Sound Leg Research Articles

Ipsilateral Island Fibula Transfer for Segmental Tibial Defects: Antegrade and Retrograde Fashion

Five patients with segmental tibial defects whose contralateral fibula could not be used as a donor were treated with ipsilateral island fibular transfer in an antegrade or retrograde fashion. Antegrade-flow pedicled flaps based on the peroneal vessel as in the conventional free flap were used for the proximal or middle one-third tibial defects, whereas retrograde-flow pedicled flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. All patients had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibia fracture, refusal to use the contralateral sound leg, or poor general condition to endure a lengthy operation. Four of the patients also had an associated fibular fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 31 to 48 months. Time to bony union ranged from 4 to 7 months. Time to full weight bearing was from 5 to 9 months after operation. All of the transferred fibulas showed hypertrophy after weight bearing. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. The limb was shorter by an average of 0.5 cm in three cases, longer by 1.1 cm in one case, and in the last case, it was uncheckable because the opposite limb was previously amputated. Limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these methods can be a valuable alternative to the contralateral free fibula flap in certain cases.

The efficacy of the one-leg cycling test for determining the anaerobic threshold (AT) of lower limb amputees.

The aim of this study was to investigate whether or not the one-leg cycling test driven by the subject's sound leg as the exercise load method is an applicable method for determining the anaerobic threshold (AT) of lower limb amputees. To evaluate physical fitness, a graded exercise test that monitored gas exchange, ventilation and heart rate (HR) was performed in 51 unilateral lower limb amputees. AT was successfully measured for 42 out of 51 subjects, an 82.3% success rate. The average AT was 12.7 +/- 2.2 ml/kg/min, and the average HR at AT points was 117.7 +/- 16.2 beats/min. The average peak oxygen uptake was 20.1 +/- 5.6 ml/kg/min, and the average peak HR was 145.1 +/- 22.4 beats/min. The peak HR exceeded the HR at AT by an average 27.4 beats/min, which indicates that a comparatively intense exercise load above the AT level is possible. The average AT was 40.9% of the predicted maximum oxygen uptake, which seems reasonable when compared to the reports of other researchers. These results suggested that the one-leg cycling test driven by the sound limb is of use as a method for determining the AT of lower limb amputees.

Analysis of the swing phase dynamics and muscular effort of the above-knee amputee for varying prosthetic shank loads

The purpose of this study was to determine the effect of varying prosthetic shank mass, while maintaining the mass centre location and moment of inertia, on the swing phase kinematics, kinetics and hip muscular effort of free speed above-knee (AK) amputee gait. Six AK amputees, wearing similar prosthetic designs, had three load conditions applied to their prosthetic shank: 1) Load 0-unloaded (X = 39.1% sound shank mass), 2) Load 1-75%, and 3) Load 2-100% sound leg mass. Despite increases in shank mass from 1.33 to 3.37 kg the AK amputee was able to maintain a consistent swing time and walking speed. As load increased, there were significant changes in the maximum knee and hip displacements, as well as phasic shifting. The prosthetic knee Resultant Joint Moment (RJM) was negligible while the shank was accelerating (periods 1 and 2), but was a major contributor during shank deceleration (periods 3 and 4). During periods 1 and 2 the principle contributors to the shank acceleration (forces resisting excessive knee flexion) were the gravitational moment (S-G) and the moment due to thigh angular acceleration (S-AT). During the periods of shank acceleration (sections 1 and 2), there was not a significant increase in the hip muscular effort. However, during sections 3 and 4, the periods associated with shank deceleration, there were significant increases in the hip muscular effort. The hip muscular effort for the complete swing phase increased as load increased by 36.7% and 71.3% for loads 1 and 2. Despite the significant increases in hip muscular effort, four of the six subjects preferred load 1 condition.

A New Method for Repairing Skin Defects of the Lower Leg under Unsatisfactory Conditions

As a new procedure for the repair of tissue defects in the lower leg under unsatisfactory conditions, we have devised a surgical procedure for peroneal island flap transfer from the opposite sound leg. This report presents three patients treated by cross-leg island flaps with reversed blood flow. This procedure can be applied for reconstruction of the leg with severe circulatory disturbance caused by arterial damage due to trauma and arterial disease such as Buerger's disease. Furthermore, joint exercise is possible because the pedicle is long and no rigid immobilization is required.

Responses of ankle musculature of healthy subjects and hemiplegic patients to sinusoidal anterior-posterior movements of the base of support.

The responses of the medical gastrocnemius and tibialis anterior muscles to continuous sinusoidal perturbation of the base of support were studied in two groups of subjects, forty-two volunteers aged 20 to 84 years and 17 hemiplegic patients aged 52 to 81 years. EMGs were recorded while subjects stood on a platform oscillating in the anterior-posterior direction. Movement amplitude was adjusted to the maximum the subject could sustain without assisted support within the limits of the instrument. In healthy subjects, two basic activation modes were indicated: (a) a reciprocal contraction pattern in which activity of the medial gastrocnemius and tibialis anterior muscles was concentrated in the anterior and posterior half of the oscillation, respectively. This pattern prevailed in the younger subjects whose maximal movement amplitude reached the highest limit of the instrument; (b) a less discrete pattern, characterized by tonic contraction and periods of coactivation of the two muscles, was seen in older subjects who had difficulties in maintaining stance on the moving platform. The disruption of the discrete reciprocal response mode in this group of patients was related to decline in function of postural mechanisms with aging and demanded additional stiffening of the ankle join, presumably a manifestation of reduced automatism in favor of closer CNS modulation. The typical response mode in the sound leg of the hemiplegic patients was variable coactivation of the two muscles. In the afflicted leg, the establishment of a motor set was impaired: Low tone was associated with negligible muscular activity, although with more elevated tone, low level uniform cocontraction was evident.

ひ骨付きｆｒｅｅ ｐｅｒｏｎｅａｌ ｆｌａｐによる下たい骨開放骨折の一治験例

A 52-year-old man sustained a severe compound injury of his left leg by traiffic accident. At the involved site, the tibia became and infected skin the over its anterior surface came into necrosis, which required extensive resection. A 25cm long fibula shaft with a 8.5 by 18cm, peroneal skin flap from the sound leg was grafted to the defect part of his involved leg with anastomosis between the donor peroneal vesseles in and the recipient tibialis anterior vesseles.Five months after surgery, the grafted fibula shaft with peroneal flap has successfully untited to the recipient site.

Motion analysis in the movements of standing up from and sitting down on a chair. A comparison of normal and hemiparetic subjects and the differences of sex and age among the normals

With regard to the motions of standing up from and sitting down on a chair, and standing quietly for thirty seconds, forty normal adults (ten young males, ten young females, ten elderly males and ten elderly females) and ten hemiparetics were compared by use of a force plate and an electrogoniometer. The hemiparetics had the following characteristics: (1) A long time was required for stabilization of sway at the center of force (C.O.F.) when standing up. (2) The C. O. F. was located to the back and deviated primarily to the sound leg, and the grade of sway was greatest during quiet standing. (3) Vertical 8 Hz fluctuation in quiet standing was seen in all cases, while in sitting down 3-4 Hz were recorded. (4) The motion time in standing up and sitting down was prolonged. (5) Long periods of initial knee flexion existed just before the knee extension in standing. (6) A broad lateral sway of C. O. F. was recorded in the standing movement. Among the normal groups, the following characteristics were noted: (1) The young stand up more rapidly. (2) The elderly needed more time to stabilize the antero-posterior sway in the standing up motion. (3) The C. O. F. of males was located more anteriorly than that of females. (4) The grade of sway in quiet standing was greater in females than in males. (5) In young males, the standing up time was shorter than the sitting down time, while in young females the situation was reversed.(ABSTRACT TRUNCATED AT 250 WORDS)

Alignment of the above-knee prosthesis.

1. A long prosthesis forces drop of the pelvis on the normal side, can cause crotch pressure and distal femoral pressure leading to discomfort, can reduce voluntary control, may force the amputee to walk with an abducted stump hip for stance phase and to swing the leg outward for toe clearance in swing phase or to compensate by rising up on the sound foot to clear the prosthetic foot. 2. A short prosthesis may shorten stride, increase listing over the prosthesis in stance phase, enhance prospects for a narrow, walking base and increase the ease of balancing o ver the prosthesis in stance phase. 3. Moving the foot forward relative to the stump increases prosthetic stride length. 4. Moving the foot posteriorly relative to the stump does the reverse. 5. Displacing the foot medially has variable effects which may include walking with a narrow base, moving the foot laterally by hip abduction of the stump for relief of pain and increased voluntary control. Stump length and strength is a strong mediator in what choice the amputee makes as he tries to get comfort, save energy and maintain a cosmetic gait. 6. Displacing the foot laterally may lead to the amputee adducting the stump to reduce the width of the walking base, or force him to lean over the prosthesis during stance phase an it, or lift his body over the prosthesis by means of a strong lateral impulse from the sound leg as the prosthesis becomes weight-bearing with the torso erect. 7. Increasing downward inclination of the prosthetic toe shortens stride on the normal side. 8. Tilting the toe upward on the prosthetic side lengthens stride on the normal side. 9. Knee axis stability is increased for a larger percentage of the stance phase on the prosthesis when the prosthetic toe is inclined — downward or when the prosthetic foot is moved forward with respect to the stump. 10. Toe-in and toe-out have comparable effects to moving the foot inward or outward except that the effects are lessened or reversed at heel contact, tending toward the effects indicated as the step advances. 12. Inversion-eversion changes are basically for cosmetic effects.

Observations on the expected decrease in proprioceptive discharge and purported advent of non-proprioceptive activity from the chronically tenotomized muscle

Uncertainties in present understanding of the net effect of chronic tenotomy on muscle sensory activity caused us to make comparisons of the multi-unit discharge from tenotomized medial gastrocnemius muscles in cats and rats. With the calf muscles fully relaxed, the dorsal root activity from the selectively denervated legs was less on the tenotomized side in 15 of 20 chronic cat preparations. In rats, activity recorded from the tenotomized muscle nerve was greater in a 2-week period following tenotomy, but not at later times. At intermediate degrees of stretch of the calf region induced by flexing the ankles activity levels from the tenotomized muscles were consistently less, whether the spindle receptors were passive or under fusimotor activation. However, with the muscles remaining as they had been throughout the chronic period, activity on the tenotomized side sometimes equalled or exceeded that developed contralaterally when flexion of the ankle approached its physiological limit. This observation was significant, since in the behaving animal, the ankle on the experimental side was often seen to be more sharply flexed than in the sound leg. Factors that might contribute to the specious appearance of increased activity in the peripheral nerve are discussed, and arguments adduced against the hypothesis that non-proprioceptive sensory endings are the source of increased discharge after tenotomy.

A NEW SIGN FOR THE DETECTION OF MALINGERING AND FUNCTIONAL PARESIS OF THE LOWER EXTREMITIES.

The sign I wish to describe is one which I have employed for the past two years. Although the cases observed number only four, I feel justified in attaching great importance to the sign because it is dependent on a normal function, which I find always exhibited in healthy persons and invariably present in the sound leg of patients suffering from hemiplegia or paresis of one leg due to some pathologic lesion. If a normal person, lying on a couch in the dorsal position, be asked to lift the right foot off the couch with the leg extended, the left heel will be observed to dig into the couch as the right leg and thigh are elevated. If you place your hand under the tendo Achillis of the left side and sense the muscular resistance offered by the left leg you will observe that the left heel is pressed on