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Current Concepts: Techniques in Lower Extremity Hernia Repair
Brendan Alleyne,
Paul Durand,
Sima Molavi,
Franziska Huettner,
Risal Djohan
Cleveland Clinic Foundation
Department of Plastic Surgery
2018-02-04
Presenter: Brendan Alleyne
Affidavit:
*To be completed by Program Director Dr. Steven Bernard
Director Name: *To be completed by Dr. Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
A muscle hernia of the lower extremity can occur when the overlying fascia has become weakened. If conservative treatment fails, surgical fascial reinforcement is required for either cosmetic reasons or clinically symptomatic patients. We are presenting two cases of symptomatic, bilateral lower extremity hernias and two surgical techniques.
Methods:
A 28-year old otherwise healthy male presented with a history of intermittent bulging over the lower third of bilateral lower extremities. The bulging caused intermittent pain with ankle dorsiflexion, on right more than left. This limited the patient's ability to exercise, especially while running. The second patient, a 32 female with a similar history of bilateral lower extremity bulging without a history of trauma, sought a definitive surgical treatment. Conservative management in both patients failed to alleviate the symptoms.
Techniques:
The first patient underwent, Gore-Tex mesh placement in underlay fashion. The left lower extremity fascial defect was repaired seventeen months after the contralateral extremity using the same technique.
The second patient underwent initial reconstruction of left leg fascial defect with the mesh underlay technique. Right leg exploration and repair of the defect occurred 8 months later with a combination repair using mesh underlay and peripheral nerve wrap/conduit of the superficial peroneal nerve.
Results:
Both patients gradually resumed preoperative exercise programs in the early post-operative months following the procedures and remained pain-free in follow-up. Follow-up MRIs showed no hernia recurrence.
Conclusion:
Lower extremity hernias can be addressed safely through the mesh support technique and with neural sheath protection in specific cases.
