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      Surgical repair of a thigh muscle herniation with synthetic mesh Translated title: Reparación quirúrgica de hernia muscular en muslo con malla sintética

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          Abstract

          Abstract We present the case of a 14-year-old female patient with a big muscle hernia in the thigh after extraction of a fascia lata strip to repair bilateral congenital ptosis. After three weeks, a progressive emergence of a large bulge between the two thigh incisions in a standing position was noticeable, with local discomfort, dull pain on exertion and unsightly appearance that worried the patient. On surgery three months later, a large tear in the fascia lata and muscle herniation was revealed. The fascial tear was debrided and a synthetic mesh was applied. Ten years later, the patient confirmed her continued asymptomatic condition. Muscular hernia of significant size as a consequence of a fascia lata strip harvest is extremely infrequent in adolescents. Surgical repair of big muscular hernias in extremities with synthetic mesh, usually used in groin hernia repair, is an infrequent orthopaedic tool but is safe, easy to apply and inexpensive.

          Translated abstract

          Resumen Presentamos el caso de una chica de 14 años con una gran hernia muscular en muslo tras extracción de una tira de fascia lata para ser utilizada en cirugía oftalmológica. Tres semanas más tarde era muy evidente en bipedestación un abultamiento entre ambas incisiones, con molestias locales, dolorimiento y preocupación por el aspecto estético. Tres meses más tarde se realizó intervención quirúrgica evidenciándose herniación de parte del músculo vasto externo con gran defecto fascial, que fue desbridado, aplicándose malla no reabsobible de polipropileno. Diez años más tarde la paciente confirmó que permanece asintomática. La aparición de una hernia muscular de gran tamaño en extremidades de adolescentes como consecuencia de extracción de fascia lata es extremadamente infrecuente. La reparación de hernias musculares de gran tamaño en extremidades mediante malla sintética, utilizada habitualmente en reparación de hernias inguinales, es una técnica rápida, segura y barata a tener en cuenta en cirugía ortopédica.

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          Anterolateral thigh flap donor-site complications and morbidity.

          The authors examined donor-site complications and morbidity in 37 patients after reconstruction with free or pedicled anterolateral thigh flaps. Intraoperative assessment included damage to the vastus lateralis muscle and whether the main pedicle of the rectus femoris muscle had been killed. Postoperative assessment of the donor site included wound healing, range of motion, muscle strength, gait, and sensation. Patients were surveyed with a questionnaire about fatigue in their activities of daily life and the appearance of the donor site. All 32 patients who underwent primary skin closure could perform activities of daily life normally, and most (87.5 percent) reported that donor-site appearance was satisfactory. However, the severity of donor-site dysfunction was related to the degree of damage to the vastus lateralis muscle, and most patients (87.5 percent) had some loss of sensation at the anterolateral aspect of the thigh. Because of adhesions between the meshed skin graft and the underlying fascia, range of motion at the hip and knee was limited in significantly more patients who had received split-thickness skin grafts (60 percent) than patients who had undergone primary skin closure (3.1 percent). Therefore, wider flaps or flaps harvested nearer the knee may increase donor-site morbidity. The authors concluded that the incidence of long-term morbidity with the anterolateral thigh flap is low, although it is increased when the flap includes the vastus lateralis muscle or is wider and requires additional skin grafting at the donor site.
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            Muscle hernias of the leg: A case report and comprehensive review of the literature.

            A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.
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              Patient-reported donor-site morbidity following anterolateral thigh free flaps.

              This study evaluated donor-site morbidity (retrospective chart review and followup questionnaire) in patients following reconstruction using an anterolateral thigh free flap. Twenty-one flaps were performed in 20 consecutive patients (mean age: 45.0 +/- 3.8 years). Primary wound closure was obtained in 52.4 percent. The perforators were intramuscular in 68 percent and septocutaneous in 32 percent. The early complications included infection (n = 2), wound dehiscence (n = 2), delayed healing (n = 8), and seroma (n = 1). Wound healing took 4.5 +/- 0.7 weeks, and leg weakness resolved completely (n = 13) by 6.6 +/- 2.0 weeks. More chronic complications (n = 19) included weakness (n = 5), pain/tightness (n = 6), contour deformity (n = 14), muscle herniation (n = 6), and unsatisfactory scar appearance (n = 6). No statistically significant differences existed in aesthetics or healing between wound-closure groups, nor in pain or weakness between perforator groups. Pain and weakness were significantly related to sacrifice of the deep fascia from the thigh through its elevation in the flap.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                December 2020
                : 43
                : 3
                : 405-409
                Affiliations
                [1] Pamplona orgnameComplejo Hospitalario de Navarra orgdiv1Orthopaedic Surgery Service orgdiv2Pediatric Trauma and Orthopedic Section Spain
                Article
                S1137-66272020000300011 S1137-6627(20)04300300011
                10.23938/assn.877
                894e7449-797a-4f88-a231-762bc1270b7e

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 06 June 2020
                : 06 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 5
                Product

                SciELO Spain

                Categories
                Clinical Notes

                Muslo,Muscular hernia,Thigh,Synthetic mesh,Hernia muscular,Malla sintética

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