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PubMed2003

Synergy of medial and lateral hamstrings at three positions of tibial rotation during maximum isometric knee flexion.

Rotation of the knee has been used to isolate the strength of the medial and lateral hamstrings during manual testing of the knee flexors. The purpose of this study was to determine if medial and lateral rotation of the knee during manual knee flexor strength testing increased the electromyographic activity of the respective hamstrings. Twenty-three women between 22 and 36 years old with no history of lower extremity injury or disease participated in the study. Indwelling fine wire electrodes were used to record EMG activity of the medial (semitendinosus and semimembranosus) and lateral (long and short heads of the biceps femoris) hamstring muscles during maximally resisted knee flexion with neutral, medial, and lateral rotation of the knee. Repeated measures analysis of variance with post hoc Bonferroni adjustments were used to compare EMG activity across the three tests. EMG activity increased significantly for the target hamstrings during ipsilateral rotation (P<0.05). The semitendinosus had a mean activity of 109% Max. during medial rotation as opposed to 95% Max. during lateral rotation. The semimembranosus averaged 107 and 89% Max. in medial and lateral rotation respectively. Conversely, both the long and short head of the biceps muscle showed significantly higher activity (P<0.05) during lateral compared to medial rotation (110 and 108% compared to 93 and 97%, respectively). Even though the differences are statistically significant they ranged from 2 to 13% only of maximum activity, the clinical importance of this small change in EMG activity is questionable.

Adult↗
PubMed1997

The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral decubitus positioning.

OBJECT: This study was designed to measure changes in tracheal and bronchial lumen distances from mainstem and secondary carina with lateral positioning, and to assess whether inflation of the endobronchial cuff before lateral positioning would further secure a double-lumen endobronchial tube (DLT) and reduce movement. DESIGN: Prospective study. SETTING: University-affiliated cancer center. PARTICIPANTS: Fifty adult patients scheduled for elective thoracic surgical procedures requiring the placement of a left DLT. INTERVENTIONS: Patients were sequentially assigned to either the endobronchial cuff-inflated group or the deflated group during lateral positioning. After induction of general anesthesia, a left polyvinylchloride (PVC) DLT was placed and the position confirmed. In the supine position, the distance from the tip of the tracheal lumen to main carina was measured using a fiberoptic bronchoscope (FOB) passed through the tracheal lumen, and the distance from the bronchial lumen to secondary carina was measured with the FOB passed through the bronchial lumen. The patients were then positioned laterally and a second set of measurements taken. Overall movement was determined by increases and decreases in tracheal and bronchial distances obtained by substracting supine values from lateral values. MEASUREMENTS AND MAIN RESULTS: There was significant tracheal movement in 40 of 50 patients, with a mean of 0.92 +/- 1.0 cm. This was predominantly in the upward direction, as seen in 35 of 50 patients. There was significant bronchial movement in 37 of 50 patients, with a mean of 0.92 +/- 1.15 cm. Also, predominance in the upward direction was seen in 34 of 50 patients. CONCLUSIONS: DLTs move with lateral positioning, regardless of endobronchial cuff inflation. The movement is predominantly in the upward direction. Therefore, fiberoptic visualization in the supine position should be used only to confirm that the endobronchial lumen is placed on the appropriate side and the cuff is at least 1 cm inside the left mainstem bronchus. Final positioning should always be verified in the lateral position.

Adult↗
PubMedDate not supplied

Computer-assisted assessment of lateral column movement following plantar fascial release: a cadaveric study.

In patients who fail conservative treatment, releasing the plantar fascia relieves heel pain but destabilizes the lateral column of the foot. After surgery, pain can present in the area of the sinus tarsi, extensor digitorum brevis muscle, between the fourth and fifth metatarsals, and at the calcaneocuboid joint. The precise mechanism and involved structures for this painful compensation remains unclear. The authors hypothesized that the lateral plantar fascial band, bifurcate and cervical ligaments, lateral talocalcaneal ligament, and interosseous talocalcaneal ligament become excessively strained after this surgery. Using eight cadaver lower extremity limbs amputated 7 cm above the ankle joint, structural changes in the foot in response to staged release of the plantar fascia were measured. All ligament, tendon, and osseous structures were exposed along the plantar, medial, and lateral aspects of the foot and ankle. Using a servohydraulic system, compressive loads in increasing increments (50 lbs) were applied along the tibial axis. Tissue and bony structure displacement in the foot was measured using images electronically captured from two fixed cameras and a digital camera following each load change. All measurements were made in pixels and converted to millimeters in a spreadsheet program. Except for plantar fascial measurements, data were expressed as percentage of initial baseline. As expected, increasing compressive loads changed all measurements [repeated measures ANOVA, p<.04]. When releasing the plantar fascia, the inferior sinus tarsi space widened (intact, 85.4+/-10.8%; 1/4 release, 87.7+/-13.0; 1/2 release, 88.3+/-9.2; 3/4 release, 91.2+/-8.8; p<.04). Lateral length increased and medial height decreased, while medial length and lateral height were unchanged as the fascia was sequentially released. Significant movement of the inferior sinus tarsi strained the bifurcate and cervical ligaments, the lateral talocalcaneal ligament, and interosseous talocaneal ligament, which may account for pain following surgery. The initial 1/4 cut of the plantar fascia exerted the greatest mechanical alteration of the foot, suggesting that a partial release may relieve heel pain while optimizing the patient's chances of maintaining structural integrity with 75% of the plantar fascia intact.

Aged↗
PubMed2000

Myosin heavy chain composition of the human lateral pterygoid and digastric muscles in young adults and elderly.

The myosin heavy chain (MyHC) content in different parts of, two jaw opening muscle, the human lateral pterygoid and the digastric muscles of five young adult and five elderly subjects (mean age 22 and 73 years, respectively) was determined, using gel electrophoresis and immunohistochemical methods. The lateral pterygoid of both young and elderly contained predominantly slow MyHC, and fast A MyHC was the major fast isoform. In contrast, the digastric was composed of slow, fast A and fast X MyHCs in about equal proportions in both age groups. About half of the lateral pterygoid fibres contained mixtures of slow and fast MyHCs, often together with alpha-cardiac MyHC. In the digastric, co-existence of slow and fast MyHCs was rare, and alpha-cardiac MyHC was lacking. On the other hand, co-expression of fast A and fast X MyHCs was found more often in the digastric than in the lateral pterygoid. In both age groups about half of the digastric IIB fibres contained solely fast X MyHC. In the lateral pterygoid, type IIB fibres with pure fast X MyHC was found in only one subject. The lateral pterygoid in elderly showed a significant amount of fibres with solely fast A MyHC, which were occasionally found in young adults. In the digastric, no significant differences were found between young and elderly, although the muscles of elderly contained lower mean value of slow MyHC, as compared to that of young muscles. It is concluded that the lateral pterygoid and the digastric muscles differ not only in the MyHC composition but also in modifications of the MyHC phenotypes during aging, suggesting that they have separate roles in jaw opening function.

Adult↗
PubMed2001

Organisation of the praesoma of Paratenuisentis ambiguus (Van Cleave, 1921) (Acanthocephala: Eoacanthocephala), with special reference to the lateral sense organs and musculature.

The praesoma of the acanthocephalan parasite Paratenuisentis ambiguus was studied at the light and the electron microscope level, with special reference to the lateral sense organs and the musculature, in order to substantiate the basal pattern of the Acanthocephala and to analyse the phylogeny of the taxon. The study includes the first ultrastructural description of a lateral sense organ in the Acanthocephala. Two sensory support cell ducts extend from the binucleate pericaryon of the sensory support cell to the lateral sense organs. On their way to the lateral sense organs the ducts penetrate the receptacle and join the anterior ventral nerves. Each lateral sense organ consists of a conical termination of one of the sensory support cell ducts, in which the neuronal fibres and dendritic terminations of the equilateral anterior ventral nerve are embedded. An analysis of the available data of praesomal sense organs in Acanthocephala suggests that lateral and apical sense organs are absent in the basal pattern of the Acanthocephala. It is likely that two lateral sense organs, a binucleate sensory support cell with two ducts and two anterior ventral nerves evolved within the stem-line of some Palaeacanthocephala, all Eoacanthocephala and all Archiacanthocephala, whereas two apical sense organs, a quadrinucleate sensory support cell with four ducts and two apical sensory nerves presumably represent an autapomorphic character of the Archiacanthocephala. Furthermore, it can be derived from data in the literature and the present study that the praesomal hooks are totally covered by epidermis in the basal pattern of the Acanthocephala, whereas the ontogenetic loss of the epidermal covering can be regarded as an autapomorphy of the Archiacanthocephala.

Acanthocephala↗
PubMed2000

Palatally displaced upper lateral incisors: relapse after orthodontic treatment and its correlation with dentoskeletal morphology.

The purpose of the present study was to determine whether the relapse tendency of the palatally positioned upper lateral incisor differs in patients treated with or without premolar extraction, and if there is any correlation between the amount of upper lateral incisor relapse and pretreatment dentoskeletal morphology or post-treatment changes. Forty-six patients with bilateral palatally displaced upper laterals who also exhibit maxillary dental constriction were separated into two groups: a premolar extraction (30 cases) group and a non-extraction (16 cases) group. All subjects had undergone orthodontic treatment with quad helix and edgewise appliances, followed by a 2-year retention period. Differences in the amount of the upper lateral incisor relapse and their correlations with the dentoskeletal morphology before and after treatment were determined on the lateral and postero-anterior cephalograms and dental casts. Results revealed that the upper lateral incisor relapse in the extraction group was significantly greater (p=0.0002) than the relapse in the non-extraction group. There was a positive correlation between incisor relapse and the distance of lateral incisor movement in both groups (r=0.539; p=0.030). Relapse in the non-extraction group was correlated with the widths of the upper dental arch (r</=-0.507, p</=0.044), with the naso-maxillary variables before treatment (r=-0.514, p=0.041), and also with changes in the upper inter-premolar and inter-molar widths during retention (r=0.514, p=0.040).

Journal Article↗
PubMed1979

Synthesis of membrane glycoproteins in rat small-intestinal villus cells. Redistribution of L-[1,5,6-3H]fucose-labelled membrane glycoproteins among Golgi, lateral basal and microvillus membranes in vivo.

The biogenesis of plasmalemma glycoproteins of rat small-intestinal villus cells was studied by following the incorporation of l-[1,5,6-(3)H]fucose, given intraperitoneally with and without chase, into Golgi, lateral basal and microvillus membranes. Each membrane fraction showed distinct kinetics of incorporation of labelled fucose and was differently affected by the chase, which produced a much greater decrease in incorporation of label into Golgi and microvillus than into lateral basal membranes. The kinetic data suggest a redistribution of newly synthesized glycoproteins from the site of fucosylation, the Golgi complex, directly into both lateral basal and microvillus membranes. The observed biphasic pattern of label incorporation into the microvillus membrane fraction may be evidence for a second indirect route of incorporation. The selective effect of the chase suggests the presence of two different pools of radioactive fucose in the Golgi complex that differ in (1) their accessibility to dilution with non-radioactive fucose, and (2) their utilization for the biosynthesis of membrane glycoproteins subsequently destined for either the microvillus or the lateral basal parts of the plasmalemma. The radioactively labelled glycoproteins of the different membrane fractions were separated by sodium dodecyl sulphate/polyacrylamide-slab-gel electrophoresis and identified by fluorography. The patterns of labelled glycoproteins in Golgi and lateral basal membranes were identical at all times. At least 14 bands could be identified shortly after radioactive-fucose injection. Most seemed to disappear at later times, although one of them, which was never observed in microvillus membranes, increased in relative intensity. All but two of the labelled glycoproteins present in the microvillus membrane corresponded to those observed in Golgi and lateral basal membranes shortly after fucose injection. The patterns of labelled glycoproteins in all membrane fractions were little affected by the chase. These data support a flow concept for the insertion of most surface-membrane glycoproteins of the intestinal villus cells.

Animals↗
PubMed2003

Hypotension following combined spinal-epidural anaesthesia for Caesarean section. Left lateral position vs. tilted supine position.

Eighty-seven pregnant mothers undergoing elective Caesarean section were randomly allocated either to the full left lateral position (n = 45) or to the supine position with 12 degrees left lateral tilt (n = 42) after a combined spinal-epidural (CSE) in the sitting position and an initial 2 min in the full right lateral position. Fewer mothers were hypotensive while in the study position [29 (64%) in lateral group vs. 38 (90%) in the tilted supine group; p = 0.03]. Mothers in the lateral group tended to become hypotensive after turning them back to the tilted supine position immediately before surgery; hence the number of mothers who were hypotensive from the insertion of the CSE until delivery were similar [36 (80%) vs. 38 (90%)]. Mothers in the lateral group needed a lower dose of ephedrine to treat their hypotension while in their study position (median (interquartile range [range]) 6 (0-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg, respectively; p = 0.04) but ephedrine requirements were similar overall (12 (6-12 [0-36]) mg vs. 12 (6-18 [0-36]) mg), respectively. The full left lateral position reduces the incidence of early hypotension compared with the tilted supine position with tilt, and makes it easier to treat.

Adult↗
PubMed2001

A comparison of the lateral and posterior retroperitoneoscopic approach for complete and partial nephroureterectomy in children.

OBJECTIVE: To report the comparative results of a selective posterior or lateral retroperitoneoscopic approach (RPA) for nephroureterectomy in children. PATIENTS AND METHODS: Following an established experience with RPA, 36 complete and 19 partial nephrouretectomies were prospectively randomized to a posterior and lateral retroperitoneoscopic approach The patients were aged 4 months to 14 years, with a body weight at operation of 5.7-82 kg. For posterior RPA the child is positioned prone, with three access ports. The operating space was created with balloon dissection and maintained with CO2 insufflation. The child was then rotated 30 degrees with the kidney in the dependent position, and the operator and assistant standing on the affected side. In the lateral approach the child is in the lateral decubitus position with the operator and assistant facing the dorsal aspect of the patient. RESULTS: There was no significant difference in operative duration between the lateral and posterior approaches for nephrectomy (65 and 47 min) or partial nephrectomy (85 and 75 min). Two lateral nephrectomies required open conversion (one upper pole and one lower pole). CONCLUSION: The posterior approach gives easy and quick access to the renal pedicle. It is preferable for complete nephrectomy alone and partial or polar excision. In children under 5 years old a near complete ureterectomy can be achieved. The lateral approach creates more inferomedial space, gives better access to ectopic kidneys and allows complete ureterectomy in all cases. Access to the pedicle in the normal position requires more frequent positioning of the kidney. Care must be taken as peritoneal tears are more common.

Adolescent↗
PubMed1993

Fetal mild idiopathic lateral ventriculomegaly: is there a correlation with fetal trisomy?

Mild idiopathic lateral ventriculomegaly in the mid-trimester fetus can be accurately detected using modern prenatal ultrasonography. Since an abnormal karyotype has been reported in some of these cases, the present prospective study was designed to evaluate, first, the prevalence of mild idiopathic lateral ventriculomegaly in the general obstetric population and, second, to determine the incidence of abnormal fetal karyotype associated with mild idiopathic lateral ventriculomegaly. Eight cases of mild idiopathic lateral ventriculomegaly (0.15%) were detected among 5400 routine prenatal sonographic examinations, between 16 and 22 weeks' gestation. Three newborn infants were found to be normal; in one baby, spontaneous resolution of the lesion occurred in utero, and, among the other five cases, two had an abnormal karyotype: one had Down's syndrome, and one trisomy 18. A review of the English literature revealed that 12% of fetuses with mild idiopathic lateral ventriculomegaly have an abnormal karyotype. Since 3% of the fetuses with Down's syndrome can be visualized in utero with mild idiopathic lateral ventriculomegaly, the calculated risk for Down's syndrome when such lesions appear is about 3%. We, therefore, conclude that karyotypic study is warranted in the mid-trimester fetus with incidental findings of mild idiopathic lateral ventriculomegaly.

Journal Article↗
PubMed2002

Chronic medial and lateral epicondylitis: a comparison of pain, disability, and function.

OBJECTIVES: To investigate pain, disability, and muscle function of the arm in medial epicondylitis and to compare the results with those in chronic lateral epicondylitis. DESIGN: Cross-sectional, case-control study. SETTING: University hospital clinic admitting chronic hand patients. PARTICIPANTS: Twenty-five patients with chronic unilateral medial epicondylitis and 25 age- and gender-matched patients with chronic unilateral lateral epicondylitis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain drawing (PD) and a pain questionnaire with 7 items of pain and disability on visual analog scale (VAS). Dolorimeter measurements of pressure pain thresholds (PPT) on 3 defined cubital points. The isometric grip strength and isokinetic performance of wrist and forearm at a radial velocity of 90 degrees/s. RESULTS: Patients with medial epicondylitis had significantly less pain under strain (6.7 vs 7.9cm on VAS, P =.03) and a smaller PD (1.9 vs 2.5, P =.02) than patients with lateral epicondylitis. The PPTs of medial epicondyles were 54% (P =.0000) lower in medial epicondylitis. In lateral epicondylitis, all 3 cubital points showed significant decreases in PPTs. The isometric grip strength (mean and maximal) decreased by 6.2% and 3.6%, compared with the patients' healthy arms (P =.03,.16) and by 11.4% and 8.9% (P =.008,.02), respectively, compared with the expected value; in lateral epicondylitis, the grip strength decreased by 11.8% and 10.6% (P =.005,.01) and by 15% and 14% (P =.003,.007), respectively, when compared with the expected grip strength. Peak torque and produced work in wrist flexion were significantly reduced by 13% and 17% (P =.005,.0001), respectively, in both diseases. In lateral epicondylitis, supination and pronation were also reduced by 10% and 15% (P =.03). CONCLUSIONS: In chronic medial epicondylitis, muscle function and pain measures showed a lesser impaired function of the arm than in chronic lateral epicondylitis. The results may be useful in rehabilitation and treatment of epicondylitis.

Adult↗
PubMedDate not supplied

Osteochondritis dissecans of the lateral femoral condyle of the knee joint.

Differences in the features of osteochondritis dissecans (OCD) affecting the lateral and medial femoral condyles were investigated in 13 patients (14 knees) treated from 1991 to 1994. OCD affected the lateral femoral condyle in 6 knees (lateral group) and the medial condyle in 8 knees (medial group). The lateral group was younger (mean age, 14 v. 20 years). The radiological stage (Brückl) of the lateral group was stage 2 in 3 knees and stage 3 in 3. The lateral menisci were all discoid and the condylar articular surface of the lesions was normal in two knees, softened in 3 and detached in 1. The medial group comprised 1 knee in stage 2, 1 in stage 3, 1 in stage 4, and 5 in stage 5. The OCD lesion showed softening in 2 knees and detachment in 6. Repetitive abnormal stress on weaker osteochondral structures in the growing period produced by a discoid meniscus during growth may cause OCD of the lateral femoral condyle.

Adolescent↗
PubMedDate not supplied

Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle.

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Adult↗
PubMed2001

Arthroscopic release for lateral epicondylitis.

PURPOSE: This study was performed to review the results of our early experience with recalcitrant lateral epicondylitis treated arthroscopically. TYPE OF STUDY: This study is a case series consisting of consecutive patients with lateral epicondylitis treated arthroscopically by 1 surgeon. METHODS: Patients failing a minimum of 6 months of conservative treatment underwent arthroscopic release of the extensor carpi radialis brevis (ECRB) origin using the proximal medial and proximal lateral portals. Associated intra-articular pathology was noted and addressed. The ECRB lesions were classified according to their gross morphology and resected with a shaver. The lateral epicondyle was then decorticated with a burr. RESULTS: Sixteen patients with recalcitrant lateral epicondylitis were treated with arthroscopic release of the ECRB origin on the lateral epicondyle. Of the 16 elbows undergoing surgery, 5 (31.3%) were noted to have a type I lesion, characterized as fraying of the undersurface of the ECRB. Five (31.3%) had a type II lesion noted by linear tears within the ECRB, and 6 (37.5%) had a type III lesion, consisting of a partial or complete avulsion of the ECRB origin. Concurrent intra-articular pathology (synovitis, osteophytes) was noted in 3 of 16 elbows (18.8%) and was addressed arthroscopically. All patients were followed-up for a minimum of 1 year; however, 4 patients were lost to follow-up for this retrospective review due to military reassignment. Follow-up was obtained on 12 of 16 (75%) of patients at an average length of 24.1 months (range, 15 to 33 months). All patients reported improvement with the procedure. The average return to unrestricted work was 6.0 days (range, 0 to 28 days). CONCLUSIONS: Arthroscopic release effectively treats lateral epicondylitis while also affording visualization of the joint space to address associated intra-articular pathology. Additionally, arthroscopic release is minimally invasive and allows early rehabilitation and return to normal activities.

Adult↗
PubMed2000

Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint.

The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. Seventeen consecutive lateral arm flaps with a skin paddle designed over the elbow joint were performed for different indications. Eleven patients were followed up postoperatively for a minimum of 6 months. The range of motion, torque, power and endurance of the elbow joint were recorded using a Cybex 340 isometric dynamometer. The values of the operated elbow were compared to those of the unoperated elbow and the deficits were expressed in percentages. The touch sensation in the territory of the posterior cutaneous nerve of the forearm was assessed using Semmes-Weinstein monofilaments. Patient satisfaction was evaluated with a self-assessment scale. The donor site scar was stretched in one patient. No patient complained of elbow pain or cold intolerance. Elbow mobility was not significantly affected by flap harvesting (P = 0.06). An extension deficit of 4% was found in four patients. The mean torque, power and endurance deficits were 7.3%, 7.5% and 4.4% respectively as compared to the contralateral side. Complete loss of sensation was not present in any of the donor sites. However, an area of hypoaesthesia with a mean size of 45 cm(2)(range 20-75 cm(2)) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle.

Adolescent↗
PubMed2001

Effect of lateral versus supine wedged position on development of spinal blockade and hypotension.

Aortocaval compression may not be completely prevented by the supine wedged or tilted positions. It is commonly believed, however, that the unmodified full lateral position after induction of spinal anaesthesia might allow excessive spread of the block. We therefore compared baseline arterial pressures in the supine wedged, sitting, tilted and full lateral positions in 40 women who were about to undergo elective caesarean section. They were then given spinal anaesthesia in the left lateral position and randomised to be turned to the right lateral or the supine wedged position, after which speed of onset and spread of blockade to cold sensation were measured every 2 min for 10 min and mean arterial pressure and ephedrine requirement were recorded every minute for 20 min. Baseline mean arterial pressure was 9 mmHg (95% CI 3 to 14) lower in the left lateral (measured in the upper arm) than in the sitting position; those in the supine wedged and tilted positions were intermediate. Following spinal anaesthesia, hypotension (defined as a reading </=80% of the baseline value in the same position) lasted 2.4 min longer (CI +0.6 to +4.1) in the supine wedged group, but there was no significant difference between the groups in maximum fall or ephedrine requirement. The upper level of block rose more rapidly in the supine wedged than in the lateral group and showed less variability. There is therefore no reason to fear the unmodified lateral group position, which may offer better protection against hypotension.

Clinical Trial↗
PubMed1996

[Differential indications for so-called "lateral release" in treatment of chondropathia patellae].

The success rate of the operation of lateral release for pain caused by the patella is reported as being between 14% and 99%. The choice between arthroscopic or open procedures does not seem to affect the results. The wide ranges of results probably reflects differences in patients selection or the method and investigations of follow up. The early term outcome usually show better results than long term follow up. This study evaluates the indications for the operation of lateral releases and discusses the result of 36 out of a total of 42 patients who were follow up for 3 years later surgery. We found that an insufficiency of dysplasia of the vastus medialis, the laxity of the capsule and soft ligaments, and a strong lateral retinaculum were important factors in the indication for this procedure. The quadriceps angle was also of prime importance, but the minor forms of patellar dysplasia played only a minor role. In the so-called hyperpression syndrome, where the patella has a strong tendency to move laterally, the simple lateral release is the single most successful operation. The indication for procedures additionally to the lateral release is examined. We found that in a case with an insufficiently guided patella, a weak capsule and ligaments, an additional capsule roughing should be performed. The presence of early degenerative changes in the joint predisposes to poor results in operations such as abrasion and pride drilling. The results in our study were assessed using the Lysholm score. Our results show that the most successful technique was the combination of an arthroscopy and an extraarticular open operation controlled by arthroscopic means. This technique was not associated with major complications such as haemarthrosis and consecutive prolonged postoperative rehabilitation. Overall we achieved a rate of 83% of good or satisfactory results at more than 3 years using the indications and techniques described above.

Adult↗
PubMed1997

[Clinical comparison between radial and lateral forearm flap].

BACKGROUND: Free fasciocutaneous flap transplantation is a versatile method for soft tissue reconstruction. This clinical study points out differences between the radial forearm flap and the lateral arm flap. METHODS: We used the radial forearm flap in 36 patients following tumor ablation and in 11 patients we used the lateral arm flap for soft tissue reconstruction. We studied the arterial and venous vessel calibers of the flaps, the vessel pedicle length, and the size of the skin paddle. Motor and sensory function tests of the upper/ lower arm and hand were performed after surgery. Recipient and donor site morbidity was noted. RESULTS: Compared to the forearm flap the lateral arm flap is bulky (1-5 cm vs. 0.5-1.5 cm), its vessel calibers are smaller (Art.: 1.4 vs. 1.8 mm, Ven.: 1.8 vs. 2.0 mm), flap size and maximum vessel pedicle length (10 vs. 12 cm) are equal. Raising the lateral arm flap is more demanding and needs more time due to the deep location of the vessel pedicle and the accompanying radial nerve within the intermuscular septum. On the other hand the lateral arm flap is advantageous because of primary wound closure of the donor site. The donor site of the forearm flap had to be covered with skin graft in all cases. We found sensory deficits of the proximal lower arm in 50% after dissection of the lateral arm flap and in 14% on the distal lower arm and thumb joint after dissection of the radial forearm flap. CONCLUSIONS: Both transplants are fasciocutaneous and optional innervated, they offer a constant anatomy and can be harvested simultaneously without interference to the head and neck team. Because of the specific characteristics of these flaps we prefer the radial forearm flap for soft tissue reconstruction. We use the lateral upper arm flap, if a forearm flap cannot be harvested, for head or neck augmentation and for reconstruction of large and deep defects.

Forearm↗