Anatomical study of rectus abdominis muscle and its clinical application

To study the neurovascular anatomy of the rectus abdominis muscle with reference to their relation to tendinous intersections of the muscle. Eight human cadavers were injected with latex/lead oxide mixture into the superior epigastric artery and external iliac artery. The vascular architecture of the superior and deep inferior epigastric arteries was studied together with the nerve supply of rectus abdominis muscle. The superior epigastric supplied the upper part of rectus muscle. It pierced the rectus muscle between the first and second tendinous intersections. The inferior epigastric artery had 3 patterns of branching; Type I the artery ascended as a single stem parallel to the muscle fibers [in 37.5% of cases]; Type II the vessel divided into 2 branches of different size after giving a perimuscular branch to the lower portion of rectus [in 50% of cases]; The medial branch was short and small to supply the lower medial portion of rectus while the lateral branch was longer with larger diameter. It ran parallel to the muscle fibers to a level above the umbilicus. Type III the deep inferior epigastric artery divided into 3 branches [in 12.5% of cases], the lower one was the smallest. The other 2 branches were of the same caliber, the medial one was short never reach the umbilicus supplying the lower medial portion of the muscle, and the lateral one was longer, ran parallel to the muscle fibers to a level above the umbilicus. The rectus muscle was innervated by lower thoracic spinal nerves in a segmental manner. The muscular perforators arranged in a vertical row from the posterior rectus sheath to the deep surface of rectus. The point of their perforation to the muscle corresponded approximately to the vascular axis which situated at the junction of lateral 1/3 and medial 2/3 of rectus. The perforators of the anterior rectus sheath to skin arranged also in a vertical row lateral to mid line of rectus above the umbilicus and medial to mid line below the umbilicus. Both the superior and deep inferior epigastric arteries supplied the rectus abdominis. The inferior epigastric artery was more reliable than the superior epigastric artery, as it was easily accessible and easily separated from the muscle with minimal damage. It can be used for free tissue transplantation to perineum, genital area and the abdominal wall. A strip of anterior rectus sheath, should be preserved between the intersections to prevent rupture of the vulnerable rectus abdominis and its vessels due to presence of substantial connective tissue within the muscle between the tendinous intersections. During obtaining muscle flaps, denervation of the remaining muscle occurred if more than medial half of the muscle was taken with the flap, due to vertical arrangement of segmental nerve supply of the rectus at the junction of lateral 1/3 with the medial 2/3

Anatomical study of gracilis muscle: arterial findings enhance graciloplasty

To study the neurovascular anatomy of gracilis and to search for different pedicles of suitable size, proximal to dominant pedicle, which could support blood flow to the whole gracilis. Twelve lower limbs obtained from 6 human cadavers were injected with latex/lead oxide mixture into the femoral arteries. The gracilis muscles were dissected, marking the arterial and venous supply, and the nerve entry points. The overall length of the muscle and the length of its tendon were measured. The overall length of musculotendinous unit of gracilis was 42 to 44 cm. The tendon comprised 6 to 8 cm. The main arterial supply to the muscle entered 9-12 cm from the pubic tubercle [diameter, 0.1-0.3 cm]. It arised from the profundafemoris artery and passed between the adductor longus and brevis to enter the upper third of the muscle. The middle pedicle entered the middle of the muscles 19 to 21.5 cm from the pubic tubercle [diameter 0.1 to 0.2cm]. It originated from the femoral artery, passed on the lower border of adductor longus. The distal pedicle was the smallest one, originated from the femoral artery on the lower border of adductor magnus deep to sartorius. It entered the lower part of gracilis. There were additional 2 pedicles found in 2 lower limbs of the same cadaver. One pedicle was proximal to the dominant pedicle and the other was inferior to the middle pedicle. The former was of 0.2 cm in diameter. It originated from the profundafemoris artery in one limb and from the medial femoral circumflex artery in the other limb. Both entered the muscle 3.3 cm or 3.5 cm inferior to the pubic tubercle. The other pedicle arised from the femoral artery. It supplied the sartorius muscle and entered the gracilis below its middle. The motor nerve arised from obturator nerve and entered the muscle in association with the main pedicle. The neurovascular anatomy of gracilis was found to be remarkably consistent from specimen to specimen varying only in the length of muscle and tendon, and the number of minor pedicles supplying it. The existence of proximal pedicle of suitable diameter suggests that it might be able to support the whole gracilis without supply from the main pedicle. This study confirms the suitability of gracilis for segmental functional muscle transfer