Microanatomy And Histological Study Of Recovery Of Function Of Intrinsic Muscle Of Hand Using The Intrinsic Muscle Of Foot

BackgroundThe hand is the evolutional product mankind.The function of intrinsic muscle of hand is the key point of function of upper limb and the opposition and digital opposition of thumb,the flection of metacarpophalangeal joint and the straighten of interphalangeal joint are the main composition of the function of intrinsic muscle of hand.Through the efforts of many scholar in about 100 years,the flexion and extend of shoulder,elbow and wrist joints have been achieved big progress relating to the recovery of brachial plexus injury,however,the functional recovery of intrinsic muscle of hand have not been resolved at present..The active and practice hand have not been reconstructed for the patient whose brachial plexus injury through the complicated operation that need long-term and multiple efforts.Our presumption is to select the suitable representative object and transplant to the hand after the nerve fiber of donator have been reached the wrist.In this way,it can avoid the muscle tissue cataplasia because of out of neurotrophy long time and recover the function of hand.So we plan to select the proper intrinsic muscle of foot to replace the atrophy intrinsic muscle of hand and recover the partial function of intrinsic muscle of hang.The key point of nerve recovery is to provid the correct path way for the regenerated axon and gain recontrol for the effector organ.The selected nerve transposition is the one of effective methods to treat the brachial plexus root avulsion at present.The key point of the successful operation is how to correct select nerve branch matching each other.To use the intrinsic muscle of foot to recover the function of intrinsic muscle of hand that suffering the brachial plexus injury,we must understand in detail the anatomy and histologic feature of intrinsic muscle of foot.So this paper using the Chinese adult cadaver and utilizing microanatomy and histochemistry slice method have studied the anatomy and histologic feature of three group intrinsic muscle of foot.We combining the anatomy and histologic feature of intrinsic muscle of hand have researched the probability of operation in order to find the more suitable transplantation donator to replace the muscle of thenar.We hope to guide the functional recovery treatment of intrinsic muscle of hand because of the clinical brachial plexus injury and provide the practice and needed data of anatomy and histology for the functional recovery of intrinsic muscle of hand that suffering the brachial plexus root avulsed wound.ObjectivesWe studied the anatomy of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis and to find the suitable transplantation vicarious muscle for the transplantation of intrinsic muscle of hand.To provide morphologic data of nerve anastomose of transplantation of intrinsic muscle of hand,we studied the histological feature of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis.Materials and methodsWe studied the anatomy of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis and their blood supply and nerve dominant using 36 Chinese adult lower limb specimen(male,26 sides;female 10 sides)that have been fixed by formalin and perfused using red emulsion and assisted by operating microscope.Using 6 fresh cadaver specimen(adult,male),we separated the nerve tract branch of three group intrinsic muscle of foot.According to the above-mentioned methods labeled and segmented the nerve tract,after labeling the aspect using Chinese ink we draw the materials from the middle point and the separated point.We obtained the sectional slice(section thickness,7μm,Loyez myelin staining)after fixed by formalin and using regular paraffin imbedding. Quantitative analysis of histological slice was processed using image analysis system: the density of myelinated fiber of each branch and nervous section,section area of nerve fiber and section area of nerve trunk was measured respectively.The number of myelinated fiber and the ratio of nerve fiber and connective tissue was calculated respectively.ResultsThe flexor digitorum brevis and halluces and extensor digitorum brevis are bipennate muscle and sibling the strength construction as well as the intrinsic muscle of hand.The long,width and thickness of flexor digitorum-brevis,halluces and extensor digitorum brevis are the same with the measurements of intrinsic muscle of hand.So the flexor digitorum brevis,halluces and extensor digitorum brevis are suitable to recover the intrinsic muscle of hand as the donator.The length,width,thickness of flexor digitorum brevis,abductor hallucis, halluces and extensor digitorum brevis is 8.82±0.59cm,2.75±0.17cm,1.49±0.12cm; 11.92±1.11cm,2.86±0.21cm,1.75±0.17cm;8.55±0.80cm,4.22±0.38cm, 0.85±0.15cm respectively.Statistical treatment:there is no significant deviation between the length of halluces and extensor digitorum brevis and flexor digitorum brevis.The length of abductor hallucis is more than the length of halluces and extensor digitorum brevis and flexor digitorum brevis.The width of halluces and extensor digitorum brevis is lesser than extensor digitorum brevis and abductor hallucis.The flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis has the independence and relative permanent blood supply respectively and the blood vessels are easy to seek.The length and caliber of blood vessel stem can be satisfy the need to anastomosis with the peripheral blood vessel of wrist and guarantee the blood transportation and living of the transplanted object.The caliber of artery of flexor digitorum brevis,medial plantar artery and the maximum liberation length is 0.76±0.17mm,1.25±0.19mm and 4.66±0.96mm respectively.The caliber of artery of halluces and extensor digitorum brevis,dorsal artery of foot and the maximum liberation length is 0.65±0.11mm,1.30±0.22mm and 2.01±0.68mm respectively.The caliber of artery of abductor hallucis,medial plantar artery and the maximum liberation length is 0.82±0.12mm,1.16±0.15mm and 6.13±1.13mm respectively.The flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis has the independence and relative permanent innervation respectively and has the different length that can be liberated respectively.If select the thenar muscular branch of median nerve or the deep branch of ulnar nerve as the anastomosis object, the nervous section area and nerve fiber density of the muscular branch of halluces and extensor digitorum brevis have obviously dominance.If selecting the separate point of nerve tract as the site to anastomose,the probability of the functional recovery of nerve is maximum.The left and right diameter and anteroposterior diameter of the middle point nerve tract of flexor digitorum brevis and the maximum liberation point of nerve is 1.58±0.28mm,0.81±0.20mm and 0.66±0.22mm,1.42±0.21mm respectively.The natural liberation length and the maxmum liberation length is 2.07±0.20cm, 3.90±0.23cm respectively.The left and right diameter and anteroposterior diameter of the middle point nerve tract of c and the liberation point of nerve is 1.08±0.21mm,0.35±0.09mm and 0.95±0.22mm,0.32±0.08mm respectively.The natural liberation length and the maxmum liberation length is 2.61±0.47em,5.20±0.62cm respectively.The left and right diameter and anteroposterior diameter of the middle point nerve tract of abductor hallucis and the liberation point of nerve is 1.50±0.17mm, 1.04±0.20mm and 1.23±0.19mm,0.83±0.15mm respectively.The natural liberation length and the maxmum liberation length is 4.96±0.74cm,8.16±1.09cm respectively.Statistical treatment:there is no significant deviation of the section area of middle point of nerve tract between the abductor hallucis and flexor digitorum brevis. The section area of flexor digitorum brevis is lesser than the section area of flexor digitorum brevis and abductor hallucis.There is no significant deviation of the section area of the liberation point of nerve tract between the abductor hallucis and flexor digitorum brevis.The section area of the liberation point of nerve of halluces and extensor digitorum brevis is lesser than the section area of flexor digitorum brevis andc.The liberation length of abductor hallucis is bigger than the liberation length of halluces and extensor digitorum brevis and flexor digitorum brevis.There is no significant deviation of the section area of middle point of nerve tract between flexor digitorum brevis and abductor hallucis.The section area of middle point of nerve tract of flexor digitorum brevis is lesser than that of flexor digitorum brevis and abductor hallucis.Showing the myelinated fiber of different site of three group intrinsic muscle of foot using Loyez myelin staining.The medullary sheath of myelinated fiber was to show light blue,axon no stained and the peripheral connective tissue of nerve fiber showing light grey that was easy to identify on the nerve section of different sit of nerve tract of flexor digitorum brevis,abductor hallucis,halluces and extensor digitorum brevis using myelin staining.The section area of middle point and separated point of muscular branch of three group intrinsic muscles of foot,section area of nerve tract and the number of myelinated fiber can be measured through micro-image analysis system.These histological index can provide reference data for clinical operational design of recovering function of intrinsic muscle of hand that suffering brachial plexus injury and to estimate the prognosis.The counting of myelinated fiber of nerve tract of flexor digitorum brevis, halluces and extensor digitorum brevis and abductor hallucisThe section area of nerve branch at different site of three group intrinsic muscles of foot is to show:the area of middle point and separated point of flexor digitorum brevis is 5.65±0.62 mm~2 and 3.98±0.35 mm~2 respectively.The area of middle point and separated point of halluces and extensor digitorum brevis is 2.05±0.19 mm~2 and 1.54±0.24 mm~2 respectively.The area of middle point and separated point of abductor hallucis is 5.83±0.36 mm~2 and 3.61±0.24 mm~2 respectively.The section area of nerve tract of three group intrinsic muscles of foot at different site is to show:the area of middle point and separated point of flexor digitorum brevis is 3.63±0.42 mm~2 and 2.71±0.44 mm~2 respectively.The area of middle point and separated point of halluces and extensor digitorum brevis is 1.58±0.20mm~2 and 1.19±0.13mm~2 respectively.The area of middle point and separated point of abductor halIucis is 4.04±0.25mm~2 and 3.14±0.19mm~2 respectively.The quantity of myelinated fiber of three group intrinsic muscles of foot at different site are showing:the quantity of middle point and separated point of flexor digitorum brevis is 745.33±97.57 roots and 826.17±62.41 roots respectively.The quantity of middle point and separated point of halluces and extensor digitorum brevis is 505.33±34.02 roots and 550.00±56.97 roots respectively.The quantity of middle point and separated point of abductor hallucis is 936.83±90.34 roots and 1064.33±141.24 roots respectively.Statistical treatment:the quantity of nerve fiber of separated point of halluces and extensor digitorum brevis is lesser than that of flexor digitorum brevis and abductor hallucis.When the proximal nerve fiber is insufficient,the transplantation of halluces and extensor digitorum brevis has the more probability to gain the useful reinnervation.There is no significant deviation between the quantity of myelinated fiber at the middle point of flexor digitorum brevis and that of abductor hallucis and between the quantity of myelinated fiber at the separated point of flexor digitorum brevis and that of abductor hallucis.There is significant deviation between the quantity of myelinated fiber at the middle point and the separated point of halluces and extensor digitorum brevis.The quantity of myelinated fiber at the separated point is bigger than that of the middle point of nerve tract of halluces and extensor digitorum brevis.There is significant deviation between the section area of nerve tract at the middle point and that of separated point in three group intrinsic muscles of foot.The section area of nerve tract at the middle point is bigger than that of separated point in three group intrinsic muscles of foot.The section area of nerve at middle point of halluces and extensor digitorum brevis is lesser than that of extensor digitorum brevis and that of abductor hallucis.The section area of nerve at separated point of halluces and extensor digitorum brevis is lesser that of extensor digitorum brevis and that of abductor hallucis.There is significant deviation between the density of nerve fiber at the middle point and that of separated point in the three group intrinsic muscles of foot.The density of nerve fiber at the middle point of nerve tract is lesser than that separated point in three group intrinsic muscles of foot respectively.The density of nerve fiber at the middle point ofhalluces and extensor digitorum brevis is bigger than that of extensor digitorum brevis and that of abductor hallucis.The density of nerve fiber at the separated point ofhalluces and extensor digitorum brevis is bigger than that of extensor digitorum brevis and that of abductor hallucis.ConclusionsAccording to the anatomic finding,if selecting the thenar muscular branch of median nerve and the deep branch of ulnar nerve as the anastomose object to recover the function of muscle of thenar,the halluces and extensor digitorum brevis has the obviously dominance relating to the hitologic feature,the volume and the anastomose aspect of nervous branch.According to the histological finding,if selecting the thenar muscular branch of median nerve and the deep branch of ulnar nerve as the anastomose object to recover the function of muscle of thenar,the halluces and extensor digitorum brevis has the obviously dominance relating to the section area of nerve tract,the quantity of nerve fiber and the density of nerve fiber.In order to raise the availability of nerve fiber,the motor tract branch at the wrist should be selected as the nerve donator of intrinsic muscles of foot.The cutting point of neural stalk should be selected at the separated point and the succeeding rate is bigger using the branch of nerve tract to anastomose with the branch of thenar muscles.In order to recover the muscle strength level reaching 3-4 grade of the transplanted intrinsic muscles of foot,we selected the separated point of nerve tract of intrinsic muscles of foot as the afiastomose site as example.The quantity of nerve fiber passing through the anastomose aperture at least need:660.94 strips(extensor digitorum brevis),440 strips(halluces and extensor digitorum brevis),851.46 strips(abductor hallucis).This paper selecting the clinical demand relating to the function of intrinsic muscles of hand does not recover after the brachial plexus injury and select the intrinsic muscle of foot and their nerve tract group as the researching object at the first time.This paper selecting selectivity tissue displacement to recover the function of intrinsic muscles of hand as the researching aim,taking the development results of microsurgical technology to the functional recovery of intrinsic muscles of hand that suffering from the brachial plexus injury.According to the histological and anatomic finding of part intrinsic muscles of foot and their neurovascular features,researched the probability of using transplantation of intrinsic muscles of foot having neurovascular stem to recover the function of intrinsic muscles of hand.These results will to provide practice and sciential data for the design of operational plan.