Comprehensive assessment of the donor-site of the anterolateral thigh flap: A prospective study in 33 patients.

BACKGROUND: The anterolateral thigh (ALT) free flap has been an extremely versatile flap. The purpose of this study was to propose comprehensive functional assessments of the donor site. METHODS: A total of 33 ALT flaps were enrolled prospectively. Objective assessments included isokinetic testing of the knee, and electromyographic examination of the lateral femoral cutaneous nerve (LFCN). The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor-site scar. RESULTS: On the donor side, a significant decrease in most isokinetic muscle strength values was obvious 1 year postoperatively (P < .01). The normal side showed a compensatory increase 1 year postoperatively in the majority of isokinetic muscle strength values (P < .05). The majority of patients (70%) showed decreased sensory conduction velocity of the LFCN or no response to the microcurrent stimulation postoperatively. The aesthetic outcome was satisfactory. CONCLUSION: The decline in functional parameters at the donor-site was common. However, much more research is needed.

Assessment of low-frequency fatigue with two methods of electrical stimulation.

The aim of this study was to compare the use of transcutaneous vs. motor nerve stimulation in the evaluation of low-frequency fatigue. Nine female and eleven male subjects, all physically active, performed a 30-min downhill run on a motorized treadmill. Knee extensor muscle contractile characteristics were measured before, immediately after (Post), and 30 min after the fatiguing exercise (Post30) by using single twitches and 0.5-s tetani at 20 Hz (P20) and 80 Hz (P80). The P20-to-P80 ratio was calculated. Electrical stimulations were randomly applied either maximally to the femoral nerve or via large surface electrodes (ES) at an intensity sufficient to evoke 50% of maximal voluntary contraction (MVC) during a 80-Hz tetanus. Voluntary activation level was also determined during isometric MVC by the twitch-interpolation technique. Knee extensor MVC and voluntary activation level decreased at all points in time postexercise (P < 0.001). P20 and P80 displayed significant time x gender x stimulation method interactions (P < 0.05 and P < 0.001, respectively). Both stimulation methods detected significant torque reductions at Post and Post30. Overall, ES tended to detect a greater impairment at Post in male and a lesser one in female subjects at both Post and Post30. Interestingly, the P20-P80 ratio relative decrease did not differ between the two methods of stimulation. The low-to-high frequency ratio only demonstrated a significant time effect (P < 0.001). It can be concluded that low-frequency fatigue due to eccentric exercise appears to be accurately assessable by ES.

Mononeuropathy multiplex in hemophilia: an electrophysiologic assessment.

Single nerve lesion or mononeuropathy caused by extrinsic compression of hematoma or hemarthrosis is consistently reported for hemophilic patients. To study the manifestation of peripheral nerve lesions, an extensive nerve conduction study of peripheral nerves and specific nerves in correlation with clinical involvement was carried out on 126 hemophilic patients. We found 24 patients with 34 peripheral nerve lesions. The frequency of nerve lesion positively correlated with the severity of hemophilia (p < 0.01) and increasing age (p < 0.05). Nerve lesions occurred more commonly in lower extremities than in upper extremities. The femoral nerve was most commonly involved. Seven patients were identified to have mononeuropathy multiplex with 2 or more nerve lesions involving more than one extremity. All of these patients had chronic condition. Our findings suggest that mononeuropathy multiplex may occur in hemophilic patients.

A quantitative assessment of presynaptic inhibition of Ia afferents in spastics. Differences in hemiplegics and paraplegics.

Soleus H-reflex facilitation evoked by a supramaximal conditioning stimulation to the femoral nerve was investigated in 28 healthy control subjects and 35 spastic patients of whom 17 were paraplegics with bilateral spinal cord lesion and 18 were hemiplegics with unilateral cerebral lesion. Heteronymous facilitation from quadriceps to soleus was measured 0.4 ms after onset, while the monosynaptic Ia excitation is still uncontaminated by any non-monosynaptic effect and can be used to assess ongoing presynaptic inhibition on Ia terminals to soleus motor neurons. In paralegics, this heteronymous Ia facilitation was significantly larger than in control subjects (all individual results in these patients being above the mean observed in controls). This must reflect a decrease in presynaptic inhibition of Ia terminals in the paraplegics explored here. There was no correlation between this decreased presynaptic inhibition of Ia terminals and the degree of spasticity measured by Ashworth's scale. Surprisingly, the amount of heteronymous Ia facilitation in hemiplegics was the same as in normal subjects. This indicates that presynaptic inhibition of Ia terminals is unchanged in these patients and disagrees with the usual interpretation of reduced vibratory inhibition of the soleus H-reflex in hemiplegics. It is argued that this disagreement is due to the fact that vibratory inhibition of the reflex also depends on post-activation depression following repetitive synaptic transmission.

Saphenous nerve evoked potentials and the assessment of intraabdominal lesions of the femoral nerve.

A technique for recording somatosensory evoked potentials after stimulation of the patellar branch of the saphenous nerve is described and the results from 11 normal subjects and from two patients with intraabdominal femoral nerve injuries are presented. One patients developed a nerve lesion after an abdominal surgical procedure and the second suffered a gunshot wound causing femoral nerve paralysis. Both patients recovered spontaneously. Evoked potentials from saphenous nerves showed a significant discrepancy between faster motor recovery and delay in reinstating sensory axonal conduction.