Novosti
Khirurgii
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Year 2017 Vol. 25 No 1

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2017.1.20   |  

A.V. CHERNYH, E.I. ZAKURDAEV, E.F. CHEREDNIKOV, N.V. YAKUSHEVA, V.G. VITCHINKIN, M.P. ZAKURDAEVA, Y.V. MALEEV

A METHOD FOR PREVENTING OF INTRAOPERATIVE INTERCOSTAL NERVE TRAUMATIZATION AT HERNIOTOMY OF UMBILICAL HERNIAS

FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko",
Voronezh,
The Russian Federation

Objectives. To develop a method of prognostication of the number of intercostal nerves in the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall.
Methods. The unfixed corpses (n= 88) of both sexes without pathology of the anterior abdominal wall were studied: 45% of male corpses (average age 53,811,9 years) and 55% females (51,913,2 years). Linea bicostalis (the distance between the lower points of the costal arches) and linea bispinalis (the distance between the front upper iliac spines) were measured. The number of the intercostal nerves at the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall was established.
Results. Linea bicostalis on the average composed 29,20,3 cm and the linea bispinalis - 28,20,2 cm. In the area of the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region of the anterior abdominal wall, 2 pairs of the intercostal nerves were more often observed (60% of cases), rarely 1 pair of nerves (20%). In 11% of cases there were 3 pairs of intercostal nerves to the rectus abdominis muscle, and 4 pairs of nerves in 2% of cases. In 7% of cases the asymmetric number of the intercostal nerves was registered. Using the logistic regression technique, the method was proposed predicting the probability of finding 2 pairs of intercostal nerves in the area of the lateral edge of the aponeurotic sheath of rectus abdominis muscle in the umbilical region at anterior abdominal wall: P=100×(1/(1+e^(12,1+0,33×a1-0,76×a2))), where P is the probability of finding 2 pairs of intercostal nerves, a1 linea bispinalis, a2 linea bicostalis.
Conclusion. The developed method allows predicting the quantity of the intercostal nerves in the area of the lateral edge of the aponeurotic sheath of the rectus abdominis muscle in the umbilical region of the anterior abdominal wall and can be recommended for use in clinical practice.

Keywords: anterior abdominal wall, aponeurotic sheath, rectus abdominis muscle, innervation, intercostal nerves, umbilical hernia, hernia repair
p. 20-25 of the original issue
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Address for correspondence:
394036, the Russian Federation, Voronezh,
Student str., 10,
FGBOU HE Voronezh State
Medical University named after NN Burdenko,
Department of operative surgery and
topographic anatomy.
Tel.: 8 951 566-43-61
E-mail: ezakurdaev@rambler.ru
Evgeny I. Zakurdaev
Information about the authors:
Chernyh A.V. MD, Professor, Head of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Zakudaev E.I. PhD, Assistant of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Cherednikov E.F. MD, Professor, Head of the faculty surgery department, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Yakusheva N.V. PhD, Ass. Professor of the operative surgery departmentr with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Vitchinkin V.G. PhD, Ass. Professor of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Zakudaeva M.P. Post-graduate student of the operative surgery departmentr with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
Maleev Y.V. MD, Ass. Professor of the operative surgery department with topographic anatomy, FSBEE HE "Voronezh State Medical University Named After N.N. Burdenko".
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