Monday, April 22, 2013
A 20 year old man is involved in a bombing and has penetrating injury to his leg. He is taken immediately to the operating theatre and undergoes an above-the-knee amputation of his leg. Post-operatively, he is admitted to the wards, continued on antibiotics, and started on thromboprophylaxis. During the first few days post-operatively, however, the patient continues to have pain at the site of the amputation requiring high doses of IV opiates. The patient points out exactly where the pain is, and injection of lidocaine relieves the pain. The patient is taken back to the OR and a biopsy is shown below.
Excision of the problem relieves the pain and the patient eventually transfers to a rehabilitation facility. However, even in the rehabilitation facility, the patient complains of burning, electric, aching pain in the amputated limb. X-ray does not show any bone spurs, local tissue oxygen tension is normal, and there is no evidence of infection.
Challenge 2: What's the diagnosis here?
First image of woodcut by Hans von Gersdorff is in the public domain, from Wikipedia; second image shown under Fair Use.