Morphological Classification of the Sagittal Tendon Plate in the Soleus Muscle in Japanese Cadavers / Clasificación Morfológica de la Lámina Tendinosa Sagital del Músculo Sóleo en Cadáveres Japoneses

SUMMARY: The human soleus muscle has attracted attention in the fields of sport science, rehabilitation medicine, etc. for improving exercise performance in training, preventing injuries, and rehabilitation. The sagittal tendon plate of the soleus muscle is particularly important in rehabilitation. Few studies, however, have evaluated the shape of the sagittal tendon plate in the human soleus muscle in detail and attempted to classify its variations based on its morphology. In this study, we conducted a detailed analysis of the morphology of the sagittal tendon plates in soleus muscle specimens from Japanese cadavers and constructed a morphology-based classification system and evaluated their frequencies of occurrence. First, the specimens were divided into those with a sagittal tendon plate that was visible on the anterior surface (pennate muscle group) and those without (non-pennate muscle group). Next, based on the "number" and "breadth" of the sagittal tendon plates, the pennate muscle group specimens were further classified into four classes: Class I (one tendon, thin), Class II (one tendon, slightly broad), Class III (one tendon, very broad), and Class IV (two tendons, thin). Subsequently, the specimens were further divided into three types based on the position where the sagittal tendon plate joined the Achilles tendon: median tendon type, lateral tendon type, and medial tendon type (a total 13 divisions). When 458 Japanese soleus muscle specimens were classified into these divisions, the occurrence frequencies of Class I-IV were 80.57 %, 4.59 %, 5.46 %, and 1.09 %, respectively. In Class I, the median tendon type was more frequent than the lateral and medial tendon types, accounting for 48.47 % overall. The classification types of the sagittal tendon plate and their respective occurrence frequencies shown in this study are expected to serve as fundamental data in implementing rehabilitation of soleus muscle.

El músculo sóleo humano ha atraído la atención de la ciencia del deporte, la medicina de rehabilitación, etc. para mejorar el rendimiento del ejercicio en el entrenamiento, prevenir las lesiones y rehabilitación. La lámina tendinosa sagital del músculo sóleo es particularmente importante en la rehabilitación. Sin embargo, pocos estudios han evaluado en detalle la forma de la placa lámina sagital en el músculo sóleo humano y han intentado clasificar sus variaciones en función de su morfología. Realizamos un análisis detallado de la morfología de las láminas de los tendones sagitales en muestras de músculo sóleo de cadáveres japoneses y construimos un sistema de clasificación basado en la morfología y, además, evaluamos su frecuencia de aparición. Los especímenes se dividieron en aquellos con una lámina de tendón sagital que era visible en la superficie anterior (grupo muscular pennado) y aquellos sin (grupo muscular no pennado). A continuación, según el "número" y el "ancho" de las láminas de los tendones sagitales, las muestras del grupo de músculos pennados se clasificaron en cuatro clases: Clase I (un tendón, delgado), Clase II (un tendón, ligeramente ancho), Clase III (un tendón, muy ancho) y Clase IV (dos tendones delgados). Posteriormente, las muestras se dividieron en tres tipos, según la posición donde la lámina del tendón sagital se unía al tendón calcáneo: tipo de tendón mediano, tipo de tendón lateral y tipo de tendón medial (un total de 13 divisiones). En estas divisiones se clasificaron 458 especímenes de músculo sóleo de indiviuos japoneses, las frecuencias de ocurrencia de Clase I-IV fueron 80,57 %, 4,59 %, 5,46 % y 1,09 %, respectivamente. En la Clase I, el tipo de tendón mediano era más frecuente que los tipos de tendón lateral y medial, representando el 48,47 % del total. Se espera que los tipos de clasificación de la lámina del tendón sagital y sus respectivas frecuencias de aparición, que se reportan en este estudio, sirvan como datos fundamentales para implementar la rehabilitación del músculo sóleo.

Biometría del nervio para el músculo sóleo y sus implicancias clínicas / Nerve biometry for the soleus muscle and its clinical implications

RESUMEN: Las lesiones del nervio fibular común y/o sus ramos derivados trae como consecuencia, pérdida total o parcial de la capacidad para realizar flexión dorsal del complejo tobillo-pie, una opción viable para tratar esta patología es la transferencia nerviosa, que consiste en utilizar un nervio donante para restaurar la función de un nervio dañado. Es frecuente la utilización del nervio para el músculo sóleo (NS) como donante para restaurar la función del nervio fibular común o profundo, por lo cual es indispensable conocer en detalle la anatomía de este nervio. Se utilizaron 22 miembros inferiores pertenecientes a las Unidades de Anatomía de las Universidades de Chile y de Santiago, Chile. Se realizó disección del nervio para el músculo sóleo, se observó número de ramos principales y secundarios, así como también se registró su origen y la longitud de ellos, además se dividió a la pierna en cuadrantes para determinar la localización de los puntos motores. El nervio para el músculo sóleo en la mayoría de los casos (95,4 %) es único y se origina desde el nervio tibial o en tronco común con otro ramo muscular. La distancia promedio entre el origen de NS y la línea biepicondilar fue de 28,77 mm; la longitud promedio de NS hasta su división en ramos secundarios o penetración directa fue de 52 mm. El NS se dividió en ramos secundarios (RS), observándose que en 12 casos fue en 2 RS, en 3 casos en 3 RS y en 7 casos no hubo RS. Los puntos motores se localizaron en el quinto proximal de la pierna, 23 casos en el primer cuadrante lateral y 4 casos en el primer cuadrante medial; en el cuarto proximal de la pierna, 7 casos en el segundo cuadrante lateral y 4 casos en el segundo cuadrante medial. Los datos obtenidos serán un aporte al conocimiento anatómico y a la cirugía reconstructiva de los nervios de la región.

SUMMARY: Injuries to the common fibular nerve and/or its derived branches result in total or partial loss of the ability to dorsiflex the ankle-foot complex. A viable option to treat this pathology is nerve transfer, which consists of using a donor nerve to restore function to a damaged nerve. The use of the nerve for the soleus muscle (SN) is frequent as a donor to restore the function of the common or deep fibular nerve, for which it is essential to know in detail the anatomy of this nerve. Twenty-two lower limbs belonging to the anatomy units of the Universities of Chile and Santiago were used. Dissection was performed until the SN was reached, the number of main and secondary branches (SB) was observed, as well as their origin and length, and the leg was divided into quadrants to determine the location of the motor points. The SN in most cases (95.4 %) is unique and originates from the tibial nerve or from the common trunk with another muscular branch. The average distance between the origin of the NS and the biepicondylar line was 28.77 mm; the average length of NS until its division into SB or direct penetration was 52 mm. The NS was divided into SB, observing that in 12 cases it was in 2 branches, in 3 cases in 3 branches and in 7 cases there were no SB. The motor points were located in the proximal fifth of the leg, 23 cases in the first lateral quadrant and 4 cases in the first medial quadrant; in the proximal quarter of the leg, 7 cases in the second lateral quadrant and 4 cases in the second medial quadrant. The data obtained will be a contribution to anatomical knowledge and reconstructive surgery of the nerves of the region.

Anthropometry of the black adult tibia: a South African study / Antropometría de la tibia del negro adulto: un estudio sudafricano

The tibia is the medial long bone of the leg and is characterized by a shaft and two expanded extremities. Despite the recent advent of tibial bone graft harvesting, the tibia has also been confirmed to be of great forensic significance. As this appears to be the only tibial dry bone study done in Southern Africa, this study aimed to investigate morphological and morphometric parameters that are of clinical and anthropometric importance. Morphological and morphometric examination of 302 adult tibial bone specimens of Black South Africans obtained from the osteological bank of the Discipline of Clinical Anatomy at the University of KwaZulu-Natal was performed. The sample consisted of 168 males and 134 females with an age range of 15 to 87 years old. The number of nutrient foramina were: (a) One (male: 98.2%; female: 99.3%); (b) Double (male: 1.8%; female: 0.7%); Relationship of nutrient foramen to the soleal line: (a) infero-medial (male: 0.6%; female: 1.5%); (b) inferior but directly opposite the middle of the bone (male: 8.2%; female: 2.2%); (c) infero-lateral (male: 81.8%; female: 88.9%); (d) infero-lateral, along interrosseous crest (male: 4.1%; female: 3.0%); (e) supero-medial (male: 4.7%; female: 3.7%); (f) supero-medial, along interrosseous crest (male: 0.6%; female: 0%); (g) supero-lateral (male: 0%; female: 0.7%). Statistically significant differences were recorded in tibial morphometric parameters between males and females. The relationship between the number of nutrient foramina and the soleal line was of statistical significance (p= 0.002). The greater prevalence of a single foramen observed in this study compared favorably with that reported in previous literature. The recognition of the regional distribution of the nutrient foramina may prevent injury during tibial bone graft procedures. A thorough understanding of the tibial anatomy may also assist with the provision of demographic data required in forensic investigation.

La tibia es el hueso largo y medial de la pierna, con un eje y dos extremos expandidos. Además de ser considerado como posible donante de injerto, se ha confirmado su importancia en el ámbito forense. Este estudio tuvo como objetivo investigar los parámetros morfológicos, morfométricos y antropométricos de la tibia que son de importancia clínica. Se llevó a cabo un examen morfológico y morfométrico de 302 muestras de tibias perteneciente a negros sudafricanos adultos, obtenidas desde el banco osteológico del Departamento de Anatomía Clínica de la Universidad de KwaZulu-Natal. La muestra estuvo constituída por 168 hombres y 134 mujeres, con un rango etario entre 15 y 87 años. El número de forámenes nutricios fueron los siguientes: (a) Únicos (hombres: 98,2%; mujeres 99,3%); (b) Doble (hombres: 1,8%; mujeres: 0,7%). La relación del foramen nutricio con la línea del sóleo fue: (a) infero-medial (hombres: 0,6%; mujeres: 1,5%); (b) inferior y anterior a la mitad inferior del hueso (hombres: 8,2%; mujeres: 2,2%); (c) infero-lateral (hombres= 81,8%; mujeres= 88,9%); (d) infero-lateral, a lo largo del margen interóseo (hombres: 4,1%; mujeres: 3,0%); (e) supero-medial (hombres: 4,7%; mujeres: 3,7%); (f) supero-medial, a lo largo del margen interóseo (hombres: 0,6%; mujeres: 0%); (g) supero-lateral (hombres: 0%; mujeres: 0,7%). Estadísticamente, se registraron diferencias significativas en los parámetros morfométricos tibiales entre hombres y mujeres. La relación entre el número de forámenes nutricios y la línea del sóleo tuvo significación estadística (p= 0,002). La mayor prevalencia de un solo foramen nutricio observada en este estudio, se compara favorablemente con los casos reportados en la literatura analizada. El reconocimiento de la distribución regional de los forámenes nutricios puede evitar lesiones durante los procedimientos de injerto de hueso tibial. Un conocimiento profundo de la anatomía de la tibia también puede aportar datos demográficos necesarios para la investigación forense.

Tratamento das áreas cruentas de perna com retalhos locais / Treatment of open wounds of the leg by using local flaps

INTRODUÇÃO: Até os anos 70, a reparação de perdas de substância na perna representava, quase sempre, um problema de solução muito difícil ou, até, insolúvel. Atualmente, embora ainda constitua um campo para os mais experientes, as áreas cruentas na perna já contam com várias técnicas confiáveis e algumas relativamente simples para sua reparação. Este trabalho visa equacionar condutas reparadoras de feridas de perna, utilizando tecidos locais. MÉTODO: Estudo retrospectivo pela análise de casos de reconstrução de perna com retalhos locais realizados pelos autores. Foram incluídos os retalhos dermoadiposos, fasciocutâneos, fasciossubcutâneos e musculares. RESULTADOS: Foram operados 70 pacientes que possuíam áreas cruentas na perna, em consequência de fratura de tíbia, osteomielite, perda tecidual isquêmica, úlcera crônica e tumoração de pele. Os resultados foram avaliados segundo etiologia, tipo de procedimento cirúrgico e complicações. CONCLUSÕES: A opção do tratamento de áreas cruentas de membros inferiores com retalhos locais é bastante válida. A escolha do retalho vai depender de condições locais da perna e da região anatômica afetada. No terço superior da perna, utilizamos retalhos fasciocutâneos baseados na rede vascular do joelho ou retalho de gastrocnêmio. Já no médio, os principais retalhos foram o solear e o fasciossubcutâneo de panturrilha. E, por fim, no inferior, o principal retalho usado foi o fasciossubcutâneo de panturrilha.

INTRODUCTION: Until the 70s, repairing loss of tissue in the leg was almost always difficult, or even impossible. Currently, only the most experienced surgeons are able to repair open wounds of the leg. Nevertheless, several reliable and simple techniques are currently available. This work aimed to evaluate repair techniques for leg wounds by using local tissues. METHOD: The authors performed a retrospective study of cases of leg reconstruction using local flaps. Dermoadipose, fasciocutaneous, fasciosubcutaneous, and muscle flaps were used. RESULTS: Seventy patients who had open areas in the leg due to tibial fractures, osteomyelitis, ischemic tissue loss, chronic ulcer, or skin tumor underwent surgery. Results were evaluated according to etiology, type of surgical procedure, and complications. CONCLUSIONS: The option of treating open wounds of the lower limbs by using local flaps is very valid. Selection of the flap type depended on local conditions in the leg, and the anatomical region affected. In the upper third of the leg, we used fasciocutaneous flaps, based on the vascular network of the knee, or gastrocnemius flaps. In the middle third of the leg, we used the soleus muscle as the primary flap, and fasciosubcutaneous flaps in the calf region. In the lower third of the leg, a fasciosubcutaneous flap of the calf was primarily used.

Influência de posições do joelho no torque e atividade mioelétrica do tríceps sural na flexão plantar isométrica máxima / Influence of knee positions on torque and myoelectric activity of triceps surae at maximum isometric plantar flexion

Os objetivos do estudo foram comparar o torque isométrico máximo de flexão plantar, em duas posições de joelho e analisar a variação da atividade miolétrica dos músculos do tríceps sural nas duas condições. A amostra composta de 14 homens saudáveis. O pé direito dos participantes foi fixado ao adaptador do aparelho isocinético com o tornozelo em 90 graus. Duas contrações isométricas voluntárias máximas de cinco segundos foram obtidas para cada posição do joelho: estendido e com 90 graus de flexão. Foram analisados o pico de torque flexor plantar médio e o valor RMS do sinal eletromiográfico (EMG) dos três segundos intermediários do gastrocnêmio lateral (GNL), gastrocnêmio medial (GNM) e sóleo para cada posição. Os torques médios nas posições de joelho em extensão e flexão foram 100,4 ± 17,4 Nm e 72,6 ± 18,4 Nm, respectivamente. Os gastrocnêmios apresentaram uma redução do valor RMS relativo com o joelho em flexão (40,5 ± 10,5 e 31,7 ± 25,6% para o GL e GM, respectivamente) enquanto o sóleo aumentou nessa condição (35,6 ± 28,9%). A redução do torque de flexão plantar parece estar associada ao resultado de um compromisso entre a inibição da atividade mioelétrica dos GNM e GNL, e otimização da ativação do sóleo. Os resultados podem contribuir no auxílio da prescrição de exercícios direcionados para o tríceps sural, enfatizando a ativação de diferentes músculos com variações no ângulo articular do joelho.

The aim of this study was to compare the maximum torque of plantar flexors using two knee positions and analyze the mioelectric activity variation of the muscles in both conditions. The sample was composed of 14 healthy men. The participants were positioned on the dynamometer with the right foot attached to the adapter in neutral position (ankle at 90º). Two five seconds of two consecutives maximum isometric voluntary contractions were obtained for each knee position: full extended and 90o. The gastrocnemius lateralis (GNL), medialis (GNM) and soleus RMS value of eletomyography signal and the plantar flexor peak torque average were acquired during three intermediate seconds. The average torques in the knee positions of extension and flexion were 100.4 ± 17.4 Nm and 72.6 ± 18.4 Nm respectively. With the knee flexed, the gastrocnemius presented a decreased activation (40.5 ± 10.5 e 31.7 ± 25.6% for lateral and medial, respectively) while the soleus showed an increased (35.6 ± 28.9%). The reduction of torque appears to result from a compromise between the inhibition of myoelectric activity of the gastrocnemius medialis and lateralis, while the soleus activation is optimized. The results may contribute to exercise prescription plantar flexors muscles emphasizing the different muscles activation varying the knee position.

Efeito do treinamento concorrente nas fibras musculares de ratos Wistar / Efecto del entrenamiento concurrente en fibras musculares de las ratas Wistar / Concurrent training effect on muscle fibers in Wistar rats

The aim of the present study was to determine the modeling of muscle fibers in rats submitted to different exercise protocols. Fifty-five Wistar rats were submitted divided into four different groups: Control group (CG; N=16); endurance training group (ETG; N=13), strength training group (STG; N=13) and concurrent training group (CTG; N=13). The intensity of endurance training was determined by the critical workload. Statistical analysis involved the Kruskal-Wallis test for multiple comparisons, followed by Dunn's post test (p<0.05). All animals submitted to training exhibited an increase in the cross-sectional area of the muscle fibers. The largest increase (p>0.05) occurred in the STG and CTG at both four (mean:2952,95 ± 878,39 mean:2988,84 ± 822,58) and eight weeks respectively (mean:3020,26 ± 800.91; mean:3104,91 ± 817,87). The findings demonstrate similar results obtained with strength training and concurrent training, with a greater increase in muscle fiber area in both groups in comparison to the control group and group submitted to endurance training.

O objetivo deste estudo foi observar a modelação das fibras musculares de ratos submetidos a diferentes protocolos de treinamento físico. Foram utilizados 55 animais da raça Wistar, dos quais foram submetidos a quatro diferentes tratamentos, sendo estes: o grupo controle (CTLE), treinamento aeróbio (TAE), treinamento de força (TAN) e treinamento concorrente (TCc). A intensidade do treinamento aeróbio foi determinada pela carga crítica de trabalho. Utilizou-se o teste de Kruscal-Wallis para comparações múltiplas, com pós-teste de Dunn, adotou-se o valor de significância de 5% (p=0,05). Observou-se que os grupos de animais treinados mostraram aumento na área de secção transversa (AST) das fibras musculares. Não foi verificada diferença significante (p>0,05) entre os grupos TAN e TCc, tanto em quatro (média:2952,95 ± 878,39 média:2988,84 ± 822,58) como após oito semanas (média:3020,26 ± 800,91; média:3104,91 ± 817,87). Os protocolos de TAN e TCc não se diferenciaram entre si e demonstraram aumento da AST quando comparados aos demais grupos de animais.

Nota el modelado de las fibras musculares en ratas sometidas a diferentes protocolos del entrenamiento físico. Se utilizaron 55 ratas Wistar, que fueron sometidas a cuatro tratamientos diferentes: grupo de control (CTLE), entrenamiento aeróbico (TAE), entrenamiento de fuerza (TF) y la entrenamiento concurrente (TC). La intensidad de entrenamiento aeróbico se determinó por el carga crítica del trabajo. Se utilizó la prueba Kruscal-Wallis para comparaciones múltiples con Dunn del postest, se adoptó el nivel del significancia en 5% (p=0,05). Se observó que lós grupos de animales entrenados mostraron una mayor área de sección transversal (AST) en las fibras musculares. No hubo diferencia significativa (p>0,05) entre el TF y TC, tanto en cuatro (media:2952,95 ± 878,39; media:2988,84 ± 822,58) y después de ocho semanas (media:3020,26 ± 800,91; media:3104,91 ± 817,87). Se concluyó que los protocolos de TF y TC no difirieron. Además, demostraron aumento del AST en comparación con los otros grupos de animales.

El uso de colgajos en la reconstrucción de defectos de cobertura en la pierna distal y dorso de pie / The use of flaps in the reconstruction of defects of coverage in the distal leg and dorsum of the foots

Resumen Objetivo: Mostrar las posibilidades quirúrgicas que existen en el tercio distal de la pierna y presentar la experiencia en los últimos 15 años con estos colgajos. Materiales y métodos: Se revisó durante 15 años los colgajos de sóleo directo e invertido, fasciocutáneos, de sural invertido y algunos colgajos libres para cubrir defectos en el tercio distal de la pierna y pie. Resultados: Se revisó a 112 pacientes con seguimiento mínimo de 3 meses; 18 tenían compromiso del tobillo y pie y el resto tenía exposiciones de tendones y/o de elementos neurovasculares. Los colgajos más usados fueron el sóleo, el sural invertido y el fasciocutáneo invertido. Se presentaron complicaciones menores, como necrosis distal de bordes, en cuatro colgajos, sin afectar la cobertura final. Un colgajo libre sufrió necrosis total. Discusión: Fracturas abiertas de tibia requieren cobertura rápida para disminuir los índices de infección y favorecer la curación. El sóleo sigue siendo de los más usados entre los colgajos locales para los defectos del tercio medio de la tibia. En esta serie se muestra que es apto para muchas reconstrucciones en la pierna distal, ya que se evita muchas veces el uso de un colgajo libre. El colgajo sural invertido es de gran seguridad y versatilidad, y llega a cubrir muchas veces defectos grandes en el dorso del pie y en el talón. Los colgajos libres son de mayor complejidad, debido a que se requiere personal especializado, así que es recomendable solucionar estos problemas con colgajos locales musculares, fasciocutáneos o neurocutáneos.

Abstract Objectives: report the surgical possibilities that exist in the distal third of the leg and present the experience in the past 15 years with these flaps Materials and methods: During 15 years we performed different flaps like soleus flaps, reversed fasciocutaneous flaps, reversed sural flaps and some microsurgical free flaps to cover defects in the distal third of the leg and the foot Results: We reviewed 112 patients followed at least 3 months, 18 had ankle joint or foot exposure and the other had exposure tendons and / or neurovascular elements. The most used flaps were the soleus, the reversed sural and the reversed fasciocutaneous. Distal necrosis was observed in the edge of the four flaps, but not affecting the final coverage. One of the free flaps suffered a total necrosis. Discussion: Open tibial fracture required fast coverage to reduce infection and promote healing.The soleus muscle is still the main flap to cover the defects of the middle third of the tibia. This series shows that this flap is suitable for many distal leg reconstructions, often avoiding the use of a free flap. The reverse sural flap is very safe and versatile, and is a good option to cover defects on the dorsum of the foot and heel. Free flaps are of greater complexity requiring specialized staff. It is recommended to solve these problems with local flaps, muscle flaps, fasciocutaneous or neurocutaneous flaps.

Efeito da corrente alternada simétrica sinusoidal na musculatura estriada esquelética desnervada experimentalmente / Effect of sinusoidal alternated current in experimentally denerved skeletal striated muscle

Introdução: A utilização da estimulação elétrica (EE) no tratamento de músculos desnervados tem sido muito estudada, pois auxilia na reinervação tardia e minimiza a atrofia muscular. Objetivo: Neste estudo, avaliamos a EE através da corrente alternada simétrica sinusoidal na manutenção dos aspectos morfológicos dos músculos Extensor longo dos dedos (EDL) e Sóleo desnervados experimentalmente. Método: Quarenta ratos da linhagem wistar foram divididos em quatro grupos experimentais (n=10): Em grupo controle inicial (GCI), controle Final (GCF), desnervado (GD), e em desnervado e estimulado (GDE). A aplicação EE no músculo EDL e sóleo teve início 48 horas após a lesão nervosa, sendo aplicada três vezes por semana durante quarenta e cinco dias. Cortes transversais foram corados com HE para a mensuração da morfometria das fibras musculares. Para a análise estatística foi utilizado a análise de variância (one-way - ANOVA) seguido pelo teste de tukey (p < 0,05). Resultados: Os animais do grupo D e DE apresentaram uma diminuição da área de secção transversal (AST) quando comparadas ao CF. Porém o grupo DE minimizou a atrofia muscular, pois houve diferença estatisticamente significativa quando comparado ao D, tanto no músculo EDL quanto no sóleo. Conclusão: A EE foi eficiente na manutenção dos aspectos morfológicos dos músculos EDL e sóleo, minimizando a atrofia muscular. Podendo ser um tratamento útil para as lesões nervosas periféricas.

Introduction: the use of electrical stimulation (ES) in the treatment of denervated muscles has been studied as it assists in the late reinnervation and minimizes muscle atrophy. Purpose: this study assessed the ES through the symmetric sinusoidal alternating current in the maintenance of the morphological aspects of the experimentally denervated Extensor digitorum longus (EDL) and Soleus muscles. Method: Forty Wister rats were divided into four experimental groups (n = 10): initial control group ( ICG), final control group (FCG), denervated group (DG) and denervated and stimulated group (DSG). ES was first applied in the soleus and EDL muscle 48 hours after nerve injury, the applications took place three times per week for forty-five days. Cross-sections were stained with HE to perform the morphometric analysis of the muscle fibers. We used the analysis of variance (one-way - ANOVA) followed by the Tukey test (p < 0.05) for statistical analysis. Results: the animals belonging to group D and DE showed a decrease in the crosssectional area (CSA) when compared to FCG. However, the group DE had muscular atrophy minimized, as there was a statistically significant difference when compared to D, both for EDL and soleus muscles. Conclusion: the ES was effective in maintaining the morphological aspects of the EDL and soleus muscles, minimizing muscle atrophy. This may be a useful treatment for the peripheral nerve injuries.

Unilateral third/accessory head of the gastrocnemius muscle: a case report / Tercera cabeza unilateral del músculo gastrocnemio: reporte de un caso

The superficial muscle group of the posterior compartment of leg forms a powerful muscular mass in the calf. The two-headed gastrocnemius is the most superficial muscle of this group, and forms the proximal, most prominent part of the calf. Gastrocnemius muscle exhibits numerous variations in the origin and/or insertion. The present report describes the incidental occurrence of the third/accessory head of gastrocnemius muscle in the left lower limb. During routine educational dissection of a 54-year old American female cadaver in the Anatomy lab of the Medical University of the Americas, Nevis, West Indies, we found an unusual 10.8 cm long muscle in the left popliteal region, attached proximally to the lateral aspect of the popliteal surface of femur, and distally terminated as a tendon which was attached at the junction of the medial and lateral heads of gastrocnemius muscle. No such variation was found on the right side. This is described as a case of third / accessory head of gastrocnemius muscle...

El grupo muscular superficial del compartimento posterior de la pierna forma una poderosa masa muscular. El músculo gastrocnemio de dos cabezas es el más superficial de este grupo y forma la parte proximal, más prominente de la pantorrilla. El músculo gastrocnemio presenta numerosas variaciones en el origen y/o inserción. El informe describe la presencia de una tercera/accesoria cabeza del músculo gastrocnemio, encontrada. durante una disección de rutina en un cadáver de una mujer americana de 54 años, en el Laboratorio de Anatomía de la Medical University of the Americas, Nevis, West Indies. La variación muscular inusual medía 10,8 cm de longitud y se originaba en la región poplítea izquierda, proximalmente en la cara lateral de la superficie poplítea del fémur, y se insertaba en un tendón que se adhería a la unión de las cabezas medial y lateral del músculo gastrocnemio. La variación no se encontró en el lado derecho. Este hallazgo se describe como un caso de tercera/accesoria cabeza del músculo gastrocnemio...

Effects of nandrolone decanoate and resistance exercise on skeletal muscle in adult male rats / Efectos del decanoato de nandrolona y el ejercicio de resistencia en el músculo esquelético de ratas machos adultos

The aim of this study was to compare the effects of resistance exercise associated or not with nandrolone decanoate (ND) on skeletal muscles and body mass of adult male rats. Training protocol consisted of 15 jump sessions, for 6 weeks. ND (5mg/kg) was administered twice a week. The exercise was effective in inducing respective enlargements in fiber areas of extensor digitorum longus and soleus muscles. ND associate with exercise was also able to induce increases in fiber areas these muscles. In untrained group that received nandrolone decanoate an improved in muscular parameters could be observed. In conclusion, the resistance exercise was able to promote an enlargement in fiber areas of both muscles studied without ND treatment, indicating that after a period of time of adaptation to exercise, the muscular effects caused by ND could be achieved in the same way by exercise, without ND and without risks for health.

El objetivo de este estudio fue comparar los efectos del ejercicio de resistencia con o sin decanoato de nandrolona (DN) en el músculo esquelético y la masa corporal de ratas macho adultas. El protocolo de entrenamiento consistió en 15 sesiones durante 6 semanas de saltos. DN 5mg/kg se administró dos veces durante la semana. El ejercicio fue efectivo para inducir un aumento en el área de las fibras de los músculos extensor largo de los dedos y sóleo. El DN asociado con el ejercicio fue capaz de inducir un aumento en el área de las fibras de los músculos. En el grupo de DN sin entrenamiento, se observó un aumento en los parámetros musculares evaluados. El ejercicio de resistencia sin DN fue capaz de promover un aumento en el área de las fibras de los músculos, lo que indica que después de un período de adaptación al ejercicio, el efecto en los músculos causada por la DN se logró por el ejercicio, sin una gestión DN y los consiguientes peligros para la salud.

Rotación de colgajos musculares para cobertura de defectos en fracturas abiertas de tibia producidas por armas de fuego / Rotation of muscular flaps to cover the defects in open tibial fractures caused by firearms

INTRODUCCIÓN. Las fracturas abiertas de tibia producidas por armas de fuego son lesiones que requieren un desbridamiento adecuado y radical, estabilización de la fractura y cobertura precoz de las partes blandas con tejido bien vascularizado. Los colgajos musculares rotacionales del gastrocnemio y el sóleo desempeñan un papel muy importante en la cobertura de dichas lesiones. El objetivo de este trabajo fue mostrar los resultados de la cobertura de este tipo de fracturas en la pierna mediante colgajos musculares del gastrocnemio y el sóleo. MÉTODOS. Se presentó una serie de 25 pacientes con fracturas abiertas de tibia producidas por armas de fuego, 8 de las cuales eran del tipo III A y 17, del tipo III B. Las lesiones se localizaron en el tercio superior de la tibia (6), en el tercio medio (15) y en el tercio medio inferior (4). Los músculos empleados para colgajos fueron la cabeza medial del gastrocnemio (19 pacientes) y la parte medial del sóleo (6 pacientes). RESULTADOS. La media de tiempo de colocación del colgajo después de la lesión fue de 12 días. Entre las complicaciones que se presentaron se registró la necrosis parcial del colgajo (1 paciente) y la infección superficial (2 pacientes), que resolvieron con tratamiento médico. CONCLUSIONES. Los colgajos musculares rotacionales constituyen una importante alternativa de tratamiento en las fracturas abiertas producidas por armas de fuego, y pueden ser colocados por el cirujano ortopédico sin necesidad de técnicas microquirúrgicas. De esta forma se facilita la cobertura de estructuras nobles, con un bajo índice de complicación

INTRODUCTION: Tibial open fractures caused by firearms are lesions requiring a radical and appropriate debridement. Fracture stabilization and early cover of soft parts with well visualized tissue. Rotator muscular flaps of soleus and gastrocnemius muscles play a significant role in cover of such lesions. The aim of present paper was to show the results of cover of this type of legs fractures using muscular flaps from gastrocnemius and the soleus muscles. METHODS: Present series includes 25 patients with open tibial fractures caused by firearms, 8 of them were of type III A and 17 of type III B. Lesions were located in high third of the tibia (6), in medium third (15) and in lower medium third (4). The muscles used for flaps were the gastrocnemius medial head (19 patients) and the medium part of soleus (6 patients). RESULTS: Average time for flap placement after lesion was of 12 days. Among complications present there was a partial flap necrosis (1 patient) and the superficial infection (2 patients) resolved with medical treatment. CONCLUSIONS: Rotator muscular flaps are an essential alternative of treatment in open fractures caused by firearms and may be placed by an orthopedic surgeon without microsurgical techniques. Thus, it is possible the cover of a simple structures with a low rate of complication

INTRODUCTION. Les fractures ouvertes du tibia causées par des armes à feu sont des lésions requérant un débridement approprié et radical, une stabilisation de la fracture et une couverture précoce des parties molles avec un tissu bien vascularisé. Les lambeaux en rotation des muscles gastrocnémien et soléaire jouent un rôle très important dans le traitement de ces dites lésions. Le but de ce travail est de montrer les résultats du traitement de ce type de lésion par des lambeaux des muscles gastrocnémien et soléaire.MÉTHODES. Une série de 25 patients atteints de fractures ouvertes du tibia (8 du type III A et 17 du type III B), produites par des armes à feu, est présentée. Les lésions étaient localisées au tiers supérieur (6), au tiers moyen (15), et au tiers moyen inférieur du tibia (4). On a utilisé des lambeaux de la tête médiale du muscle gastrocnémien (19 patients) et de la partie médiale du muscle soléaire (6 patients).RÉSULTATS. Le temps moyen de placement du lambeau après la lésion a été 12 jours. Parmi les complications on a rencontré la nécrose partielle du lambeau (1 patient) et l'infection superficielle (2 patients), ayant obtenu la résolution avec un traitement médical.CONCLUSIONS. Les lambeaux musculaires en rotation constituent une alternative importante pour le traitement des fractures ouvertes causées par des armes à feu, et ils peuvent être placés par le chirurgien esthéticien sans l'utilisation des techniques micro-chirurgicales. Ainsi, la couverture des structures sensibles se rend plus facile et sans risque de complications

Using standing postures as a practical alternative to gait analysis for assessing normal neuromotor activity variation of the ankle muscle antagonists: a soleus H-reflex and EMG activity study comparing patients with hemiplegia to healthy subjects / Uso de posturas erguidas como alternativa práctica al análisis de marcha para evaluar la actividad neuromotora normal de los antagonistas del tobillo: una comparación entre pacientes hemiplégicos y sujetos normales

The purpose of this study was to evaluate and compare the soleus H-reflex amplitudes recorded in three standing postures between a group of patients with stroke and a group of healthy subjects. Nine ambulatory patients were compared with 10 healthy subjects. Measures were recorded during quiet standing (QS), heels raised (PO) and with the foot of the measured leg held just off the ground while standing on the opposite leg (SW). The results showed that patients, as opposed to the healthy group, did not inhibit soleus H-reflex in the SW posture. As opposed to evaluating ankle motor control during gait, the PO and SW standing postures appeared to offer a practical and objective method to assess soleus H-reflex when the purpose is to determine impairment (or recovery) of ankle neuromotor control in stroke survivors.

El propósito de este estudio fue evaluar y comparar la amplitud de el reflejo H en el músculo sóleo en tres posturas en la posición de pie entre un grupo de pacientes con hemiplejia y un grupo de individuos sanos. Nueve pacientes ambulatorios fueron comparados con diez individuos sanos. Registros fueron obtenidos en la posición de pie bipedal (QS), bipedal con talones elevados (PO), y unipedal manteniendo el pie afectado ligeramente elevado sin contacto con el piso (SW). Los resultados mostraron que los pacientes, en contraste con el el grupo sano, no presentaron inhibición del reflejo H en la postura SW. Comparado a registros del reflejo H obtenidos durante la marcha, aquellos obtenidos con las posturas PO y SW aparecen como un método más práctico y objetivo para evaluar el reflejo H del soleus si el propósito es determinar nivel de pérdida (o recuperación) de el control neuromotor del tobillo en pacientes con hemiplejia.

Feathered fibres of human soleus muscle / Fibras penniformes del músculo sóleo humano

The large size of superficial group of muscles of back of leg is a characteristic feature of the musculature of man being related directly to its erect posture and mode of progression. Triceps surae is one of the powerful muscles of the body after Gluteus maximus and Quadriceps femoris. To make the muscle more powerful nature has devised a unique method of packing the fibers in a small space by pennation. There exists a bipenniform mass as a peculiarly human feature. Its feathered fasciculi arise from the deep (anterior) surface of the soleus muscle. Most of the textbooks of Anatomy and the available literature on the triceps surae or the tendoachillis do not appreciate and describe this fascinating aspect of the muscle. It was Schafer et al. (1923) who gave a detailed account of this muscle. Standring et al. (2005) have also described this muscle in great detail. We have studied the unique features of this part of soleus muscle. Bipennate arrangement was seen in 86 percent (right-83 percent; left-89 percent); and its maximum width was found to be 3.63 cm (Rt-3.71cm; Lt-3.55cm). Median tendinous septum was directed backwards and medially. Thus this muscle will further increase the power of contraction of soleus, which is so very important for a bipedal gait.

El gran tamaño de los grupos musculares superficiales de la parte posterior de la pierna es un rasgo característico de la musculatura del hombre siendo relacionado directamente con su postura erguida y el modo de progresión. El músculo tríceps sural es uno de los músculos más potentes del cuerpo después de los músculos glúteo magno y cuadríceps femoral. Para hacer al músculo más potente, la naturaleza ha ideado un método único de empaquetamiento de las fibras en un pequeño espacio por pennación. Existe una masa bipenniforme como una característica peculiarmente humana. Los fascículos pennados surgen desde la superficie profunda (anterior) del músculo sóleo. La mayoría de los textos de Anatomía y la literatura disponible sobre el músculo tríceps sural o el tendón de Aquiles no se aprecia ni se describe este aspecto fascinante que tienen los músculos. Fue Schafer (1923) quien dió una detallada descripción del músculo sóleo y posteriormente, Standring et al. (2005) también describieron detalladamente al músculo. Estudiamos las características únicas de esta parte del músculo sóleo, observando una disposición bipenniforme en el 86 por ciento de los casos (derecha 83 por ciento; izquierda 89 por ciento). El ancho máximo del músculo fue de 3,63 cm (derecha 3,71cm; izquierda 3,55cm). El septo tendinoso mediano se dirigió hacia posterior y medial, aumentando así aún más el poder de contracción del músculo sóleo, el cual es muy importante para la bipedestación.

Estudo morfométrico do músculo sóleo de ratos da linhagem wistar pós?imobilização articular / Morphometric study of post-joint immobilization of soleus muscle on wistar lineage rats

Todos os tipos de imobilização contribuem para a atrofia muscular e, em apenas alguns dias, os músculos passam por diminuição de volume ou perda de função, conhecidos como atrofia. Assim, com uma ou duas semanas de imobilização, as atividades metabólicas são consideravelmente reduzidas e suas fibras musculares substituídas por tecido cicatricial fibroso denso. Dessa forma, este estudo teve como objetivo analisar o efeito da imobilização articular do músculo sóleo do membro posterior de ratos no perfil morfométrico, em diferentes períodos. Foram utilizados dez Rattus navergicus albinus machos, variedade Wistar, que foram divididos em dois grupos com cinco animais cada, sendo o primeiro grupo submetido à imobilização por sete dias e o segundo por 14 dias. O controle do experimento foi obtido a partir do membro contralateral direito do respectivo animal. A imobilização do membro posterior esquerdo foi por meio de uma órtese adaptada. A análise morfométrica do sóleo foi realizada por meio de cortes transversais não seriados de 5 µm de espessura. Foram analisadas, por meio das imagens obtidas, a área das fibras musculares, juntamente com a densidade do tecido conjuntivo, comparando-as ao Grupo-controle, referentes à perna contralateral. Com sete e 14 dias de imobilização, pode-se observar redução significativa (p < 0,05) na área das fibras musculares, associada a um aumento dos espaços intersticiais, principalmente ao redor dos fascículos musculares. Isto sugere ampliação na densidade do tecido conjuntivo e hipotrofia muscular. Com isso, conclui-se que a imobilização, mesmo que por curto período de tempo, pode alterar a integridade da musculatura esquelética, com importantes implicações funcionais.

All types of immobilization contribute to muscular atrophy and, in a few days, the muscles undergo volume reduction or loss of function, known as atrophy. Thus, with one or two weeks of immobilization, metabolic activities are considerably reduced and muscle fibers are replaced by dense fibrous scar tissue. This study has as objective to analyze the effect of joint immobilization of the soleus muscle of posterior members of rats on morphometric profile view, at periods of 7 and 14 days. Ten male Rattus navergicus albinus, Wistar variety, were used, separated into two groups of 5 animals each, with the first group submitted to immobilization for 7 days and the second for 14 days. The experiment control was acquired from the right contralateral member of each animal. The immobilization of the left posterior member was done by adapted orthesis. The morphometric analysis of soleus was by non-serial cross sections, 5µm thick. From the obtained images, the muscle fibers areas were analyzed, including connective tissue density, comparing with the control group. With 7 and 14 days of immobilization, a significant reduction (p < 0.05) in muscle fiber area can be observed, associated with an increase in interstitial spaces, mostly around muscle fascicules. This suggests there is an increase in conjunctive tissue density and muscular hypotrophy. Thus, it can be concluded that immobilization, even for a short period of time, can change skeletal musculature, with important functional implications.

Efeito do treinamento físico com diferentes temperaturas nas características morfológicas do músculo sóleo de ratos / The effects of physical training under different temperatures on the morphologic characteristics of the rat soleus muscle

O presente estudo teve por objetivo avaliar o efeito de diferentes temperaturas no músculo sóleo de ratos submetidos ao treinamento físico. Quinze ratos, da linhagem Wistar, machos, com idade de 100 ± 10 dias e peso variando entre 300 e 350 gramas, foram divididos em: Grupo Controle (n=5), Grupo 12ºC (n=5) e Grupo 33ºC (n=5). Os animais do grupo controle não realizaram o treinamento. Os grupos experimentais 12ºC e 33ºC foram exercitados por 5 semanas, 3 vezes por semana, inicialmente por 15 minutos, sendo o tempo aumentado gradualmente até 60 minutos. Os animais foram sacrificados 24h após o último dia de corrida e amostras do músculo sóleo foram coletadas e congeladas em nitrogênio líquido. Cortes histológicos (8?m) foram submetidos à coloração por HE. No grupo G33ºC, os animais apresentaram grande dificuldade para realizar a corrida, mostrando sinais de fadiga e exaustão. A avaliação histológica do músculo sóleo do grupo controle mostrou fibras musculares com morfologia preservada, aspecto poligonal, núcleos periféricos e organizadas em fascículos pelo perimísio, envoltas pelo endomísio. As características morfológicas identificadas nos animais dos grupos G12ºC e G33ºC foram: fibras de diferentes diâmetros, hipertróficas, atróficas, splitting, intenso infiltrado inflamatório, edema, fagocitose e necrose. Este estudo morfológico encontrou lesões nos dois grupos treinados; não houve diferença no grau de lesão muscular nos dois grupos experimentais, porém os animais do grupo 12ºC não apresentaram dificuldades para realização da corrida. No conjunto, os resultados mostram que o protocolo de treinamento com temperaturas de 12ºC e 33ºC induziu lesões no músculo sóleo de rato.

This study assesses the effects of different temperatures on the rat soleus muscle submitted to physical training. Fifteen male 100±10 yrold, 300-350g, Wistar rats were divided into: Control Group (n=5), 12ºC Group (n=5) and 33ºC Group (n=5). Animals from Control Group performed no exercise. Animals from the experimental 12ºC and 33ºC Groups performed exercises for 5 weeks, 3 times a week, at fi rst for 15 min, increasing gradually to 60 min. The animals were sacrifi ced 24h after the last running day, and soleus muscle samples were collected and frozen in liquid nitrogen. Histological cuts (8?m) were HE-stained. In the 33ºC Group, the animals presented a great diffi cult to keep running, showing signs of fatigue and exhaustion. The histological analysis of the soleus muscle from Control Group showed muscle fi bers with preserved morphology, polygonal aspect, peripherals nucleus and organized in fascicles by perimysium involved by endomysium. The morphological characteristics identifi ed in the animals from the experimental 12ºC and 33ºC Groups were: different diameter fi bers, hypertrophic, atrophic, splitting, intense infl ammatory infi ltrate, edema, phagocytosis, and necrosis. This morphologic study showed injuries in both exercised groups; there was no difference in the muscular lesion grade between the two temperatures, and the best performance was from the 12ºC Group. After all, the result shows that the training protocol at 12ºC and 33ºC induced rat soleus muscle injuries.

The Accessory Soleus Muscle: Case Report and a Review of the Literature / El Músculo Soleo Acesorio: Reporte de Caso y Revisión de la Literatura

Durante una disección de rutina, se encontró un músculo soleo accesorio, en la pierna izquierda de un cadáver masculino. El músculo se localizaba posteromedialmente en la pierna, entre los músculos flexor largo de los dedos y largo del hálux. Su origen estaba en el tercio superior de la fascia anterior del músculo soleo y su inserción se realizaba, a través de un tendón en la superficie anteromedial del hueso calcáneo.

An accessory soleus muscle was found in the left leg of a male cadaver in the dissecting room. The muscle was situaded posteromedially, between the soleus muscle and the flexor digitorum longus and flexor hallucis longus. The origin of the muscle was in the superior third of the anterior fascia of the soleus muscle and the insertion, was attached with separate tendon, in the anteromedial surface of calcaneus bone.