scholarly journals Neurotized latissimus dorsi flap: functional lower limb coverage in subacute trauma reconstruction

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Julie Chakriya Kvann ◽  
Stephanie Thibaudeau ◽  
Alain Joe Azzi ◽  
Teanoosh Zadeh
Keyword(s):  
Lower Extremity ◽  
Latissimus Dorsi ◽  
Soft Tissue Coverage ◽  
Muscle Flaps ◽  
Functional Reconstruction ◽  
Lower Extremity Muscle ◽  
First Case ◽  
Extremity Trauma ◽  
Latissimus Dorsi Flaps

AbstractIn the reconstruction of the mangled lower extremity, muscle flaps are well known for their reliable use in soft tissue coverage, however very few reports document their functional reconstruction potential as neurotized muscle flaps. This case illustrates that free neurotized latissimus dorsi flaps are a good option for long-term functional reconstruction in the mangled lower extremity. Our report is the first case in the literature to date describing a subacute reconstruction with a functional latissimus dorsi in lower extremity trauma. 

scholarly journals Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Chisato Hayashi ◽  
Soshiro Ogata ◽  
Tadashi Okano ◽  
Hiromitsu Toyoda ◽  
Sonoe Mashino
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Physical Exercise ◽  
Lower Extremity ◽  
Physical Function ◽  
Community Dwelling ◽  
Group Exercise ◽  
Community Based ◽  
Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

scholarly journals Microsurgical Reconstruction of the Lower Extremity

2019 ◽  
Vol 33 (01) ◽  
pp. 054-058 ◽  
Author(s):  
Luke Grome ◽  
William Pederson
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Donor Site ◽  
Foot Drop ◽  
Long Term Results ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction

AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

scholarly journals A retrospective analysis of latissimus dorsi–serratus anterior chimeric flap reconstruction in 47 patients with extensive lower extremity trauma

2018 ◽  
Vol 51 (01) ◽  
pp. 024-032
Author(s):  
Ravi Kumar Mahajan ◽  
Krishnan Srinivasan ◽  
Abhiskek Bhamre ◽  
Mahipal Singh ◽  
Prakash Kumar ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Latissimus Dorsi ◽  
Defect Size ◽  
Soft Tissue Reconstruction ◽  
Serratus Anterior ◽  
Advantages And Disadvantages ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Free Flap Transfer

ABSTRACT Background: Many flaps have been described for reconstruction of lower extremity defects, including, Latissimus Dorsi, Rectus abdominis, Anterolateral thigh perforator flaps, each having advantages and disadvantages. The defect location, size and specific geometric pattern of defect influences the type of flap that can be used. In this case series, we describe the specific situations where the use of chimeric latissimus dorsi–serratus anterior (LD + SA) free flaps are of advantage in providing complete wound cover. Materials and Methods: Case records of all patients who underwent LD + SA free flap transfer for lower extremity trauma at Amandeep Hospital, from Feb 2006 to Feb 2017 were reviewed. Patients were categorised based on the anatomical location and size of defect. The method of usage of the chimeric segments, recipient vessels and type of anastomosis were noted. Flap complications, if any were reviewed. Result: 47 patients with lower limb defects were included in the study. All cases were post traumatic in nature. Defect size ranged from 180 sq cm to 1050 sq cm. Average defect size was 487.70 sq cm. All patients underwent soft tissue reconstruction with LD + SA flap. Complete wound cover was obtained. Conclusion: Latissimus dorsi + Serratus anterior free tissue transfer is an effective, reliable method of providing cover to extensive lower limb traumatic defects with minimal donor site morbidity, with added freedom of inset and flap positioning. Specific use is seen in patients with broad proximal defect, long defect in the leg, defects involving adjacent anatomical areas and in large defect with dead space.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

2017 ◽  
Vol 34 (02) ◽  
pp. 121-129 ◽  
Author(s):  
Pierre Moullot ◽  
André M. Gay ◽  
Baptiste Bertrand ◽  
Régis Legré ◽  
Nathalie Kerfant ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Aesthetic Outcome ◽  
Anterolateral Thigh ◽  
Alt Flap

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

Lower-Extremity Muscle Flaps

1984 ◽  
Vol 15 (3) ◽  
pp. 441-449 ◽  
Author(s):  
Phillip G. Arnold ◽  
George B. Irons
Keyword(s):  
Lower Extremity ◽  
Muscle Flaps ◽  
Lower Extremity Muscle

Long-Term Outcomes after Lower Extremity Trauma

1996 ◽  
Vol 41 (1) ◽  
pp. 4-9 ◽  
Author(s):  
J. Laurence Butcher ◽  
Ellen J. MacKenzie ◽  
Brad Cushing ◽  
Gregory Jurkovich ◽  
John Morris ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Long Term Outcomes ◽  
Lower Extremity Trauma ◽  
Extremity Trauma

scholarly journals MON-687 Diabetic Muscle Infarction (DMI) a Rare Under-Recognised Complication of Diabetes Mellitus (DM): A Series of Three Cases

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maheswaran Dhanasekaran ◽  
Preeti Kishore ◽  
Ulrich K Schubart
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Vascular Complications ◽  
Muscle Group ◽  
Tissue Ischemia ◽  
Lower Extremity Muscle ◽  
Cell Counts ◽  
Muscle Infarction ◽  
Normal White Blood Cell

Abstract Background: Diabetic muscle infarction (DMI) also known as diabetic myonecrosis is an acute, rare, microangiopathic complication of long-standing poorly controlled Diabetes Mellitus (DM). DMI presents as severe pain and swelling of the affected muscle group, usually of the lower extremities. It generally occurs in patients with established vasculopathy from uncontrolled diabetes including retinopathy and nephropathy. However, a clear association of DMI to long term mortality has not yet been defined. Proposed pathophysiologic mechanisms for DMI are microvascular endothelial damage complicated by thromboembolic events triggering an inflammatory cascade, leading to local tissue ischemia and eventual infarction. Alterations in the coagulation-fibrinolysis system and vasculitis have also been invoked. About 50% of the cases have DMI recurrence in the setting of uncontrolled DM. Clinical Case: We report 3 cases of DMI diagnosed in patients with long-standing poorly controlled DM with at least two established micro-vascular complications. The lower extremity muscle group was affected, especially the thigh muscles and paraspinal muscle in one case. Biochemical parameters were significant for normal white blood cell counts, elevated erythrocyte sedimentation rate (112, 105, 145 mm/hr respectively; n 0–15 mm/hr) and C-reactive protein (CRP) (54.3, 260, 162 mg/L respectively; n 0–5.0 mg/L) and elevated creatine kinase in two cases (539 and 379 U/L; n 5–150 U/L). Infectious work-up including blood cultures were negative. Lower extremity doppler was negative in all three cases. Diagnosis was established with the help of MRI in two cases showing diffuse hyperintensities of the muscle groups involved and muscle biopsy in the third showing neutrophilic and eosinophilic inflammation and areas of necrosis, fibrosis and hemorrhage. Treatment involved adequate pain management and anti-platelet therapy along with tight glycemic control. No recurrence thus far was noticed in all three patients. Conclusion: DMI should be considered in the differential diagnosis of patients with the aforementioned risk factors who did not show a response to antibiotics, as administered for presumed cellulitis. Though self-limiting, studies have shown a long term temporal correlation with increased all-cause mortality in patients with DMI. Hence DMI is considered as another cardiovascular risk equivalent. Further studies are needed to explore strategies aimed at preventing DMI and its recurrence.

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