Poly-L-lactic acid(PLLA)has become a popular treatment for body skin laxity,especially in female patients;however,research on its use in male patients remains limited,particularly in addressing changes in the gluteal ...Poly-L-lactic acid(PLLA)has become a popular treatment for body skin laxity,especially in female patients;however,research on its use in male patients remains limited,particularly in addressing changes in the gluteal region due to aging.This case report investigates the efficacy of PLLA in treating skin laxity in the gluteal area of three male patients aged 36,41,and 50 years who were treated at the Antony Barbosa Institute between May 2023 and June 2024.The Male Gluteal Contour Method^(TM):C-Tech Collagen Boost was employed using a C-shaped injection technique with an 18G×70 mm cannula.Patients underwent four sessions of PLLA injections,reconstituted with bacteriostatic sterile water and lidocaine,at 4–6-week intervals.Improvements in the gluteal contour and skin laxity were noted in all patients,with increased collagen production contributing to enhanced muscle definition and firmness.Minimal side effects such as mild bruising,swelling,and tenderness were reported,and no nodules were observed.This study highlights the importance of tailored treatment plans that cater to the specific needs of middle-age and older men.The C-shaped injection technique allowed for an even distribution of the biostimulator while respecting male anatomy.PLLA is a promising nonsurgical solution for improving male gluteal contour and skin quality,although further research with larger groups is warranted to establish more definitive guidelines for its use in male gluteal augmentation.展开更多
Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection ...Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection is a novel technique for the treatment of nerve pain due to entrapment. The use of hydrodissection for the treatment of deep gluteal syndrome has not been reported. Methods: A case report involved a 42-year-old female presenting with deep gluteal syndrome. Case report: We report, with patient consent, an ultrasound-guided superior gluteal nerve hydrodissection method used for treating the deep gluteal syndrome. A previously healthy 42-year-old female patient sought medical attention due to persistent left gluteal pain. Trials of joint injections, physiotherapy, and epidural blocks were unsuccessful. Hydrodissection under ultrasound-guidance allowed separation of the fascial plane in areas with significant neural innervation. We targeted the superior gluteal nerve with hydrodissection offering the patient immediate and persistent relief from her symptoms. Conclusion: Ultrasound-guided hydrodissection of the superior gluteal nerve offers an effective and novel diagnostic and treatment option for deep gluteal syndrome.展开更多
Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscle...Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscles contracture, being subjected to a 'Z-shaped' release lengthening operation and efficiency exercise, was clearly standardized. All the cases were followed up from 3 months to 2 years with the effective rate being 100 %, the cure rate being 98. 5 %, the recent complications being 5%, and the far complications being 0. 2 %. It was concluded that the clear diagnosis combined with standarized operation and efficiency functional exercise could greatly improve the therapeutic effects of gluteal muscles contracture.展开更多
To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patie...To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondence or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.展开更多
Variations in the course of the inferior gluteal nerve and artery were observed in Japanese cases (4/94 sides). In these variation cases, the inferior gluteal nerve exited the pelvis from the upper edge of the pirifor...Variations in the course of the inferior gluteal nerve and artery were observed in Japanese cases (4/94 sides). In these variation cases, the inferior gluteal nerve exited the pelvis from the upper edge of the piriformis (suprapiriformis foramen) in 4/4 sides (4.26%). In 2/4 sides (2.13%), the normal inferior gluteal artery was not observed, except that a fine artery exited the pelvis from the inferior piriformis foramen to form an “arch” with the superior gluteal artery under the gluteal maximus in 1/4 side. Moreover, in 1/4 side, a twig of the internal pudendal artery exited pelvis from inferior piriformis foramen and distributed to the surrounding tissues. The present observations of the inferior gluteal nerve and artery course are very important and useful for surgeons and nurses.展开更多
There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding ...There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.展开更多
Gluteal compartment syndrome(GCS) is a rare condition. We present a case of gluteal muscle strain with hematoma formation, methicillin-resistant Staphylococcus aureus(MRSA) superinfection, leading to acute GCS, rhabdo...Gluteal compartment syndrome(GCS) is a rare condition. We present a case of gluteal muscle strain with hematoma formation, methicillin-resistant Staphylococcus aureus(MRSA) superinfection, leading to acute GCS, rhabdomyolysis and acute kidney injury. This combination of diagnoses has not been reported in the literature. A 36-year-old Caucasian male presented with buttock pain, swelling and fever after lifting weights. Gluteal compartment pressure was markedly elevated compared with the contralateral side. Investigations revealed elevated white blood cell, erythrocyte sedimentation rate, C-reactive protein, creatine kinase, creatinine and lactic acid. Urinalysis was consistent with myoglobinuria. Magnetic resonance imaging showed increased T2 signal in the gluteus maximus and a central hematoma. Cultures taken from the emergency debridement and fasciotomy revealed MRSA. He had repeat, debridement 2 d later, and delayed primary closure 3 d after. GCS is rare and must be suspected when patients present with pain and swelling after an inciting event. They are easily diagnosed with compartment pressure monitoring. The treatment of gluteal abscess and compartment syndrome is the same and involves rapid surgical debridement.展开更多
Objective: 1Department of Anatomy, College of Basic Medical Sciences, Second Military Medical University, Shanghai 200433, China 2Department of Orthopedic Surgery, Changhai Hospital, Second Military Medical University...Objective: 1Department of Anatomy, College of Basic Medical Sciences, Second Military Medical University, Shanghai 200433, China 2Department of Orthopedic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Abstract Objective: To study the anatomical basis of transferring the superior gluteal nerve to the pudendal nerve in reconstructing the functional impairment in simple conus medullaris or pudendal nerve injury. Methods: Superior gluteal nerve and pudendal nerve were observed and measured by the gross and microsurgical anatomical methods in 62 sides of 31 adult cadavers. Results: Superior gluteal nerve came out of the superior foreman of piriformis as 1 to 4 branches(29.03%,56.45%,12.90% and 1.61% respectively) and the pelvic-leaving points were mainly in the middle 1/3(85.48%) of the line from the posterior superior iliac spine to the ischial tuberosity. The length of the inferior branch of the superior gluteal nerve was more than 5 cm, and the distance between the pelvic-leaving points of the superior gluteal nerve and pudandal nerve was about 4 cm only. The pudendal nerve left the pelvis mainly in the middle 1/3(48.39%) of the line from the posterior superior iliac spine to the ischial tuberosity,or at the junction of its inferior-middle 1/3(46.77%). In clinic, we have successfully made the operation transferring the superior gluteal nerve to the pudendal nerve in 3 patients suffered from the injury of conus medullaris. Conclusion: Distance between the pelvic-leaving points of the superior gluteal nerve and the pudendal nerve is close, so the inferior branch of the gluteal nerve can be anastomosed with the pudendal nerve directly. Transferring the superior gluteal nerve with higher spinal segemental origin to the pudendal nerve of a lower spinal segemental origin is practical and easy.展开更多
The injection of adjuvant substances for aesthetic purposes is a public health problem, for 40 years this problem has been described throughout our continent, the vast majority of women patients are affected by the in...The injection of adjuvant substances for aesthetic purposes is a public health problem, for 40 years this problem has been described throughout our continent, the vast majority of women patients are affected by the infiltration of silicon, mineral oils, automotive oil, methyl methacrylate, cement and various oily substances. This is a 54-year-old female patient who for about 30 years for cosmetic purposes was injected with mineral oil (quantity unknown) in both glutei with the aim of buttock augmentation. Physical examination was observed an important deformity in each buttock, hyperkeratosis with discoloration in both buttocks, loss of bilateral projection, right buttock with a secondary tumor of 22 cm × 11 cm and left 22 cm × 10 cm, stony appearance, local hyperthermia, painful on manipulation, with diffuse nodular lesions measuring 2 cm × 2 cm, without evidence of loss of continuity that would condition secretion leakage. Surgical planning is based on the very important size of the initial defect that we would have to reconstruct, so that the rotation of two wide-based flaps could guarantee better survival and occlusion of the defect, since the realization of a graft would cause a significant deformity, and the realization of a microsurgical flap in a fibrous tissue would inevitably result in its necrosis. The pathophysiology of the adjuvant disease is extremely complex, therefore it must be addressed by a multidisciplinary group with extensive experience.展开更多
Gluteal hernias are extremely uncommon and occur as a result of deficiency or defect in the gluteal musculature. Our case reports one such incidence in a one year old girl with review of available literature. The clin...Gluteal hernias are extremely uncommon and occur as a result of deficiency or defect in the gluteal musculature. Our case reports one such incidence in a one year old girl with review of available literature. The clinical presentation and imaging findings are discussed comprehensively. We thus lay emphasis on the importance of real-time ultrasonography as the method of choice to identify hernia contents, peristalsis and obstruction if any.展开更多
INTRODUCTION Benign metastasising leiomyoma (BML) is a rare condition marked by well-differentiated smooth muscle tumours appearing outside the uterus in women with a history of uterine leiomyoma.Metastasis from leiom...INTRODUCTION Benign metastasising leiomyoma (BML) is a rare condition marked by well-differentiated smooth muscle tumours appearing outside the uterus in women with a history of uterine leiomyoma.Metastasis from leiomyoma is found to be most common in the lungs(79.5%),but other organs,including the heart,lymph nodes,spine and soft tissues,can also be affected.展开更多
Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We repor...Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.展开更多
背景:梨状肌综合征是因梨状肌病变压迫坐骨神经致下肢疼痛的一种临床常见病症,目前临床尚无统一诊断标准和治疗共识。目的:全面探讨梨状肌综合征领域研究现状、趋势及热点。方法:于2024-11-13在PubMed数据库中检索有关梨状肌综合征的主...背景:梨状肌综合征是因梨状肌病变压迫坐骨神经致下肢疼痛的一种临床常见病症,目前临床尚无统一诊断标准和治疗共识。目的:全面探讨梨状肌综合征领域研究现状、趋势及热点。方法:于2024-11-13在PubMed数据库中检索有关梨状肌综合征的主题词和自由词并制定检索策略,在Web of Science核心合集数据库中检索发表的相关文献,经语言、文献类型限定及人工筛选后,运用Excel、VOSviewer、CiteSpace、Sci Explorer等工具进行可视化分析。结果与结论:共纳入238篇文献,涵盖了128个期刊和478个机构,共有57个国家或地区的1033位作者为梨状肌综合征领域贡献了宝贵的研究成果,其中总被引量5742次,平均每篇被引24次,H指数是42。1994-2024年,全球梨状肌综合征领域研究发文量呈增长趋势,美国在该领域发文量最多,发文量最多作者是Fishman,发文量最多的机构是美国哈佛大学,最有影响力的期刊是《Archives of Physical Medicine and Rehabilitation》,研究主要集中在梨状肌综合征的诊断、解剖与病因、治疗管理。预测未来的研究将继续围绕“解剖”“臀深综合征”“管理”展开。展开更多
Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the don...Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients （study group）. The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm× 10 cm to 26 cm× 22 cm （mean 16.3 cm× 13.5 cm）. Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm （mean 18.2 cm × 14 cm）. Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 （mean 5.9） and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group （80%, 8/10） significantly increased than that of control group （（25%, 3/12）, X2=4.583, P=0.032）. Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.展开更多
Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasion...Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasionally lead to fatal uncontrollable bleeding during surgery.展开更多
Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not a...Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not all patients are candidates,whether due to their leaner habitus or a history of prior abdominal surgery.The gluteal donor site in many patients can provide adequate soft tissue for autologous breast reconstruction,even in lean patients,with a scar that remains well-hidden.This review presents an overview of the superior gluteal artery perforator(SGAP)flap as an invaluable tool for autologous breast reconstruction.展开更多
BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical di...BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.展开更多
文摘Poly-L-lactic acid(PLLA)has become a popular treatment for body skin laxity,especially in female patients;however,research on its use in male patients remains limited,particularly in addressing changes in the gluteal region due to aging.This case report investigates the efficacy of PLLA in treating skin laxity in the gluteal area of three male patients aged 36,41,and 50 years who were treated at the Antony Barbosa Institute between May 2023 and June 2024.The Male Gluteal Contour Method^(TM):C-Tech Collagen Boost was employed using a C-shaped injection technique with an 18G×70 mm cannula.Patients underwent four sessions of PLLA injections,reconstituted with bacteriostatic sterile water and lidocaine,at 4–6-week intervals.Improvements in the gluteal contour and skin laxity were noted in all patients,with increased collagen production contributing to enhanced muscle definition and firmness.Minimal side effects such as mild bruising,swelling,and tenderness were reported,and no nodules were observed.This study highlights the importance of tailored treatment plans that cater to the specific needs of middle-age and older men.The C-shaped injection technique allowed for an even distribution of the biostimulator while respecting male anatomy.PLLA is a promising nonsurgical solution for improving male gluteal contour and skin quality,although further research with larger groups is warranted to establish more definitive guidelines for its use in male gluteal augmentation.
文摘Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection is a novel technique for the treatment of nerve pain due to entrapment. The use of hydrodissection for the treatment of deep gluteal syndrome has not been reported. Methods: A case report involved a 42-year-old female presenting with deep gluteal syndrome. Case report: We report, with patient consent, an ultrasound-guided superior gluteal nerve hydrodissection method used for treating the deep gluteal syndrome. A previously healthy 42-year-old female patient sought medical attention due to persistent left gluteal pain. Trials of joint injections, physiotherapy, and epidural blocks were unsuccessful. Hydrodissection under ultrasound-guidance allowed separation of the fascial plane in areas with significant neural innervation. We targeted the superior gluteal nerve with hydrodissection offering the patient immediate and persistent relief from her symptoms. Conclusion: Ultrasound-guided hydrodissection of the superior gluteal nerve offers an effective and novel diagnostic and treatment option for deep gluteal syndrome.
文摘Summary: The operation methods, clinical classification, postoperative function exercise of gluteal muscles contracture were investigated. Clinically and retrospectively, treatment of 1280 patients with gluteal muscles contracture, being subjected to a 'Z-shaped' release lengthening operation and efficiency exercise, was clearly standardized. All the cases were followed up from 3 months to 2 years with the effective rate being 100 %, the cure rate being 98. 5 %, the recent complications being 5%, and the far complications being 0. 2 %. It was concluded that the clear diagnosis combined with standarized operation and efficiency functional exercise could greatly improve the therapeutic effects of gluteal muscles contracture.
文摘To investigate the efficacy of a combination therapy on gluteal muscle contracture, 286 definitely diagnosed patients were subjected to surgical treatment, and then functional exercises and physical therapy. The patients with severe symptoms were asked to have a set of specially-designed functional exercises. All the patients were followed up for 3 to 24 months by hospital visit, correspondence or telephone interview. The effective rate was 100%, and the curative rate was up to 94.6%. Few patients developed complications and relapse was rare. It is concluded that the combination therapy, including surgical removal of diseased tissues, functional exercises and physical therapy, is an effective approach for the treatment of severe juvenile gluteal muscle contracture.
文摘Variations in the course of the inferior gluteal nerve and artery were observed in Japanese cases (4/94 sides). In these variation cases, the inferior gluteal nerve exited the pelvis from the upper edge of the piriformis (suprapiriformis foramen) in 4/4 sides (4.26%). In 2/4 sides (2.13%), the normal inferior gluteal artery was not observed, except that a fine artery exited the pelvis from the inferior piriformis foramen to form an “arch” with the superior gluteal artery under the gluteal maximus in 1/4 side. Moreover, in 1/4 side, a twig of the internal pudendal artery exited pelvis from inferior piriformis foramen and distributed to the surrounding tissues. The present observations of the inferior gluteal nerve and artery course are very important and useful for surgeons and nurses.
文摘There are 12 billion injections given worldwide every year. For many injections, the intramuscular route is favoured over the subcutaneous route due to the increased vascularity of muscle tissue and the corresponding increase in the bioavailability of drugs when administered intramuscularly. This paper is a review of the variables that affect the success of intramuscular injections and the implications that these success rates have in psychiatry and general medicine. Studies have shown that the success rates of intended intramuscular injections vary between 32 and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition. These rates are found to be even lower for certain at-risk populations, such as obese patients and those on antipsychotic medications. The variables associated with an increased risk of injection failure include female sex, obesity, site of injection, and subcutaneous fat depth. New guidelines and methods are needed in order to address this challenge and ensure that patients receive optimum care. Looking forward, the best way to improve the delivery of intramuscular injections worldwide is to develop uniform algorithms or innovative medical devices to confirm or guarantee successful delivery at the bedside.
文摘Gluteal compartment syndrome(GCS) is a rare condition. We present a case of gluteal muscle strain with hematoma formation, methicillin-resistant Staphylococcus aureus(MRSA) superinfection, leading to acute GCS, rhabdomyolysis and acute kidney injury. This combination of diagnoses has not been reported in the literature. A 36-year-old Caucasian male presented with buttock pain, swelling and fever after lifting weights. Gluteal compartment pressure was markedly elevated compared with the contralateral side. Investigations revealed elevated white blood cell, erythrocyte sedimentation rate, C-reactive protein, creatine kinase, creatinine and lactic acid. Urinalysis was consistent with myoglobinuria. Magnetic resonance imaging showed increased T2 signal in the gluteus maximus and a central hematoma. Cultures taken from the emergency debridement and fasciotomy revealed MRSA. He had repeat, debridement 2 d later, and delayed primary closure 3 d after. GCS is rare and must be suspected when patients present with pain and swelling after an inciting event. They are easily diagnosed with compartment pressure monitoring. The treatment of gluteal abscess and compartment syndrome is the same and involves rapid surgical debridement.
文摘Objective: 1Department of Anatomy, College of Basic Medical Sciences, Second Military Medical University, Shanghai 200433, China 2Department of Orthopedic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Abstract Objective: To study the anatomical basis of transferring the superior gluteal nerve to the pudendal nerve in reconstructing the functional impairment in simple conus medullaris or pudendal nerve injury. Methods: Superior gluteal nerve and pudendal nerve were observed and measured by the gross and microsurgical anatomical methods in 62 sides of 31 adult cadavers. Results: Superior gluteal nerve came out of the superior foreman of piriformis as 1 to 4 branches(29.03%,56.45%,12.90% and 1.61% respectively) and the pelvic-leaving points were mainly in the middle 1/3(85.48%) of the line from the posterior superior iliac spine to the ischial tuberosity. The length of the inferior branch of the superior gluteal nerve was more than 5 cm, and the distance between the pelvic-leaving points of the superior gluteal nerve and pudandal nerve was about 4 cm only. The pudendal nerve left the pelvis mainly in the middle 1/3(48.39%) of the line from the posterior superior iliac spine to the ischial tuberosity,or at the junction of its inferior-middle 1/3(46.77%). In clinic, we have successfully made the operation transferring the superior gluteal nerve to the pudendal nerve in 3 patients suffered from the injury of conus medullaris. Conclusion: Distance between the pelvic-leaving points of the superior gluteal nerve and the pudendal nerve is close, so the inferior branch of the gluteal nerve can be anastomosed with the pudendal nerve directly. Transferring the superior gluteal nerve with higher spinal segemental origin to the pudendal nerve of a lower spinal segemental origin is practical and easy.
文摘The injection of adjuvant substances for aesthetic purposes is a public health problem, for 40 years this problem has been described throughout our continent, the vast majority of women patients are affected by the infiltration of silicon, mineral oils, automotive oil, methyl methacrylate, cement and various oily substances. This is a 54-year-old female patient who for about 30 years for cosmetic purposes was injected with mineral oil (quantity unknown) in both glutei with the aim of buttock augmentation. Physical examination was observed an important deformity in each buttock, hyperkeratosis with discoloration in both buttocks, loss of bilateral projection, right buttock with a secondary tumor of 22 cm × 11 cm and left 22 cm × 10 cm, stony appearance, local hyperthermia, painful on manipulation, with diffuse nodular lesions measuring 2 cm × 2 cm, without evidence of loss of continuity that would condition secretion leakage. Surgical planning is based on the very important size of the initial defect that we would have to reconstruct, so that the rotation of two wide-based flaps could guarantee better survival and occlusion of the defect, since the realization of a graft would cause a significant deformity, and the realization of a microsurgical flap in a fibrous tissue would inevitably result in its necrosis. The pathophysiology of the adjuvant disease is extremely complex, therefore it must be addressed by a multidisciplinary group with extensive experience.
文摘Gluteal hernias are extremely uncommon and occur as a result of deficiency or defect in the gluteal musculature. Our case reports one such incidence in a one year old girl with review of available literature. The clinical presentation and imaging findings are discussed comprehensively. We thus lay emphasis on the importance of real-time ultrasonography as the method of choice to identify hernia contents, peristalsis and obstruction if any.
文摘INTRODUCTION Benign metastasising leiomyoma (BML) is a rare condition marked by well-differentiated smooth muscle tumours appearing outside the uterus in women with a history of uterine leiomyoma.Metastasis from leiomyoma is found to be most common in the lungs(79.5%),but other organs,including the heart,lymph nodes,spine and soft tissues,can also be affected.
文摘Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.
文摘背景:梨状肌综合征是因梨状肌病变压迫坐骨神经致下肢疼痛的一种临床常见病症,目前临床尚无统一诊断标准和治疗共识。目的:全面探讨梨状肌综合征领域研究现状、趋势及热点。方法:于2024-11-13在PubMed数据库中检索有关梨状肌综合征的主题词和自由词并制定检索策略,在Web of Science核心合集数据库中检索发表的相关文献,经语言、文献类型限定及人工筛选后,运用Excel、VOSviewer、CiteSpace、Sci Explorer等工具进行可视化分析。结果与结论:共纳入238篇文献,涵盖了128个期刊和478个机构,共有57个国家或地区的1033位作者为梨状肌综合征领域贡献了宝贵的研究成果,其中总被引量5742次,平均每篇被引24次,H指数是42。1994-2024年,全球梨状肌综合征领域研究发文量呈增长趋势,美国在该领域发文量最多,发文量最多作者是Fishman,发文量最多的机构是美国哈佛大学,最有影响力的期刊是《Archives of Physical Medicine and Rehabilitation》,研究主要集中在梨状肌综合征的诊断、解剖与病因、治疗管理。预测未来的研究将继续围绕“解剖”“臀深综合征”“管理”展开。
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30971128）.
文摘Background Perforator flaps are used extensively in repairing soft tissue defects. Superior gluteal artery perforator flaps are used for repairing sacral defects, but the tension required for direct closure of the donor area after harvesting of relatively large flaps carries a risk of postoperative dehiscence. This research was to investigate a modified superior gluteal artery perforator flap for repairing sacrococcygeal soft tissue defects. Methods From June 2003 to April 2010, we used our newly designed superior gluteal artery perforator flap for repair of sacrococcygeal soft tissue defects in 10 patients （study group）. The wound and donor areas were measured, and the flaps were designed accordingly. Wound healing was assessed over a follow-up period of 6-38 months. From January 1998 to February 2003, twelve patients with sacrococcygeal pressure sores were treated with traditional methods, VY advancement flaps or oblong flaps, as control group. Results After debridement, the soft tissue defects ranged from 12 cm× 10 cm to 26 cm× 22 cm （mean 16.3 cm× 13.5 cm）. Four patients were treated using right-sided flaps ranging from 15 cm × 11 cm to 25 cm × 20 cm （mean 18.2 cm × 14 cm）. Four patients were treated using left-sided flaps, and two were treated using both right- and left-sided flaps. Suction drains were removed on postoperative Days 3-21 （mean 5.9） and sutures were removed on postoperative Days 12-14. Each flap included 1-2 perforators for each of the donor and recipient sites. Donor sites were closed directly. All flaps survived. In eight patients, the wounds healed after single-stage surgery. After further debridement, the wounds of the remaining two patients were considered healed on postoperative Days 26 and 33, respectively. The rate of first intention in the study group （80%, 8/10） significantly increased than that of control group （（25%, 3/12）, X2=4.583, P=0.032）. Follow-up examinations found that the flaps had a soft texture without ulceration. In the two patients without paraplegia, the range of motion of the hip joints was not affected. Conclusion The use of the quadrilobed superior gluteal artery perforator flap can overcome the disadvantages of traditional perforator flaps and represents an improved approach for repairing soft tissue defects in the sacrococcygeal region.
文摘Intramuscular hemangioma usually involues only a single muscle,but it may demonstrate regional involvement and can occasionally grow extremely large.In the latter condition,resection can be very difficult and occasionally lead to fatal uncontrollable bleeding during surgery.
文摘Free flap autologous breast reconstruction is becoming more and more common for post-mastectomy reconstruction.Abdominally-based tissue flaps are the first choice for many reconstructive breast microsurgeons,but not all patients are candidates,whether due to their leaner habitus or a history of prior abdominal surgery.The gluteal donor site in many patients can provide adequate soft tissue for autologous breast reconstruction,even in lean patients,with a scar that remains well-hidden.This review presents an overview of the superior gluteal artery perforator(SGAP)flap as an invaluable tool for autologous breast reconstruction.
基金Supported by Research fund of Dankook University in 2023,No.R202300627.
文摘BACKGROUND Patients with paraplegia are vulnerable to ischial pressure ulcers.Surgical treatments often lead to complications such as seroma and infection,necessitating repeated interventions that increase surgical difficulty.This case report aimed to introduce a novel treatment strategy combining negative pressure wound therapy(NPWT)with a fenestrated Penrose drain to manage refractory seroma in patients with a history of ischial pressure ulcers.CASE SUMMARY A 63-year-old woman presented with soft tissue defects on the left ischium and right trochanter.After surgical debridement,an inferior gluteal artery perforator(IGAP)flap was used to reconstruct the left ischium.NPWT was applied at a setting of 75 mmHg on postoperative day 3 owing to the development of seroma,combined with a fenestrated Penrose drain to facilitate effective drainage of serous fluid.A 54-year-old man presented with a 4 cm×2 cm ulcer on the left ischium after previous excision and flap coverage.After thorough debridement,the IGAP flap was elevated,and NPWT with a fenestrated Penrose drain was implemented immediately postoperatively at 75 mmHg to promote drainage.Both patients achieved a stable recovery without complications.CONCLUSION NPWT combined with a fenestrated Penrose drain placement is a promising strategy for addressing refractory seromas in cases of complex pressure ulcers.
