Morphological Classification of the Sagittal Tendon Plate in the Soleus Muscle in Japanese Cadavers / Clasificación Morfológica de la Lámina Tendinosa Sagital del Músculo Sóleo en Cadáveres Japoneses

SUMMARY: The human soleus muscle has attracted attention in the fields of sport science, rehabilitation medicine, etc. for improving exercise performance in training, preventing injuries, and rehabilitation. The sagittal tendon plate of the soleus muscle is particularly important in rehabilitation. Few studies, however, have evaluated the shape of the sagittal tendon plate in the human soleus muscle in detail and attempted to classify its variations based on its morphology. In this study, we conducted a detailed analysis of the morphology of the sagittal tendon plates in soleus muscle specimens from Japanese cadavers and constructed a morphology-based classification system and evaluated their frequencies of occurrence. First, the specimens were divided into those with a sagittal tendon plate that was visible on the anterior surface (pennate muscle group) and those without (non-pennate muscle group). Next, based on the "number" and "breadth" of the sagittal tendon plates, the pennate muscle group specimens were further classified into four classes: Class I (one tendon, thin), Class II (one tendon, slightly broad), Class III (one tendon, very broad), and Class IV (two tendons, thin). Subsequently, the specimens were further divided into three types based on the position where the sagittal tendon plate joined the Achilles tendon: median tendon type, lateral tendon type, and medial tendon type (a total 13 divisions). When 458 Japanese soleus muscle specimens were classified into these divisions, the occurrence frequencies of Class I-IV were 80.57 %, 4.59 %, 5.46 %, and 1.09 %, respectively. In Class I, the median tendon type was more frequent than the lateral and medial tendon types, accounting for 48.47 % overall. The classification types of the sagittal tendon plate and their respective occurrence frequencies shown in this study are expected to serve as fundamental data in implementing rehabilitation of soleus muscle.

El músculo sóleo humano ha atraído la atención de la ciencia del deporte, la medicina de rehabilitación, etc. para mejorar el rendimiento del ejercicio en el entrenamiento, prevenir las lesiones y rehabilitación. La lámina tendinosa sagital del músculo sóleo es particularmente importante en la rehabilitación. Sin embargo, pocos estudios han evaluado en detalle la forma de la placa lámina sagital en el músculo sóleo humano y han intentado clasificar sus variaciones en función de su morfología. Realizamos un análisis detallado de la morfología de las láminas de los tendones sagitales en muestras de músculo sóleo de cadáveres japoneses y construimos un sistema de clasificación basado en la morfología y, además, evaluamos su frecuencia de aparición. Los especímenes se dividieron en aquellos con una lámina de tendón sagital que era visible en la superficie anterior (grupo muscular pennado) y aquellos sin (grupo muscular no pennado). A continuación, según el "número" y el "ancho" de las láminas de los tendones sagitales, las muestras del grupo de músculos pennados se clasificaron en cuatro clases: Clase I (un tendón, delgado), Clase II (un tendón, ligeramente ancho), Clase III (un tendón, muy ancho) y Clase IV (dos tendones delgados). Posteriormente, las muestras se dividieron en tres tipos, según la posición donde la lámina del tendón sagital se unía al tendón calcáneo: tipo de tendón mediano, tipo de tendón lateral y tipo de tendón medial (un total de 13 divisiones). En estas divisiones se clasificaron 458 especímenes de músculo sóleo de indiviuos japoneses, las frecuencias de ocurrencia de Clase I-IV fueron 80,57 %, 4,59 %, 5,46 % y 1,09 %, respectivamente. En la Clase I, el tipo de tendón mediano era más frecuente que los tipos de tendón lateral y medial, representando el 48,47 % del total. Se espera que los tipos de clasificación de la lámina del tendón sagital y sus respectivas frecuencias de aparición, que se reportan en este estudio, sirvan como datos fundamentales para implementar la rehabilitación del músculo sóleo.

Biometría del nervio para el músculo sóleo y sus implicancias clínicas / Nerve biometry for the soleus muscle and its clinical implications

RESUMEN: Las lesiones del nervio fibular común y/o sus ramos derivados trae como consecuencia, pérdida total o parcial de la capacidad para realizar flexión dorsal del complejo tobillo-pie, una opción viable para tratar esta patología es la transferencia nerviosa, que consiste en utilizar un nervio donante para restaurar la función de un nervio dañado. Es frecuente la utilización del nervio para el músculo sóleo (NS) como donante para restaurar la función del nervio fibular común o profundo, por lo cual es indispensable conocer en detalle la anatomía de este nervio. Se utilizaron 22 miembros inferiores pertenecientes a las Unidades de Anatomía de las Universidades de Chile y de Santiago, Chile. Se realizó disección del nervio para el músculo sóleo, se observó número de ramos principales y secundarios, así como también se registró su origen y la longitud de ellos, además se dividió a la pierna en cuadrantes para determinar la localización de los puntos motores. El nervio para el músculo sóleo en la mayoría de los casos (95,4 %) es único y se origina desde el nervio tibial o en tronco común con otro ramo muscular. La distancia promedio entre el origen de NS y la línea biepicondilar fue de 28,77 mm; la longitud promedio de NS hasta su división en ramos secundarios o penetración directa fue de 52 mm. El NS se dividió en ramos secundarios (RS), observándose que en 12 casos fue en 2 RS, en 3 casos en 3 RS y en 7 casos no hubo RS. Los puntos motores se localizaron en el quinto proximal de la pierna, 23 casos en el primer cuadrante lateral y 4 casos en el primer cuadrante medial; en el cuarto proximal de la pierna, 7 casos en el segundo cuadrante lateral y 4 casos en el segundo cuadrante medial. Los datos obtenidos serán un aporte al conocimiento anatómico y a la cirugía reconstructiva de los nervios de la región.

SUMMARY: Injuries to the common fibular nerve and/or its derived branches result in total or partial loss of the ability to dorsiflex the ankle-foot complex. A viable option to treat this pathology is nerve transfer, which consists of using a donor nerve to restore function to a damaged nerve. The use of the nerve for the soleus muscle (SN) is frequent as a donor to restore the function of the common or deep fibular nerve, for which it is essential to know in detail the anatomy of this nerve. Twenty-two lower limbs belonging to the anatomy units of the Universities of Chile and Santiago were used. Dissection was performed until the SN was reached, the number of main and secondary branches (SB) was observed, as well as their origin and length, and the leg was divided into quadrants to determine the location of the motor points. The SN in most cases (95.4 %) is unique and originates from the tibial nerve or from the common trunk with another muscular branch. The average distance between the origin of the NS and the biepicondylar line was 28.77 mm; the average length of NS until its division into SB or direct penetration was 52 mm. The NS was divided into SB, observing that in 12 cases it was in 2 branches, in 3 cases in 3 branches and in 7 cases there were no SB. The motor points were located in the proximal fifth of the leg, 23 cases in the first lateral quadrant and 4 cases in the first medial quadrant; in the proximal quarter of the leg, 7 cases in the second lateral quadrant and 4 cases in the second medial quadrant. The data obtained will be a contribution to anatomical knowledge and reconstructive surgery of the nerves of the region.

Application of soleus perforator flapfrom the lateral leg in repair of oral and maxil-lofacial defects / 医学研究生学报

ObjectiveReconstruction of oral and maxillofacial defects following resection of oral and maxillofacial malignant tumors is required to restore the patient's appearance and oral function. The aim of this study was to evaluate the application and value ofsoleus perforator flap from the lateral leg in repair of oral and maxillofacial defects.MethodsIn this retrospective study, ten patients with oral and maxil-lofacial malignancies who were admitted to the Department of Oral and Maxillofacial Surgery in Fuyang People's Hospital during the period from May 2015 to March 2019 were enrolled. The effect of soleus perforator flap from the lateral leg was ana-lyzed.At 1 month and 3 months after surgery, the recovery of oral function and donor sites, quality of life and surgical satisfaction were followed.ResultsAllpatients underwent operation successfully without skin flap necrosis or serious complications.At 3 months after surgery,voice function and swallowing func-tion were level 3. The scar hyperplasia was 1 case,donor itching1 case and paresthesia or dysfunction 0 case.Compared with those at 1 month after surgery, the scores at 3 months after surgery were increased using the University of Washington Quality of Life (UW-QOL) questionnaire(P<0.05). At 1 month and 3 months after sur-gery,patient satisfaction rateswere 80.00% and 90.00%, respectively.ConclusionThe soleus perforator flap from the lateral leg isideal for repairing oral and maxillofacial defects. The postoperative recovery of oral functio-nand donor sites is goodwith high quality of life and surgical satisfaction.

MRI presentation and pathogenesis of tennis legs / 中华放射学杂志

Objective To evaluate the imaging features of MRI of tennis legs and to explore the pathogenesis of tennis legs. Methods A retrospective analysis was made on the MRI images of 38 patients with tennis legs which met the criteria and were clinically diagnosed in our hospital from May 2014 to June 2018. All patients underwent non?enhanced MRI. Coronal T1WI、T2WI fast spin echo (TSE) and transverse proton density weighted imaging (PDWI) were performed. The signs of fluid collection between gastrocnemius muscle (GM) and soleus muscle (SM),muscle and tendon injuries, superficial vein dilatation of calf were observed and recorded. Results Coronal T1WI, T2WI TSE and transverse PDWI sequences showed 30 (75.0%) places fluid collection (hematoma or effusion) between medial head of the gastrocnemius muscle (MCM) and SM, 11 (27.5%) places fluid collection (hematoma or effusion) between lateral head of gastrocnemius muscle(LGM)and SM,7 (17.5%) places fluid collection (hematoma or effusion) in MGM and 2 (5.0%) placesin SM. There were 17 (42.5%) places that hematoma or effusion spread around the fascia of the lower leg. The diameter and thickness of hematoma or effusion are about 1.7-22.3 cm and 0.2-3.5 cm, respectively. Rupture of the GM was seen in 37 (92.5%) places,including 37 places rupture of the MGM at the myotendinous junction, 15 places rupture of the LGM at the myotendinous junction, 24 places tendonrupture of MGM,3 places tendon rupture of MGM and LGM,and 2 places tendon rupture of LGM. The maximum diameter of tendon rupture was 1.2-27.0 mm. The muscle rupture of MGM was seen in one place, and muscle rupture of MGM and LGM was seen in one place at the same time. Rupture of the SM was seen in 15 (37.5%) places, including 15 places rupture of the SM at the myotendinous junction, 2 places muscle rupture of SM, 6 places tendonrupture of SM. The maximum diameter of tendon rupture was 2.5-14.9 mm. Rupture of plantaris tendon (PT) was seen in 4 (10.0%) places. Superficial vein dilatation was seen in 3 (7.5%) places. Conclusion This study shows that the rupture of the MGM at the myotendinous junction and the tendon is the main responsibility of tennis leg.

Effects of Treadmill Running on Capillary Density and Apelin Expression in Soleus Muscle of High-fat Diet Rats / 中国运动医学杂志

Objective To observe the alteration of capillary density and apelin/APJ expression in soleus muscles of high-fat diet rats.Methods Male 5-week-old Sprague-Dawley rats were randomly divided into a control group and a high-fat diet group.After 12 weeks of high-fat diet,16 rats were se lected and randomly divided into a sedentary group and a treadmill running group.The exercise rats underwent 60-minute treadmill running at 26 m/min 5 days a week for 10 weeks.The body weight,body fat and blood lipid level were measured for all rats.The protein expression of Soleus CD31 and apelin was determined using immunohistochemical staining,soleus apelin content was determined using the radioimmunoassay,and the mRNA expression of apelin/APJ was detected using real-time PCR.Results Compared with the control group,significant increase was observed in the body weight,body fat and the level of total triglyceride,total cholesterol and low density lipoprotein cholesterin,but significant decrease was found in the high density lipoprotein cholesterin in the high-fat diet group.There were no significant differences in the capillary density and mRNA levels of apelin/APJ between the two groups.Compared with the sedentary high-fat diet group,significant improvement was observed in the body weight and blood lipid level of the treadmill running group.Moreover,significant increase was also observed in the capillary density,the expression of apelin/APJ mRNA,as well as that of apelin protein in the treadmill running group (P＜0.05).Conclusion The treadmill running can significantly increase capillary density of obese rats,as it may activate the expression of Apelin/APJ.

The effect of ß-hydroxy-ß-methylbutyrate (HMB) on the morphology of skeletal muscle after concurrent training

The aim of the present study was to investigate the effects of β-hydroxy-β-methylbutyrate (HMB) supplementation in association with concurrent training on morphological soleus muscle of rats. Wistar male rats were divided randomly into four groups: Control (C), Supplemented (S), Training (T) and Training + Supplemented (TS). Groups S and TS received 76mg/kg/day of HMB and the training groups (T and TS) were inserted into concurrent training program 3 times/week for 8 weeks. HMB had positive effects either on body composition of the animals or in type II muscle fibers. The concurrent exercise training was able in reducing the total fat mass as well as in increasing the diameter of muscle fibers. Our findings shows that HMB had an anti-catabolic effect with reference to the parameters of volume, weight and morphology of the soleus muscle, and there was a positive interaction between HMB supplementation and concurrent exercise training

Tratamento das áreas cruentas de perna com retalhos locais / Treatment of open wounds of the leg by using local flaps

INTRODUÇÃO: Até os anos 70, a reparação de perdas de substância na perna representava, quase sempre, um problema de solução muito difícil ou, até, insolúvel. Atualmente, embora ainda constitua um campo para os mais experientes, as áreas cruentas na perna já contam com várias técnicas confiáveis e algumas relativamente simples para sua reparação. Este trabalho visa equacionar condutas reparadoras de feridas de perna, utilizando tecidos locais. MÉTODO: Estudo retrospectivo pela análise de casos de reconstrução de perna com retalhos locais realizados pelos autores. Foram incluídos os retalhos dermoadiposos, fasciocutâneos, fasciossubcutâneos e musculares. RESULTADOS: Foram operados 70 pacientes que possuíam áreas cruentas na perna, em consequência de fratura de tíbia, osteomielite, perda tecidual isquêmica, úlcera crônica e tumoração de pele. Os resultados foram avaliados segundo etiologia, tipo de procedimento cirúrgico e complicações. CONCLUSÕES: A opção do tratamento de áreas cruentas de membros inferiores com retalhos locais é bastante válida. A escolha do retalho vai depender de condições locais da perna e da região anatômica afetada. No terço superior da perna, utilizamos retalhos fasciocutâneos baseados na rede vascular do joelho ou retalho de gastrocnêmio. Já no médio, os principais retalhos foram o solear e o fasciossubcutâneo de panturrilha. E, por fim, no inferior, o principal retalho usado foi o fasciossubcutâneo de panturrilha.

INTRODUCTION: Until the 70s, repairing loss of tissue in the leg was almost always difficult, or even impossible. Currently, only the most experienced surgeons are able to repair open wounds of the leg. Nevertheless, several reliable and simple techniques are currently available. This work aimed to evaluate repair techniques for leg wounds by using local tissues. METHOD: The authors performed a retrospective study of cases of leg reconstruction using local flaps. Dermoadipose, fasciocutaneous, fasciosubcutaneous, and muscle flaps were used. RESULTS: Seventy patients who had open areas in the leg due to tibial fractures, osteomyelitis, ischemic tissue loss, chronic ulcer, or skin tumor underwent surgery. Results were evaluated according to etiology, type of surgical procedure, and complications. CONCLUSIONS: The option of treating open wounds of the lower limbs by using local flaps is very valid. Selection of the flap type depended on local conditions in the leg, and the anatomical region affected. In the upper third of the leg, we used fasciocutaneous flaps, based on the vascular network of the knee, or gastrocnemius flaps. In the middle third of the leg, we used the soleus muscle as the primary flap, and fasciosubcutaneous flaps in the calf region. In the lower third of the leg, a fasciosubcutaneous flap of the calf was primarily used.

Anatomical study of the nerve regeneration after selective neurectomy in the rabbit: clinical application for esthetic calf reduction / 대한해부학회지

The purposes of this study were therefore to characterize the degeneration and regeneration of nerves to the calf muscles after selective neurectomy, both macroscopically and microscopically, and to determine the incidence of such regeneration in a rabbit model. Seventy four New Zealand white rabbits were used. Selective neurectomy to the triceps surae muscles was performed, and the muscles were subsequently harvested and weighed 1-4 months postneurectomy. The gastrocnemius muscles were stained with Sihler's solution to enable the macroscopic observation of any nerve regeneration that may have occurred subsequent to neurectomy. The change in triceps surae muscle weight was measured along the time course of the experiment. After neurectomy, nerve degeneration was followed by regeneration in all cases. The weight of the triceps surae muscle decreased dramatically between completion of the neurectomy and 1 month postneurectomy, but increased thereafter. The nerve branches were weakly stained with Sihler's solution until 2 months postneurectomy, and then strongly stained after 3 months. The number of myelinated axons was decreased at 2 month after neurectomy compared to nonneurectomized controls, but then gradually increased thereafter. Although there are currently no reports on the incidence of recovery after calf reduction, it may be a very common occurrence in the clinical field based on our findings. The findings of this study provide fundamental anatomical and surgical information to aid planning and practice in calf-reduction surgery.

Immobilization and therapeutic passive stretching generate thickening and increase the expression of laminin and dystrophin in skeletal muscle

Extracellular matrix and costamere proteins transmit the concentric, isometric, and eccentric forces produced by active muscle contraction. The expression of these proteins after application of passive tension stimuli to muscle remains unknown. This study investigated the expression of laminin and dystrophin in the soleus muscle of rats immobilized with the right ankle in plantar flexion for 10 days and subsequent remobilization, either by isolated free movement in a cage or associated with passive stretching for up to 10 days. The intensity of the macrophage response was also evaluated. One hundred and twenty-eight female Wistar rats were divided into 8 groups: free for 10 days; immobilized for 10 days; immobilized/free for 1, 3, or 10 days; or immobilized/stretched/free for 1, 3, or 10 days. After the experimental procedures, muscle tissue was processed for immunofluorescence (dystrophin/laminin/CD68) and Western blot analysis (dystrophin/laminin). Immobilization increased the expression of dystrophin and laminin but did not alter the number of macrophages in the muscle. In the stretched muscle groups, there was an increase in dystrophin and the number of macrophages after 3 days compared with the other groups; dystrophin showed a discontinuous labeling pattern, and laminin was found in the intracellular space. The amount of laminin was increased in the muscles treated by immobilization followed by free movement for 10 days. In the initial stages of postimmobilization (1 and 3 days), an exacerbated macrophage response and an increase of dystrophin suggested that the therapeutic stretching technique induced additional stress in the muscle fibers and costameres.

Efeito do treinamento concorrente nas fibras musculares de ratos Wistar / Efecto del entrenamiento concurrente en fibras musculares de las ratas Wistar / Concurrent training effect on muscle fibers in Wistar rats

The aim of the present study was to determine the modeling of muscle fibers in rats submitted to different exercise protocols. Fifty-five Wistar rats were submitted divided into four different groups: Control group (CG; N=16); endurance training group (ETG; N=13), strength training group (STG; N=13) and concurrent training group (CTG; N=13). The intensity of endurance training was determined by the critical workload. Statistical analysis involved the Kruskal-Wallis test for multiple comparisons, followed by Dunn's post test (p<0.05). All animals submitted to training exhibited an increase in the cross-sectional area of the muscle fibers. The largest increase (p>0.05) occurred in the STG and CTG at both four (mean:2952,95 ± 878,39 mean:2988,84 ± 822,58) and eight weeks respectively (mean:3020,26 ± 800.91; mean:3104,91 ± 817,87). The findings demonstrate similar results obtained with strength training and concurrent training, with a greater increase in muscle fiber area in both groups in comparison to the control group and group submitted to endurance training.

O objetivo deste estudo foi observar a modelação das fibras musculares de ratos submetidos a diferentes protocolos de treinamento físico. Foram utilizados 55 animais da raça Wistar, dos quais foram submetidos a quatro diferentes tratamentos, sendo estes: o grupo controle (CTLE), treinamento aeróbio (TAE), treinamento de força (TAN) e treinamento concorrente (TCc). A intensidade do treinamento aeróbio foi determinada pela carga crítica de trabalho. Utilizou-se o teste de Kruscal-Wallis para comparações múltiplas, com pós-teste de Dunn, adotou-se o valor de significância de 5% (p=0,05). Observou-se que os grupos de animais treinados mostraram aumento na área de secção transversa (AST) das fibras musculares. Não foi verificada diferença significante (p>0,05) entre os grupos TAN e TCc, tanto em quatro (média:2952,95 ± 878,39 média:2988,84 ± 822,58) como após oito semanas (média:3020,26 ± 800,91; média:3104,91 ± 817,87). Os protocolos de TAN e TCc não se diferenciaram entre si e demonstraram aumento da AST quando comparados aos demais grupos de animais.

Nota el modelado de las fibras musculares en ratas sometidas a diferentes protocolos del entrenamiento físico. Se utilizaron 55 ratas Wistar, que fueron sometidas a cuatro tratamientos diferentes: grupo de control (CTLE), entrenamiento aeróbico (TAE), entrenamiento de fuerza (TF) y la entrenamiento concurrente (TC). La intensidad de entrenamiento aeróbico se determinó por el carga crítica del trabajo. Se utilizó la prueba Kruscal-Wallis para comparaciones múltiples con Dunn del postest, se adoptó el nivel del significancia en 5% (p=0,05). Se observó que lós grupos de animales entrenados mostraron una mayor área de sección transversal (AST) en las fibras musculares. No hubo diferencia significativa (p>0,05) entre el TF y TC, tanto en cuatro (media:2952,95 ± 878,39; media:2988,84 ± 822,58) y después de ocho semanas (media:3020,26 ± 800,91; media:3104,91 ± 817,87). Se concluyó que los protocolos de TF y TC no difirieron. Además, demostraron aumento del AST en comparación con los otros grupos de animales.

Enzymatic dissociation of long muscles from mice: a model for the study of skeletal muscle fiber types / Disociación enzimática de músculos largos de ratón: un modelo para el estudio de los tipos de fibras del músculo esquelético

The enzymatic dissociation of short muscles from mice, such as flexor digitorum brevis, has allowed a great accumulation of physiological, pharmacological and biochemical knowledge about skeletal muscle. However, this body of knowledge has been restricted to the types of fibers present in these muscles. Information about the other fiber types has been limited and has been primarily obtained by the manual isolation of fibers from other species, typically rats, via a difficult and time-consuming procedure. In this report, the author describes a technique for the enzymatic dissociation of long muscles, such as soleus or extensor digitorum longus (EDL), which can be applied to study a wider spectrum of fiber types and larger quantities of cells. Additionally, the kinetics of Ca2+ transients obtained in soleus and EDL fibers are compared in this report. The usefulness of this methodology for other physiological, biochemical and molecular biology experiments is also discussed. This methodology introduces the possibility of using the whole spectrum of fiber types to study normal muscle biology and the pathophysiology of muscle diseases.

La disociación enzimática de músculos cortos de ratón, como el flexor digitorum brevis, ha permitido la acumulación de gran cantidad de información fisiológica, farmacológica y bioquímica sobre el músculo esquelético, la cual, sin embargo, ha estado limitada a los tipos de fibras presentes en estos músculos. La acumulación de información sobre los demás tipos de fibras ha sido escasa y se ha logrado mediante el aislamiento manual de fibras en otras especies, clásicamente en ratas: un procedimiento difícil y que toma mucho tiempo. En este trabajo se presenta una descripción de la técnica que permite la disociación enzimática de músculos largos de ratón como el soleus o el extensor digitorum longus (EDL), lo cual aumenta el espectro de tipos de fibras y el número de ellas disponibles para el estudio de los fenómenos biológicos en el músculo esquelético. Además se compara la cinética de los transitorios de Ca2+ en fibras de soleus y EDL y se prueba la utilidad del modelo en otros experimentos que utilizan técnicas de fisiología, bioquímica y biología celular. Esto abre la posibilidad de utilizar todo el espectro de fibras musculares para estudiar la biología muscular y la fisiopatología de las enfermedades musculares.

El uso de colgajos en la reconstrucción de defectos de cobertura en la pierna distal y dorso de pie / The use of flaps in the reconstruction of defects of coverage in the distal leg and dorsum of the foots

Resumen Objetivo: Mostrar las posibilidades quirúrgicas que existen en el tercio distal de la pierna y presentar la experiencia en los últimos 15 años con estos colgajos. Materiales y métodos: Se revisó durante 15 años los colgajos de sóleo directo e invertido, fasciocutáneos, de sural invertido y algunos colgajos libres para cubrir defectos en el tercio distal de la pierna y pie. Resultados: Se revisó a 112 pacientes con seguimiento mínimo de 3 meses; 18 tenían compromiso del tobillo y pie y el resto tenía exposiciones de tendones y/o de elementos neurovasculares. Los colgajos más usados fueron el sóleo, el sural invertido y el fasciocutáneo invertido. Se presentaron complicaciones menores, como necrosis distal de bordes, en cuatro colgajos, sin afectar la cobertura final. Un colgajo libre sufrió necrosis total. Discusión: Fracturas abiertas de tibia requieren cobertura rápida para disminuir los índices de infección y favorecer la curación. El sóleo sigue siendo de los más usados entre los colgajos locales para los defectos del tercio medio de la tibia. En esta serie se muestra que es apto para muchas reconstrucciones en la pierna distal, ya que se evita muchas veces el uso de un colgajo libre. El colgajo sural invertido es de gran seguridad y versatilidad, y llega a cubrir muchas veces defectos grandes en el dorso del pie y en el talón. Los colgajos libres son de mayor complejidad, debido a que se requiere personal especializado, así que es recomendable solucionar estos problemas con colgajos locales musculares, fasciocutáneos o neurocutáneos.

Abstract Objectives: report the surgical possibilities that exist in the distal third of the leg and present the experience in the past 15 years with these flaps Materials and methods: During 15 years we performed different flaps like soleus flaps, reversed fasciocutaneous flaps, reversed sural flaps and some microsurgical free flaps to cover defects in the distal third of the leg and the foot Results: We reviewed 112 patients followed at least 3 months, 18 had ankle joint or foot exposure and the other had exposure tendons and / or neurovascular elements. The most used flaps were the soleus, the reversed sural and the reversed fasciocutaneous. Distal necrosis was observed in the edge of the four flaps, but not affecting the final coverage. One of the free flaps suffered a total necrosis. Discussion: Open tibial fracture required fast coverage to reduce infection and promote healing.The soleus muscle is still the main flap to cover the defects of the middle third of the tibia. This series shows that this flap is suitable for many distal leg reconstructions, often avoiding the use of a free flap. The reverse sural flap is very safe and versatile, and is a good option to cover defects on the dorsum of the foot and heel. Free flaps are of greater complexity requiring specialized staff. It is recommended to solve these problems with local flaps, muscle flaps, fasciocutaneous or neurocutaneous flaps.

The effects of fracture fixation on joint contracture and disuse atrophy in immobilized rat soleus muscle / 体力科学

In the present study, we investigated the effects of fracture fixation on joint contracture and disuse muscle atrophy. We surgically fractured the right hind limbs of male Wistar rats, and then fixed the right ankle joints at maximal plantar flexion for two weeks using dorsal splints. Compared with immobilized healthy and sham operated joints, the fractured joints concomitantly showed highly restricted range of motion and significantly higher degrees of disuse atrophy in soleus muscle; decrease of muscle fiber cross sectional area, development of central core lesion and a change in myosin heavy chain isoforms from slow type myosin to fast type myosin. Therefore, it is suggested that orthopedic fracture fixation induces intense disuse muscle atrophy to aggravate joint contracture.

Feathered fibres of human soleus muscle / Fibras penniformes del músculo sóleo humano

The large size of superficial group of muscles of back of leg is a characteristic feature of the musculature of man being related directly to its erect posture and mode of progression. Triceps surae is one of the powerful muscles of the body after Gluteus maximus and Quadriceps femoris. To make the muscle more powerful nature has devised a unique method of packing the fibers in a small space by pennation. There exists a bipenniform mass as a peculiarly human feature. Its feathered fasciculi arise from the deep (anterior) surface of the soleus muscle. Most of the textbooks of Anatomy and the available literature on the triceps surae or the tendoachillis do not appreciate and describe this fascinating aspect of the muscle. It was Schafer et al. (1923) who gave a detailed account of this muscle. Standring et al. (2005) have also described this muscle in great detail. We have studied the unique features of this part of soleus muscle. Bipennate arrangement was seen in 86 percent (right-83 percent; left-89 percent); and its maximum width was found to be 3.63 cm (Rt-3.71cm; Lt-3.55cm). Median tendinous septum was directed backwards and medially. Thus this muscle will further increase the power of contraction of soleus, which is so very important for a bipedal gait.

El gran tamaño de los grupos musculares superficiales de la parte posterior de la pierna es un rasgo característico de la musculatura del hombre siendo relacionado directamente con su postura erguida y el modo de progresión. El músculo tríceps sural es uno de los músculos más potentes del cuerpo después de los músculos glúteo magno y cuadríceps femoral. Para hacer al músculo más potente, la naturaleza ha ideado un método único de empaquetamiento de las fibras en un pequeño espacio por pennación. Existe una masa bipenniforme como una característica peculiarmente humana. Los fascículos pennados surgen desde la superficie profunda (anterior) del músculo sóleo. La mayoría de los textos de Anatomía y la literatura disponible sobre el músculo tríceps sural o el tendón de Aquiles no se aprecia ni se describe este aspecto fascinante que tienen los músculos. Fue Schafer (1923) quien dió una detallada descripción del músculo sóleo y posteriormente, Standring et al. (2005) también describieron detalladamente al músculo. Estudiamos las características únicas de esta parte del músculo sóleo, observando una disposición bipenniforme en el 86 por ciento de los casos (derecha 83 por ciento; izquierda 89 por ciento). El ancho máximo del músculo fue de 3,63 cm (derecha 3,71cm; izquierda 3,55cm). El septo tendinoso mediano se dirigió hacia posterior y medial, aumentando así aún más el poder de contracción del músculo sóleo, el cual es muy importante para la bipedestación.

Hidatidosis primaria de la musculatura de la pierna que simula un caso de fasceítis eosinofílica: reporte de un caso / Hydatid cyst of the soleus muscle: report of one case

Hydatid cysts may occasionally be confused with soft tissue tumors such as sarcomas. We report a 43 years oíd female living in a rural zone, presenting with a painful tumor in her left leg. A CAT sean showed the presence of a solid-eystic lesion in the left soleus muscle. A biopsy of the zone was informed as eosinophilic fasceitis and steroids were indicated. Two months later a new CAT sean showed that the lesion was increasing in size. An IgG for hydatidosis was positive. The patient was subjected to a cystectomy and the pathology report informed a hydatid cyst.

En nuestro país la hidatidosis sigue siendo un importante problema de salud pública. Generalmente compromete el hígado y el pulmón, sin embargo, se han reportado casos con compromiso de diversos órganos, como bazo, peritoneo y otras ubicaciones. Excepcionalmente puede presentarse como un tumor de partes blandas simulando un sarcoma u otro tumor. Presentamos un caso clínico de una paciente con hidatidosis de la musculatura de la pierna derecha tratado en el Hospital Base Osorno, que simuló una fasceítis eosinofílica; además se revisa el estado del arte de la hidatidosis muscular.

Myostatin Gene Expression Level in the Soleus Muscle of Tail-Suspended Rats / 中国实验动物学报

Objective To study the effect of tail-suspending on myostatin(MSTN)expression in the soleus muscle of rats.Methods The MSTN mRNA levels in soleus muscle of tail-suspended and normal control rats were measured and compared.Results The MSTN mRNA in soleus muscle of tail-suspended rats was 2.2 times(hind limb unloading for 14 days)and 3.5 times(hind limb unloading for 30 days) higher than that in normal control rats (P<0.05).The relative wet weight of the soleus muscle in tail-suspended rats was decreased by 11%(unloading 14 days)and 1 9%(unloading 30 days),respectively,compared with that in normal control rats.Conclusion The expression of MSTN mRNA is elevated in the soleus muscle of tail-suspended rats,probably due to atrophy of the soleus muscle.

Estudo morfométrico do músculo sóleo de ratos da linhagem wistar pós?imobilização articular / Morphometric study of post-joint immobilization of soleus muscle on wistar lineage rats

Todos os tipos de imobilização contribuem para a atrofia muscular e, em apenas alguns dias, os músculos passam por diminuição de volume ou perda de função, conhecidos como atrofia. Assim, com uma ou duas semanas de imobilização, as atividades metabólicas são consideravelmente reduzidas e suas fibras musculares substituídas por tecido cicatricial fibroso denso. Dessa forma, este estudo teve como objetivo analisar o efeito da imobilização articular do músculo sóleo do membro posterior de ratos no perfil morfométrico, em diferentes períodos. Foram utilizados dez Rattus navergicus albinus machos, variedade Wistar, que foram divididos em dois grupos com cinco animais cada, sendo o primeiro grupo submetido à imobilização por sete dias e o segundo por 14 dias. O controle do experimento foi obtido a partir do membro contralateral direito do respectivo animal. A imobilização do membro posterior esquerdo foi por meio de uma órtese adaptada. A análise morfométrica do sóleo foi realizada por meio de cortes transversais não seriados de 5 µm de espessura. Foram analisadas, por meio das imagens obtidas, a área das fibras musculares, juntamente com a densidade do tecido conjuntivo, comparando-as ao Grupo-controle, referentes à perna contralateral. Com sete e 14 dias de imobilização, pode-se observar redução significativa (p < 0,05) na área das fibras musculares, associada a um aumento dos espaços intersticiais, principalmente ao redor dos fascículos musculares. Isto sugere ampliação na densidade do tecido conjuntivo e hipotrofia muscular. Com isso, conclui-se que a imobilização, mesmo que por curto período de tempo, pode alterar a integridade da musculatura esquelética, com importantes implicações funcionais.

All types of immobilization contribute to muscular atrophy and, in a few days, the muscles undergo volume reduction or loss of function, known as atrophy. Thus, with one or two weeks of immobilization, metabolic activities are considerably reduced and muscle fibers are replaced by dense fibrous scar tissue. This study has as objective to analyze the effect of joint immobilization of the soleus muscle of posterior members of rats on morphometric profile view, at periods of 7 and 14 days. Ten male Rattus navergicus albinus, Wistar variety, were used, separated into two groups of 5 animals each, with the first group submitted to immobilization for 7 days and the second for 14 days. The experiment control was acquired from the right contralateral member of each animal. The immobilization of the left posterior member was done by adapted orthesis. The morphometric analysis of soleus was by non-serial cross sections, 5µm thick. From the obtained images, the muscle fibers areas were analyzed, including connective tissue density, comparing with the control group. With 7 and 14 days of immobilization, a significant reduction (p < 0.05) in muscle fiber area can be observed, associated with an increase in interstitial spaces, mostly around muscle fascicules. This suggests there is an increase in conjunctive tissue density and muscular hypotrophy. Thus, it can be concluded that immobilization, even for a short period of time, can change skeletal musculature, with important functional implications.

The effect of a low dose of clenbuterol on rat soleus muscle submitted to joint immobilization

The aim of the present study was to evaluate the effect of joint immobilization on morphometric parameters and glycogen content of soleus muscle treated with clenbuterol. Male Wistar (3-4 months old) rats were divided into 4 groups (N = 6 for each group): control, clenbuterol, immobilized, and immobilized treated with clenbuterol. Immobilization was performed with acrylic resin orthoses and 10 µg/kg body weight clenbuterol was administered subcutaneously for 7 days. The following parameters were measured the next day on soleus muscle: weight, glycogen content, cross-sectional area, and connective tissue content. The clenbuterol group showed an increase in glycogen (81.6 percent, 0.38 ± 0.09 vs 0.69 ± 0.06 mg/100 g; P < 0.05) without alteration in weight, cross-sectional area or connective tissue compared with the control group. The immobilized group showed a reduction in muscle weight (34.2 percent, 123.5 ± 5.3 vs 81.3 ± 4.6 mg; P < 0.05), glycogen content (31.6 percent, 0.38 ± 0.09 vs 0.26 ± 0.05 mg/100 mg; P < 0.05) and cross-sectional area (44.1 percent, 2574.9 ± 560.2 vs 1438.1 ± 352.2 µm²; P < 0.05) and an increase in connective tissue (216.5 percent, 8.82 ± 3.55 vs 27.92 ± 5.36 percent; P < 0.05). However, the immobilized + clenbuterol group showed an increase in weight (15.9 percent; 81.3 ± 4.6 vs 94.2 ± 4.3 mg; P < 0.05), glycogen content (92.3 percent, 0.26 ± 0.05 vs 0.50 ± 0.17 mg/100 mg; P < 0.05), and cross-sectional area (19.9 percent, 1438.1 ± 352.2 vs 1724.8 ± 365.5 µm²; P < 0.05) and a reduction in connective tissue (52.2 percent, 27.92 ± 5.36 vs 13.34 ± 6.86 percent; P < 0.05). Statistical analysis was performed using Kolmogorov-Smirnov and homoscedasticity tests. For the muscle weight and muscle glycogen content, two-way ANOVA and the Tukey test were used. For the cross-sectional area and connective tissue content, Kruskal-Wallis and Tukey tests were used. This study emphasizes the importance of anabolic pharmacological...

Efeito do treinamento físico com diferentes temperaturas nas características morfológicas do músculo sóleo de ratos / The effects of physical training under different temperatures on the morphologic characteristics of the rat soleus muscle

O presente estudo teve por objetivo avaliar o efeito de diferentes temperaturas no músculo sóleo de ratos submetidos ao treinamento físico. Quinze ratos, da linhagem Wistar, machos, com idade de 100 ± 10 dias e peso variando entre 300 e 350 gramas, foram divididos em: Grupo Controle (n=5), Grupo 12ºC (n=5) e Grupo 33ºC (n=5). Os animais do grupo controle não realizaram o treinamento. Os grupos experimentais 12ºC e 33ºC foram exercitados por 5 semanas, 3 vezes por semana, inicialmente por 15 minutos, sendo o tempo aumentado gradualmente até 60 minutos. Os animais foram sacrificados 24h após o último dia de corrida e amostras do músculo sóleo foram coletadas e congeladas em nitrogênio líquido. Cortes histológicos (8?m) foram submetidos à coloração por HE. No grupo G33ºC, os animais apresentaram grande dificuldade para realizar a corrida, mostrando sinais de fadiga e exaustão. A avaliação histológica do músculo sóleo do grupo controle mostrou fibras musculares com morfologia preservada, aspecto poligonal, núcleos periféricos e organizadas em fascículos pelo perimísio, envoltas pelo endomísio. As características morfológicas identificadas nos animais dos grupos G12ºC e G33ºC foram: fibras de diferentes diâmetros, hipertróficas, atróficas, splitting, intenso infiltrado inflamatório, edema, fagocitose e necrose. Este estudo morfológico encontrou lesões nos dois grupos treinados; não houve diferença no grau de lesão muscular nos dois grupos experimentais, porém os animais do grupo 12ºC não apresentaram dificuldades para realização da corrida. No conjunto, os resultados mostram que o protocolo de treinamento com temperaturas de 12ºC e 33ºC induziu lesões no músculo sóleo de rato.

This study assesses the effects of different temperatures on the rat soleus muscle submitted to physical training. Fifteen male 100±10 yrold, 300-350g, Wistar rats were divided into: Control Group (n=5), 12ºC Group (n=5) and 33ºC Group (n=5). Animals from Control Group performed no exercise. Animals from the experimental 12ºC and 33ºC Groups performed exercises for 5 weeks, 3 times a week, at fi rst for 15 min, increasing gradually to 60 min. The animals were sacrifi ced 24h after the last running day, and soleus muscle samples were collected and frozen in liquid nitrogen. Histological cuts (8?m) were HE-stained. In the 33ºC Group, the animals presented a great diffi cult to keep running, showing signs of fatigue and exhaustion. The histological analysis of the soleus muscle from Control Group showed muscle fi bers with preserved morphology, polygonal aspect, peripherals nucleus and organized in fascicles by perimysium involved by endomysium. The morphological characteristics identifi ed in the animals from the experimental 12ºC and 33ºC Groups were: different diameter fi bers, hypertrophic, atrophic, splitting, intense infl ammatory infi ltrate, edema, phagocytosis, and necrosis. This morphologic study showed injuries in both exercised groups; there was no difference in the muscular lesion grade between the two temperatures, and the best performance was from the 12ºC Group. After all, the result shows that the training protocol at 12ºC and 33ºC induced rat soleus muscle injuries.

The Accessory Soleus Muscle: Case Report and a Review of the Literature / El Músculo Soleo Acesorio: Reporte de Caso y Revisión de la Literatura

Durante una disección de rutina, se encontró un músculo soleo accesorio, en la pierna izquierda de un cadáver masculino. El músculo se localizaba posteromedialmente en la pierna, entre los músculos flexor largo de los dedos y largo del hálux. Su origen estaba en el tercio superior de la fascia anterior del músculo soleo y su inserción se realizaba, a través de un tendón en la superficie anteromedial del hueso calcáneo.

An accessory soleus muscle was found in the left leg of a male cadaver in the dissecting room. The muscle was situaded posteromedially, between the soleus muscle and the flexor digitorum longus and flexor hallucis longus. The origin of the muscle was in the superior third of the anterior fascia of the soleus muscle and the insertion, was attached with separate tendon, in the anteromedial surface of calcaneus bone.