Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps

Abstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible

Stability of Nonexpansive Monotone Systems and Application to Recurrent Neural Networks

This letter shows that trajectories of continuous-time monotone systems (in the sense of Kamke-Muller) converge to equilibrium points if their vector field is continuously differentiable and if they are nonexpansive w.r.t. a diagonally weighted infinity norm. Differently from the current literature trend, the system is not required to be contractive but merely nonexpansive, thus allowing for multiple equilibrium points. Easy-to-check conditions on the vector field to verify that the system is both monotone and nonexpansive are provided. This is done by showing that nonexpansiveness is implied by subhomogeneity of the system, a generalization of the translation invariance property. We apply the results in the context of RNNs, thus providing sufficient conditions for convergence of the state trajectories of nonexpansive monotone neural networks that are not contractive

Dynamic Max-Consensus and Size Estimation of Anonymous Multi-Agent Networks

In this paper we propose a novel consensus protocol for discrete-time multi-agent systems (MAS), which solves the dynamic consensus problem on the max value, i.e., the dynamic max-consensus problem. In the dynamic max-consensus problem to each agent is fed a an exogenous reference signal, the objective of each agent is to estimate the instantaneous and time-varying value of the maximum among the signals fed to the network, by exploiting only local and anonymous interactions among the agents. The absolute and relative tracking error of the proposed distributed control protocol is theoretically characterized and is shown to be bounded and by tuning its parameters it is possible to trade-off convergence time for steady-state error. The dynamic Max-consensus algorithm is then applied to solve the distributed size estimation problem in a dynamic setting where the size of the network is time-varying during the execution of the estimation algorithm. Numerical simulations are provided to corroborate the theoretical analysis

Clinical significance of the buccal fat pad: how to determine the correct surgical indications based on preoperative analysis

Background: Despite the multitude of clinical and aesthetic uses, the correct surgical indications for buccal fat pad (BFP) removal have yet to be fully elucidated. Although the procedure is widely performed and promoted for aesthetic purpose, literature lacks of studies accounting for a proper evaluation of patients undergoing BFP removal. Methods: Between 2012 and 2016 patients seeking an improvement of the malar contour by reduction of the submalar prominence have been visited at the Department of Plastic Surgery of the Institution. A preoperative MRI was requested in order to correctly identify the volume of the BFP and the presence of a masseter muscle (MM) hypertrophy. Results: According to clinical examination and the results of the preoperative imaging, patients were offered different treatment options: patients with BFP hypertrophy underwent BFP removal through an itraoral approach; patients with MM hypertrophy received injection of 50 UI of botulinum toxin (BTX). No complications were observed in the postoperative period and all patients were satisfied with the results. Conclusions: According to the experience, midface contouring procedures should take account of both surgeons’ experience, patients’ expectations and anatomical evaluation. As such, there is no given approach suitable for all cases. Suggested visual criteria, clinical examination and imaging analysis are useful in establishing patient’s condition and determining the appropriate methods of treatment to enhance the facial profile

Las multitudes católicas argentinas en la primera mitad del siglo XX. Religión, política y sociedad de masas

The article reviews the theoretical and historiographical interpretations on the processes of mobilization and formation of Catholic crowds in Argentina in the first half of the 20th century. The performative effects of the so-called “classic paradigm” of secularization are analyzed and the need arises to relocate the contributions of the political perspective, developed in the context of the 1980s, in a broader explanatory framework, capable of incorporating the contributions of recent social and cultural history. For this purpose, an approach is outlined that, based on the concept of the multitude, aims to bring different dimensions of the phenomenon into dialogue, underlining its polyhedral nature and its political and/or ideological irreducibility.El artículo pasa revista a las interpretaciones teóricas e historiográficas sobre los procesos de movilización y conformación de multitudes católicas en la Argentina de la primera mitad del siglo XX. Se analizan los efectos performativos del llamado “paradigma clásico” de la secularización y se plantea la necesidad de reubicar los aportes de la perspectiva política, gestada en el contexto de la década de 1980, en un marco explicativo más amplio, capaz de incorporar los aportes recientes de la historia social y cultural. Con dicho propósito se delinea un acercamiento que, basado en el concepto de multitud, pretende poner en diálogo diferentes dimensiones del fenómeno, subrayando su naturaleza poliédrica y su irreductibilidad política y/o ideológica.

Debatir la política. Marta Bonaudo (1944-2020): trayectoria académica e historiográfica

El ensayo ofrece un recorrido a través de la trayectoria académica de la historiadora Marta Bonaudo, fallecida a finales de 2020. Por un lado, reconstruyo las principales influencias teóricas e historiográficas que fue metabolizando en diferentes momentos. Por otro, intento ofrecer un breve balance de sus principales aportes en los campos de la historia política regional argentina, la historia de género y los estudios comparativos y transnacionales. Por último, subrayo su importancia en la construcción colectiva del campo historiográfico profesional en la Argentina a partir de la década de 198