Shakir, Sameer;Card, Elizabeth B.;Kimia, Rotem;Greives, Matthew R.;Nguyen, Phuong D.
Archives of Plastic Surgery
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v.49
no.2
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pp.174-183
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2022
Management of traumatic skull base fractures and associated complications pose a unique reconstructive challenge. The goals of skull base reconstruction include structural support for the brain and orbit, separation of the central nervous system from the aerodigestive tract, volume to decrease dead space, and restoration of the three-dimensional appearance of the face and cranium with bone and soft tissues. An open bicoronal approach is the most commonly used technique for craniofacial disassembly of the bifrontal region, with evacuation of intracranial hemorrhage and dural repair performed prior to reconstruction. Depending on the defect size and underlying patient and operative factors, reconstruction may involve bony reconstruction using autografts, allografts, or prosthetics in addition to soft tissue reconstruction using vascularized local or distant tissues. The vast majority of traumatic anterior cranial fossa (ACF) injuries resulting in smaller defects of the cranial base itself can be successfully reconstructed using local pedicled pericranial or galeal flaps. Compared with historical nonvascularized ACF reconstructive options, vascularized reconstruction using pericranial and/or galeal flaps has decreased the rate of cerebrospinal fluid (CSF) leak from 25 to 6.5%. We review the existing literature on this uncommon entity and present our case series of n = 6 patients undergoing traumatic reconstruction of the ACF at an urban Level 1 trauma center from 2016 to 2018. There were no postoperative CSF leaks, mucoceles, episodes of meningitis, or deaths during the study follow-up period. In conclusion, use of pericranial, galeal, and free flaps, as indicated, can provide reliable and durable reconstruction of a wide variety of injuries.
Jun Ho Choi;Sang Seong Oh;Jae Ha Hwang;Kwang Seog Kim;Sam Yong Lee
Archives of Craniofacial Surgery
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v.24
no.1
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pp.37-40
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2023
Penetrating wounds to the face are cosmetically devastating and can be life-threatening. If the foreign body causing the penetrating wound is a piece of wood, small remnants might be left behind after the initial treatment. A 33-year-old male patient presented to the emergency center after a piece of lumber pierced his face as a passenger in a traffic accident. The patient's vital signs were stable, and emergency surgery was performed to remove the foreign body and repair the soft tissue. No noteworthy complications were seen after open reduction and internal fixation of the facial bone fractures. Seven months after the accident, the patient underwent scar revision along with full-thickness skin grafting for post-traumatic scars. After the surgery, pus-like discharge which was not previously present was observed, and the graft did not take well. A residual foreign body, which was the cause of graft failure, was found on computed tomography and the remaining foreign body was removed through revision surgery. The patient is receiving outpatient follow-up without any complications 6 months after surgery. This case demonstrates the importance of performing a careful evaluation to avoid missing a residual foreign body, especially if it is of wooden nature.
The Korean Archaeological Dictionary, which represents Korean archaeological knowledge information, contains refined and high-quality information written by expert collective intelligence. This is a characteristic that clearly distinguishes it from overseas archaeological data archives, and can be called differentiated infrastructure data. However, it has not played a role as an information service or knowledge information platform reflecting the latest digital technology. As a way to maximize these strengths and compensate for weaknesses, it was proposed to develop and operate a GIS-based knowledge and information platform for Korean archaeology. To realize this, it is necessary to develop a title management system centered on repositories and metadata that can collect and store various information, link open linked data design and related systems, develop a search function that can analyze and visualize data in response to the big data era, and establish a WebGIS-based information service system. This will be a platform to continuously manage, supplement, and update Korean archaeological knowledge information, build a ubiquitous environment where anyone can use information anytime, anywhere, and create various types of business models.
Gianluca Sapino;Rik Osinga;Michele Maruccia;Martino Guiotto;Martin Clauss;Olivier Borens;David Guillier;Pietro Giovanni di Summa
Archives of Plastic Surgery
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v.50
no.6
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pp.593-600
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2023
Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee jointmobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.
The purpose of the archival appraisal has gradually changed from the selection of records to the documentation of the society. In particular, the qualitative and quantitative developments of the current digital technology and web have become the driving force that enables semantic acquisition, rather than physical one. Under these circumstances, the concept of 'documentary heritage' has been re-established internationally, led by UNESCO. Library and Archives Canada (LAC) reflects this trend. LAC has been trying to develop a new appraisal model and an acquisition model at the same time to revive the spirit of total archives, which is the 'Whole-of-society approach'. Features of this approach can be summarized in three main points. First, it is for documentary heritage and the acquisition refers to semantic acquisition, not the physical one. And because the object of management is documentary heritage, the cooperation between documentary heritage institutions has to be a prerequisite condition. Lastly, it cannot only documenting what already happened, it can documenting what is happening in the current society. 'Whole-of-society approach', as an appraisal method, is a way to identify social components based on social theories. The approach, as an acquisition method, is targeting digital recording, which includes 'digitized' heritage and 'born-digital' heritage. And it makes possible to the semantic acquisition of documentary heritage based on the data linking by mapping identified social components as metadata component and establishing them into linked open data. This study pointed out that it is hard to realize documentation of the society based on domestic appraisal system since the purpose is limited to selection. To overcome this limitation, we suggest a guideline applied with 'Whole-of-society approach'.
To develop the effective methods of flowering stimulation, Hinoki cypress (Chamaecyparis obtusa Sieh. et Zuec.) grafts growing in a seed orchard and in a clone bank in Southern Breeding Station of Cheju were applied with gibberellin treatments, and predicted the seed production potential. In the seed orchard, $GA_{4/7}$ 1.5cc was injected into the stem of drafts and sprayed whale tree crown with $GA_3$ 300ppm and $GA_{4/7}$ 300ppm. Un the other hand, in the clonal archives, drafts were given intrusion of $GA_{4/7}$ 1.5cc into the excised and open inner part of bark wind $GA_3$ 20mg and sprayed with $GA_3$ 300ppm. Additionally, grafts growing in the seed orchard were treated with gibberellins at 3 different periods of time and 3 different treatments during the growing season. The results obtained here are summarized as follows : 1. All of the applications of Gilbberellin promoted female flower formation. Among these, the treatment of intrusion of $GA_{4/7}$ 1.5cc into the excised and open inner part of bark was racist effective, followed by the spraying of $GA_3$ 300ppm. Similarly, the applications of gibberellin promoted male flower formation. 2. Regarding the time of applications, treatment on August 15 was more effective than those of August 31 and September 11 in the stimulation of female flowers. On the contrary, there was no significant difference in the number of male flowers among 3 different time treatments. 3. It was supposed that the application of the intrusion of $GA_{4/7}$ 1.5cc into the excised and open inner part of bark on August 15 showing the best effect in female flower formation can produce 22.12kg seeds per ha. 4. Considerable significant difference existed among clones for both female and male flower formations. 5. Flower formation, especially female flower formation, seemed to be partially associated with the genetic potential of individual trees.
This study began with the question: "what influence would the width of river surface have on visual preference, provided that the environment surrounding the river does not change?" to evaluate the visual preference factors of the river scenery which could vary according to the change of water level. To estimate the minimum flow needed for river sceneries, field survey of Youngsan river was carried out to collect the field data and evaluated the visual preference factors to obtain a most preferred W/B ratio. At Youngsan bridge location, the feeling of open space factors, physical characteristic factors and complexity factors appeared to have significant relations to visual preferences. At Imgok bridge location, complexity factors, aesthetic factors and physical characteristic factors have significance to visual preferences. As a result of multi regression modeling, it was found that physical factors affected visual preferences the most at urban river locations and complexity factors affected the most visual preferences at rural river locations. As a results of this study, the most preferred W/B ratio was estimated as which vary from 0.5 to 0.7 and this results can contribute to the field of river landscape design to maximize the users' satisfaction level.
This paper defines the telepresence as a particular type of experience, rather than a collection of hardware. Defining telepresence in this way provides a means for examining telepresence in relation to other types of mediated experience. Presence refers to the natural perception of an environment, and telepresence refers to the mediated perception of an environment. Factors influencing whether a particular mediated environment will induce a sense of telepresence include the following: the combination of sensory stimuli employed in the environment, the ways in which participants are able to interact with the environment, and the characteristics of the individual experiencing the environment. Telepresence art invites the people from remote worlds to networked cyber space and creates the experience of 'being there' by making participants control the virtual reality system and receive feedback from their teleactions. It is the way to produce an open and engaging experience that manifests the cultural changes brought about by remote control, remote vision, telekinesis, and real-time exchange of audiovisual information. The principal determinants of telepresence are sensory immersion, sensory fidelity, cognitive fidelity and personal factors. This paper applies the 4 determinants to telepresence art works such as Ken Goldberg's Telegarden, Monika Fleischmann & Wolfgang Strauss' The Home of the Brain, Paul Sermon's Telematic Dreaming, Telematic Vision, Eduardo Kac's Uriapuru, Simon Penny's Traces and Paul Sermon & Andrea Zapp's A Body of Water.
Kim, Sug Won;Lee, Won Jai;Seo, Dong Wan;Chung, Yoon Kyu;Tark, Kwan Chul
Archives of Reconstructive Microsurgery
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v.9
no.2
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pp.114-119
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2000
The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.
Park, Sang-Ryul;Kim, Ji-Hoon;Hwang, Jae-Ha;Kim, Kwang-Seog;Lee, Sam-Yong
Archives of Plastic Surgery
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v.37
no.5
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pp.555-560
/
2010
Purpose: Facial allotransplantation (FA) could provide an excellent alternative to current treatments for facial disfigurement. However, despite being technically feasible, there continues to be various ethical and psychosocial issues associated with the risks and benefits of performing FA. The purpose of this study is to investigate risk acceptance and expectations in FA. Methods: In a quantitative assessment of risk versus benefit with respect to FA, from 2004 to 2008, Barker et al. developed and published a questionnaire-based instrument (Louisville Instrument for Transplantation [LIFT]), which contained 237 standardized questions. In the current study, the authors assessed risk versus benefits and expectations of FA using a Korean version of the LIFT. Respondents in three study groups (lay public, n=140; medical students, n=120; doctors, n=34) were questioned about risk acceptance as related to immunosuppression and tissue rejection, and expectations as related to quality of life improvement, and functional and aesthetic outcomes. A summary of the data has been provided and statistical analyses were performed. Results: Among the three study groups, results indicated that doctors accept the least amount of risk for a facial allotransplant, followed by medical students, and finally lay public. There was a significant statistical difference in three of the four questions regarding risk acceptance between the groups (p < 0.05). In general, lay public exhibited higher expectations for facial allotransplantation than the other groups. Additionally, there was a significant statistical difference in the importance of aesthetic outcome between the groups (p < 0.05). Conclusion: The authors' data indicate the three populations have vastly different levels of risk acceptance and expectations with regard to FA. Therefore, it is very important that surgeons establish clear, open, and thorough communication with patients in their consultations regarding FA. This is particularly important with respect to whether or not a patient's level of risk acceptance and expectations are progmatic.
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