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Advanced autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The flap is marked in the inner thigh crease, just below the inguinal ligament, extending posteriorly in the inferior buttock crease. The skin paddle of the flap is marked with the widest point centered over the gracilis muscle. The skin paddle is ideally 8–12 cm wide, as closure under excessive tension can result in donor site breakdown, scar widening, and labial spreading. A pinch test of the inner thigh in the adducted position helps confirm the extent of skin that can be removed. The anterior extent of the incision should not exceed the adductor longus by more than 2–3 cm.3 This hides the donor scar in the gluteal crease while avoiding an obvious anterior scar. Additionally, posterior incision placement minimizes dissection in the femoral triangle, decreasing the risk of lymphatic disruption.
Fundamentals
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The number of origins, or heads, may be incorporated into the name as ‘ceps’. Biceps brachii, triceps brachii and quadriceps femoris have two, three and four heads respectively. Muscles may be named by the location of their origin and insertion attachments, with the origin being named first, for example, brachioradialis originates on the arm (brachium) and inserts onto the radius. The action of the muscle may be incorporated into its name as flexor, extensor, adductor or abductor. Adductor longus adducts the thigh at the hip (see hip – muscles). Muscle names may become quite long if they include a combination of these different classifications: extensor carpi radialis longus is a long wrist (carpi) extensor on the radial side of the forearm (see wrist and hand – muscles). This name incorporates the action, joint, location and relative size of the muscle.
Hernias
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Surgical anatomy➢ Boundaries of the femoral triangleInguinal ligament superiorly.Medial border of sartorius muscle laterally.Medial border of adductor longus medially.Iliacus, psoas, pectineus and adductor longus form the floor.Superficial fascia and great saphenous vein form the roof.➢ Contents of the femoral triangleFrom medial to lateral (VAN): femoral vein, femoral artery, femoral nerve.➢ Boundaries of the femoral canalAnteriorly: Inguinal ligament.Medially: lacunar ligament.Laterally: femoral vein.Posteriorly: pectineal ligament.➢ Contents of the femoral canalLymph node (Cloquet’s node) and fat.➢ Location of femoral herniasBelow and lateral to the pubic tubercle.
Sex-related differences in hip and groin injuries in adult runners: a systematic review
Published in The Physician and Sportsmedicine, 2023
Bailey J. Ross, Greg M. Lupica, Zakari R. Dymock, Cadence Miskimin, Mary K. Mulcahey
There was minimal data on return to running specifically following hip/groin injuries in the included studies. In a recent case series of athletes with chronic adductor strain and/or tendinopathy, Gill et al. found 97% (31/32) were able to achieve successful RTS at a mean time of 12 weeks following adductor longus tenotomy [54]. This RTS rate is slightly higher than the pooled 81.4% (range, 68.8% to 86.6%) RTS rate found for hip/groin RRIs in this review. However, Gill et al.’s analysis included American football athletes; therefore, their results may not be directly comparable to our running-focused analysis. With respect to sex-related differences in RTS following RRIs, only one included study reported the time to RTS following hip/groin RRIs for each sex separately and found 85.7% of the males and 86.2% of the females achieved RTS within 3 weeks of injury [22]. Similarly, Lambert et al. found no significant differences between male and female athletes in either time lost due to RRI or post-RTS performance [55].
Management of a nonathlete with a traumatic groin strain and osteitis pubis using manual therapy and therapeutic exercise: A case report
Published in Physiotherapy Theory and Practice, 2020
Kyle Feldman, Carla Franck, Christine Schauerte
One of the primary muscles often involved in a groin strain is the adductor longus. A traumatic strain of the adductor longus is reported in 62–66% of the groin injuries of highly active young athletes who compete in sports such as soccer, football, tennis and hockey, which involve running, kicking, and twisting. Forty-eight percent of people with an acute groin strain have a previous history of the same injury showing high reoccurrence rate (Anderson, Strickland, and Warren, 2001; Ekstrand and Hilding, 1999; Hölmich et al., 2014; Kachingwe and Grech, 2008; Morelli and Smith, 2001; Roos, 1997; Serner et al., 2015). No articles have reported the number of nonathletes with the same injuries making it probable that it is much less common. High velocity movements such as sprinting, kicking, stretching and jumping can lead to adductor longus strains, yet only 1 in 13 clinical injuries are typically confirmed with ultrasound (Ekstrand and Hilding, 1999; Garvey and Hazard, 2014; Hegedus et al., 2013; Kachingwe and Grech, 2008; Serner et al., 2015; Woodward, Parker, and MacDonald, 2012; Yuill, Pajaczkowski, and Howitt, 2012), while most diagnoses are formed clinically, based on a subjective and objective examination.
A case of inclusion body myositis complicated by microscopic polyangiitis
Published in Scandinavian Journal of Rheumatology, 2018
S Yamada, H Yamashita, K Taira, A Hida, N Arai, J Shimizu, Y Miyaji, M Sonoo, A Yashima, Y Takahashi, H Kaneko
As the prednisolone dosage was tapered, the serum creatine kinase level began to increase, peaking at 363 U/L. In March 2016, the serum CRP level increased slightly and azathioprine was added for suspected MPA relapse; the CRP subsequently normalized. However, the serum creatine kinase level did not decrease. In May 2016, the muscle weakness was more prominent in the knee extensors than in the hip flexors and in the finger flexors than the shoulder abductors. Electromyography on the left flexor digitorum profundus muscle revealed denervation potentials and low-amplitude motor unit potentials with normal recruitment. Histopathological examination of the skeletal muscle biopsy specimen from the right tibialis anterior revealed chronic myopathic changes with scattered muscle fibres with rimmed vacuoles (Figure 1). Immunohistochemistry revealed the up-regulation of major histocompatibility complex class I (MHC-I) on the sarcolemma of all muscle fibres, deposits of p62/SQSTM1 in fibres with rimmed vacuoles, and scattered CD8-positive endomysial lymphocytes. Electron microscopy revealed cytoplasmic tubulofilamentous inclusions in fibres with rimmed vacuoles. These findings established a diagnosis of clinically defined IBM according to the 2011 European Neuromuscular Centre IBM research diagnostic criteria (1). Magnetic resonance imaging of the thigh showed muscle enhancement, especially the adductor longus and left quadriceps, corresponding to IBM. Anti-cN-1A antibody, which is positive in 33–76% of IBM patients (2, 3), was positive in a cell-based assay, but did not show typical staining. We continued glucocorticoids on a maintenance dose and administered azathioprine; these did not improve the muscle weakness.