Displacement Of Flap Research Articles

A proposal for improving the noise floor of the gravitational wave antenna Niobè

The gravity wave detector at the University of Western Australia is based on a bending flap of 0.45 kg tuned near the fundamental resonant frequency of a 1.5 tonne resonant bar of 710 Hz. The displacement of the bending flap is monitored with a 9.5 GHz superconducting re-entrant cavity transducer. The performance of the transducer is related to the development of a low-noise microwave pump oscillator to drive the transducer. In this study we describe how to improve the quality of the existing microwave pump oscillator using a second servo frequency control system.

Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis

A 45-year-old man was struck in the left eye by the edge of a paper shopping bag 3 weeks after having laser in situ keratomileusis (LASIK). The injury resulted in partial displacement of the LASIK flap. The patient developed diffuse lamellar keratitis (DLK) the day after the flap was repositioned. By day 4, visual acuity diminished to 20/60. By day 9, the clinical evidence of the DLK had resolved, and by day 15, uncorrected visual acuity was 20/20. Eye trauma 3 weeks after LASIK can result in displacement of the LASIK flap, and DLK can develop following flap replacement. Long-term anatomic and visual results are usually good.

The Anchor Subperiosteal Forehead Lift

The coronal incision used for brow lift procedure has a high rate of localized alopecia, widening, and depression of the scar at the suture line. Other sequelae of the standard coronal brow lift incision procedure are “stretchback” with a recurrent brow ptosis, poor brow elevation, and numbness beyond the incision line. Factors causing alopecia are tension, use of a monopolar cautery, use of key sutures with undue tension, one-layer closure, and sutures left too long. Recurrent brow ptosis may be due to anterior displacement of the posterior scalp flap, stretching of the anterior frontal skin flap, or insufficient power of the weakened frontalis muscle. Poor brow elevation may be due to unsatisfactory dissection on the glabella and orbital rims. Numbness and itching beyond the incision line are due to a low coronal incision. To avoid these problems, the following principles were followed: (1) If not contraindicated, the incision is made high on the vertex of the head, posterior to a biauricular line. (2) The pericranium is included in the frontal flap starting at the incision lines. (3) The subperiosteal dissection is continued down to the orbital rims and nasal bones. (4) The release of the periosteum at the arcus marginalis or just above allows repositioning of the brow structures. (5) The inelastic pericranium maintains the position of the elevated structures and avoids stretching of the frontal skin. (6) The integrity of the frontalis muscle is maintained completely. (7) Two large triangles of scalp resected in the posterior flaps allow fixing the position of the posterior scalp and match better the length of the anterior flap. (8) The galea periosteal rim flap allows anchoring of the frontal flap to the undersurface of the posterior scalp flap. This stabilizes the closure with minimal tension on the hair-bearing portion of the scalp. The wide surface of contact avoids depression and widening at the suture line. (9) Closure with skin staples avoids constriction of the hair follicles. (10) Hemostasis is done with a bipolar cautery. (11) No through-and-through key sutures are used. Some of these principles were introduced to the endoscopic subperiosteal forehead lift. The modifications mentioned above have been used in 92 open brow/face lift procedures with excellent aesthetic and functional results and minimal complications. (Plast. Reconstr. Surg. 95: 993, 1995.)

The Anchor Subperiosteal Forehead Lift

The coronal incision used for brow lift procedure has a high rate of localized alopecia, widening, and depression of the scar at the suture line. Other sequelae of the standard coronal brow lift incision procedure are "stretch-back" with a recurrent brow ptosis, poor brow elevation, and numbness beyond the incision line. Factors causing alopecia are tension, use of a monopolar cautery, use of key sutures with undue tension, one-layer closure, and sutures left too long. Recurrent brow ptosis may be due to anterior displacement of the posterior scalp flap, stretching of the anterior frontal skin flap, or insufficient power of the weakened frontalis muscle. Poor brow elevation may be due to unsatisfactory dissection on the glabella and orbital rims. Numbness and itching beyond the incision line are due to a low coronal incision. To avoid these problems, the following principles were followed: (1) If not contraindicated, the incision is made high on the vertex of the head, posterior to a biauricular line. (2) The pericranium is included in the frontal flap starting at the incision lines. (3) The subperiosteal dissection is continued down to the orbital rims and nasal bones. (4) The release of the periosteum at the arcus marginalis or just above allows repositioning of the brow structures. (5) The inelastic pericranium maintains the position of the elevated structures and avoids stretching of the frontal skin. (6) The integrity of the frontalis muscle is maintained completely. (7) Two large triangles of scalp resected in the posterior flaps allow fixing the position of the posterior scalp and match better the length of the anterior flap. (8) The galea periosteal rim flap allows anchoring of the frontal flap to the undersurface of the posterior scalp flap. This stabilizes the closure with minimal tension on the hair-bearing portion of the scalp. The wide surface of contact avoids depression and widening at the suture line. (9) Closure with skin staples avoids constriction of the hair follicles. (10) Hemostasis is done with a bipolar cautery. (11) No through-and-through key sutures are used. Some of these principles were introduced to the endoscopic subperiosteal forehead lift. The modifications mentioned above have been used in 92 open brow/face lift procedures with excellent aesthetic and functional results and minimal complications.

Facial Translocation for Cranial Base Surgery.

The complexity of cranial base surgery is a reflection of skull base anatomy as well as technical demands for maximum visualization, control of essential structures, adequate tumor resection and/or reconstruction. Facial translocation has been developed as a new approach to cranial base. It consists of extensive modular facial disassembly which includes displacement of composite facial soft tissue flap and craniofacial skeleton. It creates surgical field with epicenter in nasopharynx and infratemporal fossa allowing easy expansion into sphenoid bone and cranial fossae as well as craniovertebral junction. Reconstruction is functional and esthetic. Versatility of this approach permits expansion into neighboring craniofacial regions. During a 14-month period (11/88-12/89), this facial translocation approach to cranial base was utilized in 20 patients. The approach provided excellent visualization of the involved cranial base permitting oncological as well as reconstructive procedures. All patients healed primarily. Two patients were reoperated on at 4 and 6 months postoperatively; one for a bone graft infection and the other for tumor recurrence. The facial translocation approach offers favorable exposure of the critical zones of cranial base resulting in increased surgical safety and benefit of cranial base surgery.

Enveloping the Bladder with Displacement of Flap of the Rectus Abdominis Muscle for the Treatment of Neurogenic Bladder

Neurogenic bladder is a frequent occurrence. A new surgical technique has been designed and was used successfully in 18 patients with ideal results. The key point of the operation is to turn over a flap of rectus abdominis muscle to envelop the bladder. Contraction of the muscle flap and the abdominal muscles would enhance voiding ability. In the meantime, the bladder is displaced forward and the resultant change in the bladder-posterior urethral angle also favors voiding. Since the bladder is near the anterior abdominal wall manual compression during voiding is made easier. All of these advantages greatly facilitate voiding. (J. Urol., 144: 1194–1195, 1990)

A new surgical approach to nasopharyngeal angiofibroma

Surgical resection of nasopharyngeal angiofibromas is dificult because of their readiness to bleed and their anatomic location. Transnasal or pharyngeal surgical approaches, although commonly used, are blind and result in high frequency of recurrence. Furthermore, transmaxillary resection involves unnecessary multilation. Five cases of nasopharyngeal angiofibromas are reported, which have been removed completely, using a new transpalatine approach through the hard palate which avoids all those problems. Posterior displacement of a palatine flap permits entrance to the nasal cavity and gives ample exposure of the nasopharynx which facilitates complete resection of the tumor under direct vision. Reconstruction by replacing the flap is very simple. No complication or recurrences have been experienced after a maximum follow-up of 3 years.

The pharyngeal flap operation in cleft palate: A clinical study of eighty-two cases

Summary A report is made of eighty-two cleft palate patients treated by the posterior pharyngeal flap operation during a twelve-year period. Indications for this surgical procedure are considered and a detailed description is given of a surgical technique to prevent scar contracture and late displacement of the pharyngeal flap when it is based superiorly. A method for reconstruction of the soft palate utilising buccal and pharyngeal flaps is also reported. Post-operative complications are mentioned. The velopharyngeal anatomy was studied on clinical examination and by means of cinefluorography on an average four years and ten months post-operatively. The results were compared with detailed analyses of speech, hearing and nasal function. Patients operated upon before the age of 10 years all demonstrated normal speech; of those below the age of 20 years 97 per cent. were rated as having acceptable intelligibility compared with 77 per cent. when the operation had been performed after that age. No adverse effects on hearing or nasal function were found following operation, and some observations indicated improved hearing. No significant differences in any respect were revealed between the two groups of patients with superiorly and inferiorly based pharyngeal flaps. On the basis of the observations provided by this follow-up study conclusions are formed on the prognosis of the pharyngeal flap operation in various conditions of cleft palate deficiency.

One-stage push-back operation for congenital insufficiency of the palate

An additional operative step in the technique of the push-back operation for congenitally short palate is described. This step consists of the removal of a portion of the posterior wall of the bony pterygopalatine canal, thus permitting easy backward displacement of the mucoperiosteal flap and the soft palate. By this step the blood supply and inervation of the palate are preserved. The procedure permits satisfactory lengthening of the palate by a one-stage operation. The operation may be applied to cases in which there is congenital insufficiency of the palate without cleft as well as to cases in which there is shortening of the palate in association with incomplete or complete clefts.