Acute appendicitis presenting as thigh abscess in a child: a case report

A case of retrocecal appendicitis is described in a 6-year-old male child who presented with thigh abscess. The presence of a positive psoas stretch test, feculent discharge, an enteric growth on bacteriological examination, and intraabdominal fluid collection on abdominal ultrasound provided clues to the presence of an intraabdominal source of sepsis. Laparotomy revealed a perforated retrocecal appendix with surrounding collection communicating into the thigh. Appendectomy with drainage of retroperitoneal and thigh collections under adequate antibiotic coverage resulted in a satisfactory recovery. We describe our experience with the present case and discuss the pertinent literature.     

Cardiac, arterial and venous adaptation to weightlessness during 6-month MIR spaceflights with and without thigh cuffs (bracelets)

The objectives of this investigation were to study the effects of thigh cuffs (bracelets) on cardiovascular adaptation and deconditioning in 0 g. The cardiovascular parameters of six cosmonauts were measured by echocardiography, Doppler, and plethysmography, during three 6-month MIR spaceflights. Measurements were made at rest during preflight (−30 days), inflight (1, 3–4, and 5–5.5 months) without cuffs (morning) and after 5 h with cuffs, and during postflight (+3 and +7 days). Lower-body negative pressure (LBNP) measurements were performed 1 day after each resting session. Inflight values of left ventricle end-diastolic volume and stroke volume measured without the thigh cuffs (−8 to −24% and −10 to −16%, respectively, both P < 0.05) were lower than corresponding preflight values. The jugular and femoral vein cross-sectional areas (A _jv and A _fv, respectively) were enlarged (A _jv: by 23–30%, P < 0.001; A _fv: by 33–70% P < 0.01). The renal and femoral vascular resistances (R _ra and R _fa, respectively) decreased (R _ra: by −15 to −16%, P < 0.01; R _fa: by −5 to −11%, P < 0.01). Inflight, the thigh cuffs reduced the A _jv (by −12 to −20%, P < 0.02), but enlarged the A _fv (A _fv: by 9–20%, P < 0.02) and increased the vascular resistance (R _ra: by 8–13%, P < 0.05; R _fa: by 10–16%, P < 0.01) compared to corresponding inflight, without-cuffs values. During LBNP (−45 mmHg, where 1 mmHg=133.3 N/m²), R _fa and the ratio between cerebral and femoral blood flow (Q˙ _ca/Q˙ _fa) increased less inflight and postflight (+25% for R _fa and +30% for Q˙ _ca/Q˙ _fa) than during preflight (60% for R _fa and 75% for Q˙ _ca/Q˙ _fa, P < 0.01). This reduced vasoconstrictive response and less efficient flow redistribution toward the brain was associated with orthostatic intolerance during postflight stand tests in all of the cosmonauts. The calf circumference increased less inflight and postflight (6% P < 0.05) than preflight (9% P < 0.05). The vascular response to LBNP remained similarly altered throughout the flight. The thigh cuffs compensated partially for the cardiovascular changes induced by exposure to 0 g, but did not interfere with 0 g deconditioning. Accepted: 5 November 1999     

Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis

BackgroundThe purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems.MethodsWe conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results.ResultsAmong the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02–0.09; Z = −2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76–1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59–1.40; Z = −0.44, P = 0.663).ConclusionsWe did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty.Trial RegistrationPROSPERO Identifier: CRD42021231240     

“Emergency” definitive reconstruction of a necrotising fasciitis thigh debridement defect with a pedicled TRAM flap

INTRODUCTIONNecrotising fasciitis (NF) is a rare, severe, rapidly progressing and life-threatening synergistic infection primarily affecting the superficial fascia. A novel method of definitive and aesthetic reconstruction of NF thigh defects by using a pedicled transverse rectus abdominis myocutaneous (TRAM) flap without recourse to temporising skin grafts is presented.PRESENTATION OF CASEA 30-year-old parous woman presented in extremis with fulminant NF of her left anteromedial thigh. Following emergency radical debridement and intensive care stabilisation she was reconstructed 48 h later in a single stage with a pedicled TRAM flap islanded on the ipsilateral deep inferior epigastric vessels. There was excellent contour restoration of her thigh and coverage of the exposed femoral vessels.DISCUSSIONPedicled flaps based on the rectus abdominis muscle provide a large, readily available reconstructive option for correction of substantial regional defects as herein illustrated. They are robust when based on dominant inferior vascular pedicle with a long reach and wide arc of rotation when designed transversely (as a TRAM flap).CONCLUSIONThis case also illustrates that definitive flap reconstruction of NF can be successfully undertaken in the emergent setting, thereby negating the need for large areas of skin grafting which can lead to contractures with consequent functional impairment and suboptimal aesthetic results.     

大腿肌皮瓣移植修复口腔颌面部复杂组织缺损的临床效果观察

【目的】探讨和观察大腿前外侧皮瓣在口腔颌面部组织缺损的临床修复中的疗效。【方法】回顾性的研究了2010年1月-2012年12月在我院完成的27例大腿前外侧皮瓣移植。【结果】27例患者中24例在Ⅰ期和Ⅱ期愈合,且效果较好。1例大腿肌皮瓣因动脉栓塞而失败,1例出现静脉栓塞,经抢救后好转成功,2例出现感染,其它无并发症出现,其余23例术中、术后均未出现血管危象等现象,成功率为96.3%,随访恢复效果均较好。【结论】口腔颌面部的复杂组织缺损患者,大腿肌皮瓣移植修复是进行修复的理想选择,只要严格掌握手术适应证,就可获得预期的良好效果。     

Acute Anterior Thigh Compartment Syndrome Revisited: A Case Report and Review of Literature

Abstract We present a rare case of acute anterior compartment syndrome of the thigh in a rugby player with no history of trauma during the game. Decompressive fasciotomy with subsequent closure of the wound resulted in good outcome. Acute compartment syndrome of the thigh should be suspected following vigorous exercise and fasciotomy is to be performed on urgent basis.     

Eccentric hamstring strength deficit and poor hamstring-to-quadriceps ratio are risk factors for hamstring strain injury in football: A prospective study of 146 professional players

Objectives

The purpose of this study was to investigate whether preseason isokinetic strength measures were predictive of future HSI among professional football players.

Anatomy and potential clinical significance of the vastoadductor membrane

Few reports are found in the extant medical literature regarding the vastoadductor membrane. This membrane effectively creates a subcompartment within the subsartorial canal. The lower limbs of 16 embalmed adult cadavers were dissected to identify the vastoadductor membrane and note its measurements. A vastoadductor membrane was identified in all specimens and was derived from the medial intermuscular septum. This membrane connected the medial edge of the vastus medialis muscle to the lateral edge of the adductor magnus muscle. Membranes were all wider proximally and narrowed distally. The mean length of this structure was 7.6 cm. The mean width of the vastoadductor membrane at its proximal, midportion, and distal parts was 2.2, 1.7, and 0.5 cm, respectively. The mean distance from the anterior superior iliac spine to the proximal border of the vastoadductor membrane was 28 cm. The mean distance from the distal border of the membrane to the adductor tubercle was 10 cm. Seventy-five percent of specimens exhibited a fenestrated vastoadductor membrane. Branches of the saphenous nerve to the skin of the medial thigh pierced the vastoadductor membrane in 31% of specimens. Two specimens demonstrated branches derived from the branch of the obturator nerve that pierced this membrane en route to the skin of the medial thigh. Perforating venous branches from the great saphenous vein were identified in 22% of specimens. As compression of the femoral artery at the adductor hiatus is a well-recognized entity, the clinician may also try to explore potential compression of this vessel more proximally by an overlying vastoadductor membrane. The authors would also hypothesize that due to the interconnection between the adductor magnus and vastus medialis by the vastoadductor membrane that a potential synergy exists between the functions of these two muscles.