• Computers and Concrete
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• v.20 no.4
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• pp.461-468
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• 2017

With the increasing demand in the production of concrete, there is a need for adopting a feasible, economical and sustainable technique to fulfill practical requirements. Self-Compacting Concrete (SCC) is one such technique which addresses the concrete industry in providing eco-friendly and cost effective concrete. The objective of the present study is to develop a mix design for SCC with Crushed Rock Fines (CRF) as fine aggregate based on the plastic viscosity of the mix and validate the same for its fresh and hardened properties. Effect of plastic viscosity on the fresh and hardened properties of SCC is also addressed in the present study. SCC mixes are made with binary and ternary blends of Fly Ash (FA) and Ground Granulated Blast Slag (GGBS) with varying percentages as a partial replacement to Ordinary Portland Cement (OPC). The proposed mix design is validated successfully with the experimental investigations. The results obtained, indicated that the fresh properties are best achieved for SCC mix with ternary blend followed by binary blend with GGBS, Fly Ash and mix with pure OPC. It is also observed that the replacement of sand with 100% CRF resulted in a workable and cohesive mix.

• Archives of Plastic Surgery
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• v.45 no.1
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• pp.85-88
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• 2018

Local flaps exhibit excellent color matching that no other type of flap can compete with. Moreover, surgery using a local flap is easier and faster than surgery using a distant or free flap. However, local flaps can be much more difficult to design. We designed 2 templates to plan a V-Y rotation advancement flap. The template for a unilateral V-Y rotation advancement flap was used on the face (n=5), anterior tibia (n=1), posterior axilla (n=1), ischium (n=1), and trochanter (n=2). The template for a bilateral flap was used on the sacrum (n=8), arm (n=1), and anterior tibia (n=1). The causes of the defects were meningocele (n=3), a decubitus ulcer (n=5), pilonidal sinus (n=3), and skin tumor excision (n=10). The meningocele patients were younger than 8 days. The mean age of the adult patients was 50.4 years (range, 19-80 years). All the donor areas of the flaps were closed primarily. None of the patients experienced wound dehiscence or partial/total flap necrosis. The templates guided surgeons regarding the length and the placement of the incision for a V-Y rotation advancement flap according to the size of the wound. In addition, they could be used for the training of residents.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.235-240
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• 2019

Background The efficacy of Limberg flap reconstruction for pilonidal sinus with acute abscess remains unclear. This study aimed to compare outcomes after Limberg flap reconstruction for pilonidal sinus disease with and without acute abscess. A secondary objective was to perform a review of the literature on the topic. Methods A retrospective chart review was conducted of all patients who underwent excision and Limberg flap reconstruction for pilonidal sinus from 2009 to 2018. Patient demographics, wound characteristics, and complication rates were reviewed and analyzed. Results Group 1 comprised 19 patients who underwent Limberg flap reconstruction for pilonidal sinus disease without acute abscess and group 2 comprised four patients who underwent reconstruction for pilonidal sinus disease with acute abscess. The average defect size after excision was larger in group 2 than group 1 ($107.7{\pm}60.3cm^2$ vs. $61.4{\pm}33.8cm^2$, respectively). There were no recurrences, seromas or cases of flap necrosis postoperatively. There was only one revision surgery needed for evacuation of a postoperative hematoma in group 1. There were comparable rates of partial wound dehiscence treated by local wound care, hematoma, need for revision surgery and minor infection between group 1 and group 2. Conclusions Limberg flap reconstruction for pilonidal sinus in the setting of acute abscess is a viable option with outcomes comparable to that for disease without acute abscess. This practice will avoid the pain and cost associated with a prolonged local wound care regimen involved in drainage of the abscess prior to flap reconstruction.

• Archives of Plastic Surgery
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• v.45 no.2
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• pp.135-139
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• 2018

Background Static reconstruction surgery that tightens the tension of the inferior tarsus, thereby raising the lax lower eyelid, is a common treatment for paralytic ectropion of the lower eyelid. We present one such operative procedure, in which an orbicularis oculi muscle flap was used. Methods The surgical technique involves partial resection of the tarsus and the skin, as well as a superior-based orbicularis oculi muscle flap that is sutured to the firm tissue present on the Whitnall tubercle. The muscle flap is approximately 7 mm in width and 15 mm in length, with a superior pedicle that is attached to the tarsus at the medial point of the resected tarsus. The procedure results in contact between the ocular surface and the lower eyelid. Results The procedure was performed in 11 patients with lower eyelid ectropion due to facial paralysis. Ten cases showed a favorable outcome following surgery, with stable results seen over an average follow-up period of 4.5 years. In one case, recurrence of ectropion was observed 2 months after surgery due to an insufficient correction, and the patient required repeat surgery. Conclusions The orbicularis oculi muscle flap was an effective means of suspension and was able to maintain long-term traction tension. This procedure can therefore be considered a favorable treatment option for lower eyelid ectropion due to facial paralysis.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.283-288
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• 2008

Purpose: The purpose of this study is to evaluate the transverse cervical artery of those who received preoperative radiotherapy or radical neck dissection and those who are unable to utilize the branch of external carotid artery system, which are most commonly used as recipient artery in head and neck reconstruction. Methods: 10 patients were selected as head and neck cancer candidates for study. 8 patients received radical neck dissection or modified radical neck dissection and 3 patients underwent preoperative radiotheraphy. In call cases, reconstruction using free flap was performed with transverse cervical artery as recipient artery and posterolateral cervical vein or transverse cervical vein as recipient vein. Results: Partial necrosis of flap due to wound infection was noted in one case and successful microsurgery was achieved in all other cases. The average pedicle length was 9.3 cm and all arteries underwent end to-end anastomosis. In 7 patients, posterolateral cervical vein was used as recipient artery and transverse cervical vein was utilized in 3 patients. Conclusion: In cases where recipient artery from external carotid system cannot be utilized due to preoperative radiotherapy or radical neck dissection, the transverse cervical artery can be an alternative option of choice. Due to diverse variations of transverse cervical vein as a recipient vein, the posterolateral cervical vein may be considered in such cases.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.534-541
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• 2018

Background Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy. Methods All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy. Results During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast ($62{\pm}4$), nipple reconstruction ($61{\pm}4.8$), overall outcome ($74.3{\pm}5$), and psychosocial well-being ($77.7{\pm}3.2$). Conclusions Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.495-500
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• 2008

Purpose: Adequate tissue oxygenation is considered as an essential factor for wound healing. In the non-diabetic population, an uncompromised macrocirculation generally leads to adequate tissue oxygenation. On the contrary, the macrocirculation in diabetic patients may not correlate with tissue oxygenation because of structural changes in the capillary basement membrane. Nevertheless, many medical professionals in Korea rely on macrocirculation evaluation when predicting wound healing potential of the diabetic ulcers. The purpose of this study is to compare reliability of two common macrocirculation assessment methods, Doppler probing and CT angiography, on tissue oxygenation in diabetic foot patients. Methods: Doppler and CT angiography scores were given according to the patency of the anterior and posterior tibial arteries. Tissue oxygenation was measured by transcutaneous partial oxygen tension($TcpO_2$). Doppler and CT angiography scores were statistically analyzed against $TcpO_2$ values. Sixty-eight diabetic foot ulcer patients were included in this study. Results: The test was carried out on Doppler score and $TcpO_2$ variables displayed a p-value of 0.0202, and concluded that the two variables were statistically dependent. The test used to determine for linear trends between Doppler scores and $TcpO_2$ variables displayed a p-value of 0.0149, displaying statistical linear trend between the two variables. On the contrary, the tests between CT angiography scores and $TcpO_2$ variables showed p-values of 0.1242 and 0.6590, that means no correlation between CT angiography and $TcpO_2$ scores. Conclusion: Doppler probing is more reliable than CT angiography in predicting tissue oxygenation of diabetic foot ulcers.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.245-250
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• 2011

Purpose: Composite tissue allotransplantation has emerged as a new therapeutic modality to reconstruct major tissue defects of the head, neck and extremities. A questionnaire-based instrument, the Louisville Instrument for Transplantation (LIFT), has been developed to objectively assess the risk-versus-benefit ratio for composite tissue allotransplantation procedures. The objective of this study is to assess if the LIFT is a useful, reliable and valid tool to apply to the Korean population. Methods: Seventy-three medical students and 60 lay public completed the LIFT questionnaire (translated to Korean) over the period from February 2010 to April 2010. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was analyzed using Pearson's correlation coefficient. Construct validity was assessed by comparing Pearson's correlation coefficients between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. Results: Measurements of the test-retest reliability showed that Pearson's correlation coefficients ranged from 0.241 to 0.902, and Cronbach's alphas ranged from 0.52 to 0.80 for medical students and from 0.63 to 0.83 for the lay public. Pearson's correlation coefficients showed significant correlations between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. Hand transplant showed a significant correlation in medical students. Foot, hand, two hands, larynx, partial face transplants showed significant correlations for the lay public. Conclusion: The applicability of the LIFT to the Korean population was found to be reliable and valid. The LIFT may serve as a useful tool for clinical application in the Korean population.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.504-508
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• 2012

Background The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is seroma formation in the back. Many clinical studies have shown that fibrin sealant reduces seroma formation. We investigated any statistically significant differences in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of the latissimus dorsi myocutaneous flap harvested for immediate breast reconstruction after skin-sparing partial mastectomy. Methods A total of 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous island flap. Of those, 23 patients underwent the procedure without fibrin sealant and the other 23 were administered the fibrin sealant. All flaps were elevated with manual dissection by the same surgeon and were analyzed to evaluate the potential benefits of the fibrin sealant. The correlation analysis and Mann-Whitney U test were used for analyzing the drainage volume according to age, weight of the breast specimen, and body mass index. Results Although not statistically significant, the cumulative drainage fluid volume was higher in the control group until postoperative day 2 (530.1 mL compared to 502.3 mL), but the fibrin sealant group showed more drainage beginning on postoperative day 3. The donor site comparisons showed the fibrin sealant group had more drainage beginning on postoperative day 3 and the drain was removed 1 day earlier in the control group. Conclusions The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits of the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with patients before its use as a part of informed consent.

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.1-10
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• 2009

Purpose: Partial necrosis of skin flaps remains a substantial problem in reconstructive surgery. We investigated the potential use of an adenovirus vector encoding the VEGF, COMP-angiopoietin-1 gene in an attempt to promote the viability of the inferior epigastric artery flap in a rat model. Methods: Three by six cm lower abdominal transverse skin flaps, supplied only by the left inferior epigastric artery, were designed. After skin flap elevation, the adenovirus VEGF and adenovirus COMP-angiopoietin-1 were injected into the distal portion of the flap, which has a high tendency of developing flap ischemia. Control animals were injected with the same volume of normal saline. On 3, 7 and 14 days after the flap elevation, the flap survival and vascularization were assessed using Visitrak digital$^{(R)}$, CD31 immunohistochemistry in addition to evaluating the general histological characteristics. Results: There was a significant increase in the mean percentage of flap viability by 89.8%, 91.1% and 94.8% in flaps transfected with adenovirus VEGF, COMP-angiopoietin-1, coadministraion of VEGF and COMP-angiopoietin-1 at seven days, and by 95.6%, 94.8% and 96.3% at 14 days. Histological assessment revealed that there were more blood vessels formed after adenovirus with VEGF, COMP-angiopoietin-1 or VEGF plus COMP-angiopoietin-1 than with adenovirus Lac Z. Conclusion: The results of this study suggest that adenovirus-mediated VEGF, COMP-angiopoietin-1 gene therapy, promote therapeutic angiogenesis in patients that undergo reconstructive procedures.