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At least 199 records · Page 11Linked to original sources
PubMed1991

Accuracy of self-measurement of body fat distribution by waist, hip, and thigh circumferences.

There are indications that body fat distribution, independent of obesity, may be a disease risk factor. The accuracy of self-measurement of waist, hip, and thigh circumferences, indicators of fat distribution, were examined for 227 women (aged 19-45) who were sent either a calibrated or uncalibrated tape measure and subsequently remeasured by a trained technician. Subjects tended to underestimate all circumferences somewhat. Spearman correlations between self-measurement and technician measurement were 0.88, 0.89, and 0.86 for the waist, hip, and thigh, respectively, and 0.65 and 0.77 for the waist-to-hip waist-to-thigh ratios. Correlations for waist, but not other measures, were better with the uncalibrated than with the calibrated tape. Accuracy did not vary within strata of education, body mass index, or waist-to-hip ratio. Subjects were able to measure their circumferences with reasonable accuracy. Circumference measures were more accurate than were computed ratios of circumferences; waist-to-thigh ratios were more accurate than were waist-to-hip ratios.

Abdomen↗
PubMed1985

Relationship of pelvic and thigh motions during unilateral and bilateral hip flexion.

We filmed the hip flexion movement with a 16-mm motion picture camera to determine if a synergistic relationship between the pelvis and thigh existed. Seventeen young subjects, whose pelvises and thighs were marked with tape, underwent active and passive, unilateral and bilateral hip flexion while in the supine position. Analysis of the film revealed that the hip flexion movement is composed of two components--pelvic rotation and flexion of the thigh on the pelvis. Between one fourth and one third of the hip flexion movement was the consequence of pelvic rotation. This rotation always occurred within the first 8 degrees of the hip flexion movement. When therapists evaluate and treat patients with disorders of the thigh, pelvis, or lumbar spine, they should be aware that these structures normally move in synergy with one another. We suggest that the pelvifemoral relationship be examined further in studies with a wide range of healthy subjects and patients with a variety of clinical disorders.

Adolescent↗
PubMed1993

Applications of the posterior thigh flap.

As our population ages and spinal cord injuries continue at their present rate due to motor vehicle accidents and handgun injuries, the development of pressure sores will most likely increase in frequency. The three major populations at risk to develop pressure sores include the elderly, long-term hospital patients, and neurologically impaired patients. the posterior thigh flap evolved during our experience with the lower extremity muscle flaps. We have used 22 posterior thigh flaps in 21 patients. We have found that it is a reliable flap with a dependable blood supply that can be used in the soft tissue coverage of trochanteric, ischial, and some sacral wounds. In addition, the posterior thigh flap can be used as a pedicled flap in the management of heel and foot wounds. In this review, the anatomy and application of the posterior thigh flap are elaborated.

Child, Preschool↗
PubMed1994

Closure of multiple pressure sores with split total thigh flap.

Pressure sores remain a pervasive and recurrent problem in the chronically bedridden and immobilized insensate patient populations, such as those with spinal cord injury. Various musculocutaneous flaps based on muscles of the buttock and thigh are routinely used to close primary, uncomplicated ulcers. The gluteus maximus, tensor fascia lata, and posterior thigh muscles, for example, can be used to close the majority of primary defects. In the case of extensive and recurrent ulceration, however, particularly when the hip joint or proximal femur is infected or marked heterotopic ossification is present, these conventional flaps are inadequate. The total thigh flap offers a solution to some of these problems by providing a large volume of tissue as a unit to cover the defects, particularly in cases in which other reconstructive options have been exhausted. We describe a modification in the total thigh flap procedure by splitting the flap according to its vascularity to achieve closure of multiple pressure ulcers in a one-stage procedure.

Adult↗
PubMed2002

Posterior thigh perforator-based flap: a new experimental model in rats.

Animal research has added a great deal of understanding to flap hemodynamics. The rat is the most commonly used animal in flap research, and various flap models have been devised. In the current study the authors developed a single-perforator-based flap model in rats. In 30 rats, anatomic dissection and flap elevation based on a single musculocutaneous perforator artery arising from the biceps femoris muscle were performed. The vascular basis of this new flap was cleared by anatomic dissection of the posterior thigh in 6 rats. The survival pattern of the proposed flap was investigated in three groups of rats. Each group consisted of 8 rats and had different flap dimensions. In the first group the flap was located in the posterior thigh and was 3 x 2 cm. All flaps survived in this group at the end of the first week. In the second group the same flap was extended to the gluteal region and was 3 x 4 cm. Again, all flaps survived. In the last group an oversized flap (3 x 12 cm) was planned from the posterior thigh to the scapular region based on the same perforator artery. In this group only 61 +/- 7.2% (mean +/- standard deviation) of the flap survived at the end of the first week. Microangiography was performed in each group and the vascular architecture of the pedicle (perforator artery) was seen. This new posterior thigh perforator-based flap model is simple and reliable with a constant survival pattern. Thus, it could be used in studies investigating the physiological and pathophysiological changes of perforator-based flaps.

Angiography↗
PubMed2002

Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study.

The authors performed an anatomic study on 16 thighs of 11 fresh white cadavers at the Ludwig-Maximilian University of Munchen, Germany. They analyzed the anatomic pattern and caliber of both the lateral circumflex femoral arterial system and the perforators nourishing the anterolateral thigh flap. They found regularly a majority of musculocutaneous perforators, mainly in the central third of the thigh, arising from the descending branch of the lateral circumflex femoral artery. Despite the small number of cadavers, they identified several differences in the anatomy of the lateral circumflex femoral arterial system. These variabilities, especially regarding the descending branch and its perforators, could have clinical importance. They also suggest new dissection studies by comparing white and oriental anatomy. Their aim is to establish whether any difference in the variability of the lateral circumflex femoral arterial system could increase the popularity, currently greater in Eastern Europe, of the anterolateral thigh flap.

Femoral Artery↗
PubMed1997

Thigh pain and total hip arthroplasty: scintigraphy with 2.5-year followup.

From January 1988 to May 1990, 60 patients underwent 68 total hip arthroplasties at the Eisenhower Army Medical Center. The authors excluded 11 patients (11 hips) in whom infection developed, who were lost to followup, or who had incomplete records, leaving 49 patients (57 hips) as the study population. The 35 uncemented and 22 cemented femoral stems were evaluated with technetium bone scans at 1 week, 6 months, 1 year, and 2.5 years after surgery. Patients with uncemented femoral stems had markedly more thigh pain and more radiopharmaceutical uptake around the stem tip at 2.5 years followup than did patients with cemented femoral stems. In addition, patients with thigh pain had more uptake around the stem tip and a higher incidence of bone hypertrophy around the stem tip than did those without thigh pain, suggesting stress transfer as a cause of thigh pain.

Adult↗
PubMedDate not supplied

Comparison of back versus thigh donor sites in pediatric patients with burns.

To substantiate an observation that donor sites that are harvested from the back scar less than those that are harvested from thighs, donor sites from both areas were evaluated for the extent of scarring. For donor sites that were harvested more that 1 year before evaluation, no significant improvements were observed. Back donor sites that were evaluated less than or equal to 1 year after harvest had significant improvements in height, color, edema, suppleness, and cosmetic appearance than those harvested from thighs. Thirty-two patients had both back and thigh donor sites harvested at the same time. Back donor sites had significant improvement in scar height, color, and edema. Cosmetic improvements were also observed. Significantly more patients preferred the back donor site over that of the thigh. The back is the preferred donor site for skin grafts in the pediatric burn population.

Back↗
PubMed2002

Delayed presentation of acute compartment syndrome after contusion of the thigh.

Acute compartment syndrome has been described as a result of thigh contusion in several contact sports, and emergent fasciotomy has routinely been recommended. However, recent data suggest that thigh contusions in athletes presenting with isolated elevation of compartment pressures in the absence of neurovascular deficits may be treated expectantly. We describe a case of anterior thigh contusion, which initially presented with isolated compartmental hypertension without neurovascular symptoms. Under nonoperative treatment the patient developed delayed acute compartment syndrome from persistent muscular hemorrhage ten days after the initial trauma, requiring operative treatment. This case demonstrates that expanding hematoma formation may result in delayed increase of intramuscular pressures and compromise of myoneural perfusion in patients with severe thigh contusions. Early evacuation of the hematoma may help to prevent late development of compartment syndrome and reduce the risk for long-term complications.

Acute Disease↗
PubMed1999

Lateral thigh free flap for head and neck reconstruction.

OBJECTIVES: To present the technique of lateral thigh free flap reconstruction in the head and neck and review the use of this procedure in 58 head and neck defect reconstructions. STUDY DESIGN: Retrospective review in the setting of a tertiary, referral, and academic center. METHODS: Retrospective review of patient records in cases of lateral thigh free flap reconstruction for head and neck defects. Records were reviewed for patient age, gender, pathologic findings, type of reconstruction (pharyngoesophageal, glossectomy, oropharyngeal, or external soft tissue defects), recipient and donor-site complications, and flap failure. RESULTS: Fifty-eight patients underwent lateral thigh flap reconstruction from 1984 to 1997. Patient age ranged from 10 to 76 years. Thirty-nine patients were men, and 19 were women. Forty-three flaps were used for pharyngoesophageal reconstruction, nine for glossectomy defects, two for oropharyngeal defects, and four for external, soft tissue defects. All resections were for squamous cell carcinoma, except one case of recurrent hemangiopericytoma. One flap failure occurred from venous thrombosis (1.7%). Forty-two of 43 pharyngoesophageal defects were successfully reconstructed (97.6%). Five temporary salivary leaks were noted, but no frank fistulas occurred. One fistula occurred in the oropharyngeal reconstruction group. Four minor donor-site complications were noted (6.9%). CONCLUSION: This series demonstrates the low donor-site morbidity, as well as the reliability and versatility, of the lateral thigh free flap for head and neck reconstruction.

Adolescent↗
PubMed1988

Fascial anchoring technique in medial thigh lifts.

The medical thigh lift has not gained widespread acceptance since its introduction 20 years ago because of problems such as inferior scar migration, labial separation, and early recurrence of ptosis. Anchoring of the inferior skin flap to the tough, inelastic deep layer of the superficial perineal fascia has reduced such complications. Originally described by Colles in 1811, this fascial layer helps define the perineal-thigh crease. Eighteen patients having medial thigh lifts in combination with liposuction were followed for 6 to 24 months. The technique involves initial liposuction followed by resection of a crescent of redundant skin and fat at the superior medial thigh. The inferior skin flap is suspended from Colles' fascia of the perineum with subdermal PDS sutures. No undermining or deepithelialization of flaps is performed. Complications are few, and patient satisfaction is high.

Adipose Tissue↗
PubMed1995

Lateral thigh free flap in head and neck reconstruction.

To understand the role of the lateral thigh flap in head and neck reconstruction, we performed injection studies and anatomic dissections in 2 fresh and 61 preserved cadaver extremities followed by 10 clinical cases involving defects after tumor ablation. The flap, based on the third perforator of the profunda femoris artery, is designed on the posterolateral aspect of the distal thigh. The pedicle courses through the biceps short head, allowing optional transfer of this muscle. Defects of the oral cavity, pharynx, cervical esophagus, and external skin were successfully restored. One flap was unsuccessful because of intraoperative injury to the vascular pedicle. Compared with the radial forearm flap, the lateral thigh flap provides more tissue and the donor scar is more easily hidden, but the vascular pedicle is shorter, of smaller caliber, and more variable. The lateral thigh flap provides thin, pliable, and reliable tissue for a variety of needs in properly selected patients.

Adult↗
PubMed2001

Clinical application of the free thin anterolateral thigh flap in 31 consecutive patients.

In this retrospective study, 31 reconstructions using thin anterolateral thigh flaps and six cadaveric dissections of the thigh were investigated in consideration of the anatomic variations of the perforator vessels in the adipose layer, the safe area of flap circulation, and the clinical indications. Three variations of the perforator vessel course in the adipose layer were predicted correctly. The safe radius of a thin anterolateral thigh flap with a thickness of 3 to 4 mm was determined to be approximately 9 cm from the point where the perforator met the skin. The use of a thin anterolateral thigh flap for reconstruction of the neck, axilla, anterior tibial area, dorsum of the foot, circumference on the ankle, forearm, and dorsum of the hand was therefore recommended.

Adipose Tissue↗
PubMed2002

Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases.

The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue defect reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients in Chang Gung Memorial Hospital. A total of 439 flaps were cutaneous or fasciocutaneous flaps based on musculocutaneous perforators. The analysis of the flap failures was done only in this perforator series. In six cases, no suitable skin vessel was found during the dissection of the flaps. The complete success rate was 96.58 percent (424 of 439). Of the 15 failure cases, eight were complete and seven were partial (10 percent to 60 percent of the flap). Thirty-four flaps were reexplored, and 19 (56 percent) were salvaged. In this study, some of the reasons for the flap failure, unique to the anterolateral thigh perforator flap, were identified. They include inadvertent division of perforator at the fascial plane as a result of inadequate knowledge of perforator anatomy, inadvertent injury to the perforator during intramuscular dissection (noted by the surgeon or ignored) as a result of inexperience, and twisting of the pedicle during inset of the flap at the recipient site. Technical pearls in the harvest of the anterolateral thigh perforator flap are as follows: mapping of the skin vessels with a Doppler probe before flap design, meticulous dissection of the perforator under surgical loupe or even lower-magnification microscope, inclusion of a small fascia cuff around the perforator, and intermittent topical use of Xylocaine during the intramuscular dissection of the perforators. During reexploration, one must search for twisting of the pedicle and small bleeders from the branches of the intramuscular perforators.

Adolescent↗
PubMed2004

Preoperative color Doppler assessment in planning of anterolateral thigh flaps.

The anterolateral thigh flap has many advantages, but it has not yet achieved widespread use because the perforators exhibit considerable anatomical variation and their locations are difficult to predict preoperatively. The authors performed a prospective study to investigate whether acoustic Doppler flowmetry and color Doppler ultrasonography were helpful for preoperative localization of the perforators in anterolateral thigh flaps. Ten patients scheduled for anterolateral thigh flap surgery were examined preoperatively with both acoustic Doppler flowmetry and color Doppler ultrasonography, and all points where the perforators seemed to penetrate the fascia lata were mapped. The actual perforating points were identified intraoperatively and were compared with the preoperatively mapped points. Fifteen perforators were detected in 10 patients. The concordance rate with acoustic Doppler flowmetry was 40 percent (95 percent confidence interval, 15 to 68 percent; p = 0.05). In contrast, the concordance rate with color Doppler ultrasonography was 100 percent (95 percent confidence interval, 81 to 100 percent; p = 0.05). Color Doppler examination was significantly more accurate than acoustic Doppler examination (determined by the binomial test; p < 0.0014). Three-dimensional anatomical information around the perforators was further useful in elevating flaps. The authors conclude that color Doppler examination can accurately identify the perforators and is useful for planning in anterolateral thigh flap surgery, whereas acoustic Doppler examination is unreliable.

Adult↗
PubMed2004

Distally based anterolateral thigh flap: an anatomic and clinical study.

The distally based anterolateral thigh flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based anterolateral thigh flap to the knee region could be improved. The authors have actually used this flap in three cases. In 11 thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal flap size was 7.0 x 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 +/- 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the anterolateral thigh flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.

Adult↗
PubMed2005

Defining vascular supply and territory of thinned perforator flaps: part I. Anterolateral thigh perforator flap.

BACKGROUND: The anterolateral thigh perforator flap is increasingly being used for trauma and reconstructive surgical cases. With the thinned flap design, greater survivability and a decrease in donor-site morbidity are observed. To increase our knowledge of the vascular territories in these flaps, an anatomic study was performed to determine pedicle number, location, and diameter; accompanying veins; vascular territory; and where surgical incisions can be made safely during thinning, as opposed to the "danger zone." METHODS: Thirteen anterolateral thigh perforator flaps were harvested from seven adult cadavers. The largest perforator arteries were cannulated, and flaps were thinned to a thickness of 6 to 8 mm, with a 2.5-cm radius from the perforator retained. Vascular territories were quantified before and after thinning by nonradiographic and radiographic methods. A series of dyes were injected: red dye for skin (photography) followed by Omnipaque for the whole flap (radiography) before thinning, and blue dye for skin (photography) and lead oxide for the whole flap (radiography) after thinning. Pedicle locations were determined by ratios of anatomical landmarks. Danger zone measurements were derived at specific thicknesses using lateral radiographs of each flap. RESULTS: In anterolateral thigh perforator flaps, the mean perforator artery diameter at the fascia level was 1.00 +/- 0.08 mm (range, 0.84 to 1.11 mm) and the mean number of perforator arteries was 1.69 +/- 1.03 (+/-SD). Perforator pedicles were located near the midpoint of the line between the anterior superior iliac spine and the lateral aspect of the patella in the vertical axis. The mean vascular territories were 256 +/- 52.5 cm2 (photography) and 351 +/- 72.8 cm2 (radiography) in unthinned flaps and 211 +/- 65.7 cm2 (photography) and 289 +/- 106.6 cm2 (radiography) in thinned flaps. Differences in overall vascular territories after thinning were 83.3 percent (photography) and 81.8 percent (radiography) compared with unthinned flaps. Four respective vascular territory maps were drawn showing surgical territories using percentile confidence intervals (98th and 90th) and averages. From the skin at thicknesses of 4, 6, and 8 mm, the 98th percentile danger zones were 33 to 37 mm (proximal to distal), 30 to 35 mm, and 27 to 31 mm from the pedicle in the vertical axis, respectively; in the horizontal axis, they were 30 to 34 mm (medial to lateral), 28 to 31 mm, and 25 to 29 mm. CONCLUSIONS: These data define anterolateral thigh perforator flap pedicle location, number, and diameter before harvesting, surgical danger zones during thinning, and vascular territories after thinning. The authors' guidelines provide surgeons with anatomical vascular territory maps to design and harvest specific flaps for optimal results.

Aged↗
PubMed2006

The extended approach to the vascular pedicle of the anterolateral thigh perforator flap: anatomical and clinical study.

BACKGROUND: The anterolateral thigh perforator flap is a well-described and versatile flap that has specific advantages. However, the variable anatomy makes flap elevation challenging. Furthermore, the dissection of the proximal part of the pedicle that runs underneath the rectus femoris muscle demands continuous pull by an assistant and is inconvenient and tiring for the surgeon. A technique that facilitates dissection of the proximal pedicle part is suggested. It is useful in both pedicled and free flap transfer, when maximum pedicle length is crucial. METHODS: Five anterolateral thigh perforator flaps were dissected using the extended technique. Four were transferred as free flaps and one as an island pedicled flap. In addition, anatomical cadaver studies were performed bilaterally in five fresh cadavers to further clarify the relevant anatomy. RESULTS: All flaps survived well. One patient suffered from donor-site infection caused by inadequate drainage. Conservative treatment with daily dressing changes resulted in satisfactory healing. Two patients suffered from hypesthesia of part of the lateral thigh area. No patient experienced any difficulty in daily activities and none suffered from knee extension lag. CONCLUSIONS: An extended approach for dissection of the anterolateral thigh perforator flap is described that is useful in both pedicled and free flap transfers. Cautious tunnel creation is a prerequisite for avoidance of complications.

Dissection↗