RESUMEN
SUMMARY: The Innervation Zones (IZ) correspond to clusters of neuromuscular junctions. The traditional method of locating IZs through voluntary muscle contractions may not be feasible in individuals with motor disorders. Imposed contractions by electrostimulation are an alternative. However, there is limited evidence regarding the factors that affect inter-evaluator concordance and the number of localized IZs when using imposed contraction. The main objective of this research was to determine the effect of the amplitude of compound motor action potentials (CMAPs) containing the M-wave on inter-evaluator agreement. As a secondary objective, was investigate the effect on the number of detected IZs. Twenty-four healthy volunteers (age: 21.2 ± 1.5years, weight: 67.4 ± 13.2kg, height: 1.68 ± 0.80m) participated in the study. Electrostimulation was applied to the tibial nerve to induce contraction of the medial gastrocnemius. The IZ were identified based on the M-wave recorded through multichannel electromyography. A receiver operating characteristic (ROC) analysis was conducted to assess sensitivity and specificity in detecting the IZs. Inter-rater agreement was evaluated using a two-way mixed effects test to determine the intraclass correlation coefficients (ICC). A p-value less than 0.05 was considered statistically significant. The ROC analysis revealed that for both evaluators, a specificity of 95% was achieved with an amplitude ≥30 %. The area under the ROC curve was 0.980 [0.964, 0.996], indicating a strong influence of CMAP amplitude on detection of IZs. The highest level of agreement (ICC = 0.788 [0.713, 0.844]) among the evaluators was observed with CMAP amplitudes equal to or greater than 80 % of the maximum M-wave. The findings of this study demonstrate that both the number and the inter-evaluator concordance for detecting IZs using imposed contractions are strongly influenced by the amplitude of the M-wave. Higher M-wave amplitudes were associated with improved concordance and increased IZ detection, making it crucial to standardize amplitude settings for reliable outcomes.
Las Zonas de Inervación (IZ) corresponden a grupos de uniones neuromusculares. El método tradicional para localizar IZs mediante contracciones musculares voluntarias puede no ser factible en personas con trastornos motores. Las contracciones impuestas mediante electro estimulación son una alternativa. Sin embargo, existe poca evidencia sobre los factores que afectan la concordancia entre evaluadores y el número de IZs localizadas al usar este tipo de contracciones. El objetivo de esta investigación fue determinar el efecto de la amplitud de los potenciales de acción motores compuestos (PAMCs) que contienen la onda M sobre la concordancia entre evaluadores. Como objetivo secundario, se investigó el efecto sobre el número de IZs detectadas. Veinticuatro voluntarios sanos (edad: 21.2 ± 1.5 años, peso: 67.4 ± 13.2 kg, altura: 1.68 ± 0.80 m) participaron en el estudio. Se aplicó electroestimulación al nervio tibial para inducir la contracción del gastrocnemio medial. Las IZs se identificaron según la onda M registrada mediante electromiografía multicanal. Se realizó un análisis de curva de las característica del receptor (ROC) para evaluar la sensibilidad y especificidad en la detección de las IZs. La concordancia entre evaluadores se evaluó utilizando una prueba de efectos mixtos de dos vías para determinar los coeficientes de correlación intraclase (ICC). Se consideró un valor de p menor que 0.05 como estadísticamente significativo. El análisis ROC reveló que para ambos evaluadores se logró una especificidad del 95% con una amplitud ≥30 %. El área bajo la curva ROC fue de 0.980 [0.964, 0.996], lo que indica una fuerte influencia de la amplitud del CMAP en la detección de las IZs. El nivel más alto de concordancia (ICC = 0.788 [0.713, 0.844]) entre los evaluadores se observó con amplitudes de CMAP iguales o mayores al 80 % de la onda M máxima. Los hallazgos de este estudio demuestran que tanto el número como la concordancia entre evaluadores para detectar IZs mediante contracciones impuestas están fuertemente influenciados por la amplitud de la onda M. Las amplitudes más altas de la onda M se asociaron con una concordancia mejorada y un aumento en la detección de IZs, lo que hace crucial estandarizar los ajustes de amplitud para obtener resultados confiables.
Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Músculo Esquelético/inervación , Variaciones Dependientes del Observador , Curva ROC , Sensibilidad y Especificidad , Electromiografía/métodos , Contracción MuscularRESUMEN
Objective:To evaluate the surgical effect of repairing soft tissue defect of hand and foot with medial gastrocnemius fascia flap combined with skin graft.Methods:From January, 2018 to June, 2019, 10 patients were treated with transfers of free medial gastrocnemius fascia flaps combined with skin graft to repair soft tissue defect of hand and foot. The size of free fascial flap was 5.0 cm×8.0 cm-12.0 cm×15.0 cm. After successful transfer on the wound, the skin was grafted onto the fascial flap, and the donor site was sutured directly. The appearance and function of the recipient and donor sites were observed and the effect of the operation was evaluated. Sensory recovery was assessed by the standard set by British Medical Research Council (BMRC) at the last follow-up.Results:All the free medial gastrocnemius fascia flap survived. After 6-10 days of granulation tissue growing, the skin grafts were transferred and all survived. All patients entered follow-up for 3-9 months, with an average of 7.5 months. The tissue at the recipient sites were soft and wear-resistant without swelling or ulceration. According to the self-designed evaluation system of soft tissue defect reconstruction, 10 patients had score from 68 to 92 (average, 75.2) . At the last follow-up, sensory recovery was assessed by BMRC, 7 cases were excellent and 3 cases were good.Conclusion:The repair of hand and foot soft tissue defect by the free medial gastrocnemius fascia flap combined with skin graft has advantages in constancy of vascular anatomy of free fascia tissue, long vascular pedicle and for repair of various types of hand and foot defects. Skin of the recipient area is soft with good appearance without swelling after the reconstruction of fascia flap. It is a method of treatment in repair of soft tissue defect of hand and foot by avoiding the thinning of a flap in the second procedure.
RESUMEN
We present the case of a left medial gastrocnemius and plantar muscle agenesis in a 58-years old male cadaveric specimen from the Anatomy Laboratory at the Universidad Industrial de Santander (Bucaramanga-Colombia). These unusual muscle absences and associated functional alterations, enrich anatomical knowledge and become important by the time the affected individual may need a reconstructive procedure.
Se presenta un caso de agenesia de los músculos gastrocnemio medial y plantar izquierdos en un espécimen cadavérico masculino de 58 años, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga- Colombia). Estas raras ausencias musculares enriquecen el conocimiento anatómico con sus alteraciones funcionales concomitantes y permiten postular los posibles procedimientos reconstructivos requeridos en los individuos que las presentan.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Rodilla/anomalías , Pierna/anomalías , Músculo Esquelético/anomalías , CadáverRESUMEN
OBJECTIVE: To investigate the effectiveness of V-Y advanced medial gastrocnemius muscle flap to repair soft tissue defects in the middle and lower segments of the anterior tibia. METHODS: Between March 2008 and March 2014, 8 patients with skin and soft tissue defects of the anterior tibia were treated, including 6 males and 2 females with an average age of 36.2 years (range, 28-47 years). The soft tissue defects located at the left leg in 5 cases and at the right leg in 3 cases. The causes included traffic accident injury in 6 cases, and heavy pound injury in 2 cases. Three cases had simple soft tissue defects, and the disease course was 5 hours, 6 days, and 14 days, respectively. Five cases had soft tissue defects and fractures, including 1 case of Pilon fracture, and 4 cases of middle and distal tibial fracture; open reduction and internal fixation were performed in 3 cases, the implementation of external fixation in 2 cases; 1 case had chronic osteomyelitis at 11 months after operation, and 4 cases had skin necrosis and wound infection at 1 to 2 weeks after operation; the duration was 1-12 months (mean, 3.4 months). The skin and soft tissue defect area was 5.2 cm×2.5 cm to 13.0 cm×5.5 cm. Debridement was given, and vacuum sealing drainage was used in 6 cases, and then V-Y advancement of medial gastrocnemius muscle flap was used to cover the wound. Because of light wound contamination, the wound was repaired by the flap after emergency debridement in 1 case; 1 patient with osteomyelitis underwent flap repair at immediate after sensitive antibiotics use and debridement. The size of medial gastrocnemius muscle flaps ranged from 15 cm×6 cm to 26 cm×15 cm. The donor site was sutured in 3 cases or repaired with skin graft in 5 cases. RESULTS: One case had tension blisters in the distal flap, which was cured after symptomatic treatment. The flap and skin graft survived, and primary healing was obtained in the other cases. Seven patients were followed up 6-18 months (mean, 9 months). The texture and appearance of the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 12 to 18 mm (mean, 16 mm). The plantar flexion was weaker than that of normal side, but the patients could normally walk and had normal gait. CONCLUSIONS: The V-Y advancement of medial gastrocnemius muscle flap is recommendable to repair soft tissue defects in the middle and lower segments of the anterior tibia for the advantages of reliable blood supply, simple operation, high survival rate of the flap, and satisfactory appearance.
RESUMEN
Objective To investigate the clinical efficiency of branch artery of the sural medial gastrocnemius muscle flap combine with sural nerve nutritional vessel axial.Methods From February 2006to March 2010,according to the position and size of the soft tissue defects,the muscle flap combined with branch artery of the sural medial gastrocnemius and sural nerve nutritional vessel axial were desingned and obtained to repair 7 cases of sofi tissue defects of the upper-region of the tibial.The flap size ranged from 8.0 cm × 8.0 cm to 12.0 cm × 10.0 cm.The vessel pedicle of branches ranged from 1.8-3.0 cm.The distribution of the vessel pedicle of branches ranged from 10.0-17.0 cm on the distant popliteal fossa,and ranged from 2.0-5.0 cm on the back of medial line.Results The outline and function were satisfactory during 6-15 months follow-up.Conclusion The blood supply of this flap is reliable without sacrifice of major arteries.Flap elevation is easy.It can transfer to a long distance and can repair large skin defects.It is very useful in repairing upper-region of the tibial large soft tissue defect.
RESUMEN
In Orientals, hypertrophy of calves frequently found. In 1990, Mladick and Watanabe presented extensive and specific operative techniques for reduction of calves and ankles. however, they cautioned that liposuction should be restricted in the muscular type of calf because their anatomic characteristics led easily to complications and low satisfaction rate. the chief reason for this problem is due to hypertrophy of lower legs that is caused by muscular hypertrophy. In preoperative considerations for the patient selection, most patients have hypertrophy of the gastrocnemius muscles. Calf muscles composed of the medial, lateral gastrocnemius and soleus muscles. To identify the muscle hypertrophy clinically, the patient should stand on toe-tip posture and check out the pinch test for the measurement of fat thickness. Muscular hypertrophy of the calves is divided into 3 types, such as medial upper half, lateral upper half and total hypertrophy with or without excess fat of lower legs. The indications of calves reduction depends on the excess fat of lower leg, calf muscle hypertrophy and combined excess fat and muscle hypertrophy. The methods of calves reduction are as follows weight control, liposuction, calf muscle resection and combined procedures. But the postoperative results are not as dramatic as abdomen and have low satisfaction rate because there are many postoperative complications, such as surface irregularities, asymmetrical shape, scars with hyperpigmentation and infection. I reported that the neurectomy of medial gastrocnemius muscle is the new ideal method on calf muscle hypertrophy with medial bulging by the contraction of medial gastrocnemius muscle on toe tip stance especially in 1993. Recently this method are popular but the procedure needs expert skill. So muscular disuse atrophy by botox injection to medial gastrocnemius muscle is introduced temporarily. Other method such as muscle reduction by RF, denervation method by RF or alcohol injection to the area near nerve branches to medial gastrocnemius below popliteal fossa are also introduced but they are effected temporarily due to reinnervation of neurotization and neuroma in conduits. The surgical procedure is simple, easy and safe method and it can be done under the local anesthesia with sedation. The transverse incision 2 cm in length was done over the distal crease of popliteal fossa, and divided fascia and exposed the tibial nerve. and identify and confirm the 4 branches of medial gastrocnemius, sural, soleus and lateral gastrocnemius with nerve stimulation by electric current and then the nerve branch to medial gastrocnemius muscle has to be divided and removed above 3 cm in length. Skin closure was done with meticulous hemostasis. The postoperative care is simple. The wound was dressed with mild compression and changed daily. The patients can walk and go home immediately after surgery. We recommended early exercise and wearing the pressure garments to support shrinkage and smooth contouring of medial bulging area on calves during 3 months. The postoperative results are very satisfied from 1 to 3 month and there are no functional deficit and no edema, indurations and irregularity. The calf reduction rate was about 10% shrinkage(34cm in diameter on the superior 1/3 calves portion was reduced to 31cm in diameter, mean reduction is 2.5-3cm in diameter.) due to the muscular atrophy caused by neurectomy of medial gastrocnemius. In this report, I described that neurectomy of nerve branch to medial gastrocnemius muscle is a new ideal method for calf reduction and this procedure induce the superior results than the other procedures on calf muscle hypertrophy with 13 years long term follow up. I think my procedure is more rational and also effective, simple, easy, and safe for significant reduction of calves circumference and improvement of cosmesis on hypertrophy of lower leg.
Asunto(s)
Humanos , Abdomen , Anestesia Local , Tobillo , Cicatriz , Desnervación , Edema , Fascia , Estudios de Seguimiento , Hemostasis , Hiperpigmentación , Hipertrofia , Pierna , Lipectomía , Músculo Esquelético , Músculos , Atrofia Muscular , Trastornos Musculares Atróficos , Transferencia de Nervios , Neuroma , Selección de Paciente , Cuidados Posoperatorios , Complicaciones Posoperatorias , Postura , Piel , Nervio Tibial , Dedos del Pie , Heridas y LesionesRESUMEN
According to recent research, Korean women are very interested in calf reduction. Asian women want to have slim and straight legs more than Occidental women. Thick calves are divided by three types. One is muscular hypertrophy type and another is lipodystrophy type, and the other is mixed type. The authors focused on medial gastrocnemius muscle hypertrophy using radiofrequency generator. From July 2004 to July 2007, We did calf reductions for women who wanted to have aesthetically slim legs. Under intravenous anesthesia, we made a tiny pin hole with 18 gauze needle and injected local anesthetics. Radiofrequency probe(Dr. Oppel(R) radiofrequency, Sometech Medical Co.) was inserted and then We produced radiofrequency energy with a foot switch and made mean 150-200 points focal coagulation necrosis at each medial gastrocnemius muscle. There were little major complications such as seroma, hematoma, infection, gait disturbance, scar, sensory change etc. Some patients had moderate swelling during first week, but it was improved soon. Calf reduction using radiofrequency energy is very useful tool for hypertrophied medial gastrocnemius muscle. But we need more study for standardization of energy power, for certain amount of muscle damage to have reproducibility for predictability of durability and for possibility of rebound hypertrophy.
Asunto(s)
Femenino , Humanos , Anestesia Intravenosa , Anestésicos Locales , Pueblo Asiatico , Cicatriz , Pie , Marcha , Hematoma , Hipertrofia , Pierna , Lipodistrofia , Músculo Esquelético , Necrosis , Agujas , SeromaRESUMEN
PURPOSE: The present study was designed to evaluate the effect of intermittent electrical stimulation (ES) of the sciatic nerve on the expression of neuronal nitric oxide synthase (nNOS) protein in the soleus and in the medial gastrocnemius muscles 2 weeks following hindlimb suspension (HS). MATERIALS AND METHODS: In the HS+ES group, a pair of stainless steel electrodes were placed at the midportion of the unilateral sciatic nerve during hindlimb unloading. Square wave pluses with a 5 seconds ON-OFF pattern were applied to the sciatic nerve 4 hours a day for 14 days. The electrical stimulation parameters were 20 Hz, 0.3 ms, 1-5 voltage. 14 days later the sciatic nerve stimulation maximal twitch response was measured in the soleus and medial gastrocnemius muscles using an isometric tension transducer and polygraph. Western blot was used to analyze the expression of nitric oxide synthase (nNOS) protein in hindlimb muscles. RESULTS: The soleus muscle consisted of slow-twitch muscle fiber and showed a prominent decrease in maximum twitch tension and muscle weight than the medial gastrocnemius muscle 2 weeks after hindlimbs suspension. Hindlimbs suspension caused a reduction in the relative quantity of nNOS protein by 89% and 55% in the soleus and the medial gastrocnemius muscles, respectively, after 2 weeks of unloading compared with the ambulatory controls. However, intermittent electrical stimulation of the sciatic nerve delayed reduction significantly with respect to the expression of nNOS protein and twitch tension during hindlimb unloading. CONCLUSION: The results suggest that application of electrical stimulation to the sciatic nerve has a significant effect on NO signal transduction by regulating nNOS expression in atrophied hindlimb extensor muscles.