New Dimensions for a Challenging Security Environment: Growing Exposure to Critical Space Infrastructure Disruption Risk

Space systems have become a key enabler for a wide variety of applications that are vital to the functioning of advanced societies. The trend is one of quantitative and qualitative increase of this dependence, so much so that space systems have been described as a new example of critical infrastructure. This article argues that the existence of critical space infrastructures implies the emergence of a new category of disasters related to disruption risks. We inventory those risks and make policy recommendations for what is, ultimately, a resilience governance issue

The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound

Propeller Perforator Flaps in Distal Lower Leg: Evolution and Clinical Applications

Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot

Propeller Perforator Flaps in Distal Lower Leg:Evolution and Clinical Applications

Simple or complex defects in the lower leg, and especially in its distal third, continue to bea challenging task for reconstructive surgeons. A variety of flaps were used in the attemptto achieve excellence in form and function. After a long evolution of the reconstructivemethods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps andfasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor andPalmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda,and separately Kroll and Rosenfield described the first applications of such flaps. Perforatorflaps, whether free or pedicled, gained a high popularity due to their main advantages:decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforatorflaps in lower leg was possible due to a better understanding of the cutaneous circulation, legvascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design.This review will describe the evolution, anatomy, flap design, and technique of the main distallypedicled propeller perforator flaps used in the reconstruction of defects in the distal third ofthe lower leg and foot

Critical Space Infrastructures: Risk, Resilience and Complexity

This book introduces readers to the topical area of CSI: critical space infrastructure, which is defined as an emerging domain of systems-of-systems encompassing hardware, workforce, environment, facilities, business and organizational entities. Further, it includes unmanned air systems, satellites, rockets, space probes, and orbital stations, and involves multi-directional interactions essential for maintenance of vital societal functions (i.e., health, safety, economic and social well-being), the loss or disruption of which would have significant impact on virtually any nation. The topics covered include the main elements of CSI, CSI taxonomy, effects of CSI on other infrastructure systems, establishing quantitative and qualitative parameters, global and national effects of CSI failure, cascading disruptive phenomena, chilling effects in various fields, CSI protection, deliberate threats to space systems (e.g., electromagnetic pulse attacks), space governance, and a path forward for CSI research. Modern society is highly dependent on the continuous operation of critical infrastructure systems for the supply of crucial goods and services including, among others, the power supply, drinking water supply, and transportation systems; yet space systems – which are critical enablers for several commercial, scientific and military applications – are rarely discussed. This book addresses this gap. [From the back cover]https://digitalcommons.odu.edu/emse_books/1020/thumbnail.jp

New Dimensions for a Challenging Security Environment: Growing Exposure to Critical Space Infrastructure Disruption Risk

Abstract Space systems have become a key enabler for a wide variety of applications that are vital to the functioning of advanced societies. The trend is one of quantitative and qualitative increase of this dependence, so much so that space systems have been described as a new example of critical infrastructure. This article argues that the existence of critical space infrastructures implies the emergence of a new category of disasters related to disruption risks. We inventory those risks and make policy recommendations for what is, ultimately, a resilience governance issue

Long-term results after muscle-rib flap transfer for reconstruction of composite limb defects

The authors present the long-term results in a series of 44 cases with post-traumatic bone defects solved with muscle-rib flaps, between March 1997 and December 2007. In these cases, we performed 21 serratus anterior-rib flaps (SA-R), 10 latissimus dorsi-rib flaps (LD-R), and 13 LD-SA-R. The flaps were used in upper limb in 18 cases and in lower limb in 26 cases. With an overall immediate success rate of 95.4% (42 of 44 cases) and a primary bone union rate of 97.7% (43 of 44 cases), and despite the few partisans of this method, we consider that this procedure still remains very usefully for small and medium bone defects accompanied by large soft tissue defects

The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations.

BACKGROUND Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. METHODS All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. RESULTS Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). CONCLUSIONS Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence