The Use of Living Fascia Transplant to Repair a Hernia of the Tibialis Anticus Muscle

Hartzell, John B.

doi:10.1001/jama.1936.92770330002007a

Cited by 16 publications

(8 citation statements)

References 6 publications

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“…A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus. Described treatments include decompressive fasciotomy (16,17,20,24,39,45,46,62), direct primary fascial repair (1,11,15,20,26,36,39,41,47), tibial periosteal flap (37,63), fascial patch grafting or stripping (woven strips of fascia) using autologous fascia lata (1,2,4,15,31,33) and the use of synthetic mesh (23,30,36,40,48,52,54). Partial muscle excision has been described as a solitary treatment and as an adjunct for excessive muscle volume interfering with repair (1,14).…”

Section: Discussionmentioning

confidence: 99%

Muscle hernias of the leg: A case report and comprehensive review of the literature

Nguyen

Wheatley

et al. 2013

Canadian Journal of Plastic Surgery

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A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Muscle hernias of the leg: A case report and comprehensive review of the literature

Nguyen

Wheatley

et al. 2013

Canadian Journal of Plastic Surgery

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“…If symptoms persist despite ongoing treatment and conservative treatment fails to alleviate symptoms, an operative treatment should be considered 14 . Available surgical procedures were reported as direct repair 15 , fascial grafting 16 , fasciotomy 7,17 , partial muscular excision and more recently mesh grafting 18,19 . Direct repair is possible when the defect is small and the laxity of the borders permits approximation.…”

Section: Discussionmentioning

confidence: 99%

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

Dönmez

Evrenos²,

Cereb³

et al. 2019

Muscle Ligaments and Tendons J

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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.

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“…Many of the cases report muscle herniation of the leg, especially the thigh. Hereby, the tibialis anterior hernia is most common and has been described in various cases [ 5 , 8 , 9 , 13 , 14 , 17 - 20 ]. Muscular hernias of the posterior compartment, however, are rare.…”

Section: Discussionmentioning

confidence: 99%

“…Different treatment options for symptomatic extremity muscle herniation in the lower limb have been described [ 5 - 9 ]. These techniques were mostly used for tibialis anterior muscle herniation and include conservative management (activity limitation, compressive stockings...) as well as fasciotomy, direct approximation of the fascial defect, tibial periosteal flap, partial muscular excision, and patch repair with autologous fascia lata, [ 9 ]or synthetic mesh[ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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BackgroundMuscle 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 presentationWe 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.ConclusionsMuscle 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.

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The Use of Living Fascia Transplant to Repair a Hernia of the Tibialis Anticus Muscle

Cited by 16 publications

References 6 publications

Muscle hernias of the leg: A case report and comprehensive review of the literature

Muscle hernias of the leg: A case report and comprehensive review of the literature

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

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

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