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Background: Postoperative free flap monitoring is essential for immediately detecting obstruction of anastomosed vessels with successive recovery surgery for salvaging flaps. We performed postoperative nursing monitoring using handheld Doppler sonography, but nurses reported feeling anxious with this approach and demanded a clear-cut evaluation method. Therefore, we implemented monitoring with the fingerstall-type tissue oximeter Toccare, a noninvasive device that enables easy flap checking by simply touching the flap with a probe. Method: Handheld Doppler was used for nursing monitoring from April to October 2020, with anxiety associated with its use reported. We collected information via an anonymous questionnaire to determine the reason for the anxiety. Toccare was subsequently applied for postoperative free flap monitoring by nurses. The protocol involved measuring tissue oxygen saturation by touching the flap with a Toccare probe every 4 hours from 24 to 100 hours postoperatively. Seven months later, a second anonymous questionnaire was conducted, and results were compared. Result: Free deep inferior epigastric artery perforator flaps and anterolateral thigh flaps (n = 5 each) were included. The average tissue oxygen saturation values in the deep inferior epigastric artery perforator and anterolateral thigh flaps were 52.0% and 52.4%, respectively. According to the second questionnaire about Toccare, 7% felt anxious, 62% felt slightly anxious, and 31% did not feel anxious. Toccare was preferred by 89% of nurses who had used both methods. Conclusions: Flap monitoring using Toccare reduced nurses’ anxiety. A numerical evaluation method with easy handling and clear doctor call criteria is essential for low-anxiety nursing monitoring. more...

Replacing an infected prosthetic thoracic aorta graft carries a high re-infection risk. We previously reported two clinical cases successfully treated with a new muscular wrapping technique: latissimus dorsi (LD) muscle flap with a distally based serratus anterior (SA) extension; however, a cadaveric study to prove the regular existence of the distal attachment area was lacking. We tried to establish an appropriate way of elevating the combined muscle flap safely. All of the cadavers were preserved using the Thiel embalming technique to retain flexibility. We checked for the existence of the distal attachment area between the LD and SA. Combined muscle flaps were elevated proximally while identifying the thoracodorsal artery, including the LD and SA branches. After the SA branch was ligated and cut, the SA muscle was manually peeled from the LD muscle with only the distal tight attachment area remaining. Contrast-enhanced computed tomography was performed using a multislice computed tomography system. Six human cadavers (three men, three women: 91 years old, on average) were examined. All six LD and SA combined muscle flaps showed a distal tight attachment area at the level from the seventh rib to the ninth rib. The tip of the SA muscle easily reached the sternum. Contrast-enhanced computed tomography failed to reconfirm the distal vascular flow from the LD to the reverse SA muscle, which we had visualized in a clinical case. We demonstrated the anatomical reliability of the new Y-shaped muscular flaps, which are suitable for preventing re-infection of aortic graft replacement. more...

A near-real-time computerized ionospheric tomography (CIT) technique was developed over the East Asian sector to specify the 3-D electron density field. The technique is based on a plethora of Global Navigation Satellite System observables within the region of interest which is bounded horizontally 110°–160°E and 10°–60°N and extending from 80 to 25, 000 km in altitude. Prior to deployment, studies validated the CIT results using ionosonde, middle-upper atmosphere radar and occultation data and found the technique to adequately reconstruct the regional ionosphere vertical structure. However, with room for improvement in estimating the peak height and avoiding physically unrealistic negative densities in the final solution, we present preliminary results from a technique that addresses these issues by incorporating CIT results into a data assimilation (DA) technique. The DA technique adds ionosonde bottomside measurements into CIT results, thereby improving the accuracy of the reconstructed bottomside 3-D structure. More specifically, on average CIT NmF2 and hmF2 improve by more than 60%. Further, during analysis, ionospheric electron densities are assumed to be better described by probability log-normal distribution, which introduces the positivity constraint that is mandatory in ionospheric imaging. more...

Wassel VI radial polydactyly is associated with metacarpal adduction and radial deviation of the metacarpophalangeal joint of the ulnar duplicate. The soft tissue abnormalities responsible for these deformities were characterized using preoperative multi-planar three-dimensional ultrasound and intraoperative observation in four patients. In all patients, the abductor pollicis brevis and superficial head of the flexor pollicis brevis inserted into the radial first metacarpal, whereas the adductor pollicis and deep head of the flexor pollicis brevis inserted into the ulnar thumb. Aberrant location of the flexor pollicis longus and absence of the A1 pulley system was associated with severe radial deviation. An additional superficial thenar muscle along the ulnar metacarpal was associated with minimal metacarpal adduction. Uneven forces on the ulnar duplicate could be associated with these characteristic deformities and joint instability. Knowledge of these abnormalities allows better planning of surgery and further insight into this rare radial polydactyly configuration.Level of evidence: II. more...

This paper demonstrates and assesses the capability of the advanced three-dimensional (3-D) ionosphere tomography technique, during severe conditions. The study area is northeast Asia and quasi-Japan-centred. Reconstructions are based on total electron content data from a dense ground-based global navigation satellite system receiver network and parameters from operational ionosondes. We used observations from ionosondes, Swarm satellites and radio occultation (RO) to assess the 3-D picture. Specifically, we focus on St. Patrick’s day geomagnetic storm (17–19 March 2015), the most intense in solar cycle 24. During this event, the energy ingested into the ionosphere resulted in Dst and Kp and reaching values ~ − 223 nT and 8, respectively, and the region of interest, the East Asian sector, was characterized by a ~ 60% reduction in electron densities. Results show that the reconstructed densities follow the physical dynamics previously discussed in earlier publications about storm events. Moreover, even when ionosonde data were not available, the technique could still provide a consistent picture of the ionosphere vertical structure. Furthermore, analyses show that there is a profound agreement between the RO profiles/in-situ densities and the reconstructions. Therefore, the technique is a potential candidate for applications that are sensitive to ionospheric corrections. more...