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At least 271 records · Page 15Linked to original sources
PubMed2005

Acute appendicitis presenting as thigh abscess in a child: a case report.

A case of retrocecal appendicitis is described in a 6-year-old male child who presented with thigh abscess. The presence of a positive psoas stretch test, feculent discharge, an enteric growth on bacteriological examination, and intraabdominal fluid collection on abdominal ultrasound provided clues to the presence of an intraabdominal source of sepsis. Laparotomy revealed a perforated retrocecal appendix with surrounding collection communicating into the thigh. Appendectomy with drainage of retroperitoneal and thigh collections under adequate antibiotic coverage resulted in a satisfactory recovery. We describe our experience with the present case and discuss the pertinent literature.

Abscess↗
PubMed2006

Hip, thigh and calf muscle atrophy and bone loss after 5-week bedrest inactivity.

Unloaded inactivity induces atrophy and functional deconditioning of skeletal muscle, especially in the lower extremities. Information is scarce, however, regarding the effect of unloaded inactivity on muscle size and function about the hip. Regional bone loss has been demonstrated in hips and knees of elderly orthopaedic patients, as quantified by computerized tomography (CT). This method remains to be validated in healthy individuals rendered inactive, including real or simulated weightlessness. In this study, ten healthy males were subjected to 5 weeks of experimental bedrest and five matched individuals served as ambulatory controls. Maximum voluntary isometric hip and knee extension force were measured using the strain gauge technique. Cross-sectional area (CSA) of hip, thigh and calf muscles, and radiological density (RD) of the proximal tibial bone were measured using CT. Bedrest decreased (P < 0.05) average (SD) muscle strength by 20 (8)% in knee extension, and by 22 (12)% in hip extension. Bedrest induced atrophy (P < 0.05) of extensor muscles in the gluteal region, thigh and calf, ranging from 2 to 12%. Atrophy was more pronounced in the knee extensors [9 (4)%] and ankle plantar flexors [12 (3)%] than in the gluteal extensor muscles [2 (2)%]. Bone density of the proximal tibia decreased (P < 0.05) by 3 (2)% during bedrest. Control subjects did not show any temporal changes in muscle or bone indices (P > 0.05), when examined at similar time intervals. The present findings of a substantial loss in hip extensor strength and a smaller, yet significant atrophy of these muscles, demonstrate that hip muscle deconditioning accompanies losses in thigh and calf muscle mass after bedrest. This suggests that comprehensive quantitative studies on impaired locomotor function after inactivity should include all joints of the lower extremity. Our results also demonstrate that a decreased RD, indicating bone mineral loss, can be shown already after 5 weeks of unloaded bedrest, using a standard CT technique.

Adult↗
PubMed1985

Gluteal thigh flap repair of chronic perineal wounds.

Since the introduction of the gluteal thigh flap in 1979, we have had the opportunity to study and modify this reconstructive technique in over 40 patients. Our successful experience with the gluteal thigh flap in six consecutive patients with difficult, nonhealing perineal pelvic sinuses has increased our confidence with this modality and led to a modified technique. Bilateral deepithelialized and well-vascularized flaps are harvested from the posterior thighs and transferred to the perineal wounds on pliable musculofascial pedicles through the ischiorectal space. Proper filling of the pelvic space requires adequate debridement, which may include release of a bottleneck narrowing of the sacral promontory. Donor site morbidity is minimal and temporary. Follow-up periods of 8 months to 5 years have revealed no wound recurrence.

Adult↗
PubMed1984

The free thigh flap: a new free flap concept based on the septocutaneous artery.

Based on the septocutaneous artery flap concept, the thigh, which is the commonest conventional donor site for split-skin grafts, can also become a donor area for skin flaps. The thigh flap, with its large and long neuro-vascular pedicle, can be used either as a free flap or as an island flap as an alternative to the lower abdominal flap, groin flap, tensor fasciae latae myocutaneous flap, sartorius myocutaneous flap or the gracilis myocutaneous flap. The anatomical basis, operative technique and characteristics of the thigh flap are discussed.

Adult↗
PubMed1989

The anterolateral thigh flap; variations in its vascular pedicle.

The anterolateral thigh flap is based on the septocutaneous perforators of the lateral circumflex femoral artery. Little has been written about anomalies of its vascular pedicle. We report two variants of the pedicle vessel in eight patients in whom this flap was used, and absence of the perforators in five other cases in whom it was attempted. The anterolateral thigh flap has the advantages of thin and pliable skin, long and large pedicle, inconspicuous donor scar and the technical possibility of combination with fascia, sensory nerve and iliac bone. If the perforators are absent, a tensor fasciae latae musculocutaneous flap or anteromedial thigh flap is available with only minor changes of the flap outline.

Adolescent↗
PubMed1989

The lower posterolateral thigh flap.

The vascular basis of a new distally based flap in the distal third of the posterolateral thigh has been studied in 30 cadaver limbs. This flap is supplied mainly by direct cutaneous branches of the popliteal artery and of the lateral superior genicular artery. Its use as a distally based fasciocutaneous flap for defects of the knee is illustrated and its potential as a free flap is discussed. A classification of various flaps from the posterolateral region of the thigh is also proposed. In the light of the anatomical studies, the cutaneous blood supply of the distal posterolateral region and other regions of the thigh is reviewed.

Aged↗
PubMedDate not supplied

Clinical experience and surgical anatomy of 32 free anterolateral thigh flap transplantations.

The anterolateral thigh flap, first described by Song, is one of the septocutaneous flaps in the thigh. Since November 1985 we have transferred 32 anterolateral thigh flaps successfully without any loss. Six of these flaps were performed in Australia. The vascular pedicles are divided into three types: fasciocutaneous perforator (37.5%-12/32), vertical musculocutaneous perforator (56.2%-18/32) and horizontal musculocutaneous perforator (6.6%-2/32). This paper presents the surgical anatomy of the flap and clinical experience.

Adolescent↗
PubMed2005

[Anterolateral thigh flap. Retrospective study].

The anterolateral thigh flap is a cutaneous or fasciocutaneous perforator flap, extensively used in China, Japan, Taiwan (Demirkan et al., 2000; Kimata et al., 1997; Koshima et al., 1993; Luo et al., 1999) but infrequently in Europe, probably because of variations in origin and course of the cutaneous perforators rending its use apparently less reliable. This study is about 13 anterolateral thigh flaps performed between November 1, 1998, and December 30, 2002, on 13 patients, four women, nine men. Among these 13 flaps, 11 were free flaps, two were pedicled flaps. The surgical procedure was decided because of loss of soft tissue localised in: floor of the mouth (2 flaps), limb (9 flaps), inguinal-illiac region (2 flaps). The mean age of patients was 47.7 years (ext. 23 years and 69 years). The quality of the result was evaluated by the surgeon as good or very good, fair or bad. The function of the donor site was evaluated by questionnaire of the patient and physical examination of knee extension. Three free flaps were re-explored because of venous thrombosis, one of them necrosed. No functional impairment was found. The result was evaluated by the surgeon as good or very good in 11 cases, fair for one case, "bad" in the case were the flap was lost. The results of the reconstructive procedure using the anterolateral thigh flap are satisfying. This flap is reliable if the surgical technique is strictly applied.

Adult↗
PubMed2006

Retroperitoneal false aneurysm presenting as anterior thigh pain and weakness: a case report.

This case highlights the importance of considering retroperitoneal pathology in the differential diagnosis of anterior thigh pain and weakness. We describe a woman in her mid seventies with a history of a left total hip arthroplasty and lumbar decompression who presented with left anterior thigh pain and left lower-extremity weakness. A computed tomography scan of the retroperitoneum revealed a mass along the left iliopsoas muscle. An arteriogram revealed a large false aneurysm that communicated with the left common femoral artery. Surgery to resect the aneurysm revealed exposed parts of the hip replacement that may have contributed to the formation of the aneurysm. We concluded that imaging of the retroperitoneum should be considered in any patient presenting with anterior thigh pain and weakness.

Aged↗
PubMed2006

Giant combined microdissected thin thigh perforator flap.

Despite recent advances in reconstructive surgery, extremely wide and thin flap coverage has rarely been reported. Recently, the authors developed a technique for transferring a very wide and thin flap from the thigh area using microdissection. In this procedure, both perforators of the anterolateral thigh flap and the tensor fasciae latae perforator flap were microdissected simultaneously and these two perforator flaps were elevated in combination based on the common pedicle of the vessels. In this report, the detailed technique of the procedure is described along with a discussion of the safety of this giant flap in consideration of 60 clinical experiences of microdissected thin tensor fasciae latae perforator and anterolateral thigh flaps.

Adolescent↗
PubMed2006

The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery.

OBJECTIVE: The experience with 191 flaps from the anterolateral thigh is described with special regard to variations of vascular anatomy and possible flap designs. PATIENTS: Since 1992, 191 flaps from the anterolateral thigh donor site were used in 187 patients. The size of the defects varied from 3 x 5 cm to 21 x 10 cm, being located in nearly all areas of the head and neck region including the skull base. METHODS: The functional and aesthetic outcome was routinely evaluated during follow-up of the patients. All complications and secondary procedures were documented during the whole follow-up period ranging from 4 weeks to 11.2 years. RESULTS: Six different patterns of variations were observed concerning the flap pedicle, but none of these resulted in failure of flap raising except for two patients, in whom no perforators could be found. Poor functional results were observed in 17 patients, and debulking procedures or scar revisions were carried out in 58 of the 187 patients. Nine flap types reaching from voluminous and large myocutaneous flaps to ultra-thin cutaneous perforator flaps were used, enabling closure of virtually any type of soft tissue defect. Twelve flaps were lost, resulting in a success rate of 93.7%. CONCLUSION: Due to the combined advantages of minimal donor site morbidity, the option of simultaneous flaps and the satisfying results, the anterolateral thigh can be considered a universal donor site which is ideally suited for soft tissue reconstruction in cranio-maxillofacial surgery.

Adipose Tissue↗
PubMed2005

Thigh muscle strength and endurance in patients with COPD compared with healthy controls.

The aim of this study was to evaluate thigh muscle strength and endurance in patients with COPD compared with healthy controls. Forty-two patients (26 women; 16 men) with moderate to severe COPD and 53 (29 women; 24 men) age-matched healthy controls participated in the study. The subjects were tested for maximum voluntary contractions (MVC), endurance and fatigue of the thigh muscles on an isokinetic dynamometer (KinCom). Endurance was expressed as the number of attained repetitions of knee extension and muscle fatigue as a fatigue index (FI). MVC in knee extension was 17% lower in female patients (P=0.017) but no difference was found in male patients (P=0.56) compared to controls. MVC in knee flexion was lower both in female (51%) (P<0.001) and male patients (40%) (P<0.001) compared to controls. Both female and male patients had significantly lower muscle endurance compared to controls. Female patients had a higher FI (22.5%) than female controls (10%) (P=0.001) while no difference was found regarding FI between male patients (15%) and male controls (10%) (P=0.103). The level of self-reported everyday physical activity did not differ between groups. The results showed impaired skeletal muscle function in COPD, except for MVC in knee extension in male patients. Female patients seemed to be more prone to decrease in thigh muscle function. More focus on improving muscle strength and muscle endurance should be considered when designing pulmonary rehabilitation programs. Patients with preserved level of physical activity can be included in exercise programs and gender-related differences should be taken into account.

Activities of Daily Living↗
PubMed2005

Detection of muscle calcifications by thigh CT scan in neurocysticercosis patients.

Twenty-five patients with calcified neurocysticercosis (two to four intraparenchymal brain calcifications) were asked to have a non-contrasted computed tomography (CT) scan of the thighs to determine the frequency of muscle calcifications detected by this technique. Thirteen (52%) showed one or more muscle calcifications. The numbers of calcifications in the thighs and the brain were not correlated. Patients with a positive CT scan for muscle calcifications were also examined by X-rays to compare both methods. Only 6 of 13 had visible calcifications on X-ray. Thigh CT scans can demonstrate muscle calcifications in a significant proportion of patients with calcified neurocysticercosis.

Adolescent↗
PubMed1996

Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio.

OBJECTIVE: To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period. DESIGN: Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness. SETTING: University hospital. SUBJECTS: Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization. OUTCOME MEASUREMENTS: Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer. RESULTS: Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05). CONCLUSION: The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.

Adipose Tissue↗
PubMedDate not supplied

Effect of the thigh-cuffs on the carotid artery diameter jugular vein section and facial skin edema: HDT study.

OBJECTIVE: To evaluate the distal arterial, venous and skin changes in a group using thigh cuffs during daytime and in a control group. METHOD: Cardiac, arterial, venous parameters were measured by echography and Doppler. Skin thickness was measured by high frequency echography. RESULTS & DISCUSSION: Head down position induced plasma volume reduction, increased cerebral resistance, reduced lower limb resistance. The jugular vein increased whereas the femoral and popliteal veins decreased. All these changes were already observed in previous HDT. Common carotid diameter decreased, Front head skin thickness increased and Tibial skin thickness decreased. Eight hours with thigh cuffs increased the cardiac and carotid sizes which is in agreement with the plasma volume increase. Conversely they reduced the cerebral vascular resistance, jugular section and front head edema which may explain the sensation of comfort reported by the subjects. At the lower limb level the thigh cuffs restored the skin thickness to pre-HDT level but enlarged markedly the femoral and popliteal veins. HR, BP, CO, TPR did not change.

Bed Rest↗
PubMed2003

Head and neck reconstruction with anterolateral thigh flap.

OBJECTIVE: Our goal was to present our experience with the free anterolateral thigh flap for reconstruction of various cutaneous and mucosal defects of the head and neck. STUDY DESIGN: We conducted a retrospective review of 37 patients who underwent reconstruction between 1994 and 2002. Outcome measures included ethnicity, flap harvest technique, vascular anatomy, flap success, general surgical complications, and donor site morbidity. RESULTS: The majority of our patients were white (n = 33). The size of the 39 free anterolateral thigh flaps varied from 24 to 252 cm(2). There was 1 arterial failure and flap loss (2.6%) and 2 venous occlusions that were both salvaged. The donor site was closed primarily in 37 cases and with a split-thickness skin graft in 2 cases. CONCLUSIONS: This is the first report on using the free anterolateral thigh flap in whites. This free transfer has proved to be a versatile and reliable flap for reconstruction of the head and neck.

Adult↗
PubMed2003

[Uterine liposarcoma invading abdominal wall and inguinal region. Immediate reconstruction using a pedicled anterolateral thigh flap].

The anterolateral thigh flap is a particular flap of the vastus lateralis musculocutaneous flap (perforator flap). This flap was used as a pedicled flap to reconstruct the abdominal wall and to cover the inguinal region following the resection of a voluminous tumor of the womb invading the abdominal wall, the femoral vessels and the skin. The flap included a large facial paddle nourishing a skin island and a little muscle paddle including the perforator vessel. This medially positioned facial paddle allowed to increase the area of useful flap. So it was possible to reconstruct a 10x15 cm abdominal wall defect, and to cover the vascular decking in inguinal region with this only flap. In spite of the harvesting of a small muscular paddle of vastus lateralis (with conservation of the motor nerve) the function of thigh extension has been preserved. Besides the subtlety described to increase the "solid" surface of the fragment, it seems that the anterolateral thigh flap is perfectly useful to cover defects of soft tissues in inguinal region after vascular surgery, indication which was not reported to our knowledge in spite of the high frequency of these losses defects.

Abdominal Wall↗
PubMed1999

Sitting balance II: reach direction and thigh support affect the contribution of the lower limbs when reaching beyond arm's length in sitting.

The effects of reach direction and extent of thigh support on the contribution of the lower limbs during seated reaching were examined. Twelve healthy subjects aged 59-79 years performed self-paced reaching forwards and diagonally to both sides and under three thigh support conditions. Vertical ground reaction forces (GRF) and leg muscle activity were monitored bilaterally. Reach direction affected both the magnitude of peak vertical GRF and the relative distribution of vertical GRF through the feet, demonstrating that the lower limbs work cooperatively to control the motion of the body mass. Extent of thigh support also affected the magnitude of peak vertical GRF through the feet. In addition, the EMG data confirmed the active contribution of the lower limbs when reaching beyond arm's length, with muscles in both lower limbs activated in all trials.

Aged↗