O primeiro arabesque é uma pose elementar do ballet clássico e para realiza-la, a bailarina precisa dominar quesitos técnicos que incluem: a manutenção do turnout, o posicionamento do pé de apoio (em meia-ponta ou em ponta), a utlização de sapatilhas específicas e as estratégias de inicação do movimento (arabesque relevé ou arabesque piqué). Assim, o proposito deste estudo foi descrever, avaliar e comparar os padrões cinéticos e cinemáticos do membro inferior da bailarina durante a execução do primeiro arabesque realizado com os quesitos técnicos acima descritos a fim de entender as diferenças e similaridades entre os quesitos avaliados. A amostra foi composta por 26 bailarinas com 13,5±5.02 anos de ballet clássico, as quais realizaram o arabesque piqué e relevé, com sapatilhas de ponta e meiaponta de forma aleatorizada, acompanhados por uma cadência musical adequada. Foram adquiridos: a componente vertical da força reação do solo (FRS) e do centro de pressão (COP), a variação angular das articulações do joelho e tornozelo nos planos sagital, frontal e transversal, além dos momentos articulares sagitais de joelho e tornozelo calculados por dinâmica inversa. As comparações inter-condições foram realizadas por ANOVAs dois fatores [estratégia de iniciação (2) x sapatilha(2)]. A avaliação da componente vertical da FRS mostrou efeito de interação entre sapatilhas e estratégias de iniciação, além de efeitos isolados no aumento da FRS vertical para o arabesque relevé. A avaliação do comportamento do COP mostrou efeito de interação entre todas as variáveis, novamente apontando maiores oscilações em relação ao arabesque relevé. As diferentes sapatilhas não modificaram o comportamento angular e nem o momento articular resultante de joelho e tornozelo, revelando que a estratégia de iniciação é fator determinante no resultado biomecânico final do arabesque / The first arabesque is an elementary pose of classical ballet. To perform it, the dancer needs to lead with technical questions that include: the maintenance of the turnout, the positioning of the support foot (pointe or half-pointe), the iniciation movement strategies (piqué or relevé arabesque). Thus, the purpose of this study was to describe, evaluate and compare the kinetic and kinematic patterns of the lower limb of the dancer during the execution of the first arabesque performed with the technical questions described above in order to understand the differences and similarities between the evaluated items. The sample consisted of 26 dancers with 13.5 ± 5.02 years of classical ballet, who performed the piqué and relevé arabesque, with slippers or pointe shoes, in randomized trails, accompanied by a suitable musical cadence. Were evaluated: the vertical component of the ground reaction force (FRS), the center of pressure distribution (COP), the angular variation of the knee and ankle joints in the sagittal, frontal and transverse planes, and the sagittal knee and ankle joint loads (inverse dynamics). The inter-condition comparisons were performed by ANOVAs two factors [initiation strategy (2) x ballet shoes (2)]. The evaluation of the vertical component of FRS showed an interaction effect between shoes and initiation strategies, as well as isolated effects in the increase of vertical FRS for arabesque relevé. The evaluation of the behavior of the COP showed an interaction effect among all variables, again pointing to greater oscillations in relation to the arabesque relevé. The different ballet shoes (pointe shoe or slipper) did not modify the angular behavior nor the knee and ankle joint loads, revealing that the initiation strategy is a determining factor in the final arabesque biomechanical result

PURPOSE: The purpose of the study was to examine the relationship between bat swing velocity and lower extremity strength and power in NCAA Division-I softball athletes. METHODS: Twenty-nine softball athletes (age = 19.8 ± 1.3 years, height = 167.9 ± 6.8 cm, mass = 76.4 ± 18.1 kg) participated in the study. Athletes were tested on unloaded and loaded (20kg) squat and countermovement jump peak force, peak power, and jump height performed on a force platform sampling at 1000Hz. During practice, athletes were tested on swing velocity using a timing gate system. Pearson-product moment zero-order correlations were calculated between bat swing velocity and lower extremity strength and power. Statistical significance was set at p≤0.05. RESULTS: Moderate to strong relationships were observed between swing velocity and peak force at all conditions: SJ 0kg (r= 0.51, p= 0.005), SJ 20kg (r= 0.50, p= 0.006), CMJ 0kg (r= 0.44, p= 0.016), CMJ 20kg (r= 0.43, p= 0.022). Additionally, relationships were observed between swing velocity and peak power at all conditions: SJ 0kg (r= 0.45, p= 0.015), SJ 20kg (r= 0.40, p= 0.031), CMJ 0kg (r= 0.53, p= 0.003), CMJ 20kg (r= 0.45, p= 0.015). No statistically significant relationships were observed between swing velocity and jump height. CONCLUSIONS: Swing velocity was related to lower extremity force and power variables. Considering the known effects of strength training on lower extremity strength and power production, these results provide background for inclusion of lower extremity strength training for the development of swing velocity in NCAA Division-I softball athletes.

Introduction: Baseball pitching is considered one of the most intense aspects within the game of baseball, as well as the most complicated dynamic throwing task in all of sports. The biomechanics of pitching have been heavily investigated in an attempt to identify optimal pitching mechanics in terms of pitching performance. Previous quantified upper body kinetics research has concluded that improved muscle strength is needed in attempting to achieve adequate upper body kinetics and efficient pitching performances. Therefore, it is the purpose of this research study to compare the lower extremity muscle and upper extremity muscle activation patterns and kinematic variables associated with the curveball pitch and the fastball pitch when pitching from the wind-up and stretch position. Methods: Twelve skilled (competed at the NCAA collegiate level) baseball pitchers volunteered to be research subjects for this study. The participants were fitted with six surface electromyography (EMG) bipolar electrodes (Delsys Inc., Boston, Massachusetts) on the stride leg biceps femoris, medial gastrocnemius, ipsilateral side (throwing arm side) lower trapezius, upper trapezius, triceps brachii and biceps brachii. Each participant underwent maximum voluntary isometric contraction (MVIC) testing and then performed a pitching analysis. All EMG variables of interest were normalized using MVIC data and then compared between pitching types and pitch delivery. Shoulder rotation, shoulder abduction, elbow flexion and extension, elbow angular velocity and pelvis rotation were determined using motion capture (Motion Analysis Corp., Santa Rosa, SA) and Visual 3D software (C-Motion Inc., Germantown, MD). Paired t-tests and factorial analyses were performed using SPSS (p ≤ 0.05). Results and Discussion: Significant differences in the peak and mean muscle activity for the fastball and curveball pitched from wind-up and stretch position were observed. Significant differences in the kinematic variables between the fastball and curveball from the wind- up and stretch were also observed. These findings suggest that upper and lower muscle activity could be associated with enhanced pitching technique and pitching performance. Pitching kinematic differences associated with the diverse pitch types as well as the multiple pitch deliveries may impact the overall “wear and tear” on a pitcher’s health and pitching arm. Conclusions: Many differences were found, between both the pitching type and the pitching delivery as well as the kinematic variables. These findings suggest that upper and lower muscle activity could be associated with enhanced pitching technique and pitching performance to keep a baseball pitcher healthy and on the pitching mound longer into the season, decreasing the rate of injury. Shoulder rotation and pelvis rotation, as well as the elbow angular velocity and elbow flexion-extension, have an impact on the pitcher’s ability to stay off the disabled list and in the game longer. Determining pitch types along with delivery types that enhance the pitcher’s ability to stay active without injury will provide a way to make the game of baseball safer for the future generation of all stars.

Computational modeling in the field of biomechanics is becoming increasingly popular and successful in practice for its ability to predict function and provide information that would otherwise be unobtainable. Through the application of these new and constantly improving methods, kinematics and joint contact characteristics in pathological conditions of femoroacetabular impingement (FAI) and total hip arthroplasty (THA) were studied using a lower extremity computational model. Patients presenting with FAI exhibit abnormal contact between the femoral neck and acetabular rim leading to surrounding tissue damage in daily use. THA is the replacement of both the proximal femur and acetabular region of the pelvis and is the most common surgical intervention for degenerative hip disorders. A combination of rigid osteoarticular anatomy and force vectors representing soft tissue structures were used in developing this model. Kinematics produced by healthy models were formally validated with experimental data from Burnfield et al. This healthy model was then modified to emulate the desired morphology of FAI and a THA procedure with a range of combined version (CV) angles. All soft tissue structures were maintained constant for each subsequent model. Data gathered from these models did not provide any significant differences between the kinematics of healthy and FAI but did show a large amount of variation in all THA kinematics including incidents of dislocation with cases of lower CV angles. With the results of these computational studies performed with this model, an increased understanding of hip morphology with regards to STS has been achieved.

Tai Chi Chuan is a safe alternative for those who wish to improve balance and physical wellbeing. It is a popular form of exercise that is supported by a growing body of research aimed towards improving the health of a sedentary elderly population. The purpose of this study was to examine the biomechanical features of the lower extremity during performance of two Tai Chi movements, the “Repulse Monkey (RM)” and “Wave-hands in clouds (WHIC).” The study’s parameters included quantitative measures of the temporospatial, kinematic, and kinetic characteristics of the lower extremities. A group of experienced male Tai Chi practitioners (n = 15) between the ages of 65 to 75, performed “Repulse Monkey (RM)”, “Wave-hand in Cloud (WHIC)”, and forward walking. Three-dimensional (3-D) kinematic and kinetic data was collected using VICON motion analysis system with 10 infrared cameras and 4 force plates. The following variables were examined: stride width, step length, step width, single- and double-support times, centre of mass (COM) displacement, peak joint angles, range of motion, peak joint moments, time to peak moment, and ground reaction force (GRF). The differences in the measurements of the two Tai Chi movements were compared with walking using two-way ANOVA. The study’s results showed that the two Tai Chi movements elicit gentle and fluid changes to position of the upper body mass and the joints in the lower extremity. In terms of joint kinematics, the knee remained flexed throughout RM and WHIC. Unlike walking, RM had larger abduction and adduction angles at the knee joints and large plantar- and dorsiflexion ROM at the ankle. Reduced posterior, mediolateral, and vertical GRF were seen; the loading joints at the ankle and hip were gentle and smaller than walking. Varus/valgus moments were notably larger at the knee joint during RM and eversion moment was larger at the ankle joint during WHIC movement. A large, but slow loading rate at the knee joint has implication towards the viscoelastic properties of the knee. A better understanding of RM and WHIC would facilitate the improvement of balance, physical capacity, and joint flexibility for the elders.

Tai Chi Chuan is a safe alternative for those who wish to improve balance and physical wellbeing. It is a popular form of exercise that is supported by a growing body of research aimed towards improving the health of a sedentary elderly population. The purpose of this study was to examine the biomechanical features of the lower extremity during performance of two Tai Chi movements, the “Repulse Monkey (RM)” and “Wave-hands in clouds (WHIC).” The study’s parameters included quantitative measures of the temporospatial, kinematic, and kinetic characteristics of the lower extremities. A group of experienced male Tai Chi practitioners (n = 15) between the ages of 65 to 75, performed “Repulse Monkey (RM)”, “Wave-hand in Cloud (WHIC)”, and forward walking. Three-dimensional (3-D) kinematic and kinetic data was collected using VICON motion analysis system with 10 infrared cameras and 4 force plates. The following variables were examined: stride width, step length, step width, single- and double-support times, centre of mass (COM) displacement, peak joint angles, range of motion, peak joint moments, time to peak moment, and ground reaction force (GRF). The differences in the measurements of the two Tai Chi movements were compared with walking using two-way ANOVA. The study’s results showed that the two Tai Chi movements elicit gentle and fluid changes to position of the upper body mass and the joints in the lower extremity. In terms of joint kinematics, the knee remained flexed throughout RM and WHIC. Unlike walking, RM had larger abduction and adduction angles at the knee joints and large plantar- and dorsiflexion ROM at the ankle. Reduced posterior, mediolateral, and vertical GRF were seen; the loading joints at the ankle and hip were gentle and smaller than walking. Varus/valgus moments were notably larger at the knee joint during RM and eversion moment was larger at the ankle joint during WHIC movement. A large, but slow loading rate at the knee joint has implication towards the viscoelastic properties of the knee. A better understanding of RM and WHIC would facilitate the improvement of balance, physical capacity, and joint flexibility for the elders.

Introdução: O alongamento é um recurso bastante presente em estratégias que visem à prevenção da flexibilidade e/ou reabilitação, e tem sido preconizado como sendo importante componente do exercício físico. Diversos estudos têm mostrado a eficácia de diferentes técnicas, porém não há unanimidade em estudos de efeito crônico no que diz respeito à técnica mais eficiente, bem como sua relação com a força muscular. Com isso o objetivo deste estudo foi comparar o efeito de duas formas distintas de alongamento sobre aspectos musculoesqueléticos dos isquiotibiais de mulheres jovens. Métodos: Este estudo é um ensaio clínico randomizado. A amostra foi composta por 18 mulheres jovens divididas em três grupos: (GCon) grupo controle (n= 6; 24,0±2,8 anos); (GEst) grupo que realizou alongamento estático passivo (n= 6; 23,3±2,2 anos) e (GFnp) grupo que realizou alongamento de facilitação neuromuscular proprioceptiva (n= 6; 24,6±2,6 anos). A avaliação do torque muscular, flexibilidade, ativação elétrica e arquitetura muscular foi realizada uma semana antes do início do treinamento e a reavaliação, uma semana após o término. Para a avaliação do torque muscular dos flexores e extensores do joelho foi utilizado um dinamômetro isocinético. A avaliação da flexibilidade foi composta pelos testes de Elevação do Membro Inferior Estendido (EXT) e de Extensão de Joelho Modificado (TEJ) onde a amplitude de movimento (ADM) foi mensurada através de um goniômetro universal. A avaliação da ativação elétrica do vasto lateral, reto femoral e bíceps femoral foi realizada simultaneamente ao teste de força muscular e flexibilidade utilizando-se um eletromiógrafo. A arquitetura muscular foi avaliada através da ultrassonografia. O treinamento consistiu de um programa de quatro semanas de alongamento com três sessões semanais. Cada sessão era composta por uma repetição de alongamento, estático (30s) ou FNP (6s de contração máxima seguido por 30s de alongamento). O GCon não realizou treinamento. Para análise estatística foi utilizada uma ANOVA de dois fatores para a comparação entre os grupos e entre momentos seguida de um posthoc de Bonferroni. Para análise foi utilizado o software SPSS 20.0 e o nível de significância adotado foi α de 0,05. Resultados: A ADM mensurada pelo teste EXT apresentou aumento significativo entre os momentos pré e pós do GEst (pré= 80,8º±11,0 e pós= 94,5º±10,2; p= 0,013), não havendo diferenças entre os grupos (p>0,05); também houve diferença no torque concêntrico dos flexores de joelhos nos três grupos quanto ao momento, GEst (pré= 66,3Nm±12,9 e pós= 70,0Nm±8,1; p=0,023), GFnp (pré= 79,1Nm±12,7 e pós= 83,5Nm±11,6; p=0,014) e Gcon (pré= 71,1Nm±10,1 e pós= 74,1Nm±14,6; p=0,003), porém não houve diferença entre os grupos. A contração excêntrica desse grupo muscular não apresentou diferença significativa intra e inter grupos, assim como a espessura e a ativação elétrica muscular (p>0,05). Conclusão: Não houve diferença entre os grupos, porém o protocolo de alongamento estático passivo proposto propiciou um aumento da ADM e do torque da musculatura isquiotibial, sem influência na espessura muscular e ativação elétrica, dados que sugerem ser o ganho de ADM decorrente do aumento da tolerância do indivíduo ao alongamento do que decorrente de mudanças na estrutura muscular. / Introduction: Stretching is a very present action strategies aimed at prevention of flexibility and/or rehabilitation, and has been recommended as an important component of exercise. Several studies have shown the effectiveness of different techniques, but there is no unanimity in chronic effect studies as regards the most efficient technique, as well as its relationship with muscular strength. Thus the aim of this study was to compare the effect of two different forms of stretching on musculoskeletal aspects of the hamstrings of young women. Methods: This study is a randomized clinical trial. The sample consisted of 18 young women divided into three groups: (GCon) control group (n= 6; 24.0±2.8 years); (GEst) group performed passive static stretching (n= 6; 23.3±2.2 years) and (GFnp) group performed proprioceptive neuromuscular facilitation stretching (n= 6; 24.6±2.6 years). Evaluation of muscular torque, flexibility, muscle activation and muscle architecture was evaluated a week before the start of training and reevaluated, a week after the end. For the evaluation of knee flexors and extensors muscular torque was used an isokinetic dynamometer. The flexibility assessment was made by Single Leg Raise Test (SLR) and Modified Knee Extension Test (KET) where the range of motion (ROM) was measured using a goniometer. The evaluation of the electrical activation of the vastus lateralis, rectus femoris and biceps femoris was held simultaneously with the muscle strength test and flexibility using a electromyography. Muscle architecture was assessed by ultrasonography. The training consisted of a four weeks program of stretching with three weekly sessions. Each session consisted of a single stretching repetition, static (30s) or PNF (6s maximum contraction followed by 30 seconds elongation). The GCon not trained. Statistical analysis was performed using a two-way ANOVA for comparison between groups and between moments followed by post-hoc Bonferroni test. For analysis was used SPSS 20.0 and the level of significance was α of 0.05. Results: ROM measured by SLR test showed a significant increase between pre and post GEst (pre= 80.8º±11.0 and post= 94.5º±10.5; p= 0.013), with no differences between the groups (p> 0.05); also was difference between pre and post training in concentric torque of the knee flexors in the three groups, GEst (pre= 66.3Nm±12.9 and post= 70.0Nm±8.1; p= 0.023), GFnp (pre= 79.1Nm±12.7 and post= 83.5Nm±11.6; p= 0.014) and GCon (pre= 71.1Nm±10.1 and post= 74.1Nm±14.6; p= 0.003), but there was no difference between groups. The eccentric contraction of this muscle group showed no significant difference intra and inter groups, as well as the thickness and muscle electrical activation (p>0.05). Conclusion: There was no difference between the groups but the proposed passive static stretching protocol provided an increase in ROM and torque of the hamstring muscles, but no effects on muscle thickness and electrical activation, data that suggest the gain of ROM occurred due to the increase of the individual's tolerance to stretching, and not from changes in muscle structure.

Introdução: O alongamento é um recurso bastante presente em estratégias que visem à prevenção da flexibilidade e/ou reabilitação, e tem sido preconizado como sendo importante componente do exercício físico. Diversos estudos têm mostrado a eficácia de diferentes técnicas, porém não há unanimidade em estudos de efeito crônico no que diz respeito à técnica mais eficiente, bem como sua relação com a força muscular. Com isso o objetivo deste estudo foi comparar o efeito de duas formas distintas de alongamento sobre aspectos musculoesqueléticos dos isquiotibiais de mulheres jovens. Métodos: Este estudo é um ensaio clínico randomizado. A amostra foi composta por 18 mulheres jovens divididas em três grupos: (GCon) grupo controle (n= 6; 24,0±2,8 anos); (GEst) grupo que realizou alongamento estático passivo (n= 6; 23,3±2,2 anos) e (GFnp) grupo que realizou alongamento de facilitação neuromuscular proprioceptiva (n= 6; 24,6±2,6 anos). A avaliação do torque muscular, flexibilidade, ativação elétrica e arquitetura muscular foi realizada uma semana antes do início do treinamento e a reavaliação, uma semana após o término. Para a avaliação do torque muscular dos flexores e extensores do joelho foi utilizado um dinamômetro isocinético. A avaliação da flexibilidade foi composta pelos testes de Elevação do Membro Inferior Estendido (EXT) e de Extensão de Joelho Modificado (TEJ) onde a amplitude de movimento (ADM) foi mensurada através de um goniômetro universal. A avaliação da ativação elétrica do vasto lateral, reto femoral e bíceps femoral foi realizada simultaneamente ao teste de força muscular e flexibilidade utilizando-se um eletromiógrafo. A arquitetura muscular foi avaliada através da ultrassonografia. O treinamento consistiu de um programa de quatro semanas de alongamento com três sessões semanais. Cada sessão era composta por uma repetição de alongamento, estático (30s) ou FNP (6s de contração máxima seguido por 30s de alongamento). O GCon não realizou treinamento. Para análise estatística foi utilizada uma ANOVA de dois fatores para a comparação entre os grupos e entre momentos seguida de um posthoc de Bonferroni. Para análise foi utilizado o software SPSS 20.0 e o nível de significância adotado foi α de 0,05. Resultados: A ADM mensurada pelo teste EXT apresentou aumento significativo entre os momentos pré e pós do GEst (pré= 80,8º±11,0 e pós= 94,5º±10,2; p= 0,013), não havendo diferenças entre os grupos (p>0,05); também houve diferença no torque concêntrico dos flexores de joelhos nos três grupos quanto ao momento, GEst (pré= 66,3Nm±12,9 e pós= 70,0Nm±8,1; p=0,023), GFnp (pré= 79,1Nm±12,7 e pós= 83,5Nm±11,6; p=0,014) e Gcon (pré= 71,1Nm±10,1 e pós= 74,1Nm±14,6; p=0,003), porém não houve diferença entre os grupos. A contração excêntrica desse grupo muscular não apresentou diferença significativa intra e inter grupos, assim como a espessura e a ativação elétrica muscular (p>0,05). Conclusão: Não houve diferença entre os grupos, porém o protocolo de alongamento estático passivo proposto propiciou um aumento da ADM e do torque da musculatura isquiotibial, sem influência na espessura muscular e ativação elétrica, dados que sugerem ser o ganho de ADM decorrente do aumento da tolerância do indivíduo ao alongamento do que decorrente de mudanças na estrutura muscular. / Introduction: Stretching is a very present action strategies aimed at prevention of flexibility and/or rehabilitation, and has been recommended as an important component of exercise. Several studies have shown the effectiveness of different techniques, but there is no unanimity in chronic effect studies as regards the most efficient technique, as well as its relationship with muscular strength. Thus the aim of this study was to compare the effect of two different forms of stretching on musculoskeletal aspects of the hamstrings of young women. Methods: This study is a randomized clinical trial. The sample consisted of 18 young women divided into three groups: (GCon) control group (n= 6; 24.0±2.8 years); (GEst) group performed passive static stretching (n= 6; 23.3±2.2 years) and (GFnp) group performed proprioceptive neuromuscular facilitation stretching (n= 6; 24.6±2.6 years). Evaluation of muscular torque, flexibility, muscle activation and muscle architecture was evaluated a week before the start of training and reevaluated, a week after the end. For the evaluation of knee flexors and extensors muscular torque was used an isokinetic dynamometer. The flexibility assessment was made by Single Leg Raise Test (SLR) and Modified Knee Extension Test (KET) where the range of motion (ROM) was measured using a goniometer. The evaluation of the electrical activation of the vastus lateralis, rectus femoris and biceps femoris was held simultaneously with the muscle strength test and flexibility using a electromyography. Muscle architecture was assessed by ultrasonography. The training consisted of a four weeks program of stretching with three weekly sessions. Each session consisted of a single stretching repetition, static (30s) or PNF (6s maximum contraction followed by 30 seconds elongation). The GCon not trained. Statistical analysis was performed using a two-way ANOVA for comparison between groups and between moments followed by post-hoc Bonferroni test. For analysis was used SPSS 20.0 and the level of significance was α of 0.05. Results: ROM measured by SLR test showed a significant increase between pre and post GEst (pre= 80.8º±11.0 and post= 94.5º±10.5; p= 0.013), with no differences between the groups (p> 0.05); also was difference between pre and post training in concentric torque of the knee flexors in the three groups, GEst (pre= 66.3Nm±12.9 and post= 70.0Nm±8.1; p= 0.023), GFnp (pre= 79.1Nm±12.7 and post= 83.5Nm±11.6; p= 0.014) and GCon (pre= 71.1Nm±10.1 and post= 74.1Nm±14.6; p= 0.003), but there was no difference between groups. The eccentric contraction of this muscle group showed no significant difference intra and inter groups, as well as the thickness and muscle electrical activation (p>0.05). Conclusion: There was no difference between the groups but the proposed passive static stretching protocol provided an increase in ROM and torque of the hamstring muscles, but no effects on muscle thickness and electrical activation, data that suggest the gain of ROM occurred due to the increase of the individual's tolerance to stretching, and not from changes in muscle structure.

INTRODUÇÃO: A reconstrução de defeitos de partes moles da região plantar representa grande desafio à Cirurgia Plástica. Há controvérsias com relação ao tipo de tecido ideal a ser empregado: se muscular ou cutâneo. OBJETIVO: O presente estudo pretende avaliar os resultados da reconstrução e reabilitação de pacientes portadores de defeitos complexos da região plantar por meio da utilização de retalho composto, muscular e cutâneo, proveniente da região anterolateral da coxa. MÉTODOS: No período de julho 2009 a julho 2011, 25 pacientes portadores de defeitos plantares e com idades variando de 19 a 76 (média: 57,1 anos), sendo 14 do sexo masculino e 11 do sexo feminino, foram tratados no Hospital das Clínicas da FMUSP. Dos 25 pacientes, 22 apresentavam defeitos resultantes de ressecções de melanoma e 3, perdas decorrentes de traumatismo do membro inferior. A neurorrafia entre o nervo cutâneo femoral lateral, presente no retalho anterolateral, e o ramo calcâneo presente no defeito na região plantar foi realizado em 7 pacientes. O período médio de seguimento foi de 12 meses. RESULTADOS: O componente muscular de todos (100%) os retalhos manteve-se viável. Com relação ao componente cutâneo, houve 2 casos de perda parcial e 1 caso de perda total. Após 4 semanas de pós-operatório, o contorno foi considerado bom em 19 casos; a estabilidade adequada em 23 casos e a deambulação satisfatória em 22 casos. Os 7 retalhos submetidos à reinervação recuperaram grau de sensibilidade cutânea inferior ao do local de origem. CONCLUSÕES: O retalho proposto foi adequado para a reconstrução dos defeitos da região plantar. Observou-se baixa incidência de complicações locais. A qualidade do contorno, estabilidade ou deambulação foi considerada adequada na maioria dos casos. Não se verificou vantagem dos retalhos inervados sobre os não inervados / INTRODUCTION: Reconstruction of soft tissue defects of the plantar region represents a major challenge in plastic surgery. There is controversy regarding the ideal type of tissue to be used: muscle or skin. OBJECTIVE: This study aims to evaluate the results of the reconstruction and rehabilitation of patients with complex defects of the plantar region by using a composite flap of muscle and skin from the anterolateral thigh. METHODS: From july 2009 to july 2011, 25 patients with plantar defects and aged 19-76 (mean: 57.1 years), 14 males and 11 females, were treated at Hospital das Clinicas. Twenty-two patients had defects resulting from resection of melanoma and 3 losses resulting from trauma of the lower limb. Neurorrhaphy between the lateral femoral cutaneous nerve, present in the anterolateral flap, and the calcaneal branch defect, present in the plantar region, was performed in 7 patients. The mean follow-up was 24 months. RESULTS: The muscular component of all (100%) flaps remained viable. There were 2 cases of partial loss and 1 case of total loss of the cutaneous component. At 4 weeks postoperatively, the contour was considered good in 19 cases; stability adequate in 23 cases and ambulation satisfactory in 22 cases. The 7 flaps submitted to reinnervation recovered less skin sensitivity in comparison with the donor site. CONCLUSIONS: The proposed flap is suitable for reconstruction of defects in the plantar region. Few local complications were observed. The quality of the contour, stability and ambulation were considered adequate in most cases. No advantage was found for the innervated over the non-innervated flap

Contexto: Existem controvérsias na literatura médica sobre potenciais alterações da hemodinâmica venosa dos membros inferiores durante a gravidez. Objetivo: Estudar a drenagem venosa em membros inferiores e suas alterações na gestação (1º, 2º e 3º trimestres) e pós-parto mediante Mapeamento Dúplex (MD) das veias profundas e superficiais e a Pletismografia a Ar (PGA). População: Foram recrutadas vinte mulheres primigestas, sem doença venosa prévia, junto aos Núcleos de Saúde da Família ligados ao Centro de Saúde Escola da FMRP-USP. Métodos: O estudo hemodinâmico venoso nos membros inferiores foi realizado empregando-se dois métodos não invasivos: o MD e a PGA. Foram registrados os diâmetros e os refluxos das principais veias (femoral comum, femoral, poplítea, safena magna e parva) dos membros inferiores por meio do MD. Foram avaliados pela PGA: o índice de enchimento venoso (IEV), a fração de ejeção (FE), a fração de volume residual (FVR) e o esvaziamento venoso (OF-outflow). Todos os registros foram obtidos em 3 diferentes períodos da gestação e no pós-parto. Os dados foram estatisticamente analisados e considerou-se p?0,05. Resultados: Houve aumento do diâmetro venoso no território da femoral comum e da safena magna infravalvar bilateralmente, nos 2º e 3º trimestres. Na PGA, registrou-se diminuição da FVR bilateral, elevação do IEV à direita e aumento do OF bilateral no decorrer da gestação. Observou-se edema em 4 (15%) gestantes no segundo trimestre e 11 (55%) no terceiro trimestre. Quanto ao refluxo, documentouse um caso no 2º trimestre no território da safena magna supravalvar esquerda (5%) e mais dois casos no 3º trimestre (15%), sendo uma no território da safena magna infravalvar esquerda e outra gestante com refluxo nos territórios de safena magna infravalvar e safena parva esquerdas. Após o parto, houve regressão de todas essas alterações anatômicas e hemodinâmicas da drenagem venosa dos membros inferiores. Conclusão: Apesar do aumento significativo dos diâmetros das veias femorais comuns e safenas magnas infravalvares bilateralmente, diminuição da FVR bilateral, elevação do IEV à direita, aumento do OF durante a gestação, todas essas alterações retornaram aos parâmetros anatômicos e hemodinâmicos venosos iniciais, após o parto / Background: The relation between pregnancy and venous reflux is still misunderstood and some authors question if pregnancy is the main cause of venous reflux and venous disease. Objective: analyze venous hemodynamics in healthy primigravidae during the first, second and third trimester of pregnancy and in the puerperium. Methods: prospective study with 20 primigravidae evaluated in the first, second and third trimester of pregnancy and postpartum. Duplex scan evaluated venous diameters and reflux; air plethysmography evaluated venous filling index (VFI), ejection fraction (EF), residual volume fraction (RVF), outflow fraction (OF )in both limbs. OF in the right limb while the patient was in left lateral decubitus position was also evaluated. Results: During pregnancy, there was bilateral increase in venous diameters in common femoral and infravalvar great saphenous veins; occurrence of reflux in the left surpravalvar great saphenous vein in one patient (5%) in the second trimester; and occurrence of reflux more other two patents (15%) in the third trimester: one in the left infravalvar great saphenous vein, and other in the left popliteal and small saphenous vein. All these alterations observed during pregnancy disappeared after delivery. VFI decreased after delivery in the left limb, but increased progressively in the right limb, returning to basal level after delivery; EF did not change; RVF decreased during pregnancy, mainly in left limb, and returned to basal level after delivery; OF increased during pregnancy and returned to basal levels after delivery; OF in left lateral decubitus did not change. Conclusion: pregnancy caused a diameter increase in bilateral common femoral and great saphenous veins, unilateral right increase in VFI, bilateral decrease in the RVF and bilateral increase in OF. All these parameters returned to initial status after delivery