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Tempski J, Fibiger G, Majka K, Pękala J, Łazarz D, Malinowski K, Walocha JA, Pękala P. Clinical anatomy of the inferior gluteal nerve - systematic review and meta-analysis. Ann Anat 2025; 260:152661. [PMID: 40220798 DOI: 10.1016/j.aanat.2025.152661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 03/19/2025] [Accepted: 04/08/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND The variations and patterns presented by inferior gluteal nerve (IGN) have been linked to iatrogenic complications, particularly in pelvic operations. The aim of this meta-analysis was to obtain data regarding IGN morphometry, communication and relationship with nervous structures of the gluteal area, course, pattern and muscle innervation. METHODS A large-scale search was conducted (PubMed, Embase, Science Direct and Web of Science) with no restrictions on date or language. Included categories involved prevalence, course, patterns, origin and distances from respective anatomical landmarks. RESULTS A total of 20 studies (n = 1235 hemipelves) were incorporated into our publication. The distance between the main branch of IGN and the greater trochanter was 70.2 mm (95 %CI:37.9-102.5). In the mid-gluteal region, the nerve was 22.6 mm (95 %CI:11.3-33.8) away from the ischial spine. Moreover, for this study's purpose we distinguished seven morphological IGN variants, which presented different courses in regard to the piriformis muscle. The most common was type I, in which IGN went under the piriformis muscle and its prevalence equaled 90.6 % (95 %CI:83.2-98.4;p < 0.001). CONCLUSION Clinicians, particularly those performing hip surgeries, should be aware of the potential variations of IGN and their associated challenges, as such knowledge can help mitigate the risk of injury to this structure. The IGN's close proximity to the greater trochanter plays a crucial role in the posterior approach to the hip, as it could be used as a landmark to help prevent iatrogenic damage during this procedure.
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Affiliation(s)
- Jonasz Tempski
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
| | - Grzegorz Fibiger
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Kraków, Poland; ARTROMED Orthopedic and Rehabilitation Center, Kraków, Poland
| | - Katarzyna Majka
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Kraków, Poland
| | - Jakub Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Dominik Łazarz
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Konrad Malinowski
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Artromedical Orthopedic Clinic, Bełchatów, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- International Evidence-Based Anatomy Working Group, Kraków, Poland; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Kim EC, Park JD, Wee SY, Kim SY. Measurement of combined flap thickness for reconstruction of decubitus ulcer using computed tomography. World J Clin Cases 2023; 11:7562-7569. [DOI: 10.12998/wjcc.v11.i31.7562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/23/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Various reconstruction options have been introduced to treat decubitus ulcers. A combined flap that takes advantage of the fasciocutaneous and muscle flaps has been proven to be effective in reconstructing decubitus ulcers in previous studies. However, no studies have measured combined flap thickness. This is the first study to demonstrate the superiority of the combined flap by measuring its thickness using enhanced abdominopelvic computed tomography (APCT).
AIM To evaluate combined flap modality as a useful reconstruction option for decubitus ulcers using measurements obtained through APCT.
METHODS Fifteen patients with paraplegia who underwent combined flap surgery for reconstruction of decubitus ulcers between March 2020 and December 2021 were included. The defects in the skin and muscle components were reconstructed separately. The inner gluteus muscle flap was split and manipulated to obliterate dead space. The outer fasciocutaneous flap was transposed to cover the muscle flap and opening of the decubitus ulcer. Subsequently, we performed enhanced APCT at 3 wk and 6 mo postoperatively to measure the flap thickness.
RESULTS The mean flap thickness was 32.85 ± 8.89 mm at 3 wk postoperatively and 29.27 ± 8.22 mm at 6 mo postoperatively. The flap thickness was maintained without any major complications such as contour deformities or recurrence.
CONCLUSION Although there was a significant decrease in flap thickness as measured by APCT, the combined flap provided sufficient padding and maintained its thickness even at 6 mo after reconstruction, suggesting that the combined flap modality may be a useful reconstruction option for patients with paraplegic decubitus ulcers.
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Affiliation(s)
- Eun Chan Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gyeonsangbuk-do, Gumi 39371, South Korea
| | - Jeong Do Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gyeonsangbuk-do, Gumi 39371, South Korea
| | - Syeo-Young Wee
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gyeonsangbuk-do, Gumi 39371, South Korea
| | - Se-Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Gumi Hospital, Gyeonsangbuk-do, Gumi 39371, South Korea
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Manzaneda Cipriani RM, Babaitis R, Vega HD, Viaro M, Flores E, Adrianzen GA. Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4918. [PMID: 37020987 PMCID: PMC10069849 DOI: 10.1097/gox.0000000000004918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
The gluteal region remains the preferred site for fat grafting. However, the transition from the gluteal region to the thighs has not been well studied. This study aimed to describe an echographic guidance hamstring volumization procedure (Hv-FAT) as a complement to body contouring surgery.
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Thickness of the Deltoid Muscle and Location of the Anterior Branch of the Axillary Nerve and the Posterior Circumflex Humeral Artery for Deltoid Injections. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1784572. [PMID: 36567904 PMCID: PMC9779993 DOI: 10.1155/2022/1784572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
Abstract
This study investigated the thickness of the deltoid muscle and the location of the anterior branch of the axillary nerve (AAN) and posterior circumflex humeral artery (PCHA), with the goal of maximizing the effectiveness of deltoid injections. Forty specimens from 22 adult Korean cadavers were used. A reference line was identified, connecting the anterior point of the deltoid muscle (AP) and the posterior point of the deltoid muscle (PP) on the surface. The midpoint between the AP and PP was used as the origin point (OP). The line connecting the OP and the lowest point of the deltoid tuberosity (DP) was used as the y-axis. The mean distance of the reference line from the AP to PP was 4.7 ± 0.7 cm. The vertical mean length of the deltoid muscle from the OP and DP was 16.1 ± 1.0 cm. At the 3, 5, and 7 cm sites, the thickness of the deltoid muscle was 0.62 ± 0.9, 0.73 ± 0.7, and 1.3 ± 1.1 cm, respectively. Most of the branches of the axillary nerve were concentrated in the third section (4-6 cm, 51%), while the branches of the PCHA were predominantly found in the fourth section (6-8 cm, 69%). The peripheral branches of the AAN entering the muscle were distributed between 2.2 and 9.8 cm from the acromion. The mean number of the peripheral branches of the AAN was 9.6 ± 3.4. In the deltoid muscle, the mean number of peripheral branches of the PCHA was 8.2 ± 2.8. Administering deltoid injections 5-6 cm below the OP is recommended to avoid axillary nerve injury.
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Wijker BJ, de Groot S, van Dongen JM, van Nassau F, Adriaansen JJE, Achterberg-Warmer WJ, Anema JR, Riedstra AT, van Tulder MW, Janssen TWJ. Electrical stimulation to prevent recurring pressure ulcers in individuals with a spinal cord injury compared to usual care: the Spinal Cord Injury PREssure VOLTage (SCI PREVOLT) study protocol. Trials 2022; 23:156. [PMID: 35172888 PMCID: PMC8848924 DOI: 10.1186/s13063-022-06088-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pressure ulcers (PUs) on the buttocks are among the most common secondary complications in individuals with chronic spinal cord injury (SCI). PUs can result from sitting for extended periods, disuse atrophy, increased sitting pressure and reduced circulation. Compared with usual care, activation of paralysed muscles using electrical stimulation (ES) has been shown to markedly increase paralysed muscle mass, improve circulation of skin and muscle and improve sitting pressure distribution. ES might therefore be a useful method to reduce PU incidence. METHODS A multicentre randomized controlled trial (SCI PREVOLT) will be conducted with an economic and process evaluation alongside. One hundred participants with a SCI in the chronic phase and a minimal incidence of 1 PU in the last 5 years will be recruited from rehabilitation centres across the Netherlands. Participants will be stratified by centre and age and randomized to the intervention or control group. The intervention group will use ES at least 1 h/day during at least 4 times a week for 1 year next to usual care. The control group will only receive usual care. The primary outcome is the incidence of PUs, measured by a blinded person assessing the presence or absence of a PU on the buttocks on a photo made by the participant or his/her caregiver. The incidence of a PU will be evaluated every 2 weeks. Secondary outcomes include interface pressure distribution, blood flow in the profunda femoris artery, muscle thickness of the hamstrings and gluteal muscles and questionnaires about different dimensions of life, e.g. participation and quality of life. Secondary outcomes will be measured at baseline and 3, 6, 9 and 12 months after randomization. DISCUSSION This study will assess if electrical stimulation is a (cost-)effective method to prevent PUs and reduce the risk factors of getting PUs. If ES is effective and cost-effective compared with usual care, ES could be implemented in daily treatment of individuals with a SCI. TRIAL REGISTRATION Netherlands Trials Register NTR NL9469 . Registered on 26 May 2021.
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Affiliation(s)
- Boas J. Wijker
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sonja de Groot
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - Johan R. Anema
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Andries T. Riedstra
- Paraplegia Organization | Dwarslaesie Organisatie Nederland (DON), Nijkerk, The Netherlands
| | - Maurits W. van Tulder
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas W. J. Janssen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
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Wang Y, Yang J, Yan Y, Zhang L, Guo C, Peng Z, Kong Q. Possible pathogenic mechanism of gluteal pain in lumbar disc hernia. BMC Musculoskelet Disord 2018; 19:214. [PMID: 29996837 PMCID: PMC6042418 DOI: 10.1186/s12891-018-2147-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/20/2018] [Indexed: 02/05/2023] Open
Abstract
Recent reported results by Fang et al. published in BMC Musculoskeletal Disorders have added to the weight of evidence supporting association between gluteal pain and lumbar disc hernia. Their clinical finding shows the L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. Indeed, many possible mechanisms may explain why patients experience pain in the gluteal area. In this Correspondence, we would like to highlight several possible mechanisms of LDH-related gluteal pain based on detailed analysis of the sensory innervation of the gluteal region. We hope this can better explain the phenomenon found by Fang et al. We believe the principle mechanism is compression/irritation of L5 or S1 dorsal rami (intraspinal portion), which produce gluteal pain by irritating superior/medial cluneal nerve and referred pain from facet joints and sacroiliac joints. In addition, the presence of proximal sciatica could also induce gluteal pain. Lastly, fibers in the superior or inferior gluteal nerve could be compressed/irritated in LDH, inducing LDH-related gluteal pain. However, additional studies are needed in the future to delineate the exact mechanism(s).
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Affiliation(s)
- Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jin Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yuqing Yan
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lifeng Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Chuan Guo
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zhiyu Peng
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qingquan Kong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China.
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Ramos-Gallardo G, Orozco-Rentería D, Medina-Zamora P, Mota-Fonseca E, García-Benavides L, Cuenca-Pardo J, Contreras-Bulnes L, Ambriz-Plasencia AR, Curiel-Beltran JA. Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation, Anatomic Study in Fresh Cadavers. J INVEST SURG 2017; 31:292-297. [PMID: 28485991 DOI: 10.1080/08941939.2017.1321703] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. METHODS A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. RESULTS We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. CONCLUSIONS The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.
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Affiliation(s)
- Guillermo Ramos-Gallardo
- a University of Guadalajara, Centro Universitario de la Costa , Puerto Vallarta , Jalisco , México
| | - David Orozco-Rentería
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Pablo Medina-Zamora
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Eduardo Mota-Fonseca
- c Instituto Jalisciense de Ciencias Forenses , Puerto Vallarta , Jalisco , México
| | - Leonel García-Benavides
- b Antiguo Hospital Civil de Guadalajara, Fray Antonio Alcalde , Puerto Vallarta , Jalisco , México
| | - Jesus Cuenca-Pardo
- d Asociación Mexicana de Cirugía, Plástica, Estética y Reconstructiva , Puerto Vallarta , Jalisco , México
| | - Livia Contreras-Bulnes
- d Asociación Mexicana de Cirugía, Plástica, Estética y Reconstructiva , Puerto Vallarta , Jalisco , México
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Buttock Reshaping With Intramuscular Gluteal Augmentation in an Asian Ethnic Group: A Six-Year Experience With 130 Patients. Ann Plast Surg 2014; 77:272-9. [PMID: 25536198 DOI: 10.1097/sap.0000000000000399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the definition of what constitutes "beautiful buttocks" has been changing with time, the buttocks are generally perceived as an important element of sexual attraction and beauty in every culture. In Asian culture, "beautiful buttocks" are defined by an aggregate of the following 4 components: S-shaped curvature from the lower back to the buttocks, sufficient muscle volume, sufficient fat volume, and appropriate skin elasticity. The goal of our gluteal augmentation was therefore to restore the back curvature, provide sufficient hip volume (projection), and reposition the point of maximal gluteal projection to be higher than the pubic hair. The purpose of this study was to review the authors' 6-year (2008-2014) experience with intramuscular gluteal augmentation techniques using an oval-shaped smooth-surface silicon elastomer. After intergluteal fusiform incisions were made, we bluntly dissected the subcutaneous tissue deep down to the gluteus maximus muscle by using the xyz method introduced by Dr. Gonzalez. Most of the patients in this case series underwent additional procedures at the time of the gluteal augmentation, whereas 90% of patients underwent concomitant liposuction. The results were assessed objectively using serial photography and subjectively according to patients' assessment on a 5-score scale.The mean rating for patient satisfaction with the procedure was 4.6 of 5, whereas consensus ratings by 2 independent plastic surgeons showed a mean score of 4.2 of 5. The intramuscular gluteal augmentation technique using an oval-shaped smooth surface silicon elastomer resulted in excellent cosmetic outcomes and permitted successful reshaping of the buttocks.
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Muresan C, Brownstein GM, Shureih SF. Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty. Aesthet Surg J 2014; 34:1234-43. [PMID: 25121782 DOI: 10.1177/1090820x14545159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Plastic surgeons are exploring novel techniques for augmentation gluteoplasty as the demand for this procedure increases annually in the United States. OBJECTIVES The authors retrospectively reviewed a series of lower abdominal dermal-fat graft augmentation gluteoplasties to validate the procedure. METHODS Nine consecutive patients underwent abdominoplasty or torsoplasty in which 2 oval dermal-fat grafts were excised, de-epithelialized, and then implanted into subfascial gluteal pockets for augmentation. All operations were independently conducted by 1 of 2 surgeons at facilities in Maryland and New Jersey. RESULTS The mean age of the 9 female patients was 46 years. The mean dermal-graft size was 188 cm(2), and the mean graft weight was 288 g. One graft became infected and required excision 39 days after the procedure. There were no other complications. All surviving grafts provided a substantial increase in posterior projection and long-lasting gluteal volume. CONCLUSIONS Dermal-fat graft augmentation gluteoplasty provides a voluminous, natural-feeling, and durable aesthetic result. The procedure should be considered a viable option for patients undergoing abdominoplasty or torsoplasty, especially as more experience is gained. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Claude Muresan
- Dr Muresan is a resident, Department of Surgery, Union Memorial Hospital in Baltimore, MarylandDr Brownstein is a plastic surgeon in private practice in Berlin, New JerseyDr Shureih is a plastic surgeon in private practice in Baltimore, Maryland
| | - Gary M Brownstein
- Dr Muresan is a resident, Department of Surgery, Union Memorial Hospital in Baltimore, MarylandDr Brownstein is a plastic surgeon in private practice in Berlin, New JerseyDr Shureih is a plastic surgeon in private practice in Baltimore, Maryland
| | - Samir F Shureih
- Dr Muresan is a resident, Department of Surgery, Union Memorial Hospital in Baltimore, MarylandDr Brownstein is a plastic surgeon in private practice in Berlin, New JerseyDr Shureih is a plastic surgeon in private practice in Baltimore, Maryland
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Remodelage fessier esthétique par transfert graisseux. ANN CHIR PLAST ESTH 2013; 58:194-200. [DOI: 10.1016/j.anplas.2012.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 10/29/2012] [Indexed: 02/06/2023]
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Ho Quoc C, Mojallal A. Région fessière : analyse sémiologique et application pour le remodelage par lipofilling. ANN CHIR PLAST ESTH 2012; 57:580-6. [DOI: 10.1016/j.anplas.2012.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/13/2012] [Indexed: 02/06/2023]
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Hwang SW, Nam YS, Hwang K, Han SH. Thickness and tension of the gluteal aponeurosis and the implications for subfascial gluteal augmentation. J Anat 2012; 221:69-72. [PMID: 22578136 DOI: 10.1111/j.1469-7580.2012.01510.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to elucidate the thickness and tension of the gluteal aponeurosis (GA) as related to subfascial gluteal augmentation. Twenty buttocks from 10 Korean fresh cadavers (age range: 69-92 years, five men and five women) were dissected. Five radial lines were made from the greater trochanter (GT) to the highest point of origin of the gluteus maximus muscle (GM), the posterior inferior iliac spine (PSIS), the piriformis line (P), the coccyx (Co) and the ischial tuberosity (IT). The upper four lines were intersected by three curvilinear lines that divided them by a quarter, half and three-quarters ratios, and the lowest line was divided by a third ratio and a two-thirds ratio. At the 14 intersecting points, the force needed to break the 6 mm width of the GA was measured. The thickness of the GA was also measured with a digital caliper. The GA was widest at the GT-Co line (161.7±15.8 mm), and it was narrowest at the GT-IT line (106.5±21.2 mm). At most of the points (12 among the 14 points), the breaking strength of the GA was greater than 20 Newtons (N). The breaking strength of the GA did not vary significantly according to the locations (P=0.568, anova). The breaking strength of the males (22.8±6.6 N) was significantly greater than that of the females (20.3±7.5 N, P=0.003, t-test). The thickness of the GA varied according to the locations (0.4±0.2 mm to 0.7±0.3 mm). The thickness of the GA of the upper part (GT-GM line: 0.64±0.24 mm; GT-PSIS line: 0.66±0.23 mm; GT-P line: 0.66±0.24 mm) was significantly greater (P=0.040, 0.017, 0.018, respectively) than that of the lower part (GT-IT line: 0.49±0.18 mm). The GA of the males (0.70±0.23 mm) was significantly thicker than that of the females (0.53±0.21 mm, P<0.001, t-test). We conclude that the GA is capable of holding gluteal implants in the proper position, as the average force to break up the 6 mm width of the GA in females was greater than 20 N.
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