Aim:Quadriceps strength and knee extension,the most important factors limiting the ability to rise from a chair,are crucial for walking at an appropriate speed,ascending and descending stairs,and performing activities...Aim:Quadriceps strength and knee extension,the most important factors limiting the ability to rise from a chair,are crucial for walking at an appropriate speed,ascending and descending stairs,and performing activities such as running,dancing,and jumping.Resection of the anterior compartment of the thigh,including all four quadriceps muscles,for the treatment of a sarcoma is uncommon;however,when necessary,it is very debilitating and adversely affects a patient's quality of life without functional reconstruction.Currently,there are a limited number of complex and difficult reconstructions to restore quadriceps function that have been described with variable outcomes.We describe a simple technique that employs a single gracilis functional muscle transfer to replace essential quadriceps function.Methods:This is a case series describing the use of either a free or pedicled single gracilis muscle to restore quadriceps function following sarcoma resection.Results:Four patients underwent an anterior compartment sarcoma resection that resulted in a large segmental defect and/or denervation of all four quadriceps muscles such that no quadriceps function would remain without reconstruction.All four patients underwent a functional reconstruction using a single gracilis.Three of the living patients achieved British Medical Research Counsel Grade 4 strength,can achieve full knee extension,are able to navigate stairs,and are able to ambulate without a brace.The fourth patient unfortunately was deceased in under three months following his tumor resection.Conclusion:Despite its small size in comparison to the quadriceps muscles,with physiotherapy and training,the gracilis muscle demonstrates the capacity to hypertrophy and replace quadriceps function following limb salvage surgery.展开更多
Restoration of upper extremity function poses a unique surgical challenge.With considerations ranging from ensuring appropriate skeletal support and musculotendinous and ligamentous anatomy,restoring adequate vascular...Restoration of upper extremity function poses a unique surgical challenge.With considerations ranging from ensuring appropriate skeletal support and musculotendinous and ligamentous anatomy,restoring adequate vascularity and innervation,and providing sufficient soft tissue coverage,upper extremity injuries present a diverse range of reconstructive problems.Recent history has been marked by an expansion of novel techniques for addressing these complex issues.Sophisticated modalities,such as targeted muscle reinnervation,free functional muscle transfer,and vascularized composite allotransplantation,have become some of the most powerful tools in the armamentarium of the reconstructive surgeon.This review article aims to define the distinguishing features of each of these modalities and reviews some of their unique advantages and limitations.展开更多
The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage has been the main goal. More commonly, this is being achieved with a combination of neo-adjuvant radiotherap...The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage has been the main goal. More commonly, this is being achieved with a combination of neo-adjuvant radiotherapy,followed by wide excision and soft tissue reconstruction in the form of vascularised soft tissue transfer. Although limb salvage is now readily achievable, the resultant functional disabilities following excision of major musculotendinous and neurovascular structures can be life changing. In recent years, there has been a move towards functional limb reconstruction in the form of free functioning muscle transfer. This paper reviews the advances in functional limb reconstruction in the setting of preoperative radiation and reports our experience in this challenging reconstructive field.展开更多
文摘Aim:Quadriceps strength and knee extension,the most important factors limiting the ability to rise from a chair,are crucial for walking at an appropriate speed,ascending and descending stairs,and performing activities such as running,dancing,and jumping.Resection of the anterior compartment of the thigh,including all four quadriceps muscles,for the treatment of a sarcoma is uncommon;however,when necessary,it is very debilitating and adversely affects a patient's quality of life without functional reconstruction.Currently,there are a limited number of complex and difficult reconstructions to restore quadriceps function that have been described with variable outcomes.We describe a simple technique that employs a single gracilis functional muscle transfer to replace essential quadriceps function.Methods:This is a case series describing the use of either a free or pedicled single gracilis muscle to restore quadriceps function following sarcoma resection.Results:Four patients underwent an anterior compartment sarcoma resection that resulted in a large segmental defect and/or denervation of all four quadriceps muscles such that no quadriceps function would remain without reconstruction.All four patients underwent a functional reconstruction using a single gracilis.Three of the living patients achieved British Medical Research Counsel Grade 4 strength,can achieve full knee extension,are able to navigate stairs,and are able to ambulate without a brace.The fourth patient unfortunately was deceased in under three months following his tumor resection.Conclusion:Despite its small size in comparison to the quadriceps muscles,with physiotherapy and training,the gracilis muscle demonstrates the capacity to hypertrophy and replace quadriceps function following limb salvage surgery.
文摘Restoration of upper extremity function poses a unique surgical challenge.With considerations ranging from ensuring appropriate skeletal support and musculotendinous and ligamentous anatomy,restoring adequate vascularity and innervation,and providing sufficient soft tissue coverage,upper extremity injuries present a diverse range of reconstructive problems.Recent history has been marked by an expansion of novel techniques for addressing these complex issues.Sophisticated modalities,such as targeted muscle reinnervation,free functional muscle transfer,and vascularized composite allotransplantation,have become some of the most powerful tools in the armamentarium of the reconstructive surgeon.This review article aims to define the distinguishing features of each of these modalities and reviews some of their unique advantages and limitations.
文摘The management of extremity soft tissue sarcoma is constantly evolving, and, in recent decades, limb salvage has been the main goal. More commonly, this is being achieved with a combination of neo-adjuvant radiotherapy,followed by wide excision and soft tissue reconstruction in the form of vascularised soft tissue transfer. Although limb salvage is now readily achievable, the resultant functional disabilities following excision of major musculotendinous and neurovascular structures can be life changing. In recent years, there has been a move towards functional limb reconstruction in the form of free functioning muscle transfer. This paper reviews the advances in functional limb reconstruction in the setting of preoperative radiation and reports our experience in this challenging reconstructive field.
