Traumatic Tibialis Anterior Muscle Herniation with a Large Fascial Defect Managed by Prolene Mesh Repair: A Rare Case Report

Abstract

Introduction:

Tibialis anterior muscle herniation is an uncommon condition caused by a defect in the deep fascia, most frequently following trauma.

Case Report:

We report a rare case of a 22-year-old male who presented with symptomatic tibialis anterior muscle herniation 1 year after blunt trauma. Clinical examination revealed a reducible swelling over the anterolateral aspect of the right leg, becoming prominent on standing and muscle contraction. Intraoperatively, a large fascial defect measuring approximately 9 × 3 cm was identified.

Conclusion:

The defect was successfully managed using a Prolene mesh for tension-free repair. At the 6-month follow-up, the patient was asymptomatic with no recurrence or complications. This case highlights Prolene mesh repair as a reliable option for large traumatic fascial defects.

Learning Point of the Article:

Traumatic tibialis anterior muscle herniation with large fascial defects can be effectively managed with tension-free Prolene mesh repair, providing excellent functional and cosmetic outcomes.

Introduction

Muscle herniation is a rare clinical entity characterized by protrusion of muscle tissue through a defect in the overlying fascia [1]. The tibialis anterior muscle is the most commonly involved due to its superficial location and vulnerability to trauma [2]. Although many cases are asymptomatic, patients may present with pain, functional limitation, or cosmetic deformity [3]. Recent literature supports surgical intervention in symptomatic cases, particularly when large fascial defects are present [4,5,6]. We report a rare traumatic tibialis anterior muscle herniation with a large fascial defect treated successfully using Prolene mesh repair.

Case Report

A 22-year-old male presented with a swelling over the anterolateral aspect of the right leg that became prominent on standing and during contraction of the tibialis anterior muscle. The patient complained of intermittent pain during physical activity. There was a history of blunt trauma to the same leg 1 year before presentation.

On clinical examination, a soft, reducible bulge was observed over the tibialis anterior region. The swelling appeared at rest and became prominent on ankle dorsiflexion (Fig. 1).

Figure 1.

Pre-operative clinical photograph.

No neurovascular deficit was noted. As the clinical findings were classical, no imaging studies were performed.

Given persistent symptoms and cosmetic concern, surgical intervention was planned.

Surgical technique

Under regional anesthesia and tourniquet control, a longitudinal incision was made over the swelling. Intraoperatively, a large fascial defect measuring approximately 9 × 3 cm was identified with herniation of the tibialis anterior muscle (Fig. 2).

Figure 2.

Intraoperative photograph.

After reduction of the muscle, primary closure was deemed unsafe due to the size of the defect.

A Prolene mesh was placed over the defect and secured to the surrounding healthy fascia using non-absorbable sutures, ensuring a tension-free repair (Fig. 3).

Figure 3.

Intraoperative photograph.

The wound was closed in layers (Fig. 4).

Figure 4.

Immediate post-operative photograph.

Post-operative outcome

The post-operative period was uneventful. At the 6-month follow-up, the patient was pain-free, with no recurrence of herniation and a satisfactory cosmetic outcome (Fig. 5).

Figure 5.

Follow-up photograph.

Discussion

Recent literature suggests that traumatic tibialis anterior muscle herniation is increasingly recognized due to improved clinical awareness [1,3]. Diagnosis is often clinical, while dynamic ultrasound or MRI may be reserved for equivocal cases [7,8,9]. Surgical options include fasciotomy, primary repair, autologous grafts, and synthetic mesh reinforcement [4,6,7].

Historically, muscle herniation of the leg has been described in early surgical literature, emphasizing its traumatic etiology and varied presentation [10,11,12]. Fasciotomy may relieve symptoms but can worsen cosmetic appearance, while primary closure of large defects carries a risk of compartment syndrome [7,10]. Contemporary reports favor synthetic mesh reinforcement for large defects, providing durable support and minimizing recurrence [2,5,6]. In our case, prolene mesh repair resulted in excellent functional and cosmetic outcomes without complications at 6 months.

Conclusion

Prolene mesh repair is a safe, effective, and reproducible technique for managing large traumatic fascial defects associated with tibialis anterior muscle herniation.

Clinical Message.

Large traumatic fascial defects causing tibialis anterior muscle herniation can be effectively treated using Prolene mesh repair, achieving excellent functional and cosmetic outcomes.

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