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PubMed2005

The venous return simulator: an effective tool for investigating the effects of external compression on the venous hemodynamics--first results after thigh compression.

BACKGROUND: To present a virtual model, the venous return simulator (VRS), designed to compute venous hemodynamic variations when compression is applied to the leg. METHODS: The VRS defines a numerical network of the lower extremity and computes the dynamic variables (flow rate, venous diameter and internal pressure) for a defined external pressure. The VRS was based on physiological data from the literature and clinical studies on healthy subjects. Clinical correlations were required to confirm its validity; for this purpose, we carried out experiments simulating the conditions of a clinical trial, in which the diameter of superficial and deep veins was measured while increasing pressures (20, 40 and 60 mmHg.) were applied to the thighs of patients enduring deep valvular insufficiency and venous ulcers. The diameters and flow rates calculated using our VRS model were compared with the experimental data obtained at the same thigh compression levels. RESULTS: The numerical results of VRS are in good agreement with the clinical data obtained by Duplex, (R2 = 0.96). In accordance with the in vivo measurement the computed results show that only a pressure greater than 40 mmHg is able to reduce the venous diameter at thigh-level, both in the great saphenous vein and in the femoral vein. CONCLUSION: The venous return simulator computes lower limb hemodynamic parameters under static conditions. The good correlation existing between the VRS and the data obtained in a previous clinical study shows that this numerical approach could provide a useful means of predicting the hemodynamic consequences of compression therapy.

Bandages↗

PubMed2002

Paraparesis due to spinal leiomyosarcoma lesion in the thoracic spine accompanied by two leiomyosarcoma lesions in the back and the thigh over an interval of 4 years.

We present an 83-year-old man who developed three different leiomyosarcoma lesions in the thigh, back, and thoracic spine. The pathology of the thigh tumour was pleomorphic leiomyosarcoma. MRI after 4 years showed a vertebral bone lesion associated with spinal cord compression at T7 and a paravertebral mass lesion at T9-T10. Surgical treatment for the spinal lesion which caused paraparesis improved the neurological symptoms. The pathological features of the lesions in the back and spine were identical and rather distinct from those of the previous thigh lesion. Spinal leiomyosarcoma causing paraparesis and the two other with soft-tissue leiomyosarcoma lesions with different pathological features in a single patient over a period of 4 years is an extremely rare occurrence.

Aged↗

PubMed2002

Effects of two electrical stimulation frequencies in thigh muscle after knee surgery.

The purpose of this study was to compare the effects of two protocols of electrical stimulation combined with voluntary contractions on the recovery of thigh muscles after anterior cruciate ligament (ACL) surgery. Ten sportsmen with a mean age of 26 yrs were randomly assigned into two groups: a 80 Hz stimulated group (5 patients) and a 20 Hz stimulated group (5 patients). All patients received electrical stimulation of the quadriceps femoris, five days a week, for 12 weeks, and had a standard program of voluntary contractions. Muscle and fat volumes of the thigh were assessed using MRI before surgery and after 12 weeks of rehabilitation. Quadriceps and hamstring muscle strength were evaluated by isokinetic measurements. Twelve weeks after surgery, the quadriceps peak torque deficit in the operated limb with respect to the non operated limb at 180 degrees /s and 240 degrees /s was significantly (p < 0.05) less in the 20 Hz group than in the 80 Hz group. This difference was not confirmed when comparing the pre-surgery quadriceps peak torque of the operated limb with the post-surgery one. Subcutaneous fat volume was increased for the two groups at the post-surgery test. This increase was significantly (p < 0.05) greater for the 80 Hz group. Thigh muscle volume deficit was not significantly different between the two groups.

Adipose Tissue↗

PubMed2005

Rationale for reconstruction of large scalp defects using the anterolateral thigh flap: structural and aesthetic outcomes.

The advent of free tissue transfer has provided multiple options that allow preservation and maintain both the structural and aesthetic status of the scalp. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Eleven free anterolateral thigh flaps were used to reconstruct soft-tissue defects of different regions of the scalp. Two of these flaps were used for the occipital region, six for temporal regions, two for the frontoparietal midline region, and the remaining flap for a defect of the forehead. The study consisted of 10 males and one female whose ages ranged from 18 to 82 years (mean age: 52.5 years). Six patients had primary or recurrent cancer, four had acute or subacute wounds resulting from trauma or craniotomy, and one had high-tension electrical burn injury. The size of the flaps ranged from 14 to 27 cm in length and from 6 to 18 cm in width. The overall flap success rate was 100%. In two cases, primary thinning of the flap was performed to reconstruct a tissue defect of the temporal region in one patient and a forehead defect in the other. In two patients, the fascial layer of the flap was used as a source for a vascularized fascial flap to cover defects of the dura mater. No secondary corrections, including debulking procedures or scar revision, were necessary. No infections or hematomas were observed. Six cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed directly. No donor-site morbidity was observed. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent flap option for most scalp defects.

Adolescent↗

PubMed1995

Decreased torque and electromyographic activity in the extensor thigh muscles in chondromalacia patellae.

The alterations in thigh muscle properties of chondromalacia patellae patients during isometric and dynamic endurance tests were studied using a variokinetic knee testing system linked to surface EMG. A total of 41 patients (chondromalacia group) with arthroscopically certified chondromalacia of the patella were studied. The control group consisted of 31 healthy adult volunteers with no history of knee pain or trauma. Peak torque values were 21% (p < 0.01) and force output values 25% (p < 0.05) lower on the symptomatic side of the chondromalacia group than in the control group. The decrease in the ratio between integrated EMG (IEMG) and measured force were found in all parts of the quadriceps femoris muscle in patients with chondromalacia of the patella in isometric extension. No change in the normalized IEMG levels of the thigh muscles were found between chondromalacia patients and controls in dynamic endurance test. The severity of the chondromalacia of the patella did not affect the level of electromyographic activation in thigh muscles. The ratio of normalized EMG levels of vastus medialis and vastus lateralis did not differ between the groups. The present study showed that chondromalacia patellae patients have reduced force and electromyographic activation levels of quadriceps femoris muscle. Especially, the explosive strength of the quadriceps femoris muscle is reduced.

Adolescent↗

PubMed1984

Thigh claudication due to profunda femoris artery occlusion.

Thigh claudication is usually caused by aortoiliac occlusive disease. A patient with unilateral thigh claudication and normal femoral pulses was found to have isolated profunda femoris occlusion and was successfully treated by profundaplasty. Although this syndrome is rare, a review of vascular anatomy of the thigh and mechanisms of claudication explains its existence.

Arterial Occlusive Diseases↗

PubMed2003

The thigh extension of the lesser saphenous vein: from Giacomini's observations to ultrasound scan imaging.

BACKGROUND: Giacomini described a vein that now bears his name almost 130 years ago. Subsequent anatomic studies detail his findings but receive inadequate attention in clinical and surgical textbooks. The purpose of this study was to present a summary of the original observations by Giacomini, present our ultrasound scan findings, and review later anatomic, venographic, and ultrasound scan studies. METHODS: The study was a literature review and experience with duplex ultrasound scanning from units in Italy and Australia. RESULTS: Giacomini described a thigh extension from the lesser saphenous vein that passed to join with the greater saphenous vein, which since then bears his name, and described also the other destinations of the thigh extention to deep veins through perforators or an end as multiple tributaries in the superficial tissues or muscles. Duplex ultrasound scanning shows that the vein can be affected by varicose disease with reflux either upwards or downwards in the thigh to the greater or lesser saphenous veins respectively. CONCLUSION: Ultrasound scan imaging has brought the vein of Giacomini from the realm of anatomic dissection to an important structure to be considered in the clinical management of chronic venous disease.

Anatomy↗

PubMed2002

Estimation of thigh muscle and adipose tissue volume using magnetic resonance imaging and anthropometry.

Thigh muscle volume is a useful determinant of functional fitness. However, anthropometric prediction of muscle content is influenced by the variability of adipose tissue accumulation. The aims of this study were to predict thigh muscle and adipose tissue volumes from anthropometry and to assess the validity of the method by examining the various components of the measurements and the assumptions involved. The 19 participants (9 men, 10 women; age 23-49 years) varied in adiposity. They all underwent magnetic resonance imaging (MRI) of the upper leg and the eight men and two women with the lowest adiposity underwent detailed anthropometry involving girths and skinfolds. Using MRI as the reference method, muscle volume was predictedfrom anthropometry using a circular concentric model, and the assumptions inherent in the method were tested further using the MRI data alone. Muscle volume was best predicted by anthropometry in the 10 leanest participants using a five-slice truncated cone model that overestimated the mean MRI value by 30% (R2 = 0.95; standard error of estimate = 288 cm3; P < 0.001). A single skinfold plus girth measurement at the mid-thigh almost matched its predictive ability, but with an increased bias. Measurements of leg circumference by means of the two techniques agreed well. The assumption of a circular cross-section was valid. In contrast, the agreement between skinfold thickness measured by caliper and superficial adipose tissue thickness by MRI was poor, contributing to the scatter of fat and lean area comparisons. An anterior skinfold thickness measurement underestimated the area of superficial adipose tissue at that level, particularly at the most proximal and distal sites. Although these limitations increase the uncertainties of muscle volume determination by anthropometry, they do not prevent its valid prediction in leaner individuals. The prediction of superficial adipose tissue was poorer.

Adipose Tissue↗

PubMed2000

Standardized thigh muscle area measured by computed axial tomography as an alternate muscle mass index for nutritional assessment of hemodialysis patients.

BACKGROUND: Quantification of muscle mass, which represents the largest protein pool in the body, is important for nutritional assessment but is difficult to achieve with conventional methods in hemodialysis patients. OBJECTIVE: We measured the cross-sectional area of the thigh occupied by muscle by using computed tomography and compared this with other muscle mass indicators. DESIGN: Thigh muscle area (TMA) was examined and correlated with creatinine production and various nutritional indexes in 163 patients undergoing hemodialysis. Where appropriate, TMA was expressed relative to bone area in the thigh (TBA) to avoid the influence of body size. RESULTS: TMA was highly correlated with creatinine production as measured in the spent dialysate (r = 0.85, P < 0.001), indicating that TMA substantially reflects total-body muscle mass. TMA standardized for TBA was negatively correlated with age and positively correlated with other nutritional indicators including body weight, body mass index, serum albumin, serum transthyretin, and protein catabolic rate. Multiple regression analysis revealed that of these variables, age, serum albumin, and protein catabolic rate independently predicted TMA standardized for TBA. By using correlations with various nutritional indicators, we concluded that patients with a value <10.0 for TMA standardized for TBA were likely to be malnourished whereas those with a value >13.0 were likely to be well nourished. CONCLUSIONS: These results indicate that TMA standardized for TBA, measured by computed tomography, is a reliable indicator of muscle mass that could be used for nutritional assessment of hemodialysis patients.

Aged↗

PubMed2003

Pharmacodynamic profile of daptomycin against Enterococcus species and methicillin-resistant Staphylococcus aureus in a murine thigh infection model.

OBJECTIVE: To describe the pharmacodynamic profile of daptomycin against methicillin-resistant Staphylococcus aureus (MRSA) and Enterococci species based on bacterial density in an immunocompromised mouse thigh infection model. MATERIALS AND METHODS: The pharmacodynamic (PD) profile of daptomycin was determined against two MRSA, one vancomycin-resistant Enterococcus faecium, and one vancomycin-susceptible Enterococcus faecalis using the immunocompromised murine thigh model. Efficacy was assessed by the change in log10 cfu in thighs after 24 h of drug treatment. RESULTS: Daptomycin produced a maximal kill of 4.5-5 log10 cfu against the MRSA and 1.5-2 log10 for the Enterococcus species. AUC/MIC was the most predictive of the PD parameters. Utilizing MICs determined in serum or broth in the calculation of the PD parameters had minimal effect on this correlation. AUCfree/MICbroth required for static effects with MRSA and Enterococcus species were 12-36 and 5-13, whereas 99% of maximal kill was achieved at ratios of 171-442 and 38-157, respectively. CONCLUSIONS: These data reveal the potent in vivo bactericidal activity of daptomycin against MRSA and Enterococcus species using clinically achievable drug exposures (dose 4-6 mg/kg per day) currently under investigation in man.

Animals↗

PubMed2004

Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients.

BACKGROUND: Arterial calcification is a common problem in patients with chronic kidney disease, and has been associated with adverse clinical outcomes. The goal of the present study was to evaluate whether pelvic artery calcifications are associated with technical failure of arteriovenous thigh grafts in haemodialysis patients. METHODS: From 1 January 1999 to 30 June 2002, thigh grafts were placed in 54 haemodialysis patients who had exhausted all options for permanent vascular access in the upper extremities. Perioperative computed tomography (CT) of the abdomen and pelvis was obtained in 32 of the patients for diagnostic purposes unrelated to vascular access planning. Two radiologists, who were blinded to the graft outcomes, scored the vascular calcifications on CT of the distal aorta, common iliac, external iliac and common femoral arteries on a semi-quantitative 5-point scale. The association between technical graft failure (inability to complete the anastomosis) and the vascular calcification score was analysed. RESULTS: There was a high inter-observer agreement in scoring vascular calcification (kappa = 0.801). Among 26 patients with absent or mild pelvic arterial calcifications (grade 1-2) on CT, none (0%) experienced technical graft failure. In contrast, three of six patients (50%) with moderate to severe calcification (grade 3-5) had technical graft failures (P = 0.004 by Fisher's exact test). The cumulative 1 year graft patency was lower in the group with grade 3-5 calcification (33 vs 81%, P = 0.09). The two groups were similar in age, gender, race, diabetes, duration of dialysis, serum calcium, serum phosphorus and serum parathyroid hormone. CONCLUSION: There is a strong association between pelvic artery calcifications and technical failure of thigh grafts. The presence of moderate to severe vascular calcification is predictive of poor cumulative 1 year graft patency.

Arteries↗

PubMed1979

Medial thigh lift.

Medial thigh ptosis, characterized by rhytidosis and seen commonly from aging and great weight loss, is seldom improved by lateral or posterior thigh lift. A simple procedure has been developed to correct this laxity of the upper, inner thighs. This consists of symmetrical resection of a crescent-shaped segment of skin and subcutaneous tissue having the distribution of an L1 embryological dermatome, just inferior to the inguinal crease. Despite temporary sensory loss and spreading of scars in some patients, the procedure has been gratifying to both patient and surgeon. Patients must be carefully selected, as the procedure does not correct either trochanteric lipodystrophy or ptosis, or lipodystrophy medial to and just superior to the knee.

Female↗

PubMed1994

The random upper posterior thigh fasciocutaneous flap.

A superiorly based random posterior thigh fasciocutaneous flap has evolved as a coexisting variant of the gluteal thigh composite flap, which is frequently important due to commonly encountered vascular anomalies in this region, such as absence of the descending branch of the inferior gluteal artery. This flap is distinguished by its reliance on the longitudinally oriented axis of the fascial plexus of the upper posterior thigh that is serviced predictably by multiple perforators from the cruciate anastomosis. In a series of 8 such flaps used in 7 patients over the past 10 years, only a single major complication has ensued. Therefore, it has proved to be of tremendous value as another simple, rapidly elevated option to close adjacent ischial or trochanteric defects; it supplements the other known flaps needed here because there is always a high risk of pressure sore recurrence. No muscle needs to be sacrificed, making this flap also a reasonable alternative for the ambulatory patient.

Dermatologic Surgical Procedures↗

PubMed1995

Anterolateral thigh free flap.

The descending branch of the lateral femoral circumflex artery is a large-caliber artery that passes obliquely across the upper third of the thigh and descends between the vastus lateralis and rectus femoris muscles. It sends perforators through the septum between these muscles and through the vastus lateralis muscle and supplies a large area of skin on the anterolateral aspect of the thigh. We report our experience with our first 44 consecutive anterolateral thigh flaps, which were used for a variety of soft-tissue deficits. Twenty-five of these flaps were used for lower extremity reconstruction. 10 were used in the upper extremity, and 9 were used in the head and neck. The overall success rate was 96%. Six flaps required reoperation; of these, 2 flaps were lost, one from a venous thrombosis and the other from arterial thrombosis, both of which were in the lower extremity. In approximately one third of cases, the flap was raised as a septofasciocutaneous flap, but in two thirds it was necessary to include a small segment of vastus lateralis muscle as well as fascia with the flap. The flap has been particularly useful for lower extremity reconstruction, and in patients who are not fit for general anesthesia, it is possible to perform the flap transfer with epidural anesthesia. The flap has the advantage of a long vascular pedicle with large-caliber vessels and thus is suitable as a flow-through flap. It may also be sensate and has provided a versatile soft-tissue coverage option with minimal long-term donor-site complications.

Adolescent↗

PubMed2002

Alternative method to improve the repair of the donor site of the anterolateral thigh flap.

The groin flap was designed to improve the conventional repair of the donor site of the anterolateral thigh flap. The modification method was applied successfully to cover the defects of donor sites of anterolateral thigh flaps in five patients. An ideal color match and a stable and completed composition for the donor sites were obtained. Little morbidity of the donor sites occurred. Cosmetic and functional rehabilitations of the donor sites were achieved. These results suggest the potential and novel method to improve the repair of the donor sites of anterolateral thigh flap.

Adolescent↗

PubMed2001

Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure: a single-blind, randomized, controlled trial.

OBJECTIVE: To determine the impact of an 8-wk neuromuscular stimulation program of thigh muscles on strength and cross-sectional area in patients with refractory heart failure listed for transplantation. DESIGN: Forty-two patients with a stable disease course were assigned randomly to a stimulation group (SG) or a control group (CG). The stimulation protocol consisted of biphasic symmetric impulses with a frequency of 50 Hz and an on/off regime of 2/6 sec. RESULTS: Primary outcome measures were isometric and isokinetic thigh muscle strength and muscle cross-sectional area. Our results showed an increase of muscle strength by mean 22.7 for knee extensor and by 35.4 for knee flexor muscles. The CG remained unchanged or decreased by -8.4 in extensor strength. Cross-sectional area increased in the SG by 15.5 and in the CG by 1.7. CONCLUSIONS: Activities of daily living as well as quality of life increased in the SG but not in the CG. Subscales of the SF-36 increased significantly in the SG, especially concerning physical functioning by +7.5 (1.3-30.0), emotional role by +33.3 (0-66.6), and social functioning by +18.8 (0-46.9), all P < 0.05. Neither a change nor a decrease was observed in the CG. Neuromuscular electrical stimulation of thigh muscles in patients with refractory heart failure is effective in increasing muscle strength and bulk and positively affects the perception of quality of life and activities of daily living.

Activities of Daily Living↗

PubMed1992

Anterior compartment syndrome of the thigh in athletes--indications for conservative treatment.

Anterior compartment syndrome of the thigh resulting from blunt contusion without an accompanying fracture is rare. The treatment advocated for it by most authors has been surgical. However, because wound infection rates are high and loss of knee range of motion is frequent, we considered conservative treatment in selected patients. Six athletes who developed an anterior thigh compartment syndrome shortly after sustaining a blunt contusion to the quadriceps with an accompanying massive hematoma were studied prospectively. Tissue pressure, renal function, and creatinine phosphokinase (CPK) levels were closely monitored. Fasciotomy was not performed, despite sustained pressure elevations above 50 mm Hg. Neurologic function was not affected. At follow-up examination 1 year later, no limitation of joint motion nor weakness of the quadriceps were observed. Thus in selected young patients in whom an isolated anterior compartment syndrome of the thigh occurs, conservative treatment yielded results superior to fasciotomy.

Adult↗

PubMed1983

Two new cutaneous free flaps: the medial and lateral thigh flaps.

Two new cutaneous free-flap donor areas are described on the medial and lateral sides of the thigh. The medial thigh flap is supplied by an unnamed artery from the superficial femoral artery and is drained by the accompanying venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve. The lateral thigh flap has its vascular pedicle from the third perforating artery of the profunda femoral artery and its accompanying vein. The lateral femoral cutaneous nerve provides sensation over the area. These flaps provide a large surface area of both skin and subcutaneous tissue without the usual bulk of subcutaneous fat and muscle. Their desirable features include long vascular pedicles with large vessel diameters and potential of being neurovascular flaps with specific sensory nerve supply and predictable anatomy. The principal disadvantage is that the donor site may leave a slight contour defect with primary closure or require grafting when a large flap is taken. We predict that these flaps will become important donor sites for reconstructive problems requiring resurfacing of cutaneous defects in various anatomic areas.

Aged↗