Surgical repair of an anterior tibialis muscle hernia with Mersilene mesh

A Traumatic Neuroma Formation Following Fasciotomy for the Treatment of Tibialis Anterior Muscle Herniation: A Case Report

Muscle herniation of the lower extremity, such as tibialis anterior muscle herniation (TAMH), is not a rare cause of leg pain in athletes. However, a few studies have reported surgical treatment for TAMH, and the optimal surgical procedure remains controversial. Fasciotomy was reported to be effective for patients with TAMH. However, this procedure would be associated with a risk of intraoperative injury to the superficial peroneal nerve (SPN), although no previous literature has reported this complication. This case report aimed to report a case of bilateral TAMHs in which a traumatic neuroma of the SPN developed after fasciotomy. A 16-year-old baseball player presented with painful swelling lesions of the bilateral lower extremities (1 lesion on the right, 3 lesions on the left) after sports activities. An ultrasonographic evaluation showed swelling lesions of the anterolateral parts of the bilateral lower extremities in the standing position after dashing, while these lesions were not detected in the supine position. A fasciotomy of the crural fascia was performed after conservative treatment failed. Several days after surgery, the patient presented with weakened touch sensation over the dorsal area of the left foot. At the three-month follow-up examination, a swelling lesion with hard elasticity was identified. The palpation of this lesion caused a radiating sensation in the area supplied by the SPN. He was able to return to playing baseball six months after surgery. The patient was asymptomatic without palpation of the traumatic neuroma of the SPN at the latest follow-up examination. In conclusion, the present case report suggests that orthopedic surgeons need to consider the risk of iatrogenic injury to the SPN during fasciotomy for the treatment of TAMHs. However, there may be a risk of injuring the SPN because of the many variants of the course of the SPN within the compartment of the lower extremities.

Muscle herniae: Conservative and surgical management. Systematic review

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.

Polypropylene Mesh Repair of Traumatic Hernia of the Vastus Lateralis

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.

Double layer repair of tibialis anterior muscle hernia in a soccer player: a case report and review of the literature

BACKGROUND

muscle herniations usually present in athletes especially in the lower legs; occurring through defects in the deep fascial layer of the muscles and typically seen following local blunt trauma or muscle hypertrophy after strenuous exercise. Management of muscle hernias varies from conservative therapy to surgical repair and usually needs multidisciplinary collaboration for differential diagnosis.

METHODS

herein tibialis anterior muscle hernia in 17-year-old male soccer player was presented. The diagnosis was confirmed with dynamic ultrasonographic views changing with the different movements of the ankle. Since the symptoms were not relieved with conservative methods, surgical repair of the defect was offered.

RESULTS

we preferred to repair fascial defect with double layer and Mesh graft that were placed over primary suture repair. No complications were reported such as wound or mesh infection postoperatively. The patient was clinically satisfied and returned his previous activity level after 3 months of surgery. After 2 years of follow-up the feature of the bulge was dissolved and player was satisfied with the operation.

CONCLUSION

knowledge of the lower extremity muscle herniation is essential for both proper management and/or surgical referral. The importance of protective devices in prevention, dynamic ultrasonography in diagnosis and double layer repair of the fascial defect with Mesh graft in treatment of muscle herniations were highlighted.

Repair of tibialis anterior muscle herniation using periosteum

Muscular herniation consists of focal muscular protrusions through an acquired or congenital fascial defect. The anterior tibialis muscle is most frequently affected. Asymptomatic muscle hernias are usually treated conservatively. For severe symptoms or cosmetic complaints, several surgical techniques are available to treat muscle herniation, including fasciotomy, fascial patch grafting using autologous fascia lata, or synthetic mesh. However, the optimal surgical approach remains debatable. The authors propose a novel and reproducible surgical method using a periosteal turn-down technique. This surgical technique has the advantages of fewer complications, greater cost-effectiveness, and high reproducibility. The authors find this to be a useful technique.

Repair of traumatic muscle herniation with acellular porcine collagen matrix

BACKGROUND

Muscle hernias are uncommon clinical conditions with no uniform solution of repair. Biocompatible mesh allows for repair of hernias without the donor site morbidity and complications from direct repair under tension.

METHODS

Over a 6-month period at a Level 1 Trauma centre, four consecutive symptomatic muscle hernias were identified, two in the forearm and two in the lower limb. Three resulted from high-speed motorbike accidents, one from a mining accident. All patients had hernia repair at a minimum of 4 months post accident. A 10 × 15 cm × 1.0 mm sheet of acellular collagen matrix was fashioned to fit as an underlay of the fascia defect. Patients were clinically followed at the 2-, 6-, 12- and 26-week mark. Final phone contact was made 18 months post-operatively.

RESULTS

All patients were pleased with their cosmetic and functional outcomes. All patients returned to work and sport 3 months after reconstruction.

CONCLUSION

Symptomatic hernias as a result of trauma can be safely reconstructed with a biological mesh implant. This approach can prevent complications from previously described methods and return to active lifestyles with good results.

Gastrocnemius muscle herniation as a rare differential diagnosis of ankle sprain: case report and review of the literature

Background

Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described.

Case presentation

We present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch.

Conclusions

Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic) ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects.

Surgical repair of abductor hallucis muscle herniation: a case report

Herniation of the abductor hallucis muscle has rarely been reported in the literature. This condition causes localized pain, especially while weight bearing, as a result of a complex cascade of biomechanical events directly related to loss of integrity of the medial wall of the foot. The authors present a case of a flexor retinaculum tear with subsequent herniation of the abductor hallucis muscle. When conservative treatment options failed to provide significant relief, surgical intervention was performed, which revealed ischemic muscle tissue and a partial flexor retinaculum tear. The nonviable muscle was surgically debrided and the fascial defect was repaired with a polypropylene nonabsorbable synthetic surgical mesh. This herniorrhaphy reestablished medial compartment support, thus allowing the patient to return to pain-free ambulation.

Tibialis anterior muscle herniation

BACKGROUND

Tibialis anterior herniation occurs through a defect in the deep fascial layer of the lower extremity. While this entity is not uncommon, it has been rarely reported in the dermatologic literature.

OBJECTIVE

To highlight the occurrence of tibialis anterior herniation and its presentation and treatment.

METHODS

Case report.

RESULTS

We present a case of tibialis anterior herniation in a patient who presented with asymptomatic nodules in her lower extremities. The nodules were flesh-colored, soft, and compressible with palpation.

CONCLUSION

The diagnosis of tibialis anterior herniation should be considered in patients with positionally variable subcutaneous nodules, especially in the lower extremities. It is caused by a defect in the deep fascial layer and often involves the lower extremities. In addition, knowledge of the diagnosis and treatment is essential for both proper management and/or surgical referral.

Imaging of sports-related muscle injuries

Muscle derangements in athletes have a wide variety of causes, treatments, and prognoses. Given that the cause and severity of sports-related injuries may be difficult to determine clinically in some cases, MR imaging is utilized increasingly to evaluate muscle injuries in athletes. After reviewing useful MR imaging techniques, this article focuses on MR imaging of the most common causes of muscle pain and disability in athletes, including myotendinous strain, delayed onset muscle soreness, muscle contusion, myositis ossificans, muscle laceration, muscle herniation, and compartment syndrome. The differential diagnosis of various signal intensity abnormalities in muscle also is reviewed.

Magnetic resonance imaging of hereditary hernias of the peroneus longus muscle

Herniation of the left peroneus longus muscle was present in three male members of the same family, being the first reported case of this condition in a familial setting. The hernias were differentiated from other mass lesions and varices by magnetic resonance imaging. The images demonstrated a fascial defect originating in the area where vessels and nerves penetrate the fascia, suggesting that the three men had a congenital weakness in the fascia.

Bilateral multiple muscle hernias of the leg repaired with Marlex mesh

We report a case of multiple muscle hernias of the legs, resulting from regular, intense, physical exertion. The multiple fascial defects were closed with Marlex mesh. On review after 5 years, there were no recurrences of the hernias.