Hinge Flap Research Articles

Structural and mechanism design of an active trailing-edge flap blade

A conventional rotor control system restricted at 1/rev frequency component is unable to vary the hub vibratory loads and the aeroacoustic noise, which exist in high frequency components. Various active rotor control methodologies have been examined in the literature to alleviate the problem of excessive hub vibratory loads and noise. The active control device manipulates the blade pitch angle with arbitrary higher harmonic frequencies individually. In this paper, an active trailing-edge flap blade, which is one of the active control methods, is developed to reduce vibratory loads and noise of the rotor through modification of unsteady aerodynamic loads. Piezoelectric actuators installed inside the blade manipulate the motion of the trailing edge flap. The proposed blade rotates at higher speed and additional structures are included to support the actuators and the flap. This improves the design, as the blade is able to withstand increased centrifugal force. The cross-section of the active blade is designed first. A stress/strain recovery analysis is then conducted to verify its structural integrity. A one-dimensional beam analysis is also carried out to assist with the construction of the fan diagram. To select the actuator and design the flap actuation region, the flap hinge moment is estimated via a CFD analysis. To obtain the desired flap deflection of ±4°, three actuators are required. The design of the flap actuation region is validated using a test bed with a skin hinge. However, because the skin hinge induces additional flap hinge moment, it does not provide sufficient deflection angle. Therefore, the flap hinge is replaced by a pin-type hinge, and the results are evaluated.

Reversible Femtosecond Laser-Assisted Myopia Correction: A Non-Human Primate Study of Lenticule Re-Implantation after Refractive Lenticule Extraction

LASIK (laser-assisted in situ keratomileusis) is a common laser refractive procedure for myopia and astigmatism, involving permanent removal of anterior corneal stromal tissue by excimer ablation beneath a hinged flap. Correction of refractive error is achieved by the resulting change in the curvature of the cornea and is limited by central corneal thickness, as a thin residual stromal bed may result in biomechanical instability of the cornea. A recently developed alternative to LASIK called Refractive Lenticule Extraction (ReLEx) utilizes solely a femtosecond laser (FSL) to incise an intrastromal refractive lenticule (RL), which results in reshaping the corneal curvature and correcting the myopia and/or astigmatism. As the RL is extracted intact in the ReLEx, we hypothesized that it could be cryopreserved and re-implanted at a later date to restore corneal stromal volume, in the event of keratectasia, making ReLEx a potentially reversible procedure, unlike LASIK. In this study, we re-implanted cryopreserved RLs in a non-human primate model of ReLEx. Mild intrastromal haze, noted during the first 2 weeks after re-implantation, subsided after 8 weeks. Refractive parameters including corneal thickness, anterior curvature and refractive error indices were restored to near pre-operative values after the re-implantation. Immunohistochemistry revealed no myofibroblast formation or abnormal collagen type I expression after 8 weeks, and a significant attenuation of fibronectin and tenascin expression from week 8 to 16 after re-implantation. In addition, keratocyte re-population could be found along the implanted RL interfaces. Our findings suggest that RL cryopreservation and re-implantation after ReLEx appears feasible, suggesting the possibility of potential reversibility of the procedure, and possible future uses of RLs in treating other corneal disorders and refractive errors.

A New Technique for Correction of Simple Congenital Earlobe Clefts

The earlobe plays an important part in the aesthetic appearance of the auricle. Congenital cleft earlobe may vary considerably in severity from a simple notching to extensive tissue deficiency. Most patients with cleft earlobe require surgical correction because of abnormal appearance. In this article, a new surgical technique for correcting congenital simple cleft earlobe using diametric hinge flaps is introduced. We retrospectively reviewed 4 patients diagnosed with congenital cleft earlobe between 2008 and 2010. All of them received this new surgical method. The patients were followed up from 3 to 6 months. All patients attained relatively full bodied earlobes with smooth contours, inconspicuous scars, and found their reconstructed earlobes to be aesthetically satisfactory. One patient experienced hypoesthesia in the area operated on, but recovered 3 months later. No other complications were noted. This simple method not only makes full use of the surrounding tissues to reconstruct full bodied earlobes but also avoids small notch formation caused by the linear scar contraction sometimes seen when using more traditional methods.

Single-Stage Turn-Over Muscular Hinge Flap With Burow's Full-Thickness Skin Graft to Repair Oral Commissure Defect

1Department of Dermatology, School of Medicine, Stanford University, Redwood City, California, Address correspondence and reprint requests to: Sumaira Z. Aasi, MD, Department of Dermatology, Stanford University, 450 Broadway St, Pavilion C 2nd Floor, Redwood City, CA 94063, or e-mail: [email protected] The authors have indicated no significant interest with commercial supporters.

Skin graft survival on subcutaneous hinge flaps: An algorithm for nasal reconstruction

To assess the survival of full-thickness skin grafts and perichondrial cutaneous grafts when placed on subcutaneous soft tissue flaps used in nasal reconstruction. Retrospective case series from a secondary-care cutaneous cancer practice. Twenty-eight patients with nasal defects secondary to basal cell carcinoma excision were included. Clinical information, including case notes and photography, was obtained and analyzed. Graft survival was assessed in relation to type of graft and subcutaneous soft tissue flap employed for the reconstruction. Overall graft survival was 79%, with 89% and 74% for perichondrial cutaneous graft and full-thickness skin grafts, respectively. Anecdotally, procerus and nasalis flaps were found to yield higher graft survival than cheek fat flaps. The combination of subcutaneous soft tissue flap and skin graft cover offers a valuable addition to the treatment algorithm for nasal reconstruction following cutaneous malignancy excision.

Large deformation finite element analysis investigating the performance of anchor keying flap

Suction embedded plate anchors, as used in practice, include a hinged keying flap aligned with the main anchor plate (fluke). The flap was designed to rotate away from the shank during keying of the anchor, to minimise loss of anchor embedment and the associated reduction in pull-out resistance. However, it has been observed experimentally that the flap is activated only once keying is nearly completed, and thus does not assist in reducing embedment loss. In this paper, the performance of the keying flap is investigated using a large deformation finite element approach based on frequent mesh regeneration. The moment acting at the flap hinges, determined from the soil pressures and shear forces on the keying flap, is quantified. The moment controlling the flap activation depends mainly on the net soil pressure on the front or back face of the flap, and this prevents activation of the flap while the anchor is rotating significantly. The flap is only activated once the anchor motion becomes dominated by forward translation, normal to the plate. Various factors affecting flap activation and embedment loss are explored, including flap height, eccentricity of the padeye, soil strength profile, initial anchor depth and load inclination.

ヒンジ皮弁と陰圧閉鎖療法で閉鎖できた胃皮膚瘻の1例

ヒンジ皮弁と陰圧閉鎖療法で閉鎖できた胃皮膚瘻の1例

Applications of femtosecond lasers in ophthalmic surgery

Purpose: To review recent advancements in applications of the femtosecond (FS) laser in ophthalmology. Design: Literature review and commentary. Results: With the FS laser, it is now possible to produce a more precise flap diameter, hinge and depth of the flap in laser in situ keratomileusis surgery. Recently, the FS laser has been used for both flap creation and refractive correction by lenticule extraction. This laser can also be used for preparing host and donor tissue in different shapes so as to obtain faster recovery and improved postoperative visual acuity. Intracorneal ring segments for keratoconus and post-laser in situ keratomileusis ectasia can be placed using the FS laser. Higher precision of capsulorrhexis and lens softening is also achievable with FS laser-assisted cataract surgery. Conclusion: Innovations focused on improving FS laser technology will continue and will lead to expanded applications of the FS laser in ocular surgery.

Application of Bilateral De-epithelialized Hinge Flap to Correct the Deep Depressed Scar

The scar is formed following the trauma or severe inflammation, and it is one of the critical problems in the field of plastic and reconstructive surgery. To date, continuous efforts have been made to correct scar. Still, however, it remains challenging to remove scar completely. The scar formation is a process that occurs during the wound healing, which is characterized by the synthesis of abnormal collagen and irregular changes on the skin surface [1]. Various factors that may affect the wound healing process, leads to the formation of various types of scars such as linear scar and depressed one. Most cases of the linear scars are corrected using a scar revision. This leads to good treatment outcomes. In addition, small-sized depressed scars are corrected using a dermal-fat grafting or an autologous fat grafting [2]. But the fillers are disadvantageous in that the rate of absorption is relatively higher and additional surgeries are required to provide filling materials. Various methods have therefore been used to correct deep depressed scars. But the correction of deep depressed scars poses challenging problems for plastic surgeons. In the past, de-epithelialized scar So-Min Hwang, Sang-Hwan Lee, Hong-Il Kim, Yong-Hui Jung, Hyung-Do Kim

A control and automation system for wave basins

This paper presents the new active absorption wave basin, named Hydrodynamic Calibrator (HC), constructed at the University of São Paulo (USP), in the Laboratory facilities of the Numerical Offshore Tank (TPN). The square (14m×14m) tank is able to generate and absorb waves from 0.5Hz to 2.0Hz, by means of 148 active hinged flap wave makers. An independent mechanical system drives each flap by means of a 1HP servo-motor and a ball-screw based transmission system. A customized ultrasonic wave probe is installed in each flap, and is responsible for measuring wave elevation in the flap. A complex automation architecture was implemented, with three Programmable Logic Computers (PLCs), and a low-level software is responsible for all the interlocks and maintenance functions of the tank. Furthermore, all the control algorithms for the generation and absorption are implemented using higher level software (MATLAB®/Simulink block diagrams). These algorithms calculate the motions of the wave makers both to generate and absorb the required wave field by taking into account the layout of the flaps and the limits of wave generation. The experimental transfer function that relates the flap amplitude to the wave elevation amplitude is used for the calculation of the motion of each flap. This paper describes the main features of the tank, followed by a detailed presentation of the whole automation system. It includes the measuring devices, signal conditioning, PLC and network architecture, real-time and synchronizing software and motor control loop. Finally, a validation of the whole automation system is presented, by means of the experimental analysis of the transfer function of the waves generated and the calculation of all the delays introduced by the automation system.

Neurotrophins and Nerve Regeneration-Associated Genes are Expressed in the Cornea After Lamellar Flap Surgery

To determine the in vivo expression of neurotrophins (NTs) and nerve regeneration-associated genes (RAGs) after surgically creating a hinged lamellar corneal flap in thy1-YFP mice. Lamellar corneal flaps with multiple hinges were created in thy1-YFP mice. Mice were killed at weeks 2, 4, and 8. Quantitative polymerase chain reaction was performed to determine the expression of NTs and RAGs in the corneas after lamellar transection. Nerve growth factor (Ngf), brain-derived neurotrophic factor (Bdnf), glial cell-derived neurotrophic factor (Gdnf), neurotrophin 3, neurotrophin 5, small proline-rich repeat protein 1A (Sprr1a), growth-associated protein 43 (Gap43), and beta III tubulin (Tubb3) gene expressions were analyzed. Whole-mount confocal immunofluorescence and Western analyses were performed for localization and abundance of robustly expressed genes. Sprouts of fine YFP-positive fronds emanating from transected (injured) nerve bundles were seen in the flap area at 2 weeks onward. Bdnf and Sprr1a were robustly and significantly expressed at 2 weeks postoperatively (>2-fold increase in expression; P<0.05). Bdnf localized to thy1-YFP+ cells in operated corneas. Sprr1a localized to corneal epithelial cell membranes. At 8 weeks, none of the NTs and RAGs had increased expression. Bdnf (ρ=0.73, P=0.001) and Sprr1a (ρ=0.76, P=0.001) showed a significant positive correlation with beta III tubulin. The neurotrophin Bdnf and RAG Sprr1a are robustly and significantly expressed during corneal nerve regeneration in vivo.

Closure of a tracheocutaneous fistula by two hinged turnover skin flaps and a muscle flap: A case report

INTRODUCTIONTracheocutaneous fistula is a complication of tracheostomy. Tracheocutaneous fistulectomy followed by primary closure carries a high possibility of complications. PRESENTATION OF CASEAn 11-year-old boy underwent surgery to repair a tracheocutaneous fistula, using skin and muscle flaps. A vertical incision was made around the fistula and 3 skin flaps were prepared: 2 hinge flaps, and 1 to cover the skin defect (advanced flap). The 2 hinged turnover flaps were invaginated by multiple layered sutures, and a strap muscle flap was placed over the resulting tracheal closure. An advanced skin flap was used to cover the area of the previous defect. The patient was extubated immediately after surgery. He was discharged on the sixth postoperative day without tracheal leakage or subcutaneous emphysema. The patient is currently doing well, with no respiratory symptoms and no recurrence at the postoperative 5 months. DISCUSSIONOur technique is minimally invasive and has a low risk of lumen stenosis, other complications, or recurrence. CONCLUSIONThis technique demonstrates the multiple-layered closure of a tracheocutaneous fistula, using skin flaps and a muscle flap.

Structural insights into the South African HIV-1 subtype C protease: impact of hinge region dynamics and flap flexibility in drug resistance

The HIV protease plays a major role in the life cycle of the virus and has long been a target in antiviral therapy. Resistance of HIV protease to protease inhibitors (PIs) is problematic for the effective treatment of HIV infection. The South African HIV-1 subtype C protease (C-SA PR), which contains eight polymorphisms relative to the consensus HIV-1 subtype B protease, was expressed in Escherichia coli, purified, and crystallized. The crystal structure of the C-SA PR was resolved at 2.7 Å, which is the first crystal structure of a HIV-1 subtype C protease that predominates in Africa. Structural analyses of the C-SA PR in comparison to HIV-1 subtype B proteases indicated that polymorphisms at position 36 of the homodimeric HIV-1 protease may impact on the stability of the hinge region of the protease, and hence the dynamics of the flap region. Molecular dynamics simulations showed that the flap region of the C-SA PR displays a wider range of movements over time as compared to the subtype B proteases. Reduced stability in the hinge region resulting from the absent E35-R57 salt bridge in the C-SA PR, most likely contributes to the increased flexibility of the flaps which may be associated with reduced susceptibility to PIs.An animated interactive 3D complement (I3DC) is available in Proteopedia at http://proteopedia.org/w/Journal:JBSD:36

Interpolated subcutaneous fat pedicle melolabial flap for large nasal lining defects

Full-thickness nasal deformities are a reconstructive challenge. Restoration of a reliable internal lining is critical for a successful reconstruction. Septal hinge flaps are the workhorse for internal lining defects. However, these and other intranasal mucosal flaps are sometimes unavailable due to prior harvest or previous oncologic resection. We present the two-stage interpolated subcutaneous fat pedicle melolabial flap for lining large defects when traditional intranasal flaps are unavailable. This approach is particularly useful when one forehead flap has already been expended, preserving the patient's remaining forehead tissue for external cover.

The History of LASIK

Keratomileusis, brainchild of Jose I. Barraquer Moner, was conceived and developed as the first stromal sculpting method to correct refractive error in 1948. The word "keratomileusis" literally means "sculpting" of the "cornea." Barraquer's first procedures involved freezing a disc of anterior corneal tissue before removing stromal tissue with a lathe. Over the years, the procedure continued to develop, first through the Barraquer-Krumeich-Swinger non-freeze technique where tissue was removed from the underside of the disc by a second pass of the microkeratome. In-situ keratomileusis was later developed by passing the microkeratome a second time directly on the stromal bed. The procedure became known as automated lamellar keratoplasty with the invention of an automated microkeratome and was further refined by replacing the disc without sutures and later by stopping the microkeratome before the end of the pass to create a hinged flap, as first demonstrated in 1989. The history of the excimer laser dates back to 1900 and the quantum theory, eventually leading to the discovery that 193-nm ultraviolet excimer laser pulses could photoablate tissue without thermal damage. Ultrastructural and wound healing studies confirmed that large area ablation could be performed in the central cornea. This was described as photorefractive keratectomy in 1986 and the first sighted eyes were treated in 1988. An excimer laser was first used to sculpt from the stromal bed under a hinged flap created manually using a trephine and scalpel in 1988. The incorporation of a microkeratome in 1990 finally led to laser in situ keratomileusis-LASIK-as we know it today.

Low pass filters and differential tympanal tuning in a paleotropical bushcricket with an unusually low frequency call

Low-frequency sounds are advantageous for long-range acoustic signal transmission, but for small animals they constitute a challenge for signal detection and localization. The efficient detection of sound in insects is enhanced by mechanical resonance either in the tracheal or tympanal system before subsequent neuronal amplification. Making small structures resonant at low sound frequencies poses challenges for insects and has not been adequately studied. Similarly, detecting the direction of long-wavelength sound using interaural signal amplitude and/or phase differences is difficult for small animals. Pseudophylline bushcrickets predominantly call at high, often ultrasonic frequencies, but a few paleotropical species use lower frequencies. We investigated the mechanical frequency tuning of the tympana of one such species, Onomarchus uninotatus, a large bushcricket that produces a narrow bandwidth call at an unusually low carrier frequency of 3.2 kHz. Onomarchus uninotatus, like most bushcrickets, has two large tympanal membranes on each fore-tibia. We found that both these membranes vibrate like hinged flaps anchored at the dorsal wall and do not show higher modes of vibration in the frequency range investigated (1.5-20 kHz). The anterior tympanal membrane acts as a low-pass filter, attenuating sounds at frequencies above 3.5 kHz, in contrast to the high-pass filter characteristic of other bushcricket tympana. Responses to higher frequencies are partitioned to the posterior tympanal membrane, which shows maximal sensitivity at several broad frequency ranges, peaking at 3.1, 7.4 and 14.4 kHz. This partitioning between the two tympanal membranes constitutes an unusual feature of peripheral auditory processing in insects. The complex tracheal shape of O. uninotatus also deviates from the known tube or horn shapes associated with simple band-pass or high-pass amplification of tracheal input to the tympana. Interestingly, while the anterior tympanal membrane shows directional sensitivity at conspecific call frequencies, the posterior tympanal membrane is not directional at conspecific frequencies and instead shows directionality at higher frequencies.

Aerodynamic analysis and design of Busemann biplane: towards efficient supersonic flight

Aiming to realize a low-drag supersonic transport, Busemann biplane concept was adopted in this study. Two- and three-dimensional (2D and 3D) biplanes were analysed and designed to improve their aerodynamic performance using computational fluid dynamics. It was confirmed that 3D biplane wings have better aerodynamic-performance areas than 2D biplane airfoils. A winglet is also useful for improvement of their aerodynamic performance. Aerodynamic characteristics of these biplanes at their off-design conditions were also analysed. In 3D wings, a flow choking and its attendant hysteresis as starting problems, which arise when the biplanes accelerate from low Mach numbers, disappear at lower Mach numbers than those in 2D airfoils. It was confirmed that hinged slats and flaps are effective to settle these issues. Finally, interference effects of a body with the biplanes were investigated. When the biplane wings are affected by the expansion waves from the body, their aerodynamic performance at the design Mach number and the starting Mach number are better and lower than those of their isolated wings, respectively. A 3D biplane wing obtained by an inverse-design method was applied to the body. The wing of this wing–body configuration achieves higher aerodynamic performance than the 2D flat-plate airfoil at sufficient lift conditions, which is the almost identical performance of 2D biplane airfoils.

Operation of the alula as an indicator of gear change in hoverflies

The alula is a hinged flap found at the base of the wings of most brachyceran Diptera. The alula accounts for up to 10 per cent of the total wing area in hoverflies (Syrphidae), and its hinged arrangement allows the wings to be swept back over the thorax and abdomen at rest. The alula is actuated via the third axillary sclerite, which is a component of the wing hinge that is involved in wing retraction and control. The third axillary sclerite has also been implicated in the gear change mechanism of flies. This mechanism allows rapid switching between different modes of wing kinematics, by imposing or removing contact with a mechanical stop limiting movement of the wing during the lower half of the downstroke. The alula operates in two distinct states during flight-flipped or flat-and we hypothesize that its state indicates switching between different flight modes. We used high-speed digital video of free-flying hoverflies (Eristalis tenax and Eristalis pertinax) to investigate whether flipping of the alula was associated with changes in wing and body kinematics. We found that alula state was associated with different distributions of multiple wing kinematic parameters, including stroke amplitude, stroke deviation angle, downstroke angle of incidence and timing of supination. Changes in all of these parameters have previously been linked to gear change in flies. Symmetric flipping of the alulae was associated with changes in the symmetric linear acceleration of the body, while asymmetric flipping of the alulae was associated with asymmetric angular acceleration of the body. We conclude that the wings produce less aerodynamic force when the alula is flipped, largely as a result of the accompanying changes in wing kinematics. The alula changes state at mid-downstroke, which is the point at which the gear change mechanism is known to come into effect. This transition is accompanied by changes in the other wing kinematic parameters. We therefore find that the state of the alula is linked to the same parameters as are affected by the gear change mechanism. We conclude that the state of the alula does indeed indicate the operation of different flight modes in Eristalis, and infer that a likely mechanism for these changes in flight mode is the gear change mechanism.

Tracheal Reconstruction Using S-Shaped Skin Flaps and a Conchal Cartilage Graft

We have devised a technique of two-stage tracheal reconstruction using S-shaped skin flaps and an aural conchal cartilage graft. During the first operation, S-shaped skin flaps were elevated before resection of the trachea. A tracheocutaneous fistula was created at the tracheal defect using S-shaped skin flaps while placing the conchal cartilage graft underneath. During the second operation, a skin incision was made around the fistula to elevate the hinge flaps, including the cartilage. The edges of the hinge flaps were sutured to form the tracheal lumen, and the area of the skin defect was then closed with double-rotation skin flaps.

Preservation of the Nasal Valve Area With a Lateral Crural Hinged Flap: A Cadaveric Study

Overresection of the lateral crura of the lower lateral cartilages is referred to as the most common cause of nasal valve collapse after rhinoplasty. The modern approach to functional rhinoplasty recognizes the importance of the tip framework's structural integrity and preserves tip support. Traditional cephalic resections of lateral crura were performed on one side of five adult cadaver noses. On the opposite sides, hinged flaps of lateral crura were created. The noses were cross-sectioned at or near the internal nasal valve level, and the difference between the two sides was described. The study findings demonstrated improvement in the postoperation nasal valve area of the hinged flap side compared with the cephalic trim side. This preliminary study showed that the hinged flap is an option in nasal tip reduction surgery that may provide improved long-term aesthetic and functional outcomes through preservation of the nasal valve area.