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Background Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae. Materials and methods Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed. Results The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors. Conclusion Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.

Background Sensory innervation to the shoulder provided by the distal suprascapular nerve (dSSN) remains the subject of debate. The purpose of this study was to establish consensus with respect to the anatomic features of the sensory branches of the dSSN. The relevant hypothesis was that the dSSN would give off 3 sensory branches providing innervation to the posterior glenohumeral (PGH) capsule, the subacromial bursa, in addition to the coracoclavicular and acromioclavicular ligaments. Methods The division, course, and distribution of the sensory branches that originated from the dSSN and innervated structures around the shoulder joint were examined macroscopically by dissecting 37 shoulders of 19 fresh-frozen cadavers aged of 83.0 years (range, 74-98 years). Results The 37 dSSN provided 1 medial subacromial branch (MSAb), 1 lateral subacromial branch (LSAb), and 1 PGH branch (PGHb) to the shoulder joint. This arrangement allowed for bipolar—MSAb and LSAb—innervation of the subacromial bursa, acromioclavicular (MSAb and LSAb) and coracoclavicular (MSAb) ligaments, as well as the PGH capsule (PGHb). Conclusions The dSSN provided 2 subacromial branches and 1 PGHb to the shoulder joint. This arrangement allowed for bipolar—MSAb and LSAb—innervation of the subacromial bursa, acromioclavicular and coracoclavicular ligaments, as well as the PGH capsule.

Background A bone landmark–based approach (LBA) to the distal suprascapular nerve (dSSN) block is an attractive “low-tech” method available to physicians with no advanced training in regional anesthesia or ultrasound guidance. The primary aim of this study was to validate the feasibility of an LBA to blockade of the dSSN by orthopedic surgeons using anatomic analysis. The secondary aim was to describe the anatomic features of the sensory branches of the dSSN. Materials and methods An LBA was performed in 15 cadaver shoulders by an orthopedic resident. Then, 10 mL of methylene blue–infused 0.75% ropivacaine was injected around the dSSN; 2.5mL of red latex solution was also injected to identify the position of the needle tip. The division and distribution of the sensory branches that originate from the suprascapular nerve were described. Results The median distance between the dSSN and the site of injection was 1.5 cm (0-4.5 cm). The most common injection site was at the proximal third of the scapular neck (n = 8). Fifteen dSSNs were stained proximal to the origin of the most proximal sensory branch. All 15 dSSNs gave off 3 sensory branches that innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. Conclusions An LBA for anesthetic blockade of the dSSN by an orthopedic surgeon is a simple, reliable, and accurate method. Injection close to the suprascapular notch is recommended to involve the dSSN proximally and its 3 sensory branches.

Background: The inferior turbinate is probably the most important anatomical structure within the nasal airway. However, relatively little is known concerning its 3D anatomy. Complete removal of the IT may lead to severe functional disorders and reconstruction is often necessary. Methods: We performed an anatomical study using modern 3D reconstruction tools (Amira 5.4.2 software). The study was conducted on 200 inferior turbinates obtained from CT-scanned images. Metric and morphological analyses were performed. Our aim was to assess 3D polymorphism of the inferior turbinate in humans, and to evaluate gender dimorphism and age-related differences. Results: Anatomical characteristics of the inferior turbinate were poorly heterogeneous. Metric analyses revealed no gender dimorphism or age-related differences, except in the elderly, where the inferior turbinate was usually less curved. Morphological analyses defined that the mean shape was related to age and gender. Differences were limited and are summarized in this manuscript. Conclusions: This very reproducible methodology may have clinical applications regarding, e.g., sinonasal cancer or empty-nose syndrome.

In radical cystectomy, the surgeon generally ligates the umbilical artery at its origin. This artery may give rise to several arteries that supply the sexual organs. Our aim was to evaluate pelvic and perineal devascularisation in women after total cystectomy. We carried out a prospective anatomical and radiological study. We performed bilateral pelvic dissections of fresh adult female cadavers to identify the dividing branches of the umbilical artery. In parallel, we examined and compared the pre- and postoperative imaging investigations [magnetic resonance imaging (MRI) angiography] in patients undergoing cystectomy for benign disease to quantify the loss of pelvic vascularisation on the postoperative images by identifying the occluded arteries. The anatomical study together with the radiological study visualised 35 umbilical arteries (n = 70) with their branching patterns and collateral arteries. The uterine artery originated from the umbilical artery in more than 75% of cases (n = 54) of the internal pudendal artery in 34% (n = 24) and the vaginal artery in 43% (n = 30). The postoperative MRI angiograms showed pelvic devascularisation in four patients. Devascularisation was dependent on the level of surgical ligation. In the four patients with loss of pelvic vascular supply, the umbilical artery had been ligated at its origin. The umbilical artery gives rise to various branches that supply the pelvis and perineum. If the surgeon ligates the umbilical artery at its origin during total cystectomy, there is a significant risk of pelvic and perineal devascularisation.

Purpose Total elbow arthroplasty for the treatment of patients with severe elbow osteoarthritis is associated with postoperative activity limitations and risk of midterm complications. Elbow denervation could be an attractive therapeutic option for young, active patients. The aim of our study was to assess the feasibility of selective total elbow denervation via 2 anteriorly based approaches. Methods Selective total elbow denervation was performed in 14 cadaver elbows by 2 fellowship-trained elbow surgeons. Lateral and medial approaches to the elbow were used. The length of skin incisions and the minimum distance between them were noted. The number of articular branches identified and their respective distances from the lateral or medial epicondyle of the humerus were recorded. Results The anterolateral and anteromedial approaches allowed for the identification of all mixed and sensory nerves in all 14 cases. The mean number of resultant articular branches per cadaver was 1 for the musculocutaneous nerve , 2 (range, 1–3) for the radial nerve , 1 (range, 1–3) for the posterior cutaneous nerve of the forearm, 2 (range, 1–3) for the ulnar nerve , and 2 (range, 1–3) for the medial antebrachial cutaneous nerve; the collateral ulnar nerve was connected directly to the capsule. The length of the medial and lateral incisions was 15 cm (range, 12–18 cm) and 12 cm (range, 10–16 cm), respectively. The mean minimum distance between the incisions was 7.5 cm (range, 6.7–8.5 cm). Conclusions The findings suggest that selective elbow denervation via 2 approaches is feasible. Clinical relevance Selective elbow denervation via 2 approaches is feasible. Surgeons should target the articular branches of the musculocutaneous, radial, ulnar, and collateral ulnar nerves, posterior cutaneous nerve of the forearm, as well as medial antebrachial cutaneous nerves when carrying out this procedure.

Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty-one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano-receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

Introduction The aim of this work was to analyze the transvaginal approach in minimally invasive surgery in terms of anatomical, histopathological and functional characteristics, to show the safety of this surgical approach. Methods Anatomical study was first conducted by dissection on fresh cadavers of adult women in order to measure the distance between the vaginal incision and the ureters, rectum and hypogastric nerves. In parallel, an anatomopathological study detailed and compared the macroscopic and histological characteristics of the anterior and posterior surfaces of vaginal samples obtained from cadavers and patients in the context of a hysterectomy for benign pathology. Finally, patients who underwent a transvaginal approach nephrectomy or transplantation were retrospectively enrolled for a clinical examination and an evaluation of their sexuality. Results The anatomical study conducted on seventeen cadavers showed that the posterior vaginal fornix was remote from the major structures of the pelvis such as rectum, ureters, hypogastric plexus, which allowed a safe incision. Mechanical tests further demonstrated that the posterior vaginal fornix was more extensible than the anterior and histological features showed no major vascular or nervous structures. Ten patients were included in the retrospective clinical study. Long-term follow up showed no negative impact on the texture of the vagina or satisfaction from sexual intercourse. Conclusions Anatomical, histological and functional data supported that transvaginal approach by posterior vagina fornix incision is a minimally invasive surgery that can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indication for this approach.

Introduction Le nerf suprascapulaire (NSS) assure la majorite de l’innervation sensitive de l’epaule. Cependant, la distribution des branches sensitives du NSS reste encore debattue. L’objectif etait de proposer une description consensuelle des branches sensitives du NSS. Methodes Les divisions, les courses, et la distribution des branches sensitives du NSS innervant les structures de l’epaule ont ete examinees macroscopiquement par la dissection de 37 epaules de 19 cadavres frais âges en moyenne de 83 ans (74–89). Resultats Les 37 NSS donnaient 1 branche sous acromiale mediale (bSAM) et 1 branche sous acromiale laterale (bSAL), et une branche gleno-humerale posterieure (bGHP) a l’epaule. Cette distribution permettait une innervation bipolaire – mediale (bSAM) et laterale (bSAL) – de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaires (bSAM), et de la capsule gleno-humerale posterieure (bGHP). Conclusion Le NSS donnait deux branches sous acromiales et une branche gleno-humerale posterieure a l’epaule. Cette distribution permettait une innervation bipolaire – mediale et laterale – de la bourse sous acromiale, des ligaments acromio- et coraco-claviculaires, et de la capsule gleno-humerale posterieure.

The origin of the middle meningeal artery (MMA) may vary although it can arise from the ophthalmic artery (OA) with a 0.5% prevalence. We report the exceptional bilateral asymmetric origin from the OAs that has not previously been reported in the literature. Surgeons should be aware of this variation as it could be crucial in the setting of an endovascular approach for meningeal lesions, as in our observation. A 50-year-old male underwent a preoperative cerebral digital subtracted angiography that incidentally revealed MMAs arising from the OA on both sides. In fact, the origin was asymmetric because it was complete on the right side with the anterior and posterior branches of the MMA arising from the OA, whereas it was partial on the left side, with only the anterior branch arising from the OA. The CT scan showed the absence of the foramen spinosum only on the right side. This paper discusses the unique anatomic variation in the light of MMA embryology and its different origins. Knowledge of this variation may have a practical impact in cases of cerebral embolization.

Resume Le but de ce travail experimental a partir de 16 pieces anatomiques etait de valider la ligne bi-epicondylienne (LBE) et la ligne de fond de trochlee (LW) dont Whiteside a souligne l’orthogonalite constante a la precedente, en prenant comme reference finale l’evaluation tomodensitometrique. Le logiciel VectorVision Knee 1.6 du navigateur Brain LAB (Feldkirchen, Allemagne) a ete utilise pour enregistrer les donnees morphometriques et spatiales par trois chirurgiens et deux fois de suite dans les conditions de la navigation operatoire de pose d’une prothese totale de genou (PTG). Trois axes determines grâce a la saisie tactile du pointeur : la LBE, la tangente aux condyles posterieurs (TCP) et la LW. L’ordinateur deduisait l’angle ACP entre LBE et TCP et l’angle de Whiteside (AW) entre la LW et la perpendiculaire a la LBE. Les valeurs de moyennes naviguees de l’ACP etaient de 2,43° pour l’operateur junior, de 4,31° par l’operateur senior 1 et de 5,28° par l’operateur senior 2 et de 5,53° en tomodensitometrie. Les valeurs moyennes de l’AW etaient de 0,76 °pour l’operateur junior, de 1,67° pour le senior 1, de 0,9° pour le senior 2et de 0,6° au scanner. L’analyse des variances par le test de Kruskal-Willis a identifie une source de variabilite entre les femurs et pour l’angle AW une fiable reproductibilite inter operateur et repetabilite intraobservateur de respectivement de 0, 39/7,59 et 1,82. Pour l’angle ACP la variance de la reproductibilite inter operateur, la repetabilite intraobservateur et des constantes des pieces anatomiques etaient respectivement de 5, 01/6,29 et 4,58. En accord avec la litterature, cette etude experimentale valide l’hypothese de Whiteside : en premiere approximation la la ligne de fond de trochlee est perpendiculaire a la ligne qui joint les deux reliefs epicondyliens mais des variations individuelles. De meme, la determination sous-navigation par reperage tactile des reliefs epicondyliens n’est pas fiable. L’interdependance de la coupe condylienne posterieure et de l’equilibre ligamentaire est l’option personnalisee a conseiller.

Introduction/Objectifs La neurostimulation du nerf hypoglosse (XII) est actuellement une alternative therapeutique prometteuse dans le traitement du syndrome d’apnees-hypopnees obstructives du sommeil. Une stimulation supra-selective des branches terminales du XII, dont la branche a destinee de la portion horizontale du muscle genioglosse (GGh), permettrait son optimisation. Nous avons defini a partir des donnees recentes de la litterature [1] , [2] un protocole de reperage percutane standardise permettant la localisation des branches destinees a GGh. Materiels/patients et methodes Dix sujets cadaveriques frais ont ete disseques apres injection percutanee bilaterale d’un colorant. Le protocole d’injection etait standardise et avait pour objectif de verifier la presence de la branche GGh dans le volume colore. Les coordonnees du point moteur, retenu comme la penetration de la branche GGh dans le muscle genioglosse, et son ecart par rapport au centre de la zone coloree etaient mesures dans un repere tridimensionnel dont l’origine etait situee a la moitie de la distance genio-hyoidienne (GH). Resultats La ou les branches GGh etaient incluses dans le volume colore dans 50 % des cas, 65 % chez les femmes contre 22 % chez les hommes (p = 0,046). Seulement 27 % des branches etaient incluses chez les patients ayant une distance GH≥50 mm contre 67 % chez ceux ayant une distance GH Conclusions Le point moteur GGh a ete colore dans au moins 50 % des cas dans notre etude et cela avec precision selon l’axe GH. Cependant, des ajustements sont necessaires en fonction de l’indice de masse corporelle, de la distance GH ou encore du perimetre cervical.

The accidental discovery of a retrotracheal left pulmonary artery in a 4-month-old infant encouraged us to review the various embryologic theories concerning this very rare anomaly and perform an anatomic update in order to better define surgical treatment. Nathan underwent surgery for a bilateral inguinal hernia at the age of 4 months. The postoperative period was marked by malaise associated with dyspnoea, stridor, tachycardia and sweating. A X-ray of the thorax, oesophageal transit and angio scan presented an intertracheo-oesophageal left pulmonary artery and a reimplantation of the left pulmonary artery was successfully performed. A retrotracheal left pulmonary artery is a very rare malformation. From development of pulmonary vascularisation, three embryologic theories have been advanced to explain this anomaly. From an anatomic point of view, Landing et al. proposed in 1982 a classification system of retrotracheal left pulmonary artery. Today, current radiological techniques not only provide a precise diagnosis but also make it possible to define appropriate care for the different types of this malformation.

Introduction En 2014, Delclaux et al. [1] ont rapporte un cas clinique de double neurotisation du nerf ulnaire selon la technique de Battiston et Lanzetta [2] , modifiee par l’utilisation du nerf interosseux posterieur (NIOP) permettant une recuperation notee S2 a 18 mois de recul. Le but de la presente etude est d’evaluer la faisabilite d’un transfert du NIOP sur la branche sensitive du nerf ulnaire (BSNU) afin de restaurer la sensibilite de protection dans la region hypothenarienne. Materiel et methode Une etude anatomique a ete realisee par 2 operateurs independants sur 16 poignets cadaveriques frais. Les branches sensitives et motrices du NU ont ete dissequees sous lunettes microchirurgicales. Une dissection fasciculaire, de distal en proximal du NU a ete realisee. Le NIOP a ete disseque de distal en proximal par une voie d’abord dorsale. Le NIOP a ete ensuite recupere en anterieur, via la membrane interosseuse. Les fascicules sensitifs palmaires ulnaires ont ete sutures aux fascicules du NIOP par des points separes a l’Ethilon 10/0. La largeur, le nombre de fascicules (NIOP, BSNU), la longueur de l’intraneurodissection du NU, ont ete mesures. Enfin, une analyse histologique, des fascicules sutures, a ete realisee. Resultats La suture directe entre la BSNU et le NIOP a ete possible pour chaque cas. La longueur de l’intraneurodissection du NU etait en moyenne de 40 mm (30–60 mm). La largeur (3,95 mm ± 0,72 versus 4,95 mm ± 0,94) et le nombre de fascicules du NIOP (8,33 ± 2,99 versus 18,58 ± 6,55) sont adaptes pour realiser cette technique. En revanche, l’analyse histologique a montre une perte axonale totale de 6 NIOP au niveau de la zone a suturer soit 37,5 % d’echec de la technique. Conclusions La presente etude confirme la faisabilite anatomique d’une neurotisation sensitive de la BSNU par le NIOP a condition d’eviter une perte axonale significative. Celle-ci peut etre expliquee par une traction excessive sur le NIOP.

Introduction En 2014, S. Delclaux et al. ont rapporte un cas de double neurotisation du nerf ulnaire selon la technique de Battiston et Lanzetta, modifiee par l’utilisation du nerf interosseux posterieur (NIOP) permettant une recuperation classee S2 a 18 mois de recul. Le but de la presente etude est d’evaluer la faisabilite d’un transfert du NIOP sur la branche sensitive superficielle du nerf ulnaire (BSNU) afin de restaurer la sensibilite de protection dans la region hypothenarienne. Materiel et methode La technique chirurgicale a ete realisee par 2 operateurs independants (PL, LD) sur 16 poignets cadaveriques frais. Les branches sensitives et motrices du NU ont ete dissequees sous lunettes microchirurgicales. Une dissection fasciculaire, de distal en proximal du NU a ete realisee. Le NIOP a ete aborde par une voie d’abord dorsale centree sur l’articulation radio-ulnaire distale et disseque de distal en proximal. Le transfert du NIOP etait realise au travers la membrane interosseuse. Les fascicules sensitifs palmaires du 4 e et 5 e rayon ont ete sutures aux fascicules du NIOP par des points separes a l’Ethilon 10 0. La largeur des deux nerfs, le nombre de fascicules (NIOP, BSNU) et la longueur de l’intraneurodissection du NU ont ete mesures (PL, LD). L’analyse histologique des fascicules sutures a ete realisee par un medecin anatomopathologiste (MCS). Resultats La suture directe entre la BSNU et le NIOP a ete realisable pour chaque specimen. La longueur de l’intraneurodissection du NU etait en moyenne de 40 mm (30–60 mm). La largeur moyenne etait de 3,95 mm ± 0,72 (NIOP) versus 4,95 mm ± 0,94 (BSNU), le nombre moyen de fascicules etait de 8,33 ± 2,99 (NIOP) versus 18,58 ± 6,55 (BSNU). Parmi les fascicules, 60 % ± 35 comportaient 0 axones. Cinq NIOP comportaient 100 % fascicules sans axone. Conclusions L’etude confirme la faisabilite anatomique d’une neurotisation de la BSNU par le NIOP mais le potentiel de recuperation est limite par la faible reserve axonale du NIOP. Cependant, cette technique semble etre une alternative de choix pour la neurotisation de la BSNU.

The accidental discovery of a retrotracheal left pulmonary artery in a 4-month-old infant encouraged us to review the various embryologic theories concerning this very rare anomaly and perform an anatomic update in order to better define surgical treatment. Nathan underwent surgery for a bilateral inguinal hernia at the age of 4 months. The postoperative period was marked by malaise associated with dyspnoea, stridor, tachycardia and sweating. A X-ray of the thorax, oesophageal transit and angio scan presented an intertracheo-oesophageal left pulmonary artery and a reimplantation of the left pulmonary artery was successfully performed. A retrotracheal left pulmonary artery is a very rare malformation. From development of pulmonary vascularisation, three embryologic theories have been advanced to explain this anomaly. From an anatomic point of view, Landing et al. proposed in 1982 a classification system of retrotracheal left pulmonary artery. Today, current radiological techniques not only provide a precise diagnosis but also make it possible to define appropriate care for the different types of this malformation.

La necrose vulvaire post-traumatique est une complication rare (2 %) et seulement decrite lors de fractures du bassin avec lesion de l’artere pudendale interne par atteinte de la branche ischiopubienne. Sa survenue apres reduction d’une fracture de l’extremite superieure du femur n’est a ce jour pas citee dans la litterature. Nous rapportons le cas d’une jeune patiente de 17 ans, sans antecedent particulier ayant presente une fracture spontanee du col femoral gauche. Il a ete realise en urgence la mise en place d’une traction trans-tibiale apres reduction de la fracture. La patiente a presente une embolie graisseuse a minima qui a fait differer le geste chirurgical. Une osteosynthese du femur par clou, sur billot place en appui pubien a ete realisee 72 h apres la prise en charge initiale. Les suites operatoires ont ete compliquees d’un œdeme vulvaire diagnostique en postoperatoire immediat ayant evolue sous la forme d’une necrose de la petite levre gauche. Dix seances de caisson hyperbare ont ete realisees en association a une detersion des zones de necrose toutes les 48 h sous anesthesie generale. Malgre le traitement precoce, une resection complete de la petite levre gauche a du etre realisee. La theorie anatomique de lesion de l’artere pudendale interne a ete ecartee dans les fractures extra capsulaires en depit des variations de son origine mises en evidence par une revue de la litterature. Une atteinte par compression sur le billot au cours de la chirurgie a donc ete retenue. La priorite de la discussion anatomique est basee sur l’etude du trajet de l’artere pudendale interne et de son site de compression afin de discuter d’une modelisation de l’appui pubien lors de ces manœuvres. L’objectif etant la preservation fonctionnelle de l’erection chez l’homme et de la sensibilite perineale chez la femme.

S3, S6 and S10 are the most commonly used agents for tissue plastination. Surprisingly, their chemical structures are not known. We therefore decided to fully characterize these products by standard analytical methods: multinucleus magnetic resonance, infrared spectroscopy and size exclusion chromatography. These experiments have shown that Biodur S10 is a polydimethylsiloxane with a molecular weight of 27,200 and silanol functionalities, Biodur S6 is tetraethoxysilane, and Biodur S3 is a mixture the main component of which is dibutyltindilaurate.

Treatment of carpal tunnel syndrome consists in decompression of the median nerve by section of the flexor retinaculum. Usually, this surgery improves the disease with disappearance of the symptoms. However, some painful sequelae may remain such as painful discharges, paresthesiae or permanent anesthesia of the base of the thumb or of the scar related to an injury of the palmar cutaneous branch of the median nerve (PCBm). This study was performed to define the accurate emergence and the anatomic characteristics of this nerve in relation to stable landmarks. Moreover, it assessed the importance of the visual identification of the branch during section of the flexor retinaculum. Thirty-five hands were dissected under macroscopic examination and under magnification of the thinnest branches. Measurements were performed with a caliper and the forearm in supination. Determination of the bistyloid line showed variability in the location of the distal wrist crease. Thus, it could not be used as a landmark to locate the PCBm. The palmar cutaneous branch is the distal collateral branch of the median nerve in the forearm. It emerges on its radial side, on average 44.3 mm before the bistyloid line. It courses in line with the third finger and perforates the antebrachial aponeurosis about 5.7 mm from the bistyloid line. This emergence can be located in the palm, where it can be injured if the incision is performed in line with the third finger. The PCBm usually ends in the palm by division into two or three branches. The lateral branch supplies the skin of the thenar eminence while the medial, usually shorter branch supplies the midline part of the palm. This study has shown the importance of performing the cutaneous incision in line with the fourth finger to avoid injury to the PCBm.