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Pushpa NB, Patra A, Ravi KS, Viveka S, Pushpalatha K, Smitha MC. Reappraisal of the anatomical diversities of the pyramidalis muscle with their potential clinical applicability: cadaveric analysis. Surg Radiol Anat 2024; 46:203-210. [PMID: 38182780 DOI: 10.1007/s00276-023-03278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION The present study examined the morphology and morphometric parameters of the pyramidalis muscle (PM) in detail with their potential applicability in making midline infra-umbilical incisions and biomechanics of the linea alba. METHODS PM was examined in 51 formalin-fixed cadavers (36 males and 15 females), and based on the mode of insertion or the level of apex, the formation or shape of the muscle was classified into nine types (Mori's classification). RESULTS Bilateral PM was more prevalent (39.21%) than unilateral (1.96%) (p = 0.001). All the cases showed side symmetry except one. Mori's type 7 (right PM is higher apex and the left PM with elongated origin) was the most common form. The mean length of PM in males and females was 4.51 ± 0.14 and 3.33 ± 0.12 cm on the right and 4.51 ± 0.11 and 3.26 ± 0.16 cm on the left side. The mean width of right-sided PMs in males and females was 1.90 ± 0.17 and 1.58 ± 0.13 cm and left-sided 1.88 ± 0.14 and 1.55 ± 0.38 cm. The mean of pyramidalis-pubo-umbilical index (PPI) in males and females was 32.82 ± 1.65 and 27.50 ± 1.08, respectively. The mean insertion angle was 24.56 ± 3.07 on right side and 23 ± 2.03 on the left side (p = 0.03). Male predominance existed on right- and left-sided PM length (p < 0.001 and p < 0.001), width (p = 0.001) and PPI (p = 0.001). The strong positive correlation (r = 0.83) between length and width indicates a symmetrical muscle augmentation in the two dimensions. CONCLUSION PM is an inconsistent anatomical structure with persistent morphology. The level and angle of insertion into the linea are crucial in the biomechanics of linea alba. PPI, determining the termination level would be useful to surgeons making midline infra-umbilical incisions.
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Affiliation(s)
- N B Pushpa
- JSS Medical College, JAASHER, Mysore, India
| | - Apurba Patra
- All India Institute of Medical Sciences, Bathinda, India.
| | - K S Ravi
- All India Institute of Medical Sciences, Gorakhpur, India
| | - S Viveka
- Healiosomed Academy, Bangalore, India
| | | | - M C Smitha
- JSS Medical College, JAASHER, Mysore, India
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Vadgaonkar R, Prameela MD, Kumar CG, Blossom V, Tonse M, Murlimanju BV, Pai MM, Prabhu LV. Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications. Anat Cell Biol 2021; 54:178-183. [PMID: 33827991 PMCID: PMC8225473 DOI: 10.5115/acb.20.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022] Open
Abstract
The reconstructive surgeries utilize pes anserinus (PA) tendons, because of their lesser post-operative clinical deficits and donor site morbidity. These surgeries require anatomical knowledge about the extent of PA formation. The goal of this study was to determine the length and width of the PA formation. The objectives were to measure the distance of its upper limit, lower limit, and vertical distance from the tibial tuberosity (TT). The present descriptive cross sectional study included 53 embalmed cadaveric lower extremities. The upper and lower limits of PA were exposed with the careful dissection. Measurements of the dimensions were performed with the help of a digital vernier caliper (Mitutoyo Co., Kanagawa, Japan). The PA length, width, distance of its upper limit, lower limit, and vertical distance of it from the TT were 47.4±13.3 mm, 37.3±7.2 mm, 47.6±12.5 mm, 54.6±10.4 mm, and 39.1±14.2 mm, respectively over the right extremity. The same measurements were 46.3±14.7 mm, 39.1±9.4 mm, 39.1±5.9 mm, 49.5±8.2 mm, and 36.4±12.1 mm, respectively for the left extremity. The extent of PA was observed to be extremely variable. The preoperative knowledge about the dimensions of PA will help the plastic and orthopedic surgeon put the accurate skin incision, decreasing the donor site morbidity and biomechanical instability of the PA grafts. We suggest that, preoperative ultrasound measurement of the PA may help the operating surgeon to prevent the complications like injury to the infrapatellar branch of saphenous nerve.
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Affiliation(s)
- Rajanigandha Vadgaonkar
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M D Prameela
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chettiar Ganesh Kumar
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana Blossom
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mamatha Tonse
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B V Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mangala M Pai
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Latha V Prabhu
- Department of Anatomy, Kasturba Medical College, Mangalore, India.,Manipal Academy of Higher Education, Manipal, Karnataka, India
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