scholarly journals Modern Views on the Clinical Anatomy of the Medial Cutaneous Nerve of Arm and the Prospects for its Use in Reconstructive Surgery

2021 ◽  
Vol 10 (1) ◽  
pp. 77-84
Author(s):  
N. S. Gorbunov ◽  
M. E. Gorban ◽  
K. V. Kober ◽  
Yu. V. Zinenko
Keyword(s):  
Brachial Plexus ◽  
Reconstructive Surgery ◽  
Skin Flap ◽  
Pain Syndrome ◽  
Cutaneous Nerve ◽  
Clinical Anatomy ◽  
Neuropathic Pain Syndrome ◽  
Surgical Interventions ◽  
Areola Complex ◽  
Subcutaneous Layer

In the modern aspect, the relevance of damage to the medial cutaneous nerve of the arm during surgical interventions in the axilla and brachial region is displayed. Due to the superficial location in the subcutaneous layer, the nerve is most often subject to accidental damage, including in brachioplasty, axillary lymphodissection, breast cancer surgeries and breast augmentation. The material on variant anatomy, macroscopic structure and topography of the nerve is presented. The medial cutaneous nerve of the arm is formed from the medial cord of the brachial plexus, in some cases - from the posterior cord; isolated cases of the absence of the nerve are described. When exiting the axilla at arm level, the nerve penetrates into the deep brachial fascia, passes in the subcutaneous layer medially from the basilic vein of the arm and provides sensitive innervation to the skin of the medial surface of the arm, the skin of the medial epicondyle and the olecranon of the ulna. The medial cutaneous nerve of the arm has an average of 7-8 cutaneous branches, which are characterized by significant variability in the location under the skin. The significance of the medial cutaneous nerve of the arm in clinical practice, namely, in surgical interventions in the arm region, the development of neuropathic pain syndrome, brachial plexus blockages and the diagnosis of nerve damage, medial cord and inferior trunk of the brachial plexus. This review summarizes recent data, which allow to form a more complete picture of the clinical anatomy of the medial cutaneous nerve of arm and the possibilities of its use in reconstructive surgery. An especially relevant area is the possibility of using a medial skin flap of the arm with directed innervation by the medial cutaneous nerve of the arm for reconstruction and restoration of the sensitivity of the nipple-areola complex.

scholarly journals Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications

2018 ◽  
Vol 7 (11) ◽  
pp. 457 ◽  
Author(s):  
Ke-Vin Chang ◽  
Kamal Mezian ◽  
Ondřej Naňka ◽  
Wei-Ting Wu ◽  
Yueh-Ming Lou ◽  
...  
Keyword(s):  
Pain Syndrome ◽  
Cutaneous Nerve ◽  
Clinical Implications ◽  
Neuropathic Pain Syndrome ◽  
Femoral Cutaneous Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Ultrasound Technology ◽  
Subcutaneous Layer ◽  
Entrapment Syndromes

Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.

Efficacy and Safety of Two-Level Block of Brachial Plexus in Surgeries on Proximal Upper Extremity

2013 ◽  
Vol 20 (3) ◽  
pp. 65-68
Author(s):  
V. B Dubinenkov ◽  
P. A Lyuboshevskiy ◽  
S. V Larionov ◽  
M. S Zvorygina ◽  
N. A Koryshkov
Keyword(s):  
Brachial Plexus ◽  
Upper Extremity ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Control Group ◽  
Surgical Interventions ◽  
Study Results ◽  
Intercostobrachial Nerve

Study results for 71 patients (mean age 58.3±3.4 years) who were operated on for the injury of shoulder joint, upper and middle humerus are presented. Surgical intervention was performed under regional anesthesia. Block of superficial cervical plexus and intercostobrachial nerve was applied in all cases. Additionally in the main group (n=37) two-level block of brachial plexus (BBP): interscalene blockade in complex with supraclavicular one was used, in control group (n=34) — one-level block, i.e. either interscalene or supraclavicular was performed. Pain syndrome was assessed by visual analogue scale. It was shown that in surgical interventions on proximal upper extremity two-level BBP provided higher quality of anesthetic effect and postoperative analgesia, enabled to decrease the expenditure of opioid analgesics within the first postoperative day and, hence, the risk of related side effects development. Number of complications was not significantly different between the two groups.

Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Lower Extremities ◽  
Pain Syndrome ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Type I ◽  
Sixth Edition ◽  
Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

Facial reconstructive surgery after tumour removal in a guinea pig (Cavia porcellus)

2021 ◽  
Vol 26 (1) ◽  
pp. 1-4
Author(s):  
Anna Linda Nógrádi ◽  
Judit Kojer ◽  
Dóra Csatári ◽  
Iain Cope ◽  
Tibor Németh
Keyword(s):  
Guinea Pig ◽  
Reconstructive Surgery ◽  
Skin Flap ◽  
Advancement Flap ◽  
Cavia Porcellus ◽  
Post Surgery ◽  
Tumour Removal ◽  
Nerve Sheath ◽  
Peripheral Nerve Sheath Tumour ◽  
Made In

A 2-year-old male guinea pig (Cavia porcellus) presented with a pea-sized swelling on his right labium. The tumour was excised and reconstructive surgery was performed using a single pedicle advancement flap, leaving the bottom of the lip intact on account of it being essential for food apprehension and manipulation. Two parallel skin incisions were made in the rostrocaudal direction for almost half the length of the head and the resulting skin flap was carefully undermined, to avoid damaging the follicles and the muscles of the whiskers. The flap was carefully sutured over the excisional defect and at 1.5 months post-surgery, only a small residual scar remains. The lips are intact, the surgical site is covered with fur and many of the whiskers have regrown. Histopathology showed the excised mass to be a grade 1 soft tissue sarcoma, most likely a malignant peripheral nerve sheath tumour.

Neuropathic pain syndrome as an occult manifestation of injury of the spinal cord after surgical repair of aortic coarctation

2000 ◽  
Vol 10 (4) ◽  
pp. 413-415 ◽  
Author(s):  
Luc M Beauchesne ◽  
Angela Mailis ◽  
Gary D Webb
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Rare Complication ◽  
Pain Syndrome ◽  
Neuropathic Pain Syndrome ◽  
Cord Injury ◽  
Unusual Symptoms ◽  
Arterial Branch

AbstractInjury to the spinal cord injury with paraplegia, is a rare complication of surgical repair of aortic coarctation recognized immediately post-operatively. We present the case of a 41-year-old male undergoing surgery for restenosis at the site of a repair. Intra-operatively, he suffered inadvertent injury to an intercostal arterial branch during isolation of the aorta below the graft. Over the following months, he developed unusual symptoms involving the legs and genitourinary tract which, only after extensive investigations, were attributed to ischemic damage to the spinal cord related to the surgery. We suspect that similar syndromes reflecting injury to the spinal cord injury may be unrecognized following surgical repair of coarctation.

Development of the Paranasal Sinuses in Children: Implications for Paranasal Sinus Surgery

1993 ◽  
Vol 102 (9) ◽  
pp. 705-711 ◽  
Author(s):  
Gerald Wolf ◽  
Wolfgang Anderhuber ◽  
Frederick Kuhn
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Age Groups ◽  
Clinical Importance ◽  
Sinus Surgery ◽  
Clinical Anatomy ◽  
Surgical Interventions ◽  
Stage Of Development ◽  
Paranasal Sinus Surgery

The pediatric nasal cavity and paranasal sinuses, when compared to those in adults, differ not only in size but also in proportion. Knowledge of the unique anatomy and pneumatization of children's sinuses is an important prerequisite to understanding the pathogenesis of sinusitis and its complications. It is also important in evaluation of radiographs and in planning surgical interventions. In order to study the development of the paranasal sinuses in children and relate clinical anatomy to sinus surgery, the sinuses in 102 pediatric skulls and cadaver heads were measured. The results were classified by stage of development into 4 different age groups: newborn and 1 to 4, 4 to 8, and 8 to 12 years. The characteristics of each group and their clinical importance for paranasal sinus surgery are described.

Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position

2021 ◽  
Vol 14 (11) ◽  
pp. e243408
Author(s):  
Anna Katrina Hay ◽  
Anna McDougall ◽  
Peter Hinstridge ◽  
Sanjeev Rajakuldendran ◽  
Wai Yoong
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Rare Complication ◽  
Patient Positioning ◽  
Sensory Innervation ◽  
Plexus Brachialis ◽  
Clinical Anatomy ◽  
Reduction Strategies ◽  
Risk Reduction Strategies ◽  
Endometriosis Surgery

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient’s quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.

First experience with chronic epidural spinal cord stimulation in Khanty-Mansi autonomous okrug — clinical observations

2021 ◽  
Vol LIII (2) ◽  
pp. 94-100
Author(s):  
Olga A. Bondarenko ◽  
Gaspar V. Gavrilov ◽  
Vadim A. Padurets ◽  
Roman V. Kasich
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Chronic Neuropathic Pain ◽  
Neuropathic Pain Syndrome ◽  
Epidural Stimulation ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation ◽  
And Migration

Purpose of the work. The article is devoted to the first experience of epidural stimulation in the Khanty-Mansiysk Autonomous Okrug at the budgetary institution Surgut Clinical Trauma Hospital. Clinical examples are presented for two main indications for the application of this technique (disease of the operated spine, a consequence of spinal cord injury in combination with chronic neuropathic pain syndrome). Research methods. An assessment of the intensity of pain syndrome was given according to a visual analogue scale, the Pain Detect questionnaire; indicators of anxiety, depression on the HADS scale; quality of life according to the Oswestry questionnaire for a follow-up period of 6-12 months in patients with chronic epidural stimulation. Results. A positive assessment of the action during test neurostimulation was 63.3% (38 patients). Of the established permanent systems, a good result was achieved and persisted for 12 months or more in 96% (24 patients). It was necessary to change the stimulation parameters in 13% (3 patients). Revision of permanent systems was performed in 20% (5 patients), due to the progression of the degenerative-dystrophic process of the spine, damage and migration of system elements. Conclusions. Chronic epidural spinal cord stimulation has established itself as a personalized, highly effective, minimally invasive and safe method of treating chronic neuropathic pain syndromes. Multicomponent corrective action is of scientific interest and requires further study.

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