Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileu...Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileusis(LASIK)surgery.Epithelial ingrowth is a known complication of LASIK surgery,typically manageable with minimal measures.However,severe cases may necessitate more aggressive interventions,such as flap amputation[1].LASIK is a widely performed refractive surgery with high success rates and excellent visual outcome[2].展开更多
Modeling the dynamics of flapping wing aerial vehicle is challenging due to the complexity of aerodynamic effects and mechanical structures.The aim of this work is to develop an accurate dynamics model of flapping win...Modeling the dynamics of flapping wing aerial vehicle is challenging due to the complexity of aerodynamic effects and mechanical structures.The aim of this work is to develop an accurate dynamics model of flapping wing aerial vehicle based on real flight data.We propose a modeling framework that combines rigid body dynamics with a neural network to predict aerodynamic effects.By incorporating the concept of flapping phase,we significantly enhance the network’s ability to analyze transient aerodynamic behavior.We design and utilize a phase-functioned neural network structure for aerodynamic predictions and train the network using real flight data.Evaluation results show that the network can predict aerodynamic effects and demonstrate clear physical significance.We verify that the framework can be used for dynamic propagation and is expected to be utilized for building simulators for flapping wing aerial vehicles.展开更多
Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may b...Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may be challenging because of the radiation damage to regional tissues.As a result,distant free flaps may be an optimal choice.For instance,the gracilis muscular free flap(GMFF)has consistent vascular anatomy and can be used to reconstruct small defects.We report three cases of uncontrolled ORN-TB requiring an extensive temporal bone resection followed by vascularized obliteration with a GMFF.The patients reported complete control of the main otologic symptoms(otorrhea,otalgia,and aural fullness)and optimal functional and aesthetic outcomes.Finally,the patients reported significant improvement in quality of life despite early postoperative complications.To our knowledge,the GMFF had not been used to obliterate temporal bone defects in patients with ORN-TB.展开更多
The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The sur...The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The surnames and given names of these authors are reversed:Saro-Buendía Miguel,Andresen-Lorca Belén,Pérez-García Alberto,Llópez Carratala Nacho,Carreres Polo Joan,Armengot Carceller Miguel,Perolada Valmaña Jose María.It should be Miguel Saro-Buendía,Belén Andresen-Lorca,Alberto Pérez-García,Nacho Llópez Carratala,Joan Carreres Polo,Miguel Armengot Carceller,Jose María Perolada Valmaña.展开更多
Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside a...Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.展开更多
Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperati...Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.展开更多
Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for reconstructive procedures in the chest has many advantages. Yet, despite the excellent reported results, the use of DF has not been w...Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for reconstructive procedures in the chest has many advantages. Yet, despite the excellent reported results, the use of DF has not been widespread. Some factors for the less widespread use of DF have been, concern about diaphragmatic function, hesitation to use such a vital muscle for reconstructive purposes, and most importantly, the technical aspects for the preparation of the flap. Methods: Using a cadaveric model, the vascular anatomy of the diaphragm and the steps for the preparation of the DF was defined and illustrated for both the right and left hemidiaphragm. Results: No perioperative mortality with the use of DF has been recorded. Function of the native diaphragm has not been impaired. Bronchopleural fistulas and pericardial defects have healed in all instances. Excellent repair has been achieved in all patients with esophageal lesions. The disruption of the repaired native diaphragm and visceral herniation has been reported but it has been attributed to the learning curve and the technique of repair. Conclusion: With a better understanding of the vascular anatomy of the diaphragm and a formal methodical approach to harvesting the DF, more surgeons will be encouraged to use DF with excellent results.展开更多
There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer...There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.展开更多
Cicatricial ectropion of the eyelid is an eversion of its edge, which has moved away from the globe. It is frequently the result of cicatricial retraction after trauma. The main risk is the occurrence of a corneal ulc...Cicatricial ectropion of the eyelid is an eversion of its edge, which has moved away from the globe. It is frequently the result of cicatricial retraction after trauma. The main risk is the occurrence of a corneal ulcer or chronic conjunctivitis. Their treatment is often difficult, especially when the ectropion is old and significant. There are several classic techniques for correcting cicatricial ectropions, but the technique of the myocutaneous flap combined with external tarsorrhaphy without damage to the canthal ligament is minimally invasive, not very widespread, yet responds very well to the rules of plastic surgery. We report two cases of post-traumatic cicatricial ectropions of the left lower eyelid, respectively in a 33-year-old and an 87-year-old, treated using this technique. The surgical procedure was performed in two stages, after evaluation of the skin of the flap to be harvested: harvesting of the flap and closure plasty including external tarsorrhaphy. Patient follow-up did not note any complications. This combined technique offers a minimally invasive alternative for the often-delicate treatment of ectropions.展开更多
A robust Reynolds-Averaged Navier-Stokes(RANS)based solver is established to predict the complex unsteady aerodynamic characteristics of the Active Flap Control(AFC)rotor.The complex motion with multiple degrees of fr...A robust Reynolds-Averaged Navier-Stokes(RANS)based solver is established to predict the complex unsteady aerodynamic characteristics of the Active Flap Control(AFC)rotor.The complex motion with multiple degrees of freedom of the Trailing Edge Flap(TEF)is analyzed by employing an inverse nested overset grid method.Simulation of non-rotational and rotational modes of blade motion are carried out to investigate the formation and development of TEF shedding vortex with high-frequency deflection of TEF.Moreover,the mechanism of TEF deflection interference with blade tip vortex and overall rotor aerodynamics is also explored.In nonrotational mode,two bundles of vortices form at the gap ends of TEF and the main blade and merge into a single TEF vortex.Dynamic deflection of the TEF significantly interferes with the blade tip vortex.The position of the blade tip vortex consistently changes,and its frequency is directly related to the frequency of TEF deflection.In rotational mode,the tip vortex forms a helical structure.The end vortices at the gap sides co-swirl and subsequently merge into the concentrated beam of tip vortices,causing fluctuations in the vorticity and axial position of the tip vortex under the rotor.This research concludes with the investigation on suppression of Blade Vortex Interaction(BVI),showing an increase in miss distance and reduction in the vorticity of tip vortex through TEF phase control at a particular control frequency.Through this mechanism,a designed TEF deflection law increases the miss distance by 34.7%and reduces vorticity by 11.9%at the target position,demonstrating the effectiveness of AFC in mitigating BVI.展开更多
Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstr...Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023.All repairs utilized a multidisciplinary approach with urology,colorectal,and plastic surgery teams.Postoperatively,patients were maximally drained with foley catheter and suprapubic tube(SPT).Initial voiding cystourethrogram(VCUG)was performed at 4 weeks post-repair.If there was a persistent leak,catheter drainage was maintained for 4 additional weeks and VCUG was repeated.Success was defined as absence of leak on VCUG within 3 months after surgery.Results:22 patients met inclusion criteria.68%of patients had history of external beam radiation therapy(EBRT),13.6%had brachytherapy,and 40.9%had cryotherapy.Initial post-operative VCUG was negative in 10 patients(45.5%).Of the 12 patients with a persistent fistula,5(42%)had no evidence of fistula on subsequent VCUG after 4 weeks.Overall,68%of patients were successfully treated with gracilis interposition flap.There was a significant difference of repair success based on EBRT status(p<0.05).Conclusions:We report a success rate of 68%for gracilis flap repair of RUF.Our cohort had a higher rate of prior radiation therapy compared to other studies.A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage.Gracilis interposition flap is a reasonable surgical treatment for RUF.展开更多
The flow control at low Reynolds numbers is one of the most promising technologies in the field of aerodynamics,and it is also an important source of the innovation for novel aircraft.In this study,a new way of nonlin...The flow control at low Reynolds numbers is one of the most promising technologies in the field of aerodynamics,and it is also an important source of the innovation for novel aircraft.In this study,a new way of nonlinear flow control by interaction between two flexible flaps is proposed,and their flow control mechanism is studied employing the self-constructed immersed boundary-lattice Boltzmann-finite element method(IB-LB-FEM).The effects of the difference in material properties and flap length between the two flexible flaps on the nonlinear flow control of the airfoil are discussed.It is suggested that the relationship between the deformation of the two flexible flaps and the evolution of the vortex under the fluid-structure interaction(FSI).It is shown that the upstream flexible flap plays a key role in the flow control of the two flexible flaps.The FSI effect of the upstream flexible flap will change the unsteady flow behind it and affect the deformation of the downstream flexible flap.Two flexible flaps with different material properties and different lengths will change their own FSI characteristics by the induced vortex,effectively suppressing the flow separation on the airfoil’s upper surface.The interaction of two flexible flaps plays an extremely important role in improving the autonomy and adjustability of flow control.The numerical results will provide a theoretical basis and technical guidance for the development and application of a new flap passive control technology.展开更多
Soft tissue reconstruction of the radial thumb tip remains surgically challenging,particularly when standard options such as kite or Brünelli flaps are less suitable due to anatomical constraints.This technical n...Soft tissue reconstruction of the radial thumb tip remains surgically challenging,particularly when standard options such as kite or Brünelli flaps are less suitable due to anatomical constraints.This technical note presents the case of a 37-year-old male with a radial-sided distal thumb defect reconstructed using a reverse homodigital dorsoradial flap.Two key refinements were applied:preservation of approximately 5 mm of subcutaneous tissue to support venous outflow and a 3-5 mm proximal safety margin at the pivot point based on Doppler assessment to reduce pedicle tension during 180◦rotation.The flap was inset without tunneling and healed without complications.Functional recovery was confirmed by progressive improvements in the disabilities of the arm,shoulder and hand score(from 25 at 1 month to 4.2 at 1 year),normal range of motion,and two-point discrimination(from 5 mm to 4 mm).This case highlights the practical advantages of flap design refinement for radial thumb reconstruction and supports its reproducibility in similar clinical scenarios.However,as this is a single case report,further validation with studies involving multiple cases is necessary to confirm the reliability and broad applicability of these refinements.展开更多
To propel the application of a bottom-hinged flap breakwater in real sea conditions,a two-dimensional computational fluid dynamics numerical model was conducted to investigate the pitching motion response and wave att...To propel the application of a bottom-hinged flap breakwater in real sea conditions,a two-dimensional computational fluid dynamics numerical model was conducted to investigate the pitching motion response and wave attenuation in random waves.First,the flow velocity distribution characteristic of the pitching flap at typical times was summarized.Then,the effects of random wave and flap parameters on the flap’s significant pitching angle amplitude θ_(s) and hydrodynamic coefficients were investigated.The results reveal that θ_(s) and wave reflection coefficient K_(r) values increase with increasing significant wave height Hs,random wave steepnessλs,and flap relative height.As Hs andλs increase,the wave transmission coefficient K_(t) increases while the wave dissipation coefficient K_(d) decreases.Additionally,K_(t) decreases with increasing flap relative height.With increasing equivalent damping coefficient ratio,θ_(s) and K_(t) decrease,while K_(r) and K_(d) increase.The relationships betweenλs and flap relative height on the one hand andθ_(s),K_(r),K_(t),and K_(d) in random waves on the other hand are compared to those in regular waves.Based on the equal incident wave energy and the equal incident wave energy flux,the pitching flap performs better in the wave attenuation capability under random waves than in regular waves.Finally,the dimensionless parameters with respect to random wave and flap were used to derive the K_(r) and K_(t) for-mulae,which were validated with the related data.展开更多
BACKGROUND Pancreatic cancer(PC)remains one of the most lethal malignancies.While flap endonuclease-1(FEN1)has been implicated in various cancers,its role in PC remains unclear.AIM To investigate the biological functi...BACKGROUND Pancreatic cancer(PC)remains one of the most lethal malignancies.While flap endonuclease-1(FEN1)has been implicated in various cancers,its role in PC remains unclear.AIM To investigate the biological functions and mechanisms of FEN1 in PC progression.METHODS FEN1 expression and its prognostic significance were analyzed using Gene Expression Omnibus,The Cancer Genome Atlas,and Genotype-Tissue Expression databases.FEN1 was knocked down or overexpressed in PC cell lines using lentiviral vectors.Cell proliferation,migration,and invasion were assessed in vitro,while tumorigenicity was evaluated in nude mouse xenografts.Molecular mechanisms were explored through RNA-sequencing and validated by western blot analysis.RESULTS FEN1 was significantly upregulated in PC tissues and correlated with poor prognosis.FEN1 promoted PC cell proliferation,migration,and invasion in vitro,as well as xenograft tumor growth in vivo.Mechanistically,FEN1 regulated epithelial-mesenchymal transition through the AKT/mTOR signaling pathway.CONCLUSION FEN1 functions as an oncogenic driver in PC progression via the AKT/mTOR signaling pathway,suggesting its potential as a therapeutic target.展开更多
Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating ...Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating early detection and timely intervention.Developing a monitoring approach that is highly sensitive,specific,noninvasive,continuous,and cost-effective is crucial for accurately assessing flap perfusion and informing clinical decisions.Methods:From April 2024 to December 2024,20 patients with oral tumors requiring flap transplantation were enrolled at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine.Continuous monitoring of various free flaps was performed utilizing a transcutaneous blood gas analyzer,both before and after surgery.This approach allowed for real-time measurement of transcutaneous partial pressure of oxygen(TcPO_(2))and transcutaneous partial pressure of carbon dioxide(TcPCO_(2)),facilitating the evaluation of perfusion dynamics across various free flap types.Results:After free flap transplantation,a reduction in blood supply resulted in a rapid decline in TcPO_(2)(to below 10 mmHg),accompanied by a gradual increase in TcPCO_(2),peaking at 135 mmHg.Following vascular anastomosis and blood flow restoration,TcPO_(2)and TcPCO_(2)exhibited opposite trends.Statistical analysis revealed no significant differences in TcPO_(2)and TcPCO_(2)measurements among the various flap types(P<0.05),indicating a consistent pattern of change across all flaps.Conclusion:The transcutaneous blood gas analyzer proves to be a reliable method for monitoring free flap perfusion.Dynamic changes in TcPO_(2)and TcPCO_(2)effectively reflect blood supply status,enabling early detection of vascular compromise and potentially enhancing flap preservation outcomes.展开更多
AIM:To investigate the outcome of combined anterior corneal elastic sublaminectomy,conjunctival flap,and prosthetic eyepiece for ocular atrophy following foldable capsular vitreous body(FCVB)implantation in severe tra...AIM:To investigate the outcome of combined anterior corneal elastic sublaminectomy,conjunctival flap,and prosthetic eyepiece for ocular atrophy following foldable capsular vitreous body(FCVB)implantation in severe trauma.METHODS:This study conducted a retrospective analysis of 38 patients who underwent conjunctival flap coverage followed by prosthetic eyepiece fitting after developing ocular atrophy secondary to FCVB surgery.Anterior corneal elastic sublaminectomy combined with conjunctival coverage was performed on the FCVBimplanted atrophic eyes.Prosthetic lenses were fitted after complete healing of the stroma and conjunctiva and suture removal.Corneal irritation,eyeball protrusion,axial length,lid height,cosmetic satisfaction,and pain numerical rating scale scores were observed before the conjunctival flap covering and after the prosthetic eyepiece surgery.RESULTS:The ocular protrusion was 11 mm preoperatively and 14 mm postoperatively,with the difference being statistically significant(Z=-5.459,P<0.001).The ocular axis length was 20.82±0.94 mm in the experimental group and 23.57±0.33 mm in the control group,showing a statistically significant difference(t=-20.207,P<0.05).The lid height was 6 mm in the experimental group and 9 mm in the control group,a difference that was statistically significant(Z=-5.326,P<0.001).The appearance satisfaction score was 1 in the experimental group and 4 in the control group,with this difference being statistically significant(Z=-5.447,P=0.001).Regarding the pain numerical rating scale score,the ranges were 0-2 in the experimental group and 0 in the control group.No discomfort was reported after wearing the prosthetic eyepiece,and the difference was not statistically significant(Z=-1.100,P>0.05).There was no statistically significant difference between pre-and post-treatment satisfaction.CONCLUSION:A conjunctival flap covering and a prosthetic eyepiece after FCVB postoperative atrophy can reduce the number of surgeries,alleviate patients’economic burdens,satisfy patients’psychological eyeball retention requirements,and provide better cosmetic efficacies for patients desiring eyeball retention or silicone-oil dependence.展开更多
AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.ME...AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.METHODS:Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis.A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect.The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft.Postoperative cosmetic and functional outcomes were evaluated.RESULTS:The mean age of the patients was 46.3±18.1y(20-70y).The defects ranged from 30%-80%of the lid width and resulted from the excision of lid tumors in 11 patients(55%)and from trauma in 9(45%)patients.Postoperative complications included one case of lateral graft ectropion,2 cases of lid retraction and 3 cases of marginal graft necrosis.Most of the patients had an acceptable final cosmetic outcome.CONCLUSION:Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction.Large defects≥50%of the horizontal length are at greater risk of complications.Reconstruction of medial defects by this technique was associated with a greater incidence of complications.展开更多
Throughout the previous studies,none of them are involved in analysing the downwash flow effect on the control surface of the Flapping Wing Rotor(FWR).An overset CFD numerical model is built up and validated to study ...Throughout the previous studies,none of them are involved in analysing the downwash flow effect on the control surface of the Flapping Wing Rotor(FWR).An overset CFD numerical model is built up and validated to study the downwash flow’s effect on the stability of the FWR.After simulation,a cone like self-lock region which acts as the critical condition determining the stability of FWR is found.Only when the flow’s resultant velocity acting on the control surface lies in the stable region,the FWR can keep stable.The size of the cone like self-lock stable region can be enlarged by increasing the maximum feasible deflection angle constrained by mechanical design or enhancing the equivalent downwash flow velocity.Among all the simulated cases,when J=2.67(f=5 Hz,■=5 r/s),the largest average equivalent downwash flow velocities are found.On the other hand,the recovery torque could be enhanced due to the increase of the arm of the lateral force.According to these simulation results,a 43 g FWR model with two control surfaces and two stabilizers is then designed.A series of flight tests is then conducted to help confirm the conclusion of the mechanism research in this work.Overall,this study points out several strategies to increase the flight stability of the FWR and finally realizes the stable climb flight and mild descent flight of the FWR.展开更多
BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-fla...BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.展开更多
文摘Dear Editor,We present this case report which discusses a patient who underwent flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following laser-assisted in situ keratomileusis(LASIK)surgery.Epithelial ingrowth is a known complication of LASIK surgery,typically manageable with minimal measures.However,severe cases may necessitate more aggressive interventions,such as flap amputation[1].LASIK is a widely performed refractive surgery with high success rates and excellent visual outcome[2].
基金supported by National Natural Science Foundation of China under Grant No.62236007the specialized research projects of Huanjiang Laboratory.
文摘Modeling the dynamics of flapping wing aerial vehicle is challenging due to the complexity of aerodynamic effects and mechanical structures.The aim of this work is to develop an accurate dynamics model of flapping wing aerial vehicle based on real flight data.We propose a modeling framework that combines rigid body dynamics with a neural network to predict aerodynamic effects.By incorporating the concept of flapping phase,we significantly enhance the network’s ability to analyze transient aerodynamic behavior.We design and utilize a phase-functioned neural network structure for aerodynamic predictions and train the network using real flight data.Evaluation results show that the network can predict aerodynamic effects and demonstrate clear physical significance.We verify that the framework can be used for dynamic propagation and is expected to be utilized for building simulators for flapping wing aerial vehicles.
文摘Osteoradionecrosis of the temporal bone(ORN-TB)is usually controlled with conservative measures.However,a temporal bone resection may be required in unresponsive cases.The reconstruction of the resulting defects may be challenging because of the radiation damage to regional tissues.As a result,distant free flaps may be an optimal choice.For instance,the gracilis muscular free flap(GMFF)has consistent vascular anatomy and can be used to reconstruct small defects.We report three cases of uncontrolled ORN-TB requiring an extensive temporal bone resection followed by vascularized obliteration with a GMFF.The patients reported complete control of the main otologic symptoms(otorrhea,otalgia,and aural fullness)and optimal functional and aesthetic outcomes.Finally,the patients reported significant improvement in quality of life despite early postoperative complications.To our knowledge,the GMFF had not been used to obliterate temporal bone defects in patients with ORN-TB.
文摘The online version of the original article can be found at:https://www.sciopen.com/article/10.26599/JOTO.2025.9540018 Erratum to Journal of Otology,2025,20(2):123-126.https://doi.org/10.26599/JOTO.2025.9540018 The surnames and given names of these authors are reversed:Saro-Buendía Miguel,Andresen-Lorca Belén,Pérez-García Alberto,Llópez Carratala Nacho,Carreres Polo Joan,Armengot Carceller Miguel,Perolada Valmaña Jose María.It should be Miguel Saro-Buendía,Belén Andresen-Lorca,Alberto Pérez-García,Nacho Llópez Carratala,Joan Carreres Polo,Miguel Armengot Carceller,Jose María Perolada Valmaña.
文摘Current breast reconstruction evaluations mostly focus on static cosmetic analysis as a measure of the clinical outcomes.Moreover,it is essential to consider the dynamic changes in the reconstructed breast alongside assessments of aesthetic symmetry,functional restoration,complication rates,and long-term stability of the reconstruction.This study aimed to assess the mobility of the reconstructed breast following various breast reconstruction techniques,specifically by comparing deep inferior epigastric perforator(DIEP) flaps and pedicled transverse rectus abdominis musculocutaneous(TRAM) flaps.We conducted a longitudinal case study to investigate the changes in breast movement resulting from different surgical interventions.The comparison showed that DIEP flap reconstruction was more likely to achieve superior breast mobility outcomes than TRAM flap reconstruction.For a better breast aesthetic outcome,it is fundamental to improve the awareness of the dynamic evaluation of the reconstructed breast at the surgical strategy level.
文摘Background: The lumbar artery perforator(LAP) flap is an important autologous option in breast reconstruction.As the lumbar perforator flap is relatively new in this field,several questions remain regarding preoperative preparation,especially concerning computed tomography(CT) and magnetic resonance imaging of the donor site.The objective of this study was to aid the surgical approach to the LAP flap in female patients by precisely determining the characteristics of the lumbar perforators.Methods: We retrospectively reviewed the computed tomographic angiography images of 20 patients who underwent evaluation of the perforator positions from the four lumbar arteries.Four characteristics were studied:length,diameter,path of the lumbar pedicle,and thickness of the tissues available for transfer.Results: We analyzed 20 CT images,identifying 149 perforating vessels of the lumbar artery.The most suitable perforator for flap harvesting was the L4 perforator,which exhibited a larger diameter,a greater number of perforasomes,and a higher percentage of the cutaneous-septal tract.Conclusion: The LAP flap is a viable option for breast reconstruction and as a free flap in women.The L4 perforator artery is the most suitable for harvesting,owing to its superior perfusion capacity,diameter,and course;however,an interposition graft may be required to lengthen the vascular pedicle.
文摘Background: The use of a vascularized pedicle flap of diaphragmatic muscle (DF) for reconstructive procedures in the chest has many advantages. Yet, despite the excellent reported results, the use of DF has not been widespread. Some factors for the less widespread use of DF have been, concern about diaphragmatic function, hesitation to use such a vital muscle for reconstructive purposes, and most importantly, the technical aspects for the preparation of the flap. Methods: Using a cadaveric model, the vascular anatomy of the diaphragm and the steps for the preparation of the DF was defined and illustrated for both the right and left hemidiaphragm. Results: No perioperative mortality with the use of DF has been recorded. Function of the native diaphragm has not been impaired. Bronchopleural fistulas and pericardial defects have healed in all instances. Excellent repair has been achieved in all patients with esophageal lesions. The disruption of the repaired native diaphragm and visceral herniation has been reported but it has been attributed to the learning curve and the technique of repair. Conclusion: With a better understanding of the vascular anatomy of the diaphragm and a formal methodical approach to harvesting the DF, more surgeons will be encouraged to use DF with excellent results.
文摘There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.
文摘Cicatricial ectropion of the eyelid is an eversion of its edge, which has moved away from the globe. It is frequently the result of cicatricial retraction after trauma. The main risk is the occurrence of a corneal ulcer or chronic conjunctivitis. Their treatment is often difficult, especially when the ectropion is old and significant. There are several classic techniques for correcting cicatricial ectropions, but the technique of the myocutaneous flap combined with external tarsorrhaphy without damage to the canthal ligament is minimally invasive, not very widespread, yet responds very well to the rules of plastic surgery. We report two cases of post-traumatic cicatricial ectropions of the left lower eyelid, respectively in a 33-year-old and an 87-year-old, treated using this technique. The surgical procedure was performed in two stages, after evaluation of the skin of the flap to be harvested: harvesting of the flap and closure plasty including external tarsorrhaphy. Patient follow-up did not note any complications. This combined technique offers a minimally invasive alternative for the often-delicate treatment of ectropions.
基金supported by the National Natural Science Foundation of China(No.11972190)。
文摘A robust Reynolds-Averaged Navier-Stokes(RANS)based solver is established to predict the complex unsteady aerodynamic characteristics of the Active Flap Control(AFC)rotor.The complex motion with multiple degrees of freedom of the Trailing Edge Flap(TEF)is analyzed by employing an inverse nested overset grid method.Simulation of non-rotational and rotational modes of blade motion are carried out to investigate the formation and development of TEF shedding vortex with high-frequency deflection of TEF.Moreover,the mechanism of TEF deflection interference with blade tip vortex and overall rotor aerodynamics is also explored.In nonrotational mode,two bundles of vortices form at the gap ends of TEF and the main blade and merge into a single TEF vortex.Dynamic deflection of the TEF significantly interferes with the blade tip vortex.The position of the blade tip vortex consistently changes,and its frequency is directly related to the frequency of TEF deflection.In rotational mode,the tip vortex forms a helical structure.The end vortices at the gap sides co-swirl and subsequently merge into the concentrated beam of tip vortices,causing fluctuations in the vorticity and axial position of the tip vortex under the rotor.This research concludes with the investigation on suppression of Blade Vortex Interaction(BVI),showing an increase in miss distance and reduction in the vorticity of tip vortex through TEF phase control at a particular control frequency.Through this mechanism,a designed TEF deflection law increases the miss distance by 34.7%and reduces vorticity by 11.9%at the target position,demonstrating the effectiveness of AFC in mitigating BVI.
文摘Objectives:To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort.Patients and Methods:We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023.All repairs utilized a multidisciplinary approach with urology,colorectal,and plastic surgery teams.Postoperatively,patients were maximally drained with foley catheter and suprapubic tube(SPT).Initial voiding cystourethrogram(VCUG)was performed at 4 weeks post-repair.If there was a persistent leak,catheter drainage was maintained for 4 additional weeks and VCUG was repeated.Success was defined as absence of leak on VCUG within 3 months after surgery.Results:22 patients met inclusion criteria.68%of patients had history of external beam radiation therapy(EBRT),13.6%had brachytherapy,and 40.9%had cryotherapy.Initial post-operative VCUG was negative in 10 patients(45.5%).Of the 12 patients with a persistent fistula,5(42%)had no evidence of fistula on subsequent VCUG after 4 weeks.Overall,68%of patients were successfully treated with gracilis interposition flap.There was a significant difference of repair success based on EBRT status(p<0.05).Conclusions:We report a success rate of 68%for gracilis flap repair of RUF.Our cohort had a higher rate of prior radiation therapy compared to other studies.A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage.Gracilis interposition flap is a reasonable surgical treatment for RUF.
基金This work was supported by the National Natural Science Foundation of China(Grant Nos.92371201,52192633,11872293,and 92152301)the Natural Science Basic Research Program of Shaanxi(Grant Nos.2024JC-YBQN-0008,and 2022JC-03)+1 种基金Shaanxi Key Research and Development Program(Grant No.2022ZDLGY02-07)the Joint Natural Science Foundation of China with Guangdong Province for TianHe-II Supercomputer Resources,and the Research Start-up Foundation of Xi’an University of Science and Technology for the High-Level Talent.
文摘The flow control at low Reynolds numbers is one of the most promising technologies in the field of aerodynamics,and it is also an important source of the innovation for novel aircraft.In this study,a new way of nonlinear flow control by interaction between two flexible flaps is proposed,and their flow control mechanism is studied employing the self-constructed immersed boundary-lattice Boltzmann-finite element method(IB-LB-FEM).The effects of the difference in material properties and flap length between the two flexible flaps on the nonlinear flow control of the airfoil are discussed.It is suggested that the relationship between the deformation of the two flexible flaps and the evolution of the vortex under the fluid-structure interaction(FSI).It is shown that the upstream flexible flap plays a key role in the flow control of the two flexible flaps.The FSI effect of the upstream flexible flap will change the unsteady flow behind it and affect the deformation of the downstream flexible flap.Two flexible flaps with different material properties and different lengths will change their own FSI characteristics by the induced vortex,effectively suppressing the flow separation on the airfoil’s upper surface.The interaction of two flexible flaps plays an extremely important role in improving the autonomy and adjustability of flow control.The numerical results will provide a theoretical basis and technical guidance for the development and application of a new flap passive control technology.
文摘Soft tissue reconstruction of the radial thumb tip remains surgically challenging,particularly when standard options such as kite or Brünelli flaps are less suitable due to anatomical constraints.This technical note presents the case of a 37-year-old male with a radial-sided distal thumb defect reconstructed using a reverse homodigital dorsoradial flap.Two key refinements were applied:preservation of approximately 5 mm of subcutaneous tissue to support venous outflow and a 3-5 mm proximal safety margin at the pivot point based on Doppler assessment to reduce pedicle tension during 180◦rotation.The flap was inset without tunneling and healed without complications.Functional recovery was confirmed by progressive improvements in the disabilities of the arm,shoulder and hand score(from 25 at 1 month to 4.2 at 1 year),normal range of motion,and two-point discrimination(from 5 mm to 4 mm).This case highlights the practical advantages of flap design refinement for radial thumb reconstruction and supports its reproducibility in similar clinical scenarios.However,as this is a single case report,further validation with studies involving multiple cases is necessary to confirm the reliability and broad applicability of these refinements.
基金supported by the National Natural Science Foundation of China(Nos.52271295,52088102).
文摘To propel the application of a bottom-hinged flap breakwater in real sea conditions,a two-dimensional computational fluid dynamics numerical model was conducted to investigate the pitching motion response and wave attenuation in random waves.First,the flow velocity distribution characteristic of the pitching flap at typical times was summarized.Then,the effects of random wave and flap parameters on the flap’s significant pitching angle amplitude θ_(s) and hydrodynamic coefficients were investigated.The results reveal that θ_(s) and wave reflection coefficient K_(r) values increase with increasing significant wave height Hs,random wave steepnessλs,and flap relative height.As Hs andλs increase,the wave transmission coefficient K_(t) increases while the wave dissipation coefficient K_(d) decreases.Additionally,K_(t) decreases with increasing flap relative height.With increasing equivalent damping coefficient ratio,θ_(s) and K_(t) decrease,while K_(r) and K_(d) increase.The relationships betweenλs and flap relative height on the one hand andθ_(s),K_(r),K_(t),and K_(d) in random waves on the other hand are compared to those in regular waves.Based on the equal incident wave energy and the equal incident wave energy flux,the pitching flap performs better in the wave attenuation capability under random waves than in regular waves.Finally,the dimensionless parameters with respect to random wave and flap were used to derive the K_(r) and K_(t) for-mulae,which were validated with the related data.
基金Supported by Youth Science and Technology Fund Program of the Natural Science Foundation of Gansu Province,No.21JR7RA645 and No.23JRRA1317.
文摘BACKGROUND Pancreatic cancer(PC)remains one of the most lethal malignancies.While flap endonuclease-1(FEN1)has been implicated in various cancers,its role in PC remains unclear.AIM To investigate the biological functions and mechanisms of FEN1 in PC progression.METHODS FEN1 expression and its prognostic significance were analyzed using Gene Expression Omnibus,The Cancer Genome Atlas,and Genotype-Tissue Expression databases.FEN1 was knocked down or overexpressed in PC cell lines using lentiviral vectors.Cell proliferation,migration,and invasion were assessed in vitro,while tumorigenicity was evaluated in nude mouse xenografts.Molecular mechanisms were explored through RNA-sequencing and validated by western blot analysis.RESULTS FEN1 was significantly upregulated in PC tissues and correlated with poor prognosis.FEN1 promoted PC cell proliferation,migration,and invasion in vitro,as well as xenograft tumor growth in vivo.Mechanistically,FEN1 regulated epithelial-mesenchymal transition through the AKT/mTOR signaling pathway.CONCLUSION FEN1 functions as an oncogenic driver in PC progression via the AKT/mTOR signaling pathway,suggesting its potential as a therapeutic target.
基金supported by the Fundamental Research Program(grant no.:JYZZ228)the Clinical Research Booster Program(grant no.JYLJ202311)of the Shanghai Ninth Peoples’Hospital of Shanghai Jiao Tong University School of Medicine.
文摘Background:Free flap transplantation has emerged as a prevalent technique in reconstructive surgery for patients with oral cancer.Postoperative monitoring of flap perfusion is critical for flap survival,necessitating early detection and timely intervention.Developing a monitoring approach that is highly sensitive,specific,noninvasive,continuous,and cost-effective is crucial for accurately assessing flap perfusion and informing clinical decisions.Methods:From April 2024 to December 2024,20 patients with oral tumors requiring flap transplantation were enrolled at the Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine.Continuous monitoring of various free flaps was performed utilizing a transcutaneous blood gas analyzer,both before and after surgery.This approach allowed for real-time measurement of transcutaneous partial pressure of oxygen(TcPO_(2))and transcutaneous partial pressure of carbon dioxide(TcPCO_(2)),facilitating the evaluation of perfusion dynamics across various free flap types.Results:After free flap transplantation,a reduction in blood supply resulted in a rapid decline in TcPO_(2)(to below 10 mmHg),accompanied by a gradual increase in TcPCO_(2),peaking at 135 mmHg.Following vascular anastomosis and blood flow restoration,TcPO_(2)and TcPCO_(2)exhibited opposite trends.Statistical analysis revealed no significant differences in TcPO_(2)and TcPCO_(2)measurements among the various flap types(P<0.05),indicating a consistent pattern of change across all flaps.Conclusion:The transcutaneous blood gas analyzer proves to be a reliable method for monitoring free flap perfusion.Dynamic changes in TcPO_(2)and TcPCO_(2)effectively reflect blood supply status,enabling early detection of vascular compromise and potentially enhancing flap preservation outcomes.
基金Supported by National Natural Science Foundation of China(No.82260210)General Project of Jiangxi Provincial Traditional Chinese Medicine Science and Technology Plan(No.2023B1368).
文摘AIM:To investigate the outcome of combined anterior corneal elastic sublaminectomy,conjunctival flap,and prosthetic eyepiece for ocular atrophy following foldable capsular vitreous body(FCVB)implantation in severe trauma.METHODS:This study conducted a retrospective analysis of 38 patients who underwent conjunctival flap coverage followed by prosthetic eyepiece fitting after developing ocular atrophy secondary to FCVB surgery.Anterior corneal elastic sublaminectomy combined with conjunctival coverage was performed on the FCVBimplanted atrophic eyes.Prosthetic lenses were fitted after complete healing of the stroma and conjunctiva and suture removal.Corneal irritation,eyeball protrusion,axial length,lid height,cosmetic satisfaction,and pain numerical rating scale scores were observed before the conjunctival flap covering and after the prosthetic eyepiece surgery.RESULTS:The ocular protrusion was 11 mm preoperatively and 14 mm postoperatively,with the difference being statistically significant(Z=-5.459,P<0.001).The ocular axis length was 20.82±0.94 mm in the experimental group and 23.57±0.33 mm in the control group,showing a statistically significant difference(t=-20.207,P<0.05).The lid height was 6 mm in the experimental group and 9 mm in the control group,a difference that was statistically significant(Z=-5.326,P<0.001).The appearance satisfaction score was 1 in the experimental group and 4 in the control group,with this difference being statistically significant(Z=-5.447,P=0.001).Regarding the pain numerical rating scale score,the ranges were 0-2 in the experimental group and 0 in the control group.No discomfort was reported after wearing the prosthetic eyepiece,and the difference was not statistically significant(Z=-1.100,P>0.05).There was no statistically significant difference between pre-and post-treatment satisfaction.CONCLUSION:A conjunctival flap covering and a prosthetic eyepiece after FCVB postoperative atrophy can reduce the number of surgeries,alleviate patients’economic burdens,satisfy patients’psychological eyeball retention requirements,and provide better cosmetic efficacies for patients desiring eyeball retention or silicone-oil dependence.
文摘AIM:To evaluate the outcome and the degree of patient satisfaction with the reconstruction of full-thickness medial and central lower lid defects using a pendular flap of the remaining lateral part of the lower lid.METHODS:Totally 20 patients with full thickness medial or central lower lid defects that could not be repaired by direct closure with or without cantholysis.A sliding full-thickness composite flap was created from the lateral part of the remaining lid to cover the defect.The posterior lamella of the induced lateral defect was repaired by either a periosteal flap alone or in combination with a free tarsal graft.Postoperative cosmetic and functional outcomes were evaluated.RESULTS:The mean age of the patients was 46.3±18.1y(20-70y).The defects ranged from 30%-80%of the lid width and resulted from the excision of lid tumors in 11 patients(55%)and from trauma in 9(45%)patients.Postoperative complications included one case of lateral graft ectropion,2 cases of lid retraction and 3 cases of marginal graft necrosis.Most of the patients had an acceptable final cosmetic outcome.CONCLUSION:Reconstruction of moderate-sized defects in the medial/central lower lid via a sliding flap yielded acceptable cosmetic and functional outcomes with high patient satisfaction.Large defects≥50%of the horizontal length are at greater risk of complications.Reconstruction of medial defects by this technique was associated with a greater incidence of complications.
基金supported by the following funding organizations in China:National Natural Science Foundation of China(Grant No.52375116 and Grant No.52105285)the Aeronautical Science Foundation of China(Grant No.ASFC-20230023052001)+3 种基金China Postdoctoral Science Foundation(Grant No.2024M754237)National Key Research and Development Program of China(2024YFB470920001)Science and Technology Plan Project of Wenzhou Municipality(Grant No.ZG2024001)Basic Public Welfare Research Program of Wenzhou(Grant No.G2023046).
文摘Throughout the previous studies,none of them are involved in analysing the downwash flow effect on the control surface of the Flapping Wing Rotor(FWR).An overset CFD numerical model is built up and validated to study the downwash flow’s effect on the stability of the FWR.After simulation,a cone like self-lock region which acts as the critical condition determining the stability of FWR is found.Only when the flow’s resultant velocity acting on the control surface lies in the stable region,the FWR can keep stable.The size of the cone like self-lock stable region can be enlarged by increasing the maximum feasible deflection angle constrained by mechanical design or enhancing the equivalent downwash flow velocity.Among all the simulated cases,when J=2.67(f=5 Hz,■=5 r/s),the largest average equivalent downwash flow velocities are found.On the other hand,the recovery torque could be enhanced due to the increase of the arm of the lateral force.According to these simulation results,a 43 g FWR model with two control surfaces and two stabilizers is then designed.A series of flight tests is then conducted to help confirm the conclusion of the mechanism research in this work.Overall,this study points out several strategies to increase the flight stability of the FWR and finally realizes the stable climb flight and mild descent flight of the FWR.
文摘BACKGROUND Managing Gustilo type ⅢB fractures in patients with type 2 diabetes is challenging due to delayed healing and elevated complication risks.This retro-spective study highlights the successful use of free-flap transfer combined with plate fixation,contributing insights into effective management strategies for these complex cases.AIM To evaluate free-flap transfer with plate fixation for managing Gustilo ⅢB fractures in diabetic patients,focusing on outcomes.METHODS A retrospective analysis of six cases was conducted with a minimum follow-up period of three years.Patients underwent free-flap transfer and plate fixation for fracture management.Outcomes assessed included bone union,flap viability,and complications requiring intervention or plate removal.The follow-up period ranged from three to four years.Persistent infections beneath the flap developed in two patients,necessitating daily wound care.RESULTS Bone healing occurred within 17 to 34 months,with plate removal required in three patients after fracture consolidation.Traumatic osteomyelitis was observed in at least one patient.Despite challenges such as sinus formation and variations in flap pedicle anatomy,successful bone union and flap viability were achieved in all cases.Freeflap transfer combined with plate fixation shows promise for treating Gustilo type ⅢB fractures in patients with diabetes.While infection and the need for plate removal surgeries were observed,consistent success in bone healing and flap viability highlights the potential of this approach.CONCLUSION Free-flap transfer with plate fixation effectively manages Gustilo ⅢB fractures in diabetics,achieving bone/flap healing despite infection risks.Careful patient selection and further validation are critical.
