Management of chronic expanding haematoma using triamcinolone after latissimus dorsi flap harvesting

[Muscle injuries: the importance of high-resolution dynamic sonography in diagnostics, treatment and monitoring]

BACKGROUND

Muscle injuries are common in football. Imaging diagnostics have a major role in establishing a diagnosis. The main diagnostic procedures are MRI and ultrasound. Both diagnostics have advantages and disadvantages, which should be balanced against each other.

NEW ULTRASONIC TECHNIQUES

The role of MRI as the gold standard is increasingly being replaced by high-resolution ultrasound techniques, and MRI imaging is not always useful. To detect complications in the early stages it is advised to perform regular ultrasound-imaging check-ups. The healing process can be monitored, and it offers additional options for ultrasound-guided interventions such as hematoma punctures and targeted infiltrations.

ADVANTAGES AND DISADVANTAGES

However, ultrasound imaging is highly user dependent. Experienced operators can eliminate this disadvantage, which makes ultrasound a superior imaging system in many areas, especially for dynamic examinations. Nevertheless, MRI imaging remains a necessary imaging method in certain areas.

[CME-Sonography 105: Ultrasound in Sports Injuries]

CME-Sonography 105: Ultrasound in Sports Injuries Abstract. Muscle injuries are frequent in athletes and in the general population. For therapy and prognosis, it is important to understand the total extent of the injury and to be aware of possible complications. In most cases ultrasound is a useful tool for diagnostics of muscle injuries. However, muscle ultrasound is not as common as joint ultrasound; this article discusses the possibilities of high-resolution dynamic ultrasound in diagnostics and its limitations.

Chronic Persisting Hematoma: Report of a Case and Literature Review

The authors present a unique case of chronic persisting hematoma formation at the site of a remote congenital melanocytic nevus excision with tissue expander reconstruction. Similarities between chronic persisting hematoma and chronic encapsulated seroma are addressed to provide guidance on the appropriate workup and management for the plastic surgeon. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ultrasound Imaging in Sport-Related Muscle Injuries: Pitfalls and Opportunities

Muscle injuries occur frequently in athletes, accounting for more than one-third of sport-related trauma. Athletes most affected by these injuries are those practicing football and track and field, with hamstrings and gastrocnemius-soleus as the mainly involved sites. Muscle injuries lead to loss of competitions, long recovery times and risk of re-injury with a consequent increase of the management costs. It is therefore advisable to make an accurate and timely diagnosis to establish appropriate interventions for proper healing in the shortest time. In this context, ultrasound imaging is widely used for diagnosis of musculoskeletal disorders because of several advantages including absence of radiation, portability, good spatial resolution, and the ability to perform dynamic tests. The aim of this review is to address the role of US in the evaluation of athletes with muscle injuries. US may play a pivotal role for the management of sport-related muscle injuries because it is fast and relatively cheap, allowing dynamic muscle assessment and time series evaluation of the healing process.

Chronic Expanding Hematoma on Latissimus Dorsi Free Flap Donor Site Grown Over 17 Years

ABSTRACT

The latissimus dorsi free flap (LDFF), that provides long vascular pedicle with rich vascularization and adequate bulk for maxillofacial defect coverage, is utilized in microvascular surgery for maxilla-mandibular reconstruction with high success rate, less morbidity, and ability to provide facial symmetry. In addition, it can reduce the risk of adjuvant therapies, such as radiotherapy. Seroma formation at the donor site following LDFF harvest has been reported as a common postoperative sequela. On the other hand, chronic expanding hematoma (CEH) in an LDFF donor site is a rare postoperative complication. In this case report, the authors describe a rare occurrence of a solidified CEH on an LDFF donor site in a male patient 17 years after mandible reconstruction surgery. For treatment, the patient underwent mass resection with drain placement and quilting suture, resulting in reduction of the hematoma and faster healing.

Treatment of late solidified hematoma in back donor site after breast reconstruction with latissimus dorsi flap: report of three cases

Background

Late solidified hematoma is a rare complication of breast reconstruction with latissimus dorsi (LD) flap. The majority of hematomas occur in the immediate postoperative period; however, some cases can occur at a distant point in time after surgery and do not have a definitive mechanism of injury or develop symptoms immediately after the triggering event. Moreover, treatment of hematoma has not yet been established.

Case presentation

Breast reconstruction with LD flap has been performed between January 2014 and June 2018 in more than 275 cases. We report 3 cases of late solidified hematoma at the back-donor site that have developed years after breast reconstruction with LD flap, in which a surgical approach was performed because the solidified hematomas could not be treated with percutaneous aspiration.

Conclusions

We report successful surgical treatment and histological findings of late-onset solidified hematoma as a rare complication of Breast reconstruction with LD flap.

Ultrasound-guided procedures to treat sport-related muscle injuries

Ultrasound is well known as a low-cost, radiation-free and effective imaging technique to guide percutaneous procedures. The lower limb muscles represent a good target to perform such procedures under ultrasound guidance, thus allowing for clear and precise visualization of the needle during the whole procedure. The knowledge of guidelines and technical aspects is mandatory to act in the most safe and accurate way on target tissues that can be as small as a few millimetres. This review will focus above the local treatments of traumatic lower limb muscle injuries described in literature, focusing on new and promising approaches, such as platelet-rich plasma treatment of muscle tears in athletes. For each procedure, a brief how-to-do practical guide will be provided, emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the lower limb muscles.