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Waller G, Fox JA, Domingue GA, Ringenberg J, White J. Bilateral Lower Extremity Calcific Myonecrosis: A Case Report. J Orthop Case Rep 2023; 13:122-128. [PMID: 38025377 PMCID: PMC10664218 DOI: 10.13107/jocr.2023.v13.i11.4030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Calcific myonecrosis is a rare soft-tissue disease where a single muscle or muscle compartment is replaced with central liquefaction and peripheral calcification. This disease usually occurs in a single limb after trauma. Until now, bilateral muscle involvement has not been previously reported. Case Report A 73-year-old woman presented with symptomatic masses in the soft tissues of bilateral anterior thighs. She had no known history of trauma but recalled a specific tearing sensation episode in both her legs while squatting when weightlifting in the distant past. The patient had calcified masses that had replaced the rectus femoris muscle bilaterally with associated effects on hip and knee range of motion. The patient underwent excision of a portion of calcific myonecrosis and two locations of rectus femoris tenotomies in one leg and only a simple rectus femoris tenotomy on the contralateral leg. The patient subsequently experienced a significant improvement in hip and knee motion and a reduction in associated pain on both sides. Conclusion Historical and radiographic information are key in making the diagnosis of calcific myonecrosis. Treatment decisions should be based on the patient's symptoms balanced with the morbidity of the expected procedures. Symptomatic patients should be considered for excision of the symptomatic involved areas. A tenotomy may be a viable option if a limitation in motion is the primary complaint. Asymptomatic patients with a stable lesion and imaging should undergo conservative management due to the high risk of infection and wound healing problems.
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Affiliation(s)
- Garrett Waller
- Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jake A Fox
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grayson A Domingue
- Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jon Ringenberg
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeremy White
- Department of Orthopaedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Expansile calcific myonecrosis arising in the lower leg: A case report and recommendation for treatment. J Orthop Sci 2022; 27:1149-1153. [PMID: 31870641 DOI: 10.1016/j.jos.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/23/2019] [Accepted: 11/28/2019] [Indexed: 11/23/2022]
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Higuchi T, Yamamoto N, Nishida H, Hayashi K, Takeuchi A, Tsuchiya H. Treatment of infected calcific myonecrosis with chronically discharging sinus caused by iatrogenic aspiration: A case report. Int J Surg Case Rep 2022; 95:107145. [PMID: 35561467 PMCID: PMC9108875 DOI: 10.1016/j.ijscr.2022.107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Calcific myonecrosis (CM) is a rare, benign post-traumatic sequela which is often challenging to differentiate from soft tissue tumors. Infected CM is recalcitrant and sometimes requires invasive treatment despite its benign nature. We present a case of infected CM in which MRI and 201Tl scintigraphy proved useful for diagnosis and intralesional debridement with prolonged placement of a suction tube allowed for successful treatment. Case presentation A 71-year-old man had undergone repeated aspiration for swelling of the lower leg and presented with a sustained pyogenic discharging wound. He underwent intralesional debridement of purulent necrotic tissue followed by prolonged suction tube placement. Enterobacter cloacae was detected in the discharge, and specific antibiotics were administered. Once the wound closed, a new sinus recurred four months after surgery, warranting reoperation with debridement of the remnant fascia and necrotic tissue with suction tube replacement. The wound healed eight months after the first surgery with no signs of recurrence. Clinical discussion CM can be diagnosed based on its unique imaging features and a history of compartment syndrome. To avoid infection, CM must be treated conservatively without surgical invasions, such as biopsy or aspiration. Extensive debridement with a myocutaneous flap is nevertheless recommended for infected CM treatment, despite significant invasion including intraoperative bleeding being problematic. Conclusion MRI and 201Tl scintigraphy can help diagnose CM and avoid biopsy to exclude malignancy. Intralesional debridement of necrotic tissue with prolonged suction tube placement could be a valid treatment alternative to reduce the invasiveness of infected CM. Calcific myonecrosis is a rare, benign posttraumatic sequela. Biopsy to differentiate malignancy can cause calcific myonecrosis. Absence of accumulation on enhanced MRI or 201Tl scintigraphy helped diagnosis. Extensive debridement and flaps are reliable but invasive in case of infection. Intralesional debridement with prolonged tube placement may be less invasive.
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Affiliation(s)
- Takashi Higuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
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Snake Bite Management: A Scoping Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3506. [PMID: 33936914 PMCID: PMC8084039 DOI: 10.1097/gox.0000000000003506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/20/2023]
Abstract
Background: Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population. Methods: A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE. Results: One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed. Conclusions: Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.
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Angelini A, Mavrogenis AF, Pagliarini E, Trovarelli G, Fanelli GN, Cappellesso R, Ruggieri P. Calcific Myonecrosis of the Leg: A Rare Entity. ACTA ACUST UNITED AC 2019; 55:medicina55090542. [PMID: 31466356 PMCID: PMC6780786 DOI: 10.3390/medicina55090542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 11/20/2022]
Abstract
Calcific myonecrosis is a rare disease that has been shown to be a late sequela of trauma. This article presents a 68-year-old man with calcific myonecrosis of the leg 40 years after a tibial fracture complicated with peroneal nerve palsy. The soft tissue mass increased in size after another injury to the leg that occurred two years before his presentation. Physical examination at presentation showed a palpable extra-osseous mass at the anterior aspect of the left leg; the mass was not adherent to adjacent soft-tissues and bone, and it was painless but tender to palpation. Radiographs of the left leg showed extensive calcification at the soft-tissue of the anterior and posterior leg. An ultrasonography-guided trocar biopsy was done; histological findings were indicative of calcific myonecrosis. Given the benign entity of the lesion and known high rate of complications, he was recommended for no further treatment except for clinical and imaging observation. Located at the site of the biopsy, he experienced infection with drainage that eventually healed after six months with antibiotics and wound dressing changes. During the last follow-up examination, two years after diagnosis, the patient was asymptomatic without progression of the mass.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 115 27 Athens, Greece
| | - Elisa Pagliarini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Giulia Trovarelli
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy
| | - Giuseppe Nicolò Fanelli
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, 35128 Padova, Italy
| | - Rocco Cappellesso
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35128 Padova, Italy.
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Gangrade K, Yeotikar G, Wadhwani A, Naneria V. Calcific Myonecrosis of the Leg: A Case Report. CASE REPORTS IN ORTHOPEDIC RESEARCH 2019. [DOI: 10.1159/000502031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Calcific myonecrosis is characterized by central liquefaction and peripheral calcification involving the entire muscle mass and is considered to be a late sequel of compartment syndrome. Being a rare presentation, considering differential diagnosis is important. Diagnosis is based on history of trauma and typical radiological features. Symptomatic patients require complete excision of the mass while asymptomatic patients can be treated nonoperatively.
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Ukon Y, Tanaka T, Nagata S, Hagizawa H, Imura Y, Tamiya H, Oshima K, Naka N, Aoki Y, Kuratsu S. Calcific myonecrosis mimicking soft tissue sarcoma: A case report. Oncol Lett 2018; 15:7909-7913. [PMID: 29731908 PMCID: PMC5920900 DOI: 10.3892/ol.2018.8320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/28/2018] [Indexed: 12/26/2022] Open
Abstract
Calcific myonecrosis is a rare soft tissue condition. The first case was reported in 1960, however, the precise pathophysiology of calcific myonecrosis remains unclear. The disease was thought to arise from compartment syndrome within a confined space resulting in necrosis and fibrosis, subsequent repeated intralesional hemorrhage, mass enlargement and calcification. Several previous reports have described calcific myonecrosis, which include the formation of calcific myonecrosis after a prolonged period of post trauma. Notably, calcific myonecrosis has typically been described in the lower legs and characteristic imaging findings have been indicated. Furthermore, surgical intervention carries a high risk of complications. In the present case report 2 cases of calcific myonecrosis that occurred after a prolonged period of time following a traumatic event that impacted the lower leg were reported. CT images revealed disruption of calcified fascia and disease expansion into the outside of the fascia. Previous reports have implied that there is late focal enlargement of calcific myonecrosis following earlier enlargement, which may be caused by herniation through muscle fascia. However, no previous publications have focused on images for evidence of late local enlargement. To the best of our knowledge, this is the first report focusing on fascial herniation of calcific myonecrosis using images. Analysis of this feature using images may aid clinicians to differentiate calcific myonecrosis from malignancies.
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Affiliation(s)
- Yuichiro Ukon
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan.,Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Shigenori Nagata
- Department of Pathology and Cytology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hiroki Hagizawa
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yoshinori Imura
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Hironari Tamiya
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Kazuya Oshima
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Yasuaki Aoki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Himeji Hospital, Himeji, Hyogo 670-8540, Japan
| | - Shigeyuki Kuratsu
- Department of Orthopaedic Surgery, Belland General Hospital, Sakai, Osaka 599-8247, Japan
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