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Background This study aimed to quantify the blood flow of free flaps and compare the blood flow of small vessel (<0.8 mm) and larger vessel (>0.8 mm) anastomosed free flaps. Methods This retrospective study included patients treated successfully with a perforator free flap in the lower extremity between June 2015 and March 2017. A color duplex ultrasound system measured the flow volume through the pedicle by analyzing the mean flow peak velocity, flow volume, and flow volume per 100 g of the flap. Results A total of 69 patients were enrolled in this study. There was no statistical difference in peak velocity between the small vessel anastomosed free flap (25.2 ± 5.6) and larger vessel anastomosed free flap (26.5 ± 5.4). Flow volume (6.8 ± 4.2 vs. 6.3 ± 3.6) and flow volume/100 g (3.6 ± 3.9 vs. 6.2 ± 6.9) also did not show significant differences. Conclusion Small vessel (<0.8 mm) free flaps showed similar flow velocity and flow volume to larger vessel (>0.8 mm) anastomosed free flaps. Blood flow to the small vessel anastomosed free flap was sufficient despite its small vessel size. [ABSTRACT FROM AUTHOR]

Background Implant-based breast reconstruction is associated with increased risk of early infection and late-stage capsular contracture. Objectives We evaluated the feasibility of a dual drug–releasing patch that enabled the controlled delivery of antibiotics and immunosuppressants in a temporally and spatially appropriate manner to the implant site. Methods The efficacy of a dual drug–releasing patch, which was 3-dimensional–printed (3D-printed) with tissue-derived biomaterial ink, was evaluated in rats with silicone implants. The groups included implant only (n = 10); implant plus bacterial inoculation (n = 14); implant, bacterial inoculation, and patch loaded with gentamycin placed on the ventral side of the implant (n = 10), and implant, bacterial inoculation, and patch loaded with gentamycin and triamcinolone acetonide (n = 9). Histologic and immunohistochemical analyses were performed 8 weeks after implantation. Results The 2 drugs were sequentially released from the dual drug–releasing patch and exhibited different release profiles. Compared to the animals with bacterial inoculation, those with the antibiotic-only and the dual drug–releasing patch exhibited thinner capsules and lower myofibroblast activity and inflammation, indicating better tissue integration and less foreign body response. These effects were more pronounced with the dual drug–releasing patch than with the antibiotic-only patch. Conclusions The 3D-printed dual drug–releasing patch effectively reduced inflammation and capsule formation in a rat model of silicone breast reconstruction. The beneficial effect of the dual drug–releasing patch was better than that of the antibiotic-only patch, indicating its therapeutic potential as a novel approach to preventing capsular contracture while reducing concerns of systemic side effects. [ABSTRACT FROM AUTHOR]

The mammalian target of rapamycin (mTOR) inhibitors are used to prevent organ transplant rejection and are preferred over other immunosuppressants due to its low nephrotoxicity. However, mTOR inhibitors have been associated with various adverse effects including lymphedema. Although rare in incidence, previously known treatments for mTOR inhibitor-induced lymphedema were limited to discontinuation of related drugs and complex disruptive therapy with variable results. In this article, three patients who developed lymphedema in their lower limbs after using mTOR inhibitors, including two bilateral and one unilateral case, were treated with physiologic surgery methods such as lymphovenous anastomosis (LVA) and lymph node transfer. The efficacy of the treatment was evaluated. In the three cases described, cessation of the drug did not lead to any reduction in edema. The use of LVA and lymph node transfer resulted in early reductions in volume but failed to sustain over time. All patients underwent secondary nonphysiologic surgery such as liposuction resulting in sustained improvement. This series presents the first physiologic approach to mTOR inhibitor-induced lymphedema. Although further study is warranted, the physiologic surgical options may have limited success and nonphysiologic options may offer better sustainable results. [ABSTRACT FROM AUTHOR]

Background. In this study, we established two rat models that mimic human submuscular and premuscular breast reconstruction. We analyzed the capsule formation according to surgical techniques and adjacent tissues, including the chest wall tissues, such as the ribs and acellular dermal matrices (ADMs) that come in contact with silicone implants. Methods. This study consisted of experiments on 12 Sprague–Dawley rats that underwent implant reconstruction using ADM. They were divided into two groups: rats that underwent dual-plane implantation (n = 6; group 1) and those that underwent premuscular implant insertion (n = 6; group 2). All rats were irradiated with 35 Gy of fractionated radiation. Three months after surgery, the histology and immunochemistry of the capsule tissues of the ADM, muscle, and chest wall were analyzed. Results. Overall capsule thickness was thicker in group 1. Based on the tissue in contact with the silicone implant, ADM had a thinner capsule, less inflammation, less fibrosis, and less vascularization than the muscle and chest wall tissues. Conclusions. This study described two rat models of clinically relevant implant-based breast reconstruction using a submuscular and premuscular plane, ADM, and irradiation. Overall, the premuscular implantation rat model was associated with a thinner capsule. The ADM in contact with the silicone implant, even after irradiation, had superior protection from radiation compared with the other tissues. [ABSTRACT FROM AUTHOR]

Background This cadaveric study aimed to describe the anatomy of the profunda artery perforators (PAPs). Methods In total, nine free cadavers with 18 upper thighs were dissected, 12 of which were from female cadavers, and 6 were from male cadavers. The average age of the cadavers was 84.7 ± 4.2 years. Dissection was performed to evaluate the anatomic position and characteristics of the femoral PAPs. The perforator distance from the gluteal sulcus, number of perforators, perforating muscles, diameter of the perforators, origin of the perforators, and number of nerves passing above and below the perforators were determined. Results The average number of perforators that penetrate the adductor magnus muscle was 2.5. The average distance from the origin of the perforators to the gluteal sulcus was 71.72 ± 28.23 mm. The average numbers of the obturator nerves passing above and below the perforator in the adductor magnus muscle were 1.3 (range, 0–4) and 0.7 (range, 0–2), respectively. Conclusion The results provide a detailed anatomic basis for the PAP flap. The perforators of a PAP flap may be included in a flap with a transverse design. Sacrificing the small obturator nerves during dissection may not lead to significant donor site morbidity. [ABSTRACT FROM AUTHOR]

Background This study compared the reconstructive outcomes and fat necrosis of the profunda artery perforator (PAP) flap with those of the deep inferior epigastric perforator (DIEP) flap. Methods Data on all DIEP and PAP flap breast reconstructions performed between 2018 and 2021 at Asan Medical Center were compared. The overall reconstructive outcomes and presence of fat necrosis were analyzed through ultrasound evaluation performed by a board-certified radiologist. Results The PAP (n = 43) and DIEP flaps (n = 99) were used to reconstruct 31 and 99 breasts, respectively. The average age of the patients in the PAP flap group (39.1 ± 7.3 years) was lower than in the DIEP flap group (47.4 ± 7.7 years), and the body mass index (BMI) of patients undergoing PAP flap reconstruction (22.7 ± 2.8 kg/m 2) was lower than those undergoing DIEP flap reconstruction (24.3 ± 3.4 kg/m 2). There was no total loss of both flaps. Donor site morbidity was higher in the PAP flap group (11.1%) compared with the DIEP flap (1.0%). The rate of fat necrosis was higher in the PAP flaps (40.7%) than in the DIEP flaps (17.8%) during ultrasound. Conclusion In our study, we found that PAP flap reconstruction tended to be performed in patients who were younger with lower BMIs compared with the DIEP flap. Successful reconstructive outcomes were observed in both the PAP and DIEP flaps; however, a higher rate of necrosis was observed in the PAP flap compared with the DIEP flap. [ABSTRACT FROM AUTHOR]

Background Despite the extensive use of various imaging modalities, there is limited literature on comparing the reliability between indocyanine green (ICG) lymphography, MR Lymphangiogram (MRL), and high frequency color Doppler ultrasound (HFCDU) to identify lymphatic vessels. Method In this study of 124 patients, the correlation between preoperative image findings to the actual lymphatic vessel leading to lymphovenous anastomosis (LVA) was evaluated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and simple detection were calculated. Subgroup analysis was also performed according to the severity of lymphedema. Results Total of 328 LVAs were performed. The HFCDU overall had significantly higher sensitivity for identifying lymphatic vessels (99%) over MRL (83.5%) and ICG lymphography (82.3%)(p < 0.0001). Both ICG lymphography and HFCDU had 100% specificity and PPV. The NPV was 3.6%, 6.5% and 57.1% respectively for MRL, ICG lymphography, and HFCDU. All modalities showed high sensitivity for early stage 2 lymphedema while HFCDU showed a significantly higher sensitivity for late stage 2 (MRL:79.7%, ICG:83.1%, HFCDU:97%) and stage 3 (MRL:79.7%, ICG:79.7%, HFCDU:100%) over the other two modalities (p < 0.0001). Conclusion This study demonstrated while all three modalities are able to provide good information, the sensitivity may alter as the severity of lymphedema progresses. The HFCDU will provide the best detection for lymphatic vessels throughout all stages of lymphedema. However, as each modality provides different and unique information, combining and evaluating the data according to the stage of lymphedema will be able to maximize the chance for a successful surgical outcome. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate the usefulness of the selective use of the superficial circumflex iliac artery perforator (SCIP) and the superficial inferior epigastric artery (SIEA) flap as a workhorse flap from the groin area with precise preoperative surgical planning. Methods A total of 79 free flap reconstructions were performed in the study period; 35 SCIP free flaps and 19 SIEA free flaps were performed in the study period. Detailed preoperative surgical planning was performed using computed tomography (CT) angiography and color Doppler ultrasound. Detailed anatomical information of the flaps and reconstructive outcomes were evaluated. Results Flap characteristics between SCIP free flaps and SIEA free flaps were similar. The average transverse distance of the perforator from anterior superior iliac spine was 15.91 cm in SCIP free flaps and 43.15 cm in SIEA free flaps. The overall flap success rate was 96.4%. Majority of the patients achieved satisfactory contour without debulking surgery. Donor site morbidity was minimal with one case of wound dehiscence. Conclusion The selective use of the SCIP and SIEA free flap in groin area is a safe and useful technique. The surgical outcomes were reliable and similar between the SCIP and SIEA free flaps. Preoperative vascular planning using CT angiography and color Doppler ultrasound is essential for selecting the proper flap. [ABSTRACT FROM AUTHOR]

Background  Among the many factors involved in reconstructive microsurgery, identifying a good recipient vessel is one of the key elements leading to a successful result. Methods  Multiple modalities have been used to identify recipient vessels from simple palpation of axial arteries to hand-held Doppler, duplex ultrasound, computed tomography angiograms, and other advanced techniques. Although these various modalities bring their own unique advantages, using the duplex ultrasound can provide far superior and real-time information based on the anatomy and physiology of the recipient vessel. Results  Duplex ultrasound is a valuable and powerful tool for reconstructive surgeons who are interested in performing microsurgery or supermicrosurgery. Conclusion  As we enter the era of individualized/customized reconstruction using superthin flaps, perforator-to-perforator anastomosis, and supermicrosurgery, understanding and becoming versatile with duplex ultrasound will be critical especially in choosing recipient vessels. [ABSTRACT FROM AUTHOR]

Background  The local flaps, especially perforator and keystone flaps, are used as first-line treatment option in reconstruction of small tomoderate-sized defect of the extremity. However, the high complication rate associated with these flaps may hinder this usage. Methods  This article reviews the technical and clinical aspect of using color duplex ultrasound)CDU) in the preoperative, intraoperative, and postoperative period for propeller and keystone flaps. Results  CDU allows the surgeon to understand the anatomical aspect of the perforator such as the location, point of penetration on the deep fascia, subcutaneous pathway)axiality) and physiological aspect such as velocity and flow volume. Understanding and utilizing this information will allow accurate preoperative design, intraoperative decision making, and postoperative monitoring, leading to better outcome. Conclusion  Carefully designed local perforator flaps based on anatomy and physiology using CDU will be a powerful armamentarium for reconstruction of the lower extremity. [ABSTRACT FROM AUTHOR]

The absence of standardized methods of the visible defects quantification has induced inconsistent results in quality assurance of OLED displays. Herein, an effective quantification method for evaluating horizontal line defects by interference of flexible OLED and touch sensor were proposed and a specific contrast sensitivity (CS) levels below 1.0 was established as meaning "invisible defect". [ABSTRACT FROM AUTHOR]

Background  Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. Patients and Methods  This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. Results  Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p < 0.05). Conclusion  The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty. [ABSTRACT FROM AUTHOR]

This study aimed to analyze long-term performance of JPCP (jointed plain concrete pavement) according to changes in standard mix design using evaluation of concrete properties based on Korea HPMS (highway pavement management system) and Korea LTPP (long-term pavement performance) data accumulated for over 15 years. The concrete pavements built in the 2010s by the specification of a durability-based mix design adopted in 2010 were found to have better performance with much fewer surface distresses than the concrete pavements built before 2010 by the specification of a classical strength-based mix design. Also, in order to realize long-life concrete pavement, experimental construction was carried out for high-durability concrete mix design. The performance monitoring data for the construction site implied that the high-durability mix design can make it possible to lead a long-life concrete pavement. [ABSTRACT FROM AUTHOR]

The morphologies and surface conditions of ZnO microstructures have been controlled facilely via a microwave-assisted one-pot synthetic route by varying the ammonia concentration of the reaction mixture. Ammonia affects the nucleation, growth, and hydrolysis kinetics of a zinc glycerolate intermediate to induce shape variation from flower-like ZnO microstructures to various ZnO twin microstructures with a preferred exposure of ± (0001) polar planes. The as-prepared ZnO microstructures are mesoporous, as they have large specific surface areas and high specific pore volumes that have resulted from the microwave-assisted fast hydrolysis of the zinc glycerolate intermediate microstructures. Owing to the novel features of microwaves, the ZnO microstructures have numerous microcracks and wrinkles on their surfaces and show characteristic defect-driven orange emission, whose intensity increases with the specific surface area. The photocatalytic degradation rate constant of rhodamine B via our prepared ZnO microstructures has been found to increase linearly with the specific surface area, the specific pore volume, and the polar-surface exposure. Our simple and rapid microwave-assisted synthetic method is considered to be beneficial to the development of morphology-controlled metal oxides that are applicable for eco-friendly waste-water treatments. [ABSTRACT FROM AUTHOR]

Mesoporous anatase TiO2 nanostructures with diverse morphologies ranging from rod-like 1D nanostructures to diverse hedgehog-like 3D hierarchical nanostructures have been found to display highly efficient photocatalytic and photovoltaic performances. Hierarchical 3D nanostructures exhibit 5.5 times higher photocatalytic activity than rod-like 1D nanostructures, and the DSSC efficiency of hierarchical 3D nanostructures becomes as high as 5.37%, which is 50% higher than the DSSC efficiency of 1D nanostructures. The high photocatalytic performances of the hierarchical 3D anatase TiO2 nanostructures have been attributed mainly to their large specific pore volume, whereas the high photovoltaic performances of hierarchical 3D nanostructures have been attributed not only to their high specific surface area and the large specific pore volume but also to their interparticular connectivity. Comparative experimental studies have shown that the as-prepared hierarchical mesoporous anatase TiO2 nanostructures show superior photocatalytic (three times higher) and photovoltaic performances (35% higher) to commercially available Degussa P25 TiO2. [ABSTRACT FROM AUTHOR]

The morphologies of anatase TiO2 crystals have been varied facilely from rod-like structures to various hedgehog-like hierarchical structures via formation of titanium glycerolate precursors as sacrificial templates. The morphologies of the precursors have been readily controlled under microwave irradiation by adjusting the relative solvent volumes of isopropanol and glycerol. The simple hydrolysis of the as-prepared titanium glycerolate precursors for 10 min under microwave irradiation has yielded intrinsic morphology-retained anatase TiO2 nanostructures. The smooth surfaces of the precursors have been turned into rough surfaces of anatase TiO2 crystals during the hydrolysis, suggesting that our as-prepared anatase TiO2 nanostructures have high potential applications in diverse fields such as photocatalysis and in solar cells. It has been suggested that the variation of the relative volume fractions of isopropanol and glycerol having significantly different boiling points and viscosity values has changed the nucleation and growth kinetics so the morphologies as well as the sizes of titanium glycerolate precursors can be controlled. [ABSTRACT FROM AUTHOR]

Theexcited-state proton transfer (ESPT) of 7-hydroxyquinoline(7HQ) in bulk alcoholic solvents has been explored with variationof protic hydrogen atoms as well as alcohols. By measuring time-resolvedkinetic profiles at two different excitation wavelengths, we haveobserved conformation-specific pathways in the ESPT of 7HQ. Thereare two possible rotamers of 7HQ according to the configuration ofits hydroxyl group, which are transand cis. On one hand, trans-7HQ cannot undergo proton transferwithin its excited-state lifetime because the internal rotation ofthe hydroxyl group to form cis-7HQ hardly occurs.On the other hand, some cis-7HQ molecules exist ascyclic complexes of 7HQ·(alcohol)2at the moment ofexcitation, and the cyclic complexes can undergo ESPT rapidly viatunneling. However, the other cis-7HQ molecules shouldundergo solvent reorganization to form cyclic 7HQ·(alcohol)2complexes prior to intrinsic ESPT, and the solvent reorganizationbecomes the rate-determining step. In contrast to proton transfer,where intrinsic ESPT and solvent reorganization have been observedseparately in time-resolved kinetic profiles, intrinsic deuteron transferis too slow to be distinguished kinetically from solvent reorganization. [ABSTRACT FROM AUTHOR]

Background: In this study, the authors compared conventional and robot-assisted mastectomy and breast reconstruction. To the authors' knowledge, this study is the first to report the results of robot-assisted mastectomy and breast reconstruction and provide a comparison of patient-reported outcomes., Method: This retrospective study included 473 breasts of 423 patients who underwent conventional mastectomy and breast reconstruction and 164 breasts of 153 patients who underwent robot-assisted mastectomy and breast reconstruction from July of 2019 to October of 2021. Demographic and oncologic data, reconstructive outcomes, and patient-reported outcomes (BREAST-Q) were evaluated. The results of implant-based and autologous breast reconstruction were evaluated separately., Results: Skin necrosis requiring surgical débridement occurred significantly more frequently in the conventional group (8.0%) than in the robot-assisted group (2.0%) in implant-based reconstruction ( P = 0.035). At 6 to 12 months, patients who underwent robot-assisted breast reconstruction showed a higher Sexual Well-being score for implant-based reconstruction and a higher Physical Well-being score for autologous breast reconstruction than conventional breast reconstruction according to the BREAST-Q questionnaire., Conclusions: Robot-assisted mastectomy and breast reconstruction was associated with less skin necrosis and better patient-reported outcomes (Sexual Well-being for implant-based reconstruction and Physical Well-being for autologous breast reconstruction) than the conventional option. Robotic surgery could be a good option for mastectomy and breast reconstruction., Clinical Question/level of Evidence: Therapeutic, III., (Copyright © 2023 by the American Society of Plastic Surgeons.)