The Experts below are selected from a list of 1647 Experts worldwide ranked by ideXlab platform
Hans-beat Ris - One of the best experts on this subject based on the ideXlab platform.
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closure of large intrathoracic airway defects using extrathoracic Muscle flaps
The Annals of Thoracic Surgery, 2004Co-Authors: Antoine Meyer, Thorsten Krueger, Domenico Lepori, Michael Dusmet, Johndavid Aubert, Philippe Pasche, Hans-beat RisAbstract:Abstract Background Prospective assessment of pedicled extrathoracic Muscle flaps for the closure of large intrathoracic airway defects after noncircumferential resection in situations where an end-to-end reconstruction seemed risky (defects of > 4-cm length, desmoplastic reactions after previous infection or radiochemotherapy). Methods From 1996 to 2001, 13 intrathoracic Muscle transpositions (6 latissimus dorsi and 7 Serratus Anterior Muscle flaps) were performed to close defects of the intrathoracic airways after noncircumferential resection for tumor (n = 5), large tracheoesophageal fistula (n = 2), delayed tracheal injury (n = 1) and bronchopleural fistula (n = 5). In 2 patients, the extent of the tracheal defect required reinforcement of the reconstruction by use of a rib segment embedded into the Muscle flap followed by temporary tracheal stenting. Patient follow-up was by clinical examination bronchoscopy and biopsy, pulmonary function tests, and dynamic virtual bronchoscopy by computed tomographic (CT) scan during inspiration and expiration. Results The airway defects ranged from 2×1 cm to 8×4 cm and involved up to 50% of the airway circumference. They were all successfully closed using Muscle flaps with no mortality and all patients were extubated within 24 hours. Bronchoscopy revealed epithelialization of the reconstructions without dehiscence, stenosis, or recurrence of fistulas. The flow-volume loop was preserved in all patients and dynamic virtual bronchoscopy revealed no significant difference in the endoluminal cross surface areas of the airway between inspiration and expiration above (45 ± 21 mm 2 ), at the site (76 ± 23 mm 2 ) and below the reconstruction (65 ± 40 mm 2 ). Conclusions Intrathoracic airway defects of up to 50% of the circumference may be repaired using extrathoracic Muscle flaps when an end-to-end reconstruction is not feasible.
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A comparative evaluation of intrathoracic latissimus dorsi and Serratus Anterior Muscle transposition
European Journal of Cardio-Thoracic Surgery, 2000Co-Authors: Matthias Kurt Widmer, Thorsten Krueger, Didier Lardinois, Andrej Banic, Hans-beat RisAbstract:Background: Comparison of intrathoracic latissimus dorsi (LD) versus Serratus Anterior (SA) Muscle transposition for treatment of infected spaces, broncho-pleural fistulae, and for prophylactic reinforcement of the mediastinum after extended resections following induction therapy. Patients and methods: Twenty LD and 17 SA transfers were performed for prophylactic reinforcement (11 LD; nine SA), and treatment of infections (nine LD; eight SA) from 1995 to 1998. Results: The 30-day mortality was 0% following prophylactic reinforcement and 29% following treatment of infections (three LD; two SA). Prophylactic mediastinal reinforcement was successful in 11 of 11 patients with LD and nine of nine with SA transpositions, and treatment of infected spaces in eight of nine patients with LD and two of three with SA transfers. Morbidity requiring re-intervention consisted of flap necrosis (one LD), bleeding (one SA), and skin necrosis over a winged scapula (one SA). Subcutaneous seromas and chest wall complaints were more frequent following LD (45 and 36%, respectively) compared with SA transfers (29 and 27%, respectively), whereas impaired shoulder girdle function was more frequent after SA than after LD transfer (27 vs. 21%). Conclusion: Intrathoracic LD and SA Muscle transpositions are both efficient for the prevention or control of infections following complex thoracic surgery, and are both associated with similar and acceptable morbidity and long-term sequelae. q 2000 Elsevier Science B.V. All rights reserved.
Cumhur İbrahim Başsorgun - One of the best experts on this subject based on the ideXlab platform.
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circumflex scapular artery myocutaneous and or vascularized scapular chimeric flap
Journal of Surgical Research, 2016Co-Authors: Arzu Akcal, Tahsin Görgülü, Seckin Aydin Savas, Mehmet Af Akcal, Mehmet Can Ubur, Cumhur İbrahim BaşsorgunAbstract:Abstract Background Chimeric osteomyocutaneous flaps harvested from the subscapular artery system have been used in clinical practice. We describe the use of a novel circumflex scapular artery myocutaneous and/or vascularized scapular chimeric flap in a rat model and demonstrate optimal skin flap dimensions. Materials and methods An 8 × 4-cm-rectangular skin flap based on the circumflex scapular artery flap was harvested, and the mean percentage of the surviving flap area and the necrotic area were calculated to be 71% ± 17.9% and 29% ± 17.9%, respectively. Using flap dimensions determined in the first part of our study, a 4 × 3-cm quadrangular portion of skin was marked over the scapula, and the Serratus Anterior Muscle and a portion of the scapular bone were included in our chimeric flap model. Results The mean percentages of the surviving flap and necrotic areas were 74% ± 6% and 25% ± 6%, respectively. Microangiographic and histologic studies revealed the vascularity of the skin island and identified the branches of the circumflex scapular artery that supplied the bone and Muscle. Conclusions The circumflex scapular artery myocutaneous and/or vascularized partial scapular chimeric flap may be considered a branch-based chimeric flap and can be an acceptable flap model due to its simplicity, reliability, and consistent vascularity. Furthermore, this flap may have potential applications in studying chimeric flap hemodynamics.
Arzu Akcal - One of the best experts on this subject based on the ideXlab platform.
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circumflex scapular artery myocutaneous and or vascularized scapular chimeric flap
Journal of Surgical Research, 2016Co-Authors: Arzu Akcal, Tahsin Görgülü, Seckin Aydin Savas, Mehmet Af Akcal, Mehmet Can Ubur, Cumhur İbrahim BaşsorgunAbstract:Abstract Background Chimeric osteomyocutaneous flaps harvested from the subscapular artery system have been used in clinical practice. We describe the use of a novel circumflex scapular artery myocutaneous and/or vascularized scapular chimeric flap in a rat model and demonstrate optimal skin flap dimensions. Materials and methods An 8 × 4-cm-rectangular skin flap based on the circumflex scapular artery flap was harvested, and the mean percentage of the surviving flap area and the necrotic area were calculated to be 71% ± 17.9% and 29% ± 17.9%, respectively. Using flap dimensions determined in the first part of our study, a 4 × 3-cm quadrangular portion of skin was marked over the scapula, and the Serratus Anterior Muscle and a portion of the scapular bone were included in our chimeric flap model. Results The mean percentages of the surviving flap and necrotic areas were 74% ± 6% and 25% ± 6%, respectively. Microangiographic and histologic studies revealed the vascularity of the skin island and identified the branches of the circumflex scapular artery that supplied the bone and Muscle. Conclusions The circumflex scapular artery myocutaneous and/or vascularized partial scapular chimeric flap may be considered a branch-based chimeric flap and can be an acceptable flap model due to its simplicity, reliability, and consistent vascularity. Furthermore, this flap may have potential applications in studying chimeric flap hemodynamics.
Noriaki Ichihashi - One of the best experts on this subject based on the ideXlab platform.
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electromyographic analysis of a selective exercise for the Serratus Anterior Muscle among patients with frozen shoulder and subacromial impingement syndrome
American Journal of Physical Medicine & Rehabilitation, 2021Co-Authors: Junsuke Miyasaka, Noriaki Ichihashi, Ryuzo Arai, Yuji Yoshioka, Aoi Matsumura, Satoshi Hasegawa, Shinichi Kuriyama, Shinichiro Nakamura, Shuichi MatsudaAbstract:Objective Patients with shoulder disorders show altered periscapular Muscle activity [e.g., decreased Serratus Anterior (SA) and increased upper trapezius (UT) activities]. We herein devised a novel method for strengthening SA without excessive UT activation, named Squeezing Ball exercise (SB-ex) in which patients squeezed a ball between both elbows with maximum voluntary isometric contraction in the horizontal adduction direction with the arms elevated at a 45° angle. The present study aimed to investigate if the SB-ex could produce high Muscle activity in the SA in patients with frozen shoulder and subacromial impingement syndrome (SAIS) before the rehabilitation intervention. Design This is a proof-of-concept study. SA and UT activities during SB-ex were evaluated using electromyography (EMG) in 16 patients with frozen shoulders and SAIS. EMG signals were normalized using maximal voluntary isometric contraction (MVIC), and the Muscle balance ratios (UT/SA) were calculated. Results The average SA and UT activity was 69.9% ± 30.8% and 10.2% ± 6.3% MVIC during the SB-ex, respectively, whereas the UT/SA ratio of the affected side was 0.15 ± 0.07. Conclusion The high SA activation and low UT/SA ratio during SB-ex could be attributed to the limb position where shortened SA exerts itself without painful subacromial impingement. SB-ex could be a novel rehabilitation tool for patients with frozen shoulders and SAIS.
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Scapular kinematic and shoulder Muscle activity alterations after Serratus Anterior Muscle fatigue.
Journal of shoulder and elbow surgery, 2018Co-Authors: Jun Umehara, Ken Kusano, Masatoshi Nakamura, Katsuyuki Morishita, Satoru Nishishita, Hiroki Tanaka, Itsuroh Shimizu, Noriaki IchihashiAbstract:Background Although the Serratus Anterior Muscle has an important role in scapular movement, no study to date has investigated the effect of Serratus Anterior fatigue on scapular kinematics and shoulder Muscle activity. The purpose of this study was to clarify the effect of Serratus Anterior fatigue on scapular movement and shoulder Muscle activity. Methods The study participants were 16 healthy men. Electrical Muscle stimulation was used to fatigue the Serratus Anterior Muscle. Shoulder Muscle strength and endurance, scapular movement, and Muscle activity were measured before and after the fatigue task. The Muscle activity of the Serratus Anterior, upper and lower trapezius, Anterior and middle deltoid, and infraspinatus Muscles was recorded, and the median power frequency of these Muscles was calculated to examine the degree of Muscle fatigue. Results The Muscle endurance and median power frequency of the Serratus Anterior Muscle decreased after the fatigue tasks, whereas the Muscle activities of the Serratus Anterior, upper trapezius, and infraspinatus Muscles increased. External rotation of the scapula at the shoulder elevated position increased after the fatigue task. Conclusion Selective Serratus Anterior fatigue due to electric Muscle stimulation decreased the Serratus Anterior endurance at the flexed shoulder position. Furthermore, the Muscle activities of the Serratus Anterior, upper trapezius, and infraspinatus increased and the scapular external rotation was greater after Serratus Anterior fatigue. These results suggest that the rotator cuff and scapular Muscle compensated to avoid the increase in internal rotation of the scapula caused by the dysfunction of the Serratus Anterior Muscle.
Geoffrey G Hallock - One of the best experts on this subject based on the ideXlab platform.
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the extended latissimus dorsi Serratus Anterior chimeric local free flap for salvage of the complicated posterolateral thoractomy incision
Injury-international Journal of The Care of The Injured, 2019Co-Authors: Geoffrey G HallockAbstract:Abstract Background Composite chest wall reconstruction, following the assurance of chest wall stability, often requires well-vascularized soft tissue coverage with flaps to insure adequate wound healing. Unfortunately, prior surgical approaches such as the posterolateral thoractomy incision or extensive wound breakdown may impede the availability of local or regional choices. A free flap would then be a reasonable option, but in the unstable patient a new donor site is unreasonable. Instead, the otherwise inadequate Muscle remnants often transected by the usual thoracotomy incision can be extended by microvascular grafts to provide the necessary reach to the defect. Method The ipsilateral cephalic latissimus dorsi and/or Serratus Anterior Muscle remnants following their transection by a posterolateral thoractomy incision can be simultaneously raised as a chimeric flap pedicled in common by the thoracodorsal vessels. The distance the pedicle must be extended to reach the defect requiring coverage is measured, and a vascular graft from the descending branch of the lateral circumflex femoral vessels of the same length is harvested. The thoracodorsal vessels are divided, the vascular graft inserted and anastomosed end-to-end to the cut ends of the former, and then the flap can be stretched the required distance for insetting. Result A case example of use of the ipsilateral latissimus dorsi–Serratus Anterior Muscle remnants used after extension with arterial and venous grafts to the thoracodorsal vessels as the recipient site is presented with successful salvage of a life-threatening posteriolateral thoractomy wound dehiscence. Conclusion Transection of Muscles from a posterolateral thoracotomy incision does not preclude their use as flaps in extenuating circumstances. Their pedicle can be extended using vascular grafts and microvascular techniques in a sense to create a local free flap to provide another solution to a challenging problem.
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facial reconstruction using a combined flap of the subscapular axis simultaneously including separate medial and lateral scapular vascularized bone grafts
Annals of Plastic Surgery, 2002Co-Authors: Grant A Fairbanks, Geoffrey G HallockAbstract:With the better understanding of the blood supply to the scapula, combined flaps of the lateral scapula along with the latissimus dorsi and/or Serratus Anterior are well known. The medial border of the scapula, in this respect, has been underused. The authors present a case report in which a conjoined combined free flap consisting of four free tissue transfers based on the subscapular axis was used in simultaneous reconstruction of a gunshot wound to the face. This included a medial scapular osteofasciocutaneous flap for the mandible, a lateral scapular osseous flap for the Anterior maxilla, a Serratus Anterior Muscle flap for the cheek, and a separate latissimus dorsi musculocutaneous flap for the forehead. This flap was successful and provides another alternative to the resolution of complex problems needing multiple areas of both soft-tissue coverage and vascularized bone graft.
