[Differences in anatomical area-specific wound healing in hidradenitis suppurativa/acne inversa after surgery].

BACKGROUND: Hidradenitis suppurativa/acne inversa is an inflammatory, debilitating disease for which wide local excision of the affected area with secondary wound healing is considered the treatment of first choice for the inactive scarring form or after adequate anti-inflammatory medical treatment. OBJECTIVES: In this study, we aimed to assess the duration of complete secondary wound healing after surgical intervention for hidradenitis suppurativa/acne inversa. MATERIALS & METHODS: Twenty-three surgical procedures in 17 consecutive patients (eight female, nine male) were evaluated for duration of secondary wound healing at axillary or anogenital/inguinal sites. To investigate the contribution of hair follicle bulge progenitor cells in wound re-epithelialization, tissue samples of lesional and perilesional skin were analysed for expression of the stem cell marker, cytokeratin 15 (CK15), and CD200, a marker for human follicular stem cells that resides in the bulge area. RESULTS: Initial wound size did not differ significantly between surgical wounds in the axillary (mean: 30.0 cm2 ± 5.4) and anogenital/inguinal (mean: 35.3 cm2 ± 5.7) region. However, healing time to complete wound closure was almost twice as fast in the anogenital/inguinal (mean: 132 days ± 10.4) than axilla area (mean: 254 days ± 39.1; p < 0.01). The accelerated wound healing in the anogenital/inguinal region was accompanied by significantly enhanced CK15 and CD200 expression, compared to axillary wounds (p < 0.05). CONCLUSION: The anogenital/inguinal region showed significantly faster secondary wound healing after surgical intervention for hidradenitis suppurativa/acne inversa compared to axillary wounds. We suspect differences in pilosebaceous unit density and thus hair follicle progenitor cells (as mirrored by CK15 and CD200 expression) to be the main driver behind this finding.

Running biomechanics in football players with and without hip and groin pain. A cross-sectional analysis of 116 sub-elite players.

OBJECTIVE: Examine whether football players with hip and/or groin (hip/groin) pain have impaired running biomechanics when compared to pain-free players, analysing men and women independently. DESIGN: Cross-sectional. SETTING: Biomechanics laboratory. PARTICIPANTS: Seventy-eight (62 men, 16 women) football players with >6months of hip/groin pain and a positive flexion-adduction-internal rotation test and 38 (25 men, 13 women) asymptomatic players. MAIN OUTCOME MEASURES: Pelvis angles and hip, knee, and ankle joint angles and moments were analysed during the stance phase of overground running at 3-3.5 m⋅s-1. Continuous joint angle and moment data were compared between symptomatic and asymptomatic football players of the same sex using statistical parametric mapping. Joint moment impulses (area under the curve) were compared between groups using linear regression models. RESULTS: Symptomatic football players did not display significant differences in pelvis angles or lower-limb joint angles, moments, or moment impulses during the stance phase of running, when compared to asymptomatic players of the same sex. CONCLUSION: Our large sample of football players with hip/groin pain who were still participating in competitive sport displayed similar running biomechanics to asymptomatic players. Impaired running biomechanics might exist in people with worse hip/groin pain, warranting future investigation.

Muscle activity of cutting manoeuvres and soccer inside passing suggests an increased groin injury risk during these movements.

Cutting manoeuvres and inside passing are thought to increase the risk of sustaining groin injuries. But both movements have received little research attention in this regard. The purpose of this study was to investigate the muscle activity of adductor longus and gracilis as well as hip and knee joint kinematics during [Formula: see text]-cutting and inside passing. Thirteen male soccer players were investigated with 3D-motion capturing and surface electromyography of adductor longus and gracilis while performing the two movements. Hip and knee joint kinematics were calculated with AnyBody Modelling System. Muscle activity of both muscles was significantly higher during the cutting manoeuvre compared to inside passing. Kinematics showed that the highest activity occurred during phases of fast muscle lengthening and eccentric contraction of the adductors which is known to increase the groin injury risk. Of both movements, cutting showed the higher activity and is therefore more likely to cause groin injuries. However, passing might also increase the risk for groin injuries as it is one of the most performed actions in soccer, and therefore most likely causes groin injuries through overuse. Practitioners need to be aware of these risks and should prepare players accordingly through strength and flexibility training.

Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries: A Prospective Cohort Study.

OBJECTIVE: To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries. DESIGN: Prospective observational cohort study. METHODS: Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with 4 repeated clinical measures during rehabilitation: the extent of palpation pain (length and width in centimeters), the bent-knee fall-out test (BKFO; in centimeters), hip abduction range of motion (in degrees), and eccentric hip adduction strength (in Newton meters per kilogram). We analyzed the association between each clinical measure and the percent progression of rehabilitation until return to sport (RTS), divided into 2 RTS milestones: (1) clinically pain free, and (2) completion of controlled sports training. RESULTS: The analyses included 61 male athletes for RTS milestone 1 and 50 athletes for RTS milestone 2, and 381 to 675 tests were performed for each clinical measure. The median time to RTS milestones 1 and 2 was 15 days (interquartile range, 12-29 days) and 24 days (interquartile range, 16-34 days), respectively. Each repeated clinical measure individually explained 13% to 36% of the variance in rehabilitation progression to the RTS milestones. The extent of palpation pain explained the highest variance of the progression of rehabilitation (R2 = 0.26-0.27 for length and R2 = 0.36 for width, P<.001). Eccentric adduction strength (R2 = 0.19-0.27, P<.001) improved throughout rehabilitation, whereas the flexibility tests (BKFO, R2 = 0.13-0.15; P<.001 and hip abduction range of motion, R2 = 0.19-0.21; P<.001) returned to normal values early in rehabilitation. CONCLUSION: Repeated measures of adductor strength, flexibility, and palpation pain provided only a rough impression of rehabilitation progress following acute adductor injuries in male athletes. These clinical measures cannot define a precise recovery point during rehabilitation. J Orthop Sports Phys Ther 2021;51(3):126-134. Epub 28 Oct 2020. doi:10.2519/jospt.2021.9951.

Multifactorial Determinants of Running Injury Locations in 550 Injured Recreational Runners.

PURPOSE: Despite the health benefits of running, the prevalence of running-related injuries (RRI) remains high. The underlying risk factors between these injuries are still not well understood. Therefore, the aim of this study was to compare biomechanical, anthropometric, and demographic injury risk factors between different locations in injured recreational runners. METHODS: In this retrospective case-control analysis, 550 injured runners (49.6% female) with a medically diagnosed RRI were included. All runners had undergone an instrumented treadmill analysis to determine habitual footstrike pattern, vertical instantaneous load rate, peak vertical ground reaction force (vGRF) and cadence. Injuries were classified by location according to a recent consensus statement. A logistic regression model was used to determine the association between the biomechanical parameters and RRI locations. Because injuries can be associated with age, sex, and body mass index, these variables were also entered into the logistic regression. RESULTS: Strike pattern and peak vGRF were the only biomechanical variable distinguishing an injury from the group of injuries. A midfoot strike differentiated Achilles tendon injuries (odds ratio [OR], 2.27; 90% confidence interval [CI], 1.17-4.41) and a forefoot strike distinguished posterior lower leg injuries (OR, 2.59; 90% CI, 1.50-4.47) from the rest of the injured group. Peak vGRF was weakly associated with hip injuries (OR, 1.14; 90% CI, 1.05-1.24). Female sex was associated with injuries to the lower leg (OR, 2.65; 90% CI, 1.45-4.87) and hip/groin (OR, 2.22; 90% CI, 1.43-3.45). Male sex was associated with Achilles tendon injuries (OR, 1.923; 90% CI, 1.094-3.378). CONCLUSIONS: Sex, foot strike pattern, and vGRF were the only factors that distinguished specific injury locations from the remaining injury locations.

Short and long lever adductor squeeze strength values in 100 elite youth soccer players: Does age and previous groin pain matter?

OBJECTIVE: To examine adductor squeeze strength in elite youth soccer players by investigating the relationship of age and previous one-year groin pain on adductor squeeze force outputs, and to provide reference values for youth players. DESIGN: Cross-sectional study. PARTICIPANTS: Elite youth soccer players (n = 100; age 14.5 ± 1.9 years; height 168.0 ± 10.7 cm; mass 60.7 ± 13.0 kg) participated. MAIN OUTCOME MEASURES: Adductor squeeze tests were captured in short and long lever positions, and groin pain assessed via subjective retrospective questionnaire. Multiple linear regressions were computed to compare the effects of age and previous one-year groin pain on adductor squeeze strength. RESULTS: Raw adductor squeeze force values (N) had a moderate positive relationship with age (short r = 0.517, p < 0.001; long r = 0.457, p < 0.001), but not when force is normalized to body mass (N/kg; short r = 0.014, p = 0.444; long r = -0.173, p = 0.043). Previous groin pain did not have an effect on short or long lever squeeze strength. Reference values for long lever adductor squeeze strength (3.59 ± 0.77 Nm/kg) are provided. CONCLUSION: Age and previous groin pain do not have an effect on adductor squeeze strength values in elite youth soccer players, so comparing values to the present adolescent cohort can be quickly interpreted without adjustment for age or previous injury.

Three-dimensional visualization and measurement of myopectineal orifice in non-inguinal hernia patients.

PURPOSE: The myopectineal orifice (MPO) is a weak area at lower part of the anterior abdominal wall that directly determines the mesh size required in inguinal hernia repair. However, MPO data have mainly been acquired from measurements of cadavers or anesthetized patients. Furthermore, there are very few reports on the measurement of the MPO in Chinese patients. The present study aimed to use three-dimensional visualization technology to measure the MPO in live non-anesthetized Chinese patients, and to use this information to indicate the appropriate mesh size required for inguinal hernia repair. METHODS: In this study, we used the parameters of the MPO and the pelvis that were measured in 40 patients with peripheral arterial disease of the lower limb arteries (80 inguinal regions) using Medraw software (Image Medraw Technology Co., Ltd., China). RESULTS: The result showed that the average width and height of the MPO were 5.71 ± 0.99 cm and 4.96 ± 0.69 cm, respectively (5.22 ± 0.77 cm and 5.13 ± 0.63 cm in males, and 6.20 ± 0.95 cm and 4.80 ± 0.71 cm in females). The average projected area of the MPO was 16.06 ± 4.37 cm2 on the left, and 15.61 ± 4.10 cm2 on the right (P > 0.05). CONCLUSION: Three-dimensional visualization was used to measure the area, width, and height of the MPO in living non-anesthetized Chinese patients. MPO area was correlated with age, but not with pelvic parameters.

Proclaim™ DRG Neurostimulator System for the management of chronic, intractable pain.

Chronic pain is consistently listed as one of the most costly and disabling health problems worldwide. In an effort to treat these suffering individuals, significant amounts of time and energy have been devoted to discover safe and effective pain relieving treatments. Dorsal root ganglion stimulation is the newest treatment modality to be created for chronic intractable pain. In this manuscript, we review the history and development, published research and safety profile of the Proclaim™ DRG Neurostimulator System (Abbott, TX, USA). At last, we offer our outlook on future developments with dorsal root ganglion stimulation.

The relationship between cam morphology and hip and groin symptoms and signs in young male football players.

BACKGROUND: Conflicting and limited high-quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). OBJECTIVES: This cross-sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. METHODS: Academy male football players (n = 49, 17-24 years) were included. Standardized antero-posterior pelvic and frog-leg lateral radiographs were obtained at baseline, 2.5- and 5-year follow-up. The femoral head-neck junction was quantified by: Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°). Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5- to 5-year follow-up). Current symptoms at 5-year follow-up were assessed using a hip and groin pain question and by the "Hip and Groin Outcome Score" (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5-year follow-up. RESULTS: Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15-8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. CONCLUSION: Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.

Segmental coordination and variability of change in direction in long-standing groin pain.

BACKGROUND: Long-standing groin pain (LSGP) is a chronic painful condition resulting in both impaired performance and time loss from participation in multidirectional field sport. RESEARCH QUESTION: What are the differences in intersegmental coordination strategy and variability of trunk-pelvic and thigh coupling during change of direction in subjects with athletic LSGP and asymptomatic control subjects? METHODS: A motion analysis system was used to collect 3-D kinematic data of the continuous relative phase and the variability of the right and left leg hip. Thoracic-thigh segment data were also collected during multiple ipsilateral turns at a self-selected pace from 16 males with LSGP and 16 asymptomatic controls. It is worth mentioning that, for a more detailed analysis, we divided each cycle diagram into four phases. Independent T-tests were used to compare the two groups. RESULTS: Subjects with LSGP demonstrate except in phase 2 of the left foot, more out-of-phase movement with both increased variabilities in right/ left thigh - pelvic coupling, right/ left thigh-thoracic, and pelvic- thoracic in every 4 phases and in the decoupling of segmental coordination. SIGNIFICANCE: Decrease in coordination with higher variability is apparent in subjects with LSGP and this aberrant coordination may lead to unexpected compensatory strategies and control impairments.

Calcific tendinopathy of the direct head of rectus femoris: a rare cause of groin pain treated with ultrasound guided percutaneous irrigation.

Groin pain can be caused by a myriad of pathologies. Abnormalities of the rectus femoris are a very rare cause of groin pain; calcific tendinopathy of the direct head is particularly so, with only two case reports in the literature. We report the first case of calcific tendinopathy of the direct head of the rectus femoris that was treated effectively with ultrasound-guided percutaneous irrigation of calcific tendinopathy (USPICT). The anatomy of the rectus femoris and the technique for US-PICT of the rectus femoris are also described.

Electromyographic analysis of hip adductor muscles in soccer instep and side-foot kicking.

A possible link between soccer-specific injuries, such as groin pain and the action of hip adductor muscles has been suggested. This study aimed to investigate neuromuscular activation of the adductor magnus (AM) and longus (AL) muscles during instep and side-foot soccer kicks. Eight university soccer players performed the two types of kick at 50%, 75% and 100% of the maximal ball speed. Surface electromyography (EMG) was recorded from the AM, AL, vastus lateralis (VL) and biceps femoris (BF) muscles of both kicking and supporting legs and the kicking motions were three-dimensionally captured. In the kicking leg, an increase in surface EMG with an increase in ball speed during instep kicking was noted in the AM muscle (p < 0.016), but not in AL, VL or BF muscles (p > 0.016). In the supporting leg, surface EMG of both AM and AL muscles was significantly increased with an increase in the ball speed before ball impact during both instep and side-foot kicks (p < 0.016). These results suggest that hip adductor muscles markedly contribute to either the kicking or supporting leg to emphasise the action of soccer kicks.

High prevalence of hip and groin problems in professional ice hockey players, regardless of playing position.

PURPOSE: The prevalence of hip and groin problems in professional male ice hockey is unknown and suspected to differ between playing positions. The purpose of this study was to explore potential differences in the seasonal prevalence of hip and groin problems between playing positions in male elite ice hockey players and to explore the relationship between symptom duration and hip and groin function at the beginning of the new season. METHODS: Male ice hockey players [n = 329 (92 goalkeepers, 93 defensemen, 144 forwards), Mean age (SD): 24 (5)] from the professional leagues in Sweden responded to an online survey. The survey assessed presence of hip and groin problems (time loss and non-time loss) and symptom duration (categorized into 0, 1-6, or > 6 weeks) in the previous season, and current self-reported hip and groin function (Copenhagen Hip and Groin Outcome Score). RESULTS: During the previous season, 175 players (53.2%) had experienced hip and groin problems. Non time loss problems were experienced by 158 (48%) and time loss problems were experienced by 97 (29.5%) players. No significant differences between playing positions were found. Self-reported function differed significantly between players with different symptom duration and more disability was reported among players with longer symptom duration (p ≤ 0.002). CONCLUSION: Regardless of playing position, hip and groin problems were prevalent in male ice hockey players. Players with hip and groin problems during the previous season had significantly worse hip and groin function in the beginning of the new season, and longer symptom duration was associated with more disability. LEVEL OF EVIDENCE: III.

[Footballer's hip]. / Die Fußballerhüfte.

Although complaints and injuries in the knee and ankle joints are very prevalent in football, the hip has so far been given very little attention. Complaints in this area are often attributed to pathological changes in the inguinal region. However, intraarticular differential diagnoses are often not taken into consideration. This article gives an overview of possible hip pathology in footballers, as well as its diagnosis and treatment.

Does athletic groin pain affect the muscular co-contraction during a change of direction.

BACKGROUND: Groin pain is one of the common problems in multidirectional sports. It seems that abnormal muscular activity and improper movement strategy led to prolongation and high rate of this injury. Therefore, the aim of this study was to Comparing the Average amplitude of Electromyography (AEMG), co-contraction ratio (CCR) of selected thigh and thoracic muscle during turning in individuals with chronic groin pain and healthy individuals. METHODS: Surface electromyography was collected from the internal oblique/transversus abdominis (IO/TrA), multifidus (MF), adductor Longus (AL) and gluteus Medius (GM) for AEMG and CCR analyzed in 16-males with LSGP and 16-controls in four motion phases during 11 cycles of gait coupled with turning. RESULTS: Results revealed that in the AEMG apart from the third phase in the muscle of the IO/ Tr. A muscle and in the second phase in the MF muscle in the trunk and in the third phase in the muscle of the AL and the fourth phase in the GM foot Left There was a significant difference in other phases. There was a significant difference in the CCR, except in the second phase of the trunk and the fourth phase of the left foot in the rest of the phases. CONCLUSIONS: It seems that in athletes with LSGP, have selective muscular activation and CCR have during turning, that may be resulting in compensatory strategies and movement control defects, which may be a useful tool to predict LSGP occurrence in players with a history of groin pain.

Functional movement screen and Y balance tests in adolescent footballers with hip/groin symptoms.

OBJECTIVES: To assess the correlation between the functional movement screen (FMS) and Y balance test (Y-BT) performance, and the self-reported hip/groin problems, and to compare healthy with hip/groin pain participants. DESIGN: a cross-sectional study. SETTING: Sports hall in a football club. PARTICIPANTS: 43 elite adolescent football (soccer) players. MAIN OUTCOME: The Copenhagen Hip and Groin Outcome Score (HAGOS), Anterior, posterolateral and posteromedial distance of Y-BT, FMS score. MEASURES: Y balance and FMS test kit, HAGOS questionnaire. RESULTS: The posterolateral, posteromedial distance and composite reach score of the Y-BT were lower in participants with hip/groin problems (p < 0.05). FMS performance was similar in healthy and hip/groin groups. There was a weak correlation (r = 0.32, p= 0.03) between the HAGOS Activities of Daily Living subscale and FMSstabil. In the Y-BT the posterolateral reach was weakly correlated with Symptoms (r = 0.35-0.44, p < 0.02) and moderately correlated with Pain (r = 0.44, p < 0.01) subscales. Posteromedial direction reach with the right leg was weakly correlated with Symptoms (r = 0.32, p = 0.04) and Pain (r = 0.39, p = 0.01). The Y-BT composite score was moderately correlated with Symptoms and Pain (r = 0.42-0.44, p < 0.01). CONCLUSIONS: The Y-BT and the FMS subtests were weakly or moderately correlated with self-reported hip/groin problems. Thus, these tests should be investigated further in adolescent footballers because they may have potential to predict hip and groin problems.

Lower limb biomechanics during low- and high-impact functional tasks differ between men and women with hip-related groin pain.

BACKGROUND: The effect of pain on lower limb biomechanics during walking has been found to be sex specific for certain joint diseases. However, it is not known if sex is an effect-modifier in people with hip pain. Therefore, the aim of the study was to determine the differences in lower limb biomechanics between men and women with hip-related groin pain during functional tasks. METHODS: 65 male and 23 female football players with hip-related groin pain were recruited. Biomechanical data were recorded during walking and the single-leg drop jump. Hip, knee and ankle joint kinematics and kinetics were calculated. Differences between men and women were assessed using statistical parametric mapping. FINDINGS: Walking: Men with hip-related groin pain walked with lower hip flexion and internal rotation angles during stance compared to women. During different sections of stance, men also displayed a lower hip adduction angle and 'external' adduction moment, a lower knee flexion angle and 'external' flexion moment, as well as greater 'external' dorsi-flexion moment and impulse. Single-leg drop jump: Men with hip-related groin pain displayed a lower hip flexion angle during early stance, and greater 'external' knee flexion and ankle dorsi-flexion moments. The impulse of the 'external' dorsi-flexion moment was also greater for men compared to women. INTERPRETATION: Men and women with hip-related groin pain display differing lower limb biomechanics in both low and high impact tasks. Sex may therefore be a potential effect modifier in people with hip-related groin pain. Future research in this area should incorporate sex-specific analyses. TRIAL REGISTRATION NUMBER: NA.

What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis.

BACKGROUND: In athletes, hip and groin pain is considered to be associated with hip intra-articular pathologies and hip osteoarthritis (OA). A greater understanding of the relationship between hip and groin pain and imaging findings is required. OBJECTIVE: Our objective was to undertake a systematic review and meta-analysis to determine the prevalence of hip intra-articular pathologies and hip OA in athletes with and without hip and groin pain. METHODS: Seven electronic databases were searched on 29 January 2018 for studies investigating the prevalence of hip intra-articular pathologies and hip OA using X-ray, magnetic resonance imaging, magnetic resonance arthrography or computed tomography. The search, study selection, quality appraisal and data extraction were performed by two independent reviewers. When studies were considered homogenous, meta-analysis was undertaken. A strength of evidence was given to pooled results. RESULTS: Twenty studies reporting on the prevalence of hip intra-articular pathologies and hip OA in athletes were identified. Included studies were considered moderate to high risk of bias, with only three studies adjudged as low risk of bias. In asymptomatic athletes, limited evidence identified a labral tear prevalence of 54% per person and moderate evidence of 33% per hip. In symptomatic athletes, moderate evidence of a labral tear prevalence of 20% per hip was found. Moderate evidence of a cartilage defect prevalence of 10% per person was reported in asymptomatic athletes. In symptomatic athletes, cartilage defect prevalence was 7-40%. In asymptomatic athletes, the prevalence of hip OA was 0-17%, compared with 2% in symptomatic athletes. CONCLUSION: The prevalence of hip intra-articular pathologies and hip OA in symptomatic and asymptomatic athletes is variable. Labral tears and cartilage defects appear to be seen often in athletes with and without pain. Hip OA is rarely seen in athletes either with or without hip and groin pain. STUDY REGISTRATION: PROSPERO registration CRD42017082457.

Pedicled neurocutaneous anterolateral thigh flap for groin reconstruction - A case report.

Several different flaps based on the feeding vessels of sensitive nerves have been described in the limbs. This article reports the case of a neurocutaneous flap based on the lateral femoral cutaneous nerve (LFCN), employed for reconstruction of an inguinal defect. A 61-years-old female patient had undergone vulvectomy and bilateral inguinal lymphadenectomy for vulvar cancer with postoperative left groin wound breakdown. After a 3 weeks negative pressure therapy course, she presented a 10 × 4 cm skin and subcutaneous defect with undermined edges in the left inguinal area. Reconstruction with 14 × 6 cm pedicled left anterolateral thigh flap was planned. After the dissection of the vascular pedicle and of the sensitive nerve, complete thrombosis of both the veins and arterial spasm of perforating pedicle was detected. As the flap color was good, and slow marginal bleeding was present, we inspected the small vessels surrounding the nerve that were pulsating. To confirm the vascularization coming from the neural pedicle, we clamped the perforator and performed intraoperative indocyanine green (ICG) fluorescence angiography that showed a good fluorescence of the flap with a proximal to distal pattern of progression. The flap was transferred on the neural pedicle, survived completely, and wounds healed normally. Three months after surgery, the patient underwent radiotherapy, with uneventful course. In her last follow-up, 2 years after surgery, patient was free of disease and the flap showed normal scarring. This is the first case reported of a pedicled neurocutaneous flap based on the LFCN, indicating that in case of unsuitable perforators it could be an alternative pedicle.