Cases reported "Necrosis"

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1/36. Calcific myonecrosis.

    Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision.
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ranking = 1
keywords = tibia
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2/36. Confirmation of arterial deficiencies in a limb with necrosis following clubfoot surgery.

    This study describes postoperative necrosis of the hallux and first ray in a child with clubfoot. Arteriography performed on this child's lower limbs demonstrated, in the operated leg, hypoplasia of both the anterior and posterior tibial arteries and failure of the dorsalis pedis artery to traverse the tarsus and complete the deep plantar arch. Previously, congenital vascular deficiency was suggested to predispose such operated limbs to necrosis. These findings confirm the association between vascular deficiency and necrosis. In this present study, the metabolic demands of wound healing were sufficient in a limb with vascular deficiency to cause localized distal hypoperfusion leading to cyanosis and necrosis of the hallux and medial foot.
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ranking = 1
keywords = tibia
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3/36. Reconstructive surgery for a defect in the shaft of the ulna due to osteomyelitis. Long-term result of a case.

    An eight and a half-year-old boy suffered from chronic osteomyelitis of the left ulna with sinuses, destruction of the middle three-quarters with the presence of necrotic bone and posterolateral dislocation of the radial head. The operative treatment included sequestrectomy and gradual reduction of the radial head after application of an Anderson apparatus. In a second procedure a corticocancellous tibial bone graft was used to bridge the ulnar gap, and later the redislocated radial head was excised. At the latest follow-up, 45 years postoperatively, the limb is fit with normal muscle strength and very satisfactory motion of the elbow and wrist joints, and the patient works as a hard manual laborer.
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ranking = 1
keywords = tibia
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4/36. erdheim-chester disease with extensive marrow necrosis: a case report and literature review.

    erdheim-chester disease is a rare systemic disorder characterized by a fibrosing xanthogranulomatous infiltration of multiple organs. We report a case of erdheim-chester disease with diffuse necrosis leading to difficulty in making a prompt diagnosis. Radiologically, osteosclerotic lesions with osteolytic element involved metadiaphyses of both proximal tibia, and retroperitoneal infiltrations encasing both kidneys, both adrenals, and aorta were found. A biopsy of the tibia showed diffuse infiltration of foamy histiocytes, Touton-type giant cells, and fibroblastic cells associated with extensive coagulative necrosis. Immunohistochemically, foamy histiocytes were positive for CD68 and peanut agglutinin and negative for S-100 protein. A few Langerhans' cells, which were difficult to identify in hematoxylin-eosin stain, were highlighted by immunostain for S-100 protein. The patient received supportive therapy and was alive 1 1/2 years after diagnosis, with newly developed bilateral retrobulbar lesions and worsened heart failure.
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ranking = 2
keywords = tibia
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5/36. Staged vascular reconstruction along with repeatedly performed angiography to prevent ischemic limb loss with Buerger's disease: report of a case.

    An aggressive approach to vascular reconstruction should be adopted in patients with Buerger's disease and peripheral ischemia who are often young and otherwise active. A patient with severe Buerger's disease is reported who was treated successfully by complete vascular reconstruction with staged bypass surgery while also performing repeated angiography to preserve the foot function. A 48-year-old man with Buerger's disease presented with necrosis of the foot. angiography showed occlusion of the right distal external iliac artery and no runoff below the knee. Repeated angiography after performing a lumbar sympathectomy demonstrated patency of the distal portion of the deep femoral artery. angiography was again performed after a reconstruction of the deep femoral artery and patency of the anterior tibial artery was observed. A staged bypass operation on the tibial artery was therefore able to achieve a prompt healing of both the toe ulcers and plantar wound.
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ranking = 2
keywords = tibia
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6/36. Acute tarsal tunnel syndrome following partial avulsion of the flexor hallucis longus muscle: a case report.

    An acute posterior tibial nerve compression from a partially ruptured flexor hallucis longus (FHL) muscle is reported. This etiology for acute tarsal tunnel syndrome has not been previously described. A 17-year-old male sustained multiple injuries in a motor vehicle accident, including a tibial shaft fracture and a posterior medial right ankle laceration of the same limb. The injured limb had no sensation on the plantar aspect of the foot and heel, decreased active great toe flexion, and associated leg pain. Exploration of the posterior tibial nerve for presumed laceration revealed the nerve to be intact, but compressed in a tense tarsal tunnel from a retracted partially ruptured flexor hallucis longus tendon. decompression of the tunnel and resection of the devascularized muscle resulted in complete neurologic recovery.
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ranking = 3
keywords = tibia
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7/36. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop.

    Acute exertional compartment syndrome is the result of muscle ischemia within a tight fascial compartment. We report a 22-year-old boxer, with recent intake of anabolic steroids, who developed acute exertional compartment syndrome of the lower legs following an assault from which he had to run away. He presented with bilateral footdrop. Nerve conduction studies (NCS) and electromyography (EMG) were consistent with bilateral deep and superficial peroneal neuropathies, but magnetic resonance imaging (MRI) demonstrated hemorrhagic necrosis of the pretibial muscles. This case illustrates that the differential diagnosis for footdrop includes not only central and peripheral nervous system and muscle causes, but also compartment syndromes.
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ranking = 1
keywords = tibia
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8/36. Spontaneous achilles tendon rupture in a patient with systemic lupus erythematosus due to ischemic necrosis after methyl prednisolone pulse therapy.

    Spontaneous tendon rupture in a patient with systemic lupus erythematosus (SLE) is a rare but potentially disabling complication. Minor trauma, local inflammation and long term corticosteroid therapy are regarded as possible causes. However, ischemic necrosis of the tendon resulting from hypercoagulability and methyl prednisolone (MTP) pulse therapy has not been reported. We present a 20-year old female, newly diagnosed with lupus, who has high titer antiphospholipid antibodies, hyperhomocysteinemia and protein s deficiency. Her severe clinical symptoms of lupus were improved after MTP pulse therapy. Several days later, cold sensation over the right lower leg developed. On day 15 after pulse therapy, acute onset of right heel pain occurred when she was ascending stairs. rupture of the right achilles tendon was demonstrated by sonography and MRI. A Doppler sonography revealed narrowing and abrupt cessation of blood flow in the right popliteal artery. heparin treatment was started. The angiography performed two days after heparinization revealed narrow caliber and decreased flow of the right tibial artery below the right ankle. Surgical repair of the tendon was successful and the pathology of the resected tendon revealed focal necrosis, degeneration and capillary proliferation. MTP pulse therapy in a lupus patient with hypercoaguable state with hyperhomocysteinemia, protein s deficiency and high titer antiphospholipid antibodies may cause spontaneous tendon rupture.
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ranking = 1
keywords = tibia
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9/36. Distally based lateral and medial leg adipofascial flaps: need for caution with old, diabetic patients.

    BACKGROUND: Reconstruction of defects around the ankle region has always been challenging for plastic surgeons. Distally based lateral and medial leg adipofascial flaps are among the flaps of choice for coverage of this difficult region. Presented here is the authors' clinical experience with these flaps, particularly emphasizing the complicated attempts in diabetic patients. methods: Seven skin defects around the ankle were reconstructed with lateral and medial leg adipofascial flaps. The lowermost perforators of the peroneal or posterior tibial artery were identified preoperatively, and a straight incision through skin only was made proximal to this perforator. With the skin flaps reflected, the adipofascial flap was than raised in the subfascial plane. The perforators to be retained in the base were located and the flap was then turned over to cover the defect, followed by application of a split-thickness skin graft over the flap. The donor site was closed primarily. RESULTS: The ages of the patients ranged from 25 to 80 years, and the size of the flaps ranged from 3 x 5 cm to 7 x 10 cm. Four defects were reconstructed with lateral leg adipofascial flaps, and medial leg adipofascial flaps were used in three. Two flaps healed uneventfully. Partial or total graft loss and partial flap necrosis were observed in five patients, four of whom were diabetic. CONCLUSIONS: leg adipofascial flaps offer a valuable option for repair of defects around the ankle in many cases. However, adipofascial flaps should be used with caution in old, diabetic patients and, when performed, the probability of a second or third procedure should be considered.
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ranking = 1
keywords = tibia
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10/36. case reports: an unusual complication of radiofrequency ablation treatment of osteoid osteoma.

    Osteoid osteoma is a benign bone tumor traditionally treated nonoperatively or by operative excision. However, radiofrequency ablation is being used increasingly for treatment, as there are several reports supporting its effectiveness. radio-frequency ablation is precise, minimally invasive, safe, effective, and associated with minimal complications and reduced use of healthcare resources. We report a patient treated with radiofrequency ablation for tibial osteoid osteoma and thermal necrosis of the skin.
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ranking = 1
keywords = tibia
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