• Title/Summary/Keyword: Defects

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Through-and-through Nasal Reconstruction with the Bi-Pedicled Forehead Flap

  • Agostini, Tommaso;Perello, Raffaella;Russo, Giulia Lo;Spinelli, Giuseppe
    • Archives of Plastic Surgery
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    • v.40 no.6
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    • pp.748-753
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    • 2013
  • Background Nasal reconstruction is one of the most difficult challenges for the head and neck surgeon, especially in the case of complex full thickness defects following malignant skin tumor resection. Full-thickness defects require demanding multi-step reconstruction. Methods Seven patients underwent surgical reconstruction of full-thickness nasal defects with a bi-pedicled forehead flap shaped appropriately to the defect. Patients were aged between 58 and 86 years, with a mean age of 63.4 years. All of the tumors were excised using traditional surgery, and in 4 of the patients, reconstruction was performed simultaneously following negativity of fresh frozen sections of the margins under general anesthesia. Results Nasal reconstruction was well accepted by all of the patients suffering non-melanoma skin tumors with acceptable cosmetic outcomes. The heart-shaped forehead flap was harvested in cases of subtotal involvement of the nasal pyramid, while smaller defects were reconstructed with a wing-shaped flap. No cartilaginous or osseous support was necessary. Conclusions This bi-pedicled forehead flap was a valid, versatile, and easy-to-implement alternative to microsurgery or multi-step reconstruction. The flap is the best indication for full-thickness nasal defects but can also be indicated for other complex facial defects in the orbital (exenteratio orbitae), zygomatic, and cheek area, for which the availability of a flap equipped with two thick and hairless lobes can be a valuable resource.

The Anconeus Muscle Free Flap: Clinical Application to Lesions on the Hand

  • Jeon, Byung-Joon;Jwa, Seung Jun;Lee, Dong Chul;Roh, Si Young;Kim, Jin Soo
    • Archives of Plastic Surgery
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    • v.44 no.5
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    • pp.420-427
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    • 2017
  • Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was $18.7cm^2$ (range, $13.5-30cm^2$). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

The influence of mechanical damage on the formation of the structural defects on the silicon surface during oxidation (규소 결정 표면의 구조 결함의 형성에 미치는 기계적 손상의 영향)

  • Kim, Dae-Il;Kim, Jong-Bum;Kim, Young-Kwan
    • Journal of the Korean Crystal Growth and Crystal Technology
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    • v.15 no.2
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    • pp.45-50
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    • 2005
  • During oxidation process, several type of defects are formed on the surface of the silicon crystal which was damaged mechanically before oxidation. As the size of abrasive particle increases multiple dislocation loops are produced favorably over oxidation-induced stacking faults, which are dominantly produced when ground with finer abrasive particle. These defects are not related with the crystal growth process like Czochralski or directional solidification. During directional solidification process, twins and stacking faults are the two major defects observed in the bulk of the silicon crystal. On the other hand, slip dislocations produced by the thermal stress are not observed. Thus, not only in single crystalline silicon crystal but also in multi-crystalline silicon, extrinsic gettering process with programmed production of surface defects might be highly applicable to silicon wafers for purification.

Reconstruction of nasal ala and tip following skin cancer resection

  • Park, Young Ji;Kwon, Gyu Hyeon;Kim, Jun Oh;Ryu, Woo Sang;Lee, Kyung Suk
    • Archives of Craniofacial Surgery
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    • v.20 no.6
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    • pp.382-387
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    • 2019
  • Background: Defects of the nasal ala and tip have a complex three-dimensional structure that makes them challenging to reconstruct. Many reconstructive options have been described for nasal ala and tip defects, ranging from primary closure to local flaps and skin grafts. However, it is difficult to determine which method will yield the best cosmetic results in each individual case. Thus, the purpose of this study was to determine which surgical procedures for reconstructing defects of the nasal ala and tip have better cosmetic results. Methods: From 2008 to 2018, 111 patients underwent surgery to reconstruct skin defects after resection of skin cancer in the nasal ala or tip. Their charts were reviewed to obtain data on age, sex, surgical location, size of the defect, surgical method, and cosmetic results using a visual analog scale (VAS). Results: For nasal ala reconstruction, the most commonly used surgical technique was the nasolabial flap (n= 42). This method also had the highest VAS score (7/10). The most commonly selected surgical method for nasal tip reconstruction was the bilobed flap (n= 13), and bilobed flaps and primary closure had the highest VAS score (7/10). Conclusion: Nasolabial flaps showed excellent cosmetic results for the reconstruction of nasal ala defects, while primary closure and bilobed flaps yielded excellent cosmetic results for the reconstruction of nasal tip defects.

A COMPARATIVE STUDY OF ROENTGENOGRAPHIC APPEARANCE OF PERIODONTAL OSSEOUS LESIONS (치조병소에 대한 X-선학적 비교연구)

  • Khim Jhai Dhuck
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.10 no.1
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    • pp.63-68
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    • 1980
  • The purpose of this article is to re-examine the roentgenographic appearance of alveolar osseous in an effort to determine the value of the orthopantomogram in the diagnosis of periodontal disease. A total of 158 osseous lesions from 13 human dry skulls were studied. 14 Ultra-speed periapical films, 2 bitewing films and Kodak panoramic film are used to obtain radiographs of all defects. The bisecting technic was used, with a target-film distance of. 8 inches and exposure factors of 70 kVp, 10MA and 0.4 sec. at anterior teeth, 0.6 see at posterior teeth in exposure time. For orthopantomogram, Panoura Eight-C was used with a exposure factors of 90kVp, 10MA. and 15sec. exposure time. All films were developed in a light. tight darkroom at 68°F for 4½ minutes. Comparison of orthopantomogram and intraoral films on the view-box was carefully studied in relation to the types of osseous defect visually evident; Proximal intraosseous defects, Interproximal craters, Interproximal hemisepta, Furcal defects on multirooted teeth, and Facial or Lingual one-walled defects. The results obtained were as follows; 1. Proximal osseous defects throughout the dental arches and furcal defects on facial and lingual surfaces of multirooted teeth can be identified with a high degree of accuracy from their orthopantomographic appearances. 2. Lesions on facial or lingual surface of the alveolar arches are rather difficult to locate or recognize on the dental radiographs. 3. In determining whether the proximal and furcal lesions are located facially or lingually, Orthopantomogram is superior to the conventional film Orthopantomogram obtained with standardization of head in proper position revealed the complete visualization of alveolar bone without showing occlusal surface of molars and proximal superimposition of teeth. Thus, on the standardized orthopantomograms, The roentgenographic characteristics of each defect were determined.

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Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps

  • Ahn, Deok Ki;Lew, Dae Hyun;Roh, Tai Suk;Lee, Won Jai
    • Archives of Plastic Surgery
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    • v.42 no.5
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    • pp.619-625
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    • 2015
  • Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from $5{\times}4$ to $20{\times}8cm^2$. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.

Second Toe Plantar Free Flap for Volar Tissue Defects of the Fingers

  • Cho, Yong Jin;Roh, Si Young;Kim, Jin Soo;Lee, Dong Chul;Yang, Jae Won
    • Archives of Plastic Surgery
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    • v.40 no.3
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    • pp.226-231
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    • 2013
  • Background The reconstruction of volar surface defects is difficult because of the special histologic nature of the tissue involved. The plantar surface is the most homologous in shape and function and could be considered the most ideal of reconstructive options in select cases of volar surface defects. In this paper, we evaluate a single institutional case series of volar tissue defects managed with second toe plantar free flaps. Methods A single-institution retrospective review was performed on 12 cases of reconstruction using a second toe plantar free flap. The mean age was 33 years (range, 9 to 54 years) with a male-to-female ratio of 5-to-1. The predominant mechanism was crush injury (8 cases) followed by amputations (3 cases) and a single case of burn injury. Half of the indications (6 cases) were for soft-tissue defects with the other half for scar contracture. Results All of the flaps survived through the follow-up period. Sensory recovery was related to the time interval between injury and reconstruction-with delayed operations portending worse outcomes. There were no postoperative complications in this series. Conclusions Flexion contracture is the key functional deficit of volar tissue defects. The second toe plantar free flap is the singular flap whose histology most closely matches those of the original volar tissue. In our experience, this flap is the superior reconstructive option within the specific indications dictated by the defect size and location.

Reconstruction of Large Facial Defects via Excision of Skin Cancer Using Two or More Regional Flaps

  • Lee, Dong Min;Bae, Yong Chan;Nam, Su Bong;Bae, Seong Hwan;Choi, June Seok
    • Archives of Plastic Surgery
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    • v.44 no.4
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    • pp.319-323
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    • 2017
  • Background Free-flap surgery and skin grafting can be used to reconstruct large facial defects that may result after skin cancer removal by Mohs micrographic surgery (MMS). However, these two methods may produce low postsurgical patient satisfaction with aesthetics, and free-flap surgery may produce an undue burden for the majority of skin cancer patients, who are of advanced age. Hence, the authors examined outcomes of large facial defect reconstruction using multiple flaps. Methods Among patients undergoing MMS for skin cancer at Pusan National University Hospital between January 2013 and December 2015, we evaluated 7 patients (2 males, 5 females; average age, 73.14 years) treated for large facial defects from basal cell carcinoma. Based on operative and follow-up records, we investigated the number and type of flaps used, postsurgical complications, and patients' post-surgical satisfaction. Results Two and 3 types of flaps were used for 5 and 2 patients, respectively. Most frequently used were nasolabial flaps (7 times in 6 patients) and forehead flaps (once in each of 4 patients). The average follow-up period was 14 months, with no complications-including necrosis, hematoma, or wound dehiscence-observed. Post-surgical satisfaction averaged 4.4 out of a maximum of 5 points. Conclusions Reconstruction using two or more flaps for large facial defects after skin cancer removal using MMS produced satisfactory outcomes while preventing aesthetic problems. Practitioners should consider using multiple flaps when choosing a reconstruction method for large facial defects following skin cancer removal.

Analysis of Impact Behavior of Al-Alloy Castings Considering Internal Defects (내부 결함을 포함한 주조 알루미늄 합금의 충격 거동 해석)

  • Jo, Seong-Woo;Kwak, Si-Young
    • Transactions of the Korean Society of Mechanical Engineers A
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    • v.36 no.12
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    • pp.1599-1604
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    • 2012
  • In general, internal defects, such as shrinkage in casting, cause stress concentration and can be a starting point for cracks. Therefore, it is important to understand the effects of internal defects on the mechanical properties including the impact behavior. This study aim is to evaluate the effects of internal casting defects on the impact performance of Al-alloy castings. Both an experimental method and computational analysis were used to achieve the research objective. The internal defects in the casting were scanned using an industrial CT scanner, and their shape was simplified using ellipsoidal primitives for impact analysis. The good agreement between the experimental and computer simulation results verified the reliability of the proposed computational method for the FEA of casting components with internal defects.

Development of a defect analysis and control system based on CMMI (CMMI 기반의 결함 분석 및 통제 시스템 개발)

  • Cho, Sung-Min;Han, Hyuk-Soo
    • Journal of Internet Computing and Services
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    • v.8 no.2
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    • pp.15-22
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    • 2007
  • As we detect defects and eliminate them in early stages, we can make better quality software. For doing this task, we need to use a defect tracking system which con effectively track and manage defects that give severe effects on software quality. Those existing defect tracking systems have some weaknesses as we apply them to organizations that use CMMI for process improvements. Major problems of those systems are that they require the organizations to collect many types of defect data at a time without providing the proper explanation and even without the support of defect management process. The organizations at CMMI maturity level 2 and 3 have problems for analyzing those defects because there is no specific process area at CMMI maturity level 2 and 3 which directly handles defect managing activites. This paper resolves those problems by developing a defect tracking system which offers methods of managing defects. And the system provides guidelines of which defects should be gathered for each CMMI mathurity levels. The system also has functions to generate various status and statistic information on defects, and to assign defect data to the person in charge so that he or she track the defect to the closure

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