Chest wall ulcer induced by postmastectomy radiation therapy (PRMT) remains challenging for plastic surgeons because of the reduced blood supply, fibrosis, and impaired cellular potential in the irradiated area. In this study, chest wall ulcer was treated with negative pressure wound therapy (NPWT) and the latissimus dorsi myocutaneous (LDM) flap reconstruction in 2 stages. A retrospective study was performed on consecutive patients with chronic radiation-induced ulcers in chest wall from June 2012 to June 2017. Surgical debridement and NPWT were performed in the first stage and the chest wall reconstructed by the LDM flap transplantation after extensive debridement in the second stage. There were 10 female patients with chest wall ulcers with a mean age of 60.3 years. The average duration of the ulcers was 21.2 months and the ulcers varied from 1 × 2 to 5 × 7 cm2. Histological examination denied any recurrent breast cancer or radiation-related malignancy. Negative pressure wound therapy was applied with 100 to 125 mm Hg negative pressure during a period of 5 to 7 days in the first stage. The LDM flap varied from 11 × 15 to 15 × 20 cm2. The mean follow-up was 25.9 months. All the flaps survived well with satisfactory appearance and there was no donor-site morbidity or ulcer recurrence during the follow-up period. The staged treatment of the chest wall radiation ulcer incorporated the benefits of NPWT and LDM flap. It is beneficial in increasing the blood and nutrient supply to the irradiated tissue, enhancing the debridement and promoting tissue healing, thus improving the flap survival and decreasing the ulcer recurrence.
Driving at an unsignalized roundabout is a complex traffic scenario that requires both traffic safety and efficiency. At the unsignalized roundabout, the driving policy does not simply maintain a safe distance for all vehicles. Instead, it pays more attention to vehicles that potentially have conflicts with the ego-vehicle, while guessing the intentions of other obstacle vehicles. In this paper, a driving policy based on the Soft actor-critic (SAC) algorithm combined with interval prediction and self-attention mechanism is proposed to achieve safe driving of ego-vehicle at unsignalized roundabouts. The objective of this work is to simulate a roundabout scenario and train the proposed algorithm in a low-dimensional environment, and then test and validate the policy in the CARLA simulator to ensure safety while reducing costs. By using a self-attention network and interval prediction algorithms to enable ego-vehicle to focus on more temporal and spatial features, the risk of driving into and out of the roundabout is predicted, and safe and effective driving decisions are made. Simulation results show that our proposed driving policy can provide collision risk avoidance and improve vehicle driving safety, resulting in a 15% reduction in collisions. Finally, the trained model is transferred to the complete vehicle system of CARLA to validate the possibility of real-world deployment of the policy model.
OBJECTIVE
To explore the treatment of superficial incision dehiscence after abdominal surgery by Z-plasty combined with negative-pressure wound therapy.
METHODS
A retrospective study was performed on seven patients with superficial abdominal incision dehiscence from October 2018 to February 2019. All patients were given systemic antibiotics and nutrition support. During the first stage, surgical debridement with negative-pressure wound therapy was performed. Local Z-plasty was performed in the second stage.
RESULTS
The incision healed well in all patients, and no infection or necrosis occurred in the flaps. During the follow-up of 7.3 months (range, 5-10 months), no incision rupture or redehiscence occurred.
CONCLUSIONS
Surgical debridement, negative-pressure wound therapy, and Z-plasty can be used to treat superficial abdominal incision dehiscence and achieve good therapeutic effect and prognosis. Z-plasty can be used as an alternative to direct suture of incisions because of its simplicity and excellent results.
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