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Directory of Open Access Journals Sweden. Bakamjian introduced the deltopectoral skin flap en , and there after it was used extensively for reconstructive surgery of the head and neck.
This work is a review of the reconstructive experience afforded by several authors and evaluates the technical modifications used to enhance the reliability of this flap. The authors describe the ability of the deltopectoral flap raised bilaterally to provide tissue enough for an extensive irradiated neck, allowing resurfacing a bilateral cutaneous defect after radiation therapy.
The deltopectoral flap remains a useful and reliable tissue source for superficial neck reconstruction by implementing several technical modifications.
No hubo sufrimiento de los colgajos ni se manifestaron alteraciones en la funcionalidad de los hombros en ambos casos. Presentamos el caso de una paciente con un defecto en la espalda de 17 cm. Thoracolumbar defects have been treated by a variety of surgical methods. Primary closure, skin grafting, reverse latissimus dorsi musculocutaneous flap, transverse lumbosacral back flap, local randomly designed rotation, or transposition flaps may be indicated in occasional cases, but there is limited indication for their use in some cases with a wide lesion or when the surrounding tissues have been compromised by previous surgery or irradiation.
Perforator flaps are specially indicated for ambulatory patients, in which large amounts of well-vascularized skin and subcutaneous tissue are transfered easily based on one perforator vessel without sacrificing main vessels or muscles. The authors present a patient with a 17 cm wide defect in the midback region and exposed bone after excision of a squamous cell carcinoma, treated by two perforator flaps based on. Tram works TCMC. CERN Multimedia. In order to allow the final switchover of traffic, as part of the on-going Tram works TCMC , please note that the traffic lights at Entrance B will be out of service from 7 to 14 February.
In order to ensure traffic safety and allow CERN employees to exit the site, a temporary roundabout will be installed during this week. Exploring road design factors influencing tram road safety - Melbourne tram driver focus groups.
Therefore, Melbourne tram drivers are responsible for controlling one of the heaviest vehicles on road ranging from shared tram lanes to exclusive tram lanes. In addition to different tram lane configurations, tram drivers need to follow different traffic signal phases at intersections including tram priority signals as well as need to serve passengers at various types of closely spaced tram stops.
Despite all these challenges, no research has explored tram driver perceptions of the risk factors on different tram route road design configurations. Therefore, the aim of this study is to investigate how tram drivers' safety perceptions alter along various tram route sections, signal settings and stop configurations.
A tram driver focus group approach was adopted for this research involving thirty tram drivers 4 female and 26 male drivers. The tram drivers' age ranged from 29 to 63 years, with an average age of The participating tram drivers perceived that the raised tram tracks and tramways with raised yellow curbing beside tracks are safer lane priority features on the Melbourne tram network compared to full-time, part-time and mixed traffic tram lanes.
They regarded 'hook turns' as a safe form of tram signal priority treatment at intersections and platform tram stops as the safest tram stop design for all passengers among all other tram stop designs in Melbourne.
Findings of this research could enhance the understanding of crash risk factors for different tram route features and thus can offer effective planning strategies for transit agencies to improve tram road safety.
All rights reserved. To the best of our knowledge, the recreation of an inframammary fold after TRAM flap breast reconstruction has not yet been described. This article offers a technique for the creation of an inframammary fold as a secondary procedure. The technique has been performed thus far in two patients with good aesthetic outcomes and no postoperative complications. It may also be suitable for adding bulk to the TRAM flap, especially in bilateral breast reconstruction, and for other minor chest deformities.
Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity.
However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM -flap. During a months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. The operations were performed by two teams working simultaneously. The average operating time was 3. For immediate reconstruction, 6. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein.
Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients.
Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction.
These results reveal a low complication rate for breast reconstruction with the free TRAM -flap. The advantages of this technique as compared to the pedicled technique are discussed. Following the development of the transverse rectus abdominis myocutaneous TRAM flap, the lower abdomen has been recognized as a prime source of high quality autogenous tissue, especially useful in breast reconstruction.
More recently, the ability to harvest a similar adipocutaneous component without sacrifice of the rectus muscle has revolutionized the field of reconstructive surgery. The advent of perforator flaps has allowed plastic surgeons to achieve the same highly esthetic results as with the former myocutaneous flaps while significantly decreasing the donor site morbidity.
With the deep inferior epigastric artery perforator DIEP flap and. Tram -related trauma in Melbourne, Victoria. To establish the incidence and pattern of injuries in patients presenting to hospital with tram -related injuries. Data on tram -related injury pertaining to calendar years were extracted from three datasets: the population-based Victorian State Trauma Registry for major trauma cases, the Victorian Emergency Minimum Dataset for ED presentations and the National Coroners' Information System for deaths.
Incidence rates adjusted for the population of Melbourne, and trends in the incidence of tram -related ED presentations and major trauma cases, were analysed and presented as incidence rate ratios IRR. There were patients who presented to ED after trauma related to trams in Melbourne during the study period. Of these, patients had injuries classified as major trauma. Most falls occurred inside the trams.
There was also a significant increase in the incidence rates of major trauma cases IRR 1. Most cases of trauma related to trams have minor injuries and are discharged following ED management. Primary prevention of falls in trams and the separation of pedestrians from trams are key areas requiring immediate improvement. In the face of increasing trauma associated with trams , continuing safety surveillance and targeted public safety messages are important to sustain trams as safe and effective mode of transport.
Full Text Available Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado.
Rescate articular con colgajo anterolateral del muslo. Presentamos 2 casos de amputaciones. En ambos pacientes realizamos cobertura con colgajo anterolateral de muslo anastomosado a la arteria radial en el caso de la extremidad superior, y a la arteria genicular descendente en la extremidad inferior.
Full Text Available La espalda es una excelente zona dadora de colgajos. Puede emplearse como colgajo libre o en isla. Back is an excellent donor site for flaps. The tora codorsal perforator flap, based on cutaneous vessels from toracodorsal artery and vein that pass through Latissimus Dorsi muscle, is a modified conventional musculocutaneous Latissimus Dorsi flap that allows easier movility and a volume reduction.
This flap can be used both, free flap or island flap. We present the anatomy, dissection and applica tions of this flap. Aplicaciones del colgajo frontonasal para la cobertura de defectos nasales. No observamos alteraciones en la fuerza ni en la sensibilidad respecto al preoperatorio en el antebrazo intervenido. The detailed technology of power-line infra, regulator, and pick-up device is described for train application, respectively. Furthermore, implementation and experimental results for wireless power transfer electric tram are presented.
Vibro-acoustic performance of newly designed tram track structures. Rail vehicles in interaction with a railway structure induce vibrations that are propagating to surrounding structures and cause noise disturbance in the surrounding areas.
Since tram tracks in urban areas often share the running surface with road vehicles one of top priorities is to achieve low maintenance and long lasting structure. Research conducted in scope of this paper gives an overview of newly designed tram track structures designated for use on Zagreb tram network and their performance in terms of noise and vibration mitigation.
Research has been conducted on a m long test section consisted of three tram track types: standard tram track structure commonly used on tram lines in Zagreb, optimized tram structure for better noise and vibration mitigation and a slab track with double sleepers embedded in a concrete slab, which presents an entirely new approach of tram track construction in Zagreb.
Track has been instrumented with acceleration sensors, strain gauges and revision shafts for inspection. Relative deformations give an insight into track structure dynamic load distribution through the exploitation period. Further the paper describes vibro-acoustic measurements conducted at the test site. To evaluate the track performance from the vibro-acoustical standpoint, detailed analysis of track decay rate has been analysed. Opposed to measurement technique using impact hammer for track decay rate measurements, newly developed measuring technique using vehicle pass by vibrations as a source of excitation has been proposed and analysed.
Bone scan in breast cancer patients with mastectomy and breast reconstruction with a myocutaneous TRAM flap. Objectives: To report findings in bone scans for breast cancer patients with mastectomy and breast reconstruction with transverse rectus abdominis myocutaneous flap TRAM.
Exclusion criteria were: Absence of bone scan image, breast reconstruction by other approaches. Conclusions: Bone scans in breast cancer patients with mastectomy and TRAM flap can have different imaging presentations, procedure details diminish reporting errors. TRAM flap may present fat necrosis areas, which should be differentiated from recurrence in bone scans.
Additional imaging and biopsy will be needed to diagnose this finding. The sophisticated control of the tram bogie on track. Full Text Available The paper deals with the problems of routing control algorithms of new conception of tram vehicle bogie.
The main goal of these research activities is wear reduction of rail wheels and tracks, wear reduction of traction energy losses and increasing of running comfort. The testing experimental tram vehicle with special bogie construction powered by traction battery is utilized for these purposes.
This vehicle has a rotary bogie with independent rotating wheels driven by permanent magnets synchronous motors and a solid axle. The wheel forces in bogie are measured by large amounts of the various sensors placed on the testing experimental tram vehicle.
The use of a modified abbé island flap to reconstruct primary lip defects of over 80 %
Directory of Open Access Journals Sweden. En los 13 casos se obtuvo buena cobertura del defecto a cubrir. Dos pacientes necesitaron tenolisis y dos zetaplastias. Todos los colgajos realizados en miembro inferior permitieron la vuelta a la actividad deportiva normal. Aug 8, Full Text Available Presentamos nuestra experiencia con el uso de un colgajo previamente descrito, el colgajo denominado en cono por la forma final que obtiene, como la de un barquillo de helado con su bocado.