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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.
REFERENCES
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.
3.Ramaswamy CN. Topical lignocaine gel on skin graft donor sites. Br J Plast Surg. 1991. 44:157.
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.
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.
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.
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.
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.
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.
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