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The Clinical Application of Anterolateral Thigh Flap  [PDF]
Yao-Chou Lee,Haw-Yen Chiu,Shyh-Jou Shieh
Plastic Surgery International , 2011, DOI: 10.1155/2011/127353
Abstract: The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. 1. Introduction Since Song et al. [1] introduced the anterolateral thigh flap in 1984, it gains popularity because of several advantages [2, 3]. First, the flap can be harvested simultaneously as two-team work. The operation time could be shortened. Second, the pedicle length is long enough to anastomosis with recipient vessels. The vein graft could be avoided. Third, the large caliber of pedicle vessels makes microanastomosis easier. Fourth, the flap could serve as fasciocutaneous, adipofascial, or myocutaneous flap as needed. Fifth, the flap can have great volume variability. Pliability could be achieved by primary thinning. Bulkiness could be added by incorporation of the deepithelialized skin or a portion of muscle cuff. Sixth, the lateral femoral cutaneous nerve can be included to provide as a sensate flap. Seventh, the flap pedicle could bridge the vascular gap as flow-through flap, especially in mangled extremities. Eighth, the donor site morbidity is minimal. 2. Flap Anatomy 2.1. Perforator Both septocutaneous and musculocutaneous perforators were identified in the anterolateral thigh flaps. Initially, it was thought that septocutaneous route composes the dominance [1, 4]. Recently, the anatomic studies suggested that musculocutaneous route takes the majority [2, 5–7]. In Shieh et al.’s and Wei et al.’s reports, 83.2% and 87.1% of perforators were found to be musculocutaneous, respectively [2, 3]. The differences between each studies might relate to the bias of the selection of the perforators by different authors.
Limite: Sinfonia do sentimento
La Ferla, Jorge;
ARS (S?o Paulo) , 2008, DOI: 10.1590/S1678-53202008000200006
Abstract: limite. sinfonia do sentimento é uma análise comparativa entre duas obras que marcam a história do cinema na américa latina. o filme "limite" de mário peixoto (1931) e "perón sinfonia del sentimiento" de leonardo favio (1998) s?o interpretados a partir de nossa atualidade, primeira década do terceiro milênio, momento crítico, frente ao desaparecimento dos suportes analógicos fundamentais do cinema e do vídeo. a partir de um presente onde predomina a uniformidade expressiva e a máquina digital, retomam-se os valores de mise en scéne de ambos os projetos experimentais realizados por dois dos mais importantes diretores da história do cinema do continente. o contraste entre os usos do fílmico, do vídeo, e da pós-produ??o digital permitem uma leitura do uso criativo de diversos suportes audiovisuais a partir da tens?o que estabelecem esses grandes criadores, entre máquina e imaginário. atualmente produzir cinema na américa latina continua sendo uma tarefa complexa, dolorosa e titanica. peixoto e favio s?o referências permanentes no processo de uma escritura poética em audiovisual confrontada com os modelos do espetáculo predominante nos meios de massa.
Breast reconstruction with free anterolateral thigh flap
Raje R,Chepauk R,Shetty K,Prasad R
Indian Journal of Plastic Surgery , 2003,
Abstract: The most common methods of breast reconstruction involve harvest of flaps from the lower abdomen. However it has certain limitations, including its use in patients who desire pregnancy in the future. Here, the anterolateral thigh flap, though an unconventional donor site, has been used with good results in four of our patients.
PINZAMIENTO ANTEROLATERAL DEL TOBILLO: EVALUACION ECOTOMOGRAFICA
Inzulza C,Alonso; Robertson C,Winston;
Revista chilena de radiología , 2002, DOI: 10.4067/S0717-93082002000100007
Abstract: ultrasound anatomic evaluation of normal and pathologic ligaments of the lateral aspect of ankle was performed. the objective of this study was to determine the usefulness of this exam in patients suggesting anterolateral impingement. both sides were studied in fifteen (15) normal patients and in fourteen (14) patients submitted by the orthopedic surgeon with suggestive symptoms. ligaments studied included: anterior tibiofibular, anterior talofibular and calcaneofibular. they were observed as an echogenic strip with posterior hypoechoic structures. eleven (11) ligaments demonstrated alterations in eight (8) patients, with swelling and convexity of the strip. four (4) patients had arthroscopic surgery and good correlation with ultrasound was found. high-resolution ultrasound can be a good diagnostic exam in anterolateral impingement especially if it is considered as an economic alternative when compared to mr
Subtalar anterolateral dislocations: case report and literature review
R. M. Capelli,V. Galamrini,L. Crespi
Journal of Orthopaedics and Traumatology , 2002, DOI: 10.1007/s101950200047
Abstract: We present the case of a 19-year-old man who sustained an isolated subtalar anterolateral dislocation. The incidence of this dislocation is very low, and generally it is associated with fractures or open wounds. We examine and discuss the treatment and the long term follow-up at two years, and review literature about it. We completed the evaluation with computed tomography. We consider favourable the result of this case, with patient satisfaction.
PINZAMIENTO ANTEROLATERAL DEL TOBILLO: EVALUACION ECOTOMOGRAFICA  [cached]
Alonso Inzulza C,Winston Robertson C
Revista Chilena de Radiología , 2002,
Abstract: Se realizó una evaluación de la anatomía ultrasonográfica de los ligamentos normales y patológicos de la región lateral del tobillo, con el objeto de determinar su utilidad en pacientes con clínica sugerente de pinzamiento anterolateral. Se estudiaron ambos lados en 15 pacientes sanos y en 14 pacientes referidos por traumatólogo con clínica sugerente. Los ligamentos evaluados fueron los: tibioperoneo anterior (TPA), peroneoastragalino (PA) y peroneocalcáneo. (PC) En pacientes sanos se observan como bandas ecogénicas, rectas, con estructura hipoecoica posterior. En 8 pacientes con sospecha clínica se detectó alteración en 11 ligamentos, observándose aumento de volumen y convexidad de la banda. A cuatro de estos pacientes se les practicó cirugía endoscópica encontrándose una buena correlación con los hallazgos ecotomográficos. En todos se indicó correctamente los ligamentos comprometidos. La ecotomografía de alta resolución puede ser un buen método diagnóstico en el pinzamiento anterolateral del tobillo a nivel de PA y TPA, especialmente si se considera como método alternativo a la RM por su bajo costo y accesibilidad Ultrasound anatomic evaluation of normal and pathologic ligaments of the lateral aspect of ankle was performed. The objective of this study was to determine the usefulness of this exam in patients suggesting anterolateral impingement. Both sides were studied in fifteen (15) normal patients and in fourteen (14) patients submitted by the orthopedic surgeon with suggestive symptoms. Ligaments studied included: anterior tibiofibular, anterior talofibular and calcaneofibular. They were observed as an echogenic strip with posterior hypoechoic structures. Eleven (11) ligaments demonstrated alterations in eight (8) patients, with swelling and convexity of the strip. Four (4) patients had arthroscopic surgery and good correlation with ultrasound was found. High-resolution ultrasound can be a good diagnostic exam in anterolateral impingement especially if it is considered as an economic alternative when compared to MR
Extended Anterolateral Thigh Flaps for Reconstruction of Extensive Defects of the Foot and Ankle  [PDF]
Lifeng Liu, Xuexin Cao, Lin Zou, Zongyu Li, Xuecheng Cao, Jinfang Cai
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083696
Abstract: The anterolateral thigh flap has been used for coverage of defects in the foot and ankle for years. Conventional extended anterolateral thigh flaps do not undergo thinning procedures, which limit their application. Here, a clinical series of 24 patients is reported in which extended anterolateral thigh flaps were used for posttraumatic foot and ankle reconstruction. Of the 24 flaps, 14 were simple extended anterolateral thigh fasciocutaneous flaps and 10 were thinned extended anterolateral thigh flaps. One artery and two veins, including a superficial vein and an accompanying vein, were anastomosed to vascularize each flap. Follow-up of the 24 patients ranged from 10 months to 4 years postoperatively. All 24 flaps survived successfully, except one case that had partial flap necrosis distally due to excessive thinning. The cutaneous flap territory ranged from 250 cm2 to 400 cm2 (mean, 297 cm2). Only one patient received a debulking procedure. No ulceration occurred in any of the flaps due to contact with the shoe. The extended anterolateral thigh flap is a good alternative for extensive soft tissue defects of the foot and ankle. This study also supports the high reliability and excellent vascular supply of moderate thinned extended ALT flaps.
Two Cases of Distal Anterolateral Thigh Flap  [PDF]
Masami Saito, Naohiro Kimura, Mamoru Tnegawa, Yoichi Tomizuka, Taku Tsukakoshi, Masamitsu Onda
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.43035
Abstract:

We report our experience with two cases of anterolateral thigh flaps based on the musculocutaneous perforators arising from a more distal part of the descending branch than in the conventional anterolateral thigh flap. Case 1: A 53-year-old man with a skin ulcer over the anterior surface of the left tibia secondary to plate fixation for an open fracture. The perforator marked with preoperative Doppler was located 8 cm proximal to the superior border of the patella. Without thinning, the flap was 10 × 4 cm in size and 5 mm thick. Case 2: A 46-year-old man with necrosis of the right index finger after replantation. The flap was 5 × 3 cm in size and 3 mm in thickness. This distal anterolateral thigh flap can be raised as a quite thin flap with a long pedicle and, therefore, is considered useful in the reconstruction of various soft tissue defects.

Qual o valor da análise semi-quantitativa dos exames de FDG-PET no diagnóstico da esclerose mesial temporal?  [cached]
Duarte Paulo S.,Zhuang Hongming,Couturier Olivier,Alavi Abass
Arquivos de Neuro-Psiquiatria , 2001,
Abstract: O objetivo deste estudo foi comparar a análise visual dos exames de FDG-PET com uma análise semi-quantitativa no diagnóstico da esclerose mesial temporal (EMT). MéTODOS: Este estudo incluiu 21 pacientes com confirma o histopatológica de EMT. Os dados referentes à análise visual foram obtidos dos relatórios dos exames. As imagens de FDG-PET foram analisadas de forma semi-quantitativa utilizando-se regi es de interesse (ROIs) desenhadas em 19 cortes tomográficos perpendiculares ao maior eixo do lobo temporal. Estas ROIs dividiram cada um dos lobos temporais em três regi es (lateral, inferior e medial). Um índice de assimetria foi calculado para cada regi o. RESULTADOS: A análise visual dos exames de FDG-PET demonstrou assimetria no metabolismo em todos os pacientes. Todos, menos 1 dos pacientes foram submetidos a lobectomia temporal do tipo standard do lado descrito como hipometabólico pelo exame de FDG-PET. Utilizando como critério um índice de assimetria maior ou igual a 9% em ao menos uma das regi es, a análise semi-quantitativa demonstrou assimetria considerada significativa em 18 pacientes. Esta assimetria coincidiu com o lado da cirurgia e foi confirmada como correspondente à área de eslerose em todos menos um dos pacientes (o mesmo paciente citado acima). CONCLUS O: A análise semi-quantitativa n o forneceu qualquer informa o adicional em rela o à interpreta o visual das imagens nesta série de pacientes.
O jornalista lobo mau em Deu a Louca na Chapeuzinho: um olhar sob a perspectiva do imaginário  [PDF]
Moraes, Heloisa Juncklaus Preis,Alves, Emanuelle Querino
Sess?es do Imaginário , 2010,
Abstract: O presente trabalho discute a imagem e a atua o do jornalista na sociedade, observando as características da personagem do Lobo Mau, na anima o infantil Deu a Louca na Chapeuzinho, sob a perspectiva do Imaginário (Durand, 2001; Morin, 1997; Silva, 2006). Os resultados constatam a influência do Imaginário na forma o do conceito coletivo sobre a figura da personagem e, possivelmente, na profiss o de jornalista. Temos o espectador que espera o Lobo Mau e que encontra um Lobo que n o é mau, mas que é visto como tal, por causa do imaginário que se têm sobre a personagem e o que esperar dela. The present work discusses the journalist image and actuation in society by the observation of the Wolf’s character behavior in the animation movie Hoodwinked, through the Imaginary perspective (Durand, 2001; Morin, 1997; Silva, 2006). The results show the influence that the Imaginary have in the formation of the journalist’s profession collective idea. We have the spectator that expects for an evil wolf but finds out that the wolf is not evil, although he’s seen that way, because of the imaginary around the character and what we’re used to expect of him.
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