José Carlos Prates

Surgical Anatomy of the Internal Thoracic Artery

BACKGROUND The internal thoracic artery (ITA) has become increasingly important in coronary artery bypass grafting due to the excellent long-term results. This study reviews its anatomic characteristics. METHODS The ITAs of 100 cadavers were examined and their origin, relation to the phrenic nerve, presence of lateral costal branch; origin of pericardiacophrenic arteries, length, level and type of ITA termination, relation with the transverse muscle of thorax, collateral parietal branches, and distance between the ITA and sternal margins were studied. RESULTS The ITA was present in all cases, originating directly from the subclavian artery or from a common trunk with other arteries. Its length was 20.4 cm on average, and the most frequent level of termination was at the sixth intercostal space, existing as a bifurcation in 93% and as a trifurcation in 7%. The pericardiacophrenic artery originated from the ITA in 89%. The lateral costal branch was present in 15% of the cases. The ITA was covered by the transverse muscle of the thorax for 7.5 cm (average) and was crossed anteriorly by the phrenic nerve in 70.0%. CONCLUSIONS Information provided by this study may contribute to knowledge of its anatomic characteristics and in turn help prevent complications in ITA dissections.

Median artery and superficial palmar branch of the radial artery in the carpal tunnel

In the carpal tunnel there are the flexor muscle tendons, their sheaths, and the median nerve. Because its walls are inflexible, any thickening of its components that reduce its area may compress the median nerve. There are many reasons for nerve compression, including persistence of the median artery into adult life. We dissected the arteries in the carpal tunnel of 102 hands of 51 adult cadavers of both sexes, age range 23-77 years, and injected latex into 42 hands. In the carpal tunnel we sought the median artery and the superficial palmar branch of the radial artery. We found the median artery in 23 of 102 cases (23%), and its calibre ranged from 0.7 to 2.7 mm, mean (SD) 1.6 (0.5) mm. In 16 cases it made up part of the superficial palmar arch. The superficial palmar branch of the radial artery was partly responsible for the distal irrigation of the hand in 48 cases (47%); and in three hands (3%) it passed through the carpal tunnel. The external diameters of these vessels were 1.8, 1.9, and 1.8 mm, respectively. These arteries might cause compression of the median nerve and consequently the carpal tunnel syndrome.

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.

The deep plantar arch in humans: constitution and topography.

Abstract The integrity of the various structures within the feet depends on their blood supply. Lesions of the feet often require revascularization, which if successful avoids the need for amputation. To provide greater anatomical detail to aid vascular surgery and imaging, the anatomy and constitution of the deep plantar arch was studied in 50 adult cadaveric feet. The arteries of the foot were injected with red neoprene latex and dissected under magnification. The deep plantar arch, present in all feet, was the result of anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 72% of specimens (Type I arches) and the lateral plantar artery in 22% (Type II), with the contribution being equal in 6% (Type III). The medial plantar artery contributed to the medial segment of the deep plantar arch by its deep branch in 12% of specimens. The distance between the deep plantar arch and each interdigital commissure was generally constant, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the distal part of this third in 90%. The deep plantar arch is, therefore formed mainly by the deep plantar artery, a branch of the dorsal artery of foot its location can be estimated if foot length is known.

Innervation of the abductor digiti minimi muscle of the human foot: anatomical basis of the entrapment of the abductor digiti minimi nerve.

Abstract. The origin, relationships and innervation of the abductor digiti minimi muscle were determined in 145 human feet, from formaldehyde-fixed cadavers. The muscle arises from both processes of the calcaneal tuberosity, from the plantar aponeurosis and from the septum which separates it from the flexor digitorum brevis muscle. The nerve to the abductor digiti minimi muscle arises next to the origin of the lateral plantar nerve, close to the abductor hallucis muscle, and descends becoming closely related to the medial face of the calcaneus and the deep face of the abductor hallucis muscle. Then, it passes inferiorly through the origin of the quadratus plantae muscle and later divides into two branches for the two heads of the muscle.

The ulnar tunnel: a rare disposition of its contents

The ulnar tunnel is located at the proximal part of the hand radial to the pisiform bone and to the proximal part of the carpal tunnel. Inside it lie the ulnar nerve and artery. Compression of the ulnar nerve in this tunnel is often reported. Cysts, occupational trauma, fractures and muscle variations are among the main causes (Schjelderup, 1964; Kleinert & Hayes, 1971). Damage to the ulnar nerve and artery during the endoscopic decompression of the carpal tunnel has been reported recently (Agee et al. 1992; Nath et al. 1993; De Smets & Fabry, 1995). The structures within the ulnar tunnel are closely related to the medial part of the flexor retinaculum, in particular the ulnar artery which is located lateral to the ulnar nerve. During a study of this region we found a rare disposition of the contents of this tunnel. We believe that knowledge of this variation is important for the surgical anatomy of this region.

Unilateral absence of the thoracic part of the trapezius muscle

The absence of some muscles, such as pectoralis major, serratus anterior and quadratus femoris have been described, however the absence of trapezius, either in isolation or in association with other structures, is not often observed. In this case study, we present a case of partial absence of the left trapezius muscle in an adult black male cadaver, which had a large aponeurosis replacing the ascending fibres and some of the transverse fibres of the muscle. Histological analysis showed the presence of a few muscle fibres in the aponeurosis. From a functional viewpoint, it is possible that this individual would have had difficulty in moving his shoulder, especially during flexion, abduction and circumduction of the arm.

Relação anatômica entre a porção posterior do ânulo mitral e as artérias coronárias: implicações no tratamento cirúrgico

OBJECTIVE: This work aimed to analyze the anatomical relationship among the mitral annulus, the circumflex artery and the posterior left ventricular artery, correlating the distance among the structures mentioned to the pattern of coronary network dominance. METHOD: Eighty-five human hearts, previously preserved in 10% formaldehyde solution, were studied. The coronary network dominance pattern was initially evaluated. Next, atriotomy and left ventriculotomy in the posterior wall of the heart were performed, starting from the lung veins toward the heart apex through the mitral annulus. The atrial wall was removed at the level of the annulus, all around the posterior annulus. Onto the annulus, five points were demarcated: 1 - anterior commissure, 2 - between the anterior commissure and the half-point of the posterior annulus, 3 -half- point of the posterior annulus, 4 - between the half-point of the posterior annulus and the posterior commissure, 5 - posterior commissure. In these points the distance was measured among the structures with an electronic calliper. RESULTS: Right dominance was observed in 81.17% of the cases, balanced dominance in 16.47% and left dominance in 2.35%. Right dominance hearts showed that the area of lower distance between the annulus and the coronary arteries was the anterior commissure, where the circumflex artery was distant to the annulus 3.996 ± 1.865mm while the area of greater distance was the posterior comissure, measuring 7.783 ± 2.615mm. CONCLUSION: This study provided better understanding of the anatomical relationship between the mitral valve and the adjacent coronary arteries, therefore helping cardiac surgeons to prevent operative complications.

Estudo anatômico da artéria torácica interna aplicado à cirurgia cardiovascular

The internal thoracic artery (ITA) was studied because of its increased utilization in myocardial revascularization surgery due to the excellent long-term results. A review of its anatomical characteristics to clear some morphological aspects was made, aiming to help the extension of its utilization and prevent operative complications. The study was carried out in 100 cadavers; the anterior sternocostal wall of the thorax was removed and the arteries were injected with Neoprene Latex. The ITA originated directly from the subclavian artery in 82.5% and from a common trunk with other arteries in 17.5%. Its lenght was 20.4 ± 2.1 cm in average and the most frequent end point was the 6th intercostal space (52.5%). The end point form was as bifurcation in 93% and as trifurcation in 7%. The relation of ITA with the sternal margins was, on average, 10.3 ± 3.2 mm at the level of first intercostal space and 19.2 ± 6.0 mm at the level of 6th intercostal space. It was covered by the transverse muscle of thorax in a distance of 7.5 ± 2.7 cm long (average) and the lateral costal branch was present in 15%. The ITA was crossed anteriorly by phrenic nerve in 70% and posteriorly in 30%. Informations provided by this study may help prevent complications in ITA dissections and to improve our knowledgement on its anatomical characteristics.

Anatomía y Variaciones del Tronco Celíaco

El objetivo de este estudio fue analizar la anatomia del tronco celiaco a traves de sus diametro, longitud, origen y variacion de sus ramos. Fueron disecados 69 cadaveres fijados en formalina al 10% en los Laboratorios Anatomia de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Universidad Lusiadas de Santos y Universidad Santo Amaro (UNISA), Brasil y 20 cadaveres del Servicio de Verificacion de Obitos de la Universidad Sao Paulo (USP) y de la Universidad Federal de Sao Paulo (UNIFESP/EPM), Brasil. Las disecciones de la region del tronco celiaco fueron realizadas despues de hacerlo con la cavidad peritoneal. Los resultados obtenidos permitieron llegar a las siguientes conclusiones: 1) La longitud media del tronco celiaco hasta su primera rama, la arteria gastrica izquierda y/o esplenica en 81 cadaveres fue de 1,23 cm en el sexo masculino y 1,18 cm en el femenino. Verificamos como primer ramo del tronco celiaco, la arteria gastrica izquierda en 55 (67,90%), arteria esplenica en dos (2.47%), ambas en seis (7,41%), y en 18 (22,22%), las tres arterias trifurcandose en la misma altura formando el triple de Haller. 2) La medida de la longitud del tronco celiaco hasta su ultimo ramo, la arteria hepatica comun y/o esplenica en 68 cadaveres, tuvo una longitud media de 1,74 cm en el sexo masculino y 1,74 cm en el femenino. Verificamos como ultimo ramo del tronco celiaco, la arteria hepatica comun en 13 (19,12%), la arteria esplenica en cuatro (5.88%), ambas en 33 (48,53%) y en 18 (22,22%), las tres arterias trifurcandose en la misma altura. 3) La medida del diametro del tronco celiaco en 77 cadaveres tuvo una mediana de 0.65 cm en el sexo masculino y 0,67 cm en el femenino. 4) La medida de la distancia entre el tronco celiaco y la arteria mesenterica superior en 76 cadaveres, tuvo una mediana de 0,72 cm en el sexo masculino y 0,74 cm en el femenino. 5) El tronco celiaco emitio las arterias gastrica izquierda, esplenica y