Polypropylene mesh repair of iatrogenic thigh hernias

0 1998 Elsevier ELSEVIER

hjury Vol. 29, No. 6, p. 478, 1998 Science Ltd. All rights reserved Printed in Great Britain 0(120-1383/98 $19.OO+l~.OO

PII: s0020-1383(98)00086-2

Polypropylene hernias Huw Richards,

mesh repair of iatrogenic

thigh

Rhys Thomas and Shanti S. Upadhyay

Cardiff Royal Infirmary, Cardiff, UK

Injury, Vol. 29, No. 6, 478,1998

Wound healing was uneventful and the patient returned to contact sport eight weeks later having made a full functional recovery with no recurrence of herniation.

Introduction It is rare for muscle hernias of the limbs to be symptomatic except for those related to chronic exertional compartment syndromes’. Iatrogenic hernias which follow compartmental decompression or as a result of joint arthroplasty seldom need surgical intervention. We report two casesof symptomatic thigh muscle herniation repaired using a polypropylene mesh.

Discussion Muscle hernias of the limbs are relatively rare’. They occur either as a result of trauma or surgery. The majority are asymptomatic but patients can experience dull pain on exertion. This may be due to compression of the herniated muscle by the fascial edges of the mouth of the hernia as the muscle becomes engorged. There are case reports in the literature which suggest that limb hernias should not be repaired because of the dangers of precipitating an acute compartment syndrome. These reports relate to the leg not the thigh’,“. The use of a polypropylene mesh ensured that there was no major decrease in compartmental volume and as a result decreased the risk of a compartment syndrome. It also facilitated the closure of the defect. We are unaware of reported cases of polypropylene mesh being used in the repair of muscle hernias in the limbs.

Case reports Case

1

A 63 year old man presented one year after an initially uncomplicated total hip replacement. He complained of weakness in the operated limb and an uncomfortable ‘dragging’ sensationon exertion. There was a dehiscenceof the fascialata and a large vastus lateralis herniation. Direct surgical repair of the defect was impossibleas the edges could not be apposed.The defect was closedusing a length of polypropylene mesh. There were no complicationsand the patient was symptom free at three months. Case 2

A 28 year old rugby player developed a large anterior thigh haematoma as a result of a high impact tackle. Under general anaesthesiaa 500ml congealed haematoma was evacuated via a lateral approach. The wound was closedin layers and the patient made a good early recovery. Six weeks later found there was a dehiscenceof the repair with a large hernia of vastus lateralis through the fascia lata. The patient complained of an unremitting ‘dragging’ sensation which became unbearable after exercise, associatedwith a feeling of ‘weakness’ in the affected limb and concern over the cosmetic appearance. Physiotherapy was unsuccessfulin relieving his symptoms. Operative repair was undertaken at 12 weeks. At operation it was evident that the edgesof the fascia lata could not be apposed.The defect was closed using a double layer of polypropylene mesh.

References

’

1 Mubarak SJand HargensAR. Cumprtmerlt Syndromes and Volkmnnn’s Contructure, 1st edn. W. B. Saunders, Philadelphia, 1981:p. 76. 2 Simon HE and Sacchet HA. Muscle hernias of the legs. Am J Surg 1945; 67: 87. 3 4

Paton DF. The pathogenesisof anterior tibia1syndrome. J BoneJoint Surg 1968;50B: 383-385. Wolfort FG, Mogelvang LC and Filtzer HS. Anterior tibia1 compartment syndrome following muscle hernia repair. Arch Surg 1973;106:97-99.

Paper accepted 17 March 1998. Requests for repri& slzouldbeaddressed to: Dr Huw Richards, 4 Part y Delyn, Morriston, Swansea,UK.