Side Of Flap Research Articles

Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery

Abstract Background Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion. Methods A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI). Results A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Transpterygoid approaches showed greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability. Conclusion ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.

Cyanoacrylate versus suture as flap closure methods in mandibular third molar surgery: a split-mouth randomized controlled clinical study.

Sutures have been the standard flap closure method of choice following mandibular third molar surgery but can lead to some complications. Tissue adhesives, including cyanoacrylate, have emerged as alternative flap closure method in this surgery to overcome such drawbacks. However, limited clinical trials can be found. Therefore, the aim of this clinical study was to compare two methods of flap closure in mandibular third molar surgery, cyanoacrylate and 4/0 silk sutures, by assessing post-operative outcome measures (pain, swelling, trismus, and healing) and patient-reported outcome measures (PROMs). A randomized split-mouth clinical trial was designed, in which mandibular third molar (M3M) extractions were performed, where the control side flap was closed with 4/0 silk sutures and the test side flap with cyanoacrylate. Swelling, pain, trismus, healing, and PROMs were recorded post-operatively. These variables were analyzed by means of the nonparametric Mann-Whitney U test, using SPSS statistical software version 28.0.0 (IBM® SPSS®, Chicago, IL, USA). For all results, a 95% confidence interval was recorded (significance level p < 0.05, two-tailed). A total of 17 patients were recruited and 34 mandibular third molar extractions were performed. No statistically significant differences were found in terms of swelling, pain, trismus, healing, and PROMs between both groups (p<0.05). No statistically significant differences were found between flap closure with 4/0 silk sutures and cyanoacrylate, in terms of surgical post-operative outcomes and PROMs. However, further studies with larger sample sizes are required to be able to affirm it with greater certainty.

Optical cross-correlation analog computing based on dielectric metasurface at mid-infrared wavelengths

Compared to inefficient, energy-intensive digital computing, optical analog computing has significant advantages in terms of computational speed and power consumption. Traditional optical analog computing is typically based on Fourier lenses and spatial frequency filters, which are bulky and difficult to integrate. These disadvantages can be overcome by replacing Fourier lenses and spatial frequency filters in traditional optical analog computing via a metasurface. We showcase a real-time compact optical cross-correlation analog computing based on a dielectric metasurface. An extra phase profile is introduced in the metasurface to approximate the Fresnel diffraction integral as the Fourier transform to realize a more compact scheme. The optical cross-correlation analog computing is derived by directly modulating the impinging optical field. A reference circular pattern of a circular target is highlighted recognized and identified by the operation. The recognition accuracy was analyzed by comparing the recognition peaks with the shifted center of the circle, showing that the operation is affected by the side flap of the other circle pattern in the background. Optical analog computing with a compact and powerful kernel may find potential solutions for bio-detection, pattern recognition, information retrieval, and electron tomography.

Bursaphelenchus glaucae n. sp. isolated from larval faeces of a longhorn beetle, Aeolesthes chrysothrix chrysothrix (Bates), in its pupal chamber constructed in the dead wood of Quercus glauca Thunb. from Japan

Summary A Bursaphelenchus species belonging to the hofmanni group (corneolus subgroup) was isolated from a small piece of larval faeces of the longhorn beetle Aeolesthes chrysothrix chrysothrix in its pupal chamber. The chamber was constructed in a dead wood section of Quercus glauca obtained from a live tree. The material was obtained during a management procedure of a garden tree to remove the dead part from live tree. The species is typologically characterised by its three-lined lateral field, the position of its secretory-excretory pore overlapping with the metacorpus anterior half, a very small spicule with distinctive broad and rounded condyles, a flattened trapezoid-shaped rostrum and small flattened cucullus, the presence of seven (P1, P2 and P3 papilliform and P5 gland) male genital papillae, a female vulva with a side flap and female tail forming an elongate conoid with a strongly ventrally curved posterior half and narrowly rounded or digitate tip. The species is typologically close to B. corneolus, sharing a small cucullus and female tail shape, but can be distinguished from the other species by the position of the secretory-excretory pore and the spicule rostrum shape. Phylogenetically, the new species forms a well-supported clade with B. corneolus, but can be distinguished by its clearly separable phylogenetic status inferred from SSU and D2-D3 LSU sequences and the difference in the ITS sequence. The new species is described as B. glaucae n. sp. Although the nematode was isolated from the larval faeces of A. c. chrysothrix, it has not been directly isolated from the insect body to date, thus, the carrier insect of the nematode has not been determined.

Analysis of Vascular Anatomy in Deep Inferior Epigastric Perforator Flap

Abstract Objectives The deep inferior epigastric artery perforator (DIEP) flap is considered the gold standard in autologous breast reconstruction. One of the existing challenges of the procedure is maintaining a pedicle of suitable length and diameter for flap survival. In this study, we analyzed the vascular anatomy of bi-pedicle DIEP flap cases in terms of the vessel diameter, the rate of secondary venae comitantes, and pedicle length to determine the efficacy of microvascular anastomosis and venous drainage. Methods We retrospectively evaluated 108 patients who underwent immediate breast reconstruction using free bi-pedicle DIEP flaps between 2012 and 2019. The patient characteristics, diameters of the deep inferior epigastric artery (DIEA) and accompanying veins (DIEVs), DIEA pedicle length, vessel re-anastomosis rate, flap failure rate, and fat necrosis were recorded. Results Comparison of the right side and left side diameters and pedicle lengths obtained showed no significant differences (p &gt; 0.05). A total of 148 sides (68.52%) of flaps had double venous drainage, whereas 68 sides (31.48%) of flaps had one. Vein congestion occurred in 5 cases, and all involved with just one DIEV anastomosis. No arterial occlusions were observed. Conclusions This is an analysis of extensive clinical data in terms of DIEA, DIEV, and pedicle length. The low vein congestion rate observed reveals adequate venous drainage was achieved in the DIEV system for DIEP reconstruction. Adequate deep inferior epigastric vessel pedicle length and vessel size, as well as greater than 60% of flaps with secondary DIEV, may allow comfortable microsurgery with reduced complications.

Virtual Surgical Guidance Improves Quality of Life Following Scapular Free-Flap Reconstruction of Maxillary Defects

BackgroundThe best way for maxillary reconstruction remains the subject of debate, with negative impacts on the patient’s quality of life (QOL). PurposeThis study was designed to evaluate the QOL outcomes following maxillary reconstruction using a scapular-free flap, with and without the computer-aided design and computer-aided manufacturing (CAD/CAM) technique. Study design and patientsA prospective randomized controlled clinical trial was performed following the CONSORT checklist. To be included, patients suffering from maxillary defects without previous surgery or lymph node involvement were selected. Patients with poor oncological prognosis, deficient performance status, preoperative chemotherapy, or radiotherapy, besides vascular contraindications, were excluded. Predictor variableThe predictor variable was the reconstruction technique, grouped into two equal categories. Patients were randomly assigned to reconstruction with a scapular-free flap, with the control group not utilizing a guide and the study group utilizing a CAD/CAM-customized guide. Outcome variableThe primary outcome variable was the various domains of QOL, measured using the University of Washington-QOL (UW-QOL) score, 12 months after reconstruction. Covariatesage; sex; scapular flap side; and maxillary defect tumour type, histopathology, side, length, class, sagittal, and axial differential areas were considered. AnalysesShapiro-Wilk and Kolmogorov-Smirnov tests were performed for normality. For comparisons between the two groups, Student’s t-test and Mann-Whitney test were used. The category variables were compared using the chi-square test. p ≤ 0.05 was considered statistically significant. ResultsThe sample was composed of twenty-two eligible patients, eleven in each group. The mean age of the control group was (50.09±17.14) years, and 45.45% were male, while in the study group, the mean age was (48.36±14.14) years, with 36.36% male. All the patients were evaluated, showing statistically significant differences between control and study groups in terms of pain, appearance, chewing, swallowing, speech, and shoulder (p ≤ 0.05), indicating that the scapular-free flap with a CAD/CAM osteotomy guide had improved the patient's QOL. ConclusionsThe findings of this study indicate that VSP with a CAD/CAM customized osteotomy guide using a scapular-free flap can improve QOL in maxillary reconstruction in terms of pain, appearance, chewing and swallowing food, pronouncing words, and shoulder QOL outcomes.

Sensory re-education after free neurovascular toe pulp flap for digital pulp reconstruction

PurposeTo evaluate the effectiveness of a sensory re-education (SR) program after free neurovascular toe pulp flap for finger or thumb pulp defect reconstruction. MethodsFrom January 2015 to January 2020, 49 patients with finger or thumb pulp defects treated with free fibular side flaps of the great toe or tibial side flaps of the second toe were recruited. The patients were randomly divided into two groups one month after surgery. The training group received the SR program and the control group underwent the traditional rehabilitation program. Clinical evaluation included Semmes-Weinstein Monofilament (SWM) tests, static two-point discrimination (2-PD), and sensibility grading, measured at 1, 3, 6, 9 and 12 months postoperatively. ResultsA total of 42 patients completed the follow-up, including 22 (16 males) patients in the training group and 20 patients (12 males) in the control group. Compared with 1 month after the operation, significant improvements in sensory recovery were observed at 3, 6, 9, and 12 months postoperatively in both groups. In addition, earlier sensory recovery was seen in the SR group compared to the control group, showing significant differences at 3 and 6 months but not at 9 and 12 months postoperatively. ConclusionAlthough SR seemed to accelerate preliminary sensory recovery after free neurovascular toe pulp flaps for digital defect reconstruction, the program should be reconsidered as it offers no significant improvement over the control group at later follow-up stages.

Тактика хирургического лечения пациента с непроникающей травмой роговицы, после ранее перенесенной операции ФемтоЛАЗИК (клинический случай)

Purpose. to present the tactics of surgical treatment of a patient with non-penetrating corneal trauma after previously undergone FemtolaSIK surgery. Material and methods. Patient m., 28 years old, addressed to the clinic of Volgograd branch with complaints of decreased visual acuity and feeling of foreign bODy on the right eye after trauma. during the repair of the braking system foreign bODies got into the right eye, which resulted in the rupture of the corneal flap in the paracentral region, with multiple metal foreign bODies getting into the corneal flap, under the corneal flap and into the stromal bed. Results. the patient underwent surgery: repositioning of the corneal flap with removal of multiple foreign bODies. mechanical partial deepithelization of the corneal flap in the zone of nonpenetrating corneal wound was performed. Foreign bODies and epithelial cells from the surface of the corneal bed and the back side of the epithelial-stromal flap were completely removed. the corneal flap was straightened and adapted. a soft contact lens was applied. Conclusion. repositioning of the corneal flap with removal of foreign bODies and epithelial cells in nonpenetrating corneal trauma allowed to preserve high visual functions in the patient after FemtolaSIK. Keywords: FemtoLASIK, keratorefractive surgery, corneal foreign body, non-penetrating corneal wound

Efficacy of a novel integrated biliary stent and nasobiliary catheter system for accidental tube deviation in biliary drainage.

Background and study aims Endoscopic nasobiliary drainage is accompanied by a risk of accidental removal of the nasobiliary drainage (NBD) tube, especially through self-removal in elderly patients. We studied the usefulness of an integrated biliary stent and nasobiliary catheter system (UMIDAS NB stent) for biliary drainage in case of accidental NBD tube removal. Patients and methods From April to November 2022, we placed a UMIDAS NB stent in 30 patients with acute cholangitis or obstructive jaundice. We evaluated the plastic stent (PS) position at the time of accidental stent removal and before the planned endoscopic procedure. In addition, we studied the ratio of successful biliary drainage and complications based on the usage of UMIDAS. Results All 11 patients with accidental stent removal exhibited correct PS position in X-ray fluoroscopy. Of the 19 patients with planned NBD tube removal, three had complete PS migration into the common bile duct and three had incomplete migration (the duodenal side flap entered the bile duct). In summary, 80% (24/30) of PS were in the correct position, and all patients had successful biliary drainage and no complications. Conclusions The UMIDAS NB stent might be useful for biliary drainage in patients with a high risk of NBD tube self-removal.

The Optimal Layer for Breast Augmentation in an Autologous Fat Grafting Murine Model.

Fat grafting is an effective procedure for breast augmentation, but the variations in this technique result in unpredictable fat retention. Therefore, animal models are needed to simulate the operation and the optimal layer for fat retention. An autologous fat grafting murine model for breast augmentation was built to detect a new layer for fat grafting in the chest. The left side of the female rat inguinal fat flap was harvested, dissected into small pieces, and autotransplanted into 3 different layers of the breast. Retention rate and hematoxylin and eosin (H&E) staining were measured at 1, 4, 8 12, and 16 weeks. Immunofluorescence staining was utilized to detect adipocytes and endothelial cells, and immunohistochemistry was conducted to evaluate the expression of integrins β1 and α6. The volume of fat grafts slightly grew in the intramuscular and submuscular layers at Week 4. Retention rates in the subcutaneous layer and submuscular layer were significantly higher than the intramuscular layer at Week 16. H&E staining showed that oil cysts existed in the subcutaneous layer throughout the 16 weeks. At the terminal time point, well-vascularized mature adipose structures were observed in intramuscular and submuscular layers, with smaller adipocytes in intramuscular layers. Immunohistochemistry analysis showed that integrin β1 was identically expressed in every adipocyte in all the layers, whereas integrin α6 selectively expressed in bigger adipocytes in the intramuscular layer. The expression intensities of integrin β1 and α6 were significantly higher in the intramuscular layer than in the subcutaneous and submuscular layers. The angiogenic and moderate mechanical environment makes the submuscular layer the optimal layer for fat retention.

Covert-inspired flaps: an experimental study to understand the interactions between upperwing and underwing covert feathers

Birds are agile flyers that can maintain flight at high angles of attack (AoA). Such maneuverability is partially enabled by the articulation of wing feathers. Coverts are one of the feather systems that has been observed to deploy simultaneously on both the upper and lower wing sides during flight. This study uses a feather-inspired flap system to investigate the effect of upper and lower side coverts on the aerodynamic forces and moments, as well as examine the interactions between both types of flaps. Results from wind tunnel experiments show that the covert-inspired flaps can modulate lift, drag, and pitching moment. Moreover, simultaneously deflecting covert-inspired flaps on the upper and lower sides of the airfoil exhibit larger force and moment modulation ranges compared to a single-sided flap alone. Data-driven models indicate significant interactions between the upper and lower side flaps, especially during the pre-stall regime for the lift and drag response. The findings from this study are also biologically relevant to the observations of covert feathers deployment during bird flight. Thus, the methods and results summarized here can be used to formulate new hypotheses about the coverts role in bird flight and develop a framework to design covert-inspired flow and flight control devices for engineered vehicles.

Study on the application of multi-angle imaging related technology in the construction process

Abstract The mufti-angle imaging technique is proposed to address the wall position offset and the side flaps and gate flaps caused by the sparse array in the ultra-wide band through-wall radar building layout imaging, using the characteristic that the azimuth upward distance profile is similar around the main flap but different around the side flap/gate flap. Firstly, after the backward projection algorithm obtains the wall image of each viewpoint, the mufti-directional two-dimensional matching filter is used to enhance the image of each viewpoint and eliminate the effect of side flaps and raster flaps. Then the images of each viewpoint are decomposed by combining the multistage transform, i.e., the non-down sampling contour let transform, and the obtained low-frequency components and high-frequency components are fused using the corresponding fusion rules, respectively. Finally, the final fused building layout image is obtained by non-down sampling contour let inverse transform. The simulation experimental data show that the running time of the method in this paper is 10.99s. It shows that the proposed method enhances the outline and detail information of the building wall, and the final fused image obtained has prominent wall image, clearer edge contours, and good retention of overall detail information. The quality of image fusion is greatly improved than other methods, which paves the way for subsequent fusion methods including chatterers such as construction building corners and windows and doors.

Bursaphelenchus ogawanus n. sp. isolated from bark material of Fagus japonica Maxim. from Japan

Summary A Bursaphelenchus species belonging to the abietinus group was isolated from a bark sample of Fagus japonica infested by an unidentified Dryocoetes bark beetle. The species is typologically characterised by its two-lined lateral field, mitten-shaped spicule possessing a well-developed and dorsally truncate condylus, narrow triangular rostrum and a distinct cucullus, the presence of seven (P1, P2, P3 papilliform and P5 gland-opening-like) male genital papillae, female vulva with side flap and the long, smoothly tapering and ventrally recurved female tail with strongly ventrally recurved distal part. The species is typologically close to B. irokophilus and B. rainulfi but can be distinguished from these two species by the shape of spicule rostrum, which is narrower in the new species. Phylogenetically, the new species forms a well-supported clade with B. rainulfi but can be distinguished from them by the differences in the SSU and D2-D3 LSU sequences. The new species is described as Bursaphelenchus ogawanus n. sp.

Visual Perception of Breast Free Flap Size Is Influenced by Radiation Changes of Surrounding Tissue.

Microsurgical reconstruction for bilateral mastectomy defects after unilateral radiation often results in asymmetry, despite both flap tissues never being radiated. Photos of 16 patients who received prior radiation to one breast and underwent bilateral abdominal free flap reconstruction were taken postoperatively. Layperson and expert assessment were attained via online crowdsourcing and a panel of attending surgeons and senior residents. Stratification by interflap weight differences was done for subanalysis. A total of 399 laypersons responded, with the majority (57.3%) reporting that the radiated breast appeared smaller than the nonradiated breast. When the photos were stratified by interflap weight differences, the photos with the radiated side flap weight over 3% more than nonradiated side were significantly more likely to be perceived by laypersons as the same size (odds ratio [OR] = 2.7; p < 0.001) and of similar aesthetic (OR = 1.9; p < 0.001) when compared with photos with same-sized flaps. Of the expert responses (n = 16), the radiated side was perceived as smaller 72.3% of the time and the nonradiated side appeared more aesthetic 52.7% of the time. Contrary to layperson responses, the experts tend to report the radiated side as smaller despite varying flap weight. Interestingly, expert raters were significantly more likely to rate the flaps of equal aesthetics when the radiated side has a flap larger by 3% or more (OR = 3.6; p < 0.001). Higher aesthetic scores were noted when larger flaps were inset to the radiated envelope by both laypersons and experts, suggesting potential technical refinement in reconstructive outcomes.

Parametric optimization for van drag reduction using a side flap

In current study, the aerodynamic drag reduction of a simplified van model was numerically explored by mounting a side flap on the rear end, on the basis of ANSYS-Fluent, an established Computational Fluid Dynamics (CFD) software. A robust Taguchi test design method was leveraged to optimize the independent parameters related to side flap design in order to achieve the best combination for maximum drag reduction with minimum test numbers. The accuracy of the numerical study was validated using the benchmark, Ahmed body model. The current study outcomes established the efficiency of adding a side flap to weaken the longitudinal vortices, at the rear part of the van model, for the purpose of reducing the aerodynamic drag. In this study, the authors achieved a maximum reduction of 11.50% for total drag coefficient and 11.73% for pressure drag coefficient.

A Quantitative Assessment on Perceived Physiological Comfort of Clothing during Lactation

Background: Physiological comfort refers to sensorial comfort including temperature, fit and fabric weight. Because pregnant and lactating women undergo various physiological changes, it is important to identify optimal comfort features regarding clothing. This will promote and increase breastfeeding duration. The purpose of this research is to compare physiological comfort of two types of clothing. They include designed clothing (DC) ,such as side flaps to access breasts and a strap which gets unhooked ), and conventional clothing(CC), like center front button closure, center front zipper, knitted V-neck shirt, and a t-shirt.&#x0D; Methods: This was a quantitative research study conducted to examine perceived physiological comfort of clothing during lactation (IRB# 1-1056432-1). Data were collected from 217 lactating women who were on lactated related social media sites (e.g., BabyCenter blog). A validated and reliable survey was developed by interviewers. It was a series of questions including demographic ones and assessed seven physiological features. Data were analyzed using descriptive statistics, frequencies (number and percent), and, a sample t-test. &#x0D; Results: After comparing DC with CC, authors found that DC provided greater physiological comfort. Statistically significant differences (p≤ .05) were found between garment coverage in reference to temperature (i.e. warmth) and satisfaction with the length of the garment.&#x0D; Conclusions: The results have practical implications for a variety of professions including apparel designers and lactation health care providers. Currently, there is little to no research which investigated physiological comfort of outerwear clothing for lactating mothers.&#x0D;

Identifying the flap side‐edge noise contribution of a wind turbine blade section with an adaptive trailing edge

AbstractActive trailing‐edge technology is a promising application for localized load alleviation of large‐diameter wind turbine rotors, accomplished using one or more control surfaces in the rotor blade's outer region. This work focuses on identifying noise contributions from the flap side‐edge and the trailing edge in a laboratory condition. Measurements were conducted in the Acoustic Wind Tunnel Braunschweig (AWB) at the German Aerospace Center's (DLR) Braunschweig site. The small‐scale model has a span of 1,200 mm and a chord length of 300 mm. The control surface, a plain flap, has a span of 400 mm and a chord length of 90 mm. Far‐field noise was measured using a phased‐microphone array for various flow speeds, angles of attack, and flap deflection angles. Due to the size of the model and assumed closeness of the sound sources, two noise reduction addons were installed interchangeably: trailing‐edge brush and flap side‐edge porous foam for sound source identification. Analysis of the far‐field noise reveals that, while changes to the flap deflection angle alter the far‐field noise spectra, the trailing‐edge noise remains the predominant noise source at deflection angles and . No additional noise level was observed from the flap side edge within the measurable frequency range at these angles. The flap side‐edge noise has an increased role for frequency larger than 2 kHz for the larger flap deflection angles of and .

Application of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: an analysis of 39 cases

Objective: To explore the therapeutic effect and contributing factors of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Methods: Thirty-nine patients with recurrent nasopharyngeal carcinoma admitted to the Eye, Ear, Nose and Throat Hospital of Fudan University from July 2016 to July 2019 were reviewed, with 19 males and 20 females, aging from 30 to 75 years old. All patients underwent endoscopic nasopharyngectomy, followed by reconstruction with the pedicle nasoseptal flap. The methods of preoperative assessment, mucosal flap preparation and nasopharyngeal reconstruction were summarized, and factors affecting the survival of the pedicle nasoseptal flap were discussed. The rates between groups were compared by Fisher's exact test. Results: Ipsilateral mucosal flap was used in 19 cases while contralateral mucosal flap in 20 cases. After the operation, there were 33 cases with complete epithelialization and 6 cases with flap necrosis. Univariate analysis suggested that the number of radiotherapy courses was an important factor affecting the survival of flap (OR=7.429, 95%CI: 1.120-49.270, P=0.042). However, gender, age, type of transnasal endoscopic nasopharyngectomy, osteonecrosis, side of flap and internal carotid artery resection had no influence on flap survival (all P>0.05). All patients were followed-up for 24 to 60 months. Among them, 8 patients had local recurrence and then operated again, 4 patients survived with systemic metastases and 2 patients died. Conclusion: The pedicle nasoseptal flap is a good material for reconstruction for endoscopic nasopharyngectomy, but it is less effective for patients with multiple course radiotherapy.

Cross-sectional Vascularization Pattern of the Adipofascial Anterolateral Thigh Flap for Application in Tissue-engineered Bone Grafts.

Background:As part of the engineering of bone grafts, wrapping constructs in well-vascularized tissue, such as fascial flaps, improves bone formation. Our aim was to understand the cross-sectional vascularization pattern of human adipofascial flaps for this application.Methods:Seven adipofascial anterolateral thigh (ALT) flaps were harvested from five human cadaveric specimens. Axial vessel density was analyzed by immunohistochemistry and quantitative histology.Results:We found a high density of blood vessels directly superficial to and close to the fascia. A secondary plexus in between this first suprafascial plexus and the subdermal plexus was also identified. In all specimens, this second plexus showed less vascular density, and appeared to be at a constant level within the suprafascial fat throughout the flaps. The peak measurements for this secondary plexus varied between 1.2 and 2 mm above the deep fascia, depending on the donor’s body mass index.Conclusions:Quantitative immunohistochemistry is a reliable method to quantify and locate vessel density in an adipofascial flap. This is vital information before wrapping nonvascularized material into such a flap to estimate the inosculation potential of these vessels and likelihood of survival of the tissue. To profit from both suprafascial vascular plexuses, a correlation between subcutaneous tissue thickness and distance of the second plexus to the fascia should be further investigated. For the moment, we recommend maintaining at least 2–3 mm of subcutaneous fatty tissue on the fascia, to profit from both plexuses. Engineered constructs should be wrapped on the superficial medial side of the fascial flap to enhance vascularization.

Study the Possibility of Creating Mucosal Valve Mechanism at Ureteric Orifice without Obstructing the Urine Outflow but Preventing the Urine Backflow into the Ureters.

Objective:To study the possibility of creating mucosal valve mechanism at ureteric orifice without obstructing the urine outflow but preventing the urine backflow into the ureters.Materials and Methods:Ethical waiver was obtained from the institutional ethical committee. Prospective experimental study was conducted on the post-mortem specimen of intact bladder with urethra and bilateral ureters retrieved from the already slaughtered lamb available in the meat market. Feeding tube inserted via urethral opening into the bladder lumen and bladder inflated with saline demonstrated no reflux of urine via transverse cut opening of ureters. Bladder lumen opened, ureteric orifices incised backwards to eliminate the obliquity. After closing the bladder opening, saline inflation test demonstrated bilateral reflux of saline via cut openings of bilateral ureters. Bladder was re-opened. The upper limb of horizontal U started 10 mm lateral and 8 mm above the refluxing ureteric orifice. Distal most curvature of horizontal U was kept 5 mm medial to ureteric orifice continuing along the lower limb of horizontal U terminating 10 mm lateral and 8 mm below the refluxing ureteric orifice, mucosal flaps from superior and inferior incision mobilized and edges joined to cover the ureteric orifice creating a flap valve mechanism. Influx of saline via cut end of ureters demonstrated no obstruction. Bladder was closed. Saline inflation test and contrast study demonstrated abolition of reflux on flap side and persistence of reflux on another side.Results:Five such experiments were conducted. On the side where the valve was created, Vesicoureteral reflux was abolished in four but in one minimal reflux still persisted.Conclusion:Creating a mucosal flap valve around the ureteric orifice can prevent reflux in 80% of cases without obstruction and without the necessity of ureteric mobilization or creating submucosal tunnel.