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


METHODS
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.
Aristotelian University of Thessaloniki, E.Amynis 18, TK 54621, Thessaloniki, Greece. p.symeonidis@gmail.com.
Panagiotis
P
Symeonidis
Interbalkan European Medical Center, Mitropoleos 46-48, TK 54623, Thessaloniki, Greece. daniilidisnik@gmail.com.
Nikolaos
N
Daniilidis
Aristotelian University of Thessaloniki, Egnatia 142, TK 54622, Thessaloniki, Greece. givissis@otenet.gr.
Panagiotis
P
Givissis
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000175:diagnosis* / Q000601:surgery; D010525:Peripheral Nerves / Q000473:pathology* / Q000601:surgery; D012867:Skin / Q000294:innervation*
Neuroma; Post-traumatic; Skin mapping; Surgical approach; War injury