Anatomic variability of the nerves of the triceps surae in early human fetuses

Background. Establishing fetal anatomical variability of intramuscular nerves and their connections plays an important role in the search for and development of new methods for the diagnostic and treatment posterior region of the leg. Objective – to find out the topographic and anatomical features of the innervation of the triceps surae in human fetuses 4-6 months. Methods. The study was performed on 46 human fetuses 81.0-230.0 mm crown-rump length (CRL) length using macromicroscopic preparation, vascular injection, and morphometry. Results. In early human fetuses, the anatomical variability of the distribution of intramuscular nerves in the thickness of the triceps surae was established, which is due to the variability of the structure and topography of the tibial nerve, structural and functional organization of triceps surae, arterial branching and interneural connections in the thickness of the heads of the gastrocnemius and soleus in fetuses of different and the same age groups, and sometimes in the same fetus. Conclusion. The main source of innervation of the triceps surae is the tibial nerve, which can be presented by a single trunk, main and additional trunks, or several independent trunks. The nerves in the thickness of the triceps are unevenly distributed. The highest concentration of muscular branches of the tibial nerve is determined in the medial head of the gastrocnemius and the medial part of the soleus. Information on fetal topography of intramuscular nerves in the thickness of the right and left triceps surae, as well as forms of their anatomical variability, both in fetuses of different and the same age and sometimes in the same fetus, due to structural-functional organization of the components of the triceps surae, the type of branching of arteries and nerves in the thickness of the heads of the gastrocnemius and soleus. Atypical variants of the topography of the tibial nerve and common fibular nerve in early fetuses, as well as interneural connections in the thickness of the components of the triceps surae, are more common on the right lower leg.

Macro-Microscopic Features of the Leg Muscles Innervation

The purpose of the study was to disclose topographic anatomical features of the extra- and intramuscular innervation points of the leg. Materials and methods. 15 adult human subjects and one-month old baby legs at three levels were studied using such methods: cross-sections according to N.I. Pirogov technique, histotopographic sections, macro-microscopic method, histological staining with hematoxylin-eosin and Krutsay. Results. In our macro-microscopic study, the main attention was paid to the individual anatomical variability in the innervation of the lower leg muscles. Study of the nerves of the leg muscles allowed to clarify the course of the neurovascular bundle of the leg at its three levels, taking into account individual age characteristics, and also to show the myeloarchitectonics of both the main nerve trunks and their intramuscular branches. Such differences in the location of the leg muscles of an adult and of one month-old baby undoubtedly related to the fact that the child’s muscular belly is longer in relation to the tendon. The histotopography of intramuscular nerves on total transverse sections of antagonistic muscles was studied: flexor and extensor digitorum longus, longus flexor and extensor of the big toe, and also the spectrum of myelin fibers contained in these nerves in a one-month-old baby and an adult was investigated. On histotopographic sections of the extensor digitorum longus nerve in a one-month-old baby, thick-diameter myelin fibers are absent, whereas in the long finger flexor nerve, on average, they are 0.5%. The number of thin and medium is respectively 8%, 13% and 83.5%, 16%. However, we have determined individual anatomical variability in the location of the vessels in relation to the main nerve trunks, as well as differences in the topography of the nerve in the corresponding muscles. Conclusion. In the nerves of the leg muscles, features were found, both in quantitative and qualitative composition of the conductors forming them; in the nerves of the flexor muscles, the composition of the nerve fibers is more diverse (with a slight predominance of the number of medium, thick and very thick fibers), which is associated with the peculiarity of their functions; in adulthood, the % ratio in the spectrum of myelin fibers in the nerves of the lower leg changes significantly

Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler’s method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5–15%, 25–35%, 45–55%, and 70–80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15–20%, 35–40%, 55–60%, and 90–100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections.

Neuromuscular Damage and Repair after Dry Needling in Mice

Objective. Some dry needling treatments involve repetitive and rapid needle insertions into myofascial trigger points. This type of treatment causes muscle injury and can also damage nerve fibers. The aim of this study is to determine the injury caused by 15 repetitive punctures in the muscle and the intramuscular nerves in healthy mouse muscle and its ulterior regeneration.Methods. We repeatedly needled thelevator auris longusmuscle of mice, and then the muscles were processed with immunohistochemistry, methylene blue, and electron microscopy techniques.Results. Three hours after the dry needling procedure, the muscle fibers showed some signs of an inflammatory response, which progressed to greater intensity 24 hours after the procedure. Some inflammatory cells could still be seen when the muscle regeneration was almost complete seven days after the treatment. One day after the treatment, some changes in the distribution of receptors could be observed in the denervated postsynaptic component. Reinnervation was complete by the third day after the dry needling procedure. We also saw very fine axonal branches reinnervating all the postsynaptic components and some residual sprouts the same day.Conclusion. Repeated dry needling punctures in muscle do not perturb the different stages of muscle regeneration and reinnervation.