Anatomy of rectus femoris muscle flap and anterolateral thigh muscle flap and their application in reconstruction of postoperative defects of oral malignant tumour / 中华显微外科杂志

Objective:To investigate the anatomy of rectus femoris muscle flap and the anterolateral thigh muscle flap and their clinical application in reconstruction of large soft tissue defects after the removal of oral malignant tumour.Methods:From December 2006 to June 2009, 8 specimens of Chinese adult cadavers fixed in 10% formaldehyde were dissected to perform anatomy of anterolateral thigh region at the School of Basic Medical Sciences, Kunming Medical University. Anatomical images were analysed using Image-Pro Plus 6.0. Then, a retrospective study was performed on 19 patients who had postoperative defects after oral malignant tumour surgery and the defects were reconstructed with the rectus femoris muscle flap and the anterolateral thigh muscle flap from March 2020 to July 2022 at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital, Kunming Medical University. The postoperative defects of the 19 patients ranged from 3.0 cm×6.0 cm to 5.0 cm×10.0 cm. Ten rectus femoris muscle flaps, 8 anterolateral thigh muscle flaps and 1 combined rectus femoris muscle flap and anterolateral thigh muscle flap were used. The muscular flaps sized from 4.0 cm × 8.0 cm to 6.0 cm × 11.0 cm. Regular postoperative outpatient follow-ups were conducted.Results:The lengths of vessels of the harvested rectus femoris muscle flap and anterolateral thigh muscle flap were 63.4 mm± 12.9 mm and 112.5 mm± 19.6 mm, respectively. The starting outer diameters of the lateral circumflex thigh artery, the oblique branch of the lateral circumflex thigh artery and the descending branch of the lateral circumflex thigh artery were 2.92 mm±0.72 mm, 1.88 mm±0.23 mm and 2.29 mm±0.43 mm, respectively. Postoperative follow-up lasted for 7 to 32 months, with 17.5 months in average. Seventeen flaps were completely survived and the rectus femoris muscle flap was completely mucosalised 5 weeks after surgery. However, 2 rectus femoris muscle flaps had necrosis of which one was changed to a tongue flap reconstruction and the other encountered flap necrosis during postoperative radiotherapy and healed after debridement and dressing changes. There was no postoperative complication in the donor sites. Other than the 2 patients, all other 17 patients had satisfactory clinical outcomes.Conclusion:Both of the starting outer diameters and length of vessels of the femoris muscle flap and the anterolateral thigh muscle flap meet the requirements for reconstruction of maxillofacial defects, and both muscular flaps are simple to prepare, in good reconstructive results with few complication, as well as an excellent outcome. They are feasible approaches for reconstruction of large soft tissue defects left after the removal of an oral malignant tumour.

Reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting / 中华显微外科杂志

Objective To investigate the clinical effect of reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting. Methods From January, 2009 to January, 2017, 25 patients with soft tissue defect in foot and ankle were treated with transplan-tation of the trimmed free anterolateral thigh muscle flap combined with skin grafting. Of the 25 cases, there were 5 cases located in medial foot, 10 cases in dorsum of foot, 7 cases in external of foot and 3 cases in the toe. The areas of wounds were 8.0 cm ×6.0 cm to 18.0 cm ×10.0 cm. The anterolateral thigh muscle flap was from 4.0 cm ×3.0 cm ×0.3 cm to 10.0 cm×8.0 cm×1.5 cm. All the cases were operated in fracture fixation and wound without obvious infection. Early rehabilitative exercise under the protection of orthosis were done after 4 weeks of the operation and to assess. The injuried limb function were assessed in 1 year postoperatively according to Marylands scale. Results All cases were followed-up for 12 to 24 months (average, 16.2 months). All the muscle flaps and skin survived. The healing time were 12 to 24 days, averaged of 17.1 days. Patients could wear shoes normally and resume normal life and work. The appearance and walking function were satisfying and no further debulking procedures were needed . The surgery function were assessed according to Marylands scale, and the results was 22 cases for excellent, and 3 cases for good. Conclusion Ttrimmed free anterolateral thigh muscle flap combined with skin grafting is a good option for the repair of foot and ankle defect at non-weight-bearing area, and it has the advantages such as the doner site is small inva-sive, the muscle flap is easy to be harvested, and can avoid debulking surgery to wear shoes normally.

RELATIVE GROWTH AND DEVELOPMENT ON THIGH MUSCLE THICKNESSES AND BALL KICKING PERFORMANCES IN MALE JUNIOR SOCCER PLAYERS / 体力科学

The purpose of this study was to investigate the relative growth of thigh muscle thickness and development of ball kicking performance in junior male soccer players.The study participants included 235 Japanese male soccer players aged between 10 and 18 years. Subjects were classified into 10 groups on the basis of their body height every 5 cm. The thickness of the anterior and posterior thigh muscles (MTA and MTP, respectively) were measured using B-mode ultrasonography. The ball distance (BD) and ball velocity (BV) were measured using a tape measure and a speed gun, respectively. By using a custom-made speed meter, we measured the maximal swing velocity of the lower limb (SV) while the players were kicking the ball. These parameters, along with the height, were plotted on a logarithmic graph to obtain the allometric equation y = bx^a.There was a sharp bend in the graph showing the relationships between MTA, MTP, BV, SV, and body height. The growth indexes "a" of MTA and MTP were increased at 157.3 cm and 159.9 cm, respectively. The development indexes "a" of BV and SV were increased at 144.3 cm and 146.1 cm, respectively. However, there were 2 sharp bends in the graph showing the relationships between BD and body height. The development index "a" of BD showed the highest value from 150.5 to 171.2 cm.These results suggested that the developmental spurt in ball kicking performance was faster than the growth spurt in muscle thickness of the thigh.

Estimation Regression of Thigh Muscle Volume by Anthropometry / 체질인류학회지

The purpose in this study is to make a regression model for the prediction of skeletal muscle volume in thigh. For this purpose, men,14 and women,6 were included in this study. They were measured 22 independent variables by CT and anthropometry methods. CT Image analysis were performed with INFINITT, Rapidia 2.8, Korea. The results in this study are as following. There were not significant (P=.000) between CT-measured variables and predicted variables by anthropometry, excepting the difference (P=0.01) at thigh top muscle circumference. Therefore, many of variables could be applied with parameters for estimation equation by anthropometry. The estimation equation, obtained for thigh muscle volume using the predicted mid-thigh muscle circumference corrected by skinfold thickness and predicted total femur bone volume, was Y(Mtot)=127.4134x(X1)+18.7767x(X2)-5998.62. Where, X1 is predicted mid-thigh muscle circumference and X2 is predicted total femur bone volume. R2 in this model is .97, and SEE is 123 mL, CV 3.6%. In conclusion, the determination of skeletal muscle volume in thigh can be highly validated with estimaton model in this study. Therefore it also be apply to predicting thigh muscle volume in korean adults.

THE RELATIONSHIP BETWEEN CARDIAC MUSCLE, SKELETAL MUSCLE MASS, AND VESSEL STRUCTURE IN ELDERLY WOMEN / 体力科学

The purpose of this study was to clarify the relationship between left ventricular muscle mass, skeletal muscle volume and vessel structures in elderly women (n=15, 76.0±5.4 years). We measured the thigh muscle thickness, and brachial and common carotid arterial diameter using B-mode ultrasound method. Posterior wall thickness, interventricular septal thickness, left ventricular end-diastolic internal diameter, and aorta artery were measured by B-mode echocardiography. No significant relationship was obtained between brachial and common carotid arterial diameters, and aortic diameter. On the other hand, significant correlation coefficients were obtained between cardiac muscle thickness and thigh muscle thickness (r=0.674, p<0.01). A significant correlation coefficient was also obtained between the estimated skeletal muscle volume and left ventricular mass [LVmass](r=0.542, p<0.05). The slope of regression equation between estimated thigh muscle volume and LVmass in elderly women in this study was (y=0.11x+75.65) steeper than in children (y=0.06x+14.02) reported previously. These results indicate that the ventricular muscle (LVmass) is closely related to the skeletal muscle volume in ordinary elderly women and skeletal muscle mass at a given LVmass is smaller in elderly women than children.

Role of Thigh Muscle in the Carotid artery Intima-Media Thickness and Insulin resistance / 대한내분비학회지

BACKGROUND: There have been recent reports that the fat distribution within skeletal muscle and the amount of muscle mass are associated with insulin resistance and the development of type 2 diabetes mellitus (T2DM). This study evaluated the impacts of visceral fat and thigh muscle from patients with T2DM and healthy subjects on atherosclerosis and insulin resistance. METHODS: Forty-two patients with newly-developed T2DM and 11 healthy subjects were selected for the study. The diabetic patients were subdivided into two groups, those under 40 years of age, as the young T2DM (n=21) group, and 40 years-old or greater, as the old T2DM (n=21) group. CT scans were obtained for all patients at the L4-L5 level and at the mid-portion between the greater trochanter and upper margin patella. The carotid intima-media thickness (IMT) was also measured using high resolution B-mode ultrasonography. RESULTS: The mean visceral fat area (VFA) in the old T2DM group was 169.4+/-13.2cm2, which was significantly greater than that found in the healthy subjects (67.9+/-7.92cm2, P<0.001) and young T2DM group (127.1+/-10.4cm2, P<0.05). The mean visceral fat to normal density muscle area ratio (VMNR) in the old T2DM group was 1.50+/-0.19, which was greater than in the healthy subjects (0.46+/-0.52, P<0.001) and young T2DM group (1.01+/-0.10, P<0.05). The total thigh muscle areas in the young and old T2DM groups were smaller than that in the healthy subjects, but without statistical significance. VMNR showed a positive correlation with the IMT and HOMA-IR. However, the total thigh muscle area was negatively correlated with the IMT. The normal density muscle area also showed significant negative correlations with the IMT and HOMA-IR. In a multiple regression analysis, age and VMNR were the most important independent risk factors of an increased carotid IMT. CONCLUSION: This study showed that the role of thigh muscle, as well as that of visceral fat, played a very important role in the occurrence of atherosclerosis. VMNR was found to be an especially important independent factor for an increased carotid IMT.

Insulin Resistance as an Associated Factor of Essential Hypertension in Korean

BACKGROUND: The insulin resistance is reported as the independent risk factor of the DM and the ischemic heart disease. The association between the insulin resistance and the essential hypertension was reported at the various countries and races. We performed this study to know if the hypertensive patients show the increased insulin resistance than that of the normotensive persons and factors that influence the insulin resistance and the blood pressure. METHODS: The serum lipid profiles, OGTT, body habitus measurement and abdominal CT at umbilical level were performed in 24 hypertensive patients(male : 10, female : 14) and 45 normotensive persons(male : 19, female : 26) who showed the same distributions of age, sex, weight and body mass index(BMI). RESULTS: The average age of the hypertensive group was 49.1+/-7.9 years, and that of the normotensive group was 46.1+/-7.6 years(p>0.05). The average blood pressure of the hypertensive group was 152.2+/-14.2/98.4+/-6.4mmHg and that of the normotensive group was 116.8+/-9.4/78.2+/-49.mmHg(p<0.001). The hypertensive group had significantly higher area under curve(AUC) of glucose(246.8+/-30.4 Vs 219.2+/-32.2mg/dL.hr) and AUC of insulin(88.9+/-38.2 Vs 69.6+/-34.2microU/mL.hr) than the normotensive group(p<0.05), while there were no differences in the age, sex, weight, body mass index(BMI) and waist to hip ratio(WHR) between two groups. They had nodifferences in lipid profile and plasma renin activity. In CT assessment, the hypertensive group had significantly higher visceral fat to thigh muscle area ratio(VSFTM ratio)(0.61+/-0.29 Vs 0.47+/-0.20) and visceral fat to thigh muscle and fat area ratio(VSFTMF ratio)(0.27+/-0.10 Vs 0.22+/-0.13)(p<0.05), while they had same degree of visceral fat to subcutaneous fat area(VS) ratio and visceral fat area. The visceral fat area, VSFTM ratio, VS ratio, visceral fat area to thigh fat area ratio(VSFTF ratio) were positively correlated with AUC of insulin and AUC of glucose ordinary(p<0.05). After adjustment for plasma insulin, AUC of insulin, VS ratio, VSFTM ratio, age and BMI, the AUC of glucose was positively correlated with the diastolic blood pressure(R square=0.19, p <0.05) and the AUC of glucose and WTR were positively correlated with the systolic blood pressure(R square=0.26, p<0.05). THe subgroup over the 75 percentile of AUC of glucose, AUC of insulin and VSFTM ratio in study population had significantly higher odds ratio of the hypertension(OR of AUC of glusose : 5.8, OR of AUC of insulin : 3.2, OR of VSFTM ratio : 4.5, p<0.05). CONCLUSION: These results suggest that the insulin resistance is more prevalent in the hypertensive patients and associated with the hypertension.

THE EXAMINATION OF TRAINING CONDITIONS CONCEWRNING INCREASE IN THIGH MUSCLE USING ISOKINETIC EXERCISE / 体力科学

The effect of isokinetic training was investigated for the strength development in the thigh muscles under various training conditions. Thirty one males from healthy high-school students served as subjects of this study. Training was performed using a Cybex II machine with two kinds of repeated load conditions (number of repetitions, cf. Table 1 & Fig. 1) at to different rotational speeds (30 degrees and 180 degrees per second) . The training was done three times per week for nine weeks. The effects of training were evaluated on the basis of the amount of increase in the strength during knee flexion and extension.<BR>The results were summarized as follows :<BR>1) The effect of training became apparent most swiftly under the rotational speed of 180 degrees per second and light load of repetitions, respectively.<BR>2) The largest increase in the muscluar strength was observed for the group with training speed of 180 degrees per second and hevey load of repetitions, respectively.<BR>3) The strength increased periodically every four or five week for all conditions.