RESUMO
Introduction This study was done to analyze the morphometric features of the inguinal canal with different types of inguinal hernias to determine the appropriate size of mesh required to cover potential sites of recurrence. A morphometric assessment in the particular population is essential to recommend the appropriate mesh size in inguinal hernias to cover all the potential sites of recurrence. Materials and methods This was a prospective observational study, including all consecutive patients undergoing open inguinal hernia repair under local/regional/general anesthesia over a period of three years. Surgeries that were done in emergencies for complicated hernias, laparoscopic repair, and recurrent inguinal hernias were excluded. Intra-operative parameters were studied to predict the appropriate mesh size, which included the position of the superficial and deep inguinal ring (SIR and DIR) with the diameter, the distance of SIR and DIR from the anterior superior iliac spine (ASIS), and the distance from the summit of the muscular arch to the inguinal ligament. The differences in morphometric details between the types of hernias and categorical variables were assessed using the chi-square test. Results The study included a total of 170 patients with a mean age of 50.67 + 17.59 years. An indirect hernia was the most common type in patients less than 60 years. The mean distance from ASIS to SIR was 10.2+ 1.9 cm, and in indirect hernia patients, it was found to be significantly increased (p=0.042). The mean distance from ASIS to DIR was 4.14+1.57 cm, where the indirect hernia patients had a significantly less distance (p=0.029). The mean length of the inguinal canal in a direct hernia was 5.66 + 0.5 cm, whereas, in an indirect inguinal hernia, it was 6.46 + 0.8 cm, which was significant (p=0.029). The mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch was 4.03 cm, and there was no significant difference between the indirect and direct hernia patients. Conclusion After considering the morphometric assessments of the length of the inguinal canal, the mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch, the mean distance from ASIS to DIR, the ideal mesh size for the population would be 9 X 15 cm to cover all the potential sites of recurrence.
RESUMO
Multiple muscular and neurovascular anomalies in upper limb are reported continuously in medical literature because of their clinical significance. A unique case of the triad of variations was encountered during routine dissection activity. The variations observed were: 1) Accessory third head of biceps brachii; 2) High division of Brachial Artery; 3) Communication between Musculocutaneous Nerve and Median Nerve. Taken independently these variations are common but it is rare in a single cadaver. These abnormalities were found unilaterally on the right arm of the cadaver. The third head of biceps brachii was seen to be originating from the medial border and adjacent area on the anteromedial surface of the humerus at the level of insertion of coracobrachialis fusing with main muscle belly just before it forms the tendon. Additional head of biceps brachii was supplied by a branch from the Median Nerve. This branch after supplying the additional head of biceps was seen to join the Musculocutaneous Nerve. Further, a higher bifurcation of brachial artery was observed at the level of insertion of coracobrachialis. The medial division was traced distally as radial artery and the lateral division was traced as ulnar artery. The knowledge of these variations is of immense importance to correlate abnormal displacement of fractured bone segments, avoiding fatal injuries to vital structures, transradial angiography and diagnostic clinical neurophysiology.