Arriving at SKINTED (Surgery of the Knee, Injury to the Infrapatellar Branch of the Saphenous Nerve, Traumatic Eczematous Dermatitis): A Case Report

Abstract

Surgery of the knee, injury to the infrapatellar branch of the saphenous nerve, traumatic eczematous dermatitis (SKINTED) is a postsurgical localized dermatitis specifically linked to total knee arthroplasty (TKA). It is due to autonomic denervation following surgically inflicted nerve injury. It develops several months to years following a surgical trauma. It is being referred to by various names in the literature. Locoregional immune dysfunction due to lymphatic injury after surgery is the currently accepted theory. It must be distinguished from atopic dermatitis, allergic contact dermatitis/sensitization induced by topical medications or implanted metal hypersensitivity dermatitis, and post-traumatic eczema/dermatitis. We present a case of an elderly female patient in her 50s with dry eczematous lesions over the lateral aspect of the surgical incision over both knees developed three months following bilateral total knee replacement (TKR) done in view of osteoarthritis. The patient responded well to topical corticosteroid and emollient treatment. We have also reviewed the literature to provide an overview of potential concepts of etiopathogenesis described in the literature and to clear up any ambiguity surrounding various labels given to this entity.

Keywords: autonomic denervation dermatitis; immunocompromised district; saphenous nerve; skinted; tkr.

Figure 1. Erythematous plaques with scaling and xerosis noted lateral to incision over left knee.

Figure 2. Minimal area of erythematous plaque with scaling noted over right knee.

Figure 3. Histopathology reveals hyperkeratosis, spongiosis, elongation of rete ridges and dermis showing infiltration by lymphocytes