How Do Scholars Conceptualize And Conduct Health And Digital Health Literacy Research? Survey Of Federally Funded Scholars, Mayank Sakhuja, Brooks Yelton Ma, Lmsw, Simone Kabarana, Lauren Schaurer, Jancham Rachel Rumthao, Samuel Noblet, Michelle Angelique Arent, Mark M. Macauda Phd, Mph, Lorie Donelle Phd, Rn, Fcan, Daniela B. Friedman Ph.D.

Faculty Publications

Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from …

Length Of Stay Di Instalasi Gawat Darurat Sebagai Indikator Mutu Pelayanan Kesehatan Di Rumah Sakit X Tahun 2024, Gustiane Adriani Dwisari, Kurnia Sari

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The Emergency Department (ED) is crucial for ensuring patient care and safety in hospitals. A key performance indicator is Length of Stay (LOS), where prolonged LOS can lead to overcrowding, increase the risk of adverse events, and lower patient satisfaction. This study examines the service flow, barriers, and root causes of LOS in Hospital X's ED and provides improvement recommendations. Data were gathered through observation of 30 patients, interviews, and document reviews. Lean Thinking principles and the BAS method from BASICS (Baseline, Assess, Suggest Solution, Implement, Check Result, Sustain) were used in the analysis, employing flowcharts to map the process, …

Rencana Strategis Peningkatan Kinerja Poliklinik Eksekutif Rumah Sakit X Tahun 2024 -2027: Pendekatan Balanced Scorecard, Irfan Rohot Uli Manik, Adang Bachtiar

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Hospital X is a private hospital that has executive polyclinic services. Medical record data shows that in the last four years, the number of visits from the executive polyclinic unit has never reached the target set. This research is to prepare the strategic plan for improving the executive polyclinic of Hospital X's performance for 2024-2027. The types of data in this research are primary data and secondary data. Primary data is qualitative data from in-depth interviews, Consensus Decision Making Group (CDMG) with informants, and direct observation. Secondary data consists of quantitative data and qualitative data. Strategy implementation will be described …

Manajemen Rumah Sakit Dalam Kesiapsiagaan Menghadapi Bencana Di Rsud Balaraja: Metode Hospital Safety Index, Puspita Gaharu Nisaa, Robiana Modjo

National Journal of Occupational Health and Safety

Hospitals are required to provide health services under disaster conditions, serving as the front line to help survivors and patients. RSUD Balaraja of Tangerang Regency, the only Type B hospital owned by the Regency Government, is exposed to high potential disaster hazards, including floods, extreme waves, abrasions and tsunamis, as well as moderate risk of earthquakes. This study aims to analyse hospital management in disaster preparedness using a cross-sectional design with quantitative and qualitative approaches through Module 4 of the Hospital Safety Index and a phenomenological approach. The results showed that hospital management was rated as moderately safe in disaster …

Gambaran Persepsi Pengawas Terhadap Efektivitas Geotab Dalam Mengendalikan Risiko Kecelakaan Kendaraan Ringan Di Divisi X, Aisyah Yasmin Zafirah, Chandra Satrya

National Journal of Occupational Health and Safety

This study aims to understand supervisors' perceptions of the effectiveness of Geotab as a control measure for mitigating the risk of collisions involving light vehicles. Conducted in Division X of PT. X, a mining industry, from February to June 2023, this descriptive, semi-qualitative study collected data through control effectiveness questionnaires, interviews, and document review. The variables studied include the relevance, coverage, reliability, reactivity, resource competence, and supervision system of Geotab. Questionnaire results showed supervisor perception scores of 3.09 for relevance (appropriate), 3.10 for coverage (appropriate), 3.06 for reliability (appropriate), 2.99 for reactivity (appropriate), 2.93 for resource competence, and 2.95 for …

The Relationship Between Snacking And Sugar, Salt, Fat Intake On Nutritional Status Of Adolescents Of Smkn 30 Jakarta, Khoirul Anwar, Syifa Aulia Putri

Indonesian Journal of Public Health Nutrition (IJPHN)

Excessive consumption of sugar, salt, and fat including from snacks can increase the risk of obesity or being overweight. The objective of this study to analyze the relationship between snacking and sugar, salt, and fat intake on nutritional status in adolescents. This design is cross-sectional with a sample of 90 grade X students at SMKN 30 Jakarta. The data collected include physical activity data using the Global Physical Activity Questionnaire (GPAQ), snacking habit data, frequency of sugar, salt, and fat consumption using the SQ-FFQ. The results of the correlation test showed that there was a significant relationship between snacking habits …

Factors Related To The Consumption Of Sugar-Sweetened Beverages (Ssbs) Among High School Students At Sma Negeri 68 Jakarta In 2024, Debora Karyoko, Wahyu Kurnia Yusrin Putra, Teguh Jati Prasetyo

Indonesian Journal of Public Health Nutrition (IJPHN)

Indonesia ranked third in Southeast Asia for Sugar-Sweetened Beverages (SSBs) consumption in 2022, with a consumption rate of 20.23 liters/person/year. According to Riskesdas in 2018, 61.3% of the Indonesian population consumed more than once a day and 47.5% in 2023. This study aims to understand the patterns and levels of SSB consumption among various factors in students of SMA Negeri 68 Jakarta in 2024. This cross-sectional study was conducted from April to May 2024 with 134 respondents using questionnaires and interviews for 24-hour food recall and SQ-FFQ. Univariate analysis showed that 12.69% of respondents had high SSB consumption. Bivariate analysis …

The Relationship Of Dietary Pattern And Physical Activity On Cholesterol Level In Young Adults, Wahyuni Sammeng

Indonesian Journal of Public Health Nutrition (IJPHN)

High blood cholesterol levels are a serious problem because they are one of the risk factors for degenerative diseases such as cardiovascular. Research data shows that in Ambon City, 32.49% of the population has the habit of consuming fatty/cholesterol/fried foods ≥1 time per day. The purpose of this study was to determine the relationship between dietary habit and physical activity with blood cholesterol levels. The type of research used was quantitative, sampling technique used was convenience sampling for 30 people. The independent variables in this study were dietary intake (amount, frequency, and type) measured using a semi-quantitative FFQ and physical …

Different Food Coping Strategies In Urban And Semi-Urban Areas During Coronavirus Disease 2019 (Covid-19) Pandemic, Sandra Fikawati, Ahmad Syafiq, Rizna Notarianti, Syilga Cahya Gemily

Indonesian Journal of Public Health Nutrition (IJPHN)

Consumption-related behavior implemented as an effort to maintain household food security is referred to as a food coping strategy (FCS). This study aims to describe the selection of FCS by families in urban and semi-urban areas in Indonesia during the COVID-19 pandemic. This research is a cross-sectional study with a total sample of 517 people who live in urban (Jakarta) and semi-urban (Depok) areas. The research data was taken from primary research data that had been collected online and purposively through Posyandu cadres who had access to family/community in October-December 2020. Data analysis used the chi-square test and multiple logistic …

Evaluation And Lessons Learned From The Dissemination And Implementation Science Scholars Program In The National Cancer Prevention And Control Research Network, Daniela B. Friedman, Cam Escoffery, Elaine H. Morrato, Cynthia A. Thomson, Courtney N. Petagna, Freda Allyson Hucek, Mary Wangen, Aubrey Villalobos, James R. Hébert Scd, Samuel Noblet, Mayank Sakhuja, David O. Garcia, Jennifer L. Cruz, Stephanie B. Wheeler

Faculty Publications

Background:

The Centers for Disease Control and Prevention (CDC)-funded Cancer Prevention and Control Research Network (CPCRN) has been a leader in cancer-related dissemination & implementation (D&I) science. Given increased demand for D&I research, the CPCRN Scholars Program launched in 2021 to expand the number of practitioners, researchers, and trainees proficient in cancer D&I science methods. Methods:

The evaluation was informed by a logic model and data collected through electronic surveys. Through an application process (baseline survey), we assessed scholars’ competencies in D&I science domains/subdomains, collected demographic data, and asked scholars to share proposed project ideas. We distributed an exit survey …

Assessing The Relative Efficacy Of Components Of Opioid-Free Anaesthesia In Adult Surgical Patients: Protocol For A Systematic Review And Component Network Meta-Analysis, Amparo Belltall, Guido Mazzinari, Aisling Ní Eochagáin, Tom Wall, Ary Serpa Neto, Oscar Diaz-Cambronero, Daniel Sessler, Donal J Buggy, Juan Cata, Markus W Hollmann

Faculty, Staff and Student Publications

Introduction: The rise of opioid-free anaesthesia (OFA) aims to reduce postoperative pain while reducing opioid-related side effects during surgery. However, the various adjuvant agents used in OFA complicate the evaluation of their effectiveness and risks. Recent reviews question the clinical benefits of OFA, highlighting the need for thorough evaluation. This protocol describes a network meta-analysis to compare the effectiveness of OFA with opioid-based anaesthesia and will identify key components for optimal postoperative outcomes.

Methods and analysis: We will perform a systematic search of literature published in English without time restriction in Embase, The Cochrane Library, MEDLINE (via PubMed) and CINAHL, …

Short-Term Outcomes Of A Healthy Relationship Intervention For The Prevention Of Sexual Harassment And Sexual Assault In The Us Military: Pilot Pretest-Postest Study, Belinda Hernandez, Ross Shegog, Christine Markham, Susan Emery, Elizabeth Baumler, Laura Thormaehlen, Rejane Andina Teixeira, Yanneth Rivera, Olive Pertuit, Chelsey Kanipe, Iraina Witherspoon, Janis Doss, Victor Jones, Melissa Peskin

Faculty, Staff and Student Publications

BACKGROUND: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program's goal is to increase Airmen's knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen's overall well-being and mission readiness.

OBJECTIVE: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of …

Chikungunya Pathogenesis In Cardiac Tissues And Its Evaluation In Stem Cell Derived Cardiac Models, Elizabeth M. Traverse

USF Tampa Graduate Theses and Dissertations

Chikungunya Virus (CHIKV) is a single stranded RNA alphavirus primarily vectored by Aedes aegypti and Aedes albopictus mosquitos. CHIKV has circulated in tropical and sub-tropical regions of Africa and Asia, but outbreaks in the past two decades have seen the virus spread to Europe, South America, and the Caribbean. Disease from CHIKV infection typically results in fever, malaise, and sometimes debilitating arthralgia. However, there are concerning abnormal presentations that affect the human heart, including myocarditis, heart failure, and death. These symptoms are seen in all age groups and sexes and are not connected to particular strains or mutations in the …

Social Determinants Of Health And How They Affect A Small Rural Community (Case Study) Eastern Shore Of Maryland, Kristopher S. Durham, Lindsay Gietzen

Pacific Journal of Health

The Eastern Shore of Maryland is rural and is characterized by prevalent poverty, housing instability, lack of access to healthcare, chronic diseases, substance abuse, and issues with transportation to access healthcare services. The same problems exist for the population in Maryland and the United States. Understanding the challenges experienced by rural communities in Maryland is critical to addressing the vulnerable population. This study is an explanatory case study that examines the social determinants of health and how those affect small rural communities on the Eastern Shore of Maryland by examining literature published between 2016 and 2024. The literature reviewed resulted …

A Phenotypic Characterization Of Staphylococcus Aureus Bacteremia Clinical Isolates, Sara Dj Daniels

USF Tampa Graduate Theses and Dissertations

Staphylococcus aureus is a human pathogen of serious concern because of its ability to cause serious and wide-ranging disease. Of particular concern is the ability of S. aureus to cause bacteremia (SAB), allowing the bacteria to disseminate and spread to various organs. This study addressed this issue through the phenotypic characterization of two methicillin-resistant S. aureus (MRSA) clinical isolates taken from patients with sustained complicated bacteremia at Tampa General Hospital, referred to as SA1097 and SA1098. A battery of phenotypic tests was conducted on these strains, including a growth curve, hemolysis and proteolysis screenings, cytotoxicity assays using human neutrophils, blood …

Professional Development: A Mixed Methods Study Of Masters Of Public Health Alumni, Orna Baron-Epel, Yana Douvdevany, Dana Ivancovsky-Wajcman, Paul Barach, Osnat Bashkin, Katarzyna Czabanowska, Keren Dopelt, Nadav Davidovitch, Szczepan Jakubowski, Fiona Macleod, Maureen Malowany, Leah Okenwa-Emegwa, Maya Peled-Raz, Shira Zelber-Sagi

College of Population Health Faculty Papers

INTRODUCTION: We examined the perceptions of the Master of Public Health (MPH) degree graduates regarding their personal competencies, job performance and professional development using a mixed method, explanatory sequential design.

METHODS: A cross-sectional, self-administered questionnaire of the Haifa School of Public Health alumni who graduated between 2005 and 2022 was disseminated to 849 graduates between March and June 2022, from which 127 responded (response rate: 14.90%). This was followed by 24 in-depth interviews with alumni from the same sample (conducted between November 2022 and March 2023).

RESULTS: The sample included 74.8% of females with a mean age of 40.7 years, …

Feasibility Of The Mind+Soul Culturally Tailored Brain Healthy Diet: A Pilot Study, Ashley R Shaw, Robyn Honea, Dinesh Pal Mudaranthakam, Kate Young, Eric D Vidoni, Jill K Morris, Sandra Billinger, Mickeal N Key, Jannette Berkley-Patton, Jeffrey M Burns

Faculty, Staff and Student Publications

Alzheimer’s disease (AD) disproportionately impacts Black Americans, who are three times more likely to develop AD. While heart-healthy diets have shown potential in reducing AD risk, research on adapted dietary interventions for Black American communities remains limited. This pilot study assessed the feasibility and acceptability of an adapted brain healthy diet intervention (MIND + SOUL) and explored changes in cardiometabolic risk and cognition. Twenty-nine participants completed the 12-week intervention, which included culturally tailored health education, cooking classes, health coaching, and groceries. Feasibility was assessed by attendance and retention rates, while acceptability was measured by two questionnaires. Participants had a mean …

Open Access In The Age Of Ai: The Journal Of Appalachian Health And Hurricane Helene Recovery, Noah Wren, Bradley Firchow

Journal of Appalachian Health

The recent destruction brought upon the Appalachian region by Hurricane Helene has emphasized the importance of the Journal of Appalachian Health. As an open-access peer-reviewed source of information, the Journal plays a critical role in not only facilitating public health research about Hurricane Helene, but also combating misinformation regarding the event. In the days following Hurricane Helene, misinformation about the federal government’s response, along AI generated images, have left many in the region confused and misled about what had happened. Going forward, the Journal will play an necessary part in making sure accurate information is shared to understand how …

Credentialing Care: Covid-19 And The Bureaucratization Of Doulas, Ellen Block, Julie Johnson Searcy, Angela N. Castañeda

Sociology Faculty Publications

Doulas in the United States offer embodied, informational, and continuous one-on-one care to birthing people. Doulas have historically sought certification to gain knowledge through training and to gain legitimacy for healthcare providers and clients. During the COVID-19 pandemic, hospitals required doulas to provide proof of certification. The COVID-19 pandemic, and the proliferation of state-sponsored doula programs, has sparked a shift in how doulas are viewed and regulated, enabling new forms of bureaucratic oversight and control. Based on participant observation, surveys, and semi-structured interviews, we examine the connection between certification and care including motivations doulas have for certification, the perceived value …

Α4 Nicotinic Acetylcholine Receptors In Lipopolysaccharide-Related Lung Inflammation, J. Ritzenthaler, Walter H. Watson, Jesse Roman

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Sepsis remains an important healthcare challenge. The lungs are often affected in sepsis, resulting in acute lung injury characterized by inflammation. Mechanisms involving lipopolysaccharide (LPS) stimulation of toll-like receptor (TLR) signaling with induction of proinflammatory pathways have been implicated in this process. To date, however, studies targeting these pathways have failed to improve outcomes. We have found that LPS may also promote lung injury through the activation of α4 nicotinic acetylcholine receptors (α4 nAChRs) in immune cells. We observed increased expression of α4 nAChRs in human THP-1 monocytic cells exposed to LPS (100 ng/mL, 24 h). We also observed that …

Psychosocial Factors, Stress And Sleep Among Rural Appalachian Kentucky Residents With Type 2 Diabetes Mellitus, Blake Dipaola, Zoe Taylor, Eric Hennemann, Brittany L. Smalls, Philip M. Westgate, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region.

Purpose: To better understand these associated health burdens, the relationship among these conditions and psychosocial factors—such as depressive symptoms, distress, empowerment, and social support—was examined among Appalachian residents with T2DM.

Methods: Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used …

Nutrition Education Needs And Barriers Of Uninsured Clients Who Utilize Free Clinics In Western North Carolina, Manan Roy, Alisha Farris, Erin Loy, Lauren Sastre, Danielle L. Nunnery

Journal of Appalachian Health

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region.

Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities.

Results: Depending on the clinic, 49-58% of participants were …

Excess Potassium Promotes Autophagy To Maintain The Immunosuppressive Capacity Of Myeloid-Derived Suppressor Cells Independent Of Arginase 1, Ramesh Thylur Puttalingaiah, Matthew J. Dean, Liqin Zheng, Phaethon Philbrook, Dorota Wyczechowska, Timothy Kayes, Luis Del Valle, Denise Danos, Maria Dulfary Sanchez-Pino

School of Medicine Faculty Publications

Potassium ions (K+) are critical electrolytes that regulate multiple functions in immune cells. Recent studies have shown that the elevated concentration of extracellular potassium in the tumor interstitial fluid limits T cell effector function and suppresses the anti-tumor capacity of tumor-associated macrophages (TAMs). The effect of excess potassium on the biology of myeloid-derived suppressor cells (MDSCs), another important immune cell component of the tumor microenvironment (TME), is unknown. Here, we present data showing that increased concentrations of potassium chloride (KCl), as the source of K+ ions, facilitate autophagy by increasing the expression of the autophagosome marker LC3β. Simultaneously, excess potassium …

The Lived Experiences Of Work Related Violence Against Public Health Professionals During Covid-19 Pandemic, Cynthia Howell

Walden Dissertations and Doctoral Studies

Work-related violence (WRV) against public health professionals is increasingly prevalent worldwide but received much greater attention during the COVID-19 pandemic. This qualitative study addressed a gap in the literature by exploring public health professionals' experiences with WRV threats, what factors contributed to their vulnerability, and the severity of these threats during the COVID-19 pandemic from 2020 to 2023. Rogers' (1975) Protection Motivation Theory was the conceptual framework for phenomenological study. Twelve public health professionals, both male and female, including epidemiologists, nurses, physicians, researchers/scientists, and community health workers, who actively worked during the COVID-19 pandemic and were residents of New York …

Health Risks Associated With Adopting New-Generation Disposable Products Among Young Adults Who Use E-Cigarettes, Shuyao Ran, James J Yang, Megan E Piper, Hsien-Chang Lin, Anne Buu

Faculty, Staff and Student Publications

New-generation disposable e-cigarettes have become increasingly popular among young adults in the USA since the FDA's partial flavor ban. This study aims to examine longitudinal changes in health risks among young adults who adopted these novel products, as well as the health effects of device types beyond the effects of other important e-cigarette characteristics. This study recruited e-cigarette users via voluntary response sampling from three college campuses in the USA to respond to four-wave online surveys conducted in four consecutive semesters. Among the participants who adopted disposables during the study, their health risks (dependence symptoms, respiratory symptoms, combustible tobacco use) …

Assessing The Climate Readiness Of Physician Education Leaders In Graduate Medical Education, Deborah Simpson, Anne Getzin, Aaron A. Levy, Victoria Gillet

Journal of Patient-Centered Research and Reviews

Climate change affects patient health through an array of exposures, including increasing heatwaves, extreme weather events, poor air quality, and expanding vector-borne illnesses. Physicians are at the forefront of addressing the health consequences of these exposures with patients, and environmental sustainability has become a priority for health care organizations. Accordingly, climate change and health is becoming a critical area for graduate medical education (GME). As GME leaders design and drive education in residency and fellowship programs, understanding those leaders’ baseline knowledge on this topic and its alignment with their organizations’ priorities is an essential step in the development of climate …

Barriers To Help-Seeking Behavior For Maternal Mental Health Disorders: Application Of The Health Belief Model, Tobi F. Oloyede, Joanne Chopak-Foss

Journal of the Georgia Public Health Association

Perinatal mood and anxiety disorders (PMADs) have become a leading cause of maternal mortality due to suicide among women in the first year following pregnancy. Although the profile for new mothers who die by suicide is predominantly white, disparities exist between Black and White women in their seeking help for perinatal and/or post-natal mood disorders. For Black, Indigenous, and People of Color (BIPOC), there are differences in the perceptions of the benefits of seeking help for PMADs. The COVID-19 pandemic exacerbated maternal mental health disorders in the United States particularly for women who live in communities with limited access to …

Beyond The Checklist: Pilot Education, Aviation Resources, And Health Management Skills, Nancy Smith

Pacific Journal of Health

The research study investigates if pilots find aviation health-related materials provided from training or aviation associations to support their own health needs. A mixed methods convergent parallel design was conducted by sampling 27 pilots within general aviation to assess their utilization of aviation health-related materials, health management skills including self-efficacy and prioritization, as well as their views of implementing particular health topics into aviation training. Results of the study indicate that it is unclear if pilots find aviation health materials useful in managing their health, pilots have a relatively high level of self-efficacy and ability to prioritize one’s health and …

Understanding The Role Of Perceived Racial Discrimination On Adolescent Mental Health During The Covid-19 Pandemic, Jill V. Klosky, Delia Lang, Briana Woods-Jaeger, Julie Gazmararian

Journal of the Georgia Public Health Association

Abstract

Background: Adolescent mental health declined during the COVID-19 pandemic. Racial discrimination, which may negatively affect adolescent mental health, has increased. This study sought to understand whether pre-pandemic reports of racial discrimination predicted changes in adolescent depression, anxiety, and self-esteem from before to during the COVID-19 pandemic.

Methods: Two online surveys were administered at two public high schools in semi-rural, north-central Georgia; one in Spring 2020, just before the closing of public schools due to COVID-19; the other to the same students in Fall 2020.

Results: Most participants were White (62%) and the majority (88%), reported the same or better …

A Unique Advantage Of A 24-Hour Surgical Delay In Autologous Breast Reconstruction, Devin M. Melancon, Daniel Yoo, Zachary Stern-Buchbinder, Samantha Morin, Hugo St. Hilaire, Robert J. Allen

School of Medicine Faculty Publications

Summary: The surgical delay technique can be used effectively in autologous breast reconstruction when there is unfavorable flap vascular anatomy or when the reconstruction necessitates a larger volume of donor tissue to obtain optimal results. The length of time between surgically delaying the flap to pedicle division and inset of the flap often varies based on surgeon preference but is typically approximately a week or longer. The authors present a case in which a 24-hour surgical delay was successfully used to augment deep inferior epigastric perforator flaps for autologous reconstruction. This technique is beneficial as it does not allow time …