Calcific Myonecrosis of the Leg Treated by Debridement and Limited Access Dressing

Sreenivas, T.; Menon, Jagdish; Nataraj, A. R.

doi:10.1177/1534734613479382

Cited by 8 publications

(11 citation statements)

References 10 publications

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“… 10 Simple debridement and direct closure or staged closure using skin grafts with NPWT appears to be the most frequently used surgical technique. 3 Regarding postoperative management, NPWT appears to be useful for treating CM after complete resection. However, for infected wounds, NPWT-id is more suitable than NPWT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

Nagano

Yamamoto

Yanagibayashi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Calcific myonecrosis (CM) is a rare condition in which a large calcified mass develops after trauma. Generally, CM occurs in a lower extremity, and there have been no reports of its occurrence in the upper arm. We report 2 cases of infected CM, including a rare case of CM occurrence in the arm and a typical case in the leg. Case 1: An 84-year-old woman presented with a draining sinus and a large calcified mass in the arm and axillary region. The mass involved the neurovascular bundle; thus, complete resection was impossible. We performed surgical debridement and postoperative negative-pressure wound therapy with instillation and dwell. Case 2: A 43-year-old man presented with a large calcified mass in the right leg and 2 draining sinuses. After surgical debridement, negative-pressure wound therapy was initiated. However, the wound became infected, and we performed additional debridement, followed by a split thickness skin grafting. The infection was controlled in both patients, although complete resection was not feasible. Complete resection is generally considered the optimum treatment for infected CM, but it is difficult to achieve in some patients. Negative-pressure wound therapy with instillation and dwell appears as a good option for postoperative management if complete resection of infected CM cannot be achieved.

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Section: Discussionmentioning

confidence: 99%

“…Reportedly, negative-pressure wound therapy (NPWT) is useful for the postoperative management of CM. 3 , 4 However, NPWT with instillation and dwell (NPWT-id) appears to be more appropriate for treating infected CM. Here, we report a case of 2 patients with infected CM requiring surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

Nagano

Yamamoto

Yanagibayashi

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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show abstract

“… In those who had undergone surgical intervention, simple debridement and direct closure or staged closure using skin grafts with NPWT application appears to be the most frequently used surgical technique. Less frequently, skin graft application and the use of muscle to fill defects have also been described, although these procedures are much less common.…”

Section: Discussionmentioning

confidence: 99%

A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound

Tan

Loh²,

Nizamoglu³

et al. 2017

International Wound Journal

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Tan AMY, Loh CYY, Nizamoglu M, Tare M. A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound. Int Wound J 2018; 15:170-173 AbstractThe occurrence of calcific myonecrosis of the anterior compartment of the leg is rare. Common risk factors include a history of trauma, although little is known about the exact pathophysiology, latency period or triggering factors resulting in disease progression. Macroscopically, it begins with a single muscle being replaced by a fusiform calcified mass, which progresses peripherally. We present a rare case of a 7-year history of chronic discharging sinus overlying the site with protruding calcified muscle and discuss the senior author's wound management strategy and surgical considerations. The initial approach used dressing applications to reduce wound exudate while obtaining repeated imaging for disease progression comparison. Repeated CT scans showed significant disease progression from a single solitary amorphous soft tissue calcification to disseminated scattered calcified myonecrosis. In planning such surgeries, extensive debridement and temporary wound coverage is the first stage. Subsequent definitive coverage includes skin grafting of the remaining defect.

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“…[ 1 ] The condition usually manifests as a firm and enlarging mass with or without pain several decades following the initial trauma, sometimes accompanied by multiple discharge sinuses or infections. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 ] Surgical treatment is a definitive treatment option, but is associated with a high risk of postoperative complications, such as infection or chronic sinus formation. [ 2 ] In case of sinus formation, wound management becomes difficult and there is a potential risk of secondary infection. We report a case of calcific myonecrosis in a patient who had leg trauma 18 years before the formation of enlarging mass with a sinus tract.…”

Section: Introductionmentioning

confidence: 99%

Management of calcific myonecrosis with a sinus tract

2018

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Rationale:Calcific myonecrosis is a very rare late sequela that occurs in patients who have had trauma accompanied by vascular compromise, in which a single muscle or entire muscles in a compartment undergoes necrosis and form a calcified mass. It is mostly a benign entity, but some cases cause bone destruction and form non-healing chronic sinuses. In such cases, wound management becomes difficult and there is a potential risk of secondary infection.Patient concerns:A 60-year-old male was referred for evaluation of a pain, erythematous changes, and draining sinus of the anterolateral aspect of his left leg. He had an open reduction and internal fixation as well as a stent insertion in the femoral artery owing to a distal femur fracture and femoral artery rupture.Diagnoses:A thick fluid with a chalk-like material was discharged through the shiny skin via the sinus. The radiographs of the left leg showed a large, fusiform-shaped, radiopaque soft tissue mass in the space between the tibia and fibula. We performed an incisional biopsy to differentiated soft tissue sarcoma and malignant cells were found. Pathologic evaluation revealed acute and chronic inflammation with dystrophic calcification. These findings led to the diagnosis of calcific myonecrosis.Interventions:We performed an extensive debridement of the anterior and deep posterior compartments to ensure definitive treatment. Upon performing extensive debridement, we inserted a drain tube and performed primary closure.Outcomes:The fluid continued to be discharged through the drain even after the surgery; delayed wound healing occurred 4 weeks following the surgery, and there was no recurrence at follow-up conducted 2 years later.Lessons:Calcific myonecrosis is mostly a benign entity, but some cases of calcific myonecrosis cause bone destruction and form non-healing chronic sinuses. In such cases, surgical treatment is required, during which the necrotic tissue and calcific material must be extensively debrided and drained.

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Calcific Myonecrosis of the Leg Treated by Debridement and Limited Access Dressing

Cited by 8 publications

References 10 publications

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

Management of Infected Calcific Myonecrosis: A Report of 2 Cases

A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound

Management of calcific myonecrosis with a sinus tract

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