scholarly journals Distal major pedicle of sartorius muscle flap: Anatomical study and its clinical implications

2018 ◽  
Vol 51 (01) ◽  
pp. 040-045
Author(s):  
K. N. Manjunath ◽  
M. S. Venkatesh ◽  
Ashwini Shivaprasad
Keyword(s):  
Gastrocnemius Muscle ◽  
Muscle Flap ◽  
Sartorius Muscle ◽  
Lateral Aspect ◽  
Muscle Flaps ◽  
Suitable Alternative ◽  
Myocutaneous Flaps ◽  
Mean Diameter ◽  
The Mean ◽  
Clinical Cases

ABSTRACT Background: Reconstruction of the popliteal region has limited option in terms of muscle flaps or myocutaneous flaps. Gastrocnemius muscle or the myocutaneous flaps are the option for majority of cases. However, reach of Gastrocnemius is limited if the wound is on the distal one-third thigh or the lateral aspect of knee region. Similarly, if the wound injures the muscle, then coverage becomes all the more difficult. Although inferiorly based fasciocutaneous flaps can cover the wound in case of bony injuries, muscle flaps are beneficial as they help in fracture healing. However, in cases with direct gastrocnemius muscle injury or if the wound on the distal one-third thigh or the lateral aspect then the options of muscle flaps is limited. An inferiorly based sartorius muscle can be one suitable alternative to cover this region. Aims and Objective: The aim is to devise an inferiorly based sartorius muscle flap for coverage of lower thigh, popliteal and upper one-third leg region. Objectives: (1) To identify the location of distal major (largest diameter) pedicle in cadavers and its clinical application. (2) To determine the arc of rotation with distal major pedicle as pivot point. Methods: Ten Cadavers and 20 sartorius muscle dissected out. Prior silicone injection onto the femoral vessels was done to identify the location of the perforators for the sartorius muscle. The distance of perforators from anterior superior iliac spine (ASIS) measured and the diameter of each perforator by transverse cut measured using callipers. In clinical cases, the arc of rotation was measured by keeping the distal perforator intact as pedicle (detaching the muscle from the ASIS without detaching from the insertion and then rotating it). Results: Out of the 10 cadavers analysed, 6 were male and 4 were female. The mean location of the distal major pedicle was at 35.25 cm from ASIS and range was between 30.4 cm to 38.3 cm. There was no significant variation between right and left limbs in individual cadaver (range 0.2 cm–1.6 cm). The mean diameter of the arterial component of distal major pedicle was 1.54 mm. In three clinical cases where this flap was harvested the arc of rotation were 95°, 110°, 125°. In one of the cases where flap was used to cover the tibial plateau (arc of rotation 155°), distal end of the muscle necrosed. Conclusion: This cadaver study supported by various other studies show that it has sizeable distal pedicle based on which whole muscle can be harvested as flap. In our study, the usual location of this pedicle is at 35 cm from ASIS. The mean diameter of the widest pedicle in distal one-third was 1.54 mm which along with other small diameter pedicle can support the entire muscle. This flap reached up to the infrapatellar region without any vascular compromise.

scholarly journals Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

2017 ◽  
Vol 4 (7) ◽  
pp. 2157 ◽  
Author(s):  
Ahmed Fawzy ◽  
Ahmed Gaber ◽  
Hesham Abugruidah ◽  
Ahmed El Kased
Keyword(s):  
Donor Site ◽  
Bypass Graft ◽  
Vascular Grafts ◽  
Muscle Flap ◽  
Sartorius Muscle ◽  
Vascular Protection ◽  
Muscle Flaps ◽  
Inguinal Lymphadenectomy ◽  
Superficial Skin ◽  
Femoral Vessels

Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

scholarly journals Suitability of denervated muscle flaps as recipient sites for pancreatic islet cell transplantation

2021 ◽  
Vol 48 (1) ◽  
pp. 133-143
Author(s):  
Jong-Lim Park ◽  
Taewoon Kim ◽  
Baek-Kyu Kim
Keyword(s):  
Blood Glucose ◽  
Islet Transplantation ◽  
Islet Cell ◽  
Gastrocnemius Muscle ◽  
Muscle Flap ◽  
Islet Cell Transplantation ◽  
Muscle Flaps ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Polymerase Chain

Background Extensive research has been conducted on islet transplantation as a possible cure for diabetes. Islet transplantation in the liver via the portal vein has shown remarkable results, but numerous other recipient sites are currently being investigated. We aimed to show the effectiveness of using a muscle flap as a recipient site for islet transplantation.Methods Islet cells were harvested from 12 isogenic Lewis rats, and then diabetes was induced in another 12 isogenic Lewis rats by streptozotocin injection. In six rats, 3,000 islets were transplanted into gastrocnemius muscle flaps, and in the other six rats, the same number of islets were transplanted into the gastrocnemius muscle. The transplanted islet cell function between the two groups was compared by means of blood glucose tests, glucose tolerance tests, immunohistochemistry, and real-time reverse transcription polymerase chain reaction.Results In the muscle flap group, blood glucose levels significantly decreased after islet transplantation. Blood glucose levels were significantly different between the two groups at 3 weeks after transplantation. The muscle flap group showed nearly normoglycemic results upon the glucose tolerance test, whereas the muscle group was hyperglycemic. Immunohistochemical evaluation showed positive results against insulin and glucagon in biopsies of both groups, and the islet cell density was higher in the muscle flap group. There were no statistically significant differences between the two groups in real-time reverse transcription polymerase chain reaction results.Conclusions Our results suggest that muscle flaps are promising candidates for islet cell transplantation.

scholarly journals Cadaveric study using radio-opaque contrast to determine arterial communication between the two bellies of gastrocnemius muscles

2016 ◽  
Vol 49 (01) ◽  
pp. 53-58 ◽  
Author(s):  
Pawan Agarwal ◽  
K. L. Gupta ◽  
P. Yadav ◽  
Dhananjaya Sharma
Keyword(s):  
Popliteal Artery ◽  
Gastrocnemius Muscle ◽  
Muscle Flap ◽  
Future Application ◽  
X Rays ◽  
The Mean ◽  
Sural Artery ◽  
Distally Based ◽  
The Right ◽  
Gastrocnemius Muscles

ABSTRACT Introduction: Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but has a limitation in covering middle one-third tibial defects. The inferiorly based hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third of the leg. The arterial communication between the gastrocnemius muscle heads has been demonstrated, the consistent location, however, was not studied in large specimens. Materials and Methods: This study was conducted on sixty specimens of gastrocnemius muscles harvested from thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius muscle using radio-opaque contrast with future application of taking one head of muscle distally based for coverage of middle third defect of tibia. A total of 60 specimens were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were taken, and collaterals between two bellies in lower half were noted and the distance of collaterals from the muscles top edge was also noted. Results: We found the communications between both bellies of the gastrocnemius muscle in all specimens in both legs. The mean distance of communications from the upper edge of the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm in the right leg, respectively. The mean distance of communications from upper edge of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78 cm in the left leg. The distal communications between gastrocnemius bellies were not constant in their location, but all the connections were present in distal 3.79 cm of raphe. Conclusion: This study supports the future application of inferior-based hemigastrocnemius muscles flap to cover defects of middle third leg. When distally based hemigastrocnemius flap is planned roughly 1/3rd of distal attachment or distal 3.79 cm of connection between raphe should be maintained to preserve the vascular communications between the two bellies.

Sartorius Muscle Flaps for Vascular Groin Wound Complications

2015 ◽  
Vol 81 (11) ◽  
pp. 1163-1169 ◽  
Author(s):  
Michael B. Brewer ◽  
Christian J. Ochoa ◽  
Karen Woo ◽  
Sarah M. Wartman ◽  
Vahagn Nikolian ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Muscle Flap ◽  
Skin Grafting ◽  
Wound Complication ◽  
Wound Complications ◽  
Sartorius Muscle ◽  
Soft Tissue Coverage ◽  
Vascular Surgeon ◽  
Muscle Flaps ◽  
Rotational Flap

Sartorius myoplasty (SM) has been used as an adjunct for soft tissue coverage in vascular groin wound complications. However, the reliability of SM as a primary muscle flap has been questioned. The purpose of this study is to determine the reliability of SM performed by vascular surgeons in the management of vascular groin wound complications. A retrospective review was performed on all patients who underwent SM from 1997 to 2012. The three indications for SM were prophylactic, infection, and noninfectious wound complication. Failure of SM was defined as operative reintervention for bleeding, persistent wound drainage, or infection. A total of 99 patients underwent 103 SM procedures. The patients were 43 per cent male and 57 per cent female; the mean age was 69 years. The indication for SM was infectious in 62 cases (60%), prophylactic in 21 cases (20%), and noninfectious in the remaining 20 cases. Failure of SM occurred in 11 cases (11%). Of these, salvage bypass and/or salvage muscle flap was required in eight cases (73%). When salvage bypass was required, extra-anatomic obturator bypass was performed in 80 per cent of cases. Salvage wound coverage included rectus abdominus flap (60%), rotational flap (20%), and skin grafting (20%). Seventy-three per cent of failures came from the infectious wound group. The most common reason for SM failure was hemorrhage (45%). In 82 per cent of the cases, the sartorius muscle was still viable at reoperation and was used for continued muscle coverage. SM performed by the vascular surgeon provides reliable soft tissue coverage for vascular groin wound complications and should be used as the primary muscle flap in the majority of patients. In cases of SM failure, the vascular surgeon should consider other more extensive muscle flap options.

Non-isothermal crystallization behavior of spinel crystals in FeO-SiO2-TiO2-V2O3-Cr2O3 slag

2018 ◽  
Vol 116 (1) ◽  
pp. 110
Author(s):  
Lixiong Shao ◽  
Jiang Diao ◽  
Wang Zhou ◽  
Tao Zhang ◽  
Bing Xie
Keyword(s):  
Cooling Rate ◽  
Crystallization Behavior ◽  
Crystal Size ◽  
Growth Mechanisms ◽  
Vanadium Slag ◽  
Growth Behaviour ◽  
Temperature Range ◽  
Chromium Spinel ◽  
Mean Diameter ◽  
The Mean

The growth behaviour of spinel crystals in vanadium slag with high Cr2O3 content was investigated and clarified by statistical analyses based on the Crystal Size Distribution (CSD) theory. The results indicate that low cooling rate and Cr2O3 content benefit the growth of spinel crystals. The chromium spinel crystals firstly precipitated and then acted as the heterogeneous nuclei of vanadium and titanium spinel crystals. The growth mechanisms of the spinel crystals at the cooling rate of 5 K/min consist two regimes: firstly, nucleation control in the temperature range of 1873 to 1773 K, in which the shapes of CSD curves are asymptotic; secondly, surface and supply control within the temperature range of 1773 to 1473 K, in which the shapes of CSD curves are lognormal. The mean diameter of spinel crystals increases from 3.97 to 52.21 µm with the decrease of temperature from 1873 to 1473 K.

scholarly journals Bark proportion of Scots pine industrial wood

2021 ◽  
Author(s):  
Ferréol Berendt ◽  
Erik Pegel ◽  
Lubomir Blasko ◽  
Tobias Cremer
Keyword(s):  
Supply Chain ◽  
Scots Pine ◽  
Bark Thickness ◽  
Wood Supply ◽  
Volume Proportion ◽  
Bark Damage ◽  
Mass Proportion ◽  
Mean Diameter ◽  
The Mean

AbstractBark characteristics are not only used in the forest-wood supply chain, for example to calculate standing volumes, but also to transform wood volumes and masses. In this study, bark thickness, bark volume and bark mass were analyzed on the basis of 150 Scots pine discs, with a mean diameter of 13 cm. The mean double bark thickness was 3.02 mm, the mean bark volume proportion was 5.6% and mean bark mass proportion was 3.3%. Bark proportions were significantly affected by the log-specific variables ‘diameter over bark’, ‘proportion of bark damage’ and ‘double bark thickness’.

scholarly journals Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weiwei Ruan ◽  
Menglu Li ◽  
Qiaofeng Guo ◽  
Bingyuan Lin
Keyword(s):  
Phase I ◽  
Calcium Sulfate ◽  
Tibial Plateau ◽  
Gastrocnemius Muscle ◽  
Tibial Plateau Fracture ◽  
Muscle Flap ◽  
Iliac Bone ◽  
Type Iii ◽  
Plateau Fracture ◽  
Fracture Surgery

Abstract Purpose To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. Methods From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications. Results All patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87). Conclusion Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

CONTROLLABLE CHEMICAL VAPOR DEPOSITION SYNTHESIS OF SINGLE-WALL CARBON NANOTUBES USING MIST FLOW METHOD

NANO ◽  
2012 ◽  
Vol 07 (06) ◽  
pp. 1250045 ◽  
Author(s):  
YUN SUN ◽  
RYO KITAURA ◽  
TAKUYA NAKAYAMA ◽  
YASUMITSU MIYATA ◽  
HISANORI SHINOHARA
Keyword(s):  
Electron Microscopy ◽  
Carbon Nanotubes ◽  
Chemical Vapor Deposition ◽  
Vapor Deposition ◽  
Chemical Vapor ◽  
Single Wall Carbon Nanotubes ◽  
Flow Method ◽  
Mist Flow ◽  
Mean Diameter ◽  
The Mean

The influences of synthesis parameters on the mean diameter and diameter distribution of as-grown single-wall carbon nanotubes (SWCNTs) with chemical vapor deposition (CVD) using the mist flow method have been investigated in detail with Raman spectroscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). We found that CVD reaction temperature and flow rate play an essential role in controlling the mean diameter and the quality of as-grown SWCNTs. Furthermore, we found that the carbon supply kinetics can be a dominant factor to determine the diameter of as-grown SWCNTs in the present mist flow method. Under a different combination of various parameters, the mean diameter of SWCNTs can be varied from 0.9 nm to 1.5 nm controllably.

Initial Clinical Experience with Percutaneous Atherectomy in the Infragenicular Arteries

2003 ◽  
Vol 10 (5) ◽  
pp. 987-993 ◽  
Author(s):  
Thomas Zeller ◽  
Ulrich Frank ◽  
Karlheinz Bürgelin ◽  
Uwe Schwarzwälder ◽  
Peter-Christian Flügel ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Ankle Brachial Index ◽  
Peroneal Artery ◽  
Lesion Length ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Below The Knee ◽  
Directional Atherectomy ◽  
Mean Diameter ◽  
The Mean

Purpose: To evaluate the efficacy and safety of a new atherectomy device for the treatment of infragenicular lesions in arteries with a reference diameter of at least 2.5 mm. Methods: Twenty-seven below-the-knee lesions in 17 patients (12 men; mean age 69±12 years) with chronic peripheral arterial occlusive disease were treated with directional atherectomy. The target lesion was in the popliteal artery (segment 3) in 2 (7%) cases, the tibioperoneal trunk in 12 (44%), the peroneal artery in 8 (30%), the anterior tibial artery in 2 (7%), and the posterior tibial artery in 3 (11%). Six (22%) of the lesions were in-stent stenoses. The mean diameter stenosis was 87%±9%, and the mean lesion length was 34±24 mm. Results: All but 2 (7%) of the lesions could be treated successfully (residual stenosis <30%) with the atherectomy catheter (93% technical success) using an average of 5±2 (range 1–10) passes of the device. Six lesions (22%) were treated after predilation and 21 (78%) with primary atherectomy. In 8 (30%) lesions, additional balloon angioplasty was performed. The 2 failures were in heavily calcified lesions through which the device could not pass despite predilation. The mean diameter stenosis after atherectomy was 14%±22% (range 0%–90%); after additional balloon angioplasty, the mean residual stenoses reduced to 12%±21% (range 0%–100%). One (6%) of the 2 patients who failed atherectomy sustained a thrombotic occlusion of the target vessel. This complication was treated successfully with local lysis, but the vessel reoccluded 3 days later; a stent was implanted. The mean ankle-brachial index increased from 0.50±0.27 to 0.86±0.40 before discharge. Conclusions: Below-the-knee native vessel lesions and in-stent restenoses with a diameter of at least 2.5 mm can be treated successfully and safely with this new atherectomy catheter. Additional balloon angioplasty was necessary in only a few cases.

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