Cases reported "Leg Injuries"

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1/86. Muscle hernias of the lower leg: MRI findings.

    Muscle hernias of the lower leg involving the tibialis anterior, peroneus brevis, and lateral head of the gastrocnemius were found in three different patients. MRI findings allowed recognition of herniated muscle in all cases and identification of fascial defect in two of them. MR imaging findings and the value of dynamic MR imaging is emphasized.
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ranking = 1
keywords = tibia
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2/86. Tibial artery false aneurysm: uncommon result of blunt injury occurring during athletics.

    Two young men presented with symptoms following lower extremity injuries sustained in the normal course of participation in sports. One played baseball while the other competed in Tae Kwon Do. One case presented with digital ischemia, the other developed a pulsating hematoma. Each came to angiography, and each proved to have a false aneurysm of a tibial artery. The tibial artery was ligated in each case, without further complications. The patient with digital ischemia was thought to have sustained microemboli, and also underwent lumbar sympathectomy.
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ranking = 2
keywords = tibia
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3/86. compartment syndromes.

    A patient is presented who developed the Compartment Syndrome, following blunt trauma to the lower limb. A "fibulectomy-fasciotomy" was performed. This allowed restoration of normal peripheral circulation of the limb but failed to prevent ischaemic necrosis developing in the anterior tibial, peroneal and posterior tibial compartments. compartment syndromes in the lower limb are discussed, with a view to their early recognition and management.
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ranking = 2
keywords = tibia
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4/86. Free flap to the arteria peronea magna for lower limb salvage.

    A 36-year-old woman sustained an amputation of her right leg at the thigh level and a degloving injury of her left foot and ankle region in an accident during a suicide attempt. Primarily, her left foot was covered with a split skin graft, resulting in a soft-tissue defect at the medial malleolus and at the calcaneus bone. Reconstruction was planned with a free latissimus dorsi muscle flap. Preoperative examinations revealed an arteria peronea magna with a hyperplastic peroneal artery solely providing arterial blood supply to the foot. The arteria peronea magna divided into two branches proximal to the upper ankle joint, replacing the dorsal pedis artery and the medial plantar artery. Tibial posterior and tibial anterior arteries were hypoplastic-aplastic. Microvascular end-to-end anastomoses of the flap vessels to the medial branch ("medial plantar artery") of the arteria peronea magna and its concomitant vein at the medial malleolar bone level were successfully performed. The postoperative course was uneventful. Four weeks postoperatively, the patient started walking assisted by a prosthesis on her right thigh stump. This experience demonstrates that even in a case of arteria peronea magna, free flap surgery for lower limb salvage is a reliable and worthwhile method.
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ranking = 1
keywords = tibia
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5/86. Reconstruction of a tibial defect with microvascular transfer of a previously fractured fibula.

    A 43-year-old man sustained severe injuries to his lower limbs with extensive soft-tissue damage and bilateral tibial-fibular fractures. Acutely, the patient underwent external fixation and a free latissimus dorsi flap for soft-tissue coverage of the left leg. However, the tibia had a nonviable butterfly fragment that left a 7-cm defect after debridement. Subsequently, the contralateral fractured fibula was used as a bridging vascularized graft for this tibial defect. The transfer of a fibula containing the zone of injury from a previous high-energy fracture has not been reported. This case demonstrates the successful microvascular transfer of a previously fractured fibula for the repair of a contralateral tibial bony defect.
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ranking = 8
keywords = tibia
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6/86. Necrotizing fasciitis.

    A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.
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ranking = 1
keywords = tibia
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7/86. limb salvage of lower-extremity wounds using free gracilis muscle reconstruction.

    An extensive series reviewing the benefits and drawbacks of use of the gracilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic chronic wounds is reviewed. In addition, the wound size, injury patterns, problems, and results unique to the use of the gracilis as a donor muscle for lower-extremity reconstruction are identified. In a 7-year period from 1991 to 1998, 50 patients underwent lower-extremity reconstruction using microvascular free gracilis transfer at the University of maryland shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22 patients who underwent reconstruction for coverage of acute lower-extremity traumatic soft-tissue defects associated with open fractures. The majority of patients were victims of high-energy injuries with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successful limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a reliable and predictable tool in lower-extremity reconstruction, with a flap success and limb salvage rate comparable to those in other large studies.
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ranking = 2
keywords = tibia
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8/86. An easy and versatile method of coverage for distal tibial soft tissue defects.

    BACKGROUND: The distally based superficial sural artery flap, first described as a distally based neuroskin flap by Masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. In the difficult area of defects in the lower leg and the ankle and heel region, it has a wide variety of indications, even in the vascularly compromised patients. It has the largest arc of rotation of all flaps that have been described in this region. The most important advantage is that it does not compromise a major artery. It is simple to dissect and has a low donor morbidity. methods: We reported our experience with this new flap in 15 cases and also described a new indication for the patients with neglected ruptures of the achilles tendon. RESULTS: In 13 patients, the flap was successfully transferred. In two cases, partial necrosis of the flap ensued, which healed with secondary intention. CONCLUSION: This flap deserves a high degree of interest in the reconstructive armamentarium of the trauma surgeon.
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ranking = 4
keywords = tibia
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9/86. Pedicled foot fillet flap based on the tibialis anterior vessels: case report.

    A case of an 18-year-old male with extensive posterior and lateral soft-tissue loss of the lower leg is reported. There was a segmental defect of 20 cm in the tibialis posterior neurovascular bundle, and the injury was not considered reconstructable. There was extensive soft-tissue trauma to the posterior compartments of the leg, with an intact and well-perfused foot. A primary amputation was indicated. The foot was used as a fillet flap for tibial length preservation and optimal stump coverage. The foot fillet flap was pedicled on the tibialis anterior vessels, preserving the deep plantar, first dorsal metatarsal, and anterior communicating vessels. The postoperative evolution was uneventful, with successful prosthetic adaptation.
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ranking = 7
keywords = tibia
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10/86. Sagittal split tibialis anterior muscle flap.

    The potential use of the tibialis anterior muscle as a vascularized flap requires consideration of some function preservation technique because this is not an expendable muscle. A direct longitudinal vertical or partial sagittal split of this muscle will allow coverage of mid-tibial defects without impairing function. This is a valuable alternative for small defects, especially if the muscle is already exposed in the wound. The muscle must be malleable enough to allow stretching over the tibia, because otherwise posteromedial undermining (as used in the medial- hinged anterior turnover version) would be necessary to obtain the desired reach. This as a variation of the latter, if possible, not only is more expedient to implement but also better preserves the microcirculation of the muscle to ensure viability.
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ranking = 7
keywords = tibia
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