Free Flap Monitoring. Using Tissue Oxygen Measurement and Positron Emission Tomography

Aims:This study was carried out to evaluate the feasibility of two different methods to determine free flap perfusion in cancer patients undergoing major reconstructive surgery. The hypotheses was that low perfusion in the flap is associated with flap complications. Patients and methods: Between August 2002 and June 2008 at the Department of Otorhinolaryngology – Head and Neck Surgery, Department of Surgery, and at the PET Centre, Turku, 30 consecutive patients with 32 free flaps were included in this study. The perfusion of the free microvascular flaps was assessed with positron emission tomography (PET) and radioactive water ([¹⁵O] H₂O) in 40 radiowater injections in 33 PET studies. Furthermore, 24 free flaps were monitored with a continuous tissue oxygen measurement using flexible polarographic catheters for an average of three postoperative days. Results: Of the 17 patients operated on for head and neck (HN) cancer and reconstructed with 18 free flaps, three re-operations were carried out due to poor tissue oxygenation as indicated by p_tiO₂ monitoring results and three other patients were reoperated on for postoperative hematomas in the operated area. Blood perfusion assessed with PET (BF_PET) was above 2.0 mL / min / 100 g in all flaps and a low flap-to-muscle BFPET ratio appeared to correlate with poor survival of the flap. Survival in this group of HN cancer patients was 9.0 months (median, range 2.4-34.2) after a median follow-up of 11.9 months (range 1.0-61.0 months). Seven HN patients of this group are alive without any sign of recurrence and one patient has died of other causes. All of the 13 breast reconstruction patients included in the study are alive and free of disease at a median follow-up time of 27.4 months (range 13.9-35.7 months). Re-explorations were carried out in three patients due data provided by p_tiO₂ monitoring and one re-exploration was avoided on the basis of adequate blood perfusion assessed with PET. Two patients had donorsite morbidity and 3 patients had partial flap necrosis or fat necrosis. There were no total flap losses. Conclusions: P_tiO₂ monitoring is a feasible method of free flap monitoring when flap temperature is monitored and maintained close to the core temperature. When other monitoring methods give controversial results or are unavailable, [₁₅O] H₂O PET technique is feasible in the evaluation of the perfusion of the newly reconstructed free flaps.

Bartlett-Lewis of rectangular pulse modified model: estimate of parameters for simulation of precipitation in sub-hourly duration

The Bartlett-Lewis Rectangular Pulse Modified (BLPRM) model simulates the precipitous slide in the hourly and sub-hourly and has six parameters for each of the twelve months of the year. This study aimed to evaluate the behavior of precipitation series in the duration of 15 min, obtained by simulation using the model BLPRM in situations: (a) where the parameters are estimated from a combination of statistics, creating five different sets; (b) suitability of the model to generate rain. To adjust the parameters were used rain gauge records of Pelotas/RS/Brazil, which statistics were estimated - mean, variance, covariance, autocorrelation coefficient of lag 1, the proportion of dry days in the period considered. The results showed that the parameters related to the time of onset of precipitation (λ) and intensities (μx) were the most stable and the most unstable were ν parameter, related to rain duration. The BLPRM model adequately represented the mean, variance, and proportion of the dry period of the series of precipitation lasting 15 min and, the time dependence of the heights of rain, represented autocorrelation coefficient of the first retardation was statistically less simulated series suitability for the duration of 15 min.

Vulvar reconstruction should be performed using gluteal-fold perforator flap because of less morbidities and complications

The autors present a case of bilateral vulvar defects after abrasion of malignant skin neoplasm, reconstructed with a gluteal-fold perforator flap, resulting in a successful outcome.

Ureteral reconstruction with abdominal wall muscle flap: experimental study in rabbits

The authors detail the experimental development of a technique for the reconstruction of the ureter using a tubular shape, muscle flap of the abdominal wall. the preliminary results indicate the feasibility of this surgical technique.

Parameter optimization of AC rectangular wave outputs for aluminum cold wire GTAW

The objective of this work was to optimize the parameter setup for GTAW of aluminum using an AC rectangular wave output and continuous feeding. A series of welds was carried-out in an industrial joint, with variation of the negative and positive current amplitude, the negative and positive duration time, the travel speed and the feeding speed. Another series was carried out to investigate the isolate effect of the negative duration time and travel speed. Bead geometry aspects were assessed, such as reinforcement, penetration, incomplete fusion and joint wall bridging. The results showed that currents at both polarities are remarkably more significant than the respective duration times. It was also shown that there is a straight relationship between welding speed and feeding speed and this relationship must be followed for obtaining sound beads. A very short positive duration time is enough for arc stability achievement and when the negative duration time is longer than 5 ms its effect on geometry appears. The possibility of optimizing the parameter selection, despite the high inter-correlation amongst them, was demonstrate through a computer program. An approach to reduce the number of variables in this process is also presented.

Ultimate capacity of stainless steel rectangular hollow section X- joints at low temperatures

Growing demand for stainless steel construction materials has increased the popularity of substitutive materials for austenitic stainless steels. The lean duplex grades have taken their place in building of structures exposed to corrosive environments. Since the duplex grades are relatively new materials, the current codes and norms do not fully cover the newest duplex grades. The joints tested in this thesis were designed and studied according to Eurocode 3, even though all the materials are not yet accepted to the standards. The main objective in this thesis was to determine the differences of the used materials in behaviour under loading at low temperatures. Tests in which the deformation and strength properties of the joints were determined were done at the temperature of -46°C, which is the requirement of temperature for structures designed according to Norsok standards. Results show that replacing the austenitic grade with the lean duplex grade is acceptable.

Formulación de flujos óptimos en forma rectangular por el método de Newton incorporando dispositivos FACTS

Tesis (Maestría en Ciencias de la Ingeniería Eléctrica con Especialidad en Potencia) UANL

Facial artery musculomucosal flap for reconstruction of skull base defects

Facial Artery Musculomucosal Flap in Skull Base Reconstruction Xie L. MD, Lavigne F. MD, Rahal A. MD, Moubayed SP MD, Ayad T. MD Introduction: Failure in skull base defects reconstruction can have serious consequences such as meningitis and pneumocephalus. The nasoseptal flap is usually the first choice but alternatives are necessary when this flap is not available. The facial artery musculomucosal (FAMM) flap has proven to be successful in head and neck reconstruction but it has never been reported in skull base reconstruction. Objective: To show that the FAMM flap can reach some key areas of the skull base and be considered as a new alternative in skull base defects reconstruction. Methods: We conducted a cadaveric study with harvest of modified FAMM flaps, endoscopic skull base dissection and maxillectomies in 13 specimens. Measures were taken for each harvested FAMM flap. Results: The approximate mean area for reconstruction from the combination of the distal FAMM and the extension flaps is 15.90 cm2. The flaps successfully covered the simulated defects of the frontal sinus, the ethmoid areas, the planum sphenoidale, and the sella turcica. Conclusion: The FAMM flap can be considered as a new alternative in the reconstruction of skull base defects. Modifications add extra length to the traditional FAMM flap and can contribute to a tighter seal of the defect as opposed to the FAMM flap alone.

Wide Band Rectangular Microstrip Antenna using Symmetric T-shaped Feed

Bandwidth enhancement of a rectangular microstrip antenna using a T-shaped microstrip feed is explored in this paper. A 2:1 VSWR impedance bandwidth of 23% is achieved by employing this technique. The far-field patterns are stable across the pass band. The proposed antenna can be used conveniently in broadband communications

A Wideband Rectangular Microstrip Antenna Using an Asymmetric t-shaped Feed

An electromagnetically coupled T-shaped microstrip feed used to enhance the impedance bandwidth of a rectangular microstrip antenna is reported. The proposed antenna offers a 2:1 VSWR bandwidth of -36% with an increase in gain of 0.8 dB

FDTD analysis of a symmetric T-strip fed wideband rectangular microstrip antenna

A theoretical analysis of a symmetric T-shaped rnicrostripfed rectangular microstrip antenna using the finite-difference titnedoniain (FDTD) method is presented in this paper. The resonant frequency, return loss, impedance bandwidth, and radiation patterns are predicted and are in good agreement with the measured results

L-strip excited wideband rectangular microstrip antenna

This paper presents the outcome of the experimental studies performed on L-strip fed compact rectangular microstrip antenna. The effect of the feed parameters upon the characteristics of the antenna is studied in detail. The antenna offers an impedance bandwidth of nearly 20% and is suitable for broadband applications

T-strip-fed High-Permittivity Rectangular Dielectric Resonator Antenna for Broadband Applications

rectangular low-density, high-permittivity dielectric resona or antenna (DRA) excited by T-shaped microstrip feed offering a 2:1 VSWR bandwidth of -22% at 2.975 GHz is reported. The design methoaology and experimental results of the antenna are discussed. The excellent gain and radiation performance of the proposed antenna project: it as a potential candidate for telecommunication applications

L-strip-fed Wideband Rectangular Dielectric Resonator Antenna

In this paper, the advantages of using L-shaped microviij) feed to e.tcite a rectangular dielectric resonator cuuenna (DRA) by elemanagnetic coupling are presented. This feeding technique enhances the hardsvidth and gain of the antenna without affecting its size. The experimental re srdts are validated using Fidelity software based on the finitedifference tine-domain (FDTD) method

Rectangular Dielectric Resonator Antenna on a Conductor-backed Co-planar

In this paper, we present an effective excitation of a reelangular dielectric resonator antennas (DRA) with a conductor-hacked coplanar waveguide (CB-CPW). The radiation and resonance characteristics are found to van,, depending on the orientation of the DR on doe coplanar feed line. The effect of finite and infinite ground planes of CB-CPIV on the radiation characteristics of the rectangular DRA is studied. The orientation and position of the DR are optimized for maximum gain and bandwidth. The optimized antenna ,geometry offers --10.46 dBi gain and 7.5% bandwidth with low cross-polar radiation characteristics