Hatchet Thigh Flap with Hemi-gluteus Flap for Recurrent Ischial Sore Reconstruction

Background: Ischial pressure sores are the most challenging sores to treat because of associated bursa and high rate of recurrence. Reconstruction flaps originating in the thigh have a disadvantage as movement may increase shear forces, and tension during closure may lead to wound dehiscence. To circumvent these problems, we hereby present a hatchet thigh flap with good mobility, which can be used for recurrent cases as well.Methods: All patients treated at our hospital in the last 5 years for ischial pressure sores were included in the study. The flap is elevated in the subfascial plane from lateral to medial until the medial circumflex artery perforators are revealed. In recurrent cases the lower half of the gluteus maximus muscle is used to fill in the cavity while the flap from the previous surgery is re-advanced.Results: Sixteen patients (11 males and five females) were in the study. The median age of the patient was 54 years (range, 25–82 years). All the flaps survived fully. Two patients had recurrence at three sites, which were successfully reconstructed by advancing the same flap and hemi-gluteus muscle. An average of 6 months follow-up after surgery for recurrence showed stable reconstruction.Conclusion: The hatchet thigh flap is easy to dissect and reliable for ischial pressure sores. It can be used effectively in recurrent cases when combined with hemi-gluteus flaps.

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Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1188.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 755-760 ◽

Cited By ~ 2

Author(s):

T-F. Lou ◽

M. Hamushan ◽

H. Li ◽

C-Y. Wang ◽

Y. Chai ◽

...

Keyword(s):

Tract Infection ◽

Internal Fixation ◽

Distraction Osteogenesis ◽

Wound Dehiscence ◽

High Rate ◽

Fixation Index ◽

Major Complications ◽

The Mean ◽

Pin Tract Infection

AimsThe aim of this study was to describe the technique of distraction osteogenesis followed by arthrodesis using internal fixation to manage complex conditions of the ankle, and to present the results of this technique.Patients and MethodsBetween 2008 and 2014, distraction osteogenesis followed by arthrodesis using internal fixation was performed in 12 patients with complex conditions of the ankle due to trauma or infection. There were eight men and four women: their mean age was 35 years (23 to 51) at the time of surgery. Bone healing and functional recovery were evaluated according to the criteria described by Paley. Function was assessed using the ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS).ResultsA solid fusion of the ankle and eradication of infection was achieved in all patients. A mean lengthening of 6.1 cm (2.5 to 14) was achieved at a mean follow-up of 25.2 months (14 to 37). The mean external fixation index (EFI) was 42 days/cm (33.3 to 58). The function was judged to be excellent in six patients and good in six patients. Bone results were graded as excellent in ten patients and good in two patients. The mean AOFAS score was 37.3 (5 to 77) preoperatively and 75.3 (61 to 82) at the final follow-up. Minor complications, which were treated conservatively, included pain, pin-tract infection, loosening of wires, and midfoot stiffness. Major complications, which were treated surgically included grade V pin-tract infection with inflammation and osteolysis, poor consolidation of the regenerate bone, and soft-tissue invagination. The reoperations required to treat the major complications included the exchange of pins and wires, bone grafting and invagination split surgery.ConclusionThe technique of distraction osteogenesis followed by arthrodesis using internal fixation is an effective form of treatment for the management of complex conditions of the ankle. It offers a high rate of union, an opportunity to remove the frame early, and a reduced EFI without infection or wound dehiscence. Cite this article: Bone Joint J 2018;100-B:755–60.

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Inferior Gluteus Maximus Island Flap for Reconstruction of Ischial Pressure Sores

Annals of King Edward Medical University ◽

10.21649/akemu.v23i1.1521 ◽

2017 ◽

Vol 23 (1) ◽

Author(s):

Yawar Sajjad ◽

Beenish Rahat ◽

Salman Hameed

Keyword(s):

Case Series ◽

Gluteus Maximus ◽

Wound Dehiscence ◽

Island Flap ◽

Wound Management ◽

Medical Institute ◽

High Recurrence Rate ◽

Pressure Sores ◽

Retrospective Case ◽

Grade 3

Surgical management of ischial pressure sores has always been a challenge due to high recurrence rate. Ischial pressure sores develop due to unrelieved pressure over the Ischium. Inferior gluteus maximus island flap has been used effectively for coverage of ischial pressure sores.Objective: To describe the efficacy of inferior gluteus maximus flap for reconstruction of ischial pressure sores.Methods: A retrospective case series, consisted of sample of 17 cases. The study was conducted in the Department of Plastic and Reconstructive Surgery, Post Graduate Medical Institute, Lahore General Hospital Lahore, over a period of 8 years from March 2008 to March 2016. The case series included17 patients with grade 3 and grade 4 ischial pressure sores, comprising 12 male and 5 female, with age range of 28 to 64 (mean = 46 years).Follow-up ranged from 1 to 4 years with a mean of 2.5 years. Inferior gluteus maximus island flap was used for reconstruction of Ischial pressure sores.Results: In thirteen (76%) of the seventeen patients, wound healed uneventfully without any complication. Partial wound dehiscence was observed in 2 patients (12%). Both of these healed with conservative wound management. Recurrence was seen in 2 patients (12%) after 8 months. These two patients underwent reoperation and gluteus maximus flap was readvanced that resulted in satisfactory wound coverage.Conclusion: Inferior gluteus maximus island flap can be considered as a reliable option for reconstruction of ischial pressure sores.

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Effects of Early Progressive Eccentric Exercise on Muscle Size and Function After Anterior Cruciate Ligament Reconstruction: A 1-Year Follow-up Study of a Randomized Clinical Trial

Physical Therapy ◽

10.2522/ptj.20070189 ◽

2009 ◽

Vol 89 (1) ◽

pp. 51-59 ◽

Cited By ~ 73

Author(s):

J Parry Gerber ◽

Robin L Marcus ◽

Leland E Dibble ◽

Patrick E Greis ◽

Robert T Burks ◽

...

Keyword(s):

Eccentric Exercise ◽

Cruciate Ligament ◽

Gluteus Maximus ◽

Exercise Group ◽

Quadriceps Femoris ◽

Muscle Volume ◽

Gluteus Maximus Muscle ◽

Anterior Cruciate ◽

And Function

Background and Purpose The authors previously reported that focused eccentric resistance training during the first 15 weeks following anterior cruciate ligament reconstruction (ACL-R) induced greater short-term increases in muscle volume, strength, and measures of function relative to standard rehabilitation. The purpose of this study was to evaluate the effects of early progressive eccentric exercise on muscle volume and function at 1 year after ACL-R. Participants and Methods Forty patients who had undergone an ACL-R were randomly assigned to 1 of 2 groups: a group that received early progressive eccentric exercise (n=20) and a group that received standard rehabilitation (n=20). Seventeen participants in the eccentric exercise group and 15 participants in the standard rehabilitation group completed a 1-year follow-up. Magnetic resonance images of the thighs were acquired 1 year after ACL-R and compared with images acquired 3 weeks after surgery. Likewise, routine knee examinations, self-report assessments, and strength and functional testing were completed 1 year after surgery and compared with previous evaluations. A 2-factor analysis of variance for repeated measures (group × time) was used to analyze the data. Results Compared with the standard rehabilitation group, improvements in quadriceps femoris and gluteus maximus muscle volume in the involved lower extremity from 3 weeks to 1 year following ACL-R were significantly greater in the eccentric exercise group. Improvements in quadriceps femoris and gluteus maximus muscle volume were 23.3% (SD=14.1%) and 20.6% (SD=12.9%), respectively, in the eccentric exercise group and 13.4% (SD=10.3%) and 11.6% (SD=10.4%), respectively, in the standard rehabilitation group. Improvements in quadriceps femoris muscle strength and hopping distance also were significantly greater in the eccentric exercise group 1 year postsurgery. Discussion and Conclusions A 12-week focused eccentric resistance training program, implemented 3 weeks after ACL-R, resulted in greater increases in quadriceps femoris and gluteus maximus muscle volume and function compared with standard rehabilitation at 1 year following ACL-R.

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Combined V-Y Fasciocutaneous Advancement and Gluteus Maximus Muscle Rotational Flaps for Treating Sacral Sores

BioMed Research International ◽

10.1155/2016/8714713 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Hyun Ho Han ◽

Eun Jeong Choi ◽

Suk Ho Moon ◽

Yoon Jae Lee ◽

Deuk Young Oh

Keyword(s):

Donor Site ◽

Gluteus Maximus ◽

Muscle Thickness ◽

Donor Site Morbidity ◽

Pressure Sore ◽

Fasciocutaneous Flap ◽

Common Site ◽

Modified Method ◽

Gluteus Maximus Muscle

The sacral area is the most common site of pressure sore in bed-ridden patients. Though many treatment methods have been proposed, a musculocutaneous flap using the gluteus muscles or a fasciocutaneous flap is the most popular surgical option. Here, we propose a new method that combines the benefits of these 2 methods: combined V-Y fasciocutaneous advancement and gluteus maximus muscle rotational flaps. A retrospective review was performed for 13 patients who underwent this new procedure from March 2011 to December 2013. Patients’ age, sex, accompanying diseases, follow-up duration, surgical details, complications, and recurrence were documented. Computed tomography was performed postoperatively at 2 to 4 weeks and again at 4 to 6 months to identify the thickness and volume of the rotational muscle portion. After surgery, all patients healed within 1 month; 3 patients experienced minor complications. The average follow-up period was 13.6 months, during which time 1 patient had a recurrence (recurrence rate, 7.7%). Average thickness of the rotated muscle was 9.43 mm at 2 to 4 weeks postoperatively and 9.22 mm at 4 to 6 months postoperatively (p=0.087). Muscle thickness had not decreased, and muscle volume was relatively maintained. This modified method is relatively simple and easy for reconstructing sacral sores, provides sufficient padding, and has little muscle donor-site morbidity.

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Ischiadic Nerve Lesion Due to Metastasis of a Non-Differentiated Urethra Carcinoma: Case Report and Review of the Literature

Clinical Oncology and Research ◽

10.31487/j.cor.2021.03.04 ◽

2021 ◽

pp. 1-5

Author(s):

Pavel Adam ◽

Jiří Kasík ◽

Petr Jaroš ◽

Pavel Kalvach ◽

David Hepnar ◽

...

Keyword(s):

Case Report ◽

Clinical Practice ◽

Gluteus Maximus ◽

Diagnostic Process ◽

Nerve Lesion ◽

Review Of The Literature ◽

Disc Protrusion ◽

Gluteus Muscle ◽

History Of ◽

Gluteus Maximus Muscle

In clinical practice, we encounter mechanical lesions of the ischiadic nerve most frequently with a trauma of the pelvis circle or because of surgical injury in the alloplastic treatment of the hip joint. Other causes for nerve lesions are sporadic or even rare. To such ones also belongs compression of the nerve by metastasis of a urethra carcinoma to the gluteus maximus muscle. A typical manifestation of this nerve injury is a tibioperoneal paresis with a preponderance in its peroneal component. The diagnostic process can be additionally complicated by a contemporal vertebrogenic syndrome with radiculopathy, the more so, when an intervertebral disc protrusion on imaging would be discovered. We present a case of a woman with a two-year history of an undifferentiated urethra carcinoma which has metastasized into the gluteus muscle and has produced a compression of the ischiadic nerve.

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Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/2/121 ◽

2008 ◽

Vol 8 (2) ◽

pp. 121-128 ◽

Cited By ~ 31

Author(s):

Aritetsu Kanemura ◽

Minoru Doita ◽

Tetsuhiro Iguchi ◽

Koichi Kasahara ◽

Masahiro Kurosaka ◽

...

Keyword(s):

Cervical Myelopathy ◽

Late Complication ◽

Gluteus Maximus ◽

Resonance Imaging ◽

Spinous Processes ◽

Weighted Magnetic Resonance Imaging ◽

Gluteus Maximus Muscle ◽

Axial Symptoms ◽

Membrane Defects

Object The authors describe 4 cases of delayed dural laceration by hydroxyapatite (HA) spacer causing tetra-paresis following double-door laminoplasty. There are few reports of iatrogenic spinal cord lesions developing after double-door laminoplasty, although some complications such as postoperative C-5 paralysis or axial symptoms have been reported. The purpose of this report is to draw attention to the possibility of delayed dural laceration and its triggering mechanism. Methods One hundred thirty patients treated for cervical myelopathy were followed up for an average of 2 years and 9 months after laminoplasty. Results Four patients experienced aggravation of cervical myelopathy. Anterior dislodgement of HA spacers was shown on plain lateral radiographs. Follow-up T2-weighted magnetic resonance imaging demonstrated that the dislodged HA spacers were surrounded by cerebrospinal fluid at the time of aggravation. The dislodged HA spacers were removed and the dural membrane defects were repaired by patching with the fascia of the gluteus maximus muscle. The preoperative symptoms improved after the second operation in all patients. Conclusions It is hypothesized that the loosening of the HA spacer in split spinous processes could occur with the movement of the cervical spine and/or the breakage of the suture before bone bonding. Anterior dislodgement of the HA spacer toward the spinal canal would cause dural laceration by direct friction between the dural membrane and the dislodged HA spacer, resulting in clinical aggravation. Despite the well-documented advantages of using HA spacers for double-door laminoplasty, possible laceration due to a dislodged HA spacer should be considered as a late complication.

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Pedicled Chimeric Perforator Flap Based on Inferior Gluteal Vessel Axis for the Reconstruction of Stage-Four Primary Ischial Pressure Sores—A New Design

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1729505 ◽

2021 ◽

Vol 54 (02) ◽

pp. 177-185

Author(s):

Dharanipriya Arikrishnan ◽

Thalaivirithan Margabandu Balakrishnan ◽

Jaganmohan Janardhanam

Keyword(s):

Perforator Flap ◽

Gluteus Maximus ◽

Wound Dehiscence ◽

Late Recurrence ◽

Cadaver Study ◽

Pedicled Flap ◽

Control Group ◽

Pressure Sores ◽

Chimeric Flap ◽

Vessel Axis

Abstract Background “Subfascial void reconstruction” in ischial pressure sores (IPSs) goes a long way in the amelioration of the common complications like persistent drainage, infection, wound dehiscence, and late recurrence. No locoregional flaps suffice this requirement. So we have designed a chimeric pedicled flap based on the inferior gluteal vessel axis (IGVA) perforators with two tissue components: (1) Pacman-style fasciocutaneous flap on a perforator and (2) gluteus maximus muscle (inferior portion) on another independent perforator. Aim and Methods After confirming the feasibility of novel design of chimeric pedicled IGVA perforator flap with cadaver study, we embarked on the clinical study with this chimeric flap. In this prospective cohort study, the study and the control existed in the same patient so that the biological factors affecting the wound healing would be the same. Results Twenty-one patients were included whose mean age was 39 years. Late recurrence occurred in one patient (4.8%) of chimeric flap while the control group (who had undergone conventional reconstruction) had recurrence in 11 patients (52.4%). On assessment with overall institutional score, grade A was observed in 18 patients of the chimeric IGVA flap group (p < 0.045), and in only 3 patients of the control group. Conclusions This anatomically construed flap, a new addendum in the armamentarium of reconstruction of IPSs, with its potential to congruently fill the ischiogluteal subfascial void may provide a lasting solution for preventing recurrences.

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Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

SAGE Open Medicine ◽

10.1177/20503121211014707 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110147

Author(s):

Nobuhiko Sumiyoshi ◽

Kazuhiro Oinuma ◽

Yoko Miura

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Reactions ◽

Small Diameter ◽

High Rate ◽

Metal Debris ◽

Total Hip ◽

Metal On Metal ◽

Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

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Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1322-4811 ◽

2020 ◽

Author(s):

Erika Vainieri ◽

Raju Ahluwalia ◽

Hani Slim ◽

Daina Walton ◽

Chris Manu ◽

...

Keyword(s):

Limb Salvage ◽

Diabetic Foot ◽

Emergency Admission ◽

Arterial Disease ◽

Major Amputation ◽

Outcome Data ◽

High Rate ◽

Free Survival ◽

Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

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Discovery of five new Galactic symbiotic stars in the VPHAS+ survey

Monthly Notices of the Royal Astronomical Society ◽

10.1093/mnras/stab195 ◽

2021 ◽

Vol 502 (2) ◽

pp. 2513-2517

Author(s):

Stavros Akras ◽

Denise R Gonçalves ◽

Alvaro Alvarez-Candal ◽

Claudio B Pereira

Keyword(s):

Spectroscopic Data ◽

Selection Criterion ◽

Optical Spectra ◽

Emission Lines ◽

High Rate ◽

Symbiotic Stars ◽

Selection Of

ABSTRACT We report the validation of a recently proposed infrared (IR) selection criterion for symbiotic stars (SySts). Spectroscopic data were obtained for seven candidates, selected from the SySt candidates of Akras et al. by employing the new supplementary IR selection criterion for SySts in the VST/OmegaCAM Photometric H-Alpha Survey. Five of them turned out to be genuine SySts after the detection of H α, He ii, and [O iii] emission lines as well as TiO molecular bands. The characteristic O vi Raman-scattered line is also detected in one of these SySts. According to their IR colours and optical spectra, all five newly discovered SySts are classified as S-type. The high rate of true SySts detections of this work demonstrates that the combination of the H α emission and the new IR criterion improves the selection of target lists for follow-up observations by minimizing the number of contaminants and optimizing the observing time.

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