Mr Sandeep B¹, Mr Jeremy Rawlins¹

¹Fiona Stanley Hospital, willeton, Australia

Abstract:

Introduction

Burns surgical management includes tangential and subfascial excision for removal of dead tissue and resurfacing with skin graft.

Not often we encounter neuroma related pain requiring surgical intervention. We report a case of lower limb neuroma along peroneal nerve territory requiring excision of neuroma and burial of proximal stump in Muscle.

Method:

Patient’s operative data – preoperative assessment, intraoperative findings and postoperative assessment were noted.

Histopathological assessment was also done to confirm the diagnosis and rule out other pathological conditions.

Case:

A 47 year old gentleman who previously had suffered 3% TBSA flame burns on left leg- requiring tangential excision and skin grafting to dorsal foot and anterior leg.

Had and uneventful recovery during immediate post op. However 8 months post op he started complaining about shooting neuroma pain along lateral calcaneal nerve branch territory leading to avoid work and even limping.

Clinical examination confirmed Neuroma pain with positive tinnels sign. MRI was performed to confirm the above findings.

He underwent surgery to remove area of skin graft over the lateral calcaneal nerve and proximally along the sural nerve biopsy site explored wit excise segment of nerve and burry proximal nerve into peroneus muscle. He had good operative outcome with complete relieve of pain.

Result:

Skin grafting can cause neuroma due to scar contracture and need to be assessed for neuroma if patient reports ongoing discomfort or localised pain.

Biography:

Qualified  general surgeon and dual-qualified plastic surgeon from India and Australia. Major interest in trauma and Burns reconstruction. Undergone 5 years fellowship training in the above  fileds.

Presently work as consultant burns surgeon in Fiona Stanley Hospital and consultant plastic surgeon in Royal Perth Hospital, WA