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PubMedDate not supplied

Retroperitoneal perforation of the appendix presenting as right thigh abscess.

A case of retroperitoneal perforation of the appendix presenting with a thigh abscess is described. The patient presented with pyrexia (38 degrees C) and abdominal and right thigh pain. There was tenderness in the right loin. His white blood cell count was 22 x 10(9)/L. An intravenous urogram revealed tapering of the right ureter at the L2/L3 level and suggested an infected obstructive uropathy. The patient failed to respond to drainage and antibiotics, so we performed a computed tomography scan, which showed a retroperitoneal abscess extending to the gluteal region and thigh, with signs of small bowel obstruction. This precipitated surgery. The route of extension of infection was through the sacrosciatic notch, which is considered to be a rare way of spread. The patient made a slow but eventual recovery. The overall mortality of this condition is high, but early recognition of an abdominal source of sepsis with appropriate treatment can improve survival.

Abscess↗

PubMed2002

[Repair of circular cicatricial contracture of the thigh using deep inferior epigastric perforator flap].

OBJECTIVE: To provide an ideal method for repairing the circular cicatricial contracture of thigh. METHODS: Deep inferior epigastric perforator (DIEP) island flaps was elevated based only on the deep inferior epigastric artery and vein and transferred to cover the thigh wound after scar had been resected. RESULTS: Four DIEP island flaps was applied clinically and all flaps survived. The size of the flaps ranged from (8 cm x 28 cm) to (11 cm x 32 cm). Venous return and edema had been obviously improved postoperatively. There was no abdominal weakness and hernia in the donor sites. CONCLUSION: DIEP flap not only retains the advantages of TRAM flap such as good blood supply and rich tissue volume, but also preserves the integrity of the rectus abdominis muscle. DIEP island flap is a good material for repair of the circular cicatricial contracture of the thigh.

Adolescent↗

PubMed2003

[Experience of vaginal reconstruction by using a pudendal-thigh island flaps].

OBJECTIVE: To evaluate a pudendal-thigh island flap for vaginal reconstruction. METHODS: Forty-seven patients with congenital absence of vagina were undergoing the treatment. Based on the pedicle including the posterior labial neurovascular bundle, a pudendal-thigh island flap was designed and raised in the groin crease just lateral to the labia majora under the deep fascia. It was then transferred to the tunnel between the urethra and the anus for reconstruction of the vagina. RESULTS: From May of 1993 to July of 2001, 47 patients were successfully treated for the vaginal reconstruction with the flap. The results were satisfactory without complications. CONCLUSION: The above mentioned technique could be a safe and effect method for vaginal reconstruction with the advantages of reliable blood supply, good sensation and few complications. The areaes with the bilateral pudendal-thigh could be large enongh for the vaginal reconstruction without problem of the donor closure.

Fasciotomy↗

PubMedDate not supplied

Retained surgical sponge in the thigh: report of the third known case in the limb.

We report a retained surgical sponge (gossypiboma) in the thigh, which mimicked a neoplasm. A 25-year-old man, who had a past history of external fixation for femoral shaft fracture, complained of swelling in the left thigh with pain. A radiograph of the thigh showed periosteal reaction. T1-weighted magnetic resonance (MR) images showed a well-defined mass with heterogenous signal intensity, and T2-weighted images showed tortuous lines of low signal intensity within the mass. Surgical excision revealed a retained gauze sponge within the mass. Histopathological examination revealed foreign body reaction related to the retained gauze sponge. Our case, the third to our knowledge of gossypiboma in a limb, demonstrated characteristic MR imaging findings.

Adult↗

PubMed2004

Changes in superficial blood distribution in thigh muscle during LBNP assessed by NIRS.

INTRODUCTION: The present study was designed to determine how superficial blood distributed in the lower limb muscle during graded lower body negative pressure (LBNP). METHODS: Near-infrared spectroscopy (NIRS) was used to evaluate the blood volume change in the thigh muscles of seven volunteers during 35 min graded LBNP (rest, -10, -20, -30, -40, -50 mm Hg, and recovery). RESULTS: Deoxygenated and total hemoglobin (Hb) increased in proportion to the magnitude of LBNP applied to the thigh muscles. Oxygenated Hb rose significantly at -10 mm Hg LBNP, although the increase leveled off during subsequent increments of LBNP. Systolic pressure significantly decreased from 120 mm Hg at rest, to a value of 108 at -50 mm Hg LBNP. In contrast, mean and diastolic pressures were well maintained during graded LBNP. The increased total and deoxygenated Hb might indicate that blood was held in venous space, and the magnitude of rise in blood volume corresponded to the change in LBNP. On the other hand, oxygenated Hb change seems to reflect mainly blood accumulated in arterial space by interacting between mechanical stretch induced by LBNP and vasoconstriction caused by augmented sympathetic nerve activity. CONCLUSION: From these results, blood distribution in thigh muscles was different and was affected by the strength of LBNP. The data assessing oxygenation sites of Hb were found to be useful as indices of estimating superficial blood pooling in the muscle during LBNP.

Adult↗

PubMedDate not supplied

Malignant solitary fibrous tumor of the thigh accompanied by hypoglycemic coma. A case report.

A case of malignant solitary fibrous tumor of the thigh with liver and lung metastasis, suspicious of non-islet cell tumor-associated hypoglycemia is reported. The patient, a 76-year-old woman, was initially aware of an increasing soft tissue tumor in the left thigh, and episodes of hypoglycemia gradually developed. These frequent episodes ceased after resection of the thigh tumor, which was diagnosed as malignant solitary fibrous tumor. Considering that (i) the primary lesion developed in a rare site, (ii) the tumor was a malignant variant (accompanied by liver and lung metastasis), and (iii) the lesion was accompanied by typical hypoglycemic episodes, this case seemed to be extremely rare.

Aged↗

PubMedDate not supplied

Intra abdominal abscess presenting as a thigh abscess.

Secondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitis.

Abdominal Abscess↗

PubMed2006

[Clinical applications of anterolateral thigh flap].

OBJECTIVE: To discuss different applications of anterolateral thigh flap in repairing large skin-soft tissue defects. METHODS: From January 1997 to July 2004, 27 patients with large-complex tissue defects were treated using anterolateral thigh flap. The tissue defect was located at face in 9 cases, at cervix in 4 cases, at lower limbs in 6 cases, at vulvae in 4 cases, at hip in 1 case, at groin in 1 case and at breast tissue in 2 cases. The defect area was from 9 cm X 8 cm to 20 cm X 15 cm and the flap was harvested from 10 cm X 8 cm to 33 cm X 15 cm. RESULTS: Flaps survived in 26 cases after operation, and patients were satisfied with local function and appearance; flap necrosis occurred only in 1 case, and the defect was covered with free skin graft after dress exchanges. Twenty-three cases were followed up from 3 months to 2 years. The appearance and the sense of recipient site were similar to the adjacent tissue. No obvious malformation of the donor site was observed. No local recurrence was found in the 6 cases of malignancy during the follow-up from 6 months to 15 months. CONCLUSION: Anterolateral thigh skin flap can provide enough tissue to repair large skin-soft tissue defect, and can be used in different ways. So anterolateral femoral skin flap is an ideal flap in repairing large skin-soft tissue defect.

Fascia↗

PubMedDate not supplied

Primary hydatid cyst of the thigh.

Echinococcosis of the musculoskeletal system is found in 0,5-4% of the patients suffering from hydatid disease. We describe a case of primary hydatid cyst of the posterior thigh in a 73 year-old woman, who presented with a painless mass. The diagnosis was set intraoperatively after biopsy of the cyst wall. A wide excision of the cyst with part of the attached muscles was performed. The postoperative course of the patient was uneventful. A postoperative CT-scan of the thorax and abdomen revealed no signs of other echinococcal cysts. Thus, the case was considered as a primary hydatid cyst of the thigh. The patient received adjuvant oral treatment with albendazole for six months. The patient remains in good general condition and without any signs of recurrence, one year after the operation. Hydatid disease should be considered in the differential diagnosis of any cystic mass detected in the thigh, especially if occurs in regions where the disease in endemic.

Aged↗

PubMed1991

Morphometry of the human thigh muscles. A comparison between anatomical sections and computer tomographic and magnetic resonance images.

The present study examined the relative accuracy and precision of MR and CT procedures for determining the CSA of individual muscles from the human thigh. Serial AN, CT and MR cross-sections were obtained from three cadaveric lower limbs. The MR measurements provided accurate and precise values for the CSAs of most thigh muscles, generally within +/- 7.5% of the AN standard. In contrast, CT tended systematically to overestimate the AN CSA by 10-20%. Retest procedures indicated that highly reliable measurements could be obtained from both MR and CT images. However, subjective interpretations of boundaries between closely apposed muscle bellies, particularly for muscles with more than one head, were necessary for resolving entities in the imaging records and this decreased the relative accuracy of MR and CT measures. Interestingly, MR records demonstrated an incomplete septum between vastus lateralis and vastus intermedius more prominently than AN cross-sections. The novel cross-validation procedures used in this study also highlighted several system-based errors in the MR records that, if undetected and left uncorrected, would have seriously biased the morphometric data obtained with this technique. In general, MR provides high resolution images of the human thigh muscles which may be used to obtain valid measures of the CSA of these structures.

Cadaver↗

PubMed1990

[Reversed anterolateral thigh island flap and myocutaneous flap transplantation].

The blood supply of free anterolateral thigh flap and myocutaneous flap comes from the descending branch of the lateral femoral circumflex artery. On the basis of anatomical data, the descending branch coincides with the lateral superior genicular artery. Therefore, the authors suggested reversed anterolateral thigh island flap and myocutaneous flap transplantation. The blood supply of the reversed island flap, is from the lateral superior genicular artery. The flap seemed to have a constant vascular anatomy with a long pedicle and a large diameter, so that dissection of the flap can be accomplished easily. Moreover, donor defects were usually closed primarily without the need of skin-grafting. Since 1985, 4 cases of soft tissue defect around the knee joint have been repaired with reversed anterolateral thigh island flap and myocutaneous flap. All flaps survived completely and obtained satisfactory results. In this paper, the anatomy, design and operative technique of the flap are discussed.

Adolescent↗

PubMed1986

[Adult T cell leukemia accompanied by marked swelling of the left thigh].

A patient with adult T cell leukemia (ATL) whose chief complaint was marked swelling of left thigh is reported. A 72-year-old woman was diagnosed as having ATL based on a high titer of anti-ATLA antibody and abnormal lymphocytes with convoluted nuclei. Computed tomography revealed swelling of her left thigh and a large low-attenuation mass in its muscles. Aspirate from her thigh contained many abnormal cells. Though chemotherapy reduced the swelling for two weeks, she had a relapse and died. This is the first case of ATL having such an onset reported in Japan.

Aged↗

PubMed1984

Secondary hip-buttock-thigh plasty.

Correction of sequelae of primary hip-buttock-thigh plasty has become a common challenge in aesthetic plastic surgery. Suggested techniques for dealing with this problem include denuding the skin at the depressed area, pulling thigh flaps upward and outward, using dermal buried flaps, and utilizing liposuction. Liposuction can be used successfully in combination with classic hip-buttock-thigh plasty to enhance the aesthetic result as well as to facilitate the surgical technique.

Adipose Tissue↗

PubMed1983

Thigh muscle strength in below-knee amputees.

The aim of this investigation has been to study the magnitude of the reduction of thigh muscle strength of below-knee amputees and to correlate the strength to the degree of atrophy and to the clinical function. Thirty-two below-knee amputees participated in examinations of the isometric and isokinetic knee extension and flexion strength using an isokinetic dynamometer (Cybex II). The atrophy was evaluated by measuring the mean muscle fibre area on muscle biopsies of the vastus lateralis and the cross-sectional area of the quadriceps and hamstring muscles measured with computed tomography. The isometric and isokinetic knee extension and flexion strength in the amputated leg with and without prosthesis was significantly lower than the strength in the non-amputated leg (p less than 0.01). Knee extension strength was significantly correlated to the mean muscle fibre area of the vastus lateralis. There was no correlation between strength and the cross-sectional area of the quadriceps muscles. There was, however, a significant correlation between the side differences (amputated leg versus non-amputated leg) in isometric knee extension and flexion strength and the side differences in cross-sectional areas. The reduction in isometric and isokinetic knee extension and flexion strength in the amputated leg both with and without prosthesis compared with the non-amputated leg was larger than the reduction in cross-sectional areas of the quadriceps and hamstring muscles and in muscle fibre areas of the vastus lateralis. This indicates that besides muscle atrophy changes in motor unit recruitment pattern may be of importance for the reduction in muscle strength. Isometric and isokinetic knee extension and flexion strength values in the amputated leg with prosthesis were significantly correlated to step length, maximal walking speed and circumference of the thigh. These results indicate that below-knee amputees with a better preserved thigh muscle strength have a good walking capacity.

Adult↗

PubMed1983

[Passage from the thigh to the retroperitoneum through the obturator foramen of an enormous recurrent lipoma].

The authors refer to an enormous lipoma relapsing from the thigh and the retro-peritoneum space which they have observed. Underlying the rarity of the case, they reveal their reasons whereby one must consider the origin of this lipoma the medial region of the thigh, and the foramen obturatorium the passage-way of the same lipoma from the thigh to the retroperitoneum. Furthermore considering the frequent impossibility of complete removal of these extremely developed lipomas rendering a reserved quod vitam prognosis.

Humans↗

PubMed1995

[Non-Hodgkin's lymphoma presenting as a soft tissue tumor in the connective tissue at the thigh].

A 62-year-old man visited our hospital in July 1993, because of a right thigh mass which had grown gradually since two years previously. Physical examination revealed that the mass at the right thigh region, was elastic soft and about 15 x 10 cm in diameter, without regional lymph node swelling. An ultrasound study showed a hypoechogenic and mesh patterned mass. MRI revealed that the tumor was well defined from subcutaneous adipose tissue and skeletal muscle, indicating that it arose in connective tissue. Angiography demonstrated diffuse hypervascularization of the tumor, and Gallium scintigraphy showed remarkable accumulation at the tumor. Serum IgM was increased, which was proven to be an monoclonal hypergammopathy (IgM, lambda). Histological examination of a biopsied specimen obtained from the thigh mass revealed B cell lymphoma, lymphoplasmacytic cell type. The patient achieved a complete remission after surgical treatment following radiation and combination chemotherapy.

Humans↗

PubMed1994

An experience of ischemic limb salvage associated with myositis ossificans of the left thigh.

A case of ischemic limb salvage associated with myositis ossificans of the left thigh in a 66-year-old man was reported. The patient had a medical history of cerebral palsy and a cervical spinal cord injury, and had an operative past history of hip arthroplasty for fracture of the left femoral neck 10 years before. He showed ischemic symptoms such as paleness, coldness, and loss of the left dorsal arterial pulsation in the left toe, and had a rapidly growing mass in the left thigh. Roentgenography and computed tomography showed a mass 10 cm by 10 cm by 8 cm in size with severe calcification in the left quariceps muscle. Occlusion of the left common femoral artery was found in the arteriogram. Surgery was carried out in order to establish an accurate diagnosis and to rescue the left lower limb. The arterial pulsation was recovered as the result of completely resecting the left quariceps muscle tumor. The pathohistological diagnosis was of myositis ossificans in the quariceps muscle of the thigh. Etidronate disodium was administered in order to prevent a recurrence postoperatively. The patient has been well for the 13 months since surgery.

Aged↗

PubMed1993

[The value of bone scintigraphy in thigh pain following cementless hip prosthesis].

Persisting postoperative pain of the thigh is a common problem of cementless hip endoprostheses occurring in about 15-20% of the patients. We performed a comparative study including patients with (n = 40) and without (n = 45) pain of the thigh. 85 cementless porous-coated anatomic (PCA) hip endoprostheses in 74 patients were examined. All patients underwent clinical examination including a standardized questionnaire, x-ray, and 3-phase bone scintigraphy. Slight or moderate 99mTc-MDP uptake in the area of the greater and lesser trochanter as well as at the tip was a common finding in PCA prostheses in patients without pain and was not a sign of loosening of the hip. Radiologically, there was no difference between patients with and without pain. However, persisting pain of the thigh in patients with PCA prosthesis corresponded with an increased uptake at the tip and the medial and lateral femur, not being a sign of loosening even in this group. The special biomechanical conditions of cementless prostheses causing inhomogeneous intraosseous stress distribution are supposed to be the reason for that.

Adult↗