Jacqueline Silva Brito Lima

Bases anatômicas para o bloqueio anestésico do plexo braquial por via infraclavicular

BACKGROUND AND OBJECTIVES: This study shows the constant infraclavicular fossa presence, aiming at using it as a pathway for infraclavicular brachial plexus block. Determining the point where brachial plexus fascicles may be located within the fossa, the authors have proposed measurements from the anterior surface of the clavicle and the angle formed by the deltoid muscle and the clavicle (deltoclavicular angle). The first measurement allows the in-depth location of the site crossed by the brachial plexus. The second determines fascicles projection within the fossa, corresponding to the needle insertion point on the skin. METHODS: Measurements were made between the anterior surface of the clavicle and brachial plexus fascicles, and from the deltoclavicular angle to superficial fascicles projection. Based on the anatomic findings a technique of infraclavicular brachial plexus approach was proposed. RESULTS: A hundred infraclavicular regions in cadavers were analyzed. Infraclavicular fossa was detected in 96 cases where brachial plexus fascicles were totally or partially (97.9%) located. The distance between the anterior surface of the clavicle and brachial plexus fascicles was in average of 2.49 cm and from the deltoclavicular angle to superficial fascicles projection was 2.21 cm. CONCLUSIONS: Values obtained allow for the precise location of the needle insertion point which, when perpendicular to the skin, reaches brachial plexus without danger of causing pneumothorax or vascular injury, providing more safety to anesthesiologists and allowing the return to the practice of brachial plexus block below the clavicle.

Bases anatômicas para utilização do músculo fibular terceiro em retalhos miocutâneos

BACKGROUND: Myocutaneous flaps have been increasingly used in surgical reconstruction of the lower limbs, requiring the use of muscles that result in less functional and esthetic damage as flaps. This study aimed to evaluate the use of the fibularis tertius muscle (in terms of frequency and anatomy) as flaps in this procedure. METHODS: Sixty-four lower limbs from preserved cadavers were dissected and evaluated based on the following parameters: proximal insertion, distal insertion, syntopy, morphology, and morphometry. RESULTS: The fibularis tertius muscle was detected in 96.9% of the study cases. Most proximal insertions (96.8%) were found at the interosseous membrane, anterior border of the fibula, and anterior intermuscular septum. Most distal insertions (77.4%) were found at the lateral and dorsal sides of the 5th metatarsal. Mean value of muscle belly length was 17.89 cm and width was 1.95 cm. The mean length of the distal tendon with no muscle fibers was 1.2 cm, and the mean width was 0.45 cm. CONCLUSIONS: The fibularis tertius muscle is frequent and has a distinct morphology, making it a viable option for the repair of lower limb (distal segment) defects.

Morphometric study of the latissimus dorsi muscle in human fetuses

Introduction: The latissimus dorsi muscle (LDM) is broad and triangular and performs extension, adduction, and internal rotation motions of the arm. The LDM is vascularized by the thoracodorsal vessels and perforating branches of the posterior intercostal and lumbar arteries and is considered a type V Mathes and Nahai flap that is of great applicability in plastic surgery. The goal of the present study was to analyze the morphometry and vascularization of LDM in human fetuses. Method: The axillary region and the LDM of eight human fetuses (three female, five male) were dissected at 20-32 weeks’ gestation in the supine position with full arm abduction. We measured the subscapular and thoracodorsal vessel lengths and conducted a muscle morphometric analysis. Results: In all fetuses, the thoracodorsal vessels conferred primary vascularization of the LDM. In 25%, the subscapular vein was directly confluent with the axillary vein; 25% of the cases presented with a double scapular circumflex vein. The branch to the serratus anterior muscle was unique in all cases. In 50% of cases, the angular branch of the thoracodorsal artery was visualized, while 25% of them came from the branch to the serratus anterior muscle. The distances between muscle insertion and input of the neurovascular pedicle were 1.1 and 1.9 cm in fetuses 21 and 26 weeks, respectively. The anterior muscle margin was on the mid-axillary line in all fetuses. Conclusion: The observed constant morphometry and reduced anatomical variation of the vascular pedicle enabled the possibility of research involving the use of LDM in intrauterine surgical reconstructions.

Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study

BACKGROUND AND OBJECTIVES This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

Avaliação do envolvimento dos fascículos do plexo braquial no bloqueio por via infraclavicular: estudo em cadáveres não fixados

BACKGROUND AND OBJECTIVES This study shows how occurs the diffusion of the anesthetic into the sheath through the axiliary infraclavicular space and hence prove the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, and 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

Evaluación de las Variaciones del Ángulo de Torsión del Fémur en Fémures Aislados de Individuos Brasileños

En corte axial del femur, generalmente la orientacion del eje del cuello femoral se ubica en diferente plano del eje de los condilos. La formacion angular que el eje del cuello hace, en relacion a la de los condilos, es conocida como angulo de torsion femoral. Los autores realizaron mediciones de los angulos de torsion (o antetorsion) en 56 femures humanos adultos, de ambos sexos, siendo 26 derechos y 30 izquierdos. La literatura investigada presenta varios valores que varian de 8 a 25. Los valores obtenidos en las mediciones buscaron determinar el valor del angulo de torsion en ese material y compararlo con los datos de la literatura. Tambien se determinaron los valores que, permitieran conocer si el miembro inferior tenia rotacion lateral o medial patologicas. Los valores obtenidos de los angulos en las mediciones variaron entre 0 y 35. En el lado derecho, el promedio del angulo de torsion fue de 20,8 y el del lado izquierdo de 14,86, lo que indica una mayor tendencia del lado derecho a tener anteversion.

Anatomical study of the accessory axillary vein in cadavers: a contribution to the axillary surgical approach

Abstract Background The axillary vein is an important blood vessel that participates in drainage of the upper limb. Some individuals present a second axillary vein (accessory axillary vein), which is an important collateral drainage path. Objectives The goal of this study was to determine the incidence of the accessory axillary vein and to describe this vessel’s topography. Methods In this study, axillary dissections were carried out on twenty-four (24) human cadavers of both sexes that had been fixed with 10% formaldehyde. The upper limbs of the cadavers were still attached to the bodies and the axillary structures were preserved. Data collection was carried out and the axillary structures of the cadavers were compared. Results The incidence of accessory axillary veins was 58.3%, with no significant preference for sex or for side of the body. The accessory axillary vein originated from the lateral brachial vein in 39.28% of cases, from the common brachial vein in 35.71% of cases, and from the deep brachial vein in 25% of cases. Conclusions Its high incidence and clinical relevance make the accessory axillary vein important for provision of collateral circulation in the event of traumatic injury to the axillary vein.

Músculo Aductor Mínimo en Individuos Brasileños

Entre el grupo muscular que realiza la aduccion de la articulacion del cuadril se destaca el musculo aductor magno, cuya porcion superior de la parte aductora puede constituir el musculo aductor minimo. En la literatura hay pocas citaciones sobre este musculo, mas alla de la presencia de datos divergentes entre diversos autores. De este modo, el objetivo de este estudio ha sido el de analizar el musculo aductor minimo con relacion: a sus inserciones proximal y distal, a las disposiciones de las fibras musculares y establecer la incidencia del mismo. Cincuenta miembros inferiores aislados de cadaveres adultos de ambos sexos fueron disecados. Los resultados encontrados demuestran que el musculo fue observado en dieciseis casos (32%), presentando: insercion proximal predominante en el ramo isquiopubiano (37,5%), e insercion distal en la linea aspera del femur (100%). Las fibras musculares estaban dispuestas de forma oblicua en catorce casos (87,5%) y con disposicion transversal en apenas dos casos (12,5%). Por lo tanto, este estudio servira como base para nuevos trabajos cientificos sobre el musculo aductor minimo, con el objeto de clasificarlo como un musculo aislado.