输尿管狭窄的重建是泌尿外科具有挑战性的手术之一,针对不同位置及长度的狭窄,有多种重建术式可供选择,利用膀胱肌瓣输尿管狭窄成形术是经典修复下段狭窄的术式。本文就膀胱肌瓣输尿管狭窄成形术手术治疗的进展作一综述,供临床参考。Rec...输尿管狭窄的重建是泌尿外科具有挑战性的手术之一,针对不同位置及长度的狭窄,有多种重建术式可供选择,利用膀胱肌瓣输尿管狭窄成形术是经典修复下段狭窄的术式。本文就膀胱肌瓣输尿管狭窄成形术手术治疗的进展作一综述,供临床参考。Reconstruction of ureteral strictures represents one of the most challenging surgeries in urology. Various reconstructive techniques are available for strictures of different locations and lengths, among which the use of ureteral strictureplasty with Boari bladder flap is a classic approach for repairing lower segment strictures. This article provides a comprehensive review of the advancements in surgical management using ureteral strictureplasty with Boari bladder flap, serving as a clinical reference.展开更多
Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reco...Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.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
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
Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,t...Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,thereby restricting the performance of everyday activities.Therefore,a wide variety of reconstruction options are available.In this study,our main aim was to have a clear surgical plan prior to surgery according to preoperative findings and the degree of thumb abduction span.Methods:This study was conducted at Kasr Al-Ainy Hospital.This cohort study included 33 patients with cicatricial first web space contractures who underwent reconstructive procedures to restore the first web space.Patients were assessed preoperatively and categorized according to the degree of contracture,and the reconstruction procedure was chosen accordingly.They were assessed using both objective and subjective methods.Results:In this study,33 cases of cicatricial contracture of the first web space due to physical or thermal trauma were included.Measurements of the change in the span of abduction were performed for all patients included in the study preoperatively and postoperatively.Skin grafting and skin substitutes had an average change in abduction span of 32.5°(±14.4°),Z-plasty release had a mean of 30.59°(±8.82°)increase in abduction span,regional flaps had an increase of 40.71°(±12.39°),while distant flaps had an increase of 35°(±3.54°).Conclusion:No single reconstruction method can be used in all cases.When viewing a patient,one must consider that each individual has a unique representation.However,if we follow a systematic method for the initial evaluation,the most efficient flap can be chosen for each case,thus reducing the need for secondary procedures.Categorizing the cases according to the abduction span into mild,moderate,or severe forms is the first building block of this algorithm.Adjacent tissue condition,patient occupation,compliance,and the need to return to work are important factors.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
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
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
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
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
Cold-flow experiments on planar Expansion Deflection(ED)nozzle flows are conducted under a simulated startup-shutdown process of rocket motors.The purpose is to investigate the flow and performance characteristics in ...Cold-flow experiments on planar Expansion Deflection(ED)nozzle flows are conducted under a simulated startup-shutdown process of rocket motors.The purpose is to investigate the flow and performance characteristics in ED nozzles,capture the behavior of shock flapping,and explore asymmetric flow dynamics utilizing a symmetric nozzle.A total pressure condition,characterized by rapid rise followed by a slow fall,is employed to simulate the continuous startup and shutdown processes.The schlieren imaging technique and high-frequency pressure transducers are employed to obtain the flow information.The experimental results indicate that the flow characteristics differ between the startup and shutdown processes with a hysteresis observed in the nozzle wake mode transition.During the startup process,the shock waves are pushed outward of the nozzle,while during the shutdown process,the flow propagates inward dominated by Mach stems.Counterintuitive results are demonstrated,namely,the mode transition is not the cause of the sudden thrust decrease,and the moment of maximum thrust does not coincide with the moment of maximum total pressure.During the operation of the nozzle,two stages of shock wave flapping occur,accompanied by significant wall pressure oscillations.These oscillation frequencies are demonstrated to be related to the inherent acoustic frequencies of the test chamber.An improved pressure ratio method is proposed to predict the position of the shock oscillation separation point.The prediction results revealed the shock behavior during the flapping process.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 Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches....BACKGROUND Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches.The complex anatomy,involving anterior and posterior lamellae,requires tailored reconstruction for optimal functionality.AIM To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hos-in dry eye and tears,which may lead to long-term consequences such as chronic conjunctivitis,discomfort,or photo-phobia.To prevent this issue,scars should be oriented vertically or perpendicularly to the free eyelid margin when the size of the tumor allows.In employing a malar flap to repair a lower eyelid defect,the malar incision must ascend diagonally;this facilitates enhanced flap advancement and mitigates ectropion by restricting vertical traction.Conse-quently,it is imperative to maintain that the generated tension remains consistently horizontal and never vertical[9].Lagophthalmos is a disorder characterized by the inability to completely close the eyelids,leading to corneal exposure and an increased risk of keratitis or ulceration;it may arise following upper eyelid surgery.To avert this issue,it is essential to preserve a minimum of 1 cm of skin between the superior edge of the excision and the inferior boundary of the eyebrow.Epiphora may occur in cancers involving the lacrimal puncta,requiring their removal.As previously stated,when employing a glabellar flap to rectify medial canthal abnormalities,it is essential to prevent a trapdoor effect or thickening of the flap relative to the eyelid skin to which it is affixed.Constraints about our proposed algorithm enco-mpass limited sample sizes and possible publication biases in existing studies.Subsequent investigations ought to examine long-term results to further refine the algorithm.Future research should evaluate the algorithm across varied populations and examine the impact of novel graft materials on enhancing reconstructive outcomes.CONCLUSION Eyelid reconstruction remains one of the most intriguing challenges for a plastic surgeon today.The most fascinating aspect of this discipline is the need to restore the functionality of such an essential structure while maintaining its aesthetics.In our opinion,creating decision-making algorithms can facilitate reaching this goal by allowing for the individualization of the reconstructive path while minimizing the incidence of complications.The fact that we have decreased the incidence of severe complications is a sign that the work is moving in the right direction.The fact that there has been no need for reintervention,neither for reconstructive issues nor for inadequate oncological radicality,overall signifies greater patient satisfaction as they do not have to undergo the stress of new surgeries.Even the minor complic-ations recorded are in line with those reported in the literature,and,even more importantly for patients,they are of limited duration.In our experience,after a year of application,we can say that the objective has been achieved,but much more can still be done.Behind every work,a scientific basis must be continually renewed and refreshed to maintain high-quality standards.Therefore,searching for possible alternative solutions to be included in one’s surgical armamentarium is fundamental to providing the patient with a fully personalized option.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
文摘输尿管狭窄的重建是泌尿外科具有挑战性的手术之一,针对不同位置及长度的狭窄,有多种重建术式可供选择,利用膀胱肌瓣输尿管狭窄成形术是经典修复下段狭窄的术式。本文就膀胱肌瓣输尿管狭窄成形术手术治疗的进展作一综述,供临床参考。Reconstruction of ureteral strictures represents one of the most challenging surgeries in urology. Various reconstructive techniques are available for strictures of different locations and lengths, among which the use of ureteral strictureplasty with Boari bladder flap is a classic approach for repairing lower segment strictures. This article provides a comprehensive review of the advancements in surgical management using ureteral strictureplasty with Boari bladder flap, serving as a clinical reference.
文摘Background: Numerous reconstruction methods have been developed for myelomeningocele defects;however,no published reports have been published on the preferred reconstruction method in Malaysia.This study reviewed reconstruction techniques and outcomes in patients with myelomeningocele at our center.Methods: A retrospective study was conducted on reconstruction methods and outcomes in patients with myelomeningocele referred to the Plastic and Reconstructive Unit,Hospital Universiti Sains Malaysia(HUSM),Kelantan,for wound coverage from to 1997–2023.Data on patient demographics,defect size,reconstruction methods,operation duration,flap-related complications,and secondary repairs were collected and analyzed.Results: Thirteen patients were identified in this retrospective study,comprising 5 female patients,7 male patients,and 1 ambiguous gender patient.Wound closures were performed using primary closure method,local flaps,or regional flap closure.Nine(69.2%) of the thirteen patients underwent soft tissue reconstruction using the local flap,three(23.1%) underwent primary closure,and only one(7.7%) patient underwent wound closure with a regional flap.Flap-related complications were observed in four of the thirteen patients,including wound breakdown in two cases and partial flap necrosis in two cases.Of these four patients,secondary repair was required in three: split-thickness skin grafting was performed in two,and primary closure in one.The remaining patient was managed conservatively with dressings.Patients were followed up for a mean duration of56.6(±62.4) months,and complete healing was achieved in all cases.Conclusion: Myelomeningocele repair remains challenging,and a multidisciplinary approach is recommended.We demonstrated various local and regional flap closure methods with good outcomes.Reconstruction techniques should be tailored for individual cases based to the surgeon expertise.
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.
文摘Background:The first web space not only plays an integral role in hand functionality,but also holds an important aesthetic function for patients with cicatricial contractures,which hinders the ability to move joints,thereby restricting the performance of everyday activities.Therefore,a wide variety of reconstruction options are available.In this study,our main aim was to have a clear surgical plan prior to surgery according to preoperative findings and the degree of thumb abduction span.Methods:This study was conducted at Kasr Al-Ainy Hospital.This cohort study included 33 patients with cicatricial first web space contractures who underwent reconstructive procedures to restore the first web space.Patients were assessed preoperatively and categorized according to the degree of contracture,and the reconstruction procedure was chosen accordingly.They were assessed using both objective and subjective methods.Results:In this study,33 cases of cicatricial contracture of the first web space due to physical or thermal trauma were included.Measurements of the change in the span of abduction were performed for all patients included in the study preoperatively and postoperatively.Skin grafting and skin substitutes had an average change in abduction span of 32.5°(±14.4°),Z-plasty release had a mean of 30.59°(±8.82°)increase in abduction span,regional flaps had an increase of 40.71°(±12.39°),while distant flaps had an increase of 35°(±3.54°).Conclusion:No single reconstruction method can be used in all cases.When viewing a patient,one must consider that each individual has a unique representation.However,if we follow a systematic method for the initial evaluation,the most efficient flap can be chosen for each case,thus reducing the need for secondary procedures.Categorizing the cases according to the abduction span into mild,moderate,or severe forms is the first building block of this algorithm.Adjacent tissue condition,patient occupation,compliance,and the need to return to work are important factors.
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.
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.
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 the National Natural Science Foundation of China(No.12002102)。
文摘Cold-flow experiments on planar Expansion Deflection(ED)nozzle flows are conducted under a simulated startup-shutdown process of rocket motors.The purpose is to investigate the flow and performance characteristics in ED nozzles,capture the behavior of shock flapping,and explore asymmetric flow dynamics utilizing a symmetric nozzle.A total pressure condition,characterized by rapid rise followed by a slow fall,is employed to simulate the continuous startup and shutdown processes.The schlieren imaging technique and high-frequency pressure transducers are employed to obtain the flow information.The experimental results indicate that the flow characteristics differ between the startup and shutdown processes with a hysteresis observed in the nozzle wake mode transition.During the startup process,the shock waves are pushed outward of the nozzle,while during the shutdown process,the flow propagates inward dominated by Mach stems.Counterintuitive results are demonstrated,namely,the mode transition is not the cause of the sudden thrust decrease,and the moment of maximum thrust does not coincide with the moment of maximum total pressure.During the operation of the nozzle,two stages of shock wave flapping occur,accompanied by significant wall pressure oscillations.These oscillation frequencies are demonstrated to be related to the inherent acoustic frequencies of the test chamber.An improved pressure ratio method is proposed to predict the position of the shock oscillation separation point.The prediction results revealed the shock behavior during the flapping process.
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.
文摘BACKGROUND Eyelid reconstruction is an intricate process,addressing both aesthetic and functional aspects post-trauma or oncological surgery.Aesthetic concerns and oncological radicality guide personalized approaches.The complex anatomy,involving anterior and posterior lamellae,requires tailored reconstruction for optimal functionality.AIM To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hos-in dry eye and tears,which may lead to long-term consequences such as chronic conjunctivitis,discomfort,or photo-phobia.To prevent this issue,scars should be oriented vertically or perpendicularly to the free eyelid margin when the size of the tumor allows.In employing a malar flap to repair a lower eyelid defect,the malar incision must ascend diagonally;this facilitates enhanced flap advancement and mitigates ectropion by restricting vertical traction.Conse-quently,it is imperative to maintain that the generated tension remains consistently horizontal and never vertical[9].Lagophthalmos is a disorder characterized by the inability to completely close the eyelids,leading to corneal exposure and an increased risk of keratitis or ulceration;it may arise following upper eyelid surgery.To avert this issue,it is essential to preserve a minimum of 1 cm of skin between the superior edge of the excision and the inferior boundary of the eyebrow.Epiphora may occur in cancers involving the lacrimal puncta,requiring their removal.As previously stated,when employing a glabellar flap to rectify medial canthal abnormalities,it is essential to prevent a trapdoor effect or thickening of the flap relative to the eyelid skin to which it is affixed.Constraints about our proposed algorithm enco-mpass limited sample sizes and possible publication biases in existing studies.Subsequent investigations ought to examine long-term results to further refine the algorithm.Future research should evaluate the algorithm across varied populations and examine the impact of novel graft materials on enhancing reconstructive outcomes.CONCLUSION Eyelid reconstruction remains one of the most intriguing challenges for a plastic surgeon today.The most fascinating aspect of this discipline is the need to restore the functionality of such an essential structure while maintaining its aesthetics.In our opinion,creating decision-making algorithms can facilitate reaching this goal by allowing for the individualization of the reconstructive path while minimizing the incidence of complications.The fact that we have decreased the incidence of severe complications is a sign that the work is moving in the right direction.The fact that there has been no need for reintervention,neither for reconstructive issues nor for inadequate oncological radicality,overall signifies greater patient satisfaction as they do not have to undergo the stress of new surgeries.Even the minor complic-ations recorded are in line with those reported in the literature,and,even more importantly for patients,they are of limited duration.In our experience,after a year of application,we can say that the objective has been achieved,but much more can still be done.Behind every work,a scientific basis must be continually renewed and refreshed to maintain high-quality standards.Therefore,searching for possible alternative solutions to be included in one’s surgical armamentarium is fundamental to providing the patient with a fully personalized option.
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.
