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João Goyri-o’neill - One of the best experts on this subject based on the ideXlab platform.
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A rare variant of the ulnar artery with important clinical implications: a case report
BMC Research Notes, 2012Co-Authors: Diogo Casal, Diogo Pais, Tiago Toscano, Tiago Bilhim, Luís Rodrigues, Inês Figueiredo, Sónia Aradio, Maria Angélica-almeida, João Goyri-o’neillAbstract:Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the Brachial artery, pierced the Brachial Fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the anteBrachial Fascia. It then dipped into the forearm Fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.
R. De Caro - One of the best experts on this subject based on the ideXlab platform.
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Anatomical study of myoFascial continuity in the anterior region of the upper limb.
Journal of Bodywork and Movement Therapies, 2009Co-Authors: Antonio Stecco, Carla Stecco, Veronica Macchi, Andrea Porzionato, Vincent Delmas, Julie Ann Day, R. De CaroAbstract:Fifteen unembalmed cadavers were dissected in order to study the "anatomical continuity" between the various muscles involved in the movement of flexion of the upper limb. This study demonstrated the existence of specific myoFascial expansions, with a nearly constant pattern, which originate from the flexor muscles and extend to the overlying Fascia. The clavicular part of the pectoralis major sends a myoFascial expansion, with a mean length of 3.6cm, to the anterior region of the Brachial Fascia, and the costal part sends one to the medial region of the Brachial Fascia (mean length: 6.8cm). The biceps brachii presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7cm and a base of 1.9cm, and a second, less evident, longitudinal expansion (mean length: 4.5cm, mean width: 0.7cm). Lastly, the palmaris longus sends an expansion to the Fascia overlying the thenar muscles (mean length: 1.6cm, mean width: 0.5cm). During flexion, as these muscles contract, the anterior portion of the Brachial and anteBrachial Fascia is subject to tension. As the Fascia is rich in proprioceptive nerve endings, it is hypothesized that this tension activates a specific pattern of receptors, contributing to perception of motor direction. If the muscular Fascia is in a non-physiological state, these mechanisms are altered, and the proprioceptors in the Fascia may be incorrectly activated, thus giving rise to many types of extra-articular pain.
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The expansions of the pectoral girdle muscles onto the Brachial Fascia: morphological aspects and spatial disposition.
Cells Tissues Organs, 2008Co-Authors: Carla Stecco, Veronica Macchi, Andrea Porzionato, Roberto Aldegheri, Vincent Delmas, Antonio Stecco, E. Vigato, Anna Parenti, R. De CaroAbstract:Background/Aims: The aim of this study was to analyse the relationships between the expansions of the pectoral girdle muscles, i.e. pectoralis major, latissimus dorsi and deltoid, a
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Anatomy of the deep Fascia of the upper limb. Second part: study of innervation
Morphologie, 2007Co-Authors: Carla Stecco, O. Gagey, Veronica Macchi, Andrea Porzionato, R. De Caro, Roberto Aldegheri, Anna S. Belloni, Assunta Pozzuoli, Vincent DelmasAbstract:Abstract Analysis of specimens taken from different areas of the deep Fascia in 20 upper limbs was made in order to establish which kind of nerve fibres and endings are present in the deep muscular Fascia. The flexor retinaculum and the lacertus fibrosus were also evaluated because they are anatomically hardly separable from the deep muscular Fascia, although they have different functions. In particular, specimens were taken at the level of: (a) the expansion of pectoralis major onto the bicipital Fascia, (b) the middle third of the Brachial Fascia, (c) the lacertus fibrosus, (d) the middle third of the anteBrachial Fascia, (e) the flexor retinaculum. This study demonstrated an abundant innervation of the Fascia consisting in both free nerve endings and encapsulated receptors, in particular, Ruffini and Pacini corpuscles. However, differences in innervation were verified: the flexor retinaculum was resulted the more innervated element whilst lacertus fibrosus and the pectoralis major expansion the less innervated. These results suggest that the retinaculum has more a perceptive function whereas the tendinous expansions onto the Fascia have mostly a mechanical role in the transmission of tension. The hypothesis that the Fascia plays an important role in proprioception, especially dynamic proprioception, is therefore advanced. In fact, the Fascia is a membrane that extends throughout the whole body and numerous muscular expansions maintain it in a basal tension. During a muscular contraction these expansions could also transmit the effect of the stretch to a specific area of the Fascia, stimulating the proprioceptors in that area.
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Tendinous muscular insertions onto the deep Fascia of the upper limb. First part: anatomical study.
Morphologie, 2007Co-Authors: Carla Stecco, O. Gagey, Veronica Macchi, Andrea Porzionato, R. De Caro, Roberto Aldegheri, Vincent DelmasAbstract:We examined 30 upper limbs in order to study the tendinous muscular insertions into the deep Fascia and to verify whether they have a specific anatomical arrangement and to measure their resilience to traction. We have found that the Fascia receives many tendinous muscular insertions, which are always present and exhibit a constant anatomical structure. In particular, the pectoralis major Fascia always continues with the Brachial Fascia in two distinct ways: the Fascia overlying the clavicular part of pectoralis major had an expansion towards the anterior Brachial Fascia, whereas the Fascia covering its costal part extended into the medial Brachial Fascia and the medial intermuscular septum. The lacertus fibrosus was also composed by two groups of fibres: the main group was oriented downwards and medially, the second group longitudinally. The palmaris longus opened out into a fan-shape in the palm of the hand and sent some tendinous expansions to the flexor retinaculum and Fascia overlying the thenar eminence muscles. In the posterior region of the arm, the Fascia of the latissimus dorsi sent a fibrous lamina to the triceps Brachial Fascia. The triceps tendon inserted partially into the anteBrachial Fascia, while the extensor carpi ulnaris sent a tendinous expansion to the Fascia of the hypothenar eminence. It is hypothesized that the tendinous muscular insertions maintain the Fascia at a basal tension and create myoFascial continuity between the different muscles actuating flexion and extension of the upper limb, stretching the Fascia in different ways according to the different motor directions.
Christian Fontaine - One of the best experts on this subject based on the ideXlab platform.
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ANATOMICAL BASES FOR THE POSTERIOR Brachial Fascia FREE FLAP
2011Co-Authors: Christian Fontaine, Guillaume Wavreille, Jérôme Bricout, Xavier Demondion, Christophe ChantelotAbstract:Fasciae represent a very interesting source of thin, well vascularized soft tissue, which allows gliding of the underlying tendons, especially for coverage of particular anatomical zones, such as the dorsal aspect of the hand and fingers. Some Fasciae (such as the Fascia temporalis free fiap) have already been used in this way as free fiaps for the coverage of the extremities. The aim of this study was to investigate the blood supply of the posterior Brachial Fascia (PBF), in order to precise the anatomical bases of a new free Fascial fiap. Our study was based on dissections of 18 cadaveric specimens from 10 formalin preserved corpses. Six upper limbs were used to fictively harvest this fiap The PBF was thin; its surface was broad, easily separable of the overlying subcutaneous and underlying muscular planes in its upper two thirds. It was richly blood supplied by two main pedicles: the posterior Brachial neurocutaneous branch and the Fascial branch of the upper ulnar collateral artery. The well vascularized area was 115mm long and 54mm broad in average. These two pedicles were quite constant (respectively 17 cases and 14 cases out of the 18 specimens) and of sufficient caliber to allow microsurgical anastomoses in good conditions. A rich venous network, satellite of the arteries, was always present. An arterial by-pass between both arterial pedicles could spare venous sutures when both arterial pedicles are present and communicating within the Fascial depth (13 cases out of 18). Harvesting the fiap was easy through a posteromedial approach in a patient in supine position. The donor site could always be closed and its scare was well acceptable. The first clinical case is presented in a patient suffering from recurrent tendinous adhesions at the dorsum of the hand after a close trauma with extensive hematoma, after failure of 2 previous tenolyses. After a third tenolysis, the free PBF fiap was performed. The Fascia was covered with a free skin graft at day 6. The coverage was nice and the outcome of the tenolysis at 6 month was -15/80 (active motion) and +20/100 (passive motion).
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Anatomical bases of the free posterior Brachial Fascial flap
Surgical and Radiologic Anatomy, 2010Co-Authors: Guillaume Wavreille, Jérôme Bricout, Sébastien Mouliade, Stéphane Lemoine, Grégory Prodhomme, Prakash Khanchandani, Christophe Chantelot, Christian FontaineAbstract:Purpose Fascias can be used for reconstruction of gliding surfaces of upper and lower extremities or when thin, pliable coverage is required. Free large and well-vascularised Fascial flaps are not very many and harvesting is seldom onto upper limb. The aim of this work was to study blood supply of the posterior Brachial Fascia in order to define the anatomical bases of a new free Fascial flap. Methods Our study included dissection on 18 anatomic specimens from 10 cadavers. Measures of the flap and blood supply were studied. Histological study was performed to analyse vessels location and measures into flap thickness. Results The posterior Brachial Fascia was thin, with a broad surface area and easily separable from the subcutaneous and muscular plane. Its average surface size is 115-mm length and 54-mm width. It was richly vascularised by two major pedicles: the cutaneous posterior Brachial pedicule and the Fascial branch of the superior ulnar collateral artery. Satellite venous elements were always present. A rich vascular network exists within the thickness of the Fascia. Surgical procedure of flap harvesting is described. Conclusion Harvesting of the flap can be carried out by a posteromedial approach into upper limb, without significant donor-site morbidity. This flap is adapted to cover and reconstruct gliding tendinous surfaces onto hand or fingers.
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Anatomical bases of the free posterior Brachial Fascial flap.
Surgical and Radiologic Anatomy, 2009Co-Authors: Guillaume Wavreille, Jérôme Bricout, Sébastien Mouliade, Stéphane Lemoine, Grégory Prodhomme, Prakash Khanchandani, Christophe Chantelot, Christian FontaineAbstract:Purpose Fascias can be used for reconstruction of gliding surfaces of upper and lower extremities or when thin, pliable coverage is required. Free large and well-vascularised Fascial flaps are not very many and harvesting is seldom onto upper limb. The aim of this work was to study blood supply of the posterior Brachial Fascia in order to define the anatomical bases of a new free Fascial flap.
Diogo Casal - One of the best experts on this subject based on the ideXlab platform.
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A rare variant of the ulnar artery with important clinical implications: a case report
BMC Research Notes, 2012Co-Authors: Diogo Casal, Diogo Pais, Tiago Toscano, Tiago Bilhim, Luís Rodrigues, Inês Figueiredo, Sónia Aradio, Maria Angélica-almeida, João Goyri-o’neillAbstract:Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the Brachial artery, pierced the Brachial Fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the anteBrachial Fascia. It then dipped into the forearm Fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.
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A rare variant of the ulnar artery with important clinical implications: a case report
BMC Research Notes, 2012Co-Authors: Diogo Casal, Diogo Pais, Tiago Toscano, Tiago Bilhim, Luís Rodrigues, Sónia Aradio, Maria Angélica-almeida, Ines Carreira Figueiredo, João Goyri-o'neillAbstract:Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the Brachial artery, pierced the Brachial Fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the anteBrachial Fascia. It then dipped into the forearm Fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.
Carla Stecco - One of the best experts on this subject based on the ideXlab platform.
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Anatomical study of myoFascial continuity in the anterior region of the upper limb.
Journal of Bodywork and Movement Therapies, 2009Co-Authors: Antonio Stecco, Carla Stecco, Veronica Macchi, Andrea Porzionato, Vincent Delmas, Julie Ann Day, R. De CaroAbstract:Fifteen unembalmed cadavers were dissected in order to study the "anatomical continuity" between the various muscles involved in the movement of flexion of the upper limb. This study demonstrated the existence of specific myoFascial expansions, with a nearly constant pattern, which originate from the flexor muscles and extend to the overlying Fascia. The clavicular part of the pectoralis major sends a myoFascial expansion, with a mean length of 3.6cm, to the anterior region of the Brachial Fascia, and the costal part sends one to the medial region of the Brachial Fascia (mean length: 6.8cm). The biceps brachii presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7cm and a base of 1.9cm, and a second, less evident, longitudinal expansion (mean length: 4.5cm, mean width: 0.7cm). Lastly, the palmaris longus sends an expansion to the Fascia overlying the thenar muscles (mean length: 1.6cm, mean width: 0.5cm). During flexion, as these muscles contract, the anterior portion of the Brachial and anteBrachial Fascia is subject to tension. As the Fascia is rich in proprioceptive nerve endings, it is hypothesized that this tension activates a specific pattern of receptors, contributing to perception of motor direction. If the muscular Fascia is in a non-physiological state, these mechanisms are altered, and the proprioceptors in the Fascia may be incorrectly activated, thus giving rise to many types of extra-articular pain.
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The expansions of the pectoral girdle muscles onto the Brachial Fascia: morphological aspects and spatial disposition.
Cells Tissues Organs, 2008Co-Authors: Carla Stecco, Veronica Macchi, Andrea Porzionato, Roberto Aldegheri, Vincent Delmas, Antonio Stecco, E. Vigato, Anna Parenti, R. De CaroAbstract:Background/Aims: The aim of this study was to analyse the relationships between the expansions of the pectoral girdle muscles, i.e. pectoralis major, latissimus dorsi and deltoid, a
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Anatomy of the deep Fascia of the upper limb. Second part: study of innervation
Morphologie, 2007Co-Authors: Carla Stecco, O. Gagey, Veronica Macchi, Andrea Porzionato, R. De Caro, Roberto Aldegheri, Anna S. Belloni, Assunta Pozzuoli, Vincent DelmasAbstract:Abstract Analysis of specimens taken from different areas of the deep Fascia in 20 upper limbs was made in order to establish which kind of nerve fibres and endings are present in the deep muscular Fascia. The flexor retinaculum and the lacertus fibrosus were also evaluated because they are anatomically hardly separable from the deep muscular Fascia, although they have different functions. In particular, specimens were taken at the level of: (a) the expansion of pectoralis major onto the bicipital Fascia, (b) the middle third of the Brachial Fascia, (c) the lacertus fibrosus, (d) the middle third of the anteBrachial Fascia, (e) the flexor retinaculum. This study demonstrated an abundant innervation of the Fascia consisting in both free nerve endings and encapsulated receptors, in particular, Ruffini and Pacini corpuscles. However, differences in innervation were verified: the flexor retinaculum was resulted the more innervated element whilst lacertus fibrosus and the pectoralis major expansion the less innervated. These results suggest that the retinaculum has more a perceptive function whereas the tendinous expansions onto the Fascia have mostly a mechanical role in the transmission of tension. The hypothesis that the Fascia plays an important role in proprioception, especially dynamic proprioception, is therefore advanced. In fact, the Fascia is a membrane that extends throughout the whole body and numerous muscular expansions maintain it in a basal tension. During a muscular contraction these expansions could also transmit the effect of the stretch to a specific area of the Fascia, stimulating the proprioceptors in that area.
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Tendinous muscular insertions onto the deep Fascia of the upper limb. First part: anatomical study.
Morphologie, 2007Co-Authors: Carla Stecco, O. Gagey, Veronica Macchi, Andrea Porzionato, R. De Caro, Roberto Aldegheri, Vincent DelmasAbstract:We examined 30 upper limbs in order to study the tendinous muscular insertions into the deep Fascia and to verify whether they have a specific anatomical arrangement and to measure their resilience to traction. We have found that the Fascia receives many tendinous muscular insertions, which are always present and exhibit a constant anatomical structure. In particular, the pectoralis major Fascia always continues with the Brachial Fascia in two distinct ways: the Fascia overlying the clavicular part of pectoralis major had an expansion towards the anterior Brachial Fascia, whereas the Fascia covering its costal part extended into the medial Brachial Fascia and the medial intermuscular septum. The lacertus fibrosus was also composed by two groups of fibres: the main group was oriented downwards and medially, the second group longitudinally. The palmaris longus opened out into a fan-shape in the palm of the hand and sent some tendinous expansions to the flexor retinaculum and Fascia overlying the thenar eminence muscles. In the posterior region of the arm, the Fascia of the latissimus dorsi sent a fibrous lamina to the triceps Brachial Fascia. The triceps tendon inserted partially into the anteBrachial Fascia, while the extensor carpi ulnaris sent a tendinous expansion to the Fascia of the hypothenar eminence. It is hypothesized that the tendinous muscular insertions maintain the Fascia at a basal tension and create myoFascial continuity between the different muscles actuating flexion and extension of the upper limb, stretching the Fascia in different ways according to the different motor directions.