New possible surgical approaches for the submammary adipofascial flap based on its arterial supply

2016 ◽  
Vol 42 (5) ◽  
pp. S2-S3
Author(s):  
Ehab Elzawawy ◽  
Melad Kelada ◽  
Ahmed Alkarmouty
Keyword(s):  
Arterial Supply ◽  
Surgical Approaches ◽  
Adipofascial Flap

scholarly journals New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Ehab M. Elzawawy ◽  
Melad N. Kelada ◽  
Ahmed F. Al Karmouty
Keyword(s):  
Breast Implants ◽  
Partial Mastectomy ◽  
Surgical Approaches ◽  
Lateral Part ◽  
Medial Part ◽  
Fat Necrosis ◽  
Adipofascial Flap ◽  
Multiple Origins ◽  
Inferior Portion ◽  
Perforator Vessels

Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.

The Arterial Supply of the Sesamoid Bones of the Hallux: The Course and Source of the Nutrient Arteries as an Anatomical Basis for Surgical Approaches to the Great Toe

Foot & Ankle ◽  
1992 ◽  
Vol 13 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Michael L. Pretterklieber ◽  
Axel Wanivenhaus
Keyword(s):  
Arterial Supply ◽  
Surgical Approaches ◽  
Great Toe ◽  
Anatomical Dissection ◽  
Plantar Artery ◽  
Anatomical Basis ◽  
Sesamoid Bones ◽  
Type C ◽  
Insight Into ◽  
Medial Plantar Artery

The arterial supply of the hallux sesamoids was studied in 29 human feet by anatomical dissection. Eight of them underwent radiographic analysis prior to dissection. The sesamoid arteries branch off from the digital plantar arteries of the hallux, which, in turn, are derived from the medial plantar artery and the plantar arch (type A), the plantar arch (type B), or the medial plantar artery (type C). The respective frequencies of types A, B, and C were 52%, 24%, and 24%. The number of sesamoid arteries varied from one (55%) to three (10%) and the number increased with the size of the sesamoid bones. Anatomical knowledge of the course and distribution of these vessels may be of great help to the orthopedist in the understanding of the pathogenesis of avascular necrosis and may provide insight into several technical aspects regarding surgery of the hallux.

Surgical management of deep-seated dural arteriovenous malformations

1997 ◽  
Vol 87 (2) ◽  
pp. 198-206 ◽  
Author(s):  
Adam I. Lewis ◽  
Szymon S. Rosenblatt ◽  
John M. Tew
Keyword(s):  
Skull Base ◽  
Arteriovenous Malformations ◽  
Carotid Arteries ◽  
Venous Hypertension ◽  
Arterial Supply ◽  
Surgical Approaches ◽  
External Carotid ◽  
Cerebral Veins ◽  
Inferior Petrosal Sinus ◽  
Dural Avm

✓ The best treatment for deep-seated dural arteriovenous malformations (AVMs) remains controversial. Therapeutic options include transarterial and transvenous embolization, surgical excision of the dural nidus, ligation of draining veins, and stereotactically guided radiation treatment. The authors report on their experience with the application and technique of skull base surgical approaches for deep-seated dural AVMs. Their series includes six patients who were surgically treated for five tentorial dural AVMs and one inferior petrosal sinus dural AVM between 1991 and 1995. Three patients presented with progressive brainstem dysfunction, one had progressive myelopathy, and two suffered subarachnoid hemorrhage. Venous hypertension caused progressive neurological deterioration in four patients and ruptured venous aneurysms caused hemorrhage in two patients. Four of the five tentorial dural AVMs received bilateral arterial supply from the internal carotid arteries and external carotid arteries (ECAs). The dural AVM of the inferior petrosal sinus was fed from both vertebral arteries and ECAs. In this series, all dural AVMs drained into deep cerebral veins. Intra- and postoperative angiographic studies were used to document complete obliteration in each case. After surgery, three patients developed transient, delayed (24–72 hours) neurological worsening. One month postsurgery, all six patients showed improvement from their preoperative neurological function. Surgical resection of these deep-seated dural AVMs was accomplished by eliminating the arterial supply rather than ligating the draining veins to avoid aggravating the underlying venous hypertension. This study demonstrates an important role for skull base surgical approaches in the management of patients with deep-seated dural AVMs that have hemorrhaged, are not obliterated by embolization, and for which stereotactically guided radiation therapy is an unsuitable option.

Innervation of endoneurial microvessels in human sural nerve

1992 ◽  
Vol 50 (1) ◽  
pp. 920-921
Author(s):  
John L. Beggs ◽  
Peter C. Johnson ◽  
Astrid G. Olafsen ◽  
C. Jane Watkins
Keyword(s):  
Blood Flow ◽  
Blood Vessels ◽  
Blood Supply ◽  
Peripheral Nerves ◽  
Sural Nerve ◽  
Nerve Fibers ◽  
Arterial Supply ◽  
Autonomic Nerve ◽  
Vasa Nervorum ◽  
Endoneurial Blood Flow

The blood supply (vasa nervorum) to peripheral nerves is composed of an interconnected dual circulation. The endoneurium of nerve fascicles is maintained by the intrinsic circulation which is composed of microvessels primarily of capillary caliber. Transperineurial arterioles link the intrinsic circulation with the extrinsic arterial supply located in the epineurium. Blood flow in the vasa nervorum is neurogenically influenced (1,2). Although a recent hypothesis proposes that endoneurial blood flow is controlled by the action of autonomic nerve fibers associated with epineurial arterioles (2), our recent studies (3) show that in addition to epineurial arterioles other segments of the vasa nervorum are also innervated. In this study, we examine blood vessels of the endoneurium for possible innervation.

Surgical Approaches to the Brain Stem

1993 ◽  
Vol 4 (3) ◽  
pp. 457-468 ◽  
Author(s):  
Dennis Y. Wen ◽  
Roberto C. Heros
Keyword(s):  
Brain Stem ◽  
Surgical Approaches ◽  
The Brain

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Surgical Approaches to the Suprasellar Infrachiasmatic Region: Comparison among Pterional, Subfrontal, and Endoscopic Endonasal Approaches

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Francisco A. Filho ◽  
Rodrigo Cavalcante ◽  
Milton Rastelli ◽  
Omar Ramirez ◽  
Alessandro Paluzzi ◽  
...  
Keyword(s):  
Surgical Approaches ◽  
Endoscopic Endonasal

Factors Predicting Recurrence after Resection of Clival Chordoma using Variable Surgical Approaches and Radiation Modalities

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Arman Jahangiri ◽  
Aaron Chin ◽  
Jeffrey Wagner ◽  
Sandeep Kunwar ◽  
Christopher Ames ◽  
...  
Keyword(s):  
Surgical Approaches ◽  
Clival Chordoma

The Blood Supply to the Canine Palmar Metacarpal Sesamoid Bones

1995 ◽  
Vol 08 (02) ◽  
pp. 76-81 ◽  
Author(s):  
M. A. Cake ◽  
R. A. Read
Keyword(s):  
Blood Supply ◽  
Vascular Supply ◽  
Arterial Supply ◽  
Sesamoid Bones ◽  
Vascular Compromise

SummaryEleven canine forelimbs were examined using either gross dissection or a modified Spalteholz technique to investigate the blood supply of the palmar metacarpal sesamoid bones. In addition, the sesamoid bones, from two prepared skeletons, were examined for the presence of vascular foramina. Multiple vascular foramina were observed over the sesamoid surface. The most consistent elements of the arterial supply were proximal vessels supplying the axial and dorsal abaxial sides of the bone. In addition, palmar and distal sources often made contributions to the blood supply. Various minor or occasional sources were noted. This study demonstrates that the palmar metacarpal sesamoid bones of the dog have an abundant but highly variable vascular supply.The blood supply of the canine palmar metacarpal sesamoid bones was examined, using several methods, in order to evaluate the possible involvement of vascular compromise in sesamoid disease. It was found that the sesamoid bones have an abundant blood supply which is presumably resistant to disruption.

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