The groin flap is currently considered one of the main strategies and surgical procedures for flap reconstruction and defect coverage. Traumatic skin defect of forearm and hand with exposed bone or tendon must be covered with a flap. Based on the surgeon preference and condition of the wound and patient, free flap or pedicle flap can be used. However, in a situation that vessels of recipient site have been damaged, use of free flap is contraindicated. We herein report a 27-year-old man with high energy trauma to the right upper extremity with large skin defect and vascular injury. He underwent pedicle groin flap after several times of irrigation and debridement with complete coverage. In the 1-year follow-up, he had favourable functional and cosmetic recovery. The pedicle groin flap can be a versatile and reliable flap to cover large traumatic skin defect with vascular injury.
Vanishing Testes Syndrome (VTS) also known as Testicular Regression Syndrome (TRS) is a condition in which there is absence or incomplete development of testis of varying degrees in 46XY subjects with normal external genitalia. This situation is observed in overall 5% of patients presented with cryptorchidism. We relate a case of VTS in an adult here, in which the subject had absent left testes on clinical examination, but MRI showed presence of atrophic testes at the level of deep inguinal ring. Orchidectomy of left testis was performed and the left testicular artery was followed which had a blind ending. The blind end was also resected and both of the specimens of the parenchyma of testicular tissues and blood vessel were sent for biopsy.
The anatomical knowledge of the musculocutaneous nerve and its variations play an important role for the surgeons, due to the fact that one of the complications in many upper-limb surgical procedures involve injury to this nerve. During our routine dissection, we observed an anatomical variation of the musculocutaneous nerve taking origin from the lateral cord of the brachial plexus and after passing through the coracobrachialis muscle it then gave a communicating branch to the median nerve in the left upper limb of a male cadaver. The union between the musculocutaneous nerve and the median nerve occurred approximately at the midpoint of the arm. We consider this variation to be rare.
A foreign body is an object lying partially or completely within the body that originated from the external environment. Foreign bodies are generally encountered in the orofacial region following trauma or iatrogenic procedures. If untreated can lead to serious complications like pain, swelling and infection. Here is a case report of a retained foreign body in the orofacial region of 32-year-old male patient. This paper highlights the problems associated with diagnosis, localising and managing unlikely foreign bodies at unusual facial sites.
Introduction: Urinary bladder rupture is a rare life-threatening event. Especially patients with alcohol intoxication are unable to provide a clear medical history. Physical examination often shows an acute abdominal pain. Under these circumstances, the diagnosis of a urinary bladder rupture requires a high index of suspicion.
Presentation of Case: After a long party night with consumption of alcohol, a 42-years old man wakes up with severe abdominal pain. Physical examination shows peritonitis- signs, especially in the lower abdominal part. Ultrasound detects free intraperitoneal fluid. The CT scan of the Abdomen shows perihepatic fluid. With the diagnosis of the acute abdomen without any radiological signs of perforation, we performed a laparotomy. Intraoperatively a 3x2 cm rupture of the superior wall is seen and closed with sutures. After the operation, the patient is received to the ICU.
Discussion: Urinary bladder rupture has a high mortality often due to late diagnosis. Spontaneous rupture of the urinary bladder is often associated with malignant disease, bladder outflow obstruction and neurogenic bladder. Alcohol-intoxicated patients are challenging cases in the emergency room. A clear history of the disease is not presented. In our case, the patient had no history of trauma or any known urological diseases. So, it is possible as reported previously in a few earlier cases that urinary retention in these cases may be due to rapid filling of the bladder secondary to the diuretic effect of alcohol. Moreover, nausea and vomiting might lead to enhanced intra-abdominal pressure and a higher probability of spontaneous bladder rupture.
Conclusion: Spontaneous rupture of the urinary bladder is a rare cause for acute abdominal pain with a high mortality because of delayed diagnosis. Especially Alcohol-intoxicated patients are not able to present any history of the disease. Moreover a urinary bladder rupture should be considered by patients with alcohol intoxication and without any traumatic event or known urological diseases as it is presented in our case.
