Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction
JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH
Authors: Li, Zhangcan; Zheng, Dawei; Zheng, Jian; Qi, Weiya; Qi, Qiang; Liu, Yunyun
Abstract
Objectives This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients. Methods A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense, and two-point discrimination recovery results. Results CTA and CDS performed preoperatively could accurately and rapidly identify the position, location and course of the superficial circumflex iliac artery perforator. All wounds healed by the first follow-up and no complications occurred at the follow-up visit. All flaps survived, the patients achieved proximal interphalangeal joint (PIP) ranges of motions (ROM) from 80 to 100 degrees and distal interphalangeal joint (DIP) ROM from 65 to 80 degrees. The tactile sense and pain sense recovered, and average of the two-point discrimination scores was 9.3 mm (range 7-12 mm). The donor area was primarily sutured with a tidy scar in the underwear region. Conclusion CTA and CDS performed preoperatively are accurate and intuitive methods for assessing the location and course of SCIP. The SCIP flap is suitable for pediatric patients due to its small vessel caliber, specific functional and esthetic benefits. It can be designed in a lobulated fashion in order to repair two or more wounds during one surgery. We suggest that the free single-pedicle bilobed SCIP flap should be considered a good option choice for multi-digit defect reconstruction in pediatric patients in the clinic.
Pond-In-Pond: An alternative system for wastewater treatment for reuse
JOURNAL OF ENVIRONMENTAL CHEMICAL ENGINEERING
Authors: Adhikari, Kushal; Fedler, Clifford B.
Abstract
When treating municipal wastewater, there are two choices to be made that determine which treatment system will be utilized; will the effluent be discharged to a stream or will it be reused for beneficial purposes such as growing agricultural crops by land application. For land application systems, the effluent quality is less stringent, usually 2-3 times higher than that required for stream discharge. In addition, the public tends to be more supportive when it comes to the reuse of wastewater in irrigation rather than the reuse in households. A simple, low cost, low energy pond treatment system has been widely used for reuse systems. However, there is a lack of specific design guidelines for pond treatment systems, and selection of a design procedure is difficult to ascertain. This study examines various pond design approaches and recommends the use of a Pond-In-Pond (PIP) approach as the more appropriate design layout for reuse purposes, where PIP is the integration of two types of ponds-anaerobic and aerobic. The results from the Computational Fluid Dynamics (CFD) analysis of a flow-diversion mechanism in recent studies and performance data from existing PIP systems show that the PIP is a promising concept for wastewater reuse systems. The PIP system under study produced an average annual effluent BOD of approximately 40 mg/L.