Simple Flap Research Articles

A modified supraclavicular artery island flap for reconstruction of oral and maxillofacial defects

ObjectiveTo overcome the limitation of the supraclavicular artery island flap (SCAIF), we describe a modified SCAIF which incorporates a portion of the upper trapezius and the superficial branch of the transverse cervical artery (TCA) for the reconstruction of oral and maxillofacial defects. Study designThe modified SCAIF was used on 20 patients at our hospital between April 2013 to August 2022. All patients underwent resection of the primary lesion site and immediate reconstruction with the modified SCAIF. Demographic data and flap details were recorded. Complications were assessed for at least a 6-month follow-up period. ResultsThis study included 20 patients. The mean flap harvest time was 50 minutes. The mean flap length was 6.0 cm, and the mean flap width was 5.0 cm. All flaps of 20 cases survived with good appearance, and no shoulder morbidity was found during a follow-up period of at least 6 months. ConclusionThe modified SCAIF is a versatile and reliable local flap option for moderate to large reconstruction in this special region after resection of the primary lesions. We found this simple flap design has overcome the limitations of the traditional one with a reliable blood supply and adequate tissue for larger defects.

Effects of kinematic parameters and corrugated structure on the aerodynamic performance of flexible dragonfly wings

The effects of unsteady motions of flapping flat plates and corrugated structures in different parameters are studied using fluid–solid coupling and overlapping grid methods. Based on the dragonfly’s right forewing and right hindwing model, these actions include sweeping and pitching, take-off acceleration, and tandem wings cruising in the reverse phase at 180°. The results show that when the advance ratio J=0.36, the “inflow deflection” improves the aerodynamic force in two degrees of freedom compared to simple flapping. When considering only the impact of flexibility, the aerodynamic forces of flexible flat plates and corrugated structures are better than those of the rigid wing models. Considering the effect of corrugated structures, the lift of flexible corrugated wings diminishes, but more thrust is generated. From the perspective of vortex street, vortex rings materialize only in the downstroke stage, while the attachment effect of leading-edge vortices is noticeable in several models. In the same phase flapping, the two wings combine to form a giant wing, which generates significant forward flight momentum. In out-of-phase flapping mode, the series wings generate two lifts and two or three thrust peaks to attain the required forward flight speed while sustaining a high lift.

Impact of flapping trajectory and foil gap on induced thrust of a flapping foil

Wings and fins with tandem configuration are commonly observed in a flock of birds or schools of fish for enhanced performance while flying and summing. Emerging study on these subject underpinned by flapping foil is challenging. However, our study focuses on the tandem hydrofoil by varying the conventional (vertical heave and pitch motion) flapping motion to two new flapping trajectories: (i) elliptical and (ii) fishtail flapping trajectories. The hydrodynamic efficiency, such as propulsive efficiency and wake structure of the tandem hydrofoil, are examined using computational methods. The effect of Strouhal number (St) and inter-foil spacing are also discussed along with the flapping trajectories. The results show that by implementing the two new flapping trajectories, the induced thrust of the hind foil can be enhanced up to 45% compared to the simple flapping. This study shed new light on improving the biomimetic propulsion device, as it aims to enhance the elicited thrust of the hydrofoil.

Manejo multimodal de aneurisma cirsoideo. Reporte de un caso y revisión de la literatura

Scalp arteriovenous malformations (AVMs), commonly known as cirsoid aneurysms, are complex collections of arteries and veins that communicate directly. It has been postulated that AVMs occur both through the activation of inactive fistulous lesions and through the formation of new fistulous vascular channels through the canalization of injured vessels. Depending on their size and complexity, a variety of strategies can be used to treat them. The case of a 53-year-old male is presented who came for evaluation due to an increase in the volume of a pulsating lesion that extended from the right parietotemporal region accompanied by holocraneal headache and tinnitus. A cerebral angiotomography was performed in which a lesion composed of ectatic serpentine images, with a right extracranial location, subsequently diagnostic cerebral angiography was performed demonstrating a right frontoparietal fistulous and plexiform arteriovenous shunt fed by afferents from the right superficial temporal, posterior auricular, occipital and middle meningeal arteries, with drainage through a varicose and ectatic vein towards the external jugular vein. An endovascular embolization of the arteriovenous shunt was performed via the femoral route in two stages, achieving a “pressure cooker” construction to perform the injection of embolizing fluid and have a subtotal embolization of 93%, with this it was possible to perform a microsurgical resection with a right fronto-parietal-temporal approach resecting the deepest part, leaving the scalp with embolized vessels without resecting. To close the surgical wound, a simple flap rotation was performed to cover the skin defect derived from its resection. The patient underwent post-resection cerebral panangiography, identifying the absence of arteriovenous shunt. Depending on the extent and anatomical complexity of the malformation, clinical manifestations may vary. More than 80% of AVMs will be present at birth and the rest may develop after head trauma or surgical interventions. Appropriate therapeutic intervention is needed through selective angiography, during which endovascular embolization of the major feeding vessels can be performed before open surgical intervention. Volume-based three-dimensional computed tomography reconstructions can be used for further planning. Surgical reduction of post-embolization arterial supply will reduce intraoperative hemorrhage, facilitating total surgical resection. Removal can result in large, full-thickness skin defects that may be difficult to reconstruct without compromising functional and cosmetic results. Keywords: Cirsoid aneurysm; multimodal management; treatment; endovascular; giant

Experimental Investigation on the Combined Blowing Control of a Hybrid Wing Body Aircraft

Combined blowing was performed on a Hybrid Wing Body (HWB) aircraft through wind tunnel testing at a Reynolds number of 1.75 × 106. The full cycle of separation and reattachment under the control of combined blowing was implemented using Computational Fluid Dynamics (CFD), and the mechanism of combined blowing inhibiting separation was analyzed. The aerodynamic characteristics of the baseline and the independent effects of the blown deflected trailing edge (TE), blown leading edge (LE), and combined blowing on the TE and LE were investigated. The results clearly show that combined blowing can inhibit the development of cross-flow, reduce the accumulation of a boundary layer at the tip, and inhibit the flow separation effect. The effect of using seamless simple flaps alone to increase the lift is limited; blowing control is required to enhance the lift further. Applying the blown deflected TE can improve the lift linear segment, so that 30° flap achieves the lift gain of 40° flap without control, while the drag coefficient is approximately 0.02 smaller, but the stall gradually advances. Using the blown LE can significantly increase the stall angle from 12° to 18°. However, the lift linear segment remains unaffected. In particular, combined blowing can achieve the control effect of improving the lift linear segment, delaying stall, and decreasing drag. Moreover, the maximum lift coefficient is approximately 0.19, and the lift-to-drag ratio increment in the control state with a 30° flap deflection angle is above 2.2 in the angle of attack range of 4° to 12° compared to the uncontrolled state with a 40° flap deflection angle.

Aerodynamic Evaluation of Flapping Wings with Leading-Edge Twisting

The purpose of the current study is to emphasize the characteristics and phenomena of leading-edge twisting in flapping wing vehicles. A fused deposition modeling (FDM) 3D printing method is applied to develop the flapping mechanisms with bevel gears to achieve the leading-edge twisting. Three flapping mechanisms were developed, including simple flapping only (type-A1: normal servo mechanism), flapping with continuous leading-edge twisting (type-B: servo-bevel gear mechanism), and flapping with restricted leading-edge twisting via mechanical stoppers (type-B1: servo-bevel gear mechanism with adjustable mechanical stoppers). Utilizing a low-speed wind tunnel, the aerodynamic performances of these mechanisms are examined by extracting their lift and net thrust forces. The wind tunnel testing data showed that the flapping with restricted leading-edge twisting via mechanical stoppers (type-B1) showed better performance than the simple flapping (type-A1) by 32.9%, and also better performance than the flapping with continuous leading-edge twisting (type-B) by 64%. Next, MATLAB software was used to create the 3D wing surfaces from the instantaneous stereophotography Kwon3D trajectories to fully sketch the leading-edge twisting features. The 2D airfoil cut sections at the mean aerodynamic chord at different stroke moments depict the instantaneous angles of attack to justify the aforementioned wind tunnel testing data and it was verified using a theoretical trajectory model. This comprehensive study using the 3D-printed mechanisms is well suited for the quantitative evaluation of the lift contribution from leading-edge twisting.

Experience of using a supraclavicular flap in reconstruction of oral cavity defects

Introduction. In case of cancer of the oral mucosa at the first stage, the standard treatment approach is radical surgical intervention, with the formation of extensive defects leading to aesthetic and functional disorders. Taking into account the characteristics of defects, choosing a flap is a difficult task. Currently, there is a wide selection of regional and microvascular free flaps. However, not all flaps meet the requirements. The supraclavicular fasciocutaneous flap, being a regional flap, has a number of advantages: easy to harvest, reliable due to the constancy of the vascular pedicle, primary closure of the donor site, scarcity of hair, the possibility of closing various defects of the oral cavity. Aim. To evaluate the possibility of using a supraclavicular flap in patients with oral cancer to restore the defects after surgical treatment.Materials and methods. The study included 10 patients with malignant tumors of the oral cavity who underwent surgical intervention with defect replacement using supraclavicular flap at the N. N. Blokhin National Medical Research Center of Oncology between February of 2015 and May of 2021. In 4 cases, buccal mucosa was affected; in 3 cases, the retromolar area; in 1 case, oral floor mucosa; in 1 case, mandibular alveolar ridge; in 1 case, mobile tongue. Flap sizes were 5–10 × 5–8 cm. Three (3) patients had history of radiotherapy, and 1 of them had a radical dose.Results. In 4 patients without previous radiotherapy, partial flap necrosis was observed. In 1 patient, sutural diastasis in the oral cavity after partial flap necrosis was diagnosed. There were no cases of total flap necrosis and fistula formation. Suture dehiscence in the donor bed was observed in 1 patient only.Conclusion. Use of supraclavicular flap is an option for oral cavity defect replacement after surgical intervention in patients with malignant tumors of the oral cavity producing satisfactory esthetic and functional results. The advantages of this flap are simple flap dissection, reliability of vascular pedicle, flexibility, possibility of replacing large defects, scant hair coverage.

Clinical application of an expanded reverse-island flap with two dorsal metacarpal arteries and dorsal metacarpal nerves in index- and middle-finger-degloving injury repair and amputation reconstruction

The dorsal metacarpal artery flap (DMAF) is irrefutable as an effective way of repairing long finger defects, and hand surgeons might consider using it for long finger reconstruction or degloved injury repair. Unfortunately, the DMAF containing a single dorsal metacarpal artery (DMA) hinders the treatment effect. The sensory restoration of long fingers and the reconstruction of phalangeal joints and tendon grafts are unsolved challenges as well. We reported our experience in reconstructing the index and middle finger by a reverse-island flap with two DMAs and dorsal metacarpal nerves (DMNs) with blood supply. We reviewed ten patients with finger-crush injuries affecting eight index fingers and two middle fingers. Degloving injuries occurred in two patients, and finger amputations occurred in eight others. Two patients received simple flap reconstruction, and eight received finger reconstruction, including seven from abandoned phalangeal joints and tendon grafts of the severed finger and one from the iliac crest bone graft. All patients underwent finger reconstruction by an expanded reverse-island flap consisting of two DMAs and DMNs up to a maximal size of 9×8 cm2. Postoperative follow-up evaluation showed a satisfactory appearance and functional recovery of the reconstructed fingers. We posit that the expanded reverse-island flap involving two DMAs and DMNs constitutes a feasible and safe option for restoring a severely damaged index or middle finger, particularly for patients who are unwilling to undergo toe-to-finger transplantation to reconstruct the injured long fingers.

Revisiting the East-West advancement flap: great for multiple anatomic locations.

The east-west advancement flap is a simple flap traditionally used to repair Mohs surgery defects on the nose. We aim to demonstrate this flap can be used with good cosmetic outcome and minimal complications on a variety of anatomical sites. This study was a case series of four patients taking place between March 2021 and September 2021 with 4- to 6-week postoperative follow-up. Four male patients were included in the study. Repair sites included the helix, chin, wrist, and scalp. All patients and the Mohs surgeon reported satisfaction with the cosmetic outcome at 4- to 6-week postoperative follow-up with no complications. The east-west advancement flap is a viable repair option for Mohs surgery defects on a variety of anatomical sites.

Free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect

To explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children's finger wounds with digital artery defect. Between July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases. All flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking. The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children's finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.

Reading Man Flap for Sacral Pressure Ulcer Reconstruction

Background: The treatment of pressure sores represents a great challenge to health care professionals.Although, pressure ulcers management requires a multidisciplinary approach, the soft tissue defects requiringreconstruction are mainly considered for surgical repair. Local myocutaneous and fasciocutaneous flaps canprovide stable coverage of pressure sores.Aim of Study: To evaluate the versatility and outcomes of “reading man flap” in the reconstruction of sacralpressure sores.Patients and Method: Between April 2015 to January 2017, ten patients with sacral pressure sore weretreated by using Reading man flap. The patient’s ages were ranging between 35-65 years (mean 53), 6 ofthem were males, and 4 were females. All of them were subjected to local wound care and managementwithout considerable benefit. We exclude those patients with poor medical status and patients with severecontracture and spasticity. The diameter of the sacral pressure sores ranging from 4cm to 7cm (mean 5.5cm).Results: The “reading man flap” technique was seen to be a useful, versatile and simple flap for coverageof pressure sores, with no postoperative complications in 8 of our patients during the follow up period. Theother 2 patients, one of them developed partial flap necrosis (treated conservatively), and the other onedeveloped recurrence after 2 months.Conclusion: The “reading man flap” was found to be a versatile and easily performed technique for closureof small to medium sized sacral pressure sores.

Active flap control with the trailing edge flap hinge moment as a sensor: using it to estimate local blade inflow conditions and to reduce extreme blade loads and deflections

Abstract. Active trailing edge flaps are a promising technology that can potentially enable further increases in wind turbine sizes without the disproportionate increase in loads, thus reducing the cost of wind energy even further. Extreme loads and critical deflections of the blade are design-driving issues that can effectively be reduced by flaps. In this paper, we consider the flap hinge moment as a local input sensor for a simple flap controller that reduces extreme loads and critical deflections of the DTU 10 MW Reference Wind Turbine blade. We present a model to calculate the unsteady flap hinge moment that can be used in aeroelastic simulations in the time domain. This model is used to develop an observer that estimates the local angle of attack and relative wind velocity of a blade section based on local sensor information including the flap hinge moment of the blade section. For steady wind conditions that include yawed inflow and wind shear, the observer is able to estimate the local inflow conditions with errors in the mean angle of attack below 0.2∘ and mean relative wind speed errors below 0.4 %. For fully turbulent wind conditions, the observer is able to estimate the low-frequency content of the local angle of attack and relative velocity even when it is lacking information on the incoming turbulent wind. We include this observer as part of a simple flap controller to reduce extreme loads and critical deflections of the blade. The flap controller's performance is tested in load simulations of the reference turbine with active flaps according to the IEC 61400-1 power production with extreme turbulence group. We used the lifting line free vortex wake method to calculate the aerodynamic loads. Results show a reduction of the maximum out-of-plane and resulting blade root bending moments of 8 % and 7.6 %, respectively, when compared to a baseline case without flaps. The critical blade tip deflection is reduced by 7.1 %. Furthermore, a sector load analysis considering extreme loading in all load directions shows a reduction of the extreme resulting bending moment in an angular region covering 30∘ around the positive out-of-plane blade root bending moment. Further analysis reveals that a fast reaction time of the flap system proves to be critical for its performance. This is achieved with the use of local sensors as input for the flap controller. A larger reduction potential of the system is identified but not reached mainly because of a combination of challenging controller objectives and the simple controller architecture.

Transverse vaginal septum managed by simple flap surgery technique: A case report.

BackgroundTransverse Vaginal Septum (TVS) is a rare congenital abnormality, classified as the Mullerian duct anomaly development.1,2 TVS incidence range from 1:2.000 to 1:72.000. Management of TVS may only requirement local excision with a simple end to end anastomosis of the vagina, and use of skin grafts, but this technique has been reported has common complications of secondary tissue contracture, which often lead to stenosis of the vagina.3 In this case we managed TVS with simple flap technique to avoid such postoperative complications and maintain caliber of vagina.CaseA 11 years old girl complained cyclical abdominal pain since a year ago without history of menstrual blood. Patient already had vaginal surgery for removing menstrual blood, but after vaginal surgery the menstrual blood cannot be removed, then referred to our hospital. Ultrasound examination revealed hematometra and hemocolpos. The septum location was 3,38 cm proximal distance from vaginal introitus with the thickness of 8.1 mm. We performed simple excision of the septum with formerly performed distal vaginal septum mucosa preparation creating lateral flaps, then approximating the flaps to the edge of the proximal vaginal mucosa with interrupted suture continued with hymenorraphy. The patient has no complaint 6 months after surgery with vaginal length 8 cm, and had regular menstrual cycle.ConclusionA simple flap surgery technique can be done in transverse vaginal septum, with no complication such as tissue contracture, vaginal stenosis, or insightly scarring. This is a simple technique and can be done with hymenorraphy to restore normal anatomy of hymen.

Lambeau perforant pour couverture des kystes sacrococcygiens : à propos de 8 cas

Multiple surgical revisions (exeresis and directed healing) of recurrent pilonidal cysts are sources of unstable scars. Chronic ulcerations often appear with or without authentic recidivism. A local fasciocutaneous perforating flap based on the parasacral arteries would bring healthy tissue and avoid the disadvantages of conventional techniques (musculo-cutaneous or random).A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients. The perforators are identified by Doppler probe before the gesture, then the flap is traced obliquely according to the size of the loss of substance. The gesture is short, not morbid and accessible to all by a technique that excludes fine dissection of the pedicle. The duration of hospitalization is 2days.Despite two minor and resolving complications (a hematoma and a disunion of the donor sit) the healing was complete and without recurrence in all patients at 2years, with 100% satisfaction.This reliable and reproducible simple flap becomes the reference technique in our department for the sequelae of recurrent sacro-coccygeal cyst.

Soft tissue coverage using pedicled flap in combat zone: a case series

BackgroundSoft tissue reconstruction is typically conducted after evacuation from theater of operations. If circumstances do not allow timely evacuation, however, defect site may need to be reconstructed in the combat zone.Case presentationA total of 41 patients with extremity soft tissue defect were treated using pedicled flaps by a single orthopedic surgeon during four deployments in Chad, Afghanistan and Mali between 2010 and 2017. The mean age was 25.6 years. A total of 46 injury sites in extremities required flap coverage: 19 combat-related injuries (CRIs) and 27 non-combat related injuries (NCRIs). Twenty of the injury sites were infected. Overall, 63 pedicled flap transfers were carried out: 15 muscle flaps, 35 local fasciocutaneous flaps and 13 distant fasciocutaneous flaps. The flap types used did not differ for CRIs or NCRIs. Mean follow-up was 71 days. Complications included deep infection (n = 6), flap failure (n = 1) and partial flap necrosis (n = 1). Limb salvage rate was 92.7% (38/41).ConclusionsSoft tissue defect can be managed with simple pedicled flaps in theatre of operations if needed. Basic reconstructive procedures should be part of the training for military orthopedic surgeons.Trial registrationRetrospectively registered in January 2019 (2019-0901-001).

The Role of Buckling in the Estimation of Compressive Strength of Corrugated Cardboard Boxes.

This paper presents analytical methods for estimating the static top-to-bottom compressive strength of simple corrugated packaging, in which the torsional and shear stiffness of corrugated cardboard as well as the panel depth-to-width ratio are included. The methods are compared herein with a basic and more detailed buckling description with the successful McKee formula, which is over fifty years old but still widely used among packaging designers and quality control departments. Additionally, the assumptions and applied simplifications used in the literature are analyzed, and the limits of applicability of different versions of the selected methods are checked. Finally, all approaches are verified with the experiment results of various packaging designs made of corrugated cardboard. The results show that, for certain proportions of dimensions of simple flap boxes, simplified methods give an even two times larger estimation error than the analytical approach proposed in the paper. Furthermore, it is evidenced that including all flexural, torsional and shear stiffnesses in the buckling force estimation gives a very precise prediction of the box compressive strength for the full range of package dimensions.

Precise Formation-Flying Telescope in Target-Centric Orbit: the Solar Case

We present the general concept of a telescope with optics and detectors mounted on two separate spacecrafts, in orbit around the telescope’s target (scopocentric or target-centric orbit), and using propulsion to maintain the Target-Optics-Detector alignment and Optics-Detector distance. Specifically, we study the case of such a telescope with the Sun as the target, orbiting at sim 1 AU. We present a simple differential acceleration budget for maintaining Target-Optics-Detector alignment and Optics-Detector distance, backed by simulations of the orbital dynamics, including solar radiation pressure and influence of the planets. Of prime interest are heliocentric orbits (such as Earth-trailing/leading orbits or Distant Retrograde Orbits), where thrust requirement to maintain formation is primarily in a single direction (either sunward or anti-sunward), can be quite minuscule (a few m/s/year), and preferably met by constant-thrust engines such as solar electric propulsion or even by solar sailing via simple extendable and/or orientable flaps or rudders.

Versatility of the Radial Forearm Free Flap in Head and Neck Reconstruction. A Study of 58 Cases

IntroductionThe radial forearm free flap (RFFF) is a widely used tool in head and neck reconstructive surgery. It stands out as a relatively simple flap to achieve; it is versatile and has features that enable the reconstruction of complex head and neck defects. The aim of the study was to present our results using the RFFF in the reconstruction of seated defects in the head and neck area. Material and methodsA retrospective, observational and analytical study that included 58 cases of RFFF interventions, performed between January 2002 and July 2019. The data studied were the age and sex of the patients, location of the tumour, histological type, previous radiation therapy (RT), number of venous anastomoses performed in the surgery and body temperature in the immediate postoperative period, at 24 and 48 h following surgery. ResultsThe percentage of viable RFFF was 82.8%. None of the variables analysed appear to be a risk factor for flap failure. The most frequent cause of flap failure was venous thrombosis. ConclusionsMicrovascularised flaps play an important role in reconstructive surgery, the RFFF being one of the most interesting for head and neck reconstruction. It is a very versatile tool that allows the reconstruction of many of the sites where the head and neck surgeon operates.

High-Lift Performance Enhancement Using Active Flow Control

The aerodynamic performance of conventional high-lift systems is typically achieved using multi-element flap configurations with cross-stream gaps that necessitate the use of complex positioning mechanisms with significant penalties in terms of weight, part count, and fabrication cost. In the present investigation, the performance of a high-lift airfoil in Fowler flap and simple flap configurations is enhanced using active aerodynamic flow control. Actuation is applied using a spanwise arrays of fluidically oscillating jets located upstream and downstream of the leading edge of the flap that increase the extent of flow attachment along the surface of the flap at deflections of up to . Actuation leads to significant improvement in the performance of the Fowler flap compared with an optimized baseline configuration ( increased by up to 30%) and enables the high-lift performance of a single-element, simple flap without a cross-stream gap to match or exceed the performance of the optimized baseline Fowler configuration. It is also shown that incorporating a cross-stream gap with the simple flap enables increased lift at reduced actuation levels.

Reconstruction of large perineal defects after advanced malignant tumour resection: a simple gluteal thigh flap modification

Reconstruction of large defects in the perineal region, after resection of advanced malignant tumours is challenging because both coverage of the perineal skin defect and adequate filling of the pelvic space must be achieved simultaneously. This manuscript introduces a simple gluteal posterior thigh flap modification for the reconstruction of such defects. A trilobed flap, in the gluteal and posterior thigh regions, was designed to be of an adequate size to repair the dermal and pelvic floor defects. After the flap was elevated and rotated 90°, the posterior thigh portion was denuded. The lateral portion of the deep gluteal fascia was incised to allow medial advancement. Thus, the flap could be easily moved to fill the defect, without tension. To evaluate the results, we reviewed 8 patients with large (>10 cm in diameter) advanced perineal carcinomas. For each patient, the defect was successfully reconstructed using the technique described. A secondary operation was required for one patient, due to atheromatosis that developed several months after the operation. Another patient developed donor site wound dehiscence and was treated with skin grafting. The described technique facilitates the effective reconstruction of large perineal defects.