Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Handy locoregional flaps for nasal reconstruction

Background Skin lesions on the nose are common.Multiple surgical techniques have been used for nasal reconstruction.These options may be autogenous or alloplastic and can be performed in single or multiple stages.The choice of coverage depends on the nature of the lesion,location on the nose,and available donor sites.This study aimed to evaluate the surgical outcomes of using locoregional flaps for nasal reconstruction.Methods A total of 27 patients underwent surgery.There were 9 men and 18 women,aged 7 months to 93 years.Four patients presented with involuting hemangioma,five patients with ischemic necrosis of the columella,and five patients with congenital nevus;the remaining 13 patients were previously diagnosed with basal cell carcinoma.Six techniques have been described for nasal reconstruction at our institution from 2016 to 2020.Most patients had basal cell carcinoma(n=13).Locoregional flaps and primary sutures were used for nasal reconstruction.Results The complications were minimal.One patient had a superficial infection and one experienced postoperative bleeding.No recurrence was observed,and none of the patients asked for a second opinion.Conclusion Radical excision of tumors combined with analysis of nasal defects and nearby donor sites is essential for nasal reconstruction.The use of locoregional flaps leads to consistent and good aesthetic outcomes.

Influence of Flap Parameters on the Aerodynamic Performance of a Wind-Turbine Airfoil

A numerical method has been used to analyze the flow field related to a NACA 0015 airfoil with and without a flap and assess the influence of the flap height and angle on the surface pressure coefficient,lift coefficient,and drag coefficient.The numerical results demonstrate that the flap can effectively improve the lift coefficient of the airfoil;however,at small attack angles,its influence is significantly reduced.When the angle of attack exceeds the critical stall angle and the flap height is 1.5%of the chord length,the influence of the flap becomes very evident.As the flap height increases,the starting point of the separation vortex gradually moves forward and generates a larger wake vortex.Optimal aerodynamic characteristics are obtained for 1.5%(of the chord length)flap height and a 45°flap angle;in this case,the separation vortex is effectively reduced.

In-situ measurement via the flow-through method and numerical simulations for radon exhalation during measurements of the radon exhalation rate

Small-scale measurements of the radon exhalation rate using the flow-through and closed-loop methods were conducted on the surface of a uranium tailing pond to better understand the differences between the two methods.An abnormal radon exhalation behavior was observed,leading to computational fluid dynamics(CFD)-based simulations in which dynamic radon migration in a porous medium and accumulation chamber was considered.Based on the in-situ experimental and numerical simulation results,variations in the radon exhalation rate subject to permeability,flow rate,and insertion depth were quantified and analyzed.The in-situ radon exhalation rates measured using the flow-through method were higher than those measured using the closed-loop method,which could be explained by the negative pressure difference between the inside and outside of the chamber during the measurements.The consistency of the variations in the radon exhalation rate between the experiments and simulations suggests the reliability of CFD-based techniques in obtaining the dynamic evolution of transient radon exhalation rates for diffusion and convection at the porous medium-air interface.The synergistic effects of the three factors(insertion depth,flow rate,and permeability)on the negative pressure difference and measured exhalation rate were quantified,and multivariate regression models were established,with positive correlations in most cases;the exhalation rate decreased with increasing insertion depth at a permeability of 1×10^(−11) m^(2).CFD-based simulations can provide theoretical guidance for improving the flow-through method and thus achieve accurate measurements.

Mass Transfer-Promoted Fe^(2+)/Fe^(3+)Circulation Steered by 3D Flow-Through Co-Catalyst System Toward Sustainable Advanced Oxidation Processes

Realizing fast and continuous generation of reactive oxygen species(ROSs)via iron-based advanced oxidation processes(AOPs)is significant in the environmental and biological fields.However,current AOPs assisted by co-catalysts still suffer from the poor mass/electron transfer and non-durable promotion effect,giving rise to the sluggish Fe^(2+)/Fe^(3+)cycle and low dynamic concentration of Fe^(2+)for ROS production.Herein,we present a three-dimensional(3D)macroscale co-catalyst functionalized with molybdenum disulfide(MoS_(2))to achieve ultra-efficient Fe^(2+)regeneration(equilibrium Fe^(2+)ratio of 82.4%)and remarkable stability(more than 20 cycles)via a circulating flow-through process.Unlike the conventional batch-type reactor,experiments and computational fluid dynamics simulations demonstrate that the optimal utilization of the 3D active area under the flow-through mode,initiated by the convectionenhanced mass/charge transfer for Fe^(2+)reduction and then strengthened by MoS_(2)-induced flow rotation for sufficient reactant mixing,is crucial for oxidant activation and subsequent ROS generation.Strikingly,the flow-through co-catalytic system with superwetting capabilities can even tackle the intricate oily wastewater stabilized by different surfactants without the loss of pollutant degradation efficiency.Our findings highlight an innovative co-catalyst system design to expand the applicability of AOPs based technology,especially in large-scale complex wastewater treatment.

Nasal flap preservation in endoscopic dacryocystorhinostomy for nasolacrimal duct obstruction

AIM:To compare surgical outcomes between the conventional endoscopic dacryocystorhinostomy(DCR)and a modified endoscopic DCR for the treatment of nasolacrimal duct obstruction(NLDO),and evaluate factors associated with the surgical success rate.METHODS:Medical records of patients who underwent primary DCR surgery between January 2016 and July 2020 at the Otorhinolaryngology Department of Eye and Ear International Hospital,Lebanon were reviewed.RESULTS:The study group consisted of 50 consecutive modified endoscopic DCR and the control group consisted of 138 consecutive conventional endoscopic DCR.The success rates at 1y were 98.0%(49 out of 50)for modified DCR,significantly higher compared to 84.8%(117/138)for the conventional DCR;there was no significant difference in the success rate throughout the years in terms of both surgical techniques.The modified surgery vs traditional[adjusted odds ratio(aOR)=14.96]and having an adjunctive septoplasty surgery vs not(aOR=3.99)were significantly associated with higher odds of success.CONCLUSION:Mucosal flap preservation and apposition shows significant improvement in the surgical success rate.Moreover,there is no statistically significant difference found in terms of complication rate and mean operative time between the conventional and the modified techniques.

游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的应用

目的探讨游离股前外侧Flow-through皮瓣在手部复杂性断指再植创面修复中的临床应用及疗效。方法2016年5月-2022年11月,应用股前外侧Flow-through皮瓣急诊修复15例手部复杂性断指再植创面。通过旋股外侧降支动脉主干或穿支串联断指,完成复杂性断指血运重建,其中皮肤软组织缺损面积:7.0 cm×8.0 cm~12.0 cm×23.0 cm,主干血管缺损长度3.5~10.0 cm,对于合并血管、神经或肌腱缺损者,行血管移植、神经移植或携带阔筋膜张肌重建,合并手部死腔嵌合穿支肌皮瓣移植修复,术后门诊或微信随访分析患指及皮瓣情况评估并指导锻炼。结果除1例断指再植坏死,其余皮瓣及断指再植全部成活。患者均获得随访,随访时间6~24个月,断指及皮瓣成活质量良好,皮瓣厚度与周围皮肤接近,质地柔软,无严重瘢痕,恢复部分保护性感觉;断指指体轻度萎缩,恢复指体外形,功能恢复满意,两点辨别觉达5~11 mm;末次随访时根据中华医学会手外科学会上肢部分功能评定试用标准评定再植指功能:优3例,良9例,可2例,差1例,优良率达80%。结论应用游离股前外侧Flow-through皮瓣急诊修复手部复杂性断指再植创面,利用旋股外侧动脉降支或分支与缺损的主干动脉桥接,实现了重建远端血液循环及覆盖创面的双重功能,明显缩短手术时间,提高皮瓣及指体血运重建率,效果良好,值得临床推广。

When the Combination of a Chinese Flap and Dufourmentel Makes It Possible to Treat a Hopeless Case of Squamous Cell Carcinoma of the Upper Lip

Cancers of the lip are the leading cause of labial defects, and treatment is essentially surgical. The success of a repair is assessed by two essential criteria: The functional character of the lip (restoration of continence allowing feeding) and the aesthetic quality of the repair. However, for many patients from countries whose medical infrastructure does not allow them to undertake complex reconstructions locally, medical transfers represent their only chance of treatment. The aim of this article is to share with you an extreme clinical case of labial reconstruction, the management of which was a real challenge, using two major flaps: the free ante-brachial flap and the DUFOURMENTEL-type bi-pediculated scalp flap.

Impact of Blade-Flapping Vibration on Aerodynamic Characteristics of Wind Turbines under Yaw Conditions

Although the aerodynamic loading of wind turbine blades under various conditions has been widely studied,the radial distribution of load along the blade under various yaw conditions and with blade flapping phenomena is poorly understood.This study aims to investigate the effects of second-order flapwise vibration on the mean and fluctuation characteristics of the torque and axial thrust of wind turbines under yaw conditions using computational fluid dynamics(CFD).In the CFD model,the blades are segmented radially to comprehensively analyze the distribution patterns of torque,axial load,and tangential load.The following results are obtained.(i)After applying flapwise vibration,the torque and axial thrust of wind turbines decrease in relation to those of the rigid model,with significantly increased fluctuations.(ii)Flapwise vibration causes the blades to reciprocate along the axial direction,altering the local angle of attack and velocity of the blades relative to the incoming wind flow.This results in the contraction of the torque region from a circular shape to a complex“gear”shape,which is accompanied by evident oscillations.(iii)Compared to the tangential load,the axial load on the blades is more sensitive to flapwise vibration although both exhibit significantly enhanced fluctuations.This study not only reveals the impact of flapwise vibration on wind turbine blade performance,including the reduction of torque and axial thrust and increased operational fluctuations,but also clarifies the radial distribution patterns of blade aerodynamic characteristics,which is of great significance for optimizing wind turbine blade design and reducing fatigue risks.

Management of Square Carcinoma of the Lower Lip Using Camille-Bernard Flap under Local Anesthesia: When Constraints Dictate Our Attitude

Introduction: Squamous cell carcinomas of the lip essentially pose a therapeutic management problem. In the West, their treatment is done under general anesthesia and follows the classic rules of oncology. In our context of exercise, we sometimes have a different attitude dictated by various constraints. Observation: 55-year-old patient with no notable history, seen in consultation for a very large ulcerative-budding lesion on the right 2/3 of the lower lip with mucocutaneous involvement without lymph node findings found on examination. Faced with this suspicious lesion and the patient’s financial difficulties, we decided to operate under local anesthesia to remove this tumor. The oncological excision was followed by immediate plasty using a Camille-Bernard flap with a good immediate aesthetic and functional result and postoperative day 7. The patient was unable to take his surgical specimen to anatomy-pathology and was lost to follow-up due to lack of financial resources. On anatomo-pathological analysis of the surgical specimen, the margins were healthy with confirmation of squamous cell carcinoma (anapathological reading made for scientific interest). Discussion: The particular mentality of certain patients and their difficult financial conditions push us to have an unconventional therapeutic attitude in oncology, but which nevertheless makes it possible to resolve certain problems that we often face. Local anesthesia is possible and realistic in cases like ours and the results can be acceptable and life-saving.

股前外侧Flow-through皮瓣修复下肢大面积缺损合并主干动脉缺损

目的探讨应用股前外侧Flow-through皮瓣修复下肢大面积缺损合并主干动脉缺损的临床疗效。方法2017年9月-2022年3月,应用股前外侧Flow-through皮瓣修复下肢大面积缺损并主干动脉缺损10例,其中合并胫后动脉缺损7例,胫前动脉缺损3例。一期行骨折外固定,VSD覆盖创面,二期行股前外侧Flow-through皮瓣修复术。结果10例皮瓣均成活,1例皮瓣远端少许坏死,经换药后伤口愈合,2例术后出现静脉危象,探查后皮瓣成活。随访8~24个月,平均15个月,皮瓣外观质地良好,5例因皮瓣臃肿行皮瓣修整。供区除伤口瘢痕及色素沉着外,未出现功能影响等并发症。结论股前外侧Flow-through皮瓣穿支可靠,血管蒂长,轴心血管管径粗,可重建主干血管,是修复下肢大面积缺损合并主干动脉缺损的较好选择。

Evaluation of the versatility of perforators-enhanced rhomboid flap technique for ischial sores reconstruction

Background: Prolonged pressure on the skin known as pressure sores, can cause frequent injuries to the skin and underlying tissues. However, several prevention approaches, including non-surgical and surgical management,are available. In flap surgery for pressure sores, a variety of flap types may be used;each offers certain benefits and some incidences of complications and recurrence. This study evaluated the versatility of the perforatorenhanced rhomboid flap technique for ischial sore construction.Methods: This prospective study was conducted in the Plastic Surgery Department of Fayoum University Hospital.The perforator-enhanced rhomboid flap technique was employed in 20 patients with ischial pressure sores who failed to respond to conservative treatment. A proper history was obtained and a preoperative arterial duplex was performed to determine the site of the prominent perforators for their preservation at the base of the flap.Postoperative follow-ups and evaluations were performed.Results: The mean age of the study group was 43.7 ± 13.1, ranging from 19 to 65 years. Moreover, 80% of the participants were males while 20% were female. The main etiology of the sores was paraplegia in 45% of cases.The mean surface area of sores was 24.8 ± 6.3 cm2. In 75% of cases, the color match of the flap was rated as excellent. Similarly, 70% of the patients rated flap thickness as excellent. In 55% of the cases, the scar appearance was deemed excellent. Overall satisfaction was reported as excellent by 40% of the patients, while only 5% reported poor satisfaction. Approximately, 10% of the cases were identified with seroma, and 30% had wound dehiscence of a mean size of 1.33 ± 0.98 cm and required around 6.8 ± 1.9 weeks to heal.Conclusion: The perforator-enhanced rhomboid flap technique is a versatile method for reconstructing ischial pressure sores owing to its technical ease, short operative time, reliable vascularity, aesthetic outcome, matching skin color, and short recovery time. The main limitations include large defects with large surface areas, lack of a nearby donor site for a rhomboid flap, and scarring from prior procedures around the sore.

Adaptability of bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection

Background:Several reconstructive techniques have been used to reconstruct scalp defects.Numerous researchers have studied the utilization of bipedicled scalp advancement flaps for scalp defect coverage.In this study,we will assess the adaptability of a bipedicled scalp advancement flap for coverage of huge scalp defects after tumor resection.Methods:This study was performed at the Plastic Surgery Department,Fayoum University Hospital,on 20 patients with huge scalp tumors treated by adequate excision and reconstructed using a bipedicled scalp advancement flap from December 2021 to July 2023.Results:The study was conducted on 20 patients:16(80%)were men and 4(20%)were women presenting with large scalp tumors.The mean age was 57.4 years(33-68 years).The sites of the tumors were 10(50%)occipital,6(30%)parietal,and 4(20%)parieto-occipital.No major complications occurred postoperatively,and the bipedicled flaps survived well in all cases,with no necrosis.Conclusion:Huge scalp defects after tumor resection can be safely reconstructed with a large versatile bipedicled advancement scalp flap,either transversely or longitudinally oriented,with favorable functional results and accepted aesthetic results,apart from the alopecic area over the grafted donor site,which can be treated by tissue expansion if desired later.

游离尺动脉腕上皮支flow-through皮瓣修复手指软组织缺损

手部致伤原因众多,导致的手部软组织缺损也呈现多样化,其中伴有指动脉损伤的手指软组织缺损占有较大比例。以往修复此类创伤先用静脉血管移植修复指动脉后,再采用其他多种方式,如邻指皮瓣、腹部带蒂皮瓣、掌背动脉皮瓣、逆行指动脉皮瓣、静脉动脉化皮瓣等修复[1]。但该类手术操作繁琐,术中需于前臂尺侧切取静脉血管移植,造成额外瘢痕存留,且增加手术操作时间。另外,采用腹部带蒂皮瓣,仍需等待3~4周方能断蒂,治疗周期较长,手术效果难以达到患者预期目标,患者认可度差。因此,采用一种既能够同时修复指动脉及手指软组织缺损又能缩短治疗周期的方法就显得十分必要。本文采用游离尺动脉腕上皮支flow-through皮瓣修复手指软组织缺损患者12例,取得了较好的效果。

Pedicled abdominal flap using deep inferior epigastric artery perforators for forearm reconstruction: A case report

BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.

Using Mustardé Flap for Reconstruction of a Traumatic Facial Injury: Case Report

Flaps become the first option when primary closure is not possible, using them to reduce the tension in the closure, as well as improving the texture and color, which ends in having a better aesthetic outcome. The Mustardé flap is a flap used for the cheek and lower eye lid defects. We present a 26-year-old male with an avulsive wound in the right maxillary region, with no bone injuries, taken to the operative room performing a Mustardé Flap for reconstruction of the defect area. Patient completed a 7-day antibiotic regimen, using non-steroid anti-inflammatories for pain, wound cleaning and flap hydration with mineral oil, subsequently having an adequate clinical and aesthetic evolution. Conclusion: The Mustardé flap can be a useful pedicled flap for the reconstruction of full-thickness defects.

Lateral circumflex femoral artery perforator flap for the reconstruction of head soft tissue defects:Cross-region venous anastomosis

Background:Owing to its unique characteristics,the lateral circumflex femoral artery perforator(LCFAP)flap is often preferred for repairing head wounds with exposed skulls.However,given the vascular distribution in the head,particularly the veins,can lead to postoperative complications such as venous congestion of the flap.The rates of vascular exploration and necrosis in these flaps are significantly higher than in other body regions.Therefore,it is crucial to identify a safe and effective method for venous anastomosis of free flaps in the head region.Methods:This retrospective case series study included 10 patients with large head soft tissue defects treated at the Burn and Plastic Surgery Department of the Affiliated Hospital of Zunyi Medical University from January 2020 to December 2022.The head defects were reconstructed using LCFAP flaps,with flap veins anastomosed to the external jugular vein in the neck,either directly or via a bridging technique.Results:Among the 10 adult patients with massive head wound defects,7(70%)were men.The patients’mean age was 53.0 years(48–59 years).The wound defects were caused by trauma in 6(60%)patients and by tumors in 4(40%)patients.Postoperatively,no significant complications occurred,and all LCFAP flap survived without necrosis.Conclusion:The descending branch of the LCFAP flap effectively repairs massive head wound defects.The venous anastomosis method for this flap is associated with a low incidence of venous complications and a high patency rate,making it a clinically valuable reference.

Thrust Optimization of Flapping Wing via Gradient Descent Technologies

The current work aims at employing a gradient descent algorithm for optimizing the thrust of a flapping wing. An in-house solver has been employed, along with mesh movement methodologies to capture the dynamics of flow around the airfoil. An efficient framework for implementing the coupled solver and optimization in a multicore environment has been implemented for the generation of optimized solutionsmaximizing thrust performance & computational speed.

Unusual Anterolateral Fascio Cutaneous Tight Flap for Extremity Soft Tissue Reconstruction

Soft tissue sarcoma is rare neoplasms that affect mainly the extremities. Surgery is the mean treatment and the resection results in extensive muscle and skin loss. The anterolateral tight flap is a good option for sarcomas arising in knees, superior third of legs and the medial face of thigh. The anatomy knowledge and the multidisciplinary approach is very important for a successful reconstruction. The authors report a successful case treated with the anterolateral tight flap and a literature review.