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Bonaventura B, Panayi AC, Hummedah K, Palackic A, Tapking C, Haug V, Kilian K, Runkel A, Bliesener B, Kneser U, Hundeshagen G. Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study. Burns 2024; 50:767-773. [PMID: 38036375 DOI: 10.1016/j.burns.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns. PATIENTS AND METHODS Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes. RESULTS A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003). CONCLUSION PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.
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Affiliation(s)
- Bastian Bonaventura
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Kamal Hummedah
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Katja Kilian
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alexander Runkel
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bjoern Bliesener
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
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David JA, Gusenoff JA. Circumferential Surgical Contouring of the Upper and Lower Body. Clin Plast Surg 2024; 51:95-110. [PMID: 37945080 DOI: 10.1016/j.cps.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Body contouring surgeons encounter a wide range of deformities affecting multiple areas of the body. Combining and staging procedures can assist in optimizing outcomes, but there is no one-size-fits-all approach to surgical sequencing and timing. A meticulous, individualized approach to preoperative planning can lead to reliable, aesthetically pleasing results that align with the patient's goals and preferences. In this article, we present our latest ideas on circumferential body contouring surgery and discuss the integration of lower body lift procedures with those of the abdomen, upper body, breasts, back, and arms to create a comprehensive 360° transformation.
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Affiliation(s)
- Joshua A David
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA
| | - Jeffrey A Gusenoff
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA.
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Goli R, Faraji N, Janghiyamachi R, Talebiazar N. Nicolau syndrome after intramuscular injection of methocarbamol: A rare case report. Toxicol Rep 2023; 11:346-348. [PMID: 37859670 PMCID: PMC10582772 DOI: 10.1016/j.toxrep.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
Background Methocarbamol is a muscle relaxant medication that is commonly used to treat muscle spasms and musculoskeletal pain. Methocarbamol intramuscular injection can cause necrosis of the soft tissue. This rare condition can create severe adverse event with permanent disability. Case presentation A 32-year-old woman with no significant past medical history presented to the emergency department with severe pain, redness, and swelling involving her left buttock and the surrounding back area. Clinical discussion The necrotic changes due to methocarbamol intramuscular injection can progress rapidly, leading to the formation of deep ulcers, cellulitis, and even abscesses. Prompt recognition and intervention are crucial to prevent further tissue damage and complications. Conclusion Comprehending the fundamental mechanisms and identifying risk factors related to this complication is imperative in enabling healthcare professionals to proficiently manage and avert its manifestation.
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Affiliation(s)
- Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Razieh Janghiyamachi
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University, Marand Branch, Tabriz, Iran
| | - Nasim Talebiazar
- Department of Psychiatric, Urmia University of Medical Sciences, Urmia, Iran
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Danilla S, Troncoso E, Jara R, Dominguez C, Albornoz C, Erazo C, Sepulveda S, Nielsen J, Serra S, Yamada N. What Makes a Beautiful Buttock Beautiful? A Case-Control Study Comparing Buttocks Models versus Normal Women by Magnetic Resonance Imaging, Photography and Anthropometry. Aesthetic Plast Surg 2023; 47:1896-1904. [PMID: 36542093 DOI: 10.1007/s00266-022-03222-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe characteristics of women with aesthetically ideal buttocks and differentiate them from women with normal buttocks. METHODS Case-control study comparing anatomy of women with ideal buttocks (buttocks models) to women with normal buttocks using magnetic resonance images, anthropometric measurements and photography. RESULTS Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker gluteus maximus muscle (GMM). A bigger GMM adds more projection to the C point, point of maximum projection in the lateral view is 2.7 cm higher than the pubic bone. The amount of subcutaneous fat was equal in models and controls. CONCLUSIONS Our study provides new knowledge regarding the tridimensional aspects of the beauty of the buttocks area. A beautiful buttock is a conjunction of adequate bony shape, muscle development, subcutaneous fat layer, and tight skin. Comparing to normal women, buttocks models have a narrower waist, narrower iliac crest, wider C point, wider hips and bigger and thicker Gluteus Maximus Muscle. Accurate understanding of the aesthetic goals in a given patient can guide surgical technique. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Stefan Danilla
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile.
| | - Ekaterina Troncoso
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Rocio Jara
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Carlos Dominguez
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Claudia Albornoz
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Cristian Erazo
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Sergio Sepulveda
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Johanna Nielsen
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Sofia Serra
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
| | - Naomi Yamada
- Departamento de Cirugía, Unidad de Cirugía Plástica, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile
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Danilla S, Micheli D. Aesthetic Ideals of the Female Buttocks: Concepts and Techniques. Clin Plast Surg 2023; 50:533-540. [PMID: 37704321 DOI: 10.1016/j.cps.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This article explores the importance of understanding the tridimensional artistic anatomy of the back, pelvis, and thighs in gluteal surgery. It emphasizes the need for plastic surgeons to have a comprehensive knowledge of these anatomic structures to achieve successful outcomes. The authors highlight the significance of ethnic differences in determining ideal aesthetic results and stress the importance of considering and respecting these variations. Individualization of treatment is a key principle in gluteal surgery, as each patient has unique preferences and needs. Effective communication and collaboration between the surgeon and the patient are crucial in determining desired aesthetic goals and achieving satisfactory outcomes.
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Affiliation(s)
- Stefan Danilla
- Cirujano Plástico Magíster en Epidemiología Clínica, Clínica AUREA, Santiago, Chile.
| | - Diana Micheli
- Equipo de Cirugia Plástica, Pontificia Universidad Catolica, Santiago, Chile
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Jain VK, Iyengar KP, Rana N, Agarwal A, Botchu R. Tuberculosis of ischial tuberosity as a rare cause of gluteal pain: A case series of 9 patients with review of literature. J Clin Orthop Trauma 2022; 28:101852. [PMID: 35402154 PMCID: PMC8991308 DOI: 10.1016/j.jcot.2022.101852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Osteo-articular Mycobacterium tuberculosis infection of the ischial tuberosity is a rare cause of gluteal pain. METHODS A retrospective clinico-radiological review of nine patients with Mycobacterium tuberculosis infection of the ischial tuberosity was undertaken. The spectrum of presenting features, diagnostic challenges, radiological findings with particular emphasis on Magnetic resonance imaging (MRI) and clinical course was reviewed. RESULTS All the 9 patients (5 male: 4 female) aged between 8 and 50 years of age (mean 15.3 years) developed insidious onset of buttock pain over a period of weeks to months with difficulty in walking. Microbiological and/or histopathological confirmation of Mycobacterium tuberculosis infection was undertaken in all cases. Complementary MRI revealed diffuse bone marrow signal hypointense or isointense on T1-weighted and hyperintense on T2-weighted and STIR images. MRI was able to provide anatomic details of soft tissue lesions and extensions. MRI illustrated the sinus tract in one patient. Ultrasound imaging allowed diagnostic and therapeutic management of in 3 patients. CONCLUSION Tuberculosis of ischial tuberosity can be a rare cause of gluteal pain. Delay in diagnosis could be due to an indolent natural history, unusual presentation and clinical features. A high index of suspicion especially in endemic areas with complementary imaging and microbiological or histopathological confirmation of Mycobacterium tuberculosis infection is necessary for definitive diagnosis. Targeted treatment under the umbrella of Anti-Tubercular Therapy is crucial in achieving successful clinical outcome.
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Affiliation(s)
- Vijay Kumar Jain
- Professor, Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author.
| | | | - Nipun Rana
- Consultant, GRIPMER, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Agarwal
- Department of Pediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Rajesh Botchu
- Consultant Musculoskeletal Radiologist, Royal Orthopedic Hospital, Birmingham, UK
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Kim BK, Jung SH, Han D. Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume? Hip Pelvis 2022; 34:18-24. [PMID: 35355627 PMCID: PMC8931946 DOI: 10.5371/hp.2022.34.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume. Materials and Methods A total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed. Results In the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (P<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (P=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (P=0.042) and total gluteus areas (P=0.035) were significantly higher in the stable group. Conclusion Gluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.
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Affiliation(s)
- Byung-Kook Kim
- Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Suk Han Jung
- Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
| | - Donghun Han
- Department of Orthopaedic Surgery, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
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Semciw AI, Visvalingam VN, Ganderton C, Lawrenson P, Hodges PW, Kemp J, Collins NJ. The immediate effect of foot orthoses on gluteal and lower limb muscle activity during overground walking in healthy young adults. Gait Posture 2021; 89:102-8. [PMID: 34265525 DOI: 10.1016/j.gaitpost.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/21/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although foot orthoses are often used in the management of lower limb musculoskeletal conditions, their effects on muscle activation is unclear, especially in more proximal segments of the lower limb. RESEARCH QUESTION Primary aim: Is there an immediate effect of foot orthoses on gluteal muscle activity during overground walking in healthy young adults? Secondary aim: Is there an immediate effect of foot orthoses on the activity of hamstring, quadriceps and calf muscles? METHODS In eighteen healthy young adults, muscle activity was recorded using fine wire electrodes for gluteus minimus (GMin; anterior, posterior) and gluteus medius (GMed; anterior, middle, posterior); and surface electrodes for gluteus maximus (GMax), hamstring, quadriceps and calf muscles. Participants completed six walking trials for two conditions; shoe and shoe with prefabricated foot orthoses. Muscle activity was normalised to the peak activity of the shoe condition and analysed using one-dimensional statistical non-parametric mapping to identify differences across the gait cycle. RESULTS Activity of GMed (anterior, middle, posterior) and GMin (posterior) was reduced in early stance phase when the orthosis was worn in the shoe (p < 0.05). GMin (anterior) activity was significantly reduced during swing (p < 0.05). Muscle activity was also significantly reduced during the orthoses condition for the lateral hamstrings and calf muscles (p < 0.05). SIGNIFICANCE Using foot orthoses may provide a strategy to reduce demand on GMin, GMed, lateral hamstring and calf muscles while walking.
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Leal MC, Alexander JG, Beber EH, Baptista JDS. The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region. Autops Case Rep 2021; 11:e2020239. [PMID: 34307211 PMCID: PMC8214885 DOI: 10.4322/acr.2020.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
The gluteal region contains important neurovascular and muscular structures with diverse clinical and surgical implications. This paper aims to describe and discuss the clinical importance of a unique variation involving not only the piriformis, gluteus medius, gluteus minimus, obturator internus, and superior gemellus muscles, but also the superior gluteal neurovascular bundle, and sciatic nerve. A routine dissection of a right hemipelvis and its gluteal region of a male cadaver fixed in 10% formalin was performed. During dissection, it was observed a rare presentation of the absence of the piriformis muscle, associated with a tendon fusion between gluteus and obturator internus, and a fusion between gluteus minimus and superior gemellus muscles, along with an unusual topography with the sciatic nerve, which passed through these group of fused muscles. This rare variation stands out with clinical manifestations that are not fully established. Knowing this anatomy is essential to avoid surgical iatrogeny.
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Affiliation(s)
- Matheus Coelho Leal
- Universidade Federal do Espirito Santo (Ufes), Departamento de Morfologia, Laboratório de Estudo em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - João Gabriel Alexander
- Universidade Federal do Espirito Santo (Ufes), Departamento de Morfologia, Laboratório de Estudo em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Eduardo Henrique Beber
- Universidade Federal do Espirito Santo (Ufes), Departamento de Morfologia, Laboratório de Estudo em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
| | - Josemberg da Silva Baptista
- Universidade Federal do Espirito Santo (Ufes), Departamento de Morfologia, Laboratório de Estudo em Morfologia Aplicada (LEMA), Vitória, ES, Brasil
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Scott J, Sheridan B, Andrus R, Monday N, Selby A, Bush TR. Tissue matters: In-vivo tissue properties of persons with spinal cord injuries to inform clinical models for pressure ulcer prevention. J Biomech 2021; 120:110389. [PMID: 33780812 DOI: 10.1016/j.jbiomech.2021.110389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 01/01/2023]
Abstract
The prevalence of pressure ulcers in patients with spinal cord injuries has been estimated to be between 30% and 47%. Individuals with spinal cord injuries sit for a majority of the time, increasing the risk of developing pressure ulcers in the buttocks and thighs due to large internal stresses. Human body models have been developed to study the formation of pressure ulcers, yet a persistent limitation in these models has been the material properties used to represent the soft tissues in the buttocks and thighs. Specifically, soft tissue material property data have not included wheelchair users, such as those with spinal cord injuries. The goals of this research were 1) to determine the in-vivo material properties of soft tissue in the thighs and buttocks of individuals with spinal cord injuries and 2) compare these to properties obtained from able-bodied people. Results indicated that the proximal and middle thigh regions of those who had a spinal cord injury were softer than the same regions as able-bodied individuals, while the distal thigh regions were stiffer. These findings are vital because they indicate that models developed using properties from able-bodied individuals will not produce internal stress or strain magnitudes that represent individuals who have a spinal cord injury. This information suggests that models should obtain material property data sets from their desired population. Human body models must represent the population being studied if they are to inform clinical assessments and make accurate patient predictions.
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Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021; 9:100325. [PMID: 33662705 PMCID: PMC8072144 DOI: 10.1016/j.esxm.2021.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction. AIM To determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI). METHODS A total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection. MAIN OUTCOME MEASURES PISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures. RESULTS For the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression. CONCLUSION The female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.
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Affiliation(s)
- U J Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - M S Lee
- Sophie-Marceau Women's Clinic, Daegu, South Korea
| | - S H Jung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - S H Ahn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - O Y Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea.
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Montealegre G, Uribe R, Martínez-Ceballos MA, Rojas-Villarraga A. ASIA syndrome symptoms induced by gluteal biopolymer injections: Case-series and narrative review. Toxicol Rep 2021; 8:303-314. [PMID: 33552929 PMCID: PMC7856393 DOI: 10.1016/j.toxrep.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background The number of plastic surgery procedures have been rising in the last few years. The morbi-mortality due to illegal use of biopolymers is a public health problem. One of the clinical consequences, foreign body modelling reaction, may be a precursor of ASIA (Autoimmune/Inflammatory disease induced by adjuvants) syndrome.The objective of this article is to present a case-series study of patients who developed ASIA syndrome following gluteal injection with biopolymers and emphasize the importance of toxic exposure in triggering autoimmune responses. A surgical technique used on some of the patients in the study is described. Methods A group of thirteen patients, diagnosed with foreign body modelling reaction, who developed ASIA syndrome confirmed by approved criteria was followed between May 2016 and May 2018. The "Butterfly Wings Technique," a new surgical procedure for patients who have medium to severe compromise, was used on five of them.A narrative literature review was done to look for subjects with ASIA syndrome and gluteal biopolymer infiltration. Results All the patients in the present case-series with foreign body modelling reaction developed ASIA syndrome. Some of them had a background of familial autoimmunity. Five of the patients were surgically treated and saw a clinical improvement after the extraction of the biopolymer with the proposed technique.The narrative literature review identified 7 articles related to the disease through the database search. Conclusions We suggest that foreign body modelling reaction should be considered a precursor to ASIA syndrome. New research projects will be needed in the future to evaluate the factors that determine when ASIA syndrome is triggered in a patient with this reaction.
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Affiliation(s)
- Giovanni Montealegre
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | - Rosa Uribe
- Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital San José, Bogotá, Colombia
| | | | - Adriana Rojas-Villarraga
- Fundación Universitaria de Ciencias de la Salud (FUCS), Cra 19 No. 8A – 32, Bogotá, Colombia
- Corresponding author.
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Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain 2020; 33:305-317. [PMID: 32989195 PMCID: PMC7532296 DOI: 10.3344/kjp.2020.33.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don’t know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Physical Medicine and Rehabilitation Department, Brahmanbaria Medical College, Brahmanbaria, Bangladesh.,School of Health Sport and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Suzon Al Hasan
- Physical Medicine and Rehabilitation Department, Rajshahai Medical College, Rajshahai, Bangladesh
| | - Johannes J Rasker
- Faculty of Behavioral Management and Social Sciences, Psychology Health and Technology, University of Twente, Enschede, The Netherlands
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Ghareeb A, Kakaje A, Ghareeb A, Nahas MA. An enormous arteriovenous malformation presenting in a child in sacro-gluteal region and managed successfully by recurrent embolisation and surgery. Int J Surg Case Rep 2020; 71:244-249. [PMID: 32492638 PMCID: PMC7264987 DOI: 10.1016/j.ijscr.2020.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
A massive arterio-venous malformation (AVM) on the buttock of a young girl. Recurrent embolisation and surgery made total resection possible. This is the first report from the Middle East of such a case in a child. This AVM was sucessfully managed by repeated embolization and resection. Management should not be postponed from financial disadvantge.
Background Arteriovenous malformations (AVMs) are rare congenital lesions that affect multiple regions. AVMs often affect the brain and the buttock is the least common. They are usually congenital, but discovered later in life as they are asymptomatic, small and resemble a benign lesion. However, they can abruptly grow and become symptomatic and life-threatening as they can bleed and get infected. Presentation of case An eight-year-old girl presented with ulcerated and bleeding AVM at the sacro gluteal region. However, due to financial difficulty, it grew to reach an enormous size of (15*15*2 cm) in the buttock. It was later managed by multiple embolisation followed by total surgical resection. Discussion This case reflects the first case of enormous AVM in the sacro-gluteal region in a child in the Middle East as they rarely reach such huge sizes. Total resection was possible by repeat embolisation and surgery. Conclusion Embolisation can render even huge AVM operable. AVMs should be treated as early as possible as they continue to grow and drastically decrease the quality of life of the patient.
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Affiliation(s)
- Amjad Ghareeb
- Damascus University, Faculty of Medicine, Damascus, Syria.
| | - Ameer Kakaje
- Damascus University, Faculty of Medicine, Damascus, Syria.
| | - Ayham Ghareeb
- Damascus University, Faculty of Medicine, Damascus, Syria
| | - Mohamad Ali Nahas
- Chief of Vascular and Endovascular Surgery Department, Al Assad University Hospital, Damascus, Syria
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Chen LM, Xu LW, Liu Y, Wang G. [Effects of free perforator propeller flap from buttock in repairing deep wound of buttock]. Zhonghua Shao Shang Za Zhi 2020; 36:106-109. [PMID: 32114727 DOI: 10.3760/cma.j.issn.1009-2587.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effects of free perforator propeller flap from buttock in repairing deep wound of buttock. Methods: From February 2016 to May 2018, 27 patients with buttock skin and soft tissue defects caused by various reasons were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of People's Liberation Army, including 19 males and 8 females, aged from 28 to 70 years. Among the protopathy, there were 14 cases of pressure sores, 7 cases of scar carcinoma, 2 cases of low-temperature scald, 2 cases of abscess, and 2 cases of pilonidal sinus. The wounds were located in the sacrococcygeal region in 15 cases, the ischial tuberosity in 8 cases, and the rest area of buttock in 4 cases after injury or lesion resection. The size of wounds ranged from 4.0 cm×4.0 cm to 12.0 cm×6.0 cm after debridement or extended resection. The free perforator propeller flaps from buttock with areas of 8.0 cm×4.0 cm-16.0 cm×6.0 cm were used to repair the wounds, and the donor sites were selected adjacent to the wounds where the skins were relatively loose. All flaps took buttock free perforator vessels as the axis and were transferred in propeller-type to repair the wounds. The donor sites were directly closed and sutured. The survival, complications, and follow-up of flaps were recorded. Results: All the flaps survived 100% in 27 patients. Congestion formed under flaps 2-6 days post operation in 2 patients due to inadequate drainage, which were healed after dressing change and drainage for 14-18 days. The sutures of flaps in the other cases were removed in 10-14 days post operation, and the wounds were healed. Follow-up for 2-12 months showed that the shapes of flaps and the donor sites were plump, which were not much different from the healthy sides, and the flaps could bear weight. Conclusions: Repairing buttock deep wound with buttock free perforator propeller flap has good effects. The donor site can be designed in the area adjacent to the wound where the skin is relatively loose and can be directly closed and sutured while repairing the wound, which can ensure plump buttock appearance.
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Affiliation(s)
- L M Chen
- Burn and Plastic Surgery Center, the 940th Hospital of the Joint Logistic Support Force of PLA, Lanzhou 730050, China
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Souto LRM. Invited Discussion on: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and the Textured Implant Crisis. Aesthetic Plast Surg 2020; 44:13-15. [PMID: 31654091 DOI: 10.1007/s00266-019-01528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022]
Abstract
The author discusses some important points about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and adds new and updated information about the disease (ALCL). LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Luís Ricardo Martinhão Souto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculdade de Medicina de Marília (FAMEMA), Avenida Presidente Roosevelt, 41, Marília, SP, CEP 17501-480, Brazil.
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Tabatabaiee A, Takamjani IE, Sarrafzadeh J, Salehi R, Ahmadi M. Pressure Pain Threshold in Subjects With Piriformis Syndrome: Test-Retest, Intrarater, and Interrater Reliability, and Minimal Detectible Changes. Arch Phys Med Rehabil 2019; 101:781-788. [PMID: 31821801 DOI: 10.1016/j.apmr.2019.10.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to assess the test-retest, intrarater, and interrater reliability of using the pressure pain threshold (PPT) in healthy and affected piriformis muscles and to estimate its absolute reliability. As a secondary objective, the degree of tenderness of the affected piriformis muscles was compared with healthy piriformis muscles. STUDY DESIGN This study used a comparative and reliability-based design. SETTING Rehabilitation clinic. PARTICIPANTS Patients (N=30) with unilateral piriformis muscle syndrome (30 affected and 30 healthy piriformis muscles) were recruited, and the PPT of both the healthy and affected piriformis muscles was recorded using digital algometry. Measurements of PPT were done by 2 raters (rater 1 and 2), which were selected at random order. Rater 1 repeated the PPT measurements 24-72 hours after initial assessment. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE PPT. RESULTS Excellent intrarater intraclass correlation coefficient (ICC) values were observed for the PPT of the affected piriformis (ICC: 0.86-0.96) and the healthy piriformis (ICC: 0.88-0.96) in the same session. The PPT measurements using digital algometry showed good-to-excellent interrater reliability (ICC: 0.64-0.92) and test-retest reliability (ICC: 0.72-0.95) in both the healthy and affected piriformis muscles. The findings revealed a significant decrease in the PPT of the affected piriformis muscle in comparison to the healthy piriformis muscle (mean difference 12.76; 95% confidence interval, 15.69-9.82; P<.001). CONCLUSIONS Digital algometry is a reliable tool for measuring piriformis PPT, regardless of the testing session and the rater. Patients with unilateral piriformis muscle syndrome have increased tenderness and decreased PPT in the affected piriformis muscle in comparison to the healthy piriformis muscle.
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Affiliation(s)
- Abbas Tabatabaiee
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Javad Sarrafzadeh
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Pan DJ, Jiang W, Li YL, Li HW. [Repair of skin and soft tissue defects of vulva, vagina, and buttock with internal pudendal artery perforator " angel wing" island flaps in six cases]. Zhonghua Shao Shang Za Zhi 2019; 35:540-542. [PMID: 31357826 DOI: 10.3760/cma.j.issn.1009-2587.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
From November 2015 to July 2017, six patients with skin and soft tissue defects of vulva, vagina, and buttock after resection of vulvar tumors were hospitalized in our unit. All patients were female, aged 45-70 years. Among them, four patients had bilateral defects, and two patients had unilateral defect. The defect area on each side ranged from 6 cm×4 cm to 12 cm×6 cm. Internal pudendal artery perforator " angel wing" island flaps were used to repair and reconstruct the defects. The area of flaps ranged from 7 cm×5 cm to 14 cm×7 cm. The donor sites were sutured directly. All 10 flaps of 6 patients survived. Two patients had local incision infection 3 days after operation. One of the two patients was healed 2 weeks after dressing change, and the other one underwent debridement and suture 1 week after dressing change and was healed 1 week after surgery. Follow-up for 6-12 months after surgery showed no recurrence of tumors, no eversion of vagina, better shape of vulva in bilateral reconstruction cases, and slightly worse symmetry in unilateral reconstruction cases. The skin of the reconstructed area was soft, with sensations of pain, temperature, and touch recovered in varying degrees. The distance of a two-point discrimination was 20-30 mm. Linear scars were left in the flap donor sites, with no impact on squatting or striding. In vaginal examination, 1.5 to 2.0 fingers could be inserted in bilateral reconstruction cases, while 2.0 to 3.0 fingers could be inserted in unilateral reconstruction cases. The anus functioned well during defecation.
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Affiliation(s)
- D J Pan
- Department of Burns and Plastic Surgery, Dali Bai Autonomous Prefecture People's Hospital, Dali 671000, China
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Shim DM, Kim TG, Koo JS, Kwon YH, Kim CS. Is It Radiculopathy or Referred Pain? Buttock Pain in Spinal Stenosis Patients. Clin Orthop Surg 2019; 11:89-94. [PMID: 30838112 PMCID: PMC6389522 DOI: 10.4055/cios.2019.11.1.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/26/2018] [Indexed: 11/06/2022] Open
Abstract
Background Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. Methods Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. Results One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). Conclusions The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
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Affiliation(s)
- Dae Moo Shim
- Department of Orthopaedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Tae Gyun Kim
- Department of Orthopaedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Jun Sung Koo
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Young Ho Kwon
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Chang Su Kim
- Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea
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Min HJ, Kim YJ. Analysis of gluteal subcutaneous and muscle thickness in infants and children for application to intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps. Arch Plast Surg 2018; 45:550-6. [PMID: 30466235 DOI: 10.5999/aps.2017.01760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 09/12/2018] [Indexed: 11/08/2022] Open
Abstract
Background To achieve improvements in intramuscular injection, autologous fat grafting, and gluteal artery perforator flaps in infants and children, the relationships of computed tomography (CT)-determined gluteal muscle thickness (MT) and subcutaneous tissue thickness (SCT) with age and body mass index (BMI) were analyzed. Methods Gluteal SCT and MT at ventrogluteal (VG) and dorsogluteal (DG) sites were measured in a standardized manner in 350 patients aged 0 to 6 years who had visited a tertiary hospital and had undergone abdominopelvic CT between January 2005 and December 2016. Recorded measurements were analyzed using one-way analysis of variance and stepwise multiple regression to identify the factors that were most closely related to MT and SCT. Results Subcutaneous tissue at VG sites was thinner than at DG sites, but not significantly so in any age group. Muscles tended to be thinner at VG sites in 4 to 7-year-old, but thicker at VG sites in 1 to 3-year-old, though the differences were not significant. MT in the VG and DG regions was found to be related to age, and SCT in these regions to be related to age and BMI. Conclusions The VG and DG sites should be considered as alternatives for intramuscular injection in infants and children when the anterolateral site is problematic. In addition, considering the gluteal MT and SCT of infants and children should help produce good results in autologous fat grafting and gluteal artery perforator flap harvesting.
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Semciw AI, Pizzari T, Woodley S, Zacharias A, Kingsley M, Green RA. Targeted gluteal exercise versus sham exercise on self-reported physical function for people with hip osteoarthritis (the GHOst trial - Gluteal exercise for Hip Osteoarthritis): a protocol for a randomised clinical trial. Trials 2018; 19:511. [PMID: 30236151 PMCID: PMC6149073 DOI: 10.1186/s13063-018-2873-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Clinical practice guidelines recommend exercise as the first line of management for hip osteoarthritis, yet high-quality evidence from Cochrane reviews suggest only slight benefits for pain and physical function; and no benefit on quality of life (low-quality evidence). However, the scope of physical impairments identified in people with hip osteoarthritis may not have been adequately addressed with targeted rehabilitation options in previous randomised controlled trials (RCTs). Potential targeted options include gait retraining to address spatio-temporal impairments in walking; motor control training to address deep gluteal (gluteus minimus) dysfunction; and progressive, high-intensity resistance exercises to address atrophy of the gluteal muscles. The aim of this study is to investigate the effect of a targeted gluteal rehabilitation programme that incorporates gait retraining, motor control and progressive, high-intensity resistance-strength training, to address physical activity levels and self-reported physical function in people with mild to moderate disability from hip osteoarthritis. METHODS Ninety people diagnosed with mild to moderately disabling hip osteoarthritis will be recruited and randomised to receive one of two exercise programmes (sham or GHOst programme). Interventions will be 12 weeks in duration, with weekly, supervised physiotherapy sessions, and daily home exercises. Both groups will receive standardised education. Outcomes will be assessed at baseline, 7 weeks, 13 weeks (primary time-point) and 25 weeks. The primary outcome will be self-reported physical function measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include physical activity measured with a tri-axial accelerometer, physical function tests, self-reported physical activity, isometric hip-muscle strength tests, hip-related patient-reported outcome measures, pain thoughts and depressive symptoms, quality of life, global rating of change, gluteal-muscle activity (electromyography (EMG)) and gluteal-muscle size and adiposity (magnetic resonance imaging (MRI)). DISCUSSION This will be the first study to compare a targeted gluteal rehabilitation programme to a sham exercise programme. The targeted GHOst programme includes exercises designed to address gait impairments as well as gluteal-muscle atrophy and dysfunction. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347 . Registered retrospectively on 5 July 2017. Protocol version 3.0.
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Affiliation(s)
- Adam Ivan Semciw
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport; La Trobe University, Bundoora, VIC, Australia
| | - Stephanie Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Anita Zacharias
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
| | - Michael Kingsley
- Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Rod A Green
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC, Australia
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Nteli Chatzioglou G, Govsa F, Bicer A, Ozer MA, Pinar Y. Physical attractiveness: analysis of buttocks patterns for planning body contouring treatment. Surg Radiol Anat 2018; 41:133-140. [PMID: 30167823 DOI: 10.1007/s00276-018-2083-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND As buttocks region is one of the most characteristic features of the ideal female body figure, the popularity of gluteal region contouring is on the rise. Perception of body form is influenced by its shape and size. Interventions to modify the form of this region are often difficult due to influence. The aim of this study is to investigate the attractiveness of various buttock shapes with the aid of a dedicated software. METHODS Standard personal photographs of the lower body were obtained from 200 healthy volunteers. Linear analyses were made and anatomical perception was calculated according to reference points. RESULTS Compared to males, all measurements concerning buttock dimensions were a significantly greater in females. Proportional assessments revealed that in females, the most attractive buttock waist-to-hip ratio was 0.75 from the posterior view. This ratio was 0.85 in males. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 in females. Positioning of the lateral prominence at the inferior gluteal fold was rated by 25% of the respondents as the most attractive in males from the posterior view. From the lateral view, the most prominent portion positioned at the midpoint (a 50:50 vertical ratio) was considered the most attractive for females. CONCLUSIONS These results suggest that utilizing digitalized reference values for a given body region may be an invaluable tool for determination of the correct fat volume, thus individualization of body contouring procedures. With the help of certain software, this research has shown that it is possible to measure the parameters of buttock, which may in turn be used to offer the best solution for any individual in quest for an improved buttocks form. New ideal waist-to-hip ratios of 0.7 update the previous standards.
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Affiliation(s)
- Gkionoul Nteli Chatzioglou
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Ahmet Bicer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mehmet Asim Ozer
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yelda Pinar
- Digital Imaging and 3D Modelling Laboratory, Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
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Abstract
Gluteal augmentation is rapidly gaining in popularity and this is driving aesthetic surgeons to gain experience and develop techniques to meet patient expectations. Currently, the 2 main techniques - gluteal fat grafting and gluteal implant for augmentation have significant limitations. Autologous fat grafting seems to have a mortality rate significantly higher than other aesthetic procedures. Implant based gluteal augmentation is equally difficult. This is a broad review of all the complications associated with both types and autologous gluteal augmentation. Society and individual surgeons are developing guidelines for the procedure based on theoretic etiologies. Gluteal implant augmentation is also fraught with problems.
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Affiliation(s)
- Bivik Shah
- Private Practice, Columbus Institute of Plastic Surgery, Columbus, OH 43213, USA; Department of Plastic Surgery, Ohio State University, Columbus, OH 43215, USA.
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Andrade GA, Coltro PS, Andó A, Lima RV, Müller Neto BF, Silva VZ, Farina Junior JA. Gluteal Augmentation with Silicone Implants: A New Proposal for Intramuscular Dissection. Aesthetic Plast Surg 2017; 41:872-7. [PMID: 28233133 DOI: 10.1007/s00266-017-0823-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Gluteoplasty has gained notoriety over the last decades, which has motivated the development of various surgical techniques. Nevertheless, the fear of dissection of the intramuscular plane without direct visualization may inhibit learning and development of gluteal augmentation with implants. Moreover, literature detailing the technical steps of intramuscular dissection for the construction of the implant pocket is scarce. This study presents a new approach to intramuscular dissection for gluteal augmentation with silicone implants, a variation of the conventional surgical technique. METHODS We performed a retrospective analysis of a series of 12 female patients submitted to a variation of the intramuscular dissection technique for gluteal augmentation with silicone implants. Data from patients, implants, follow-up time, postoperative complications, and the degree of patient satisfaction were obtained. This technique follows the principle of alternating spatulas to perform the blunt dissection of the implant pocket. RESULTS In this series, the proposed technique is controlled and safe for intramuscular dissection, which can be used for both experienced and training surgeons. This technique is based on well-known anatomical points and references. We observed that the implant was well positioned and covered, the patients were satisfied with the result, and the number of complications was low. CONCLUSIONS This variation of the intramuscular dissection technique for gluteal augmentation with silicone implants provides an easily reproducible and safe procedure that involves well-controlled technical steps, especially during dissection of the intramuscular pocket. In this series of patients, training surgeons learned faster, results were satisfactory, and the number of complications was low. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Serra-Guimarães F, De Barros MAV, Aboudib JH, Da Mota DSC, Leal DG, De Castro CC, Nahas FX. Does intramuscular gluteal augmentation using implants affect sensitivity in the buttocks? J Plast Reconstr Aesthet Surg 2017; 70:801-805. [PMID: 28400090 DOI: 10.1016/j.bjps.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/21/2017] [Accepted: 03/05/2017] [Indexed: 11/27/2022]
Abstract
The evolution of techniques and materials has made gluteoplasty a safe and reproducible operation with high acceptance among surgeons and patients. Functional aspects should be considered in gluteoplasty but are poorly studied. The sensitivity of the buttocks is fundamental as it represents an erogenous zone and provides protection through sensory stimuli for the prevention of pressure sores and burns. This study aimed to evaluate the sensitivity of the gluteal region in patients undergoing gluteal augmentation with implants. We included 20 consecutive patients undergoing gluteoplasty and 20 controls not undergoing gluteal surgery. All patients are females and were being treated at the Division of Plastic Surgery of the Rio de Janeiro State University. The right and left gluteal regions were delimited, and each one was divided into four quadrants numbered 1-8. Sensitivity tests were performed in all quadrants for six different stimuli: touch, heat, cold, pain, vibration, and pressure. The mean age and BMI were 36.3 years and 26.3, respectively. No difference in sensitivity was observed in the gluteal region after augmentation gluteoplasty when compared with those patients who had no operation in this series. Prospective and controlled studies are needed to better assess these issues.
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Affiliation(s)
- Fernando Serra-Guimarães
- Division of Plastic Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University, Brazil.
| | | | - Jose Horacio Aboudib
- Division of Plastic Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University, Brazil
| | | | | | - Claudio Cardoso De Castro
- Division of Plastic Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University, Brazil
| | - Fabio Xerfan Nahas
- Division of Plastic Surgery, Federal University of São Paulo, Brazil; Division of Plastic Surgery, Rio de Janeiro State University (UERJ), Boulevard 28 de setembro, 77 Vila Isabel, 20.551-030 Rio de Janeiro, RJ, Brazil
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Ouédraogo MS, Vignon-Pennamen MD, Battistella M, Levy A, Feuilhade de Chauvin M, Petit A. [Chromomycosis acquired in a non-tropical area: A case report]. Ann Dermatol Venereol 2017; 144:438-442. [PMID: 28396061 DOI: 10.1016/j.annder.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 02/07/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chromomycosis, or chromoblastomycosis, is caused by cutaneous inoculation of dematiaceous fungi of telluric or plant origin. It is generally seen in tropical or subtropical zones. Treatment of the condition is known to be complex. Herein we report a case of chromomycosis contracted in a temperate region of Eastern Europe/Central Asia that was effectively treated with oral itraconazole and terbinafine in combination with cryotherapy. PATIENTS AND METHODS A 44-year-old immunocompetent male subject consulted for a lesion on the buttocks that he had sustained 16 years earlier, and which, although never previously treated, had only become troublesome within the last few months. The examination revealed a large erythemato-squamous plaque containing a heterogeneous infiltrate. The diagnosis was based upon biopsy, with histological examination revealing sooty mould ; culture of a second sample showed the causative agent to be Fonsecaea pedrosoi. After 30 months of treatment combining oral terbinafine at a very high dose (1000mg/day), topical terbinafine and adjuvant cryotherapy, considerable, though incomplete, improvement was obtained. Finally, combined use of terbinafine (500mg/day) and itraconazole (200mg/day) led to clinical and histological cure. DISCUSSION The possibility of acquiring chromomycosis other than in a tropical zone is slight but has nevertheless been described, particularly in Eastern Europe. In our patient, the exact source of contamination is unknown, although it may have been acquired through frequent horse-riding or use of saunas. This case confirms the efficacy of combined itraconazole and terbinafine against this condition, which is usually difficult to treat.
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Affiliation(s)
- M S Ouédraogo
- Service de dermatologie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - M-D Vignon-Pennamen
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Battistella
- Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Levy
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Feuilhade de Chauvin
- Service de mycologie parasitologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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Ballivian Rico J, Esteche A, Hanke CJ, Ribeiro RC. Buttock Lifting with Polypropylene Strips. Aesthetic Plast Surg 2016; 40:215-22. [PMID: 26801197 DOI: 10.1007/s00266-015-0599-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the results of gluteal suspension with polypropylene strips. PATIENTS AND METHODS Ninety healthy female patients between the ages of 20 and 50 years (mean, 26 years), who wished to remodel their buttocks from December 2004 to February 2013 were studied retrospectively. All 90 patients were treated with 2 strips of polypropylene on each buttock using the following procedures: 27 (30 %) patients were suspended with polypropylene strips; 63 (70 %) patients were treated with tumescent liposuction in the sacral "V", lower back, supragluteal regions, and flanks to improve buttocks contour (aspirated volume of fat from 350 to 800 cc); 16 (18 %) patients underwent fat grafting in the subcutaneous and intramuscular layers (up to 300 cc in each buttock to increase volume); 5 (6 %) patients received implants to increase volume; and 4 (4.4 %) patients underwent removal and relocation of intramuscular gluteal implants to improve esthetics. RESULTS Over an 8-year period, 90 female patients underwent gluteal suspension surgeries. Good esthetic results without complications were obtained in 75 of 90 (84 %) cases. Complications occurred in 15 of 90 (16.6 %) patients, including strip removal due to postoperative pain in 1 (1.1 %) patient, and seroma in both subgluteal sulci in 3 (3.3 %) patients. CONCLUSION The results of this study performed in 90 patients over 8 years showed that the suspension with polypropylene strips performed as a single procedure or in combination with other cosmetic methods helps to enhance and lift ptosed gluteal and paragluteal areas. LEVEL OF EVIDENCE IV This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Abstract
The author started injecting large quantities of fat in the breasts, thighs, and buttocks in 1985. The Brazilian Buttock technique was first presented in 1987; since then, The author has been writing and lecturing about it worldwide. In the past few years, the technique became very popular; it has changed the ideal of beauty in many countries. Recently, The author started using adipose-derived stem cell-based therapies for buttock augmentation to improve the results of fat graft survival.
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Affiliation(s)
- Luiz S Toledo
- Medical Arts Clinic, Dubai London Clinic, Saudi-German Hospital, PO Box 213522, Jumeirah, Dubai, United Arab Emirates.
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Khodaee M, Jones D, Spittler J. Obturator Internus and Obturator Externus Strain in a High School Quarterback. Asian J Sports Med 2015; 6:e23481. [PMID: 26448844 PMCID: PMC4594131 DOI: 10.5812/asjsm.23481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/08/2014] [Accepted: 11/08/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction: Buttock pain is a relatively common complaint among adolescent athletes and can have a very broad differential diagnosis. Case Presentation: The authors present a previously unreported case of acute obturator internus and obturator externus strain in an adolescent male American football player. The diagnosis was made by MRI. The patient was treated with relative rest, physical therapy, and gradual return to physical activities as tolerated. Conclusions: Despite rarity of the hip external rotator muscles strains, it should be considered in the differential diagnosis of athletes with proximal posterior thigh and buttock pain.
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Affiliation(s)
- Morteza Khodaee
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
- Corresponding author: Morteza Khodaee, Department of Family Medicine, University of Colorado School of Medicine, 80238, Denver, USA. Tel: +1-7208489056, Fax: +1-7208489050, E-mail:
| | - Daniel Jones
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
| | - Jack Spittler
- Department of Family Medicine, University of Colorado School of Medicine, Denver, USA
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Falótico GG, Torquato DF, Roim TC, Takata ET, de Castro Pochini A, Ejnisman B. Gluteal pain in athletes: how should it be investigated and treated? Rev Bras Ortop 2015; 50:462-8. [PMID: 26417570 PMCID: PMC4563074 DOI: 10.1016/j.rboe.2015.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/01/2014] [Indexed: 01/02/2023] Open
Abstract
Gluteal pain is a frequent symptom in athletes, and defining it etiologically is a challenge for orthopedists. In the present study, using an anatomical approach to the posterior region of the pelvis and the proximal femur, divided into four quadrants, systematized investigation is proposed with the aim of optimizing the treatment and accelerating athletes' return to their sport, through correct diagnosis.
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Semciw AI, Freeman M, Kunstler BE, Mendis MD, Pizzari T. Quadratus femoris: An EMG investigation during walking and running. J Biomech 2015; 48:3433-9. [PMID: 26116043 DOI: 10.1016/j.jbiomech.2015.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/01/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
Dysfunction of hip stabilizing muscles such as quadratus femoris (QF) is identified as a potential source of lower extremity injury during functional tasks like running. Despite these assumptions, there are currently no electromyography (EMG) data that establish the burst activity profile of QF during any functional task like walking or running. The objectives of this study were to characterize and compare the EMG activity profile of QF while walking and running (primary aim) and describe the direction specific action of QF (secondary aim). A bipolar fine-wire intramuscular electrode was inserted via ultrasound guidance into the QF of 10 healthy participants (4 females). Ensemble curves were generated from four walking and running trials, and normalized to maximum voluntary isometric contractions (MVICs). Paired t-tests compared the temporal and amplitude EMG variables. The relative activity of QF in the MVICs was calculated. The QF displayed moderate to high amplitude activity in the stance phase of walking and very high activity during stance in running. During swing, there was minimal QF activity recorded during walking and high amplitudes were present while running (run vs walk effect size=4.23, P<0.001). For the MVICs, external rotation and clam produced the greatest QF activity, with the hip in the anatomical position. This study provides an understanding of the activity demands placed on QF while walking and running. The high activity in late swing during running may signify a synergistic role with other posterior thigh muscles to control deceleration of the limb in preparation for stance.
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Affiliation(s)
- Adam I Semciw
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; La Trobe University Sport, Exercise and Rehabilitation Research Focus Area, Bundoora, Victoria, Australia.
| | - Michael Freeman
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Breanne E Kunstler
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - M Dilani Mendis
- Centre for Musculoskeletal Research, Mary Mackillop Institute for Health Research, Australian Catholic University, Brisbane, Queensland, Australia
| | - Tania Pizzari
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia; La Trobe University Sport, Exercise and Rehabilitation Research Focus Area, Bundoora, Victoria, Australia
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Semciw AI, Green RA, Pizzari T. Gluteal muscle function and size in swimmers. J Sci Med Sport 2015; 19:498-503. [PMID: 26100856 DOI: 10.1016/j.jsams.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/12/2015] [Accepted: 06/01/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the gluteus medius and minimus segments size and activity in swimmers versus non-swimmers. DESIGN Case matched-control cross-sectional study. METHODS The three segments of gluteus medius (anterior, middle and posterior) and two segments of gluteus minimus (anterior and posterior) were evaluated using electromyography and magnetic resonance imaging in 15 swimmers (7 elite and 8 non-elite) and 15 gender- and aged-matched controls. For each muscle segment, values were obtained for peak amplitude, average amplitude, and time to peak from each phase of the gait cycle (0-20%, 20-60%, and total stance). RESULTS The pattern of anterior gluteus minimus EMG activity in swimmers demonstrated additional activity early in the gait cycle when compared with controls. The segmental differences between anterior and posterior gluteus minimus during gait identified in the control group were not present in the swimmers. Overall, there were no significant differences in the gluteus medius EMG characteristics between groups and muscle size was not significantly different between groups for any of the hip abductor muscles. CONCLUSIONS The preliminary evidence of non-segmental differences within the gluteus minimus of swimmers (as opposed to non-swimmers) might implicate reduced-gravity environments in contributing to subsequent changes in deep stabiliser muscles. Such changes might predispose the athlete to a greater risk of lower limb injury during weight bearing activities.
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Affiliation(s)
- Adam I Semciw
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Australia.
| | - Rodney A Green
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Australia; Department of Pharmacy and Applied Sciences, La Trobe University, Australia
| | - Tania Pizzari
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Australia; School of Allied Health, College of Science, Health and Engineering, La Trobe University, Australia
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Saad PF, Saad KR, Armstrong DMFDO, Soares BLDF, de Almeida PHF, Razuk Filho Á. Inferior gluteal artery pseudoaneurysm related to intramuscular injection. Int J Surg Case Rep 2014; 6C:29-32. [PMID: 25506847 PMCID: PMC4334878 DOI: 10.1016/j.ijscr.2014.10.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/01/2022] Open
Abstract
A case of pseudoaneurysm of the IGA following intramuscular injection in the buttock. Importance careful physical examination in order to avoid misdiagnosis. Diagnosis and therapy are facilitated by catheter angiography.
INTRODUCTION Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. PRESENTATION OF CASE The authors present a case of pseudoaneurysm of the inferior gluteal artery related to an iatrogenic injury due to intramuscular injection of medication, which was treated with selective embolization of the artery during angiography. DISCUSSION The most common manifestation of an inferior gluteal artery pseudoaneurysm is the presence of a painful mass in the buttock that may or may not be associated with neurological symptoms due to compression of the sciatic nerve. Ultrasound with color Doppler and computerized tomography with multi-detectors are useful non-invasive tools for diagnosis. However, both diagnosis and therapy are facilitated by catheter angiography. CONCLUSION This case cautions that although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. It also illustrates the usefulness of a minimally invasive modality for treatment of these lesions.
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Affiliation(s)
- Paulo Fernandes Saad
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Karen Ruggeri Saad
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil.
| | | | - Bruno Leonardo de Freitas Soares
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Paulo Henrique Freitas de Almeida
- School of Medicine of Vale do São Francisco Federal University, Av. José de Sá Maniçoba, s/n, Centro, Petrolina 56304917, PE, Brazil
| | - Álvaro Razuk Filho
- Holy House Medical Sciences Faculty of São Paulo, Rua Dr. Cesário Motta Jr., 61, São Paulo 01221020, SP, Brazil
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Eun HK, Chung HS, Yoon SP. Uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a Korean male cadaver. Anat Cell Biol 2014; 47:141-3. [PMID: 24987553 PMCID: PMC4076423 DOI: 10.5115/acb.2014.47.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 01/12/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022] Open
Abstract
We found a rare case of uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a 39-year-old Korean male cadaver, whose cause of death was rectal carcinoma. The inferior gluteal artery branches off downwards at a time, the muscular rami ran in parallel with one another, and the articular ramus gave another muscular branch and has an anastomosis with the medial circumflex femoral artery. Knowledge of vascular variations in the gluteal region may give useful information of versatile flaps for reconstruction and the prominent articular ramus found in this case is good enough to consider the existence of the anastomosis between the medial circumflex femoral artery and the inferior gluteal artery as normal, not rudimentary.
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Affiliation(s)
- Heung Kee Eun
- Jeju National University School of Medicine, Jeju, Korea
| | - Hee Sup Chung
- Jeju National University School of Medicine, Jeju, Korea
| | - Sang Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
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Kim DY, Choi HN, Park JH, Kim SR, Kim H, Han YS. Regional analysis of soft tissue thickness on korean buttocks and application to fasciocutaneous flap design. Arch Plast Surg 2014; 41:133-9. [PMID: 24665421 DOI: 10.5999/aps.2014.41.2.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/09/2013] [Accepted: 08/15/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. METHODS Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. RESULTS According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. CONCLUSIONS The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.
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Semciw AI, Green RA, Murley GS, Pizzari T. Gluteus minimus: an intramuscular EMG investigation of anterior and posterior segments during gait. Gait Posture 2014; 39:822-6. [PMID: 24314814 DOI: 10.1016/j.gaitpost.2013.11.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 11/04/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
Gluteus minimus is believed to consist of two structurally and functionally unique segments (anterior and posterior); however there is a lack of electromyography (EMG) research that attempts to verify current theoretical knowledge of this muscle. The purpose of this study was therefore to evaluate the function of gluteus minimus during gait, and to determine whether anterior and posterior segments are functionally independent. Bipolar fine wire intramuscular EMG electrodes were inserted into anterior and posterior gluteus minimus segments of fifteen healthy volunteers (9 males) according to previously verified guidelines. Participants completed a series of four walking trials, followed by maximum voluntary isometric contractions in five different positions. Temporal and amplitude variables for each segment were compared across the gait cycle with independent t-tests. The relative contribution of each segment to the maximum resisted trials was compared with Mann-Whitney U tests (α = 0.05). Anterior and posterior segments were contracting at different relative intensities for three of the five maximum resisted trials (effect size = 0.39 to 0.62, P < 0.037). The posterior segment was larger in EMG amplitude (peak and average) during the first 20% of the gait cycle (effect size = 0.96 to 1.03, P < 0.02), while the anterior segment peaked later in the stance phase (effect size = 0.83, P = 0.034). Gluteus minimus is therefore composed of functionally independent segments. These results build on contemporary theoretical knowledge and may signify hip stabilising roles for each segment across different phases of the gait cycle.
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Affiliation(s)
- Adam I Semciw
- Lower Extremity & Gait Studies Research Group, La Trobe University, Australia; Department of Physiotherapy, La Trobe University, Australia.
| | - Rodney A Green
- Lower Extremity & Gait Studies Research Group, La Trobe University, Australia; Department of Rural Human Biosciences, La Trobe University, Australia
| | - George S Murley
- Lower Extremity & Gait Studies Research Group, La Trobe University, Australia; Department of Podiatry, La Trobe University, Australia
| | - Tania Pizzari
- Lower Extremity & Gait Studies Research Group, La Trobe University, Australia; Department of Physiotherapy, La Trobe University, Australia
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Willemsen JC, Lindenblatt N, Stevens HP. Results and long-term patient satisfaction after gluteal augmentation with platelet-rich plasma-enriched autologous fat. Eur J Plast Surg 2013; 36:777-82. [PMID: 24273385 DOI: 10.1007/s00238-013-0887-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022]
Abstract
Background Buttock augmentation is gaining increasing popularity in aesthetic surgery. The relatively high incidence of complications after silicone implant placement lead to the increased use of lipofilling techniques, yielding variable results with respect to graft take rate and long-term stability. Platelet-rich plasma (PRP) has been shown to have beneficial effects on wound healing and angiogenesis in the past. Therefore, we aimed at investigating the long-term results and patient satisfaction after PRP-enriched lipofilling for buttock augmentation. Methods Twenty-four bilateral gluteal augmentations with PRP-enriched autologous fat were performed. Additionally, contour shaping was achieved by liposuction of the adjacent zones. Post-operative results and complications were recorded, and satisfaction with buttock shape was estimated by a patient questionnaire. Results Mean follow-up time was 44 months, and mean amount of transferred fat was 481 cc for both sides. No seroma or hematoma formation, infection or liponecrosis were reported during the post-operative follow-up. Subjective patient satisfaction in general increased from preoperatively to 3 months postoperatively and declined only slightly in the long-term course. Satisfaction levels in general were specific for each patient. Patient recovery was quick, and the majority of patients returned to work within 10 days after surgery. Conclusions PRP-enhanced lipofilling of the buttocks proved to be a safe procedure including a low complication rate and consistent results. However, subjective patient expectations have to be taken into account when choosing the indication. Further large volume studies are needed to elucidate the potential and benefit of PRP in this context. Level of Evidence: Level IV, therapeutic study.
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Jianbing T, Biao C, Qin L, Yanhong W. Topical negative pressure coupled with split-thickness skin grafting for the treatment of hidradenitis suppurativa: a case report. Int Wound J 2013; 12:334-7. [PMID: 23834292 DOI: 10.1111/iwj.12116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/16/2013] [Accepted: 06/01/2013] [Indexed: 11/30/2022] Open
Abstract
Hidradenitis suppurativa is a cutaneous, chronic, recurrent inflammatory disease. Here, we report the case of a 66-year-old man who had hidradenitis suppurativa in the buttocks. He suffered from diabetes mellitus. In the past, he had perianal abscesses. Because of improper treatment of furuncle infections in the buttocks, skin ulcers formed, which worsened and resulted in multiple fistulas. The skin lesion surface was large and the infection was severe. After wound debridement treatment, topical negative pressure and nutritional support were given. After one and a half months, the wound healed with split-thickness skin grafting. In a 2-year follow-up, there was no evidence of hidradenitis suppurativa recurrence.
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Affiliation(s)
- Tang Jianbing
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Cheng Biao
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Li Qin
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
| | - Wu Yanhong
- Department of Plastic Surgery, The Key Laboratory of Trauma Treatment & Tissue Repair of Tropical Area, HuaBo Bio-Pharmaceutic Institute of Guangzhou, General Hospital of Guangzhou Military Command, Guangzhou, P. R. China
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