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
Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective ph...Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective photometric analysis comparing this technique with the same closure using Gortex®suture.This study is designed to compare the degree of areolar widening and safety profile of using absorbable barbed sutures for periareolar closure versus permanent smooth suture.Methods:A retrospective chart review was conducted of all patients whose periareolar closures were performed using an interlocking purse-string technique over a 10-year period.Only patients undergoing circumvertical mastopexy were included.All had photometric evaluation and follow-up performed within 6-24 months.Results:In total,20 patients(40 areolas),which were closed with absorbable barbed suture,were analyzed photometrically.In this suture group,areola size increased a mean of 4.9%from baseline,and no complications(0%)were observed.This compared favorably with previously reported complication rates using permanent sutures and with a series of cases presented herein in which permanent smooth suture was used for purse string closure.The degree to which absorbable barbed suture controls areolar spread was shown to be significantly better than those where permanent smooth purse string techniques were employed.Conclusion:Circumvertical mastopexy closures using absorbable barbed suture was shown to be safe and effective and compared favorably to older techniques using permanent smooth suture for similar closures.This paper lends support to the safety of using absorbable barbed suture in circumareolar closures to limit areolar spread.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Aim:The primary author previously described his technique for periareolar closure in mastopexy using a pinwheel interlocking purse string with absorbable barbed suture and now reports the results of a retrospective photometric analysis comparing this technique with the same closure using Gortex®suture.This study is designed to compare the degree of areolar widening and safety profile of using absorbable barbed sutures for periareolar closure versus permanent smooth suture.Methods:A retrospective chart review was conducted of all patients whose periareolar closures were performed using an interlocking purse-string technique over a 10-year period.Only patients undergoing circumvertical mastopexy were included.All had photometric evaluation and follow-up performed within 6-24 months.Results:In total,20 patients(40 areolas),which were closed with absorbable barbed suture,were analyzed photometrically.In this suture group,areola size increased a mean of 4.9%from baseline,and no complications(0%)were observed.This compared favorably with previously reported complication rates using permanent sutures and with a series of cases presented herein in which permanent smooth suture was used for purse string closure.The degree to which absorbable barbed suture controls areolar spread was shown to be significantly better than those where permanent smooth purse string techniques were employed.Conclusion:Circumvertical mastopexy closures using absorbable barbed suture was shown to be safe and effective and compared favorably to older techniques using permanent smooth suture for similar closures.This paper lends support to the safety of using absorbable barbed suture in circumareolar closures to limit areolar spread.
