China
Africa
Explore chapters and articles related to this topic
Tissue coverage for exposed vascular reconstructions (grafts)
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kaitlyn Rountree, Vikram Reddy, Sachinder Singh Hans
The gastrocnemius muscle is harvested through an incision made along the medial tibia just posterior to the pes anserinus and carried to 10 cm superior to the medial maleoulus.32 The fascia of the superficial posterior compartment of the leg is opened sharply with either knife or electrocautery throughout the length of the compartment. The gastrocnemius muscle is separated with gently blunt dissection from the underlying soleus, keeping in mind that the distal tendon fibers become intimately jointed to form the Achilles tendon. Dissection in the proximal incision reveals the two distinct heads of the gastrocnemius muscle with the sural nerve reliably located between their heads. It is important to identify the sural nerve and protect it and the accompanying vascular pedicles entering the muscle heads superiorly. Distally the two heads become confluent, making the distinction between them difficult. Begin separation of the heads of the gastrocnemius muscle proximally and continue distally by following the raphe of the investing fascial envelopes and developing the plane sharply. The flap is then released distally, with or without a portion of tendon depending on coverage needs, taking care to separate the fibers of the gastrocnemius from the deeper fibers of the soleus muscle. Again, either muscle belly can be harvested independently or together. Figure 36.3 demonstrates use of the medial head of the gastrocnemius muscle for coverage of an autologous vein bypass conduit.
Foot and ankle radiology
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Flexor digitorum accessorius longus (FDAL) tendon can arise from any structure in the posterior compartment of the leg. FDAL tendon traverses through the flexor retinaculum into the tarsal tunnel where it is closely related to the posterior tibial artery and the tibial nerve. Due to its intimate relationship with the neurovascular bundle in the tarsal tunnel, it is predisposed to tarsal tunnel syndrome and tenosynovitis of the FDL tendon (Figure 22.22).
Venous anatomy
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
The anterior tibial veins drain the dorsum of the foot and course from the ankle up the anterior compartment of the leg, lateral to the tibia, and close to the interosseous membrane which connects the tibia and fibula. Near the junction of these two bones at the knee, the vessels penetrate the interosseous membrane entering the posterior compartment of the leg. Of note, isolated deep vein thrombosis (DVT) of the anterior tibial veins is very infrequent, at less than 2% (N. Labropolous, personal communication).
Sensory neurotization of muscle: past, present and future considerations
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Steven D. Kozusko, Alexander J. Kaminsky, Louisa C. Boyd, Petros Konofaos
After analyzing the relevant experimental studies, a few key findings are apparent. First, most studies on sensory neurotization are in animals, in particular, rats. The studies are sound experimental models, but they do not report on human data. Second, there is a lack of consistency on the nerve and/or muscle chosen for neurotization. In one study, it was the posterior compartment of the leg. In another study, it was the musculocutaneous nerve of the arm. It is difficult to draw strict comparisons when multiple nerves and muscles are being analyzed. Additionally, the duration of time for sensory protection varied. Sensory protection duration was for 6 weeks in one study, while for another it lasted 6 months. The variable amount of time for sensory protection does little to establish guidelines for temporal guidelines. Lastly, measurements varied in the animal studies. Some studies analyzed muscle weight. Other studies looked at histology. Axon and motor endplate counts were acquired in another study. The variables are different in each of the animal studies. As one can see, there is a paucity of literature on the subject of sensory neurotization, and in what is present there is wide variability in study design.