Scar Tissue Causing Saphenous Nerve Entrapment: Percutaneous Scar Release and Fat Grafting

Abstract

Summary:Painful neuropathies can be caused by nerve compression or neuromas. Nerve compressions can arise from scar adhesions causing painful posttraumatic entrapment of nerve branches via fibrosis. The classical treatment methods include neurolysis and nerve transposition. In this case, we present the treatment of recurrent scar entrapment of the saphenous nerve with percutaneous neurolysis and lipofilling in a patient who had previously undergone an open neurolysis procedure. Resolution of the condition without any complications was noted during the 2-month clinical follow-up. Percutaneous neurolysis and lipofilling are shown to be safe and reproducible methods for the treatment of neuropathic compressive scars.

Evaluation of a new adipose tissue processing method for breast and buttock fat grafting procedures

“…Although the use of this technique has already been reported in the buttock [11] and lower extremities [12], to the best of our knowledge, no study has evaluated its safety and effectiveness in breast surgery.…”

“…In this study, we focus on a new fat processing technique that involves adipose tissue washing, "micronization," and decantation. This technique has been reported in a few studies in the scientific literature [11,12], but, to the best of our knowledge, no study on its safety and effectiveness in a sufficiently large patient series has been published so far.…”

Infrapatellar Branch of the Saphenous Nerve Injury: Implications for the Physical Therapist

“…Non-surgical causes of IBSN injury are less prevalent. Macrotrauma from a fall [6,18] or a direct blow to the medial thigh or knee [6,15,21,22] have been reported. Additionally, overuse injuries from running [12,17,20] have been suspected of causing damage to the IBSN.…”

“…Some authors contest the reliability of these methods [2,13,14,24], and it has been suggested that missed diagnoses may be consequent to focus on the primary branch of the saphenous nerve and not the infrapatellar branch [10]. Imaging, via magnetic resonance imaging (MRI) or computerized tomography (CT), is also utilized for diagnosis [18,22,24,25,61,62]. Occasionally, exploratory surgery is required to identify injury to the IBSN [1,13].…”

“…Injury to the infrapatellar branch of the saphenous nerve (IBSN) is an underreported condition [1,2] which has important implications for the physical therapist. Due to its location, the IBSN is especially vulnerable to damage following surgery, [3][4][5][6][7][8][9][10][11] but it may also be injured through trauma or unknown causes [1,7,[12][13][14][15][16][17][18][19][20][21][22]. In most individuals, injury may elicit minor symptoms, such as hypoesthesia or anesthesia [3].…”