Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach.

Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the types of abdominally based flaps, their anatomy, and their drawbacks. 2.

The Full Continuum of Robotic Breast Surgery: Robotic-assisted Mastectomy, Robotic DIEP Flap, and Robotic Supermicrosurgery.

In recent years, robotic surgery has rapidly expanded to improve surgical outcomes in a variety of surgical subspecialties. Although plastic surgery has taken longer to integrate robotic surgery into practice, the advantages of robotic-assisted surgery, including improved visualization and resolution, minimally invasive approaches, and the ability to surpass human precision and scale, have driven its more recent adoption into plastic surgery. Currently, procedures performed with robotic assistance that are considered part of the continuum of surgical treatment of breast cancer include robotic-assisted nipple-sparing mastectomy, reconstruction with the robotic latissimus dorsi flap or the deep inferior epigastric artery perforator flap, and robotic microsurgery for the flap anastomosis and/or the surgical treatment of lymphedema.

Inverse design of a nano-photonic wavelength demultiplexer with a deep neural network approach.

In this paper, we propose a pre-trained-combined neural network (PTCN) as a comprehensive solution to the inverse design of an integrated photonic circuit. By utilizing both the initially pre-trained inverse and forward model with a joint training process, our PTCN model shows remarkable tolerance to the quantity and quality of the training data. As a proof of concept demonstration, the inverse design of a wavelength demultiplexer is used to verify the effectiveness of the PTCN model.

Holographic Duals of Argyres-Douglas Theories.

We propose the first explicit holographic duals for a class of superconformal field theories of Argyres-Douglas type, which are inherently strongly coupled and provide a window onto remarkable nonperturbative phenomena (such as mutually nonlocal massless dyons and relevant operators of fractional dimension). The theories under examination are realized by a stack of M5-branes wrapped on a sphere with one irregular puncture and one regular puncture. In the dual 11d supergravity solutions, the irregular puncture is realized as an internal M5-brane source.

Ethnic Disparities in Thrombotic and Bleeding Diatheses Revisited: A Systematic Review of Microsurgical Breast Reconstruction across the East and West.

Background:  Ethnicity has been shown to play a role in disparate coagulative responses between East Asian and Caucasian patients undergoing nonmicrovascular surgery. In this study, we sought to further investigate this hematologic phenomenon between the two ethnic groups within the field of microsurgical breast reconstruction.

Methods:  A systematic review examining the reported incidence of microvascular thrombosis and all-site bleeding among breast free flaps in East Asians and Westerners was performed.

Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand.

Background: Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function.

Functional Outcomes for Basilar Joint Arthroplasty with Meniscus Allograft Compared with Trapeziectomy Alone.

Background: Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce the risk of scaphoid impingement, the senior author developed an interposition arthroplasty technique using meniscal allograft. We hypothesize that the use of meniscus improves outcomes and subsequent functionality compared with trapeziectomy alone.

Venous Thromboembolism Chemoprophylaxis in Burn Patients: A Literature Review and Single-Institution Experience.

Hospitalized burn patients meet the criteria for Virchow's triad (endothelial damage, hypercoagulability, and stasis), predisposing them to venous thromboembolism (VTE). Although the disease burden of VTE suggests a need for prevention in this population, unreliable reported VTE rates, costly and complicated prophylaxis regimens, and chemoprophylaxis risks have prevented the establishment of a universal protocol. This paper reviews thromboprophylaxis practices both in the literature and at our own institution.

The State of Burn Care Training During Plastic Surgery Residency.

Introduction: There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care.

Methods: Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018-2019 academic year.

Double-pass microwave photonic sensing system based on low-coherence interferometry.

In this Letter, we propose and experimentally demonstrate, to the best of our knowledge, a novel high-performance microwave photonic sensing system employing a reflective double-pass spectrum-slicing sensing scheme, based on low-coherence interferometry in combination with a dispersive medium. The setup is implemented by configuring a double-pass spectrum slicing sensing scheme, which significantly increases the output power level of a low-coherence optical source by approximately 12 dB to compensate for the optical loss of the system. Moreover, since the light passes through the same optical path twice, the conversion efficiency between the applied optical path difference and the dependent radiofrequency (RF) resonance shift is doubled compared to the conventional approaches.

Patient with a total artificial heart maintained on outpatient dialysis while listed for combined organ transplant, a single center experience.

Advanced mechanical circulatory support is increasingly being used with more sophisticated devices that can deliver pulsatile rather than continuous flow. These devices are more portable as well, allowing patients to await cardiac transplantation in an outpatient setting. It is known that patients with renal failure are at increased risk for developing worsening acute kidney injury during implantation of a ventricular assist device (VAD) or more advanced modalities like a total artificial heart (TAH).

Ocular Reconstruction Using Bone-Anchored Implants in Irradiated Facial Deformities After Tumor Extirpation.

Background: Surgical resection of ocular malignancies can result in complex craniofacial defects that can be difficult to reconstruct with conventional reconstruction techniques. Craniofacial prosthesis supported by bone-anchored implants has evolved as a reliable alternative in such scenarios.

Methods: The authors describe a patient who underwent extensive facial resection secondary to squamous cell carcinoma resulting in significant facial deformities.

Topical Minocycline Effectively Decontaminates and Reduces Inflammation in Infected Porcine Wounds.

Background: Wound infection can impair postoperative healing. Topical antibiotics have potential to treat wound infection and inflammation and minimize the adverse effects associated with systemic antibiotics.

Methods: Full-thickness porcine wounds were infected with Staphylococcus aureus.

Development of a precise experimental burn model.

Background: Porcine wounds closely mimic human wounds and are often used experimentally in burn studies. Multiple burn devices have been reported but they rarely described precise amount of heat transfer and the burn devices generally have low and varying heat capacity resulting in significant and varying temperature drop.

Methods: The authors developed a customized aluminum burn device with cork insulation and high heat capacity.

Extracellular Matrix and Dermal Fibroblast Function in the Healing Wound.

Fibroblasts play a critical role in normal wound healing. Various extracellular matrix (ECM) components, including collagens, fibrin, fibronectin, proteoglycans, glycosaminoglycans, and matricellular proteins, can be considered potent protagonists of fibroblast survival, migration, and metabolism. Advances in tissue culture, tissue engineering, and ex vivo models have made the examination and precise measurements of ECM components in wound healing possible.

Distributed optical signal processing for microwave photonics subsystems.

We propose and experimentally demonstrate a novel and practical microwave photonic system that is capable of executing cascaded signal processing functions comprising a microwave photonic bandpass filter and a phase shifter, while providing separate and independent control for each function. The experimental results demonstrate a single bandpass microwave photonic filter with a 3-dB bandwidth of 15 MHz and an out-of-band ratio of over 40 dB, together with a simultaneous RF phase tuning control of 0-215° with less than ± 3 dB filter shape variance.

Full-thickness porcine burns infected with Staphylococcus aureus or Pseudomonas aeruginosa can be effectively treated with topical antibiotics.

Burn and blast injuries are frequently complicated by invasive infections, which lead to poor wound healing, delay in treatment, disability, or death. Traditional approach centers on early debridement, fluid resuscitation, and adjunct intravenous antibiotics. These modalities often prove inadequate in burns, where compromised local vasculature limits the tissue penetration of systemic antibiotics.

Topical delivery of ultrahigh concentrations of gentamicin is highly effective in reducing bacterial levels in infected porcine full-thickness wounds.

Background: Injury to the skin can predispose individuals to invasive infection. The standard of care for infected wounds is treatment with intravenous antibiotics. However, antibiotics delivered intravenously may have poor tissue penetration and be dose limited by systemic side effects.

Instantaneous high-resolution multiple-frequency measurement system based on frequency-to-time mapping technique.

A new microwave photonic instantaneous frequency measurement system that can simultaneously measure multiple-frequency signals while achieving very high resolution and wide frequency measurement range is presented. It is based on the frequency-to-time mapping technique implemented using a frequency shifting recirculating delay line loop and a narrowband optical filter realized by the in-fiber stimulated Brillouin scattering effect. Experimental results demonstrate the realization of a multiple-frequency measurement capability over a frequency range of 0.

Microwave photonic mixer with high spurious-free dynamic range.

A new linearized photonic mixer structure, which can fully eliminate the third-order intermodulation distortion, is presented. It is based on an integrated dual-parallel Mach-Zehnder modulator to which an optimized RF split and an optimized optical phase shift are applied, in series with a Mach-Zehnder modulator driven by the LO. The mixer achieves a very high spurious-free dynamic range performance, it enables essentially infinite isolation between the RF and LO ports, and it has the ability to function over a multioctave frequency range.

Optical-to-RF phase shift conversion-based microwave photonic phase shifter using a fiber Bragg grating.

A novel microwave photonic phase shifter structure is presented. It is based on the conversion of the optical carrier phase shift into an RF signal phase shift via controlling the carrier wavelength of a single-sideband RF-modulated optical signal into a fiber Bragg grating. The new microwave photonic phase shifter has a simple structure and only requires a single control to shift the RF signal phase.

High conversion efficiency microwave photonic mixer based on stimulated Brillouin scattering carrier suppression technique.

A new microwave photonic mixer that can achieve a high conversion efficiency is presented. It is based on using the stimulated Brillouin scattering loss spectrum to suppress the optical carrier at the output of two optical phase modulators driven by the RF signal and the LO, respectively. Experimental results are presented, which demonstrate a high conversion efficiency of 11.

Microwave photonic signal processing.

Photonic signal processing offers the advantages of large time-bandwidth capabilities to overcome inherent electronic limitations. In-fibre signal processors are inherently compatible with fibre optic microwave systems that can integrate with wireless antennas, and can provide connectivity with in-built signal conditioning and electromagnetic interference immunity. Recent methods in wideband and adaptive signal processing, which address the challenge of realising programmable microwave photonic phase shifters and true-time delay elements for phased array beamforming; ultra-wideband Hilbert transformers; single passband, widely tunable, and switchable microwave photonic filters; and ultra-wideband microwave photonic mixers, are described.