Cutaneous Nerve Research Articles

Loss of NF1 accelerates uveal and intra-dermal melanoma tumorigenesis and oncogenic GNAQ transforms Schwann cells.

NF1 encodes the multifunctional tumour suppressor protein, neurofibromin, which is best known for its causative role in Neurofibromatosis type 1 and in regulating MAPK signaling. Neurofibromin, in a context-specific manner, is involved in various tumorigenic processes, including those in melanocytes. This study investigated whether NF1 loss can collaborate with oncogenic GNAQ to promote melanoma in the dermis or eyes, where the G alpha q pathway is almost always activated. We found that heterozygous 17q11.2 loss that includes the NF1 locus is a recurrent phenomenon in human intra-dermal and uveal melanomas described in the literature. We studied the effects of Nf1 haploinsufficiency in mice expressing oncogenic GNAQ-Q209L in melanocytes and Schwann cells of peripheral nerves using the Plp1-creERT transgene, with tamoxifen at 5-weeks of age. Nf1 haploinsufficiency accelerated melanoma formation and/or growth. RNAseq analysis found significant pathways related to cAMP signaling and myogenesis. In addition, 20% of the differentially expressed genes were homologous to genes whose expression correlates with prognosis in human uveal melanoma. Unexpectedly, we found that GNAQ-Q209L alone was sufficient to drive cutaneous nerve sheath tumors, with one GNAQ-Q209L expressing Nf1 haploinsufficient mouse also developing a plexiform variant. These tumors strongly resembled neurofibromas. We searched the cBioPortal for Cancer Genomics database and found plexiform neurofibromas with the GNAQ T96S hotspot mutation. The Plp1-creERT; GNAQ-Q209L model with tamoxifen at 5 weeks may be useful as a pre-clinical model for neurofibroma. Our studies emphasize the importance of GNAQ and NF1 in regulating neural crest derived cells existing in a dermal-like environment.

Optimizing Anesthetic Techniques: Special Brachial Plexus and Cutaneous Blocks in Clavicle Fracture Surgeries in Bangladesh

Background: This study compares the efficacy, safety, and resource utilization of brachial plexus + cutaneous nerve blocks (RAG) versus conventional anesthesia (CAG) in patients undergoing clavicle fracture surgeries. Methods: A total of 100 patients were enrolled and equally divided into the RAG (n=50) and CAG (n=50) groups. Baseline characteristics, intraoperative and postoperative outcomes, postoperative complications, length of hospital stay, and resource utilization were evaluated. Pain control was assessed using the Visual Analog Scale (VAS), and patient satisfaction was measured with a satisfaction score. Results: Baseline characteristics were comparable between the groups. Significant differences were observed in postoperative pain control, with the RAG group demonstrating lower VAS scores at all postoperative intervals (p < 0.001). Patient satisfaction was significantly higher in the RAG group (9.5 ± 0.8 vs. 8.3 ± 1.3, p < 0.001). Although no significant differences were found in respiratory depression, nausea, or wound infections, the RAG group showed trends toward reduced nausea and prolonged recovery. The RAG group also had a significantly shorter length of hospital stay (2.8 ± 0.7 days vs. 3.4 ± 1.0 days, p < 0.01) and reduced supplemental analgesic use (20% vs. 50%, p < 0.001). Ultrasonographic guidance was used in 80% of RAG cases. Conclusion: Brachial plexus and cutaneous nerve blocks provide superior postoperative pain control, greater patient satisfaction, and shorter recovery times compared to conventional anesthesia. These advantages, coupled with reduced reliance on supplemental analgesics, make regional anesthesia a more efficient and cost-effective option for clavicle fracture surgeries. Ultrasonographic guidance may further enhance the application of this technique in clinical practice.

Spatial histomorphometry reveals that local peripheral nerves modulate but are not required for skeletal adaptation to applied load in mice

Abstract Mechanical loading is required for bone health and results in skeletal adaptation to optimize strength. Local nerve axons, particularly within the periosteum, may respond to load-induced biomechanical and biochemical cues. However, their role in the bone anabolic response remains controversial. We hypothesized that spatial alignment of periosteal nerves with sites of load-induced bone formation would clarify this relationship. To achieve this, we developed RadialQuant, a custom tool for spatial histomorphometry. Tibiae of control and neurectomized (sciatic/femoral nerve cut) pan-neuronal Baf53b-tdTomato reporter mice were loaded for 5-days. Bone formation and periosteal nerve axon density were then quantified simultaneously in non-decalcified sections of the mid-diaphysis using RadialQuant. In control animals, anabolic loading induced maximal periosteal bone formation at the site of peak compression, as has been reported previously. By contrast, loading did not significantly change overall periosteal nerve density. Neurectomy depleted ~90% of all periosteal axons, with near-total depletion on load-responsive surfaces. Neurectomy alone also caused de novo bone formation on the lateral aspect of the mid-diaphysis. However, neurectomy did not inhibit load-induced increases in periosteal bone area, mineralizing surface, or bone formation rate. Rather, neurectomy spatially redistributed load-induced bone formation towards the lateral tibial surface with a reduction in periosteal bone formation at the posterolateral apex (-63%) and enhancement at the lateral surface (+1360%). Altogether, this contributed to comparable load-induced changes in cortical bone area fraction. Our results show that local skeletal innervation modulates but is not required for skeletal adaptation to applied load in our model. This supports the continued use of loading and weight-bearing exercise as an effective strategy to increase bone mass, even in patients with peripheral nerve damage or dysfunction.

UVB Induces Sympathetic Nervous System Activation and Norepinephrine Secretion to Regulate TheSkin Color of Mice Through the β2-AR/AP-1 Pathway in Epidermal Keratinocytes.

The aim of this study was to investigate how ultraviolet B (UVB) light regulates AP-1 expression via the β2-adrenergic receptor (β2-AR) in epidermal keratinocytes, which in turn regulates melanin synthesis in melanocytes, thereby modulating downstream melanin production in skin hair follicles and altering mouse skin color. We established a UV-irradiated mouse model to investigate the effects of UV radiation on changes in skin color. By measuring changes in the expression of genes related to cutaneous sympathetic nerves, norepinephrine synthesis and melanin synthesis, we investigated the relationship between β2-AR expression and cutaneous melanogenesis and determined the localization of β2-AR in cells. The results of the siRNA-mediated transfection of keratinized cells with downregulated β2-AR expression were further verified in vitro. Our results suggest that UVB alters the color of the dorsal skin in mice by activating the AP-1/IL-6 pathway, which triggers the sympathetic release of norepinephrine, thereby increasing β2-AR expression in keratinocytes. Overall, our study improves the current understanding of how UVB light influences skin color changes and highlights the complex interplay between ultraviolet radiation and skin physiology.

Keratinocyte-derived extracellular vesicles in painful diabetic neuropathy.

Painful diabetic neuropathy (PDN) is a challenging complication of diabetes with patients experiencing a painful and burning sensation in their extremities. Existing treatments provide limited relief without addressing the underlying mechanisms of the disease. PDN involves the gradual degeneration of nerve fibers in the skin. Keratinocytes, the most abundant epidermal cell type, are closely positioned to cutaneous nerve terminals, suggesting the possibility of bi-directional communication. Extracellular vesicles are lipid-bilayer encapsulated nanovesicles released from many cell types that mediate cell to cell communication. The role of keratinocyte-derived extracellular vesicles (KDEVs) in influencing signaling between the skin and cutaneous nerve terminals and their contribution to the genesis of PDN has not been explored. In this study, we characterized KDEVs in a well-established high-fat diet mouse model of PDN using primary adult mouse keratinocyte cultures. We obtained highly enriched KDEVs through size-exclusion chromatography and then analyzed their molecular cargo using proteomic analysis and small RNA sequencing. We found significant differences in the protein and microRNA content of high-fat diet KDEVs compared to KDEVs obtained from control mice on a regular diet, including pathways involved in axon guidance and synaptic transmission. Additionally, using an in vivo conditional extracellular vesicle reporter mouse model, we demonstrated that epidermal-originating GFP-tagged KDEVs are retrogradely trafficked into the dorsal root ganglion (DRG) neuron cell bodies. This study presents the first comprehensive isolation and molecular characterization of the KDEV protein and microRNA cargo in RD and HFD mice. Our findings suggest a potential novel communication pathway between keratinocytes and DRG neurons in the skin, which could have implications for PDN.

Robotic-Assisted Microsurgery in Gender-Affirming Phalloplasty.

Genital gender-affirming masculinization surgeries require handling of small vessels and nerves handling in deep planes. Since the introduction of the Symani Surgical System for robotic-assisted microsurgery in clinical practice, its value in handling small and deep vessels via additional distal motion axes, motion scaling, and tremor elimination has been demonstrated. We combined the Symani with the robotic exoscope RoboticScope to achieve maximum flexibility and ergonomics for the microsurgeon. Here, we present the initial application of robotic-assisted microsurgery for gender-affirming phalloplasty. The Symani and the RoboticScope were used to perform the end-to-side nerve coaptation of the lateral antebrachial cutaneous nerve to the dorsal nerve of the clitoris with five epineural 9.0 Ethilon sutures. Arterial anastomosis to the deep inferior epigastric artery (DIEA) was completed in an end-to-end fashion with six 8.0 Ethilon sutures. Cephalic vein anastomosis to the great saphenous vein was performed manually in an end-to-end fashion using a 3.5-mm coupler. The time for nerve coaptation was 17 minutes; for arterial anastomosis, 26 minutes; and for vein anastomosis, 6 minutes. Time for flap ischemia was 157 minutes. Incision to closure was performed in 401 minutes. Symani's tremor elimination and motion scaling support precise arterial anastomosis and nerve coaptation. The additional degrees of freedom distal to the tips of the instruments enable flexible operation in deep planes, such as the periclitoral space. Combining Symani with a robotic exoscope enables a comfortable remote positioning for the surgeon. The presented case demonstrates feasibility and encourages further exploration to elucidate the potential benefits of this robotic-assisted technique.

An approach to the prevention and treatment of neuropathic pain at the radial forearm phalloplasty donor site

This article presents a comprehensive strategy for both the prevention and treatment of neuropathic pain at the radial forearm (RF) donor site. This strategy is presented within the framework of RF phalloplasty, based on the senior author’s practice and the premise that of all RF reconstructions, phalloplasty holds the greatest potential for postoperative neuropathic pain due to flap size and the inherent division of multiple antebrachial cutaneous nerves to provide for flap sensation. This proposed protocol offers a thorough care pathway that integrates techniques in peripheral nerve surgery with perioperative clinical strategies to prevent and treat neuropathic pain. Specific technical recommendations for the prevention and treatment of postoperative neuromas, compression neuropathies, and hyperalgesia of each peripheral nerve involved in RF phalloplasty flap harvest are proposed. These strategies can be adapted and applied to RF flaps utilized in other reconstructive areas.

The Diagnosis and Management of Meralgia Paresthetica: A Narrative Review.

Meralgia paresthetica (MP) is a sensory mononeuropathy affecting the lateral femoral cutaneous nerve. Diagnosis is typically made clinically, often utilising multiple diagnostic aids such as imaging and electrophysiology. Upon diagnosis, the management of MP follows the standard ladder, with conservative management first line, followed by steroid injection and finally surgery. Surgery may be neurolysis or neurectomy. A literature review of the PubMed database was performed identifying 594 papers regarding MP or the lateral femoral cutaneous nerve. Following a two-stage screening process and reference searching, 34 articles were included in this review, 11 discussing diagnosis and 23 discussing management. Despite the longstanding knowledge of MP, there remains limited comprehensive research discussing its diagnosis and management. Diagnosis of MP is based on clinical examination, imaging and electrophysiology. There is no obviously superior diagnostic strategy for MP. Once that diagnosis is made, the management strategy is typical of any condition, wherein a patient will move up the intervention ladder. It is apparent that conservative management and steroid injection are both adequate in most patients. Where these strategies fail, surgical options such as decompression, radiofrequency ablation or neurectomy are suitable for the majority of remaining patients. While both neurolysis and neurectomy are described as appropriate strategies, there is a scope for discussion regarding whether one is superior. Other management strategies such as botox, acupuncture and kinesio taping may have some value, but limited research exists on these strategies and further research into these is required.

Anatomical study of the innervation of the posterior elbow joint capsule: implications for ultrasound-guided peripheral nerve block and radiofrequency ablation procedures

IntroductionUltrasound-guided peripheral nerve block and radiofrequency ablation have been developed for pain management in various joints including the hip, knee and shoulder, but not the elbow. Precise three-dimensional (3D) localization...

Protein-based functional hydrogel improves cutaneous nerve repair and diabetic wound healing

Protein-based functional hydrogel improves cutaneous nerve repair and diabetic wound healing

Meralgia Paresthetica Secondary to Adnexa Cyst: A Case Report.

Meralgia paresthetica (MP) is an entrapment syndrome of the lateral femoral cutaneous nerve characterized by tingling, numbness, itching and burning pain, and dysesthesia in anterolateral aspect of thigh. In this case report, we present a 37-year-old non-obese female with 2-month history of progressive pain and tingling on the anterolateral side of right thigh. Clinical features of patient were consistent with MP, which was confirmed via electrodiagnostic study. Subsequent abdominopelvic and transvaginal sonography revealed a mass-like lesion measuring 92 × 61 mm in right adnexa adjacent to the right ovary. Following diagnosis, the patient underwent cystectomy, resulting in immediate resolution of symptoms. This case highlights the importance of comprehensive evaluation in patients presenting with MP symptoms, including consideration of abdominopelvic pathology as a potential contributing factor.

Micro Current Versus Trans Cutaneous Nerve Stimulation in Treatment of Post Herpetic Neuralgia

Micro Current Versus Trans Cutaneous Nerve Stimulation in Treatment of Post Herpetic Neuralgia

A Quasi-experimental Study of Optimized Retractor Management on the Incidence of Femoral Nerve Injury Following Gynecological Surgery.

Background Femoral neuropathy is a significant postoperative complication in gynecological surgery that can severely impact patient mobility and quality of life. Among various mechanisms of nerve injury, retractor-induced compression against the pelvic sidewall has been identified as a particularly crucial causative factor. Despite this well-recognized mechanism and its clinical importance, few studies have investigated specific preventive strategies for this iatrogenic complication. Objective This study aimed to evaluate the effectiveness of standardized modifications in retractor management protocols for reducing the incidence of retractor-associated femoral nerve injury following gynecological surgery for benign tumors. Methods This single-center quasi-experimental study compared two consecutive cohorts of patients undergoing gynecological surgery for benign tumors between February 2018 and July 2019. Women aged ≥20 years who received combined general and epidural anesthesia were eligible. The study consisted of two phases: an eight-month pre-intervention phase evaluating femoral nerve injury incidence under conventional retractor management (n = 107), followed by a 10-month post-intervention phase (n = 108) assessing the impact of three standardized protocol modifications, i.e., optimization of a hand-held retractor insertion depth, mandatory 30-minute intervals for retractor release, and conversion to non-metallic self-retaining abdominal wall retraction systems. Results Implementation of modified retractor management protocols resulted in a significant reduction in the incidence of femoral nerve injury from 6.5% (7/107 patients) to 0.9% (1/108 patients) (P = 0.035), with an odds ratio of 0.134 (95% CI: 0.012-0.807). All cases presented with unilateral neurological deficits confined to femoral and lateral femoral cutaneous nerve distributions, manifesting as quadriceps and iliopsoas muscle weakness with associated sensory disturbances. Complete neurological recovery was achieved in all cases within one to 12 months (mean duration: 5.5 ± 3.9 months). Conclusions This study demonstrates that implementing standardized modifications in retractor management protocols significantly reduces the risk of femoral nerve injury following gynecological surgery for benign tumors. The combination of optimized retractor depth, standardized release intervals, and non-metallic retraction systems provides a practical and effective approach to preventing this significant surgical complication. Future studies incorporating quantitative measures of retractor positioning and pressure may help establish standardized guidelines for optimal retractor management.

Meralgia Paresthetica: An Anatomical Review and Surgical Case Presentation Utilizing a Robotic Exoscope.

Meralgia paresthetica (MP) is a neuropathic condition marked by pain, tingling, and numbness in the anterolateral thigh, primarily caused by compression of the lateral femoral cutaneous nerve (LFCN). Although compression often occurs beneath the inguinal ligament, anatomical variations can lead to different entrapment sites. Treatments range from conservative measures to surgical decompression, depending on symptom severity. This study provides an anatomical review of the LFCN and presents a unique case of MP where the LFCN was compressed by the sartorius fascia rather than the typical site beneath the inguinal ligament. The study also explores the use of the Synaptive Modus X robotic exoscope for surgical decompression. This article presents a case study of a man in his 40s with a 15-year history of chronic MP symptoms, where the LFCN was atypically compressed by the sartorius fascia. Surgical decompression was performed using the robotic exoscope, a device offering high-definition, 3-dimensional visualization. At 13 weeks postoperatively, the patient experienced improvement in thigh sensation and no pain. He returned to baseline ambulation with no complications. The exoscope allowed precise identification of the LFCN's anatomy and compression site, proving effective in enhancing surgical precision. This is the first report of primary LFCN decompression using the Synaptive Modus X exoscope. The device provides excellent visualization, ergonomic benefits, and educational advantages, making it a valuable alternative to traditional microscopes and loupes in nerve decompression and other microsurgical procedures. Further studies are needed to assess its cost-effectiveness and broader applications in plastic surgery.

Analgesic effect of lateral femoral cutaneous nerve block to the pericapsular nerve group (PENG) block in primary total hip arthroplasty: a randomized clinical trial.

Adequate hip joint and surgical incision analgesia represent a challenge in the postoperative period of primary total hip arthroplasty (THA). This study aimed to evaluate whether the combination of the lateral femoral cutaneous nerve block (LFCN block) and the pericapsular nerve group block (PENG block) influences postoperative analgesia and rescue opioids, in primary THA surgeries. A trial was proposed with 74 patients for THA surgeries under spinal anesthesia, where 37 received PENG block (GPENG) and the other 37, PENG block and LFCN block (GPENG+LFC). The primary outcome was the presence and intensity of pain at rest and on movement, using the Numeric Rating Scale. The secondary main outcome was the total consumption of opioids. The follow-up was 48 h. Significantly fewer patients reported pain in the GPENG+LFC compared to GPENG: at rest, in 4 h (17 [45.95%] vs. 28 [75.68%] respectively, P=0.088), 12 h (4 [10.81%] vs. 17 [45.95%] respectively, P=0.016), and 24 h (4 [10.81%] vs. 13 [35.14%] respectively, P=0.0252); on movement, in 4 h (17 [45.95%] vs. 30 [81.08%] respectively, P=0.0002), 12 h (4 [10.81%] vs. 19 [51.35%] respectively, P=0.0003), and 24 h (5 [13.51%] vs. 14 [37.84%] respectively, P=0.0166). Total opioid consumption was significantly lower in GPENG+LFC compared to GPENG up to 48 hours postoperatively (1200 mg of tramadol and 6 mg of nalbuphine vs. 2400 mg and 21 mg respectively, P=0.0188). The combination of the LFCN block and the PENG block, compared to the sole PENG block, results in better analgesia at rest and on movement up to 24 h and a reduction in the total consumption of opioids up to 48 h after THA.

Intranasal Treatment with Cannabinoid 2 Receptor Agonist HU-308 Ameliorates Cold Sensitivity in Mice with Traumatic Trigeminal Neuropathic Pain.

Post-traumatic trigeminal neuropathy (PTTN) is a sensory abnormality caused by injury to the trigeminal nerve during orofacial surgery. However, existing analgesics are ineffective against PTTN. Abnormal microglial activation in the caudal part of the spinal trigeminal nucleus caudal part (Sp5C), where the central trigeminal nerve terminals reside, plays an important role in PTTN pathogenesis. Therefore, regulating microglial activity in Sp5C appears to be an important approach to controlling pain in PTTN. Cannabinoid receptor 2 (CB2) is expressed in immune cells including microglia, and its activation has anti-inflammatory effects. The current study demonstrates that the repeated intranasal administration of CB2 agonist HU-308 ameliorates the infraorbital nerve cut (IONC)-induced hyperresponsiveness to acetone (cutaneous cooling). The therapeutic efficacy of oral HU-308 was found to be less pronounced in alleviating cold hypersensitivity in IONC mice compared to intranasal administration, indicating the potential advantages of the intranasal route. Furthermore, repeated intranasal administration of HU-308 suppressed the activation of Sp5C microglia in IONC mice. Additionally, pretreatment with the CB2 antagonist, SR 144528, significantly blocked the anti-nociceptive effect of repeated intranasal administration of HU-308 on cold hypersensitization in IONC mice. These data suggest that the continuous stimulation of CB2 ameliorates PTTN-induced pain via the inhibition of microglial activation. Thus, CB2 agonists are potential candidates for novel therapeutic agents against PTTN.

Secukinumab Reduces Psoriasis-associated Pruritus and Regenerates the Cutaneous Nerve Architecture: Results from PSORITUS a Doubleblind, Placebo-controlled, Randomized Withdrawal Phase IIIb Study.

The occurrence of pruritus in psoriasis was previously underestimated but is a significant burden. Secukinumab (SEC), a monoclonal anti-interleukin-17A antibody, efficiently controls signs of psoriasis, but the effect on pruritus and cutaneous neuroanatomy remained unknown. The primary objective of this study (NCT02362789) was to evaluate the superiority of SEC treatment vs placebo on pruritus intensity (visual analogue scale; VAS). Furthermore, the treatment-dependent course of pruritus in association with absolute Psoriasis Area Severity Index (PASI) score, as well as cutaneous histopathology and neuroanatomy, was assessed. Open-label SEC 300 mg s.c. was administered regularly until week 16. Patients who reached a ≥ 98% PASI reduction (PASI ≥ 98) were randomized to receive either placebo or SEC up to week 32. Punch biopsies were collected from lesional psoriatic (baseline, weeks 16 and 32) and non-lesional (baseline) skin for histopathological and neuroanatomical analyses. VAS scores improved significantly after open-label SEC treatment but relapsed upon placebo (29.92 ± 33.8) compared with SEC (12.30 ± 22.6; p = 0.036). After SEC-dependent improvement in PASI, histopathology, marker expression and neuroanatomy, relapse was observed with treatment discontinuation in all parameters except neuroanatomy. SEC was superior to placebo by efficiently controlling reduced pruritus intensity, clinically normalizing skin lesions, and reversing histopathological abnormalities. The neuroanatomy recovered upon SEC and remained stable even after withdrawal.

Ultrasound-assisted Trigger Point Injection for Cutaneous Nerve Entrapment Syndrome.

Ultrasound-assisted Trigger Point Injection for Cutaneous Nerve Entrapment Syndrome.

Sural-to-medial femoral cutaneous amplitude ratio in early diagnosis of uremic neuropathy.

Medial femoral cutaneous (MFC) sensory nerve action potentials (SNAPs) can be easily recorded using distal stimulation. This study aimed to identify a new parameter using MFC SNAPs for the early electrophysiological diagnosis of length-dependent axonal polyneuropathy (LDAP) associated with uremic neuropathy. Patients with chronic renal failure who were referred to the electrodiagnostic laboratory due to symptoms suggesting polyneuropathy were included. Assessments encompassed neurological examination, Michigan Neuropathy Screening Instrument (MNSI), and Semmes-Weinstein monofilament test. Antidromic radial, median, ulnar, MFC, sural, and superficial peroneal sensory; median, ulnar, tibial, and peroneal motor nerve conduction studies were performed. Sural-to-radial amplitude ratio (SRAR) and sural-to-medial femoral cutaneous amplitude ratio (SMFCAR) were calculated, and their diagnostic sensitivities were compared with the age and sex matched healthy controls. Thirty-two chronic renal failure patients (mean age 60.0 ± 9.6 years) and 37 controls (60.6 ± 9 years) were included. MNSI indicated clinical polyneuropathy in 59.4% of patients, while sural SNAP amplitude was diagnostic in 78%. Median SRAR and SMFCAR values were significantly lower in patients than controls (p < .001 for both). The cut-off values for SMFCAR and SRAR were <1.82 and <0.30, respectively, both with a sensitivity of 59% and a specificity of 94%. Sural SNAP is the most sensitive parameter in the diagnosis of LDAP. SMFCAR is not superior to SRAR. If the sural SNAP amplitude is normal, SMFCAR can serve as an alternative to SRAR in dialysis patients with bilateral arteriovenous fistulae or in those unable to undergo radial NCS.

An earthquake reality: fasciotomy wounds and treatments

Earthquake-induced Crush Syndrome and subsequent acute kidney injury are important issues that affect morbidity and mortality. Fasciotomies prolong the length of stay in intensive care unit in patients with Compartment Syndrome due to the complications it causes. Infections and delayed wound healing are two common complications among these. Therefore, early closure of fasciotomy wounds is recommended. Although different treatments can be applied for treatment of wounds, data on this subject in pediatric patients are insufficient. We report the case of a 15-year-old girl who developed acute renal failure due to crush syndrome after being trapped in the wreckage for 9 hours and undergoing fasciotomy procedures for four locations, in the left extremity, two in the thigh and two in the cruris. Hemodialysis, antihypertensive, and antibiotic treatment were administered during the intensive care follow-up due to acute kidney injury, hypertension, and sepsis. With negative pressure therapy, silver alginate wound dressing, and hyperbaric oxygen therapy, all wounds epithelialized within two months. However, rehabilitation for drop foot syndrome caused by nerve cuts in the left extremity continues.