J Korean Foot Ankle Soc.  2019 Dec;23(4):212-215. 10.14193/jkfas.2019.23.4.212.

Visually Indistinguishable Intractable Neuroma Management after Below Knee Amputation: A Case Report

• Shin SK
• Kim KC
• Roh Y
• Kim J

• KMID: 2465947
• DOI: http://doi.org/10.14193/jkfas.2019.23.4.212

Abstract

Symptomatic neuromas after amputation can be troublesome to treat and make it difficult to properly fit a brace. Surgical management is required when conservative management such as prosthetic socket modification or local injections fail. However, small cutaneous nerves adhere to adjacent soft tissue and they are difficult to locate. The authors suggest that ultrasonography guided tattoo localization using a charcoal suspension is useful to find a visually indistinguishable neuroma.

Keyword

Amputation; Neuroma; Ultrasonography; Charcoal

MeSH Terms

Amputation*
Braces
Charcoal
Knee*
Neuroma*
Ultrasonography
Charcoal

Figure

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  Figure 1 Preoperative photograph shows blue circle marked amputee end marked with Tinel's sign.

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  Figure 2 A cutaneous nerve on lateral side of the amputee end was dissected (A) and embedded into muscle layer (B).

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  Figure 3 A missed cutaneous nerve on anterior and medial side of the amputee end in first exploration (A) was marked with activated charcoal suspension assisted by ultrasonograph (B). (C) A preoperative ultrasonographic image shows tip of needle (arrow) approaching to nerve ending.

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  Figure 4 A cutaneous nerve was found near charcoal deposit on medial (A) and anterior side of amputee end (B). (C) This nerve was a L-shaped single branch.

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