Cases reported "Leg Ulcer"

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1/16. magnetic resonance imaging evaluation of monostotic fibrous dysplasia of the tibia.

    The authors present a case report documenting the evaluation of monostotic fibrous dysplasia by magnetic resonance imaging. This type of evaluation demonstrates specificity for this disease process when combined with other imaging studies, laboratory findings, and clinical presentation. This technique is extremely useful in the identification of a no-touch lesion, allowing avoidance of an unnecessary bone biopsy.
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2/16. tibia fracture after fibula resection for distal peroneal bypass.

    The lateral approach to the distal peroneal artery has been used by vascular surgeons for 25 years. No complications specifically related to this approach have previously been reported. We reviewed 18 cases of peroneal bypass for limb salvage using the lateral approach with fibula resection and found that two of these cases had ipsilateral tibia fractures within 1 year of the bypass. Eight out of 18 cases were women, and two of these eight had tibia fracture. Both women suffered from osteoporosis. We conclude that tibia fracture is a possible complication of this approach, especially in elderly women with osteoporosis.
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3/16. A case study using larval therapy in the community setting.

    This article discusses the use of larval therapy by district nurses in wound bed preparation in the community. A case study is presented of a patient with a persistently necrotic and painful anterior tibial wound post-fasciotomy. The case study offers an insight into the practicalities involved in the use of larvae as effective and safe debriders of tissue for wound bed preparation. It is concluded that larval therapy is an underused and misunderstood resource when considering effective wound care and this treatment should be actively considered as an alternative therapy in wound care. There is a need for both qualitative and quantitative research in this field, enabling a more thorough discussion to be entered into by all practitioners with an interest in this subject.
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keywords = tibia
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4/16. Metastatic tuberculous abscesses in an immunocompetent patient.

    The decreased incidence of infectious diseases in developed countries may make their diagnosis difficult. Cutaneous tuberculosis is an example of this fact. A 44-year-old man presented with two painful abscesses on his lower extremities, which developed into chronic ulcers. A cutaneous biopsy revealed necrotizing granulomas in the dermis. Ziehl-Neelsen and periodic acid-Schiff stain were negative. Mantoux test was positive. Tc-99m scintigraphy showed increased uptake in the bone tissue of the left ankle and right tibiae, without direct relation to cutaneous lesions. Chest X-ray showed micronodular, apical, bilateral infiltrates, reduced volume of the right lung, and cavitation of the right superior lobe. mycobacterium tuberculosis was grown from sputum and skin biopsy samples. isoniazid, rifampin and pyrazinamide treatment for 2 months, followed by isoniazid and rifampin for 12 months, resulted in complete resolution. The clinical features of cutaneous tuberculosis in our patient were characteristic of tuberculous abscesses. Some uncommon findings, such as the low number of lesions, negative acid-fast resistant stains in cutaneous biopsy samples and his preserved general state of health, may be explained by a higher competence of the immune system than is usual in this clinical subset of disseminated tuberculosis. Cutaneous tuberculosis should be included in the differential diagnosis of cutaneous abscesses in immunocompetent patients.
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keywords = tibia
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5/16. The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications.

    Defects in the distal third of the lower leg with bone or tendon exposure may require local or free flap reconstruction. For small and moderate lesions, the distally pedicled peroneus brevis muscle flap may be an effective procedure with less morbidity than a free tissue transfer. Six cadaveric specimens were dissected to determine the location of distal pedicles and the flap type. This flap was found to be a Type IV flap, and the location of distal pedicle was always located within 6 cm from the fibula tip. This flap was performed on 6 patients to cover defects in the distal third of the lower leg. The defect areas were the pretibial region in 2 cases, the lateral malleolus in 3 cases, and the achilles tendon in 1 case. The peroneus brevis muscle was detached from the uppermost point of the fibula to obtain enough length to cover the defect. All flaps survived except 1 that experienced distal flap necrosis. Minor complications included skin graft failure in 2 cases. However, the final results demonstrated a smooth contour that eliminated dead space. Limited donor site morbidity was obtained in all cases. The distally peroneus brevis muscle flap therefore offers an alternative for reconstructive surgeons dealing with soft tissue defects of the lower leg.
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keywords = tibia
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6/16. pyoderma gangrenosum coexisting with acute myelogenous leukaemia.

    The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.
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keywords = tibia
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7/16. Distally based medial island septocutaneous flap for repair of soft-tissue defects of the lower leg.

    A medial island septocutaneous flap, based on the lower septocutaneous vessels from the posterior tibial artery and vein, has been designed. This flap was rotated 90 degrees in 5 cases and 180 degrees in 2 cases to cover soft-tissue defects on the lower third of the leg.
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ranking = 0.25
keywords = tibia
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8/16. Giant cell vasculitis with extravascular granulomas in an adolescent.

    We describe an 18-year-old white male who developed lower extremity ischemia requiring amputation. He presented at 14 with pulmonary infiltrates, hepatosplenomegaly, fever, rash, adenopathy, uveitis, and arthralgias; clinical and laboratory findings were consistent with mycoplasma pneumoniae infection. Despite adequate treatment with antibiotics, he developed chronic arthralgias and fevers, with rash and pericardial effusion. Criteria for the diagnosis of systemic lupus erythematosus were not met; juvenile rheumatoid arthritis was diagnosed presumptively. Over the subsequent 4 years he developed lymphadenopathy with biopsy-proven nonnecrotizing granulomas, chronic leg ulceration with granulomatous histology, and acute-onset impending gangrene of the left foot. A biopsy of the posterior tibial artery demonstrated giant cell arteritis. Although the histologic features were consistent with Takayasu's arteritis, complete aortic arteriography was normal. Examination of the amputated leg showed multifocal segmental giant cell arteritis. Clinicopathologic features suggested, but were not fully consistent with, juvenile systemic granulomatosis. His disease may represent a separate sarcoid-like entity in the broad spectrum of vasculitis.
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keywords = tibia
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9/16. limb salvage despite extensive tissue loss. Free tissue transfer combined with distal revascularization.

    Extensive lower-extremity tissue loss may preclude limb salvage despite successful arterial reconstruction. We attempted to avoid limb loss in such patients by combining arterial bypass with microvascular free tissue transfer. Fourteen patient (12 diabetic), 33 to 74 years of age, presented with extensive tissue loss in 15 lower extremities, exposing bone or tendon on the heel, ankle, lower part of the leg, or hindfoot. Mean ulcer size was 5 X 8 cm. Four patients had had previous contralateral below-knee amputations. Femorodistal (seven), popliteal-distal (three), or femoropopliteal (four) bypass, or tibial angioplasty (one), was performed to provide sufficient inflow for free tissue transfer. Serratus anterior, scapular, latissimus dorsi, rectus abdominis, gracilis, ulnar, or temporalis free flaps were used. One free flap failed due to venous thrombosis and was corrected with a second flap. limb salvage was achieved in 14 (93%) of 15 limbs during a mean follow-up of 24 months. The single amputation occurred due to severe foot ischemia in a patient whose femorodistal bypass remained patent only to the viable free flap. The remaining 13 patients (14 limbs) became ambulatory, including those with free flaps to weight-bearing regions.
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ranking = 0.25
keywords = tibia
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10/16. Transposition of the tendo calcaneus for post-traumatic bone defects of the tibia.

    Certain post-traumatic defects of the lower extremity present difficult problems in therapy and current methods of management do not offer satisfactory solutions. One such defect is an ulcerative lesion of the lower limb eroding the tibia and forming a chronic, rigid-walled cavity. We describe an operation in which the bone cavity is filled by viable tissue which acts as a bed for a skin graft. In chronic stasis ulcers it has been established that the tendo calcaneus will accept a skin graft, provided the paratenon is left undisturbred.
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ranking = 1.25
keywords = tibia
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