INTRODUCTION:Laparoscopy has been in vogue for more than 2 decades. Making portals in the anterior abdominal wall for introducing laparoscopic instruments is done with trocar and cannula which is a blind procedure. Stab incision and trocar insertion, though safe, at times can lead to injury of blood vessels of anterior abdominal wall more so the inferior epigastric artery (IEA). Trauma to abdominal wall vessels is 0.2%-2% of laparoscopic procedures and said to be 3 per 1000 cases. Injury to IEA is one of the commonest complications seen. Purpose of the present study was to observe the course of IEA in 50 formalin preserved cadavers, by dissection.MATERIALS AND METHODS:In 50 formalin fixed cadavers, IEA was exposed by opening the rectus sheath. Rectus was divided and IEA was exposed. Five reference points A, B, C, D, and E were defined. A was at pubic symphysis, while E at umbilicus. B, C, and D were marked at the distance of 3.5, 7, and 10.5 cm, respectively from pubic symphysis. Distances of the IEA from these midline points were measured with the help of sliding vernier calipers.RESULTS:Significant observation was variations in the length of IEA. It was seen to end at a lower level than normal (three cases on right and four on left side) by piercing rectus. In 14, cadavers artery did not reach up to umbilicus on both sides. Nearest point of entry of IEA in to rectus sheath at the level of pubic symphysis was 1.2 cm on left and 3.2 cm on right side. Farthest point from point A was 6.8 cm on right and 6.9 cm on left side. Width of strip of abdominal wall which was likely to have IEA beneath was up to 4 cm till level C and beyond which it widened up to 5cm on left side and 6 cm on right at umbilicus.DISCUSSION:Present study did reveal notable variations in length and termination of IEA. No uniformity in entry of IEA in to the rectus sheath was observed. Findings did concur with earlier observations but the strip of skin of arterial zone was not equidistant from midline but had moved more medially on left side. Medial limit of this safety zone found to be lesser than 2 cm on left side. However, the lateral limit of the zone was within 7.5 cm. Additional variation was strip of abdominal wall likely to have IEA beneath was up to 4 cm till level C and had diverging limits beyond C. IEA was more notorious in its course. These variations prompt for a preoperative mapping of IEA and thus a useful step in preoperative protocol.

Background:The Extensor pollicis longus and brevis and abductor pollicis longus muscles have evolved progressively in different primates according to the function expected from the pollux finger. Analysis of individual muscles in different primates can help our understanding of evolution. Aims and objective: The present study was undertaken to study these three muscles and to note the variations therein and to attempt to explain the existence of these variations on the probable basis of their evolutionary history. Methodology: The extensor pollicis longus, brevis and abductor pollicis longus muscles were dissected meticulously in 100 upper limbs of adult cadavers. Results: In case of extensor pollicis longus and extensor pollicis brevis, 2% incidence of duplication of muscle and 1% of duplication of tendon and 1% incidence of duplication of muscle and 2% of duplication of tendon was observed respectively. In case of abductor pollicis longus 23% incidence of variation was observed. The muscle was observed to split into multiple tendons of muscles to have widespread attachment beyond the 1st metacarpal bone. Conclusion: The extensor pollicis longus with minimum variation seems to have settled in its evolutionary trajectory. In 8% of abductor pollicis longus studied, superficial and deep heads were observed. Oudenaarde states that the superficial head is used for range of movement and the deep set of fibers are used for strength of contraction. Elliot observes that the wide attachment of the abductor pollicis longus on the muscles abductor pollicis brevis and the opponens pollicis, the 1st carpometacarpal joint capsule and trapezium bone could be for better anchorage for radial deviation at the wrist joint. The extensor pollicis brevis muscle is seen as a separate muscle only in humans, hylobatids and gorillas whereas in all other primates. The chimpanzee hand seems to have evolved one step further with two extensor pollicis brveis muscles.

No abstract

No abstract

No abstract