The authors reconstructed hand defects using a new type of the extended groin flap in two patients. The extended portion includes the lateral femoral cutaneous nerve (LFCN) and the artery accompanying the LFCN (LFCA). Circulation to the extended portion was maintained by the communicating branches between the LFCA and the superficial circumflex iliac artery (SCIA). The flap was used as a pedicle flap in one patient and as a free flap in the other patient. The extended portion was elevated as an island flap based on LFCA in the latter. These flaps, including the extended portion, were transferred successfully. We have already reported use of the inferior extension of the groin flap based on the descending branch of the SCIA, in 2002. However, the extension technique described here is a different type of extension, due to the use of a different nutrient vessel. We believe that this new technique increases the usefulness of the groin flap.
The posterior calf region is a useful donor site for skin or composite flaps including muscle and/or nerves. We reported the first clinical use of the lateral gastrocnemius perforating artery flap including a vascularized sural nerve in 2003. This flap was elevated based on a perforator arising from the lateral head of the gastrocnemius muscle. However, we have since encountered vascular variations in these perforators. We subsequently developed a reliable technique for harvesting this flap in the course of treating 10 patients. Safe flap elevation from the lateral aspect of the posterior calf requires preservation of one of the superficial sural arteries until reliable perforators arising from gastrocnemius muscle lateral head are encountered during dissection. When such perforators are not observed, nutrient vessels such as superficial sural arteries or muscle perforators originating from vessels other than the lateral sural artery must be selected as a flap pedicle.
Twenty-four cadavers (48 sides) were used to clarify the terminal insertional segment and communications of the vertebral nerve in the cervical region under a surgical microscope. After displacing the prevertebral muscles (longus colli and longus capitis) laterally, the ventral parts of the transverse foramen of vertebrae (from C2 to C6) were removed, and the insertional segment and communicates of the vertebral nerve surrounding the vertebral artery were observed. The results showed: (1) the vertebral nerve ascended along the ventral or mediodorsal vertebral artery and terminated mainly at C3 (22/36 sides) but not terminated at C4 or C5 only; (2) the superficial communicates from the cervical sympathetic trunk ran in a proximal and distal direction when the fibers entered the anterior branches of the cervical nerves. The fibers running to the proximal direction communicated with the vertebral nerve in the part of transverse foramen; (3) motor and/or sensory rami supplying the prevertebral muscles, corpus vertebrae and intervertebral discs could pass through an "arched-shaped" fiber bundle on the ventral surface of the vertebral artery. In conclusion, the vertebral nerve and the fibers surrounding the vertebral artery could be considered as a stable deep pathway of cervical sympathetic nerves. The deep pathway (vertebral nerve and its branches) with the superficial pathways (cervical sympathetic trunk and its branches) formed a sympathetic nervous "plexus" in the cervical region. This sympathetic nervous "plexus" may be involved in the effects of cervical ganglionic blockade.
For many years, nerve transfer has been commonly used as a treatment option following peripheral nerve injury, although the precise mechanism underlying successful nerve transfer is not yet clear. We developed an animal model to investigate the mechanism underlying nerve transfer between branches of the spinal accessory nerve (Ac) and suprascapular nerve (Ss) in rats, so that we could observe changes in the number of motor neurons, investigate the 3-dimensional localization of neurons in the anterior horn of the spinal cord, and perform an electromyogram (EMG) of the supraspinatus muscle before and after nerve transfer treatment. The present experiment showed a clear reduction in the number of γ motor neurons. The distributional portion of motor neurons following nerve transfer was mainly within the neuron column innervating the trapezius. Some neurons innervating the supraspinatus muscle also survived post-transfer. Compared with the non-operated group, the EMG restoration rate of the supraspinatus muscle following nerve transfer was 60% in the experimental group and 80% in a surgical control group. Following nerve transfer, there was a distinct reduction in the number of γ motor neurons. Therefore, γ motor neurons may have important effects on the recovery of muscular strength following nerve transfer. Moreover, because the neurons located in regions innervating either the trapezius or supraspinatus muscle were labeled after Ac transfer to Ss, we also suggest that indistinct axon regeneration mechanisms exist in the spinal cord following peripheral nerve transfer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.