Cases reported "Necrosis"

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11/36. Use of a cross-leg free muscle flap to reconstruct an extensive burn wound involving a lower extremity.

    A young patient sustained a high-voltage burn with extensive destruction of the soft tissue in his left lower extremity. Occlusion of the anterior and posterior tibial arteries, loss of toe extensors and the superficial and deep peroneal nerves were noted, besides the exposure of the lower end of the tibia and metatarsal bones. In the absence of proper recipient vessels, a cross-leg free latissimus dorsi muscle flap with overlying skin and depending on the vessels of the contralateral foot was used successfully for reconstruction of the defect. The pedicle was divided 3 weeks after microvascular anastomosis and the flap survived completely. This technique permits transfer of free flaps to compromised wounds without available recipient vessels, and the latissimus dorsi muscle flap, with its characteristics of large size and copious vascularity, could be split to cover exposed bones in different areas simultaneously.
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ranking = 1
keywords = tibia
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12/36. Medial hemisoleus muscle flap: a reliable flap for soft tissue reconstruction of the middle-third tibial wound.

    Although the medial hemisoleus muscle has been considered a local reconstructive option for soft-tissue reconstruction of the middle-third tibial wound, its reliability and usefulness has been debated among plastic surgeons. This study reports one surgeon's experience with medial hemisoleus muscle flaps and shows their application for soft tissue reconstruction of middle-third tibial wounds. Over the past 2 years, 10 patients underwent soft tissue reconstruction of a middle-third tibial wound with a medial hemisoleus muscle flap and skin graft. The flap was elevated with emphasis on the preservation of as many perforators to the flap as possible while allowing adequate arch rotation of the flap to cover the exposed tibia and/or hardware. All patients were followed for up to 2 years. There was no total flap loss, and limb salvage was achieved in every patient in this series. Only two patients with peripheral vascular disease developed small partial but insignificant distal flap necrosis and were treated with debridement and flap advancement. The tibial wounds of all patients subsequently healed with excellent cosmetic outcome during follow-up. The results from this study indicate that the medial hemisoleus muscle flap is reliable for soft-tissue reconstruction of a middle-third tibial wound. Meticulous flap elevation with the preservation of perforators to the flap is the key for such success.
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ranking = 5
keywords = tibia
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13/36. Large uterine fibroids causing mechanical obstruction of the inferior vena cava and subsequent thrombosis: a case report.

    A 35-year-old woman presented with severe left leg swelling and pain after a spontaneous abortion of a 20-week fetus. Duplex ultrasound imaging confirmed venous thrombosis of the left iliac, common femoral, superficial femoral, deep femoral, greater saphenous, posterior tibial, and popliteal, peroneal, and soleal veins. A computed tomography scan showed large uterine fibroids that were completely compressing the distal inferior vena cava and both ureters, with associated hydronephrosis. A magnetic resonance venography showed the inferior vena cava proximal to the mechanical obstruction was free of thrombosis but was dilated at 27 mm in the suprarenal location. A hysterectomy was performed and an 8-pound uterus was removed. Intraoperative ultrasound of the inferior vena cava showed a patent crescent shaped vein with no thrombus and adequate venous blood flow. pathology of the uterus showed a large leiomyoma with necrosis. Her lower extremity symptoms resolved.
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ranking = 0.5
keywords = tibia
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14/36. Isolation of agent associated with cat scratch disease bacillus from pretibial biopsy.

    We describe the isolation and cultural characteristics of a Gram-negative bacillus that is very similar to the presumed etiologic agent of cat scratch disease. The organism was isolated from a tibial lesion of a male patient who had been hospitalized for severe necrotizing pancreatitis. The significance of the isolate in this patient remains uncertain.
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ranking = 2.5
keywords = tibia
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15/36. Intraarticular corticosteroids possibly leading to local osteonecrosis and marrow fat induced synovitis.

    We describe a woman with recurrent synovitis in one or both knees treated with intraarticular corticosteroid injections and two 6-day courses of methylprednisolone tablets. She later developed osteonecrosis of her distal femora and proximal tibiae. Her course was complicated by persistent synovitis associated with a large quantity of necrotic fat in the joint fluid.
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ranking = 0.5
keywords = tibia
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16/36. Necrosis leading to amputation following clubfoot surgery.

    amputation after clubfoot surgery is a rare and catastrophic complication. This case report involves an amputation necessitated by postoperative necrosis on the medial side of the foot. To our knowledge, only one brief published report of necrosis following clubfoot surgery exists in the literature, and that report contains little clinical information. Although we know of several additional cases of necrosis following clubfoot surgery, the details of these cases remain unavailable to us for publication. The clubfoot deformity is almost always associated with vascular deficiencies involving the anterior tibial and dorsalis pedis arteries, as well as their derivatives. Since the area of necrosis in this case report coincided with the anatomic distribution of the derivatives of the congenitally reduced or absent dorsalis pedis artery, we suggest that insufficient blood flow to the dorsal and medial sides of the foot, and to the hallux contributed to the necrosis. In our opinion, the surgeon should assume that an abnormal vascular pattern, as described here, is present unless proven otherwise.
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ranking = 0.5
keywords = tibia
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17/36. Single stage reconstruction of a large tibial defect using a free vascularised osteomyocutaneous ulnar transfer.

    We present the case of a young man with 13 cm of bone and soft-tissue loss in the tibia and a severe traction injury of the brachial plexus. A free vascularised composite transfer of the bone and soft tissues of the ulnar side of the forearm was undertaken to reconstruct the defect. Bony union was achieved after a year and was followed by complete functional recovery of the lower limb.
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ranking = 2.5
keywords = tibia
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18/36. Intraosseous fat necrosis associated with acute pancreatitis: MR imaging.

    Necrosis of fatty bone marrow, caused by lipolytic enzymes, is a rare complication of several pancreatic disorders. A 44-year-old man with polyarthritis, subcutaneous nodules, and osteolysis associated with alcoholic pancreatitis underwent magnetic resonance (MR) imaging of the knees. In the marrow of the distal femur and proximal tibia, the images showed multiple foci of abnormal signal intensity compatible with the diagnosis of fat necrosis secondary to acute pancreatitis. Because MR imaging can depict abnormalities in fatty marrow that seem to precede necrosis, this modality may add early diagnostic information.
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ranking = 0.5
keywords = tibia
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19/36. Solitary increased tibial uptake of 99mTc-diphosphonate unmasking pancreatic tumor-related medullary fat necrosis.

    Pancreatic inflammation and tumors can induce various systemic lesions of steatonecrosis. We report here the case of a 73-year-old woman presenting a painful left leg. Roentgenograms and tomograms of the left tibia were normal. Radionuclide bone scan showed diffuse increased uptake in the whole tibia and a CT scan of the same region demonstrated an unusual pattern of bone tumor. Tibial biopsy revealed intra medullary steatonecrosis and led to the discovery of a pancreatic carcinoma.
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ranking = 3
keywords = tibia
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20/36. Combined osteocutaneous microvascular flap procedure for extensive bone and soft tissue defects in the tibia.

    Recent experience with bone healing seems to advocate vascularized bone grafts in cases of large bone gaps or significant scarring, following irradiation, in the presence of low-grade infection, and in congenital pseudarthrosis of the tibia. When extensive bone and skin replacement are needed, the microvascular procedures currently available may not meet specific reconstructive requirements. To augment the advantages of the vascularized fibular graft for tibial substitution (strength, straightness, length, and predictability of vascular supply) with the benefits of free skin, muscle, or musculocutaneous flaps, separate on-demand harvesting of these tissue units and their microvascular combination can be useful in selected cases. In a study of 4 patients, the vascularized fibula was combined with a free latissimus dorsi flap. The procedure was facilitated and shortened by connecting the peroneal vessels to branches of the thoracodorsal or to the scapular circumflex artery and vein outside the operative field. The main supporting vessels of the combined composite tissue block were then anastomosed only to one pair of vessels in the leg.
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ranking = 3
keywords = tibia
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