Mário Yoshihide Kuwae

Estudo anatômico do músculo gastrocnêmio medial visando transferência muscular livre funcional

There are not many papers in which the anatomy of the medial gastrocnemius muscle (MGM) was studied in depth or in which the medial gastrocnemius muscle was used remotely as free muscle for functional transfer. OBJECTIVES: The authors present the results of dissecting the MGM and its neurovascular bundle, the innervation in particular, with the purpose of making an anatomical contribution to the study. METHODS: 40 specimens were dissected, including knee joint and leg (20 right legs and 20 left legs) of 40 adult cadavers (26 male and 14 female), 20 fixated with formaldehyde and 20 fresh cadavers. A detailed anatomical study was performed to evaluate the standard distribution, the pathway, the number, and the length of MGM innervation. RESULTS:In 95% of the cases, the medial sural nerve was seen to be a single motor branch, with a mean length of 3.29 cm. An average 1.66 cm in length can be gained by dissecting the epineurium, separating it from the medial popliteal nerve. CONCLUSION: The MGM has a neurovascular bundle with irrigation and terminal innervation that permits its functional free muscle transfer to upper limbs and not only as a local flap of the lower limbs.

Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle

Objective: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. Materials and methods: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. Results: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. Conclusion: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants.

Contribuição ao estudo anatômico do retalho vascularizado corticoperiosteal do côndilo medial do fêmur

OBJECTIVE: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. MATERIALS AND METHODS: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. RESULTS: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. CONCLUSION: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants.

Estudo anatômico das artérias perfurantes do músculo gastrocnêmio medial

OBJETIVOS: Os autores apresentam os resultados da disseccao do feixe vascular do musculo gastrocnemio medial (MGM) e de suas arterias perfurantes, com o objetivo de contribuir anatomicamente para seu estudo. METODOS: Foram dissecadas 13 pecas englobando o joelho e perna (oito a direita e cinco a esquerda), de 13 cadaveres adultos (oito masculinos e cinco femininos), todos frescos. Foi realizado estudo anatomico e radiologico detalhado avaliando o padrao de distribuicao, trajeto, numero e comprimento da irrigacao do MGM e de suas arterias perfurantes. RESULTADO: Foi observado que a arteria sural medial (ASM) divide-se em dois troncos intramusculares principais (medial e lateral) e que em 90% dos casos as perfurantes provem do tronco lateral. Em 38,5% dos casos, foi identificada uma perfurante, ao passo que duas perfurantes sao observadas em 46,1% dos casos. Todas as arterias perfurantes estavam entre 5,7cm e 14,0cm da prega poplitea e entre 16,5cm e 34,0cm do maleolo medial. CONCLUSAO: A irrigacao do MGM pela ASM e suas arterias perfurantes faz-se adequada para sua utilizacao como retalho miocutâneo no membro inferior.

Resection osteotomy for calcaneus flattening after micro-surgical flap: technical note ☆

An open fracture of the calcaneus with loss of substance is a challenging injury and requires specialized care, involves high costs, and demands attention despite its lower incidence. The main complications are osteomyelitis, pressure ulcers, and fistulas, as well as pain conditions in the lateral, medial, and plantar regions. This is due to the wide loss of tissue and the change in anatomical conformation of the calcaneus in some cases. However, in cases of flattening of the calcaneus bone, these complications may be prevented or treated successfully. This technical note describes the resection osteotomy technique for calcaneus flattening to prevent and treat complications after micro-surgical flap in cases of open fracture or loss of substance.

Transtriquetral perihamate fracture-dislocation: case report

The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

Osteomielite aguda do escafóide: relato de caso

The authors report a rare case of acute osteomyelitis of the scaphoid bone in the left wrist, due to Staphylococcus aureus, in a 53 year-old paraplegic man without an apparent initial cause. The treatment used was based in specific venous therapy with antibiotics and surgical draining, with good functional result after six months.