title: Endoscopic evacuation of a hematoma resulting from strain injury of the medial head of the gastrocnemius muscle.
abstract: Strain of the medial head of the gastrocnemius muscle (GM) is a common injury that can be confirmed by ultrasound (US) or magnetic resonance imaging. We report a case of strain injury of the medial head of the GM, with a hematoma between the soleus muscle and the GM. US revealed an enlarged hypoechoic area between the soleus and the GM. By US-guided puncture, only a small amount of old blood was evacuated. Hence we undertook a surgical approach. It was performed under general endotracheal anesthesia, in the prone position. The most superficial area of hematoma was shown by US. A sharp 4-mm trocar was inserted in the posteromedial side of the calf and the hematoma was partially evacuated by suction. The cavity was washed out with saline solution. The arthroscope was then inserted. A second portal was made laterally and a shaver was inserted under optic control. The inflow pressure was not allowed to exceed 45 mm Hg. The shaver was used to remove blood coagula and fibrin septa that divided the cavity. The fibrous cavity membrane was debrided. By the end of the procedure, the circumference of the leg was reduced by 3 cm and the skin was softer on palpation. The patient was discharged the next day. One week after surgery, US examination revealed only a thin hypoechoic area in place of the previous collection. Two weeks after surgery, he was able to walk painlessly, and at 6 weeks he had regained normal walking activity.
authors.affiliation: Department of Traumatology, Clinic for Surgery, Clinical Hospital Centre Rijeka, Rijeka, Croatia. tedi_cicvaric@yahoo.com
authors.forename: Tedi
authors.initials: T
authors.lastname: Cicvarić
authors.forename: Alan
authors.initials: A
authors.lastname: Sustić
authors.forename: Damir
authors.initials: D
authors.lastname: Miletić
authors.forename: Matjaz
authors.initials: M
authors.lastname: Veselko
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mozetic
authors.forename: Josip
authors.initials: J
authors.lastname: Spanjol
mesh_terms: D000368:Aged; D004724:Endoscopy; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000150:complications*; D008297:Male; D018482:Muscle, Skeletal / Q000293:injuries*; D013180:Sprains and Strains / Q000150:complications*; D014463:Ultrasonography