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The "Sombrero-Shape" Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier's Gangrene

  • Sapino, Gianluca;Gonvers, Stephanie;Cherubino, Mario;di Summa, Pietro G.
    • Archives of Plastic Surgery
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    • v.49 no.3
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    • pp.453-456
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    • 2022
  • When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name "sombrero" as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months' follow-up. The ALT flap design "sombrero" modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure.

Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps

  • Allen Wei-Jiat Wong;Grace Hui-Min Tan;Frederick Hong-Xiang Koh;Min Hoe Chew
    • Archives of Plastic Surgery
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    • v.50 no.5
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    • pp.496-500
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    • 2023
  • Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction. We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. The bilateral gracilis muscles are inset in a fashion that allows orthograde contraction of the muscle to narrow and collapse the neoanal opening. With biofeedback training, the patient is able to regain dynamic continence and return to function without a stoma. There was also no need for neurotization or microsurgery techniques to restore sphincteric function to the anus. The patient was able to reverse his stoma 14 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation.

교내-교외 통합형 영어교사 연수 사례 연구: 한국 캠브리지 ICELT를 중심으로

  • Lee, Hyo-Sin
    • English Language & Literature Teaching
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    • v.16 no.1
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    • pp.259-281
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    • 2009
  • The ICELT(In-Service Certificate in English Language Teaching) is a highly practical course-based English teacher education program which integrates classroom teaching and off-site teacher training. This case study analyzes the three-year implementation of the ICELT program in Korea and discusses its effects and the implications for improving the inservice English teacher education system. It has been found that the course participants were satisfied with the quality of its execution, thinking that it contributed to their professional development in the areas of teaching practice, methodology and language competence. The study has identified several success factors as shared program goals among the course participants, including systematic selection of course participants, well-qualified tutors and the proper provision of resources including syllabus, teaching materials and course assessment system. Nonetheless, it has been suggested that attention needs to be paid to generalized application of the ICELT for English teacher education due to the limitations such as the heavy workload caused by the program, lack of course participants' collaboration with other teachers at their schools and tutors' poor understanding of the Korean education context. Bearing this in mind, the implications for improving the inservice English teacher education system in Korea have been discussed. Finally, further studies have been suggested, which are concerned with in-depth investigation in exploring the division of roles between native English speaking tutors and Korean ones and the impact of the program on the sustainability of course participants' professional development and the impact on schools.

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A Visual Programming Tool for Constructing Object-Oriented C++ Class (객체 지향 C++클래스 생성을 위한 시각 프로그래밍 도구)

  • Ha, Su-Cheol
    • The Transactions of the Korea Information Processing Society
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    • v.2 no.1
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    • pp.23-33
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    • 1995
  • This paper describes a visual programming tool which provides novice programmer as well expert with the abilites to capture real physical world of problem domain and to manipulate it user-friendly using icons and symbols. Therefore, novice can understand object-oriented features of C++ incrementally and construct classes easily. For this, we introduce some visual metaphors which are displayed as tables. The tables can not only represent objects and classes, but also be considered themselves as icons. We have named these tables as table-icons. Three levels of table-icons(i.e., Super Table-Icons, Intermediate Table-Icons and Detailed Table-Icons) are proposed to follow up appropriate evolution of object-oriented concepts. Table-icons are not simple pictographs but are activated and expanded to table forms. And then, developer can inset necessary entities into table body and delete useless entities from it. These table-icons are applied to a diagramming technique, C++gram[18], which is suggested for designing and implementing C++ programs.

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A Study on Consideration factors for Selection of Institution, When Arbitration Clause Inserted in International Commercial Contracts (국제상사계약(國際商事契約)에서 중재조항(仲裁條項) 삽입시 중재기관 선택에 따른 고려사항)

  • Oh, Won-Suk;Jeong, Hee-Jin
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.55
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    • pp.63-93
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    • 2012
  • The purpose of this paper is to examine the consideration factors, from both parties' perspective, to select the most appropriate arbitral institution when they inset an arbitration clause in their contract. Accordingly, the author analyzed the advantages of institutional arbitration compared to non-institutional arbitration. The typical advantages of institutional arbitration would include: $\bullet$ Benefits of using an established set of rules $\bullet$ Services provided by the institution $\bullet$ Low risks of obstruction $\bullet$ Enhancement of the possibilities of enforcement $\bullet$ Forecast of the estimated cost $\bullet$ Specially useful for existing disputes Next, this author examined the consideration factors when selecting the institution in respect of the following factors: $\bullet$ Institution's arbitration rules $\bullet$ Institution's rule regarding the appointment of arbitrators $\bullet$ Ability of administrators of each institution $\bullet$ Reputation of the arbitral institution and the likability of enforceability of its award $\bullet$ Cost $\bullet$ Choice of the arbitral institution in relation to the choice of place of arbitration Finally, this author reviewed Model Arbitration Clause of major international or local Institutions, including ICC, AAA, LCIA, KCAB, CIETAC, ICSID and WIPO. Further examination was given to the selection of the numbers of the arbitral tribunal, the seat of arbitration and the language of arbitration, according to the designated articles in each institution's arbitration rules.

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Use of a helical composite free flap for alar defect reconstruction with a supermicrosurgical technique

  • Jeong, Hyung Hwa;Choi, Dong Hoon;Hong, Joon Pio;Suh, Hyun Suk
    • Archives of Plastic Surgery
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    • v.45 no.5
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    • pp.466-469
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    • 2018
  • The highly contoured nature of the nose and the abundant free margin makes it especially difficult to reconstruct. In this report, we describe the use of a new helical rim free flap technique for the reconstruction of full-thickness nasal alar defects via supermicrosurgery. Briefly, after a wide excision with a margin of 0.7 cm, an alar defect with a size of $1{\times}1{\times}0.5cm$ was obtained, which included the full thickness of the skin, mucosa, and lower lateral cartilage. Vessel dissection was performed in a straightforward manner, starting from the incision margin for flap harvest, without any further dissection for reach the greater trunk of the superficial temporal artery. The flap was inset in order to match the contour of the contralateral ala. We closed the donor site via rotation and advancement. No donor site morbidity was observed, despite the presence of a small scar that could easily be covered with hair. The alar contour was satisfactory, and the patient was satisfied with the results. The supermicrosurgical technique did not require further dissection to identify the vessels for anastomosis, leading to better cosmetic outcomes and a reduced operating time.

A Study on Detection of Cutting Tool Fracture by Dual Signal Measurements (이중신호에 의한 공구파손 검출에 관한 연구)

  • 윤재웅;양민양;박화영
    • Transactions of the Korean Society of Mechanical Engineers
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    • v.16 no.4
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    • pp.707-722
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    • 1992
  • Fracture of a cutting tool is one of the most serious problems in machining systems. Therefore, several methods have been proposed so far to detect cutting tool fracture. However, most of them have some problems from the viewpoint of practical applications. In this study, the feasibility of using acoustic emission and cutting force signals for the detection of massive tool breakages as well as small fracture of cutting tools were investigated. Turning experiments were performed using conventional carbide inset tools under realistic cutting conditions and the SM45C steel and heat treated SM45C steel were used as a workpiece. And the sensitivities of the AE and cutting force signals to the fracture of cutting tools were illustrated. Finally, a detection algortithm for the fracture of cutting tools was developed through the analysis of these dual signals in the several types of tool fracture.

Pathogenicity and Multiplication of Entomopathogenic Nematode, Steinernema carpocapsae Weiser, on Been Armyworm, Spodoptera exigua (Hubner) and Tobacco Cutworm, Spodoptera litura(Fabricius) (파밤나방(Spodoptera exigua (Hubner))과 담배거세미나방(Spodoptera litura(Fabricius))에 대한 곤충병원선충(Steinernema carpocapsae Weiser)의 감염력 및 증식력)

  • 한상찬;이성섭;김용균
    • Korean journal of applied entomology
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    • v.38 no.3
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    • pp.255-260
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    • 1999
  • Pathogenicity and multiplication of entomopathogenic nematode, Steinernema carpocapsae Weiser, ere analyzed in two insect hosts, Spodoptera exiga (Hubner) and Sp. litura(Fabricius). The estimated ${LC}^{50}s$(lethal concentration of the infective juveniles to kill 50% of the host insect population) were not different between tow insect species or among their developmental stages on the filter paper assay, thought the actual numbers of the infected nematodes were varied among them. The significant variation, however occurred in nematode multiplication between tow inset hosts. Temperature also gave sosignificatn effect on nematode multiplication rate that it took 6 days after infection at $25^{\circ}C$, but did 12 days at $20^{\circ}C$ to show the maximal nematode population peak($\approx$500,000 infective juveniles(IJ) in a 5th instar larva of Sp. litura and $\approx$-100,000 IJ in a 5th instar larva of Sp. exigua).

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Design of Microstrip Patch Antenna on UHF Band using Multiple Meander for Metal Attached (금속 부착용 멀티 미앤더형 UHF 대역 마이크로스트립 패치 안테나 설계)

  • Park, Chan-Hong;Choi, Yong-Seok;Koo, Dong-Jin;Jang, Sung-Won;Seong, Hyeon-Kyeong
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2012.10a
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    • pp.307-311
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    • 2012
  • In this paper, a novel particle swarm optimization method based on IE3D is used to design a mobile communication Microstrip Patch Antenna. The aim of the thesis is to Design and fabricate an inset fed rectangular Microstrip Antenna and study the effect of antenna dimensions Length (L), Width (W) and substrate parameters relative Dielectric constant (${\varepsilon}r$), substrate thickness on Radiation parameters of Band width. When the antenna was designed, a dual-band, dual-polarized antenna was used to secure the bandwidth and improve performance, and a coaxial probe feeding method so that the phased array of antenna is easy.

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A Study on Design of Microstrip Patch Antenna for Mobile Communication Systems using IE3D (IE3D를 이용한 단일 급전 이동통신용 마이크로스트립 패치 안테나 설계에 관한 연구)

  • Park, Jong-Dae;Park, Byeong-Ho;Shim, Woo-Seop;Kim, Myeong-Dong;Seong, Hyeon-Kyeong
    • Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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    • 2012.10a
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    • pp.316-319
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    • 2012
  • In this paper, a novel particle swarm optimization method based on IE3D is used to design a mobile communication Microstrip Patch Antenna. The aim of the thesis is to Design and fabricate an inset fed rectangular Microstrip Antenna and study the effect of antenna dimensions Length (L), Width (W) and substrate parameters relative Dielectric constant (${\varepsilon}r$), substrate thickness on Radiation parameters of Band width. When the antenna was designed, a dual-band, dual-polarized antenna was used to secure the bandwidth and improve performance, and a coaxial probe feeding method so that the phased array of antenna is easy.

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