A Variation of the Double Deep Fibular Nerve with Multiple Connections to the Superficial Fibular Nerve on the Dorsal Aspect of the Foot
Yıl 2024,
, 144 - 147, 30.08.2024
Merve Küçüker
,
Hüma Kaçar
,
Kemal Emre Özen
Öz
In this case report, we aim to present our observation of a rare variation on the dorsum of the foot, including the double deep fibular (peroneal) nerve and its connections to superficial nerves. The cutaneous nerves of both feet ' dorsum were examined during a routine dissection on a formalin-fixed adult male cadaver. During the dissection of the dorsum of the right foot, it was observed that the deep fibular nerve (DFN) surfaced at two distinct points by piercing the investing fascia. Then, these two branches converged, and DFN had connections at three different points with the superficial fibular (peroneal) nerve (SFN). However, the superficial nerve anatomy of the dorsum of the left foot exhibited the anatomical structure commonly described in classical textbooks. To the best of our knowledge, the variation of double DFN with multiple connections to the SFN has not been previously described in the literature. Understanding the innervation of the dorsum of the foot may be clinically substantial in preventing nerve injuries during surgical interventions. The knowledge regarding rare superficial nerve variations may contribute to the success of anaesthesia applications, especially in the ankle and dorsum of the foot.
Kaynakça
- 1. Robert J Spinner, Benjamin M Howe. Leg. In: Susan Standring, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed: Elsevier; 2016. p. 1414-6.
- 2. Malikov S, Casanova D, Magualon G, Branchereau A. Surgical anatomy of the lateral supramalleolar flap in arteritic patients: an anatomic study of 24 amputation specimens. Surg Radiol Anat. 2003;25(2):89-94. DOI: 10.1007/s00276-003-0098-x.
- 3. Arshad Z, Aslam A, Shdefat SA, Khan R, Jamil O, Bhatia M. Complications following ankle arthroscopy. Bone Joint J. 2023;105-B(3):239-46. DOI: 10.1302/0301-620x.105b3.bjj-2022-0796.r1.
- 4. Cheredath A, Ankolekar VH, Sylvan DSA. Variable patterns of the cutaneous innervation of the dorsum of the foot and its clinical implication. Ann Med Surg (Lond). 2021;66:102404. DOI: 10.1016/j.amsu.2021.102404.
- 5. Gupta C, Kiruba NL, Dsouza AS, Radhakrishnan P. A morphological study to note the variable patterns of cutaneous innervation on the dorsum of foot in south Indian human foetuses and its clinical implications. Adv Biomed Res. 2013;2:15. DOI: 10.4103/2277-9175.107980.
- 6. Kosinski C. The Course, Mutual Relations and Distribution of the Cutaneous Nerves of the Metazonal Region of Leg and Foot. J Anat. 1926;60(Pt 3):274-97. PMID: 17104102
- 7. Nayak VS, Bhat N, Nayak SS, Sumalatha S. Anatomical variations in the cutaneous innervation on the dorsum of the foot. Anat Cell Biol. 2019;52(1):34-7. DOI: 10.5115/acb.2019.52.1.34.
- 8. Thomson A. Second Annual Report of the Committee of Collective Investigation of the Anatomical Society of Great Britain and Ireland for the Year 1890-91. J Anat Physiol. 1891;26(Pt 1):76-93. PMID: 17231960
- 9. Wahee P, Aggarwal A, Harjeet, Sahni D. Variable patterns of cutaneous innervation on the dorsum of foot in fetuses. Surg Radiol Anat. 2009;32(5):469-75. DOI: 10.1007/s00276-009-0587-7.
- 10. FIPAT. Terminologia Anatomica. 2nd ed: Federative International Programme for Anatomical Terminology; 2019. 285-6 p.
- 11. Lawrence SJ, Botte MJ. The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int. 1995;16(11):724-8. DOI: 10.1177/107110079501601110.
- 12. Ucerler H, Ikiz ZAA. The Variations of the Sensory Branches of the Superficial Peroneal Nerve Course and its Clinical Importance. Foot Ankle Int. 2005;26(11):942-6. DOI: 10.1177/107110070502601108.
Ayağın Dorsal Yüzünde Nervus Fibularis Superficialis ile Çoklu Bağlantılara Sahip Çift Nervus Fibularis Profundus Varyasyonu
Yıl 2024,
, 144 - 147, 30.08.2024
Merve Küçüker
,
Hüma Kaçar
,
Kemal Emre Özen
Öz
Bu vaka raporunda ayak sırtında çift nervus fibularis (peronealis) profundus (DFN) ve yüzeyel sinirlerle olan bağlantılarını içeren nadir bir varyasyona ilişkin gözlemimizi sunmayı amaçladık. Formalinle fikse edilmiş yetişkin bir erkek kadavra üzerinde rutin eğitim diseksiyonu sırasında her iki ayak sırtının kutanöz sinirleri incelendi. Sağ ayak sırtı diseksiyonu sırasında DFN’nin fascia investiens’i iki ayrı noktada delerek yüzeye çıktığı görüldü. Daha sonra bu iki dal birleşti ve DFN'nin nervus fibularis (peronealis) superficialis (SFN) ile üç farklı noktada bağlantısı oldu. Ancak sol ayak sırtının yüzeyel sinir anatomisi, klasik ders kitaplarında yaygın olarak tanımlanan anatomik yapıyı sergiliyordu. Bildiğimiz kadarıyla, çift DFN'nin SFN'ye çoklu bağlantılarla varyasyonu literatürde daha önce tanımlanmamıştır. Ayak sırtının innervasyonunun anlaşılması, cerrahi müdahaleler sırasında sinir yaralanmalarının önlenmesi açısından klinik açıdan önemli olabilir. Nadir görülen yüzeysel sinir varyasyonlarının bilinmesi, özellikle ayak bileği ve ayak sırtında anestezi uygulamalarının başarısına katkı sağlayabilir.
Etik Beyan
Çalışmamız, tıp fakültesi anatomi eğitim laboratuvarında bulunan, ulusal yasal ve etik prosedürler tamamlanarak elde edilmiş kadavra üzerinde yapılmıştır. Bu nedenle ayrı bir etik kurul onay belgesi bulunmamaktadır.
Kaynakça
- 1. Robert J Spinner, Benjamin M Howe. Leg. In: Susan Standring, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed: Elsevier; 2016. p. 1414-6.
- 2. Malikov S, Casanova D, Magualon G, Branchereau A. Surgical anatomy of the lateral supramalleolar flap in arteritic patients: an anatomic study of 24 amputation specimens. Surg Radiol Anat. 2003;25(2):89-94. DOI: 10.1007/s00276-003-0098-x.
- 3. Arshad Z, Aslam A, Shdefat SA, Khan R, Jamil O, Bhatia M. Complications following ankle arthroscopy. Bone Joint J. 2023;105-B(3):239-46. DOI: 10.1302/0301-620x.105b3.bjj-2022-0796.r1.
- 4. Cheredath A, Ankolekar VH, Sylvan DSA. Variable patterns of the cutaneous innervation of the dorsum of the foot and its clinical implication. Ann Med Surg (Lond). 2021;66:102404. DOI: 10.1016/j.amsu.2021.102404.
- 5. Gupta C, Kiruba NL, Dsouza AS, Radhakrishnan P. A morphological study to note the variable patterns of cutaneous innervation on the dorsum of foot in south Indian human foetuses and its clinical implications. Adv Biomed Res. 2013;2:15. DOI: 10.4103/2277-9175.107980.
- 6. Kosinski C. The Course, Mutual Relations and Distribution of the Cutaneous Nerves of the Metazonal Region of Leg and Foot. J Anat. 1926;60(Pt 3):274-97. PMID: 17104102
- 7. Nayak VS, Bhat N, Nayak SS, Sumalatha S. Anatomical variations in the cutaneous innervation on the dorsum of the foot. Anat Cell Biol. 2019;52(1):34-7. DOI: 10.5115/acb.2019.52.1.34.
- 8. Thomson A. Second Annual Report of the Committee of Collective Investigation of the Anatomical Society of Great Britain and Ireland for the Year 1890-91. J Anat Physiol. 1891;26(Pt 1):76-93. PMID: 17231960
- 9. Wahee P, Aggarwal A, Harjeet, Sahni D. Variable patterns of cutaneous innervation on the dorsum of foot in fetuses. Surg Radiol Anat. 2009;32(5):469-75. DOI: 10.1007/s00276-009-0587-7.
- 10. FIPAT. Terminologia Anatomica. 2nd ed: Federative International Programme for Anatomical Terminology; 2019. 285-6 p.
- 11. Lawrence SJ, Botte MJ. The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int. 1995;16(11):724-8. DOI: 10.1177/107110079501601110.
- 12. Ucerler H, Ikiz ZAA. The Variations of the Sensory Branches of the Superficial Peroneal Nerve Course and its Clinical Importance. Foot Ankle Int. 2005;26(11):942-6. DOI: 10.1177/107110070502601108.