TOPOGRAPHIC AND ANATOMICAL RELATIONSHIPS OF INTRAMUSCULAR ARTERIES AND NERVES IN THE SHOULDER REGION OF HUMAN FETUSES

Abstract

In modern surgical practice, there is a growing need to improve techniques of operative interventions. Despite advancements in diagnosis and treatment, combined shoulder injuries remain a pressing problem. In the past, surgical intervention for combined trauma primarily focused on saving the patient's life. However, today it is essential not only to preserve life but also to restore the function of the injured structures. Humerus fractures are observed in 27.9% of polytrauma cases, significantly complicating urgent diagnostic and treatment procedures and worsening the patient's condition. A comprehensive study of the topographical and anatomical relationships of intramuscular arteries and nerves at the shoulder level can facilitate the selection of optimal surgical approaches, prevent iatrogenic damage, and contribute to the patient's rapid rehabilitation. The objective of this study was to identify the distribution patterns of arteries and nerves at different levels of the shoulder in human foetuses. Materials and Methods. The study involved the examination of upper limb preparations from 48 human foetuses, ranging from 81.0 to 370.0 mm in parietal-caudal length without external signs of anatomical deviations or anomalies in the development of the skeletal and muscular structures of the upper limbs. Macromicroscopic dissection, vessel injection, and morphometry techniques were employed. Results and Discussion. In human foetuses, the upper and middle thirds of the shoulder were found to have the highest concentration of intramuscular arteries and nerves. The entry points of arteries and nerves, their topography and branching patterns within the shoulder muscles did not always align. Arterial branches generally entered the muscles at slightly more distal locations than the nerve trunks, following the shortest path to reach the muscles. The levels at which arteries and nerves start branching to supply and innervate the muscles of the anterior and posterior shoulder groups, vary in human foetuses. This variation depends on the individual anatomical variability of the major vascular and nerve trunks. Conclusion: The levels of arterial and nerve abduction are related to the topographic and anatomical features of a particular shoulder muscle. Considering the topography of intramuscular arteries and nerves, it is advisable to perform incisions along the direction of muscle bundles, particularly near the lower border of the neurovascular unit of the brachial biceps. This approach can offer higher clinical and surgical effectiveness.