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1.
J Pak Med Assoc ; 71(Suppl 5)(8): S75-S78, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634021

RESUMO

OBJECTIVE: To study the frequency of the thigh, hip and groin soft tissue sarcomas and retrospectively analyse the management, treatment results, and outcomes of these uncommon malignant tumours, in a tertiary care hospital of the city of Karachi. Methodology: Data of soft tissue tumours registered from 2017-2018 was retrieved during January 2019 to March 2019 from Aga Khan University Hospital, Karachi bone and soft tissue tumour registry. A retrospective review was performed and all soft tissue tumour cases treated with surgical intervention (with adjuvant /neoadjuvant therapy) or palliative intention were included. RESULTS: Total 119 cases of soft tissue tumours (STS) were identified out of which 85 were malignant cases (sarcomas) while 30 were benign. On presentation 84 (70.6%) were primary cases. On topographical distribution, there were 25 patients who had hip, groin and thigh sarcoma. Of these, 15 were males and 10 were females. As treatment, neo-adjuvant radiation was done in 4 (16%) patients and adjuvant chemo/radio therapy was given to 13 (52%) patients. Wide margin excision was performed in 19 (76%) patients and 4 (16%) had amputation. Reconstruction was offered to 3 (12%) patients. In post-surgical complications, 1 (4%) patient had wound infection. On final surgical histopathology, majority of the sarcomas were liposarcomas, myxofibrosarcoma, synovial sarcoma and Leiomyosarcoma. Post-surgery recurrence occurred in 7 (28%) patients. Overall survival was 76%. CONCLUSIONS: In treatment of soft tissue sarcoma, limb salvage is an achievable option and survival results are also good.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Feminino , Virilha , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Estudos Retrospectivos , Sarcoma/epidemiologia , Sarcoma/terapia , Neoplasias de Tecidos Moles/epidemiologia , Neoplasias de Tecidos Moles/terapia , Centros de Atenção Terciária , Coxa da Perna , Resultado do Tratamento
2.
Ann Palliat Med ; 10(9): 10108-10113, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628931

RESUMO

Extensive necrosis of lower extremity muscles through the clinical practice of limb salvage after a case of high level crushing injury. A case of car accident injury complicated with necrotizing fasciitis, myositis, and septic shock was admitted to our hospital. The pathogenic factors, clinical characteristics, and surgical repair of this case were analyzed. Septic shock, pulmonary infection and atelectasis, and skin and soft tissue injury of lower limbs were all effectively treated, and limbs were saved successfully. After wound healing, the patient was discharged from hospital and entered the follow-up rehabilitation treatment. Although there is no direct trauma to the distal extremity below the cross-section of both lower extremities, there are still hypoxic ischemic changes, which can easily be ignored in the early stage. If not treated in time, myofascial and osteofascial compartment syndrome, necrotizing fasciitis, myositis, and sepsis are often secondary in the later stage, which should be warned against. During surgical debridement, attention should be paid to the protection of the source artery, and debridement and surgical exploration should be carried out according to the trend of blood vessels. The interecological muscle tissue between the intersections should be kept as far as possible, and the main nerves, blood vessels, and musculocutaneous perforators should be kept to ensure the blood supply of the skin flap.


Assuntos
Lesões por Esmagamento , Fasciite Necrosante , Fasciite Necrosante/cirurgia , Humanos , Músculos , Necrose , Coxa da Perna
3.
Acta Ortop Mex ; 35(1): 80-84, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480445

RESUMO

INTRODUCTION: Pyomyositis is a term that denotes pyogenic infection usually primary skeletal muscle, associated with hematogenous dispersion due to transient bacteremia, or penetrating trauma, usually forming abscesses. Classically described frequently in tropical areas and predominantly affecting the lower limb musculature, however, in recent decades it has increasingly been associated with areas of temperate climates and relatively more frequently in immunosuppressed patients, being the patients under 30 years the most affected. CLINICAL CASE: Male of 15 years without relevant medical history. The patient had no history of trauma, falls, surgical interventions, infections or any other systemic condition. He came because of a clinical picture of 7 days of evolution characterized by pain referred to the groin and left iliac crest area associated with claudication and hyperthermia not quantified, which yielded partially to NSAIDs and paracetamol, but without achieving improvement so it is taken emergency by relatives. CONCLUSIONS: It is necessary to bear in mind this pathology when performing the differential diagnostic approach of a patient presenting with pain and functional limitation of some joint associated with data suggestive of an infectious or inflammatory process.


Assuntos
Piomiosite , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético , Dor , Piomiosite/diagnóstico , Coxa da Perna
4.
J Spec Oper Med ; 21(3): 30-35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529801

RESUMO

BACKGROUND: During strap pulling, how limb tourniquet sliding is prevented affects secured pressure achievement. Data from model setups indicated moving the Tactical Ratcheting Medical Tourniquet (Tac RMT; m2 inc.) holding loop location could be advantageous regarding strap-pulling pressure achievement. METHODS: Self- and buddy-strap pull applications to the arm and mid-thigh were done with the commercially available Tac RMT with the holding loop adjacent to the strap redirect buckle (NEAR) and with a modified Tac RMT with the holding loop moved to the far end of the toothed ladder from the redirect (FAR). Arm applications had the strap redirect buckle on the lateral aspect of the arm. Thigh applications had the strap redirect buckle on the lateral aspect and included applications with the strap's free end pulled downward and applications with the strap free end pulled upward. Buddy- arm and thigh pull-upward applications with FAR allowed a nonstandard technique of including thumb assistance of the strap into the redirect. RESULTS: With standard technique, five of six pairs had lower FAR secured pressures (median difference, 16mmHg). When thumb assistance was used, four of five NEAR-FAR pairs had higher FAR secured pressures (median difference, 40mmHg). The thumb strap feeding technique was neither simple nor obvious. CONCLUSIONS: Moving the holding loop location is unlikely to be advantageous for Tac RMT actual applications. Model setup findings need to be checked with applications by humans to humans.


Assuntos
Coxa da Perna , Torniquetes , Humanos , Pressão
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1177-1181, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523285

RESUMO

Objective: To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. Methods: Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade. Results: The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal. Conclusion: Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.


Assuntos
Carcinoma Basocelular , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Lesões dos Tecidos Moles , Feminino , Humanos , Masculino , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(36): e27209, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516525

RESUMO

RATIONALE: Follicular dendritic cell sarcoma (FDCS) is an intermediate-grade malignancy originating from follicular dendritic cells. Nodal FDCS is the most common type, meaning that the extranodal type may not be recognized and could be easily misdiagnosed. Reported extranodal sites include the head and neck, retroperitoneum, spleen, liver, and gastrointestinal tract. FDCS in the soft tissue is extremely rare. PATIENT CONCERNS: A 75-year-old male presented with complaints of a localized swelling and intra-muscular soft tissue mass in the left upper thigh. DIAGNOSIS: The present tumor consisted of fascicular or vague storiform-arranged spindle cells with less pleomorphism and many lymphoid aggregates. Tumor cells were positive for CD21, CD35, CD68, vimentin, and EGFR. Intra-muscular FDCS was confirmed by immunohistochemical studies. INTERVENTIONS: The patient received a wide marginal excision, followed by adjuvant radiotherapy. OUTCOMES: Symptomatic improvements were achieved and no subsequent relapses were observed. LESSONS: If the tumor arises in the extranodal sites, especially in the soft tissue, it is difficult to include FDCS in the differential diagnosis. When the immunoprofile is not consistent with that of common spindle cell tumors, immunostaining for follicular dendritic cell markers such as CD21, CD23, and CD35, as well as further immunohistochemistry for D2-40, CD68, EGFR, Epstein-Barr virus, and BRAF can be helpful for the diagnosis and subtyping of FDCS. To the best of our knowledge, the present case is the first case of intramuscular FDCS.


Assuntos
Sarcoma de Células Dendríticas Foliculares/diagnóstico , Idoso , Biomarcadores Tumorais/metabolismo , Sarcoma de Células Dendríticas Foliculares/diagnóstico por imagem , Sarcoma de Células Dendríticas Foliculares/cirurgia , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Coxa da Perna
7.
Acta Chir Orthop Traumatol Cech ; 88(4): 321-324, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34534063

RESUMO

Large unresectable STS presents a therapeutic challenge. Several options are being explored to avoid amputation without compromising the oncological outcome. Neoadjuvant chemotherapy delivers inconsistent and rather unsatisfactory results, preoperative radiotherapy compromises healing, hence it can impede adjuvant systemic treatment. We present a case report of neoadjuvant use of isolated limb perfusion with TNF-alfa and Alkeran (Melphalan) in a patient with initially unresectable large myxoid liposarcoma of the thigh. We achieved 55% reduction in size of the tumor that allowed for wide resection with a safe margin. Pathology confirmed 99% tumor necrosis. The patient has a full function of his extremity and is disease-free at one year follow-up. ILP should be considered as a treatment option which, in selected cases, can contribute to limb sparing surgery. Key words: sarcoma, soft tissue, regional perfusion, chemotherapy, surgery, orthopedic, limb salvage.


Assuntos
Lipossarcoma Mixoide , Terapia Neoadjuvante , Adulto , Quimioterapia do Câncer por Perfusão Regional , Extremidades , Humanos , Salvamento de Membro , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/tratamento farmacológico , Lipossarcoma Mixoide/cirurgia , Perfusão , Coxa da Perna
8.
Sensors (Basel) ; 21(18)2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34577275

RESUMO

(1) Background: The purpose of this study was to evaluate the day-to-day variability and year-to-year reproducibility of an accelerometer-based algorithm for sit-to-stand (STS) transitions in a free-living environment among community-dwelling older adults. (2) Methods: Free-living thigh-worn accelerometry was recorded for three to seven days in 86 (women n = 55) community-dwelling older adults, on two occasions separated by one year, to evaluate the long-term consistency of free-living behavior. (3) Results: Year-to-year intraclass correlation coefficients (ICC) for the number of STS transitions were 0.79 (95% confidence interval, 0.70-0.86, p < 0.001), for mean angular velocity-0.81 (95% ci, 0.72-0.87, p < 0.001), and maximal angular velocity-0.73 (95% ci, 0.61-0.82, p < 0.001), respectively. Day-to-day ICCs were 0.63-0.72 for number of STS transitions (95% ci, 0.49-0.81, p < 0.001) and for mean angular velocity-0.75-0.80 (95% ci, 0.64-0.87, p < 0.001). Minimum detectable change (MDC) was 20.1 transitions/day for volume, 9.7°/s for mean intensity, and 31.7°/s for maximal intensity. (4) Conclusions: The volume and intensity of STS transitions monitored by a thigh-worn accelerometer and a sit-to-stand transitions algorithm are reproducible from day to day and year to year. The accelerometer can be used to reliably study STS transitions in free-living environments, which could add value to identifying individuals at increased risk for functional disability.


Assuntos
Acelerometria , Vida Independente , Idoso , Feminino , Humanos , Reprodutibilidade dos Testes , Coxa da Perna
9.
Ned Tijdschr Geneeskd ; 1652021 05 05.
Artigo em Holandês | MEDLINE | ID: mdl-34346639

RESUMO

A 44-year-old man presented with a swelling of his right thigh three weeks after a fall of his scooter, in which he had experienced a sheering trauma on the tarmac. The painless swelling had increased gradually to a size of 20 x 10 cm. Ultrasonography showed a fluid filled separation of the subcutis and fascia. The diagnosis was a Morel-Lavallee lesion.


Assuntos
Lesões dos Tecidos Moles , Coxa da Perna , Acidentes , Adulto , Edema , Humanos , Masculino , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Ultrassonografia
10.
Medicine (Baltimore) ; 100(34): e27011, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449472

RESUMO

RATIONALE: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Common sites for metastasis are the liver and peritoneum, whereas skeletal muscle metastases are rare. PATIENT CONCERNS: A 59-year-old man with skeletal muscle metastasis was diagnosed during a period of adjuvant imatinib therapy following the recurrence of GIST of the small intestine. DIAGNOSIS: The patient was diagnosed with skeletal muscle metastasis of GIST based on immunohistochemistry and molecular pathology analysis results. INTERVENTION: Extensive resection of the left thigh tumor was performed. The patient underwent whole-exome sequencing of tissue examination. The results suggest that resistance to imatinib may have been developed, and the patient was therefore administered sunitinib instead. OUTCOMES: Complete remission was observed following sunitinib therapy. LESSONS: In cases of skeletal muscle metastasis diagnosed during a period of adjuvant imatinib therapy following the recurrence of a GIST of the small intestine, whole exome sequencing may be used to discover more gene variations.


Assuntos
Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Musculares/secundário , Músculo Esquelético/patologia , Resistencia a Medicamentos Antineoplásicos/genética , Neoplasias Gastrointestinais/tratamento farmacológico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Mesilato de Imatinib/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/tratamento farmacológico , Neoplasias Musculares/cirurgia , Sunitinibe/uso terapêutico , Coxa da Perna/patologia , Sequenciamento Completo do Exoma
11.
Ann Plast Surg ; 87(3): 298-309, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397518

RESUMO

BACKGROUND: Extensive reconstruction of complex full-thickness chest wall oncological defects is challenging. Bilateral free anterolateral thigh (ALT) myocutaneous flap transfer for the complex reconstruction of a large area of the chest wall is discussed. MATERIALS AND METHODS: We reported a single unit's experience in 1-staged multilayered reconstruction of large full-thickness chest wall defects in 22 patients (16 primary chest wall tumor cases, 5 locally advanced breast cancer cases, and 1 osteoradionecrosis case) treated between 2011 and 2018. Bilateral ALT myocutaneous flaps together with traditional cement implant or unmovable/movable joint conformable titanium struts were used for chest wall reconstruction. The anatomical characteristics of pedicle origin and pattern of the venae comitantes of the ALT myocutaneous flap, recipient vessels, and anastomosis patterns were described. RESULTS: Bilateral ALT myocutaneous flaps were used for soft tissue reconstruction in 22 cases. Different methods of flap harvesting and vascular anastomosis were selected as needed. No vein grafts or arteriovenous loops were required. We observed 3 vascular patterns of the flap pedicle, including 1 oblique branch and descending branch (59.1%, n = 26), 2 single descending branch (9.1%, n = 4), and 3 double branches of the descending branch (31.8%, n = 14). The flap was harvested pedicled with solely the oblique branch in 7 (15.9%) cases, solely the descending branch in 28 (63.6%) cases to minimize the donor site morbidity, and pedicled with the oblique and descending branch in 9 (20.5%) cases to achieve multiple vascular anastomosis choices. Stable skeletal reconstructions were achieved using traditional cement implant (13.6%, n = 3) or conformable titanium struts (86.4%, n = 19), with good fixation strength. Complication risk was low. An algorithmic approach to management is presented and recommended. CONCLUSION: Various forms of bilateral ALT myocutaneous flap transfer with different skeletal reconstruction presents as a reliable treatment for patients with large full-thickness chest wall defects. Anatomical variations in the pedicle and pattern of venae comitantes of the ALT myocutaneous flap are reported. In some challenging cases, finding the vessels in the recipient area is difficult. The clinical significance of each vascular pattern is delineated, and surgical technical considerations are discussed on the basis of the recipient area requirements and types of a flap's vascular anatomy.


Assuntos
Retalhos de Tecido Biológico , Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos , Parede Torácica , Humanos , Coxa da Perna/cirurgia , Parede Torácica/cirurgia
13.
Pan Afr Med J ; 39: 15, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394806

RESUMO

Primary musculoskeletal echinococcosis is rare and accounts for 2-3% of the patients with hydatid disease. We report a case of giant primary hydatid cysts of the thigh and the gluteal region in an 82-year-old female, who presented with a painful multiple palpable mass. The diagnosis was confirmed by imaging and serology. Total resection was performed through an extended lateral approach of the thigh and intraoperative findings revealed infected giant hydatid cysts. The postoperative outcome was uneventful. Albendazole drug (400mg per day) was given for the next 3 months. At 6 months follow-up, the patient was satisfied with no complications or recurrence.


Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Equinococose/diagnóstico , Idoso de 80 Anos ou mais , Nádegas/parasitologia , Terapia Combinada , Equinococose/terapia , Feminino , Seguimentos , Humanos , Coxa da Perna/parasitologia
14.
Acta Chir Plast ; 63(2): 57-63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34404218

RESUMO

BACKGROUND: Flaps are the essence of reconstructive surgery. The ability to successfully design, execute and manage the flaps makes plastic surgery an outstanding speciality. The choice of flap is mainly guided by the type of the defect. However, certain factors like technique feasibility, duration of the surgery and patient factors do have a role in decision making. The primary type of free flap (whether a muscle or a fasciocutaneous flap) is dictated by the defect or the wound characteristics. However, the choice of flap depends on various factors like the component of flap, pedicle length required, the ease of harvest and donor site morbidity. Tensor fascia lata (TFL) is one myocutaneous flap, which has well developed components other than a muscle. MATERIALS AND METHODS: The patients admitted to a tertiary care hospital with the diagnosis of composite tissue defect in any region of the body were enrolled for this study from November 2016 to November 2018. Patients undergoing free TFL flap reconstruction are studied. The duration of flap harvest, the anatomical site of pedicle, flap outcome and the need of secondary surgery were analysed. RESULTS: Totally 14 patients were reconstructed with a free TFL flap. The anatomic location of the defect was more frequent on lower limbs - 8 cases (58%), followed by the upper limb and the head and neck area (3 cases, each 21%). The mean flap harvest time was -62.07 (45-80) min. The mean size of pedicle entry was 8.7 cm from the anterior superior iliac spine. Out of the 14 flaps, there were 10 (71%) flaps successful completely and 4 (29%) of them had partial loss. CONCLUSION: A free TFL flap harvest time is very short compared to any other flaps and hence makes it the flap of choice in patients who are critical and cannot withstand long operating time.


Assuntos
Retalhos de Tecido Biológico , Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos , Fascia Lata/transplante , Humanos , Coxa da Perna
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(8): 1027-1032, 2021 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-34387433

RESUMO

Objective: To explore the feasibility and accuracy of modified three longitudinal and five transverse method in locating perforating branches before anterolateral thigh perforator flap (ALTP) repair. Methods: Between January 2019 and December 2019, 41 patients with skin and soft tissue defects were repaired with ALTP. There were 31 males and 10 females. The age ranged from 18 to 61 years, with an average of 32 years. The soft tissue defects were caused by trauma in 38 cases, and the time from injury to operation was 3-7 days, with an average of 4 days. The wounds left after excision of scar contracture deformity because of burn in 3 cases. Soft tissue defects located at upper limbs in 16 cases and lower limbs in 25 cases. The size of soft tissue defects ranged from 10 cm×4 cm to 25 cm×12 cm. Before operation, zonesⅠ, Ⅱ, Ⅲ, and Ⅳwere formed on the anterolateral thigh by modified three longitudinal and five transverse method. The perforating branches were detected in these four zones by Doppler ultrasound, and the skin flaps were designed according to the wound area. The perforating branches were explored during operation, and the distribution and types of perforating branches in each zone and the relationship between perforating branches and lateral femoral cutaneous nerve were observed. The ALTP with the size of 12 cm×5 cm to 30 cm×10 cm was used to repair the wound, and the donor site was sutured directly or repaired with the flap. Results: A total of 117 perforating branches were detected in 41 patients before operation, and 111 perforating branches were found during operation, with a false positive rate of 5%. The probability of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were 56%, 73%, 76%, and 66% respectively, and the false positive rates were -9%, 7%, 16%, and 4%, respectively. All perforating branches located near the trunk of lateral femoral cutaneous nerve, especially in posterolateral area. There were only 1 perforating branch in 6 cases, 2 perforating branches in 12 cases, 3 perforating branches in 10 cases, and 4 perforating branches in 13 cases. The main types of perforating branches in zonesⅠ, Ⅱ, Ⅲ, and Ⅳ were transverse perforating branches, oblique perforating branches, descending perforating branches, and descending perforating branches, respectively. Partial distal necrosis occurred in 2 cases and complete necrosis occurred in 1 case after operation, and the wounds were repaired with skin grafts. The remaining 38 flaps survived successfully, and the wounds and the incisions of donor sites healed by first intention. All patients were followed up 3 to 12 months, with an average of 6 months. The appearance and texture of the skin flap were acceptable, and linear scar remained in the donor site. Conclusion: It can simply locate and distinguish the perforating branches and better protect the lateral femoral cutaneous nerve by using the modified three longitudinal and five transverse method before ALTP repair.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(8): 1033-1037, 2021 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-34387434

RESUMO

Objective: To evaluate the effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury. Methods: Between February 2016 and March 2020, 14 patients with hand twist trauma combined with forearm main vascular injury were admitted. There were 10 males and 4 females. The mean age was 36.3 years (range, 22-53 years). There were 5 cases with left hand and 9 cases with right hand. The degloving injury of hand was rated as type ⅢA in 2 cases, type ⅢB in 9 cases, and type Ⅳ in 3 cases. The size of soft tissue defects range from 8.0 cm×4.5 cm to 13.5 cm×8.0 cm. Of all patients, 11 cases were ulnar artery injury and 3 cases were radial artery injury. Time from injury to operation was 2-16 hours (mean, 7.1 hours). The free anterolateral thigh flaps with the size of 10.0 cm×5.5 cm to 15.0 cm×9.5 cm were used to repair the soft tissue defects with the "T" shape anastomosis of blood vessel in 8 cases or direct anastomosis of blood vessel in 6 cases. The donor sites were directly sutured in 9 cases and repaired with free skin graft in 5 cases. Results: All patients were followed up 6-12 months (mean, 10.5 months). The vascular crisis occurred in 1 case and the flap survived with symptomatic treatment after operation. Other flaps survived and the wounds healed by first intention. All donor sites healed by first intention and the skin grafts survived. Three cases underwent the fat-free trimming at 4-5 months after operation. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the hand function was evaluated as excellent in 4 cases, good in 7 cases, and fair in 3 cases, with an excellent and good rate of 78.6% at last follow-up. Conclusion: Because the diameter of the descending branch of the lateral femoral circumflex artery is similar to that of the ulnar artery and radial artery, the use of free anterolateral thigh flap can not only repair the wound and obtain a good hand shape, but also repair blood vessels and promote recovery of hand function.


Assuntos
Retalhos de Tecido Biológico , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Lesões do Sistema Vascular , Adulto , Feminino , Antebraço , Humanos , Masculino , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/cirurgia
17.
Zhongguo Ying Yong Sheng Li Xue Za Zhi ; 37(3): 300-304, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34374244

RESUMO

Objective: To investigate the effect of different arterial occlusion pressure and intermittent time on KAATSU-loaded deep-squat exercise on the characteristics of thigh muscle activation, find out the suitable relative value of personal blood pressure limit causing the maximum activation, and to provide some theoretical basis and practical reference for athletes to carry on the KAATSU Training scientifically. Methods: Ten elite male players were recruited, four kinds of external pressure condition with 0% arterial occlusion pressure (AOP), 40%AOP, 50%AOP, 60%AOP, respectively, were performed with 30%1RM(One repetition maximum)intensity of intermittent and continuous KAASTU-loaded deep-squat exercise. Wave plus wireless surface electromyography instrument was used to collect the surface EMG signals of the lower thigh muscle group. Root mean square (RMS) calculation was used to estimate muscle activity level. The normalized RMS values of the anterior thigh group and posterior thigh group were calculated by RMS of MVC, two-factor ANOVA analysis of variance were used to explore the effect of the activation of various muscle on external express and intermittent mode, to analyze the discrepancy during different external pressure. Results: ①A two-factor analysis of variance showed that different %AOP had significant effect on the normalized values of RMS of muscle measured by KAATSU deep-squat exercise(P<0.05), but intermittent mode had no significant effect on the standard value of RMS of muscle(P>0.05). The interaction of external pressure and intermittent mode on muscle RMS was not significant(P>0.05); ②The normalized RMS values of Rectus Femoris, Vastus Medialis, Vastus Lateralis, Biceps Femoris, Semitendinosus were significantly increased (P<0.05)in 50% AOP pressure condition during intermittent and continuous exercise; ③ The normalized RMS values of RF and VL were significantly increased(P<0.05)in 50% AOP pressure condition during intermittent and continuous exercise. The %MVC values of Vastus Medialis and Semitendinosus were significantly increased(P<0.05)in 60% AOP pressure condition during intermittent exercise. Conclusion: This study further verified that 50% AOP pressure can significantly improve the optimal activation quadriceps and posterior thigh groups and produce the best training effect for the high level handball players. It can not only promote the coordinated development of the agonist and antagonist, but also avoid overloading and prevent hamstring injury. At the same time, the intermittent mode is recommended to adopt the decompression intermittent mode.


Assuntos
Músculo Esquelético , Coxa da Perna , Eletromiografia , Exercício Físico , Humanos , Masculino , Músculo Quadríceps
18.
Cir Cir ; 89(4): 461-468, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34352861

RESUMO

OBJETIVO: Este estudio tuvo como objetivo describir los resultados clínicos del colgajo anterolateral de muslo y radial de antebrazo, para la reconstrucción hipofaríngea y esofágica en un hospital de cuarto nivel en Bogotá, Colombia. MÉTODOS: Estudio retrospectivo inlcuyo 38 pacientes a los que se les realizó reconstrucción funcional esofágica con colgajo de antebrazo radial o anterolateral de muslo (ALT) entre febrero de 2010 y diciembre de 2017. RESULTADOS: Edad media fue de 51 años. El 80% genero femeninp. Los defectos laringoesofágicos estuvieron presentes en el 80%. Se requirió reconstrucción circunferencial total en el 60% de los pacientes. Se realizaron injertos braquio-radiales en el 26% y colgajos anterolaterales de muslo en el 74%. La tasa global de complicaciones tempranas fue del 30%, de las cuales el 20% fueron fístulas (braquio-radial, 2,8%; colgajo libre de ALT, 8,3%). Las complicaciones tardías (20%) incluyeron estenosis y obstrucción de la luz del injerto distal. Solo el 10% de los pacientes no pudieron tolerar la alimentación oral y el 50% de este paciente necesitó gastrostomía permanente. En cuanto al seguimiento oncológico durante el postoperatorio de 24 meses, no se observó recidiva tumoral. CONCLUSIÓN: Los resultados funcionales de la reconstrucción con colgajo braquio-radial y ALT fueron satisfactorios. Nuestros hallazgos sugieren que la ALT tiene una menor incidencia de complicaciones posoperatorias que el colgajo radial de antebrazo. La elección del tipo de colgajo dependerá del tamaño y la ubicación del defecto. Los defectos pequeños y parcialmente cubiertos se benefician del uso de un colgajo radial, y para reconstrucciones faríngeas más grandes y circunferenciales con posibles requisitos de radioterapia, se benefician de un colgajo ALT. OBJECTIVE: This study aimed to describe clinical outcomes of anterolateral thigh (ALT) and radial forearm flap in hypopharyngeal and esophageal reconstruction in a fourth level hospital in Bogotá, Colombia. METHODS: This retrospective study included 38 patients who esophageal functional reconstruction using radial forearm or ALT flap at our center between February 2010 and December 2017. RESULTS: Mean age was 51 years. About 80% of the included patients were females. Laryngoesophageal defects were present in 80%. Total circumferential reconstruction was required in 60% of patients. Brachial-radial grafts were performed in 26% and anterolateral thigh flaps in 74%. Overall, early complication rate was 30%, which 20% were fistulae (brachial-radial, 2.8%; ALT free flap, 8.3%). Late complications (20%) included stenosis and distal graft lumen obstruction. Only 10% of patients were unable to tolerate oral feeding and 50% of this patient needed permanent gastrostomy. Regarding oncological follow-up during the 24-month post-operative, no tumor recurrence was observed. CONCLUSIONS: Functional outcomes of reconstruction with brachial-radial and ALT flap were satisfying. Our findings suggest that ALT has a lower incidence of post-operative complications than radial forearm flap. The choice of the type of flap will depend on the size and location of the defect. Small and partially covered defects benefit from the use of a radial flap, and for larger and circumferential pharyngeal reconstructions with possible radiotherapy requirements, they benefit from an ALT flap.


Assuntos
Neoplasias Retais , Coxa da Perna , Colômbia , Feminino , Antebraço , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
J Bodyw Mov Ther ; 27: 233-238, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391239

RESUMO

OBJECTIVES: To evaluate the effect of Miofascial Release (MFR) on knee extensors strength, at different duration times of application. METHOD: 51 healthy individuals were randomly assigned to one of three groups (3min, 5min or placebo) in this randomized clinical trial. The knee extensors strength was assessed in two conditions: pre and post-intervention, using an isokinetic dynamometer, at speeds of 60° and 120°/s. MFR was applied on the anterior surface of the thigh for 3min or 5 min, according to the experimental groups. The placebo group underwent through the application of a non-therapeutic gel, associated with 3min of a light touch on the skin. Peak torque, total work and mean power were the isokinetic variables analyzed through a multivariate analysis of variance (MANOVA) with p ≤ 0.05. RESULTS: Our findings suggest a main effect and interaction between moments (pre and post-intervention) and speeds (60° and 120°/s) for total work and mean power (p < 0.01). Likewise, main effect and interaction of speed were observed for peak torque (p < 0.01). There were no significant differences for the other analyzed variables. CONCLUSION: No significant main effect of MFR were detected in any of the proposed application time on peak torque, total work and mean power, in the knee extensors, compared to the placebo group.


Assuntos
Articulação do Joelho , Músculo Quadríceps , Humanos , Joelho , Força Muscular , Músculo Esquelético , Coxa da Perna , Torque
20.
J Bodyw Mov Ther ; 27: 9-15, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391318

RESUMO

INTRODUCTION: The effectiveness of different forms of cryotherapy and combined compression (cryo-compression) commonly used in sport to enhance recovery following exercise are not fully understood. Therefore, the exploration of protocols that use contemporary cryo-compression is warranted. The purpose of the study was to investigate the effectiveness of using a cryo-compression device to recover hamstrings eccentric strength following a fatiguing exercise. METHODS: Eighteen healthy male adult footballers were randomly allocated to receive cryo-compression or rest following a lower limb fatiguing protocol. Cryo-compression was applied for 15-min, target temperature of 10 °C, and high intermittent pressure (5-75 mm Hg) using the Game Ready® device. Rest consisted of 15-min in a prone position on a plinth. To induce hamstring fatigue, participants performed the Yo-Yo intermittent fatigue test (IFT). Skin surface temperature (Tsk) and hamstring eccentric strength measures were taken at three time points; pre-IFT, immediately post-fatigue test (IPFT), and immediately post-intervention (IPI) (rest or Game Ready®). Participants returned one week later and performed the Yo-Yo IFT again and were exposed to the opposite intervention and data collection. RESULTS: Significant decreases in Tsk over the posterior thigh were reported for all timepoints compared to pre cryo-compression temperatures (p=<0.05). Overall data displayed no significant main effects for timepoint or condition for PT or AvT (p=<0.05). There was no timepoint × condition interaction for PT or AvT (p=<0.05). Collapse of the data by condition (CC/R) demonstrated no significant effect for time for PT or AvT (p=>0.05). CONCLUSIONS: No significant changes in HES occurred after exposure to cryo-compression or rest applied immediately following the Yo-Yo IFT. Further investigations to maximise beneficial application of contemporary cryo-compression applications in sport are required. Multiple measures of performance over rewarming periods, within competitive training schedules after sport-specific training are required to develop optimal cooling protocols for recovery.


Assuntos
Músculos Isquiossurais , Força Muscular , Adulto , Exercício Físico , Teste de Esforço , Humanos , Masculino , Músculo Esquelético , Coxa da Perna
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