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Maffulli N, Quaranta M, Poeta N, Oliva F, Padhiar N, Chan O. Minimally invasive fasciotomy for symptomatic tibialis anterior muscle hernia. Surgeon 2023; 21:e63-e70. [PMID: 35168905 DOI: 10.1016/j.surge.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Symptomatic muscle herniae are an uncommon cause of chronic exercise induced leg pain. The most common site for muscle hernia is the tibialis anterior muscle. This study evaluates the outcome of a minimal incision fasciotomy in patients with a symptomatic muscle hernia of the tibialis anterior muscle, and their return to normal daily activities including sport. METHODS The study reports mid-term results in a series of 22 consecutive patients (17 males and 5 females, median age: 22 years) with a unilateral tibialis anterior MH who had undergone minimally invasive fasciotomy between 2008 and 2019. Clinical outcomes were assessed with SF-36 and European Quality of Life-5 Dimensions scale (EQ-5D). The ability to participate in sport before and after surgery, and the time to return to training (RTT) and to sport (RTS) were recorded. RESULTS At a median follow up after surgery of 23 months, both questionnaires showed a statistically significant improvement (P < 0.005). At the latest follow up, 16 of patients (73%) had returned to pre-injury or higher levels of sport/activity. The median time to return to training and to return to sport was 7 and 11 weeks respectively. No severe complications and no recurrence of symptoms were recorded. CONCLUSION Minimally invasive fasciotomy is effective and safe for patients suffering from muscle hernia of the tibialis anterior muscle with good results in the mid-term. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England, UK; School of Pharmacy and Biotechnology, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, UK.
| | - Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | - Nat Padhiar
- The London Independent Hospital, London, UK.
| | - Otto Chan
- Department of Medical Imaging, The London Independent Hospital, London, UK.
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Quaranta M, Poeta N, Oliva F, Maffulli N. Muscle herniae: Conservative and surgical management. Systematic review. Surgeon 2022; 21:181-189. [PMID: 35292215 DOI: 10.1016/j.surge.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 01/19/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Muscle herniae are often unrecognized. The primary objective of this systematic review is to evaluate the outcomes of conservative and surgical management for muscle herniae. The secondary objective is to define the most appropriate management for muscle herniae depending on aetiology and size of the fascial defect. METHODS The PRISMA guidelines were used to organize this systematic review to assess the different management modalities and identify possible criteria useful to guide the management of muscle herniae. An electronic search of PubMed and Scopus databases was performed. RESULTS A total of 132 patients were identified. Conservative management was carried out in 22 (16.7%) patients, and 110 (83.3%) patients underwent surgical procedures. Pain was reported in 3/22 (13.6%) patients managed conservatively. Post-surgical pain was reported in 0/5 (0%) patients treated with autologous graft repair, 1/15 (6.7%) patient with mesh repair, 2/13 (15.4%) patients with direct repair and 11/77 (14.3%) patients with fasciotomy. Return to normal activity was possible in 16/22 (72.7%) patients treated conservatively, 5/5 (100%) patients undergoing autologous graft repair, 13/15 (86.7%) with mesh repair, 62/77 (80.52%) with fasciotomy and 4/12 (33.3%) with direct repair. CONCLUSION In congenital muscle herniae, fasciotomy should be considered the surgical choice to prevent complications. In post-traumatic muscle hernia, a small fascial defect can be treated with the direct suture repair, while mesh repair and autologous graft repair should be considered the most appropriate procedures to avoid severe complications such as compartment syndrome.
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Affiliation(s)
- Marco Quaranta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England, UK; Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK.
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Wang L, Liu H, Ma T, Wu X, Zhang L. Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap. Orthop Surg 2021; 13:758-767. [PMID: 33666370 PMCID: PMC8126942 DOI: 10.1111/os.12948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/27/2020] [Accepted: 01/16/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes. METHODS This study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow-up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale. RESULTS The average body mass index (BMI) was 26.6 ± 1.7 kg/m2 (range, 23.9 to 28.7 kg/m2 ). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm2 ). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm2 ). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second-stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow-up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article. CONCLUSIONS The free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.
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Affiliation(s)
- Li Wang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China.,Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, China
| | - Huiren Liu
- Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, China
| | - Tiepeng Ma
- Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, China
| | - Xueqiang Wu
- Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China.,Department of Orthopedic Surgery, Emergency General Hospital, Beijing, China
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A Rare Case of Quadriceps Muscle Herniation Diagnosed by Dynamic Ultrasound. Am J Phys Med Rehabil 2020; 99:e154-e155. [PMID: 32282364 DOI: 10.1097/phm.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of donor site complications of supra- versus subfascially harvested anterolateral thigh perforator free flaps: A meta-analysis. J Craniomaxillofac Surg 2020; 48:56-66. [DOI: 10.1016/j.jcms.2019.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/27/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022] Open
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Polypropylene Mesh Repair of Traumatic Hernia of the Vastus Lateralis. Plast Reconstr Surg Glob Open 2019; 7:e2101. [PMID: 30881835 PMCID: PMC6416141 DOI: 10.1097/gox.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 12/03/2022]
Abstract
Myofascial herniations of the lower limb are a rare cause of chronic nerve compression and pain. They may have congenital or traumatic origin, and the tibialis anterior muscle is the most frequent localization. A few cases will require operative management. An unusual case of symptomatic, acquired hernia of the vastus lateralis muscle in a young male basketball player is reported. After drainage of a compressive hematoma, the patient developed chronic pain and myositis of the vastus lateralis by friction against the edge of tensor fascia lata muscle. Secondary surgical reconstruction involved a polypropylene mesh repair 4 years after the initial trauma. This procedure has been described in a very small number of patients after iatrogenic lesions in total hip arthroplasty and on anterolateral thigh perforator flap donor site. Instead of denial and stoicism, this simple intervention could be proposed to patients as a therapeutic option.
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Fischer S, Diehm Y, Hirche C, Kremer T, Daigeler A, Kneser U, Hernekamp JF. Comparison of sub- versus suprafascially raised anterolateral thigh free flaps with regard to donor-site morbidity, function and aesthetics. Microsurgery 2017; 38:444-449. [DOI: 10.1002/micr.30274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/22/2017] [Accepted: 11/10/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Sebastian Fischer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - Yannick Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - Thomas Kremer
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
| | - J. Frederick Hernekamp
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Clinic Ludwigshafen; University of Heidelberg; Ludwigshafen, 67071 Germany
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Muscle hernias of the leg: A case report and comprehensive review of the literature. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255031302100408] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Donor-site Morbidity of Medial and Lateral Thigh-based Flaps: A Comparative Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1012. [PMID: 27975004 PMCID: PMC5142470 DOI: 10.1097/gox.0000000000001012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/29/2016] [Indexed: 11/26/2022]
Abstract
Background: Free and pedicled medial and lateral thigh-based flaps are common reconstructive procedures. However, there have been no comparative studies of morbidity between medial and lateral donor sites. Methods: We conducted an Enterprise Data Warehouse-based review of all the senior authors’ (R.D.G., G.A.D., and M.S.A.) thigh-based free and pedicled flaps. Patient demographic data, donor-site complications, drain duration, and number of postoperative visits were collected and compared. Complications were also compared between fasciocutaneous flaps and muscle or myocutaneous flaps, and skin grafted donor sites. Results: We analyzed 352 flap donor sites, with 155 medial and 197 lateral. Two hundred seventeen (217) flaps were pedicled. Flap types included 127 gracilis, 27 rectus femoris, 134 anterolateral thigh, and 36 vastus lateralis-only flaps. There were no significant differences in complications between medial (17.4%) and lateral thigh (21.3%) donor sites, although lateral thigh flaps had a mean of 1 additional postoperative visit. Rates of wound dehiscence/healing issues were significantly higher in both gracilis myocutaneous flaps (25.9%) and flaps requiring a skin grafted donor site (31.2%). Postoperative therapeutic anticoagulation was the only significant risk factor for a donor-site complication. Flap complications resulted in increased drain duration and postoperative office visits. Conclusions: Donor-site morbidity is similar in both lateral and medial thigh-based flaps. The inclusion of muscle in the flap from either donor site does not seem to increase complications, but the inclusion of a skin paddle with gracilis muscle, or a skin grafted lateral thigh donor site, results in increased wound healing complications.
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Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap: systematic literature review of specific donor-site complications and their management. J Craniomaxillofac Surg 2012; 41:15-21. [PMID: 22727900 DOI: 10.1016/j.jcms.2012.05.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/15/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The anterolateral thigh flap (ALT) is one of the most common flaps used in reconstructive microsurgery, due to its demonstrated lower donor-site morbidity when compared to other sites. Despite this, there are case reports of specific donor-site complications following the raising of an ALT flap. To date, there has been no systematic review of ALT-flap-related complications and overall ALT donor-site morbidity. METHODS A systematic review of the English-language literature was performed to identify specific donor-site complications following ALT-flap creation. RESULTS Fifteen articles met the study criteria and were included for analysis. ALT-flap donor-site complications were classified according to the tissue component involved (vessels/nerves, deep fascia, muscles). CONCLUSIONS Donor-site morbidity following raising of an ALT flap is minimal. ALT-flap versatility fulfils all of the needs of reconstruction, however we identified less common, but straightforward, complications that occurred when elevating overly large skin paddles (with widths measuring more than 10-12 cm), when sacrificing a main motor branch, when developing the pedicle too far proximally, when including too much fascia and when neglecting proper haemostasis. We suggest a basic algorithm for minimising donor-site morbidity and controlling complications, thereby reducing overall patient morbidity, shortening hospital stays and reducing costs.
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Affiliation(s)
- Tommaso Agostini
- CTO-AOUC, Department of Traumatology and Maxillofacial Surgery, CTO, Florence, Italy.
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Townley W, Royston E, Karmiris N, Crick A, Dunn R. Critical assessment of the anterolateral thigh flap donor site. J Plast Reconstr Aesthet Surg 2011; 64:1621-6. [DOI: 10.1016/j.bjps.2011.07.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/03/2011] [Accepted: 07/09/2011] [Indexed: 11/26/2022]
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