Dermatome

Background/aims: Chronic tattoo reactions requiring treatment have increased. Laser removal is not ideal for removal of allergic reactions. Surgical removal of culprit pigment situated in the outer dermis by dermatome shaving is rational and need to be revisited.

Materials/methods: Fifty four tattoos with chronic reactions in 50 patients were treated with dermatome shaving. Tattoos with red/red nuances dominated the material. In total, 52 operations were performed in infiltration and 2 in general anaesthesia. Shaving was performed to the level in the dermis free of tattoo pigment as assessed visually by the surgeon.

Dermatome

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A dermatome is an area of skin that is mainly supplied by afferent nerve fibres from the dorsal root of any given spinal nerve.[1][2]There are 8 cervical nerves (C1 being an exception with no dermatome),12 thoracic nerves,5 lumbar nerves and 5 sacral nerves.Each of these nerves relays sensation (including pain) from a particular region of skin to the brain.

Along the thorax and abdomen, the dermatomes are like a stack of discs forming a human, each supplied by a different spinal nerve. Along the arms and the legs, the pattern is different: the dermatomes run longitudinally along the limbs. Although the general pattern is similar in all people, the precise areas of innervation are as unique to an individual as fingerprints.

A dermatome is an area of skin supplied by sensory neurons that arise from a spinal nerve ganglion. Symptoms that follow a dermatome (e.g. like pain or a rash) may indicate a pathology that involves the related nerve root. Examples include somatic dysfunction of the spine or viral infection. Certain skin problems tend to orient the lesions in the dermatomal direction.

In referred pain, sensory nerve fibers such as that from dermatomes may come together at the same spinal cord level as the general visceral afferent fibers such as that from the heart.When the general visceral sensory fiber is stimulated, the central nervous system does not clearly discern whether the pain is coming from the body wall or from the viscera, so it perceives the pain as coming from somewhere on the body wall, e.g. left arm/hand pain, jaw pain.So the pain is "referred to" the related dermatomes of the same spinal segment.[3]

Viruses that lie dormant in nerve ganglia (e.g. varicella zoster virus, which causes both chickenpox and shingles), often cause either pain, rash or both in a pattern defined by a dermatome (a zosteriform pattern). However, the symptoms may not appear across the entire dermatome.

Sensory testing is a common noninvasive method of evaluating nerve function that relies on the knowledge of skin dermatomes and sensory fields of cutaneous nerves. Research to determine the extent of the dermatomes was conducted in Europe during the late nineteenth and early twentieth centuries. Experiments performed on cadavers, monkeys, and human patients prior to 1948 resulted in the creation of similar but somewhat different dermatome maps. A radically different map with long, swirling dermatomes was produced by Keegan and Garrett in 1948. This map was derived largely by examining compression of dorsal nerve roots by vertebral disc herniation. The maps appearing in textbooks are inconsistent. Some books show a version of the early maps, some show the Keegan and Garrett map, and others show maps that are not consistent with either. The purpose of this paper is to discuss the history of dermatome maps, including the experimental procedures by which each was obtained, and to relate the early maps to those found in textbooks commonly used in healthcare education programs. The paper discusses the significance of these maps as used for clinical diagnosis and the need for further research.

processing.... Drugs & Diseases > Anatomy Dermatomes Anatomy Updated: Oct 13, 2017 Author: Stephen Kishner, MD, MHA; Chief Editor: Thomas R Gest, PhD more... Share Print Feedback Close Facebook Twitter LinkedIn WhatsApp Email webmd.ads2.defineAd({id: 'ads-pos-421-sfp',pos: 421}); Sections Dermatomes Anatomy Sections Dermatomes Anatomy Overview Gross Anatomy Natural Variants Other Considerations Questions & Answers Show All Media Gallery Tables References Overview Overview The surface of the skin is divided into specific areas called dermatomes, which are derived from the cells of a somite. These cells differentiate into the following 3 regions: (1) myotome, which forms some of the skeletal muscle; (2) dermatome, which forms the connective tissues, including the dermis; and (3) sclerotome, which gives rise to the vertebrae. A dermatome is an area of skin in which sensory nerves derive from a single spinal nerve root (see the following image).

The 31 spine segments on each side give rise to 31 spinal nerves, which are composed of 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal spinal nerve. Dermatomes exist for each of these spinal nerves, except the first cervical spinal nerve. Sensory information from a specific dermatome is transmitted by the sensory nerve fibers to the spinal nerve of a specific segment of the spinal cord.

Along the thorax and abdomen, the dermatomes are evenly spaced segments stacked up on top of each other, and each is supplied by a different spinal nerve. The dermatomes along the arms and legs differ from the pattern of the trunk dermatomes, because they run longitudinally along the limbs. The general pattern is similar in all people, but significant variations exist in dermatome maps from person to person. [1]

Charts based on injection of local anesthetics into single dorsal root ganglia show bands of hypalgesia to be continuous longitudinally from the periphery to the spine. Maps derived from other methods, such as observation of herpes zoster lesion distributions or surgical root section, show discontinuous patterns. In addition, innervation from one dermatomal segment to another overlaps considerably, more so for touch than for pain. As the dermatomes travel from the back to the chest and abdomen, they tend to dip inferiorly. [6]

The dermatome is a basic concept, yet much variability exists between dermatome maps in standard anatomy and medical guideline textbooks. A review of 14 different dermatome maps by Lee et al showed striking variations within each individual map. [7] Nearly all maps reviewed were based on 2 primary sources, Foerster [8] and/or Keegan and Garrett. [9]

Dermatomes are derived from the outer portion of an embryo from which the skin and subcutaneous tissues are developed and become the areas of skin supplied by the branches of a single dorsal root ganglion. In the developing embryo, dermatomes arise from somitic mesoderm, which develops from the middle layer of embryonic tissue lateral to the developing neural tube. Dermatomes are arranged with basic segmental pattern in the vertebrate trunk, although some overlap exists with similar areas above and below.

The dermatomes of the trunk are relatively evenly spaced out; however, considerable overlap of innervations between adjacent dermatomes often occurs. Thus, a loss of afferent nerve function by one spinal nerve would not generally cause complete loss of sensation, but a decrease in sensation may be experienced.

The organization of dermatomes in the limbs is more complex than that of the dermatomal distribution in the trunk as a result of the limb buds and corresponding dermatomes being "pulled out" during early embryologic development.

Contrary to the considerable overlap of the dermatomes of the trunk, the overlap between the peripheral nerves of the limbs (upper and lower extremities) is far less extensive (see the following image). Thus, in the limbs, complete interruption of a single peripheral nerve typically produces changes in sensation that are, indeed, appreciated by a patient.

Posterolateral thigh (just inferior to L4 dermatome) and wraps around to lateral aspect of the anterior lower leg and dorsum of the foot; it crosses the knee joint on the lateral aspect of the knee; also covers the plantar aspect of the foot and the second through fourth toes

Understanding the nerve distribution along the dermatomes is helpful in determining how certain diseases, such as shingles and some other neurological conditions, target one area of the body. The letter-number combinations show the relationship between each area and its corresponding sensory nerve. The vertebrae are classified as C for cervical, T for thoracic, L for lumbar, and S for sacral. The trigeminal nerve is the fifth cranial nerve, represented by V.

This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the dermatomes picture).

Shingles occurs more commonly on the chest and back, but can involve the arms and legs. The small blisters on this person's hand represent involvement of the dermatome innervated by the 7th cervical nerve. (See the Dermatomes picture.)

Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the dermatome picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. Herpes zoster is caused by the same virus that causes chickenpox.

Laparoscopic appendectomy (LA), used since 1980, is a common surgical technique for acute appendicitis (AA) treatment. Laparoscopic surgical techniques can achieve higher patient satisfaction than conventional open surgery techniques. However, many patients complain of severe pain after laparoscopic abdominal surgeries. In this study, we compared single-dermatome laparoscopic appendectomy (SDLA), wherein all trocars were placed at the same dermatome field, with standard laparoscopic appendectomy (SLA), wherein trocars were placed at multiple dermatome sites, in terms of postoperative pain and patient satisfaction. 17dc91bb1f