Topography of the pelvic autonomic nerves - an anatomical study to facilitate nerve-preserving total mesorectal excision.

INTRODUCTION: Urogenital dysfunction caused by iatrogenic injury to the autonomic nerves persists as a common complication of rectal cancer surgery. This study aims to investigate the relationship between autonomic nerves and the 'holy plane' with the intention of identifying hazardous sites at which urogenital dysfunction may occur. PATIENTS AND METHODS: Dissection of the 'holy plane' and preparation of the autonomic nerves were performed on Thiel-embalmed bodies. The morphology of the inferior hypogastric plexus and its distance to nearby reference points was recorded. RESULTS: In all 28 bodies (13 females, 15 males), we observed that the autonomic nerves were enveloped in parietal pelvic fascia and thereby absent from the 'holy plane' of total mesorectal excision. The midpoint of the inferior hypogastric plexus resided 85 mm from the sacral promontory, and 47 mm from the coccygeal apex. Both distances were significantly longer in men than in women (p < 0.01, p < 0.01). The ureter coursed 11 mm superiorly to the inferior hypogastric plexus. Distal to the ischial spine, it ran 13 mm laterally to the mesorectal fascia. Differences between females and males were not statistically significant (p = 0.32, p = 0.85). CONCLUSIONS: Pursuit of the 'holy plane' spares the autonomic nerves. Restricted visibility may complicate the identification and sparing of the autonomic nerves, and, thus, requires the meticulous planning and execution of surgery. Contextual, the ureter may act as another landmark for the localisation of the inferior hypogastric plexus, additionally to the already established lateral ligaments of the rectum.

Morphology of the Posterior Interosseous Nerve with Regard to Entrapment Syndrome.

BACKGROUND: Posterior interosseous nerve (PIN) entrapment syndrome is a rare condition and is predisposed by anatomical factors such as narrow passages through fibrous arcades; whereas, the Arcade of Frohse (AF) is the most common entrapment point. The aim of this study was to evaluate the entrance and exit points of the PIN into the supinator in detail. MATERIALS AND METHODS: One hundred unpaired upper extremities underwent dissection. The PIN's entrance and exit points from the supinator were depicted. The distances between the tip of the radial head (RH) and the AF and the exit point of the PIN from the supinator were measured. Further, it was checked if the borders of the AF and the exit point were muscular, tendinous or a combination of these. RESULTS: The interval between the PIN's entry into the supinator and the tip of the RH was at a mean of 28.9 mm. Concerning the border of the AF, in 54 cases a muscular and in 46 specimens a tendinous version could be observed. The interval between the exit point of the PIN and the tip of the RH proved to be at a mean of 64.2 mm. Further, the exit's border was muscular in 65 specimens and tendinous in 35 cases. CONCLUSION: During surgical treatment of the PIN syndrome, it needs to be kept in mind that approximately one-third of all patients might also suffer from entrapment at the exit point of the PIN.

Prevalence of the distal oblique bundle of the interosseous membrane of the forearm: an anatomical study.

A study was undertaken to examine the presence of the distal oblique bundle of the forearm in a large sample in order to describe its true prevalence. The study sample consisted of 200 cadaveric forearms. Fifteen were excluded due to defects in the distal interosseous membrane. In the remaining 185 specimens, the distal interosseous membrane was examined following removal of soft tissue, to determine whether a distal oblique bundle was present and whether there were connecting fibres to the distal radio-ulnar joint. The distal oblique bundle was observed in 53 specimens (29%). In 45 of these forearms (85%), one or more connecting fibres to the distal radio-ulnar joint were identified. The presence of a distal oblique bundle in 29% is less frequent than that reported in previous literature. The presence of the distal oblique bundle should be noted and may be of importance in the management of disorders of the distal radio-ulnar joint.