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At least 487 records · Page 27Linked to original sources
PubMed1991

Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases.

Eight patients with an anterior thigh muscle contusion or rupture developed an acute anterior compartment syndrome. All patients had an increased pressure in the quadriceps muscle, ranging between 41 and 80 mm Hg. At fasciotomy, three cases had a hematoma in the rectus femoris and four in the vastus intermedius, and in one case only, edema of the anterior compartment was found. Postoperatively, there was immediate pain relief in all cases, and after about 4 weeks, all patients had normal function. We recommend broad indications for fasciotomy and evacuation of hematoma after thigh muscle contusion or rupture.

Acute Disease↗
PubMed1990

Acute compartment syndrome of the thigh: case report.

Compartment syndrome of the thigh is a recognized, yet uncommon, condition characterized by excessive thigh pain following trauma, especially if accompanied by decreasing neurological function. A case is presented in a patient with a subtrochanteric fracture of the femur due to a gunshot wound. Surgical decompression corrected the problem.

Adult↗
PubMed1996

Proprioceptive mechanisms in the cruciate ligaments: an electromyographic study on reflex activity in the thigh muscles.

The hypothesis of a proprioceptive mechanism arising from mechanoreceptors in the cruciate ligaments and with efferences to the thigh muscles is investigated in an animal model. Electromyographic (EMG) studies of the quadriceps and hamstrings muscles were performed in six sheep anesthetized by intravenous injection of chloralose on applying static and dynamic shear forces to isolated fascicle bundles in the anterior (ACL) and posterior (PCL) cruciate ligaments at 200 to 500 N and 50 to 200 N/sec, respectively. With the help of an external fixator, the knee joint position was varied at 25 to 150 degrees. The relative preload of the anteromedial and posterolateral fascicles in the ACL and the anterior and posterior fascicles in the PCL induced by variation of the joint angle was measured with the help of strain gages. By static and dynamic loading of the anteromedial group of the ACL, EMG activity in the hamstrings increases significantly to 159 +/- 22 and 257 +/- 46 microV seconds, respectively (p < 0.001), with a simultaneous suppression of the quadriceps activity. Static and dynamic loading of the posterolateral ACL group results in a significant excitation of the quadriceps with mean potentials of 142 +/- 29 and 173 +/- 23 microV seconds, respectively (p < 0.001). Mechanical shear applied both to the anterior and posterior fascicles of the PCL induces a significant activation of the ipsilateral quadriceps muscles with a simultaneous inhibition of the hamstrings (p < 0.001). The quality of mechanical loading, i.e., static or dynamic shear, determines the degree of muscular recruitment significantly (p < 0.01). The joint angle contributes to a modulation in the quantitative EMG excitation. Linear regression analysis of the integrated EMG potential values and the amount of passive preload induced by the respective joint position results in a close correlation (r = + 0.78 to + 0.86). The results lead to the conclusion that a proprioceptive mechanism exists that arises from the cruciate ligaments and influences the tone in the thigh muscles. The degree of muscle excitation on mechanical ligament loading is modulated by the amount of preload in the ACL and PCL and the quality of load applied.

Animals↗
PubMed1977

Use of dermal-fat suspension flaps for thigh and buttock lifts.

A new technique for the correction of trochanteric bulges is described. A buried dermal-fat flap is used as a suspensory mechanism to hang the weight of the thigh skin and subcutaneous tissues on the deep fascia, rather than on the upper skin flap. This technique is particularly applicable to patients with asymmetry of the buttocks and thighs as well as those with ptosis of the buttocks. Another advantage is that it creates a new gluteal fold at a predetermined higher level.

Adipose Tissue↗
PubMed1989

A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report.

The blood supply to the skin of the perineum, medial groin, and upper thigh was studied in fresh female cadavers. The pudendal-thigh flap was designed as a result to reconstruct the vagina. The flaps are raised bilaterally in the groin crease just lateral to the labia majora and then are transposed toward the midline and sutured together to form a skin-lined cul-de-sac which opens at the introitus. The technique has been used successfully in three patients to reconstruct the vagina. The first patient, an adult, was reconstructed after total pelvic exenteration for malignancy, while two children had reconstructions for congenital vaginal anomalies. This technique is superior to currently available methods because it is simple and reliable. No stents or dilators are needed. It is safe technique without complications in our hands. The reconstructed vagina has a natural angle for intercourse and is sensate. The donor scars in the groin are well hidden.

Adult↗
PubMed1995

Connected deep femoral and gluteal perforator-based flap for repair of an extensive defect on the posterior thigh.

An island connected "Siamese" deep femoral and gluteal perforator-based flap with double vascular pedicles, the perforators from the deep femoral and superior gluteal arteries, was transferred successfully to repair an extensively large posterior thigh defect in an 84-year-old man. For reconstruction of large, massive defects of the posterior thigh region, this connected "Siamese" flap has the following advantages: (1) the flap and the pedicles are nearest to the defect, (2) the skin territory of the flap is extremely long, (3) the flap elevation is easy, because there are several perforators that can be considered as pedicle candidates in both the deep femoral and the gluteal perforator-based flaps, (4) there is no necessity for positional change to elevate the flap, and (5) no sacrifice of muscles implies little postoperative functional limitation of the donor leg.

Aged↗
PubMed2001

Lateral intermuscular septum of the thigh and short head of the biceps femoris muscle: an anatomic investigation with new clinical applications.

An anatomic study was performed to reappraise the vasculature of the lateral intermuscular septum of the thigh and muscles associated with it using 12 preserved cadaver legs. Several possible new clinical applications of the lateral intermuscular septum and the short head of the biceps femoris were identified as follows: (1) short head of biceps femoris muscle or musculoseptal flap based on the second and/or third profunda perforating vessels, or based on the superior lateral genicular vessels, with or without the iliotibial tract and the deep fascia, and with or without the motor nerve of the short head; (2) transverse extension of the fascial portion of the tensor fasciae latae muscle or musculocutaneous flap to include the lateral intermuscular septum; (3) combination use of items 1 and 2, above; and (4) free septofascial graft using the lateral intermuscular septum and iliotibial tract. It is anticipated that the distally based short head of the biceps femoris muscle flap will be an additional option for repairing defects around the knee, and that a free short head of the biceps femoris muscle flap based on the profunda femoris perforating vessels will be useful in functional reconstruction such as reanimation of the paralyzed face. The lateral intermuscular septum can be incorporated into the short head of biceps femoris muscle flap or into the tensor fasciae latae flap, and it also can be used as a free fascial graft. Functional deficit resulting from harvesting the short head of the biceps femoris and the lateral intermuscular septum is minimal, and donor wound at the lateral lower thigh seems to be acceptable.

Adult↗
PubMed2002

Use of free thin anterolateral thigh flaps combined with cervicoplasty for reconstruction of postburn anterior cervical contractures.

Free thin anterolateral thigh flaps combined with cervicoplasty were used in a series of seven patients undergoing reconstruction for previous burn injury from September of 2000 to May of 2001 at Chang Gung Memorial Hospital. This method uses a suprafascial dissection technique to provide a thin flap to improve cervical contour. Neck contractures had resulted from flame burns in six patients and from a chemical burn in one patient. The mean age was 32.7 years (range, 22 to 45 years). The size of excised scar ranged from 10 x 2 cm to 26 x 5 cm (mean, 19.7 x 3.3 cm). The size of flaps ranged from 11 x 5 cm to 26 x 8 cm (mean, 21.3 x 6.5 cm). Average operative time was 6 hours. Average hospital stay was 10 days. All flaps survived, with one flap sustaining partial marginal loss. The donor site was closed primarily in five cases and by using a split-thickness skin graft in two cases. At a mean follow-up time of 5 months, the functional improvement was measured as follows: a mean increase in extension of 30 degrees (preoperatively, 95 degrees; postoperatively, 125 degrees), a mean increase in rotation of 18 degrees (preoperatively, 59 degrees; postoperatively, 77 degrees), and a mean increase in lateral flexion of 12.5 degrees (preoperatively, 26.5 degrees; postoperatively, 39 degrees). The average cervicomandibular angle was improved by 25 degrees (preoperatively, 145 degrees; postoperatively, 120 degrees). This series demonstrates that the use of free thin anterolateral thigh flaps combined with cervicoplasty provides a one-stage reconstruction with a thin, pliable flap that achieves good cervical contour with low donor-site morbidity.

Adult↗
PubMed1982

Colonic perforation with thigh abscess: an unusual presentation of tuberculous spondylitis.

A 29-year-old woman, admitted with a left thigh abscess, was subsequently found to have tuberculosis of the spine. The disease was complicated by fistulous involvement of the sigmoid colon which led to bowel perforation and dissection of the resulting retroperitoneal abscess into the thigh. The clinical presentation was that of a polymicrobial soft tissue abscess, with the tuberculous etiology delineated only on further evaluation.

Abscess↗
PubMed2004

Wide contoured thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures.

We examined the amount of thigh tourniquet pressure that can be reduced from the typical 300 to 350 mm Hg by using a new automated plethysmographic limb occlusion pressure measurement technique. We also examined how much pressure could be reduced by using a wide contoured cuff compared with a standard cuff and if limb occlusion and systolic blood pressures were well correlated. Patients having surgery with a thigh tourniquet were randomized into two groups, one group having surgery with a standard cuff and the other with a wide cuff. Pressure was set at the automatically measured limb occlusion pressure plus a safety margin. Systolic blood pressure and quality of the bloodless field were recorded. The standard cuff maintained an acceptable bloodless field for 18 of 20 patients at an average pressure of 242 mm Hg, and the wide cuff was acceptable for 19 of 20 patients at an average of 202 mm Hg. One patient in each group had a poor bloodless surgical field at the initial pressure, and one patient in each group had a poor bloodless surgical field after a sharp rise in blood pressure during surgery. Systolic blood pressure was not correlated well enough to limb occlusion pressure to be used alone to set the optimum cuff pressure. The automated limb occlusion pressure technique and the wide contoured cuff reduced average pressure by 33-42% from typical pressures.

Adult↗
PubMed2004

Compartment syndrome of the thigh: an unusual complication after spinal surgery.

Compartment syndrome of the thigh is an uncommon pathology, and its acute presentation after spinal surgery is rare. Because a large muscle mass is involved and systemic manifestations of crush syndrome and altered mental status are present, such abnormalities may lead to a delay in appropriate diagnosis and subsequent treatment. A 56-year-old man who was suspected of having a posterior compartment syndrome in the thigh after spinal decompression in the knee-chest position was evaluated clinically and with the use of a catheter for intracompartmental pressure measurement as a tool to help establish the diagnosis and monitor the evolution. Because of sciatic involvement and a demonstrated increase in the pressure in the posterior compartment with myoglobinuria and acute renal failure, prompt longitudinal fasciotomy was performed with excellent neurologic recovery and improvement of both clinical parameters and mental status.

Compartment Syndromes↗
PubMed2003

Muscular atrophy in the hemiplegic thigh in patients after stroke.

OBJECTIVES: This study evaluated muscular atrophy in the hemiplegic limbs by assessing the muscle volume of the thighs in stroke patients. DESIGN: Muscle volume of the bilateral thighs was determined by computed tomographic scanning in 50 hemiplegic patients after stroke. RESULTS: The average muscle volume in the hemiplegic side was significantly lower than that in the nonhemiplegic side. When the patients were divided into the two groups aged <65 yr old and >/=65 yr, age-dependent reduction in the muscle volume was significant only in the nonhemiplegic side. In addition, the ratio of the muscle volume in hemiplegic side to that in non-hemiplegic side was lower in the younger group than in the older group, with close to significance (P = 0.07). Muscle volume in both hemiplegic and nonhemiplegic sides correlated positively with Barthel index and negatively with patient age. CONCLUSION: Muscle volume decreases in the hemiplegic side in stroke patients.

Age Factors↗
PubMed2004

Vascular anatomy of the anterolateral thigh flap.

Arterial and venous anatomy and their relation to the anterolateral thigh flap were examined in 10 specimens of six fresh cadavers in which radiopaque materials were injected into both the arterial and venous systems. Territories and positions of individual perforating arteries were measured, and the venous drainage pathway of the flap was analyzed. All specimens were radiographed stereoscopically to observe the three-dimensional structure of the arteries and veins. The territory of each perforating artery was smaller than expected. Most of the venous blood that had perfused the dermis was considered to pool in a polygonal venous network located in the skin layer and to enter the descending branch of the lateral circumflex femoral artery through large descending veins. The venous territories were considered different from the arterial territories. The findings in this study suggest that the design of the anterolateral thigh flap should be based on the venous architecture rather than on the arterial architecture and that the flap survival rate might be improved if thinning is performed appropriately.

Angiography↗
PubMed2006

Composite anterolateral thigh-fascia lata flap: a good alternative to radial forearm-palmaris longus flap for total lower lip reconstruction.

BACKGROUND: Major defects of the lower lip are challenging to the reconstructive surgeon. The major goals in treating total lower lip defects are reconstruction of the external skin and mucosal lining and maintenance of oral competence and sphincter function. The authors describe reconstruction of total lower lip and larger full-thickness defects including the cheek and commissure by means of a composite anterolateral thigh-fascia lata free flap. METHODS: The flap was harvested with 5-cm fascial extensions at the superior and inferior margins. The flap was folded over the fascia lata to restore the intraoral lining and cover the external skin defect. Fascia lata extensions were divided longitudinally into two fascial strips at both margins of the flap. Two strips were tunneled through the orbicularis muscle in the upper lip and sutured to each other and to the orbicularis muscle. The remaining two strips were anchored to the zygomatic bone periosteum by permanent sutures. This procedure was used in 11 patients. RESULTS: In all cases, disease was advanced squamosus cell carcinoma. The patients' ages ranged from 37 to 72 years. Nine patients had cancer of the lower lip and two patients had a buccal cancer involving the lip. The entire lower lip, bilateral modiolus, and part of the cheek were resected in all patients, and mandibulectomy was performed in three patients. Flap survival was 100 percent. One patient died 10 days after the operation because of cardiopulmonary arrest. At the end of the 1-year follow-up period, all patients had good oral continence at rest and had achieved sufficient oral competence when eating. Eight patients were able to resume a regular diet and two patients could eat a soft diet. CONCLUSIONS: This flap is a good choice for reconstruction of the extensive head and neck defects. We think that anterolateral thigh-fascia lata composite flap has maximum reconstructive capacity and minimal donor-site morbidity. This flap has many advantages over the radial forearm flap and should replace to the composite radial forearm palmaris longus tendon flap when total lower lip reconstruction is concerned.

Adult↗
PubMed2003

Reconstruction of an extensive thigh defect with the paraumbilical TRAM flap.

Reconstruction of extensive defects after radical resection of soft-tissue sarcomas of the extremities has become an essential part of the limb salvage approach to the management of these tumors. The authors describe the successful use of a paraumbilical transverse rectus abdominis musculocutaneous flap with the pedicle based on the inferior epigastric artery for reconstruction of a 24- x 22-cm soft-tissue and skin defect of the anterior thigh after wide local excision of a recurrent malignant fibrous histiocytoma. The ability to mobilize a large amount of well-vascularized soft tissue from an acceptable donor site, the versatility of flap design, the extensive arc of rotation, and the dependability of the inferior epigastric vascular pedicle are all distinct advantages of using this flap in the reconstruction of massive defects of the thigh.

Aged↗
PubMed2004

Lower limb necrosis after use of the anterolateral thigh free flap: is preoperative angiography indicated?

The large and potentially sensate skin territory, the reliability, and the versatility of the anterolateral thigh flap have led to its use for the reconstruction of soft-tissue defects of the head and neck region, extremities, and trunk. Most authors describe the functional disturbances in the donor site as minimal and, to date, no cases of circulatory disturbance of the lower limb as a result of anterolateral thigh flap transplantation have been described. The authors report a patient with partial necrosis of the foot and calf caused by the interruption of the descending branch of the lateral circumflex femoral artery, which acted as a critical collateral for the obstructed superficial femoral artery. Based on their observations of this patient, the authors recommend preoperative angiography of the donor leg in patients in whom palpable popliteal pulsations are lacking. Intraoperatively, the chances of postoperative circulatory disturbance of the lower leg can be decreased by observation of the lower leg circulation after clamping of the flap's pedicle. Immediate arterial reconstruction using a venous graft is to be considered in cases in which the adequacy of circulation is debatable.

Angiography↗
PubMed2006

Use of anterolateral thigh and lateral arm fasciocutaneous free flaps in lateral skull base reconstruction.

Lateral skull base defects following tumor ablation are ideally reconstructed with microvascular free tissue transfer. Although the rectus abdominis free flap is the workhorse in skull base reconstruction, it has a number of drawbacks. Anecdotal reports have indicated that fasciocutaneous free flaps may be useful alternatives in selected cases. Patients undergoing lateral arm (4 cases) or anterolateral thigh (8 cases) fasciocutaneous free flap reconstruction of lateral skull base defects between 1999 and 2005 were therefore reviewed. Twelve consecutive patients (4 males, 8 females) with a mean age of 63 years (range, 39 to 74) underwent such reconstruction following resection of lateral (11 cases) and anterolateral (1 case) skull base lesions. Eight patients had squamous cell carcinoma, 3 had infection or osteoradionecrosis, and 1 had adenoid cystic carcinoma. The duration of surgery (from induction of anesthesia to exit from the operating room) averaged 14.5 hours (range, 10 to 19.5 hours). All donor sites were closed directly. All the flap transfers were successful, with minimal reconstructive and donor site morbidity. During the follow-up period (average, 18 months; range, 2-48 months), 2 patients died of metastatic disease, and another 2 died of other unrelated causes. The remaining 8 patients are alive and disease free. It is concluded that lateral arm and anterolateral thigh fasciocutaneous free flaps should be considered as viable reconstructive options for lateral skull base ablative defects.

Adult↗
PubMed2005

Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap.

Arteriovenous malformations are high flow lesions that remain a challenge in the field of plastic surgery, interventional radiology, and neurosurgery. This is especially true for large lesions requiring a comprehensive team approach. From March 2001 to August 2004, six patients with arteriovenous malformation having extensive involvement of the skin underwent selective embolization followed by resection and reconstruction with anterolateral thigh perforator flap. The age of patients ranged from 22 to 43 years (average, 29 years); four were male and two were female. The size of the defect ranged from 8 x 10 cm to 12 x 14 cm. During the follow-up period from 3 months to 41 months, two patients required ancillary procedures to improve their aesthetic appearances. All patients achieved acceptable contour, appearance, and sensation without any incidence of recurrences. The anterolateral thigh perforator flap provides a large, thin and sensible flap. The anatomy of the flap is relatively constant and reliable. Despite the extensive involvement of arteriovenous malformation of the face, with selective embolization, maximal resection, and coverage with a well-vascularized tissue, it can be safely removed and successfully reconstructed.

Adult↗