Perineural vascular network of the deep branch of the radial nerve following methylene blue injection: an anatomical study - 18/08/26

Doi : 10.1016/j.hansur.2026.102757

Thomas Yvonnet ^a,⁎ , Nicolas Bigorre ^b, Marie Loisel ^a, Thomas Daoulas ^c

^a Orthopedic Surgery Department, CHU Rennes Hopital Pontchaillou, 2 rue Henri le Guilloux, 35000, France

^b Orthopedic Surgery Department, Clinique Saint Léonard, 18 Rue de Bellinière, 49800 Trélazé, France

^c Orthopedic Surgery Department, CHU de Brest, Boulevard Tanguy Prigent, 29200 Brest, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 18 August 2026

Abstract

Objective

The aim of this study was to determine the anterior or posterior predominance of the methylene-blue-stained perineural vascular network surrounding the deep branch of the radial nerve (DBRN).

Methods

An anatomical study was conducted on ten elbows from five fresh-frozen donor bodies following low-flow methylene blue injection into the brachial artery. The methylene-blue-stained perineural vascular network surrounding the DBRN within the supinator muscle was observed and classified into three groups: posterior to the nerve, mixed, or anterior. The distribution of the stained network along the nerve was analyzed, as well as the morphology of the tendinous arch of the supinator muscle and the superficial layer of the supinator muscle.

Results

Ten elbows were dissected. Fifty percent showed a posterior staining pattern (Group 1), 20% a mixed pattern (Group 2), and 30% an anterior pattern (Group 3). The stained network was concentrated proximally in 40% of cases, extended along the entire intramuscular course of the nerve within the supinator muscle in 40%, and was limited to the distal portion in 20%. The tendinous arch of the supinator muscle was tendinous in 40%, musculotendinous in 40%, and purely muscular in 20% of cases. The superficial layer of the supinator was musculotendinous in 60% and purely muscular in 40%.

Conclusions

This descriptive anatomical study showed that the DBRN is surrounded by a methylene-blue-stained perineural vascular network with substantial interindividual variability. Given the limitations inherent to the injection technique, these findings should be interpreted as preliminary observations rather than a definitive characterization of the vascularization of the DBRN. Their clinical implications will need to be confirmed by further studies.