Extra- and intramuscular nerves distributions of the triceps surae muscle as a basis for muscle resection and botulinum toxin injections.
OBJECTIVE
To compare the distribution of extramuscular nerve branches with their intramuscular ramifications in the triceps surae muscle, thus providing anatomical substantiation for the topography of muscle resection and botulinum toxin injections.


METHODS
Dissection and modified Sihler's staining of 18 whole-mount human cadaveric specimens.


RESULTS
The distance between the areas with the highest extramuscular branch density and the area of densest intramuscular arborization in gastrocnemius and soleus muscles is approximately 10% of the calf length. This finding should be taken into consideration during nerve blocking and botulinum toxin injections for the treatment of spasticity. Intramuscular nerve arborization patterns make it possible to outline neuromuscular segments in the gastrocnemius and soleus muscles.


CONCLUSIONS
Surgical or therapeutic interventions in areas of high extramuscular and intramuscular nerve density can increase the efficacy and safety of botulinum toxin injections and neurotomy. Intramuscular nerve branching patterns should be taken into consideration during triceps surae resection.
Sheverdin
V A
VA
Division of Anatomy and Developmental Biology, Department of Oral Biology, Oral Science Research Center, Human Identification Research Center, Research Center for Orofacial Hard Tissue Regeneration, BK 21 Project, Yonsei University College of Dentistry, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, South Korea.
Hur
M S
MS
Won
S Y
SY
Song
W C
WC
Hu
K S
KS
Koh
K S
KS
Kim
H J
HJ
D000368:Aged; D000369:Aged, 80 and over; D001905:Botulinum Toxins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D007866:Leg / Q000294:innervation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation* / Q000601:surgery
D001905:Botulinum Toxins