iPURSE 2016

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https://ir.lib.pdn.ac.lk/handle/20.500.14444/40

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Browsing iPURSE 2016 by Author "Alahakoon, A.M.B.D."

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    Anatomical variations in the radial artery observed in its origin and course: a cadaveric study
    (University of Peradeniya, 2016-11-05) Nanayakkara, T.D.; Alahakoon, A.M.B.D.; Wickramarathna, A.A.D.; Nasim, F.N.; Herath, P.P.B.; Ekanayaka, E.M.K.G.H.B.K.; Rajamanthri, P.S.; Dissanayake, J.K.
    The radial artery is one of the main two branches of the brachial artery. It usually originates at the level of the head of the radius in the cubital fossa and courses along the forearm deep to the flexor muscles; then crosses the anatomical snuff box where it contributes to the formation of deep palmer arch and sometimes to the superficial palmer arch. Anatomical variations are observed in its origin, course, branching pattern, diameter and mode of termination. The radial artery has been described as a route of transcatheter coronary interventions and a site of arterial blood sampling. Therefore, understanding the occurrence and types of variations related to the anatomy of the radial artery would reduce failure rates of the above procedures and complications associated with them. During routine dissection, 28 limbs of 14 cadavers were examined for the origin course and branching pattern. Among the 14 cadavers, high origin of the radial artery was observed in two cadavers. One (J10) had a unilateral (left upper limb) variation with an origin on the arm 18cm above the medial epicondyle, whereas, the other cadaver (J4) had a bilateral variation with the origin 17 cm above the medial epicondyle. J10 and J4 radial arteries followed a superficial and deep course respectively. An aberrant artery originating from the second part of the axillary artery, which runs a superficial course, was observed in the left upper limb of one cadaver (J12). In addition to this, the aberrant artery, the normal radial and ulnar arteries were identified at their origin at the level of head of the radius. Out of 28 upper limbs dissected four radial arteries (14.2%) exhibit variations in origin and course or an aberrant artery. Anatomical variations of the radial artery are relatively common. It has clinically significant implications as the artery is considered one of the best routes for transarterial interventions. There is emerging evidence that imaging the artery for possible variations prior to the procedure can reduce the failure rates.
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    Palmaris longus muscle: prevalence of absence and morphological variations, a Sri Lankan cadaveric study
    (University of Peradeniya, 2016-11-05) Herath, P.P.B.; Nasim, F.N.; Ekanayaka, E.M.K.G.H.B.K.; Nanayakkara, T.D.; Alahakoon, A.M.B.D.; Wickramarathna, A.A.D.; Rukmal, R.K,P.B.; Dissanayake, J.K.
    Palmaris longus (PL) is a muscle which originates from the common flexor origin of the forearm as a relatively small fleshy belly which is replaced distally by a long ribbon like tendon. This tendon merges with the palmar aponeurosis and it can be clinically demonstrated by pinching the pads of thumb and little finger together in a flexed wrist (Schaeffer’s test). Morphological variations such as reversal of muscle tendon orientation; duplication and triplication; variations in its origin and insertion; and accessory slips are recorded. Nevertheless, the common aberration reported is the unilateral or bilateral absence of PL, which varies among different ethnicities. Our objective was to find out the prevalence of absence of PL and morphological variations in Sri Lankans by cadaveric dissections. Thirty two limbs in 9 male and 7 female cadavers were dissected in the Department of Anatomy, Faculty of Medicine, Peradeniya. All cadavers belonged to the Sri Lankan Sinhalese ethnic group. The skin and fascia of the upper limb were reflected. Forearm muscles arising from the common flexor origin and the PL were identified. Attachments, morphology, and variations were verified by careful inspection. Absences of PL in both forearms were found in one male cadaver (6.25%). One male cadaver (6.25%) had duplication of the muscle on both limbs. The second belly was originating from the common flexor origin medial to PL and developed a similar ribbon like tendon distally which was attached to the volar ligament in front of the wrist. PL is considered as a vestigial muscle in humans, but it’s found to be important for power grip in arboreal primates. In humans it was demonstrated that PL improves gripping among sports personnel who handle racquets and bats, where absence of it may reduce performance. In surgery PL is often used for tendon transplants. The absence of PL is found to be more prevalent among Caucasians and lower incidence found in Mongolians. Frequency of absence in this study is higher than other Asians and lower than Caucasians. However, it is important to study larger populations and more cadavers to understand its variations and prevalence.
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    Relationship of suprascapular neurovascular bundle to suprascapular ligament: a cadaveric study
    (University of Peradeniya, 2016-11-05) Nasim, F.N.; Wickramarathna, A.A.D.; Nanayakkara, T.D.; Alahakoon, A.M.B.D.; Herath, P.P.B.; Ekanayaka, E.M.K.G.H.B.K.; Wijenayake, W.M.W.C.; Dissanayaka, J.K.
    The suprascapular nerve usually runs beneath the suprascapular ligament/superior transverse scapular ligament at the suprascapular notch and the spinoglenoid ligament (inferior transverse scapular ligament) at the spinoglenoid notch. However, the location of the artery and vein is highly variable according to literature. The suprascapular nerve arises from the upper trunk of the brachial plexus (C5, C6) whilst the artery usually originates as the first branch of the thyrocervical trunk. The artery and vein join the nerve at the medial half of the superior border of the scapula where variations are described. These variations may lead to decreased space in suprascapular notch. Thus, we conducted a descriptive study to recognize the relationship of the structures in the suprascapular neurovascular bundle to the suprascapular ligament and to classify variations. 34 formalin fixed human cadaveric shoulders in 17 cadavers were used, to dissect the suprascapular region. Here the relationship of the suprascapular nerve, artery and vein to the ligament was noted. The study was carried out in the dissection laboratory of Department of Anatomy, Faculty of Medicine, University of Peradeniya, Sri Lanka in the year 2016. The relationships were categorized into 5, Type A being artery above the ligament, with vein below (2.94%), Type B where artery and vein ran above (70.58%), type C where both vein and artery ran below (17.64%), type D where vein ran above whilst artery ran below (2.94%) and type E which had two arteries one running above and the other below with a vein running above (5.88%). In all types the nerve ran below the ligament. Knowledge of the morphological variations of the suprascapular region with regard to the neurovascular bundle is an important consideration during surgical and arthroscopic procedures around the suprascapular notch. It is also important to understand the variations that can induce entrapment of suprascapular nerve. The vulnerability towards entrapment in various morphological types could be further studied using living subjects especially in those involved in violent overhead sports. Thus, the knowledge gained is important during surgical interventions of the region to predict and prevent complications, and also for etiological diagnosis in patients coming with suprascapular neuropathy.
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    The superficial ulnar artery: an unusual origin and course
    (University of Peradeniya, 2016-11-05) Wickramarathna, A.A.D.; Nanayakkara, T.D.; Alahakoon, A.M.B.D.; Nasim, F.N.; Herath, P.P.B.; Ekanayaka, E.M.K.G.B.K.; Gunasena, H.R.; Dissanayake, J.K.
    The brachial artery which is the continuation of the axillary artery divides into radial and ulnar branches at the level of the neck of the radius in the cubital fossa. Ulnar artery passes deep to the deep head of pronator teres, fibrous arch of the flexor digitorum superficialis muscle and median nerve. Running medially with ulnar nerve on its ulnar side it enters the palm to continue as the superficial palmar arch. Superficial ulnar artery (SUA) is a rare anatomical variation where the artery runs close to a major vein throughout its course. Therefore, it is at risk of damage during interventions such as venepuncture. During the routine dissection of an adult male cadaver in the Department of Anatomy, Faculty of Medicine, Peradeniya, an unusual origin and course of ulnar artery was found on the left side. The origin of the SUA was from the 2nd part of axillary artery just proximal to the confluence of medial and lateral roots of the median nerve. It had a course medial to the median nerve immediately underneath the deep fascia and passed onto the forearm above the forearm flexor muscles. Having a superficial course in the forearm closely related to the basilic vein, it came in to the normal position between ulnar nerve and flexor carpi ulnaris tendon at mid forearm level. According to literature SUA has been described to be arising directly from the axillary or brachial artery. In some instances the brachial artery too adapts a superficial course and gives rise to SUA which is also known as superficial brachioulnar artery. Variations in the arterial system in extremities are a major clinical concern, especially in surgery, venepuncture and interventional radiology. Accidental arterial cannulations at ventromedial forearm could occur during anaesthesia. Accidental intra-arterial injection of some drugs may lead to gangrene in the distal parts of the limb. Therefore, it is important to understand its occurrence, the types and course of such variations in different populations to prevent such iatrogenic damage which may end up in consequences such as loss of a part of a limb.