Left Groin Research Articles

When an inguinal hernia is more than just a hernia with ovary and fallopian tube involvement: a case report

BackgroundFinding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass.Clinical presentationWe describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh.DiscussionInguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents.ConclusionThis report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications.

Left Testicular Torsion in an Undescended Left Testis in a 5-Year-Old Boy: A Case Report

Purpose: Testicular torsion is a urological emergency characterized by the twisting of the spermatic cord structures, and subsequent loss of blood supply to the ipsilateral testis leading to testicular ischemia and infarction. This condition, if not promptly treated, can result in permanent testicular damage. Within 6 hours from onset of testicular pain, testicular exploration is recommended.While testicular torsion is common in normally descended testes, its occurrence in an undescended testis is rare and poses unique diagnostic and management challenges. Methodology: A 5-year-old male presented with a 6-hour history of severe left groin pain. Clinical examination revealed an empty left Hemiscrotum and a tender left groin swelling. Doppler ultrasound confirmed the absence of the left testis in the scrotum, locating it in the left groin with markedly reduced blood supply, suggestive of testicular torsion. Laboratory investigations, including a complete blood count, were within normal limits. Urgent surgical intervention involved detorsion and bilateral orchidopexy, leading to complete resolution of symptoms and an uneventful recovery. Findings: This case highlights the diagnostic difficulties associated with testicular torsion in an undescended testis. The rarity of this condition necessitates heightened clinical suspicion in patients with cryptorchidism presenting with acute abdominal or groin pain. Relevant literature and case reports emphasize the importance of early diagnosis and treatment to salvage the affected testis. Doppler ultrasonography is the diagnostic modality of choice, though clinical suspicion should guide management due to the possibility of false negatives. Surgical intervention remains the definitive treatment, with timely detorsion and orchidopexy being crucial for favorable outcomes. Unique Contribution to Theory, Practice and Policy: Testicular torsion in an undescended testis requires prompt recognition and multidisciplinary management to prevent long-term complications such as infertility. Clinicians should maintain a high index of suspicion for this condition in pediatric patients presenting with inguinal swelling and ipsilateral empty hemiscrotum. Early surgical intervention is essential for the preservation of testicular function and favorable patient outcomes.

Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

BackgroundCompartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.Case presentationWe report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher–Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.ConclusionThis case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher–Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.

Isolated spermatic cord metastasis of prostate cancer after radiotherapy detected with 18F-PSMA PET/CT: a case report and literature review.

We report the case of a 65year-old male with prostate cancer previously treated with external beam radiotherapy and 2years of androgen deprivation therapy. His nadir PSA reached undetectable level but gradually increased to 0.89ng/dL. 18F-PSMA PET/CT demonstrated a PSMA-avid lesion at left spermatic cord. Left groin exploration revealed an 8mm left vas deferens mass. Mass excision was performed and pathology result showed prostatic adenocarcinoma. The metastatic route is unknown but the possible routes are intraluminal route via ejaculatory duct, hematogenous route and lymphatic route. This case also highlights the role of 18F-PSMA PET/CT to detect a recurrent lesion at an atypical site in biochemical failure patients even at the low PSA level.

Atypical presentation of lipoma in left groin resembling as 3rd testis

Lipoma are benign adipose tumor which usually present in the subcutaneous tissues. Lipomas are characterized as slow-growing, soft, mobile, round and asymptomatic masses on the head, neck, shoulders, and the back. They usually develop between the ages of 40-60.

Robot-assisted Exploration of the Alcock Canal: A Novel Surgical Technique

ObjectiveTo demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve. SettingPudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a trans-gluteal incision.1-2 This surgical approach offers limited visualization and ability for nerve decompression.3 With the current technique, a full exposure and decompression of the pudendal nerve was achieved. ParticipantsA 44-year-old para 2 with symptoms of left pudendal neuralgia. InterventionsA 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with three robotic ports using the daVinci® Xi robotic system. ConclusionWith the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra-operative or post-operative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. While all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury,4 the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia.

FDG PET/CT in Staging and Response Evaluation of Primary Urothelial Carcinoma of the Urethra.

Primary urethral urothelial carcinoma is a rare aggressive tumor with a high propensity for local invasion and regional and distal metastases. We describe the usefulness of FDG PET/CT in management of a patient with primary urethral urothelial carcinoma. FDG PET/CT at initial staging showed FDG-avid primary tumor and lymph node metastasis of the left groin, and mild or no activity of the lung metastases due to small size. FDG PET/CT after 4 cycles of chemotherapy showed progression of the primary tumor and lung metastases, partial response of the left inguinal lymphadenopathy, and multiple new sites of FDG-avid metastases.

Inguinal lymphangioma in an adult patient mimicking an irreducible inguinal hernia: A case report

IntroductionLymphangiomas are rare benign vascular malformations of the lymphatic system. They are usually located in the head, neck, and axilla and are typically present during the first two years of life. A few cases of inguinal lymphangioma have been reported in adults. Case presentationWe report a 35-year-old male who presented with left groin swelling for a one-year duration associated with on and off pain. On examination, he had soft, irreducible left inguinal swelling with positive cough impulse and no tenderness on palpation. Ultrasound (US) and magnetic resonance imaging (MRI) were done for him, showing a well-defined lobulated cystic lesion located between subcutaneous and deep fascia measuring around 6.5 × 4.2 × 8.1 cm with multiple internal septations. The lesion shows Low signal intensity in the T1 weighted image and high signal intensity in the T2 weighted image. 97 % alcohol was injected under US guidance and aspirated after 30 min. The swelling significantly decreased in size clinically and radiologically during the follow-up. Clinical discussionLymphangioma rarely occurs in the inguinal region, presenting a diagnostic challenge as it mimics various inguinal conditions. Differential diagnoses include inguinal hernia, hydrocele of the cord, lymphadenopathy, or hematoma. Imaging is used to determine the size, invasion, relation to surrounding structures, and extension to the abdominal cavity. MRI is the diagnostic modality of choice in non-emergency settings. Complete surgical excision is the gold standard for the management with the lowest risk of recurrence. Alternative non-surgical treatment options have been used successfully in poor surgical candidates. Different sclerosing agents have been used with low complications and rates of recurrence. Ethanol is a widely available sclerosing agent, and it was used with no recurrence or side effects during the follow-up period. ConclusionSurgeons should have a high index of suspicion when investigating any inguinal mass, considering such a rare presentation as part of the differential. Sclerotherapy is an effective treatment for lymphangioma and should be considered as an alternative modality in non-surgical candidates.

Iliopsoas Bursitis Compressing an External Iliac Vein Stent

We report a case of external iliac vein (EIV) compression due to iliopsoas bursitis. A 78-year-old man with a prior left total hip arthroplasty (THA) and left lower extremity (LLE) deep vein thrombus (DVT) presented with chronic LLE edema. Initial ultrasound examination revealed deep venous reflux and evidence of ipsilateral outflow vein obstruction. A left groin mass thought to be a hernia was noted. Conservative management was unsuccessful. Subsequent venography and intravascular ultrasound demonstrated severe stenosis of the distal EIV. A stent was placed but could not be fully expanded despite repeated venoplasty. Following the procedure, pelvic computed tomography (CT) showed extrinsic compression of the EIV and stent likely caused by iliopsoas bursitis.

Inguinal hernia coexisting with spermatic cord leiomyoma

Leiomyomas primarily occur in the uterus, small bowel, and esophagus, with occasional instances found in the genitourinary system-bladder, epididymis, prostate, testis, and penis. Among these, scrotal leiomyomas, belonging to genital leiomyomas, present as solitary growths within scrotal structures, displaying gradual growth. Specifically, spermatic cord leiomyoma is exceptionally rare, with limited cases since the 1950s. A 63-year-old male exhibited persistent left groin pain and swelling, initially suggesting a hernia. Examination revealed an inguinal hernia and a palpable, mobile 3 cm solid mass. Ultrasonography identified a well-defined solid hypoechoic lesion. Magnetic resonance imaging (MRI) displayed a 37x24 mm ovoid lesion, hinting at its origin from the spermatic cord. Surgical intervention involved hernia repair and mass excision, confirming leiomyoma via histopathology. Spermatic cord leiomyomas, rare and hernia-mimicking, highlight the crucial role of MRI in accurate preoperative diagnosis, emphasizing the need to consider leiomyoma in inguinal mass differentials.

#1061 Brucella infection in a patient with renal cystic disease and renal imaging changes before and after treatment: a case report

Abstract Background and Aims Brucellosis can affect nearly all systems. Genitourinary involvement is uncommon in patients with brucellosis, accounting for approximately 10% of cases. We diagnosed a rare case of renal cysts with brucellosis and reported renal imaging changes before and after treatment. Method A 38-year-old man was admitted to our hospital in September 2021 with complaints of elevated serum creatinine, proteinuria for more than 2 months, and intermittent fever for 2 weeks. In July 2020, the patient experienced fatigue, and a rash on all four extremities. He denied experiencing low back pain or joint swelling. Urine analysis revealed the following: BLD (+), Pro (+), 24-hour urine protein (24 h UP) 0.7 g; blood: Cr 11.88 mg/dL, UA 77.51 mg/dL, ALP 217 IU/L, and GGT 227 IU/L. MRI revealed multiple small punctate areas with short T1 signals in both kidneys and splenomegaly. Soon, he experienced persistent afternoon fever with a maximum temperature of 39.0°C, along with night sweats and left lumbar pain. There were no symptoms of cough, expectoration, or urinary tract irritation. The patient had diabetes mellitus and diabetic retinopathy. He has lived in the Inner Mongolia Autonomous Region. He denied having any contact with raw milk or mice. His father and sister had kidney disease and diabetes. In September 2021, the patient was admitted to our hospital. Urinalysis revealed BLD (-), Pro 0.3 g/L, and 24 hUP 1.39 g; blood: HGB 117 g/L, ALP 227 U/L, GGT 221 U/L, Cr 2.56 mg/dL, UA 88.79 mg/dL, and K 3.2 mEq/L. The infection indicators were as follows: the standard tube agglutination test (+) (Fig. 1), Brucella (+) in blood culture, a positive qualitative test for blood cryptococcal antigen and qualitative positive results for 6 Cryptococcus neoformans sequences in bronchoalveolar lavage fluid using next-generation sequencing. Ultrasound showed multiple cysts in both kidneys. It also showed uneven echogenicity in the left testis and visible lymph nodes in the left neck, bilateral axillae and groin. CT revealed cavitary nodules and ground-glass opacities in the right middle lobe, as well as splenomegaly. MRI revealed renal cysts (Fig. 2a, b, c) and abscesses (Fig. 2e, f, g). The patient was diagnosed with stage 3 chronic kidney disease (CKD), pulmonary cryptococcosis, and brucellosis associated with renal abscess, left orchitis, splenomegaly, multiple lymphadenopathies, rash, and hyperuricemia. Doxycycline, rifampicin, and fluconazole were administered. He had no fever, his low back pain had disappeared, and his rash were relieved. Results A reexamination after 2 months revealed the following: the urinalysis results revealed a BLD (-), Pro(-), and 24 hUP 0.15 g; blood: GGT 107 IU/L; ALP 72 IU/L; Cr 1.89 mg/dL; UA 0.22 mg/dL; and K 4.0 mEq/L. Ultrasound revealed a decrease in the size of the spleen. MRI revealed the liquefaction of renal abscesses. Brucella therapy has been found to be effective. Conclusion The patient was a young man who was infected with both Brucella and Cryptococcus. Although his hometown was in an area affected by an epidemic, his current residence was not affected. Namely, he was immunocompromised, which was associated with diabetes. After receiving anti-Brucella treatment, his symptoms disappeared, the renal abscess liquefied, but creatinine decreased to levels similar to those at onset without a decreasing trend. These findings suggest that the patient had underlying CKD that was not associated with Brucellosis. We believe that the CKD was diabetes and renal cysts. He had hyperuricemia, hypomagnesaemia, unexplained asymptomatic abnormal liver function, and mild proteinuria. Imaging indicated the presence of renal cysts. In addition to having diabetes, he had a family history of kidney disease and diabetes. We diagnosed the patient with CKD and as having autosomal dominant tubulointerstitial disease (ADTKD) associated with the HNF1B pathogenic gene mutation. This gene mutation is also rare in ADTKD patients. Genetic testing revealed that the causative genes include NM001303448. Potential causative genes included NM000128. The mutated genes mentioned above are not typical causative genes for HNF1B or other types of ADTKD.

Two cases of strangulated bowel obstruction due to exposed vessel and nerve after laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer

BackgroundThe majority of small bowel obstructions (SBO) are caused by adhesion due to abdominal surgery. Internal hernias, a very rare cause of SBO, can arise from exposed blood vessels and nerves during pelvic lymphadenectomy (PL). In this report, we present two cases of SBO following laparoscopic and robot-assisted lateral lymph node dissection (LLND) for rectal cancer, one case each, of which obstructions were attributed to the exposure of blood vessels and nerves during the procedures.Case presentationCase 1: A 68-year-old man underwent laparoscopic perineal rectal amputation and LLND for rectal cancer. Four years and three months after surgery, he visited to the emergency room with a chief complaint of left groin pain. Computed tomography (CT) revealed a closed-loop in the left pelvic cavity. We performed an open surgery to find that the small intestine was fitted into the gap between the left obturator nerve and the left pelvic wall, which was exposed by LLND. The intestine was not resected because coloration and peristalsis of the intestine improved after the hernia was released. The obturator nerve was preserved. Case 2: A 57-year-old man underwent a robot-assisted rectal amputation with LLND for rectal cancer. Eight months after surgery, he presented to the emergency room with a complaint of abdominal pain. CT revealed a closed-loop in the right pelvic cavity, and he underwent a laparoscopic surgery with a diagnosis of strangulated SBO. The small intestine was strangulated by an internal hernia caused by the right umbilical arterial cord, which was exposed by LLND. The incarcerated small intestine was released from the gap between the umbilical arterial cord and the pelvic wall. No bowel resection was performed. The umbilical arterial cord causing the internal hernia was resected.ConclusionAlthough strangulated SBO due to an exposed intestinal cord after PL has been a rare condition to date, it is crucial for surgeons to keep this condition in mind.

Rare Diagnosis in the Emergency Department: Traumatic Testicular Dislocation

Abstract: Introduction: Traumatic Testicular Dislocation (TTD) is a rare form of scrotal trauma, involving the displacement of the scrotum directly towards the surrounding tissues due to direct compression, often occurring towards the inguinal area. In this report, we present a case of TTD in an adult patient involved in a motor vehicle accident and provide a brief review of this rare condition. Case Report: An 18-year-old male patient was brought to our emergency department following a motorcycle accident. The patient reported a new swelling in his left groin. On physical examination, the left side of the scrotum was found to be empty, without the presence of hematoma. A swelling in the described area was palpated in the left inguinal region. A CT scan, conducted due to trauma, did not reveal the left testis in its normal position; instead, the testis was identified in the left inguinal region. Scrotal Doppler ultrasound was performed. The left testis was manually manipulated and descended into the left scrotum by Urologist. Conclusion: Testicular dislocation is a rare complication of blunt scrotal trauma. Even in the presence of multiple injuries, a thorough examination of the testicles is always recommended. Ultrasound (USG) and Doppler USG are the most useful diagnostic tools for TTD, but CT can also be helpful in cases of complex trauma. While TTD is not a life-threatening condition, a careful plan is recommended for the repositioning of the testis.

Acupotomy combined with Korean medicine treatment in a patient with acute sacroiliac pain unresponsive to conventional therapy: A case report

RationaleAcute injury to the sacroiliac joint (SIJ) can result from high-energy external forces that cause a combination of axial loading and sudden rotational movements, resulting in severe pain that cannot be relieved by regular nonsteroidal anti-inflammatory drugs. The treatment includes injections of steroids and local anesthetics to reduce pain and promote healing. Here, we report the case of a patient with acute sacroiliac pain who did not respond to conventional injection therapy. Patient concernsA 58-year-old male patient who did not exercise regularly experienced pain in his left groin and difficulty walking while kicking on his right leg. He received two injections and manual therapy at a local orthopedic clinic; however, his symptoms did not improve despite taking painkillers. DiagnosesRadiographic images showed no abnormalities. After confirming the cause of onset, pain pattern, physical examination, and tenderness, the patient was diagnosed with an acute SIJ sprain (static blood). InterventionsAt the first visit, a single acupotomy was performed on the seven treatment points identified during the physical examination, and immediate improvement in symptoms was confirmed. From then on, Korean medicine (KM) treatments, such as acupuncture, cupping, chuna, and bee venom pharmacopuncture, were performed. OutcomesImmediately after acupotomy, groin pain improved by 80 %, gait immediately normalized, and the patient showed no symptoms at the 9th visit. LessonsFor SIJ-type groin pain that does not respond to existing treatments, immediate relief is achieved after a single acupotomy at the exact treatment point. Therefore, in the future, the importance of identifying a precise treatment point for SIJ pain should be recognized, and the use of Korean medicine treatment techniques, including acupotomy, should be considered.

You’re a pain in my side! Abscess and microperforation as a complication of therapy from early-stage endometrial cancer: A case report

This paper reports on a 55-year-old woman presenting with left lower quadrant and groin pain that posed a significant diagnostic challenge. She had a history of obesity and stage 1B endometrial carcinoma treated with surgery and radiation 1-year prior. Despite several unsuccessful biopsy attempts and unclear imaging findings, she was ultimately diagnosed with a pelvic sidewall abscess secondary to a bowel microperforation, a rare late complication of radiation related to adhesions, weakened bowel, and peristalsis. Her condition was successfully treated with drainage and antibiotics. It is widely known that patients with endometrial cancer and comorbid obesity often experience diagnostic delay, weight stigma, and other barriers and thus deserve careful attention and continued advocacy.

An inguinal surprise: strangulated femoral hernia

Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. There are few reports of strangulated femoral hernia. Femoral hernias, often, are usually delegated to a secondary differential or if even rarer not considered at all during dubious presentations as groin swellings which are irreducible without the classical features which have usually been described in our surgical literatures, Inguinal being forefront for diagnosis. We herein present a 45-year-old female had come to the outpatient department at MVJ MC and RH with the complaints of swelling in the left groin for 5 years and pain for 8 days sudden onset with irreducibility, with no features of small bowel obstruction. She was diagnosed as having a left side obstructed inguinal hernia after appropriate radiological investigations and underwent inguinal exploration. Intraoperative diagnosis of left sided strangulated femoral hernia with omentum as its content was made. Omentectomy with herniorrhaphy was done and post-operative period was uneventful, and patient was discharged with regular follow up. Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

T-cell non-Hodgkin lymphoma of lymphoblastic type revealed by a chronic swollen testicle managed in the urology department of Laquintinie Hospital in Douala, Cameroon

Background: Non-Hodgkin T-cell lymphomas typically develop in lymph node territories, and primary extra nodal locations are rare. The clinical presentation is nonspecific, dominated by signs of compression. Imaging aids in suspicion, and histology confirms the diagnosis. Clinical Observation: A 61-year-old patient initially hospitalized for the management of upper gastrointestinal bleeding six months ago was referred to the urology outpatient clinic due to a chronic swollen testicle persisting for a year. A non-contributory testicular ultrasound showed peri scrotal lymphedema with inguinal lymphadenopathy, right orchid epididymitis, and left epididymitis. Blood tests were normal. Despite antibiotic therapy, there was no improvement in the clinical condition. Physical examination revealed painless and mobile cervical, axillary, and inguinal lymph nodes. Pelvic MRI suspected a probable lymphoma. A lymph node biopsy in the left groin confirmed a non-Hodgkin T-cell lymphoma of lymphoblastic type infiltrating the capsule. The patient was transferred to haematology for further management. Conclusion: T-cell lymphoblastic lymphoma is primarily characterized by nodal involvement. There is a diagnostic delay that is anatomopathological in nature. Management involves polychemotherapy.

Gait analysis of a patient after femoral nerve and malignant soft tissue tumor resections: a case report

BackgroundMalignant femoral soft tissue tumors are occasionally resected together with the femoral nerves, but this can cause loss of knee extensor muscle activity. To the best of our knowledge, no previous reports have detailed the gait analysis of such cases in combination with electromyography. Herein, we report the gait analysis of a patient who underwent left groin synovial sarcoma and left femoral nerve resection 12 years ago.Case presentationWe analyzed the gait of a 38-year-old man who was able to walk unaided after the resection of a synovial sarcoma in the left groin together with the ipsilateral femoral nerve. The muscle activities of the affected medial (MH) and lateral hamstrings (LH), and lateral heads of the gastrocnemius (GL) were increased during 50–75% of the stance phase. The hip flexion angle of the affected limb was smaller, and the ankle plantar flexion angle of the affected limb was larger than that of the non-affected limb. This means that in the affected limb, the hip and ankle angles were adjusted to prevent knee collapse, and the MH, LH, and GL muscles contributed in the mid- and late-stance phases. Moreover, we found that the hamstring and gastrocnemius of the affected limb worked together to keep the ipsilateral knee extended in the mid-stance phase and slightly flexed in the late-stance phase.ConclusionsPatients capable of walking after femoral nerve resection may control their hamstrings and gastrocnemius muscles collaboratively to prevent ipsilateral knee collapse in the mid- and late-stance phases.

Morphea caused by COVID-19 infection, first polish case report

Morphea, a localized scleroderma variant, is a rare dermatological condition characterized by fibrosis and thickening of the skin. While its etiology remains unclear, there have been reports of its association with viral infections, including COVID-19. We present a case of morphea in a 26-year-old female patient with a history of two episodes of COVID-19. The patient exhibited cutaneous lesions on her left forearm, bilateral axillae, and groin, accompanied by abdominal wall induration Laboratory investigations revealed no significant abnormalities, except for positive antinuclear antibodies (ANA) with various patterns. This case highlights the potential association between COVID-19 infection and the development of morphea, underscoring the importance of considering this relationship in patients presenting with dermatological manifestations following COVID-19. Further research is needed to elucidate the underlying mechanisms and optimize treatment strategies for such cases. Key words: COVID-19, Morphea, Post-COVID-19 Morphea, Skin diseases

Synergistic Clinical Application of Synthetic Electrospun Fiber Wound Matrix in the Management of a Complex Traumatic Wound: Degloving Left Groin and Thigh Auger Injury

Synergistic Clinical Application of Synthetic Electrospun Fiber Wound Matrix in the Management of a Complex Traumatic Wound: Degloving Left Groin and Thigh Auger Injury