Body position and cuff size influence lower limb arterial occlusion pressure and its predictors: implications for standardizing the pressure applied in training with blood flow restriction.

Background: Arterial occlusion pressure (AOP) is a relevant measurement for individualized prescription of exercise with blood flow restriction (BFRE). Therefore, it is important to consider factors that may influence this measure. Purpose: This study aimed to compare lower limb AOP (LL-AOP) measured with 11 cm (medium) and 18 cm (large) cuffs, in different body positions, and explore the predictors for each of the LL-AOP measurements performed. This information may be useful for future studies that seek to develop approaches to improve the standardization of pressure adopted in BFRE, including proposals for equations to estimate LL-AOP. Methods: This is a cross-sectional study. Fifty-one healthy volunteers (males, n = 25, females, n = 26; Age: 18-40 years old) underwent measurement of thigh circumference (TC), brachial blood pressure, followed by assessments of LL-AOP with medium and large cuffs in positions supine, sitting and standing positions. Results: The large cuff required less external pressure (mmHg) to elicit arterial occlusion in all three-body positions when compared to the medium cuff (p < 0.001). The LL-AOP was significantly lower in the supine position, regardless of the cuff used (p < 0.001). Systolic blood pressure was the main predictor of LL-AOP in the large cuff, while TC was the main predictor of LL-AOP with the medium cuff. Body position influenced strength of the LL-AOP predictors. Conclusion: Our results indicate that LL-AOP and its predictors are substantially influenced by body position and cuff width. Therefore, these variables should be considered when standardizing the pressure prescribed in BFRE.

Frailty and sarcopenia in patients with acute-on-chronic liver failure: Assessment and risk in the liver transplant setting.

Frailty and sarcopenia are well-recognized factors related to worse outcomes in patients with cirrhosis, including liver transplant (LT) candidates. Implications of pre-LT functional and muscle deterioration also affect post-LT outcomes. Patients with cirrhosis and acute-on-chronic liver failure (ACLF) have a lower survival rate, both before and after LT. There is a need to better identify those patients with ACLF who would benefit from LT. This review aims to present the available data about frailty and sarcopenia in patients with ACLF in the LT setting. An exhaustive review of the published literature was conducted. Data regarding frailty and sarcopenia in LT candidates with ACLF are scarce and heterogeneous. Studies evaluating frailty and sarcopenia in critically ill patients outside the liver literature are also presented in this review to enrich the knowledge of this field in expansion. Frailty and sarcopenia seem to contribute to worse outcomes in LT candidates with ACLF, both before and after LT. Sarcopenia evaluation may be the most prudent approach for those very sick patients. Skeletal muscle index assessed by computed tomography is recommended to evaluate sarcopenia. The role of muscle ultrasound and bioelectrical impedance analysis is to be determined. Frailty and sarcopenia are crucial factors to consider on a case-by-case basis in LT candidates with ACLF to improve patient outcomes.

Músculos Isquiotibiales. Análisis de su Uso y Propuesta de Inclusión en Terminologia Anatomica / Hamstring Muscles. Analysis of its Use and Proposal for Inclusion in Terminologia Anatomica

Terminologia Anatomica Internacional publicada el año 2019 en inglés y el 2001 en español contiene los nombres oficiales de las estructuras anatómicas. Sin embargo, existen términos que no están incluidos en esta terminología, y son ampliamente utilizados, es el caso del término músculos isquiotibiales. El objetivo de este trabajo fue analizar la utilización del término músculos isquiotibiales, músculos del compartimento femoral posterior y músculos del compartimento femoral flexor. Se realizó una revisión narrativa que incluyó 37 libros de anatomía, 3 diccionarios de terminología médica y biológica, 10 bases de datos y 15 recursos digitales. En los libros publicados después del año 2001 el 55,6 % utilizaba el término músculos isquiotibiales y el 18,5 % utilizó músculos del compartimento femoral posterior. En ningún diccionario se encontró el uso de los términos músculos isquiotibiales, músculos del compartimento femoral posterior ni músculos del compartimento femoral flexor. En las bases de datos se encontraron 12.104 artículos con el término músculos isquiotibiales, cinco con el término músculos del compartimento femoral posterior y uno con el término músculos del compartimento femoral flexor. En los recursos digitales de anatomía el 50 % utilizaba el término músculos isquiotibiales, el 37,5 % el término músculos del compartimento femoral posterior y el 12,5 % músculos del compartimento femoral flexor. En conclusión, el uso del término músculos isquiotibiales supera ampliamente al uso de los términos indicados por Terminologia Anatomica Internacional. Adicionalmente, este término es anatómicamente descriptivo y unívoco. Al respecto, parece apropiado valorar la incorporación del término músculos isquiotibiales en Terminologia Anatomica Internacional.

SUMMARY: The Terminologia Anatomica published in 2019 in English and 2001 in Spanish conTAIns the official names of anatomical structures. However, there are terms that are not included in this terminology, and are widely used, such as the term "hamstring muscles. The objective of this work was to analyze the use of the terms hamstring muscles, muscles of the posterior compartment of thigh and muscles of the flexor compartment of thigh. A narrative review was carried out that included 37 anatomy books, 3 dictionaries of medical and biological terminology, 10 databases and 15 digital resources. Results: In the books published after 2001, 55.6 % used the term hamstring muscles, 18.5 % muscles of the posterior compartment of thigh and 0 % muscles of the flexor compartment of thigh; In no dictionary was the use of the terms hamstring muscles, muscles of the posterior compartment of thigh or muscles of the flexor compartment of thigh found; In the databases, 12,104 articles were found with the term hamstring muscles, 5 with the term muscles of the posterior compartment of thigh and 1 with the term muscles of the flexor compartment of thigh; In the digital anatomy resources, 50 % used the term hamstring muscles, 37.5 % the term muscles of the posterior compartment of thigh and 12.5 % muscles of the flexor compartment of thigh. In conclusion, the use of the term hamstring muscles far exceeds the use of the terms indicated by the International Anatomical Terminology. Additionally, this term is anatomically descriptive and univocal. In this regard, it seems appropriate to assess the incorporation of the term hamstring muscles in Terminologia Anatomica.

Necrotizing fasciitis of the thigh secondary to perforated rectal cancer: the sciatic foramen as a route for infective spread.

Necrotizing fasciitis (NF) is a potentially life-threatening surgical emergency. It is a rapidly progressive infection of soft tissues, and mortality is related to the degree of sepsis and the general condition of the patient. It is a rare condition that requires a rapid diagnosis and surgical treatment is aggressive debridement. There are a small number of reported cases of perforation of a rectal malignancy leading to NF of the thigh. We present a case with rectal cancer in which the sciatic foramen had provided a channel for the spread of pelvic infection into the thigh.

La fascitis necrotizante es una emergencia quirúrgica potencialmente mortal. Es una infección de tejidos blandos rápidamente progresiva y la mortalidad está relacionada con el grado de sepsis y el estado general del paciente. Es una condición poco común que requiere un diagnóstico rápido, y el tratamiento quirúrgico consiste en un desbridamiento agresivo. Existe un pequeño número de casos notificados de perforación de neoplasia maligna de recto que conduce a fascitis necrotizante del muslo. Presentamos un caso de cáncer de recto en el cual el foramen ciático fue el canal para la propagación de la infección pélvica al muslo.

Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication.

PURPOSE: The hamstrings muscles are innervated by sciatic nerve branches. However, previous studies assessing which and how many branches innervate each muscle have yielded discrepant results. This study investigated the innervation patterns of hamstrings. MATERIALS AND METHODS: Thirty-five cadaver limbs were investigated. The average age of subjects was 78.6 ± 17.2 years, with 48.6% male and 51.4% female, while 57.1% were right limbs and 42.9% left. The sciatic nerve, hamstrings and associated structures were dissected. The number of nerve branches for each muscle and the level where they penetrated the muscle were recorded. RESULTS: The sciatic nerve was connected by a fibrous band to the long head of the biceps femoris. This muscle was innervated by either one or two branches, which penetrated the muscle into its superior or middle third. The short head of the biceps femoris was innervated by a single nerve that usually penetrated its middle third, but sometimes inferiorly or, less commonly, superiorly. The semitendinosus was always innervated by two branches, the superior branch penetrating its upper third, the inferior mostly the middle third. The semimembranosus usually was innervated by a single nerve branch that penetrated the muscle at its middle or lower third. Four specimens revealed common nerves that innervated than one muscle. CONCLUSIONS: We have characterized hamstring innervation patterns, knowledge that is relevant to neurolysis, surgery of the thigh, and other procedures. Moreover, a mechanical connection between the sciatic nerve and biceps femoris long head was identified that could explain certain neuralgias.

Incidence of the tensor of the vastus intermedius: A cadaveric study.

INTRODUCTION: The quadriceps femoris muscle is present in the anterior region of the thigh and is classically described as a muscle with four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. A few years ago, a "fifth head" was described and named the tensor of the vastus intermedius (TVI). The TVI belly is in line with the belly of the vastus lateralis, and its aponeurosis imposes considerable tension on the vastus intermedius, medializing its action, to play a significant role in knee extension. OBJECTIVE: To perform a study of the TVI incidence in a Brazilian population and describe its variations. MATERIAL AND METHODS: We dissected lower limbs from cadavers previously fixed in 10% formaldehyde, belonging to the Laboratory of Anatomy of the Department of Morphology of the Biosciences Center of the Federal University of Rio Grande do Norte. RESULTS: Eighty-one lower limbs were analyzed with only 33 (40.74%) of them presenting TVI. All four types of TVI described by the literature were present in our sample with the following distribution: type 1 with 15.15%; type 2 with 9.1%; type 3 with 33.33%; type 4 with 42.42%. DISCUSSION: Although the literature points to the TVI as a normal belly of the quadriceps, making it a "quinticeps", our analysis points to the TVI as a variation and probably a matter of regionality. However, the presence of TVI is not a rare case and cannot be disregarded, which makes this study important for anatomists, physiotherapists, physicians, and surgeons.

Muscle strength and psychometric properties of the health-related quality of life in patients with soft tissue sarcoma resection in the thigh.

OBJECTIVES: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. METHODS: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). RESULTS: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). CONCLUSIONS: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.

A new marker cluster anchored to the iliotibial band improves tracking of hip and thigh axial rotations.

Tracking hip and thigh axial rotation has limited accuracy due to the large soft tissue artifact. We proposed a tracking-markers cluster anchored to the prominent distal part of the iliotibial band (ITB) to improve thigh tracking. We investigated if the ITB cluster improves accuracy compared with a traditionally used thigh cluster. We also compared the hip kinematics obtained with these clusters during walking and step-down. Hip and thigh kinematics were assessed during a task of active internal-external rotation with the knee extended, in which the shank rotation is a reference due to smaller soft-tissue artifact. Errors of the hip and thigh axial rotations obtained with the thigh clusters compared to the shank cluster were computed as root-mean-square errors, which were compared by paired t-tests. The angular waveforms of this task were compared using the statistical parametric mapping (SPM). Additionally, the hip waveforms in all planes obtained with the thigh clusters were compared during walking and step-down, using Coefficients of Multiple Correlation (CMC) and SPM (α = 0.05 for all analyses). The ITB cluster errors were approximately 25 % smaller than the traditional cluster error (p < 0.001). ITB cluster errors were smaller at external rotation angles while the traditional cluster error was smaller at internal rotation angles (p < 0.001), although the clusters' waveforms were not significantly different (p ≥ 0.005). During walking and step-down, both clusters provided similar hip kinematics (CMC ≥ 0.75), but differences were observed in parts of the cycles (p ≤ 0.04). The findings suggest that the ITB cluster may be used in studies focused on hip axial rotation.

Assessment of lower limb trophism in fetuses with open spina bifida using fractional thigh volume of three-dimensional ultrasound.

OBJECTIVE: To assess the trophism of the lower limbs of fetuses with open spina bifida using fractional thigh volume (TVOL) of three-dimensional (3D) ultrasound. METHODS: A prospective cross-sectional study was carried out with normal fetuses and with open spina bifida (myelomeningocele and rachischisis) at 26 weeks' gestation. The TVOL (delimitation of five cross-sectional areas of the middle portion of the limb) was evaluated, as well as the subjective assessment of hypotrophy and lower limb movement. RESULTS: Thirty-one fetuses with open spina bifida, 21 with myelomeningocele and 10 with rachischisis, and 51 normal fetuses were included. There were no significant differences in the TVOL between normal and spina bifida fetuses (p = 0.623), as well as between normal fetuses, with myelomeningocele and with rachischisis (p = 0.148). There was no significant difference in the TVOL of fetuses with spina bifida with or without lower limb hypotrophy (p = 0.148). Fetuses with spina bifida and with lower limb movement had higher TVOL values than fetuses without lower limb movement (p = 0.002). CONCLUSION: There were no significant differences in the TVOL measurement of normal and spina bifida fetuses (rachischisis and myelomeningocele). Fetuses with spina bifida without spontaneous movement of the lower limbs had lower TVOL values.

Muscle strength and psychometric properties of the health-related quality of life in patients with soft tissue sarcoma resection in the thigh

Abstract Objectives: The aim of this study was to evaluate the effect of STS resection in the thigh on MS and the HRQoL. Methods: Fourteen adults patients with STS in the thigh who underwent wide resection and limb preservation were evaluated. The patients were submitted to the Mini-Mental State Examination (MMSE). A hand-held dynamometer was used to measure the MS the flexors, adductors, abductors, and extensors muscles of the operated and non-operated thighs and between the dominant and non-dominant operated sides. The Musculoskeletal Tumor Society (MSTS) and Short Form Health Survey-36 (SF-36) questionnaires were applied to quantify the psychometric properties of the HRQoL. The data were submitted to statistical analysis using the Wilcoxon test (MS), and Mann-Whitney and Spearman correlation (MSTS and SF-36) (α = 0.05). Results: There was no significant difference in MS between the operated side and the non-operated side, and between the dominant and non-dominant operated side (ρ > 0.05). The MSTS presented a significant difference in the emotional acceptance for patients submitted to radiotherapy (ρ = 0.029). The SF-36 showed significant differences in the emotional aspect for patients submitted to chemotherapy (ρ = 0.027) and in the social aspect between the dominant and non-dominant operated side (ρ = 0.024). Conclusions: The HRQoL of adult patients is hampered after the treatment of STS even when MS is maintained.

Utilização de retalho baseado na artéria genicular lateral superior na cobertura de lesões de membros inferiores: relato de casos / Use of a flap based on the superior lateral genicular artery to cover lower limb injuries: case reports

O joelho é uma das principais articulações do corpo humano e, em função de sua conformação e funcionalidade, é facilmente suscetível a lesões. A reconstrução cirúrgica de lesões ao redor do joelho e região proximal da perna representa um grande desafio devido à exposição de estruturas osteoarticulares, tendinomusculares e neurovasculares e tem sido realizada com uso de diversos retalhos musculares e musculocutâneos. Outros retalhos também são descritos para tratamento dessas lesões, embora em menor frequência na literatura, como o retalho cutâneo baseado no pedículo da artéria genicular lateral superior. A seguir, é apresentado o relato de cinco casos de pacientes vítimas de acidentes motociclísticos nos quais realizou-se a cobertura da lesão ao redor do joelho e região proximal da perna com o uso do retalho cutâneo baseado no pedículo da artéria genicular lateral superior, nos quais foram obtidos uma boa cobertura das lesões, alta taxa de sobrevida do retalho, bons resultados clínicos e estéticos. O uso do artéria genicular lateral superior apresenta vantagens estéticas, visto que a cor e a textura do retalho são semelhantes às da região do joelho e conferem uma aparência de melhor qualidade, além de não causarem problemas de mobilidade articular.

The knee is one of the main joints in the human body, and due to its conformation and functionality, it is easily susceptible to injuries. Surgical reconstruction of injuries around the knee and proximal region of the leg represents a major challenge due to the exposure of osteoarticular, tendinomuscular and neurovascular structures and has been performed using various muscle and musculocutaneous flaps. Other flaps are also described for treating these lesions, although less frequently in the literature, such as the cutaneous flap based on the pedicle of the superior lateral genicular artery. Next, It presents a report of five cases of patients who were victims of motorcycle accidents in which the lesion was covered around the knee and proximal region of the leg using a skin flap based on the pedicle of the superior lateral genicular artery, in which good coverage of lesions, high flap survival rate, good clinical and aesthetic results. The use of the superior lateral genicular artery presents aesthetic advantages since the color and texture of the flap are similar to those of the knee region and provide a better quality appearance, in addition to not causing joint mobility problems.

Sarcoma pleomórfico indiferenciado de partes blandas: a propósito de un caso / Undifferentiated pleomorphic soft tissue sarcoma: a case report

RESUMEN Fundamento: los sarcomas de partes blandas son tumoraciones agresivas que pueden provocar la muerte de los pacientes, existen muchos tipos histológicos y se pueden localizar en cualquier parte del cuerpo humano. Objetivo: conocer un paciente con sarcoma pleomórfico indiferenciado en la región del muslo derecho. Presentación del caso: paciente de 52 años de edad, de raza blanca, masculino, sin antecedentes mórbidos de salud, acude a la consulta externa de Ortopedia y Traumatología por referir tener una bolita en el muslo derecho que en el último mes ha crecido y se acompaña de ligero dolor en la zona. Mediante la exploración física se observó aumento de volumen a nivel del muslo derecho en la cara posterolateral. A la palpación se comprobó la tumoración de bordes irregulares, mal definidos, móvil de localización por debajo de la fascia y consistencia dura. Al tener en cuenta todos los elementos anteriores, se decidió llevar el paciente al quirófano, para tratamiento de tipo quirúrgico, donde se realizó exéresis de la tumoración descrita con anterioridad, la que fue enviada al Departamento de Anatomía Patológica para estudio histológico que reveló sarcoma pleomórfico indiferenciado con células gigantes. Conclusiones: el sarcoma pleomórfico indiferenciado es una tumoración maligna infrecuente de partes blandas con un pronóstico reservado. Los síntomas y signos son más evidentes en el periodo de crecimiento rápido. Los exámenes imagenológicos como el ultrasonido de alta definición y la imagen de resonancia magnética son los más importantes. El tratamiento de elección primario es el quirúrgico, seguido de la radio y quimioterapia.

ABSTRACT Background: soft tissue sarcomas are aggressive tumors that can cause the death of patients, there are many histological types and can be located anywhere in the human body. Objective: to report a patient with undifferentiated pleomorphic sarcoma in the right thigh region. Case report: a 52-year-old white male patient with no morbid health history, who goes to the external Orthopedics and Traumatology clinic referring to have a little ball in the right thigh that has grown in the last month and it is accompanied by slight pain in the area. On physical examination, an increase in volume was observed at the level of the right thigh in the posterolateral area. On palpation, the tumor of irregular, bad-defined edges, mobile location below the fascia and hard consistency was checked. Taking into account all the previous elements, it is decided to take the patient to the operating room, for surgical treatment, where the tumor described above was extracted, it was sent to the Pathology department for histological study that revealed undifferentiated pleomorphic sarcoma with giant cells. Conclusions: undifferentiated pleomorphic sarcoma is an uncommon soft tissue tumor with a poor prognosis. Symptoms and signs are more evident in the period of rapid growth. Imaging tests such as high definition ultrasound and magnetic resonance imaging are the very importants. The primary treatment of choice is surgery, followed by radio and chemotherapy.

Características de lesões em paratletas da Indonésia antes das Olimpíadas de Tóquio em 2020: um estudo transversal / Injury characteristics of Indonesian paraathletes prior to Tokyo Olympics 2020: a crosssectional study

OBJETIVOS: Esta pesquisa tem como objetivo elucidar as características das lesões em atletas da seleção da Indonésia. MÉTODOS: Os sujeitos deste estudo foram nove atletas (masculino = 5, feminino = 4) com homens em torno da idade de 28 ± 9,13 e mulheres 28 ± 5,66 anos. A abordagem do método é descritiva com uma técnica de estudo transversal usando um questionário sobre histórico de lesões, tipos de lesões, fatores de lesões e gerenciamento de lesões para atletas indonésios que competiram nos Jogos Olímpicos de Tóquio em 2020. A análise de dados é representada em números e porcentagens e o teste exato de Fisher é usado para determinar a relação entre as variáveis. RESULTADOS: Os resultados do estudo relataram que os atletas indonésios sofreram lesões nos membros inferiores (70%), a parte do corpo que frequentemente sofre lesões foi a coxa (28%) e o tipo de lesão que frequentemente sofreu foi entorse / torção. CONCLUSÃO: As características da lesão na categoria sprint (pista) formam um padrão de lesões na coxa, tendão de Aquiles, tornozelo e joelho. Parece não haver correlação entre gênero, frequência de treinamento, proporção de lesões, número de partidas e tipo de aquecimento. A implicação é que o gerenciamento de lesões é necessário antes e durante a competição, considerando a biomecânica, a fisiopatologia e os problemas psicossociais. As estratégias de prevenção de lesões por treinadores e equipes médicas devem levar a uma redução mais significativa de lesões e otimizar a saúde, segurança e bem-estar dos atletas.

BACKGROUND: Sports for people with disabilities and injuries have been the subject of discourse in the professional literature in the fields of traumatology and sports medicine. OBJECTIVE: This research aims to elucidate the injury characteristics of athletes in the Indonesian national team. The subject of this study were nine athletes (male=5, female=4) with males around the age of 28±9.13 and females 28±5.66 years. METHOD: The method approach is descriptive with a crosssectional study technique using a questionnaire about injury history, types of injury, injury factors, and injury management for Indonesian Para Athletics Athletes who have competed in the 2020 Tokyo Olympics. Data analysis is depicted in numbers and percentages and Fisher's exact test is used to determine the relationship between variables. RESULTS: The study results reported that Indonesian athletes suffered injuries of the lower limbs (70%), part of the body that is frequently injured was the thigh (28%) and the type of injury that was often experienced sprain/twist. CONCLUSION: The injury characteristics in the sprint (track) category form a pattern of injuries to the thigh, Achilles tendon, ankle, and knee. There appears to be no correlation between gender, training frequency, injury share, match number, and warm-up type. The implication is that injury management is necessary before and during competition by considering biomechanics, pathophysiology, and psychosocial problems. Injury prevention strategies by coaches and medical teams should lead to more significant injury r

Mesotelioma epitelioide multicístico infiltrando parede abdominal e coxa: relato de caso / Multicystic epithelioid mesothelioma infiltrating abdominal wall and thigh: case report

RESUMO O mesotelioma epitelioide multicístico é um tumor benigno raro que surge a partir de modificações nas células mesoteliais peritoneais. Relatamos um caso de um grande mesotelioma epitelioide multicístico em paciente do sexo feminino com infiltração em parede abdominal e coxa. Foi realizada a ressecção ampla do tumor e reconstrução com múltiplos retalhos fasciocutâneos randomizados em região do abdome, flancos, retalhos de coxa direita e esquerda e retalho de vulva. Segue há 9 meses com cicatrização completa sem recidiva e sem queixas.

Abstract Multicystic epithelioid mesothelioma is a rare benign tumor that arises from changes in peritoneal mesothelial cells. We report a large multicystic epithelioid mesothelioma case in a female patient with infiltration into the abdominal wall and thigh. Extensive tumor resection and reconstruction were performed with multiple fasciocutaneous flaps randomized in the abdominal region, flanks, right and left thigh flaps and vulva flap. It has been in full healing for nine months without recurrence and complaints.

Avulsão do tendão reto femoral em atleta amador: relato de caso diagnosticado pela ressonância magnética / Rectus femoris tendon avulsion in an amateur athlete: case report diagnosed by magnetic resonance

Introdução: o músculo reto femoral é o músculo mais frequentemente lesado do grupo quadríceps durante chutes e corridas repetitivas, apesar de suas avulsões serem raras. A dor localizada na coxa proximal e a incapacidade de flexionar o quadril e/ou estender o joelho associado à história do paciente de contração violenta ou alongamento forçado do grupo muscular do quadríceps femoral podem indicar uma avulsão do reto femoral. Objetivo: relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: revisão do prontuário, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: homem de 46 anos com dor localizada no quadril esquerdo com irradiação para a coxa por três meses após cair no chão com a região dolorida em um jogo de futebol. A dor começou subitamente uma semana após a queda. A ressonância magnética do quadril apresentava avulsão completa do reto femoral esquerdo, distando 2 cm da espinha ilíaca anterior inferior com efusão líquida adjacente. Conclusão: este relato demonstra a dificuldade de diagnosticar essa lesão, pois o seu exame físico é inespecífico, podendo simular patologias mais complexas, necessitando de exames complementares para seu correto diagnóstico.

Introduction: the rectus femoris muscle is the most frequently injured muscle of the quadriceps group during repetitive kicking and sprinting. Avulsions of the rectus femoris are rare injuries. Pain located at the proximal thigh and disability in flexing the hip and/or extending the knee associated with a patient history of a violent contraction or forceful stretching of the quadriceps femoris muscle group can indicate an avulsion of rectus femoris. Objective: report a case and review the literature about this uncommon lesion. Materials and Methods: we reviewed medical records, photographic records of diagnostic methods, and reviews from the literature. Results: a 46-year-old man with pain located at the left anterior hip with irradiation to the thigh for three months after falling to the ground with the sore region in a soccer game. The pain started suddenly one week after the fall. The MRI of the hip featured complete avulsion of the left rectus femoris, being 2 cm distal from the anterior inferior iliac spine with adjacent liquid effusion. Conclusion: this report demonstrates the difficulty of diagnosing this lesion, since its physical examination is non-specific, and it can simulate more complex pathologies, requiring complementary tests for its correct diagnosis.

Use of anterolateral thigh free flap for reconstruction and salvage of thoracic limb caused by an arteriovenous malformation.

Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.

Harvesting the anterolateral thigh flap with non-sizable perforators.

BACKGROUND: The anterolateral thigh flap (ALT) has proven over time to be one of the best reconstructive workhorses due to its versatility and reliability. Without preoperative imaging, vascular anomalies such as having no sizable perforator are sometimes encountered during dissection. We propose a technique, based on a modified version of the traditional myocutaneous ALT to allow harvest of the flap based on non-sizable perforators. This technique can also enable the splitting of a flap when only one sizable perforator is present. METHODS: A retrospective review of patients who received reconstruction with free ALT flap from 2013 to 2019 by the senior author HSS was performed and included all flaps in which non-sizable perforators were harvested. Data collected for analysis included patient demographics, flap size, defect location, inset type, and flap survival. SURGICAL TECHNIQUE: Despite detachment of the majority of skin paddle from the muscle, the flap is harvested with a sleeve of areolar tissue containing preferably more than one non-sizable perforator attached to a small muscular segment of the vastus lateralis containing the pedicle. RESULTS: A total of 349 ALT flaps were performed during the review period by senior author HSS, and 25 flaps were harvested with non-sizable perforator, 10 of which were to enable a split. There were no total losses and 6 partial losses; 2 were amenable to direct closure after debridement, 1 required skin graft, and 3 required a new flap for wound coverage. Incorporating more than one non-sizable perforator increases the reliability of the flap. This technique should be used with caution in patients with multiple underlying comorbidities and when a flow-through flap is required. We were able to achieve primary closure of all donor sites. CONCLUSIONS: It is possible to harvest the anterolateral thigh flap without sizable perforators by conversion to a modified version of the myocutaneous flap. In well-selected patients, using our technique, several non-sizable perforators can reliably perfuse an ALT without the need to use an alternative donor site. This maximizes the number of harvestable ALTs and increases the reconstructive potential by splitting previously "un-splitable" flaps.

Repair of a complex abdominal wall defect with anterolateral thigh flap: a good surgical alternative.

INTRODUCTION: Reconstruction of the abdominal wall with major defects usually represents a surgical challenge, especially in cases where the defects are recurrent and have a large size that avoids the use of adjacent tissues for an adequate closure. According to each region the abdomen topography is divided into three regions: upper, middle and lower. Several reconstructive alternatives have been described according to the affected area of the abdomen that include the separation of the muscularis aponeurotic components of the abdominal rectus sheath, the flap of the rectus abdominus muscle with or without cutaneous island, the flap dependent on the dorsal muscle and muscular or musculocutaneous thigh flaps to reconstruct the lower area of the abdomen which is called anterolateral thigh (ALT) flap. The ALT flap has become the best option for large recurrent defects in any of the thirds due to its great versatility. CASE REPORT: We present the case of a 50-year-old patient with an abdominal wall defect, loss of domain and exposure of prosthetic material. Patient had a surgical history of open cholecystectomy, necrosectomy due to acute pancreatitis with open abdomen management and attempted repair of the abdominal defect twice with mesh placement. The abdominal wall was reconstructed with an ALT free flap with a fascia lata component with anastomosis to superior epigastric vessels in a successful manner. Nowadays patient remains without evidence of recurrence of the hernia at 1 year follow-up. DISCUSSION/CONCLUSION: The aim of this paper is to illustrate the ALT flap with a fascia lata component anastomosed to the superior epigastric vessels as a good option to reconstruct complex defects of the upper third of the abdomen.

INTRODUCCIÓN: La reconstrucción de la pared abdominal con grandes defectos suele representar un desafío quirúrgico, sobre todo cuando los defectos son recurrentes y tienen un gran tamaño que dificulta la utilización de tejidos adyacentes para un cierre adecuado. La pared abdominal anterior se divide en tres regiones para su reconstrucción; superior, media e inferior. De acuerdo con cada región se han descrito diferentes técnicas de reconstrucción de pared, como la separación de componentes musculoaponeuróticos de la vaina de los rectos abdominales, el colgajo del músculo recto abdominal con o sin isla cutánea, el colgajo dependiente del músculo dorsal ancho y colgajos musculares o músculocutáneos del muslo para reconstruir el tercio inferior del abdomen, llamado colgajo anterolateral de muslo (ALT, por sus siglas en inglés). El ALT se ha convertido en una buena alternativa para los grandes defectos recurrentes en cualquiera de los tercios debido a su gran versatilidad. CASO CLÍNICO: Presentamos el caso de un paciente de 50 años con un defecto de pared abdominal, pérdida de dominio y exposición de material protésico (malla). Tenía el antecedente quirúrgico de colecistectomía abierta, necrosectomía por pancreatitis aguda con manejo de abdomen abierto (incisión en línea media supra-infraumbilical) e intento de reparación del defecto abdominal en dos ocasiones con colocación de malla (que se encontraba expuesta). El defecto existente se desmanteló y resecó en bloque desde el interior de la pared abdominal, dejando bordes aponeuróticos sanos, quitando todo el tejido cicatricial, la malla y los bordes cutáneos enfermos. Se realizó la reconstrucción de la pared abdominal con ALT con un componente de fascia lata con anastomosis a vasos epigástricos superiores, de manera exitosa. Actualmente no hay evidencia de recurrencia del defecto herniario tras 1 año de seguimiento. DISCUSIÓN/CONCLUSIÓN: El objetivo de este trabajo es describir el ALT con componente de fascia lata con anastomosis a los vasos epigástricos superiores como una buena alternativa para reconstruir defectos de pared complejos del tercio superior del abdomen.

Effect of probiotics and Yucca schidigera extract supplementation on broiler meat quality

The current study investigated the effect of dietary supplementation with probiotics and Yucca schidigera extract on physicochemical parameters, proximate composition, mineral content and fatty acid profile of broiler breast and thigh muscles. In total, 240 one-day old broilers were randomly allocated into two dietary treatments groups: 1) Control (basal diet), 2) experimental (basal diet with two probiotics Pediococcus acidilactici and Saccharomyces cerevisiae and Yucca schidigera extract). The results showed that the pH value was higher in the experimental group than in the control group (p < 0.05). However, drip, cook and thaw losses were not influenced by dietary treatment (p > 0.05). A significant increase in protein, Fe, Zn, Na, P and a significant decrease in lipid, Cu and Cr contents was exhibited in experimental group relative to control group (p < 0.05). The proportion of stearic acid and saturated fatty acids was significantly (p < 0.05) reduced, whereas linoleic acid and polyunsaturated fatty acids contents were significantly (p < 0.05) increased in breast and thigh muscles of fed the experimental diet. We concluded that additive supplementation of the diet with probiotics and Yucca schidigera extract could improve meat quality.(AU)

Effect of probiotics and Yucca schidigera extract supplementation on broiler meat quality

The current study investigated the effect of dietary supplementation with probiotics and Yucca schidigera extract on physicochemical parameters, proximate composition, mineral content and fatty acid profile of broiler breast and thigh muscles. In total, 240 one-day old broilers were randomly allocated into two dietary treatments groups: 1) Control (basal diet), 2) experimental (basal diet with two probiotics Pediococcus acidilactici and Saccharomyces cerevisiae and Yucca schidigera extract). The results showed that the pH value was higher in the experimental group than in the control group (p 0.05). A significant increase in protein, Fe, Zn, Na, P and a significant decrease in lipid, Cu and Cr contents was exhibited in experimental group relative to control group (p < 0.05). The proportion of stearic acid and saturated fatty acids was significantly (p < 0.05) reduced, whereas linoleic acid and polyunsaturated fatty acids contents were significantly (p < 0.05) increased in breast and thigh muscles of fed the experimental diet. We concluded that additive supplementation of the diet with probiotics and Yucca schidigera extract could improve meat quality.