PubMed · 7272713
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C D Marsden, P A Merton, H B Morton. 1981. Human postural responses.. https://doi.org/10.1093/brain%2F104.3.513
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The surgical management of LLD has gradually evolved from a time when patients were bedridden in traction for prolong periods of time to the point at which much of the treatment time is spent in mobility. Improved surgical techniques, such as percutaneous epiphysiodesis and distraction osteogenesis, have contributed greatly to the success of surgery for LLD. Factors affecting outcome and patient satisfaction must be weighed carefully before selecting treatment for LLD.
The selection of recipient vessels distal to an extremity defect can be tantalizing option, offering the potential advantage of rapid accessibility to relatively large vessels that, in turn, would simplify revascularization of any desired microsurgical tissue transfer. However, such a maneuver contradicts the traditional dictum that any microanastomosis should be proximal to the zone of injury. A retrospective review of experiences with free flaps to the extremities corroborated this predilection for proximally-based flaps, which were successful in 115 of 136 cases (84.6 percent). Eleven distally-based flaps were also attempted: four were converted intraoperatively to proximally-based flaps; one was moved to an even more distal site, necessitating an interposition vein graft; and one totally failed. Although six (54.5 percent) distally-based flaps were ultimately successful, the incidence of problems encountered overall negated most benefits, so that this option for recipient vessels would rarely be justified.
In this paper, we present a method for assessing the exactness of sensing and setting the positions of joints and limbs, using a measure we call target resolution. Target resolution, derived from information theory but ultimately based on variance, estimates the fewest number of discrete, equally spaced targets required within a range to provide the maximum possible information transfer from any target set. We argue that target resolution provides better insight into the exactness of position sense than does the usual measure of accuracy based on mean or constant error. Studies have shown that measures of mean error in setting or indicating positions of joints or limbs exhibit lability; they drift and show considerable sensitivity to factors such as previous positions of the limb and learning. We derive the equation for calculating target resolution and give example resolutions for several joints we have tested. Target resolution often gives a quite different impression of proprioceptive exactness than do measures of accuracy based on mean error.