Classification of skin grafts.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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\r\n\tThe scope of this book encompasses theory and applications of differential equations of various types. Differential equations are extremely important, especially nowadays since they are known as a fundamental way of modeling dynamical systems and, thus, their properties such as stability, instability, periodic and chaotic behaviors which are extremely important when studying dynamical systems. The applications have been growing in numbers and include autonomous vehicles (with examples being driverless cars and satellites), robotics, medical surgery, precision agriculture, and smart buildings, to name a few. The complexity and techniques of analyzing behaviors of differential equations depend on whether they are ordinary, linear or nonlinear, infinite-dimensional or stochastic, etc. Another important topic is how to control differential equations to achieve particular properties that they do not possess without any control action. The control designs heavily depend on the type of differential equations as well as different constraints imposed on the control variables as well as on the information available to the controllers.
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He is a visiting professor in various universities in Serbia (Belgrade and Novi Sad), China, Germany, and the USA (University of California at Berkeley). Currently, he is an Associate Editor for the Journal of Optimization Theory and Applications.",coeditorOneBiosketch:null,coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"318375",title:"Prof.",name:"Dusan",middleName:null,surname:"Stipanovic",slug:"dusan-stipanovic",fullName:"Dusan Stipanovic",profilePictureURL:"https://mts.intechopen.com/storage/users/318375/images/system/318375.jpg",biography:"Professor Dusan Stipanovic received his B.S. degree in electrical engineering from the University of Belgrade, Belgrade, Serbia in 1994, and the M.S.E.E. and Ph.D. degrees in electrical engineering from Santa Clara University, Santa Clara, California in 1996 and 2000, respectively. Dr. Stipanovic had been an Adjunct Lecturer and Research Associate with the Department of Electrical Engineering at Santa Clara University (1998-2001), and a Research Associate in Professor Claire Tomlin’s Hybrid Systems Laboratory of the Department of Aeronautics and Astronautics at Stanford University (2001-2004). In 2004, he joined the University of Illinois at Urbana-Champaign where he is now Professor in the Controls Group of the Coordinated Science Laboratory and Department of Industrial and Enterprise Systems Engineering. He is a visiting Professor in the School of Electrical Engineering of the University of Belgrade in Serbia, School of Computer Science and Technology or the University of Science and Technology in Hefei, China, Technical School of the University of Novi Sad in Serbia, and in the Robotics and Telematics Department at the University of Würzburg in Germany. He also held visiting faculty positions in the EECS Department at the University of California at Berkeley. His research interests include decentralized control and estimation, stability theory, optimal control, and dynamic games with applications in control of autonomous vehicles, precision agriculture, circuits, and medical robotics. Dr. Stipanovic served as an Associate Editor on the Editorial Boards of the IEEE Transactions on Circuits and Systems I and II. 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The German federal government intends to reduce the daily land consumption to 30 ha per day in 2020 [3]. In 13 years between 1993 and 2010, land consumption in Germany was significantly higher than 100 ha per day. In the other 5 years, the undershooting of the 100 ha mark has been mostly due to lower economic growth rates or an economic slump [4]. Particularly rural areas were affected by excessive land consumption. Almost 50% of the converted land is sealed [5].
In order to achieve the 30 ha target, there is a broad consensus about the necessity to support planning by means of economic instruments. In this discussion, tradable planning permits turned out to be the instrument of choice, at least among the scientists. In Germany, a lot of research has been underway on this issue for years now (for example, see [6]). Among others, a pilot project is also in preparation [7, 8], as it was planned in the coalition agreement of the current federal government [9].
The idea of tradable planning permits stems from the concept of tradable CO2 rights, more accurately the cap and trade system. Within the cap and trade regime, pollution rights should be limited in quantity and made tradable. Due to the cap on the pollution possible, the system is considered ecologically effective. If the mechanism is applied to the field of land use planning, the communal development plans are only legally valid if they are backed by planning permits, which have to be held by the communes. The communes – as the planning authorities – and not the land owners are the holders of the planning permits. This is an important difference from “tradable development rights”, where private-sector actors are the sellers and buyers (for example, see [10]).
Due to the trade, the scheme is also regarded as being efficient because only those actors with the lowest marginal abatement costs reduce the emissions. The permits can be bought and sold by the communes on an organized trading platform.
The cap on the permits helps to circumvent rationality traps (game theory) which otherwise would appear. In Germany, for instance, communes competed against each other to attract new inhabitants and industries in order to get more tax revenues and higher shares out of the financial equalization scheme. This competition was a race to the bottom in many cases. Among others, the results in many cases have been almost empty residential or commercial areas and high infrastructure costs. However, if a community waives the preparation of new building areas, the neighbouring municipality takes the chance.
Within the cap and trade scheme, such rationality traps might be broken up [11]: Due to the costs of the permits, only such communes whose benefits of land development exceed the costs of the permits will buy planning permits and carry out land development. If land conversion can be avoided at costs below the costs of the planning permits, communes waive the right to further development. Maybe they can also reconvert the land into a natural state. Hence, if there is no need for holding permits, such communes will sell them to other communes (for example, see [12]). If they do not sell the “free” rights, they will suffer opportunity costs. This means that communes with high marginal abatement costs (tax revenues, jobs etc.) are the buyers of the rights, while communes with low marginal abatement costs are the sellers. In the end, all marginal abatement costs equalize at the price of the tradable permits. In the trading planning permits scheme, the secondary market is the institutional heart of the mechanism.
Although it sounds quite appealing at first glance, we want to show that the application of the cap and trade scheme to land use planning is anything but self-evident and not a promising approach per se.
Tradable planning permits are considered to be a sort of magic bullet. On the one hand, the cap on development permits makes the system effective. On the other hand, only those communes with the highest benefits (additional taxes and shares from financial equalization schemes) carry out the development. Communes with low opportunity costs waive the right to development. Hence the scheme is also efficient, because the planning rights are used at the locations with the highest benefits.
However, contrary to what intuition would suggest, we want to show that effectiveness and efficiency don’t harmonize if the concept is applied to land use planning. In contrast, the cap and trade approach cannot meet the goals of efficiency and effectiveness at the same time (“incompatibility thesis”) [13]. The argument is based on the following two statements:
In order to be efficient, a cap and trade system needs wide system boundaries. At least in small or medium-sized countries, such wide system boundaries go hand in hand with a unified planning permit and a unit price.
In contrast to CO2, effective land use planning doesn’t require control of a scale, but of a structure. A land use structure cannot be controlled effectively by a single planning permission with a single price.
There is a central difference between the cap and trade on CO2 and the cap and trade on planning permits. Considering the consequences for global warming, it does not matter where the CO2 is emitted due to the diffusion characteristics of the greenhouse gas. Hence the task is to control a scale (maximal CO2 emissions anywhere) by capping the quantity of emissions. However, regarding land use planning, not only the scale but also the structure of land use has to be controlled. The quantity of land as a whole can hardly be extended. Instead, the relevant issue relates to changes in the structure of land use, which is for instance forestry, agriculture, industry, settlements etc. It is of central importance where the land use takes place and for which purpose. Hence CO2 permits are a homogenous good, but land use rights shouldn’t be.
At present, the structure of land use is controlled by the planning system. According to the proponents of the tradable development rights idea, land use planning should not be substituted but supported by the economic tool (“primacy of planning”) [14].
Planning is necessary to break up a possible Nash equilibrium [11] caused by the behaviour of land owners: If, in the absence of any planning, only the willingness to pay decides about land use patterns, a spatial disaster may result and people may run into a rationality trap. If, for example, German people were allowed to realize the favoured model of the detached one-family house in green surroundings, urban sprawl would happen, with negative ecological, economic and social impacts.
At the same time, planning is necessary to protect such forms with weak financial endowments which cause important positive external effects. If no plan provided public spaces e.g. for kindergartens and schools, such forms would have to compete with actors with a high willingness to pay (e.g. banks). Hence they could not be realized. However, without such facilities, the value of the area would often be lower than with them. Good planning should consider the variety of functions of land (e.g. ecological, spiritual). Such forms of land use that move beyond efficiency and profitability are not only important for the cohesion of the social system, but in many cases also for the resilience of the ecological system (for example, see [15]). Planning has to balance the competing demands of various stakeholders, including groups with low budgets and the protection of nature.
Although the primacy of planning is wide consensus, in recent debates it has been argued that tradable planning permits may counteract land use planning [13]. The “incompatibility thesis” is based on the required design of a cap and trade regime. A major justification of the system is its efficiency. The efficiency of the cap and trade system is caused by differences in marginal abatement costs:
Those communes with high marginal abatement costs buy planning permits on the market at the lower market price. The difference is the benefits from the cap and trade system.
On the other hand, such communes with low marginal abatement costs reduce their harmful activities and sell the free certificates on the market. The difference between market price and marginal abatement costs is the profit from abatement.
In the end, the marginal abatement costs of all the actors equal the market price of the planning permits. The higher the differences of marginal abatement costs of the acting communes, the higher the efficiency potential of the regime will be.
However, high differences in abatement costs can be achieved by a wide design in terms of space, time, participants and the objects of trade:
In categorical terms, diverse spatial categories (living, commerce, mixed use, traffic etc.) have to be gathered in one single planning permit (“universal” certificate). This is any land for human settlement and transport infrastructure without regard to its different components;
Regarding the market participants, the discussion is about also including individuals or NGOs instead of only permitting communes as traders;
In spatial terms, scientists agree that the trade boundaries have to be as wide as possible (e.g. whole of Germany, no single states);
Considering the time dimension, banking and borrowing is also discussed in order to use differences in the marginal abatement costs over the timeline.
In Germany, in the last decade the preferred design is characterized by
A country-wide regime (although the pilot project mentioned above will only comprise selected communes) which incorporates the administrative support of the different states of the federation [16].
A universal certificate which comprises the whole area for settlement and traffic [16].
Banking should be allowed (at least the transfer into the following provisional period), in order to allow long-term development strategies for the communes. In contrast, there is much scepticism with regard to providing the opportunity to use the rights before owning them (borrowing) [17].
Regarding the market participants, an extension of participants beyond the communes has not been discussed seriously so far.
Hence the efficiency potential can only be exhausted if the target is “scale” instead of “structure” (which would make sub-markets necessary). The scale target has to fix wide system boundaries (in contrast to other tradable development rights schemes; for example, see [13]). The scale target and the wide system boundaries are mutually dependent.
There is also another reason why a working trade system would not be possible without wide boundaries: Narrow markets cause high price volatility of the permits. The higher the price volatility, the more insecure the economic success of abatement activities and the less abatement activities will take place. Thus the target is to set the condition for organized trade of the permits.
Having shown the necessity for wide system boundaries in a cap and trade model, the next question is whether a land use structure – not a scale – can be controlled within such a system. We want to illustrate the problem within figure 1 below. The land use plan sets the allowed land use A (e.g. industry) at the maximum of CA. The maximal land use B (e.g. housing) is limited by CB. The marginal abatement costs (MAC) are MACA for land use type A and MACB for land use type B. For simplification purposes, the illustration doesn’t include more land use types.
If a commune waives the right to development of additional sites, it has to suffer marginal abatement costs. Such marginal abatement costs are mainly opportunity costs. If, for instance, a residential area is not realized, a German municipality gets lower shares of the income tax revenues, lower property tax revenues and lower revenues out of the fiscal equalization scheme. If an industrial site cannot be realized, the opportunity costs also comprise lost business tax revenues. Also indirect effects have to be considered, such as income multiplier effects which otherwise would have been initiated by construction activities. All these interrelations and effects are quite complex and include feedbacks within the system. Basically, the scale of opportunity costs is not quite clear. Fiscal impact analysis could provide for more cost transparency, but it is in an early stage. Some fiscal impact tools used so far for residential areas turned out to have quite different performance; for industrial areas no reliable fiscal impact tool is available so far. Also within the above-mentioned pilot model of tradable development rights the development of reliable fiscal impact analysis tools is acknowledged to be important in order to get a better idea about the marginal abatement costs.
However, in the subsequent figure we assume, contrary to the facts, that there is an accurate idea about the volume of the marginal abatement costs of land use type A and B. Hence we can derive a mathematical function of MAC, being dependent on the scale of land use of the different types.
First, let’s assume that the caps for land use type A (CA) and B (CB) are set according to the land use plans. We assume that the land use planning also properly computes the marginal damages (MD), which are illustrated with the dotted line for both types of land use. With this theoretical “trick” we can take into account that planners care for quantity as well as for quality of land use (for example, see [17]). Therefore, the planning target (CA and CB) corresponds perfectly with the intersection of marginal abatement costs and marginal damage of land use type A (EA) and B (EB).
Moreover, theoretically the marginal damage of land use type B can be expressed in equivalents of the marginal damage of land use type A. Such equivalents are useful for the definition of a universal cap. Analogous equivalents are also used in the greenhouse gas emission permit schemes. In the Kyoto regime for instance, global warming potentials (GWPs) are used in order to express the global warming potential of the other greenhouse gases in relation to CO2, whose GWP is standardized to 1. Hence, if caps for different land use types should reflect such equivalents (for simplification purposes a linear function is used below), we get for instance a function such as:
The total cap results by aggregation of the caps of the individual land use types:
It is important to note that the equivalents only reflect an average consideration. However, different communes may have different structures of land use; thus the equivalents don’t represent their individual situation.
In the subsequent diagram, the added marginal abatement costs (MACA+B) show the aggregate demand curve, and the aggregated cap (CA+B) shows the aggregate supply curve of all land used for settlement and traffic, set by the planning authorities. The intersection point determines the unit price of the universal development right P* [13]. The illustration holds true for an individual municipality as well as for the aggregation of municipalities.
The figure shows why a unit price causes economic incentives to violate the land use plans:
Regarding land use type A, the mayor in charge will extend the land use until the intersection point (IA) of the unit price P* and the marginal abatement costs MACA. From this point on, the costs for additional planning permits exceed the benefits from additional land use. However, regarding the land use plan (and the marginal damage), more development of land use type A would be possible (up to EA and CA respectively). Insofar there is a loss of welfare, indicated by the gap between MA and CA. In order to support the land use planning, price PA would be necessary instead of the unit price P*.
Looking at land use type B, the mayor increases land development until his/her benefits of additional development MACB equal the unit price of the development P* (in point IB or MB respectively). However, this is much more than the land use plans have fixed (CB). If the caps reflect the intersection point EB of marginal damage function MDB and marginal abatement costs MACB, this point IB is also far beyond efficiency (in EB). In order to get an effective and efficient result, price PB would have been necessary.
Aberrations with a universal planning permit (adapted from [13])
From the figure above we may derive two important results:
The trading model, which is based on wide system boundaries and a single tradable planning permit, is not able to support land use planning. With a unit price, it is only able to control scale but not structure.
Nonetheless, the supporters assert effectiveness. Obviously, they refer to the CO2 blueprint and only consider the control of scale, but ignore the necessity to control structure. There is no assessment of the welfare losses which are caused by overshooting and undershooting of the planning targets so far (differences between MA,B and CA,B). Therefore, also no proper statement about the net efficiency gains (efficiency gains minus the welfare losses, due to overshooting and undershooting) of the cap and trade system can be provided.
Sometimes, supporters suppose that the deviations and aberrations are negligible. Depending on the price of the permits, the position of the caps and the marginal abatement costs, the aberrations and welfare losses can be randomly quite high or low. There is no evidence for a correction mechanism, which might be able to reduce such aberrations systematically. Hence, overshootings and undershootings probably don’t equalize in aggregation. The system is as effective as a poor marksman who is currently missing the target in different directions. Aggregating the shooting errors doesn’t turn the poor marksman into a champion.
Against this background, we can describe the central system conflict as follows:
The rationale of the cap and trade regime is efficiency. However, efficiency can only be achieved within a wide design of the system, among others based on a universal certificate (including all categories of land for human settlement and transport infrastructure);
In contrast, the required primacy of planning can only be maintained within a tightly structured system. In contrast to the controlling of the scale of CO2 emissions, the settlement structure cannot be controlled by one cap (certificate) and one price, but needs a diversity of prices with a diversity of certificates.
If a structure is “treated” with a single price, welfare losses have to be expected due to overshooting and undershooting of the planning targets. Hence the net efficiency gains and net welfare effects of a cap and trade regime for land use policy are not clear at all.
The supporters of the tradable planning permits claim that planning should impose a correcting action if necessary. However, our argument is that precisely due to the counteracting economic signals, planning cannot impose such an action.
The problem could theoretically be solved by a variety of tightly segmented sub-markets with diverse price settings. Sub-markets which adapt the categories of land use planning (market segmentation in categorical terms) have been discussed e.g. by Henger and Schröter-Schlaack [17]. Spatial boundaries which limit the trading rights to regions with similar protection status (market segmentation in spatial terms) have been addressed e.g. by Williams [18], Walz et al. [16], Henger and Bizer [19]. However, in most countries such markets would be too small and thus inefficient [17]. At least in the German discussion, the conflict of goals which appears in the cap and trade scheme was decided in favour of efficiency and against market segmentation. Within a system with wide boundaries, such an incompatibility could perhaps be avoided in a few countries with high population and centralized land use planning systems, such as China. However, so far there is no sound research about the minimum size of such markets and the requirements for the land use planning system.
Within a cap and trade system, the initial distribution might be done by auction or by providing the permits to the communes without costs (according to alternative allotment formulas). Simulation experiments with German municipalities related to the cap and trade scheme also showed that the initial distribution of rights is quite a critical issue, which may endanger acceptance [20]. In order to guarantee the acquis of the communes, discussions have so far favoured “grandfathering” schemes, in which the status quo of land consumption is not touched. However, such grandfathering schemes are probably less efficient than auction schemes [13, 17].
Basically, the required primacy of planning is not compatible with the system of tradable planning permits. If the basic idea of capping planning permits should be kept, a redesign of the regime is necessary.
In order to support the planning system (“primacy of planning”), the planning permits should best be defined in a tight manner which is in line with the categories of the planning system. For instance, if planners are thinking in categories such as residential, industrial or mixed areas, traffic etc., the planning permits should also follow these categories. This also facilitates the handling of the system. Planning permits should basically be mandatory for all sorts of developed areas. For instance, recreational space may have also negative ecological impacts.
The caps could be administered on different administrative levels, e.g. at the level of the states, even at the level of regions (or in other countries: at county level). However, the administration needs a certain human capacity. In Germany, the 30 ha cap might be broken down into lower administrative levels without problems.
However, within a tight definition of a variety of planning permits at a low administration level (e.g. region), the “markets” for each right would be quite narrow. Hence the allocation mechanism shouldn’t be based on the secondary market (trade – “horizontal coordination”) but on the primary market, namely auctions (“vertical coordination”). The auction of planning permits to the communes could be done periodically. Giving the focus to auction doesn’t mean a complete ban on trade but a reduction of its significance. Due to the tight design of the sub-markets, organized trade wouldn’t be possible anyway. Instead, over-the-counter trade would be feasible, regulated by the planning permits administration. Within the proposed design, different types of planning rights (residential, industrial etc.) were auctioned and traded at different prices.
The administration should also guarantee that it will take back the planning permits for a fixed price (based on the auction price). Thus communes could also think about changing the land use plans and the redevelopment of shrinking areas into the natural state. Deconstruction would be encouraged, because the communes could be sure about the compensation.
A system which is based on auction might be designed tightly with regard to space, time, participants and objects of the design. The system may work with only a few participants. It may work even at regional level. Within the auction, the development rights are allocated to those communes that can make the best use of them. Moreover, without the overshooting and undershooting of the cap and trade regime, welfare losses also are avoided.
Despite the segregation of sub-markets, the system is also efficient. However, in terms of efficiency it is not clear if such a cap and auction system will or will not compete with a cap and trade system, which is based on a single, universal development right. Nonetheless, if in doubt, recognizing the primacy of planning within the conflicts of goals means subordination of efficiency. From a system theory point of view, economic efficiency shouldn’t be a guiding value [15] of superior significance anyway, at least not in land use management. Instead, the guiding value of efficiency has to be balanced with other guiding values.
The regime sketched out above has to face some serious counterarguments relating to political viability: In an auction, the powerful communes with a high willingness to pay will prevail. Moreover, the financial situation of the communes would be even more strained and the municipalities’ acquis would be encroached (see section 3.5.). Hence the question is how to increase the acceptance of a cap and auction model.
On the one hand, certain transition regulations such as free development rights for existing settlements would certainly be helpful, but not nearly enough on their own.
On the other hand, the view of the discussion about climate policy might be promising. Within the Kyoto regime, it has not been possible to put in place effective caps, mainly because the problems of distribution and “climate justice” have not been solved yet [21]. The regime was based on “grandfathering”. Hence those countries with the most aggressive occupancy of the atmosphere and most responsibility for the climate problem got most rights. This was considered as being unjust by countries with developing and emerging economies. Basically, the same holds true in terms of land use permits.
However, many of the objections mentioned above could be countered by establishing a redistribution mechanism. Within such a redistribution mechanism, the money paid by the communes in the auction could be firstly collected in a fund (“land trust”), which is administered by the affected communes. Second, the money is redistributed to the communes, preferably according to the number of their inhabitants (other redistribution keys are also possible). In this respect, all inhabitants are considered as “co-owners” of the planning permits, and thus they should participate in equal shares from the revenues of the auction. Considering the CO2 emission trading schemes, this idea has been popularized by Peter Barnes [22]. Applied to land use planning, a similar redistribution scheme has already been suggested by Krumm [23]. However, his proposal was based on a price-steering basis: Basically, communes should be charged for any new land conversion using a fixed rate per square meter. The money should be pooled in a fund and redistributed to the communes, preferably according to the number of citizens.
If redistribution to the communes were carried out according to the population, the payments into the “land trust” would be according to the land used per capita, whereas the redistribution would be according to the average use per capita. Hence, besides the cap, an additional incentive for a sustainable land use is implemented:
If the actual land use per capita is higher than the average land use, the commune in charge is a net contributor to the “land trust”;
If the actual land use per capita is lower than the average, the responsible commune is a net beneficiary;
If the actual land use corresponds to average land use, there is no difference compared with the status quo.
Because every commune tries to get net benefits out of the land trust, there will be a current dynamic incentive to carry out efficient and effective land use management. In terms of microeconomics, the dynamic incentive is pushed by the substitution effect, whereas the income effect is eliminated by the redistribution scheme (“Slutsky equation”, see [24]).
Moreover, within this redistribution mechanism, an average access to the planning permits is granted, also for financially weak communes. The redistribution mechanism serves as an ecological financial equalization scheme between the municipalities. Not unlike a lease mechanism, communes with land consumption rates above average pay to communes with land consumption rates below average.
The effects of the redistribution system are far reaching. To mention just some of them:
Currently, for instance, some German communes can take some “fiscal rents” due to their location, at the expense of other municipalities. This holds true particularly for the communes in the wealthy commuter belt of bigger cities (“Speckgürtel”). They benefit from the migration out of the bigger cities (e.g. young families), which are “bleeding”. In such peripheral communes, land prices are often lower and the environmental conditions are often better than in the big cities. However, a great deal of the attractiveness is caused by uncompensated spillovers. According to the central locations principle [25] the bigger cities provide a variety of public goods at the commuter belt’s benefit. Thus urban sprawl is fuelled, and the financial performance of bigger cities gets weaker and weaker. However, in the proposed regime, the whole fiscal surplus will be skimmed off dependent on the type of auction. The willingness to pay of the commuter belt’s communes includes the expected fiscal rents (from spillovers). The fiscal rents are redistributed to all communes according to the number of the people, also to the bigger cities. Due to the higher density of population, the redistribution scheme will compensate the bigger cities for their efforts.
The model is applicable in situations of growth as well as in shrinking areas. In aging societies such as Germany, in particular rural regions are affected by shrinking. However, land conversion and land consumption is highest ex urbia. Urban sprawl turns out to be luxury which is increasingly difficult to finance. The redistribution model may stimulate migration to more compact settlements, with a higher supply of public goods. The system would provide an incentive for renaturation measures in rural communes. This would have positive side effects, considering e.g. vacancy rates and the value of existing properties.
By skimming off the rents from certain types of land use, communes get more indifferent towards land use alternatives. On a regional level, coordination between municipalities and the allotment of certain functions (industry, tourism etc.) towards different communes is easier than today. Thus, integrated approaches of regional development might be put in place without high resistance of the communes affected.
With regard to the technical implementation of the system, some minor problems have to be solved. For instance, in order to create equal conditions in the auction, the communes should pay into the land trust in the same “logical second” as the redistribution happens. This means the communes are only charged or rewarded by the balances (net position of pay-in and pay-out). Moreover, it has to be figured out on which administrative level the system should be applied. Basically, the redistribution mechanism should be tied to the scope of the cap and auction scheme.
One should be clear about the fact that no money for natural protection would be raised within the redistribution scheme. However, modifications are possible: If, for instance, a natural park as a common public good has to be financed, the redistribution could be carried out after first deducting the expenses for covering the park. Such decisions depend on the land trust and the planning authorities. A legal basis for the cooperation arrangement is necessary.
The proposed model may be appealing, but it is not a “silver bullet”. The framework has to be completed by other instruments. For instance, the price of real estate may rise due to successful capping of planning rights. Thus, access problems for socially weak groups might be caused. Hence a suitable land taxation system which transfers shares of land rents and land value to the community would be desirable for example.
The concept of tradable planning permits transforms the idea of the CO2 cap and trade regime to spatial planning. Analyzing the tool, we have at least to refer to effectiveness (planning, ecology), allocation (economy) and distributional aspects (social).
Regarding effectiveness, there is a broad consensus about the primacy of planning. Any economic tool should support planning instead of substituting it. However, planning land is not the same as planning the maximum permissible load of CO2 in the atmosphere. The former requires a planning of structure, the latter a planning of scale, since it is irrelevant where the emission takes place.
Planning the structure of land use cannot be supported by a unit price, as a result of a universal certificate for all types of land use (for settlement and traffic). In contrast, a variety of sub-markets are necessary, with a different price setting. Meanwhile, more and more planners are also becoming sceptical about the supporting effects of a cap and trade regime.
Supporting the planning of a structure within a variety of sub-markets may be inferior compared with the efficiency of a cap and trade system with wide system boundaries. On the other hand, efficiency losses due to overshooting or undershooting might be avoided. The efficiency losses might be minimized by auctioning the permits to the needy communes on the primary market (“vertical allocation”). Although trade shouldn’t be forbidden, an organized secondary market is dispensable (subordination of a “horizontal allocation mechanism”). Moreover, both systems would have to prevent strategic acquisitions of permits (impediment of development in other communes by an artificial shortage of supply), e.g. by a current devaluation of the permits.
Regarding the blueprint of CO2 trade, a comprehensive arrangement on a global scale has so far failed due to distribution disputes. Also a cap and auction system for planning permits wouldn’t be acceptable particularly for communes with a weak financial endowment if there were no correction. This is the reason why the cap and auction regime should be completed by a redistribution mechanism which is based on equal stakes in the scarce land use opportunities.
However, more research is necessary in order to deal with the details of the counter-proposal outlined in this article. So far, in Germany politics has supported the cap and trade approach; as has the allocation of research funds. Critics who pointed out the incompatibility between effectiveness and efficiency in the cap and trade approach have been pushed aside. This also holds true for the combination of caps, auction and redistribution, which couldn’t be assessed so far. However, in experimental simulations the acceptance of the cap and trade regime among the practitioners was obviously not very high. Among others, the results of the cap and trade game turned out to be quite sensitive in terms of an increase of the complexity of the framework [20]. In contrast, at least the redistribution approach of Krumm was highly accepted (here, basically, also no fiscal impact assessment is necessary) [26]. Maybe it is time to widen the scope of the research paradigm to extend beyond the cap and trade regime.
A skin graft is a piece of skin of variable thickness without any vascular connection, separated from the donor site, and afterwards transposed over the recepient site which is to be repaired [1].
This technique was used initially in India about 2.500–3.000 years ago by Tilemaker Caste. It was later rediscovered inthe XIX century and was the most used technique during World War I and II. And in 1823 Buenger was the first to describe a succesful intervention by transfering skin from the buttcheek to the nose [1]. It is a basic technique and an option of reconstruction after a tumor resection, in case of ulcers and burned patients [1].
Skin graft execution is simpler than most skin flaps and can be performed in almost any wound with a vascularized bed. One of the great advantages of skin grafts is that they are very variable in size and shape to allow wound closure of wound defects of different sizes. There are many sites that can be donor sites making it easier for the skin to match.
Wound closure should always follow the principles of the reconstructive ladder, which directs the surgeon to use the least complex method of closure to achieve an ideal cosmetic result [2].
Often a graft may be used when healingof a full thickness wound by second intention, a primary closure, or utilization of a local flap are not feasible options [3].
In some instances, grafts can be used in combination with linear repairs or flaps for skin reconstruction surgery. In addition, skin grafts can be used for shallow defects, or in a patient with multiple morbidities who cannot tolerate a more complex or multi-stage repair [4].
There are many ways in which skin grafts can be classified, based on their origin, thickness, composition, time in which they are performed, geometry and if it meshed or not (Table 1).
Character | Types |
---|---|
Origin |
|
Thickness |
|
Time |
|
Expansion |
|
Classification of skin grafts.
According to their origin, skin grafts can be divided in 3: Autografts, allografts and xenografts.
Autografts are taken from the patient’s own skin, and they are the most common used skin grafts.
Allografts come from another person’s skin. And xenograftsare derived from another species, other than human skin, for example porcine grafts. Both allografts and xenografts are used in chronic wounds or burn wounds. Their utility comes from their ability to stimulate wound healing, provide protection and achieve debridement [3].
In terms of thickness, they are distinguished as: Split-thickness skin grafts and full-thickness skin grafts [1] and composite grafts.
Split-thickness skin grafts are composed by epidermis and a variable thickness of dermis. They can be subdivided in 3 [1]:
Thin: 0.15–0.25 mm
Intermediate: 0.3–0.4 mm
Thick: 0.5–0.6 mm
Full-thickness skin grafts are composed of epidermis and dermis with skin appendages [1].
The amount of dermis in the skin graft determines many properties of the graft, such as resistance to pressure and shear forces, shrinkage, sensitibity and esthetic results. In other words, the thicker the graft the better mechanical, functional and aesthethic properties, but also this means that the neo and revascularization of the graft will be more difficult.
If the graft includes other tissue besides skin it is a composite graft. Composite grafts are made by two different tisular structures, skin and cartilage most of the cases [1].
According to the moment in time in which the graft is realized [1]:
Immediate: Realized just after the resection of the tumor. To repair the loss of substance.
Differed: The graft is performed in a second intervention, in order to have the confirmation of clean margins. This approach is justified for agressive tumors and tumor relapse, to obtain granulation tissue when the surgery is extense in depth and/or width, and exceptionally when hemostasis of the reciepent site cannot be achieved [1].
Another way to classify skin grafts is based if a technique is used to expand the graft itself. If the skin graft is directly applied onto the defect without further treatment this is called an unmeshed or sheet graft [5].
A mesh graft is when multiple slits are made on the graft. Usually this is made with a mechanical mesher and it is common to apply this on split-thickness skin grafts. Meek graft is a skin graft that is cut in stripes, equal in lenght and width. It used a cork plate and a machine with rotating blades. Punch grafts are obtained using a punch, which allows to obtain multiple full-thinkcness skin grafts, it is a useful technique to cover large wound areas.
The survival of skin grafts is a complex process that involves different phases. In order to undestand them it is necessary to remember how the skin is irrigated.
Skin consists of 2 basic layers, the epidermis and dermis. The dermis is divided into a papillary and reticular layer. Within the dermis resides the skin’s neurovascular supply. The subcutaneous tissue beneath the skin contains the superficial fascia and subcutaneous fat [6].
The skin vasculature consists of a deep dermal/subcutaneous plexus and a superficial plexus [6]. Both plexi are connected via communicating vessels. The superficial plexus can be found in the reticular dermis, near its junction with the papillary dermis. The deep plexus, located in the subcutaneous tissue, consists of an extensive venous plexus, capable of holding large quantities of blood and an accompanying artery. The deep plexus supplies vessels to the pilosebaceous units and the superficial plexus. Arteriovenous anastomoses also exist in the region [6, 7]. The superficial plexus originates vascular loops within the papillary dermis. Nutrients diffuse into the epidermis because no vessels cross the dermal-epidermal junction. Venous and lymphatic systems exist in a similar arrangement [6].
Unlike flaps, grafts depend on the ingrowth of capillaries from the recipient site for their ultimate survival [8].
For the first 24–48 hours, the graft initially derives oxygen and nutrients from the underlying bed by diffusion (plasmatic diffusion or imbibition). The graft can increase in weight by up to 40%. During imbibition, the graft and the wound bed are held together via a layer of fibrin. The fibrin is eventually replaced by granulation tissue [2, 3, 8].
The second phase, inosculation, is defined by an anastomosis of the preexistent vessels of the graft and the wound base. This phase occurs during the second and third postoperative days [3].
For graft-take tooccur, the recipient site must be capableof producing capillary buds. Since capillaryoutgrowth is needed both to producegranulation tissue and to nourish askin graft, areas that granulate well (muscle and deep fascia), acceptgrafts readily. Other surfaces, such astendon denuded of its fascia covering, exposed bone, or cartilage, are incapableof producing granulation tissue and, therefore, are unable to nourish a skingraft [9].
Also the skingraft must remain in close approximationto the recipient bed during thephase of capillary ingrowth. The presenceof air, serum, or fluid between thegraft and recipient bed creates a barrierthrough which the capillaries cannotgrow fast enough to prevent necrosis ofthe graft [9].
Revascularization involves the growth, proliferation, and connection of vessels from the recipient base and sidewalls. The rate of revascularization is dependent on the thickness of the graft and the vascularity of the recipient bed. As a general rule, the thinner theskin graft, the faster it establishes a blood supply [9].
Within 4 to 7 days, full circulation has been restored to the graft. Restoration of lymphatic circulation also occurs within 7 days. Reinnervation of the graft begins approximately 2 to 4 weeks after grafting; however, full sensation may require several months or even years to return to normal [8].
STSG are indicated for large defects (>5 cm), slow- or nonhealing chronic wounds, or as a temporary cover when monitoring a wound bed for potential cancer recurrence [3, 10].
This type of skin graft is useful when the definitive reconstruction of a wound is delayed, either for surveillance of an aggressive cancer or when granulation tissue is needed on the bed of the recepient site.
Donor site selection is based on the size of the graft needed to cover the wound, the patient’s ability to care for the donor site and how the donor site wound would affect the patient’s daily activities (walk, sit, sleep). Taking all this in consideration the medial and lateral thighs are most used for donor site. Also it is practical to consider donor sites that can be hiddenunder clothing, such as the medial or lateral upper arm, abdomen, back andbuttocks. Donorsites that offer large flat surfaces also facilitate theharvesting of STSGs [11].
Once the donor area has been selected, it should be shaved of all hair to aid in the harvesting and handling of the skin graft [8].
The donor site should be prepared and draped in the normal sterile fashion and local anesthesia may be infiltrated [4]. If the graft requirement is significant, saline may be infiltrated instead of local anesthesia to make the graft harvesting easier.
STSG may be harvested using a dermatome or the freehand technique, depending on the size of graft needed and location of the recipient site [3].
There are many electric dermatomes available (e.g. Davol, Padgett, Zimmer), all of them with adjustable graft width and thickness.
After marking the dimensions of the graft (mark the skin graft 15–20% larger than needed and thus allow for shrinkage), the skin is lubricated with sterile ointment. The assistant surgeon should keep the skin flat and stretched by counter-tension [12].
The dermatome is held at a 30° to 45° angle, and advanced, from proximal to distal, while traction is maintained on the skin. Toothless forceps are used to prevent the graft from getting snared, and the dermatome is lifted away while still engaged [10, 11, 12].
After the STSG is obtained it is transferred to a sterile-saline soaked gauze to keep it moist. Attention must be paid in order not to confuse the dermal and epidermal surface when handling the skin graft. A useful tip is to remember that the dermal surface glistens more than the epidermal side and also the edges of the graft will curve to the dermal surface.
Meshing the STSG allows the graft to cover a wound that is larger in dimensions than the unmeshed STSG. Meshing increases the coverage area by 25–35% and also increases the flexibility of the graft so it can be used over mobile surfaces such as joints [4].
It also provides fenestrations in the skin graft that allow the egress of fluid from the wound bed, which minimizes the chance of seroma or hematoma formation and subsequent graft failure. Mechanical meshing of grafts is recommended when they are being used to cover defects >8 cm in diameter or when extensive serosanguineous drainage is anticipated [4].
Meshing can be accomplished in a variety of ways, but the most common and efficient method is to use a hand-powered mechanical mesher to produce multiple uniform slits in a skin graft, approximately 0.05 inches apart. The skin to be meshed is placed on a carrier with the dermis side up and spread over the carrier. The graft is then passed through the mesher. It is is then covered with moist saline gauze. Split thickness grafts can be meshed to obtain expansion from 1:1 upto 1:4. In case of paucity of donor site and large recipient area the graft can be meshed to achieve expansion of 1:9. The survival of such widely meshed graft can be improved by covering it with 1: 3 meshed allograft. This methodis called sandwich grafting. Xenograft can also be used for this purpose. The disadvantages of meshing include suboptimal cosmesis and delay in ultimate closure of the grafted site [2, 8].
The donor site should be temporarily covered with gauze soaked in 1% lidocaine with epinephrine while attention is quickly turned back to the graft. The epinephrine in the solution promotes hemostasis in this acute, abrasion-like donor site [4].
The recipient site must be prepared before the placement of the STSG. Since there must be close contact between the skin graft and wound bed, a good hemostasis should be done in order to prevent hematoma formation. If the wound bed has granulated tissue all the fibrinous debris have to be removed.
When the STSG is placed over the recipient site sometimes it needs to be cut to fit the size of the wound. After the graft is trimmed it has to be attached to initiate contact between the graft and the wound bed. In order to achieve this a tie-over dressing is used. First apply an antibiotic impregnated gauze on the graft, after a foam dressing or sponge is putover the gauze, put single sutures around the defect and leave long tails of the sutures, this long tails will be tied over the dressing or sponge.
Attention is subsequently turned to the donor site, which is best treated as a superficial abrasion. Further hemostasis is usually not necessary. A moist occlusive dressing is applied, making use of antibiotic ointment or petrolatum and a nonadherent dressing such aspolymer film [4].
The donor site presents important drainage during the first 48 hrs, this is a normal process and it is important to inform the patient. In order to avoid fluid colection the dressing can be punctured at the site to allow drainage or the dressing can be changed more frequently.
In the postoperative period the most important part is to minimize all physical activity. Since any abrupt or strong movement may affect the graft, shearing forces can be created and the graft itself may be damaged or bleeding from the wound bed can occur. Separation of the graft from the recipient site compromises its vascularization and eventually its survival. This is why the patient is adviced to elevate the intervened area and restrict all physical efforts.
The manipulation of the dressings should be kept at minimum in order to avoid contamination or involuntary movement that may disrupt the process of revascularization of the graft, which takes about 3 to 5 days.
After wound healing is achieved it is important to advice the patient to avoid sunshine and to use sun-blocking agents to prevent hyperpigmentation, use a greasy ointment to reduce dryness and itching [12].
The advantages of using this type of skin graft are: Very easy and fast harvesting, provides good color match in most cases, they may be obtained from any area of the body, provides skin for large defects [12].
The disadvantages of this type of grafts are: Graft contraction and hyperpigmentation (Split thickness grafts will contract 10–20% immediately after harvest and up to 20–50% over time), fixation may be inadequate, leading to shearing and wound dehiscence, cannot be used on exposed tendon, nerves, cartilage, or bone, development of hematoma or seroma may lead to poor vascularization of the graft, in case of wound infection, skin graft may turn necrotic within 24 h [2, 12].
FTSG are very useful in dermatologic surgery, especially after the removalof a skin cancer, areas that are conducive to FTSG include nasal ala and tip, helix, medial canthus, lower eyelid, digits, and extremities. FTSG should be limited to less than 5 cm [3].
In order to maximize cosmesis, various factors must be taken into account when choosing a site to harvest, including photodamage, color, existing adnexal structures (hair), and the appearance of the donor site scar. Donor skin should be devoid of malignant lesions or any changes that might later be confused for recurrence of malignancy. Commonly used sites for FTSG are: pre- and postauricular regions, creases of the upper eyelids, nasolabial folds, supraclavicular region, lateral neck, antecubital fossa, and groin [3, 8].
Once the appropriate donor site has been chosen, anesthetized, cleansed, and prepared for harvest, a template of the defect is made by using gauze, cardboard labels, or foil from suture packaging. The template is then transposed to the donorsite.
The skin graft will contract at the recepient site, for this reason it is important to make the template 10–20% bigger in order to avoid distortion of the anatomy of the area that was intervened. When eyelids defects are closed using a skin graft the template needs to be oversized more so that ectoprion will not develop.
Full thickness grafts should be harvested at the level just deep to the dermis, not down to fascia, as the graft will need to be thinned [2]. Once the graft is obtained, all the subcutaneous tissue must be removed using curved iris scissors. Remove the adherent fat by putting the graft under tension. Roll the graft overyour forefinger and pull it down with your middle finger and thumb [12]. The goal is to expose the dermis. Since any remaining fat will obstruct the imbibition phase.
Remoistening the graft periodically with sterile saline or local anesthetic during the defatting procedure is recommended to prevent desiccation [11].
Before placing a skin graft, the recipient site must be clean and not actively bleeding [8].
After placing the graft in the recepient site it needs to be fixated with sutures. Optimal suturing technique is with the needle entering the graft first, 2–3 mm from the edge, and then exiting in the adjacent recipient site skin and subsequently tied with 3–4 throws of a square knot. Distance between sutures is usually 3–4 mm [4] (Figures 1 and 2).
Initial attachment of the Full-skin graft.
Complete placement of sutures attaching the FSG.
It is important to place sutures sufficiently deep such that both the papillary and reticular dermis of the graft and recipient site are directly aligned with each other. Suturing that is too superficial apposes only the papillary dermis, leaving a dead space in the deeper reticular dermis which tends to retract more than the superficial papillary dermis. This increases the risk of both hematoma formation and a depressed, more visible scar. Excessively superficial suturing has also been implicated as a potential etiology of graft pin-cushioning [4].
Bolsters are used to stabilize and protect the graft and to provide a uniform pressure dressing to the grafted area. Bolster materials include saline-soaked dental rolls, saline-soaked gauze, and mineral oil–soaked cotton balls. The bolsters should have a nonstick surface and should be fitted to the size of the graft. They are secured with simple interrupted sutures using 4–0 silk are placed in pairs directly across from one another 2–3 mm from the graft margins. Bolsters are left in place for 5 to 7 days [3, 10].
The donor site is repaired later after the graft has been placed as it is important to allow nutrient diffusion to the graft to begin [3].
During the postoperative period the use of antibiotic oinment is recommended for the recipient and donor site in order to avoid infection. Also the dressing in the recipient site has to be checked every day for one week and every 2 to 3 days at the donor site. Both areas have to be cleaned with saline solution. The sutures can be removed after 7–8 days.
Development of pink color during 3 to 7 days signals neovascularization and successful graft take. Over the ensuing 1 to 2 months, pink color diminishes, but the graft may remain lighter than surroundingskin (Figures 3 and 4) [10].
Full-skin graft appearance after removing the bolster (48 hrs).
Full-skin graft appearance at one month after the surgery.
The advantages of this technique are: easy and rapid harvesting, provides excellent color match and adequate thickness of the skin, a small scar remains after skin harvesting and primary closure of the donor site [12].
The disadvantages of this type of grafts are: limited size of skin for harvesting, donor site will require STSG when primary closure is not possible [12].
This type of graft consists of two different type of tissues. Mostly cartilage with or without subcutaneous tissue and the overlying skin. Because they offer support and structure composite grafts are used to repair full-thickness defects of the nasal ala and helical rim. The size of the defect for this type of graft is 1 cm or less.
They can also beused to fill partial-thickness defects that extend toodeeply for a full-thickness skin graft to heal withoutleaving a concavity or contraction of the free margin [13].
The metabolic needs of composite grafts differ from the needs of skin grafts, the former have greater demands and needs rapid revascularization in order to survive. The blood flow formed by the anastomoses between the wound bed and composite graft can extend only to a small portion beyond the margin of the graft. Portions of the graft that are beyond 1 cm from the vessel anastomoses is at risk of not receiving appropiate blood flow and is at risk of necrosis.
Its survival depends on passivediffusion of oxygen and nutrients through theperichondrium from adjacent vascularized tissue. The vascularity of the recipient bed is also aconsideration. The nasal ala is generally well suppliedwith blood vessels and can usually support composite grafts [13].
Because the cartilage in these grafts carries with itthe skin that will cover the cutaneous portion of thedefect, the donor site should be chosen so that thetexture, color, and nature of appendages match as best aspossible the features of the recipient site [13].
The ear exhibits a wide range of thicknesses, curvatures, and appendage-type structures [13]. Composite auricular graftsharvested from the helical crus are particularlyuseful, because they provide thin skin that istightly adherent to the underlying cartilage. Thegraft affords structural support and resemblesfine nasal skin being reconstructed [10].
First, the recipient site is measured andthe donor site marked such that the composite graftwill be approximately 5–10% larger than thedefect. This oversizing will compensatefor the natural shrinkage of the graft that occurs during healing [13].
Once the donor site has been closed, the graft isprepared. Using a pair of curved iris scissors, the skinis trimmed from the wings to expose the underlyingcartilage. The remaining cartilaginous pegs shouldframe the lateral aspects of the graft [13]. A hemostat or scissors maybe used to undermine pockets on each side of the defect. These pockets should run parallel to the alar or helicalrim and should only be deep enough to accommodatethe cartilaginous pegs of the composite graft. And the cartilaginouspegs are gently inserted into these pocketsso that the graft interlocks with its recipient bed [13].
The graft is securedin place with a single layer of suture throughskin and perichondrium, minimizing sutures passing through cartilage. Limiting sutures andgraft trauma facilitates robust vessel ingrowth [10].
Antibiotic-impregnated gauze should be placed inthe patient’s nostril to stabilize the alar rim. Apressure dressing or bolster should be used to stabilize the graft [13].
In the postoperative perdiod, the intranasal gauze needs to stay for 24-48 hrs and then removed so that the wound can be cleaned. Any activity that may elevate the patient’s blood pressure has to be avoided. The sutures can be removed after 7 days.
Composite grafts change their color during the following days after the procedure. At first the graft will be pallid because of tha lack of blood flow. After 6 hrs it changes color to lightly pink, representing the begining of the vessel anastomoses. The next 24–48 hrs the graft becomes blue because of venous congestion that follows, and will remain like this for a week, until venous drainage begins. Later it will become pink and this indicates adequate blood flow and graft survival. The pink color will increase in the next days reaching a red color as the healing process continues. After 2 to 6 months later the red color will disappear. The final tone can be achieved after 1 or 2 years.
All types of grafts can present complications that may compromise it’s survival.
Complete or partial graft failure is the primary complicationseen with FTSGs. Causes for failure includehematoma, graft-bed contact disruption, infection, smoking, and excessive electrocoagulation of the wound base [8].
If the skin graft develops necrosis it should not be debrided, the necrotic tissue serves as a natural dressing that allows new skin formation under it. There can be some contour alterations made by the healing process, specially on the nose (elevation), that can improve by themselves in a period of 6 months, if after that period the alterations remain dermabrasion or intralesional steroids can be used.
The acute complications of STSG are the same of those presented by FTSG (hematoma, seroma, graft movement). Long term complications of STSG are related to skin graft contraction that may distort free margins, impair function, develop graft fragility or alter the final aesthethic result.
If infection of the graft is suspected or developed a skin culture needs to be performed and proper antibiotics should be given.
In composite grafts short-term potential complications, includebleeding, infection, and necrosis of the graft. This last complication presents initially as a yellowish whiteness that remains and then is followed by the aparition of a black eschar.
Should the graft become necrotic, the escharshould not be debrided. The necrosis may only besuperficial, with the underlying dermis and cartilage still viable [13].
Long term complications of composite grafts are consequence of an inappropiate anchorage of the graft to the recipient site, trauma or extreme contractural forces, all of which can cause displacement or deformation of the graft.
Since their initial use almost 3.000 years ago skin grafts have been a very useful option for wound repair. Whether it is due to an ulcer, burn or surgery, wound closure can be accomplished via skin grafts in any of their modalities. Skin grafts offer a very useful alternative for reconstruction that can be applied to almost any site of the body. It is imperative to select an adequate donor site to offer the best match possible. The process and technique of each type of graft is easy to perfom. And with the correct sterile and surgical technique the possibilty of complications is minimized. This type of wound management should not be considered as a last resort, since their advantages outweigh the disadvantages.
This is a brief overview of the main steps involved in publishing with IntechOpen Compacts, Monographs and Edited Books. Once you submit your proposal you will be appointed a Author Service Manager who will be your single point of contact and lead you through all the described steps below.
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We demonstrate that the networks with NOMA outperform other multiple access schemes in terms of sum capacity, EE and SE.",book:{id:"5480",slug:"towards-5g-wireless-networks-a-physical-layer-perspective",title:"Towards 5G Wireless Networks",fullTitle:"Towards 5G Wireless Networks - A Physical Layer Perspective"},signatures:"Refik Caglar Kizilirmak",authors:[{id:"188668",title:"Dr.",name:"Refik Caglar",middleName:null,surname:"Kizilirmak",slug:"refik-caglar-kizilirmak",fullName:"Refik Caglar Kizilirmak"}]},{id:"63215",title:"Smart Antenna Systems Model Simulation Design for 5G Wireless Network Systems",slug:"smart-antenna-systems-model-simulation-design-for-5g-wireless-network-systems",totalDownloads:2253,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"The most recent antenna array technologies such as smart antenna systems (SAS) and massive multiple input multiple output (MIMO) systems are giving a strong increasing impact relative to 5G wireless communication systems due to benefits that they could introduce in terms of performance improvements with respect to omnidirectional antennas. Although a considerable number of theoretical proposals already exist in this field, the most common used network simulators do not implement the latest wireless network standards and, consequently, they do not offer the possibility to emulate scenarios in which SAS or massive MIMO systems are employed. This aspect heavily affects the quality of the network performance analysis with regard to the next generation wireless communication systems. To overcome this issue, it is possible, for example, to extend the default features offered by one of the most used network simulators such as Omnet++ which provides a very complete suite of network protocols and patterns that can be adapted in order to support the latest antenna array systems. The main goal of the present chapter is to illustrate the improvements accomplished in this field allowing to enhance the basic functionalities of the Omnet++ simulator by implementing the most modern antenna array technologies.",book:{id:"6844",slug:"array-pattern-optimization",title:"Array Pattern Optimization",fullTitle:"Array Pattern Optimization"},signatures:"Vincenzo Inzillo, Floriano De Rango, Luigi Zampogna and Alfonso A. Quintana",authors:null},{id:"52919",title:"Waveform Design Considerations for 5G Wireless Networks",slug:"waveform-design-considerations-for-5g-wireless-networks",totalDownloads:3399,totalCrossrefCites:1,totalDimensionsCites:2,abstract:"In this chapter, we first introduce new requirements of 5G wireless network and its differences from past generations. The question “Why do we need new waveforms?” is answered in these respects. In the following sections, time‐frequency (TF) lattice structure, pulse shaping, and multicarrier schemes are discussed in detail. TF lattice structures give information about TF localization of the pulse shape of employed filters. The structures are examined for multicarrier, single‐carrier, time‐division, and frequency‐division multiplexing schemes, comparatively. Dispersion on time and frequency response of these filters may cause interference among symbols and carriers. Thus, effects of different pulse shapes, their corresponding transceiver structures, and trade‐offs are given. Finally, performance evaluations of the selected waveform structures for 5G wireless communication systems are discussed.",book:{id:"5480",slug:"towards-5g-wireless-networks-a-physical-layer-perspective",title:"Towards 5G Wireless Networks",fullTitle:"Towards 5G Wireless Networks - A Physical Layer Perspective"},signatures:"Evren Çatak and Lütfiye Durak‐Ata",authors:[{id:"19414",title:"Prof.",name:"Lutfiye",middleName:null,surname:"Durak-Ata",slug:"lutfiye-durak-ata",fullName:"Lutfiye Durak-Ata"},{id:"189749",title:"M.Sc.",name:"Evren",middleName:null,surname:"Çatak",slug:"evren-catak",fullName:"Evren Çatak"}]},{id:"54645",title:"Power‐Over‐Fiber Applications for Telecommunications and for Electric Utilities",slug:"power-over-fiber-applications-for-telecommunications-and-for-electric-utilities",totalDownloads:2566,totalCrossrefCites:11,totalDimensionsCites:19,abstract:"Beyond telecommunications, optical fibers can also transport optical energy to powering electric or electronic devices remotely. This technique is called power over fiber (PoF). Besides the advantages of optical fiber (immunity to electromagnetic interferences and electrical insulation), the employment of a PoF scheme can eliminate the energy supplied by metallic cable and batteries located at remote sites, improving the reliability and the security of the system. Smart grid is a green field where PoF can be applied. Experts see smart grid as the output to a new technological level seeks to incorporate extensively technologies for sensing, monitoring, information technology, and telecommunications for the best performance electrical network. On the other hand, in telecommunications, PoF can be used in applications, such as remote antennas and extenders for passive optical networks (PONs). PoF can make them virtually passives. We reviewed the PoF concept, its main elements, technologies, and applications focusing in access networks and in smart grid developments made by the author’s research group.",book:{id:"5914",slug:"optical-fiber-and-wireless-communications",title:"Optical Fiber and Wireless Communications",fullTitle:"Optical Fiber and Wireless Communications"},signatures:"Joao Batista Rosolem",authors:[{id:"202012",title:"Dr.",name:"Joao",middleName:"Batista",surname:"Batista Rosolem",slug:"joao-batista-rosolem",fullName:"Joao Batista Rosolem"}]},{id:"75267",title:"Wireless Power Charging in Electrical Vehicles",slug:"wireless-power-charging-in-electrical-vehicles",totalDownloads:596,totalCrossrefCites:1,totalDimensionsCites:1,abstract:"Wireless Power Transfer (WPT) technology can transfer electrical energy from a transmitter to a receiver wirelessly. Due to its many advantages, WPT technology is a more adequate and suitable solution for many industrial applications compared to the power transfer by wires. Using WPT technology will reduce the annoyance of wires, improve the power transfer mechanisms. Recently, the WPT gain enormous attention to charging the on-board batteries of the Electric Vehicle (EV). Several well-known car manufacturing companies start efforts to adopt WPT technology and enhance its features. Therefore, WPT can be achieved through the affordable inductive coupling between two coils named a transmitter and a receiver coil. In EV charging applications, transmitter coils are located underneath the road, and receiver coils are installed in the EV. The inductive WPT of resonant type is generally applied to medium-high power transfer applications like EV charging because it achieves better energy efficiency. In this chapter, various WPT technologies are discussed and tested in EV wireless charging applications. 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The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. 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Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null},subseries:{paginationCount:3,paginationItems:[{id:"7",title:"Bioinformatics and Medical Informatics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",isOpenForSubmission:!0,editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",slug:"slawomir-wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",biography:"Professor Sławomir Wilczyński, Head of the Chair of Department of Basic Biomedical Sciences, Faculty of Pharmaceutical Sciences, Medical University of Silesia in Katowice, Poland. 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He completed a one-year Post-Doctoral Fellowship awarded by the DFAIT (Foreign Affairs and International Trade Canada) at the Institute of Biomedical Engineering of the University of New Brunswick (Canada) in 2010. Currently, he is Professor in the Faculty of Electrical Engineering (UFU). He has authored and co-authored more than 200 peer-reviewed publications in Biomedical Engineering. He has been a researcher of The National Council for Scientific and Technological Development (CNPq-Brazil) since 2009. He has served as an ad-hoc consultant for CNPq, CAPES (Coordination for the Improvement of Higher Education Personnel), FINEP (Brazilian Innovation Agency), and other funding bodies on several occasions. He was the Secretary of the Brazilian Society of Biomedical Engineering (SBEB) from 2015 to 2016, President of SBEB (2017-2018) and Vice-President of SBEB (2019-2020). He was the head of the undergraduate program in Biomedical Engineering of the Federal University of Uberlândia (2015 - June/2019) and the head of the Centre for Innovation and Technology Assessment in Health (NIATS/UFU) since 2010. He is the head of the Postgraduate Program in Biomedical Engineering (UFU, July/2019 - to date). He was the secretary of the Parkinson's Disease Association of Uberlândia (2018-2019). Dr. Andrade's primary area of research is focused towards getting information from the neuromuscular system to understand its strategies of organization, adaptation and controlling in the context of motor neuron diseases. His research interests include Biomedical Signal Processing and Modelling, Assistive Technology, Rehabilitation Engineering, Neuroengineering and Parkinson's Disease.",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",isOpenForSubmission:!0,editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",slug:"luis-villarreal-gomez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",biography:"Dr. Luis Villarreal is a research professor from the Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana, Baja California, México. 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For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}}]},{type:"book",id:"7218",title:"OCT",subtitle:"Applications in Ophthalmology",coverURL:"https://cdn.intechopen.com/books/images_new/7218.jpg",slug:"oct-applications-in-ophthalmology",publishedDate:"September 19th 2018",editedByType:"Edited by",bookSignature:"Michele Lanza",hash:"e3a3430cdfd6999caccac933e4613885",volumeInSeries:2,fullTitle:"OCT - Applications in Ophthalmology",editors:[{id:"240088",title:"Prof.",name:"Michele",middleName:null,surname:"Lanza",slug:"michele-lanza",fullName:"Michele Lanza",profilePictureURL:"https://mts.intechopen.com/storage/users/240088/images/system/240088.png",biography:"Michele Lanza is Associate Professor of Ophthalmology at Università della Campania, Luigi Vanvitelli, Napoli, Italy. His fields of interest are anterior segment disease, keratoconus, glaucoma, corneal dystrophies, and cataracts. His research topics include\nintraocular lens power calculation, eye modification induced by refractive surgery, glaucoma progression, and validation of new diagnostic devices in ophthalmology. \nHe has published more than 100 papers in international and Italian scientific journals, more than 60 in journals with impact factors, and chapters in international and Italian books. He has also edited two international books and authored more than 150 communications or posters for the most important international and Italian ophthalmology conferences.",institutionString:'University of Campania "Luigi Vanvitelli"',institution:{name:'University of Campania "Luigi Vanvitelli"',institutionURL:null,country:{name:"Italy"}}}]},{type:"book",id:"7560",title:"Non-Invasive Diagnostic Methods",subtitle:"Image Processing",coverURL:"https://cdn.intechopen.com/books/images_new/7560.jpg",slug:"non-invasive-diagnostic-methods-image-processing",publishedDate:"December 19th 2018",editedByType:"Edited by",bookSignature:"Mariusz Marzec and Robert Koprowski",hash:"d92fd8cf5a90a47f2b8a310837a5600e",volumeInSeries:3,fullTitle:"Non-Invasive Diagnostic Methods - Image Processing",editors:[{id:"253468",title:"Dr.",name:"Mariusz",middleName:null,surname:"Marzec",slug:"mariusz-marzec",fullName:"Mariusz Marzec",profilePictureURL:"https://mts.intechopen.com/storage/users/253468/images/system/253468.png",biography:"An assistant professor at Department of Biomedical Computer Systems, at Institute of Computer Science, Silesian University in Katowice. Scientific interests: computer analysis and processing of images, biomedical images, databases and programming languages. He is an author and co-author of scientific publications covering analysis and processing of biomedical images and development of database systems.",institutionString:"University of Silesia",institution:null}]},{type:"book",id:"6843",title:"Biomechanics",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/6843.jpg",slug:"biomechanics",publishedDate:"January 30th 2019",editedByType:"Edited by",bookSignature:"Hadi Mohammadi",hash:"85132976010be1d7f3dbd88662b785e5",volumeInSeries:4,fullTitle:"Biomechanics",editors:[{id:"212432",title:"Prof.",name:"Hadi",middleName:null,surname:"Mohammadi",slug:"hadi-mohammadi",fullName:"Hadi Mohammadi",profilePictureURL:"https://mts.intechopen.com/storage/users/212432/images/system/212432.jpeg",biography:"Dr. Hadi Mohammadi is a biomedical engineer with hands-on experience in the design and development of many engineering structures and medical devices through various projects that he has been involved in over the past twenty years. Dr. Mohammadi received his BSc. and MSc. degrees in Mechanical Engineering from Sharif University of Technology, Tehran, Iran, and his PhD. degree in Biomedical Engineering (biomaterials) from the University of Western Ontario. He was a postdoctoral trainee for almost four years at University of Calgary and Harvard Medical School. He is an industry innovator having created the technology to produce lifelike synthetic platforms that can be used for the simulation of almost all cardiovascular reconstructive surgeries. He’s been heavily involved in the design and development of cardiovascular devices and technology for the past 10 years. 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