Reconstruction Attempts Research Articles

Forehead Flap - A Salvage Option for Failed Anterolateral Thigh Flap in Buccal Mucosa Carcinoma Reconstruction

Introduction: Pedicled lateral forehead flap could be a valuable option for reconstruction in the floor of the orbit and floor of the mouth in the absence of other resources available. Case presentation: A-57-year-old male with multiple comorbidities, underwent partial maxillectomy, hemi mandibulectomy and hemiglossectomy with infratemporal fossa clearance due to a rapidly spreading buccal mucosa carcinoma on the left side. The last resort was the pedicled lateral forehead flap after unsuccessful reconstructive attempts with an anterolateral thigh flap. Discussion: The pedicled forehead flap which has rich vascularity, decreased donor site morbidity and reliable anatomy made it a favorable locoregional flap for oral reconstruction. Conclusion: Flaps should be chosen considering the patient’s condition and resources available. Forehead flap due to its proximity is an ideal option for reconstruction of oral cavity defects.

Library of the Historical and Genealogical Society in Moscow at the Beginning of the 20th Century: The Reconstruction Attempt

Library of the Historical and Genealogical Society in Moscow at the Beginning of the 20th Century: The Reconstruction Attempt

Social mix in Zagreb’s large housing estates

In Western and Northern Europe, post-war large housing estates (LHEs) stand out as areas of segregated and minority-populated housing, and have faced numerous attempts of reconstruction with the idea of social mixing. LHEs in Central and Eastern Europe had different developmental pathways. The heterogeneous structure of these estates has persisted until today, but due to the systematic neglect and aging, the estates are threatened by physical and social deterioration. The analysis is based on a survey conducted in Croatia in 2022 on two types of housing estates (socialist and post-socialist; N (Zagreb = 657). The results confirm that the social composition in both types of estates is mixed, with a predominance of middle-class residents and without pronounced social differences. The residential satisfaction is high, so the majority of residents are stayers. Nevertheless, certain regeneration policies should be adopted because the population of the socialist LHEs is aging, which could jeopardize the present heterogeneity and make maintenance of multifamily buildings more challenging, thus contributing to further deterioration of the estates.

Virtually Reconstructing Bernhard Heine’s Osteotome

The osteotome was a hand-cranked medical chainsaw designed in 1830 by the German surgeon Bernhard Heine. Before Heine, surgeons used crude, manual tools, such as hammers, chisels, and handsaws. The osteotome was among the first mechanical tools used in orthopedic surgery, and it preceded the later use of the motorized chainsaw for woodcutting. Due to the small number of units manufactured, questions remain about the osteotome’s usage. To facilitate conservation and assist with investigation, Heine’s osteotome was digitally reconstructed. As with other digital reconstruction attempts in cultural heritage, assumptions were made to facilitate reproduction. To highlight the functional similarities and contrasts between early and contemporary tools, its parts were compared with contemporary chainsaws and surgical tools. Contemporary orthopedic surgeons have largely shifted away from medical chainsaws, such as the osteotome, in favor of reciprocating saws. Due to its small size and medical purpose, the osteotome was designed for greater precision than a modern industrial chainsaw. Based on the reproduction and comparative analysis, the device was likely used in a manner more similar to modern medical reciprocating saws than to its direct descendant, the industrial chainsaw. The Heine osteotome mechanized surgery and its descendants are still used in medicine and the industry. The osteotome model enabled an analysis of its function and use.

Volodymyr Naumenko’s private library: information potential and reconstruction attempt

Volodymyr Naumenko’s private library: information potential and reconstruction attempt

First attempt of directionality reconstruction for atmospheric neutrinos in a large homogeneous liquid scintillator detector

The directionality information of incoming neutrinos is essential to atmospheric neutrino oscillation analysis since it is directly related to the oscillation baseline length. Large homogeneous liquid scintillator detectors, while offering excellent energy resolution, are traditionally very limited in their capabilities of measuring event directionality. In this paper, we present a novel directionality reconstruction method for atmospheric neutrino events in large homogeneous liquid scintillator detectors based on waveform analysis and machine learning techniques. We demonstrate for the first time that such detectors can achieve good direction resolution and potentially play an important role in future atmospheric neutrino oscillation measurements. Published by the American Physical Society 2024

Evaluation on improved sparse signal reconstruction algorithm for trusted AI and DCS technology

The improved Sparse Signal Reconstruction (SR) algorithm for Trusted Artificial Intelligence (AI) and Distributed Compressed Sensing (DCS) technology was thoroughly investigated. The study verified its effectiveness and advantages in trusted AI and DCS systems, which have significant implications for enhancing the credibility, security, and performance of signal processing and AI algorithms. The reconstruction performance was evaluated using Orthogonal Matching Pursuit (OMP), Basis Pursuit (BP), and Least Absolute Shrinkage and Selection Operator (LASSO). The analysis primarily focused on runtime, refactoring errors, and the number of successful reconstruction attempts. When K = 4, K = 6, K = 8, and K = 10, OMP outperformed BP and LASSO in terms of successful reconstructions, demonstrating better performance and higher reconstruction precision.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Abstract
 Introduction & Objectives : A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (alpha-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find alpha-SMA protein expression in myofibroblasts derived from orbital socket contracture.
 Methods : In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for alpha-SMA expression.
 Results : In this study, there were 2 out of 5 (40%) positive alpha-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts in patient with history of recurrent contraction.
 Conclusion : Alpha-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive alpha-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Purpose: A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (?-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find ?-SMA protein expression in myofibroblasts derived from orbital socket contracture. Methods: In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for ?-SMA expression. Result: In this study, there were 2 out of 5 (40%) positive ?-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts. Conclusion: ?-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive ?-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

A Nineteenth-Century Italian Workshop of Neo-Late Medieval and Renaissance Ivory Instruments

Some twenty ivory stringed instruments preserved in three main collections and corresponding to an instrumentarium in use at the end of the Middle Ages and the beginning of the Renaissance form a very homogeneous group. These instruments seem to have been made by the same workshop at the very end of the nineteenth century. Are they attempts of reconstruction or counterfeits?

(Re)calibrating heritage: Al-Jdeideh (post-)conflict transformations in Aleppo, Syria

This paper examines how armed conflict impacts the recalibration of Aleppo’s historic urban and cultural fabric, using the Al-Jdeideh quarter as a case study. This article critically reflects on the ongoing (post-)conflict, top-down (post-)reconstruction activities in Aleppo’s historic core, drawing on ethnographic research of visual mapping and semi-structured interviews with current Aleppo dwellers in the city and former dwellers displaced across Europe. Our findings highlight that the current reconstruction activities lack locals’ values and needs, and amplify the altered socio-economic dynamics between the (former) communities’ absence and presence. Therefore, these activities are resulting in a skewed representation of what once was a major hub of culture, commerce, heritage, and everyday life. As such, the paper argues that the current reconstruction attempts lack a comprehensive and context-specific approach, and need to explore more inclusive pathways of human-centered and sustainable recovery.

Зеркала памяти: Людмила Шестакова и Михаил Глинка. Статья вторая

The article continues its examination of one of the memorial articles by Liudmila Shestakova (1816–1906). The analysis of the correlation of her memoirs of her brother with his own personal self-perception, his compositional and public activities prove the following: Shestakova was very subjective in her description of the last years of the life of a person who was close to her. At the center of our attention is Shestakova’s assertion of the “fading” of Glinka’s musical talent, his limited creative activities and the wish to withdraw from music entirely, which manifested itself in him from time to time. The sources for such a perspective are analyzed. Parallels are traced with the attitude of society towards the late stage of Alexander Pushkin’s evolution as a poet and artist. Shestakova’s perspective of Glinka’s milieu is examined. Special attention is paid to the analysis of the document sent to Shestakova by Siegfried Wilhelm Dehn. Proof is provided that Shestakova’s memoirs presented in the article had been conducive in no small degree to the formation of the myth of the barrenness of the last stage of Glinka’s music, which has survived to a considerable degree up to our days. The attempt of reconstruction of Glinka’s activities after a decade and a half after his demise was the result of the subjective view of Glinka’s sister on the composer’s legacy during the final years of his life, which created an impact on Glinka studies in Russia during the 19th and 20th centuries.

A Warming Southern Gulf of Mexico: Reconstruction of Anthropogenic Environmental Changes From a Siderastrea siderea Coral on the Northern Coast of Cuba

AbstractThe Gulf of Mexico is a vital region for the Atlantic Meridional Overturning Circulation (AMOC), that fuels the exchange of heat between the tropics and the polar regions. A weakening of the AMOC would have dire consequences for the planet. First observations and ocean models show that this process has already started. Very limited knowledge of the components that are part of the AMOC such as the Loop Current (LC) make it difficult to understand its dynamics as well as changes in strength or temperature since the onset of the Industrial Revolution. Currently, there are no continuous in situ sea surface temperature or salinity measurements for the southeastern Gulf of Mexico or reconstruction attempts for this region, showing the necessity for high‐resolution climate archives. A Siderastrea siderea coral core was retrieved from the northwestern Cuban coast and used as a sub‐seasonally resolved sea surface temperature and hydroclimate archive. The approach is based on skeletal δ18O, and trace and minor element contents show an increase in temperature over 160 years since 1845 of 2.6–3.3°C. A possible stagnation of the warming trend set in after the 1980s, indicating a potential weakening of the Loop Current. Impacts in sea surface salinity such as El Niño events in the Pacific region can still be detected in the Gulf of Mexico as decreases in salinity in 1998 from the reconstructed δ18OSW coral record. In situ measurements remain crucial to understand the dynamics in the LC and its influence on the AMOC.

Secondary dynamic midface reanimation with gracilis free muscle transfer after failed reconstruction attempt: A 15-year experience

The quantitative outcome of secondary reanimation after a failed primary reconstruction attempt for facial paralysis is rarely reported in the literature. This study aimed to investigate the feasibility of secondary reanimation with gracilis free muscle transfer (GFMT) and whether this outcome is influenced by the primary reconstruction. Twelve patients with previously failed static procedures (static group, n=6), temporal muscle transfer (temporal transfer group, n=2), and GFMT (GFMT group, n=4) were all secondarily reanimated with GFMT. The clinical outcome was graded with the eFACE metric. The objective oral commissure excursion was measured with Emotrics, and the artificial intelligence software FaceReader evaluated the intensity score (IS) of emotional expression. The mean follow-up was 40±27 months. The eFACE metric showed a statistically significant (p<0.05) postoperative improvement in the dynamic and smile scores across all groups. In the GFMT group, oral commissure with smile (75.75±20.43 points), oral commissure excursion while smiling with teeth showing (32.7±4.35mm), and the intensity of happiness emotion while smiling without teeth showing (IS of 0.37±0.23) were significantly lower as compared with the static group postoperatively (98.83±2.86 points, p=0.038; 41.7±4.35mm, p=0.025; IS 0.83±0.16, p=0.01). Our data suggest that secondary dynamic reconstruction with GFMT is feasible should the primary reconstruction fail. The secondary GFMT appears to improve the outcome of primary GFMT; however, the oral commissure excursion while smiling might be lower than that in patients who had static procedures as primary reconstruction.

‘Call the Bluff’ or ‘Build Back Better’—Anti‐corruption reforms in post‐war Ukraine

AbstractThe fight against corruption is presented as a leading principle in policy papers and at donor conferences discussing Ukraine's reconstruction. It therefore mirrors the usual narrative surrounding post‐war reconstruction and democracy promotion attempts. However, reconstruction aid has historically been used for illicit means by elites and ended up strengthening an uneven system rather than building a resilient and successful country, despite the window of opportunity for the latter. Rather than just proposing principles, this paper therefore poses the question of how actors involved in the reconstruction process can be bound to stick to their previously propagated and formally existing principles. The analysis combines academic and policy‐oriented studies and highlights the combined importance of the external and internal dimension for a successful outcome. It proposes a ‘double conditionality’ mechanism, where an independent, technocratic institution holds frozen, Russian assets and partially reimburses Western donors only after successful audits on the reconstruction aid are conducted. This conditionality puts domestic pressure on aid givers to follow through with the anti‐corruption conditions formulated beforehand and to call out any reform bluff on Kyiv's side. Paired with a credible EU accession perspective, this can bring about the much‐needed stimulus for a build back better scenario.

The M2-M1 middle cerebral artery reimplantation bypass with protective superficial temporal artery to middle cerebral artery bypass for giant partially thrombosed middle cerebral artery aneurysm in the hybrid operating suite.

Giant middle cerebral artery (MCA) aneurysms are complex and challenging. Revascularization is frequently required in addition to trapping or clip reconstruction, and the MCA reimplantation bypass is ultimately needed when aneurysm excision is planned. The operation was conducted in the hybrid operating suite, where an intraoperative cerebral angiography revealed a compromised MCA after multiple attempts of clip reconstruction. Therefore, we decided to perform an M2-M1 reimplantation bypass in conjunction with trapping and aneurysmectomy. Reimplantation bypass can be a rescue procedure for revascularization in complex aneurysms. The angioarchitecture varies among individuals; therefore, the optimal bypass technique should be tailored.

MP42-13 ROBOTIC NON-TRANSECTING URETERAL REIMPLANTATION: A MULTI-INSTITUTIONAL EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP42-13 ROBOTIC NON-TRANSECTING URETERAL REIMPLANTATION: A MULTI-INSTITUTIONAL EXPERIENCE Brian Chao, David Strauss, Matthew Lee, Teona Iarajuli, Jennifer Nguyen, Ashley Alford, Michael Stifelman, Daniel Eun, and Lee Zhao Brian ChaoBrian Chao More articles by this author , David StraussDavid Strauss More articles by this author , Matthew LeeMatthew Lee More articles by this author , Teona IarajuliTeona Iarajuli More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Ashley AlfordAshley Alford More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Daniel EunDaniel Eun More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic non-transecting ureteroneocystostomy (reimplantation) is an efficacious alternative to conventional reimplantation for mid- to distal ureteral strictures. We sought to update our multi-institutional experience with this technique and analyze intermediate-term outcomes. METHODS: We retrospectively reviewed a multi-institutional database of robotic ureteral reconstruction (CORRUS, or Collaborative of Reconstructive Robotic Ureteral Surgery) for patients undergoing robotic non-transecting reimplantation. Demographic, perioperative, and postoperative data were captured and reported using descriptive statistics. The primary outcome of interest was freedom from recurrent ureteral stenosis, defined as the absence of obstructive findings on follow-up imaging. Minimum follow-up duration for inclusion was three months. RESULTS: We identified 50 patients (comprising 55 ureters) who underwent robotic non-transecting ureteroneocystostomy between 2016 and 2022. Demographic, perioperative, and postoperative data are shown in the accompanying Table 1. Median stricture length was 2.8 cm (IQR 1–4). 17 patients (34%) had a history of radiation and 28 (56%) had prior abdominal or pelvic surgeries. 15 patients (30%) failed endoscopic stricture management; three (6%) failed prior reconstructive attempts. There was one intraoperative complication, a gastric injury repaired primarily by general surgery without subsequent sequelae. There were no immediate (≤30 days) postoperative complications. Over a median follow-up of 17.1 months (7.2–32.0), 47 patients (94%) comprising 52 ureters (95%) remained free from recurrent stricture disease. CONCLUSIONS: Our updated experience reaffirms the safety and efficacy of robotic non-transecting ureteral reimplantation. Despite a high proportion of patients with complex stricture disease, reimplantation was accomplished with minimal morbidity, satisfactory patency rates, and durable outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e572 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Chao More articles by this author David Strauss More articles by this author Matthew Lee More articles by this author Teona Iarajuli More articles by this author Jennifer Nguyen More articles by this author Ashley Alford More articles by this author Michael Stifelman More articles by this author Daniel Eun More articles by this author Lee Zhao More articles by this author Expand All Advertisement PDF downloadLoading ...

GPR investigations at San Nicolò Church: a case-study from the 1669 eruption in the old settlement of Misterbianco (Etna, Sicily)

Misterbianco, located on the southern slope of Mt. Etna (eastern Sicily), was destroyed in the past by two catastrophic events that raised the old town to the ground. The first was the great eruption of 1669, whose lava front buried dozens of villages encountered along its path, entirely destroying the architectural heritage of Etna's southern flank. The second event was the disastrous 1693 Val di Noto earthquake, which caused major destruction throughout south-eastern Sicily, also damaging the few still standing buildings in the town. The GPR survey performed at this site, 350 years after the eruption, allowed a first attempt of planimetric reconstruction of the San Nicolò Church. Starting from the site history, we present the results of an integrated approach that involves history, volcanology and geophysics aimed at addressing future archaeological excavations for the protection of archaeological and monumental assets in a difficult setting as this volcanic environment.

Free Flap Reconstruction of Recalcitrant Defects in Cleft Palate Patients.

Defects of the palate can be as a result of oronasal fistula of cleft patients and the ablative surgery of tumors. There are many studies about reconstruction of the defects of plate in the literature and most of them are related to tumor surgery. Despite the use of free flaps in cleft patients being not a new approach, the articles in the literature are very few. The authors describe the experience of oronasal fistula reconstructions with free flaps with a new modification of tensionless inset of the free flap's pedicle. Between 2019 and 2022, 2 males and 1 female, 3 consecutive cleft patients underwent free flap surgery because of recalcitrant palatal defects. One patient had 5 and each of remain had 3 unsuccessful reconstructive attempts previously. The age of patients was ranged from 20 to 23 years old. Radial forearm flap was the option of oral lining reconstruction for all patients. In 2 patients, the flap was modified as a skin tail was linked to the flap for covering the pedicle as tensionless closure. There was a mucosal swelling in first patient who underwent classical pedicle inset as mucosal tunneling. In 1 patient there was a spontaneous bleeding from the anterior side of the flap and it stopped without medical interventions, spontaneously. There was no additional complication. All flaps survived without anastomosis problems. Incision of the mucosa rather than tunneling provides good surgical exposure and bleeding control and modified flap design may be beneficial and reliable for tensionless pedicle inset and covering.

Negative Pressure Therapy for Treatment of Wounds with Exposed Bone and Dura

Introduction: Previous dogma has rejected that it is safe to apply a wound vacuum dressing directly onto the brain dura without a barrier. This case presents successful wound healing in a patient with previous failed free flap and skin grafting of her frontotemporal craniotomy wound with wound vacuum dressing application. Case Presentation: The patient is a 76-year-old female with a past medical history of an osseous meningioma who has undergone four prior resections (1994, 2002, 2012, 2021). She underwent her last craniotomy and resection with neurosurgery, leaving a large frontotemporal defect. At that time, a local flap was utilized by extending the resection incision pre- and post-auricular in a “face lift” fashion to gain closure of 95% of the defect. After two months, she returned to the OR due to loss of two areas of the local flap, anteriorly over the left forehead and posteriorly near the rotation point just superior to the ear. There was exposed bone and cranioplasty. A bipedicle fasciocutaneous flap was then created from the left frontal hairline to the midline occipital region with supraorbital and left occipital artery vascular supply. A split-thickness skin graft was applied to the posterior area that was still uncovered. She continued to experience complications with necrosis of areas of the skin flap, which included an additional cranioplasty and attempted local flap coverage, as well as a radial forearm free flap. Flap healing was complicated by pseudomonas infection, which caused partial failure with an area of exposed bone and scarred dura. Management and Outcomes: A black sponge wound vacuum dressing with silver impregnated barrier dressing was applied to the area on the non-wound side of the sponge. Over the course of three months, the patient experienced marked reduction in the size of the wound with progressive closure. Discussion: There has been literature on the benefit of wound vacuum assisted closure in complex wounds and reconstructions in various parts of the body with evidence of reduced surgical site infections and wound necrosis. However, evidence of benefit in scalp reconstruction is largely limiterrd to case series and reports. In these described case reports patients had improved outcomes with fewer dressing changes, and increased success with subsequent skin grafts. Similarly, our patient underwent wound vacuum therapy, after recurrent chronic wound infection with bony defect and recurrent flap failure. She had improved wound healing, resolution of infection and decrease of the defect size. Conclusion: In conclusion, there is a potential bernefit to using wound vacuum assisted therapy in scalp defects that have failed previous reconstruction attempts that merits serious consideration. In this case, it has allowed for better wound healing and has allowed the patient an improved quality of life. Corresponding Author: Yitzchok Greenberg, 2799 W Grand Bvd, Detroit, MD 48202; 313-673-7190