Medial thigh lift in post-bariatric patients: Our encouraging experience

Background: A high rate of postoperative complications following inner thigh lift is reported in the medical literature. The authors present the results of a study on the validity of inner thigh contouring, with liposuction and concomitant skin excision, in postbariatric patients.

Methods: This study examined the charts of 46 postbariatric female patients, who underwent medial thigh lift with a ‘T’ scar technique and concomitant liposuction, between February 2010 and February 2013. Complications were recorded. A questionnaire was administered to the patients at the 1-year follow-up visit. Preoperative and 1-year postoperative photographs were compared, superimposed, and analysed.

Results: This study did not observe major systemic complications, haematoma, seroma, infection, skin necrosis, lymphoceles, or lymphoedema. Minor complications were three cases of wound dehiscence and two cases of deepithelialisation. At the 1-year follow-up visit, caudal scar migration, genital distortion, recurrent ptosis, or deformity of the inner thigh contour were not observed. Questionnaires and a comparison of pre- and 1-year postoperative pictures showed encouraging results.

Conclusions: The medial thigh lift technique described and assessed in this article is a straightforward surgical procedure, with considerable functional and aesthetic results. Liposuction, early mobilisation, and appropriate postoperative management are pivotal to reduce postoperative downtime and complications.     

Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve

An assessment of local anaesthetic blockade of the lateral femoral cutaneous nerve using a standard technique was made. The rate of successful blockade was high, but the area of sensory loss was inconsistent between patients and was more anterior and distal than described in textbooks of anatomy.     

股外侧穿支皮瓣的临床应用研究

目的 探讨股外侧穿支皮瓣修复四肢软组织缺损的可行性与临床疗效. 方法 通过解剖红色乳胶灌注的6例成人下肢标本,观测大腿中下段外侧区皮肤穿支数目、分布、蒂长、外径、走行与类别.结合 解剖研究结果设计13例皮瓣修复四肢不同形状创面,皮瓣面积3.0 cm×3.0 cm～19.0 cm×8.0 cm.其中带蒂转移l例,游离移植12例,2例采用穿支皮瓣组合移植. 结果 13例皮瓣全部顺利成活.术后随访3～6个月,皮瓣外形不臃肿,质地柔软,有弹性,色泽良好,未发生冻伤与溃疡.供区无一例出现肌肉粘连或瘢痕挛缩畸形导致的关节活动障碍.直接缝合的病例仅留线性瘢痕,植皮修复者植皮区域饱满无凹陷. 结论 股外侧穿支皮瓣薄而柔软、外形较美观、解剖分离相对简单、手术创伤小等优点,游离移植适合四肢中小型皮肤缺损创面修复,带蒂转移适宜修复膝、腘部位创面,组合移植适宜修复四肢大面积创面.     

吻合血管的股前外侧皮瓣在临床中的应用

目的：探讨游离移植股前外侧皮瓣修复体表软组织缺损的临床效果。方法：自1986年10月至2002年1月，应用股前外侧游离移植皮瓣治疗体表组织缺损11例。结果：11例皮瓣全部存活，没有出现血管危象，术后经（6－18）个月随访，效果均满意。结论：游离股前外侧皮瓣血供充分，部位隐蔽，可切取面积大，是修复大面积体表组织缺损的理想皮瓣。     

Extended anterolateral thigh pedicled flap for reconstruction of trochanteric and gluteal defects: A new & innovative approach for reconstruction

Descending branch of the lateral circumflex femoral artery (LCFA) is commonly used pedicle for anterolateral thigh (ALT) flap. Oblique branch of LCFA is an alternative pedicle that can be used in microvascular surgery. According to review of literature and to the best of our knowledge we could not find the use of oblique branch of LCFA as a pedicle of the ALT flap in regional soft tissue reconstruction. Here we presented a case of a 55-year-old man sustaining soft tissue injury and wound over the left trochanteric and gluteal region following a road traffic accident, who was treated by the use of extended ALT pedicle flap with oblique branch of LCFA as the pedicle for reconstruction of soft tissue defect in trochanteric and gluteal regions with successful outcome.     

阴股沟皮瓣应用解剖学研究

目的明确阴股沟皮瓣的解剖学基础.方法对10具(20侧)成年女尸阴股沟区皮肤进行解剖学研究.结果阴股沟皮瓣存在多重血液供应;其中,闭孔动脉前皮支分布于皮瓣中部,浅出点距会阴正中线(3.0±0.5)cm,距阴道口前缘(1.7±0.4)cm距耻骨下支外侧缘(0.6±0.2)cm,管径(0.8±0.1)mm;阴唇后动脉主要供应大阴唇,并恒定地以本干的形式在大阴唇皮下与阴部外浅动脉形成血管吻合,在阴道口后缘前后各1.5cm的范围内,发出2、3支阴唇后动脉外侧支,外径为(0.7±0.3)mm,分布于阴股沟皮瓣后部;阴部外浅动脉斜形穿过皮瓣上端走向大阴唇,沿途发出柳枝状血管分支分布于皮瓣上端.结论阴股沟皮瓣阴道再造所利用的血管是阴唇后动脉外侧支,而非阴唇后动脉主干;由于闭孔动脉前皮支浅出点位置较高而且固定,以之为蒂形成的皮瓣不适用于阴道再造,而适合于会阴部较小皮肤缺损的修复.     

Morel-Lavallee lesion in distal thigh: A case report

It is a relatively rare condition involving a close degloving injury due to direct trauma with tangential force followed by the separation of the subcutaneous tissue from the underlying fascia. The rupture of small perforating vessels in this area, resulting in the formation of a cavity that filled with blood, lymph and fat foci, the latter being sometimes necrotic. Morel-Lavallée lesion was originally described in the lateral aspect of the proximal thigh, which is the most common site of this lesion; however other anatomic sites such as periscapular, lumbar and gluteal regions, ankles and knees have been described in the literature. Various methods of treatment has been described, but open debridement can result in a successful functional outcome.     

Chest wall reconstruction using a combined musculocutaneous anterolateral�Canteromedial thigh flap

We present a massive 25 cm × 20 cm chest wall defect resulting from resection of recurrent cystosarcoma phyllodes of the breast along with six ribs exposing pleura. The chest wall was reconstructed with a Prolene mesh–methylmethacrylate cement sandwich while soft tissue reconstruction was carried out using a combined free anterolateral–anteromedial thigh musculocutaneous flap with two separate pedicles, anastomosed to the thoracodorsal and thoracoacromial vessels respectively. We explain our rationale for and the advantages of combining the musculocutaneous anterolateral thigh flap with the anteromedial-rectus femoris thigh flap.     

A Rare Anatomical Variation in the Pedicle of Anterolateral Thigh (ALT) Flap

Free anterolateral thigh (ALT) flap finds its place in the front row among the soft-tissue flaps used for complex reconstruction of various defects. Its versatile tissue component and ease of harvesting with minimal donor site morbidity made it a popular flap. However, its variable vascular anatomy alerts the reconstructive surgeon to remain aware of the common variation and vigilant with regard to unusual variation. Commonly described variations are about the origin and course of pedicle and perforators. There are rare reports regarding the presence of double arteries and single vein in the flap pedicle. Here, the authors describe these unusual anatomical variations in the pedicle of ALT flap, with two arteries and one vein, and discuss the surgical implication of the same.     

Analgesia following femoral neck surgery. Lateral cutaneous nerve block as an alternative to narcotics in the elderly

In a prospective controlled randomised trial on patients undergoing operative repair of fractured neck of femur via a lateral incision, the postoperative analgesic requirements of one group of patients who received a lateral cutaneous nerve block were compared with a second group who received no block. The former group were found to need significantly less intramuscular pethidine in the first 24 hours, and 44% required no supplementary analgesia whatsoever during this period. The time to first dose of opioid in the remainder was greatly increased. No untoward sequelae associated with the nerve block were seen.     

CT血管造影显示旋股外侧动脉穿支

目的评价不同CTA扫描方案显示旋股外侧动脉(LCFA)穿支的能力。方法将28例除大腿以外的四肢外伤患者及27名健康志愿者随机分为3组。对A组(15人,30侧大腿)采用双侧大腿低放射剂量扫描方案,B组(15人,30侧大腿)采用双侧大腿常规放射剂量扫描方案,C组(25人,25侧大腿)采用单侧大腿常规放射剂量扫描方案进行CTA检查。记录辐射吸收剂量,观察LCFA显示情况及起源,测量LCFA主干开口内径、降支开口内径、降支长度、降支血管分级、降支穿支数量、穿支末端最小内径。结果 B组中1例(2侧大腿)因对比剂渗漏未能完成检查。3组共83侧大腿,LCFA起自股动脉分别为A组7侧、B组8侧、C组6侧,起自股深动脉分别为A组23侧、B组20侧、C组19侧。3组间,辐射吸收剂量、降支长度、降支穿支末端最小内径、降支血管分级及降支穿支数量差异均有统计学意义(P均0.001),LCFA主干及降支开口内径差异均无统计学意义(P均0.05)。结论单侧大腿常规放射剂量CTA显示LCFA细小穿支的能力优于双侧低放射剂量及双侧常规剂量CTA,而3种扫描方案对较大血管的显示效果相近。     

An alternative model of composite tissue allotransplantation: groin–thigh flap

This study focuses on development of a simpler and nonfunctional model that includes all the same tissue components as the traditional hind limb allotransplantation in rats. Adult male inbred Wistar rats (WF, RT1^u) weighing 250–300 g were used as syngeneic ( n  = 12) donors and recipients of a new experimental model for composite tissue allotransplantation. In the allogenic group ( n  = 4), adult male Brown Norway rats (BN, RT1ⁿ) weighing 200–250 g were used as donors. A groin–thigh osteo-myocutaneous flap, composed of skin (groin), muscle (thigh), and bone (2/3 femur), based on the femoral vessels and superficial epigastric vessels, was developed for composite tissue allotransplantation. All the flaps were successful except for two dying soon postoperatively. Histology confirmed vessel patency in the syngeneic group and acute rejection in the allogenic group. The total operative time was shortened compared with the standard and other modified models of rat hind limb allotransplantation. Advantages of this new model include its simplicity, relative purity, and the more humanistic fact that it does not cause claudication to the animals as does standard orthotopic hind limb transplantation, or extra-deformity to the recipients as does the heterotopic hind limb model.     

Reconstruction of complex thoraco-abdominal defects with extended anterolateral thigh flap

Background:

The reconstruction of complex thoraco-abdominal defects following tumour ablative procedures has evolved over the years from the use of pedicle flaps to free flaps. The free extended anterolateral thigh flap is a good choice to cover large defects in one stage.

Materials and Methods:

From 2004 to 2009, five patients with complex defects of the thoracic and abdominal wall following tumour ablation were reconstructed in one stage and were studied. The commonest tumour was chondrosarcoma. The skeletal component was reconstructed with methylmethacrylate bone cement and polypropylene mesh and the soft tissue with free extended anterolateral thigh flap. The flaps were anastomosed with internal mammary vessels. The donor sites of the flaps were covered with split-skin graft.

Result:

All the flaps survived well. One flap required re-exploration for venous congestion and was successfully salvaged. Two flaps had post operative wound infection and were managed conservatively. All flap donor sites developed hyper-pigmentation, contour deformity and cobble stone appearance.

Conclusion:

Single-stage reconstruction of the complex defects of the thoraco-abdominal region is feasible with extended anterolateral thigh flap and can be adopted as the first procedure of choice.     

股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

Critical sites of entrapment of the posterior division of the obturator nerve: anatomical considerations

In the current anatomic study, special attention was given to the relationship of the posterior division of the obturator nerve to surrounding structures: the obturator canal and the fibromuscular and vascular structures of the medial thigh region. These intimate relationships may, in certain conditions, constitute critical sites of entrapment of the posterior division of the obturator nerve and may present a diagnostic challenge to the manual practitioner. Knowledge of the potential sites of entrapment of the posterior division of the obturator nerve can aid in differential diagnosis of peripheral neuropathies, provide an anatomic basis for obturator nerve pathology, and guide effective patient management, including the application of modern diagnostic techniques and safe surgical procedures.     

右侧大腿血管内乳头状内皮细胞增生1例

正患者男,72岁,右侧大腿肿胀,伴疼痛、无力10天余;10余天前该处撞伤,无其他特殊病史。查体:右大腿外侧肿胀,皮肤发紫,压痛(+)。实验室检查:D-二聚体0.88mg/L。超声:右大腿外侧实性为主混合性包块。DR:右侧股骨未见异常。CT:右股骨周围肌肉间隙见6.5cm×6.4cm×12.9cm不规则软组织肿块,密度不均,边界不清,内见片状稍高密度影(图1A);增强后病灶轻度不均匀强化,边缘强化明显(图1B),右侧股动脉受压移位(图1C)。     

股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

中原地区青年女性臀部和大腿形态测量及临床意义

目的通过对中原地区青年女性臀部及大腿形态学测量及分析,为临床相关手术提供美学参考。方法测量551名未婚健康女性腰围、臀围、大腿最大围、大腿长及大腿长身高比,并根据不同身高组、体重组对相关数据进行统计分析。结果测量数据显示腰围、臀围、大腿最大围、大腿长及大腿长身高比分别为（70．74±5．86）、（87．16±4．19）、（51．87±3．27）、（42．35±2．38）cm及（26．1±1．23）％。臀围及大腿最大围在不同身高、体重组之间差异有统计学意义,且与身高、体重、腰围均存在正相关;大腿长、大腿长身高比在不同身高组之间差异有统计学意义,且与身高呈正相关。结论中原地区青年女性有关臀部及大腿形态学测量数据可为相关整形手术方案的制定及修复效果的评价提供依据,特别是对脂肪抽吸术具有一定的I临床参考价值。