Summary
Anal neosphincter formation with electrically stimulated gracilis muscle is used increasingly for the surgical treatment of fecal incontinence. An alternative to gracilis might be of interest if this muscle is not available. 30 semitendinosus muscles and 15 long heads of biceps femoris were investigated on human cadavers. In particular, the nerve and vascular supply of these muscles was studied, both representing basic factors for muscle transposition. The long head of biceps femoris m. was found to receive its dominant vascular supply from the first and second perforating artery and its nerve supply from one motor branch out of the sciatic nerve, both as described in literature. The examination of semitendinosus m., however, revealed new anatomical aspects in its vascular supply. In all cases semitendinosus m. was found to receive dominant vascular pedicles from the medial circumflex femoral artery close to the ischial tuberosity and the second perforating artery. The nerve supply consisted of two motor branches out of the sciatic nerve. Both muscles fulfilled several basic criterias for transposition to the anus. However, regarding these requirements, semitendinosus offered distinct advantages in comparison with the long head of biceps femoris. Due to its vascular and nerve topography, semitendinosus seems suitable to serve as an alternative to gracilis.
Résumé
La graciloplastie électro-stimulée est utilisée de plus en plus fréquemment dans le traitement chirurgical de l'incontinence anale. L'utilisation d'un autre muscle peut être intéressante si le muscle gracile n'est pas utilisable. 30 muscles semitendineux et 15 longs chefs du biceps fémoral ont été étudiés sur des cadavres humains. Ce travail a porté particulièrement sur l'innervation et la vascularisation de ces muscles, dont dépendent les possibilités de transposition. Le long chef du m. biceps fémoral recevait sa vascularisation principale de la première et de la deuxième artère perforante et son innervation d'une branche motrice venant du nerf sciatique, tel que cela est décrit dans la littérature. L'étude du m. semitendineux a montré de nouveaux aspects anatomiques dans sa vascularisation. Dans tous les cas ce muscle recevait sa vascularisation principale de l'artère circonflexe médiale près de la tubérosité ischiatique et de la deuxième a. perforante. Son innervation venait de deux branches motrices du nerf sciatique. Ces deux muscles répondaient aux critères nécessaires pour leur transposition comme néo sphincter. Cependant, compte-tenu de sa vascularisation et de son innervation, le m. semitendineux répond mieux aux impératifs anatomiques que le long chef du biceps et représente une alternative au muscle gracile pour la création d'un néo sphincter anal.
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Rab, M., Mader, N., Kamolz, L.P. et al. Basic anatomical investigation of semitendinosus and the long head of biceps femoris muscle for their possible use in electrically stimulated neosphincter formation. Surg Radiol Anat 19, 287–291 (1997). https://doi.org/10.1007/BF01637592
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DOI: https://doi.org/10.1007/BF01637592