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At least 541 records · Page 30Linked to original sources
PubMed1998

The lateral thigh V-Y flap for the repair of ischial defects.

The lateral thigh fasciocutaneous flap described by Maruyama et al in 1984 is a useful method for the repair of ischial and trochanteric defects. We clinically re-evaluated the potential vascular territory of the nutrient artery for this flap, i.e., the first profunda perforator, and have newly designed the postero-lateral thigh V-Y flap in the area including the proximal two-thirds of the posterior thigh. This flap was applied to five difficult or recurrent ischial defects, and satisfactory results were obtained in all cases. For the reconstruction of ischial defects, the postero-lateral thigh V-Y flap has the following advantages; the proximal and well-vascularised portion of the flap is inserted into the area of the previously excised pressure sore, and this flap can potentially be readvanced if a recurrent pressure sore should develop. A Z-plasty can be performed to prevent excessive tension on the skin closure at the junction of the V-Y advancement flap. The postero-lateral thigh V-Y flap can be considered one of the first-line options for both primary and recurrent ischial pressure sores.

Adult↗
PubMed1999

Recurrence rates of ischial sores in para- and tetraplegics treated with hamstring flaps: an 8-year study.

We have collected data on the second follow-up of 27 patients who underwent musculocutaneous flap closure of their ischial pressure sores. Thirty-seven ulcers were operated on between 1988 and 1993 using the V-Y advancement hamstring musculocutaneous island flap. At the initial follow-up (mean = 20 months) in 1993, despite 33% of patients having had recurrent ulcers and 14.8% having undergone re-advancements, only 14% of patients had non-healing ulcers. In 1997, follow-up period ranged from 18 to 90 months, with a mean of 62 months. Four patients were lost to follow-up resulting in 23 patients (n = 23) for the current study. Nine patients were tetraplegic and the remaining 14 were paraplegic. Four of the 23 patients had died at follow-up therefore making the number of living patients 19 (n = 19). The total number of ulcers operated on in the current study was 29 (U = 29). Overall, ulcer and patient recurrence rates were 41.4% and 47.8% respectively. Despite this, 89.5% of patients had intact flaps at the time of follow-up. We recommend the use of the hamstring V-Y musculocutaneous flap as a reliable and safe reconstructive modality in the management of ischial pressure sores and by identifying the group of patients susceptible to ulcer recurrence we have proposed a protocol for their long-term follow-up.

Adolescent↗
PubMed2000

Staging of bone neoplasms: an orthopedic oncologist's perspective.

The process of staging bone tumors is complex. The goal of staging is to define the type of tumor and its extent. Like staging for other neoplasms, it stratifies patients into groups based on prognosis and established treatment protocols. Staging is a multidisciplinary effort involving orthopedic oncologists, musculoskeletal radiologists, and orthopedic pathologists. The diagnosis is often suggested on clinical examination and review of the radiographs. The biopsy usually confirms the clinical and radiographic impression. However, biopsy is difficult and leads to errors in diagnosis in nearly 20% of cases. These errors may make limb salvage impossible and adversely affect survival. For this reason, staging and especially the biopsy should be done in the institution where definitive treatment is planned.

Adult↗
PubMed2002

Reinnervated medial gastrocnemius free flap for closure of a recurrent ischial pressure sore: case report.

A 42-year-old T7 level paraplegic man had undergone multiple local flap transfers for closure of a recurrent left ischial pressure sore. When wound breakdown again occurred and regional flap transfers were no longer a possibility, a medial gastrocnemius free flap was transferred to the ischial region. Reinnervation of this flap was accomplished by interposing a sural nerve graft between a proximal intercostal nerve and the tibial motor nerve branch of the gastrocnemius muscle. Following the return of protective sensation, the patient has developed no new ischial pressure ulcerations.

Accidental Falls↗
PubMed1997

Ischial tuberosity apophysitis and avulsion among athletes.

Ischial tuberosity pain in athletes may be caused by several clinical entities, which include acute and old bony or periosteal avulsions and apophysitis. We studied the natural course of these injuries based on our clinical case series of fourteen patients with apophysitis and twenty-one with avulsion of the ischial tuberosity. Only patients with the diagnosis confirmed by X-ray finding were included. The clinical diagnostic criteria by ischial apophysitis consisted of gradually increasing functional and palpatory pain at the ischial tuberosity without any major trauma at the beginning of the symptoms. Typically there was asymmetry on plain radiographs of the ischial tuberosities in apophysitis; the involved apophyseal area became sclerotic, wider than the non-symptomatic apophysis, osteoporotic patches developed and the lower margin of the ischial tuberosity became irregular. The patients with avulsion reported an acute trauma at the beginning of the symptoms and an avulsion fragment was immediately after injury or later seen in plain radiographs. The mean age of the patients with apophysitis (14.1 yrs) was lower than that of the subjects with avulsions (18.9 yrs). Apophysitis of the ischial tuberosity usually healed well without complications. Avulsions often caused more prolonged pain with referral pain to the posterior parts of the thigh which often required operative interventions. A small bony or periosteal avulsion sometimes grew to a pseudotumor calcification. We recommend conservative treatment as the primary treatment modality for both ischial tuberosity apophysitis and avulsion fractures.

Adolescent↗
PubMed1984

[Computed tomographic control of the conventional x-ray findings in space-occupying lesions of the bony pelvis].

The CT and conventional radiological findings in 30 patients with space-occupying lesions of the pelvic bones were compared. 73% of the tumours diagnosed by CT were shown by conventional means and in 71% their extent was correctly estimated. Lesions at the ilio-sacral junction are not demonstrated as well by conventional methods as those near the hip joint. The lesions most frequently missed by conventional radiography lie in the dorsal part of the ilium and in the lateral mass of the sacrum.

Adolescent↗
PubMed1980

[Compensatory joints at the pelvis (author's transl)].

An osteochondrosis ischio-pubica represents a "testing site" for the integrity of the pelvis not only during child age but in adults as well. If all naturally available compensatory mechanisms have been exhausted especially following a change of range of motion in the pelvis ring structure, fatigue fractures or zones in transformation in the area typical of osteochondrosis ischio-pubica may appear. These fractures or transformation zones respectively to our mind have joint character, because they are capable of temporarily replacing lost mobility of physiological joints. Healing is achieved through rest, muscular balance and a specific physiotherapy. The purpose of this muscular training is to cushion all unphysiological motions in the pelvis and to support and boost the function of those joints still well preserved.

Biomechanical Phenomena↗
PubMed2005

Sensitivity for pressure difference on the ischial tuberosity.

Although research on sitting and sitting postures has been done for decades, the field of the subjective feeling of comfort or discomfort during sitting is still an unexplored field. On the basis of those studies some manufacturers claim enhanced subjective comfort because of pressure-relieving qualities of the seat cushions. The question is: does a relatively small pressure reduction enhance comfort? Before that question can be answered, the sensitivity for pressure differences applied to the skin must first be determined. The aim of this study was therefore, to determine the sensitivity of the ischial tuberosity for pressure difference in a healthy population. For this study five males and five females aged between 19 and 30 years with no exercise-induced muscle ache were selected. The (Deltaa) was determined for which stimulus (a + Deltaa) was judged as exceeding stimulus (a) in 50% of the trials. This value was called (Deltaa0.5) and was determined with an adapted simple up - down method with forced choice. Two different values for (a) were used: (a) = 13.3 kPa and (a) = 26.5 kPa and the pressure was applied with two different contact surface with diameters of 10 mm and 20 mm. For (a) = 26.5 kPa and d = 10 mm a Deltaa0.5 = 2.7 kPa was found. For (a) = 26.5 kPa and d = 20 mm a Deltaa0.5 = 3.5 kPa was found. For (a) = 13.3 kPa and d = 20 mm a Deltaa0.5 = 1.9 kPa was found.

Adult↗
PubMed2002

Sitting pressure and perfusion of buttock skin in paraplegic and tetraplegic patients, and in healthy subjects: a comparative study.

The distribution of sitting pressure and ability to respond with reactive hyperaemia were studied in a group of paraplegic and tetraplegic patients (n = 8) with spinal cord lesions and healthy controls (n = 10) using a pressure sensitive plate and laser Doppler perfusion imager. The results show that the mean sitting pressure of the patients was 9.9 N/cm2 (left) and 11.7 N/cm2 (right) compared with 3.5 N/cm2 (left) and 3.6 N/cm2 (right) in controls. The differences were significant on both the left (p < 0.01) and right (p < 0.05) sides. The maximum pressure in patients was 42.9 N/cm2 (left) and 48.7 N/cm2 (right), and in controls 12.0 N/cm2 (left) and 12.9 (right) (p < 0.01). Both groups showed a reduction in skin perfusion in the seat area during sitting compared with unloaded resting, and in the controls it was significantly increased (p < 0.001 on both sides) during the reactive hyperaemic phase immediately after sitting. Compared with the preload values, the patients showed a similar but slightly weaker picture significant on the right side (p < 0.05), but not on the left. The hyperaemia was not uniformly distributed, but occurred where the pressure was greater than 2 N/cm2. There was no correlation between the amount of reactive hyperaemia and absolute values of sitting pressures. We conclude that tetraplegic and paraplegic patients have significantly higher sitting pressures than normal controls, and that the hyperaemic response in the buttock region in the upright position after pressure load is slightly weaker in the patients, which could be of importance for the development of decubitus ulcers.

Adult↗
PubMed2004

Partially de-epithelialised and buried V-Y advancement flap for reconstruction of sacrococcygeal and ischial defects.

Defects in the sacrococcygeal and ischial soft tissues can be treated with gluteus maximus and posterior thigh V-Y advancement flaps. However, late complications include recurrence and dehiscence of the suture line. Increasing the amount of the soft tissues over the bony prominences and multilayered closure may have an advantage for long-term durability. We modified the V-Y advancement technique by de-epithelialising the medial parts of the flap and burying them under the opposing edge of the wound or the flap. Sixteen patients with various defects of the sacrococcygeal and ischial soft tissues were operated on using this technique. All the flaps healed well with no partial or complete loss of the flap. Three patients developed complications. The main advantage of our technique is the use of healthy tissues to obliterate the dead spaces under the edges of the wound or the opposing flap. In this way, not only the defect in the skin but the defect in the subcutaneous tissue, with its iceberg tip at the surface, is treated effectively. To have an additional layer of tissue between the bone and the superficial tissues provides an extra cushion of soft tissue and avoids putting the suture line directly over the bony prominences. We used this modification safely for both unilateral and bilateral flaps. It could also be used successfully in other parts of the body.

Adult↗