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At least 415 records · Page 23Linked to original sources
PubMed2006

The in-the-crease inferior gluteal artery perforator flap for breast reconstruction.

BACKGROUND: Perforator free flaps harvested from the abdomen or buttock are excellent options for breast reconstruction. They enable the reconstructive surgeon to recreate a breast with skin and fat while leaving muscle at the donor site undisturbed. The gluteal artery perforator free flap using buttock tissue was first introduced by the authors' group in 1993. Of the 279 gluteal artery perforator flaps, the authors have performed for breast reconstruction, 220 have been based on the superior gluteal artery and 59 have been based on the inferior gluteal artery. The authors have found that for some women with excess tissue in the upper buttock and hip area, use of the gluteal artery perforator flap resulted in an improvement at the donor site, whereas for others the aesthetic unit of the buttock was clearly disrupted. Therefore, the authors have recently been placing the scar in the inferior buttock crease to improve donor-site aesthetics. METHODS: The authors have now performed 31 in-the-crease inferior gluteal artery perforator free flaps for breast reconstruction and found that the results are very favorable. RESULTS: The removal of tissue from the inferior buttock results in a tightened, lifted appearance. The resultant scar is well concealed within the infrabuttock crease, and exposure or injury of the sciatic nerve has not occurred. Extended beveling at this site is also possible, with less risk of causing an unsightly depression. The final aesthetic result of the scar lying within the inferior buttock crease is very favorable. All patients report satisfaction with the donor site. Complications included one total flap loss, two reoperations for venous congestion, one hematoma, two cases with delayed wound healing at the recipient site, and one with delayed wound healing at the buttock. CONCLUSION: The in-the-crease inferior gluteal artery perforator flap from the buttock is now the authors' primary alternative to the deep inferior epigastric perforator flap from the abdomen for breast reconstruction.

Adult↗
PubMed1994

Injection granulomas. Intramuscle or intrafat?

OBJECTIVES: Intramuscular injection is a commonly used route of parenteral drug administration. We studied the fat vs muscle location, the depth of calcified buttock granulomas, and the thickness of subcutaneous fat. Data were assessed with respect to the length of a needle commonly used in intramuscular buttock injections. DESIGN: Three hundred thirty-eight sequential pelvic computed tomographic scans were studied. Subcutaneous fat thickness was measured for each patient at the upper outer quadrant of the buttock. The location and depth of each calcified granuloma were also recorded. SETTING: Tertiary care academic teaching hospital. RESULTS: One hundred sixty-four calcified granulomas were found in 67 patients. One hundred fifty-two of these granulomas were in fat and 12 were in muscle; this was statistically significant using a single-sample binomial distribution (P < .001;95% confidence interval, 0.04 to 0.13). The mean (+/- SD) subcutaneous fat thickness at the upper outer quadrant of the buttock was 5.0 +/- 1.9 cm, with female patients having a mean subcutaneous fat thickness of 5.7 +/- 1.8 cm vs 4.4 +/- 1.7 cm for male patients. CONCLUSIONS: The finding that buttock subcutaneous fat thickness exceeds the length of the most commonly used needle for intramuscular buttock injection (3.8 cm), together with the preponderance of calcified granulomas found in the fat of female patients, suggests that the currently used injection technique may not be therapeutically optimal. We suggest that longer needles be used for intramuscular buttock injections in adults.

Adipose Tissue↗
PubMed1997

Comparison of the local tolerability and adhesion of a new matrix system (Menorest) for estradiol delivery with an established transdermal membrane system (Estraderm TTS).

OBJECTIVE: To compare the local tolerability and adhesion of two transdermal systems for estradiol delivery, an established membrane system (Estraderm TTS 50) and a new matrix system (Menorest). METHODS: 275 healthy female subjects participated in this two-centre, open-label, within subject comparative study. Subjects received twice-weekly application of one placebo reservoir to the right abdomen and buttock and one matrix to the left abdomen and buttock for 21 days (wearing 4 patches simultaneously). Skin irritation, pruritus (by direct questioning) and adhesion were assessed at each patch change using rating scales. RESULTS: Overall the two systems showed comparable local tolerability and adhesion assessed by 1590 readings for each system type on buttocks and abdomen. Skin irritation occurred less frequently with Estraderm TTS than Menorest on both buttocks (11.9% vs. 15.9%) and abdomen (13.7% vs. 15.9%). The incidence of pruritus was low for both systems with over 90% of applications on buttocks and 88% on abdomen being associated with no pruritus at all. Mild pruritus was seen slightly more frequently with Estraderm TTS than Menorest on both buttock (4.8% vs. 3.3%) and abdomen (7.8% vs. 2.8%). Similar adhesion was seen for both systems on the buttocks although the incidence of patches falling off was slightly lower with Estraderm TTS compared to Menorest (8.9% vs. 13.1%). On the abdomen the pattern was reversed with slightly better adhesion for Menorest. CONCLUSIONS: The results suggest that there are no significant clinically relevant differences between the local tolerability and adhesion of an established membrane system for estradiol delivery (Estraderm TTS) and a newly introduced matrix system (Menorest).

Abdomen↗
PubMed2004

Management and outcomes in 353 surgically treated sciatic nerve lesions.

OBJECT: This is a retrospective analysis of 353 surgically treated sciatic nerve lesions in which injury mechanisms, location, time to surgical repair, surgical techniques, and functional outcomes are reported. Results are presented to provide guidelines for management of these injuries. METHODS: One hundred seventy-five patients with buttock-level and 178 with thigh-level sciatic nerve injury were surgically treated at the Louisiana State University Health Sciences Center between 1968 and 1999. Buttock-level injury mechanisms included injection in 64 patients, hip fracture/dislocation in 26, contusion in 22, compression in 19, gunshot wound (GSW) in 17, hip arthroplasty in 15, and laceration in 12; at the thigh level, GSW was the cause in 62 patients, femoral fracture in 34, laceration in 32, contusion in 28, compression in 12, and iatrogenic injury in 10. Patients with sciatic nerve divisions in which positive intraoperative nerve action potentials (NAPs) were found underwent neurolysis and attained at least Grade 3 functional outcomes in 108 (87%) of 124 and in 91 (96%) of 95 buttock- and thigh-level tibial divisions, respectively, compared with 84 (71%) of 119 and 75 (79%) of 95, respectively, in the peroneal divisions. For suture repair, recovery to at least Grade 3 occurred in eight (73%) of 11 buttock-level and in 27 (93%) of 29 thigh-level tibial division injuries, and in three (30%) of 10 buttock-level and 20 (69%) of 29 thigh-level peroneal division lesions. For graft repair, good recovery occurred in 21 (62%) of 34 and in 43 (80%) of 54 buttock- and thigh-level tibial divisions, respectively, even in proximal repairs requiring long grafts, and in only nine (24%) of 37 and 22 (45%) of 49 buttock- and thigh-level peroneal division lesions, respectively. CONCLUSIONS: Surgical exploration and neurolysis after positive NAP readings, or repair with sutures or grafts after negative NAP results are worthwhile in selected cases.

Adolescent↗
PubMed1985

Pharmacologic manipulation of the microcirculation in cutaneous and myocutaneous flaps in pigs.

The vascular effects of isoxsuprine, diazoxide, and isoproterenol were studied in arterial buttock flaps and latissimus dorsi myocutaneous flaps in pigs. Capillary blood flow to the skin and muscle of these flaps was measured by the radioactive microsphere (15-mu diameter) technique 6 hours postoperatively under pentobarbital anesthesia. It was observed that isoproterenol, a beta-adrenergic receptor agonist, was not effective in augmentation of skin blood flow in the arterial buttock flaps. However, isoproterenol significantly increased capillary blood flow to the arterialized portion of latissimus dorsi myocutaneous flaps compared with controls. Isoxsuprine and diazoxide (vascular smooth muscle relaxants) significantly (p less than 0.05) increased total capillary blood flow to the skin of arterial buttock flaps and to the skin and muscle of the latissimus dorsi myocutaneous flaps. However, the increase in capillary blood flow occurred mainly in the arterialized portion of these flaps. The capillary blood flow, which was supplied by the small arteries in the distal portion of the arterial buttock and latissimus dorsi flaps, was not increased by treatment with isoxsuprine or diazoxide. Therefore, there was also no increase in the maximum distance of capillary blood flow from the pedicle to the distal end of the flaps. These observations led us to hypothesize that different sizes (diameters) of arteries in the skin and muscle have different reactivity (or sensitivity) to vasodilatory drugs. In the present experiment, the large dominant artery of the arterial buttock and latissimus dorsi flaps responded to isoxsuprine or diazoxide (vascular smooth-muscle relaxants), resulting in an increase in blood supply to the capillaries in the proximal portion of the flaps. On the other hand, the small arteries in the distal portion (random portion) of these flaps were not sensitive to isoxsuprine or diazoxide. Therefore vasodilation did not occur, and there was no increase in blood supply to the capillaries in the distal portion of arterial buttock and latissimus dorsi flaps. This explanation also lent support to our previous report that treatment with isoxsuprine did not augment skin viability in the distal portion of arterial buttock and latissimus dorsi flaps. It is suggested that research in pharmacologic manipulation of skin blood flow and viability in skin flap surgery should emphasize the sensitivity of small arteries to various drug actions.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗