Periosteal ganglion cyst of tibia: A rare case report

INTRODUCTION AND IMPORTANCE

Periosteal ganglion cyst is a rare disorder, found only in 55 out of 100,000 people annually. Periosteal ganglion location may cause partial external cortical destruction with irregular saucerization and erosion. This report presents a rare case of periosteal ganglion cyst that occurred of the cruris sinistra.

CASE PRESENTATION

A male patient, 68 years old, came with complaint of a lump in the left cruris since one year ago. Nine months later, the lump has increased in size like a chicken egg and still felt painless. MRI result revealed a well-circumscribed multilocular cystic lesion in the peri-osseous soft tissue of the tibia. We performed directly excisional biopsy within the mass, and the histopathology result was periosteal ganglion cyst.

CLINICAL DISCUSSION

The exact pathogenesis of periosteal ganglion is unclear. Synovial herniation and mucoid degeneration of the connective tissue of the periosteum are two suggested mechanisms. In some cases, ganglion cysts may compress nearby nerves. Surgical treatment is recommended for patients who still experience symptoms after non-surgical management has failed. Complete resection of the cyst and surrounding periosteum is recommended to prevent recurrence. After 6 months post-operative follow up clinical examination, no recurrence symptoms founded on the patient.

CONCLUSION

Periosteal ganglion is a rare lesion and may mimic other bone surface lesions. Resection of the periosteal ganglion cyst with surrounding periosteum is important to prevent recurrence.

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture - A case report

INTRODUCTION

The challenging issue that still remains for reverse sural flap is the withstand of the flap against time, the width of coverage area, and the donor site morbidity such as pain after the medial or lateral sural cutaneous nerve harvested.

PRESENTATION OF CASE

A 55 years old male was suffered from traumatic Achilles tendon rupture for 3 months and was repaired with Krakow's technique in a medical center in Pemalang, Indonesia. After the surgery, the defect was revealed as another surgery was planned to cover the skin defect. The author had chosen the bipedicled reverse sural fasciocutaneous flap in regular basis which addressed the superiority and viability of the flap, thus the donor site morbidity was also concerned as the preservation of medial and lateral sural cutaneous nerve, which leading to good quality of life as the patient still could feel and sensate his medial and lateral leg.

DISCUSSION

The bipedicled reverse sural fasciocutaneous flap was successfully covered the skin defect on post traumatic Achilles tendon reconstruction, with retained medial sural nerve on its place, and the remaining harvested skin area was leave opened without skin graft which healed spontaneously.

CONCLUSION

Bipedicled reverse sural fasciocutaneous flap with retained medial sural nerve offer a good clinical outcome either the viability of the flap and the maintained sensation along the medial and lateral sural cutaneous nerve distribution.