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Eliminazione mediante microchirurgia del dolore in caso di distrofia simpatica riflessa dell'arto inferiore

Eliminazione mediante microchirurgia del dolore in caso di distrofia simpatica riflessa dell’arto inferiore

27 novembre, 2020

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16-year-old girl with intense pain in her right foot. After two previous unsuccessful interventions, she was diagnosed with complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy. The patient is polymedicated and suffers from severe functional difficulties.

Initial situation
Initial situation of the patient before Dr. Piñal’s new procedure. The image allows to observe the signs of previous surgeries.

The problem

The patient comes to Dr. Piñal with disabling pain and the associated symptoms of reflex sympathetic dystrophy in the lower limb.

Strangulation of the tibial nerve
The shaded area indicates the section of the tibial nerve strangulated by scar tissue.

The goals

Dr Piñal performs a diagnostic reevaluation that rules out dystrophy and identifies the origin of pain in the strangulation of the tibial nerve, which provides sensitivity to the sole of the foot, due to scar tissue. This analysis leads to the design of a new microsurgical procedure, the purpose of which is to eliminate pain and restore function of the affected limb.

Microsurgical procedure designed by Dr Piñal
The illustration summarizes the microsurgical procedure designed by Dr Piñal: the wrapping of the tibial nerve with a vascularized fat flap taken from the inner thigh of the patient.

The plan

The Spanish surgeon proposes the microsurgical release of the tibial nerve trunk. This in turn is wrapped in a vascularized adipofascial flap (that is, fat with artery and veins) taken from the inner thigh. The flap provides irrigation and a new gliding surface for the nerve. The vascular connections made are in a range less than a millimeter in diameter.

Intervened area
In the left image, view of the tibial nerve already partially freed from the scar tissue. On the right, nervous structure of the intervened area.
Flap and vascular connections
The upper photograph allows us to observe the dimensions of the vascularized adipofascial flap (right) and its vascular connections, less than a millimeter in diameter .
Examination of the patient four weeks after the procedure.
Testimony of the patient for Telemadrid news (11/08/20).

The results

The new procedure eliminates pain and allows the patient to regain function in her right lower extremity.

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