1,720,983 research outputs found
Combined femoro-distal endovascular revascularisation and plastic reconstruction with free-flap transfer in large ischemic ulcers of lower limbs
No full textBackground. Diabetic patients with lower limb critical ischemia and large trophic lesions in most cases require above or below knee amputation. Combined vascular infrainguinal revascularisation and microvascular free flap transfer allow, in selected cases, the preservation of limb function. Methods. In this study we report our experience of 3 diabetic patients with large trophic lesions of the lower limbs treated, in the past year, with endovascular femorotibial revascularisation combined with free-tissue transfer. The revascularisation procedures consisted of tibial PTA in 2 cases and superficial femoral PTA in 1 case. The plastic reconstruction was made using free-flap muscle tissue with skin graft. Results. Functional limb salvage was achieved in 2 patients, whereas 1 patient underwent an above-knee amputation following local infective complications at 10 months. Conclusions. These results are encouraging and in selected cases this combined procedure may offer an alternative treatment to amputation. However, the complexity of this technique not only involves the surgical operation itself, but also the postoperative care. Close collaboration between the vascular surgeon, plastic surgeon and physician is important to plan the surgical strategy and patient care
Lussazione palmare isolata dell’articolazione radio ulnare distale : presentazione di un caso clinico
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Emergency free flap for the reconstruction of open injuries of the upper limb: a review
No full textDebridement of all necrotic and contaminated tissues followed by immediate soft: tissue coverage in order to obtain primary healing is nowadays the standard approach to all open injuries of the extremities. In 1977 Foucher et al. introduced for the first time the concept of immediate treatment at one time of all injured tissues in complex traumas of the upper limb. The final goal of this therapeutic approach is early postoperative mobilization of the hand and of the whole upper extremity. Any delay in treatment will lead to higher risk of infection, to granulation tissue formation and extended fibrosis, reduced flap survival rate, longer hospital stay, late rehabilitation and eventually to poor function. The advantages of an emergency free-flap reconstruction are salvage of exposed vital structures, reduction of bacterial colonization and immediate reconstruction of all damaged structures in the first surgical procedure, allowing for early rehabilitation and eventually leading to better functional recovery. In the absence of life-threatening injuries the absolute indication for an emergency free flap is exposure of a reconstructed vessel and/or of the main artery of the limb. Other absolute indications are salvage free flaps harvested from non replantable amputated parts and the flow-through flaps used for limb revascularization. The golden period for free-tissue transfer is the first 24 hours after injury. In the literature there is evidence that three days and even five days are of no detriment to final outcome if debridement is accurate and bacterial load low. Longer delays are consistently associated with higher infection rate, flap failure, multiple secondary procedures, longer hospital stay and eventually poor function. Disadvantages are the need for a well experienced surgeon capable, first of all, of a careful assessment of the general condition of the patient and of the remaining function of the affected limb. Further critical points are the extent of the debridement and the choice of the receiving vessels. Only when a surgically clean wound is obtained should a definitive closure be undertaken. In our opinion there are multiple methods available to close a complex wound of the extremities and the surgeon should choose the technique that offers the best chance of success at the lowest risk for the patient
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Hypervelocity Impacts Against Shields Protecting Space Structures
No full textIn this paper simulations of hypervelocity impacts of space debris against double bumper shields are presented. The Tillotson equation of state and the failure criterion on the material have been implemented in MSC/DYTRAN through fortran user written subroutines. Improvements of the results have been obtained by the use of a third subroutine that introduces the mass of the grid points belonging to failed elements. The influence of the number of elements, of the different equations of state and failure criteria and of the reduction of the mass of failed elements have been investigated. The results, postprocessed with MSC/PATRAN, are shown at different times during the impact
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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