Rajiv Gandhi University of Health Sciences Bangalore ...



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE ADDRESS |DR. RASHI NIGAM |

| | |# 3515, 14th A Main, Indira Nagar |

| | |Bangalore – 560045. |

|2. |NAME OF THE INSTITUTION |Dr. B. R. Ambedkar Medical College, |

| | |K.G.Halli, Bangalore – 560045 |

|3. |COURSE OF THE STUDY AND SUBJECT |MD (Anatomy) |

|4. |DATE OF ADMISSION TO COURSE |31st May 2012 |

|5. |TITLE OF THE TOPIC |

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| |A STUDY OF THE FORMATION, COURSE AND THE BRANCHING PATTERN OF THE DORSALIS PEDIS ARTERY IN ADULT HUMAN CADAVERS AND ITS CLINICAL |

| |CORRELATION. |

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|6. |BRIEF RESUME OF THE INTENDED WORK: |

| |6.1 NEED FOR THE STUDY: |

| |With changing life style and increasing stress, mankind is more liable for disease like diabetes and hypertension. Diabetic |

| |neuropathy leads to foot infection and ischemia, leading to risk of major amputation. In the effort of salvaging the ischemic limb |

| |dorsalis pedis artery bypass plays a major role. The dorsalis pedis artery with its major branches is the most preferred recipient |

| |vessel for bypass graft.1 |

| |Injuries to the arteries are common in case of road traffic accidents. 2 In such cases, Dorsal pedis artery can be used for |

| |performing microvascular surgeries for foot repair. The knowledge of the course and the variations of Dorsalis pedis artery is |

| |required for performing colour doppler ultrasound for measuring the blood flow in the artery. |

| |Hence the study of formation and branching pattern of dorsalis pedis artery has been taken up. |

| |6.2 REVIEW OF LITERATURE |

| |Dorsalis pedis artery is the dorsal artery of the foot and is the continuation of the anterior tibial artery distal to the ankle. |

| |3,4 It passes to the proximal end of the first intermetatarsal space where it turns into the sole between the heads of the first |

| |dorsal interosseous to complete the plantar arch.3,5 |

| |Branches of dorsalis pedis artery- |

| |1- Lateral and medial tarsal arteries |

| |2-Arcuate artery |

| |3-First dorsal metatarsal artery |

| |4-Cutaneous branches.3,5 |

| |Dorsalis pedis artery behaves like the radial artery in the hand, sending its branch between the first and second metatarsal bone to|

| |reach the planter surface of the plantar arch.6 |

| |The dorsalis pedis artery is normally palpable on the dorsum of the foot midway between the medial and lateral malleoli.3,5 |

| |In some cases, it was observed that the dorsalis pedis artery was a continuation of the perforating branch of the peroneal artery. 7|

| |In diabetic patients, the tibio peroneal vessels frequently show atherosclerotic changes and the vessels are often heavily |

| |calcified. The degree of ischemia may be severe and extensive. The small arteries in the foot are relatively spared, making distal |

| |bypass to these arteries possible and allowing foot salvage in case of threatened limb loss.8 |

| |When the dorsalis pedis artery was patent preoperatively, 98.6% bypass were successful.9 |

| |Dorsalis pedis artery is the principal outflow vessel for revascularization of foot.10 |

| |In patient without a patent pedal arch, occlusion of the dorsalis pedis artery can lead to ischemia of the toes.11 |

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| |6.3 OBJECTIVES OF THE STUDY |

| |To study the origin of dorsalis pedis artery. |

| |To study the branching pattern of dorsalis pedis artery. |

| |To study the course of dorsalis pedis artery. |

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|7. |MATERIALS AND METHODS |

| |7.1 SOURCE OF DATA |

| |The study will be conducted on lower limb specimens of adult cadavers allotted to 1st year MBBS students for dissection including |

| |the dissected specimens available in the department of anatomy, DR.B.R.Ambedkar medical college Bangalore. |

| |7.2 METHOD OF DATA COLLECTION |

| |The specimens shall be obtained from the formalin fixed adult cadavers, dissected by the 1st year MBBS students, Department of |

| |Anatomy, DR.B.R.Ambedkar medical college, Bangalore. The dissected specimens will be serially numbered and photographed. |

| |7.2.1 SAMPLE SIZE |

| |The study will be conducted on 50 specimens. |

| |7.2.2 DURATION OF STUDY |

| |The study will be conducted from September 2012 to March 2014. |

| |7.2.3 INCLUSION CRITERIA |

| |All specimens obtained from adult cadavers. The specimens of all the age groups and both sexes have been included. |

| |7.2.4 EXCLUSION CRITERIA |

| |The specimens in which the artery is damaged or incomplete will be excluded. |

| |7.2.5 STATISTICAL ANALYSIS |

| |The data will be analyzed in terms of the number and percentage of the variation in the formation and branches of the dorsalis pedis|

| |artery. Cross tabulations will be done to study the variations according to side. Chi-square test will be applied to assess the |

| |significance of association between the side and variations. |

| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO, PLEASE |

| |DESCRIBE BRIEFLY. |

| |No, the study does not require any investigations or interventions in patients. |

| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE 7.3? |

| |Yes. |

|8. |LIST OF REFERENCES |

| |Vijayalakshmi S, Gunupriya Raghunath, Varsha Shenoy. Anatomical study of Dorsalis pedis artery and its clinical correlations. |

| |Journal of Clinical and Diagnostic Research. 2011 Apr; Vol. 5(2):287-290. |

| |Anson B J, Maddock W G. Callander’s Surgical Anatomy. 3rd ed. W.B Saunders Company. 1952; 1008-1009. |

| |Susan Standring. Gray’s Anatomy: The Anatomical Basis of Clinical Practice.40thEd. Spain: Churchill Livingstone; 2008. p.1455, 1456.|

| |Cunnigham, Romanes G.J. Cunningham’s Textbook of Anatomy.12th Ed. Hongkong: Oxford university Press; 1981. p. 941, 942. |

| |Last R.J. Anatomy Regional and Applied. 6th Ed. Singapore: Churchill livingstone; 1978. p.170. |

| |Hollinshed W. Henry. Anatomy for surgeons: The Back and Limbs 3rd Ed. USA: Harper and Row; 1982. Vol 3. p. 601,602. |

| |Klenerman Leslie. The Foot and its disorders. 3rd Ed. Great Britain. Blackwell scientific publications. 1991; p. 213,215-216. |

| |M.Doherty Gerard. Current Diagnosis and Treatment: Surgery. 13th Ed. USA: Mc Graw Hill Lange; 2010. p. 755. |

| |Porter John M. Yearbook of vascular surgery.USA: Mosby-year book; 1996. p.275. |

| |Frank B. Pomposelli, Edward J, Marcaccio, Gary W. Gibbons, David R. Campbell, Dorothy V. Freeman, et.al. Dorsalis pedis arterial |

| |bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus: J vasc surg: 1995; 21:375-84. |

| |R. Bellosta, M. Talarico, L. Luzzani and A. Sarcina . Non-atherosclerotic Dorsalis pedis artery True Aneurysm; Case report and |

| |Literature review. Ejves extra. 2005; 10: 146-148. |

| |9. |

| |Signature of Candidate |

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| |10. |

| |Remarks of the guide |

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| |The present study is having significance in conditions like thromoboangiitis obliterance and diabetes mellitus, hence may be taken |

| |up. |

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| |11. |

| |11.1 Name and designation of guide |

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| |11.2 Signature |

| |Dr. B R Ramesh |

| |Professor & HOD |

| |Dept. of Anatomy |

| |Dr. B R Ambedkar Medical College |

| |Bangalore – 560045 |

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| |11.3 Co-guide |

| |11.4 Signature |

| |Not applicable |

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| |11.5 Head of the Department |

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| |11.6 Signature |

| |Dr. B R Ramesh - MBBS,MS |

| |Professor & HOD |

| |Dept. of Anatomy |

| |Dr. B R Ambedkar Medical College |

| |Bangalore – 560045 |

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| |12. |

| |12.1 Remarks of the Chairman and Principal |

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| |12.2 Signature |

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