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Gudefin S, Weiss A, Ciucur E, Herlin C. [Rare case of reconstruction of the anterior thigh compartment after resection of high-grade sarcoma by hybrid technique: Latissimus dorsi free flap associated with a medial gastrocnemius pedicled flap]. ANN CHIR PLAST ESTH 2024; 69:207-211. [PMID: 37271656 DOI: 10.1016/j.anplas.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The soft tissue sarcomas of the limbs require extensive surgical excision. Reconstructive surgery plays an essential role in its management to preserve the limb, as exposed in a case of thigh sarcoma. CLINICAL CASE A 73-year-old patient has a large sarcoma within the quadriceps. Its excision requires resection of the entire anterior thigh compartment. Preservation of the limb is permitted by reconstruction by latissimus dorsi free flap and medial gastrocnemius pedicled flap. The patient resumed walking using an orthosis at 3 months. CONCLUSION Surgery to remove a sarcoma of a limb can threaten the integrity of the limb. Plastic surgery, with all the reconstruction techniques, contributes to the preservation of a functional limb.
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Affiliation(s)
- S Gudefin
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Carrémeau, place du Pr.-Robert-Debré, 30029 Nîmes, France.
| | - A Weiss
- Service de chirurgie orthopédique, traumatologique et chirurgie du rachis, CHU de Carrémeau, place du Pr.-Robert-Debré, 30029 Nîmes, France
| | - E Ciucur
- Service de chirurgie plastique, reconstructrice et esthétique, CHU de Carrémeau, place du Pr.-Robert-Debré, 30029 Nîmes, France
| | - C Herlin
- Chirurgie plastique reconstructrice et esthétique - brûlés, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
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Farfán E, Rojas S, Olivé-Vilás R, Rodríguez-Baeza A. Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication. Surg Radiol Anat 2024:10.1007/s00276-024-03371-4. [PMID: 38652253 DOI: 10.1007/s00276-024-03371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
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.
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Affiliation(s)
- Emilio Farfán
- Anatomy Department, Medicine School, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins #340, Santiago, Chile.
| | - Santiago Rojas
- Department of Morphological Sciences (Human Anatomy and Embryology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Olivé-Vilás
- Sports Medicine Department, Consorci Sanitari de Terrassa- CAR Sant Cugat, Barcelona, Spain
- Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alfonso Rodríguez-Baeza
- Department of Morphological Sciences (Human Anatomy and Embryology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Shirodkar K, Iyengar KP, Mehta J, Azzopardi CA, Botchu R. Right-sided meralgia paresthetica from lateral femoral cutaneous nerve neuroma. J Ultrasound 2024:10.1007/s40477-024-00883-y. [PMID: 38573474 DOI: 10.1007/s40477-024-00883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/15/2024] [Indexed: 04/05/2024] Open
Abstract
Meralgia Paresthetica (MP) causes outer thigh discomfort, numbness, and tingling. Compression or injury to the Lateral Femoral Cutaneous Nerve (LFCN), which gives sensory innervation to outer aspect of the thigh. It frequently gets impinged beneath the inguinal ligament resulting in in sensory impairment in the distribution of LFCN. Compression of the LFCN is a frequent cause of MP, whereas LFCN neuromas is a rare cause. This case report describes a unique case of Meralgia Paresthetica produced by a LFCN neuroma and enhances our knowledge of Meralgia Paresthetica.
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Affiliation(s)
- K Shirodkar
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - K P Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - J Mehta
- Department of Spinal Surgery, Royal Orthopedic Hospital, Birmingham, UK
| | - C A Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Heo Y, Yang M, Nam SM, Lee HS, Kim YD, Won HS. New insight into the vasto-adductor membrane for safer adductor canal blockade. Korean J Pain 2024; 37:132-140. [PMID: 38433475 PMCID: PMC10985484 DOI: 10.3344/kjp.23292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/23/2023] [Accepted: 12/16/2023] [Indexed: 03/05/2024] Open
Abstract
Background : This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). Methods : Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. Results : The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. Conclusions : Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.
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Affiliation(s)
- Yanguk Heo
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Miyoung Yang
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
- Sarcopenia Total Solution Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung Min Nam
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
| | - Hyun Seung Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Yeon-Dong Kim
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hyung-Sun Won
- Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
- Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
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S Oliveira S, G L Bandeira W, M Lopes L, R M Lima R, C Cavalcante J. Incidence of the tensor of the vastus intermedius: A cadaveric study. Morphologie 2024; 108:100609. [PMID: 37897940 DOI: 10.1016/j.morpho.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 10/30/2023]
Abstract
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.
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Affiliation(s)
- S S Oliveira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - W G L Bandeira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L M Lopes
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - R R M Lima
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J C Cavalcante
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Elie BBM, Tshass CB, Ganywamulume B, Musimwa P, Kaguku N, Désiré AM. Bone tumors in children: Round cell sarcoma of the thigh: A case report. Int J Surg Case Rep 2024; 116:109382. [PMID: 38364754 PMCID: PMC10943929 DOI: 10.1016/j.ijscr.2024.109382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Bone tumor in children is a very large pathology and represents about 5% of pediatric cancers located mainly in the limbs. This is a case of a rare form of bone tumor of the round cell sarcoma type of the right femur in an 18-month-old female infant whose diagnosis and therapeutic decision are specific. CASE PRESENTATION We present an 18-month-old girl, admitted to the panzi general reference hospital and presenting a painful swelling of the right thigh evolving for more than a month and which gradually increased in size in a febrile context with ipso-lateral inguinal adenopathy; Bone biopsy revealed round cell sarcoma and immunohistochemistry was not available. While waiting for chemotherapy, the proposed surgery was a hip disarticulation in an 18-month-old girl. CLINICAL DISCUSSION Early discovery of the tumor at infant age is rare, it can occur in any part of the limb. The lower end of the femur and the upper end of the tibia or fibula account for 60% of cases. Its diagnosis is not easy, the management and improvement of the prognosis are linked to the use of chemotherapy and local treatment and conservative surgical resection, avoiding amputation or disarticulation. It is not easy to accept, neither for the child's parents nor for the healthcare team. CONCLUSION Thigh sarcoma in an infant is rare and atypically discovered when faced with complications, infection or remote signs with difficulty in diagnosis and management; multidisciplinarity is very necessary, also involving psychologists despite the poor prognosis.
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Affiliation(s)
- Bugashane Bwa Mihigo Elie
- Surgery Department, Faculty of medicine and public health, Evangelical University in Africa, Bukavu, South Kivu, Congo; Surgery Department, Panzi General Referral Hospital, Bukavu, South Kivu, Congo.
| | - Chasinga Baharanyi Tshass
- Biological laboratory, Faculty of Medicine and Public Health, Evangelical University in Africa, Bukavu, South Kivu, Congo; Pathological Anatomy Laboratory, Panzi General Referral Hospital, Bukavu, South Kivu, Congo
| | | | - Patrick Musimwa
- Surgery Department, Faculty of medicine and public health, Evangelical University in Africa, Bukavu, South Kivu, Congo; Surgery Department, Panzi General Referral Hospital, Bukavu, South Kivu, Congo
| | - Nfundiko Kaguku
- Surgery Department, Faculty of medicine and public health, Evangelical University in Africa, Bukavu, South Kivu, Congo; Surgery Department, Panzi General Referral Hospital, Bukavu, South Kivu, Congo
| | - Alumeti Munyali Désiré
- Surgery Department, Faculty of medicine and public health, Evangelical University in Africa, Bukavu, South Kivu, Congo; Surgery Department, Panzi General Referral Hospital, Bukavu, South Kivu, Congo; Surgery Department, Faculty of medicine, Official University of Bukavu, Bukavu, South Kivu, Congo; Pillar of Legal Medicine, Sexual Violence Survivors Program, Panzi General Referal Hospital, Bukavu, South Kivu, Congo; Research Department, Natural Sciences Research Center, Lwiro, Kabare, South Kivu, Congo
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Kim HS, Kim H, Kim S, Cha Y, Kim JT, Kim JW, Ha YC, Yoo JI. Precise individual muscle segmentation in whole thigh CT scans for sarcopenia assessment using U-net transformer. Sci Rep 2024; 14:3301. [PMID: 38331977 PMCID: PMC10853213 DOI: 10.1038/s41598-024-53707-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
The study aims to develop a deep learning based automatic segmentation approach using the UNETR(U-net Transformer) architecture to quantify the volume of individual thigh muscles(27 muscles in 5 groups) for Sarcopenia assessment. By automating the segmentation process, this approach improves the efficiency and accuracy of muscle volume calculation, facilitating a comprehensive understanding of muscle composition and its relationship to Sarcopenia. The study utilized a dataset of 72 whole thigh CT scans from hip fracture patients, annotated by two radiologists. The UNETR model was trained to perform precise voxel-level segmentation and various metrics such as dice score, average symmetric surface distance, volume correlation, relative absolute volume difference and Hausdorff distance were employed to evaluate the model's performance. Additionally, the correlation between Sarcopenia and individual thigh muscle volumes was examined. The proposed model demonstrated superior segmentation performance compared to the baseline model, achieving higher dice scores (DC = 0.84) and lower average symmetric surface distances (ASSD = 1.4191 ± 0.91). The volume correlation between Sarcopenia and individual thigh muscles in the male group. Furthermore, the correlation analysis of grouped thigh muscles also showed negative associations with Sarcopenia in the male participants. This thesis presents a deep learning based automatic segmentation approach for quantifying individual thigh muscle volume in sarcopenia assessment. The results highlights the associations between Sarcopenia and specific individual muscles as well as grouped thigh muscle regions, particularly in males. The proposed method improves the efficiency and accuracy of muscle volume calculation, contributing to a comprehensive evaluation of Sarcopenia. This research enhances our understanding of muscle composition and performance, providing valuable insights for effective interventions in Sarcopenia management.
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Affiliation(s)
- Hyeon Su Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea.
| | - Hyunbin Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Shinjune Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Daejeon, South Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, School of Medicine, Inha University Hospital, Incheon, South Korea.
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Bale LSW, Damjanovic MM, Damjanovic IG, DiMaio NM, Herrin SO. Tensor fasciae suralis - Prevalence study and literature review. Morphologie 2024; 108:100762. [PMID: 38325018 DOI: 10.1016/j.morpho.2024.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
Tensor fasciae suralis (TFS) is an accessory muscle of the posterior lower extremity. Although TFS has been documented in cadaveric and radiological reports, its prevalence remains unknown. The TFS variant is noteworthy to anatomists, as it may be encountered in the dissection laboratory, and clinicians, as the muscle could potentially cause confusion during physical examination or diagnostic imaging. Multiple variations of TFS have been reported in the literature, suggesting the need for a classification system. We dissected 236 formalin-fixed cadaveric lower limbs to determine the prevalence of TFS. The PubMed and MEDLINE databases were searched to compare the anatomical features of independent TFS case reports. In our prevalence study, the TFS muscle was identified in three lower limbs (1.3%). In total, 38 cases of TFS (32 cadaveric and six radiological) were identified in the literature. Our literature review revealed that the accessory muscle most often arises as a single head from the long head of the biceps femoris, yet many other presentations have been documented. The need for a classification system to distinguish between the subtypes of TFS became apparent during the literature review. Tensor fasciae suralis is a rare muscle, present in only 3 of 236 (1.3%) cadaveric lower limbs dissected in this study. We propose the use of a classification system, based on muscle origin and number of heads, to better organize the subtypes of TFS.
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Affiliation(s)
- L S W Bale
- Queen's University, Department of Biomedical & Molecular Sciences, Kingston, Ontario K7L 3L4, Canada
| | - M M Damjanovic
- Queen's University, Department of Biomedical & Molecular Sciences, Kingston, Ontario K7L 3L4, Canada
| | - I G Damjanovic
- Queen's University, Department of Biomedical & Molecular Sciences, Kingston, Ontario K7L 3L4, Canada.
| | - N M DiMaio
- University of Toronto, Faculty of Medicine, Toronto, Ontario M5S 1A8, Canada
| | - S O Herrin
- University of Western States, Department of Basic Sciences, Portland, OR 97230, USA
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Younis PA, Davis S, Sweedan AO, ElSabbagh AM, Fernandes RP. Volumetric changes in post hemiglossectomy reconstruction with anterolateral thigh free flap versus radial forearm free flap. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00889-5. [PMID: 38114394 DOI: 10.1016/j.ijom.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
The volume of the reconstructed tongue is considered a critical factor for tongue function. Studies investigating the difference in volume loss between the anterolateral thigh free flap (ALTF) and radial forearm free flap (RFFF) used in reconstruction of the tongue after hemiglossectomy are lacking. The aim of this study was to determine whether there is a significant difference in shrinkage between these two flaps. This was a retrospective study of all patients treated for tongue cancer by hemiglossectomy who underwent either ALTF or RFFF reconstruction at the University of Florida College of Medicine between January 2018 and April 2022. Computed tomography scans were used to measure the volumetric changes in the ALTF and RFFF at two time points over a 6-month period. Of the 85 patients assessed, 10 fulfilled the inclusion criteria: five were reconstructed with an ALTF and five with a RFFF. All underwent adjuvant radiotherapy. The mean ALTF percentage shrinkage was 39.6% ± 3.9%, while for the RFFF it was 51.1% ± 6.2% (P = 0.008). Therefore, it is recommended that the difference in volume loss between the two flaps is taken into consideration. It is suggested that in hemiglossectomy cases, the ALTF is made 1.4 times larger than the defect, while the RFFF is made 1.5 times larger.
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Affiliation(s)
- P A Younis
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; Department of Oral and Maxillofacial Surgery - Head and Neck Division, University of Florida Health College of Medicine - Jacksonville, Jacksonville, Florida, USA.
| | - S Davis
- Rehabilitation Services, University of Florida Health - Jacksonville, Jacksonville, Florida, USA.
| | - A O Sweedan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - A M ElSabbagh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - R P Fernandes
- Department of Oral and Maxillofacial Surgery - Head and Neck Division, University of Florida Health College of Medicine - Jacksonville, Jacksonville, Florida, USA.
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Masoodi Z, Steinbacher J, Wimberger P, Panhofer PT, Tzou CHJ. Chronic Fistulas of Thigh Presenting Unusually in an Operated Patient of Carcinoma Rectum. More Than What Meets the Eye! INT J LOW EXTR WOUND 2023; 22:774-778. [PMID: 34866452 DOI: 10.1177/15347346211065526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic skin lesions of the thigh (wounds, fistulas etc) are relatively uncommon, vis-à-vis, their notorious cousins over the distal limb. Even when present, the cause is usually obvious, mostly as trauma or a systemic affliction. We present an unusual case of chronic fistulas over the right thigh in a patient of carcinoma rectum for which anterior resection and an end colostomy was done 4 years earlier. Postsurgical pelvic abscesses finding their way into the thigh are a known entity, but they are usually accompanied by systemic/local features and their presentation is within a shorter time span. The novelty of our case lies in its manifestation (as a cluster of chronic fistulas and not a frank abscess), its late presentation as well as in the absence of any systemic/local inflammatory signs. Our primary objective is to educate wound physicians about the origin of such fistulas whenever they deal with patients who have had a preceding surgical intervention of the abdomen. In our humble opinion, this will ease out many diagnostic and management dilemmas, that such patients can potentially pose.
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Affiliation(s)
- Zulqarnain Masoodi
- Hospital of Divine Savior, Vienna, Austria
- Florence Multi Specialty Hospital, Srinagar, India
| | | | | | | | - Chieh-Han John Tzou
- Hospital of Divine Savior, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
- TZOU MEDICAL, Vienna, Austria
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Lim M, Kim JM, Yang J, Kwon J, Kim KD, Jeong ES, Rhu J, Choi GS, Joh JW, Lee SK. Upper thigh skeletal muscle index predicts outcomes in liver transplant recipients. Ann Surg Treat Res 2023; 105:219-227. [PMID: 37908380 PMCID: PMC10613820 DOI: 10.4174/astr.2023.105.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The skeletal muscle index (SMI) at the L3 level is widely used to diagnose sarcopenia. The upper thigh (UT) also reflects changes in whole-body muscle mass, but no study has examined this using the UT to diagnose sarcopenia in liver transplantation (LT). This study aimed to determine an optimal cut-off value for UT-SMI and investigate how sarcopenia diagnosed by UT-SMI correlates with outcomes in LT recipients. Methods In this retrospective study of 332 LT patients from 2018 to 2020, we investigated the association between sarcopenia diagnosed by UT-SMI and patient outcomes after LT. Results The cut-off values for UT-SMI were 38.3 cm2/m2 for females (area under the curve [AUC], 0.927; P < 0.001) and 46.7 cm2/m2 for males (AUC, 0.898; P < 0.001). The prevalence of sarcopenia diagnosed by UT-SMI was 33.4% in our cohort. Patient and graft survival rates in the UT-SMI sarcopenia group were significantly poorer than those in the UT-SMI non-sarcopenia group (P < 0.001 and P < 0.001). UT-SMI was an independent prognostic factor for patient survival (hazard ratio [HR], 2.182; 95% confidence interval [CI], 1.183-4.025; P = 0.012) and graft survival (HR, 2.227; 95% CI, 1.054-4704; P = 0.036) in our multivariable Cox analysis. Conclusion We confirmed that sarcopenia diagnosed by UT-SMI is associated with outcomes in LT recipients. In addition, UT-SMI was identified as an independent prognostic factor for patient survival and graft survival. Therefore, UT-SMI could be a good option for CT-based evaluations of sarcopenia in LT recipients.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Deok Kim
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Eun Sung Jeong
- Department of Surgery, Dongguk University Medical Center, Goyang, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
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12
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Vitti LFR, Hanasilo CEH, Silva CM, Etchebehere M. Muscle strength and psychometric properties of the health-related quality of life in patients with soft tissue sarcoma resection in the thigh. Clinics (Sao Paulo) 2023; 78:100283. [PMID: 37783169 PMCID: PMC10562151 DOI: 10.1016/j.clinsp.2023.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/13/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023] Open
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.
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Affiliation(s)
- Liza Furlan Ranzani Vitti
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Carlos Eduardo Hideo Hanasilo
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Cleide Moreira Silva
- Research Committee, Statistical Service, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil
| | - Mauricio Etchebehere
- Department of Orthopaedics and Traumatology, Faculdade de Medicina da Universidade de Campinas, Campinas, SP, Brazil.
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Wang F, Fang S, Li J, Yuan L, Hou B, Zhu J, Jiao Y, Liu Z, Qian M, Santini F, Wang Q, Chen L, Feng F. Correlation analysis of quantitative MRI measurements of thigh muscles with histopathology in patients with idiopathic inflammatory myopathy. Eur Radiol Exp 2023; 7:51. [PMID: 37589922 PMCID: PMC10435435 DOI: 10.1186/s41747-023-00350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/29/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To validate the correlation between histopathological findings and quantitative magnetic resonance imaging (qMRI) fat fraction (FF) and water T2 mapping in patients with idiopathic inflammatory myopathy (IIM). METHODS The study included 13 patients with histopathologically confirmed IIM who underwent dedicated thigh qMRI scanning within 1 month before open muscle biopsy. For the biopsied muscles, FF derived from the iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) and T2 time from T2 mapping with chemical shift selective fat saturation were measured using a machine learning software. Individual histochemical and immunohistochemical slides were evaluated using a 5-point Likert score. Inter-reader agreement and the correlation between qMRI markers and histopathological scores were analyzed. RESULTS Readers showed good to perfect agreement in qMRI measurements and most histopathological scores. FF of the biopsied muscles was positively correlated with the amount of fat in histopathological slides (p = 0.031). Prolonged T2 time was associated with the degree of variation in myofiber size, inflammatory cell infiltration, and amount of connective tissues (p ≤ 0.008 for all). CONCLUSIONS Using the machine learning-based muscle segmentation method, a positive correlation was confirmed between qMRI biomarkers and histopathological findings of patients with IIM. This finding provides a basis for using qMRI as a non-invasive tool in the diagnostic workflow of IIM. RELEVANCE STATEMENT By using ML-based muscle segmentation, a correlation between qMRI biomarkers and histopathology was found in patients with IIM: qMRI is a potential non-invasive tool in this clinical setting. KEY POINTS • Quantitative magnetic resonance imaging measurements using machine learning-based muscle segmentation have good consistency and reproductivity. • Fat fraction of idiopathic inflammatory myopathy (IIM) correlated with the amount of fat at histopathology. • Prolonged T2 time was associated with muscle inflammation in IIM.
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Affiliation(s)
- Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shiyuan Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Yuan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Qian
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Francesco Santini
- Department of Research and Analytic Services, University Hospital Basel, Basel, Switzerland.
- Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Qian Wang
- Department of Rheumatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Weishorn J, Heid S, Bruckner T, Merle C, Renkawitz T, Innmann MM. How is hip anatomy reconstruction and inlay wear associated up to 10 years after primary THA using ceramic on highly crosslinked polyethylene bearings? BMC Musculoskelet Disord 2023; 24:400. [PMID: 37202754 DOI: 10.1186/s12891-023-06501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Conventional polyethylene (PE) wear has been reported to be associated with femoral offset reconstruction and cup orientation after THA. Thus, the present study aimed (1) to determine the polyethylene wear rate of 32 mm ceramic heads with highly cross-linked polyethylene (HXLPE) inlays up to 10 years postoperatively and (2) to identify patient and surgery-related factors affecting the wear rate. METHODS A prospective cohort study was performed, investigating 101 patients with 101 cementless THAs and ceramic (32 mm) on HXLPE bearings after 6-24 months, 2-5 years and 5-10 years postoperatively. The linear wear rate was determined using a validated software (PolyWare®, Rev 8, Draftware Inc, North Webster, IN, USA) by two reviewers, blinded to each other. A linear regression model was used to identify patient and surgery-related factors on HXLPE -wear. RESULTS After an initial bedding-in phase of 1 year after surgery, the mean linear wear rate was 0.059 ± 0.031 mm/y at ten years (mean 7.7 years; SD 0.6 years, range 6-10), being below the osteolysis relevant threshold of 0.1 mm/year. The regression analysis demonstrated that age at surgery, BMI, cup inclination or anteversion and the UCLA score were not associated with the linear HXLPE-wear rate. Only increased femoral offset showed a significant correlation with an increased HXLPE-wear rate (correlation coefficient of 0.303; p = 0.003) with a moderate clinical effect size (Cohen's f²=0.11). CONCLUSION In contrast to conventional PE inlays, hip arthroplasty surgeons may be less concerned about osteolysis-related wear of the HXLPE if the femoral offset is slightly increased. This allows focusing on joint anatomy reconstruction, hip stability and leg length.
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Affiliation(s)
- Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Samira Heid
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
- Department of Orthopaedic Surgery, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Bouzid YB, Krimech O, El Ouagari H, Ibnoussina O, Lamrani MO, Zouaidia F. Rare case of Malign Peripheral Nerve Sheath Tumor complicating a solitary giant neurofibroma of the thigh. Int J Surg Case Rep 2023; 106:108224. [PMID: 37105026 PMCID: PMC10164757 DOI: 10.1016/j.ijscr.2023.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/08/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Malign Peripheral Nerve Sheath Tumor is rare and can occur on a solitary neurofibroma or as part of neurofibromatosis type 1. The occurrence of a giant solitary neurofibroma in the thigh is rare and its complication in MPNST is much rarer. The diagnosis is based on a combination of radiological, histological and immunohistochemical evidence. CASE PRESENTATION We present the case of a 55 years old woman who presented a mass of the posterior aspect of the thigh without any other abnormality on systemic examination. MRI showed a T1 hyposignal and a T2 hypersignal and the biopsy performed was in favor of a neurofibroma. After surgical resection, the histological study of the surgical specimen revealed an MPNST developing on a pre-existing neurofibroma. After 5 months, the patient had moderate knee stiffness with thigh amyotrophy. CLINICAL DISCUSSION The occurrence of MPNST on a giant solitary neurofibroma of the thigh is extremely rare. MRI allows evoking the diagnosis but radiologists are confronted with a problem of differential diagnosis. Histological examination supports the diagnosis in addition to immunohistochemical examination. Only surgical treatment can give hope for a cure. Recurrences remain frequent with a 5-year survival of 50 %. CONCLUSION Early diagnosis is essential to prevent the evolution of the tumor and the occurrence of poor prognostic factors compromising the management, increasing the risk of recurrence and affecting the overall survival of patients.
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Affiliation(s)
- Yassine Ben Bouzid
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco.
| | - Omar Krimech
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Hamza El Ouagari
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Othmane Ibnoussina
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Moulay Omar Lamrani
- Department of Orthopaedic and Trauma Surgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Fouad Zouaidia
- Department of Pathological Anatomy, Ibn Sina University Hospital, Rabat, Morocco
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Ooms M, Beckmann L, Ayoub N, Raith S, Puladi B, Houschyar K, Hölzle F, Modabber A. Evaluation of anterolateral thigh flap dimensions with virtual flap models. Int J Oral Maxillofac Surg 2023; 52:168-174. [PMID: 35659500 DOI: 10.1016/j.ijom.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/26/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
Free flaps are commonly used for head and neck reconstruction. However, flap dimensions are still evaluated by visual and tactile assessment. The aim of this study was to enable preoperative planning of flap dimensions for soft tissue reconstruction based on clinical parameters. Computed tomography records from 230 patients dated from 2009 to 2019 were analysed retrospectively. A virtual, three-dimensional anterolateral thigh flap model was standardized, aligned to segmented leg models in two positions, and flap thicknesses and volumes were determined. Associations of flap thickness and volume with clinical parameters were evaluated, and an approximative calculation method was derived. The laterally positioned anterolateral thigh flap showed an average (interquartile range) thickness of 15.6 mm (8.7 mm) and volume of 1.5 cm3 (0.9 cm3) per cm2. The medially positioned anterolateral thigh flap showed an average (interquartile range) thickness of 16.3 mm (8.7 mm) and volume of 1.6 cm3 (0.9 cm3) per cm2. For both flap positions, leg circumference was the strongest predictor of flap thickness (β = 0.545, P < 0.001 and β = 0.529, P < 0.001) and flap volume (β = 0.523, P < 0.001 and β = 0.480, P < 0.001). Flap dimensions can be calculated based on leg circumference, and this preoperative planning of flap dimensions can help the surgeon to select the appropriate flap.
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Affiliation(s)
- M Ooms
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - L Beckmann
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - N Ayoub
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Raith
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - B Puladi
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - K Houschyar
- Clinic for Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
| | - F Hölzle
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - A Modabber
- Clinic for Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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17
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Gontijo BA, Fonseca ST, Araújo PA, Magalhães FA, Trede RG, Faria HP, Resende RA, Souza TR. A new marker cluster anchored to the iliotibial band improves tracking of hip and thigh axial rotations. J Biomech 2023; 147:111452. [PMID: 36682212 DOI: 10.1016/j.jbiomech.2023.111452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Bruna A Gontijo
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Sérgio T Fonseca
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Priscila A Araújo
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Fabricio A Magalhães
- College of Education, Health, and Human Sciences, Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE, USA
| | - Renato G Trede
- Graduate Program in Rehabilitation and Functional Performance, Department of Physical Therapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Brazil
| | - Henrique P Faria
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Renan A Resende
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Thales R Souza
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Brazil.
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Yu XX, Yang SF, Ji CS, Qiu SQ, Qi YD, Wang XM. A novel computed tomography angiography technique: guided preoperative localization and design of anterolateral thigh perforator flap. Insights Imaging 2022; 13:190. [PMID: 36512153 DOI: 10.1186/s13244-022-01318-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anterolateral thigh perforator (ALTP) flap is considered a versatile flap for soft tissue reconstruction. Computed tomography angiography (CTA) is used for mapping perforator in abdominal-based reconstruction; however, it is less commonly used in ALTP due to its poor imaging efficacy. In this study, we introduced a novel CTA technique for preoperative localization and design of ALTP flap and evaluated its value in directing surgical reconstruction. RESULTS Thirty-five patients with soft tissue defects were consecutively enrolled. Modified CTA procedures, such as sharp convolution kernel, ADMIRE iterative reconstruction, 80 kV tube voltage, high flow contrast agent and cinematic rendering image reconstruction, were used to map ALTPs. A total of 287 perforators (including 884 sub-branches) were determined, with a mean of 5 perforators per thigh (range 2-11). The ALTPs were mainly concentrated in the "hot zone" (42%, 121/287) or the distal zone (41%, 118/287). Most perforators originated from the descending branch of the lateral circumflex femoral artery (76%, 219/287). Three perforator types, namely musculocutaneous (62%, 177/287), septocutaneous (33%, 96/287), and mixed pattern (5%, 14/287), were identified. The median pedicle length measured by two methods was 4.1 cm (range 0.7-20.3 cm) and 17.0 cm (range 4.7-33.9 cm), respectively, and the median diameter of the skin flap nourished by one perforator was 3.4 cm (IQR 2.1-5.7 cm). Twenty-eight ALTP flaps were obtained with the guidance of CTA, and 26 flaps survived after follow-up. CONCLUSIONS The proposed CTA mapping technique is a useful tool for preoperative localization and design of ALTP flap.
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Affiliation(s)
- Xin-Xin Yu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Shi-Feng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Cong-Shan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Shen-Qiang Qiu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China
| | - Yao-Dong Qi
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China.
| | - Xi-Ming Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan, 250021, Shandong, China.
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Kang SH, Lee KH, Chang Y, Choe YS, Kim JP, Jang H, Shin HY, Kim HJ, Koh SB, Na DL, Seo SW, Kang M. Gender-specific relationship between thigh muscle and fat mass and brain amyloid-β positivity. Alzheimers Res Ther 2022; 14:145. [PMID: 36195949 PMCID: PMC9531420 DOI: 10.1186/s13195-022-01086-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The relationship of specific body composition in the thighs and brain amyloid-beta (Aβ) deposition remained unclear, although there were growing evidence that higher muscle and fat mass in thighs had a protective effect against cardiometabolic syndromes. To determine whether muscle mass and fat mass in the thighs affected amyloid-beta (Aβ) positivity differently in relation to gender, we investigated the association of muscle mass and fat mass with Aβ positivity using positron emission tomography (PET) in individuals without dementia. METHODS We recruited 240 participants (134 [55.8%] males, 106 [44.2%] females) without dementia ≥45 years of age who underwent Aβ PET, bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DEXA) scans of the hip in the health promotion center at Samsung Medical Center in Seoul, Korea. Lower extremity skeletal muscle mass index (LASMI) was measured using BIA, and gluteofemoral fat percentage (GFFP) was estimated using DEXA scans of the hip. We investigated the associations of LASMI and GFFP with Aβ positivity using logistic regression analyses after controlling for age, APOE4 genotype, and cognitive stage. RESULTS Higher muscle mass in the thighs, measured as LASMI (odds ratio [OR]=0.27, 95% confidence interval [CI] 0.08 to 0.84, p=0.031) was associated with a lesser risk of Aβ positivity in only females. Higher fat mass in the thighs, measured as GFFP (OR=0.84, 95% CI 0.73 to 0.95, p=0.008) was associated with a lesser risk of Aβ positivity in only males. However, the association between LAMSI (p for interaction= 0.810), GFFP (p for interaction= 0.075) and Aβ positivity did not significantly differ by gender. Furthermore, LAMSI only negatively correlated with centiloid (CL) values in females (r=-0.205, p=0.037), and GFFP only negatively correlated with CL values only in males (r=-0.253, p=0.004). CONCLUSIONS Our findings highlight the importance of recognizing that gender differences exist with respect to the specific body composition to potentially protect against Aβ deposition. Therefore, our results may help in designing gender-specific strategies for controlling body composition to prevent Aβ deposition.
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Affiliation(s)
- Sung Hoon Kang
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyung Hyun Lee
- grid.264381.a0000 0001 2181 989XDepartment of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Yoosoo Chang
- grid.264381.a0000 0001 2181 989XCenter for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yeong Sim Choe
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jun Pyo Kim
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyemin Jang
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Young Shin
- grid.264381.a0000 0001 2181 989XCenter for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jin Kim
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- grid.222754.40000 0001 0840 2678Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Duk L. Na
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Won Seo
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea ,grid.414964.a0000 0001 0640 5613Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, South Korea
| | - Mira Kang
- grid.264381.a0000 0001 2181 989XDepartment of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XCenter for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea ,grid.264381.a0000 0001 2181 989XDigital Innovation Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Rodriguez J, Suneja N, von Keudell A, Zhang D. Surgical demographics of acute thigh compartment syndrome. Injury 2022; 53:3481-3485. [PMID: 35906118 DOI: 10.1016/j.injury.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome. METHODS A cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up). RESULTS The mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh. CONCLUSION Delays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.
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Affiliation(s)
| | - Nishant Suneja
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Arvind von Keudell
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Rigshospitalet, Department of Orthopedic Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Dafang Zhang
- Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Lee YS, Kim J, Jeong JJ. Deep vein thrombosis in the thigh: MR imaging in two cases with atypical presentations. Skeletal Radiol 2022; 51:1511-1516. [PMID: 34905075 DOI: 10.1007/s00256-021-03974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 02/02/2023]
Abstract
Deep vein thrombosis (DVT) is a common clinical problem affecting the lower extremities. Prompt imaging of suspected DVT is helpful for rapid diagnosis and proper treatment. However, patients without clear predisposing factors for DVT may be directed to alternative diagnoses of a musculoskeletal disorder. The few case reports and studies of magnetic resonance (MR) imaging of unsuspected DVT are limited to the calf and knee. Here, we report two cases with a rare presentation of thigh MR imaging of unsuspected DVT. Identifying branching, abnormal intraluminal signals on fluid-sensitive imaging, or rim-enhancing tubular structures within the edema of the thigh muscle is important for differentiating intramuscular DVT from other thigh pathologies.
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Affiliation(s)
- Yeon Soo Lee
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-ro, Chung-gu, Daejeon, Republic of Korea, 34943.
| | - Jichang Kim
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-ro, Chung-gu, Daejeon, Republic of Korea, 34943
| | - Jae Jung Jeong
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
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22
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Engelke K, Ghasemikaram M, Chaudry O, Uder M, Nagel AM, Jakob F, Kemmler W. The effect of ageing on fat infiltration of thigh and paraspinal muscles in men. Aging Clin Exp Res 2022; 34:2089-2098. [PMID: 35633478 PMCID: PMC9464152 DOI: 10.1007/s40520-022-02149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Background Myosteatosis, skeletal muscle fat infiltration, is associated with inflammation and fibrosis. The age-related increase of myosteatosis is an important characteristic of sarcopenia and contributes to fragility. Aims To investigate the impact of healthy aging on intermuscular adipose tissue (IMAT) and muscle fat fraction (FF) in the thigh and the paraspinal muscles in males. Methods In 54 healthy males (age 20–70), all active hobby golfers, magnetic resonance imaging was performed to determine volume of IMAT, volume of muscle tissue (MT) and of percentage of FF. Results Between ages 20–70, at the thigh, IMAT/MT volume and MT FF increased annually by 2.9% and 1.3%, respectively. At the psoas IMAT/Psoas volume did not change with age. MT FF increased by 1.5% annually. At the erector spinae IMAT/Erector volume decreased by 0.3% and MT FF increased by 2.8% annually. Discussion With increasing age, in males, thigh muscle atrophied, muscle tissue was partly replaced by adipose tissue and remaining muscle tissue also contained more fat. Similar effects were observed in the erector spinae. The psoas muscle did not atrophy, although MT FF also increased with age. Overall correlations with age were weak to moderate with higher correlations observed in the paraspinal muscles. Conclusions Age-related increases of muscle fat infiltration were observed in the thigh and in the spine. Muscle atrophy did not occur in the psoas. In cross-sectional studies, an adjustment of volumetric parameters by muscle volume is advisable when comparing age-dependent results. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02149-1.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Mansour Ghasemikaram
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
| | - Franz Jakob
- Bernhard-Heine-Center for Locomotion Research, University of Würzburg, Brettreichstrasse 11, 97074, Würzburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Maximiliansplatz 3, 91054, Erlangen, Germany
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Mechó S, Iriarte I, Pruna R, Pérez-Andrés R, Rodríguez-Baeza A. A newly discovered membrane at the origin of the proximal tendinous complex of the rectus femoris. Surg Radiol Anat 2022. [PMID: 35536396 DOI: 10.1007/s00276-022-02954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/21/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The rectus femoris (RF) forms the anterior portion of the quadriceps muscle group. It has a proximal tendinous complex (PTC) which is constituted by a direct tendon (DT), an indirect tendon (IT), and a variable third head. Direct and indirect tendons finally converge into a common tendon (CT). All the PTC shows a medially sloping in its proximal insertion.We investigated several anatomical specimens and discovered a new component: a membrane connecting the CT with the anterior superior iliac spine. Such membrane constitutes a new origin of the PTC. The aim of this study was to clarify whether this membrane was an anatomical variation of the PTC or a constant structure and to describe its morphology and trajectory. MATERIAL AND METHODS We dissected 42 cadaveric lower limbs and examined the architecture of the PTC. We paid special attention to the morphology and interaction patterns between the tendons and the membrane. RESULTS We demonstrated that the membrane is a constant component of the PTC. It has a lateral to medial trajectory and is in relation to the common tendon, the DT, and IT, which present a medial slope. This suggests that the membrane has an stabilizer role for the PTC, acting as a corrector of the inclined vector of the complex. CONCLUSION The RF injuries are frequent in football. The newly discovered membrane is a constant component of the PTC and its integrity should be included in the algorithm to diagnose injuries.
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Munk EF, Tielemans HJ, Ulrich DJ, Hummelink S. Evaluating the accuracy of three-dimensional surface-imaging for circumference analysis of the thigh. J Plast Reconstr Aesthet Surg 2022; 75:3199-3207. [PMID: 35644884 DOI: 10.1016/j.bjps.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/21/2021] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Three-dimensional (3D) surface-imaging is an increasingly popular and useful tool in surgical planning and evaluation. These systems are used for anthropometric measurements of the face, breast and upper extremity. Its accuracy has, however, not yet been evaluated for the thigh. This could prove useful in the evaluation of autologous breast reconstructions using fasciocutaneous tissue of the thigh, such as the profunda artery perforator (PAP) flap. METHODS Thirty-five patients who underwent PAP flap surgery and 35 healthy controls were included. Thigh circumferences were measured using a flexible measuring tape at pre-defined levels. 3D images of the thigh were taken with the Canfield Vectra XT and fused to create 3D reconstructions. 3D circumferences were measured using the Vectra Analysis Module. Measuring tape and 3D circumferences were compared for mutual agreement. RESULTS Thigh circumference measurements by measuring tape correlated excellently with 3D measurements (r = 0.999). Bland-Altman plots demonstrated good agreement with a mean difference of -1.2 mm between the measuring tape and 3D measurements. The mean relative difference of both methods was -0.24%. Paired t-tests showed no significant statistical differences between the measuring tape and 3D circumference measurements in legs that underwent PAP flap surgery and without. CONCLUSIONS Flexible measuring tape and 3D circumference measurements of the thigh show excellent correlation. Three-dimensional surface imaging can thus be used to measure thigh circumferences in both patients with and without prior surgery of the thigh.
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Affiliation(s)
- Elleke Fl Munk
- From the Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre (Radboudumc), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
| | - Hanneke Jp Tielemans
- From the Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre (Radboudumc), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Dietmar Jo Ulrich
- From the Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre (Radboudumc), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Stefan Hummelink
- From the Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre (Radboudumc), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
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Mavrogenis AF, Agrogiannis G, Toutouzas KG. Primary immature teratoma of the thigh: a review. Eur J Orthop Surg Traumatol 2022; 33:773-778. [PMID: 35377080 DOI: 10.1007/s00590-022-03256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022]
Abstract
Teratomas are a subtype of germ cell tumors composed of a variety of somatic tissues derived from more than one of the three germinal layers (ectoderm, endoderm and mesoderm). They can be classified as mature tumors and immature tumors. Teratomas most commonly arise at the sacrococcygeal region and the gonads. The occurrence of a teratoma outside the common gonadal and midline locations is exceptional. This review article lists the reported primary and metastatic malignant teratomas in extragonadal locations and discusses the possible explanation for the atypical location, their treatment and prognosis.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - George Agrogiannis
- Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos G Toutouzas
- First Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, School of Medicine, Hippocration General Athens Hospital, Athens, Greece
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26
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Lee HJ, Lee JH, Bang CH, Jung JY, Park YM. High-intensity Focused Ultrasound Treatment for Excessive Subcutaneous Fat in Abdomen, Upper Arms, and Thigh: a Pilot Study. J Cosmet Dermatol 2022; 21:2009-2014. [PMID: 35080337 DOI: 10.1111/jocd.14801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) has been recently introduced as a non-invasive therapeutic modality for controlling excessive subcutaneous fat. OBJECTIVE The efficacy and safety of the HIFU device for sculpting the abdomen, upper arm, and thigh were evaluated. MATERIALS AND METHODS Ten subjects with more than 10 mm of subcutaneous fat in the abdomen, upper arm, and/or thigh were recruited. We evaluate mean change in the thickness and circumference of subcutaneous fat of each treated area measured using ultrasound 12 weeks after the procedure, the degree of pain, and subject and practitioner satisfaction 12 weeks after the procedure. RESULTS The mean change of subcutaneous fat thickness in the abdomen, upper arm, and thigh measured using ultrasound 12 weeks after the procedure was -4.33 ± 2.42, -1.86 ± 1.35, and -1.86 ± 1.35 mm, respectively. Compared with pretreatment, subcutaneous fat thickness of the abdomen and upper arm was significantly reduced (p = 0.0020 and p = 0.0004, respectively), but not in the thigh (p = 0.0716). Highest patient satisfaction was for the abdomen. Pain was generally tolerable. CONCLUSION The results from the present study indicate HIFU can be an effective and safe therapeutic modality for removing excessive subcutaneous fat in humans.
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Affiliation(s)
- Hyun Ji Lee
- Department of Dermatology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kho JSB, Botchu R, Rushton A, James SL. MRI features of ERSA (exercise-related signal abnormality) lesions in professional soccer players. Skeletal Radiol 2022; 51:557-64. [PMID: 34228195 DOI: 10.1007/s00256-021-03857-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to describe the prevalence, anatomy and morphology of ERSA (exercise-related signal abnormality) lesions, a previously undescribed pattern of muscle signal changes on MRI in professional soccer players with suspected acute thigh muscle injury. METHODS A multicenter retrospective review was performed of 287 MRIs of professional soccer players referred for suspected acute thigh injury from August 2017 to February 2020. MR images were reviewed for muscle signal abnormalities corresponding to a peritendinous ovoid region or a subfascial ring of faint increased signal on fluid-sensitive MR images. Imaging features including anatomical site, morphology, and craniocaudal length were recorded. Concomitant acute muscle injury was graded in accordance with the British Athletics Muscle Injury Classification (BAMIC). RESULTS ERSA lesions comprising a peritendinous ovoid region, a subfascial ring, or both, were identified in 40 muscles across 31/287 studies (10.8%). These lesions had a mean length of 15.8 cm and were predominantly located in the proximal or mid-portions of muscles. Affected muscles were rectus femoris (n = 22), adductor longus (n = 11), semitendinosus (n = 6) and biceps femoris (n = 1). 21/31 studies (67.7%) had a BAMIC grade 1-4 injury in a separate muscle, which were largely (81%) in a separate anatomic compartment or contralateral. CONCLUSION ERSA lesions were evident on MRI in 10.8% of our cohort of professional soccer players referred for suspected acute thigh muscle injury. Characteristic morphology and the longitudinal length (mean 15.8 cm) distinguish ERSA lesions from recognized patterns of acute muscle injury.
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Schwaiger K, Pumberger P, Wimbauer J, Russe E, Schaffler G, Wechselberger G. [Decompression of the lateral femoral cutaneous nerve of the thigh : Treatment of meralgia paresthetica]. Oper Orthop Traumatol 2021. [PMID: 34739548 DOI: 10.1007/s00064-021-00747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Treatment of non-responding pain to conservative treatment located at the anterolateral thigh with surgical decompression of the lateral femoral cutaneous nerve of the thigh (LFCN). INDICATIONS Compression syndrome of the LFCN; patients suffering from the following symptoms: pain (dysesthesia), numbness (paresthesia), hypersensibility to temperature (or temperature changes) along the course of the LFCN located at the anterolateral thigh. CONTRAINDICATIONS A new or recrudescent hernia with additional pain or recent laparoscopic hernia repair as a supposed iatrogenically induced compression of the LFCN. SURGICAL TECHNIQUE Dissection and release of the LFCN of connective tissue, scar tissue, bone rims, and retraction located along the passage underneath the inguinal ligament and distally. POSTOPERATIVE MANAGEMENT Suture removal after 10-14 days, no sports for 2 weeks. Physiotherapy if necessary. Neurography 4 months after surgery (obligatory if symptoms are persistent). The patient should be followed up for about 24 months. RESULTS Of the patients, 69% had a history of trauma or surgery, which were designated as the onset of pain. Of these patients, 78% had hip prostheses and 22% had previous falls. Postoperatively, a significant reduction of pain of 6.6 points on the numeric rating scale was observed. All other evaluated parameters also improved postoperatively. Patient satisfaction was high, with 86% reporting complete satisfaction, and 14% reporting partial satisfaction.
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Kim J, Ryu JA, Lee J. Quantification of the Elastic Property of Normal Thigh Muscles Using MR Elastography: Our Initial Experience. Taehan Yongsang Uihakhoe Chi 2021; 82:1556-1564. [PMID: 36238872 PMCID: PMC9431979 DOI: 10.3348/jksr.2020.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/20/2020] [Accepted: 04/02/2021] [Indexed: 11/19/2022]
Abstract
Purpose This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of normal thigh muscles using MRE. Materials and Methods This prospective study included 10 volunteer subjects [mean age, 32.5 years, (range, 23-45 years)] who reported normal activities of daily living and underwent both T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion-encoding gradient was used in the MRE to map the propagating shear waves in the muscle. Elastic properties were quantified as the shear modulus of the following four thigh muscles at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris. Results The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis, 1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ± 0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris, with reader 1 and 2, respectively. No significant difference was observed in the shear modulus based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation (p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p = 0.194 for reader 1 and p = 0.355 for reader 2). Conclusion MRE is a quantitative technique used to measure the elastic properties of individual muscles with excellent inter-observer agreement. Age was consistently significantly negatively correlated with the shear stiffness of muscles, except for the vastus medialis.
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Taniguchi M, Yamada Y, Yagi M, Nakai R, Tateuchi H, Ichihashi N. Estimating thigh skeletal muscle volume using multi-frequency segmental-bioelectrical impedance analysis. J Physiol Anthropol 2021; 40:13. [PMID: 34593041 PMCID: PMC8485471 DOI: 10.1186/s40101-021-00263-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background The primary aim of this study was to investigate whether using the extracellular water/intracellular water (ECW/ICW) index and phase angle combined with segmental-bioimpedance analysis (BIA) improved the model fitting of skeletal muscle volume (SMV) estimation. The secondary aim was to compare the accuracy of segmental-BIA with that of ultrasound for estimating the quadriceps SMV measured with MRI. Methods Seventeen young men (mean age, 23.8 ± 3.3 years) participated in the study. The T-1 weighted images of thigh muscles were obtained using a 1.5 T magnetic resonance imaging (MRI) scanner. Thigh and quadriceps SMVs were calculated as the sum of the products of anatomical cross-sectional area and slice thickness of 6 mm across all slices. Segmental-BIA was applied to the thigh region, and data on the 50-kHz bioelectrical impedance (BI) index, ICW index, ECW/ICW index, and phase angle were obtained. The muscle thickness index was calculated as the product of the mid-thigh muscle thickness, determined using ultrasound, and thigh length. The standard error of estimate (SEE) of the regression equation was calculated to determine the model fitting of SMV estimation and converted to %SEE by dividing the SEE values by the mean SMV. Results Multiple regression analysis indicated that the combination of 50-kHz BI and the ECW/ICW index or phase angle was a significant predictor when estimating thigh SMV (SEE = 7.9 and 8.1%, respectively), but were lower than the simple linear regression (SEE = 9.4%). The ICW index alone improved the model fitting for the estimation equation (SEE = 7.6%). The model fitting of the quadriceps SMV with the 50-kHz BI or ICW index was similar to that with the skeletal muscle thickness index measured using ultrasound (SEE = 10.8, 9.6 and 9.7%, respectively). Conclusions Combining the traditionally used 50-kHz BI index with the ECW/ICW index and phase angle can improve the model fitting of estimated SMV measured with MRI. We also showed that the model suitability of SMV estimation using segmental-BIA was equivalent to that on using ultrasound. These data indicate that segmental-BIA may be a useful and cost-effective alternative to the gold standard MRI for estimating SMV.
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Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yosuke Yamada
- National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ryusuke Nakai
- Kokoro Research Center, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshige Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Spalkit S, Sinha A, Prakash M, Sandhu MS. Dermatomyositis: Patterns of MRI findings in muscles, fascia and skin of pelvis and thigh. Eur J Radiol 2021; 141:109812. [PMID: 34118766 DOI: 10.1016/j.ejrad.2021.109812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This review discusses characteristic, subtle, and florid changes in muscle, fascia, skin, and subcutaneous tissue of the lower limbs in MR imaging in patients with dermatomyositis. MATERIAL AND METHODS This review is based on the analysis of 43 patients with dermatomyositis who were imaged from January 2014 to March 2021 in our institute as well a critical review of literature of MRI in dermatomyositis. RESULTS Muscle involvement is predominantly bilaterally symmetric and involves anterior, posterior as well as medial compartments of the thigh. Diffuse intramuscular hyperintensity on T2-weighted images is a common pattern of involvement. Isolated myofascial involvement or muscular with myofascial involvement can also occur. Nodular areas of hyper intensity and enhancement is another uncommon pattern of muscle involvement. Reticular pattern of subcutaneous tissue involvement and skin thickening is best seen on fat saturated T2 -weighted images. Calcification in the subcutaneous tissues appears hypointense with a surrounding hyperintense rim on all pulse sequences which shows peripheral enhancement. MRI patterns of involvement range from subtle myofascial and skin involvement to florid muscular involvement. Diffusion weighted imaging is useful for myofascial involvement. Whole body MR can detect changes at unusual sites in muscles and extra skeletal involvement. Contrast enhanced imaging has no added benefit. Treatment responders show a return to normal signal intensity on MRI. CONCLUSION This review highlights the patterns of muscle, skin, and subcutaneous tissue involvement of thighs in dermatomyositis on conventional MRI and the role of whole-body MR, diffusion weighted imaging and limited role of contrast enhanced imaging.
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Claassen H, Schmitt O, Schulze M, Wree A. Deep femoral artery: A new point of view based on cadaveric study. Ann Anat 2021; 237:151730. [PMID: 33798692 DOI: 10.1016/j.aanat.2021.151730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In diagnostic angiographic procedures, the knowledge of arterial variations in the femoral artery (FA), deep femoral artery (DFA) and lateral and medial circumflex femoral arteries (LCFA, MCFA) has a great impact. MATERIAL AND METHODS The frequency of branching patterns of these arteries was investigated in 111 thighs of body donors. Gender and side differences were analyzed statistically. RESULTS The median distance of separation of the DFA from the FA in relation to the inguinal ligament (IL) was 3.29 cm. High origins (1-2 cm below IL) and middle origins (3-5 cm below IL) of the DFA were found in an equal distribution of 39.3% and 41.1%, respectively. Low origins (6-10 cm below IL) were rare (19.6%) but showed a tendential significance toward expression in males (p = 0.096). The origin of the LCFA from the FA (19.8%) or DFA (70.2%) are in line with the findings of other groups. The origin of the MCFA from FA (14.4%) or DFA (74.7%) showed that circumflex femoral arteries arose mostly from DFA. A trifurcation of the FA into the DFA, LCFA and MCFA was only observed in 9.9% and, therefore, less frequently than reported by others. Branches of the femoral nerve (FN) passed mostly anterior (46.4%) or anterior and posterior (47.8%) to the LCFA. The rare constellation of branches of FN passing only posterior to the LCFA (5.8%) showed a tendential significance to left side expression (p = 0.084). CONCLUSIONS Taken together, this is the first classification of the median distance of separation of the DFA from the FA in relation to the IL in three defined groups. The knowledge of DFA branching pattern is essential for recent therapy options of cardiac diseases using a femoral artery access: transcatheter aortic valve replacement, catheter-based miniaturized ventricular assist device and veno-arterial extracorporal membrane oxygenation. The variant topography of the branches of FN in relation to LCFA should be kept in mind when harvesting an anterolateral thigh flap.
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Affiliation(s)
- H Claassen
- Department of Anatomy, Rostock University Medical Center, Gertrudenstraße 9, D-18057 Rostock, Germany; Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsstraße 19, D-91054 Erlangen, Germany.
| | - O Schmitt
- Department of Anatomy, Rostock University Medical Center, Gertrudenstraße 9, D-18057 Rostock, Germany
| | - M Schulze
- Department of Anatomy, Rostock University Medical Center, Gertrudenstraße 9, D-18057 Rostock, Germany
| | - A Wree
- Department of Anatomy, Rostock University Medical Center, Gertrudenstraße 9, D-18057 Rostock, Germany
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Dooley K, Drew MK, Snodgrass SJ, Schultz A, McGann T, Blyton S, Pizzari T, Rio E, Donnan L, Edwards S. Male basketball players who report hip and groin pain perceive its negative impact both on- and off-court: A cross-sectional study. J Sci Med Sport 2021; 24:660-664. [PMID: 33707154 DOI: 10.1016/j.jsams.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain. DESIGN Cross-sectional. METHODS Fifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n=38; Italian n=13) self-reported current/historical hip/groin 'discomfort/pain' and 'problems', and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain. RESULTS Twenty-one players (41%) self-reported hip/groin 'discomfort/pain', of which nine perceived no 'problems'. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI -25.24, -5.97), Pain (5.00; -16.42, -2.81), Function in daily living (0.00; -26.72 to -5.59), Function in sport and recreation (6.25; -21.24, -5.33), and hip and/or groin Quality of Life (5.00; -28.63, -8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; -51.25, -20.00), with players self-reporting hip/groin discomfort/pain scoring lower. CONCLUSION Most players who perceive both hip/groin 'discomfort/pain' and 'problems' also report training/playing time loss, suggesting players' perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function.
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Affiliation(s)
- Katherine Dooley
- School of Health Sciences, The University of Newcastle, Australia.
| | - Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Australia
| | | | - Adrian Schultz
- School of Environmental & Life Sciences, The University of Newcastle, Australia
| | - Tye McGann
- School of Health Sciences, The University of Newcastle, Australia
| | - Sarah Blyton
- School of Environmental & Life Sciences, The University of Newcastle, Australia
| | - Tania Pizzari
- Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - Ebonie Rio
- Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - Luke Donnan
- School of Community Health, Charles Sturt University, Australia
| | - Suzi Edwards
- School of Environmental & Life Sciences, The University of Newcastle, Australia
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Samsami M, Qaderi S, Zebarjadi Bagherpour J, Lucero-Prisno DE. A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh. Int J Surg Case Rep 2021; 79:475-478. [PMID: 33757266 PMCID: PMC7868820 DOI: 10.1016/j.ijscr.2021.01.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Hydatid Disease (HD), or hydatidosis or echinococcosis, is an endemic infection and a major public health concern in the Mediterranean region. At times it involves the primary soft tissues, such as in the breast and muscle, though this is quite uncommon even in endemic areas. PRESENTATION OF CASES A. A 31 year-old woman complained of a gradual progressive, painless lump in the left axillary tail of spence for two years. Examination revealed a firm lump measuring 5cm × 5cm, non-mobile, in the left axillary tail of Spence. B. A 32 year-old woman presented with mild and continuous pain in lateral aspect of left thigh. On examination, there was a round, non-tender, non-mobile mass in the lateral aspect of her left thigh. Preoperative imaging studies in both patients revealed evidence of HD. Both of the patients underwent surgery and received Albendazole twice per day for 10 days, before and three months after surgery. DISCUSSION The disease can be diagnosed by serological and radiological modalities, both of which are not definitive. Ultrasonography should be the first diagnostic modality of soft tissue HD, however, MRI can be used to understand clearly the surgical involvements of structures. The standard treatment of soft tissue HD is surgery using pericystectomy techniques, as well as anthelmintic therapy. CONCLUSION HD should be suggestive in soft tissues if mass is slowly developing and presenting with local extension, particularly in endemic countries. Excision of HD using pericystectomy technique is the first choice of intervention for HD of soft tissues.
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Affiliation(s)
- Majid Samsami
- Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shohra Qaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Javad Zebarjadi Bagherpour
- Department of General Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Don Eliseo Lucero-Prisno
- Faculty of Management and Development Studies, University of the Philippines, Los Banos, Laguna, Philippines.
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Chaabouni R, Bahloul E, Sellami K, Turki H. [A hollow on the thighs]. Rev Med Interne 2021; 42:515-516. [PMID: 33455837 DOI: 10.1016/j.revmed.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- R Chaabouni
- Service de dermatologie, hôpital Hédi Chaker, route El Ain, km 0,5, 3029 Sfax, Tunisie.
| | - E Bahloul
- Service de dermatologie, hôpital Hédi Chaker, route El Ain, km 0,5, 3029 Sfax, Tunisie
| | - K Sellami
- Service de dermatologie, hôpital Hédi Chaker, route El Ain, km 0,5, 3029 Sfax, Tunisie
| | - H Turki
- Service de dermatologie, hôpital Hédi Chaker, route El Ain, km 0,5, 3029 Sfax, Tunisie
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Mohamed S, El Ansari W, Ben-Gashir M, Abusabeib A. Ossifying fibromyxoid tumor in the lower extremity mimicking a sebaceous cyst. Case report and literature review. Int J Surg Case Rep 2021; 79:37-43. [PMID: 33450587 PMCID: PMC7811059 DOI: 10.1016/j.ijscr.2020.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 12/03/2022] Open
Abstract
Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue tumor varing from benign to malignant according to histology. Preoperative diagnosis is challenging, the current case of OFMT mimicked a sebaceous cyst on ultrasound. Correlation of imaging and fine needle aspiration findings narrows the differential diagnosis of OFMT. All patients must undergo prolonged postoperative follow up to assess for recurrence or rarely metastasis.
Introduction Ossifying fibromyxoid tumor (OFMT) is an uncommon soft tissue neoplasm, with malignant potential and unclear histogenesis. OFMT exhibits a spectrum of histopathologic features including benign (typical), atypical and malignant subtypes. To the best of our knowledge, about 300 cases have been reported worldwide. We present the first reported case from Qatar. Presentation of case A 36-year old Egyptian male, with no comorbidities was admitted electively as a day case for excision of left thigh suspected sebaceous cyst under local anesthesia. History, physical examination and soft tissue ultrasound imaging were unremarkable. Intraoperatively, the patient was found to have a hard-calcified mass adhering to the surrounding fascia which was excised en bloc. The histopathology result was of ossifying fibromyxoid tumor. The post-operative course along with 40 months follow-up were uneventful in terms of surgical complications and recurrence. Discussion OFMT has marked features in terms of cytology. Though it is difficult to diagnose preoperatively, it should be considered in tumors involving soft tissue that demonstrate prominent ossification and calcification. Conclusion OFMT is a rare soft tissue neoplasm, and should be considered as a differential diagnosis in any subcutaneous swelling with a bony component. All OFMT patients should undergo a long course of follow-up to rule out and assess any recurrence or metastasis in the malignant variants.
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Affiliation(s)
- Sugad Mohamed
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed Ben-Gashir
- Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Abdelrahman Abusabeib
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Ramprasath DR, Chezian SV, Surendar V. Identification of Tibial Malrotation After Nailing Using Unique CT Scan Reference Line, and Influence of Position of Leg for Distal Locking on Rotation. Indian J Orthop 2021; 55:662-8. [PMID: 33995870 DOI: 10.1007/s43465-020-00307-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Tibial torsion can be measured by various clinical and radiological methods. Computed tomography (CT) scan measurement is currently the investigation of choice. The purpose of our study was to compare the clinical and CT scan methods to reveal malrotation after nailing of tibia and also to find out if leg position for distal locking has any influence on incidence of malrotation. MATERIALS AND METHODS We have included 106 patients (21-68 years) of tibia nailing, and categorised them as category A (figure of four position n = 54) and category B (knee straight position n = 52) based on limb position for distal locking. The plumb line measurement, Thigh Foot Axis (TFA) and CT scan measurement (using new reference line) were documented and compared with the uninjured limb. RESULTS We observed plumb line measurement to be the most inaccurate method followed by TFA method. CT scan measurement was the most accurate method showing external rotations (> 10º) in 32 cases (30.1%) and internal rotation (> - 10º) in five cases (4.71%). The TFA method had a sensitivity of 44% and specificity of 86% in identifying malrotations. The interobserver reliability for CT scan measurement was 0.96. Even though statistically not significant (P value), figure of four position for distal locking leads to larger number of malrotations (both external and internal rotation). CONCLUSION CT scan is the most accurate method of measuring malrotation. The new reference line used in our study provides accurate measurement of malrotation. The two different positions of leg for distal locking do not have a statistically significant influence on incidence of malrotation.
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Abstract
PURPOSE The quadriceps femoris has been described as a muscle composed by four heads: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Each head fuse with the other ones making up the quadriceps tendon, which inserts into the patella. Nevertheless, there has been described a fifth component of the quadriceps muscle in recent anatomical publications. Understanding this fifth head may be important for orthopedics and radiologist. METHODS Cadaveric dissection of left thigh of a female 83 years old was performed to demonstrate a fifth head of the quadriceps femoris muscle. RESULTS In this study, a fifth head of the quadriceps femoris muscle was found in the left thigh of a female cadaver 83 years old. This fifth head was made up by four independent muscular fascicles attaching in a common flat tendon that joins distally with the lateral border of the quadriceps tendon. The fifth head found was supplied by branches of the ascending branch of the lateral femoral circumflex artery and by branches of the deep lateral division of the femoral nerve. CONCLUSIONS The incidence of this fifth belly in cadaveric studies has been reported as a range from 29 to 100%. However, no published articles refer an anatomical finding such as this multi-bellied fifth head. The knowledge of the existence and location of the fifth belly is necessary to make accurate diagnosis of QF muscle strains. Its anatomical course may be involved in patellar tracking.
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Affiliation(s)
- P Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, C/Amadeo Vives s/n, 28009, Madrid, Spain.
- Department of Human Anatomy, Universidad Alfonso X El Sabio, Avda de la Universidad 1, 28691, Madrid, Spain.
| | - Ł Olewnik
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, 90-151, Poland
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, 90-151, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, 90-151, Poland
| | - S Quinones
- Department of Human Anatomy and Embryology, Medical Faculty, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - J Sanudo
- Department of Human Anatomy and Embryology, Medical Faculty, Universidad Complutense de Madrid, Madrid, 28040, Spain
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Tian X, Yan X, Wu J, Song H, Shen Z. Recurrent broad ligament leiomyosarcoma with pancreatic and thigh metastasis: a case report. BMC Surg 2020; 20:143. [PMID: 32600468 PMCID: PMC7325277 DOI: 10.1186/s12893-020-00804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leiomyosarcoma (LMS) is an uncommon mesenchymal neoplasm, which infrequently metastasizes to pancreas and thigh. Clinical presentation and imaging findings of metastatic broad ligament LMS are often nonspecific. Complete excision plays an important role in treatment of patients with localized LMS. CASE PRESENTATION Here, we report a case of a 33-year-old woman with recurrent broad ligament LMS metastasizing to pancreas and thigh. Previously, she was diagnosed with broad ligament LMS and underwent hysterectomy, bilateral salpingo-oophorectomy. The disease-free interval was 2.5 years until metastases were found. Computerized tomography (CT) of abdomen and thighs, magnetic resonance imaging (MRI) of thighs and whole-body 18-fluorodeoxyglucose positron emission tomography - computed tomography (PET-CT) performed, revealed pancreatic and thigh metastasis. Ultrasonography-guided biopsy and histological examinations confirmed LMS at both the sites. Pancreatic metastasis was completely resected first. Then the patient underwent surgical resection of thigh metastasis when both chemotherapy and radiotherapy failed. She recovered well and remained free of disease recurrence in the 2 years follow-up. CONCLUSIONS Though imaging lacks specificity, it is a valuable asset in assessing the burden of disease and characterizing lesions while histological examination with immunohistochemistry is helpful for the diagnosis of LMS. Complete surgical resection of all metastatic sites where-ever feasible should be strongly considered in a treated case of broad ligament LMS with a durable disease-free interval.
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Affiliation(s)
- Xuan Tian
- School of Medicine, Nankai University, Tianjin, 300071 China
| | - Xin Yan
- School of Medicine, Nankai University, Tianjin, 300071 China
| | - Jun Wu
- The Second Hospital of Jilin University, Changchun, 130033 China
| | - Hongli Song
- School of Medicine, Nankai University, Tianjin, 300071 China
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, 300192 China
| | - Zhongyang Shen
- School of Medicine, Nankai University, Tianjin, 300071 China
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, 300192 China
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Zazo A, Zazo R, Shashaa MN, Alkarrash MS, Brimo Alsaman MZ, Niazi A. Uncommon musculoskeletal femoral hydatid cyst disturbs a female for a year: Case report. Ann Med Surg (Lond) 2020; 55:30-32. [PMID: 32435477 PMCID: PMC7231815 DOI: 10.1016/j.amsu.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/10/2020] [Accepted: 04/18/2020] [Indexed: 11/11/2022] Open
Abstract
“Hydatid cyst” which also known as cystic Echinococcosis is a parasitic infestation caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most sites to occur. Incidence in muscles is exceptionally rare. We report a case of a 36-year-old female presented with an uncomfortable mass in the upper medial of her right thigh without any presence of other symptoms. She lived in a rural area in Manbij, which is an endemic area of hydatid cysts in Syria. She was a shepherdess; therefore she had direct contact with sheep and dogs. Ultrasound examination showed a cyst located between adductor longus muscle and gracilis muscle closed to the deep femoral artery. The patient was treated with pharmaceutical therapy for a week before cystectomy, which was done under general anesthesia. The cyst was dissected between the fibers of adductor longus muscle from the lateral side and fibers of the gracilis muscle from the medial side. The cyst with all its layers was resected. Musculoskeletal Echinococcosis is a rare disease, because of intramuscular growth of cysts is restricted by muscle's contractility, the muscles are undesirable habitat for Echinococcus granulosus and because of the hepatic barrier role. Many cysts are revealed by complications such as nerve compressions, infections simulating an acute abscess or a malignant tumor. Hydatid cyst present as mass of soft tissue, particularly in endemic areas, as a result of contaminated water. MRI considered the best technique in the diagnosis. Incidence of Hydatid cyst in muscles is exceptionally rare. MRI considered the best technique in the diagnosis. Confirming the final preoperative diagnosis of muscle hydatid cysts is important. Hydatid cyst should consider as a differential diagnosis for masses of soft tissue.
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Affiliation(s)
- Aya Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Rama Zazo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | | | | | | - Ammar Niazi
- General Surgery Department, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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Abstract
INTRODUCTION Myxoid soft tissue tumors consist of a heterogeneous group of mesenchymal neoplasms with a hallmark of the abundant extracellular myxoid matrix. Intramuscular myxomas are rare benign tumor affecting the musculoskeletal system. The common sites include the thigh, upper arm, calf, and the buttocks. Magnetic resonance imaging is the radiological modality of choice in diagnosing these cases, while tissue biopsy is the gold standard. CASE PRESENTATION A 70-year-old male presented to orthopedics out-patient department with complaints of a humongous swelling engulfing his right thigh all around. The gradual and progressive appearance of burning sensations and rest pain around the affected area with difficulty in bearing weight, over the past 6-7 months forced him to seek medical attention. Biopsy and imaging were performed followed by final excision. The tumor was removed En-bloc and post-operative period was uneventful. The patient did not show any signs recurrence and was asymptomatic until the final followup of 26 months. CONCLUSION Myxomatous swelling mimics an intramuscular lipoma, sarcoma, hematoma, or a hemangioma and must be carefully evaluated. En-bloc excision without spillage is the treatment of choice which ensures long and lasting recovery.
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Affiliation(s)
- Manjeet Singh
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, Haryana, India
| | - Subodh Kumar Pathak
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, Haryana, India,Address of Correspondence: Dr. Subodh Kumar Pathak, Department of Orthopaedics, MMIMSR, M M Deemed to be University, E-mail:
| | - Vishesh Verma
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, Haryana, India
| | - Praveen Thivari
- Department of Orthopedics, MMIMSR, M M Deemed to be University, Mullana, Ambala, Haryana, India
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Guedes T, Coelho G, Guimarães J, Costa H. [Use of Anterolateral Thigh Free Flap in the Treatment of a Sternal Keloid]. ACTA MEDICA PORT 2019; 32:784-787. [PMID: 31738707 DOI: 10.20344/amp.10955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022]
Abstract
Hypertrophic and keloid scars represent hyperproliferative disorders that can have a significant impact on patients' lives. The authors present the case of a 53 years-old male with a sternal keloid after excision of a sebaceous cyst and multiple sessions of steroid infiltration, with worsening of the lesion. The patient underwent complete excision of the scar and reconstruction with an anterolateral thigh flap - ALT. The postoperative period was uneventful, with no signs of relapse. Keloid scar treatment in sternal area implies a reconstruction with no tension, in order to avoid relapse. Treatment of this type of scars is complex and a challenge to the plastic surgeon. In this case, a microvascular tissue transfer was used to reconstruct the large defect that ultimately resulted after scar excision, in a tension-free manner.
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Affiliation(s)
- Tiago Guedes
- Serviço de Cirurgia Plástica, Reconstrutiva, Craniomaxilofacial e Unidade de Microcirurgia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Porto. Portugal
| | - Gustavo Coelho
- Serviço de Cirurgia Plástica, Reconstrutiva, Craniomaxilofacial e Unidade de Microcirurgia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Porto. Portugal
| | - João Guimarães
- Serviço de Cirurgia Plástica, Reconstrutiva, Craniomaxilofacial e Unidade de Microcirurgia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Porto. Portugal
| | - Horácio Costa
- Serviço de Cirurgia Plástica, Reconstrutiva, Craniomaxilofacial e Unidade de Microcirurgia. Centro Hospitalar de Vila Nova de Gaia/Espinho. Porto. Portugal
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Inhuber S, Sollmann N, Schlaeger S, Dieckmeyer M, Burian E, Kohlmeyer C, Karampinos DC, Kirschke JS, Baum T, Kreuzpointner F, Schwirtz A. Associations of thigh muscle fat infiltration with isometric strength measurements based on chemical shift encoding-based water-fat magnetic resonance imaging. Eur Radiol Exp 2019; 3:45. [PMID: 31748839 PMCID: PMC6868073 DOI: 10.1186/s41747-019-0123-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of the thigh muscle fat composition using magnetic resonance imaging (MRI) can provide surrogate markers in subjects suffering from various musculoskeletal disorders including knee osteoarthritis or neuromuscular diseases. However, little is known about the relationship with muscle strength. Therefore, we investigated the associations of thigh muscle fat with isometric strength measurements. METHODS Twenty healthy subjects (10 females; median age 27 years, range 22-41 years) underwent chemical shift encoding-based water-fat MRI, followed by bilateral extraction of the proton density fat fraction (PDFF) and calculation of relative cross-sectional area (relCSA) of quadriceps and ischiocrural muscles. Relative maximum voluntary isometric contraction (relMVIC) in knee extension and flexion was measured with a rotational dynamometer. Correlations between PDFF, relCSA, and relMVIC were evaluated, and multivariate regression was applied to identify significant predictors of muscle strength. RESULTS Significant correlations between the PDFF and relMVIC were observed for quadriceps and ischiocrural muscles bilaterally (p = 0.001 to 0.049). PDFF, but not relCSA, was a statistically significant (p = 0.001 to 0.049) predictor of relMVIC in multivariate regression models, except for left-sided relMVIC in extension. In this case, PDFF (p = 0.005) and relCSA (p = 0.015) of quadriceps muscles significantly contributed to the statistical model with R2adj = 0.548. CONCLUSION Chemical shift encoding-based water-fat MRI could detect changes in muscle composition by quantifying muscular fat that correlates well with both extensor and flexor relMVIC of the thigh. Our results help to initiate early, individualised treatments to maintain or improve muscle function in subjects who do not or not yet show pathological fatty muscle infiltration.
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Affiliation(s)
- Stephanie Inhuber
- Department of Sport and Health Sciences, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sarah Schlaeger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Caroline Kohlmeyer
- Department of Sport and Health Sciences, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Kreuzpointner
- Department of Sport and Health Sciences, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Ansgar Schwirtz
- Department of Sport and Health Sciences, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
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Innmann MM, Weishorn J, Bruckner T, Streit MR, Walker T, Gotterbarm T, Merle C, Maier MW. Fifty-six percent of proximal femoral cortical hypertrophies 6 to 10 years after Total hip arthroplasty with a short Cementless curved hip stem - a cause for concern? BMC Musculoskelet Disord 2019; 20:261. [PMID: 31142303 PMCID: PMC6542080 DOI: 10.1186/s12891-019-2645-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 01/24/2023] Open
Abstract
Background Thigh pain and cortical hypertrophies (CH) have been reported in the short term for specific short hip stem designs. The purpose of the study was to investigate 1) the differences in clinical outcome, thigh pain and stem survival for patients with and without CHs and 2) to identify patient and surgery-related factors being associated with the development of CHs. Methods A consecutive series of 233 patients with 246 hips was included in the present retrospective diagnostic cohort study, who had received a total hip arthroplasty (THA) between December 2007 and 2009 with a cementless, curved, short hip stem (Fitmore, Zimmer, Warsaw, IN, USA). Clinical and radiographic follow-up, including the radiographic parameters for hip geometry reconstruction, were prospectively assessed 1, 3, and 6 to 10 years after surgery. Results Cortical hypertrophies were observed in 56% of the hips after a mean of 7.7 years, compared to 53% after 3.3 years being mostly located in Gruen zone 3 and 5. There was no significant difference for the Harris Hip Score and UCLA score for patients with and without CHs. Only one patient with a mild CH in Gruen zone 5 and extensive heterotopic ossifications around the neck of the stem reported thigh pain. The Kaplan Meier survival rate after 8.6 years was 99.6% (95%-CI; 97.1–99.9%) for stem revision due to aseptic loosening and no association with CHs could be detected. Postoperative increase in hip offset was the only risk factor being associated with the development of CHs in the regression model (ΔHO; OR 1.1 (1.0–1.2); p = 0.001). Conclusions The percentage of cortical hypertrophies remained almost constant in the mid-term compared to the short-term with the present cementless short hip stem design. The high percentage of cortical hypertrophies seems not be a cause for concern with this specific implant in the mid-term. Level of evidence Diagnostic Level IV
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Affiliation(s)
- Moritz M Innmann
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Johannes Weishorn
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Marcus R Streit
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tilman Walker
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Tobias Gotterbarm
- Department of Orthopaedic and Trauma Surgery, Kepler University Hospital, Med Campus III Krankenhausstraße 9, 4021, Linz, Austria
| | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Michael W Maier
- Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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Hardes J, Guder W, Nottrott M, Podleska L, Täger G, Dudda M, Streitbürger A. [Endoprostheses for stump formation after hip disarticulation]. Orthopade 2019; 48:582-587. [PMID: 30937492 DOI: 10.1007/s00132-019-03721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hip disarticulation is a psychologically and physically demanding procedure. However, it remains a therapeutical option whenever limb salvage proves impossible due to sarcoma, severe implant-associated infections or trauma. The stump lengthening procedure (SLP) is a surgical technique that allows partial salvage of the thigh through endoprosthetic proximal femur replacement after hip disarticulation, depending on the amount of viable soft tissue coverage. This leads to a more appealing visual appearance, facilitates prosthetic fitting and significantly improves limb function. OBJECTIVES Description of indications for SLP, surgical technique, presentation of clinical and functional outcomes. METHODS Review of applying literature and presentation of outcomes of our own SLP collective. RESULTS The risk of local recurrence does not increase after SLP compared to hip disarticulation. While the majority of patients can be fitted with an exoprosthesis, a walking aid is usually necessary for ambulation. Exoprostheses are usually worn throughout the entire day, and patients manage distances of a mean of 2000 metres, even if reconstruction lengths are less than 10 cm. Patients aged 50 years or older tend to wear their exoprosthesis for shorter periods of daywear and achieve significantly poorer functional scores. Postoperative complications are common at a rate of 52%. Periprosthetic infection (21%) and soft tissue perforation of the implant with subsequent implant-associated infection (14%) were the most severe complications observed. CONCLUSIONS The stump lengthening procedure poses a feasible alternative to classic hip disarticulation in patients with multiple prior operations and/or advanced stages of disease. It leads to satisfactory cosmetic and functional results without jeopardizing local tumor control. Stump perforation presents as the most common complication. Apart from improving the ability to sit down comfortably, both patients treated with a curative and palliative intent manage to ambulate using exoprostheses. With increasing age at the time of operation, walking aids are necessary for ambulation.
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Affiliation(s)
- J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - W Guder
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Nottrott
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - L Podleska
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - G Täger
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Dudda
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Streitbürger
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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46
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Thierfelder KM, Gerhardt JS, Gemescu IN, Notohamiprodjo S, Rehnitz C, Weber MA. Imaging of hip and thigh muscle injury: a pictorial review. Insights Imaging 2019; 10:20. [PMID: 30771029 PMCID: PMC6377690 DOI: 10.1186/s13244-019-0702-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/25/2018] [Indexed: 01/28/2023] Open
Abstract
Muscle injuries of the hip and thigh are a highly relevant issue in competitive sports imaging. The gold standard in diagnostic imaging of muscle injuries is magnetic resonance imaging (MRI). Radiologists need to be familiar with typical MRI findings in order to accurately detect and classify muscle injuries. Proper interpretation of the findings is crucial, especially in elite athletes. In soccer players, muscle injuries of the hip and thigh are the most common reason for missing a game.The present pictorial review deals with the diagnostic assessment, especially MRI, of muscle injuries of the hip and thigh. Typical MR findings in muscle injuries include edema, hematoma, and tendinous avulsion as well as partial or complete muscle tear. To estimate the time to return to play, a grading into three groups-muscle strain, partial tear, complete tear-has traditionally been used. Taking into account the most recent literature, there are other prognostic factors such as the longitudinal length of a tear, the tendon's intramuscular component, or persisting edema.
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Affiliation(s)
- Kolja M Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Judith S Gerhardt
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Ioan N Gemescu
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, Bucharest, Romania
| | | | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
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Abstract
BACKGROUND Gastrocnemius muscle and musculocutaneous flaps are very versatile and one of the commonly used flaps for lower extremity reconstruction. There is significant literature available on the use of these flaps. However, we feel that the potential of the gastrocnemius musculocutaneous (GMC) flaps has not yet been fully explored in terms of increasing their reach, viability and arc of rotation. An attempt is made to refine the technique of flap harvestation to optimize outcomes of this versatile flap. METHODS Six patients of complex lower limb defects were managed using the GMC flaps. Harvesting of the flap was always initiated from the posterior midline to include the proximal sural pedicle, sural nerve, short saphenous vein and the muscle belly of either the medial or the lateral gastrocnemius muscle along with the cutaneous paddle. All the flaps were islanded and denervated. The origin of the gastrocnemius muscle was detached in all cases to increase the reach of this flap. RESULTS The flap can reliably and comfortably cover defects from middle third-lower third junction of thigh and the entire posterior aspect of the thigh. Such a local option offers relatively simple but more cost-effective approach to complex clinical problem with tolerable impairment of the donor site. CONCLUSION The GMC flap can be considered as a worthwhile alternative to free-tissue transfer for limb salvage.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Rahul Bhadgale
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Ankur Karanjkar
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Rohit Phulwer
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Chaitanya Ramteke
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
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Han SJ, Boyko EJ, Kim SK, Fujimoto WY, Kahn SE, Leonetti DL. Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans. Diabetes Metab J 2018; 42:488-495. [PMID: 30302961 PMCID: PMC6300439 DOI: 10.4093/dmj.2018.0022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Skeletal muscle plays a major role in glucose metabolism. We investigated the association between thigh muscle mass, insulin resistance, and incident type 2 diabetes mellitus (T2DM) risk. In addition, we examined the role of body mass index (BMI) as a potential effect modifier in this association. METHODS This prospective study included 399 Japanese Americans without diabetes (mean age 51.6 years) who at baseline had an estimation of thigh muscle mass by computed tomography and at baseline and after 10 years of follow-up a 75-g oral glucose tolerance test and determination of homeostasis model assessment of insulin resistance (HOMA-IR). We fit regression models to examine the association between thigh muscle area and incidence of T2DM and change in HOMA-IR, both measured over 10 years. RESULTS Thigh muscle area was inversely associated with future HOMA-IR after adjustment for age, sex, BMI, HOMA-IR, fasting plasma glucose, total abdominal fat area, and thigh subcutaneous fat area at baseline (P=0.033). The 10-year cumulative incidence of T2DM was 22.1%. A statistically significant interaction between thigh muscle area and BMI was observed, i.e., greater thigh muscle area was associated with lower risk of incident T2DM for subjects at lower levels of BMI, but this association diminished at higher BMI levels. CONCLUSION Thigh muscle mass area was inversely associated with future insulin resistance. Greater thigh muscle area predicts a lower risk of incident T2DM for leaner Japanese Americans.
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Affiliation(s)
- Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Soo Kyung Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Wilfred Y Fujimoto
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Steven E Kahn
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA, USA
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Massaad A, Assi A, Bakouny Z, Bizdikian AJ, Skalli W, Ghanem I. Alterations of treatment-naïve pelvis and thigh muscle morphology in children with cerebral palsy. J Biomech 2018; 82:178-185. [PMID: 30389259 DOI: 10.1016/j.jbiomech.2018.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 08/09/2018] [Accepted: 10/20/2018] [Indexed: 11/29/2022]
Abstract
Lower limb (LL) muscle morphology and growth are altered in children with cerebral palsy (CP). Muscle alterations differ with age and with severity of motor impairment, classified according to the gross motor classification system (GMFCS). Muscle alterations differ also with orthopedic intervention, frequently performed at the level of the shank muscles since an early age, such as the gastrocnemius. The aim was to investigate the alterations of treatment-naïve pelvis and thigh muscle lengths and volumes in children with GMFCS levels I and II, of varying ages. 17 children with CP (GMFCS I: N = 9, II: N = 8, age: 11.7 ± 4 years), age-matched to 17 typically developing (TD) children, underwent MRI of the LL. Three-dimensional reconstructions of the muscles were performed bilaterally. Muscle volumes and lengths were calculated in 3D and compared between groups. Linear regression between muscle volumes and age were computed. Adductor-brevis and gracilis lengths, as well as rectus-femoris volume, were decreased in GMFCS I compared to TD (p < 0.05). Almost all the reconstructed muscle volumes and lengths were found to be altered in GMFCS II compared to TD and GMFCS I. All muscle volumes showed significant increase with age in TD and GMFCS I (R2 range: 0.3-0.9, p < 0.05). Rectus-femoris, hamstrings and adductor-longus showed reduced increase in the muscle volume with age in GMFCS II when compared to TD and GMFCS I. Alterations of treatment-naïve pelvis and thigh muscle volumes and lengths, as well as muscle growth, seem to increase with the severity of motor impairment in ambulant children with CP.
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Affiliation(s)
- Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Aren Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph in Beirut, Lebanon
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Al-Hakkak SMM. Adductor magnus muscle primary hydatid cyst rare unusual site: A case report. Int J Surg Case Rep 2018; 51:379-384. [PMID: 30268065 PMCID: PMC6170218 DOI: 10.1016/j.ijscr.2018.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The preferred localization of human echinococcosis is the liver and lungs, which account for 85% of cases. Primary musculoskeletal hydatidosis are seldom reported in literature and their incidence is unknown. Primary solitary intramuscular hydatid disease is rare, even in countries in which echinococcosis is endemic and accounts for 1% of all human echinococcosis sites. CASE PRESENTATION 37-year-old male farmer presented with primary hydatid cyst of the upper medial side of right thigh (Inside adductor magnus muscle) who was managed successfully by preoperative and postoperative dual treatment of albendazole together with surgery. DISCUSSION This site of localization has not been reported previously. It is essential to establish definitive preoperative diagnosis of skeletal muscle hydatid cysts. This contraindicates certain treatment options like marginal excision or incisional biopsy due to the likelihood of dissemination and anaphylactic shock on spillage. Pericystectomy remains treatment of choice in musculoskeletal hydatid cysts. CONCLUSION Hydatid disease should be included in the differential diagnosis of muscular masses, regardless of its location, especially in endemic areas.
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