Basal cell carcinoma(BCC)is the most prevalent form of skin cancer in the world,primarily affecting sun-exposed areas,including the periocular region.When BCC occurs near the eyes,surgical treatment becomes uniquely c...Basal cell carcinoma(BCC)is the most prevalent form of skin cancer in the world,primarily affecting sun-exposed areas,including the periocular region.When BCC occurs near the eyes,surgical treatment becomes uniquely complex.Excess excisions may cause detrimental effects to eyelid function and undesirable aesthetic outcomes.Conversely,adequate resection must occur to prevent further disease progression.Mohs micrographic surgery(MMS),a technique offering high remission rates,is often employed for periocular BCC.This method allows for precise cancer removal while preserving as much healthy tissue as possible,balancing the need for both effective treatment and aesthetic and functional preservation.Following Mohs surgery of periocular BCC,reconstruction methods vary and can be tailored based on the size of the resection and the functional requirements of the affected tissue.Amongst these methods,primary closure with and without secondary intentions,direct margin repair,local flap closure and advance flap,Tenzel flap,tarso-conjunctival flap,periocular skin grafting,and structural grafting are commonly utilized and each has its advantages and limitations.In the future,advancements in synthetic flaps and stabilizing glues in the periocular region may provide additional tools for post-Mohs reconstruction.However,these emerging techniques require further research to establish efficacy and safety,especially in more complex and sensitive regions like the periocular tissues.The primary purpose of this review is to provide a comprehensive analysis of periocular reconstructive techniques following Mohs surgery,comparing their efficacy,functional outcomes,and aesthetic considerations while addressing recent advancements such as synthetic flaps and stabilizing glues to guide clinical decision-making.展开更多
Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several ele...Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.展开更多
Objective: The aim of this research was to find out if reconstructive surgery is the best option to improve the quality of life of patients with rheumatoid arthritis compared to other monotherapy or combination therap...Objective: The aim of this research was to find out if reconstructive surgery is the best option to improve the quality of life of patients with rheumatoid arthritis compared to other monotherapy or combination therapy treatments.Methods: The research uses a mixed qualitative-quantitative, correlational, and cross-sectional approach. The medical records of a sample of 28 patients with rheumatoid arthritis who were treated at Rio Hospital in Riobamba-Ecuador in the period 2022-2024 were reviewed. The Health Assessment Questionnaire (HAQ) was used to assess quality of life, and the Diseases Activity Score (DAS) 28 was used to measure the degree of joint involvement. To establish the correlation between variables, HJ Biplot multivariate analysis was applied in RStudio. Results: A high correlation was found between quality of life and the degree of joint involvement DAS 28, patients with a degree of high activity (more unfavorable condition) have a worse quality of life due to their severe disability. Both quality of life and the degree of joint involvement were also correlated with the treatment they receive, patients with worse quality of life and a higher degree of joint involvement received combined therapy as treatment. Patients who have undergone reconstructive surgery have a better quality of life. Overweight patients tend to have greater joint involvement and poorer quality of life. Conclusions: The results suggest that reconstructive surgery plays an important role in the management of patients with advanced rheumatoid arthritis, helping to restore function and improve quality of life.展开更多
Although many multi-view clustering(MVC) algorithms with acceptable performances have been presented, to the best of our knowledge, nearly all of them need to be fed with the correct number of clusters. In addition, t...Although many multi-view clustering(MVC) algorithms with acceptable performances have been presented, to the best of our knowledge, nearly all of them need to be fed with the correct number of clusters. In addition, these existing algorithms create only the hard and fuzzy partitions for multi-view objects,which are often located in highly-overlapping areas of multi-view feature space. The adoption of hard and fuzzy partition ignores the ambiguity and uncertainty in the assignment of objects, likely leading to performance degradation. To address these issues, we propose a novel sparse reconstructive multi-view evidential clustering algorithm(SRMVEC). Based on a sparse reconstructive procedure, SRMVEC learns a shared affinity matrix across views, and maps multi-view objects to a 2-dimensional humanreadable chart by calculating 2 newly defined mathematical metrics for each object. From this chart, users can detect the number of clusters and select several objects existing in the dataset as cluster centers. Then, SRMVEC derives a credal partition under the framework of evidence theory, improving the fault tolerance of clustering. Ablation studies show the benefits of adopting the sparse reconstructive procedure and evidence theory. Besides,SRMVEC delivers effectiveness on benchmark datasets by outperforming some state-of-the-art methods.展开更多
Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for ...Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.展开更多
Mining operation, especially underground coal mining, always has the remarkable risks of ground control. Passive seismic velocity tomography based on simultaneous iterative reconstructive technique （SIRT） inversion ...Mining operation, especially underground coal mining, always has the remarkable risks of ground control. Passive seismic velocity tomography based on simultaneous iterative reconstructive technique （SIRT） inversion is used to deduce the stress redistribution around the longwall mining panel. The mining-induced microseismic events were recorded by mounting an array of receivers on the surface, above the active panel. After processing and filtering the seismic data, the three-dimensional tomography images of the p-wave velocity variations by SIRT passive seismic velocity tomography were provided. To display the velocity changes on coal seam level and subsequently to infer the stress redistribution, these three-dimensional tomograms into the coal seam level were sliced. In addition, the boundary element method （BEM） was used to simulate the stress redistribution. The results show that the inferred stresses from the passive seismic tomograms are conformed to numerical models and theoretical concept of the stress redistribution around the longwall panel. In velocity tomograms, the main zones of the stress redistribution arotmd the panel, including front and side abutment pressures, and gob stress are obvious and also the movement of stress zones along the face advancement is evident. Moreover, the effect of the advance rate of the face on the stress redistribution is demonstrated in tomography images. The research result proves that the SIRT passive seismic velocity tomography has an ultimate potential for monitoring the changes of stress redistribution around the longwall mining panel continuously and subsequently to improve safety of mining operations.展开更多
A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was valida...A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.展开更多
TEM observation and analysis have been conducted on bainitie transformation with and without the influence of externally applied tensile sress for alloyed steel 35MV7. Recrystallizafion was found to occur within the b...TEM observation and analysis have been conducted on bainitie transformation with and without the influence of externally applied tensile sress for alloyed steel 35MV7. Recrystallizafion was found to occur within the bainitic structures transformed at 450 ℃ in cases of both with and without the application of external stress, and coupling between the reconstructive and displacive mechanisms is expected, due to the relatively high holding temperature and high dislocation density yielded with the displacive mechanism. RecrystaUization was not observed within the bainitic structures transformed at lower temperature of 350 ℃, both with and without the application of stress; However, for the stressed specimen, the structure with very fine subgrains was found to be preserved and not reconstructed thermically, due to the low temperature and short holding time.展开更多
Electrical capacitance tomography technique reconstructs dielectric constant distribution in an object by measuring the capacitances between the eletrode pairs which are mounted around this object. Because of the limi...Electrical capacitance tomography technique reconstructs dielectric constant distribution in an object by measuring the capacitances between the eletrode pairs which are mounted around this object. Because of the limitation of measurement condition, the measured data are imcomplet. This paper describes a multiresolution reconstructive algorithm which is based on network theory for electrical capacitance tomography technique. The dielectric constant distribution of flow of two components in a pipeline is reconstructed. The algorithm is as follows: Firstly, construct a rough, first level system model, and assume the dielectric constant distribution of the region to be reconstructed. After iteration, the dielectic constant of each unit can be reconstructed. Secondly, construct a finer, second level the system model and determine the initial dielectric constant of each unit in the region to be reconstructed according to related information between two levels. After iteration, the image of the pipeline's cross section can be reconstructed. The results of simulated experiments about different kinds of medium distributions show that this algorithm is effective and can converge.展开更多
Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and educatio...Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.展开更多
Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks...Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.展开更多
Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The...Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The less invasive approach aims to correct curvature without intervening directly on the fibrous plaque while the more complex "corporoplasty" applies specific geometric criteria and uses different autologous and heterologous grafts. Each approach has its pros and cons and decisionmaking should be tailored to the individual patient's expectations. Other surgical options include different use of patches to cover the tunica albuginea defect, with the choice depending on the surgeon's personal experience. Despite the wide range of autologous(buccal mucosa, vein, dermis, etc.) and heterologous grafts(bovine pericardium, swine intestinal submucosa, porcine dermis, etc.) none currently represents the real "gold standard" because the data are extremely variable and frequently not representative. Several factors seem to favor buccal mucosa grafts over inert biocompatible materials: as vital tissue, buccal mucosa tends to heal rapidly, immediately integrating with the surrounding albuginea tissue. This translates into a more rapid resumption of spontaneous erections(after 3/4 d) and sexual activity and into a reduced risk of curvature relapse and erectile dysfunction after surgery. Another advantage of the buccal mucosa graft is its low cost. In conclusion, despite the recent development of some exciting new surgical techniques we are still unable to deliver a definitive take-home message about reconstructive surgery in PD because the majority of the studies reported insufficient data. However, since it is clear that major outcomes, besides the cosmetic result, are the patient's and partner's satisfaction and the economic impact of each technique, we recommend they be included among the outcome assessment parameters in further展开更多
We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sa...We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.展开更多
The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to in...The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.展开更多
Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on c...Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.展开更多
Compressive sensing is a powerful method for reconstruction of sparsely-sampled data, based on statistical optimization. It can be applied to a range of flow measurement and visualization data, and in this work we sho...Compressive sensing is a powerful method for reconstruction of sparsely-sampled data, based on statistical optimization. It can be applied to a range of flow measurement and visualization data, and in this work we show the usage in groundwater mapping. Due to scarcity of water in many regions of the world, including southwestern United States, monitoring and management of groundwater is of utmost importance. A complete mapping of groundwater is difficult since the monitored sites are far from one another, and thus the data sets are considered extremely “sparse”. To overcome this difficulty in complete mapping of groundwater, compressive sensing is an ideal tool, as it bypasses the classical Nyquist criterion. We show that compressive sensing can effectively be used for reconstructions of groundwater level maps, by validating against data. This approach can have an impact on geographical sensing and information, as effective monitoring and management are enabled without constructing numerous or expensive measurement sites for groundwater.展开更多
The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evo...The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.展开更多
This study introduced a differential polarization division multiplexing(DPDM)scheme for all-fiber high-accuracy spectral measurement.Launching two orthogonal linearly polarized light beams into multimode fibers,the DP...This study introduced a differential polarization division multiplexing(DPDM)scheme for all-fiber high-accuracy spectral measurement.Launching two orthogonal linearly polarized light beams into multimode fibers,the DPDM elegantly reconstructs the input spectra from the differential speckle,which is more comprehensive spectral-to-spatial encoding with fewer noises and better contrast.A spectral measurement with 2 pm resolution and 2000 channels was achieved.Compared with traditional transmission matrix and polarization division multiplexing schemes,the proposed DPDM approach reduced the spectral reconstruction error by 77%and 69%,respectively,offering a simple and effective solution for highly accurate spectral measurements.展开更多
This study presents a high-accuracy,all-fber mode division multiplexing(MDM)reconstructive spectrometer(RS).The MDM was achieved by utilizing a custom-designed 3×1 mode-selective photonics lantern to launch disti...This study presents a high-accuracy,all-fber mode division multiplexing(MDM)reconstructive spectrometer(RS).The MDM was achieved by utilizing a custom-designed 3×1 mode-selective photonics lantern to launch distinct spatial modes into the multimode fber(MMF).This facilitated the information transmission by increasing light scattering processes,thereby encoding the optical spectra more comprehensively into speckle patterns.Spectral resolution of 2 pm and the recovery of 2000 spectral channels were accomplished.Compared to methods employing single-mode excitation and two-mode excitation,the three-mode excitation method reduced the recovered error by 88%and 50%respectively.A resolution enhancement approach based on alternating mode modulation was proposed,reaching the MMF limit for the 3 dB bandwidth of the spectral correlation function.The proof-of-concept study can be further extended to encompass diverse programmable mode excitations.It is not only succinct and highly efcient but also well-suited for a variety of high-accuracy,high-resolution spectral measurement scenarios.展开更多
ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as As...ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.展开更多
文摘Basal cell carcinoma(BCC)is the most prevalent form of skin cancer in the world,primarily affecting sun-exposed areas,including the periocular region.When BCC occurs near the eyes,surgical treatment becomes uniquely complex.Excess excisions may cause detrimental effects to eyelid function and undesirable aesthetic outcomes.Conversely,adequate resection must occur to prevent further disease progression.Mohs micrographic surgery(MMS),a technique offering high remission rates,is often employed for periocular BCC.This method allows for precise cancer removal while preserving as much healthy tissue as possible,balancing the need for both effective treatment and aesthetic and functional preservation.Following Mohs surgery of periocular BCC,reconstruction methods vary and can be tailored based on the size of the resection and the functional requirements of the affected tissue.Amongst these methods,primary closure with and without secondary intentions,direct margin repair,local flap closure and advance flap,Tenzel flap,tarso-conjunctival flap,periocular skin grafting,and structural grafting are commonly utilized and each has its advantages and limitations.In the future,advancements in synthetic flaps and stabilizing glues in the periocular region may provide additional tools for post-Mohs reconstruction.However,these emerging techniques require further research to establish efficacy and safety,especially in more complex and sensitive regions like the periocular tissues.The primary purpose of this review is to provide a comprehensive analysis of periocular reconstructive techniques following Mohs surgery,comparing their efficacy,functional outcomes,and aesthetic considerations while addressing recent advancements such as synthetic flaps and stabilizing glues to guide clinical decision-making.
文摘Traumatic amputations remain one of the most frequent and disturbing wounds of armed conflict.In this scenario,most amputees develop residual and phantom limb pain,impacting their quality of life.There are several elective surgical procedures available for both conditions,such as neuroma excision followed by nerve reconstruction,nerve relocation,e.g.,surgically implanting a transected nerve into a muscle,nerve transfers in cases of associated paralysis,and most recently,regenerative peripheral nerve interface surgery.Whenever possible in the post-conflict phase,a coordinated effort between traveling humanitarian surgeons specializing in reconstructive microsurgery and local healthcare providers is essential for successfully treating phantom and chronic residual limb pain in post-conflict amputees.While providing a detailed logistical framework for global humanitarian missions is beyond the scope of this article,we provide a brief perspective on a topic of utmost importance for reconstructive surgeons worldwide:the high-quality care and treatment of refugees and those whose lives have been impacted by conflict,disaster,or displacement.
文摘Objective: The aim of this research was to find out if reconstructive surgery is the best option to improve the quality of life of patients with rheumatoid arthritis compared to other monotherapy or combination therapy treatments.Methods: The research uses a mixed qualitative-quantitative, correlational, and cross-sectional approach. The medical records of a sample of 28 patients with rheumatoid arthritis who were treated at Rio Hospital in Riobamba-Ecuador in the period 2022-2024 were reviewed. The Health Assessment Questionnaire (HAQ) was used to assess quality of life, and the Diseases Activity Score (DAS) 28 was used to measure the degree of joint involvement. To establish the correlation between variables, HJ Biplot multivariate analysis was applied in RStudio. Results: A high correlation was found between quality of life and the degree of joint involvement DAS 28, patients with a degree of high activity (more unfavorable condition) have a worse quality of life due to their severe disability. Both quality of life and the degree of joint involvement were also correlated with the treatment they receive, patients with worse quality of life and a higher degree of joint involvement received combined therapy as treatment. Patients who have undergone reconstructive surgery have a better quality of life. Overweight patients tend to have greater joint involvement and poorer quality of life. Conclusions: The results suggest that reconstructive surgery plays an important role in the management of patients with advanced rheumatoid arthritis, helping to restore function and improve quality of life.
基金supported in part by NUS startup grantthe National Natural Science Foundation of China (52076037)。
文摘Although many multi-view clustering(MVC) algorithms with acceptable performances have been presented, to the best of our knowledge, nearly all of them need to be fed with the correct number of clusters. In addition, these existing algorithms create only the hard and fuzzy partitions for multi-view objects,which are often located in highly-overlapping areas of multi-view feature space. The adoption of hard and fuzzy partition ignores the ambiguity and uncertainty in the assignment of objects, likely leading to performance degradation. To address these issues, we propose a novel sparse reconstructive multi-view evidential clustering algorithm(SRMVEC). Based on a sparse reconstructive procedure, SRMVEC learns a shared affinity matrix across views, and maps multi-view objects to a 2-dimensional humanreadable chart by calculating 2 newly defined mathematical metrics for each object. From this chart, users can detect the number of clusters and select several objects existing in the dataset as cluster centers. Then, SRMVEC derives a credal partition under the framework of evidence theory, improving the fault tolerance of clustering. Ablation studies show the benefits of adopting the sparse reconstructive procedure and evidence theory. Besides,SRMVEC delivers effectiveness on benchmark datasets by outperforming some state-of-the-art methods.
文摘Large-scale defects of body in the reconstructive surgical practice,and the help-lessness of their repair with autologous tissues,have been an important factor in the development of artificial biological products for the temporary,definitive,or staged repair of these defects.A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices(ADMs).In recent years,not only the type of tissue from which ADMs are produced,product range,diversity and areas of use have increased,but their use in reconstructive fields,especially in post oncologic breast surgery,has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future.It is essential that reconstructive surgeons become familiar with some of the ADM’s as well as the advantages and limitations to their use.This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the arma-mentarium of reconstructive surgeons.Brief considerations of possible future directions for ADMs are also conducted in the end.
文摘Mining operation, especially underground coal mining, always has the remarkable risks of ground control. Passive seismic velocity tomography based on simultaneous iterative reconstructive technique （SIRT） inversion is used to deduce the stress redistribution around the longwall mining panel. The mining-induced microseismic events were recorded by mounting an array of receivers on the surface, above the active panel. After processing and filtering the seismic data, the three-dimensional tomography images of the p-wave velocity variations by SIRT passive seismic velocity tomography were provided. To display the velocity changes on coal seam level and subsequently to infer the stress redistribution, these three-dimensional tomograms into the coal seam level were sliced. In addition, the boundary element method （BEM） was used to simulate the stress redistribution. The results show that the inferred stresses from the passive seismic tomograms are conformed to numerical models and theoretical concept of the stress redistribution around the longwall panel. In velocity tomograms, the main zones of the stress redistribution arotmd the panel, including front and side abutment pressures, and gob stress are obvious and also the movement of stress zones along the face advancement is evident. Moreover, the effect of the advance rate of the face on the stress redistribution is demonstrated in tomography images. The research result proves that the SIRT passive seismic velocity tomography has an ultimate potential for monitoring the changes of stress redistribution around the longwall mining panel continuously and subsequently to improve safety of mining operations.
基金National Natural Science Foundation of China[Grant Numbers 81802174,81900726&82072456]Department of Science and Technology of Jilin Province,P.R.C[Grant Numbers 20200404202YY,20200403086SF&20200201453JC]+8 种基金Jilin Province Development and Reform Commission,P.R.C[Grant Number 2018C010]Education Department of Jilin Province,P.R.C[GrantNumber JJKH20180106KJ]Administration of Traditional Chinese Medicine of Jilin Province P.R.C[Grant Number 2018115]10th Youth Project of the First Hospital of Jilin University[Grant Number JDYY102019025]Department of Finance in Jilin Province[Grant Number 2019SCZT046]Undergraduate Teaching Reform Research Project of Jilin University[Grant Number 4Z2000610852]Key training plan for outstanding young teachers of Jilin University[Grant Number 419080520253]Bethune plan of Jilin University[Grant Number 470110000692]The major participant is Qing Han.
文摘A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.
文摘TEM observation and analysis have been conducted on bainitie transformation with and without the influence of externally applied tensile sress for alloyed steel 35MV7. Recrystallizafion was found to occur within the bainitic structures transformed at 450 ℃ in cases of both with and without the application of external stress, and coupling between the reconstructive and displacive mechanisms is expected, due to the relatively high holding temperature and high dislocation density yielded with the displacive mechanism. RecrystaUization was not observed within the bainitic structures transformed at lower temperature of 350 ℃, both with and without the application of stress; However, for the stressed specimen, the structure with very fine subgrains was found to be preserved and not reconstructed thermically, due to the low temperature and short holding time.
文摘Electrical capacitance tomography technique reconstructs dielectric constant distribution in an object by measuring the capacitances between the eletrode pairs which are mounted around this object. Because of the limitation of measurement condition, the measured data are imcomplet. This paper describes a multiresolution reconstructive algorithm which is based on network theory for electrical capacitance tomography technique. The dielectric constant distribution of flow of two components in a pipeline is reconstructed. The algorithm is as follows: Firstly, construct a rough, first level system model, and assume the dielectric constant distribution of the region to be reconstructed. After iteration, the dielectic constant of each unit can be reconstructed. Secondly, construct a finer, second level the system model and determine the initial dielectric constant of each unit in the region to be reconstructed according to related information between two levels. After iteration, the image of the pipeline's cross section can be reconstructed. The results of simulated experiments about different kinds of medium distributions show that this algorithm is effective and can converge.
文摘Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.
文摘Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.
文摘Surgical treatment of Peyronie's disease(PD) is still a challenge and a gold standard approach does not exist; however the main goal is to straight penile shaft, and to restore penetrative and coital capacity. The less invasive approach aims to correct curvature without intervening directly on the fibrous plaque while the more complex "corporoplasty" applies specific geometric criteria and uses different autologous and heterologous grafts. Each approach has its pros and cons and decisionmaking should be tailored to the individual patient's expectations. Other surgical options include different use of patches to cover the tunica albuginea defect, with the choice depending on the surgeon's personal experience. Despite the wide range of autologous(buccal mucosa, vein, dermis, etc.) and heterologous grafts(bovine pericardium, swine intestinal submucosa, porcine dermis, etc.) none currently represents the real "gold standard" because the data are extremely variable and frequently not representative. Several factors seem to favor buccal mucosa grafts over inert biocompatible materials: as vital tissue, buccal mucosa tends to heal rapidly, immediately integrating with the surrounding albuginea tissue. This translates into a more rapid resumption of spontaneous erections(after 3/4 d) and sexual activity and into a reduced risk of curvature relapse and erectile dysfunction after surgery. Another advantage of the buccal mucosa graft is its low cost. In conclusion, despite the recent development of some exciting new surgical techniques we are still unable to deliver a definitive take-home message about reconstructive surgery in PD because the majority of the studies reported insufficient data. However, since it is clear that major outcomes, besides the cosmetic result, are the patient's and partner's satisfaction and the economic impact of each technique, we recommend they be included among the outcome assessment parameters in further
文摘We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.
文摘The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.
基金supported by the National Nature Science Foundation(grant nos.81871577 and 81971864)。
文摘Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.
文摘Compressive sensing is a powerful method for reconstruction of sparsely-sampled data, based on statistical optimization. It can be applied to a range of flow measurement and visualization data, and in this work we show the usage in groundwater mapping. Due to scarcity of water in many regions of the world, including southwestern United States, monitoring and management of groundwater is of utmost importance. A complete mapping of groundwater is difficult since the monitored sites are far from one another, and thus the data sets are considered extremely “sparse”. To overcome this difficulty in complete mapping of groundwater, compressive sensing is an ideal tool, as it bypasses the classical Nyquist criterion. We show that compressive sensing can effectively be used for reconstructions of groundwater level maps, by validating against data. This approach can have an impact on geographical sensing and information, as effective monitoring and management are enabled without constructing numerous or expensive measurement sites for groundwater.
文摘The pectoralis major musculocutaneous (PMMC) flap has been a useful technique for head and neck reconstruction since its first description by Ariyan in 1979. However, techniques in microvascular surgery have since evolved and recently free tissue transfer has played an important role in head and neck reconstruction. Although we use free flaps as the first choice for head and neck reconstruction, similar to many other institutions, some patients at our hospital have undergone reconstruction with PMMC flaps. We retrospectively analyzed the indications and outcomes of this reconstructive technique from our experience with 12 patients. The medical records of all patients who underwent PMMC flaps at Hokkaido Cancer Center from 2001 to 2010 were reviewed. Data concerning diagnosis, main indication, site of reconstruction, previous treatment, and postoperative complications were analyzed. Of the 12 PMMC flap surgeries performed, 3 were carried out as primary reconstructive procedures, whereas 9 were done as “salvage” procedures. Flap-related complications were observed in 6 cases. Partial flap loss developed in 4 patients, although there were no cases of total flap loss. There were 3 recurrent fistulae following reconstruction with PMMC flaps. The preoperative goals of performing PMMC flap surgery were met in 83% of our cases. The authors conclude that while free flap transfer is usually the first choice for head and neck reconstruction, PMMC flaps can produce acceptable results in certain situations.
基金supported by the National Natural Science Foundation of China(No.62305391)the Hunan Innovative Province Construction Project(No.2019RS3017)+1 种基金the National Postdoctoral Program for Innovative Talents(No.BX20190063)the Scientific Fund of National University of Defense Technology(Nos.22-061 and 24ZZCX-BC-03)。
文摘This study introduced a differential polarization division multiplexing(DPDM)scheme for all-fiber high-accuracy spectral measurement.Launching two orthogonal linearly polarized light beams into multimode fibers,the DPDM elegantly reconstructs the input spectra from the differential speckle,which is more comprehensive spectral-to-spatial encoding with fewer noises and better contrast.A spectral measurement with 2 pm resolution and 2000 channels was achieved.Compared with traditional transmission matrix and polarization division multiplexing schemes,the proposed DPDM approach reduced the spectral reconstruction error by 77%and 69%,respectively,offering a simple and effective solution for highly accurate spectral measurements.
基金supported by the National Natural Science Foundation of China(NSFC)(Grant No.62305391)Hunan Innovative Province Construction Project(No.2019RS3017)Scientifc Fund of National University of Defense Technology(No.22-061).
文摘This study presents a high-accuracy,all-fber mode division multiplexing(MDM)reconstructive spectrometer(RS).The MDM was achieved by utilizing a custom-designed 3×1 mode-selective photonics lantern to launch distinct spatial modes into the multimode fber(MMF).This facilitated the information transmission by increasing light scattering processes,thereby encoding the optical spectra more comprehensively into speckle patterns.Spectral resolution of 2 pm and the recovery of 2000 spectral channels were accomplished.Compared to methods employing single-mode excitation and two-mode excitation,the three-mode excitation method reduced the recovered error by 88%and 50%respectively.A resolution enhancement approach based on alternating mode modulation was proposed,reaching the MMF limit for the 3 dB bandwidth of the spectral correlation function.The proof-of-concept study can be further extended to encompass diverse programmable mode excitations.It is not only succinct and highly efcient but also well-suited for a variety of high-accuracy,high-resolution spectral measurement scenarios.
文摘ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.
