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

Seong Kee Shin; Ki Chun Kim; Youngju Roh; Jongkyu Kim

doi:10.14193/jkfas.2019.23.4.212

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Shin, Kim, Roh, and Kim: Visually Indistinguishable Intractable Neuroma Management after Below Knee Amputation: A Case Report

Case Report

Journal of Korean Foot and Ankle Society 2019; 23(4): 212-215.

Published online: 16 December 2019

DOI: https://doi.org/10.14193/jkfas.2019.23.4.212

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

Seong Kee Shin, Ki Chun Kim

, Youngju Roh, Jongkyu Kim, ^*

Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.

^*Department of Rehabilitation, Seoul Medical Center, Seoul, Korea.

Corresponding Author: Ki Chun Kim. Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul 02053, Korea. Tel: 82-2-2276-7841, Fax: 82-2-539-1262, 711000e@naver.com

Received 7 October 2019 Revised 1 November 2019 Accepted 11 November 2019

Korean Foot and Ankle Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Amputation, Neuroma, Ultrasonography, Charcoal

Figures and Tables

Figure 1

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

Figure 2

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

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.

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.

Notes

The point of these thesis was presented by 2019 Spring Congress of Korean Foot & Ankle Society.

^{Financial support} None.

^{Conflict of interest} None.

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ORCID iDs: Ki Chun Kim
https://orcid.org/0000-0002-3731-8448
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