Extra- and intramuscular nerves distributions of the triceps surae muscle as a basis for muscle resection and botulinum toxin injections
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Abstract
Purpose
To compare the distribution of extramuscular nerve branches with their intramuscular ramifications in the triceps surae muscle, thus providing anatomical substantiation for the topography of muscle resection and botulinum toxin injections.
Methods
Dissection and modified Sihler’s staining of 18 whole-mount human cadaveric specimens.
Results
The distance between the areas with the highest extramuscular branch density and the area of densest intramuscular arborization in gastrocnemius and soleus muscles is approximately 10% of the calf length. This finding should be taken into consideration during nerve blocking and botulinum toxin injections for the treatment of spasticity. Intramuscular nerve arborization patterns make it possible to outline neuromuscular segments in the gastrocnemius and soleus muscles.
Conclusions
Surgical or therapeutic interventions in areas of high extramuscular and intramuscular nerve density can increase the efficacy and safety of botulinum toxin injections and neurotomy. Intramuscular nerve branching patterns should be taken into consideration during triceps surae resection.
Keywords
Triceps surae Innervation Resection Botulinum toxin Sihler’s stainingNotes
Acknowledgments
This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MOST) [No. R01-2007-000-11219-0].
References
- 1.Buffenoir K, Roujeau T, Lapierre F, Menei P, Menegalli-Boggelli D, Mertens P, Decq P (2004) Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy. Neurosurgery 55:1130–1137PubMedCrossRefGoogle Scholar
- 2.Calguner E, Erdogan D, Elmas C, Bahcelioglu M, Gozil R, Ayhan MS (2006) Innervation of the rat anterior abdominal wall as shown by modified Sihler’s stain. Med Princ Pract 15:98–101PubMedCrossRefGoogle Scholar
- 3.Deltombe T, Detrembleur C, Hanson P, Gustin T (2006) Selective tibial neurotomy in the treatment of spastic equinovarus foot: a 2-year follow-up of three cases. Am J Phys Med Rehabil 85:82–88PubMedCrossRefGoogle Scholar
- 4.Gulekon N, Peker T, Turgut HB, Anil A, Karakose M (2007) Qualitative comparison of anatomical microdissection, Sihler’s staining and computerized reconstruction methods for visualizing intramuscular nerve branches. Surg Radiol Anat 29:373–378PubMedCrossRefGoogle Scholar
- 5.Han KH, Joo YH, Moon SE, Kim KH (2006) Botulinum toxin A treatment for contouring of the lower leg. J Dermatolog Treat 17:250–254PubMedCrossRefGoogle Scholar
- 6.Hwang K, Kim YJ, Chung IH, Won HS, Tanaka S, Lee SI (2003) Innervation of calf muscles in relation to calf reduction. Ann Plast Surg 50:517–522PubMedCrossRefGoogle Scholar
- 7.Kim HS, Hwang JH, Lee PKW, Kwon JY, Oh-Park MY, Kim JM, Chun MH (2002) Localization of the motor nerve branches and motor points of the triceps surae muscles in Korean cadavers. Am J Phys Med Rehabil 81:765–769CrossRefGoogle Scholar
- 8.Kim MW, Kim JH, Yang YJ, Ko YJ (2005) Anatomic localization of motor points in gastrocnemius and soleus muscles. Am J Phys Med Rehabil 84:680–683PubMedCrossRefGoogle Scholar
- 9.Kim SC, Kang MH, Ock JJ (2008) Calf-contouring surgery of gastrocnemius hypertrophy: selective neurectomy of the sural nerve. Aesthetic Plast Surg 32:889–893PubMedCrossRefGoogle Scholar
- 10.Lee HJ, Lee DW, Park YH, Cha MK, Kim HS, Ha SJ (2004) Botulinum toxin A for aesthetic contouring of enlarged medial gastrocnemius muscle. Dermatol Surg 30:867–871PubMedCrossRefGoogle Scholar
- 11.Lee JT, Wang CH, Cheng LF, Lin CM, Huang CC, Chien SH (2006) Subtotal resection of gastrocnemius muscles for hypertrophic muscular calves in Asians. Plast Reconstr Surg 118:1472–1483PubMedCrossRefGoogle Scholar
- 12.Lemperle G, Exner K (1998) The resection of gastrocnemius muscles in aesthetically disturbing calf hypertrophy. Plast Reconstr Surg 102:2230–2236PubMedCrossRefGoogle Scholar
- 13.Liem RS, van Willigen J (1988) In toto staining and preservation of peripheral nervous tissue. Stain Technol 63:113–120PubMedGoogle Scholar
- 14.Liu J, Kumar VP, Shen Y, Lau HK, Pereira BP, Pho RW (1997) Modified Sihler’s technique for studying the distribution of intramuscular nerve branches in mammalian skeletal muscle. Anat Rec 247:137–144PubMedCrossRefGoogle Scholar
- 15.Loh EY, Agur AM, McKee NH (2003) Intramuscular innervation of the human soleus muscle: a 3D model. Clin Anat 16:378–382PubMedCrossRefGoogle Scholar
- 16.Parratte B, Tatu L, Vuillier F, Diop M, Monnier G (2002) Intramuscular distribution of nerves in the human triceps surae muscle: anatomical bases for treatment of spastic drop foot with botulinum toxin. Surg Radiol Anat 24:91–96PubMedCrossRefGoogle Scholar
- 17.Peker T, Gülekon N, Turgut BH, Anil A, Karakose M, Mungan T, Danisman N (2006) Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns: a transparent and microanatomic study. Plast Reconstr Surg 117(1):165–176PubMedCrossRefGoogle Scholar
- 18.Sekiya S (1991) Muscle architecture and intramuscular distribution of nerves in the human soleus muscle. Acta Anat (Basel) 140:213–223CrossRefGoogle Scholar
- 19.Tsai FC, Mardini S, Fong TH, Kang JH, Chou CM (2008) Selective neurectomy of the gastrocnemius and soleus muscles for calf hypertrophy: an anatomical study and 700 clinical cases. Plast Reconstr Surg 122:178–187PubMedCrossRefGoogle Scholar
- 20.Wongphaet P, Chinsethagij K, Suarchawaratana S, Dangprasert T, Wongphaet W (2005) Precise localization of motor branching and motor points: a cadaveric study. J Med Assoc Thai 88:1884–1891PubMedGoogle Scholar
- 21.Wu BL, Sanders I (1992) A technique for demonstrating the nerve supply of whole larynges. Arch Otolaryngol Head Neck Surg 118:822–827PubMedGoogle Scholar
- 22.Yoo WK, Chung IH, Park CI (2002) Anatomic motor point localization for the treatment of gastrocnemius muscle spasticity. Yonsei Med J 43:627–630PubMedGoogle Scholar