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At least 343 records · Page 19Linked to original sources
PubMed2001

Risk factors for groin injuries in hockey.

PURPOSE: The objective of this cohort study was to determine the level of off-season sport specific activity, peak isometric adductor torque, and hip abduction flexibility that are predictive of groin or abdominal strain injury in the National Hockey League (NHL). METHODS: The subjects were 1292 consenting NHL players. Estimated relative risks of injury are reported using the following exposures: 1) level of sport specific training in the off-season, 2) peak isometric adductor torque, 3) total hip abduction flexibility, 4) previous injury, 5) years of NHL experience, and 6) skate blade hollow measurement. Estimates of probability of injury are predicted for various levels of exposures on the basis of logistic regression analysis. RESULTS: During training camp, players who reported less than 18 sessions sport specific training in the off-season were at greater than three times the risk of injury than those who did not (relative risk (RR); 3.38 95% confidence interval (CI), 1.45-7.92). Players who reported previous history of this injury were at more than two times the risk of injury than those who did not (RR, 2.88; 95% CI, 1.33-6.26). Veterans were at greater than five times the risk of injury than rookies (RR, 5.69; 95% CI, 2.05-15.85). Peak isometric adductor torque, total abduction flexibility, and skate blade hollow measurement were not predictive of injury. There is evidence of a dose-response gradient as predicted probability of injury decreases with increasing levels of sport specific training. In the regular season, sport specific training was not as strong a risk factor (RR, 2.32; 95% CI, 1.0-5.39). CONCLUSION: Low levels of off-season sport specific training and previous injury are clearly risks for groin injury at an elite level of hockey. Future research is required to investigate prevention strategies for this injury in hockey.

Abdominal Injuries↗
PubMed1988

Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region.

Eight patients had reconstructive surgery for soft-tissue, associated Achilles tendon, and calcaneus defects on the posterior aspect of the ankle. In group A, those patients with skin, soft-tissue, and Achilles tendon loss were treated with free groin flaps that included sheets of the external oblique aponeurosis based on the superficial circumflex iliac vessel. The groin flap provided skin coverage, and the aponeurosis was rolled to form a tendon-like structure to replace the Achilles tendon. In group B, those patients with an additional calcaneus bone loss were treated with free iliac osteocutaneous flaps, together with the external oblique aponeurosis based on the deep circumflex iliac vessel. The iliac bone was then utilized to reconstruct the calcaneus defect. All composite free tissue transfers were successful, except in two group B patients who suffered partial skin loss. The advantages of this technique are (1) a single, one-stage procedure, (2) faster wound healing with fewer adhesions of the reconstructed Achilles tendon, and (3) good cosmesis and minimal morbidity at the donor site.

Achilles Tendon↗
PubMed2002

Successful treatment of 19 consecutive groin lymphoceles with the assistance of intraoperative lymphatic mapping.

Postoperative groin lymphoceles that fail to resolve spontaneously or with interventional therapy present a formidable problem that is associated with a high degree of morbidity. Numerous interventional methods and operative techniques have been described to treat these fluid collections, yet recurrence rates remain high. The use of lymphatic mapping has gained widespread use in the treatment of cutaneous malignancies and breast cancer and has been proven effective in delineating the course of lymphatic channels. We present here a series of 17 consecutive patients with 19 problematic groin lymphoceles who were treated with the assistance of intraoperative lymphatic mapping using isosulfan blue dye. To date there have been no recurrences and minimal morbidity associated with the technique and prescribed postoperative treatment regimen.

Adult↗
PubMed2003

Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes.

OBJECTIVE: To investigate the results of surgical treatment on athletes presenting with chronic symphysis syndrome (lower abdominal, groin, and adductor pain). DESIGN: Retrospective nonrandomized study. SETTING: Swiss Olympic Medical Center associated with Institute of Sports Sciences. PATIENTS: Twenty-four athletes who were treated for chronic symphysis syndrome, a combination of abdominal, groin, and adductor pain, were evaluated for an average of 6.6 years after surgery. All athletes were males, with a mean age of 25.8 years. The average duration of chronic symptoms was 17 months. INTERVENTIONS: Of patients, 20 underwent spreading of the lateral border of the sheath of the rectus abdominis muscle together with an epimysial adductor release, and 4 had only the reconstruction of the rectus abdominis muscle. MAIN OUTCOME MEASURES: Subjective (questionnaire) and objective (clinical examination) follow-up data using point scores were obtained at a mean of 6.6 years posttreatment. RESULTS: The mean point score in the subjective overall rating was 10.2 (maximum 12) and in the objective rating was 12.0 (maximum 13). Of athletes, 21 were very content, 2 were content, and 1 was not content. Full sports activity was noted in 23 of 24 athletes. CONCLUSIONS: Surgical treatment of chronic symphysis syndrome is successful and can salvage the career of athletes.

Abdominal Pain↗
PubMed2006

Algorithm for treatment of postoperative incisional groin pain after cesarean delivery or hysterectomy.

OBJECTIVE: Despite the low mortality and morbidity of major obstetric and gynecologic surgeries (including hysterectomy and cesarean delivery), women undergoing these procedures occasionally suffer from intractable postoperative suprapubic and groin pain. We present seven patients whose intractable pain lasted longer than 6 months and was not due to gynecologic disease or other obvious pathology. METHODS: Neuromas of the ilioinguinal, iliohypogastric, and/or genitofemoral nerves were suspected clinically and confirmed intraoperatively. RESULTS: After neuroma resection, all patients reported complete and durable pain relief. CONCLUSION: Intractable pain after obstetric or gynecologic surgery can be due to neuroma formation, and resection is therapeutic. We suggest an algorithm for the management of women with chronic intractable suprapubic or groin pain after major obstetric and gynecologic surgery. LEVEL OF EVIDENCE: II-3.

Algorithms↗
PubMed2006

Free microdissected thin groin flap design with an extended vascular pedicle.

BACKGROUND: The senior author has developed a method of microdissection whereby a thin perforator flap can be elevated accurately in a single-stage procedure. Recently, the authors also applied the microdissection technique to the inguinal area and elevated microdissected thin groin flap. METHODS: In preparation of the flap, the perforator penetrating the fascia of the sartorius muscle is initially detected suprafascially, and then the deep adipose and subfascial layer of the inguinal area is dissected using an operating microscope. After confirming the distribution of the blood vessels in this area, the flap is elevated while dissection is performed between the deep and superficial adipose layers. RESULTS: Six cases of scar contracture or skin defect by general burn, three cases of other types of traumatic tissue defects, and one case of skin loss at the donor site of an extended wraparound flap were successfully reconstructed with these new flaps. CONCLUSIONS: The uniform thinness and long vascular pedicle are distinctive characteristics of this flap compared with the traditional groin flap. Moreover, the buried vessels in the deep adipose layer and fascia can be confirmed by microdissection; this enables prediction of the safe area of the flap.

Adipose Tissue↗
PubMed2004

Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine.

BACKGROUND: Techniques for better hemorrhage control after injury could change outcome. We have previously shown that a zeolite mineral hemostatic agent (ZH) can control aggressive bleeding through adsorption of water, which is an exothermic process. Increasing the residual moisture content (RM) of ZH can theoretically decrease heat generation, but its effect on the hemostatic properties is unknown. We tested ZH with increasing RM against controls and other hemostatic agents in a swine model of battlefield injury. METHODS: A complex groin injury was created in 72 swine (37 +/- 0.8 kg). This included semitransection of the proximal thigh and complete division of the femoral artery and vein. After 3 minutes, the animals were randomized to 1 of 10 groups: group 1, no dressing (ND); group 2, standard dressing (SD); group 3, SD + 3.5 oz ZH with 1% RM (1% ZH); group 4, SD + 3.5 oz ZH with 4% RM (4% ZH); group 5, SD + 2 oz ZH with 1% RM (1% ZH 2oz); group 6, SD + 3.5 oz ZH with 8% RM (8% ZH); group 7, SD + chitosan-based hemostat, HemCon (HC); group 8, SD + 3.5 oz nonzeolite mineral hemostat, Quick Relief (NZH); group 9, SD + bovine clotting factors-based hemostat, Fast Act (FA); and group 10, SD + 30 g of starch-based hemostat, TraumaDex (TDex). Resuscitation (500 mL of Hespan over 30 minutes) was started 15 minutes after injury and hemodynamic monitoring was performed for 180 minutes. Primary endpoints were survival for 180 minutes and blood loss. In addition, maximum wound temperatures were recorded, and histologic damage to artery, vein, nerve, and muscle was documented. RESULTS: Use of 1% ZH decreased blood loss and reduced mortality to 0% (p < 0.05). Increasing the RM adversely affected efficacy without any significant decrease in wound temperatures. Minimal histologic tissue damage was seen with ZH independent of the percentage of RM. CONCLUSION: The use of zeolite hemostatic agent (1% residual moisture, 3.5 oz) can control hemorrhage and dramatically reduce mortality from a lethal groin wound.

Adsorption↗
PubMed2006

Testing of modified zeolite hemostatic dressings in a large animal model of lethal groin injury.

BACKGROUND: We have previously identified a granular zeolite hemostat (ZH) as an effective agent for control of severe bleeding, and it is currently being used by the US troops in the battlefield. ZH causes an exothermic reaction on application, which theoretically can be decreased by altering its chemical composition or changing its physical properties. However, the effect of these alterations on the hemostatic efficacy is unknown. We tested modified zeolites and a chitosan based dressing against controls in a swine model of battlefield injury. METHODS: A complex groin injury was created in 60 swine (40-55 kg). This included semi-transection of the proximal thigh (level of inguinal ligament), and complete division of the femoral artery and vein. After 3 minutes, the animals were assigned to (1) no dressing (ND), (2) standard dressing (SD), (3-5) SD + chemically modified ZHs, where calcium was substituted with sodium (Na), barium (Ba), or silver (Ag), respectively, (6) SD + physically modified ZH, where "beads" were packaged in a fabric bag, (7) SD + chitosan based dressing (CD). Resuscitation was started 15 minutes after application of dressing (500 mL of 6% hetastarch over 30 minutes). Survival for 180 minutes was the primary endpoint for this study. In addition, blood loss, wound temperatures, and histologic tissue damage were recorded. RESULTS: Mortality in the group that was treated with the application of bagged ZH was 10% versus 100% in the no dressing group and 50% in the SD group (p < 0.05 vs. ND and SD groups). The Na ZH group had a mortality rate of 43%, whereas application of Ba and Ag substituted zeolites, and CD were associated with a mortality rate of 25%. Ionic substitution of zeolite decreased the in vivo temperature peak by 5 to 10 degrees C. No histologic evidence of tissue necrosis was noted in this experiment. CONCLUSIONS: The use of zeolite hemostat can control hemorrhage and dramatically reduce mortality from a lethal groin wound. Modifications of zeolite hemostat can decrease the exothermic reaction and attenuate tissue damage.

Animals↗
PubMed1992

Inguinal surgery in athletes with chronic groin pain: the 'sportsman's' hernia.

Fifty athletes with chronic undiagnosed groin pain underwent surgical exploration and inguinal hernia repair. Six months later, all athletes were sent questionnaires to assess their return to sport, level of pain (using analogue pain scores) and the overall result of their surgery. Operative findings revealed a significant bulge in the posterior inguinal wall in 40 athletes. Forty-four athletes (88%) replied to the questionnaire. Forty-one athletes (93% of respondents) had returned to normal activities. Pain scores indicated a marked improvement in their level of pain (P less than 0.001). Thirty-three athletes (75%) rated the result as good and 10 (23%) as improved. It is concluded that athletes with chronic groin pain who are unable to compete in active sport should be considered for routine inguinal hernia repair if no other pathology is evident after clinical examination and investigation.

Adolescent↗
PubMed1984

Postjunctional alpha 1- and alpha 2-adrenoceptors mediating contraction in isolated human groin arteries and veins.

By means of selective agonists and antagonists for alpha 1- and alpha 2-receptors, the alpha-receptor subtypes in human groin arteries and veins were characterized and compared. In the arteries the alpha 1-receptor blocker prazosin caused a concentration-dependent parallel displacement of the noradrenaline (NA) concentration-response (cr) curve without reduction of maximum (pA2 = 9.86); the selective alpha 2-receptor antagonist rauwolscine in the concentration 10(-8) M caused a right-ward shift of the NA cr-curve without reduction of Emax, but 10(-7) M and 10(-6) M caused little or no further shift. In the veins, the two antagonists had the opposite effects. Rauwolscine caused a concentration-dependent right-ward shift of the NA cr-curve without depression of maximum (pA2 = 9.03); prazosin 10(-9) M significantly displaced the NA cr-curve, whereas 10(-8) M and 10(-7) M caused little or no further shift. The responses to the alpha 2-receptor agonist clonidine in the arteries were too small to allow calculations of pEC50 values; in the veins contractions were elicited in all vessel segments investigated (pEC50 = 6.24). Phenylephrine, selective for alpha 1-receptors, was significantly more potent in arteries than in veins. NA was significantly more potent in veins than in arteries. It is concluded that in human groin vessels, there is a functional predominance of alpha 1-receptors in the arteries and of alpha 2-receptors in the veins.

Adrenergic alpha-Agonists↗
PubMed1997

Management of groin pain in athletes.

Groin pain is a difficult clinical problem because of the variety of conditions that are potentially responsible. Much of the "theory" of groin pain is just that, theory, and much needs to be done to document the pathomechanics and symptomatology of this anatomical region. Notwithstanding the above, clinicians should be comfortable in the knowledge that they can provide relief in most cases and a cure in more than a few. The recommended diagnostic approach is anatomical, supported by judicious selection of diagnostic imaging techniques. Management then comprises a considered approach to functional recovery, allowing time to heal, regain strength, and restore mobility. Patients should be reminded that there are no short cuts and precipitate return to sport is not worth the risk in most cases.

Athletic Injuries↗
PubMed1998

Chronic groin pain in an athlete: an unusual presentation.

Persistent disabling groin pain in an active sportsman is a frustrating diagnostic and management problem for both the athlete and physician. After clinical examination and investigation there remains a group of patients who have unexplained groin pain, and may undergo lengthy periods of conservative management with numerous radiological investigations. Here we highlight such a case.

Adult↗
PubMed1996

Post-stent management with a pneumatic groin compression device and self injected low molecular weight heparin.

BACKGROUND: The benefits of intracoronary stent implantation are offset by an increased risk of complications at the arterial puncture site and a prolonged hospital stay. Much of this morbidity can be attributed to the generally perceived need to achieve systemic anticoagulation after stent implantation. AIM: To test a simplified protocol for post-stent management using the Femostop pneumatic groin compression device and low molecular weight (fractionated) heparin (LMWH) administered by subcutaneous injection. PATIENTS: A case series of 100 consecutive patients, with stable angina pectoris, undergoing coronary stenting for a suboptimal result after conventional balloon angioplasty. METHODS: All patients were managed with a new post-stent protocol using the Femostop pneumatic groin compression device and LMWH. The incidence of complications and the length of hospital stay were recorded. RESULTS: The clinical course was uncomplicated in 92 patients and their discharge from hospital was achieved on the first post-procedural day for 44 patients and on the second for the remaining 48. The rate of vascular or bleeding complications was 6%. CONCLUSIONS: LMWH administered by subcutaneous injection may provide a practical and effective alternative to the use of intravenous heparin when systemic anticoagulation is used after stent implantation.

Angioplasty, Balloon, Coronary↗
PubMed1992

Streptococcus milleri and complex groin abscesses in intravenous drug abusers.

Intravenous drug abuse is an increasing problem. Septic complications occur frequently at the injection site, especially in the groin where large abscesses around the femoral vessels can threaten life or limb. We report four patients with extensive or complex groin abscesses following attempted self-injection into the femoral vein. Streptococcus milleri was cultured from all of these abscesses and prompted a review of the isolation of this organism in this hospital.

Abscess↗
PubMedDate not supplied

Ultrasonography of chronic tendon injuries in the groin.

Ultrasonography was used in the diagnosis of 36 patients with chronic groin pain localized to the tendons of the rectus abdominis, rectus femoris, adductor muscles, hamstring muscles, and the gluteal muscles. Abnormal findings, such as focal sonolucent areas and discontinuity of tendon fibers, that are indicative of nonhealed partial ruptures were found in 28 patients. These findings differed clearly from the asymptomatic contralateral side, which was used for comparison. The abnormalities were located in three different sites: at the tendon insertion, within the tendon, and at the tendomuscular junction. Ten patients were treated surgically and the findings at surgery correlated well with the ultrasonographic findings of partial tendon tears: 9 were true-positive and 1 was a true-negative. Ultrasonography appears to be a valuable method in the diagnosis of chronic groin pain.

Adolescent↗
PubMedDate not supplied

Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes.

Eighteen tenotomies of the adductor longus tendon were performed in 16 consecutive male athletes (aged 20 to 42) as treatment for chronic groin pain. The criteria for surgery was a history of long-standing (range, 2.5 to 48 months) and distinct pain at the origin of the adductor longus muscle, refractory to conservative treatment. At followup 35 months (range, 4 to 84) after surgery, all patients were improved or free of symptoms. All but 1 of the athletes returned to the same sport within a mean of 6.6 weeks, and 12 of 16 returned to competitive sports within a mean of 14 weeks after surgery. A majority of the patients (10 of 16) returned to full athletic activity, whereas 5 of 16 performed at a reduced level. One patient discontinued his sports activity due to other causes. In conclusion, when conservative treatment fails, tenotomy of the adductor longus tendon gives good long-term functional results in the treatment of chronic groin pain that is localized at the origin of the adductor longus muscle. A decreased muscle strength was observed in this study and did not seem to influence participation in sports.

Adult↗
PubMedDate not supplied

Extended iliac exposure from the groin.

Knowledge of iliac artery and inguinal anatomy enables extraperitoneal exposure of the iliac arteries for surgical treatment of unilateral inflow disease. A method is presented for exposing the distal common iliac artery, the iliac bifurcation, and the full length of the external iliac artery by detachment and retraction of the inguinal ligament though a single extended groin incision. The indications for unilateral iliac artery exposure, revascularization, surgical anatomy, and technique of iliofemoral exposure through a single, extended groin incision are presented. Extended iliac exposure through a single, extraperitoneal exposure facilitates all methods of unilateral iliac revascularization and provides access for delivery of endovascular devices.

Aged↗
PubMed2004

Oblique groin incision for endovascular repair of abdominal aortic aneurysms.

PURPOSE: Groin incision for access to the femoral artery is necessary for stent graft repair of abdominal aortic aneurysm (AAA). However, lymphatic and infectious complications can occur during wound healing after surgery. A vertical incision traditionally is used, but a new oblique incision technique has the potential to reduce complications. We report our results from AAA stent repairs performed via oblique incisions at our center for a 33-month period. METHODS: Data for 134 consecutive patients undergoing elective stent repair of asymptomatic infrarenal AAA performed by 2 cardiovascular surgeons at a single center from July 1, 2000, to March 31, 2003, were gathered for analysis. Wound complication percentages for infections, paresthesias, sepsis, and seroma were calculated. RESULTS: In 134 patients, a total of 278 incisions were made. Reasons for extra incisions included improving catheter entry angle (5 cases), tunneling for vascular tapes (3 cases), and initial approach too low (2 cases). The percentages were, however, calculated on a per-patient basis. Thirty day analysis revealed a 0% infection rate, 4.7% incidence of paresthesias, 2.38% rate of wound seroma, and 0% wound sepsis rate. CONCLUSION: Because of the nonexistent infection rate and low wound complication rate, our data supports the use of oblique groin incisions for stent repair of asymptomatic infrarenal AAA.

Aged↗