Scapular Free Flap (유리 견갑 피판 이식술)
-
- Archives of Reconstructive Microsurgery
- /
- v.5 no.1
- /
- pp.24-34
- /
- 1996
There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.
Following research proposes "Virtualization of Smart Cards (ViSCa)" which is a security system that aims to provide a multi-device platform for the deployment of services that require a strong security protocol, both for the access & authentication and execution of its applications and focuses on analyzing Virtualization of Smart Cards (ViSCa) platform-based mobile payment service by comparing with other similar cases. At the present day, the appearance of new ICT, the diffusion of new user devices (such as smartphones, tablet PC, and so on) and the growth of internet penetration rate are creating many world-shaking services yet in the most of these applications' private information has to be shared, which means that security breaches and illegal access to that information are real threats that have to be solved. Also mobile payment service is, one of the innovative services, has same issues which are real threats for users because mobile payment service sometimes requires user identification, an authentication procedure and confidential data sharing. Thus, an extra layer of security is needed in their communication and execution protocols. The Virtualization of Smart Cards (ViSCa), concept is a holistic approach and centralized management for a security system that pursues to provide a ubiquitous multi-device platform for the arrangement of mobile payment services that demand a powerful security protocol, both for the access & authentication and execution of its applications. In this sense, Virtualization of Smart Cards (ViSCa) offers full interoperability and full access from any user device without any loss of security. The concept prevents possible attacks by third parties, guaranteeing the confidentiality of personal data, bank accounts or private financial information. The Virtualization of Smart Cards (ViSCa) concept is split in two different phases: the execution of the user authentication protocol on the user device and the cloud architecture that executes the secure application. Thus, the secure service access is guaranteed at anytime, anywhere and through any device supporting previously required security mechanisms. The security level is improved by using virtualization technology in the cloud. This virtualization technology is used terminal virtualization to virtualize smart card hardware and thrive to manage virtualized smart cards as a whole, through mobile cloud technology in Virtualization of Smart Cards (ViSCa) platform-based mobile payment service. This entire process is referred to as Smart Card as a Service (SCaaS). Virtualization of Smart Cards (ViSCa) platform-based mobile payment service virtualizes smart card, which is used as payment mean, and loads it in to the mobile cloud. Authentication takes place through application and helps log on to mobile cloud and chooses one of virtualized smart card as a payment method. To decide the scope of the research, which is comparing Virtualization of Smart Cards (ViSCa) platform-based mobile payment service with other similar cases, we categorized the prior researches' mobile payment service groups into distinct feature and service type. Both groups store credit card's data in the mobile device and settle the payment process at the offline market. By the location where the electronic financial transaction information (data) is stored, the groups can be categorized into two main service types. First is "App Method" which loads the data in the server connected to the application. Second "Mobile Card Method" stores its data in the Integrated Circuit (IC) chip, which holds financial transaction data, which is inbuilt in the mobile device secure element (SE). Through prior researches on accept factors of mobile payment service and its market environment, we came up with six key factors of comparative analysis which are economic, generality, security, convenience(ease of use), applicability and efficiency. Within the chosen group, we compared and analyzed the selected cases and Virtualization of Smart Cards (ViSCa) platform-based mobile payment service.