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1
المصدر: The American Journal of Surgery. 166:130-135
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Dissection (medical), Anastomosis, Tendons, Cadaver, medicine.artery, medicine, Humans, Aged, Aged, 80 and over, Peroneal Artery, Foot, business.industry, Soft tissue, Arteries, General Medicine, Anatomy, Middle Aged, medicine.disease, Surgery, Tibial Arteries, medicine.anatomical_structure, Dorsalis pedis artery, Female, Ankle, business, Artery
الوصف: Reconstruction of the arteries of the foot in patients with severe chronic arterial occlusive disease has become a routine and valuable procedure. However, it is frequently difficult to select the optimal site for the distal arterial anastomosis. In order to determine the most important anatomic variations of foot arteries and the relationship of the dorsalis pedis artery to crossing tendons, the following study was performed in 30 cadaver limbs of 17 persons (9 men and 8 women). Their mean age at death was 69.8 years (range: 42 to 93 years). Methods to evaluate anatomy included anatomic dissection, arteriography, and preparation of corrosion cast models. The latter was performed by injection of liquid plastic and catalyst into the tibial arteries followed by chemical débridement of the soft tissue of the foot. Photographs of the corrosion cast models were taken at various stages of soft tissue dissolution. The dorsalis pedis artery was absent in 6.7% of the cases, and the arcuate artery was absent in 33%. The dorsalis pedis artery arose from the peroneal artery in 6.7%. The dorsalis pedis artery crossed under the extensor hallucis longus tendon at the ankle in 54%, above the ankle in 43%, but below the ankle in only 3%. Our study suggests that the optimal site for the dorsalis pedis artery anastomosis on the foot is the segment distal to the ankle.
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2
المؤلفون: M. Spinner, Stephen W. Carmichael, Robert J. Spinner
المصدر: The Journal of Hand Surgery. 16:236-244
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Elbow, Fingers, Tendons, Anterior interosseous syndrome, Entrapment, medicine, Paralysis, Humans, Orthopedics and Sports Medicine, Bicipital aponeurosis, Skin, Paresis, Electromyography, business.industry, Nerve Compression Syndromes, Anatomy, Middle Aged, musculoskeletal system, medicine.disease, Median nerve, Median Nerve, Surgery, medicine.anatomical_structure, Arm, Upper limb, medicine.symptom, business
الوصف: We present a newly described entrapment of the median nerve caused by compression in the distal arm because of an accessory bicipital aponeurosis. It is characterized by the paresis or paralysis of muscles innervated by the anterior interosseous branch of the median nerve--the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus--as well as other more proximal median nerve innervated muscles, namely, the pronator teres and flexor carpi radialis. Sensibility is intact. The site of the Tinel's sign in the distal arm and the clinical appearance of an accessory bicipital aponeurosis help to localize the lesion. Electrodiagnostic studies are also important in establishing the site of the entrapment. The clinical and surgical findings are correlated with the internal topography of the median nerve at its site of compression. It is important to differentiate this syndrome from the classic anterior interosseous syndrome and other nerve entrapments at the elbow and arm. Surgical exploration is indicated if there is no clinical or electromyographic improvement in three to four months after the onset of symptoms.
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