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ABSTRACT: : With increasing use of free vascular flaps of the saphenous artery and descending genicular artery, the authors investigated the anatomical variations in cadavers.
: Thirty-one fresh cadaveric thighs were studied by anatomical dissection. The perforators and their source arteries were skeletonized along their courses to the superficial femoral artery and measured. The perforators' nomenclature and abbreviations were modified from the Gent consensus. The skin and bone perforators were evaluated for their role in skin, bone, and osteocutaneous flaps.
: The descending genicular artery was noted in 27 thighs (87 percent) and gave rise to at least one skin perforator that could be used to develop an osteocutaneous flap. The chimeric pedicle length increased and the chimeric arm length decreased, as the descending genicular artery skin perforators were more distally located. The saphenous artery was noted in all 31 thighs, and in 16 (52 percent) it originated from the superficial femoral artery. Most musculocutaneous perforators of the saphenous artery were associated with the sartorius, whereas those of the descending genicular artery were associated with the vastus medialis. Superficial femoral artery skin perforators were noted in 10 thighs (32 percent). Two clinical cases, illustrating the use of the descending genicular artery vastus medialis perforator flap and of the distal-direct perforator osteocutaneous flap, are reported.
: This study investigated the anatomical variations in the skin and bone perforators of the medial knee. Free skin or bone flaps were achieved in all specimens and osteocutaneous chimera flaps were achieved in 87 percent of the thighs.
Plastic and reconstructive surgery 03/2013; 131(3):363e-72e. · 2.74 Impact Factor
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ABSTRACT: 47 dissections of cadaver thigh were studied to investigate pedicle configurations in the lateral descending branch of the lateral circumflex femoral arterial system, which can be used in harvesting a flow-through anterolateral thigh flap. The descending branch arose from the lateral circumflex femoral artery in 38 of the dissections, and the mean diameter at its origin was 3.0mm (range, 2.2-4.0mm). Skin peforators were of the solely musculocutaneous type in 37 dissections and were a combined septo-musculocutaneous type in 10 dissections. Pure septocutaneous perforator was not found in this study. During the descending branch's journey to the distal part of the thigh, several branches went into the vastus lateralis and vastus intermedius muscles. The diameters were tapering and the mean terminal diameter was 1.3mm (range 0.9-1.8mm), which required intraoperative judgment for proper matching of diameter of the flow-through pedicle and the recipient artery. The mean total length of the descending branch from its origin to terminus was 30.3 cm (range 22.5-37.1cm). In four dissections, the descending branch could not be used as a flow-through anterolateral thigh flap because the origin of the perforator arose from the transverse branch. A flow-through anterolateral thigh flap has several advantages, including a large cutaneous area, acceptable donor-site morbidity, adjustable thickness, the ability to combine adjacent muscle or fascia lata and the possibility of simultaneous reconstruction of long arterial gap and soft-tissue defects. Four patients with severe injury and a vascular gap of longer than 10 cm in the extremities were used to confirm the usefulness of this application.
Injury 11/2008; 39 Suppl 4:47-54. · 1.98 Impact Factor
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ABSTRACT: This paper reviews the current concepts of soft-tissue injury in orthopaedic trauma. Six topics are described in this Injury Supplement, including influencing factors and mechanisms, co-morbidities, biological responses, diagnosis and treatment of closed soft-tissue injury, compartment syndrome and gunshot wounds. Since one of the current AO principles emphasises respect for soft tissue when performing open reduction and internal fixation, this article further discusses the pathophysiology of soft-tissue injury and the specific concerns in treating compartment syndrome and gunshot injury. Understanding the basic and updated principles of soft-tissue management will be beneficial for the clinical practice of orthopaedic trauma surgeons.
Injury 11/2008; 39 Suppl 4:3-17. · 1.98 Impact Factor
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ABSTRACT: We report on 45 pedicle perforator flaps without harvesting major vessels in limb reconstruction. Of our patients, 25 had major vessel injury resulting from their initial injury. In the upper extremities, there were 13 posterior interosseous artery perforator flaps, four ulnar artery perforator flaps and three radial artery perforator flaps. In the lower extremities, there were 16 peroneal artery perforator flaps with an axis on the sural nerve, five peroneal artery perforator flaps with an axis on the superficial peroneal nerve and four posterior tibial artery perforator flaps with an axis on the saphenous nerve. There were 42 successes, one total flap loss, one epidermal necrolysis and one distal tip necrosis. Greater utilisation of pedicle perforator flaps probably will occur because they are technically simple to execute, violate only the involved extremity, do not sacrifice a major source vessel, bring similar local tissues into a defect, avoid prolonged immobilisation and do not require microsurgical expertise. The concept of the pedicle perforator flap can be applied to the same axis of a neurocutaneous flap, even in cases with injured cutaneous nerves.
Injury 11/2008; 39 Suppl 4:55-66. · 1.98 Impact Factor
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ABSTRACT: Fifty thighs from fresh human cadavers were studied to evaluate the feasibility of a double functioning free muscle transfer of the gracilis and adductor longus with single common vascular pedicle anastomosis. Methylene blue intra-arterial injection and loupe-magnified dissection were used to demonstrate three groups of vascular patterns in these two muscles. The common vascular pedicles of 88% of our specimen muscles were long enough for possible anastomosis. Ten percent (type B2) were quite short, making microsurgical procedure difficult. Two percent (type A3) of our specimens were not suitable for single anastomosis. Four percent of our gracilis muscles had two major arterial pedicles that branched from the common pedicle in a Y-shaped configuration. If only one pedicle of this type is harvested during a free gracilis muscle transfer, it may cause inadequate flap perfusion. Four specimens were studied using contrast media angiography to confirm both are Mathes and Nahai type II muscle flaps. In summary, this study typed the common vascular pedicle of our sample of gracilis and adductor longus muscles and confirmed the feasibility of double functioning free muscle transfer of the gracilis and adductor longus with single vascular anastomosis.
Journal of Reconstructive Microsurgery 06/2008; 24(4):231-8. · 1.43 Impact Factor
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ABSTRACT: The efficacy of end-to-side repair as a method of nerve reconstruction has been questioned, and most studies that characterize the mode of re-innervation are marred by inappropriate experimental design and lack quantitative analysis. This makes characterization of re-innervating neurons confusing and consequently controversy remains as to the extent and source of reinnervating axons. In an experimental brachial plexus rat model, we transected the musculocutaneous nerve, labeled its neuron pool with Fast-Blue and joined the distal stump to the side of the intact ulnar nerve, or to the proximal stump of the divided ulnar nerve, to characterize neurons that reinnervate the recipient nerve. Tetramethyl-rhodamine dextran (TMRD) or fluoro-gold was used to map the reinnervating motor and sensory neurons at 12 weeks post-transection. No neurons originally labeled from musculocutaneous nerve were subsequently labeled with TMRD or fluoro-gold, showing that this original neuron pool does not contribute to re-innervation of the distal musculocutaneous nerve, but that reinnervation occurs solely by ulnar nerve motor and sensory axons. In the end-to-side group, 16.4% of the motor and 7% of the sensory donor ulnar nerve neurons re-innervated the musculocutaneous nerve exclusively, and a further 10% motor and 11.6% sensory innervated the musculocutaneous nerve by collateral sprouting of their axons. This compared to re-innervation by 62.6% of motor and 70.4% of ulnar nerve sensory neurons in the positive control that underwent end-to-end repair. Our results confirm the concept of collateral sprouting and support the use of end-to-side repair.
Journal of Neurotrauma 06/2007; 24(5):864-75. · 3.65 Impact Factor
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ABSTRACT: Duhuo Jisheng Wan (DJW) is perhaps the best known and most widely used Chinese herbal recipe for arthralgia, but the clinical study to verify its efficacy is lacking. The purpose of this study was to compare the efficacy of DJW versus diclofenac in symptomatic treatment of osteoarthritis (OA) of the knee.
This study was a randomized, double-blind, double-dummy, controlled trial. The 200 patients suffering from OA of the knee, were randomized into the DJW and diclofenac group. The patients were evaluated after a run-in period of one week (week 0) and then weekly during 4 weeks of treatment. The clinical assessments included visual analog scale (VAS) score that assessed pain and stiffness, Lequesne's functional index, time for climbing up 10 steps, as well as physician's and patients' overall opinions on improvement.
Ninety four patients in each group completed the study. In the first few weeks of treatment, the mean changes in some variables (VAS, which assessed walking pain, standing pain and stiffness, as well as Lequesne's functional index) of the DJW group were significantly lower than those of the diclofenac group. Afterwards, these mean changes became no different throughout the study. Most of the physician's and patients' overall opinions on improvement at each time point did not significantly differ between the two groups. Approximately 30% of patients in both groups experienced mild adverse events.
DJW demonstrates clinically comparable efficacy to diclofenac after 4 weeks of treatment. However, the slow onset of action as well as approximately equal rate of adverse events to diclofenac might limit its alternative role in treatment of OA of the knee.
BMC Complementary and Alternative Medicine 01/2005; 4:19. · 2.24 Impact Factor
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ABSTRACT: This study describes a consecutive series of 11 children who received a microsurgical second toe-metatarsal bone transfer for reconstructing a hypoplastic thumb associated with radial club hand, between 1996 and 2000. The parents refused pollicization in all cases for aesthetic and cultural reasons. Surgery was intended to improve hand function and cosmetic appearance. The average patient age was 3 years, and the average follow-up period was 4 years. Average surgery time for the second toe-metatarsal bone transplantation was 8 hr. The primary success rate was 90.9 percent, with one patient requiring repeat surgery owing to venous occlusion. The surgical outcomes reveal a normal growth of the transferred toe, an acceptable range of motion, and satisfactory recovery of sensation. All children achieved both small and large grasp functions. The parents were satisfied with the reconstruction procedures. Based on the preliminary results, second toe-metatarsal bone transfer appears an acceptable alternative for reconstructing radial deficiency with hypoplastic thumb.
Journal of Reconstructive Microsurgery 05/2004; 20(3):215-25. · 1.43 Impact Factor
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ABSTRACT: The purpose of this study was to compare the efficacy of electroacupuncture (EA), diclofenac and their combination in symptomatic treatment of osteoarthritis (OA) of the knee.
This study was a randomized, single-blind, placebo controlled trial. The 193 out-patients with OA of the knee were randomized into four groups: placebo, diclofenac, EA and combined (diclofenac plus EA). Paracetamol tablets were prescribed as a rescue analgesic during the study. The patients were evaluated after a run-in period of one week (week 0) and again at the end of the study (week 4). The clinical assessments included the amount of paracetamol taken/week, visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) OA Index, Lequesne's functional index, 50 feet-walk time, and the orthopedist's and patient's opinion of change.
One hundred and eighty six patients completed the study. The improvement of symptoms (reduction in mean changes) in most outcome parameters was greatest in the EA group. The proportions of responders and patients with an overall opinion of "much better" were also greatest in the EA group. The improvement in VAS was significantly different between the EA and placebo group as well as the EA and diclofenac group. The improvement in Lequesne's functional index also differed significantly between the EA and placebo group. In addition, there was a significant improvement in WOMAC pain index between the combined and placebo group.
EA is significantly more effective than placebo and diclofenac in the symptomatic treatment of OA of the knee in some circumstances. However, the combination of EA and diclofenac treatment was no more effective than EA treatment alone.
BMC Complementary and Alternative Medicine 04/2002; 2:3. · 2.24 Impact Factor
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