Eduardo Mandiola

PERFORATING BRANCHES: IMPORTANT CONTRIBUTION TO THE FORMATION OF THE DORSAL METACARPAL ARTERIES

The perforating branches that originate from the deep palmar arch of the hand have been studied to provide a complete anatomical description of these vessels and assess their importance in the blood collateral pathway of the hand. We injected latex into the arteries of 50 cadaveric hands of 25 adults, of both sexes, all of Brazilian origin. These were dissected under a stereoscopic microscope. The perforating branch of the second interosseous space originated from the deep palmar arch in 80% of the cases, and it corresponded to the radial artery passing through the second space in 16%; the one of the third interosseous space originated from the deep palmar arch in 76% of the cases and from the palmar metacarpal artery of the third interosseous space in 16%; the one of the fourth interosseous space originated from the deep palmar arch in half the cases, from the deep palmar branch of the ulnar artery in 14%, and from the palmar metacarpal artery of this space in 18%. The perforating branch of the second space anastomosed with the second dorsal metacarpal artery (DMA) in 60% of the cases and formed it in 10%; the one of the third space anastomosed with the third DMA in 20% and formed it in 64%; the one of the fourth space anastomosed with the fourth DMA in 8% and formed it in 78%. These vessels are an important anastomotic pathway between the dorsal carpal network and the deep arteries of the hand and are important in the supply to the dorsum.

Biometric study of the relationships between palmar neurovascular structures, the flexor retinaculum and the distal wrist crease

During surgical exposure of the carpal tunnel it is possible to injure the neurovascular structures closely related to the flexor retinaculum, such as the superficial palmar arch and the communicating branch between the ulnar and median nerves. Because of the importance of these structures and with the purpose of increasing knowledge of anatomical details concerning to their location, a biometric study was performed on the retinaculum and the communicating branch, and between the communicating branch and the distal wrist crease, as well as between the retinaculum and the superficial palmar arch. We dissected 56 hands from 28 Brazilian formalin‐preserved cadavers of both sexes (24 male) at the Federal University of São Paulo–Escola Paulista de Medicina, Brazil. The communicating branch was observed in 96.4% of cases and the superficial palmar arch in 78.6%. The communicating branch was found between the common palmar digital nerve of the 4th interosseous space (from the ulnar nerve) to the homonymous nerve of the 3rd interosseous space (from the median nerve). In males, the distance between the distal wrist crease and the site where the communicating branch originates from the ulnar component had an average of 33.9±5.5 mm on the right side and 30.2±8.2 mm on the left. The distance between the distal wrist crease and the junction of the communicating branch with the common palmar digital nerve of the 3rd interosseous space was 43.6±6.9 mm on the right and 40.2±6.2 mm on the left side. Conversely, in 14.8% of cases (1 female), the communicating branch was observed to emerge from the common palmar digital nerve of the 3rd interosseous space. The distance between the retinaculum and the superficial palmar arch in the axial line of the 4th metacarpal bone was on average 7.3±4.3 mm on the right and 8.3±3.5 mm on the left side. At the same level, the distance between the retinaculum and the communicating branch was 6.2±3.7 mm on the right side and 5.1±2.8 mm on the left. These results can be used as a reference during surgical procedures in the palmar region.

Trayecto del nervio gluteo inferior asociado a la división alta del nervio isquiático

El nervio gluteo inferior, ramo del plexo sacro, abandona la pelvis pasando generalmente por debajo del musculo piriforme. De este plexo se origina tambien el nervio isquiatico, el cual puede presentar variaciones en su relacion con el musculo mencionado, entre ellas, las que se refieren a la division alta del mismo. Sin embargo, son escasos los trabajos que correlacionen esta division con el trayecto del nervio gluteo inferior y su relacion con el musculo piriforme. Con el proposito de verificar una posible asociacion entre los trayectos de estos nervios, fueron disecadas 80 regiones gluteas de cadaveres de individuos brasilenos adultos en el Departamento de Morfologia de la Universidade Federal de Sao Paulo. Se encontraron dos tipos de variacion entre el nervio isquiatico y el musculo piriforme: en 9 casos (11,2 %) el nervio fibular comun paso a traves del musculo y el nervio tibial transcurrio por debajo de su margen inferior (Tipo I); en dos casos (2,5 %), correspondientes a un mismo individuo, el nervio fibular comun hizo su trayecto por sobre el margen superior del musculo piriforme y el nervio tibial paso por debajo de su margen inferior (Tipo II). En el tipo I, el nervio gluteo inferior paso a traves del musculo en 6 casos y en los 3 restantes una parte del nervio perforo al musculo y la otra paso por debajo de su margen inferior; en el tipo II, el nervio gluteo inferior transcurrio por debajo del margen inferior del musculo en uno de los casos y en el otro, una parte de este nervio se origino del nervio fibular comun y la otra, paso por debajo del margen inferior del musculo. El trayecto del nervio gluteo inferior a traves del musculo piriforme podria estar relacionado con la atrofia glutea observada en los pacientes con sindrome del musculo piriforme

BIOMETRIA DE LA ARTERIA CEREBELAR ANTERIOR-INFERIOR EN EL SEGMENTO PONTINO-ANTERIOR Y LATERAL

The clinical physicians insist in the necessity of an anatomical precise knowledge, for the success in neurochirurgical interventions during the approaching to the posterior cranial fossa. Based in previous reports, we have made an anatomical revision of the anterior inferior cerebellar artery focused to its anterior pontine and lateral pontine segments with data that may contribute to their better knowledge. This research was done by the study of 70 human brains from both sexes, collected at Sâo Paulo Medical School/ UNIFESP, Brazil, and to which them , we registred some anthropological data. The brains were inyected in its vascular system with red collored neopren latex and fixed using established anatomical techniques. The range of 1.0-1.5 mm for the external diameter of the AICA is more frecuently at right side in both sexes; in 47.4% of the Brachycephalics (BH) and in 53.1% of the Dolicho-mesocephalics (DM). At the left side and masculine sex, was observed in 45.3% and in 64.3% of feminine sex ; in 52.7% of the BH and in 53.1% of the DM. The course of the AICA at right side is ventral to abducent nerve (AN) in 68.0% in DM groups and in 69.0% in BH groups; at the left side this course was observed in 74.0% in DM and 77.0% in BH groups. The authors insist in the variability observed in the arterial patterns, when taking in consideration besides side and sex, other parameters like the cephalic index

VARIABILIDAD ANATOMICA DE LAS RAMAS MEDIAL Y LATERAL DE LA ARTERIA CEREBELAR SUPERIOR

Existe aun poca informacion cuantitativa y cualitativa disponible, de las arterias que componen el sistema vertebro-basilar, entre las cuales tenemos las cerebelares, de gran importancia en la cirugia que se realiza en la fosa posterior del craneo. Los objetivos de nuestro estudio son analizar y suplementar la informacion anatomica relacionada con la arteria cerebelar superior, considerando ademas el lado, sexo, grupo etnico e indice cefalico de los especimenes observados. La investigacion se efectuo en 70 encefalos de individuos brasilenos adultos, de ambos sexos, con registros antropologicos, colectados para investigacion, inyectados con latex neopreno y fijados en formaldehido al 10%, en el Laboratorio de Anatomia de la Escola Paulista de Medicina/UNIFESP, Sao Paulo, Brasil. La mediciones cefalicas y calculo del indice cefalico, se efectuaron de acuerdo a normas de MARTIN SALLER (1957). Los datos estadisticos fueron procesados usando los programas computacionales EPISTAT y EPI-INFO. La rama medial derecha, se origino en el segmento pontino-anterior de la arteria cerebelar superior en el 85.7 % en el sexo masculino y en el 67.9 % en el femenino; 73.3% en blancos y en el 88.0% en mestizos; en el 78.1% en dolico-mesocefalos y en el 78.9% en braquicefalos. La rama lateral derecha, se origino en el segmento ambiens en el 85.7% en ambos sexos; en el 84.5 % en blancos y en el 88.0% en mestizos; en el 87.5% en los dolico-mesocefalos y en 84.2% en los braquicefalos. La variabilidad de los patrones arteriales es evidente cuando se usan distintos parametros y se consideran caracteristicas antropologicas de los individuos en estudio

NIVEL DE DIVISION DE LA ARTERIA TIBIAL POSTERIOR

RESUMEN: La arteria tibial posterior es el principal vaso que irriga el pie a traves de sus ramas terminales, las arterias plantares medial y lateral. Las intervenciones quirurgicas a nivel del retinaculo de los musculos flexores son relativamente frecuentes, siendo necesario tener un conocimiento acabado de la region. Disecamos 100 pies de cadaveres de individuos adultos de ambos sexos, pertenecientes a los laboratorios del Departamento de Morfologia de la Universidade Federal de Sao Paulo-Escola Paulista de Medicina, Brasil y de la Unidad de Anatomia Humana de la Universidad de La Frontera, Chile. Con ayuda de una lupa estereoscopica se disecaron los vasos tibiales posteriores a nivel del retinaculo de los musculos flexores. La arteria tibial posterior se dividio distal al apice del maleolo medial en el 100% de los casos. La distancia media poblacional entre el punto de division y el apice del maleolo medial se encuentra entre 14,3 mm y 22,4 mm con 95% de confianza, no existiendo diferencia significativa entre ambos lados. La media poblacional de las distancias obtenidas entre la division de la arteria tibial posterior y el margen superior del musculo abductor del halux se encontraba entre 2,1 mm y 3,7 mm. No existe diferencia significativa entre ambos lados.

Diámetros de las arterias cerebelar superior y cerebelar anterior-inferior en el segmento pontino-anterior

At present, the clinical specialized literature, insist in the necessity of an anatomical precise knowledge, necessary for the success in neurochirurgical interventions during the approaching to the posterior cranial fossa. Based in previous reports, we have made an anatomical revision of the superior cerebellar artery and anterior inferior cerebellar artery focused to its anterior pontine segments with data that may contribute to their study and that they could be of practical useful. This study was done in 70 brains of brazilian adult cadavers, from both sexes, collected at the Anatomy Laboratory Sao Paulo Medical School / UNIFESP (Sao Paulo, Brazil), and to which them, we registred their anthropological data. It was considered the cephalics measurements too. We took the brains from skulls, using established anatomical techniques and inyected its vascular system with red collored neopren latex and fixed into a 10 % formaldehyde solution. At right side, masculine sex, the external diameter of superior cerebellar artery was 2.0 to 2.9 mm in range in 66.7% of the cases, and in the feminine sex in 82.1%; in 75.0% in dolicho-mesocephalics and 71.1% in the brachycephalics. The anterior inferior cerebellar artery external diameter at right side, masculine sex, this range of 1.0 to 1.5 mm was observed in 50% of the cases, the same porcentagem was registred in the feminine sex; in 53.1% in the dolicho-mesocephalicsand; in 47.4% in the brachycephalics. The authors insists in the variability observed in the patterns, upon taking in consideration, besides the side and sex, other parameters suchs as the cephalic index, that they are important in the face of the evident heterogeneity of our indoamerican populations

ARCO PLANTAR SUPERFICIAL EN EL HOMBRE: CARACTERISTICAS ANATOMICAS Y COMPARADAS

The human foot irrigation is different of the simian which presents frequently two plantar networks, superficial and deep. Generally, in man there is not a very developed superficial arch. This fact lead us to think in a functional adaptation undergone by the foot through the times. In order to verify the presence and anatomical characteristics of the human superficial plantar arch, we studied 50 feet from 25 adult cadavers, of both sexes, all Brazilians. The arch was present in only 7 cases (14.0%), ever unilateral and located in the distal part of the middle third of the foot. The diameter of this arch did not exceed 1.0 mm. The branches originated from this arterial formation were between 2 and 4, which bound to the plantar superficial structures following the common plantar digital nerves. Due to the presented characteristics we believe that the superficial plantar arch would be beyond of an anatomical variation, a vestige of our evolution

ESTUDIO BIOMETRICO DE LA RAMA PALMAR PROFUNDA DE LA ARTERIA ULNAR

Numerous studies on the hand arterial supply have contributed important data for the reconstructive surgery of it. With the aim of contribute to the knowledge of their arteries, we performed a biometric study of the deep palmar branch of the ulnar artery (DPB) in 60 hands from 30 cadavers of brazilian adult individuals of both sexs. The arteries were injected with latex neoprene. The DPB arose from a common branch with the hipothenar muscles branch in 46.7% of the cases; independently from the ulnar artey in 11.7%; from the ulnar proper palmar digital artery of the little finger in 15 % and from the common palmar digital artery of the fourth interosseous space in 6.7 %. In the first disposition, the common branch arose 10.6 ± 4.7 mm distal to the distal wrist crease (DWC) in female and 12.2 ± 4.1 mm in male; in second disposition the DPB origin was 33.6 ± 4.1 mm distal to the DWC in male; in third disposition it originated 35.8 ± 2.88 mm distal to the DWC in male and in last, it originated 41.0 ± 3.54 mm distal to the DWC. In 18.3% of the all cases we observed two DPB and in 1.7% it was no present. The caliber of these vessels were registrated. The DPB is important in hand arterial supply due to form a part of the deep palmar arch and sometimes, in presence of the thrombosis of the radial artery, it can carry the necessary blood to the deep palmar and dorsal regions