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1.
A A Pract ; 18(4): e01781, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38619172

RESUMO

Selection of anesthetic technique for thigh amputation is complicated by patients' comorbid conditions. The sacral erector spinae plane block (ESPB) is an emerging technique with potential as a primary anesthetic for thigh amputation. We detail a case involving a 79-year-old undergoing thigh amputation, where sacral ESPB proved insufficient, prompting a shift to spinal anesthesia. This instance underscores the necessity for further investigation into the reliability of the sacral ESPB for lower limb surgeries. Until such evidence is established, caution is advised in relying solely on the sacral ESPB for thigh amputations, and consideration of alternative techniques is recommended.


Assuntos
Anestésicos , Bloqueio Nervoso , Humanos , Idoso , Coxa da Perna/cirurgia , Reprodutibilidade dos Testes , Amputação Cirúrgica
2.
PLoS One ; 19(4): e0299099, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38564618

RESUMO

Individual muscle segmentation is the process of partitioning medical images into regions representing each muscle. It can be used to isolate spatially structured quantitative muscle characteristics, such as volume, geometry, and the level of fat infiltration. These features are pivotal to measuring the state of muscle functional health and in tracking the response of the body to musculoskeletal and neuromusculoskeletal disorders. The gold standard approach to perform muscle segmentation requires manual processing of large numbers of images and is associated with significant operator repeatability issues and high time requirements. Deep learning-based techniques have been recently suggested to be capable of automating the process, which would catalyse research into the effects of musculoskeletal disorders on the muscular system. In this study, three convolutional neural networks were explored in their capacity to automatically segment twenty-three lower limb muscles from the hips, thigh, and calves from magnetic resonance images. The three neural networks (UNet, Attention UNet, and a novel Spatial Channel UNet) were trained independently with augmented images to segment 6 subjects and were able to segment the muscles with an average Relative Volume Error (RVE) between -8.6% and 2.9%, average Dice Similarity Coefficient (DSC) between 0.70 and 0.84, and average Hausdorff Distance (HD) between 12.2 and 46.5 mm, with performance dependent on both the subject and the network used. The trained convolutional neural networks designed, and data used in this study are openly available for use, either through re-training for other medical images, or application to automatically segment new T1-weighted lower limb magnetic resonance images captured with similar acquisition parameters.


Assuntos
Aprendizado Profundo , Humanos , Feminino , Animais , Bovinos , Processamento de Imagem Assistida por Computador/métodos , Pós-Menopausa , Coxa da Perna/diagnóstico por imagem , Músculos , Imageamento por Ressonância Magnética/métodos
3.
Magy Seb ; 77(1): 1-5, 2024 Apr 02.
Artigo em Húngaro | MEDLINE | ID: mdl-38564286

RESUMO

Elorehaladott szájüregi daganatok eltávolítása után kialakult kiterjedt szövethiányok helyreállítására funkciómegtartó céllal a leggyakrabban alkalmazott eljárás a mikrovaszkuláris technikával végzett szabad szövetátültetés. Hazánkban a felületes szájüregi hiányok helyreállítására a leggyakrabban választott szabadlebeny a radiális alkarlebeny. Elsosorban vastagabb vagy nagyobb kiterjedésu hiányokra alkalmazzuk az anterolateralis comblebenyt. Az alkarlebeny esetén azonban a donorterületi szövodményráta jóval magasabb. Vékonyított anterolateralis comblebeny a hátrányokat kiiktatva alkalmas lehet az alkarlebeny intraoralis alkalmazása helyett.A korábban nyelvtumor miatt operált, alkarlebennyel rekonstruált és besugarazott 69 éves nobetegnél a korábbi mutéti terület szélén a követéses kontrollvizsgálat során recidív tumort verifikáltunk. Az Onkoterápiás Bizottság döntését követoen a recidíva eltávolítását, tangencionális mandibula reszekciót és szabad lebenyes helyreállítást terveztünk tracheotomiás védelemben. Elozetes kézi dopplerrel és duplex ultrahanggal történo perforátor meghatározás után, a jobb combon a perforátorra centrálva 6 × 8 cm-es superficialis fascia rétegében vékonyított anterolateralis comblebenyt preparáltunk. A lebeny vastagsága 6-8 mm, az érnyél hossza 12 cm volt, mely az intraoralis hiányra ideális volt. A nyakon elkészített mikrosebészeti anasztomózis után a donorterületet primeren zártuk.A lebeny keringése mindvégig kielégíto volt. A tracheotomiát a posztoperatív 11. napon megszüntettük, perorális táplálkozása a posztoperatív 14. napon helyreállt.Az anterolateralis comblebeny sokrétusége az anatómiájában rejlik. A korábban csak nagyobb és vastagabb hiányokra használt anterolateralis comblebeny jó adaptálhatósága és megfelelo mérete miatt felületesebb hiányokra is alkalmas. A korábban alkarlebennyel helyreállított hiányok pótlására a hasonló tulajdonságokkal rendelkezo vékonyított anterolateralis comblebeny is alkalmazható azzal a jelentos elonyével együtt, hogy a donorhely morbiditása minimális az alkarlebennyel szemben.


Assuntos
Retalhos de Tecido Biológico , Coxa da Perna , Humanos , Coxa da Perna/cirurgia , Fáscia , Mandíbula
4.
BMJ Case Rep ; 17(4)2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38569727

RESUMO

Malignant peripheral nerve sheath tumour (MPNST) is an aggressive soft tissue sarcoma with a poor prognosis, affecting most commonly the extremities. The lungs constitute the most frequent location for distant metastases. Half of all MPNSTs arise in patients with neurofibromatosis type 1, while approximately 10% are radiation induced and the rest are sporadic.The authors present a pregnant woman in her 40s with a sporadic MPNST of the lower limb and with lung metastases at diagnosis. Treatment consisted of interilioabdominal amputation, followed by adjuvant chemotherapy. Partial response and disease stabilisation were achieved with chemotherapy.Surgical resection with negative margins is the only potentially curative therapy, while radiation therapy and chemotherapy might be useful in the neoadjuvant or adjuvant setting, but their advantage in survival is not demonstrated. In the reported case, chemotherapy permitted the achievement of partial response and stabilisation of the disease.


Assuntos
Fraturas Espontâneas , Neoplasias de Bainha Neural , Neurofibrossarcoma , Feminino , Gravidez , Humanos , Coxa da Perna/patologia , Neoplasias de Bainha Neural/complicações , Neoplasias de Bainha Neural/cirurgia , Neoplasias de Bainha Neural/diagnóstico , Gestantes , Fêmur/patologia
5.
Sensors (Basel) ; 24(6)2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38544198

RESUMO

Lower extremity exercises are considered a standard and necessary treatment for rehabilitation and a well-rounded fitness routine, which builds strength, flexibility, and balance. The efficacy of rehabilitation programs hinges on meticulous monitoring of both adherence to home exercise routines and the quality of performance. However, in a home environment, patients often tend to inaccurately report the number of exercises performed and overlook the correctness of their rehabilitation motions, lacking quantifiable and systematic standards, thus impeding the recovery process. To address these challenges, there is a crucial need for a lightweight, unbiased, cost-effective, and objective wearable motion capture (Mocap) system designed for monitoring and evaluating home-based rehabilitation/fitness programs. This paper focuses on the development of such a system to gather exercise data into usable metrics. Five radio frequency (RF) inertial measurement unit (IMU) devices (RF-IMUs) were developed and strategically placed on calves, thighs, and abdomens. A two-layer long short-term memory (LSTM) model was used for fitness activity recognition (FAR) with an average accuracy of 97.4%. An intelligent smartphone algorithm was developed to track motion, recognize activity, and calculate key exercise variables in real time for squat, high knees, and lunge exercises. Additionally, a 3D avatar on the smartphone App allows users to observe and track their progress in real time or by replaying their exercise motions. A dynamic time warping (DTW) algorithm was also integrated into the system for scoring the similarity in two motions. The system's adaptability shows promise for applications in medical rehabilitation and sports.


Assuntos
Exercício Físico , Dispositivos Eletrônicos Vestíveis , Humanos , Terapia por Exercício , Perna (Membro) , Coxa da Perna
6.
Artigo em Alemão | MEDLINE | ID: mdl-38513641

RESUMO

Ultrasound (US) technology has significantly expanded the spectrum of regional anesthesiological procedures in recent years. Abdominal wall blocks are becoming an increasingly integral part of a multimodal postoperative pain concept after abdominal surgery, gynecological or urological interventions. Thoracic epidural analgesia remains the gold standard for extensive surgery. The requirement for rapid postoperative mobilization and discharge after lower extremity surgery has led to the abandonment of neuroaxial or plexus blocks in favor of selective, peripheral blocks such as the PENG block or adductor canal block. The following article is intended to show the reader the change in the use of regional anesthesiological procedures for abdominal wall and lower extremity blocks using selected blockages.


Assuntos
Anestesia por Condução , Bloqueio Nervoso , Humanos , Bloqueio Nervoso/métodos , Abdome/cirurgia , Anestesia por Condução/métodos , Coxa da Perna , Dor Pós-Operatória/prevenção & controle , Dedos do Pé
7.
Microsurgery ; 44(4): e31171, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38549389

RESUMO

BACKGROUND: With the growing demand for the use of thin perforator flaps, obtaining knowledge on the superficial anatomy of perforators is imperative for stable flap elevation. Conventional modalities for perforator mapping fall short in providing such information. High-frequency ultrasound (HFUS), known for visualizing the superficially located anatomic structures, may potentially fill this void. This study aimed to evaluate the effectiveness of HFUS in the outcome of anterolateral thigh (ALT) and superficial circumflex iliac artery perforator (SCIP) flap-based reconstructions. METHODS: Consecutive patients who underwent free ALT or SCIP flap-based reconstruction from January 2021 to November 2022 were retrospectively reviewed. Perforator mapping was conducted using a handheld Doppler during the first year, while HFUS was used in the latter part. The two techniques were compared in terms of flap harvesting time and perfusion-related complication rates while considering the flap elevation plane. RESULTS: In total, 123 cases were analyzed, including 82 ALT flaps (41 in each group) and 41 SCIP flaps (16 in the Doppler and 25 in the HFUS group). The time required for flap elevation exhibited a tendency to decrease in the HFUS group, with a significant difference observed in cases involving thin flap elevation (super-thin ALT flaps and pure-skin-perforator SCIP flaps). Compared with the Doppler group, the HFUS group demonstrated significantly lower rates of PRCs, particularly partial flap necrosis. This difference remained significant in multivariable analyses. CONCLUSION: Our results suggest that HFUS might be an appealing modality for perforator mapping in cases requiring thin ALT and SCIP flap.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Retalho Perfurante/irrigação sanguínea , Coxa da Perna/cirurgia , Coxa da Perna/irrigação sanguínea , Artéria Ilíaca/cirurgia , Estudos Retrospectivos
9.
Hand Clin ; 40(2): 199-208, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38553091

RESUMO

Upper extremity reconstruction remains challenging due to the high functional and esthetic demands of this location. The anterolateral thigh (ALT) flap is a workhorse flap for microsurgical reconstruction of the upper extremity and can be elevated in various planes depending on desired thickness of the flap. Microsurgical reconstruction of the upper extremity often benefits from a thin flap that can resurface the extremity, which can provide improved functional and esthetic outcomes. This article reviews the anatomy, preoperative planning, and operative technique, as well as presents 4 cases to illustrate the outcomes and benefits of thin and thinned ALT flaps.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Humanos , Coxa da Perna/cirurgia , Retalhos Cirúrgicos , Extremidade Superior/cirurgia , Estética
10.
Microsurgery ; 44(4): e31175, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38553853

RESUMO

INTRODUCTION: The pectoral myocutaneous flap (PMF) is a workhorse regional reconstructive option for head and neck defects. It is commonly used for primary reconstructions due to its advantages or as a life-boat flap in the salvage of failed reconstructions of free flaps. However, it also has intrinsic drawbacks, such as perfusion problems and partial or complete flap loss. Although there are many studies about the advantages and use of PMF in the literature, the number of studies about salvage of this workhorse flap is inadequate. We aimed to present the use of the pedicle of previously performed PMF as a recipient for free flaps in head and neck reconstruction. METHODS: Between January 2022 and August 2023, 10 free flaps were used in nine patients (three females and six males) who had previously undergone head and neck reconstruction with PMF. The age of the patients ranged from 54 to 74 years. Seven out of the nine PMFs were previously performed by different surgical teams. Squamous cell carcinoma (SCC) was the reason for primary surgeries in all patients and the PMFs were used for right lower lip and right submandibular defect, left lower lip and mentum defect, lower lip defect, right lower lip and right submandibular defect, right retromolar trigone defect, right buccal defect, left anterolateral esophageal defect, right retromolar trigone defect and left anterolateral pharyngoesophageal defect reconstructions. The problems were partial skin island necrosis and wound dehiscence in six patients and total skin necrosis in three patients. The partial skin island necroses already showed that the pedicles were unproblematic. For patients with total skin island necrosis the muscle stalks so the pedicles were also unproblematic which were confirmed by physical examination and Doppler device. After complications, the finally defects were located in the lower lip, left lower lip and mentum, right lower lip and right submandibular area, left anterolateral esophageal area and left neck, right buccal area, right retromolar trigon, left anterolateral pharyngoesophageal fistula and left neck. The sizes of the defects were between 3 × 4 cm and 11 × 17 cm. For all patients, the pedicle of the previously harvested PMF was used as a recipient for free flaps. Since the PMF was flipped over the clavicula for the reconstruction previously, the pedicle was so close to skin or skin graft which was used for coverage of the muscle stalk. The Doppler device was used first over the clavicle where the PMF was flipped for vessel identification. After marking the vessels, a vertical zigzag incision was made on the skin or skin graft. The perivascular fatty tissue and the pedicle were encountered with minimal dissection by the guidance of Doppler. After meticulous microscopic dissection, the pedicle of PMF was prepared for anastomoses as usual. Six radial forearm free flap (RFFF) and four anterolateral thigh flap (ALT) flaps were used in the head and neck reconstructions for the nine patients. RESULTS: The sizes of the flaps were between 4 × 5 cm and 12 × 17 cm. The diameters of the recipient arteries were between 0.9 and 1.2 mm. Recipient veins were approximately the same diameter as the arteries. In one patient, two vein grafts were used for lengthening both the artery and vein to reach recipient vessels. End-to-end anastomoses without vein grafts were performed in the remaining patients. One arterial thrombosis that manifested on the first postoperative day was salvaged successfully. Hematoma was seen in two patients and wound dehiscence was seen in three patients. There was no partial or total flap necrosis and all flaps survived. The follow-up period ranged from 2 to 12 months. Despite successful reconstructions, two patients died during the follow-up period due to unrelated conditions. Functional results were acceptable in the remaining patients. CONCLUSION: The pedicle of previously used pectoral myocutaneous flaps may be a useful alternative option as the recipient for free flaps in head and neck reconstruction.


Assuntos
Retalhos de Tecido Biológico , Retalho Miocutâneo , Procedimentos de Cirurgia Plástica , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Retalhos de Tecido Biológico/irrigação sanguínea , Retalho Miocutâneo/irrigação sanguínea , Bochecha/cirurgia , Coxa da Perna/cirurgia , Necrose/cirurgia
11.
J Biomech ; 166: 112023, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38447429

RESUMO

In locomotion, the relative phasing of the limbs changes with speed and provides valuable insight to neuromuscular control of gait. At present, it is unknown if individuals trained in sprinting coordinate their limbs differently than runners from other athletic backgrounds. Therefore, we aimed to characterize the effects of speed and skill on lower limb coordination. Twenty-five physically active (PA) and fifteen track and field (TF) athletes performed 40 m running trials at self-selected speeds, from jogging to maximal sprinting. We measured lower limb kinematics during steady-speed running, and quantified coordination using continuous relative phase (CRP) methods for interlimb pairs (Thigh-Thigh, Shank-Shank) and intralimb pairs (Shank-Thigh). Regression techniques showed between-group differences in scaling of coordination with speed during the stance phase, such that coordination was significantly more antiphase during jogging and running speeds in TF. During flight the scaling between groups was similar, but there were persistent and significant differences in coordination across all speeds. Comparing only the maximal speed trials, we found interlimb coordination was significantly more antiphase for TF in both stance and flight. In all cases, Shank-Shank coordination showed the largest between-group differences. Our results demonstrate the importance of interlimb coordination at maximal sprint speed, particularly during the flight phase and between shank segments. Between-group differences in coordination at slower speeds suggest a selective tuning of coordination in trained runners. We speculate differences in limb coordination are due to acquired motor patterns from optimizing forward velocity and its mechanical determinants, which differ particularly during flight/swing and between shank segments.


Assuntos
Extremidade Inferior , Corrida , Humanos , Perna (Membro) , Marcha , Coxa da Perna , Fenômenos Biomecânicos
12.
Acta Orthop Traumatol Turc ; 58(1): 34-38, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38525508

RESUMO

OBJECTIVE: This study investigated the reconstruction of multiple long digital and hand defects using the multilobed anterolateral thigh perforator flap. METHODS: From January 2018 to January 2021, 14 patients (hands) with multiple long digital defects were treated using the multilobed anterolateral thigh perforator flap. The mean age of the patients was 35 years (range, 18-55 years). The mean size (length × width) of the defects was 12.3 × 10.6 cm (range, 9 × 7 cm-16 × 12 cm). The mean size of the flap was 13.7 × 12.1 cm (range, 11 × 8 cm-19 × 14 cm). The total active motion was compared to the opposite side (100% normal, excellent; 75%-99% normal, good; 50%-74% normal, fair; <50% normal, poor). RESULTS: In this series, 12 flaps survived completely. Partial flap necrosis occurred in 2 patients but healed with wound care. The mean follow-up period was 28 months (range, 25-34 months). Based on the total active motion scoring system, we got 1 excellent, 7 good, 7 fair, and 1 poor result. A second surgery to separate the digits was not required. CONCLUSION: Multiple digital and hand defects can be reconstructed simultaneously using the multilobed anterolateral thigh perforator flap, allowing a length-to-width ratio of greater than 1.5:1 to resurface long digital defects. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Coxa da Perna/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
13.
Ann Plast Surg ; 92(4): 412-417, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38527348

RESUMO

BACKGROUND: Free flap selection in extremity reconstruction can be challenging. The ideal flap has to be thin and pliable to achieve optimal contour and function. We explore the role of the fascia-only anterolateral thigh (fALT) flap in extremity reconstruction. METHODS: We conducted a retrospective review of our experience using fALT-free flap for extremity reconstruction over a 2-year period. Patient demographics, mechanism of injury, flap characteristics, complications- and follow-up were recorded. Descriptive statistics were calculated. RESULTS: Twelve patients were included. The median (interquartile range [IQR]) age was 34 (28-52) years. One fALT flap was used for upper extremity reconstruction, while 11 flaps were used for lower extremity reconstruction (4 for lower third of the leg, 4 for dorsum of foot, and 3 for heel). The median (IQR) flap surface area was 90 (63-120) cm2 and time from injury to reconstruction was 10 (6-16) days. The postoperative course was uneventful for all flaps except for 1 flap failure and 1 delayed healing. The median (IQR) follow-up was 2 (1-4) months. In all cases, durable soft tissue reconstruction was achieved with no need for revisions. CONCLUSIONS: The fALT-free flap can be successfully used in extremity reconstruction. The ALT fascia has robust perfusion that allows for the harvest of a large flap that can be surfaced with a split thickness skin graft. Its thin pliable tissue provides excellent contour for the hand, distal leg, and foot that does not require future thinning, optimizing the cosmetic and functional result.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Humanos , Adulto , Pessoa de Meia-Idade , Coxa da Perna/cirurgia , Extremidade Inferior/cirurgia , Fáscia/transplante , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
16.
Am J Case Rep ; 25: e942416, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38429923

RESUMO

BACKGROUND Soft tissue metastases (STMs) are less common than bone metastases and sometimes misdiagnosed as primary soft tissue malignancies. Skin, lungs, and breast are the most common primary lesions of STMs and rarely the presenting symptoms. We present an STM from lung adenocarcinoma that became a presenting symptom in nonsmoking woman. CASE REPORT A 47-year-old woman presented to our hospital with a painful mass in her right thigh and weight loss of 10 kg for 4 months. Femoral radiograph revealed a lesion suggestive of bone sarcoma. However, magnetic resonance imaging (MRI) showed it was more likely a primary soft tissue sarcoma. A small mediastinal mass was noticed on preoperative chest radiograph, and the patient denied any symptoms except the mass in the right thigh. Our clinicopathological conference team decided to perform a biopsy of mediastinal and right thigh masses. Histopathology examinations confirmed the right thigh mass as soft tissue metastasis from mediastinal mass, confirmed as lung adenocarcinoma. We treated the patient with palliative care with zoledronic acid and gefitinib. At the 6-month follow-up, the patient's symptoms significantly improved, and MRI showed a marked size reduction. CONCLUSIONS Diagnosis of STM can be difficult when presenting as the primary manifestation. Failure to identify promptly can lead to rapid disease progression and unfavorable prognosis. Failure to diagnose primary malignancy during biopsy occurs in approximately 28% of cases. This report has the potential to facilitate the avoidance of unnecessary procedures and highlight the importance of using a multidisciplinary approach in managing cases with malignancy.


Assuntos
Adenocarcinoma de Pulmão , Neoplasias Ósseas , Neoplasias Pulmonares , Sarcoma , Neoplasias de Tecidos Moles , Feminino , Humanos , Pessoa de Meia-Idade , Coxa da Perna , Neoplasias Pulmonares/patologia , Fêmur , Sarcoma/diagnóstico , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologia , Adenocarcinoma de Pulmão/patologia , Neoplasias Ósseas/patologia
17.
J Emerg Med ; 66(4): e526-e529, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38461135

RESUMO

BACKGROUND: Acute compartment syndrome can be caused by any condition that increases the pressure of an intracompartmental muscular space, resulting in ischemia, which is a limb-threatening emergency. This case report is the first known documented example of an exogenously injected peptide causing compartment syndrome. The use of natural supplements and holistic therapies is on the rise, specifically, peptide injections. It is important to obtain the history of use and routes of administration of these substances. CASE REPORT: We present a case of a 43-year-old man who presented to the Emergency Department with worsening thigh pain. The patient had injected a "peptide cocktail" into his thigh 3 days prior. Physical examination revealed trace pitting edema of the left leg with moderate muscle spasm and tenderness of the medial aspect of the distal thigh with associated numbness along the medial aspect of the knee. Point-of-care ultrasound detected intramuscular edema and free fluid in the leg. He was found to have acute compartment syndrome of the thigh secondary to the peptide cocktail injection, causing a large hematoma posterior to the adductor magnus. The patient required fasciotomy and hematoma evacuation. He ultimately left against medical advice during his hospitalization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In an age when many patients look for supplements to aid with weight loss and muscle growth, it is essential to be aware of peptide injection therapies and the potential complication of compartment syndrome.


Assuntos
Síndromes Compartimentais , Coxa da Perna , Masculino , Humanos , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Perna (Membro) , Fasciotomia , Edema/complicações , Hematoma/complicações
18.
J Plast Reconstr Aesthet Surg ; 91: 227-235, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428230

RESUMO

BACKGROUND: Lack of adequate recipient vessels in certain anatomically unfavorable locations or in complex clinical situations is still a limitation to successful microsurgical transfer. To address such complex cases, advanced microsurgical techniques should be applied. In this paper, the authors describe their experience with the Extra-anatomical Pedicle Rerouting (EPR) technique, an alternative approach that was used in selected cases throughout the body to obtain healthy recipient vessels for microsurgical reconstruction in unfavorable clinical situations where suitable recipient vessels were difficult to find. PATIENTS AND METHODS: Fifteen patients with defects of variable etiology (oncological resection, trauma, previous surgeries) located in the trunk or upper and lower extremities received EPR free flap reconstruction at our Institution. Operative data, postoperative course, and complications were recorded. Clinical and photographic follow-ups were also documented. RESULTS: A total of 15 flaps (6 antero-lateral thigh (ALT), 6 latissimus dorsi/thoracodorsal artery perforator flap (LD/TDAP), 3 deep inferior epigastric artery perforator flap (DIEP)) were transferred adopting the EPR technique for oncological (11) and post-traumatic (4) defects. According to the different clinical scenarios, the rerouted vessels were the thoraco-acromial, posterior circumflex humeral, thoracodorsal, deep inferior epigastric, lateral circumflex femoral, anterior tibial, and medial sural pedicles. Mean length of the rerouted vascular conduits was 6.53 cm. Mean operative time was 420 minutes. No major complications were registered. Minor wound dehiscence was observed and managed conservatively in 3 patients. CONCLUSIONS: The EPR technique proved to be useful in a reliable and reproducible manner in different regions of the body as an alternative solution to obtain healthy recipient vessels in anatomically and surgically unfavorable clinical situations.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Retalhos Cirúrgicos/irrigação sanguínea , Artérias/cirurgia , Extremidade Inferior , Coxa da Perna , Retalho Perfurante/irrigação sanguínea
19.
Poult Sci ; 103(4): 103554, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38401225

RESUMO

Heat stress (HS) causes oxidative damage and abnormal metabolism of muscle, thus impairing the meat quality in broilers. Selenium is an indispensable element for enhancing antioxidant systems. In our previous study, we synthesized a novel type of biogenic selenium nanoparticles synthesized with alginate oligosaccharides (SeNPs-AOS), and found that the particle size of Se is 80 nm and the Se content is 8% in the SeNPs-AOS; and dietary 5 mg/kg SeNPs-AOS has been shown to be effective against HS in broilers. However, whether SeNPs-AOS can mitigate HS-induced the impairment of thigh muscle quality in broilers is still unclear. Therefore, the purpose of this study was to investigate the protective effects of dietary SeNPs-AOS on meat quality, antioxidant capacity, and metabolomics of thigh muscle in broilers under HS. A total of 192 twenty-one-day-old Arbor Acres broilers were randomly divided into 4 groups with 6 replicates per group (8 broilers per replicate) according to a 2 × 2 experimental design: thermoneutral group (TN, broilers raised under 23±1.5°C); TN+SeNPs-AOS group (TN group supplemented 5 mg/kg SeNPS-AOS); HS group (broilers raised under 33 ± 2°C for 10 h/d); and HS + SeNPs-AOS group (HS group supplemented 5 mg/kg SeNPS-AOS). The results showed that HS increased the freezing loss, cooking loss, and malondialdehyde (MDA) content of thigh muscle, whereas decreased the total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activities, as well as downregulated the mRNA expression of SOD2, CAT, GPX3, nuclear factor erythroid 2-related factor 2 (Nrf2), selenoprotein S (SELENOS), solute carrier family 7 member 11 (SLC7A11), GPX4, and ferroportin 1 (Fpn1) of thigh muscle (P < 0.05). Dietary SeNPS-AOS reduced the b* value, elevated the pH0min value and the activities of T-SOD, GSH-Px, glutathione S-transferase (GST) and the mRNA expression levels of GSTT1, GSTA3, GPX1, GPX3, ferritin heavy polypeptide-1 (FTH1), and Fpn1 of thigh muscle in broilers under HS (P < 0.05). Nontargeted metabolomics analysis identified a total of 79 metabolites with significant differences among the four groups, and the differential metabolites were mainly enriched in 8 metabolic pathways including glutathione metabolism and ferroptosis (P < 0.05). In summary, dietary 5 mg/kg SeNPs-AOS (Se content of 8%) could alleviate HS-induced impairment of meat quality by improving the oxidative damage, metabolic disorders and ferroptosis of thigh muscle in broilers challenged with HS. Suggesting that the SeNPs-AOS may be used as a novel nano-modifier for meat quality in broilers raised in thermal environment.


Assuntos
Ferroptose , Selênio , Animais , Antioxidantes/metabolismo , Selênio/metabolismo , Galinhas/fisiologia , Coxa da Perna , Suplementos Nutricionais/análise , Músculo Esquelético , Resposta ao Choque Térmico , Superóxido Dismutase/metabolismo , Carne/análise , RNA Mensageiro/metabolismo , Ração Animal/análise
20.
Artigo em Chinês | MEDLINE | ID: mdl-38418178

RESUMO

Objective: To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. Methods: The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded. Results: During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints. Conclusions: The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Masculino , Feminino , Humanos , Coxa da Perna/cirurgia , Retalho Perfurante/cirurgia , Lesões dos Tecidos Moles/cirurgia , Extremidade Inferior/cirurgia
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