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Sample records for anterolateral thigh flap

  1. Neural Anatomy of the Anterolateral Thigh Flap

    OpenAIRE

    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...

  2. 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

  3. 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.

  4. 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

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

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

    2009-04-01

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

  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. Scalp Free Flap Reconstruction Using Anterolateral Thigh Flap Pedicle for Interposition Artery and Vein Grafts

    OpenAIRE

    Chin Whan Kim; Sung Hee Hong; Jong Hoon Lee; Suk Chan Eun; Kyung Hee Min; Jun Hyung Park

    2012-01-01

    We experienced satisfactory outcomes by synchronously transplanting an artery and vein using an anterolateral thigh flap pedicle between the vascular pedicle and recipient vessel of a flap for scalp reconstruction. A 45-year-old man developed a subdural hemorrhage due to a fall injury. In this patient, the right temporal cranium was missing and the patient had 4×3 cm and 6×5 cm scalp defects. We planned a scalp reconstruction using a latissimus dorsi free flap. Intraoperatively, there was a s...

  9. 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.

  10. Supercharging and Augmenting Venous Drainage of an Anterolateral Thigh Free Flap: Options and Indications

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    Frederic W.-B. Deleyiannis, MD, MPhil, MPH

    2014-04-01

    Full Text Available Summary: This study introduces the options for supercharging and augmenting venous drainage of an anterolateral thigh free flap. Clinical indications and options for additional microvascular anastomoses are reviewed in 5 consecutive patients. The indications were simultaneous mucosal and cutaneous defects, divergent mucosal defects, and extensively wide and long cutaneous defects. Three additional vascular pedicles were anastomosed: the transverse branch of the lateral circumflex (n = 3, a perforator coming directly off the superficial femoral artery (n = 1, and a posterior perforator from the profundus femoral artery (n = 1. The anastomosis of a separate pedicle from the superior, medial, and/or posterior-lateral thigh may be a useful technique when confronted with an extensive defect that may not reliably be reconstructed with a routine anterolateral thigh flap based on a single perforator.

  11. Combined Use of Anterolateral Thigh and Gluteal Fold Flaps for Complex Groin Reconstruction.

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    Fujiki, Masahide; Miyamoto, Shimpei; Arikawa, Masaki; Sakuraba, Minoru

    2015-10-01

    We present a case of an epithelioid sarcoma of the right groin in which wide resection resulted in a complex groin defect involving the full thickness of the abdominal wall and the perineum. We reconstructed the defect using a combination of pedicled anterolateral thigh (ALT) flap and gluteal fold flap. The functional and aesthetic results were satisfactory. The ALT flap with a robust iliotibial tract is the flap of choice for abdominal wall reconstruction; however, the area covered by the skin island of the flap is restricted because the skin island is tethered to the iliotibial tract. In such cases, a gluteal fold flap is ideal for an ALT flap. Therefore, using a combination of a pedicled ALT flap and a gluteal fold flap could be a reliable option for the reconstruction of a complex groin defect. PMID:26579347

  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. Reconstruction of Chopart's Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap.

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    Shimizu, Mari; Matsumine, Hajime; Takeuchi, Masaki

    2015-11-01

    A 63-year-old man dropped a metal chunk onto his left foot during his work and suffered a crush injury of the left forefoot. He underwent Chopart's amputation followed by stump coverage with sole skin at the orthopedic department on the same day. He was referred to our department for reconstruction because of poor vascularization and subsequent necrosis of tissue at the stump. After the necrotic tissue was debrided, exposure of the talus bone was noted. An artificial dermis was then applied to the stump wound, followed by local negative pressure wound therapy. After 3 weeks, the generation of a strong dermis-like tissue was observed at the site of artificial dermis grafting. We then performed flow-through free anterolateral thigh flap grafting to reconstruct the stump wound. This procedure involved suturing of the peroneal muscle group and tibialis anterior muscle, which were cut off during Chopart's amputation, and suturing the soft tissue surrounding the calcaneus firmly to the fascia lata of the anterolateral thigh flap, followed by suturing of the flap to the skin defect of the left foot. There were neither postoperative complications, such as skin ulcer and equinus/varus deformity, nor need for secondary repair of the grafted flap, so the patient was able to smoothly enter a rehabilitation program including gait training. The current reconstruction technique for the tissue defect following Chopart's amputation, consisting of artificial dermis grafting, negative pressure wound therapy, and flow-through free anterolateral thigh flap grafting, enabled safe and smooth gait rehabilitation with a forefoot prosthesis. PMID:26893983

  16. 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.

  17. 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.

  18. 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.

  19. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap.

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    Ozkan, Omer; Coşkunfirat, O Koray; Ozgentaş, H Ege

    2004-07-01

    Free anterolateral thigh flaps are a popular flap used for the reconstruction of various soft-tissue defects. From April, 2002 to June, 2003, 32 free anterolateral thigh flaps were used to reconstruct soft-tissue defects. Twenty-three of these flaps were used for lower extremity reconstruction, and nine were used for head and neck reconstruction. There were 24 male and eight female patients, with ages between nine and 82 years. The size of the flaps ranged from 11 to 32 cm in length and 6 to 18 cm in width. Five flaps required reoperation for vascular compromise in four patients and for twisting of the pedicle in another patient. While four of these were salvaged, one flap was lost due to recipient vessel problems. Musculocutaneous perforators were found in 23 cases, and septocutaneous perforators were found in nine cases. In four cases, thinning of the flap was performed. The flap was used as a flow-through type for lower extremity reconstruction in three patients. In two patients, the flap was used as a neurosensory type for foot reconstruction. Eighteen cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed primarily. In three patients, the donor areas required a partial skin regrafting procedure. No infections or hematomas were observed. Despite some variations in its vascular anatomy, the anterolateral thigh flap offers the following advantages: 1) it has a long and large-caliber vascular pedicle; 2) it has a wide, reliable skin paddle; 3) it may be harvested as a neurosensory flap; 4) it can be harvested whether its pedicle is septocutaneous or musculocutaneous; 5) it can be designed as a flow-through flap; 6) it can be elevated as a thin or musculocutaneous flap; and 7) the procedure can be performed by two teams working simultaneously, and no positional changes are required.

  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. 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

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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Microvascular reconstruction of the tongue using a free anterolateral thigh flap: Three-dimensional evaluation of volume loss after radiotherapy.

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    Tarsitano, Achille; Battaglia, Salvatore; Cipriani, Riccardo; Marchetti, Claudio

    2016-09-01

    The goal of tongue microvascular reconstruction is to maximise oral function with less morbidity while preserving speech and swallowing. This kind of reconstruction often requires a bigger flap volume than is actually needed to repair the defect. This is because every reconstructive flap is subject to a shrinking process due to oedema reduction and differences among individual tissue healing processes. Moreover, patients with advanced cancers often need adjuvant radiation therapy, which can result in further flap volume loss. For these reasons, we designed this study to assess the three-dimensional flap volume loss after tongue reconstruction using an anterolateral thigh flap (ALTF). Our aim was to analyse the effects of radiotherapy on flap volume loss. The volume of ALTF was evaluated using the following protocol: an initial (T1) post operative magnetic resonance imaging (MRI) scan was acquired between 3 and 8 weeks after the reconstructive procedure; a second (T2) MRI scan was obtained 6 months later; and a third (T3) MRI scan was performed 1 year after the end of treatment. Three-dimensional flap contouring was carried out, with outlining of the graft margin and comparison of its tissue density with that of the surrounding structures. Flap volume was calculated using dedicated software. In total, 20 patients who satisfied the inclusion criteria were enrolled. Adjuvant radiation therapy was administered in 11 of the 20 patients. In the patients treated with postoperative radiotherapy, the mean flap volume loss was 16.5 cm(3). The patients who were not irradiated postoperatively showed a mean flap volume loss of 6.9 cm(3); this difference was statistically significant (p = 0.041). Our study indicated that 12 months after the end of treatment, patients reconstructed with an anterolateral thigh free flap had an average volume loss of 44.2% if treated with radiotherapy, whereas an average flap shrinkage of 19.8% occurred in patients who did not undergo

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

    OpenAIRE

    Aditya Aggarwal; Hardeep Singh; Sanjay Mahendru; Vimalendu Brajesh; Sukhdeep Singh; Srinivasan Krishnan; Rakesh Kumar Khazanchi

    2016-01-01

    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...

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

    OpenAIRE

    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...

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

    Institute of Scientific and Technical Information of China (English)

    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.

  7. 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

  8. Application of anterolateral thigh perforator flap for repair of soft tissue defect of the hand%股前外侧穿支皮瓣修复手部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    张兴奎; 李虎; 夏勇; 王彬; 张桂红; 唐阳平; 苗峰; 丁桂友; 张亮; 董中洋; 郭彬; 马晓辉

    2012-01-01

    目的 探讨应用游离修薄股前外侧穿支皮瓣修复手部软组织缺损的临床效果.方法 对28例手部软组织缺损创面,采用股前外侧皮瓣游离移植修复.术中切取游离皮瓣至仅剩血管蒂相连时,修薄皮瓣,从外周至血管皮支穿出点附近按次序阶梯样修剪,保留穿出点周围1.5~2.0cm组织不予修剪,同时观察皮瓣血供,防止穿支损伤,皮瓣修薄后游离移植修复手部创面.结果 28例皮瓣全部存活.25例获得3~ 12个月的随访,3例失访.术后皮瓣质地柔软,弹性好,无臃肿,肤色接近正常皮肤,恢复部分感觉功能,手功能及外形恢复良好.结论 修薄股前外侧穿支皮瓣是股前外侧皮瓣的改进,皮瓣存活后疗效满意,是修复手部创面的理想方法之一.%Objective To explore the application of free anterohteral thigh perforator flap in repairing soft tissue defects of the hand and evaluate the clinical results.Methods Free anterolateral thigh perforator flap was transferred to repair soft tissue defects of the hand in 28 cases.During flap harvesting trimming of the flap was carried out when the flap was freed and only connected with its vascular pedicle.A step-wise defatting was done from the periphery of the flap towards the vascular pedicle with 1.5 to 2.0 cm tissue around the perforator preserved.Flap circulation was carefully observed to prevent damage to the perforators.The vascular pedicle was then disconnected and the flap transferred to the hand to cover the defect.Results All the 28 flaps survived.Twenty-five cases were follow-up for 3 to 12 months,while 3 cases were lost to follow-up.The flaps were supple and elastic with near normal color.There was no bulkiness.Partial sensation was restored.The function and appearance of the hand were good.Conclusion The thin anterolateral thigh perforator flap is an improvement of the traditional anterolateral thigh flap.The survived flaps are ideal in terms of covering hand defects and

  9. 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.

  10. Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection%股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损

    Institute of Scientific and Technical Information of China (English)

    徐中飞; 代炜; 张恩礁; 段维轶; 刘法昱; 谭学新; 黄绍辉; 秦兴军; 孙长伏

    2012-01-01

    PURPOSE; To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator -based chimeric anterolateral thigh (ALT)flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d- LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cmx4cm to 16cmx7cm and muscular flap was 3cm x4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications (fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet therequirements of

  11. 健侧胫后血管皮瓣桥供血的股前外侧游离皮瓣在小腿开放性骨折治疗中的应用%Clinical applications on anterolateral thigh free flap transfer bridged by posterior tibial vascular flaps from the healthy leg

    Institute of Scientific and Technical Information of China (English)

    张大伟; 祝勇刚; 李军; 赵广跃; 裴国献

    2015-01-01

    目的:探讨小腿软组织缺损合并受区血管损伤无法作为供血血管时游离皮瓣移植的解决办法。方法设计以健侧胫后血管为轴心的舌形皮瓣,卷成皮管,作为血管蒂而携带游离皮瓣移植修复,将双下肢固定于平行位置。结果采用健侧胫后血管形成顺行皮管桥携带游离皮瓣移植修复伤肢创面缺损15例,皮瓣全部成活,创面修复。在双下肢固定于平行位置(并腿)的情况下,术后较易进行皮瓣观察、换药和功能锻炼。结论采用并腿方式固定双下肢,以健侧肢体胫后血管向游离股前外侧皮瓣供血,是解决患侧肢体大面积软组织缺损合并主干血管严重损伤的一种理想修复方法。%Objective To provide a clinical method in the treatment of soft tissue defect in lower extremities by anterolateral thigh free flap transfer in cases without usable blood vessels in receiving areas. Methods Posterior tibial vascular flaps were designed as supplying blood vessel pedicles to carry anterolateral thigh free flaps for soft tissue defect repair. Both lower extremities were fixed in a parallel style. Results Anterograde posterior tibial vascular flap with anterolateral thigh free flap transfer was applied successfully in 15 cases of lower limb defect reconstruction. All combined flaps survived, and defects were reconstructed. Compared to cross-leg flaps, it was more easier to observe blood supply of flaps, change dressing and functional exercise in parallel-leg style. Conclusions Parallel-leg style combined flap is an ideal method in free flap transfer in the cases with large soft tissue defects without usable blood vessels in the receiving area.

  12. Ⅰ期移植复合股前外侧穿支皮瓣治疗ⅢC型开放性损伤%Primary composite anterolateral thigh perforator flap transfer for treatment of Gustilo type Ⅲ C open fracture

    Institute of Scientific and Technical Information of China (English)

    王欣; 潘佳栋; 黄耀鹏; 周丹亚; 胡瑞斌; 杨科跃; 陈宏; 章伟文

    2014-01-01

    Objective To investigate the procedure techniques and clinical effects for treatment of cases on the brink of amputation with composite anterolateral thigh perforator flap (ALTP) in primary surgery.Methods From July 2008 to December 2012,9 cases on the verge of amputation received primary composite ALTP transfer to perform limb salvage surgery.All cases were Gustilo type Ⅲ C open injuries resulted from traffic accidents which involved upper extremities in 3 cases and lower extremities in 6 cases.Emergent fracture fixation was done for 5 cases; primary external fixation followed by definitive bone grafting was done for 4 cases combined with bone defects.Types of flaps consisted of flow-through ALTPs in 4 cases,chimeric ALTPs in 2 cases,flow-through + chimeric ALTPs in 2 cases,flow-through + chimeric + polyfoliate ALTP in 1 case.Size of flaps ranged from 10 cm × 6 cm-22 cm × 9 cm.Donor sites were closed primarily.Results Limb salvage succeeded for all the 9 cases.Six flaps survived uneventfully,but another 3 flaps developed tension blisters and survived eventually after stitches removing and blood-letting.Postoperative follow-up was 5-36 months.All cases achieved bone union in 4.5-8 months (mean,6.3 months).Conclusion Emergent composite ALTP transfer can not only save the limb,but also reduce the recovery time and complications and contribute to the early recovery of limb function.%目的 探讨急诊Ⅰ期移植复合股前外侧穿支皮瓣(anterolateral thigh perforator flap,ALTP)挽救濒临截肢患者肢体的手术方法与临床疗效. 方法 2008年7月-2012年12月对9例濒临截肢的患者采用Ⅰ期移植复合ALTP进行保肢手术.所有患者均为交通伤所致的GustiloⅢC型开放性损伤.上肢3例,下肢6例,其中急诊行骨折内固定5例,伴骨缺损Ⅰ期予外固定、Ⅱ期行植骨内固定4例.移植单纯桥接动脉型ALTP 4例,单纯嵌合型AL-TP 2例,桥接动脉+嵌合型ALTP 2例,桥接动脉+嵌合+分叶型ALTP 1

  13. 股前外侧盖美拉皮瓣修复手部复合型损伤的临床研究%Clinical study of chimera flap in anterolateral thigh in repairment of hand compound injury

    Institute of Scientific and Technical Information of China (English)

    王秀超

    2014-01-01

    目的:探讨并联股前外侧盖美拉组合皮瓣在修复手部复合型组织缺损的临床应用,分析相关并发症的出现原因以及处理对策。方法针对临床已治疗病例,搜集有关该术式治疗前后疗效对比数据,分析总结治疗效果,并进行探讨性分析总结。结果本研究纳入治疗的19例病例中,皮肤软组织创面皆获得良好的修复,皮瓣成活率100%,其中旋股前动脉降支并联支配的阔筋膜及部分髂胫束修复手背部肌腱组织缺损,术后手部背伸功能皆得到了一定的恢复。结论深入地了解和掌握旋股前动脉降支的生理走行及相关变异,有助于切取组合型皮瓣组织以应对由于高能量或热压致伤所导致的手部软组织复杂性缺损,该术式取得了良好的临床疗效,为手外伤的治疗提供了新思路,但其不足之处仍有待进一步探讨。%Objective To investigate the clinical application of parallel anterolateral thigh chimera flap in repair-ment of hand composite tissue defects,and analyze the causes and countermeasures of related complications. Methods For the patients who had clinical treatment,the comparative data of the surgical treatment effects before and after the opera-tion were collected,and the effects were analyzed. Results Among the 19 cases in this study,the skin and soft tissue wounds all got good repairment,the flap survival rate was 100%,where femoral artery descending branch in parallel and some disposable fascia lata hand back iliotibial tendon tissue defect repair postoperative dorsiflexion of hand functions were been some recovery. Conclusions Depth understanding and knowledge of femoral artery descending branch of physiology course and related variants,helps cut the flap tissue in response to a combination of high energy or heat injury as a result of the complexity of hand soft tissue defect,the surgery style and achieved good clinical efficacy for the treatment of hand

  14. 一期原位修薄的游离股前外侧穿支皮瓣修复足末端创面%Free anterolateral thigh perorator flap: in situ one-stage thinning for the coverage of the distal foot defects.

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 徐永清; 李军; 梅良斌; 王毅

    2011-01-01

    目的 探索一期原位修薄的股前外侧穿支皮瓣游离移植修复足远端创面缺损的可行性.方法2009年1月至2010年8月,应用游离股前外侧穿支皮瓣移植修复足终末端创面9例.术中皮瓣切取根据创面需要,或原位保留深层皮下脂肪和深筋膜于供区(6例),或保留全层脂肪和深筋膜于供区(3例).皮瓣供区直接缝合或中厚皮片植皮.平均手术时间为4.0 h.皮瓣大小为12 cm×8 cm~16 cm×10cm.结果 本组1例术后出现静脉危象,经探查后好转.其余8例愈合顺利,未有无边缘坏死,全部病例皮瓣供区植皮未出现坏死.随访3~16个月,皮瓣质地外观良好,比常规切取的游离穿支皮瓣厚度减少一半,术后双足穿同样尺码的鞋,患者无再次修薄的要求.结论应用一期原位修薄的游离股前外侧穿支皮瓣修复足终末端创面,血供可靠,外形更好,无需二期修薄.%Objective To explore the feasibility of the in situ one-stage thinning of the anterolateral thigh perforator flap for repairing the distal foot defects. Methods From Jun. 2009 to Aug. 2010, 9 cases with distal foot defects were treated with anterolateral thigh perforator flap. During the harvesting of the flap, either the deep layer of the subcutaneous fat and the deep fascia were preserved in situ (6 cases) or the whole layer of the subcutaneous fat and the deep fascia were preserved in situ (3 cases) according to the wound requirements. The donor sites were directly closed or covered with split-thickness skin grafts. The average operating time was 4.0 hours. The flap size ranged from 12x8cm~16cmxl0cm. Results One flap had vein thrombosis postoperatively and the complication was solved after the re-exploration. The other 8 flaps healed uneventfully without any marginal necrosis. There was no skin grafts loss on the donor sites. At a 3~16 months follow up, the flaps took well with good contours. The thickness of these flaps was half of those harvested with

  15. Preparation method and application value of anterolateral thigh free-style perforator flap on reconstruction of oral and maxillofacial defects%股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值

    Institute of Scientific and Technical Information of China (English)

    黄磊; 白植宝; 吴晓琴

    2015-01-01

    ObjectiveTo study the preparation method and application value of anterolateral thigh free-style perforator flap on reconstruction of oral and maxillofacial defects.Methods 86 patients with oral and maxillofacial defects, who were diagnosed and treated in our hospital, were selected and were divided into two groups according to random number table. To compare the treatment effect between control group of 43 patients who were treated with anterolateral thigh flap preparation technology, and observation group of 43 patients who were treated with anterolateral thigh free-style perforator flap preparation technology. Results The operation time and donor site healing time in observation group were obviously shorter than which in control group, the incision length in observation group was obviously less than which in control group, the transplantation effect in observation group was obviously better than which in control group, the incidence of flap greyish white, increased tension, local edema, donor site pain, muscle herniation, wound dehiscent, long dated lower-limb muscular strength weakness were obviously lower in observation group than which in control group, the good recovery rate of shape, speech, swallowing function were obviously higher than which in control group, the differences were statically significant(P<0.05).Conclusion Anterolateral thigh free-style perforator flap preparation technology applied on reconstruction of oral and maxillofacial defects has better treatment effect and higher safety, is worthy of clinical popularization and application.%目的:探讨股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值。方法选取本院2008年5月~2014年10月诊治的口腔颌面部缺损患者86例,采用随机数字表法分为两组,43例患者采用传统股前外侧皮瓣制备术治疗为对照组,43例患者采用股前外侧free-style穿支皮瓣制备术治疗为观察组,比较

  16. 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

  17. 股前外侧岛状皮瓣联合自体中厚皮片游离移植治疗阴茎阴囊广泛Paget病切除后大面积皮肤破损的疗效分析%Use of anterolateral thigh flap and split-thickness skin grafting for soft tissve defectionof massive penoscrotal Paget's disease

    Institute of Scientific and Technical Information of China (English)

    徐衍盛; 周宇; 李峰永

    2014-01-01

    Objective To evaluate the effectiveness of using the anterolateral thigh flap and splitthickness skin grafting to repair large skin defect secondary to the excision of massive penoscrotal Paget's disease.Methods Clinical data of 6 patients with massive penoscrotal Paget's disease were retrospectively reviewed.The patients were admitted to our institute from Feb.2005 to Oct.2010 with mean age of 64 (55-68) years.No other neoplasm and enlarged inguinal lymph node were detected on physical examination,ultrasonography and CT scan.All cases underwent wide local excision of skin lesion which was taken 2 cm beyond the boundary under epidural anesthesia.An anterolateral thigh flap was used to reconstruct the scrotum,and the skin defect of penis was repaired by split-thickness skin grafting.Results Operation was uneventful for the 6 patients,with mean skin defect of 185 (150-210) cm2.The mean operative duration was 270 (210-300) min,and the mean blood loss was 75 (35-150) ml.Negative surgical margins were confirmed on postoperative pathology.Five patients recovered smoothly with satisfying cosmetic appearance,and one patient demonstrated partial necrosis of the flap which was repaired on secondary surgery.The mean follow-up was 37 (10-60) months,and no relapse was found.Conclusions It is an effective method to use anterolateral thigh flap and split-thickness skin grafting to repair large skin defect secondary to excision of massive penoscrotal Paget's disease.%目的 探讨应用股前外侧岛状皮瓣联合自体中厚皮片游离移植修复阴茎阴囊广泛Paget病切除后大面积皮肤缺损的疗效.方法 回顾性分析2005年2月至2010年10月收治的6例阴茎阴囊广泛Paget病患者的临床资料.年龄55~68岁,平均64岁 查体及B超、CT等辅助检查未发现其他恶性肿瘤存在,腹股沟未触及肿大淋巴结.患者均在硬膜外麻醉下接受扩大病灶切除术,切除范围超过病变边缘2 cm,用股前外侧岛状皮瓣重建阴

  18. Transplantation of the free anterolateral thigh flap combined with iliotibial band for reconstruction of children's soft tissue defects at foot and ankle%股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    胡锐; 任义军; 严立; 李凡; 韩琼; 程文俊; 勘武生

    2014-01-01

    目的 探讨游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损的临床效果. 方法 2008年1月至2013年1月,采用游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损并重建功能共25例.创面缺损部位足跟部12例,足背部8例,内踝3例,外踝2例;所有患者均伴有不同程度骨折或脱位,且合并有跟腱、足背伸肌腱、内外踝侧副韧带等软组织缺损,软组织缺损髂胫束重建长度3 ~ 16 cm;游离股前外侧皮瓣面积8 cm×5 cm~ 18 cm×12 cm.所有病例术后2周皮瓣成活后在支具保护下行早期康复训练.结果 术后随访6 ~ 24个月,平均14个月;皮瓣全部成活,仅2例皮瓣远端小面积坏死,经换药等治疗愈合;创面愈合时间12~24 d,平均15.1d;术后按Thermann量表功能评定,14例为优,9例为良,可2例,优良率92%.结论 游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损并重建功能,是安全有效的策略,其供区损伤小,缩短治疗周期,能减轻患儿痛苦.%Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were

  19. 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

  20. 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

  1. 带髂胫束的股前外侧皮瓣游离移植修复膝关节周围皮肤软组织合并髌韧带缺损疗效观察%Repair of skin and soft tissue defects around the knee joints combined with patellar ligament defects using free anterolateral thigh flaps with iliotibial tracts

    Institute of Scientific and Technical Information of China (English)

    韩夫; 胡大海; 刘洋; 于洪亮; 马少军; 魏国兴; 郑朝

    2015-01-01

    Objective To observe clinical efficacy of using free anterolateral thigh flaps with iliotibial tracts in repairing skin and soft tissue defects around the knee joints with patellar ligament defects.Methods Twelve patients with skin and soft tissue defects around the knee joints and patellar ligament defects were hospitalized from June 2010 to June 2014.The defects of skin and soft tissue ranged from 7 cm × 6 cm to 16 cm × 12 cm in area, and patellar ligament ranged from 5 to 12 cm in length and 2.5 to 4.0 cm in width.Free anterolateral thigh flaps with iliotibial tracts were used to repair these defects.During reconstruction of patellar ligament, both ends of iliotibial tract were successively folded to form tendon-like threelayer structure at first, and then the newly formed structure was wrapped around the broken ends of patellar ligament and fixed with suture.The flap size ranged from 9 cm ×8 cm to 18 cm × 14 cm.The iliotibial tract ranged from 7 to 14 cm in length and 8 to 12 cm in width.The donor sites were closed by grafting with autologous split-thickness skin harvested from thigh or trunk, and parked with gauze.Immediately after operation, the knee joints were fixed in extension with orthosis for 6 weeks.Weight bearing training of affected limbs being kept in extension position was started from 2 weeks after operation, and flexion and extension exercise of affected knee joints was begun from 6 weeks after operation.Before operation and 12 months after operation, the degree of pain around the knee joints and knee joint function were evaluated with the interna tional knee documentation committee knee uation form, and the ranges of flexion and extension of knee joints were also evaluated.The integrity of reconstructed patellar ligament was assessed by color Doppler ultrasound from 6 to 12 months after operation.The occurrence of surgery-related complications was observed in all patients within 12 months after operation.Results (1) After operation, all

  2. 股前外侧free-style穿支皮瓣在口腔颌面部缺损修复重建中的应用%Application of vascularized anterolateral thigh perforator flap harvested with free-style approach in oral and maxillofacial reconstruction

    Institute of Scientific and Technical Information of China (English)

    陈洁; 蒋灿华; 尹乒; 杨龙; 吴晓珊; 黄龙; 翦新春

    2015-01-01

    目的 探讨股前外侧free-style穿支皮瓣的制备方法及其在口腔颌面部缺损修复重建中的应用价值. 方法 2013年8月-2014年5月,采用free-style手术方式制备股前外侧穿支皮瓣一期修复53例口腔颌面部肿瘤根治术后缺损.术前应用手持式声学多普勒标记股前外侧供区皮肤血管穿支,并以此为中心根据受区缺损的大小和范围设计相应形状的皮瓣.术中先通过内侧的皮瓣边缘切口于阔筋膜上暴露穿支,然后逆行解剖出足够长度的血管蒂,部分病例根据受区需要于显微镜下对皮瓣进行修薄处理. 结果 53例皮瓣均移植成功,5例因修薄出现表皮剥脱,4例边缘部分坏死经清创换药后愈合.术后随访5~ 14个月,受区外形及语音、吞咽功能恢复较好.供区均一期关闭且无伤口裂开、切口瘢痕增生及远期下肢肌力下降等并发症发生. 结论 股前外侧free-style穿支皮瓣制备方法通过术前精确定位血管穿支能在最大限度保存供区美观、减少功能损害的同时达到理想的修复效果,符合现代修复重建外科微创、精细及个体化的理念.%Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in

  3. Vaginal reconstruction using perineal-thigh flaps with subcutaneous pedicle.

    Science.gov (United States)

    Chen, Z; Chen, C; Chen, M; Zhang, J; Wu, N; Wang, J

    1991-03-01

    A technique of vaginal reconstruction using bilateral, perineal-thigh flaps with subcutaneous pedicle is described. In this procedure, the flaps were raised bilaterally and introduced into an artificial space between the urinary bladder and rectum. The blood supply for the flaps flows from the perineal artery through anastomotic branches to the external pudendal artery. The authors used the technique on four patients, and all the flaps survived entirely. There was no complication. According to a more than two-year follow-up survey, the reconstructed vaginas are expansible and contract little. No stent is needed. There is good sensitivity in the wall of the artificial vagina because sensory nerves run through the flaps.

  4. 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

  5. 高频彩色多普勒超声在游离股前外侧穿支皮瓣中血管皮支定位的应用研究%Study of the application of high frequency color Doppler in skin branch blood vessel positioning in dissociative anterolateral thigh flap

    Institute of Scientific and Technical Information of China (English)

    丰波; 呼和; 王永军; 张澜; 庞有明; 牛克成

    2013-01-01

    Objective To study the distribution pattern of the perforating blood vessels, body surface positioning and haemodynamics in dissociative anterolateral thigh flap (ALTF) by making use of high frequency color Doppler technology, which will provide the reference evidence in selecting the advantage side between the two donor sides prior to surgery. Methods To test the number, caliber, starting point, traveling course, location passing through the deep fascia, mean flow rate of two-side ALFT perforating blood vessels on 30 healthy volunteers and 13 cases of surgical patients by high frequency color Doppler, and by making the comparison of the observation of perforating blood vessels during the surgery with that detected by color Doppler, statistic analysis had been conducted. Results All together 192 perforating arteries had been detected among 30 healthy people and 13 cases of patients, and among which 79.3% were myocutaneous perforator, 18.6% were septocutaneous perforator and 2.1% were direct cutaneous perforator. Perforating caliber was (1.02±0.41)mm;There was no statistic significance between left side and right side in mean flow rate of blood(P>0.05), but there was statistic significance between males and females, with higher mean flow rate among males than females(P0.05). Frequency spectrum demonstration:forward wave in contraction period, extreme slow flow rate or without blood flow in diastole period with low speed and high resistance one-way spectrum. Conclusions High frequency color Doppler can directly observe lateral femoral circumflex artery, the descending branch of the lateral circumflex femoral artery, as well as the characters of bigger perforating blood vessels in terms of number, caliber, structure of blood vessel wall, extending direction, distribution area, haemodynamics, blood vessel quality evaluation and body surface positioning. The perforating results in 13 cases of patients observed during surgeries are consistent with the detection by

  6. 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.

  7. 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

  8. Thoraco dorsal artery perforator flap for trismus release in a young girl.

    Science.gov (United States)

    Deneuve, Sophie; Qassemyar, Quentin; Blancal, Jean-Philippe; Couloignier, Vincent; Sainte-Rose, Christian; Janot, François; Kolb, Frederic

    2015-11-01

    Trismus is a frequent complication occurring after treatment of tumors of the pterygomaxillary fossa. Local flaps and full-thickness skin grafts fail to release it because they usually lead to scar contracture in previously irradiated tissues. We propose to release it with a thoracodorsal artery perforator flap, which is feasible in children like other perforator flaps. It is interesting because it is thinner than the anterolateral thigh flap and its scar may be less disgraceful and easier to hide.

  9. 带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带%The retrograde femoral anterolateral skin flap composited with iliotibial band to repair patellar composite tissue defect and rebuild the patellar ligament

    Institute of Scientific and Technical Information of China (English)

    孙中建; 徐鹏; 孙萌萌; 王晶

    2014-01-01

    目的:探讨带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带的效果。方法对2007年3月—2011年8月收治的髌前软组织并髌骨缺损的16例患者,采用带髂胫束的逆行股前外侧皮瓣移植修复并重建髌韧带,皮瓣切取范围7.5 cm×10.5 cm~8.5 cm×13.5 cm,髂胫束切取长度7.0~13.0 cm,宽度5.0~7.0 cm,随访时间6个月~3年。结果16例患者皮瓣均成活,优9例,良5例,可2例。结论带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带的方法是修复髌前软组织并髌骨缺损的一种有效术式。%Objective To discuss the effect of retrograde anterolateral thigh flap with iliotibial band to repaire prepatellar compound tissue defects and reconstruct patellofemaral ligament. Methods From March 2007 to August 2011, 16 patients of prepatellar compound tissue defects were covered in this study. All the patients were repaired and patellofemaral ligament were reconstructed by retrograde anterolateral thigh flap with iliotibial band. The flaps ranged from 7.5 cm×10.5 cm to 8.5 cm×13.5 cm, the length of iliotibial band was from 7 cm to 13 cm and the width was from 5 cm to 7 cm. All patients were followed-up from 0.5 year to 3 years. Results All the flaps survived, 9 cases completely survived, 5 cases mostly survived, 2 cases partly survived. Conclusion Retrograde anterolateral thigh flap with iliotibial band is an effective operation to repair prepatellar compound tissue defects and reconstruct patellofemaral ligament.

  10. Repair of Tissue Defects of Tendon and Skin of Back of Hand by Femoral Anterolateral Free Flap with Iliotibial Tract%带髂胫束股前外侧皮瓣游离移植修复手背组织缺损

    Institute of Scientific and Technical Information of China (English)

    陈立科; 陈四华; 吴波; 唐畅宇; 周先培

    2011-01-01

    Objective To observe the clinical outcome of repair of the tissue defects of the tendon and skin with thigh anterolateral free flap with iliotibial tract. Methods The data was reviewed from June 2006 to June 2010, which the thigh anterolateral free flap with iliotibial tract were used to repair the defects of the tendon and skin of back of hand in 12 patients. The skin flap was 7 cm×10 cm~8 cm×12 cm in area. The iliotibial tract was 7~13 cm in length and 8~10 cm in width. Institute of Hand Surgery of Chinese Medical Association was to assess the effect. The fellow-up of the 12 patients was 6 months~4 years. Results All the flaps survived after the operation. The result showed excellent in 3 patients, good in 6 and fair in 3. Conclusion It is an effective surgical method to repair the tissue defects of the tendon and skin with thigh anterolateral free flap with iliotibial tract.%目的 评定带骼胫束的股前外侧皮瓣游离移植修复手背组织缺损的疗效.方法 回顾2006年6月~2010年6月,用带髂胫束的股前外侧皮瓣游离移植修复伸指肌腱并发手背区皮肤缺损12例,皮瓣切取范围7cmx10cm~8cmx12cm.髂胫束的切取长度7~13cm,宽度8~10cm.按中华医学会手外科学会上肢功能评定标准评定疗效.随访6个月~4年.结果 后所有皮瓣均成活.优3例,良6例,可3例.结论 带髂胫束的股前外侧皮瓣游离移植是一种有效修复合伸指肌腱并手背区皮肤缺损的手术方法.

  11. 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.

  12. A Case Report on Bilateral Knee Coverage Following Septic Arthritis: Lateral Distal Thigh Island Flap and Medial Head Gastrocnemius Flap Methods

    Directory of Open Access Journals (Sweden)

    Abdolrazaghi

    2016-03-01

    Full Text Available Introduction Septic arthritis is the rheumatological and orthopedic emergency that causes the most difficulties with joints–especially knee and hip joints. The clinical symptoms include pain, swelling, inflammation, stiffness, and a limited range of motion in both active and passive joints. Debridement of the necrotic tissue is one beneficial method for septic arthritis treatment, although soft tissue defects around joints are a challenging issue for surgeons. Our purpose was to investigate the consequences of two flap surgery methods undertaken to repair soft tissue damaged during knee joint debridement caused by septic arthritis. Case Presentation This is a case report concerning a patient who had septic arthritis in the knee area and so underwent soft tissue surgery. The reconstruction methods were not the same for both knees as the lateral distal thigh island flap reparation method was used on the left knee and the medial head gastrocnemius flap method was utilized on the right. We then investigated the results and outcomes of the surgery three months later. Conclusions Lower extremity movement extent was carefully evaluated and, in respect to muscle strength, the patient was able to walk independently three months after the surgery. The patient’s balance was studied and the results showed moderate levels of stability.

  13. 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

  14. Colgajo póstero-medial de muslo (adductor: a propósito de un caso Postero-medial thigh flap (adductor flap: case report

    Directory of Open Access Journals (Sweden)

    L. Gómez-Escolar Larrañaga

    2008-12-01

    Full Text Available En pacientes con úlceras masivas o confluentes en la región glútea, puede ser necesaria la amputación de la extremidad inferior y la reconstrucción mediante colgajos totales de muslo para la cobertura del defecto. Esta técnica es muy agresiva y además de las evidentes secuelas físicas que crea puede generar importantes trastornos psíquicos para el paciente. Presentamos el caso de una paciente con una gran úlcera por decúbito en la región isquio-trocantéreosacra en la que se empleó el colgajo Adductor como alternativa a la amputación de la extremidad inferior.Amputation of the lower extremity and total thigh flaps may be necessary for coverage in patients with massive multiple or confluent sores in the buttock region. This is an aggressive technique with important physical and psychological consequences for the patient. The Adductor flap was used as an alternative of the amputation in a patient with a big ischial-trocantericsacral pressure sore.

  15. [Fasciocutaneous flap of the posterior surface of the thigh with distal pedicle. Anatomical study and surgical value. A propos of 3 cases].

    Science.gov (United States)

    Lambert, F; Cariou, J L; Couturaud, B; Bellavoir, A

    1996-04-01

    In the light of previous studies, the authors conducted an anatomical study on 21 cadaveric dissections with injection in order to define the characteristics of the distally based fasciocutaneous flap of the posterior surface of the thigh, described for the first time in 1988 by Maruyama. This leaf-shaped flap extends from the popliteal region to the gluteal sulcus. It possesses an axial arterial network derived from the popliteal artery, reinforced by the perforating arteries derived from the vessel or the profunda femoris artery. The venous return is ensured by venae comitantes and the communicating saphenous vein. The flap raising technique is described. From 1991 to 1994, 3 patients were operated in order to cover a defect of the knee (1 case) and amputation stumps (2 cases). The postoperative course was uneventful and the results were considered to be stable and of excellent quality with a follow-up of 2 to 4 years.

  16. 带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损%Clinical application of free super-thin anterolateral femoral perforator lobulated skin flap with nerve for repair of tissue defect of the foot and ankle

    Institute of Scientific and Technical Information of China (English)

    董玉金; 张铁慧; 钟声; 任远飞

    2016-01-01

    upper limb function evaluation of upper limb, the results were excellent in 22 cases, good in 9, fair in 1, with 97%(31/32) overall excellent and good rate. Conclusion The free super⁃thin anterolateral femoral perfo⁃rator lobulated skin flap with nerve is an improvement of the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering foot and ankle defects and restore function.%目的:探讨应用带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损的临床效果。方法回顾性分析2011年1月至2014年12月,采用带神经削薄的游离股前外侧穿支分叶皮瓣修复32例足踝部软组织缺损患者资料,男20例,女12例;年龄21~50岁,平均35.5岁;均为足踝背侧合并足底皮肤缺损,创面均伴有肌腱、骨或内固定外露,缺损面积12 cm×10 cm~20 cm×15 cm。采用超声多普勒确定皮瓣穿支血管部位,并以此为中心,根据缺损创面的形状及大小,设计携带股前外侧皮神经皮瓣,切取该皮瓣,保留大部分阔筋膜,游离皮瓣至仅血管蒂相连时,修薄皮瓣,从外周至血管皮支穿出点附近按次序阶梯样修剪并削除皮下脂肪,皮瓣四周皮下脂肪可完全削去,仅保留真皮层,穿出点周围1.0~2.0 cm组织不予修剪;观察皮瓣血供,防止穿支血管损伤,皮瓣修薄后,形成分叶皮瓣,移植修复足踝部创面。结果32例患者术后无一例发生血管危象,皮瓣均成活,其中1例在术后第5天出现皮瓣远端约1.5 cm×1.0 cm浅表坏死,经换药后愈合。32例患者均获得随访,随访时间6~24个月,平均13个月;术后皮瓣质地柔软,弹性好,无臃肿,肤色接近正常皮肤,感觉功能恢复良好,两点辨别觉为3.0~5.0 mm,足踝功能及外形恢复良好。根据中华医学会手外科学会上肢部分功能评定试用标准,评分为55~100分,平均90分,其中优22例,良9

  17. The free femoral anterolateral flap combined with iliotibial band to repair dorsalis pedis composite tissue defects%带髂胫束的游离股前外侧皮瓣修复足背复合组织缺损

    Institute of Scientific and Technical Information of China (English)

    孙灵通; 陈瑜; 陈娟; 朱英箭; 王曦; 朱文龙

    2015-01-01

    Objective To assess the effect on free femoral anterolateral skin flap with the iliotibial band to repair the curative effect of dorsalis pedis composite tissue defects. Methods From September 2008 to June 2011, femoral anterolateral flap transplantation with the iliotibial band to repair and toe tendon concurrent instep area skin defect in 16 cases, skin flap ranged from 6.5 cm × 9.0 cm~6.5 cm × 10.5 cm, the length of the iliotibial band was cut 7.0~11.0 cm, 6.0~9.0 cm width. According to the Chinese medical association in to the upper extremity function evaluation standard to assess efficacy. Follow-up for 6 months to 2 years. Results All flaps survived after operation. Excellent in 9 cases, good in 5 cases, fair in 2 cases. Conclusion With femoral anterolateral flap transplantation iliotibial band is an effective method to repair dorsalis pedis composite tissue defect and rebuild toe tendon surgery method.%目的:探讨带髂胫束的游离股前外侧皮瓣修复足背复合组织缺损的疗效。方法对2008年9月—2011年6月收治的16例足背复合组织缺损,采用带髂胫束的股前外侧皮瓣游离移植修复,皮瓣切取范围6.5 cm×9.0 cm~12.0 cm×22.0 cm,髂胫束的切取长度7.0~25.0 cm,宽度6.0~9.0 cm。结果术后所有皮瓣均成活。优9例,良5例,可2例,优良率87.5%。结论带髂胫束的股前外侧皮瓣游离移植修复足背复合组织缺损并重建趾伸肌腱是一种有效的手术方法。

  18. [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.

  19. 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.

  20. The use of free flaps in skull base reconstruction.

    Science.gov (United States)

    Macía, G; Picón, M; Nuñez, J; Almeida, F; Alvarez, I; Acero, J

    2016-02-01

    Skull base tumours are rare, comprising less than 1% of all tumours of the head and neck. Surgical treatment of these tumours involves the approach, the resection, and the reconstruction of the defect, which present a challenge due to the technical difficulty and anatomical complexity. A retrospective study of 17 patients with tumours involving the skull base, treated by resection and immediate reconstruction using microsurgical free flaps, is presented; 11 were men and six were women. The following types of flap were used: osteocutaneous fibula flaps, fasciocutaneous anterolateral thigh flaps, and myocutaneous latissimus dorsi flaps. The most common histology of the tumours was squamous cell carcinoma. The most frequent point of origin was the paranasal sinuses (58.8%). All of the free flaps used for reconstruction were viable. A cerebrospinal fluid fistula occurred in two patients, and in one of these cases, meningoencephalitis led to death. In conclusion, the reconstruction of large defects of the skull base after ablation requires a viable tissue that in many cases can be obtained only through the use of microvascular free flaps. The type of flap to be selected depends on the anatomical structures and size of the defect to be restored.

  1. 三种修复手部创面皮瓣的临床疗效评价%Three different flaps for coverage of soft tissue defects in the hand:a clinical evaluation

    Institute of Scientific and Technical Information of China (English)

    谢仁国; 汤锦波; 茅天; 徐静; 王古衡; 刘国峰

    2009-01-01

    Objective To evaulate the clinical results of posterior interosseous artery flap, anterolateral thigh flap and medial sural artery perforator flap for coverage of soft tissue defects in the hand and to provide useful guidance on clinical selection of flaps. Methods Twenty-three cases with soft tissue defects of the hand repaired with these three different flaps were followed up and evaluated. DASH scores, touch and pressure (Semmes-Weinstein monofllament test), 2-point discrimination (motion 2PD and static 2PD), thermal sensation, flap bulkiness and donor site contracture were recorded and analyzed statistically. Results There were no significant differences in all detected data among these three different flaps, except for flap bulkiness. The transplanted anterolateral thigh flap was much bulkier than the other two flaps. Concldusion The posterior interesseous artery flap, anterolateral thigh flap and medial sural artery perforator flap have their own characteristics. Flap selection should be evideuce-based to suit individual case and clinical requirement.%目的 比较骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣的临床疗效,为临床的皮瓣选用提供参考.方法 对应用骨间背侧动脉皮瓣、股前外侧皮瓣和腓肠内侧动脉穿支皮瓣修复手部创面的23例患者进行随访,比较分析DASH(disability of the arm,shoulder and hand)分数、损伤的部位、触觉压觉(Senunes-Weinstein单丝法)、两点分辨觉(动、静态,m2PD、s2PD)、温度觉、臃肿程度和供区瘢痕挛缩程度.结果 三种皮瓣的DASH评分、瘢痕挛缩程度、皮瓣的臃肿程度、触觉压觉、两点分辨觉和温度觉的结果 ,差异均没有统计学意义;股前外侧皮瓣的臃肿程度高于其他两种皮瓣,差异具有统计学意义.结论 三种皮瓣各有特点,临床选择应该根据各种客观要求,不要主观臆测.

  2. 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.

  3. Lateral Genicular Artery Flap for Reconstruction of a Large Knee Defect, Following Oncological Resection - Case Report.

    Science.gov (United States)

    Zbuchea, Andrei

    2016-01-01

    This article presents the case of a 53 years old patient, with ulcerated and infected dermatofibrosarcoma, extended on the anterolateral side of the left knee. The postexcisional defect, exposing patella, was covered through a regional cutaneous flap of the distal third of the thigh, upper lateral genicular artery-based, measuring 20/10 cm, together with expanded free skin split grafts, applied in proximal third of the leg and distal third of the left thigh. Surgical stages and favorable postoperative evolution are exposed. Selection of a particular surgical procedure, depending on the extent and location of the postexcisional defect, as well as therapeutic alternatives according to the literature data, are also discussed. In conclusion, the lateral genicular artery flap represents a useful surgical procedure for covering anterolateral extended defects of the knee, by bringing pliable, supple and flexible cutaneous tissue, similar to original skin, without bulk or irregularities. Moreover, this flap dissection and transposition to the defect does not involve making microsurgical vascular anastomosis. PMID:27604676

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

    Directory of Open Access Journals (Sweden)

    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.

  5. MYOCUTANEOUS FLAPS IN RECONSTRUCTION OF ORTHOPAEDIC DEFECTS : RURAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Bakane

    2015-09-01

    Full Text Available Post traumatic and post excisional full thickness tissue defects as well as exposed implants and bones after surgery are challenging to orthopedic surgeons. Management of these complex injuries become difficult if the wound closure cannot be brought primarily. A flap is a unit of tissue that may be transferred from donor to a recipient site while maintaining its blood supply. Many such type of flaps are used to cover the defects and the donor site is either closed primarily or covered by skin graft. We present our experie nce of managing post traumatic , post excisional defect at Acharya Vinoba Bhave Rural Hospital by various types of flaps such as reverse sural artery flap, gastrocnemius and anterolateral thigh flaps which have significantly reduced the morbidity and long t erm complications of the open wounds. The non - availability of expertise, experience of surgeon in the field of reconstruction and poverty are the major constraints in rural India. Our experience of three cases is discussed.

  6. 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.

  7. Nursing care of the treatment for degloving injury in foot by the combination of free femoral anterolateral skin flap transplantation and vacuum sealing drainage technique%游离股前外侧皮瓣联合负压封闭引流技术治疗全足皮肤套状撕脱伤患者的护理

    Institute of Scientific and Technical Information of China (English)

    傅育红; 朱丽萍; 莫兰

    2015-01-01

    Objective To explore the clinical nursing methods for the treatment of the skin degloving injury in foot by the combination of free femoral anterolateral skin flap transplantation and vacuum sealing drainage (VSD) technique. Methods From January 2010 to January 2014, 18 cases of the skin degloving injury in foot were treated by debridement and implant skin, negative pressure drainage and irrigation at first period, then the operation to repair the foot wound by transplant femoral anterolateral skin flap were done at second period. Nurses applied the key technology of VSD into postoperative nursing. Nurses should master the observation method and characteristics for the flow of blood to the flap skin, the method for foot position nursing, afford effective analgesic care, and flap local high flow oxygen therapy,improve the local tissue oxygen partial pressure and introduce the foot early functional exercise during postoperative. Results Eighteen cases flaps all survived. Clients were followed-up for 6 to 12 months,the discovery showed that all of the clients had good flap blood supply,the skin was soft and elastic,and the function of foot were recovered well. Conclusions The combination of of free femoral anterolateral skin flap transplantation and VSD technique apply into foot degloving injury repairation postoperative care,by application of high quality nursing, it really can improve the success rate of surgery and reduce the pain for clients.%目的:探讨游离股前外侧皮瓣联合负压封闭引流(VSD)技术治疗全足皮肤套状撕脱伤的临床护理方法。方法2010年1月至2014年1月,我院对18例全足皮肤套状撕脱伤患者采用一期清创皮肤回植,VSD加冲洗,二期行股前外侧皮瓣移植修复足部创面术,术后护理人员应用了VSD技术的护理关键,掌握皮瓣的血供观察方法与特点、足部体位的护理方法、有效的镇痛护理、皮瓣局部高流量吸氧、提高局部组织氧分

  8. Colgajo sural medial: un nuevo colgajo de perforantes para la reconstrucción del territorio maxilofacial Medial sural flap: a new flap for maxillofacial reconstruction

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    Ignacio Arribas-García

    2012-12-01

    Full Text Available Introducción: La reconstrucción microquirúrgica de defectos mucocutáneos craneofaciales se realiza con técnicas descritas desde hace muchos años y se basan fundamentalmente en el colgajo radial, el anterolateral de muslo y el lateral de brazo, entre otros. Se presenta un nuevo colgajo microvascularizado fasciocutáneo para la reconstrucción de defectos en el territorio de cabeza y cuello, el colgajo de perforantes dependiente de la arteria sural medial. Material y métodos: Se presentan 4 pacientes con carcinoma epidermoide de cavidad oral, donde se realizaron 4 colgajos dependientes de la arteria sural medial para la reconstrucción de sus defectos tras la cirugía ablativa de la lesión tumoral. Resultados: El colgajo sural medial presentó una excelente adaptabilidad y una adecuada viabilidad en todos los casos, con unos buenos resultados funcionales, estéticos y con escasa morbilidad de la zona donante. Conclusión: Se presenta una nueva técnica reconstructiva en defectos de cabeza y cuello.Introduction: Microsurgical reconstruction of craniofacial mucocutaneous defects have been performed for many years using well-known techniques, that are mainly based on flaps from the radial forearm, the anterolateral thigh and lateral arm, among others. We present the medial sural artery perforator flap, a new vascularized fasciocutaneous flap for head and neck reconstruction. Material and methods: We present four patients with oral squamous cell carcinoma. A medial sural artery flap was performed for the oral reconstruction after tumour ablation surgery. Results: The medial sural flap showed excellent adaptability and adequate viability in all cases, with good functional and aesthetic results and low donor site morbidity. Conclusion: We present a new reconstructive technique in head and neck defects.

  9. 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

  10. 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.

  11. 股外侧筋膜及前臂游离带蒂皮瓣联合即刻修复下唇全层缺损的临床研究%Clinical application of forearm free flap and lateral thigh fascia in the reconstruction of whole lower lip defect

    Institute of Scientific and Technical Information of China (English)

    阿不都克力木江·买买提; 买买提吐逊; 胡尔曼·巴合提别克; 阿迪力江·赛买提; 居来提·吐尔逊

    2015-01-01

    Objective To investigate the clinical application of forearm free flap and lateral thigh fascia in the reconstruction whole lower lip defect. Methods Combination of forearm free flap and lateral thigh fascia were used in 13 patients to reconstruct the whole lower lip defect which was caused by trauma.Microsurgery techniques was applied to vascular anastomosis,radial artery anastomized to facial artery and cephalic vein to external jugular vein. Results 13 patients with lower soft tissue defects were reconstructed with forearm arm free flap combination with lateral thigh fascia,and flaps were alive without severe complication.Only one flap showed mild distal part necrosis,and healed completely.All patients were followed up for 1-36 months,the flaps presented good quality and attachment.Patients were well satisfied with the appearance and function. Conclusion Vastus lateralis fascia and forearm free joint immediate pedicle flap to repair lower lip full-thickness defects, the appearance of repair and functional recovery is superior to other treatments.%目的:探讨前臂游离带蒂血管皮瓣及股外侧筋膜组织联合应用即刻修复下唇部软组织全层缺损的临床效果.方法:对因外伤后的下唇部软组织全层缺损的创面用前臂桡侧游离皮瓣及股外侧筋膜联合修复13例,应用显微外科技术将桡动脉与面动脉吻合,头静脉与颈外静脉吻合.结果:联合即刻修复下唇部各类全层软组织缺损13例,全部存活;1例皮瓣远端少许坏死,经换药治疗后完全愈合.术后随访1~36个月,成活的皮瓣质地优良,与基底附着良好,外观比较满意,未见塌陷下垂,功能及口角恢复良好.结论:股外侧筋膜及前臂游离带蒂皮瓣联合即刻修复下唇全层缺损(尤其双侧口角缺损),对外观修复及功能恢复优越于其他治疗方法.

  12. 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.

  13. 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

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

    Science.gov (United States)

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

    2004-02-01

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

  15. 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

  16. 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.

  17. Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee.

    Science.gov (United States)

    Kernkamp, Willem A; van de Velde, Samuel K; Bakker, Eric W P; van Arkel, Ewoud R A

    2015-12-01

    Anterolateral rotatory instability (ALRI) occurs after injury to the anterior cruciate ligament (ACL) and the anterolateral structures of the knee. We present a technique for anterolateral extra-articular soft-tissue (ALES) reconstruction of the knee that can be used in revision ACL reconstruction cases, cases of persistent ALRI after adequate ACL reconstruction, and cases with severe ALRI after primary ACL rupture. The surgeon performs ALES reconstruction with a strip of iliotibial tract autograft while respecting the anatomic origin and insertion of the anterolateral ligament. The purpose of this reconstruction is to restore the normal anterolateral rotatory stability of the knee in ALES-deficient patients. PMID:27284525

  18. The reparation of flyback avulsion injury of skin in foot by anterolateral thigh flap and sural neurovascular flap with their neural anastomosis%股前外侧皮瓣和腓肠神经营养血管皮瓣联合修复足部套状撕脱伤

    Institute of Scientific and Technical Information of China (English)

    刘勇; 裴国献; 张成进; 王成琪; 李忠; 姚旺祥; 梅良斌

    2006-01-01

    目的 探讨吻合神经的股前外侧皮瓣和腓肠神经营养血管皮瓣联合修复足部套状逆行撕脱伤的临床效果.方法 足部套状逆行撕脱伤患者14例,男10例,女4例;年龄16~58岁,平均31岁.切取带股前外侧皮神经的股前外侧皮瓣移植至足部,将股前外侧皮神经与足底内侧神经吻合,并将足底外侧神经植入股前外侧皮瓣的足底修复区;转移腓肠神经营养血管皮瓣修复足外侧部.将腓浅神经及其分支分别与腓肠内、外侧皮神经吻合.按照Swanson等制定的周围神经损伤临床疗效评定方法,将感觉分成S1~S5 5级,将感觉恢复范围分为R1(<25%)、R2(25%~50%)、R3(50%~75%)与R4(75%~100%)4级.结果 14例移植皮瓣均成活,术后外形良好.术后6个月足部感觉恢复分级:足内侧,S2 6足,S3 8足;足底,S2 9足,S3 5足;足外侧,S2 3足,S3 11足.足部感觉恢复范围:足内侧,R1 4足,R210足;足底,R1 8足、R2 6足;足外侧,R1 4足、R2 10足.术后9个月足部感觉恢复分级:足内侧,S3 7足,S4 7足;足底,S2 2足,S3 6足,S4 6足;足外侧,S3 8足,S4 6足.足部感觉恢复范围:足内侧,R2 5足,R3 8足,R4 1足;足底,R2 8足,R3 4足,R4 2足;足外侧,R2 5足,R3 7足,R4 2足.结论 吻合神经的股前外侧皮瓣和腓肠神经营养血管皮瓣联合修复足部套状逆行撕脱伤具有供区隐蔽、实用,受区感觉恢复理想的特点.

  19. The application of free flap in oral-maxillofacial defects in head and neck tumors%游离组织瓣在口腔-颌面头颈肿瘤缺损修复中的应用

    Institute of Scientific and Technical Information of China (English)

    徐家友

    2014-01-01

    Objective To investigate the free tissue flap in oral and maxillofacial surgery in head and neck cancer defects application value .Methods 154 cases of oral and maxillofacial tissue defects ,50 cases of tongue-mouth floor area defects ,13 cases of cheek palate defect ,35 cases of maxillary defect ,27 cases for the mandible , 28 cases of maxillary defects were selected .All patients underwent defect for free flap surgery oral and maxillofacial defects,of which 43 cases of forearm flap,fibula composite flap 15 cases,24 cases of diaphragmatic bone flap ,antero-lateral thigh flap flap 26 cases,free chest major muscle flap in 12 cases,15 cases of fibula flap,the other free flap, 34 patients were retrospectively analyzed the survival rate and postoperative complications .Results 154 cases of free flap,the survival rate was 96.75%.Which forearm flap survival rate was 97.67%;phrenic bone flap survival rate was 95.83%;anterolateral thigh flap survival rate was 96.15%;free pectoralis major flap survival rate was 91.67%;fibu-la flap survival was 93.33%;anterolateral thigh flap survival rate was 100.00%.Determination of the language defini-tion,154 patients,138 patients more than 90.00%clarity,while 16 patients more than 70.00%speech intelligibility. Conclusion Oral and maxillofacial traumatic tissue defects using free tissue flap reconstruction has certain safety and efficacy,the most common forearm free flap and fibula .Traumatic soft tissue defects in the early positive selection of free flap can effectively prevent tissue deformation and shift repair success rate ,postoperative language function recov-ery is good,it is worthy of clinical application .%目的:探讨游离组织瓣移植在口腔颌面头颈肿瘤缺损修复术中的应用价值。方法选择154例口腔颌面组织缺损患者,有50例为舌口底区缺损,13例为面颊腭部缺损,35例为上颌骨缺损,27例为下颌骨缺损,28例为上颌骨缺损。对所有缺损患者行游离组织

  20. 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...

  1. Liposuction-assisted medial thigh lift in obese and non obese patients

    Directory of Open Access Journals (Sweden)

    Abdelmohsen Khalaf Aboueldahab

    2013-01-01

    Full Text Available Introduction: The abdomen, thighs and buttocks are often the areas of greatest concern to patients following massive weight loss due to bariatric surgery. The typical appearance of the patient who has lost a massive amount of weight derives from a combination of factors, including gender-dependent body morphology and a change in body mass index, which lead to skin and soft-tissue excess and poor skin tone. Thigh laxity and redundancy represents a great challenge to both patients and surgeons. Not only because of the difficulty to satisfy the patients, but also due to the higher incidence of complications especially, with those obese patients who have not undergone bariatric surgery before. The problems with such patients are due to the heavy thighs that require both debulking and tight anchorage to prevent scar migration or labial distortion. Aim of the Work: The aim of the present study is to improve the aesthetic outcome and avoid the complications of medial thigh lifting with simultaneous liposuction in obese and non-obese. Patients and Methods: A total of 25 female patients presented during the period from January 2007 to July 2011 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 20 patients medial transverse thigh lift was performed, to treat medial thigh friction and laxity particularly in the upper half. Whereas, in the other five patients were suffering from upper and lower medial thigh bulkiness, vertical thigh lift was performed. Results: All patients recovered well in 2 weeks and showed improvement of thigh contour. Scar downward displacement in one patient. No skin necrosis or seroma. No labial distortion or separation encountered. Conclusion: Simultaneous liposuction and thigh lift gave good results provided proper patients selection, appropriate technique to each patient, meticulous, cautious liposuction and handling of the tissues and most importantly is the deep tight anchorage sutures to guard

  2. 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.

  3. Repair of electrical burns in the limbs with flap%四肢电烧伤创面的皮瓣修复

    Institute of Scientific and Technical Information of China (English)

    金秀; 王涛; 蒋子平; 于家傲; 路来金

    2015-01-01

    artery flap,1 case was treated by free latissimus dorsi flap,3 cases were treated by free anterolateral thigh flaps;1 case was treated by reverse island forearm posterior interosseous flap,2 cases were treated by posterior perforator reversed island flaps of the lower leg,1 case was treated by anterolateral perforator reversed island flaps of the lower leg.The area of flap was from 42.0 cm × 13.0 cm to 6.0 cm × 3.0 cm.The survival rate of the flap,the appearance and function of limb were observed.Results All these patients were followed up from 4 months to 3 years 6 months,the mean time was 6 months and 20 days.Thirty-five flaps survived completely,accounting for 92.1%,and 3 cases suffered partial necrosis at the distal end,accounting for 7.9%.Secondary healing was achieved by dress changing.The appearance of the limbs was satisfactory.Among the 28 cases whose bums were on the hands,the total number of excellent and good was 15,medium was 8,and 5 poor cases.The excellent and good rate was 57.1%.Conclusion Early repairing of the electrical burns with flaps is the effective method for protecting the deep structures of the limb,preventing and control the secondary infections and preserve the function of the limbs.

  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. Anterolateral Ligament Reconstruction Technique: An Anatomic-Based Approach.

    Science.gov (United States)

    Chahla, Jorge; Menge, Travis J; Mitchell, Justin J; Dean, Chase S; LaPrade, Robert F

    2016-06-01

    Restoration of anteroposterior laxity after an anterior cruciate ligament reconstruction has been predictable with traditional open and endoscopic techniques. However, anterolateral rotational stability has been difficult to achieve in a subset of patients, even with appropriate anatomic techniques. Therefore, differing techniques have attempted to address this rotational laxity by augmenting or reconstructing lateral-sided structures about the knee. In recent years, there has been a renewed interest in the anterolateral ligament as a potential contributor to residual anterolateral rotatory instability in anterior cruciate ligament-deficient patients. Numerous anatomic and biomechanical studies have been performed to further define the functional importance of the anterolateral ligament, highlighting the need for surgical techniques to address these injuries in the unstable knee. This article details our technique for an anatomic anterolateral ligament reconstruction using a semitendinosus tendon allograft. PMID:27656361

  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. Surgical Dissection of the Anterolateral Ligament.

    Science.gov (United States)

    Daggett, Matthew; Busch, Kyle; Sonnery-Cottet, Bertrand

    2016-02-01

    Recent investigations into the structure and function of the anterolateral ligament (ALL) have resulted in renewed interest in the role of the lateral extra-articular structures in rotational control of the knee. With increased focus on the ALL, debate about the anatomic characteristics, the functional role in knee stability, and even the existence of this lateral structure has ensued. This article describes our dissection method for the ALL. Through careful dissection and precise elevation of the iliotibial band, the ALL can be clearly identified as a distinct structure with an attachment near the lateral epicondyle on the femur and an insertion in a fan-like fashion onto the tibia, between the Gerdy tubercle and the fibular head. This investigation provides the surgeon with anatomic landmarks to use during surgical reconstruction of the ALL. PMID:27274451

  8. Rescate articular con colgajo anterolateral del muslo

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. The application of free tissue flap in simultaneous reconstruction of defects after tongue cancer resection%应用游离组织瓣同期修复舌癌切除后缺损

    Institute of Scientific and Technical Information of China (English)

    史也; 张韬; 陈永宁; 赵继志; 余立江; 石钿印; 马超

    2013-01-01

    Objective To discuss the feasibility of using free tissue flap for simultaneous tongue reconstruction after tongue cancer resection.Method Radial forearm flaps and anterolateral thigh flaps were used for simultaneous reconstruction of different defects after tongue cancer resection in 47 cases.The functional evaluation was assessed during the follow-up period of 3 months to 9 years.Results Only one flap failed,giving a success rate of 97.7%.The 36 patient available for postoperative follow-up were all able to communicate in basic languages and eat normally.Among them,normal speech was found in 34,while slurred speech was found in two.31 patients could eat normal diet,while eight could eat soft diet and two could eat liquid diet.Conclusions Simultaneous tongue reconstruction with free tissue flap is a reliable method with high successful rate.Flaps selection based on different tongue defects is the key point to achieve good functional and cosmetic results for the reconstruction tongue.%目的 探讨应用游离皮瓣行舌癌根治性切除后同期舌再造的可行性.方法 根据缺损大小不同分别对47例舌癌患者,应用前臂皮瓣和股前外侧皮瓣即时修复舌癌根治性切除后的舌缺损.术后随访3个月至9年,并对患者修复后的功能进行评价.结果 47例皮瓣中仅1例失败,其余均成活,成活率97.7%.术后36例随访患者均可进行基本正常的语言交流和进食,其中34例语音清晰,2例不清晰;31例可进普食,4例进软食,1例进流食.结论 应用游离皮瓣修复舌癌根治性切除后的舌缺损,方法可靠且成功率较高.根据缺损范围选择适合的修复方式是获得较理想的舌形态和功能的关键.

  11. Extradigital Glomus Tumor of Thigh

    Directory of Open Access Journals (Sweden)

    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.

  12. 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

  13. 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

  14. 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.

  15. Fasciocutaneous flaps

    NARCIS (Netherlands)

    D.E. Tolhurst (David)

    1988-01-01

    textabstractAbout that time the concept of independent myocutaneous vascular territories (Me Craw and Dibbell, 1977) was beginning to take hold but the deep fascia, sandwiched between muscles and the skin, was largely regarded as an isolating layer of dense, avascular fibrous tissue from which flaps

  16. 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.

  17. 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.

  18. 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.)

  19. 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.)

  20. Overview of thigh injuries in dance.

    Science.gov (United States)

    Deleget, Alison

    2010-01-01

    Thigh injuries include musculotendinous strains of the quadriceps, hamstrings, adductors, iliotibial band (ITB), and bony injuries to the shaft of the femur. There is scant information in the literature regarding thigh injuries in dance, which appear to range from 5% to 16% of total injury incidence. Hamstring strains and ITB syndrome are the most commonly reported thigh injuries. Hamstring injuries occur most frequently during slow stretching when the dancer's hip is flexed and knee extended. Uniquely in dancers, adductor injury occurs concurrently with hamstring injuries in approximately one-third of cases. Snapping of the ITB at the lateral hip and knee may result from imbalance of thigh muscle strength and flexibility. To date no quadriceps strain injuries or stress injuries to the shaft of the femur have been reported in the dance medicine literature. As dancers notoriously underestimate time needed to return to dance, it can be suggested that early return to work is a contributing factor to chronic injury. Further research is needed regarding the incidence and nature of injury to the thigh among dancers. PMID:21067687

  1. Overview of thigh injuries in dance.

    Science.gov (United States)

    Deleget, Alison

    2010-01-01

    Thigh injuries include musculotendinous strains of the quadriceps, hamstrings, adductors, iliotibial band (ITB), and bony injuries to the shaft of the femur. There is scant information in the literature regarding thigh injuries in dance, which appear to range from 5% to 16% of total injury incidence. Hamstring strains and ITB syndrome are the most commonly reported thigh injuries. Hamstring injuries occur most frequently during slow stretching when the dancer's hip is flexed and knee extended. Uniquely in dancers, adductor injury occurs concurrently with hamstring injuries in approximately one-third of cases. Snapping of the ITB at the lateral hip and knee may result from imbalance of thigh muscle strength and flexibility. To date no quadriceps strain injuries or stress injuries to the shaft of the femur have been reported in the dance medicine literature. As dancers notoriously underestimate time needed to return to dance, it can be suggested that early return to work is a contributing factor to chronic injury. Further research is needed regarding the incidence and nature of injury to the thigh among dancers.

  2. 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.)

  3. 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.)

  4. 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.)

  5. 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.)

  6. Myositis Ossificans in the Thigh of a Lacrosse Player.

    Science.gov (United States)

    Goyal, Kamal; Pettis, Christopher R; Bancroft, Ashley E; Wasyliw, Christopher W; Scherer, Kurt F

    2015-08-01

    An 18-year-old man presented with mid left thigh pain after sequential lacrosse injuries 1 month and 2 weeks prior. Physical examination was significant for a tender mass in the mid left thigh. PMID:26313164

  7. 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

  8. Distally based split vastus lateralis myocutaneous flap for reconstruction of post electrical injury defects around knee joint

    Directory of Open Access Journals (Sweden)

    Manish Zade

    2016-11-01

    Conclusions: This new flap is a reliable option for extensive soft tissue defects around knee secondary to high voltage electric burns where free flap is challenging due to deeper location of recipient vessels and damage due to burn injury. Donor area in upper thigh remains hidden and is with no functional deficit. [Int J Res Med Sci 2016; 4(11.000: 4701-4704

  9. Proximal Humerus Fracture Plating Through the Extended Anterolateral Approach.

    Science.gov (United States)

    Gardner, Michael J

    2016-08-01

    Several approaches to the proximal humerus for fracture fixation are possible. The traditional utilitarian approach to the shoulder, the deltopectoral, has distinct disadvantages when performing fracture reduction and locked plating. The anterolateral acromial approach exploits the intermuscular plane between the anterior and middle heads of the deltoid. After identifying the position of the axillary nerve as it crosses this interval, fracture reduction and fixation is performed. Direct access to both the greater and the lesser tuberosities is facilitated. The cancellous surface of the humeral head fragment provides an excellent surface for direct manipulation without further endangering the extraosseous soft tissue attachments. PMID:27441923

  10. 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.

  11. 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

  12. [Impressions on the thighs; semicircular lipoatrophy].

    Science.gov (United States)

    de Rie, M A

    1998-04-01

    An otherwise healthy woman aged 28 had symmetrical band-shaped dents on both thighs. She worked as a secretary; several female colleagues showed identical lesions. An investigation showed that the arrangement of the office equipment combined with sharp-edged desk tops caused these abnormalities. The diagnosis made read 'semicircular lipoatrophy caused by repetitive leaning against a desk'. This is probably a common problem, although it rarely leads to consultation of a dermatologist.

  13. 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

  14. 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

    • 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...... 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)

      Haitham H. Khalil

      2008-01-01

      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.

    • Cervicofacial flap revisited

      Directory of Open Access Journals (Sweden)

      Dhananjay V. Nakade

      2016-11-01

      Conclusions: Cervicofacial flap is simple, easy to operate, consume less operating time as compared to microvascular flap. It is less complicated and especially useful in diabetic, hypertensives and old debilitated patients with high risk of anaesthesia. [Int J Res Med Sci 2016; 4(11.000: 4669-4674

    • Applied anatomy of modified anterolateral approach for type C fractures of the distal femur%改良股前外侧入路治疗股骨远端C型骨折的应用解剖

      Institute of Scientific and Technical Information of China (English)

      骆松; 戴闽; 张斌; 戴江华; 聂涛; 邱平

      2013-01-01

      Objective To provide anatomic basis for treating type C fractures of the distal femur by the modified anterolateral approach of the thigh.Methods Main anterolateral muscles,ligaments were observed on 12 lower limbs of adult cadavers; the modified anterolateral approach was used,and the vessels and nerves related to the posterolateral approach were measured.Results The modified anterolateral approach could fully expose the distal femur without risk of injuring the important nerves and vessels.What's more,it did not affectthe iliotibial band and could attenuate the damage to the quadriceps femoris,which could cffectivelyprotectthe extensor mechanism of the knee joint.Conclusions The treatment of the fracture of the distal femur by the modified anterolateral approach is safe,less traumatic and and greater in exposure.it is worth of further promotion.%目的 为改良股前外侧入路治疗股骨远端C型骨折提供解剖学基础.方法 福尔马林防腐成人下肢标本12例,解剖观察大腿下段前外侧的主要肌肉、韧带的分布;采用改良前外侧手术入路,测量该入路相关的神经、血管走行特点.结果 改良股前外侧入路可充分显露股骨远端,不损伤重要神经血管,不损伤髂胫束并减少了对股四头肌的损伤,有效地保护了伸膝装置.结论 改良股前外侧入路治疗股骨远端C型骨折具有安全,损伤较小,暴露充分等优点,有一定的推广价值.

  1. Pedicled perforator flaps

    DEFF Research Database (Denmark)

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

    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 recon......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...... more practical and creative to use a free-style manner during pedicled perforator flap surgery, instead of being obliged to predefined templates for this type of procedure....

  2. Reconstruction of large skin and soft tissue defect in the front upper of tibia with free flap of anastomosis saphenous vessels%吻合隐血管的游离皮瓣修复胫前中上段大面积皮肤软组织缺损

    Institute of Scientific and Technical Information of China (English)

    周洪杰; 隋海明; 杜全红; 史永安; 迟涛胜; 丛海波

    2015-01-01

    目的 探讨游离皮瓣修复胫前中上段大面积皮肤软组织缺损时吻合受区隐血管的可行性.方法 2009年6月-2014年4月,收治伴有胫前中上段大面积皮肤软组织缺损患者16例,其中男10例,女6例;年龄24~ 56岁,平均34.5岁,经全身支持治疗并多次清创结合VSD治疗后行创面修复手术,术前均设计采用吻合隐血管的游离股前外侧皮瓣移植修复. 结果 14例按术前设计进行,2例改用吻合健侧胫后血管的交腿皮瓣修复(1例隐动脉管径过细,1例隐动脉长段损伤变性栓塞,均不适合行血管吻合),14例吻合隐血管的皮瓣全部成活,其中12例一期愈合,2例皮瓣远端尖部部分坏死,经换药后逐渐愈合.13例经过6个月~2年随访,皮瓣外观无臃肿、质地优良,软组织缺损创面修复满意. 结论 胫前中上段大面积皮肤软组织缺损的游离皮瓣移植修复可选择吻合受区隐血管.%Objective To explore the feasibility of repairing the large area skin and soft tissue defect in thefront upper of tibia by free flap with anastomosis of saphenous vessels.Methods From June,2009 to April,2014,16 cases (10 males and 6 females) of large area skin and soft tissue defect in the front upper of tibia were treatedwith free flap.The ages ranged from 24 to 56 years old,averaged of 34.5 years old.The supportive therapy and repeated debridement combined with VSD,and designed to use free anterolateral thigh flap with anastomosis of saphenous vessels before repairing operation.Results Fourteen patients accorded with preoperative design,in which 2 cases were adopted cross leg flap anastomosis posterior tibia vessels of the healthy side (1 case of saphenous artery diameter too small,and 1 case of saphenous artery long injury degeneration,unsuitable for vascular anastomosis).All 14 flaps survived,expect 2 cases were part-necrosis in the end of the flap,and gradually healed by dressing exchange.Conclusion Reconstruction of large area skin

  3. 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.

  4. 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.

  5. 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...

  6. Thigh circumference and risk of heart disease and premature death

    DEFF Research Database (Denmark)

    Heitmann, Berit L; Frederiksen, Peder

    2009-01-01

    OBJECTIVE: To examine associations between thigh circumference and incident cardiovascular disease and coronary heart disease and total mortality. DESIGN: Prospective observational cohort study with Cox proportional hazards model and restricted cubic splines. SETTING: Random subset of adults...... in Denmark. PARTICIPANTS: 1436 men and 1380 women participating in the Danish MONICA project, examined in 1987-8 for height, weight, and thigh, hip, and waist circumference, and body composition by impedance. MAIN OUTCOME MEASURES: 10 year incidence of cardiovascular and coronary heart disease and 12.5 years...... 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 below...

  7. 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...

  8. 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...

  9. Blowing Flap Experiment: PIV Measurements

    Science.gov (United States)

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

    2004-01-01

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

  10. 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

  11. 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.

  12. 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...

  13. The Versatile Modiolus Perforator Flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Thomsen, Jorn Bo

    2016-01-01

    BACKGROUND: Perforator flaps are well established, and their usefulness as freestyle island flaps is recognized. The whereabouts of vascular perforators and classification of perforator flaps in the face are a debated subject, despite several anatomical studies showing similar consistency. In our...

  14. 倒“Y”形血管吻合游离皮瓣移植在肢体创面修复与功能重建中的应用%Tissue defect repair and functional reconstruction of the limb with free flap by inverted-Y-shape microvascular anastomosis

    Institute of Scientific and Technical Information of China (English)

    任高宏; 胡稷杰; 裴国献

    2012-01-01

    Objective To discuss the clinic application and surgical technique of the free flap by inverted-Y-shape microvascular anastomosis in tissue defect repair and functional reconstruction of the limb.Methods Twenty-two flaps in 18 patients were involved in the study between June 2006 and September 2010 ( 12 cases for soft tissue defect repair with exposure of the tendons, bones or joints, and 6 cases for functional reconstruction; five cases were around the elbows and 13 cases were around the extremity of the lower limb). Before free flap graft, twelve cases with infective tissue defect were debrided extensively and covered with vacuum sealing drainage from 1 to 2 times and each time last 5 to 7 days until the granulation tissue growing well.Designed the free anterolateral thigh flaps with the transverse and descending branches of the lateral femoral circumflex vessels or free latissimus dorsi flaps with the subscapular and circumflex scapular vessels forming a inverted-Y-shape pedicle to repair the tissue defect or to reconstruct the limb function.The recipient artery was sectioned and the arterial tree of the flap was anastomosed to the recipient vessel by two end-to-end anastomoses.This inverted-Y-shape microvascular anastomosis could supply blood for both the free flap and the extremity of the limb.Not all of the veins of the recipient limb need to be cut off.Observed the circulation of the limb extremity, and evaluated the quality of flaps' survival. Results Complete flap survival was achieved in 21 flaps and without vaso-occlusive crisis; while partial flap loss in 1 case, which healed after changing dressings.The mean follow-up was 16.2 (6-36) months postoperatively,appearance of the flaps and the functions of limbs were satisfactory, and no obvious complication was found in the donor site. Conclusion The free flap by inverted-Y-shape microvascular anastomosis is a new choice for the tissue defect repair and functional reconstruction of the limb,especially for

  15. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective.

    Science.gov (United States)

    Porrino, Jack; Maloney, Ezekiel; Richardson, Michael; Mulcahy, Hyojeong; Ha, Alice; Chew, Felix S

    2015-02-01

    OBJECTIVE. A recent publication has drawn attention to the anterolateral ligament, a structure of the knee with which most radiologists are unfamiliar. We evaluate this structure on MRI; clarify its origin, insertion, meniscal relationship, and morphologic appearance; and identify its relationship with the Segond fracture. MATERIALS AND METHODS. A total of 53 routine knee MRI studies interpreted as normal were reviewed to characterize the anterolateral ligament. A further 20 knee MRI studies with a Segond fracture were assessed to determine a relationship between the fracture and the anterolateral ligament. RESULTS. In all 53 cases, a structure was present along the lateral knee connecting the distal femur to the proximal tibia, with meniscofemoral and meniscotibial components. This structure was somewhat ill defined and sheetlike, inseparable from the adjacent fibular collateral ligament proximally and iliotibial band distally. Aside from one case limited by anatomic distortion, all cases with a Segond fracture exhibited attachment of this structure to the fracture fragment (19/20 cases). CONCLUSION. An ill-defined sheetlike structure along the lateral knee exists attaching the distal femur, body of lateral meniscus, and proximal tibia. This structure has been referenced in the literature dating back to Paul Segond's original description of the Segond fracture in 1879. The structure is identifiable on MRI and appears to be attached to the Segond fracture fragment. For the radiologist, it may be best to forgo an attempt to separate this structure into discrete divisions, such as the anterolateral ligament, because these individual components are inseparable on routine MRI. PMID:25615760

  16. 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...

  17. Liposarcoma of the thigh with mixed calcification and ossification

    Directory of Open Access Journals (Sweden)

    Jeremy R. Child, MD

    2016-09-01

    Full Text Available Liposarcoma is one of the most common soft-tissue sarcomas. Calcification and ossification can occur in liposarcoma; however, the presence of both ossification and calcification is a very rare entity. We present a case of a partially calcified and ossified dedifferentiated liposarcoma of the thigh in a 76-year-old woman, which contained heterologous elements of chondrosarcoma and rhabdomyosarcoma.

  18. 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...

  19. 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...

  20. 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...

  1. Engineered Vascularized Muscle Flap.

    Science.gov (United States)

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

    2016-01-01

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

  2. 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.

  3. Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury.

    Science.gov (United States)

    Sonnery-Cottet, Bertrand; Barbosa, Nuno Camelo; Tuteja, Sanesh; Daggett, Matt; Kajetanek, Charles; Thaunat, Mathieu

    2016-02-01

    Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision. After the femoral-end loop graft is fixed, the tibial fixation of each strand is performed in full extension for optimal isometry. PMID:27274456

  4. 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.

  5. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    Science.gov (United States)

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  6. 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...

  7. Percutaneous anterolateral balloon kyphoplasty for metastatic lytic lesions of the cervical spine.

    Science.gov (United States)

    Lykomitros, Vasilis; Anagnostidis, Kleovoulos S; Alzeer, Ziad; Kapetanos, George A

    2010-11-01

    The purpose of our report is to describe a new application of kyphoplasty, the percutaneous anterolateral balloon kyphoplasty that we performed in two cases of metastatic osteolytic lesions in cervical spine. The first patient, aged 48 years, with primary malignancy in lungs had two metastatic lesions in C2 and C6 vertebrae. Patient's complaints were about pain and restriction of movements (due to the pain) in the cervical spine. The second patient, aged 70 years, with primary malignancy in stomach, had multiple metastatic lesions in thoracolumbar spine and C3, C4 and C5 vertebrae without neurological symptoms. The main symptoms were from cervical spine with severe pain even in bed rest and systematic use of opiate-base analgesic. The preoperative status was evaluated with X-rays, CT scan, MRI scan and with Karnofsky score and visual analogue pain (VAS) scale. Both patients underwent percutaneous anterolateral balloon kyphoplasty via the anterolateral approach in cervical spine under general anaesthesia. No clinical complications occurred during or after the procedure. Both patients experienced pain relief immediately after balloon kyphoplasty and during the following days. The stiffness also resolved rapidly and cervical collars were removed. VAS score significantly improved from 85 and 95 preoperatively to 30 in both patients. Karnofsky score showed also improvement from 40 and 30 preoperatively to 80 and 70, respectively, at the final follow-up (7 months after the procedure). Fluoroscopy-guided percutaneous anterolateral balloon kyphoplasty proved to be safe and effective minimally invasive procedure for metastatic osteolytic lesions of the cervical spine, reducing pain and avoiding vertebral collapse. Experience and attention are necessary in order to avoid complications.

  8. 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...

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

    Directory of Open Access Journals (Sweden)

    Sandra Olivia

    2013-07-01

    Full Text Available 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 radiographic outcomes of surgical papilla preservation flap in the area that requires aesthetic. Case 1 was a surgical incision flap with preservation of papillae on the anterior region of teeth 11 and 12, with a full veneer crown on tooth 12. Case 2 was a surgical incision flap with preservation of papillae on the posterior region of tooth 46 with inlay restoration. Evaluation for both cases were obtained by incision papilla preservation of primary closure was perfect, good aesthetic results, minimal gingival recession and the interdental papillae can be maintained properly. In conclusion, periodontal flap surgery on the anterior region or regions that require high aesthetic value could be addressed with papilla preservation incision. Incision papilla preservation should be the primary consideration in periodontal flap surgery if possible.DOI: 10.14693/jdi.v19i3.144

  10. 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.

  11. Combined Anterior and Anterolateral Stabilization of the Knee With the Iliotibial Band.

    Science.gov (United States)

    Lutz, Christian; Sonnery-Cottet, Bertrand; Imbert, Pierre; Barbosa, Nuno Camelo; Tuteja, Sanesh; Jaeger, Jean-Henri

    2016-04-01

    Interest and knowledge on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in rotational control of the knee. This article describes a technique that allows for a combined anterior cruciate ligament (ACL) and anterolateral reconstruction, using an Iliotibial band (ITB) autograft. The graft is detached from the vastus lateralis from proximal to distal, at the center portion from ITB, preserving its distal insertion on the Gerdy tubercle. Its width is 1 cm for the distal part, used for the anterolateral ligament reconstruction, and 3 cm for the proximal part. An outside-in femoral tunnel is drilled respecting both the preferred favorable isometric femoral insertion site and the femoral ACL footprint. An ACL reconstruction combined with a lateral tenodesis with a continuous ITB graft respects the anatomical and isometric rules providing superior internal rotational control of the knee in comparison with a stand-alone ACL reconstruction.

  12. Combined Anterior and Anterolateral Stabilization of the Knee With the Iliotibial Band.

    Science.gov (United States)

    Lutz, Christian; Sonnery-Cottet, Bertrand; Imbert, Pierre; Barbosa, Nuno Camelo; Tuteja, Sanesh; Jaeger, Jean-Henri

    2016-04-01

    Interest and knowledge on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in rotational control of the knee. This article describes a technique that allows for a combined anterior cruciate ligament (ACL) and anterolateral reconstruction, using an Iliotibial band (ITB) autograft. The graft is detached from the vastus lateralis from proximal to distal, at the center portion from ITB, preserving its distal insertion on the Gerdy tubercle. Its width is 1 cm for the distal part, used for the anterolateral ligament reconstruction, and 3 cm for the proximal part. An outside-in femoral tunnel is drilled respecting both the preferred favorable isometric femoral insertion site and the femoral ACL footprint. An ACL reconstruction combined with a lateral tenodesis with a continuous ITB graft respects the anatomical and isometric rules providing superior internal rotational control of the knee in comparison with a stand-alone ACL reconstruction. PMID:27354943

  13. 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.

  14. Free flap transfer for closure and interposition-arthroplasty in noma defects of the lateral face associated with bony ankylosis.

    Science.gov (United States)

    Giessler, Goetz A; Schmidt, Andreas B; Deubel, Ute; Cornelius, C-Peter

    2004-09-01

    Noma defects of the anterolateral face are often associated with fibrous or bony ankylosis fusing the mandibula to the skull base. According to the extent of the ankylosis, the temporomandibular joint mobility can be restricted or even completely frozen. In third world conditions the surgical approach to severe forms of bony ankylosis consists of a single linear opening osteotomy (trismus release) and the closure of the noma defect with locoregional flaps. Relapse of jaw immobility is common and may be caused by minor bone resection, the lack of adequate postoperative physiotherapy, or even the scarring of the defect coverage. In 4 years the authors have gained increasing experience with folded free flaps for simultaneous closure of outer and inner lining of large noma defects and the maintenance and training of re-established jaw function by the use of a dynamic external distractor fixed between the zygoma and the mandibular body. The authors report the bony reankylosis can be reduced by extended wedge osteotomies of the bony bridge and tip-like shaping of the ascending mandibular ramus. To preclude the reossification of the osteotomy site and fibrous scar formation, a dermofatty or muscular tail of the free flap is interposed into the bone gap. Two cases were treated according to this concept with a free parascapular and a latissimus dorsi flap in combination with simultaneous arthroplasty. During a 6-month follow-up period, no signs of a recurrent reduction of mandibular movement were noted in either case.

  15. Flap-Edge Blowing Experiments

    Science.gov (United States)

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

    2003-01-01

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

  16. [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

  17. 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.

  18. 14 CFR 23.701 - Flap interconnection.

    Science.gov (United States)

    2010-01-01

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

  19. 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...

  20. Radiated noise from an externally blown flap

    Science.gov (United States)

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

    1975-01-01

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

  1. 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.

  2. 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

  3. 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

  4. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    Science.gov (United States)

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation.

  5. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    Science.gov (United States)

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation. PMID:27517028

  6. 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.

  7. Thigh circumference and risk of heart disease and premature death: prospective cohort study

    DEFF Research Database (Denmark)

    Heitmann, Berit; 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 below...... 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....

  8. 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

  9. 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

  10. PIV Measurements on a Blowing Flap

    Science.gov (United States)

    Hutcheson, Florence V.; Stead, Daniel J.

    2004-01-01

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

  11. 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.

  12. 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.

  13. Do thigh circumference and mass changes alter knee biomechanics during walking?

    Science.gov (United States)

    Westlake, Carolyn G; Milner, Clare E; Zhang, Songning; Fitzhugh, Eugene C

    2013-03-01

    Obese adults walk with different biomechanics compared to healthy weight adults. Previous studies have focused on knee biomechanics because they are associated with development and progression of osteoarthritis. Changes in thigh mass and circumference that occur as body weight increases may influence gait. The purpose of this study was to determine if increases in thigh mass and circumference alter gait biomechanics. For 20 healthy weight young adults (10 male and 10 female) knee kinematic, kinetic and gait temporospatial variables were collected using a three-dimensional motion capture system and a force platform during over ground walking. Data were collected during control, increased thigh mass, increased thigh circumference, and both increased mass and circumference conditions. Increases in thigh segment parameters reflected changes expected with a 10 point increase in body mass index. Step width was wider during the added circumference and combination conditions compared to the control condition. Increases in thigh circumference associated with obesity increase step width. This suggests the greater step width observed in obese adults compared to healthy weight adults is a result of the physical constraints introduced by their wider thigh segments. Peak knee flexion angle, peak knee extension moment, peak knee adduction angle, and peak knee abduction moment were similar in all conditions. Thus, acute changes in thigh segment parameters did not result in knee biomechanics suggestive of an increased risk of knee osteoarthritis.

  14. Isokinetic dynamometer evaluation of the effects of early thigh diameter difference on thigh muscle strength in patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft

    Science.gov (United States)

    Kılınç, Bekir Eray; Kara, Adnan; Camur, Savas; Oc, Yunus; Celik, Haluk

    2015-01-01

    After anterior cruciate ligament (ACL) reconstruction, which muscle groups are more affected from frequently developing thigh muscle atrophy is a matter of debate. We evaluate the effect of thigh circumference difference between patients’ knees who were administered the ACL reconstruction with hamstring tendon autograft and intact knees, on torque between the hamstring and quadriceps muscles. Fifty-five patients at least 6 months follow-up period available were included in our study. Power measurements of quadriceps and hamstring muscle groups in patients’ extremities were done by using isokinetic dynamometer. The maximum torque values at 60°/sec, 240°/sec in frequency, positions of flexion and extension were determined. In accordance with our findings it is still possible to encounter the thigh atrophy in average 28 months after ACL reconstruction surgery even under physical rehabilitation programs and appropriate follow-up. It is inevitable for the clinician to consider these changes in diagnosis and rehabilitation stages. It can’t be ignored that muscle weakness mechanisms developing in the thigh circumference vary according to the thigh muscle group and knee flexors play an important role in thigh atrophy when determining an appropriate rehabilitation program after reconstruction application. PMID:25960982

  15. 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.

  16. Open antero-lateral dislocation of the elbow. A case report

    Directory of Open Access Journals (Sweden)

    Roy Bibas R

    2002-01-01

    Full Text Available Abstract Background Open dislocations are infrequent, often associated with damage to the neuro vascular structures. We present an unusual case of an open antero-lateral dislocation of the elbow, which was not associated with any vascular or neural injury. Case presentation A 34 year female dance instructor sustained an open dislocation of her elbow. Surgical exploration was undertaken. No major neurovascular injury was present. There was almost complete disruption of all the muscular and ligamentous attachments to the distal humerus and the proximal radius and ulna, which were not formally repaired during surgery. The elbow was found to be very unstable, and was placed in a back slab. The functional recovery was complete in about six months, the patient regaining full range of elbow movement. Elbow dislocations without associate fractures are adequately treated by manipulation and reduction, in spite of the almost complete disruption of the soft tissues around the joint.

  17. Case report: necrosis of the anterolateral papillary muscle--an unusual mechanical complication of myocardial infarction.

    Science.gov (United States)

    Abu Saleh, Walid K; Aljabbari, Odeaa; Ramlawi, Basel; Ramchandani, Mahesh

    2015-01-01

    We report the case of a 66-year-old woman with no significant past medical history who presented to the Emergency Department at Houston Methodist Hospital with 24 hours of chest pain. An electrocardiogram was done, an electrocardiogram confirmed a posterolateral ST elevation myocardial infarction. An immediate and successful percutaneous coronary intervention of a totally occluded ramus intermedius was performed. Six hours later she developed pulmonary edema, cardiogenic shock, severe acidosis, and anuria. Echocardiography showed severe mitral regurgitation due to a ruptured anterolateral papillary muscle, and emergency surgery revealed necrosis of this muscle. A bioprosthetic mitral valve was placed, and extracorporeal membrane oxygenation was needed for 3 days. This is a rare mechanical complication of myocardial infarction, which usually affects the posteromedial papillary muscle. The patient subsequently made a good recovery. One month later, just prior to discharge home, the patient developed pneumonia and sepsis, and she expired from multiorgan failure. PMID:25793030

  18. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotary stability

    DEFF Research Database (Denmark)

    Tavlo, Mette; Eljaja, S; Tranum-Jensen, Jørgen;

    2016-01-01

    Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction...... of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured...... with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...

  19. Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination

    Directory of Open Access Journals (Sweden)

    Camilo Partezani Helito

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the presence of the anterolateral ligament (ALL of the knee in magnetic resonance imaging (MRI examinations.METHODS: Thirty-three MRI examinations on patients' knees that were done because of indications unrelated to ligament instability or trauma were evaluated. T1-weighted images in the sagittal plane and T2-weighted images with fat saturation in the axial, sagittal and coronal planes were obtained. The images were evaluated by two radiologists with experience of musculoskeletal pathological conditions. In assessing ligament visibility, we divided the analysis into three portions of the ligament: from its origin in the femur to its point of bifurcation; from the bifurcation to the meniscal insertion; and from the bifurcation to the tibial insertion. The capacity to view the ligament in each of its portions and overall was taken to be a dichotomous categorical variable (yes or no.RESULTS: The ALL was viewed with signal characteristics similar to those of the other ligament structures of the knee, with T2 hyposignal with fat saturation. The main plane in which the ligament was viewed was the coronal plane. Some portion of the ligament was viewed clearly in 27 knees (81.8%. The meniscal portion was evident in 25 knees (75.7%, the femoral portion in 23 (69.6% and the tibial portion in 13 (39.3%. The three portions were viewed together in 11 knees (33.3%.CONCLUSION: The anterolateral ligament of the knee is best viewed in sequences in the coronal plane. The ligament was completely characterized in 33.3% of the cases. The meniscal portion was the part most easily identified and the tibial portion was the part least encountered.

  20. Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases

    Institute of Scientific and Technical Information of China (English)

    LU Lai-jin; GONG Xu; LIU Zhi-gang; ZHANG Zhi-xin

    2006-01-01

    Objective:To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.Methods: From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.Results: In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours,colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery(British Medical Research Council, BMRC ), the sense function of the flaps resumed S3 after operation for 1 year.In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.Conclusions: To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries.Postoperative flap color and texture are similar to normal fingers.

  1. Internal Mammary Artery Perforator flap

    NARCIS (Netherlands)

    Schellekens, P.P.A.

    2012-01-01

    Reconstructive surgery evolved as a result of the enormous numbers of World War I and II victims, long before profound knowledge of the vascularity of flaps was present. Sophisticated imaging techniques have given us at present a thorough understanding of the vascularity of tissues so that randomly

  2. Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete

    Directory of Open Access Journals (Sweden)

    Moo Ing How

    2015-01-01

    Conclusion: A high index of suspicion for compartment syndrome is needed in all severe quadriceps contusion. Vascular injury can cause thigh compartment syndrome in sports trauma. MRI findings of deep thigh muscle swelling and “blow-out” tear of the vastus lateralis are strongly suggestive of severe quadriceps injury, and may be a harbinger of delayed thigh compartment syndrome.

  3. 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

  4. 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.

  5. 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.

  6. Formation of a reliable capsular flap in a rat model.

    NARCIS (Netherlands)

    Schuringa, M.C.; Hartman, E.H.M.; Ruhe, P.Q.; Jansen, J.A.; Spauwen, P.H.M.

    2007-01-01

    Prefabrication can be used to produce capsular flaps; other researchers have confirmed the feasibility of such flaps. Before the possibilities of capsular flaps can be explored, a reliable method to create these flaps has to be established first. METHODS: To produce capsular flaps in a rat model, th

  7. 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

  8. 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.

  9. 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.

  10. Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ho Cheol; Shin, Tae Beom; Park, Mee Jung; Kim, Ji Eun; Choi, Hye Young; Bae, Kyung Soo; Choi, Dae Seob; Na, Jae Boem; Jeong, Seong Hoon [Gyeongsang National University Hospital, College of Medicine, Jinju (Korea, Republic of)

    2011-02-15

    We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess. From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated. 15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5- 27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved. Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure

  11. 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

  12. Exotic wakes of flapping fins

    DEFF Research Database (Denmark)

    Schnipper, Teis

    We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured, with unpreced......We present, in 8 chapters, experiments on and numerical simulations of bodies flapping in a fluid. Focus is predominantly on a rigid foil, a model fish, that performs prescribed pitching oscillations where the foil rotates around its leading edge. In a flowing soap film is measured......-speed and the strength ratio of the vortices formed at the foil’s leading and trailing edge. The simulated vortex particles and measured thickness variations in the soap film show similar behaviour which indicates that the soap film provides a good approximation the flow of a two-dimensional incompressible and Newtonian...

  13. Root coverage with bridge flap

    Directory of Open Access Journals (Sweden)

    Pushpendra Kumar Verma

    2013-01-01

    Full Text Available Gingival recession in anterior teeth is a common concern due to esthetic reasons or root sensitivity. Gingival recession, especially in multiple anterior teeth, is of huge concern due to esthetic reasons. Various mucogingival surgeries are available for root coverage. This case report presents a new bridge flap technique, which allows the dentist not only to cover the previously denuded root surfaces but also to increase the zone of attached gingiva at a single step. In this case, a coronally advanced flap along with vestibular deepening technique was used as root coverage procedure for the treatment of multiple recession-type defect. Here, vestibular deepening technique is used to increase the width of the attached gingiva. The predictability of this procedure results in an esthetically healthy periodontium, along with gain in keratinized tissue and good patient′s acceptance.

  14. 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...

  15. 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...

  16. 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.

  17. Idoneidad del colgajo anterolateral de muslo para reconstrucción de grandes defectos craneofaciales

    Directory of Open Access Journals (Sweden)

    David González-Ballester

    2014-07-01

    Full Text Available La reconstrucción de grandes defectos en la región craneal y del cuero cabelludo constituyen un reto para el cirujano reconstructivo. Diversos factores pueden influir en la selección de un determinado método quirúrgico, tales como: anatomía del defecto, factores dependientes del paciente, preferencias del cirujano, etc. En condiciones desfavorables, tales como grandes defectos, presencia de infección o cirugías previas, los colgajos microvascularizados se presentan superiores al resto de técnicas reconstructivas en la recuperación de la integridad craneofacial. Presentamos un varón de 57 años de edad con defecto estético importante en región frontal e infección crónica activa de más de 20 años de evolución reconstruido con un colgajo libre microvascularizado de la región antero-lateral del muslo de una forma dual, solucionando con ello el cuadro infeccioso al aportar tejido sano vascularizado; y el defecto estético al añadir volumen, consiguiéndose un excelente resultado final.

  18. 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.

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

    Science.gov (United States)

    Roberto, Tarantino; Daniele, Marruzzo; Martina, Cappelletti; Tiziano, De Giacomo; Roberto, Delfini

    2012-01-01

    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. PMID:23193382

  20. [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

  1. 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

  2. [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

  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. Prefabricated flaps for bone reconstructive surgery

    NARCIS (Netherlands)

    Hartman, E.H.M.

    2004-01-01

    Tissue engineering of bone could help minimise donor site defects of conventional bone flaps like the fibula, iliac crest, radius and scapula. First a review is given on the literature of donor site morbidity of these flaps. Then the use of MRI is investigated for longitudinal study of ectopic bone

  5. Piezoelectrically actuated insect scale flapping wing

    Science.gov (United States)

    Mukherjee, Sujoy; Ganguli, Ranjan

    2010-04-01

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

  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 this, three different...

  7. Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at any Fixation Angle

    Science.gov (United States)

    Schon, Jason; Brady, Alex; Moatshe, Gilbert; Cruz, Raphael; Chahla, Jorge; Dornan, Grant; Turnbull, Travis L.; Engebretsen, Lars

    2016-01-01

    Objectives: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge because up to 25% of patients may present with a residual pivot shift following surgery. Advocacy for reconstruction of the anterolateral ligament (ALL) is rapidly increasing because biomechanical studies have reported that the ALL is a significant contributor to internal rotational stability of the knee. Although several graft fixation angles for the anatomic ALL reconstruction (ALLR) have been reported in literature, none have been biomechanically validated. Therefore, the purpose of this study was to assess the effect of ALLR graft fixation angle on knee joint kinematics in the clinically relevant setting of a concomitant ACLR. The goal was to find the optimal knee flexion angle for fixation of the ALLR graft that would most accurately restore native knee kinematics without introducing overconstraint to the knee. It was hypothesized that all fixation angles would significantly reduce rotational laxity compared to the sectioned ALL state and that fixation at 30° would best reproduce native joint kinematics. Methods: Eight non-paired fresh-frozen human cadaveric knees with no prior injury, surgical history, or gross anatomic abnormality were evaluated with a 6 degree-of-freedom robotic system. Each specimen underwent a full kinematic assessment in each of the following states: 1) intact, 2) anatomic single-bundle (SB) ACLR with intact ALL, 3) anatomic SB ACLR with sectioned ALL, 4) 7 anatomic SB ACLR and ALLR states utilizing ALL graft fixation knee flexion angles of 0°, 15°, 30°, 45°, 60°, 75° and 90°, and 5) sectioned ACL and ALL. Internal rotation during a 5 N-m internal rotation torque and anterior displacement during an 88 N anterior load were recorded at 15° intervals between 0° and 120° of knee flexion. Axial plane displacement and

  8. 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 ...

  9. 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.)

  10. 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.)

  11. 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.

  12. 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

  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. 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.

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

    Science.gov (United States)

    Platt, Robert C

    1936-01-01

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

  16. 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

  17. 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...

  18. 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.

  19. 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.

  20. Flap-augmented shrouds for aerogenerators

    Science.gov (United States)

    Seginer, A.

    1976-01-01

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

  1. 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.

  2. 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...

  3. 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.)

  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. 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...

  7. 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...

  8. 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.

  9. Effect of postmortem deboning time on sensory descriptive flavor and texture profiles of cooked boneless skinless chicken thighs

    Science.gov (United States)

    Three replicate trials were conducted to investigate the effect of deboning time on sensory descriptive profiles of cooked boneless skinless thigh meat (iliotibialis, iliofibularis and the femoritibialis). Carcasses (42-d old birds) were obtained from a commercial processing plant. Thighs were hot-b...

  10. Interpreting laser Doppler recordings from free flaps.

    Science.gov (United States)

    Svensson, H; Holmberg, J; Svedman, P

    1993-01-01

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

  11. Neuromuscular properties of the thigh muscles in patients with Ehlers-Danlos syndrome

    NARCIS (Netherlands)

    Gerrits, K.H.; Voermans, N.C.; Haan, A. de; Engelen, B.G. van

    2013-01-01

    INTRODUCTION: Ehlers-Danlos syndrome (EDS), a connective tissue disorder, may lead to impaired contractile function of lower limb muscles. METHODS: To test this hypothesis and to understand the possible mechanisms involved, isometric function of the thigh muscles was investigated at different joint

  12. 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

  13. 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.

  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. The relationships of waist and mid-thigh circumference with performance of college golfers.

    Science.gov (United States)

    Son, Seungbum; Han, Kunho; So, Wi-Young

    2016-03-01

    [Purpose] Our aim was to evaluate the relationships between waist and mid-thigh circumference, used as proxy measures of trunk and lower limb strengths, respectively, and selected parameters of driver and putting performance in Korean college golfers. [Subjects and Methods] The participants were 103 college golfers (81 male, 20 to 27 years old). Measurements of body composition, waist and mid-thigh circumference, and grip strength, as well as assessment of golf performance, including driver distance, driver swing speed, putting accuracy, and putting consistency, were performed at the golf performance laboratory at Konkuk University in Chungju-si, Republic of Korea. Average round score was obtained from 10 rounds of golf completed during the study period. The relationships between strength measures and golf performance were evaluated by partial correlation analysis, with adjustment for age, golf experience, and body mass index. [Results] Waist circumference did not correlate with any of the performance variables in both males and females. Mid-thigh circumference correlated with putting consistency (r = 0.364) in males and with putting consistency (r = 0.490) and accuracy (r = 0.547) in females. No other significant correlations between waist and mid-thigh circumference and golf performance were identified. [Conclusion] Lower limb strength may be an important component of putting performance. Further studies are needed to fully characterize the contributions of trunk strength to performance.

  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. 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 <1.0% intra-calibration and ~2.0% inter-calibration) but systematically overestimates (~6%) thigh 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.

  20. 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 <1.0% intra-calibration and ~2.0% inter-calibration) but systematically overestimates (~6%) thigh 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

  1. 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.

  2. 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

  3. 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

  4. 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

  5. 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....

  6. 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.

  7. The prepuce free flap in 10 patients : modifications in flap design and surgical technique

    NARCIS (Netherlands)

    Werker, Paul M N

    2002-01-01

    The prepuce free flap was used in 10 oral and oropharyngeal reconstructions. During the course of this study, various modifications took place. Residual penile skin necrosis and skin island necrosis early in the series led to modification of flap design. This solved the donor-site problem by placing

  8. A simplified approach to reconstruction of hemipelvectomy defects with lower extremity free fillet flaps to minimize ischemia time.

    Science.gov (United States)

    Bibbo, Christopher; Newman, Andrew S; Lackman, Richard D; Levin, L Scott; Kovach, Stephen J

    2015-12-01

    External hemipelvectomy associated with trauma or during the operative management of musculoskeletal sarcomas may yield a soft tissue defect that can only be sufficiently covered by free tissue transfers. The application of "spare-parts surgery," such as a fillet of leg or thigh flap, uses distal uninvolved parts that are otherwise viable tissues as donor tissues to cover defects. This concept has great utility to achieve soft tissue coverage in challenging cases, such as hemipelvectomy. However, during such complicated and time-consuming cases, prolonged ischemia time of the proposed donor tissues can be problematic. We describe a technique developed by the senior author (SJK) that minimizes the ischemia time of donor free tissues during external hemipelvectomy. This technique is applicable to other surgeries where filleted spare parts are the donor-site source for free tissue transfer. PMID:26576702

  9. 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.

  10. 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.

  11. 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

  12. Electromyographic activity of the anterolateral abdominal wall muscles during the vesical filling and evacuation

    Directory of Open Access Journals (Sweden)

    Ahmed Shafik

    2007-06-01

    Full Text Available

    BACKGROUND: The role of the anterolateral abdominal wall muscles (AAWMs during the vesical filling and evacuation has not been sufficiently addressed in the literature. We have investigated the hypothesis that the AAWMs exhibit the increased electromyographic (EMG activity on the vesical distension and contraction which presumably assists vesical evacuation.

    METHODS: The effects of the vesical balloon distension on the vesical pressure (VP, vesical neck (VNP pressures and the AAWMs' EMG activity were studied in 28 healthy volunteers aged 40.7 ± 9.7 years (18 men, 10 women. These effects were tested after the individual anesthetization of the bladder and AAWMs and after saline infiltration.

    RESULTS: The VP and the VNP showed a gradual increase upon the incremental vesical balloon distension which started at a distending volume of 120–140 ml. At a mean volume of 364.6 ± 23.8 ml, the VP increased to a mean of 36.6 ± 3.2 cmH2O, the VNP decreased to 18.4 ± 2.4 cmH2O, and the AAWMs EMG registered a significant increase. This effect disappeared in the individual bladder and in the AAWMs' anesthetization. However, it did not disappear in the saline administration.

    CONCLUSIONS: The AAWMs appear to contract simultaneously with vesical contraction. This action presumably increases the IAP and it

  13. 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.

  14. Intraoperative flap complications in lasik surgery performed by ophthalmology residents

    Directory of Open Access Journals (Sweden)

    Lorena Romero-Diaz-de-Leon

    2016-01-01

    Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.

  15. Flow field of flexible flapping wings

    Science.gov (United States)

    Sallstrom, Erik

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

  16. 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.

  17. 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.

  18. 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.

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. 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...

  4. 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

  5. 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...

  6. 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...

  7. 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.

  8. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

  10. 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.

  11. 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.

  12. 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.

  13. 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.)

  14. 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

  15. 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 .

  16. 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...

  17. 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...

  18. 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: ...

  19. 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.

  20. 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...

  1. Coordination among thigh muscles including the vastus intermedius and adductor magnus at different cycling intensities.

    Science.gov (United States)

    Saito, Akira; Watanabe, Kohei; Akima, Hiroshi

    2015-04-01

    Although many studies have been focused on muscle synergies in the lower limbs, synergies of the thigh muscles during cycling have not been investigated in detail. We examined synergies of the thigh muscles including the vastus intermedius (VI) and adductor magnus (AM) while cycling. Eight healthy men pedaled at 20%, 40%, 60%, 80% and 100% of maximal aerobic power output at a constant cadence of 60 rpm. Surface electromyography (EMG) recorded signals from the deep VI and the three superficial quadriceps femoris (QF) muscles, the two hamstrings and the AM. The root mean square of the EMG signal was averaged every 2° of crank rotation and normalized by the peak value for each muscle. We used factor analysis to assess normalized EMG recordings while cycling and to identify thigh muscle synergies. The VI, the superficial QF muscles and the AM dominated the first muscle synergy at all power output levels. The AM also formed a second synergy with the two hamstrings at all power output levels. These results suggest that the VI coordinates with the other QF and AM muscles, and that the AM coordinates with the QF and hamstring muscles while cycling.

  2. 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.

  3. Influence of exercise training with thigh compression on heat-loss responses.

    Science.gov (United States)

    Amano, T; Inoue, Y; Koga, S; Nishiyasu, T; Kondo, N

    2015-06-01

    We investigated the effect of thigh compression, which accelerates activation of central command and muscle metabo- and mechanoreceptors, on the adaptation of sweating and cutaneous vascular responses during exercise heat acclimation. Nine non-heat-acclimated male subjects were acclimated to heat (32 °C and 50% RH) while cycling [50% of maximum oxygen uptake ( V ˙ O 2 m a x )] 60 min/day for 7 days (control group). The experimental group (n = 9) conducted the same training while the proximal thighs were compressed by a cuff at 60 mmHg. V ˙ O 2 m a x , acetylcholine-induced forearm sweating rate (iontophoresis), and mean sweating and cutaneous vascular responses on the forehead, chest, and forearm (SRmean and CVCmean ) during passive heating were evaluated before and after training. Training significantly increased V ˙ O 2 m a x while did not affect acetylcholine-induced sweating rates in either group. Training significantly decreased Tb thresholds for SRmean and CVCmean during passive heating without the alternations of sensitivities in both groups. Although SRmean during passive heating at a given ΔTb was not improved in either group, CVCmean was significantly (P training only in experimental group. Our results indicate that thigh cuff compression during exercise heat acclimation does not influence adaptation of the sweating response but attenuate cutaneous vasodilation.

  4. 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

  5. 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

  6. 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...

  7. [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

  8. Suspension Bridge Flutter for Girder with Separate Control Flaps

    DEFF Research Database (Denmark)

    Huynh, T.; Thoft-Christensen, Palle

    Active vibration control of long span suspension bridge flutter using separated control flaps (SFSC) has shown to increase effectively the critical wind speed of bridges. In this paper, an SFSC calculation based on modal equations of the vertical and torsional motions of the bridge girder including...... the flaps is presented. The length of the flaps attached to the girder, the flap configuration and the flap rotational angles are parameters used to increase the critical wind speed of the bridge. To illustrate the theory a numerical example is shown for a suspension bridge of 1000m+2500m+1000m span based...

  9. The study of expanded tri-lobed flap in a rabbit model: possible flap model in ear reconstruction?

    Directory of Open Access Journals (Sweden)

    Yüreklý Yakup

    2003-12-01

    Full Text Available Abstract Background Local flaps are widely used in reconstructive surgery. Tri-lobed skin flap is a relatively new flap and there has been no experimental model of this flap. This flap can be used for repair of full thickness defects in the face, ears and alar region. Based on the size of ears in a rabbit, we designed a model of ear reconstruction using expanded tri-lobed flap. Local flaps are more advantageous in that they provide excellent color and texture matching up with those of the face, adequately restore ear contour, place scars in a favorable location and ideally accomplish these goals in a single stage with minimal donor site morbidity. Methods Eight adult New Zealand rabbits were divided into two groups. 50 ml round tissue expander were implanted to four rabbits. After completion of the expansion, a superiorly based tri-lobed flap was elevated and a new ear was created from the superior dorsal skin of each rabbit. Scintigraphy with Technetium-99m pertecnetate was performed to evaluate flap viability. Results Subtotal flap necrosis was seen in all animals in non-expanded group. New ear in dimensions of the original ear was created in expanded group without complication. Perfusion and viability of the flaps were proved by Technetium-99m pertecnetate scintigraphy. Conclusion According to our knowledge this study is the first to demonstrate animal model in tri-lobed flap. Also, our technique is the first application of the trilobed flap to the possible ear reconstruction. We speculated that this flap may be used mastoid based without hair, in human. Also, tri-lobed flap may be an alternative in reconstruction of cylindrical organs such as penis or finger.

  10. 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

  11. Breast reconstruction by pedicled transverse rectus abdominis myocutaneous flap

    Directory of Open Access Journals (Sweden)

    Kozarski Jefta

    2004-01-01

    Full Text Available Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.

  12. 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

  13. 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.

  14. Enhanced Correlation of SMART Active Flap Rotor Loads

    Science.gov (United States)

    Kottapalli, Sesi

    2011-01-01

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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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).

  20. STUDY OF VARIOUS MODIFICATIONS OF REVERSE SURAL ARTERY FLAP

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    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

  1. 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

  2. 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

  3. 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.

  4. EFFECT OF GENOTYPE, SEX AND KEEPING TECHNOLOGY ON THE CHEMICAL COMPOUNDS OF BREAST AND THIGH MEAT

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    SZ. KONRÁD

    2013-07-01

    Full Text Available In the recent decades because of the alternative poultry meat production technologies (free range and organic farming, which are gaining ground in some of the European countries, only special slow growing breeds and hybrids can be used. The end products created by crossing the indigenous Yellow Hungarian hen with different meat type cocks were suitable for alternative keeping technology. The valuable meat parts of the pure bred Yellow Hungarian kept in free range for 84 days and the end product created with crossing (first group as well as the valuable meat parts of Ross 308 broilers fattened for 42 days in intensive keeping technology (second group were thoroughly examined in order to establish whether the genotype, sex and/or keeping technology has any kind of influence on different chemical parameters of the meat. There were no essential differences between the dry matter content of breast meat of the two different keeping technology groups (25.34 and 26.25%. However, dry matter content of thigh was 5.28 to 7.48 percentage points higher in the second group. Protein contents of breast and thigh meat were not affected by the keeping technology. Fat content of thigh meat was two and a half times higher than in the first group (6.03 and 13.73%. Thus, this study have revealed that only the ash content of breast meat affected from the keeping technology, as this parameter was higher in the first group than the second group (0.84 to 1.05 % vs 0.53 %.

  5. 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.

  6. 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.

  7. 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...

  8. 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.

  9. 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

  10. Power performance optimization and loads alleviation with active flaps using individual flap control

    Science.gov (United States)

    Pettas, Vasilis; Barlas, Thanasis; Gertz, Drew; Madsen, Helge A.

    2016-09-01

    The present article investigates the potential of Active Trailing Edge Flaps (ATEF) in terms of increase in annual energy production (AEP) as well as reduction of fatigue loads. The basis for this study is the DTU 10 MW Reference Wind Turbine (RWT) simulated using the aeroelastic code HAWC2. In an industrial-oriented manner the baseline rotor is upscaled by 5% and the ATEFs are implemented in the outer 30% of the blades. The flap system is kept simple and robust with a single flap section and control with wind speed, rotor azimuth, root bending moments and angle of attack in flap's mid-section being the sensor inputs. The AEP is increased due to the upscaling but also further due to the flap system while the fatigue loads in components of interest (blade, tower, nacelle and main bearing) are reduced close to the level of the original turbine. The aim of this study is to demonstrate a simple and applicable method that can be a technology enabler for rotor upscaling and lowering cost of energy.

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

    Science.gov (United States)

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

    2015-03-01

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

  12. 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.

  13. 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.

  14. 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.

  15. Flight test pilot evaluation of a delayed flap approach procedure

    Science.gov (United States)

    Bull, J. S.; Edwards, F. G.; Foster, J. D.; Hegarty, D. M.; Drinkwater, F. J., III

    1977-01-01

    Using NASA's CV-990 aircraft, a delayed flap approach procedure was demonstrated to nine guest pilots from the air transport industry. Four demonstration flights and 37 approaches were conducted under VFR weather conditions. A limited pilot evaluation of the delayed flap procedure was obtained from pilot comments and from questionaires they completed. Pilot acceptability, pilot workload, and ATC compatibility were quantitatively rated. The delayed flap procedure was shown to be feasible, and suggestions for further development work were obtained.

  16. 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...

  17. 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...

  18. 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.

  19. [Pedicled versus free TRAM flap for breast reconstruction].

    Science.gov (United States)

    Galla, T J; Lukas, B; Feller, A M

    1999-03-01

    In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

  20. 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...

  1. 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.

  2. 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.

  3. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  5. 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)

  6. 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.

  7. 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

  8. Cervicopectoral flap in head and neck cancer surgery

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    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.

  9. A novel animal model for skin flap prelamination with biomaterials

    Science.gov (United States)

    Zhou, Xianyu; Luo, Xusong; Liu, Fei; Gu, Chuan; Wang, Xi; Yang, Qun; Qian, Yunliang; Yang, Jun

    2016-01-01

    Several animal models of skin flap construction were reported using biomaterials in a way similar to prefabrication. However, there are few animal model using biomaterials similar to prelamination, another main way of clinical skin flap construction that has been proved to be reliable. Can biomaterials be added in skin flap prelamination to reduce the use of autogenous tissues? Beside individual clinical attempts, animal model is needed for randomized controlled trial to objectively evaluate the feasibility and further investigation. Combining human Acellular Dermal Matrix (hADM) and autologous skin graft, we prelaminated flaps based on inguinal fascia. One, two, three and four weeks later, hADM exhibited a sound revascularization and host cell infiltration. Prelaminated skin flaps were then raised and microsurgically transplanted back to groin region. Except for flaps after one week of prelamination, flaps from other subgroups successfully reconstructed defects. After six to sixteen weeks of transplantation, hADM was proved to being able to maintain its original structure, having a wealth of host tissue cells and achieving full revascularization.To our knowledge, this is the first animal model of prelaminating skin flap with biomaterials. Success of this animal model indicates that novel flap prelamination with biomaterials is feasible. PMID:27659066

  10. Differentiation of fat, muscle, and edema in thigh MRIs using random forest classification

    Science.gov (United States)

    Kovacs, William; Liu, Chia-Ying; Summers, Ronald M.; Yao, Jianhua

    2016-03-01

    There are many diseases that affect the distribution of muscles, including Duchenne and fascioscapulohumeral dystrophy among other myopathies. In these disease cases, it is important to quantify both the muscle and fat volumes to track the disease progression. There has also been evidence that abnormal signal intensity on the MR images, which often is an indication of edema or inflammation can be a good predictor for muscle deterioration. We present a fully-automated method that examines magnetic resonance (MR) images of the thigh and identifies the fat, muscle, and edema using a random forest classifier. First the thigh regions are automatically segmented using the T1 sequence. Then, inhomogeneity artifacts were corrected using the N3 technique. The T1 and STIR (short tau inverse recovery) images are then aligned using landmark based registration with the bone marrow. The normalized T1 and STIR intensity values are used to train the random forest. Once trained, the random forest can accurately classify the aforementioned classes. This method was evaluated on MR images of 9 patients. The precision values are 0.91+/-0.06, 0.98+/-0.01 and 0.50+/-0.29 for muscle, fat, and edema, respectively. The recall values are 0.95+/-0.02, 0.96+/-0.03 and 0.43+/-0.09 for muscle, fat, and edema, respectively. This demonstrates the feasibility of utilizing information from multiple MR sequences for the accurate quantification of fat, muscle and edema.

  11. Retroperitoneal abscess complicated with necrotizing fasciitis of the thigh in a patient with sigmoid colon cancer

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    Tokunaga Masakazu

    2009-10-01

    Full Text Available Abstract Background Necrotizing fasciitis of the thigh due to the colon cancer, especially during chemotherepy, has not been previously reported. Case presentation A 67-year-old man admitted to the hospital was diagnosed with sigmoid colon cancer that had spread to the left psoas muscle. Multiple hepatic metastases were also found, and combination chemotherapy with irinotecan and S-1 was administered. Four months after the initiation of chemotherapy, the patient developed gait disturbance and high fever and was therefore admitted to the emergency department of our hospital. Blood examination revealed generalized inflammation with a high C-reactive protein level. Computed tomography of the abdomen and pelvis showed gas and fluid collection in the retroperitoneum adjacent to the sigmoid colon cancer. The abscess was locally drained under computed tomographic guidance; however, the infection continued to spread and necrotizing fasciitis developed. Consequently, emergent debridement was performed. The patient recovered well, and the primary tumor was resected after remission of the local inflammation. Conclusion Necrotizing fasciitis of the thigh due to the spread of sigmoid colon cancer is unusual, but this fatal complication should be considered during chemotherapy for patients with unresectable colorectal cancer.

  12. 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 muscle, significant changes in ARVs during the recovery phase with an increase in speed were seen in the right leg only (P muscles (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.

  13. Nonuniform changes in MRI measurements of the thigh muscles after two hamstring strengthening exercises.

    Science.gov (United States)

    Mendiguchia, Jurdan; Garrues, Mirian A; Cronin, John B; Contreras, Bret; Los Arcos, Asier; Malliaropoulos, Nikos; Maffulli, Nicola; Idoate, Fernando

    2013-03-01

    Although many different hamstring strengthening exercises exist, the effect on site specific activation of these exercises on different muscles of the leg is unclear. This study investigated the effects of the eccentric leg curl (LC) and lunge (L) exercises on the biceps femoris long head (BFl), biceps femoris short head (BFs), semitendinosus (ST), semimembranosus (SM), and adductor magnus (AM). Each leg of 11 male professional soccer players was randomly assigned to an LC or L exercise protocol (3 sets of 6 repetitions). Functional magnetic resonance imaging (fMRI) of the subjects' thighs were performed before and 48 hours after the intervention. Fifteen axial scans of the thigh interspaced by a distance of 1/15 right femur length (Lf) were obtained. The fMRI data were analyzed for signal intensity changes. No significant changes were observed in absolute short tau inversion recovery values for the SM and BFs. Significant changes for the ST (∼21-45%) from sections 4 to 10, AM (∼2-13%) at section 4, and BFl (∼ -3 vs. 8%) at section 7 were noted. LC exercises load all the regions of the ST muscle. The L exercises load the proximal regions of the BFl and AM. These findings may have relevance when designing protocols for prevention and rehabilitation of hamstring injuries. PMID:23443215

  14. Dietary oxidized poultry offal fat: broiler performance and oxidative stability of thigh meat during chilled storage

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    AMC Racanicci

    2008-03-01

    Full Text Available Two experiments were conducted to evaluate the effects of dietary oxidized poultry offal fat on the performance of broilers and on the oxidative stability of dark chicken meat. One hundred and sixty male chicks were fed a corn-soybean meal diet containing 4% fresh or oxidized poultry fat from 10 to 47 days of age. Fresh fat was stored frozen until diets were produced, and oxidized fat was obtained by electrical heating (110 to 120 ºC. Birds were slaughtered at 47 days of age, and carcass characteristics were measured. Skinless and deboned thigh meat was stored chilled during 12 days, and samples were periodically collected to assess their quality and oxidative stability. Dietary oxidized fat did not affect bird performance or carcass characteristics. During chilled storage, meat color (L*, a* and b* was not affected by dietary treatments; however, TBARS (Thiobarbituric Acid Reactive Substances values were higher (P<0.05 in thigh meat from chickens fed the oxidized fat, indicating that oxidative stability was adversely affected.

  15. 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 changes in both IMAT and TMA were similar across the lifestyle intervention groups and directly corresponded with moderate weight loss (P 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 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

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

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    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.

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

    Science.gov (United States)

    Thouzé, A.; Monnet, T.; Begon, M.; Pain, M. T. G.

    2010-06-01

    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.

  18. Anatomy of anterolateral portals of elbow arthroscopy%肘关节镜前外侧入路的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    吴关; 鲁谊

    2016-01-01

    目的:初步探讨肘关节镜前外侧入路向前方的变化范围。方法选用10具新鲜上肢标本,在肘关节屈曲90°下,测量近端前外侧入路、前外侧入路、外侧入路与桡神经的距离;测量改良后3个入路前方5 mm 与桡神经的距离。结果标准入路的近端前外侧入路、前外侧入路、外侧入路与桡神经的距离平均值分别为:12.8 mm、8.5 mm、3.8 mm,改良后的近端前外侧入路、前外侧入路、外侧入路与桡神经的距离平均值分别为4.1 mm、2.2 mm、-0.5 mm。结论肘关节近端前外侧入路与前外侧入路之间的连线区可向前方5 mm 进行操作,越靠远端距离桡神经越近;前外侧入路与外侧入路距离桡神经较近,不建议向前方改变入路。%[Abstract ] Background From the 1 980s, elbow arthroscopic surgery has been rapidly developing and widely applied.Indications for elbow arthroscopic surgery include:loose bodies,stiff elbow,elbow synovitis,and elbow cartilage injury etc.In recent years,more and more scholars try to apply elbow arthroscopy in more complex operations,such as ligament repair,reconstruction,and fracture fixation and so on.Currently,there are quite a few reports on reduction and fixation of radial head fracture, humerus capitellum fracture, ulna coronoid fracture under elbow arthroscopy. Recently,we started to conduct elbow arthroscopic fracture reduction and internal fixation,and found that due to the varying types of fracture morphologies and locations,the conventional lateral elbow approach sometimes cannot access satisfactory fixation angles.Due to the narrow space in the elbow joint and complex anatomical relationship of the peripheral nerves,nerve injury is common in elbow surgery and consequences are often serious.Therefore,we aim to explore better approaches to protect the radial nerve based on study of anatomical specimens. Here we used either an improved anterolateral elbow approach that entered at a more

  19. 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.

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

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    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.

  1. 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.

  2. 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

  3. Navier-Stokes Computations of a Wing-Flap Model With Blowing Normal to the Flap Surface

    Science.gov (United States)

    Boyd, D. Douglas, Jr.

    2005-01-01

    A computational study of a generic wing with a half span flap shows the mean flow effects of several blown flap configurations. The effort compares and contrasts the thin-layer, Reynolds averaged, Navier-Stokes solutions of a baseline wing-flap configuration with configurations that have blowing normal to the flap surface through small slits near the flap side edge. Vorticity contours reveal a dual vortex structure at the flap side edge for all cases. The dual vortex merges into a single vortex at approximately the mid-flap chord location. Upper surface blowing reduces the strength of the merged vortex and moves the vortex away from the upper edge. Lower surface blowing thickens the lower shear layer and weakens the merged vortex, but not as much as upper surface blowing. Side surface blowing forces the lower surface vortex farther outboard of the flap edge by effectively increasing the aerodynamic span of the flap. It is seen that there is no global aerodynamic penalty or benefit from the particular blowing configurations examined.

  4. Relationship between site-specific loss of thigh muscle and gait performance in women: the HIREGASAKI study.

    Science.gov (United States)

    Abe, Takashi; Ogawa, Madoka; Loenneke, Jeremy P; Thiebaud, Robert S; Loftin, Mark; Mitsukawa, Naotoshi

    2012-01-01

    Sarcopenia is observed as a site-specific loss of skeletal muscle mass, however, it is unknown whether the site-specific sarcopenia is associated with development of physical disability. The purpose of this study was to examine the relationship between age-related thigh muscle loss and gait performance. Fifty-three women aged 52-83 years had their thigh muscle thickness (MTH) measured by ultrasound at five sites on the anterior (30%, 50%, and 70% of thigh length) and posterior (50% and 70% of thigh length) aspects of their thigh. Maximum and normal walking speeds, zig-zag walking time, and maximal voluntary isometric knee extension and flexion strength were measured. Age was inversely correlated to the anterior and posterior MTH ratio (e.g., anterior 50%:posterior 70% MTH ratio [r=-0.426, p=0.002]), thus the site-specific muscle loss of the thigh was observed in the present sample. There were no significant correlations between the anterior/posterior MTH ratio and maximum and normal walking speeds. However, the ratios of anterior 50%:posterior 70% MTH (r=-0.430) and anterior 30%:posterior 70% MTH (r=-0.444) were correlated (p=0.001) to zig-zag walking test. After adjusting for age, height and weight, the anterior 30%:posterior 70% MTH (r=-0.292, p=0.040) was inversely correlated to zig-zag walking performance. Isometric knee extension strength was also inversely correlated to zig-zag walking. Our results suggest that an age-related loss of adductor/quadriceps muscles may be associated with a decrease in a relatively difficult task performance such as zig-zag walking. PMID:22795673

  5. Quadrilobed superior gluteal artery perforator flap for sacrococcygeal defects

    Institute of Scientific and Technical Information of China (English)

    HAI Heng-lin; SHEN Chuan-an; CHAI Jia-ke; LI Hua-tao; YU Yong-ming; LI Da-wei

    2013-01-01

    Background Perforator flaps are used extensively in repairing soft tissue defects.Superior gluteal artery perforatorflaps are used for repairing sacral defects,but the tension required for direct closure of the donor area after harvesting ofrelatively large flaps carries a risk of postoperative dehiscence.This research was to investigate a modified superiorgluteal artery perforator flap for repairing sacrococcygeal soft tissue defects.Methods From June 2003 to April 2010,we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients (study group).The wound and donor areas were measured,and the flaps were designed accordingly.Wound healing was assessed over a follow-up period of 6-38 months.From January 1998 to February 2003,twelve patients with sacrococcygeal pressure sores were treated with traditional methods,VY advancement flaps or oblong flaps,as control group.Results After debridement,the soft tissue defects ranged from 12 cm × 10 cm to 26 cm × 22 cm (mean 16.3 cm x 13.5cm).Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm (mean 18.2 cm × 14cm).Four patients were treated using left-sided flaps,and two were treated using both right-and left-sided flaps.Suction drains were removed on postoperative Days 3-21 (mean 5.9) and sutures were removed on postoperative Days 12-14.Each flap included 1-2 perforators for each of the donor and recipient sites.Donor sites were closed directly.All flaps survived.In eight patients,the wounds healed after single-stage surgery.After further debridement,the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33,respectively.The rate of first intention in the study group (80%,8/10) significantly increased than that of control group ((25%,3/12),X2=4.583,P=-0.032).Follow-up examinations found that the flaps had a soft texture without ulceration.In the two patients without

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

    Science.gov (United States)

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

    2016-01-01

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

  7. 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

  8. 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.)

  9. 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.)

  10. 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.)

  11. 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.

  12. 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.

  13. 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.

  14. Breast ptosis managed by mastopexy using the triple flaps procedure.

    Science.gov (United States)

    Gheita, Alaa; Moftah, Ali

    2011-02-01

    Breast ptosis is a highly unattractive appearance of the breast. In the mind, it is associated with aging, multiple pregnancies, lactation, and senile changes. Its correction by mastopexy presents one of the greatest challenges to the breast surgeon aiming at a pleasant full conical shape and stability of the results. The authors present their mastopexy procedure using a triple-flap method based on the principle of a superior pedicle flap mammaplasty. The technique, presented in detail, basically consists of a superior pedicle dermaglandular flap that carries the nipple-areola complex between outer and inner flaps. The outer flap is rotated inward and upward behind the main superior pedicle to give fullness to the breast and fixed to the chest wall. The inner flap is double-breasted on top or superficial to outer flap, and both are sutured to each other resembling a hammock or a cradle that carries the main superior pedicle middle flap. The results are presented and advantages discussed. This method, besides its simplicity, gives good projection with a pleasant and attractive conical shape to the breast and upper fullness, frequently negating the need for an implant. In addition, the results were stable in the long term, with no need for a mesh or any other foreign material. PMID:20652567

  15. Repair of large palatal fistula using tongue flap

    Directory of Open Access Journals (Sweden)

    Fejjal Nawfal

    2014-01-01

    Full Text Available Large palatal fistulas are a challenging problem in cleft surgery. Many techniques are used to close the defect. The tongue flap is an easy and reproductible procedure for managing this complication. The authors report a case of a large palatal fistula closure with anteriorly based tongue flap.

  16. 14 CFR 25.701 - Flap and slat interconnection.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flap and slat interconnection. 25.701....701 Flap and slat interconnection. (a) Unless the airplane has safe flight characteristics with the... sides of the plane of symmetry must be synchronized by a mechanical interconnection or...

  17. 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

  18. Oral functional outcome after intraoral reconstruction with nasolabial flaps

    NARCIS (Netherlands)

    Hofstra, EI; Hofer, SOP; Nauta, JM; Roodenburg, JLN; Lichtendahl, DHE

    2004-01-01

    In this study, the functional and aesthetic outcome of patients with nasolabial flaps in the floor of the mouth was examined. Sixteen patients underwent reconstruction of the floor of the mouth with 19 nasolabial flaps after resection of a squamous cell carcinoma. Eight patients received postoperati

  19. 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.

  20. Preoperative CT angiography reduces surgery time in perforator flap reconstruction

    NARCIS (Netherlands)

    Smit, Jeroen M.; Dimopoulou, Angeliki; Liss, Anders G.; Zeebregts, Clark J.; Kildal, Morten; Whitaker, Iain S.; Magnusson, Anders; Acosta, Rafael

    2009-01-01

    The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in perfora

  1. 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.

  2. 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

  3. 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.

  4. 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 ...

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  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. 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.

  12. Comparative anatomy of the thigh nerves of Cebus libidinosus (Rylands et al., 2000

    Directory of Open Access Journals (Sweden)

    R.A.G.M.F. Aversi-Ferreira

    2011-03-01

    Full Text Available Non-human primates have constituted an important group among animals subjected to various studies. Ethological, evolutionary and paleontological studies have revealed changes in anatomical structures linked to the evolution of primates, considered in studies on the comparative anatomy between Cebus libidinosus and other neotropical monkeys or those from the Old World, and the detailed knowledge on their anatomy may represent an important factor for their preservation and protection when the animals are brought to veterinary clinics after accidents or illnesses. In terms of veterinary importance, sometimes these animals arrive in the veterinary medical clinics after accidents, needing surgery or clinical treatment, but the little data available on anatomy has impaired the correct proceedings. The main justification for studies on C. libidinosus, is due to little information about the anatomy related to C. libidinosus in Brazilian and worldwide scientific literature. In this study, the distribution, enervation and path of the femoral and sciatic nerves of the pelvic limb (thigh of C. libidinosus were studied and these results were compared with literature on the anatomy of humans, chimpanzees and baboons. In general, the enervation model of the four primates is identical, but in specific terms, the differences in enervations indicate evolution convergence closer to the branch of baboons in the evolutionary tree, and these data corroborate other comparative studies in relation to the same primates to vessels, muscles and nerves. In conclusion, the nerve organization in the thigh of C. libidinosus is identical to baboon, chimpanzee and homo, but more similar to baboon. The specific differences found indicate an ancient phylogenic origin to C. libidinosus and baboons (data corroborated by other studies.

  13. 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.

  14. 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

  15. Submental flap as an alternative to microsurgical flap in intraoral post-oncological reconstruction in the elderly.

    Science.gov (United States)

    Schonauer, Fabrizio; Di Martino, Annalena; Nele, Gisella; Santoro, Mariangela; Dell'Aversana Orabona, Giovanni; Califano, Luigi

    2016-09-01

    Oral and oropharyngeal squamous cell carcinoma (Scc) occur most commonly in middle-aged and elderly individuals. Free flaps are commonly used for reconstruction of extensive tumor resection defects in the oral cavity. Age alone is not an independent variable for increased risk in microvascular reconstruction; however operative time and ASA risk score correlated with medical complications but not with surgical complications. The submental island flap has proven to be a reliable alternative in reconstruction of composite oral cavity defects for its thinness, pliability and versatility in design, shared by the radial forearm free flap, and its advantageous donor site. The submental flap can be easily raised and involves shorter operative time and hospital stay compared to the free-flap procedure. It can be an excellent choice in patients with a high ASA risk score, moreover in elderly patients, where the potential complications linked to microsurgical procedures are avoided. PMID:27255573

  16. Effect of heparin on prevention of flap loss in microsurgical free flap transfer: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Xuan-Liang Pan

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

  17. 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

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Gusmão Sebastião

    2002-01-01

    Full Text Available 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 a sutura lambdóide. Nos exames de imagem, especialmente na ressonância magnética, foi possível identificar a incisura pré-occipital e/ou a protuberância na parede craniana relacionada a ela, bem como o sulco parieto-occipital e a sutura lambdóide, referências que permitem a definição do limite anterolateral do lobo occipital.

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

    Science.gov (United States)

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

    2014-10-01

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

  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. The infrahyoid flap: a comprehensive review of an often overlooked reconstructive method.

    Science.gov (United States)

    Deganello, Alberto; Leemans, C René

    2014-08-01

    The infrahyoid flap is a myocutaneous pedicled flap mainly nourished by the superior thyroid vessels through the perforators of the infrahyoid muscles. This thin and pliable flap provides a skin island of about 7 by 4 cm from the central part of the anterior neck. The flap can be transferred on its pedicle of superior thyroid artery and vein to reconstruct medium sized head and neck defects created after cancer ablation. We have successfully used this flap in a series of 40 cases with no total flap loss and with 1 case of superficial skin necrosis. The aim of this review is to highlight the clinical usefulness of this pedicled flap even in the microvascular free flap era. A comprehensive review of the available literature reporting on the infrahyoid flap has been carried out using a web search. The history of the infrahyoid flap, the surgical technique with technical innovations, the clinical utility and limitations of this flap, are reported and discussed. Among the 7 larger series (cohort larger than 50 cases) a total of 956 flaps were performed, and the global success rate was 91.7%, with failures being mainly related to partial skin necrosis, as the rate of total (skin and muscle) flap necrosis was only 1%. This flap is reliable, easy to harvest during neck dissection, oncologically safe, it does carry a negligible donor site morbidity. This paper highlights how the infrahyoid flap can represent an excellent reconstructive solution in selected patients and head and neck sites. PMID:24856306

  6. 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.

  7. 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.

  8. Post-facelift flap necrosis treatment using charged polystyrene microspheres

    Science.gov (United States)

    Weissman, Oren; Farber, Nimrod; Remer, Eric; Tessone, Ariel; Trivizki, Omer; Bank, Jonathan; Winkler, Eyal; Zilinsky, Isaac; Haik, Josef

    2013-01-01

    BACKGROUND: Flap necrosis following facial rhytidectomy constitutes a vexing and grievous complication to the patient and the surgeon. Treatment modalities that can expedite wound healing and re-epithelialization rates are highly desired. OBJECTIVES: To assess wound healing and re-epithelialization rates of open wounds following postrhytidectomy flap necrosis treated with commercially available charged polystyrene microspheres (Polyheal-1, Polyheal Ltd, Israel). METHODS: Flap necrosis following rhytidectomy with open wounds in three female patients were treated using dressings soaked with Polyheal-1. Wound closure rates were documented. RESULTS: The wounds demonstrated both accelerated granulation tissue formation and rapid re-epithelialization rates. No complications or side effects were encountered. CONCLUSIONS: Charged polystyrene microspheres may offer a new and efficacious way to treat open wounds due to flap necrosis following facial rhytidectomy. Further research with larger patient numbers is still needed to verify these findings. PMID:24431937

  9. 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.

  10. 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.

  11. Optimization of Kinematics of a Flapping Wing Mechanism

    Science.gov (United States)

    George, Ryan; Thomson, Scott; Mattson, Christopher; Colton, Mark; Tree, Mike

    2010-11-01

    Flapping flight offers several potential advantages over conventional fixed wing flight, such as agility and maneuverability in confined spaces, potentially decreased noise and detectability, and hovering capability. In this presentation, a water tunnel-based flapping wing apparatus is introduced that allows for arbitrary wing trajectories in three rotational degrees of freedom and simultaneous measurements of lift and thrust production. An optimal flapping trajectory for takeoff is found using hardware-in-the-loop optimization methodology. Wing motion derived from high-speed imaging of a ladybug during takeoff is used as a first iteration of the hardware-in-the-loop optimization. Using real-time force measurements and a gradient-based optimization approach, the algorithm searches for the optimal trajectory for a variety of parameters such as lift or efficiency. Hardware performance is assessed. Results from the optimization routine, including the final flapping trajectory are reported for both rigid and compliant wings.

  12. 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...

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. [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

  19. 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...

  20. 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...

  1. 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.

  2. 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...

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

    Directory of Open Access Journals (Sweden)

    Joseph Richard Dusseldorp, BCom, MBBS(Hons

    2014-10-01

    Conclusions: This study confirms that perforator size is a critical factor in optimizing blood flow in perforator-based free tissue transfer. Further research is required to understand the flow dynamics of perforator flaps based on multiple perforators. However, surgeons should be cognizant that a single large perforator may have substantially higher flow rates than multiple small perforators. Routine FVI calculation is recommended to ensure complete flap survival.

  4. Reconstruction of the Lower Extremity Using Free Flaps

    OpenAIRE

    Min Jo Kang; Chul Hoon Chung; Yong Joon Chang

    2013-01-01

    Background The aim of lower-extremity reconstruction has focused on wound coverage and functional recovery. However, there are limitations in the use of a local flap in cases of extensive defects of the lower-extremities. Therefore, free flap is a useful option in lower-extremity reconstruction. Methods We performed a retrospective review of 49 patients (52 cases) who underwent lower-extremity reconstruction at our institution during a 10-year period. In these patients, we evaluated causes an...

  5. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    Science.gov (United States)

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

  6. 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)

  7. Aquacel Surgical Dressing after Thigh Lift: A Case–Control Study

    Science.gov (United States)

    Bocchiotti, Maria A.; Baglioni, Elisabetta A.; Spaziante, Luca; Frenello, Ambra

    2016-01-01

    Background: The postoperative dressing in patients undergoing thigh lift is often difficult, not very resistant to movement, and uncomfortable for the patient, and often exposes surgical site to infection, maceration, or delay in wound healing. Methods: We included 40 patients in a case–control crossover study with no period effects, who were treated both by Aquacel Surgical and a traditional wound dressing. Surveys with a 10-point scale evaluation were used to assess nontraumatic removal level, ease of application, adhesion, and strength of the 2 treatments. We reported the number of days necessary for wound healing, the number of infection cases, and wound-related complications. Costs of the 2 medications were also considered. Ten days after surgery, patients answered a questionnaire with 6 multiple-choice questions to assess comfort, pain at dressing change, pruritus, strength, and number of dressing changes. Results: Compared with controls, surveys revealed Aquacel Surgical to be less traumatic to remove, easier to apply, and to be more adherent and stronger. Significant acceleration of the wound healing was also evident with Aquacel Surgical compared with the traditional dressing. Nonsignificant differences were reported about the risk of infection and wound-related complications between the 2 treatments. A statistical analysis of costs revealed that Aquacel Surgical is significantly more expensive than the traditional medication. Conclusion: We recommend the use of Aquacel Surgical in all the surgery procedures where the risk of wound dehiscence and maceration is high.

  8. 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.

  9. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    Science.gov (United States)

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery. PMID:24467313

  10. 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

  11. 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

  12. Clinical study on the island flap pedicled with vessels of the femoral cutaneous nerves%股前皮神经营养血管蒂岛状皮瓣的临床应用

    Institute of Scientific and Technical Information of China (English)

    邓永高; 陈伟明; 邹仲兵; 赵海生; 陈志生

    2001-01-01

    目的为开发应用股前皮神经营养血管蒂岛状皮瓣提供实践依据及应用价值和适应证。方法经6例应用股前皮神经营养血管皮瓣修复皮肤软组织缺损病例的临床实践,证实该皮瓣的解剖位置和适用范围。结果 6例皮瓣均成活良好,皮肤颜色、质地接近正常,创面一期愈合。结论股前皮神经营养血管皮瓣修复大腿、腹股沟区、会阴及膝部皮肤软组织缺损有良好疗效。%Objective To explore the clinical indications of the island flap pedicled with vessels of the femoral cutaneous nerves. Methods 6 cases of skin and deep soft tissue defects have been repaired with the island flap pedicled with vessels of the femoral cutaneous nerves. The anatomical location and indications were verified. Results The 6 cases showed excellent or good results in terms of color and thickness of the flap. Conclusion The island flap pedicled with vessels of the femoral cutaneous nerves is an effective method for treatment of skin and deep soft tissue defects in the thigh, perineum and knee.

  13. 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...

  14. 'Serious thigh muscle strains': beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains.

    Science.gov (United States)

    Brukner, Peter; Connell, David

    2016-02-01

    Why do some hamstring and quadriceps strains take much longer to repair than others? Which injuries are more prone to recurrence? Intramuscular tendon injuries have received little attention as an element in 'muscle strain'. In thigh muscles, such as rectus femoris and biceps femoris, the attached tendon extends for a significant distance within the muscle belly. While the pathology of most muscle injures occurs at a musculotendinous junction, at first glance the athlete appears to report pain within a muscle belly. In addition to the musculotendinous injury being a site of pathology, the intramuscular tendon itself is occasionally injured. These injuries have a variety of appearances on MRIs. There is some evidence that these injuries require a prolonged rehabilitation time and may have higher recurrence rates. Therefore, it is important to recognise the tendon component of a thigh 'muscle strain'.

  15. Heterogeneous recruitment of quadriceps muscle portions and fibre types during moderate intensity knee-extensor exercise: effect of thigh occlusion

    DEFF Research Database (Denmark)

    Krustrup, Peter; Söderlund, Karin; Relu, Mihai U.;

    2009-01-01

    (MOD; 29+/-4 W) and with thigh OCC, and moderate exercise followed by 90-s of intense exercise (HI; 65+/-8 W). Temperatures were continuously measured in m. vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) and successive muscle biopsies were obtained from VL. During MOD, muscle...... temperature increase (DeltaT(m)) in RF was 0.52+/-0.09 degrees C, which was 57% and 73% higher (Pmuscle CP in slow twitch (ST) and fast......The involvement of quadriceps femoris muscle portions and fibre type recruitment was studied during submaximal knee-extensor exercise without and with thigh occlusion (OCC) and compared with responses during intense exercise. Six healthy male subjects performed 90-s of moderate exercise without...

  16. Unsteady Aerodynamics of Flapping Wing of a Bird

    Directory of Open Access Journals (Sweden)

    M. Agoes Moelyadi

    2013-04-01

    Full Text Available The unsteady flow behavior and time-dependent aerodynamic characteristics of the flapping motion of a bird’s wing were investigated using a computational method. During flapping, aerodynamic interactions between bird wing surfaces and surrounding flow may occur, generating local time-dependent flow changes in the flow field and aerodynamic load of birds. To study the effect of flapping speed on unsteady aerodynamic load, two kinds of computational simulations were carried out, namely a quasi-steady and an unsteady simulation. To mimic the movement of the down-stroke and the upstroke of a bird, the flapping path accorded to a sinus function, with the wing attitude changing in dihedral angle and time. The computations of time-dependent viscous flow were based on the solution of the Reynolds Averaged Navier-Stokes equations by applying the k-e turbulence model. In addition, the discretization for the computational domain around the model used multi-block structured grid to provide more accuracy in capturing viscous flow, especially in the vicinity of the wing and body surfaces, to obtain a proper wing-body geometry model. For this research, the seagull bird was chosen, which has high aspect ratio wings with pointed wing-tips and a high camber wing section. The results include mesh movement, velocity contours as well as aerodynamic coefficients of the flapping motion of the bird at various flapping frequencies.

  17. 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

    The development of a morphing trailing edge system for wind turbines, also called a flap system, is presented. The functionality is simple as the flap deflection is controlled by pressurized air or a fluid in a number of voids in the flap made of an elastic material. It is thus a robust system...... as 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...... and glued together with a load carrying part with a connector part that allows an easy attachment on the blade section. After tests in the laboratory the flap was mounted on a 2m long blade section mounted on a newly developed test rig. A 10m long boom with the blade section was installed on a 100kW turbine...

  18. 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.

  19. 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.

  20. 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.

  1. 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...

  2. 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...

  3. 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

  4. 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.

  5. 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...

  6. 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

  7. [Covering losses of cutaneous substance of the leg and foot using skin flaps. Apropos of 76 cases].

    Science.gov (United States)

    Oberlin, C; Alnot, J Y; Duparc, J

    1988-01-01

    Between 1983 and 1987, 76 flap grafts were performed in the leg and foot. In general, 3 types of flap were used: --51 ipsilateral flaps, the majority of which were musculo-cutaneous flaps from the medial head of gastrocnemius (17 cases). --17 cross-leg flaps from the opposite limb, the majority of which were medial fascio-cutaneous flaps (13 cases). --8 free flaps, making use of microsurgical techniques. The indications for cross-leg flaps and free flaps have become more limited in favour of local regional pedicle flaps. The lower part of the leg and amputation stumps in the foot are easily covered by distal leg pedicle flaps and amputation stumps of the upper third of the leg can be covered by a flap of fascia lata with a distal pedicle based on the superolateral branches of the peri-articular plexus of the knee.

  8. 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

  9. 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

  10. Effect of exercise intervention on thigh muscle volume and anatomical cross-sectional areas--quantitative assessment using MRI.

    Science.gov (United States)

    Hudelmaier, Martin; Wirth, Wolfgang; Himmer, Maria; Ring-Dimitriou, Susanne; Sänger, Alexandra; Eckstein, Felix

    2010-12-01

    The objective of this study was to evaluate the location-specific magnitudes of an exercise intervention on thigh muscle volume and anatomical cross-sectional area, using MRI. Forty one untrained women participated in strength, endurance, or autogenic training for 12 weeks. Axial MR images of the thigh were acquired before and after the intervention, using a T1-weighted turbo-spin-echo sequence (10 mm sections, 0.78 mm in-plane resolution). The extensor, flexor, adductor, and sartorius muscles were segmented between the femoral neck and the rectus femoris tendon. Muscle volumes were determined, and anatomical cross-sectional areas were derived from 3D reconstructions at 10% (proximal-to-distal) intervals. With strength training, the volume of the extensors (+3.1%), flexors (+3.5%), and adductors (+3.9%) increased significantly (P muscle volumes. The study shows that MRI can be used to monitor location-specific effects of exercise intervention on muscle cross-sectional areas, with the proximal aspect of the thigh muscles being most responsive. PMID:20665894

  11. Thigh muscle size and vascular function after blood flow-restricted elastic band training in older women

    Science.gov (United States)

    Yasuda, Tomohiro; Fukumura, Kazuya; Tomaru, Takanobu; Nakajima, Toshiaki

    2016-01-01

    We examined the effect of elastic band training with blood flow restriction (BFR) on thigh muscle size and vascular function in older women. Older women were divided into three groups: low-intensity elastic band BFR training (BFR-Tr, n = 10), middleto high-intensity elastic band training (MH-Tr, n = 10), and no training (Ctrl, n = 10) groups. BFR-Tr and MH-Tr groups performed squat and knee extension exercises using elastic band, 2 days/week for 12 weeks. During BFR-Tr exercise session, subjects wore pressure cuffs around the most proximal region of both thighs. The following measurements were taken before (pre) and 3-5 days after (post) the final training session: MRI-measured muscle cross-sectional area (CSA) at mid-thigh, maximum voluntary isometric contraction (MVIC) of knee extension, central systolic blood pressure (c-SBP), central-augmentation index (c-AIx), cardio-ankle vascular index testing (CAVI), ankle-brachial pressure index (ABI). Quadriceps muscle CSA (6.9%) and knee extension MVIC (13.7%) were increased (p muscle CSA as well as maximal muscle strength, but does not decrease vascular function in older women. PMID:27244884

  12. 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.

  13. 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.

  14. 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.

  15. Development of a mouse model of abdominal cutaneous flaps for breast reconstruction.

    Directory of Open Access Journals (Sweden)

    Daniel John Womac

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

  16. Relationship of electrical resistance end morphological changes thigh rats after modeling of open fracture (experimental study

    Directory of Open Access Journals (Sweden)

    Pavlova T.M.

    2016-06-01

    Full Text Available Background. Due to the development of industry, increasing number of vehicles on the roads rate of traumatic injuries among adult population causing disability and mortality is still high in all countries of the world. Among all fractures of long bones open diaphyseal fractures ranges from 28% to 53%. Objective. To study the relationship of electrical resistance and morphological features of the femur of white male rats after modeling the open fracture. Methods. Studies were conducted on white male rats aged about 3 months. Digital multimeter UT70B was used to measure the electrical resistance of bones in experimental animals after 1 and 3 hours of experimental modeling of opened bone fracture. Histological and electron microscopic studies were performed to evaluate bone structure. Results. 1 hour after modeling an open bone fracture it was detected the presence of empty lacunae or gaps filled with detritus. 3 hours after the experiment cellular density in the first studied area was reduced 4.1 times, in the second area - 3.2 times comparing with the control. Conclusion. These histological examination and study of the electrical resistance of bone fragments after re-fracture (with or without coagulation fragments indicate similar changes in direction of the bone. Electrical resistance after testing in the clinical setting can be used for testing the bone fragments after an open fracture to assess viability. We have developed a technique for evaluation the electrical resistance making it possible to predict the viability of bone tissue with opened diaphyseal fractures of extremities on early stages. Citation: Pavlova TM, Berezka MI. [Relationship of electrical resistance end morphological changes thigh rats after mod-eling of open fracture (experimental study]. Morphologia. 2016;10(2:31-9. Ukrainian.

  17. RECONSTRUCTION OF FACIAL SKIN DEFECT BY VARIOUS FLAPS : OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Atishkumar B.

    2015-08-01

    Full Text Available INTRODUCTION : Face represents complete personality of human being. Cosmetically it is very important part of a person especially for woman. There are many situations when due to disease or trauma, facial defect arises, which requires reconstruction by either local or distant surgical flaps . METHODS AND MATERIALS : In rural places, we come across many patients suffering from trauma and skin malignancy of face. These patients require reconstruction done esthetically with local flaps. Objective of this study is to share our exper ience of providing esthetically good results at our secondary referral care center. Hereby, we present case series of 14 patients operated at our institute. These patients were analyzed according to the age, sex, nature of injury and anatomical location of lesion on the face. All these patients were operated and reconstruction of defect was done with various local flaps best suited for respective lesion, under local anesthesia or sedation. Post - operative nature of wound was analyzed for flap viability or fl ap necrosis . RESULTS : Amongst them were 7 male and 7 female, ages ranging from 4 to 80 years. 7out of 14 patients were of basal cell carcinoma, 4 were due to trauma, 2 were due to dog bite and 1 case of recurrent pleomorphic adenoma at root of nose. All patients had excellent flap viability at end of 6 months and flap achieving almost similar color and contour as that of surrounding skin. CONCLUSION : Reconstruction of facial defects by local flaps is very easy and cost effective technique. This can be don e even at secondary referral care centre with minimal availability of facilities

  18. 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.

  19. Why Do Elephants Flap Their Ears?

    Science.gov (United States)

    Koffi, Moise; Jiji, Latif; Andreopoulos, Yiannis

    2009-11-01

    It is estimated that a 4200 kg elephant generates as much as 5.12 kW of heat. How the elephant dissipates its metabolic heat and regulates its body temperature has been investigated during the past seven decades. Findings and conclusions differ sharply. The high rate of metabolic heat coupled with low surface area to volume ratio and the absence of sweat glands eliminate surface convection as the primary mechanism for heat removal. Noting that the elephant ears have high surface area to volume ratio and an extensive vascular network, ear flapping is thought to be the principal thermoregulatory mechanism. A computational and experimental program is carried out to examine flow and heat transfer characteristics. The ear is modeled as a uniformly heated oscillating rectangular plate. Our computational work involves a three-dimensional time dependent CFD code with heat transfer capabilities to obtain predictions of the flow field and surface temperature distributions. This information was used to design an experimental setup with a uniformly heated plate of size 0.2m x 0.3m oscillating at 1.6 cycles per second. Results show that surface temperature increases and reaches a steady periodic oscillation after a period of transient oscillation. The role of the vortices shed off the plate in heat transfer enhancement will be discussed.

  20. Island medial plantar artery perforator flap for reconstruction of plantar defects.

    Science.gov (United States)

    Koshima, Isao; Narushima, Mitsunaga; Mihara, Mokoto; Nakai, Ikuo; Akazawa, Satoshi; Fukuda, Norio; Watanabe, Yorikatsu; Nakagawa, Masahiro

    2007-11-01

    Three cases in which island medial plantar artery perforator flaps were successfully transferred for coverage of the plantar defects are described. This perforator flap is different from the medial plantar flap based on the medial plantar artery. The flap has no fascial component and is nourished only with the perforator of the medial plantar vessel. Therefore, transection of the medial plantar artery is usually unnecessary. This flap can cover defects on the forefoot and heel without transaction of the medial plantar system. The advantages of this flap are no need for deep or long dissection for the medial plantar vessel, no exposure of the plantar sensory nerve, a short time for flap elevation, minimal donor-site morbidity, relatively large flap survival, and no damage of both the posterior tibial and medial plantar neurovascular systems. PMID:17992152

  1. 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.

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

    Science.gov (United States)

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

    2012-12-01

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

  3. Doppler-assisted vascular pedicle flaps in eyelid and periorbital reconstruction.

    Science.gov (United States)

    Yeatts, R P; Newsom, R W; Matthews, B L

    1996-09-01

    The use of a transcutaneous ultrasonic Doppler flow detector to identify the supratrochlear and superficial temporal arteries permits the design of narrow-based, thin-tipped forehead flaps for use in medial canthal and eyelid reconstruction. In the 13 cases described, the axial, vascular supply of a proposed myocutaneous forehead flap was determined with a transcutaneous ultrasonic Doppler flow detector permitting narrow-based pedicle widths of 0.8 to 1.2 cm. The design of the distal portion of the flap was determined by the primary defect. The width of the flap varied from 1.5 to 4.0 cm, with the flap's axial length limited only by the hairline. This use of the ultrasonic Doppler flow detector, permitting narrow-based, thin-tipped vascular pedicle flaps, has assisted in refining the concept of forehead flaps and has made these flaps an acceptable primary reconstructive technique in the periorbital region. PMID:8790111

  4. 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

  5. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery.

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

    Science.gov (United States)

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

    2003-05-01

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

  7. Distally Based Iliotibial Band Flap: Anatomic Study with Surgical Considerations.

    Science.gov (United States)

    Wong, Victor W; Higgins, James P

    2016-09-01

    Background Reconstruction of high-risk fascia, tendon, or ligament defects may benefit from vascularized tissue. The iliotibial band (ITB), a thick fibrous tract of connective tissue, serves as a potential donor site for free tissue transfer but its blood supply has not been thoroughly investigated. The aim of this anatomical study was to investigate the vascular supply to the distal ITB and its role as a free fascial flap. Methods We dissected 16 fresh-frozen cadaveric legs and injected latex into the superolateral geniculate artery (SLGA). A distal ITB fascial flap was designed and measurements were taken for flap dimensions, pedicle length and size, and SLGA perfusion territory. Results The SLGA perfused 11.5 ± 2.3 cm of distal ITB (proximal to the lateral femoral epicondyle) and provided 6.4 ± 0.7cm of pedicle length to the ITB flap. Conclusions Chimeric options to include bone (from the lateral femoral condyle), cartilage (from the lateral femoral trochlea), muscle (from vastus lateralis or biceps femoris), and skin are possible. Surgical harvest techniques are proposed, including preservation of ITB insertions to minimize lateral knee instability. Clinical validation is needed to determine the role of the distal ITB free fascial flap in reconstructive microsurgery. PMID:27135145

  8. 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 ...

  9. 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...

  10. 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...

  11. 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

  12. Immediate Bilateral Breast Reconstruction with Unilateral Deep Superior Epigastric Artery and Superficial Circumflex Iliac Artery Flaps.

    Science.gov (United States)

    Hansen, Keith S; Gutwein, Luke G; Hartman, Brett C; Sood, Rajiv; Socas, Juan

    2016-09-01

    Autologous breast reconstruction utilizing a perforator flap is an increasingly popular method for reducing donor site morbidity and implant-related complications. However, aberrant anatomy not readily visible on computed tomography angiography is a rare albeit real risk when undergoing perforator flap reconstruction. We present an operative case of a patient who successfully underwent a bilateral breast reconstruction sourced from a unilateral abdominal flap divided into deep superior epigastric artery and superficial circumflex iliac artery flap segments. PMID:27689054

  13. 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

  14. 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.

  15. Use of Thoracodorsal Artery Perforator Flaps to Enhance Outcomes in Alloplastic Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Jonathan Bank, MD

    2014-05-01

    Conclusions: Patients who underwent irradiation before TDAP flap did not have a higher complication rate when compared with patients who had a full LD flap following radiation. By integrating well-vascularized, nonradiated tissue of a TDAP flap in reconstruction, overall complication rate may be minimized and the results are comparable to the generally accepted method of utilizing the entire latissimus dorsi muscle.

  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. Physiological, aerodynamic and geometric constraints of flapping account for bird gaits, and bounding and flap-gliding flight strategies.

    Science.gov (United States)

    Usherwood, James Richard

    2016-11-01

    Aerodynamically economical flight is steady and level. The high-amplitude flapping and bounding flight style of many small birds departs considerably from any aerodynamic or purely mechanical optimum. Further, many large birds adopt a flap-glide flight style in cruising flight which is not consistent with purely aerodynamic economy. Here, an account is made for such strategies by noting a well-described, general, physiological cost parameter of muscle: the cost of activation. Small birds, with brief downstrokes, experience disproportionately high costs due to muscle activation for power during contraction as opposed to work. Bounding flight may be an adaptation to modulate mean aerodynamic force production in response to (1) physiological pressure to extend the duration of downstroke to reduce power demands during contraction; (2) the prevention of a low-speed downstroke due to the geometric constraints of producing thrust; (3) an aerodynamic cost to flapping with very low lift coefficients. In contrast, flap-gliding birds, which tend to be larger, adopt a strategy that reduces the physiological cost of work due both to activation and contraction efficiency. Flap-gliding allows, despite constraints to modulation of aerodynamic force lever-arm, (1) adoption of moderately large wing-stroke amplitudes to achieve suitable muscle strains, thereby reducing the activation costs for work; (2) reasonably quick downstrokes, enabling muscle contraction at efficient velocities, while being (3) prevented from very slow weight-supporting upstrokes due to the cost of performing 'negative' muscle work.

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Buffeting Response of Suspension Bridge Girder with Separate Control Flaps

    DEFF Research Database (Denmark)

    Huynh, Truc; Thoft-Christensen, Palle

    This paper presents the calculation of the root mean square (RMS) response of a suspension bridge using separate control flaps (SCF) in turbulence conditions. It is assumed that the mean wind velocity is not large enough to cause coupled vibrations and that single mode buffeting response is of in......This paper presents the calculation of the root mean square (RMS) response of a suspension bridge using separate control flaps (SCF) in turbulence conditions. It is assumed that the mean wind velocity is not large enough to cause coupled vibrations and that single mode buffeting response...... on the basis of independent flutter derivatives and independent aeroelastic coefficients from the girder and from the flaps. The theory is demonstrated by a numerical example based on a long-span suspension bridge model with the Great Belt girder....

  7. 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.

  8. Role of platysma muscle flap in depressed scars of neck

    Directory of Open Access Journals (Sweden)

    Rakesh K Sandhir

    2011-01-01

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

  9. 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.

  10. 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.

  11. 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

  12. Competitive athletic participation, thigh muscle strength, and bone density in elite senior athletes and controls.

    Science.gov (United States)

    McCrory, Jean L; Salacinski, Amanda J; Hunt Sellhorst, Sarah E; Greenspan, Susan L

    2013-11-01

    The relationship between participation in highly competitive exercise, thigh muscle strength, and regional and total body bone mineral density (BMD) in elite senior athletes and healthy elderly controls was investigated. One hundred and four elite senior athletes (age: 72.6 ± 6.4 years, height: 168.7 ± 8.6 cm, mass: 72.6 ± 13.5 kg, 57 male:47 female) and 79 healthy controls (age: 75.4 ± 5.6 years, height: 170.8 ± 25.5 cm, mass: 79.5 ± 11.7 kg, 46 male:33 female) participated in this cross-sectional study. Vitamin D and calcium intake were assessed via a recall survey. Isometric knee extension and flexion peak torque were measured via a custom strength measurement device. Total body and regional BMD of the hip, radius, and spine were assessed with a dual-energy x-ray absorptiometer. For each BMD site assessed, multivariate linear regression analysis was performed in 4 steps (α = 0.10) to examine the contribution of (a) age, sex, bodyweight, and calcium and vitamin D intake; (b) group (elite senior athlete, control); (c) knee extension peak torque; and (d) knee flexion peak torque on BMD. Sex, age, bodyweight, and calcium and vitamin D intake explained a significant amount of variance in BMD in each site. Group was not significant. Knee extension peak torque explained an additional 3.8% of the variance in hip BMD (p = 0.06). Knee flexion peak torque was not correlated to BMD at any of the sites assessed. In conclusion, participation in highly competitive athletics was not related to total body or regional BMD. Age, sex, bodyweight, and vitamin D and calcium intake were significantly related to BMD at all the sites assessed. Quadriceps strength contributed slightly to hip BMD. Our results imply that participation in highly competitive senior athletics does not have a protective effect on BMD, perhaps because of a lower bodyweight or other confounding factors.

  13. In vivo activity of cefquinome against Escherichia coli in the thighs of neutropenic mice.

    Science.gov (United States)

    Shan, Qi; Liang, Chaoping; Wang, Jing; Li, Jufeng; Zeng, Zhenling

    2014-10-01

    Cefquinome is a cephalosporin with broad-spectrum antibacterial activity, including activity against enteric Gram-negative bacilli such as Escherichia coli. We utilized a neutropenic mouse model of colibacillosis to examine the pharmacodynamic (PD) characteristics of cefquinome, as measured by organism number in homogenized thigh cultures after 24 h of therapy. Serum drug levels following 4-fold-escalating single doses of cefquinome were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The pharmacokinetic (PK) properties of cefquinome were linear over a dose range of 10 to 640 mg/kg of body weight. Serum half-lives ranged from 0.29 to 0.32 h. Dose fractionation studies over a 24-h dose range of 2.5 to 320 mg/kg were conducted every 3, 6, 12, or 24 h. Nonlinear regression analysis was used to determine which pharmacodynamic parameter best correlated with efficacy. The free percentage of the dosing interval that the serum levels exceed the MIC (fT>MIC) was the PK-PD index that best correlated with efficacy (R(2) = 73% for E. coli, compared with 13% for the maximum concentration of the free drug in serum [fCmax]/MIC and 45% for the free-drug area under the concentration-time curve from 0 to 24 h [fAUC0-24]/MIC). Subsequently, we employed a similar dosing strategy by using 4-fold-increasing total cefquinome doses administered every 4 h to treat animals infected with four additional E. coli isolates. A sigmoid maximum-effect (Emax) model was used to estimate the magnitudes of the %fT>MIC associated with net bacterial stasis, a 1-log10 CFU reduction from baseline, and a 2-log10 CFU reduction from baseline; the corresponding values were 28.01% ± 2.27%, 37.23% ± 4.05%, and 51.69% ± 9.72%. The potent bactericidal activity makes cefquinome an attractive option for the treatment of infections caused by E. coli.

  14. MRI-guided gas bubble enhanced ultrasound heating in in vivo rabbit thigh.

    Science.gov (United States)

    Sokka, S D; King, R; Hynynen, K

    2003-01-21

    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 while 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. MRT2-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

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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

  20. 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.

  1. 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

  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. 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...

  4. 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)

  5. Orbicularis oris musculomucosal flap for anterior palatal fistula

    Directory of Open Access Journals (Sweden)

    Tiwari V

    2006-01-01

    Full Text Available Anterior palatal fistulae or residual anterior clefts are a frequent problem following palatoplasty. Various techniques have been used to repair such fistulae, each having its own advantages and disadvantages. We have successfully used orbicularis oris musculomucosal flap to close anterior fistula and residual clefts in 25 patients. This study shows the superiority of this flap over other techniques because of its reliable blood supply, easy elevation and transfer to fistula site and finally because it is a single-stage procedure.

  6. 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

  7. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    , 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...... of 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...

  8. Covering the Dorsal Finger Defect with Reverse Cross Finger Flap

    Directory of Open Access Journals (Sweden)

    Kaan Gurbuz

    2014-12-01

    Full Text Available Reconstruction of finger extensor zone defects with or without tendon gaps still remains a challenge for surgeons. Although surgical treatments may differ, and range from the use of local, regional, to free flaps, the outcomes for all cases are not satisfactory. In this case report, we present a case of a 3rd finger extensor side crush injury including a defect of Dd (Digit Dorsal 1, Dd2 and Dd3 defects of extensor zones with tendon gap. Tendon gap was reconstructed using m. palmaris longus tendon graft and the defect was covered with reversed cross-finger flap (random pattern with good cosmetic and excellent functional results.

  9. Unsteady wake measurements of an oscillating flap at transonic speeds

    Science.gov (United States)

    Bodapati, S.; Lee, C.-S.

    1984-01-01

    The steady and unsteady wake profiles of an airfoil with an oscillating flap were measured at nominal free stream Mach number of 0.8 in the NASA Ames 11 x 11-foot wind tunnel. The instantaneous wake velocity and pressure profiles at four axial locations are presented up to one chord length from the trailing edge. Both fundamental harmonic frequency and typical time history data are presented to observe the effects of airfoil incidence and flap angle. The drag coefficient obtained from the wake pressure measurements is compared with that obtained from the airfoil pressure distribution.

  10. Experimental study of flapping jets in a soap film

    Science.gov (United States)

    Lee, Julia; Kim, Ildoo; Mandre, Shreyas

    2015-11-01

    Plateau and Rayleigh's observation and explanation on jet instability have inspired us over the years and there has been a significant advance in understanding the jet dynamics. Here, we present a quasi-two-dimensional experimental study of flapping jets in a soap film. Newtonian and non-Newtonian solutions are injected in a flowing soap film. Thinning, break-ups, and beads-on-a-string of the jets, and axisymmetric vortices shredded from the flapping jets are visualized. We employ PIV of the flow motion around the jets to gain an understanding of the roles of instabilities in the flow.

  11. Hand Allograft Saved by an Ultrathin Groin Flap

    Science.gov (United States)

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

    2016-01-01

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

  12. Management of osteoradionecrosis of the mandible with myocutaneous flaps

    International Nuclear Information System (INIS)

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

  13. Non-invasive vascular imaging in perforator flap surgery

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Dept. of Radiology, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)], e-mail: lucasaba@tiscali.it; Atzeni, Matteo; Ribuffo, Diego [Dept. of Surgery, Section of Plastic Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy); Rozen, Warren Matthew [Jack Brockhov Reconstructive Plastic Surgery Research Unit, Dept. of Anatomy and Cell Biology, The Univ. of Melbourne, Parkville, Victoria (Australia); Alonso-Burgos, Alberto [Dept. of Radiology, Clinica Univ., Univ. de Navarra, Pamplona (Spain); Bura, Raffaella [Dept. of Surgery, Section of Vascular Surgery, Azienda Ospedaliero Univ. (AOU), di Cagliari-Polo di Monserrato, Cagliari (Italy)

    2013-02-15

    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.

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

    Directory of Open Access Journals (Sweden)

    Shubham Kumar

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Biomechanical corneal changes induced by different flap thickness created by femtosecond laser

    Directory of Open Access Journals (Sweden)

    Fabricio W. Medeiros

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the impact of the creation of corneal flaps at different thicknesses on the biomechanical properties of swine corneas. METHOD: Twelve swine eyes were obtained to form two groups: 100 μm flap thickness and 300 μm flap thickness. Each eye was submitted to the following examinations: raster topography to investigate corneal curvature alterations, ocular response analyzer to investigate corneal hysteresis change, optical coherence tomography to measure central corneal and flap thickness and sonic wave propagation velocity as a measure of stiffness, before and immediately after flap creation. After flap amputation, surface wave velocity measurements were repeated. RESULTS: Measured flap thicknesses were statistically different for thin and thick flap groups, with an average of 108.5 + 6.9 and 307.8 + 11.5 μm respectively. Hysteresis and corneal resistance factor did not change significantly after flap creation in the thin flap group. With thicker flaps, both parameters decreased significantly from 8.0 +1.0 to 5.1 +1.5 mmHg and from 8.2 + 1.6 to 4.1 +2.5 mmHg respectively. Simulated keratometry values increased in the thick flap group (from 39.5 + 1 D to 45.9+1.2 D after flap creation but not in the thin flap group (from 40.6 + 0.6 D to 41.4+ 1.0 D. Regarding surface wave velocity analysis, the surgical procedures induced statistically lower results in some positions. CONCLUSION: In the experimental conditions established by this model, thicker flaps presented a greater biomechanical impact on the cornea.

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

    Science.gov (United States)

    Panse, Nikhil; Sahasrabudhe, Parag

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nikhil Panse

    2014-01-01

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

  19. Combination of Nasolabial V-Y Advancement Flap and Glabellar Subcutaneous Pedicled Flap for Reconstruction of Medial Canthal Defect

    Directory of Open Access Journals (Sweden)

    Hiromichi Matsuda

    2014-02-01

    Full Text Available A 77-year-old woman presented with a 1-year history of a right medial canthal tumor, which was histopathologically diagnosed as a basal cell carcinoma. After removal of the tumor with a 4-mm safety margin, the defect occupied the areas superior and inferior to the medial canthal tendon. We first reconstructed the lower part of the defect using a nasolabial V-Y advancement flap to make an elliptic defect in the upper part. We then created a glabellar subcutaneous pedicled flap to match the residual upper elliptic defect with the major axis set along a relaxed skin tension line. The pedicled glabellar flap was passed through a subcutaneous tunnel to the upper residual defect. At 6 months postoperatively, the patient showed no tumor recurrence and a good cosmetic outcome.

  20. Rescue of lip switch flap at risk of necrosis due to venous congestion for cleft lip deformity.

    Science.gov (United States)

    Sugiyama, Madoka; Saijo, Hideto; Kazuto, Hoshi; Takato, Tsuyoshi

    2016-01-01

    In a 21-year-old male with bilateral cleft lip who developed marked venous congestion of a lip switch flap, we returned the grafted flap to the donor site to improve blood circulation of the flap and then re-transplanted it, which prevented flap necrosis. Here, we report the procedure and case. PMID:27583269