Extensive calcific myonecrosis of the lower leg treated with free tissue transfer

Treatment of infected calcific myonecrosis with chronically discharging sinus caused by iatrogenic aspiration: A case report

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.

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Calcific myonecrosis is a rare, benign posttraumatic sequela.

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Biopsy to differentiate malignancy can cause calcific myonecrosis.

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Absence of accumulation on enhanced MRI or ²⁰¹Tl scintigraphy helped diagnosis.

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Extensive debridement and flaps are reliable but invasive in case of infection.

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Intralesional debridement with prolonged tube placement may be less invasive.

Traumatic calcific myonecrosis with abscess and outflow of sequestrum: A case report

Calcific myonecrosis (CM) is a rare benign long-term complication secondary to trauma, especially when trauma is combined with neurovascular injury or osteofascial compartment syndrome. CM frequently manifests as an asymptomatic mass and the anterior tibial area is the most common site, which is apt to be misdiagnosed as a bone tumor. In addition, even if the diagnosis is clear, the therapy is controversial because some authors suggested regular follow-up could replace surgery. However, patients with CM are prone to infection. Under such conditions, infection is hard to be controlled and non-surgical therapy will provide the limited effect. Here we reported a rare and interesting case about a patient diagnosed with calcific myonecrosis in our hospital. Imaging presented typical and impressive features of CM in his left leg. Besides, the patient suffered severe infection and antibiotics played a limited role. Subsequently, the abscess formed and the incision is unhealed after abscess incision drainage with the lasting outflow of pus and sequestrum. Finally, surgery was conducted and we found his anterior tibial muscle was replaced by osteoid and necrotic tissues. Postoperative pathology identified traumatic tumoral calcinosis. This patient now has no evidence of recurrence, with a follow-up of 22 months.