New Diets for Lymphedema
Vascular complications, aside from DVT, are rare in both pelvic and acetabular surgery. Femoral artery thrombosis, femoral artery laceration, and femoral vein laceration have been described with ilioinguinal approaches with a reported incidence of 0.8 to 2 (2,3,42,43). This may occur from intraoperative traction, direct injury due to the vessels' proximity with the surgical approach, and extrinsic compression of the femoral artery by prominent screws placed in the anterior column (44). Equally in jeopardy of injury is the lymphatic system when using the ilioinguinal approach. Damage to the lymphatic system medial to the vessels can result in chronic lymphedema of the lower extremities (26). The incidence of this complication is unknown, but thought to be rare.
Erysipelas begins with the classic signs of infection. Areas of bright red erythema (rubor) develop in the form of sharply demarcated palpable plaques. If the margin edge is inked, spread beyond the markings is noted within a matter of hours. The area is palpably warmer (calor) than the adjacent skin and the involved area is either tender to palpation (dolor) or at the very least is hypersensitive to touch. Sometimes skin sensitivity is the earliest sign. Superficial vesicles or bullae are common. Hemorrhage into the blisters may occur, and in older patients hemorrhage into the intact skin is not unusual. Cellulitis also shows the classic signs of infection but there are subtle differences. The erythema is more of a pink rather than a bright red color, and the affected part has a feel of deeper doughy swelling. The margin of color change is indistinct and there is no clearly defined plaque. The afflicted area is palpably warmer than adjacent skin and the area is painful to palpation...
Inguinal pain limb or genital swelling skin exfoliation of the affected body part usually occurring with resolution of an episode recurrent episodes of inflammation and lymphedema leading to lymphatic damage with chronic swelling and elephantiasis of the legs, arms, scrotum, vulva, and breasts
CLINICAL PRESENTATION In 40 of cases the portal of entry may not be obvious. After an incubation period of several days the disease commences abruptly with fever, malaise, and sometimes mental confusion. A small erythematous patch at the infected site rapidly spreads. The erythema is irregular with extensions or tongues along lymphatic vessels. The clinical appearance of an elevated, erythematous, indurated area with a sharp border is very characteristic. The area is hot to the touch, and tiny vesicles may be seen at the advancing margin. The tense edema gives the skin a shiny glazed appearance and is sufficient to greatly distort the facial features. Local complications include hemorrhagic infarction, ulceration, and necrosis. Regional lymphadenopathy accompanies the infection. Chronic lymphedema is a possible sequel resulting from occlusion of lymph vessels. As with many streptococcal infections acute glomerulonephritis may develop later in the convalescent period.