title: Clinical repercussions of Martin-Gruber anastomosis: anatomical study.
abstract: OBJECTIVE
  The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions.
  
  
  METHODS
  100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively.
  
  
  RESULTS
  Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2).
  
  
  CONCLUSIONS
  Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.
authors.affiliation: School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Cristina Schmitt
authors.initials: CS
authors.lastname: Cavalheiro
authors.affiliation: School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Mauro Razuk
authors.initials: MR
authors.lastname: Filho
authors.affiliation: School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Pedro
authors.affiliation: Hand Surgery Service, Conjunto Hospitalar de Sorocaba, Sorocaba, SP, Brazil.
authors.forename: Maurício Ferreira
authors.initials: MF
authors.lastname: Caetano
authors.affiliation: School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Luiz Angelo
authors.initials: LA
authors.lastname: Vieira
authors.affiliation: School of Medical and Health Sciences, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil.
authors.forename: Edie Benedito
authors.initials: EB
authors.lastname: Caetano
keywords: Arteriovenous anastomosis/anatomy & histology; Median nerve; Ulnar nerve