OBJECTIVEThe purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency. ...METHODSTwenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency. RESULTSIn the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5±0.20mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0±3.77mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer. CONCLUSIONSReconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.
AIMSThe aims of this article are to provide an overview of the technique of phalloplasty by radial forearm free flap in the context of female-to-male gender reassignment surgery, with a specific ...focus on surgical technical details and the prevention of postoperative complications. METHODSIn the light of our 30 years of experience in caring for female-to-male transgender individuals and conducting a critical review of the literature, we exhaustively present our technique of radial forearm free flap phalloplasty in female-to-male gender reassignment surgery. RESULTSThe technique of radial forearm free flap phalloplasty, utilizing a one-stage approach for neourethral and neophallus construction based on the "tube within a tube" principle, not only achieves an aesthetically pleasing appearance of the neophallus resembling a normal penis with tactile and erogenous sensitivities but also yields a functional neourethra and satisfactory penile rigidity using implants for standing voiding and sexual intercourse. This intricate surgical procedure demands not only meticulous execution of all surgical maneuvers but also high-level postoperative care. Despite refinements in technique over recent decades, aesthetic sequelae at the donor site of the flap remain subject to criticism, and postoperative complications, particularly of vascular and urological nature, remain significant. CONCLUSIONFuture optimization of the surgical technique for this procedure will be imperative to minimize postoperative complications and establish a true technical "gold standard" for phalloplasty in female-to-male transgender individuals.
The aim of this study was to compare the MRI signal of the brachial plexus and surrounding muscles before and after freezing/thawing on a murine model. A first MRI going through the brachial plexuses ...of 5 healthy Wistar rats was performed immediately post-mortem. A second MRI was performed after freezing at –30°C and then thawing at 20°C for 24hours. All MRI images were segmented to make nerve and muscular structures appear and calculate the average intensity of the MRI signal using the program ImageJ. The average nerve and muscular MRI signals were compared before and after freezing/thawing and rated in grayscale units between 0 and 255. The average intensity of the MRI signal of nerve structures was 40.315 grayscale units before freezing and 31.943 after freezing/thawing. The average intensity of the MRI signal of muscular structures was 25.44 grayscale units before freezing and 35.710 after freezing/thawing. Our results have shown that the intensity of the MRI signal of the brachial plexus was higher before freezing/thawing. The intensity of the MRI signal of muscles was lower than the intensity of the brachial plexus before freezing/thawing and higher after freezing/thawing in muscles than in brachial plexus. The MRI could be used in clinical practice to monitor the reinnervation after frozen nerve allografts.
Le but de ce travail était de comparer le signal IRM du plexus brachial et des muscles environnants avant et après congélation/décongélation sur un modèle murin. Une première IRM passant par les plexus brachiaux de 5 rats Wistar sains a été réalisée en post-mortem immédiat. Une seconde IRM a été réalisée après congélation à –30°C puis décongélation à 20°C pendant 24heures. Toutes les images IRM ont été segmentées pour faire apparaître les structures nerveuses et musculaires et en calculer l’intensité moyenne du signal IRM à l’aide du logiciel ImageJ. Les moyennes des signaux IRM nerveux et musculaires ont été comparées avant et après congélation/décongélation et exprimées en niveaux de gris compris entre 0 et 255. L’intensité moyenne du signal IRM des structures nerveuses était de 40,315 unités de niveaux de gris avant congélation et 31,943 après congélation/décongélation. L’intensité moyenne du signal IRM des structures musculaires était de 25,244 unités de niveaux de gris avant congélation et 35,710 après congélation/décongélation. Nos résultats ont montré que l’intensité du signal IRM du plexus brachial était plus élevée avant qu’après congélation/décongélation. L’intensité du signal IRM était plus basse avant congélation/décongélation dans les muscles que le plexus brachial et plus haute après congélation/décongélation dans les muscles que le plexus brachial. L’IRM pourrait être utilisée en pratique clinique pour suivre la repousse des allogreffes de nerf congelés.
Complex forearm defects with significant damage to, or loss of skin, tendon, muscle, bone and neurovascular structures represent a great challenge for surgeons. The management of such injuries, ...whether a result of trauma or tumor resection, is focused on preservation of the damaged limb and restoration of hand function. A multidisciplinary approach combining plastic and orthopedic surgical expertise in a coordinated team is proposed to address these challenging cases. The authors have laid emphasis on adequate debridement for wound bed preparation, bone stabilization and reconstruction for a stable bony framework, vascular repair for early revascularization, musculotendinous and nerve reconstruction as well as vascularized tissue coverage on a case-to-case basis to facilitate optimal functional recovery. They also maintain that besides expedient surgical treatment, early mobilization based on an individualized rehabilitation program as well as psychological and socio-professional supports are necessary means of achieving rapid and successful social integration.
Advances in microsurgery together with improvements in reconstructive surgical techniques over recent decades have enlarged the scope of available techniques for mutilated hand reconstruction, ...shifting the reconstructive paradigm from restoring hand function to providing the best functional and aesthetic results with minimal donor-site morbidity. Successful reconstruction of a mutilated hand should no longer be measured only by the degree of improvement of hand function but also by a more aesthetic hand appearance as well as by improved psychological well-being. In this article, the authors present their concept of aesthetic functional reconstruction of the mutilated hand with a focus on the indications and selection of reconstructive techniques. They emphasize that in order to select the most appropriate technique, providing the best functional and aesthetic outcomes with minimal donor-site morbidity for each individual patient, it is imperative for the reconstructive hand surgeon to possess perfect mastery of all available surgical techniques, thorough understanding of functional and aesthetic requirements and accurate appreciation of multidimensional reconstruction of a given defect of the hand. They have concluded that in precisely indicated cases, successful replantation of an amputated hand or digits remains the best reconstructive procedure designed to obtain a more functional and more normal-appearing hand, whereas, toe-to-hand transplantation, in cases of failed or impossible digit replantation, provides better results than any other digit reconstruction techniques aimed at achieving functioning digits with good appearance. Although skin graft and various distant pedicled flaps and free flaps may be valid options for coverage of some soft tissue defects of the hand, reverse flow forearm flaps, especially those based on the secondary arteries of the forearm, are often the best-suited reconstructive options for like-with-like hand reconstruction. They can provide the best matching of color, texture, soft-tissue volume, donor-recipient tissue interface and fulfill all the aesthetic and functional reconstruction requirements of moderate-sized or even large soft tissue defects of the hand, with acceptable donor site morbidity.
Augmented reality could help the identification of nerve structures in brachial plexus surgery. The goal of this study was to determine which law of mechanical behavior was more adapted by comparing ...the results of Hooke's isotropic linear elastic law to those of Ogden's isotropic hyperelastic law, applied to a biomechanical model of the brachial plexus. A model of finite elements was created using the ABAQUS® from a 3D model of the brachial plexus acquired by segmentation and meshing of MRI images at 0°, 45° and 135° of shoulder abduction of a healthy subject. The offset between the reconstructed model and the deformed model was evaluated quantitatively by the Hausdorff distance and qualitatively by the identification of 3 anatomical landmarks. In every case the Hausdorff distance was shorter with Ogden's law compared to Hooke's law. On a qualitative aspect, the model deformed by Ogden's law followed the concavity of the reconstructed model whereas the model deformed by Hooke's law remained convex. In conclusion, the results of this study demonstrate that the behavior of Ogden's isotropic hyperelastic mechanical model was more adapted to the modeling of the deformations of the brachial plexus.
Les techniques de réalité augmentée pourraient aider au repérage des tissus nerveux dans la chirurgie du plexus brachial. L’objectif de cette étude était de déterminer la loi de comportement mécanique la plus adaptée, en comparant les résultats de la loi élastique linéaire isotrope de Hooke à ceux de la loi hyperélastique isotrope d’Ogden, appliquées à un modèle biomécanique du plexus brachial. Un modèle éléments finis été élaboré à l’aide du logiciel ABAQUS® à partir d’un modèle 3D du plexus brachial obtenu par segmentation et maillage d’images IRM à 0°, 45° et 135° d’abduction de l’épaule d’un sujet sain. Ce modèle a été déformé en utilisant les lois de Hooke et d’Ogden pour reproduire les mouvements de l’épaule. Le recalage entre modèle reconstruit et modèle déformé a été évalué quantitativement par la distance de Hausdorff et qualitativement par l’identification de 3 repères anatomiques. Dans tous les cas de figure, la distance de Hausdorff était plus petite avec la loi d’Ogden qu’avec celle de Hooke. Sur le plan qualitatif, le modèle déformé avec la loi d’Ogden suivait la concavité du modèle reconstruit alors que celui déformé avec la loi de Hooke restait convexe. En conclusion, les résultats de cette étude ont permis de montrer que la loi de comportement mécanique hyperélastique isotrope d’Ogden était la plus adaptée à la modélisation des déformations du plexus brachial.
L’objectif de cette étude est d’étudier la faisabilité de la reconstruction du court abducteur du pouce par un lambeau de carré pronateur pédiculé réinnervé, et de rapporter les résultats dans un cas ...d’hypoplasie congénitale de pouce bilatérale.
Vingt-et-un membres supérieurs injectés ont été disséqués. Le carré pronateur a été levé a retro sur l’artère transverse du carpe et réinnervé sur la branche motrice du court fléchisseur du V. Le transfert a été évalué sur 3 paramètres : sa faisabilité, la longueur du pédicule et la distance entre le site de coaptation et le nerf receveur. Un transfert pédiculé de carré pronateur bilatéral a été réalisé chez un enfant de 17 mois présentant une hypoplasie congénitale de pouce bilatérale.
Le transfert était réalisable et son extrémité distale atteignait le bord radial de la MCP du pouce dans tous les cas. La longueur du pédicule distal sur l’artère transverse du carpe était de 38,6±0,20mm. La distance entre le site de coaptation à l’entrée du carré pronateur et la branche du court fléchisseur du V était de 43,4±0,38mm. À 7 mois postopératoire, on retrouve une amélioration esthétique de l’éminence thénar, une abduction M3 bilatérale du pouce et l’utilisation de la pince pollici-digitale.
Le transfert du carré pronateur pédiculé permet la reconstruction du court abducteur du pouce tant sur le plan fonctionnel qu’esthétique, sans sacrifice fonctionnel associé.
The purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency.
Twenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency.
In the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5±0.20mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0±3.77mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer.
Reconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.
The concept, analysis, and design of series switches for graphene-strip plasmonic waveguides at near infrared frequencies are presented. Switching is achieved by using graphene's field effect to ...selectively enable or forbid propagation on a section of the graphene strip waveguide, thereby allowing good transmission or high isolation, respectively. The electromagnetic modeling of the proposed structure is performed using full-wave simulations and a transmission line model combined with a matrix-transfer approach, which takes into account the characteristics of the plasmons supported by the different graphene-strip waveguide sections of the device. The performance of the switch is evaluated versus different parameters of the structure, including surrounding dielectric media, electrostatic gating and waveguide dimensions.
Advances in reflectarrays and array lenses with electronic beam-forming capabilities are enabling a host of new possibilities for these high-performance, low-cost antenna architectures. This paper ...reviews enabling technologies and topologies of reconfigurable reflectarray and array lens designs, and surveys a range of experimental implementations and achievements that have been made in this area in recent years. The paper describes the fundamental design approaches employed in realizing reconfigurable designs, and explores advanced capabilities of these nascent architectures, such as multi-band operation, polarization manipulation, frequency agility, and amplification. Finally, the paper concludes by discussing future challenges and possibilities for these antennas.
L’objectif de cet article est de faire un point sur la technique de phallopoièse par lambeau antébrachial radial libre dans le cadre de la chirurgie de réassignation sexuelle femme à homme avec un ...accent particulier sur les détails techniques chirurgicaux et sur la prévention des complications postopératoires.
À l’aune de nos 30 dernières années d’expérience de prise en charge des personnes transgenres femme à homme et d’une lecture critique de la littérature, nous présentons de manière exhaustive notre technique de phallopoièse par le lambeau antébrachial radial libre dans la chirurgie de réassignation sexuelle femme à homme.
La technique de phallopoièse par lambeau antébrachial radial libre réalisant la construction du néo-urètre et du néo-phallus en un temps opératoire selon le principe de « tube dans un tube » permet d’obtenir non seulement un aspect esthétique du néo-phallus ressemblant à une verge normale avec des sensibilités tactiles et érogènes mais également un néo-urètre fonctionnel et une rigidité pénienne satisfaisante à l’aide d’implants permettant d’uriner debout et d’avoir des rapports sexuels. C’est une procédure chirurgicale complexe nécessitant non seulement une grande qualité d’exécution des tous les gestes chirurgicaux mais également des soins postopératoires de haut niveau. Malgré les raffinements techniques apportés durant ces dernières décennies, les séquelles esthétiques au niveau du site donneur du lambeau restent critiquables et les complications postopératoires, notamment vasculaires et urologiques, demeurent élevées.
Une optimisation de la technique chirurgicale de ce procédé sera nécessaire dans le futur afin de minimiser les complications postopératoires et d’établir un véritable « gold standard » technique de la phallopoièse pour les personnes transgenres femme à homme.
The aims of this article are to provide an overview of the technique of phalloplasty by radial forearm free flap in the context of female-to-male gender reassignment surgery, with a specific focus on surgical technical details and the prevention of postoperative complications.
In the light of our 30 years of experience in caring for female-to-male transgender individuals and conducting a critical review of the literature, we exhaustively present our technique of radial forearm free flap phalloplasty in female-to-male gender reassignment surgery.
The technique of radial forearm free flap phalloplasty, utilizing a one-stage approach for neourethral and neophallus construction based on the “tube within a tube” principle, not only achieves an aesthetically pleasing appearance of the neophallus resembling a normal penis with tactile and erogenous sensitivities but also yields a functional neourethra and satisfactory penile rigidity using implants for standing voiding and sexual intercourse. This intricate surgical procedure demands not only meticulous execution of all surgical maneuvers but also high-level postoperative care. Despite refinements in technique over recent decades, aesthetic sequelae at the donor site of the flap remain subject to criticism, and postoperative complications, particularly of vascular and urological nature, remain significant.
Future optimization of the surgical technique for this procedure will be imperative to minimize postoperative complications and establish a true technical “gold standard” for phalloplasty in female-to-male transgender individuals.
PDF
