4 research outputs found
Microsurgical Reconstruction with and without Microvascular Anastomosis of Oncological Defects of the Upper Limb
No full textIntroduction: The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. Materials and methods: We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. Results: We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. Conclusions: In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition
Dermal Substitutes and Skin Grafts in the Reconstruction of Post-Traumatic Total Scalp Avulsion: A Case Series
No full textAlthough scalp defects can vary in size and thickness, scalp avulsion represents a rare occurrence. This type of lesion may have different origins, but it is usually related to long hair being caught in agricultural machinery. The management of full-thickness scalp defects poses a challenge to the head and neck surgeon due to the possible involvement of neurovascular structures and scar retraction, which can affect the esthetic restoration of the area. Several algorithms for the choice of scalp reconstruction have been proposed in the literature and different techniques are available for extensive scalp defect reconstruction (local soft tissue flap, microvascular free flap, and skin graft combined with dermal substitutes), based upon the scalp defect type. Here we describe six cases of patients with total scalp avulsion, which required a combined reconstruction with a split-thickness skin graft (STSG) and Integra® matrix immediately after the trauma
Multidisciplinary Management of Sternal Osteomyelitis Due to <i>Klebsiella aerogenes</i> after Open Heart Surgery in a Patient with Multiple Myeloma: A Case Report and Discussion of the Literature
No full textSternal wound complications following cardiac surgery, including sternal dehiscence, mediastinitis, and osteomyelitis, pose significant challenges in terms of management and patient outcomes. We present a case report highlighting the complex management of a patient who underwent open heart surgery for severe aortic valve stenosis, followed by sternal wound dehiscence and sternum osteomyelitis due to extended spectrum beta lactamase (ESBL) producing Klebsiella aerogenes. A multiple myeloma diagnosis was also suspected at the positron emission tomography (PET) scan and confirmed with bone marrow biopsy. Multidisciplinary evaluation of the case led to a comprehensive treatment plan. To control the sternal osteomyelitis, total sternectomy was performed followed by immediate reconstruction with a bone (tibia) graft from the tissue bank and fixation with the minimal hardware possible. A microsurgical latissimus dorsi free flap was required to reconstruct the soft tissue defect. After 6 weeks of antibiotic treatment with ertapenem and fosfomycin based on a culture of intraoperative material, no clinical, imaging, or laboratory signs of infection were seen. Multiple myeloma treatment was then started. At 1 year of follow up, no recurrence of infection occurred, and the reconstruction was stable and closed. Multiple myeloma is under chronic treatment with novel agent combination, with an excellent haematological response
AMADEUS: Next generation materials and solid state devices for ultra high temperature energy storage and conversion
No full textStarting in January 2017, AMADEUS (www.amadeus-project.eu) is the first project funded by the European Commission to research on a new generation of materials and solid state devices for ultra-high temperature energy storage and conversion. By exploring storage temperatures well beyond 1000 °C the project aims at breaking the mark of ∼ 600°C rarely exceeded by current state of the art thermal energy storage (TES) systems. AMADEUS Project, through a collaborative research between seven European partners, aims to develop a novel concept of latent heat thermal energy storage (LHTES) systems with unprecedented high energy density. One of the main objectives of the project is to create new PCMs (phase change materials) with latent heat in the range of 1000-2000 kWh/m3, an order of magnitude greater than that of typical salt-based PCMs used in concentrated solar power (CSP), along with developing advanced thermal insulation, PCM casing designs, and novel solid-state heat to power conversion technologies able to operate at temperatures in the range of 1000-2000 °C. In particular, the project will investigate Silicon-Boron alloys as PCMs and hybrid thermionic-photovoltaic (TIPV) devices for heat-to-power conversion. This paper describes the project R&D activities and the main results that have been attained during the first 6 months of work. This includes the first wettability and solubility analysis of liquid Si-B alloys, the numerical simulation of silicon phase-change and heat loss analysis through thermal insulation cover, as well as the first steps for the realization of the two main AMADEUS proof-of-concept experiments: the TIPV converter, and the full LHTES device.acceptedVersionThis is the authors’ accepted and refereed manuscript to the article. This article may be downloaded for personal use only. Any other use requires prior permission of the author and AIP Publishing. The following article appeared in AIP Conference Proceedings and may be found at https://doi.org/10.1063/1.506716
