Estudio morfológico y biométrico de los vínculos de los tendones de los músculos flexores superficial y profundo de los dedos de la mano humana / Anatomic and biometric study of the vincula of the tendons of flexor digitorum superficialis and profundus muscles of the human hand

Los vínculos son estructuras especializadas inherentes a los tendones flexores de los dedos, y tienen gran importancia en la nutrición de los mismos, además de facilitar la flexión de los dedos después de una transección distal del tendón (es), permitiendo que éste (os) actuen indirectamente a través de las articulaciones interfalángicas. El presente estudio tuvo como objetivo revisar aspectos morfofuncionales de los vínculos largos y cortos de los músculos flexores de los dedos de la mano. El trabajo fue realizado en 60 manos de cadáveres formolizados de individuos adultos, brasileños, con una edad promedio de 53,1±17,8 años. Los vínculos cortos fueron encontrados en 100 % de los casos, tanto en los músculos flexores superficiales de los dedos como en los profundos, siempre en número de uno en cada tendón y su localización siempre estuvo en la extremidad del tendón, antes de la inserción de éste en la articulación interfalángica proximal. Los vínculos largos presentaron gran variación morfológica, con una presencia promedio de 61,3 % en los tendones del músculo flexor superficial y de 77,9 % en el músculo flexor profundo. El número de vínculos por tendón varió aún más, no siendo posible identificar un patrón independientemente del músculo. En relación a la localización de los vínculos largos, en los tendones del músculo flexor superficial de los dedos, están insertos en la vaina fibrosa de la falange proximal, con un trayecto oblicuo y próximo a la articulación interfalángica proximal; los vínculos de los tendones del músculo flexor profundo estaban localizados en su mayoría (86,7 %) entre los tendones a nivel de la articulación interfalángica proximal, presentando un trayecto rectilíneo entre esos dos tendones, mientras que en 13,3 % estuvieron localizados muy próximos a la abertura del tendón del músculo flexor superficial para el paso del tendón del músculo flexor profundo. Los vínculos son estructuras escenciales en la mantención de la nutrición y de los movimientos de los dedos aún en presencia de lesiones, por lo tanto, es importante tener una comprensión clara de ellos para una correcta evaluación clínica pensando en la reparación, reconstrucción y rehabilitación de las disfunciones de la mano.

The vincula are specialized structures inherent in the flexor tendons of the fingers, and are of great importance in their nutrition. In addition they facilitate flexion of the fingers following a distal transection of this tendon, allowing it to operate indirectly across the interphalangeal joints. The aim of the present study was to describe anatomic and biometric aspects of the long and short vincula of the flexor muscles of the fingers. The work was carried out in hands of 60 adult Brazilian corpses, of both sexes, with an average age between 17.8±53.1 years. The short vincula were found in 100 % of cases of flexor digitorum superficialis tendons and flexor digitorum profundus muscles, and only one in each tendon, with its location always at the extremity of the tendon, prior to insertion in the proximal interphalangeal joint. The long vincula presented great morphological variation, with an average presence of 61.3 % in tendons of the flexor digitorum superficialis and 77.9 % in the flexor digitorum profundus muscle. Furthermore, the number of vincula per tendon changed, and it was not possible to identify a pattern independently of the muscle. With respect to the location of the long vincula, in the flexor superficial tendons they are inserted in the fibrous sheath of the proximal phalanx, with an oblique course and next to the proximal interphalangeal joint. The vincula of the tendons of the flexor digitorum profundus were located (86.7 %) between both tendons to level of the proximal interphalangeal joint, presenting a rectilinear course between these two tendons, whereas in 13.3 % they were located very close to the opening of the flexor superficialis muscle tendon for passage of the flexor digitorum profundus muscle tendon. The vincula are essential structures in nutrition and finger motion even when injuries are present. It is therefore, important to have a clear understanding of these structures forproper clinical evaluation in the repair, reconstruction and rehabilitation of hand dysfunctions.

Anatomy of the left atrioventricular valveapparatus in landrace pigs

The aim of this study was to describe the structures and variations of the left atrioventricular valve apparatus in pigs’ hearts. The valve apparatus elements were investigated using morphometric criteria such as the implantation base width, maximum cuspid depth and fibrous ring circumference, and using morphological criteria such as the numbers and sites of the cuspids, tendon cords and papillary muscles. We concluded that morphometric criteria such as the implantation base width and greater cuspid depth could be used to characterize the cuspids of the left atrioventricular valve apparatus; and that morphological criteria such as the number of papillary muscles, fibrous ring circumference and number of tendon cords were generally not associated with the variations in the number of cuspids. We can state that the number of cuspids in the left atrioventricular valve in pigs is variable and that commissural cuspids are frequently present.

Morphometric analysis of the angle of the femoral trochlea

The possible association between disorders of the femoropatellar joint and geometrical anatomical variations in the patellar facet and femoral sulcus motivated us to conduct a morphometric study on the angle of the femoral sulcus and to correlate this with possible variation factors, such as: length, width at the midpoint of the femur, femur inclination angle, distance between condyles and depth of the patellar facet. The material consisted of 56 dry femurs of both sexes and various ages: 24 from the right side and 32 from the left side. The patellar facets were photographed at three positions: a) start level; b) middle level; and c) end level. The angle formed in each of these positions was measured using graphical tools in CorelDraw X4. To analyze the results, the statistical tests used were chi-square and Student’s t-test for correlations. The results obtained were: a) angle of the patellar facet: mean for start level of the patellar facet = 129°01; mean for middle level = 131°35 and mean for end level = 132°14; b) mean distance between condyles = 50.29  mm; c) mean depth of the patellar facet = 9.55 mm; d) mean for Ficat and Bizou’s condylar depth index = 5.45. We concluded that the angle of the femoral sulcus increased from the start of the patellar facet to its end, and that its variability was weakly influenced by the length, width, femur inclination angle and side, according to the t-test (significance of 5%) for the correlation coefficients found.

Morphological classification of the septomarginal trabecula in humans.

Although the septomarginal trabecula is a well-known anatomical structure, there continue to be different ways of studying it. In this study, we dissected the muscle bundles that form it, and this has enabled us to present a new classification based on the origin, path, and termination of these bundles. This study was conducted on 99 hearts removed from the cadavers of adult humans aged 18 to 82 years, of which 72 were male and 27 were female. The septomarginal trabecula presents two components in its composition: one septal and the other septal- papillary, i.e. extending from the septum to the anterior papillary muscle. The septal component may be visible macroscopically, forming a fleshy third-order column, or may only be visible by means of dissection. The septal-papillary component is always visible and is a fleshy column of either second-order or third- -order type. Another parameter takes into consideration the papillary-parietal connection, i.e. the junction of the septomarginal trabecula with the anterior papillary muscle, which may be single or present ramifications to the anterior wall and/or apex. Taking these criteria as references, we have classified the septomarginal trabecula into eight types.

Anatomy of the septomarginal trabecula in Landrace pig hearts.

The limitations on the availability of organs for transplantation have aroused interest in research on xenotransplantation of whole organs or certain parts of them. Thus, studies that confirm or reject similarities between the organs of different animals have started to have important clinical applications. In the present study, we investigated the septomarginal trabecula in 34 hearts from Landrace pigs with the aim of observing their similarities with the septomarginal trabecula in humans. In pigs, the muscle bundle of the septomarginal trabecula and the right branch of the stimulating complex are dissociated. The right branch is a narrow bridge that, after going out from the upper part of the interventricular septum, is attached to the upper part of the anterior papillary muscle. On the other hand, the muscle bundle of the septomarginal trabecula is generally a resistant crest that goes from the lower part of the septum to the lower part of the anterior papillary muscle. The septomarginal trabecula presents marked anatomical differences between humans and pigs.

Anatomy of the supraventricular crest in human hearts.

The supraventricular crest is a fleshy trabecula of the right ventricle that has an important function in guiding the blood flow. However, controversy persists regarding its anatomical constitution. In this study, we aimed to investigate its frequency, formation, termination, morphometry, and relationships with the septomarginal trabecula, septal papillary muscle, right atrioventricular ring, and left posterior semilunar valve of the pulmonary trunk valve. Our material consisted of 50 hearts from adult individuals of both sexes that had been preserved in 10% formalin. They were opened along the arterial cone by means of an incision starting at the pulmonary trunk and ending at the right margin. The supraventricular crest was always present. The marginal (right) extremity was formed by two to six muscle bundles that joined together (88%). On the septal (left) side, the single muscle bundle penetrated the interventricular septum directly (88%) or by means of two or three divisions (12%). It could form a septal band (52%) and could pass over the septal papillary muscle (43.5%) or just below it (34.8%). There was a relationship of muscle fibres between these two structures in 64% of cases. Dissection of the septal band demonstrated continuity with the septomarginal trabecula (46%). In 80% of cases, the crest was connected to the right atrioventricular ring and it participated in its outline directly (64%) or by means of muscle expansions (16%). Its muscle fibres bordered the left semilunar valve of the pulmonary valve in 50% of cases. Regarding morphometry, we observed that the length varied little with increasing weight of the heart (22.6%), but the height and width increased markedly with increasing weight of the heart.

The anatomy of the human thyroid veins and its surgical application.

The present study was motivated by the importance of the thyroid veins in surgery in the anterolateral cervical region, particularly in tracheostomies, the need for information on modern diagnostic imaging techniques and the lack of specific publications on the subject. The research was performed on 30 adult human specimens by means of dissection and measurement. The superior thyroid vein was constant, single on both sides (83.3%), with its termination (87.1%) at the internal jugular vein (97.2%), either isolated (29.4%) or with other veins, mostly the lingual vein (52.1%), and was located between 1.0 and 2.5 cm below a plane that passes the upper margin of the hyoid bone. The medial thyroid vein, when present, was not constant (43.3%), was single (96.1%), terminated in the internal jugular vein and was located between 2.0 and 4.0 cm from the mid-sagittal line (84.6%). The inferior thyroid vein was constant (96.7%) and varied in number, with one (62.1%), two (27.6%) or even five occurring, and was formed by the confluence of two primary branches (78.6%) as a result of the abundance of anastomoses coming from the lower and medial parts of the gland. The number of terminations corresponded to the number of veins, at the level of the 5(th) to 8(th) rings in 36.9%, of the 9(th) to 10(th) rings in 34.8% and of the 11(th) to 14(th) rings in 28.3%, and occurred in the right brachiocephalic vein (26.1%), in the left brachiocephalic vein (60.9%) or in both veins (13.0%).

Morphometric study of the tricuspid valve in dogs.

An anatomical study of the tricuspid valve was performed in the hearts of 45 dogs using a method of dissection which preserves the integrity of the valve. Morphometrical criteria such as the width of the cusp base and larger depth of cusp and morphological criteria such as the number of tendinous cords, the perimeter of the fibrous ring and the properties of the papillary muscle were adopted for the characterization of a cusp. The tricuspid valve was not consistent with three cusps, but it was observed to present 2, 4 or 5 cusps in 68% of the cases.

Neurovascular pedicles of the tibialis anterior muscle in children / Pedículos neurovasculares del músculo tibial anterior en niños

The importance of the tibialis anterior muscle in infantile orthopedic transposition surgeries, as in myelomemngoceles, it bases this research about the neurovascular pedicles of the tibialis anterior muscle. The study was conducted on 34 legs of human cadavers that were one year old or younger at the time of death. It was observed that the tibialis anterior muscle most frequently presented from 7 to 10 arterial branches (52.4 percent). In 97.1 percent of cases these branches were derived from the anterior tibial artery. In one case the anterior tibial artery was missing and the muscle was supplied by the fibular artery. Thirty-nine and seven tenths percent of arterial branches entered the superior third of the muscle; the middle third received 40.1 percent of the branches and the inferior third received 20.2 percent of the branches. The deep fibular nerve exclusively supplied the innervation, which in91.2 percent of cases, gave off from 2 to 4 branches to the muscle, mainly to the superior (46.2 percent) and middle third (43.0 percent). Most frequently, there were two neurovascular pedicles supplying the superior third and one supplying the middle third.

La importancia del músculo tibial anterior en cirugías de transposición ortopédica en niños, así como en casos de mielomeningocele, fundamenta su estudio respecto a sus pedículos neurovasculares. El estudio se realizó en 34 miembros inferiores de cadáveres de niños de un año o menos de edad. Se observó que el músculo tibial anterior presentaba con frecuencia 7 a 10 ramas arteriales (52,4 por ciento). En 97,1 por ciento de los casos estos ramos eran derivados de la arteria tibial anterior. En dos casos, la arteria tibial anterior estaba ausente y el músculo suplió su irrigación con la arteria fibular. En relación a la entrada de las ramas, 39,7 por ciento lo hacen en el tercio superior del músculo. El tercio medio recibe 40,1 por ciento de las ramas y el tercio inferior recibe 20,2 por ciento de ellas. El nervio fibular profundo es la fuente principal de inervación, en 91,2 por ciento de los casos provee 2 a 4 ramos para el músculo, de ellos el 46,2 por ciento termina en el tercio superior y el 43 por ciento en el tercio medio. Con mayor frecuencia, existen dos pedículos neurovasculares supliendo el tercio superior y uno supliendo el tercio medio del músculo tibial anterior.

Anatomical indicators of dominance between the coronary arteries in swine.

The interest in experimental use of coronary arteries of swine as a stage towards their application in human hearts justifies the need for obtaining a detailed anatomical understanding of those arteries, particularly to evaluate similarities and differences. However, we did not find any citations about anatomical indicators of coronary dominance among swine in the literature. Many authors have used the crux cordis and the origin of the posterior interventricular branch as references for defining three types of pattern in human hearts: right, balanced and left dominance. We used 30 hearts fixed in 10% formalin from male and female Landrace swine aged five to six months, weighing 80 to 110 kg. The branch corresponding to the subsinuosal interventricular sulcus came from the right coronary artery (96.7%) or from both coronary arteries (3.3%). The subsinuosal interventricular branch presented at least one small branch that went beyond the crux cordis. The apical area presented predominance of the paraconal interventricular (left anterior descending) branch in 43.3%, the subsinuosal interventricular branch in 23.3% and presence of both arteries in 33.3%. The left coronary artery emitted 54.5% of the ventricular branches and the right coronary artery 46.5%. Taking the crux cordis and the subsinuosal interventricular branch as references, the arterial pattern in swine hearts is right dominance. The diversity of the apical pattern and the balance in the distribution of ventricular branches do not allow this to be used as an approach in isolation. The similarities between human and swine hearts also apply to the coronary artery pattern.

The subscapular artery and the thoracodorsal branch: an anatomical study.

The motive for this research was the use of the muscles of the scapular region in transposition, transplantation and reparative surgery and the need for more detailed knowledge of the blood supply to these muscles. In addition, the subscapular arterial tree may be used as a source of microvascular grafts to replace damaged or diseased portions of arteries, particularly in the hand and forearm. The research was conducted on 60 sides of corpses of adults of both sexes. It was noticed that the subscapular artery was present in 96.7% of cases and originated laterally to the pectoralis minor muscle in 76.7% of cases. The average calibre was 5.0 mm, and in 73.2% of cases it measured between 4.0 and 5.9 mm. The average length was 18.0 mm, ranging from 10.0 to 29.9 mm (76.7%). It presented in its course important relations with the axillary nerve (69%) and with the radial nerve (82.8%). Its branches were collateral (subscapular muscle - 61.3%) and terminal (except for the circumflex scapular artery), leading to the following muscles: serratus anterior (43.9%), latissimus dorsi (27.6%), and subscapular (23.3%). The thoracodorsal artery, one of the terminal branches, most frequently showed a calibre of between 2.0 and 3.9 mm (70.3%), collateral branches in 85.0%, was mainly distributed to the subscapular muscle (36.7%) and to the serratus anterior muscle (29.0%) and had terminal branches to the following muscles: latissimus dorsi (44.1%), serratus anterior (40.5%) and the subscapular (12.5%). The serratus anterior muscle received one branch in 39.5% and two branches in 41.9%, while the latissimus dorsi muscle received one branch in 66.7% and two branches in 23.1%.

Anatomic study of the tricuspid valve in children.

We performed an anatomic study of the right atrioventricular valve in children under one year of age using a conservative method of dissection of the heart valve. The main aspects studied were the number of cusps and their morphometric characteristics, such as the width of the base and the depth of the cusps. Other parameters studied were the number of papillary muscles, number of tendinous cords, and diameter of the fibrous ring and the last one were divided in three regions, anterior, posterior and septal for localization of cusps. Our results showed that the number of cusps varied from two to four. Three cusps was the commonest finding and the fourth cusp, if present, was classified as anterolateral in location. The anterior and septal cusps had bases bigger than those of the posterior and anterolateral cusps; the septal cusp was deeper than the others; and the number of tendinous cords was greater for the anterior and septal cusps than for the posterior and anterolateral cusps. In addition, the posterior region showed great variability: in 35.7% it was occupied by undeveloped valve tissue and the posterior valve in these cases was located anteriorly.

Arterial branches to the Palmaris Longus muscle.

The use of the long palmar muscle in surgeries of muscular transposition and transplantation in orthopedic and plastic surgeries has encouraged the investigation of arterial branches for the long palmar muscle. This study was carried out in 58 upper limbs of child cadavers aged up to one year. It was observed that the muscle was not present in 31.04% of the forearms. It more frequently presents one to two arterial branches which arise mainly, from the ulnar artery (85.71%) and less frequently from brachial artery (22.86%). The arterial branches penetrate the muscle through the posterior face, 62.71% being at the proximal third and 33.90% at the medium third. The most frequent models of the branch disposition were from one to two branches of the ulnar artery which penetrate the proximal thirds (28.57%) and two branches of the ulnar artery, the median and proximal thirds, respectively (17.14%).

The recurrent laryngeal nerve in relation to the inferior constrictor muscle of the pharynx.

The point of penetration of the recurrent laryngeal nerve into the larynx is recognized as the most frequent site of injury to the nerve during surgical procedures of the thyroid gland. The anatomical relationships of 25 right and left recurrent laryngeal nerves in 25 anatomical blocks from formalin-fixed human corpses have been studied. In 34 cases (68%), the recurrent laryngeal nerve penetrated into the larynx below the lower fibers of the inferior constrictor muscle of the pharynx (type 1 of penetration). In the remaining 16 cases (32%), the nerve crossed through those muscle fibers to penetrate into the larynx (type 2 of penetration). The thyroid gland was found to involve the recurrent laryngeal nerve at the penetration point into the larynx in 19 of 50 cases (38%).

Morphological study of one septal trabecula carnea of the left ventricle.

This work was carried out in 50 hearts of human adult cadavers of both sexes, whose obit causes were not related to diseases which could have been directly involved with the heart. The septal trabecula carnea was identified in 45 hearts (90%), with origin in the superior portion of the interventricular septum and the other extremity was sited in 33 cases (61.1%) in the base of the anterior papillary muscle. It was unique in 37 hearts (82.2%) and dissociated in 8 hearts (17.8%). The more frequent length and width was 40 mm and 3 mm, respectively.

[Regional irrigation of the pericardium in children]. / Irrigação regional do pericárdio em crianças.

PURPOSE: To investigate the irrigation of both fibrous pericardium and the parietal layer of serosal pericardium in children. PATIENTS AND METHODS: The cadavers of 10 children of both sexes, under the age of one. In this study we adopted the regional divisions described by DI Dio, which considers a plane between the two phrenic nerves that divides the areas of pericardium into ventral and dorsal regions. We also refer to these regions as antephrenic and retrophrenic respectively. In addition, we consider the inferior pericardium to be that portion of pericardial sac related to the diaphragm. RESULTS: The pericardium ventralis was more frequently irrigated by branches of the following arteries: thoracicae internae dextra and sinistra, pericardiacophrenica dextra in 9 cases; pericardiacophrenica sinistra in 8 cases; and less frequently, by branches of the arteriae phrenicae inferiores dextra and sinistra, epigastrica superior sinistra, thimica, rami thimici of the a. thoracica interna dextra, and rami thimicus and esophagealis of the a. subclavia dextra. The pericardium dorsalis was more frequently supplied b the following arterial branches: bronchiales in 9 cases; esophagealis of the aorta in 8 cases; and in a frequency inferior than 4 cases, we observed the following arteries: thyroidea inferior sinistra, intercostalis suprema, pericardiacophrenicae dextra and sinistra, subclavia sinistra, coronariae dextra and sinistra, phrenicae superior and inferior sinistra, thoracica interna dextra, intercostales posteriores primae dextra and sinistra, truncus costocervalis and rami esophageales of the a. gastrica sinistra. The pericardium inferior was irrigated by branches of the arteriae phrenicae inferiores dextra in 10 cases and sinistra in 9 cases. CONCLUSION: Analysis of the results demonstrated that similar behavior in the pericardium regional irrigation offers a standard for intervention in the pericardium.

Anatomical study of the human tricuspid valve.

An anatomical study of the tricuspid valve was carried out in 50 human hearts of both female and male individuals using a method of dissection which preserves the integrity of the valve. Morphometric criteria such as area of cusp, width of cusp base, relation between commissure depth and cusp depth and morphological criteria such as the presence of atrioventricular cusp node, number of tendinous cords, perimeter of fibrous ring, and properties of papillary m. were adopted for characterization of a cusp. In 64% of cases, commissural cusps were present independent of the number of tricuspid cusps. The tricuspid valve was not consistently tricuspid, but was observed to present 2, 4, 5 or 6 cusps in 72% of cases.

[Ultrastructural aspects of the atrial cardiac myocytes in albino rats subjected to the effects of cold]. / Aspectos ultra-estruturais dos cardiomiócitos atriais de ratos albinos submetidos à ação do frio.

The authors intended to study the fibers of atrial muscle of rats submitted to cold. The results specially showed the destruction of the mitochondria structure. The cristae are destroyed in part by the stress provoked. The possible factors that influence the stress provoked by the cold are discussed.