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At least 379 records · Page 21Linked to original sources
PubMed2005

Pharyngoesophageal reconstruction with the anterolateral thigh flap: a clinical and functional outcomes study.

BACKGROUND: Functional outcomes and morbidities of pharyngoesophageal reconstruction have not been satisfactory. The purpose of the present study was to evaluate such outcomes following pharyngoesophageal reconstruction with the anterolateral thigh flap. METHODS: Reconstruction of pharyngoesophageal defects was performed in 41 consecutive patients with the anterolateral thigh flap. There were 31 circumferential and 10 near-circumferential defects. In the initial nine patients, a portion of the flap was externalized for monitoring by deepithelializing a strip of skin at the distal anastomosis. This technique resulted in a 33-percent fistula rate and was thus modified for the subsequent 32 patients, in whom a true end-to-end, spatulated anastomosis was performed. RESULTS: Total flap loss occurred in one patient, and one patient had partial flap necrosis due to ischemic bowel and sepsis. The mean hospital stay was 6.7 +/- 1.9 days. With the modified technique, fistulas occurred in two out of 25 patients (8 percent) and two out of seven patients (29 percent) with circumferential and near-circumferential defects, respectively, for an overall fistula rate of 13 percent. Strictures occurred in three out of 25 (12 percent) of patients with circumferential defects only. Fluent speech was achieved in all 13 patients who had successful tracheoesophageal prosthesis placement. Among the 34 patients available for diet assessment, two patients (6 percent) required partial tube feeding owing to extensive tongue resection; all other patients tolerated a regular (88 percent) or pureed (6 percent) diet. CONCLUSION: The anterolateral thigh flap offers comparable complication rates, superior speech and swallowing functions, minimal donor-site morbidity, a quick recovery, and a short hospital stay.

Aged↗
PubMed2006

Reconstruction of the diabetic foot using the anterolateral thigh perforator flap.

BACKGROUND: The purpose of this study was to evaluate the outcome of the diabetic foot reconstructed with the anterolateral thigh perforator flap. METHODS: This study reviews 71 cases of salvaged diabetic foot over a 52-month period. Patients ranged in age from 33 to 72 years (average, 51 years), with an average follow-up of 11 months. RESULTS: Flaps survived in all but one reconstructed case, resulting in equivocal findings compared with microvascular free tissue transfer of nondiabetic patients. Early complications such as delayed healing with minor wound dehiscence were seen in three cases, and partial flap necrosis was seen in four cases. Patients with chronic infections were controlled without recurrences. During the follow-up, 69 patients achieved full weight bearing, acceptable contour, and quality of gait before diabetic foot complications. However, late complications such as recurrence of ulceration was noted in one patient, who was blind and unable to perform daily inspection of the foot. CONCLUSIONS: The anterolateral thigh perforator flap provides well-vascularized tissue that controls infection, a thin flap that provides one-stage contouring and minimizes shearing, and a skin paddle that resists pressure and improves durability. The flap can also be combined with vastus lateralis muscle to increase bulk and blood supply against large dead spaces and chronic infections. Anterolateral thigh perforator flaps can be used to achieve acceptable function and aesthetic results for diabetic foot reconstruction.

Adult↗
PubMed2006

Pursestring thigh lift: direct approach for a problematic deformity.

Extreme thigh lipodystrophy localized in a "saddlebag" distribution can be difficult to treat with conventional body-lift approaches. We present a case of extreme thigh lipodystrophy treated with suction lipectomy and direct excision of skin and fat. The circular defects were closed with pursestring sutures and yielded a greatly improved contour and minimal iatrogenic deformity or scarring. In properly selected patients, the pursestring thigh-lift can provide a superior esthetic result.

Adult↗
PubMed1974

Immunological responses to Candida albicans. I. Mouse-thigh lesion as a model for experimental candidiasis.

A mouse-thigh lesion model for experimental candidiasis is described. A standard inoculum of 5 x 10(8) yeast cells of Candida albicans, injected into the thigh muscle of C57BL/Ks mice, produced an easily measured thigh lesion that was self-limiting by 4 to 6 weeks, permitting a study of immunological responses to the infection. Examination of the histopathology of the lesion reveals that the cellular infiltrate is predominately granulocytic, and gives little evidence for an active, specific, cell-mediated immune response.

Abscess↗
PubMed1990

Hypoglycemia risk during exercise after intramuscular injection of insulin in thigh in IDDM.

The influence of bicycle exercise (60% of W170 [working capacity at a pulse rate of 170 beats/min]; 40 min) on the absorption of 125I-labeled fast-acting insulin (10 U; Actrapid human insulin) after intramuscular compared with subcutaneous injection in the thigh was studied on 2 consecutive days in 10 insulin-dependent diabetes mellitus (IDDM) patients. Insulin absorption was measured as disappearance of radioactivity (1st-order elimination rate constants) by continuous external monitoring and as appearance of plasma free immunoreactive insulin (IRI). Subcutaneous adipose tissue blood flow (ATBF) and skeletal muscle blood flow (MF) were measured concomitantly in the contralateral thigh with the 133Xe wash-out technique. Plasma glucose was determined intermittently. The rate constant for 125I-insulin increased during exercise from 0.46 +/- 0.08 to 1.17 +/- 0.14%/min after intramuscular injection (P less than 0.001) and from 0.31 +/- 0.05 to 0.45 +/- 0.09%/min (NS) after subcutaneous injection. The rate constant of 125I-insulin from muscle remained elevated during the 80-min recovery period. The peak plasma free-IRI value was 39 mU/L higher, the area under the IRI curve was approximately 80% greater, and the decrease in plasma glucose was approximately 2 mM greater after intramuscular injection. Whereas MF increased fivefold, ATBF did not rise significantly during exercise. The results demonstrate that intramuscular compared with subcutaneous thigh injection of insulin followed by bicycle exercise induces a marked increase in insulin absorption and a substantial fall in plasma glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Effect of sodium lactate on thermal inactivation of Listeria monocytogenes and Salmonella in ground chicken thigh and leg meat.

The effect of sodium lactate on thermal inactivation D- and z-values of Listeria monocytogenes and Salmonella was determined for chicken thigh and leg meat. At 55 to 70 degrees C, the D-value of L. monocytogenes in ground chicken thigh and leg meat with the addition of 4.8% sodium lactate (4.8 g sodium lactate per 100 g of meat) was 53 to 75% higher than that in the meat without sodium lactate. No significant difference was found for the D-values of Salmonella at 55 to 70 degrees C between the meat with and that without sodium lactate (4.8%. wt/wt). The z-values of both L. monocytogenes and Salmonella were not affected by sodium lactate (4.8%). The results from this study are useful for predicting thermal process lethality of L. montocytogenes and Salmonella in formulated chicken thigh and leg meat products.

Animals↗
PubMed2001

Effect of intermittent subdiastolic pressure in thigh cuffs on human arterial baroreflex.

BACKGROUND: We investigated the effects of subdiastolic variations of the pressure inside the thigh cuffs on cardiovascular oscillations and arterial baroreflex sensitivity in humans. METHODS: During 10 min of controlled breathing at low (0.1 Hz) and high (0.25 Hz) frequencies, 30 healthy subjects underwent variations of the pressure inside the thigh cuffs (from 0 to 40 mmHg) at 0.25 and 0.1 Hz respectively; the periods of controlled breathing without cuff pressure modulation were used as a control. The frequency responses of cardiovascular signals were assessed using spectral analysis, and baroreflex sensitivity by the sequence method. RESULTS: Cuff pressure modulation at 0.25 Hz did not affect the RR interval, arterial pressure, or baroreflex sensitivity; at 0.1 Hz it did not change the RR interval and arterial pressure, but engaged (0.76 +/- 0.2 of coherence) and increased the low frequency oscillations of the RR interval (from 5.6 +/- 1 to 6.1 +/- 0.9 ln ms2, p < 0.05) and improved baroreflex sensitivity by 25% (from 14.2 +/- 9 to 17.7 +/- 10 ms/mmHg, p < 0.01). CONCLUSIONS: Subdiastolic thigh cuff pressure modulation at 0.1 Hz improved the low frequency oscillations of heart rate and baroreflex sensitivity. This approach represents a new and simple non-pharmacological strategy for acutely improving baroreflex sensitivity in humans.

Adult↗
PubMed2002

[Anterolateral thigh flap for limb reconstructive surgery: four case reports].

PURPOSE OF THE STUDY: We report four cases of anterolateral thigh flap reconstructions, searching for the different advantages and disadvantages of this type of flap. MATERIAL AND METHOD: A pure skin flap was used to cover tissue loss on the plantar surface of the foot both in weight-bearing and non-weight-bearing zones as well as to cover the dorsal aspect of the first commissura of the hand. A musculocutaneous flap (fragment of the vastus lateralis) was associated with an iliac cancellous graft to treat septic nonunion of the tibia. A composite tendinocutaneous flap (fragment of the iliotibial band) was used to reconstruct extensor tendon and skin loss on the dorsal aspect of the hand. A perforating artery measuring more than 1 mm was used in all cases, but in one flap it was in the position described by Song. Side-to-side anastomosis was used in one case. For three cases, the sutured circumflex artery had the same caliber as the radial artery at the wrist level. In one case the circumflex artery had a diameter greater than the posterior tibial artery. Closure of the donor site was not possible immediately in one case. A thin skin graft was required in three cases. RESULTS: Skin healing after microsurgery was satisfactory in all cases, occurring within the usual delay. Bone healing in the patient with septic nonunion of the tibia was achieved at four months. The flap was reliable. In three cases the skin graft of the donor site only healed partially. DISCUSSION: The advantages of the antero lateral thigh flap are: surgery in the supine position, spinal anesthesia when the recipient site is on the lower limb, flap reliability, use of the flap as a bridging element, use as a composite flap. The disadvantages are: variable position of usable perforants, requirement for wide skin grafts > 6 cm to cover the donor site. CONCLUSION: The antero lateral thigh flap is a reliable flap that can be most useful when a bridging element is required and when the donor site can be closed directly.

Foot↗
PubMed2004

Enhancing circulation to lower limbs during head-down tilt by warming upper body and thighs.

BACKGROUND: Long-duration spaceflight results in deconditioning of the cardiovascular system, loss of fluid volume, bone demineralization, and atrophy of skeletal muscles, particularly affecting the lower limbs. We hypothesized that it is possible to improve blood circulation to the lower extremities in simulated microgravity by forcing the blood to deliver heat to the feet through heating parts of the upper body and thighs. METHODS: In Study 1, seven men and four women were assessed in an environmental chamber with head-down tilt (HDT) at 14 degrees, wearing a newly developed shortened multi-compartment liquid cooling/warming garment (SLCWG) with local tubing networks covering parts of the head, torso, thigh, arms, and hands, with fingers, lower leg, and feet exposed. Study 2 was the same as Study 1 with a new cohort of four men and two women, and the assessment of toe blood perfusion on all subjects. Heat was applied as follows: Stage 1--SLCWG inlet water temperature 33 degrees C to stabilize comfort; Stage 2--inlet water temperature 8-10 degrees C (in combination with HDT) to reach a criterion of 25 degrees C finger temperature (Tfing); and Stage 3--inlet water temperature 45 degrees C to restore Tfing to 33 degrees C. RESULTS: Improvement of foot circulation by delivering more heat to the upper body and thighs was noted; increases in toe temperature (Ttoe) suggest enhanced perfusion. From Stage 2 to 3, there were significant increases in Ttoe (p < 0.05), a significant decrease in diastolic BP (DBP) (p < 0.05), and a significant change across stages in subjective perception of foot comfort (p < 0.001) and foot heat (p < 0.06). Further, toe blood perfusion increased significantly from Stage 2 to 3 (p < 0.05). CONCLUSIONS: Moderate partial heating of the upper body/thighs improved blood circulation in the feet in simulated microgravity by delivering heat to the lower extremities through restriction of heat exchange with the environment in the heated body parts. This technique could serve as a supplemental countermeasure for increasing blood circulation to the lower extremities.

Adult↗
PubMed1993

Sonography of the hip and soft tissues of the thigh in children.

High-resolution real-time sonography (US) has been used for many years in departments of pediatric radiology to image soft tissues and joints in children. The purpose of this study was to review the main indications and results of US in assessing the hip (except for congenital dislocation and subluxation) and the soft tissues of the thigh and groin in children. The technical and anatomical factors relative to the optimal imaging of the hip joint and thigh muscles are also discussed and a variety of conditions considered, ranging from painful hips to soft tissue masses. In conclusion, high-resolution US emerges as a particularly useful tool in the study of children with acute hip pain (hip joint effusion), suspected osteomyelitis (fluid collection around the femoral saft) and various soft tissue of the thigh.

Hip↗
PubMed1983

Gluteal thigh flap in reconstruction of complex pelvic wounds.

Nine flaps for reconstructing pelvic wounds were centered on the posterior portion of the thigh over the inferior gluteal artery and posterior cutaneous nerve of the thighs of seven patients. No flap necrosis occurred and all wounds healed (one hematoma and one partial wound separation). Three patients had radiation wounds and three had immediate reconstruction following tumor resection. This flap represents an important advance in pelvic reconstruction and should be considered the flap of choice for this area. Contributions to the procedure from this series include (1) use in vaginal reconstruction, (2) length of flap extended to the popliteal fossa, and (3) use of an air-fluidized bed for postoperative management.

Aged↗
PubMed1993

Calcific tendinitis in the proximal thigh.

Calcific tendinitis of the proximal thigh is a benign entity that may cause significant pain. It must be distinguished from chronic or malignant disorders, such as arthritis, infection, and soft tissue/cortical neoplasms. Although it may be self-limited, some patients will benefit from medical intervention. In such cases, we recommend computed tomography-guided percutaneous steroid injection. Herein we describe the clinical and radiographic features of calcific tendinitis of the proximal thigh in 5 patients.

Adult↗
PubMed1980

Simultaneous isotope clearance from the muscles of the calf and thigh.

There has been no end to the attempts made to determine the site and severity of arterial lesions in claudicants by the use of non-invasive methods but, so far, their diagnostic value has been limited. A method whose diagnostic accuracy in determining the site and functional severity of the lesions approaches that of arteriography is discussed. The hyperaemic index, which is the ratio of the total excess of blood supply during post-exercise hyperaemia over the maximum hyperaemic flow, has been determined in the thigh and calf simultaneously, by measuring the 99Tcm muscle clearance in 30 limbs of 20 healthy volunteers and 139 limbs of 145 patients with claudication. Lumbar arteriography classified the lesions in all patients as 0-10 per cent, 10-40 per cent, 40-70 per cent and more than 70 per cent stenosis. A bivariate analysis of the hyperamic indices of the thigh and calf determined the site and whether single lesions consisted of a stenosis greater or less than 70 per cent. In limbs with combined aorto-iliac and superficial femoral lesions the values of the hyperaemic indices could determine which of the two lesions was the more severe in addition to whether lesions consisted of a stenosis greater or less than 70 per cent. These findings have been confirmed in a further blind prospective study of 47 limbs in which determination of the site and severity of lesions preceded aortography.

Arterial Occlusive Diseases↗
PubMed2004

Reinnervated anterolateral thigh flap for tongue reconstruction.

BACKGROUND: Total or near-total glossectomy defects are commonly reconstructed with rectus abdominis myocutaneous flaps for coverage. Sensory reinnervation has rarely been performed. METHODS: Thirteen consecutive total or near-total glossectomy reconstructions were performed in a 12-month period with anterolateral thigh flaps with (n = 8) or without (n = 5) sensory reinnervation to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament testing, pain, and temperature testing were performed before and after 12 months of surgery. Speech and swallow functions were assessed with an established grading system. RESULTS: Innervated flaps had superior sensory recovery to noninnervated flaps in all testing modalities. Postoperative radiotherapy may delay sensory recovery. Swallow function was better in the innervated group. Return of sensation also improves overall patient satisfaction. CONCLUSIONS: The reinnervated anterolateral thigh flap is a viable option to reconstruct total or near-total glossectomy defects with good speech and swallow functions.

Aged↗
PubMed1986

Evaluation of fetal thigh circumference measurements: a comparative ultrasound and anatomical study.

This investigation is concerned with establishing the anatomical location of the site proposed for making fetal thigh circumference (ThC) measurements with ultrasound. An evaluation of the accuracy of ultrasonic ThC measurements has also been made. The results of these studies indicate that the change in femur profile (polygonal to oval) used to identify the site of measurement (transition plane) occurs at the junction of the upper and middle thirds of the thigh, at the level of the proximal nutrient foramen of the femur. Ultrasonic ThC measurements are systematically larger (mean: 4.3%; range: 1.3-10.3%) than comparable anatomical measurements. Measurements made within 1-2 cm of the transition plane are quite similar, demonstrating that exact positioning of the plane is not necessary. These results indicate that ThC measurements can be made in a reliable manner and thus could be used to detect changes in soft tissue mass and improve weight estimation procedures.

Female↗
PubMed1986

Fetal thigh circumference: a critical evaluation of its relationship to menstrual age.

To provide standards for evaluating fetal thigh circumference measurements obtained with ultrasound, a study of the growth of this parameter during pregnancy was made. Because of possible sampling problems before 22 weeks (menstrual age), this investigation was limited to the 22-40 week time period. Regression analysis indicated that the optimal model (R2 = 88.9%) for describing thigh circumference (ThC) growth was a power function. ThC variability increased with menstrual age, from 1.3 cm at 22 weeks to 3.1 cm at 40 weeks. These data were used to construct a standard growth curve for the ThC.

Female↗
PubMed1991

Three-dimensional reconstruction and cross-sectional anatomy of the thigh musculature of the developing chick embryo (Gallus gallus).

The technique of graphical reconstruction by orthogonal projection of serial sections is used to generate three-dimensional models of embryonic chick thigh musculature at Hamburger-Hamilton ('51) stages 36 (day 10) and 39 (day 13). Unique and conserved anatomical landmarks are described, which can be used to specify position along the proximo-distal axis of the thigh from cross-sectional appearance. These landmarks provide an important reference for both current and future experimentation in which a precise developmental site must be systematically and repeatedly sampled.

Animals↗