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PubMedDate not supplied

Limb sparing surgery for vulvar groin recurrence: a case report and review of the literature.

Hemipelvectomy was successfully avoided in a patient with extensive necrotic groin recurrence of vulvar cancer after prior radiation therapy. Tumor-free resection margins were achieved by wide excision of the recurrence including resection of the pubic bone and adjacent muscles. After resection of the femoral artery, blood supply to the leg was restored by an extra-anatomic axillopopliteal bypass. A myocutaneous flap from the contralateral rectus abdominis was used for primary wound closure. Limb salvage was achieved and the patient experienced pain relief, excellent cosmesis, and independent gait. Aspects of treatment options, even though primarily palliative, in groin recurrence of vulvar carcinoma are discussed.

Aged↗
PubMed2001

Insertion of an implantable venous access device in the groin using inferior epigastric vein.

BACKGROUND: Patients with cystic fibrosis (CF) need reliable venous access that can be provided by implantable venous access devices (IVAD). Such IVADs usually are placed in the upper part of the body, but placing them in this area has 3 disadvantages: a suitable vein may not be available, the portal may be conspicuous, and there may be interference with chest physiotherapy. Positioning the IVAD in the groin by using the inferior epigastric vein (IEV) is an answer to these problems. METHODS: This is a review of 29 patients from a single surgeon's practice from 1984 to 1999. A groin incision was used to implant the IVAD and to introduce the catheter via the IEV to the inferior vena cava. RESULTS: A total of 33 IVAD were inserted in 29 patients (27 with CF). The average age at first operation was 12.4 years. Infection was seen in 5. Venous thrombosis was not seen in any patient. The average longevity of IVAD is 18.5 months. Total experience is 87 IVAD years. CONCLUSION: This is a useful route of first choice for CF patients, with an overall complication rate comparable with techniques in which IVADs are placed in the upper half of body. J Pediatr Surg 36:579-581.

Adolescent↗
PubMed2000

The use of subatmospheric pressure dressing therapy to close lymphocutaneous fistulas of the groin.

Groin lymphorrhea is an uncommon but serious complication of vascular and cardiac surgery as well as interventional procedures that cannulate the femoral vessels. Treatment options are somewhat controversial. For lymphocutaneous fistulas, a commonly used current modality is early surgical ligation with the assistance of blue-dye staining of the lymphatic anatomy. The purpose of this case series is to give the first description of a new, less invasive, approach using subatmospheric pressure dressing therapy for the treatment of the challenging problem of lymphocutaneous fistulas of the groin.

Aged↗
PubMed2003

[Vesiculitis seminalis--a rare diagnosis in case of chronic groin pain].

In this case report we present a male soccer player suffering from chronic groin pain. Exact diagnosis, i. e. seminal vesiculitis, could finally be evaluated by the means of MR Imaging, and so the patient did fully recover after selective antibiotic therapy. In this case musculoskeletal involvement because of visceral pelvic disorders may be caused by synaptic interaction between the somato-sensory and viscero-motoric system due to the close anatomical relationship between the seminal vesicle of the pelvis and the pubic bone with its insertion of the adductor muscles. In case of chronic groin pain in athletes physicians should also be aware of visceral pelvic disorders. For diagnostic evaluation MR Imaging may be of important help.

Abdominal Pain↗
PubMed2004

Imaging of hip and groin injuries in athletes.

Proper function of the hip joint is imperative for athletes who participate in sporting activities that rely on utilization of the lower extremity; these primarily include kicking, running, and jumping activities. Sports-related injuries of the hip and groin are not frequent sources of disability in athletes; however, they may present a significant diagnostic dilemma, both from a clinical and radiological standpoint. Delay in diagnosis and treatment may result in undesired complications, such as premature degenerative disease, as well as time lost from athletic activities. Magnetic resonance (MR) imaging of the hip, particularly following the intra-articular administration of gadolinium, has proven to be extremely valuable in the diagnosis of radiographically occult osseous abnormalities as well as soft-tissue injuries, such as pubalgia, musculotendinous abnormalities, and bursitis. This article will review several pathological conditions of the hip and groin in both recreational and professional athletes, with an emphasis on MR imaging as the modality of choice in the diagnosis of these injuries.

Athletic Injuries↗
PubMed2005

[Chronic groin pain in marathon race: bone apposition at insertion of the m. rectus abdominis at ramus superior ossis pubis -- case report].

In this case report we present a 56 years old long standing (20 years) Marathon runner, suffering from chronic groin pain for 1(1/2) year. The great variety of diagnosis, which are subsumed under longstanding groin pain, explain the long time to evaluated the exact diagnosis and to institute a selective therapy. A multidisciplinary investigation was necessary to reveal a bone apposition at insertion of the musculus rectus abdominis in result of a chronic pelvic instability after beginning osteoarthitis and reduced range of rotational motion of the hip. One year after resection the bone apposition the athlete was free of pain, completely resistance in running and whole re-integrated in racing competitions.

Athletic Injuries↗
PubMed2005

Microdissection thinning of a pedicled deep inferior epigastric perforator flap for burn scar contracture of the groin: case report.

A severe burn scar contracture of the groin in a 25-year-old woman was successfully reconstructed with microdissection and thinning of a pedicled deep inferior epigastric perforator (DIEP) flap. This perforator flap is a relatively thin cutaneous flap, but may still require secondary defatting procedures, especially when used for coverage of mobile anatomic areas such as the groin and axilla. A deep inferior epigastric perforator flap was radically thinned by excising the subcutaneous fatty layer very carefully under loupe magnification, to preserve the subdermal vascular plexus. One year after surgery, the patient can abduct and rotate the hip freely without limitation.

Adult↗
PubMed1998

Free groin flap for reconstruction of the tongue and oral floor.

The authors report the use of free groin flaps to close intraoral defects in 24 patients following ablative tongue cancer surgery. The lateral thin portion of the flap was used for tongue reconstruction, and the deepithelialized medial thick portion for filling the mandibular defect and for covering the important vessels in the neck. In lean patients, if the medial deepithelialized portion was too thin for adequate coverage, the proximal sartorius muscle was included to prevent postoperative orocervical fistula. The advantages of the groin flap in reconstructing the tongue and oral floor after hemiglossectomy include the following: (1) a suitable amount of tissue is available for both the tongue and oral floor; (2) the important vessels in the neck may be protected with the flap; (3) the proximal sartorius muscle can be included with the flap, if necessary; (4) donor-site morbidity is less than with other flaps; and (5) flap elevation can be done concurrently with the hemiglossectomy and radical neck dissection.

Adult↗
PubMed2002

Usefulness of autogenous bypass grafts originating distal to the groin.

PURPOSE: Infrainguinal bypass grafting with a proximal anastomosis distal to the groin has been used increasingly to conserve available conduit and reduce wound morbidity and recovery time. The usefulness of the liberalized use of distal origin grafts (DOGs) is unknown. METHODS: Consecutive autogenous DOG procedures that were performed between 1978 and 2000 were reviewed retrospectively with a computerized registry. Procedures performed as revisions to earlier infrainguinal bypass grafting procedures and for popliteal aneurysm were excluded. RESULTS: In the 22-year study period, 249 autogenous DOG procedures were performed in 217 patients. Comparison of the 159 DOGs in patients with diabetes mellitus (+DM) with the 90 grafts in patients without diabetes mellitus (-DM) revealed more associated renal disease (33% vs 9%), preoperative foot necrosis (80% vs 52%), distal popliteal artery graft origins (49% vs 37%), and non-greater saphenous conduits used (30% vs 19%) among the +DM subgroup than the -DM subgroup (P <.05). The operative mortality rate was 2.0%, the major morbidity rate was 8.8%, the early graft failure rate was 6.4%, and the early amputation rate was 2.4%, with no differences related to diabetes mellitus. Follow-up was complete in 92% of patients in a mean interval of 27 months. At 5 years, cumulative primary graft patency rates were 62% overall, 73% for the +DM subgroup, and 45% for the -DM subgroup (P <.001). The overall limb salvage rate after DOG procedures for critical ischemia was 79%, and it was 84% for the +DM subgroup and 69% for the -DM subgroup (P <.04). The overall patient survival rate was 45%, with no difference related to diabetes mellitus. CONCLUSION: Outcome after autogenous DOG revascularization is satisfactory overall. Graft patency and limb salvage after DOG for critical ischemia are significantly better among patients with diabetes mellitus than patients without diabetes mellitus, despite significantly more bypass grafting procedures performed for foot necrosis. DOG revascularization appears to be an appropriate preference for patients with diabetes mellitus with good inflow below the groin; it should be used less liberally among patients without diabetes mellitus.

Adult↗
PubMed1981

Common groin eruptions: diagnosis and treatment.

Most common groin lesions are caused by fungi, bacteria, psychogenic factors, viruses, parasites, or tumors. The workup of all patients with an inguinal skin disorder should include a history, physical examination, microscopic examination and culture of scrapings from the eruption, and examination of the eruption by Wood's light. Agents useful in treating groin lesions include topical and systemic corticosteroids and antibiotics, antipruritic agents, Burow's solution, and lindane. Prolonged use of high-potency topical corticosteroids can be deleterious.

Candidiasis, Cutaneous↗
PubMed2004

Groin injuries in professional rugby league players: a prospective study.

Altogether, 100 uninjured professional rugby league players were evaluated over a 2-year period. Their height, body mass, sum of skinfolds, girths and bone diameters were recorded. A Cybex 340 isokinetic dynamometer was used to determine peak torque, work, power, endurance ratios and peak torque ratios of the hip abductors and adductors (5 repetitions at 0.52 and 2.08 rad. s(- 1); 20 repetitions at 3.66 rad. s(- 1)) and knee flexors and extensors (4 repetitions at 1.04 and 3.14 rad. s(- 1); 30 repetitions at 5.22 rad. s(- 1)). Hip abduction and adduction were also assessed with the hip in external rotation. Discriminant function analysis was conducted on all predictor variables to develop a multivariate predictive model capable of classifying players with a high degree of accuracy into groups with and without a groin injury. The model consisted of eight variables and correctly classified 91.7% of the non-injured players and 90.5% of the injured players. The correct classification for the model as a whole was 91.4%. The aetiological factors identified as being related to injury of the groin musculotendinous unit included abduction and adduction-with-rotation peak torque, angle of adduction and abduction-with-rotation peak torque, strength ratio of hip muscle groups, bilateral difference in extension peak torque, femur diameter and body mass.

Adult↗
PubMed1982

The lymphatics of the groin flap.

This communication briefly discusses lymph-draining potentials and problems of skin flaps; describes specifically the lymphatics of the groin flap, an axial pattern flap; gives examples of its clinical application as a lymphatic wick; and explains its partial success and failure. The concept of axial pattern flaps was developed when the groin flap was described in 1972 by McGregor and Jackson. Attempts were subsequently made to delineate the extent of the vascular territories of these axial vessels. Although the flap was initially used as a pedicle flap, transfer of its vascular territory based on the axial vessels was soon undertaken, producing the so-called free flap. One desirable characteristic of this axial pattern flap was the remarkable absence of edema following elevation and transfer or transplantation to the new site. This stimulated one of us (L.C.) to review the lymph-draining potential of this flap.

Adult↗
PubMed1982

The groin flap in severe hand injuries.

We reviewed 27 patients who required 28 groin flaps for repair of hand injuries. Flap necrosis due to ischemia developed in 18% of the patients. Flap ischemia did not develop after elevation of the flap or partial division of the pedicle. All flap necroses occurred after final (total) division of the pedicle (p less than 0.05). Flap necrosis was more common following immediate insetting of the flap than after delaying the inset, but this difference was not statistically significant. Flap necrosis did not develop if the pedicle was divided in two stages, with the first stage consisting of either preliminary ligation of the superficial circumflex iliac vessels or full-thickness division of a portion of the width of the flap. Our complication rate was much lower than that previously reported for groin flaps.

Adolescent↗
PubMed1985

Internal oblique muscle pedicle flap for coverage of a major soft tissue defect of the groin.

We describe a new muscle flap, using the internal oblique muscle as a transposition flap based on the ascending branch of the deep circumflex iliac artery, for coverage of a groin defect with exposed femoral vessels. This muscle also has potential usefulness as a pedicle flap for coverage of the anterior perineum and midline lower abdominal defects. It is a thin, flat muscle with excellent vascularity and is safe and reliable to use. The donor site scar is well concealed. The disadvantages are a possibly bloody and tedious dissection, and the long-term potential for abdominal wall weakness or herniation. In the case reported, no abdominal wall laxity or herniation were noted at eight and one-half months. We believe that the internal oblique muscle flap is a useful technique that complements the already popular methods of reconstruction for groin defects.

Abdominal Muscles↗
PubMed1987

Shotgun blast injuries to the groin: reconstruction using the rectus abdominis flap.

We discuss our successful management of complex groin wounds caused by shotgun blasts at relatively short range. A straightforward approach to the problem of reconstructing the large soft-tissue defect and providing protection for the femoral artery reconstituted by Gore-Tex graft is described. We emphasize the fundamental principles of management of civilian trauma and illustrate that a Gore-Tex graft need not be covered immediately if there is any possibility that debridement is incomplete. The inferiorly based rectus abdominis flap is recommended as an excellent choice for coverage of the typical shotgun blast groin wound, making it possible to salvage the involved lower extremity in these severe injuries.

Adult↗
PubMed1989

Salvage of the infected groin vascular graft with muscle flaps.

Debridement and reconstruction of the infected groin wound, including those involving prosthetic graft material, have been performed in eight patients. Healing of the groin wound with functional preservation of the graft has been possible. Our patients have been followed up for at least six months. The procedure described here is a useful addition to the surgical armamentarium for battling this difficult problem.

Aged↗
PubMed1993

Free composite groin flap and vascularized external oblique aponeurosis for traumatic avulsion injuries of the foot.

Avulsion trauma to the dorsum of the foot is usually combined with skin and tendon loss. Five patients with such composite tissue loss were treated with composite free groin flaps including the external oblique aponeurosis based on the superficial circumflex iliac vessels. The groin flaps resurfaced the skin defect and the vascularized fascia was used to replace the absent extensor tendons in a single-stage reconstruction. All the composite free tissue transfers were successful. When compared with conventional treatments, the advantages of this technique are one-stage reconstruction, faster wound healing, and fewer adhesions of the reconstructed tendons.

Adult↗
PubMed1995

Phalloplasty in children and adolescents using the extended pedicle island groin flap.

An operative procedure for phalloplasty is reported that uses an extended pedicle island groin flap. Forming a combined groin and lower abdominal flap based on the superficial iliac and epigastric vessels is the main characteristic of this technique. The flap consists of 3 parts: 1) the lateral narrow hairless part for the neourethra, 2) the medial wide part for neophallus shaft reconstruction and 3) the base of the flap on which a flap pedicle is formed and lengthened by de-epithelializing the skin. The pedicle includes subcutaneous tissue with blood and lymph vessels. The neourethra and neophallus shaft are reconstructed using a tube-within-tube technique. The size of the flap depends on patient build. The flap is transferred to the recipient area, that is to the level of the lower margin of symphysis. Anastomosis of the new and native urethra may be done simultaneously or during the second stage of the procedure. The donor site skin defect is closed by direct approximation. During 3 years (1991 to 1993) this flap technique was performed on 24 patients (age 12 to 18 years). There were 2 main indications for treatment: 1) complete absence of the penis, and so total reconstruction of the phallus was done and 2) small dimensions of the penis or just a penile stump, and so augmentation of the penis was done. Specific indications were female transsexualism in 4 patients, penile amputation in 2 and a small disabled penis in 18 (the exstrophy-epispadias complex, intersex and micropenis). Followup ranged from 6 to 42 months (average 29). A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in 2 patients, fistulas in 2 and stenosis of the urethral anastomosis in 1. These complications were successfully resolved by corrective surgery. The method is simple and timesaving with a minor complication rate. This technique is the available alternative to the most commonly used procedure, that is microsurgical free tissue phalloplasty.

Adolescent↗