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Extra- and intramuscular nerves distributions of the triceps surae muscle as a basis for muscle resection and botulinum toxin injections

Surgical and Radiologic Anatomy volume 31, pages 615–621 (2009)Cite this article

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.

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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].

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Authors and Affiliations

  1. Division of Anatomy and Developmental Biology, Department of Oral Biology, Oral Science Research Center, Human Identification Research Center, Research Center for Orofacial Hard Tissue Regeneration, BK 21 Project, Yonsei University College of Dentistry, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea

    V. A. Sheverdin, M. S. Hur, S. Y. Won, K. S. Hu & H. J. Kim

  2. Department of Anatomy, School of Medicine, Konkuk University, Seoul, South Korea

    W. C. Song & K. S. Koh

  3. Division in Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, South Korea

    H. J. Kim

Authors
  1. V. A. Sheverdin
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  2. M. S. Hur
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  3. S. Y. Won
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  4. W. C. Song
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  5. K. S. Hu
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  6. K. S. Koh
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  7. H. J. Kim
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Corresponding author

Correspondence to H. J. Kim.

Additional information

V. A. Sheverdin and M. S. Hur contributed equally to this work.

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Sheverdin, V.A., Hur, M.S., Won, S.Y. et al. Extra- and intramuscular nerves distributions of the triceps surae muscle as a basis for muscle resection and botulinum toxin injections. Surg Radiol Anat 31, 615–621 (2009). https://doi.org/10.1007/s00276-009-0490-2

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  • DOI: https://doi.org/10.1007/s00276-009-0490-2

Keywords

  • Triceps surae
  • Innervation
  • Resection
  • Botulinum toxin
  • Sihler’s staining