PMC3350006_01
The blue skin marker demarcates the area of maximum pain in the hyperpigmented skin graft site of the left lower extremity.
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fig1
His left lower extremity distal to the knee revealed skin grafts, scarring, and hyperpigmentation (Figure 1).
The cryoprobe was inserted via a 12-gauge angiocatheter introducer proximal to the skin graft site of the left lower extremity. The ultrasound probe is being utilized to provide an in-plane view of the cryoprobe and ice ball location during cryoneurolysis treatment.
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fig2
Three milliliters (mL) of 1% lidocaine was infiltrated subcutaneously using a 27-gauge needle at the entry site for the cryoprobe located approximately 2 centimeters (cm) proximal to the skin grafts (Figure 2).
The in-plane view of the cryoprobe and fibula prior to cryolesioning.
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fig3
The proximity of the cryoprobe to the fibula was easily visualized prior to beginning cryotherapy (Figure 3). Sequential freezing and thawing pictures as presented in Figures 3-6.
Cryolesion (diameter = 0.80 cm) at 1 minute and 30 seconds into the freeze cycle. Note the hyperechoic rim with posterior acoustic shadowing emanating from the tip of the probe.
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fig4
The lesion appeared as an echo-opaque hemisphere with a hyperechoic rim with a posterior acoustic shadowing (Figure 4). Sequential freezing and thawing pictures as presented in Figures 3-6.
Cryolesion (diameter = 1.12 cm) at 4 minutes into the freeze cycle.
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fig5
The largest ultrasonographically measured cryolesion was an area of 0.85 cm2 and a circumference of 3.28 cm, at 4 minutes into freezing cycle (Figure 5). Sequential freezing and thawing pictures as presented in Figures 3-6.
Cryolesion is barely visible at 1 minute and 30 seconds into the thaw period.
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fig6
After a 4-minute cryolesion, the tissue changes were visualized at 50 seconds but then normalized at 2 minutes and 20 seconds (Figure 6). Sequential freezing and thawing pictures as presented in Figures 3-6.