Estudio biométrico de la distribución de los ramos motores del nervio fibular superficial en el compartimiento lateral de la pierna en individuos brasileiros: implicancias clínicas y variaciones / Biometric study of the distribution of the motor branches of the superficial fibular nerve in the lateral compartment of the leg in Brazilian individuals: clinical implications and variations

El propósito del presente estudio fue conocer la distribución de los ramos motores del nervio fibular superficial (NFS) y de sus respectivas penetraciones en los músculos fibulares en relación al ápice de la cabeza de la fíbula, dividiendo el compartimiento lateral de la pierna en tres regiones a fin de hacer posible una visión más segura de sus correlaciones clínicas y quirúrgicas. A través de disección, se estudiaron 60 piernas pareadas de 30 cadáveres adultos, de ambos sexos, Brasileños, con edad promedio de 44,9 años, siendo 8 de sexo femenino y 22 del masculino. Después de la disección se registraron las distancias de los puntos de penetración de los ramos del NFS en los músculos fibular largo (mFL) y corto (mFC), localizándolos en los tercios proximal, medio o distal, según fuere el caso. Se observó que el mayor número de ramos penetraron en el mFL a nivel de la parte distal del tercio proximal de la pierna, mientras que en el mFC lo hicieron en las partes proximal y distal del tercio medio de la pierna. Los ramos motores para el mFL penetraban en el vientre muscular entre 48,06 y 141,56 mm, y los ramos para el mFC lo hicieron entre 163,34 y 209,67 mm del origen del nervio. No hubo diferencias estadísticamente significativas ni entre los lados derecho e izquierdo ni entre genéros. Independiente de las diferencias metodológicas entre los estudios disponibles, el detalle de la distribución nerviosa en este compartimiento, permitirá una mayor precisión en el momento de elegirse un área para colgajo de injerto autólogo y una menor chance de lesiones iatrogénicas durante cirugías de la región.

The purpose of the present study was to know the distribution of the motor branches of the superficial fibular nerve (SFN) and their respective motor points in the fibular muscles in relation to the apex of the head of the fibula, dividing the lateral compartment of the leg in three regions in order to make possible a safer view of your clinical and surgical correlations. Through dissection, 60 paired legs of 30 adult cadavers, of both sexes, Brazilians, with an average age of 44.9 years, 8 being female and 22 male, were studied. After the dissection, the distances of the motor points of the NFS branches in the fibularis longus (FLm) and brevis (FBm) muscles were recorded, locating them in the proximal, middle or distal thirds. It was observed that the largest number of branches penetrated the FLm at the level of the distal part of the proximal third of the leg, while in the FBm they did so in the proximal and distal parts of the middle third of the leg. The motor branches for the FLm penetrated into the muscular belly between 48.06 and 141.56 mm, and the branches for the FBm did between 163.34 and 209.67 mm of the origin of the nerve. There were no statistically significant differences between the right and left sides or between genres. Regardless of the methodological differences between the available studies, the detail of the nervous distribution in this compartment will allow a greater precision at the time of choosing an area for autologous graft flap and a lower chance of iatrogenic injuries during surgeries of the region.

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured. RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured. CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

Anatomical Variants of “Short Head of Biceps Femoris Muscle” Associated with Common Peroneal Neuropathy in Korean Populations : An MRI Based Study

OBJECTIVE: In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans.METHODS: 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured.RESULTS: The 93 normal subjects were included in this study. The CPN passed through the “popliteal tunnel” formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the “popliteal tunnel”, a length of 21 mm to < 40 mm was measured.CONCLUSION: In Korean population, the course of the CPN through the “popliteal tunnel” was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

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.

Ineficácia da laserterapia aplicada no trajeto do nervo e nas raízes medulares correspondentes / Lack of effectiveness of laser therapy applied to the nerve course and the correspondent medullary roots

Objetivo: Verificar a influência da irradiação do laser de baixa intensidade na regeneração do nervo fibular comum de ratos após lesão por esmagamento. Métodos: Foram utilizados 25 ratos, divididos em três grupos: 1) nervo intacto, e não tratados; 2) nervo lesado, e não tratado; 3) nervo lesado, e laser irradiado sobre a região medular correspondente às raízes do nervo ciático e subsequentemente no trajeto do nervo lesado. A irradiação foi realizada por 14 dias consecutivos. Resultados: Foram avaliados por meio da análise funcional da marcha, através do índice funcional do peroneiro, e por análise morfométrica através do número total de fibras nervosas mielinizadas e sua densidade, número total de células de Schwann, número total de vasos sanguíneos e sua área, diâmetro mínimo da fibra e razão-G. Conclusão: De acordo com a análise estatística, não houve diferença significativa entre os grupos, e os autores concluem que a irradiação do laser de baixa intensidade possui pouca ou nenhuma influência na regeneração nervosa e recuperação funcional. Trabalho experimental.

Objective: To investigate the influence of low intensity laser irradiation on the regeneration of the fibular nerve of rats after crush injury. Methods: twenty-five rats were used, divided into three groups: 1) intact nerve, no treatment; 2) crushed nerve, no treatment; 3) crush injury, laser irradiation applied on the medullary region corresponding to the roots of the sciatic nerve and subsequently on the course of the damaged nerve. Laser irradiation was carried out for 14 consecutive days. Results: animals were evaluated by functional gait analysis with the peroneal functional index and by histomorphometric analysis using the total number of myelinated nerve fibers and their density, total number of schwann cells, total number of blood vessels and the occupied area, minimum diameter of the fiber diameter and G-quotient. Conclusion: according to the statistical analysis there was no significant difference among groups and the authors conclude that low intensity laser irradiation has little or no influence on nerve regeneration and functional recovery. Laboratory investigation.

Transferring motor branches from proximal tibial nerve for treatment of high fibular nerve injuries: An anatomical study / 第二军医大学学报

Objective To observe the anatomy of proximal tibial nerve, so as to assess the feasibility of transferring motor branches from proximal tibial nerve for treatment of the high fibular nerve or long-segment injuries.Methods Totally 23 sides of lower limbs from 12 adult cadavers were included in the present study. The branching pattern, length, diameter of motor branches of the tibial nerve in the proximal leg, location of original point relative to fibular head level and the distance from original point to the fibular neck were examined. Intraneural dissection from the bifurcation of the common fibular nerve to the proximal (deep fibular nerve and superficial fibular nerve) was performed, and then the maximum dissected length and the diameter of deep fibular nerves were observed. The deep fibular nerve was severed at the top site and simulating transfer was performed; the feasibility of suturing the motor branches from proximal tibial nerve and the deep fibular nerve was assessed. Results There were three main motor branches at the proximal leg, including the branches to the lateral and medial head of the gastrocnemius and to the soleus muscle, with the length being (36.3±9.6) mm, (44.7±8.6) mm and (53.2±9.9) mm, respectively. The maximum length of intraneural dissection of the common fibular nerve was (59.3±7.2) mm. After dissection, the branches to the soleus muscle and the lateral head of the gastrocnemius were long enough for direct nerve suture with the deep fibular division in all cadavers without tension. The branches to the medial head of the gastrocnemius were long enough for nerve suture in 21 sides (91.3%). Conclusion After intraneural dissection of the common fibular nerve, the motor branches from proximal tibial nerve can be transferred to restore the deep fibular nerve for treating high fibular nerve injuries. The branch to the soleus muscle is the best choice considering its length and diameter.

División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie / High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot

Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS), después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de origen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10 por ciento. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna.

The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN), then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a different arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

Reference Value for the Cross Sectional Area of Fibular Nerve Ultrasonography through the Anatomic Investigation in Korean

OBJECTIVE: To investigate the reference value for cross sectional area (CSA) of the fibular nerve in Koreans. METHOD: One musculoskeletal radiologist and one physiatrist performed fibular nerve ultrasonography (US) on 60 lower extremities of 30 asymptomatic Korean volunteers (16 males, 14 females). The mean age was 46.6 years (range: 21-75 years). We measured CSA of the fibular nerve at three sites: proximal portion (PP) at the bifurcation, mid-portion (MP), and an area just above the fibular head (FH). In addition, the fibular nerves of 7 lower extremities from 4 cadavers were cut from the fibular head to the proximal portion and divided into three sections (PP, MP, FH). They were subsequently fixed with 10% neutral buffered formalin and perpendicularly excised to 2 mm thickness. They were photographed by an operating microscope and CSA was measured. Using the Kruskal-Wallis test, measurements obtained from US images were compared between asymptomatic volunteers with a significance level of 0.05. RESULTS: In asymptomatic volunteers, the CSA of the three portions were PP: 13.8+/-1.2 mm2, MP: 11.1+/-1.0 mm2, FH: 10.9+/-0.6 mm2. The fibular nerves were well visualized with clear borders by US. In cadavers, the CSA of three portions were PP: 20.3+/-10.3 mm2, MP: 16.7+/-8.6 mm2, FH: 14.4+/-8.9 mm2. There was no significant difference between the three portions in asymptomatic volunteers and cadavers (p>0.05). CONCLUSION: In normal Korean adults, the area of fibular nerve at the fibular head is 10.9+/-0.6 mm2. Ultrasonographic evaluation of the fibular nerve can be helpful in diagnosing fibular nerve lesions.

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.

Morfometría de los nervios isquiático, tibial y fibular común en el hombre / Morphometry of the sciatic, tibial and common fibular nerves in man

El nervio isquiático, el más extenso del cuerpo humano, emerge de la pelvis por el foramen isquiático mayor, dividiéndose proximal a la articulación de la rodilla en los nervios tibial y fibular común. Con frecuencia, estos nervios son afectados por accidentes, por tanto, la microcirugía reparadora requiere de detallada información anatómica para efectuar con éxito sus procedimientos. El nervio isquiático puede ser lesionado por heridas penetrantes, en las luxaciones posteriores de la articulación coxal y por inyecciones intramusculares mal aplicadas en la región glútea, siendo rara la lesión del nervio tibial por estar situado profundamente protegido. En cambio, la lesión del nervio fibular común, es frecuente debido a su posición superficial, quedando muy expuesto cuando abandona la fosa poplítea y rodea el cuello de la fíbula. Realizamos el estudio debido a la escasa información morfométrica y estereológica de estos nervios. Se disecaron en 5 cadáveres de individuos adultos, de sexo masculino los nervios isquiático, tibial y fibular común. Se obtuvieron secciones transversales de cada uno de los nervios a nivel de la división del nervio isquiático y del origen de los nervios tibial y fibular común. Realizamos cortes de 5 µm de grosor, los que fueron teñidos con H.E. Obtuvimos información cuantitativa sobre medidas morfométricas, determinamos el número de fibras nerviosas de cada fascículo así como el número de fascículos existente en cada nervio. Además, determinamos, por planimetría a través del conteo de puntos, el área de los fascículos que constituían cada nervio. El número de fascículos en el nervio isquiático varió de 63 a 70, con un promedio de 66,8 (D. E. 2,59). En el nervio tibial, el número de fascículos varió de 35 a 43, con un promedio de 30 (D. E. 3,00) y en el nervio fibular común el número de fascículos varió de 17 a 25, con un promedio de 21 (D. E. 2,92). El número promedio de fibras en el nervio ciático fue de 64.535 (D. E. 3.193). En los ...

The sciatic nerve, the longest of the human body, emerging from the pelvis through the greater sciatic foramen, dividing proximal to the knee joint in the tibial and common fibular nerves. Frequently these nerves are affected by accidents, therefore, the repairing microsurgery requires detailed anatomical information in order to successfully complete these procedures. The sciatic nerve can be damaged by penetrating injuries in the posterior luxations of the hip joint, and by intramuscular injections, given incorrectly the gluteal region. Injury to the tibial nerve is rare as it is deeply located and protected. On the other hand, injury to the common fibular nerve is frequent due to its superficial position, leaving it exposed when it leaves the popliteal fossa and surrounds the fibular neck. The study was conducted due to scarce morphometric and stereologic information on these nerves. The sciatic tibial and common fibular nerves in five cadavers of individual male adults were dissected. Transverse section of each of the nerves were obtained at the level of the division of the sciatic nerve and of the origin of the tibial and common fibular nerves. Sections of 5 µm were cut which were stained with H.E. We obtained quantitative information regarding morphomtric measurements, determined the number of nerve fibres of each fascicle, as well as the number of existing fascicles in each nerve. We also determined by planimetry, through counting of points, the area of the fascicles that constituted each nerve. The number of fascicles in the sciatic nerve varied from 63 to 70 with an average of 66.8 (S.D. 2.59). In the tibial nerve the number of fascicles varied from 17 to 25 with an average of 21 (S.D. 2.92). The mean number of fibres in the sciatic nerve as of 64,535 (S.D. 3,193). In the tibial nerve it was 40,317 (S.D. 4,067) and in the common fibular nerve it was: 22,191 (S.D. 1,038). The median area of the sciatic, tibial and common fibular nerves was: 11,42 mm².

Comparação clínica e anatômica do nervo fibular na zona de segurança de Gerdy / Clinical and anatomical comparison of the fibular nerve in the Gerdy safe zone

OBJETIVO: Comparar clínica e anatomicamente os limites do nervo fibular na zona de segurança de Gerdy em cadáveres. MÉTODOS: Foram utilizados 50 espécimes anatômicos de joelhos e medidos clinicamente (antes de dissecção) para determinar as distâncias e ângulos entre: o tubérculo de Gerdy e a região posterior da fíbula (cm), ângulo entre a linha correspondente à região posterior da fíbula e a crista tibial (graus) e o ângulo entre o tubérculo de Gerdy e crista tibial (graus). Após a dissecção das peças anatômicas, os joelhos foram novamente medidos, para determinar as distâncias e ângulos entre: o tubérculo de Gerdy e o nervo fibular (cm), ângulo entre o nervo fibular, na região posterior da fíbula e a crista tibial (graus) e o ângulo entre o tubérculo de Gerdy e crista tibial (graus). RESULTADOS: Existe aumento significativo da distância entre o tubérculo de Gerdy e a região posterior da fíbula (cm), após dissecção, em média 0,26cm (p = 0,018), o que corresponde a 8,6 por cento (p = 0,007) e também existe diminuição significativa do ângulo entre a região posterior da fíbula e a crista tibial após dissecção, em média de 3º (p = 0,047), que corresponde a 2,1 por cento (p = 0,06). CONCLUSÃO: Apesar da diferença antes e depois da dissecção, a zona de segurança de Gerdy pode ser considerada segura para os procedimentos ortopédicos, na região proximal da tíbia, evitando danos ao nervo fibular e seus ramos.

OBJECTIVE: to clinically and anatomically compare the limits of the fibular nerve in Gerdy's Safe Zone in cadavers. METHODS: Fifty anatomical knee specimens were clinically measured (before dissection) to determine the distances and angles between: Gerdy's tubercle and the posterior region of fibula (cm); the angle between the line corresponding to the posterior region of fibula and the tibia crest (degrees); and the angle between Gerdy's tubercle and tibial crest (degrees). After dissection of the anatomical parts, the knees were measured again, to determine the distances and angles between: Gerdy's tubercle and the fibular nerve (cm), the angle between the fibular nerve, in the posterior region of the fibula, and the tibial crest (degrees), and the angle between Gerdy's tubercle and the tibial crest (degrees). RESULTS: There was a significant increase in the distance between Gerdy's tubercle and the posterior region of fibula (cm), after dissection, of an average 0.26 cm (p = 0.018), corresponding to 8.6 percent (p = 0.007). There was also a significant reduction in the angle between the posterior region of fibula and the tibial crest after dissection, of an average 3º (p = 0.047), corresponding to 2.1 percent (p = 0.06). CONCLUSION: Despite the difference before and after dissection, Gerdy's Safety Zone can be considered safe for orthopedic procedures involving the proximal region of the tibia, preventing damage to the fibular nerve and its branches.

Anatomical study of the fibularis longus muscle motor points and electrical stimulation therapy application / Estudio anatómico de los puntos motores del músculo fibularis longus y su aplicación en la terapia de electroestimulación

The fibularis longus muscle (FLM) has an important role in the movement of eversion of the foot and in maintaining the plantar arch. The electrostimulation procedures seek to maintain muscle trophism, increase strength and endurance, and are frequently used in physiotherapy, for which the clinician needs to know the location of the motor points of the FLM. Therefore, the purpose of this study was to determine the number and distribution of motor points of the FLM and relate them to observable parameters in the surface anatomy. Ten formalin-preserved limbs were used, and the lateral regions of the leg were dissected in detail. In all the cases, the muscle presented three fascicular patterns, the superior and anteroinferior fascicles presented two motor points each, while the posteroinferior fascicles were between 2 and 3 motor points. Our results suggest that there is a pattern of distribution of the superficial fibular nerve, whose knowledge is useful for clinical application in the FLM electrostimulation proceedings.

El músculo fibular largo (MFL) tiene una importante función en el movimiento de eversión del pié y en la mantención del arco plantar. Los procedimientos de electroestimulación buscan mantener el trofismo muscular, aumentar la potencia y resistencia y es frecuente su utilización en fisioterapia, para ello el clínico necesita conocer la localización de los puntos motores del MFL, por ello, el propósito de este estudio fue determinar el número y distribución de los puntos motores del MFL y relacionarlos con parámetros observables en la anatomía de superficie. Se utilizaron 10 miembros inferiores conservados y se disecó detalladamente la región lateral de la pierna. El músculo presentó en todos los casos una estructura trifascicular, los fascículos superiores y anteroinferiores presentaron dos puntos motores cada uno, mientras en el fascículo posteroinferior encontramos entre 2 y 3 puntos motores. Nuestros resultados sugieren que existe un patrón de distribución del nervio fibular superficial cuyo conocimiento es de utilidad clínica para los procedimientos de electroestimulación del MFL.

Nervo alógeno conservado em glicerol: estudo experimental em ratos / Glycerol-preserved allogenous nerve: an experimental study with rats

A utilização de aloenxerto de nervo conservado em glicerol é uma alternativa a auto-enxertia em casos de lesões de nervos periféricos com perda de substância que diminui a morbidade cirúrgica e provem material suficiente para a reparação neural. O objetivo deste trabalho foi comparar o grau de reparação nervosa, utilizando análises histológica e funcional, através da interposição de enxerto autógeno (grupo A), de tubo de veia conservada em glicerol (grupo B) e de interposição de nervo alógeno conservado em glicerol (grupo C) em defeitos de 5 mm no nervo fibular de ratos Wistar. A análise histológica foi feita após o sacrifício dos animais( 6 semanas) , usando o corante azul de toluidina a 1 por cento. No grupo A (auto-enxerto) verificou-se reação tecidual perineural e escape de fibras axonais mielinizadas para fora dos limites do epineuro que foi maior se comparada ao verificado no Grupo B (Veia autógena + glicerol) e Grupo C (aloenxerto de nervo).A avaliação funcional foi feita através da análise dos padrões das pegadas das patas posteriores dos ratos ("Walking Track Analysis"), nos períodos: pré-operatório, pós-operatório imediato, na terceira e sexta semanas. Na recuperação funcional, não houve diferença estatisticamente significativa entre os três grupos em nenhum dos períodos avaliados.

The use of glycerol-preserved nerve allograft is an alternative to autografting in cases of peripheral nerve injury with loss of substance, which decreases surgical morbidity and provides sufficient material for neural repair. The objective of this study was to compare the degree of nervous repair, through interposition of autogenous graft (Group A), of glycerol-preserved vein tube (Group B), and interposition of glycerol-preserved allogenic nerve (Group C) in 5-mm defects of Wistar rats' fibular nerve, using histological and functional analyses. In group A (autograft) a perineural tissue reaction and myelinated axonal fibers escape out of the epineurium boundaries were greater when compared to those observed in Group B (autogenous vein + glycerol) and Group C (nerve allograft). The functional evaluation was made by analysis of the patterns of rats' posterior footprints (Walking Track Analysis) in preoperative, early postoperative period, week 3 and week 6. Regarding functional recovery, in none of the evaluated periods was there a statistically significant difference between the three groups.

Desenvolvimento de um software flexível no estudo de regeneração nervosa periférica / Development of flexible software for studying peripheral nerve regeneration

O estudo da recuperação de lesões nervosas periféricas do isquiático, fibular e tibial, obtidos através da análise motora, é considerado um bom critério de avaliação para a quantificação do grau de avaliação nervosa. O sistema de Análise Funcional dos Nervos Periféricos - AFNP que tem a funcionalidade da informatização deste processo, além de fornecer ao usuário uma maior agilidade na avaliação, permite ao pesquisador a utilização de um número maior de animais nos grupos experimentais, facilitando não só a captação, bem como o armazenamento e o processamento dos dados. A flexibilidade foi um resultado muito importante a ser ressaltado, pois mais de um usuário tem a possibilidade de interagir no sistema.

The study of the peripheral nerve regeneration after sciatic, fibular and tibial injuries, obtained through motion analysis, is regarded as a good evaluation criterion for quantifying the degree of nervous evaluation. The Functional Analysis of the Peripheral Nerves (AFNP) system that can transform this process into a computed one, not only provides the user with a higher evaluation agility, but also allows researchers to use a larger number of animals on experimental groups, facilitating the capture and data storage and processing, as well. Flexibility was a very important result to be highlighted, because more than one user is able to interact with the system.

Anatomical and Biometric Aspects of the Cutaneous Distribution of the Superficial Fibular Nerve / Aspectos Anatómicos y Biométricos de la Distribución Cutánea del Nervio Fibular Superficial

The objective of this research was to study the cutaneous branching of the superficial fibular nerve (SFN), with a topographic and biometric focus, aiming to provide further anatomical details for foot and ankle surgery in general. There were analyzed 30 right and left lower limbs of 15 corpses of male adult Brazilian individuals. The cutaneous branching of the nerve was dissected and measurements taken with a tape measure and digital caliper. The nerve emerged at the surface as a single trunk in 66.7% and divided into two branches in 33.3% of the cases. When a single trunk emerged, it appeared at the level of the third distal of the leg in 75%, at the boundary between the middle and distal thirds in 20%, and, in the middle third in 5%. When divided, in most cases (60%), the two branches had the same topography, in general, in the distal third of the leg. The average width of the nerve, at its emergence, when single, was 3.1 ± 0.8 mm, when divided, one of its branches, the medial dorsal cutaneous nerve (MDCn) of the foot, measured 2.4 ± 0.9 mm, and the other, the intermediate dorsal cutaneous nerve (IDCn) of the foot 2.1 ± 0.6 mm. The MDCn communicated with the deep fibular nerve in 53.3%, and the IDCn with the sural nerve in 33.3%. In its distribution in the dorsum of the foot, the MDCn was related mainly with the first metatarsal bone and the first and second interosseous spaces, and the IDCn, in general, with the fourth metatarsal bone and the third and fourth interosseous spaces. There are important variations in the emergence and cutaneous branching of the SFN, which must be known in order to avoid iatrogenic injury during surgical procedures on the foot and ankle.

El propósito de esta investigación fue estudiar la ramificación cutánea del nervio fibular superficial (NFS), con enfoques topográfico y biométrico, para proveer mayores detalles anatómicos a las cirugías del pie y tobillo. Fueron analizados 30 miembros inferiores, derechos e izquierdos, de 15 cadáveres de individuos brasileños adultos, de sexo masculino. La ramificación cutánea del nervio fue disecada y las medidas fueron tomadas con cinta métrica y paquímetro digital. El nervio se observó en la superficie como tronco único en 66,7% de los casos y dividido en dos ramos en 33,3%. Cuando se presentó como tronco único, emergió a nivel del tercio distal de la pierna en 75%, en el límite entre los tercios medio y distal en 20%, y, en el tercio medio en 5%. Cuando se presentó dividido, los dos ramos tuvieron la misma topografía en 60% de los casos, en general, el tercio distal de la pierna. Al salir a la superficie, el promedio del diámetro externo del nervio, cuando era único, fue de 3,1 ± 0,8 mm, y cuando estaba dividido, uno de sus ramos, el nervio cutáneo dorsal medial (nCDM) del pie, midió 2,4 ± 0,9 mm, y el otro, el nervio cutáneo dorsal intermedio (nCDI) del pie, 2,1 ± 0,6 mm. El nCDM se comunicó con el nervio fibular profundo en 53,3% y el nCDI con el nervio sural en 33,3%. En su distribución en el dorso del pie, el nCDM estuvo relacionado principalmente con el 1er hueso metatarsiano y los dos primeros espacios interóseos, mientras que el nCDI, se relacionó en general, con el cuarto hueso metatarsiano y el tercero y cuarto espacios interóseos. La emergencia y ramificación cutánea del NFS presentan importantes variaciones que deben ser conocidas para evitar lesiones iatrogénicas durante procedimientos quirúrgicos el en pie y tobillo.