Application of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery perforator flap transfer / 中华显微外科杂志

Objective:To explore a comparative study of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery(SCIA) perforator flap transfer.Methods:Between November, 2019 and December, 2020, 21 patients with the soft tissue defects in the limbs were repaired with superficial branch of the SCIA perforator flaps. The size of flaps ranged from 3.5 cm×7.0 cm to 9.0 cm×18.0 cm. According to the upper or anterior wall of the main artery in the recipient area having branches that matched the flap artery, 2 groups were established. End-to-end group: 10 cases were anastomosed end-to-end between the flap artery and branch of the main artery in the recipient area; End-to-side group: 11 cases were anastomosed end-to-side between the flap artery and side mouth of the main artery in the recipient area. The vein of flap was anastomosed end-to-end with the accompanying vein to the main artery in the recipient area. All of the donor sites were sutured directly. All patients were followed-up for 6-12 months and the survival of the perforator flap, the appearance and function of the perforator flap and the donor site were observed. All data of the 2 groups were conducted statistical analyzed. P<0.05 was statistically significant. Results:All 10 flaps in end-to-end group survived successfully. In end-to-side group, 2 cases had venous crisis in 11 cases of flaps,the exploration revealed venous thrombosis, and the arterial end-to-side anastomosis had smooth blood flow had embolism. One flap survived after re-anastomosis of the vein, and 1 flap was changed to a pedicled abdominal flap during the re-venous crisis. The postoperative follow-up was 6 months to 1 year. The appearance and function of the flap and donor site were satisfactory, without difference between the 2 groups. The SCIA superficial branch artery caliber, recipient artery branch or lateral caliber was not statistically different between the 2 groups( P>0.05). The time of anastomosis for end-to-end group was[(16.70±1.34) min]. It was lower than that of anastomosed end-to-side group[(23.73±1.68) min]. The difference was statistically significant( P<0.01). Conclusion:In superficial branch of the SCIA perforator flap transfer, if the upper or anterior wall of the main artery in the recipient area has a branch that matches the flap artery, the flap artery should first be anastomosed with its end. Because it dose not required to make a side port, and makes the operation more convenient with a short anastomosis time; Otherwise, perform end-to-side anastomosis with the main artery of the recipient site.

Unusual bilateral sensory innervation of the dorsum of hand by lateral antebrachial cutaneous nerve: a case report / 대한해부학회지

A 68-year-old male cadaver showed bilateral variation in the sensory innervation of the dorsum of hand. On the dorsum of right hand, first digit and lateral half of second digit were supplied by lateral antebrachial cutaneous nerve (LABCN); medial side of second digit and lateral side of third digit were supplied by superficial branch of radial nerve (SBRN) and medial side of third digit, the fourth and fifth digits were supplied by dorsal cutaneous branch of ulnar nerve (DBUN). On the dorsum of the left hand, lateral side of first digit was supplied by LABCN, medial side of first digit, the second and third digits as well as the lateral side of fourth digit were supplied by SBRN; medial side of fourth digit and fifth digit were supplied by DBUN. These variations would be helpful in understanding peripheral neuropathy, in interpretation of conduction velocity studies and in reconstructive surgery of hand.

Anatomical Snuffbox and it Clinical Significance: A Literature Review / La Tabaquera Anatómica y su Importancia Clínica: Una Revisión de la Literatura

The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox's anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area.

La tabaquera anatómica, es una pequeña área triangular ubicada en la parte radial de la muñeca utilizada a menudo para realizar procedimientos clínicos y quirúrgicos. A pesar de la frecuencia con la que se utiliza esta zona, escasea la información acerca de sus detalles en la literatura. El objetivo de este estudio es conocer con detalle la anatomía de la tabaquera anatómica y sus componentes, las alteraciones reportadas a ese nivel, y los usos e importancia clínica de esta región.

An anomalous pattern of superficial branch of radial nerve - a cadaveric case report / Patrón anómalo del ramo superficial del nervio radial - reporte de caso en un cadaver

In the present case study, there is an anomalous pattern of superficial branch of radial nerve (SBRN) that can be recognized as an anatomical variant of the left upper limb of a 60 years old donated embalmed male cadaver in the Department of Human Anatomy, Universiti Putra Malaysia, in which the superficial branch of radial nerve supplies the extensor carpi radialis longus and extensor carpi radialis brevis muscle. The superficial branch of radial nerve gave off branch to supply the proximal fusion part of extensor carpi radialis longus and extensor carpi radialis brevis muscles immediately after bifurcation of the radial nerve into the superficial branch of radial nerve and deep branch of radial nerve. This variation is very important to the surgeon as the presence of the variant will make them more careful in dealing with nerve entrapment surgery, reconstructive surgery and in the pain management services, the variation giving indications for treatment.

En el presente estudio se observó un caso de un patrón anómalo del ramo superficial del nervio radial (RSNR) reconocido como una variante anatómica del miembro superior izquierdo en un cadáver de sexo masculino de 60 años perteneciente al Departamento de Anatomía Humana de la Universidad Putra, Malasia. En este caso el ramo superficial del nervio radial inervaba a los músculos extensores radial largo y corto del carpo. El ramo superficial del nervio radial otorgaba un ramo a nivel del origen fusionado de los músculos extensores radiales del carpo, inmediatamente después de la división en ramos superficial y profundo del nervio radial. Esta variación es de importancia para el cirujano debido a que requiere un mayor cuidado en el tratamiento quirúrgico de atrapamiento del nervio o cirugía reconstructiva para el manejo del dolor.

Padrones de distribución del ramo superficial del nervio radial en el dorso de la mano humana / Distribution patterns of the superficial branch of the radial nerve in the back of the human hand

La inervación sensitiva del dorso de la mano está dada generalmente por el ramo superficial del nervio radial (RSNR) y el ramo dorsal del nervio ulnar (RDNU). Con el propósito de obtener una descripción detallada del origen, trayecto, distribución y ramificación del RSNR, como también elaborar una padronización del surgimiento de los nervios digitales dorsales de la mano, se estudiaron 36 manos de cadáveres formolizados, 30 de individuos adultos brasileños y 6 de chilenos. El RSNR se hizo superficial a una distancia de 89,4 ± 12,1 mm proximal al nivel del proceso estiloides radial (PER) y se dividió en un ramo ventral y un ramo dorsal a 57,6 +/- 17,8 mm proximal al PER. Posteriormente el ramo dorsal del RSNR se dividió en un ramo radial y un ramo ulnar a 4,9 +/- 14,7 mm proximal al PER. Se realizó una clasificación en 4 padrones, según el origen de los nervios digitales dorsales proporcionados por los ramos principales del RSNR. El padrón I se observó en 75 por ciento de los casos, en tanto que el padrón II se halló en el 13,89 por ciento, el padrón III y IV se observaron en el 5,56 por ciento de las muestras, respectivamente. Se evidenció una comunicación entre el RSNR y el RNDU en el 58,3 por ciento de las muestras. El conocimiento de la disposición de los ramos sensitivos dorsales de la mano es de importancia para la anatomía quirúrgica de la región dorsal de la muñeca y la mano, ya que es un sector donde se realizan procedimientos que podrían poner en riesgo a los nervios mencionados.

The sensory innervation of the dorsum of the hand is usually given by the superficial branch of radial nerve (SBRN) and the dorsal branch of the ulnar nerve (DBUN). In order to obtaining a detailed description of the origin, course, distribution and the branching of the SBRN, and also to develop a patterning of the emergence of dorsal digital nerves of the hand, we made a dissection study on dissection of cadaver specimens, 36 hands, 30 adult Brazilians and 6 Chileans. The SBRN became superficial at a distance of 89,4 +/- 12,1 mm proximal to the level of styloid process of the radius (SPR) and it branched in a ventral and dorsal branch at a distance of 57,6 +/- 17,8 mm proximal to the level of SPR. Later the dorsal branch of SBRN branched in a radial and ulnar branch at a distance of 4,9 +/- 14,7 mm proximal to the level of SPR. It was performed a classification of four pattern, according to the source of the dorsal digital nerves provided by the main branches of SBRN. The pattern I was present in 75 percent of the cases, while the pattern II was found in 13,89 percent, patterns III and IV were observed in 5,56 percent of the samples, respectively. It was observed a communication between SBRN and DBUN in 58,3 percent of the samples. Knowledge of the arrangement of the sensitive dorsal branches is of great importance to the surgical anatomy of the dorsal region of the wrist and hand, where procedures are conducted, that could jeopardize the nerve and its branches.

Anatomy basis and clinical significance of various types of abductor hallucis superior margin arterial arcades / Bases anatómicas e importancia clínica de varios tipos de arcos arteriales del margen superior del músculo abductor del hálux

The aim of this study was to group arteries of arterial arch at the superior margin of the abductor hallucis muscle according to their constitutes and provide anatomical basis for reverse bifolicated flap based on it. The constitute, track-way and distribution of the artery, which supply the medial pedis flap, the medial plantar and the medial tarsal flap, especial the arterial arch at the superior margin of the abductor hallucis muscle were observed and analyzed on 81 lower limbs cast specimens and 2 fresh feet specimens. According to their constitute, arterial arch at the superior margin of the abductor hallucis muscle can be classified into 3 types: i) type I, It was constituted mainly by the branch of anterior medial malleolus artery and (or) the medial tarsal artery. ii) type II, It was constituted mainly by the superficial branch of the medial plantar artery; iii) type II, It was constituted mainly by the branch of anterior medial malleolus artery and the branch of medial tarsal artery anastomose with the superficial branch of the medial plantar artery, which was divided into two subtypes according to the different anastomosis of the artery: Type III 1, the type of anastomosed directly was about 48.2 percent, type III 2, The type of anastomosed indirectly was about 24.1 percent. According to the constitute of arterial arch at the superior margin of the abductor hallucis muscle can be classified into three types: The type of anterior medial malleolus artery and medial tarsal artery, the type of superficial branch of the medial plantar artery and the type of mixed. For the type mixed, two subtypes can be classified according to the different anastomosis of the artery.

El objetivo fue clasificar las arterias de arco arterial del margen superior del músculo abductor del hálux según su constitución, y proporcionar una base anatómica para el colgajo bilobulado reverso basado en él. La constitución, recorrido y distribución de las arterias que suministran los colgajos pedicular medial, plantar medial y medial del tarso, en especial el arco arterial del margen superior del músculo abductor del hálux fueron observados y analizados en 81 modelos de miembros inferiores y 2 pies frescos. De acuerdo con su constitución, el arco arterial del margen superior del músculo abductor del hálux se pueden clasificar en 3 tipos: i) tipo I, constituido principalmentepor la rama de la arteria anterior del maléolo medial y/o la arteria medial del tarso. ii) tipo II, constituido principalmente por la rama superficial de la arteria plantar medial, iii) tipo III constituido principalmente por la rama de la arteria maleolar medial anterior y la rama de la anastomosis de la arteria tarsiana medial de la rama superficial de la arteria plantar medial, que se divide en 2 subtipos diferentes de acuerdo con el tipo de anastomosis: tipo III 1, una anastomosis directa que se observó en el 48,2 por ciento, y tipo III 2, una anastomosis indirecta observada en aproximadamente el 24,1 por ciento de los casos. Según la constitución, el arco arterial del margen superior del músculo abductor del hálux se puede clasificar en 3 tipos: el tipo de arteria anterior del maléolo medial y la arteria tarsiana medial, el tipo de rama superficial de la arteria plantar medial y el tipo mixto. En el tipo mixto, pueden ser clasificados 2 subtipos de acuerdo a la diferente anastomosis de la arteria.

The lesser occipital nerve in fetuses / El nervio occipital menor en fetos

The lesser occipital nerve (LON) is an ascending superficial branch of the cervical plexus that has a variable origin either from the ventral ramus of the second cervical nerve or second and third cervical nerves and is purely sensory. Forty fetuses (right side: 40/80; left: 40/80) with gestational ages between 15 to 28 weeks were microdissected to document the anatomy of the LON. Results: a) Incidence and Morphometry: LON present in 100 percent specimens, with average length on the right and left sides of 23.59 +/- 2.32 mm and 23.45 +/- 2.27 mm, respectively; b) Course: In its ascent towards the occipital region, the LON was located on the splenius capitus muscle in 85 percent of specimens and in 15 percent of the specimens, it ascended vertically on the sternocleidomastoid muscle towards the ear, innervating its superior third; c) Branching pattern: LON displayed (i) single: 70 percent; (ii) duplicate: 26 percent and (iii) triplicate: 4 percent patterns; d) Variation in the course of LON was observed in 6 percent of the specimens. Knowledge of the anatomy and variations of the LON may assist in the understanding of cervicogenic headaches and may be of assistance to anesthetists performing regional anesthesia for surgical procedures in the neck.

El nervio occipital menor (NOM) es una rama ascendente superficial del plexo cervical que tiene un origen variable ya sea del ramo ventral del segundo nervio cervical o de los nervios cervicales segundo y tercero, y es solamente sensitivo. Cuarenta fetos (lado derecho: 40/80; izquierdo: 40/80), con edades gestacionales de 15 a 28 semanas fueron microdisecados para documentar la anatomía del NOM. a) Incidencia y morfometría: el NOM estuvo presente en el 100 por ciento de los especímenes, con una longitud media de los lados derecho e izquierdo de 23,59 +/- 2,32 mm y 23,45 +/- 2,27 mm, respectivamente; b) Curso: en su ascenso hacia la región occipital, el NOM se localiza en el músculo esplenio de la cabeza en el 85 por ciento de las muestras y en el 15 por ciento de las muestras, ascendió verticalmente sobre el músculo esternocleidomastoideo hacia el oído, inervando el tercio superior, c) Patrón de ramificación: el NOM se observa (i) individual: 70 por ciento, (ii) duplicado: 26 por ciento y (iii) triplicado: 4 por ciento de los patrones; d) Variación en el curso de NOM se observó en el 6 por ciento de las muestras. El conocimiento de la anatomía y las variaciones del NOM puede ayudar en la comprensión de los dolores de cabeza cervical y puede ser de ayuda a los anestesiólogos a realizar la anestesia regional para procedimientos quirúrgicos en el cuello.

Dorsal Digital Branch of the Thumb: An Anatomical Study / Nervio Digital Dorsal del Pulgar: Estudio Anatómico

The level of origin of digital branch to thumb (DBT) of superficial branch of radial nerve (SBRN) and its relationship to brachioradialis muscle tendon (BRT) and its fascial sheath (FS) were studied on both sides of upper extremities of 50 cadavers (n=100). The DBT of SBRN originated in the middle third of forearm in 3 cases (3%), distal third of forearm in 10 cases (10%) and in wrist and dorsum of hand in 87 cases (87%). All cases having origin in the middle third of forearm and half of the cases having origin in the distal third of forearm were closely related to BRT or its FS. The clinical importance of the study lies in the fact that the DBT supplies dorsum of the thumb and first web space which has least cutaneous overlapping. Any injury or entrapment of this nerve may lead to painful neuritis. Anatomical knowledge of such variations are important for neurologists and surgeons performing operative procedures in Quervain's release, arthroscopy and Wartenberg's disease.

Fue estudiado en los miembros superiores de 50 cadáveres, el origen del nervio digital dorsal para el pulgar (NDDP) desde el ramo superficial del nervio radial (RSNR) y sus relaciones con el tendón del músculo braquiorradial (TMB) y su vaina fascial (VF). El NDDP del RSNR se originó en el tercio medio del antebrazo en 3 casos (3%), en el tercio distal del antebrazo en 10 casos (10%) y en la muñeca y dorso de la mano en 87 casos (87%). En todos los casos en que el NDDP se originaba en el tercio medio del antebrazo y en la mitad de los casos en que se originaba en el tercio distal del antebrazo, tenía relaciones estrechas con el TMB o su VF. La importancia clínica de este estudio se basa en que el NDDP suple el dorso del pulgar y primer espacio interdigital, el cual tiene pequeñísima superposición cutánea. Alguna herida o compresión de este nervio puede llevar a neuritis dolorosa. El conocimiento anatómico de estas variaciones son importantes para neurólogos y cirujanos durante los procedimientos de liberación de Quervain, artroscopía y enfermedad de Wartenberg.

PHYSIOLOGICAL CHARACTERISTICS OF SUPERFICIAL BRANCH OF THE RADIAL NERVE INNERVATING MECHANORECEPTIVE UNITS IN THE HUMAN BODY / 西安交通大学学报(医学版)

By means of intraneural microrecording (IN-MR) and intraneural microstimulation (INMS),the characteristics of hairy skin's mechanoreceptiveunits innervated by superficial branch of radial nerve andthe sensations mediated by the nerve were ob-served on the awaking human body. A total of 47mechanoreceptive units were identified, 35 of them(74. 5%) were classified as SA units and 12 ofthem (25. 5%) as RA units, hair-follicle unit andPC unit were not found in experiments. The aver-age mechanical thresholds of SA units were some-what higher than those of RA units, receptivefields of RA and SA Ⅰ units were significantlysmaller than those of SA Ⅱ units. The type of unitexcited by INMS determined the sensations quali-y, RA units evoked intermittent tapping, SA Ⅰ u-nits evoked sustained pressure; SA Ⅱ units evokedno particular sensation when activated in isolation.The results indicate that the characteristics of themechanoreceptive units in the hairy skin do not differ from those in the glabrous skin at the humanbody.