Arc Of Rotation Research Articles

Perforator flaps based on the deltoid branch of the thoracoacromial artery: anatomical study

Objectives: Tissue defects in the lateral triangle of the neck and the anterior cervical region represent a high demand for plastic and reconstructive surgery. Their management most often requires regional or free flaps. The perforator flap based on the deltoid branch of the thoracoacromial artery (TAA) may be a good solution for these indications. The objective of this work is to propose anatomical landmarks to raise perforator flaps pedicled on the deltoid branch of the TAA. Methods: We carried out dissection of 24 perforator flaps based on the deltoid branch of the TAA, in body donor specimens preserved in a glycerin-rich, formalin-free solution. The TAA was first injected with methylene blue. The vascular territory, location of perforators relative to known landmarks, along with the flap’s potential amplitude and arc of rotation were studied. Results: The main perforating arteries of the flap were located in the middle of the deltopectoral groove, often surrounded by adipose tissue in 18 out of 24 dissections. In 22 out of 24 dissections, there were at least 2 perforator arteries originating from the deltoid branch. The average diameter of the perforator arteries was 1 mm. The flap’s amplitude of movement made it possible to reach in all cases the lateral triangle of the neck and the anterolateral cervical region. Conclusion: The thoracoacromial artery has already been used for perforator flaps. However, the individualization of its deltoid branch offers to practitioners new surgical options. This anatomical study of the perforator flap based on the deltoid branch of the TAA made it possible to review the anatomical bases for the raising of this flap, and to fix useful landmarks for the surgeon in order to propose an easily feasible surgical technique.

Safety Profile, Pros and Cons of the Submental Flap in Reconstruction of the Orofacial Defects after Malignant Tumor Resection

Objective: The main aim of this paper is to assess thesafety profile and usefulness of the submental flap as areconstructive tool for reconstructing orofacial defects aftermalignant tumor resection.Methods: A total sample of 23 patients suffering fromoral cavity cancers during two years were included. All patientsunderwent surgical excision of the primary tumor and neckdissection with immediate reconstruction of the resultantdefect using the submental flap.Results: Among patients included in the study sample,there were 15 males and 8 females. They were in the agegroup of 39 to 67 years old. Chin (1) buccal mucosa (5),alveolar margin (4), and tongue (13) were the primary tumorsites. After the operation, the evaluation of functions, swallowing,speaking, and jaw movements were all good in allpatients. Advantages include long rotation arc, short operativetime, short hospital stay, and excellent healing of the donnersite. Disadvantages include the persistence of hair in malepatients and recurrences in 5 patients.Conclusion: The study concluded that one of the bestinstruments for reconstructing orofacial tissue is the submentalflap. It is easily harvested, valid, and locally available flap.However, it is necessary to use the submental flap withadequate care in patients with a positive neck.

The Relationship Between Hip Range of Motion and Pitching Kinematics Related to Increased Elbow Valgus Loads in Collegiate Baseball Pitchers: A Pilot Study.

BackgroundHip range of motion (ROM) during baseball pitching is associated with trunk rotation and shoulder kinematics, which has shown to influence medial elbow valgus loading and pitching performance. The purpose of this study was to measure the relationship between hip rotational ROM and kinematic variables that influence elbow valgus loads in Division 1 collegiate pitchers.Study DesignDescriptive laboratory study.MethodsThree-dimensional pitching motion (Motion Analysis Corp, Santa Rosa, California) analyses were captured for seven Division 1 baseball pitchers. Six kinematic measurements related to medial elbow valgus loading were calculated while the pitchers threw fastballs. Inclinometer measurements were used to measure hip internal (IR), external (ER) ROM, and total rotational arc at the hip (IR + ER ROM). Correlations were used to evaluate the association between hip IR, ER, and total rotational arc ROM (TRARC) and six kinematic variables.ResultsTrunk angular velocity was correlated to trail hip ER and TRARC (p <0.01). Lead hip total arc ROM was associated with maximum shoulder ER (p < 0.01). Lead hip IR was correlated to elbow flexion angle at ball release (p < 0.01).ConclusionHip ROM during pitching is associated with trunk angular velocity, maximum shoulder ER and elbow flexion angle at ball release. Alterations in hip TRARC appears to influence trunk rotation velocity leading to dependence on increased shoulder ROM and decreased elbow flexion angle at ball release which is associated with diminished pitching performance and excessive medial elbow valgus loads.Level of Evidencelevel 3

Molecules to Mountains: A Multi-Proxy Investigation Into Ancient Climate and Topography of the Pacific Northwest, USA

We characterize the topographic evolution of the Pacific Northwest, United States, during the Cenozoic. New paleosol carbonate stable isotope (δ18O) results from central Oregon are presented, along with published proxy data, including fossil teeth, smectites, and carbonate concretions. We interpret a polygenetic history of Cascade Mountain topographic uplift along-strike, characterized by: 1) Steady uplift of the Washington Cascades through the Cenozoic due long-term arc rotation and shortening against a Canadian buttress, and 2) Uplift of the Oregon Cascades to similar-to-modern elevations by the late Oligocene, followed by topographic stagnation as extension developed into the Neogene. Since the Miocene, meteoric water δ18O values have decreased in Oregon, possibly due to emergence of the Coast Range and westward migration of the coastline. Spatial variability in isotopic change throughout the Pacific Northwest suggests that secular global climate change is not the primary forcing mechanism behind isotopic trends, though Milankovitch cycles may be partly responsible for relatively short-term variation.

The Influence of TMF and AMF Components on Arc Movement Characteristics in Spiral-Slot Contacts

Spiral-slot contacts produce an axial magnetic field (AMF) and the transverse magnetic field (TMF). The magnetic field between TMF contacts will affect the breaking performance of vacuum interrupters. In order to study the effect of TMF and AMF on arcing process and movement characteristics, five contacts with different TMF and AMF, but the same ratio of TMF to AMF, were designed and experimentally investigated in a demountable vacuum chamber. The arc movement phenomenon under different TMF and AMF was obtained. It was found that increasing TMF and AMF could reduce the arc jets to the outer electrode, and arc stagnation was more likely to occur in the later stage of the movement. The influence of TMF and AMF on arc movement characteristics and the utilization of contact surfaces was investigated. With the increase in TMF and AMF, the number of arc rotations increased, and the range of arc movement and the utilization of contact surface increased first and then decreased. Simulations were performed to analyze that the influence mechanism of TMF and AMF on arc movement characteristics was investigated. With the increase in TMF and AMF, the tangential force of the concentrated arc was increased, and the radial force was reduced.

Use of Perforator Propeller Flaps for Coverage of Soft issue Defects Around The Distal Leg and Ankle

Introduction: Perforator propeller flap is a suitable option to cover soft tissue defects in the distal leg and ankle which preserves the main vascular arteries of the lower extremity and muscle function. The aim of this study is to evaluate the use of perforator propeller flaps for coverage of soft tissue defects around the distal leg and ankle.&#x0D; Methods: This prospective study was donebetween December 2018 to November 2019in the Department of Burn &amp; Plastic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation ( NITOR), Dhaka. Total 32 patients with small to medium sized soft tissue defect over distal leg and ankle underwent reconstruction with perforator propeller flaps. Sixteen patients had defect over tendo achilles area, 6 had defect over lateral malleolus,7 over medial malleolus and medial aspect of distal third leg and only 3 had defect in front of ankle. Average Flap length and width were 12.72 (+4.19) &amp; 5.63 (+1.78) cm respectively. Flap rotation was measured 180 degrees in 84.37% of the cases. The propeller flaps were based on a single perforator and it was observed from the posterior tibial artery in 62.5% and peroneal artery in 37.5% of the cases.&#x0D; Results: 81.25% of the flaps completely survived. Total flap loss was observed in one case (3%) while partial flap loss occurred in 6.2% cases. Marginal flap necrosis and epidermolysis were observed in 6.2% and 3% cases respectively.&#x0D; Conclusions: Propeller flapshavereliable vascular pedicle as well as greater freedom in design and arc of rotation that extend the possibility ofreconstructing difficult wounds with local tissues and minimal donor-site morbidity.&#x0D; J Bangladesh Coll Phys Surg 2021; 39(2): 87-93

Clavicle Survival as a Free Bone Graft: A Case Report of Minor Modification Added to Pectoralis Major Flap

Introduction: Reconstruction of the surgically created defects in the head and neck regions is a crucial step in the patients’ treatment plan. Regarding the involved tissues, various flaps and grafts have been introduced in the literature. The pectoralis major myocutaneous flap (PMMF) is one of the most versatile flaps with many variations for providing more advantages. Also, when bone tissue is needed, it can be reconstructed via an osteomyocutaneous flap including rib, sternum, or clavicle. Case Presentation: In this article, a case of oral squamous cell carcinoma with the extension to facial structures and, then, reconstructed with PMMF was presented, in which a medial half of clavicle bone was resected and employed as a free bone graft. Conclusions: Sectioning clavicle not only increases the arc of rotation and mobility of the PMMF but also provides a new source of bone graft in the vicinity. Besides, the survival of the graft and integration with the native bone is noteworthy.

Effect of Longitudinal Magnetic Field on CMT Welding of Al-Alloy

A longitudinally varying magnetic field (MF) was applied during cold metal transfer (CMT) welding of Al alloys. The effect of MF on the welding process, macrostructure, microstructure and properties of weld beads was studied. The results showed that the application of MF led to arc expansion and rotation, the droplet transfer frequency decreased, the droplet volume became larger, and the droplets deflected. When the coil current was between 0 and 5 A, the weld beads porosity decreased from 4.47 to 0.26%. And when the coil current was increased to 8 A, the porosity of weld beads also increased to 2.84%. MF reduced the weld depth, wetting angle and weld reinforcement, and increased weld width. With the increase of coil current, the width of primary dendrite arms decreased from 7.75 to 5.01 μm. The area occupied by the Al–Si eutectic was enlarged, and the eutectic was refined. It was also found that the MF slightly increased the hardness of the weld beads, and the hardness distribution was more uniform.

Combined palmar and dorsal plating of four-part distal radius fractures: Our clinical and radiological results.

Objectives This study aims to investigate the radiological and clinical outcomes of four-part intraarticular distal radius fractures treated with a volar anatomically locked plate and 2 mm low-profile plates using both the volar and dorsal approaches.Patients and methods This retrospective study included 20 patients (8 males, 12 females; mean age 47±12.1; range, 25 to 67 years) who received open reduction and internal fixation with combined volar and dorsal plating to treat complex four-part distal radius fractures (shaft, radial styloid area, dorsal medial facet, volar medial facet) between May 2016 and January 2019. According to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, all fractures were 2R3-C3. According to Melone classification, one fracture was type 1, seven fractures were type 2a, three were type 2b, three were type 3 and six were type 4. The mean follow-up time was 21±7.5 (range, 12 to 36) months.Results Union was achieved in all fractures. The mean tourniquet time was 103±12 (range, 90 to 130) minutes. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 10±9, and the mean Visual Analog Scale score was 2.1±0.9. According to Mayo wrist score, five patients had excellent, six had good, six had satisfactory and three had poor results. The mean grip strength was 25.2±9.2 (range, 15 to 40) kg and 78% of opposite side. Mean wrist flexion was 48.7°±15.3° (range, 30° to 80°), extension was 52.2°±17.2° (range, 25° to 80°), radio-ulnar deviation arc was 40.7°±6.9° (range, 30° to 55°), and mean forearm rotation arc was 152.3°±11° (range, 130° to 170°).Conclusion Plating method with a dual approach may be an alternative for four-part intraarticular distal radius fractures given its early mobility advantage and satisfactory functional and radiological results.

Design and Optimization of a Hybrid Excitation System for Magnetically Driven Rotating DC Arc Plasma Generators

To eliminate the disadvantages of both the uncontrollability in the magnetic field of a permanent magnet excitation system and the high energy consumption of an electric excitation system in a traditional magnetically rotating arc plasma generator, a novel topology of a hybrid permanent magnet and electrically excited coil system is proposed. The proposed system will generate a large enough magnetic field to drive the arc rotation with a minimum consumption of materials and electric energy in the normal operation duty, and will guarantee a nearly zero magnetic field in the arc triggering stage. To optimize the hybrid excitation system, a comprehensive analysis and an optimization methodology; by combining finite element analysis, the moving the least squares approximation and an adaptive weighted particle swarm optimization, are proposed. Finally, a prototype hybrid excitation system is optimized with promising results in views of both saving a huge amount of electric power consumptions and ensuring a nearly zero magnetic field in the arc triggering.

Propeller flap: Orthoplastic approach for coverage of distal leg and ankle defects

BackgroundCovering soft tissue defects of the distal one-third of the leg and the Achilles tendon region and is a challenging problem for an orthopedic surgeon. With recent advancements in the anatomical knowledge of perforating vessels, perforator-pedicled propeller flaps have become increasingly popular in recent decades. We aimed to evaluate the clinical outcomes of our patients whose soft tissue defects in the distal leg were reconstructed with propeller flaps and assessed association of complications with age, gender, flap size and arc of rotation. MethodsPatients that had a reconstruction with a propeller flap at the ankle from 2013 to 2019 were retrospectively reviewed. The main indications for the propeller flap were small- and medium-sized soft tissue defects of the distal lower limb. 20 propeller flaps were applied to 19 patients (14 male, 5 female) for various lower extremity defects. ResultsThe mean follow-up duration was 2 years (range, 6 months to 6 years). The average flap size was 82 cm2 (range, 48–125 cm2). The flap was rotated 180 degrees in nine patients The source of the perforator vessel was the tibialis posterior artery in 14 cases, the peroneal artery in 4 cases, both the tibialis posterior and peroneal arteries in 1 case. Four complications (20 %) occured postoperatively. Two patients developed partial necrosis at the tip of the flap, and two patients developed superficial epidermolysis. No correlations were found between complications and flap size and the arc of rotation. ConclusionsThe propeller flap is a reliable option for reconstruction of small to moderate defects in the lower extremity with good clinical results and minimal donor-site morbidity. It is applicable for orthopedic surgeons who do not have microsurgical experience or an available microscope in the operating room.

Thyroid Gland Flap for Minimally Invasive Reconstructive Head and Neck Surgery.

Background:Head and neck surgery sometimes causes small defects, and salvage surgery after chemoradiotherapy poses some risk because of damage to the surgical site from the previous treatment. We have developed a novel thyroid gland flap for head and neck surgical reconstruction and here we describe elevating the flap, including arc rotation, size, and suture technique, and our outcomes to date.Methods:Thyroid gland flap reconstruction was performed in 13 cases (11 patients) between July 2009 and May 2020. The clinical importance and adverse effects of the procedure were examined. Thyroid function and blood flow of the flap were assessed, and the status of the flap and irradiated recipient tissue was examined histopathologically.Results:Median age at surgery was 64.6 years (range 49–77 years). Two of the patients underwent reconstruction with a thyroid gland flap twice. There were 4 cases of primary head and neck cancer resection with neck dissection in which the flap was harvested from the thyroid gland as reinforcement. In 1 case, surgery was performed for cervical esophageal diverticulum. In all cases, the arc was limited to 6 cm and suturing was basic. There were no complications of the surgical procedure, and the postoperative course was uneventful. Contrast-enhanced computed tomography revealed adequate enhancement of the flap. Postoperative thyroid function was normal. The thyroid gland flap was firmly adapted and fused with the irradiated recipient tissue.Conclusion:The thyroid gland flap could be an effective tissue flap fed by the superior thyroid arteriovenous pedicle for head and neck reconstruction.

Methods to optimize conformal dynamic arcs in radiation therapy treatment planning

Conformal Dynamic Arcs (CDA) can provide a useful alternative in certain clinical situations which require a higher level of 3-dimensional (3D) conformation than shaped static fields but for which modulated fields (fixed or arc) are inappropriate. Due to lack of modulation, the quality of the dose distribution produced by a CDA is highly dependent on the specific patient geometry. The ideal geometry for a CDA, in terms of achievable conformation and uniformity, is a spherical target perfectly centered in a cylindrical medium or body and utilizing a full 360 degree of rotation. This manuscript will provide or review several methods a treatment planner may employ to improve dose distributions produced by CDA as the patient and/or target geometry or degrees of arc rotation vary from the ideal. These include:1. Weighting arc segments to improve homogeneity.2. Defining asymmetric margins for fitting leaves.3. Hybrid static/CDA compensating for CDA with limited degrees of rotations.4. Improving conformation in irregular target via use of pseudo-PTV.5. Creating concave features via the use of avoidance structures.6. Editing CDA multi-leaf collimator (MLC) to remove irregular hot spots.

The effect of rectal gas on dose distribution during prostate cancer treatment using full arc and partial arc Volumetric Modulated Arc Therapy (VMAT) treatment plans.

In this study, we investigated the effect of rectal gas on the dose distribution of prostate cancer using a volumetric modulated arc therapy (VMAT) treatment planning. The first is the original structure set, clinical target volume (CTV), the rectum, and the bladder used clinically. The second is a structure set (simulated gas structure set) in which the overlapping part of the rectum and PTV is overwritten with Hounsfield Unit -950 as gas. Full arc and limited gantry rotation angle with VMAT were the two arcs. The VMAT of the full arc was 181°-179° in the clockwise (CW) direction and 179°-181° in the counterclockwise (CCW) direction. Three partial arcs with a limited gantry rotation angle were created: 200°-160 °CW and 160°-200 °CCW; 220°-140 °CW and 140°-220 °CCW; and finally, 240°-120 °CW and 120°-240 °CCW. The evaluation items were dose difference, distance to agreement, and gamma analysis. In the CTV, the full arc was the treatment planning technique with the least effect of rectal gas. In the rectum, when the gantry rotation angle range was short, the pass rate tended to reduce for all evaluation indices. The bladder showed no characteristic change between the treatment planning techniques in any of the evaluation indices. The VMAT treatment planning with the least effect on dose distribution caused by rectal gas was shown to be a full arc.

Comparison of Modern Highly Interactive Flicker-Free Steady State Motion Visual Evoked Potentials for Practical Brain-Computer Interfaces.

Motion-based visual evoked potentials (mVEP) is a new emerging trend in the field of steady-state visual evoked potentials (SSVEP)-based brain–computer interfaces (BCI). In this paper, we introduce different movement-based stimulus patterns (steady-state motion visual evoked potentials—SSMVEP), without employing the typical flickering. The tested movement patterns for the visual stimuli included a pendulum-like movement, a flipping illusion, a checkerboard pulsation, checkerboard inverse arc pulsations, and reverse arc rotations, all with a spelling task consisting of 18 trials. In an online experiment with nine participants, the movement-based BCI systems were evaluated with an online four-target BCI-speller, in which each letter may be selected in three steps (three trials). For classification, the minimum energy combination and a filter bank approach were used. The following frequencies were utilized: 7.06 Hz, 7.50 Hz, 8.00 Hz, and 8.57 Hz, reaching an average accuracy between 97.22% and 100% and an average information transfer rate (ITR) between 15.42 bits/min and 33.92 bits/min. All participants successfully used the SSMVEP-based speller with all types of stimulation pattern. The most successful SSMVEP stimulus was the SSMVEP1 (pendulum-like movement), with the average results reaching 100% accuracy and 33.92 bits/min for the ITR.

Surgical Treatment of Comminuted Coronal Shear Fracture of Distal Humerus.

ObjectiveTo investigate the surgical approach, fixation, and clinical effect of comminuted coronal shear fracture of distal humerus.MethodsFrom March 2017 to February 2019, we had used open reduction and internal fixation to treat 19 cases of comminuted distal humeral coronal shear fracture. There were 8 males and 11 females, with an average age of 44.6 years (19–72 years). There were 10 cases on left side and 9 cases on right side. All cases were closed fractures. According to Dubberley's classification, there were six cases of type 1, six cases of type 2, and seven cases of type 3. The lateral Kocher approach, extended Kocher approach, extended Kocher approach combined with a medial incision and the olecranon osteotomy approach were used for exposure. Headless screw, Kirschner wire, and suture were used to fix the fractures. Two cases were fixed with hinged elbow fixators additionally. The follow‐up was evaluated by Mayo Elbow Performance Score (MEPS).ResultsAll patients were followed up for an average of 17.1 months (range, 12 to 30 months). The average time of fracture union was 8.8 ± 1.9 weeks. There were three cases of degenerative osteoarthritis of elbow and one case of heterotopic ossification after operation. A total of 10 patients underwent removal of implants. At the last follow‐up, the elbow flexion‐extension arc was 130.5° ± 10.5°. The forearm rotation arc was 167.4° ± 6.1°. The MEPS was 85.8 ± 8.5, the results were classified as excellent in nine cases, good in eight, and fair in two. The excellent and good rate was 89.5%. The time of fracture union of type 1 was shorter than type 3 (P = 0.024), the elbow flexion‐ extension arc of type 1 fracture was better than type 2 (P = 0.043) and type 3 (P = 0.012), the forearm rotation arc of type 1 fracture was better than type 3 (P = 0.006), the MEPS of type 1 fracture was better than type 2 (P = 0.009) and type 3 (P = 0.002).ConclusionOpen reduction and internal fixation with headless screw, Kirschner wire, and suture can be used for the treatment of comminuted distal humeral coronal shear fractures. The elbow joint function can be restored satisfactorily.

The behavior of TIG welding arc in a high-frequency axial magnetic field

The effect of high-frequency axial magnetic field (HFAMF) on the shape of the welding arc and welding formation of tungsten inert gas (TIG) welding is analyzed theoretically and experimentally. The 316L stainless steel plate was welded with HFAMF produced by the excitation coil installed on the welding torch. The influence of the HFAMF on the welding process is studied by changing the magnetic frequency from 0 to 2000 Hz. The experimental results show that when the magnetic field frequency reaches 1500 Hz, the arc rotation radius is decreased to the minimum; the arc shape changes from cone to compressed cylinder; and the arc temperature, the arc pressure, and the depth-width ratio of the weld beam reached the maximum. Otherwise, the effect of applied HFAMF on the stress of arc and weld pool is discussed, and the mechanism of arc contraction is analyzed.

Comparing image qualities of dental cone-beam computed tomography with different scanning parameters for detecting root canals

Cone-beam computed tomography (CBCT) is a useful device in creating 3-dimensional images in the examining area of dentistry and is one of the most common clinical methods in detecting second mesiobuccal (MB2) canals in maxillary molars. The aim of this invitro study was to compare the image quality of the small field of view (FOV) CBCT with different rotation arcs and scanning speeds in the use of detecting root canals. A dentate human skull was scanned in Morita 3D Accuitomo 170 with 4×4cm FOV under 5mA and 90kVp. Two different rotation arcs (360° and 180°) and three different scanning modes (slow-speed mode, standard mode and high-speed mode) combined into six different groups. Five different levels of axial sections were selected from each group. Five endodontic specialists rated the image quality by focusing on the sharpness of the MB2 canal of the upper right first molar and the surrounding structures. Despite the rotation arcs, all the observers gave excellent ratings to images taken with slow-speed mode. The high-speed mode taken with 360° and 180° got the second lowest and the lowest ratings, respectively. Under the same scanning speed, the rotation arc did not have a significant difference in image quality. Slow-speed mode is inevitable in maintaining adequate image quality during taking CBCT. However, endodontists can use the half rotation mode to significantly reduce radiation dose, exposure time, and still maintain sufficient image quality for root canal anatomy assessment.

N-Decane Reforming by Gliding Arc Plasma in Air and Nitrogen

Plasma cracking of n-decane is carried out in a new type of gliding arc flow reactor in the atmosphere of nitrogen and air, at a flow range of 25–45 L/min with an interval of 5 L/min. The relationship between arc evolution and discharge voltage and current signals is established by synchronous recording with high-speed camera and oscilloscope. It is recorded that the rotating frequency of the gliding arc is in the range of 81–176 Hz, which increases with the rise of the flow rate and has no direct relationship with the type of gas. When air is used as the discharge medium, although the luminous intensity of the arc is weak, arc rotation is relatively stable, and the specific input energy is higher, which is 58% higher than that of nitrogen. In addition, the partial oxidation of n-decane provides extra heat for cracking, which is helpful to improve the efficiency of plasma cracking. The cracking products mainly include hydrogen, ethylene, acetylene, methane, propylene and ethane. The concentration of each component is higher, reaching the maximum value at the flow rate of 40 L/min, with the hydrogen selectivity of 23.1%. However, when nitrogen plasma is selected, the kinds of products are reduced, containing only hydrogen, ethylene and acetylene, and the concentrations are lower than 0.5%. Two parameters, energy conversion efficiency and carbon based characterization effective cracking rate, were proposed to evaluate the cracking effect of flow reactor.

Combining Rotation and V-Y Design for Lower Forehead and Temporal Region Reconstruction With Myocutaneous Frontal Flap: Our Experience on 27 Consecutive Cases.

Because of direct sun exposure, lower forehead and temporal area are anatomical regions with frequently observed skin tumors. The resulting defects after oncological ablations are usually treated, especially in older patients, by split thickness skin grafting or A-to-T and O-to-T flaps if facing small defects. On specific sites that expose bone or periosteum as well as when a skin graft is best avoided for cosmetic reasons, alternative reconstructive procedures should be considered. An excellent option is the use of myocutaneous frontal flap with rotation and V-Y design, which provide a reliable coverage of defects especially of the temporal area, dispensing appropriate like-tissue by its wide arc of rotation. Between 2010 and 2019, 27 patients underwent myocutaneous frontal flap with rotation and V-Y design reconstruction of medium-to-large-sized soft-tissue defects of the lower forehead and temporal area after tumor excision. The malignant skin lesions involved were basal cell carcinoma (n = 17), squamous cell carcinoma (n = 9), and melanoma (n = 1). Twenty one patients were male, and 6 were female with an average age of 64 (54-86) years. All defects were successfully resurfaced with no local recurrences. The authors present a modification to myocutaneous frontal flap harvesting, with emphasis on its extensive arc of rotation with a V-Y design to minimize donor-site morbidity. The advantages of myocutaneous frontal flap with rotation and V-Y design include a good contour with excellent color, texture, and thickness match and good to excellent aesthetic results.