh and discuss the histological and immunohistochemical features.

  10. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

    International Nuclear Information System (INIS)

    The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

  11. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, C.L.; Wilson, D.J. [Nuffield Orthopaedic Centre, Department of Radiology, Oxford (United Kingdom); Coltman, T.P. [Nuffield Orthopaedic Centre, Department of Orthopaedic Surgery, Oxford (United Kingdom)

    2008-03-15

    The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

  12. An improved dual approach to post bariatric contouring - Staged liposuction and modified medial thigh lift: A case series

    Directory of Open Access Journals (Sweden)

    Zaher Jandali

    2014-01-01

    Full Text Available Objective: Following massive weight loss (MWL medial contouring of the thigh is frequently requested to improve appearance and function. Thigh lifting can be associated with significant complications. We present a case series of post bariatric patients undergoing thigh lift using staged the liposuction, a modified T incision and a buried de-epithelialised dermal flap. Materials and Methods: From January to December 2012, 21 consecutive patients underwent a modified medial thigh lift. A retrospective review of the case notes was performed to assess complications that occurred. Results: There were no major post-operative complications in terms of reoperation, hematoma, thromboembolism and no seromas. Seven patients, all of which were smokers had minor superficial wound healing complications. Aesthetic outcomes were satisfactory for all patients at a minimum follow-up of 6 months. Conclusions: The modified ′T′ incision with staged liposuction is described. We have found the technique to be useful for a variety of different thighs. It is a reproducible method for contouring the medial thigh in MWL patients. In this series, our overall complications were low, and no seromas occurred.

  13. Aggressive angiomyxoma of the thigh

    International Nuclear Information System (INIS)

    Aggressive angiomyxoma is a rare tumour that typically occurs in the perineum in women of reproductive age. A small number of cases occurring in men have been reported, all of which were located in the low pelvis, perineum or scrotum. While benign, the tumour is locally infiltrative and consequently has a high rate of local recurrence following surgery; therefore, accurate pre-operative diagnosis is important. The characteristic location of these tumours in the low pelvis or perineum has led to speculation that aggressive angiomyxomas arise from a mesenchymal cell that is unique to the perineum. We describe a case of aggressive angiomyxoma arising in the thigh of a 54-year-old man, which we believe is the first reported instance of this rare neoplasm occurring remote from the pelvis or perineum in a male patient. Cross-sectional imaging demonstrated a well-defined mass that had low density on CT and high intensity on fluid-sensitive MR sequences. Biopsy was non-diagnostic and excision was performed. At histological analysis, the tumour exhibited the characteristic features of aggressive angiomyxoma, with bland spindle cells and large, hyalinised blood vessels in a hypocellular myxoid matrix. Extensive immunohistochemical staining further supported the diagnosis. While the imaging features of these tumours are non-specific and suggestive of myxoid neoplasms, the diagnosis should be considered whenever biopsy of a myxoid-appearing mass yields hypocellular, non-diagnostic material, despite adequate sampling. (orig.)

  14. Aggressive angiomyxoma of the thigh

    Energy Technology Data Exchange (ETDEWEB)

    Heffernan, E.J.; Alkubaidan, F.O.; Munk, P.L. [Vancouver General Hospital, Department of Radiology, Vancouver, BC (Canada); University of British Columbia, Vancouver, BC (Canada); Hayes, M.M. [BC Cancer Agency, Department of Pathology, Vancouver, BC (Canada); Clarkson, P.W. [BC Cancer Agency, Department of Surgery, Radiation Oncology and Developmental Radiotherapeutics, Vancouver, BC (Canada)

    2008-07-15

    Aggressive angiomyxoma is a rare tumour that typically occurs in the perineum in women of reproductive age. A small number of cases occurring in men have been reported, all of which were located in the low pelvis, perineum or scrotum. While benign, the tumour is locally infiltrative and consequently has a high rate of local recurrence following surgery; therefore, accurate pre-operative diagnosis is important. The characteristic location of these tumours in the low pelvis or perineum has led to speculation that aggressive angiomyxomas arise from a mesenchymal cell that is unique to the perineum. We describe a case of aggressive angiomyxoma arising in the thigh of a 54-year-old man, which we believe is the first reported instance of this rare neoplasm occurring remote from the pelvis or perineum in a male patient. Cross-sectional imaging demonstrated a well-defined mass that had low density on CT and high intensity on fluid-sensitive MR sequences. Biopsy was non-diagnostic and excision was performed. At histological analysis, the tumour exhibited the characteristic features of aggressive angiomyxoma, with bland spindle cells and large, hyalinised blood vessels in a hypocellular myxoid matrix. Extensive immunohistochemical staining further supported the diagnosis. While the imaging features of these tumours are non-specific and suggestive of myxoid neoplasms, the diagnosis should be considered whenever biopsy of a myxoid-appearing mass yields hypocellular, non-diagnostic material, despite adequate sampling. (orig.)

  15. Primary Observations on the Influence of 60Co Local Irradiation on Free Skin Flaps

    Institute of Scientific and Technical Information of China (English)

    杨建荣; 张园

    2002-01-01

    Objective To study the effect of postoperative radiation on free skin flaps.Methods Twenty-nine patients with free skin flaps applied to the plerosis of the postoperative defectwere followed up. Twenty-eight out of 29 patients received forearm free flaps while 1 had anterolater-al femoris skin flaps in a size ranging from 14 cm× 6 cm to 8 cm× 4 cm. These flaps were exposedto 60Co radiation ranging 40-69 Gy. Results Observation during irradiation: no visible changes ofskin flaps and oral mucous membrane were detected when irradiation dose was within 40 Gy; somechanges may be detected over 40 Gy. Observation 1 - 4 months after irradiation: pigmentations werefound in areas of erosion epidermis; skin flaps got dark but without evidence of necrosis. Observation2 years after irradiation: no necrosis happened in 29 skin flaps. Hairs were found on 15 of 29flaps. Sensation occurred within the margin of 1 cm. Conclusion Free skin flap can endure irradi-ation at the dose of 60 Gy.

  16. A triceps musculocutaneous flap for chest-wall defects

    Energy Technology Data Exchange (ETDEWEB)

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

    1990-09-01

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

  17. A triceps musculocutaneous flap for chest-wall defects

    International Nuclear Information System (INIS)

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

  18. MRI features of the anterolateral ligament of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Taneja, Atul K. [Hospital Israelita Albert Einstein, Musculoskeletal Radiology Division, Imaging Department, Sao Paulo, SP (Brazil); Hospital do Coracao (HCor), and Teleimagem, Musculoskeletal Imaging, Diagnostic Center, Sao Paulo, SP (Brazil); Miranda, Frederico C.; Braga, Cesar A.P.; Hartmann, Luiz G.C.; Santos, Durval C.B.; Rosemberg, Laercio A. [Hospital Israelita Albert Einstein, Musculoskeletal Radiology Division, Imaging Department, Sao Paulo, SP (Brazil); Gill, Corey M. [Department of Neurology and Cancer Center, Pappas Center for Neuro-Oncology, Boston, MA (United States)

    2014-11-27

    Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53 % male, most of the knees were from the left side (51 %), and chronic pain was the main clinical symptom (40 %). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51 % of the knees: completely visible in 11 % and partially visible in 40 %. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, thickness of 5.6 mm, and width of 1.9 mm. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized. (orig.)

  19. MRI features of the anterolateral ligament of the knee

    International Nuclear Information System (INIS)

    Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53 % male, most of the knees were from the left side (51 %), and chronic pain was the main clinical symptom (40 %). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51 % of the knees: completely visible in 11 % and partially visible in 40 %. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, thickness of 5.6 mm, and width of 1.9 mm. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized. (orig.)

  20. Magnetic resonance imaging findings in anterolateral impingement of the ankle

    International Nuclear Information System (INIS)

    Objective. To demonstrate the MR imaging findings of anterolateral impingement (ALI) of the ankle.Design and patients. Nine patients with a history of ankle inversion injury and chronic lateral ankle pain were imaged with MR imaging, and the findings correlated with the results of arthroscopy. Three additional patients with clinically suspected ALI of the ankle were also included. Ankle MR imaging studies from 20 control patients in whom ALI was not suspected clinically were examined for similar findings to the patient group.Results. MR imaging findings in the patients with ALI included a soft tissue signal mass in the anterolateral gutter of the ankle in 12 of 12 (100%) cases, corresponding to the synovial hypertrophy and soft tissue mass found at arthroscopy in the nine patients who underwent arthroscopy. Disruption, attenuation, or marked thickening of the anterior talofibular ligament was seen in all cases. Additional findings included signs of synovial hypertrophy elsewhere in the tibiotalar joint in seven of 12 patients (58%) and bony and cartilaginous injuries to the tibiotalar joint in five of 12 (42%). None of the control patients demonstrated MR imaging evidence of a soft tissue mass in the anterolateral gutter.Conclusions. ALI of the ankle is a common cause for chronic lateral ankle pain. It has been well described in the orthopedic literature but its imaging findings have not been clearly elucidated. The MR imaging findings, along with the appropriate clinical history, can be used to direct arthroscopic examination and subsequent debridement. (orig.)

  1. Magnetic resonance imaging findings in anterolateral impingement of the ankle

    Energy Technology Data Exchange (ETDEWEB)

    Jordan, L.K. III.; Cooperman, A.E. [Department of Radiology, Duke University Medical Center, Durham, NC (United States); Helms, C.A. [Department of Radiology, Duke University Medical Center, Durham, NC (United States); Duke University Medical Center, Durham, NC (United States); Speer, K.P. [Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC (United States)

    2000-01-01

    Objective. To demonstrate the MR imaging findings of anterolateral impingement (ALI) of the ankle.Design and patients. Nine patients with a history of ankle inversion injury and chronic lateral ankle pain were imaged with MR imaging, and the findings correlated with the results of arthroscopy. Three additional patients with clinically suspected ALI of the ankle were also included. Ankle MR imaging studies from 20 control patients in whom ALI was not suspected clinically were examined for similar findings to the patient group.Results. MR imaging findings in the patients with ALI included a soft tissue signal mass in the anterolateral gutter of the ankle in 12 of 12 (100%) cases, corresponding to the synovial hypertrophy and soft tissue mass found at arthroscopy in the nine patients who underwent arthroscopy. Disruption, attenuation, or marked thickening of the anterior talofibular ligament was seen in all cases. Additional findings included signs of synovial hypertrophy elsewhere in the tibiotalar joint in seven of 12 patients (58%) and bony and cartilaginous injuries to the tibiotalar joint in five of 12 (42%). None of the control patients demonstrated MR imaging evidence of a soft tissue mass in the anterolateral gutter.Conclusions. ALI of the ankle is a common cause for chronic lateral ankle pain. It has been well described in the orthopedic literature but its imaging findings have not been clearly elucidated. The MR imaging findings, along with the appropriate clinical history, can be used to direct arthroscopic examination and subsequent debridement. (orig.)

  2. Morel-Lavallee effusions in the thigh

    International Nuclear Information System (INIS)

    Objective. To assess the radiological features of Morel-Lavallee effusion in the thigh. Design and patients. A restrospective study of clinical records and radiological studies was carried out on three patients with Morel-Lavallee effusion. Results and conclusions. Ultrasound and computed tomography (CT) were able to locate the effusion in the three patients. CT demonstrated a capsule around the lesion. A fluid-fluid level was visible with both techniques. Ultrasound and CT are good methods for assessing patients with Morel-Lavallee effusion of the thigh. CT can be used to distinguish patients requiring surgical treatment from those who could be treated by conservative measures. (orig.). With 4 figs

  3. Thigh-calf contact force measurements in deep knee flexion.

    NARCIS (Netherlands)

    Zelle, J.G.; Barink, M.; Loeffen, R.; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2007-01-01

    BACKGROUND: Knee models often do not contain thigh-calf contact which occurs in deep knee flexion. Thigh-calf contact is expected to reduce muscle forces and thereby affects internal stresses in the knee joint. The purpose of this study was to measure thigh-calf contact forces. Two deep knee flexion

  4. Paravertebral and Brachial plexus block for Abdominal flap to cover the upper limb wound

    OpenAIRE

    Narendra kumar; Neelam Dogra

    2011-01-01

    We present a case report where thoracic paravertebral block and brachial plexus block were used in a sick elderly patient with poor cardiopulmonary reserve, to cover a post traumatic raw area of the upper limb by raising flap from lateral abdominal wall. The residual raw area of abdomen was then covered with the split skin graft taken from thigh.

  5. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

    Institute of Scientific and Technical Information of China (English)

    Devendra Lakhotia; Gaurav Sharma; Kavin Khatri; G.N.Kiran Kumar; Vijay Sharma; Kamran Farooque

    2016-01-01

    Purpose:Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome.There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia.The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.Methods:This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating.This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.Results:Full weight bearing was allowed in mean time period of 4.95 months (3-12 months).A major local complication of a wound which required revision surgery was seen in one case.Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound,1 case of superficial infection,1 case of sensory disturbance over the anterolateral foot,1 case of muscle hernia and 2 cases of delayed union.Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm).Conclusion:The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization.Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.

  6. A new anterolateral approach for type C fractures of the distal femur.

    Science.gov (United States)

    Bin, Zhang; Song, Luo; Binghua, Wu; Ping, Qiu; Min, Dai

    2014-01-01

    To provide an anatomic basis for treating type C distal femoral fractures by a new anterolateral approach. Twenty surgical procedures were performed in 10 adult cadaveric specimens using a new anterolateral approach followed by dissection of all lower limbs. The main anterolateral muscles and ligaments were observed. Vessels and nerves related to the new anterolateral approach were also evaluated. Full exposure of the distal femur was achieved. The iliotibial band was protected, and damage to the quadriceps femoris was reduced. The distance between the common peroneal nerve and the new incision line at the level of the lateral epicondyle of the femur was (χ̄ ± s) 8.19 ± 0.79 cm (range, 7.48-9.57 cm). This new anterolateral approach to the distal femur is safe. Although it induces slight soft tissue damage, its exposure is excellent. Knee rehabilitation can be performed in the early postoperative period. PMID:25437603

  7. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman; Demir, Ahmet

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap to...... reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  8. Correlation of Magnetic Resonance Imaging With Knee Anterolateral Ligament Anatomy

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Bonadio, Marcelo Batista; Pécora, José Ricardo; Bordalo-Rodrigues, Marcelo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2015-01-01

    Background: Anatomic and magnetic resonance imaging (MRI) studies have recently characterized the knee anterolateral ligament (ALL). So far, no study has focused on confirming whether the evaluated MRI parameters truly correspond with ALL anatomy. Purpose: To assess the validity of MRI in detecting the ALL using an anatomic evaluation as reference. Study Design: Descriptive laboratory study. Methods: A total of 13 cadaveric knees were subjected to MRI and then to anatomic dissection. Dissection was performed according to previous anatomic study methodology. MRIs were performed with a 0.6- to 1.5-mm slice thickness and prior saline injection. The following variables were analyzed: distance from the origin of the ALL to the origin of the lateral collateral ligament (LCL), distance from the origin of the ALL to its bifurcation point, maximum length of the ALL, distance from the tibial insertion of the ALL to the articular surface of the tibia, ALL thickness, and ALL width. The 2 sets of measurements were analyzed using the Spearman correlation coefficient (ρ) and Bland-Altman plots. Results: The ALL was clearly observed in all dissected knees and MRI scans. It originated anterior and distal to the LCL, close to the lateral epycondile center, and showed an anteroinferior path toward the tibia, inserting between the Gerdy tubercle and the fibular head, around 5 mm under the lateral plateau. The ρ values tended to increase together for all studied variables between the 2 methods, and all were statistically significant, except for thickness (P = .077). Bland-Altman plots showed a tendency toward a reduction of ALL thickness and width by MRI compared with anatomic dissection. Conclusion: MRI scanning as described can accurately assess the ALL and demonstrates characteristics similar to those seen under anatomic dissection. Clinical Relevance: MRI can accurately characterize the ALL in the anterolateral region of the knee, despite the presence of structures that might

  9. Combined anterolateral posterolateral rotary instability: Is posterolateral complex reconstruction necessary?

    Directory of Open Access Journals (Sweden)

    Khalilahah Nazem

    2008-02-01

    Full Text Available

    • BACKGROUND: The treatment of combined anterolateral posterolateral rotary instability has been done by correcting knee alignment, anterior cruciate ligament (ACL reconstruction plus repair or reconstruction of the posterolateral complex. Because of the technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the role of posterolateral complex (PLC in valgus knees, this study was designed to observe the results of treating this instability by ACL-reconstruction alone, after correction of varus, without reconstruction of the posterolateral complex or further extra-articular manipulation.
    • METHODS: This was a clinical trial performed on 29 patients (29 knees with combined anterolateral posterolateral rotary nstability. Subjective and objective instability signs were recorded. Arthroscopy was then performed and a valgus osteotomy was done to correct alignment. Then in a second stage, an ACL-reconstruction was carried out. Results, after a mean of 23 months follow-up, were compared to the conditions before surgery. Fisher exact test, X2 and Wilcoxon tests were used to analyze the data. P<0.05 was considered to be meaningful.
    • RESULTS: Pain was relieved in more than half and locking was improved in all of the patients. Giving way of the knee was diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001. Most of the patients returned to the preinjury level of work or sports.
    • CONCLUSIONS: Based on the results of this study, ACL-reconstruction alone, after correction of varus, can be sufficient to address this combined knee instability without farther procedures on extra-articular structures and posterolateral complex, thus avoiding unnecessary complications and longer rehabilitation.
    • Key words

    • Thigh circumference and risk of heart disease and premature death

      DEFF Research Database (Denmark)

      Heitmann, Berit L; Frederiksen, Peder

      2009-01-01

      of follow-up for total death. RESULTS: A small thigh circumference was associated with an increased risk of cardiovascular and coronary heart diseases and total mortality in both men and women. A threshold effect for thigh circumference was evident, with greatly increased risk of premature death...... circumference seems to be associated with an increased risk of developing heart disease or premature death. The adverse effects of small thighs might be related to too little muscle mass in the region. The measure of thigh circumference might be a relevant anthropometric measure to help general practitioners in...... early identification of individuals at an increased risk of premature morbidity and mortality....

    • Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores.

      Science.gov (United States)

      Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni

      2015-08-01

      We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore. PMID:26495200

    • Isokinetic performance of hip muscles after revision total hip arthroplasty via previous anterolateral approach.

      Science.gov (United States)

      Cankaya, Deniz; Aydin, Cemal; Karakus, Dilek; Toprak, Ali; Ozkurt, Bulent; Tabak, Yalçın

      2015-09-01

      We investigated the isokinetic performance of hip muscles and clinical outcomes after revision total hip arthroplasty (THA) via same anterolateral approach used in primary surgery. Thirty patients who had undergone previous THA via an anterolateral approach underwent both acetabular and femoral component revision after aseptic loosening. The Harris Hip Score (HHS) was evaluated during a minimum 2-year follow-up. The isokinetic muscle strength of the operated and nonoperated hips was assessed 1 year after surgery. The HHS improved from 49.0 to 77.4. Operated and nonoperated hips exhibited similar isokinetic performance during all measurements (flexion, extension, and abduction) (p>0.05). This prospective study showed that the anterolateral approach preserves abductor strength after revision THA in aseptic cases with acceptable functional and clinical results. The main clinical relevance of this study is that the same anterolateral approach used in previous primary THA is also safe and viable for revision THA. PMID:26435233

    • Left Anterolateral Thoracotomy for Simultaneous Correction of Ventricular Septal Defect and Coarctation of the Aorta

      OpenAIRE

      Chu, Shu-Hsun; Chou, Nai-Kuan; Chou, Tsai-Fwu; Wang, Shoei-Shen

      1994-01-01

      Three patients with ventricular septal defect and coarctation of the aorta were treated successfully by simultaneous correction of both anomalies through a single incision via a left transsternal anterolateral thoracotomy. (Texas Heart Institute Journal 1994; 21:158-60)

    • The platysma myocutaneous flap.

      Science.gov (United States)

      Baur, Dale A; Williams, Jonathan; Alakaily, Xena

      2014-08-01

      Reconstructing defects of the oral mucosa or skin of the lower one-third of the face can be accomplished by a variety of techniques. This article presents two versions of the platysma myocutaneous flap, which is a reliable, axial pattern, pedicled flap capable of providing excellent one-stage reconstruction of such defects. As discussed herein, the superiorly based and posteriorly based versions of the flap have wide application in the oral and facial region. Also provided is a review of other uses of this flap in head and neck surgery. PMID:24958382

    • Propeller TAP flap

      DEFF Research Database (Denmark)

      Thomsen, Jørn Bo; Bille, Camilla; Wamberg, Peter;

      2013-01-01

      The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to...... major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around...

    • Modified Vertical Rectus Abdominis Musculocutaneous Flap for Limb Salvage Procedures in Proximal Lower Limb Musculoskeletal Sarcomas

      Directory of Open Access Journals (Sweden)

      Tarek Mahboub

      2008-03-01

      Full Text Available Introduction and aim. Management of complicated wounds after tumor extipiration of pelvic and proximal lower limb musculoskeletal sarcoma represents an essential component in the outcome of these patients. The authors present modified vertical rectus abdominis musculocutaneous (VRAM flap techniques to reconstruct extensive defects after debridment of these complicated wounds. Material and Methods. Over a period of 4 years (2002–2005, 5 men and 2 women were managed. Median age was 21 years (range 15–49. The patients were managed for complicated lower trunk, groin, and upper thigh wounds after resection of three pelvic chondrosarcomas as well as two pelvic and two proximal femur osteosarcomas. The modifications included a VRAM flap with lateral and tongue-like extension design of the skin paddle (5 cases or a delayed extended VRAM flap (2 cases. Results. All flaps showed complete survival and healing with no ischemic events providing stable coverage. All patients were ambulant with good limb functions in terms of walking and gait after adequate rehabilitation, 2 needed support with crutches. Conclusion. The modified VRAM flaps offer reliable reconstructive tools for coverage of complex groin and thigh defects by providing larger well-vascularized soft tissue with acceptable donor site.

    • Delayed Soft Tissue Reconstruction with a Horizontal Rectus Abdominis Musculocutaneous Flap following Hip Exarticulation

      Directory of Open Access Journals (Sweden)

      Jes Christian Rødgaard

      2013-01-01

      Full Text Available Coverage of large soft tissue defects at the hip region constitutes a challenge for plastic surgeons. We report the case of a 43-year-old female with necrotizing fasciitis of the right thigh, necessitating hip exarticulation and substantial debridement of necrotic tissue. An ipsilateral horizontal rectus abdominis myocutaneous (HRAM flap was used to cover the defect. The reconstruction was carried out after the attempt of local tissue rearrangement. In light of the successful outcome, we propose that this flap be considered in the future planning of soft tissue reconstruction at the hip region.

    • The rhombic bilobed flap, a simple, geometrically designed flap

      Directory of Open Access Journals (Sweden)

      Yoshiaki Sakamoto

      2014-01-01

      Full Text Available We describe a combination of the common rhomboid flap and bilobed flap and provide an example of its use. The rhombic bilobed flap is simple to use and is associated with fewer complications, such as pin-cushioning and standing cone deformities, while minimizing the risk of skin necrosis and tension on the flap.

    • Insulin action in human thighs after one-legged immobilization

      DEFF Research Database (Denmark)

      Richter, Erik; Kiens, Bente; Mizuno, M.;

      1989-01-01

      Insulin action was assessed in thighs of five healthy young males who had one knee immobilized for 7 days by a splint. The splint was not worn in bed. Subjects also used crutches to prevent weight bearing of the immobilized leg. Immobilization decreased the activity of citrate synthase and 3-OH......-acyl-CoA-dehydrogenase in the vastus lateralis muscle by 9 and 14%, respectively, and thigh volume by 5%. After 7 days of immobilization, a two-step euglycemic hyperinsulinemic clamp procedure combined with arterial and bilateral femoral venous catheterization was performed. Insulin action on glucose uptake and tyrosine...... release of the thighs at mean plasma insulin concentrations of 67 (clamp step I) and 447 microU/ml (clamp step II) was decreased by immobilization, whereas immobilization did not affect insulin action on thigh exchange of free fatty acids, glycerol, O2, or potassium. Before and during the clamp step I...

    • Diverticular disease presenting as subcutaneous emphysema of the thigh

      OpenAIRE

      Jones, Gareth Huw; Kalaher, Helen Rebecca

      2009-01-01

      A normally fit and well 79-year-old lady presented acutely confused and shocked after a few months history of atypical left-sided back and thigh pain. She was unable to tolerate movement of her left leg and soft tissue crepitus was palpable over her thigh. Emergency incision and drainage of the leg was performed with intraoperative swabs growing Streptococcus milleri and coliforms. Postoperatively, in the Intensive Care Unit (ICU) deep faecal contamination of the wound was noted. Contrast ima...

  1. Idiopathic perniosis of the buttocks and thighs – clinical report

    OpenAIRE

    Antonio, Ana Marta; Alves, Joao; Matos, Diogo; Coelho, Ricardo

    2015-01-01

    Perniosis manifests as inflammatory cutaneous lesions mostly located on acral skin in association with cold and damp conditions. Perniosis of the thighs is quite uncommon and has been associated in the literature with horse riding (equestrian perniosis) or with other recreational activities with long time exposure to cold and humidity. We report a rare case of perniosis of the buttocks and thighs in a 34-year-old healthy woman without a previous history of horse riding or other high-risk acti...

  2. Cerebrovascular effects of the thigh cuff maneuver.

    Science.gov (United States)

    Panerai, R B; Saeed, N P; Robinson, T G

    2015-04-01

    Arterial hypotension can be induced by sudden release of inflated thigh cuffs (THC), but its effects on the cerebral circulation have not been fully described. In nine healthy subjects [aged 59 (9) yr], bilateral cerebral blood flow velocity (CBFV) was recorded in the middle cerebral artery (MCA), noninvasive arterial blood pressure (BP) in the finger, and end-tidal CO2 (ETCO2) with nasal capnography. Three THC maneuvers were performed in each subject with cuff inflation 20 mmHg above systolic BP for 3 min before release. Beat-to-beat values were extracted for mean CBFV, BP, ETCO2 , critical closing pressure (CrCP), resistance-area product (RAP), and heart rate (HR). Time-varying estimates of the autoregulation index [ARI(t)] were also obtained using an autoregressive-moving average model. Coherent averages synchronized by the instant of cuff release showed significant drops in mean BP, CBFV, and RAP with rapid return of CBFV to baseline. HR, ETCO2 , and ARI(t) were transiently increased, but CrCP remained relatively constant. Mean values of ARI(t) for the 30 s following cuff release were not significantly different from the classical ARI [right MCA 5.9 (1.1) vs. 5.1 (1.6); left MCA 5.5 (1.4) vs. 4.9 (1.7)]. HR was strongly correlated with the ARI(t) peak after THC release (in 17/22 and 21/24 recordings), and ETCO2 was correlated with the subsequent drop in ARI(t) (19/22 and 20/24 recordings). These results suggest a complex cerebral autoregulatory response to the THC maneuver, dominated by myogenic mechanisms and influenced by concurrent changes in ETCO2 and possible involvement of the autonomic nervous system and baroreflex. PMID:25659488

  3. Comparison of complications in transtrochanteric and anterolateral approaches in primary total hip arthroplasty.

    LENUS (Irish Health Repository)

    Cashman, James P

    2008-11-01

    Three surgical approaches to primary total hip arthroplasty (THA) have been in use since Charnley popularized the transtrochanteric approach. This study was designed to examine the difference in morbidity between the transtrochanteric approach and the anterolateral approach in primary THA. Information on 891 patients who underwent primary THA performed by a single surgeon was collected prospectively between 1998 and 2003 using a modified SF-36 form, preoperatively, intraoperatively, and at 3 months postoperatively. The transtrochanteric group had higher morbidity and more patients who were dissatisfied with their THA. There was a greater range of motion in the anterolateral group.

  4. Flapping of Insectile Wings

    Science.gov (United States)

    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.

  5. Control of Flap Vortices

    Science.gov (United States)

    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.

  6. Perforator Flaps for Perineal Reconstructions

    OpenAIRE

    Niranjan, Niri S.

    2006-01-01

    Whenever there is soft tissue loss from the perineum there are many options for reconstruction. These include allowing the wound to heal by secondary intention and the use of local random or axial pattern flaps, regional flaps, or free flaps. The axial skin flap can be defined as a flap based on known constant vessels of the subcutaneous tissue and its vena comitantes. The perforator flap on the other hand is a randomly selected perforator consisting of an artery with vena comitantes, which p...

  7. Percutaneous vertebroplasty via anterolateral approach for the treatment of C4 to C7 vertebral tumor

    International Nuclear Information System (INIS)

    Objective To investigate the feasibility and clinical efficacy of percutaneous vertebroplasty via anterolateral approach in treating the middle and lower cervical (C4-C7) vertebral tumor. Methods: During the past four years, percutaneous vertebroplasty via anterolateral approach was performed in 16 patients with middle or lower cervical tumor, including metastases (n=12), myeloma (n=3) and eosinophilic granuloma (n=1). Under fluoroscopic guidance, needle puncture was operated via the anterolateral approach, bone cement was injected into the target cervical body when the needle was in place. A follow-up of three months was made. Results: Twenty-one cervical bodies in the range of C4 to C7 were successfully punctured and injected with bone cement. Marked pain relief was obtained in all 16 patients. The average score of visual analogue scale (VAS) was dramatically decreased from 7 before the procedure to 1.7 after the procedure. The cervical motor function returned to good condition. Conclusion: Percutaneous vertebroplasty via anterolateral approach is a safe, effective and minimally-invasive technique in treating the middle and lower cervical (C4-C7) vertebral tumor. (authors)

  8. News You Can Use: The Knee Anterolateral Ligament and the ISAKOS Journal.

    Science.gov (United States)

    Lubowitz, James H; Provencher, Matthew T; Rossi, Michael J; Brand, Jefferson C

    2016-05-01

    The knee anterolateral ligament may be fiction, but we thought it fact. As true anatomic restoration of the anterior cruciate ligament (ACL) may not be possible today, we are open to the possibility that lateral augmentation of ACL reconstruction could be of benefit in some patients. PMID:27151446

  9. Idiopathic perniosis of the buttocks and thighs - clinical report.

    Science.gov (United States)

    António, Ana Marta; Alves, João; Matos, Diogo; Coelho, Ricardo

    2015-01-01

    Perniosis manifests as inflammatory cutaneous lesions mostly located on acral skin in association with cold and damp conditions. Perniosis of the thighs is quite uncommon and has been associated in the literature with horse riding (equestrian perniosis) or with other recreational activities with long time exposure to cold and humidity. We report a rare case of perniosis of the buttocks and thighs in a 34-year-old healthy woman without a previous history of horse riding or other high-risk activities. In this case, the use of thin and tight clothes is believed to have been enough for the development of perniosis in this susceptible subject. PMID:25612119

  10. The Evolution of Perforator Flaps

    OpenAIRE

    Khan, Farah N.; Spiegel, Aldona J.

    2006-01-01

    Perforator flaps have recently become ubiquitous in the field of plastic surgery. To understand and appreciate their unique nature, it is necessary to compare and contrast them with the development of other types of flaps. A complete yet abridged version of the history of flap surgery is presented in this article. Beginning with Sushruta's Indian cheek flap method for nasal reconstruction, a trip through time and space is taken to highlight the milestones leading to the evolution of the perfo...

  11. Skin injuries on the body and thigh of dairy cows

    DEFF Research Database (Denmark)

    Enevoldsen, Carsten; Gröhn, Y.T.; Thysen, Iver

    1994-01-01

    An epidemiological study was conducted in 18 dairy herds with the objective to characterize those groups of cows where skin injuries to the body and thighs occurred most frequently. Data were analyzed with multivariable logistic regression. The epidemiologic patterns were different in first and l...

  12. 78 FR 36304 - Proposed Information Collection (Hip and Thigh Conditions Disability Benefits Questionnaire...

    Science.gov (United States)

    2013-06-17

    ... AFFAIRS Proposed Information Collection (Hip and Thigh Conditions Disability Benefits Questionnaire... Disability Benefits Questionnaire)'' in any correspondence. During the comment period, comments may be viewed.... SUPPLEMENTARY INFORMATION: ] Title: Hip and Thigh Conditions Disability Benefits Questionnaire, VA Form...

  13. 78 FR 68906 - Agency Information Collection (Hip and Thigh Conditions Disability Benefits Questionnaire) Under...

    Science.gov (United States)

    2013-11-15

    ... AFFAIRS Agency Information Collection (Hip and Thigh Conditions Disability Benefits Questionnaire) Under... Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION CONTACT: Crystal Rennie... and Thigh Conditions Disability Benefits Questionnaire''. SUPPLEMENTARY INFORMATION: Title: Hip...

  14. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Directory of Open Access Journals (Sweden)

    QU Zhi-gang

    2012-12-01

    Full Text Available 【Abstract】 Objective: To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps. Methods: Six patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar. All wounds were in the upper extremity. The sizes of defects ranged from 15 cm×6 cm to 30 cm×18 cm. Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissi-mus dorsi. The thoracodorsal artery and its perforators were carefully protected during surgery. Results: All flaps healed primarily without flap congestion, margin necrosis or infection. The skin donor sites either received split-thickness skin graft (3 cases, mostly from the anterior thigh or was closed primarily (3 cases and had minimal morbidity. Follow-up of 6-12 months showed that the contour of flap was aesthetic and the func-tion of limb was excellent. Conclusion: Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for recon-struction of large skin and soft tissue defects in the upper extremity. Key words: Surgical flaps; Upper extremity; Soft tissue injuries; Reconstructive surgical procedures

  15. Critical analysis of extra peritoneal antero-lateral approach for lumbar plexus

    Directory of Open Access Journals (Sweden)

    Roberto Sérgio Martins

    2011-08-01

    Full Text Available Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. METHOD: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. RESULTS: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels derived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. CONCLUSION: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.

  16. Approaches to anterior and anterolateral foramen magnum lesions: A critical review

    Directory of Open Access Journals (Sweden)

    Ricardo J Komotar

    2010-01-01

    Full Text Available Foramen magnum (FM lesions represent some of the most complex cases for the modern neurosurgeon because of their location near vital brainstem structures, the vertebral arteries, and lower cranial nerves. In particular, anterior or anterolaterally located FM tumors have traditionally been most difficult to resect with high morbidity and mortality resulting from approaches through the posterior midline or transorally. For many neurosurgeons, the far lateral, extreme lateral approach, and more recently, endoscopic endonasal approaches have become the preferred modern methods for the resection of anterior or anterolateral FM tumors. In this review, we examine both operative and non-operative approaches to FM tumors, including surgical anatomy, surgical technique, and indications for operative intervention in these complex cases. In addition, we compared outcomes from prior series.

  17. Approaches to anterior and anterolateral foramen magnum lesions: A critical review

    OpenAIRE

    Komotar, Ricardo J.; Zacharia, Brad E.; McGovern, Robert A.; Sisti, Michael B.; Bruce, Jeffrey N.; Anthony L D′Ambrosio

    2010-01-01

    Foramen magnum (FM) lesions represent some of the most complex cases for the modern neurosurgeon because of their location near vital brainstem structures, the vertebral arteries, and lower cranial nerves. In particular, anterior or anterolaterally located FM tumors have traditionally been most difficult to resect with high morbidity and mortality resulting from approaches through the posterior midline or transorally. For many neurosurgeons, the far lateral, extreme lateral approach, and more...

  18. Proprioception and Clinical Results of Anterolateral Single-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation

    OpenAIRE

    Lee, Dung Chul; Shon, Oog Jin; Kwack, Byung Hoon; Lee, Sung Jun

    2013-01-01

    Purpose To evaluate the clinical and radiological results and proprioception following anterolateral single-bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation for PCL injury. Materials and Methods Twenty patients with an isolated PCL injury (16 males and 4 females) were included in this study. The mean follow-up period was 61 months (≥24 months) and the mean age of the patients was 36 years. Knee joint instability was evaluated using posterior drawer stress radi...

  19. Analysis of right anterolateral impacts: the effect of trunk flexion on the cervical muscle whiplash response

    OpenAIRE

    Narayan Yogesh; Ferrari Robert; Kumar Shrawan; Vieira Edgar

    2006-01-01

    Abstract Background The cervical muscles are considered a potential site of whiplash injury, and there is a need to understand the cervical muscle response under non-conventional whiplash impact scenarios, including variable body position and impact direction. There is no data, however, on the effect of occupant position on the muscle response to frontal impacts. Therefore, the objective of the study was to measure cervical muscle response to graded right anterolateral impacts. Methods Twenty...

  20. Analysis of right anterolateral impacts: the effect of trunk flexion on the cervical muscle whiplash response

    Directory of Open Access Journals (Sweden)

    Narayan Yogesh

    2006-05-01

    Full Text Available Abstract Background The cervical muscles are considered a potential site of whiplash injury, and there is a need to understand the cervical muscle response under non-conventional whiplash impact scenarios, including variable body position and impact direction. There is no data, however, on the effect of occupant position on the muscle response to frontal impacts. Therefore, the objective of the study was to measure cervical muscle response to graded right anterolateral impacts. Methods Twenty volunteers were subjected to right anterolateral impacts of 4.3, 7.8, 10.6, and 12.8 m/s2 acceleration with their trunk flexed forward 45 degrees and laterally flexed right or left by 45 degrees. Bilateral EMG of the sternocleidomastoids, trapezii, and splenii capitis and acceleration of the sled, torso, and head were measured. Results and discussion With either direction of trunk flexion at impact, the trapezius EMGs increased with increasing acceleration (p Conclusion When the subject sits with trunk flexed out of neutral posture at the time of anterolateral impact, the cervical muscle response is dramatically reduced compared to frontal impacts with the trunk in neutral posture. In the absence of bodily impact, the flexed trunk posture appears to produce a biomechanical response that would decrease the likelihood of cervical muscle injury in low velocity impacts.

  1. Lateral gastrocnemius myocutaneous flap transposition to the midlateral femur: extending the arc of rotation.

    Science.gov (United States)

    Agarwal, Rishi Raj; Broder, Kevin; Kulidjian, Anna; Bodor, Richard

    2014-05-01

    We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation. PMID:24401809

  2. Papilla Preservation Flap as Aesthetic Consideration in Periodontal Flap Surgery

    OpenAIRE

    Sandra Olivia; Natalina Natalina; Felix Hartono

    2013-01-01

    Flap surgery is treatment for periodontal disease with alveolar bone destruction. Surgical periodontal flap with conventional incision will result in gingival recession and loss of interdental papillae after treatment. Dilemma arises in areas required high aesthetic value or regions with a fixed denture. It is challenging to perform periodontal flap with good aesthetic results and minimal gingival recession. This case report aimed to inform and to explain the work procedures, clinical and rad...

  3. Disseminated lymphoma presenting as acute thigh pain and renal failure.

    LENUS (Irish Health Repository)

    Brown, Catherine

    2009-01-01

    A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.

  4. Flag flapping in a channel

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Satish P Bhat

    2013-01-01

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

  6. A Case of Pyomyositis and Primary Thigh Abscess in a Systemic Lupus Erythematous Patient MimickingThigh Hematoma

    OpenAIRE

    Rahele Mehrain; Abolfazl Hashemoghli; Roya Ghaemiannejad

    2011-01-01

    Routes of extension of infection into the thigh can"nbe either direct, through the subcutaneous tissue, or"nthrough naturally occurring defects in the abdominal"nwall. These include: (1) Along the psoas muscle deep"nto the inguinal ligament; (2) Through the femoral"ncanal; (3) By way of the obturator foramen; and (4)"nThrough the sacrosciatic notch. Pyomyositis is a"nprimary deep bacterial infection of the skeletal muscle"nwithout contiguous spread from...

  7. Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects

    Institute of Scientific and Technical Information of China (English)

    QU Zhi-gang; LIU Yu-jie; HE Xu; DING Xiao-hen; FANG Guan-grong

    2012-01-01

    Objective:To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocutaneous flaps.Methods:Six patients with large skin and soft tissue defects were included in this report.There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar.All wounds were in the upper extremity.The sizes of defects ranged from 15 cm×6 cm to 30 cm× 18 cm.Pedicled latissimus dorsi myocutaneous flaps were designed according to the defect area and raised with part of latissimus dorsi.The thoracodorsal artery and its perforators were carefully protected during surgery.Results:All flaps healed primarily without flap congestion,margin necrosis or infection.The skin donor sites either received split-thickness skin graft (3 cases,mostly from the anterior thigh) or was closed primarily (3 cases)and had minimal morbidity.Follow-up of 6-12 months showed that the contour of flap was aesthetic and the function of limb was excellent.Conclusion:Our experience indicates that the pedicled latissimus dorsi myocutaneous flap is favorable for reconstruction of large skin and soft tissue defects in the upper extremity.

  8. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees.

    Science.gov (United States)

    Claes, Steven; Bartholomeeusen, Stijn; Bellemans, Johan

    2014-03-01

    The purpose of this study was to identify the newly described anterolateral ligament of the human knee on magnetic resonance imaging and to describe its eventual radiological abnormalities in anterior cruciate ligament-injured subjects. A retrospective cohort study on a series of consecutive subjects undergoing anterior cruciate ligament reconstructive surgery was performed. The MR images of 206 included knees were studied and the status of the anterolateral ligament status was judged to be either "non-visualized", "normal" or "abnormal". Of all the visualized anterolateral ligaments, 44 (21.3%) were considered uninjured, while 162 (78.8%) knees demonstrated radiological ALL abnormalities. The majority of ALL abnormalities were situated in the distal part of the ligament (77.8%). In conclusion, the anterolateral ligament can be identified on classic knee magnetic resonance images. Although anterior cruciate ligament injured subjects often demonstrated associated anterolateral ligament lesions, further research is needed in order to establish the clinical relevance of these highly frequent radiological abnormalities. PMID:24873084

  9. Radiological classification of meniscocapsular tears of the anterolateral portion of the lateral meniscus of the knee

    International Nuclear Information System (INIS)

    In an arthroscopic-MRI correlation study of acute injuries to the knee it was found that anterolateral meniscocapsular separations of the lateral aspect of the knee were missed on MRI reporting. Eighty sports-related injuries of the knee were seen by experienced orthopaedic surgeons at the University of Malaya Medical Centre and at the National Sports Centre, Malaysia from January 1996 to July 1997. Fifty of the patients were suspected to have meniscal tears that were either lateral or medial on clinical examination and they were sent for MRI. Many of these patients were tertiary referrals. Magnetic resonance imaging examinations in 27 of the 50 patients were reported as not showing any intrasubstance or obvious meniscocapsular tears, but arthroscopy performed on them revealed anterolateral meniscocapsular tears of the lateral meniscus of varying degrees in nine of these patients. In retrospect the tears could be seen on MRI, and a pattern to the tears was noted and classified as follows. Type 0, normal; type 1, torn inferior or superior meniscocapsular attachment; type 2, both meniscofemoral and meniscotibial ligaments torn but with minimal separation of meniscus and capsule by fluid or synovitis; and type 3, marked separation of meniscus and capsule by fluid (> 3 mm). Ten patients who did not undergo arthroscopy for various personal and financial reasons underwent MRI which showed type 1 and type 2 tears, and were treated conservatively. These patients were all asymptomatic after 4-6 weeks with regard to clinical signs, suggesting a lateral meniscal tear. Magnetic resonance imaging therefore does reveal minor degrees of meniscocapsular tears anterolaterally when one understands the normal anatomy in this region. Copyright (1999) Blackwell Science Pty Ltd

  10. [An Adult Case of Transperineal Repair of Congenital Rectourethral Fistula Using Gracilis Muscle Flap Interposition].

    Science.gov (United States)

    Yo, Toeki; Kanematsu, Akihiro; Hanasaki, Takeshi; Nakanishi, Yukako; Togo, Yoshikazu; Suzuki, Toru; Higuchi, Yoshihide; Nojima, Michio; Yamamoto, Shingo; Okuyama, Hiroomi

    2015-07-01

    A man in his 50s was referred to our hospital after recurrent severe urinary tract infection. He had undergone anoplasty for anorectal malformation during early infancy. He noticed urinary leakage from the anus for a long time. Under diagnosis of congenital rectourethral fistula, we performed fistula closure. The fistula was transsected via transperineal incision and each stump was closed. A gracilis muscle flap approximately 30 cm long was harvested from the left thigh, brought into the deepest part between the separated rectum and urethra through a subcutaneous tunnel and fixed there. The urinary leakage from the anus disappeared, and the infection resolved. Application of gracilis muscle flap for congenital diseases is rare, but was useful in the present case. PMID:26278215

  11. Isolated pediatric hemihyperplasia requiring surgical debulking of the thigh

    Directory of Open Access Journals (Sweden)

    Benjamin D. Schultz

    2015-02-01

    Full Text Available Isolated Hemihyperplasia (IHH is a rare disorder that results in the enlargement of a portion of a limb, a complete limb or an entire half of an individual's body. We describe an 11 year-old girl with isolated hemihyperplasia of her right upper and lower extremities, breast, and vulvar region. A mass consisting of asymmetric enlargement and fatty infiltration of the right adductor compartment was first noticed at approximately 4 years of life and progressed dramatically to severely affect her gait. We surgically debulked the thigh and resected the excess skin to restore symmetry. The patient did well postoperatively, achieved excellent cosmesis, and restoration of gait.

  12. Extraskeletal Osteosarcoma of the Thigh: An Autopsy Case Report

    Directory of Open Access Journals (Sweden)

    Akihito Nagano

    2009-01-01

    Full Text Available We report a case of extraskeletal osteosarcoma (ESOS and autopsy findings. A 35-year-old man presented with an ossified tumor in the right thigh and lung metastasis. The lung tumors continued to develop despite multiagent chemotherapy and caused death within 8 months. Autopsy revealed many secondary lesions in the lungs, especially in the left lung. Histopathologically, the primary tumor and one of the secondary tumors showed proliferation of spindle-shaped tumor cells focally forming lace-like osteoid material. Therefore, we made a definite diagnosis of ESOS.

  13. Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction

    Science.gov (United States)

    Mountziaris, Paschalia M.; Soteropulos, Carol E.; Rezak, Kristen M.

    2016-01-01

    Summary: The anterolateral thigh (ALT) free flap has proven to be a reliable option for the coverage of soft tissue defects in adults and more recently in the pediatric population. When considering the use of the ALT flap in the pediatric patient, there are few studies that detail techniques specific to pediatric free flap management. We present a unique case of a 14- × 8-cm ALT flap used for traumatic wound coverage in a distal tibial injury in a 6-year-old girl. This case highlights innovative techniques in pediatric perioperative free flap monitoring and the use of continuous external tissue expansion to achieve delayed primary closure of the donor site.

  14. Active Control of Long Bridges Using Flaps

    DEFF Research Database (Denmark)

    Hansen, H. I.; Thoft-Christensen, Palle

    The main problem in designing ultra-long span suspension bridges is flutter. A solution to this problem might be to introduce an active flap control system to increase the flutter wind velocity. The investigated flap control system consists of flaps integrated in the bridge girder so each flap is...... different flap configurations for a bridge section model by using aerodynamic derivatives for a flat plate. The example shows that different flap configurations can either increase or decrease the flutter wind velocity. for optimal flap configurations flutter will not occur....

  15. Open Reduction and Internal Fixation of the Tibial Plateau Through the Anterolateral Approach.

    Science.gov (United States)

    Hake, Mark E; Goulet, James A

    2016-08-01

    Fractures of the tibial plateau are challenging injuries to treat. The lateral tibial plateau is fractured more commonly than the medial plateau and the workhorse approach for these fractures is the anterolateral approach. This approach allows visualization of the lateral joint, metaphysis, and can be extensile if there is shaft extension. We present our technique for performing the anterolateral approach while treating a Schatzker III tibial plateau fracture. Special attention is given to performing a submeniscal arthrotomy to view the joint surface and judge the reduction. A femoral distractor is placed to assist with elevation the joint surface and visualization of the lateral plateau. A cortical window is created using a triple reamer from the sliding hip screw set. The reduction is performed and supported with cancellous bone chips. Finally, a lateral locking plate with rafting screws is placed. Knowledge of this approach and the strategies needed to address lateral and some bicondlar tibial plateau fractures are crucial to good patient outcomes. PMID:27441932

  16. Anterolateral muscle sparing approach total hip arthroplasty: an anatomic and clinical study

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xian-long; SHEN Hao; QIN Xiao-long; WANG Qi

    2008-01-01

    Background Many kinds of approaches have been used for minimally invasive surgery of total hip arthroplasty (MIS-THA). However, until now when considering the balance of efficacy and associated surgical injury there is no approach widely accepted for MIS-THA. In this study, a modified anterolateral muscle sparing approach was developed to optimize MIS-THA. Methods Twenty adult cadaver specimens (40 hips) were used for anatomic research. The distance from anterior origin of the gluteus medius on the lilac crest to the anterior superior lilac spine was measured; the course of the superior gluteal nerve and the distances from the nerve to the regional anatomic landmarks were recorded. Simulated surgeries were performed in three fresh cadaver specimens to evaluate the soft tissues injury around incisions. From October 2004 to June 2006, 57 patients (57 hips) were treated with anterolateral muscle sparing minimally invasive total hip arthroplasty, of which 17 were femoral neck fractures, 9 osteoarthritis, 16 developmental dysplasia of hip (DDH) and 15 avascular necrosis (AVN). All the operations were performed by the same senior surgeon. Operation time, blood loss and drainage volume were recorded and the correlation between the local complications and the native anatomical characteristics was especially noted. All cases were followed for at least 12 months.Results The distance from the anterior origin of the gluteus medius to anterior superior lilac spine along the lilac crest was (61±4) mm (range, 55-68 mm), and the distance from inferior branch of the superior gluteal nerve to the anterior tubercle of the greater trochanter was (74±6)mm (range, 60-88 mm). In simulated surgeries, excessive distraction of tissue was found to be the main cause of the anterior border injury of the gluteus medius muscle. Of the 57 patients treated with anterolateral muscle sparing MIS-THA, the average incision length was 9 cm (range 7.5-13 cm). Blood transfusions were performed in 11

  17. Flap Edge Noise Reduction Fins

    Science.gov (United States)

    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.

  18. A Case of Pyomyositis and Primary Thigh Abscess in a Systemic Lupus Erythematous Patient MimickingThigh Hematoma

    Directory of Open Access Journals (Sweden)

    Rahele Mehrain

    2011-05-01

    Full Text Available Routes of extension of infection into the thigh can"nbe either direct, through the subcutaneous tissue, or"nthrough naturally occurring defects in the abdominal"nwall. These include: (1 Along the psoas muscle deep"nto the inguinal ligament; (2 Through the femoral"ncanal; (3 By way of the obturator foramen; and (4"nThrough the sacrosciatic notch. Pyomyositis is a"nprimary deep bacterial infection of the skeletal muscle"nwithout contiguous spread from adjacent structures,"nusually accompanied by abscess formation within"nthe skeletal muscle, but may also present as a diffuse"ninflammatory or a rapidly progressing myonecrotic"nprocess. Pyomyositis in patients with SLE has rarely"nbeen reported. Because of its rarity and often vague"nclinical presentation, it is unlikely to be considered"nduring the initial differential diagnosis. Moreover,"nthe diagnosis may be delayed as the affected muscle is"ndeeply situated and local signs are not apparent. This"ndelay in diagnosis may result in increased morbidity"nand sometimes a significant mortality rate. Here,"nwe describe a 57-year-old woman, known case of"nSLE with pyomyositis and primary left thigh abscess"nthat mimicked DVT in physical examination and"nhematoma in MRI. The purpose of this report was to"ndraw attention to this rare occurrence and to highlight"nthe etiology, presentation and the imaging features.

  19. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S; Thomsen, Jorn Bo

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle...... aspects in the context of current literature. RESULTS: The reconstructive goals were achieved in all cases without any total flap loss or major complications. Minor complications occurred in 7/34 (21 %) cases consisting of venous congestion leading to distal tip necrosis or epidermolysis; partial flap...... loss was significant in 4 cases, however never more than 10 % of the total flap size. Reconstruction was performed on the lower limb in 13 cases, upper limb in 12, and 9 cases were on the truncus. The angle of rotation was 90° in 21 cases and 180° in 13 cases. The most common indication was...

  20. Modified osteomyocutaneous iliac crest flaps transplantation.

    Science.gov (United States)

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

    2015-04-01

    The paper aims to improve the operative technique of osteomyocutaneous iliac crest flap harvesting, further minimise morbidity of donor site, and improve the effect of recipient site reconstruction. From March 2005 to March 2011, 55 cases of osteomyocutaneous iliac crest flap harvested by different methods were performed to reconstruct the defects of the extremities. Twenty-nine cases were reconstructed with a traditional deep circumflex iliac artery osteomusculocutaneous flap. Twenty-six cases were repaired with modified osteomyocutaneous iliac crest flaps. In 29 cases with a traditional DCIA osteomusculocutaneous flap, two cases showed the injured lateral femoral cutaneous nerve. Flapnecrosis was significant in two cases. Arterial compromise occurred in one case 5 days after operation completion and led to flap failure. Three flaps developed postoperative venous congestion, but only one flap received re-exploration. In the other two cases, some stitches were removed for decompression. All three flaps survived. In two cases, marginal flap necrosis occurred, but no secondary skin grafting was required. In 26 cases with modified flap transplantation, one case showed the injured lateral femoral cutaneous nerve. All flaps survived totally. Osseous integration was achieved in all 55 cases in 3 ∼ 9 months after operation. The modified osteomyocutaneous iliac crest flap technique enhances flap safety, provides the additional advantages of reducing donor-site morbidity, and improves the recipient-site contour. PMID:25001367

  1. Extranodal diffuse non hodgkin lymphoma in the thigh

    Directory of Open Access Journals (Sweden)

    Bölke E

    2010-08-01

    Full Text Available Abstract Diffuse large B-cell lymphoma usually starts as a rapidly growing mass in an internal lymph node and can grow in other areas such as the bone or intestines. About 1/3 of these lymphomas are confined to one part of the body when they are localized. In the case of a 78-year-old man, an extensive tumour was located on the right thigh. Biopsies of the tumour revealed diffuse proliferation of large lymphoid cells which have totally affected the normal architecture of striated muscle. The patient received multimodality treatment including chemotherapy of the CHOP regimen and adjuvant radiotherapy. Despite this being a fast growing lymphoma, about 3 out of 4 people will have no signs of disease after initial treatment, and about half of all people with this lymphoma are cured with therapy.

  2. Giant pyogenic granuloma of the thigh: a case report

    Directory of Open Access Journals (Sweden)

    Nthumba Peter M

    2008-03-01

    Full Text Available Abstract Introduction Pyogenic granuloma or lobular capillary hemangioma remains an etiopathological enigma, with trauma, inflammatory and infectious agents being the commonest suspected causative agents. These lesions affect mucous membranes of the upper aero-digestive tract, and skin. HIV patients diagnosed with pyogenic granuloma present with multiple lesions, caused by Bartonella spp. Case presentation A 28-year-old woman presented with a solitary large tumor on a skin graft donor site on her left thigh. On excision and histological examination the tumor was found to be a lobular capillary hemangioma (pyogenic granuloma. Further investigation in search of a possible explanation for this unusual presentation revealed HIV infection as the underlying cause. Conclusion This report underscores the fact that the full spectrum of presentation of HIV infection is still unknown. Unusual or unexpected presentations should arouse suspicion of underlying immunosuppression, especially in HIV endemic areas.

  3. Dedifferentiated liposarcoma of thigh: Tumor with monster cells

    Directory of Open Access Journals (Sweden)

    Sankappa Pundalikappa Sinhasan

    2016-01-01

    Full Text Available Sarcomas are malignant soft tissue tumors that constitute <1% of malignancies and liposarcoma (LS is the most common sarcoma with about 20%. Majority of LSs are well-differentiated (40%. About 5–10% of them will further progress and develop abrupt shift into dedifferentiated neoplastic tissue and contain nonlipogenic component that are labeled as dedifferentiated LSs. LSs commonly affect age group of 50–70 years and commonly occur over extremities and in retroperitoneum. Prognosis of LS depends on various parameters such as histological grade, type, size, location, and presence, or absence of metastasis. We hereby, report a case in 30 years adult male patient with clinical and radiological diagnoses as “intramuscular lipoma” over the thigh. Cytological examination revealed malignant nature of the soft tissue lesion. Histopathology revealed dedifferentiated LS containing highly bizarre tumor giant cells. This case report reemphasizes the cytology findings of this rare entity and reviews the literature on a dedifferentiated variant of LS.

  4. Graduated compression stockings: knee length or thigh length.

    Science.gov (United States)

    Benkö, T; Cooke, E A; McNally, M A; Mollan, R A

    2001-02-01

    The mechanisms by which graduated compression stockings prevent deep venous thrombosis are not completely understood. In the current study the physiologic effect of low-pressure graduated compression stockings on the venous blood flow in the lower limb and the practical aspects of their use were assessed. Patients having elective orthopaedic surgery at a university orthopaedic department were randomized into five groups to wear two different types of graduated compression stockings in thigh and knee lengths. Patients in the fifth control group did not wear graduated compression stockings. Venous occlusion strain gauge plethysmography was used to measure venous flow. After 20-minutes bed rest there was a highly significant increase in venous capacitance and venous outflow in patients in all of the four groups wearing stockings. There was no difference in the mean of the percentage change of venous capacitance in patients in the four groups wearing stockings. The knee length Brevet stockings were less efficient in increasing the venous outflow. There was no significant change in the venous capacitance and venous outflow in patients in the control group. Visual assessment of the fit and use of stockings was done, and patients' subjective opinion of comfort was sought. The knee length graduated compression stockings wrinkled significantly less, and significantly fewer patients reported discomfort with them. All stockings were reported to be difficult to use. Thigh and knee length stockings have a significant effect on decreasing venous stasis of the lower limb. Knee length graduated compression stockings are similarly efficient in decreasing venous stasis, but they are more comfortable to wear, and they wrinkle less. PMID:11210954

  5. Comparison of Right Anterolateral Thorocotomy with Standard Median Steronotomy for Mitral Valve Replacement

    Directory of Open Access Journals (Sweden)

    Zamir Ahmad Shah

    2013-03-01

    Full Text Available Obejectives: The objectives of this study were to compare and analyze the results of right anterolateral thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement , length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness. Methods: The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department ofCardiovascular and Thoracic Surgery at Sher‑i‑Kashmir Institute of Medical Sciences from September 2009 to August 2011. Results: This study comprised 64 patients with 23 (35.9% males and 41 (64.1% females. Sternotomy group had 10 males (31.3% and 22 females (68.7%. Thoracotomy group had 13 males (40.6% and 19(59.4% females. The length of incision between the two groups was statistically significant (P<0.0001. Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001. Scar visibility was 100% in sternotomy and around 25% in thoracotomy( P<0.0001. Conclusions: Thoracotomy through a right anterolateral aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross‑clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional

  6. Experience in Reconstruction for Small Digital Defects With Free Flaps.

    Science.gov (United States)

    Hung, Min-Hsiang; Huang, Kuo-Feng; Chiu, Haw-Yen; Chao, Wai-Nang

    2016-03-01

    Traumatic injuries to the digits resulting in soft tissue or bone loss require reconstruction. Traditionally, local flaps, such as homodigital flaps, heterodigital flaps, pedicled flaps, or distant flaps, are used for digital resurfacing. However, free tissue transfers can be used in selected patients. In this study, we present the use of different free flaps including groin skin flaps, groin osteocutaneous flaps, groin chimeric flaps, second dorsal metacarpal artery flaps, and partial toe flaps for digital reconstruction. A total of 19 digits were treated with 16 free flaps in our hospital. Of the flaps used, 5 were free groin skin flaps, 4 were free partial toe flaps, 3 were free groin chimeric flaps, 2 were free groin osteocutaneous flaps, and 2 were free second dorsal metacarpal artery flaps. The average flap size was 4.7 × 2.0 cm (range, 1.5 × 1 to 5 × 4 cm), and the average operative time was 6.0 hours (range, 4-9 hours). All flaps survived without partial or total necrosis. In conclusion, the free flap is a reliable and safe alternative for digital reconstruction. Moreover, the free groin flap provides not only a chimeric pattern for multiple fingers coverage but also an osteocutaneous pattern for thumb lengthening. The free second dorsal metacarpal artery flap provides a tenocutaneous pattern for tendon reconstruction and soft tissue coverage simultaneously, and the free partial toe flap is an excellent alternative for pulp reconstruction in terms of aesthetic appearance and functional outcome. PMID:26808771

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

    Science.gov (United States)

    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.

  8. Free thin paraumbilical perforator-based flaps.

    Science.gov (United States)

    Koshima, I; Moriguchi, T; Soeda, S; Tanaka, H; Umeda, N

    1992-07-01

    A free paraumbilical perforator-based flap fed by a muscle perforator from the inferior deep epigastric artery and with no muscle was used in 13 patients. Among them, a free thin paraumbilical perforator-based flap with a thin layer of fat, to protect the subdermal plexus of the vessels, was used in seven patients. The dominant pedicle perforator of this thin flap is usually located around the umbilicus and a large flap can be obtained. Its critical length-to-breath ratio is considered to be 4:3. The advantages of this flap are a long and large vascular pedicle, rare postoperative abdominal herniation, little bulkiness of the flap, and a relatively large skin territory. The disadvantages are technical difficulties in dissection of the perforator and anatomical variation in the location of the perforator. We believe this flap largely overcomes the problems of the conventional rectus abdominis musculocutaneous flap. PMID:1386718

  9. Bacillus Calmette-Guérin-related cold thigh abscess as an unusual cause of thigh swelling in infants following BCG vaccine administration: a case series

    Directory of Open Access Journals (Sweden)

    Al Shaalan Mohammad

    2011-09-01

    Full Text Available Abstract Introduction Thigh swelling in an infant can be a symptom of a simple benign condition or a life-threatening condition. We observed a cluster of thigh swelling episodes in infants in which the cause was Bacillus Calmette-Guérin-related cold thigh abscess. We report this unusual case series to raise awareness about this diagnosis. Case presentations We performed a retrospective review of five infants (four boys and one girl who presented with Bacillus Calmette-Guérin-related left thigh abscess. The swelling was noticed by the parents at a mean period of three months prior to presentation. The ages at presentation were five, five, eight and nine months for the boys, and six months for the girl. All of the patients were healthy Saudi infants, and received the Bacillus Calmette-Guérin vaccine at birth. Clinically, all of the patients were well and did not demonstrate signs of systemic infection. All patients underwent needle aspiration, with subsequent incision and drainage in four of the five cases. The cultures obtained from the abscess fluids were the key to establishing the diagnosis. Only three patients (60% received antituberculosis drugs. Wound healing lasted for a mean period of approximately seven months. Two-year follow-up was unremarkable for all of our patients. Conclusions Technical errors continue to be significant in the development of vaccine-related complications. Bacillus Calmette-Guérin-related cold thigh abscess is an extremely rare entity.

  10. Efficient flapping flight of pterosaurs

    Science.gov (United States)

    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

  11. Desmoid Tumor of the Thigh with Multiple Recurrences

    Directory of Open Access Journals (Sweden)

    Roxana Livadariu

    2014-05-01

    Full Text Available Background: Desmoid tumors are rare neoplasms of uncertain etiology arising from fascial or deep musculoaponeurotic structures. Although with benign histological appearance and no metastatic potential, desmoid tumors are locally aggressive tumors with a high rate of local recurrence. Case Report: The case of a 47 years old woman repeatedly operated for a recurrent desmoid tumor of the right thigh is presented. The initial radical excision was followed by adjuvant radiotherapy but local recurrence was diagnosed one year after. The pathology report revealed aspects of desmoid tumor. The patient was reoperated and subsequently referred for chemo- and hormonal therapy. A second recurrence occurred 20 months later and the patient was again operated with microscopic tumor free margins and positive long term outcome. Conclusion: Desmoid tumors are benign tumors with unpredictable natural history. Best management involves a multidisciplinary approach. Concerning diagnosis, the best approach is performing a MRI examination. Wide surgical resection with adjuvant radiation therapy remains the main treatment option for local control.

  12. An unusual form of congenital anterolateral tibial angulation - the delta tibia

    Energy Technology Data Exchange (ETDEWEB)

    Currarino, Guido [Department of Radiology, Texas Scottish Rite Hospital for Children, Dallas, TX (United States); Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX (United States); Herring, John A.; Johnston II, Charles E.; Birch, John G. [Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX (United States)

    2003-05-01

    We report three infants with a poorly known form of congenital anterolateral angulation of the tibia with distinctive features seen on lateral roentgenograms. In these films the affected tibia appears to be divided into two segments, one proximal and the other distal, which taper as they approach each other at the site of the angulation, and end separately at the apex of the curve with an intervening radiolucent gap in the anterior tibial cortex. The two tibial segments are originally bridged and held firmly in that position by a well-defined triangular osseous structure located in the concavity of the tibial bow. It appears from the three cases reported in this paper and a few comparable cases in the literature that this form of tibial bowing is not prone to fracture followed by pseudoarthrosis and that it tends to improve (and resolve) spontaneously, with a resorption of the intramedullary bony structures at the apex of the curve resulting in the formation of a normal medullary cavity. A limb length discrepancy of varying degree is the main residual change of the anomaly. (orig.)

  13. Treatment of Thoracolumbar Spinal Infections through Anterolateral Approaches Using Expandable Titanium Mesh Cage for Spine Reconstruction

    Directory of Open Access Journals (Sweden)

    Tarantino Roberto

    2012-01-01

    Full Text Available Pyogenic vertebral osteomyelitis (PVO is still a rare pathology. However, its incidence is on the rise. This is due to an increasing population with predisposing factors. Also, the availability of more effective diagnostic tools has brought it increasingly to the surgeon’s attention. In this study the patients were treated in the Neurosurgery Division of the Department of Neurological Sciences and Psychiatry of the Sapienza University of Rome, between 2001 and 2009. They had thoracolumbar pyogenic spondylitis. This study was undertaken in order to identify the correct diagnostic and therapeutic treatment needed in such cases. From the cases studied here, it is evident that spinal infections can be extremely insidious and that diagnosis tends to be reached late. Surgery, along with the antibiotic treatment, allows for eradication of the causes of the pathology by the reclamation of the affected region. Surgery is also fundamental in helping to recover vital functions and in restoring as much as possible the correct curvature of the rachises. The use of an anterolateral approach is dictated by the necessity of obtaining 360° stability as well as by the need to clear away extensive infections, which are not always reachable using a posterior approach.

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

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Baytinger, V. F., E-mail: baitinger@mail.tomsknet.ru; Kurochkina, O. S., E-mail: kurochkinaos@yandex.ru; Selianinov, K. V.; Baytinger, A. V. [Research Institute of Microsurgery, Tomsk (Russian Federation); Dzyuman, A. N. [Siberian State Medical University, Tomsk (Russian Federation)

    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.

  17. Microvascular Radial Forearm Fasciocutaneous Free Flap for Palatomaxillary Reconstruction Following Malignant Tumor Resection

    International Nuclear Information System (INIS)

    The aim of this study is to report on the patient's quality of life and outcomes after reconstruction of palatomaxillary defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and dental obturator. Material and Methods: During the period between 2005-2007, 10 patients who had palato maxillary defects were immediately reconstructed using RFFF to restore physiologic oronasal separation. All patients were treated for malignant tumors of hard palate or maxilla and all had preservation of orbital floor. Vascular anastomoses were done with the facial vessels in the neck. All the patients underwent a lateral thigh split-thickness skin graft for closure of the donor site. Outcome measurements included post-operative assessment of flap survival and healing, speech, swallowing and diet evaluation and quality of life. Dental rehabilitation was done 3 months postoperatively for all patients. Results: Flap survival was successful in all cases. In the first 2 weeks post operatively, 80% of patients had very good swallowing, speech and diet ability in the form of soft chewable foods and by the end of 6 months, all patients had very good swallowing and speech function and were able to eat all types of foods. Dental rehabilitation with obturator was easily applied and the presence of the flap did not interfere with its application. The technique improved chewing ability and cosmosis. Complications included, small oronasal fistula in 2 patients (20%) who required secondary sutures and delayed wound healing of donor site in one patient. Conclusion: RFFF for soft tissue reconstruction after maxillectomy is a reliable technique that provides a definitive physiologic separation between oral and nasal cavity. This allows very early improvement of speech and swallowing without being totally dependent on obturator. Dental rehabilitation to improve chewing and cosmoses can be done easily with minimal home care. Subsequently, the quality of life is markedly improved

  18. Adjoint-based optimization of flapping plates hinged with a trailing-edge flap

    Directory of Open Access Journals (Sweden)

    Min Xu

    2015-01-01

    Full Text Available It is important to understand the impact of wing-morphing on aerodynamic performance in the study of flapping-wing flight of birds and insects. We use a flapping plate hinged with a trailing-edge flap as a simplified model for flexible/morphing wings in hovering. The trailing-edge flapping motion is optimized by an adjoint-based approach. The optimized configuration suggests that the trailing-edge flap can substantially enhance the overall lift. Further analysis indicates that the lift enhancement by the trailing-edge flapping is from the change of circulation in two ways: the local circulation change by the rotational motion of the flap, and the modification of vortex shedding process by the relative location between the trailing-edge flap and leading-edge main plate.

  19. The anatomy and clinical application of sural blood vessel combined with free skin flap%腓肠血管联合游离皮瓣的解剖及临床应用

    Institute of Scientific and Technical Information of China (English)

    葛东江; 任志勇; 魏长月; 张坤; 张维彬; 王辉

    2014-01-01

    defect of calf. Methods 10 fresh adult cadavers were col-lected for experimental studies. Chose 8 cadavers randomly and ligate the sural medial vessel (4 cases) or sural lateral vessel (4 cases) of one limb, leaving the contralateral limb un-ligated as control. Angiography was performed to observe the blood supply of the gastrocnemius muscle after the ligation of the sural medial vessel or sural lateral vessel. For the remaining 2 cadavers, the ori-gin, diameter, and location of the communicating branch of the gastrocnemius muscle were observed by macroscopic anatomy and vascular cast. The data of 19 patients with large tissue defect of calf from October 2006 to September 2013 were analyzed retro-spectively for clinical research. There were 11 males and 8 females aged from 10-40 years (mean, 32 years). 12 patients took sural medial blood vessels as recipient vessels, and 7 patients took sural lateral blood vessels. 6 patients were grafted with free chest na-vel flaps, 8 with anterolateral thigh flap, 2 with lateral thoracic flap, and 3 with latissimus dorsi flap. The areas of wound surface were ranging from 5 cm×10 cm-8 cm×37 cm. The areas of the flap dissected were ranging from 7 cm×10 cm-10 cm×30 cm. Re-sults The study found that the blood supply of gastrocnemius muscle of the calf was multifocal, and was mainly by sural artery. When the blood supply of sural artery was cut off from one side, the gastrocnemius muscle could be supplied by the communicat-ing branches between medial and lateral head of gastrocnemius muscle and the communicating branches of soleus muscle. The communicating branches were at constant anatomical locations, with larger diameter and rich branches. All the 19 cases of free skin flip transplantation were survived. Healing time of wound was ranging from 13-29 d, among which 11 cases were primary healing, and 8 were secondary healing. The follow-up duration was ranging from 12-24 months. The flaps could endure friction of certain degree. No

  20. Davis flap: the glory still present

    Science.gov (United States)

    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

  1. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging

    International Nuclear Information System (INIS)

    The anterolateral ligament (ALL) may limit tibial internal rotation and pivot-shift following anterior cruciate ligament reconstruction. Previous studies, using magnetic resonance imaging (MRI) to identify this structure, have been inconsistent. We aimed to further characterize the anatomy of this ligament with reference to previous work. Institutional Review Board approval was gained and a retrospective study of 154 consecutive 1.5-T MRI studies was performed by a consultant musculoskeletal radiologist. Cases with a lateral compartment or cruciate injury and patients under 16 years were excluded. A total of 100 MRIs (98 patients; 63 males: 35 females; mean age, 45.3 years, range, 16-85 years) were included in the study. The ALL was visualized partially in 94 (94.0 %) of the cases and fully with distinct femoral and tibial fibers in 57 (57.0 %) of the cases. Although the femoral origin was discreet in only 57 (57.0 %) of cases, the tibial insertion (7.64 ± 1.26 mm below the joint-line) and meniscal attachment were demonstrated in all cases where the ligament was seen. Where the femoral origin was not seen, a broad expansion of the ligament was noted. We identified four types of meniscal attachment (complete, central, bipolar, and inferior-only). The thickness of the ALL, at the level of the joint-line, was 1.75 ± 0.57 mm. The ALL is a consistent structure with meniscal and tibial portions identifiable in the majority of MRI studies of the uninjured knee. There is an attachment to the lateral meniscus with anatomical variation described by our subclassification. (orig.)

  2. The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Tan Jixiang

    2014-04-01

    Full Text Available Objective: To analyze the extent of postoperative hip abductor insufficiency in primary total hip arthroplasty (THA patients undergoing anterolateral minimally invasive (ALMI approach, and to investigate whether the clinical outcomes are more favorable in femoral neck fracture (FNF patients than in non-femoral neck fracture (nFNF patients. Methods:A total of 48 patients were enrolled in this study. Each patient underwent a clinical examination preoperatively and 6, 12, 24 and 48 weeks postoperatively. The abductor torque, Trendelenburg's sign, gait velocity, Harris hip score, Oxford hip score, Westren Ontario and McMaster Universities (WOMAC score and visual analog scale pain score were recorded. Statistical evaluation was performed with SPSS software version 18.0. The significance level was set at P<0.05. Results:The abductor torque of the operated hip and the recovery ratio showed a gradual improving tendency from 6 weeks postoperatively until the last follow-up. Gait velocity, Harris hip score, Oxford hip score and WOMAC score improved significantly after the operation until 24 weeks postoperatively. In the FNF group, the abductor torque of the operated side and the recovery ratio were significantly higher than in nFNF group at 6 weeks postoperatively, however, as time passed, this trend tended to disappear. Conclusion:This study demonstrates that patients can obtain good abductor strength and function in the early postoperative period and the hip abductor function of patients who suffer from hip osteoarthritis, rheumatoid arthritis, avascular necrosis of the femoral head could be significantly improved following ALMI THA. Key words: Arthroplasty, replacement, hip; Surgical procedures, minimally invasive; Recovery of function

  3. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kosy, Jonathan D.; Mandalia, Vipul I.; Anaspure, Rahul [Royal Devon and Exeter Hospital, Princess Elizabeth Orthopaedic Centre, Exeter (United Kingdom)

    2015-11-15

    The anterolateral ligament (ALL) may limit tibial internal rotation and pivot-shift following anterior cruciate ligament reconstruction. Previous studies, using magnetic resonance imaging (MRI) to identify this structure, have been inconsistent. We aimed to further characterize the anatomy of this ligament with reference to previous work. Institutional Review Board approval was gained and a retrospective study of 154 consecutive 1.5-T MRI studies was performed by a consultant musculoskeletal radiologist. Cases with a lateral compartment or cruciate injury and patients under 16 years were excluded. A total of 100 MRIs (98 patients; 63 males: 35 females; mean age, 45.3 years, range, 16-85 years) were included in the study. The ALL was visualized partially in 94 (94.0 %) of the cases and fully with distinct femoral and tibial fibers in 57 (57.0 %) of the cases. Although the femoral origin was discreet in only 57 (57.0 %) of cases, the tibial insertion (7.64 ± 1.26 mm below the joint-line) and meniscal attachment were demonstrated in all cases where the ligament was seen. Where the femoral origin was not seen, a broad expansion of the ligament was noted. We identified four types of meniscal attachment (complete, central, bipolar, and inferior-only). The thickness of the ALL, at the level of the joint-line, was 1.75 ± 0.57 mm. The ALL is a consistent structure with meniscal and tibial portions identifiable in the majority of MRI studies of the uninjured knee. There is an attachment to the lateral meniscus with anatomical variation described by our subclassification. (orig.)

  4. Experimental skin flaps and nitric oxide

    OpenAIRE

    Gribbe, Örjan

    2006-01-01

    Abstract. Surgical flaps are used in plastic surgery to reconstruct tissue defects due to trauma or cancer removal. Occasionally flaps are subjected to ischemia and reperfusion injury leading to flap failure. Nitric oxide (NO), a small gaseous molecule, has vast physiological importance as it participates in the regulation of blood pressure, blood flow, neurotransmission and immune response. NO is synthesized by the enzyme NO synthase (NOS), which exists in both constitutiv...

  5. Wing flapping with minimum energy

    Science.gov (United States)

    Jones, R. T.

    1980-01-01

    A technique employed by Prandtl and Munk is adapted for the case of a wing in flapping motion to determine its lift distribution. The problem may be reduced to one of minimizing induced drag for a specified and periodically varying bending moment at the wing root. It is concluded that two wings in close tandem arrangement, moving in opposite phase, would eliminate the induced aerodynamic losses calculated

  6. Definição do limite anterolateral do lobo occipital em peças anatômicas e exames de imagem Definition of the anterolateral occipital lobe limit in anatomical specimens and with neuroimaging

    OpenAIRE

    Sebastião Gusmão; Cassius Reis; Uedson Tazinaffo; Celso Mendonça; Roberto Leal Silveira

    2002-01-01

    Com o objetivo de definir o limite anterolateral do lobo occipital foram estudados sete segmentos cefálicos de cadáveres humanos, 103 exames de tomografia computadorizada e 104 exames de ressonância magnética do encéfalo considerados normais. Foram encontradas uma prega da dura-máter sobre o seio transverso (plica tentorial pré-occipital) e uma protuberância óssea relacionadas diretamente com a incisura pré-occipital. Foi calculada, também, a distância média entre o sulco parieto-occipital e ...

  7. Optimal propulsive flapping in Stokes flows

    International Nuclear Information System (INIS)

    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. (paper)

  8. Optimal propulsive flapping in Stokes flows

    CERN Document Server

    Was, Loic

    2014-01-01

    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 number, we compute in this paper the optimal flapping kinematics of a rigid spheroid in a Stokes flow. The hydrodynamics for the force generation and energetics of the flapping motion is solved exactly. We then compute analytically the gradient of a flapping efficiency in the space of all flapping gaits and employ it to derive numerically the optimal flapping kinematics as a function of the shape of the flapper and the amplitude of the motion. The kinematics of optimal flapping are observed to depend weakly on the flapper shape and are very similar to the figure-eight motion observed in the motion of insect wings. Our results suggest that flapping could be a exploited experimentally as a propul...

  9. Inferior Gluteal Perforator Flaps for Breast Reconstruction

    OpenAIRE

    Allen, Robert J.; LoTempio, Maria M.; Granzow, Jay W.

    2006-01-01

    Perforator flaps represent the latest in the evolution of soft tissue flaps. They allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The powerful perforator flap concept allows transfer of tissue from numerous, well-described donor sites to almost any distant site with suitable recipient vessels. The inferior gluteal artery perforator (I-GAP) flap is one option that allows a large volume of tissue to be used for breast reconstruction w...

  10. Basic Perforator Flap Hemodynamic Mathematical Model

    Science.gov (United States)

    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.

  11. Optimal propulsive flapping in Stokes flows.

    Science.gov (United States)

    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

  12. A case of hypopharyngeal stenosis caused by late radiation injuries; Reconstruction of the hypopharynx with myomucosal tongue flap

    Energy Technology Data Exchange (ETDEWEB)

    Murofushi, Toshihisa (JR Tokyo General Hospital, Tokyo (Japan)); Funai, Hiroaki; Ohta, Yasushi; Takubo, Masamichi; Tajima, Bunji

    1990-07-01

    The authors reported a 47-year-old man with hypopharyngeal stenosis caused by late radiation injuries. At the age of ten he underwent irradiation (3000 rads) to the neck because of the cervical lymphadenopathy. He had keroid skin change at the age of 19, hypothyroidism since 26, right cervical and brachial plexus neuropathy since 33, and paralysis and papilloma of right vocal cord at 34. And at the age of 41 he underwent tracheotomy owing to laryngeal stenosis. In November 1984 (at age 43) he felt abnormal sensation on the throat but had no dysphagia nor misdigulutition. On November 1987 he had difficulties of swallowing, and could not take anything but fluid. At that time he was diagnosed as hypopharyngeal stenosis. With steroids and antibiotics his difficulties of swallowing were reduced. He experienced the same difficulties on April 1988. Since December 1988 his dysphagia got worse and was not recovered with medication. On May 17 1989, laryngopharyngectomy was performed. At the level of cricoid cartilage hypopharynx was resected. As for the posterior wall, pharynx and cervical esophagus were fixed to prevertebral fascia and anastomosed with end-to-end. And antero-lateral defects were reconstructed with myomucosal tongue flap. Postoperatively he could eat orally. On the basis of the experience of this case and the review of the literature the authors conclude that myomucosal tongue flap is one of alternatives for hypopharyngeal reconstruction. (author).

  13. Association between Thigh Muscle Volume and Leg Muscle Power in Older Women.

    Directory of Open Access Journals (Sweden)

    Ulrich Lindemann

    Full Text Available The construct of sarcopenia is still discussed with regard to best appropriate measures of muscle volume and muscle function. The aim of this post-hoc analysis of a cross-sectional experimental study was to investigate and describe the hierarchy of the association between thigh muscle volume and measurements of functional performance in older women. Thigh muscle volume of 68 independently living older women (mean age 77.6 years was measured via magnetic resonance imaging. Isometric strength was assessed for leg extension in a movement laboratory in sitting position with the knee flexed at 90° and for hand grip. Maximum and habitual gait speed was measured on an electronic walk way. Leg muscle power was measured during single leg push and during sit-to-stand performance. Thigh muscle volume was associated with sit-to-stand performance power (r = 0.628, leg push power (r = 0.550, isometric quadriceps strength (r = 0.442, hand grip strength (r = 0.367, fast gait speed (r = 0.291, habitual gait speed (r = 0.256, body mass index (r = 0.411 and age (r = -0.392. Muscle power showed the highest association with thigh muscle volume in healthy older women. Sit-to-stand performance power showed an even higher association with thigh muscle volume compared to single leg push power.

  14. Association between Thigh Muscle Volume and Leg Muscle Power in Older Women

    Science.gov (United States)

    Machann, Juergen; Blatzonis, Konstantinos; Rapp, Kilian

    2016-01-01

    The construct of sarcopenia is still discussed with regard to best appropriate measures of muscle volume and muscle function. The aim of this post-hoc analysis of a cross-sectional experimental study was to investigate and describe the hierarchy of the association between thigh muscle volume and measurements of functional performance in older women. Thigh muscle volume of 68 independently living older women (mean age 77.6 years) was measured via magnetic resonance imaging. Isometric strength was assessed for leg extension in a movement laboratory in sitting position with the knee flexed at 90° and for hand grip. Maximum and habitual gait speed was measured on an electronic walk way. Leg muscle power was measured during single leg push and during sit-to-stand performance. Thigh muscle volume was associated with sit-to-stand performance power (r = 0.628), leg push power (r = 0.550), isometric quadriceps strength (r = 0.442), hand grip strength (r = 0.367), fast gait speed (r = 0.291), habitual gait speed (r = 0.256), body mass index (r = 0.411) and age (r = -0.392). Muscle power showed the highest association with thigh muscle volume in healthy older women. Sit-to-stand performance power showed an even higher association with thigh muscle volume compared to single leg push power. PMID:27315060

  15. Unusual bilateral origins of the deep artery of thigh and associated variations

    Directory of Open Access Journals (Sweden)

    Shankar N

    2009-08-01

    Full Text Available During routine dissection of a middle aged male cadaver, an unusual origin of the deep artery of thigh was observed bilaterally. It arose from the femoral artery less than 1 cm distal to the inguinal ligament. On both sides, its diameter was greater than that of the femoral artery. An unusually distal origin of the lateral circumflex femoral artery was observed bilaterally. An unnamed branch from the deep artery of thigh on the left side was seen coursing superolaterally towards the anterior superior iliac spine. The deep external pudendal artery arose from the medial circumflex femoral artery on either side. On the right side, the femoral nerve emerged in the femoral triangle by piercing the iliacus muscle. As the deep artery of thigh is often used in vascular reconstructive procedures and is frequently visualized by various radiological imaging techniques, anatomical variations of itself as well as its branches have significant clinical implications.

  16. [Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

    Science.gov (United States)

    Lanfrey, E; Grolleau, J L; Glock, Y; Chavoin, J P; Costagliola, M

    1996-04-01

    Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials. PMID:8761064

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

    Science.gov (United States)

    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

  18. Secondary onlay free flap reconstruction of glossectomy defects following initial successful flap restoration.

    Science.gov (United States)

    Rihani, Jordan; Lee, Thomas; Ducic, Yadranko

    2013-08-01

    Patients who undergo tongue reconstruction over time may develop gradual worsening of dysarthria and dysphagia secondary to flap atrophy. At our institution, these patients undergo a secondary flap onlay procedure for augmentation of the neotongue. We review a total of 11 patients with total glossectomy defect who underwent secondary tongue augmentation with secondary onlay free flap consisting of radial forearm free flap (n = 6) and rectus free flap (n = 5). There was improvement in swallowing in 7 of 11 patients. Five (45.4%) patients achieved gastric tube independence. Seven (63.6%) patients achieved a varying degree of oral intake. All patients achieved tracheostomy independence. Dysarthria was improved in all patients. There were no flap failures. Therefore, a secondary onlay flap technique is feasible and may improve dysphagia and dysarthria to achieve gastric tube and tracheostomy independence in total glossectomy patients with delayed tongue atrophy. PMID:23625797

  19. MR and CT findings in a case of hibernoma of the thigh extending into the pelvis

    International Nuclear Information System (INIS)

    Review of the literature shows no report of hibernoma of the thigh extending into the pelvis. Herein we report a case of hibernoma which appeared on CT and MR as a well-defined pelvic mass with contrast enhancement extending through the obturator foramen into the thigh. Fat was demonstrated by CT, whereas MR, using multiplanar sections, better analyzes the extension of the mass. This case demonstrates that hibernoma as liposarcoma can extend through the obturator foramen. However, no definite diagnosis could be made by CT or MR and the tumor must be considered as a ''potential'' malignant liposarcoma. (orig.)

  20. Oxidative stability of chicken thigh meat after treatment of fennel and savory essential oils

    Directory of Open Access Journals (Sweden)

    Adriana Pavelková

    2016-05-01

    Full Text Available In the present work, the effect of the fennel and savory essential oils on oxidative stability of chicken thigh muscles during chilled storage was investigated. In the experiment were used chickens of hybrid combination Cobb 500 after 42 days of the fattening period. The obtained fresh chicken thigh with skin from left half-carcass were divided into five groups (n = 5: C - control air-packaged group; A1 - vacuum-packaged experimental group; A2 - vacuum-packaged experimental group with EDTA solution 1.50% w/w; A3 - vacuum-packaged experimental group with fennel (Foeniculum vulgare essential oil at concentrations 0.2% v/w and A4 - vacuum-packaged experimental group with savory (Satureja hortensis essential oil at concentration 0.2% v/w. The essential oils were applicate on surface chicken thighs. The chicken thighs were packaged using a vacuum packaging machine and stored in refrigerate at                 4 ±0.5 °C. The value of thiobarbituric acid (TBA expressed as amount of malondialdehyde (MDA in 1 kg sample was measured during storage in 1st, 4th, 8th, 12th and 16th day. The treatments of chicken thighs with fennel and savory essential oils show statistically significant differences between all testing groups and control group, where higher average value of MDA measured in thigh muscle of broiler chickens was in samples of control group                 (0.359 mg.kg-1 compared to experimental groups A1 (0.129 mg.kg-1, A2 (0.091 mg.kg-1, A3 (0.084 mg.kg-1 and A4 (0.089 mg.kg-1 after 16-day of chilled storage. Experiment results show that the treatment of chicken thigh with fennel and savory essential oils had positive influence on the reduction of oxidative processes in thigh muscles during chilling storage and use of essential oil is one of the options increase shelf life of fresh chicken meat.

  1. Oxidative stability of chicken thigh meat after treatment of fennel and savory essential oils

    OpenAIRE

    Adriana Pavelková

    2016-01-01

    In the present work, the effect of the fennel and savory essential oils on oxidative stability of chicken thigh muscles during chilled storage was investigated. In the experiment were used chickens of hybrid combination Cobb 500 after 42 days of the fattening period. The obtained fresh chicken thigh with skin from left half-carcass were divided into five groups (n = 5): C - control air-packaged group; A1 - vacuum-packaged experimental group; A2 - vacuum-packaged experimental group with EDTA s...

  2. Thumb Reconstruction Using Foucher’s Flap

    Science.gov (United States)

    Kola, Nardi

    2016-01-01

    BACKGROUND: Extensive pulp defects of the thumb, with the exposure of tendon or bone, are challenging reconstructive problems. Surgical treatment includes the use of local, regional, and free flaps. AIM: This paper is focused in Foucher’s neuro vascular flap. First DMCA or Foucher’s pedicle flap is a successful thumb reconstruction method, especially in patients not disturbed by its cosmetic appearance. MATERIAL AND METHODS: The first dorsal metacarpal artery (FDMCA) arises from the radial artery in the first intermetacarpal space, just distal to the tendon of the extensor pollicis longus. Pulp area of the thumb is the area where Foucher’s flap is more utilizable. This technique has other applications such as first web reconstruction, thumb lengthening, and following resection of tumors on the dorsum of the hand. RESULTS: We have in study 7 cases with work related trauma in two years period of time, between 2012 and 2014. We had only one partial flap survival and all the other flaps survived entirely. We have also taken in consideration subjective satisfaction with a range score from 4 to 10, cold intolerance, flap area and donor site sensibility with a range score from low to medium to normal. CONCLUSION: Careful pedicle discovery, secured elevation, pedicle strangulation prevention are very important for flap survival.

  3. Analysis of tail effects in flapping flight

    NARCIS (Netherlands)

    Tay, W.B.; Bijl, H.; Van Oudheusden, B.W.

    2011-01-01

    Numerical simulations have been performed to examine the interference effects between an upstream flapping airfoil and a downstream stationary airfoil in a tandem configuration at a Reynolds number of 1000, which is around the regime of small flapping micro aerial vehicles. The object

  4. Anterolateral subluxation of the tibia associated with combined anterior cruciate and medial collateral ligament tears: MR imaging of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Gyoon; Kang, Heoung Keun [Chonnam University Medical School, Kwangju (Korea, Republic of); Lee, Joong K.; Phelps, Carlton T. [Albany Medical College and Albany Medical Center Hospital, Newyork (United States)

    1995-09-15

    To evaluate the passive subluxation of the tibia on MR imaging in patient with both anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears and to demonstrate the usefulness of its measurement. The authors performed a retrospective study of 123 knees with tears of both ACL (complete, n = 70, partial, n = 53) and MCL (complete, n = 10, partial, n 113). ACL tears were documented at arthroscopy and MCL tears were interpreted by abnormal MR findings. One hundred normal knees were also studied for comparison. Using new internal landmarks, anterior subluxation was measured on an intercondylar sagittal image and lateral subluxation was measured on a mid-coronal image. Anterior subluxation of 3 mm or more was seen in 45/123(37%) abnormal knees, lateral subluxation of 3 mm or more in 20/123(16%), and anterolateral subluxation in 15/123(12%). Anterior subluxation of 5 mm or more was seen in 25/70(36%) complete ACL tears, and no knees with partial ACL tears showed anterior subluxation of 5 mm or more. Static anterolateral subluxation of the tibia occurs in knees with combined ACL and MCL tears, as measured on routine MR imaging. These measurements may help confirm the presence of ligament injuries and differentiate complete from partial ACL tear.

  5. Anterolateral subluxation of the tibia associated with combined anterior cruciate and medial collateral ligament tears: MR imaging of the knee

    International Nuclear Information System (INIS)

    To evaluate the passive subluxation of the tibia on MR imaging in patient with both anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears and to demonstrate the usefulness of its measurement. The authors performed a retrospective study of 123 knees with tears of both ACL (complete, n = 70, partial, n = 53) and MCL (complete, n = 10, partial, n 113). ACL tears were documented at arthroscopy and MCL tears were interpreted by abnormal MR findings. One hundred normal knees were also studied for comparison. Using new internal landmarks, anterior subluxation was measured on an intercondylar sagittal image and lateral subluxation was measured on a mid-coronal image. Anterior subluxation of 3 mm or more was seen in 45/123(37%) abnormal knees, lateral subluxation of 3 mm or more in 20/123(16%), and anterolateral subluxation in 15/123(12%). Anterior subluxation of 5 mm or more was seen in 25/70(36%) complete ACL tears, and no knees with partial ACL tears showed anterior subluxation of 5 mm or more. Static anterolateral subluxation of the tibia occurs in knees with combined ACL and MCL tears, as measured on routine MR imaging. These measurements may help confirm the presence of ligament injuries and differentiate complete from partial ACL tear

  6. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

    Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

    2009-01-01

    INTRODUCTION: Clinical work on the blood perfusion in skin and muscle flaps has suggested that some degree of blood flow autoregulation exists in such flaps. An autoregulatory mechanism would enable the flap to protect itself from changes in the perfusion pressure. The purpose of the present study...... was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention...... with the L-type calcium channel blocker nimodipine and the vasodilator papaverine. MATERIAL AND METHODS: Pedicled flaps were raised in pigs. Flow in the pedicle was reduced by constriction of the feed artery (n=34). A transit time flow probe measured the effect on blood flow continuously. Following...

  7. Facial artery flaps in facial oncoplastic reconstruction.

    Science.gov (United States)

    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. PMID:24037925

  8. Exotic wakes of flapping fins

    DEFF Research Database (Denmark)

    Schnipper, Teis

    downstream neighbour. When this neighbour is a second flag close by, they synchronise in frequency and the leader experiences a reduced drag compared to that on the lone flag. In case the follower is replaced by a flapping plate, upstream synchronisation and drag reduction is again found over a wide range of...... frequencies. Drag reductions up to a factor 3 are measured. Many results presented are obtained through flow visualisations. A great effort is made to produce visualisations of primarily high scientific quality, but often also with a certain aesthetic appeal....

  9. Laser resurfacing of skin flaps: an experimental comparison

    Directory of Open Access Journals (Sweden)

    Srdan Babovic

    2011-05-01

    Full Text Available Objective. The influence of Coherent Ultrapulse, TruPulse and Erbium: YAG laser skin resurfacing on survival of the skin flaps when performed simultaneously was evaluated. Material and methods. We used twelve female Yucatan minipigs in the study. Skin flaps including paniculus carnosus were raised on the animals’ back. The flaps were sutured into the defect under tension. We designed 4 experimental groups: Control-Flaps only, Group 2-Flaps + 4 immediate TruPulse laser passes, Group 3-Flaps + 2 immediate Coherent UltraPulse laser passes, Group 4-Flaps – immediate 50J/cm2 total fluence with Erbium: YAG laser. Results. Flap survival in Control group was 98.8%. There was no flap in Group 2 with complete survival. Survival of the flaps in Group 2 (Tru-Pulse ranged from 75-90%, with average flap survival area of 85.2%. In Group 3 (UltraPulse all 24 flaps had some area of necrosis. Flap survival in Group 3 ranged from 75-95%, with an average of 85.6%. In Group 4 (Erbium: YAG flap survival area ranged from 70-95%, with all 24 flaps with some area of necrosis, with average flap survival area of 87.3%. There is a significant statistical difference in flap survival area between groups 2, 3 and 4 versus Control (p<0.001. Conclusion. The results of our study suggest that laser resurfacing of skin flaps sutured under tension in the same operative session is detrimental for skin flap survival. We also found no significant difference in flap survival area between TruPulse, Coherent UltraPulse and Erbium: YAG laser treated flaps.

  10. Total endoscopic free flap harvest of a serratus anterior fascia flap for microsurgical lower leg reconstruction

    Directory of Open Access Journals (Sweden)

    Erdmann, Alfons

    2014-04-01

    Full Text Available [english] Background: A tremendous number of free flaps have been developed in the past. As the surgical result depends not only on a successful flap transfer but also on the harvest, this paper details the procedures for undertaking the first total endoscopic harvest of a serratus fascia flap for free flap transplantation to the lower leg. Patient and methods: In September 2012 we performed the first total endoscopic serratus anterior fascia free flap harvest. The incision of 2.5 cm length was made 10 cm in front of anterior muscle border of the latissimus dorsi at level with the midthorax. After insertion of a flexible laparoscopic single port system we started CO gas insufflation. We used this setting to meticulously prepare a neo cavity between atissimus dorsi and M. serratus anterior. The vessels were dissected and the thoraco-dorsal nerve was separated. With a second auxiliary incision we used a clamp to support the raising of the fascia flap from the underlying muscle. Finally we clipped the vessels to the latissimus dorsi muscle and the flap vessels at the Arteria and Vena axillaris. The flap was extracted via the 2.5 cm incision.Results: We were able to perform a total endoscopic harvest of a serratus fascia flap for free flap reconstruction of soft tissues. With this new operative technique we were able to avoid a long skin incision, which in our view lowers the morbidity at the harvest area.Conclusion: We describe a new method for the total endoscopic harvest of the serratus fascia flap for free flap transfer. The flap was harvested within reasonable time and following surgery leaves the patient with minimal donor site morbidity compared to the open technique.

  11. Hydrodynamic schooling of flapping swimmers

    Science.gov (United States)

    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.

  12. The appearance of angiolipomatosis after using laptop computer on the thighs: a relationship?

    Directory of Open Access Journals (Sweden)

    Marie Caucanas

    2011-09-01

    Full Text Available A 56-year-old patient developed angiolipomatosis of the anterior part of the thighs after repeated laptop contact localisation. Histological findings exhibit an unusual inflammatory infiltrate. We postulate that the computer could favour lipoma development by a physiopathological mechanism that remains to be clarified.

  13. Liposuction-assisted medial thigh lift in non bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Abdelmohsen K. Aboueldahab

    2014-03-01

    Results: All patients recovered well in two weeks and showed improvement of thigh contour. Scar downward displacement occurred in one patient. No skin necrosis or seroma was encountered. One patient developed superficial thrombophlebitis and required hospital stay for 5 days and anticoagulant treatment. No labial distortion or separation was encountered.

  14. In vivo MR tractography of thigh muscles using diffusion imaging: initial results

    International Nuclear Information System (INIS)

    The aims of this preliminary study were (1) to demonstrate the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and (2) to assess the value of tractography images to obtain averaged microstructural parameters, i.e., the fractional anisotropy (FA) and the mean apparent diffusion coefficient (ADC), over the whole thigh. Five healthy volunteers were included in this study. Their right thighs were imaged using diffusion tensor imaging and gradient-echo T2* sequences. Muscular tractography was performed on each muscle. MR tractography provided a good approach of the muscle shape and of the orientation of the muscle fibers. There was no aberration in the color-encoding scheme nor in the luminosity assigned to each fiber. In contrast, tendons were not drawn in any of the muscles studied. FA values ranged from 0.27 to 0.38. Mean ADC values ranged from 0.76 to 0.96 x 10-3 mm2/s. Our study demonstrated the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and of determining muscular microstructural parameters (FA and ADC). Musculoskeletal radiologists should be aware of these new developments that may provide complementary information on muscles to the usual sequences. (orig.)

  15. In vivo MR tractography of thigh muscles using diffusion imaging: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Budzik, J.F.; Le Thuc, V.; Morel, M.; Cotten, A. [Hopital Roger Salengro, CHRU de Lille, Service de Radiologie Osteoarticulaire, Lille Cedex (France); Demondion, X. [Hopital Roger Salengro, CHRU de Lille, Service de Radiologie Osteoarticulaire, Lille Cedex (France); Faculte de Medecine de Lille, Laboratoire d' Anatomie, Lille (France); Chechin, D. [Philips Medical Systems, Suresnes (France)

    2007-12-15

    The aims of this preliminary study were (1) to demonstrate the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and (2) to assess the value of tractography images to obtain averaged microstructural parameters, i.e., the fractional anisotropy (FA) and the mean apparent diffusion coefficient (ADC), over the whole thigh. Five healthy volunteers were included in this study. Their right thighs were imaged using diffusion tensor imaging and gradient-echo T2* sequences. Muscular tractography was performed on each muscle. MR tractography provided a good approach of the muscle shape and of the orientation of the muscle fibers. There was no aberration in the color-encoding scheme nor in the luminosity assigned to each fiber. In contrast, tendons were not drawn in any of the muscles studied. FA values ranged from 0.27 to 0.38. Mean ADC values ranged from 0.76 to 0.96 x 10{sup -3} mm{sup 2}/s. Our study demonstrated the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and of determining muscular microstructural parameters (FA and ADC). Musculoskeletal radiologists should be aware of these new developments that may provide complementary information on muscles to the usual sequences. (orig.)

  16. In vivo MR tractography of thigh muscles using diffusion imaging: initial results.

    Science.gov (United States)

    Budzik, J F; Le Thuc, V; Demondion, X; Morel, M; Chechin, D; Cotten, A

    2007-12-01

    The aims of this preliminary study were (1) to demonstrate the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and (2) to assess the value of tractography images to obtain averaged microstructural parameters, i.e., the fractional anisotropy (FA) and the mean apparent diffusion coefficient (ADC), over the whole thigh. Five healthy volunteers were included in this study. Their right thighs were imaged using diffusion tensor imaging and gradient-echo T2* sequences. Muscular tractography was performed on each muscle. MR tractography provided a good approach of the muscle shape and of the orientation of the muscle fibers. There was no aberration in the color-encoding scheme nor in the luminosity assigned to each fiber. In contrast, tendons were not drawn in any of the muscles studied. FA values ranged from 0.27 to 0.38. Mean ADC values ranged from 0.76 to 0.96 x 10(-3) mm2/s. Our study demonstrated the feasibility of providing in vivo 3D architecture of human thigh muscles using tractography on a 1.5T magnet, and of determining muscular microstructural parameters (FA and ADC). Musculoskeletal radiologists should be aware of these new developments that may provide complementary information on muscles to the usual sequences. PMID:17639406

  17. Temperatures in human thighs after hot pack treatment followed by ultrasound.

    Science.gov (United States)

    Lehmann, J F; Stonebridge, J B; deLateur, B J; Warren, C G; Halar, E

    1978-10-01

    Temperature distributions were measured in the anterior thigh of human volunteers after preheating with a hot pack followed by ultrasound, a frequently used therapeutic procedure. The skin surface temperature is elevated by this procedure but the highest temperature is still produced at the bone-muscle interface at the end of the treatment session. PMID:363094

  18. Thigh infection and subcutaneous emphysema: an emergency, review of literature and case discussion.

    LENUS (Irish Health Repository)

    Thakral, R

    2011-06-01

    Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.

  19. Large volume liquid silicone injection in the upper thighs : a never ending story

    NARCIS (Netherlands)

    Hofer, SOP; Damen, A; Nicolai, JPA

    2000-01-01

    This report concerns a 26-year-old male-to-female transsexual who had received a large volume liquid silicone injection of unknown grade into her upper lateral thighs to gain female contour. She presented at our outpatient clinic 4 years after the silicone injection with complaints of pain and silic

  20. Body vectoring technique with Radiesse® for tightening of the abdomen, thighs, and brachial zone

    Directory of Open Access Journals (Sweden)

    Cogorno Wasylkowski V

    2015-05-01

    Full Text Available Valeria Cogorno Wasylkowski Médico Estético Cosmetic Medicine, Clinic Novosalud, Madrid, Spain Background: The objective of this study was to investigate the efficacy, safety, and subject satisfaction of the calcium hydroxylapatite-based dermal filler Radiesse® in a novel body vectoring technique to correct skin flaccidity in the thighs, abdomen, and brachial zones.Methods: Female subjects with self-evaluated flaccidity scores ≥3 on a 6-point scale (0, no flaccidity; 5, very severe flaccidity in the zones of interest were included. Radiesse was injected according to predesigned vector maps (3 mL per thigh, 1.5 mL per hemiabdomen or brachial zone. Clinical assessments (skin density and thickness were made by an independent reviewer at an exact position before and 5 weeks after treatment using a cutometer and an ultrascan. Subjects rated skin flaccidity before and 5 weeks after treatment on the 6-point scale and performed a pinch test to self-assess changes in skin thickness. All adverse events were recorded.Results: Twenty females (aged 28–67 years were enrolled, contributing 36 treatment zones. Across all zones, 78% of flaccidity measurements improved after treatment. Improvements in skin flaccidity were most common in the thighs (82% of cases. An improvement in skin density versus baseline was observed in the majority across all zones, most frequently in the abdomen (88% of cases. Skin thickness in each zone also improved versus baseline for the majority, most frequently in the thighs (88% of cases. Mean self-assessed flaccidity scores at baseline were 3.6 (thighs, 3.7 (abdomen, and 3.8 (brachial zone, and 2.6, 2.7, and 3.0, respectively, posttreatment. All subjects reported a positive pinch test. In total, 47.0% of subjects had bruising after treatment, which resolved within a week. No serious adverse events were reported.Conclusion: Using this novel technique, Radiesse had notable results on skin flaccidity, density and thickness in

  1. [Primary thinning and de-epithelialization of microsurgical transplants from the lateral thigh].

    Science.gov (United States)

    Wolff, K D; Plath, T; Frege, J; Hoffmeister, B

    2000-03-01

    To expand the indicational spectrum of the myocutaneous vastus lateralis flap, which is often too voluminous for intraoral application, we performed extreme, primary thinning of the fat and muscle component of this microsurgical transplant in 14 patients. After subfascial localization of the 0.5- to 1.0-mm-thick perforating vessel, it is exposed through the fascia and muscles up to its exit from the descending branch of the lateral circumflex femoral artery. After isolating the perforating vessel, it is no longer necessary to include parts of the vastus lateralis muscle in the flap. The fatty tissue of the remaining epifascial fat component is completely removed except for a ca. 1- to 2-cm-wide cuff of fatty tissue and fascia around the perforating vessel. When performing this primary radical removal of the subcutaneous fatty tissue, care should be taken not to injure the deep subdermal vascular plexus. In addition to the thinning procedure, de-epithelialization of the skin was performed using scalpel blade dissection (five patients) or carbon dioxide laser (6 W, five patients). This thinning technique was used for covering ten intraoral and four extraoral defects and enabled the raising of skin flaps with a thickness of 3-5 mm even in obese patients. The vessel pedicle length of thinned flaps was between 12 and 16 cm; flap size varied between 4 x 5 and 9 x 15 cm, and the donor sites were directly closed. In one case, there was a partial necrosis (20%), but the remaining flaps healed without complications. On the intraoral flaps, a thin, smooth and pliable surface developed after re-epithelialization within 3-6 weeks. The described method expands the application possibilities of the myocutaneous vastus lateralis flap for a large number of intraoral and flat defects with minimal donor-site morbidity. PMID:10851881

  2. Fibrin glue for Gundersen flap surgery

    Directory of Open Access Journals (Sweden)

    Chung HW

    2013-03-01

    Full Text Available Hsi-Wei Chung,1 Jodhbir S Mehta1–31Singapore National Eye Centre, Singapore; 2Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore; 3Department of Clinical Sciences, Duke-NUS Graduate Medical School, SingaporePurpose: To evaluate the feasibility of fibrin glue in Gundersen flap surgery.Design: Prospective case series.Study subjects: Seven eyes of seven subjects who had undergone Gundersen flap surgery from 2009 to 2011 at the Singapore National Eye Centre, Singapore.Methods: Review of case records for outcomes after Gundersen flap surgery.Main outcome measures: Surgical success was defined as achieving a stable ocular surface. Complications to be noted included flap retraction or exposure of underlying corneal surface.Results: Surgical success was achieved in all eyes with significant reduction in ocular surface inflammation. No retractions were noted and recovery was uncomplicated.Conclusion: Fibrin glue application is a viable alternative to sutures in Gundersen flap surgery. It reduces surgical downtime, gives faster ocular surface rehabilitation, and offers similar outcomes to conventional conjunctival flap surgery.Keywords: Gundersen, conjunctival flap, fibrin glue

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

    OpenAIRE

    Kasyan, George; Tupikina, Nataliya; Pushkar, Dmitry

    2014-01-01

    Introduction Objectives were to evaluate safety and patient reported perception of the Martius fibroadipose flap for complex female urethra reconstruction. Material and methods Patients operated with a Martius flap were contacted again via telephone to rate their self–perception on cosmetic appearance, pain or numbness of the flap harvest site. Results 37 women (mean age of 46.8 yrs.) were operated with Martius flaps. Complications were limited to bleeding from the flap bed in 19% (7/37); hem...

  4. The plane problem of the flapping wing

    Science.gov (United States)

    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.

  5. Dynamic response of a piezoelectric flapping wing

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2014-01-01

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

  7. Localization and function of the cannabinoid CB1 receptor in the anterolateral bed nucleus of the stria terminalis.

    Directory of Open Access Journals (Sweden)

    Nagore Puente

    Full Text Available BACKGROUND: The bed nucleus of the stria terminalis (BNST is involved in behaviors related to natural reward, drug addiction and stress. In spite of the emerging role of the endogenous cannabinoid (eCB system in these behaviors, little is known about the anatomy and function of this system in the anterolateral BNST (alBNST. The aim of this study was to provide a detailed morphological characterization of the localization of the cannabinoid 1 (CB1 receptor a necessary step toward a better understanding of the physiological roles of the eCB system in this region of the brain. METHODOLOGY/PRINCIPAL FINDINGS: We have combined anatomical approaches at the confocal and electron microscopy level to ex-vivo electrophysiological techniques. Here, we report that CB1 is localized on presynaptic membranes of about 55% of immunopositive synaptic terminals for the vesicular glutamate transporter 1 (vGluT1, which contain abundant spherical, clear synaptic vesicles and make asymmetrical synapses with alBNST neurons. About 64% of vGluT1 immunonegative synaptic terminals show CB1 immunolabeling. Furthermore, 30% and 35% of presynaptic boutons localize CB1 in alBNST of conditional mutant mice lacking CB1 mainly from GABAergic neurons (GABA-CB1-KO mice and mainly from cortical glutamatergic neurons (Glu-CB1-KO mice, respectively. Extracellular field recordings and whole cell patch clamp in the alBNST rat brain slice preparation revealed that activation of CB1 strongly inhibits excitatory and inhibitory synaptic transmission. CONCLUSIONS/SIGNIFICANCE: This study supports the anterolateral BNST as a potential neuronal substrate of the effects of cannabinoids on stress-related behaviors.

  8. Periodic and Chaotic Flapping of Insectile Wings

    CERN Document Server

    Huang, Yangyang

    2015-01-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. The maximum power output of these flight muscles is insufficient to maintain such wing oscillations unless there is good elastic storage of energy in the insect flight system. Here, we explore the intrinsic self-oscillatory behavior of an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring. We study the wings behavior as a function of the total energy and spring stiffness. Three types of behavior are identified: end-over-end rotation, chaotic motion, and periodic flapping. Interestingly, the region of periodic flapping decreases as energy increases but is favored as stiffness increases. These findings are consistent with the fact that insect wings and flight muscles are stiff. They further imply that, by adjusting their muscle stiffness to the desired energy level, insects can maintain periodic flapping mechanically for a range of operating condit...

  9. Postirradiation flap infection about the oral cavity

    International Nuclear Information System (INIS)

    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

  10. A dynamical system for interacting flapping swimmers

    Science.gov (United States)

    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.

  11. Behind the performance of flapping flyers

    CERN Document Server

    Ramananarivo, Sophie; Thiria, Benjamin

    2010-01-01

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

  12. Mandibular reconstruction in irradiated patients utilizing myosseous-cutaneous flaps

    International Nuclear Information System (INIS)

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

  13. The Effect of Epigallocatechin Gallate on Flap Viability of Rat Perforator Abdominal Flaps.

    Science.gov (United States)

    Aksakal, İbrahim Alper; Küçüker, İsmail; Önger, Mehmet Emin; Engin, Murat Sinan; Keleş, Musa Kemal; Demir, Ahmet

    2016-05-01

    Background Epigallocatechin gallate (EGCG) is a substance abundant in green tea. In this study, the effects of EGCG on perforator flap viability were investigated. Methods A total of 40 rats were assigned to four groups of 10 each. In each subject, a 4 × 6 cm abdominal skin flap was raised and adapted back onto its place. In the control group, no further procedures were taken. In the flap group, 40 mg/kg/d EGCG was injected into the flap. In the gavage group, 100 mg/kg/d EGCG was given through a feeding tube. In the intraperitoneal group, 50 mg/kg/d EGCG was injected intraperitoneally. On the 7th postoperative day, flaps were photographed and the viable areas were measured and compared via a one-way analysis of variance. Results The ratios of viable and contracted flap area were 9.15/12.01, 4.59/16.46, 11.56/11.20, and 11.65/10.77 cm(2) for the control, flap group, gavage group, and intraperitoneal group, respectively. While the flap group yielded the worst results in the sense of flap contraction and viability (p < 0.001), the gavage and intraperitoneal groups were significantly better than those of the control group (p = 0.03). Histologically, epidermal, papillary dermal, and capillary tissue volumes were evaluated. In comparison to the control group, the flap group yielded significantly increased epidermal and dermal volumes (p = 0.03), however, these values were significantly decreased (p = 0.04) in the gavage and intraperitoneal groups. Capillary volumes were significantly decreased in EGCG treatment groups (p < 0.01). Conclusion Our experiment has shown that oral and intraperitoneal administration of EGCG increases the perforator flap viability when compared with controls, while direct injection decreases the viability. PMID:26919381

  14. Effect of Dietary Supplementation of the Combination of Gallic and Linoleic Acid in Thigh Meat of Broilers

    OpenAIRE

    Lee, Kyung Haeng; Jung, Samooel; Kim, Hyun Joo; Kim, Il Suk; Lee, Jun Heon; Jo, Cheorun

    2012-01-01

    This study was performed to investigate the combined effect of dietary supplementation of gallic and linoleic acid (GL) on the antioxidative effect and quality of thigh meat from broilers. Broilers received 3 dietary treatments: i) commercial finisher diet (control), ii) 0.5% GL (gallic:linoleic acid = 1 M:1 M), and iii) 1.0% GL during the 22 to 36 d. The pH value of broiler thigh meat was increased by GL supplementation. Water holding capacity of the thigh meat was enhanced by the 1.0% dieta...

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

    Science.gov (United States)

    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

  16. Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

    Science.gov (United States)

    Sharma, R R; Pawar, S J; Mahapatra, A K; Doctor, M; Musa, M M

    2001-06-01

    Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot. PMID:11447444

  17. Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

    Directory of Open Access Journals (Sweden)

    Sharma R

    2001-04-01

    Full Text Available Malignant peripheral nerve sheath tumour (MPNST is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot.

  18. Simultaneous thigh muscle metastasis from lung cancer and Escherichia coli gas producing myonecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Martinez, Gonzalo E. [Hospital Italiano, Department of Radiology, Cordoba (Argentina); Coursey, Courtney A.; Martinez, Salutario [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Dodd, Leslie [Duke University Medical Center, Department of Pathology, Durham, NC (United States)

    2008-08-15

    We present the case of a 41-year-old man with known large cell lung cancer who had undergone left pneumonectomy 7 months prior and who presented with a large intramuscular mass involving the posterior left thigh and upper calf. This thigh mass was ultimately surgically explored, and specimens yielded both Escherichia coli organisms and cells reflecting a skeletal muscle metastasis from the patient's known lung cancer. The patient was also found to have a rectal metastasis from his lung cancer. Intramuscular abscesses produced by gastrointestinal tract flora are a well-known presentation of colon cancer. To our knowledge, this is the first case report of the simultaneous occurrence of a skeletal muscle metastasis and an E. coli abscess in the same anatomic location. We believe the patient's rectal metastasis may have been the intermediate step in this process. (orig.)

  19. Simultaneous thigh muscle metastasis from lung cancer and Escherichia coli gas producing myonecrosis

    International Nuclear Information System (INIS)

    We present the case of a 41-year-old man with known large cell lung cancer who had undergone left pneumonectomy 7 months prior and who presented with a large intramuscular mass involving the posterior left thigh and upper calf. This thigh mass was ultimately surgically explored, and specimens yielded both Escherichia coli organisms and cells reflecting a skeletal muscle metastasis from the patient's known lung cancer. The patient was also found to have a rectal metastasis from his lung cancer. Intramuscular abscesses produced by gastrointestinal tract flora are a well-known presentation of colon cancer. To our knowledge, this is the first case report of the simultaneous occurrence of a skeletal muscle metastasis and an E. coli abscess in the same anatomic location. We believe the patient's rectal metastasis may have been the intermediate step in this process. (orig.)

  20. Electromyographic analysis of thigh muscles during track cycling on a velodrome.

    Science.gov (United States)

    Watanabe, Kohei; Sato, Takayuki; Mukaimoto, Takahiro; Takashima, Wataru; Yamagishi, Michio; Nishiyama, Tetsunari

    2016-08-01

    We aimed to investigate neuromuscular activation of thigh muscles during track cycling at various speeds. Eight male competitive cyclists volunteered to participate in this study. Surface electromyography of the vastus lateralis, biceps femoris and adductor magnus muscles of the bilateral legs was recorded during track cycling on velodromes with a 250-m track. The participants were instructed to maintain three different lap times: 20, 18 and 16 s. The average rectified value (ARV) was calculated from the sampled surface electromyography. Significantly higher ARVs were observed in the right compared to left leg for the biceps femoris muscle during both straight and curved sections at 18- and 16-s lap times (P  0.05). From our findings, it was suggested that during track cycling on a velodrome the laterality of the biceps femoris muscle activity is a key strategy to regulate the speed, and fixed neuromuscular strategies are adopted between straight and curved sections for thigh muscles. PMID:26571039

  1. Dorsal hand coverage with free serratus fascia flap

    DEFF Research Database (Denmark)

    Fotopoulos, Peter; Holmer, Per; Leicht, Pernille;

    2003-01-01

    serratus fascia flap, the connective tissue over the serratus muscle, for dorsal hand coverage. The flap consists of thin and well-vascularized pliable tissue, with gliding properties excellent for covering exposed tendons. It is based on the branches of the thoracodorsal artery, which are raised in the...... flap, leaving the long thoracic nerve intact on the serratus muscle. Coverage of the flap with split-thickness skin graft is done immediately. The free serratus fascia flap is an ideal flap for dorsal hand coverage when the extensor tendons are exposed, especially because of low donor-site morbidity....

  2. Maxillofacial reconstruction with nasolabial and facial artery musculomucosal flaps.

    Science.gov (United States)

    Braasch, Daniel Cameron; Lam, Din; Oh, Esther S

    2014-08-01

    The nasolabial and facial artery musculomucosal (FAMM) flaps are predictable methods to reconstruct perioral and intraoral defects with vascularized tissue. The nasolabial flap can be harvested as an axial or random patterned flap, whereas the FAMM flap is truly an axial patterned flap, with either a superior or an inferior base. Both flaps have been widely used to provide predictable results, with low morbidity. Future studies are needed to further prove their use in compromised patients, including patients with a history of head and neck radiation and neck dissections. PMID:25086694

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

    Directory of Open Access Journals (Sweden)

    E. A. Razgulyaeva

    2014-01-01

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

  4. Application of perforator flap for repair of finger soft tissue defect%穿支皮瓣移植在手指创面修复中的应用

    Institute of Scientific and Technical Information of China (English)

    周祥吉; 庞晖; 杨富强; 李东柱; 高学建; 范启申

    2009-01-01

    目的 探讨穿支皮瓣游离移植修复手指皮肤软组织缺损的设计和手术技巧.方法 切取小腿前外侧、小腿内侧下部、小腿外侧血管穿支皮瓣以及远段骨间背血管蒂穿支皮瓣,移植修复手指小创面13例.结果 13例皮瓣全部存活,受区与供区的功能、外观均良好.结论 在肢体部位以皮穿支或轴型血管为蒂设计穿支皮瓣,游离移植修复手指创面,患者痛苦小、损伤小,创面能获得满意覆盖.这为手外伤修复提供了一种新的选择,对术者也提出了更高的要求.%Objective To explore the surgical design and surgical techniques of perforator flap transfer for repairing soft tissue defects of the fingers. Methods Perforator flaps from anterolateral, inferomedial and lateral side of the lower leg and distal dorsal interosseous perforator mini flap were used to repair soft tissue defect of the fingers in 13 cases. Results All 13 flaps survived. The function and appearance of both the donor and recipient sites were good. Condusion Designing and harvesting a flap pedieled on a perforator or an axial vessel in the extremity for free transfer to cover soft tissue defects of the fingers offers a new surgical option for treating hand trauma, since it causes less pain and leas damage while providing satisfactory wound coverage. Meanwhile, however, it is technically more challenging to the surgeon.

  5. Lateral Thigh Fascia Lata as Interpositional Graft for Temporomandibular Joint Ankylosis

    OpenAIRE

    Alemán, Ramón Manuel; Martínez, María Guadalupe

    2011-01-01

    Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft i...

  6. Case report 441: Malignant schwannoma of soft tissue of the thigh

    International Nuclear Information System (INIS)

    A case of a radiologically ossified, malignant schwannoma of the thigh is presented in a 57-year-old man who had a palpable mass for 20 years. The authors believe that this is the first such case presented in the radiological literature. The differential diagnosis was considered and the sparse literature on the subject surveyed. Ossification of a malignant schwannoma is indeed a rare presentation of this neoplasm. (orig.)

  7. Three-dimensional Superficial Liposculpture of the Hips, Flank, and Thighs

    OpenAIRE

    Yi Xin Zhang, MD; Davide Lazzeri, MD; Luca Grassetti, MD; Alessandro Silvestri, MD; Aurelia Trisliana Perdanasari, MD; Sheng Han, MD; Matteo Torresetti, MD; Giovanni Di Benedetto, MD, PhD; Manuel Francisco Castello, MD

    2015-01-01

    Background: In the last 3 decades, liposuction has become a mainstay of the plastic surgeon’s armamentarium, and the technique has evolved considerably. We retrospectively review all of the liposuction procedures that we performed over the past 20 years. Methods: The principles of superficial 3-dimensional liposuction with respect to preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction of the hips, flanks, and thighs were described. Res...

  8. Three-dimensional Superficial Liposculpture of the Hips, Flank, and Thighs

    OpenAIRE

    Zhang, Yi Xin; Lazzeri, Davide; Grassetti, Luca; Silvestri, Alessandro; Trisliana Perdanasari, Aurelia; Han, Sheng; Torresetti, Matteo; Di Benedetto, Giovanni; Castello, Manuel Francisco

    2015-01-01

    Background: In the last 3 decades, liposuction has become a mainstay of the plastic surgeon’s armamentarium, and the technique has evolved considerably. We retrospectively review all of the liposuction procedures that we performed over the past 20 years. Methods: The principles of superficial 3-dimensional liposuction with respect to preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction of the hips, flanks, and thighs were described. Results: ...

  9. GIANT PLEXIFORM NEUROFIBROMA OF LEFT GLUTEAL AND THIGH REGION: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ravi Kumar Reddy

    2015-02-01

    Full Text Available Plexiform neurofibromas are benign tumors arising from visceral or subcutaneous peripheral nerves , which are usually associated with neurofibromatosis type 1. Giant neurofibromas are a surgical challenge because of their vascularity and extensive infiltration and require pre - operative and postoperative management strategies. This case report describes a 30 year old female with a giant plexiform neurofibroma of the left gluteal and thigh region (27kg in association with neurofibromatosis which was resected successfully.

  10. Bone anatomy of the pelvic girdle, the thigh and the leg of Myrmecophaga tridactyla (Myrmecophagidae: Pilosa

    Directory of Open Access Journals (Sweden)

    Lucas de Assis Ribeiro

    2013-11-01

    Full Text Available The giant anteater (Myrmecophaga tridactyla is the largest anteater species in the world. It is an animal of terrestrial habits, however, it has some ability to climb tall trees and termite mounds. The hard skeletal structures are of crucial importance, since they join and protect the soft organs and help support the body, shape, and get involved in movement. The appendicular skeleton is an important part of the locomotor apparatus, whose anatomical information in wild species is scarce, making it difficult to interpret data on these bones. This paper aims to describe the pelvic girdle, the thigh, and the leg skeleton in the giant anteater. We used two specimens of Myrmecophaga tridactyla Linnaeus (1758, fixed in a 3.7% aqueous formaldehyde solution. At first, the limbs were disjointed and we removed the skin, viscera, and muscles associated to the bones of the pelvic girdle, the thigh, and the leg in the specimens. Then, they were macerated in boiling water, and, subsequently, placed in a hydrogen peroxide solution. Once clean and dry, the bones were identified and described. The pelvic girdle skeleton in the giant anteater consists of the hip bone, formed by the ilium, pubis, and ischium bones; the thigh consists of the femur bone, and the leg consists of the tibia and fibula bones. In the knee joint region there is the patella, a relatively small sesamoid bone, considering the large size of this animal. The giant anteater have osteological features of the pelvic girdle, the thigh, and the leg similar to those in domestic carnivores, however, some morphological differences are made evident, something which may reflect differences in locomotor patterns.

  11. Oxidative stability of cnicken thigh meat after treatment of abies alba essential oil

    OpenAIRE

    Adriana Pavelková; Marek Bobko; Peter Haščík; Miroslava Kačániová; Jana Tkáčová

    2015-01-01

    In the present work, the effect of the Abies alba essential oil in two different concentrations on oxidative stability of chicken thigh muscles during chilled storage was investigated. In the experiment were chickens of hybrid combination Cobb 500 after 42 days of the fattening period slaughtered.  All the broiler chickens were fed with the same feed mixtures and were kept under the same conditions. The feed mixtures were produced without any antibiotic preparations and c...

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

    Science.gov (United States)

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

    1973-01-01

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

  13. Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yoon Jin; Kim, Young Hoon; Lee, Kyoung Ho; Park, Ji Hoon [Department of Radiology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lee, Hye Seung [Department of Pathology, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Jung, Seung Chai [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744 (Korea, Republic of); Joo, Seung-Moon [Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720 (Korea, Republic of)

    2014-07-01

    To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.

  14. Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

    International Nuclear Information System (INIS)

    To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean ± standard deviation, 1.7 ± 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh

  15. Neurofibromatous sensory neuropathy of the thigh in a 7-year-old boy.

    Science.gov (United States)

    Shetty, Gautam M; Murari, Ashok Shyam; Song, Hae-Ryong; Lee, Seok Hyun; Yang, Jae Hyuk

    2008-10-01

    Neuropathy is considered to be an unusual complication of neurofibromatosis 1 (NF1). Neurofibromatous neuropathy is extremely rare in the setting of paediatric age group, pure sensory mononeuropathy and NF1. The following is a description of a 7-year-old boy who presented with complains of discomfort and parasthesia on the anterior aspect of his left thigh which is an unusual mode of presentation and site of involvement. Clinical examination and imaging revealed an isolated sensory neuropathy of the left anterior femoral cutaneous nerve of the thigh secondary to plexiform neurofibromatosis involving the L1-L4 nerve roots and the anterior femoral cutaneous nerve of thigh. The main abnormality in this patient was segmental hypertrophy of the left lower limb and dilatation of left lumbar neural foramens. Subtotal excision of the neurofibromas of the anterior femoral cutaneous nerve was performed and the patient was asymptomatic at the end of 27 months (2.25 years) of followup. Although the result of treatment in this case was good, long-term followup is necessary in view of greater risk of malignant transformation and development of spinal deformity and overall long-term poor prognosis in this particular patient subgroup of NF1. PMID:17929043

  16. Validity and repeatability of a depth camera-based surface imaging system for thigh volume measurement.

    Science.gov (United States)

    Bullas, Alice M; Choppin, Simon; Heller, Ben; Wheat, Jon

    2016-10-01

    Complex anthropometrics such as area and volume, can identify changes in body size and shape that are not detectable with traditional anthropometrics of lengths, breadths, skinfolds and girths. However, taking these complex with manual techniques (tape measurement and water displacement) is often unsuitable. Three-dimensional (3D) surface imaging systems are quick and accurate alternatives to manual techniques but their use is restricted by cost, complexity and limited access. We have developed a novel low-cost, accessible and portable 3D surface imaging system based on consumer depth cameras. The aim of this study was to determine the validity and repeatability of the system in the measurement of thigh volume. The thigh volumes of 36 participants were measured with the depth camera system and a high precision commercially available 3D surface imaging system (3dMD). The depth camera system used within this study is highly repeatable (technical error of measurement (TEM) of volume when compared to the 3dMD system. This suggests poor agreement yet a close relationship, which once corrected can yield a usable thigh volume measurement. PMID:26928458

  17. Bristle-thighed Curlew Capture Data from James Campbell National Wildlife Refuge, O'ahu, Hawaii, 2012-2014

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set contains banding, morphology, and satellite telemetry information for Bristle-thighed curlews (Numenius tahitiensis) that were captured between 2012...

  18. Extended thoracodorsal artery perforator flap for breast reconstruction.

    Science.gov (United States)

    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

  19. Oxidative stability of cnicken thigh meat after treatment of abies alba essential oil

    Directory of Open Access Journals (Sweden)

    Adriana Pavelková

    2015-12-01

    Full Text Available In the present work, the effect of the Abies alba essential oil in two different concentrations on oxidative stability of chicken thigh muscles during chilled storage was investigated. In the experiment were chickens of hybrid combination Cobb 500 after 42 days of the fattening period slaughtered.  All the broiler chickens were fed with the same feed mixtures and were kept under the same conditions. The feed mixtures were produced without any antibiotic preparations and coccidiostatics. After slaughtering was dissection obtained fresh chicken thigh with skin from left half-carcass which were divided into five groups (n = 5: C - control air-packaged group; A1 - vacuum-packaged experimental group; A2 - vacuum-packaged experimental group with ethylenediaminetetraacetic acid (EDTA solution 1.50% w/w; A3 - vacuum-packaged experimental group with Abies alba oil 0.10% v/w and A4 - vacuum-packaged experimental group with Abies alba oil 0.20% v/w. The Abies alba essential oil was applicate on ground chicken things and immediately after dipping, each sample was packaged using a vacuum packaging machine and storage in refrigerate at 4 ±0.5 °C. Thiobarbituric acid (TBA value expressed in number of malondialdehyde was measured in the process of first storage day of 1st, 4th, 8th, 12th and 16th day after slaughtering and expressed on the amount of malondialdehyde (MDA in 1 kg sample. The treatments of chicken things with Abies alba essential oil show statistically significant differences between all testing groups and control group, where higher average value of MDA measured in thigh muscle of broiler chickens was in samples of control group (0.4380 mg.kg-1 compared to experimental groups A1 (0.124 mg.kg-1, A2 (0.086 mg.kg-1, A3 (0.082 mg.kg-1 and A4 (0.077 mg.kg-1 after 16-day of chilled storage. Experiment results show that the treatment of chicken thigh with Abies alba essential oil positively influenced on the reduction of oxidative processes in thigh

  20. Modified cup flap for volar oblique fingertip amputations

    Directory of Open Access Journals (Sweden)

    Ahmadli, A.

    2016-02-01

    Full Text Available We describe a modified volar “V-Y cup” flap for volar fingertip defects that do not exceed more than half of the distal phalanx for better aesthetic and functional outcome. In seven cases out of eight, the flap was elevated with a subdermal pedicle, whereas in one case, the flap was elevated as an island on the bilateral neurovascular bundle. The fingertips have been evaluated for sensibility using standard tests, hook nail deformity and patient satisfaction. Seven flaps have survived completely. The flap with skeletonized bilateral digital neurovascular bundle has shown signs of venous insufficiency on the 5 postoperative day with consecutive necrosis. Suturing the distal edges of the flap in a “cupping” fashion provided a normal pulp contour. The modified flap can be used for defects as mentioned above. Subdermally dissected pedicle-based flap is safe and easy to elevate. The aesthetic and functional outcomes have been reported to be satisfactory.

  1. The forked flap repair for hypospadias

    Directory of Open Access Journals (Sweden)

    Anil Chadha

    2012-01-01

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

  2. Deltopectoral Flap in the Era of Microsurgery

    Directory of Open Access Journals (Sweden)

    R. C. L. Chan

    2014-01-01

    Full Text Available 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.

  3. 14 CFR 25.1511 - Flap extended speed.

    Science.gov (United States)

    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...

  4. Pharyngo oesophageal strictures and its reconstruction by delto pectoral flaps

    OpenAIRE

    Guha, Goutam; S Gupta; Chakraborty, S

    2005-01-01

    Delto pectoral flap is a thin and pliable cutaneous axial flap suitable for the reconstruction of pharynx and upper oesophagus. Corrosive stricture of the pharyngo oesophageal area can very well be reconstructed by deltopectoral flap. Oesophageal reconstruction by viscera like stomach or colon often produces anastomic stricture at the upper anastomic site with hypopharynx or upper oesophagus. Delto pectoral flap can also be used to reconstruct this anastomotic stricture. Postoperative swallow...

  5. The Use of the Juri Temporo-Parieto-Occipital Flap

    OpenAIRE

    Juri, Jose; Valotta, Marìa Fernanda

    2005-01-01

    The temporo-parieto-occipital flap, introduced in 1969, was the first large monopedicled flap performed in the scalp for reconstructive and aesthetic purposes. Its versatility for correction of many areas of the scalp relies on its wide arch of rotation, based in the flap's pedicle, which is the superficial temporal artery and vein. The axial pattern of the flap is explained by the unique kind of vascularization present in the scalp, based on a profuse intraparietal blood flow with multiple a...

  6. The submental island flap for reconstruction of facial defects.

    OpenAIRE

    Prabhune K; Patni S; Gomes D.; Bhathena H; Kavarana N

    1998-01-01

    The procedure of facial resurfacing dictates that there should be an excellent colour and texture match between the facial and the transposed skin. Cervical flaps e.g. platysma flap are commonly used for reconstruction of facial defects but, with disadvantages like limited mobility, unacceptable donor site and unpredictable outcomes. The submental island flap is a new addition to the armamentorium of the Plastic Surgeon. It is an axial pattern flap based on the submental branch of facial arte...

  7. Perforator plus flaps: Optimizing results while preserving function and esthesis

    Directory of Open Access Journals (Sweden)

    Mehrotra Sandeep

    2010-01-01

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

  8. The aerodynamic and structural study of flapping wing vehicles

    OpenAIRE

    Zhou, Liangchen

    2013-01-01

    This thesis reports on the aerodynamic and structural study carried out on flapping wings and flapping vehicles. Theoretical and experimental investigation of aerodynamic forces acting on flapping wings in simple harmonic oscillations is undertaken in order to help conduct and optimize the aerodynamic and structural design of flapping wing vehicles. The research is focused on the large scale ornithopter design of similar size and configuration to a hang glider. By means of Theodorsen’s th...

  9. Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review.

    LENUS (Irish Health Repository)

    Conroy, Eimear

    2010-07-01

    Femoral head incongruency at skeletal maturity is associated with the development of osteoarthritis in early adulthood. Containment of the femoral head provides a larger surface area for remodelling of the collapsed femoral head and the development of spherical congruency. Triple pelvic osteotomy has a role to play in Legg-Calve-Perthes\\' disease by improving femoral head containment and preventing subluxation. This is traditionally a two-incision approach with significant associated morbidity. In our unit we perform triple osteotomies through a single anterolateral incision. To retrospectively review the clinical and radiographic outcome of children who had triple osteotomies performed through a single incision over a 4-year period. In our unit from 2003 to 2006 we performed eight triple osteotomies through a single incision in children aged between 6 and 12 years with Legg-Calve-Perthes\\' disease. The procedure was performed through a single anterolateral incision made beneath the middle of the iliac crest and carried forward according to Salter\\'s osteotomy. Image intensification was used to confirm iliac, pubic and ischial cuts. After performing a standard Salter\\'s osteotomy the acetabular fragment was free to rotate anteriorly and laterally. None of the children were casted and all were allowed immediate mobilization nonweight bearing with crutches for 6 weeks. Clinical results and hip function were measured preoperatively and postoperatively using the modified Harris hip score. The average length of hospital stay was 4.7 days. None of the children had a nonunion. The centre edge angle of Wiberg was measured on all preoperative and postoperative anteroposterior pelvic radiographs. In all our patients there was an improvement in the centre edge angle of Wiberg and in the modified Harris hip score. The preoperative modified Harris hip scores ranged from 38 to 60 and postoperatively ranged from 77 to 92. The preoperative centre edge angle of Wiberg ranged

  10. 14 CFR 23.1511 - Flap extended speed.

    Science.gov (United States)

    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...

  11. Peroperative evaluation of vascularity of various flaps by fluorescein technique

    Directory of Open Access Journals (Sweden)

    Bhattacharya V

    2006-01-01

    Full Text Available Background: The viability of any pedicled flap depends upon its vascularity. When a flap is dissected it becomes relatively ischaemic. Ultimately, the viability of the flap depends on the vessels incorporated in the pedicle and their perfusion capacity. There are different techniques to evaluate the blood supply of a flap. Aims: This study deals with experimental and clinical efficiency of fluorescein dye technique to evaluate the vascularity of flaps of various compositions. Materials and Methods: The experimental study was conducted on rats to standardize the technique. Thereafter clinical evaluation was conducted for different flaps namely fasciocutaneous, skeletonized perforator based fasciocutaneous, adipofascial, fasciocutaneous flap with adipofascial extension, fasciocutaneous flap with fascial extension and fasciocutaneous flap with split fascial extension. Conclusions: The paper deals in detail with the technique and method of documentation of a fluorescein study on flaps both experimentally and clinically. The appearance of fluorescein on both the surfaces and distal margin of the flap confirmed the adequacy of vascularity soon after dissection of the flaps. It was found to be an easy, safe and reliable objective method.

  12. Fibula free flap splitting for mandible reconstruction: A technical note

    OpenAIRE

    López-Arcas, José María; M. Burgueño; Del Castillo, J. L.

    2009-01-01

    Conformation of the fibula flap to passively adapt to the remaining mandible may be indeed challenging. A review of the ‘axial splitting’ technique for fibula free flaps is presented with a novel method of osteosynthesis. Adequate mandibular angle shape is achieved by performing this type of osteotomy with a minimal use of titanium hardware for flap insetting.

  13. Unilateral Breast Reconstruction Using Bilateral Inferior Gluteal Artery Perforator Flaps

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake, MD

    2015-03-01

    Conclusions: Use of bilateral IGAP flaps for breast reconstruction helps to avoid asymmetry of the inferior buttock volume and shape. Bilateral flaps provide sufficient tissue volume and allow for reconstruction of a breast comparable to the unaffected side. In patients with moderate-to-high projection breast whose abdominal tissue cannot be used for reconstruction, IGAP flaps may be a suitable alternative.

  14. Prospective evaluation of outcome measures in free-flap surgery.

    LENUS (Irish Health Repository)

    Kelly, John L

    2004-08-01

    Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +\\/- 29 min) and in those that survived (92 +\\/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.

  15. Double papilla flap technique for dual purpose

    Directory of Open Access Journals (Sweden)

    P Mohan Kumar

    2012-01-01

    Full Text Available Marginal tissue recession exposes the anatomic root on the teeth, which gives rise to -common patient complaints. It is associated with sensitivity, tissue irritation, cervical abrasions, and esthetic concerns. Various types of soft tissue grafts may be performed when recession is deep and marginal tissue health cannot be maintained. Double papilla flap is an alternative technique to cover isolated recessions and correct gingival defects in areas of insufficient attached gingiva, not suitable for a lateral sliding flap. This technique offers the advantages of dual blood supply and denudation of interdental bone only, which is less susceptible to permanent damage after surgical exposure. It also offers the advantage of quicker healing in the donor site and reduces the risk of facial bone height loss. This case report presents the advantages of double papilla flap in enhancing esthetic and functional outcome of the patient.

  16. Collective Flow Enhancement by Tandem Flapping Wings

    Science.gov (United States)

    Gravish, Nick; Peters, Jacob M.; Combes, Stacey A.; Wood, Robert J.

    2015-10-01

    We examine the fluid-mechanical interactions that occur between arrays of flapping wings when operating in close proximity at a moderate Reynolds number (Re ≈100 - 1000 ). Pairs of flapping wings are oscillated sinusoidally at frequency f , amplitude θM, phase offset ϕ , and wing separation distance D*, and outflow speed v* is measured. At a fixed separation distance, v* is sensitive to both f and ϕ , and we observe both constructive and destructive interference in airspeed. v* is maximized at an optimum phase offset, ϕmax, which varies with wing separation distance, D*. We propose a model of collective flow interactions between flapping wings based on vortex advection, which reproduces our experimental data.

  17. Numerical linearized MHD model of flapping oscillations

    Science.gov (United States)

    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.

  18. Dorso-palmar triangular finger flap-A new advancement flap for cover of finger amputations-A preliminary report

    Directory of Open Access Journals (Sweden)

    Mishra Satyanarayan

    2001-01-01

    Full Text Available A triangular V-Y type advancement flap on the finger has been designed, which advances skin from over the whole circumference of the finger, which includes both palmar and dorsal skin. The flap is sensate too. It is indicated for finger and thumb amputations proximal to the body of the nail. Six flaps were raised with five successes and one partial necrosis. This is a preliminary report on a new flap.

  19. The transversely split gracilis twin free flaps

    Directory of Open Access Journals (Sweden)

    Upadhyaya Divya

    2010-01-01

    Full Text Available The gracilis muscle is a Class II muscle that is often used in free tissue transfer. The muscle has multiple secondary pedicles, of which the first one is the most consistent in terms of position and calibre. Each pedicle can support a segment of the muscle thus yielding multiple small flaps from a single, long muscle. Although it has often been split longitudinally along the fascicles of its nerve for functional transfer, it has rarely been split transversely to yield multiple muscle flaps that can be used to cover multiple wounds in one patient without subjecting him/her to the morbidity of multiple donor areas .

  20. Flap-edge aeroacoustic measurements and predictions

    Science.gov (United States)

    Brooks, Thomas F.; Humphreys, William M.

    2003-03-01

    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 the prediction models capture much of the physics. Areas of disagreement appear to reveal when the assumed edge noise mechanism does not fully define the noise production. For the different edge conditions, extensive spectra and directivity are presented. The complexity of the directivity results demonstrate the strong role of edge source geometry and frequency in

  1. Flap Edge Aeroacoustic Measurements and Predictions

    Science.gov (United States)

    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

  2. Proximal placement of lateral thigh skin markers reduces soft tissue artefact during normal gait using the Conventional Gait Model.

    Science.gov (United States)

    Cockcroft, John; Louw, Quinette; Baker, Richard

    2016-11-01

    A primary source of measurement error in gait analysis is soft-tissue artefact. Hip and knee angle measurements, regularly used in clinical decision-making, are particularly prone to pervasive soft tissue on the femur. However, despite several studies of thigh marker artefact it remains unclear how lateral thigh marker height affects results using variants of the Conventional Gait Model. We compared Vicon Plug-in Gait hip and knee angle estimates during gait using a proximal and distal thigh marker placement for ten healthy subjects. Knee axes were estimated by optimizing thigh rotation offsets to minimize knee varus-valgus range during gait. Relative to the distal marker, the proximal marker produced 37% less varus-valgus range and 50% less hip rotation range (p < 0.001), suggesting that it produced less soft-tissue artefact in knee axis estimates. The thigh markers also produced different secondary effects on the knee centre estimate. Using whole gait cycle optimization, the distal marker showed greater minimum and maximum knee flexion (by 6° and 2° respectively) resulting in a 4° reduction in range. Mid-stance optimization reduced distal marker knee flexion by 5° throughout, but proximal marker results were negligibly affected. Based on an analysis of the Plug-in Gait knee axis definition, we show that the proximal marker reduced sensitivity to soft-tissue artefact by decreasing collinearity between the points defining the femoral frontal plane and reducing anteroposterior movement between the knee and thigh markers. This study suggests that a proximal thigh marker may be preferable when performing gait analysis using the Plug-in Gait model. PMID:26929983

  3. Repair and regeneration of vertebral body after antero-lateral partial vertebrectomy using beta-tricalcium phosphate

    International Nuclear Information System (INIS)

    Antero-lateral partial vertebrectomy (ALPV) was used for decompression in 91 patients with multilevel cervical disorders. The high-speed drill was used to excise about 1/3 of the vertebral body for relief of anterior compression of the cord and nerve roots under the operating microscope. The key point was opening of the medial wall of the foramen of transverse process at the beginning of the ALPV, allowing the determination of the lateral borders of the ALPVs. To repair and regenerate the vertebral body, a beta-tricalcium phosphate (β-TCP) block was trimmed into a cuneiform shape and implanted into the sites of the ALPV excluding the upper and lowermost vertebral bodies. Postoperative computed tomography confirmed that β-TCP was gradually replaced by newly formed bone from the surface towards the center of the block, and that the affected vertebral body was remodeled by 6 to 12 months after the implantation of β-TCP. The cortical bone borders on the bone marrow at the site of the regeneration. The pedicles on the side of the ALPVs were rebuilt during regeneration of the affected vertebrae. Thus, the vertebral foramen of the cervical spine was widened in the anterior direction at the levels of the ALPVs, resulting in restoration of the physiological size of the cervical cord. The cervical curvature remained unchanged and a certain degree of cervical mobility (mean 86%) was preserved in this series. (author)

  4. Ganglion Cyst of Knee from Hoffa’s Fat Pad Protruding Anterolaterally Through Retinacular Rent: A Case Report

    Science.gov (United States)

    Saha, Partha; Bandyopadhyay, Utpal; Mukhopadhyay, Anindya S.; Kundu, Srikanta; Mandal, Subhadip

    2015-01-01

    Introduction: Intra-articular ganglion cysts of the knee joint are rare occurrences. They are usually encountered as incidental findings in magnetic resonance imaging (MRI), or in arthroscopy. They may originate from both the cruciate ligaments and the menisci, from the popliteus tendon and alar folds, infrapatellar fat pad of Hoffa, and subchondral bone cysts. Those arising from the Hoffa’s fat pad, usually present as palpable mass at anterior aspect of the knee joint. We report a case of intraarticular ganglion cyst of knee arising from the infrapatellar fat pad and protruding anterolaterally through retinacular rent into the subcutaneous plane. Case Report: A 19-year-old young man, presented with a painless gradually increasing swelling at the anterior aspect of left knee of 9 months duration. MRI scan revealed a multilobulated, cyst with septations within the anterior aspect of the knee joint, just inferolateral to the patella, with deep extension into the infrapatellar fat pad, and superficial extension into the subcutaneous space across the retinaculum. After diagnostic arthroscopy, we performed an open excision of the cystic mass and confirmed the retinacular rent pre-operatively. Conclusion: Arthroscopic resection and debridement is the gold standard treatment in ganglion cyst of the knee. However, a subcutaneous extension may lead to incomplete arthroscopic resection: Leaving behind the residual tissue which may cause recurrence. Therefore, proper pre-operative evaluation of MR images of these cases is very important. PMID:27299075

  5. Incidence of Heterotopic Ossification after Surface and Conventional Total Hip Arthroplasty: A Comparative Study Using Anterolateral Approach and Indomethacin Prophylaxis

    Directory of Open Access Journals (Sweden)

    Dario Regis

    2013-01-01

    Full Text Available The incidence and severity of heterotopic ossification (HO in two homogeneous groups of patients that received surface replacement arthroplasty (SRA and conventional total hip arthroplasty (THA were evaluated retrospectively. Thirty-nine patients undergoing 42 hip resurfacing procedures and 41 primary cementless THAs through an anterolateral approach received a 10-day course of 150 mg/die of indomethacin postoperatively. The median surgical time was 190 minutes and 156 minutes, respectively (. At a minimum 1-year followup, the development of HO was assessed on standard X-ray using Brooker grading. Ectopic bone formation was detected in five cases (11.9%, two Brooker grade I and three grade II in the SRA group and in 14 hips (34.1%, 12 grade I and two grade II treated with conventional THA, but the difference was not significant (. No clinically relevant periprosthetic ossification (Brooker III or IV occurred in both groups. Although the difference was not statistically significant, the incidence of HO after SRA was lower than conventional THA. More extensive soft tissue trauma, bone debris, and longer operative time in hip resurfacing are not likely to be absolute risk factors for HO. Further investigations including larger patient populations are needed to confirm these findings.

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

    Directory of Open Access Journals (Sweden)

    Oscar Ochoa, MD

    2013-10-01

    Conclusions: Arterial and venous anatomies play unique roles in flap reliability. DIEP flap venous congestion must be treated expeditiously with venous augmentation to relieve venous congestion and mitigate flap morbidity.

  7. Pharmacokinetics/pharmacodynamics of antofloxacin hydrochloride in a neutropenic murine thigh model of Staphylococcus aureus infection

    Institute of Scientific and Technical Information of China (English)

    Xiu-mei XIAO; Yong-hong XIAO

    2008-01-01

    Aim:Antofloxacin hydrochloride is a new fluoroquinolone antibiotic with broad-spectrum in vitro activity.Using the neutropenic murine thigh infection model,we defined the pharmacodynamic profile and property of antofloxacin hydroehloride against Staphylococcus aureus.Methods:Single-dose pharmacokinetic studies of antofloxacin hydrochloride were carried out in thigh infected mice.Therapy was initiated at 2 h postinoculation with 5-640 mg/kg per d fractionated for different dosing regimens.The thighs were removed for bacterial measurement after 24 h of therapy,the best pharmacokinetic/ pharmacodynamic (PK/PD) index correlated with the efficacy was determined by nonlinear regression analysis.A sigmoid Emax dose-response model was used to estimate the daily dose and AUC24 h/MIC (minimal inhibitory concentration) required to achieve a static effect.Results:The PK was linear with similar elimination half-life over the dose range studied.The AUC24 h/MIC ratio was the PK/PD parameter that best correlated with efficacy (R2=92.3%,90.8% for the two organisms,compared with Cmax/MIC and T>MIC [%],respectively).The 24 h static dose ranged from 34.3 to 153.7 mg/kg per d for all S aureus strains,the total AUC24h/MIC ratio to achieve bacteriostatic effect varied from 31.7 to 122.5 (mean,65.7±30.6).Conclusion:Antofloxacin hydrochloride showed powerful antibacterial activity against the S aureus isolates used in our neutropenic infected mice model.Our data suggested that the AUC/MIC ratio appeared to be most closely linked to the bacterial outcome (R290%),and a total AUC24/MIC ratio of 65.7 appears to be the target value to achieve a net bactericidal activity against S aureus,similar to the results of other fluoroquinolones.

  8. Reliability of computed tomography measurements in assessment of thigh muscle cross-sectional area and attenuation

    International Nuclear Information System (INIS)

    Advancement in technology of computer tomography (CT) and introduction of new medical imaging softwares enables easy and rapid assessment of muscle cross-sectional area (CSA) and attenuation. Before using these techniques in clinical studies there is a need for evaluation of the reliability of the measurements. The purpose of the study was to evaluate the inter- and intra-observer reliability of ImageJ in measuring thigh muscles CSA and attenuation in patients with anterior cruciate ligament (ACL) injury by computer tomography. 31 patients from an ongoing study of rehabilitation and muscle atrophy after ACL reconstruction were included in the study. Axial CT images with slice thickness of 10 mm at the level of 150 mm above the knee joint were analyzed by two investigators independently at two times with a minimum of 3 weeks between the two readings using NIH ImageJ. CSA and the mean attenuation of individual thigh muscles were analyzed for both legs. Mean CSA and mean attenuation values were in good agreement both when comparing the two observers and the two replicates. The inter- and intraclass correlation (ICC) was generally very high with values from 0.98 to 1.00 for all comparisons except for the area of semimembranosus. All the ICC values were significant (p < 0,001). Pearson correlation coefficients were also generally very high with values from 0.98 to 1.00 for all comparisons except for the area of semimembranosus (0.95 for intraobserver and 0.92 for interobserver). This study has presented ImageJ as a method to monitor and evaluate CSA and attenuation of different muscles in the thigh using CT-imaging. The method shows an overall excellent reliability with respect to both observer and replicate

  9. [The gracilis muscle as musculocutaneous flap. Evaluation of 20 cases].

    Science.gov (United States)

    Gholam, D; Trevidic, P; Kleimann, P; Hautefeuille, P; Nicoletis, C

    1991-01-01

    The use of gracilis as muscular or myocutaneous flap is very well-known. The authors report 20 cases of gracilis flap including 13 reconstructions of the vaginal cavity following extended abdomino-perineal resection. Some technical points concerning the localization of the cutaneous part of the flap and the pedicle dissection are discussed. The use of gracilis flap is still limited in surgical teams following extended abdomino-perineal resection, nevertheless it is a very useful flap because of its low morbidity, the shortening of patient hospitalization and the very satisfying aesthetic result of the neo-vaginal cavity. PMID:1726389

  10. Hyalomma aegyptium on Spur-thighed Tortoise (Testudo graeca) in Urmia Region West Azerbaijan, Iran

    OpenAIRE

    M Tavassoli; N Rahimi-Asiabi; E Tavassoli

    2007-01-01

    Background: Ticks are obligate blood feeders that parasitize a wide variety of animals. Hyalomma aegyptium, parasitize tortoises and other small wild life and livestock. This study was carried out to determine spur-thighed tortoise (Testudo graeca) infestation to H. ageyptium in Urmia region West Azerbaijan of Iran. Methods: The study was carried out over a 16 month period from the spring of 2004 to the fall of 2005. A total of 32 tor¬toises were sampled. Results: The results indicated that 1...

  11. Use of digital image correlation and ultrasound: analysis of thigh muscle displacement fields.

    Science.gov (United States)

    Affagard, Jean-Sébastien; Feissel, Pierre; Bensamoun, Sabine F

    2015-08-01

    The understanding of the mechanical behavior of the muscle tissue is an important field of investigation with different applications in medicine, car crash and sport. Currently, few in vivo imaging techniques are able to characterize the mechanical properties of muscle. Thus, the development of an in vivo identification method is a current thematic where the displacement field measurements could be used for further interpretations. This study aims at presenting the displacement fields measured in the anterior, posterior, lateral and medial parts of the thigh muscles using ultrasound and Digital Image Correlation (DIC) techniques. The results of the displacement field measurements confirmed and are correlated with the ultrasound observations. PMID:26737128

  12. Autopsy case of lymphangiosarcoma arising from the postoperative and postirradiated site of lymphangioma of the thigh

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Tomotsugu; Fujiwara, Masayuki; Yoshie, Haruhiko; Hotchi, Masao (Shinshu Univ., Matsumoto, Nagano (Japan). Faculty of Medicine)

    1983-01-01

    A 25-year-old man had undergone resection of lymphangioma on the anterior aspect of left thigh and postoperative irradiation at the age of seven. About ten years later, lymphangiosarcoma developed at the postoperative site and he died despite wide resection, chemotherapy and irradiation. Microscopically, the malignant cells were arranged in an angiomatous pattern with endthelial lining. Ultrastructural examination of the tumor suggested the dual origin from blood and lymphatic capillaries. The pathogenesis of the tumor was considered to be closely related to local disturbances in lymph circulation at the postoperative site although no lymphedema was present.

  13. Prenatal diagnosis of a fibrosarcoma of the thigh: a case report.

    Science.gov (United States)

    Durin, Luc; Jeanne-Pasquier, Corinne; Bailleul, Patrick; Eboué, Cyril; Aicardi, Stéphanie; Herlicoviez, Michel; Dreyfus, Michel

    2006-01-01

    We report a rare case of fibrosarcoma of the thigh suspected prenatally. At 27 weeks of gestation a voluminous, vascularised mass was discovered at ultrasound on the foetus' left leg, suggestive of haemangioma or a fibrosarcoma. There were no signs of heart failure. A rapid increase in the tumour mass was noted and a caesarean section was carried out at 39 weeks because of abnormal foetal heart rate. Postnatal ultrasound examination was comparable to that carried out prenatally; pathological examination of the mass biopsied and immunohistochemical investigation provided a diagnosis of congenital fibrosarcoma. After neoadjuvant chemotherapy and surgery the infant is now in complete remission without amputation. PMID:16968999

  14. Non small-cell lung cancer with metastasis to thigh muscle and mandible: two case reports

    OpenAIRE

    Giugliano, Francesca Maria; Alberti, Domingo; Guida, Giovanna; Palma, Giampaolo De; Iadanza, Luciano; Mormile, Maria; Cammarota, Fabrizio; Montanino, Agnese; Fulciniti, Franco; Ravo, Vincenzo; Muto, Paolo

    2013-01-01

    Introduction Lung cancer is the leading cause of cancer-related death in Europe and the US. Isolated metastases to skeletal muscle and the mandible are very uncommon. Case presentation This report presents two cases. Case 1 concerns a 45-year-old Caucasian woman affected by muscle metastasis of the right thigh from non-small-cell lung cancer. Case 2 concerns a 61-year-old Caucasian man affected by mandible metastasis from non-small-cell lung cancer. Both metastases were detected by diagnostic...

  15. Propeller thoracodorsal artery perforator flap for breast reconstruction

    Science.gov (United States)

    Angrigiani, Claudio; Escudero, Ezequiel; Artero, Guillermo; Gercovich, Gustavo; Deza, Ernesto Gil

    2014-01-01

    Background The thoracodorsal artery perforator (TDAP) flap has been described for breast reconstruction. This flap requires intramuscular dissection of the pedicle. A modification of the conventional TDAP surgical technique for breast reconstruction is described, utilizing instead a propeller TDAP flap. The authors present their clinical experience with the propeller TDAP flap in breast reconstruction alone or in combination with expanders or permanent implants. Methods From January 2009 to February 2013, sixteen patients had breast reconstruction utilizing a propeller TDAP flap. Retrospective analysis of patient characteristics, clinical indications, procedure and outcomes were performed. The follow-up period ranged from 4 to 48 months. Results Sixteen patients had breast reconstruction using a TDAP flap with or without simultaneous insertion of an expander or implant. All flaps survived, while two cases required minimal resection due to distal flap necrosis, healing by second intention. There were not donor-site seromas, while minimal wound dehiscence was detected in two cases. Conclusions The propeller TDAP flap appears to be safe and effective for breast reconstruction, resulting in minimal donor site morbidity. The use of this propeller flap emerges as a true alternative to the traditional TDAP flap. PMID:25207210

  16. The double opposing myomucosal cheek flap in hard palate reconstruction.

    Science.gov (United States)

    Pabiszczak, Maciej; Banaszewski, Jacek; Pastusiak, Tomasz; Buczkowska, Agata; Wierzbicka, Małgorzata

    2015-01-01

    Limited defects in the oral cavity can be treated with local and pedicled cheek flaps. It allows to preserve the functions of the resected organ. Large defects in the midline of the hard palate can be reconstructed with double opposing myomucosal cheek flaps. The aim of this study was to discuss the methodology of the flap harvest and to show our experiences of treatment in a group of 15 patients with oral cavity cancer. In 1 patient the double opposing myomucosal cheek flap was harvested due to the wider local defect. The small size of the flap with ability to use the double opposing cheek flap in more extended defects as well as short duration of the surgery procedure can lead to reduced risk of postoperative complications. Finally, cheek flaps form an effective method of treatment of defects in the oral cavity. PMID:26388355

  17. First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

    Directory of Open Access Journals (Sweden)

    Satish Chetan

    2009-01-01

    Full Text Available Thumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 x 1.5 cm to 5 x 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

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

    Science.gov (United States)

    Tadiparthi, S; Akali, A; Felberg, L

    2009-02-01

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

  19. Clinical application of free omental flap transfer

    Energy Technology Data Exchange (ETDEWEB)

    Harii, K.

    1978-04-01

    In the field of reconstruction surgery, the greater omentum has been used as a transposed flap for the treatment of chronic lymphedema, radionecrosis, and so forth. Its transferable range was limited by the length of its pedicle. Microvascular anastomosis allows for free transplantation of this organ and has vastly expanded its usefulness.

  20. Aerohydrodynamics of flapping-wing propulsors

    Energy Technology Data Exchange (ETDEWEB)

    Rozhdestvensky, K.V.; Ryzhov, V.A. [Saint-Petersburg State Marine Technical University (Russian Federation). Dept. of Applied Mathematics and Mathematical Modeling

    2003-11-01

    It is the objective of this survey to review research and development results of flapping-wing propulsors and of vehicles equipped with them. Given the complex and multi-disciplinary character of the problem, a wide range of questions is considered in order to provide a general idea of the state-of-the-art. The main attention is directed at the aerohydrodynamics of flapping-wing propulsors. The major relevant mathematical models and the corresponding numerical results are presented together with the experimental data obtained up to the present time. Also, the physical and the design factors are discussed, which affect the aerohydrodynamic characteristics of flapping wings and that therefore have to be accounted for in the modem mathematical models. Experimental data and numerical modeling results are compared to determine domains of validity of the latter for the aerohydrodynamic design of full-scale air and marine vehicles. Also, existing engineering solutions for vehicles with flapping-wing propulsors are presented and prospective directions for future investigations are outlined. (author)

  1. Late complication of Boari bladder flap

    Energy Technology Data Exchange (ETDEWEB)

    Berzeg, Semin; Beyersdorff, Dirk; Kopka, Lars [Department of Radiology, Charite Campus Mitte, Schumannstrasse 20/21, 10117 Berlin (Germany); Baumgart, Egbert; Lenk, Severin [Department of Urology, Charite Campus Mitte, Schumannstrasse 20/21, 10117 Berlin (Germany)

    2003-07-01

    A very rare late complication of Boari bladder flap repair with development of pseudodiverticulum and recurrent genitourinary tract infection secondary to vesicoureteral reflux is presented. Radiologic evaluation of the patient comprised intravenous pyelography (IVP), micturating cystourethrogram, cystoscopy, and multislice computed tomography (MSCT). (orig.)

  2. Late complication of Boari bladder flap

    International Nuclear Information System (INIS)

    A very rare late complication of Boari bladder flap repair with development of pseudodiverticulum and recurrent genitourinary tract infection secondary to vesicoureteral reflux is presented. Radiologic evaluation of the patient comprised intravenous pyelography (IVP), micturating cystourethrogram, cystoscopy, and multislice computed tomography (MSCT). (orig.)

  3. Flapping wing aerodynamics: from insects to vertebrates.

    Science.gov (United States)

    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

  4. Periodic and chaotic flapping of insectile wings

    Science.gov (United States)

    Huang, Y.; Kanso, E.

    2015-11-01

    Insects use flight muscles attached at the base of the wings to produce impressive wing flapping frequencies. The maximum power output of these flight muscles is insufficient to maintain such wing oscillations unless there is good elastic storage of energy in the insect flight system. Here, we explore the intrinsic self-oscillatory behavior of an insectile wing model, consisting of two rigid wings connected at their base by an elastic torsional spring. We study the wings behavior as a function of the total energy and spring stiffness. Three types of behavior are identified: end-over-end rotation, chaotic motion, and periodic flapping. Interestingly, the region of periodic flapping decreases as energy increases but is favored as stiffness increases. These findings are consistent with the fact that insect wings and flight muscles are stiff. They further imply that, by adjusting their muscle stiffness to the energy level at which they are operating, insects can maintain periodic flapping mechanically for a range of operating conditions.

  5. A Miniature Controllable Flapping Wing Robot

    Science.gov (United States)

    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

  6. The Retrograde Ulnar Dorsal Flap: Surgical Technique and Experience as Island Flap in Coverage of Hand Defects.

    Science.gov (United States)

    Vergara-Amador, Enrique

    2015-09-01

    Flaps from the forearm are often used to reconstruct soft-tissue defects in the hand. The retrograde ulnar dorsal flap has the advantage that it does not sacrifice a major vascular axis. The anatomic bases of this flap are the proximal and distal branch of the ulnar dorsal artery. The distal branch is partially accompanied with the dorsal branch of the ulnar nerve, and arrives under the abductor digiti quinti muscle making anastomoses with the deep branch of the ulnar artery. The proximal branch reaching the proximal third of the forearm, and anastomose with perforating branches of the ulnar artery. I used this island flap in 12 patients with coverage defects on the hand. The biggest flap was 13×6 cm. Only 1 flap had partial necrosis which did not lead to problems. The retrograde ulnar dorsal flap is a flap designed with reverse flow from the distal branch of the ulnar dorsal artery, and which does not sacrifice the ulnar artery. The donor defect on the forearm ulnar side had a greater esthetic acceptance. Knowing other distal anastomoses, described by other authors later, dorsal at the base of the fourth interdigital space grant greater security to the retrograde ulnar dorsal flap. It is worth highlighting the importance of preserving the adipofascial tissue around the pedicle. Experience with this flap permits us to state that it is a safe and reproducible flap to cover any defect on the dorsal of the hand as well as the first web space. PMID:26079665

  7. Assessing safety of negative-pressure wound therapy over pedicled muscle flaps: A retrospective review of gastrocnemius muscle flap.

    Science.gov (United States)

    Lance, Samuel; Harrison, Lindsey; Orbay, Hakan; Boudreault, David; Pereira, Gavin; Sahar, David

    2016-04-01

    The use of negative-pressure wound therapy (NPWT) for management of open wounds and immobilization of split-thickness skin grafts (STSGs) over wounds has been well described. However, there is a concern for potential compromise of flap viability when NPWT is used for skin grafts over pedicled muscle flaps. We have used NPWT to immobilize STSGs in eight patients who underwent a pedicled gastrocnemius muscle flap operation in our department. We applied a negative pressure of -75 mmHg on the muscle flaps for 5 days postoperatively. All wounds healed successfully, with a 97.5 ± 5.5% mean STSG uptake. No flap necrosis was observed. In our series, the use of NPWT for fixation of STSGs over pedicled gastrocnemius muscle flap was effective and had no negative impact on flap viability. PMID:26732293

  8. Microbiological quality of chicken thighs after vacuum packaging, EDTA, Coriandri aetheroleum and Menthae spicata aetheroleum

    Directory of Open Access Journals (Sweden)

    Miroslava Kačániová

    2015-05-01

    Full Text Available The aim of the present work was monitoring chicken thighs microbiological quality after treatment by ethylenediaminetetraacetate (EDTA, coriander (Coriandri aetheroleum and spearmint (Menthae spicata aetheroleum essential oil, stored under vacuum packaging, at 4±0.5°C for a period of 16 days. The following treatments of chicken thighs were used: Air-packaging control samples, control vacuum-packaging samples, vacuum-packaging with EDTA solution 1.50% w/w, control samples, vacuum-packaging with Menthae crispae aetheroleum essential oil at concentrations 0.2% v/w and vacuum-packaging with Coriandri aetheroleum essential oil at concentration 0.2% v/w. The quality assessment of all samples was established by microbiological analysis. The microbiological parameters as the total viable count, Enterobacteraceae genera counts, lactic acid bacteria and Pseudomonas spp. were detected. The results of this present study suggest the possibility of application the essential oil of Coriandri aetheroleum and Menthae spicata aetheroleum as natural food preservatives and potential sources of antimicrobial ingredients for food industry.

  9. Determination of optimal placements of markers on the thigh during walking and landing

    Directory of Open Access Journals (Sweden)

    Pain M.T.G.

    2010-06-01

    Full Text Available Kinematics of skin markers are affected by skin tissue artefact with respect to the bone during sports activities or locomotion. The purpose of this study is to determine the less disturbed marker’s location for walking and landing. Twenty-six markers were put on the thigh of nine male subjects. Each subject performed a static trial, a setup movement for determining a functional hip joint centre and five walking and landing trials. The marker displacements were obtained by comparing recorded marker positions and solidified marker positions based on the geometry of the static acquisition. The markers were subsequently ranked from the worst to the least deformed. The ranking of each trial for each subject was analyzed with the concordance coefficient of Kendall and descriptive statistics were used to determine the most and the least disturbed markers. The results show reproducibility between trials for each subject for the two movements. Statistical analysis shows that the most deformed markers during walking were located close to the hip and knee joints whereas the least disturbed were on the mid-thigh. The landing analysis does not permit to determine the best markers from the worst.

  10. Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma

    International Nuclear Information System (INIS)

    To evaluate the involvement of the iliotibial band (ITB), the anterolateral ligament (ALL), and the anterior arm of the biceps femoris in MRI-diagnosed Segond fracture and to evaluate other associated findings of Segond fracture. We retrospectively reviewed the MRI of 13 cases of Segond fracture. The studies included proton density-weighted, T2-weighted, and proton density-weighted with fat saturation images in the three planes. We studied 2 cadaveric specimens with emphasis on the ALL. One cadaveric specimen was dissected while the other was sectioned in the sagittal plane. The mean age of the patients was 36 years (range, 17-52). There were 7 men and 6 women. The mean size of the Segond bone fragment was 8 x 10 x 2 mm. The distance from the tibia varied from 2 to 6 mm. Associated findings included anterior cruciate ligament (ACL) tear (n = 13), medial collateral ligament (MCL) tear (n = 8), meniscocapsular tear of the posterior horn of the medial meniscus (n = 5), and posterolateral corner involvement (n = 4). Bone marrow edema involved the mid-lateral femoral condyle and the posterior tibial plateau on both the medial and the lateral side. Edema at the Segond area was seen, but was limited. Fibular head edema was also seen. The ITB (11 out of 13) and ALL (10 out of 13) inserted on the Segond bone fragment. The anterior arm of the biceps tendon did not insert on the Segond fracture. Associated findings of Segond fracture include ACL tear, MCL tear, medial meniscus tear, and posterolateral corner injury. Both the ITB and the ALL may be involved in the Segond avulsion. The anterior arm of the biceps femoris tendon is not involved. (orig.)

  11. MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans

    Energy Technology Data Exchange (ETDEWEB)

    Partezani Helito, Camilo; Pecora, Jose Ricardo; Camanho, Gilberto Luis; Kawamura Demange, Marco [University of Sao Paulo, Faculty of Medicine, Institute of Orthopedics and Traumatology, Knee Surgery Division, Sao Paulo (Brazil); Partezani Helito, Paulo Victor; Pereira Costa, Hugo; Bordalo-Rodrigues, Marcelo [University of Sao Paulo, Faculty of Medicine, Institute of Orthopedics and Traumatology, Musculoskeletal Radiology Department, Sao Paulo (Brazil)

    2014-10-15

    This study evaluated the ability of routine 1.5-T MRI scans to visualize the anterolateral ligament (ALL) and describe its path and anatomic relations with lateral knee structures. Thirty-nine 1.5-T MRI scans of the knee were evaluated. The scans included an MRI knee protocol with T1-weighted sequences, T2-weighted sequences with fat saturation, and proton density (PD)-weighted fast spin-echo sequences. Two radiologists separately reviewed all MRI scans to evaluate interobserver reliability. The ALL was divided into three portions for analyses: femoral, meniscal, and tibial. The path of the ALL was evaluated with regard to known structural parameters previously studied in this region. At least a portion of the ALL was visualized in 38 (97.8 %) cases. The meniscal portion was most visualized (94.8 %), followed by the femoral (89.7 %) and the tibial (79.4 %) portions. The three portions of the ALL were visualized in 28 (71.7 %) patients. The ALL was characterized with greater clarity on the coronal plane and was visualized as a thin, linear structure. The T1-weighted sequences showed a statistically inferior ligament visibility frequency. With regard to the T2 and PD evaluations, although the visualization frequency in PD was higher for the three portions of the ligament, only the femoral portion showed significant values. The ALL can be visualized in routine 1.5-T MRI scans. Although some of the ligament could be depicted in nearly all of the scans (97.4 %), it could only be observed in its entirety in about 71.7 % of the tests. (orig.)

  12. Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de; Boulet, Cedric; Willekens, Inneke; Mey, Johan de; Shahabpour, Maryam [Universitair Ziekenhuis Brussel, Department of Radiology, Brussels (Belgium); Lenchik, Leon [Wake Forest University, Department of Radiology, Winston Salem, NC (United States); Cattrysse, Erik [Vrije Universiteit Brussel, Department of Experimental Anatomy, Brussels (Belgium)

    2014-12-04

    To evaluate the involvement of the iliotibial band (ITB), the anterolateral ligament (ALL), and the anterior arm of the biceps femoris in MRI-diagnosed Segond fracture and to evaluate other associated findings of Segond fracture. We retrospectively reviewed the MRI of 13 cases of Segond fracture. The studies included proton density-weighted, T2-weighted, and proton density-weighted with fat saturation images in the three planes. We studied 2 cadaveric specimens with emphasis on the ALL. One cadaveric specimen was dissected while the other was sectioned in the sagittal plane. The mean age of the patients was 36 years (range, 17-52). There were 7 men and 6 women. The mean size of the Segond bone fragment was 8 x 10 x 2 mm. The distance from the tibia varied from 2 to 6 mm. Associated findings included anterior cruciate ligament (ACL) tear (n = 13), medial collateral ligament (MCL) tear (n = 8), meniscocapsular tear of the posterior horn of the medial meniscus (n = 5), and posterolateral corner involvement (n = 4). Bone marrow edema involved the mid-lateral femoral condyle and the posterior tibial plateau on both the medial and the lateral side. Edema at the Segond area was seen, but was limited. Fibular head edema was also seen. The ITB (11 out of 13) and ALL (10 out of 13) inserted on the Segond bone fragment. The anterior arm of the biceps tendon did not insert on the Segond fracture. Associated findings of Segond fracture include ACL tear, MCL tear, medial meniscus tear, and posterolateral corner injury. Both the ITB and the ALL may be involved in the Segond avulsion. The anterior arm of the biceps femoris tendon is not involved. (orig.)

  13. A prospective randomized peri- and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach

    Directory of Open Access Journals (Sweden)

    Stefan Landgraeber

    2013-07-01

    Full Text Available There is still controversy as to whether minimally invasive total hip arthroplasty enhances the postoperative outcome. The aim of this study was to compare the outcome of patients who underwent total hip replacement through an anterolateral minimally invasive (MIS or a conventional lateral approach (CON. We performed a randomized, prospective study of 75 patients with primary hip arthritis, who underwent hip replacement through the MIS (n=36 or CON (n=39 approach. The Western Ontario\tand\tMcMaster\tUniversities Osteoarthritis Index and Harris Hip score (HHS were evaluated at frequent intervals during the early postoperative follow-up period and then after 3.5 years. Pain sensations were recorded. Serological and radiological analyses were performed. In the MIS group the patients had smaller skin incisions and there was a significantly lower rate of patients with a positive Trendelenburg sign after six weeks postoperatively. After six weeks the HHS was 6.85 points higher in the MIS group (P=0.045. But calculating the mean difference between the baseline and the six weeks HHS we evaluated no significant differences. Blood loss was greater and the duration of surgery was longer in the MIS group. The other parameters, especially after the twelfth week, did not differ significantly. Radiographs showed the inclination of the acetabular component to be significantly higher in the MIS group, but on average it was within the same permitted tolerance range as in the CON group. Both approaches are adequate for hip replacement. Given the data, there appears to be no significant long term advantage to the MIS approach, as described in this study.

  14. MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans

    International Nuclear Information System (INIS)

    This study evaluated the ability of routine 1.5-T MRI scans to visualize the anterolateral ligament (ALL) and describe its path and anatomic relations with lateral knee structures. Thirty-nine 1.5-T MRI scans of the knee were evaluated. The scans included an MRI knee protocol with T1-weighted sequences, T2-weighted sequences with fat saturation, and proton density (PD)-weighted fast spin-echo sequences. Two radiologists separately reviewed all MRI scans to evaluate interobserver reliability. The ALL was divided into three portions for analyses: femoral, meniscal, and tibial. The path of the ALL was evaluated with regard to known structural parameters previously studied in this region. At least a portion of the ALL was visualized in 38 (97.8 %) cases. The meniscal portion was most visualized (94.8 %), followed by the femoral (89.7 %) and the tibial (79.4 %) portions. The three portions of the ALL were visualized in 28 (71.7 %) patients. The ALL was characterized with greater clarity on the coronal plane and was visualized as a thin, linear structure. The T1-weighted sequences showed a statistically inferior ligament visibility frequency. With regard to the T2 and PD evaluations, although the visualization frequency in PD was higher for the three portions of the ligament, only the femoral portion showed significant values. The ALL can be visualized in routine 1.5-T MRI scans. Although some of the ligament could be depicted in nearly all of the scans (97.4 %), it could only be observed in its entirety in about 71.7 % of the tests. (orig.)

  15. Pedicle versus free flap reconstruction in patients receiving intraoperative brachytherapy.

    Science.gov (United States)

    Geiger, Erik J; Basques, Bryce A; Chang, Christopher C; Son, Yung; Sasaki, Clarence T; McGregor, Andrew; Ariyan, Stephan; Narayan, Deepak

    2016-08-01

    Introduction This study compared complication rates between pedicle flaps and free flaps used for resurfacing of intraoperative brachytherapy (IOBT) implants placed following head and neck tumour extirpation to help clarify the ideal reconstructive procedure for this scenario. Patients and methods A retrospective review of reconstructions with IOBT at our institution was conducted. Patient and treatment details were recorded, as were the number and type of flap complications, including re-operations. Logistic regressions compared complications between flap groups. Results Fifty free flaps and 55 pedicle flaps were included. On multivariate analysis, free flap reconstruction with IOBT was significantly associated with both an increased risk of having any flap complication (OR = 2.9, p = 0.037) and with need for operative revision (OR = 3.5, p = 0.048) compared to pedicle flap reconstruction. Conclusions In the setting of IOBT, free flaps are associated with an increased risk of having complications and requiring operative revisions. PMID:26983038

  16. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

    Directory of Open Access Journals (Sweden)

    Jainath

    2013-10-01

    Full Text Available A BS T R ACT : Soft tissue reconstruction of distal third leg, heel and ankle reg ion is a challenging problem because of poor vascularity and limited mobility of skin. The reverse sural artery with ideal flap thickness, minimal donor site morbidity, lack of functional muscle loss, short recovery time, wide arc of rotation and safe vasc ularity makes it a preferable flap for covering such defects. AIMS A N D OBJECTIVES : To study various modifications of distally based reverse sural artery flap to suit the defects and for better survival of flaps. RESULTS : It is a retrospective study conduct ed in our institute to cover the distal leg and foot defects.60 cases of distal leg defects exposing vital structure who underwent reverse sural artery flap coverage were included in the study .5 of the 60 flaps had complete flap necrosis and another11 fla ps had partial necrosis.73.4% of the flaps survived during the follow up period of 1 years with good functional outcome. CONCLUSIONS : Reverse sural artery flap with its modifications is a good flap for the defects of distal leg, heel and ankle defects

  17. Effect of flapping trajectories on the dragonfly aerodynamics

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The effects of translational, figure-eight and double-figure-eight flapping trajectories on the dragonfly aerodynamics were numerically studied by solving the Navier-Stokes equations. There is a common characteristic regarding the lift/drag force coefficients that the downstroke flapping provides the lift forces while the upstroke flapping creates the thrust forces for different flapping trajectories. The maximum lift force coefficient exceeds five for the translational trajectory. It is greater than six for the figure-eight and double-figure-eight flapping trajectories, which is sufficiently larger than unity under the steady state flight condition. The ellipse and double-figure-eight flapping trajectories yield the decrease of the lift force, while the figure-eight flapping trajectory yields higher lift force as well as the thrust force than the translational flapping one. During the insect flight, the wing flapping status should be changed instantaneously to satisfy various requirements. Study of the flapping trajectories on the insect aerodynamics is helpful for the design of the Micro-air-vehicles (MAVs).

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

    Science.gov (United States)

    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

  19. Temporal-based pericranial flaps for orbitofrontal Dural repair: A technical note and Review of the literature

    Directory of Open Access Journals (Sweden)

    Esther Dupépé

    2016-03-01

    Conclusions: A temporal-based pericranial flap represents an alternative vascularized pedicle flap to the classic frontal-based pericranial flap used in orbitofrontal dural repair. In certain clinical settings, the temporal-based flap may be preferable.

  20. Definição do limite anterolateral do lobo occipital em peças anatômicas e exames de imagem

    OpenAIRE

    Gusmão Sebastião; Reis Cassius; Tazinaffo Uedson; Mendonça Celso; Silveira Roberto Leal

    2002-01-01

    Com o objetivo de definir o limite anterolateral do lobo occipital foram estudados sete segmentos cefálicos de cadáveres humanos, 103 exames de tomografia computadorizada e 104 exames de ressonância magnética do encéfalo considerados normais. Foram encontradas uma prega da dura-máter sobre o seio transverso (plica tentorial pré-occipital) e uma protuberância óssea relacionadas diretamente com a incisura pré-occipital. Foi calculada, também, a distância média entre o sulco parieto-occipital e ...

  1. Treatment of lumbosacral decubitus ulcers by Lymberg flap

    International Nuclear Information System (INIS)

    The lymberg flap was used for the treatment of lumbosacral decubitus and irradiation-induced ulcer successfully in 6 lesion of 5 cases. The results were evaluated, and characteristics and indication of the method were discussed. The procedure of the method: A rhomboid flap with a side lenghth, equal to that of the lesion and with an angle of 600, was cut out, and transplanted to cover the lesion. The wound of a donor was sutured by extending the surrounding area. Of characteristics of this method, a flap can be produced in a desired shape; tension lies little on the flap; and a small area is needed for the flap. However, in recurrence, the first wound may cause circulation disturbance in a flap. Large wounds of donors sometimes cannont be closed. Therefore, a fresh case with relatively small lesions is an indication to this method. (Ueda, J.)

  2. Pumping by flapping in a viscoelastic fluid

    CERN Document Server

    Pak, On Shun

    2010-01-01

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

  3. Dynamics of Flapping Flag in Axial Flow

    Science.gov (United States)

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

    2010-11-01

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

  4. CATERPILLAR ADVANCEMENT FOR PARTIALLY NECROSED DELTOPECTORAL FLAP

    Directory of Open Access Journals (Sweden)

    Anand Narayan

    2015-04-01

    Full Text Available Development of electric lamp by Thomas Elva Edison had significant impact on human civilization. With increasing production of electrical energy to meet ongoing demands of increased frequency of electrical injuries. Despite increased awareness of potential dangers, elect ricity is responsible for many fatalities all over the world. Electrical burn accounts for ~3% of all burn related injuries. Estimated 3, 000 annual admittions to burn units. Electrical burn have bimodal distribution ~1/3 children <6 yrs ( E lectric cords & wall outlets ~2/3 miners, construction, & electrical workers. Our case is one that of a 12 year old male child having electrical injury over face and neck with exposed angle of mandible which was covered by Deltopectoral flap with caterpillar advancement of flap.

  5. Stability investigation of an airfoil section with active flap control

    OpenAIRE

    Bergami, Leonardo; Gaunaa, Mac

    2010-01-01

    This work presents a method to determine flutter and divergence instability limits for a two-dimensional (2-D) airfoil section fitted with an actively controlled trailing edge flap. This flap consists of a deformable trailing edge, which deformation is governed by control algorithms based on measurements of either heave displacement, local angle of attack or aerodynamic pressure difference measured over the airfoil. The purpose of the controlled deformable flap is to reduce fluctuations in th...

  6. USB noise reduction by nozzle and flap modifications

    Science.gov (United States)

    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.

  7. Fenestration of bone flap during decompressive craniotomy for subdural hematoma

    OpenAIRE

    Ha Son Nguyen; Ninh Doan; Christopher Wolfla; Glen Pollock

    2016-01-01

    Background: Persistent/recurrent extra-axial hemorrhage may occur after decompression of a subdural hematoma (SDH) followed by an immediate replacement of bone flap. A fenestration of the bone flap may encourage extra-axial fluid absorption; however, the literature has not explored this technique. Methods: Forty-four consecutive patients who underwent surgical decompression of SDH with immediate replacement of bone flap were divided into two groups: Fenestration (F), n = 33, and no fenest...

  8. Design of Insect-Scale Flapping Wing Vehicles

    OpenAIRE

    Ahmed Nabawy, Mostafa Ramadan

    2015-01-01

    This thesis contributes to the state of the art in integrated design of insect-scale piezoelectric actuated flapping wing vehicles through the development of novel theoretical models for flapping wing aerodynamics and piezoelectric actuator dynamics, and integration of these models into a closed form design process.A comprehensive literature review of available engineered designs of miniature rotary and flapping wing vehicles is provided. A novel taxonomy based on wing and actuator kinematics...

  9. Demography and conservation of an isolated Spur-thighed tortoise Testudo graeca population in Dobrogea (Romania

    Directory of Open Access Journals (Sweden)

    Gabriel Buică

    2013-06-01

    Full Text Available Spur-thighed tortoise is a vulnerable species. The local declines of populations led to an imperative need for conservation. Testudo graeca reaches its northern range limit in Dobrogea region, Romania. We studied a population from this region, which occupies an enclosed area of 32 ha within Histria Archaeological Complex. Based on a capture-mark-recapture study we estimated the population size of 221 ± 12.2 individuals. The observed density was 5.1 individuals/ha. The predicted population size suggests a relatively high density in relation to the area thus raising attention for a future conservation strategy. The population structure shows reduced sexual dimorphism and an unbiased sex ratio, implying a young population structure. We suggest correlating the future archaeological studies with conservation requirements of tortoises.

  10. Measurement of tibial torsion and thigh-foot angle using goniometry and computed tomography.

    Science.gov (United States)

    Stuberg, W; Temme, J; Kaplan, P; Clarke, A; Fuchs, R

    1991-11-01

    Three therapists measured tibiofibular torsion and thigh-foot angle (TFA) goniometrically in 17 normal subjects, aged three to 24 years. Tibiofibular torsion was also measured using computed tomography (CT). Differences between testers for the goniometric measures were analyzed using a nonparametric analysis of variance. Wilcoxon's rank sum test was used to determine differences between goniometric and CT measures for tibiofibular torsion. No significant difference for goniometric measures was found between testers for tibiofibular torsion or TFA. A significant difference averaging 5 degrees between goniometric and CT torsion measures was found between testers. Although a significant difference was found between the two measurement methods, the degree of difference may not represent a significant clinical difference, as a range at 5 degrees is commonly reported as the margin of error for goniometric measurements. PMID:1934735

  11. Papillary intralymphatic angioendothelioma of the thigh: A case report and review of the literature.

    Science.gov (United States)

    Ward, Katherine A; Ecker, Phillip M; White, Rebekah R; Melnik, Tanya E; Gulbahce, Evin H; Wilke, Mark S; Sangueza, Omar P

    2010-01-01

    The term angiosarcoma, encompasses several neoplasms, all of which exhibit a malignant process derived from endothelial cells of the vessels. The most common form of angiosarcoma is highly aggressive, often fatal, and usually affects the head and neck region of elderly white men. Other low-grade forms of angiosarcoma, including papillary intralymphatic angioendothelioma, also known as Dabska tumor, are less invasive, affect a wider age range, and offer a better prognosis. There are several predisposing factors that increase the risk of angiosarcoma and include chronic lymphedema of the extremities, preexisting vascular lesions, and prior radiation, often as therapy for other malignancies. We report an unusual case of a very small, low-grade angiosarcoma on the thigh of an adult female with no known predisposing risk factors. PMID:20409411

  12. The abdomen, thigh, and arm as sites for subcutaneous sodium heparin injections.

    Science.gov (United States)

    Fahs, P S; Kinney, M R

    1991-01-01

    The purpose of this study was to evaluate three subcutaneous injection sites for low-dose heparin therapy (5,000 units). One hundred and one subjects were randomly placed in one of three groups. Group A received injections in the abdomen, Group B, in the thigh, and Group C in the arm. Each subject received three injections at the one site. Activated partial thromboplastin time (APTT) was measured prior to initiation of heparin and again four hours after the first injection. Bruising was measured at 48, 60, and 72 hours postinjection. There were no statistically significant differences among groups for either changes in APTT or bruising at 60 and 72 hours postinjection. Thus the clinical practice of utilizing the abdomen as the only or preferred site for subcutaneous heparin injections was not supported. PMID:1857645

  13. Physical rehabilitation of patients with amputation stump of thigh because of trauma

    Directory of Open Access Journals (Sweden)

    Efremova O.V.

    2009-10-01

    Full Text Available The article is exposition essence of problem of renewal of ability to work of a problem of restoration after amputation at the hip. The analysis of the standard program of the standard in traumatology programs of physical rehabilitation of patients after amputation and presents the results of the developed physical rehabilitation of patients with amputating the thigh stumps due to injury. The authors propose to use the means of physical rehabilitation in accordance with the flow dynamics of the reparative processes after amputation and clinical features of injury. All this contributes to the development of compensatory own human capabilities, resulting in remission. Since these funds most physiological, their correct application does not cause complications.

  14. Intermuscular adipose tissue and thigh muscle area dynamics during an 18-month randomized weight loss trial.

    Science.gov (United States)

    Yaskolka Meir, Anat; Shelef, Ilan; Schwarzfuchs, Dan; Gepner, Yftach; Tene, Lilac; Zelicha, Hila; Tsaban, Gal; Bilitzky, Avital; Komy, Oded; Cohen, Noa; Bril, Nitzan; Rein, Michal; Serfaty, Dana; Kenigsbuch, Shira; Chassidim, Yoash; Zeller, Lior; Ceglarek, Uta; Stumvoll, Michael; Blüher, Matthias; Thiery, Joachim; Stampfer, Meir J; Rudich, Assaf; Shai, Iris

    2016-08-01

    It remains unclear whether intermuscular adipose tissue (IMAT) has any metabolic influence or whether it is merely a marker of abnormalities, as well as what are the effects of specific lifestyle strategies for weight loss on the dynamics of both IMAT and thigh muscle area (TMA). We followed the trajectory of IMAT and TMA during 18-mo lifestyle intervention among 278 sedentary participants with abdominal obesity, using magnetic resonance imaging. We measured the resting metabolic rate (RMR) by an indirect calorimeter. Among 273 eligible participants (47.8 ± 9.3 yr of age), the mean IMAT was 9.6 ± 4.6 cm(2) Baseline IMAT levels were directly correlated with waist circumference, abdominal subdepots, C-reactive protein, and leptin and inversely correlated with baseline TMA and creatinine (P < 0.05 for all). After 18 mo (86.3% adherence), both IMAT (-1.6%) and TMA (-3.3%) significantly decreased (P < 0.01 vs. baseline). The changes in both IMAT and TMA were similar across the lifestyle intervention groups and directly corresponded with moderate weight loss (P < 0.001). IMAT change did not remain independently associated with decreased abdominal subdepots or improved cardiometabolic parameters after adjustments for age, sex, and 18-mo weight loss. In similar models, 18-mo TMA loss remained associated with decreased RMR, decreased activity, and with increased fasting glucose levels and IMAT (P < 0.05 for all). Unlike other fat depots, IMAT may not represent a unique or specific adipose tissue, instead largely reflecting body weight change per se. Moderate weight loss induced a significant decrease in thigh muscle area, suggesting the importance of resistance training to accompany weight loss programs. PMID:27402560

  15. Locomotion of a flapping flexible plate

    Science.gov (United States)

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

    2013-12-01

    The locomotion of a flapping flexible plate in a viscous incompressible stationary fluid is numerically studied by an immersed boundary-lattice Boltzmann method for the fluid and a finite element method for the plate. When the leading-edge of the flexible plate is forced to heave sinusoidally, the entire plate starts to move freely as a result of the fluid-structure interaction. Mechanisms underlying the dynamics of the plate are elucidated. Three distinct states of the plate motion are identified and can be described as forward, backward, and irregular. Which state to occur depends mainly on the heaving amplitude and the bending rigidity of the plate. In the forward motion regime, analysis of the dynamic behaviors of the flapping flexible plate indicates that a suitable degree of flexibility can improve the propulsive performance. Moreover, there exist two kinds of vortex streets in the downstream of the plate which are normal and deflected wake. Further the forward motion is compared with the flapping-based locomotion of swimming and flying animals. The results obtained in the present study are found to be consistent with the relevant observations and measurements and can provide some physical insights into the understanding of the propulsive mechanisms of swimming and flying animals.

  16. Managing Flap Vortices via Separation Control

    Science.gov (United States)

    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.

  17. Acetylcysteine in random skin flap in rats

    Directory of Open Access Journals (Sweden)

    Abla Luiz Eduardo Felipe

    2005-01-01

    Full Text Available PURPOSE: Analyze the ability of Acetylcysteine to reduce distal necrosis in a random skin flap, in the rat. METHODS: The present study utilized 28 adult male Wistar-EPM rats distributed, at random, in two groups of 14 animals. Control group rats (CG received distilled water and Acetylcysteine group animals (NACG received NAC (300 mg/kg by oral infusion, 15 minutes before flap elevation. On the seventh postoperative day, percentage of distal necrosis was determined and skin samples collected in order to allow determination of MDA levels. RESULTS: The mean necrotic area in CG group (control was 66 % and in NACG group (Acetylcysteine 52 %, a statistically significant difference according to the Mann-Whitney test (U calc = 25; U crit = 45. MDA levels were lower in the CG flap skin samples than in the NACG samples (U calc = 24; U crit = 45, the oposite being true in the normal skin samples (U calc = 10; U crit = 45. CONCLUSION: Acetylcysteine was effective, according to the model used, reducing the percentage of distal necrosis in NACG rats.

  18. Pedicled and free TRAM flaps in breast reconstructions : a comparative study

    OpenAIRE

    Edsander-Nord, Åsa

    2000-01-01

    The transverse rectus abdominis musculocutaneous (TRAM) flap is frequently used when autologous tissue is desired for breast reconstruction, and it can be transferred pedicled or free. The pedicled TRAM flap is elevated as a lower transverse abdominal flap with the rectus abdominis muscle attached in the epigastric area, by which means the deep superior epigastric vessels nourish the flap. The flap is tunneled to its new position on the thoracic wall. The free TRAM flap c...

  19. Propeller Perforator Flaps in Distal Lower Leg:Evolution and Clinical Applications

    OpenAIRE

    Georgescu, Alexandru V.

    2012-01-01

    Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. T...

  20. Design, Fabrication and Testing Of Flapping Wing Micro Air Vehicle

    Directory of Open Access Journals (Sweden)

    K. P. Preethi Manohari Sai

    2016-01-01

    Full Text Available Flapping flight has the potential to revolutionize micro air vehicles (MAVs due to increased aerodynamic performance, improved maneuverability and hover capabilities. The purpose of this project is to design and fabrication of flapping wing micro air vehicle. The designed MAV will have a wing span of 40cm. The drive mechanism will be a gear mechanism to drive the flapping wing MAV, along with one actuator. Initially, a preliminary design of flapping wing MAV is drawn and necessary calculation for the lift calculation has been done. Later a CAD model is drawn in CATIA V5 software. Finally we tested by Flying.

  1. Thoracodorsal artery perforator flap for upper limb reconstruction

    International Nuclear Information System (INIS)

    Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. Results: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). Conclusion: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit. (author)

  2. Effects of primary rotor parameters on flapping dynamics

    Science.gov (United States)

    Chen, R. T. N.

    1980-01-01

    The effects of flapping dynamics of four main rotor design features that influence the agility, stability, and operational safety of helicopters are studied. The parameters include flapping hinge offset, flapping hinge restraint, pitch-flap coupling, and blade lock number. First, the flapping equations of motion are derived that explicitly contain the design parameters. The dynamic equations are then developed for the tip-path plane, and the influence of individual and combined variations in the design parameters determined. The steady state flapping response is examined with respect to control input and aircraft angular rate which leads to a feedforward control law for control decoupling through cross feed, and a feedback control law to decouple the steady state flapping response. The condition for achieving perfect decoupling of the flapping response due to aircraft pitch and roll rates without using feedback control is also found for the hover case. It is indicated that the frequency of the regressing flapping mode of the rotor system can become low enough to require consideration in the assessment of handling characteristics.

  3. Monocortical Deep Circumflex Iliac Artery Flap in Jaw Reconstruction.

    Science.gov (United States)

    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. PMID:26080179

  4. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

    Full Text Available Abstract Background Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects. Methods This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection. Results There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved. Conclusion The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.

  5. Oropharyngeal reconstruction with a pedicled submandibular gland flap.

    Science.gov (United States)

    Mashrah, Mubarak A; Zhou, Shang-Hui; Abdelrehem, Ahmed; Ma, Chunyue; Xu, Liqun; He, Yue; Zhang, Chen-Ping

    2016-05-01

    Locoregional flaps are widely used for reconstruction of small and medium defects in the oral cavity. The submandibular gland flap is a pedicled flap, which derives its blood supply from the facial artery, based on the submandibular gland. We describe the use of the flap in 20 patients who required oropharyngeal reconstruction with a pedicled submandibular gland flap after resection of a tumour between July 2012 and October 2014. Patients with squamous cell carcinoma were excluded. All flaps were pedicled on the facial vessels (inferiorly in 17 patients and superiorly in 3). The indications were: reconstruction of intraoral mucosal defects (n=13), filling the parapharyngeal dead space (n=6), and obliteration of the mastoid (n=1). All the flaps atrophied, but with no clinical effect. One patient developed partial loss of the flap, and one early leakage. There were no cases of xerostomia, and no signs of recurrence during the postoperative follow-up period of 3-26 months. The flap is useful, as it is simple and reliable for reconstruction of small to medium oropharyngeal defects in carefully selected cases, and gives good cosmetic and functional results. PMID:26388070

  6. Angiographic findings before and after transplantation of split myocutaneous flaps

    International Nuclear Information System (INIS)

    Prerequisite for successful split-skin flap transplants of myocutaneous flaps is the presence of adequate adjacent afferent and efferent vessels, thus making an arteriography of the receiving region mandatory during surgery preparation. In 20 or 29 patients in whom a split myocutaneous flap was transplanted to the lower leg, angiography revealed 22 pathological or other therapy-relevant findings. Besides the afferent vessels it is basically necessary to visualise the peripheral efferent pathways in order to prevent that vascular anastomosis to the split-skin flap obstructs the blood supply of the leg. (orig.)

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

    International Nuclear Information System (INIS)

    The discontinuous contour of a wing with conventional flaps diminishes the aerodynamic performance of an aircraft. A wing with a continuous contour does not experience extreme flow stream fluctuations during flight, and consequently has good aerodynamic characteristics. In this study, a morphing flap using shape memory alloy actuators is proposed, designed and fabricated, and its aerodynamic characteristics are investigated using aerodynamic analyses and wind tunnel tests. The ribs of the morphing flap are designed and fabricated with multiple elements joined together in a way that allows relative rotations of adjacent elements and forms a smooth contour of the morphing flap. The aerodynamic analyses of this multiple-element morphing-flap wing are performed using XFLR pro; its aerodynamic performance is compared with that of a mechanical-flap wing, and is measured through wind-tunnel tests. (papers)

  8. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot.

    Science.gov (United States)

    Kadam, Dinesh

    2016-06-01

    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects. PMID:26910652

  9. Glycyrrhetinic acid, the active principle of licorice, can reduce the thickness of subcutaneous thigh fat through topical application.

    Science.gov (United States)

    Armanini, Decio; Nacamulli, Davide; Francini-Pesenti, Francesco; Battagin, Giuliana; Ragazzi, Eugenio; Fiore, Cristina

    2005-07-01

    Cortisol is involved in the distribution and deposition of fat, and its action is regulated by the activity of 11beta-hydroxysteroid dehydrogenase. Glycyrrhetinic acid, the active principle of licorice root, blocks 11beta-hydroxysteroid dehydrogenase type 1, thus reducing the availability of cortisol at the level of adipocytes. We evaluated the effect of topical application of a cream containing glycyrrhetinic acid in the thickness of fat at the level of the thigh. Eighteen healthy women (age range 20-33 years) with normal BMI were randomly allocated to treatment, at the level of the dominant thigh, with a cream containing 2.5% glycyrrhetinic acid (n=9) or with a placebo cream containing the excipients alone (n=9). Before and after 1 month of treatment both the circumference and the thickness of the superficial fat layer of the thighs (by ultrasound analysis) were measured. The circumference and the thickness of the superficial fat layer were significantly reduced in comparison to the controlateral untreated thigh and to control subjects treated with the placebo cream. No changes were observed in blood pressure, plasma renin activity, plasma aldosterone or cortisol. The effect of glycyrrhetinic acid on the thickness of subcutaneous fat was likely related to a block of 11beta-hydroxysteroid dehydrogenase type 1 at the level of fat cells; therefore, glycyrrhetinic acid could be effectively used in the reduction of unwanted local fat accumulation. PMID:15894038

  10. Identification of Flap Motion Parameters for Vibration Reduction in Helicopter Rotors with Multiple Active Trailing Edge Flaps

    Directory of Open Access Journals (Sweden)

    Uğbreve;ur Dalli

    2011-01-01

    Full Text Available An active control method utilizing the multiple trailing edge flap configuration for rotorcraft vibration suppression and blade loads control is presented. A comprehensive model for rotor blade with active trailing edge flaps is used to calculate the vibration characteristics, natural frequencies and mode shapes of any complex composite helicopter rotor blade. A computer program is developed to calculate the system response, rotor blade root forces and moments under aerodynamic forcing conditions. Rotor blade system response is calculated using the proposed solution method and the developed program depending on any structural and aerodynamic properties of rotor blades, structural properties of trailing edge flaps and properties of trailing edge flap actuator inputs. Rotor blade loads are determined first on a nominal rotor blade without multiple active trailing edge flaps and then the effects of the active flap motions on the existing rotor blade loads are investigated. Multiple active trailing edge flaps are controlled by using open loop controllers to identify the effects of the actuator signal output properties such as frequency, amplitude and phase on the system response. Effects of using multiple trailing edge flaps on controlling rotor blade vibrations are investigated and some design criteria are determined for the design of trailing edge flap controller that will provide actuator signal outputs to minimize the rotor blade root loads. It is calculated that using the developed active trailing edge rotor blade model, helicopter rotor blade vibrations can be reduced up to 36% of the nominal rotor blade vibrations.

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-06-01

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

  13. Can the anterior-posterior thigh diameter be used as an indicator for fetal age using two-dimensional sonography?

    International Nuclear Information System (INIS)

    This study evaluated the usefulness and direct correlation of a simple new method of predicting fetal age by measurement of the anterior-posterior thigh diameter (APTD) in a normal 18 to 28 week pregnancies using two-dimensional sonography. Little published research exists in the area of fetal thigh biometry, specifically in the use of the anterior-posterior fetal thigh diameter (APTD). The only study I found was that of fetal thigh circumference. Continuing review of existing practices needs to be coupled with evaluation of alternate or additional methodology. Materials and methods: This was a quantitative prospective study of 55 patients in High Level General Hospital, Alberta, Canada. Anterior-posterior thigh diameters (APTD) were sonographically measured. The normal range for each week of pregnancy was determined five times for reliability. Results: Significant correlation was found between (APTD) and fetal age from simple line regression analysis, with 99.993% confidence intervals at each week from 18 to 28 weeks gestation. There was a correlation of 1 mm APTD per 1 week of fetal age. In addition R > 0.93, P < 0.001. The residual scatter plots confirmed the APTD validity. Conclusion: APTD is a reliable and valid method for assessing fetal age in a normal pregnancy and may be particularly useful when other parameters are unable to accurately predict fetal age. An accurate linear measurement of multiple fetal parameters allows a more complete profile of fetal growth and estimated date of delivery (EDD). APTD may also be useful in identifying fetal growth problems. All of the values of fetal age lie directly on the 'best-fit' regression line. Since the coefficient of determination (Rsq) is very high, this model is very effective

  14. Elbow Reconstruction Using Island Flap for Burn Patients

    Directory of Open Access Journals (Sweden)

    Gi Yeun Hur

    2012-11-01

    Full Text Available Background Deep burns of the elbow lead to soft tissue necrosis and infection, with exposureof deep structures. Adequate wound coverage of this area requires thin, pliable, and durabletissue, while optimal functional recovery requires early coverage and functional rehabilitation.We have found 3 types of island flaps that provide reliable coverage for the elbow.Methods A retrospective study was performed on all patients who underwent flap coverageof an elbow defect at our hospital. The patients’ data including age, sex, cause of injury, wounddimensions, timing of flap coverage, postoperative elbow motion, and complications wereinvestigated.Results Between 2001 and 2012, 16 patients were treated at our hospital. The mean agewas 53.3 years. Three kinds of flaps were performed: 9 latissimus dorsi flaps, 4 lateral armflaps, and 4 radial forearm flaps. The average defect size was 183.5 cm2 (range, 28 to 670cm2. Wound coverage was performed at mean duration of 45.9 days (range, 14 to 91 days.The mean postoperative active elbow flexion was 98° (range, 85° to 115°. Partial flap failureoccurred in 1 latissimus dorsi flap. Minor complications included partial flap loss (11.8%,hematoma (23.5%, seroma (35.3%, and wound infection (5.9%.Conclusions Flap selection for elbow reconstruction is determined by the defect size andthe extent of the adjacent tissue injury. Elbow reconstruction using an island flap is a singlestaged,reliable, and relatively simple procedure that permits initiation of early rehabilitation,thereby improving a patient’s functional outcome.

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

    Science.gov (United States)

    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

  16. Quantifying Blood Flow in the DIEP Flap: An Ultrasonographic Study

    Science.gov (United States)

    Pennington, David G.

    2014-01-01

    Background: The maximum weight of tissue that a single perforator can perfuse remains an important question in reconstructive microsurgery. An empirically based equation, known as the flap viability index (FVI), has been established to determine what weight of tissue will survive on one or more perforators. The equation is FVI = Sum d(n)^4/W, where d is the internal diameter of each perforator and W is the final weight of the flap. It has been shown that if FVI exceeds 10, total flap survival is likely, but if under 10, partial flap necrosis is probable. The aim of this study was to measure absolute flow rates in deep inferior epigastric perforator (DIEP) flap pedicles and assess correlation with the determinants of the FVI, perforator diameter and flap weight. Methods: Color Doppler ultrasound was used to quantify arterial flow in 10 consecutive DIEP flap pedicles 24 hours after anastomosis. Results: In single-perforator DIEP flaps, flow rate was highly correlated with perforator diameter (r = 0.82, P = 0.01). Mean arterial flow rate was significantly reduced in DIEP flaps with 2 or more perforators (6 vs 38 cm3/min; P perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival. PMID:25426345

  17. The application of island myocutaneous flap for challenging wounds on cervico-thoracic region

    Institute of Scientific and Technical Information of China (English)

    XING Xin; XUE Chun-yu; LI Li; HUAN Jing-ning; GUO En-tan

    2006-01-01

    Objective:To introduce the experiences in the application of island myocutaneous flap for challenging wound on cervico-thoracic region. Methods: Different myocutaneous flaps were selected according to the location, peculiarity and etiological factor of wound. There were 28 cases of island pectoralis major island myocutanuous flaps, 34 cases of latissimus dorsi island myocutaneous flaps, 19 cases of trapizius island myocutaneous flaps and 17 cases of rectus abdominis island myocutaneous flaps in this report. Results: All 98 patients with challenging wound on cervico-thoracic region were successfully treated with this method without complications, and obtained functional and cosmetic effectiveness. Conclusion:Challenging wounds in cervico-nuchal region can be repaired with pertoralis major island myocutaneous flap, latissimus dorsi island myocutaneous flap and trapizius island myocutaneous flap, while challenging wounds in thoracic region can be repaired with latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. Satisfactory functional and cosmetic results can be obtained.

  18. [Free rectus abdominis muscle perforating artery flaps for reconstruction of the head and neck defects].

    Science.gov (United States)

    Koshima, I; Handa, T; Satoh, Y; Akisada, K; Orita, Y; Yamamoto, H

    1995-01-01

    During the past eight years, tissue defects of the head and neck region in a total of 45 patients were repaired with free rectus abdominis muscle perforating artery flaps. These flaps are subclassified into (1) reduced musculocutaneous flaps, (2) thin reduced musculocutaneous flaps, (3) paraumbilical perforator-based flaps, and (4) thin paraumbilical perforator-based flaps. The advantages of these flaps are as follows. Since the flaps involve no or only a small portion of the rectus abdominis muscle, (1) the muscle can be left intact on the abdominal wall, and (2) a thin flap can be easily created by simple defatting of the flap. These flaps overcome the major disadvantages of the conventional rectus abdominis musculocutaneous flap, i.e., bulkiness of the flap and frequent postoperative abdominal herniation. The territory of the thin flaps is within 10 cm around the perforator. These flaps are suitable for defects in the head and neck region, because simultaneous flap elevation is possible at the time of tumor resection. Paraumbilical perforator-based flaps are suitable for young females and elderly patients. PMID:7897566

  19. Response of rat skin flaps to sinusoidal electromagnetic fields

    International Nuclear Information System (INIS)

    Electrical stimulation to heal bone fractures has been used clinically since the early 1970s. As a result of treatment with either direct current or electromagnetic fields, there was an indication that the electrical signals enhanced the ingrowth of blood vessels into the treated area. This possibility was one of the reasons for the initial studies on the influence of pulsed electromagnetic fields (PEMFs) on healing of skin flaps. These investigations reported a decrease in the amount of necrosis of a skin flap after PEMF treatment. The skin flap model was chosen in these studies, as it is generally accepted for the investigation of the influence of different treatments on wound healing. The skin flap is a partially detached portion of the skin which retains part of its blood supply. However, if the flap is too long for its width, part of it will die after the transfer. Flap necrosis, therefore, represents a difficult clinical problem, especially in classes where a large area has to be covered. In the present study the authors address whether enhanced skin flap survival after treatment with PEMF is signal specific, that is , whether one could obtain similar results using various sinusoidal electromagnetic fields (SEMFs). Specifically, they investigated the influence on skin flap survival of SEMFs with different frequencies but the same maximum of dB/dt

  20. Clinical study of dorsal ulnar artery flap in hand reconstruction

    Directory of Open Access Journals (Sweden)

    Khan Manal

    2009-01-01

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

  1. Pectoralis myocutaneous flap for salvage of necrotic wounds

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. Dorsalis pedis arterialized venous flap for hand and foot reconstruction

    Institute of Scientific and Technical Information of China (English)

    YU Guang; LEI Hong-yu; GUO Shuang; HUANG Jian-hua; YU Hao

    2012-01-01

    Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction.

  3. Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

    International Nuclear Information System (INIS)

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

  4. Pectoralis myocutaneous flap for salvage of necrotic wounds

    International Nuclear Information System (INIS)

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

  5. Fenestration of bone flap during interval autologous cranioplasty

    Directory of Open Access Journals (Sweden)

    Ha Son Nguyen

    2015-01-01

    Conclusion: Presumably, fenestrations augment surface area for extra-axial fluid absorption through the bone flap. Our results, regarding MLS and postoperative volume, provide support for this concept. Accordingly, bone flap fenestration has the potential to reduce extra-axial fluid accumulation.

  6. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Directory of Open Access Journals (Sweden)

    Korambayil Pradeoth

    2010-01-01

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

  7. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Science.gov (United States)

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

    2010-01-01

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

  8. Cross-leg flap: Its role in limb salvage

    Directory of Open Access Journals (Sweden)

    Agarwal Pawan

    2008-01-01

    Full Text Available Background: Pedicled cross-extremity flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. However, there are certain difficult situations where the free flap cannot be employed and alternative methods are needed. We describe our experience with cross-leg flap in 18 patients for the reconstruction of difficult leg defects in which no suitable recipient vessels were available for microvascular anastomosis in the vicinity of the defect. Materials and Methods: 18 patients (17 men and 1 woman with mean range 31.5 yrs(range 18-70 yrs grade III B tibial fractures were included in the study. fasciocuteneous cross leg flap was employed and extremities were immobilized by external Fixator. Results: Fifteen flaps were completely available with two had marginal necrosis and one supsficial epidermal necrosis.No complications were related to the donor site, flap, or by immobilization are noted. Each patient resumed essentially normal gait and activity without any stiffness of joints related with the flap or external fixator. Conclusion: The addition of external fixator stabilization aids greatly in wound care, as well as for general ease of the patient mobility and positioning. Cross-leg flap offers the possibility of salvaging limbs that are otherwise nonreconstructable.

  9. Works on theory of flapping wing. [considering boundary layer

    Science.gov (United States)

    Golubev, V. V.

    1980-01-01

    It is shown mathematically that taking account of the boundary layer is the only way to develop a theory of flapping wings without violating the basic observations and mathematics of hydromechanics. A theory of thrust generation by flapping wings can be developed if the conventional downstream velocity discontinuity surface is replaced with the observed Karman type vortex streets behind a flapping wing. Experiments show that the direction of such vortices is the reverse of that of conventional Karman streets. The streets form by breakdown of the boundary layer. Detailed analysis of the movements of certain birds and insects during flight 'in place' is fully consistent with this theory of the lift, thrust and drag of flapping wings. Further directions for research into flight with flapping wings are indicated.

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

    Science.gov (United States)

    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. PMID:24971367

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

    Directory of Open Access Journals (Sweden)

    Salvatore D'Arpa

    2014-01-01

    Full Text Available 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

    Science.gov (United States)

    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

    Energy Technology Data Exchange (ETDEWEB)

    Hubel, Tatjana Y.; Tropea, Cameron [Technische Universitaet Darmstadt, Fachgebiet Stroemungslehre und Aerodynamik, Darmstadt (Germany)

    2009-05-15

    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. (orig.)

  14. Tensor fascia lata flap versus tensor fascia lata perforator-based island flap for the coverage of extensive trochanteric pressure sores.

    Science.gov (United States)

    Kim, Youn Hwan; Kim, Sang Wha; Kim, Jeong Tae; Kim, Chang Yeon

    2013-06-01

    Tensor fascia lata (TFL) musculocutaneous flaps often require a donor site graft when harvesting a large flap. However, a major drawback is that it also sacrifices the muscle. To overcome this disadvantage, we designed a TFL perforator-based island flap that was harvested from a site near the defect and involved transposition within 90 degrees without full isolation of the pedicles. We performed procedures on 17 musculocutaneous flaps and 23 perforator-based island flaps, and compared the outcomes of these surgeries. The overall complication rate was 27.5% (11 regions). There were 7 complications related to the musculocutaneous flaps and 4 complications related to the perforator flaps. Although there were no statistical differences between those groups, lower complication rates were associated with procedures involving perforator flaps. The TFL perforator procedure is a simple and fast operation that avoids sacrificing muscle. This decreases complication rates compared to true perforator flap techniques that require dissection around the perforator or pedicle. PMID:23392259

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

    Science.gov (United States)

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

    2014-01-01

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

  16. Application of skin flaps transplantation in burn surgery in China%皮瓣移植在我国烧伤外科中的应用

    Institute of Scientific and Technical Information of China (English)

    黄晓元

    2008-01-01

    The history and application of surgical flap transplantation in burn wound were briefly reviewed. We outlined skin flap, muscuiocutaneous flap, fascia flap and neurocutaneous vascular flap in this paper and recommended repair deep wounds with flap. All in all, in this review, we hope to provide a meaningful option for clinical application of surgical flap in the future.

  17. [Mirror therapy for the treatment of phantom limb pain after bilateral thigh amputation. A case report].

    Science.gov (United States)

    Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C

    2014-12-01

    This case study is the first to report successful treatment of bilateral phantom limb pain (PLP) in a patient with bilateral thigh amputation and inefficacious medical treatment using a protocol of graded interventions including mirror therapy (MT). MT is a common treatment for PLP but requires the induction of a visual illusion of an intact limb in the mirror, usually achieved by mirroring the healthy extremity. Here, we illustrate how application of a unilateral prosthesis sufficed to induce the necessary illusion. After sequential imagery, then lateralization training, which alleviated pain attacks, the patient received a further 3-week treatment of mirror treatment. Pain intensity was reduced by more than 85 %; the number of attacks were decreased by more than 90% per day. The analgesic efficacy lasted until the unexpected death of the patient several months later. This case illustrates the mechanisms of MT through overcoming the sensory incongruences underlying the distorted body schema and its efficacy in patients with bilateral amputation. PMID:25392090

  18. Washout studies of 11C in rabbit thigh muscle implanted by secondary beams of HIMAC

    International Nuclear Information System (INIS)

    Heavy ion therapy has two definite advantages: good dose localization and higher biological effect. Range calculation of the heavy ions is an important factor in treatment planning. X-ray CT numbers are used to estimate the heavy ion range by looking up values in a conversion table which relates empirically photon attenuation in tissues to particle stopping power; this is one source of uncertainty in the treatment planning. Use of positron emitting radioactive beams along with a positron emission tomograph or a positron camera gives range information and may be used as a means of checking in heavy ion treatment planning. However, the metabolism of the implanted positron emitters in a living object is unpredictable because the chemical forms of these emitters are unknown and the metabolism is dependent on the organ species and may be influenced by many factors such as blood flow rate and fluid components present. In this paper, the washout rate of 11C activity implanted by injecting energetic 11C beams into thigh muscle of a rear leg of a rabbit is presented. The washout was found to consist of two components, the shorter one was about 4.2 ± 1.1 min and the longer one ranged from 91 to 124 min. About one third of the implanted β+ activity can be used for imaging and the rest was washed out of the target area

  19. Hygienic quality control of chicken (thighs) by means of ionizing radiations

    International Nuclear Information System (INIS)

    High quality chicken thighs, packed in polystyrene trays covered with PVC films, were treated with ionizing energy provided by a semiindustrial 60Co facility, with a dose of 2.5 kGy, at the temperature of melting ice. Control and irradiated samples were stored at 2 deg C ± 2 deg C and RH: 89 % ± 6 %. Microbiological, chemical and sensory evaluations were performed. This treatment improved significantly the hygienic quality of the product, and reduced in two log cycles the initial number of aerobic bacteria, which led to a 2.5 times extension of the commercialization period. A diminished water content was observed after irradiation. Decreasing values were also found in every sample as storage time went by; the irradiated sample, on day 23, had values 9 % lower than that of the control sample on day 2. Rancidity, measured as peroxide number, increased their values after irradiation, but in such extent that was not noticed organoleptically. It was never higher than 10 meg/kg of fat (specification of the Argentine Alimentary Codex for oils). The commercial quality of the irradiated samples was acceptable until day 22. (Author)

  20. Hyalomma aegyptium on Spur-thighed Tortoise (Testudo graeca in Urmia Region West Azerbaijan, Iran

    Directory of Open Access Journals (Sweden)

    M Tavassoli

    2007-05-01

    Full Text Available Background: Ticks are obligate blood feeders that parasitize a wide variety of animals. Hyalomma aegyptium, parasitize tortoises and other small wild life and livestock. This study was carried out to determine spur-thighed tortoise (Testudo graeca infestation to H. ageyptium in Urmia region West Azerbaijan of Iran. Methods: The study was carried out over a 16 month period from the spring of 2004 to the fall of 2005. A total of 32 tor¬toises were sampled. Results: The results indicated that 14 tortoises infected with ticks. A total of 117 ticks were collected from infested animals, the minimum and maximum tick infestation was 1-60. Ticks were attached to the axilla of fore and hind legs of tortoises. All ticks were determined to be H. aegyptium. Conclusion: H. aegyptium was the most common tick species in the study area. Due to tendency of some people to keeping tortoise as pet animal, more attention must be done to tortoise’s tick infestation. Due to existence of H. aegyptium on tor¬toises in this region more study will need to evaluate presence of this tick on other animal species and its role on transmis¬sion of diseases.

  1. Salmonella infection in illegally imported spur-thighed tortoises (Testudo graeca).

    Science.gov (United States)

    Percipalle, M; Giardina, G; Lipari, L; Piraino, C; Macrì, D; Ferrantelli, V

    2011-06-01

    The prevalence of Salmonella infection was determined in a group of spur-thighed tortoises (Testudo graeca) seized during two smuggling attempts and in a population of captive Hermann's tortoises (Testudo hermanni) sheltered in a wildlife rescue centre. Salmonella spp. was isolated in 81 of 220 (36.8%) and in 17 of 67 (25.4%) cloacal swabs collected from the T. graeca and T. hermanni tortoises respectively. Overall, a total of 21 different Salmonella serotypes were found. Some of these serotypes are common to terrestrial chelonians while others have never been reported. All cultured serotypes were non-typhoidal but nonetheless many of these have been previously reported as source of human outbreaks of reptile-related salmonellosis. Eighty-two per cent and 5.3% of the isolates were resistant to two and three anti-microbial agents respectively. However, the isolates were highly susceptible to the anti-microbials of choice for the treatment of salmonellosis such as cephalosporins and fluoroquinolones. Our findings confirm that tortoises can be considered a reservoir for Salmonella and that care should be employed when handling and breeding these animals. Tight surveillance should be enforced to avoid illegal importation and prevent the trading of live tortoises, carriers of zoonotic pathogens. PMID:20626717

  2. Wound coverage considerations for defects of the lower third of the leg

    Directory of Open Access Journals (Sweden)

    Babu Bajantri

    2012-01-01

    Full Text Available Anatomical features of the lower third of the leg like subcutaneous bone surrounded by tendons with no muscles, vessels in isolated compartments with little intercommunication between them make the coverage of the wounds in the region a challenging problem. Free flaps continue to be the gold standard for the coverage of lower third leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations by choosing distant recipient vessels. Reverse flow flaps are more useful for the coverage of the ankle and foot defects than lower third leg defects. The perforators in the lower third leg on which these flaps are based are often damaged during the injury. In medium-sized defects of less than 50 cm 2 size, local transposition flaps, perforator flaps, or propeller flaps can be used. Preoperative identification by the Doppler is essential before embarking on these flaps. Of the muscle flaps, the peroneus brevis flap can be used in selected cases with small defects. In spite of all recent developments, cross-leg flaps continue to remain as a useful technique. In rare occasions when other flaps are not possible or when other options fail it can be a life boat. In the author′s practice free flaps continue to be the first choice for coverage of wounds in the lower third leg with gracilis muscle flap for small and medium defects, latissimus dorsi muscle flap for large defects and anterolateral thigh flap when a skin flap is preferred.

  3. Wound coverage considerations for defects of the lower third of the leg.

    Science.gov (United States)

    Bajantri, Babu; Bharathi, R Ravindra; Sabapathy, S Raja

    2012-05-01

    Anatomical features of the lower third of the leg like subcutaneous bone surrounded by tendons with no muscles, vessels in isolated compartments with little intercommunication between them make the coverage of the wounds in the region a challenging problem. Free flaps continue to be the gold standard for the coverage of lower third leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations by choosing distant recipient vessels. Reverse flow flaps are more useful for the coverage of the ankle and foot defects than lower third leg defects. The perforators in the lower third leg on which these flaps are based are often damaged during the injury. In medium-sized defects of less than 50 cm(2) size, local transposition flaps, perforator flaps, or propeller flaps can be used. Preoperative identification by the Doppler is essential before embarking on these flaps. Of the muscle flaps, the peroneus brevis flap can be used in selected cases with small defects. In spite of all recent developments, cross-leg flaps continue to remain as a useful technique. In rare occasions when other flaps are not possible or when other options fail it can be a life boat. In the author's practice free flaps continue to be the first choice for coverage of wounds in the lower third leg with gracilis muscle flap for small and medium defects, latissimus dorsi muscle flap for large defects and anterolateral thigh flap when a skin flap is preferred. PMID:23162228

  4. Expanded retroauricular skin and fascial flap in congenital microtia reconstruction.

    Science.gov (United States)

    Zhang, Qingguo; Quan, Yuzhu; Su, Yuanda; Shi, Lei; Xie, Yangchun; Liu, Xinhai

    2010-04-01

    The aim of this article is to report the application of expanding retroauricular skin fascia flap, and autogenous costal cartilage for congenital microtia reconstruction. Microtia reconstruction was generally completed in 3 surgical stages. In the first surgical stage, a 50 or 80 mL kidney-shaped tissue expander was inserted subcutaneously in the retroauricular mastoid region. Inflation of saline volume increased up to 60 to 80 mL, and skin flap was expanded for 2 to 3 months postoperatively. In the second surgical stage, removal of tissue expander, formation of retroauricular skin flap, elevation of retroauricular fascia flap, and pedicles of both flaps in remnant ear side were performed. Costal cartilage was harvested from ipsilateral side chest to the ear for reconstruction. The 3D ear framework was sculpted with stabilization of structure, contour and erection. Simultaneously, intermediate full thickness skin graft of 4 x 8 cm was obtained from previous incision site from where costal cartilage was harvested. Cartilage ear framework was anchored between skin flap and fascia flap, and fixed it symmetrically to the opposite normal ear, inferior portion of the ear framework was wrapped by remnant ear lobule, expanded skin flap covered the anterior portion of the framework, fascial flap was draped to the posterior side of framework and helical rim, then fascial flap was surfaced by intermediate full thickness skin graft. Suction drain was inserted and coated between skin flap and framework, drain was removed fifth postoperative day. Tragus construction and conchal excavation with skin graft was performed in the third stage of microtia reconstruction. Between October 2000 and October 2007, 426 cases were diagnosed as unilateral microtia patients and 22 cases were bilateral microtia patients. Therefore, 448 microtia ears were treated with tissue expander and autogenous costal cartilage. In 262 cases, structure of the helix, tragus, conchal excavation

  5. Activity of imipenem against VIM-1 metallo-beta-lactamase-producing Klebsiella pneumoniae in the murine thigh infection model.

    Science.gov (United States)

    Daikos, G L; Panagiotakopoulou, A; Tzelepi, E; Loli, A; Tzouvelekis, L S; Miriagou, V

    2007-02-01

    The in-vivo activity of imipenem against VIM-1-producing Klebsiella pneumoniae (VPKP) was assessed in a thigh infection model in neutropenic mice. Animals were infected with three VPKP isolates (imipenem MICs 2, 4 and 32 mg/L, respectively) and a susceptible clinical isolate (MIC 0.125 mg/L) that did not produce any beta-lactamase with broad-spectrum activity. Bacterial density at the site of infection was determined after imipenem treatment (30 and 60 mg/kg every 2 h for 24 h). The log(10) reduction in CFU/thigh was greatest for the wild-type isolate, intermediate for the two imipenem-susceptible VPKP isolates, and lowest for the imipenem-resistant VPKP isolate. Whilst in-vivo imipenem activity appeared reduced against in-vitro susceptible VIM-1 producers compared with a VIM-1-negative control, an increased drug dosage could moderate this reduction. PMID:17328735

  6. The physicochemical properties and antioxidative potential of raw thigh meat from broilers fed a dietary medicinal herb extract mixture.

    Science.gov (United States)

    Shirzadegan, K; Falahpour, P

    2014-01-01

    A 6-wk feeding study was conducted to evaluate the antioxidative potential, indices such as quality of the thigh meat and liver of broiler chickens fed with a dietary medicinal herb extract mixture (HEM, consisting: Iranian green tea, cinnamon, garlic and chicory at a ratio of 25:15:45:15). A total of 320, one-d-old Ross (male) broiler chickens were used to investigate the effects of 0.0, 2.5, 5.0 and 7.5 g/kg HEM in the diet, on aforementioned factors. The HEM supplementation did not influence the composition of raw thigh meat except for the total phenols and crude ash (Ptaste of broilers in maximum levels. PMID:26623342

  7. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Husted, Henrik;

    2011-01-01

    OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective......, descriptive, hypothesis-generating study. SETTING: A special unit for fast-track hip and knee arthroplasty operations at a university hospital. PARTICIPANTS: Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. METHODS: All patients were evaluated before surgery...... and on the day of hospital discharge. MAIN OUTCOME MEASURES: Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). RESULTS: All investigated variables changed significantly from before to after...

  8. Uncertainty Analysis for a Jet Flap Airfoil

    Science.gov (United States)

    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.

  9. Flapping propulsion with tip pitch control

    Science.gov (United States)

    Huera-Huarte, Francisco; Gharib, Morteza

    2014-11-01

    The effect of flexibility in the propulsion performance and efficiency of oscillating pitching foils has received a large amount of attention in the past years. Scientists have used simplified robotic models that mimic the kinematics of flying and swimming animals, in order to get inspiration to build more efficient engineering systems. Compliance is one of the aspects that has received more attention, as it seems to be a common feature in nature's flyers and swimmers. Active or passive control elements are also common in nature. We will show how thrust generation in a pitching fin, can be greatly affected by controlling the tip pitch motion dynamically and independently of the fin itself. This is in fact a controlled local change of curvature of the end of the fin. A robotic system has been designed in a way that not only flapping amplitudes and frequencies can be controlled, but also the amplitudes and frequencies of the tip and the phase difference between the tip and the fin. We measured thrust forces and the vortex dynamics in the near wake of the system, by using planar DPIV (Digital Particle Image Velocimetry) in a wide variety of flapping situations with tip control. Funding from Spanish Ministry of Science through Grant DPI2012-37904 is gratefully acknowledged.

  10. Evaluation of the relation between triceps surae H-reflex, M-response latencies and thigh length in normal population

    Directory of Open Access Journals (Sweden)

    Saeid Khosrawi

    2013-01-01

    Full Text Available Background: The H-reflex is a useful electrophysiological procedure for evaluating the status of the peripheral nervous system, especially at the proximal segment of the peripheral nerve. The purpose of this study is to investigate the relation between triceps surae H-reflex and M- response latencies and thigh length in normal population, in order to determine if there is any regression equation between them. Materials and Methods: After screening 75 volunteers by considering inclusion and exclusion criteria, 72 of them were selected to enroll into our study (34 men and 38 women with the mean age of 36.04 ± 7.7 years. In all of the subjects H-reflex and M-response latencies were recorded by standard electrophysiological techniques and thigh length was measured. Finally, our data was analyzed for its relations with respect to ages in both sexes by appropriate statistical and mathematical methods. Results: Mean ± SD for H-reflex latency was 27.94 ± 1.6 ms. We found a significant correlation between H-reflex latency and M-latency (r = 0.28, no significant correlation was found between H-reflex latency and thigh length (r = -0.051. Finally based on our findings we introduce a new formula in this paper.Conclusion: We found a significant correlation among of M-response latency and other variables (H-reflex latency and thigh length. Despite this it was eliminated from our formula. The relationship between H-reflex latency and age was significant. Further studies are required to delineate the clinical usage and interpretation of the formula, which we found in this study.

  11. Elucidation of the Pharmacokinetic/Pharmacodynamic Determinant of Colistin Activity against Pseudomonas aeruginosa in Murine Thigh and Lung Infection Models▿

    OpenAIRE

    Dudhani, Rajesh V.; Turnidge, John D.; Coulthard, Kingsley; Milne, Robert W.; Rayner, Craig R.; Li, Jian; Nation, Roger L.

    2009-01-01

    Colistin is increasingly used as last-line therapy against Gram-negative pathogens. The pharmacokinetic (PK)/pharmacodynamic (PD) index that best correlates with the efficacy of colistin remains undefined. The activity of colistin against three strains of Pseudomonas aeruginosa was studied in neutropenic mouse thigh and lung infection models. The PKs of unbound colistin were determined from single-dose PK studies together with extensive plasma protein binding analyses. Dose-fractionation stud...

  12. In Vivo Pharmacokinetics and Pharmacodynamics of the Lantibiotic NAI-107 in a Neutropenic Murine Thigh Infection Model

    OpenAIRE

    Lepak, Alexander J.; Marchillo, Karen; Craig, William A.; Andes, David R.

    2014-01-01

    NAI-107 is a novel lantibiotic compound with potent in vitro activity against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this study was to examine the activity of NAI-107 against S. aureus strains, including MRSA, in the neutropenic murine thigh infection model. Serum pharmacokinetics were determined and time-kill studies were performed following administration of single subcutaneous doses of 5, 20, and 80 mg/kg body weight. The dose f...

  13. Elucidation of the pharmacokinetic/pharmacodynamic determinant of colistin activity against Pseudomonas aeruginosa in murine thigh and lung infection models.

    Science.gov (United States)

    Dudhani, Rajesh V; Turnidge, John D; Coulthard, Kingsley; Milne, Robert W; Rayner, Craig R; Li, Jian; Nation, Roger L

    2010-03-01

    Colistin is increasingly used as last-line therapy against Gram-negative pathogens. The pharmacokinetic (PK)/pharmacodynamic (PD) index that best correlates with the efficacy of colistin remains undefined. The activity of colistin against three strains of Pseudomonas aeruginosa was studied in neutropenic mouse thigh and lung infection models. The PKs of unbound colistin were determined from single-dose PK studies together with extensive plasma protein binding analyses. Dose-fractionation studies were conducted over 24 h with a dose range of 5 to 160 mg/kg of body weight/day. The bacterial burden in the thigh or lung was measured at 24 h after the initiation of treatment. Relationships between antibacterial effect and measures of exposure to unbound (f) colistin (area under the concentration-time curve [fAUC/MIC], maximum concentration of drug in plasma [fC(max)]/MIC, and the time that the concentration in plasma is greater than the MIC [fT > MIC]) were examined by using an inhibitory sigmoid maximum-effect model. Nonlinearity in the PKs of colistin, including its plasma protein binding, was observed. The PK/PD index that correlated best with its efficacy was fAUC/MIC in both the thigh infection model (R(2) = 87%) and the lung infection model (R(2) = 89%). The fAUC/MIC targets required to achieve 1-log and 2-log kill against the three strains were 15.6 to 22.8 and 27.6 to 36.1, respectively, in the thigh infection model, while the corresponding values were 12.2 to 16.7 and 36.9 to 45.9 in the lung infection model. The findings of this in vivo study indicate the importance of achieving adequate time-averaged exposure to colistin. The results will facilitate efforts to define the more rational design of dosage regimens for humans. PMID:20028824

  14. Primary ilio-psoas abscess extending to the thigh in a neonate: US, CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Prassopoulos, P.K. [Department of Radiology, University Hospital of Heraklion, Crete (Greece)]|[University of Crete, Faculty of Medicine, Department of Radiology, GR-71 110 Stavrakia, Heraklion, Crete (Greece); Giannakopoulou, C.A. [Neonatal Unit, University Hospital of Heraklion, Crete (Greece); Apostolaki, E.G.; Charoulakis, N.Z.; Gourtsoyiannis, N.C. [Department of Radiology, University Hospital of Heraklion, Crete (Greece)

    1998-08-01

    Psoas abscess in children, and especially in neonates, is an uncommon condition which is difficult to diagnose clinically. The US, CT and MR findings of a psoas abscess in a neonate, which extended to the thigh, are reported. Imaging was helpful in revealing the abnormality, in demonstrating its extension and in determining its nature. The child was treated conservatively and the abscess resolved, leaving atrophy of the psoas muscle. (orig.) With 3 figs., 11 refs.

  15. Primary ilio-psoas abscess extending to the thigh in a neonate: US, CT and MR findings

    International Nuclear Information System (INIS)

    Psoas abscess in children, and especially in neonates, is an uncommon condition which is difficult to diagnose clinically. The US, CT and MR findings of a psoas abscess in a neonate, which extended to the thigh, are reported. Imaging was helpful in revealing the abnormality, in demonstrating its extension and in determining its nature. The child was treated conservatively and the abscess resolved, leaving atrophy of the psoas muscle. (orig.)

  16. The effect of modified atmosphere packaging (MAP) on the shelf- life of refrigerated, cubed turkey thigh meat

    OpenAIRE

    Ahn, Insook

    1991-01-01

    This research was designed to investigate the effect of Modified Atmosphere Packaging (MAP) on the shelf life of refrigerated, cubed, turkey thigh meat. Modified atmospheres of 25% carbon dioxide and 75% nitrogen and 20% carbon dioxide, 60% oxygen, and 20% nitrogen were used for MAP1 and MAP2 respectively. All sample packages, MAPl, MAP 2 , and Air Control, were stored at O.5°C. Headspace gas analysis, color measurement, sensory evaluation, aerobic plate count, and ox...

  17. Differentiation of Deboned Fresh Chicken Thigh Meat from the Frozen-Thawed One Processed with Different Deboning Conditions

    OpenAIRE

    Bae, Young Sik; Lee, Jae Cheong; Jung, Samooel; Kim, Hyun-Joo; Jeon, Seung Yeop; Park, Do Hee; Lee, Soo-Kee; Jo, Cheorun

    2014-01-01

    This study was performed to evaluate the quality characteristics of three deboned categories of chicken thigh meat: one which was slaughtered and deboned in the same plant (fresh); one which was slaughtered, deboned, frozen, and thawed in the same plant (frozen-thawed); and the last which was slaughtered in a plant, deboned in a different plant, but then transferred to the original plant (fresh-outside). Surface color, drip loss, 2-thiobarbituric acid reactive substances (TBARS) value, sensor...

  18. The physicochemical properties and antioxidative potential of raw thigh meat from broilers fed a dietary medicinal herb extract mixture

    Directory of Open Access Journals (Sweden)

    K. Shirzadegan

    2014-07-01

    Full Text Available A 6-wk feeding study was conducted to evaluate the antioxidative potential, indices such as quality of the thigh meat and liver of broiler chickens fed with a dietary medicinal herb extract mixture (HEM, consisting: Iranian green tea, cinnamon, garlic and chicory at a ratio of 25:15:45:15. A total of 320, one-d-old Ross (male broiler chickens were used to investigate the effects of 0.0, 2.5, 5.0 and 7.5 g/kg HEM in the diet, on aforementioned factors. The HEM supplementation did not influence the composition of raw thigh meat except for the total phenols and crude ash (P<0.05. Furthermore, pH, water-holding capacity (WHC and acceptability of thigh meat were affecting by administration of HEM in diets (P<0.05. Meat flavor increased in the supplemented groups (P<0.05. According to our data, HEM supplementation decreased the amount of thiobarbituric acid reactive substance (TBARS in various times of storage and improved the liver lipid peroxides and superoxide dismutase (SOD activities at week 6 (P<0.05, but did not influence the catalase activity. Our results reveal that the addition of 7.5 g/kg or higher HEM in diet could be sufficient to increase the antioxidative activity and 2.5 g/kg for meat taste of broilers in maximum levels.

  19. Serotypes and antibiotic susceptibility patterns of Salmonella spp. isolates from spur-thighed tortoise, Testudo graeca illegally introduced in Italy

    Directory of Open Access Journals (Sweden)

    Cristina Giacopello

    2012-09-01

    Full Text Available The prevalence of Salmonella carriage and distribution of serotypes in spur-thighed tortoises, Testudo graeca Linnaeus, 1758 illegallyintroduced in Italy was studied to assess the risk of disease exposure for humans once these specimens were traded as pets. Antibiotic susceptibilitypatterns were also analyzed to estimate the emergence of antibiotic-resistant Salmonella strains. One hundred forty-six cloacal swabs ofspur-thighed tortoises were tested by standard bacteriological methods. Antimicrobial susceptibility tests on Salmonella strains isolated werealso performed. Ninety-one Salmonella spp. strains were isolated in 74 of 146 turtles examined and a total of 20 different serotypes were found.Out of the 91 isolates, 67 were grouped in the Salmonella enterica subspecies I. Salmonella isolates were susceptible to most of the antibioticstested. Resistance was most commonly observed against tetracycline (57.1% followed by ampicillin (33.0%, streptomycin (13.2% andamoxicillin-clavulanic acid (11.0%. Our findings confirm that wild-caught spur-thighed tortoises can carry different serotypes of Salmonella .Accordingly, strict preventive sanitation measures should be adopted when handling reptiles.

  20. Anterolateral Ankle Impingement Syndrome (review)%踝关节前外侧撞击综合征的研究进展

    Institute of Scientific and Technical Information of China (English)

    闵红巍; 刘克敏

    2014-01-01

    临床将踝关节扭伤后无骨折脱位,反复出现踝关节前外侧肿痛称为踝关节前外侧撞击综合征,为慢性踝关节疼痛的主要病因之一,受到广泛关注。本文就其发病机制、临床表现、诊断及治疗进行综述。%Ankle sprain without fracture or dislocation, accompanied by repeated ankle swelling is called as Anterolateral Ankle Im-pingement Syndrome. It is a major reason of chronic ankle pain and received extensive attention. This paper summarized its pathogenesis, clinical manifestations, diagnosis and treatment.

  1. Buccinator-based myomucosal flaps in intraoral reconstruction: A review and new classification

    OpenAIRE

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2013-01-01

    The buccinator-based myomucosal flaps are axial pattern flaps that are suitable in reconstruction of medium sized oral soft tissue defects; they are rich in blood supply, have appropriate thickness and considerable mucosal paddle, and they can secrete saliva. The present study describes surgical anatomy and blood supply of these flaps and demonstrates all possible modifications of these flaps (9 modifications). Many terms (> 10) have been used to refer to buccinator-based myomucosal flaps in ...

  2. AN ANATOMIC STUDY OF ADIPOFASCIAL FLAP OF THE LEG

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To investigate the vascular anatomy of the subcutaneous tissues and fascias of the leg. Methods Four fresh cadaver legs which had been injected with colored latex were dissected under magnification to identify the origin, course an distribution of vessels from the subfascial level to the skin. The adipofascial flap was harvested from the whole medial side of the leg and fascial flap from other leg of the same cadaver. The posterior tibial artery and its first and second supra-malleolus septal arteries were retained in these flaps. Selective injection of China ink through posterior tibial artery was carried out, and dimension of ink- stained areas was recorded. Results Three main trunk vessels of the leg gave off branches to deep fascia and subcutaneous tissues, forming a large vascular plexus in the subcutaneous tissues on the deep fascia and a deli- cate, but dense and well anastomosed vascular plexus beneath the deep fascia. The vascular plexus in the subcu- taneous tissues ran deeper than the superficial venous system. The areas stained by selective injection in adipo- fascial flaps were larger than those in the fascial flaps. Conclusion Subcutaneous tissues and deep fascia can be considered as an anatomic entity nourished by two very well developed vascular networks which lie on both sides of deep fascia. Incorporation of the deep fascia can not only protect the subcutaneous tissue from being lacerated during raising of the flap, but also enhance vascularity of the adipofascial flap. Leaving superficial veins intact while raising the skin flap does not jeopardize the vascular plexus in the subcutaneous tissues and can preserve the superficial lymnphatic vessels, so that postoperative edema of the flap or the leg could be avoided.

  3. Vascular Endothelium Growth Factor, Surgical Delay, and Skin Flap Survival

    Science.gov (United States)

    Lineaweaver, William C.; Lei, Man-Ping; Mustain, William; Oswald, Tanya M.; Cui, Dongmei; Zhang, Feng

    2004-01-01

    Objective: Cytokines may be a mechanism by which surgical delay can increase flap survival. We previously found that preoperative vascular endothelium growth factor (VEGF) administration in the rat transverse rectus abdominis myocutaneous (TRAM) flap could improve skin paddle survival. In this study, we used partial elevation of the rat TRAM flap as a surgical delay to assess endogenous cytokine expression and tissue survival comparable to undelayed TRAM flaps. Methods: In Part I, TRAM flaps underwent surgical delay procedures; 7 days later, the flaps were completely elevated and reinset. At the same time, other flaps were raised and reinset without delay. Skin paddle survival in both groups was evaluated at 7 days. In Part II, skin biopsies from TRAM zones I to IV were taken at the time of delay and at intervals of 12, 24, 48, and 72 hours. Specimens were assessed for selected cytokine gene expression by reverse transcription-polymerase chain reaction analysis (TR-PCR). Results: Surgical delay significantly (P < 0.001) increased skin paddle survival in the delayed TRAM flaps (16.14 ± 1.53 cm, 81.9%) compared with undelayed flaps (7.68 ± 3.16 cm, 40.9%). TGF-β and PDGF expressions were not changed by surgical delay, but basic fibroblast growth factor (bFGF) and VEGF expressions increased significantly (P < 0.05 and P < 0.01) after delay. Conclusions: In the rat TRAM model, surgical delay resulted in increased VEGF expression and increased skin paddle survival. These results correlate with previous studies showing the preoperative injection of VEGF increases skin paddle survival. VEGF may be an important element in the delay phenomenon and may be an agent for pharmacological delay. PMID:15166966

  4. The flap by flap dissection in terminal ballistic applied to less lethal weapons.

    Science.gov (United States)

    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. PMID:20110799

  5. Left thigh phlegmon caused by Nocardia farcinica identified by 16S rRNA sequencing in a patient with Leprosy: a case report

    OpenAIRE

    De Nardo, Pasquale; Giancola, Maria Letizia; Noto, Salvatore; Gentilotti, Elisa; Ghirga, Piero; Tommasi, Chiara; Bellagamba, Rita; Paglia, Maria Grazia; Nicastri, Emanuele; Antinori, Andrea; Corpolongo, Angela

    2013-01-01

    Background In recent years, Nocardia farcinica has been reported to be an increasingly frequent cause of localized and disseminated infections in the immunocompromised patient. However, recent literature is limited. We report a case of left thigh phlegmon caused by N. farcinica that occurred in a patient with Leprosy undergoing treatment with prednisone for leprosy reaction. Case presentation We describe the case of left thigh phlegmon caused by Nocardia farcinica in a 54-year-old Italian man...

  6. Osteoradionecrosis of the olecranon: treatment by radial forearm flap

    International Nuclear Information System (INIS)

    Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity

  7. Tolerance of gastric mucosal flap to postoperative irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Devineni, V.R.; Hayden, R.; Fredrickson, J.; Sicard, G. (Washington Univ. Medical Center, St. Louis, MO (USA))

    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.

  8. Tolerance of gastric mucosal flap to postoperative irradiation

    International Nuclear Information System (INIS)

    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

  9. A morphing trailing edge flap system for wind turbine blades

    DEFF Research Database (Denmark)

    Aagaard Madsen, Helge; Barlas, Athanasios; Løgstrup Andersen, Tom

    2015-01-01

    no mechanical or metal parts are used. The prototypes tested in the laboratory and on a blade section in a wind tunnel in the period from 2007-2010 demonstrated the functionality and the aerodynamic performance of the flap concept. In a recent research and development project INDUFLAP from 2011......-2014 the flap system has been further developed in corporation with the industrial partners Hydratech Industries (DK) and Rehau (DE). A new trailing edge flap design with spanwise voids (channels) and with a chord of 15cm suitable for a 1m chord blade section was developed. It was then manufactured by...

  10. Management of a Traumatic Flap Dislocation Seven Years after LASIK

    Directory of Open Access Journals (Sweden)

    Majid Moshirfar

    2011-01-01

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

  11. Repair of perineal radiation ulcer with gracilis myocutaneous island flaps

    International Nuclear Information System (INIS)

    Surgical procedures performed on tissues which have been radiated present great challenges because of problems such as poor wound healing, infection, exposure of important structures and potient's general exhaustion. The general principles of surgical therapy are to remove damaged tissue to the level of good minute blood supply, and to provide suitable coverage. The myocutaneous flap supported by a single muscle and neurovascular pedicle is an axial pattern flap and thought to be one of the best coverages of the sefect. We present a case in which gracilis myocutaneous flaps were used in the repair of a perineal radiation ulcer. (author)

  12. Experimental abscess in the thigh of rabbit : magnetic resonance imaging and pathologic correlation

    International Nuclear Information System (INIS)

    To understand MR imaging characteristics, of abscesses by correlation with pathologic findings, with emphasis on the hypointense rim of the abscess wall on T2-weighted images. We experimentally induced twenty abscesses on both thighs of ten New Zealand white rabbits by innoculation of E. coli. Spin-echo axial T1-weighted images(T1WI), proton density weighted images(PDWI), T2-weighted images(T2WI) and gadolinium enhanced T1WI of two rabbits were each obtained at 1 and 3 days, and at 1, 2 and 4 weeks following innoculation of pathogens. Rabbits were sacrificed after MR imaging, and freezing, sectioning along MR imaging planes and histopathologic examination were subsequently carried out. MR-pathologic correlation was performed, with emphasis on the MR signal characteristics of the abscess wall. In 19 abscesses, necrotic portions except gas showed hypointensity or hyperintensity on T1WI and hyperintensity on T2WI. Peripheral inflammatory reaction showed hypointensity on T1WI, hyperintensity on PDWI and T2WI, and contrast enhancement. Abscess wall showed slightly increased signal intensity on T1WI. A hypointense rim on PDWI and T2WI appeared from 3 days after pathogen innoculation. The rim was thickest at 1 week, and showed multilayers at 2 weeks and double layers at 4 weeks after pathogen innoculation. Cellular and necrotic debris was accumulated at the inner portion of the abscess wall. Inflammatory cells were mainly polymorphonuclear leukocytes and lymphocytes. Macrophages, which appeared at 3 days, suggested active phagocytosis at 1 week after innoculation. Thereafter, inflammatory reactions decreased and fibrosis progressed. The hypointense rim of the abscess wall on T2WI reflects the accumulation of cellular debris, the paramagnetic effect of free radicals due to active phagocytosing macrophages during the abscess forming stage, and fibrosis during the maturation stage

  13. Oblique waves lift the flapping flag.

    Science.gov (United States)

    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

  14. Flap motion of helicopter rotors with novel, dynamic stall model

    Directory of Open Access Journals (Sweden)

    Han Wei

    2016-07-01

    Full Text Available 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.

  15. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    DEFF Research Database (Denmark)

    Jacobs, Jordan; Thomsen, Jørn Bo; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur; Tos, Tina; Siim, Elsebeth; Udesen, Ann; Hölmich, Lisbet Rosenkrantz; Salzberg, Andrew

    2016-01-01

    flap in reconstructive surgery. METHODS: A multicenter, retrospective review was performed on all patients undergoing TAP flap reconstruction from August 2011 to November 2014. Data were collected from patient records as well as outpatient interviews. RESULTS: A total of 106 TAP flaps were performed in...... reconstruction as well as breast conserving surgery. This large, multicenter series describes our techniques of preoperative perforator mapping and a fast, reliable harvest. Reconstructive goals are accomplished in the great majority of patients.......BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...

  16. Numerical simulation of self-propulsion of flapping flexible plates

    Science.gov (United States)

    Lu, Xi-Yun; Hua, Ru-Nan; Fluid Mechanics Team

    2012-11-01

    Self-propulsion of flapping flexible plates has been studied numerically by means of an immersed boundary-lattice Boltzmann method for the fluid dynamics around the plate and a finite element method for the deformable flapping motion of the plate. Both the two- and three-dimensional flexible plates are investigated to reveal the propulsion properties and their differences. As a result of the fluid-plate interaction, three typical movement regimes have been identified and can be briefly described as forward, backward, and irregular movements which mainly depend on the flapping amplitude and bending rigidity. It is found that there exists an optimal range of the bending rigidity for large propulsive speed or high efficiency in the forward movement regime, consistent with the observation and measurement of swimming and flying animals. The results obtained in this study provide physical insights into understanding of the propulsive mechanisms of the flapping fin or wing of animals.

  17. 14 CFR 23.697 - Wing flap controls.

    Science.gov (United States)

    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...

  18. Subcutaneous island pedicle flap for aesthetic reconstruction of the face

    Institute of Scientific and Technical Information of China (English)

    LI Jun-hui; XING Xin; OUYANG Tian-xiang; LI Ping; XU Jie; GUO En-tan

    2006-01-01

    Objective:To investigate the outcomes of subcutaneous island pedicle flap for reconstruction of the medium-sized facial skin defects. Methods: Eighty nine cases of facial defects within one cosmetic unit following removal of skin tumors or scars were reconstructed with advancement or transposition island pedicle flaps. Patient records and postoperative photographs were reviewed retrospectively. Both patients and other surgeons were asked to assess outcome variables. Results: All flaps survived with primary healing postoperatively. Patients and surgeons judged excellent or good overall outcomes in 95.5% and 92.7%of all evaluated cases, respectively. Conclusion: The subcutaneous island pedicle flap may be an extremely versatile and reliable method for aesthetic reconstruction of medium-sized facial defects in the patients of all time of life.

  19. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian T

    2015-01-01

    INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover, in...... contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...

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

    Science.gov (United States)

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

    1984-01-01

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

  1. Development of Variable Camber Continuous Trailing Edge Flap System

    Science.gov (United States)

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

    2012-01-01

    This presentation describes the current status of the joint NASA/Boeing collaboration on the development of a variable camber continuous trailing edge flap system for use in wing shaping control for cruise drag reduction.

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

    CERN Document Server

    Wang, Shizhao; He, Guowei; Liu, Tianshu

    2013-01-01

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

  3. Reconstruction of hand contracture by reverse ulnar perforator flap

    Directory of Open Access Journals (Sweden)

    Cengiz Eser

    2016-04-01

    Full Text Available Hand burn scar contractures affect patients in aesthetic and functional aspects. After releasing these scars, the defects should be repaired. The reconstruction methods include primary suturation, Z plasty, skin grafting, local or free flaps, etc. All methods have their own advantages and disadvantages. One of the most useful flaps is the reverse ulnar perforator flap. We performed a two-staged procedure for repairing a post-burn contracture release defect in a 40-year-old male. In the first stage we applied reverse ulnar perforator flap for the hand defect, and ulnar artery and vein repair in the second stage. In conclusion, this two-staged procedure is a non-primary but useful option for hand and finger defects and prevents major vascular structure damage of the forearm. [Hand Microsurg 2016; 5(1.000: 40-43

  4. Free posterior tibial flap reconstruction for hypopharyngeal squamous cell carcinoma

    OpenAIRE

    Fei CHEN; Liu, Jun; Wang, Lihong; Lv, Dan; Zhu, Yuanzhi; Wu, Qi; Li, Guojun; Zheng, Hongliang; Tao, Xiaofeng

    2014-01-01

    Objectives The aim of this article was to determine outcomes in patients with squamous cell carcinoma of the hypopharynx (SCCHP) in whom the free posterior tibial flap was used for primary reconstruction of hypopharynx defects after cancer resection. Subjects and methods Between August 2009 and February 2012, 10 patients with SCCHP underwent posterior tibial flap reconstruction for hypopharynx defects. The corresponding clinical data were retrospectively collected and analyzed. Results Despit...

  5. Reconstruction of the thumb with osteofasciocutaneous reverse flap

    Directory of Open Access Journals (Sweden)

    Jevtović Dobrica

    2002-01-01

    Full Text Available 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 post-traumatic 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 nerves that were anastomosed with digital nerve. 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.

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

    Science.gov (United States)

    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

  7. PREDICTION OF HYDRODYNAMIC PERFORMANCE OF THE FLAP RUDDER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The paper presents a new method for predicting the hydrodynamic performance of the flap rudder behind a propeller. The hydrodynamics of the rudder was calculated by the panel method and the performance of the propeller was predicted by the simplified propeller theoty. The interaction between the rudder and propeller was determined by iterative procedure. The pressure distribution on rudder surface and the hydrodynamic performance of the flap rudder are discussed in the paper.

  8. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

    OpenAIRE

    Jainath; Peddi; Ramesha; Shankarappa; Smitha; Amaresh

    2013-01-01

    A BS T R ACT : Soft tissue reconstruction of distal third leg, heel and ankle reg ion is a challenging problem because of poor vascularity and limited mobility of skin. The reverse sural artery with ideal flap thickness, minimal donor site morbidity, lack of functional muscle loss, short recovery time, wide arc of rotation and safe vasc ularity makes it a preferable flap for covering such defects. AIMS A N D OBJECTIVES : To study various modi...

  9. Surgical procedure of Free Flap. Main nursing care

    OpenAIRE

    Manuel Molina López; Eladio J. Collado Boira; Mariano Marqués Aguilar

    2010-01-01

    The free flap surgical technique is used to cover extensive skin loss areas and situations where no flap is available, or in axial zones. The great breackthrough in the field of reconstructive surgical techniques and the creation of new units where these complex techniques are used, means that the nursing staff who work in these hospital units are adquiring greater protagonism in caring for, and the subsequent success of this type of surgery in which the problems of collaboration in all the p...

  10. Perineum-based Pediculated Scrotal Flap for Reconstructive Urethral Surgery

    OpenAIRE

    Jeong, Hee Jong

    2012-01-01

    Herein, we describe a perineum-based pediculated scrotal flap procedure for urethral reconstruction. A scrotal tubular flap was used as a substitute to correct a proximal penile urethral stricture in case 1. In case 2, a scrotal island patch was performed to treat an iatrogenic penile urethral injury. In both cases, the urethral catheter was removed on postoperative day 14 with simultaneous normal voiding cystourethrography. The excellent axial vascularization of this perineum-based pediculat...

  11. The lateral calcaneal flap for sensate heel reconstruction revisited.

    Science.gov (United States)

    Korentager, R

    1994-06-01

    Defects of the heel can be difficult to treat because they require a thin, sensate, soft-tissue cover. The lateral calcaneal flap can provide this type of reconstruction in selected patients. A 27-year-old man had a painful defect in a grafted heel that prevented him from working. A satisfactory painless heel was provided by resurfacing the area with a lateral calcaneal flap. The donor defect was minimized by interfascicular dissection of the sural nerve. PMID:8199942

  12. Flap Side Edge Liners for Airframe Noise Reduction

    Science.gov (United States)

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

    2014-01-01

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

  13. Elbow Reconstruction Using Island Flap for Burn Patients

    OpenAIRE

    Gi Yeun Hur; Woo Jin Song; Jong Wook Lee; Hoon Bum Lee; Sung Won Jung; Jang Hyu Koh; Dong Kook Seo; Jai Ku Choi; Young Chul Jang

    2012-01-01

    Background Deep burns of the elbow lead to soft tissue necrosis and infection, with exposure of deep structures. Adequate wound coverage of this area requires thin, pliable, and durable tissue, while optimal functional recovery requires early coverage and functional rehabilitation. We have found 3 types of island flaps that provide reliable coverage for the elbow. Methods A retrospective study was performed on all patients who underwent flap coverage of an elbow defect at our hospital. The pa...

  14. Optimization of Flapping Airfoils for Maximum Thrust and Propulsive Efficiency

    OpenAIRE

    Tuncer, I.H.; Kay, M.

    2004-01-01

    A numerical optimization algorithm based on the steepest decent along the variation of the optimization function is implemented for maximizing the thrust and/or propulsive efficiency of a single flapping airfoil. Unsteady, low speed laminar flows are computed using a Navier-Stokes solver on moving overset grids. The flapping motion of the airfoil is described by a combined sinusoidal plunge and pitching motion. Optimization parameters are taken to be the amplitudes of the plunge and pitching ...

  15. Optimal design of wind turbine blades equipped with flaps

    OpenAIRE

    Wiratama, I. Kade; Maheri, Alireza

    2014-01-01

    As a result of the significant growth of wind turbines in size, blade load control has become the main challenge for large wind turbines. Many advanced techniques have been investigated aiming at developing control devices to ease blade loading. Amongst them, trailing edge flaps have been proven as effective devices for load alleviation. The present study aims at investigating the potential benefits of flaps in enhancing the energy capture capabilities rather than blade load alleviation. A so...

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

    Science.gov (United States)

    Rajacic, N; Darweesh, M; Jayakrishnan, K; Gang, R K; Jojic, S

    1996-09-01

    We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and in 3 cases as a fascial flap only. The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg. Although the flap was described as reliable for covering defects around the ankle joint, we have been able to cover defects of the dorsum of the foot distally and up to the mid-third of the tibia proximally. PMID:8881785

  17. Free tissue transfer versus pedicled flap reconstruction of head and neck malignancy defects.

    LENUS (Irish Health Repository)

    O'Neill, J P

    2012-02-01

    BACKGROUND: With the advent of microsurgery the pedicled flap is considered by many to be an outdated surgical option. AIMS: To explore the relationship between flap survival and pre-morbid risk factors, conduct a comparative analysis of flap and systemic morbidities and complete a cosmesis and functionality assessment for oral and oropharyngeal reconstruction patients. METHODS: 114 patients, over a 13-year period, who had a one-stage reconstructive procedure employing the pectoralis major myocutaneous flap (PMMF) or radial forearm-free flap (RFFF). RESULTS: Variables, including age, smoking and radiation exposure were not statistically significant predictors of flap survival probability. Atelectasis was a significant post-op finding of RFFF patients. Flap dehiscence of >50% was a significant morbidity of PMMF. No statistical difference in cosmetic deformity, diet and socialisation was noted. CONCLUSIONS: Pectoralis major myocutaneous flap remains an enduring and safe flap; however, the RFFF has markedly improved speech performance over the PMMF.

  18. Surgical anatomy and utility of pedicled vascularized tissue flaps for multilayered repair of skull base defects.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Komune, Noritaka; Archer, Jacob B; Sun, Hai; Theodore, Nicholas; James, Jeffrey; Little, Andrew S; Nakaji, Peter; Sughrue, Michael E; Rhoton, Albert L; Spetzler, Robert F

    2016-08-01

    OBJECT The objective of this study was to describe the surgical anatomy and technical nuances of various vascularized tissue flaps. METHODS The surgical anatomy of various tissue flaps and their vascular pedicles was studied in 5 colored silicone-injected anatomical specimens. Medical records were reviewed of 11 consecutive patients who underwent repair of extensive skull base defects with a combination of various vascularized flaps. RESULTS The supraorbital, supratrochlear, superficial temporal, greater auricular, and occipital arteries contribute to the vascular supply of the pericranium. The pericranial flap can be designed based on an axial blood supply. Laterally, various flaps are supplied by the deep or superficial temporal arteries. The nasoseptal flap is a vascular pedicled flap based on the nasoseptal artery. Patients with extensive skull base defects can undergo effective repair with dual flaps or triple flaps using these pedicled vascularized flaps. CONCLUSIONS Multiple pedicled flaps are available for reconstitution of the skull base. Knowledge of the surgical anatomy of these flaps is crucial for the skull base surgeon. These vascularized tissue flaps can be used effectively as single or combination flaps. Multilayered closure of cranial base defects with vascularized tissue can be used safely and may lead to excellent repair outcomes. PMID:26613175

  19. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction.

    Science.gov (United States)

    Narushima, Mitsunaga; Iida, Takuya; Kaji, Nobuyuki; Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hara, Hisako; Kikuchi, Kazuki; Araki, Jun; Yamashita, Shuji; Koshima, Isao

    2016-06-01

    For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, superthin flap with the advantages of both skin graft and perforator flaps. PMID:27085610

  20. [PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

    Science.gov (United States)

    Pavlov, V N; Bakirov, A A; Kabirov, I R; Izmajlov, A A; Kutlijarov, L M; Safiullin, R L; Urmancev, M F; Sultanov, I M; Abdrahimov, R V

    2015-01-01

    Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall. PMID:26390558

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

    Science.gov (United States)

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

    2015-08-01

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

  2. A bilobed thoracoabdominal myocutaneous flap for large thoracic defects.

    Science.gov (United States)

    Charanek, Ali M

    2014-04-01

    The author presents a surgical procedure for chest-wall soft tissue reconstruction due to large losses based on a modified thoracoabdominal myocutaneous flap. Designed in a bilobed shape, it rests on the superior epigastric vessels and may include the cranial one fourth of the rectus abdominis muscle and the premuscular fascia of external oblique muscle and constitutes one of the largest flaps based on a single minor artery. Local recurrent breast tumors and adjuvant therapy associated to obesity, high blood pressure, type II diabetes, and tobacco abuse on previously debilitated patients render the usual reconstructive procedure difficulties. These become indications for this flap, whose safety is improved by maintaining the deep fascia of the external oblique muscle attached to the flap to preserve the network of the arteries close to the fascia and a wide-ranging interarterial choke anastomosis alongside the lateral projection of the flap on the thorax. Thus, a wide range of angles allows us to reach even the opposite site of the thorax over the sterna area with an easy closure of the donor site facilitated by the vertical portion of the abdominal donor site. The flap was used in 55 patients, and no serious complications, including necrosis, notable dehiscence, hematoma, seroma, or abdominal wall weakness, were observed. The overall aspect is acceptable with the visible scars over the upper part of the abdomen. PMID:23503434

  3. Evaluation of mandibular reconstruction with free vascularized fibular flap

    Institute of Scientific and Technical Information of China (English)

    Krishna Gopal Bhuju; Shuzhong Xing; Hualian Liu

    2008-01-01

    Objective: To evaluates mandible reconstruction by free vascularized fibular flap with special emphasis on the immediate complications. Methods:The clinical data of 63 patients were reviewed, 35 male and 28 female(age range l6 to 73 years). Aesthetic and functional outcomes were evaluated by follow-up and/or telephone conversation. Results:Among the 63 fibular flaps, 29 were osteocutaneous flaps with one or two skin islands. All the flaps were surviving well and the success rate was 100%. Long term donor site disability was not recorded for any patient. Thirty-one patients responded for aesthetic and functional evaluation, 20 cases(64.5%) reported their facial appearance as excellent or good, 11 (35.48%) felt fair; 14 cases (45%) could eat unrestricted diet, 17(55%) could eat soft diet; 21 cases were(67.67%) speech normal, 10(22.33%) speech intelligible. Conclusion:Free fibular flap reflects good functional and esthetic results with a high degree of consistency, and acceptable level of complications, and we strongly believe the vascularized fibular flap is the first choice for mandibular reconstruction.

  4. Flap Conformations in HIV-1 Protease are Altered by Mutations

    Science.gov (United States)

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

    2009-03-01

    HIV-1 protease (PR) is an enzyme that is a major drug target in the treatment of AIDS. Although the structure and function of HIV-1 PR have been studied for over 20 years, questions remain regarding the conformations and dynamics of the β-hairpin turns (flaps) that cover the active site cavity. Distance measurements with pulsed EPR spectroscopy of spin labeled constructs of HIV-1 PR have been used to characterize the flap conformations in the apo and inhibitor bound states. From the most probably distances and the breadth of the distance distribution profiles from analysis of the EPR data, insights regarding the flap conformations and flexibility are gained. The EPR results clearly show how drug pressure selected mutations alter the average conformation of the flaps and the degree of opening of the flaps. Molecular dynamics simulations successfully regenerate the experimentally determined distance distribution profiles, and more importantly, provide structural models for full interpretation of the EPR results. By combining experiment and theory to understand the role that altered flap flexibility/conformations play in the mechanism of drug resistance, key insights are gained toward the rational development of new inhibitors of this important enzyme.

  5. World's First Baby Born Through Natural Insemination by Father With Total Phalloplasty Reconstruction.

    Science.gov (United States)

    Gurjala, Anandev N; Nazerali, Rahim S; Salim, Ali; Lee, Gordon K

    2016-05-01

    Techniques for neophallus reconstruction have become increasingly refined, fulfilling more criteria for what is considered to be the ideal penis reconstruction. For both trauma and transgender populations, the radial forearm free flap remains the gold standard, although the pedicled or free anterolateral thigh flap is becoming a favored alternative. Despite the remarkably high rates of sexual activity reported by patients having benefited from these techniques, sexual function remains a significant challenge due to frequent complications including autologous and prosthetic stiffener failure, fistula formation, and inadequate erogenous sensation. Perhaps the ultimate criterion for neophallus reconstruction is one which not only avoids these complications by meeting the immediate goals of a competent neourethra, sensitivity, bulk, and aesthetic form but also successfully combines them into their true overarching function: procreation. In this article, we report the case of a pedicled anterolateral thigh flap neophallus reconstruction which allowed a patient to naturally conceive a child through penetrative intercourse without use of a stiffener, and led to pregnancy and subsequent birth of a baby son. We review the surgical techniques and factors that led to this patient's successful progeny. PMID:27070679

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

    Directory of Open Access Journals (Sweden)

    S Mishra

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lei Zhu

    2014-01-01

    Full Text Available 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.

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

    Science.gov (United States)

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

    2014-11-01

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

  9. Ornithopter Type Flapping Wings for Autonomous Micro Air Vehicles

    Directory of Open Access Journals (Sweden)

    Sutthiphong Srigrarom

    2015-05-01

    Full Text Available In this paper, an ornithopter prototype that mimics the flapping motion of bird flight is developed, and the lift and thrust generation characteristics of different wing designs are evaluated. This project focused on the spar arrangement and material used for the wings that could achieves improved performance. Various lift and thrust measurement techniques are explored and evaluated. Various wings of insects and birds were evaluated to understand how these natural flyers with flapping wings are able to produce sufficient lift to fly. The differences in the flapping aerodynamics were also detailed. Experiments on different wing designs and materials were conducted and a paramount wing was built for a test flight. The first prototype has a length of 46.5 cm, wing span of 88 cm, and weighs 161 g. A mechanism which produced a flapping motion was fabricated and designed to create flapping flight. The flapping flight was produced by using a single motor and a flexible and light wing structure. A force balance made of load cell was then designed to measure the thrust and lift force of the ornithopter. Three sets of wings varying flexibility were fabricated, therefore lift and thrust measurements were acquired from each different set of wings. The lift will be measured in ten cycles computing the average lift and frequency in three different speeds or frequencies (slow, medium and fast. The thrust measurement was measure likewise but in two cycles only. Several observations were made regarding the behavior of flexible flapping wings that should aid in the design of future flexible flapping wing vehicles. The wings angle or phase characteristic were analyze too and studied. The final ornithopter prototype weighs only 160 g, has a wing span of 88.5 cm, that could flap at a maximum flapping frequency of 3.869 Hz, and produce a maximum thrust and lift of about 0.719 and 0.264 N respectively. Next, we proposed resonance type flapping wing utilizes the near

  10. FLAP TRANSFERS IN UPPER LIMB RECONSTRUCTION AFTER SEVERE TRAUMA

    Directory of Open Access Journals (Sweden)

    D. Pieptu

    2010-11-01

    Full Text Available Hand and upper limb traumatic injuries are common presenting pathology in the emergency department. Extensive trauma patients approach is standardized and internationally accepted guidelines are followed. The care for the traumatic injury is secondary to the patient’s general status stabilization. After debridement, lesions inventory is made and priority is established according to their gravity. Flap surgery is a ubiquitous strategy in soft tissue reconstruction. Extensive soft tissue defects, especially over exposed bones, joints, vessels and nerves, need immediate coverage with well-vascularized tissues. Besides the obvious reason for saving critical anatomical structure, is the only way to maximize the chances for functional recovery. One-stage reconstruction, even for complex defects, is possible due to flaps versatility. Composite tissue transfer, including two three or more types of tissues, can successfully address combined bone, muscle, vessels, nerves or skin loss. The best example is the subscapular system, which offers no less than 5 different tissues and wide combinations of flaps. Even if the procedure per se involves large human, technical and financial resources, on a long term it was proved to be cost-effective, in reducing number of operations, hospital stay and rehabilitation time. Muscle flaps share first place in soft tissue reconstruction with the fasciocutaneous flaps. Yet, in functional reconstruction or in combined defects in need for composite flaps, nothing can beat the muscle flaps. In our hands, muscles flaps and the omentum are the workhorse for soft tissue and/or combined defects reconstruction. Pedicled latissimus dorsi can cover tissue defects from shoulder down to the elbow, but also reconstruct the function of shoulder muscles or totally or partially biceps or triceps loss, with minimal or no donor-site functional deficit. Whenever defects are more distal, free flap transfers are needed for optimal

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

    Science.gov (United States)

    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. PMID:26980600

  12. MRI-guided gas bubble enhanced ultrasound heating in in vivo rabbit thigh

    International Nuclear Information System (INIS)

    In this study, we propose a focused ultrasound surgery protocol that induces and then uses gas bubbles at the focus to enhance the ultrasound absorption and ultimately create larger lesions in vivo. MRI and ultrasound visualization and monitoring methods for this heating method are also investigated. Larger lesions created with a carefully monitored single ultrasound exposure could greatly improve the speed of tumour coagulation with focused ultrasound. All experiments were performed under MRI (clinical, 1.5 T) guidance with one of two eight-sector, spherically curved piezoelectric transducers. The transducer, either a 1.1 or 1.7 MHz array, was driven by a multi-channel RF driving system. The transducer was mounted in an MRI-compatible manual positioning system and the rabbit was situated on top of the system. An ultrasound detector ring was fixed with the therapy transducer to monitor gas bubble activity during treatment. Focused ultrasound surgery exposures were delivered to the thighs of seven New Zealand white rabbits. The experimental, gas-bubble-enhanced heating exposures consisted of a high amplitude 300 acoustic watt, half second pulse followed by a 7 W, 14 W or 21 W continuous wave exposure for 19.5 s. The respective control sonications were 20 s exposures of 14 W, 21 W and 28 W. During the exposures, MR thermometry was obtained from the temperature dependency of the proton resonance frequency shift. MR T2-enhanced imaging was used to evaluate the resulting lesions. Specific metrics were used to evaluate the differences between the gas-bubble-enhanced exposures and their respective control sonications: temperatures with respect to time and space, lesion size and shape, and their agreement with thermal dose predictions. The bubble-enhanced exposures showed a faster temperature rise within the first 4 s and higher overall temperatures than the sonications without bubble formation. The spatial temperature maps and the thermal dose maps derived from the MRI

  13. Thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis in postoperative surgical patients; a systematic review and network meta-analysis

    Science.gov (United States)

    Wade, Ros; Paton, Fiona; Rice, Stephen; Stansby, Gerard; Millner, Peter; Flavell, Hayley; Fox, Dave; Woolacott, Nerys

    2016-01-01

    Objectives To assess the clinical effectiveness of thigh length versus knee length antiembolism stockings for the prevention of deep vein thrombosis (DVT) in surgical patients. Design Systematic review and meta-analysis using direct methods and network meta-analysis. Methods Previous systematic reviews and electronic databases were searched to February 2014 for randomised controlled trials (RCTs) of thigh length or knee length antiembolism stockings in surgical patients. Study quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was incidence of DVT. Analysis of the DVT data was performed using ORs along with 95% CIs. The I2 statistic was used to quantify statistical heterogeneity. Results 23 RCTs were included; there was substantial variation between the trials and many were poorly reported with an unclear risk of bias. Five RCTs directly comparing thigh length versus knee length stockings were pooled and the summary estimate of effect favouring thigh length stockings was not statistically significant (OR 1.48, 95% CI 0.80 to 2.73). 13 RCTs were included in the network meta-analysis; thigh length stockings with pharmacological prophylaxis were more effective than knee length stockings with pharmacological prophylaxis, but again results were not statistically significant (OR 1.76, 95% credible intervals 0.82 to 3.53). Conclusions Thigh length stockings may be more effective than knee length stockings, but results did not reach statistical significance and the evidence base is weak. Further research to confirm this finding is unlikely to be worthwhile. While thigh length stockings appear to have superior efficacy, practical issues such as patient acceptability may prevent their wide use in clinical practice. Systematic review registration number CRD42014007202. PMID:26883236

  14. Closure of Large Pressure Ulcers utilizing the Principles of Limberg flap

    Directory of Open Access Journals (Sweden)

    Kumar Pramod

    2001-01-01

    Full Text Available A prospective study of 17 patients (21 Limberg flaps in 19 pressure ulcers was done to establish the efficacy of Limberg flap. . Limberg flaps were used in only those cases where primary closure was not possible. This flap was found to be simple to execute and short-term results were satisfactory. Also, it spares underlying muscles for future use. None of the flaps showed necrosis. Partial wound dehiscence was noticed in 7 (33.33% cases, which was managed by secondary suturing in four cases, by split skin graft in one case and by second Limberg flap in one case.

  15. Knee extension strength and post-operative functional prediction in quadriceps resection for soft-tissue sarcoma of the thigh

    Science.gov (United States)

    Tanaka, A.; Aoki, K.; Kito, M.; Okamoto, M.; Suzuki, S.; Momose, T.; Kato, H.

    2016-01-01

    Objectives Our objective was to predict the knee extension strength and post-operative function in quadriceps resection for soft-tissue sarcoma of the thigh. Methods A total of 18 patients (14 men, four women) underwent total or partial quadriceps resection for soft-tissue sarcoma of the thigh between 2002 and 2014. The number of resected quadriceps was surveyed, knee extension strength was measured with the Biodex isokinetic dynamometer system (affected side/unaffected side) and relationships between these were examined. The Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D) score and the Short Form 8 were used to evaluate post-operative function and examine correlations with extension strength. The cutoff value for extension strength to expect good post-operative function was also calculated using a receiver operating characteristic (ROC) curve and Fisher’s exact test. Results Extension strength decreased when the number of resected quadriceps increased (p < 0.001), and was associated with lower MSTS score, TESS and EQ-5D (p = 0.004, p = 0.005, p = 0.006, respectively). Based on the functional evaluation scales, the cutoff value of extension strength was 56.2%, the equivalent to muscle strength with resection of up to two muscles. Conclusion Good post-operative results can be expected if at least two quadriceps muscles are preserved. Cite this article: A. Tanaka, Y. Yoshimura, K. Aoki, M. Kito, M. Okamoto, S. Suzuki, T. Momose, H. Kato. Knee extension strength and post-operative functional prediction in quadriceps resection for soft-tissue sarcoma of the thigh. Bone Joint Res 2016;5:232–238. DOI: 10.1302/2046-3758.56.2000631. PMID:27317788

  16. Characterization of thigh and shank segment angular velocity during jump landing tasks commonly used to evaluate risk for ACL injury.

    Science.gov (United States)

    Dowling, Ariel V; Favre, Julien; Andriacchi, Thomas P

    2012-09-01

    The dynamic movements associated with anterior cruciate ligament (ACL) injury during jump landing suggest that limb segment angular velocity can provide important information for understanding the conditions that lead to an injury. Angular velocity measures could provide a quick and simple method of assessing injury risk without the constraints of a laboratory. The objective of this study was to assess the inter-subject variations and the sensitivity of the thigh and shank segment angular velocity in order to determine if these measures could be used to characterize jump landing mechanisms. Additionally, this study tested the correlation between angular velocity and the knee abduction moment. Thirty-six healthy participants (18 male) performed drop jumps with bilateral and unilateral landing. Thigh and shank angular velocities were measured by a wearable inertial-based system, and external knee moments were measured using a marker-based system. Discrete parameters were extracted from the data and compared between systems. For both jumping tasks, the angular velocity curves were well defined movement patterns with high inter-subject similarity in the sagittal plane and moderate to good similarity in the coronal and transverse planes. The angular velocity parameters were also able to detect differences between the two jumping tasks that were consistent across subjects. Furthermore, the coronal angular velocities were significantly correlated with the knee abduction moment (R of 0.28-0.51), which is a strong indicator of ACL injury risk. This study suggested that the thigh and shank angular velocities, which describe the angular dynamics of the movement, should be considered in future studies about ACL injury mechanisms. PMID:22938373

  17. Evolution of Head and Neck Microvascular Reconstructive Strategy at an Academic Centre: An 18-Year Review.

    Science.gov (United States)

    Husso, Annastiina; Mäkitie, Antti A; Vuola, Jyrki; Suominen, Sinikka; Bäck, Leif; Lassus, Patrik

    2016-05-01

    Background A remarkable development through the evolution of free flap techniques has led to the modern reconstructive head and neck surgery. This study aimed to review experiences from head and neck free-flap reconstructions performed at our institution over an 18-year period. Methods Between 1995 and 2012, 594 free-flap operations were performed on 541 head and neck patients at the Department of Plastic Surgery, Helsinki University Hospital, Finland. We retrospectively recorded hospital chart data regarding patient demographics, tumor characteristics, surgical treatment, and outcome. Results The mean age of patients increased from 53 years (1995-2000) to 56 (2007-2012), while the gender distribution remained constant (60% males). The most commonly used flap type between 1995 and 2000 was radial forearm flap (50%), while during the periods of 2001 through 2006 and 2007 through 2012 the anterolateral thigh flap was the most common method (42 and 36%, respectively). The number of different flap types and flap combinations increased during these periods (15 flap types during 1995 through 2000; 17 flap types during 2001 through 2006; and 24 flap types during 2007 through 2012). Despite a wider range of flap options used during the period 2001 through 2012, the overall flap survival rate (97%) remained constant. The prevalence of surgical complications decreased from 26% (2001 through 2006) to 21% (2007 through 2012). Conclusions During the study period, the number of flap types increased and reconstructions became more individualized. The overall surgical complication rate decreased although the mean age of patients increased. PMID:26766422

  18. Pharmacodynamics of Imipenem in Combination with β-Lactamase Inhibitor MK7655 in a Murine Thigh Model

    OpenAIRE

    Mavridou, Eleftheria; Melchers, Ria J. B.; van Mil, Anita C. H. A. M.; Mangin, E.; Motyl, Mary R.; Mouton, Johan W.

    2014-01-01

    MK7655 is a newly developed beta-lactamase inhibitor of class A and class C carbapenemases. Pharmacokinetics (PK) of imipenem-cilastatin (IMP/C) and MK7655 were determined for intraperitoneal doses of 4 mg/kg to 128 mg/kg of body weight. MIC and pharmacodynamics (PD) studies of MK7655 were performed against several beta-lactamase producing Pseudomonas aeruginosa and Klebsiella pneumoniae strains to determine its effect in vitro and in vivo. Neutropenic mice were infected in each thigh 2 h bef...

  19. Effect of thigh muscle fatigue on the biomechanical factors of the lower limbs when walking in a squatted position

    OpenAIRE

    Hong, Wan-Ki; Lee, Chul-Gab; Ko, Dae-Sik

    2016-01-01

    [Purpose] The purpose of this study was to compare and analyze the effects of thigh muscle fatigue caused by walking in a squatted position on biomechanical factors, to evaluate the risk of a job performed sitting in a squatted position for a long period of time. [Subjects and Methods] Eighteen right foot dominant women without any injuries in their joints and body in the last 6 months were selected. They walked in a squatted position, and then muscle fatigue was induced by using an isokineti...

  20. An autopsy case of lymphangiosarcoma arising from the posotoperative and postirradiated site of lymphangioma of the thigh

    International Nuclear Information System (INIS)

    A 25-year-old man had undergone resection of lymphangioma on the anterior aspect of left thigh and postoperative irradiation at the age of seven. About ten years later, lymphangiosarcoma developed at the postopeative site and he died despite wide resection, chemotherapy and irradiation. Microscopically, the malignant cells were arranged in an angiomatous pattern with endthelial lining. Ultrastructural examination of the tumor suggested the dual origin from blood and lymphatic capillaries. The pathogenesis of the tumor was considered to be closely related to local disturbances in lymph circulation at the postoperative site although no lymphedema was present. (author)

  1. The physicochemical properties and antioxidative potential of raw thigh meat from broilers fed a dietary medicinal herb extract mixture

    OpenAIRE

    K. Shirzadegan; Falahpour, P.

    2014-01-01

    A 6-wk feeding study was conducted to evaluate the antioxidative potential, indices such as quality of the thigh meat and liver of broiler chickens fed with a dietary medicinal herb extract mixture (HEM, consisting: Iranian green tea, cinnamon, garlic and chicory at a ratio of 25:15:45:15). A total of 320, one-d-old Ross (male) broiler chickens were used to investigate the effects of 0.0, 2.5, 5.0 and 7.5 g/kg HEM in the diet, on aforementioned factors. The HEM supplementation did not influen...

  2. Twenty-eight Cases of Neuritis of Lateral Cutaneous Nerve of Thigh Treated by Acupuncture and Point-Injection

    Institute of Scientific and Technical Information of China (English)

    廖明扬

    2001-01-01

    @@Neuritis of lateral cutaneous nerve of thigh, also called meralgia paresthetica, is a commonly encountered disease in clinical practice. The author has treated 28 cases of meralgia paresthetica since 1996 by acupuncture plus point-injection with satisfactory results. A report follows. Clinical Data Among the 28 cases, 13 were male and 15 female. Their age ranged from 24 to 72 years, most of the patients being 35 to 50 years; the duration of illness varied from one month to ten years and 6 cases were affected on left side, 8 cases on right side and 14 cases on both sides.

  3. Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction.

    Science.gov (United States)

    Rozen, Warren Matthew; Patel, Nakul Gamanlal; Ramakrishnan, Venkat V

    2016-04-01

    For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial surface, and the TUG flap lying superficially with its skin paddle used for nipple reconstruction and able to be monitored clinically. There were no flap or donor related complications and good aesthetic outcomes were achieved. This technique offers a further option in microsurgical breast reconstruction for patients in whom there is a paucity of abdominal tissue for reconstruction. PMID:27047791

  4. Compartment syndrome of thigh and lower leg with disruption of the popliteal vascular bundle after being run over by a 25-ton truck

    Directory of Open Access Journals (Sweden)

    Burghardt Rolf D

    2013-10-01

    Full Text Available 【Abstract】Compartment syndrome of the thigh is a rare condition, potentially resulting in devastating functional outcome. Increasing intracompartmental pressure which suppresses microcirculation and capillary perfusion may lead to cellular anoxia and muscle ischemia. The muscle compartments in the thigh have a more compliant fascia and blend anatomically into the open compartments of the pelvis, thus compensating higher volumes than the compartments in the lower leg. We present a previously unreported case in which the limb of a 36-year-old man was run over by a 25-ton truck. He presented with a sensomotor deficit in his left lower leg with full paralysis of the shank muscles and absence of all foot pulses. CT scan showed a huge haematoma in the thigh with active bleeding out of the popliteal artery into the haematoma which has already expanded into the muscle compartments of the lower leg. The limb had a disastrous compartment syndrome of the thigh and lower leg with disruption of the popliteal neurovascular bundle; however, no bones in the limb were fractured. A complete fasciotomy of all the lower limb muscle compartments was immediately performed. The artery was reconstructed with interposition of the smaller saphenous vein, which was already interrupted through the initial trauma. Key words: Compartment syndromes; Thigh; Hemorrhage; Popliteal artery; Peroneal nerve

  5. ``Schooling'' of wing pairs in flapping flight

    Science.gov (United States)

    Ramananarivo, Sophie; Zhang, Jun; Ristroph, Leif; AML, Courant Collaboration; Physics NYU Collaboration

    2015-11-01

    The experimental setup implements two independent flapping wings swimming in tandem. Both are driven with the same prescribed vertical heaving motion, but the horizontal motion is free, which means that the swimmers can take up any relative position and forward speed. Experiments show however clearly coordinated motions, where the pair of wings `crystallize' into specific stable arrangements. The follower wing locks into the path of the leader, adopting its speed, and with a separation distance that takes on one of several discrete values. By systematically varying the kinematics and wing size, we show that the set of stable spacings is dictated by the wavelength of the periodic wake structure. The forces maintaining the pair cohesion are characterized by applying an external force to the follower to perturb it away from the `stable wells'. These results show that hydrodynamics alone is sufficient to induce cohesive and coordinated collective locomotion through a fluid, and we discuss the hypothesis that fish schools and bird flocks also represent stable modes of motion.

  6. Analysis of non-symmetrical flapping airfoils

    Institute of Scientific and Technical Information of China (English)

    W.B.Tay; K.B.Lim

    2009-01-01

    Simulations have been done to assess the lift, thrust and propulsive efficiency of different types of nonsymmetrical airfoils under different flapping configurations. The variables involved are reduced frequency, Strouhal number, pitch amplitude and phase angle. In order to analyze the variables more efficiently, the design of experiments using the response surface methodology is applied. Results show that both the variables and shape of the airfoil have a profound effect on the lift, thrust, and efficiency. By using nonsymmetrical airfoils, average lift coefficient as high as 2.23 can be obtained. The average thrust coefficient and efficiency also reach high values of 2.53 and 0.6 I, respectively. The lift production is highly dependent on the airfoil's shape while thrust production is influenced more heavily by the variables. Efficiency falls somewhere in between. Two-factor interactions are found to exist among the variables. This shows that it is not sufficient to analyze each variable individually. Vorticity diagrams are analyzed to explain the results obtained. Overall, the S1020 airfoil is able to provide relatively good efficiency and at the same time generate high thrust and lift force. These results aid in the design of a better omithopter's wing.

  7. Does phosphodiesterase inhibition lessen facial flap necrosis in tobacco cigarette users?

    Science.gov (United States)

    Pfaff, Miles; Shah, Ajul; Steinbacher, Derek

    2014-02-01

    Tobacco cigarette smoking remains a serious risk factor for necrosis of local facial skin flaps. To date, no pharmacological therapies exist for cigarette smoke-induced impairment of skin flap tissue survival. Accumulating evidence suggest that phosphodiesterase-5 (PDE-5) inhibitor therapy may counteract the negative effects of cigarette smoke on flap survival. Here, we evaluate skin flap survival in a series of consecutive tobacco cigarette users treated with the PDE-5 inhibitor, sildenafil, who underwent local flap facial reconstruction. We included 11 patients (5 females; median age: 64) with a significant smoking history. Seventeen facial flaps were performed for 14 defects. All patients received sildenafil in the postoperative setting. One complication of necrosis of the flap distal margin was encountered. Follow-up was available for all patients. Our results demonstrate that facial reconstruction in tobacco cigarette smokers can be performed with improved success and that sildenafil therapy may mitigate the deleterious effects of smoking on flap survival. PMID:24488644

  8. Functional reconstruction and evaluation of oral cavity: flap design and guideline

    Institute of Scientific and Technical Information of China (English)

    Min-Sik Kim

    2008-01-01

    @@ The radial forearm free flap is a useful reconstructive method of surgical defects after oral and oropharyngeal tumor resection. We evaluated the swallowing and speech outcomes of radial forearm free flap reconstruction for oral and oropharyngeal cancers.

  9. Microsurgical reconstruction of oncological scalp defects in the elderly.

    Science.gov (United States)

    Simunovic, Filip; Eisenhardt, Steffen U; Penna, Vincenzo; Thiele, Jan R; Stark, G Björn; Bannasch, Holger

    2016-07-01

    The incidence of scalp tumors requiring radical excision increases with age. Free flap surgery is the standard reconstructive option for large defects; however, there is an ongoing uncertainty about its safety in the elderly. We conducted a review of data and report on 19 patients aged ≥75 years and 13 surgery, size of defect, flaps used, and prevalence of complications were analyzed. The patients in the elderly group had more accompanying medical conditions and a higher ASA score. Squamous cell carcinoma was the predominant tumor in the elderly and sarcoma in the younger patients. The defect size was similar in both groups. The latissimus dorsi (LD) and the anterolateral thigh (ALT) flaps were flaps of first choice, with temporal vessels most commonly used for anastomosis. Surgery lasted longer in the younger patients. There was no difference in the duration of hospital stay. No significant correlation was found between age and the flap-related or medical complications. Revision surgery was more often required in the younger patients. We conclude that free flap surgery is safe and reliable in the elderly population. The LD and the ALT are the most commonly used flaps. Advanced age should not be considered a risk factor for free flap surgery in these patients. PMID:27133193

  10. Phalloplasty: The dream and the reality

    Directory of Open Access Journals (Sweden)

    Mamoon Rashid

    2013-01-01

    Full Text Available Phalloplasty has come a long way as Plastic Surgery has evolved over the years. The complication ridden multistage tube pedicles popularized by Gillis were, with the advent of microsurgery, replaced by radial forearm flaps. The composite osteo-cutaneous version of this flap promised ′All for one and one for all′ assuring both a reliable urinary conduit and a phallus stiffener. Prelamination and prefabrication to make the neo-urethra came with the promise of reducing both fistula and strictures but that did not happen and flap failure rates increased. Penile stiffeners of various types have been introduced; the artificial ones were associated with high infection and failure rates and are best inserted after the neo-penis regains some sensitivity. With the introduction of perforator flaps the Anterolateral thigh flap in its sensate pedicled form has started replacing the Radial forearm free flap as the first choice flap because of a hidden donor area and lack of microsurgical expertise requirement. Being sensate it tolerates a stiffener better. It is now possible to reconstruct an aesthetically pleasing glans as well, thus meeting both the aesthetic and functional desires of the patient. Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems.

  11. Phalloplasty: The dream and the reality.

    Science.gov (United States)

    Rashid, Mamoon; Tamimy, Muhammad Sarmad

    2013-05-01

    Phalloplasty has come a long way as Plastic Surgery has evolved over the years. The complication ridden multistage tube pedicles popularized by Gillis were, with the advent of microsurgery, replaced by radial forearm flaps. The composite osteo-cutaneous version of this flap promised 'All for one and one for all' assuring both a reliable urinary conduit and a phallus stiffener. Prelamination and prefabrication to make the neo-urethra came with the promise of reducing both fistula and strictures but that did not happen and flap failure rates increased. Penile stiffeners of various types have been introduced; the artificial ones were associated with high infection and failure rates and are best inserted after the neo-penis regains some sensitivity. With the introduction of perforator flaps the Anterolateral thigh flap in its sensate pedicled form has started replacing the Radial forearm free flap as the first choice flap because of a hidden donor area and lack of microsurgical expertise requirement. Being sensate it tolerates a stiffener better. It is now possible to reconstruct an aesthetically pleasing glans as well, thus meeting both the aesthetic and functional desires of the patient. Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems. PMID:24501465

  12. Identification of hyperelastic properties of passive thigh muscle under compression with an inverse method from a displacement field measurement.

    Science.gov (United States)

    Affagard, Jean-Sébastien; Feissel, Pierre; Bensamoun, Sabine F

    2015-11-26

    The mechanical behavior of muscle tissue is an important field of investigation with different applications in medicine, car crash and sport, for example. Currently, few in vivo imaging techniques are able to characterize the mechanical properties of muscle. Thus, this study presents an in vivo method to identify a hyperelatic behavior from a displacement field measured with ultrasound and Digital Image Correlation (DIC) techniques. This identification approach was composed of 3 inter-dependent steps. The first step was to perform a 2D MRI acquisition of the thigh in order to obtain a manual segmentation of muscles (quadriceps, ischio, gracilis and sartorius) and fat tissue, and then develop a Finite Element model. In addition, a Neo-Hookean model was chosen to characterize the hyperelastic behavior (C10, D) in order to simulate a displacement field. Secondly, an experimental compression device was developed in order to measure the in vivo displacement fields in several areas of the thigh. Finally, an inverse method was performed to identify the C10 and D parameters of each soft tissue. The identification procedure was validated with a comparison with the literature. The relevance of this study was to identify the mechanical properties of each investigated soft tissues. PMID:26602374

  13. Oncocin Onc72 is efficacious against antibiotic-susceptible Klebsiella pneumoniae ATCC 43816 in a murine thigh infection model.

    Science.gov (United States)

    Knappe, Daniel; Adermann, Knut; Hoffmann, Ralf

    2015-11-01

    Oncocins and apidaecins are short proline-rich antimicrobial peptides (PrAMPs) representing novel antibiotic drug lead compounds that kill bacteria after internalization and inhibition of intracellular targets (e.g. 70S ribosome and DnaK). Oncocin Onc72 is highly active against Gram-negative bacteria in vitro and in vivo protecting mice in systemic infection models with Escherichia coli and KPC-producing Klebsiella pneumoniae. Here we studied its efficacy in a murine thigh infection model using meropenem as antibiotic comparator that had a 44-fold higher molar in vitro activity than Onc72. Male CD1 mice were rendered neutropenic using cyclophosphamide for four days before intramuscular infection with K. pneumoniae ATCC 43816. After 75 min oncocin Onc72 or the antibiotic comparator meropenem were administered subcutaneously with 100 mg (43 µmol) and 25 mg (65 µmol) per kg of body weight, respectively, six times every 75 min. Onc72 and meropenem administered subcutaneously reduced the thigh tissue burden of K. pneumoniae ATCC 43816 in neutropenic mice significantly by 4.14 and 4.65 a log10 cfu/g, respectively. The bacterial counts were ∼0.5 and ∼1 log10 below the pre-treatment burden, respectively, indicating bactericidal effects for both compounds. Thus, Onc72 was as efficacious as meropenem in vivo despite its much lower in vitro activity determined according to CLSI standard antimicrobial activity tests. PMID:25968331

  14. Cardiac and Vascular Responses to Thigh Cuffs and Respiratory Maneuvers on Crewmembers of the International Space Station

    Science.gov (United States)

    Hamilton, Douglas; Sargsyan, Ashot E.; Garcia, Kathleen; Ebert, Douglas; Whitson, Peggy A.; Feiveson, Alan; Alferova, Irina V.; Dulchavsky, Scott A.; Matveev, Vladimir P.; Bogomolov, Valery V.; Duncan, J. Michael

    2011-01-01

    The transition to microgravity eliminates the hydrostatic gradients in the vascular system. The resulting fluid redistribution commonly manifests as facial edema, engorgement of the external neck veins, and a decrease in leg diameter. This experiment examined the responses to modified Valsalva and Mueller maneuvers measured by cardiac and vascular ultrasound (ECHO) in a baseline steady state and during preload reduction introduced with thigh occlusion cuffs used as a counter-measure device (Braslet cuffs) measured by cardiac and vascular ultrasound examinations. Methods: Nine International Space Station crewmember subjects (Expeditions 16 - 20) were examined in 15 experiment sessions 101 +/- 46.days after launch (mean +/- SD; 33 - 185). Twenty Seven cardiac and vascular parameters were obtained with/without respiratory maneuvers before and after tightening of the Braslet cuffs. Results: Non-physicians performed diagnostic-quality cardiac and vascular ultrasound examinations using remote guidance. Three of 27 combinations of maneuvers and Braslet or Braslet alone were identified as being significant changed when compared to baseline. Eleven of 81 differences between combinations of Mueller, Valsalva or baseline were significant and related to cardiac preload reduction or increase in lower extremity venous volume. Conclusions: Acute application of Braslet occlusion cuffs causes lower extremity fluid sequestration and exerts commensurate measurable effects on cardiac performance in microgravity. Ultrasound techniques to measure the hemodynamic effects of thigh cuffs in combination with respiratory maneuvers may serve as an invaluable tool in determining the volume status of the cardiac patient at the 'microgravity bedside'.

  15. Variability in the characteristics of fresh meat and thighs in relationship to genetic type of the heavy pig

    Directory of Open Access Journals (Sweden)

    Edi Piasentier

    2010-01-01

    Full Text Available The variability in the characteristics of fresh meat and thighs in relationship with genetic type was studied on 22 lots of heavy pigs, comprising 615 female and castrated males, randomly chosen during slaughtering in groups of 20 to 30 animals per lot. Four different genetic types reared for the production of the San Daniele dry-cured ham PDO were considered: two traditionals (Large White or Duroc x (Landrace x Large White and two industrial hybrids (GOLAND and DANBRED. Fresh meat samples from longissimus dorsi muscle were collected to perform chemical and physical analysis. The right trimmed thighs were used to evaluate some morphological parameters along with weight losses during seasoning. The genetic type confirmed its important influence on pig carcass, meat and ham quality. The two industrial types, DANBRED in particular, tended to present a lower back fat values and a leaner carcass than the two Italian genetic types. Within the most important characteristics for the production of dry cured hams (subcutaneous fat thickness and seasoning losses the highest differences were found among the industrials genetic types, which cannot be simply considered as an undifferentiated homogenous group.

  16. TRAM flap in reconstructive operations in patients with breast cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhaev

    2015-01-01

    Full Text Available The treatment of breast cancer (BC is a relevant problem. Surgery is a key treatment method for BC. The volume of its operations varies from radical mastectomies to lumpectomies and, in the areas of regional metastases, from three-level lymphadenectomy to sentinel lymph node biopsy. Objective: to assess whether a displaced TRAM flap may be used for reconstructive operations for BC. The paper presents some experience in treating 11 BC patients in whom a displaced TRAMP flap was employed for reconstruction. At this time, the displaced TRAM flap was applied for delayed reconstruction in 3 patients. The mean age of the patients was 45.5 ± 15.7 years. In 8 BC patients undergoing one-stage reconstruction with a displaced TRAM flap, the treatment schedule was as follows: surgical treatment in 1 patient, combined treatment in 2 patients, and multimodality treatment in 5. The patients received targeted therapy in 3 cases or hormone therapy in 6. A lower abdominal skin-and-fat flap on one vascular pedicle was used in all the 11 patients.Indications for using a displaced TRAM flap were determined; complications were analyzed. The percentage of complications due to the use of a displaced TRAM flap was 9.1 % in our study.To reduce the rate of complications after breast reconstruction with a displaced TRAM flap, we carefully selected patients for this choiceof a plastic component. The displaced TRAM flap is one of the variants for delayed breast reconstruction despite its duration and complexity. Corrective surgery is further used to achieve breast symmetry. Corrective operations, namely, breast liposuction and submammary fold formation, were performed in 2 patients. For full breast recovery, the nipple-areolar complex is to be formed following skin-sparing mastectomies and delayed breast reconstructions. The cosmetic effect was evaluated in 11 patients as excellent in 4 (36.4 % cases, good in 7 (63.6 %. Neither local recurrences nor distant

  17. Combined use of waist and thigh circumference to identify high-risk, abdominally obese HIV+ patients

    Directory of Open Access Journals (Sweden)

    T O'Neil

    2012-11-01

    Full Text Available Background We examined whether the combination of waist (WC and thigh (ThC circumference improves the prediction of visceral adipose tissue (VAT over WC and ThC independently in HIV-infected men and women after correction for age. We also examined the independent associations between VAT, and the combination of WC and ThC with metabolic risk factors, metabolic syndrome, type 2 diabetes mellitus (T2DM and prior cardiovascular events in HIV-infected individuals. Methods Consecutive patients attending the metabolic clinic of the University of Modena in Italy between 2005 and 2009 were recruited in this cross-sectional study. Total and regional fat mass and lean mass were quantified using DEXA. A single CT image was taken for quantification of VAT and CAC. Prior cardiovascular events which occurred within a 5-year period of the clinical evaluation were analysed. A cross-fold test was used to explore different models in the ability to predict VAT in order to build an algorithm for VAT estimation (e-VAT. Regression analysis were performed to determine the univariate and multivariate relations between WC, ThC, and age with VAT. A comparison of beta coefficients for VAT and e-VAT to predict cardio-metabolic risk and events were performed using multivariable regression models after correction for BMI and age. Results 2322 HIV-infected patients were recruited: median duration of HIV infection was 182 months (IQR 126–236; median nadir and current CD4 were 172 (IQR 68–262 and 515.5 (IQR 369–700 and 75% of them had undetectable HIV1-VL. In this abstract only the results of men will be presented. Men (n=1481 had a mean age of 45.9±7.3 years, a BMI of 24.1 ± 3.8 kg/m2, a WC of 88.0±10.1 cm and a ThC of 47.8±4.3 cm. e-VAT algorithm for men was: (5.44*WC−(1.35*ThC−(1.70*age−348.1 In men, at multivariable regression models after correction for BMI and age, e-VAT was concordant to VAT in predicting HOMA, MetS Risk, prior cardiovascular events (OR=1

  18. Ipsilateral fasciocutaneous flaps for leg and foot defects

    Directory of Open Access Journals (Sweden)

    Bhattacharya V

    2003-01-01

    Full Text Available It was a revolutionary enhancement for lower limb reconstruction when fasciocutaneous flaps were first described and used in clinical practice in 1981. Subsequently persistent studies were made to emphasize and confirm the rich vascular network associated with deep fascia. Thereafter studies were directed to identify the various types of perforators supplying the deep fascia and the overlying subcutaneous tissue and skin. Accordingly the scientists classified these flaps keeping in mind their clinical applications. The authors of this article have also performed extensive research on various aspects. This has led to better understanding about the finer details of vascularity. Based on this various modifications have been made for safe application of reconstruction for defects extending from knee to sole. To avoid complications the clinician should be able to select the proper procedure as regards the donor site and the possible preoperative and postoperative technical faults. A well-designed and meticulously executed flap usually has smooth recovery. Both Colour Doppler and Audio Doppler are useful tools in planning a safe flap. Now these flaps have proved to be standard technique without requiring a special set up extensive training.

  19. Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap

    Directory of Open Access Journals (Sweden)

    Dushyant Jaiswal

    2015-01-01

    Full Text Available Introduction: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC transposition flap for the closure of tracheoesophageal fistula. Materials and Methods: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. Results: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. Conclusion: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.

  20. A modified bilobed flap design for nasal tip defects

    Directory of Open Access Journals (Sweden)

    Zhi-Guo Wang

    2014-06-01

    Full Text Available Aim: The correction of nasal tip defects presents many challenges. Zitelli's bilobed flap has been widely used for such repairing defects, but may be complicated by interrupted scars on the nasal dorsum. Our study evaluates the design principles, results, and advantages of a modified bilobed flap for repairing nasal tip defects. Methods: The primary lobe was located between the defect and the cheek, and the second lobe was located in the cheek. The width of the primary lobe was equal to that of the primary defect. The length of the primary lobe was 10% longer than the distance of the distal defect edge to the pivot point of the flap. The length of the second lobe was 30% longer than the distance of the distal defect edge to the pivot point of the flap. The width of the second lobe was 90%-100% of that of the primary lobe. The ability to close the defect under minimal tension, the cosmetic appearance, and any complications were evaluated. Results: This technique was performed in 34 cases; defect size ranged from 0.8 cm × 0.9 cm to 1.2 cm × 1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable. Conclusion: The modified bilobed flap can provide satisfying outcomes with lower morbidity and inconspicuous scarring. It is simple and suitable for repairing small- to medium-sized defects in the nasal tip.

  1. Differentiated Adipose-derived Stem Cells Promote Reinnervation of Rat Skin Flaps

    Directory of Open Access Journals (Sweden)

    Koichi Tomita, MD, PhD

    2013-06-01

    Conclusions: dASCs could improve flap reinnervation by 2 mechanisms: First, neurotrophic factors produced by dASCs facilitated regrowth of cutaneous axons from the surroundings of flap. Second, nerve growth factor released by dASCs induced the collateral sprouting of undamaged axons in adjacent tissues. In addition to the use of innervated flaps, dASC transplantation therapy could be a new approach to improve the sensory recovery of skin flaps.

  2. Repair of Head and Face Defects with the Use of Pericranial Flap

    OpenAIRE

    Mohammad Naeimi; Saeed Hosseini

    2011-01-01

    Introduction: The pericranial flaps' benefits have been described in many otolaryngologic, maxillofacial and plastic surgery literature. The benefits ar e due to the pericranial flaps unique characteristics including good flexibility and mobility, very rich blood supply from several arterial sources and access to sufficient bulk of the flap without any need for distant surgical sites. Using pericranial flaps to repair the local defects of the head and face region in several cases has been ...

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

    OpenAIRE

    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...

  4. Quantitative analysis of skin flap blood flow in the rat using laser Doppler velocimetry.

    OpenAIRE

    Marks, N J

    1985-01-01

    Two experiments carried out on rat skin flaps are described, where microvascular flow has been measured noninvasively by a laser Doppler velocimeter. Using this technique it is possible to define the limits of an axial pattern flap in terms of microvascular flow; this was found to increase when the flap is elevated. 'Random-pattern' perfusion is defined by a fall in flow. This recovers sequentially along the flap, and at a constant rate at all sites. A differential in microvascular perfusion ...

  5. Inferior Turbinate Flap for Nasal-side Closure of Palatal Fistula in Cleft Patients: Technical Note

    OpenAIRE

    Amin Rahpeyma; Saeedeh Khajehahmadi

    2015-01-01

    Summary: Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this pu...

  6. Use of bilateral groin flaps in the closure of defects of the perineum: A case report

    OpenAIRE

    Balakrishnan, Chenicheri; Klein, Justin D; Vashi, Christopher

    2006-01-01

    Reconstruction of perineal and groin defects is a challenging problem. Commonly used methods of reconstruction include skin grafts and local flaps. The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. Due to the location, the donor defect can usually be closed primarily, leaving an acceptable scar. The use of bilateral groin flaps for coverage of defects of the anterior perineum following...

  7. Numerical Investigation on the Propulsive Performance of Biplane Counter-flapping Wings

    OpenAIRE

    Deng, S.; Xiao, T.; Van Oudheusden, B.W.; Bijl, H.

    2015-01-01

    A numerical investigation is performed to address the flexing effect on the propulsion performance of flapping wing particularly on the counter-flapping wings of the biplane configuration. A Reynolds number of 10,000 is considered in the present study which corresponds to the flight regime of most existing flapping wing micro air vehicles. The computation involves solving the compressible unsteady Reynolds- averaged Native-Stokes equation using an inhouse developed code. The flapping motion i...

  8. High-resolution optical coherence tomography visualization of LASIK flap displacement

    OpenAIRE

    Salaroli, Camila Haydée Rosas; Li, Yan; Huang, David

    2009-01-01

    Uneventful myopic laser in situ keratomileusis (LASIK) was performed in both eyes of a 33-year-old woman. Two weeks after LASIK, examination of the left eye revealed flap striae radiating inferonasally from the superior hinge. The flap was relifted and repositioned to remove the irregular astigmatism and reduce the striae. Before the flap was relifted, Fourier-domain optical coherence tomography (FD-OCT) showed the gap at the temporal flap, which had not been detected by biomicroscopy. After ...

  9. Repair of a canine forelimb skin deficit by microvascular transfer of a caudal superficial epigastric flap.

    Science.gov (United States)

    Lewin, G A; Smith, J H

    2010-02-01

    Extensive skin loss from the forelimb of a Border collie was repaired by a microvascular caudal superficial epigastric flap, with secondary meshing of the flap to increase coverage. The caudal superficial epigastric artery and vein were anastomosed to the brachial artery and vein. End-to-end anastomosis to the brachial artery and vein did not compromise peripheral blood flow, and no flap necrosis was observed after subsequent limited meshing of the flap. PMID:20070493

  10. Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Bandholm, Thomas; Bencke, Jesper;

    2008-01-01

    BACKGROUND: Post-surgery thigh edema, loss of knee-extension strength, and reduced physical performance are common following a hip fracture. It is not known if knee-extension strength and physical performance are related to the edema and fracture type. The aim of this study was to examine the...... fracture type and thigh edema in the fractured limb (% non-fractured) to physical performances of basic mobility, postural control (sway), and isometric knee-extension strength were examined. All measures, except those of basic mobility, were conducted at the time of discharge, 8.5 days post...... fractured limb knee-extension strength deficit ([% non-fractured], r=-0.77, P<0.001), explaining between 32% and 59% of the variance (r(2)) in performances. INTERPRETATION: Our results indicate that fracture type and the corresponding thigh edema are important factors influencing physical performances after...

  11. Investigation of drag reduction through a flapping mechanism on circular cylinder

    Science.gov (United States)

    Asif, Md. Asafuddoula; Gupta, Avijit Das; Rana, M. D. Juwel; Ahmed, Dewan Hasan

    2016-07-01

    During flapping wing, a bird develops sufficient lift force as well as counteracts drag and increases its speed through different orientations of feathers on the flapping wings. Differently oriented feathers play a significant role in drag reduction during flying of a bird. With an objective to investigate the effect of installation of such flapping mechanism as a mean of drag reduction in case of flow over circular cylinder, this concept has been implemented through installation of continuous and mini flaps, made of MS sheet metal, where flaps are oriented at different angles as like feathers of flapping wings. The experiments are carried out in a subsonic wind tunnel. After validation and comparison with conventional result of drag analysis of a single cylinder, effects of flapping with Reynolds number variation, implementation of different orientations of mini flaps and variation of different interspacing distance between mini flaps are studied to find the most effective angle of attack of drag reduction on the body of circular cylinder. This research show that, installation of continuous flap reduces value of drag co-efficient, CD up to 66%, where as mini flaps are found more effective by reducing it up to 73%. Mini flaps of L/s=6.25, all angled at 30O, at the 30O angular position on the body of circular cylinder has been found the most effective angle of attack for drag reduction in case of flow over circular cylinder.

  12. Deep circumflex iliac artery (DCIA) free flap without DCIA: report of a unique case.

    Science.gov (United States)

    Jairath, David; Hage, J Joris

    2004-10-01

    The iliac crest free flap is a reliable source of cancellous bone, muscle, and skin. The vascularization of this flap arises from the deep circumflex iliac artery (DCIA) which allegedly is always present. The authors report a unique case of successful microvascular transplantation of an iliac crest osteomyocutaneous free flap in a patient in whom the DCIA and DCIV were absent. PMID:15534778

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

    International Nuclear Information System (INIS)

    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 (60Co) 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

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

    Directory of Open Access Journals (Sweden)

    Liu Fa-yu

    2011-10-01

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

  15. Flap reconstruction in the head and neck: expected appearance, complications, and recurrent disease

    International Nuclear Information System (INIS)

    Introduction: Reconstruction of large head and neck operative beds requires moving tissue from one region to another. These flaps may be rotated to cover a defect with the vascular supply intact, or the vascular supply can be transected and re-anastamosed to vessels in the operative bed. This article will review the types of flaps that have been developed to reconstruct treatment sites in the head and neck, describe the expected findings of a flap, and illustrate the appearance of flap complications, especially recurrent tumor. Methods and materials: Thirty-five patients with flap reconstruction were imaged either as a baseline study, or because of clinical suspicion for recurrent tumor. All patients had undergone resection of squamous cell carcinoma of the head and neck, with flap reconstruction. The computed tomographic (CT) and magnetic resonance (MR) images were retrospectively reviewed, with the clinical history and biopsy results, to determine the imaging findings of recurrent disease. Results: Recurrent tumor in the resection bed or flap appeared as a focal mass, usually at the interface of the operative site and the flap. Induration of the fat around the flap, or the fat within the flap, was an indirect finding associated with recurrence. Nodal recurrence, either ipsi or contralateral to the primary, was common. Conclusion: It is important to be aware of the type of flap used to reconstruct head and neck surgical defects. The expected appearance of the flap, and findings associated with recurrent disease are predictable, and are illustrated in the article

  16. Propeller Perforator Flaps in Distal Lower Leg: Evolution and Clinical Applications

    Science.gov (United States)

    2012-01-01

    Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot. PMID:22783507

  17. The Autospreader Flap for Midvault Reconstruction following Dorsal Hump Resection.

    Science.gov (United States)

    Moubayed, Sami P; Most, Sam P

    2016-02-01

    Dorsal hump reduction without adequate reconstitution of the midvault can often result in cosmetic or functional problems. One of the simplest techniques to avoid these problems is the use of the excess upper lateral cartilage to reconstruct the midvault (the spreader flap or autospreader). Herein we outline the history of the technique and present the specific indications and contraindications, as well as describe our method for achieving it successfully. Case studies are presented with the specific indications. Grafting alternatives to the spreader flap are also outlined. The spreader flap technique offers multiple advantages, including maximal use of local tissues, simplicity, and airway preservation. Disadvantages are the use of an external approach and the inability to use it alone in the presence of severe asymmetries. PMID:26862962

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

    Science.gov (United States)

    Jones, Robert; Lang, Amy

    2008-11-01

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

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

    Science.gov (United States)

    Choudhari, Meelan M.; Khorrami, Mehdi R.

    2008-01-01

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

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

    Science.gov (United States)

    Hardin, Jay C.; Martin, James E.

    1996-01-01

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

  1. On the forced flow around a flapping foil

    CERN Document Server

    Mandujano, Francisco

    2016-01-01

    The two dimensional incompressible viscous flow past a flapping foil immersed in a uniform stream is studied numerically. Numerical simulations were performed using a Lattice-Boltzmann model for moderate Reynolds numbers. The computation of the hydrodynamic force on the foil is related to the the wake structure. In particular, when the foil's centre of mass is fixed in space, numerical results suggest a relation between drag coefficient behaviour and the flapping frequency which determines the transition from the von K\\'arm\\'an (vKm) to the inverted von K\\'arm\\'an wake. Beyond the inverted vKm transition the foil was released. Upstream swimming was observed at high enough flapping frequencies. Computed hydrodynamic forces suggest the propulsion mechanism for the swimming foil.

  2. Four-winged flapping flyer in forward flight

    CERN Document Server

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

    2015-01-01

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

  3. Interaction of Two Flapping Flags in Axial Flow

    Science.gov (United States)

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

    2010-11-01

    The flapping of two parallel flags in axial low turbulence flow is investigated experimentally inside a small scale wind tunnel test section. The variables of the problem are the size and flexural rigidity of the flags, and the distance that separates the two flags. The flow velocity represents the control parameter that governs the coupling and flapping mode of the flags. Two flapping modes, in-phase and out-of-phase modes, were observed in the experiment. Image processing technique was used and the time series of a given point on the flag edge was analyzed. The stability condition of the flags was obtained and compared to the recent theoretical models. The dynamics of the coupling between the two flags is also studied.

  4. An Experimental Investigation on Flapping Flexible Membrane Wings

    Science.gov (United States)

    Hu, Hui; Abate, Gregg; Albertani, Roberto

    2008-11-01

    Thin and flexible membrane wings are unique to flying and gliding mammals, such as bats, flying squirrels and sugar gliders. These animals exhibit extraordinary flight capabilities with respect to maneuvering and agility that are not observed in other species of comparable size. In this study, comprehensive wind tunnel experiments are conducted to assess the effects of membrane flexibility (rigidity) on the aerodynamic performance of the flapping flexible membrane wings to quantify the benefits of using flexible membrane wings compared with conventional rigid wings for flapping-wing Micro-Air-Vehicle (MAV) applications. The present study is conducted from the viewpoint of aerospace engineers to try to leverage the unique feature of flexible membrane airfoils/wings found in bats and other flying/gliding mammals as an effective aerodynamic control method to explore the potential applications of such non-traditional, bio-inspired flexible membrane wings to flapping-wing MAVs to improve their flight agility and maneuverability.

  5. Bowel obstruction following deep circumflex iliac artery free flap harvesting.

    Science.gov (United States)

    Tan, Neil C-W; Brennan, Peter A; Senapati, Asha; Puxeddu, Roberto

    2009-12-01

    The deep circumflex iliac artery flap (DCIA) has been well described as an autograft flap used in head and neck reconstructions, particularly for large maxillary and mandibular defects. Complications, particularly at the donor site, have been well documented. Although it is considered a minor complication, herniation should not be underestimated as it can potentially lead to bowel obstruction, necessitating an emergency operation. We report a case of acute obstruction of the small bowel secondary to herniation at the donor site after harvesting a DCIA free flap for a maxillary defect, a complication that to our knowledge has been reported only once. We review the pathogenesis and possible ways to reduce the likelihood of developing this serious complication. PMID:19249144

  6. Detached Eddy Simulation of Flap Side-Edge Flow

    Science.gov (United States)

    Balakrishnan, Shankar K.; Shariff, Karim R.

    2016-01-01

    Detached Eddy Simulation (DES) of flap side-edge flow was performed with a wing and half-span flap configuration used in previous experimental and numerical studies. The focus of the study is the unsteady flow features responsible for the production of far-field noise. The simulation was performed at a Reynolds number (based on the main wing chord) of 3.7 million. Reynolds Averaged Navier-Stokes (RANS) simulations were performed as a precursor to the DES. The results of these precursor simulations match previous experimental and RANS results closely. Although the present DES simulations have not reached statistical stationary yet, some unsteady features of the developing flap side-edge flowfield are presented. In the final paper it is expected that statistically stationary results will be presented including comparisons of surface pressure spectra with experimental data.

  7. Chord-wise Tip Actuation on Flexible Flapping Plates

    Science.gov (United States)

    Martin, Nathan; Gharib, Morteza

    2015-11-01

    The aerodynamic characteristics of low aspect ratio flapping plates are strongly influenced by the interaction between tip and edge vortices. This has led to the development of tip actuation mechanisms which bend the tip towards the root of the plate in the span-wise direction during oscillation to investigate its impact. In our current work, a tip actuation mechanism to bend a flat plate's two free corners towards one another in the chord-wise direction is developed using a shape memory alloy. The aerodynamic forces and resulting flow field are investigated from dynamically altering the tip chord-wise curvature while flapping. The frequency of oscillation, stroke angle, flexibility, and tip actuation timing are independently varied to determine their individual effects. These results will further the fundamental understanding of flapping wing aerodynamics. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. DGE 1144469.

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

    Science.gov (United States)

    Butler, Paris D; Wu, Liza C

    2015-06-01

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

  9. Global-local optimization of flapping kinematics in hovering flight

    KAUST Repository

    Ghommem, Mehdi

    2013-06-01

    The kinematics of a hovering wing are optimized by combining the 2-d unsteady vortex lattice method with a hybrid of global and local optimization algorithms. The objective is to minimize the required aerodynamic power under a lift constraint. The hybrid optimization is used to efficiently navigate the complex design space due to wing-wake interference present in hovering aerodynamics. The flapping wing is chosen so that its chord length and flapping frequency match the morphological and flight properties of two insects with different masses. The results suggest that imposing a delay between the different oscillatory motions defining the flapping kinematics, and controlling the way through which the wing rotates at the end of each half stroke can improve aerodynamic power under a lift constraint. Furthermore, our optimization analysis identified optimal kinematics that agree fairly well with observed insect kinematics, as well as previously published numerical results.

  10. Video measurements of instantaneous forces of flapping wing vehicles

    Science.gov (United States)

    Jennings, Alan; Mayhew, Michael; Black, Jonathan

    2015-12-01

    Flapping wings for small aerial vehicles have revolutionary potential for maneuverability and endurance. Ornithopters fail to achieve the performance of their biological equivalents, despite extensive research on how animals fly. Flapping wings produce peak forces due to the stroke reversal of the wing. This research demonstrates in-flight measurements of an ornithopter through the use of image processing, specifically measuring instantaneous forces. Results show that the oscillation about the flight path is significant, being about 20% of the mean velocity and up to 10 g's. Results match forces with deformations of the wing to contrast the timing and wing shape of the upstroke and the downstroke. Holding the vehicle fixed (e.g. wind tunnel testing or simulations) structural resonance is affected along with peak forces, also affecting lift. Non-contact, in-flight measurements are proposed as the best method for matching the flight conditions of flapping wing vehicles.

  11. The Versatile Naso-Labial Flaps in Facial Reconstruction

    International Nuclear Information System (INIS)

    Surgical excision of tumors from the face may create a defect that is difficult to restore. Skin grafts can only cover superficial defects and has a natural tendency to contract and may not take properly. Also, because of the colour mismatch, it is not cosmetically identical to the face. The use of regional flaps such as the median forehead flaps are usually bulky, can not cover a wide range of facial reconstruction and usually require the donor area to be grafted. The naso-labial flaps are very useful and versatile local flaps, with robust vascularity that can be readily elevated without a delay. The flap can be superiorly based to reconstruct defects on the cheek, side wall or the dorsum of the nose, alae, collumula and the lower eye lid. Inferiorly based flaps can be used to reconstruct defects in the upper lip, anterior floor of the mouth and the lower lip. The flap can be turned over and used as a lining of the nose and the lip. Aim of the Study: In the current study we present our experience with utilization of the nasolabial flaps in facial reconstruction. We evaluated the indications, flap designs, technique, and complications. We will also assess the final functional and aesthetic results. Material and Methods: The study included 20 patients (12 males and 8 females) presented at the surgical department, National Cancer Institute (NCl) Cairo University with skin cancer at different areas of the face. Preoperative assessment includes. Assessment of the stage of the disease, the flap design and patient general condition. The mean age of the patients was 56.3±6 years (range ]6-62 years). Fifteen patients presented with basal cell carcinoma, 2 squamous cell carcinoma, one malignant melanoma, one keratoacanthoma, and one xeroderma pigmentosa. Nasal defects constituted 75% of cases, the rest were lower eye lid (2), one upper lip and one oral commisure beside a case of cheek reconstruction. There was no major complication; only one patient suffered a reactionary

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

    Directory of Open Access Journals (Sweden)

    Muhannad Alharbi, MD

    2013-11-01

    Full Text Available 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.

  13. TRAM Flap for Immediate Post Mastectomy Reconstruction: Comparison between Pedicled and Free Transfer

    International Nuclear Information System (INIS)

    Breast reconstruction after mastectomy is primarily carried out to improve the patients' quality of life. The most commonly used autologous tissue for reconstruction is the transverse rectums abdomens musculocutaneous flap (TRAM). The TRAM flap could be transferred either as pedicled or a free flap with microvascular anastomosis. The following work was carried out to evaluate the two techniques. Patients and Methods: Thirty-one female patients with operable breast cancer consented to immediate breast reconstruction during the period from June 1998 to December 2000. Fifteen patients had a free TRAM flap reconstruction. In sixteen patients, a pedicled TRAM flap was used. Three patients in the pedicled group underwent bilateral breast reconstruction. thus there were 19 pedicled flaps available for evaluation. Four patients in the pedicled flap group underwent reduction mammoplasty of the normal breast and in five other patients a bipedicled flap was used to achieve size matching with the reconstructed breast. Criteria for analysis included operative data, hospital stay, donor site morbidity. abdominal wall integrity, flap related complications, fat necrosis and final aesthetic result. There was no difference between the two groups as regards age and, operative time. The pedicled flap group had shorter hospital stay and less blood loss than the free flap group, which was statistically significant (ρ=0.007 and ρ=0.001, respectively). In the pedicled flap group, two patients (10.5%) experienced partial flap loss and fat necrosis was detected in two other patients. For the free flap group, two patients (13.3%) developed complete flap loss, but none suffered fat necrosis. Donor site morbidity was equal in both groups. The total number of complications was higher in the pedicled group (7/19) (36.8.8%) than in the free flap group (5/15) (33.3 degree 33.3 degree k) but this was not statistically significant (ρ=0.27). None of the patients in both groups developed abdominal

  14. Versatility of radial forearm free flap for intraoral reconstruction

    Directory of Open Access Journals (Sweden)

    Jeremić Jelena V.

    2015-01-01

    Full Text Available Introduction. The radial forearm free flap has an important role in reconstruction of the oncologic defects in the region of head and neck. Objective. The aim was to present and evaluate clinical experience and results in the radial forearm free transfer for intraoral reconstructions after resections due to malignancies. Methods. This article illustrates the versatility and reliability of forearm single donor site in 21 patients with a variety of intraoral oncologic defects who underwent immediate (19 patients, 90.5% or delayed (2 patients, 9.5% reconstruction using free flaps from the radial forearm. Fascio-cutaneous flaps were used in patients with floor of the mouth (6 cases, buccal mucosa (5 cases, lip (1 case and a retromolar triangle (2 cases defects, or after hemiglossectomy (7 cases. In addition, the palmaris longus tendon was included with the flap in 2 patients that required oral sphincter reconstruction. Results. An overall success rate was 90.5%. Flap failures were detected in two (9.5% patients, in one patient due to late ischemic necrosis, which appeared one week after the surgery, and in another patient due to venous congestion, which could not be salvaged after immediate re-exploration. Two patients required re-exploration due to vein thrombosis. The donor site healed uneventfully in all patients, except one, who had partial loss of skin graft. Conclusion. The radial forearm free flap is, due to multiple advantages, an acceptable method for reconstructions after resection of intraoral malignancies. [Projekat Ministarstva nauke Republike Srbije, br. 41006

  15. Paradoxical effects of heme arginate on survival of myocutaneous flaps.

    Science.gov (United States)

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

    2014-01-01

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

  16. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

    Full Text Available Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

  17. Global properties of magnetotail current sheet flapping: THEMIS perspectives

    Directory of Open Access Journals (Sweden)

    A. Runov

    2009-01-01

    Full Text Available A sequence of magnetic field oscillations with an amplitude of up to 30 nT and a time scale of 30 min was detected by four of the five THEMIS spacecraft in the magnetotail plasma sheet. The probes P1 and P2 were at X=−15.2 and −12.7 RE and P3 and P4 were at X=−7.9 RE. All four probes were at −6.5>Y>−7.5 RE (major conjunction. Multi-point timing analysis of the magnetic field variations shows that fronts of the oscillations propagated flankward (dawnward and Earthward nearly perpendicular to the direction of the magnetic maximum variation (B1 at velocities of 20–30 km/s. These are typical characteristics of current sheet flapping motion. The observed anti-correlation between ∂B1/∂t and the Z-component of the bulk velocity make it possible to estimate a flapping amplitude of 1 to 3 RE. The cross-tail scale wave-length was found to be about 5 RE. Thus the flapping waves are steep tail-aligned structures with a lengthwise scale of >10 RE. The intermittent plasma motion with the cross-tail velocity component changing its sign, observed during flapping, indicates that the flapping waves were propagating through the ambient plasma. Simultaneous observations of the magnetic field variations by THEMIS ground-based magnetometers show that the flapping oscillations were observed during the growth phase of a substorm.

  18. Scalp Rotation Flap for Reconstruction of Complex Soft Tissue Defects.

    Science.gov (United States)

    Costa, Dary J; Walen, Scott; Varvares, Mark; Walker, Ronald

    2016-02-01

    Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent anatomy of the scalp presents challenges and may limit reconstructive options. Objective To describe and investigate the scalp rotation flap as a reconstructive technique for complex soft tissue defects. Design Retrospective case series with a mean follow-up of 13 months. Setting Tertiary academic center. Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation flap reconstruction. Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane. The flap is rotated into the defect, and a split-thickness skin graft is placed over the donor site periosteum. Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient satisfaction with cosmetic outcome. Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification was 2.8. Mean defect size was 41 cm(2) (range: 7.8-120 cm(2)), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was 181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications. Three patients with previous radiation therapy had distal flap necrosis. Twenty-one patients (95%) reported an acceptable cosmetic result. Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex soft tissue defects. This can be particularly important in patients with significant medical comorbidities who cannot tolerate a lengthy operative procedure. PMID:26949586

  19. Theoretical performances of double Gurney Flap equipped the VAWTs

    Directory of Open Access Journals (Sweden)

    Horia DUMITRESCU

    2012-12-01

    Full Text Available A Gurney flap is simply a flat plate attached perpendicularly to the lower surface of an airfoil or wing trailing edge. A T-strip or double Gurney flap is attached to both the upper and lower surfaces. T-strips are used to modify the lifting characteristics of the baseline airfoil for vertical axis wind rotor turbines. Generally, T-strips have been used during developmental flight test as simple add-on “fixes” to improve the performances of existing aircraft vertical tails. This paper aims to investigate the performances of VAWTs equipped with T-strip on blades trailing edge.

  20. Non-invasive vascular imaging in perforator flap surgery

    International Nuclear Information System (INIS)

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