An anatomical study of the tibial nerve branches innervating the posterior tibial artery.

The arteries of the lower limbs are innervated by vascular branches (VBs) originating from the lumbar sympathetic trunk and branches of the spinal nerve. Although lumbar sympathectomy is used to treat nonreconstructive critical lower limb ischemia (CLLI), it has limited long-term effects. In addition, the anatomical structure of tibial nerve (TN) VBs remain incompletely understood. This study aimed to clarify their anatomy and better inform the surgical approach for nonreconstructive CLLI. Thirty-six adult cadavers were dissected under surgical microscopy to observe the patterns and origin points of VBs under direct vision. The calves were anatomically divided into five equal segments, and the number of VB origin points found in each was expressed as a proportion of the total found in the whole calf. Immunofluorescence staining was used to identify the sympathetic nerve fibers of the VBs. Our results showed that the TN gave off 3-4 VBs to innervate the posterior tibial artery (PTA), and the distances between VBs origin points and the medial tibial condyle were: 24.7 ± 16.3 mm, 91.7 ± 66.1 mm, 199.6 ± 52.0 mm, 231.7 ± 38.5 mm, respectively. They were mainly located in the first (40.46%) and fourth (31.68%) calf segments, and immunofluorescence staining showed that they contained tyrosine hydroxylase-positive sympathetic nerve fibers. These findings indicate that the TN gives off VBs to innervate the PTA and that these contain sympathetic nerve fibers. Therefore, these VBs may need to be cut to surgically treat nonreconstructable CLLI.

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.

A demonstraçäo de fibras nervosas do funículo umbilical humano com método imunohistoquímico / Demonstration of nerve fibers in the human umbilical cord with immunohistochemical method

Propusemo-nos a estudar a presença de elementos nervosos em segmentos justafetais de funículos umbilicais humanos. O método usado foi o da peroxidase-antiperoxidase (PAP), com o intuito de detectar a enolase neurônio-específlca, enzima tracitoplasmática dos elementos nervosos, envolvida na via glicolítica; como controle, a mesma metodologia foi aplicada em segmentos de artéria tibial posterior humana. Nos dez funículos umbilicais usados foram sempre evidenciados elementos nervosos, tanto nas suas artérias como na veia, notadamente na respectiva adventícia e parte externa da túnica muscular. No restante da parede vascular (parte interna da túnica muscular e túnica íntima) nao logramos distinguir elementos nervosos. A presença de feixes nervosos na periferia dos vasos, gradualmente mais delicados para o interior da parede vascular, sugere que estes elementos vao terminando nesta direçao.