OBJECTIVE: To provide anatomic evidence for choosing medial calcaneal nerve(MCN ) as recipient cutaneous nerve to rebuild heel sensation. METHODS: We chose 20 adult cadavers' lower limbs, dissected the MCNs, observed their original sites, shapes, courses and distribution, and measured the perpendicular distance from original sites of MCNs from tibial nerve, original sites of their branches to the tip of medial malleolus, and the external diameters of their main trunks and branches. RESULTS: The frequency of the MCN was 95% in this array. All the MCNs arose from the tibial nerve at 3.3 cm up the horizontal plane of the tip of medial malleolus. They sent out anterior branches and posterior branches from 0.3 cm below the horizontal plane of the tip of medial malleolus on average. The anterior branch dominated the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominated the sensation of the posterior and median part. The shape of MCNs, main trunks, anterior branches and posterior branches was like circular cylinder. At the origination, the external diameter of the MCN, the anterior branch and the posterior branch was 1.58, 1.13 and 0.90 mm on average, respectively. CONCLUSION The anatomical position of MCN is relatively constant, and its external diameter is suitable. The initiation is not close to the heel weight loading area. Its anatomic characteristics meet the requirements of sensation recovery of the heel, especially the heel weight loading field.
Adult ; Cadaver ; Calcaneus ; innervation ; Heel ; innervation ; Humans ; Peripheral Nerves ; anatomy & histology ; Tibial Nerve ; anatomy & histology

To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.
Adult ; Aged ; Aged, 80 and over ; *Cadaver ; Female ; Frontal Bone/anatomy & histology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Orbit/anatomy & histology ; Peripheral Nerves/*anatomy & histology ; Scalp/*innervation ; Zygoma/anatomy & histology

We investigated the distribution and navigation of periprostatic nerve fibers and constructed a 3-dimensional model of nerve distribution. A total of 5 cadaver specimens were serially sectioned in a transverse direction with 0.5 cm intervals. Hematoxylineosin staining and immunohistochemical staining were then performed on whole-mount sections. Three representative slides from the base, mid-part, and apex of each prostate were subsequently divided into 4 sectors: two lateral, one ventral, and one dorsal (rectal) part. The number of nerve fibers, the distance from nerve fiber to prostate capsule, and the nerve fiber diameters were analyzed on each sector from the representative slides by microscopy. Periprostatic nerve fibers revealed a relatively even distribution in both lateral and dorsal parts of the prostate. There was no difference in the distances from the prostate capsule to nerve fibers. Nerve fibers in the ventral area were also thinner as compared to other areas. In conclusion, periprostatic nerve fibers were observed to be distributed evenly in the periprostatic area, with the exception of the ventral area. As the number of nerve fibers on the ventral part is fewer in comparison, an excessive high up incision is insignificant during the nerve-sparing radical prostatectomy.
Adult ; Aged ; *Cadaver ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; *Models, Anatomic ; Neuroanatomy ; Peripheral Nerves/*anatomy & histology ; Prostate/*innervation ; Prostatectomy/methods ; Prostatic Neoplasms/surgery

OBJECTIVETo investigate the number, course and distribution of normal dorsal penile nerves and their clinical significance for selective neurectomy of the dorsal penile nerve in the treatment of primary premature ejaculation.

METHODSWe dissected 38 cadaveric adult penises and recorded the number, course and distribution of the dorsal penile nerves. A total of 314 cases of primary premature ejaculation underwent selective neurectomy of the dorsal penile nerve. The patients ranged between 20 and 45 years in age and from 1 to 22 years in disease course.

RESULTSThe dorsal penile nerves were distributed in parallel bilaterally in all the cadaveric penises and branched into the ventral side in 4 of them. The total number of dorsal penile nerves was (3.6 +/- 1.2) in the 38 cadaveric penises, 7 in 1 case, 6 in 1 case, 5 in 6 cases, 4 in 9 cases, 3 in 14 cases and 2 in 7 cases, while that of the 314 patients with primary premature ejaculation was (7.0 +/- 1.9), 5 in 64 cases, 6 in 56 cases, 7 in 52 cases, 8 in 40 cases, 9 in 33 cases, 10 in 28 cases, 11 in 25 cases, 12 in 11 cases and 13 in 5 cases. Selective neurectomy of the dorsal penile nerve achieved an intravaginal ejaculation latency of (4.31 +/- 1.87) minutes and sexual satisfaction rate of (61 +/- 17) %, significantly different from those before the operation ([1.24 +/- 0.32] min, [23 +/- 6] %; all P < 0.01).

CONCLUSIONThe abnormal increase of dorsal penile nerves possibly lies at the bottom of the pathogenesis of primary premature ejaculation. Selective neurectomy of the dorsal penile nerve is safe and effective for the treatment of primary premature ejaculation.

Adult ; Denervation ; methods ; Ejaculation ; Humans ; Male ; Middle Aged ; Neuroanatomy ; Penis ; innervation ; Peripheral Nerves ; anatomy & histology ; surgery ; Sexual Dysfunction, Physiological ; physiopathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the anatomy of the medial pedis composite flaps with saphenous nerve and tendon and its application in the repair of tendo calcaneus and adjacent defects.

METHODS10 cadavers (20 sides) were observed. The origin, course, size and the distribution of the medial plantar artery were studied. 12 cases with tendo calcaneus and adjacent defects were reconstructed with the medial pedis composite flaps with saphenous nerve. Donor site defects were covered with free skin graft.

RESULTSThe medial plantar artery gives off deep branch [diameter (1.5 +/- 0.3) mm] and superficial branch [diameter (1.0 +/- 0.2) mm]. In 18 sides, the deep branches give off the medial branches and lateral branches. While in 2 sides, the superficial branches give off the medial branches and lateral branches with no big branches from the deep branches. There are branches of saphenous nerve and medial dorsal cutaneous nerve in the flap. All the flaps were survived. 8 cases were followed up for one months to one years. Good color, texture and function of the flaps were achieved.

CONCLUSIONSThe medial pedis composite flaps with saphenous nerve can repair tendo calcaneus and adjacent defects. It is a easy and safe procedure with reliable anatomy and good results.

Adolescent ; Adult ; Child ; Female ; Foot ; blood supply ; surgery ; Humans ; Male ; Peripheral Nerves ; anatomy & histology ; Surgical Flaps ; blood supply ; innervation ; Young Adult

OBJECTIVETo introduce a practical, economical, and time-saving method to stain (with osmic acid) the myelin sheath in normal and regenerated peripheral nerves.

METHODSA total of 12 Sprague Dawley rats, weighing 250-320 g (mean equal to 276 g+/-38 g), were divided into two groups: a normal nerve group (n equal to 6) and a regenerated nerve group (n equal to 6). In the normal nerve group, the ventral and dorsal roots of L(4) to L(6) and their sciatic nerves were harvested for histological analysis. While in the regenerated nerve group, the right sciatic nerves were severed and then repaired with an epineurial microsuture method. The repaired nerves were harvested 12 weeks postoperatively. All the specimens were fixed in 4% paraformaldehyde and transferred to 2% osmic acid for 3-5 days. Then the specimens were kept in 75% alcohol before being embedded in paraffin. The tissues were cut into sections of 3 micromolar in thickness with a conventional microtome.

RESULTSUnder a light microscope, myelin sheaths were clearly visible at all magnifications in both groups. They were stained in clear dark colour with a light yellow or colorless background, which provided high contrast images to allow reliable morphometric measurements. Morphological assessment was made in both normal and regenerated sciatic nerves. The ratios of the myelin area to the fibre area were 60.28%+/-7.66% in the normal nerve group and 51.67%+/-6.85% in the regenerated nerve group, respectively (P less than 0.01).

CONCLUSIONSOsmic acid staining is easy to perform and a very clear image for morphometrical assessment is easy to obtain. Therefore, it is a reliable technique for quantitative evaluation of nerve morphology.

Animals ; Myelin Sheath ; pathology ; Nerve Regeneration ; Osmium Tetroxide ; Peripheral Nerves ; anatomy & histology ; pathology ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; pathology ; Staining and Labeling ; methods ; Suture Techniques

The genital organ is innervated by autonomic and somatic nerve. The former is both sympathetic and parasympathetic nerve and the later is comprised by sensory and motor fibers. The symptoms of male sexual dysfunction are sexopathy, erectile dysfunction, disorder of ejaculation and orgasm, and pianism. Not only different symptom but the same symptom can be induced by different injured nerve. The relationship between peripheral nerve injury and male sexual dysfunction should be understood correctly.
Erectile Dysfunction/etiology* ; Humans ; Male ; Parasympathetic Nervous System/injuries* ; Pelvis/innervation* ; Peripheral Nerve Injuries ; Peripheral Nerves/anatomy & histology* ; Sexual Dysfunction, Physiological/etiology* ; Spinal Cord Injuries/complications* ; Sympathetic Nervous System/injuries* ; Trauma, Nervous System/complications*

Musculoskeletal ultrasound (MSUS) has newly evolved by the mechanical improvement of the machine over past several years, becoming a part of imaging techniques for the evaluation of variable diseases in the musculoskeletal system. MSUS has proven diagnostic superiority in pathologies including rotator cuff disease of the shoulder, lateral epicondylitis of the elbow, diseases of the peripheral nerve, detection of intra-articular loose bodies and soft tissue foreign bodies, and in evaluating small superficial soft tissue tumors such as ganglion, epidermoid cyst, and glomus tumor. Besides, MSUS is very useful for obtaining tissue or fluid via percutaneous fine needle aspiration and/or biopsy for the histopathologic diagnosis. Combining MSUS with MR would play a great role in the field of the diagnostic imaging of the musculoskeletal system. The MSUS examiner should have the knowledge of cross-sectional anatomy, and of the mechanical and physical properties of ultrasound in order to interpret the ultrasound findings accurately and properly, and to avoid diagnostic errors due to variable artifacts subsequently. The goal of this article is to introduce the capabilities of MSUS in certain kinds of clinical situation and to familiarize the reader with MSUS. For the purpose, author intends to describe this article according not to the disease-, or organ-based, but to the clinical problem-based format.
Anatomy, Cross-Sectional ; Artifacts ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Diagnostic Errors ; Diagnostic Imaging ; Elbow ; Epidermal Cyst ; Foreign Bodies ; Ganglion Cysts ; Glomus Tumor ; Musculoskeletal System ; Pathology ; Peripheral Nerves ; Rotator Cuff ; Shoulder ; Ultrasonography*