Authors: Panagiotis Symeonidis Nikolaos Daniilidis Panagiotis Givissis
Publish Date: 2015/09/02
Volume: 157, Issue: 11, Pages: 1953-1958
Abstract
The operative treatment of posttraumatic 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 lesionSkin 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 posttraumatic neuromas were marked with the method A total of 18 neuromas were successfully located in the upper and lower limbsI am delighted to review a paper in which the clinical exam plays such an important role in evaluating and treating the patient even if it is done just prior to a surgical procedure The paper employs a common sense approach utilizing symbols applied to the skin that demarcate regions of normal absent or altered sensation including a Tinel’s response It is not surprising that using an incision incorporating regions of altered sensation provided adequate exposure Nevertheless this paper is a good reminder of the importance of several fundamentals that every peripheral nerve surgeon should remember and apply examine the patient on the day of surgery prior to performing a surgical procedure subjective information obtained from the patient while performing a detailed sensory examination can be very useful in planning and executing a surgical approach to traumatic nerve injuries resulting in pain and altered sensation focal nerve pathology that produces pain and is silenced or reduced with an anesthetic block not done in this study on preoperative evaluation can often be treated successfully with surgery
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