. Recently, two cases of these anomalies were encountered by the authors during elevation of iliac osteocutaneous free flaps. In the first case, the deep circumflex iliac artery was absent, and the nourishing artery of the flap was instead connected to the large iliolumbar artery. In the second case, the ascending branch, deriving from the deep circumflex iliac artery as usual, had a separate takeoff directly from the external iliac artery, and provided blood supply to the overlying skin as a musculocutaneous perforator that transversed the three muscle layers of the abdominal wall. This ascending branch was assumed to be a duplication of the deep circumflex iliac artery. Ascertaining the divergence of the deep circumflex iliac artery from the external iliac artery before beginning to raise the flap, and careful dissection of the artery, are essential for minimizing problems in flap transfer.
2/71. Free flap to the arteria peronea magna for lower limb salvage.
A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.
3/71. The distally based superficial sural flap: our experience in reconstructing the lower leg and foot.
The treatment of soft-tissue defects of the lower third of the leg and foot is often an awkward problem to tackle because of the frequent involvement of muscle, tendon, and bone, which is caused by the thinness and poor circulation of the skin covering them and by the small quantity of local tissue available for reconstruction. The authors present their experience with the use of sural flaps for the treatment of small- and medium-size defects of the distal region of the lower limb. The flap used was a distally based fasciocutaneous flap raised in the posterior region of the lower two thirds of the leg. Vascularization was ensured by the superficial sural artery, which accompanies the sural nerve together with the short saphenous vein. The authors treated 18 patients (12 men and 6 women) from May 1997 to August 1999 at the Division of Plastic Surgery, University of Turin, italy. Superficial necrosis without involvement of the deep fascia (which was grafted 1 month later) occurred in 1 patient of the 18 treated. In another 2 patients, defects were found in the flap margins, but no additional surgical revision was necessary, and recovery occurred by secondary intention. In every patient the sural flaps provided good coverage of the defects, both from a functional and an aesthetic point of view. The major advantages of this flap are its easy and quick dissection. Because the major arterial axis is not sacrificed, this flap can be used in a traumatic leg with damaged major arteries.
4/71. Pathologic features of fatal shark attacks.
5/71. Flap transfers for the treatment of perichondrial ring injuries with soft tissue defects.
Seven cases (six fresh) of perichondrial ring injury with skin defects were treated using flap transfers. The study included four boys and three girls ranging in age from 2 to 9 years (average 6). They were followed up for an average of 8 years and 10 months. The period from injury to flap coverage was 8-12 days, with an average of 10 days in the fresh cases. Fracture was noted in four cases, with one an epiphyseal fracture. Peroneal flaps were transferred in four cases, latissimus dorsi myocutaneous flaps in two, and gastrocnemius muscle flap in one. Six flaps survived perfectly, and one failed due to venous thrombosis. This latter case was treated with a cross leg flap. Postoperative radiographic assessments confirmed partial growth plate arrest in the chronic case, but all the fresh cases had no postoperative growth disturbance. Flap coverage, for perichondrial ring injuries with wide skin defects, is a useful method not only for skin coverage, but for the prevention of growth disturbances as well.
6/71. Successful free flap transfer and salvage in sickle cell trait.
7/71. limb salvage of lower-extremity wounds using free gracilis muscle reconstruction.
8/71. Imaging of frostbite injury by technetium-99m-sestamibi scintigraphy: a case report.
The appearance of superficial tissue is often an unreliable indicator of deep-tissue viability in cases of frostbite. We present a 34-year-old black man who was brought to the emergency department at fourth post-injury day with frostbite injury involving both lower extremities after prolonged exposure to subzero temperatures. In our previous experimental study, 99mTc sestamibi scintigraphy has been employed for evaluating frostbite injuries in rabbit hindlegs. In the case presented, 99mTc sestamibi scintigraphy, as a new diagnostic tool, was performed for detection of skeletal muscle perfusion on the fourth post-injury day. The scintigraphic images show diffusely reduced uptake in soft tissues of both calves and feet. It was thought that this hypoperfusion was due to viable but ischemic tissue. Five days after medical therapy, 99mTc sestamibi scan showed prominently increased uptake in both calves and feet and skin necrosis was observed. debridement of necrotic skin and subcutaneous tissue was performed, and split-thickness skin graft was applied for coverage of the skin defect. Healing was good 15 days after grafting. We think 99mTc sestamibi scan can be used for assessment of soft-tissue perfusion and evaluation of treatment in frostbite injury.
9/71. Pedicled foot fillet flap based on the tibialis anterior vessels: case report.
A case of an 18-year-old male with extensive posterior and lateral soft-tissue loss of the lower leg is reported. There was a segmental defect of 20 cm in the tibialis posterior neurovascular bundle, and the injury was not considered reconstructable. There was extensive soft-tissue trauma to the posterior compartments of the leg, with an intact and well-perfused foot. A primary amputation was indicated. The foot was used as a fillet flap for tibial length preservation and optimal stump coverage. The foot fillet flap was pedicled on the tibialis anterior vessels, preserving the deep plantar, first dorsal metatarsal, and anterior communicating vessels. The postoperative evolution was uneventful, with successful prosthetic adaptation.
10/71. Deep partial thickness burn after contact with a Meal Ready-To-Eat heater.
A case of a Meal Ready-To-Eat heater injury resulting in a deep partial thickness burn is presented. The patient was treated as an outpatient at our battalion aid station. By establishing the depth, extent, and severity of a burn injury, a decision can be made regarding whether outpatient or inpatient therapy is appropriate. A brief description of the Meal Ready-To-Eat heater injury and general guidelines for the outpatient management of burns are presented.Federal Judge Strikes Down Wisconsin Marriage Ban
June 06, 2014
A federal judge in Wisconsin ruled today in favor the freedom to marry and against the state’s marriage ban. This is the twentieth ruling by a federal or state judge that a discriminatory state marriage ban is unconstitutional since the U.S. Supreme Court gutted DOMA in a landmark decision.
U.S. District Court Judge Barbara Crabb wrote, “I conclude that the Wisconsin laws prohibiting marriage between same-sex couples interfere with plaintiffs’ right to marry, in violation of the due process clause, and discriminate against plaintiffs on the basis of sexual orientation, in violation of the equal protection clause."
In a statement today, Freedom to Marry’s President Evan Wolfson said,.”
Nineteen states and the District of Columbia have the freedom to marry. For more information on pending marriage litigation, go to.Sexism is prejudice or discrimination based on one's sex or gender.



It just also happens to be acceptable.

People can have their preferences, especially with their body.



The world is complicated. Sometimes we get a little prejudiced, don’t get too worked up about it.Sentence 1: As comfy as it is to be led from two, four, six, eight to smash the state, it is kind of the Roses are red, violets are blue of crowd inciting.

Sentence 2: The crowd was incitied.
OPTIONS:
- yes
- it is not possible to tell
- no
Is this second sentence entailed by the first?

Answer: yes
Question:
This time, at the heart of a carefully constructed thriller is a romance, which is no less