Superior Gluteal Research Articles

Effect of age and muscle type on regeneration of neuromuscular synapses in mice

A silver stain was used to investigate the regeneration of nerve terminals in mouse diaphragm, superior gluteus and tensor fasciae latae (TFL) muscles following nerve crush injury at different ages (9–530 days). The development of myelinated terminal branches and the development and elimination of terminal sprouts were little affected by age or muscle type following reinnervation. However, multiple axonal innervation developed on up to 50% of the gluteus and TFL muscle fibres, and this was subsequently eliminated only in the youngest animals.

Microvascular Free Transfer of Iliac Bone Based on the Deep Superior Branches of the Superior Gluteal Vessels

The findings from dissection, injection studies, corrosion specimens, and angiograms in 300 specimens of the iliogluteal region taken from 150 cadavers are reported. These findings suggest that the deep superior branches of the superior gluteal vessels may serve a nutritive pedicle in microvascular free transfer of iliac bone. Therefore, the operative technique has been developed and applied clinically with good results. The selection of different vessels as a nutritive pedicle for the free transfer of iliac bone is discussed.

Breast Reconstruction by Superior Gluteal Microvascular Free Flaps without Silicone Implants

The author's experience with 10 gluteus maximus myodermal free flap breast reconstructions is reviewed against the current methods of reconstruction using silicone implants, latissimus dorsi flaps, regional skin flaps, and rectus abdominis myodermal flaps. The superior gluteal free flap can achieve a reliable, permanent, and aesthetic reconstruction of the breast without silicone implants. The softness, projection, natural appearance, and patient satisfaction are excellent compared with other methods. It is particularly useful in patients who object to the use of artificial implants, are not suitable for regional flaps, or have disappointing results from previous reconstructions. Technical modifications of the flap design and selection of the recipient vessels are important.

Breast Reconstruction by Superior Gluteal Microvascular Free Flaps without Silicone Implants

Breast Reconstruction by Superior Gluteal Microvascular Free Flaps without Silicone Implants

The absence of nodal sprouts from partially denervated nerve trunks

Nodal sprouts were absent from partially denervated, silver-stained, mouse superior gluteal (SG) nerves examined between 4 and 20 days after partial denervation. Nodal sprouts were also absent from electron micrographs of partially denervated SG nerves. We conclude that an earlier report describing profuse nodal sprouting in partially denervated nerve trunks mistakenly identified fine Schwann cell processes as nodal sprouts.

The sequential development of nodal sprouts in mouse muscles in response to nerve degeneration.

Nodal sprouting in response to axonal degeneration was studied in silver-stained, wholemount preparations of the thin, sheet-like mouse muscles tensor faciae latae (TFL) and the inferior and superior gluteus maximus. Axon degeneration in TFL and gluteus was produced by cutting the L14 spinal nerve (partial denervation). Axon degeneration in the gluteus was also produced by superior gluteal and TFL nerve section (hemidenervation). Two days after partial or hemidenervation motor nerve nodal sprouts begin to appear in the intramuscular nerves. Sprout growth is rapid, since only a small percentage of sprouts are ever seen not to terminate at endplates. Sprouts continue to appear for at least three weeks after partial denervation, when there are up to five times as many endplates innervated by sprouts as by remaining intact axons. Sprouts arise at nodes near the denervated endplates, which they innervate by growing directly down the degenerating nerve. Sprout initiation proceeds sequentially in partly and hemidenervated muscles, since the average length of sprouts contacting endplates increases with time. Analysis of silver-stained muscles by combined light and electron microscopy shows that this sequential development is unlikely to be a consequence of slow growth and maturation of submicroscopic sprouts initiated nonsequentially throughout the intramuscular nerves. The observations are consistent with a nodal sprouting mechanism which requires a cellular or structural change in the denervated Schwann cell pathway to spread disto-proximally from the terminal ends of the nerves and thereby to permit the growth of nodal sprouts. The initiation of sprout growth may require a diffusible substance from degenerating nerve or denervated muscle.

Pelvic vascular bed isolation in the management of radioresistant pelvic cancer

The term “pelvic vascular bed isolation” is given to our newly described type of cancer chemotherapy. The tissues underlying the bilateral vaginal mucosa are clamped for 4–6 hr. The hypogastric, superior gluteal, inferior gluteal, internal pudendal, obturator and ovarian arteries and veins are all ligated. MMC solution ranging from 50 to 80 mg is given into the hypogastric arteries. Pelvic isolation seldom caused prohibitive complications because the lumbar artery served as a collateral shunt by making its own way into the median sacral artery. We reported here controlling recurrent cervical cancer for about one and a half year in one case, and panhysterectomized radioresistant pelvic cancer for at least 3 mo in two cases with this type of cancer chemotherapy. Clinical benefit to these patients was also great.

Accessory sacroiliac articulations with arthritic changes.

An interesting condition of some clinical importance has been demonstrated on the posterior surface of the sacrum. Accessory articulations between the ilium and sacrum may occur, and in certain cases show well advanced arthritic changes. One or two such joints may appear on either or both sides. Anatomy of the Sacroiliac Joint The sacrum is normally formed by the fused elements of five primary vertebral segments. The alae, in front, originate from the costal elements. Posteriorly, the transverse processes join to form the crests which are lateral to the posterior sacral foramina. The ear-shaped, cartilage-covered, articular surfaces arise from the anterior portions of the first two segments. These correspond to the alae of the sacrum. There is a sacral tuberosity above and behind the articular surface on either side. That portion of the innominate bone posterior to the iliac fossa faces toward the sacrum. About one-third of this medially directed surface—the so-called auricular surface, occupying the anterior inferior portion—articulates with the sacrum. The posterior superior two-thirds, the tuberosity of the ilium, does not normally articulate with the sacrum. The bone here is roughened and connected to the sacral tuberosity by the posterior sacroiliac ligaments. The sacroiliac joint is stated to be a diarthrosis capable of some minimal gliding and rotary movements. It may or may not possess a joint cavity with a synovial lining. Its nerve supply originates from the superior gluteal, the sacral plexus, and the posterior divisions of the first and second sacral nerves. The Accessory Sacroiliac Joints Various anatomists have described accessory sacroiliac joints. Most commonly these occur between the medial surface of the posterior superior iliac spine and the rudimentary transverse tuberosity just lateral to the second posterior sacral foramen. Normally the posterior superior iliac spine is 3 to 6 mm. from the posterior surface of the sacrum. When an accessory articulation is formed, the plane of the joint forms an angle with the plane of the normal sacroiliac articulation. By such an imperfect mechanical structure two bones articulate at two separate surfaces, the planes of which are angulated. Less frequently an accessory articulation may develop between the tuberosity of the ilium and the sacral tuberosity, opposite the first posterior sacral foramen. At these points articular facets form. These are covered by hyalin or fibrocartilage and appear as true diarthroidial joints 1 or 2 cm. in diameter. A small foramen between this joint and the true sacroiliac articulation furnishes passage for nutrient blood vessels. Trotter quotes the incidence of accessory sacroiliac joints as reported by different authors. The figure varied from 36 per cent in her own series of 958 pelves, down to that of Derry, 10.4 per cent in 192 skeletons.