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At least 217 records · Page 12Linked to original sources
PubMed2006

Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap.

BACKGROUND: Preoperative localization of the cutaneous perforators is an important step in designing anterolateral thigh flaps. The purpose of this study was to examine the accuracy of two commonly used Doppler devices in locating these perforators. METHODS: This study was conducted in 100 free anterolateral thigh flaps during a 2-year period. Cutaneous perforators of the anterolateral thigh flaps were localized in the clinic using the Huntleigh Mini Dopplex D-900 unit with an 8-MHz probe (Huntleigh Diagnostics Ltd., Cardiff, United Kingdom) and in the operating room just before surgery using the Koven ES-100X Mini Doppler unit with a 10-MHz sterile probe (Koven Technology, Inc., St. Louis, Mo.). The locations of Doppler signals and of the actual cutaneous perforators at surgery were plotted and compared. RESULTS: One to three cutaneous perforators of the anterolateral thigh flap were consistently found at specific locations; they were named perforators A, B, and C from proximal to distal. Perforators A, B, and C were present in 51, 89, and 62 cases, respectively, at surgery and were approximately 5 cm apart. The sensitivities and specificities in detecting perforator B were 100 percent and 0 percent, respectively, for the Huntleigh Doppler unit, and 91 percent and 55 percent for the Koven unit. The Doppler signal was within 1 cm of the actual perforator B location in 74 percent and 70 percent of the flaps with the Huntleigh and Koven units, respectively. The accuracy of Doppler examination decreased as body mass index increased. CONCLUSIONS: Preoperative handheld Doppler examination is not always accurate and should be used with caution in flap design.

Adult↗
PubMed2004

The use of free anterolateral thigh flap for reconstructing soft tissue defects of the lower extremities.

The goal of soft tissue reconstruction in the lower extremities is to provide a functional and cosmetically acceptable limb. The anterolateral thigh flap has become one of the most popular options for soft tissue defect reconstruction recently because of the large amount of skin available and the reliable and versatile nature of this material. The purpose of this article is to present our experiences with the free anterolateral thigh flap for the reconstruction of soft tissue defects of the lower extremity. From April 2002 to October 2003, 31 consecutive free anterolateral thigh flaps were used. There were 24 male and 7 female patients, and their ages were between 3 and 78 years. The size of the flaps ranged from 11 to 34 cm long and 6 to 16 cm wide. In 9 patients, the flaps were harvested in a flow-through manner to both reconstruct soft tissue defects and protect and maintain the vascular status of the lower extremities. In these patients, the pedicle was interposed between vascular gaps, either present or created, in the extremity. The patency of distal anastomosis with the course of the distal vessel was confirmed by using conventional Doppler flow monitoring in flow-through flaps. In 4 cases, thinning of the flap was performed. In 3 patients, flaps were used in a neurosensorial fashion. Four flaps required reoperation due to vascular compromises. While 3 of these were salvaged, 1 flap was lost due to recipient arterial problems. Sixteen cases underwent split-thickness skin grafting of the donor site. No infection or hematomas were observed. We conclude that the anterolateral thigh flap is an ideal and versatile material, especially for lower extremity reconstructions, with its functional and cosmetic advantages, and it can be considered a suitable alternative to the most commonly used conventional soft tissue flaps.

Adolescent↗
PubMed1985

Thigh muscle activity during maximum-height jumps by cats.

Cats were trained to jump from a force plate and touch a cotton ball suspended as high as 1.6 m. Force-plate reaction forces and double-joint hamstring muscle activity observed early in propulsion varied from one maximal jump to another. This variability is consistent with theory (31, 32, 42); that is, different coordination strategies can be implemented prior to the heels losing contact with the force plate (heel-off). Single-joint hip extensor and double-joint posterior thigh (hip extensor-knee flexor) muscles were coactivated prior to heel-off. This coactivation is probably partially responsible for the observed backward rotation of the trunk. Forepaws, observed to contact the force plate prior to heel-off, probably assist the hindlimbs in generating trunk rotation. Both single-joint knee extensor and hip extensor muscles exhibited greatest activation between heel-off and body lift-off. Single-joint flexor muscles were inactive throughout propulsion. Double-joint posterior thigh muscles were deactivated at heel-off and remained inactivated until lift-off. These observations agree with the theoretical notion that muscles should be either fully activated, inactivated, or switched from one extreme to the other (i.e., bang-bang control) between heel-off and body lift-off (31, 32, 42, 44). All seven muscles studied shortened while activated. Using computations based on muscle geometry, fiber architecture, and joint angle trajectories, I propose that sarcomeres shorten along the flat and ascending regions of the force-length curve. De- and inactivation of double-joint posterior thigh muscles between heel-off and lift-off coincided with muscle stretch. The reason for inactivation of these muscles is that the negative work that would have been generated had these muscles stayed activated would have hindered propulsion. Contractions preceded by active stretch were not observed. Enhancement of positive work by previous storage of energy in elastic musculotendinous structures is thus not used by cat thigh musculature in jumps starting from the squat. Adductor femoris, semimembranosus anterior, and biceps femoris anterior muscles were activated synergistically as one group yet differently from the synergistic activation of gracilis, semitendinosus, and biceps femoris posterior muscles. The separation of these muscles into two groups based on their activation patterns during jumping is compatible with the classification of these muscles into hip extensor and knee flexor muscle groups, respectively, based on their reflex patterns (37), spinal cord reflex connectivity (18, 30), and firing patterns during locomotion (20).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Diagnostic and prognostic value of clinical findings in 83 athletes with posterior thigh injury: comparison of clinical findings with magnetic resonance imaging documentation of hamstring muscle strain.

BACKGROUND: Little is known about the clinical features of posterior thigh injuries and their contribution to accurate diagnosis and prognostic assessment of hamstring muscle strain injury. HYPOTHESES: The clinical features of posterior thigh injury can be used to diagnose hamstring muscle strain and to predict duration of absence from competition. STUDY DESIGN: Prospective clinical study. METHODS: For two playing seasons, the clinical features of posterior thigh injury, timing of injury, and playing days lost were recorded for Australian Rules football players. Magnetic resonance imaging was used to confirm hamstring muscle injury. RESULTS: Posterior thigh injuries associated with pain and tenderness were recorded for 83 players, with magnetic resonance imaging confirming hamstring injury in 68 (82%). Most of the hamstring injuries were sudden onset (62; 91%) and occurred after a significant warm-up period (57; 84%). Of the patients whose injuries were sudden onset and occurred after the warm-up period (N = 59), 57 (97%) had hamstring muscle strain detected on magnetic resonance imaging. Hamstring muscle injury confirmed by magnetic resonance imaging was associated with a longer absence from competition (mean, 27 days) than injuries where no hamstring injury was detected (mean, 16 days). CONCLUSIONS: The clinical features of hamstring injury typically include sudden onset, pain, and tenderness, although exceptions do occur. Muscle fatigue may be important in the pathogenesis of hamstring injury.

Adult↗
PubMed2005

Does the sciatic nerve approach influence thigh tourniquet tolerance during below-knee surgery?

In this prospective, randomized, blinded study we assessed thigh tourniquet tolerance when a Labat's or a posterior popliteal approach of the sciatic nerve was used for below-knee surgery. One-hundred-twenty patients were divided into two groups of 60. A posterior popliteal (Group 1) or a Labat's (Group 2) sciatic nerve block was performed with 25 mL 1% mepivacaine + epinephrine 1:200,000. In both groups, a femoral nerve block was achieved. Patient comfort during block performance, sensory block, success rate, and thigh tourniquet tolerance were recorded. Performance of the block was significantly more comfortable in Group 1 than in Group 2 (P < 0.01). Completeness of the block at t(30 min.) and success rate were comparable in both groups. Thigh tourniquet pain increased with time in both groups. No statistically significant difference was observed between groups. We conclude that despite a complete sensory blockade of the posterior femoral cutaneous nerve in 91% of the patients, Labat's approach of the sciatic nerve provides no better thigh tourniquet tolerance than the popliteal approach. The popliteal approach is as efficient but more comfortable for the patient and is the preferred technique for below-knee surgery.

Adult↗
PubMed2000

[Ultrasound anatomy of the sciatic nerve of the thigh].

Ultrasound examinations of the sciatic nerve were performed using high-resolution transducers (7.5, 10 to 20 MHz) both in anatomical specimens and in healthy volunteers. The ultrasonographic anatomy (sono-anatomy) of the nerve, its course along the thigh and its echogenicity in comparison with muscles, tendons and adipose tissue were investigated in 10 isolated muscle/nerve preparations. In addition, the influence of the angle of the applied transducer on the various different tissues was evaluated. In the clinical part of the study, the sciatic nerve was identified ultrasonographically in both thighs of 50 sex-matched healthy volunteers aged between 2 and 76 years. The normal sciatic nerve presents as a tubular echogenic structure with parallel linear internal echoes in the longitudinal section, and as a punctiform moderately echoic structure in cross-section, with the perineurium producing bright boundary echoes. Varying the insonating angle of the transducer reduced echogenicity, but to a smaller degree than in muscles and tendons. Unequivocal identified of the sciatic nerve from the level of the gluteal fold to its bifurcation in the distal thigh was possible in all but one case. We conclude that the course of the sciatic nerve along the thigh can be reliably identified and imaged with high-resolution ultrasound.

Adolescent↗
PubMedDate not supplied

[Clinical application of the V-Y posterior thigh fasciocutaneous flap].

PURPOSE: To analyze the clinical applicability of one-stage treatment of single or multiple sores using the V-Y posterior thigh fasciocutaneous flap. METHODS: Twenty patients were treated, having 25 ulcers in the gluteal and perineal regions, being 23 pressure ulcers, 1 perianal abscess and 1 perineal trauma. In all of the patients the repair was carried out with a fasciocutaneous flap from the posterior region of the thigh. The flap was made with a superior and lateral base, preserving the fasciocutaneous branches of the inferior gluteal arteries, first and second perforating, in the treatment of ischial ulcers. In the associations of the same with sacral ulcer, a fasciocutaneous extension from the gluteal region was added to the flap for a one and only surgical procedure. A superior and medial based flap was made, preserving the fasciocutaneous branch of the inferior gluteal artery in the treatment of the trochanteric ulcers. In the associations with sacral ulcer a fasciocutaneous extension from the gluteal region was added to the posterior thigh flap which permitted the closure of all ulcers in only one surgical procedure. In the associations of trochanteric and ischial ulcers a flap with a superior base was made, preserving the fasciocutaneous branch of the inferior gluteal artery. RESULTS: There was no necrosis of the flap. The immediate complications were 3 infections, 1 dehiscences and 1 hematoma. In a follow-up period of 6 months to 29 months, with one patient being lost to follow up, there were 6 recurrences 6/24 (25.0%) in 5 patients 5/19 (26.32%). CONCLUSION: We conclude that the posterior fasciocutaneous thigh flap, in V-Y, can be used with safety in the treatment of isolated or multiple ulcers in the gluteal and perineal regions.

Adolescent↗
PubMed1989

Reflex inhibition of thigh muscles in knee injury. Causes and treatment.

There are several common findings and contradictions noted in the research related to thigh muscle reflex inhibition and sequelae that occur with knee joint injury. Reflex inhibition may be measured directly by electromyography, or the sequelae of reflex inhibition may be measured, as commonly occurs in the clinic setting. Electromyography is useful in determining the causes of reflex inhibition. The most frequently cited causes of thigh muscle reflex inhibition in knee injury are pain, joint effusion and knee immobilisation. The other measurement methods described vary from thigh circumference measurement to muscle biopsy. These methods are useful in determining the magnitude and duration of the deleterious sequelae that affect the thigh muscles after reflex inhibition. Finally, there is selectivity of reflex inhibition after knee joint injury: the quadriceps versus the hamstrings, the different components of the quadriceps muscle group, and the different types of muscle fibres. In light of these findings, several suggestions have been offered for prevention of reflex inhibition and for techniques that can be applied to rehabilitate the most affected muscle group: the quadriceps femoris. Techniques used to prevent or limit the amount of reflex inhibition include cryotherapy, transcutaneous electrical nerve stimulation, iontophoresis, phonophoresis, joint mobilisation, rest and proper positioning of the knee in rest and exercise. Electromyostimulation, electromyographic biofeedback and traditional exercise training are 3 methods used to rehabilitate the quadriceps.

Humans↗
PubMed1998

Thigh and calf girth following knee injury and surgery.

Girth measures are commonly used to assess muscle atrophy or joint effusion. Little is known, however, regarding girth measurement changes following knee injury and subsequent surgery. Therefore, the purpose of this study was to compare the thigh and calf girth measurements of involved and noninvolved extremities prior to and following knee surgery for subjects with acute and chronic knee injuries. Of the 40 subjects that were studied, 22 subjects were placed in the acute group (less than 6 months from time of injury to presurgery measurement) and 18 subjects were placed in the chronic group (greater than 6 months from time of injury to presurgery measurement). Thigh and calf girth measurements were taken prior to surgery and then prior to the initiation of outpatient rehabilitation following surgery. For the acute and chronic groups, a three-way analysis of variance (ANOVA) with repeated measures on the extremity, muscle, and time factors was used to analyze the data. For each group, the three-way ANOVA revealed a significant two-way interaction between the extremity and time factors. Post hoc analysis revealed significant differences between involved and noninvolved extremities at both the pre- and post-surgery time periods for the acute and chronic groups. While thigh and calf girth measurement differences existed between the involved and noninvolved extremities prior to and after surgery, the bulk of the girth measurement differences existed prior to surgery for both groups. Based upon the results of this study, the assessment and rehabilitation of the thigh and calf following knee injury and surgery are recommended.

Acute Disease↗
PubMed1997

Relation of abdominal and thigh adipose tissue distribution to serum lipids and glucose metabolism in obese males.

Spin-echo magnetic resonance imaging (MRI) and postprocessing for fat quantification were used to examine the relationship of abdominal and thigh adipose-tissue distribution to serum lipids and glucose metabolism in obesity. Thirteen simple obese male patients and 12 non-obese male volunteers were examined by MRI, blood pressure, and fasting blood sample levels of serum lipids, glucose, immunoreactive insulin, c-peptide, HbA1C and hematocrit. Correlations of thigh visceral and subcutaneous fat areas to serum lipid levels were generally similar, but marked differences were found between relationships of thigh versus abdominal fat areas to serum lipid levels. In addition, diastolic blood pressure was significantly correlated with the fat area, especially with the abdominal visceral fat area (r=0.51, p<0.01), but not with abdominal subcutaneous fat area. The thigh muscle area was highly and inversely correlated with c-peptide (r=-0.72, p<0.01) and systolic blood pressure (r=-0.65). Differences in correlations between visceral and subcutaneous fat areas in the abdomen to metabolic parameters were found between abdominal visceral fat areas and HbA1C and between the abdominal subcutaneous fat areas and HbA1C. These findings suggest that the character of regional fat could be heterogeneous with respect to lipid and glucose metabolism and blood pressure levels in obese males.

Abdomen↗
PubMed2001

Scrotal reconstruction using thigh pedicle flaps: long-term follow-up of 12 cases.

INTRODUCTION: Genital skin loss in men may be caused by avulsion injuries of the penis and scrotum or by gangrene of the male genitalia. Reconstruction of the scrotum after complete loss of the overlying skin is a challenging problem. We report our experience on the management of this problem. MATERIAL AND METHOD: Medical records of all male patients with massive scrotal skin loss and exposed testes treated at Ramathibodi Hospital and Noparat Rajthanee Hospital from 1990 to 1999 were reviewed. The etiologies of scrotal skin loss, technique of treatment, post-operative consequence as well as complications were noted. RESULTS: Twelve patients were described in this study. Nine patients had avulsion injuries of the penile and scrotal skin secondary to agricultural machinery accidents. Three patients were after extensive debridement of Fournierrís gangrene. The exposed testes had been placed in thigh pouches and scrotal reconstruction using thigh pedicle flaps was done 4-6 weeks later. No immediate and delayed complications were detected in all of the patients. They recovered without any sequelae and had a satisfactory cosmetic result. CONCLUSION: Extensive scrotal skin loss should be immediately treated surgically. Implantation of the exposed testes in the upper thigh pouch and delayed reconstruction of the scrotum using thigh pedicle flaps can provide excellent results

Adolescent↗
PubMedDate not supplied

The diagnosis of aorto-iliac stenosis: a comparison of thigh pressure measurement and femoral artery flow velocity profile.

Patients with vascular disease of the legs were studied by indirectly measuring thigh and ankle systolic pressures and recording the femoral artery flow profile before and after exercise with the aim of identifying those patients in whom significant aortoiliac stenosis may not have been diagnosed by angiography. A group of patients with aortoiliac stenosis or occlusion has been compared with a group with superficial femoral artery (SFA) occlusion and apparently normal controls. Resting thigh pressures were reduced in the group of patients with aortoiliac disease and with SFA occlusion. There was no significant change in thigh pressure with exercise in any group but ankle pressure fell with exercise in the patients with aortoiliac disease and with SFA occlusion. Femoral artery flow profiles provided better discrimination between the groups but six of the forty-two patients with SFA occlusions had abnormal tracings and a low thigh pressure suggesting they may have significant proximal disease.

Aorta, Abdominal↗
PubMed2005

Management of defects in the groin, thigh, and pelvic region with modified contralateral TRAM/VRAM flaps.

In patients with sarcomas, or regional recurrence of the disease, radical resection and radiation therapy is indicated to achieve cure or palliation. As a result of radical surgery, extensive radiation, or infection in the pelvic, groin or thigh region, the development of large pelvic / groin / thigh defects present a difficult surgical problem. Musculocutaneous deep epigastric island-flaps, as a modification of the extended deep inferior epigastric flap, described by Taylor et al. in 1983, are an attractive option for a successful reconstruction for this defect localisation. Two technical modifications of the contralateral extended deep inferior epigastric island-flap permitted an adequate tailoring to a defect in the posterior lateral pelvic or groin-thigh region, and avoided the drawbacks of other loco-regional or microsurgical flaps in previously irradiated fields. The skin island reached the posterior lateral pelvic region, groin or thigh. The muscular portion of this flap was suited to fill the soft tissue defects in these critical areas. These so modified flaps represent an instrument, which in selected cases may be an interesting alternative tool for closure of complex defects. No significant functional impairment secondary to the flap procedures was noted in our patients.

Bone Neoplasms↗
PubMed1991

[The effect of a thigh tourniquet on the pharmacokinetics of midazolam].

Although the general pharmacokinetics of midazolam (M) are well documented, little is known about the possible effects of a thigh tourniquet on the distribution and elimination of this drug. METHOD. Institutional approval for the study and individual informed consent were obtained. We studied 30 patients (ASA-I) without premedication who electively underwent a surgical procedure of the lower limb. Patients were divided into three groups of 10. The procedure was done in groups I and II with and in group III without tourniquet use. Anesthesia was induced in groups I and II with 0.1 mg/kg M, fentanyl 5 micrograms/kg, alcuronium-dichloride 0.15 mg/kg and etomidate 0.1-0.2 mg/kg i.v. and maintained with enflurane 0.3-1.0 vol.-%. About 20 min after midazolam injection and after exsanguination the tourniquet was applied on the proximal thigh in group I. In group II anesthesia was induced with etomidate 0.2 mg/kg and alcuronium-dichloride 0.15 mg/kg i.v., and maintained about 20 min with enflurane 1.0-1.5 vol.-% until exsanguination and tourniquet application. After this, these patients also received 0.1 mg/kg M and 5 micrograms/kg fentanyl i.v. Through an indwelling arterial line, blood samples were obtained prior to and 2, 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 165 and 180 min after M injection. Plasma M levels were measured by high-performance liquid chromatography with UV detection. These concentrations were fitted to a two-compartment open model. Comparison between groups was performed using the Kruskal-Wallis test and p less than 0.05 was considered to indicate significance. RESULTS. The groups were all comparable in age and weight, and groups I and II also in duration of thigh ischemia. Midazolam elimination half-time (t beta 1/2) was significantly shorter in group II than in groups III and I (52 min vs 126 min and 139 min; p less than 0.05). Of the calculated distribution volumes (volume of the central compartment, volume in the steady state and volume in the elimination phase), only the volume in the steady state was significantly smaller in group II than in groups III and I (p less than 0.05). Groups III and I did not differ significantly in the computed parameters. The measured initial midazolam mean concentrations in group II were twice those in groups III and I (655 ng/ml vs 323 ng/ml and 332 ng/ml). Since clearance was not significantly different between any two groups, the shorter t beta 1/2 in group II was probably due to the reduced distribution volume. CONCLUSION. These data demonstrate that in the presence of a thigh tourniquet the timing of the injection - before or after application of the tourniquet is of decisive importance. Injection after the application of a tourniquet leads to an higher plasma level and shortens the elimination half-life.

Adult↗
PubMed1987

Regional fat loss from the thigh in obese women after adrenergic modulation.

Beta-adrenergic stimulation and alpha 2-adrenergic inhibition increase lipolysis from fat cells. Twenty-eight obese women were placed on a calorie-restricted diet and one of five treatments was applied to one thigh three to five times per week for four weeks: (1) isoproterenol injections; (2) cream containing colforsin (forskolin), aminophylline, and yohimbine; (3) yohimbine cream; (4) colforsin cream; or (5) aminophylline cream. The opposite thigh was treated with a placebo (injection or cream). The treated thighs lost significantly more girth after treatment, both by injection and by cream. No adverse reactions were attributable to either the cream or the injections. It is concluded that local fat reduction from the thigh can be safely accomplished.

Adipose Tissue↗
PubMed1988

The thigh flap: an osteomyocutaneous free-flap model in the rat.

A new experimental model for free-flap transfer has been developed in the rat. This "thigh flap" is an osteomyocutaneous free flap of bone (femur), muscle (thigh), and skin (groin) based on the femoral vessels. The flap is harvested from the left groin and thigh of an inbred female rat and is transferred to a subcutaneous pocket in the left groin of a male rat of the same inbred strain. The femoral vessels supplying the flap are anastomosed end-to-end with the femoral vessels of the recipient. Thirty flaps have been transferred, with 5 technical failures. Three of the remaining 25 flaps developed necrosis within 24 hours. The other 22 flaps remained viable until the rat was sacrificed at 7 days. The survival rate of the thigh flap was thus 88 percent. The model is suitable for use in metabolic, vascular, and immunologic studies of composite free flaps.

Animals↗
PubMed1978

Value of arterial pressure measurements in the proximal and distal part of the thigh in arterial occlusive disease.

A prospective study was carried out comparing two techniques of segmental arterial pressure measurements of the leg to detect, localize and quantify regional arterial occlusive disease. The measurement of pressures of the proximal and distal parts of the thigh with the narrow cuff technique permitted correct anatomic localization of aortoiliac, femoropopliteal or combined disease in 78 per cent of diseased extremities, including all limbs with isolated aortoiliac or femoropopliteal disease. A single wide cuff arterial pressure measurement of the thigh correctly localized arterial obstructions in only 19 per cent of diseased extremities. Although a wide cuff is associated with less artifactual elevation in measured arterial pressure at the thigh, this advantage is outweighed by the limitation of diagnostic accuracy in localizing segmental arterial occlusive disease. We recommend that segmental arterial pressure measurements of the limb be made at four levels on the lower extremity, including arterial pressures of the proximal and distal parts of the thigh to achieve maximal diagnostic accuracy.

Angiography↗
PubMed1981

Thigh pressure artifacts with noninvasive techniques in an experimental model.

In an experimental canine model of isolated and tandem arterial stenoses, noninvasive thigh and calf pressure measurements were evaluated against direct intra-arterial pressures. Under control circumstances, proximal iliac arterial stenosis, and high superficial femoral artery stenosis, the noninvasive measurements were highly accurate. However, when stenoses were created distal to the high pressure cuff, a significant error in the thigh pressure measurement was observed, with an underestimation of thigh pressure and subsequent false implication of a proximal lesion. Two tandem distal lesions produced a significantly more severe thigh measurement artifact. Further, the noninvasive system was incapable of detecting a moderately severe profunda stenosis, although stenoses of the iliac and femoral system were detected in a routine, accurate, and sensitive fashion.

Animals↗