scholarly journals Anatomical study of anterior supramalleolar artery and its potential application to design a bi-foliate fasciocutaneous flap

2015 ◽  
Vol 48 (01) ◽  
pp. 017-021
Author(s):  
Ji-Yin He ◽  
Shih-Heng Chen ◽  
Kannan Karuppiah Kumar ◽  
Zhi-Hong Fan ◽  
Jie Lao ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Type A ◽  
Fasciocutaneous Flap ◽  
Lower Limbs ◽  
Anterior Tibial Artery ◽  
Medial Branch ◽  
Flap Transfer ◽  
Type D ◽  
Pedicle Length ◽  
The Mean

ABSTRACT Purpose: A further understanding of the anterior supramalleolar artery (ASMA) and its potential applications in reconstructive surgery. Materials and Methods: A total of 24 fresh lower limbs from fresh cadavers were injected with red latex for dissection. The type of origin, course, diameter of the pedicle, and the distance between the origin of the ASMA from the anterior tibial artery to the extensor retinaculum (O-R) were recorded. Bi-foliate fasciocutaneous flaps were harvested using the branches of the ASMA. Results: We found four types of origin of the ASMA, and we have accordingly classified them into four types. 10 of them were type A, 7 were type B, 6 were type C and 1 was type D. The mean O-R (origin of ASMA to retinaculum) distance was 2.0 ± 0.8 cm. The diameter of the medial branch (D1), the diameter of the lateral branch (D2), and the diameter of artery stem (D3) (only in type A) were 1.0 ± 0.2 mm, 0.8 ± 0.3 mm, 1.1 ± 0.2 mm, respectively. The mean pedicle length of the lateral flap (L1) and medial flap (L2) were 5.1 ± 1.0 cm and 3.7 ± 0.6 cm, respectively. Conclusions: The ASMA exists constantly with four different types of origin. Its sizable diameter and lengthy pedicle make it suitable for bi-foliate fasciocutaneous flap transfer.

scholarly journals Cadaveric Anatomical Study of Sural Nerve: Where is The Safe Area for Endoscopic Gastrocnemius Recession?

2017 ◽  
Vol 11 (1) ◽  
pp. 1094-1098 ◽  
Author(s):  
Alvin Chin Kwong Tan ◽  
Zhi Hao Tang ◽  
Muhammad Farhan Bin Mohd Fadil
Keyword(s):  
Achilles Tendon ◽  
Sural Nerve ◽  
Anatomical Study ◽  
Lower Limbs ◽  
Lateral Border ◽  
Safe Area ◽  
Gastrocnemius Recession ◽  
The Mean ◽  
Tendon Insertion ◽  
Calcaneal Tuberosity

Purpose: To ascertain in cadavers where the sural nerve crosses the gastro-soleus complex and where the gastrocnemius tendon merges with the Achilles tendon in relation to the calcaneal tuberosities. Methods: Twelve cadaveric lower limbs (6 right and 6 left) were dissected. The distances between the calcaneal tuberosities and the lateral border of the Achilles tendon where the sural nerve crosses from medial to lateral, as well as to the gastrocnemius tendon insertion into the Achilles tendon, were measured. Results: The mean and median longitudinal distances from the calcaneal tuberosity to where the sural nerve crosses the lateral border of the Achilles tendon are 9.9cm and 10cm respectively (range 7cm to 14cm). The mean and median longitudinal distances from the calcaneal tuberosity to where the gastrocnemius tendon inserts into the Achilles tendon are 19.9cm and 18.5cm (range 17cm to 25cm) respectively. Conclusion: It is generally safe to place the posterolateral incision more than 14cm above the calcaneal tuberosity to avoid the sural nerve if surgeons plan to use a posterolateral incision for endoscopic recession. The distance between the calcaneal tuberosity to the gastrocnemius tendon insertion into the Achilles tendon is too highly variable to be used as a landmark for locating the gastrocnemius insertion.

scholarly journals The Vascular Basis of the Pronator Quadratus Muscle Flap and Its Use in Clinical Cases

2020 ◽  
Author(s):  
Binu P. Thomas ◽  
Sasi P. Kiran ◽  
Maolin Tang ◽  
Christopher R. Geddes ◽  
Steven F. Morris
Keyword(s):  
Muscle Flap ◽  
Anatomical Study ◽  
Vascular Supply ◽  
Soft Tissue Reconstruction ◽  
Pronator Quadratus ◽  
India Ink ◽  
Pedicle Length ◽  
Human Cadavers ◽  
The Mean ◽  
Pronator Quadratus Muscle

AbstractBackground Pronator quadratus (PQ) is a deeply situated muscle in the forearm which may occasionally be utilized for soft-tissue reconstruction. The purpose of this anatomical and clinical study was to confirm vascular supply of PQ muscle (PQM) in order to optimize its transfer and confirm its utility in clinical situations. Methods In Part A of the anatomical study, fresh human cadavers (n = 7) were prepared with an intra-arterial injection of lead oxide and gelatin solution, and PQM and neurovascular pedicle were dissected (n = 14). In the anatomical study Part B, isolated limbs of embalmed human cadavers (n = 12) were injected with India ink-gelatin mixture and PQ were dissected.Results PQ is a type II muscle flap, with one major pedicle, the anterior interosseous (AI) vessels and two minor pedicles from the radial and ulnar vessels. The mean dimensions of the muscle were 5.5 × 5.0 × 1.0 cm3, mean pedicle length was 9.6 cm, and the mean diameter of the artery and the vein was 2.3 mm and 2.8 mm, respectively. The dorsal cutaneous perforating branch (DPB) of the artery supplied the skin over the dorsal forearm and wrist. This branch also anastomosed with the 1, 2 intercompartmental supraretinacular artery (ICSRA). Conclusion This study confirms the potential utility and vascular basis of the PQM flap and its associated cutaneous paddle.In the clinical part, two patients with nonhealing wounds exposing the median nerve and flexor tendons in the distal forearm were treated using the PQM flap with good results.

scholarly journals Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

2018 ◽  
Vol 46 (02) ◽  
pp. 106-112
Author(s):  
Sergi Barrera-Ochoa ◽  
David Campillo-Recio ◽  
Jorge Knorr ◽  
Xavier Mir-Bullo ◽  
Alfonso Rodríguez-Baeza ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Osteogenic Potential ◽  
Fresh Frozen ◽  
Pedicle Length ◽  
Mean Size ◽  
Microsurgical Techniques ◽  
The Mean ◽  
Radial Axis

Introduction Vascularized periosteal flaps (VPFs) have proven to be a useful technique for the treatment of unfavorable biological situations in children, with excellent results due to their osteogenic potential. The objective of this work is to present a detailed anatomical description of the periosteal vascularization of the radius and ulna, as well as the design of the forearm VPFs. Methods Anatomical study with 10 fresh-frozen specimens with antegrade injection of green colored latex. Periosteal branches of the radius and ulna, septocutaneous branches, and muscular branches were dissected. The size of the pre and postdissection flaps was measured, as well as the length of the vascular pedicles. Results The four vascular axes studied were the anterior interosseous vascular axis (AIA), radial axis (RA), ulnar axis (UA), and posterior interosseous vascular axis (PIA). The AIA (volar-radial VPF): an average of 16.2 periosteal branches were obtained, with a mean distance of 6.6 mm between them. The mean size of the VPF was 41.3 cm2 pre-dissection and 32.4 cm2 post-dissection. The average pedicle length was 16.1 cm. Vascular RA (radial VPF): an average of 20.8 branches was found, with a mean VPF size of 54.8 cm2predissection, and 39.3 cm2 post-dissection. The average pedicle length was 20.2 cm. Vascular PIA (dorsal-ulnar VPF): an average of 12.8 periosteal branches were obtained, with the mean VPF size being 26.2 cm2 pre-dissection and 20.4 cm2 post-dissection. The average pedicle length 12.6 cm. Vascular UA (ulnar VPF): an average of 10.2 periosteal branches were obtained with a mean VPF size of 37.5 cm2 pre-dissection and 28.2 cm2 post-dissection. of the average pedicle length was 14.8 cm. Conclusions We have described four new VPFs, with the most useful and versatile being the dorsal-ulnar VPF, based on the PIA, and the volar-radial, based on the AIA. The main advantages of these flaps with respect to microsurgical techniques are the simplicity and speed of the technique, its elasticity and adaptability to the recipient bed, as well as its versatility.

scholarly journals Dimensions and morphology of the sinus tympani: an anatomical study

2018 ◽  
Vol 5 (1) ◽  
pp. 60
Author(s):  
B. Y. Praveen Kumar ◽  
Deekshita Venugopal ◽  
Rajapur Parashuram ◽  
M. K. Veenapani ◽  
C. Subhash ◽  
...  
Keyword(s):  
Chronic Otitis Media ◽  
Anatomical Study ◽  
Classical Type ◽  
Type D ◽  
Sinus Tympani ◽  
Surgical Access ◽  
Mean Width ◽  
Restricted Type ◽  
The Mean ◽  
Temporal Bones

<p class="abstract"><strong>Background:</strong> The sinus tympani is a deep pocket of varying dimensions and shape situated in the retrotympanum. The sinus tympani lies medial to the facial nerve. Hence surgical access is difficult. This area is frequently involved in chronic otitis media attico antral type. Removal of disease from this area is difficult leading to cholesteatoma recidivism. The anatomy has been well described in literature. Its dimensions and morphology has not been described in the Indian population. Knowledge of the endoscopic anatomy of this area will help to eradicate disease leading to better results.</p><p class="abstract"><strong>Methods:</strong> A canal wall down mastoidectomy was performed on twenty wet temporal bones. A zero degree endoscope was introduced into the middle ear to view the sinus tympani. Using a graduated millimetre scale. The dimensions and morphology of the sinus tympani was studied.  </p><p class="abstract"><strong>Results:</strong> Twenty wet bones were dissected. The mean height of the sinus tympani was 3.55 mm. The mean width was 2.22 mm and mean depth was 1.72 mm. The morphology was as follows: 13 bones had a type A morphology (classical type), 6 had a type B morphology (confluent), 1 bone had a type D morphology (restricted type). We did not encounter a type C sinus tympani in our study.</p><p class="abstract"><strong>Conclusions:</strong> The morphology and dimensions of the sinus tympani are variable. The otologist must have a complete knowledge of the anatomy of this area to successfully eradicate disease from this area.</p>

Differentiation of lacrimal gland tumors using the multi-model MRI: classification and regression tree (CART)-based analysis

2021 ◽  
pp. 028418512110210
Author(s):  
Xiaofeng Li ◽  
Xue Wu ◽  
Jiang Qian ◽  
Yifei Yuan ◽  
Shenjiang Wang ◽  
...  
Keyword(s):  
Lacrimal Gland ◽  
Regression Tree ◽  
Type A ◽  
Classification And Regression Tree ◽  
Type B ◽  
Epithelial Tumors ◽  
Type D ◽  
Type C ◽  
The Mean ◽  
Classification And Regression

Background Little is known about the value of dynamic contrast-enhanced (DCE) in combination with diffusion-weighted imaging (DWI) for the differentiation of lacrimal gland tumors. Purpose To evaluate the ability of DCE and DWI in differentiating lacrimal gland tumors. Material and Methods DCE and DWI were performed in 72 patients with lacrimal gland tumors. Time-intensity curve (TIC) patterns were categorized as type A, type B, type C, and type D. Apparent diffusion coefficient (ADC) was measured on DWI. Then, the diagnostic effectiveness of TIC in conjunction with ADC was assessed using classification and regression tree (CART) analysis. Results Type A tumors were all epithelial; they could be further separated into pleomorphic adenoma sand carcinomas. Type B tumors were all non-epithelial tumors, which could be further separated into benign inflammatory infiltrates (BIIs) and lymphomas. Type C tumors contained both carcinomas and non-epithelial tumors, which could be diagnosed into carcinomas, BIIs and lymphomas. Type D tumors were all PAs. The mean ADC of epithelial tumors was significantly higher than that of non-epithelial tumors, and the mean ADC values were significantly different between PAs and carcinomas. Besides, the mean ADC value of BIIs was higher than that of lymphomas. Therefore, the CART decision tree made by ADC and TIC had a predictive accuracy of 86.1%, differentiating lacrimal gland tumors effectively. Conclusion Combined DCE and DWI-MRI can efficiently differentiate lacrimal gland tumors which can be of help to ophthalmologists in the diagnosis and treatment of these tumors.

scholarly journals CTNI-03. IMAGING FEATURES OF LEPTOMENINGEAL METASTASES OF NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER REAL-WORLD STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii41-ii41
Author(s):  
Junjie Zhen ◽  
Lei Wen ◽  
Shaoqun Li ◽  
Mingyao Lai ◽  
Changguo Shan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Type A ◽  
Brain Parenchyma ◽  
Imaging Features ◽  
Type B ◽  
Type D ◽  
Mri Examination ◽  
Mri Features ◽  
Brain And Spinal Cord ◽  
The Brain

Abstract BACKGROUND According to EANO-ESMO clinical practice guidelines, the MRI findings of LM are divided into 4 types, namely linear enhancement (type A), nodular enhancement (type B), linear combined with nodular enhancement (type C), and sign of hydrocephalus (type D). METHODS The MRI features of brain and spinal cord in patients diagnosed with NSCLC-LM in Guangdong Sanjiu Brain Hospital from 2010 until 2019 were investigated, and then were classified into 4 types. The imaging features were analyzed. RESULTS A total of 80 patients were enrolled in the study. The median age of the patients was 53.5 years old, and the median time from the initial diagnosis to the confirmed diagnosis of LM was 11.6 months. The results of enhanced MRI examination of the brain in 79 cases showed that the number of cases with enhancements of type A, B, C and D were 50 (63.3%), 0, 26 (32.9%) and 3 (3.8%), respectively, and that LM with metastases to the brain parenchyma was found in 42 cases (53.2%). The results of enhanced MRI examination of spinal cord in 59 cases showed that there were only enhancements of type A and C in 40 cases (67.8%) and 3 cases (5.0%), and no enhancement sign in the other 16 cases (27.2%). CONCLUSION MRI examination of brain and spinal cord will improve the detection rate of LM. The MRI features of NSCLC-LM in real world are mainly characterized by the linear enhancements of brain and spinal cord, followed by linear combined with nodular enhancement. The enhancements of type B and type D are rare in clinic. Almost half of the patients have LM and metastases to the brain parenchyma. Therefore, the differentiation of tumor metastases is needed to be paid attention to for the early diagnosis and the formulation of reasonable treatment plans.

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

scholarly journals Scrotal reconstruction with superomedial fasciocutaneous thigh flap

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
DANIEL FRANCISCO MELLO ◽  
AMERICO HELENE JÚNIOR
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Longitudinal Direction ◽  
Functional Results ◽  
Fasciocutaneous Flap ◽  
Surgical Time ◽  
Cross Sectional ◽  
Skin Loss ◽  
Scrotal Reconstruction ◽  
The Mean

ABSTRACT Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier’s gangrene). Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015. Results: fifteen patients underwent scrotal reconstruction using the proposed flap. The mean age was 48.9 years (28 to 66). Skin loss estimates in the scrotal region ranged from 60 to 100%. Definitive reconstruction was performed on average 30.6 days (22 to 44) after the initial surgical treatment. The mean surgical time was 76 minutes (65 to 90) to obtain the flaps, bilateral in all cases. Flap size ranged from 10cm to 13cm in the longitudinal direction and 8cm to 10cm in the cross-sectional direction. The complication rate was 26.6% (four cases), related to the occurrence of segmental and partial dehiscence. Conclusion: the superomedial fasciocutaneous flap of thigh is a reliable and versatile option for the reconstruction of open areas in the scrotal region, showing adequate esthetic and functional results.

The response to radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints

2018 ◽  
Vol 18 (4) ◽  
pp. 747-753
Author(s):  
Olav Rohof ◽  
Chee Kean Chen
Keyword(s):  
Joint Pain ◽  
Rating Scale ◽  
Facet Joint ◽  
Controlled Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Medial Branch ◽  
Pain Disability Index ◽  
The Mean ◽  
Facet Joint Pain

AbstractBackground and aimsThe evidence for interventional treatment of thoracic facet joint pain remains limited. This is partly due to inconsistency of the path of thoracic medial branches and a lower incidence of thoracic facet pain among spine pain patients. The purpose of this study is to evaluate the efficacy of bipolar radiofrequency (RF) neurotomy of medial branches for treating chronic thoracic facet joint pain.MethodsThis is a retrospective record review of all patients diagnosed to have thoracic facet pain with diagnostic block and subsequently treated with bipolar RF neurotomy of medial branch between January 2012 and December 2015. The outcome measures were mean changes in Numeral Rating Scale (NRS) and Pain Disability Index (PDI).ResultsThere were 71 patients with complete data available for analysis. The mean age of the patients was 57.9±11.2 years. The mean duration of pain was 23±10.5 months. The majority of patients (82%) had pain reduction of more than 50% at 12 months after bipolar RF neurotomy. The NRS decreased significantly from baseline of 7.75±1.25 to 2.86±1.53 at 3 months and 2.82±1.29 at 12 months post-procedure (p<0.001.p<0.001, respectively). The PDI improved significantly from 40.92±12.22 to 24.15±9.79,p<0.05). There were no serious adverse effects or complications of the procedure reported in this study.ConclusionsBipolar RF neurotomy of thoracic medial branch is associated with a significant reduction in thoracic facet joint pain. The promising findings from this case series merit further assessment with prospective, randomized controlled trial which will produce a more reliable and accurate finding for its clinical applications.

Initial Clinical Experience with Percutaneous Atherectomy in the Infragenicular Arteries

2003 ◽  
Vol 10 (5) ◽  
pp. 987-993 ◽  
Author(s):  
Thomas Zeller ◽  
Ulrich Frank ◽  
Karlheinz Bürgelin ◽  
Uwe Schwarzwälder ◽  
Peter-Christian Flügel ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Ankle Brachial Index ◽  
Peroneal Artery ◽  
Lesion Length ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Below The Knee ◽  
Directional Atherectomy ◽  
Mean Diameter ◽  
The Mean

Purpose: To evaluate the efficacy and safety of a new atherectomy device for the treatment of infragenicular lesions in arteries with a reference diameter of at least 2.5 mm. Methods: Twenty-seven below-the-knee lesions in 17 patients (12 men; mean age 69±12 years) with chronic peripheral arterial occlusive disease were treated with directional atherectomy. The target lesion was in the popliteal artery (segment 3) in 2 (7%) cases, the tibioperoneal trunk in 12 (44%), the peroneal artery in 8 (30%), the anterior tibial artery in 2 (7%), and the posterior tibial artery in 3 (11%). Six (22%) of the lesions were in-stent stenoses. The mean diameter stenosis was 87%±9%, and the mean lesion length was 34±24 mm. Results: All but 2 (7%) of the lesions could be treated successfully (residual stenosis <30%) with the atherectomy catheter (93% technical success) using an average of 5±2 (range 1–10) passes of the device. Six lesions (22%) were treated after predilation and 21 (78%) with primary atherectomy. In 8 (30%) lesions, additional balloon angioplasty was performed. The 2 failures were in heavily calcified lesions through which the device could not pass despite predilation. The mean diameter stenosis after atherectomy was 14%±22% (range 0%–90%); after additional balloon angioplasty, the mean residual stenoses reduced to 12%±21% (range 0%–100%). One (6%) of the 2 patients who failed atherectomy sustained a thrombotic occlusion of the target vessel. This complication was treated successfully with local lysis, but the vessel reoccluded 3 days later; a stent was implanted. The mean ankle-brachial index increased from 0.50±0.27 to 0.86±0.40 before discharge. Conclusions: Below-the-knee native vessel lesions and in-stent restenoses with a diameter of at least 2.5 mm can be treated successfully and safely with this new atherectomy catheter. Additional balloon angioplasty was necessary in only a few cases.

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