1.Presence of Additional Head of Pronator Teres Muscle and Associated Neurovascular Variations: A Rare Case Report
Sushma RK ; Srinivasa RS ; Kumar MR Bhat
Journal of Surgical Academia 2012;2(2):41-44
Arm is a site for frequent injuries and it is involved in many surgical procedures. Variations in the arm have immense clinical significance. During the dissection of a right upper limb, brachial artery was found to divide into radial and ulnar arteries, 3cm above the inter-epicondylar plane. The ulnar artery and the median nerve were then passing through a tunnel formed by an extensive additional humeral head of the pronator teres muscle. Two centimetres long fibromuscular tunnel formed by the humeral head of the pronator teres was found to arise from the medial intermuscular septum and also from the fibrous arch form the shaft of the humerus to the medial intermuscular septum. In the same cadaver, the superior ulnar collateral artery was found to arise from the profunda brachii artery which is otherwise a branch of the brachial artery. Accurate knowledge of these variation patterns is of considerable clinical significance in conduct of surgeries of arm, fracture management of humerus and diagnosis of various compressive neuropathies.
2.Bilateral Morphological Variation of Abductor Pollicis Longus and Extensor Pollicis Brevis Tendons: A Cadaveric Case Report with Clinical Perspective
Srinivasa RS ; Taranikanti V ; Mohammed AM
Journal of Surgical Academia 2017;7(1):55-58
Concurrent morphological variations of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) are
seldom reported in literature. Extra slips of APL and EPB are clinically significant as they are used to reconstruct
the ruptured tendons in the hand. Herein, we report bilateral morphological variations of APB and EPB in a male
cadaver. On each side of forearm, APL was divided into two tendinous slips within the first compartment of extensor
retinaculum. One of these slips inserted on to the radial side of base of first metacarpal bone close to the insertion of
EPB, and the other slip inserted on to both abductor pollicis brevis and opponens pollicis. EPB divided into two
tendons slips deep to the extensor retinaculum. These slips were found to be inserted on to the dorsal surface of the
base of proximal phalanx while the other inserted on to the radial aspect of the base of first metacarpal bone, close to
the insertion of APL tendon. These additional slips are frequently associated with first carpo-metacarpal subluxation
and de Quervain’s syndrome and may be responsible for the clinical manifestations of these diseases. In addition,
knowledge of the morphological variations of APL and EPB can aid orthopaedic and plastic surgeons in performing
successful tendon transplants.
3.Replaced Right Hepatic Artery Associated with Uncommon Triplet Right Renal Vein: Embryological Perspective and Clinical Importance 45
Satheesha NB ; Srinivasa RS ; Surekha DS ; Naveen K ; Anita G
Journal of Surgical Academia 2012;2(2):45-48
Vascular variations in the abdomen are common and mostly asymptomatic. Knowledge of these variations are of tremendous clinical importance in patients undergoing invasive endovascular interventions such as liver transplantation, renal transplantation, and vascular reconstruction for congenital and acquired lesions and trans-arterial chemoembolization for the hepatic tumors. During regular dissection classes for the medical undergraduates, we encountered concurrent vascular variations in an elderly male cadaver. In the present case, we report multiple vascular anomalies involving the right hepatic artery and the right renal vein. The right hepatic artery branched off from superior mesenteric artery, and it was identified as a replaced right hepatic artery. The right kidney was drained by three renal veins, the uppermost among the three twisted around the superior branch of the right renal artery before terminating into the inferior vena cava. In addition, the left kidney was supplied by two renal arteries, and drained by a single renal vein.
4.A Rare Unilateral Variation in the Course of External and Internal Carotid Arteries
Satheesha BN, Srinivasa RS, Swamy RS ; Deepthinath R ; Sudarshan S ; Naveen K
Journal of Surgical Academia 2014;4(2):35-37
Vascular variations in the neck region are not uncommon. Knowledge of incidence of morphological variations in
the course and branching of the carotid arteries is important for radiological interpretation and surgical correction
when they are symptomatic. Internal carotid artery (ICA) is known to show elongation in its extra cranial course.
Previous studies have demonstrated the incidence and clinical symptoms of this morphological entity. However, the
occurrence of elongation and looping of the external carotid artery (ECA) is seldom reported in the literature. During
regular dissections, we came across a rare case of unilateral morphological variation of both ECA and ICA, in a male
cadaver aged about 55 years. ICA presented a curved course with convexity directed posteriorly, at the level of the
C2-C3 vertebrae. ECA presented a pronounced kinking or coiling, one inch below the level of the angle of the
mandible. In addition, a linguo-facial trunk arising from the ECA also presented a pronounced kinking throughout its
entire length.
5.Short Axillary Vein and an Axillary Venous Ladder Formed by Basilic and Brachial Veins – An Anatomical and Clinical Perspective
Satheesha Nayak B ; Srinivasa RS ; Ashwini AP ; Naveen K ; Swamy RS ; Deepthinath R ; Surekha DS ; Prakashchandra S
Journal of Surgical Academia 2015;5(2):29-32
Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous
access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have
been well described in the literature. We report a rare case of formation of a short axillary vein associated with
complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in
formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic
vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial
veins was also associated with presence of three communicating veins between the basilic and brachial veins in the
axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for
planning and execution of various surgical invasive procedures involving these veins.
Axillary Vein
6.Uncommon Peritoneal Anomaly of Spleen Associated with the Unusual Relationship of Spleen with the Left Lobe of the Liver
Satheesha NB, Srinivasa Rao S ; Narendra P, Anitha G ; Surekha DS ; Naveen K ; Ashwini A ; Swamy RS
Journal of Surgical Academia 2013;3(1):47-49
Though congenital anomalies of the spleen are quite common, the peritoneal anomalies of the spleen are very rare. In
the present case, we observed two unusual phrenico-splenic ligaments connecting the spleen to the diaphragm. Apart
from this, the left lobe of the liver was elongated and was related to the diaphragmatic surface of the spleen. The
splenic artery had a straight course to the spleen, indicating the possible restricted movements of the spleen.
Knowledge of such unusual relation of spleen is essentially important for the surgeons as the elongated left lobe of
the liver might get ruptured in addition to the spleen in the fractures of the left 9th, 10th and 11th ribs. Awareness of
the straight course of the splenic artery is also of importance to Radiologists performing arterial splenoportography.
7.Unusual Path of Branches of Ilioinguinal Nerve: A Clinically Important Anatomic Variant
Satheesha BN ; Srinivasa RS ; Prakashchandra S ; Surekha DS ; Deepthinath R ; Raghu J ; Abhinitha P ; Jyothsna P
Journal of Surgical Academia 2014;4(2):59-61
Ilioinguinal nerve is a collateral branch of lumbar plexus. Its anatomical variations in relation to adjacent
musculoaponeurotic structures play a crucial role in the development of neuropathies associated with lower
abdominal surgeries. In this report, we present a rare case of unusual course and branches of the ilioinguinal nerve, in
a 55-year-old male cadaver. In the lateral part of inguinal canal ilioinguinal nerve gave three branches. Two of its
branches pierced the external oblique aponeurosis, about 6 cm above the pubic symphysis, to supply the skin of the
lower part of the anterior abdominal wall. Another branch pierced the conjoint tendon, in the medial part of the
inguinal canal about 2 cm above the superficial inguinal ring. Knowledge of unusual path of these branches may be
important to avoid injuries during the surgical repair of groin hernias. Further care should be taken while dealing
with the conjoint tendon in the Bassini procedure.