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General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
There are several described variations on the use of the sartorius muscle: Simple mobilisation without detaching origin. This has been called a ‘myoplasty’, but the use of this term is inconsistent.Detach origin and advancement of muscle – ‘transposition’.Detach origin and rotate muscle medially/internally. This sartorius ‘twist’ aims to leave the posterior medial vessels untouched and preserve the vascular supply as much as possible.
Plastic reconstructive procedures
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Andrea L. Pusic, Richard R. Barakat, Peter G. Cordeiro
The skin is incised anteriorly down to the medial group of muscles. The sartorius muscle is identified and retracted superiorly. The gracilis tendon can now be identified distally, usually through a separate short distal incision, and the tendinous insertion divided (Figure 33.14). The posterior incision is made down to the muscle, taking care not to undermine perforators from the muscle to the skin or to shear the cutaneous aspect of the flap off the muscle. The flap is then elevated from distal to proximal on the thigh. One or two large perforators to the muscle are ligated distally. The main pedicle is identified entering the proximal third of the gracilis muscle in the space between the adductor longus and adductor magnus muscles (Figure 33.15), approximately 8 to 10 cm below the pubic tubercle. Once the pedicle is identified and preserved, the proximal muscle can be dissected and, if necessary, the origin from the pubic symphysis may be divided. The entire myocutaneous flap can then be tunneled through the subcutaneous skin bridge into the vaginal defect (Figure 33.16) and exteriorized through the introitus (Figure 33.17). The bilateral flaps are sutured to each other in the midline (Figure 33.18). The neovagina is shaped into a pouch by approximating the anterior, posterior, and distal skin edges of the flaps (Figure 33.19); this can then be inserted into the pelvic space that is left after the exenteration. The proximal end of the neovagina is sutured to the introitus (Figure 33.20).
Imaging of the lower limb
Published in Sarah McWilliams, Practical Radiological Anatomy, 2011
Fig. 9.10 Axial sections through the thigh. The sartorius muscle is identified on the right due to the presence of a lipoma and its course from lateral to medial across the anterior aspect of the thigh can be seen clearly (1). (7) Gracilis (2), adductor magnus (3), vastus medialis (4), rectus femoris muscles (5), vastus lateralis (6), biceps femoris (7) and semimembranosus (8).
Surgical treatment of nonuremic calciphylaxis: a case report and review of literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Minami Tamagake, Munetomo Nagao, Chieko Miura, Yoshimichi Imai
We present the case of a 55-year-old female patient with a history of breast cancer, adenomyosis of the uterus, and gastroesophageal reflux, with normal renal function, and not taking warfarin. She initially bruised the lateral area of her right thigh, which became a painful and indurated nodule with redness (Figure 1a). Gradually, she experienced severe radiating pain and numbness over her entire right lower limb and was referred to a local orthopedic hospital. The relevant medication history included agents containing activated vitamin D3 and calcium supplementation for osteoporosis. Computed tomography (CT) revealed extensive soft tissue calcification and inflammation reaching the sartorius muscle at the initial lesion site (Figure 1b). A partial excision biopsy was performed, and pathological examination revealed diffuse necrosis and calcareous deposits in the lesion.
Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial
Published in Scandinavian Journal of Urology, 2021
Palaniappan Ravisankar, Kanuj Malik, Anand Raja, Kathiresan Narayanaswamy
The standard inguinal lymph node dissection was performed as described below. Briefly, an 8- to 14-cm lazy-S incision was made, 3–4 cm below the groin crease. After the incision, the skin flaps were raised to the level of the Scarpa fascia using electrocautery, which was also used to seal any visible leaking lymphatic vessels. The boundaries of the dissection of lymphatic tissue were the inguinal ligament superiorly, the sartorius muscle laterally, the adductor longus muscle medially, and the apex of femoral triangle inferiorly. The floor of the dissection was the femoral vessels and the pectineus, with the superficial and deep nodes removed. The saphenous vein inside the femoral triangle was ligated and dissected. The sartorius muscle transposition was done to cover the exposed femoral vessels.
Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block
Published in Baylor University Medical Center Proceedings, 2019
Johanna Blair de Haan, Nadia Hernandez, Sophie Dean, Sudipta Sen
The blocks were performed under ultrasound guidance with the patient in the supine position in the preoperative holding area. A high-frequency linear ultrasound transducer and a 21-gauge blunt-tipped echogenic needle were used for both blocks. The FI block was performed as described by Hebbard et al.3 Using the ultrasound transducer in a parasagittal plane, the anterior superior iliac spine was identified. The ultrasound probe was translated medially until the “bowtie” of the FI appeared over the iliacus muscle, bound cranially by the internal oblique muscle and caudally by the sartorius muscle. Following skin sterilization, the needle was advanced in plane in a caudal-to-cranial direction until normal saline was seen to spread underneath the FI over the iliacus muscle, and 20 mL of 0.5% bupivacaine hydrochloride was deposited in this location. We then performed the QL type 1 block as described by Blanco and McDonnell.4 The ultrasound probe was placed between the iliac crest and the lower costal margin in a transverse orientation, and the external oblique, internal oblique, and transverse abdominis were identified. The probe was translated posteriorly and laterally until the transverse abdominis muscle terminated superficial to the QL muscle. The skin was sterilized. The needle was advanced in plane from anterior to posterior until the tip was positioned between the QL and internal oblique, medial to the termination of the transverse abdominis, and 20 mL of 0.5% bupivacaine hydrochloride was injected.