The common fibular nerve (and its branches) in fetuses / El nervio fibular comun (y sus ramos) en fetos

The common fibular nerve (CFN), is a branch of the sciatic nerve (SN) that exits the popliteal fossa and is located at the tuberculum of the fibula. At the tuberculum of the fibula, the CFN bifurcates into deep (DFN) and superficial (SFN) fibular nerves. Forty fetuses were micro-dissected to (i) describe the course of the CFN in relation to the tuberculum and neck of the fibula in fetuses; (ii) describe the branches, distribution and relation of the DFN and SFN to muscles within the anterolateral compartment of the leg. The CFN, DFN and SFN were present in all specimens dissected; the CFN measured a mean length (mm) of 16.03 and 16.69 on the right and left sides respectively. Bifurcation of the CFN related to the tuberculum of fibula (right; left) - above 20/80 (25%); 14/80 (17.5%); below 6/80 (7.5%); 10/80 (12.5%) and at the tuberculum 54/80 (67.5%); 56/80 (70%). The DFN bifurcated into medial and lateral branches in 68/80 (85%) and 54/80 (67.5%) on the right and left sides, respectively. The SFN bifurcated into a medial branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively and a lateral branch in 78/80 (97.5%) and 76/80 (95%) on right and left sides, respectively. The course and distribution of the CFN, DFN and SFN were consistent with the literature reviewed and descriptions found in standard anatomical textbooks. However, our findings show that the DFN has a variable number of branching patterns, which is unique to this fetal study and an intermediate branch of the SFN which was recorded in 3/80 cases.

El nervio fibular común (NFC), es un ramo del nervio isquiático (NI) que sale de la fosa poplítea y se ubica a nivel de la cabeza de la fíbula. A ese nivel, el NFC se bifurca en los nervios fibular profundo (NFP) y superficial (NFS). Cuarenta fetos fueron micro disecados para (i) describir el curso del NFC en relación con la cabeza y cuello de la fíbula en fetos; (ii) describir los ramos, distribución y relación del NFP y NFS con los músculos dentro del compartimento anterolateral de la pierna. El NFC, NFP y NFS estuvieron presentes en todos los especímenes disecados; el NFC presentó una longitud promedio de 16,03 y 16,69 (mm) en el lado derecho e izquierdo, respectivamente. La bifurcación del NFC se relacionó con la cabeza de la fíbula del lado derecho e izquierdo: por encima en 25% y 17,5%; por debajo 7,5% y 12,5 % y a nivel de la cabeza en 67,5 % y 70%. El NFP se bifurcó en ramos medial y lateral en un 85% en el lado derecho y 67,5% en el izquierdo. El NFS se bifurcó en una ramo medial en el 97,5% y 95% en los lados derecho e izquierdo, respectivamente, y un ramo lateral en el 97,5% y 95% del lados derecho e izquierdo, respectivamente. El curso y distribución del NFC, NFP y NFS coincidieron con la literatura revisada y textos de anatómia normal. Sin embargo, observamos que el NFP tiene un número variable de patrones de ramificación, único para este estudio fetal y un ramo intermedio del NFS que fue visto en 3/80 casos.

Aggressive fibromatosis - impact of prognostic variables on management : general surgery

Objective. To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation. Materials and methods. Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed retrospectively. There were 14 males and 28 females. The lesions involved the head and neck in 6 cases(14); the thorax in 6 (14); the extremities in 19 (45) and the abdomen in 11 (26). Thirty-seven patients (88) presented to the clinic for the first time; whereas 5 (12) had recurrent disease at presentation. Fifteen patients (36) underwent excision only; 15 (36) had excision followed by postoperative radiation; 8 (19) had biopsy only; and 4 (9) had radiation only. The median dose of radiation was 60 Gy (range 9 - 70 Gy). Results. One patient had local failure following excision and postoperative radiation therapy. The local control was 100for surgery alone and 86for surgery followed by postoperative radiation at 24 months. On univariate analysis; age; sex; positive margins; primary or recurrent presentation; site of involvement and initial treatment did not affect local control significantly. Eight of 19 patients (42) receiving radiation developed severe moist desquamation following treatment; and all these patients had doses of 60 Gy or more. Conclusion. Surgery with or without radiation therapy gave excellent local control. The addition of radiation therapy to surgery as well as other known prognostic parameters did not impact on local control. The morbidity of radiation treatment is considerable; as noted in this series; and adjuvant radiation therapy should therefore be considered only in situations where the risk of recurrence and the morbidity of re-excision are high