Free Arm Research Articles

Changes in Functional Magnetic Resonance Imaging Cortical Activation with Cross Education to an Immobilized Limb

The purpose of this study was to assess cortical activation associated with the cross-education effect to an immobilized limb, using functional magnetic resonance imaging. Fourteen right-handed participants were assigned to two groups. One group (n = 7) wore a cast and strength trained the free arm (CAST-TRAIN). The second group (n = 7) wore a cast and did not strength train (CAST). Casts were applied to the nondominant (left) wrist and hand. Strength training was maximal isometric handgrip contractions (right hand) 5 d·wk(-1). Peak force (handgrip dynamometer), muscle thickness (ultrasound), EMG, and cortical activation (functional magnetic resonance imaging) were assessed before and after the intervention. CAST-TRAIN improved right handgrip strength by 10.7% (P < 0.01) with no change in muscle thickness. There was a significant group × time interaction for strength of the immobilized arm (P < 0.05). Handgrip strength of the immobilized arm of CAST-TRAIN was maintained, whereas the immobilized arm of CAST significantly decreased by 11% (P < 0.05). Muscle thickness of the immobilized arm decreased by an average of 3.3% (P < 0.05) for all participants and was not different between groups after adjusting for baseline differences. There was a significant group × time interaction for EMG activation (P < 0.05), where CAST-TRAIN showed an increasing trend and CAST showed a decreasing trend, pooled across arms. For the immobilized arm of CAST-TRAIN, there was a significant increase in contralateral motor cortex activation after training (P < 0.05). For the immobilized arm of CAST, there was no change in motor cortex activation. Handgrip strength training of the free limb attenuated strength loss during unilateral immobilization. The maintenance of strength in the immobilized limb via the cross-education effect may be associated with increased motor cortex activation.

O111. Free lateral arm flap: A versatile technique for reconstruction of different body districts

O111. Free lateral arm flap: A versatile technique for reconstruction of different body districts

Standing long jump and handheld halters; is jumping performance improved?

The purpose of this experimental study was to document the kinematic and dynamic characteristics of the standing long jump without extra loading and with handheld weights (halters) of different mass and to investigate any association between the former and jumpers' performance. Fifteen subjects (13 males and 2 females) between the ages of 19 and 21 years old participated in this horizontal prospective study. Each participant performed standing long jumps. Regarding the jumping technique, free arm swinging without or with handheld halters of different weights (1.5 kg and 3 kg in each hand) was used. The subjects repeated the jumping set (consisted of free arm swinging jump, jumping with 3 kg and then with 6 kg handheld halters) three times and the three different technique jumps were performed in a random order. The jumping distance was significantly increased 7 cm (2.7%) with 3 kg handheld halters compared to free arm jumps (p=0.006). In addition the subjects jumped 5 cm further with 6 kg handheld weights (2.67±0.27 m) than without (2.62±0.21 m) (statistically significant difference, p=0.005). The horizontal displacement of the center of mass was significantly increased with 3 kg and 6 kg handheld compared to free arm jumps (p=0.007, p=0.005 respectively). Take off angle of center of mass difference was statistically significant between 0 kg (36±5o) and 6 kg (29±5o) handheld weights (12.13% decrease, p=0.001). A gradual significant increase in the horizontal take off velocity of the center of mass was depicted between free arm and 3 kg halters jump (3.5% increase) and 3 kg weights and 6 kg ones (3.69% increase). In conclusion greater distance is achievable during a loaded standing long jump due to 1) horizontal translation of the center of mass, 2) the greater ground reaction force that is generated, 3) decrease in take off angle of center of mass and 4) increase in the horizontal take off velocity of the center of mass.

Treatment of Segmental Bone and Soft-Tissue Defects of the Forearm With the Free Osteocutaneous Lateral Arm Flap

Complex defects of the forearm often require microvascular reconstruction with osteocutaneous free flaps to salvage the limb. In this review, we report our experience with the use of the free osteocutaneous lateral arm flap to reconstruct such defects in four patients. Three male patients with osseous defects of the ulna and one defect of the radius with associated soft-tissue defects were treated with a free osteocutaneous lateral arm flap between 2004 and 2007. The indications for the procedure included posttraumatic osteitis (3) and bone with soft-tissue defects after trauma (1). We evaluated the patients with respect to postoperative results by evaluating the range of motion, pain, strength, and score on the disabilities of the arm, shoulder, and hand questionnaire. Donor-site morbidity was also documented. The average length of segmental bone defects was 5.75 cm. The average dimension of the skin paddle was 99.5 cm. The average duration of follow-up was 43.3 months. All bone flaps healed without nonunion; the fasciocutaneous flaps healed without complications. No problems related to microanastomoses were found. Functional results were very satisfactory; disabilities of the arm, shoulder, and hand questionnaire scores showed a median of 5.8 (0-10.8). All patients had returned to their preinjury occupations. This analysis demonstrates that the free osteocutaneous lateral arm flap is an effective treatment for combined segmental osseous and soft-tissue defects of the forearm that are caused by osteitis and trauma.

The Effect of No Arm Swing and Arm Swing on Drop Jump Performance

Jump performance is used to assess and predict player readiness across a training season. Therefore, it is important to control factors that may change jump technique which may influence specific test results. PURPOSE: The aim of the present study was to observe the influence of free arm swing and no arm swing on drop jump characteristics: contact time (CT), flight time (FT), peak force (PF), relative peak force (RPF), and jump height (JH). METHODS: Drop jump testing was conducted across a training season in 10 NCAA Division I female basketball players. Participants reported seven times to the Biomechanics lab on the same day and time during seasonal training. The same general warm-up of 3-min on a cycle ergometer followed by a specific dynamic warm-up was performed each session. Participants performed two drop jump trials from a box height of 30cm, onto two force plates (1000Hz). RESULTS: Paired-sample t-tests revealed a significant difference in Hands on hip and Hands free CT (0.40 ± 0.08s vs. 0.42 ± 0.08s; p=0.000), FT (0.40 ± 0.02s vs. 0.44 ± 0.02s; p=0.029), PF (2996.3 ± 300.8N vs. 3249.7 ± 498.8N; p=0.000), RPF (3.92 ± 0.6 vs. 4.24 ± 0.7 (xBW); p=0.000), and JH (20.1 ± 0.02cm vs.24.1 ± 0.02; p=0.013). CONCLUSION: These data indicate that drop jump characteristics were altered by hand placement. Hands free drop jump trials produced significantly better scores than hands on hips in women collegiate basketball players.

Balance, Safety, and Passion: Three Principles for Academic Leaders

Mywork as Chair of a department of psychiatry has taught me three principles that seem to be fundamental to the role of academic leader. They include maintaining a balance in responding to the needs and input of faculty members, creating a safe place for learners to explore and grow, and helping both faculty members and trainees to find a career-sustaining passion. The first principle is balance. Each of us can recall those rare and wonderful moments of enlightenment that punctuate our lives. One of mine came on a trip to Italy with my daughter and her Latin club. In Rome, we visited the remarkable Villa Borghese museum, which houses an impressive array of the sculpture work of Gian Lorenzo Bernini. Already drawn in by the swirling vortexes of motion that Bernini creates with each of his pieces, I found myself standing before his “Escape from Troy” (circa 1619). In this piece, he depicts Aeneas fleeing the battle (2). He is not alone in his journey. On his back, he carries Anchises, his aging father. Clinging to his legs is his son, Ascanius, yet a mere boy. At that moment, I recognized myself in Aeneas, and identified with his predicament. At home were parents negotiating the final journey of their lives, dependent on me, my wife, and other caregivers for safe passage, even as our children were holding on to us until their legs were strong enough to run alone. Our challenge was to weigh the needs of all of them in the balance and decide how much of ourselves to give to each one. In later years, having moved into my role as Chair, I have drawn strength and guidance from the truth conveyed by Bernini in this piece. In countless ways, an academic leader is thrust into the role of seeking a balance between the influence of the wisdom of the past (older faculty members) and the idealism of the next generation (younger faculty members and trainees). Anchises is holding the Penates (family household gods), which represent the knowledge and traditions that give our current experiences context and meaning. Ascanius clings with his free arm to the sacred fire of the hearth that is symbolic of the passion and energy of youth that spurs us on to change and renewal. How to honor and validate the contributions of senior faculty while encouraging and incorporating the ideas of the newest members of our field is surely one of our great challenges as academic leaders. Similarly, we are also called upon to humanely manage the integrity of the aging “Anchiseses” in our departments who may have lost a step or two, while, at the same time, minimizing the negative impacts of impetuous “Ascaniuses.” No department can thrive without at least a modicum of new blood, but no department can afford to invest in every creative whim put forward by residents and junior faculty. A second principle I have found to be important as an academic leader is establishing a culture of safety. Early in my career, during a faculty discussion of why a resident was struggling to learn, one of my earliest mentors, Walter Ricci, commented that one of the biggest obstacles to learning is the fear of humiliation (Ricci W: personal communication). His words stopped me in my tracks. If he was correct, then centuries of hallowed medical teaching tradition would be called into question. Not long after this moment of truth, another mentor, Jerry Kay, published an article in JAMA describing medicine’s time-honored—and misguided—use of humiliation as a teaching tool (3). He confirmed Dr. Ricci’s assertion that good teachers beget good students by creating a learning environment where it Received October 4, 2010; accepted December 8, 2010. Dr. Munro is affiliated with the Department of Psychiatry at the University of Missouri-Kansas City in Kansas City. Address correspondence to Stuart Munro, M.D., Department of Psychiatry, University of Missouri-Kansas City, 1000 East 24th Street, KS City, KS 66217; stuart.munro@ dmh.mo.gov (e-mail). Copyright © 2011 Academic Psychiatry

Arm movement improves performance in clinical balance and mobility tests

Previous studies have suggested that arm movements can contribute to preventing the loss of balance or falls, and that aging affects the functions of arm movements. Clinical balance and mobility tests may be able to detect such aging effects. As the first step to approaching this question, the purpose of this pilot study was to investigate the effects of arm movements on the performance of clinical balance and mobility tests. Ten participants were evaluated in four clinical tests: (1) Maximal Step Length Test (MST), (2) Step Test (ST), (3) Timed Up and Go Test (TUG), and (4) Walk along an Elliptical Line (WEL). Each test was performed with free and limited arm movement and the outcomes were compared. Statistical analysis indicated a significant improvement in test performance when arms were used freely for three out of four tests (MST, ST and TUG), with inconclusive results on WEL. This pilot study showed improved performance on the clinical balance and mobility tests, suggesting that the contribution of arm movements is sufficiently large to be detected. This implies a feasibility for novel usage of clinical balance and mobility tests, i.e., to test the effectiveness of arm usage in balance and mobility.

Free flap transplantation in the reconstruction of large area defects in head and neck

Objective To review clinical experience of free flap transferring in the reconstruction of head and neck defects. Methods Fifteen free anterolateral thigh flaps, 5 free deep inferior epigastric flaps and 3 free lateral arm flaps were used to reconstruct large area head and neck defects. Results All 23 free flaps were alive with good appearance. 1 case survived by performing embolectomy after suffering arterial crisis and delayed recovery of wound took place in 2 cases. Conclusion Free flap transplantation is an ideal choice for reconstructing large area cranio-facio-cervical defects. Key words: Head and neck; Free flap; Transfer; Microsurgical operation

Einsatzmöglichkeiten des freien lateralen Oberarmlappens zur Defektdeckung an Hand und Unterarm

The purpose of this retrospective study was to verify the advantages and disadvantages of the free lateral arm flap for defect reconstruction of the forearm and hand. The data of 21 patients who underwent defect coverage of the forearm and hand with the free lateral arm flap between 2002 and 2010 were analyzed. The mean patient age was 48 years (range 17-78 years). The results concerning defect origin, flap size, pedicle length, operative time, revision of the anastomosis or other complications, donor site morbidity and length of hospital stay were evaluated. In 6 cases the defect was on the forearm and in 15 on the hand. The majority of defects were infections or chronic wounds. The overage flap width ranged from 3 to 8 cm and the length from 5 to 20 cm. Revision of the anastomosis was only necessary in one case and flap survival rate was 100%. In all patients primary closure of the donor site was possible without complications during the healing procedure. The results underline the good reliability of the free lateral arm flap with a satisfactory aesthetic appearance excellent tissue quality and frequent primary donor site closure.

Relation between physical capacity, nutritional status and systemic inflammation in COPD

Decreased physical capacity, weight loss, fat-free mass depletion and systemic inflammation are frequently observed in patients with chronic obstructive pulmonary disease (COPD). Our aim was to examine relations between physical capacity, nutritional status, systemic inflammation and disease severity in COPD. Forty nine patients with moderate to severe COPD were included in the study. Spirometry was preformed. Physical capacity was determined by a progressive symptom limited cycle ergo meter test, incremental shuttle walking test, 12-minute walk distance and hand grip strength test. Nutritional status was investigated by anthropometric measurements, (weight, height, arm and leg circumferences and skinfold thickness) and bioelectrical impedance assessment was performed. Blood samples were analyzed for C-reactive protein (CRP) and fibrinogen. Working capacity was positively related to forced expiratory volume in 1 s (FEV(1) ) (p < 0.001), body mass index and fat free mass index (p = 0.01) and negatively related to CRP (p = 0.02) and fibrinogen (p = 0.03). Incremental shuttle walk test was positively related to FEV(1) (p < 0.001) and negatively to CRP (p = 0.048). Hand grip strength was positively related to fat free mass index, and arm and leg circumferences. Fifty to 76% of the variation in physical capacity was accounted for when age, gender, FEV(1) , fat free mass index and CRP were combined in a multiple regression model. Physical capacity in chronic obstructive pulmonary disease is related to lung function, body composition and systemic inflammation. A depiction of all three aspects of the disease might be important when targeting interventions in chronic obstructive pulmonary disease.

A randomized placebo-controlled trial of melatonin for poor appetite in advanced cancer patients.

TPS319 Background: Although initially thought to be synthesized exclusively in the pineal gland and primarily involved as a circadian messenger of light and dark, melatonin is now recognized to have multiple actions and synthesized in various tissues including lymphocytes and the gastrointestinal tract. Melatonin supplementation stimulates appetite in animals, and its presence in the digestive tract is associated with intestinal transit and nutrient absorption. Altered levels of melatonin are found in patients with a range of cancers and preliminary nonrandomized studies in patients with advanced solid tumors suggest melatonin may attenuate weight loss, anorexia, fatigue, and depression. These studies are limited by a lack of blinding and the absence of placebo controls. Melatonin appears to be safe at doses up to 300 mg daily in noncancer patients and after prolonged use in normal volunteers. Methods: Eligibility criteria include patients with solid gastrointestinal tumors or lung cancer, a ≥ 5% involuntary weight loss within the last 6 months and anorexia > 3 (0 is best and 10 is worst) on the Edmonton Symptom Assessment Scale (ESAS). Patients with untreated endocrine dysfunction (hypoadrenalism and thyroid abnormalities) are excluded and nutritional impact symptoms such as nausea, diarrhea, mucositis, constipation, or clinical depression should be resolved or stable for ≥2 weeksat the time of inclusion. Design is a double-blind placebo-controlled trial of 20 mg melatonin vs. placebo for 4 weeks. At the end of 4 weeks, all study patients are given the opportunity to take 20 mg melatonin at night for an additional 4 weeks. The primary objective at 4 weeks is to determine whether melatonin improves appetite in patients with advanced lung cancer or gastrointestinal cancer as defined by a decrease of 1.5 in appetite score from baseline (on ESAS). The secondary objectives include body weight, lean body mass (by bioelectrical impedance and bone free arm muscle area), caloric intake (24 hour diet recall), resting energy expenditure (indirect calorimetry) and serum levels of C-reactive protein. Current accrual stands at 62 patients, and we anticipate enrolling 126. No significant financial relationships to disclose.

Rescue of postoperative carotid blowout in head and neck neoplasms

To investigate the prevention and rescuing measures of postoperative fatal bleeding induced by carotid blowout in head and neck tumors. Seven cases with postoperative carotid bleeding treated from October 2003 to August 2009 were reviewed retrospectively. Of the patients, 6 were with common carotid blowout and one with internal carotid artery blowout. All patients underwent pre- or post-operative radiotherapy for primary head and neck tumours and 3 patients had neck defect repair with deltopectoral skin flap, frontal flap or free radial arm flap respectively. After carotid blowout bleeding, the patients were treated in time with X ray transcatheter intervention including transcatheter arterial embolization (TAE) and self-expanding covered stent implantation, followed by repairing the carotid region with appropriate myocutaneous flaps. Of 7 patients with carotid blowout, 5 patients were successfully rescued with X ray transcatheter intervention, of them 2 with self-expanding covered stent implantation and 2 with TAE respectively, and other 2 patients died due to rapid bleeding. Of the successfully rescued patients, 2 patients were with the repair of carotid area by pectoralis major myocutaneous flap, one by submental flap and one by local flap, but another one not with flap repair. Follow-up showed the 3 patients rescued with self-expanding covered stent implantation were survival for 6, 12, and 20 months, respectively, and the 2 patients rescued with TAE died of repeated carotid blowout in 2 and 13 months later, respectively. The planned and timely X ray transcatheter intervention is an effective method to treat carotid blowout bleeding in the patients underwent head and neck tumour surgeries. Compared with TAE, self-expanding covered stent implantation may be more reliable for restoring the blood supply of head and neck region, with less complications. One-stage repair of carotid region with myocutaneous flap is of great importance to protect the carotid and to promote the wound healing.

The preparation of multimetallic complexes using sterically bulky N-centred tripodal dialkyl phosphino ligands

Sterically bulky monodentate and bidentate phosphines have been widely used as ligands for metal complexation and catalyst formation. Bulky tridentate phosphine ligands are however much rarer and have not been widely investigated even though they may be considered attractive ligands for coordination chemistry studies and catalysis. Here we report the synthesis of two new N-centred tripodal phosphine ligands bearing bulky cyclohexyl and tert-butyl groups. The coordination chemistry of the cyclohexyl triphosphine ligand N(CH 2PCy 2) 3 ( 4) was investigated and found to react with Mo and W hexacarbonyls preferentially forming bidentate metal tetracarbonyl complexes [Mo(CO) 4{N(CH 2PCy 2) 3-κ 2 P}] ( 6) and [W(CO) 4{N(CH 2PCy 2) 3-κ 2 P}] ( 7) over the expected facial capping tridentate complexes. The steric bulk of the cyclohexyl groups on the phosphorus atoms is sufficient to prevent the third arm of the ligand from coordinating and adopting the required geometry for facial coordination. This ‘steric control’ at the metal centre results in the third arm remaining freely available for further metal coordination. The coordination chemistry of this free phosphine arm on complexes 6 and 7 was investigated further and used to prepare a series of gold, platinum and silver multimetallic complexes. The X-ray crystal structures of the resulting mixed bi and trimetallic complexes [W(CO) 4{N(CH 2PCy 2) 3-κ 2 P}AuCl] ( 8), [[Mo(CO) 4{N(CH 2PCy 2) 3-κ 2 P}] 2(μ-PtCl 2)] ( 9) and [[W(CO) 4{N(CH 2PCy 2) 3-κ 2 P}] 2(μ-Ag)]ClO 4 ( 11) are reported.

The relationships between percent body fat and other anthropometric nutritional predictors among male and female children in Nigeria

The relationships between the percent body fat and other nutritional predictors were assessed among forty male and forty female children aged 2 – 10 years. Both sexes were age – matched. There was no significant difference in age between the two groups (P >0.001). A weak significant positive correlation was observed between the percent body fat and height – armspan ratio in female children (r = 0.300;P = 0.05). Height showed a high positive correlation with body’s armspan in males (r = 0.916; P= 0.001) Body mass armspan (BMA) correlated positively and significantly with body mass index (BMI) in female (r = 0.922;P = 0.001). The corrected bone – free arm muscle area (AMA) gave positive values in females while two negative values of corrected AMA were observed in males. Mid – upper arm circumference (MUAC) appeared to be a more sensitive predictor of protein – energy malnutrition (PEM) in these children. The mean MUAC was 17.03cm in males and 17.0 cm in females, respectively. There was evidence of overweight and obesity in both children. The mid – arm muscle circumference (MAMC) gave mean value of 14.44 and 13.07 cm in males and females, respectively. The clinical significance of MUAC, MAMC and corrected AMA measurements are discussed (Afr. J. Biomed. Res. 9: 45 – 52, 2006) Keywords: body fat, Nutrition, anthropometric, children, Nigeria

The [Pd(bipy)]2+ “merry-go-round”: Insights into the lability of the Pd–N bond

Abstract Two tripods (1 and 2) featuring pyrimidinyl pendant arms have been synthesized from 5-(1H-pyrazol-3-yl)-pyrimidine (5) and 1,3,5-tribromomethylbenzene derivatives. Reaction with three equivalents of [Pd(bipy)](NO3)2 to form a macrotricycle closed by palladium coordination unexpectedly afforded the mononuclear species [Pd(1)(bipy)]2+ and [Pd(2)(bipy)]2+. These complexes show fluxional behavior on the 1H NMR timescale, the [Pd(bipy)]2+ fragment hopping between the pyrimidinyl coordinating moieties. The ΔGc‡’s estimated by the coalescence method are temperature independent, which means that ΔSc‡ = 0. This indicates that the “merry-go-round” process of [Pd(bipy)]2+ occurs intramolecularly, presumably by nucleophilic attack of the free pyrimidinyl arm to the bound Pd2+ center. This phenomenon permits to quantify the lability of the Pd–N coordination bond, the average ΔGc‡ ≈ ΔHc‡ value being 70 kJ mol–1.

Bis(triethano-lamine)nickel(II) sulfate.

The title compound, [Ni(C6H15NO3)2]SO4, contains two triethano­lamine (TEA) ligands bound to an Ni2+ metal centre, which lies on a crystallographic inversion centre, and one sulfate anion located on a twofold rotation axis such that the asymmetric unit contains one-half molecule of the cation and of the anion. The triethano­lamine ligands coordinate via each axial N atom and two of the three O atoms, while the third arm of the ligand has the hydroxyl group pointing away from the metal centre. The sulfate anions are hydrogen bonded to the coordinated hydroxyl groups and also to the free arm, forming a two-dimensional supra­molecular hydrogen-bonded network expanding parallel to (010).

Dinamometría en niños y jóvenes de entre 6 y 18 años: valores de referencia, asociación con tamaño y composición corporal

Introduction Handgrip strength is an important test to evaluate physical fitness and nutritional status. The main objective of this research is to prepare a reference standard applicable to the Spanish population of both sexes between 6 and 18 years old. At the same time, to extend our knowledge of normal variation of this characteristic with age, gender, size and body composition. Materials and methods The sample consisted of 2125 subjects between the 6 and 18 years (1176 boys and 949 girls). The handgrip strength of both hands was taken with a digital adjustable dynamometer. Weight, height, forearm circumference and skin fold thickness were measured mass index, fat free. Body mass, percentage of fat and total, muscle and fat forearm areas were estimated. Ontogenetic and sexual variability of dynamometric force was analysed and a table was produced with the mean, standard deviation and percentile distribution, by hand, age and gender. Multiple correlation analysis was applied to establish the relationship between handgrip dynamometric force, body mass index and body composition variables. Results and conclusion Handgrip strength increases with age and a significant sexual dimorphism from the age of 12 years is observed. Growth charts with normal values obtained in healthy Spanish children and teenagers could be used as a reference pattern. The correlation between hand static force and fat free mass or arm muscle area is stronger than with direct size variables or body mass index.

Strength training the free limb attenuates strength loss during unilateral immobilization

The objective was to determine if strength training the free limb during a 3-wk period of unilateral immobilization attenuates strength loss in the immobilized limb through cross-education. Thirty right-handed participants were assigned to three groups. One group (n = 10) wore a cast and trained the free arm (Cast-Train). A second group (n = 10) wore a cast and did not train (Cast). A third group (n = 10) received no treatment (control). Casts were applied to the nondominant (left) wrist and hand by a physician. Strength training was maximal isometric ulnar deviation (right hand) 5 days/wk. Peak torque (dynamometer), electromyography (EMG), and muscle thickness (ultrasound) were assessed in both arms before and after the intervention. Cast-Train improved right arm strength [14.3 (SD 5.0) to 17.7 (SD 4.8) N x m; P < 0.05] with no significant muscle hypertrophy [3.73 (SD 0.43) to 3.84 (SD 0.52) cm; P = 0.09]. The immobilized arm of Cast-Train did not change in strength [13.9 (SD 4.3) to 14.2 (SD 4.6) N x m] or muscle thickness [3.61 (SD 0.51) to 3.57 (SD 0.43) cm]. The immobilized arm of Cast decreased in strength [12.2 (SD 3.8) to 10.4 (SD 2.5) N x m; P < 0.05] and muscle thickness [3.47 (SD 0.59) to 3.32 (SD 0.55) cm; P < 0.05]. Control showed no changes in the right arm [strength: 15.3 (SD 6.1) to 14.3 (SD 5.8) N x m; muscle thickness: 3.57 (SD 0.68) to 3.52 (SD 0.75) cm] or left arm [strength: 14.5 (SD 5.3) to 13.7 (SD 6.1) N x m; muscle thickness: 3.55 (SD 0.77) to 3.51 (SD 0.70) cm]. Agonist muscle activation remained unchanged after the intervention for both arms [right: 302 (SD 188) to 314 (SD 176) microV; left: 261 (SD 139) to 288 (SD 151) microV] with no group differences. Strength training of the free limb attenuated strength loss in the immobilized limb during unilateral immobilization. Strength training may have prevented muscle atrophy in the immobilized limb.

Sensate Lateral Arm Flap for Defects of the Lower Leg

Ideally, reconstruction of lower extremity soft tissue defects includes not only an esthetically pleasing 3-dimensional shape and solid anchoring to the underlying structures to resist shear forces, but should also address the restoration of sensation. Therefore, we present a prospective study on defect reconstruction of the lower leg and ankle to evaluate the role of sensate free fasciocutaneous lateral arm flap and the impact of sensory nerve reconstruction. Thirty patients were allocated randomly to the study group (n = 15) that obtained end-to-side sensate coaptation using the lower lateral cutaneous brachial nerve to the tibial nerve using the epineural window technique, or to the control group reconstructed without nerve coaptation. At 1-year follow-up the patients were evaluated for pain sensation, thermal sensibility, static and moving 2-point discrimination, and Semmes-Weinstein monofilament tests. Data from both groups were compared and statistically analyzed with the Mann-Whitney U test and the Fisher exact test. Flaps of the study group reached a static and moving 2-point discrimination and Semmes-Weinstein monofilament tests nearly equal to the contralateral leg area and significantly better than flaps of the control group. Donor damage morbidity of the tibial nerve did not occur. To our point of view resensation should be carried out by end-to-side neurorrhaphy to the tibial nerve because of the superior restoration of sensibility.

A Single-Stage Reconstruction of a Complex Achilles Wound with Modified Free Composite Lateral Arm Flap

Composite defect of the posterior aspect of the heel, including the Achilles tendon, usually is very difficult to reconstruct as we face the problems of controlling infection, resurfacing the deficient skin defect, and restoring plantar flexion. With the latest advances in microsurgery, several free composite flaps have been used to reconstruct the defect in the Achilles tendon region to achieve stable and functional soft tissue coverage. We report such a single-stage reconstruction of a complex Achilles wound using the modified neurosensory lateral arm free flap including the triceps tendon strip and the posterior cutaneous nerve. Authors' rolled-up triceps tendon strip method is presented for the one-stage reconstruction of the Achilles tendon and soft tissue defect, providing good contour, strong tension, and protective sensation. The follow-up has proved a satisfactory outcome.