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<29>

Unique Identifier

11371853

Authors


McHenry TP. Early JS. Schacherer TG.

Institution

Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Title


Peroneus brevis rotation flap: anatomic considerations and clinical experience.

Source


Journal of Trauma-Injury Infection & Critical Care. 50(5):922-6, 2001 May.

Abstract


BACKGROUND: Large soft tissue defects of the distal third of the leg are common occurrences at trauma centers. Massive defects often require vascularized free tissue transfer for coverage; however, smaller defects may frequently be closed by rotation of local tissue. The peroneus brevis muscle is ideally located to provide coverage of the exposed distal fibula. METHODS: An anatomic dissection of the peroneus brevis muscle and its vascular pedicles was performed in 10 fresh cadaveric leg specimens. Patients who underwent this procedure at our institution were retrospectively reviewed. RESULTS: Each dissected muscle had an average of 3.5 vascular pedicles (range, 2-6), which arose from the peroneal artery in all but two cases. The average distance of the distal pedicle from the tip of the lateral malleolus was 6.7 cm (range, 3.5-12.0 cm). The muscle belly ended an average of 6.0 mm proximal to the tip of the lateral malleolus. Half of the specimens had muscle bellies that extended to or past the tip of the lateral malleolus. This rotation flap has been successful in covering four wounds with exposed distal fibula in four patients. CONCLUSION: The anatomic characteristics of the peroneus brevis muscle are ideal for soft tissue coverage of the distal fibula. Ease of elevation and reliability have made this rotational flap the procedure of choice for small soft tissue defects over the distal fibula at our institution.

<30>

Unique Identifier

9624634

Authors


Melham TJ. Sevier TL. Malnofski MJ. Wilson JK. Helfst RH Jr.

Institution

Ball Memorial Hospital, Muncie, IN 47304, USA.

Title


Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.

Source


Medicine & Science in Sports & Exercise. 30(6):801-4, 1998 Jun.

Abstract


This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.

<31>

Unique Identifier

11932577

Authors


Willems ME. Stauber WT.

Institution

Department of Physiology, West Virginia University, PO Box 9229, Morgantown, WV 26506, USA. mwillems@hsc.wvu.edu

Title


Force deficits by stretches of activated muscles with constant or increasing velocity.

Source


Medicine & Science in Sports & Exercise. 34(4):667-72, 2002 Apr.

Abstract


PURPOSE: Force deficits produced by constant (CV) versus increasing velocity (IV) stretches of rat plantar flexor muscles at low and high levels of nerve activation were studied. METHODS: Twenty repeated stretches were imposed on isometric contractions by ankle rotation from 90 degrees to 40 degrees at 300 degrees.s(-1) and at 3000 degrees.s(-2) during 80-Hz (CV80 and IV80) and 20-Hz stimulation (CV20 and IV20). Rest periods between contractions were 3 min. Isometric and peak stretch forces during the stretch protocols and force-frequency relationships before and 1 h after the stretch protocols were measured. RESULTS: Peak stretch forces were similar for IV80-CV80 and for IV20-CV20 rats but were lower for IV20-CV20 than for IV80-CV80 rats throughout the stretch protocol. At the end of the stretch protocol, isometric force deficits were similar for IV80 (49.9 +/- 2.1%) and CV80 (54.5 +/- 2.5%) and for IV20 (16.4 +/- 2.8%) and CV20 (15.8 +/- 1.9%) but lower for IV20-CV20 rats. In contrast, for all groups, deficits in peak stretch force were similar at the end of the stretch protocol (IV80: 35.0 +/- 1.8%, CV80: 32.3 +/- 2.2%, IV20: 26.8 +/- 3.6%, CV20: 28.0 +/- 2.0%). After 1 h, isometric force deficits were similar for either IV80-CV80 or IV20-CV20 at 5, 10, 20, 40, 60, and 80 Hz stimulation but were lower for IV20-CV20. CONCLUSIONS: Variation in velocity of ankle rotation with similar peak stretch forces did not influence the amount of stretch-induced force deficits. High peak stretch forces produced greater isometric force deficits than low peak stretch forces, but the relative loss in peak stretch force was not force dependent. Different mechanisms may account for isometric force deficits and peak stretch force deficits caused by repeated stretches of activated skeletal muscles.

<32>

Unique Identifier

11992498

Authors


Yajima H. Tamai S. Kobata Y. Murata K. Fukui A. Takakura Y.

Institution

Department of Orthopaedic Surgery, Nara Medical University, Japan.

Title


Vascularized composite tissue transfers or open fractures with massive soft-tissue defects in the lower extremities.

Source


Microsurgery. 22(3):114-21, 2002.

Abstract


From 1982 to 1998, we treated 39 patients with type IIIB and IIIC fractures in the lower extremities by vascularized composite tissue transfers. Thirty-four of the lesions affected the lower leg, and 5 the foot and ankle. The peroneal flap was used in 25 cases, the latissimus dorsi musculocutaneous flap in 12, the scapula flap in 1, and the gracilis muscle flap in 1. In cases with a peroneal flap transfer, 18 cases used osteocutaneous flap with a fibula. Postoperative circulatory disturbances resulted in revision surgery in 9 patients. Eventually, grafting was successful in 37 patients. In patients with a lower leg reconstruction, additional bone grafting was performed in 7 of 16 patients with cutaneous or musculocutaneous flap transfers. No patient with osteocutaneous flap transfers required an additional bone grafting. The mean periods between injury and time to bone union were 11.7 months in patients with cutaneous flap transfers, and 7.5 months in patients with osteocutaneous flap transfers. Copyright 2002 Wiley Liss, Inc.

<33>

Unique Identifier

7724195

Authors


Attinger C.

Institution

Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA.

Title


Soft-tissue coverage for lower-extremity trauma. [Review] [127 refs]

Source


Orthopedic Clinics of North America. 26(2):295-334, 1995 Apr.

Abstract


In summary, a rational approach to soft-tissue coverage in the ankle and foot should help lower osteomyelitis and bone nonunion rates and yield an excellent functional result. In addition to adequate fixation, it is crucial to first obtain a clean healthy wound by doing as many debridements as necessary. The goal should be to achieve coverage within the first week of injury to avoid the sequelae of a later closure; i.e., a potentially much higher infection rate and nonunion rate. The reconstructive options range from secondary intention, to primary closure, to skin grafts, to local flaps, to microsurgical free flaps. The choice should be dictated by the health of the patient, the existing bony and neurovascular anatomy, and the desired ultimate objective. Given the currently available orthopedic and plastic surgical techniques, it is possible to salvage almost any foot or ankle; however, we should not be carried away by our surgical armamentorium. If the salvaged extremity will take more than a year to heal, will be barely functional, and will be a constant source of pain, then a below-knee amputation should strongly be considered. The challenge in the coming decade comes both in picking the correct extremity to salvage and in applying the techniques described previously to restore it to its preinjury state. [References: 127]

<34>

Unique Identifier

10597683

Authors


Lee HB. Lew DH. Oh SH. Tark KC. Kim SW. Chung YK. Lee YH.

Institution

Department of Plastic and Reconstructive Surgery, Yonsei University, Wonju College of Medicine, Wonju Christian Hospital, Korea. hblee@rics.bwh.harvard.edu

Title


Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap.

Source


Plastic & Reconstructive Surgery. 104(1):111-9, 1999 Jul.

Abstract


The combined loss of the Achilles tendon and the overlying soft tissue in the young ambulant patient with expectations of a normal life is a challenging problem. These patients need not only soft tissue but also dynamic and functional reconstruction. Four cases of major defects of the Achilles tendon and overlying soft tissue after trauma are presented. In each case, the tendon and the overlying soft tissues were reconstructed using only a latissimus dorsi muscle free flap and overlying split-thickness skin graft. In conventional methods, evolved in the reconstruction of the Achilles tendon and soft tissue, the size of the defect was a limit. However, this technique can be used to reconstruct an extensive defect, including distal calf muscle to the plantar metatarsal area. In one case, the flap was harvested in a myocutaneous unit, and the skin portion was deepithelialized for the coverage and enough padding on the bony exposure area in reverse position. The purpose of the present study was to reevaluate the potential of denervated muscle flap for a force-bearing conduit as an alternative reconstructive method of the Achilles tendon. The denervated latissimus dorsi muscle in this study eventually experienced the process of atrophy and fibrosis but maintained its original length. Although there remained some atrophic muscle fibers, a fibrosis of the muscle fibers formed a tendon-like fibrous band, and so the action of the posterior calf muscle could be transmitted through the tendon-like fibrotic change of the denervated latissimus dorsi muscle. The advantages of this technique are that (1) it is a single procedure, (2) it is adaptable to a wide range of defect sizes, (3) it allows faster wound healing supported by well-vascularized tissues, (4) it produces satisfactory function of the ankle joint and a padding effect, and (5) it produces good contour of the posterior calf to the sole and an acceptable donor-site morbidity.

<35>

Unique Identifier

12621187

Authors


Xu Y. Li J. Lin Y. Li Z. Guo Y. Wang X. Ruan M.

Institution

Department of Orthopaedics, Kunming Military General Hospital, Kunming 650032, People's Republic of China. xuyongqingkm@163.net

Title


The free thoracoumbilical flap for resurfacing large soft-tissue defects of the lower extremity.

Source


Plastic & Reconstructive Surgery. 111(3):1167-73, 2003 Mar.

Abstract


Both cadavers and living patients were studied regarding a method to resolve large skin defects with bone exposure in the leg, with long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. Forty-six casting mold specimens of cadaveric legs were investigated. There were rich communication branches among the anterior tibial artery, posterior tibial artery, and fibular artery in the foot and ankle, which complemented each other well. Twenty-six patients with large skin defects with bone exposure in the proximal or middle segment of the leg were admitted to the authors' hospital. Among those patients, 19 demonstrated long-distance thrombosis of the anterior tibial vessels or posterior tibial vessels resulting from traumatic lesions. During treatment, a thoracoumbilical flap based on the inferior epigastric vessels was anastomosed to the distal stump of the anterior tibial vessels or the posterior tibial vessels, with reversed flow. All defects were successfully repaired, with good color and texture matches of the flaps. This method can be used for patients with normal anterior tibial vessels or posterior tibial vessels, normal distal stumps of the injured blood vessels, and good reversed flow. The method has the advantages of dissecting blood vessels in the recipient area during the debridement, not affecting the blood circulation of the injured leg, not sacrificing blood vessels of the opposite leg, and not fixing the patient in a forced posture. The muscles are less bulky in the distal one-third of the leg, and the blood vessels are shallow and can be dissected and anastomosed easily. When the flap is used for reconstruction in the proximal two-thirds of the leg, the blood vessel pedicle of the free flap is at a straight angle, without kinking.

<36>

Unique Identifier

11335815

Authors


Eren S. Ghofrani A. Reifenrath M.

Institution

Division of Plastic and Hand Surgery, St. Agatha Hospital, Cologne, Germany.

Title


The distally pedicled peroneus brevis muscle flap: a new flap for the lower leg.

Source


Plastic & Reconstructive Surgery. 107(6):1443-8, 2001 May.

Abstract


Defects of the skin and soft tissue in the region of the lateral malleolus of the ankle and the Achilles tendon, resulting in exposed bone, tendons, or osteosynthetic material, cannot be covered with free skin transplants. Local or free flaps must be employed. The authors present the construction of a peroneus brevis muscle flap with a distal pedicle as a useful alternative. Between 1993 and 1999, distal pedicled peroneus brevis muscle flaps were used in 19 patients with various types of defects. During construction of the flap, both the long peroneal muscle and the peroneal artery remained intact. In the region of the distal third of the fibula, consistently arranged branches run from the artery into the muscle, and these form the distal pedicle. The proximal portion of the muscle can be transposed distally and easily extends to the tip of the fibula and the attachment of the Achilles tendon to the calcaneus. Primary healing occurred in 16 patients undergoing flap construction. Donor-site morbidity was mostly limited to the donor-site scar. The distally pedicled peroneus brevis muscle flap is a reliable means for covering defects in the lower leg. This form of muscle flap has not yet been described in the known literature. In the authors' opinion, this flap constitutes a logical and valuable extension of local flap procedures for plastic surgery in the distal leg region.

<37>

Unique Identifier

11214053

Authors


Touam C. Rostoucher P. Bhatia A. Oberlin C.

Institution

Service de Chirurgie Orthopedique et Traumatologique, H pital Bichat, Paris, France. chabanetouam@bch.ap-hop-paris.fr

Title


Comparative study of two series of distally based fasciocutaneous flaps for coverage of the lower one-fourth of the leg, the ankle, and the foot.[see comment].

Comments


Comment in: Plast Reconstr Surg. 2001 Nov;108(6):1837; PMID: 11711993

Source


Plastic & Reconstructive Surgery. 107(2):383-92, 2001 Feb.

Abstract


Skin defects over the lower one-fourth of the leg and over the foot are difficult to cover. Two types of pedicled fasciocutaneous flaps used to cover such defects were studied: the lateral supramalleolar flap and the distally based sural neurocutaneous flap. The series consisted of 27 and 36 cases, respectively. The lateral supramalleolar flap was used 27 times: for skin defects over the ankle (4), foot (16), and leg (7). The distally based sural neurocutaneous flap was used 42 times: over the foot (24), ankle (13), and leg (5). Fourteen of these patients were 65 years of age or older, and local vascularity was diminished in 16 cases. The flaps were evaluated clinically twice: in the immediate postoperative period for survival or for partial or total flap necrosis, and again to determine the presence of pain at the donor or recipient sites and the cosmetic appearance. Thirty-nine patients (62 percent) were reviewed subsequently, with a mean follow-up of 5 years for the supramalleolar flap and 2 years for the sural neurocutaneous flap. The results were evaluated for the presence or absence of pain, the appearance of the flap, the disability due to the insensate nature of the flap, and the presence or absence of secondary ulceration. Painful neuromata were noted in three cases with the sural neurocutaneous flap, whereas complete necrosis of the supramalleolar artery flap occurred in three patients. The distally based sural neurocutaneous island flap is very reliable, even in debilitated patients. Though the lateral supramalleolar artery flap offers the possibility of covering the same areas as the sural neurocutaneous flap, it is much less reliable in the presence of diminished local vascularity (18.5 percent failure rate as compared with 4.8 percent for the sural neurocutaneous flap). Because the procedure can cover extensive defects and is easy to perform, the distally based sural neurocutaneous flap was the method of choice for covering skin defects over the foot, heel, ankle, and the lower one-fourth of the leg. The lateral supramalleolar artery flap is indicated only when the sural neurocutaneous flap is contraindicated.

<38>

Unique Identifier

7480252

Authors


Jeng SF. Wei FC. Noordhoff MS.

Institution

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.

Title


One rectus abdominis muscle for two separated soft-tissue reconstructions.

Source


Plastic & Reconstructive Surgery. 96(6):1454-8, 1995 Nov.

Abstract


One rectus abdominis muscle flap, when based on superior and inferior pedicles, can be transferred simultaneously as two free-muscle flaps in two different configurations during the same operation. The two free flaps based on either pedicle are safe, reliable, and extremely well vascularized. Excellent functional and cosmetic results have been achieved in five patients with minimal donor-site morbidity. It has been our flap of choice for reconstructing the moderate- to large-sized defects at two separate sites of the upper and lower extremities.

<39>

Unique Identifier

9774020

Authors


Berthe JV. Toussaint D. Coessens BC.

Institution

Department of Plastic Surgery at the Free University of Brussels, Belgium.

Title


One-stage reconstruction of an infected skin and Achilles tendon defect with a composite distally planned lateral arm flap.

Source


Plastic & Reconstructive Surgery. 102(5):1618-22, 1998 Oct.

Abstract


In this paper, the treatment of a complicated Achilles tendon defect with a composite lateral arm flap with distal design of the skin paddle has been presented. The extended portion of the flap was sufficient to restore adequate contour to the posterior aspect of the ankle, and reinervation showed good protective sensation at 1 year. In terms of resurfacing, the use of the reinervated lateral arm flap with a distal design of the skin paddle seems advantageous. The weakening of the reconstructed Achilles tendon, although without clinical incidence and impairment of elbow extensors at this stage, may indicate that a better substitute than the triceps tendon has to be found. Nevertheless, we would best reconstruct such an Achilles tendon defect by the same technique because of the well vascularized autologous tissue it provides, limiting the risk of infection.

<40>

Unique Identifier

9200323

Authors


Johannsen F. Langberg H.

Institution

Department of Rheumatology, Bispebjerg Hospital, Denmark.

Title


The treatment of acute soft tissue trauma in Danish emergency rooms.

Source


Scandinavian Journal of Medicine & Science in Sports. 7(3):178-81, 1997 Jun.

Abstract


Rest, ice, compression, elevation (RICE) is the most recommended treatment for acute traumatic soft tissue injuries. A questionnaire was given to all Danish emergency rooms (n = 5) regarding their routines for acute treatment of ankle sprains and muscle contusions. Complete answers were received from 37 emergency rooms (73%), covering the treatment of 111 ankle sprains and 101 muscle contusions. Treatment with RICE was given in a minority of injuries, ice (21%), compression (32%) and elevation (58%) similarly between injury types. A complete RICE treatment was rarely applied (3%). Verbal information on RICE and rehabilitation was given in less than half of the cases. We conclude that the acute treatment of ankle sprains and muscle contusions in the Danish emergency rooms is not applied in accordance with consensus from international literature, and that the instruction in rehabilitation should be improved.
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