Background: The mitral valve apparatus, consisting of the mitral valve leaflets and commissures and subvalvular apparatus-papillary muscles and chordae tendinae; is one of the most complex and intricately designed structures present in the human body and therefore the understanding of anatomical variations of papillary muscles becomes important for surgical interventional procedures, in response to the increasing incidence of valvular heart defects. The aim of the cadaveric analysis was to identify the disparity in the morphometry of the papillary muscles of the mitral valve complex. Therefore this study was taken up with an effort to extend the concepts previously presented as well as to overcome deficiencies in the knowledge of gross architecture and positional nomenclature of the papillary muscles.Materials and methods: Fifty formalinized cadaveric hearts were the material for study. Papillary muscles of left ventricle were classified according to a system developed by Berdajs et al., (2005), by precisely measuring shapes lengths and widths.
Results:The significant outcome of this study indicates that no two papillary muscles out of the 50 specimens had the same size, shape or position. All the hearts had two distinct groups of muscles -anterolateral and posteromedial. Specific analysis of each group revealed data regarding the muscles. In the antero-lateral group of the specimens, the maximum height and width of the muscles was 37.40mm and 17.06mm respectively and in the postero-lateral group, 33.86 and 26.90mm respectively. Conical shaped muscles were the most commonly found muscles owing to the minimum obstruction posed by them to blood flow.Implication: Better understanding of morphological variations can help cardiothoracic surgeons to customize surgical procedures according to the papillary muscle pattern of the individual patient.
The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site. KEY WORDS: Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve, Medial Dorsal Cutaneous Nerve Flap, Intermediate Dorsal Cutaneous Nerve Flap, Soft Tissue Defects, Open Reduction And Internal Fixation Of Fibula, Arthroscopy, Local Anesthetic Block, First Dorsal Metatarsal Artery Flap, Defects In Distal Dorsalis Pedis, Compression And Entrapment Neuropathies.
Background: Variations in the level of terminal branching of tibial nerve into medial and lateral plantar nerve in the posterior tarsal tunnel and its relations with posterior tibial artery has tremendous clinical importance. Tibial nerve and its terminal branches are at risk of entrapment in the posterior tarsal tunnel which is called as tarsal tunnel syndrome. The results of surgeries for tarsal tunnel syndrome are variable or suboptimal. The reason could be poor understanding of detailed anatomy of the tarsal tunnel and potential sites of nerve compression. Information regarding the same can help in endoscopic decompression surgeries for tarsal tunnel syndrome with minimal exposure of the region to be operated. Knowledge regarding these variations can also help the anesthetists to give ultrasonography guided ankle block without puncturing the blood vessels.Materials and Methods: The authors have studied topographic anatomy of tibial nerve and its terminal branches in relation with posterior tarsal tunnel in 50 formalinized cadaveric feet. Authors divided the location of division of tibial nerve in posterior tarsal tunnel (PTT) into seven levels and also categorized the distance between the point of terminal division of tibial nerve (TN) and point of terminal division of posterior tibial artery (PTA) in four categories.Results and conclusion: Tibial nerve divides relatively higher than the posterior tibial artery in the PTT. Both lie in the same compartment in the tarsal tunnel. The tibial nerve is situated deep to posterior tibial blood vessels .The neurovascular bundle is covered by an unyielding fibrous tissue which could be the reason for the entrapment. Commonest division level of tibial nerve in PTT is level 4 which means the division lies in the range of 6mm to 10mm above the distal border of flexor retinaculum. In 52% of feet the distance between point of division of TN and point of division of PTA is in a range between 0-5mm above the distal border of flexor retinaculum falling under category 1.
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