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Venter, Gerda Email
Morphology of the palmaris longus and plantaris muscles employed as flaps in reconstructive surgery
Dr A N Van Schoor
Tendons are frequently used for reconstructive surgery. This includes palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. These two muscles are also considered to be the easiest tendons to harvest, and therefore they remain the ideal choices for plantaris,or tendon grafts. Apart from what is mentioned in the literature, questions remain such as: which characteristics do the palmaris longus and plantaris muscles possess that make them suitable for use as flaps or grafts in reconstructive surgery and; how can knowledge of the characteristics of these muscles improve reconstructive surgery in South Africa? The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence. A statistical significant difference was found between the male and female sample when considering the length of the palmaris longus muscle. When comparing the palmaris longus muscle to the plantaris muscles, it was found that there is a statistical significant difference between them as well. Therefore, although these muscles may look alike, when it comes to the surgical aspect it is suggested that the palmaris longus is used when a wider tendon is preferred and the plantaris muscle when a longer tendon is needed. The prevalence of the palmaris longus and plantaris muscles compared well with studies done on other population groups. No correlation was found between the sex of the cadaver and the prevalence of the palmaris longus and plantaris muscles. In addition it was established that there is no relationship between the prevalence of the palmaris longus and plantaris muscles in the same individual. A possible phylogenetic degenerative trend for the palmaris longus muscle was also examined. After studying various age groups, it was determined that such a trend could not be established for this sample. In conclusion, based on the morphology and prevalence of the palmaris longus and plantaris muscles in a South African population, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery. But it is of utmost importance that the reconstructive surgeon, working on South African patients, remember that both these muscles are subject to variation and not only will it be beneficial to employ proper detection methods to determine the viability of either muscle before considering its suitability in reconstructive surgery but also a sound knowledge of the anatomy of these muscles must be known.
AFRIKAANS : Tendons word dikwels gebruik vir rekonstruktiewe chirurgie. Dit sluit die M. palmaris longus en M. plantaris, die lang ekstensors van die tone en vingers, sowel as die fleksors van die vingers in. Die chirurg moet sy of haar keuse van die skenkertendon baseer op dit wat benodig word, byvoorbeeld tendongrootte, ~lengte en ~breedte. Die mees gesogte tendons in rekonstruktiewe chirurgie is di� van M. palmaris longus en M. plantaris. Hierdie twee spiere word ook geag as die maklikste spiere om te oes / bekom, en daarom bly hulle die ideale keuse vir weefselsnitte of tendon-oorplantings. Afgesien van wat in die literatuur beskryf word, bly die volgende vrae onbeantwoord: Watter eienskappe maak M. palmaris longus en M. plantaris geskik vir die gebruik as weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie en, hoe kan kennis van hierdie eienskappe van di� spiere, rekonstruktiewe chirurgie in Suid-Afrika verbeter? M. palmaris longus en M. plantaris is inderdaad onderworpe aan variasie van die algemene anatomie, vorm, aanhegtings, aksies en / of aanwesigheid en/of afwesigheid. 'n Statistiese beduidende verskil is gevind tussen die manlike en vroulike steekproef ten opsigte van die lengte van M. palmaris longus. M. palmaris longus is met M. plantaris ook vergelyk en daar was gevind dat
daar 'n statisties beduidende verskil tussen hierdie spiere is. Alhoewel hierdie spiere dieselfde lyk, is dit belangrik om in ag te neem dat as dit by die chirurgiese aspekte kom, word daar voorgestel dat M. palmaris longus eerder gebruik moet word wanneer 'n wyer tendon verkies word en M. plantaris gekies moet word wanneer �n langer tendon benodig word. Daar is goeie ooreenkoms tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris wanneer hul met studies, wat op die ander bevolkingsgroepe gedoen was, vergelyk word. Geen ooreenkomste was tussen die geslag van die kadawer en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris gevind nie. Daarbenewens was dit vasgestel dat daar geen verhouding tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris in dieselfde individu is nie. 'n Moontlike filogenetiese degeneratiewe tendens vir M. palmaris longus is ook ondersoek. Na die bestudering van verskillende ouderdomsgroepe, is daar bepaal dat so 'n tendens nie bevestig kon word vir hierdie steekproef nie. Ter afsluiting, die morfologie en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris, in 'n Suid-Afrikaanse bevolking, is ideaal vir die gebruik van weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie. Maar dit is van uiterste belang dat die rekonstruktiewe chirurg, wie met Suid-Afrikaanse pasi�nte werk, onthou dat beide hierdie spiere onderworpe is aan variasie. Dit sal dus voordelig wees om behoorlike opsporingsmetodes te gebruik om die vatbaarheid van hierdie spiere in rekonstruktiewe chirurgie vas te stel, maar hy of sy het ook kennis van die anatomie van hierdie spiere, nodig.
Venter, G 2011, Morphology of the palmaris longus and plantaris muscles employed as flaps in reconstructive surgery, MSc dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd-05222012-121917