Alternative Regional Flaps When Anterolateral Thigh Flap Perforator is not Feasible

This paper presents the scheme to select alternative flaps limited to the region of the ipsilateral thigh when the perforator of the anterolateral thigh flap is not feasible. Total of 564 consecutive microsurgery cases using anterolateral thigh perforator flap was reviewed from March of 2001 to January of 2009. Total of 12 cases used a contingent flap due to anatomical and technical complications of the anterolateral thigh perforator. The alternatives were skin perforator flaps adjacent to the initial flap (3 cases of upper anterolateral thigh flap, 4 cases of anteromedial thigh flap), vastus lateralis muscle flap with skin graft (2 cases), and anterolateral thigh flap as septocutaneous flap without a prominent perforator on the septum (3 cases). All flaps survived and provided coverage as planned but one case using septocutaneous flap without a prominent perforator was noted with partial necrosis. Adjacent flaps around the anterolateral thigh perforator flap may provide useful alternative flaps in cases of failed elevation. Limiting the contingent secondary flap to this region may reduce further donor site morbidity and still provide an adequate flap for reconstruction

The paradox of drowned carbonate platforms and the origin of Cretaceous Pacific guyots

Geochemical, stratigraphic and palaeolatitudinal data from deep boreholes drilled through Pacific guyots—flat-topped seamounts—help to explain the drowning of these Cretaceous shallow-water carbonate platforms that once thrived through the accumulation of biogenic and inorganic calcium carbonate sediment in mid-oceanic regions. The platforms drowned sequentially over a 60-million-year interval while they were being transported northward by Pacific plate motion through a narrow equatorial zone (∼0–10° S). Such platforms were apparently resistant to the effects of Cretaceous oceanic anoxic events. Although the mechanism responsible for drowning remains unknown, the tropics have not always been the refuge for atolls that they are toda