The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

BACKGROUND: Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes. METHODS: Twenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the 'Lymphatic Vessel Analysis Protocol' (LVAP) plug-in for Image J® software. RESULTS: We found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35 × 19 cm and 34 × 10 cm, respectively. CONCLUSION: Our findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a 'T' or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay

Differences between urban and rural population with respect to demand on forestry aspects, in a case study of the Turkish province of Bal kesir Diferenças entre a população urbana e rural em matéria das suas exigências de silvicultura, estudo de caso da província turca de Bal kesir

Inhabitants of urban and rural areas are important participants in the process of developing and implementing forest policy. Thus, it is essential to determine their demands and attitudes towards forestry issues. In this context, the demands and evaluation of forest functions are investigated in a case study of the Turkish province of Bal kesir. The findings of the case study show that differences in terms of demands among inhabitants of rural and urban areas are related to forest fires fighting, crimes fighting, forestry-tourism integration, forestation and regeneration activities, and the enlargement of forest areas. The main differences among their assessments of forest functions are related to fire wood production, and the provision of flood and erosion control, nature protection, and recreational opportunities. The findings are important for conflict management and for local decision making. By using the findings of similar studies, the provincial organizations should harmonize their priorities with the expectations of relevant interest groups.<br>A política de silvicultura da população urbana e rural é uma participante fundamental no processo de formação e execução das florestas. Portanto, é importante determinar as exigências e as aproximações em matéria da silvicultura. A determinação das exigências da população urbana e rural no âmbito desse processo e a interpretação destinada aos assuntos das funções da floresta foram pesquisadas tendo como base a província turca de Bal kesir. As constatações resultantes do estudo na região demonstraram que as diferenças entre as exigências da população urbana e rural em matéria da silvicultura são a luta contra os incêndios florestais, a luta contra os delitos florestais, a integração de silvicultura-turismo, as atividades de reflorestamento e rejuvenescimento da floresta e a ampliação dos campos florestais. Por outro lado, as diferenças fundamentais entre as constatações feitas em matéria das funções da floresta são a produção de lenha, a prevenção de erosão e inundação, a protecção natural, o projeto de recreação. Os resultados obtidos são importantes para a gestão de estudo e para a tomada de decisões no âmbito local. As instituições locais devem adaptar as suas prioridades e as exigências dos grupos interessados tirando proveito das constatações obtidas em estudos semelhantes

Role of Bioeconomy in the Achievement of Sustainable Development Goals

International audienc