The arterial and muscular variations of the upper limbs are common but important with regard to surgical approaches. Even though anomalies of the coracobrachialis muscle are rare, anatomical variations of the biceps brachii, existence of the accessory muscles in the forearm and persistent median artery are known and well documented. During routine dissection, we observed some important anatomical variations in a 50-year-old male cadaver. The variations were unilateral. The anomalies were: third head for biceps brachii muscle, an accessory belly for coracobrachialis muscle crossing the median nerve and brachial vessels and continuing with the medial head of triceps brachii muscle to be inserted to the olecranon process (coracoulnaris), a persistent median artery and an additional muscle in the anterior compartment of forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.
This study is designed to evaluate twenty patients after sural nerve harvest using the single longitudinal incision method. The area of sensory loss to pin prick was assessed by the authors at different intervals. Donor site factors, scar cosmesis, functional status and complications were assessed using a questionnaire. The mean area of anaesthesia at one month was 65 cm2 and it had reduced by 77% to 15 cm2 at one and a half years. The mean area of reduced sensation was 49 cm2 at one month and it increased by 18% to 58 cm2 over the same period. Therefore, the total area of sensory deficit was reduced by 36% from 114 cm2 at one month to 73 cm2 at one and a half years. Subjective patient evaluation indicated moderate level of pain during immediate post surgical period, which reduced significantly at one month. A low level of neuroma symptoms was recorded throughout the study period. At a mean follow-up period of two years, there was no area of anaesthesia in 50% of the patients. Mean area of anaesthesia for all patients was 12 cm2 and mean area of reduced sensation was 55 cm2. Subjective patient evaluation indicated a low level of pain, neuroma symptoms and numbness over the sural nerve sensory distribution. Twenty five percent of the patients were not satisfied with the scar appearance. Function and daily activities were not affected significantly. No surgical complications were observed.