Major Nerve Research Articles

Peripheral nerve injury arising in anaesthesia practice.

In this article, we will discuss the pathophysiology of peripheral nerve injury in anaesthetic practice, including factors which increase the susceptibility of nerves to damage. We will describe a practical and evidence-based approach to the management of suspected peripheral nerve injury and will go on to discuss major nerve injury patterns relating to intra-operative positioning and to peripheral nerve blockade. We will review the evidence surrounding particular strategies to reduce the incidence of peripheral nerve injury during nerve blockade, including nerve localisation methods, timing of blocks, needle techniques and design, injection pressure-monitoring and local anaesthetic and adjunct choice.

Penetrating neck trauma

Penetrating neck traumas are traumas that pass through the platysma muscle, and they account for 5% to 10% of all neck traumas. Penetrating head traumas can damage vital structures such as the airways, esophagus, major nerves and vessels. Thus, patients with penetrating neck traumas should be treated in hospital, and doctors should be careful when deciding on the best treatment. Currently, the need for surgery can be established based on imaging tests, clinical status of the patient, medical history, physical examination, and laboratory tests. Exploratory surgery is not necessary particularly because it is associated with complications. We present two patients with penetrating neck traumas who were treated in our center: a 22-year-old patient with a foreign body that, for two years, mimicked a tumor, and a 45-year-old patient with a stab wound requiring immediate treatment. In the first patient, finding the foreign body earlier would have allowed an immediate removal, which would have prevented subsequent surgery and reduced the risks of leaving the foreign body in the neck. In the second patient, immediate contrast-enhanced computed tomography (CT) of the neck showed a foreign body, its size and position, which helped to plan surgery. Conclusions: In hemodynamically stable patients with penetrating neck traumas, doctors should choose the best treatment based on imaging, medical history, and physical examination.

A double-helix and cross-patterned solenoid used as a wirelessly powered receiver for medical implants

Many medical implants need to be designed in the shape of a cylinder (rod), a cuboid or a capsule in order to adapt to a specific site within the human body or facilitate the implantation procedure. In order to wirelessly power these types of implants, a pair of coils, one is located inside the human body and one is outside, is often used. Since most organs such as major muscles, blood vessels, and nerve bundles are anatomically parallel to the body surface, the most desired wireless power transfer (WPT) direction is from the external power transmission pad (a planar coil) to the lateral surface of the implant. However, to obtain optimal coupling, the currently used solenoid coil requires being positioned perpendicular to the body surface, which is often medically or anatomically unacceptable. In this research, a concentric double-helix (DH) coil with an air core is presented for use in implantable devices. Two helical coils are tilted at opposite angles (±45 degrees) to form a cross pattern. The WPT system is designed using the magnetic resonance concept for wireless power transfer (MR-WPT). The power transfer efficiency (PTE) relies on the near-field magnetic coupling which is closely related to the location and orientation of the DH coil. We explain how the novel structure of the DH solenoid magnifies the mutual inductance with the widely adopted circular planner coil and how the PTE is improved in comparison to the case of the conventional solenoid coil. We also study an important case where the double-helix power reception coil is laterally and angularly misaligned with the transmitter. Finally, our computational study using the finite element method and experimental study with actually constructed prototypes are presented which have proven our new double-helix coil design.

Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): study protocol for a randomised controlled pilot study

BackgroundPain after major lower limb amputation for peripheral arterial disease (PAD) is a significant problem. A perineural catheter (PNC) can be placed adjacent to the major nerve at the time of amputation with a continuous local anaesthetic infusion given postoperatively to try and reduce pain. Although low-quality observational data suggest that PNC usage reduces postoperative opioid requirements, there are limited data regarding its effect on pain. The aim of PLACEMENT is to explore the feasibility of running an effectiveness trial to assess the impact of a PNC with continuous local anaesthetic infusion, inserted at the time of amputation, on short and medium-term postoperative outcomes.Methods/designFifty patients undergoing a major lower limb amputation (below or above the knee) for PAD will be recruited from two centres. Patients will be randomised in a 1:1 ratio to receive standard postoperative analgesia, with or without insertion of a PNC and local anaesthetic infusion for the first 5 postoperative days. Outcome data will be captured for the first 5 days, including pain scores (primary outcome, captured three times a day), opioid use, nausea or vomiting, itching, dizziness and complications. Patients will be contacted 2 and 6 months after surgery to assess quality of life, phantom limb pain, chronic stump pain and total healthcare costs. Semi-structured interviews will be conducted with at least 10 patients (dependent on saturation of analytic themes on preliminary coding) purposefully sampled to achieve variation in site and study arm. Interviews will explore patients’ perception of post-amputation pain and its treatment, and experience of study processes. Semi-structured interviews with 5–10 health professionals will explore feasibility, fidelity, and acceptability of the study. Data from this pilot will be used to assess feasibility of, and estimate parameters to calculate the sample size for an effectiveness trial. Full ethical approval has been granted (Wales Research Ethics Committee 3 reference number 16/WA/0353).DiscussionPLACEMENT will be the first study to explore the feasibility of running an effectiveness trial on PNC usage for postoperative pain in amputees, and provide parameters to calculate the appropriate sample size for this study.Trial registrationISRCTN.com, ISRCTN85710690. Registered on 21 October 2016.European Clinical Trials Database (EudraCT), 2016-003544-37. Registered on 24 August 2016.

Nerves in the cavernous tissue of the glans penis: An immunohistochemical study using elderly donated cadavers

IntroductionThe topographical anatomy of the composite nerve fibers in the human glans penis is poorly characterized. Therefore, histological methods were used to analyze nerves to the cavernous tissue at the distal end of the corpus spongiosum. MethodsImmunohistochemical techniques were used to detect S100, neuronal nitric oxide synthase, tyrosine hydroxylase, and vasoactive intestinal polypeptide protein expressions in frontal or sagittal penile sections obtained from 20 donated, older male cadavers. ResultsAt or near the coronal sulcus at the dorsal midline, three to seven terminal branches of the unilateral dorsal nerve ran deeply or centrally along the distal dull end of the corpus cavernosum and entered the glans cavernous tissue. Once there, the nerve divided into thinner branches (neuronal nitric oxide synthase or tyrosine hydroxylase positive) and the major nerve section reached the surface skin of the glans. Several thin nerves took highly arduous paths, as evidenced in ventral subcutaneous tissue of the distal third of the penis. DiscussionHistological examination revealed a neurovascular bundle that penetrated the glans cavernous tissue toward the skin covering, with a rich nerve supply to the skin folds at and near the coronal sulcus.

Bruch's membrane opening minimum rim width : Correlation and diagnostic accuracy in comparison to peripapillary retinal nerve fiber layer thickness

Glaucoma is one of the main causes of blindness in the Western hemisphere. Because the disease often painlessly progresses it remains unnoticed until major optic nerve head damage occurs in many cases. That is why new, more sensitive diagnostic methods are needed. Bruch's membrane opening minimum rim width (BMO-MRW), measured with the new glaucoma module premium edition (GMPE) was recently introduced as amore accurate tool to detect glaucomatous changes. The purpose of this study was to assess the correlation of SPECTRALIS® spectral domain optical coherence tomography (SD-OCT) and the GMPE anatomic positioning module (APS module) for retinal nerve fiber layer thickness (RNFLT) measurements. The second aim was to assess the diagnostic accuracy of BMO-MRW. Prospective study of 41eyes (41patients) with glaucoma and 26eyes from 26healthy controls. Scans were obtained using SPECTRALIS® SD-OCT and RNFLT was measured with both modules and compared using Spearman's rank test. The BMO-MRW was assessed by GMPE. Sensitivity, specificity and area under receiver operating characteristics curves (AUROC) of each sector of the optic nerve were calculated and compared using the method of Delong etal. We found apositive correlation (0.694-0.955, p< 0.0001) between RNFLT measurements by standard SD-OCT and all diameters of RNFLT of APS module within all sectors. The AUROC of RNFLT in standard SD-OCT was 0.693 for the inferior nasal sector (NI) and BMO-MRW was 0.85 inNI. The difference in AUROC was statistically significant (p= 0.0049). No other sector showed statistically significant differences. The RNFLT measurements of both modules showed apositive correlation and appear to be comparable. The BMO-MRW in one sector (NI) showed a significantly higher accuracy of measurement than standard RNFLT. All other sectors showed a comparable accuracy of measurement.

Recommendations to Reduce Risk of Nerve Injury During Bernese Periacetabular Osteotomy (PAO).

The Bernese periacetabular osteotomy (PAO) is a widely used procedure to reorient a dysplastic acetabulum resulting from developmental dysplasia of the hip, retroversion, protrusio, or some deformities with a traumatic etiology. Throughout the execution, the lateral femoral cutaneous nerve (LFCN) as well as the obturator, femoral, and sciatic nerves can be injured. Injury to 1 of the 3 major nerves is a devastating event for the patient followed by an ill-defined period of hope for nerve recovery and fear of lifelong disability. Surgical experience is an essential factor in reducing the prevalence of nerve injury, whereas proof of the value of intraoperative fluoroscopy and nerve monitoring still must be established. Although it is known that, for example, the ischial cuts of the complex osteotomy place the sciatic nerve at risk, the action causing the nerve injury is rarely clear in the individual situation. The literature has been mostly limited to reports of incidence and offers little analytic information. Through the use of cadaveric dissections, we visualized the possible impacts of the different steps of the procedure on the nerves in their anatomic vicinity, and the present report demonstrates how nerves can be protected with retractor positioning and how lower-limb positioning can lead to nerve relaxation, an important means to avoid mechanical injury. While the frequent injuries of the LFCN are exclusively related to the approach, sciatic nerve injuries are mainly the result of the ischial osteotomy steps and femoral nerve injuries are seen nearly exclusively with the correction of the acetabular fragment. The authors implemented the demonstrated measures for 9 years, during which approximately 800 periacetabular osteotomies resulted in a total of 2 femoral and 2 sciatic nerve lesions-or a nerve injury rate of 0.5%. The nerves injuries resolved within 6 to 9 months in 3 hips, and 1 patient had a definitive foot drop requiring a splint at the time of writing.

Endoscopic Sciatic Nerve Decompression After Fracture or Reconstructive Surgery of the Acetabulum in Comparison With Endoscopic Treatments in Idiopathic Deep Gluteal Syndrome.

The purpose of this study was to assess the endoscopic findings of the sciatic nerve and clinical outcomes of major traumatic sciatic nerve neuropathies after fracture or reconstructive surgery of the acetabulum with idiopathic deep gluteal syndrome (DGS) groups. Retrospective review of patient reports. Level I trauma center of a tertiary university hospital. The study included 70 patients who consecutively underwent endoscopic sciatic nerve decompression. Patients who had previous fractures or reconstructive surgeries of the acetabulum were categorized as the major trauma group, whereas those without major trauma were categorized as the idiopathic group (45 patients) after a minimum of 24-months of follow-up period. The results were evaluated using the modified Harris Hip Score (mHHS), Hip outcome, and 12-Item Short Form Health Survey scores, respectively. In the major trauma group, all patients with sensory symptoms showed some degree of relief after the endoscopic sciatic nerve release. None of the patients with complete foot drop demonstrated complete improvement. Three patients with motor weakness without foot drop showed complete improvement in motor function. The mean mHHS increased from 61.5 ± 13.4 to 84.1 ± 8.1 (P = 0.031). In the idiopathic DGS group, the mean mHHS increased from 73.8 ± 10.3 to 94.4 ± 5.3 (P = 0.003). The Benson outcomes rating in the major trauma group was statistically lower than that in the idiopathic DGS group. Endoscopic release of the sciatic nerve after fractures or reconstructive surgeries could provide some improvements without complications. However, more favorable outcomes were observed in the idiopathic DGS group.

The spectrum of Charcot-Marie-Tooth disease due to myelin protein zero: An electrodiagnostic, nerve ultrasound and histological study

ObjectiveNerve ultrasound (US) data on myelin protein zero (MPZ)-related Charcot-Marie-Tooth disease (CMT) are lacking. To offer a comprehensive perspective on MPZ-related CMTs, we combined nerve US with clinics, electrodiagnosis and histopathology. MethodsWe recruited 36 patients (12 MPZ mutations), and correlated nerve US to clinical, electrodiagnostic measures, and sural nerve biopsy. ResultsAccording to motor nerve conduction velocity (MNCV) criteria, nine patients were categorized as “demyelinating” CMT1B, 17 as “axonal” CMT2I/J, and 10 as dominant “intermediate” CMTDID. Sural nerve biopsy showed hypertrophic de-remyelinating neuropathy with numerous complex onion bulbs in one patient, de-remyelinating neuropathy with scanty/absent onion bulbs in three, axonal neuropathy in two, mixed demyelinating-axonal neuropathy in five. Electrodiagnosis significantly differed in CMT1B vs. CMT2I/J and CMTDID subgroups. CMT1B had slightly enlarged nerve cross sectional area (CSA) especially at proximal upper-limb (UL) sites. CSA was negatively correlated to UL MNCV and not increased at entrapment sites. Major sural nerve pathological patterns were uncorrelated to UL nerve US and MNCV. ConclusionsSural nerve biopsy confirmed the wide pathological spectrum of MPZ-CMT. UL nerve US identified two major patterns corresponding to the CMT1B and CMT2I/J-CMTDID subgroups. SignificanceNerve US phenotype of MPZ-CMT diverged from those in other demyelinating peripheral neuropathies and may have diagnostic value.

Application of electromyography combined with magnetic resonance imaging in the diagnosis of brachial plexus injury in newborns

Objective To investigate the characteristics of electromyography(EMG) and MRI in the diagnosis of brachial plexus injury in newborns. Methods First, the EMG examination was conducted in 30 newborns with brachial plexus injury, where the brachial plexus of the five major nerve conduction and muscle EMG activity were measured.Second, the brachial plexus MRI was conducted to compare with the first examination. Results EMG revealed that 25 cases of upper and middle trunk palsy(83.3%), 4 cases of total plexus palsy(13.3%) and 1 case of lower trunk palsy(3.3%) in the 30 cases, as well as 6 cases of plexus pre-ganglionic injury(20.0%), 7 cases of complete injury(23.3%), 23 cases of incomplete injury(76.7%). MRI showed that 5 cases of upper and middle trunk palsy(16.7%), 1 case of total plexus palsy(3.3%), 1 case of lower trunk palsy(3.3%), and 7 cases of plexus pre-ganglionic injury(23.3%)in the whole 30 cases. Conclusion EMG and MRI are both helpful to localize the brachial plexus injury.But EMG performs better compared with MRI towards the slight incomplete injury.Therefore, the combination of both methods can provide an accurate guidance for diagnosis. Key words: Newborn; Brachial plexus injury; Electromyography; Magnetic resonance imaging

Ultrasonography of the Sural Nerve: Normal and Pathologic Appearances.

Ultrasonography (US) of peripheral nerves has gained wide popularity because of the increased definition of modern high-frequency electronic transducers, as well as the well-known advantages of US, which include easy availability, low cost, and the possibility of realizing a dynamic examination. Traditionally, US has been deployed to assess the major nerves of the limbs. More recently, US has also been used to assess the normal appearance and pathologic changes of smaller subcutaneous nerves. The sural nerve is a small sensory nerve in the subcutaneous tissues of the calf that can be affected by a variety of disorders. This pictorial essay illustrates the normal anatomy of the sural nerve, the technique for its examination by US, as well as the US appearance of its main pathologic changes.

Ganglionic and non-ganglionic neurons in frog heart: do they differ?

This study was designed to compare the morphology of neurons in relation to their distance from the major nerve trunks in the heart of the frog Rana temporaria. Seventy-nine intracardiac neurons were labelled intracellularly with fluorescent markers Lucifer Yellow CH and Alexa Fluor 568. The neurons located on the extensions of the vagus nerve were considered as ganglionic, while neurons spread loosely at further distance from these extensions were considered as non-ganglionic. The mean area of the soma in ganglionic neurons was about 25% larger than in non-ganglionic neurons. Ganglionic neurons had a higher soma area/nucleus area ratio than non-ganglionic neurons. Although both the total number and the total length of dendrite-like processes was similar between the two groups, ganglionic neurons had significantly fewer dendrite-like processes from the soma (1.5±0.3 vs. 3.9±1.0; P&lt;0.05) and shorter total length of these processes from the soma (63±18 μm vs. 178±51 μm; P&lt;0.05). In conclusion, ganglionic and non-ganglionic frog intracardiac neurons exhibit substantial morphological differences. We hypothesize that these differences may indicate different projections or variations in the number of their preganglionic inputs.

Axonal components of nerves innervating the human arm.

Axons traveling within the brachial plexus are responsible for the dexterous control of human arm and hand movements. Despite comprehensive knowledge on the topographical anatomy of nerves innervating the human upper limbs, the definite quantity of sensory and motor axons within this neural network remains elusive. Our aim was to perform a quantitative analysis of the axonal components of human upper limb nerves based on highly specific molecular features from spinal cord level to the terminal nerves at wrist level. Nerve specimen harvest at predefined harvesting sites (plexus roots and cords as well as major nerves originating from the brachial plexus innervating the arm and hand) was performed in 9 human heart-beating organ donors. Double immunofluorescence staining using antibodies against choline-acetyltransferase and neurofilament was performed to differentiate motor and sensory axons on nerve cross sections. Three hundred fifty thousand axons emerge from the spinal cord to innervate the human upper limb, of which 10% are motor neurons. In all nerves studied, sensory axons outnumber motor axons by a ratio of at least 9:1. The sensory axon contribution increases when moving distally, whereas only 1,700 motor axons reach the hand to innervate the intrinsic musculature. Our results suggest that upper limb motor execution, and particularly dexterous coordination of hand movement, require an unexpectedly low number of motor neurons, with a large convergence of afferent input for feedback control. Ann Neurol 2017;82:396-408.

Cell Replacement Therapy for Optic Nerve Disorders

This review article explains major optic nerve disorders and cell replacement therapy. This article also signifies new innovative methods, biopharmaceuticals, implantable biomaterials, devices and diagnostic tools developed for restoration of vision. It asserts notable technological advancements made for regeneration of neurons and restoration of visual system network. However, for finding quick solutions of optical- neuronal disorders more advanced biomaterial cell scaffolds and concurrent efforts are needed to revitalize visual-neural receptor system. This article stresses upon novel bioengineered methods mainly required to activate endogenous stem and progenitor cells, which could reawaken cells in dormancy, instructing them to promote repair and regeneration in optic nerve cells and retina. For better management of optic nerve disorders, the important role of tissues, genes, growth factors and proteins, nanomedicine and nanotechnology, and all underlying mechanisms should fully be investigated. This article tries to explore all possibilities to find quick solutions for treatment of loss of vision/ photoreceptors and degeneration of optic neural network despite all ongoing challenges. Moreover, for solving visual disorders, neurodegenerative blinding diseases novel cell-based therapeutic strategies are to be developed with future applications in regenerative medicine.

Neuroanatomy of the Pig Cardiac Ventricles. A Stereomicroscopic, Confocal and Electron Microscope Study.

Although the pig is a model for heart disease, the neuroanatomy of cardiac ventricles (CV) in this species remains undetailed. We aimed to define the innervation pattern of pig CV, combining histochemistry for acetylcholinesterase, immunofluorescent labeling and electron microscopy. Forty nine examined pig hearts show that the major nerves supplying the ventral side of CV descend from the venous part of the heart hilum. Fewer in number and smaller in size, epicardial nerves supply the dorsal half of the CV. Epicardial nerves on the left ventricle are thicker than those on the right. Ventricular ganglia of various sizes distribute at the basal level of both CV. Averagely, we found 3,848 ventricular neuronal somata per heart. The majority of somata were cholinergic, although ganglionic cells of different neurochemical phenotypes (positive for nNOS, ChAT/nNOS, or ChAT/TH) were also observed. Large and most numerous nerves proceeded within the epicardium. Most of endocardium and myocardium contained a network of nerve bundles and nerve fibers (NFs). But, a large number of thin nerves extended along the bundle of His and its branches. The majority of NFs were adrenergic, while cholinergic NFs were scarce yet more abundant than nitrergic ones. Sensory NFs positive for CGRP were the second most abundant phenotype after adrenergic NFs in all layers of the ventricular wall. Electron microscopy elucidated that ultrastructure of nerves varied between different areas of CV. The described structural organization of CV provides an anatomical basis for further functional and pathophysiological studies in the pig heart. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1756-1780, 2017. © 2017 Wiley Periodicals, Inc.

Abstract 3728: Imaging biomarkers of aromatase-inhibitor induced joint pain

Abstract Estrogen receptor positive (ER+) breast cancer patients undergoing treatment with aromatase inhibitors (AI) tend to discontinue the supplement when to painful side effects appear. It is believed that women with AI-induced musculoskeletal syndrome (AIMSS) have specific physiological conditions that differentiate them from women with normal aging-related inflammatory processes (e.g., rheumatoid arthritis or RA). Ultrasound shear wave elastography (USWE) provides a real-time, quantitative assessment of the elastic modulus of soft tissue, which is a potential biomarker that is altered in women with AIMSS. Because USWE is a completely noninvasive technique available on state-of-the-art clinical ultrasound scanners, it can be readily applied to study patients who undergo AI treatment and help predict adverse effects during therapy. A Siemens s3000 clinical scanner and 9 MHz linear probe were used for USWE of the hands and wrists in postmenopausal women on AI, postmenopausal women with RA and healthy postmenopausal women. The scans included an evaluation of major wrist tendons, nerve, and joints with shear wave velocities ranging from 0.5 to 15 m/s, which are directly related to the local shear modulus – an absolute measure of tissue stiffness. The ultrasound images and raw shear wave data were then analyzed in MATLAB-TM using a custom graphical user interface (GUI) to calculate the distribution of velocities (or shear moduli) in a user-defined region of interest (ROI). The results were exported to a spreadsheet in Excel for further analysis and comparison among the different groups. Initial results suggest the shear wave velocity and estimated Young’s modulus (λ) were significantly higher in AI patients (14.6 ± 0.2 m/s, λ=642 ± 17 kPa) compared to RA (6.84 ± 1.1 m/s, λ=143 ± 43 kPa) and healthy (7.58 ± 0.9 m/s, λ=174 ± 42 kPa) patients. These values suggest that the mechanical properties of tendons in the wrist may change during treatment with AI and contribute to joint pain in these subjects. It is critical that ER+ patients on AI complete their full treatment. As a potential biomarker of AIMSS and associated pain, USWE may help predict which patients are most susceptible to these side effects, promote early intervention to reduce or eliminate symptoms, and help increase adherence to AI therapy. Citation Format: Brian A. Goldstein, Mihra Taljanovic, Pavani Chalasani, C. Kent Kwoh, Amanda Hadden, Russell Witte, Jessica Martinez. Imaging biomarkers of aromatase-inhibitor induced joint pain [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3728. doi:10.1158/1538-7445.AM2017-3728

Clinial application of free posterlateral leg perforator flap in the reconstruction of soft tissue defects at oral and maxillofacial region

Objective To investigate the outcome of free posterolateral leg perforator flap in the reconstruction of soft tissue defects of oral and maxillofacial area. Methods From February, 2014 to August, 2016, 16 patients were performed defect reconstruction following oral cancer ablation with free posterolateral leg perforator flap including 3 cases of sequamous cell carcinoma of the tongue, 6 cases of carcinoma of the buccal mucosa, 7 cases of sequamouse cell carcinoma of the floor of mouth. The flap ranged from 5.0 cm×3.0 cm to 13.0 cm ×9.0 cm in size, and were adjected to the soft tissue defects of oral and maxillofacial area. The outcome of reconstruction was evaluated by considering the facial appearance, the swallowing and the speach function, the ranges of mouth opening and patient prognosis. Results All 15 transplanted flaps survived well and only 1 survived after disposing in time, because of vascular crisis. The donor sites were closed directly without donor-site morbidity. All patients were satisfactory with their facial appearance, the ranges of mouth opening and swallowing and speech function. Conclusion The free posterolateral leg perforator was an ideal free tissue for repairing functionally oral and maxillofacial defects, sinceit including some beneficial characteristic such as constant blood vessel, flexible and divese design, abundant and position-latent donor site tissues, small operation loss, flexible preparation and loss of major vascular nerves. Key words: Oral cancer; Tissue defects of oral and maxillofacial; Posterolateral leg perforator flap; Rconstruction

Periprostatic innervation: New issues based on segmental analysis of 10 human cadaver pelvic blocs.

The exact paths of periprostatic nerves have been under debate over the last decades. In the present study, the topographic distribution of nerves around the prostate and their relative distances from the prostatic capsule were analyzed in male cadaver visceral blocs. The pelvic organs from ten fresh male cadavers were removed and serial sectioned en bloc for histological investigation. The macroslices was divided into four sectors. Each sector was centrally covered with a raster dividing each sector in three subsectors numbered clockwise. The prostatic capsule was identified, and distances of 2.5 and 5 mm from the prostate were demarked with lines. We quantified the number of nerve fibers present in each subsector of each slide and recorded their position relative to the prostatic capsule. In general, the topographic analysis revealed that the majority of nerves were identified in sectors 4 through 9, corresponding to the posterolateral and posterior surfaces of the prostate gland. At the prostate base, the majority of nerves were found at the posterolateral and posterior surfaces of the gland. Within the mid-region of the prostate, the same topographic distribution pattern was observed, but the nerve fibers were closer to the prostatic capsule. At the apical region, the percentage of nerve fibers identified in the anterior region was higher, despite their major concetration in the posterior surface. The nerves identified at the apex were mainly located up to 2.5 mm from the prostate. This proximity to the prostate was specifically observed in the anterolateral and anterior sectors. In the craniocaudal sense, the percentage of nerves identified between 2.5 and 5 mm from the prostatic capsule remained constant. A significant number of nerve fibers were present in the anterior and anterolateral positions, especially at the apex. The anterior nerves were closer to the prostate. This proximity suggests that the anterior nerves may participate in local physiology and that the cavernous nerves are probably formed by the posterior nerve fibers. It is likely that the safe distance of 2.5 mm from all surfaces of the prostate may be related to cavernous fiber preservation.

Quantitative sonographic parameters of the peripheral nerves in healthy individuals

Introduction. Ultrasonography allows non-invasive scanning of the peripheral nerves to record quantitative and qualitative parameters. Objective. To determine the normal cross-sectional area (CSA) of the nerves in arms and legs, as well as spinal nerves in healthy volunteers. Materials and methods. Bilateral ultrasonography of the peripheral nerves in arms and legs, as well as the spinal nerves in the brachial plexus was carried out in healthy volunteers: 40 males and 40 females with the mean age of 40.3±15.1 (range, 18–70 years). A Sonoscape S20 ultrasound scanner (China) with an 8–15 MHz linear sensor. The cross-sectional area of the peripheral nerves was assessed. Height, weight, the body mass index (BMI), age, and gender were included in analysis. Results. The reference CSA values for the major nerves of arms, legs, and spinal nerves of the brachial plexus were obtained. No reliable correlation of the main anthropometric parameters (height, weight, and BMI) as well as age and gender with the CSA of the peripheral nerves and the brachial plexus was found. Conclusions. The findings are in accordance with the measured parameters reported by other authors, indicating that our methodological approach to nerve ultrasonography is similar to those used in other laboratories.

Anastomosis of dorsal branch of the proper digital nerve dorsal distal interphalangeal joint perforator flap to repair finger tip defect of skin tissue

Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect, and at the same time, the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction. Methods From September 2012 to March 2015, 78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai, all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde, transferred to repair the skin defect of finger end, and anastomosis of dorsal branch of the proper digital nerve reconstruction. Results Postoperative vascular crisis occurred in 8 cases, 2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived, the wounds healed in I stage, and the donor site healed in I stage.All the 73 cases were followed up, the follow-up period ranged from 3.0 to 12.0 months, an average of (7.8±2.5) months.The postoperative appearance and feel good, soft texture, abrasion resistance, no tenderness, cold resistance, dynamic two-point recovered to 4.0-8.0 mm, average (5.3±0.9) mm.Static two-point discrimination was 4.0-9.0 mm, average (5.8±1.2) mm.The method of TAM was used to determine the function of the 67 fingers, good for the 7 finger, but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%. Conclusion The operation without sacrifice of major arteries and nerves by finger, the middle finger dorsal skin for non functional surface area, and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction, without surgery two times, is one of the ideal surgical repair of skin defect of the finger end. Key words: Dorsal branch of digital artery; Perforator flap; Skin defect of finger end; Refers to the inherent nerve