THE EARTH SYSTEM PREDICTION SUITE: Toward a Coordinated U.S. Modeling Capability

The Earth System Prediction Suite (ESPS) is a collection of flagship U.S. weather and climate models and model components that are being instrumented to conform to interoperability conventions, documented to follow metadata standards, and made available either under open source terms or to credentialed users. The ESPS represents a culmination of efforts to create a common Earth system model architecture, and the advent of increasingly coordinated model development activities in the U.S. ESPS component interfaces are based on the Earth System Modeling Framework (ESMF), community-developed software for building and coupling models, and the National Unified Operational Prediction Capability (NUOPC) Layer, a set of ESMF-based component templates and interoperability conventions. This shared infrastructure simplifies the process of model coupling by guaranteeing that components conform to a set of technical and semantic behaviors. The ESPS encourages distributed, multi-agency development of coupled modeling systems, controlled experimentation and testing, and exploration of novel model configurations, such as those motivated by research involving managed and interactive ensembles. ESPS codes include the Navy Global Environmental Model (NavGEM), HYbrid Coordinate Ocean Model (HYCOM), and Coupled Ocean Atmosphere Mesoscale Prediction System (COAMPS®); the NOAA Environmental Modeling System (NEMS) and the Modular Ocean Model (MOM); the Community Earth System Model (CESM); and the NASA ModelE climate model and GEOS-5 atmospheric general circulation model.

Bipedicled fronto-occipital flap for reconstruction of postoncologic defects of the lateral scalp

Presented here are two clinical cases of extensive defects of the scalp secondary to surgical resection of invasive basal cell carcinoma on the parietal region, successfully treated by means of very large, bipedicled fronto-occipital flaps, based anteriorly on the supratrochlear-supraorbital vessels and posteriorly on the occipital and posterior auricular vessels. Considering both the location and the large size of the scalp defects, different surgical techniques are discussed and the potential use of bipedicled scalp flaps is considered, designed either sagittally or coronally as fronto-occipital or temporo-temporal flaps. The bipedicled fronto-occipital scalp flap is believed to represent a simple, secure, and useful reconstructive procedure for cutaneous coverage of extensive defects located on the lateral scalp.

Sideburn reconstruction with an expanded supraauricular trapezoidal flap

Although loss of the sideburn and temporal scalp with subsequent alopecia is relatively frequent as a consequence of traumatic, surgical, and iatrogenic processes, not many techniques of sideburn reconstruction have been reported. We present a two-stage technique to correct the long-sideburns when there is an associated temporal alopecic defect due to trauma or surgery by means of an expanded supra-auricular trapezoidal flap. The method can achieve not only a satisfactory appearance of the sideburn but also a normal capillary line from the occipital to the frontal region.

Aesthetic reductive thyroid chondroplasty

A modified technique to reduce the prominent laryngeal cartilage is presented.

Anatomic study of the superficial perineal neurovascular pedicle: implications in vulvoperineal flap design

Thirty superficial perineal neurovascular pedicles from 15 formaldehyde-fixed female cadavers were dissected and analyzed with the purpose of establishing the anatomic basis for the design and elevation of vulvoperineal fasciocutaneous flaps based on their anatomic elements. The average internal diameter of the superficial perineal artery was 0.53 +/- 0.2 mm, determined by means of an image analysis system. Three distinct anatomic patterns of cutaneous arterial vascularization were seen bilaterally, and two types of vulvoperineal fasciocutaneous flaps are described.

The Málaga flap for vaginoplasty in the Mayer-Rokitansky-Kuster-Hauser syndrome: experience and early-term results

We report our experience in vaginoplasty for the treatment of six cases of the Mayer-Rokitansky syndrome using bilateral vulvoperineal fasciocutaneous flaps measuring 8 to 9 X 3 cm. We consider a detailed description of the operative technique, noting the modifications that we have introduced as our experience increased, in addition to the cosmetic and functional results. On the other hand, the indications for using this vaginoplasty are presented. On the basis of our clinical results, the actual anatomy of the blood vessels leading to the pedicle of the flap, and the geometric design of the vulvoperineal flap, the following technical points can be made: (1) It is a secure and reliable technique because of well-established vascularization beneath the lateral border of the labia majora. (2) It is a straightforward method because the transposition and rotation of a vertical flap is easier than the use of more distant flaps. (3) There is a minor risk of injury to the superficial perineal neurovascular pedicle and Bartholin's gland. (4) Innervation extends into the external two-thirds of the artificial vagina. And (5) an acceptable cosmetic and functional result is achieved without the need to use dilators, obturators, or molds.

The injured foot: cutaneous coverage with a distally based posterior tibial cross leg flap

Treatment of extensive soft tissue defects of the foot has long been a challenging problem for the reconstructive surgeon. We report a series of 5 injured feet with major soft tissue loss and significant bony injury, treated with distally based cross leg flaps based on the posterior tibial artery, with satisfactory cosmetic and functional results. The survival of the flap was complete in 4 of the 5 patients; in one case, the flap suffered about 2-3 cm distal partial necrosis. The mean hospital stay was 30 days, and walking without ambulatory support was possible about 60 days postoperatively. We consider this procedure a potential alternative to microvascular techniques for the treatment of severe foot injuries, in an area where microsurgery reconstruction is fraught with difficulties.

Treatment of vaginal agenesis with vulvoperineal fasciocutaneous flaps

A simple surgical technique is reported for the treatment of vaginal agenesis utilizing vulvoperineal fasciocutaneous flaps based on the terminal vessels of the internal pudendal artery. Two vulvoperineal axial flaps are sutured together, skin surface opposed, then rotated posteriorly into rectovesical space. The operation has been performed on one patient, with good anatomic and functional results and without complications.