Pub Date : 2024-11-14DOI: 10.1016/j.sycrs.2024.100070
Hanne-Eva van Bremen , Jorn P. Meekel , Steven P. Kerssemakers , Gerwin A. Fransen , Sandra Muller
Background
Core needle biopsy of the breast is a widely used technique to obtain a specimen for histopathological examination. Stereotactic biopsy occasionally result incomplications such as infection or hematoma. The development of a pseudoaneurysm after breast biopsy; however, is a rare complication.
Case presentation
A 56-year-old postmenopausal woman using a vitamin K antagonist presented with a suspicious lesion in the lateral upper quadrant of the right breast, initially classified as BI-RADS 3. After 24 months, an increase in calcification led to reclassification as BI-RADS 4, prompting stereotactic biopsy without periprocedural complications. One month later, the patient presented with continuous swelling accompanied by pain. Ultrasound and Doppler revealed a concentric collection with a to-and-fro waveform, indicating a pseudoaneurysm. Treatment with thrombin injection successfully induced thrombosis. Follow-up at six weeks demonstrated complete regression of the mass without signs of residual blood flow.
Conclusions
Thrombin injection appears to be a safe and effective treatment for the occurrence of pseudoaneurysm following stereotactic breast biopsy.
背景乳腺芯针活检是一种广泛使用的技术，用于获取标本进行组织病理学检查。立体定向活检偶尔会导致感染或血肿等并发症。然而，乳腺活检后出现假性动脉瘤是一种罕见的并发症。病例介绍 一位 56 岁的绝经后妇女在服用维生素 K 拮抗剂后出现右乳房外上象限可疑病变，最初被归类为 BI-RADS 3。一个月后，患者出现持续肿胀并伴有疼痛。超声波和多普勒显示有一个同心的集合体，波形忽高忽低，显示为假性动脉瘤。注射凝血酶的治疗成功诱导了血栓形成。结论注射凝血酶似乎是治疗乳腺立体定向活检术后假性动脉瘤的一种安全有效的方法。
{"title":"Pseudoaneurysm in the axillary tail of the breast following stereotactic biopsy: A case report and literature review","authors":"Hanne-Eva van Bremen , Jorn P. Meekel , Steven P. Kerssemakers , Gerwin A. Fransen , Sandra Muller","doi":"10.1016/j.sycrs.2024.100070","DOIUrl":"10.1016/j.sycrs.2024.100070","url":null,"abstract":"<div><h3>Background</h3><div>Core needle biopsy of the breast is a widely used technique to obtain a specimen for histopathological examination. Stereotactic biopsy occasionally result incomplications such as infection or hematoma. The development of a pseudoaneurysm after breast biopsy; however, is a rare complication.</div></div><div><h3>Case presentation</h3><div>A 56-year-old postmenopausal woman using a vitamin K antagonist presented with a suspicious lesion in the lateral upper quadrant of the right breast, initially classified as BI-RADS 3. After 24 months, an increase in calcification led to reclassification as BI-RADS 4, prompting stereotactic biopsy without periprocedural complications. One month later, the patient presented with continuous swelling accompanied by pain. Ultrasound and Doppler revealed a concentric collection with a to-and-fro waveform, indicating a pseudoaneurysm. Treatment with thrombin injection successfully induced thrombosis. Follow-up at six weeks demonstrated complete regression of the mass without signs of residual blood flow.</div></div><div><h3>Conclusions</h3><div>Thrombin injection appears to be a safe and effective treatment for the occurrence of pseudoaneurysm following stereotactic breast biopsy.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"4 ","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.sycrs.2024.100071
Tim Baumgartner, Hishaam Ismael, David Young
Small bowel diverticulosis, less common than colonic diverticulosis (incidence 1–2 %), predominantly affects males, and risk increases with age. Approximately 15 % or patients present with complications including bleeding, perforations with peritonitis, or fistulas, and these complications can be fatal with mortality rates as high as 40 % in cases of perforation. While some reports have suggested that patients can avoid surgery with bowel rest and antibiotics, or the use of CT guided aspiration of abscesses related to the disease, this case series examines 5 patients with perforated jejunal diverticulitis at a single institution successfully managed with surgical resection in the emergent and elective settings following recurrence of symptoms. There are limitations to medical management and lifestyle modifications alone, while elective surgical resection is effective in symptom management and risk reduction.
{"title":"Management of perforated jejunal diverticulitis: A case series and literature review","authors":"Tim Baumgartner, Hishaam Ismael, David Young","doi":"10.1016/j.sycrs.2024.100071","DOIUrl":"10.1016/j.sycrs.2024.100071","url":null,"abstract":"<div><div>Small bowel diverticulosis, less common than colonic diverticulosis (incidence 1–2 %), predominantly affects males, and risk increases with age. Approximately 15 % or patients present with complications including bleeding, perforations with peritonitis, or fistulas, and these complications can be fatal with mortality rates as high as 40 % in cases of perforation. While some reports have suggested that patients can avoid surgery with bowel rest and antibiotics, or the use of CT guided aspiration of abscesses related to the disease, this case series examines 5 patients with perforated jejunal diverticulitis at a single institution successfully managed with surgical resection in the emergent and elective settings following recurrence of symptoms. There are limitations to medical management and lifestyle modifications alone, while elective surgical resection is effective in symptom management and risk reduction.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"4 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.sycrs.2024.100077
Dima Malkawi, Janet Lee, Micheal Shane McNevin
Non-Hodgkin's lymphomas are a diverse group of immune system cancers that can affect any organ in the body. Few reports describe the development of malignant lymphoma in internal or external hemorrhoids. We present the case of a 67-year-old female with a long-standing history of non-bleeding, prolapsing hemorrhoids, and recent significant weight loss. Following an excisional hemorrhoidectomy, pathological analysis revealed high-grade diffuse large B-cell non-Hodgkin lymphoma (DLBCL) involving the mucosal hemorrhoid tissue. The case underscores the importance of considering malignancy in atypical presentations of common conditions. Treatment for anal canal lymphomas remains uncertain, with medical management generally preferred over surgery. Accurate diagnosis requires histopathologic examination due to the overlap of clinical features with other pathologies.
非霍奇金淋巴瘤是一种多种多样的免疫系统癌症，可影响身体的任何器官。很少有报告描述恶性淋巴瘤发生在内痔或外痔。我们介绍了一例 67 岁女性的病例，她长期患有不出血、脱垂的痔疮，近期体重明显下降。痔切除术后，病理分析发现高级别弥漫大 B 细胞非霍奇金淋巴瘤（DLBCL）累及痔粘膜组织。该病例强调了在常见疾病的非典型表现中考虑恶性肿瘤的重要性。肛管淋巴瘤的治疗方法仍不确定，通常首选药物治疗而非手术治疗。由于临床特征与其他病变重叠，准确诊断需要组织病理学检查。
{"title":"High-grade diffuse large B cell non-Hodgkin lymphoma involving the mucosal hemorrhoid tissue: A case report","authors":"Dima Malkawi, Janet Lee, Micheal Shane McNevin","doi":"10.1016/j.sycrs.2024.100077","DOIUrl":"10.1016/j.sycrs.2024.100077","url":null,"abstract":"<div><div>Non-Hodgkin's lymphomas are a diverse group of immune system cancers that can affect any organ in the body. Few reports describe the development of malignant lymphoma in internal or external hemorrhoids. We present the case of a 67-year-old female with a long-standing history of non-bleeding, prolapsing hemorrhoids, and recent significant weight loss. Following an excisional hemorrhoidectomy, pathological analysis revealed high-grade diffuse large B-cell non-Hodgkin lymphoma (DLBCL) involving the mucosal hemorrhoid tissue. The case underscores the importance of considering malignancy in atypical presentations of common conditions. Treatment for anal canal lymphomas remains uncertain, with medical management generally preferred over surgery. Accurate diagnosis requires histopathologic examination due to the overlap of clinical features with other pathologies.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bariatric surgery has quickly emerged as one of the most effective treatments for obesity in the world and is mostly known as a safe and effective method; however, in some cases, it may lead to life-threatening complications. One of these complications is fistula, which may result in high mortality and morbidity. The treatment methods for this condition have been subject to ongoing discussion, ranging from endoscopic procedures to surgery. However, the outcome of each approach remains uncertain for both patients and surgeons. A 21-year-old man presented with pulmonary symptoms such as cough, pleuritic chest pain, and fever two months after laparoscopic sleeve gastrectomy and in further investigations, the diagnosis of gastrobronchial fistula (GBF) was confirmed. The treatment of the patient was based on endoscopic procedures and prioritizing minimally invasive methods over surgical interventions.
The treatment approach that is recommended for patients with GBF is the stepwise method, in which the next step is performed according to the patient's condition. Also, the treatment was based on minimally invasive procedures like endoscopic-based methods, also it is advisable to avoid conducting invasive treatments such as surgical procedures until the patient has shown a response to either non-invasive or minimally invasive treatments.
Conclusion
The key finding of this case report emphasizes that in situations of acute or unstable conditions or even if there is still hope for treatment, it's better to avoid invasive procedures. Rather, opting for non-invasive or minimally invasive treatments is favored to stabilize the patient's clinical or lab parameters, or to maintain a steady and consistent weight. Therefore, it is advisable to refrain from or delay surgical and invasive procedures during the acute stages or when a GBF is newly diagnosed, allowing the patient to attain a more stable clinical condition and use surgical approaches as a complementary choice besides minimally invasive procedures.
{"title":"A stepwise treatment of gastrobronchial fistula after laparoscopic sleeve gastrectomy: A case report\"","authors":"Behrouz Keleidari , Koorosh Parchami , Erfan Sheikhbahaei , Mohammad ghayoomi","doi":"10.1016/j.sycrs.2024.100076","DOIUrl":"10.1016/j.sycrs.2024.100076","url":null,"abstract":"<div><div>Bariatric surgery has quickly emerged as one of the most effective treatments for obesity in the world and is mostly known as a safe and effective method; however, in some cases, it may lead to life-threatening complications. One of these complications is fistula, which may result in high mortality and morbidity. The treatment methods for this condition have been subject to ongoing discussion, ranging from endoscopic procedures to surgery. However, the outcome of each approach remains uncertain for both patients and surgeons. A 21-year-old man presented with pulmonary symptoms such as cough, pleuritic chest pain, and fever two months after laparoscopic sleeve gastrectomy and in further investigations, the diagnosis of gastrobronchial fistula (GBF) was confirmed. The treatment of the patient was based on endoscopic procedures and prioritizing minimally invasive methods over surgical interventions.</div><div>The treatment approach that is recommended for patients with GBF is the stepwise method, in which the next step is performed according to the patient's condition. Also, the treatment was based on minimally invasive procedures like endoscopic-based methods, also it is advisable to avoid conducting invasive treatments such as surgical procedures until the patient has shown a response to either non-invasive or minimally invasive treatments.</div></div><div><h3>Conclusion</h3><div>The key finding of this case report emphasizes that in situations of acute or unstable conditions or even if there is still hope for treatment, it's better to avoid invasive procedures. Rather, opting for non-invasive or minimally invasive treatments is favored to stabilize the patient's clinical or lab parameters, or to maintain a steady and consistent weight. Therefore, it is advisable to refrain from or delay surgical and invasive procedures during the acute stages or when a GBF is newly diagnosed, allowing the patient to attain a more stable clinical condition and use surgical approaches as a complementary choice besides minimally invasive procedures.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.sycrs.2024.100063
Eduardo R. Bautista , Pocholo Carlo R. Bernardo , Tricia Angela G. Sarile , Czarlo M. Dela Victoria , Mary Grace G. Gana , Ana Melissa F. Hilvano-Cabungcal , Ferri P. David-Paloyo , Siegfredo R. Paloyo
{"title":"Corrigendum to “Thrombectomy under deep hypothermic circulatory arrest (DHCA) for renal cell carcinoma with atrio-caval thrombus” [Surg Case Rep: Adv Tech 2 (2024) 1-4, 100036]","authors":"Eduardo R. Bautista , Pocholo Carlo R. Bernardo , Tricia Angela G. Sarile , Czarlo M. Dela Victoria , Mary Grace G. Gana , Ana Melissa F. Hilvano-Cabungcal , Ferri P. David-Paloyo , Siegfredo R. Paloyo","doi":"10.1016/j.sycrs.2024.100063","DOIUrl":"10.1016/j.sycrs.2024.100063","url":null,"abstract":"","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.sycrs.2024.100072
José De Jesús Herrera-Esquivel, Carlos A. Zacaula-Aguilar, Enrique Cortinez-Encarnación, Ana Karen García-Ávila, José Rodrigo Muñoz-Gutiérrez, Miguel Ángel Domínguez-Varela, Manuel A. Pérez-Turrent
Introduction
Immunoglobulin G4-related disease (IgG4-RD) is a rare, systemic autoimmune fibroinflammatory disorder affecting the pancreatobiliary tract, often mimicking malignancies. Diagnosis relies on clinical and histological features, using Mayo Clinic HISORt and Japan Biliary Association criteria.
Case series
Two patients with IgG4-RD presented with abdominal symptoms and abnormal liver function tests. Imaging and endoscopic ultrasound (EUS) revealed bile duct stenosis and pancreatic abnormalities. Elevated serum IgG4 levels and histopathological findings confirmed the diagnosis. Both patients responded well to prednisone, showing clinical improvement and normalization of liver function tests.
Discussion
IgG4-RD represents a diagnostic challenge due to its diverse manifestations. Accurate diagnosis requires a multidisciplinary approach, incorporating clinical, radiological, serological, and histopathological findings. Early recognition and corticosteroid therapy are crucial for achieving remission.
Conclusion
The establishment of diagnostic criteria and advanced imaging techniques has improved the management of IgG4-RD. However, distinguishing it from other biliary disorders remains challenging, necessitating ongoing research and collaboration among medical professionals.
{"title":"Endoscopic approach for pancreatobiliary involvement in IgG4 related disease","authors":"José De Jesús Herrera-Esquivel, Carlos A. Zacaula-Aguilar, Enrique Cortinez-Encarnación, Ana Karen García-Ávila, José Rodrigo Muñoz-Gutiérrez, Miguel Ángel Domínguez-Varela, Manuel A. Pérez-Turrent","doi":"10.1016/j.sycrs.2024.100072","DOIUrl":"10.1016/j.sycrs.2024.100072","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunoglobulin G4-related disease (IgG4-RD) is a rare, systemic autoimmune fibroinflammatory disorder affecting the pancreatobiliary tract, often mimicking malignancies. Diagnosis relies on clinical and histological features, using Mayo Clinic HISORt and Japan Biliary Association criteria.</div></div><div><h3>Case series</h3><div>Two patients with IgG4-RD presented with abdominal symptoms and abnormal liver function tests. Imaging and endoscopic ultrasound (EUS) revealed bile duct stenosis and pancreatic abnormalities. Elevated serum IgG4 levels and histopathological findings confirmed the diagnosis. Both patients responded well to prednisone, showing clinical improvement and normalization of liver function tests.</div></div><div><h3>Discussion</h3><div>IgG4-RD represents a diagnostic challenge due to its diverse manifestations. Accurate diagnosis requires a multidisciplinary approach, incorporating clinical, radiological, serological, and histopathological findings. Early recognition and corticosteroid therapy are crucial for achieving remission.</div></div><div><h3>Conclusion</h3><div>The establishment of diagnostic criteria and advanced imaging techniques has improved the management of IgG4-RD. However, distinguishing it from other biliary disorders remains challenging, necessitating ongoing research and collaboration among medical professionals.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculous appendicitis is very infrequent, estimated to occur in only 0.1 % of all appendectomies. Appendicular tuberculosis can manifest as either a primary or secondary infection. Primary appendicular tuberculosis is even more uncommon and occurs in the absence of any detectable primary focus elsewhere in the body.
Case Presentation
In this report, we present a challenging case of primary tuberculous appendicitis that does not appear to have originated from the lungs. This case highlights the importance of considering tuberculosis in the differential diagnosis of appendicitis, especially in regions where tuberculosis is endemic or in patients with a history of tuberculosis exposure.
Clinical Discussion
Diagnosing tuberculous appendicitis can be challenging due to its rarity and the non-specific nature of its symptoms, which often mimic those of more common conditions such as acute appendicitis and because of these non-specific symptoms, tuberculous appendicitis is mostly diagnosed only after surgical intervention.
Conclusion
This case underscores the need for a high index of suspicion and thorough diagnostic evaluation in patients with atypical presentations of appendicitis specifically in patients with chronic complaints. Treatment typically involves a combination of surgical intervention to remove the affected appendix and a prolonged course of anti-tuberculous medication to eradicate the infection and prevent recurrence.
{"title":"Acute appendicitis due to extrapulmonary tuberculosis","authors":"Hamidreza Zamani , Seyed Pedram Kouchak Hosseini , Soheil Bagherian Lemraski , Hojatolah Khoshnoudi , Mohammad Aghaei , Alireza Haghbin Toutounchi","doi":"10.1016/j.sycrs.2024.100075","DOIUrl":"10.1016/j.sycrs.2024.100075","url":null,"abstract":"<div><h3>Introduction and Importance</h3><div>Tuberculous appendicitis is very infrequent, estimated to occur in only 0.1 % of all appendectomies. Appendicular tuberculosis can manifest as either a primary or secondary infection. Primary appendicular tuberculosis is even more uncommon and occurs in the absence of any detectable primary focus elsewhere in the body.</div></div><div><h3>Case Presentation</h3><div>In this report, we present a challenging case of primary tuberculous appendicitis that does not appear to have originated from the lungs. This case highlights the importance of considering tuberculosis in the differential diagnosis of appendicitis, especially in regions where tuberculosis is endemic or in patients with a history of tuberculosis exposure.</div></div><div><h3>Clinical Discussion</h3><div>Diagnosing tuberculous appendicitis can be challenging due to its rarity and the non-specific nature of its symptoms, which often mimic those of more common conditions such as acute appendicitis and because of these non-specific symptoms, tuberculous appendicitis is mostly diagnosed only after surgical intervention.</div></div><div><h3>Conclusion</h3><div>This case underscores the need for a high index of suspicion and thorough diagnostic evaluation in patients with atypical presentations of appendicitis specifically in patients with chronic complaints. Treatment typically involves a combination of surgical intervention to remove the affected appendix and a prolonged course of anti-tuberculous medication to eradicate the infection and prevent recurrence.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.sycrs.2024.100074
Fadlurrahman Manaf , Azmi Farhadi
Background
Soft tissue defects that afflict the ankle and foot are mostly the result of trauma. Large wounds with soft tissue defects, especially in the ankle and foot, are a reconstructive challenge due to the lack of availability of local tissues and recipient vessels.
Case Presentation
We report a female with a crush injury of the right foot and a Lisfranc injury due to a motor vehicle accident. The patient had a soft tissue defect 20 × 10 cm2 with bone and tendon exposed. The patient had a fasciocutaneous flap from the posteromedial of the distal contralateral leg for soft tissue reconstruction. Both legs were stabilized with a cast. The cross-leg flap was separated from the donor site three weeks later, and K-Wire was removed. Flap evaluation was good, and the patient resumed normal gait and activity without any stiffness of joints related to the flap or cast.
Discussion
Reconstruction of soft tissue defects in the ankle and foot is a challenge for surgeons due to the paucity of local and regional tissues and associated vessel injuries. Cross-leg flap can be suitable alternative option. In this case, we use medially based fasciocutaneous perforator cross-leg flap, based on the posterior tibial artery perforators. Cross-leg flaps are less technically demanding, and the probability of reexploration is lower than in free flaps. The cross-leg flap has the disadvantage of prolonged immobilization and uncomfortable resting positions.
Conclusion
Cross-leg flap can be alternative solution for covering large soft tissue defects in ankle and foot with its advantages and disadvantages.
背景踝关节和足部软组织缺损大多是外伤所致。由于缺乏局部组织和受体血管，大面积软组织缺损的伤口，尤其是踝关节和足部的软组织缺损，是重建的一大挑战。患者的软组织缺损面积为 20 × 10 平方厘米，骨头和肌腱外露。患者从对侧腿部远端后内侧取出筋膜皮瓣进行软组织重建。双腿用石膏固定。三周后，将跨腿皮瓣与供体部位分离，并移除 K 线。皮瓣评估结果良好，患者恢复了正常的步态和活动，没有出现任何与皮瓣或石膏有关的关节僵硬。 讨论由于缺乏局部和区域组织以及相关的血管损伤，踝关节和足部软组织缺损的重建对外科医生来说是一项挑战。跨腿皮瓣是一种合适的替代选择。在本病例中，我们使用了以胫后动脉穿孔器为基础的内侧筋膜皮穿孔器交叉腿皮瓣。与游离皮瓣相比，交叉腿皮瓣的技术要求较低，再次探查的概率也较低。结论：交叉腿皮瓣可作为覆盖踝关节和足部大面积软组织缺损的替代方案，但也有其优缺点。
{"title":"Cross-leg flap, alternative surgery for post traumatic soft tissue defect of ankle and foot","authors":"Fadlurrahman Manaf , Azmi Farhadi","doi":"10.1016/j.sycrs.2024.100074","DOIUrl":"10.1016/j.sycrs.2024.100074","url":null,"abstract":"<div><h3>Background</h3><div>Soft tissue defects that afflict the ankle and foot are mostly the result of trauma. Large wounds with soft tissue defects, especially in the ankle and foot, are a reconstructive challenge due to the lack of availability of local tissues and recipient vessels.</div></div><div><h3>Case Presentation</h3><div>We report a female with a crush injury of the right foot and a Lisfranc injury due to a motor vehicle accident. The patient had a soft tissue defect 20 × 10 cm2 with bone and tendon exposed. The patient had a fasciocutaneous flap from the posteromedial of the distal contralateral leg for soft tissue reconstruction. Both legs were stabilized with a cast. The cross-leg flap was separated from the donor site three weeks later, and K-Wire was removed. Flap evaluation was good, and the patient resumed normal gait and activity without any stiffness of joints related to the flap or cast.</div></div><div><h3>Discussion</h3><div>Reconstruction of soft tissue defects in the ankle and foot is a challenge for surgeons due to the paucity of local and regional tissues and associated vessel injuries. Cross-leg flap can be suitable alternative option. In this case, we use medially based fasciocutaneous perforator cross-leg flap, based on the posterior tibial artery perforators. Cross-leg flaps are less technically demanding, and the probability of reexploration is lower than in free flaps. The cross-leg flap has the disadvantage of prolonged immobilization and uncomfortable resting positions.</div></div><div><h3>Conclusion</h3><div>Cross-leg flap can be alternative solution for covering large soft tissue defects in ankle and foot with its advantages and disadvantages.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.sycrs.2024.100073
Halil Ibrahim BULUT , Erhan OKAY , Tolga ONAY , Enes KANAY , Korhan OZKAN
Background
Limb tumors, though rare, pose significant challenges to surgical management due to their impact on limb function and quality of life. Effective treatment requires precise tumor resection alongside advanced reconstructive techniques to restore limb function, particularly in cases of compromised bone healing. Titanium cages, traditionally used in spinal surgeries, have recently gained attention for their potential in limb reconstruction within orthopedic oncology, offering a novel approach to managing complex bone defects.
Case Presentation
This retrospective case series presents two patients treated with titanium cages for limb reconstruction following tumor resection.
Case 1: A 53-year-old female with a solitary plasmacytoma of the femur experienced a pathological fracture and nonunion after initial treatment. A titanium cage was employed to bridge the resected bone segment, leading to successful callus formation at the six-month follow-up and restored limb function.
Case 2: A 31-year-old female with a giant cell tumor and hemangioma of the foot underwent en bloc resection followed by reconstruction using a vertebral cage and iliac corticospongious graft. Six months postoperatively, the patient had resumed full weight-bearing with no complications.
Conclusion
Titanium cages offer a promising solution for limb reconstruction in patients with tumors, particularly for large bone defects where traditional methods may be inadequate. This case series demonstrates successful outcomes in limb preservation and functional recovery using titanium cages. Their use in the adult population shows potential for broader application in orthopedic oncology, warranting further clinical investigation.
{"title":"Innovative approaches to cage reconstructions in orthopedic limb surgery: Advances and insights with two cases","authors":"Halil Ibrahim BULUT , Erhan OKAY , Tolga ONAY , Enes KANAY , Korhan OZKAN","doi":"10.1016/j.sycrs.2024.100073","DOIUrl":"10.1016/j.sycrs.2024.100073","url":null,"abstract":"<div><h3>Background</h3><div>Limb tumors, though rare, pose significant challenges to surgical management due to their impact on limb function and quality of life. Effective treatment requires precise tumor resection alongside advanced reconstructive techniques to restore limb function, particularly in cases of compromised bone healing. Titanium cages, traditionally used in spinal surgeries, have recently gained attention for their potential in limb reconstruction within orthopedic oncology, offering a novel approach to managing complex bone defects.</div></div><div><h3>Case Presentation</h3><div>This retrospective case series presents two patients treated with titanium cages for limb reconstruction following tumor resection.</div><div>Case 1: A 53-year-old female with a solitary plasmacytoma of the femur experienced a pathological fracture and nonunion after initial treatment. A titanium cage was employed to bridge the resected bone segment, leading to successful callus formation at the six-month follow-up and restored limb function.</div><div>Case 2: A 31-year-old female with a giant cell tumor and hemangioma of the foot underwent en bloc resection followed by reconstruction using a vertebral cage and iliac corticospongious graft. Six months postoperatively, the patient had resumed full weight-bearing with no complications.</div></div><div><h3>Conclusion</h3><div>Titanium cages offer a promising solution for limb reconstruction in patients with tumors, particularly for large bone defects where traditional methods may be inadequate. This case series demonstrates successful outcomes in limb preservation and functional recovery using titanium cages. Their use in the adult population shows potential for broader application in orthopedic oncology, warranting further clinical investigation.</div></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.sycrs.2024.100069
Giovanni De Nobili, Severino Cericola, Vincenzo Casolino, Simone Di Russo, Erika Peca, Rossana Percario, Roberta Dimalio, Gauro D'Urbano, Paolo Panaccio
Background
Hydrocarbon products are generally used by drug addict patients in attempt to emulate drug effects or as a means of self-harm. These substances can be assumed through inhalation or by intravenous or intramuscular injection. When hydrocarbons are injected intramuscularly into the limbs, they can cause the compartment syndrome, necessitating surgical intervention.
Cases series
We describe a series of three cases in which compartment syndrome developed following hydrocarbon intramuscular injection of hydrocarbons and was successfully treated with urgent fasciotomy. The cases involve three young men who injected gasoline or diesel fuel in their arms and legs. In each case, urgent fasciotomy was necessary to evacuate the intramuscular collection that was rapidly expanding. The three patients were then discharged from our Surgical Department with no complications and were followed up in outpatient visits.
Conclusion
Intramuscular hydrocarbon injection can mainly lead to compartment syndrome and tissue necrosis. In the three cases we have reported, urgent fasciotomy successfully prevented ischemic damage to the limbs and facilitated the drainage of toxic substances, thereby preventing patient’s systemic poisoning and septic lethal consequences.
{"title":"Compartment syndrome following self-injection of hydrocarbon: A case series","authors":"Giovanni De Nobili, Severino Cericola, Vincenzo Casolino, Simone Di Russo, Erika Peca, Rossana Percario, Roberta Dimalio, Gauro D'Urbano, Paolo Panaccio","doi":"10.1016/j.sycrs.2024.100069","DOIUrl":"10.1016/j.sycrs.2024.100069","url":null,"abstract":"<div><h3>Background</h3><p>Hydrocarbon products are generally used by drug addict patients in attempt to emulate drug effects or as a means of self-harm. These substances can be assumed through inhalation or by intravenous or intramuscular injection. When hydrocarbons are injected intramuscularly into the limbs, they can cause the compartment syndrome, necessitating surgical intervention.</p></div><div><h3>Cases series</h3><p>We describe a series of three cases in which compartment syndrome developed following hydrocarbon intramuscular injection of hydrocarbons and was successfully treated with urgent fasciotomy. The cases involve three young men who injected gasoline or diesel fuel in their arms and legs. In each case, urgent fasciotomy was necessary to evacuate the intramuscular collection that was rapidly expanding. The three patients were then discharged from our Surgical Department with no complications and were followed up in outpatient visits.</p></div><div><h3>Conclusion</h3><p>Intramuscular hydrocarbon injection can mainly lead to compartment syndrome and tissue necrosis. In the three cases we have reported, urgent fasciotomy successfully prevented ischemic damage to the limbs and facilitated the drainage of toxic substances, thereby preventing patient’s systemic poisoning and septic lethal consequences.</p></div>","PeriodicalId":101189,"journal":{"name":"Surgery Case Reports","volume":"3 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950103224000690/pdfft?md5=52d51200834ccef7afe4f6be25574608&pid=1-s2.0-S2950103224000690-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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