Free Radial Research Articles

Complex Nasal Reconstruction: A Methodical Approach to the Three-Stage Paramedian Forehead Flap

AbstractComplex nasal reconstructions require adequate planning with an accurate estimation of the time necessary to perform each stage. Reconstructions of the entire nose, multiple subunits, or a substantial subunit typically require lining replacement and cartilage grafting. Securing the lining prior to a staged reconstruction is preferred, but options such as the Menick folded paramedian forehead flap (PMFF) allow for lining coverage at the time of the first stage. The free radial forearm flap and the PMFF remain the gold standard for the initial lining coverage. Cartilage grafting is fundamental to complex nasal reconstructions and can be secured in either the first or the second stage. Staged reconstructions require thorough patient education, patience from both the patient and the surgeon, and an understanding that final revisions may be necessary.

Use of the superficial circumflex iliac artery perforator flap for urethra and/or shaft reconstruction in gender diverse persons: 10-year single center experience.

Although the free radial forearm flap (FRFF) is the gold standard for phalloplasty, the conspicuous donor-site scar, need for microsurgery and the tendency for the phallus to deflate over time makes both patients and surgeons look for alternatives. We describe our long-term experience with the pedicled superficial circumflex iliac artery (SCIP) flap for urethral and/or penile shaft reconstruction. This flap can be applied for similar indications as FRFF-phalloplasty, but with primary closure of the donor site(s) and without microsurgery. We retrospectively reviewed surgical outcomes of all patients who underwent urethra and/or shaft reconstruction using SCIP-flaps as part of phalloplasty for gender-affirming surgery in our center between 2012 and 2022. Over a 10-year period, 55 SCIP-flaps were performed as part of phalloplasty. This included 47 unilateral SCIP-flaps, of which 10 were used for shaft reconstructions and 37 for urethra reconstructions. Primary closure was achieved in 100% of patients. No failures were observed for shaft reconstructions.For urethra reconstructions, 8 SCIP-urethras (14%) failed completely, and 3 SCIP-flaps were converted to free flaps. In total, 82% of patients with a SCIP-urethra reconstruction were able to stand while voiding.Eight bilateral SCIP-flaps were performed for one-stage shaft and urethra creation, of which 3 patients (38%) experienced urethral fistulas and/or strictures. This study shows that the SCIP-flap is a technically feasible and safe pedicled alternative for urethral and penile shaft reconstruction in gender diverse individuals, with similar urethral complication rates compared to FRFF and ALT-phalloplasty, however, with potentially lower shaft sensation.

Physiological and Functional Restoration of the Modiolus Using a Double Tendon Sling in Patients With Full-Thickness Oral Defects.

Reconstruction of the oral modiolus should be considered for facial defects involving the lip and cheek. We have performed free flap reconstruction using a novel technique that includes a vertical and a horizontal sling for full-thickness defects involving the oral commissure. We used a free radial forearm flap and the palmaris longus tendon to correct lip and cheek defects in 6 patients (3 men, 3 women; age, 55-84 years). The tendon was divided into 2 portions for use as the double sling. One sling was used to connect the upper and lower stumps of the orbicularis oris in the vertical direction and the other to connect the vertical sling and masseter muscle. The outcomes assessed were esthetic appearance and functional results. The facial defects ranged in size from 3.0 cm × 4.0 cm to 7.0 cm × 6.0 cm and the mucosal defects from 1.5 cm × 4.0 cm to 6.5 cm × 5.0 cm. The length of the harvested tendon ranged from 11.5 to 13.5 cm. All flaps survived without complications. Good esthetic outcomes were achieved (excellent facial appearance, n = 1; no lip deviation or drooping, n = 5). Functionally, all patients had acceptable mouth opening and were able to eat a regular diet. Good physiological and functional results can be achieved using a double tendon sling for reconstruction of the modiolus in patients with full-thickness defects involving the oral commissure.

LARYNGOPHARYNGEAL RECONSTRUCTION IN A PREGNANT WOMAN: A CLINICAL CASE

Relevance: Cancer in pregnancy is a very serious clinical condition that seriously affects women and their families, as well as the medical staff who provide care. Diagnostic and therapeutic solutions must balance the appropriate treatment with the risk to the fetus. In developed countries, cancer in pregnant women has become more common over the past 30 years due to an increase in the number of older women giving birth. Melanoma, lymphoma, leukemia, and cancers of the breast, cervix, ovaries, gastrointestinal tract, and genitourinary system are the most common malignant neoplasms in pregnant women. Head and neck cancers are rare in pregnancy. A total of 3 cases of locally advanced laryngopharyngeal cancer were recorded in patients aged 23 to 28 years in 2017-2023 at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. This article describes a case of advanced squamous cell carcinoma of the laryngeal region in a young pregnant woman and also discusses the diagnosis and treatment of head and neck cancer in pregnant women. The study aimed to describe a clinical case of squamous cell carcinoma of the larynx in a pregnant patient. Methods: The description of a clinical case presents data from laboratory, instrumental, and physical research methods of a pregnant patient with hypopharynx squamous cell carcinoma, who was examined, treated, and followed up at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. The patient was diagnosed with IVA laryngopharyngeal cancer T4aN2cM0. Grade III dysphagia. Laryngeal stenosis. Grade II cachexia” and received three courses of neoadjuvant polychemotherapy. Then, she underwent surgical intervention in the volume of laryngopharyngectomy and reconstructive surgery using a free radial flap and was administered adjuvant external beam radiation therapy. Results: The article presents the results of laryngopharyngectomy for locally advanced squamous cell carcinoma of the hypopharynx. The postoperative period was without complications, the patient was discharged 14 days after surgery in satisfactory condition and continued adjuvant radiation therapy. Conclusions: The reviewed clinical case demonstrates the importance of an integrated approach to treating laryngopharyngeal cancer, including effective reconstruction of postoperative defects using free fasciocutaneous flaps.

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap.

Free flaps and their modifications are used to reconstruct multiple large defects in the lip and face. In this study, we present our results on the reconstruction of these defects using bipaddle and sensate free radial forearm-palmaris longus flaps and subsequent revision surgeries. Patient medical records of 11 patients with a mean age of 63.9 ± 12.8 years were retrospectively reviewed. Functional oral competence, lip cosmetics, lip sensation, and donor forearm scars were evaluated using the drooling rating scale, visual analog scale, Semmes Weinstein Monofilament test, and patient and observer scar assessment scale, respectively. The mean dimensions of distal and proximal skin paddles of bipaddle free radial forearm-palmaris longus flaps were 12.7 ± 9.9 and 20.5 ± 3.8 cm2. Mean lengths of the bridge and proximal pedicles were 4.7 ± 1.6 and 5.5 ± 0.7 cm. All the flaps survived. No drooling was observed in the 2 patients without lower lip defects. The mean drooling scores of the 9 patients with lower lip defects were statistically different (Analysis of Variance, pANOVA < 0.00001) at 3, 6, 9, and 12 months postoperatively. The differences between 3 and 12 months were the most significant (pANOVA < 0.00001, pTUKEY < 0.000001). The lip sensation and drooling scores showed a strong positive correlation (r = 0.8504). All patients were able to speak fluently, drink fluid without leakage, and blow a balloon easily. All patients and observers were satisfied with the lip cosmetics, with no significant difference between satisfaction scores (P = 0.087615).There was a statistically significant difference (P < 0.00001) between mean sensation scores of surrounding healthy lip (2.94 ± 0.27) and free flaps (4.15 ± 0.4). All the donor scars healed uneventfully.

Exogenous Melatonin Enhances Moisture Stress Tolerance in Mango (Mangifera indica L.) through Alleviating Oxidative Damages.

In subtropical regions, April to June represents a temporary moisture stress for mango trees, leading to huge economic loss. Although water is available in the deep root zone, the upper soil surface, which has fibrous roots, is dry, and the tree transpiration rate is high. Moisture stress causes an increased oxidation state, which is detrimental to fruit growth and development. Finding substitutes for moisture stress management is important for sustainable mango production. To manage this moisture stress in mango, we tested if foliar application of 20, 50, 100 and 150 μM melatonin helped to maintain a reduced oxidation state in the cells. Applications were made at three phenological stages of fruit development (marble, egg and mature fruit stages) in 16-year-old trees and the same plants for each treatment were followed over three years. Melatonin application indeed improved the fruit yield of mango. Moisture stress decreased yield by 55.94% compared to irrigated trees but only by 7.5% in melatonin treatment. Also, more 'A' grade fruits were harvested in irrigated and melatonin-treated conditions than in non-irrigated and non-treated conditions. Indeed, the total chlorophyll content in the leaves of moisture-stressed melatonin-treated trees (12.58 mg.g-1 fresh weight) was well above non-treated trees (6.77 mg.g-1) and similar to irrigated trees (12.50 mg.g-1). A dose-dependent increase in the chlorophyll content of melatonin-treated plants was found. Similarly, the activities of catalase, peroxidase, superoxidase dismutase enzymes in leaves of irrigated and melatonin-treated trees were lower than in non-irrigated condition, and superoxide free radial formation was lower in moisture-stressed melatonin-treated trees (0.77 nmol H2O2.mg-1 protein) and irrigated trees (0.65) than moisture-stressed non-treated trees (4.27). Significant variations was found in antioxidants (total, reduced and oxidized glutathione and ascorbate) content and antioxidant enzymes' activities (i.e., glutathione reductase and ascorbate peroxidase) in irrigated, melatonin-treated and non-irrigated conditions. Overall, 150 μM exogenous melatonin applied three times at different fruit development stages may be a sustainable and useful approach to manage transient moisture stress in mango trees thanks to its positive action on the antioxidant system.

Repair of Surgical Defect by Pectoralis Major Flap Versus Free Radial Forearm Flap in Buccal Carcinoma: Assessment of Quality of Life

Background: Soft tissue reconstruction of the oral cavity is the most critical factor in achieving a successful functional result. Malignant lesions occurring in the buccal area are usually treated with primary surgical and/or radiotherapy of the head and neck region. Depending on the location and size of the buccal tumor, radical surgical treatment often affects all oral function such as speech, swallowing, chewing, oral rehabilitation, nutrition and appearance. To maximize postoperative function, flap repair is currently the preferred method for reconstruction of buccal defects after major surgery. Among the flaps most commonly used are pedicle pectoralis major myocutaneous flap and the free radial forearm fasciocutaneous flap. The choice of the best reconstructive option is still controversial. Objective: To find out the quality of life after repair of surgical defect by pectoralis major flap versus free radial forearm flap in buccal carcinoma. Methods: This prospective study was conducted in the department Otolaryngology- Head &amp; Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2017 to August 2019. A total number of 44 cases of buccal carcinoma patient who had the inclusion criteria were enrolled as a study sample. These subjects were selected from the Department of Otolaryngology-Head &amp; Neck Surgery, Department of Oral &amp; Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, National Institute of ENT, Tejgaon, Dhaka. Comparison of nominal or ordinal variables between patients who have undergone surgery with either the RFFF or PMMF were analyzed using a chi-square test. The UW-QOL scores were compared for each domain using the nonparametric Mann-Whitney test. P-value &lt; .05 was accepted as the level of significance. Results: In this study 40 out of 44 patients were completed UW-QOL questionnaires. The median age was 52 (range 40-65years), the male-female ratio was 1.44:1. All were habituated in either smoking or betel leaf/ nut or alcohol. Most of them were illiterate to the primary level of education and suffering from stage- iii tumor. All these variables were statistically insignificant except gender. Patients reconstructed with RFFF felt better in shoulder domains than PMMF but felt worse appearance domains and these were statistically significant in both 3 months and 6 months postoperatively. Conclusion: The study result had shown that reconstruction of the defect after buccal cancer resection using either RFFF or PMMF significantly influences patient’s quality of life. This study will provide valuable information for surgeons who will decide reconstruction modalities for buccal cancer and also will help the patients getting a better outcome. Bangladesh J Otorhinolaryngol 2023; 29(1): 32-38

Monolithic fiber/foam-structured catalysts: beyond honeycombs and micro-channels

ABSTRACT Heterogeneous catalysis plays a pivotal role in the current chemical and energy vectors production. Notably, to fully utilize the intrinsic activity and selectivity of a catalyst, the chemical reactor has to be designed and operated optimally to achieve enhanced heat/mass transfer, well-defined contact time of reactants, uniform flow pattern, and high permeability. Structured catalysts are a promising strategy to overcome the major drawbacks encountered in the traditional packed-bed reactor technology due to the improved hydrodynamics in combination with enhanced heat/mass transfer. Newly emerged fiber/foam-substrates, with an entirely open 3D network structure, bring distinct advantages over the honeycomb and micro-channel contacting methods, including free radial diffusion, eddy-mixing driven heat/mass transfer, large area-to-volume ratio, and high contacting efficiency. However, how to place the nanocatalysts onto the fiber/foam-substrates is a challenging problem because the commercial washcoating method has great limitations such as the nonuniformity and easy exfoliation of coatings. This review discusses the newly developed non-dip-coating methods for the fiber/foam-structured catalysts and their promising applications in the strongly exo-/endo-thermic and/or high throughput reaction processes.

An Unreported Variation of Origin of Posterior Tibial Artery Encountered During Free Fibula Flap Harvest.

Variations in the division of popliteal artery and origin of the 3 vascular systems are well documented. Here, we report a case in which the posterior tibial artery originated from the peroneal artery, in lower leg and then followed the normal course. The anomaly was detected intraoperatively precluding the harvest of free fibula flap. The procedure was abandoned and fibula was fixed using plates and screws and a free radial forearm flap was done over 2 mini-plates, which spanned the bone gap. A second bone flap procedure was to be planned in another sitting.The anomalous origin of posterior tibial artery from the peroneal artery in lower leg did not fall into any of the categories described previously by Kim et al (Ann Surg 1989;210:776-81.). In the event such atypical anatomy is encountered, it must be delineated, and the surgical plan adjusted accordingly. Flexibility in surgical approach can prevent vascular catastrophe.

Enhanced dye degradation performance enabled by swift electron mediator decorated WO3/g-C3N4/V2O5 hybrid nanomaterials.

Organic pollutants such as dyes and pharmaceutical drugs have become a significant environmental problem due to their unrestricted discharge, especially in water bodies. As a result, an economically viable and environmentally friendly approach to their degradation in water bodies is required and the incorporation of metal tungstate with single metal oxide has attracted attention due to its potential ability towards the photocatalytic degradation of pollutants. The work demonstrates a WO3/g-C3N4/V2O5 nanocomposite synthesized using a facile routewet impregnation method. The results revealed that WO3/g-C3N4/V2O5 nanocomposites are suitable, mainly for their better surface properties, enhanced visible-light absorption, and preferred band positions. Besides that, the degradation of methylene blue (MB) dye is carried out and demonstrated that the complete degradation occurs over 120min using 10mg L-1 of WO3/g-C3N4/V2O5 nanocomposite under UV-visible-light irradiation. The scavenger experimental result implies that the photogenerated free electrons and superoxide radials are important role in MB dye degradation. In addition, a possible mechanism is proposed for the photocatalytic activity of WO3/g-C3N4/V2O5 nanocomposite. Moreover, the stability analysis demonstrated that the WO3/g-C3N4/V2O5 nanocomposite can be recycled multiple times.

Designing the heterostructured FeWO4/FeS2 nanocomposites for an enhanced photocatalytic organic dye degradation

The present study, reports a facile approach for the synthesis of FeWO4/FeS2 nanocomposites were demonstrated through hydrothermal method. The surface morphology, crystalline structure, chemical composition, optical properties of the prepared samples was analysed by different various technique. The result observed analysis indicates that, the formation of heterojunction by 2:1wt% of FeWO4/FeS2 nanohybrid has the lowest recombination rate of electron-hole pairs and the least electron transfer resistance. Due to its the broad absorption spectral range and preferable energy band gap, the (2:1) FeWO4/FeS2 nanohybrid photocatalyst exhibits an excellent ability to remove MB dye when exposed to UV–Vis. Light irradiation. Its photocatalytic activity of (2:1) FeWO4/FeS2 nanohybrid is higher than other as prepared samples due to its synergistic effects, enhanced light absorption and high charge carrier separation. Radical trapping experimental result implies that the photo-generated free electrons and hydroxyl radials are essential to degrade the MB dye. Furthermore, a possible future mechanism for FeWO4/FeS2 nanocomposites photocatalytic activity was discussed. Moreover, the recyclability analysis demonstrated that the FeWO4/FeS2 nanocomposites can be recycled multiple times. The enhanced photocatalytic activity of 2:1 FeWO4/FeS2 nanocomposites is promising for the further application of visible light driven photocatalyst in wastewater treatment.

Unconventional Approach to Neck Dissection: A Rare Case of Cervical Kyphosis.

Carcinoma of the head, neck and face is a challenge faced by surgeons worldwide. This case report presents a complicated surgical approach utilised in a patient diagnosed with right lower lip and gingivobuccal sulcus carcinoma, with a fixed neck flexion deformity due to ankylosing spondylitis. The patient, a 55-year-old man with cervical kyphosis, was declared inoperable due to his complex anaesthetic and surgical requirements. We performed a successful wide local excision of the tumour with a right marginal mandibulectomy, and later reconstructed the defect using a left free radial forearm flap.

A Novel Technique to Convert Static Sling into a Dynamic Sling in Reconstruction of Total Lower Lip Defects Using Palmaris Longus Tendon with Free Radial Forearm Flap and Case Series.

Lower lip reconstruction has been a major challenge for the reconstructive surgeons since time immemorial. Various types of reconstruction had been described for the reconstruction of lower lip ranging from local flaps to free tissue transfer to free functioning muscle transfer. For complete lower lip defects, the free radial forearm flap with palmaris longus tendon has been the standard of reconstruction for many years. Literatures suggests various techniques for utilizing palmaris longus tendon sling as a static as well as dynamic structure. The limitation with static reconstruction is the loss of sling support with time leading to eversion and drooping of the reconstructed lower lip and drooling of saliva. In this article we describe a simpler and novel technique which converts static reconstruction into a dynamic one with a series of 5 patients. Aim of this prospectivestudy wasto evaluate the post operative functional and aesthetic outcome of our technique of total lower lip reconstruction using free radial forearm flap with palmaris longus sling reconstruction. The medical records included were demographics, including age, gender, and reason for the acquired defect, lip reconstructed, reconstructive method, flap survival, and outcomes. At 6months follow up, all patients had satisfactory outcome and were able to take oral diets and none of the patients complained of drooling, an inability to eat in a public setting, or microstomia. This technique which is a simpler modification can be helpful in converting the traditional static sling reconstruction of lower lip into a dynamic one resulting in good aesthetic and functional outcomes.

Different forms of free radial collateral artery perforator flaps for reconstruction after removal of oral tumors

Objective: To investigate the efficacies of different forms of free radial collateral artery perforator flaps in repairing the defects after oral tumor surgeries. Methods: From May 2016 to March 2021, 28 patients (22 males, 6 females, aged 35-62 years) with oral tumors admitted by Hunan Cancer Hospital received the reconstructive surgeries with the free radial collateral artery perforator flaps after removal of oral tumors, including 24 cases of tongue cancer (11 cases of tongue marginal cancer, 9 cases of tongue belly cancer and 4 cases of tongue cancer involved in the floor of the mouth) and 4 cases of buccal and oral cancer. Four forms of radial collateral artery perforator flaps were used: single perforator flaps for 6 cases, double perforators flaps for 7 cases, flaps without perforator visualization for 10 cases and chimeric perforator myocutaneous flaps for 5 cases. The recipient vessels were the superior thyroid artery and superior thyroid vein, and if second concomitant vein available, it was anastomosed with internal jugular vein in end-to-side fashion. SPSS 20.0 statistical software was used to analyze the data. Results: The mean length of flaps was (9.7±0.4) cm, mean width (4.4±0.3) cm and mean thickness (1.1±0.4) cm. The mean length of the vascular pedicles was (7.1±0.6)cm (6.0-8.0 cm), the mean diameter of the radial accessory arteries was (1.1±0.3)mm (0.8-1.3 mm). Eleven cases(39.3%) had respectively one accompanying vein and 17 cases(60.7%) had respectively two accompanying veins, with the mean diameter of (1.1±0.3) mm (0.8-1.3 mm). All the 28 flaps survived, the donor and recipient wounds healed in one stage, the appearances of the flaps were satisfactory, only linear scars remained in the donor sites, and the upper arm functions were not significantly affected. Follow up for 12-43 months showed that the flaps were soft with partially mucosalization, the reconstructed tongue and buccal cavity were in good shape, and the swallowing and language functions were satisfactory. The swallowing and language functions were retained to the greatest extent in 3 cases with near total tongue resection, although the functions were still significantly affected. There was no local recurrence of the tumor during follow-up. One case had regional lymph node metastasis, and further lymph node dissection and comprehensive treatment were performed, with satisfactory outcomes. Conclusions: The vascular pedicle of the radial collateral artery perforator flap has a constant anatomy, which can be prepared in different forms to improve the safety of the operation and minimize the donor site damage. It is an ideal choice for the repair of small and medium-sized defects after oral tumor surgery.

Donor Site Defect Coverage of the Forearm with Dermal Substitute After Harvesting Radial Forearm Free Flap for Phalloplasty: Is MatriDerm® Worth the Effort?

An aesthetically and functionally pleasing phalloplasty is most commonly performed by a free radial forearm flap. However, the problem with donor site morbidity on the forearm remains unsolved. The aim of this study was to evaluate if the use of a dermal template such as MatriDerm® on the donor site significantly decreases the incidence of complications based on the Clavien–Dindo classification, such as wound healing disorders and reoperation rate, and if it could shortens the duration of hospital stay. A case series analysis was conducted at our institution. A total of 21 patients divided into two groups undergoing the phallic construction after the Gottlieb and Levine design in a single center underwent the donor site defect coverage either by MatriDerm® and split-thickness skin graft from the thigh or by full-thickness skin graft from the groin area. The use of MatriDerm® and split-thickness skin graft showed to have a statistically significant impact on the rate of complications (p = 0.008). Complications that were treated conservatively as well as that require surgical revision were significantly lower in the MatriDerm® group than in the full-thickness skin graft group (p = 0.002). Complications occurred not only at the forearm but also at the groin, where the full-thickness skin graft was harvested. The large dimension of the free radial forearm flap used for phalloplasty resulted in a significant donor site morbidity, leading to wound healing disorders, reoperations, and extended length of hospital stay. Therefore, we consider the use of dermal templates such as MatriDerm® as worth the additional effort and costs in this patient collective.

Evaluating Sensation Recovery in Noninnervated Free Flaps Used for Oral Reconstruction

Association between time and sensation recovery in noninnervated flaps remains unclear. Our goal was to evaluate the recovery of sensation in noninnervated free flaps used for oral reconstruction. A prospective cohort study was designed and consecutive patients undergoing noninnervated free flap surgery for oral reconstruction from a tertiary medical center were enrolled. The primary outcome variable was sensory recovery of light touch, pain, hot, and cold temperature. Sensory recovery was scored as per the test on the central portion and 4 peripheral sections of every flap. The Kaplan-Meier method was used to estimate the functional recovery at different time points and the association between clinicopathologic variables and sensation recovery at 24months after surgery was analyzed using the chi-squared test and logistic regression analysis. Eighty patients were included with a median age of 50years. At 3months postoperatively, no patients exhibited sensation recovery. Positive flap sensitivity began to appear mildly at 6months postoperatively and gradually increased for at least 24months. The 24-month sensation recovery rates of light touch, pain, and temperature were 70.0% (95% confidence interval [CI]: 59.2 to 78.9%), 42.5% (95% CI: 32.3 to 53.4%), and 33.8% (95% CI: 24.45 to 44.6%), respectively. In univariate analysis, 80.5% (95% CI: 66.0 to 89.8%) of the free radial forearm flaps showed light touch sensation recovery, which was statistically higher than 59.0% (95% CI: 43.4 to 72.9%) in other flaps (P=.036). Flap size ≤ 65cm2 predicted better pain sensation recovery with 57.5% (95% CI: 42.2 to 71.5%) compared to 27.5% (95% CI: 16.1 to 42.8%) in flap size > 65cm2 groups (P=.007). Logistic regression analysis confirmed flap size ≤ 65cm2 (P=.032, odds ratio=1.957, 95% CI: 1.034 to 4.389) and not smoking (P=.015, odds ratio=2.564, 95% CI: 1.673-5.482) offered better sensation recovery of pain and hot temperature, respectively. Sensation recovery in noninnervated free flaps was common and related to not smoking and flap size.

Use of free radial forearm and pronator quadratus muscle flap: Anatomical study and clinical application.

The authors present an anatomical study and clinical experience with radial forearm flap (RFF) and pronator quadratus muscle (PQM) application in the reconstruction of various body areas. The aim was to describe the anatomical placement and proportions of the PQM, the anatomical location of the major arterial branch of the radial artery supplying the PQM, and the application of this knowledge in clinical practice. The anatomical study was based upon an analysis of 13 fresh adult cadaver upper extremities, of which nine were female and four male; both arms from the same donors were used in four cases. The study of the PQM was performed using a dye-containing intraarterial injection, standard macro- and micro-preparation techniques, and chemical digestion. The data on the PQM size in males and females, thickness of the radial artery branch (the principal artery nourishing the muscle), and its position were analysed. The radial artery branch nourishing the PQM was identified in all cadaveric specimens of the anatomical study. In addition, 12 patients underwent reconstructions of soft and bony tissue defects using a RFF+PQM (pedicled or free flap). The radial artery branch perfusing the PQM was identified in all cases. The flap was used for the management of defects of the head (seven cases), arm (three cases) and lower leg (two cases). The harvest site healed well in all cases and, with the exception of one case in which a partial necrosis of the flap was observed, all flaps remained viable, which demonstrated the safety of the method.

Free radial oscillations of an actuated cylindrical tube

This work investigates the free radial oscillations of an electrically actuated cylindrical tube. Classical Knowles’ tube problem is explored here with the application of an external electric field. One of the prime objectives is to study the effect of sudden pressure removal from the cylindrical actuator. We attempt to correlate our problem physiologically with an arterial tissue actuation. The tube is introduced to an electrical actuation with an externally applied electric field and is subjected to a sudden pressure which is removed instantly to explore the purely free radial oscillations. Generally, such kind dynamic effects are neglected in designing cylindrical actuators. The dielectric cylindrical tube is assumed to be incompressible, isotropic, and infinite. The obtained results assert that the application of an external electric field reduces the amplitude of the radial oscillations and thus makes the tube contract. Essentially, the actuation is elevating the stiffness of the tube. A similar effect is also observed in the blood vessels, wherein the electric signaling helps the vessels to contract. We propose a complete analytical solution approach that is highly significant in designing cylindrical muscle actuators for various futuristic applications in the biomimetic and medical field.

Modification of the single‐tube radial forearm phalloplasty technique to allow for urinary meatal reconstruction: A report of two cases

The free radial forearm flap is the gold standard technique for transgender phalloplasty due to superior complication rates compared to other methods. However, reconstruction of the urinary tract, including urethral lengthening and creation of a pars pendula urethra within the flap, carries a high rate of complications. The risk of complications and a lack of desire for standing urination are reasons patients elect for single-tube phalloplasty. However, to date, single-tube phalloplasties lack creation of a urinary meatus, which affects the aesthetics of the reconstruction. The purpose of this report is to describe a technique for creating an aesthetic urinary meatus in single-tube phalloplasty. We herein describe the technique in the use of two healthy transgender males (ages 31 and 39). Both patients did not desire micturition through the neophallus, but still desired the appearance of a meatus at the tip of the neophallus. Single-tube radial forearm phalloplasty was performed for both patients. The radial forearm flaps for each patient were 14 × 15 cm. Meatoplasty was performed at the time of flap elevation utilizing an intact 1 × 4cm intact strip of ulnar sided skin during flap tubularization. This strip of skin was then invaginated to create a neomeatal pouch. The postoperative course was uncomplicated for both patients following at 5-day hospital stay for flap monitoring. Follow up time was 7 and 8 months. The neomeatal pouch persisted in both patients and the patients were satisfied with the appearance of the tips of the neophalluses.

Free vibrations and buckling analysis of cross-ply composite nanoplates by means of a Mesh Free Radial Point Interpolation Method

The paper deals with the dynamic analysis of composite simply supported nanoplates modelled according to the second order strain gradient theory. Numerical results are obtained by means of a Mesh Free Radial Point Interpolation Method. Both uniaxial and biaxial buckling as well as free vibration analysis are considered. The buckling analysis is performed on plates with different aspect ratio a/b and variable E1/E2 ratio. For the vibration analysis, the geometry and mechanical properties of the plate are kept constant while different lamination sequences are accounted for. Moreover, different values of the nonlocal parameter ℓ are considered for both analyses. Finally, the numerical results are compared against the analytical results find in the literature, the comparison being made in terms of percentage error between the two.