• Journal of Korean Academy of Nursing
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• v.23 no.1
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• pp.56-67
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• 1993

The purpose of this study was to compare the circumference and skinfold thickness of upper and lower limb and the leg strength of the casted limb with those of the normal limb after removal of a leg cast. The subjects for the study were orthopedic patients who had had long and short leg casts or splints due to tibial, fibulal, metatarsal, calcaneus fracture or ankle sprains. The subjects were divided into two groups, those who had the cast on for less than 40 days and those for over 41 days. Circumference and skinfold thickness of the upper and lower limb on the side on which the cast was ap-plied were compared with those of the contralateral side after removal of the cast. Circumference and skinfold thickness of the upper and lower limb, and leg strength for those in a cast for under 40 days were compared with those of over 41 days for both the side to which cast was applied and the contralateral side. Measurements were made after removal of the cast. Skinfold thickness was measured by fat caliper, circumference was measured by tape and lower extremity strength was determined with flat foot pressing on an electronic digital health meter in the sitting position. The results can be summarized as follows : 1. The circumference of the upper and lower leg on the side on which the cast was applied, when measured after the cast was removed, were significantly less than those of the normal side, 93.88%, 93.11% each. 2. Skinfold thickness of the quadriceps and gastrocnemius on the side on which the cast was applied were significantly less than those of the normal side when measured after removal of the cast, 85.98%, 82.85% respectively. 3. Leg strength on the side where the cast was applied was significantly 1ss than that on the normal side, 60.20%. 4. There was no difference in the circumference of upper and lower limbs, skinfold thickness or leg strength on the side where the cast was applied between the group which had the cast applied for under 40 days and the group that had it applied for over 41 days. 5. The circumference of the upper arm and lower leg on the normal side for the group that had the cast applied for over 41 days was significantly greater than the group that had the cast application for under 40 days. T ere was no difference between the two groups in the circumference of the forearm and upper leg, skinfold thickness and leg strength in the normal side. From these results, it may be concluded that muscle atrophy was apparent in the casted limb compared to the normal limb, and the circumference of the upper arm and lower leg, and leg strength on the normal side increased after removal of the cast in the group which had the cast on for more than 41 days.

• Journal of Korean Academy of Nursing
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• v.24 no.4
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• pp.517-528
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• 1994

The purpose of this study was to compare the circumference, skinfold thickness and strength of the normal and casted lower limb prior to casting and following removal of the cast. The subjects for the study were nine orthopedic patients who had had long and short leg casts due to a tibial, fibula, or calcaneus fracture, or to a lateral collateral ligament rupture. Circumference, skinfold thickness, and strength of the normal and casted lower limb following removal of the cast were compared with those prior to the application of the cast. Measurements were made before cast application and after removal of the cast. Skinfold thickness was measured by fat caliper, circumference was measured by tape and strength was determined by measuring the length of time the leg was held elevated at 45$^{\circ}$. The results can be summarized as follows 1. There was no change in the normal limb in the circumference of the midthigh and midcalf after casting as compared to before cast application. 2. In the casted limb the circumference of the midthigh decreased by 3.23% and that of the midcalf decreased significantly by 7.49% during the period of casting. 3. In the normal limb skinfold thickness of the quadriceps decreased and that of gastrocnemius increased by 20.63% during the period of cast application. 4. In the casted limb skinfold thickness of the quadriceps decreased significantly by 12.37% and that of gastrocnemius decreased by 10% during the period of cast application. 5. Strength of the normal lower extremity decreased significantly by 48.37% and that of casted lower extremity decreased remarkably by 73.07% during the period of cast application. 6. Circumference of the midthigh and the midcalf decreased significantly by 7.6% and 9.4% respectively on the casted side as compared to the normal side. Skinfold thickness of the quadriceps and the gastrocnemius on the casted side decreased by 6.12% and 18.55% respectively as compared to the normal side and strength in the lower extremity on the casted side decreased significantly by 44.32% as compared to the nor-mal side. From these results, it may be concluded that muscle atrophy occurs in the casted lower limb and muscle strength of the normal lower limb are also reduced during the period of application of a leg cast.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.165-174
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• 1998

Large soft tissue defect of the ankle and foot can present a difficult reconstructive problem to the surgeon. Local musculocutaneous, local fasciocutaneous or free flap is usually the first choice for providing soft tissue coverage. However, in certain situations, local flaps from the same leg and free flap may not be suitable. These include extensive soft tissue injury, where no suitable recipient vessels can be found, previous local fasciocutaneous flap or free flap failure. In such cases, we have utilized the septocutaneous(fasciocutaneous) branch flap of posterior tibial artery from the opposite healthy limb. We present 5 cases of cross leg flaps, which have been modernized with current understanding of vascular anatomy and current fixation technology. All cross leg flaps were based on the axial blood supply of the fasciocutanous branch of the posterior tibial artery. Cross-clamping with bowel clamp was used to create intermittent periods of ischemia. Adjacent lower extremity joints were exercised during the periods of attachment. The results have been quite encouraging. We conclude that the cross leg flap using septocutaneous flap and cast immobilization can be successfully and expeditiously used to cover defects of the ante and foot.