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Sample records for latissimus dorsi flap

  1. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap.

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    Szychta, Pawel; Butterworth, Mark; Dixon, Mike; Kulkarni, Dhananjay; Stewart, Ken; Raine, Cameron

    2013-10-01

    To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction. Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months. The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p reconstructed breast (p = 0.0001). We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

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    Muhannad Alharbi, MD

    2013-11-01

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

  3. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover......, in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... unilateral LD breast reconstructions were performed in 126 women during the ten-year period. The median age of the women was 48.5 years, and they mainly had secondary reconstruction (90%). The average time to removal of the last drain was 6.3 days, and the average time to discharge was 6.9 days. A total...

  4. Salvage of extensively burned upper limbs by a pedicled latissimus dorsi flap.

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    Delay, E; Foyatier, J L; el Kollali, R; Comparin, J P; Weil, E; Latarjet, J

    1995-09-01

    Very deep burns of the arm and elbow lead to soft tissue necrosis and infection with exposure of important structures. Aggressive debridement should be performed as early as possible to cut the vicious circle, and the defect, which may be extensive, should be covered by well-vascularized tissues. The reliability and versatility of the pedicled latissimus dorsi muscle or musculocutaneous flap make it our first choice in the management of this problem. A retrospective study of three patients for whom salvage of the upper limb has been achieved by the use of a pedicled latissimus dorsi flap is presented, illustrating the advantages of this technique.

  5. The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

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    Mark A. Lee, MBBS, FRACS

    2014-05-01

    Conclusions: Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices.

  6. Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap

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    Divya N Upadhyaya

    2012-01-01

    Full Text Available Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap.

  7. The pedicled transverse partial latissimus dorsi myocutaneous flap for reconstruction of the radiated partial mastectomy defect

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    Zachary Farris

    2015-03-01

    Full Text Available The pedicled partial latissimus dorsi myocutaneous flap based on the transverse branch of the thoracodorsal artery is described as it offers several advantages for reconstruction of radiated partial mastectomy defects. It maintains bulk and vascularity while having a favorable morbidity profile compared to the total flap. Specifically, seroma rates and length of drain use should be reduced. The anatomical location of the transverse branch allows creation of the flap outside the radiated field. Further, the flap preserves the lateral and inferior portions of the latissimus dorsi and the muscle is not detached from its insertion allowing preservation of the posterior axillary fold. Finally, the transversely oriented skin paddle offers favorable scar healing.

  8. Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

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    Chae Eun Yang

    2014-09-01

    Full Text Available BackgroundCurrently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars.MethodsTen patients who underwent partial mastectomy and immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest were reviewed retrospectively. The total operation time, hospital stay, and complications were reviewed. Postoperative scarring, overall shape of the reconstructed breast, and donor site deformity were assessed using a 10-point scale.ResultsIn the mean follow-up of 11 weeks, no tumor recurrence was reported. The mean operation time was 294.5 (±38.2 minutes. The postoperative hospital stay was 11.4 days. Donor site seroma was reported in four cases and managed by office aspiration and compressive dressing. Postoperative scarring, donor site deformity, and the overall shape of the neobreast were acceptable, scoring above 7.ConclusionsReplacement of 20% to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap by using endoscopic harvesting is a good alternative reconstruction technique after partial mastectomy. Short incision benefits from a very acceptable postoperative scar, less pain, and early upper extremity movement.

  9. Reconstruction of the replanted hand with latissimus dorsi muscle and serratus anterior fascia combined flap.

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    Ozçelik, Derya; Uğurlu, Kemal; Turan, Tuğrul

    2003-04-01

    Reconstruction with the latissimus dorsi muscle flap, combined with the serratus anterior fascia flap, was performed to cover two large and separate palmar and dorsal forearm skin defects in a patient, whose hand had been replanted 20 days earlier after traumatic amputation at the distal forearm level. As a result, a total forearm amputation was salvaged by microsurgical replantation and a free combined flap of the subscapular system. This new application of the combined flap allowed the reconstruction of large and separate wounds of the replanted hand, and provided gliding surfaces for tendons.

  10. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

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    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

  11. Autologous breast reconstruction with endoscopic latissimus dorsi musculosubcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance.

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    Monticciolo, D L; Ross, D; Bostwick, J; Eaves, F; Styblo, T

    1996-08-01

    The objective of this study was to define and evaluate mammographic changes in patients treated with breast-conserving therapy and a new reconstructive technique that uses autologous tissue from a latissimus dorsi musculosubcutaneous flap. Of 20 patients who underwent either immediate or delayed endoscopic latissimus dorsi muscle flap reconstruction after lumpectomy, 13 also had postsurgery mammograms available for review. Radiographic findings assessed included skin thickening, density or radiolucency at the reconstruction site, density around the flap, fat necrosis, calcifications, and the presence of surgical clips. Mammograms for three patients (23%) revealed thickening that we believed was attributable to radiation therapy. No patient had increased density in the flap itself; all flaps were relatively radiolucent centrally (13/13; 100%). Mammograms revealed density around the rim of the flap in four patients (31%). This density was most likely secondary to latissimus dorsi muscle fibers and did not limit radiographic evaluation. One patient had calcifications, probably secondary to fat necrosis. No oil cysts were seen. In the majority of patients (11/13; 85%), surgical clips were visible. Endoscopic latissimus dorsi muscle flap reconstruction, previously used only for mastectomy patients, is now being used for improved esthetic outcome in selected patients who desire breast conservation. Our results indicate that the mammographic findings are predictable. The most common findings are relative radiolucency centrally, with or without density from muscle fibers around the edges of the area of tissue transfer. The transplanted musculosubcutaneous flap does not interfere with mammographic evaluation.

  12. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

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    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Manytreatment options are available, but no treatment results in a complete cure. We report acase of lymphedema that occurred after modified radical mastectomy in a breast cancerpatient who showed objective improvement after delayed breast reconstruction with anlatissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer hadundergone modified radical mastectomy with axillary lymph node dissection and postoperativeradiotherapy 12 years previously. Four years after surgery, lymphedema developed andincreased in aggravation despite conservative treatment. Eight years after the first operation,the patient underwent delayed breast reconstruction using the extended latissimus dorsimyocutaneous flap method. After reconstruction, the patient’s lymphedema symptomsshowed dramatic improvement by subjective measures including tissue softness and feeling oflightness, and by objective measures of about 7 mL per a week, resulting in near normal rangesof volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayedbreast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful topatients with lymphedema after mastectomy. This may be a good option for patients who areworried about the possibility of the occurrence or aggravation of secondary lymphedema.

  13. 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...

  14. Does Fibrin Sealant Reduce Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap?

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    Han Gyu Cha

    2012-09-01

    Full Text Available Background The most common complication of latissimus dorsi myocutaneous flap in breastreconstruction is seroma formation in the back. Many clinical studies have shown that fibrinsealant reduces seroma formation. We investigated any statistically significant differences inpostoperative drainage and seroma formation when utilizing the fibrin sealant on the site ofthe latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction afterskin-sparing partial mastectomy.Methods A total of 46 patients underwent immediate breast reconstruction utilizing alatissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedurewithout fibrin sealant and the other 23 were administered the fibrin sealant. All flaps wereelevated with manual dissection by the same surgeon and were analyzed to evaluate thepotential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U testwere used for analyzing the drainage volume according to age, weight of the breast specimen,and body mass index.Results Although not statistically significant, the cumulative drainage fluid volume was higherin the control group until postoperative day 2 (530.1 mL compared to 502.3 mL, but thefibrin sealant group showed more drainage beginning on postoperative day 3. The donor sitecomparisons showed the fibrin sealant group had more drainage beginning on postoperativeday 3 and the drain was removed 1 day earlier in the control group.Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Becausethe benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussedwith patients before its use as a part of informed consent.

  15. 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.

  16. Can angiogenesis induced by chronic electrical stimulation enhance latissimus dorsi muscle flap survival for application in cardiomyoplasty?

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    Overgoor, Max L E; Carroll, Sean M; Papanicolau, George; Carroll, Camilla M A; Ustüner, Tuncay E T; Stremel, Richard W; Anderson, Gary L; Franken, Ralph J P M; Kon, Moshe; Barker, John H

    2003-01-01

    In cardiomyoplasty, the latissimus dorsi muscle is lifted on its primary neurovascular pedicle and wrapped around a failing heart. After 2 weeks, it is trained for 6 weeks using chronic electrical stimulation, which transforms the latissimus dorsi muscle into a fatigue-resistant muscle that can contract in synchrony with the beating heart without tiring. In over 600 cardiomyoplasty procedures performed clinically to date, the outcomes have varied. Given the data obtained in animal experiments, the authors believe these variable outcomes are attributable to distal latissimus dorsi muscle flap necrosis. The aim of the present study was to investigate whether the chronic electrical stimulation training used to transform the latissimus dorsi muscle into fatigue-resistant muscle could also be used to induce angiogenesis, increase perfusion, and thus protect the latissimus dorsi muscle flap from distal necrosis. After 14 days of chronic electrical stimulation (10 Hz, 330 microsec, 4 to 6 V continuous, 8 hours/day) of the right or left latissimus dorsi muscle (randomly selected) in 11 rats, both latissimus dorsi muscles were lifted on their thoracodorsal pedicles and returned to their anatomical beds. Four days later, the resulting amount of distal flap necrosis was measured. Also, at predetermined time intervals throughout the experiment, muscle surface blood perfusion was measured using scanning laser Doppler flowmetry. Finally, latissimus dorsi muscles were excised in four additional stimulated rats, to measure angiogenesis (capillary-to-fiber ratio), fiber type (oxidative or glycolytic), and fiber size using histologic specimens. The authors found that chronic electrical stimulation (1) significantly (p < 0.05) increased angiogenesis (mean capillary-to-fiber ratio) by 82 percent and blood perfusion by 36 percent; (2) did not reduce the amount of distal flap necrosis compared with nonchronic electrical stimulation controls (29 +/- 5.3 percent versus 26.6 +/- 5

  17. Efficacy of Quilting Sutures and Fibrin Sealant Together for Prevention of Seroma in Extended Latissimus Dorsi Flap Donor Sites

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    In Soo Shin

    2012-09-01

    Full Text Available BackgroundThe extended latissimus dorsi flap is important for breast reconstruction. Unfortunately, donor site seroma is the most common complication of extended latissimus dorsi flap for breast reconstruction. Although using fibrin sealant in the donor site reduces the rate of seroma formation, donor site seroma remains a troublesome complication. The purpose of this study was to analyze the effectiveness of the combination of quilting sutures and fibrin sealant in the latissimus dorsi donor site for the prevention of seroma.MethodsForty-six patients who underwent breast reconstruction with extended latissimus flap were enrolled in the study. The patients received either fibrin sealant (group 1, n=25 or a combination of fibrin sealant and quilting sutures (group 2, n=21 in the extended latissimus dorsi donor site. Outcome measures were obtained from the incidence, volume of postoperative seroma, total drainage amount, indwelling period of drainage, and duration of hospital stay.ResultsThe incidence of seroma was 76% in group 1 and 42.9% in group 2 (P=0.022. We also found significant reductions in seroma volume (P=0.043, total drainage amount (P=0.002, indwelling period of drainage (P=0.01, and frequency of aspiration (P=0.043. The quilting sutures did not affect the rate of drainage, tube reinsertion, or hospital stay.ConclusionsThe use of quilting sutures combined with fibrin sealant on the latissimus dorsi flap donor site is helpful for reducing the overall seroma volume, frequency of aspiration, and total drainage amount.

  18. Skin grafted latissimus dorsi flap for reconstruction of lateral aesthetic units of the face.

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    Longo, Benedetto; Laporta, Rosaria; Pagnoni, Marco; Campanale, Antonella; Grippaudo, Francesca Romana; Santanelli Di Pompeo, Fabio

    2015-03-01

    Reconstruction of large defects of the lateral region of the face is rather challenging due to the unique color, texture, and thickness of soft tissues in this area. Microsurgical free flaps represent the gold standard, providing superior functional and aesthetic restoration. Purpose of this study was to assess reliability of skin-grafted latissimus dorsi (LD) flap, for a pleasant and symmetric reconstruction of the lateral aesthetic units of the face compared to a control group of patients addressed to perforator flaps. From November 2008 to June 2012, 5 patients underwent skin-grafted LD flap reconstruction of defects involving the lateral aesthetic units of the face, with 8.1 ± 0.5 × 9.7 ± 1.3 cm mean size. A 1-to-4 Likert scale was used to assess skin color, texture, shape, and bulkiness. Using the Pressure-Specified Sensory Device epicritic, proprioceptive, and protopathic sensitivities were tested. Outcomes were compared with those of a control group of 5 patients addressed to reconstruction with perforator flaps (3 anterolateral thigh flap, 2 vertical deep inferior perforator flap). At mean 21-month follow-up all flaps healed uneventfully without need for revisions, all developing more satisfactory results in terms of skin color (P = 0.028) and texture (P = 0.021) match, shape (P = 0.047) and bulkiness (P = 0.012) compared with perforator flaps. No differences in epicritic, proprioceptive, and protopathic sensitivities were observed (P > 0.05) between the two groups. Skin-grafted LD flap may be a suitable option for reconstruction of wide defects of the lateral aesthetic units of the face.

  19. Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

    OpenAIRE

    Chae Eun Yang; Tai Suk Roh; In Sik Yun; Young Seok Kim; Dae Hyun Lew

    2014-01-01

    Background Currently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars. Methods Ten patients who under...

  20. Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

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    2017-01-01

    Background: Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging. Methods: Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3). Results: The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred. Conclusions: The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds. PMID:28740770

  1. Chest wall reconstruction in thoracoabdominal ectopia cordis: using the pedicled osteomuscular latissimus dorsi composite flap.

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    Lampert, Joshua A; Harmaty, Marco; Thompson, Elizabeth Chabner; Sett, Suvro; Koch, R Michael

    2010-11-01

    Ectopia cordis is a rare congenital defect characterized by complete or partial displacement of the heart outside the thoracic cavity. Repair of ectopia cordis can present a reconstructive challenge often requiring a staged approach. Ideally, structural integrity and protection of the heart are restored using autologous tissues capable of growth. In addition, reconstruction of the thorax must proceed without compromise to pulmonary or cardiovascular stability. The following article describes repair of thoracoabdominal ectopia cordis in a patient with pentalogy of Cantrell. Reconstruction of the chest wall was accomplished using a musculoosseus composite flap involving segments of the 9th and 10th ribs and overlying pedicled latissimus dorsi muscle. This is the first report known to the authors of such a repair.

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

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    Aktas Alper

    2003-12-01

    Full Text Available Abstract Background Latissimus dorsi musculocutaneous flap is one of the most frequently performed reconstructive techniques in surgery. Latissimus dorsi muscle has two arcs of rotation. It is classified as type V muscle. This muscle can be elevated on the thoracodorsal artery to cover large defects in the anterior chest and also, the muscle can be elevated on the segmental vessels to cover midline defects posteriorly. The aim of this study was to create a new arc of rotation on a vertical axis for the muscle and investigate effectiveness of vascular and chemical delays on the latissimus dorsi muscle flap with an inferior pedicle in an experimental rat model. We hypothesized that the latissimus dorsi muscle would be based on inferior pedicle by delay procedures. Methods We tested two different types of delay: vascular and combination of vascular and chemical. We also tried to determine how many days of "delay" can elicit beneficial effects of vascular and combination delays in an inferior pedicled latissimus dorsi musculocutaneous flap. To accomplish this, 48 male Sprague-Dawley rats were randomly subjected to vascular or combination delay (vascular and chemical. In addition, one ear of each rat was assigned into a delay procedure and the other ear was used as a control. Results were evaluated macroscopically, and micro-angiography and histological examinations were also performed. As a result, there was a significant difference in viable flap areas between vascular delay alone and control groups (p Results The higher rate of flap viability was obtained in seven-day vascular delay alone. However, there was no significant difference in the viability between seven-day vascular delay and five-day vascular delay (p Conclusion The combination of vascular and chemical delays increased the rate of viability. Nevertheless, there was no significant difference between vascular delay alone and combination of vascular and chemical delays. Chemical delay did

  3. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps.

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    Guerra, Aldo Benjamin; Gill, Paul Singh; Trahan, Chris G; Ruiz, Bernardo; Lund, Kerstin M; Delaune, Christie L; Thibodeaux, Brett A; Metzinger, Stephen Eric

    2005-02-01

    Muscle and musculocutaneous flaps have been used reliably in reconstruction of soft-tissue defects for many years. Previous experimental studies have shown musculocutaneous flaps to be superior to the random pattern and fasciocutaneous flaps in the management of infected wounds. Over the past decade, perforator flaps have gained acceptance as alternative methods of reconstruction in the clinical setting that can decrease donor-site morbidity and hospital stay, and increase patient satisfaction. The authors theorized that perforator flaps may be able to handle infected wounds better than random pattern and fasciocutaneous flaps because their blood supply is essentially the same as many of their musculocutaneous counterparts. The goal of this study was to compare the S1 perforator-based skin flap and latissimus dorsi musculocutaneous flap in the dorsal flank of the rabbit with the introduction of bacteria to simulate both superficial and deep wound infection. Measurements of oxygen tension and regional perfusion index were performed on both types of flaps to ascertain their viability and capacity to heal. The authors found no statistical significance between latissimus dorsi musculocutaneous and S1 perforator flaps in the rabbit with respect to superficial and deep wound infections. The regional perfusion index was calculated for postoperative days 1, 2, and 4. No statistically significant difference between the two flaps using the regional perfusion index could be identified. Additionally, regional perfusion for both types of flaps was greater than 0.6, indicating that their capacity to heal wounds is similar.

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

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

    2016-01-01

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

  5. Application of three-dimensional digitalized reconstruction of latissimus dorsi myocutaneous flap

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    Yuanzhi ZHANG; Jianwei LI; Yanbing LI; Dan JIN; Jionghao CHEN; Shizhen ZHONG; Guoxian PEI

    2008-01-01

    Developments of digital technology and three-dimensional (3D) reconstruction allowed a precise description of anatomic structures. With the introduction of Visible Human Project and Virtual Chinese Human (VCH) techniques, more detailed anatomic images could be obtained. Digitized visible models of these structures can be applied as a useful tool in clinical training. The aim of this study was to reconstruct the normal structures of thoracodorsal artery in 3D images and to establish the digitized visible models of latissimus dorsi myocutaneous (LDM) flap. The cross-sectional images from the four VCH datasets were reviewed to study LDM and thoraco-dorsal artery structures on a section-by-section basis. Next, two adult fresh cadaver specimens were perfused with lead oxide-gelatine mixture and subject to radio-graphic CT scanning on their torsos. The cross-sectional images from the CT images were reviewed to study thor-acodorsal artery structures. Three-dimensional computer-ized reconstructions of LDM flap structures were conducted from these datasets by using Amira 3.1 (TGS) software respectively. The 3D reconstructed visible models established from these datasets perfectly displayed the anatomic characteristics of LDM flap.

  6. IMMEDIATE BREAST RECONSTRUCTION WITH LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP: A SUITABLE OPTION FOR CHINESE WOMEN AFTER MASTECTOMY

    Institute of Scientific and Technical Information of China (English)

    DI Gen-hong; YU Ke-da; WU Jiong; QI Fa-zhi; LU Jin-song; SHEN Zhen-zhou; SHAO Zhi-min

    2006-01-01

    Objective: To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing thepedicled transverse rectus abdominis myocytaneous flap (TRAM) reconstruction with latissimus dorsi myocytaneous flap (LTD) reconstruction plus implants or not after mastectomy due to breast cancer. Methods: From Jan. 2000 to Jul. 2005, 74staged 0-Ⅱ patients (mean age 39) were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results: The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases (83.8%) were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance (P=0.442,Fisher' exact test). Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1%cumulative locoregional recurrence and 100% overall survival by following up to 66 months (median 9 months). The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion: Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.

  7. Spectral analysis of blood perfusion in the free latissimus dorsi myocutaneous flap and in normal skin

    Energy Technology Data Exchange (ETDEWEB)

    Liu Xudong [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Zeng Bingfang [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Fan Cunyi [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Jiang Peizhu [Department of Orthopaedic Surgery, Shanghai No. 6 People' s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233 (China); Hu Xiao [Department of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030 (China)

    2006-01-07

    To find the properties in the oscillatory components of the cutaneous blood flow on the successful free flap, a wavelet transform was applied to the laser Doppler flowmetry (LDF) signals which were measured simultaneously on the surfaces of the free latissimus dorsi myocutaneous flap and on the adjacent intact skin of the healthy limb, of 18 patients. The frequency interval from 0.0095 to 1.6 Hz was examined and was divided into five subintervals (I: 0.0095-0.021 Hz; II: 0.021-0.052 Hz; III: 0.052-0.145 Hz; IV: 0.145-0.6 Hz and V: 0.6-1.6 Hz) corresponding to endothelial metabolic, neurogenic, myogenic, respiratory and cardiac origins. The average amplitude and total power in the frequency range 0.0095-1.6 Hz as well as within subintervals I, II, IV and V were significantly lower for signals measured on the free flap than those obtained in the healthy limb. However in interval III, they were significantly higher. The normalized spectral amplitude and power in the free flap were significantly lower in only two intervals, I and II, yet in interval III they were significantly higher; no statistical significance was observed in intervals IV and V. The distinctive finding made in this study, aside from the decrease of endothelial metabolic processes and sympathetic control, was the significant increase of myogenic activity in the free flap. It is hoped that this work will contribute towards knowledge on blood circulation in free flaps and make the monitoring by LDF more reliable.

  8. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap.

    Science.gov (United States)

    Homma, Tsutomu; Okazaki, Mutsumi; Tanaka, Kentaro; Uemura, Noriko

    2017-07-01

    Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.

  9. Simultaneous Surgical Treatment for Smile Dysfunction and Lagophthalmos Involving a Dual Latissimus Dorsi Flap

    Directory of Open Access Journals (Sweden)

    Tsutomu Homma, MD

    2017-07-01

    Full Text Available Summary:. Paralytic lagophthalmos and smile dysfunction are serious complications of facial paralysis and various reconstructive procedures have been developed to treat them. Among these procedures, there is no doubt that dynamic procedures are more effective than static ones. The 1-stage simultaneous surgical treatment of these 2 dysfunctions with a dynamic procedure involving a single muscle would be ideal, but no such methods have been reported. In this article, we present a 1-stage method for the simultaneous surgical treatment involving the use of a dual latissimus dorsi muscle flap. In this method, 2 muscle flaps based on the descending and transverse branches of the thoracodorsal vessels are transferred to the face. The descending and transverse branches of the thoracodorsal nerve are sutured to separate branches of the masseteric nerve. Using this method, complete eyelid closure during strong clenching and voluntary smiling during weak clenching without eyelid closure were achieved. Although our method does not result in spontaneous smiling, we believe that it is a good option for some patients with long-standing facial paralysis.

  10. Brachial plexus injury after transfer of free latissimus dorsi musculocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    周友清; 陈亮; 胡韶楠; 顾玉东

    2002-01-01

    @@ Free latissimus dorsi muscle transfer is widely used for functional reconstruction of flexion of elbow and fingers after brachial plexus injury at later stage, as well as for soft tissue coverage because of its large size and long and reliable pedicle with adequate vessel diameter.

  11. Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

    Directory of Open Access Journals (Sweden)

    Jiajun Feng

    2016-03-01

    Full Text Available BackgroundThe aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.MethodsWe analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.ResultsThe average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.ConclusionsThis approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

  12. Variation of the latissimus dorsi

    Directory of Open Access Journals (Sweden)

    Ishani P Shah

    2014-01-01

    Full Text Available A typical muscle variation of latissimus dorsi - the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer, coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before.

  13. Latissimus dorsi muscle-flap over Gore-Tex patch for coverage of large thoracic defects in paediatric Ewing sarcoma.

    Science.gov (United States)

    Gapany, Christophe; Raffoul, Wassim; Zambelli, Pierre-Yves; Joseph, Jean-Marc

    2009-05-01

    Primary rib involvement accounts for 16% of paediatric Ewing sarcoma (ES). Neo-adjuvant chemotherapy and surgical tumor resection may leave large thoracic wall defects requiring complex reconstruction in a growing individual. We report our experience in three children aged 3, 10, and 12 years, in whom single-stage resection and reconstruction were performed using a Gore-Tex Dualmesh patch, covered by a latissimus dorsi rotation flap harvested in continuity with the thoracolumbar fascia. The youngest patient also had a vertical expandable prosthetic titanium rib (VEPTR) anchored to help prevent subsequent scoliosis throughout growth. (c) 2009 Wiley-Liss, Inc.

  14. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back.

    Science.gov (United States)

    Serra-Renom, José M; Serra-Mestre, José M; Martinez, Lourdes; D'Andrea, Francesco

    2013-10-01

    Results obtained with breast-conserving therapy are not always satisfactory. Reconstruction with a pure latissimus dorsi muscle flap is a useful option. The techniques described for endoscopic dissection of the flap create several scars on the back. As a result, they do not improve on the open approach, which causes a horizontal scar at the level of the bra strap. The authors' technique avoids all scars on the back using a single incision in the highest folds of the axilla, which also is used for the sentinel node biopsy or lymphadectomy and quadrantectomy. The study was performed with 23 patients. The tumor was extracted via a clockwise downward periareolar incision and via another incision in a fold of the axilla. Through this axillary incision, the sentinel lymph node biopsy or lymphadectomy was performed, and the external part of the latissimus dorsi muscle was harvested endoscopically for the reconstruction. Both the medical team and the patients reported high satisfaction with the aesthetic and functional results due to the preservation of the breast shape and the absence of any scarring on the back. Endoscopy-assisted techniques make either three small scars on the back or one long scar, with the muscle sectioned distally, or a vertical incision in the midaxillary line, which may form a hypertrophic or keloid scar. The authors' approach avoids the creation of these scars on the back because the endoscopy and the distal sectioning of the muscle flap are performed through the single axillary incision.

  15. The use of a pedunculated, extended latissimus dorsi flap in primary and secondary breast reconstruction procedures--case report.

    Science.gov (United States)

    Maciejewski, Adam; Ulczok, Rafał; Dobrut, Mirosław; Szumniak, Ryszard; Półtorak, Stanisław

    2012-07-01

    The extended latissimus dorsi flap (LD) is used in breast reconstruction since the 70's. LD flap is often used in corrective surgery in cases of unsatisfactory cosmetic results after breast-conserving therapy. In our department LD flap has several uses. In addition to free microvascular flaps - which applies in breast reconstructive surgery is routine, there are clinical situations where the use of pedicled LD flap is justified. The main indications for its use are: the inability to apply microvascular flap, the general condition (diabetes, advanced atherosclerosis), smoking, previous surgery of abdominal wall, abdominal obesity, patient preferences. Approximately 30% of patients after breast reconstruction require corrective procedures. Group which uses extended LD flap account for 24 patients. In 16 cases it was used for elective breast reconstruction. In the remaining eight cases it was used in the corrective procedures symmetry and shape of the previously reconstructed breast. Based on our own experience it can be concluded that the LD flap with an alternative to microvascular techniques. Complication rate when using the LD flap is relatively low and includes: seroma and slight motor disability of the shoulder girdle.

  16. Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

    Science.gov (United States)

    Samuel, Madan; Parapurath, Rajiv

    2016-01-01

    Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete congenital diaphragmatic agenesis using a combination of autologous living bio-tissue and synthetic mesh in a neonate born in the NMC Specialty Hospital in Dubai, United Arab Emirates, in May 2014. Poor Apgar scores, a scaphoid abdomen and absent breath sounds over the right hemithorax were observed at birth. Chest and abdominal X-rays revealed a diaphragmatic hernia. The neonate was stabilised using high-frequency oscillatory ventilation, nitric oxide and sildenafil. The right diaphragm was reconstructed using combined latissimus dorsi and serratus anterior muscle flaps reinforced by a flexible composite mesh. At 12 months old, the infant had normal respiratory function and the diaphragm was intact. No disabilities of the shoulder or scapula were observed. This case indicates that a combination of living tissue and synthetic mesh can be used to reconstruct a functional diaphragm with efficient pleuroperitoneal separation. PMID:26909223

  17. Pyoderma gangrenosum following complex reconstruction of a large-scale lower limb defect by combined Parascapular and latissimus dorsi flap

    Science.gov (United States)

    Cordts, Tomke; Bigdeli, Amir K.; Harhaus, Leila; Hirche, Christoph; Kremer, Thomas; Kneser, Ulrich; Schmidt, Volker J.

    2017-01-01

    A female patient with a critical soft tissue defect after elective knee replacement surgery was transferred to our department for reconstruction. As wounds were rapidly progressing, necrotizing fasciitis was initially suspected but eventually ruled out by histopathological analysis. A 50 × 15 cm defect was then reconstructed by means of a combined Parascapular and latissimus dorsi flap before, a couple days later, the patient developed tender pustules and ulcers involving the flap as well as the donor site. Attempts of excising necrotic areas not only continued to fail but seemed to worsen the patient's wound and overall condition. Eventually, pyoderma gangrenosum (PG) was diagnosed and local and systemic therapy was initiated but treatment proved to be challenging and insufficient at first. Being an extremely aggressive disease, early diagnosis is crucial and PG should always be suspected when rapidly progressive ulceration on surgical sites is observed. PMID:28096323

  18. The outcome of Jarcho-Levin syndrome treated with a functional latissimus dorsi flap - A series of three cases

    Directory of Open Access Journals (Sweden)

    Bipin A Gangurde

    2012-01-01

    Full Text Available Introduction: Jarcho-Levin syndrome is manifested by vertebral body and rib malformations. Large rib defects with paradoxical chest motion lead to early deathdue to progressive respiratory insufficiency, hence it is a lethal syndrome. The only means of improving survival is early stabilisation of the chest wall defect by containing the thoracic herniation. Nitcher et al. and Thatte et al. showed that reconstruction of the chest wall was life saving. Thatte et al. had postulated that early coverage of the lungs and thoracic contents with functional latissimus dorsi may prevent the visceral overgrowth and secondary pleural changes. Materials and Methods: Our three cases which had medium- and long-term follow-up help to support this postulation. Three patients were assessed retrospectively. Their ages at surgery were 6 months, 8 months and 1 year, respectively. All had laboured breathing and paradoxical respiration. All of them were operated with ipsilateral latissimus dorsi flap. Results: The results were evaluated clinically. The patients had reduced or no respiratory infections. The lung compliance improved and they had no tachypnoea on walking, running or playing. Conclusion: Hence, this can be used as a life-saving procedure for Jarcho-Levin syndrome on a long-term basis.

  19. Reconstruction of the pelvis and perineum with a free latissimus dorsi myocutaneous flap: a case report.

    LENUS (Irish Health Repository)

    Kieran, I

    2012-11-01

    Reconstruction of the perineum and pelvic cavity in continuity is an uncommon and difficult challenge. This case describes a 66-year-old man who presented following recurrence of a Dukes\\' B rectosigmoid adenocarcinoma that had been treated nine years previously by anterior resection, 5-fluorouracil and radiotherapy. His recurrent disease was treated with radical pelvic exenteration with formation of an end colostomy and urinary ileal conduit. A post-operative pelvic collection necessitated incisional drainage via the perineum. This resulted in a perineal defect in continuity with the pelvic cavity, neither of which healed in spite of alternate day packing with antiseptic dressings. The perineum and cavity were reconstructed successfully with a microvascular transfer of the latissimus dorsi using the primary gracilis pedicle as recipient donor vessels.

  20. Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy.

    Science.gov (United States)

    Wolter, A; Scholz, T; Diedrichson, J; Arens-Landwehr, A; Schroeder-Finckh, R; Liebau, J

    2013-11-01

    Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

  1. Latissimus dorsi volteado para reconstrucción de carcinoma basocelular gigante en un paciente anciano Latissimus dorsi turn over flap for giant basal cell carcinoma reconstruction in elderly patient

    Directory of Open Access Journals (Sweden)

    J. Balaguer-Cambra

    2009-03-01

    Full Text Available Los carcinomas basocelulares son tumores cutáneos de crecimiento lento aunque pueden llegar a tener un gran tamaño a lo largo de los años si el entorno socioeconómico y asistencial del paciente es pobre, como sucede en el caso que presentamos, en el que la lesión ulcerada en la línea media de la espalda llegó a medir 21 x 13 cm de diámetro. El colgajo de Latissimus Dorsi permite gracias a sus dos pedículos y a ser pivotado, una posibilidad reconstructiva en el caso de pacientes ancianos, evitando el uso de colgajos libres.Basal cell carcinoma are well known as slow local growth cutaneous tumors that can enlarge through years in low socioeconomic and poor health assistance environments, as in the case that we present, with a 21 x 13 cm ulcerated lesion located over back midline. The Latissimus Dorsi muscle flap offers a reliable reconstruction in elderly patients avoiding the use of free flaps. This flap, because of its two different pedicles, can be used to reach defects in opposite directions.

  2. The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study

    Directory of Open Access Journals (Sweden)

    Apichai Angspatt

    2017-07-01

    Full Text Available Background Donor site seroma is the most common complication after latissimus dorsi (LD flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction. Methods In this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated. Results In the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24. Both the mean percutaneous aspirated volume (P=0.004 and the number of percutaneous aspirations (P=0.001 were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05. Conclusions This study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.

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

    Science.gov (United States)

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

    2015-07-01

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

  4. Use of latissimus dorsi pedicled myocutaneous flap for reconstruction in the chest area of an 8-month-old female infant with ectopia cordis.

    Science.gov (United States)

    Dastagir, Khaled; Breymann, Thomas; Heckmann, Andreas; Horke, Alexander; Vogt, Peter Maria

    2014-12-01

    Ectopia cordis (EC) is characterized by a complete or partial malposition of the heart outside the thorax. Despite the interdisciplinary treatment, the repair of EC is still very difficult and offers new surgical challenges because of its complexity and various combinations with other anomalies. We report the successful outcome after using a pedicled latissimus dorsi flap in reconstructive surgery in the setting of chronic wound dehiscence in an 8-month-old female infant born with a thoracic EC and omphalocele.

  5. Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma

    OpenAIRE

    2016-01-01

    This animal was presented with a large-sized infiltrative lipoma in the abdominal wall that had been noted for 4 years. This lipoma was confirmed by histological examination from a previous biopsy, and the infiltrative features were identified by a computerized tomography scan. The surgical removal created a large-sized abdominal defect that was closed by a combination of latissimus dorsi and external abdominal oblique muscle flaps in a pedicle pattern. A small dehiscence at the most distal e...

  6. Neo-phalloplasty with re-innervated latissimus dorsi free flap: a functional study of a novel technique.

    Science.gov (United States)

    Ranno, R; Veselý, J; Hýza, P; Stupka, I; Justan, I; Dvorák, Z; Monni, N; Novák, P; Ranno, S

    2007-01-01

    Twenty two patients with gender dysphoria underwent neo-phalloplasties using a novel technique. Latissimus dorsi musculocutaneus re-innervated free flap was used to allow voluntary rigidity of the neo-penis. From the first 22 patients, 18 have obtained motoric function of reconstructed penis; the "paradox erection" was obtained. 14 patients came for examination after a follow-up period of mean 26.4 months. We evaluated the motility and shape changes of neo-phallus measuring its different size and dimension during relax and muscle contraction. The range of neo-phallus length in relaxed position was between 7 and 17 cm (mean 12.2 cm), its circumference in the same position had a range between 13 and 20 cm (mean 13.7 cm). All patients were able to contract the muscle with an average length reduction of 3.08 cm and an average circumference enlargement of 4 cm. In this study, the dimensions and motility were quantified demonstrating the neo-phallus function and size changes during sexual intercourse.

  7. Oncological safety and quality of life associated with mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap.

    Science.gov (United States)

    Min, Sun Young; Kim, Hyun Yul; Jung, So-Youn; Kwon, Youngmee; Shin, Kyung Hwan; Lee, Seeyoun; Kim, Seok Won; Kang, Han-Sung; Yun, Young Ho; Lee, Eun Sook

    2010-01-01

    To determine the quality of life (QoL) of breast cancer patients who underwent mastectomy and immediate breast reconstruction with a latissimus dorsi myocutaneous flap (LD), and the oncological safety of the procedure. Between May 2001 and March 2007, 2,566 patients had breast cancer surgery at the National Cancer Center, Korea. Of the 2,566 patients, 1,699 had breast-conserving surgery (BCS) and 120 had a mastectomy with an immediate LD. We retrospectively compared the oncologic safety of the two techniques. We also assessed the QoL using the EORTC QLQ BR-23 and Zung's self-rating depression scale in 52 LD patients, 104 age- and stage-matched patients who underwent BCS, and 104 age-matched healthy women. The LD group had earlier stage disease than the BCS group at baseline, but following surgery, the groups did not differ in the rates of local recurrence or systemic metastases. Compared with the healthy group, the patient groups had poorer functioning and more depression (p Mastectomy with immediate reconstruction should be considered carefully and tailored to the patient's needs and characteristics.

  8. Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap.

    Science.gov (United States)

    Munhoz, Alexandre Mendonça; Montag, Eduardo; Arruda, Eduardo; Okada, Alberto; Brasil, José Augusto; Gemperli, Rolf; Filassi, José Roberto; Ferreira, Marcus Castro

    2011-06-01

    Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management.

  9. Latissimus dorsi myocutaneous flap for burned breast reconstruction%应用背阔肌岛状肌皮瓣修复烧伤后乳房畸形

    Institute of Scientific and Technical Information of China (English)

    王阳; 赵茹; 王晓军; 刘志飞; 乔群

    2008-01-01

    目的 介绍应用背阔肌岛状肌皮瓣修复前胸壁烧伤后所致乳房瘢痕挛缩畸形的临床效果.方法 应用扩张或未扩张的背阔肌岛状肌皮瓣修复烧伤后乳房瘢痕、部分缺损畸形,其中轻、中度烧伤后乳房缺失2例,采用背阔肌岛状肌皮瓣修复重度乳房缺失5例,采用扩张的背阔肌岛状肌皮瓣修复.结果 共治疗7例,术后肌皮瓣完全成活,乳房形态明显改善,无肌皮瓣坏死、背部伤口感染、裂开及肩部功能障碍等并发症发生.供区无明显后遗畸形及功能障碍.结论 背阔肌岛状肌皮瓣血运良好,操作简便易行,是修复烧伤乳房畸形的较好方法.%Objective Thermal burns of the anterior chest disfigure the female breast, and the postburn breast deformity is a sequela of severe scar contraction of the burned chest. For deformities that affected the mammary development, museulocutaneous flaps were used. Here we introduce our experience in using the latissimus dorsi myocutaneous island flap in burned breast reconstruction. Methods During the past 7 years, 7 female patients with such deformities required reconstruction, the expanded or unex-panded latissimus dorsi musculocutaneous island flaps were used in the partial reconstruction of burned breast. In the mild deformities group (2 cases), unexpanded latissimus dorsi musculocutaneous island flaps were used. For patients with undeveloped mammary glands (5 cases), expanded latissimus dorsi musculocutaneous island flaps were used. Results The procedure was performed in 7 patients and all the flaps were alive, with significant improvement of breast appearance. The complication rate was low. There were no deformity and dysfuction in the donor site. Conclusions The technique has many advanta-ges: beautiful contour of breast, good blood supply of the flap, no donor site morbidity. It provides the plastic surgeon with an excellent, safe and consistently successful method for burned breast reconstrue

  10. [Free latissimus dorsi flap revascularized by double venous graft on the femoral trifurcation in the treatment of lumbar radionecrosis. Apropos of 2 cases].

    Science.gov (United States)

    Rostane, D; Manise, O; Lucas, A; Miard, F; Perez, M; Watier, E; Pailheret, J P

    1994-06-01

    Two patients were operated in 1989 and 1992 for lumbar chronic osteoradionecrosis (toxi-infection collapsus in one of the two cases). Conventional coverage procedures (skin graft, local flaps) or distally based latissimus dorsi musculo-cutaneous flap (second case) were attempted but failed. So we realised in a one stage procedure a free musculo-cutaneous flap in the case no. 1 and a free muscular flap, later skin grafted, in the case no. 2. Venous and arterial bypass were provided by 40 cm long saphenous veins harvested from the thighs, and allowed to reach the lumbar site with proximal anastomosis performed on the femoral artery. The results were considered to be excellent. That short experience shows that long venous bypass with microsurgical free transfer can be safely performed. This results in an extremely high flow shunt.

  11. Repair of a large soft tissue defect in the leg with cross-leg bridge free transfer of a latissimus dorsi myocutaneous flap: a case report

    Directory of Open Access Journals (Sweden)

    ZHANG Gong-lin

    2012-12-01

    Full Text Available 【Abstract】A 48-year-old man sustained a traffic accident injury to his left leg. It was an open fracture of the left tibia and fibula accompanied by a large soft tissue de-fect (27 cm×7 cm. Doppler examination revealed the poste-rior tibial artery was occluded due to thrombosis. Three weeks after injury, the latissimus dors myocutaneous flap was elevated with a T-shaped vascular pedicle and was in-terposed between the two vascular ends of the posterior tibial vessel of the contralateral leg. Two end to end anasto-moses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap’s T-shaped vascular pedicle. The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg. The vascular pedicle was cut off after 28 days and the flap sur-vived completely. After 3-years’ follow-up postoperatively, a good contour was confirmed at the recipient area. The right tibia and fibula fractures were confirmed healing radiologically. The posterior tibial artery of contralateral leg was demonstrated patent by clinical and Doppler examinations. Key words: Surgical flaps; Leg injuries; Soft tissue injuries; Wound healing

  12. Repair of a large soft tissue defect in the leg with cross-leg bridge free transfer of a latissimus dorsi myocutaneous 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 48-year-old man sustained a traffic accident injury to his left leg.It was an open fracture of the left tibia and fibula accompanied by a large soft tissue defect (27 cm×7 cm).Doppler examination revealed the posterior tibial artery was occluded due to thrombosis.Three weeks after injury,the latissimus dors myocutaneous flap was elevated with a T-shaped vascular pedicle and was interposed between the two vascular ends of the posterior tibial vessel of the contralateral leg.Two end to end anastomoses were performed between the two vascular ends of the posterior tibial vessel of the contralateral leg and the latissimus dors myocutaneous flap's T-shaped vascular pedicle.The latissimus dorsi myocutaneous flap was used for repair of a large soft tissue defect of the left leg.The vascular pedicle was cut offafter 28 days and the flap survived completely.After 3-years' follow-up postoperatively,a good contour was confirmed at the recipient area.The right tibia and fibula fractures were confirmed healing radiologically.The posterior tibial artery of contralateral leg was demonstrated patent by clinical and Doppler examinations.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Use of latissimus dorsi flap pedicle as a T-junction to facilitate simultaneous free fibular flap inset in lower extremity salvage.

    Science.gov (United States)

    Hwang, Kyu Tae; Youn, Seungki; Kim, Jeong Tae; Lee, Seung Hoon; Ng, Siew-Weng; Kim, Youn Hwan

    2012-04-01

    Marjolin's ulcer is a very aggressive form of squamous cell carcinoma arising from chronic wounds or unstable scars. A resection margin of at least 2 cm with clear deep margin is required on removal. A 79-year-old male presented with chronic osteomyelitis of the left anterior tibial region with chronic ulceration. Biopsy revealed squamous cell carcinoma. The tumour, measuring 8 cm, was resected with surrounding unstable scar tissue including en bloc resection of the involved tibial bone, leaving the posterior cortex. Reconstruction was done with a fibular free flap from the contralateral side, but the pedicle length was too short to reach the anterior tibial vessels. To bridge the vascular gap, and to cover the soft-tissue defect, a latissimus dorsi free flap was harvested using the muscle-sparing method. The thoracodorsal vessels were used as an interpositional graft to anastomose the peroneal vessels of the fibular flap. The patient was ambulatory by 4 months, and complete bone union was seen after 6 months. During the 18-month follow-up period, there was no evidence of recurrence.

  15. [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.

  16. Free latissimus dorsi flap with long venous grafts for closure of a soft tissue defect of the spine in a patient with Noonan's syndrome: a case report.

    Science.gov (United States)

    Sinis, Nektarios; Lanaras, Tatjana Ismini; Kraus, Armin; Werdin, Frank; Schaller, Hans-Eberhard; Peek, Alberto

    2009-01-01

    A 23-year-old male patient was operated for a soft tissue defect of the spine using a free musculocutaneous latissimus dorsi flap with two 21-cm long venous grafts connecting the flap to its vascular supply at the thoracodorsal vessels. This young patient suffered from Noonan's Syndrome that is a complex hereditary malformation syndrome with clinical features often leading to spinal deformities and gibbus development. The defect originated from a former internal vertebral fixation that was necessary for erective correction of such a spinal deformity. After perforation of the introduced material and debridement the defect was 4 x 8 cm in size, which was successfully closed by the free latissimus dorsi transfer. However, two venous grafts were necessary because the extension of the pedicled muscle was not sufficient to reach the defect. This is the first case in literature where a free flap was used with two venous grafts to close a soft tissue defect of the spine in the special case of a vertebral deformity based on a Noonan's Syndrome.

  17. Long-term prospective assessment of shoulder function after breast reconstruction involving a latissimus dorsi muscle flap transfer and postoperative radiotherapy.

    Science.gov (United States)

    Sowa, Yoshihiro; Morihara, Toru; Kushida, Rie; Sakaguchi, Koichi; Taguchi, Tetsuya; Numajiri, Toshiaki

    2017-05-01

    Several investigators have evaluated the impaired function of the shoulder after removal of the latissimus dorsi muscle for breast reconstruction. However, a few investigators have studied whether including radiotherapy has a negative effect on functional recovery of the shoulder by a long-term follow-up after surgery. In this study, we compared objective measurements of shoulder function preoperatively and postoperatively for 3 years after latissimus dorsi muscle (LDM) flap transfer and postoperative radiotherapy (PRT). Eighteen patients who underwent unilateral transfer of a pedicled LDM flap and PRT within 2 months of breast-conserving surgery were enrolled in this study. Range of motion (ROM) and muscle strength in exhaustive shoulder movements were measured before surgery, and at 3 and 6 months, and 1 and 3 years. The results of ROM measurements at 3months postsurgery showed significant decreases in both flexion and abduction by 7.1 and 9.2 % and at 3 years postsurgery by 4.7 and 5.7 %. The muscle strength measurements at 3 months postsurgery showed statistically significant decreases both in adduction and in the 2nd medial rotation by 30.7 and 25.9 % and at 3 years postsurgery by 36.4 and 20.4 %. A significant improvement in these impairments was not observed for 3 years after surgery compared with that at 3 months after surgery. A combination of the LDM flap procedure and PRT could be associated with a higher incidence of tissue adhesions in both flexion and abduction and muscle deficit both in adduction and in the 2nd medial rotation.

  18. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema.

    Science.gov (United States)

    Nicoli, Fabio; Orfaniotis, Georgios; Lazzeri, Davide; Lim, Seong Yoon; Kiranantawat, Kidakorn; Chen, Pei-Yu; Ciudad, Pedro; Chilgar, Ram M; Sapountzis, Stamatis; Sacak, Bulent; Chen, Hung-Chi

    2016-11-01

    Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016.

  19. [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].

    Science.gov (United States)

    Chiriac, S; Dissaux, C; Bruant-Rodier, C; Djerada, Z; Bodin, F; François, C

    2016-11-17

    The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision.

  20. Treatment of muscular contraction deformities with botulinum toxin type A after latissimus dorsi flap and sub-pectoral implant breast reconstruction.

    Science.gov (United States)

    Figus, Andrea; Mazzocchi, Marco; Dessy, Luca Andrea; Curinga, Giuseppe; Scuderi, Nicolò

    2009-07-01

    Unusual and probably underestimated complications following breast reconstruction with a latissimus dorsi (LD) flap and sub-pectoral implant are the LD muscle twitching and the breast contour deformities from pectoralis major (PM) muscle contraction. Surgical muscle denervation is usually indicated for these complications. Botulinum toxin A (BTX-A) infiltration has been described in reducing breast contour deformity in sub-pectoral implant after breast augmentation or reconstruction. Between January 2002 and April 2006, 71 consecutive patients underwent delayed unilateral breast reconstructions with LD flap and sub-pectoral implant after mastectomy. All patients reporting discomforting signs and symptoms from muscle contraction in the reconstructed breast were included in this prospective study. Thirteen patients (18.3%) were selected and treated with BTX-A percutaneous local injections. Signs and symptoms were evaluated, after 4, 8 and 12 months, by the patients and by a panel of three physicians not involved in the study, using a five-point scale. During the study period all patients reported a decrease or disappearance of the signs and symptoms. After 12 months, 11 patients received three BTX-A infiltrations, demonstrating considerable improvements compared to the pre-treatment status. Wilcoxon matched pairs rank sum test showed a statistical difference between pre-treatment and post-treatment scores after 14 days (P<0.01) and 12 months (P<0.001). Our experience shows that muscular contraction deformities after breast reconstruction with a LD flap plus implant are not uncommon complications. The use of BTX-A infiltrations is an effective, not surgical, low cost and low risk procedure to treat these complications. It is an easy procedure to be performed on an outpatient basis with a temporary effect but safely repeatable and reproducible; it avoids hospitalisation or further surgical procedures and demonstrates tolerable latency with satisfactory outcomes.

  1. Successful excision of a radiation fistula that required a partial sacral resection and repair with a free latissimus dorsi musculocutaneous flap

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Satoshi; Tajima, Sadao; Ueda, Kouichi; Tanaka, Yoshio; Akamatsu, Jun; Ohba, Sohsuke; Ohmiya, Yuka [Osaka Medical Coll., Takatsuki (Japan)

    1996-08-01

    We report a case in which a radiation abscess with its drainage fistula of the presacral region was successfully treated. Eighteen years earlier, the patient, a 76-year-old female, had received radiation therapy after the excision of a uterine cancer. After this surgery, 11 years later, a presacral radiation abscess developed and was treated conservatively for 5 years. As the abscess did not respond, an incision was made for abscess drainage and this method was used for 2 years without success. Construction of a 3D solid model of her pelvis and fistulous tract led to the selection of an effective surgical approach that entailed a partial sacral resection (half of the S3 and the entire S4 and S5 regions), which allowed wide access to the presacral area, so that resecting the abscess was quite easy. On resection, the space was filled with a free latissimus dorsi musculocutaneous flap. The postoperative course has shown no morbidity and continues to remain uneventful. (author)

  2. Reconstrucción mamaria mediante el colgajo musculocutáneo del dorsal ancho Breast reconstruction with latissimus dorsi musculocutaneous flap

    Directory of Open Access Journals (Sweden)

    C. Colás

    2005-01-01

    Full Text Available En la reconstrucción mamaria intentamos conseguir la mayor simetría posible con la mama contralateral, en el menor número de intervenciones, con la menor secuela posible y con la máxima seguridad. Cuando tenemos mala calidad cutánea en el tórax tenemos que utilizar técnicas que aportan un tejido bien vascularizado, de buena calidad, que conseguimos a cierta distancia en vez de usar los propios tejidos del tórax. En este artículo se revisa el colgajo musculocutáneo del dorsal ancho, la técnica de elevación, variaciones del colgajo, ventajas e inconvenientes del mismo. Se trata de una técnica de gran seguridad, versátil, con pocas secuelas en la zona donante, de tiempo quirúrgico relativamente corto y con buenos resultados estéticos.In breast reconstruction we try to achieve the greatest possible symmetry with the contralateral breast, with the smallest number of interventions, the least possible sequel and the greatest safety. When we find poor cutaneous quality in the thorax we must use techniques that provide a well vascularised tissue of good quality, which we obtain at a certain distance instead of using the thorax tissues themselves. This article reviews the latissimus dorsi musculocutaneous flap, the technique of elevation, variations of the flap, and the advantages and drawbacks involved. This is a very safe and versatile technique, with few sequels in the donor area, with a relatively short surgery time and with good aesthetic results.

  3. Skin-sparing mastectomy and immediate latissimus dorsi flap reconstruction: a retrospective analysis of the surgical and patient-reported outcomes

    Directory of Open Access Journals (Sweden)

    Kim Zisun

    2012-11-01

    Full Text Available Abstract Background Skin-sparing mastectomy (SSM and latissimus dorsi (LD flap immediate breast reconstruction (IBR is a tailored surgical procedure. The surgical and patient-reported outcome (PRO of SSM and LD IBR were assessed. Methods Retrospective data of 146 SSMs performed by a single surgeon was reviewed. Among patients included in the data, 65 patients underwent SSM and LD IBR without a prosthetic implant. A survey estimating the degree of patient satisfaction (poor, fair, good, and excellent as regards the cosmetic outcomes of surgery was performed. The patients were divided into two groups according to their degree of satisfaction (excellent group versus non- excellent group, and analysis was done to identify factors affecting the highest patient satisfaction. Results The mean age of the patients was 48.4 years, and pathological results were: infiltrating ductal carcinoma (n = 48, 73.8%, ductal carcinoma in situ (n = 15, 23.1%, and others (n = 2, 3.1%. One patient received postmastectomy radiotherapy. After a mean follow-up of 34 months, no local recurrence occurred. There was no skin necrosis or LD flap loss. Donor site morbidities were seroma (n = 8, 12.3%, scarring (n = 8, 12.3%, and back pain (n = 6, 9.2%. Fifty patients (76.9% were satisfied and 40% reported their degree of satisfaction as excellent. Breast symmetry (P P P = 0.021, and panel assessment score (P Conclusions Our SSM and LD IBR was safe, with no local recurrence and low morbidities, and produced a sufficiently high level of patient satisfaction. Achieving breast symmetry and nipple cosmesis would be the key to meeting the patient’s expectation.

  4. 多种背阔肌瓣游离移植修复下肢缺损%Application of latissimus dorsi flap in different forms in repair of skin and soft tissue defects in lower extremities

    Institute of Scientific and Technical Information of China (English)

    张丕红; 黄晓元; 龙剑虹; 范鹏举; 任利成; 曾纪章; 肖目张

    2009-01-01

    Objective To explore repair methods of skin and soft tissue defects in lower extremities with free latissimus dorsi flaps. Methods Forty-two patients with wounds and soft tissue defects in lower extremities, including 4 cases on knee, 22 cases on leg, 15 cases on ankle and foot, 1 case with extensive a-vulsion from knee to dorsum of foot, were hospitalized in our unit from February 1996 to February 2008. Wounds or soft tissue defects were respectively repaired with latissimus dorsi musculoeutaneous flaps, latissi-mus dorsi muscle flaps, latissimus dorsi perforator flaps with preserved vascular sleeves, 2 double-leaf seg-mental latissimus dorsi compound flaps after debridement. The flaps ranged from 18 cm×8 cm to 40 cm×18 cm in size. The donor sites were covered by skin grafting in 19 cases. Results All wounds were healed primarily except vascular crisis occurred in 3 cases, partial necrosis of skin at donor site in 2 cases, and graft site(1 case). Follow-up for 3 to 24 months of 31 patients showed: six cases received two-stage plastic operation on account of bulkiness with trouble in wearing shoes, and mild contraction of muscular flap in 3 cases. Conclusions Latissimus dorsi flap in various forms can be satisfactory for repair of large skin and soft tissue defects in lower extremities.%目的 寻找应用背阔肌瓣游离移植修复下肢缺损的方法.方法 1996年2月-2008年2月,笔者单位应用游离背阔肌瓣修复下肢皮肤及组织缺损患者42例,其中膝部4例,小腿22例,足、踝部15例,膝下至足背严重撕脱1例.清创后采用背阔肌肌皮瓣、背阔肌肌瓣植皮、保留肌袖的背阔肌穿支皮瓣、分叶背阔肌组织瓣修复创面.组织瓣切取范围18 cm×8 cm~40 cm × 18cm.结果 除3例患者术后发生血管危象,2例供区植皮和1例肌瓣植皮部分坏死外,其余患者创面均一次性愈合.随访3~24个月,6例患者皮瓣外形臃肿,影响穿鞋,再次行皮瓣修薄术;3例肌瓣植

  5. Functional Latissimus Dorsi Transfer for Upper-Extremity Reconstruction: A Case Report and Review of the Literature

    Science.gov (United States)

    Therattil, Paul J.; Russo, Gerardo; Lee, Edward S.

    2017-01-01

    Objective: The latissimus dorsi flap is a workhorse for plastic surgeons, being used for many years for soft-tissue coverage of the upper extremity as well as for functional reconstruction to restore motion to the elbow and shoulder. The authors present a case of functional latissimus dorsi transfer for restoration of elbow flexion and review the literature on technique and outcomes. Methods: A literature review was performed using MEDLINE and the Cochrane Collaboration Library for primary research articles on functional latissimus dorsi flap transfer. Data related to surgical techniques and outcomes were extracted. Results: The literature search yielded 13 relevant studies, with a total of 52 patients who received pedicled, functional latissimus dorsi flaps for upper-extremity reconstruction. The most common etiology requiring reconstruction was closed brachial plexus injury (n = 13). After flap transfer, 98% of patients were able to flex the elbow against gravity and 82.3% were able to flex against resistance. In the presented case, a 77-year-old man underwent resection of myxofibrosarcoma of the upper arm with elbow prosthesis placement and functional latissimus dorsi transfer. The patient was able to actively flex against gravity at 3-month follow-up. Conclusions: A review of the literature shows that nearly all patients undergoing functional latissimus dorsi transfer for upper-extremity reconstruction regain at least motion against gravity whereas a large proportion regain motion against resistance. Considerations when planning for functional latissimus dorsi transfer include patient positioning, appropriate tensioning of the muscle, safe inset, polarity, management of other affected upper-extremity joints, and educating patients on the expected outcomes. PMID:28293330

  6. Application value of latissimus dorsi flap in first stage of breast reconstruction%背阔肌皮瓣在乳房一期重建中的应用价值

    Institute of Scientific and Technical Information of China (English)

    崔世恩; 凌飞海; 马士辉; 李晓薇; 黄志华; 郑书楷

    2015-01-01

    Objective To investigate application value of latissimus dorsi flap in first stage of breast reconstruction.Methods A total of 164 patients receiving first stage of breast reconstruction after breast cancer operation as study subjects were randomly divided into observation group and control group, with 82 cases in each group. The observation group received latissimus dorsi flap combined with prosthesis implantation, and the control group received prosthesis implantation alone. Brest appearance and complications were compared between the two groups after operation.Results Both groups received successful breast reconstruction. The observation group had good rate of breast appearance as 92.68%, and the control group had that as 60.98%. The difference between the two groups had statistical significance (P0.05).Conclusion Latissimus dorsi flap is helpful to improve breast appearance, without obvious adverse reactions. This method is worth clinical promotion and application.%目的 探讨背阔肌皮瓣在乳腺癌术后乳房一期重建中的应用价值.方法 164例接受乳腺癌术后乳房一期重建患者作为研究对象, 随机分为观察组与对照组, 各82例.观察组采取背阔肌皮瓣联合假体置入, 对照组单纯假体置入, 术后比较两组乳房美观度和并发症.结果 两组均顺利完成乳房重建手术, 观察组乳房美观优良率为92.68%, 对照组乳房美观优良率60.98%, 组间比较差异有统计学意义(P0.05).结论 背阔肌皮瓣有助于提高重建乳房的美观度, 无明显不良反应, 值得临床推广应用.

  7. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction

    Science.gov (United States)

    Friedman, Michael V.; Stensby, J. Derek; Hillen, Travis J.; Demertzis, Jennifer L.; Keener, Jay D.

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a “muscle up.” Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. PMID:26502450

  8. 乳腺癌改良根治术同步背阔肌肌皮瓣乳房再造的护理配合*%Nursing cooperation of immediate breast reconstruction with the latissimus dorsi myocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    蹇琳; 吴荷玉; 刘晓; 刘红

    2016-01-01

    目的:总结乳腺癌改良根治术同步背阔肌肌皮瓣乳房再造的护理配合要点。方法对20例乳腺癌患者行乳腺癌改良根治术中背阔肌肌皮瓣即刻乳房再造,做好术前准备,术中配合,注意患者体位,维持患者体温,严格执行无菌、无瘤技术操作等。结果20例患者行乳腺癌改良根治术中背阔肌肌皮瓣即刻乳房再造,术后患者均无皮瓣坏死,未发生明显并发症,手术效果满意。结论手术室护士重视术前心理护理,术中严格执行无菌和无瘤技术,安全摆放及变换手术体位以及正确使用各种仪器设备是保证手术顺利进行的关键。%Objective To summarize the experience of nursing cooperation for immediate breast reconstruction with the latissimus dorsi myocutaneous flap. Methods Twenty breast cancer patients underwent modified radical surgery with intraoperative immediate application of the latissimus dorsi myocutaneous flap in combination with the same period breast prosthesis for breast reconstruction. The nursing measures included preoperative preparation and mental support, intraoperative active cooperation, position care, sustaining of body temperature and strict aseptic and disease-free technology. Results All the breast cancer patients lived through breast cancer modified radical immediate breast reconstruction. No flap necrosis occurred , neither did obvious complications. The operations were satisfactory. Conclusion The key to the breast reconstruction for the breast cancer patients exists in preoperative psychological nursing , intraoperative strict aseptic and disease-free technology , the proper operation position and the correct use of instruments and equipment.

  9. Brystrekonstruktion med m. latissimus dorsi er et godt valg hos kvinder med brystkræft

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian T

    2015-01-01

    Breast reconstruction using autologous tissue is commonly used in breast cancer patients who have received radiation therapy. The use of a latissimus dorsi flap is a safe and viable alternative to the use of an abdominal flap. The cosmetic results are excellent but there is need for a better...... understanding of the donor-site morbidity in regard to potential loss of shoulder function. We believe that it is possible to improve the procedure through optimized surgical technique in combination with the implementation and the benefits of fast-track surgery....

  10. Latissimus dorsi transposition for sequelae of obstetric palsy

    Directory of Open Access Journals (Sweden)

    Enrique Vergara- Amador

    2010-10-01

    Full Text Available Background: In obstetric palsy, limitation in the external abduction and rotation of the shoulder is the most frequent sequelae. Glenohumeral deformity is the result of muscular imbalance between the external and internal rotators. Releasing the contracted muscles and transferring the latissimus dorsi are the most common surgeries in this case. Patients and methods: We operated on 24 children between 4 and 8 years of age with obstetric palsy sequelae to elevate the subscapularis muscle off the anterior surface of the scapula posteriorly and transfer the latissimus dorsi. The patients received a minimum of 2 years of follow up. They were evaluated based on Mallet’s and Gilbert’s classifications. Results: All of the patients recovered within the above mentioned classifications. Out of 22 children evaluated via Mallet’s classification, all improved from 3 to 4 on that scale. With respect to Gilbert’s classification, 16 children improved one degree and 8 improved 2 degrees. All of the patients’ parents were satisfied with the results. Discussion: The benefit from releasing contracted muscles and muscle transfer to improve shoulder abduction in the sequelae of obstetric palsy has been amply reported in the literature. The results we had from elevating the subscapularis muscle off the anterior surface of the scapula and transferring the latissimus dorsi were good. Children who were difficult to classify based on the described scale were taken note of and some sub-classifications for Gilbert’s descriptions were proposed. Patients must be selected carefully. To transfer the latissimus dorsi, it is necessary to have good passive mobility in abduction, a minimum of 20º of external rotation and no joint deformities. When negative external rotation is found, the subscapularis muscle should be released. When there is glenohumeral joint deformity in older children, other methods are recommended, such as rotational humeral osteotomy.

  11. Latissimus dorsi transposition for sequelae of obstetric palsy

    Directory of Open Access Journals (Sweden)

    Enrique Vergara-Amador

    2010-09-01

    Full Text Available Background: In obstetric palsy, limitation in the external abduction and rotation of the shoulder is the most frequent sequelae. Glenohumeral deformity is the result of muscular imbalance between the external and internal rotators. Releasing the contracted muscles and transferring the latissimus dorsi are the most common surgeries in this case.Patients and methods: We operated on 24 children between 4 and 8 years of age with obstetric palsy sequelae to elevate the subscapularis muscle off the anterior surface of the scapula posteriorly and transfer the latissimus dorsi. The patients received a minimum of 2 years of follow up. They were evaluated based on Mallet’s and Gilbert’s classifications.Results: All of the patients recovered within the above mentioned classifications. Out of 22 children evaluated via Mallet’s classification, all improved from 3 to 4 on that scale. With respect to Gilbert’s classification, 16 children improved one degree and 8 improved 2 degrees. All of the patients’ parents were satisfied with the results.Discussion: The benefit from releasing contracted muscles and muscle transfer to improve shoulder abduction in the sequelae of obstetric palsy has been amply reported in the literature. The results we had from elevating the subscapularis muscle off the anterior surface of the scapula and transferring the latissimus dorsi were good. Children who were difficult to classify based on the described scale were taken note of and some sub-classifications for Gilbert’s descriptions were proposed. Patients must be selected carefully. To transfer the latissimus dorsi, it is necessary to have good passive mobility in abduction, a minimum of 20º of external rotation and no joint deformities. When negative external rotation is found, the subscapularis muscle should be released. When there is glenohumeral joint deformity in older children, other methods are recommended, such as rotational humeral osteotomy.

  12. Continued twitching of the latissimus dorsi miniflap after breast conservation therapy: a case report

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    Huang Du-Ping

    2012-06-01

    Full Text Available Abstract We report a case of continued twitching of the latissimus dorsi muscle following breast conservation therapy, along with immediate reconstruction with a latissimus dorsi miniflap, which continued despite several attempts at control including BTX-A percutaneous local injection, and was finally cured by delayed division of the thoracodorsal nerve via a small well-tolerated axillary incision.

  13. Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

    Science.gov (United States)

    Anastasopoulos, Panagiotis P.; Alexiadis, George; Spyridonos, Sarantis; Fandridis, Emmanouil

    2017-01-01

    Background: Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. Methods: Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. Results: Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. Conclusion: Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component. PMID:28400877

  14. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and subsequent particulate iliac bone grafting

    DEFF Research Database (Denmark)

    Hillerup, Soren; Elberg, Jens Jorgen; Thorn, Jens Jorgen

    2014-01-01

    The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot......, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve...

  15. Activity patterns in latissimus dorsi and sternocleidomastoid in classical singers.

    Science.gov (United States)

    Watson, Alan H D; Williams, Caitlin; James, Buddug V

    2012-05-01

    The aim of this study was to investigate and compare the roles of the accessory respiratory muscles, latissimus dorsi (LD), and sternocleidomastoid, in classical singing. Electromyography was used to record the activity of these muscles in six classically trained female singers carrying out a number of singing and nonsinging tasks. Movements of the chest and abdominal walls were monitored simultaneously using inductive plethysmography, and the sound of the phonations was recorded. In normal breathing, LD is active transiently during very deep inhalations and in inhalation against resistance. During exhalation it becomes active again as residual capacity is approached or when air is expelled with great force. Sternocleidomastoid (SCM) supports inhalation when lung volume nears 100% vital capacity or when this is very rapid. All singers engaged LD in supported singing where it was associated with maintaining an expanded thorax. In coloratura singing, pulses of activity of increasing amplitude were often seen in LD toward the end of the breath. These were synchronized with each note. During a short phrase typical of the end of an aria, which was sung at full volume with the projected voice, both LD and SCM were active simultaneously. Spectral analysis of muscle activity demonstrated that in some singers, activity in LD and more rarely SCM, fluctuated in phase with vibrato. LD appears to play a significant role in maintaining chest expansion and the dynamic processes underlying vibrato and coloratura singing in classically trained singers. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  16. Architectural analysis and predicted functional capability of the human latissimus dorsi muscle.

    Science.gov (United States)

    Gerling, Michael E; Brown, Stephen H M

    2013-08-01

    The latissimus dorsi is primarily considered a muscle with actions at the shoulder, despite its widespread attachments at the spine. There is some dispute regarding the potential contribution of this muscle to lumbar spine function. The architectural design of a muscle is one of the most accurate predictors of muscle function; however, detailed architectural data on the latissimus dorsi muscle are limited. Therefore, the aim of this study was to quantify the architectural properties of the latissimus dorsi muscle and model mechanical function in light of these new data. One latissimus dorsi muscle was removed from each of 12 human cadavers, separated into regions, and micro-dissected for quantification of fascicle length, sarcomere length, and physiological cross-sectional area. From these data, sarcomere length operating ranges were modelled to determine the force-length characteristics of latissimus dorsi across the spine and shoulder ranges of motion. The physiological cross-sectional area of latissimus dorsi was 5.6±0.5 cm2 and normalized fascicle length was 26.4±1.0 cm, indicating that this muscle is designed to produce a moderate amount of force over a large range of lengths. Measured sarcomere length in the post-mortem neutral spine posture was nearly optimal at 2.69±0.06 μm. Across spine range of motion, biomechanical modelling predicted latissimus dorsi acts across both the ascending and descending limbs of the force-length curve during lateral bend, and primarily at or near the plateau region (where maximum force generation is possible) during flexion/extension and axial twist. Across shoulder range of motion, latissimus dorsi acts primarily on the plateau region and descending limbs of the force length curve during both flexion/extension and abduction/adduction. These data provide novel insights into the ability of the latissimus dorsi muscle to generate force and change length throughout the spine and shoulder ranges of motion. In addition, these

  17. Giant desmoid tumour of the thorax following latissimus dorsi and implant breast reconstruction: case report and review of the literature

    LENUS (Irish Health Repository)

    Collins, AM

    2017-03-01

    The case of a giant thoracic desmoid tumour in a 44-year-old woman, who presented two years following a breast reconstruction with a latissimus dorsi (LD) flap and implant, is reported. Clinical findings included a rapidly growing, painless mass. Computed tomography (CT) suggested skin and intercostal soft tissue invasion. The tumour was resected en bloc with the LD muscle, implant capsule and underlying rib segments. The resultant thoracic and abdominal wall defects were reconstructed with Dualmesh® and polypropylene meshes respectively. There was no evidence of recurrence at thirty-six months follow-up.

  18. Main morphological characteristics of the vascular pedicle of latissimus dorsi muscle and their relevance in operative treatment

    Directory of Open Access Journals (Sweden)

    Ilić Marko

    2010-01-01

    Full Text Available Introduction. Considering operative treatment of various pathological conditions and traumatic injuries of extremities latissimus dorsi flap presents the most frequently used flap in reconstructive surgery. Objective. The aim of this paper was to analyze anatomical characteristics of the vascular pedicle of the latissimus dorsi muscle followed by morphometric analyzes of vascular elements. Methods. This paper was carried out in cooperation with the Institute of Anatomy of the School of Medicine, University of Belgrade. The study was based on 40 cadaver dissections followed by anatomical and morphometric analyzes. The first analysis included the determination of thoracodorsal artery (TDA origin and its lateral and terminal branches, and the second one the observation of artery path. Furthermore the same features were analyzed on the thoracodorsal vein. During morphometric analyzes artery and vein length and diameter were recorded. Results. Our results showed that TDA always contains one lateral branch, while three other lateral branches were inconstant. In most cases TDA terminated in two branches, upper and lower, with average distance of 3.4 cm from the muscle. The mean recorded pedicle length was 9.9 cm. The average inner diameter of TDA was 1.85 mm. In further analyses the average observed thoracodorsal vein length was 10.5 cm with mean diameter of 2.93 mm. The result showed that vein origin was usually represented with two branches. Conclusion. The thoracodorsal artery is a blood vessel of considerable length and diameter which represents a great advantage in reconstructive flap surgery.

  19. Acute traumatic tear of latissimus dorsi muscle in an elite track athlete

    Directory of Open Access Journals (Sweden)

    Mehmet Mesut Çelebi

    2013-05-01

    Full Text Available Soft tissue injuries constitute 30-50% of all sports related injuries; however, injury to the latissimus dorsi muscle is quite rare with only a few cases reported in the literature. Herein, we describe an acute traumatic tear of the latissimus dorsi muscle in an elite track athlete, which has not been reported in the track and field sports before. The injury was caused by forceful resisted arm adduction that took place at hurdling and starting from the block. A pseudotumor appearance in the axillary region was misdiagnosed as a mass. The diagnosis was made by ultrasound alone and the patient was managed conservatively.

  20. Acute traumatic tear of latissimus dorsi muscle in an elite track athlete.

    Science.gov (United States)

    Celebi, Mehmet Mesut; Ergen, Emin; Ustüner, Evren

    2013-08-02

    Soft tissue injuries constitute 30-50% of all sports related injuries; however, injury to the latissimus dorsi muscle is quite rare with only a few cases reported in the literature. Herein, we describe an acute traumatic tear of the latissimus dorsi muscle in an elite track athlete, which has not been reported in the track and field sports before. The injury was caused by forceful resisted arm adduction that took place at hurdling and starting from the block. A pseudotumor appearance in the axillary region was misdiagnosed as a mass. The diagnosis was made by ultrasound alone and the patient was managed conservatively.

  1. 背阔肌肌皮瓣联合假体在乳腺癌术后二期乳房再造中的应用%Application of Latissimus Dorsi Myocutaneous Flap with Breast Implant in Delayed Breast Reconstruction after Mastectomy

    Institute of Scientific and Technical Information of China (English)

    郑厚兵; 单秀英; 陈祥锦; 张惠灏; 朱有志; 王美水; 王彪

    2015-01-01

    目的:探讨背阔肌肌皮瓣联合假体植入在乳腺癌术后二期乳房再造术中的临床应用。方法2009年至2013年,共8例乳腺癌术后年轻患者接受二期乳房再造手术。术前以排水法测定健侧乳房体积,根据患者健侧乳房形状、大小及背部组织情况,设计胸背部供区皮瓣,术中测量移植皮瓣的容积,然后根据健侧乳房和移植皮瓣的容积差,选择大小合适的乳房假体,将假体埋植于背阔肌-胸大肌后间隙,利用背阔肌肌皮瓣移植联合乳房硅胶假体进行二期乳房再造。结果本组患者术后随访6个月至4年,再造乳房外形较佳,效果满意,供区无明显并发症。结论对于年轻有生育要求的乳腺癌术后乳房缺失患者,健侧乳房较大,利用背阔肌肌皮瓣联合假体进行乳房再造,可取得良好的手术效果。%Objective To explore the application of latissimus dorsi myocutneous flap and breast implant in delayed breast reconstruction surgery after mastectomy. Methods From 2009 to 2013, 8 cases received delayed breast reconstruction operation after mastectomy. The breast volumetry measurement technique was used to determine the mass of the breast preoperatively, then the donor flap was designed at the chest-back region according to the condition of the dorsal skin and the shape of the contralateral breast. The mass of graft flap was measured intraoperatively, then the suitable implant was selected based on the difference between the volume of the contralateral breast and the graft flap. The breast implant was then placed in the interspace between the latissimus dorsi muscle and the pectoralis major muscle to reconstruct the breast (secondary phase). Results All patients were followed up for 6 months to 4 years. The overall appearance of the constructed breast were satisfactory, no significant complications were observed in the donor region. Conclusion For young patients of breast cancer with

  2. Clinical application of the latissimus dorsi musculocutaneous flap with a few muscle in repairing the larger limbs defect%改良背阔肌肌皮瓣游离修复软组织缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    盛辉; 田恒进; 靖树林; 王志勇; 张治家; 李德保

    2014-01-01

    Objective To explore the anatomy basis and clinical effect of the latissimus dorsi musculo-cutaneous flap with a few muscle.Methods Based on anatomical study,the latissimus dorsi musculocuta-neous flap with a few muscle was designed and transferred to reconstruct 1 cases of the calcar pedis′s soft tissue defect,2 cases of the dorsum pedis′s soft tissue defect,2 cases of the anticnemion′s soft tissue de-fect,1 case of the whole scalp avulsion injury with large skull exposure.Among these flaps,7 flaps were designed to perforator flap with a few muscle,1 flap was reserving partly thoracodorsal nerve.The flap area ranged from 1 5.0 cm×8.0 cm to 22.0 cm×12.0 cm.Results 7 flaps survived completely,follow-up was performed for 3 to 12 months,the appearance and color of the flaps were satisfaction.Conclusion This kind of the flap has reliable blood supply and could be operated conveniently and safely.It is an ideal method to repair the larger limbs soft-tissue defect.%目的:探讨应用胸背动脉外侧支供血的改良背阔肌肌皮瓣移植修复软组织缺损创面的临床效果。方法对7例软组织缺损的患者采用胸背动脉外侧支供血改良背阔肌肌皮瓣进行移植修复。利用胸背血管的外侧支供血带少许肌袖,皮瓣解剖时保留胸背神经的主干及内侧支,皮瓣面积15.0 cm×8.0 cm~22.0 cm×12.0 cm。结果7例皮瓣完全成活,1例胫前软组织缺损的患者术后2 h 出现血管危象,经探查重新吻合静脉,创口Ⅰ期愈合。背部供区植皮创面4例Ⅰ期愈合,3例边缘部分皮片坏死,经换药治愈。对所有患者随访3~12个月,皮瓣外形与功能均较满意。结论利用胸背动脉外侧支供血改良背阔肌肌皮瓣移植修复软组织缺损是较为理想的方法,临床上值得推广应用。

  3. Descripción anatómico-quirúrgica del colgajo dorsoepigástrico: una opción diferente en reconstrucción mamaria Anatomical and surgical description of a new concept in breast reconstruction: muscle sparing dorsoepigastric flap of latissimus dorsi

    Directory of Open Access Journals (Sweden)

    J.L. Haddad Tame

    2012-03-01

    Full Text Available La importancia de las mamas para el equilibrio biopsico-social de la mujer es evidente. Las secuelas físicas y psíquicas de la mastectomía pueden ser tratadas mediante cirugía de reconstrucción mamaria; la búsqueda de nuevas opciones reconstructivas con menor incidencia de complicaciones y que permitan obtener mejores resultados estéticos, sigue vigente en nuestros días. En un estudio piloto realizado en 3 cadáveres frescos identificamos la anatomía neurovascular del músculo dorsal ancho, que fue constante en los hallazgos, por lo que en una segunda etapa procedimos a realizar reconstrucción mamaría mediante un colgajo dorsoepigástrico conservador de músculo dorsal ancho en 9 pacientes. El diseño del colgajo permite tomar una tira de 5 a 7cms del borde lateral del dorsal ancho, que incluye la rama descendente de la arteria tóracodorsal. La tasa global de complicaciones fue del 0.63 %, por lo que la morbilidad del sitio donante fue menor que la que se presenta con otro tipo de colgajos, y el resultado estético fue muy satisfactorio. Consideramos que el colgajo dorsoepigástrico conservador de músculo dorsal ancho es una excelente opción reconstructiva para las pacientes mastectomizadas, si bien se trata de un estudio piloto y necesitamos ampliar la muestra de pacientes para validar los resultados.Breast importance is evident for women quality of life. The physical and psychological trauma of mastectomy can be treated by breast reconstruction, so it´s important to search for new reconstructive options decreasing complications and improving the cosmetic results. By an anatomical study in 3 fresh cadavers we observed the neurovascular anatomy of the latissimus dorsi and we founded a constant anatomy; then we realized the dorsoepigastric muscle sparing of latissimus dorsi flap taking a strip of 5 to 7cm from lateral edge of the muscle including the descending branch of the thoracodorsal artery in 9 patients meeting inclusion

  4. Sonography and MRI of latissimus dorsi strain injury in four elite athletes

    Energy Technology Data Exchange (ETDEWEB)

    Pedret, Carles [Unitat Medicina Esportiva Consorci Sanitari del Garraf, Barcelona (Spain); Centre Diagnostic per Imatge de Tarragona, Tarragona (Spain); Balius, Ramon [Generalitat of Catalonia, Sports Catalan Council, Catalonia (Spain); Idoate, Fernando [Clinica San Miguel, Department of Radiology, Pamplona (Spain)

    2011-05-15

    The objective of this study was to describe the MR and sonographic findings in latissimus dorsi (LD) muscle strain in athletes, and to review the most common injuries described in the literature, most of which are humeral avulsions. Four injuries and two reinjuries of the myotendinous junction of the LD were followed from the day of injury until the return to play. Sonography (US) and MR imaging were performed in each case to confirm the diagnosis and to monitor the healing process. All cases had acute and isolated pain in the back of the shoulder while performing an eccentric maneuver of the arm and the shoulder. US and MR images demonstrated that injuries were located in the middle and cranial portion of the latissimus dorsi surrounding the myotendinous junction. After rehabilitation, all players played at high level again. Isolated lesions of LD are very rare. They can be demonstrated by US and MR images. (orig.)

  5. APPLICATION OF COMPUTED TOMOGRAPHIC ANGIOGRAPHY IN REPAIRING SKIN DEFECT AFTER SCALP AVULSION WITH FREE LATISSIMUS DORSI FLAP TRANSPLANTATION%CT血管造影在背阔肌皮瓣游离移植修复头皮撕脱伤创面中的应用

    Institute of Scientific and Technical Information of China (English)

    何永静; 王继华; 杨云; 刘垠; 张景波; 朱礼昆; 郭树忠; 朱剑萍; 刘红莉

    2013-01-01

    目的 探讨CT血管造影(computed tomographic angiography,CTA)及三维重建技术在背阔肌皮瓣游离移植修复头皮撕脱伤伴大面积颅骨外露创面中的应用价值.方法 2007年10月-2012年6月,收治9例严重头皮撕脱伤伴大面积颅骨外露女性患者.年龄23~54岁,平均38岁.致伤原因:机器绞伤6例,交通事故伤2例,高处坠落伤1例.其中3例伤后行头皮原位回植后坏死,6例行清创包扎.伤后至入院时间8h~7d,平均1d.头皮撕脱范围为头皮面积的75%~90%,平均81%;颅骨外露范围为头皮面积的55%~70%,平均63%;2例伴单侧耳廓撕脱.术前对面颈部及背部血管行CTA及三维重建,分析颞浅动、静脉,面动脉,颈外静脉和胸背动、静脉解剖结构并测量管径.根据CTA检查结果,7例以背阔肌皮瓣修复创面,2例以背阔肌肌瓣联合植皮修复.7例患者根据术前设计顺利完成手术;2例术前颞浅血管显示较差者,以大隐静脉作为移植血管与相关血管吻合.背阔肌皮瓣切取范围20 cm×14 cm~25 cm×20 cm,供区减张缝合后植皮修复;肌瓣切取面积分别为23 cm×16 cm及16cm×10cm,供区直接缝合.结果 术中血管管径测量结果与术前比较差异较小,不影响血管吻合.手术时间6~8 h,平均6.5h.术后背阔肌肌(皮)瓣及植皮均成活,创面Ⅰ期愈合;供区切口Ⅰ期愈合.患者均获随访,随访时间3个月~2年,平均6个月.皮瓣质地柔软,皮肤无破溃.结论 采用背阔肌皮瓣游离移植修复头皮撕脱伤伴大面积颅骨外露创面时,术前可行CTA检查明确供、受区可供吻合的血管解剖结构及管径,指导手术方案设计及实施,以缩短手术时间,提高术中血管吻合准确率.%Objective To investigate the clinical value of computed tomographic angiography (CTA) and three-dimensional reconstruction technique in repairing scalp avulsion wound with large skull exposure by the free latissimus dorsi flap

  6. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury.

    Science.gov (United States)

    Friedman, Michael V; Stensby, J Derek; Hillen, Travis J; Demertzis, Jennifer L; Keener, Jay D

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a "muscle up." Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level.

  7. Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete

    LENUS (Irish Health Repository)

    Mc Hugh, N

    2017-08-01

    We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation. Therefore, careful multidisciplinary work-up is crucial, and should involve appropriate radiological and histopathological investigations. Here, we propose the aetiology of LD PM to be persistent myotrauma induced by repetitive rowing motions. Symptoms and rate of progression ultimately determine the management which includes surveillance and\\/or conservative resection. There have been no documented cases of recurrence or malignant transformation.

  8. Rotura del músculo Latissimus dorsi en un deportista de trialsín

    OpenAIRE

    Pacheco Arajol, Laura; Balius Matas, Ramon

    2007-01-01

    Paciente de 24 años, deportista de alto nivel de trialsín. Durante una exhibición deportiva, en un salto, sufre la inusual rotura del músculo Latissimus dorsi por mecanismo indirecto. El tratamiento conservador da buenos resultados, de manera que el deportista no presenta secuelas en el ámbito funcional; en el aspecto estético presenta alteración en el relieve muscular durante la contracción. A la palpación no aparece la cobertura muscular que proporcionaría el músculo en condiciones normale...

  9. Partial mastectomy and m. latissimus dorsi reconstruction for radiation-induced fibrosis after breast-conserving cancer therapy

    NARCIS (Netherlands)

    A.N. van Geel (Albert); T. Lans (Titia); R. Haen (Roel); R.T.J. Wai (Rudi Tjong Joe); M. Menke-Pluijmers

    2011-01-01

    textabstractBackground: Patients with severe complaints of radiation-induced fibrosis after breast-conserving therapy and not responding to conservative therapy, were treated by partial mastectomy and m. latissimus dorsi reconstruction. Method: To determine the feasibility and outcome of this

  10. Muscle-derived Decellularised Extracellular Matrix Improves Functional Recovery in a Rat Latissimus Dorsi Muscle Defect Model

    Science.gov (United States)

    2013-12-01

    Piccolo R, et al. Experimental abdominal wall defect repaired with acellular matrix. Pediatr Surg Int 2002;18:327e31. 28. Willett NJ, Li MT, Uhrig BA...matrix (M-ECM). Methods: Ten percent of the mass of the latissimus dorsi (LD) was excised. Three groups were examined: 1) no repair of defect (DEF), 2...to develop therapies for ex- tremity10,11 or abdominal muscle repair.16 For the devel- opment of potential therapies for craniofacial muscle repair

  11. Effect of Propafenone on the Contractile Activity of Latissimus Dorsi Muscle Isolated in an Organ Chamber: Experimental Study in Rats

    Directory of Open Access Journals (Sweden)

    Ricardo Simões

    2002-03-01

    Full Text Available OBJECTIVE: To study the effect of propafenone on the contractile function of latissimus dorsi muscle isolated from rats in an organ chamber. METHODS: We studied 20 latissimus dorsi muscles of Wistar rats and divided them into 2 groups: group I (n=10, or control group - we studied the feasibility of muscle contractility; group II (n=10, in which the contralateral muscles were grouped - we analyzed the effect of propafenone on muscle contractility. After building a muscle ring, 8 periods of sequential 2-minute baths were performed, with intervals of preprogrammed electrical stimulation using a pacemaker of 50 stimuli/min. In group II, propafenone, at the concentration of 9.8 µg/mL, was added to the bath in period 2 and withdrawn in period 4. RESULTS: In group I, no significant depression in muscle contraction occurred up to period 5 (p>0.05. In group II, a significant depression occurred in all periods, except between the last 2 periods (p0.05. CONCLUSION: Propafenone had a depressing effect on the contractile function of latissimus dorsi muscle isolated from rats and studied in an organ chamber.

  12. Bipolar Latissimus Dorsi Transfer for Restoration of Pectoralis Major Function in Poland Syndrome.

    Science.gov (United States)

    Buchanan, Patrick; Leyngold, Mark; Mast, Bruce A

    2016-01-01

    Poland syndrome typically presents as a unilateral congenital complete or partial absence of the pectoralis major muscle, variably with other associated anomalies. Reconstruction of the defect typically concentrates on aesthetic restoration with functional outcomes being unsuccessful or limited. We present an innovative means of true muscle transfer that provided functional benefit to increase upper extremity strength. A 16-year-old adolescent boy with Poland syndrome manifesting as left pectoralis major muscle agenesis wished to undergo functional reconstruction. He wanted to play on his high school football team, but could not meet the minimum weightlifting requirements. An ipsilateral latissimus dorsi muscle bipolar functional transfer was done with bone-anchored inset into the sternum and humerus so that muscle flexion would replace the absent pectoralis major. A progressive weight training program was then instituted postoperatively. At 9 months, a significant increase in left upper extremity strength was confirmed. The patient ultimately was able to surpass the weightlifting requirements for his high school football team, and joined the team. Our highlighted procedure restored functional outcome using both plastic surgical principles and orthopedic techniques for muscle and tendon repair: bipolar muscle transfer and load-bearing muscle inset. Heretofore, transfer of the latissimus for provision of pectoralis major function has not been reported. Functional reconstruction was possible due to stable, bipolar muscle transfer with load-bearing muscle attachments into cortical bone of the anterior sternum and anteromedial aspect of the humerus. The techniques described should be within the skill set of most plastic surgeons, so that functional restoration for those with Poland syndrome is possible and accessible.

  13. Magnetic resonance imaging appearance of partial latissimus dorsi muscle tendon tear

    Energy Technology Data Exchange (ETDEWEB)

    Le, Huy B.Q.; Lee, Steven T.; Lane, Michael D.; Munk, Peter L.; Malfair, David [University of British Columbia, Department of Radiology, Vancouver General Hospital, Vancouver (Canada); Blachut, Piotr A. [University of British Columbia, Department of Orthopedics, Vancouver General Hospital, Vancouver (Canada)

    2009-11-15

    There is still a paucity of information about the clinical presentation, treatment and imaging findings of latissimus muscle tears. Only one study has specifically described the magnetic resonance imaging (MRI) features of latissimus tendon tears. We describe a case of a high-grade tear in the latissimus muscle tendon in an active water skier with no significant prior medical history. MRI demonstrated at least a 50% tear of the latissimus tendon, manifesting as increased signal intensity on T2-weighted sequences and surrounding edema, as well as a diminutive tendon at the humeral insertion. (orig.)

  14. Obstetric paralysis: anterior arthroscopic release of the shoulder and transfer of the latissimus dorsi using a homologous graft

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: Description of a new surgical technique for treating the shoulders of patients with sequelae of obstetric paralysis. Preliminary analysis on the results obtained from this technique. METHODS: Five consecutive patients underwent the proposed surgical procedure, consisting of arthroscopic anterior joint release followed by transfer of the latissimus dorsi tendon (elongated and reinforced with a homologous tendon graft to the posterosuperior portion of the greater tubercle, using a single deltopectoral approach. All the patients were reevaluated after a minimum postoperative period of twelve months. The functional assessment was based on the range of motion and the modified Mallet classification system. Statistical analyses were not possible because of the small sample. RESULTS: Overall, passive and active lateral rotations increased, while medial rotation decreased. The other movements (elevation, capacity to place a hand in the mouth and capacity to place a hand behind the neck had less consistent evolution. The mean modified Mallet score improved by 4.2 points (from 11.4 to 15.6. CONCLUSION: The latissimus dorsi tendon can be transferred to the posterosuperior portion of the greater tubercle through a single deltopectoral approach when elongated and reinforced with a homologous tendinous graft.

  15. Vascular delay of the latissimus dorsi provides an early hemodynamic benefit in dynamic cardiomyoplasty.

    Science.gov (United States)

    Ali, A T; Santamore, W P; Chiang, B Y; Dowling, R D; Tobin, G R; Slater, A D

    1999-05-01

    Dynamic cardiomyoplasty (CMP) as a surgical treatment for chronic heart failure improves functional class status for most patients. However, significant hemodynamic improvement with latissimus dorsi muscle (LDM) stimulation has not been consistent. The current protocols do not allow early LDM stimulation after CMP surgery. We hypothesized that vascular delay of LDM would increase myocardial assistance after CMP and allow early (48-h) LDM stimulation after CMP. Mongrel dogs (n = 24) were divided in four groups: 1) controls (n = 6), single-stage CMP; 2) Group ES (n = 6), single-stage CMP with early LDM stimulation beginning 48 h, postoperatively; 3) Group VD (n = 6), vascular delay of the LDM followed by CMP without early LDM stimulation, and 4) Group VDES (n = 6), vascular delay of LDM (14-18 days), followed by CMP with early stimulation (48 h postoperatively). Two weeks after CMP, global cardiac dysfunction was induced by injecting microspheres into the left coronary artery. LDM-assisted (S) beats were compared with nonstimulated beats (NS) by measuring aortic pressure (AoP), LV pressure, aortic flow, and by calculating first derivative of LV contraction (+/-dP/dt), stroke volume (SV), and stroke work (SW). In ES, LDM stimulation had no effect on the hemodynamic parameters. In the other groups, LDM stimulation significantly (p VDES. In VD, LDM stimulation increased peak AoP by 21.5+/-3.8 mm Hg, LVP by 22.1+/-4.1 mm Hg, dP/dt by 512+/-163 mm Hg/sec, SV by 10.4+/-2.3 mL, and SW by 22.1+/-5.4 g/m(-1). Similarly, in VDES, LDM stimulation increased peak AoP by 24.1+/-4.7 mm Hg, LVP by 26.2+/-4.3 mm Hg, dP/dt by 619+/-47 mm Hg/sec, SV by 6.5+/-0.7 mL, and SW by 16.7+/-4.1 g/m(-1). In dogs with global LV dysfunction, CMP after vascular delay resulted in a significant improvement in hemodynamic function measured 2 weeks after surgery. This improvement was not provided by single-stage CMP with or without early stimulation. Vascular delay of the LDM before surgery may play

  16. Estudo do alcance do retalho do músculo grande dorsal para o revestimento cutâneo da coluna An anatomic study of latissimus dorsi and its suitability for spinal soft tissue coverage

    Directory of Open Access Journals (Sweden)

    Kelly Cristina Moutinho da Costa

    2009-01-01

    Full Text Available INTRODUÇÃO: A crescente indicação cirúrgica na terapêutica das patologias da coluna vertebral, ocasionada pela melhoria tecnológica aplicada ao tratamento cirúrgico, que proporciona cada vez mais uma cirurgia mais segura, mais rápida, menos invasiva e com melhores resultados funcionais, tem nos levado a um aumento nas complicações pós-operatórias da coluna vertebral. As complicações podem ser mecânicas, biológicas, estruturais ou relacionadas ao material de síntese. As infecções em cirurgia de coluna vertebral, embora raras, ocorrem em 3-6%, constituem um dilema para o cirurgião de coluna, além de graves desdobramentos clínicos para o paciente. A importância do uso do retalho do grande dorsal esta implicada na tentativa de cobertura de partes moles e melhora no padrão vascular regional. OBJETIVO: Avaliar a confiabilidade do retalho do músculo grande dorsal para cobertura de defeitos cutâneos na coluna. MATERIAL E MÉTODO: Foram dissecados 17 músculos grande dorsal de cadáver e medido o quanto eles passavam da linha média na altura de C7, T7 e transição toracolombar. RESULTADOS E CONCLUSÃO: O estudo anatômico realizado comprovou a eficácia desse método.INTRODUCTION: There has been a dramatic increase in spine surgery. New surgical instrumentation and less invasive techniques make surgical procedure faster, safer, achieving better functional results. With this increasing number of operations, the number of back surgery failures has also increased. Complications may be mechanical, biological, or related to problems on instrumentation frames. The rate of spinal infections lies between 3-6 % and it´s still a challenge. After debridement and removal of all infected nonviable soft tissue, it is sometimes difficult to obtain wound closure. Pedicled latissimus dorsi muscle flap coverage provides wound healing by promoting vascularized tissue to reduce dead spaces, enhancing local oxygen delivery, and facilitating

  17. Patient-reported outcomes and their predictors at 2- and 3-year follow-up after immediate latissimus dorsi breast reconstruction and adjuvant treatment.

    Science.gov (United States)

    Winters, Z E; Afzal, M; Balta, V; Freeman, J; Llewellyn-Bennett, R; Rayter, Z; Cook, J; Greenwood, R; King, M T

    2016-04-01

    The aim of this study was to estimate the impact 2 and 3 years after surgery of implant-assisted latissimus dorsi (LDI) and autologous latissimus dorsi (ALD) flap breast reconstructions on patient-reported outcomes (PROs), and, secondarily, to determine whether baseline characteristics can predict PROs. This was a multicentre prospective cohort study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and breast cancer module (QLQ-BR23), Functional Assessment of Cancer Therapy - Breast (FACT-B), and Hospital Anxiety and Depression Scale (HADS) PROs were completed before surgery and at 2 and 3 years after breast reconstruction. The effects of LDI and ALD, adjusted for baseline clinicodemographic characteristics, were estimated with multiple linear regressions. Effect sizes above 0·5 were considered clinically important. Some 206 patients (LDI 93, ALD 113) were recruited in 2007-2013; 66·5 per cent were node-negative and 34·6 per cent received radiotherapy. Women with adverse clinicopathological factors were more likely to have received radiotherapy and to undergo ALD. Patients in both surgical groups showed clinically important effects at 2 and 3 years, including improvements in emotional scales, but worse physical functioning, social well-being, body image and anxiety. Radiotherapy adversely affected social functioning at 2 years (P = 0·002). Women undergoing ALD reconstruction had significantly improved sexual functioning at 3 years (P = 0·003) relative to those who had LDI procedures, even after adjusting for case mix (P = 0·007). At 3 years, younger women experienced worse physical well-being than older women (P = 0·006), and chemotherapy was associated with worse arm symptoms (P = 0·005). Clinically important changes occurred in physical functioning, breast symptoms, body image and psychological distress. These results will guide selections of key PRO

  18. 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.

  19. The role of pectoralis major and latissimus dorsi muscles in a biomechanical model of massive rotator cuff tear.

    Science.gov (United States)

    Campbell, Sean T; Ecklund, Kier J; Chu, Eileen H; McGarry, Michelle H; Gupta, Ranjan; Lee, Thay Q

    2014-08-01

    Superior migration of the humeral head after massive rotator cuff tear (mRCT) is thought to lead to cuff tear arthropathy. Previous biomechanical studies have demonstrated the ability of the pectoralis major and latissimus dorsi (PM/LD) muscles to resist this migration. This study examined the role of PM/LD muscles on glenohumeral joint forces and acromiohumeral contact pressures in a mRCT model. Six cadaveric shoulders were tested using a custom shoulder-testing system. Muscle insertions of the rotator cuff, deltoid, and PM/LD were preserved and used for muscle loading. Specimens were tested in 3 different humeral rotation positions at 0° abduction and 2 rotation positions at 60° abduction. Testing was performed for intact specimens, after supraspinatus removal, and after supraspinatus/infraspinatus/teres minor removal. PM/LD were loaded or unloaded to determine their effect. Humeral head kinematics, glenohumeral joint forces, and acromiohumeral contact area and pressure were measured. For the mRCT condition at 0° abduction, unloading the PM/LD resulted in superior shift of the humeral head. Acromiohumeral contact pressures were undetectable when the PM/LD were loaded but increased significantly after PM/LD unloading. After mRCT, superior joint forces were increased and compressive forces were decreased compared with intact; loading the PM/LD resolved these abnormal forces in some testing conditions. In mRCT, the PM and LD muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. Strengthening or neuromuscular training of this musculature, or both, may delay the progression to cuff tear arthropathy. Published by Mosby, Inc.

  20. The Effects of Bag Style on Muscle Activity of the Trapezius, Erector Spinae and Latissimus Dorsi During Walking in Female University Students

    Directory of Open Access Journals (Sweden)

    Hardie Rebecca

    2015-03-01

    Full Text Available Back pain is common in adolescents which has been associated with carrying a bag. However, there is little research examining the effects of bag style in female adolescents. The aim of the study was to investigate the effects of different bag conditions on muscle activity of the trapezius, erector spinae and latissimus dorsi muscles in female university students during walking. Twelve female university students walked on a treadmill for 5 minutes at 1.1 m/s during five conditions; control, 1 strapped rucksack, 2 strapped rucksack, ipsilateral shoulder strap and contralateral shoulder strap, each containing 10% bodyweight. Electromyography for the trapezius, erector spinae and latissimus dorsi was recorded for the last 30 s of each condition. Two-way ANOVA and paired t-tests were used to identify differences between right and left muscles and between bag conditions. Results showed that muscle activity of the left trapezius was significantly higher than the right trapezius during the 1 strap rucksack condition. For the left trapezius, the 2 strapped rucksack and the control condition had significantly lower muscle activity compared to the 1 strapped rucksack and the ipsilateral shoulder strap. For the left erector spinae muscle, there was significantly greater muscle activity when wearing the contralateral shoulder strap compared to the control. For the right erector spinae, significantly lower muscle activity was observed when wearing the 2 strapped rucksack compared to the ipsilateral shoulder strap and contralateral shoulder strap. There were no significant differences in muscle activity of the latissimus dorsi muscles between any of the bag conditions. These findings suggest that a two strapped rucksack should be used when carrying loads to reduce spinal muscle activity which may, in turn, reduce reports of back pain in female adolescents.

  1. 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.

  2. Effect of different cooking methods on lipid oxidation and formation of free cholesterol oxidation products (COPs) in Latissimus dorsi muscle of Iberian pigs.

    Science.gov (United States)

    Broncano, J M; Petrón, M J; Parra, V; Timón, M L

    2009-11-01

    The aim of this work was to study the influence of different cooking methods (grilled (GR), fried (FP), microwave (MW) and roasted (RO)) on lipid oxidation and formation of free cholesterol oxidation products (COPs) of meat from Iberian pigs that have been fed on an intensive system. Moisture and total lipid content, TBARs, hexanal and COPs were measured in Latissimus dorsi muscle samples. Cooking did not produce changes in total lipid content in meat but induced significantly higher lipid oxidation (TBARs and hexanal values) (p<0.001) and cholesterol oxidation (COPs) (p<0.01). When the different cooking methods were studied, the grilled method was the least affected by lipid oxidation (TBARs and hexanal) compared to the others. There were no significant differences among different cooking methods on COPs values. The most abundant cholesterol oxides were both 7α-hydroxycholesterol and 7β-hydroxycholesterol in all groups studied.

  3. Three-dimensional analysis of the shoulder motion in patients with massive irreparable cuff tears after latissimus dorsi tendon transfer (LDT).

    Science.gov (United States)

    Ippolito, Giorgio; Serrao, Mariano; Napoli, Francesco; Conte, Carmela; Miscusi, Massimo; Coppola, Gianluca; Pierelli, Francesco; Costanzo, Giuseppe; De Cupis, Vincenzo

    2016-10-01

    Latissimus dorsi tendon transfer (LDT) is a recent method for surgical treatment of massive, irreparable posterosuperior cuff tears (MIPCT). So far, there are no studies on the quantitative motion analysis of the shoulder and latissimus dorsi (LD) muscle activation after LDT. The changes in shoulder movements after LDT can be objectively assessed by the 3-D motion analysis. These changes may not be due to an increased activity of the LD muscle as external rotator. The shoulder kinematics of nine patients with MIPCT were recorded through a 3-D motion analysis system, before LTD (T0), and after 3 (T1) and 6 (T2) months post-LDT. Maximal shoulder flexion-extension, abduction-adduction, and horizontal abduction-adduction, and the internal and external circumduction of the shoulder joint were measured during upright standing posture. Surface EMG activity of the LD muscle was recorded during both internal rotation (IR) and external rotation (ER) tasks in three different postures. A significant increase of shoulder movements was observed at T2 compared with T0 for almost all motor tasks. A significant effect of LDT was also found on LD-IR/ER ratio in posture 1 at T2 compared with T0 and T1. No significant effects were found for the LD-IR/ER ratio in the other postures. Our study indicates that LDT is effective in shoulder motion recovery. Such improvement is not associated with a change in function of the LD muscle, which may be induced by a depression of the humeral head into the glenoid cavity instead.

  4. Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus

    Directory of Open Access Journals (Sweden)

    Frederico Barra de Moraes

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. METHODS: This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1 range of motion (ROM of elbow flexion, in degrees, using manual goniometry and (2 grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1 elbow flexion ROM ≥ 80° and (2 elbow flexion strength ≥ M3. The Fisher exact and Kruskal-Wallis tests were used (p < 0.05. RESULTS: The patients' mean age was 32 years (range: 17-56 and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100% in group 1 and in five patients (83.3% in group 2 (p = 0.462. None of the patients presented M5, and one patient (16.7% in group 2 had a poor result (M2. Elbow flexion ROM with a gain ≥ 80° (daily functions was found in six patients (86% in group 1 and in three patients (50% in group 2 ( p = 0.1. CONCLUSION: The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used.

  5. Latissimus dorsi free flap reconstruction of major abdominal defect in treatment of giant Marjolin's ulcer

    DEFF Research Database (Denmark)

    Steffensen, Signe Muus; Thomassen, Anders; Jensen, Jesper Poul Naested;

    2014-01-01

    peritoneum seemed free of tumor invasion, which was essential to radical surgery planning. The tumor was completely removed with clear margins of resection and no metastasis in the resected lymph nodes. The PET/CT scan was repeated after 4 months, showing no signs of recurrence....

  6. A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle

    Directory of Open Access Journals (Sweden)

    Marek Konarik

    2014-09-01

    Full Text Available A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”. Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

  7. Heterotopic bone formation in the musculus latissimus dorsi of sheep using β-tricalcium phosphate scaffolds: evaluation of an extended prefabrication time on bone formation and matrix degeneration.

    Science.gov (United States)

    Spalthoff, S; Jehn, P; Zimmerer, R; Möllmann, U; Gellrich, N-C; Kokemueller, H

    2015-06-01

    We previously generated viable heterotopic bone in living animals and found that 3 months of intrinsic vascularization improved bone formation and matrix degeneration. In this study, we varied the pre-vascularization time to determine its effects on the kinetics of bone formation and ceramic degradation. Two 25-mm-long cylindrical β-tricalcium phosphate scaffolds were filled intraoperatively with autogenous iliac crest bone marrow and implanted in the latissimus dorsi muscle in six sheep. To examine the effect of axial perfusion, one scaffold was surgically implanted with (group C) or without (group D) a central vascular bundle. All animals were sacrificed 6 months postoperatively and histomorphometric measurements were compared to previous results. All implanted scaffolds exhibited ectopic bone growth. However, bone growth was not significantly different between the 3-month (group A, 0.191±0.097 vs. group C, 0.237±0.075; P=0.345) and 6-month (group B, 0.303±0.105 vs. group D, 0.365±0.258; P=0.549) pre-vascularization durations, regardless of vessel supply; early differences between surgically and extrinsically vascularized constructs disappeared after 6 months. Here, we describe a reliable procedure for generating ectopic bone in vivo. A 3-month pre-vascularization duration appears sufficient and ceramic degradation proceeds in accordance with bone generation, supporting the hypothesis of cell-mediated resorption.

  8. Anatomical Research of the Three-dimensional Route of the Thoracodorsal Nerve, Artery, and Veins in Latissimus Dorsi Muscle

    Directory of Open Access Journals (Sweden)

    Nagahiro Takahashi, MD

    2013-05-01

    Conclusions: The thoracodorsal nerves ran in a shallower layer, and the depth to the nerve in the muscle flap in actual facial reanimation surgery is safe enough to avoid damage to the nerves. The LD muscle may be thinned to half its original thickness safely.

  9. INNERVATED RECTUS-ABDOMINIS MYOFASCIAL FLAP FOR DYNAMIC CARDIOMYOPLASTY

    NARCIS (Netherlands)

    WIJNBERG, DS; EBELS, T; ROBINSON, PH

    1994-01-01

    This study examined the rectus abdominis myofascial flap as an innervated nap for dynamic cardiomyoplastic purposes. It is common to use the latissimus dorsi to wrap or patch around or in the heart, but there is a need for more innervated skeletal muscle for a variety of reasons. The rectus abdomini

  10. [Thoracodorsal pedicled perforator flap for chest wall and breast reconstruction in children: Illustration with two clinical cases].

    Science.gov (United States)

    Minetti, C; Colson, T; Gisquet, H; Pujo, J; Brix, M; Simon, E

    2014-02-01

    Perforator flaps represent a new approach in reconstructive surgery including the thoracodorsal perforator flap. It can be used as a free or pedicled tissue transfer. By exposing two clinical cases, we demonstrate that this flap is an interesting option for children and adolescents chest wall skin coverage with less morbidity compared to myocutaneous latissimus dorsi flap. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. Oral and maxillofacial-head and neck reconstruction with soft tissue free flaps of 41 cases:A single team's experience%Oral and maxillofacial-head and neck reconstruction with soft tissue free flaps of 41 cases: A single team's experience

    Institute of Scientific and Technical Information of China (English)

    白岫峰; 阿里木江·吾守; 郑军; 李刚

    2013-01-01

    Objective To retrospectively review the single team's experience of oral and maxillofacial-head and neck reconstruction involving 41 soft tissue free flap procedures.Methods From 1994 to 2012,41 patients who underwent oral and maxillofacial-head and neck soft tissue free flap reconstruction at the Department of Oral and Maxillofacial-Head and Neck Surgical Oncology,Hospital and College of Stomatology,Xi'an Jiaotong University,were reviewed with clinicopathologic data.Results The 41 patients included 24 men and 17 women with a mean age of 54 years.A total of 41 soft tissue free flaps were performed to reconstruct different anatomical structures in the head and neck region including oral mucosa,facial bone,head and neck skin.Two types of soft tissue free flaps were used to reconstruct surgical defects,including radial forearm flap and latissimus dorsimyocutaneous flap.Radial forearm flaps were used for 37cases and latissimus dorsi-myocutaneous flaps were 4 cases.Of 41 cases,39 were successful,with an overall success rate of 95.1%.There were 2 free flap failures,including one radial forearm flap and one latissimus dorsi-myocutaneous flap (partial flap necrosis); hence,the flap success rates for radial forearm flap and latissimus dorsimyocutaneous were,respectively,97.3% and 87.5%.Conclusions Radial forearm flap and latissimus dorsi-myocutaneous flap are reliable soft tissue free flaps to repair oral and maxillofacial-head and neck area with high success rate,which resulted in good functionally and cosmetically with fewer complications both donor and recipient sites.

  12. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    Science.gov (United States)

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap.

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

    Science.gov (United States)

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

    2013-11-01

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

  14. 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.

  15. Diabetic limb salvage procedure with bone allograft and free flap transfer: a case report

    Science.gov (United States)

    Godoy-Santos, Alexandre L.; Amodio, Daniel T.; Pires, André; Lima, Ana L. M.; Wei, Teng H.; de Cesar-Netto, Cesar; Armstrong, David G.

    2017-01-01

    ABSTRACT The aim of this case report was to describe a successful diabetic limb salvage procedure in the treatment of an infected diabetic foot ulcer through a multidisciplinary team approach and complex surgical reconstruction involving a femoral head bone allograft and musculocutaneous latissimus dorsi free flap. The decision to proceed with aggressive staged efforts at diabetic limb salvage should be made only after careful consultation with the patient, his or her family, and the rest of the multidisciplinary healthcare team.

  16. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L; Udesen, Ann;

    2015-01-01

    BACKGROUND: The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction co...... there is a learning curve, this simple modified technique does not demand any perforator or other vessel dissection. Any trained plastic surgeon should be able to adopt the technique into the growing armamentarium of breast reconstruction possibilities....

  17. Regional flaps in head and neck reconstruction: a reappraisal.

    Science.gov (United States)

    Colletti, Giacomo; Tewfik, Karim; Bardazzi, Alessandro; Allevi, Fabiana; Chiapasco, Matteo; Mandalà, Marco; Rabbiosi, Dimitri

    2015-03-01

    Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underlined the effectiveness and reliability of a variety of flaps. The marketing laws as applied to surgical innovations are reviewed to help in the understanding of why regional flaps are regaining wide popularity in head and neck reconstruction. From January 2009 to January 2014, 45 regional flaps were harvested at San Paolo Hospital to reconstruct head and neck defects. These included 35 pectoralis major muscular and myocutaneous flaps, 4 lower trapezius island or pedicled flaps, 3 supraclavicular flaps, 2 latissimus dorsi pedicled flaps, and 1 fasciocutaneous temporal flap. The basic literature of marketing regarding the diffusion of new products was also reviewed. Two myocutaneous pectoralis major flaps were complicated by necrosis of the cutaneous paddle (one complete and one partial). No complete loss of any of the 45 flaps was observed. At 6 months of follow-up, 2 patients had died of multiple organ failure after prolonged sepsis. The 43 remaining patients had acceptable morphologic and functional results. Regional and free flaps appear to compete in many cases for the same indications. From the results of the present case series, regional flaps can be considered reliable reconstructive choices that are less expensive than their free flap alternatives. The "resurrection" of regional flaps can be partially justified by the changes in the global economy and the required adaptation of developed and developing countries. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Free perforating branch flap for primary repairing the huge soft-tissue defects on the scalp and face.

    Science.gov (United States)

    Wang, Hong-Yuan; Wang, Ming-Gang; Yu, Gang; Chu, Yan-Jun; Wang, Kai; Wei, Xiang-Pin; Sun, Jing-Wu

    2016-11-01

    This study aimed to explore the effect of free perforating branch flap on the reconstruction of huge soft-tissue defects on the scalp and face. Sixteen cases of huge soft-tissue defects on the scalp and face were reconstructed by nine latissimus dorsi-free perforator flaps and seven anterolateral thigh-free perforator flaps. The defects area was from 12 cm× 7 cm to 20 cm × 11 cm, while the flaps area was from 14 cm × 8 cm to 23 cm × 12 cm. The survival, planeness, chromatic aberration, radiotherapy toleration of flap and the function, scar of donor site were observed postoperatively. All of the flaps were survived completely, and 15 cases presented for primary reconstruction; one underwent secondary reconstruction. One of the patients died one-year postoperatively due to intracranial tumor recurrence and the others had no recurrence. All of the flaps showed perfect shape and appropriate thickness. No roentgen ulcer was observed except for some extent of chromatic aberration. The donor-site scar was larvaceous and the function was good. This study indicated that the latissimus dorsi-free perforator flap or anterolateral thigh-free perforator flap was an ideal choice for the reconstruction of defects on the scalp and face.

  19. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique.

    Science.gov (United States)

    Gilman, Kaitlyn; Ipaktchi, Kyros; Moore, Ernest E; Barnett, Carlton; Gurunluoglu, Raffi

    2010-05-07

    An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  20. Reconstruction of an emergency thoracotomy wound with free rectus abdominis flap: Anatomic and radiologic basis for the surgical technique

    Directory of Open Access Journals (Sweden)

    Barnett Carlton

    2010-05-01

    Full Text Available Abstract An alcoholic 50-year-old male patient with a history of schizophrenia sustained stab wounds into both ventricles and left lung, and survived following an emergency department thoracotomy. The EDT wound, however became infected requiring serial debridements of soft tissue, rib cartilage and sternum. Regional flap options such as pectoralis major and latissimus dorsi muscle flaps could not be employed due to inadequate reach of these flaps. Additionally, bilateral transection of the internal mammary arteries during emergency thoracotomy eliminated the use of rectus abdominis muscles as pedicled flaps based on the superior epigastric vasculature. Therefore, the EDT wound was reconstructed by using the right rectus abdominis muscle as a free flap. The deep inferior epigastric vessels of the flap were anastomosed to the right internal mammary vessels proximal to their transection level in the third-forth intercostal space. The flap healed with no further wound complications.

  1. Noninvasive Free Flap Monitoring Using Eulerian Video Magnification

    Directory of Open Access Journals (Sweden)

    Yuan Fang Liu

    2016-01-01

    Full Text Available Eulerian Video Magnification (EVM can enhance subtle changes in videos to reveal what was once invisible to the naked eye. In this proof of concept study, we investigated using EVM as a novel form of free flap monitoring. Free flaps with skin paddles were filmed in the operating room with manipulation of their pedicles. In a representative 77-year-old female who received a latissimus dorsi-serratus-rib composite free flap, EVM was able to detect blockage of arterial or venous supply instantaneously, providing a visible representation through degree of color change in videos. EVM has the potential to serve as a powerful free flap monitoring tool with the benefit of being noninvasive, sensitive, easy-to-use, and nearly cost-free.

  2. 背阔肌解剖变异在乳腺癌腋窝淋巴结清扫术中的临床意义%Clinical Significance of Latissimus Dorsi Mutation in Axillary Lymph Node Dissection for Breast Carcinoma

    Institute of Scientific and Technical Information of China (English)

    张钢龄; 张培礼; 朱敬军; 杨七玉; 祁燕云; 杜华

    2012-01-01

    目的:通过对腋窝处变异的背阔肌进行详尽解剖,为降低乳腺癌腋窝淋巴结清扫术中腋窝处重要神经血管损伤,减少手术并发症提供依据.方法:收集128例行腋窝淋巴结清扫术的乳腺癌患者中发生背阔肌解剖变异19例,对该19例患者的背阔肌变异肌束进行详尽的大体解剖,找到其起点与止点,并测量长、宽、厚度,观察与腋窝神经、血管、淋巴结的毗邻关系.结果:19例发生背阔肌解剖变异的肌束均从背阔肌外侧缘发出一束肌腱,向内上走行,横跨腋血管神经束,在其上方,呈“扇形”腱膜延续为喙锁胸筋膜的一部分止于喙突.其中14例为单肌束走行,5例变异肌束从背阔肌发出后与胸大肌外缘发出一肌束会合,再并行向上.该变异肌束与背阔肌止端健呈“丫”型夹持着腋血管神经束.肋间臂神经从其表面或深面通过.其内下侧毗邻胸背神经及肩胛下血管,后外毗邻肩胛下血管外淋巴组织.结论:背阔肌变异肌束可造成腋窝淋巴结清扫术的解剖混淆,给腋淋巴结清扫术时的定位带来困难.因此,了解此种变异在腋窝淋巴结清扫术中具有重要意义.%This study aimed to provide the basic surgical guidelines for important injured nerves and vessels in the axilla during axillary lymph node dissection and reduce surgery-related complications by dissecting the variant latissimus dorsi (LATS) in the axilla. Methods: Data of 19 cases with LATS mutation from 128 breast carcinoma cases who underwent axillary lymph node dissection were collected and studied. The start and end points of the variation of muscle bundle (VOMB) were found by analyzing a full gross anatomy of the variant muscle bundle of LATS in the 19 cases. Length, width, and depth of VOMB were measured. Adjacent relationship among the axillary nerve, blood vessels, and lymph nodes in the axilla was observed. Results: Among the 19 cases with LATS mutation, each VOMB

  3. [Emergency free flap in reconstruction of the lower limb. Thirty-five years of experience].

    Science.gov (United States)

    Bellidenty, L; Chastel, R; Pluvy, I; Pauchot, J; Tropet, Y

    2014-02-01

    Authors analyzed 89 cases (86 patients) of lower limb extensive soft tissue defects reconstruction during 1978 to 2013. The mean age is 37 years and 2 months old (range: 5-84 years old). A total of 71 males and 15 female were included. Free flaps were used in emergency in 23 cases for principally covering Gustilo 3B open lower limb fracture and in a later stage for 66 cases all referred from their center for coverage of exposed bone, with frequently osteomyelitis. About the selection of free flaps, in 47 cases we used a latissimus dorsi flaps, 12 cases of epiploon free transfer (in septic area), 10 cases of gracilis transfer and 10 serratus anterior flaps. There are one medial gastrocnemius flap, 2 composite soleus and fibular free flap, 2 antebrachial flap, one inguinal myoosteocutaneous flap, 1 transferred from the other lower limb and one inguinal cutaneous flap. There are 18 free flap losses: one in emergency and 17 after delayed reconstruction. Authors retrospectively analyzed the results (complications, osteomyelitis) according to the timing for lower extremity reconstruction. They found a low infection and flap failure rates (4%) when the coverage is made in the same operating time than initial fracture fixation, they increase to 60% for osteomyelitis and to 23% for flap failure when the reconstruction is delayed.

  4. Vibratory segment function after free flap reconstruction of the pharyngoesophagus.

    Science.gov (United States)

    Haughey, B H; Fredrickson, J M; Sessions, D G; Fuller, D

    1995-05-01

    Reconstructive options following total laryngopharyngectomy include thin, pliable free tissue segments, approximating the natural thickness of the pharyngeal wall. The authors have investigated outcomes in the following clinical series, emphasizing speech and swallowing. Twelve cancer patients underwent laryngopharyngectomy with or without glossectomy. Eight jejunal, 1 radial forearm, and 3 innervated latissimus dorsi flaps were used for vibratory segment (VS) reconstruction, and all 12 patients underwent tracheoesophageal puncture (TEP). Eleven patients achieved intelligible speech, with a median intelligibility of 93%. The vibrating segments showed fluttering of the free flap tissue when studied by videopharyngography. Vocal quality was lower pitched and softer than "conventional" TEP speech. All patients achieved oral intake as their primary mode of nutrition. Free flaps are a successful option for VS reconstruction in patients undergoing laryngopharyngectomy or glossopharyngolaryngectomy, obviating the need for written or electrolarynx communication.

  5. Negative-pressure wound therapy and early pedicle flap reconstruction of the chest wall after epirubicin extravasation.

    Science.gov (United States)

    Papadakis, Marios; Rahmanian-Schwarz, Afshin; Bednarek, Marzena; Arafkas, Mohamed; Holschneider, Philipp; Hübner, Gunnar

    2017-05-15

    Accidental extravasation is a serious iatrogenic injury among patients receiving anthracycline-containing chemotherapy. The aim of this work is to present a combination therapy for chest wall reconstruction following epirubicin extravasation. Herein, we report a 68-year-old woman with massive soft tissue necrosis of the anterolateral chest wall after epirubicin extravasation from a port implanted in the subclavicular area. The necrotic tissue was resected, the port was removed, and negative-pressure wound therapy was applied. Three weeks later, a latissimus dorsi pedicle flap was successfully used to cover the defect. To the best of the authors' knowledge, this is the first report of a strategy comprising the combination of negative-pressure wound therapy and a latissimus pedicle flap for reconstruction of the chest wall after soft tissue necrosis following epirubicin extravasation.

  6. [Repair of lower extremity soft tissue defect with free musculo-cutaneous flaps bridging with healthy contralateral posterior tibial vessel].

    Science.gov (United States)

    Chengde, Xia; Haiping, Di; Jidong, Xue; Yaohua, Zhao; Xiaoliang, Li; Qiang, Li; Xihua, Niu; Yonglin, Li; Hongkai, Lian

    2015-05-01

    To observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect. From February 2006 to June 2013, 10 patients with soft tissue defect on lower shank and foot were included. The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap, or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap. The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot. The wound area ranged from 40 cm x 21 cm to 22 cm x 15 cm, with flap size from 48 cm x 26 cm to 25 cm x 18 cm. Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus. The kirschner wires were removed at 4 weeks and pedicles were cut off 5-8 weeks postoperatively. Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting. All the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness. During the follow-up period of 3 months to 2 years follow up, the ambulatory function of injured legs recovered gradually with satisfactory appearance. The reanastomosed posterior tibial vessel on the healthy side was recovered. Appropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot. It is a safe and effective method for limb salvage.

  7. 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.

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

    Science.gov (United States)

    Momeni, A; Krischak, S; Bannasch, H

    2006-01-01

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

  9. Analysis of Microvascular Free Flap Failure Focusing on the Microscopic Findings of the Anastomosed Vessels.

    Science.gov (United States)

    Seo, Mi Hyun; Kim, Soung Min; Huan, Fan; Myoung, Hoon; Lee, Jong Ho; Lee, Suk Keun

    2015-10-01

    Microvascular flap reconstruction is known as successful technique, although vascular thrombosis can cause free flap failure. To analyze the histologic characteristics and causes of free flap failure, this clinical study examined failed free flaps, including the microanastomosed sites. This study included a total of 5 failed flaps, including 3 radial forearm free flaps, 1 latissimus dorsi free flap, and 1 fibular free flap, all performed with microvascular reconstruction surgery from 2009 to 2011 at Seoul National University Dental Hospital. At the resection surgeries of the failed nonviable flaps, histologic specimens including the microanastomosed vessels were acquired. For light microscope observation, the slides were stained with hematoxylin and eosin (HE), and also with Masson trichrome. Selected portions of graft tissue were also observed under transmission electron microscope (TEM). It was found that the cause of flap failure was the occlusion of vessels because of thrombi formation. During the microanastomosis, damage to the vessel endothelium occurred, followed by intimal hyperplasia and medial necrosis at the anastomosed site. In the TEM findings, some smooth muscle cells beneath endothelium were atrophied and degenerated. The formation of thrombi and the degeneration of the smooth muscle cells were coincident with vascular dysfunction of graft vessel. The damaged endothelium and the exposed connective tissue elements might initiate the extrinsic pathway of thrombosis at the microanastomotic site. Therefore, it is suggested that accurate surgical planning, adequate postoperative monitoring, and skillful technique for minimizing vascular injury are required for successful microvascular transfer.

  10. Elastofibroma Dorsi

    OpenAIRE

    Rosell Pradas, J.; Ramírez Tortosa, C. L.; Carazo Martínez, O.; Guerrero Fernández, J. A; Vara Thorbeck, R.

    1992-01-01

    Se realiza un estudio clínico-patológico de dos casos, mujeres de 57 y 45 años, de "elastofibroma dorsi" intervenidos quirúrgicamente. En una enferma apareció como una tumoracion asintomática y en otra asociada a dolor en el hombro irradiado a miembro superior derecho. Se describen las particularizadas clínicas, las exploraciones complementarias, los hallazgos quirúrgicos y las características histológicas de estos tumores de partes blandas cuyo origen debe referirse a una alte...

  11. 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)

  12. Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap.

    Science.gov (United States)

    Jamjoom, Hytham; Alnoman, Hatem; Almadani, Yasser

    2016-12-01

    The keystone flap, an emerging reconstructive option that can be used in many parts of the body, is gaining popularity among reconstructive surgeons. These reliable and versatile flaps can be used for large myelomeningocele closure. A modified bilateral keystone flap was used to achieve tension-free closure of a large thoracolumbar myelomeningocele associated with severe kyphosis in a newborn girl. The flap was modified by undermining in the subfascial plane in the medial aspect of the middle third. This undermining was performed to facilitate flap movement while preserving random musculocutaneous perforators captured within the island of tissues. Laterally, we approached the border of the latissimus dorsi and dissected in the submuscular plane instead of the subfascial plane to preserve more muscular fasciocutaneous perforators. We achieved soft-tissue coverage that was durable, stable, and protective. Wound healing was prompt, and the patient had a satisfactory cosmetic result. No postoperative complications were observed, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The proposed modified keystone flap is a promising addition to the armament of reconstructive surgeons that might improve outcomes and minimize complications in myelomeningocele repair. Keystone flaps provide an ideal reconstructive option for large thoracolumbar myelomeningocele repair. They are reliable, robust, and aesthetically acceptable.

  13. Functional Reconstruction of Sarcoma Defects Utilising Innervated Free Flaps

    Directory of Open Access Journals (Sweden)

    Damien Grinsell

    2012-01-01

    Full Text Available Soft-tissue reconstruction following preoperative radiotherapy and wide resection of soft tissue sarcoma remains a challenge. Pedicled and free tissue transfers are an essential part of limb sparing surgery. We report 22 cases of sarcoma treated with radiotherapy and wide excision followed by one-stage innervated free or pedicled musculocutaneous flap transfers. The resection involved the upper limb in 3 cases, the lower limb in 17, and the abdominal wall in 2. The flaps used for the reconstruction were mainly latissimus dorsi and gracilis. The range of motion was restored fully in 14 patients. The muscle strength of the compartment reconstructed was of grades 4 and 5 in all patients except one. The overall function was excellent in all the cases with functional scores of 71.2% in the upper limb and 84% in the lower limb. The only 2 major complications were flap necrosis, both revised with another flap, one of which was innervated with restoration of function. Innervated flaps are valuable alternatives for reconstruction after sarcoma resection in the extremity and in the abdominal wall. The excellent functional results are encouraging, and we believe that innervated muscle reconstruction should be encouraged in the treatment of sarcoma after radiotherapy and wide resection.

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

    Science.gov (United States)

    Ogawa, Tomoko; Yamakawa, Tomomi

    2016-01-01

    Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap. The patient was a 27-year-old female with moderate ptotic breasts, who had ductal carcinoma in situ in the lower outer quadrant of her left breast. After NSM through the inframammary fold (IMF) incision, the subcutaneous fat of the intended inframammary area was undermined, and the tongue shaped adipofascial flap was pulled up in the intended area. After inserting a tissue expander under the major pectoral muscle, this adipofascial flap was reflected back to the inferior portion of the breast area. After modeling the breast mound with this flap, the inframammary skin incision was sutured. Eleven months later, the patient underwent surgery to replace the expander with a permanent implant. Eight months after the replacement with an implant, the cosmetic result is good. This procedure can be performed through the same skin incision on the IMF as NSM. Total breast reconstruction using the inframammary adipofascial flap with an implant can be an alternative approach to achieving symmetry in some patients. This method is useful for breast reconstruction after NSM for young patients with moderate-ptotic breasts. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

    Science.gov (United States)

    Rosich-Medina, Anais; Bouloumpasis, Serafeim; Di Candia, Michele; Malata, Charles M.

    2015-01-01

    Introduction The total ‘rib’-preservation method of dissecting out the internal mammary vessels (IMV) during microvascular breast reconstruction aims to reduce free flap morbidity at the recipient site. We review our five-year experience with this technique. Patients & methods An analysis of a prospectively collected free flap data cohort was undertaken to determine the indications, operative details and reconstructive outcomes in all breast reconstruction patients undergoing IMV exposure using the total ‘rib’-preservation method by a single surgeon. Results 178 consecutive breast free flaps (156 unilateral, 11 bilateral) were performed from 1st June 2008 to 31st May 2013 in 167 patients with a median age of 50 years (range 28–71). There were 154 DIEP flaps, 14 SIEA flaps, 7 muscle-sparing free TRAMs, 2 IGAP flaps and one free latissimus dorsi flap. 75% of the reconstructions (133/178) were immediate, 25% (45/178) were delayed. The mean inter-costal space distance was 20.9 mm (range 9–29). The mean time taken to expose and prepare the recipient IMV's was 54 min (range 17–131). The mean flap ischaemia time was 95 min (range 38–190). Free flap survival was 100%, although 2.2% (4 flaps) required a return to theatre for exploration and flap salvage. No patients complained of localised chest pain or tenderness at the recipient site and no chest wall contour deformity has been observed. Discussion & conclusion The total ‘rib’-preservation technique of IMV exposure is a safe, reliable and versatile method for microvascular breast reconstruction and should be considered as a valid alternative to the ‘rib’-sacrificing techniques. PMID:26468373

  16. Unusual explosive growth of a squamous cell carcinoma of the scalp after electrical burn injury and subsequent coverage by sequential free flap vascular connection – a case report

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    Beier Justus P

    2005-11-01

    Full Text Available Abstract Background Squamous cell carcinomos may arise from chronic ulcerating wounds in scars, most commonly postburn scars. Tumour growth usually takes place over months to years. Localization on the scalp is a relatively rare condition. Case presentation This report presents the case of a 63-year-old man with chronic ulceration of a postburn scar of the scalp due to an electrical burn 58 years ago. Sudden tumour growth started within weeks and on presentation already had extended through the skull into frontal cortex. After radical tumour resection, defect was covered with a free radial forearm flap. Local recurrence occurred 6 weeks later. Subsequent wide excision including discard of the flap and preservation of the radial vessels was followed by transfer of a free latissimus dorsi muscle flap, using the radial vessels of the first flap as recipient vessels. The patient received radiotherapy post-operatively. There were no problems with flap survivals or wound healing. Due to rapidly growing recurrence the patient died 2 months later. Conclusion Explosive SCC tumour growth might occur in post-burn scars after more than 50 years. As a treatment option the use of sequential free flap connections might serve in repeated extensive tumour resections, especially in the scalp region, where suitable donor vessels are often located in distance to the defect.

  17. Sensitive areolar reconstruction in using a neurocutaneous island flap based on the medial antebrachial cutaneous nerve.

    Science.gov (United States)

    Bertelli, J A; Pereira Filho, O J; Ely, J B

    1999-11-01

    Sensory reconstruction has recently been stressed in breast reconstruction. However, there are no reports concerning the reconstruction of a sensitive areola. The bilateral reconstruction of a sensitive areola using a neurocutaneous flap based on the medial antebrachial cutaneous nerve is reported. The flap was harvested from the distal third of the forearm as an island flap and tunneled to reach the apex of the new breast, which was previously reconstructed using a 135-cc, gel-filled, silicone prosthesis covered by a latissimus dorsi myocutaneous flap. Six months later, fine sensibility in the reconstructed areola was demonstrated. The patient could perceive light touch, pain, and 14 mm two-point discrimination. At 2 months after surgery, 50 percent of cutaneous faulty stimulus location was observed. However, at 4 and 6 months after surgery, faulty location disappeared. Six months after harvesting the medial antebrachial cutaneous nerve, the sensory deficit was minimal; it included a hypoesthesic zone of 4 to 7 cm and an anesthesic zone of 2.5 to 5 cm on the middle third of the forearm. Fifteen months after the procedure, no hypoesthesic zone was observed; only a 2 to 3 cm anesthesic zone on the proximal medial side of the forearm existed. This sensory deficit passed unnoticed by the patient. The technique developed here is a refinement in breast reconstruction, and we think it should be used in selected patients.

  18. 乳腺分叶状肿瘤患者行背阔肌肌皮瓣乳房再造术围手术期护理%Perioperative nursing of breast phyllodes tumor patients taking breast reconstruction with latissimus dorsal myocutaneous flap

    Institute of Scientific and Technical Information of China (English)

    黄月芳

    2016-01-01

    目的:探讨乳腺分叶状肿瘤患者行背阔肌肌皮瓣乳房再造术围手术期的护理方法。方法:回顾性分析我院2010年3月~2014年3月收治的25例患者的临床资料总结围手术期间的护理方法。结果:本组患者均手术过程顺利,术后发生并发症4例,经对症处理皮瓣均存活。术后半年随访显示,患者对再造乳房的形态和感觉均表示可以接受。结论:做好乳腺分叶状肿瘤患者行背阔肌肌皮瓣乳房再造术围手术期的护理,可明显提高手术治疗效果,减少并发症的发生,提高患者满意度。%Objective:To explore nursing method of perioperative nursing of breast phyllodes tumor patients taking breast reconstruction with latissimus dorsal myocutaneous flap. Methods:Retrospectively analyzed the clinical information of 25 patients admitted by our hospital from March 2010 to March 2014,sum-marized their nursing method in perioperative nursing. Results:The operations of patients in this group were smooth,and the flaps of 4 patients having com-plication all survived after symptomatic treatment. The postoperative follow - up after half a year showed that all the patients could accept the shape and feel-ing of the reconstructed breast. Conclusion:Good perioperative nursing to breast phyllodes tumor patients taking breast reconstruction with latissimus dorsal myocutaneous flap can significantly improve the surgical result,reduce the complication incidence and enhance patientsˊ satisfaction.

  19. Secondary free-flap reconstruction following ablation for acute invasive fungal sinusitis.

    Science.gov (United States)

    Allensworth, Jordan J; Troob, Scott H; Weaver, Tyler S; Gonzalez, Javier D; Petrisor, Daniel; Wax, Mark K

    2017-04-01

    Acute invasive fungal sinusitis (AIFS) is a frequently fatal infection for which extensive and debilitating surgical debridement is a mainstay of therapy. Resulting defects are often composite in nature, mandating free tissue-transfer reconstruction. Outcomes data for free flap reconstruction are limited. The purpose of this study was to examine surgical outcomes and survival in patients undergoing free flap transfer following invasive fungal sinusitis. Retrospective case series. Between 1995 and 2015, patients undergoing operative debridement for AIFS were identified. Surgical records were used to identify survivors of acute infection who subsequently underwent free flap reconstructive surgery. Patient demographics, cause of immune compromise, defect description, flap type, perioperative complications, indications for revision surgery, functional outcomes, and long-term survival were reviewed. Forty-four patients were treated for AIFS, of those, 30 (68%) survived acute infection. Ten patients underwent maxillectomy, six with orbital exenteration, and were designated candidates for reconstruction. Eight patients underwent reconstruction. Median time from debridement to reconstruction was 67.5 days. Flap types included latissimus dorsi, scapula, anterolateral thigh, rectus, radial forearm, and fibula. Median follow-up was 7.7 months. No perioperative complications were encountered, and all subjects remained disease-free, able to speak and eat normally without prosthetic supplementation. Seven patients (87%) are currently alive. Reconstruction of defects left by invasive fungal sinusitis using free-tissue transfer resulted in successful flap survival, with no disease recurrence for all defects and flap types reviewed. Survivors of AIFS are able to tolerate midface reconstruction, with favorable functional outcomes and survival rates. 4. Laryngoscope, 127:815-819, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Fascia redefined: anatomical features and technical relevance in fascial flap surgery.

    Science.gov (United States)

    Stecco, Carla; Tiengo, Cesare; Stecco, Antonio; Porzionato, Andrea; Macchi, Veronica; Stern, Robert; De Caro, Raffaele

    2013-07-01

    Fascia has traditionally been thought of as a passive structure that envelops muscles, and the term "fascia" was misused and confusing. However, it is now evident that fascia is a dynamic tissue with complex vasculature and innervation. A definition of fascia as an integral tissue has been provided here, highlighting the main features of the superficial and deep fasciae. Wide anatomic variations and site-specific differences in fascial structure are described, coupled with results of our extensive investigations of fascial anatomy. This will enable surgeons to make better decisions on selecting the appropriate fascia in the construction of fascial flaps. The use of the superficial or deep fasciae in the creation of a fascial flap cannot be selected at random, but must be guided by the anatomical features of the different types of fasciae. In particular, we suggest the use of the superficial fascia, such as the parascapular fascio-cutaneous free flap or any cutaneous flap, when a well-vascularized elastic flap, with the capacity to adhere to underlying tissues, is required, and a fascio-cutaneous flap formed by aponeurotic fascia to resurface any tendon or joints exposures. Moreover, the aponeurotic fascia, such as the fascia lata, can be used as a surgical patch if the plastic surgeon requires strong resistance to stress and/or the capacity to glide freely. Finally, the epimysial fascia, such as in the latissimus dorsi flap, can be used with success when used together with the underlying muscles. Clearly, extensive clinical experience and judgment are necessary for assessment of their potential use.

  1. Microvascular free flaps in the management of war wounds with tissue defects

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    Kozarski Jefta

    2003-01-01

    Full Text Available Background. War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. Methods. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defects. The main criteria for the application of free flaps were: general condition of the wounded, size, localization, and structure of tissue defects. For the extensive defects of the tissue, as well as for severely contaminated wounds latissimus dorsi free flaps were used. For tissue defects of distal parts of the lower extremities, scapular free flaps were preferred. While using free tissue transfer for recompensation of bone defects, free vascularized fibular grafts were applied, and in skin and bone defects complex free osteoseptocutaneous fibular, free osteoseptocutaneous radial forearm, and free skin-bone scapular flaps were used. Results. After free flap transfer 16 (14,4% revisions were performed, and after 8 unsuccessful revisions another free flaps were utilized in 3 (37,5% patients, and cross leg flaps in 5 (62,5% patients. Conclusion. The treatment of war wounds with large tissue defects by the application of free microvascular flaps

  2. Single-stage maxillary and nasal floor reconstruction with the double-paddle rectus abdominis musculocutaneous free flap.

    Science.gov (United States)

    Herman, Charles K; Benacquista, Teresa; Brindzei, Nelya; Berdichevsky, Max; Baum, Thomas; Strauch, Berish

    2007-04-01

    Palatal integrity is essential for useful speech, deglutition, good oral hygiene, and prevention of nasal regurgitation. Maxillary defects after tumor extirpation, therefore, can have serious functional and cosmetic implications. Given the often disappointing results obtained with local and regional pedicled flaps for maxillary reconstruction, a variety of microvascular free flaps have been utilized in recent years, including the rectus abdominis, fibular, radial forearm, and latissimus dorsi flaps. Experience with these techniques has been documented in a limited number of case reports. We describe our single-stage approach to maxillary and nasal floor reconstruction with the double skin-paddle rectus abdominis musculocutaneous free flap. A series of five patients is presented; six of these immediate free flap reconstructions were performed for defects resulting from tumor resection. A vertical rectus abdominis musculocutaneous free flap was used in all cases, designing two separate skin paddles to accommodate the measured maxillary and nasal floor deficiencies. Anastomoses of the deep inferior epigastric artery and vena comitans were performed end-to-end to the facial artery and vein, respectively. In addition, orbital floor reconstruction with calvarial bone grafts or titanium mesh was performed in all five patients. Separation of the oral and nasal cavities was maintained postoperatively. No intraoperative complications, perioperative mortalities, flap losses, instances of skin paddle necrosis, hematomas, or oronasal fistulae were observed. One patient required bedside drainage of a surgical site abscess that resolved without adverse sequelae. Over the past 4 years, the double skin-paddle rectus abdominis musculocutaneous free flap has provided reliable results at our institution for single-stage reconstruction of maxillary and nasal floor defects. This reconstructive technique should be considered a viable method that can alleviate the functional and cosmetic

  3. 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.

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

    DEFF Research Database (Denmark)

    Ikander, Peder; Sørensen, Jens Ahm

    2015-01-01

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

  5. Effects of microsurgical free flap transfer on oral and maxillofacial reconstruction%游离皮瓣移植修复口腔颌面部缺损的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    翟沁凯; 王绪凯; 卢利; 孙长伏; 谭学新; 秦兴军; 黄绍辉

    2011-01-01

    Objective To analyze the clinical value of microsurgical free flap transfers for oral and maxillofacial region reconstruction.Methods One hundred and sixty-eight consecutive microsurgical free flap transfers performed on patients who had oral and maxillofacial defects from premodinantly surgical procedure due to carcinoma from March 2006 to August 2010 were reviewed.Concerning data include 90 free radial forearm flap,31 free fibular flap,39 anterolateral thigh flap and 8 latissmus dorsi musculocutaneous flap.Observe the microsurgical free plap survival rate and complication postoperatively.Results The overall success rate of flap was 97.6%(164/168).The overall complication rate was 6.5% (11/168).The flap crisis rate was 5.4% (9/168)including the vessel thrombosis rate 66.7% (6/9), and the flap salvage rate was 55.6% (5/9).Survival rate of radial forearm free flap,anterolateral thigh flap,fibular flap and latissmus dorsi musculocutaneous flap were 97.8% ,97.4% ,96.8%, 100% respectively.The features and functions of patients were mainly satisfactory after 2 ~ 2.5 years' follow-ups.Conclusions Mierosurgieal free flap transfer for oral and maxiilofaeial region defects is safe and reliable.The free radial forearm flap was most commonly used, followed by anterolateral thigh flap,fibular free flap and latissimus dorsi flap.%目的 探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值.方法 选择2006年03月-2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例.术后观察皮瓣成活率和并发症.结果 成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97

  6. Colgajo bilateral de perforantes lumbares para la reconstrucción de un severo defecto tóracolumbar Bilateral lumbar perforator flap in reconstruction of a wide toracolumbar defect

    Directory of Open Access Journals (Sweden)

    P. Benito Duque

    2006-06-01

    Full Text Available En la reconstrucción de los defectos toracolumbares se han empleado numerosas técnicas quirúrgicas. Ocasionalmente se puede utilizar el cierre directo, injertos de piel, colgajos de dorsal ancho volteado y lumbosacro transverso, colgajos de transposición o de rotación tipo random, pero están limitados cuando los tejidos circundantes están radiados o presentan cicatrices por cirugías previas. Igualmente, la extensión del defecto puede hacerlos inviables. Los colgajos de perforantes están especialmente indicados en pacientes con deambulación conservada, haciendo posible el aporte de una gran superficie de piel y tejido subcutáneo bien vascularizado, basado en los vasos perforantes y evitando así el sacrificio de vasos principales o músculos. Presentamos el caso de una paciente con un defecto en la espalda de 17 cm. De diámetro secundario a la resección de un tumor espinocelular con exposición de cuerpos vertebrales, tratado mediante la transposición de dos colgajos basados en las arterias perforantes lumbares asociados a un colgajo de rotación de dorsal ancho miocutáneo.Thoracolumbar defects have been treated by a variety of surgical methods. Primary closure, skin grafting, reverse latissimus dorsi musculocutaneous flap, transverse lumbosacral back flap, local randomly designed rotation, or transposition flaps may be indicated in occasional cases, but there is limited indication for their use in some cases with a wide lesion or when the surrounding tissues have been compromised by previous surgery or irradiation. Perforator flaps are specially indicated for ambulatory patients, in which large amounts of well-vascularized skin and subcutaneous tissue are transfered easily based on one perforator vessel without sacrificing main vessels or muscles. The authors present a patient with a 17 cm wide defect in the midback region and exposed bone after excision of a squamous cell carcinoma, treated by two perforator flaps based on

  7. Tissue flap repair strategy for severe defects of skin and soft tissue around the knee joints%膝关节周围严重皮肤软组织缺损的组织瓣修复策略

    Institute of Scientific and Technical Information of China (English)

    沈余明; 马春旭; 胡骁骅; 王成; 张琮

    2015-01-01

    Objective To explore selection and method of tissue flaps for the repair of severe defects of skin and soft tissue around the knee joints.Methods Fifty-four patients with wounds around the knee joints, all accompanied by exposure or necrosis of tendon or bone and exposure of prosthesis, were hospitalized in our burn center from June 2008 to December 2014.Five of them were with knee joint injury.After thorough debridement or tumor resection, the wound area ranged from 5 cm × 5 cm to 46 cm× 22 cm.Three patients were repaired with free latissimus dorsi myocutaneous flaps, 7 were repaired with modified sartorius myocutaneous flaps, 8 were repaired with gastrocnemius myocutaneous flaps, one was repaired with gastrocnemius muscle flap, two were repaired with posterior leg flaps combined with gastrocnemius muscle flaps, one was repaired with femoral biceps muscle flap combined with gastrocnemius muscle flap, 13 were repaired with reverse anterolateral thigh island flaps, two were repaired with reverse anterolateral thigh island flap combined with gastrocnemius myocutaneous flaps, two were repaired with superior lateral genicular flaps, 4 were repaired with reverse posterior thigh island flaps, 11 were repaired with saphenous artery flaps.Patellar ligament was reconstructed in 4 patients.The tissue flap size ranged from 5 cm × 5 cm to 38 cm × 19 cm.Some donor sites were sutured directly, and the others were closed by split-thickness skin grafting obtained from ipsilateral or contralateral legs.Results Among 59 tissue flaps of 54 patients, 55 tissue flaps of 50 patients survived, while necrosis of the distal part was observed in 4 tissue flaps, including one saphenous artery flap, two reverse anterolateral thigh island flaps, and one free latissimus dorsi myocutaneous flap.Among them, 3 flaps with necrosis at the distal part healed after debridement followed by skin grafting, one myocutaneous flap healed by transplanting gastrocnemius myocutaneous flap.During the

  8. The identification of blood circulation in the operation of free flap transplantation%游离皮瓣移植术中血液循环判断

    Institute of Scientific and Technical Information of China (English)

    顾加祥; 田恒; 张乃臣; 刘宏君; 潘俊博; 董佳生

    2012-01-01

    Objective To explore the significance of identifying blood circulation in the operation of free flap transplantation to a successful flap surgery. Methods Twenty - six patients who suffered from trauma and soft tissue loss in our hospital from Mar. 2007 to Dec. 2009 received free skin flap transplantation with latissimus dorsi muscle and thigh anterolatera flap. The correlation between flap flexibility, color, the color of the venous blood, and flap survival after surgery were observed. Results After surgery, it was found that the flap survival was good if the flap flexibility and the color of the flap had the same color with the donor area and the venous blood became mauve. Conclusion The identification of blood circulation in the operation of free flap transplantation is important to a successful flap surgery.%目的 探讨游离皮瓣移植术中血液循环判断对皮瓣手术成功的指导意义.方法 对2007年3月~2009年12月26例外伤后皮肤和软组织缺损的患者行游离背阔肌和股前外侧皮瓣移植,观察术中吻合血管后皮瓣的弹性、色泽,吻合处静脉血流的颜色和术后皮瓣的存活之间的关系.结果 游离皮瓣移植术中吻合血管后,如皮瓣的弹性正常、色泽逐渐转为原供区切取前色泽,静脉血流颜色转为(淡)紫红色,则皮瓣术后存活良好.结论 游离皮瓣移植术中静脉血流和皮瓣颜色等血液循环的判断对皮瓣存活有重要的参考的意义.

  9. Immediate Single-stage Endoscopic Latissimus Dorsi Breast and Nipple Reconstruction

    Directory of Open Access Journals (Sweden)

    Joaquim Muñoz i Vidal, MD

    2014-03-01

    Full Text Available Summary: Immediate breast reconstruction usually is a multistep surgical treatment. We introduce a new technique with positive results that reduces the reconstruction to 1 single step. This new technique promises to reduce patient consequences from multistaged procedures while reducing the costs. A retrospective review of 7 patients is presented.

  10. Elastofibroma dorsi – differential diagnosis in chest wall tumours

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    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  11. Combined vascular reconstruction and free flap transfer in diabetic arterial disease.

    Science.gov (United States)

    Vermassen, F E; van Landuyt, K

    2000-01-01

    Gangrenous lesions of the foot or lower leg due to severe diabetic arterial disease resulting in extensive soft tissue defects with exposed bones or tendons often result, even after successful revascularisation, in staged or primary amputation. We present our experience with 45 such patients treated with combined arterial reconstruction and free tissue transfer for limb-salvage. All presented with peripheral vascular disease of diabetic origin, and extensive gangrenous lesions that could not be treated by simple wound closure or skin-grafting without major amputation. A total of 53 arterial reconstructions and 47 free-flap transfers were performed. In the majority of patients, the distal anastomosis was on a pedal or tibial vessel. These bypass grafts or a native revascularized artery served as the inflow tract for the free flap which was anastomosed using microsurgical techniques. Venous anastomoses were preferentially performed on the deep venous system. Donor muscles were Musculus rectus abdominis (n=37), Musculus latissimus dorsi (n=5), Musculus serratus anterior (n=3), and a perforator flap (n=2) tailored to the size of the defect and covered with a split thickness graft (STG). The operation was set up as a combined procedure in 39/45 patients, two teams working simultaneously, limiting the mean operative time to 6 h. Early reinterventions had to be performed in 14 patients resulting in five flap losses of which two could be treated with a new free flap transfer and three were amputated. Three other patients died in the postoperative period, leaving us with a total of 39/45 patients leaving the hospital with a full-length limb. Independent ambulation was achieved in 32 of these 39 patients. During late follow-up (mean 26 months) eight bypasses occluded resulting in two amputations and two new vascular reconstructions. Combined survival and limb-salvage rate was 84% after 1 year, 77% after 2 years and 65% after 3 years. The advantages of this combined technique

  12. 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

    目的 探讨四肢电烧伤创面皮瓣修复的修复方法和手术适应证. 方法 1997年5月-2014年6月,共收治四肢电烧伤后软组织缺损患者38例,分别于电烧伤后7~14d内采用了皮瓣修复,其中局部旋转皮瓣4例,鱼际皮瓣1例,示指背侧皮瓣2例,交腿皮瓣1例,足底内侧皮瓣1例,带蒂背阔肌皮瓣2例,前臂骨间后动脉逆行岛状皮瓣4例,掌背动脉逆行岛状皮瓣4例,髂腹股沟皮瓣10例;游离桡动脉皮瓣1例,游离背阔肌皮瓣1例,游离股前外侧皮瓣3例;前臂后侧骨间前动脉穿支逆行岛状皮瓣1例,小腿后侧穿支逆行岛状皮瓣2例,小腿前外侧穿支逆行岛状皮瓣1例.皮瓣切取范围42.0 cm×13.0 cm~6.0 cm×3.0 cm.结果 术后随访时间4~42个月,平均6、7个月.皮瓣完全成活35例,占92.1%;尖端部分坏死3例,占7.9%.坏死部分经局部换药均在术后1个月内自行愈合.肢体和手的外形较为满意,手腕部电烧伤病例28例,功能优和良共15例,占57.1%;中8例,占28.6%;差5例,占14.3%. 结论 对电烧伤创面进行早期皮瓣修复,是保护肢体深部组织结构、预防控制继发感染、最大限度保留肢体功能的有效方法.%Objective To investigate the surgical indications and repair methods for the treatment of electrical bums in the limbs.Methods Thirty-eight cases since May,1997 to June,2014 who underwent flap treatment in 7-14 days after electrical bums was summarized.Among these patients,4 cases were treated by local flaps,1 case was treated by thenar flap,2 cases were treated by dorsal island skin flap of the index finger,1 case was treated by cross-leg flap,1 case was treated by medial plantar skin flap;2 cases were treated by pedicle latissimus dorsi flaps,4 cases were treated by antebrachial flap with a pedicle of the posterior interosseous artery,4 cases were treated by metacarpal artery reversed island flaps,10 cases were treated by groin flaps;1 case was treated by free radial

  13. Foot and ankle reconstruction:an experience on the use of 14 different flaps in 226 cases%足踝软组织重建的皮瓣选择策略:14种皮瓣226例分析

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 梅良斌; 吕乾; 王毅; 范新宇; 李福兵; 吴一鹏; 徐永清

    2014-01-01

    ,pedicled peroneal artery perforator flap,pedicled tibial artery perforator flap,and medial plantar flap.The free flaps were latissimus musculocutaneous flap,anterolateral thigh musculocutaneous flap,groin flap,lateral arm flap,anterolateral thigh perforator flap,peroneal artery perforator flap,thoracdorsal artery perforator flap,and medial arm perforator flap.The sensory nerve coaptation was not performed for all of flaps.One hundred and ninety-four cases were combined with open fractures.One hundred and sixty-two cases had tendon ruptures.Results Of the 62 pedicled flaps,11 had partial loss.Among 164 free flaps,8 flaps were completely lost,and 5 were partly lossed.The resiudal defects were managed by the secondary procedures.Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps),ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing,and infection was found in 14 flaps.All of patients except for one regained protective sensation from 3 to 12 months postoperatively.All of limbs were preserved and the patients regained walking and daily activities.Conclusion Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus,dorsal hindfoot and midfoot.Plantar foot,forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap.For the infected wounds with dead space,the free latissimus dorsi musculocutaneous flap remained to be the optimal choice.

  14. 远端蒂腓肠神经营养血管肌皮瓣修复足踝部创面22例疗效观察%Distal Pedicle Sural Nerve Nutrient Vessels Musculo Cutaneous Flap in Repair of 22 Patients with Damaged Ankle Latissimus Dorsi Myocutaneous Wound

    Institute of Scientific and Technical Information of China (English)

    贾玉俊; 陈长青; 伦保国

    2012-01-01

    目的 观察远端蒂腓肠神经营养血管肌皮瓣修复足踝部皮肤软组织缺损所致的创伤性骨髓炎创面的临床疗效.方法 选择我院2006年6月-2010年6月收治的踝周、足部软组织缺损导致的创面感染22例,行远端蒂腓肠神经营养血管肌皮瓣修复术.结果 19例伤口一期愈合,有2例皮瓣边缘坏死和1例形成窦道,换药清创后治愈.结论 应用远端蒂腓肠神经营养血管肌皮瓣修复足踝部创伤性软组织缺损、骨髓炎创面是有效且可行的.

  15. Immediate breast reconstruction with latissimus dorsi musculo-cutaneous pedicle flap after modified radical mastectomy with skin preservation%保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造

    Institute of Scientific and Technical Information of China (English)

    孙海荣; 范先成; 胡小戊

    2010-01-01

    目的 介绍保留皮肤的乳癌改良根治术后即时背阔肌肌皮瓣乳房再造的经验.方法 对Ⅰ,Ⅱ期乳腺癌行保留乳房皮肤经皮下切除乳腺组织,清扫腋窝淋巴结,应用背阔肌肌皮瓣即时乳房再造.结果 应用该方法治疗37例,经随访75个月,再造乳房自然柔软,外观形态良好,满意率94.6%.结论 保留皮肤的乳腺癌根治术后即时背阔肌肌皮瓣乳房再造具有操作方便,治疗效果良好,患者满意度高,是值得推广的好方法.

  16. Application of bridged free latissimus dorsi musculo-cutaneous flap on the soft tissue defects in lower extremities%桥式游离背阔肌肌皮瓣在下肢软组织缺损中的应用

    Institute of Scientific and Technical Information of China (English)

    谢庭鸿; 黄晓元; 龙剑虹; 肖目张; 张明华

    2005-01-01

    目的观察应用桥式游离背阔肌肌皮瓣修复下肢软组织缺损的效果. 方法采用桥式游离背阔肌肌皮瓣修复7例下肢严重软组织损伤患者.术前对拟行移植的背阔肌肌皮瓣血管和健肢血管行超声多普勒检查,以确认皮瓣及健肢血管循环良好.清创后,根据创面大小、深度设计皮瓣,用作携带桥的皮瓣长度较双下肢手术部位之间距离长10%左右;供区面积较受区大20%,形成皮管部位的皮肤设计应宽大,避免张力过大对血管造成压迫.然后行皮瓣修复术.观察皮瓣成活情况,总结手术指征及应注意的问题. 结果 7例患者手术后皮瓣均成活.除2例患者因皮瓣较为臃肿行皮瓣修薄术外,其余患者术后外形良好,功能恢复满意.手术指征:患侧肢体一条主要的动脉(胫前或胫后动脉)受损,不宜用另一条动脉作吻合血管行游离皮瓣移植术者;患侧肢体受伤严重,深层组织结构破坏,血管损伤情况不明或估计难以找到受区血管者;对侧健肢的重要血管无损伤者.注意点:术前应考虑桥式皮瓣的血运及断蒂后皮瓣是否能够成活.术后注意皮瓣血运,术区妥善固定. 结论桥式游离背阔肌肌皮瓣修复下肢软组织缺损效果满意.恰当的创面处理、宽大的皮瓣、稳妥的固定是手术成功的关键.

  17. Browse Title Index

    African Journals Online (AJOL)

    Items 1 - 50 of 95 ... Vol 3, No 1 (2007), Breast disease including breast developmental anomalies ... pedicled latissimus dorsi musculocutaneous flap in delayed reconstruction of ... Vol 9, No 2 (2013), Homograft in burn therapy – any relevance?

  18. Microsurgical free flaps at Kathmandu Model Hospital.

    Science.gov (United States)

    Rai, S M; Grinsell, D; Hunter-Smith, D; Corlett, R; Nakarmi, K; Basnet, S J; Shakya, P; Nagarkoti, K; Ghartimagar, M; Karki, B

    2014-01-01

    Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at Kathmandu Model Hospital in 2007 with the support from Interplast Australia and New Zealand. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal. A retrospective cross sectional study was conducted using the clinical records of all the microsurgical free flaps performed at Kathmandu Model Hospital from April 2007 to April 2014. Fifty-six free flaps were performed. The commonest indication was neoplasm followed by post-burn contracture, infection and trauma. Radial artery forearm flap was the commonest flap followed by fibula, antero-lateral thigh, rectus, tensor facia lata, lattisimus dorsi, deep inferior epigastric artery perforator, and deep circumflex iliac artery flap. Radial artery forearm flaps and anterolateral thigh flaps were mostly used for burn contracture reconstructions. Twelve of the 13 (92%) fibulae were used for mandibular reconstruction for oral cancer and ameloblastoma. Rectus flaps were used mainly for covering defects over tibia. Hospital stay ranged from six to 67 days with an average of fourteen. Fifteen patients (26%) developed complications. The duration of operation ranged from six hours to 10.5 hours with an average of nine hours. The longest follow up was for four years. Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team.

  19. Free composite flap transplantation use for head and neck reconstruction%游离组织瓣移植修复头颈部肿瘤术后组织缺损的临床分析

    Institute of Scientific and Technical Information of China (English)

    王朝晖; 陈锦; 李春华; 蔡永聪; 李彬; 王少新

    2013-01-01

    Objective To evaluate the effects of free composite flap transplantation on reconstruction of postoperative defects of head and neck. Methods Clinical data of 101 consecutive free flap transfers performed in 100 patients from 2003 to 2012 was studied retrospectively. Accoding to the donor sites, the free flaps included free radial forearm flaps ( n = 61 ) , latissimus dorsi flaps ( n = 18 ) , free fibula flaps ( n = 7 ) , rectus abdominis flaps ( n = 2 ) , anterolateral thigh flaps ( n = 10), iliac bone flaps ( n = 2 ) , and scapular flaps ( n = 1 ) . The reconstruction sites included oral region ( n = 47 ) , oropharyngeal region ( re = 16 ) , mandible region ( n = 9 ) , maxillofacial region (n = 20 ) , neck region ( re = 6 ) , neck and back region ( n = 2 ) . To observe the healing of free tissue flap transplantation. Results All the patients were followed up for 2 months to 5 years postoperatively. Of all the 101 flaps, 98 survived and necrosis occurred in 3. The total survival rate of flaps was 97. 03% , with a postoperative complication rate of 11. 8% (12/101 ). The patients were generally satisfied with their shape and function. Conclusions With various donor tissues, free tissue flap transplantation is reliable and safe in the reconstruction of postoperative defects in head and neck.%目的 探讨吻合血管的游离组织瓣在头颈肿瘤术后组织缺损修复中的应用.方法 2003年5月~ 2012年4月收集头颈肿瘤术后组织缺损患者100例,其中口腔47例,口咽部16例,下颌骨9例,颌面部20例,颈部6例,项背部2例;所有患者应用吻合血管的游离组织瓣(101处)修复组织缺损,其中游离前臂皮瓣61处,游离背阔肌皮瓣1 8处,游离腓骨肌皮瓣7处,游离腹肌穿支皮瓣2处,游离股前外侧皮瓣10处,游离髂骨肌瓣2处,游离肩胛皮瓣1处;观察游离组织瓣修复组织缺损处后的愈合情况.结果 术后随访2个月至5年,患者术后外形及功能均恢复正常,101

  20. Cinco pacientes, once colgajos libres: resultados a largo plazo Five patients, eleven free flaps: long-term results

    Directory of Open Access Journals (Sweden)

    C. Olvera Caballero

    2006-09-01

    this series, complexity of the problem was the main indication for the double method. The recipient zone was the lower extremities in four of the patients and the face in the fifth. The etiology were burn sequelae in two, post-traumatic sequelae in two and postsurgical and mielomeningocele sequelae in one. Four latissimus dorsi flaps, five scapular flaps one peroneus and one gracilis flaps were used. The recipient sites and surgical technique are described. Long-term follow-up makes it possible to demonstrate the outstanding adaptability of free flaps, their resilience and their usefulness as a first-choice reconstructive procedure

  1. THE RECTUS-ABDOMINIS CARDIOMYOPLASTIC PROCEDURE - PRELIMINARY-RESULTS

    NARCIS (Netherlands)

    WIJNBERG, DS; HENSEN, AG; GRANDJEAN, PA; SCHREUDER, JAH; ROBINSON, PH; EBELS, T

    1994-01-01

    The rectus abdominis myofascial flap (RAMF) was investigated as a viable alternative to the latissimus dorsi flap for dynamic cardiomyoplasty. In human and animal cadaver experiments and live sheep, it was possible to use the RAMF for innervated intrathoracic use. The RAMF was stimulated by a specia

  2. THE RECTUS-ABDOMINIS CARDIOMYOPLASTIC PROCEDURE - PRELIMINARY-RESULTS

    NARCIS (Netherlands)

    WIJNBERG, DS; HENSEN, AG; GRANDJEAN, PA; SCHREUDER, JAH; ROBINSON, PH; EBELS, T

    1994-01-01

    The rectus abdominis myofascial flap (RAMF) was investigated as a viable alternative to the latissimus dorsi flap for dynamic cardiomyoplasty. In human and animal cadaver experiments and live sheep, it was possible to use the RAMF for innervated intrathoracic use. The RAMF was stimulated by a specia

  3. Repair of lower extremity soft tissue defect with free musculo-cutaneous flaps bridging with healthy contralateral posterior tibial vessel%游离肌皮瓣桥接胫后血管修复对侧下肢软组织缺损

    Institute of Scientific and Technical Information of China (English)

    夏成德; 狄海萍; 薛继东; 赵耀华; 李晓亮; 李强; 牛希华; 李永林; 连鸿凯

    2015-01-01

    Objective To observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect.Methods From February 2006 to June 2013,10 patients with soft tissue defect on lower shank and foot were included.The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap,or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap.The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot.The wound area ranged from 40 cm × 21 cm to 22 cm×15 cm,with flap size from 48 cm×26 cm to 25 cm×18 cm.Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus.The kirschner wires were removed at 4 weeks and pedicles were cut off 5 ~ 8 weeks postoperatively.Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting.Results All the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness.During the follow-up period of 3 months to 2 years follow up,the ambulatory function of injured legs recovered gradually with satisfactory appearance.The reanastomosed posterior tibial vessel on the healthy side was recovered.Conclusions Appropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot.It is a safe and effective method for limb salvage.%目的 观察游离肌皮瓣与健肢胫后血管桥接修复对侧下肢软组织缺损的临床效果.方法 2006年2月至2013年6月,对10例小腿下段及足部软组织缺损患者,应用健肢胫后血管与游离背阔肌肌皮瓣、背阔肌肌皮瓣联合胸脐皮瓣、股前外侧肌肌皮瓣的血管吻合,形成以健肢

  4. 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

  5. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation.

    Science.gov (United States)

    Weitgasser, Laurenz; Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

  6. Elastofibroma dorsi: MRI diagnosis in a young girl

    Energy Technology Data Exchange (ETDEWEB)

    Devaney, D. [Dept. of Histopathology, Hospital for Sick Children, London (United Kingdom); Livesley, P. [Dept. of Orthopaedics, Hospital for Sick Children, London (United Kingdom); Shaw, D. [Dept. of Paediatric Radiology, Hospital for Sick Children, London (United Kingdom)

    1995-06-01

    With indications for computerised imaging expanding, elastofibroma dorsi will probably be seen more frequently. This report describes an elastofibroma presenting in an 11-year-old girl and its appearance by magnetic resonance imaging. Presumptive diagnosis by magnetic resonance imaging may prevent unnecessary radical surgery. (orig.)

  7. The interpectoral fascia flap.

    Science.gov (United States)

    Beer, Gertrude M; Manestar, Andrew; Manestar, Mirjana

    2008-09-01

    Despite the great number of pedicled and free flaps that are available for defect and contour repair, the number of fascia flaps with an axial blood supply are sparse. Such flaps with their gliding function are mandatory, whenever coverage with very thin, well-vascularized tissue is necessary. To the currently established fascia flaps, (the temporoparietal fascia flap, the radial forearm fascia flap, the lateral arm fascia flap, and the serratus anterior fascia flap), we want to add a new fascia flap, the interpectoral fascia flap. We dissected the interpectoral fascia flap from 20 cadavers. In each of the 40 hemichests, the trunk of the thoracoacromial vessels was selectively injected with red polyurethane and the tissue containing the pectoral branches was separated from the overlying pectoralis major muscle and converted into an independent fascia flap. The maximum flap length was 13.5 cm and the maximum breadth was 10.3 cm. The length of the vascular pedicle before entering the flap was 3.9 cm +/- 1.4 cm with a range of 1.5-6.8 cm. Concerning the arc of rotation, all 40 flaps reached the posterior axillary fold, and 29 flaps (73%) reached the mandibular border. This new fascia flap has applications as pedicled and as free flap. The pedicled flap is used in the neck region, in the axillary region and as gliding tissue between the nipple-areola complex and the pectoralis major muscle. The usage of the fascia flap as a free flap has similar characteristics as the other fascia flaps.

  8. Neurovascular free-muscle transfer for the treatment of established facial paralysis following ablative surgery in the parotid region.

    Science.gov (United States)

    Takushima, Akihiko; Harii, Kiyonori; Asato, Hirotaka; Ueda, Kazuki; Yamada, Atsushi

    2004-05-01

    Neurovascular free-muscle transfer for facial reanimation was performed as a secondary reconstructive procedure for 45 patients with facial paralysis resulting from ablative surgery in the parotid region. This intervention differs from neurovascular free-muscle transfer for treatment of established facial paralysis resulting from conditions such as congenital dysfunction, unresolved Bell palsy, Hunt syndrome, or intracranial morbidity, with difficulties including selection of recipient vessels and nerves, and requirements for soft-tissue augmentation. This article describes the authors' operative procedure for neurovascular free-muscle transfer after ablative surgery in the parotid region. Gracilis muscle (n = 24) or latissimus dorsi muscle (n = 21) was used for transfer. With gracilis transfer, recipient vessels comprised the superficial temporal vessels in 12 patients and the facial vessels in 12. For latissimus dorsi transfer, recipient vessels comprised the facial vessels in 16 patients and the superior thyroid artery and superior thyroid or internal jugular vein in four. Facial vessels on the contralateral side were used with interpositional graft of radial vessels in the remaining patient with latissimus dorsi transfer. Cross-face nerve grafting was performed before muscle transfer in 22 patients undergoing gracilis transfer. In the remaining two gracilis patients, the ipsilateral facial nerve stump was used as the primary recipient nerve. Dermal fat flap overlying the gracilis muscle was used for cheek augmentation in one patient. In the other 23 patients, only the gracilis muscle was used. With latissimus dorsi transfer, the ipsilateral facial nerve stump was used as the recipient nerve in three patients, and a cross-face nerve graft was selected as the recipient nerve in six. The contralateral facial nerve was selected as the recipient nerve in 12 patients, and a thoracodorsal nerve from the latissimus dorsi muscle segment was crossed through the upper lip

  9. The submental island flap.

    Science.gov (United States)

    Sterne, G D; Januszkiewicz, J S; Hall, P N; Bardsley, A F

    1996-03-01

    The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.

  10. 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...

  11. Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

    OpenAIRE

    Burgoyne Gwyne; Anderson Anne; Patani Neill; Reefy Sara; Osman Hisham; Mokbel Kefah

    2010-01-01

    Abstract Background The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated. Methods 137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), L...

  12. 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

  13. 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....

  14. A composite medial plantar flap for the repair of an achilles' tendon defect: a case report.

    Science.gov (United States)

    Dumont, C E; Kessler, J

    2001-12-01

    The surgical management of infected necrosis of the Achilles' tendon and overlying skin is very demanding, and reconstruction with vascularized tendon and skin flaps is considered the benchmark procedure. The authors report a 65-year-old man who sustained a chronic wound after operative repair of a chronic rupture of the Achilles' tendon. A pedicled medial plantar flap including the surrounding vascularized plantar aponeurosis was elevated. The plantar aponeurosis was split and used to bridge the 4-cm-long tendon defect. The flap donor site was covered with a thin skin graft. The flap survived completely without recurrence of the infection. At the 7-month follow-up, the reconstructed Achilles' tendon showed a good functional result and a normal range of dorsi- and plantar flexion of the foot. This technique is of great interest in comparison with free flaps because it does not require vascular anastomosis in a septic environment or a secondary debulking operation, yet it still provides both vascularized tendon and skin graft.

  15. Spontaneous Flapping Flight

    Science.gov (United States)

    Vandenberghe, Nicolas; Zhang, Jun; Childress, Stephen

    2004-11-01

    As shown in an earlier work [Vandenberghe, et. al. JFM, Vol 506, 147, 2004], a vertically flapping wing can spontaneously move horizontally as a result of symmetry breaking. In the current experimental study, we investigate the dependence of resultant velocity on flapping amplitude. We also describe the forward thrust generation and how the system dynamically selects a Strouhal number by balancing fluid and body forces. We further compare our model system with examples of biological locomotion, such as bird flight and fish swimming.

  16. Treatment of 10 cases of trismus resulting from head and neck radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wakamatsu, Keita; Harashina, Takao [Saitama Medical School, Kawagoe (Japan). Saitama Medical Center; Tsuchiya, Yuichi; Ohtsuru, Hiroshi

    2001-07-01

    Ten cases of trismus following irradiation of head and neck cancer are reported. The patients were 4 males and 6 females with a mean age of 54.2 years. We preformed 2 arthroplasties, and used 4 scapular flaps, 2 groin flaps, 1 omental flap, and 1 latissimus dorsi flap. The maximum mouth opening in each patient improved, and all patients were able to open past 2 finger breadth after treatment. Use of vascularized tissue is important to prevent atrophy of transferred bone and other soft tissues, and infection. In addition, even if trismus is improved after surgery, mouth opening exercises are needed to prevent recurrence of trismus. (author)

  17. Thermal injury in TAPIA breast reconstruction

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L.; Sørensen, Jens Ahm

    2017-01-01

    This paper presents two case reports on thermal injury to a breast reconstructed by the TAPIA method. In both cases the injuries were caused by excessive sun exposure. Thermal injury to flaps used in breast reconstruction has previously been described but most commonly in abdominal flaps, which may...... be due to the relative high frequency of this type of reconstructions. Reports of thermal injury to reconstructions using the Latissimus Dorsi flap are rare. The injuries previously described are most often caused by severe heat exposure. The thoracodorsal artery perforator (TAP)-flap can be used...

  18. Breast Reconstruction with Flap Surgery

    Science.gov (United States)

    Breast reconstruction with flap surgery Overview By Mayo Clinic Staff Breast reconstruction is a surgical procedure that restores shape to ... breast tissue to treat or prevent breast cancer. Breast reconstruction with flap surgery is a type of breast ...

  19. Differential impact of visual feedback on plantar- and dorsi-flexion maximal torque output.

    Science.gov (United States)

    Toumi, Anis; Jakobi, Jennifer M; Simoneau-Buessinger, Emilie

    2016-05-01

    The effect of visual feedback on enhancing isometric maximal voluntary contractions (MVC) was evaluated. Twelve adults performed plantar-flexion and dorsi-flexion MVCs in 3 conditions (no visual feedback, visual feedback, and visual feedback with target). There was no significant effect of visual conditions on dorsi-flexion MVC but there was an effect on plantar-flexion. Irrespective of whether a target was evident, visual feedback increased plantar-flexion MVC by ∼15%. This study highlights the importance of optimal feedback to enhance MVC.

  20. Effects of tetracycline administration on the proteomic profile of pig muscle samples (L. dorsi)

    DEFF Research Database (Denmark)

    Gratacos-Cubarsi, M.; Castellari, M.; Hortos, M.

    2008-01-01

    Effect of tetracycline (TC) administration on the proteomic profile of pig muscle was evaluated by 2D electrophoresis and MALDI-TOF mass spectrometry. The TC content at slaughter was determined in L. dorsi samples by HPLC-DAD. Mean residual concentration of TC in the muscle of treated animals, ca...

  1. Reverse Abdominoplasty: A Practical Option for Oncological Trunk Reconstruction

    OpenAIRE

    Pantelides, Nicholas M.; Mondal, Debabrata; WISHART, GORDON C.; Malata, Charles M.

    2013-01-01

    Objectives: Following radical oncological resection, full-thickness upper central trunk defects present a significant challenge. Common reconstructive options include pedicled flaps, such as pectoralis major, rectus abdominis, and latissimus dorsi. In complex cases, free tissue transfer may be required. Reverse abdominoplasty, although initially described for cosmetic body contouring, can be used to reconstruct upper central trunk defects following radical tumour ablation. We present 4 such a...

  2. Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

    OpenAIRE

    Gore, Sinclair M.; WISHART, GORDON C.; Malata, Charles M.

    2012-01-01

    Objective: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. Methods: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Results: Clearance of periductal mastitis and infection has been ...

  3. The Gradual Expansion Muscle Flap

    Science.gov (United States)

    2014-01-01

    defects can usu- ally be obtained with a rotational flap , larger size defects commonly require free tissue transfer. A number of techni- ques have...feasible.21,22 Because limb salvage situations occur in which rota- tional muscle coverage is inadequate and free flap coverage is less desirable, we...larger defects which previously would have required free tissue transfer. Surgical Technique The GEM flap for large soft tissue defects of the leg requires

  4. Sliding flap tracheoplasty.

    Science.gov (United States)

    Gates, G A; Tucker, J A

    1989-12-01

    The optimal method for surgical management of subglottic stenosis is based upon careful assessment of the location, caliber, length, and maturity of the stenotic segment, as well as associated conditions. For patients with a mature stenosis of short length, excision of the anterior arch of the cricoid and first ring and immediate reconstruction by means of a sliding flap of the next two to three rings of trachea offer a one-stage definitive treatment without the need for grafting. We report four cases of subglottic stenosis and one case of cricoid chondroblastoma in which reconstruction of the airway was successful and prompt. For carefully selected cases, sliding flap tracheoplasty may be a useful alternative to procedures in which the airway is expanded by means of grafting.

  5. Cross finger flaps.

    Science.gov (United States)

    Kisner, W H

    1979-01-01

    Proper fingertip reconstruction requires good skin and soft tissue coverage, preservation of function and as normal an appearance as possible. The cross finger flap results in negligible joint stiffness, minimal morbidity and little work-time loss. An important factor is the conservation of finger length permitted by this technique. This method of repair is underutilized. It is indicated in several types of fingertip amputations where bone shortening would be detrimental.

  6. 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....... The color Doppler ultrasonography study detected a sizeable perforator at the level of the modiolus lateral to the angle of the mouth within a radius of 1 cm. This confirms the anatomical findings of previous authors and indicates that the modiolus perforator is a consistent anatomical finding, and flaps...

  7. The Simplified Posterior Interosseous Flap.

    Science.gov (United States)

    Cavadas, Pedro C; Thione, Alessandro; Rubí, Carlos

    2016-09-01

    Several technical modifications have been described to avoid complications and simplify dissection. The authors describe some technical tips that make posterior interosseous flap dissection safer and more straightforward.

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

    Directory of Open Access Journals (Sweden)

    Satish P Bhat

    2013-01-01

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

  9. [Immediate breast reconstruction for breast cancer].

    Science.gov (United States)

    Yamamoto, Daigo; Tanaka, Yoshihito; Tsubota, Yu; Sueoka, Noriko; Endo, Kayoko; Ogura, Tsunetaka; Nagumo, Yoshinori; Kwon, A-Hon

    2014-11-01

    We performed immediate breast reconstruction after nipple-sparing mastectomy or skin-sparing mastectomy and evaluated the reconstruction procedure, cosmesis, and complications. Among the 30 patients included in the study, 6 received latissimus dorsi flaps, 1 received a transverse rectus abdominis myocutaneous flap, 7 received deep inferior epigastric perforator flaps, 1 received an implant, and 15 received tissue expanders. In addition, the results were excellent in 25 patients, good in 3 patients, and poor in 2 patients. As the number of patients with breast cancer is increasing, the demand for breast reconstruction will increase. Therefore, it is essential to choose an appropriate method of breast reconstruction for each case.

  10. 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

  11. Peroneal Flap for Tongue Reconstruction.

    Science.gov (United States)

    Lin, Ying-Sheng; Liu, Wen-Chung; Lin, Yaoh-Shiang; Chen, Lee-Wei; Yang, Kuo-Chung

    2017-07-01

    Background For large tongue defects, reconstructive surgeons have devised a variety of feasible options, such as radial forearm free flap and anterolateral thigh (ALT) flap. In our institution, peroneal flap has been the workhorse flap for the soft tissue defect in head and neck reconstruction. We present our experience using peroneal flap in tongue reconstruction. Patients and Methods The study included 47 patients who had undergone tongue reconstructions with peroneal flaps after tumor resection. The size and location of the defect after tumor resection determined whether the peroneal flaps could be harvested as pure septocutaneous flaps to solely reconstruct the neotongue or to carry an additional muscle bulk to fill the adjacent defect. Retrospective chart review was used to look for postoperative complications and to perform functional assessments (which were also performed through telephone inquiry). Results Of the 47 patients, 3 (6%) had flap failure and 1 (2.1%) had partial flap necrosis. The hemiglossectomy group had better results than the total glossectomy group with respect to speech and diet, but neither of these results reached statistical significance (p = 1.0 for speech and p = 0.06 for diet). The results of the subtotal glossectomy group were better than those of the total glossectomy group with respect to diet (p = 0.03). No statistically significant differences were noted among the three groups with respect to cosmetic aspect (p = 0.64). Conclusions Considering its reasonable postoperative complication rates and functional results, peroneal flap can be considered a feasible option for tongue reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. 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...

  13. Skin flaps and grafts - self-care

    Science.gov (United States)

    ... Regional flaps - self-care; Distant flaps - self-care; Free flap - self-care; Skin autografting - self-care; Pressure ulcer ... your wound To care for the graft or flap site: You may need to rest ... around it clean and free from dirt or sweat. DO NOT let the ...

  14. Surgical Treatment of Giant Recurrent Breast Phyllodes Tumor

    Institute of Scientific and Technical Information of China (English)

    Xiru LI; Yungong YANG; Jiandong WANG; Bing MA; Yuanchao JIN; Rong LI

    2008-01-01

    In this study, a recurrent massive phyllodes tumor of the breast was surgically removed and the grafting was used to repair the local skin defects. A 29-y female patient had recurring breast phyllodes tumor of extremely large size in the chest wall after the excision of a previous tumor. The massive phyllodes tumor was eliminated by completely removing the layers of the skin and tissues above the costal bones with incisal margin being 2 cm away from the tumor lesion. The latissimus dorsi myocutaneous flap, lateral thoracic skin flap, and rectus abdominis myocutaneous flap were grafted to replace the lost tissues due to the surgery. Anti-infection and anticoagulation treatments were used after the surgery. The graft flaps had sufficient blood supply and good blood circulation,and the incisions mostly healed. The outcome of the surgery was acceptable. For the surgical treatment of the massive phyllodes tumor in the chest wall, it is an alternative of choice to use latissimus dorsi myocutaneous flap, lateral thoracic skin flap and rectus abdominis myocutaneous flap in combination for skin grafting.

  15. Flap Edge Noise Reduction Fins

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

    Shinya, K

    1999-12-01

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

  17. Monolithically Integrated Micro Flapping Vehicles

    Science.gov (United States)

    2012-08-01

    Mechanical Logic • Memory Mm-Scale Ground Mobility Actuation & Mechanisms Ultrasonic Motors Reversible Adhesion Platform Design...MEMS Mm-Scale Ground Mobility PiezoMEMS Haltere Actuation & Mechanisms Ultrasonic Motors Reversible Adhesion Platform Design Flapping

  18. Active Control of Long Bridges Using Flaps

    DEFF Research Database (Denmark)

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

    The main problem in designing ultra-long span suspension bridges is flutter. A solution to this problem might be to introduce an active flap control system to increase the flutter wind velocity. The investigated flap control system consists of flaps integrated in the bridge girder so each flap...... is the streamlined part of the edge of the girder. Additional aerodynamic derivatives are shown for the flaps and it is shown how methods already developed can be used to estimate the flutter wind velocity for a bridge section with flaps. As an example, the flutter wind velocity is calculated for different flap...... configurations for a bridge section model by using aerodynamic derivatives for a flat plate. The example shows that different flap configurations can either increase or decrease the flutter wind velocity. for optimal flap configurations flutter will not occur....

  19. Microstructural and mechanical properties of camel longissimus dorsi muscle during roasting, braising and microwave heating.

    Science.gov (United States)

    Yarmand, M S; Nikmaram, P; Djomeh, Z Emam; Homayouni, A

    2013-10-01

    This study was conducted to investigate the effects of various heating methods, including roasting, braising and microwave heating, on mechanical properties and microstructure of longissimus dorsi (LD) muscle of the camel. Shear value and compression force increased during microwave heating more than roasting and braising. Results obtained from scanning electron microscopy (SEM) showed more damage from roasting than in either braising or microwave heating. Granulation and fragmentation were clear in muscle fibers after roasting. The perimysium membrane of connective tissue was damaged during braising, while roasting left the perimysium membrane largely intact. The mechanical properties and microstructure of muscle can be affected by changes in water content during cooking.

  20. The rat saphenous flap: a fasciocutaneous free flap model without panniculus carnosus.

    Science.gov (United States)

    Mutaf, M; Tasaki, Y; Tanaka, K; Fujii, T

    1995-10-01

    The rat saphenous flap is described as a new experimental model for free flap studies. This is a fasciocutaneous free flap based on the saphenofemoral vascular pedicle. The flap may include the entire medial aspect of the lower leg between the knee and ankle. Thirty flaps were harvested from 15 inbred rats. Each flap was transferred to the anterior neck of a recipient rat of the same inbred strain so that 15 flaps were vascularized free flaps using the standard end-to-end microvascular technique and the other 15 flaps were nonvascularized free grafts. All but two (technical failure) of the vascularized flaps showed complete survival, whereas all nonvascularized flaps completely necrosed 2 weeks after transfer. It was concluded that the rat saphenous flap has several advantages such as a long and consistent vascular pedicle, ease of harvest, and an all-or-none survival pattern. Furthermore, as a unique feature of this flap, histological analysis revealed that the rat saphenous flap is composed of the skin and underlying fascia without panniculus carnosus. We therefore suggest that the rat saphenous flap is the first true fasciocutaneous free flap model in the rat. In this paper, in addition to illustrating the anatomy of the saphenous vessels and describing a new fasciocutaneous free flap model based on these vessels, we have documented some anatomical details of the rat leg that have never been described in the literature related to the rat anatomy.

  1. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap.

    Science.gov (United States)

    Healy, Claragh; Allen, Robert J

    2014-02-01

    It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed between August 1992 and August 2012. Indication for surgery; mastectomy pattern in primary reconstruction; flap type, whether unilateral or bilateral; recipient vessels; and adjunctive procedures were recorded. The DIEP was the most commonly performed flap (66%), followed by the superior gluteal artery perforator flap (12%), superficial inferior epigastric artery perforator flap (9%), inferior gluteal artery perforator flap (6%), profunda artery perforator flap (3%), and transverse upper gracilis flap (3%). Primary reconstruction accounted for 1,430 flaps (50%), secondary 992 (35%), and tertiary 425 (15%). As simultaneous bilateral reconstructions, 59% flaps were performed. With each flap, there typically ensues a period of enthusiasm which translated into surge in flap numbers. However, each flap has its own nuances and characteristics that influence patient and physician choice. Of note, each newly introduced flap, either buttock or thigh, results in a sharp decline in its predecessor. In this practice, the DIEP flap has remained the first choice in autologous breast reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Buried free flaps in head and neck reconstruction: higher risk of free flap failure?

    Science.gov (United States)

    Reiter, M; Harréus, U; Kisser, U; Betz, C S; Baumeister, Ph

    2017-01-01

    Thrombosis of the pedicle is central to free flap failure, and early revision of a compromised flap is the key to successfully salvage a flap. Therefore, the majority of free flaps in reconstructive head and neck surgery are used with the ability to visually examine the flap. Sometimes, due to intra-operative circumstances, it is necessary to use a flap that cannot be monitored externally. These flaps are called buried flaps and have the reputation of being put at risk. The current literature provides only limited data to support or disprove this position. A single institution retrospective review of patient charts between 2007 and 2015 was performed. Flap monitoring was carried out with hand-held Doppler of the pedicle hourly for the first 72 h in all cases. Additional duplex ultrasound was performed in the majority of buried flaps. A total of 437 flaps were included into the study. 37 flaps (7.8 %) were identified to fulfill the criteria of a buried free flap. In total, four patients had complications, three of which required operative reexploration. All interventions were successful, resulting in no flap loss in our series. An accurate operation technique combined with meticulous monitoring protocols supported by duplex ultrasound can result in satisfactory outcome of buried flaps. No enhanced risk of flap loss of buried flaps was found in our cohort.

  3. Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap.

    Science.gov (United States)

    Han, Fengshan; Wang, Guangnan; Li, Gaoshan; Ping, Juan; Mao, Zhi

    2015-01-01

    Our aim was to summarize the treatment of degloving injury involving multiple fingers using combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap. Each degloved finger was debrided under microscopic guidance and embedded in the superficial layer of the abdominal fascia. The abdominal skin was sutured to the skin on the back and side of the hand to promote circumferential healing. After removal, the only remaining injured region was on the flexor surface, and this was repaired by multiple dorsal toe flaps, toe-web flaps, and dorsalis pedis flaps to provide blood vessels and sensory nerves. All fingers had proper flap thickness 3-6 months after surgery, and required only lateral Z-plasty modification with web deepening and widening to narrow the fingers and extend their relative length. We completed flap-graft and finger narrowing for 25 fingers in eight patients. Abdominal skin flaps and dorsal toe flaps were grafted, and resulted in both firmness and softness, providing finger flexibility. The dorsal toe flap provided good blood circulation and sensory nerves, and was used to cover the finger-flexor surface to regain sensation and stability when holding objects. During the 1-8 years of follow-up, sensation on the finger-flexor side recovered to the S3-4 level, and patient satisfaction based on the Michigan Hand Outcomes Questionnaire was 4-5. Flap ulcers or bone/tendon necrosis were not observed. Treatment of degloving injury involving multiple fingers with combined abdominal superficial fascial flap, dorsalis pedis flap, dorsal toe flap, and toe-web flap was effective and reliable.

  4. 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.

  5. Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.

    Science.gov (United States)

    Wong, Chin-Ho; Teoh, Lam-Chuan; Lee, Jonathan Y-L; Yam, Andrew K-T; Khoo, David B-A; Yong, Fok-Chuan

    2008-03-01

    The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap. Four patients with large finger wounds were reconstructed with free digital artery flap. Our indications for digital artery free flap were concomitant injuries to adjacent fingers that precluded their use as donor sites. The arterial supply of the flap was from the digital artery and the venous drainage was from the dominant dorsal vein of the finger. The flap was harvested from the ulnar side of the finger. The digital nerve was left in situ to minimize donor morbidity. The donor site was covered with a full-thickness skin graft and secured with bolster dressings. Early intensive mobilization was implemented for all patients. All flaps survived. No venous congestion was noted and primary healing was achieved in all flaps. In addition to providing well-vascularized tissue for coverage of vital structures, the digital artery was also used as a flow-through flap for finger revascularization in one patient. Donor-site morbidity was minimal, with all fingers retaining protective pulp sensation and the distal and proximal interphalangeal joints retaining full ranges of motion. In conclusion, the free digital artery flap is a versatile flap that is ideal for coverage of large-sized finger defects in situations where local flaps are unavailable. Donor-site morbidity can be minimized by preservation of the digital nerve, firmly securing the skin graft with bolster dressings, and early mobilization of the donor finger.

  6. Combined posterior flap and anterior suspended flap dacryocystorhinostomy: A modification of external dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    Amarendra Deka

    2010-01-01

    Conclusion : We believe that combined posterior flap and anterior suspended flap DCR technique is simple to perform and has the advantage of both double flap DCR and anterior suspension of anterior flaps. The results of the study showed the efficacy of this simple modification.

  7. Effects of vitamin E supplementation on loin (Longissimus dorsi quality in Brahman x Thai native cattle

    Directory of Open Access Journals (Sweden)

    Tangkawattana, P.

    2005-11-01

    Full Text Available This experiment was conducted to study effects of vitamin E supplementation on physical, chemical and eating quality of longissimus dorsi muscle of Brahman x Thai native cattle. Four groups of three Brahman x Thai native steers, weighing 150-160 kg, were fed with concentrate supplemented with vitamin E at 0, 100, 200, 400 ppm before and after grazing in the pasture. The experiment lasted 120 days. At the end of the feeding trial all cattle were slaughtered and longissimus dorsi muscles were collected to determine various meat quality aspects. The results showed that the lowest shear force value of meat in the 400-ppm group indicated a more tender in comparison to the others. All supplementation levels had no effect on pH of the meat. Water holding capacity of the meat (after chilled for 24 hours from the 100-ppm group, was significantly different (P0.05 either triobarbituric acid (TBA value or eating quality (tenderness, juiciness, flavor and overall acceptability.

  8. Comparison of outcomes of pressure sore reconstructions among perforator flaps, perforator-based rotation fasciocutaneous flaps, and musculocutaneous flaps.

    Science.gov (United States)

    Kuo, Pao-Jen; Chew, Khong-Yik; Kuo, Yur-Ren; Lin, Pao-Yuan

    2014-10-01

    Pressure sore reconstruction remains a significant challenge for plastic surgeons due to its high postoperative complication and recurrence rates. Free-style perforator flap, fasciocutaeous flap, and musculocutaneous flap are the most common options in pressure sore reconstructions. Our study compared the postoperative complications among these three flaps at Kaohsiung Chang Gung Memorial Hospital. From 2003 to 2012, 99 patients (54 men and 45 women) with grade III or IV pressure sores received regional flap reconstruction, consisting of three cohorts: group A, 35 free-style perforator-based flaps; group B, 37 gluteal rotation fasciocutaneous flaps; and group C, 27 musculocutaneous or muscle combined with fasciocutaneous flap. Wound complications such as wound infection, dehiscence, seroma formation of the donor site, partial or complete flap loss, and recurrence were reviewed. The mean follow-up period for group A was 24.2 months, 20.8 months in group B, and 19.0 months for group C. The overall complication rate was 22.9%, 32.4%, and 22.2% in groups A, B, and C, respectively. The flap necrosis rate was 11.4%, 13.5%, and 0% in groups A, B, and C, respectively. There was no statistical significance regarding complication rate and flap necrosis rate among different groups. In our study, the differences of complication rates and flap necrosis rate between these groups were not statistically significant. Further investigations should be conducted. © 2014 Wiley Periodicals, Inc.

  9. Traumatic Forefoot Reconstructions With Free Perforator Flaps.

    Science.gov (United States)

    Zhu, Yue-Liang; He, Xiao-Qing; Wang, Yi; Lv, Qian; Fan, Xin-Yv; Xu, Yong-Qing

    2015-01-01

    The forefoot is critical to normal walking; thus, any reconstruction of forefoot defects, including the soft tissues, must be carefully done. The free perforator flap, with its physiologic circulation, lower donor site morbidity, and minimal thickness is the most popular technique in plastic and microsurgery, and is theoretically the most suitable for such forefoot reconstruction. However, these flaps are generally recognized as more difficult and time-consuming to create than other flaps. In 41 patients with traumatic forefoot defects, we reconstructed the forefoot integument using 5 types of free perforator flaps. The overall functional and cosmetic outcomes were excellent. Three flaps required repeat exploration; one survived. The most common complications were insufficient perfusion and the need for second debulking. The key to our success was thoroughly debriding devitalized bone and soft tissue before attaching the flap. Forefoot reconstruction with a free perforator flap provides better function, better cosmesis, better weightbearing, and better gait than the other flaps we have used.

  10. [Development and current status of perforator flaps].

    Science.gov (United States)

    Xu, Dachuan; Zhang, Shimin; Tang, Maolin; Ouyang, Jun

    2011-09-01

    To provide a comprehensive review for development and existing problems of the perforator flaps. The related home and abroad literature concerning perforator flaps was extensively reviewed. The perforator flaps are defined as the axial flaps nourished solely by small cutaneous perforating vessels (perforating arteries and veins), which are exclusively composed of skin and subcutaneous fat. The perforator flaps have the advantages as follows: less injury at donor site, less damage to the contour of the donor site, good reconstruction and appearance of the recipient site flexible design, and short time of postoperative recovery, which have been widely used in reconstructive surgery. The perforator flaps are the new development of the microsurgery, which usher an era of small axial flaps; However, the controversies of the definition, vascular classification, the nomenclature, and the clinical application of the perforator flaps still exist, which are therefore the hot spot for future study.

  11. Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap

    OpenAIRE

    Kim, Ji-Wan; Hwang, Jong-Hyun; Ahn, Kang-Min

    2016-01-01

    Background Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better recons...

  12. Elastofibroma dorsi

    Directory of Open Access Journals (Sweden)

    Juan Pablo Ghisi

    2016-11-01

    Full Text Available Paciente de sexo femenino de 68 años que se palpa una tumoración subescapular derecha asociado a dolor regional y resalto de la escápula durante los movimientos.  Se presentan imagenes para su discusion

  13. The Variability of Growth Hormone Gene Associated with Ultrasound Imaging of Longissimus dorsi Muscle and Perirenal Fat in Rabbits

    Directory of Open Access Journals (Sweden)

    T. I. Amalianingsih

    2014-04-01

    Full Text Available Identification of genes in rabbits correlated to economic traits were intended to improve and develop their genetic quality. The objective of this research was to analyze the variability of growth hormone gene (GH in three rabbit breeds, i.e. Rex, Satin, and Reza (Rex and Satin crosses then was associated with ultrasound imaging of Longissimus dorsi muscle and perirenal fat thickness. Identification of the variability of growth hormone gene was analyzed using PCR RFLP technique from blood samples of 33 mature male rabbits in Indonesian Research Institute for Animal Production (IRIAP. Thickness of Longissimus dorsi muscle and perirenal fat were imaged and measured by using ultrasound unit at 2nd to 3rd lumbar vertebrae in the left body side. PCR product of GH gene fragment (231 base pair /bp was digested with restriction enzyme Bsh1236I. PCR-RFLP patterns were allele T resulted in an undigested fragment of 231 bp; allele C resulted in fragment of 169 bp and 62 bp. The result showed that Bsh1236I GH gene had three genotypes, i.e. CC, TT, and CT. There were signifficant association of Longissimus dorsi muscle thickness between rabbit breed (P<0.05. There was no significant association between GH Bsh1236I gene polymorphism and imaging ultrasound of Longissimus dorsi muscle and perirenal fat thickness. The association of characteristic genotype of GH|Bsh1236I gene with measurement phenotype was not significant, however it had potency as marker assisted selection (MAS.

  14. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2012-09-01

    Full Text Available BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap (n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

  15. [Functional hemitongue reconstruction with free forearm flap].

    Science.gov (United States)

    Liao, Gui-Qing; Su, Yu-Xiong; Liu, Hai-Chao; Li, Jin; Fahmha, Numan; Ou, De-Ming; Wang, Qin

    2008-07-01

    To investigate the clinical application of free forearm flap in the functional hemitongue reconstruction. From July 2002 to November 2006, 40 patients with tongue cancer underwent hemiglossectomy and primary hemitongue reconstruction with free forearm flaps. In some cases, the lateral antebrachial cutaneous nerves of the flaps were anastomosed with the lingual nerve to restore the flap sensation. All patients recovered uneventfully after surgery with no morbidity in the donor site. All free flaps survived. The average follow-up period was 2 years and 6 months. The aesthetic and functional results were both satisfactory. The swallowing and speech function were almost normal. The flap sensation was partially restored. Good functional hemitongue reconstruction can be achieved with free forearm flaps.

  16. Histochemical and ultrastructural study of an elastofibroma dorsi coexisting with a high grade spindle cell sarcoma

    Directory of Open Access Journals (Sweden)

    M Alberghini

    2009-06-01

    Full Text Available Elastofibroma dorsi is a pseudotumoral fibroproliferative lesion characterized by polymorphic fiber-like deposits of elastinophilic material. Several theories have been reported explaining the pathogenesis of elastofibroma. Recent cytogenetic studies have demonstrated chromosomal instability in elastofibromas, not normally observed in non-neoplastic tissues. These chromosomal defects are commonly observed in aggressive fibromatosis too. Such clinical observations suggest a multistage pathogenetic mechanism for the onset of elastofibroma. This study, using histochemical, immunohistochemical staining techniques, and ultrastructural examination, describes the detection of an otherwise typical elastofibroma contextual to a high grade sarcoma. Hence, the coexistence of elastofibroma and high-grade sarcoma may suggest a causal link between the two pathological entities. The results obtained suggest that the coexistence of the two pathological entities is conceivably coincidental.

  17. Comparative proteomic analysis of longissimus dorsi muscle in immuno- and surgically castrated male pigs.

    Science.gov (United States)

    Shi, Xuebin; Li, Chunbao; Cao, Miaodan; Xu, Xinglian; Zhou, Guanghong; Xiong, Youling L

    2016-05-15

    We compared proteomic profiles of male pig muscles after active immunization against gonadotropin releasing hormone (GnRH) and surgical castration. Longissimus dorsi samples were collected from immunocastration (IC) and surgical castration (SC) groups (n=15 each). Muscle proteins were extracted and then identified by data-independent label-free nano LC-MS/MS. A total of 610 proteins were identified, 50 of which were differentially expressed (P<0.05) between immuno- and surgical castration. Twenty-two of 50 differentially expressed proteins were higher in abundance for IC group and 27 proteins with abundance change folds greater than 1.5 differed with castration methods. Proteins involved in cytoskeleton and immunity were abundant in IC group. Several heat shock proteins (HSPs) and laminins were abundant in SC group.

  18. 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.

  19. THE IMPACT OF CONJUGATED LINOLEIC ACID ADDITION ON PH VALUE OF LONGISSIMUS DORSI MUSCLE

    Directory of Open Access Journals (Sweden)

    Przemysław WASILEWSKI

    2009-08-01

    Full Text Available The subject of research was 60 crossbred gilts, divided into 6 groups, fed the fodder with addition of conjugated linoleic acid (CLA or sunflower oil (SFO in amount: 0.5; 1.0; and 2.0 %, respectively. Animals were slaughtered with the body weight ca. 95 kg. The aim of research was to determine pH value of loin meat tissue (Longissimus dorsi of right half-carcass in 45 minutes, 2, 3, 4, 5, 6 hours and 24 hours after slaughter. Results were statistically elaborated using one-way variance analysis. Longissimus dorsi muscle pH values measured 45 minutes after slaughter in case of all groups of pigs were in range from 6.34 up to 6.47, what shows good meat quality. The lowest pH1 (measured 45 minutes after slaughter had meat of fatteners where addition of 2 % sunflower oil was given into fodder and the highest value of this trait was in group of individuals where also was given sunflower oil in 1 % amount. Statistical significant differences in pH value measured in different time after slaughter i.e. after 45 minutes, 2, 3, 4, 6 and 24 hours between tested groups of pigs were not stated. The exception is the result of pH measurement 5 hours after slaughter. Statistical significant differences were between group of pigs getting 0.5 % addition of conjugated linoleic acid characterized by the highest pH value of meat and group of animals fed the fodder with 1 % addition of conjugated linoleic acid (P≤0.01. On the basis of the results obtained in presented paper may be stated that feeding pigs with addition of conjugated linoleic acid in amounts 0.5; 1.0 and 2.0 % did not impact negatively on meat quality defined by pH value.

  20. 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

  1. Sternocleidomastoid Muscle Flap after Parotidectomy.

    Science.gov (United States)

    Nofal, Ahmad Abdel-Fattah; Mohamed, Morsi

    2015-10-01

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

  2. Sternocleidomastoid Muscle Flap after Parotidectomy

    Directory of Open Access Journals (Sweden)

    Nofal, Ahmad Abdel-Fattah

    2015-04-01

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

  3. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S;

    2015-01-01

    not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...

  4. Maxillofacial osseous reconstruction using the angular branch of the thoracodorsal vessels.

    LENUS (Irish Health Repository)

    Dolderer, Jürgen H

    2010-09-01

    Mandibular and maxillary resections can produce complex three-dimensional defects requiring skeletal, soft tissue, and epithelial reconstruction. The subscapular vascular axis offers a source of skin, bone, and muscle on a single pedicle for microvascular flap transfer. We reviewed four cases where the subscapular vascular pedicle was used as a source of tissue for complex facial reconstructions in maxillofacial defects. Reconstruction of these complex defects was performed with a latissimus dorsi muscle or myocutaneous flap in combination with the lateral border of the scapula, harvested on the angular branch of the thoracodorsal vessels. There were three cases of maxillectomy and one case of partial mandibulectomy for malignant tumors. In each case, the angular branch of the thoracodorsal artery supplied 6 to 8 cm of the lateral border of the scapula and a latissimus dorsi myocutaneous flap was used for soft tissue reconstruction. Follow-up ranged from 9 months to 3 years and in all cases there was successful bony union. Shoulder movement was normal. This series encourages the further use of subscapular axis flaps as flexible sources of combined myocutaneous and osseous flaps on a single vascular pedicle in cases of complex maxillofacial reconstruction.

  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. 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.

  7. Transfer of free myocutaneous flap in treatment of refractory post-traumatic osteomyelitis of the lower leg and foot%游离肌皮瓣移植治疗难治性小腿和足部创伤后骨髓炎

    Institute of Scientific and Technical Information of China (English)

    韩久卉; 张英泽; 田德虎; 韩金豹; 郭尔斐; 查君璞

    2010-01-01

    ). According to the Ciemy-Mader classification, there were 3 cases for ⅢA, 2 for ⅢBL, 4 for ⅥA and 2 for ⅥBL. After radical debridement, free myocutaneous flaps were immediately performed. Nine latissimus dorsi and 2 rectus abdominis myocutaneous flaps were used.External fixation was applied in 6 patients with skeletal instability due to tibial defects. Results An average follow-up was 3.5 years. Two cases suffered partial necrosis and were managed successfully with split-thickness skin grafts later. In 4 patients of presenting segmental bone defect, autogenous bone grafting was applied in one patient and achieved consolidation after 5 months; bone transplantation in 2 patients and achieved consolidation after 8 and 10 months; and vascularized fibula graft in one patient in whom the gap of the tibia was about 10 cm and achieved consolidation after 4 months. The other 7 patients of this group achieved bone consolidation without bone graft. Conclusion The cornerstone of the treatment of chronic osteomyelitis was to be the radical debridement of all involved necrotic and infected soft tissue and bone.The free myocutaneous flaps transfer which has the advantage of obliteration of dead space and stable coverage of the defect was a safe and viable treatment option in chronic osteomyelitis of the lower leg and foot.

  8. Muscular Pedicled Lateral Chest Composite Flap—A New Nonmicrosurgical Option for Forearm Salvage

    Directory of Open Access Journals (Sweden)

    Ichiro Shiokawa, MD

    2014-12-01

    Full Text Available Summary: Posttraumatic upper or lower limb salvage is still challenging. Under difficult situations in which only one vessel supplies the hand or foot, free microvascular reconstruction might damage not only the transferred tissue but also the terminal hand or foot. Two cases of incomplete amputation of the unilateral forearm with large radius bone and soft tissue loss were reconstructed using a newly-refined pedicled osteomyocutaneous flap including vascularized rib, lateral part of the latissimus dorsi muscle, and skin as a lateral chest flap. After insetting of the flap, the transferred limb is fixed with a soft bandage, and the flap is divided no less than 4 weeks after the first operation. The flap completely survived, and bone union between the rib and radius was observed. Although our treatment needed a two-stage procedure, safe and secure reconstruction with an appropriate amount of tissue for salvage was accomplished.

  9. The evolving breast reconstruction

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur

    2014-01-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally...... not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized...... for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods....

  10. Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom

    Science.gov (United States)

    Bottle, Alex; Mayer, Erik; Patten, Darren K.; Rao, Christopher; Aylin, Paul; Hadjiminas, Dimitri J.; Athanasiou, Thanos; Darzi, Ara; Gui, Gerald

    2015-01-01

    Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions. Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis. Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013. Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline. PMID:26495220

  11. Histological Profile of the Longissimus Dorsi Muscle in Polish Large White and Polish Landrace Pigs and its Effect on Loin Parameters and Intramuscular Fat Content

    National Research Council Canada - National Science Library

    Anna Bereta; Mirosław Tyra; Katarzyna Ropka-Molik; Dorota Wojtysiak; Marian Różycki; Robert Eckert

    2014-01-01

    The objective of this study was to analyse differences in individual fibre types in the histological profile of the longissimus dorsi muscle and their effect on pork carcass lean content and level of intramuscular fat (IMF...

  12. 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.

  13. The place of nasolabial flap in orofacial reconstruction: A review

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-12-01

    Conclusion: Nasolabial flap is an old flap for reconstructive purposes. Over time different modifications have been introduced to expand its usage. Clear definition of the terms used with this flap is given.

  14. Freestyle Local Perforator Flaps for Facial Reconstruction

    Directory of Open Access Journals (Sweden)

    Jun Yong Lee

    2015-01-01

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

  15. Dermatosurgery Rounds - The Island SKIN Infraorbital Flap

    Directory of Open Access Journals (Sweden)

    Georgi Tchernev

    2017-07-01

    Full Text Available The main objective in dermatologic surgery is complete excision of the tumour while achieving the best possible functional and cosmetic outcome. Also we must take into account age, sex, and tumour size and site. We should also consider the patient's expectations, the preservation of the different cosmetic units, and the final cosmetic outcome. Various reconstructive methods ranging from secondary healing to free flap applications are usedfor the reconstruction of perinasal or facial defects caused by trauma or tumour surgery. Herein, we describe the nasal infraorbital island skin flap for the reconstruction in a patient with basal cell carcinoma. No complications were observed in operation field. The infraorbital island skin flap which we describe for the perinasal area reconstruction is a safe, easily performed and versatile flap. The multidimensional use of this flap together with a relatively easy reconstruction plan and surgical procedure would be effective in flap choice.

  16. Freestyle Local Perforator Flaps for Facial Reconstruction.

    Science.gov (United States)

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

    2015-01-01

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

  17. Free flaps for pressure sore coverage.

    Science.gov (United States)

    Lemaire, Vincent; Boulanger, Kevin; Heymans, Oliver

    2008-06-01

    Management of pressure sores still represents a major challenge in plastic surgery practice due to recurrence. The surgeon may have to face multiple or recurrent pressure ulcerations without any local flap left. In this very limited indication, free flap surgery appears to be a useful adjunct in the surgical treatment. We reviewed our charts looking for patients operated for a pressure sore of the sacral, ischial, or trochanteric region. We found 88 consecutive patients representing 108 different pressure sores and 141 flap procedures. Among these patients, 6 presented large sores that could not be covered with a pedicled flap and benefited from free flap surgery (4.2% of all procedures). Stable coverage was achieved in 80% of these patients after a mean follow-up of 32 months. Comparison between pedicled and free flaps groups showed a trend in the latest concerning the presence of diabetes, incontinence, paraplegia, and male sex.

  18. Head and neck reconstruction with pedicled flaps in the free flap era

    NARCIS (Netherlands)

    Mahieu, R.; Colletti, G.; Bonomo, P.; Parrinello, G.; Iavarone, A.; Dolivet, G.; Livi, L.; Deganello, A.

    2016-01-01

    Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results.

  19. Resternal closure versus pectoral muscle flap following omental flap in treatment of deep sternal wound infection

    Directory of Open Access Journals (Sweden)

    Fouad Rassekh

    2016-05-01

    Conclusion: Omental flap is safe, easy and effective technique in management of mediastinitis with DSWI following open heart surgery in CABG patients either this procedure was followed by reclosure of the sternum or bilateral pectoral flap. However, reclosure of the sternum is more physiological and less invasive than doing bilateral pectoral flap leaving the sternum unclosed.

  20. Pectoralis major flap for head and neck reconstruction in era of free flaps.

    Science.gov (United States)

    Kekatpure, V D; Trivedi, N P; Manjula, B V; Mathan Mohan, A; Shetkar, G; Kuriakose, M A

    2012-04-01

    The aim of this study was to evaluate factors affecting the selection of pectoralis major flap in the era of free tissue reconstruction for post ablative head and neck defects and flap associated complications. The records of patients who underwent various reconstructive procedures between July 2009 and December 2010 were retrospectively analysed. 147 reconstructive procedures including 79 free flaps and 58 pectoralis major flaps were performed. Pectoralis major flap was selected for reconstruction in 21 patients (36%) due to resource constrains, in 12 (20%) patients for associated medical comorbidities, in 11 (19%) undergoing extended/salvage neck dissections, and in 5 patients with vessel depleted neck and free flap failure salvage surgery. None of the flaps was lost, 41% of patients had flap related complications. Most complications were self-limiting and were managed conservatively. Data from this study suggest that pectoralis major flap is a reliable option for head and neck reconstruction and has a major role even in this era of free flaps. The selection of pectoralis major flap over free flap was influenced by patient factors in most cases. Resource constraints remain a major deciding factor in a developing country setting.

  1. Posterior interosseous free flap: various types.

    Science.gov (United States)

    Park, J J; Kim, J S; Chung, J I

    1997-10-01

    The posterior interosseous artery is located in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi muscles. The posterior interosseous artery is anatomically united through two main anastomoses: one proximal (at the level of the distal border of the supinator muscle) and one distal (at the most distal part of the interosseous space). In the distal part, the posterior interosseous artery joins the anterior interosseous artery to form the distal anastomosis between them. The posterior interosseous flap can be widely used as a reverse flow island flap because it is perfused by anastomoses between the anterior and the posterior interosseous arteries at the level of the wrist. The flap is not reliable whenever there is injury to the distal forearm or the wrist. To circumvent this limitation and to increase the versatility of this flap, we have refined its use as a direct flow free flap. The three types of free flaps used were (1) fasciocutaneous, (2) fasciocutaneous-fascia, and (3) fascia only. Described are 23 posterior interosseous free flaps: 13 fasciocutaneous flaps, 6 fasciocutaneous-fascial flaps, and 4 fascial flaps. There were 13 sensory flaps using the posterior antebrachial cutaneous nerve. The length and external diameter of the pedicle were measured in 35 cases. The length of the pedicle was on average 3.5 cm (range, 3.0 to 4.0 cm) and the external diameter of the artery averaged 2.2 mm (range, 2.0 to 2.5 mm). The hand was the recipient in 21 patients, and the foot in 2. All 23 flaps covered the defect successfully.

  2. Free flap pulse oximetry utilizing reflectance photoplethysmography

    OpenAIRE

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

    2013-01-01

    The successful salvage of a free flap is dependent on the continuous monitoring of perfusion. To date there is no widely accepted and readily available post-operative monitoring technique to reliably assess the viability of free flaps by continuously monitoring free flap blood oxygen saturation. In an attempt to overcome the limitations of the current techniques a reflectance photoplethysmographic (PPG) processing system has been developed with the capability of real-time estimation of arteri...

  3. Four Flaps Technique for Neoumbilicoplasty

    Directory of Open Access Journals (Sweden)

    Young Taek Lee

    2015-05-01

    Full Text Available The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding.

  4. Dynamic stall in flapping flight

    Science.gov (United States)

    Hubel, Tatjana; Tropea, Cameron

    2007-11-01

    We report on experiments concerning unsteady effects in flapping flight, conducted in the low-speed wind tunnel of the TU Darmstadt using a mechanical flapping-wing model. Particle Image Velocimetry (PIV) was used for qualitative and quantitative analysis parallel and perpendicular to the flow field. A sensitivity analysis of the main flight parameters has been performed, with specific attention to the flight envelope of 26,500 dynamic stall effect could be verified by the direct force measurement as well as the flow visualization. The observation of the leading-edge vortex for typical bird flight reduced frequencies shows that this flow cannot be approximated as being quasi- steady. This in effect proves that adaptive wings are necessary to fully control these unsteady flow features, such as dynamic stall.

  5. Flapping Wing Flight Dynamic Modeling

    Science.gov (United States)

    2011-08-22

    von Karman, T. and Burgers, J. M., Gerneral Aerodynamic Theory - Perfect Fluids , Vol. II, Julius Springer , Berlin, 1935. [24] Pesavento, U. and Wang...L., Methods of Analytical Dynamics , McGraw-Hill Book Company, New York, 1970. [34] Deng, X., Schenato, L., Wu, W. C., and Sastry, S. S., Flapping...Micro air vehicle- motivated computational biomechanics in bio ights: aerodynamics, ight dynamics and maneuvering stability, Acta Mechanica

  6. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    Science.gov (United States)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  7. Microgravity-Induced Transcriptome Adaptation in Mouse Paraspinal longissimus dorsi Muscle Highlights Insulin Resistance-Linked Genes

    Directory of Open Access Journals (Sweden)

    Guido Gambara

    2017-05-01

    Full Text Available Microgravity as well as chronic muscle disuse are two causes of low back pain originated at least in part from paraspinal muscle deconditioning. At present no study investigated the complexity of the molecular changes in human or mouse paraspinal muscles exposed to microgravity. The aim of this study was to evaluate longissimus dorsi adaptation to microgravity at both morphological and global gene expression level. C57BL/N6 male mice were flown aboard the BION-M1 biosatellite for 30 days (BF or housed in a replicate flight habitat on ground (BG. Myofiber cross sectional area and myosin heavy chain subtype patterns were respectively not or slightly altered in longissimus dorsi of BF mice. Global gene expression analysis identified 89 transcripts differentially regulated in longissimus dorsi of BF vs. BG mice. Microgravity-induced gene expression changes of lipocalin 2 (Lcn2, sestrin 1(Sesn1, phosphatidylinositol 3-kinase, regulatory subunit polypeptide 1 (p85 alpha (Pik3r1, v-maf musculoaponeurotic fibrosarcoma oncogene family protein B (Mafb, protein kinase C delta (Prkcd, Muscle Atrophy F-box (MAFbx/Atrogin-1/Fbxo32, and Muscle RING Finger 1 (MuRF-1 were further validated by real time qPCR analysis. In conclusion, our study highlighted the regulation of transcripts mainly linked to insulin sensitivity and metabolism in longissimus dorsi following 30 days of microgravity exposure. The apparent absence of robust signs of back muscle atrophy in space-flown mice, despite the overexpression of Atrogin-1 and MuRF-1, opens new questions on the possible role of microgravity-sensitive genes in the regulation of peripheral insulin resistance following unloading and its consequences on paraspinal skeletal muscle physiology.

  8. Optimal propulsive flapping in Stokes flows

    CERN Document Server

    Was, Loic

    2014-01-01

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

  9. Extended locoregional use of intercostal artery perforator propeller flaps.

    Science.gov (United States)

    Baghaki, Semih; Diyarbakirlioglu, Murat; Sahin, Ugur; Kucuksucu, Muge Anil; Turna, Akif; Baca, Bilgi; Aydın, Yağmur

    2017-05-01

    Besides conventional flaps, intercostal artery perforator flaps have been reported to cover trunk defects. In this report the use of anterior intercostal artery perforator (AICAP) flap, lateral intercostal artery perforator (LICAP) flap and dorsal intercostal artery perforator (DICAP) flap for thoracic, abdominal, cervical, lumbar and sacral defects with larger dimensions and extended indications beyond the reported literature were reevaluated. Thirty-nine patients underwent surgery between August 2012 and August 2014. The age of the patients ranged between 16 and 79 with a mean of 49 years. The distribution of defects were as follows; 12 thoracic, 8 parascapular, 3 cervical, 8 abdominal, 4 sacral and 4 lumbar. AICAP, LICAP and DICAP flaps were used for reconstruction. Fifty-two ICAP flaps were performed on 39 patients. Flap dimensions ranged between 6 × 9 cm and 14 × 35 cm. Twenty-six patients had single flap coverage and 13 patients had double flap coverage. Forty-six flaps have been transferred as propeller flaps and 6 flaps have been transferred as perforator plus flap. Forty flaps (75%) went through transient venous congestion. In one DICAP flap, 30% of flap was lost. No infection, hematoma or seroma were observed in any patient. Follow-up period ranged between 3 and 32 months with a mean of 9 months. The ICAP flaps provide reliable and versatile options in reconstructive surgery and can be used for challenging defects in trunk. © 2016 Wiley Periodicals, Inc.

  10. Expression of ADAMTS4 and ADAMTS5 in longissimus dorsi muscle related to meat tenderness in Nanyang cattle.

    Science.gov (United States)

    Zhang, X H; Qi, Y X; Gao, X; Li, J Y; Xu, S Z

    2013-10-18

    The ADAMTS4 and ADAMTS5 are secreted proteases, which can cleave aggrecan, brevican and versican to regulate rebuilding of the extracellular matrix. We analyzed the ADAMTS4 and ADAMTS5 gene expression patterns in longissimus dorsi muscle at intervals from 135 days fetal age to 30 months old by qRT-PCR in Nanyang cattle. Expression of ADAMTS4 was significantly higher in 135 and 185-day-old fetuses than at other stages, while expression of ADAMTS5 decreased during development. The promoter regions of ADAMTS4 and ADAMTS5 were cloned and the transcription factor binding sites were analyzed with bioinformatic methods. Twelve and six potential transcription factor binding sites were found in the promoter regions of ADAMTS4 and ADAMTS5 genes, respectively. Three transcription factors (MZF1, C/EBPb, and NF-kap) were selected to analyze the expression pattern during the development of the longissimus dorsi muscle. MZF1 was significantly co-expressed with ADAMTS4, while C/EBPb expression was significantly negatively associated with that of ADAMTS4. We concluded that the expression of ADAMTS4 is positively regulated by MZF1 and negatively regulated by C/EBPb. We examined the relationships of ADAMTS4 and ADAMTS5 expression with tenderness of longissimus dorsi muscle; ADAMTS4 was significantly and negatively correlated with meat tenderness. We conclude that ADAMTS4 participates in the regulation of muscle development in cattle.

  11. CT scanning carcases has no detrimental effect on the colour stability of M. longissimus dorsi from beef and sheep.

    Science.gov (United States)

    Jose, C G; Pethick, D W; Jacob, R H; Gardner, G E

    2009-01-01

    This study investigated the effect of computerised tomography imaging (CT scan), for carcase composition determination, on the oxy/metmyoglobin ratio, hue and L(∗), a(∗) and b(∗) scores of M. longissimus dorsi from both beef and lamb. Beef and lamb M. longissimus dorsi were divided into four proportions and randomly allocated to one of the following treatments; CT 30 day aged; CT fresh; control 30 day aged; control fresh. Colour measurements were made over a 96h retail display period. CT scan had little effect on the colour of both lamb and beef across all colour parameters. There was a small negative affect observed in CT aged samples (PCT. Aged M. longissimus dorsi clearly had a worse colour stability than the fresh packaged samples, while beef was a lot more colour stable than lamb. It appears that CT scan for the purpose of body composition determination will not have any commercially relevant impact on colour stability of both beef and lamb.

  12. Meridian-like character of re- flex electromyogram activity in longissimus dorsi muscles

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    We studied the temporal and spacial character of theelectromyogram (EMG) evoked by acupuncture in lon-gissimus dorsi (LD) muscles of rat, and evaluated the effect of needling direction or local blockade on EMG propagation. When certain sites on LD muscle were acupunctured, asyn-chronous EMG could be activated not only at the acupunc-tured point, but also within the muscle region supplied by the adjacent 2-3 vertebral segments. The EMG evoked by stimulation on the borderline of aponeurosis and muscle venter was larger in amplitude than those on the other sites in the same vertebral segment. When the distance from the recorded site to stimulated site increased, the EMG ampli-tude decreased, and its latency prolonged. Acupuncture in an oblique direction toward rostral or caudal side of the muscle enhanced the EMG amplitude in the same direction. EMG activity was weakened and its propagation was blocked by local injection of procaine. These results indicated that the character of EMG propagation evoked by acupuncture was related to the mechanism of needle-feeling propagation along the meridian.

  13. Transcriptome profiling of Musculus longissimus dorsi in two cattle breeds with different intramuscular fat deposition

    Directory of Open Access Journals (Sweden)

    Elke Albrecht

    2016-03-01

    Full Text Available Intramuscular fat (IMF deposition is a physiological process in cattle and is highly variable among breeds suggesting a large influence of genetic factors besides environmental factors. In order to elucidate molecular pathways underlying the genetic variation in this trait we compared transcriptomes of Musculus longissimus dorsi (MLD in steers of Japanese Black and Holstein Friesian cattle breeds fed a high energy diet typically applied in Japan to achieve maximum IMF content. We identified a total of 569 differentially expressed genes (DEGs with the majority (433 up-regulated in Japanese Black cattle. This breed is characterized by an extreme capacity for IMF deposition. Subsequent Ingenuity Pathway Analysis (IPA revealed a gene network linking parameters of cell morphology and maintenance with lipid metabolism. The data from this study were deposited in NCBI's Gene Expression Omnibus and are accessible through GEO Series accession number GSE75348. We provide here a dataset which is of potential value to dissect molecular pathways influencing differences in fat deposition under high-energy nutrition.

  14. Quality characteristics of the Musculus longissimus dorsi from Pecora dell’Amiata reared in Tuscany

    Directory of Open Access Journals (Sweden)

    Roberto Tocci

    2017-07-01

    The trial was performed with ewes and lambs deriving from the local breed Pecora dell’Amiata. In this work, the Musculus longissimus dorsi (M. longissimus thoracis + lomborum physical-chemical and nutritional characteristics of 23 ewes and 20 lambs were compared. The ewes of the trial were over 7 years old while the lambs were on average 80 days old. Ewe meat has shown lower drip loss (4.14 vs 2.71% and lightness (L* 38.6 vs 45.3 values, and higher PH (6.15±0.07, shear force (8.4 vs 2.31 kg, fat content (5.9 vs 2.0%. The lamb meat lipids had higher polyunsaturated fatty acid content (PUFA: 14.58 vs 9.25% and higher PUFA/Saturated Fatty Acids (SFA ratio (0.31 vs 0.20. The PCA analysis identified two distinct groups regarding ewe and lamb meat respectively for the fatty acids composition and the health indices. Ewe meat showed dietetic and nutritional characteristics similar to that of lamb meat. These characteristics may allow in the future, to the ewe meat valorisation, now not appreciated by Tuscan and Italian market.

  15. Primary reconstruction of skin avulsion injury on both feet%双足皮肤脱套伤的一期修复

    Institute of Scientific and Technical Information of China (English)

    刘勇; 张成进; 付兴茂; 王剑利; 张雪涛; 王蕾; 隋志强

    2014-01-01

    目的 探讨利用双侧股前外侧皮瓣联合胸脐皮瓣或背阔肌肌皮瓣一期修复双足皮肤脱套伤的临床效果.方法 2005年6月至2011年8月共利用双侧股前外侧皮瓣联合胸脐皮瓣或背阔肌肌皮瓣一期修复双足皮肤脱套伤4例.其中切取带股前外侧皮神经的股前外侧皮瓣修复足底,胸脐皮瓣或背阔肌肌皮瓣修复足背.结果 4例双足脱套伤均一期修复,皮瓣存活,术后功能外形良好,随访6个月至2年,足底感觉恢复良好,两点辨距觉为14~18 mm,行走正常.结论 利用双侧股前外侧皮瓣联合胸脐皮瓣或背阔肌肌皮瓣一期修复双足皮肤脱套伤,是一种较好的修复方法.%Objective To investigate the therapeutic effect of primary reconstruction of skin avulsion injury with bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.Methods From June 2005 to Aug.2011,4 cases with skin avulsion injury on both feet were treated.The bilateral anterolateral thigh flaps,including with anterolateral thigh cutaneous nerves,were transferred to cover the feet plantar.The thorax umbilicus flap or latissimus dorsi flap were used to cover the feet dorsum.Results All the skin avulsion injury were reconstructed primarily.All the flaps survived completely with good cosmetic and functional results.The patients were followed up for 6 months to 2 years with good sensory recovery(two point discrimination:14-18 mm).Conclusion The skin avulsion injury on both feet can be primarily reconstructed by bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

  16. Reconstruction of Complex Facial Defects Using Cervical Expanded Flap Prefabricated by Temporoparietal Fascia Flap.

    Science.gov (United States)

    Zhang, Ling; Yang, Qinghua; Jiang, Haiyue; Liu, Ge; Huang, Wanlu; Dong, Weiwei

    2015-09-01

    Reconstruction of complex facial defects using cervical expanded flap prefabricated by temporoparietal fascia flap. Complex facial defects are required to restore not only function but also aesthetic appearance, so it is vital challenge for plastic surgeons. Skin grafts and traditional flap transfer cannot meet the reconstructive requirements of color and texture with recipient. The purpose of this sturdy is to create an expanded prefabricated temporoparietal fascia flap to repair complex facial defects. Two patients suffered severe burns on the face underwent complex facial resurfacing with prefabricated cervical flap. The vasculature of prefabricated flap, including the superficial temporal vessel and surrounding fascia, was used as the vascular carrier. The temporoparietal fascia flap was sutured underneath the cervical subcutaneous tissue, and expansion was begun in postoperative 1 week. After 4 to 6 months of expansion, the expander was removed, facial scars were excised, and cervical prefabricated flap was elevated and transferred to repair the complex facial defects. Two complex facial defects were repaired successfully by prefabricated temporoparietal fascia flap, and prefabricated flaps survived completely. On account of donor site's skin was thinner and expanded too fast, 1 expanded skin flap was rupture during expansion, but necrosis was not occurred after the 2nd operation. Venous congestion was observed in 1 patient, but after dressing, flap necrosis was not happened. Donor site was closed primarily. Postoperative follow-up 6 months, the color, texture of prefabricated flap was well-matched with facial skin. This method of expanded prefabricated flap may provide a reliable solution to the complex facial resurfacing.

  17. Analysis of biplane flapping flight with tail

    NARCIS (Netherlands)

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

    2012-01-01

    Numerical simulations have been performed to examine the interference effects between an upstream flapping biplane airfoil arrangement and a downstream stationary tail at a Reynolds number of 1000, which is around the regime of small flapping micro aerial vehicles. The objective is to investigate th

  18. 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.

  19. Energy management - The delayed flap approach

    Science.gov (United States)

    Bull, J. S.

    1976-01-01

    Flight test evaluation of a Delayed Flap approach procedure intended to provide reductions in noise and fuel consumption is underway using the NASA CV-990 test aircraft. Approach is initiated at a high airspeed (240 kt) and in a drag configuration that allows for low thrust. The aircraft is flown along the conventional ILS glide slope. A Fast/Slow message display signals the pilot when to extend approach flaps, landing gear, and land flaps. Implementation of the procedure in commercial service may require the addition of a DME navigation aid co-located with the ILS glide slope transmitter. The Delayed Flap approach saves 250 lb of fuel over the Reduced Flap approach, with a 95 EPNdB noise contour only 43% as large.

  20. 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...

  1. Energy management - The delayed flap approach

    Science.gov (United States)

    Bull, J. S.

    1976-01-01

    Flight test evaluation of a Delayed Flap approach procedure intended to provide reductions in noise and fuel consumption is underway using the NASA CV-990 test aircraft. Approach is initiated at a high airspeed (240 kt) and in a drag configuration that allows for low thrust. The aircraft is flown along the conventional ILS glide slope. A Fast/Slow message display signals the pilot when to extend approach flaps, landing gear, and land flaps. Implementation of the procedure in commercial service may require the addition of a DME navigation aid co-located with the ILS glide slope transmitter. The Delayed Flap approach saves 250 lb of fuel over the Reduced Flap approach, with a 95 EPNdB noise contour only 43% as large.

  2. White light spectroscopy for free flap monitoring.

    Science.gov (United States)

    Fox, Paige M; Zeidler, Kamakshi; Carey, Joseph; Lee, Gordon K

    2013-03-01

    White light spectroscopy non-invasively measures hemoglobin saturation at the capillary level rendering an end-organ measurement of perfusion. We hypothesized this technology could be used after microvascular surgery to allow for early detection of ischemia and thrombosis. The Spectros T-Stat monitoring device, which utilizes white light spectroscopy, was compared with traditional flap monitoring techniques including pencil Doppler and clinical exam. Data were prospectively collected and analyzed. Results from 31 flaps revealed a normal capillary hemoglobin saturation of 40-75% with increase in saturation during the early postoperative period. One flap required return to the operating room 12 hours after microvascular anastomosis. The T-stat system recorded an acute decrease in saturation from ~50% to less than 30% 50 min prior to identification by clinical exam. Prompt treatment resulted in flap salvage. The Spectros T-Stat monitor may be a useful adjunct for free flap monitoring providing continuous, accurate perfusion assessment postoperatively.

  3. DIEP flap sentinel skin paddle positioning algorithm.

    Science.gov (United States)

    Laporta, Rosaria; Longo, Benedetto; Sorotos, Michail; Pagnoni, Marco; Santanelli Di Pompeo, Fabio

    2015-02-01

    Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward. Skin paddle (SP) position was preoperatively drawn following mastectomy type incisions; in skin-sparing mastectomies types I-III a small SP (sSP) replaces nipple-areola complex; in skin-sparing mastectomy type IV, SSP is positioned between wise-pattern branches while in type V between medial/lateral branches. In case of nipple-sparing mastectomy SSP is positioned at inframammary fold or in lateral/medial branches of omega/inverted omega incision if used. Three hundred forty-seven DIEP flap breast reconstructions were reviewed and stratified according to SP type into group A including 216 flaps with large SP and group B including 131 flaps with SSP and sSP. Sixteen flaps (4.6%) were taken back for pedicle compromise, 13 of which were salvaged (81.25%), 11 among 13 from group A and 2 among 3 from group B. There was no statistical difference between the groups concerning microvascular complication rate (P = 0.108), and time until take-back (P = 0.521) and flap salvage rate (P = 0.473) resulted independent of SP type. Our results suggest that early detection of perfusion impairment and successful flaps salvage could be achieved using SSP for buried DIEP flap monitoring, without adjunctive expensive monitoring tests.

  4. 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...... of frequencies. Drag reductions up to a factor 3 are measured. Many results presented are obtained through flow visualisations. A great effort is made to produce visualisations of primarily high scientific quality, but often also with a certain aesthetic appeal....

  5. Use of rotation scalp flaps for treatment of occipital baldness.

    Science.gov (United States)

    Juri, J; Juri, C; Arufe, H N

    1978-01-01

    We have used 25 rotation scalp flaps to treat occipital baldness associated with fronto-parietal baldness (the third flap), and 35 such flaps for the correction of isolated occipital baldness. We have not had any flap necrosis, and our patients have been well satisfied with the results of this surgery.

  6. An Algorithmic Approach to Total Breast Reconstruction with Free Tissue Transfer

    Directory of Open Access Journals (Sweden)

    Seong Cheol Yu

    2013-05-01

    Full Text Available As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. Each flap comes with its own advantages and disadvantages related to tissue properties and donor-site morbidity. Currently, the problem is how to determine the most appropriate flap for a particular patient among those potential candidates. Based on a thorough review of the literature and accumulated experiences in the author’s institution, this article provides a logical approach to autologous breast reconstruction. The algorithms presented here can be helpful to customize breast reconstruction to individual patient needs.

  7. 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.

  8. Comparison the physicochemical quality indicators of Musculus Longissimus Dorsi from Mangalitsa Breed and their crossbreeds

    Directory of Open Access Journals (Sweden)

    Ondrej Debreceni

    2016-12-01

    Full Text Available In recent years, there has been a current trend in the market of pork to create products based on traditional, regional specialities, where is used technology such as drying, smoking and fermentation of products. These products require a specific quality of meat from pure-bred indigenous breeds or their crossbreeds with emphasis on dry matter content, intramuscular fat content in meat and fatty acid composition with higher share of unsaturated fatty acids and essential fatty acids. Due to this fact, indigenous breed such as the Mangalitsa has received attention from the aspect of high meat quality and meat products compared to pig meat breeds. The aim of study was to compare the meat quality of Musculus longissimus dorsi from Mangalitsa breed, the crossbreeds Mangalitsa x Duroc and the pig meat breed Slovak Large White. The experimental material comprised of 28 pcs of pigs, which were reared in the same intensive conditions and they were fed ad libitum by complete feed mixtures for fatteners. The fattening period lasted from 30 kg to 100 kg of body weight. In the presented study was found that the crossbreeds Mangalitsa x Duroc had lighter colour of meat and the Mangalitsa had darker colour than Slovak Large White (P < 0.01. From the point of texture of meat, it was found stiffer meat from Slovak Large White and more tender meat from crossbreeds Mangalitsa x Duroc compared to meat of Mangalitsa (P < 0.01. The crossbreeds Mangalitsa x Duroc had the highest intramuscular fat content and cholesterol content in meat (P < 0.01. The intramuscular fat content and cholesterol content was the lowest in Slovak Large White (P < 0.01. The results indicate that utilization of Mangalitsa breed for crossing with pig meat breeds can improve quality meat traits in their crossbreeds, which are requiring for production of special meat products.

  9. Microbiological shelf life of fresh, chilled reindeer meat (M. longissimus dorsi

    Directory of Open Access Journals (Sweden)

    Eva Wiklund

    2011-04-01

    Full Text Available In this pilot study loin muscles (M. longissimus dorsi from six reindeer calves (aged 4 months were used to determine shelf life of fresh, chilled reindeer meat stored at +4 °C, measured as microbiological quality (aerobic microorganisms and Escherichia coli. The loins were collected at boning 3 days post slaughter and divided in five pieces that were randomly assigned to five different storage times; sampling directly after packaging and after chilled storage for 2, 3, 4 and 5 weeks at +4 °C. Samples were vacuum packaged and transported chilled to Hjortens Laboratory in Östersund, Sweden (accredited by SWEDAC according to SS-EN ISO/IEC 17025:2005 for food analysis where the storage, microbiological sampling and analysis took place according to the protocols of Nordic Committee on Food Analysis (NMKL. The total amount of aerobic microorganisms at the first sampling directly after packaging (three days post slaughter was 3.4 ± 0.3 log10 CFU/g. After two and three weeks of vacuum packaged chilled storage at +4°C the microbiological quality of the samples was on the border-line to poor (6.8 ± 0.3 log10 CFU/g. At four and five weeks of chilled storage the levels of aerobic microorganisms were significantly highest (P≤0.05 and the limit for acceptable quality of 7 log10 CFU/g aerobic bacteria had been passed (7.3 ± 0.3 log10 CFU/g and 7.8 ± 0.3 log10 CFU/g, respectively. Very few of the reindeer meat samples were contaminated with Escherichia coli bacteria. The results from the present pilot study suggest that storage time for vacuum packaged fresh, chilled reindeer meat should not exceed 3 weeks at a temperature of +4 °C.

  10. 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.

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

    Science.gov (United States)

    Fujioka, Masaki; Hayashida, Kenji; Senju, Chikako

    2014-01-01

    Skin defects of the heel have frequently been reconstructed using the medial plantar flap; however, forefoot coverage has remained a challenge, because the alternatives for flap coverage have been very limited. We describe a case of malignant melanoma on the lateral forefoot that was radically removed and reconstructed successfully with a distally based medial plantar flap, together with a free anterolateral thigh flap. The advantages of this flap include that it does not reduce the vascular supply to the foot owing to reconstruction of the medial plantar vascular systems, reduces the risk of flap congestion, minimizes donor site morbidity, and enables the transport of structurally similar tissues to the plantar forefoot. We believe this technique is a reasonable reconstructive option for large lateral plantar forefoot defects.

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

    Science.gov (United States)

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

    2015-09-01

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

  13. Monitoring of free TRAM flaps with microdialysis.

    Science.gov (United States)

    Udesen, A; Løntoft, E; Kristensen, S R

    2000-02-01

    The aim of this investigation was to follow the metabolism of free TRAM flaps using microdialysis. Microdialysis is a new sampling technique that provide opportunities to follow the biochemistry in specific organs or tissues. A double-lumen microdialysis catheter or probe, with a dialysis membrane at the end, is introduced into the specific tissue. Perfusion fluid is slowly pumped through the catheter and equilibrates across the membrane with surrounding extracellular concentrations of low molecular weight substances. The dialysate is collected in microvials and analyzed by an instrument using very small volumes. Glucose, glycerol, and lactate concentrations were measured in the flaps and compared with those in a reference catheter that was placed subcutaneously in the femur. The investigation continued 72 hr postoperatively. The study group consisted of 14 women who underwent reconstruction with a free TRAM flap, and one woman with a double TRAM flap. During flap ischemia, the concentration of glucose was reduced, while the lactate and glycerol levels increased. The differences between the flaps and controls were statistically highly significant. After reperfusion of the flaps, the concentrations of glucose, lactate, and glycerol approached normal. One flap failed because of an arterial anastomosis thrombosis. This was clearly demonstrated by the samples from the microdialysis: the concentration of glucose fell to an unmeasurable level; the concentration of lactate increased for a period before it stopped due to lack of glucose; and the concentration of glycerol increased to a very high level, probably because ischemia caused damage to the cell membranes of which glycerol is an important part. The authors concluded that microdialysis can detect ischemia in free flaps at an early stage, making early surgical intervention possible.

  14. Proteomic Assessment of the Relevant Factors Affecting Pork Meat Quality Associated with Longissimus dorsi Muscles in Duroc Pigs

    Science.gov (United States)

    Cho, Jin Hyoung; Lee, Ra Ham; Jeon, Young-Joo; Park, Seon-Min; Shin, Jae-Cheon; Kim, Seok-Ho; Jeong, Jin Young; Kang, Hyun-sung; Choi, Nag-Jin; Seo, Kang Seok; Cho, Young Sik; Kim, MinSeok S.; Ko, Sungho; Seo, Jae-Min; Lee, Seung-Youp; Shim, Jung-Hyun; Chae, Jung-Il

    2016-01-01

    Meat quality is a complex trait influenced by many factors, including genetics, nutrition, feeding environment, animal handling, and their interactions. To elucidate relevant factors affecting pork quality associated with oxidative stress and muscle development, we analyzed protein expression in high quality longissimus dorsi muscles (HQLD) and low quality longissimus dorsi muscles (LQLD) from Duroc pigs by liquid chromatographytandem mass spectrometry (LC-MS/MS)–based proteomic analysis. Between HQLD (n = 20) and LQLD (n = 20) Duroc pigs, 24 differentially expressed proteins were identified by LC-MS/MS. A total of 10 and 14 proteins were highly expressed in HQLD and LQLD, respectively. The 24 proteins have putative functions in the following seven categories: catalytic activity (31%), ATPase activity (19%), oxidoreductase activity (13%), cytoskeletal protein binding (13%), actin binding (12%), calcium ion binding (6%), and structural constituent of muscle (6%). Silver-stained image analysis revealed significant differential expression of lactate dehydrogenase A (LDHA) between HQLD and LQLD Duroc pigs. LDHA was subjected to in vitro study of myogenesis under oxidative stress conditions and LDH activity assay to verification its role in oxidative stress. No significant difference of mRNA expression level of LDHA was found between normal and oxidative stress condition. However, LDH activity was significantly higher under oxidative stress condition than at normal condition using in vitro model of myogenesis. The highly expressed LDHA was positively correlated with LQLD. Moreover, LDHA activity increased by oxidative stress was reduced by antioxidant resveratrol. This paper emphasizes the importance of differential expression patterns of proteins and their interaction for the development of meat quality traits. Our proteome data provides valuable information on important factors which might aid in the regulation of muscle development and the improvement of meat

  15. ELECTRIC CONDUCTIVITY OF LONGISSIMUS DORSI MUSCLE OF PIGS FED THE FODDER WITH ADDITION OF CONJUGATED LINOLEIC ACID

    Directory of Open Access Journals (Sweden)

    Przemysław WASILEWSKI

    2009-06-01

    Full Text Available The aim of research was to investigate the impact of feeding pigs the fodder with addition of different level of conjugated linoleic acid on results of electric conductivity of Longissimus dorsi muscle. Electric conductivity (LF, Ger. Leitfähigkeitmessung is the method of meat quality estimation. This technique uses high relationships between electric conductivity and the other parameters of meat quality. In breeding and production of pigs the aim is to obtain fatteners of low fat and high meat content simultaneously keeping good meat tissue quality. One of the ways of their quality improvement is using fodder supplements as i.e. conjugated linoleic acid (CLA. Results of many research proved that conjugated linoleic acid impacts also in a favourable way on humans health because reduces cholesterol level, prevents from heart attacks and some cancers, stimulates immune system and has antiinfl ammatory properties. Statistical analysis covered the results of 60 crossbred gilts, divided into 6 groups, fed the fodder with addition of conjugated linoleic acid (CLA or sunfl ower oil (SFO in amounts: 0.5; 1.0; and 2.0 %, respectively. Fattening period of animals lasted for 8 weeks with ad-libitum feeding. In 1, 3, 6 hour, 24 hours, 3 and 7 days after slaughter electric conductivity of muscle tissue was measured – muscle Longissimus dorsi. Electric conductivity measured in different time after slaughter was not statistically diversed between tested groups of animals. The results concerned electric conductivity of muscle Longissimus dorsi of pigs fed the fodder with addition of conjugated linoleic acid should be stated as satisfactory and proved normal meat. Therefore, feeding pigs the fodder with CLA addition in amount of 0.5; 1.0 and 2.0 % did not impacts negatively on meat quality.

  16. Neglected Giant Scalp Basal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Anne Kristine Larsen, MD

    2014-03-01

    Full Text Available Summary: Rarely, basal cell carcinoma grows to a giant size, invading the underlying deep tissue and complicating the treatment and reconstruction modalities. A giant basal cell carcinoma on the scalp is in some cases treated with a combination of surgery and radiation therapy, resulting in local control, a satisfactory long-term cosmetic and functional result. We present a case with a neglected basal cell scalp carcinoma, treated with wide excision and postoperative radiotherapy, reconstructed with a free latissimus dorsi flap. The cosmetic result is acceptable and there is no sign of recurrence 1 year postoperatively.

  17. Rupture of an expander prosthesis mimics axillary cancer recurrence.

    LENUS (Irish Health Repository)

    Ismael, T

    2005-10-01

    Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.

  18. Neglected giant scalp Basal cell carcinoma

    DEFF Research Database (Denmark)

    Larsen, Anne Kristine; El-Charnoubi, Waseem-Asim Ghulam; Gehl, Julie;

    2014-01-01

    SUMMARY: Rarely, basal cell carcinoma grows to a giant size, invading the underlying deep tissue and complicating the treatment and reconstruction modalities. A giant basal cell carcinoma on the scalp is in some cases treated with a combination of surgery and radiation therapy, resulting in local...... control, a satisfactory long-term cosmetic and functional result. We present a case with a neglected basal cell scalp carcinoma, treated with wide excision and postoperative radiotherapy, reconstructed with a free latissimus dorsi flap. The cosmetic result is acceptable and there is no sign of recurrence...

  19. Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

    LENUS (Irish Health Repository)

    Thomason, Katherine

    2014-07-01

    Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

  20. The Clinical Application of Anterolateral Thigh Flap

    Directory of Open Access Journals (Sweden)

    Yao-Chou Lee

    2011-01-01

    Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe.

  1. New drag laws for flapping flight

    Science.gov (United States)

    Agre, Natalie; Zhang, Jun; Ristroph, Leif

    2014-11-01

    Classical aerodynamic theory predicts that a steadily-moving wing experiences fluid forces proportional to the square of its speed. For bird and insect flight, however, there is currently no model for how drag is affected by flapping motions of the wings. By considering simple wings driven to oscillate while progressing through the air, we discover that flapping significantly changes the magnitude of drag and fundamentally alters its scaling with speed. These measurements motivate a new aerodynamic force law that could help to understand the free-flight dynamics, control, and stability of insects and flapping-wing robots.

  2. Effect of ageing time in vacuum package on veal longissimus dorsi and biceps femoris physical and sensory traits

    Directory of Open Access Journals (Sweden)

    G. Baldi

    2015-09-01

    Full Text Available Study evaluated the effects of vacuum ageing (2, 4, 6, 8, 10, 12, 16 days on veal loin (longissimus dorsi; LD and silverside (biceps femoris; BF physical and sensory characteristics. Ageing did not affect cooking loss, increased LD pH and L*, a* and b* in both muscles. Shear force (SF decreased until day 6 in LD and day 10 in BF. Aroma, flavor and taste were not affected, while texturetraits were improved. SF was negative correlated with tenderness and juiciness and positive correlated with BF fibrousness and stringy sensation. Ageing improved texture properties withoutaltering other sensory traits.

  3. Variation of the Surface of the Longissimus Dorsi (LD Muscle and the Section of the Leg of Mutton at Young Sheep of Different Breed Structures

    Directory of Open Access Journals (Sweden)

    Elena Ilişiu

    2010-10-01

    Full Text Available The research was done on carcasses from the slaughter of young male sheep intensively fattened belonging to the local Tsigai race of mountain ecotype and its half-breeds with Suffolk and German blackface (GCCN. The purpose of the research was to determine Logissimus dorsi (LD and leg of moutton area, because these parts provide information on Ist meat quality. Research results have noted that lots of half-breeds achieved higher Longissimus dorsi (LD and leg of moutton area, compared with the pure breed batch. Compared with Tsigai breed, Longissimus dorsi (LD area deterrmined was higher with 10,75% to Suffolk x Tsigai half-breeds, and 0,07% respectively to German Blackface x Tsigai half-breeds. Leg of moutton area was higher with 17,27% to Suffolk x Tsigai halfbreeds, and 2,75% respectively to German Blackface x Tsigai half-breeds. Research carried out special information on Ist meat quality on carcass.

  4. Paramedian forehead flap combined with hinge flap for nasal tip reconstruction*

    Science.gov (United States)

    Cerci, Felipe Bochnia; Dellatorre, Gerson

    2016-01-01

    The paramedian forehead flap is a great option for restoration of complex nasal defects. For full-thickness defects, it may be used alone or in combination with other methods. We present a patient with a basal cell carcinoma on the distal nose treated by Mohs micrographic surgery, and a resulting full-thickness defect repaired with paramedian forehead flap combined with a hinge flap. For optimal results with the paramedian forehead flap, adequate surgical planning, patient orientation and meticulous surgical technique are imperative.

  5. 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...

  6. 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...

  7. Vascular anatomy of the anteromedial thigh flap

    Directory of Open Access Journals (Sweden)

    Jeremy Mingfa Sun

    2017-09-01

    Conclusion: The anatomy of the RFB, which is critical in the blood supply of the AMT flap, is constant and predictable. The location of the perforators is predictable, which aids preoperative planning.

  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. The flow around a flapping foil

    Science.gov (United States)

    Mandujano, Francisco; Malaga, Carlos

    2016-11-01

    The flow around a two-dimensional flapping foil immersed in a uniform stream is studied numerically using a Lattice-Boltzmann model, for Reynolds numbers between 100 and 250, and flapping Strouhal numbers between 0 . 01 and 0 . 6 . The computation of the hydrodynamic force on the foil is related to the wake structure. When the foil's is fixed in space, numerical results suggest a relation between drag coefficient behaviour and the flapping frequency which determines the transition from the von Kármán to the inverted von Kármán wake. When the foil is free of translational motion up-stream swimming at constant speed is observed at certain values of the flapping Strouhal. This work was partially supported by UNAM-DGAPA-PAPIIT Grant Number IN115316.

  10. Freestyle Local Perforator Flaps for Facial Reconstruction

    OpenAIRE

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

    2015-01-01

    For the successful reconstruction of facial defects, various perforator flaps have been used in single-stage surgery, where tissues are moved to adjacent defect sites. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. Of four complicated cases, three developed venous congestion, which resolved in the subacute postoperative period, and one patient with partial necrosi...

  11. [Experience in the treatment of severe pressure sore].

    Science.gov (United States)

    Xu, Xi-Sheng; ma, Zheng-Zheng; Zhou, Yong-Sheng; Ou, Cai-Sheng; Cheng, Yong; Chen, Kai; Li, Bo-Tong; Zhou, Hai-Yang; Hu, Yong-Cai

    2011-11-01

    To summarize the experience in the treatment of severe pressure sore. From Aug. 2007 to Jun. 2011, 21 cases of severe pressure sore with 43 III-IV degree lesions were treated with combination treatment, including vacuum sealing drainage technique, local fascia flaps, upper or lower gluteus maximus island myocutaneous flaps, lower gluteus maximus myocutaneous flap, neurocutaneous femoris posterior flaps, tensor fascia lata island myocutaneous flaps, free latissimus dorsi myocutaneous flaps, and skin graft, combined with stryker frame and nursing tracking guidance. 13 of 21 cases had multiple pressure sore. Among them, 5 III degree pressure sores were covered by skin grafting and 3 non-caudal III degree pressure sores (pressure sore. All the 43 wounds healed completely. 5 wounds in 3 cases had effusion under flap which healed after re-drainage. The wounds were not healed in 3 cases with flap transposition which were also healed after re-debridement. All the flaps survived completely. 16 cases were followed up for 2-26 months. Recurrence happened in 4 cases after discharge because of not following the required nursing care. Comprehensive application of vacuum sealing drainage technique, multiple myocutaneous flaps and skin grafting, combined with stryker frame and nursing tracking guidance after discharge can be used for the treatment of severe pressure sore with satisfactory results.

  12. Free flap reconstruction of giant defects after cranial-facial combined resection%颅颌面联合切除术后大型缺损的游离组织瓣修复

    Institute of Scientific and Technical Information of China (English)

    孙坚; 张志愿; 邱蔚六; 林国础; 唐友盛; 竺涵光

    2001-01-01

    Objective To investigate the clinical value of free flap in the reconstruction of giant tissue defects after cranial-facial combined resection. Methods Twenty-five patients who suffered from malignant tumors involving the base skull were reported. They were treated with different types of free flap reconstruction: pictorials major myocutaneous flap (PMMF) in 15 cases, PMMF combined with radial forearm flap in 5 cases, and dorsal latissimus myocutaneous flap in 5 cases (which 2 cases were given serratus anterior muscle). Results One patient died from acute cerebral edema and there was no any other severe complication. Of the 25 cases of free flap reconstruction, 23 free flap survived with one forearm flap's and one PMMF's necrosis. Conclusion Free flap reconstruction overcomes the disadvantages of the pedical tissue flap. Free flap is better in the rehabilitation of the contour and function than the island flap and decrease severe complication. We recommend free flap application in the reconstruction of cranial-facial tissue defects.%目的 探讨游离组织瓣修复颅颌面联合切除术后大型缺损的应用价值。方法 自1980年7月以来,对25例恶性肿瘤侵及颅底的患者,共32块组织瓣进行各类游离组织瓣修复术。其中胸大肌肌皮瓣15例,胸大肌皮瓣联合前臂桡侧皮瓣5例,背阔肌肌皮瓣5例(其中2例联合前锯肌)。结果 除1例死于急性脑水肿外,无其它严重并发症发生。本组技术开展早期组织瓣移植后血管危象出现率较高(3/7),其主要表现为静脉吻合口栓塞,而以后的出现率则明显降低(2/25)。25例游离组织瓣,除1例前臂皮瓣全部坏死及1例胸大肌皮瓣坏死外,其余全部成活。结论 游离组织瓣修复颅颌面联合切除术后大型缺损克服了早期带蒂组织皮瓣修复中长度及组织量不足,并减少了术后脑脊液漏等并发症,有利于患者术后外形及功能的恢复。

  13. Radial forearm free flap pharyngoesophageal reconstruction.

    Science.gov (United States)

    Azizzadeh, B; Yafai, S; Rawnsley, J D; Abemayor, E; Sercarz, J A; Calcaterra, T C; Berke, G S; Blackwell, K E

    2001-05-01

    This study evaluates the outcome of pharyngoesophageal reconstruction using radial forearm free flaps with regard to primary wound healing, speech, and swallowing in patients requiring laryngopharyngectomy. Retrospective review in the setting of a tertiary, referral, and academic center. Twenty patients underwent reconstruction of the pharyngoesophageal segment using fasciocutaneous radial forearm free flaps. All free flap transfers were successful. An oral diet was resumed in 85% of the patients after surgery. Postoperative pharyngocutaneous fistulas occurred in 4 patients (20%) with 3 resolving spontaneously. Distal strictures also occurred in 20% of the patients. Five patients who underwent tracheoesophageal puncture achieved useful speech. Advantages of radial forearm free flaps for microvascular pharyngoesophageal function include high flap reliability, limited donor site morbidity, larger vascular pedicle caliber, and the ability to achieve good quality tracheoesophageal speech. The swallowing outcome is similar to that achieved after jejunal flap pharyngoesophageal reconstruction. The main disadvantage of this technique relates to a moderately high incidence of pharyngocutaneous fistulas, which contributes to delayed oral intake in affected patients.

  14. Mastoid fascia kite flap for cryptotia correction.

    Science.gov (United States)

    Simon, François; Celerier, Charlotte; Garabedian, Erea-Noël; Denoyelle, Françoise

    2016-11-01

    Cryptotia is one of the most common malformations of the upper auricle with aesthetic and functional consequences, however there is no standard treatment. We present the surgical technique and results of a kite flap procedure which can be used in the different cryptotia subtypes. We reviewed all patients treated in our department from 2010 to 2015, using a mastoid fascia kite flap technique. The incision of this local flap follows the retro-auricular sulcus along the rim of the helix superiorly and drawing a skin paddle inferiorly. The mastoid fascia is exposed and a superiorly and posteriorly based flap is drawn and detached from the skull. Finally, the skin paddle is rotated and sutured between the superior helix and temporal skin creating the superior sulcus. The retro-auricular incision is closed directly inferiorly. Six patients (mean age 12) and seven ears were studied. One patient had bilateral cryptotia and only two had a normal contralateral ear. Mean follow-up was of 45 months. There was no skin necrosis, no complications reported and no revision surgery. We describe a reliable flap with a simple design and improved aesthetic result, as the thickness of the flap projects the helix well, the scar is entirely hidden in the retro-auricular sulcus and the direct suture induces a harmonious medialization of the inferior part of the ear and earlobe. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. 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....

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

    Directory of Open Access Journals (Sweden)

    Min Jae Lee

    2012-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Min Jae Lee

    2012-07-01

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

  18. 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.

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

    Directory of Open Access Journals (Sweden)

    Ichiro Hashimoto, MD

    2014-05-01

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

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

    NARCIS (Netherlands)

    Werker, Paul M N

    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

  1. 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

  2. Versatility of the Anterolateral Thigh Free Flap: The Four Seasons Flap

    Science.gov (United States)

    Di Candia, Michele; Lie, Kwok; Kumiponjera, Devor; Simcock, Jeremy; Cormack, George C.; Malata, Charles M.

    2012-01-01

    Presented at the following academic meetings: ○ 56th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) Fasano (Brindisi), Italy, September 26-29, 2007 ○ 42nd Meeting of the European Society for Surgical Research (ESSR), Warsaw, Poland, May 21-24, 2008 ○ Winter Meeting, British Association of Plastic, Reconstructive and Aesthetic Surgeons, (BAPRAS) London, December 1-3, 2009 Background: The anterolateral free flap has become increasingly popular at our institution year on year. We decided to review our experience with this flap and study the reasons for this trend. Methods: A retrospective review of all anterolateral thigh free flaps performed at Addenbrooke's University Hospital from the available charts was carried out. This chart review included patients' demographics, indications, flap size, recipient vessels used, ischemia time, flap, and donor site outcomes. All flap perforator vessels were located preoperatively using a handheld Doppler ultrasound probe. Results: From October 1999 to December 2008, 55 anterolateral thigh flaps were performed in 55 patients to reconstruct a variety of soft-tissue defects (upper and lower limbs, chest wall, skull base, head and neck). Flap size ranged 12 to 35 cm in length and 4 to 11 cm in width. During flap elevation, the main supply to the flap was found to be a direct septocutaneous perforator in 41% (n = 23) of the cases as opposed to a musculocutaneous perforator, which was found in 59% (n = 32). The mean ischemia time was 82 minutes (range, 62-103). The overall flap success rate was 100%. Two flaps were successfully salvaged after reexploration for venous congestion. The donor site morbidity was minimal. The mean follow-up time was 18 months (range, 2-48). Discussion and Conclusion: The anterolateral thigh free flap was found to be a very reliable flap (100% success) across a wide range of clinical indications. It facilitates microvascular anastomoses as evidenced by the short

  3. [Flap techniques in secondary alveoloplasty: a comparison between two types of flap].

    Science.gov (United States)

    Hugentobler, M; Dojcinovic, I; Richter, M

    2006-06-01

    The aim of this study was to compare two surgical soft tissue coverage techniques of secondary alveolar grafts in cleft lip and palate patients: the gingival mucoperiostal slidind flap and the mucosal rotation flap. Fifty-two secondary alveolar bone grafts were retrospectively included in the study. Four clinical parameters were evaluated: post-operative dehiscence, oro-nasal fistula relapse, canine eruption through the graft and postoperative secondary periodontal procedures. Gingival mucoperiostal flaps had less postoperative dehiscence, more fistula relapse and needed less secondary periodontal procedures. Based on this study and on literature data, gingival mucoperiostal flap provides better quality of soft tissue coverage. Flap design doesn't influence canine eruption. Bone graft complications are increased with poor oral hygiene, if canine eruption occurred before surgery and in older patients.

  4. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap.

    Science.gov (United States)

    Tarsitano, A; Vietti, M V; Cipriani, R; Marchetti, C

    2013-12-01

    The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy appeared to be fundamental to predict post-treatment functional outcomes. The data obtained in the present study indicate that swallowing capacity after hemiglossectomy is better when an anterolateral thigh flap is used. No significant differences were seen for speech intelligibility or quality of life between free radial forearm flap and anterolateral thigh flap.

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

    Science.gov (United States)

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

    2012-08-07

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

  6. Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction.

    Science.gov (United States)

    McCulley, Stephen J; Schaverien, Mark V; Tan, Veronique K M; Macmillan, R Douglas

    2015-05-01

    Partial breast reconstruction using pedicled perforator flaps from the thoracodorsal (TDAP) and lateral intercostal arteries (LICAP) is well described. The article introduces the lateral thoracic artery perforator (LTAP) flap as an additional valuable option from the lateral chest wall and reports clinical experience and outcomes. The anatomy of the LTAP flap is reviewed and the results of a consecutive series are reported. In a series of 75 consecutive cases of lateral chest wall perforator flaps used for reconstruction of partial breast defects, 12 (17%) were raised as pure LTAP flaps, and a further 19 (27%) as combined LTAP/LICAP flaps. The LTAP was therefore used in 44% of flaps overall. One LTAP flap (delayed case) had early venous compromise that settled spontaneously. The LTAP flap is a reliable option for partial breast reconstruction from the lateral chest wall, particularly in the immediate setting. It allows comparable flap size to be harvested compared to LICAP flaps. The LTAP flap can be raised on its own pedicle allowing greater mobilization or it can be incorporated into the more commonly used LICAP flap to augment perfusion. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Morbidity after flap reconstruction of hypopharyngeal defects.

    Science.gov (United States)

    Clark, Jonathan R; Gilbert, Ralph; Irish, Jonathan; Brown, Dale; Neligan, Peter; Gullane, Patrick J

    2006-02-01

    Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects. A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10-year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro-omental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy. The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P=.046) and flap-related morbidity (P=.037), hypocalcemia (Pspeech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition. The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were

  8. Effect of soy lecithin on total cholesterol content, fatty acid composition and carcass characteristics in the Longissimus dorsi of Hanwoo steers (Korean native cattle).

    Science.gov (United States)

    Li, Xiang Zi; Park, Byung Ki; Hong, Byuong Chon; Ahn, Jun Sang; Shin, Jong Suh

    2017-06-01

    This study aims to investigate the effect of soy lecithin on the total cholesterol content, the fatty acid composition and carcass characteristics in the Longissimus dorsi in Hanwoo steers. Hanwoo steers (24 head) were fed two diets: Control (CON) (concentrate + alcohol-fermented feed (AFF)) and soy lecithin treatment (CON + soy lecithin at 0.5% of the AFF). Soy lecithin treatment increased average daily gain, serum concentrations of triglyceride, total cholesterol and high-density lipoprotein-cholesterol in the blood. A lower cholesterol concentration was found in the Longissimus dorsi for the soy lecithin diet compared to the CON diet. With respect to the marbling score and quality grade of Longissimus dorsi, soy lecithin supplementation significantly increased the C20:5n3, C22:4 and polyunsaturated fatty acids contents compared to the CON diet. Soy lecithin supplementation would alter the total cholesterol content, polyunsaturated fatty acid profile and meat quality of Longissimus dorsi. © 2016 Japanese Society of Animal Science.

  9. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps.

    Science.gov (United States)

    Zhang, C; Sun, J; Zhu, H; Xu, L; Ji, T; He, Y; Yang, W; Hu, Y; Yang, X; Zhang, Z

    2015-06-01

    This study represents the surgical experience of 4481 microvascular free flap cases performed at the authors' institution in China, between 1979 and 2013. Four thousand four hundred and eighty-one patients underwent reconstruction with 4640 flaps: 56% radial forearm flaps, 8% iliac crest flaps, 13% fibula flaps, 10% anterolateral thigh flaps, and other flaps. In the overwhelming majority of cases, the flap transfer was required following tumour resection (97.5%). Three hundred and twenty minor complications (6.9%) occurred. One hundred and eighteen major complications (2.5%) were encountered: 114 cases of failure (2.4%) and four deaths. Among the 118 cases with major complications, 26 - 22.0% - had received radiotherapy; this proportion was higher than the 6.9% in the minor complications group and 8.1% in the non-intervention group. Venous thrombosis was the most common complication at the recipient site and was the main cause of flap failure. When a compromised flap is identified, surgical re-exploration should not be delayed. This study confirms that free flaps are reliable in achieving successful reconstruction in the head and neck region; however this technique requires extensive clinical experience. Owing to the large number of flap options, microsurgeons should always pay attention to the details of the different surgical defects and choose the most appropriate flap.

  10. Unilateral breast reconstruction after mastectomy - patient satisfaction, aesthetic outcome and quality of life

    DEFF Research Database (Denmark)

    Juhl, Alexander A.; Christensen, Søren; Zachariae, Robert;

    2017-01-01

    BACKGROUND: An increasing number of women undergo a breast reconstruction (BR) after treatment for breast cancer. The aim of the present study was to evaluate patient-reported esthetic satisfaction, quality of life (QoL), and the association between these, following different types of BR. MATERIALS......-reported esthetic satisfaction scale. Additionally, patients were asked if they experienced a change in QoL owing to the BR. Based on reconstructive method and timing, participants were divided into four groups, three delayed: an abdominal flap group, a latissimus dorsi flap group, an implant ± thoracodorsal flap...... AND METHODS: All women who underwent unilateral BR in Central Denmark Region between January 2005 and July 2011 were included. Participants were sent a questionnaire package, which included the Body Image Scale, The Beck Depression Inventory, the Impact of Event Scale, and a study-specific patient...

  11. 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.

  12. Anterior Palatal Island Advancement Flap for Bone Graft Coverage ...

    African Journals Online (AJOL)

    2015 Journal of Surgical Technique and Case Report | Published by Wolters Kluwer - Medknow. 42. Anterior Palatal Island ... prosthodontic treatments should have ideal characteristics, as .... are rotated palatal flap and palatal advanced flap.

  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. 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

  15. 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...

  16. Paramedian forehead flap thinning using a flexible razor blade.

    Science.gov (United States)

    Justiniano, Hilda; Edwards, Julia; Eisen, Daniel B

    2009-03-15

    Paramedian forehead flaps are sometimes required to resurface large or deep nasal defects. The flap often needs to be thinned to match the contour of the surrounding skin at the recipient site. We describe a technique to thin the distal potion of the paramedian forehead flap using a flexible razor blade, the Dermablade. Once familiar with it, this same technique may be applied to thin other interpolation flaps.

  17. The aerodynamic and structural study of flapping wing vehicles

    OpenAIRE

    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...

  18. "A Free thenar flap – A case report"

    OpenAIRE

    Chow Shew; Fung Boris KK; Garg Rajesh; Ip Wing

    2007-01-01

    Abstract We present a case report of a free thenar flap surgery done for a volar right hand middle finger, distal and middle phalanx degloving injury. A free thenar flap is a fasciocutaneous sensate flap supplied by a constant branch of the superficial radial artery and its variable nerve supply. It has a distinct advantage of low donor site morbidity, better cosmesis and texture of the flap. No immobilization is required postop. The donor site can be closed primiarily.

  19. 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.

  20. Comparative Study Between Two Flaps—Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries

    National Research Council Canada - National Science Library

    Ahmed, Mohd Viqar; Rastogi, Sanjay; Baad, Rajendra K; Gupta, Anurag K; Nishad, Sumita G; Bansal, Mansi; Kumar, Sanjeev; Oswal, Rakesh; Mahendra, P; Bhatnagar, Alok

    2013-01-01

    .... The large variety of flaps available for periapical surgeries reflects the number of variables to be considered before choosing an appropriate flap design. In this study; Ocshenbein-Leubke (OL) and trapezoidal (TZ...

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

    Science.gov (United States)

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

    1996-06-01

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

  2. [Reconstruction of the oral cavity: the free radial forearm flap versus the free jejunal flap].

    Science.gov (United States)

    Belli, E; Cicconetti, A; Matteini, C

    1995-05-01

    The concentration in a restricted area such as the oral cavity of the essential anatomic structures for mastication, deglutition, speech, salivary drainage and respiration makes it indispensable to ensure not only the structural reconstruction of the region but also, and above all, a functional reconstruction of the anatomic unit affected by resection. The use of revascularised flaps has extended both the quantity and quality of reconstructive methods available. In the context of the oral cavity the most widely used flaps are the radial forearm free flap and jejunum free flap. In this paper the authors report their personal experience in a group of 13 patients (6 radial forearm and 7 jejunum) undergoing oral cavity reconstruction using free flap. For each flap the authors describe the microsurgical procedure, the clinical characteristics of the post-operative period, the locoregional complications, the donor site and lastly the long-term clinical, anatomopathological and functional modifications 6-12 months after primary treatment. Moreover, they highlight the varying characteristics of the two flaps and make a critical assessment of the advantages and disadvantages of using one or other method. Lastly, in the light of their experience and a review of international literature, the authors underline the importance of making a careful choice and personalized reconstruction, and finally outline their own criteria of choice.

  3. 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.

  4. 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...

  5. Haemodynamics and viability of skin and muscle flaps

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, H.M.

    1985-01-01

    In reconstructive surgery, occasional free flap failures occur despite the clinical and technical advances in microsurgery of the past few years. To minimize these losses a better understanding of basic flap physiology must be achieved. The objectives of this work were the investigation of the haemodynamic characteristics of skin and muscle flaps in normal and compromised circumstances, the viability of skin and muscle flaps after pedicle ligation or ischaemia, and the possible interrelationship of haemodynamics and viability. A Wistar rat groin island skin flap model was used to assess flap survival following vascular compromise produced by vessel ligation. Survival was seen earliest following loss of the artery and was not dependent on circulation through the vascular pedicle after 5 days. A study using free groin flaps in rats gave similar results. Normal free groin flaps were then transferred to irradiated Fischer F344 rats. Delayed neovascularization was shown at a time corresponding to the onset of the late phase of the response to skin radiation. A canine inferior epigastric free skin flap model was established to determine the normal haemodynamic parameters during free flap transfer. A canine gracilis free muscle flap model was developed. Normal haemodynamic parameters are given. These parameters were examined after ischaemia. Survival of the muscle followed ischaemia of 4 hours or less. Flap survival is not dependent solely on arterial input or venous drainage. More complex phenomena such as the reactive hyperaemia following ischaemia are implicated in survival.

  6. 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.

  7. 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. PMID:25993077

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Chae Min Kim

    2014-07-01

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

  10. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective.

    Science.gov (United States)

    Ho, Adelyn L; Tyldesley, Scott; Macadam, Sheina A; Lennox, Peter A

    2012-03-01

    To describe the clinical outcomes of patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy and preoperative radiotherapy, followed by skin-sparing mastectomy (SSM) and immediate autologous breast reconstruction (IABR). A retrospective review of 30 LABC patients who underwent SSM and IABR between 1997 to 2007 was performed. Data were drawn from patient records and the University of British Columbia (UBC) Breast Reconstruction and British Columbia Cancer Agency databases. All 30 patients received neoadjuvant chemotherapy, preoperative radiotherapy, SSM, and IABR. Fifteen patients (50%) had stage IIIA disease, 13 (43%) stage IIIB, and 2 (6.7%) stage IIIC. Reconstruction types included the pedicled transverse rectus myocutaneous flap (n = 24), the latissimus dorsi flap (n = 5), and a combination of transverse rectus myocutaneous and latissimus dorsi flap (n = 1). The median follow-up was 3.51 years (range 1-9.4 years). Local complications included mastectomy flap necrosis (n = 3), partial flap necrosis (n = 1), fat necrosis (n = 1), seroma (n = 3), infection (n = 2), and flap fibrosis (n = 1). The incidence of donor site complications was 20%. Overall 5-year actuarial locoregional relapse-free, distant relapse-free, and disease-specific survival rates were 80, 65, and 68%, respectively. Excellent or good physician-rated aesthetic results were achieved in 66% of patients. The UBC protocol avoids irradiation of the autologous breast reconstruction. Outcomes compare with findings from similar studies with respect to local recurrence, distant relapse, overall survival, and surgical complication rates. Neoadjuvant chemotherapy and preoperative radiotherapy in LABC patients desiring autologous breast reconstruction can be considered a safe option.

  11. Distinctive genes determine different intramuscular fat and muscle fiber ratios of the longissimus dorsi muscles in Jinhua and landrace pigs.

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    Ting Wu

    Full Text Available Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF. Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1 are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90, we identified a novel gene porcine FLJ36031 (pFLJ, which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF.

  12. Distinctive genes determine different intramuscular fat and muscle fiber ratios of the longissimus dorsi muscles in Jinhua and landrace pigs.

    Science.gov (United States)

    Wu, Ting; Zhang, Zhenhai; Yuan, Zhangqin; Lo, Li Jan; Chen, Jun; Wang, Yizhen; Peng, Jinrong

    2013-01-01

    Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF). Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase) are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1) are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90), we identified a novel gene porcine FLJ36031 (pFLJ), which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF.

  13. Characterizing differential poststroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation.

    Science.gov (United States)

    Palmer, Jacqueline A; Zarzycki, Ryan; Morton, Susanne M; Kesar, Trisha M; Binder-Macleod, Stuart A

    2017-04-01

    Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery poststroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, poststroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, whereas conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to poststroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor poststroke walking recovery and in neurologically intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared with dorsiflexor muscles in individuals with poor poststroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles compared with the neurologically intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor vs. dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery.NEW & NOTEWORTHY The present study observed that lower-limb corticomotor asymmetry resulted from both reduced paretic and enhanced nonparetic limb corticomotor excitability compared with

  14. Chemical composition and tenderness of longissimus dorsi muscle from non- castrated Murrah buffaloes slaughtered at different weights

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    A. de Amorim Ramos

    2010-02-01

    Full Text Available Buffalo meat production has been arising interest breeder and emerges as alternative to consumer, more and more demanding of the quality products. Thus, this research was conducted to study the chemical composition and tenderness of Longissimus dorsi muscle from 10 non-castrated Murrah buffaloes slaughtered at different weights. The research was carried in feedlot of School of Veterinary Medicine and Animal Science of the Sao Paulo State University, Botucatu, São Paulo, Brazil. Animals were divided in two groups, received diet ad libitum and slaughtered when reached 450 and 500 kg of live weight. The experiment design was completely randomized, with five repetitions to each treatment. Meat sample from Longissimus dorsi muscle, taken between 12th and 13th ribs, were carried analysis of moisture, crude protein, fat, ash, Longissimus muscle area (LMA, fat thickness (FT, marbling, calorie and tenderness. It did not have significant difference between the groups. Average values at of 76.0; 20.7; 2.1 and 1.2 of moisture, crude protein, fat and ash respectively, were obtained. Calorie, tenderness, LMA, FT and marbling were obtained at average values of 132 kcal/100g; 3.94 kgf; 34.2 cm²; 5.9 mm and 2 points, respectively. Values obtained for tenderness are similar in the literature and has been proving that buffalo meat is tender (< 5kgf. Positive correlation was observed between the protein percentage and the shear force of the meat. The buffalo meat is excellent alternative source of red protein of high biological value to feeding of Brazilian consumers.

  15. Study on the Correlations between Mineral Contents in Musculus Longissimus Dorsi and Meat Quality for Five Breeds of Pigs

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    REN Guang-zhi

    2008-01-01

    Full Text Available The correlations between mineral contents in musculus longissimus dorsi and meat quality for five breeds of pigs were studied in this experiment. Two imported breeds (Duroc and Yorkshires and three local breeds (Huainan pig, Nanyang black pig, Queshan black pig from Henan province of China were chosen in this trial. Ten 90 kg finishing pigs were selected randomly to slaughter from each breed. Mineral contents of K, Na, Ca, Fe, Mn, Cu and Zn in musculus longissimus dorsi were detected by atomic absorption spectrophotometry and their correlations with meat quality were also analyzed. The results showed : (1 Mn and protein contents had no significant difference among all the breeds (p>0.05, (2 K content in Duroc was higher than that in the other four breeds significantly (p<0.01, (3 Mineral contents of Na, Ca, Mn, Fe, Cu and Zn in local breeds were higher than that in the imported breeds significantly (p<0.01, (4 Marble stripes and meat colour in local breeds were superior to the imported ones, (5 Intramuscular fat content of local breeds was higher than that of the imported ones (p<0.01, (6 There was a significant positive correlation between Zn and the other mineral contents in the muscle (p<0.01 or p<0.05, (7 Both Cu and Fe contents had a significant positive correlation with meat color (p<0.05, but negative correlation with drip loss (p<0.05, (8 There was a positive correlation between Zn and intramuscular fat content (p<0.01, but negative correlation between Zn and drip loss (p<0.01. In conclusion, Minerals in muscle had significant correlations with meat quality elements, but no significant correlations with meat protein and fat contents.

  16. The angel flap for nipple reconstruction.

    Science.gov (United States)

    Wong, Wendy W; Hiersche, Matthew A; Martin, Mark C

    2013-01-01

    Creation of an aesthetically pleasing nipple plays a significant role in breast reconstruction as a determining factor in patient satisfaction. The goals for nipple reconstruction include minimal donor site morbidity and appropriate, long-lasting projection. Currently, the most popular techniques used are associated with a significant loss of projection postoperatively. Accordingly, the authors introduce the angel flap, which is designed to achieve nipple projection with lasting results. The lateral edges of the flap and the area surrounding the top of the nipple are de-epithelialized and the flaps are wrapped to create a nipple mound composed primarily of dermis. Decreasing the amount of fat within core of the nipple and enhancing dermal content promotes long-lasting projection. Furthermore, the incision pattern fits within a desired areolar size, preventing unnecessary superfluous extension of the incisions. Thus, the technique described herein achieves the goals of nipple reconstruction, including adequate and long-lasting projection, without extension of the lateral limb scars.

  17. Double papilla flap technique for dual purpose

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    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.

  18. [Reconstruction of full-thickness nasal alar defect with combined nasolabial flap and free auricular composite flap].

    Science.gov (United States)

    Peng, Weihai; Rong, Li; Wang, Wangshu; Liu, Chao; Zhang, Duo

    2014-05-01

    To investigate the technique and its effect of combined nasolabial flap and free auricular composite flap for full-thickness nasal alar defect. From March 2010 to March 2013, 9 patients with full-thickness nasal alar defects were treated with combined nasolabial flaps and free auricular composite flaps. Composite auricular flap was used as inner lining and cartilage framework. The nasolabial flap at the same side was used as outer lining. All the patients were followed up for 6-18 months (average, 12 months). All the 9 composite auricular flaps survived completely. Epidermal necrosis happened at the distal end of 1 nasolabial flap. Alar rim was almost normal and symmetric nose was achieved in 6 cases. The arc and the thickness of the alar rim was not enough in 3 cases, resulting in asymmetric appearance. The survival area of auricular composite flap can be enlarged with nasolabial flap. The auricular helix edge can be reserved to reconstruct nasal alar rim with smooth and natural arc. Large full-thickness nasal alar defedts can be reconstructed with combined nasolabial flaps and free auricular composite flaps.

  19. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction

    NARCIS (Netherlands)

    Hekner, D.D.; Roeling, TAP; van Cann, EM

    2016-01-01

    The aim of this study was to investigate the vascular anatomy of the distal forearm in order to optimize the choice between the radial forearm free flap and the ulnar forearm free flap and to select the best site to harvest the flap. The radial and ulnar arteries of seven fresh cadavers were injecte

  20. The transversely split gracilis twin free flaps

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    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 .

  1. Pre-expanded Intercostal Perforator Super-Thin Skin Flap.

    Science.gov (United States)

    Liao, Yunjun; Luo, Yong; Lu, Feng; Hyakusoku, Hiko; Gao, Jianhua; Jiang, Ping

    2017-01-01

    This article introduces pre-expanded super-thin intercostal perforator flaps, particularly the flap that has a perforator from the first to second intercostal spaces. The key techniques, advantages and disadvantages, and complications and management of this flap are described. At present, the thinnest possible flap is achieved by thinning the pre-expanded flap that has a perforator from the first to second intercostal spaces. It is used to reconstruct large defects on the face and neck, thus restoring function and cosmetic appearance. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Fascia-only anterolateral thigh flap for extremity reconstruction.

    Science.gov (United States)

    Fox, Paige; Endress, Ryan; Sen, Subhro; Chang, James

    2014-05-01

    The ability to use the anterolateral thigh (ALT) flap as a vascularized fascial flap, without skin or muscle, was first documented by Koshima et al in 1989. The authors mention the possibility of using the fascia alone for dural reconstruction. Despite its description more than 20 years ago, little literature exists on the application of the ALT flap as a vascularized fascial flap. In our experience, the ALT flap can be used as a fascia-only flap for thin, pliable coverage in extremity reconstruction. After approval from the institutional review board, the medical records and photographs of patients who had undergone fascia-only ALT free flaps for extremity reconstruction were reviewed. Photographic images of patients were then matched to patients who had undergone either a muscle-only or a fasciocutaneous free flap reconstruction of an extremity. Photographs of the final reconstruction were then given to medical and nonmedical personnel for analysis, focusing on aesthetics including color and contour. Review of cases performed over a 2-year period demonstrated similar ease of harvest for fascia-only ALT flaps compared to standard fasciocutaneous ALT flaps. Fascia-only flaps were used for thin, pliable coverage in the upper and lower extremities. There was no need for secondary procedures for debulking or aesthetic flap revision. In contrast to muscle flaps, which require muscle atrophy over time to achieve their final appearance, there was a similar flap contour from approximately 1 month postoperatively throughout the duration of follow-up. When a large flap is required, the fascia-only ALT has the advantage of a single-line donor-site scar. Photograph comparison to muscle flaps with skin grafts and fasciocutaneous flaps demonstrated improved color, contour, and overall aesthetic appearance of the fascia-only ALT over muscle and fasciocutaneous flaps. The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over

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

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    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.

  4. CT诊断背部弹力纤维瘤%CT diagnosis of elastofibroma dorsi

    Institute of Scientific and Technical Information of China (English)

    丁长伟; 刘鹏; 张军; 王秋实; 潘诗农; 郭启勇

    2012-01-01

    To explore the CT findings of elastofibroma dorsi (EFD). Methods Twelve patients with EFD confirmed by pathology were collected retrospectively. All patients underwent plain chest CT, while 2 of them (4 lesions) underwent contrast enhanced CT before surgery. Clinical features and CT characteristics of EFD were analyzed. Results Twelve patients were all female. Clinical manifestation shown that lesions were on the right side in 9 patients, on the left in 1 patient, and bilateral lesions were detected in 2 patients. There was 1 sub-clinical lesion in each patient with single lesion at the contralateral side. All lesions located in the deep subscapular muscle in the back. Totally 24 lesions were found with CT. Masses were flat mound-like or semi-circular, mainly were muscular-like density, and fat densities were seen along the long axis of masses, presenting as spaced stripe in 16 lesions, while distributing as irregular islands in 8 lesions. The masses were irregular edged, with strip of skeletal-muscular density to transitional areas. Areas attached to ribs and serratus anterior muscle near shoulder were blurred, with disappeared fat gaps. Fat gaps in other positions were turbid (16 lesions) or clear (8 lesions). The lesion slightly enhanced in 1 case, did not enhance in other 3 cases. Conclusion EFD should be considered when unilateral or bilateral subscapular areas asymptomatic masses presenting as muscle-like density with striated fat spaced, not enhancing or mild patchy strengthening were detected on CT in middle-aged women. Bilateral CT examination is necessary for detecting sub-clinical stage lesions.%目的 探讨背部弹力纤维瘤(EFD)的CT表现.方法 回顾性分析12例接受胸部CT检查并经手术病理证实的EFD患者,其中10例接受CT平扫,2例(4个肿块)同时接受CT增强扫描.分析EFD的临床特点及CT表现特征.结果 12例患者均为女性,临床表现为9例病灶位于右侧、1例位于左侧、2例病灶累及双侧.10例

  5. Perforator-based fasciocutaneous flap for pressure sore reconstruction.

    Science.gov (United States)

    Lin, Chih-Hsun; Ma, Hsu

    2012-12-01

    Pressure sore reconstruction is always a challenge for plastic surgeons due to its high recurrence rate. In addition to the myocutaneous flap, the perforator-based fasciocutaneous flap has become a new entity used for pressure sore reconstruction. This study presents a series of 26 perforator-based fasciocutaneous flaps for pressure sore reconstruction, with good outcomes in 21 patients from July 2008 to April 2011. The flaps were advanced, transposed, or rotated to obliterate the defects. Twenty of 26 flaps healed uneventfully without complication. One patient had a flap that totally necrosed, one had partial flap necrosis (flap rotated 180° in the above two cases), one had infection and healed by a secondary flap, one had minor wound dehiscence, one died of pneumonia 1 week postoperatively, and recurrence developed in one patient. The perforator-based fasciocutaneous flap is a reliable method and produced good results in this series. These flaps are well vascularised, have enough soft tissue bulk, and have a high degree of mobilisation freedom.

  6. Effect of Systemic Antioxidant Allopurinol Therapy on Skin Flap Survival

    Science.gov (United States)

    Rasti Ardakani, Mehdi; Al-Dam, Ahmed; Rashad, Ashkan; Shayesteh Moghadam, Ali

    2017-01-01

    BACKGROUND It has been reported that systemic administration of allopurinol improves cell survival. This study was aimed to evaluate effects of allopurinol on skin flaps in dogs. METHODS Twenty dogs underwent one skin flap surgery with a 2-week interval. The first procedure was performed according to the standard protocols. The second phase was started by a 1-week pretreatment with allopurinol. Length of the necrotic zone was measured and recorded daily. At each phase, flaps were removed and sent for histopathological study after 1 week observation. RESULTS Mean length of the necrotic zone in allopurinol treated skin flaps has been significantly less than normal flaps over all 7 days of observation (p<0.0001). Histopathology study showed less inflammation and more normal tissue structure in the allopurinol treated skin flaps. CONCLUSION It was demonstrated that systemic administration of allopurinol significantly improved skin flap survival. PMID:28289614

  7. Breast reconstruction by pedicled transverse rectus abdominis myocutaneous flap

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    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.

  8. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap

    OpenAIRE

    TARSITANO, A.; VIETTI, M.V.; Cipriani, R; MARCHETTI, C.

    2013-01-01

    SUMMARY The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy ...

  9. Dorsalis Pedis Free Flap: The Salvage Option following Failure of the Radial Forearm Flap in Total Lower Lip Reconstruction

    OpenAIRE

    Theodoros Stathas; Georgios Tsinias; Dimitra Tsiliboti; Aris Tsiros; Nicholas Mastronikolis; Panos Goumas

    2014-01-01

    Reconstruction after resection of large tumors of the lower lip requires the use of free flaps in order to restore the shape and the function of the lip, with the free radial forearm flap being the most popular. In this study we describe our experience in using the dorsalis pedis free flap as a salvage option in reconstruction of total lower lip defect in a patient with an extended lower lip carcinoma after failure of the radial forearm free flap, that was initially used. The flap was integra...

  10. An evaluation of resource utilisation of single stage porcine acellular dermal matrix assisted breast reconstruction: A comparative study.

    Science.gov (United States)

    Kilchenmann, Ashley J R; Lardi, Alessia M; Ho-Asjoe, Mark; Junge, Klaus; Farhadi, Jian

    2014-12-01

    To evaluate resource utilization of single stage porcine acellular dermal matrix (ADM) assisted breast reconstruction compared with tissue expander (TE), latissimus dorsi flap and implant (LD/I) and latissimus dorsi flap and TE (LD/TE) reconstructive techniques. Clinical data was collected for length of stay, operative time, additional hospitalisations and operative procedures, and outpatient appointments for 101 patients undergoing unilateral implant based breast reconstruction. Resources utilised by ADM (Strattice Reconstructive Tissue Matrix™) patients were analysed and compared to the resource usage of traditional techniques. 25 patients undergoing single stage ADM (ADM/I) were compared with 27 having TE, 32 having LD/I and 17 having LD/TE reconstructions. Follow up was 24 months. Compared to TE, ADM/I had similar length of stay and operative time, lower rate and number of additional procedures, fewer, shorter re-admissions (p reconstructions in both complication-free and complicated settings over a 24-month period, despite requiring aesthetic revision in 60.9% of patients. Compared to LD/I, resource utilisation was commensurate in complication-free and complicated settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Intrathoracic migration of a breast implant after minimally invasive cardiac surgery.

    Science.gov (United States)

    Songcharoen, Somjade Jay; McClure, Michael; Aru, Roberto G; Songcharoen, Somprasong

    2015-03-01

    The aging population, in combination with the popularity of breast augmentation with implants, presents surgeons with a growing number of cases involving women undergoing minimally invasive cardiac surgery (MICS) who have breast implants. We present an unusual complication involving the delayed migration of a subpectoral implant into the chest cavity through an iatrogenic defect after a minimally invasive mitral valve repair. This chest wall defect was ultimately repaired with a latissimus dorsi flap. Although MICS has been described in women with breast implants, the documented experience remains limited. Most authors classically recommend explantation of the prosthesis to provide access to the chest wall; however, some have later suggested preserving the implant capsule in situ while performing the cardiac procedure with gentle retraction. From our literature review and experience, we recommend that the posterior capsule should remain intact. If this is not possible, then the chest wall closure should be reinforced with either mesh, soft tissue, or both. Soft tissue options include the conversion from a subpectoral to a subglandular position to use the pectoralis major, or a latissimus dorsi muscle flap. With the increasing number of these cases along with the complexities of minimally invasive procedures, close communication and planning should be undertaken between both cardiothoracic and plastic surgeons when taking care of these patients. Above all, when faced with postoperative complications after MICS, the plastic surgeon must maintain a high index of clinical suspicion and consider the possibility of intrathoracic migration of an implant so that proper workup and planning may be initiated.

  12. To flap or not to flap: a discussion between a fish and a jellyfish

    Science.gov (United States)

    Martin, Nathan; Roh, Chris; Idrees, Suhail; Gharib, Morteza

    2016-11-01

    Fish and jellyfish are known to swim by flapping and by periodically contracting respectively, but which is the more effective propulsion mechanism? In an attempt to answer this question, an experimental comparison is made between simplified versions of these motions to determine which generates the greatest thrust for the least power. The flapping motion is approximated by pitching plates while periodic contractions are approximated by clapping plates. A machine is constructed to operate in either a flapping or a clapping mode between Reynolds numbers 1,880 and 11,260 based on the average plate tip velocity and span. The effect of the total sweep angle, total sweep time, plate flexibility, and duty cycle are investigated. The average thrust generated and power required per cycle are compared between the two modes when their total sweep angle and total sweep time are identical. In general, operating in the clapping mode required significantly more power to generate a similar thrust compared to the flapping mode. However, modifying the duty cycle for clapping caused the effectiveness to approach that of flapping with an unmodified duty cycle. These results suggest that flapping is the more effective propulsion mechanism within the range of Reynolds numbers tested. This work was supported by the Charyk Bio-inspired Laboratory at the California Institute of Technology, the National Science Foundation Graduate Research Fellowship under Grant No. DGE-1144469, and the Summer Undergraduate Research Fellowships program.

  13. 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

  14. Microsurgery flap in endodontic surgery: case report.

    Science.gov (United States)

    Cecchetti, F; Ricci, S; DI Giorgio, G; Pisacane, C; Ottria, L

    2009-01-01

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

  15. Pearls for perfecting the mastoid interpolation flap.

    Science.gov (United States)

    Justiniano, Hilda; Eisen, Daniel B

    2009-06-15

    Helical rim ear defects can present a reconstructive challenge to the Mohs surgeon. Multiple options exist including wedge excision, helical rim advancement flaps, bilobed flap, and grafts, to name a few. Wedge excision of the ear may result in a noticeable anteverted, smaller ear, and disrupts auricular cartilage with the possibility of chondritis and excess pain. Helical rim advancements can result in anteversion of the ear and a smaller lobule. Mastoid interpolation flaps, which are also called retroauricular to auricular flaps, can be a useful alternative in patients who are willing to return for a second procedure. They are easy to perform and can result in a highly aesthetic reconstruction in which the ear size and form are maintained. The donor skin comes from an area that is hidden from view and heals with minimal complications. We present our suggestions for performing these reconstructions. Ways to optimize results, potential pitfalls, and postoperative care instructions are discussed. Step by step videos are included with this manuscript.

  16. Flapping wing aerodynamics: from insects to vertebrates.

    Science.gov (United States)

    Chin, Diana D; Lentink, David

    2016-04-01

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

  17. [Vestibularly displaced flap with bone augmentation].

    Science.gov (United States)

    Bakalian, V L

    2009-01-01

    The aim of this study is to achieve esthetic gingival contours with the help of less traumatic mucogingival surgeries. 9 Patients were operated with horizontal deficiencies in 9 edentulous sites, planned to be restored with fixed partial dentures. In all cases there was lack of keratinized tissues. Temporary bridges were fabricated to all patients. Before surgery the bridges were removed and the abutment teeth were additionally cleaned with ultrasonic device. A horizontal incision was made from lingual (palatal) side between the abutment teeth, which was connected with two vertical releasing incisions to the mucogingival junction from the vestibular side. The horizontal incision was made on a distance 6-10 mm from the crest of the alveolar ridge. A partial thickness flap in the beginning 3-5 mm, then a full thickness flap up to the mucogingival junction, then a partial thickness flap was made. The flap was mobilized and displaced vestibularly. In the apical part the cortical bone was perforated, graft material was put and the flap was sutured. In all 9 cases the horizontal defect was partially or fully eliminated. The width of the keratinized tissues was also augmented in all cases. The postoperative healing was without complications, discomfort and painless. The donor sites also healed without complications. The application of Solcoseryl Dental Adhesive Paste 3 times a day for 7-10 days helped for painless healing of the donor site. The offered method of soft tissue and bone augmentation is effective in the treatment of horizontal defects of edentulous alveolar ridges of not big sizes. It makes possible to achieve esthetic results without traumatizing an additional donor-site.

  18. Reconstruction of the anterior floor of the mouth with the inferiorly based nasolabial flap

    NARCIS (Netherlands)

    van Wijk, MP; Damen, A; Nauta, JM; Lichtendahl, DHE; Dhar, BK

    2000-01-01

    The results of reconstruction of the anterior floor of the mouth, using 105 nasolabial flaps in 79 patients were reviewed in a retrospective study. Of those flaps, 82% healed uneventfully; flap survival was 95%. Considerable flap loss occurred in 5%. Primary dehiscence was observed in 5% of all flap

  19. 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.

  20. 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).

  1. The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients.

    Science.gov (United States)

    Hanwright, Philip J; Davila, Armando A; Hirsch, Elliot M; Khan, Seema A; Fine, Neil A; Bilimoria, Karl Y; Kim, John Y S

    2013-10-01

    The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes. Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI ≥ 30) and non-obese (BMI breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction (p reconstructions (OR = 1.09, OR = 1.05, OR = 1.10, respectively; p reconstructions (p = 0.001 and p reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%). The NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. A new flap alternative for trochanteric pressure sore coverage: distal gluteus maximus musculocutaneous advancement flap.

    Science.gov (United States)

    Nisanci, Mustafa; Sahin, Ismail; Eski, Muhitdin; Alhan, Dogan

    2015-02-01

    Management of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap.

  3. Propionato de cálcio no amaciamento do músculo Longissimus dorsi de bovinos de corte

    Directory of Open Access Journals (Sweden)

    Pedreira Aparecida Carla de Moura Silveira

    2003-01-01

    Full Text Available A maciez da carne é influenciada pela atuação do sistema proteolítico das calpaínas, durante o processo de maturação pós-morte. O propionato de cálcio fornece cálcio suficiente para aumentar a concentração de cálcio plasmático e, assim, ativar essas proteases dependentes de cálcio, melhorando a maciez da carne. Os objetivos desta pesquisa foram avaliar o efeito do fornecimento via oral de propionato de cálcio nas características quali-quantitativas da carcaça de bovinos de corte. Neste estudo, 24 machos castrados (3/4 Simental+1/4 Nelore receberam, por via oral, os tratamentos 0 ou 630 g de propionato de cálcio, 12 horas antes do abate. Após o abate, foram estudados o amaciamento e as perdas por cozimento após 1, 8 e 15 dias de maturação, a análise sensorial, o pH da carne, a área do olho do lombo, a espessura de gordura, os rendimentos da carcaça e a concentração de cálcio no plasma e no músculo Longissimus dorsi. Os resultados mostraram que o tratamento com propionato de cálcio não teve efeito sobre as características de carcaça, a concentração de cálcio no músculo Longissimus dorsi, a força de cisalhamento, as perdas por cozimento e a maciez, o sabor e avaliação geral na análise sensorial. O tratamento com propionato de cálcio aumentou a concentração de cálcio plasmático e melhorou a suculência sensorial.

  4. 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.

  5. Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap.

    Science.gov (United States)

    Mücke, Thomas; Loeffelbein, Denys J; Kolk, Andreas; Wagenpfeil, Stefan; Kanatas, Anastasios; Wolff, Klaus-Dietrich; Mitchell, David A; Kesting, Marco R

    2013-09-01

    Several microvascular free flaps are available for reconstruction of the osseous components after resections for head and neck cancer. We have prospectively evaluated patients treated by bony microsurgical reconstruction to identify predictors of adverse outcomes for delayed wound healing and failure of free flaps. All patients from July 2007 to June 2011 who had reconstructions with microvascular fibular or iliac crest flaps immediately after resection of the tumour were evaluated. There were a total of 156 bony free flaps: 120 (77%) fibular and 36 (23%) iliac crest flaps. A total of 133 (85%) were successful. Delayed wound healing was more common with the iliac crest flap (p=0.01) at the intraoral site (p=0.04). Significantly more iliac crest free flaps failed (p=0.02). Anastomosis to the facial artery (p=0.05) and facial vein (p=0.04), and duration of overall operating time were associated with a significantly higher risk of failure of the flap. Patients with cancer of the head and neck who require microsurgical bony reconstruction are at increased risk of postoperative complications. Significantly more complications were found with the iliac crest flap, whereas the fibular flap was associated with a significantly longer operating time.

  6. 组合皮瓣修复小腿及足踝部大面积软组织缺损%Repairing massive soft tissue defects below the knee with combined flaps

    Institute of Scientific and Technical Information of China (English)

    任高宏; 任义军; 王钢; 胡稷杰; 黎润光; 裴国献

    2009-01-01

    目的 探讨应用组合皮瓣修复小腿及足踝部大面积软组织缺损的临床应用价值和手术技巧. 方法 2005年1月至2008年12月采用组合皮瓣移植治疗36例小腿及足踝部大面积软组织缺损患者,其中采用游离股前外侧肌皮瓣组合携带健侧胫后血管的单桥式皮瓣修复14例,游离股前外侧肌皮瓣组合腓肠神经营养血管皮瓣修复11例,游离背阔肌皮瓣组合带健侧胫后血管的单桥式皮瓣修复6例,游离胸脐皮瓣组合局部转移腓肠肌皮瓣修复3例,游离股前外侧穿支皮瓣组合游离胸脐皮瓣修复1例,游离股前外侧肌皮瓣、游离胸脐皮瓣分别组合携带顺、逆行健侧胫后血管的双桥式皮瓣修复1例. 结果 本组有3例术后出现血管危象并进行了血管探查,解除动脉危象后1例游离皮瓣成活,1例游离皮瓣边缘坏死经换药后创面愈合,另1例静脉栓塞探查术后游离皮瓣部分坏死.其余33例患者移植组织令部成活,创面一期修复,总成功率为97.2%(35/36).术后随访4~36个月,平均16个月,皮瓣质地柔软,外形良好,患肢足踝功能恢复满意. 结论 采用不同形式的组合皮瓣移植,为小腿及足踝部大面积软组织缺损的修复提供了一个可行且有效的技术方法 ,手术虽有一定风险,但可有效降低伤残率,恢复肢体功能,缩短疗程.%Objective To explore the clinical value of repairing massive soft tissue defects below the knee with diverse combined flaps. Methods From January 2005 to December 2008, 36 patients with massive soft tissue defects below the knee were treated with combined flaps, including free anterolateral thigh flaps in 14 cases and free latissimus dorsal muscular flaps in 6 cases (both combined with posterior tibial vascular single bridge flaps from the healthy limb), free anterolateral thigh flaps combined with local transferred saphe-nous neurocutaneous vascular flaps in 11 cases, free thoraco-umbilical flaps plus

  7. Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps

    Institute of Scientific and Technical Information of China (English)

    YAN Xiao-qing; YANG Hong-yan; ZHAO Yu-ming; YOU Lei; XU Jun

    2007-01-01

    Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce

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

    National Research Council Canada - National Science Library

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

    2015-01-01

    To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap...

  9. 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.

  10. The "Gent" consensus on perforator flap terminology: preliminary definitions.

    Science.gov (United States)

    Blondeel, Phillip N; Van Landuyt, Koen H I; Monstrey, Stan J M; Hamdi, Moustapha; Matton, Guido E; Allen, Robert J; Dupin, Charles; Feller, Axel-Mario; Koshima, Isao; Kostakoglu, Naci; Wei, Fu-Chan

    2003-10-01

    Due to its increasing popularity, more and more articles on the use of perforator flaps have been reported in the literature during the past few years. Because the area of perforator flaps is new and rapidly evolving, there are no definitions and standard rules on terminology and nomenclature, which creates confusion when surgeons try to communicate and compare surgical techniques. This article attempts to represent the opinion of a group of pioneers in the field of perforator flap surgery. This consensus was reached after a terminology consensus meeting held during the Fifth International Course on Perforator Flaps in Gent, Belgium, on September 29, 2001. It stipulates not only the definitions of perforator vessels and perforator flaps but also the correct nomenclature for different perforator flaps. The authors believe that this consensus is a foundation that will stimulate further discussion and encourage further refinements in the future.

  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. Pedicled perforator flaps in the head and neck.

    Science.gov (United States)

    Hofer, Stefan O P; Mureau, Marc A M

    2010-10-01

    Perforator flaps, since their first description in 1989, have in many ways revolutionized reconstructive surgery. Whereas little more than a decade ago many surgeons were still hesitant to fully trust perforator flaps to be a reliable option, nowadays these flaps are often first choice. Investigators have to remain critical, however, of their advances and realize that not every reconstruction will require or benefit from a perforator flap, as previously well-established, nonperforator flaps still have their indication and can give excellent results. The most important skill in reconstructive surgery of the head and neck is not cutting the flap but assessing the defect, planning the reconstruction, and choosing wisely from the ever-increasing options available.

  13. High-affinity glutamate transporter and glutamine synthetase content in longissimus dorsi and adipose tissues of growing Angus steers differs among suckling, weanling, backgrounding, and finishing production stages.

    Science.gov (United States)

    Matthews, J C; Huang, J; Rentfrow, G

    2016-03-01

    Skeletal muscle and adipose tissues play important roles in maintaining whole-body Glu and N homeostasis by the uptake of Glu and release of Gln. To test the hypothesis that expression of high-affinity Glu transporters (GLAST1, EAAT4, EAAC1, GLT-1) and glutamine synthetase (GS) would increase in longissimus dorsi and adipose tissue of newborn Angus steers randomly assigned ( = 6) to develop through suckling (S; 32 d) and/or weanling (W; 184 d), backgrounding (B; 248 d), and finishing (F; 423 d) production stages. Carcass quality was determined at slaughter to verify shifts in adipose and lean deposition with development. Expression of mRNA (RT-PCR/Southern) and relative protein abundance (Western analysis) were determined in tissue homogenates isolated from longissimus dorsi, and kidney and subcutaneous adipose. The effect of production stage or tissue type on carcass and protein abundance was assessed by 1-way ANOVA using the GLM procedure of SAS, and Fisher's protected LSD procedure was used to separate data means. Neither GLAST1 nor EAAT4 mRNA or protein was detected. EAAC1, GLT-1, and GS mRNA were identified in all tissues, but GLT-1 and GS protein were not detected in kidney or subcutaneous adipose, and GS protein was not detected in longissimus dorsi. The EAAC1 content of subcutaneous ( = 0.06) and kidney ( = 0.02) adipose was 2 times greater in B and F than W steers, whereas GS was 5 times greater ( F). For longissimus dorsi, EAAC1 ( W > B = F, S = W > B = F, respectively). Within F steers, EAAC1 and GLT-1 mRNA was expressed by subcutaneous, kidney, omental, mesenchymal, and intramuscular adipose tissues, whereas GS mRNA was expressed by all except for intramuscular. Only EAAC1 protein was detected in any adipose tissue, with EAAC1 content being 104% and 112% greater ( adipose, respectively, and not differing ( > 0.45) from omental or mesenchymal adipose. These data demonstrate (1) longissimus dorsi and adipose tissues of steers developing through typical

  14. Protein and lipid oxidation in Longissimus dorsi and dry cured loin from Iberian pigs as affected by crossbreeding and diet.

    Science.gov (United States)

    Ventanas, Sonia; Estevez, Mario; Tejeda, Juan Florencio; Ruiz, Jorge

    2006-04-01

    Lipid and protein oxidation in Longissimus dorsi (LD) and dry-cured loins from pigs with different genetic (pure Iberian (IBP), Iberian female×Duroc male (IB×D) and Duroc female×Iberian male (D×IB)) and feeding backgrounds (free rearing on acorn and pasture (MON), concentrates high in oleic acid and supplemented with 250ppm of vitamin E(HOVE) and control concentrates (CON)) were investigated. Diet influenced the fatty acids profile from PL and α- and γ-tocopherol contents of LD. IBP-MON pigs showed the lowest malonaldehyde (MDA) values at 200min of iron induced muscle oxidation. Dry-cured loins from IBP-HOVE pigs had significantly (p<0.05) higher values of TBARS than those from the other batches. Neither the diet nor crossbreeding affected hexanal counts in dry-cured loins. Protein carbonyl content showed a similar trend to that observed for MDA values in LD, suggesting a protective role of tocopherol against lipid and protein oxidation. The positive and significant correlations between iron induced lipid oxidation in LD (200 min) and carbonyl content in LD and dry-cured loin (R(2): 0.55 and R(2): 0.52, respectively, p<0.01) support the relationship between lipid and protein oxidation.

  15. Differential miRNA expression profiles in the longissimus dorsi muscle between intact and castrated male pigs.

    Science.gov (United States)

    Cai, Zhaowei; Zhang, Lifan; Jiang, Xiaoling; Sheng, Yifei; Xu, Ningying

    2015-04-01

    MicroRNAs (miRNAs) are important modulators of skeletal muscle development in multiple mammalian species, but their role in skeletal muscle growth in castrated male pigs has not been well studied. The aim of the present study was to determine the role of miRNAs in longissimus dorsi muscle under castration. Our results showed that castration caused a significant decrease in serum testosterone levels as well as carcass lean mass, but led to an increase in carcass fat mass. Moreover, miRNA expression profiles in skeletal muscle were significantly altered by castration, and seven differentially expressed miRNAs were discovered. More importantly, functional analysis suggested that these differentially expressed miRNAs and their targets are involved in the regulation of skeletal muscle contractile function and fat metabolism. Taken together, these results demonstrate altered miRNA expression in skeletal muscle of castrated male pigs, and suggest a potential mechanism underlying the effects of castration on porcine skeletal muscle growth.

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

    OpenAIRE

    2014-01-01

    Objective: Penile syringomas are rare lesions usually occurring in isolation. We report the excision and reconstruction of multiple synchronous penile shaft syringomas with local scrotal flaps. Methods: We report a rare case of excision of multiple penile syringomas and reconstruction with scrotal flaps in a 29-year-old man. Results: Penile syringomas were excised and reconstructed with scrotal flaps in a single-stage procedure. Conclusions: In addition to providing wound coverage, this recon...

  17. [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.

  18. Design, manufacturing and testing of Controllable Rubber Trailing Edge Flaps

    DEFF Research Database (Denmark)

    Løgstrup Andersen, Tom; Aagaard Madsen, Helge; Barlas, Thanasis K

    The overall goal for the INDUFLAP project was realization of a test facility for development and test of Controllable Rubber Trailing Edge Flaps (CRTEF) for wind turbines. This report covers experimental work at DTU Wind Energy including design, manufacture and test of different configurations...... of flaps with voids in chord- or spanwise direction. Development of rubber flaps has involved further design improvements. Non-metallic spring elements and solutions for sealing of continuous extruded rubber profiles have been investigated....

  19. [Osteomuscular serrato-costal free flap: application to mandibular reconstruction].

    Science.gov (United States)

    Breton, P; Henry, J F; Crezoit, E; Souchere, B; Freidel, M

    1992-06-01

    The serrato-costal free flap provides a large costal flap vascularized by a digitation of the serratus anterior muscle supplied by the dorsal thoracic artery. The flap is easy and rapid to raise with low morbidity. The repair obtained is functionally very satisfactory, but does not allow insertion of an implant. Six cases are reported. The indications of this technique of mandibular reconstruction are discussed.

  20. Herpes Simplex Virus 1 Infection on a Reconstructive Free Flap

    OpenAIRE

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

    2013-01-01

    Objective: Herpes simplex virus 1 (HSV1) is a widespread virus that primarily causes orofacial infection. Methods: We present a case of HSV1 infection on a free radial forearm flap used to reconstruct a palate defect. Initially, the free flap appeared healthy; however, after 48 hours the free flap appeared in distress, with dark red colour and fast capillary refill. Venous congestion was suspected, and the patient underwent a second operation where no vascular compromise was found. Vesicles w...

  1. Microdialysis in clinical practice: monitoring intraoral free flaps.

    Science.gov (United States)

    Jyränki, Janne; Suominen, Sinikka; Vuola, Jyrki; Bäck, Leif

    2006-04-01

    Clinical examination is still the gold standard of postoperative free flap monitoring, but with intraorally situated and/or buried flaps, it can be difficult or impossible. Microdialysis is a sampling technique which offers the possibility to monitor the metabolism of a flap continuously. Ischemia can be detected by monitoring the changes in glucose, lactate, and pyruvate levels in interstitial fluid of the specific tissue. Our aim was to use microdialysis to monitor the metabolism of free flaps used for reconstructions inside the oral cavity/oropharynx and to evaluate the reliability and usefulness of this new monitoring method.Twenty-five consecutive patients who underwent oral cavity/oropharynx cancer resection and immediate reconstruction with free flap were included in the study. A microdialysis catheter was placed into the subcutaneous adipose tissue of the flap in the end of the surgical procedure. Dialysate samples were taken on an hourly basis for 72 hours postoperatively. Routine clinical monitoring was carried out by experienced nursing staff. Clinical findings were recorded and later compared with microdialysis values. Two flaps out of 25 failed in spite of reoperations. In both problem cases, microdialysis indicated ischemia 1 to 2 hours before it became clinically evident. During flap ischemia, the lactate/pyruvate ratio increased, glucose concentrations reduced, whereas lactate level increased when compared with normal values. Our results indicate that microdialysis is safe for the patient and the flap. It can reliably detect flap ischemia at an early stage. This is especially useful in buried flaps when clinical monitoring is difficult. Microdialysis may also reduce the patient discomfort caused by repeated clinical examination of the flap.

  2. 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.

  3. A crosslinguistic lexicon of the labial flap

    Directory of Open Access Journals (Sweden)

    Kenneth S. Olson

    2004-01-01

    Full Text Available We provide a large sample of the occurrences of the labial flap in the world’s languages, including audio and video data from the Mono dialect of Mid-Southern Banda. This sample provides the evidence for Olson and Hajek’s (2003 crosslinguistic generalizations concerning the articulation, the geographic distribution, the genetic distribution, and the phonological status of the speech sound.

  4. Mastectomy skin flap necrosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Robertson SA

    2017-03-01

    Full Text Available Stuart A Robertson,1 Johann A Jeevaratnam,2 Avi Agrawal,2 Ramsey I Cutress,3,4 1Department of Surgery, University Hospital Coventry and Warwickshire NHS Trust, Coventry, 2Department of Breast Surgery, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, 3Department of Breast Surgery, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, 4Somers Cancer Research UK Centre, Southampton General Hospital Southampton, UK Introduction: Mastectomy skin flap necrosis (MSFN has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods: A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results: MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion: MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. Keywords: mastectomy, flap, necrosis, complication, breast surgery

  5. 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

    2016-09-01

    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.

  6. 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.

  7. [Expanded pedicled forearm flap for reconstruction of multiple finger amputations].

    Science.gov (United States)

    Alvarez Jorge, A; Martelo Villar, F

    2000-05-01

    Soft-tissue injuries of the hand frequently require flap coverage to preserve structures damaged at the time of injury or to facilitate later reconstruction. The radial forearm flap makes local tissue readily available and offers a simple method of reconstruction. Secondary augmentation of the skin flap by means of tissue expansion appears to be a useful alternative to improve the possibilities of reconstruction. This case report describes a primary reconstruction of a hand with multiple finger amputations using both techniques: Forearm flap and tissue expansion.

  8. 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.

  9. Pre-expanded Deep Inferior Epigastric Perforator Flap.

    Science.gov (United States)

    Monsivais, Sharon E; Webster, Nicholas D; Wong, Stacy; Saint-Cyr, Michel H

    2017-01-01

    The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-expanding DIEP flaps cause a possible delay phenomenon improving vascularity, decrease donor site morbidity, and increase the area that can be covered. Pre-expansion requires staged procedures, has risk of extrusion and infection, causes temporary contour deformity during the expansion process, and requires a longer course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection and planning. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Staged retroauricular flap for helical reconstruction after Mohs micrographic surgery*

    Science.gov (United States)

    Cerci, Felipe Bochnia

    2016-01-01

    Staged retroauricular flap is a great option for full-thickness defects along the helical rim and antihelix. Donor site consists of the posterior ear, postauricular sulcus and mastoid area. The advantages of this flap include hidden donor scar, donor tissue similarity and rich vascularity. We present a case of collision tumor on the left helix treated with Mohs micrographic surgery and the resulting full-thickness defect repaired with a staged retroauricular flap. This flap is an effective technique for full-thickness helical defect repair with relatively little operative morbidity. High esthetic and functional results may be obtained restoring the ear size and shape.

  11. Epiglottis reconstruction with free radial forearm flap after supraglottic laryngectomy.

    Science.gov (United States)

    Hsiao, Hung-Tao; Leu, Yi-Shing; Tung, Kwang-Yi

    2010-01-01

    A bilobed free radial forearm flap was designed to reconstruct a defect in the epiglottis and tongue base in 2 patients who underwent supraglottic laryngectomy. The flap was initially sutured in the shape of the epiglottis to prevent aspiration during deglutition. Six months after surgery, after a full course of radiation therapy, the flap had flattened and underwent atrophy, but the patients still had good voice production and were able to swallow well without any aspiration. Regardless of the final shape of the reconstructed epiglottis, it will suffice to prevent aspiration if the flap is large enough to occlude the tracheal outlet.

  12. Translational damping on high-frequency flapping wings

    Science.gov (United States)

    Parks, Perry A.

    Flapping fliers such as insects and birds depend on passive translational and rotational damping to terminate quick maneuvers and to provide a source of partial stability in an otherwise unstable dynamic system. Additionally, passive translational and rotational damping reduce the amount of active kinematic changes that must be made to terminate maneuvers and maintain stability. The study of flapping-induced damping phenomena also improves the understanding of micro air vehicle (MAV) dynamics needed for the synthesis of effective flight control strategies. Aerodynamic processes which create passive translational and rotational damping as a direct result of symmetric flapping with no active changes in wing kinematics have been previously studied and were termed flapping counter-force (FCF) and flapping counter-torque (FCT), respectively. In this first study of FCF measurement in air, FCF generation is measured using a pendulum system designed to isolate and measure the relationship of translational flapping-induced damping with wingbeat frequency for a 2.86 gram mechanical flapper equipped with real cicada wings. Analysis reveals that FCF generation and wingbeat frequency are directly proportional, as expected from previous work. The quasi-steady FCF model using Blade-Element-Theory is used as an estimate for translational flapping-induced damping. In most cases, the model proves to be accurate in predicting the relationship between flapping-induced damping and wingbeat frequency. "Forward-backward" motion proves to have the strongest flapping-induced damping while "up-down" motion has the weakest.

  13. Medial circumflex femoral artery flap for ischial pressure sore

    Science.gov (United States)

    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 skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap. PMID:19881020

  14. 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

  15. Cervicopectoral flap in head and neck cancer surgery

    Directory of Open Access Journals (Sweden)

    Sivrioglu Nazan S

    2003-12-01

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

  16. Mastectomy skin flap necrosis: challenges and solutions

    Science.gov (United States)

    Robertson, Stuart A; Jeevaratnam, Johann A; Agrawal, Avi; Cutress, Ramsey I

    2017-01-01

    Introduction Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. Methods A MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance. Results MSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited. Conclusion MSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem. PMID:28331365

  17. [Free radial forearm flap and myocutaneous flaps in oncological reconstructive surgery of the oral cavity, Comparison of functional results].

    Science.gov (United States)

    Pompei, S; Caravelli, G; Vigili, M G; Ducci, M; Marzetti, F

    1998-03-01

    In modern multi-disciplinary cancer treatment, rehabilitation and functional results represent utmost intent in reconstructive surgery of the oral cavity. Even in cases where the stage of disease is advanced) and the perspective of survival is limited, it is possible to achieve an acceptable quality of life. The authors report, in this study, the morpho-functional results and the morbidity observed in glossectomies in which the reconstruction was performed using three different methods. In a total of 264 reconstructive flaps of the head and neck regions, the authors considered three groups of 15 patients that had had reconstruction after the demolitive procedure. Respectively these groups were divided by the followed methods: free forearm flap, pectoralis major myocutaneous flap and nasolabial flap. The morbidity showed an extremely low rate of flap loss in all the groups, but "minor" complications, such as fistulas and leakages, were significantly more frequent in the myocutaneous flaps group. Functional evaluation for speech and deglutition showed good results in most patients. Extremely severe postoperative conditions as a permanent NG tube or incomprehensible speech had been observed in less than 15% of the cases. Particularly, the pectoralis major flap, showed its best functional performances in the total or subtotal glossectomies with a sacrifice of the muscles of the oral floor. The free forearm flap is reliable and safe with its low thickness and pliability, especially for partial glossectomies. The nasolabial flap was confirmed to be the first reconstructive choice for selected limited resections of the tongue and of the antero-lateral floor. With this experience it is possible, even in more complex free flaps, to reduce the time consumption and the complication rate. Free flaps do not substitute routinely myocutaneous and conventional flaps, but they represent the "ideal" reconstructive alternatives for specific and selected indications.

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

    DEFF Research Database (Denmark)

    Pettas, Vasilis; Barlas, Athanasios; Gertz, Drew Patrick;

    2016-01-01

    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...... 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...

  19. Primaer brystrekonstruktion i forbindelse med mastektomi ved mammacancer. Indikation, procedure og umiddelbare operative resultater

    DEFF Research Database (Denmark)

    Elberg, J J; Mollerup, C L; Dahlstrøm, K K

    2000-01-01

    Mastectomy and immediate reconstruction of 122 breasts were performed in 109 patients in close collaboration between plastic surgeons and general surgeons. In 56 patients reconstruction was performed using tissue expanders including 13 bilateral operations, 29 patients had a latissimus dorsi...... received systemic treatment and 10 local radiotherapy as well. There was no complication during systemic therapy related to reconstruction. In 10 cases local radiotherapy was performed in full, with a delay of four weeks in one patient and a need for correction of the radiation field during treatment...... myocutaneous flap and 24 a free transverse rectus abdominis myocutaneous flap. There were 27 postoperative local complications in 122 reconstructions (22%), in five the reconstruction was lost. Only patients clinically in stage I were considered for reconstruction. After histopathological staging 27 patients...

  20. 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.

  1. Comparison of a new flap design with the routinely used triangular flap design in third molar surgery.

    Science.gov (United States)

    Yolcu, Ü; Acar, A H

    2015-11-01

    The aim of this study is to introduce a new flap design in the surgical removal of impacted mandibular third molars - a lingually based triangular flap - and to compare this flap design with the routinely used triangular flap. This randomized, prospective, split-mouth study involved 22 patients with impacted bilateral mandibular third molars that were symmetrically positioned, mesially angulated, and retained in bone. The impacted teeth were removed in two sessions, using two different flap designs: the new alternative flap and the traditional triangular flap. Postoperative complications (pain, swelling, trismus, alveolar osteitis, and wound dehiscence) were recorded on days 2, 7, 14, and 21. The data obtained were analysed using the χ(2) test, the Mann-Whitney U-test, and Pearson's correlation. In terms of the severity of postoperative facial swelling and trismus, there were no statistically significant differences between the flap designs (P>0.05). The alternative flap exhibited higher pain scores at 12h post-surgery (Pthird molar surgery.

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

    Science.gov (United States)

    Smith, C. C., Jr.

    1973-01-01

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

  3. Complex lower face reconstruction using a combined technique of Estlander flap and subscapular artery system free flaps.

    Science.gov (United States)

    Hamahata, Atsumori; Saitou, Takashi; Beppu, Takeshi; Shirakura, Satoshi; Hatanaka, Akio; Yamaki, Takashi; Sakurai, Hiroyuki

    2013-12-01

    When advanced mandibular carcinoma is resected, the defect may include lip and oral commissure. Free flap insertion is commonly used to reconstruct the lip defect. Although improvements in the oral reconstructive method via free flap use have been reported, functional and aesthetic results of the oral sphincter remain limited. This case report describes two individuals presenting with massive lower face defects, including a lower lip defect and a mandibular bone defect. Reconstruction was accomplished using the Estlander flap and free subscapular system of flaps. In both cases, the free subscapular artery system flap was elevated from the mandibular bone defect and other mucosal defect. The lower lip and oral commissure defect was reconstructed via Estlander flap. Free flaps survived 100% and both cases healed without complication. Patients regained good oral sphincter function with no reports of drooling. Thus, in cases involving massive lower face resection, including that of the lower lip and mandibular bone, this method of reconstruction when combined with lip-switch flap and subscapular artery system flap can prove to be useful.

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

    Directory of Open Access Journals (Sweden)

    Uğbreve;ur Dalli

    2011-01-01

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

  5. Fatty Acid Composition of Longissimus dorsi Muscle of Suffolk Down Lambs Fed on Different Dryland Forages Composición de Ácidos Grasos del Músculo Longissimus dorsi de Corderos Suffolk Down Alimentados con Diferentes Forrajes

    Directory of Open Access Journals (Sweden)

    María Asunción Gallardo

    2011-12-01

    Full Text Available Sheep production on dryland is based on natural pasture. The aim of this study was to evaluate the effect of dryland legume pastures on the fatty acid composition of lamb meat. The study included 21 Suffolk Down male lambs aged about 2-mo that were randomly assigned to three types of pastures: successional pasture, subterranean clover/Wimmera ryegrass (Trifolium subterraneum L./Lolium rigidum Gaudin, or red clover/Wimmera ryegrass (T.pratense L./L. rigidum for 66 d, and slaughtered after. The fatty acid profile measured in the Longissimus dorsi muscle showed no significant differences as to the content of saturated (SFA, polyunsaturated fatty acids (PUFA, and the omega6/omega3 rate (co6/co3. There was a trend (p > 0.06 towards a higher monounsaturated fatty acid (MUFA content in the meat of lambs fed on red clover when compared to the other pasture types. Although there were no significant differences among treatments, the results obtained with natural pasture cannot be extrapolated to natural dryland pastures due to their high legume content. It is concluded that using subterranean clover/Wimmera ryegrass would provide a similar meat quality when compared to results obtained from forage based on red clover/Wimmera ryegrass.La producción ovina en el secano está basada en la pradera natural. El objetivo de este estudio fue evaluar el efecto de praderas de leguminosas de secano sobre la composición de ácidos grasos de la carne de cordero. El estudio incluyó 21 corderos machos Suffolk Down, de alrededor de 2 meses de edad, los que fueron asignados aleatoriamente en tres praderas: pradera sucesional, trébol subterráneo/ ballica Wimmera (Trifolium subterraneum L./Lolium rigidum Gaudin o trébol rosado/ballica Wimmera (T. pratense L./L. rigidum, por 66 d, siendo posteriormente sacrificados. El perfil de ácidos grasos, medido en el musculo Longissimus dorsi no mostró diferencias significativas en contenido de ácidos grasos saturados (SFA

  6. A Gimps Study on Tame Rabbits Micro-Arterial Vessels in Latissimus Dorsi, Trapezius, Gracilis, and Musculus Triceps Surae(Ⅱ)%家兔背阔肌、后斜方肌、股薄肌和小腿三头肌微细血管构筑初探之二

    Institute of Scientific and Technical Information of China (English)

    李天锡; 刘振娅; 马焕英; 那毅

    2001-01-01

    近年来,根据临床的需要和肌皮瓣移植手术的开展,有关肌肉血管应用解剖学的研究逐渐引起人们的重视.但实验动物例如家兔肌肉内的微细血管的构筑情况目前仍然不清楚.本文就是针对这一情况,对家兔进行不同方法处理后解剖,观察动脉血管在背阔肌、后斜方肌、股薄肌和小腿三头肌的血管类型及血管源头;并取相关肌肉制作石蜡切片进行显微观察记数、测量、确定微细血管在家兔背阔肌、后斜方肌、股薄肌和小腿三头肌内的密度和管腔直径.为肌肉损伤后的修复提供依据,希望通过进一步实验应用到临床实践,造福于人类.

  7. 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

  8. 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

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

    Science.gov (United States)

    Stowers, Amanda K; Lentink, David

    2015-03-25

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

  10. Poland's syndrome in women: 24 cases study and literature review

    Institute of Scientific and Technical Information of China (English)

    ZHU Lin; ZENG Ang; WANG Xiao-jun; LIU Zhi-fei; ZHANG Hai-lin

    2012-01-01

    Background Since its first description in 1841,numerous variations and treatments of Poland's syndrome (congenital deficiency of the pectoralis major muscle associated with brachysyndactyly) have been reported.None of the reports,however,involved female Chinese patients.Methods A retrospective study of 24 female patients was conducted to guide the selection of methods of surgical reconstruction.The patients were divided into three groups according to the degree of thoracic tissue development.Type Ⅰ (mild):Limited tissue loss which can be treated with simple filling with autologous fat and/or an artificial breast implant.Type Ⅱ (moderate):Moderate thoracic tissue hypoplasia where the breast parenchyma can still offer adequate implant coverage.Mammoplasty using a latissimus dorsi muscular flap with an implant was performed in this group.The flap was used to fill the infraclavicular hollow,and the implant was placed in the dual-plane pocket.Type Ⅲ (severe):Severe thoracic tissue hypoplasia,without sufficient parenchyma to offer implant coverage.A latissimus dorsi muscular flap was used to form a total submuscular pocket in which an implant was placed.Results The numbers of Type Ⅰ,Ⅱ,and Ⅲ patients were 15,3,and 6,respectively.All of the flaps and injected fat demonstrated good survival.Satisfactory cosmetic results were exhibited during the follow-up period of 1 to 9 years.Conclusions Although this group of patients showed varied conditions,they can be roughly divided into three types according to the degree of thoracic tissue development.In our experience,this classification is simple and useful in choosing the breast reconstruction options.

  11. Complex Technique of Large Sural Flap: An Alternative Option for Free Flap in Large Defect of the Traumatized Foot

    Directory of Open Access Journals (Sweden)

    Naser Mohammadkhah

    2011-04-01

    Full Text Available The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.

  12. Antioxidant supplementation in pig nutrition: effects on shelf life of longissimus dorsi muscle and consumers’ preferences for smoked cured ham.

    Directory of Open Access Journals (Sweden)

    Federica Maghin

    2015-07-01

    Full Text Available The effects of dietary supplementation with antioxidant mixture in medium-heavy swine on oxidative status, nutritional and sensory characteristics of longissimus dorsi (LD muscle and smoked cured ham were evaluated. Seventy-four pigs (PIC x Max Grow, were assigned to two experimental groups: control (CT and treated supplemented with antioxidant mixture (AOX for 45 days before slaughter. The total antiradicalic activity of blood (KRL test and carcass dressing percentage was positively affected (P<0.05 by AOX supplementation. Chemical composition of LD was not affected by dietary treatment. Oxidative stability and colour indices were significantly affected (P<0.05 by dietary treatment and storage time (0, 6, 12, 15 days under modified atmosphere packs - MAP. Sensory analysis revealed that at 12 and 15 days of storage a loss of colour beside presence of off odors was higher (P<0.05 in CT than AOX group. The seasoning losses of smoked cured ham tended to be lower (P=0.06 in AOX group than CT. Physical and chemical composition was not affected by dietary treatment. Sensory analysis revealed a difference between CT and AOX (P<0.05 in salty and sweet taste. Furthermore, the consumer test revealed that smoked cured ham from AOX were preferred (P<0.05 than CT. Dietary supplementation with antioxidant mixture improves total antioxidant status, carcass dressing percentage and smoked cured ham seasoning losses. The oxidative, colour stability and sensory parameters of LD muscle was improved in AOX groups during refrigerated storage in MAP. Antioxidant mixture positively affect the consumer preference of smoked cured ham, without affecting other quality parameters.

  13. Experimental and numerical study of an autonomous flap

    NARCIS (Netherlands)

    Bernhammer, L.O.; Navalkar, S.T.; Sodja, J.; De Breuker, R.; Karpel, M.

    2015-01-01

    This paper presents the experimental and numerical study of an autonomous load alleviation concept using trailing edge flaps. The flaps are autonomous units, which for instance can be used for gust load alleviation. The unit is self-powered and self-actuated through trailing edge tabs which are moun

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

    Science.gov (United States)

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

    2009-01-01

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

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. Bifurcation to forward flapping flight at intermediate Reynolds number.

    Science.gov (United States)

    Vandenberghe, Nicolas; Zhang, Jun; Childress, Stephen

    2003-11-01

    The locomotion of most fish and birds is realized by flapping wings or fins transverse to the direction of travel. According to early theoretical studies, a flapping wing translating at finite speed in an inviscid fluid experiences a propulsive force. In steady forward flight this thrust is balanced by drag. Such "lift-based mechanisms" of thrust production are characteristic of the Eulerian realm, where discrete vortical structures are shed. But, when the Reynolds number is small, viscous forces dominate and reciprocal flapping motions are ineffective. A flapping wing experiences a net drag and cannot be used to propel an organism. We have devised an experiment to bridge the two regimes, and to examine the transition to forward flight at intermediate Reynolds numbers. We study the dynamics of an horizontal wing that is flapped up and down and is free to move either forwards or backwards. This very simple kinematics emphasizes the demarcation between low and high Reynolds number because it is effective in the Eulerian realm but has no effect in the Stokesian realm. We show that flapping flight occurs abruptly as a symmetry breaking bifurcation at a critical flapping frequency. Beyond the bifurcation the forward speed increases linearly with the flapping frequency. The experiment establishes a clear demarcation between the different strategies of locomotion at large and small Reynolds number.

  20. 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.

  1. Coverage of soft tissue defect in palm with prefabricated flap

    Institute of Scientific and Technical Information of China (English)

    ZHANG Gong-lin; CAI Guo-rong; ZHANG Ming; ZHENG Liang-jun; ZHANG Yan

    2008-01-01

    @@ The coverage of large soft tissue defects in palm remains a challenge in the plastic recon-structive surgery. There are many local tissue transfers described for small-sized defects of hand, whereas large defect require regional flaps such as the radial forearm flap or free tissue transfer.1-5

  2. The versatility of the pectoralis major flap in reconstructive surgery

    NARCIS (Netherlands)

    Corten, E.M.L.

    2008-01-01

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

  3. Monitoring microvascular free flaps with tissue oxygen measurement and PET.

    Science.gov (United States)

    Schrey, Aleksi R; Kinnunen, Ilpo A J; Grénman, Reidar A; Minn, Heikki R I; Aitasalo, Kalle M J

    2008-07-01

    Tissue oxygen measurement and positron emission tomography (PET) were evaluated as methods for predicting ischemia in microvascular free flaps of the head and neck. Ten patients with head and neck squamous cell cancer underwent resection of the tumour followed by microvascular reconstruction with a free flap. Tissue oxygenation of the flap (P(ti)O(2)) was continuously monitored for three postoperative (POP) days and the blood flow of the flap was assessed using oxygen-15 labelled water and PET. In three free flaps a perfusion problem was suspected due to a remarkable drop in P(ti)O(2)-values, due to two anastomosis problems and due to POP turgor. No flap losses occurred. During the blood flow measurements with PET [mean 8.5 mL 100 g(-1) min(-1 )(SD 2.5)], the mean P(ti)O(2) of the flaps [46.8 mmHg (SD 17.0)] appeared to correlate with each other in each patient (pmonitoring system of free flaps. The perfusion-study with PET correlates with P(ti)O(2)-measurement.

  4. CARACTERÍSTICAS DE QUALIDADE DO CONTRAFILÉ (m. L. dorsi DE TOUROS JOVENS DA RAÇA NELORE

    Directory of Open Access Journals (Sweden)

    Maria Lourdes S. ABULARACH

    1998-05-01

    Full Text Available Com o objetivo de analisar as características de qualidade da carne de touros jovens da raça Nelore e os possíveis efeitos da idade, entre os 690 e os 780 dias, nessas características, efetuou-se o abate de 113 bovinos, que haviam sido confinados por um período de 109 dias com ração à base de 20% de concentrado e 80% de volumoso. Todas as carcaças foram tipificadas pela Inspeção Federal na sala de matança do frigorífico e resfriadas por 24 h em câmara fria (Tinicial=5°C; Tfinal=2°C. Meias carcaças (lado direito, N=51, do tipo B - do Sistema B R A S I L - de animais de 23 a 26 meses foram desossadas. Dois bifes (2,5cm de espessura de contrafilé (m. L. dorsi de cada uma foram embalados à vácuo e maturados por 7 dias a 0-2°C. O pH variou entre 5,44 e 5,83 e apenas duas amostras tinham pH ³ 5,70. O valor L* (luminosidade médio foi de 34,85. As médias de umidade e gordura foram de 75,65% e 1,71%, respectivamente. A média de força de cisalhamento foi de 6,70kg e não foi influenciada pela idade do animal entre 690 e 734 dias, mas apresentou uma tendência (Teste t, p=0,22 de aumento entre 735 e 780 dias. Não se detectou influência da idade do animal nas demais características de qualidade analisadas (Teste t, p>0,20. Concluiu-se que o contrafilé de animais como esses pode ter problemas de aceitação na faixa mais exigente de mercado, e que carcaças tipificadas como B, presumivelmente o melhor tipo, não apresentam necessariamente as melhores características de qualidade da carne.Quality traits of boneless rib cut (L. dorsi muscle from Nelore young bulls. To study the meat quality traits of Nelore breed young bulls, and the effect of age (690-780 days on them, 113 animals were slaughtered after 109 days of intensive feeding with 20% concentrate and 80% roughage. All the carcasses were graded at the slaughter floor by the Federal Inspection and chilled for 24 hours (Tinitial=5°C, Tfinal=2°C. Fifty one half carcasses

  5. [Decisional algorithm in extended neoplasms of the hypopharynx and the cervical esophagus].

    Science.gov (United States)

    Benazzo, M; Bertino, G; Spasiano, R; Gatti, P; Capelli, M

    2005-01-01

    Hypopharynx reconstruction must deal with restoration of not a simple tubed conduit but a complex arrangement of constrictive and propulsive forces with fine sensory circuits. The chosen surgical approach should guarantee both complete removal of tumor and re-establishement of the two primary functions of the district: first swallowing and then phonation. We retrospectively reviewed data of 67 patients who had undergone oncologic reconstruction of hypopharynx with either pedicled or free flaps at the ENT Department of IRCCS Policlinico S Matteo, University of Pavia, between November 1994 and July 2004. Type and extension of the defect following cancer removal guided the selection of reconstructive procedure. Partial defects, with more than 50% mucosa spared, in absence of chance of being closed primarly, were covered with radial forearm free flaps as first choice; pedicled flaps such as pectoralis major and SCM rotational flaps were used instead if free flaps contraindicated by general and/or local conditions. With circumferential defects reconstruction was accomplished by means of jejunum free flap, as first choice. Adverse local abdominal conditions mandated the alternative use of either tubulized or tunnelized fasciocutaneous free flaps, such as radial forearm and lateral thigh. When free flaps use contraindicated, or in case of salvage surgery after flap loss, pectoralis major and latissimus dorsi pedicled flap were chosen. Both reconstructions with free and pedicled flaps were successful in an high percentage of cases (>85%). Analysis of incidence and causes of flap failure are reported in this work. In the free flaps group of patients a lower rate of complications were registered, allowing a faster patient discharge from hospital (36% versus 81.3%). An oral swallowing function was gained in 92% of free flaps and 62.5% of pedicled flaps. Excellent and exclusive oral nutrition (free diet), was obtained in 54% of free flaps and 25% of pedicled flaps. None of

  6. Composição química e de ácidos graxos do músculo longissimus dorsi e da gordura subcutânea de tourinhos Red Norte e Nelore Chemical composition and of fatty acids of the muscle longissimus dorsi and backfat of Red Norte and young Nellore bulls

    Directory of Open Access Journals (Sweden)

    Leandro Sâmia Lopes

    2012-04-01

    Full Text Available Objetivou-se com este trabalho avaliar a composição química e o perfil de ácidos graxos do músculo longissimus dorsi e da gordura subcutânea de tourinhos Red Norte e Nelore terminados em confinamento. Utilizaram-se 44 animais, sendo 22 Red Norte com peso vivo inicial médio de 367±30 kg e 22 do grupo Nelore com peso vivo inicial médio de 361±30 kg. Os animais receberam ração à vontade durante 112 dias e foram abatidos com 519 e 482 kg, respectivamente. Amostras do músculo longissimus dorsi e da gordura subcutânea foram coletadas 24 horas após abate entre a 12ª e 13ª costelas para análise da composição centesimal e do perfil de ácidos graxos. As análises de ácidos graxos foram realizadas por meio de cromatografia gasosa, em coluna capilar de 100 m. Não houve diferença na composição química da carne entre os grupos genéticos. Nos animais Red Norte, foram maiores os teores dos ácidos graxos pentadecanoico, palmítico, palmitoleico, linoleico e ácido linoleico conjugado (CLA, enquanto nos animais Nelore foi encontrado o maior teor de ácido oleico. O músculo longissimus dorsi apresentou maiores teores dos ácidos láurico, heptadecenoico, esteárico, linoleico, α-linolênico e araquidônico. Em comparação ao músculo longissimus dorsi, na gordura subcutânea foram maiores os teores dos ácidos mirístico, miristoleico, pentadecanoico, palmítico, palmitoleico, oleico e CLA. Os animais Red Norte apresentaram maiores teores de ácidos graxos saturados em comparação aos Nelore. Em bovinos, o perfil de ácidos graxos depositados no músculo é diferente do observado na gordura subcutânea. O perfil de ácidos graxos da carne de tourinhos difere entre grupos genéticos.The objective of this study was to evaluate the chemical composition and the fatty acid profile of the longissimus dorsi muscle and the backfat thickness of Red Norte and Nellore young bulls finished in feedlot. Fourty-four animals (22 Red Norte with

  7. Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK

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    Tsai TH

    2017-04-01

    Full Text Available Tsung-Han Tsai,1 Kai-Ling Peng,1 Chien-Jen Lin2 1Department of Ophthalmology, 2Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan Background: Laser in situ keratomileusis (LASIK is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK.Case presentation: A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of −0.75 D to 1.0 D ×175° in her right eye 1 month later.Literature review: We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014.Conclusion: Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could

  8. Breast Reconstruction Using Tram Flap: Prospective Outcome and Complications

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    Homayoon Zehtab

    2006-07-01

    Full Text Available Background:The transverse rectus abdominis musculocutaneous TRAM flap remains the gold standard for postmastectomy reconstruction either immediate or delayed.However,transfer of TRAM flap can be associated with donor site morbidities and complications in flap.A successful reconstruction consists of careful patient selection, surgical technique and meticulous preoperative planning.This study was designed to evaluate outcome and complications of breast reconstruction with TRAM flap in association with patient conditions and risk factors, prospectively. Methods: Breast reconstruction was performed in 44 women consecutively,using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomy accompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. Results: The mean age of the patients was 40.41±4.43 years. Thirty (68.18% patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAM flaps were used in 26(59.09% and 14(31.81% reconstructions, respectively. The abdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18% patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%, partial flap loss (13.64%, etc. Satisfaction rates were excellent in 10 (22.72%, good in 25 (56.82%, moderate in five (11.36%, and poor in four (9.09% patients. The mean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 in patients with contralateral and ipsilateral flaps,respectively (p>0.05.A significant association was observed between overall complications and comorbidities. Partial flap loss and fat necrosis was associated with smoking, and abdominal hernia was associated with obesity marginally.Conclusions:The outcome of breast reconstruction using TRAM flap is similar by

  9. Reconstruction of weightbearing forefoot defects with digital artery flaps.

    Science.gov (United States)

    Liu, Lifeng; Cao, Xuecheng; Cai, Jinfang

    2015-01-01

    Reconstruction of a defect of the weightbearing forefoot region remains a challenging problem owing to the limited alternatives available. The digital artery flap can be used for coverage of defects in the weightbearing forefoot. The present study reports our results using a digital artery flap for reconstruction of soft tissue defects of the weightbearing forefoot in 8 patients. The mean patient age was 35 ± 11.3 years. The etiology of the soft tissue defects included 4 (50%) traumatic events, 2 (25%) dysfunctional scars, and 2 (25%) neuropathic ulcerations. The mean postoperative follow-up duration was 22 ± 11.1 months (range 12 months to 4 years). All 8 flaps survived successfully. The complications included 1 case of delayed healing of a neuropathic ulceration. The digital artery flap is a good alternative for soft tissue defects of the weightbearing forefoot. The surgical techniques for harvesting the flaps are easy to manage.

  10. Distally Based Abductor Hallucis Adipomuscular Flap for Forefoot Plantar Reconstruction.

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    Lee, Sanglim; Kim, Min Bom; Lee, Young Ho; Baek, Jeong Kook; Baek, Goo Hyun

    2015-09-01

    Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based adipomuscular abductor hallucis flap for the treatment of 7 patients with soft tissue defect on the plantar forefoot after diabetic ulcer (n = 2), excision of melanoma at the medial forefoot (n = 3), and posttraumatic defects of the plantar forefoot (n = 2). The size of the defects ranged from 6 to 36 cm. All defects were covered successfully without major complications. The distally based adipomuscular flap from the abductor hallucis muscle provides a reliable coverage for small and moderate defects of the plantar and medial forefoot. This flap is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise.

  11. [Correction of severe alar retraction with alar rotation flap].

    Science.gov (United States)

    Hong, Chun; Zheng, Dongxue; Lu, Lixin

    2015-01-01

    To investigate the therapeutic effect of alar rotation flap for severe alar retraction. Patients with severely retracted alar underwent ala reconstruction using alar rotation flaps and autogenous cartilage batten grafts. First, costal cartilage was used to reshape the nasal tip and nasal dorsum. Then cartilage patch was used to extend and thicken the retracted alar. Then the alar rotation flap was transferred to correct retracted alar. Fourteen patients with severe alar retraction underwent alar reconstruction with alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, with improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision healed with acceptable cosmetic results, with obvious scar in only one patient (one side). The alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Scar can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.

  12. Coarse-grained models for interacting, flapping swimmers

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    Oza, Anand; Ristroph, Leif; Shelley, Michael; Courant Institute Applied Math Lab Collaboration

    2016-11-01

    We present the results of a theoretical investigation into the dynamics of interacting flapping swimmers. Our study is motivated by ongoing experiments in the NYU Applied Math Lab, in which freely-translating, heaving airfoils interact hydrodynamically to choose their relative positions and velocities. We develop a discrete dynamical system in which flapping swimmers shed point vortices during each flapping cycle, which in turn exert forces on the swimmers. We present a framework for finding exact solutions to the evolution equations and for assessing their stability, giving physical insight into the preference for certain observed "schooling states". The model may be extended to arrays of flapping swimmers, and configurations in which the swimmers' flapping frequencies are incommensurate. Generally, our results indicate how hydrodynamics may mediate schooling and flocking behavior in biological contexts. A. Oza acknowledges the support of the NSF Mathematical Sciences Postdoctoral Fellowship.

  13. Function of the sensate free forearm flap after partial glossectomy.

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    Biglioli, Federico; Liviero, Fabio; Frigerio, Alice; Rezzonico, Angela; Brusati, Roberto

    2006-09-01

    To compare functional recovery of sensitive free forearm flaps with non-sensitive free forearm flaps, following reconstruction for partial glossectomy. Sixteen patients underwent partial glossectomy for oncological reasons, of whom: nine patients underwent repair with non-sensitive free forearm flaps (group A) and seven with sensitive free flaps (group B). All patients underwent the following tests: (1) tactile sensitivity evaluation, localization of stimulus, sharp/blunt definition, discrimination between two points (static and dynamic), thermal sensitivity to heat/cold; (2) speech evaluation by means of the modified Fanzago test; (3) subjective evaluation concerning the degree of satisfaction of the following functions: swallowing, feeding and talking. The sensitivity and logopaedic evaluation tests and the subjective evaluation charts highlight an overall better functional recovery of the sensitive repair than the non-sensitive ones. In patients who have undergone partial glossectomy repair with free forearm neurofasciocutaneous flaps allow good recovery of oral functions and, therefore, a good quality of life.

  14. 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.

  15. Free Flap Procedures for Reconstruction After Head and Neck Cancer.

    Science.gov (United States)

    Kini, Erin

    2015-12-01

    Patients with head and neck cancer are seeking improved surgical procedures to avoid severe defects that result from head and neck cancer resection. Free flap reconstruction provides vascularized tissue that has been transferred from a distant donor site on a patient's body to a recipient site, markedly improving wound closure and protecting structures of the head and neck. This article discusses free flap procedures for reconstruction after head and neck cancer resection, including the following procedure phases: airway protection and neck dissections, tumor resection, flap harvest, microvascular anastomosis of the flap, and reconstruction and closure. The article also explains specific risk factors for patients undergoing free flap procedures that have been identified in the literature and include procedure length, hypothermia, and pressure injuries. Each of these factors is discussed regarding its specific effect on this patient population, and the nursing interventions to reduce these risks are identified.

  16. Thenar flap for severe finger tip injuries in children.

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    Fitoussi, F; Ghorbani, A; Jehanno, P; Frajman, J M; Penneçot, G F

    2004-04-01

    Twelve children aged between 18 months and 11 years old who had sustained a severe fingertip amputation with total or subtotal pulp loss were treated with a distal-based thenar flap. The injuries were palmar oblique amputations or avulsion injuries involving the pulp and the nail bed. The pedicles of the thenar flaps were divided after 18 to 25 days and none suffered any necrosis. At the final follow-up, no interphalangeal joint contractures were found, the average two point discrimination was 5mm, the thenar scar was asymptomatic and the subcutaneous tissue of the thenar flap was providing sufficient bulk to produce a rounded contour, like a normal fingertip. The thenar flap is a useful technique for use with severe fingertip injuries when local flaps cannot provide enough soft tissue and replantation is not possible.

  17. Alar flap combined with free auricular composite flap for the reconstruction of nasal alar defect.

    Science.gov (United States)

    Lin, Wentao; Qing, Yong; Liu, Jia; Cen, Ying

    2015-03-01

    The nasal ala plays an important role in the aesthetic appearance of the nose. Repairing the nasal alar defect, especially full-thickness alar defect, is one of the difficulties of plastic surgeons. In this article, a new surgical method is introduced about repairing full-thickness alar defect with free auricular composite flaps and local nasal alar rotation and advancement tissue flaps. We retrospectively reviewed 6 patients with a diagnosis of full-thickness alar defect between 2010 and 2013. All of them accepted this new surgical method. The patients were followed up for 6 to 12 months. The method used local nasal alar rotation and advancement tissue flap to form new nasal rim and made the defect of nasal rim shift to alar groove region. After that, we harvested free auricular composite flap to repair the new defect. All patients attained relatively symmetrical nostrils with a natural, smooth, integrated alar rim and inconspicuous scars. All the reconstructed nasal alae were aesthetically satisfactory. Slight atrophy of grafts was observed in all patients. The shape of the donor ear changed a little. Two patients experienced hyperpigmentation change and one patient presented slight hypertrophic scar in the suture site. No other complications were observed. This simple method not only reconstructed almost normal nasal alar rims and alar grooves but also improved the survival rate of the composite grafts without any free edges. This method also changed the traditional free auricular tissue flap location from the nasal alar rim to the upper alar groove region, which would help achieve more aesthetic appearance. This new method is a creative and useful technique for the repair of full-thickness alar defect.

  18. 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.

  19. Infrahyoid myofascial flap for tongue reconstruction.

    Science.gov (United States)

    Windfuhr, Jochen P; Remmert, Stephan

    2006-11-01

    For selected cases, reconstruction of the tongue may be required after tumor removal. This study was undertaken to demonstrate a simplified concept of tongue reconstruction with emphasis on infrahyoid myofascial flaps (IMF). The defects of the tongue were classified in 23 patients according to the extent of tumor growth, functional and surgical aspects. The oral tongue (OT; n = 1), base of tongue (BT; n = 12) or both areas (OT and BT; n = 10) were involved, with (n = 14) or without (n = 9) infiltration of adjacent tissues. Minor defects (extent (1/4) or less) required no reconstructive procedure at any area. Major defect closure (extent (1/2)-3/4) was accomplished with a combination of IMF covered by a radial forearm flap (RFF). A complete reconstruction of the OT was achieved with a combination of a bilateral IMF covered by a RFF. Whenever the complete BT has to be removed, interposition of a vein graft to establish a sufficient arterial blood supply to the remaining OT is mandatory. Moreover, a larynx lift to prevent aspiration is recommendable. Resection of adjacent soft tissues requires a larger RFF (OT; BT) or flaps from the shoulder-back region (BT and OT). Whenever the integrity of the mandible has to be sacrificed, a free fibula graft serves as an excellent tool for reconstruction. IMF serves as a reliable tool for minor or major reconstructive procedures of the tongue. Reliability and versatility of IMF may contribute to a reduced time required for surgery since harvesting is performed in the neck area immediately after neck dissection. Moreover, harvesting of the IMF does not result in an increased postoperative morbidity. Hence, functional restoration can be achieved with a more cost-effective procedure.

  20. A New Surgical Procedure for Penile Reconstruction by Combined Free Radial Forearm Flap and Dorsalis Pedis Flap.

    Science.gov (United States)

    Ma, Sunxiang; Cheng, Kaixiang; Liu, Yang; Chen, Fuguo

    2016-11-01

    To introduce a new surgical procedure for penile reconstruction, emphasizing both the aesthetic appearance and the function by combined free radial forearm flap and dorsalis pedis flap. In this procedure, the penis was subdivided into 2 anatomic subunits: the penile shaft and the glans penis. A sequential innervated radial forearm free flap was combined with a dorsalis pedis free flap to reconstruct the penile shaft and the glans, separately. Cartilage prosthesis was implanted at the same time. Since May 2011, 14 biologically male patients with total penile losses by various reasons were treated with this procedure. Patient satisfaction was evaluated by questionnaire, and sensory testing was performed. The ages of the patients ranged between 21 and 53 years (mean, 35.2 years). The average follow-up period was 38.1 months (range, 25.5-56 months). Twenty-five flaps in 11 patients were 100% viable. One dorsalis pedis flap in a patient underwent partial necrosis. There were no cases of urethral fistula or urethral stenosis, but 1 case of prosthesis infection and 1 case of abdominal hernia were recorded. The sensation of the neophallus recovered 3-6 months after surgery, and the patient satisfaction rate was quite high. The new surgical procedure of combined free radial forearm flap and dorsalis pedis flap for penile reconstruction achieves both satisfactory aesthetic and functional results. We recommend this procedure as an alternative ideal method for total penile reconstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. Speech and swallowing function after reconstruction with a radial forearm free flap or a pectoralis major flap for tongue cancer.

    Science.gov (United States)

    Su, Wan-Fu; Chen, Shyi-Gen; Sheng, Hwa

    2002-07-01

    The tongue plays a more significant role in English than in Mandarin, both in apical-palatal consonant production and tense-lax distinction. Theoretically, the same surgical intervention may produce a less significant impact on postoperative Mandarin production. The impact of tongue reconstruction on Mandarin articulation has not been reported. This study compared the tongue function outcome obtained using two methods of tongue reconstruction, radial forearm free flap transfer and pectoralis major flap transfer. Twenty-five patients with carcinoma of the tongue underwent tumor resection. The surgical defects were reconstructed using a pectoralis major flap in six patients and a radial forearm flap in 19 patients. Swallowing and speech function were evaluated 6 months to 5 years after the reconstruction. Speech intelligibility and a Mandarin articulation test were used to evaluate the articulation proficiency before and after surgery. Clinical evaluation of deglutition included a questionnaire on dietary habits and a swallowing rating of 1 to 7. Clinical evaluation showed that patients with free flap reconstruction had more intelligible speech (p = 0.014) even after total glossectomy. Assessment of data obtained by clinical questionnaire showed no significant difference between the two groups in swallowing function. Motility due to flap pliability increased speech intelligibility but had little effect on swallowing function. Our results suggest that radial forearm flap transfer is better than pectoralis major flap transfer in preserving speech function and that there is no significant difference between the two methods of reconstruction in their impact on swallowing function.

  3. Endoscopic, assisted, modified turbinoplasty with mucosal flap.

    Science.gov (United States)

    Puterman, M M; Segal, N; Joshua, B-Z

    2012-05-01

    A variety of surgical methods have been developed to reduce the volume of the inferior turbinates, in order to create a more patent nasal airway. We describe a technique used in our department since February 2002 for all patients undergoing inferior turbinectomy. We resect with endoscopic assistance the lateral mucosa and bony inferior turbinate. This technique can reduce a large volume of the turbinate while preserving the mucosal continuity and the submucosa by covering the raw surface with a mucosal flap. We believe our method minimises post-operative side effects and complications such as dryness, infection, bleeding and pain.

  4. Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

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    Carolyn L. Mulvey, BS

    2013-05-01

    Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

  5. A new flap design for release of parallel contracture bands: dual opposing five-flap z-plasty.

    Science.gov (United States)

    Ersoy, Burak

    2014-12-01

    Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  6. Flap prefabrication and stem cell-assisted tissue expansion: how we acquire a monoblock flap for full face resurfacing.

    Science.gov (United States)

    Li, Qingfeng; Zan, Tao; Li, Haizhou; Zhou, Shuangbai; Gu, Bin; Liu, Kai; Xie, Feng; Xie, Yun

    2014-01-01

    Total face skin and soft-tissue defects remain one of the biggest challenges in reconstructive surgery. Reconstruction of the entire face with uniform coverage and delicate features is difficult to achieve. To avoid the patchwork result seen in multiple flaps and skin grafts, 1 monoblock flap that has similar color, texture, and thickness might be an ideal option to minimize the incisional scars and several surgical procedures but is unavailable with current approaches because of the lack of sufficient matched tissue and the unreliable blood supply for such a large flap. To acquire a monoblock flap for full face reconstruction, we combine the prefabricated flaps, skin overexpansion, and bone marrow mononuclear stem cell transplantation for total facial resurfacing. In this article, we present our experience from our case series that provides universally matched skin and near-normal facial contour. It is a reliable and an excellent reconstructive option for massive facial skin defect.

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

    Science.gov (United States)

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

    2010-04-01

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

  8. Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore–Mid Foot Skin Defect

    Science.gov (United States)

    Wu, Hao; Sheng, Jia-Gen

    2016-01-01

    Background: Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside. Methods: We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting. Results: Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely. Conclusion: This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot. PMID:27975013

  9. [Early effectiveness of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects].

    Science.gov (United States)

    Chen, Yongfeng; Zhang, Kai; Li, Jiancheng; Xu, Jingcheng; Liao, Shengkai; Xu, Tao

    2011-09-01

    To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness. Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm x 5.5 cm to 10.0 cm x 7.5 cm. According to Brown's classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance. All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of speech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions. According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for

  10. The free vascularized flap and the flap plate options: comparative results of reconstruction of lateral mandibular defects.

    Science.gov (United States)

    Shpitzer, T; Gullane, P J; Neligan, P C; Irish, J C; Freeman, J E; Van den Brekel, M; Gur, E

    2000-12-01

    Reconstruction of the mandible and oral cavity after segmental resection is a challenging surgical problem. Although osteocutaneous free flaps are generally accepted to be optimal for reconstruction of anterior defects, the need for bony reconstruction for a pure lateral mandibular defect remains controversial. A retrospective study. A retrospective comparative study of short- and long-term outcomes of three different reconstruction techniques for lateral defects was performed. In total, 57 patients were included, of whom 27 had a plate and pedicled pectoralis major myocutaneous flap (PMMF group), 16 had a plate and free radial forearm flap (FRFF group), and 14 had an osteocutaneous free flap. Functionality, flap failure, and complications were scored. Plates had to be removed in 7 of the 27 patients in the PMMF group and 2 of the 16 in the FRFF group; none of the 14 osteocutaneous free flaps failed. The difference was of borderline statistical significance (P = .055). Longterm functional outcome revealed no statistically significant difference in oral deglutition (P = .76) or in facial contour (P = .36). Oral continence was significantly better in patients in the FRFF group (88%) as compared with the PMMF group (52%) or the osteocutaneous free flap group (43%) (P = .02). On the other hand, the results for speech favored the osteocutaneous free flap group; 13 of 14 patients (92.9%) had a normal score compared with 12 of 16 patients (75%) in the FRFF group and 17 of 27 (63%) in the PMMF group. However, this represented a borderline statistically significant result (P = .06). For lateral mandibular defects, the osteocutaneous free flap is reliable and durable in the long term. However, in a selected group of patients either of the two flap-plate options is a viable reconstructive option.

  11. Goal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: A pilot study

    OpenAIRE

    Funk, Duane; Bohn, James; Mutch, WAC; Hayakawa, Tom; Buchel, Edward W

    2015-01-01

    Fluid replacement is an important aspect of surgery and is particularly challenging in patients undergoing microvascular free flap reconstruction. The use of vasopressors can compromise blood flow to the flap, a problem also encountered with inadequate volume replacement, which can lead to ischemia and flap loss. However, excessive perioperative fluid administration may lead to flap loss resulting from venous engorgement and flap edema. This uncertainty, in part, prompted the authors of this ...

  12. Microdialysis in reconstructive surgery : a clinical and experimental study focusing on monitoring flap metabolism and viability

    OpenAIRE

    Röjdmark, Jonas

    2000-01-01

    When flap procedures are used to repair complex tissue wounds adequate flap circulation is of supreme importance. If the circulation is disturbed by either vascular occlusion, hemorrhage, or infection, delayed healing and flap necrosis may ensue. Early recognition of flap ischemia followed by appropriate surgical and/or pharmacotherapeutical measures may be crucial for flap survival. In the present thesis the microdialysis (MD) technique was used for the first time in recons...

  13. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects.

    Science.gov (United States)

    Funk, G F; Laurenzo, J F; Valentino, J; McCulloch, T M; Frodel, J L; Hoffman, H T

    1995-03-01

    To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects. Case series. The University of Iowa Hospitals and Clinics, Iowa City. Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe mid-facial trauma; and one had Romberg's disease. Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used. Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery. The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series. The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.

  14. Design and construction of an airfoil with controlled flap

    Science.gov (United States)

    Amin, Md. Ruhul; Rahman, S. M. Mahbobur; Mashud, Mohammad; Rabbi, Md. Fazle

    2017-06-01

    For modern aircrafts maneuvering control and reduction of power loss is a matter of great concern in Aerodynamics. Separation of airflow over the wings of aircraft at high angle of attack or at other situations is a hindrance to proper maneuvering control. As flow separation increases drag force on the aircraft, it consumes excess power. For these reasons much effort and research has gone into the design of aerodynamic surfaces which delay flow separation and keep the local flow attached for as long as possible. One of the simple and cost-effective way is to use a hinged flap on the wing of the aircraft, which lifts and self-adjusts to a position dependent on the aerodynamic forces and flap weight due to reversed flow at increasing angle of attack. There is a limitation of this kind of process. At very high angles of attack, the reversed flow would cause the flap to tip forwards entirely and the effect of the flap would vanish. For recovering this limitation an idea of controlling the movement or rotation of the flap has been proposed in this paper. A light surface was selected as a flap and was coupled to the shaft of a servo motor, which was placed on a model airfoil. For controlling the angle of rotation of the motor as well as the flap arbitrarily, an electronic circuit comprising necessary components was designed and applied to the servo motor successfully.

  15. Droplet ejection and sliding on a flapping film

    Science.gov (United States)

    Chen, Xi; Doughramaji, Nicole; Betz, Amy Rachel; Derby, Melanie M.

    2017-03-01

    Water recovery and subsequent reuse are required for human consumption as well as industrial, and agriculture applications. Moist air streams, such as cooling tower plumes and fog, represent opportunities for water harvesting. In this work, we investigate a flapping mechanism to increase droplet shedding on thin, hydrophobic films for two vibrational cases (e.g., ± 9 mm and 11 Hz; ± 2 mm and 100 Hz). Two main mechanisms removed water droplets from the flapping film: vibrational-induced coalescence/sliding and droplet ejection from the surface. Vibrations mobilized droplets on the flapping film, increasing the probability of coalescence with neighboring droplets leading to faster droplet growth. Droplet departure sizes of 1-2 mm were observed for flapping films, compared to 3-4 mm on stationary films, which solely relied on gravity for droplet removal. Additionally, flapping films exhibited lower percentage area coverage by water after a few seconds. The second removal mechanism, droplet ejection was analyzed with respect to surface wave formation and inertia. Smaller droplets (e.g., 1-mm diameter) were ejected at a higher frequency which is associated with a higher acceleration. Kinetic energy of the water was the largest contributor to energy required to flap the film, and low energy inputs (i.e., 3.3 W/m2) were possible. Additionally, self-flapping films could enable novel water collection and condensation with minimal energy input.

  16. 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.

  17. Periodontal status following trapezoidal and semilunar flaps in apicectomy.

    Science.gov (United States)

    Chindia, M L; Valderhaug, J

    1995-09-01

    Apicectomy is offered where routine endodontics cannot resolve periapical inflammation. This study compared the influence on periodontal attachment level of two surgical procedures, the trapezoidal (TF) and the semilunar (SF) flaps. Twenty patients aged 16-44 years (mean 23.2 years), were randomly assigned to either flap procedure. Prior to surgery the patients received periodontal prophylaxis and oral hygiene instruction. Records were made of gingival indices, pocket depth and the distance from the cemento-enamel junction to the bottom of the gingival pocket. The measurements involved buccal surfaces of 13 to 23. The TF flap extended from 14 to 24 between the interdental papillae, whereas the SF flap was carried in a semi circle from 14 to 24 about 2mm from the attached gingiva. The surgical wounds were closed with black silk sutures. Antibiotics and analgesics were prescribed. Sutures were removed after one week. On recall after 6, 12 and 24 weeks the same measurements as before surgery were made. No statistically significant change was observed in pocket depth or attachment level between TF and SF flaps (p > 0.05). However, the TF flap produced less noticeable scarification than the SF flap.

  18. Treatment of vaginal stenosis with fasciocutaneous Singapore flap.

    Science.gov (United States)

    Clifton, Marisa M; Gurunluoglu, Raffi; Pizarro-Berdichevsky, Javier; Baker, Todd; Vasavada, Sandip P

    2017-03-01

    Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap. We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation. She subsequently developed a rectovaginal fistula requiring repair with a right-sided gracilis flap. When her stenosis recurred, she underwent vaginal reconstruction with a medial thigh flap. The Singapore flap is a pudendal thigh flap centered on the labial crural fold with a base at the perineal body. As the cutaneous innervation is spared, this flap is sensate. This technique is one option for patients with complex vaginal stenosis who have failed conservative management. However, it is imperative the patient perform vaginal dilation postoperatively and maintain close follow-up with her surgeon, as vaginal stenosis can recur. Postradiation vaginal stenosis is a complex condition to treat; however, vaginal reconstruction with a thigh flap can provide excellent cosmetic and functional results.

  19. Modified lumbar artery perforator flaps for gluteal pressure sore reconstruction.

    Science.gov (United States)

    Yoon, Chi Sun; Yim, Ji Hong; Kim, Min Ho; Ha, Won; Kim, Kyu Nam

    2016-03-21

    Gluteal perforator flaps (GPFs) are the most useful for gluteal region pressure sore reconstruction. However, application is difficult if the surrounding area has scar tissue from previous operations or trauma, especially with recurrent sores. We describe the use of modified lumbar artery perforator flaps when GPFs cannot be used. Between May 2009 and April 2014, 51 patients underwent gluteal pressure sore reconstructions with gluteal (n = 39) or modified lumbar artery (n = 12) perforator flaps. Patients in the modified lumbar artery perforator group had scar tissue from trauma or previous surgery. In this retrospective review, we analyzed patient age and sex, defect size and location, operative time, follow-up duration, immediate postoperative issues, flap necrosis, dehiscence, re-operation, donor-site morbidity and recurrence. Complications and clinical outcomes were compared between groups. We found no significant differences in patient demographics, surgical complications or clinical outcomes. There were eight cases of temporary congestion (20.51%) and four of partial flap necrosis (10.25%) in the gluteal perforator group. In the modified lumbar artery perforator group, there were three cases of temporary congestion (25%) and one of partial flap necrosis (8.33%). No pressure sores recurred during follow-up in either group. GPFs are the gold standards for gluteal pressure sores, but modified lumbar artery perforator flaps are relatively easy and useful when GPFs cannot be used due to scar tissue. © 2016 Royal Australasian College of Surgeons.

  20. The 'reading man flap' for pressure sore reconstruction.

    Science.gov (United States)

    Sapountzis, Stamatis; Park, Hyoung Joon; Kim, Ji Hoon; Chantes, Achilleas; Beak, Rong Min; Heo, Chan Yeong

    2011-09-01

    The treatment of pressure sores represents a significant challenge to health care professionals. Although, pressure wound management demands a multidisciplinary approach, soft tissue defects requiring reconstruction are often considered for surgical management. Myocutaneous and fasciocutaneous flaps can provide stable coverage of pressure sores. Here, we describe our experience using a recent fasciocutaneous flap, which is named 'reading man' flap, in sacral, ischial, and trochanteric pressure sores. During a period of 1 year the authors operated 16 patients, 11 men, and 5 women, using the reading man flap. The ages of the patients ranged from 24 to 78 years. The location of pressure sores was 8 sacral, 5 ischial, and 3 trochanteric pressure sores. The mean size of pressure sores was 8 cm × 9 cm. All pressure sores covered bt the Reading Man flap healed asymptomatically. After follow-up of 2-8 months, no recurrences were encountered and no further surgical intervention was required. The reading man flap was found to be a useful technique for the closure of pressure sore in different anatomic locations. The advantage of tension-free closure and the minimal additional healthy skin excision made this flap a useful tool in pressure sore reconstructions.

  1. Free jejunal flaps can be monitored by use of microdialysis.

    Science.gov (United States)

    Sorensen, Hanne Birke

    2008-08-01

    When new combinations of preoperative treatments of carcinoma of the esophagus are implemented, surgical morbidity and mortality become even more important risk factors. This study investigated whether the risk of postoperative complications caused by ischemia in the reconstructed esophagus can be reduced using microdialysis as monitoring method. This is a retrospective study of 14 patients undergoing resection of carcinoma in the upper part of the esophagus and reconstruction with a free jejunal flap. The metabolism in all 14 jejunal transfers was monitored by use of microdialysis. The data were analyzed looking for reliable parameters detecting critical ischemia. Critical ischemia was suspected in two cases. Both of these cases were surgically revised, ischemia in the jejunal flap was verified, and the jejunal flaps were revascularized. All 14 jejunal flaps survived. Using the concentration of glucose in the microdialysate, it was possible to detect the two cases of critical ischemia. Yet, the most reliable parameter seemed to be the retrospectively calculated lactate:glucose ratio; in both the ischemic flaps, the lactate:glucose ratio exceeded more than 1000% the maximum values found in all the nonischemic flaps. Microdialysis is a promising monitoring method for surveillance of free jejunal flaps.

  2. Reconstruction of the thumb tip using palmar neurovascular flaps.

    Science.gov (United States)

    Harenberg, P S; Jakubietz, R G; Jakubietz, M G; Schmidt, K; Meffert, R H

    2012-04-01

    Reconstruction of the tip of the thumb using a neurovascular flap. Transverse defects of the thumb's tip or large defects of the palmar pulp (max. 2.0-2.5 cm) with exposure of bone and/or tendons. Extensive crush injury, heavy wound contamination, circulatory disorders, acute infection, very large defects (> 2.0-2.5 cm finger length), circumferential soft tissue defects, and previous defects/operations (relative). Supine position, hand supinated, tourniquet, loupe magnification. Mid-lateral incisions along both sides of the finger running from the defect to the interphalangeal joint (small defect) or proceeding further proximally. Careful elevation of the flap including both neurovascular bundles leaving dorsal branches of the bundles (long fingers only) and the flexor tendon sheath intact. Suture of the flap in either flexion position (i.e., advancement flap) (Moberg) or by creating an island-flap through an additional transverse skin incision along the flap's base (O'Brien). Finally, closure of the defect at the flap's base using a full thickness skin graft, Z plasty, or V-Y plasty. Plaster cast (finger slightly flexed) for 2 weeks. Reliable method. Good functional results with good sensibility and only minor reduction in range of motion.

  3. Modified anterograde pedicle advancement flap in fingertip injury.

    Science.gov (United States)

    Lee, S H; Jang, J H; Kim, J I; Cheon, S J

    2015-11-01

    Soft tissue reconstruction is needed to maintain the maximum length of the fingers in fingertip injury. The purpose of this study was to present an anterograde pedicle advancement flap technique, for the treatment of fingertip injuries, which involved a modification to the anterograde advancement flap by the dissection of the digital nerve and artery with a pedicle to advance the flap. This technique was used in 12 fingers in patients who had undergone soft tissue reconstruction of fingertip injuries between January 2012 and October 2013. The sizes of the flaps ranged from 8 × 7 mm to 14 × 10 mm. The mean length of advancement was 9.7 mm (range 7-13). The mean value of the static two-point discrimination test of the healed flaps was 5.1 mm (range 4-6) and the flaps survived in all the 12 cases. The modified anterograde pedicle advancement flap provides a reliable coverage of sensate soft tissue without bone shortening in fingertip injuries.Level II. © The Author(s) 2014.

  4. CT 诊断肩背部弹力纤维瘤14例%CT Diagnosis of Elastofibroma Dorsi

    Institute of Scientific and Technical Information of China (English)

    贾承晔; 杨署; 王敏; 刘瑞

    2015-01-01

    目的:探讨肩背部弹力纤维瘤的CT表现。方法回顾性分析14例接受胸部CT检查并经手术病理证实的EFD患者,其中12例接受CT平扫,2例同时接受CT增强扫描。分析EFD的临床特点及CT表现特征。结果14例患者均为女性,临床表现病灶位于右侧4例、左侧8例、2例累及双侧。CT 共发现16个病灶,呈扁丘状或半圆形肿块,主要呈肌样密度,内见条纹状脂肪密度,增强扫描病灶未见明显强化。结论中老年女性单侧或双侧肩胛下角区无症状性扁丘状肿块,CT 表现为肌样密度伴条纹状脂肪密度无明显强化者,应考虑EFD。应双侧对照,以利于发现体表不易触及的亚临床阶段的病灶。%Objective To explore the CT findings of elastofibroma dorsi (EFD ) .Methods Fourteen pa-tients with EFD confirmed by pathology were collected retrospectively .All patients underwent plain chest CT , while 2 of them underwent contrast enhanced before surgery .clinicalfeatures and CT characteristics of EFD were、all analyzed .Results Fourteen patients were all female .Clinical manifestation shown that lesions were on theright side in 4 patients ,on the left in 8 patients ,and bilateral lesion were detected in 2 patients .Masses were flat mound-like or semi-circular ,mainly were muscular -like density ,and fat density were seen of masses ,pre-senting as spaced stripe .The lesion did not enhance in 2 patients .Conclusions EFD should be considered when unilateral or bilateral subscapular areas asymptomatic masses presenting as muscle -like with striated fatspaced , not enhancing were detected on CT in middle -aged women .Bilateral CT examination is necessary for detecting sub-clinical stage lesions .

  5. Transcript profiles in longissimus dorsi muscle and subcutaneous adipose tissue: a comparison of pigs with different postweaning growth rates.

    Science.gov (United States)

    Pilcher, C M; Jones, C K; Schroyen, M; Severin, A J; Patience, J F; Tuggle, C K; Koltes, J E

    2015-05-01

    Although most pigs recover rapidly from stresses associated with the transition of weaning, a portion of the population lags behind their contemporaries in growth performance. The underlying biological and molecular mechanisms involved in postweaning differences in growth performance are poorly understood. The objective of this experiment was to use transcriptional profiling of skeletal muscle and adipose tissue to develop a better understanding of the metabolic basis for poor weaned-pig transition. A total of 1,054 pigs was reared in commercial conditions and weighed at birth, weaning, and 3 wk postweaning. Transition ADG (tADG) was calculated as the ADG for the 3-wk period postweaning. Nine pigs from both the lowest 10th percentile (low tADG) and the 60th to 70th percentile (high tADG) were harvested at 3 wk postweaning. Differential expression analysis was conducted in longissimus dorsi muscle (LM) and subcutaneous adipose tissue using RNA-Seq methodology. In LM, 768 transcripts were differentially expressed (DE), 327 with higher expression in low tADG and 441 with higher expression in high tADG pigs (q muscle metabolism and physiology, functional annotation analysis of the DE transcripts was conducted using DAVID and Pathway Studio analytic tools. The group of DE genes with lower expression in LM of low tADG pigs was enriched in genes with functions related to muscle contraction, glucose metabolism, cytoskeleton organization, muscle development, and response to hormone stimulus (enrichment score > 1.3). The list of DE genes with higher expression in low tADG LM was enriched in genes with functions related to protein catabolism (enrichment score > 1.3). Analysis of known gene-gene interactions identified possible regulators of these differences in gene expression in LM of high and low tADG pigs; these include forkhead box O1 (FOXO1), growth hormone (GH1), and the glucocorticoid receptor (NR3C1). Differences in gene expression between poor transitioning pigs and

  6. 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.

  7. Subcutaneous pedicle propeller flap: An old technique revisited and modified!

    Directory of Open Access Journals (Sweden)

    Durga Karki

    2016-01-01

    Full Text Available Background: Post-burn axillary and elbow scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of abduction and extension that should be achieved, respectively, while treating either of the joint. The aim of this paper is to highlight the use of subcutaneous pedicle propeller flap for the management of post-burn axillary and elbow contractures. Methodology: This is a prospective case study of axillary and elbow contractures managed at a tertiary care hospital using propeller flap based on subcutaneous pedicle from 2009 to 2014. Surgical treatment comprised of subcutaneous-based pedicle propeller flap from the normal tissue within the contracture based on central axis pedicle. The flap was rotated axially to break the contracture. The technique further encompassed a modification, a Zig-Zag incision of the flap, which was seen to prevent hypertrophy along the incision line. There was a mean period of 12 months of follow-up. Results: Thirty-eight patients consisting of 22 males and 16 females were included in this study among which 23 patients had Type II axillary contractures and 15 had moderate flexion contractures at elbow joint. The post-operative abduction achieved at shoulder joint had a mean of 168° whereas extension achieved at elbow had a mean of 175°. The functional and aesthetic results were satisfactory. Conclusion: The choice of surgical procedure for reconstruction of post-burn upper extremity contractures should be made according to the pattern of scar contracture and the state of surrounding skin. The choice of subcutaneous pedicle propeller flap should be emphasised because of the superior functional results of flap as well as ease to learn it. Moreover, the modification of propeller flap described achieves better results in terms of scar healing. There is an inter-positioning of healthy skin in between the graft, so it prevents scar band formation all around the flap.

  8. Adipofascial Anterolateral Thigh Flap Safety: Applications and Complications

    Directory of Open Access Journals (Sweden)

    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.

  9. Role of ulnar forearm free flap in oromandibular reconstruction.

    Science.gov (United States)

    Gabr, E M; Kobayashi, M R; Salibian, A H; Armstrong, W B; Sundine, M; Calvert, J W; Evans, G R D

    2004-01-01

    The ulnar forearm flap is not frequently utilized for oromandibular reconstruction. This study evaluated the usefulness of the ulnar free flap for reconstruction. A retrospective study of 32 patients was conducted. The ulnar forearm flap was combined with an osseous flap in 24 patients. Nine females and 23 males with a mean age of 58.15 years comprised our study population. Squamous-cell carcinoma was the diagnosis in 93.75% of cases (56.25% T4), of which 20% were recurrent. Functional evaluation of swallowing was based on the University of Washington Questionnaire (UWQ). The mean hospital stay was 9.8 days. The external carotid (100%) was the recipient artery, and the internal jugular (74.07%) was the main recipient vein. Overall flap survival was 96.8%. One flap was lost due to unsalvageable venous thrombosis. Major local complications were seen in 9.4% of cases and included partial flap loss, hematoma, and an orocutaneous fistula. At the time of this study, 21 patients were available for functional evaluation. Speech was rated excellent and good in 33.3% of patients. Swallowing was found good in 28.6% of patients. Chewing was rated excellent and good in 47.6% of patients. Cosmetic acceptance was rated good in 71.4% of cases. The ulnar forearm is a useful free flap in oromandibular reconstruction. It is available when the radial artery is the dominant artery of the hand. Being more hidden, it may be more cosmetically accepted. It affords pliable soft tissue for lining and/or covering of oromandibular defects, and can be used as a second choice after other free-flap failures. Copyright 2004 Wiley-Liss, Inc.

  10. [Comparison of postmortal changes in the ultrastructure of the masseter muscle and the longissimus dorsi muscle in pigs with PSE-meat].

    Science.gov (United States)

    Bergmann, V

    1975-01-01

    Samples of the two muscles were taken from 8 Landrace fattened pigs, affected with pale, soft exudative meat, during stunning and 15, 30, 45 and 60 minutes after death; also 2, 3, 6, 12, 24 and 48 hours after slaughter, with storage at 20 degrees C for the first six hours and 2-5 degrees C subsequently. Considerable changes were found during the first hour after death, or even in samples taken during stunning, in longissimus dorsi samples. These consisted of destruction of mitochondria and sarcoplasmic reticulum, breakdown of cell membranes, liberation of clumps of fibre protein, disappearance of glycogen, rigor and destruction of capillaries. Such changes would account for the features of pale, soft exudative meat such as water loss, brief rigor, pale colour, deficiency of energy-rich phosphates. By contrast, in the masseter muscles of the same animal these changes did not occur until later, or were in port absent. In both muscle the breakdown of fibres took place by destruction of the "I" bands and the "Z" strips, and this process also commenced in longissimus dorsi before masseter.

  11. Developmental changes in the expression of the GLUT2 and GLUT4 genes in the longissimus dorsi muscle of Yorkshire and Tibetan pigs.

    Science.gov (United States)

    Liang, Y; Yang, X M; Gu, Y R; Tao, X; Zhong, Z Z; Gong, J J; Chen, X H; Lv, X B

    2015-02-13

    Glucose transporter proteins 2 and 4 (GLUT2 and GLUT4) play important roles in glucose transport and energy metabolism. Changes in the levels of GLUT2 and GLUT4 mRNA were measured in longissimus dorsi muscle from the lean Yorkshire and fat Tibetan pig breeds at six different time points (1, 2, 3, 4, 5, and 6 months) with quantitative real-time polymerase chain reactions. The results showed that GLUT2 and GLUT4 mRNA were abundantly expressed in the longissimus dorsi muscle and that the developmental expression patterns were similar in both breeds. Tibetan pigs exhibited higher intramuscular fat and GLUT2 mRNA levels, while Yorkshire pigs exhibited a higher myofiber cross-sectional area (CSA) and GLUT4 mRNA levels. Furthermore, the changes in the GLUT4 mRNA levels were strongly and positively correlated with the CSA over a period of six months. These results exhibit time- and breed-specific expression patterns of GLUT2 and GLUT4, which highlight their potential as candidate genes for assessing adipose deposition and muscle development in pigs. These differences in the expression of GLUT family genes may also have indications for meat quality.

  12. Risk Factors Leading to Free Flap Failure: Analysis From the National Surgical Quality Improvement Program Database.

    Science.gov (United States)

    Sanati-Mehrizy, Paymon; Massenburg, Benjamin B; Rozehnal, John M; Ingargiola, Michael J; Hernandez Rosa, Jonatan; Taub, Peter J

    2016-11-01

    The objective of this study was to identify risk factors for free flap failure among various anatomically based free flap subgroups. The 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing microvascular free tissue transfer based on current procedural terminology codes. Univariate analysis was performed to identify any association between flap failure and the following factors: age, gender, race, body mass index (BMI), diabetes, smoking, alcohol use, hypertension, intraoperative transfusion, functional health status, American Society of Anesthesiologists class, operative time, and flap location. Factors yielding a significance of P free flap reconstruction met inclusion criteria. Multivariate logistic regression identified BMI (adjusted odds ratio [AOR] = 1.07, P = 0.004) and male gender (AOR = 2.16, P = 0.033) as independent risk factors for flap failure. Among the "breast flaps" subgroup, BMI (AOR = 1.075, P = 0.012) and smoking (AOR = 3.35, P = 0.02) were independent variables associated with flap failure. In "head and neck flaps," operative time (AOR = 1.003, P = 0.018) was an independent risk factor for flap failure. No independent risk factors were identified for the "extremity flaps" or "trunk flaps" subtypes. BMI, smoking, and operative time were identified as independent risk factors for free flap failure among all flaps or within flap subsets.

  13. The relative survival of composite free flaps in head and neck reconstruction.

    Science.gov (United States)

    Van Genechten, M L V; Batstone, M D

    2016-02-01

    Various composite free flaps are available for reconstruction of bony head and neck defects. The aim of this study was to compare the relative success of four different bony free flaps. One hundred and seventy-three microvascular composite free flap reconstructions for bony defects of the head and neck region, performed over the period April 2008 to April 2015, were reviewed retrospectively. The type of free flap, indication for free flap reconstruction, age at harvesting of the free flap, use of pre- or postoperative radiotherapy, and free flap failure were examined. For the 173 reconstructions performed, 84 fibula free flaps, 43 iliac crest free flaps, 32 scapula free flaps, and 14 osteocutaneous radial forearm free flaps were harvested. The mean age at time of harvesting was 40.7 years for the iliac crest, 57.3 years for the fibula, 64.3 years for the scapula, and 73.9 years for the osteocutaneous radial forearm free flap. No complete free flap failure was documented, nor was there any failure of bony segments. Three fibula flap skin paddles did not survive. No returns to theatre for salvage were required. This study showed no difference in the survival rates of these four types of composite free flap.

  14. Does body mass index matter while selecting the flap type for pharyngeal reconstructions?

    Science.gov (United States)

    Calli, Caglar; Teknos, Theodoros N; Agrawal, Amit; Schuller, David E; Ozer, Enver; Songu, Murat

    2014-05-01

    The aim of our study was to investigate the effect of patient-related factors, such as the body mass index (BMI) and tumor size, in selecting the flap type for the reconstruction of pharyngeal defects. This retrospective review included 182 patients with pharyngeal defect reconstructions with free and pedicled flaps at the Ohio State University from January 2005 to December 2008. We conducted a retrospective comparison of variety of different flap reconstruction techniques. We compared different flap reconstruction with BMI and tumor size without functional outcome such as swallowing and speech data. Although there was no statistically significant correlation (P > 0.05) when comparing the free flaps with pedicled flaps according to the BMI and tumor size, there was an obvious tendency to prefer radial forearm free flap over anterolateral thigh free flap in patients who are overweight and those with obesity with a ratio of 32:3. In the same group of patients, a similar tendency was observed to prefer fibular free flap over iliac crest free flap with a ratio of 14:5, whereas the ratio was becoming 3:5 in favor of iliac crest free flap over fibular free flap in patients with BMI of 24 or lower. Despite the fact that surgeons' experience with a certain flap type is one of the most important factors while determining which flap to reconstruct, BMI might have a significant impact while selecting the free flap types for the reconstruction of pharyngeal defects.

  15. Successful femtosecond LASIK flap creation despite multiple suction losses

    Science.gov (United States)

    Syed, Zeba A.; Melki, Samir A.

    2014-01-01

    Summary We present a case of successful completion of a laser in situ keratomileusis (LASIK) procedure despite 5 episodes of suction loss during femtosecond flap creation in a 30-year-old man with no risk factors. The patient had an uncorrected distance visual acuity of 20/20 in both eyes at his 2-month follow-up visit. Our experience in this case shows that multiple suction losses during femtosecond LASIK flap creation do not preclude completion of a successful procedure with excellent visual outcomes. Caution and technique modification are advised if multiple laser passes are applied to avoid creating multiplanar flaps. PMID:25097457

  16. 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.

  17. 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.

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

    National Research Council Canada - National Science Library

    Liang, Yujie; Cui, Yaqi; Liao, Guiqing

    2015-01-01

    .... Although lateral upper arm free flap (LUFF) and radial forearm free flap (RFFF) are similar in texture and thickness, significant differences can be noticed in the donor-site function and surgical demands...

  19. Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps for breast reconstruction: a systematic review of flap complication rates and donor-site morbidity.

    Science.gov (United States)

    Sailon, Alexander M; Schachar, Jeffrey S; Levine, Jamie P

    2009-05-01

    Free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps represent increasingly popular options for breast reconstruction. Although several retrospective, small-scale studies comparing these flaps have been published, most have failed to find a significant difference in flap complication rates or donor-site morbidity. We systematically reviewed the current literature, and subsequently pooled and analyzed data from included studies. Included studies reported flap complications and/or donor site morbidities for both flap types. Eight studies met the inclusionary criteria. For flap complications, there was a statistically significant difference between deep inferior epigastric perforator and free transverse rectus abdominis myocutaneous flaps in fat necrosis rates (25.5 +/- 0.49 vs. 11.3% +/- 0.41%, P flap options.

  20. Rigid-body kinematics versus flapping kinematics of a flapping wing micro air vehicle

    OpenAIRE

    Caetano, J.V.; Weehuizen, M.B.; De Visser, C.C.; De Croon, G.C.H.E.; de Mulder, M.

    2015-01-01

    Several formulations have been proposed to model the dynamics of ornithopters, with inconclusive results regarding the need for complex kinematic formulations. Furthermore, the impact of assumptions made in the collected results was never assessed by comparing simulations with real flight data. In this study two dynamic models of a Flapping Wing Micro Aerial Vehicle (FWMAV) were derived and compared: a) single rigid body aircraft equations of motion and b) Virtual Work Principle derivation fo...

  1. Versatility of the Anterolateral Thigh Free Flap: The Four Seasons Flap

    OpenAIRE

    Di Candia, Michele; Lie, Kwok; Kumiponjera, Devor; Simcock, Jeremy; Cormack, George C.; Charles M. Malata

    2012-01-01

    Presented at the following academic meetings: ○ 56th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery (SICPRE) Fasano (Brindisi), Italy, September 26-29, 2007 ○ 42nd Meeting of the European Society for Surgical Research (ESSR), Warsaw, Poland, May 21-24, 2008 ○ Winter Meeting, British Association of Plastic, Reconstructive and Aesthetic Surgeons, (BAPRAS) London, December 1-3, 2009 Background: The anterolateral free flap has become increasingly popular at our in...

  2. Flapping wing micro-aerial-vehicle:Kinematics, membranes, and flapping mechanisms of ornithopter and insect flight

    Institute of Scientific and Technical Information of China (English)

    Mohd Firdaus Bin Abas; Azmin Shakrine Bin Mohd Rafie; Hamid Bin Yusoff; Kamarul Arifin Bin Ahmad

    2016-01-01

    The application of biomimetics in the development of unmanned-aerial-vehicles (UAV) has advanced to an exceptionally small scale of nano-aerial-vehicles (NAV), which has surpassed its immediate predecessor of micro-aerial-vehicles (MAV), leaving a vast range of development possi-bilities that MAVs have to offer. Because of the prompt advancement into the NAV research devel-opment, the true potential and challenges presented by MAV development were never solved, understood, and truly uncovered, especially under the influence of transition and low Reynolds number flow characteristics. This paper reviews a part of previous MAV research developments which are deemed important of notification; kinematics, membranes, and flapping mechanisms ranges from small birds to big insects, which resides within the transition and low Reynolds number regimes. This paper also reviews the possibility of applying a piezoelectric transmission used to pro-duce NAV flapping wing motion and mounted on a MAV, replacing the conventional motorized flapping wing transmission. Findings suggest that limited work has been done for MAVs matching these criteria. The preferred research approach has seen bias towards numerical analysis as com-pared to experimental analysis.

  3. Flapping wing micro-aerial-vehicle: Kinematics, membranes, and flapping mechanisms of ornithopter and insect flight

    Directory of Open Access Journals (Sweden)

    Mohd Firdaus Bin Abas

    2016-10-01

    Full Text Available The application of biomimetics in the development of unmanned-aerial-vehicles (UAV has advanced to an exceptionally small scale of nano-aerial-vehicles (NAV, which has surpassed its immediate predecessor of micro-aerial-vehicles (MAV, leaving a vast range of development possibilities that MAVs have to offer. Because of the prompt advancement into the NAV research development, the true potential and challenges presented by MAV development were never solved, understood, and truly uncovered, especially under the influence of transition and low Reynolds number flow characteristics. This paper reviews a part of previous MAV research developments which are deemed important of notification; kinematics, membranes, and flapping mechanisms ranges from small birds to big insects, which resides within the transition and low Reynolds number regimes. This paper also reviews the possibility of applying a piezoelectric transmission used to produce NAV flapping wing motion and mounted on a MAV, replacing the conventional motorized flapping wing transmission. Findings suggest that limited work has been done for MAVs matching these criteria. The preferred research approach has seen bias towards numerical analysis as compared to experimental analysis.

  4. Transpositional flap technique for mandibular vestibuloplasty.

    Science.gov (United States)

    Wessberg, G A; Hill, S C; Epker, B N

    1979-06-01

    Various surgical techniques for a mandibular vestibuloplasty have been advocated. A transpositional labial flap technique used by us for 23 patients since May 1976, and based on a procedure described by Edlan, has been presented with results of nine-month follow-up examinations of six patients. Clinical, radiographic, and histological evaluations completed at three-month intervals showed that this transpositional vestibuloplasty compared favorably with other similar techniques in postoperative time of healing, condition of attached mucosa, stability of increased vestibular depth, and amount of resorption of labial bone. Advantages of this procedure over other mandibular vestibuloplasty techniques are its simplicity, low morbidity, decreased operating time, feasibility of use of local anesthesia and conscious sedation on an outpatient basis, and elimination of the need for a graft. The disadvantage of the procedure is that it requires healthy preexisting vestibular mucosa for optimal results.

  5. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    Science.gov (United States)

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  6. 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

  7. 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

  8. Revisit of Nasolabial Flap in the Reconstruction of Defects Involving ...

    African Journals Online (AJOL)

    Departments of Oral and Maxillofacial Surgery, MGV's K.B.H. Dental College, Nashik, Maharashtra, ... free radial forearm flap techniques for oral floor reconstruction, the ... status do not permit a lengthy anesthetic and surgical procedure,.

  9. Superficial Circumflex Iliac Artery Perforator Flap for Dorsalis Pedis Reconstruction.

    Science.gov (United States)

    Tashiro, Kensuke; Yamashita, Shuji

    2017-04-01

    Reconstruction of dorsalis pedis with soft tissue is challenging because it needs to preserve thin structure to ensure that the patient will be able to wear shoes. Here, we report the use of a thin superficial circumflex iliac artery perforator (SCIP) flap in dorsalis pedis reconstruction. A 67-year-old man presented with a third-degree burn, which exposed his extensor tendons. A thin SCIP flap from the left inguinal region measuring 15 × 4 cm was transferred to the dorsalis pedis region. Postoperatively, no major cosmetic or functional problems were observed. Because the invasiveness of the donor site is nearly same between SCIP flap and skin graft from inguinal region, SCIP flap is better solution in point of textural qualities for dorsalis pedis reconstruction.

  10. extended pedicle rectus abdominis myocutaneous flap for groin

    African Journals Online (AJOL)

    Damary

    2005-03-10

    Mar 10, 2005 ... a flabby and redundant abdominal tissue is used as a huge extended ... functional muscle in head and neck. This flap is ... the aneurysm and adjacent muscle planes. The distal ... Histology of the excised portion of aneurysmal.

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

    Directory of Open Access Journals (Sweden)

    Han Wei

    2016-01-01

    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.

  12. A totally laparoscopic peritoneal free flap for reconstruction of hand

    Institute of Scientific and Technical Information of China (English)

    En-Qi Guo; Qing-Ping Xie

    2016-01-01

    Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons.Here,we present a case of hand reconstruction with a totally laparoscopic peritoneal flap.The anterior rectus sheath was preserved in situ.The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand.The defect of the dorsal hand was 17 cm × 12 cm.The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications.A following split-thickness skin graft offered the successful wound closure.Motor and sensory function improved gradually within the first year follow-up.The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue defects accompanied by exposed tendons on the hand and foot.

  13. Regional Myocutaneous Flaps for Head and Neck Reconstruction ...

    African Journals Online (AJOL)

    the costs of free and regional flap surgery, the reality in limited. Table 5: Variables ... tissue bulk, limited pedicle length and arc of rotation, as well as reduced shoulder ... Acknowledgment. Nursing Staff of the Department of OMFS, LASUTH.

  14. The Use of Frozen Autogenous Bone Flap for Cranioplasty

    Directory of Open Access Journals (Sweden)

    Houshang Moin

    2005-11-01

    Full Text Available Background: The artificial methods of cranioplasty such as using metals or alloplastic materials have some disadvantages, comparning with autogenic bone flaps. We tried to show that the autogenic flaps have less complications when used in cranioplasty. Methods: With good sealing of bone flap after extraction and preserving in -70 to -800 C, in Immounology Department, the autogenic bone was fixed in the previous site. Results: From 10 patients, one of them developed infection and osteomyelitic bone was extracted. No bone resorption was detected. Background: Comparing with other studies of autogenous bone flap cranioplasty, we have similar rate of complication. In other studies, the rate of infection was almost equal to our results. So using autogenous bone in our center is advisable. Key words: cranioplasty, autogenous bone, frozen bone, infection

  15. 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.

  16. 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.

  17. 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.

  18. Lift enhancement by dynamically changing wingspan in forward flapping flight

    Science.gov (United States)

    Wang, Shizhao; Zhang, Xing; He, Guowei; Liu, Tianshu

    2014-06-01

    Dynamically 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 for biologically inspired dynamic morphing wings. Numerical simulations of the low-Reynolds-number flows around the flapping morphing wing are conducted in a parametric space by using the 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 by both changing the lifting surface area and manipulating the flow structures responsible to the vortex lift generation. The physical mechanisms behind the lift enhancement are explored by examining the three-dimensional flow structures around the flapping wing.

  19. Application analysis on different suture of scleral flap in trabeculectomy

    Directory of Open Access Journals (Sweden)

    Ning Liu

    2014-05-01

    Full Text Available AIM: To research the application of scleral flap suture in trabeculectomy. METHODS: Totally 114 primary angle-closure glaucoma patients, aged from 36-72 years old, were selected as the objects, and randomly divided into research group and control group. The two groups received different administration methods. Traditional sewing method of sclera flap was used in research group and improved sewing method of sclera flap was used in control group. RESULTS: There was statistical differences between postoperative intraocular pressure of the patients in the observation group and the control group after 1d; 2wk; 1, 3mo(PPP>0.05.CONCLUSION: It is safe and effective that the improved sewing method of sclera flap for trabeculectomy of acute angle-closure glaucoma, and it is a better method to avoid the occurrence of shallow anterior chamber than the traditional sewing method in the early stage after operation.

  20. 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.