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Acta Neurochirurgica

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01-11-2015 | Technical Note - Neurosurgical Techniques

A simple method of skin mapping for planning the operative approach in peripheral nerve injuries

Authors: Panagiotis Symeonidis, Nikolaos Daniilidis, Panagiotis Givissis

Published in: Acta Neurochirurgica | Issue 11/2015

Abstract

Background

The operative treatment of post-traumatic neuromas includes open exploration, excision of adhesions and/or neurectomy. Apart from the anatomical variations of the peripheral nerves and their branches’ routes, nerves may be further deviated from their expected anatomical locations due to scar tissue formation. We describe a simple and reproducible method of preoperative skin marking which aids the development of an accurate surgical exposure for the localisation of a lesion.

Method

Skin marking is based on clinical assessment and is performed by the bedside on the day of the operation. It consists of mapping the skin with permanent marker by repeatedly using three symbols, namely √, O or X. These refer respectively to areas of normal sensation, numbness (decreased or no sensation without paraesthesia) and pain/dysaesthesia. Points with a positive Tinel sign were marked with an “X in a square”. Fourteen patients, aged 21–55 years old, with post-traumatic neuromas, were marked with the method. A total of 18 neuromas were successfully located in the upper and lower limbs.

Results

In all cases the preoperative skin marking corresponded to the course of the nerve and/or its branches. All patients were improved with a good to excellent clinical outcome.

Conclusions

Planning the surgical approach according to the skin marking enabled limited operative exposures and corresponded to atypical locations and branching of the peripheral nerves.

Adams JH (1992) Grienfield’s Neurolopathology, 5th edn. Oxford University Press, New York, pp 1160–1166

Apaydin N, Basarir K, Lukas M, Tubbs RS, Uz A, Kinik H (2008) Compartmental anatomy of the superficial fibular nerve with an emphasis on fascial release operations of the leg. Surg Radiol Anat 30(1):47–52CrossRefPubMed

Barret SL, Al D, Rosson GD, Walters L (2006) Superficial peroneal nerve (superficial fibularis nerve): the clinical implications of anatomic variability. J Foot Ankle Surg 45(3):174–176CrossRef

Bennet MI, Attal N, Backonja MN, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tolle TR, Wittchen HU, Jensen TS (2007) Using screening tools to identify neuropathic pain. Pain 127:199–203CrossRef

Burciel KJ, Johans T, Ochoa J (1993) Surgical treatment of painful traumatic neuromas. J Neurosug 78(5):714–719CrossRef

Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L, Haanpaa M, Jensen TS, Serra J, Treede RD (2010) EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol 17:1010–1018CrossRefPubMed

Dayan V, Cura L, Cubas S, Carriquiry G (2008) Surgical anatomy of the saphenous nerve. Ann Thorac Surg 85(3):896–900CrossRefPubMed

Drizenko A, Demondion X, Luyckx F, Mestdaqh H, Cassaqnaud X (2004) The communicating branches between the sural and superficial peroneal nerves in the foot: a review of 55 cases. Radiol Anat 26(6):447–452CrossRef

Ducic I, Dellon A, Graw KS (2006) The clinical importance of variations in the surgical anatomy of the superficial peroneal nerve in the mid-third of the lateral leg. Ann Plast Surg 56(6):635–638CrossRefPubMed

10.

Haanpää M, Treede RD (2010) Diagnosis and classification of neuropathic ain. In: Ballantyne JC (ed) Pain clinical updates, vol 18(7). IASP, Seattle, pp 18-27

11.

Mahakkanukrauh P, Chomsung R (2002) Anatomical variations of the sural nerve. Clin Anat 15(4):263–266CrossRefPubMed

12.

Prakash Q, Bhardwaj AK, Sinqh DK, Rajini T, Jayanthi V, Sinqh G (2010) Anatomic variations of superficial peroneal nerve: clinical implications of a cadaver study. Ital J Anat Embryol 115(3):223-228

13.

Treede RD, Jensen TS, Cambell JN, Gruccu G, Dostrovsky JO, Griffith JW, Hansson P, Huqhes R, Nurmikko T, Serra J (2008) Redefinition of neuropathic pain and a grading system for clinical use: consensus statement on clinical and research diagnostic criteria. Neurology 70:1630–1635CrossRefPubMed

14.

Trumble TE (2000) Peripheral nerve injury: pathophysiology and repair. In: Feliciano DV, Moore EE, Mattox KL (eds) Trauma, 4th edn. McGraw-Hill, New York, pp 1047–1055

15.

Seventer V, Bach FW, Toth CC, Serpell M, Temple J, Murphy TK, Nimour M (2010) Pregabalin in the treatment of post-traumatic peripheral neuropathic pain: a randomized double, blind trial. Eur J Neurol 17(8):1082–1089CrossRefPubMed

Title: A simple method of skin mapping for planning the operative approach in peripheral nerve injuries
Authors: Panagiotis Symeonidis
Nikolaos Daniilidis
Panagiotis Givissis
Publication date: 01-11-2015
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 11/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2561-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A simple method of skin mapping for planning the operative approach in peripheral nerve injuries

Abstract

Background

Method

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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