Experimental Study On Intramuscular Innervation Of Some Muscular Flaps And Muscles In Calf

Objective①To observe and measure the morphous and starting point of the commonly used muscle flaps in clinical (abductor hallucis muscle, latissimus dorsi muscle, gracilis muscles, pectoralis minor muscle, rectus abdominis and sartorius muscle) and the calf muscle, clarify the origin of the muscle , measure the point where the nerve entry, determine how to divide the muscle into several part.②To observe the trip and the distribution of the nerve after entering the muscle, and divide the muscle into several parts on the basis of the result of Sihler's intramuscular nerve staining.③To classify the muscles into several group according to the result of gross anatomy and Sihler's intramuscular nerve staining.④To discuss whether the commonly used muscle flaps and the calf muscles could be divide into several parts which making up the deficiency of the basic anatomy and provide anatomy evidence for transplanting one part of the muscle in clinical.Methods1,Gross anatomy methodMuscles were separated from 15 adult cadavers'calfs which were fixed in 10% formaldehyde for half a year (including commonly used muscle flaps in clinic of 8 cadavers). In this process, observe the morphous of the muscles, the direction of the muscle bundles, which nerves and how many nerve branches dominate the muscles; measure the length and the starting point of the muscles, the point in which the nerve branches enter the muscles (take the fibular head plane as the zero plane ); cut the muscles in the sagittal and horizontal section, observe the distribution of the intramuscular tendon.2,Staining method of intramuscular nerve Test object are 92 pieces of calf muscles and 24 pieces of clinical commonly used muscle flaps which were dissected from fresh adult cadavers, including extramuscular nerve stem. Modified Sihler's technique was adopted. Through fixing, maceration and depigmentation, decalcification, staining, destaining, neutralization, clearing, the muscles become transparent and the intramuscular nerves were dyed amethyst. We can observe the distribution of the intramuscular nerves.3,Method of categorize musclesAccording to Lim's method that categorized the upper limb muscles and the results of the gross anatomy and intramuscular nerve staining, we divided the muscles into several types.Results1,Results of gross anatomy Through the gross anatomy study of calfs and clinical common used muscular flaps, we discover that some muscles can be divided into several parts. These muscles are flat muscle (popliteus, pectoralis minor, latissimus dorsi), bipennate (peroneus longus, soleus muscle, some of flexor digitorum longus),complex muscle (gastrocnemius), ring-pennate (tibialis anterior, tibialis posterior) and multi-abdominal muscle (rectus abdominis)2,Results of intramuscular nerve stainingAfter Sihler's staining, the muscle presents a transparent or translucent form, shape integrity. The intramuscular nerve branches are dyed into hyacinthine and can be seen clearly. There are many muscles that can be split into several parts for transplant, for example, gastrocnemius, soleus, tibialis anterior, tibialis posterior and peroneus longus.①Abductor hallucis can be divided into anterior, medius, posterior part.②Latissimus dorsi can be divided into 3～4 parts.③Gracilis can be divided into superior, medius, inferior part.④We can take one of the muscle belly of rectus abdominis as transplant donate.⑤pectoralis minor can be divided into superior and inferior part.⑥We can take the medial or the lateral part of the sartorius for transplantation.3,Results of muscle integrated classification Muscle classification table4,The distribution rule of the intramuscular nerve①If the nerve enter the muscle at the origin of the muscle, and the direction is paralleled with the long axis of the muscle, it will extend along with the muscle (extensor pollicis longus, atissimus dorsi).②If the nerve enters distal to the origin of the muscle, a proximal recurrent branch is given to supply the proximal part of the belly (gracilis, sartorius).③If the nerve enter the muscle in the middle of it, and vertical to the long axis of muscle, the nerve will send out the left, right and front branchs,and then divide the muscle into three compartments.Conclusion①It is very important to the clinical medicine that study the calf muscles and the clinical commonly used muscles in the gross anatomy and the enter point of the nerve branches. It will give a guidance to the clinical medicine in how to avoid injuring nerves during muscle transplantation and how to split muscles into several compartment for transplantation. ②It is an ideal method to study the intramuscular nerve that combine Sihler's technique with gross anatomy.③We can classify the skeletal muscle according to the result of the gross anatomy and intramuscular nerve staining. All the muscles except unipennate can be compartmently transplant.④There are rules for the distribution of the nerve branches in the muscles.