Surgical Anatomy of the Medial Antebrachial Cutaneous Nerve: Clinical Application in Ulnar Nerve Decompression Surgery in the Elbow

Introduction Lesion to the posterior branch of the medial antebrachial cutaneous nerve (MACN) is one of the causes of revision of the ulnar nerve decompression surgery in the elbow.To avoid the morbidity associated with this injury, cadaver dissections were performed to identify this branch in its course through the ulnar tunnel. Methods We included 20 upper extremities of fresh cadaveric specimens. The posterior branch of the MACN was identified proximal to medial epicondyle and followed past the ulnar tunnel. The number of ramifications and their coordinates were recorded in a Cartesian plane, with the medial epicondyle as the central point. Results The posterior branch passed proximal and posterior to the medial epicondyle in all specimens, except one. The average of the adjusted x value is of 30 mm, and of the adjusted y value is -18 mm. Additionally, we determined that the posterior branch passes at an average angle of 30° with respect to the x axis. Conclusion The anatomical descriptions of this branch focused on surgical release of the ulnar nerve in the elbow are limited, and measures are only described in the horizontal plane (from proximal to distal). Schematizing the anatomy of this branch in its course throughout the ulnar tunnel will facilitate its identification during the procedures. However, variability and asymmetry in the branching pattern should be considered.

Incidence and documentation of ear lobe numbness after parotidectomy: our 20 years' experience

Introduction: Parotidectomy carries a risk of postoperative complications including facial nerve palsy and Frey’s syndrome. Less attention, however, has been given to the management of the greater auricular nerve (GAN) during parotidectomy. Providing sensory supply to the auricle, the greater auricular nerve is often sacrificed for access to the parotid gland during surgery. This results in anaesthesia and paraesthesia of the ear lobe and significant patient morbidity. Aim: To review the electronically available documentation of post-parotidectomy ear lobe numbness in our follow-up clinic letters of the past 20 years. Methods: For this retrospective case series our departmental database of over 850 patients undergoing parotidectomy was used as the primary data source. The information collected from electronic records included documentation of intraoperative details, post-operative recovery and incidence of ear lobe numbness post-operatively. The current study was completed between October and November 2020. SPSS and Excel were used for data collection and analysis. Results: The incidence of ear lobe numbness was found to be higher in the patient cohort whose posterior branch of the GAN had been sacrificed during surgery (58% compared to 46%). This agrees with the published literature that preservation of the posterior branch of the GAN decreases the post-operative sensory deficit to the auricle. However, this audit was limited by the incomplete recording of GAN sacrifice intra-operatively and post-operative GAN dysfunction. Discussion: As any tissue removed, added or altered in surgery requires accurate record-keeping, the outcome of the greater auricular nerve during parotidectomy should always be included in the operation notes. A proforma made available within the department may allow for a standardised recording of recognised complications.

The modified bilobed flap for reconstructing sacral decubitus ulcers

Background Sacral pressure ulcers are associated with high morbidity and, in some cases, result in mortality from severe sepsis. Local flaps are frequently used for reconstruction of stage III and IV pressure ulcers. An ideal flap should be simple to design, have a reliable vascular supply and minimal donor site morbidity. Our study evaluates the use of a bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery to reconstruct the sacral pressure ulcer. Case presentation We performed a retrospective analysis of paraplegic patients with sacral pressure ulcers treated with our bilobed flaps from January 2015 to December 2019. A description of our management, operative protocol, outcome and complications is outlined. Seven paraplegic patients (6 male, 1 female; average age 53.1 years) with sacral pressure ulcers were treated with our bilobed flap based on the superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery. The average size of the pressure ulcers was 7 × 5 cm (range 6.2 × 4.5 cm to 11 × 10 cm). All 7 flaps survived. The patients were followed up for 12 months without significant complications, such as flap necrosis or recurrence. Conclusions The superficial branch of the superior gluteal artery or the posterior branch of the fourth lumbar artery reliably supplies the bilobed flap. The superior cluneal nerve can be included in the design. The technique is simple and reliable. It should be included in the reconstructive algorithm for the management of sacral pressure ulcers.

Desmicola lamdongensis sp. n. (Oxyuridomorpha: Thelastomatidae) from Vietnamese wood-burrowing cockroaches (Panesthiinae)

A new thelastomatid species, Desmicola lamdongensis sp. n. from the hindgut of Panesthiinae cockroaches collected in Bi Doup-Nui Ba National Park, Vietnam is described and illustrated. Males of the new species are characterized by seven to eight modified ventrally projected cuticular annuli on the posterior third of body and the straight spicule with a pointed distal tip; females are distinguished by the presence of tiny circular protrusions on the lip surface, three setiform sensilla as interlabial formations, horseshoe-shaped amphids and smooth oval egg-shells. D. lamdongensis sp. n. differs from the rest of Desmicola species in having males with ventrally projected cuticular annuli on the posterior body third vs. semispherical ventral cuticular protuberance. Similarly to females of other species of the genus, females of D. lamdongensis sp. n. possess a seminal receptacle only on the posterior branch of the reproductive system that allows them to produce a mixture of fertilized and non-fertilized eggs among their progeny. A key to species of Desmicola based on females is given. Posterovulva danieli Spiridonov & Ivanova, 1998 is regarded as D. danieli n. comb. in accordance with the latest revision of the genus (Adamson & Van Waerebeke 1992).

Description of Tylencholaimus discus sp. n. (Nematoda, Dorylaimida, Tylencholaimidae) from Iran

A new species of the genus Tylencholaimus, collected in natural areas of Iran, is described and illustrated, including SEM observations. Tylencholaimus discus sp. n. is characterized by its 0.65–0.76 mm long body, lip region offset by weak constriction and 7–7.5 µm broad with a conspicuous perioral disc, odontostyle 6–7 µm long, odontophore 9–10.5 µm long and visibly flanged rather than knobbed, neck 230–259 µm long with anterior region weakly muscular and basal expansion 98–125 µm long or occupying 42–49% of total neck length, female genital system mono-prodelphic, posterior branch reduced to a uterine sac 2–20 µm long or much shorter (0.1–0.6 times) than body diameter but very occasionally consisting of uterus, sphincter and a small terminal mass all together measuring 35–40 µm long, V = 65–74, tail short and rounded (13–17 µm, c = 41–57, c’ = 0.6–0.8), and male unknown.