Clinical observation of endoscopic skull base reconstruction with an anterolateral thigh free fascia flap

Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is the main treatment for radiation osteonecrosis.The repair after the operation is very important.Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain,aggravating osteonecrosis.This study aimed to verify the feasibility and safety of the ante-rolateral thigh free fascia flap in repairing large skull base defects.Methods:From June 2021 to July 2022,a total of 12 patients with a history of radiotherapy for naso-pharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head&Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects.During the endoscopic operation,a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction.The preoperative and postoperative pain scores were retrospectively analyzed,and the dynamic changes in endoscopic surgery sites were observed.Results:The 12 patients had a median age of 58 y,with 8(66.7%)males and 4(33.3%)females.The median headache score for the patients was 5(4-7)before surgery.The patient's headache was significantly relieved postoperatively,with 11 patients having a score of 0 and one patient having a score of 1.The stench was completely resolved after the operation.There were no serious complications during the perioperative period or 12 months after the operation.Conclusion:The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.

Fetal Thigh Circumference versus Fetal Abdominal Subcutaneous Tissue Thickness in Prediction of Fetal Weight in Term Pregnant Women

Background: Fetal weight estimation by ultrasound is an important factor in obstetrics;it is directly related to the gestational age which helps to plan the mode of delivery and labor management. Objective: to compare between fetal thigh circumference (TC) and abdominal subcutaneous tissue thickness (SCT) in estimating birthweight in term pregnant women. Patients and Methods: This prospective cohort study was conducted at outpatient clinic or emergency room, Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from March 2022 until May 2023. During this study, 100 term pregnant females with gestational age 37 - 40 weeks attended El Demerdash Maternity Hospital and scheduled for delivery either at outpatient clinic or emergency room were enrolled, after consenting each of them. Basic fetal biometry was performed by an expert and professional medical personnel to ensure the accuracy of examination results. Fetal abdominal subcutaneous thickness and fetal thigh circumference were measured for assessment of gestational age and correlated with actual fetal body weight. In the current study, three formulas;Hadlock, Vintzileos’ and SCT formula were correlated with actual fetal body weight after birth. Results: The present study revealed that TC formula is closer to the actual birth weight, followed by Hadlock formula, while the SCT formula is the furthest from it. Conclusion: To increase the accuracy of birth estimations, regular ultrasound examinations should include fetal thigh circumference measurement.

Applying Average Anthropometric Reference Measurements to Thigh Lift Surgical Design in Females: A Novel Technique

Background: Thigh lift is a common procedure in plastic surgery. Surgeon’s sense or tailor tacdundancy to bek is mainly the methods used for designing thigh lift currently. This article is an attempt to find a method/a reference point to define the exact amount of re excised. Introduction: Anthropometry reference measurements can be applied in designing thigh lift surgery. Classically, anthropometry binds the calf circumference with mid-thigh circumference and upper thigh (gluteal) circumference to make postoperative results more harmonious and natural. Method: To find out the anthropometrically referenced ratio of the calf circumference with mid-thigh circumference and upper thigh (gluteal) circumference, anthropometric databases and studies done on females addressing different ages, countries and races with average BMI (body mass index) were reviewed. Chosen studies should include the calf circumference, mid-thigh circumference and/or upper thigh (gluteal) circumference. Anthropometrically referenced upper and mid-thigh circumferences can be calculated preoperatively. Result: 64:92:100 was concluded as a pooled mean ratio out of nine different studies addressing the ratio of the calf circumference:mid-thigh circumference:upper thigh (gluteal) circumference. Conclusion: Postoperative anthropometrically referenced mid and upper thigh circumferences can be calculated by measuring the calf circumference and applying the 64:92:100 ratio. Markings are done intraoperatively using my innovated “Stab-Push-Pinch-Mark” or SPPM technique for drawing a rough surgical design, then tweaked using the anthropometrically referenced 64:92:100 ratio results.

A Case of Harvesting Anterolateral Thigh Flaps Twice from the Ipsilateral Thigh of a Single Patient in Separate Operations

Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.

Tracking of Thigh Flexion Angle during Gait Cycles in an Ambulatory Activity Monitoring Sensor Network

An accelerometry-based gait analysis approach via the platform of sensor network is reported in this paper. The hardware units of the sensor network are wearable accelerometers that are attached at the limbs of human body. For the specific task of gait analysis, flexion angles of the thighs during gait cycles are computed. A Kalman filter is designed to estimate the flexion-extension angle, angular velocity of the thigh using the output of the wearable accelerometers. The proposed approach has been applied to four subjects and the performance is compared with video-based approach. Comparative results indicate that with the proposed Kalman filter, the sensor network is able to track the movement of the thighs during gait cycles with good accuracy and simultaneously detect major gait event of foot contact from the waveform of the angular velocity.

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns:A Retrospective Case Series

Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Finite Element Analysis of Contact Pressures between Seat Cushion and Human Buttock-Thigh Tissue

Unrelieved pressure on load-bearing muscle tissues of humans can produce pressure ulcers. In a seated upright posture, the highest pressures occur inferior to the ischial tuberosities (ITs). Moreover, the vibration can initiate the development of pressure ulcer. Therefore, the seat cushion is not only used to lower the maximum seating pressure on buttocks but also minimize the transmission of vibration to human body. The purpose of this study was to investigate the effects of varying vertical vibration frequencies on seat-interface contact pressure during sitting on three different seat cushions by using a finite element modeling approach. A simplified two-dimensional human buttock-thigh model was developed to simulate the mechanical response of the muscle of buttocks and thigh under vertical vibration. Static and vibrational loads with five different frequencies of 0.1, 1, 10, 30 and 50 Hz and the same amplitude of 3 mm were applied to different seat cushions. The result showed that the “SAF 6060” seat cushion with both hyperelastic and viscoelastic behaviors could be effective in reducing the amplitude of varying maximum contact pressure, especially for the frequency of 10-20 Hz. This method could help in design of seat cushions with appropriate material properties and shape so as to reduce vibrations transmitted to human body at a certain frequency range.

THIRTY-SIX CASES OF NEURITIS OF LATERAL CUTANEOUS NERVE OF THIGH TREATED BY MAGNETIC ROUND PLUM-BLOSSOM NEEDLE PLUS INFRARED RADIATION

Thirty-six cases of neuritis of lateral cutaneous nerve of thigh were treated by mag-netic round plum-blossom needle plus infrared radiation and it was compared with simpleacupuncture treatment.Statistical analysis indicated that there was no significant difference in thetheraPeutic effects between the two methods,but magnetic round Plum-blossom needle Plus in-frared radiation had as high therapeutic effect as simple acupuncture treatment and with themethod pateints suffered less without infection and it was easily to be accepted by patients.

Reduction Aid in Proximal Femoral Fractures: The Thigh Support

Reducing the Unstable Intertrochanteric Fractures in a closed manner is challenging especially in the old and aged people with co morbidities. We provide a simple reducing aid to achieve the fracture reduction. This will protect your surgical resident’s or operating theatre practitioner’s back in maintaining the reduction throughout the procedure and continuing with the procedure of cephalomedullary nailing. It will also facilitate in the better rehabilitation of the patient with minimal morbidity and offer a good radiographic view.

Repair of a severe palm injury with anterolateral thigh and ilioinguinal flaps: A case report

BACKGROUND In daily life and work,there are more and more patients with trauma to the hand,which often results in skin and soft tissue defects.Although there are many repair methods,the function and appearance of the fingers will be adversely affected if the repair is inadequate.CASE SUMMARY In the present report we describe an 18-year-old male patient whose right hand was mangled by a machine.X-ray imaging showed that a right hand bone(middle finger)was absent and the alignment was poor.After hospitalization,he was diagnosed with a severe right hand injury,skin and soft tissue defects,partial finger defects,and a skin degloving injury.He underwent reconstructive surgery with anterolateral thigh and ilioinguinal flaps.After two repair operations,satisfactory results were obtained,including good fracture healing,good skin flap shape,and good wrist joint function.CONCLUSION This case highlights the good effect of anterolateral thigh and ilioinguinal flaps repair technique on severe palm injury.

Two Cases of Distal Anterolateral Thigh Flap

We report our experience with two cases of anterolateral thigh flaps based on the musculocutaneous perforators arising from a more distal part of the descending branch than in the conventional anterolateral thigh flap. Case 1: A 53-year-old man with a skin ulcer over the anterior surface of the left tibia secondary to plate fixation for an open fracture. The perforator marked with preoperative Doppler was located 8 cm proximal to the superior border of the patella. Without thinning, the flap was 10 × 4 cm in size and 5 mm thick. Case 2: A 46-year-old man with necrosis of the right index finger after replantation. The flap was 5 × 3 cm in size and 3 mm in thickness. This “distal” anterolateral thigh flap can be raised as a quite thin flap with a long pedicle and, therefore, is considered useful in the reconstruction of various soft tissue defects.

Soft tissue neuroendocrine carcinoma of thigh: A case report with literature review

A rare case of advanced neuroendocrine carcinoma of thigh in a young adult female, diagnosed with the aid of immunohistochemistry and electron microscopic examinations together with a review of the literature are reported. The primary tumor involved the lateral aspect of thigh without bone involvement. Patient showed significant response with adjuvant chemoradiotherapy following incomplete surgery.

Frictional Melanosis of Rubbing Thighs in Iraqi Patients

Background: Frictional melanosis of rubbing inner thighs is a common problem among Iraqi females causing great psychological and cosmetic impact. It might simulate lifa disease but it is a different entity. It is unfortunately not reported in the medical literatures although commonly encountered in daily clinical practice. Objective: To evaluate the hyperpigmentation of inner aspects of thighs in Iraqi females as an isolated pigmentary problem. Patient and Methods: Sixty patients with frictional melanosis of rubbing thighs were seen in Department of Dermatology, Baghdad Teaching Hospital in this case descriptive, clinical and histopathological study, during the period from April 2011 to March 2012. Any associated skin problems were also noticed like folliculitis and boils at area of friction. Forty individuals were enrolled in the present work as the healthy control group. The pigmentation was assessed by clinical, Wood’s light and histopathological examinations (H&E and Fontana stains). Body mass index was obtained for all patients and obesity was graded according to WHO recommendations. Results: The ages of patients ranged between 19 - 52 (32.86 ± 7.65) years, with 59 (98.3%) females and 1 (1.6%) male. By Wood’s light examination, accentuation in pigmentation was observed in 39 (58%) patients, while 21 (42%) of lesions showed no change. Body mass index was ranged from 23.3 - 43.6 (34.04 ± 4.13), history of vigorous rubbing of pigmented area with washing tool (lifa) was positive in 46 (76.6%) patients. Skin biopsies in 10 patients showed pure dermal melanophages in 3 of biopsies with slight melanosis of basal layer of epidermis, while the other 7 biopsies showed mainly increase in basal melanin. There was a statistically significant association between obesity and the severity of pigmentation of the inner thighs. Forty control individuals (2 males and 38 females) were assessed, their ages ranged from 19 - 50 (31.72 ± 6.40) years. All females were within normal weight while males were overweight and BMI was ranged from 19.7 - 28.2 (22.49 ± 1.84). All control individuals showed no pigmentation of inner aspects of thighs. Conclusion: Frictional melanosis of rubbing thighs is considered a new entity which had been not reported before in the medical literatures. This is a disease of mostly young obese females and the effective therapy is weight reduction and possibly liposuction.

Superficial Myxoid Liposarcoma of the Thigh

Myxoid liposarcoma is the most common form of myxoid sarcoma. Their primary and superficial localizations are very rare compared to the deeper forms. We report the case of myxoid liposarcoma in a 57-year-old patient. The clinical picture marked by painless swelling of the right thigh had evolved over a period of about ten years. The diagnosis was guided by ultrasound and magnetic resonance imaging. A pathological examination of the surgical specimen after removal of the tumor helped to clarify the diagnosis. We discuss the clinical presentation and therapeutic management.

The Antero-Lateral Thigh Flap in Coverage of Extensive Post Traumatic Upper Limb Defects

Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.

Scalp and Dura Matter Complex Reconstruction Using Free Anterolateral Thigh Flap with Vascularized Fascia

The reconstruction of large scalp and dural defects is difficult. Anterolateral thigh (ALT) flap is now widely used because of its reliable blood supply to the skin paddle. Additionally, ALT can be harvested with a large skin paddle and large, well-vascularized fascia. We have successfully treated eight scalp and dural composite defect cases (five male and three female) using ALT with vascularized fascia. The patients’ mean age was 59.1 ± 20.4 years ranging from 31 to 83 years. The mean dural defect size was 73 ± 21 cm2, ranging from 50 to 120 cm2. There were no postoperative infections, bleeding, cerebrospinal fluid leakage, or meningitis. Further discussion about the usefulness of vascularized fascia may be required and we believe that plastic surgeons, head and neck surgeons, and neurosurgeons should report on the results of dural reconstruction.

EXPERIENCE WITH VAGINAL RECONSTRUCTION USING PUDENDAL-THIGH FLAPS-REPORT OF 9 CASES

Objective To review our eoperience of vaginal reconstruction using pudendal- thigh flap.Methods In the past 4 years, 9 patients suffering from the congenital vaginal agenesis underwent vaginalreconstruction using the pudendal- thigh flaps. The modilications of the surgical technique were de-tailed. Results All patients recovered satisfactorily from surgery and have been lollowed - up for a mean of 1.5years. There were no instances of flap loss, penetration of rectum and urethra. On final examination, all patientswere recorded as having a satislactory result, complete flap take, adequate dimensions and depth of neovagina andthe external appearance of the perineum and vagina was satisfactory. All married patients reported a satisfactoryintercourse. Conclusion The result proves that neurovascular pudendal- thigh flaps provide excellent tissue forvaginal reconstruction with low complication rate and good results. This operation does not cause an ugly donorsite scar and can be completed in single stage, without need of loparotomy and postoperative daily dilation. It isbelieved that this method can serve as a reliable alternative in vaginal reconstruction, which is one of the mostchallenging subjects of plastic surgery.

Prefabricated Anterolateral Thigh Flaps for Phalloplasty in Female-to-Male Transsexuals

Background Phalloplasty is still a challenging operation because of the high urethral complication rate.Several options regarding different flaps can be chosen,but there is still no perfect solution for phalloplasty in female-to-male(FTM)transgender patients.Our group tried to use prefabricated anterolateral thigh(ALT)flaps for phalloplasty to overcome the urethral complications.Methods A total of 21 transgender patients were included from 2010 to 2019.A twostage operation was performed to reconstruct the phallus.The vaginal mucosa was prefabricated as neourethra at the first stage,and the shaft of the phallus was reconstructed at the second stage.Results All reconstructed phallus survived completely in our study,and the satisfaction rate was 76.2%.The total complication rate was 57.1%.The occurrence of fistula and strictures after the operation was 52.4%and 5.8%,respectively Conclusion Prefabricated ALT flaps with vaginal mucosa have a lower stricture rate.This technique provides a simple,effective surgical option in FTM transsexuals.

Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis:An extremely fulminant form of a common disease

作为通常在每日的实践遇到的疾病，急性阑尾炎通常与低死亡和患病率容易被诊断并且设法。然而，急性阑尾炎可以偶尔变得非常地复杂并且威胁的生命。一个 56 岁的人，在这录取以前健康，由于刺高发烧，差的胃口，尿痛，进步正确胁腹并且为 3 d 的大腿的痛苦的胀大被带到医院。软织物的重要煽动性的变化被注意，包含到膝关节的从潜水艇胸肋缘的全部正确箱子。正确下肢的痛苦的残疾和在右少腹的腹膜炎的明显的符号被揭示。实验室结果揭示了白细胞增多和提高的 C 反应的蛋白质水平。腹的 CT 表明几与集体效果在正确制动火箭腹区域传达了煤气包含的脓肿，向上推十二指肠和胰腺的头，压缩并且装入箱内劣等的静脉腔，破坏鹦鹉病肌肉并且向下把进正确大腿。剖腹术和正确大腿探索立即被执行，坦率的脓的大约 500 mL 被排干。一枚破裂的制动火箭盲肠的附录是脓肿的原因。病人充分在第三个操作以后的星期的结束恢复了。这个盒子提醒我们那急性阑尾炎应该在一个紧急情况基础上小心地被对待避免严肃的复杂并发症。CT 扫描是选择的诊断工具，与象病人的幸存的关键的足够的排水跟随的快速的评估。

Twenty-eight Cases of Neuritis of Lateral Cutaneous Nerve of Thigh Treated by Acupuncture and Point-Injection

Neuritis of lateral cutaneous nerve of thigh, also called meralgia paresthetica, is a commonly encountered disease in clinical practice. The author has treated 28 cases of meralgia paresthetica since 1996 by acupuncture plus point-injection with satisfactory results. A report follows. Clinical Data Among the 28 cases, 13 were male and 15 female. Their age ranged from 24 to 72 years, most of the patients being 35 to 50 years; the duration of illness varied from one month to ten years and 6 cases were affected on left side, 8 cases on right side and 14 cases on both sides.