J Korean Foot Ankle Soc.  2014 Sep;18(3):133-136. 10.14193/jkfas.2014.18.3.133.

Ultrasound-guided Nerve Block for Skin Grafting on Large Diabetic Ulcer of Foot and Leg: A Technical Report

Affiliations
  • 1Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea. faschan@daum.net

Abstract

Skin grafting is often required for diabetic ulcerative foot lesions. In skin grafting, effective regional or local anesthesia into the donor and recipient areas plays a significant role in continuous control of pain. We report on a technique of ultrasound-guided nerve block on the femoral, sciatic, and lateral femoral cutaneous nerves in large split-thickness skin grafting for ulcer of the foot and leg.

Keyword

Skin graft; Ultrasound-guided nerve block; Lateral femoral cutaneous nerve; Femoral nerve; Sciatic nerve

MeSH Terms

Anesthesia, Local
Femoral Nerve
Foot*
Humans
Leg*
Nerve Block*
Sciatic Nerve
Skin Transplantation*
Tissue Donors
Ulcer*

Figure

  • Figure 1. Skin grafting is needed for the ulcerative legion of foot and leg after improvement of the soft tissue.

  • Figure 2. A needle is approaching to the LFCN medial to ASIS under ultrasound guidance. LFCN: lateral femoral cutaneous nerve, ASIS: anterior superior iliac spine, Med.: medial, Lat.: lateral.

  • Figure 3. (A) In supine position, an ultrasound probe is used to find the femoral nerve in femoral triangle. (B) Femoral nerve is located lateral to the femoral artery in femoral triangle. Med.: medial, Lat.: lateral.

  • Figure 4. (A) With the hip joint in 30o∼ 45o flexion, an ultrasound probe is placed on the posterior surface of thigh to detect the sciatic nerve. (B) Anesthetic fluid was injected where the tibial nerve and peroneal nerve merge with sciatic nerve under ultrasound guidance. Med.: medial, Lat.: lateral.

  • Figure 5. After ice test and pin prick test, the area of anesthesia was marked with skin pen as a donor-site on the left thigh.

  • Figure 6. The large ulcerative lesion was completely healed at 5 months after the surgery.


Cited by  1 articles

Ultrasound-Guided Regional Nerve Block in Below-Knee Amputation
Jae-Hwang Song, Chan Kang, Deuk-Soo Hwang, Dong-Hun Kang, Chang-Hyun Yoo
J Korean Orthop Assoc. 2018;53(5):435-442.    doi: 10.4055/jkoa.2018.53.5.435.


Reference

1.Elmas C., Elmas Y., Gautschi P., Uehlinger P. Combined sciatic 3-in-1 block. Application in lower limb orthopedic surgery. An-aesthesist. 1992. 41:639–43.
2.Wardrop PJ., Nishikawa H. Lateral cutaneous nerve of the thigh blockade as primary anaesthesia for harvesting skin grafts. Br J Plast Surg. 1995. 48:597–600.
Article
3.Ramaswamy CN. Topical lignocaine gel on skin graft donor sites. Br J Plast Surg. 1991. 44:157.
Article
4.Gupta A., Bhandari PS., Shrivastava P. A study of regional nerve blocks and local anesthetic creams (Prilox) for donor sites in burn patients. Burns. 2007. 33:87–91.
Article
5.Goodacre TE., Sanders R., Watts DA., Stoker M. Split skin grafting using topical local anaesthesia (EMLA): a comparison with infiltrated anaesthesia. Br J Plast Surg. 1988. 41:533–8.
Article
6.Ohlsén L., Englesson S., Evers H. An anaesthetic lidocaine/prilo-caine cream (EMLA) for epicutaneous application tested for cutting split skin grafts. Scand J Plast Reconstr Surg. 1985. 19:201–9.
Article
7.Cuignet O., Pirson J., Boughrouph J., Duville D. The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures. Anesth Analg. 2004. 98:1077–81.
Article
8.Shannon J., Lang SA., Yip RW., Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique. Reg Anesth. 1995. 20:100–4.
9.Marhofer P., Greher M., Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005. 94:7–17.
10.Kang C., Hwang DS., Kim YM., Kim PS., Jun YS., Hwang JM, et al. Ultrasound-guided femorosciatic nerve block by orthopaedist for ankle fracture operation. J Korean Foot Ankle Soc. 2010. 14:90–6.
Full Text Links
  • JKFAS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr