Relationship to the superficial radial nerve and anatomic variations of the first extensor compartment in Thai population: a basis for successful de Quervain tenosynovitis treatment.

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft.

INTRODUCTION: The central ridge of the patella is the thickest area of patella and varies among patients. This cadaveric study identified the location and thickness of the bone at the central patella ridge for bone-patellar tendon-bone (BPTB) harvesting. MATERIALS AND METHODS: Fifty cadaveric knees were assessed. First, the morphology, length, width, and location of the central patellar ridge were recorded. Then, we transversely cut the patella 25 mm from the lower pole and measured the thickness of the anterior cortex, cancellous bone, and cartilage from both the mid-patella and the central ridge location. Finally, the depth of the remaining cancellous bone at the mid-patella was compared to the bone at the central ridge. RESULTS: The location of the central-patellar ridge deviated medially from the mid-patella in 46 samples with an average distance of 4.36 ± 1 mm. Only 4 samples deviated laterally. The mean patella length was 41.19 ± 4.73 mm, and the width was 42.8 ± 5.25 mm. After a transverse cut, the remaining cancellous bone was significantly thicker at the central ridge compared to the bone at the mid-patella. CONCLUSIONS: Most of the central patellar ridge deviated medially, approximately 4 mm from the mid-patella. Harvesting the graft from the central ridge would have more remaining bone compared to the mid-patella.

New aspect of morphometric study of the superior peroneal retinaculum: pertinent data for surgical repair and reconstruction.

BACKGROUND: This study was conducted to investigate characteristics, attachments and morphometric parameters of the superior peroneal retinaculum (SPR). MATERIALS AND METHODS: Morphology and morphometric details including width, length, thickness and angle of alignment of SPR in 109 embalmed cadaveric legs were investigated. The occurrence of peroneal tendon tear was also noted. RESULTS: Most of SPR originated from the fibrocartilaginous ridge of the lateral malleolus. The SPR might be a single band or split into proximal and distal bands inserted on the posterior intermuscular septum and lateral wall of calcaneus, respectively. Based on the characteristics and insertion patterns, the SPR could be divided into 3 types: type I (double band with subtype Ia and Ib), type II (single band) and type III (single band) with the prevalence of 56.88% (12.84%, 44.04%), 1.83%, and 41.28%, respectively. The average coordinate (X, Y axis) of the midpoint of width at origin measured from the tip of fibula in all types was 7.26±3.15 and 10.45±4.52 mm. The average coordinate of the midpoint at insertion on the posterior intermuscular septum was 24.06±4.94 and 13.35±5.18, and those inserted on the lateral wall of calcaneus was 21.45±7.88 and 13.59±6.73 mm. Prevalence of peroneus brevis (PB) tendon tear was 12.84% (14 cases) and was associated with SPR type Ib with statistical significance. CONCLUSIONS: Precise information of the characteristics, morphometric data and coordinates of attachment sites of SPR are essential for surgical procedures and reconstruction.

Different effect of percutaneous plate insertion via anteromedial vs anterolateral approach on intracompartmental pressure of the leg: A cadaveric study.

BACKGROUND: Currently Minimally Invasive Plate Osteosynthesis (MIPO) technique for tibial shaft fracture management has gained wide attention. However, an increased intracompartmental pressure after the plate insertion may result in postoperative acute compartment syndrome. We reported the difference of immediate effect of percutaneous plate insertion using 2 approaches of MIPO technique on anterior compartment pressure of the legs. MATERIALS AND METHODS: Eight soft cadaveric legs (one female and three males) without previous history of skeletal trauma or surgery were infused with normal saline to create the sustained intracompartmental pressure of 20mm Hg in all four compartments. The Synthes® 4.5mm 11-hole Narrow Locking Compression Plate was inserted via anteromedial and anterolateral approach. Anterior compartment pressure was measured by portable digital monitoring device through side-port needle (Stryker® Intracompartmental Monitoring Device) before and after plate insertion for each approach. RESULTS: By using anteromedial approach, a mean of anterior compartment pressure was increased by 0.375mm Hg after plate insertion (5 of 8 legs had no change in pressure and the remaining 3 resulted in 1mm Hg pressure elevation). For anterolateral plate insertion, all of the 8 legs had an elevation of anterior compartment pressure with a mean of 3.5mmHg (ranged from 2 to 6mm Hg). CONCLUSIONS: When both approaches were compared to each other, the anterolateral plate insertion resulted in higher intracompartmental pressure elevation of the anterior compartment than the anteromedial approach. Surgeon should be more aware of acute compartment syndrome when considering the anterolateral approach in treating close tibial fracture. However, in patients with suspected acute compartment syndrome, close observation and continuous monitoring of the intracompartmental pressure is still imperative for all healthcare provider.

Anatomy of osterior antebrachial cutaneous nerve related to the lateral epicondyle and interepicondylar line / Anatomía del nervio cutáneo posterior del antebrazo relacionado con el epicóndilo lateral y la línea interepicondilar

Posterior antebrachial cutaneous nerve (PACN) is a branch of radial nerve supplying the skin of posterior forearm. Data regarding its anatomy remain insufficient especially the origin and number of branches. We dissected 101 upper extremities from 32 male and 20 female cadavers to expose the PACN. In all specimens, the nerve emerged from the deep fascia at the hiatus proximal to the interepicondylar line (IEL) with mean distances of 7.24 and 7.44 cm in males and females, respectively. Percentage of this distance to the arm length was 23.2 % and 26.1 % in males and females, respectively. After penetrating the deep fascia, the PACN coursed in the subcutaneous layer and crossed the IEL anterior to the lateral epicondyle (LE) in all cases. The mean distances from the crossing point to the LE along the IEL were 1.52 cm in males and 1.34 cm in females. Regarding the branches of PACN, at least 50 % of the specimens had up to 3 or 4 branches originating either proximal or distal to the hiatus. In two arms, one of these branches passed posterior to the LE. Moreover, there were communicating branches between the PACN and the lateral antebrachial cutaneous nerve in 9 specimens. Gender and side differences were found in some measurement parameters. These data are crucial for avoiding the PACN injury during surgical procedures around the elbow.

El nervio cutáneo posterior del antebrazo (NCPA) es un ramo del nervio radial que inerva la piel del antebrazo. Los datos acerca de su anatomía siguen siendo insuficientes en especial en cuanto a su origen y el número de ramos. Disecamos 101 miembros superiores de cadáveres pertenecientes a 32 hombres y 20 mujeres para exponer el NCPA. En todas las muestras, el nervio surgió de la fascia profunda en el hiato proximal a la línea interepicondilar (LIE) con distancias medias de 7,24 y 7,44 cm en hombres y mujeres, respectivamente. El porcentaje de esta distancia a la longitud del brazo fue 23,2 % y 26,1 % en hombres y mujeres, respectivamente. Después de penetrar la fascia profunda, el NCPA continuaba en el tejido subcutáneo y cruzaba la LIE anterior al epicóndilo lateral (EL) en todos los casos. Las distancias medias desde el punto de cruce del EL a lo largo de la LIE fueron 1,52 cm en hombres y 1,34 cm en mujeres. Con respecto a las ramos del NCPA, al menos 50 % de las muestras tenían hasta 3 o 4 ramos, ya fuesen proximales o distales al hiato. En dos de los brazos, uno de estos ramos pasó posterior al EL. Por otra parte, en 9 de las muestras se observó comunicación entre los ramos del NCPA y el nervio cutáneo antebraquial lateral. No se encontraron diferencias secundarias o de sexo en algunos parámetros de medición. Estos datos son esenciales para evitar las lesiones durante los procedimientos quirúrgicos alrededor del codo que involucren el NCPA.

Anatomy of the sural nerve related to calcaneal tendon, intermalleolar line and small saphenous vein / Anatomía del nervio sural en relación con el tendón calcáneo, la línea intermaleolar y la vena safena parva

Sural nerve (SN) courses from the posterior aspect of leg to the lateral side of ankle and foot. Anatomy of the SN is of clinical importance due to its involvement in nerve biopsy, nerve graft harvesting including injuries during calcaneal tendon repair. Despite substantial knowledge in the literature, more easily located landmarks and data regarding the symmetry are still needed. Ninety-eight lower extremities from 31 males and 18 females were dissected in this study. The SN originated from the union between the medial and lateral sural cutaneous nerves in 52.0 % of the legs. The distance from the union point to the intermalleolar line (IML) was 16.3±8.4 (SD) cm. The ratio of this distance to the fibular length (apex of head to lateral malleolus or LM) was 0.47±0.23 cm. In 84.7 % of the legs, the SN initially coursed medial to and then crossed the lateral border of calcaneal tendon at the distance of 8.4±2.1 cm above the IML. The ratio to the fibular length was 0.25±0.06 cm. At the level of IML, the SN was posterior to the most prominent part of the LM in 95.9 % of the legs with the distance of 2.6±0.5 cm. At the closest point, the SN was lateral to the small saphenous vein in 74.5 % of the legs and the distance from this point to the IML was 10.6±4.7 cm. The ratio to the fibular length was 0.31±0.14 cm. Side difference or asymmetry was observed in a substantial number of specimens. These data are crucial for not only localizing the SN during biopsy and graft harvesting but also avoiding the nerve injury during relevant surgical procedures.

El nervio sural (NS) transcurre por la región posterior de la pierna, el tobillo y el pie. La anatomía del NS es de importancia clínica durante la realización de una biopsia, el desarrollo de injerto de nervio, incluyendo lesiones del nervio durante la reparación del tendón calcáneo. A pesar del conocimiento sustancial en la literatura, aún se necesitan puntos de referencia más fáciles de localizar e información sobre la simetría. Noventa y ocho miembros inferiores de 31 hombres y 18 mujeres fueron disecados. El NS se originó a partir de la unión entre los nervios cutáneo sural medial y cutáneo sural lateral en el 52,0 % de las piernas. La distancia desde el punto de unión a la línea intermaleolar (IML) fue de 16,3±8,4 (SD) cm. La relación de esta distancia a la longitud de la fíbula (vértice de la cabeza al maléolo lateral o LM) fue de 0,47±0,23 cm. En el 84,7 % de las piernas, el NS se ubicó inicialmente medial y luego cruzó el margen lateral del tendón calcáneo a una distancia de 8,4±2,1 cm proximal a la IML. La relación de longitud de la fíbula fue de 0,25±0,06 cm. A nivel de la IML, el NS se localizaba posterior a la parte más prominente de la LM en el 95,9 % de las piernas, con una distancia de 2,6±0,5 cm. En el punto más cercano, el NS se localizaba lateral a la vena safena parva en 74,5 % de las piernas y la distancia desde este punto hasta la IML fue de 10,6±4,7 cm. La relación de longitud de la fíbula fue 0,31±0,14 cm. La diferencia entre los lados o asimetría se observó en un número considerable de ejemplares. Estos datos son esenciales no sólo para localizar el NS durante la biopsia y la realización del injerto sino también para evitar la lesión del nervio durante procedimientos quirúrgicos relevantes.

Medial antebrachial cutaneous nerve: anatomical relationship with the medial epicondyle, basilic vein and brachial artery / Nervio cutáneo antebraquial medial: relación anatómica con el epicóndilo medial, vena basílica y arteria braquial

Medial antebrachial cutaneous nerve (MACN) courses in the medial arm to provide sensory innervation to the medial forearm. Its anatomy has been partly described since data regarding its branching pattern and distances to adjacent landmarks are still lacking. The purpose of this study was to provide morphometric anatomy of the MACN with comparisons between sides and sexes. Ninety-six upper extremities from 26 males and 22 females were dissected. We found that up to 5 branches of MACN pierced the deep fascia with the maximum of 4 reaching the interepicondylar line (IEL). Presence of 2 and 3 branches was found in the majority of cases (> 80%). The distances from these branches to the landmarks varied considerably. In case of no branch, the mean distances to the medial epicondyle (ME) and brachial artery (BA) were approximately 1.5 cm while those to the basilic vein (BV) were 0.7 cm in both sexes. Regardless of the branching pattern, the MACN could pass over or close (within 0.5 cm) to the ME, BV and BA. Asymmetry in the branching pattern was found in 50% of specimens. Sex but not side differences were observed in some measurement parameters. These data are crucial for not only localizing the MACN during nerve block and graft harvest but also avoiding the nerve injury during surgical procedures.

El recorrido del nervio cutáneo antebraquial medial (NCAM) proporciona la inervación sensorial medial del antebrazo. Su anatomía se ha descrito en parte, porque los datos relativos a su patrón de ramificación y distancias a puntos de referencia adyacentes son insuficientes. El propósito de este estudio fue proporcionar datos morfométricos sobre la anatomía del NCAM, comparando entre lados y sexos. Se disecaron 96 miembros superiores de 26 hombres y 22 mujeres. Se encontró que 5 ramos del NCAM traspasaron la fascia profunda y llegaron 4 hasta la línea interepicondilar (LIE). Presencia de 2 y 3 ramos se encontró en la mayoría de los casos (>80%). Las distancias de estos ramos a los puntos anatómicos variaron considerablemente. En caso de ausencia de ramos, la distancia medial al epicóndilo medial (EM) y arteria braquial (AB) fueron de aproximadamente 1,5 cm, mientras que a la vena basílica (VB) fueron 0,7 cm en ambos sexos. Independientemente del patrón de ramificación, el NCAM podría pasar sobre o cerca (a menos de 0,5 cm ) del EM, VB y AB. Asimetría en el patrón de ramificación se encontró en 50% de las muestras. Diferencias en algunos de los parámetros de medición se observaron según sexo, pero no por lado. Estos datos son relevantes para localizar el NCAM durante el bloqueo del nervio y la toma de injertos, sino también para evitar la lesión del nervio durante los procedimientos quirúrgicos.

Sartorial branch of saphenous nerve: anatomical relationship with bony landmarks and great saphenous vein / Ramo sartorial del nervio safeno safeno: relación anatómica con puntos de referencia óseos y de la vena safena magna

Sartorial branch of saphenous nerve (medial crural cutaneous nerve) originates at the medial side of the knee and descends along the great saphenous vein (GSV) to innervate the medial aspect of the leg. Its anatomy is of concern in surgical procedures and anesthetic block. However, the measurement data related to palpable bony landmarks with comparison between sexes and sides are lacking. Dissection was done in 95 lower limbs from both sexes. We found that the nerve pierced the deep fascia alone in most cases (92.6%). This piercing point was always distal to the adductor tubercle with the distance of 5-6 cm which was 15% of the leg length (the distance between the adductor tubercle and medial malleolus). The nerve was 7 cm medial to the tibial tuberosity. At the mid-level of leg length, the nerve was slightly over 4 cm medial to the anterior tibial margin. The nerve terminally divided 7 cm proximal to the medial malleolus. Furthermore, the anatomical relationship between the nerve and the GSV was highly variable. The nerve was constantly anterior, posterior or deep to the GSV in 8.4%, 15.8% and 2.1%, respectively. Crossing between the two structures was observed in 57.9% of specimens and the distance to the medial malleolus was 18 cm. Symmetry was found in most parameters and significant gender differences were observed in some distances. These results are important for avoiding the sartorial nerve injury and locating the nerve during relevant procedures.

El ramo sartorial del nervio safeno (nervio cutáneo medial de la pierna) se origina en el lado medial de la rodilla y desciende a lo largo de la vena safena magna (VSM) para inervar la cara medial de la pierna. Su anatomía es motivo de preocupación en los procedimientos quirúrgicos y en el bloqueo anestésico. Sin embargo, los datos de medición relacionados con puntos de referencia óseos palpables y la comparación entre los lados y en ambos sexos son escasas. Se realizó la disección en 95 miembros inferiores de ambos sexos. Se encontró que el nervio perforó la fascia profunda en la mayoría de los casos (92,6%). Esta punta de perforación fue siempre distal al tubérculo del músculo aductor magno a una distancia de 5-6 cm, que representaba el 15% del largo de la pierna (la distancia entre el tubérculo del aductor magno y el maléolo medial). El nervio se localizaba 7 cm medial a la tuberosidad tibial. Al nivel del tercio medio en ambas piernas, el nervio estaba a una distancia un poco mayor a 4 cm medial al margen anterior de la tibia. El nervio se dividía 7 cm proximal al maléolo medial. Por otra parte, la relación anatómica entre el nervio y la VSM fue muy variable. El nervio era constantemente anterior, posterior o profundo a la VSM en 8,4%, 15,8% y 2,1%, respectivamente. Cruce entre las dos estructuras anatómicas se observó en el 57,9% de las muestras y la distancia hasta el maléolo medial fue de 18 cm. La simetría se encuentra en la mayoría de los parámetros y diferencias de sexo significativas se observaron en algunas distancias. Estos resultados son importantes para evitar la lesión del nervio sartorial y localizar el nervio durante los procedimientos pertinentes.

Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein.

The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve supplying the lateral aspect of forearm. Because of its close proximity to the biceps brachii tendon (BBT), the lateral epicondyle (LE), and the cephalic vein (CV), surgery and venipuncture in the cubital fossa can injure the LACN. Measurement data regarding the relative anatomy of LACN are scarce. We, therefore, dissected 96 upper extremities from 26 males and 22 females to expose the LACN in the cubital fossa and forearm. The LACN consistently emerged from the lateral margin of BBT. It then pierced the deep fascia distal to the interepicondylar line (IEL) in 84.4% with mean distances of 1.8 ± 1.1 and 1.2 ± 0.9 cm (male and female, respectively). At the level of IEL, the LACN in all cases was medial to the LE (5.9 ± 1.1 cm male and 5.2 ± 0.9 cm female). Two types of branching were observed: single trunk (78.1%) and bifurcation (21.9%). Asymmetry in the branching pattern was observed in 6 males and 1 female. Concerning the relationship to the CV, the LACN ran medially within 1 cm at the level of IEL in 78.7%. Moreover, in 10 specimens, the LACN was directly beneath the CV. In the forearm, the LACN tends to course medial to the CV. Significant differences in the measurement data between genders but not sides were found in some parameters. These data are important for avoiding LACN injury and locating the LACN during relevant medical procedures.

Morphometric analysis of the human superficial radial nerve.

The superficial radial nerve (SRN) is one of the cutaneous nerves biopsied for diagnosis of peripheral neuropathy. Morphometric analysis is employed to provide more quantitative data regarding the histomorphology of nerve biopsy. To detect early structural changes, morphometric data from normal nerves are necessary for diagnostic criteria. Unlike the sural nerve, morphometric data on the normal SRN have not been reported. Therefore, a morphometric analysis of the normal human SRN was done in this study. The nerves were harvested bilaterally from 21 fresh human bodies, yielding 34 nerves after excluding damaged ones. Transverse semi-thin sections were analyzed for the number of fascicles, myelinated fiber and axon diameters, myelin sheath thickness, g ratio, density and total number of myelinated fibers using the three-window sampling method. We found that 2-16 fascicles were present. Mean fiber and axon diameters were 6.32 +/- 0.09 (SEM) and 3.44 +/- 0.06 microm, respectively. Average myelin thickness was 1.44 +/- 0.03 microm. Average g ratio was 0.56 +/- 0.01. Mean density of fibers was 8,872.9 +/- 167.4/mm(2). The number of fibers varied from 1,390 to 10,941, with an average of 6,495 +/- 474. These parameters were independent of age. Asymmetry in the number of fibers was also noted in four cases. The data obtained in this study can be applied to histomorphometric evaluations of SRN biopsies, although the possibility of asymmetry should be considered.

Ganglioside GM1 (porcine) ameliorates paclitaxel-induced neuropathy in rats.

BACKGROUND: Paclitaxel, an anti-neoplastic agent effective against several solid tumors, has several side effects including peripheral neuropathy. So far, there are no effective treatments for this complication. Monosialic acid ganglioside (GM1) has been shown to protect neurons against injuries and degeneration. However, its efficacy in the treatment of paclitaxel-induced neuropathy has not been verified. OBJECTIVE: To evaluate the effect of porcine GM1 on neurophysiological abnormalities in rats receiving paclitaxel. MATERIAL AND METHOD: Fifty-four Wistar rats were divided into control, vehicle for paclitaxel (Cremophor EL), paclitaxel, and paclitaxel + GM1 groups. Paclitaxel 16 mg/kg/week for five consecutive weeks was given intraperitoneally. Treatment with 30 mg/kg 5 days per week of GM1 was started 3 days prior to the first dose and continued until 3 days after the last dose of paclitaxel. Tail and hind paw thermal thresholds including tail motor nerve conduction velocity (MNCV) were measured prior to and after the start of treatments. Histopathology of the sciatic nerve was also examined. RESULTS: Paclitaxel alone induced thermal hypoalgesia and reduced tail MNCV Less severe abnormalities were also found with the vehicle. GM1 appeared to prevent the development of hypoalgesia and ameliorated the decreased MNCV without any evidence of Guillain-Barre Syndrome. Mild endoneurial edema and axonal degeneration in the sciatic nerve sections were seen in paclitaxel treated rats. Microtubule accumulation and activated Schwann cell were also presented in the paclitaxel treated groups. CONCLUSION: These data suggest that porcine GM1 may be useful in the prevention and treatment of paclitaxel-induced neuropathy. However the adverse effect of Cremophor EL should be of concern.

Anatomy of the lateral femoral cutaneous nerve related to inguinal ligament, adjacent bony landmarks, and femoral artery.

Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty-five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy.

Anatomy of the superficial peroneal nerve related to the harvesting for nerve graft.

The superficial peroneal nerve (SPN) is one of the two main branches of the common peroneal nerve, which become cutaneous nerve on the lateral side of distal leg and dorsum of foot. The use of SPN as nerve graft has been introduced; however, important data regarding the morphometric anatomy of this nerve and its branches, medial and intermediate dorsal cutaneous nerves (MDN and IDN, respectively) to support this application remain incomplete. Eighty-five legs of cadavers were dissected and the branching pattern was classified into Type 1 (penetration of the main trunk of SPN from the deep fascia) or Type 2 (separate penetration of the MDN and IDN). The length of SPN, MDN and IDN from the penetration points until before subsequent branching was measured. In addition, the penetration points were located by referring to the intermalleolar line and the lateral malleolus. Type 1 was found in the majority of specimens independent of gender (71.8%). Asymmetry in the branching pattern was observed in nine cases (20.9%). The average length of the SPN, MDN and IDN without branches was 7.7, 8.1 and 5.5 cm, respectively. The penetration points of the SPN, MDN and IDN were located 5.1, 7.6 and 5.5 cm above the intermalleolar line, respectively. These data are important for using the SPN as a graft.

Anatomic characteristics and surgical implications of the superficial radial nerve.

BACKGROUND: Superficial radial nerve (SRN) that lies superficially on the radial side of the distalforearm and dorsum of the hand, can be injured by various procedures. Thus, precise knowledge in its variation is crucial. OBJECTIVE: Since there were no such data in Thai population, provide the variation data of the SRN in Thai cadavers. This is likely to be more accurate when applied in Thailand. MATERIAL AND METHOD: The authors studied the branching pattern and the course of SRN in 40 Thai cadavers. RESULTS: The extra type, replacement of SR3 by a branch of the lateral antebrachial cutaneous nerve, was found (4.7%) and the incidences of other patterns were different from those of previous reports. Moreover; asymmetry and gender difference were also demonstrated. The authors observed the higher frequencies of the SRN lying over the snuff box and first dorsal compartment of the wrist compared to other reports. The distances to important landmarks were measured and the presented data were comparable to those of other studies with no significant differences between sides or genders. CONCLUSION: These findings suggest that the different variations of the SRN among various races should be concerned during the relevant procedures.

Surgical anatomy of fissures and foramina in the orbits of Thai adults.

BACKGROUND: The anatomy of orbital foramina appears to vary depending on the population studied Moreover; different data between sides and genders have been reported. OBJECTIVE: The present study was done to provide the morphometric data of the orbitalforamina related to side and gender in Thai subjects. MATERIAL AND METHOD: One hundred orbits from 50 adult dried skulls were used. Gender of each skull was identified and the distances from the constant landmarks to the foramina in the medial, superior; inferior and lateral walls were measured. RESULTS: In the medial wall, the mean distances from the anterior lacrimal crest to the optic canal (OC), anterior, and posterior ethmoidalforamina were 42.2, 23.5, and 36. 0 mm for both sides and genders, respectively. The average distances from the supraorbital notch/foramen in the roof to the superior orbital fissure (SOF), OC, and lacrimal foramen were 44.7, 40.0, and 33.6 mm, respectively. In the inferior wall, the distances from the infraorbital rim to the OC, inferior orbital fissure (IOF), and the posterior edge of roof of the infraorbital canal were 46.2, 21.7, and 12.3 mm, respectively. The distances from the frontozygomatic suture to the OC, SOF, IOF and LF were 46.9, 34.5, 24.0, and 27.2 mm, respectively. When compared to those of the previous reports, several considerable differences that may be of clinical importance were observed. Moreover, some distances were significantly different between sides or genders. CONCLUSION: The present results suggest that race, side, and gender should be concerned during the orbital surgery and the data are good references for Thai subjects.

Accuracy of the three-window sampling method in morphometric analysis of human sural nerve.

Morphometry has an important role in the assessment of sural nerve biopsies as a part of early detection of structural abnormalities in peripheral nerve. Various sampling methods have been used to reduce time and effort needed in the analysis of total nerve fibers but their accuracy remains controversial. We examined the accuracy of three-window sampling method in the morphometric evaluation of human sural nerve biopsies by comparing with the total fiber quantification. Three windows (0.012 mm(2) each) were placed in every possible fascicle in the sections and data from all windows were pooled and analyzed for the number of myelinated axons, myelinated fiber diameter, axon diameter, myelin thickness, g ratio as well as myelinated fiber density. Means and ranges of the data from the two techniques were similar and the agreement was further confirmed by intraclass correlation analysis. These findings indicate that the three-window sampling method can be used to evaluate human sural nerve with accuracy.