Peronea Magna Artery Challenging Proximal Fibula Resection of Ewing’s Sarcoma, Report of a Case

Surgical resection of the fibula is commonly done for either to obtain structural bone graft or to respect the fibula if involved by bone tumor. The vascular anatomy around the popliteal fossa is complex and has to be studied prior to any attempt of surgical resection. We present a case of 11 years old female patient who was diagnosed as a Ewing’s sarcoma of the fibula and her pre-operative CT angiography showed a vascular anomaly of Peronea magna artery. Following adjuvant chemotherapy, the patient was treated by wide local resection and the surgical procedure has to be modified in order to save the dominant peroneal artery the vascularity of the limb.

Vascular Proximity Increases the Risk of Local Recurrence in Soft-Tissue Sarcomas of the Thigh—A Retrospective MRI Study

The aim of this study was to establish the prognostic effects of the proximity of the tumor to the main vessels in patients affected by soft tissue sarcomas (STS) of the thigh. A total of 529 adult patients with deeply seated STS of the thigh and popliteal fossa were included. Vascular proximity was defined on MRI: type 1 > 5 mm; type 2 ≤ 5 mm and >0 mm; type 3 close to the tumor; type 4 enclosed by the tumor. Proximity to major vessels type 1–2 had a local recurrence (LR) rate lower than type 3–4 (p < 0.001). In type 4, vascular by-pass reduced LR risk. On multivariate analysis infiltrative histotypes, high FNLCC grade, radiotherapy administration, and type 3–4 of proximity to major vessels were found to be independent prognostic factors for LR. We observed an augmented risk of recurrence, but not of survival as the tumor was near to the major vessels. When major vessels were found to be surrounded by the tumor on preoperative MRI, vascular resection and bypass reconstruction offered a better local control.

Variations in Course and Branching of Sciatic Nerve and it’s Relation to Pyriformis Syndrome

Background: Sciatic nerve is a branch of sacral plexus. It passes below the pyriformis and divides in the popliteal fossa. Higher division and relation of sciatic nerve to pyriformis have been documented. Beaton and Anson have classified relation of sciatic nerve to pyriformis. The aim of this study is to find incidence of variant anatomy of sciatic nerve as per Beaton and Anson classification. Materials and methods: 48 formalin embalmed lower limbs used for regular anatomy teaching were used. Branching and course of sciatic nerve was observed in gluteal region,thigh and popliteal fossa. Observations: As per Beaton and Anson classification, we found 81.2% showed type A or normal arrangement. Type B variation was seen in 14.6% while 4.2% showed type D variation. Conclusion: Variations in branching of sciatic nerve and it’s relation to pyriformis muscle are important from point of view of Surgeons and Anaesthetists. Knowledge of these variations will help reducing block failures in cases of sciatica, pyriformis syndrome and hip replacement surgeries. KEY WORDS: Sciatic nerve, Sacral plexus, Pyriformis Syndrome, Hip replacement.

Clear Cell Sarcoma of Tendon and Aponeuroses with Excessive Melanin Production – An Unusual Presentation

Clear cell sarcoma of tendons and aponeuroses also called as malignant melanoma of soft parts is a rare tumor of neural crest origin with 70% of them possessing balanced translocation t(12; 22). Approximately 50% of the tumor produces melanin which often shows focal pigmentation or needs special stains to demonstrate melanin. Production of excessive melanin by this tumor is very unusual and very few case reports are available in literature. We report a case of Clear cell sarcoma with excessive melanin production in a 50-year-old female patient involving the left popliteal fossa.

Role of the Popliteal Fossa in Knee Problems: Theoretical Considerations and Practical Implications

The popliteal fossa is located at the back of the knee joint and it is an area where blood vessels and nerves and also lymph nodes pass. Popliteal fossa injuries includes nearly 2% of acute knee injuries. The treatment of chronic injuries are always more difficult than acute ones, because its diagnosis would depend on careful interpretation of specific clinical exams. In this review, we describe our current understanding of role of popliteal fossa in knee problems, and summarize the anatomy and functional role of popliteal fossa and popliteomeniscal fibers, and mechanism of popliteomeniscal fibers injuries, and discuss strategies for diagnosis of popliteomeniscal fibers lesions, differential diagnosis, and treatment of the posterolateral corner injuries.

Cadaveric Study of the Mode of Termination of the Sciatic Nerve in a Malian Population: Cases of Trifurcation and Hexafurcation

Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.

Popliteal Fossa Sarcomas

Background and Aim: Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%–5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample.Materials and Method: Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes.Results: The mean age of the patients was 48 ± 21.23 (range 3–72) years at the time of diagnosis. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (25%). At the latest follow-up, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease.Conclusions: Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins.