Modified Combined Physiological and Debulking Procedure for Lower Limb Lymphedema to Achieve Both Immediate and Sustained Results in Lymphedema

2021 ◽  
pp. 153473462110023
Author(s):  
Mohd Altaf Mir ◽  
Sameer S. Mahakalkar ◽  
Muhammed Rashim
Keyword(s):  
Lower Limb ◽  
Operative Procedure ◽  
Young Age ◽  
Single Stage ◽  
Tribal Community ◽  
Bilateral Lower Limb ◽  
The Right ◽  
Grade Iii

A 17-year-old girl presented with bilateral lower limb lymphedema since 3 years. Lymphedema in the right leg was Grade III, not pitting and not reducing in size after limb elevation. She hailed from a tribal community. Considering her young age, a single-stage operative procedure for her lymphedematous leg was followed, as she was not prepared for a multistaged operation. However, this operative procedure needed to be a combination of both, debulking and physiological procedures, so as to give her immediate limb girth reduction as well as reduction in recurrence, as seen with debulking procedures. We report a newer technique that could achieve both goals.

Limb Salvage Procedure in a Patient of High-tension Electric Burns Utilising Delay Phenomenon in Perforator-based Flap- A Case Report

2021 ◽  
Author(s):  
Shailendra Singh
Keyword(s):  
Lower Limb ◽  
Burn Injury ◽  
Salvage Procedure ◽  
Delay Procedure ◽  
Knee Amputation ◽  
High Tension ◽  
Bilateral Lower Limb ◽  
The Right ◽  
Electric Burns ◽  
Delay Phenomenon

Electric burn is a devastating injury causing tissue and organ loss. We present here a case of an electric burn injury over a bilateral lower limb and bilateral upper limb. The patient had undergone left above-knee amputation, thus cross-leg flap from the left side was not possible and due to electric burns, the vascularity of the right leg was also doubtful therefore a delayed flap was planned to cover the exposed defect over the right knee and defect over the right tibia. The Flaps underwent a delay procedure before the final inset so that the flap undergo ischemic preconditioning and the neovascularization that increases the size of the flap and chances of survival of the flap by manifold.

scholarly journals Bilateral Lower Limb Edema Caused by Compression of the Retrohepatic Inferior Vena Cava by a Giant Hepatic Hemangioma

2013 ◽  
Vol 98 (3) ◽  
pp. 229-233 ◽  
Author(s):  
Sami Akbulut ◽  
Mehmet Yilmaz ◽  
Aysegul Kahraman ◽  
Sezai Yilmaz
Keyword(s):  
Inferior Vena Cava ◽  
Lower Limb ◽  
Inferior Vena ◽  
Vena Cava ◽  
Hepatic Hemangioma ◽  
Limb Edema ◽  
Bilateral Lower Limb ◽  
Right Lobe ◽  
The Right ◽  
Giant Hepatic Hemangioma

Abstract Hemangiomas are the most common benign primary tumors of the liver and their prevalence ranges from 0.4% to 20%. Approximately 85% of hemangiomas are clinically asymptomatic and are incidentally detected in imaging studies performed for other causes. In a very small minority of patients, nausea, vomiting, abdominal pain, distension, palpable mass, obstructive jaundice, bleeding, and signs and symptoms of Budd-Chiari syndrome may develop due to compression of bile duct, hepatic vein, portal vein, and adjacent organs. Occasionally, external compression of inferior vena cava may lead to edema and/or indirect symptoms such as deep vein thrombosis of the lower limbs. In this report, we present a case of giant hepatic hemangioma that completely filled the right lobe of the liver. The patient presented with bilateral lower limb edema and pain. A computed tomography scan detected a 9 × 11 × 12 cm mass indicative of a hemangioma in the right lobe of the liver that compressed the inferior vena cava. The patient refused treatment initially but returned 6 months later presenting with the same symptoms. At that time, the mass had increased in size and a hepatectomy was performed, preserving the middle hepatic vein. By postoperative month 13, the swelling in the lower extremities had decreased significantly and the inferior vena cava appeared normal.

scholarly journals Anticoagulation in pulmonary TB induced deep vein thrombosis is it always warranted: a case report

2020 ◽  
Vol 8 (7) ◽  
pp. 2678
Author(s):  
Binal Nitin Lodaria ◽  
Prasad Muley ◽  
Dhrumika Sheth
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Independent Risk Factor ◽  
Color Doppler ◽  
Pulmonary Tb ◽  
Vein Thrombosis ◽  
The Right ◽  
High Index Of Suspicion ◽  
Deep Vein ◽  
Grade Iii

India is a densely populated developing country and accounts for one quarter of the total tuberculosis cases reported worldwide. Deep vein thrombosis (DVT) has been associated with 1.5-3.4% cases of tuberculosis. A 14 year female presented with complaints of cough with progressive breathlessness (NYHA Grade III) since 15 days along with easy fatiguability and fever for 3 days. The patient was started on Anti-Tubercular Treatment (ATT) as per RNTCP guidelines after thorough investigations. One week after the patient was started on ATT, the patient developed edema of the right lower limb accompanied by pain. Color doppler was suggestive of thrombosis in the superficial and deep veins. Early immobilization and physiotherapy was started immediately. Over a period of 10 days, the swelling gradually decreased, and pain subsided. Tuberculosis is an independent risk factor for the development of venous thromboembolism irrespective of the presence of other risk factors. Emphasis is thus laid on high index of suspicion and early diagnosis to control and prevent further complications like pulmonary embolism. We can propose that in patients diagnosed with pulmonary tuberculosis, early immobilization and physiotherapy can prevent the development of DVT.

Giant cell arteriitis in critical bilateral lower limb ischemia

VASA ◽  
2013 ◽  
Vol 42 (5) ◽  
pp. 375-378 ◽  
Author(s):  
Magdalena Chudala ◽  
Katarzyna Drozdz ◽  
Pawel Gac ◽  
Tomasz Kuniej ◽  
Bozena Sapian-Raczkowska ◽  
...  
Keyword(s):  
Giant Cell ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Bilateral Lower Limb

Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

scholarly journals Surgical management outcome of cerebral schistosomiasis: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Moayad Moawia ZainElabdin Ahmed ◽  
Haytham Hussein Mohammed Osman ◽  
Alaa Hatim Ameer Mohamed ◽  
Alaaeldin Ginawi
Keyword(s):  
Surgical Resection ◽  
Clinical Laboratory ◽  
Parasitic Infection ◽  
Differential Diagnoses ◽  
Limb Weakness ◽  
General Test ◽  
Bilateral Lower Limb ◽  
Laboratory Investigations ◽  
The Right ◽  
Antiparasitic Agents

Abstract Background Schistosomiasis is a parasitic infection that commonly affects the gastrointestinal and genitourinary tracts. Cerebral schistosomiasis is rare, and few operative cases have been reported in the literature. Diagnosis is usually challenging due to the similarity of the lesion to many other brain conditions. Treatment usually requires surgical resection combined with the use of antiparasitic agents, which often results in good outcomes and excellent prognosis. Case presentation A 24-year-old, previously healthy Afro-asiatic man presented to our neurosurgical outpatient clinic complaining of headache and an attack of convulsions. On examination, he had bilateral lower limb weakness more on the right side. Laboratory investigations including stool and urine general test results were unremarkable. Magnetic resonance imaging of the brain was performed and showed an intra-axial left parietal mass; a granulomatous lesion was suggested in the differential diagnoses. The patient underwent craniotomy and total resection of the lesion. Histopathology confirmed the presence of active cerebral Schistosoma mansoni infection. Orally administered praziquantel was initiated at a dose of 20 mg/kg twice a day for a total of 3 days along with oral administration of corticosteroids for 2 weeks. The patient improved postoperatively without residual weakness and with no further convulsions. Conclusion Cerebral schistosomiasis is a rare but important consideration in the list of differential diagnoses of cerebral space-occupying lesions. This is of particular importance in in endemic areas like Sudan. In order to reach a diagnosis, careful social and occupational history need to be obtained and correlated with the clinical, laboratory, and radiological findings. Surgical resection along with the use of proper antiparasitic agents usually provides the best clinical outcomes.

scholarly journals Esthetic and Functional Improvement of Asymmetric Lower Limb Overgrowth in a Proteus Syndrome Patient: a Combined Surgical Technique

2021 ◽  
Author(s):  
Francesca Riccardi ◽  
Simone Catapano ◽  
Giuseppe Cottone ◽  
Dino Zilio ◽  
Luca Vaienti
Keyword(s):  
Adipose Tissue ◽  
Lower Limb ◽  
Vascular Malformations ◽  
Functional Improvement ◽  
Proteus Syndrome ◽  
Phosphatase And Tensin Homolog ◽  
Tensin Homolog ◽  
Genetic Mosaicism ◽  
Phosphoinositide 3 Kinase ◽  
The Right

AbstractProteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results.

scholarly journals Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke

2021 ◽  
pp. 154596832199904
Author(s):  
Brice T. Cleland ◽  
Sangeetha Madhavan
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
Motor Pathways ◽  
Movement Accuracy ◽  
Transcallosal Inhibition ◽  
Paretic Limb ◽  
Bilateral Lower Limb ◽  
Ankle Movement ◽  
Lower Limb Movement ◽  
Clinical Measures

Background Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. Objective Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. Methods In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. Results Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb ( P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions ( P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere ( P = .002) and during dynamic than isometric conditions ( P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy ( R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry ( R2 = 0.19, P = .03). Conclusions Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.

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