A comparison between combined open bypass revascularization and free tissue transfer versus endovascular revascularization and free tissue transfer for lower limb preservation.

BACKGROUND: Extensive defects of the lower limb as a result of diabetes and peripheral vascular disease require multidisciplinary treatment. Numerous studies with regards combining vascular bypass surgery and free tissue reconstruction of the lower limb had been published. However the trend has evolved toward a combination of endovascular revascularization and free flap reconstruction. The aim of this study was to compare the safety and efficacy of this combination of treatment to the traditional combination of bypass surgery and free tissue reconstruction. METHODS: All patients who had undergone vascular bypass surgery and free tissue reconstruction of the lower limb as well as those who had undergone endovascular angioplasty with free tissue transfer for lower limb preservation, over a 10-year period was included in this study. RESULTS: A total of 46 patients that underwent limb preservation were included in this study, 22 patients underwent open bypass revascularization and free flap transfer and 24 patients underwent endovascular revascularization and free tissue transfer. There were no differences between the two methods with regards to age, sex, defect size, TransAtlantic InterSociety Consensus level, Wagner classification, length of hospitalization, limb preservation rate, total flap necrosis rate, and partial flap necrosis rate. More importantly, there was no significant difference in the limb preservation rate (P = 0.14). CONCLUSION: In this study we found that the safety and the success rate of lower limb preservation using a combination of endovascular revascularization and free tissue reconstruction is comparable to using a combination of bypass surgery and free tissue transfer.

Non-doped solid-state white light-emitting electrochemical cells employing the microcavity effect.

Solid-state white light-emitting electrochemical cells (LECs) have attracted research attention owing to their advantages of simple device structure, low operation voltage and compatibility with solution processes. In this work, we demonstrate a simple approach to obtain white electroluminescence (EL) from non-doped LECs based on a blue-emitting complex. With a relatively thicker emissive layer, red emission can be additionally enhanced by the microcavity effect when the recombination zone moves to appropriate positions. Hence, white EL can be harvested by combining blue emission from the complex and red emission from the microcavity effect. These non-doped white LECs show external quantum efficiencies and power efficiencies up to 5% and 12 lm W(-1), respectively. These results show that efficient white EL can be obtained in simple non-doped LECs.

Quartz resonator assembling with TSV interposer using polymer sealing or metal bonding.

This paper presents one wafer level packaging approach of quartz resonator based on through-silicon via (TSV) interposer with metal or polymer bonding sealing of frequency components. The proposed silicon-based package of quartz resonator adopts several three-dimensional (3D) core technologies, such as Cu TSVs, sealing bonding, and wafer thinning. It is different from conventional quartz resonator using ceramic-based package. With evaluation of mechanical structure design and package performances, this quartz resonator with advanced silicon-based package shows great manufacturability and excellent performance to replace traditional metal lid with ceramic-based interposer fabrication approach.

Endovascular revascularization and free tissue transfer for lower limb salvage.

Combined bypass surgery with free flap reconstruction is an established method for lower limb salvage. But the success of the combination of endovascular revascularization together with free tissue transfer has so far not been well established. A retrospective review of all patients who had undergone endovascular revascularization and reconstructed with free tissue transfer for lower limb salvage at Tzu Chi Dalin General Hospital between 2008 and 2012 was performed. A total of 26 legs underwent limb salvage in 24 patients. There were 10 male and 14 female patients. Their average age was 71.4 years. The average time interval between endovascular intervention and free tissue transfer was 8 days. There was 100% flap survival but partial flap necrosis was seen in three patients. A high rate of wound infection was seen in eight patients, all requiring further debridement. The total limb salvage rate at 1-year follow-up was 96% and 92% at the 2-year follow-up. In conclusion, the success rate of lower limb salvage using a combination of endovascular revascularization and free tissue reconstruction is comparable to using a combination of bypass surgery and free tissue transfer. It is associated with a high flap success rate and a high limb salvage rate. It provides physicians with a further treatment option in the management of ischemic lower limbs with extended tissue loss.

Static contrast technique for creating transpedal arterial access in patients with tibioperoneal occlusions.

Transpedal arterial access is a useful but challenging technique for patients with tibioperoneal occlusions. It is associated with a long learning curve, requires the administration of a large amount of contrast media, and exposes patients and interventionists to additional radiation. Here we present a new technique by which it is easier and faster to create a transpedal arterial access.

Reconstruction of advance head and neck cancer patients after tumor ablation with simultaneous multiple free flaps: indications and prognosis.

Simultaneous multiple free flaps have become a useful option in head and neck reconstructions. We performed a 10-year retrospective study between 2001 and 2010. There were 58 men and 1 woman. The overall mortality rate was 51.7%. The longest surviving patient is 9 years and 4 months, whereas the shortest surviving patient was 72 days. The mean survival period was 47.1 (6.8) months. Age (P = 0.755) and tumor size (P = 0.115) did not play a major role, but surgical margin, lymph node, and tumor recurrence were significant in patient survival with a P value of 0.026, 0.01, and 0.026, respectively. If wide excision with a margin that can be free of tumor can be performed, lymph nodes are not involved, and this is a primary tumor, then time and effort should be spent in a successful simultaneous multiple free flap reconstruction.

Free tissue transfers for limb salvage in patients with end-stage renal disease on dialysis.

BACKGROUND: Microvascular surgery plays a major role in the reconstructive process of limb salvage. However, microsurgery in the patient with renal disease is still considered a high-risk procedure. Some authors have even recommended immediate amputation because of poor long-term survival in patients with renal failure and lower limb ischemia. METHODS: A retrospective review of all patients with end-stage renal disease on hemodialysis who underwent free flap surgery at Dalin Tzu Chi General Hospital was included in the study. Data were collected over a 5-year period, between June of 2005 and June of 2009. RESULTS: A total of 20 patients were included in the study, of which 11 were men and nine were women. The average age of the patients was 63 years. All had a history of diabetes mellitus with peripheral vascular disease. Seven of the 20 patients had undergone prior vascular intervention. The total flap survival rate was 95 percent. Four patients eventually required major limb amputation because of progressive infection at the recipient site. There were no further major limb amputations in these patients during the long-term follow-up. The total limb salvage rate was 80 percent. The average follow-up was 30 months. CONCLUSIONS: The authors' present approach shows that the results of limb salvage in this particular group of patients are not as discouraging as previously reported. In the description of patients with renal disease, the authors suggest that they not be described as one entity but that they be divided into subgroups so that this better reflects the risk of surgery and the success of limb salvage.