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At least 433 records · Page 24Linked to original sources
PubMed2006

More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap.

For obliterating a dead space, especially deep and slender, it is more challenging for a reconstructive surgeon to design a musculocutaneous flap by conventional technique. Tethering at the midway of a musculocutaneous flap while inset is not unusual, and trimming of excess muscle may jeopardize the perfusion of the skin. Based on the lateral femoral circumflex system (LFCS), introducing a chimeric concept into the reconstruction of these difficult wounds will simplify the flap design and give more degrees of freedom to inset the flap. Technique of intramuscular dissection of perforators is frequently demanded. Vastus lateralis muscle based on the distal runoff of the LFCS can be included with sharp dissection. Using chimeric concept in the application of anterolateral thigh flap, the muscle and skin can be considered as individual units although they base on a single pedicle. The dimension of skin and the volume of muscle can be tailored as adequate as desired. While insetting the flap, the lengthy pedicles distal to the bifurcation enhance a three-dimensional reconstruction without difficulty. Chimeric concept of anterolateral thigh flap affords more degrees of freedom for difficult reconstructions.

Adolescent↗
PubMedDate not supplied

MRI of epithelioid sarcoma of the thigh.

A 31-year-old woman with epithelioid sarcoma of the thigh is presented. The patient had had a progressively growing mass in her left thigh for 4 months. Magnetic resonance imaging (MRI) showed a subcutaneous mass with a central area of hypointensity and serpiginous hyperintensity in the peripheral portion. Such findings have not been reported before. Histologic findings were compatible with epithelioid sarcoma.

Adult↗
PubMed2004

Intensity-modulated radiotherapy for soft tissue sarcoma of the thigh.

PURPOSE: Fracture of the femur is one of the late complications of adjuvant radiotherapy for patients with soft tissue sarcomas of the thigh, who receive external beam irradiation after limb-sparing surgery. When the target volume approximates the femur, it is often inevitable that a large segment of the femur will receive full prescription dose with conventional radiation techniques. We report the dosimetric feasibility of intensity- modulated radiation therapy (IMRT) techniques to achieve adequate target coverage and bone sparing. METHODS AND MATERIALS: Treatment planning was performed using both three-dimensional conformal radiotherapy (3D-CRT) and IMRT techniques for 10 patients with soft tissue sarcoma of the thigh with tumor approaching the femur. None of the patients had bony involvement. For all patients, the gross total volume (GTV) and the femur were contoured. The clinical target volume (CTV) was defined as the GTV with a 1.5-cm margin axially, except at the bone interface where the bone interface was used as CTV if the 1.5-cm axial margin extended beyond the bone interface. In the superior-inferior direction, the CTV margin placed around the GTV varied from 5 to 10 cm. The planning target volume (PTV) was defined as the CTV with 5-mm margin all around. The 3D conformal technique consisted primarily of two to three beams with wedges or partial transmission blocks as compensators. For the IMRT technique, five coplanar beams were used, chosen so as to spare much of the surrounding soft tissue and to clear the other extremity or groin areas. IMRT plans were designed to adequately treat the planning target volume and spare the femur as much as possible. RESULTS: Dose distributions and dose-volume histograms were analyzed. PTV coverage was comparable with both IMRT and 3D-CRT plans. Dose distributions were more conformal with IMRT, however, especially for patients with large variations of contours. The volume of the femur receiving at least full prescription (63 Gy) V100 decreased on average by approximately 57%, from 44.7 +/- 16.8% with 3D-CRT to 18.6 +/- 9.2% with IMRT (p < 0.01). For 3 patients with a GTV surrounding <50% of the circumference of the femur, the reduction in the V100 to the femur ranged from 61% to 79%. The hot spots in the femur, as measured by D05 (the dose encompassing 5% of volume), reduced on average from 67.2 +/- 1.8 Gy with 3D-CRT to 65.0 +/- 1.2 Gy with IMRT (p < 0.01). The mean dose to the femur was on average 38.5 +/- 11.5 Gy with IMRT, compared with 40.9 +/- 12.7 Gy with 3D-CRT. The volume of the surrounding soft tissues, defined as the ipsilateral limb excluding the PTV and the femur, receiving at least prescription dose (63 Gy) was reduced on average by about 78%, from 997 +/- 660 cc with 3D-CRT to 201 +/- 144 cc with IMRT (p < 0.01). The D05 to the surrounding soft tissues was on average 58.7 +/- 4.7 Gy with IMRT, compared to 67.8 +/- 1.3 Gy with 3D-CRT (p < 0.01), a reduction of approximately 13%. The mean dose to the surrounding soft tissues was comparable in both plans. The volume of the skin (from surface to 5 mm depth) receiving prescription dose (63 Gy) declined by roughly 45%, from 115 +/- 40 cc with 3D-CRT to 61 +/- 20 cc with IMRT (p < 0.01), with IMRT providing full skin dose coverage to scars. The hot spots in the skin decreased from 68.0 +/- 1.7 Gy with 3D-CRT to 65.2 +/- 1.2 Gy with IMRT (p < 0.01). The mean dose to the skin lessened from 51.5 +/- 4.7 Gy with 3D- CRT to 44.0 +/- 4.2 Gy with IMRT (p < 0.01), a reduction of 14%. CONCLUSIONS: Intensity-modulated radiation therapy techniques can reduce the dose to the femur without compromising target coverage by achieving concave dose distributions around the interface of the PTV and the femur. At the same time, IMRT can reduce the hot spots significantly in the surrounding soft tissues and skin. Whether such dosimetric improvements can translate into reduction of complications and/or improving local control needs to be investigated.

Femur↗
PubMed2006

Thigh abscess caused by Eikenella corrodens and Streptococcus intermedius: a case report.

A 35-year-old Chinese female has a large thigh abscess without a clear source. No underlying diseases were revealed in the patient. The combination of clindamycin and cefazolin or vancomycin was administered but without a clinical response. Eikenella corrodens and Streptococcus intermedius were isolated from puncture drainage. Then, ceftriaxone was administered and a surgery of incision and further draining was carried. Eventually, the patient recovered. To our knowledge, this is the first case of thigh abscess in a previous healthy adult.

Abscess↗
PubMed2005

Possible generators of retrotrochanteric gluteal and thigh pain: the gemelli-obturator internus complex.

OBJECTIVE: To investigate and correlate the anatomy of the gluteal region with the clinical findings of retrotrochanteric and posterior thigh pain, as seen in clinical chiropractic practice, and describe potential treatment options. METHODS: A descriptive gross anatomic study is correlated to a case presentation of a patient with deep persistent aching pain in the retrotrochanteric region of the left hip and upper posterolateral thigh. RESULTS: The structures that are located in the same location as the retrotrochanteric pain described by the patient are the gemelli-obturator internus muscle complex and associated bursae. CONCLUSIONS: In patients with persistent gluteal and sciatica-like pain, especially when centered in the retrotrochanteric region, the gemelli-obturator internus muscle complex and associated bursae should be considered as a possible source of the pain.

Buttocks↗
PubMed2005

Alterations in thigh subcutaneous adipose tissue gene expression in protease inhibitor-based highly active antiretroviral therapy.

Use of protease inhibitor (PI)-based highly active antiretroviral therapy (HAART) has been associated with altered regional fat distribution, insulin resistance, and dyslipidemias. To assess how PI-based HAART affects adipocyte gene expression in male HIV-1-infected patients, reverse transcription-polymerase chain reaction was used to quantify messenger RNA expression of adipocyte transcription factors and adipocytokines in thigh and abdominal subcutaneous adipose tissue from male (1) HIV-1 seronegative subjects (control, n = 9), (2) asymptomatic treatment-naive HIV-1-infected patients (naive, n = 6), (3) HIV-1-infected patients who were receiving antiretroviral agents but never received PIs (PI naive, n = 5), (4) HIV-1-infected patients who were receiving PI-based HAART (PI, n = 7), and (5) HIV-1-infected patients who discontinued the PI component of their antiviral therapy more than 6 months before enrollment (past PI, n =7). In the PI group, the messenger RNA expression levels of the CCAAT/enhancer-binding protein alpha , leptin, and adiponectin (18%, P < .01; 23%, P < .05; and 13%, P < .05, respectively) were significantly lower than the levels measured in the PI-naive group. These results are consistent with previous studies on the effects of PIs on cultured adipocytes. Prospective longitudinal studies of thigh fat adipose tissue gene expression could provide further insights on the pathogenesis of metabolic complications associated with PI-based HAART.

Abdomen↗
PubMedDate not supplied

Thigh rotation and the anterior approach to the sciatic nerve: a magnetic resonance imaging study.

BACKGROUND AND OBJECTIVES: The anterior approach to the sciatic nerve block may be associated with a high failure rate because the nerve lies posterior to the lesser trochanter of the femur at the level of needle insertion. However, previous work using cadavers demonstrated that internal rotation of the leg renders the nerve more accessible to the anterior approach. METHODS: Ten volunteers consented to undergo magnetic resonance imaging. Markers were placed on the surface where a needle would have been inserted for an anterior approach to the sciatic nerve. Three scans were then performed: the first with both legs in the neutral position, the second with maximal bilateral internal rotation at the hip, and the third with maximal bilateral external rotation at the hip. RESULTS: Examination of the scans by a consultant radiologist showed that, as the thigh is rotated, the number of scans showing an unobstructed needle passage from the skin marker to the sciatic nerve rate increased from 5% in external rotation to 85% in internal rotation. The number of times the needle path passed through femoral neurovascular bundle also fell from 55% in external rotation to 15% in internal rotation. CONCLUSIONS: The results confirm that, as the thigh is moved from an externally to an internally rotated position, the sciatic nerve becomes more accessible by the anterior approach at the level of the lesser trochanter, and the risk of femoral artery or nerve puncture is reduced but not eliminated.

Adult↗
PubMed2005

A comparison of HIFU-induced lesion size measurement based on gross histological examination and image of bovine thigh in vitro.

The aim of this study was to investigate the agreement in HIFU-induced lesion sizes between measurements based on gross histological examination and those from images. Experiments were conducted in an experimental arrangement with a three-way multiscan ultrasonic inspection system and imaging was done by B-mode ultrasound (US). Bovine thigh muscle with and without fascia lata was treated with an in situ spatially averaged focal intensity ranging between 750 W cm(-2) and 1565 W cm(-2) and sonication-time was variable from 8 to 20s. Assessment of the two measurement methods showed a rather weak correlation in the samples without fascia lata. For clarity and convenience in the discussion, sample muscles with and without fascia lata were labeled F and M, respectively. It was difficult to measure the lesion size from ultrasonographic images of F samples, so there was disagreement in the samples with fascia lata. This investigation showed that the presence of fascia lata in bovine thigh muscle has the likely effect of affecting the ultrasound image and makes it difficult to distinguish coagulated tissue from surrounding healthy tissue. There was no significant correlation between ultrasonography and the gross histological findings in M samples. Data supported that at for an in situ spatially averaged focal intensity ranging between 750 W cm(-2) and 1565 W cm(-2) and relatively shorter exposures (sonication-time variable from 1 to 8s) higher correlation between image and gross histology measurement was found in excised bovine muscle specimens.

Animals↗
PubMed2004

Rectovaginal radiation fistula repair using an obturator fasciocutaneous thigh flap.

BACKGROUND: Rectovaginal fistulae are a known complication of pelvic radiotherapy utilizing locally applied isotope implants. Most often, either permanent colostomy or reconstruction with a well-vascularized flap is necessary. Traditional techniques for fistula repair utilize bulky muscle flaps, disfiguring pudendal artery flaps or may require laparotomy. CASE: We describe the management of a 26-year-old woman with a large radiation-induced rectovaginal fistula. A fasciocutaneous medial thigh flap based on terminal branches of the obturator artery and vein was used without colostomy and resulted in pain-free sexual function and minimal vulva disfigurement. CONCLUSION: A medial thigh fasciocutaneous flap without muscle can be transferred into the vagina on the obturator vessels and may become the preferred method for managing large rectovaginal fistulas.

Adenocarcinoma↗
PubMed1997

Advantages of polytetrafluoroethylene arteriovenous loops in the thigh for hemodialysis access.

BACKGROUND: The upper thigh is an alternative but infrequently used site to the forearm for placement of subcutaneous polytetrafluoroethylene (PTFE) arteriovenous conduits in patients requiring hemodialysis for end stage renal failure. This site has the great advantage of easier accessibility for self-cannulation. METHODS: The outcome was reviewed for 74 PTFE loops placed in 61 patients between 1985 and 1991. RESULTS: Mean loop survival time was 99.8 weeks (SD 78.0) when patients with early failure (<1 week), and those patients whose loops functioned adequately until transplantation or death were excluded. Infection occurred in 12 of 74 loops. CONCLUSIONS: Thigh PTFE loops provide satisfactory medium- to long-term vascular access for hemodialysis although, like all other forms of access currently available, they fall short of the ideal for prolonged dialysis.

Arteriovenous Anastomosis↗
PubMed1990

The incidence and sites of medial thigh communicating veins: a phlebographic study.

One hundred saphenograms in 65 patients were reviewed to assess the number and distribution of communicating veins on the medial aspect of the thigh. Sixty-one per cent of the legs had one or more communicating veins in the middle third of the thigh (Hunter's canal), 27% were in the lower third and 1% in the upper third. Eleven per cent of the legs investigated had no evidence of communicating veins. The number of communicating veins ranged from none to three. Because of the range in the number and position of the communicating veins, which are potential sites of venous incompetence, their phelebographic demonstration by varicography is recommended in legs with recurrent varicose veins.

Adult↗
PubMed2003

Creation of a neovagina with use of a pudendal thigh fasciocutaneous flap and restoration of uterovaginal continuity.

OBJECTIVE: To create a neovagina and an endocervival canal in two patients with vaginal aplasia and a functioning uterus. DESIGN: Technique and instrumentations. SETTING: University hospital. PATIENT(S): A 31-year-old woman with vaginal aplasia and a double noncommunicating uterus (classified as Mayer-Rokitansky-Kuster-Hauser syndrome) and a 19-year-old woman with partial vaginal aplasia and a functional uterus. INTERVENTION(S): Creation of a neovagina by using the bilateral pudendal thigh fasciocutaneous flap procedure and laparotomy to establish uterovaginal continuity. MAIN OUTCOME MEASURE(S): Clinical follow-up evaluation of restoration of outflow of menstrual blood and coital satisfaction. RESULT(S): Uterovaginal continuity was established in both patients, resulting in normal menstruation. Granulomatous polyps occurred in one patient, and stenosis at the site of anastomosis occurred in the other patient; these conditions were successfully managed. Unimpeded menstrual flow continued after 1 year of follow-up in one patient and 3 years of follow-up in the other patient. CONCLUSION(S): Bilateral fasciocutaneous pudendal thigh flaps permit vaginal reconstruction and a uterovaginal connection in patients with vaginal agenesis and a functional uterus. The main advantages of this technique are that postoperative dilatation is not necessary, sensation is maintained, and the resulting scar is inconspicuous. The main disadvantage is the presence of some sebaceous vaginal secretion and hair in the vaginal lining; the latter can be managed by preoperative and postoperative laser depilation.

Adult↗
PubMed2003

Anterolateral thigh flap: an ideal soft tissue flap.

Microsurgical reconstruction has evolved to a stage where a nearly 100% success rate has been achieved. Therefore, refinement of the functional and aesthetic result, as well as a decrease in donor site morbidity have become the major concerns. The anterolateral thigh flap meets these requirements; its wide application to various fields is based on the following charateristics. Its reliable vascularity. Its vascular pedicle is long and large, at least 8 cm (can be 20 cm). Flap territory is large and easy to design. The pedicle can be at the periphery of the flap. Its length can be 40 cm and its width can be half of the thigh, with the maximal dimension as large as 40 x 20 cm (800 cm2). Primary trimming of the flap to 3 mm to 5 mm in thickness does not compromise its vascularity. The subcutaneous fat can be included to facilitate gliding of the underlying tendons. To harvest chimeric flaps, the following components can be included: muscles, fascia and bone (an osseous flap can be joined to the flap with microvascular anastomoses). A two-team approach is possible, because the recipient site is usually far away from the donor site. Usually it does not require that the patient change position. It can be closed primarily without skin graft if its width is less than 8 cm. The donor site is easily covered with clothes, and the motor function is least affected. Care should be taken in flap dissection, inset, and postoperative care, as well as strategies for re-exploration.

Head and Neck Neoplasms↗
PubMed2003

The thigh as a model for free style free flaps.

Following a set of principles, free style free flaps may be harvested from any region of the body where a Doppler signal is heard. By using a retrograde dissection technique, the skin vessel is traced through its subfascial course (intramuscular or septocutaneous), until adequate length or vessel size is achieved. If a "free style free flap" is not originally planned, this approach can be usedwhen anatomic variations or unexpected events are encountered. The thigh, a region that is familiar to the surgical team at Chang Gung Memorial Hospital, was chosen as the site to begin exploring this style of flap harvest. Nine flaps were harvested as free style free flaps from the thigh and were used successfully for the reconstruction of complex defects.

Adult↗
PubMedDate not supplied

[Electromagnetic lipolysis and semicircular lipoatrophy of the thighs].

INTRODUCTION: The semicircular lipoatrophy of the thighs is a disorder whose incidence remained rare for years. Only recently, an "epidemic" situation emerged, affecting hundreds of subjects who shared a status of administrative employee. OBSERVATION: The older etiopathogenic hypotheses give way to a newer one implying the electromagnetic fields generated by computers and their wirings. The resulting modifications in the intrinsic bioelectrical properties of the skin could influence the biology of macrophages exhibiting lipophagic activity in the hypodermis. The electroactivation of these cells could lead to TNF-alpha release. DISCUSSION: The semicircular lipoatrophy of the thighs is a problem that may affect an employee out of two. Rather than hoping an efficaceous drug therapy, prevention must be advocated by adapting the work conditions related to the use of computerized devices.

Electromagnetic Fields↗
PubMed2002

Segmentation of fat and muscle from MR images of the thigh by a possibilistic clustering algorithm.

Physical training is proved to induce changes in physical capacity and body composition. We propose in this article a fast, unsupervised and fully three-dimensional automatic method to extract muscle and fat volumes from magnetic resonance images of thighs in order to assess these changes. The technique relies on the use of a fuzzy clustering algorithm and post-processings to accurately process the body composition of thighs. Results are compared on 11 healthy voluntary elderly people with those provided on the same data by a validated method already published, and its reliability is assessed on repeated measures on three subjects. The two methods statistically agree when computing muscle and fat volumes, and clinical implications of this fully automatic method are important for medicine, physical conditioning, weight-loss programs and predictions of optimal body weight.

Algorithms↗
PubMed1998

Lateral thigh flap reconstruction in the head and neck.

The lateral thigh free flap is a fasciocutaneous flap based on the cutaneous perforators of the deep femoral vessels. Although originally described in 1983, it has had very few reports in the literature. This article describes the flap and reports our findings and outcomes in nine cadavers (18 thighs) and 33 clinical cases. The position of the vascular pedicle may vary in each case but has always been found to be present. Successful transfer occurred in 30 of 33 cases. Flap loss was attributable to infection, fistula, and hematoma in three of four cases. The flap was especially useful in large defects, most commonly total and base-of-tongue defects. We have found this flap to be reliable and to result in minimal morbidity.

Cadaver↗
PubMed1983

Perforated cecal carcinoma presenting as thigh emphysema.

Gastrointestinal perforation into the retroperitoneum may present as thigh emphysema. In the elderly, abdominal symptoms may be minimal. We report a patient with a perforated cecal carcinoma presenting as right hip pain with thigh emphysema. A diagnosis of perforated intra-abdominal viscus was suspected from the radiographs. The patient initially did well after surgery, which included a hemicolectomy and debridement of necrotic muscle down to the knee. He later succumbed from cardiac arrest following a dyspneic episode.

Adenocarcinoma↗