Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed.@*METHODS@#Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases.@*RESULTS@#All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes.@*CONCLUSION@#The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

Caracterización de la comunicación ulnar-mediano palmar profunda en una muestra con material cadavérico / Characterization of ulnar-median deep palmar communication in a sample with cadaveric material

RESUMEN: La comunicación Ulnar-Mediano Palmar Profunda (CUMPP) es la conexión entre la rama profunda del nervio ulnar (NU) y la rama del nervio mediano (NM) que inerva a los músculos tenares como la cabeza superficial del flexor corto del pulgar. Son escasos los trabajos que se ocupan de esta rama comunicante, y su prevalencia es reportada con una amplia variabilidad, en un rango del 16-77 %. Este estudio no probabilístico, descriptivo, transversal, evaluó la frecuencia y características morfológicas de la CUMPP en 106 manos de especímenes cadavéricos frescos no reclamados, a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga (Colombia). Se observó rama comunicante CUMPP en 39 especímenes (50,2 %), de los cuales 12 (44,5 %) fueron bilate- rales, 15 (55,6 %) unilaterales, con predominio unilateral derecho para 9 casos (60 %), sobre el izquierdo de tan solo 6 casos (40 %). No se evidenciaron diferencias estadísticamente significativas con relación al lado de presentación (P=0,223). En 21 especímenes (54 %) se observó el tipo IV; mientras que el tipo I fue encontrado en 4 casos (10 %). El promedio de la longitud de la rama comunicante fue de 24,67 DE 6,46 mm; mientras que la distancia del punto proximal de la CUMPP al surco distal del carpo fue de 41,4 DE 2,6 mm. Nuestros hallazgos no son concordantes con lo reportado en la mayoría de estudios previos. Diversos factores como el tamaño de las muestras, las diferentes metodologías de medición y las expresiones fenotípicas de cada grupo de población evaluado, pueden explicar la variabilidad de la CUMPP.

SUMMARY: Deep Palmar Ulnar-Medium Communication (DPUMC) is the connection between the deep branch of the ulnar nerve (UN) and the median nerve (MN) branch, that innervates the thenar muscles as the superficial head of the short flexor of the thumb. Few studies dealing with this communicating branch, and its prevalence is reported with a wide variability in the range of 16-77 %. This non-probabilistic, descriptive, cross-sectional study; evaluated the frequency and morphological characteristics of DPUMC in 106 hands of fresh unclaimed cadaveric specimens, that underwent necropsy at the Institute of Legal Medicine of Bucaramanga (Colombia). DPUMC communicating branch was observed in 39 specimens (50.2 %), of which 12 (44.5 %) were bilateral, 15 (55.6 %) unilateral, with right unilateral predominance for 9 cases (60 %), on the left of only 6 cases (40 %). There were no statistically significant differences in relation to the presentation side (P = 0.223). In 21 specimens (54%), type IV was observed; while type I was found in 4 cases (10%). The average length of the communicating branch was 24.67 SD 6.46 mm; while the distance from the proximal point of the DPUMC to the distal carpal groove was 41.4 SD 2.6 mm. Our findings are not consistent with those reported in most previous studies. Various factors such as sample size, different measurement methodologies and phenotypic expressions of each population group evaluated can explain the variability of the DPUMC.

Teres minor innervation and injection site / Inervación y sitio de inyección del músculo redondo menor

The aim of this study was to elucidate the injection point on the teres minor (TM) for effective injection. Thirty-two specimens from 16 adult Korean cadavers (10 males and 6 females, age ranging from 42 to 102 years) were used in the study. The reference line between the inferior point on the inferior angle of the scapula (IA) and the most prominent point on the acromial angle of the scapula (AA) on the surface were identified. The measurements expressed the two above-mentioned parameters as X and Y coordinates in relation to the reference line. The X coordinate was located at 128.1±10.4 mm (78.1±5.7 %) and the Y coordinate was located at 25.3±7.6 mm (15.5±4.8 %). The recommended site according to this can be used for injections in patients with TM stiffness.

El objetivo fue determinar el punto de inyección en el músculo redondo menor (MRM) para llevar a cabo una correcta inyección. Se utilizaron 32 muestras correspondientes a 16 cadáveres adultos coreanos (10 hombres y 6 mujeres, entre 42 a 102 años de edad). Se identificó en la superficie la línea de referencia entre el punto inferior en el ángulo inferior de la escápula (AI) y el punto más prominente en el ángulo acromial de la escápula (AA). Las mediciones expresaron los dos parámetros mencionados anteriormente como coordenadas X e Y en relación con la línea de referencia. La coordenada X se encuentra a 128,1±10,4 mm (78,1±5,7 %) y la coordenada Y estaba situada a 25,3±7,6 mm (15,5±4,8 %). El sitio recomendado de acuerdo a estos resultados se puede usar para preparaciones inyectables en pacientes con rigidez del MRM.

Auriculotemporal and greater auricular nerve blocks have roles in patients with Ramsay Hunt syndrome with trigeminal nerve involvement: A report of two cases

Ramsay Hunt syndrome (RHS) refers to herpes zoster infection of the geniculate ganglion of the facial nerve. Cases complicated by multicranial nerve involvement in the process of reactivation of the virus, which are known to show virulent clinical course and worse prognosis, are not common in literature as in practice, and there has been only one reported case of suspected co-involvement of the trigeminal nerve in Korean literature. Therefore, in cases of RHS with severe rash over the face and neck, it is pertinent to give consideration to such multiple involvement in their early presentation. Facial nerve palsy and herpes related pain are the two worrisome complication, which could be alleviated by early treatment with neural blockade in addition to oral medication. Especially, nerve blocks are known to decrease the extent of nerve inflammation or damage, thereby facilitating recovery and probably preventing postherpetic neuralgia. We report two rare cases of Ramsay Hunt syndrome with trigeminal nerve involvement, where early implementation of blockade of somatic peripheral nerve branches, in addition to the conventional treatment, promoted early recovery.

Morphology and topography of the lingual nerve in Koreans

Two major salivary glands, submandibular duct, lingual nerve, and vessels are situated beneath the mouth floor. Among these, passing through the pterygomandibular space, lingual nerve is innervated to the lingual gingiva and the mucosa of mouth floor, and is responsible for the general sensation of the anterior two thirds of the tongue. So, the injury of the lingual nerve during an anesthesia or surgery in the retromolar area may cause complications such as a numbness, a loss of taste of the tongue and the other dysfunctions. Therefore, to find out the morphology and the course of lingual nerve and to clarify the topographical relationships of lingual nerve at the infratemporal fossa and paralingual space area, 32 Korean hemi-sectioned heads were dissected macroscopically and microscopically with a viewpoint of clinical aspect in this study. This study demonstrated various anatomical characteristics with relation to the course and topography of the lingual nerve in Koreans. And clinical significances based on the anatomical variations through the topography of the courses and communications between the mandibular nerve branches were described in details.

THE INDIRECT PATHWAY OF THE SOMATIC AFFERENT ELEMENTS FROM TRIGEMINAL NERVE TO NUCLEUS TRACTUS SOLITARII——A LIGHT AND ELECTRON MICROSCOPIC HRP TRANSGANGLIONIC AND RETROGRADE TRACING STUDY / 解剖学报

The indirect pathway of the somatic afferent elements from trigeminal nerve (TGN) to nucleus tractus solitarii (NTS) was studied with the light and electron microscopic HRP transganglionic and retrograde tracing. After HRP was injected into NTS at the level of obex, the retrogradely labeled cells were mainly found in the interstitial nucleus buried in the spinal tract of TGN along caudal subnucleus. The interstitial nucleus was also the terminating area of the primary afferent fibers of lingual and inferior orbital nerves. Under electron microscope, it was found that the primary afferent terminals of lingual and inferior orbital nerves formed synapses on the dendrites of neurons in the interstitial nucleus. Moreover, in cellular architecture, the interstitial nucleus and the superficial laminae of the caudal nucleus of TGN were similar and continuous with each other. Hence, the pathway from the TGN to NTS via the interstitial nucleus is consisted of two neurons and the sensations transmitted through this pathway may be considered to be somatic. It is presumed that this pathway composed of two neurons might modulate the visceral afferent function in NTS when certain points in the skin area innervated by TGN were acupunctured.