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PubMed1994

Comparative study of split thickness skin grafts taken from the scalp and thigh in children.

We compared 29 split thickness skin grafts taken from the thigh (group I) and 37 taken from the scalp (group II). The study was prospective with a follow-up period of 1 year. The average age was 29 months. Included in group I were those children whose parents refused permission for their hair to be shaved and those with burns to the head. We compared ease of technique, percentage of graft accepted, quality of the graft and after-effects of the donor site. Acceptance of the graft was close to 100 per cent in both groups. Harvesting was more difficult from the scalp (P < 0.0001). The quality of the grafts was identical in both groups. After-effects at the donor site were absent in group II and evident in group I (P < 0.0001). There was no alopecia. The scalp represented a better donor site for split-thickness skin grafting than the thigh in the child.

Burns↗

PubMed1992

Subsequently occurring leiomyosarcoma and desmoid tumor of the right thigh.

We present the case of a 44-year-old patient with a primary leiomyosarcoma of the right upper thigh, who developed a second mesenchymal lesion at the same thigh, diagnosed as an extra-abdominal desmoid tumor, some months after surgical treatment of his leiomyosarcoma. Clinically, histomorphologically, DNA cytometrically, immunohistochemically and radiologically the different histogenetic origin of the two lesions could be proven. The patient died 17 months after his first tumor diagnosis of lung metastases of his leiomyosarcoma.

Adult↗

PubMed1999

Liposuction of the thigh.

This article discusses liposuction of the thigh. All aspects of preoperative evaluation, anesthesia, operative technique, and postoperative care are reviewed. Issues relating to safety are emphasized as are aesthetic dimensions of liposuction of the thigh.

Adipose Tissue↗

PubMed1998

Anterior compartment resection of the thigh in soft-tissue sarcomas.

AIMS: Soft-tissue sarcomas of the anterior thigh present technical problems due to the proximity of the femoral vessels, and the disability caused by a standard anterior compartment resection. METHODS: We treated 44 consecutive patients with primary sarcomas in the anterior thigh with wide resection (n = 15), and modified (n = 26) or standard (n = 3) compartment resection. No patient had amputation as primary treatment. RESULTS: The overall rate of local recurrence was 6/44 (14%). Local recurrence was observed in 1/3 patients with standard anterior compartment resection and 5/41 (12%) of those with wide excision or modified compartment resection. It was noted in 1/6 (17%) patients with adjuvant radiation and 5/38 (13%) of those treated with surgery alone. One of six patients with local recurrence required amputation. The 5-year survival rate was 66% varying significantly according to grade. CONCLUSIONS: Limb preservation was possible in 98% of patients. Wide resection or modified compartment resection was feasible in the majority (93%) of patients resulting in improved function.

Adult↗

PubMed1995

An unusual cause of thigh pain after total hip arthroplasty.

The aim of total hip arthroplasty surgery is to relieve pain. There are many postulated causes of thigh pain following total hip arthroplasty, some of which are not easily corrected. Muscle hernia as a result of hip surgery is a cause of thigh pain that is disabling, relatively easy to diagnose, and may be preventable.

Aged↗

PubMed1997

Combined popliteal and posterior cutaneous nerve of the thigh blocks for short saphenous vein stripping in outpatients: an alternative to spinal anesthesia.

STUDY OBJECTIVE: To compare a combination of peripheral nerve blocks with spinal anesthesia in ambulatory patients undergoing short saphenous vein stripping. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 28 ASA physical status l and II ambulatory surgery patients undergoing short saphenous vein stripping. INTERVENTIONS: 14 patients received a popliteal block (sciatic nerve block at the popliteal fossa) using 30 ml of alkalinized 3% chloroprocaine and a posterior cutaneous nerve of the thigh block with 10 ml of 1% lidocaine. The 14 patients who were randomized to the spinal anesthesia group received 65 mg of 5% hyperbaric lidocaine. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in age and gender between the two groups (mean age 53 +/- 13 years, 8 men and 20 women). Patients in the peripheral nerve block group recovered significantly faster in phase 1 of the postanesthesia care unit (PACU) (67 +/- 10 min vs. 122 +/- 50 min, p < 0.01) and were discharged home sooner (222 +/- 53 min vs. 294 +/- 69 min, p < 0.01) than the patients in the spinal anesthesia group. CONCLUSIONS: The combination of popliteal and posterior cutaneous nerve of the thigh blocks provided adequate anesthesia and a faster recovery profile with a similar subjective acceptance of both anesthetic techniques in ambulatory patients undergoing short saphenous vein stripping in the prone position.

Ambulatory Surgical Procedures↗

PubMed2001

Skeletal muscle characteristics, muscle strength and thigh muscle area in patients before and after cardiac transplantation.

BACKGROUND: Patients with chronic heart failure demonstrate several skeletal muscle abnormalities. The underlying mechanisms are unclear. After cardiac transplantation, cardiac function is restored, but exercise capacity is still impaired. AIM: To evaluate the influence of cardiac transplantation on skeletal muscle fibre composition, fibre area and capillarization as well as muscle enzymes, lactate, thigh muscle area and strength. METHODS: Ten patients were longitudinally investigated before, 1-3 and 6-9 months after transplantation. Ten healthy individuals served as controls. A biopsy from the lateral vastus muscle was obtained and the thigh muscle area was measured with computed tomography. Muscle strength in the knee extensors and exercise capacity were also evaluated. RESULTS: Muscle lactate was elevated in patients vs. controls (3.6+/-3.0 vs. 1.5+/-0.7 mmol/kg wet wt., P=0.037), and decreased to normal (1.4+/-0.3 mmol/kg wet wt., P=0.038) after transplantation. Citrate synthase activity was decreased in patients (5.6+/-1.5 micromol/g wet wt./min) vs. controls (8.1+/-1.6 micromol/g wet wt./min, P=0.0018), and did not change post transplantation. Patients had decreased number of capillaries in contact with each fibre vs. controls (2.6+/-0.5 vs. 3.5+/-1.0, P=0.039) which persisted post transplantation. Exercise capacity increased after transplantation (74+/-22 vs. 118+/-26 W, P=0.0002), whereas muscle strength did not improve significantly. CONCLUSION: The persisting intrinsic abnormalities in skeletal muscle after cardiac transplantation may contribute to the impaired exercise capacity observed in cardiac transplant recipients.

Case-Control Studies↗

PubMed2003

Unknown AV-fistula as reason for post-traumatic hematoma of the thigh.

A case is reported of a 28-year-old patient with gradually developing massive swelling of the right thigh after sustaining a blunt trauma. 3 1/2 months after the injury, surgery was performed because of a persisting tumor at the thigh. Intraoperatively, massive bleeding occurred, the bleeding vessel was sutured. Postoperative angiography disclosed arteriovenous (av) fistulae from the internal iliacal artery to a gluteal vein as source for the bleeding. The feeding artery was closed by coiling, the patient recovered completely. To the authors' knowledge, development of an av-fistula following blunt trauma has not been described previously. Similarly, the differential diagnosis of a posttraumatic bleeding of a congenital av-malformation was not yet reported. The authors emphasize, that prior to the surgery of inadequately behaving hematomas, an angiography should be performed.

Adult↗

PubMed1999

Spectral analysis of heart rate variability and pulmonary responses to topical applications of 2% aminophylline-based thigh cream.

OBJECTIVE: Noninvasive assessment of the immediate and delayed cardiopulmonary response to a 2% aminophylline-based topical thigh reducing cream. DESIGN: Prospective, double-blind, randomized, counterbalanced study with application of: no cream (NC), placebo cream (PC) or 2% aminophylline cream (AC). SUBJECTS: Nine healthy women (aged: 23+/-3 y; weight: 58+/-3 kg; height: 165+/-7 cm; body fat: 19+/-6%; estimated maximal aerobic fitness VO2max): 40+/-4 ml/kg/min). MEASUREMENTS: Medical history, skin patch test, skinfolds, YMCA submaximal cycle ergometry test, psychological evaluations (POMS and Speilberger STAI-1). Pulmonary function and spectral analysis on heart rate variability, measured immediately post-and 4 h post-treatment, on three separate days within a three-week period. RESULTS: Pulmonary function did not change. The averaged R-R interval (ms) was significantly lower for the immediate post AC treatment, but returned to baseline in 4 h. CONCLUSION: Application of a 2% aminophylline-based thigh cream does not affect pulmonary function, however, it may cause a temporary, transient reduction in the averaged R-R interval.

Administration, Cutaneous↗

PubMed2000

Klippel-Trenaunay-Weber syndrome presenting as massive lymphangiohemangioma of the thigh: prenatal diagnosis.

We report a case of Klippel-Trenaunay-Weber syndrome presenting prenatally as a massive congenital lymphangiohemangioma of the thigh. Routine ultrasonographic examination revealed multiple distorted cystic areas extending from the right flank through the right lower extremity of a 30-week fetus. A diagnosis of cystic lymphangioma of the thigh was suspected prenatally. Neonatal evaluation confirmed the prenatal findings. Neonatal color Doppler imaging revealed blood vessels within the tumor. The differential diagnosis is discussed together with available therapeutic procedures.

Adult↗

PubMed2002

Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles.

Neurolytic blockade is one of the therapeutic possibilities to treat spasticity of various muscles. In patients with spasticity of the adductor thigh muscles, a percutaneous approach to the obturator nerve is often difficult. We describe a new approach to the obturator nerve and we examine its feasibility. The second objective was to assess the efficacy of obturator neurolysis for the management of adductor thigh muscle pain and spasticity associated with hemiplegia or paraplegia. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Neurolysis was performed by injection of 65% ethanol. We performed 27 blocks in 23 patients. Technical evaluation was achieved in terms of number of attempted needle insertions, time to accurate location of the nerve and success rate. The efficacy of the block was assessed using four scores: degree of alleviation of muscle spasm and triple flexion of the lower limb, improvement of gait and facilitation of hygienic care. Success rate of the technique was 100% with a time to accurate nerve location of 130+/-35 s. Compared with scores measured immediately before the block, all studied parameters were significantly improved. Efficiency was significant on adductor muscle spasticity (p<0.001 at 1 day and p<0.01 at 60 and 120 months). Triple flexion was also significantly improved (p<0.05 from 1 to 120 days), as well as gait (p<0.02) and hygiene (p<0.01) scores. No complications occurred. The combined approach of the obturator nerve represents a new technique which proved to be accurate, fast, simple, highly successful and reproducible. Obturator neurolysis was confirmed as an efficient and cost-effective technique to reduce adductor muscle spasm and related pain and to improve gait and hygienic care in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurone.

Adult↗

PubMed2000

The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction.

In search of an alternative soft tissue free flap donor site to radial forearm flap and rectus abdominis flap in head and neck reconstruction, we used the anterolateral thigh flap for reconstruction of various defects in the head and neck in 59 patients. The aim was to demonstrate the versatility of this donor site and propose a new approach to achieve a safer flap dissection. With the exception of three cases, all defects resulted from excision of malignant tumours. The defects were categorised as full thickness defects of the mandible (33.9%), full thickness defects of the cheek (52.5%) and others (13.6%). During the flap dissection a direct septocutaneous pedicle was observed in 12% of the cases. In the remaining cases there were only musculocutaneous perforators and the flaps were raised either as a split vastus lateralis musculocutaneous flap (72%) or as a perforator flap (16%), depending on the required thickness. Total flap survival was 96.7% with one total and one partial failure and two re-explorations (3.3%). The mean follow-up time was 7.1 months (range: 1-12 months). In conclusion, the anterolateral thigh flap is a versatile and dependable flap that can be adapted to any type of defect by modifying the flap design and composition. It should be considered to be a musculocutaneous flap of the vastus lateralis muscle that can also be raised as a perforator flap. When harvested and used in this context, the flap dissection becomes very safe and consistent, nullifying the only major disadvantage associated with this donor site.

Adolescent↗

PubMedDate not supplied

[Blood pressure difference between upper arm and thigh, and aortic stiffness in healthy subjects and in patients after coarcectomy].

BACKGROUND: The blood pressure difference between the right arm and the legs is often used as an estimate of a possible gradient across a coarctation or recoarctation aortae. We wanted to test the reliability of this hypotheses while estimating the local stiffness of the aortae ascendens and abdominalis. PATIENTS: We examined 50 healthy children and adolescents as well as 50 patients of a similar age after repair of an coarctation aortae. There was no relevant recoarctation on echocardiography or magnet resonance tomography. METHODS: We measured in all patients the blood pressure by oscillometry three times on the right upper arm and thigh. At the same time we measured the systolic and diastolic diameter of the aorta before the branching of the truncus brachiocephalicus and the branching of the truncus coeliacus. The local stiffness was calculated, using the stiffness index b, from the aortic diameter and the corresponding blood pressure. RESULTS: The systolic blood pressure difference showed in healthy subjects and patients after coarctation a wide range (about 60 mm Hg). The diastolic and mean blood pressure showed a slightly smaller range. There was no significant difference in this respect between the two groups. The stiffness index beta was elevated after coarcectomy in the aorta ascendens compared to healthy subjects. The local stiffness of the abdominal aortae were similar in both groups and showed a similar increase with advancing age. DISCUSSION: The blood pressure difference between the upper arm and thigh showed a wide range. Therefore is the blood pressure difference an unreliable tool to estimate the severity of a re-coarctation. The local stiffness of the aorta ascendens was elevated after coarctation and implied at least a partial loss of the Windkessel. The local stiffness in the aorta abdominalis was normal after coarctation repair.

Adolescent↗

PubMed2003

Versatile anterolateral thigh perforator flap: case of tailored reconstruction for a large temporal and parotidectomy defect.

Perforator flaps have introduced an advance in microsurgical reconstruction, by allowing the design of flaps that are tailored for a specific defect. In this report, the reconstructive technique in a case of temporal squamous-cell carcinoma is presented as an example of this trend. Following wide resection of the skin tumor, superficial parotidectomy was performed as a part of the lymph-node dissection. An anterolateral thigh perforator flap was harvested, including a segment of the vastus lateralis muscle in connection with the skin perforators, to reconstruct both the skin defect and the parotidectomy-related soft-tissue deficit. The muscle segment was reinnervated by the greater auricular nerve to diminish atrophy. The aesthetic result was satisfactory. Minor's starch-iodine test demonstrated prevention of Frey's syndrome. The anterolateral thigh flap is a versatile donor that allows individual variations in design for custom-made flaps.

Carcinoma, Squamous Cell↗

PubMed2005

Patient-reported donor-site morbidity following anterolateral thigh free flaps.

This study evaluated donor-site morbidity (retrospective chart review and followup questionnaire) in patients following reconstruction using an anterolateral thigh free flap. Twenty-one flaps were performed in 20 consecutive patients (mean age: 45.0 +/- 3.8 years). Primary wound closure was obtained in 52.4 percent. The perforators were intramuscular in 68 percent and septocutaneous in 32 percent. The early complications included infection (n = 2), wound dehiscence (n = 2), delayed healing (n = 8), and seroma (n = 1). Wound healing took 4.5 +/- 0.7 weeks, and leg weakness resolved completely (n = 13) by 6.6 +/- 2.0 weeks. More chronic complications (n = 19) included weakness (n = 5), pain/tightness (n = 6), contour deformity (n = 14), muscle herniation (n = 6), and unsatisfactory scar appearance (n = 6). No statistically significant differences existed in aesthetics or healing between wound-closure groups, nor in pain or weakness between perforator groups. Pain and weakness were significantly related to sacrifice of the deep fascia from the thigh through its elevation in the flap.

Adult↗

PubMed2006

Free anterolateral thigh flap for reconstruction of major craniofacial defects.

Free-tissue transfer has revolutionized skull-base surgery by expanding the ability to perform cranial base resection and by improving the quality of reconstruction. The anterolateral thigh flap has come recently into use in the field of head and neck reconstruction. Its role in craniofacial and midface reconstruction has not been specifically defined. This study involved a total of 18 patients who were treated over a 5-year period from 1998 to 2003. Seventeen patients had locally advanced head and neck cancer, requiring craniofacial resection, and one patient had a complicated gun shot wound of the forehead. Thirteen patients were treated at the National Cancer Institute, Cairo University, Egypt, and five patients at the University of Miami, Florida. The patients presented with defects of the anterior skull base (5), lateral skull base (3), scalp and calvarium (3), and the midface (7). The anterolateral thigh flap was used as a myocutaneous flap in 11 cases and as a perforator fasciocutaneous flap in seven cases. Musculocutaneous perforators supplied the majority of flaps (17/18). Total flap survival occurred in 17 cases; one patient developed complete flap necrosis. The most commonly used recipient vessels were the facial vessels and the external jugular vein. Major complications included one case with meningitis; the patient died after failure of treatment. Another patient died 6 weeks postoperatively from pulmonary embolism. One patient developed CSF leak that stopped spontaneously. In addition, two patients developed minor wound dehiscence that healed spontaneously. The donor-site wound healed without problems except in two cases. One patient had an incomplete take of the skin graft; the other developed wound infection and superficial sloughing. Both wounds healed spontaneously. In addition to the feasibility of simultaneous flap harvesting with tumor resection, the flap's advantage in skull base reconstruction is its reliable blood supply, which can provide adequate dural cover and protection of the brain. Its size and moderate thickness are suitable for reconstruction of scalp and calvarial defects. The abundance of reliably vascularized fat in the flap may be an advantage in long-term maintenance of the volume of the flap in midface reconstruction. Similar to other soft tissue flaps, additional skeletal reconstruction may still be required to achieve an optimal functional and aesthetic result.

Adolescent↗

PubMed1989

Thigh circumference in the detection of intrauterine growth retardation.

Intrauterine growth retardation (IUGR) is associated with an increase in perinatal mortality as well as long-term neurobehavioral morbidity. Despite the increasing sophistication of antenatal fetal assessment, the diagnosis of growth retardation remains difficult. Since the fetal effects of growth inhibition are variable, no one ultrasonic parameter can diagnose with certainty the growth-retarded fetus. The reduction of thigh circumference with IUGR is secondary to the muscle wasting that is characteristic of this disease process. The sensitivity (77.8%) and specificity (75%) of thigh circumference may make it a useful additional sonographic parameter in the evaluation of fetal growth retardation.

Embryonic and Fetal Development↗

PubMed1980

[Longitudinal data of physical growth of healthy children. III. Circumferences of thorax, upper arm, thigh and calf of children aged 2 to 15 years (author's transl)].

From 1968--1978 a longitudinal study was performed concerning development of thorax, upper arm, thigh and calf circumferences in 709 boys and 711 girls 2--15 years old. In boys the mean increase in thoracic circumference amounted to 32.9 cm, in upper are circumference to 8.3 cm, in thigh circumference to 20.6 cm and in calf circumference to 13.0 cm. The corresponding circumferences in girls amounted to 30 cm, 7.9 cm, 22.4 cm and 12.7 cm. In boys the circumferences developed almost linearly until year 15. Girls had the same linear development until year 13. Between years 14 and 15 girls had in increased development of all circumferences studied.

Adolescent↗