Anatomical basis for a technic of cutting flaps out of the musculus rectus femoris for creating a rectal sphincter apparatus

As demonstrate the surgical anatomy investigations of the m. rectus femoris performed in 100 preparations, obtained from corpses of persons belonging to various age periods, in connection with sphincteroplasty the vascular-nervous hilus of the muscle is projected at the level of the upper third of its medial part. The ascending branch of the lateral femoral circumflex artery with the vein of the same name and the muscular branch of the femoral nerve get into their composition. The intramuscular course of the vessels and nerves of the I-III orders of branching and that of the muscular fasciculi coincide. For the sphincteroplasty it is expedient to use muscular-tendinous flaps, cut out from the medial part of the musculus.     

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.     

Innervation pattern of the deep extensor abdominal muscle in the crayfish species Astacus astacus

The deep extensor abdominal muscle consisting of one medial and two lateral muscle bundles together with the nerve innervating the muscles of crayfish species Astacus astacus, was prepared. Light microscopic investigations of methylene blue stained preparations showed that the nerve innervating the deep extensor abdominal muscle consists of five distinct axons. The five axons were stained separately with lucifer yellow and the innervation pattern of the axons was determined. To confirm the histological results the axons were also stimulated with a suction electrode to elicit excitatory postsynaptic currents on the muscle membrane which were detected using a macro patch electrode. The muscle is innervated by a common excitatory and a common inhibitory axon branching over all three muscle bundles and sending additionally a branch to the L1-bundle of the next posterior segment, and by two axons specific for the two lateral muscle bundles. The axon specific for the innervation of the L1-bundle sends also a branch to the L1-bundle of the next posterior segment. In addition there is one excitatory axon which directly innervates the medial muscle bundle of the next posterior segment branching in most of the cases also to the medial bundle of the segment where it originates.Abbreviations DEAM deep extensor abdominal muscle - EPSC excitatory postsynaptic current - IPSC inhibitory postsynaptic current - L lateral - M medial - GABA -aminobutyric acid     

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.     

Neurovascular activation requires conduction through vessels

In experiments on rats, a hind leg was transected except for the femoral nerve, artery and vein. The femoral nerve was stimulated by electrical pulses, with one electrode attached to the nerve in the amputation gap and another placed in the inferior caval vein. At each pulse of stimulation, contraction could be recorded in femoral muscles. Ligation of the femoral vessels suspended the contractions within a fraction of a second; contractions resumed when ligation ended. Propagation of neural stimuli to femoral muscles therefore required an intact electrical communication through associated vessels. This is possible because conducting blood plasma and its capillary junction with the interstitial fluid form an "external" closed circuit branch of low resistance with the neuromuscular unit. In testing the interstitial tissue fluid as an alternative to the vascular "outer" communication, a higher voltage of stimulation was required for muscle contractions.     

The zygomaticotemporal branch of the trigeminal nerve: an anatomical study

This study was conducted to determine the site of emergence of the zygomaticotemporal branch of the trigeminal nerve from the temporalis muscle and to identify the number of its accessory branches and their locations. A pilot study, conducted on the same number of patients, concluded that the main zygomaticotemporal branch emerges from the deep temporal fascia at a point on average 17 mm lateral and 6 mm cephalad to the lateral palpebral commissure, commonly referred to as the lateral canthus. These measurements, however, were obtained after dissection of the temporal area, rendering the findings less reliable. The current study included 20 consecutive patients, 19 women and one man, between the ages of 26 and 85 years, with an average age of 47.6 years. Those who had a history of previous trauma or surgery in the temple area were excluded. Before the start of the endoscopic forehead procedure, the likely topographic site of the zygomaticotemporal branch was marked 17 mm lateral and 6 mm cephalad to the lateral orbital commissure on the basis of the information extrapolated from the pilot study. The surface mark was then transferred to the deeper layers using a 25-gauge needle stained with brilliant green. After endoscopic exposure of the marked site, the distance between the main branch of the trigeminal nerve or its accessory branches and the tattoo mark was measured in posterolateral and cephalocaudal directions. In addition, the number and locations of the accessory branches of the trigeminal nerve were recorded. On the left side, the average distance of the emergence site of the main zygomaticotemporal branch of the trigeminal nerve from the palpebral fissure was 16.8 mm (range, 12 to 31 mm) in the posterolateral direction and an average of 6.4 mm (range, 4 to 11 mm) in the cephalad direction. On the right side, the average measurements for the main branch were 17.1 mm (range, 15 to 21 mm) in the lateral direction and 6.65 mm (range, 5 to 11 mm) in the cephalic direction. Three types of accessory branches were found in relation to the main branch: (1) accessory branch cephalad, (2) accessory branch lateral, and (3) accessory branches in the immediate vicinity of the main branch. This anatomical information has proven colossally helpful in injection of botulinum toxin A in the temporalis muscle to eliminate the trigger sites in the parietotemporal region and surgical management of migraine headaches triggered from this zone.     

Aberrant cutaneous nerve of the thigh arising from the sciatic nerve in the human

An aberrant cutaneous nerve of the thigh arising from the peroneal portion of the human sciatic nerve or common peroneal nerve was observed in 9 cases (4.6% of sides). After giving a branch to the short head of the biceps femoris muscle and a branch to the knee joint, this cutaneous nerve reaches the subcutaneous tissue by passing between the short head of the biceps femoris and the vastus lateralis or by piercing through the biceps femoris. The authors presume that the cutaneous nerve shows the presence of the potential cutaneous nerve routes from the common peroneal nerve to the skin of the lateral aspect of the thigh.     

Electron Microscopy of Peripheral Nerves and Neuromuscular Junctions in the Wasp Leg

The peripheral nerve branch innervating the femoral muscles of the common yellow jacket (Vespula carolina) has been found to possess a thick lemnoblast basement membrane and a complex mesaxon. The term "tunicated nerve" is proposed to designate the type of peripheral nerve in which one or several axons are loosely mantled by meandering, cytoplasm-enclosing membranes of the lemnoblast. The peripheral axon courses longitudinally in a groove in the muscle fiber between the plasma membrane of the muscle fiber and a cap formed by lemnoblast and tracheoblast. The junction is characterized by apposition of plasma membranes of axon and muscle fiber, abundant mitochondria, and synaptic vesicles in the axon, and aggregates of "aposynaptic granules" plus mitochondria and endoplasmic reticulum on the muscle side of the synapse. Unlike the vertebrate striated muscle fiber, no complex infolding of the synapsing plasma membrane of the muscle fiber occurs. The "connecting tissue" of the insect is formed by tracheoblasts, their basement membranes, and the basement membranes of other cells. Further mechanical support is given by the ramifying tracheoles. The physiologic roles of the specialized structures are considered.     

Distally based anterolateral thigh flap: an anatomic and clinical study

The distally based anterolateral thigh flap has been used for coverage of soft-tissue defects of the knee and upper third of the leg. This flap is based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral system. The purpose of this study was to examine the results of anatomical variations of the descending branch of the lateral circumflex femoral artery and the retrograde blood pressure of the descending branch of the lateral circumflex femoral artery so that the surgical technique for raising and transferring a distally based anterolateral thigh flap to the knee region could be improved. The authors have actually used this flap in three cases. In 11 thighs of six cadavers, the descending branch of the lateral circumflex femoral artery had a rather consistent connection with the lateral superior genicular artery or profunda femoral artery in the knee region. The pivot point, located at the distal portion of the vastus lateralis muscle, ranges from 3 to 10 cm above the knee. In their three cases, the maximal flap size was 7.0 x 16.0 cm and was harvested safely, without marginal necrosis. The mean pedicle length was 15.2 +/- 0.7 cm (range, 14.5 to 16 cm). The average proximal and distal retrograde blood pressure of the descending branch of the lateral circumflex femoral artery was also studied in another 11 patients, and the anterolateral thigh flap being used for reconstruction of head and neck defects showed 58.3 and 77.7 percent of proximal antegrade blood pressure, respectively. The advantages of this flap include a long pedicle length, a sufficient tissue supply, possible combination with fascia lata for tendon reconstruction, and favorable donor-site selection, without sacrifice of major vessels or muscles.     

Distally based vastus lateralis muscle flap for coverage of wounds about the knee

The blood supply to the vastus lateralis muscle has been evaluated by dye injection techniques in fresh cadaver dissections. The main dominant blood supply is the descending branch of the lateral femoral circumflex artery. Vascular contributions from distal perforators of the superficial femoral artery, the superior geniculate artery, fill the main vascular pedicle in a retrograde fashion. Latex staining is observed consistently in the proximal third of the muscle. Five patients are presented in whom the distally based vastus lateralis muscle flap was successfully used to cover defects above the knee. Superficial muscle necrosis is a complication of this operation but has not precluded its usefulness. It is anticipated that this flap will be useful in the armamentarium of reconstructive surgeons treating such problematic patients.     

Applied anatomy of the anterolateral femoral flap

A study of the source of the blood supply to the anterolateral femoral flap was carried out on 42 lower limbs of adult cadavers (among them 35 cadavers with injection of red latex and 1 with india ink into the arteries and 6 vascular cast specimens), and the surface locations of the vascular pedicle were detected on 50 healthy adults. It was found that the descending branch of the lateral circumflex femoral vessel was an ideal axial vessel. There are constant perforating branches of the myocutaneous artery or cutaneous branches from the intermuscular space to the anterolateral femoral skin. The area extends about 12 x 30 cm. Within the flap, the anterior branch of the anterolateral cutaneous nerve of the high is located. This flap has been widely used for free transplantation in China since 1983 with satisfactory results.     

Architectonics of the arteries of the latissimus dorsi muscle in humans and dogs

Vascularisation of musculus latissimus dorsi in man and dog was studied in 50 preparations. Methods of x-ray angiography, preparation and macro-microscopy of cleared preparations were used. The nutrition of the muscle was stated to carry out at the expense of the thoracodorsal artery and of the musculocutaneous branches of the intercostal arteries. Vascular-neuronal "gate" of the muscle is projected on the upper third of its lateral portions. A rich network of intrasystemic and intersystemic anastomoses makes it possible to switch off one or several sources of additional nutrition for the muscle. The most favourable conditions of blood supply exist for the muscle lateral portions which are reasonable to use for plastic purposes.     

The long-term influence of decentralisation or preganglionic hypogastric nerve stimulation in vivo on the reinnervation of minced vas deferens in the guinea-pig

Previous studies have shown that minced regenerating smooth muscle of the guinea-pig vas deferens becomes reinnervated by nerves growing in from the surrounding intact vas deferens. Using electron microscopy, we have examined the effect of altering activity in the preganglionic nerves, either by decentralisation, or by chronic stimulation of the hypogastric nerve, in vivo, on the reinnervation of regenerating smooth muscle cells. Chronic stimulation induced earlier reinnervation than that seen in unstimulated (sham-operated) or decentralised preparations; the number of nerve profiles present in four preparations stimulated for up to 7 days was approximately 10-20 times that seen in unstimulated or decentralised preparations. However, electron micrographs revealed that "empty" nerve terminals were a feature following stimulation for longer periods. Decentralised preparations showed little change of reinnervation, at least up to 7 weeks. Compensatory changes in the density of innervation were found in the unstimulated contralateral vas deferens.     

Organization of the larval pre-ecdysis motor pattern in the tobacco hornworm,Manduca sexta

The tobacco hornworm, Manduca sexta, undergoes several larval molts before transforming into a pupa and then an adult moth. Each molt culminates in ecdysis, when the old cuticle is shed. Prior to each larval ecdysis, the old cuticle is loosened by pre-ecdysis behavior, which consists of rhythmic compressions that are synchronous along the abdomen and on both body sides, and rhythmic retractions of the abdominal prolegs. Both pre-ecdysis and ecdysis behaviors are triggered by a peptide, eclosion hormone. The aim of the present study was to investigate the neural circuitry underlying larval preecdysis behavior. The pre-ecdysis motor pattern was recorded in isolated nerve cords from eclosion hormone-treated larvae, and the effects of connective transections and ionic manipulations were tested. Our results suggest that the larval pre-ecdysis compression motor pattern is coordinated and maintained by interneurons in the terminal abdominal ganglion that ascend the nerve cord without chemical synaptic relays; these interneurons make bilateral, probably monosynaptic, excitatory connections with identified pre-ecdysis motor neurons throughout the abdominal nerve cord. This model of the organization of the larval pre-ecdysis motor pattern should facilitate identification of the relevant interneurons, allowing future investigation of the neural basis of the developmental weakening of the pre-ecdysis motor pattern that accompanies the larval-pupal transformation.Abbreviations A3, A4... abdominal ganglia 3, 4... - AT terminal abdominal ganglion - ALE anterior lateral external muscle - DN dorsal nerve - DN_A anterior branch of the dorsal nerve - DN_L lateral branch of the dorsal nerve - DN_P posterior branch of the dorsal nerve - EH eclosion hormone - TP tergopleural muscle - VN ventral nerve - VN_A anterior branch of the ventral nerve - VN_L lateral branch of the ventral nerve - VN_P posterior branch of the ventral nerve     

Functional topography and ultrastructure of periarticular mechanoreceptors in the lateral elbow region of the rat

The distribution and ultrastructure of sensory nerve endings were investigated in the deep lateral elbow region of the rat. Three zones of distribution of mechanoreceptors were distinguished, each in relation to the functional architecture of the connective and muscular tissue in that area: (1) a zone with muscle spindles, Golgi tendon organs, free nerve endings and single small lamellated corpuscles ('muscle-tendon spectrum'), situated in the middle third of the supinator muscle and its superficial aponeurosis; (2) a zone with small lamellated corpuscles and free nerve endings, situated pericapsularly to the humeroradial joint capsule ('shearing spectrum'): this moderately dense, irregular connective tissue is covered by the proximal continuation of the supinator's aponeurosis, and muscle fibers insert from beneath this aponeurosis, which displays, as a part of the joint capsule, a strong collagenous tissue plate; (3) a zone with only free nerve endings within the tendon-like, most proximal part of the supinator's aponeurosis, inserting into the periosteal layer of the lateral humeral epicondyle ('endotenonial spectrum'): it is part of the joint capsule. The ultrastructure of these sensory endings is described and the distribution pattern of the mechanoreceptors observed is discussed in relation to the classification into 'muscle receptors' and 'joint receptors'.     

An anomalous muscle (accessory subscapularis-teres-latissimus muscle) in the axilla penetrating the brachial plexus in man.

An anomalous muscle passing through the brachial plexus was found in 10 cases out of 380 sides of 190 human cadavers in the dissection course. The muscle was designated as 'accessory subscapularis-teres-latissimus muscle'. This muscle arose near the lateral margin of the scapula, either from the surface of the subscapularis muscle or from the border of the quadrangular terminal tendon of the latissimus dorsi or from both of those sources when the muscle was divided into two heads. It ran obliquely upward to fuse with the insertion of the subscapularis. The largest anomaly was 2.5 cm in width and 7 cm in length. This muscle could be classified into three types on the basis of its nerve supply and its relation to the brachial plexus. The type I muscle crossed over the axillary and lower subscapular nerves, behind the radial nerve and was innervated by the lower subscapular nerves. The type II musclepenetrated the brachial plexus separating the radial nerve into two roots; the upper from the posterior division of the upper trunk and the lower from the posterior divisions of the middle and lower trunks. The type II muscle was supplied by a branch of the radial nerve, which originated always at the same level as the origin of the thoracodorsal nerve. The type III muscle passed through the further more ventrocaudal level of the plexus; in one case it divided the radial nerve into an upper root from the posterior divisions of the upper and middle trunks and a lower root from the lower trunk, and, in another case, into an upper main root from all the three trunks and a lower slender root from the lower trunk. The type III muscle was supplied by branches from the radial and in addition from the thoracodorsal nerve in one case. In four out of ten cases, the subscapular or thoracodorsal artery also passed posterior to the anomalous muscle. A discussion was made on the nature of the anomalous muscle.     

Functional disturbances in the nervous structures of the respiratory tract in rats following nitrogen dioxide inhalation

The functional state of rat's airway smooth muscle was not changed after nitrogen dioxide inhalation for 30 days. The smooth muscle contraction increased only at second stimulation of preganglionic nervous fibers. Removal of mucosa or Novocain blockade of receptors decreased control smooth contraction at nerve and muscle fiber stimulation but the repeated stimulation of nerve increased the muscle contraction. The processing of trachea and bronchus preparations by prednisolon (1-10 microg/ml) decreased muscle reactions to 12% only at nerve stimulation. Prednisolon didn't change reactions of preparations with removed or blockaded receptors induced by nerve stimulation, but prednisolon (10 microg/ml) increased contraction at muscle stimulation. The relax effect of prednisolon on airway smooth muscle realizes via tracheobronchial receptors. High doses of prednisolon may direct effect on muscle increasing its contraction.     

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.     

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.