ABSTRACT
Usability and functionality are important when designing hand-wearable robots; however, satisfying both indicators remains a challenging issue, even though researchers have made important progress with state-of-the-art robot components. Although hand-wearable robots require sufficient actuators and sensors considering their functionality, these components complicate the robot. Further, robot compliance should be carefully considered because it affects both indicators. For example, a robot's softness makes it compact (improving usability) but also induces inaccurate force transmission (impacting functionality). To address this issue, we present in this paper a tendon-driven, hybrid, hand-wearable robot, named Exo-Glove Shell. The proposed robot assists in three primitive motions (i.e., thumb opposition motion, which is known as one of the most important hand functions, and flexion/extension of the index/middle fingers) while employing only four actuators by using an under-actuation mechanism. The Exo-Glove Shell was designed by combining a soft robotic body with rigid tendon router modules. The use of soft garments enables the robot to be fitted well to users without customization or adjustment of the mechanisms; the metal routers facilitate accurate force transmission. User tests conducted with an individual with a spinal cord injury (SCI) found that the robot could sufficiently and reliably assist in three primitive motions through its four actuators. The research also determined that the robot can assist in various postures with sufficient stability. Based on the grasp stability index proposed in this paper, user stability-when assisted by the proposed robot-was found to be 4.75 times that of an SCI person who did not use the Exo-Glove Shell.
ABSTRACT
BACKGROUND: The fibular free flap is considered one of the most valuable options for mandible reconstruction. A perforator flap has gained widespread acceptance in oral and maxillofacial reconstruction. Typically, the fibula flap is obtained primarily with the distal perforator due to its reliable blood supply, with less attention given to the proximal perforators during the harvesting process. Normally, the distal perforator of the fibula exhibits stability and shows limited anatomical variations. However, there have been reported cases in which the distal perforator is absent. At times, these vascular abnormalities remain undetectable through Doppler examination or preoperative angiography evaluation. Therefore, this case details the experience of encountering the rare event of vascular abnormality in oral cancer surgery. CASE PRESENTATION: This article reports the case of a patient who presented with a congenital absence of the distal perforator in the peroneal artery, attributed to a vascular abnormality. Additionally, we provide a review of the concept of utilizing the proximal perforator as an alternative approach in the flap harvesting process. CONCLUSIONS: While the distal perforator of the peroneal artery is typically utilized for fibula free flap procedures, surgeons must remain cognizant of the potential for its absence due to aberrant anatomy. Recognizing an alternative approach in such cases can be pivotal for precise surgical planning and favorable outcomes in oral and maxillofacial reconstruction.