Cristina Schmitt Cavalheiro

Clinical repercussions of Martin-Gruber anastomosis: anatomical study

Objective The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. Method 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. Results Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). Conclusion Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

INTRAMUSCULAR MARTIN-GRUBER ANASTOMOSIS

Objective : This paper reports the incidence, origin, course and anatomical relationships of intramuscular Martin-Gruber anastomosis. Methods : Anatomical dissection of 100 limbs from 50 adults cadavers was performed. The intramuscular Martin-Gruber anastomosis was found in five forearms, three in the right and two in the left side, one was bilateral. All communication were located between the anterior interosseous nerve and the ulnar nerve. Conclusion : The purpose of intramuscular Martin-Gruber anastomosis, which we found in 5% of dissected limbs, is to supply the flexor digitorum profundus muscle and it is unlikely to have any influence on the innervation of the intrinsic muscles of the hand. Level of Evidence IV, Cases Series.

ANATOMIC STUDY OF THE NERVOUS COMMUNICATION BETWEEN THE MEDIAN AND MUSCULOUCUTANEOUS NERVE

ABSTRACT Objective: The aim of this study was to analyze the incidence of nerve communication between the musculocutaneous and median nerve. Methods: Anatomical dissection of 40 limbs from 20 fetal cadavers was performed at the Laboratory of Anatomy, Faculdade de Ciências Médicas e da Saúde da Pontifícia Universidade Católica de São Paulo. Results: A communicating branch was found in 10 upper limbs. In nine limbs there was a musculocutaneous-median anastomosis (type I); and in one limb there was a median-musculocutaneous anastomosis (type II). Conclusion: It is very important to know these anatomical variations, especially when considering clinical examination, diagnostic, prognostic and surgical treatment. Level of Evidence IV, Case Series.

Transferência de nervos (neurotizações) no tratamento das lesões traumáticas do plexo braquial

Brachial plexus avulsion injuries are usually caused by car and motorcycle accidents. Their consequences are devastating and represent a challenge to the surgeons who assist these patients. Positive results of this procedure depend on the interval between the injury and the definitive treatment. The treatment of brachial plexus avulsion injuries invariably involves the use of neurolysis, direct nerve repair, nerve grafts, and neurotization procedures. Several nerves have been used as donors in neurotizations. In general, there are two types of donor: extraplexal (intercostal, spinal accessory, and phrenic nerves, motor branches of the cervical plexus, and contralateral C7 root) and intraplexal (proximal spinal nerve stumps or collateral motor branches of the preserved brachial plexus). In fact, the intraplexal neurotization represents the classical form of nerve transfers.

Anatomical study on the innervation of the elbow capsule

Objectives To put forward an anatomical description of the innervation of the elbow capsule, illustrated through morphological analysis on dissections. Methods Thirty elbows from fresh fixed adult cadavers aged 32–74 years, of both sexes, were dissected. Results Among the dissected arms, we observed that the median nerve did not have any branches in two arms, while it had one branch in five arms, two branches in two arms, three branches in ten arms, four branches in nine arms and five branches in two arms. The radial nerve did not have any branches in two arms, while it had one branch in two arms, two branches in nine arms, three branches in ten arms, four branches in five arms and five branches in two arms. The ulnar nerve did not have any branches in three arms, while it had one branch in six arms, two branches in four arms, three branches in five arms, four branches in seven arms, five branches in four arms and six branches in one arm. Conclusions We observed branches of the radial, ulnar and medial nerves in the elbow joint, and a close relationship between their capsular and motor branches.