Morphological Characteristics of the Sphenoid Sinus and Endoscopic Localization of the Cavernous Sinus.

The aim of this study was to investigate the relationship between the morphological characteristics of the sphenoid sinus and endoscopic localization of the cavernous sinus (CS) using an extended endoscopic endonasal transsphenoidal approach. Thirty sides of CS in 15 adult cadaver heads were dissected to simulate the extended endoscopic endonasal transsphenoidal approach, and the morphology of the sphenoid sinus and anatomic structures of CS were observed. The opticocarotid recess (OCR), ophthalmomaxillary recess (V1V2R), and maxillomandibular recess (V2V3R) in the lateral wall of the sphenoid sinus were presented in 16 sides (53.3%), 6 sides (20%), and 4 sides (13.3%) of the 30 sides, respectively. OCR is a constant anatomic landmark in endoscopy and coincides with the anterior portion of the clinoidal triangle. The C-shaped internal carotid artery (ICA) in the lateral wall of the sphenoid sinus was presented in 11 sides (36.7%), the upper one-third of which corresponds to the middle portion of the clinoidal triangle, and the lower two-thirds of which correlates to the supratrochlear triangle, infratrochlear triangle, and ophthalmic nerve in CS, around which the medial, lateral, and anteroinferior interspaces are distributed. From a front-to-behind perspective, the C-shaped ICA consists of inferior horizontal segment, anterior vertical segment, clinoidal segment as well as partial subarachnoid segment of the ICA. OCR and C-shaped ICA in the lateral wall of the sphenoid sinus are the 2 reliable anatomic landmarks in the intraoperative location of the parasellar region of CS.

Architectural properties of the neuromuscular compartments in selected forearm skeletal muscles.

The purposes f this study were to (i) explore the possibility of splitting the selected forearm muscles into separate compartments in human subjects; (ii) quantify the architectural properties of each neuromuscular compartment; and (iii) discuss the implication of these properties in split tendon transfer procedures. Twenty upper limbs from 10 fresh human cadavers were used in this study. Ten limbs of five cadavers were used for intramuscular nerve study by modified Sihler's staining technique, which confirmed the neuromuscular compartments. The other 10 limbs were included for architectural analysis of neuromuscular compartments. The architectural features of the compartments including muscle weight, muscle length, fiber length, pennation angle, and sarcomere length were determined. Physiological cross-sectional area and fiber length/muscle length ratio were calculated. Five of the selected forearm muscles were ideal candidates for splitting, including flexor carpi ulnaris, flexor carpi radials, extensor carpi radialis brevis, extensor carpi ulnaris and pronator teres. The humeral head of pronator teres contained the longest fiber length (6.23 ± 0.31 cm), and the radial compartment of extensor carpi ulnaris contained the shortest (2.90 ± 0.28 cm). The ulnar compartment of flexor carpi ulnaris had the largest physiological cross-sectional area (5.17 ± 0.59 cm(2)), and the ulnar head of pronator teres had the smallest (0.67 ± 0.06 cm(2)). Fiber length/muscle length ratios of the neuromuscular compartments were relatively low (average 0.27 ± 0.09, range 0.18-0.39) except for the ulnar head of pronator teres, which had the highest one (0.72 ± 0.05). Using modified Sihler's technique, this research demonstrated that each compartment of these selected forearm muscles has its own neurovascular supply after being split along its central tendon. Data of the architectural properties of each neuromuscular compartment provide insight into the 'design' of their functional capability. In addition to improving our understanding of muscle anatomy and function, elucidation of forearm neuromuscular compartments architecture may ultimately provide information useful for selection of muscle subdivisions used in tendon transfer.

[A cadaveric study on establishing an individualized navigation template for the placement of occipital condyle screws using a three-dimensional printing technique].

OBJECTIVES: To investigate the feasibility of establishing an individualized navigation template for occipital condyle screws insertion using a fused deposition modeling based three-dimensional printing forming technique, and to evaluate the accuracy and safety of template-assisted condyle screw insertion. METHODS: Thirty adult occipitocervical specimens were selected to take a CT-scan. After original Dicom data imported into the Mimics software, the craniocervical junction models were created, which were used to evaluate anatomic structures and define the screw-related parameters. Design and generate the cavity models of the occipital condyle based on a three-dimensional printing forming technique. After using a free-hand procedure to create a navigation template with a well-established screw path, finish bilateral condyle screws insertion assisted by the navigation template. Anatomy study and CT-scan were taken postoperatively to access the position of the screws. RESULTS: Sixty condyle screws were implanted assisted by 30 individualized navigation templates with an average time cost of (91.4 ± 8.2) s. The axial medial angle, sagittal cranial angle and distance between the entry point to atlantooccipital joint surface were (33.2 ± 6.4)°, (8.9 ± 3.4)°, (3.9 ± 0.9) mm, respectively. The variations due to different sex and sides resulted in a statistically insignificant difference of the parameters. Anatomy study and CT-scan indicated no intrusion of the vertebral artery, hypoglossal canal, condyle emissary vein canal or atlantooccipital joint. Fifty-nine condyle screws were completely contained within the condyle, while only 1 screw perforated lateral condyle wall. CONCLUSIONS: Using the Mimics software for establishing the occipital condyle and related cavity model based on CT-scan images proves to be a feasible and precise method.Occipital condyle screws insertion assisted by a three-dimensional printing model is highly accurate and simple, which could be a new alternative to conventional technique.

Anatomic study of fabella and its surrounding structures in a Chinese population.

PURPOSE: To explore the anatomic features of the fabella and its relationship with the common peroneal nerve and the fabellofibular ligament, so as to provide anatomical evidence for clinical diagnosis and treatment of fabella diseases in a Chinese population. METHODS: Sixty-one formalin-fixed knee specimens were obtained for anatomic dissection. Structural features of the fabella were investigated by radiological and histological tests. RESULTS: There were 53 cases (86.89%) with fabellae in the lateral head of the gastrocnemius muscle, including 34 bony ones (55.74%), whereas only 6 cases had fabellae in the medial head (9.84%). The fabellae were accompanied by common peroneal nerves on their surfaces in 11 cases (20.8%), and the presence of the fabella was not generally predictive of a fabellofibular ligament. As much as 57.9% of the cartilage fabellae were not visualized on radiograph. The structure of the ossified fabella is similar to a typical long bone. CONCLUSIONS: Fabellae were mainly present in the lateral head of the gastrocnemius muscle in a large proportion of the Chinese population. More than half of the cartilage fabellae were not visualized on radiograph. Its clinical significance could not be ignored by physicians and anatomists.

Expanded endoscopic endonasal transsphenoidal approach to determine morphological characteristics and clinical considerations of the cavernous sinus venous spaces.

The study aimed at investigating the morphological characteristics and interconnected regularities of the cavernous sinus (CS) venous spaces using an expanded endoscopic endonasal transsphenoidal approach. Surgical dissections were performed for 15-colored silicon-injected human head specimens. The CS venous spaces were examined for their morphological and clinical characteristics using an expanded endoscopic endonasal transsphenoidal approach. The intracavernous course of the internal carotid artery (ICA) divided the CS venous spaces into four interconnected virtual compartments: medial, anteroinferior, posterosuperior, and lateral. The CS venous spaces had peculiar morphological characteristics; the medial compartment was C-shaped while the anteroinferior compartment resembled a boat's bow. The mean distances from the medial border of the inferior horizontal segment of cavernous ICA to the mid-line of the pituitary gland (PG) were 6.07 ± 1.61 mm (left) and 5.97 ± 1.89 mm (right); the mean distances from the medial border of the subarachnoid segment of cavernous ICA to the mid-line of the PG were 5.77 ± 1.16 mm (left) and 5.63 ± 1.17 mm (right); the mean distances from the medial border of the anterior vertical segment of cavernous ICA to the mid-line of the PG were 10.27 ± 1.74 mm (left) and 10.47 ± 1.90 mm (right). Morphological characteristics and the knowledge of the interconnected regularities of the CS venous spaces may help surgeons accurately locate the neurovascular structure, and thus may contribute to the effective prediction of tumor invasion and extension during endoscopic CS surgery.

Synchrotron radiation phase-contrast X-ray CT imaging of acupuncture points.

Three-dimensional (3D) topographic structures of acupuncture points were investigated by using synchrotron radiation in-line X-ray phase contrast computerized tomography. Two acupuncture points, named Zhongji (RN3) and Zusanli (ST36), were studied. We found an accumulation of microvessels at each acupuncture point region. Images of the tissues surrounding the acupuncture points do not show such kinds of structure. This is the first time that 3D images have revealed the specific structures of acupuncture points.

Profiling of innervations of mimetic muscles in fresh human cadavers using a modified Sihler's technique.

The nerve map of the human face, although important in guiding facial surgery, has not been well defined. In this study we applied a modified Sihler's technique to profile intramuscular innervation of human mimetic muscles. Six fresh cadaveric heads were used. The intramuscular distribution of the facial nerve in human mimetic muscles was visualized using a modified Sihler's technique. Modified Sihler's staining revealed a three-dimensional picture of the clearly purple-black intramuscular facial and sensory nerves. The nerve branching patterns of both facial halves were asymmetrical. None of the fine nerve branches crossed over the midline. The facial nerve branches divided into secondary rami and formed a mesh-like plexus before entering the target muscles at a right angle. The modified Sihler's technique can profile intramuscular innervation of human mimetic muscles. Our nerve map of the face offers valuable guidance for facial reanimation surgery, facial cosmetic surgery, and parotid surgery.

Quantitative anatomical study of male pelvic autonomic plexus and its clinical potential in rectal resection.

The pelvic autonomic nerves innervate the pelvic viscera, and carry a high risk of damage during surgery. This high risk has been ascribed to the complex interrelationship of pelvic paravisceral structures and the difficulty in identifying particular structures, despite the fact that the anatomic characteristics of the pelvic autonomic plexus have been well documented. We dissected ten male embalmed adult cadavers with particular attention to the quantitative parameters of the pelvic plexus and its subsidiary plexus. The right inferior hypogastric plexus and its rectal branch were found to be significantly longer and wider than the left one, while the transverse diameter of the vesical and prostatic branches of the left side was significantly larger the right. The inferior mesenteric plexus gave off fibers directly to form the pelvic plexus in four of 20 hemipelves (20%). In the side-by-side comparison, the distance to midpoint of the sacral promontory of the left rectal plexus was significantly longer than that of the right, whereas the maximum length (the length of the longest nerve fiber from origin to corresponding organ) of the left vesical plexus was significantly shorter than that of the right. Additionally, the craniocaudal and dorsoventral diameters of the right pelvic autonomic plexus were significantly shorter those of the left. The quantitative parameters relating to the pelvic autonomic plexuses not only can enhance our understanding of its anatomy and function, but can also be used as references for surgical procedures and robot-assisted surgery.

Intramuscular innervations of muscle flaps that are commonly used in clinical settings.

PURPOSE: Abductor hallucis, latissimus dorsi, gracilis, rectus abdominis, sartorius and pectoralis minor are muscle flaps that are commonly used in clinic, but their intramuscular innervation has seldom been systematically investigated. METHODS: Five Chinese fresh human cadavers were included in the study and abductor hallucis, latissimus dorsi, gracilis, rectus abdominis, sartorius and pectoralis muscles were dissected. After gross anatomy measurement, the specimens were then stained by Sihler's staining technique. Intramuscular innervation was observed and the number as well as distribution was recorded. RESULTS: Intramuscular nerves were clearly visualized by Sihler's staining technique. Based on the shape and muscle-tendon morphology, Lim et al. in Muscle Nerve 29:523-530, 2004 grouped the muscles into trapezoidal-shaped (type I), spindle-shaped (type II), and combination-shaped (type III). According to Lim's study the abductor hallucis was a type IIb muscle and was divided into two compartments by the distal tendon. Latissimus dorsi was a type I muscle, divided into 3-4 compartments by intramuscular nerve branches. Gracilis was a type IIa muscle and the distal part was divided into two compartments by intramuscular nerve branches. Rectus abdominis was a type III muscle and the four bellies comprised four compartments, each of which could be designated as a subunit. Sartorius was a type II muscle and it could be divided into 2-3 compartments along the long axis. Pectoralis minor was a type I muscle that was divided into two compartments by extramuscular terminal nerves. CONCLUSIONS: The six muscles are divided into several compartments by the tendon or nerve branches, and all of them make good donor tissue for muscle compartment transfer in reconstructive surgery.

Neurovascular details about forearm muscles: applications in their clinical use in functional muscular transfer.

PURPOSE: The concept of muscle subunits has been introduced for limb reconstruction and functional conservation of donor site, yet it requires thorough understanding of neurovascular anatomy of muscles. The present study provides neurovascular details of forearm skeletal muscles. METHODS: Twenty-eight forearms were dissected totally, ten for observing extramuscular nerve distribution, ten for observing intramuscular nerve distribution by modified Sihler's technique, and the other eight for observing intramuscular artery distribution by aqueous barium sulfate infusion. The forearm muscles were classified into three different types according to Lym's classification. Numbers of extramuscular and intramuscular nerves were counted and compared between the types. Intramuscular vascular distribution was also classified into three different types according to Mathes' method. Intramuscular vascular distribution was compared with nerve distribution as well. RESULTS: There were also some variations in the composition of muscular branches. Numbers of intramuscular nerve branches were significantly higher in muscle types IIa and III. Morphology and intramuscular neurovascular distribution of type II muscles are easy to split into two independent parts for functional muscular flap transfer according to morphology and intramuscular neurovascular distribution. CONCLUSIONS: The present study elucidated that flexor carpi ulnaris and radialis, extensor carpi ulnaris, and carpi radialis brevis were suitable for functional muscular transfer from several different insights, but the roles of pronator teres and supinator remained to be controversial. This study might be very helpful to plastic surgeons and anatomists.

Do acupuncture points exist?

We used synchrotron x-ray fluorescence analysis to probe the distribution of four chemical elements in and around acupuncture points, two located in the forearm and two in the lower leg. Three of the four acupuncture points showed significantly elevated concentrations of elements Ca, Fe, Cu and Zn in relation to levels in the surrounding tissue, with similar elevation ratios for Cu and Fe. The mapped distribution of these elements implies that each acupuncture point seems to be elliptical with the long axis along the meridian.

[A dynamic model describing lymphatic circulation].

Based on the morphology and function of lymphatic vessel, and on the achievements of researches in the regulatory mechanism of lymphatic circulation, we fully considered the dynamic interaction of blood, interstitial fluid and lymph fluid; then we imitated and used Sungawa's method of analyzing the heart output, and finally set up a dynamic model for describing lymphatic circulation. Comparison of our calculating results with the data from Ikomi's experiment showed that they were identical, thus indicating that our model is of value in explaining the dynamic mechanism of lymphatic circulation. In this paper is especially calculated the relationship between lymph flow and massage frequency, which is useful for analyzing the effect of massage on the lymph flow rate with respect to this model.

Functional analysis in vivo of engineered valved venous conduit with decellularized matrix and two bone marrow-derived progenitors in sheep.

Tissue engineering has been considered a promising approach for creating grafts to replace autologous venous valves. Here, ovine bone marrow-derived endothelial progenitor cells (EPCs) and multipotent adult progenitor cells (MAPCs) were harvested and then loaded into decellularized venous matrix to create tissue-engineered (TE) valved vein. Subsequently, the ovine femoral veins containing the valve were removed and replaced by TE grafts or acellular matrix only. The morphology and function were analysed for up to 1 year by ultrasonography, angiography, H&E staining and scanning electron microscopy (SEM). The differentiation of seeded cells was traced immunofluorochemically. The results showed that decellularized venous matrix could initially and feebly attract endogenous cells, but failed afterwards and were insufficient to restore valve function. On the contrary, the seeded cells differentiated into endothelial cells (ECs) in vivo and formed a monolayer endothelium, and smooth muscle cells within the scaffold therefore produced TE grafts comparable to the native vein valve. This TE graft remained patent and sufficient after implantation into the venous circuit of the ovine lower extremity for at least 6 months. Unfortunately, cells seeded on the luminal surface and both sides of the leaflets lost their biological functions at 12 months, resulting in thrombosis formation and leading to complete occlusion of the TE grafts and impotent venous valves. These findings suggest that this TE valved venous conduit can function physiologically in vivo in the medium term. Before translating this TE venous valve into clinical practice, the durability should be improved and thrombogenicity should be suppressed. Copyright © 2016 John Wiley & Sons, Ltd.

Biocompatibility evaluation of tissue-engineered valved venous conduit by reseeding autologous bone marrow-derived endothelial progenitor cells and multipotent adult progenitor cells into heterogeneous decellularized venous matrix.

Clinical treatment of chronic deep venous insufficiency remains difficult despite the availability of various therapies. Previous experimental efforts have demonstrated that the tissue-engineered valvedvenous conduit (TEVV) is a promising option to replace the damaged venous valve. The aim of the present study was to evaluate the TEVV by reseeding bone marrow-derived endothelial progenitor cells and multipotent adult progenitor cells into acellular matrix according to International Standard ISO10993, and to clarify their interactions with blood, the local effect after implantation both in vitro and vivo, and immunogenicity. The results showed that the 2-cm long TEVV did not cause haemolysis in vitro and remained patent without thrombosis formation in vivo. However, the luminal surface of TEVV was partially covered by multilayer cells. Compared with the native ovine femoral vein segment, the TEVV beneath the mouse skin produced significant mononuclear cell infiltration, with serum interleukin-6 and tumour necrosis factor-α similar to normal. The TEVV maintained its structural integrity, while the native ovine femoral vein segments fell apart at postoperative week nine. The TEVV implantation did not change serum immunoglobulin G. In addition, the seeds and extracts of the scaffold did not affect the proliferation of mouse lymphocytes. These findings suggest that the histocompatibility, haemocompatibility and immunogenicity of this TEVV are acceptable owing to complete removal of the cellular components of autologous seeds and residues of chemical regents, thus providing an experimental basis for further clinical translation. Copyright © 2014 John Wiley & Sons, Ltd.

Two methods can simultaneously display both intramuscular nerves and blood vessels.

BACKGROUND: The arrangement and relationship of intramuscular nerves and blood vessels are critical to clinical physicians, but the majority of previous studies could not reflect them precisely. METHODS: In method 1, after rabbits were perfused with barium sulfate liquid silica gel, the specimen muscle was isolated and subjected to Sihler staining. The specimen muscles then underwent optical photography and molybdenum target radiography. The obtained photograph and the radiograph were then overlapped together to draw a map of intramuscular nerves and blood vessels. In method 2, after rabbits and child cadavers were perfused with semitransparent red liquid silica gel, the specimen muscle was isolated and subjected to Sihler staining. Finally, the specimen muscles were placed on an x-ray film viewer for photography. RESULTS: Both methods had ideal outcomes. Through digital subtraction angiography, a distribution map of intramuscular nerves and blood vessels could be obtained in method 1, whereas in the photographs taken through method 2, the intramuscular nerves were counterstained with dark blue and the intramuscular blood vessels were stained red, which was more precise and direct. In method 2, specimens could be made into stereoscopic models. CONCLUSIONS: These two methods that can simultaneously display intramuscular nerves and blood vessels have been significantly improved and lead to a good result. They also have their own advantages. When a muscle studied is small or flat, method 2 is recommended because of its conciseness and convenience. If the muscle is large, method 1 is applicable.

Anatomic study of popliteus complex of the knee in a Chinese population.

This study explored the anatomic relationship of the popliteus complex (PC) and collected anatomic data of PC in a Chinese population. The anatomic study was performed using 81 formalin-fixed knees. The femoral attachment of the popliteus tendon could be classified into three types with respect to femoral attachment of the lateral collateral ligament. The popliteofibular ligament presented as ligament (87.7%) or fascia (12.3%), originating from the musculotendinous junction of the popliteus muscle or just proximal to it. Given the great variability of the posterolateral structures, reconstructive surgeons should design a method based on individual anatomic features, rather than a fixed reconstructive surgery.

[Experimental research of neuromuscular compartments and muscular architecture of forearm skeletal].

OBJECTIVE: To reveal morphologic features and physiological function in compartments of human forearm muscles, and investigate the possibility of transplantation of neuromuscular compartments. METHODS: Sohier's neural staining technique was used to study the nerve branches distribution of forearm skeletal muscles in 5 human cadavers (aging 26-39 years), including flexor carpi radialis, flexor carpi ulnaris (FCU), extensor carpi radialis brevis, extensor carpi ulnaris, palmaris longus (PL), flexor pollicis longus, pronator teres (PT). According to Wickiewicz's methods, Ulnar compartment and radial compartment of forearm skeletal muscles above mentioned from 10 human cadavers were used to study the muscle architectural features. RESULTS: Each nerve branches run into the ulnar compartment and radial compartment respectively. There was statistically significant difference between the two physiological cross section areas (PSCA) of each neuromuscular compartment from forearm muscles (P < 0.05). Among them, PSCA of ulnar compartment of FCU was the largest. The PSCA of ulnar compartment of PT was the smallest. There was no statistically difference between the ratio (PSCA/muscle wet weight) of each neuromuscular compartment from forearm muscles (P > 0.05). As the ratio of PSCA to the muscle fiber length, the ulnar compartment of PT and the two compartments of PL had the highest one while the ulnar compartment of FCU had the smallest; and there was no statistically difference among the other neuromuscular compartments (P > 0.05). CONCLUSION: Each of forearm muscles be divided into ulnar compartment and radial compartment and they have their own nerve supply. And there are significant differences in the physiological function in compartments of forearm muscles, which can be references in muscular compartment transplantation.

Morphological characteristics of the anterior ethmoidal artery in ethmoid roof and endoscopic localization.

OBJECTIVES: To provide anatomical data to help identify and locate the anterior ethmoidal artery (AEA) precisely during endoscopic procedures. METHOD: We dissected 15 adult cadaver heads, which provided 30 specimens, to study morphological characteristics, courses, and several types of variations. RESULTS: We found the average diameter of the AEA to be 0.80 +/- 0.24 mm. In 85.7% of the cases, the artery was seen between the second and third lamella. Other locations were over the roof of the frontal recess cells (10.7%) and the roof of the posterior ethmoid sinus (3.6%). The AEA ran parallel to the ethmoid roof and formed a slight curve. When viewed from the superior side, the angle formed by the long axis of the artery and the lamina papyracea was 60.5 degrees +/- 16.4 degrees. In 83.3% of the cases, the anterior ethmoidal canal (AEC) was identified as a separate canal, and in 16.7% the canal was embedded in the ethmoid roof. In 10 of the 30 cases (33.3%), the AEC presented some degree of dehiscence. CONCLUSION: As a result of these dissections, we found that the AEA's course in the ethmoid roof varies. The morphological characteristics-that the AEA runs parallel to the ethmoid roof, forming a slight posterolateral to anteromedial curve as it passes from the orbit to the cribriform plate-are the most reliable factors used to identify the artery during surgery.

[Anatomic study of intramuscular nerve and blood vessel in forearm muscles: an anatomical study].

OBJECTIVE: To study the distribution of intramuscular nerve and blood vessels in forearm muscles and to discuss the possibility of dividing the forearm muscles into independent functional units. METHODS: (1) The muscles were dissected in 10 forearms from 5 fresh adult human cadavers and stained with the Sihler's nerve staining; (2) The blood vessels were studied in eight forearm muscles from 4 fresh adult human cadavers with irrigation of a mixture of 30% barium sulfate and gelatin from brachial artery and then X-photographed. All pictures were compared to study the intramuscular distribution of nerve and blood vessels. RESULTS: The intramuscular nerve branches were stained purple-black and visualized clearly. The muscles were classified into three types according to the distribution characters of intramuscular nerve and blood vessels. And the types of muscles could be further subdivided into a and b subtypes. CONCLUSION: According to the neurovascular distribution, the forearm muscles in type II a and type III a can be divided into independent function units for muscle functional transplantation.

Observation and measurements of long thoracic nerve: a cadaver study and clinical consideration.

Long thoracic nerve (LTN) is an important nerve originating from cervical nerve roots. It varies a lot in origins and branches, which lead to several clinical problems, such as diagnosis, prophylaxis and treatment of LTN injury. LTN was dissected in 38 cadavers in the present study. Origin, level of union, branches, sites where nerve entered the muscle, length of nerve trunk and branches as well as transverse diameter were documented. Different derivations of LTN were observed, and C4-7, C5-7, C5 and C7, C5-7, C5-8, C6 and C7, and branch from C6 was the most important components of LTN. After evolution, LTN trunk was composed by superior and inferior trunks at scalenus muscle or the three superior slips level. Branches of LTN traveled on the surface of the six superior slips of anterior serratus muscle and then penetrated through the inferior slips without correlation between different branches. Mean length of trunk of LTN is 111.73 (30.08) mm, axis of cross section was 2.27x0.96 mm at the union level and 1.91 x 0.68 mm at the end branch. Each slip was innervated by 1-4 branches of LTN. The observation and measurement data described in our study presented some variations and could provide clinicians with important information on diagnosis, prophylaxis and treatment of LTN injury and pursuing more suitable muscle flaps for reconstruction operation.