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At least 631 records · Page 35Linked to original sources

[One-stage vagina reconstruction using the pudendal-thigh skin flap].

OBJECTIVE: This is to introduce a method for vagina reconstruction using the pudendal-thigh skin flap. METHODS: The pudendal-thigh skin flap has been used for vagina reconstruction in 70 cases since 1989. RESULTS: All the operations were successful and the method has become a mature technique. CONCLUSION: The advantages of the method are 1. the reconstructed vagina has good sensation and stable in maintaining its dimensions; 2. the linear scars of the donor site are hidden and inconspicuous; 3. the appearance of the perineum looks well; 4. the procedure is simple and favors its application.

Adolescent↗

Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.

A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. Pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. Magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. Rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.

Adult↗

Graduated compression stockings: knee length or thigh length.

The mechanisms by which graduated compression stockings prevent deep venous thrombosis are not completely understood. In the current study the physiologic effect of low-pressure graduated compression stockings on the venous blood flow in the lower limb and the practical aspects of their use were assessed. Patients having elective orthopaedic surgery at a university orthopaedic department were randomized into five groups to wear two different types of graduated compression stockings in thigh and knee lengths. Patients in the fifth control group did not wear graduated compression stockings. Venous occlusion strain gauge plethysmography was used to measure venous flow. After 20-minutes bed rest there was a highly significant increase in venous capacitance and venous outflow in patients in all of the four groups wearing stockings. There was no difference in the mean of the percentage change of venous capacitance in patients in the four groups wearing stockings. The knee length Brevet stockings were less efficient in increasing the venous outflow. There was no significant change in the venous capacitance and venous outflow in patients in the control group. Visual assessment of the fit and use of stockings was done, and patients' subjective opinion of comfort was sought. The knee length graduated compression stockings wrinkled significantly less, and significantly fewer patients reported discomfort with them. All stockings were reported to be difficult to use. Thigh and knee length stockings have a significant effect on decreasing venous stasis of the lower limb. Knee length graduated compression stockings are similarly efficient in decreasing venous stasis, but they are more comfortable to wear, and they wrinkle less.

Bandages↗

[Repair of rectovaginal fistula using pudendal-thigh flap pedicled on the obturator artery].

OBJECTIVE: This is to introduce a new method for repair of rectovaginal fistual. METHODS: On the basis of an anatomical study a new type of the pudendal-thigh flap pedicled on the obturator artery has been designed to repair rectovaginal fistual. RESULTS: 4 patients were treated with this method. All flaps survived and the fistula between vagina and rectum was closed primarily. CONCLUSIONS: The advantages of the pudendal-thigh flap pedicled on the obturator artery include: 1. Good blood supply; 2. Relative thin and hairless; 3. Perfect hiding of the donor site. We think that it is one of the best methods of rectovaginal fistula repair.

Adult↗

The musculature of the hip and thigh of the white-tailed deer (Odocoileus virginianus, Rafinesque, 1832).

The musculature of the hip and thigh of the white-tailed deer (Odocoileus virginianus) is illustrated and described with emphasis on origins and insertions of individual muscles. Published works on the myology of domestic Bovidae (Bos taurus; Ovis aries; Capra hircus), Camelidae (Camelus bactrianus; Lama glama) and Cervidae (Cervus nannodes-canadensis) have been used for comparisons of individual muscles. The musculature of the hip and thigh of Odocoileus is substantially similar to that of other Artiodactyla investigated, except for slight differences of individual muscles. The most obvious differences involve the mm. obturatorius externus, obturatorius internus and pectineus. In Odocoileus as in domestic Bovidae and Cervus, the m. obturatorius externus is divided into an intrapelvic and an extrapelvic part whereas in Camelidae the intrapelvic part of the muscle is lacking. In the species considered, the m. obturatorius internus is present only in Camelus and Lama. In Odocoileus, the m. pectineus is divided into two distinct parts whereas in other Artiodactyla investigated the division lies apparent only toward its insertion.

Animals↗

Vertical rectus abdominis myocutaneous flap cover for lower abdomen, chest wall, groin and thigh defects following resection of malignant tumours.

Vertical rectus abdominis mycutaneous (VRAM) flap provides a reliable flap cover for large soft tissue defects of chest wall, torso, groin, perineum and thigh. It has been mainly used in trauma and benign conditions. Between January 1994 through January 1999, eight patients with locally advanced malignant tumors underwent radical resection and reconstruction using pedicled VRAM flap. Inferiorly based VRAM flap was used in five patients and superiorly based VRAM flap in three patients. Defect size ranged from 144 to 900 CM2. (mean 386 cm2). Average blood loss for combined resection and reconstruction was 600ml. (range 400-800 ml.) Primary closure of both donor and recipient sites achieved in all patients. There was no wound infection, flap necrosis or abdominal hernia. There patients received postoperative radiotherapy and chemotherapy and two patients received radiotherapy only. All the the patients are alive and free of local recurrence at mean follow up 32 months. Results of our study shows that VRAM flap is versatile and sturdy flap with a wide are of rotation and it can reach diverse anatomical sites like torso, chestwall, thigh and perineum to cover large defects following radical resection for tumors.

Adult↗

The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity.

From April of 2000 to May of 2003, 28 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (six cases were combined with vastus lateralis muscle flaps). All wounds were open for a minimum period of 6 weeks (average, 24.7 months; range, 6 weeks to 52 months). The average patient age was 42.8 years (range, 18 to 71 years), there were 21 male and seven female patients, and the average follow-up period was 18.2 months (range, 5 to 41 months). The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in eight cases, and diabetic foot in 10 cases. The surface defects ranged from 50 to 153 cm. The wounds were debrided an average of 2.5 times and then reconstructed with flap and treated with antibiotics for 6 weeks. Antibiotic beads were used in six cases and secondary bone graft procedures were performed in seven cases 3 months after the flap coverage. All 28 flaps were successful without any signs of recurrences or persistent osteomyelitis, but partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes. These wounds healed spontaneously. All patients achieved acceptable gait function after rehabilitation. No debulking procedure was necessary in any case. Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, provided that total debridement and obliteration of dead spaces are achieved. A well-vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis.

Adolescent↗

Pudendal thigh flap for congenital absence of vagina.

OBJECTIVE: To increase the armamentarium of plastic surgeons with description of one of the relatively newer flap for the reconstruction of congenital absence of vagina. METHODS: All patients of congenital absence of vagina selected for surgery were explained every detail about the procedure. Five out of ten opted for this procedure. In all patients bilateral pudendal thigh flap based on posterior labial artery, a branch of internal pudendal artery, were raised on either side of labia. They were sutured in midline and inserted into the neo-vagina created by dissection in between rectum and urinary bladder. RESULTS: This flap was used in five patients with minor postoperative problems and with good anatomical and functional results. CONCLUSION: Pudendal thigh flap is a useful technique to reconstruct the vagina.

Adolescent↗

[Late results of patients with amputation of the thigh (author's transl)].

111 patients with amputation of the thigh of the last world war were examined. Besides the complaints in their thigh they suffered mostly from low back pain and osteoarthritis in the knee of the other leg. For a medical report it is important to decide whether the low back pain comes from lumbar disc disease or from secondary scoliosis of the lumbar spine which is caused by the amputation. Secondary changes in the spine and in the other leg can also be expected when a lower limb is heavily injured.

Aged↗

The effects of O-(beta-hydroxy-ethyl)-rutosides (HR) on acute lymphoedema in rats' thighs, with and without macrophages.

The effect of O-(beta-hydroxy-ethyl)-rutosides (HR), injected subcutaneously, was investigated on experimental acute lymphoedema in rat thighs. The oedema was reduced from a 30% increase over the normal weight, to one of 13%. When the macrophages were destroyed by the intraperitoneal injection of silica (for eight days before the initiation of lymphoedema) the oedema of the thigh increased to 41% - thus showing the importance of these cells in limiting high-protein oedemas. When HR was given to animals treated with silica the oedema was no longer reduced (42%). Thus HR reduces a high-protein oedema substantially via the macrophages.

Animals↗

Bone scanning in the adductor insertion avulsion syndrome ("thigh splints").

Shin splints is a defined clinical entity resulting from extreme tension on muscles inserting on the tibia, resulting in periosteal elevation which is detectable by bone scanning. The clinical equivalent in the thigh has been described. We found scintigraphic changes in the femurs of seven short, female, basic trainees at the Fort Dix Army base, most of whom were referred for stress fractures elsewhere in the lower extremities. The scan findings were generally noted in the upper or mid femurs, always involved the anteromedial cortex, and were bilateral in five of the seven subjects. The abnormalities were linear and suggested periosteal elevation, and did not have the typical appearance of stress fracture. Since the findings correspond to the insertion of one or more adductor muscle groups, the descriptive term "adductor insertion avulsion syndrome" or "thigh splints" is proposed for this entity.

Adolescent↗

The effect of a thigh tourniquet on the incidence of deep venous thrombosis after operations on the fore part of the foot.

We performed a prospective randomized clinical study to determine whether use of a thigh tourniquet influences the incidence of deep venous thrombosis. The lower limbs of patients who were scheduled for elective surgery on the fore part of the foot were randomized and assigned to one of three treatment categories: Group I, no tourniquet; Group II, exsanguination by an Esmarch bandage before tourniquet application; and Group III, exsanguination by elevation of the extremity prior to application of a tourniquet. The 117 limbs of seventy-one patients included in this study were evaluated preoperatively and twenty-four and seventy-two hours postoperatively with 125I-labeled fibrinogen, and preoperatively and seventy-two hours postoperatively with Doppler ultrasound studies and phleborheography. The findings in all of the Doppler ultrasound studies and all of the phleborheograms were normal. Two of the 125I-fibrinogen studies were positive, but subsequent contrast venography revealed that these were false-positive findings. We therefore concluded that the use of a thigh tourniquet does not increase the risk of deep venous thrombosis in patients who have had an operation on the fore part of the foot.

Adult↗

Surface direct current bioelectric potentials in the normal and injured human thigh.

Skin bioelectric potentials were obtained from both normal and injured human thighs using surface direct current silver/silver chloride monitoring electrodes. Electrical patterns in normal subjects fell into 4 distinct groups. In subjects with injured thigh significant electrical differences were associated with bone formation. The findings are discussed.

Contusions↗

[Radical vulvectomy using Way's method with bilateral removal of inguinal, thigh, iliac and veil lymph nodes in the clinic].

Thirty-one cards of women after radical vulvectomy in Way's mode were analysed. Metastases in inguinal, thigh, iliac and veil lymph nodes were found only in 19.35%. Authors conclude that removal of iliac and veil lymph nodes can be given up after previously negative outcome of intra-operative examination of inguinal and thigh lymph nodes. Mean period of patient's staying in hospital was long--about 40 days. In 51.6% of cases the blood group was "A", with the mean for the whole country 40.5%.

Adult↗

Carcinomatous perforation of the sigmoid colon presenting as a thigh mass.

We report a patient presenting with a left psoas abscess causing necrotizing fasciitis of the upper thigh. The patient underwent exploration of the left thigh through a medial approach, confirming necrotizing fasciitis of the adductor compartment and the femoral triangle. The infective process also involved the left psoas. This was explored retroperitoneally through a left pararectal laparotomy incision. Further exploration revealed a carcinomatous ulcer of the sigmoid colon. Despite active resuscitation, antibiotic therapy, and further debridement, the patient died three days after admission.

Aged↗

Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves.

This meta-analysis used all original articles from 1966 to June 1996 that fit the preset inclusion criteria to examine the clinical effectiveness of intermittent pneumatic compression (IPC) devices in preventing deep vein thrombosis (DVT) and pulmonary embolism and to compare the results of knee-high sleeves to thigh-high sleeves. IPC devices decreased the relative risk of DVT by 62 per cent when compared with placebo, 47 per cent compared with graduated compression stockings, and 48 per cent compared with mini-dose heparin. IPC devices significantly decreased the relative risk of DVT compared with placebo in high-risk patients such as neurosurgery and major orthopedic surgery patients and in modest risk patients such as general surgery patients. In major orthopedic surgery patients, the incidence of DVT was similar for IPC- and warfarin-treated patients; however, IPC was significantly better than warfarin at decreasing the incidence of calf only DVT, whereas warfarin seemed to be better at decreasing proximal DVT. IPC devices are effective in decreasing the incidence of DVT in patients at moderate to high risk and are probably more efficacious than graduated compression stockings or mini-dose heparin; however, IPC devices are not protective against pulmonary embolism. The data directly comparing the various methods of compression (knee-high versus thigh-high sleeves and graded-sequential versus uniform compression) are sparse and conflicting.

Bandages↗

Integrative Analysis Uncover the Effects and Multi-Omics Features of Thigh Muscle Fat Infiltration.

The health impacts and underlying biological pathways of thigh muscle fat infiltration (TMFI) remain incompletely understood. In this study, we analyzed TMFI measured by magnetic resonance imaging in 55,120 UK Biobank participants and found that higher TMFI was significantly associated with all-cause mortality as well as with all major system-specific diseases examined (p values ranged from 2.50&#x2009;&#xd7;&#x2009;10-88 to 9.97&#x2009;&#xd7;&#x2009;10-04). TMFI also mediated the effects of lifestyle factors on health-related outcomes, with mediation proportions ranging from 6.7% to 71.7%. A genome-wide association study (GWAS) identified 79 lead single nucleotide polymorphisms (SNPs) linked to TMFI, and the polygenic risk score for TMFI was significantly associated with mortality and all incident diseases across examined organ systems in an independent subset of UK Biobank participants of European ancestry who were not included in the TMFI GWAS (n&#x2009;=&#x2009;362,286, all p&#x2009;<&#x2009;0.05). Gene-drug interactions identified multiple drugs that could potentially modulate TMFI. Analysis of single-cell transcriptomic data indicated that myogenic cells were strongly linked to TMFI (p&#x2009;=&#x2009;7.08&#x2009;&#xd7;&#x2009;10-08). Summary-data-based Mendelian randomization and Transcriptome-Wide Association Study analyses revealed numerous genes whose expression in specific tissues was associated with TMFI. Proteomic and metabolomic profiling uncovered a broad array of circulating biomarkers associated with TMFI, many of which mediated the effects of modifiable factors and genetic risk on TMFI. Overall, our results highlight the biological relevance of TMFI to human health and provide insights into the multi-omics mechanisms underlying TMFI, identifying potential targets for interventions.

Humans↗

The role of the anterolateral thigh flap for pharyngoesophageal reconstruction.

OBJECTIVE: To elucidate the advantages and disadvantages of the anterolateral thigh flap (ALTF) for pharyngoesophageal reconstruction, we assessed this donor site and compared it with the radial forearm free flap (RFFF). DESIGN: Retrospective medical chart review. SETTING: Tertiary care referral center. SUBJECTS: Twenty-three consecutive patients who underwent pharyngoesophageal reconstruction using an ALTF or RFFF. INTERVENTION: Pharyngoesophageal reconstruction. MAIN OUTCOME MEASURES: Patient medical charts were assessed for age, histopathological diagnosis, preoperative treatment, surgical defect, tracheoesophageal speech, flap survival, donor and recipient site complications, and swallowing function. RESULTS: Twenty-three patients (12 who underwent reconstruction with ALTF and 11 with RFFF) were included in the study. Both donor sites provided adequate tissue for pharyngoesophageal reconstruction; however, the RFFF group demonstrated a higher rate of postoperative donor site complications including skin graft loss and extremity edema and stiffness. Postoperatively, the ALTF group demonstrated no gait disturbance and no donor site complications. All 23 patients in both groups were able to tolerate an unrestricted oral diet; however, 3 patients who underwent reconstruction with an RFFF experienced cervical esophageal stenosis, whereas only 1 patient with an ALTF experienced stenosis. CONCLUSION: In this preliminary series, the ALTF represents an excellent source of tissue for pharyngoesophageal reconstruction and is associated with a lower rate of donor site morbidity and anastomotic stenosis compared with the RFFF donor site.

Adult↗