The proper knowledge of the course and ramification of the blood vessels of the lower limbs is very important for surgeons and interventional radiologist. This is because the lower limb arteries are commonly involve with peripheral occlusive arterial diseases and the femoral artery at the femoral triangle is widely used for certain clinical procedures like arterial catheterization. Although there are several studies on the branching pattern of the femoral artery in the femoral triangle the Sri Lankan studies are spars.
SUMMARY:Variations of the peripheral nerve formation, communication and distribution are clinically important because such knowledge can be used for proper planning of surgeries and evaluating effects of nerve injuries and clinical imaging. Median nerve is known to have several such variations. However studies done on median nerve in Sri Lankan subjects are spars. The objective of this study was to find out anatomical variations of the median nerve with regards to its variations in roots and relations to the arteries in the axilla and arm. The study was done using 98 upper limbs of 49 formalin fixed cadavers. They were dissected and anatomy of the median nerve formations was studied focusing its variations of the roots and relation to the arteries. Anatomical variations of MN formation were observed in 33 (33.67 %) upper limbs with 4 bilateral and 25 unilateral variations. These variations were classified broadly in to two groups, variations of roots (15.3 %) and variation of arterial relations (18.37 %). There were three types of numerical variations (9.18 %) and three types of morphological variations (6.12 %) of roots. The median nerve was found to form in relation to the 2 nd part of the axillary artery in 6.12 %, abnormal relation to the 3 rd part of the axillary artery in 2.04 %, normal relation to the 3 rd part of the axillary artery in 81.63 %, and brachial artery in 10.2 % of the specimens. The current study highlights the presence of different anatomical variations at median nerve formation with regards to its roots and arterial relations and describes three rare forms of anomalies which were not found on literature survey. KEY WORDS: Median nerve; Roots variations; Abnormal relations; Morphology. INTRODUCTIONAnatomy of peripheral nerve formation and distribution can vary. Knowledge of such variations is important in clinical practice for evaluation of nerve injuries without misinterpretation of clinical symptoms and during surgeries of limbs to prevent accidental injuries to nerves. Median nerve is one of the nerves that show multiple variations in its formation, communications and distribution. There are number of studies done on abnormal communications of the median nerve in the axilla and arm. But there are only few studies have been done to find out variations of median nerve formations and its relation to the arteries in the axilla and arm. Therefore the main aim of this study was to identify anatomical variation of the median nerve formation and to find out the site of formation of median nerve in relation to axillary artery or the brachial artery. MATERIAL AND METHODThe study was done within a period of 3 years in the Department of Anatomy Faculty of Medicine University of Ruhuna, Sri Lanka, during undergraduate training. A total number of 98 upper limbs in 49 formalin fixed cadavers which included 29 males and 20 females were dissected according to the Cunningham's manual of practical Anatomy. The brachial plexus was studied meticulously to find out the anatomical variations of formations of t...
Abstract:-Drains are being used in abdominal surgery since Hippocrates time therapeutically and prohpylactically aiming to reduce morbidity and early recovery of patients. But these drains are not without complications. The complications range from simple drain site infection to drain site hernia of bowel leading to strangulation and necrosis. We report a case of drain site hernia (DSH) in a 47 year-old women who presented with obstructed large incisional hernia through a previous laparotomy scar. During surgery for the incisional hernia an incarcerated DSH was identified at her right iliac fossa region. Both herniae were repaired successfully and patient's recovery was uneventful. We reviewed the literature regarding the drain site hernia and other complications of abdominal drains. The article describes types of drains, their complications and predisposing factors for those complications and the steps to be taken for the prevention.
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