Neural Perforasomes of the Upper Extremity

Area of Science:

• Anatomy
• Vascular Surgery
• Neuroscience

Background:

• The vascularization of peripheral nerves is crucial for their function.
• Recent advancements necessitate a clearer understanding of nerve blood supply.
• The hypothesis proposed discrete vascular territories, termed neural perforasomes, for upper extremity nerves.

Purpose of the Study:

• To investigate and map the extrinsic vascular supply of the major peripheral nerves in the upper extremity.
• To determine if this blood supply can be categorized into distinct neural "perforasomes."

Main Methods:

• Cadaveric upper limbs underwent arterial system perfusion using gelatin-red lead oxide.
• Perforating vessels supplying the radial, median, and ulnar nerves were identified via fluoroscopy and dissection.
• Nerve perfusion was quantified, and source arteries were selectively cannulated to assess contributions.

Main Results:

• Neural perforasomes for the radial, median, and ulnar nerves were successfully mapped.
• Specific nerve segments, including distal superficial radial and posterior interosseous nerves, showed absent staining.
• Areas lacking vascular staining correlated with common nerve compression sites.

Conclusions:

• Peripheral nerves exhibit segmental extrinsic perfusion, organized into neural perforasomes with minimal overlap.
• The identified avascular zones in nerves align with known sites of nerve entrapment.
• This segmental vascularization pattern may predispose these areas to compression injuries.