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.

Anatomical study of motor branches from tibial nerve transfer to restore the deep fibular nerve / 中华显微外科杂志

Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.

Morfometría de los nervios sensitivos del dorso del pie en el hombre / Morphometry of the sensitive nerves of the dorsum of the foot in man

La inervación cutánea del dorso del pie, está dada por los nervios fibular superficial (NFS), ramo del nervio fibular común; sus ramos, cutáneo dorsal medial (NCDM) y cutáneo dorsal intermedio (NCDI), así como también por el cutáneo dorsal lateral (NCDL), ramo del nervio sural y el ramo cutáneo del nervio fibular profundo (RCNFP). Estos, pueden ser lesionados en su proximidad con estructuras óseas en su ubicación más superficial, en intervenciones quirúrgicas, por compresión, tracción o fricción crónica. Realizamos un estudio morfométrico y estereológico en 5 muestras de NFS, NCDM, NCDI, NCDL y RCNFP en cadáveres de individuos adultos, masculinos. Se obtuvieron secciones transversales de cada uno de los nervios después de su origen, a nivel del tercio distal de la pierna y del dorso del pie. Realizamos cortes de 4 um de grosor, teñidos con H.E. El promedio de fascículos fue: NFS 12 (D.E. 2,39); NCDM 8 (D.E. 4,82); NCDI 5 (D.E. 1,67); NCDL 7 (D.E. 3,27) y RCNFP 4 (D.E. 1,30). El promedio de fibras para el NFS, NCDM, NCDI, NCDL y RCNFP fue: 14.080, 7.636, 4.602, 3.732 y 2.941, respectivamente. El área promedio del NFS, NCDM, NCDI, NCDL y RCNFP fue: 1,54 mm2 (D. E. 0,22), 0,82 mm2 (D. E. 0,31), 0,54 mm2 (D. E. 0,23), 0,42 mm2 (D.E. 0,19) y 0,32 mm2 (D.E. 0,13) respectivamente. Con este estudio, se espera contribuir al conocimiento morfológico respecto a los factores que podrían influir en el grado de recuperación de lesiones nerviosas, importantes en la clínica y en las técnicas de microcirugía.

The cutaneous innervation on the dorsum of the foot, is given by the superficial fibular nerves (SFN) a branch of the common fibular nerve: its branches, and cutaneous medial dorsal (MDCn) and cutaneous intermediate dorsal (IDCn). Also, the cutaneous lateral dorsal (LDCn) branch of the sural nerve and cutaneous branch of the deep fibular nerve (DFCBn). These can be injured in their proximity with osseous structures in their most superficial location, in surgical procedures, by compression, traction or chronic friction. We carried out a morphometric and stereological study in 5 samples of SFN, MDCn, IDCn, LDCn and DFCBn in cadavers of adult male individuals. Transverse sections of each of the nerves were obtained following its origin, at the level of the distal third of the leg and dorsum of the foot. We realized slices of 4 um thick, stained with H.E. The average of the fascicles was: SFN 12 (D. E. 2.39); MDCn 8 (D. E. 4.82); IDCn 5 (D. E. 1.67); LDCn 7 (D. E. 3.27) and DFCBn 4 (D. E. 1.30). The average of fibers for SFN, MDCn, IDCn, LDCn, and DFCBn was: 14.080, 7.636, 4.602, 3.732 y 2.941 respectively. Average area of SFN, MDCn, IDCn, LDCn, and DFCBn was 1.54 mm2 (D. E. 0.22), 0.82 mm2 (D. E. 0.31), 0.54 mm2 (D. E. 0.23), 0.42 mm2 (D. E. 0.19) y 0.32 mm2 (D. E. 0.13) respectively. With this study we hope to contribute to morphological information in reference to factors that could influence in the degree of recovery of nerve lesions, important in clinic as well as microsurgery techniques.