The innervation of the medial humeral epicondyle: implications for medial epicondylar pain.

The purpose of this study was identification of the innervation of the medial humeral epicondyle which has not been described before. In 20 patients, the medial intermuscular septum was evaluated histopathologically: the nerve was identified in 15 specimens without S-100 staining, and in the remaining 5 with S-100 staining. In six fresh cadavers, bilateral dissections identified the source of this nerve as the radial nerve in the axilla, coursing adjacent to the ulnar nerve in the upper arm, then moving laterally to be superficial to, or within, the medial intermuscular septum, until the nerve terminated in the periosteum of the medial humeral epicondyle, at the origin of the flexor-pronator muscle mass. In one specimen, a branch from the ulnar nerve in the axilla contributed to this nerve to the medial humeral epicondyle.

Reconstruction of the median sternotomy wound dehiscence using the latissimus dorsi myocutaneous flap.

BACKGROUND: Currently the internal thoracic artery (ITA) is the conduit of preference for coronary artery revascularization. Although this artery offers several advantages over the saphenous vein there is a higher incidence of postoperative sternal wound infection with its use. This incidence further increases with the use of bilateral internal thoracic arteries (BITA). The use of muscle or omental flaps to treat this complication has significantly reduced the morbidity and mortality. Typically the pectoralis major (PM) or the rectus abdominis (RA) muscles are the preferred method of reconstruction of the infected sternotomy wound. METHODS: In a retrospective study over a four-year period from February 1994 to October 1998, nine patients underwent reconstruction of an infected median sternotomy wound with a latissimus dorsi myocutaneous flap (LDMF). RESULTS: All of the patients in our study were successfully treated with a single LDMF with the exception of one who required a rectus abdominis flap to cover the lateral aspect of the recalcitrant poststernotomy infected wound. There was a single patient who had a wound dehiscence at the donor site. CONCLUSIONS: The LDMF is reliable and serves as an adjunct for treating sternotomy infections. The flap provides sufficient amount of pedicle length and muscle mass for coverage. Although there is a need to turn the patient into a lateral decubitus position once the debridement is performed the flap harvest and its mobilization is technically straightforward with a short operative time, 135 minutes on average with a range of 97 to 171 minutes. Furthermore, there exists an anatomical advantage in using the LDMF; harvest of the LDMF does not disrupt collateral blood supply to the sternum and parasternal tissues.