Double Transposition Research Articles

A Comprehensive Review of Bilobed Flaps in Nasal Reconstruction: Technique, Outcomes, and Considerations.

Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects. This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations. In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds. While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

Double Transposition and Physician-Modified Endografting for Complex Arch Aneurysm

Double Transposition and Physician-Modified Endografting for Complex Arch Aneurysm

Management of supraglottic stenosis using interarytenoid Z-plasty: how I do it.

Supraglottoplasty is the primary surgical treatment of congenital laryngomalacia. Supraglottic stenosis is a rare complication of supraglottoplasty that is difficult to manage. This study presents a new endoscopic mucosa-sparing Z-plasty double transposition flap technique that was used to manage supraglottic stenosis following supraglottoplasty for severe congenital laryngomalacia in an eight-month-old infant. At 10 months post-operatively, the patient remained asymptomatic and flexible laryngoscopy showed adequate supraglottic patency. Endoscopic interarytenoid Z-plasty is a safe and effective technique in the management of paediatric supraglottic stenosis.

THE DICHOTOMY BETWEEN JURISDICTION AND ADMISSIBILITY IN INTERNATIONAL ARBITRATION

AbstractThe dichotomy between jurisdiction and admissibility developed in public international law has drawn much attention from arbitrators and judges in recent years. Inspired by Paulsson's ‘tribunal versus claim’ lodestar, attempts have been made to transpose the distinction from public international law to investment treaty arbitration, yielding a mixed reception from tribunals. Remarkably, a second leap of transposition has found firmer footing in commercial arbitration, culminating in the prevailing view of the common law courts in England, Singapore and Hong Kong that arbitral decisions on admissibility are non-reviewable. However, this double transposition from international law to commercial arbitration is misguided. First, admissibility is a concept peculiar to international law and not embodied in domestic arbitral statutes. Second, its importation into commercial arbitration risks undermining the fundamental notion of jurisdiction grounded upon the consent of parties. Third, the duality of ‘night and day’ postulated by Paulsson to distinguish between reviewable and non-reviewable arbitral rulings is best reserved to represent the basic dichotomy between jurisdiction and merits.

Experience with double transposition flaps and intravelar veloplasty for closure of wide cleft palates

ABSTRACT Background: Repairing a wide cleft palate is a challenging task for surgeons. The goals of cleft palate repair such as achieving anatomical closure of the defect, complete velopharyngeal closure, speech development, and to minimize dentoalveolar anomalies are difficult to achieve in wide and massive cleft palates. Several methods have been described for the same. We performed double transposition flaps combined with intravelar veloplasty in our patients. In this article, we share our experience with the same. Materials and Methods: We reviewed 9 cases, in which double transposition flaps with intravelar veloplasty were performed. Patient demographics, clinical data, and outcomes were analyzed. Functional status including nasal resonance and palatal mobility were assessed with nasal endoscopy. Results: The average age at the time of surgery was 17 months. Four patients had associated diseases. The mean operative time was 55.7 min. The mean follow-up period is 23.7 months. Only posterior palatal closure was done in all the cases and patients were managed temporarily with obturators and are planned for delayed closure later. Conclusion: Double transposition flap is a safe, effective, and technically less demanding procedure. It has no wound complications and can avoid the need for osteotomy to correct maxillary retrusion. The main drawback of the procedure is the creation of an anterior palatal fistula that needs closure later.

Double transposition flap for lower eyelid reconstruction: case report of a new surgical approach

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Random mucosal rotating flaps for rostral to mid maxillary defect reconstruction: 26 dogs (2000-2019).

To evaluate the feasibility and the complications following single or double random mucosal rotating (transposition or interpolation) flaps for the closure of rostral to mid maxillary defects in dogs. Medical records of dogs treated with single or double random mucosal rotating flaps after maxillectomy for oral lesions or traumatic loss of tissue, were evaluated. Clinical findings, surgery performed, outcome and postoperative complications (major and minor) were extracted. Twenty-six client-owned dogs were retrospectively included. Dogs underwent maxillectomy for canine acanthomatous ameloblastomas (9), oral squamous cell carcinomas (4), peripheral odontogenic fibromas (4), oral melanomas (3), oral fibrosarcomas (2), dentigerous cysts (2) and oral osteosarcoma (1) and trauma resulting in an oronasal fistula (1). Twenty-three dogs underwent a single transposition or interpolation flap and three dogs were treated with a double transposition flap. Postoperative complications, including dehiscence or flap necrosis, occurred in six dogs. Random mucosal rotating (transposition or interpolation) flaps are versatile when used to close rostral maxillary defects in dogs. Postoperative complications appear to be more likely when these flaps are used to close mid maxillary defects.

Bilobed flaps for cutaneous nasal defects: a case series

The bilobed flap is a local flap used for the reconstruction of small to moderate cutaneous nasal defects. It was first described by Esser in 1918 for use in nasal tip reconstruction. It is a double transposition flap where the first flap serves to fill the primary defect, and a second smaller fills the secondary defect. This approach seeks to distribute tension across a wider area. It is a random pattern flap with no specified blood supply. This study was done at the department of plastic and reconstructive surgery, Saveetha medical college and hospital, from January 2018 to December 2018. Five patients (four female and one male) underwent bilobed flap to reconstruct the cutaneous nasal defects out of which three patients had naevus while two patients had basal cell carcinoma nose. Their ages ranged from 35-68 years with a mean age of 52 years. The procedures were done under local anaesthesia. Post-operatively, all sutures were removed on the 5th day. This technique was performed in 5 cases with defect size ranging from 0.9×1.1 to 1.3×1.8 cm. All defects were closed under minimal wound tension, all scars were inconspicuous, no obvious complications occurred, and the aesthetic outcomes were considered favorable. The bilobed flap is a versatile, easy to perform and reliable flap for closure of small nasal cutaneous defects with good aesthetic outcomes, reduced morbidity and less scarring.

Double transposition flaps for the reconstruction of a large forehead defect involving the lateral eyebrow

Double transposition flaps for the reconstruction of a large forehead defect involving the lateral eyebrow

Basal cell carcinoma excision with bilobed flap nasal reconstruction

: Basal cell carcinoma (BCC) is a slow growing, locally destructive, malignant tumor of the skin. It is derived from non- keratinizing cells that originate from the basal layer of the epidermis. After excision nasolabial flap, median forehead dorsal nasal flap, glabellar flaps, bilobed flaps, cheek and craniofacial flaps are used for nasal reconstruction. The Zitelli’s bilobed flap is one of the most useful flaps for nasal reconstruction. It is a simple double transposition flap and is designed to move more skin, without deformation. A 60-years old male patient reported to our department with complains of circular raised and reddish discoloration lesion on the left side of the nose. Surgical excision and reconstruction of defect using bilobed flap was planned under general anaesthesia. The flap was designed in such a manner that the flap could be turned over the defect on the ala of the nose and closure of the donor site could be done primarily without deformity. Surgical excision of the nose lesion was done and reconstruction was performed using bilobed flap. The patient has been followed up for 1year with no evidence of recurrence. The bilobed flap is a versatile and reliable flap for coverage of small skin and soft tissue defects of the lower third of the nose. It gives a successful outcome if it is designed well and performed properly. In this case it helped us to achieve a defect free cosmetically fine nose after excision of basal cell carcinoma nose.

Total autogenous revascularization of an innominate artery occlusive disease

Total autogenous revascularization of an innominate artery occlusive disease

Multicentre experience with the frozen elephant trunk technique to treat penetrating aortic ulcers involving the aortic arch.

Our goal was to evaluate the use of the frozen elephant trunk (FET) technique for the treatment of penetrating aortic ulcers involving the aortic arch. Between January 2008 and January 2020, a total of 34 patients had the FET technique at 3 aortic centres. The indication for the FET technique was unsuitability for thoracic endovascular aortic repair due to the lack of a sufficient proximal landing zone even after supra-aortic rerouting (subclavian transposition, double transposition), ectasia of the ascending aorta/aortic arch (>40 mm) and/or a shaggy proximal thoracic aorta. Additional cardiac procedures were performed in 14 patients (41%), and the beating heart technique was used in 7 patients (21%). Perioperative mortality was 18% (n = 6); 3 of these patients had a major stroke (9%). No case of spinal cord ischaemia was observed, and 2 patients (6%) developed a non-disabling stroke. After a median follow-up of 7 (first quartile: 1; third quartile 29) months, 2 patients (6%) died (1 of malignant disease and 1 of an unclear cause); 10 additional aortic interventions in all aortic segments (29%; endovascular: n = 8 [24%] and conventional surgical: n = 2 [6%]) were performed in 8 patients. The FET technique is a good treatment option for patients with penetrating aortic ulcers involving the aortic arch unsuitable for thoracic endovascular aortic repair. However, the high obliterative atherosclerotic load in these patients is accompanied by an un-neglectable risk of perioperative neurological injury. Concomitant cardiac surgical procedures are frequently needed. Patients commonly require secondary aortic procedures in all aortic segments, emphasizing the need for thorough primary conceptual planning and stringent follow-up.

The Bilobe Flap for Nasal Reconstruction.

Repair of nasal defects is technically challenging due to inelastic nasal skin and unforgiving nasal geometry. The bilobe flap is a double transposition flap that can transpose skin from cephalad to caudad to repair defects of the lower third of the nose. However, pincushioning may complicate this flap, yielding untoward aesthetic outcomes. We review our single surgeon series of patients who underwent bilobe flap reconstruction of nasal defects, and describe our surgical technique to minimize pincushioning and poor aesthetic outcomes. This was a retrospective chart review of patients who underwent bilobe flap reconstruction of nasal defects at a tertiary referral facial plastic and reconstructive surgery clinic between January 1, 2010 and February 12, 2019. All postoperative clinic notes were analyzed for complications, reports of unfavorable cosmetic outcome, and rates of revision procedures. Surgical technique is described. In the analysis, 125 patients were included, of whom 84 (67%) patients were women, and the mean (standard deviation) age was 60.7 (12.5) years. Complications were reported in 20 (16%) patients, including scars, pincushioning, and nasal obstruction. Five patients underwent revision surgery (4%), including scar revision and z-plasty. Pincushioning was reported in four patients (3.2%), of whom three underwent scar revision procedures. One patient had alar notching requiring correction. There was no statistically significant association between ear cartilage graft and complications (p = 0.84) or requirement of intervention (p = 1.0). Univariate and multivariate logistic regression did not show statistically significant association between size of the defect and the presence of complications (p > 0.05). The bilobe flap is an excellent transposition flap for the repair of small nasal tip defects. By adequately thinning the transposition flap of excess subcutaneous tissue prior to inset, rates of poor aesthetic outcomes, revision procedures, and pincushioning are minimized.

Secure Dissemination and Protection of Raster Data using Merkle Hash Tree based Cryptowatermarking

Due to rapid development in the Internet and other communication technologies, it becomes quite easy to copy and distribute multiple illegal copies of high value and sensitive data. Raster data is one of the high voluminous data and it requires huge efforts to sense and generate this data. Therefore, ownership protection as well as its integrity become one of the key problems in spatial information service. There are lot many schemes are available for watermarking and encryption individually, but if both are combined gives manifold advantages. This paper presents a cryptowatermarking scheme by combining watermarking and encryption to protect the copyright of raster data as well as to provide security dissemination level. We have proposed a scheme by employing double transposition, LSB substitution watermarking and Merkle Hash Tree for encryption and watermarking. It has been observed that the proposed scheme is not only robust against encryption attacks, but also has transparency, strongness, large data hiding capacity and correct extraction of watermark.

Objective evaluation of vertical Z-plasty with double transposition vermillion flaps for secondary whistling deformity correction: A method for uni- and bilateral correction

ObjectivesThis study describes a modified method for secondary correction of whistling deformities in patients with unilateral and bilateral cleft lip/palate (CL/P), using a horizontal double transposition vermilion flap, including parts of the orbicularis oris muscle. The pre- and postoperative results were objectively evaluated. Study design34 patients with a whistling deformity who underwent secondary reconstruction between 07/2013 and 11/2018 were included in this study (mean age 20.2 ± 11.6 years). 24 patients were male and 10 female. 30 patients presented with cleft lip and palate (CLP) — 15 bilateral, nine on the left side and six on the right. Four patients had only a left-side cleft lip (CL).The whistling deformity reconstruction was carried out using two triangular transposition vermilion flaps with muscle parts, for a vertical Z-plasty. The surgical procedure is normally performed under local anesthesia in all patients older than 10 years. For statistical evaluation, the size of the whistling defect in the vermilion was determined on photographs before and 6–9 months after surgery. The individual defect score (DS) was evaluated pre- and postoperatively. In all patients, no additional surgical procedures, such as rhinoplasty or scar correction in the upper lip, were carried out simultaneously. ResultsMinor (DS < 400), moderate (DS 400–1400), and severe (DS > 1400) whistling defects were surgically corrected. The whistling defect score was significantly reduced in all patient groups (p < 0.001). In six patients the result of surgery was rated as 'acceptable' (DS > 30), in five patients as 'good' (DS 10–30), and in 23 patients as 'very good' (DS 0–10). ConclusionsThis study describes a modified method for whistling deformity reconstruction in uni- and bilateral clefts. The aesthetic results are based on a reconstruction of the subcutaneous muscle layers and the creation of a symmetrical lip contour and prolabium using transposition flaps from the lateral side of the cleft. The great advantage is the uncomplicated performance under local anesthesia, even for all children over 10 years, and the short operation time. Postoperative complications did not occur.

Double transposition and single branched TEVAR for total arch replacement in chronic dissection

Double transposition and single branched TEVAR for total arch replacement in chronic dissection

Implementation of Super-Encryption with Trithemius Algorithm and Double Transposition Cipher in Securing PDF Files on Android Platform

This study aims to combine the trithemus algorithm and double transposition cipher in file security that will be implemented to be an Android-based application. The parameters being examined are the real running time, and the complexity value. The type of file to be used is a file in PDF format. The overall result shows that the complexity of the two algorithms with duper encryption method is reported as Θ (n2). However, the processing time required in the encryption process uses the Trithemius algorithm much faster than using the Double Transposition Cipher. With the length of plaintext and password linearly proportional to the processing time.

Nose defects reconstruction with the Zitelli bilobed flap.

The skin cancers of the head and neck district are localized mostly on the nose, which, by being in the center of the mid-face, has an important aesthetic role. Therefore, many reconstructive techniques have been studied; among them regional skin flaps appeared the most suitable since they guaranteed the oncological radicality as well as a good aesthetic outcome. In this paper, we present our experience with the use of the Zitelli bilobed flap, which is defined as a double transposition flap for the reconstruction of the nose defects. From 2008 to 2012, we have treated 86 patients (56 men and 30 women, aged between 47 and 83 years) for skin cancer of the nose (72% basal-cell carcinoma, 28% squamous cell carcinoma); for all patients, the nose defects' reconstruction was performed by means of the modified Zitelli bilobed flap. The results were evaluated by short- and long-term follow-up; no infections or major complication were reported, while high preservation of the patient's facial characteristics and normal functions of the nose were observed. In 12 cases, little distortions of the alar rim were recorded although these patients still evaluated the cosmetic outcome as good. In our experience, the Zitelli bilobed flap remains a robust and reliable tool for the reconstruction of the nose defects, since it preserves its function, while ensuring a good aesthetic result.

The “reading man” flap for reconstruction of large periorbital defects

ABSTRACTPurpose: The “reading man” flap (RMF), a double advancement transposition cutaneous flap named for its appearance, has been described in the reconstruction of various circular skin defects, particularly in the malar region. We describe two cases where this flap was used to reconstruct the lower eyelid/periorbital region.Methods: Two oculoplastic patients with lower eyelid basal cell carcinomas underwent Mohs micrographic excision resulting in a large skin defects. In both cases, reconstruction was performed using the RMF.Results: At 6 months, both patients achieved good cosmetic results with no case of secondary eyelid malposition.Conclusion: The RMF is a useful adjunct to the armamentarium of the oculoplastic surgeon for the reconstruction of large periorbital defects.

Hybrid Treatment of the Aberrant Right Subclavian Artery (Arteria Lusoria): Feasibility Study on 180 Angio-CTs

The aberrant right subclavian artery or arteria lusoria (AL) is the most frequent anatomical variation of the supra-aortic trunks (SAT). Treatment is only warranted in the presence of an aneurysm because of the risk of rupture, or in symptomatic cases with signs of compression of the esophagus or the trachea, with embolisms causing right upper limb ischemia of vertebrobasilar cerebrovascular accidents. The conventional surgical treatment of AL is the closure of the origin of AL and the revascularization of the right subclavian artery through a left thoracotomy. With the appearance of endovascular techniques, some of these patients can be treated with minimally invasive hybrid techniques. The aim of this study is to evaluate the feasibility of the endovascular treatment of AL based on the radioanatomical analysis of the thoracic angio-computed tomographies. We analyzed 180 thoracic angio-computed tomographies using millimeter cuts (<1.2 mm) performed between 2010 and 2015 in the Nancy University Hospital in which an AL was fortuitously discovered. Symptomatic ALs and pediatric patients were excluded. The diameters of the SATs and the aorta and the distances between the SATs were measured. The data were processed with the t-test using the SPSS 22 software. Our results showed the presence of a Kommerell diverticulum in 36 cases (20%) and of a bi-carotid trunk in 91 cases (50.5%). The average distance between the left subclavian artery (LSCA) and AL was 5.4 ±4.3 mm. To obtain a proximal neck >20 mm for the implantation of a thoracic stent graft, a double transposition or bypass was always necessary (LSCA to left common carotid artery, AL to right common carotid). An additional debranching of the left common carotid artery was necessary in 33.8% of the cases and of all the SATs in 2.9% of the cases. The radio-anatomical study showed that no patient was eligible for conventional thoracic endovascular aneurysm repair to treat an aneurysmal AL. The hybrid approach is feasible using a double transposition or a bypass before the implantation of a stent graft, if needed associated with a debranching of the common carotid arteries.