Free functional rectus femoris muscle transfer for restoration of extension of the foot after lower leg compartment syndrome

In severely injured lower extremities with loss of the anterior compartment, the free functional rectus femoris musculocutaneous flap was used to restore extension of the foot and in soft-tissue reconstruction. From June 2000-July 2002, 3 patients were treated with this technique. Mean follow-up of the 3 patients was 27 months. Electromyography and the Stanmore system (recording pain, need for orthosis, ability to wear normal shoes, activity level, muscle power, active extension of the foot, and foot posture) were used to assess results of functional rectus femoris transfer. One patient had an excellent result, one patient had a good result, and one patient had a poor result, as assessed by the Stanmore system. Free functional rectus femoris transfer can obtain excellent results in treating foot-drop and soft-tissue defects due to lower leg compartment syndrome and loss of all muscles of the anterior compartment. (c)     

Sagittal knee kinematics after rectus femoris transfer without hamstring lengthening

The purpose of this study was to assess the sagittal knee kinematics of rectus femoris transfer without hamstring lengthening. A retrospective review of seventeen children (29 knees) was performed. Gait analysis was performed prior to surgery and repeated at a minimum of one year after surgery. Sagittal knee kinematics were analyzed. Stance minimum knee flexion increased 7 degrees; swing maximum knee flexion increased 5 degrees; and swing minimum knee flexion increased 5 degrees. The present study confirmed previously reported increases in swing maximum knee flexion. Increases in stance minimum knee flexion and swing minimum knee flexion were also found. These findings have not been previously reported.     

Sagittal knee kinematics following combined hamstring lengthening and rectus femoris transfer

The purpose of this study was to review knee kinematics following combined hamstring lengthening and rectus femoris transfer. Previous findings reported in the literature include kinematic changes in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), and swing-phase maximum knee flexion; the timing of swing-phase maximum knee flexion and swing-phase minimum knee flexion (extension); and total knee excursion. Twenty-three children underwent bilateral (22) or unilateral (1) hamstring lengthening and rectus femoris transfer (45 knees) at the Shriners Hospitals for Children in Lexington, KY between January 1996 and December 2001. Sagittal knee kinematic data were obtained as part of a complete gait study accomplished before surgery and at 1 year after surgery. Values were compared using a paired t test method set at a p < .05 level to determine statistical significance. Changes were seen in the magnitude of stance-phase maximum knee flexion, stance-phase minimum knee flexion (extension), swing-phase maximum knee flexion, and swing-phase minimum knee flexion (extension); in the timing of swing-phase maximum knee flexion; and in total knee excursion.     

Contralateral rectus abdominis muscle flap coverage for a radionecrotic groin defect

An inferiorly based contralateral rectus abdominis muscle flap was utilized to reconstruct an infected, radionecrotic wound in the groin. The selection criteria for this particular flap are discussed, comparing it to other reconstructive choices. It is believed that the contralateral rectus muscle flap is a good reconstructive choice, since its blood supply is distant to the site of the radiation-induced vascular insufficiency.     

Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle

The anterolateral thigh flap (ALTF) has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle.     

Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer.

Dynamic reconstruction of the abdominal wall using a free reinnervated rectus femoris muscle and an island tensor fascia lata transfer was performed for a large herniation with loss of the bilateral rectus abdominis muscles of the abdominal wall. The tensor fascia lata transfer was used to close an inner side of the abdominal defect, and the rectus femoris muscle replaced the rectus abdominis muscle deficit. The motor nerve of the rectus femoris muscle was sutured to the motor branch of the intercostal nerve. Postoperatively, the transferred rectus femoris muscle was reinnervated via electromyography, and there was no abdominal protrusion and no hernia recurrence.     

Free functional muscle transfer for the upper extremity

Free functional muscle transfers are an excellent treatment option in patients when significant time has passed after a nerve injury. In addition, they are the treatment of choice for reconstruction of established Volkmann's ischemic contracture, muscle loss from trauma, or tumor resection, and in congenital muscle absence. In cases where there is both soft tissue and functional muscle loss, free functional muscle transfers can address these problems together. This article focuses on the key principles for functional reconstruction of the upper extremity with free functional muscle transfers.     

A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation: anatomic basis and clinical applications.

The present study was conducted to investigate the intra-muscular neurovascular anatomy and the intra-muscular tendon distribution of the rectus femoris muscle to reassess the reliability of technique of harvesting a longitudinally split segmental muscle flap, and to present our clinical experience on usefulness of the longitudinally split segmental rectus femoris muscle flap as a method for reconstruction of the paralysed face in a series of 25 patients. Twenty fresh cadavers were systemically injected with lead oxide, gelatin and water. Based on the anatomy of intra-muscular neurovascular structure in the rectus femoris muscle, 25 consecutive patients with established facial paralysis were treated by using a two-stage method combining neurovascular free-muscle transfer with cross-face nerve grafting. Follow-ups were 15-24 months. All of the 25 patients showed significantly improvement in the appearance of the oral commissure and oral competence. Satisfactory results of facial reanimation were obtained in 23 patients. Among these cases, near-natural facial expression was achieved. Recovery continued up to 2 years postoperatively. There were two cases having poor movement of transferred muscle 2 years postoperatively. No complications occurred in the donor site. In conclusion, the present study has demonstrated the suitability for subdivision of the segment muscle flap of the rectus femoris into two functional units with a common neurovascular pedicle. This series has further demonstrated the safety and reliability of using the rectus femoris muscle flap for facial reanimation.     

Outcome of hamstring lengthening and distal rectus femoris transfer surgery

To evaluate the outcome of hamstring lengthening and distal rectus femoris transfer, a retrospective study was performed comparing preoperative and postoperative gait analysis data from 16 children with neurologic involvement. Postoperatively, the timing of peak knee flexion during swing and the total arc of knee motion significantly improved. Hamstring range of motion and knee extension at terminal swing significantly improved, but stride length and gait velocity did not for the overall population. Patients who used braces postoperatively showed an improvement in stride length and velocity when wearing orthoses. This suggests that postoperative bracing may be needed in some patients to maximize the surgical outcome.     

吻合神经血管的股直肌肌瓣游离移植治疗晚期面瘫的改进

目的：探索吻合神经血管的动力性功能肌肉游离移植治疗晚期面瘫的方法。方法：自1994年以来我们在股直肌肌肉内神经血管解剖研究的基础上，采用带神经和肌肉内肌腱的股直肌肌瓣的吻合神经血管的游离移植治疗晚期面瘫7例。结果：术后患者于静态时双侧口角对称。2例在术后8个月恢复口角自主活动，另5例均在术后10－12个月恢复口角自主活动。结论：带肌肉肌肌腱的股直肌肌瓣的吻合神经血管的游离移植，既有利于劈裂肌肉瓣时避免血管神经损伤，又有利于维持移植肌瓣的正常肌张力以及悬吊下垂的口角。     

Effect of high-intensity running in rectus femoris muscle fiber in rats.

The effect of a 12-week high-intensity intermittent exercise program on fiber type composition and the oxidative capacity of rectus femoris skeletal muscle from 20 male Wistar rats (Trained, n = 10; Sedentary, n = 10) was histochemically determined. The training exercise program was developed in a motorized treadmill. It consisted of four running bouts of 2 min duration at 48 m/min, alternated with recovery intervals of 4 min. Training increased relative cross-sectional area of oxidative fibers (I, IIA, IIX) and decreased the same parameter in type IIB non-oxidative fibers (P < 0.001). Our results suggest that this type of strength exercise program is enough to induce changes in muscle fiber composition. This opens a possibility to use this kind of exercise in preventing and treating muscle atrophy.     

Comparison of rectus femoris transposition with traditional transfer for treatment of stiff knee gait in patients with cerebral palsy

Purpose To assess the outcome of children with cerebral palsy following reposition of the distal rectus femoris tendon for treatment of stiff knee gait. Methods Children with cerebral palsy with stiff knee gait who underwent rectus femoris transfer were studied retrospectively. Inclusion criteria were cerebral palsy of diplegic or quadriplegic type, preoperative and 1 year postoperative three-dimensional motion analysis, and no other surgery except rectus femoris transfer at the time of study. The patients were separated into two groups: in group I, the rectus femoris was transferred to the distal medial hamstring tendons, either the gracilis or the semitendinosus; in group II, the distal tendon of the rectus femoris was transposed laterally and attached to the iliotibial band/intermuscular septum. Results Peak knee flexion during swing phase, total dynamic knee range of motion, knee range of motion during swing phase, and time to peak knee flexion during swing phase were all improved in both groups. Hip and pelvic kinematics were not influenced by the surgery. Velocity, stride length, and cadence were all improved following the surgery. There was no difference between the transfer group and the transposition group. Conclusion These findings suggest that distal transfer of the rectus femoris is effective in improving swing phase knee function by diminishing the mechanical effect of the dysphasic swing phase activity of the rectus femoris, not by converting the rectus femoris to an active knee flexor. No financial support was received for this study.     

The response of the rabbit rectus femoris muscle to ischemia and reperfusion.

The rectus femoris muscle of the rabbit is perfused by a single artery and vein and is a valuable new model for study of ischemia-reperfusion injury of skeletal muscle. The consequences of increasing duration of ischemia to the rectus femoris have been examined. Postischemic muscle survival (means +/- SEM), as measured by Nitro blue tetrazolium (NBT) staining 24 hr after ischemia, was 90.5 +/- 1.5% after 2 hr normothermic ischemia, 77.1 +/- 7.7% after 3 hr, 41.8 +/- 7.6% after 3 1/2 hr, and 10.7 +/- 8.7% after 4 hr. Histology confirmed the NBT findings at 24 hr and showed considerable regeneration of muscle fibers 1-2 weeks after injury. The injury caused by 3 1/2 hr normothermic ischemia is the most suitable baseline for study of the effects of pharmacological agents in ischemic muscle injury. Further study of the effects of 3 1/2 hr ischemia by a quantitative Evan's blue method revealed a rapid increase in vascular permeability commencing at the start of reperfusion and lasting for 5-6 hr. Vascular labeling with saccharated ferric oxide showed widespread labeling of venules within the injured muscle and electron microscopic examination showed severe injury to both leaking and nonleaking small blood vessels. However, increased vascular permeability accounted for only a small part of the increase in weight of ischemic muscle.     

针刀干预对膝骨关节炎兔股直肌组织形态及超微结构的影响

目的:观察针刀干预对膝骨关节炎(knee osteoarthritis,KOA)兔股直肌组织形态及超微结构的影响,揭示针刀治疗KOA可能的疗效机制.方法:选取6月龄新西兰雄性兔24只,体质量(2.0±0.5)kg,采用随机数字表法分为空白组、模型组、针刀组,每组8只.改良Videman法左后肢伸直位石膏固定制动6周复制...     

游离胫后动脉穿支皮瓣修复(足母)趾腓侧皮瓣供区创面

目的　介绍应用游离胫后动脉穿支皮瓣修复(足母)趾腓侧皮瓣供区创面,为减少供区损伤提供治疗方法.方法 2009年6月至2010年12月,对5例拇、手指软组织缺损,采用(足母)趾腓侧皮瓣游离移植修复,对(足母)趾供区创面同时采用游离胫后动脉穿支皮瓣进行移植修复,小腿供区创面直接缝合.结果 术后5例游离(足母)趾腓侧皮瓣和胫后动脉穿支皮瓣全部存活,皮瓣外观和功能恢复良好,平均随访时间7个月,(足母)趾腓侧皮瓣和胫后动脉穿支皮瓣两点分辨觉平均为5mm和7mm.结论 游离(足母)趾腓侧皮瓣修复拇、手指软组织损伤的同时应用胫后动脉穿支皮瓣一期修复(足母)趾供区创面,避免了术后局部疼痛、皮肤破溃等并发症,是一种理想的覆盖供区创面的治疗方法.