Search results for: propeller flap
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 115

Search results for: propeller flap

85 Innovative Strategies for Chest Wall Reconstruction Following Resection of Recurrent Breast Carcinoma

Authors: Sean Yao Zu Kong, Khong Yik Chew

Abstract:

Introduction: We described a case report of the successful use of advanced surgical techniques in a patient with recurrent breast cancer who underwent a wide resection including the hemi-sternum, clavicle, multiple ribs, and a lobe of the lung due to tumor involvement. This extensive resection exposed critical structures, requiring a creative approach to reconstruction. To address this complex chest wall reconstruction, a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap were successfully utilized. The use of a free vascularized bone flap allowed for rapid osteointegration and resistance against osteoradionecrosis after adjuvant radiation, while a four-zone tram flap allowed for reconstruction of both the chest wall and breast mound. Although limited recipient vessels made free flaps challenging, the free fibula flap served as both a bony reconstruction and vascular conduit, supercharged with the distal peroneal artery and veins of the peroneal artery from the fibula graft. Our approach highlights the potential of advanced surgical techniques to improve outcomes in complex cases of chest wall reconstruction in patients with recurrent breast cancer, which is becoming increasingly relevant as breast cancer incidence rates increases. Case presentation: This report describes a successful reconstruction of a patient with recurrent breast cancer who required extensive resection, including the anterior chest wall, clavicle, and sternoclavicular joint. Challenges arose due to the loss of accessory muscles and the non-rigid rib cage, which could lead to compromised ventilation and instability. A free fibula osteocutaneous flap and a four-zone TRAM flap with vascular supercharging were utilized to achieve long-term stability and function. The patient has since fully recovered, and during the review, both flaps remained viable, and chest mound reconstruction was satisfactory. A planned nipple/areolar reconstruction was offered pending the patient’s decision after adjuvant radiotherapy. Conclusion: In conclusion, this case report highlights the successful use of innovative surgical techniques in addressing a complex case of recurrent breast cancer requiring extensive resection and radical reconstruction. Our approach, utilized a combination of a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap, demonstrates the potential for advanced techniques in chest wall reconstruction to minimize complications and ensure long-term stability and function. As the incidence of breast cancer continues to rise, it is crucial that healthcare professionals explore and utilize innovative techniques to improve patient outcomes and quality of life.

Keywords: free fibula flap, rectus abdominis musculocutaneous flap, post-adjuvant radiotherapy, reconstructive surgery, malignancy

Procedia PDF Downloads 42
84 A Clinical Study on the Versatility of Lateral Supra Malleolar Flap in Lower Limb Wound Reconstruction

Authors: Animesh Gupta

Abstract:

Objective: The purpose of this study is to evaluate the versatility and outcome of lateral supra malleolar flap (LSMF) in soft tissue reconstruction of the regions including the distal leg, ankle, dorsal foot and heel. Methods: From March 2021 to April 2023, 18 patients with soft tissue defects in the regions, including the distal leg, ankle, dorsal foot and heel, who underwent LSMF repair for lower limb wound reconstruction were analyzed. The location, size of the defects, etiology, outcome, complications, and other alternative options were studied and presented. Results: The follow-up period of the cases was 3-6 months after surgery. All flaps were successful; however, one flap was complicated by venous congestion and was managed by loosening a few sutures and the patient was required to elevate the affected limb to resolve the issue. Conclusion: The LSMF has numerous advantages in repairing soft tissue defects in areas involving the ankle, distal leg, heel and dorsum of the foot. In comparison to reverse sural flaps for repairing defects in the heel and lower leg, LSMF offers shorter operation time, shorter hospitalization, lower cost, and fewer postoperative complications.

Keywords: lateral supra malleolar flap, LSMF, soft tissue reconstruction, lower leg defect

Procedia PDF Downloads 49
83 An Experimental Study of Diffuser-Enhanced Propeller Hydrokinetic Turbines

Authors: Matheus Nunes, Rafael Mendes, Taygoara Felamingo Oliveira, Antonio Brasil Junior

Abstract:

Wind tunnel experiments of horizontal axis propeller hydrokinetic turbines model were carried out, in order to determine the performance behavior for different configurations and operational range. The present experiments introduce the use of two different geometries of rear diffusers to enhance the performance of the free flow machine. The present paper reports an increase of the power coefficient about 50%-80%. It represents an important feature that has to be taken into account in the design of this kind of machine.

Keywords: diffuser-enhanced turbines, hydrokinetic turbine, wind tunnel experiments, micro hydro

Procedia PDF Downloads 236
82 Dynamic Modeling of an Unmanned Aerial Vehicle with Petro-Engine

Authors: Khaled A. Alsaif, Mosaad A. Foda

Abstract:

In the following article, we present the dynamic simulation of an unmanned aerial vehicle with main fuel engine in the middle to carry most of the weight. This configuration will increase the flight time of the vehicle for a given payload size as opposed to the traditional quad rotor, where only DC motors are used. A parametric study to investigate the effect of the propellers ratio (main rotor propeller diameter to secondary rotor propeller diameter), the angle of incidence of the main rotor and the twist angle of the main rotor blades on selected performance criteria is presented.

Keywords: unmanned aerial vehicle (UAV), quadrotor, petrol quadcopter, flying robot

Procedia PDF Downloads 423
81 Uranoplasty Using Tongue Flap for Bilateral Clefts

Authors: Saidasanov Saidazal Shokhmurodovich, Topolnickiy Orest Zinovyevich, Afaunova Olga Arturovna

Abstract:

Relevance: Bilateral congenital cleft is one of the most complex forms of all clefts, which makes it difficult to choose a surgical method of treatment. During primary operations to close the hard and soft palate, there is a shortage of soft tissues and their lack during standard uranoplasty, and these factors aggravate the period of rehabilitation of patients. Materials and methods: The results of surgical treatment of children with bilateral cleft, who underwent uranoplasty using a flap from the tongue, were analyzed. The study used methods: clinical and statistical, which allowed us to solve the tasks, based on the principles of evidence-based medicine. Results and discussion: in our study, 15 patients were studied, who underwent surgical treatment in the following volume: uranoplasty using a flap from the tongue in two stages. Of these, 9 boys and 6 girls aged 2.5 to 6 years. The first stage was surgical treatment in the volume: veloplasty. The second stage was a surgical intervention in volume: uranoplasty using a flap from the tongue. In all patients, the width of the cleft ranged from 1.6-2.8 cm. All patients in this group were orthodontically prepared. Using this method, the surgeon can achieve the following results: maximum narrowing of the palatopharyngeal ring, long soft palate, complete closure of the hard palate, alveolar process, and the mucous membrane of the nasal cavity is also sutured, which creates good conditions for the next stage of osteoplastic surgery. Based on the result obtained, patients have positive results of working with a speech therapist. In all patients, the dynamics were positive without complications. Conclusions: Based on our observation, tongue flap uranoplasty is one of the effective techniques for patients with wide clefts of the hard and soft palate. The use of a flap from the tongue makes it possible to reduce the number of repeated reoperations and improve the quality of social adaptation of this group of patients, which is one of the important stages of rehabilitation. Upon completion of the stages of rehabilitation, all patients had the maximum improvement in functional, anatomical and social indicators.

Keywords: congenital cleft lips and palate, bilateral cleft, child surgery, maxillofacial surgery

Procedia PDF Downloads 88
80 The Aesthetic Reconstruction of Post-Burn Eyebrow Alopecia with Bilateral Superficial Temporal Artery Island Scalp Flap

Authors: Kumar Y., Suman D., Sumathi

Abstract:

Introduction: Burns to the face account for between one-fourth and one-third of all burns. The loss of an eyebrow due to a burn or infection can have negative physical and psychological consequences for patients because eyebrows have a critical functional and aesthetic role on the face. Plastic surgeons face unique challenges in reconstructing eyebrows due to their complex anatomy and variations within genders. As a general rule, there are three techniques for reconstructing the eyebrow: superficial temporal artery island flap, a composite graft from the scalp, and mini or micro follicular grafts from the scalp. In situations where a sufficient amount of subcutaneous tissue is not available and the defect is big such as the case of burns, flaps like the superficial temporal artery scalp flap remain reliable options. In 2018, a 17-year-old female patient presented to the department of Burns Plastic and reconstructive Surgery of Guru Teg Bahadur Hospital, Delhi, India. A scald-burn injury to the face occurred two years before admission, resulting in bilateral eyebrow loss. We reconstructed the bilateral eyebrows using bilateral scalp island flaps based on the posterior branch of the superficial temporal artery. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations and the patient stated that she was more comfortable with her social relationships. Among the current treatment procedures, the superficial temporal artery island flap continues to be a versatile option for reconstructing the eyebrows after alopecia, especially in cases of burns. Results: During the 30 days follow-up period, the scalp island flap remained vascularised with normal hair growth, without complications. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance; the patient stated that she was more comfortable with her social relationships. Conclusion: In this case report, we demonstrated how scalp island flaps pedicled by the superficial temporal artery could be performed very safely and reliably to create new eyebrows.

Keywords: alopecia, burns, eyebrow, flap, superficial temporal artery

Procedia PDF Downloads 193
79 Marine Propeller Cavitation Analysis Using BEM

Authors: Ehsan Yari

Abstract:

In this paper, a numerical study of sheet cavitation has been performed on DTMB4119 and E779A marine propellers with the boundary element method. In propeller design, various parameters of geometry and fluid are incorporated. So a program is needed to solve the flow taking the whole parameters changing into account. The capability of analyzing the wetted and cavitation flow around propellers in steady, unsteady, uniform, and non-uniform conditions while decreasing computational time compared to numerical finite volume methods with acceptable precision are the characteristic features of the present method. Moreover, modifying the position of the detachment point and its corresponding potential value has been considered. Numerical results have been validated with experimental data, showing a good conformation.

Keywords: cavitation, BEM, DTMB4119, E779A

Procedia PDF Downloads 19
78 Constructing a Physics Guided Machine Learning Neural Network to Predict Tonal Noise Emitted by a Propeller

Authors: Arthur D. Wiedemann, Christopher Fuller, Kyle A. Pascioni

Abstract:

With the introduction of electric motors, small unmanned aerial vehicle designers have to consider trade-offs between acoustic noise and thrust generated. Currently, there are few low-computational tools available for predicting acoustic noise emitted by a propeller into the far-field. Artificial neural networks offer a highly non-linear and adaptive model for predicting isolated and interactive tonal noise. But neural networks require large data sets, exceeding practical considerations in modeling experimental results. A methodology known as physics guided machine learning has been applied in this study to reduce the required data set to train the network. After building and evaluating several neural networks, the best model is investigated to determine how the network successfully predicts the acoustic waveform. Lastly, a post-network transfer function is developed to remove discontinuity from the predicted waveform. Overall, methodologies from physics guided machine learning show a notable improvement in prediction performance, but additional loss functions are necessary for constructing predictive networks on small datasets.

Keywords: aeroacoustics, machine learning, propeller, rotor, neural network, physics guided machine learning

Procedia PDF Downloads 179
77 Cross-Dialectal Study of Issues in Dagbanli Phonology

Authors: Abdul-Razak Inusah

Abstract:

The study is a cross-sectional investigation of issues in Dagbanli Phonology, a Mabia language spoken in the Northern Region of Ghana. The issues investigated and assessed for the purpose of Dagbanli phonology are the status of the velar fricatives [x, ɣ] and the flap [ɾ] across Dagbanli dialects. The ethnographic approach is employed to solicit the primary data from bucolic Dagbanli speech communities. The descriptive method is engaged for the analysis of the primary data available. The investigation reveals that the dialects have the velar fricatives [x, ɣ] confined to specific segmental contexts with a particular inventory stricture. The flap[ɾ] is noticed to occur mostly in intervocalic but entirely missing in Dagbanli indigenous words in word-initial. The velar fricatives [x, ɣ] and the flap[ɾ] are observed to be non-contrastive and only suffice as dialectal allophones in the language. The paper shows evidence of coalesce of non-coronal labial /m/ and coronal fricative /s/ to produce dorsal fricative [x] in intervocalic and coalesce of stem final stop /ɡ/ and suffix onset fricative /s/ to yield the dorsal fricative [x], a finding which shows the status of the segment [x] in Dagbanli phonology. The paper concludes that the segments [x], [ɣ] and [ɾ] are positional variants of /ɡ+s/ or /m+s/, /ɡ/ and /d/.

Keywords: Dagbani, phonology, dialect, segment, fricatives, coalesce

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76 Evolution of Gravity Flap Structures in the Southern Central Atlas of Tunisia. Example: Northern of Orbata Anticline (Ben Zannouch Structure)

Authors: Soulef Amamria, Mohamed Sadok Bensalem, Mohamed Ghanmi

Abstract:

Several works found in the fold-and-thrust belt area of the southern central atlas of Tunisia, which were often related with tectonic shortening, are, in fact, related to superficial gravity structures. These gravitational collapse structures have developed in the northern flank of jebel Orbata. These include rock-slides, rock falls, wrinkle folds, slip sheets, and flaps. The Gravity collapse structures of ben zannouch are parallel to the major thrust of Bou Omrane between Orbata and El Ong structures. The thrust activity of Bou Omrane associated to the important paleo-slope to the south and plastic lithology (incompetent marly and gypsum layers) facilitates the development of the Ben Zannouch Flap structure. The definition in the first time of gravitional collapse structures in Tunisia, particularly in the northern flank of Jebel Orbata, is controlled by three principal structural conditions: the fragmentation of the landslide surfaces, the lithology, and the topography. Other regional factors can be distinguished in the southern-central Tunisian Atlas as the seismity activity of the Gafsa fault and the wetter conditions during the postglacial period.

Keywords: collapse structure, flap structure, gravity structures, thrust activity

Procedia PDF Downloads 59
75 Minimizing Ship’S Breakdown Maintenance Due to Rope Entangled In Propeller With “Si Kuman” On Mooring Boat PSC I in Surabaya

Authors: Jogi Prayogo, Dwi Qaqa Prasetyatama, Rahmad Dwi Afandi, Kunto Arief Prasetyo, Viorel Herniza Leksono

Abstract:

PT. Pertamina Trans Kontinental managed a fleet of 364 ships in 2018 - 2020. In that period, there were 8 incidents of ship damage, causing breakdown maintenance on 6 ships belonging to PT Pertamina Trans Kontinental throughout Indonesia's operational areas due to ropes entangled in propellers. The company's losses that were caused by the fouled propellers amounted to 306.35 Million Rupiah. Of the 8 incidents, Mooring Boat PSC I was taken as a pilot project for further analysis considering the location of the ship which is in Surabaya and Mooring Boat PSC I has experienced 2 incidents of rope entanglement that caused the company's losses due to the largest Breakdown Maintenance amounted to 200.99 Million Rupiah. After analyzing the rope entanglement in the ship's propeller based on the data of Mooring Boat PSC I related to the location of propellers that are often fouled in the conventional propulsion system, it was found that there is a suitable location for the implementation of SI KUMAN tool that serves to cut ropes to prevent the occurrence of rope entangled in ship propellers. The determination of SI KUMAN tool is based on the strength of the ship's material to be installed and a suitable design to prevent the occurrence of ropes being entangled in propellers. After the installation of the "SI KUMAN" tool and monitoring carried out for 1 year period (August 2020 - August 2021), it was found that SI KUMAN tool can eliminate the risk of fouled propeller incidents which previously occurred twice in one year so that the company's loss amounted to 200.99 Million Rupiah can be eliminated and SI KUMAN tool can still operate optimally.

Keywords: breakdown maintenance, mooring boat, fleet, fouled propeller, rope entangled, cut

Procedia PDF Downloads 149
74 Grisotti Flap as Treatment for Central Tumors of the Breast

Authors: R. Pardo, P. Menendez, MA Gil-Olarte, S. Sanchez, E. García, R. Quintana, J. Martín

Abstract:

Introduction : Within oncoplastic breast techniques there is increased interest in immediate partial breast reconstruction. The volume resected is greater than that of conventional conservative techniques. Central tumours of the breast have classically been treated with a mastectomy with regard to oncological safety and cosmetic secondary effects after wide central resection of the nipple and breast tissue beneath. Oncological results for central quadrantectomy have a recurrence level, disease- free period and survival identical to mastectomy. Grissoti flap is an oncoplastic surgical technique that allows the surgeon to perform a safe central quadrantectomy with excellent cosmetic results. Material and methods: The Grissoti flap is a glandular cutaneous advancement rotation flap that can fill the defect in the central portion of the excised breast. If the inferior border is affected by tumour and further surgery is decided upon at the Multidisciplinary Team Meeting, it will be necessary to perform a mastectomy. All patients with a Grisotti flap undergoing surgery since 2009 were reviewed obtaining the following data: age, hystopathological diagnosis, size, operating time, volume of tissue resected, postoperative admission time, re-excisions due to positive margins affected by tumour, wound dehiscence, complications and recurrence. Analysis and results of sentinel node biopsy were also obtained. Results: 12 patients underwent surgery between 2009-2015. The mean age was 54 years (34-67) . All had a preoperative diagnosis of ductal infiltrative carcinoma of less than 2 cm,. Diagnosis was made with Ultrasound, Mamography or both . Magnetic resonance was used in 5 cases. No patients had preoperative positive axilla after ultrasound exploration. Mean operating time was 104 minutes (84-130). Postoperative stay was 24 hours. Mean volume resected was 159 cc (70-286). In one patient the surgical border was affected by tumour and a further procedure with resection of the affected border was performed as ambulatory surgery. The sentinel node biopsy was positive for micrometastasis in only two cases. In one case lymphadenectomy was performed in 2009. In the other, treated in 2015, no lymphadenectomy was performed as the patient had a favourable histopathological prognosis and the multidisciplinary team meeting agreed that lymphadenectomy was not required. No recurrence has been diagnosed in any of the patients who underwent surgery and they are all disease free at present. Conclusions: Conservative surgery for retroareolar central tumours of the breast results in good local control of the disease with free surgical borders, including resection of the nipple areola complex and pectoral major muscle fascia. Reconstructive surgery with the inferior Grissoti flap adequately fills the defect after central quadrantectomy with creation of a new cutaneous disc where a new nipple areola complex is reconstructed with a local flap or micropigmentation. This avoids the need for contralateral symmetrization. Sentinel Node biopsy can be performed without added morbidity. When feasible, the Grissoti flap will avoid skin-sparing mastectomy for central breast tumours that will require the use of an expander, prosthesis or myocutaneous flap, with all the complications of a more complex operation.

Keywords: Grisotti flap, oncoplastic surgery, central tumours, breast

Procedia PDF Downloads 295
73 The Accuracy of an In-House Developed Computer-Assisted Surgery Protocol for Mandibular Micro-Vascular Reconstruction

Authors: Christophe Spaas, Lies Pottel, Joke De Ceulaer, Johan Abeloos, Philippe Lamoral, Tom De Backer, Calix De Clercq

Abstract:

We aimed to evaluate the accuracy of an in-house developed low-cost computer-assisted surgery (CAS) protocol for osseous free flap mandibular reconstruction. All patients who underwent primary or secondary mandibular reconstruction with a free (solely or composite) osseous flap, either a fibula free flap or iliac crest free flap, between January 2014 and December 2017 were evaluated. The low-cost protocol consisted out of a virtual surgical planning, a prebend custom reconstruction plate and an individualized free flap positioning guide. The accuracy of the protocol was evaluated through comparison of the postoperative outcome with the 3D virtual planning, based on measurement of the following parameters: intercondylar distance, mandibular angle (axial and sagittal), inner angular distance, anterior-posterior distance, length of the fibular/iliac crest segments and osteotomy angles. A statistical analysis of the obtained values was done. Virtual 3D surgical planning and cutting guide design were performed with Proplan CMF® software (Materialise, Leuven, Belgium) and IPS Gate (KLS Martin, Tuttlingen, Germany). Segmentation of the DICOM data as well as outcome analysis were done with BrainLab iPlan® Software (Brainlab AG, Feldkirchen, Germany). A cost analysis of the protocol was done. Twenty-two patients (11 fibula /11 iliac crest) were included and analyzed. Based on voxel-based registration on the cranial base, 3D virtual planning landmark parameters did not significantly differ from those measured on the actual treatment outcome (p-values >0.05). A cost evaluation of the in-house developed CAS protocol revealed a 1750 euro cost reduction in comparison with a standard CAS protocol with a patient-specific reconstruction plate. Our results indicate that an accurate transfer of the planning with our in-house developed low-cost CAS protocol is feasible at a significant lower cost.

Keywords: CAD/CAM, computer-assisted surgery, low-cost, mandibular reconstruction

Procedia PDF Downloads 117
72 W-WING: Aeroelastic Demonstrator for Experimental Investigation into Whirl Flutter

Authors: Jiri Cecrdle

Abstract:

This paper describes the concept of the W-WING whirl flutter aeroelastic demonstrator. Whirl flutter is the specific case of flutter that accounts for the additional dynamic and aerodynamic influences of the engine rotating parts. The instability is driven by motion-induced unsteady aerodynamic propeller forces and moments acting in the propeller plane. Whirl flutter instability is a serious problem that may cause the unstable vibration of a propeller mounting, leading to the failure of an engine installation or an entire wing. The complicated physical principle of whirl flutter required the experimental validation of the analytically gained results. W-WING aeroelastic demonstrator has been designed and developed at Czech Aerospace Research Centre (VZLU) Prague, Czechia. The demonstrator represents the wing and engine of the twin turboprop commuter aircraft. Contrary to the most of past demonstrators, it includes a powered motor and thrusting propeller. It allows the changes of the main structural parameters influencing the whirl flutter stability characteristics. Propeller blades are adjustable at standstill. The demonstrator is instrumented by strain gauges, accelerometers, revolution-counting impulse sensor, sensor of airflow velocity, and the thrust measurement unit. Measurement is supported by the in house program providing the data storage and real-time depiction in the time domain as well as pre-processing into the form of the power spectral densities. The engine is linked with a servo-drive unit, which enables maintaining of the propeller revolutions (constant or controlled rate ramp) and monitoring of immediate revolutions and power. Furthermore, the program manages the aerodynamic excitation of the demonstrator by the aileron flapping (constant, sweep, impulse). Finally, it provides the safety guard to prevent any structural failure of the demonstrator hardware. In addition, LMS TestLab system is used for the measurement of the structure response and for the data assessment by means of the FFT- and OMA-based methods. The demonstrator is intended for the experimental investigations in the VZLU 3m-diameter low-speed wind tunnel. The measurement variant of the model is defined by the structural parameters: pitch and yaw attachment stiffness, pitch and yaw hinge stations, balance weight station, propeller type (duralumin or steel blades), and finally, angle of attack of the propeller blade 75% section (). The excitation is provided either by the airflow turbulence or by means of the aerodynamic excitation by the aileron flapping using a frequency harmonic sweep. The experimental results are planned to be utilized for validation of analytical methods and software tools in the frame of development of the new complex multi-blade twin-rotor propulsion system for the new generation regional aircraft. Experimental campaigns will include measurements of aerodynamic derivatives and measurements of stability boundaries for various configurations of the demonstrator.

Keywords: aeroelasticity, flutter, whirl flutter, W WING demonstrator

Procedia PDF Downloads 53
71 Application of Pedicled Perforator Flaps in Large Cavities of the Breast

Authors: Neerja Gupta

Abstract:

Objective-Reconstruction of large cavities of the breast without contralateral symmetrisation Background- Reconstruction of breast includes a wide spectrum of procedures from displacement to regional and distant flaps. The pedicled Perforator flaps cover a wide spectrum of reconstruction surgery for all quadrants of the breast, especially in patients with comorbidities. These axial flaps singly or adjunct are based on a near constant perforator vessel, a ratio of 2:1 at its entry in a flap is good to maintain vascularity. The perforators of lateral chest wall viz LICAP, LTAP have overlapping perfurosomes without clear demarcation. LTAP is localized in the narrow zone between the lateral breast fold and anterior axillary line,2.5-3.8cm from the fold. MICAP are localized at 1-2 cm from sternum. Being 1-2mm in diameter, a Single perforator is good to maintain the flap. LICAP has a dominant perforator in 6th-11th spaces, while LTAP has higher placed dominant perforators in 4th and 5th spaces. Methodology-Six consecutive patients who underwent reconstruction of the breast with pedicled perforator flaps were retrospectively analysed. Selections of the flap was done based on the size and locations of the tumour, anticipated volume loss, willingness to undergo contralateral symmetrisation, cosmetic expectations, and finances available.3 patients underwent vertical LTAP, the distal limit of the flap being the inframammary crease. 3 patients underwent MICAP, oriented along the axis of rib, the distal limit being the anterior axillary line. Preoperative identification was done using a unidirectional hand held doppler. The flap was raised caudal to cranial, the pivot point of rotation being the vessel entry into the skin. The donor area is determined by the skin pinch. Flap harvest time was 20-25 minutes. Intra operative vascularity was assessed with dermal bleed. The patient immediate pre, post-operative and follow up pics were compared independently by two breast surgeons. Patients were given a breast Q questionnaire (licensed) for scoring. Results-The median age of six patients was 46. Each patient had a hospital stay of 24 hours. None of the patients was willing for contralateral symmetrisation. The specimen dimensions were from 8x6.8x4 cm to 19x16x9 cm. The breast volume reconstructed range was 30 percent to 45 percent. All wide excision had free margins on frozen. The mean flap dimensions were 12x5x4.5 cm. One LTAP underwent marginal necrosis and delayed wound healing due to seroma. Three patients were phyllodes, of which one was borderline, and 2 were benign on final histopathology. All other 3 patients were invasive ductal cancer and have completed their radiation. The median follow up is 7 months the satisfaction scores at median follow of 7 months are 90 for physical wellbeing and 85 for surgical results. Surgeons scored fair to good in Harvard score. Conclusion- Pedicled perforator flaps are a valuable option for 3/8th volume of breast defects. LTAP is preferred for tumours at the Central, upper, and outer quadrants of the breast and MICAP for the inner and lower quadrant. The vascularity of the flap is dependent on the angiosomalterritories; adequate venous and cavity drainage.

Keywords: breast, oncoplasty, pedicled, perforator

Procedia PDF Downloads 162
70 Bench Tests of Two-Stroke Opposed Piston Aircraft Diesel Engine under Propeller Characteristics Conditions

Authors: A. Majczak, G. Baranski, K. Pietrykowski

Abstract:

Due to the growing popularity of light aircraft, it has become necessary to develop aircraft engines for this type of construction. One of engine system, designed to increase efficiency and reduce weight, is the engine with opposed pistons. In such an engine, the combustion chamber is formed by two pistons moving in one cylinder. Therefore, this type of engines run in a two-stroke cycle, so they have many advantages such as high power and torque, high efficiency, or a favorable power-to-weight ratio. Tests of one of the available aircraft engines with opposing piston system fueled with diesel oil were carried out on an engine dynamometer equipped with an eddy current brake and the necessary measuring and testing equipment. In order to get to know the basic parameters of the engine, the tests were carried out under partial load conditions for the following torque values: 40, 60, 80, 100 Nm. The rotational speed was changed from 1600 to 2500 rpm. Measurements were also taken for designated points of propeller characteristics. During the tests, the engine torque, engine power, fuel consumption, intake manifold pressure, and oil pressure were recorded. On the basis of the measurements carried out for particular loads, the power curve, hourly and specific fuel consumption curves were determined. Characteristics of charge pressure as a function of rotational speed as well as power, torque, hourly and specific fuel consumption curves for propeller characteristics were also prepared. The obtained characteristics make it possible to select the optimal points of engine operation.

Keywords: aircraft, diesel, engine testing, opposed piston

Procedia PDF Downloads 120
69 Understanding Evidence Dispersal Caused by the Effects of Using Unmanned Aerial Vehicles in Active Indoor Crime Scenes

Authors: Elizabeth Parrott, Harry Pointon, Frederic Bezombes, Heather Panter

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Unmanned aerial vehicles (UAV’s) are making a profound effect within policing, forensic and fire service procedures worldwide. These intelligent devices have already proven useful in photographing and recording large-scale outdoor and indoor sites using orthomosaic and three-dimensional (3D) modelling techniques, for the purpose of capturing and recording sites during and post-incident. UAV’s are becoming an established tool as they are extending the reach of the photographer and offering new perspectives without the expense and restrictions of deploying full-scale aircraft. 3D reconstruction quality is directly linked to the resolution of captured images; therefore, close proximity flights are required for more detailed models. As technology advances deployment of UAVs in confined spaces is becoming more common. With this in mind, this study investigates the effects of UAV operation within active crimes scenes with regard to the dispersal of particulate evidence. To date, there has been little consideration given to the potential effects of using UAV’s within active crime scenes aside from a legislation point of view. Although potentially the technology can reduce the likelihood of contamination by replacing some of the roles of investigating practitioners. There is the risk of evidence dispersal caused by the effect of the strong airflow beneath the UAV, from the downwash of the propellers. The initial results of this study are therefore presented to determine the height of least effect at which to fly, and the commercial propeller type to choose to generate the smallest amount of disturbance from the dataset tested. In this study, a range of commercially available 4-inch propellers were chosen as a starting point due to the common availability and their small size makes them well suited for operation within confined spaces. To perform the testing, a rig was configured to support a single motor and propeller powered with a standalone mains power supply and controlled via a microcontroller. This was to mimic a complete throttle cycle and control the device to ensure repeatability. By removing the variances of battery packs and complex UAV structures to allow for a more robust setup. Therefore, the only changing factors were the propeller and operating height. The results were calculated via computer vision analysis of the recorded dispersal of the sample particles placed below the arm-mounted propeller. The aim of this initial study is to give practitioners an insight into the technology to use when operating within confined spaces as well as recognizing some of the issues caused by UAV’s within active crime scenes.

Keywords: dispersal, evidence, propeller, UAV

Procedia PDF Downloads 137
68 Structural Morphing on High Performance Composite Hydrofoil to Postpone Cavitation

Authors: Fatiha Mohammed Arab, Benoit Augier, Francois Deniset, Pascal Casari, Jacques Andre Astolfi

Abstract:

For the top high performance foiling yachts, cavitation is often a limiting factor for take-off and top speed. This work investigates solutions to delay the onset of cavitation thanks to structural morphing. The structural morphing is based on compliant leading and trailing edge, with effect similar to flaps. It is shown here that the commonly accepted effect of flaps regarding the control of lift and drag forces can also be used to postpone the inception of cavitation. A numerical and experimental study is conducted in order to assess the effect of the geometric parameters of hydrofoil on their hydrodynamic performances and in cavitation inception. The effect of a 70% trailing edge and a 30% leading edge of NACA 0012 is investigated using Xfoil software at a constant Reynolds number 106. The simulations carried out for a range flaps deflections and various angles of attack. So, the result showed that the lift coefficient increase with the increase of flap deflection, but also with the increase of angle of attack and enlarged the bucket cavitation. To evaluate the efficiency of the Xfoil software, a 2D analysis flow over a NACA 0012 with leading and trailing edge flap was studied using Fluent software. The results of the two methods are in a good agreement. To validate the numerical approach, a passive adaptive composite model is built and tested in the hydrodynamic tunnel at the Research Institute of French Naval Academy. The model shows the ability to simulate the effect of flap by a LE and TE structural morphing due to hydrodynamic loading.

Keywords: cavitation, flaps, hydrofoil, panel method, xfoil

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67 Integrated Dynamic Analysis of Semi-Submersible Flap Type Concept

Authors: M. Rafiur Rahman, M. Mezbah Uddin, Mohammad Irfan Uddin, M. Moinul Islam

Abstract:

With a rapid development of offshore renewable energy industry, the research activities in regards of harnessing power from offshore wind and wave energy are increasing day by day. Integration of wind turbines and wave energy converters into one combined semi-submersible platform might be a cost-economy and beneficial option. In this paper, the coupled integrated dynamic analysis in the time domain (TD) of a simplified semi-submersible flap type concept (SFC) is accomplished via state-of-the-art numerical code referred as Simo-Riflex-Aerodyn (SRA). This concept is a combined platform consisting of a semi-submersible floater supporting a 5 MW horizontal axis wind turbine (WT) and three elliptical shaped flap type wave energy converters (WECs) on three pontoons. The main focus is to validate the numerical model of SFC with experimental results and perform the frequency domain (FD) and TD response analysis. The numerical analysis is performed using potential flow theory for hydrodynamics and blade element momentum (BEM) theory for aerodynamics. A variety of environmental conditions encompassing the functional & survival conditions for short-term sea (1-hour simulation) are tested to evaluate the sustainability of the SFC. The numerical analysis is performed in full scale. Finally, the time domain analysis of heave, pitch & surge motions is performed numerically using SRA and compared with the experimental results. Due to the simplification of the model, there are some discrepancies which are discussed in brief.

Keywords: coupled integrated dynamic analysis, SFC, time domain analysis, wave energy converters

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66 Design and Optimization of a Small Hydraulic Propeller Turbine

Authors: Dario Barsi, Marina Ubaldi, Pietro Zunino, Robert Fink

Abstract:

A design and optimization procedure is proposed and developed to provide the geometry of a high efficiency compact hydraulic propeller turbine for low head. For the preliminary design of the machine, classic design criteria, based on the use of statistical correlations for the definition of the fundamental geometric parameters and the blade shapes are used. These relationships are based on the fundamental design parameters (i.e., specific speed, flow coefficient, work coefficient) in order to provide a simple yet reliable procedure. Particular attention is paid, since from the initial steps, on the correct conformation of the meridional channel and on the correct arrangement of the blade rows. The preliminary geometry thus obtained is used as a starting point for the hydrodynamic optimization procedure, carried out using a CFD calculation software coupled with a genetic algorithm that generates and updates a large database of turbine geometries. The optimization process is performed using a commercial approach that solves the turbulent Navier Stokes equations (RANS) by exploiting the axial-symmetric geometry of the machine. The geometries generated within the database are therefore calculated in order to determine the corresponding overall performance. In order to speed up the optimization calculation, an artificial neural network (ANN) based on the use of an objective function is employed. The procedure was applied for the specific case of a propeller turbine with an innovative design of a modular type, specific for applications characterized by very low heads. The procedure is tested in order to verify its validity and the ability to automatically obtain the targeted net head and the maximum for the total to total internal efficiency.

Keywords: renewable energy conversion, hydraulic turbines, low head hydraulic energy, optimization design

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65 Design & Development of a Static-Thrust Test-Bench for Aviation/UAV Based Piston Engines

Authors: Syed Muhammad Basit Ali, Usama Saleem, Irtiza Ali

Abstract:

Internal combustion engines have been pioneers in the aviation industry, use of piston engines for aircraft propulsion, from propeller-driven bi-planes to turbo-prop, commercial, and cargo airliners. To provide an adequate amount of thrust piston engine rotates the propeller at a specific rpm, allowing enough mass airflow. Thrust is the only forward-acting force of an aircraft that helps heavier than air bodies to fly, depending on the mathematical model and variables included in that with the correct measurement. Test-benches have been a bench-mark in the aerospace industry to analyse the results before a flight, having paramount significance in reliability and safety engineering, depending on the mathematical model and variables included in that with the correct measurement. Calculation of thrust from a piston engine also depends on environmental changes, the diameter of the propeller, and the density of air. The project would be centered on piston engines used in the aviation industry for light aircraft and UAVs. A static thrust test bench involves various units, each performing a designed purpose to monitor and display. Static thrust tests are performed on the ground, and safety concerns hold paramount importance. The execution of this study involves research, design, manufacturing, and results based on reverse engineering initiating from virtual design, analytical analysis, and simulations. The final evaluation of results gathered from various methods such as co-relation between conventional mass-spring and digital loadcell. On average, we received 17.5kg of thrust (25+ engine run-ups – around 40 hours of engine run), only 10% deviation from analytically calculated thrust –providing 90% accuracy.

Keywords: aviation, aeronautics, static thrust, test bench, aircraft maintenance

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64 A Primary Care Diagnosis of Middle-Aged Men with Oral Cancer Who Underwent Extensive Resection and Flap Repair: A Case Report

Authors: Ching-Yi Huang, Pi-Fen Cheng, Hui-Zhu Chen, Shi Ting Huang, Heng-Hua Wang

Abstract:

This is a case of oral cancer after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap. The nursing period lasted From September 25 to October 3, 2017, through observation, interview, physical assessment, and medical record review, the author identified the following nursing problems: acute pain, impaired oral mucous membrane, and body image change. During the nursing period, the author provided individual and overall nursing care and established mutual trust through the use of empathy. Author listened and eased the patient's physical indisposition, such as wound pain, we use medications and acupuncture massage to relieve pain. However, for oral mucosa change caused by surgery, provide continuous and complete oral care and oral exercise training to improve oral mucosal healing and restore swallowing function. In the body-image changes, guided him to express his feeling after the body-image change, and enhanced support and from the family, and encouraged him to attend head and neck cancer survivor alliance which allowed the patient to accept the altered body image and reaffirm self-worth. Hopefully, through sharing this nursing experience will help to the nursing care quality of nursing care for oral cancer patients after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap.

Keywords: oral cancer, acute pain, impaired oral mucous membrane, body image change

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63 Analysis of Waterjet Propulsion System for an Amphibious Vehicle

Authors: Nafsi K. Ashraf, C. V. Vipin, V. Anantha Subramanian

Abstract:

This paper reports the design of a waterjet propulsion system for an amphibious vehicle based on circulation distribution over the camber line for the sections of the impeller and stator. In contrast with the conventional waterjet design, the inlet duct is straight for water entry parallel and in line with the nozzle exit. The extended nozzle after the stator bowl makes the flow more axial further improving thrust delivery. Waterjet works on the principle of volume flow rate through the system and unlike the propeller, it is an internal flow system. The major difference between the propeller and the waterjet occurs at the flow passing the actuator. Though a ducted propeller could constitute the equivalent of waterjet propulsion, in a realistic situation, the nozzle area for the Waterjet would be proportionately larger to the inlet area and propeller disc area. Moreover, the flow rate through impeller disk is controlled by nozzle area. For these reasons the waterjet design is based on pump systems rather than propellers and therefore it is important to bring out the characteristics of the flow from this point of view. The analysis is carried out using computational fluid dynamics. Design of waterjet propulsion is carried out adapting the axial flow pump design and performance analysis was done with three-dimensional computational fluid dynamics (CFD) code. With the varying environmental conditions as well as with the necessity of high discharge and low head along with the space confinement for the given amphibious vehicle, an axial pump design is suitable. The major problem of inlet velocity distribution is the large variation of velocity in the circumferential direction which gives rise to heavy blade loading that varies with time. The cavitation criteria have also been taken into account as per the hydrodynamic pump design. Generally, waterjet propulsion system can be parted into the inlet, the pump, the nozzle and the steering device. The pump further comprises an impeller and a stator. Analytical and numerical approaches such as RANSE solver has been undertaken to understand the performance of designed waterjet propulsion system. Unlike in case of propellers the analysis was based on head flow curve with efficiency and power curves. The modeling of the impeller is performed using rigid body motion approach. The realizable k-ϵ model has been used for turbulence modeling. The appropriate boundary conditions are applied for the domain, domain size and grid dependence studies are carried out.

Keywords: amphibious vehicle, CFD, impeller design, waterjet propulsion

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62 Aerodynamic Interference of Propellers Group with Adjustable Mutual Position

Authors: Michal Biały, Krzysztof Skiba, Zdzislaw Kaminski

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The research results of the influence of the adjustable mutual position of the propellers for getting optimal lift force on a specially designed bench. The bench consists of frame with electric motors and with attached propellers. Engines were arranged in a matrix of two columns and three rows. The distance between the columns averages from 0 to 20”, while the engine was placed at a height of 8”, 15.5” and 23.6”. By adjusting the tilt of an electric motor, an angle of the propeller in the range of 0° to 60°, by 15° was controlled. Propellers with a diameter of 8" and pitch of 4.5” were driven by brushless model engines Roxxy BL-Outrunner 2827/26 with a power of 110W (each). Rotational speed control of electric motors were realized parallel for all propellers. The speed adjustment was realized using an aggregate of radio-controlled regulators. Electric power supplied to the engines from zero to maximum power, by the setting for every 14W, was controlled by radio system. Measurement system was placed on a laboratory scale. The lift was measured and recorded by an electronic scale. The lift force for different configurations of propellers arrangement was recorded during the test. All propellers were driven in one rotational direction and in different directions when they were in the same pairs. Propellers were driven concurrently and contra-concurrently along one of the columns and along the selected rows. During the tests, except the lift, parameters such as: rotational speed of propellers, voltage and current to the electric engines were recorded. The main aim of the research was to show the influence of aerodynamic interference between the propellers to receive lift force depending on the drive configuration of individual propellers. The research has shown that, this interference exists. The increase of the lift force for a distance between columns above 26.6” was noticed during the driving propellers in different directions. The optimum tilt angle of the propeller was 45°. Furthermore there has been also approx. 12% increase of the lift for propellers driven alternately in column and contra-concurrently in relation to the contra-rotating drive in the row.

Keywords: aerodynamic, interference, lift force, propeller, propulsion system

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61 Study on Capability of the Octocopter Configurations in Finite Element Analysis Simulation Environment

Authors: Jeet Shende, Leonid Shpanin, Misko Abramiuk, Mattew Goodwin, Nicholas Pickett

Abstract:

Energy harvesting on board the Unmanned Ariel Vehicle (UAV) is one of the most rapidly growing emerging technologies and consists of the collection of small amounts of energy, for different applications, from unconventional sources that are incidental to the operation of the parent system or device. Different energy harvesting techniques have already been investigated in the multirotor drones, where the energy collected comes from the systems surrounding ambient environment and typically involves the conversion of solar, kinetic, or thermal energies into electrical energy. The energy harvesting from the vibrated propeller using the piezoelectric components inside the propeller has also been proven to be feasible. However, the impact on the UAV flight performance using this technology has not been investigated. In this contribution the impact on the multirotor drone operation has been investigated at different flight control configurations which support the efficient performance of the propeller vibration energy harvesting. The industrially made MANTIS X8-PRO octocopter frame kit was used to explore the octocopter operation which was modelled using SolidWorks 3D CAD package for simulation studies. The octocopter flight control strategy is developed through integration of the SolidWorks 3D CAD software and MATLAB/Simulink simulation environment for evaluation of the octocopter behaviour under different simulated flight modes and octocopter geometries. Analysis of the two modelled octocopter geometries and their flight performance is presented via graphical representation of simulated parameters. The possibility of not using the landing gear in octocopter geometry is demonstrated. The conducted study evaluates the octocopter’s flight control technique and its impact on the energy harvesting mechanism developed on board the octocopter. Finite Element Analysis (FEA) simulation results of the modelled octocopter in operation are presented exploring the performance of the octocopter flight control and structural configurations. Applications of both octocopter structures and their flight control strategy are discussed.

Keywords: energy harvesting, flight control modelling, object modeling, unmanned aerial vehicle

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60 An Investigation on Hybrid Composite Drive Shaft for Automotive Industry

Authors: Gizem Arslan Özgen, Kutay Yücetürk, Metin Tanoğlu, Engin Aktaş

Abstract:

Power transmitted from the engine to the final drive where useful work is applied through a system consisting of a gearbox, clutch, drive shaft and a differential in the rear-wheel-drive automobiles. It is well-known that the steel drive shaft is usually manufactured in two pieces to increase the fundamental bending natural frequency to ensure safe operation conditions. In this work, hybrid one-piece propeller shafts composed of carbon/epoxy and glass/epoxy composites have been designed for a rear wheel drive automobile satisfying three design specifications, such as static torque transmission capability, torsional buckling and the fundamental natural bending frequency. Hybridization of carbon and glass fibers is being studied to optimize the cost/performance requirements. Composites shaft materials with various fiber orientation angles and stacking sequences are being fabricated and analyzed using finite element analysis (FEA).

Keywords: composite propeller shaft, hybridization, epoxy matrix, static torque transmission capability, torsional buckling strength, fundamental natural bending frequency.

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59 Optimal Design of Wind Turbine Blades Equipped with Flaps

Authors: I. Kade Wiratama

Abstract:

As a result of the significant growth of wind turbines in size, blade load control has become the main challenge for large wind turbines. Many advanced techniques have been investigated aiming at developing control devices to ease blade loading. Amongst them, trailing edge flaps have been proven as effective devices for load alleviation. The present study aims at investigating the potential benefits of flaps in enhancing the energy capture capabilities rather than blade load alleviation. A software tool is especially developed for the aerodynamic simulation of wind turbines utilising blades equipped with flaps. As part of the aerodynamic simulation of these wind turbines, the control system must be also simulated. The simulation of the control system is carried out via solving an optimisation problem which gives the best value for the controlling parameter at each wind turbine run condition. Developing a genetic algorithm optimisation tool which is especially designed for wind turbine blades and integrating it with the aerodynamic performance evaluator, a design optimisation tool for blades equipped with flaps is constructed. The design optimisation tool is employed to carry out design case studies. The results of design case studies on wind turbine AWT 27 reveal that, as expected, the location of flap is a key parameter influencing the amount of improvement in the power extraction. The best location for placing a flap is at about 70% of the blade span from the root of the blade. The size of the flap has also significant effect on the amount of enhancement in the average power. This effect, however, reduces dramatically as the size increases. For constant speed rotors, adding flaps without re-designing the topology of the blade can improve the power extraction capability as high as of about 5%. However, with re-designing the blade pretwist the overall improvement can be reached as high as 12%.

Keywords: flaps, design blade, optimisation, simulation, genetic algorithm, WTAero

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58 Free Fibular Flaps in Management of Sternal Dehiscence

Authors: H. N. Alyaseen, S. E. Alalawi, T. Cordoba, É. Delisle, C. Cordoba, A. Odobescu

Abstract:

Sternal dehiscence is defined as the persistent separation of sternal bones that are often complicated with mediastinitis. Etiologies that lead to sternal dehiscence vary, with cardiovascular and thoracic surgeries being the most common. Early diagnosis in susceptible patients is crucial to the management of such cases, as they are associated with high mortality rates. A recent meta-analysis of more than four hundred thousand patients concluded that deep sternal wound infections were the leading cause of mortality and morbidity in patients undergoing cardiac procedures. Long-term complications associated with sternal dehiscence include increased hospitalizations, cardiac infarctions, and renal and respiratory failures. Numerous osteosynthesis methods have been described in the literature. Surgical materials offer enough rigidity to support the sternum and can be flexible enough to allow physiological breathing movements of the chest; however, these materials fall short when managing patients with extensive bone loss, osteopenia, or general poor bone quality, for such cases, flaps offer a better closure system. Early utilization of flaps yields better survival rates compared to delayed closure or to patients treated with sternal rewiring and closed drainage. The utilization of pectoralis major flaps, rectus abdominus, and latissimus muscle flaps have all been described in the literature as great alternatives. Flap selection depends on a variety of factors, mainly the size of the sternal defect, infection, and the availability of local tissues. Free fibular flaps are commonly harvested flaps utilized in reconstruction around the body. In cases regarding sternal reconstruction with free fibular flaps, the literature exclusively discussed the flap applied vertically to the chest wall. We present a different technique applying the free fibular triple barrel flap oriented in a transverse manner, in parallel to the ribs. In our experience, this method could have enhanced results and improved prognosis as it contributes to the normal circumferential shape of the chest wall.

Keywords: sternal dehiscence, management, free fibular flaps, novel surgical techniques

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57 Periodontal Disease or Cement Disease: New Frontier in the Treatment of Periodontal Disease in Dogs

Authors: C. Gallottini, W. Di Mari, A. Amaddeo, K. Barbaro, A. Dolci, G. Dolci, L. Gallottini, G. Barraco, S. Eramo

Abstract:

A group of 10 dogs (group A) with Periodontal Disease in the third stage, were subjected to regenerative therapy of periodontal tissues, by use of nano hydroxy apatite (NHA). These animals induced by general anesthesia, where treated by ultrasonic scaling, root planning, and at the end by a mucogingival flap in which it was applied NHA. The flap was closed and sutured with simple steps. Another group of 10 dogs (group B), control group, was treated only by scaling and root planning. No patient was subjected to antibiotic therapy. After three months, a check was made by inspection of the oral cavity, radiography and bone biopsy at the alveolar level. Group A showed a total restitutio ad integrum of the periodontal structures, and in group B still mild gingivitis in 70% of cases and 30% of the state remains unchanged. Numerous experimental studies both in animals and humans have documented that the grafts of porous hydroxyapatite are rapidly invaded by fibrovascular tissue which is subsequently converted into mature lamellar bone tissue by activating osteoblast. Since we acted on the removal of necrotic cementum and rehabilitating the root tissue by polishing without intervention in the ligament but only on anatomical functional interface of cement-blasts, we can connect the positive evolution of the clinical-only component of the cement that could represent this perspective, the only reason that Periodontal Disease become a Cement Disease, while all other clinical elements as nothing more than a clinical pathological accompanying.

Keywords: nanoidroxiaphatite, parodontal disease, cement disease, regenerative therapy

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56 The Use of STIMULAN Resorbable Antibiotic Beads in Conjunction with Autologous Tissue Transfer to Treat Recalcitrant Infections and Osteomyelitis in Diabetic Foot Wounds

Authors: Hayden R Schott, John M Felder III

Abstract:

Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

Procedia PDF Downloads 54