Cases reported "Osteomyelitis"

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1/128. Salvage of the lower leg using a reversed long free fibular flap.

    The advantages of end-to-side anastomoses have been well documented in microvascular surgery. The vessels of the fibular flap do not usually permit end-to-side anastomosis to recipient vessels in the proximal part of the lower leg because the pedicle length of the free fibular flap is usually too short. Therefore, vein grafts are used to elongate the vessels. If a harvested long free fibular flap that is used to bridge a massive defect of the tibia is reversed and placed into the medullary cavity of the tibia, the flap vessels can be anastomosed, using the end-to-side technique, to the recipient vessels without vein grafts in the distal part of the lower leg. Thus, the flap artery (the peroneal artery) fills in a retrograde fashion. The patient reported was reconstructed with a reversed long free fibular flap. The postoperative period was uneventful. The patient can stand and walk with a protective shoe 2 years postoperatively.
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ranking = 1
keywords = tibia
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2/128. Aspergillus osteomyelitis in a child who has p67-phox-deficient chronic granulomatous disease.

    Here we describe Aspergillus osteomyelitis of the tibia in a 9-year-old boy who has an autosomal recessive form of chronic granulomatous disease (CGD). The patient showed a p67-phagocyte oxidase (phox) deficiency, which is rare type of CGD in japan. The initial treatment which consisted of surgical debridement and antibiotic therapy with amphotericin b (AMPH), did not control the infection. aspergillus fumigatus (A. fumigatus) pure isolated from drainage fluid and necrotic bone tissue demonstrated less susceptible to antifungal agents, including AMPH, fluconazole and flucytosine. Recombinant interferon gamma was then administrated, and it was effective in controlling the course of severe invasive aspergillosis. This report indicates the use of interferon gamma might be helpful in control for Aspergillus osteomyelitis of the tibia in a child with CGD demonstrated p67-phox deficiency refractory to conventional therapy with AMPH.
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ranking = 1
keywords = tibia
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3/128. Neutrophilic dermatosis-associated sterile chronic multifocal osteomyelitis in pediatric patients: case report and review.

    Atypical pyoderma gangrenosum (PG) and sweet syndrome are neutrophilic dermatoses that share some common features. Sterile chronic recurrent multifocal osteomyelitis is a rare association of these neutrophilic dermatoses that has only been reported in children. We report a 3-year-old girl who initially presented with pain in her left hand and right leg. Roentgenograms and bone scan revealed findings of multifocal osteomyelitis affecting both femurs, the right tibia, left clavicle, right eighth costochondral junction, and left ulna. She was treated with antibiotics without improvement. Bone biopsy of the left ulna revealed histologic changes consistent with osteomyelitis, however, all cultures for bacteria, mycobacteria, and fungi were negative. She subsequently developed an ulcer surrounded by a violaceous, undermined border at the site of the bone biopsy, which also did not improve during antibiotic treatment. A biopsy specimen from this lesion demonstrated a dense perivascular and periappendageal infiltrate of neutrophils within the dermis and edema of the papillary dermis compatible with a neutrophilic dermatosis. She was treated with oral prednisone which resulted in resolution of skin lesions, bone pain, and soft tissue swelling. This case further documents the association between PG or sweet syndrome and multifocal sterile osteomyelitis.
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ranking = 0.5
keywords = tibia
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4/128. Reverse venous outflow of a free fibular osteocutaneous flap: a salvage procedure.

    The authors report 2 patients with a massive bony defect of the tibia due to chronic osteomyelitis. They reconstructed the defect using a free vascularized fibular osteocutaneous flap. Unfortunately, venous insufficiency was diagnosed 24 hours postoperatively. The previous anastomosed veins were promptly explored. The peroneal veins of the vascularized fibular bone graft were noted to be full of thrombi. After thrombectomy, the vessels became very fragile and broke down easily. It was impossible to achieve normal antegrade venous outflow from the previous vein of the donor graft; however, they found that distal runoff of the peroneal vein achieved a reverse venous outflow from the donor graft. The great saphenous vein was dissected and reanastomosed to achieve adequate venous drainage. This procedure may offer an alternative treatment for a flap with venous insufficiency.
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ranking = 0.5
keywords = tibia
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5/128. Prevention of skin and soft tissue entrapment in tibial segment transportation.

    We report of a ten year old patient with soft tissue damage and bone defect of the tibia as a sequel of osteomyelitis. After excision and stabilization with an Ilizarov fixateur segment transportation was started. In order to avoid skin and soft tissue entrapment in the docking region, we used a metal cage as a space provider, which was shortened as segment transportation progressed. To our knowledge this simple method has not been described so far.
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ranking = 2.5
keywords = tibia
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6/128. Report of a kindred with bone lesions and subcutaneous abscesses of unknown etiology.

    This case report concerns a 12-year-old boy who had a 9-year history of mandibular lesions of unknown origin. The mandible showed changes resembling chronic osteomyelitis. The tibia and temporal bone also exhibited radiolucencies. Many subcutaneous abscesses were present. The boy died at the age of 14 years as a result of rupture of the aorta. In his family, there were seven members who had bone lesions and eleven who suffered from skin abscesses.
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ranking = 0.5
keywords = tibia
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7/128. Double-stress fracture of the tibia in a ten-year-old child.

    A double-stress fracture of the tibia in a 10-year-old girl is described. Double-stress fracture of the tibia has previously been described in association with osteoarthritic varus deformity of the knee but not, to our knowledge, in a child. It is important to establish the diagnosis of stress fracture in childhood because the differential diagnosis, both clinically and on imaging, includes malignancy that must be excluded while avoiding unnecessary invasive investigations. The site of the lesions, their appearance on magnetic resonance imaging, the absence of any soft-tissue involvement, and the clinical history made the diagnosis possible. The characteristics of stress fracture shown on magnetic resonance imaging are described.
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ranking = 3
keywords = tibia
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8/128. The Boyd amputation as a treatment for osteomyelitis of the foot.

    The Boyd amputation is a surgical technique used to treat osteomyelitis of the foot. This amputation is a technically more difficult procedure to perform than the Syme amputation, but it offers certain advantages. The Boyd amputation provides a more solid stump because it preserves the function of the plantar heel pad. Also, because a portion of the calcaneus is left and fused to the tibia, the weightbearing surface is more solid than in the case of a Syme amputation. The authors recommend a Boyd amputation as an alternative to a Syme or a below-the-knee amputation to treat patients with osteomyelitis of the forefoot and midfoot.
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ranking = 0.5
keywords = tibia
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9/128. Unusual presentation of solitary bone metastasis from breast carcinoma mimicking acute osteomyelitis of the left midtibial shaft.

    The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. biopsy revealed bony metastasis from the patient's breast carcinoma.
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ranking = 3
keywords = tibia
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10/128. 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 = 0.5
keywords = tibia
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