Repercussões clínicas da anastomose de Martin‐Gruber: estudo anatômico

Abstract

ObjectiveThe main objective of this study was to describe Martin‐Gruber anastomosis anatomically and to recognize its clinical repercussions. Method100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. ResultsNerve communication between the median and ulnar nerves in the forearm (Martin‐Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: Type 1: anastomosis between the anterior interosseous nerve and the ulnar nerve (n=9); Type 2: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n=2); Type 3: anastomosis between the median nerve and the ulnar nerve (n=4); Type 4: anastomosis between branches of the median nerve and ulnar nerve heading towards the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n=5); Type 5: intramuscular anastomosis (n=5); and Type 6: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n=2). ConclusionKnowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.