Surgical anatomy of the gracilis muscle of the thigh

As demonstrates the investigation of 100 preparations, the main vascular-nervous "hilus" of the muscle is situated on the superior third of its lateral part. They contain the transversal branch of the medial artery, circumflexing the femoral bone with the accompanying vein, having the same name, and the anterior branch of the obturative nerve (92 preparations), or muscle branch of the femoral nerve (8 preparations). The muscle has a well developed network of intrasystemic and intersystemic anastomoses. Beginning from the first period of childhood, for sphincter plasticity either the whole muscle, or a graft, cut out from its lateral part, can be used.     

Structural and histochemical characteristics of different variants of the perimuscularization of the femoral vein in an experiment

Structural and histochemical changes in the region of perivenous muscular constrictors created by means of experimental perimuscularization of the femoral vein were studied and compared. Thirty-two mongrel dogs were operated on. In 18 dogs, perimuscularization was made by placing the femoral vein beneath a flap from the medial head of the musculus quadriceps femoris. In 14 dogs, the proximal segment of the dissected femoral vein was introduced through a tunnel formed in the medial head of the musculus quadriceps femoris followed by restoration of the vein continuity by an angiography apparatus. It has been shown that the method of the femoral vein introduction through the muscular tunnel is very promising, since it results in minimal histostructural changes in the vessel and the adjacent muscle.     

Anatomo-surgical bases of the sphincteroplasty technic using a musculus adductor magnus femoris flap on a nutritive pedicle

In 100 preparations it has been stated that with reference to the operation of sphincteroplasty, the main vascular-nervous fasciculus should be considered the one, which composition includes posterior branches of the obturative arteries, veins and nerve. The intramuscular course of the arterial and nervous branches coincides. For sphincteroplasty it is possible to use one type of transplants cut out of the posterior part of the muscle.     

Anatomo-experimental parallels in the elaboration of methods of increasing the viability of non-free muscle flaps used for sphincteroplasty

As demonstrate morphological investigations of transplants, obtained from thin, rectal, long adductor and semitendonous femoral muscles in 100 animals after sphincteroplasty, the methods elaborated contribute to preserve vital capacity of the muscle flaps both soon after and in a long time after the operation. Rearrangement of the blood bed in the muscle transplants and the colon sphincters formed is completely achieved by the 30th day after the operation. The blood bed becomes more powerful than the normal one.     

Functional organization of the arctiid moth tymbal (insecta,lepidoptera)

The exoskeletal morphology, muscular organization, and innervation patterns of the tymbals of seven sound-producing species of tiger moths (Arctiidae) were compared with the undifferentiated episterna of two silent species. At least three muscles are involved in sound production: the tymbal muscle, pv2, and the accessory muscles, pvl and/or pv6. All of the tymbal muscles are innervated by the IIIN2a branch of the metathoracic leg nerve, which contains two axons larger than the others. Backfills of the tymbal branch of the IIIN2a reveal a medial sensory neuropil and a population of five ipsilateral motor neurons whose somata are clustered into three groups along the anterior edge of the metathoracic ganglion. The dendritic arborizations of the motor neurons extend to the ganglionic midline but are separate from one part of the auditory neuropil observed in other noctuoids. The study concludes that the arctiid tymbal reveals only minor modifications (e.g., cuticle thinning) of the episterna of silent moths and represents a primitive form of the tymbal compared to those of the Cicadidae.     

Murine Model of Femoral Artery Wire Injury with Implantation of a Perivascular Drug Delivery Patch

Percutaneous interventions including balloon angioplasty and stenting have been used to restore blood flow in vessels with occlusive vascular disease. While these therapies lead to the rapid restoration of blood flow, these technologies remain limited by restenosis in the case of bare metal stents and angioplasty, or reduced healing and possibly enhanced risk of thrombosis in the case of drug eluting stents. A key pathophysiological mechanism in the formation of restenosis is intimal hyperplasia caused by the activation of vascular smooth muscle cells and inflammation due to arterial stretch and injury. Surgeries that induce arterial injury in genetically modified mice are useful for the mechanistic study of the vascular response to injury but are often technically challenging to perform in mouse models due to the their small size and lack of appropriate sized devices. We describe two approaches for a surgical technique that induces endothelial denudation and arterial stretch in the femoral artery of mice to produce robust neointimal hyperplasia. The first approach creates an arteriotomy in the muscular branch of the femoral artery to obtain vascular access. Following wire injury this arterial branch is ligated to close the arteriotomy. A second approach creates an arteriotomy in the main femoral artery that is later closed through localized cautery. This method allows for vascular access through a larger vessel and, consequently, provides a less technically demanding procedure that can be used in smaller mice. Following either method of arterial injury, a degradable drug delivery patch can be placed over or around the injured artery to deliver therapeutic agents.     

Ultrastructure of the Circulatory System of the Phoronid Phoronopsis harmeri Pixell, 1912. 2. Main vessels

The ultrastructure of the wall of the main blood vessels of the phoronid Phoronopsis harmeri is described. The walls of the lophophoral and left lateral vessels consist of myoepithelial cells of the coelomic lining (peritoneal cells), a thin basal lamina, and an incomplete endothelial lining. In the head region of the body, the wall of the medial vessel consists of myoepithelial cells of the coelomic lining (peritoneal cells), a basal lamina, and true muscular endothelial cells. The anterior part of the medial vessel functions as the heart. In the anterior part of the body, the medial vessel wall consists of five layers: the external nonmuscular coelothelium, a layer of the extracellular matrix, the internal muscular coelothelium, an internal layer of the extracellular matrix, and an incomplete endothelial lining. The complicated structure of the medial vessel wall may be explained by the superimposition of the lateral mesentery on the ordinary vessel wall.     

Experimental anatomical basis for a new method of revascularizing the femoral head for the treatment of avascular necrosis

Two series of experiments were performed in rabbits of both sex at the age of 2-6 months. In I series (42 rabbits) the modelling of Perthes' diseases was performed by a lesion produced in the proximal diaepiphysial femoral growth zone. Character and course of pathological processes in the femoral head and neck were studied. They were mainly correspond to 5 clinical roentgenological stages of Perthes' disease. In II series (52 rabbits) with the model of Perthes' disease the suggested operation on revascularization of the femoral head by means of a periosteal muscular graft on a feeding peduncle was applied. Histological, angiological, roentgenological investigations and the method on indication of radioactive phosphorus (P32) demonstrated good vascularizational and reparative properties of the transplant applied. In 50 patients with Perthes' disease the result of a conservative treatment were studied. In 25 patients the operation on revascularization of the femoral head by means of a periosteal muscular transplant on a feeding peduncle was applied according to the technique suggested. The analysis of the treatment results demonstrated that restoration of the femoral bone configuration and that of functioning of the coxofemoral joint occurred sooner, further progressive course of the disease was stopped, duration of treatment was shorter as compared to the conservative methods. The operation suggested could be applied together with other operative methods for treatment of Perthes' disease.     

Topography and nerve supply of the cucullaris (trapezius) of skates

Dissections of Sudan black B stained specimens reveal that, of a complex of medial, intermediate, and lateral muscles of skates, presumed homologous to the cucullaris of sharks, only the lateral muscle is innervated by a branch or branches of the vagus and is inserted, in part, to the fused pharyngobranchials of the caudal visceral arches. The medial and intermediate muscles are supplied by separate branches of rostral spinal nerves and do not attach to the branchial skeleton. The lateral muscle therefore is the most likely homologue of the cucullaris (trapezius) of sharks and perhaps other fishes and tetrapods. The medial and intermediate muscles appear to be part of the axial musculature.     

The first branch of the lateral plantar nerve and heel pain

The course and ramification pattern of the lateral plantar nerve was studied in serial sections from 4 fetal feet and in dissections from 34 adult feet with special reference to the so called first branch. This branch was found in all of the observed fetal and adult specimen. From its originating point the nerve runs immediately distally to the medial process of the calcaneal tuberosity in a lateral direction to the proximal part of the abductor digiti minimi muscle. During its course the FB gives two branches. One of them penetrates sometimes the insertion of the quadratus plantae muscle, whereas in adult feet it always sends fibres to the periosteum around the medial process of the calcaneal tuberosity and the long plantar ligament. The other innervates the flexor digitorum brevis muscle. The site of a possible entrapment is located between the abductor hallucis muscle and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the medial head of the quadratus plantae muscle. There is strong indirect evidence that the nerve is of a mixed type consisting of sensory fibres for the calcaneal periosteum and the long plantar ligament as well as motor fibres for the quadratus plantae, flexor digitorum brevis and abductor digiti minimi muscles, which may explain the characteristic pain complaints of the heel pain syndrome. The occurrence of a stiff fascia perforated by the nerve branch or a bursa around the insertion of the plantar aponeurosis as has been described by several authors and which was put forward as a possible aetiological factor could not be confirmed in our material.     

Anatomy of a duplicated human foot from a limb with fibular dimelia.

At birth, a patient presented with a right lower limb featuring preaxial polydactyly and fibular dimelia with a complete absence of the tibia. Radiographic studies of the patient's foot revealed a duplicated tarsus with eight metatarsals and toes. The three preaxial toes were surgically removed at 1 year of age. A hallux and four normal-appearing postaxial toes remained. The foot was amputated when the patient was 3 years old. Dissection of the amputated foot revealed that the muscles of the dorsum were normal, except that the tendon of the extensor hallucis brevis muscle inserted into both the hallux and toe 2, rather than only into the hallux. The few abnormalities observed among the muscles on the plantar surface of the foot included absence of the insertions of the tibialis posterior and the abductor hallucis muscles. In addition, the two heads of the adductor hallucis muscle inserted abnormally into the medial (tibial) side of metatarsal 1, rather than into the lateral side. These various muscular anomalies, in addition to the mirror duplication of the foot with the presence of only a single metatarsal 1, leads us to propose that this metatarsal probably represents two lateral (fibular) halves that form a laterally duplicated bone. Although the dorsalis pedis artery was present on the dorsal surface of the foot, most of its derivatives were absent. This artery did give rise to a supernumerary medial branch that ended abruptly in the connective tissue (presumably postsurgical scar) at the medial border of the foot. This branch may have represented a duplicated dorsalis pedis artery associated with the duplicated preaxial portion of the foot. The arteries on the plantar surface of the foot were normal. Even though some anomalies in the pattern of the cutaneous innervation were observed, the nerves of the foot were largely normal. The gross and radiographic anatomy of this specimen and the radiographic anatomy of the leg suggest that some teratogenic event occurred when developmental specification reached the level of the future knee. The teratogenic event, which probably occurred early in the fifth week of development, may have caused damage that led to a lateral duplication of both the leg and the foot with the absence of some of the most medial structures. Teratology 60:272-282, 1999.     

Anatomical separation and clinical importance of two different parts of the vastus medialis muscle

In 32 corpses, either fresh or fixed, the deviations of the two heads (musculus vastus medialis longus and musculus vastus medialis obliquus) of the vastus medialis muscle from the long axis of the femur were measured. The deviations were between 15 and 18 degrees medially for the m. vastus medialis longus and between 46 and 52 degrees medially for the m. vastus medialis obliquus. Anatomical dissections of the vastus medialis muscle in 115 fixed thigh specimens could always demonstrate a clear separation between a long head of the muscle that inserts at the base (m. vastus medialis longus) and a short head (m. vastus medialis obliquus) that inserts at the medial margin of the patella. The plane of separation could be identified by a femoral nerve's branch in every case. In 17 instances the nerve's localization was superficial, in 57 in an areolar fascial plane, and in the depth between the muscles in 41 instances. The ramification of the femoral nerve's branch that runs along the separation plane showed four types of variation. With these investigations it was possible to distinguish between two individual heads of the vastus medialis muscle not only with regard to its function, but also to its anatomy.     

Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using 'interventional' MRI

The aim of this study was to image tibio-femoral movement during flexion in the living knee. Ten loaded male Caucasian knees were initially studied using MRI, and the relative tibio-femoral motions, through the full flexion arc in neutral tibial rotation, were measured. On knee flexion from hyperextension to 120 degrees , the lateral femoral condyle moved posteriorly 22 mm. From 120 degrees to full squatting there was another 10 mm of posterior translation, with the lateral femoral condyle appearing almost to sublux posteriorly. The medial femoral condyle demonstrated minimal posterior translation until 120 degrees . Thereafter, it moved 9 mm posteriorly to lie on the superior surface of the medial meniscal posterior horn. Thus, during flexion of the knee to 120 degrees , the femur rotated externally through an angle of 20 degrees . However, on flexion beyond 120 degrees , both femoral condyles moved posteriorly to a similar degree. The second part of this study investigated the effect of gender, side, load and longitudinal rotation. The pattern of relative tibio-femoral movement during knee flexion appears to be independent of gender and side. Femoral external rotation (or tibial internal rotation) occurs with knee flexion under loaded and unloaded conditions, but the magnitude of rotation is greater and occurs earlier on weight bearing. With flexion plus tibial internal rotation, the pattern of movement follows that in neutral. With flexion in tibial external rotation, the lateral femoral condyle adopts a more anterior position relative to the tibia and, particularly in the non-weight bearing knee, much of the femoral external rotation that occurs with flexion is reversed.     

Phasic and spatial pressure measurements in a femoral artery branch model for pulsatile flow

Phasic and spatial time-averaged pressure distributions were measured in a 60-deg femoral artery branch model over a large range of branch flow ratios and at physiological Reynolds numbers of about 120 and 700. The results obtained with an in-vivo like flow wave form indicated spatial adverse time average pressure gradients in the branch vicinity which increased in magnitude with branch flow ratio, and the importance of the larger inertial effects at the higher Reynolds numbers. Pressure losses in the branch entrance region were relatively large, and corresponding flow resistances may limit branch flow, particularly at higher Reynolds numbers. The effect of branch flow was to reduce the pressure loss in the main lumen.     

“Pollical palmar interosseous muscle” (musculus adductor pollicis accessorius): Attachments,innervation, variations,phylogeny, and implications for human evolution and medicine

Most atlases and textbooks dealing with human anatomy do not refer to the “pollical palmar interosseous” (PPI) muscle of Henle. In order to undertake a fresh and detailed study of this muscle and to thus better understand human comparative anatomy and evolution, we: 1) analyze the frequency of the PPI in a large sample of human hands; 2) describe the attachments, innervation and varieties of the PPI in these hands; 3) compare the data obtained with the information available in the literature; and 4) discuss the phylogenetic origin of the PPI and the implications of our observations and comparisons for medicine and for the understanding of human evolutionary history. Within the 72 hands dissected by us, the PPI is present in 67 hands (93%), commonly having a single muscular branch, originating from the medial side of the base of metacarpal I only, inserting onto the medial side of the base of the pollical proximal phalanx and/or surrounding structures (e.g., ulnar sesamoid bone, wing tendon of extensor apparatus), and passing at least partially, and usually mainly, medial to the princeps pollicis artery. A careful study of the human PPI, as well as a detailed comparison with other mammals, strongly suggest that the muscle is evolutionarily derived from the adductor pollicis, and namely from its oblique head. Therefore, we propose that PPI should be designated by the name musculus adductor pollicis accessorius, which indicates that the muscle is most likely a de novo structure derived from the adductor pollicis. J. Morphol., 2013. © 2012 Wiley Periodicals, Inc.     

Evidence for absence of latch-bridge formation in muscular saphenous arteries

Large-diameter elastic arteries can produce strong contractions indefinitely at a high-energy economy by the formation of latch bridges. Whether downstream blood vessels also use latch bridges remains unknown. The zero-pressure medial thickness and lumen diameter of rabbit saphenous artery (SA), a muscular branch of the elastic femoral artery (FA), were, respectively, approximately twofold and half-fold that of the FA. In isolated FA and SA rings, KCl rapidly (< 16 s) caused strong increases in isometric stress (1.2 x 10(5) N/m2) and intracellular Ca2+ concentration ([Ca2+]i; 250 nM). By 10 min, [Ca2+]i declined to approximately 175 nM in both tissues, but stress was sustained in FA (1.3 x 10(5) N/m2) and reduced by 40% in SA (0.8 x 10(5) N/m2). Reduced tonic stress correlated with reduced myosin light chain (MLC) phosphorylation in SA (28 vs. 42% in FA), and simulations with the use of the four-state kinetic latch-bridge model supported the hypothesis that latch-bridge formation in FA, but not SA, permitted maintenance of high stress values at steady state. SA expressed more MLC phosphatase than FA, and permeabilized SA relaxed more rapidly than FA, suggesting that MLC phosphatase activity was greater in SA than in FA. The ratio of fast-to-slow myosin isoforms was greater for SA than FA, and on quick release, SA redeveloped isometric force faster than FA. These data support the hypothesis that maintained isometric force was 40% less in SA than in FA because expressed motor proteins in SA do not support latch-bridge formation.     

Two new cutaneous free flaps: the medial and lateral thigh flaps

Two new cutaneous free-flap donor areas are described on the medial and lateral sides of the thigh. The medial thigh flap is supplied by an unnamed artery from the superficial femoral artery and is drained by the accompanying venae comitantes. Its nerve supply is from the medial femoral cutaneous nerve. The lateral thigh flap has its vascular pedicle from the third perforating artery of the profunda femoral artery and its accompanying vein. The lateral femoral cutaneous nerve provides sensation over the area. These flaps provide a large surface area of both skin and subcutaneous tissue without the usual bulk of subcutaneous fat and muscle. Their desirable features include long vascular pedicles with large vessel diameters and potential of being neurovascular flaps with specific sensory nerve supply and predictable anatomy. The principal disadvantage is that the donor site may leave a slight contour defect with primary closure or require grafting when a large flap is taken. We predict that these flaps will become important donor sites for reconstructive problems requiring resurfacing of cutaneous defects in various anatomic areas.     

Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation

Thirty-seven consecutive free anterolateral thigh flaps in 36 patients were transferred for reconstruction of head and neck defects following cancer ablation between January of 1997 and June of 1998. The success rate was 97 percent (36 of 37), with one flap lost due to a twisted perforator. The anatomic variations and length of the vascular pedicle were investigated to obtain better knowledge of anatomy and to avoid several surgical pitfalls when it is used for head and neck reconstruction. The cutaneous perforators were always found and presented as musculocutaneous or septocutaneous perforators in this series of 37 anterolateral thigh flaps. They were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle. In type I, vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 56.8 percent of cases (21 of 37), and they were 4.83 +/- 2.04 cm in length. In type II, horizontal musculocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 27.0 percent of cases (10 of 37), and they were 6.77 +/- 3.48 cm in length. In type III, vertical septocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 10.8 percent of cases (4 of 37), and they were 3.60 +/- 1.47 cm in length. In type IV, horizontal septocutaneous perforators from the transverse branch of the lateral circumflex femoral artery were found in 5.4 percent of cases (2 of 37). They were 7.75 +/- 1.06 cm in length. The average length of vascular pedicle was 12.01 +/- 1.50 cm, and the arterial diameter was around 2.0 to 2.5 mm; two accompanying veins varied from 1.8 to 3.0 mm and were suitable for anastomosis with the neck vessels. Reconstruction of one-layer defect, external skin or intraoral lining, was carried out in 18 cases, through-and-through defect in 17 cases, and composite mandibular defect in two cases. With increasing knowledge of anatomy and refinements of surgical technique, the anterolateral thigh flap can be harvested safely to reconstruct complicated defects of head and neck following cancer ablation with only minimal donor-site morbidity.     

Stresses at the meniscofemoral joint: elastostatic investigations on the applicability of interface elements

Stress distributions at the meniscofemoral joint were analysed and the applicability of nonlinear interface elements in a finite element model (FEM) were tested. Centred and 70% off-centre load cases with a complete, a partially removed or a totally removed medial meniscus were evaluated in two dimensions. Interface width was assumed to increase linearly from almost zero to 1 mm at the inner and outer border of the femoral condyles. Maximum interface forces were found at the centre of the condyles, decreasing to zero at the peripherical and intercondylar femoral border. Simulation data concerning a removed medial meniscus or medial 70% off-centre load with complete meniscus indicated higher medial contact forces in the first case. A decrease in the elastic modulus of the articular surface tissues caused two small force transfer peaks (femoral centre and intercondylar border), which were strongly influenced by the predefined gap width.