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Journal articles on the topic 'Extremities (anatomy), surgery'
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Hammond, Jacob B., Chad M. Teven, Jonathan A. Flug, Clint E. Jokerst, Ashley L. Howarth, Max A. Shrout, Marko A. Laitinen, et al. "The Chimeric Gracilis and Profunda Artery Perforator Flap: Characterizing This Novel Flap Configuration with Angiography and a Cadaveric Model." Journal of Reconstructive Microsurgery 37, no. 07 (February 16, 2021): 617–21. http://dx.doi.org/10.1055/s-0041-1723824.
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Abstract Background A chimerically configured gracilis and profunda artery perforator (PAP) flap is highly prevalent based on recent computed tomography (CT)-imaging data. The purpose of this study is to further characterize the vascular anatomy of this novel flap configuration and determine the feasibility of flap dissection. Methods To characterize flap arterial anatomy, lower extremity CT angiograms performed from 2011 to 2018 were retrospectively reviewed. To characterize venous anatomy and determine the feasibility of flap harvest, the lower extremities of cadavers were evaluated. Results A total of 974 lower extremity CT angiograms and 32 cadavers were included for the assessment. Of the 974 CT angiograms, majority (966, 99%) were bilateral studies, yielding a total of 1,940 lower extremities (right-lower-extremity = 970 and left-lower-extremity = 970) for radiographic evaluation. On CT angiography, a chimerically configured gracilis and PAP flap was found in 51% of patients (n = 494/974). By laterality, chimeric anatomy was present in 26% of right lower extremities (n = 254/970) and 25% of left lower extremities (n = 240/970); bilateral chimeric anatomy was found in 12% (n = 112/966) of patients. Average length of the common arterial pedicle feeding both gracilis and PAP flap perforasomes was 31.1 ± 16.5 mm (range = 2.0–95.0 mm) with an average diameter of 2.8 ± 0.7 mm (range = 1.3–8.8 mm).A total of 15 cadavers exhibited chimeric anatomy with intact, conjoined arteries and veins allowing for anatomical tracing from the profunda femoris to the distal branches within the tissues of the medial thigh. Dissection and isolation of the common pedicle and distal vessels was feasible with minimal disruption of adjacent tissues. Chimeric flap venous anatomy was favorable, with vena commitante adjacent to the common pedicle in all specimens. Conclusion Dissection of a chimeric medial thigh flap consisting of both gracilis and PAP flap tissues is feasible in a cadaveric model. The vascular anatomy of this potential flap appears suitable for future utilization in a clinical setting.
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Scaglioni, Mario, and Hiroo Suami. "Anatomy of the Lymphatic System and the Lymphosome Concept with Reference to Lymphedema." Seminars in Plastic Surgery 32, no. 01 (February 2018): 005–11. http://dx.doi.org/10.1055/s-0038-1635118.
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AbstractPrecise knowledge of the lymphatic system normal anatomy is essential for understanding what structural changes occur in patients with lymphedema. In this article, the authors first review previous anatomical studies and summarize the general anatomy of the lymphatic system and lymphatic pathways in the upper and lower extremities. Second, they introduce their new anatomical concept, the “lymphosome,” which describes how the lymphatic vessels in a particular region connect to the same subgroup of regional lymph nodes. In addition, they describe the anatomical relationship between the perforating lymphatic vessels and arteries. In the last section, they explain the anatomical changes in the lymphatics after lymph node dissection, with reference to secondary lymphedema.
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Ramírez, Esmitt, and Ernesto Coto. "Implant Deformation on Digital Preoperative Planning of Lower Extremities Fractures." International Journal of Creative Interfaces and Computer Graphics 3, no. 1 (January 2012): 1–15. http://dx.doi.org/10.4018/jcicg.2012010101.
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Preoperative planning is an essential step before performing any surgical procedure. Computer Aided Orthopedic Surgery (CAOS) systems are extensively used for the planning of surgeries for fractures of lower extremities. These systems are input an X-Ray image of the fracture and the planning can be digitally overlaid onto the image. In many cases, when an implant is added to the planning, it does not fit perfectly in the patient’s anatomy and therefore it is bended to be adjusted to the bone. This paper presents a new method for the deformation of implants in CAOS systems, based on the Moving Least Squares (MLS) method. Several improvements over the original MLS are introduced to achieve results visually similar to the real procedure and make the deformation process easier and simpler for the surgeon. Over 100 clinical surgeries have been already planned successfully using a CAOS system that employs the proposed technique.
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Machen, S. Karen, Kirk A. Easley, and John R. Goldblum. "Synovial Sarcoma of the Extremities." American Journal of Surgical Pathology 23, no. 3 (March 1999): 268–75. http://dx.doi.org/10.1097/00000478-199903000-00004.
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Leibaschoff, Gustavo, Julio Ferreira, and Jose Luis Ciucci. "Anatomic-Radiologic Comparison of the Effects of Liposculpture on the Lymphatic System of the Lower Extremities." American Journal of Cosmetic Surgery 12, no. 4 (December 1995): 287–92. http://dx.doi.org/10.1177/074880689501200402.
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A study of the lymphatic anatomy of the leg was performed using lymphography. Methods of visualization of the lymphatic anatomy are discussed and include radiographic visualization during surgery and direct examination of tissues after injection of vital dyes. Using these methods, the effect of liposuction on the lymphatics of the leg was studied in a single patient. Results of this preliminary study indicate that liposuction of the lower extremity does not cause disruption of the lymphatic system of the leg.
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Campisi, Corrado, Francesco Boccardo, Rosalia Lavagno, Lorenz Larcher, Corradino A. Campisi, and Miguel Amore. "Lymphatic drainage of mammary gland and upper extremities: From anatomy to surgery to microsurgery." Journal of the American College of Surgeons 215, no. 3 (September 2012): S124—S125. http://dx.doi.org/10.1016/j.jamcollsurg.2012.06.324.
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Goldschmidt, Ezequiel, Amir H. Faraji, Brian T. Jankowitz, Paul Gardner, and Robert M. Friedlander. "Use of a near-infrared vein finder to define cortical veins and dural sinuses prior to dural opening." Journal of Neurosurgery 133, no. 4 (October 2020): 1202–9. http://dx.doi.org/10.3171/2019.5.jns19297.
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Near-infrared (NIR) light is commonly used to map venous anatomy in the upper extremities to gain intravenous access for line placement. In this report, the authors describe the use of a common and commercially available NIR vein finder to delineate the cortical venous anatomy prior to dural opening.During a variety of cranial approaches, the dura was directly visualized using an NIR vein finder. The NIR light source allowed for recognition of the underlying cortical venous anatomy, dural sinuses, and underlying pathology before the dura was opened. This information was considered when tailoring the dural opening. When the dura was illuminated with the NIR vein finder, the underlying cortical and sinus venous anatomy was evident and correlated with the observed cortical anatomy. The vein finder was also accurate in locating superficial lesions and pathological dural veins. A complete accordance in the findings on the pre– and post–dural opening images was observed in all cases.This simple, inexpensive procedure is readily compatible with operative room workflow, necessitates no head fixation, and offers a real-time image independent of brain shift.
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Heckman, James D. "Operating Room Guide to Cross Sectional Anatomy of the Extremities and Pelvis." Journal of Bone & Joint Surgery 72, no. 4 (April 1990): 638. http://dx.doi.org/10.2106/00004623-199072040-00034.
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Fanous, Andrew A., and William T. Couldwell. "Transnasal excerebration surgery in ancient Egypt." Journal of Neurosurgery 116, no. 4 (April 2012): 743–48. http://dx.doi.org/10.3171/2011.12.jns11417.
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Ancient Egyptians were pioneers in many fields, including medicine and surgery. Our modern knowledge of anatomy, pathology, and surgical techniques stems from discoveries and observations made by Egyptian physicians and embalmers. In the realm of neurosurgery, ancient Egyptians were the first to elucidate cerebral and cranial anatomy, the first to describe evidence for the role of the spinal cord in the transmission of information from the brain to the extremities, and the first to invent surgical techniques such as trepanning and stitching. In addition, the transnasal approach to skull base and intracranial structures was first devised by Egyptian embalmers to excerebrate the cranial vault during mummification. In this historical vignette, the authors examine paleoradiological and other evidence from ancient Egyptian skulls and mummies of all periods, from the Old Kingdom to Greco-Roman Egypt, to shed light on the development of transnasal surgery in this ancient civilization. The authors confirm earlier observations concerning the laterality of this technique, suggesting that ancient Egyptian excerebration techniques penetrated the skull base mostly on the left side. They also suggest that the original technique used to access the skull base in ancient Egypt was a transethmoidal one, which later evolved to follow a transsphenoidal route similar to the one used today to gain access to pituitary lesions.
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Smith, Tamara A., Kirk A. Easley, and John R. Goldblum. "Myxoid/Round Cell Liposarcoma of the Extremities." American Journal of Surgical Pathology 20, no. 2 (February 1996): 171–80. http://dx.doi.org/10.1097/00000478-199602000-00005.
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M. Kanlić, Enes, Fabian DeLaRosa, and Miguel Pirela-Cruz. "Computer Assisted Orthopaedic Surgery – CAOS." Bosnian Journal of Basic Medical Sciences 6, no. 1 (February 20, 2006): 7–14. http://dx.doi.org/10.17305/bjbms.2006.3202.
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The use of computer navigation in orthopedic surgery allows for real time intraoperative feedback resulting in higher precision of bone cuts, better alignment of implants and extremities, easier fracture reductions, less radiation and better documentation than what is possible in classical orthopaedic procedures. There is no need for direct and repeated visualization of many anatomical landmarks (classical method) in order to have good intraoperative orientation. Navigation technology depicts anatomy and position of "smart tools" on the screen allowing for high surgical precision (smaller number of outliers from desired goal) and with less soft tissue dissection (minimally invasive surgery - MIS). As a result, there are more happy patients with less pain, faster recovery, better functional outcome and well positioned, long lasting implants. In general, navigation cases are longer on the average 10 to 20 minutes, special training is required and equipment is relatively expensive. CAOS applications in knee and hip joint replacement are discussed.
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Rastogi, Rakhi, Virendra Budhiraja, and Kshitij Bansal. "Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication." ISRN Anatomy 2013 (September 26, 2013): 1–3. http://dx.doi.org/10.5402/2013/501813.
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Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.
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Shah, Kabeer K., Jonathan B. McHugh, Andrew L. Folpe, and Rajiv M. Patel. "Dermatofibrosarcoma Protuberans of Distal Extremities and Acral Sites." American Journal of Surgical Pathology 42, no. 3 (March 2018): 413–19. http://dx.doi.org/10.1097/pas.0000000000000998.
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Travis, William D., Peter M. Banks, and Herbert M. Reiman. "Primary Extranodal Soft Tissue Lymphoma of the Extremities." American Journal of Surgical Pathology 11, no. 5 (May 1987): 359–66. http://dx.doi.org/10.1097/00000478-198705000-00004.
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Malek, Elia, and Johnny S. Salameh. "Common Entrapment Neuropathies." Seminars in Neurology 39, no. 05 (October 2019): 549–59. http://dx.doi.org/10.1055/s-0039-1693004.
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AbstractEntrapment neuropathies are defined as compression of peripheral nerves due to known or unknown causes. The high incidence and variety of presentations require a comprehensive knowledge of these conditions, especially in neurology and orthopedic surgery clinical practices. Detailed knowledge of topographic anatomy, clinical manifestations, and appropriate use of electrophysiological studies with selective addition of neuromuscular ultrasonography are needed to establish an early and accurate diagnosis to advice patients and provide them with a comprehensive treatment plan. In this article, we discuss the most common forms of entrapment neuropathies in the upper and lower extremities.
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SHIRALI, S., M. HANSON, G. BRANOVACKI, and M. GONZALEZ. "The Flexor Pollicis Longus and its Relation to the Anterior and Posterior Interosseous Nerves." Journal of Hand Surgery 23, no. 2 (April 1998): 170–72. http://dx.doi.org/10.1016/s0266-7681(98)80167-8.
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Sixty paired cadaver upper extremities were dissected to study the anatomy of the flexor pollicis longus in the forearm and its relation to the median and anterior interosseous nerves. An accessory head was noted in 33 (55%) of 60 specimens. The accessory head was noted to pass anterior to the anterior interosseous nerve in all specimens. The accessory head was noted to pass posterior to the median nerve in 57 specimens, and anterior to the nerve in three. Tendon or muscle anomalies were noted in eight specimens (13%), seven of which involved an anomalous attachment between the FPL and the flexor digitorum profundus of the index.
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Lim, Soobin, Noah Atwi, Sarah Long, Aran Toshav, and Frank Lau. "Variations in the Anterolateral Thigh Flap's Vascular Anatomy in African Americans." Journal of Reconstructive Microsurgery 34, no. 04 (October 7, 2017): 300–306. http://dx.doi.org/10.1055/s-0037-1604087.
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Background Variations in anterolateral thigh (ALT) arterial anatomy are well documented. Ethnicity is a known risk factor for vascular variation in several organ systems, but its impact on ALT anatomy has not been studied. Anecdotally, we observed frequent ALT arterial variation in African American (AA) patients. We thus hypothesized that AA patients have higher rates of anomalous branching. Materials and Methods A total of 277 computed tomography angiograms (513 lower extremities) captured between May 1, 2013 and May 31, 2015 at a tertiary academic medical center were retrospectively analyzed to determine ALT arterial branching. Patient records were examined to ascertain demographics. Data were analyzed using descriptive statistics and multinomial logistic regression. Results Males comprised 84.5%. Ethnic distribution was 55.2% AA and 36.5% Caucasian. The descending branch of the lateral circumflex femoral artery (dLCFA) originated from non-LCFA arteries (deep femoral, common femoral, or superficial femoral arteries) in 18.9% of Caucasian versus 9.1% of AA (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33–3.93, p < 0.01). An oblique branch was identified in 41.1% of Caucasian versus 51.9% of AA (OR: 1.56; 95% CI: 1.08–2.24, p = 0.02). Ethnicity was the only driving factor of dLCFA and oblique branch of the LCFA (oLCFA) anatomy (Wald chi-square: 14 and 11, p = 0.03 and 0.02, respectively). Conclusions Ethnicity significantly affects ALT arterial anatomy. AA are more likely to have classical dLCFA branching with a fourth oLCFA branch. A flap with an unrecognized oLCFA-dominant supply places patients at a higher risk for flap failure and loss. We recommend preoperative imaging before undertaking an ALT flap reconstruction.
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Mazzaferro, Daniel, Ping Song, Sameer Massand, Rohit Jaiswal, Lee Pu, and Michael Mirmanesh. "The Omental Free Flap—A Review of Usage and Physiology." Journal of Reconstructive Microsurgery 34, no. 03 (November 15, 2017): 151–69. http://dx.doi.org/10.1055/s-0037-1608008.
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Background The omental flap has a rich history of use over the last century, and specifically as a free flap in the last four decades. It has a wide variety of applications in reconstructive surgery and has shown itself to be a reliable donor tissue. We seek to review the properties that make the omental free flap a valuable tool in reconstruction, as well as its many surgical applications in all anatomic regions of the body. Methods We conducted a narrative review of the literature on Medline and Google Scholar. We reviewed basic science articles discussing the intrinsic properties of omental tissue, along with clinical papers describing its applications. Results The omental free flap is anatomically suitable for harvest and wound coverage and has molecular properties that promote healing and improve function at recipient sites. It has demonstrated utility in a wide variety of reconstructive procedures spanning the head and neck, extremities, and viscera and for several purposes, including wound coverage, lymphedema treatment, and vascularization. It is also occasionally employed in the thoracic cavity and chest wall, though more often as a pedicled flap. More novel uses include its use for cerebrospinal fluid leaks. Conclusions The omental free flap is a valuable option for reconstructive efforts in nearly all anatomic regions. This is a result of its inherent anatomy and vascularity, and its angiogenic, immunogenic, and lymphatic properties.
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Grover, Seema, Suprabhat Bolisetti, Shailesh Sangani, Sonali Gadhavi, and Neeraja Kulkarni. "Spectrum of vascular abnormalities in color Doppler examination of upper extremities tested for suitability for AV fistula creation in patients of renal failure." International Journal of Advances in Medicine 4, no. 1 (January 23, 2017): 47. http://dx.doi.org/10.18203/2349-3933.ijam20170029.
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Background: Almost all patients with end stage renal disease require haemodialysis at some stage of their disease and arteriovenous fistula is the most convenient option. The purpose of this study was to analyse the prevalence of vascular abnormalities in the upper limbs of patients posted for creation of haemodialysis access. Knowledge of the variant anatomy of upper limb vessels helps in better planning of surgery, avoiding unnecessary surgery and improving the success rate of haemodialysis access creation.Methods: This study is a retrospective analysis of colour Doppler study of 150 upper extremities of end stage renal disease patients posted for AV fistula creation. The limbs were evaluated for arterial and venous anatomy rendering them fit or unfit for fistula creation.Results: We found abnormal vasculature in more than 60% of the upper limbs. Congenital arterial abnormality was found in 9 % of upper limbs and venous abnormality was found in 65 % of upper limbs. Unnecessary surgery could be avoided in approximately 74 % of patients. 10 % had correctable abnormality.Conclusions: Pre-operative ultrasound and Doppler assessment resulted in more patients being subjected to proximal fistulas and alternate suitable dialysis processes like permcath or peritoneal dialysis. Primary fistula success rate obtained by this pre-operative evaluation was close to 95 %.
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Becker, Robert L., Ltcol, David Venzon, Ernest E. Lack, Ulrika V. Mikel, Sharon W. Weiss, and Timothy J. OʼLeary. "Cytometry and Morphometry of Malignant Fibrous Histiocytoma of the Extremities." American Journal of Surgical Pathology 15, no. 10 (October 1991): 957–64. http://dx.doi.org/10.1097/00000478-199110000-00006.
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Guo, Danqing, Michel Kliot, Logan McCool, Alexander Senk, Brionn Tonkin, and Danzhu Guo. "Percutaneous cubital tunnel release with a dissection thread: a cadaveric study." Journal of Hand Surgery (European Volume) 44, no. 9 (June 12, 2019): 920–24. http://dx.doi.org/10.1177/1753193419856591.
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This cadaveric study tested the feasibility of decompressing the ulnar nerve across the elbow percutaneously with a commercially available surgical dissection thread, a guiding needle, hydrodissection and ultrasound guidance. We performed the procedure in 19 fresh-frozen cadaveric upper extremities. Subsequently, we did an anatomical dissection of the specimens to visualize the extent of ulnar nerve decompression and the extent of damage to surrounding structures. The cubital tunnel and deep across the medial elbow were completely transected leaving the ulnar nerve fully decompressed in all cases. There was no evidence of direct injury to the ulnar nerve or adjacent neurovascular structures. A prerequisite knowledge of sonographic anatomy and experience with interventional ultrasound is essential. Future clinical studies should evaluate this technique’s safety and efficacy compared with conventional ones.
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Brant, William E. "Ultrasonography of Muscles and Tendons. Examination Technique and Atlas of Normal Anatomy of the Extremities." Journal of Bone & Joint Surgery 71, no. 7 (August 1989): 1118. http://dx.doi.org/10.2106/00004623-198971070-00036.
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Winaikosol, Kengkart, and Palakorn Surakunprapha. "Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach." Archives of Plastic Surgery 49, no. 05 (September 2022): 689–95. http://dx.doi.org/10.1055/s-0042-1756348.
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Abstract Background Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping. Methods A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses. Result The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery. Conclusions The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.
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Sliesarenko, S. V., P. A. Badiul, B. Mankovsky, and О. I. Rudenko. "One-stage reconstruction of bone defects with fibula perforator flap." Issues of Reconstructive and Plastic Surgery 24, no. 2 (August 31, 2021): 28–40. http://dx.doi.org/10.52581/1814-1471/77/03.
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At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.
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Kalinin, R. E., I. A. Suchkov, I. N. Shanaev, A. A. Nekliudov, A. M. Tyshchenko, V. A. Vovk, M. A. Klosova, and O. V. Volchenko. "CLINICAL ANATOMY OF THE PERFORATING VEINS OFTHE PROXIMAL LOWER LIMBS." Novosti Khirurgii 29, no. 1 (February 23, 2021): 28–37. http://dx.doi.org/10.18484/2305-0047.2021.1.28.
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Objective. To clarify the topographic and anatomical feature of the perforating veins (PVs) in the proximal part of the lower extremity. Methods. 70 amputated lower extremities from the patients with severe ischemia were subjected to sectional anatomical study; 2800 patients with varicose disease underwent lower extremity sonography. Results. PVs were primarily located on the medial surface of the thigh. In the upper third of the thigh PVs drain into superficial femoral vein. It was detected that one or two PVs occur sin the lower third of the hip draining into superficial femoral vein and originating from the great saphenous vein in 73.6% cases. All PVs were accompanied by an arterial branch from the superficial femoral artery. Anatomical sectional study revealed that a nervous branch accompanied PVs in the lower third of the thigh. Two or four PVs were detected on the lateral surface of the thigh. PVs in the popliteal fossa could be referred to as “atypical” due to their rare occurence (0.4% of cases at sonography) in combination with absent typical sapheno-popliteal junction. PVs in this area were not supported by the intermuscular septa. PVs drained laterally into popliteal vein of the lower limb in 100% cases, while small saphenous vein drained into great saphenous vein in the upper third of the leg or into the intersaphenous vein. Conclusion. Perforating veins constitute perforating bundles (PV, arterial branch, nervous branch), which are predominantly located along the intermuscular septa, which create a constant and strong orientation along the direction of the great vessels. This ensures stable hemodynamics of great vessels and perforating complexes and does not allow squeezed tham togeter during physical exertion. What this paper adds For the first time it has been proved that the perforating veins of the gluteal region pass through the fascia and the thickness of the gluteus maximus muscle and enter the superior and inferior gluteal veins, being transmuscular perforating veins. For the first time it has been established that the location of the femoral perforating veins along the intermuscular septa allows preserving the hemodynamics of the perforating complexes without any squeezed in physical exertion.
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Kraus, Gary E., Richard D. Bucholz, and Thomas R. Weber. "Spinal cord arteriovenous malformation with an associated lymphatic anomaly." Journal of Neurosurgery 73, no. 5 (November 1990): 768–73. http://dx.doi.org/10.3171/jns.1990.73.5.0768.
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✓ Spinal cord arteriovenous malformations (AVM's), like other vascular anomalies of the central nervous system, can be associated with similar vascular lesions of the skin and viscera. A 7-year-old girl, who presented with rapidly progressing paraplegia, was found to have a spinal cord AVM, cutaneous angioma, and a chylous malformation of the lymphatic system. She had previously undergone treatment for a posterior thoracic cutaneous angioma. At surgery, upon incision of the paravertebral muscle fascia, viscous pale fluid was encountered emanating from a foramen in the thoracic lamina. The spinal AVM was resected in spite of concern that the abnormality represented spinal osteomyelitis. Postoperatively, there was full return of function in the lower extremities, along with recurrent episodes of chylothorax, which slowly came under control with dietary manipulation. A review of the anatomy of the thoracic duct and nontraumatic causes of chylothorax is presented, and the association of cutaneous and central angiomas is discussed. Finally, the treatment of chylothorax is delineated.
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Lucertini, G., A. Viacava, A. Grana, and P. Belardi. "Injury to the Common Peroneal Nerve during Surgery of the Lesser Saphenous Vein." Phlebology: The Journal of Venous Disease 14, no. 1 (March 1999): 26–28. http://dx.doi.org/10.1177/026835559901400107.
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Objective: To evaluate the incidence and associated problems of common peroneal nerve (CPN) injury, which can occur during short saphenous vein (SSV) surgery. Design: A retrospective cohort study. Setting: Section of Vascular Surgery in a University Hospital. Patients: In a consecutive series of 88 patients (31 male, 57 female, ages ranging from 35 to 68 years, mean 49), 104 lower extremities were operated on for SSV insufficiency. Interventions: Each patient was assessed by clinical examination, duplex scanning and in some cases by venography (ascending venography and/or varicography). Surgery was carried out via a longitudinal or transverse approach in the popliteal region or the posterior aspect of the thigh. Main outcome measures: Haemodynamic criteria, cosmetic outcome and complications of the surgical procedures due to SSV insufficiency were considered. In particular, we focused on neurological complications. Results: Abnormality of foot dorsiflexion was observed in two out of 104 (2%) cases. This complication was caused by injury to the CPN. Recovery had occurred 1 year later. Conclusions: Two factors seem to be essential in preventing this neurological complication: (a) good knowledge of surgical anatomy and (b) a cautious, accurate surgical technique. The incidence of this complication has been underestimated, but its importance and medico-legal implications must be emphasised.
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Weiss, Sharon W., and Vasantha K. Rao. "Well-Differentiated Liposarcoma (Atypical Lipoma) of Deep Soft Tissue of the Extremities, Retroperitoneum, and Miscellaneous Sites." American Journal of Surgical Pathology 16, no. 11 (November 1992): 1051–58. http://dx.doi.org/10.1097/00000478-199211000-00003.
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Gomez-Eslava, Barbara, and Luis Alejandro García-González. "Surgical Anatomy of the Medial Antebrachial Cutaneous Nerve: Clinical Application in Ulnar Nerve Decompression Surgery in the Elbow." Revista Iberoamericana de Cirugía de la Mano 49, no. 01 (May 2021): 019–23. http://dx.doi.org/10.1055/s-0041-1730002.
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Abstract Introduction Lesion to the posterior branch of the medial antebrachial cutaneous nerve (MACN) is one of the causes of revision of the ulnar nerve decompression surgery in the elbow.To avoid the morbidity associated with this injury, cadaver dissections were performed to identify this branch in its course through the ulnar tunnel. Methods We included 20 upper extremities of fresh cadaveric specimens. The posterior branch of the MACN was identified proximal to medial epicondyle and followed past the ulnar tunnel. The number of ramifications and their coordinates were recorded in a Cartesian plane, with the medial epicondyle as the central point. Results The posterior branch passed proximal and posterior to the medial epicondyle in all specimens, except one. The average of the adjusted x value is of 30 mm, and of the adjusted y value is -18 mm. Additionally, we determined that the posterior branch passes at an average angle of 30° with respect to the x axis. Conclusion The anatomical descriptions of this branch focused on surgical release of the ulnar nerve in the elbow are limited, and measures are only described in the horizontal plane (from proximal to distal). Schematizing the anatomy of this branch in its course throughout the ulnar tunnel will facilitate its identification during the procedures. However, variability and asymmetry in the branching pattern should be considered.
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Kalinin, Roman, Igor Suchkov, Ivan Shanaev, and Nina Mzhavanadze. "Evaluation of the Clinical Anatomy of the Most Important Perforator Veins of the Lower Extremities by Dissection and Duplex Ultrasound Scanning." European Journal of Vascular and Endovascular Surgery 58, no. 6 (December 2019): e268-e269. http://dx.doi.org/10.1016/j.ejvs.2019.06.865.
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Jain, Ekta, Lata Kini, Rita Alaggio, and Sarangarajan Ranganathan. "Myxoinflammatory Fibroblastic Sarcoma of Eyeball in an Infant: A Rare Presentation." International Journal of Surgical Pathology 28, no. 3 (October 8, 2019): 306–9. http://dx.doi.org/10.1177/1066896919879497.
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Myxoinflammatory fibroblastic sarcoma (MIFS) is a rare soft tissue neoplasm most commonly occurring in the distal extremities of adult patients. It is a low-grade neoplasm with high rate of local recurrence but low rate of metastasis. We describe a case of MIFS of eyeball in an infant. An enucleation surgery was performed, and on the basis of histopathological and immunohistochemical evaluation, a diagnosis of MIFS was rendered. Till date more than 400 cases of MIFS have been reported with only a single case report of MIFS in an adult in iris. To the best of our knowledge, ours is the first case of MIFS in the eye in a child. Considering its rarity in children and especially in an infant (this seems to be the youngest patient in the literature), close follow-up is essential as the biology of these lesions cannot be predicted.
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Asakra, Rana, Shane Zaidi, and Khin Thway. "Metastatic Sclerosing Epithelioid Fibrosarcoma in Bone Marrow." International Journal of Surgical Pathology 25, no. 8 (July 11, 2017): 702–4. http://dx.doi.org/10.1177/1066896917720727.
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Sclerosing epithelioid fibrosarcoma (SEF) is an aggressive neoplasm thought to be related to low-grade fibromyxoid sarcoma, which typically occurs in middle-aged adults in the deep soft tissues of the lower extremities and trunk. It comprises nests and cords of relatively uniform epithelioid polygonal cells with clear or eosinophilic cytoplasm in densely sclerotic stroma, and it is typically associated with EWSR1 gene rearrangements, and most commonly EWSR1-CREB3L1 fusions. As primary SEF can arise in bone, and bone is also a common metastatic site for SEF, its recognition at this site is important. We illustrate bone marrow showing diffuse infiltration by SEF and highlight the potential for confusion with a range of neoplasms such as carcinoma, hematolymphoid neoplasms, and other sarcomas.
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Wright, Mark P., Matthew R. Smeds, Lonnie Wright, and Ahsan T. Ali. "High-Resolution CT Angiogram for Lower Extremity Vein Mapping." American Surgeon 83, no. 3 (March 2017): 257–59. http://dx.doi.org/10.1177/000313481708300320.
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High-resolution CTangiogram (CTA) has replaced traditional diagnostic angiography as the main preoperative imaging modality for vascular surgery patients. Although the use of CTA is increasing for arterial imaging, it has not been used routinely for vein mapping. The goal of this study was to evaluate the accuracy of CTA for venous anatomy and compare it to a standard venous duplex ultrasound (DUS). When the vein was used for bypass, the quality and size of the vein were evaluated in the operating room. As part of a preoperative workup before lower extremity revascularization, 16 patients underwent a CTA followed by a DUS. Although the CTA provided useful arterial anatomy, the greater saphenous vein (GSV) was also evaluated. In total, 22 GSV were evaluated in 11 patients. The vein diameter was measured by CTA at four locations: saphenofemoral junction, midthigh, knee joint, and midcalf region. Duplication or other anomalies were also noted, when present. These measurements were taken by an interventional radiologist independently and before the DUS. Routine vein mapping with diameter measurements were then performed with DUS in a vascular laboratory by registered vascular technicians. Measurements for each limb were then compared between CTA and DUS using linear regression (mean ± SD). There was no statistical difference in the diameter of the GSV when measured using a CT or a DUS at the standard points of measurements. Furthermore, the operative findings confirmed the CTA to be very accurate. There were four duplications in the GSV which were all seen on the CTA, whereas only two of these were identified by DUS. There was one vein found to be sclerotic and unusable by DUS that was not identified by CTA. CTA is as accurate as DUS for evaluation of superficial venous anatomy in the lower extremities. CTA can provide global anatomy and can be used as a one-stop imaging modality for both arterial and venous anatomy. However, sclerosis is not detected by CTA.
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Franco, Michael J., Dennis C. Nguyen, Benjamin Z. Phillips, and Susan E. Mackinnon. "Intraneural Median Nerve Anatomy and Implications for Treating Mixed Median Nerve Injury in the Hand." HAND 11, no. 4 (July 8, 2016): 416–20. http://dx.doi.org/10.1177/1558944716643290.
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Background: Nerve transfers have resulted in increased interest in the microanatomy of peripheral nerves. Herein, we expand our understanding of the internal anatomy of the digital nerve to the ulnar index and long fingers, the radial long and ring fingers, and the nerves to the second and third web spaces. Methods: The median nerve was dissected from the digital nerves to the antecubital fossa in 14 fresh upper extremities. The distance of proximal internal neurolysis of the fascicles to the second and third web space and proper digital nerves was measured relative to the radial styloid. Plexi encountered during proximal lysis were noted. Results: Digital nerves to the ulnar index and radial long fingers were lysed 2.4 ± 0.5 cm (mean ± SD), and digital nerves to the ulnar long and the radial ring fingers were lysed 3.0 ± 0.6 cm distal to the radial styloid. Fascicles to the third web space were lysed to the takeoff of the anterior interosseous nerve, 21.1 ± 1.4 cm. Plexus groupings were encountered at 4.5 ± 1.6 cm, 8.3 ± 1.2, cm and 16.1 ± 1.9 cm proximal to radial styloid. The fascicles to the second web space were lysed to 5.0 ± 1.2 cm proximal to radial styloid where a plexus grouping was encountered. Another plexus group was found at 3.3 ± 1.3 cm. Conclusions: We demonstrate that extended internal neurolysis of second web space, along with the digital nerves, is technically and clinically feasible. This technique can be used to treat mixed median nerve injury in the hand and wrist.
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Cheney, Robert A., Paul G. Melaragno, Michael J. Prayson, Gordon L. Bennett, and Glen O. Njus. "Anatomic Investigation of the Deep Posterior Compartment of the Leg." Foot & Ankle International 19, no. 2 (February 1998): 98–101. http://dx.doi.org/10.1177/107110079801900208.
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The purpose of this study is to critically investigate the anatomy of the deep posterior compartment of the leg. Specifically, the relationship of the deep posterior compartment to the superficial posterior compartment and their insertion onto the posteromedial border of the tibia are assessed. Cross-sectioning of 10 fresh-frozen cadaver legs was performed at 2-cm increments. The inferior surface of each section was photographed. The photographs were visually analyzed, and the fascial separation between the posterior compartments along with their relationship to the posteromedial border of the tibia were recorded for each specimen. Magnetic resonance images in the axial plane of 10 healthy, normal volunteers’ lower extremities at 2-cm increments were obtained and analyzed. All specimens and images demonstrated that the medial fascial attachment of the deep posterior compartment was along the posteromedial aspect of the tibia in the proximal third of the leg and was not superficially accessible. In the proximal third of the leg, the superficial posterior compartment fascial attachment overlapped the deep posterior compartment by inserting medial and anterior to the deep posterior compartment fascial attachment. In the middle and distal thirds of the leg, the medial fascial attachment of the deep posterior compartment shifted medially and anteriorly, making the deep posterior compartment superficially accessible. The surgeon must appreciate the change in the anatomic relationships along the medial side of the leg while performing double-incision four-compartment fasciotomy release to obtain a complete release of the muscular portion of the deep posterior compartment.
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Zhukov, O. B., B. G. Alekyan, and A. E. Vasiliev. "Complications of X-ray endovascular treatment of the May–Thurner syndrome." Andrology and Genital Surgery 20, no. 3 (October 1, 2019): 93–100. http://dx.doi.org/10.17650/2070-9781-2019-20-3-93-100.
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The article describes a clinical case of treatment of complications of the May–Thurner syndrome. Asymmetry of blood flow in the iliac veins and signs of their narrowing were observed. Phlebography showed special characteristics of pelvic vessels, trajectory of the surgery was planned. Stenting of the left iliac vein is considered the optimal treatment for such patients if the pressure in it is above 5 mmHg compared to the inferior vena cava. Specialized venous self-expanding stents are an efficient choice for stenting. Access can be performed through the popliteal vein on the unilateral side and / or the femoral or humeral artery, jugular or subclavian access can be used depending on the patient’s anatomy and the size of the delivery device. The female patient underwent coil embolization of varicocele of the lower pelvic veins. At repeat examination after 3 months, pelvic pain was minimal, no pain during sex, no varicocele in the groin and lower extremities. Contrastenhanced spiral computed tomography with 3D reconstruction of the pelvic veins didn’t show any signs of pelvic congestion syndrome.
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Finney, Fred T., Aaron McPheters, Natalie V. Singer, Jaron C. Scott, Karl J. Jepsen, James R. Holmes, and Paul G. Talusan. "Microvasculature of the Plantar Plate Using Nano–Computed Tomography." Foot & Ankle International 40, no. 4 (December 19, 2018): 457–64. http://dx.doi.org/10.1177/1071100718816292.
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Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.
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Laskin, William B., Markku Miettinen, and John F. Fetsch. "Calcareous Lesions of the Distal Extremities Resembling Tumoral Calcinosis (Tumoral Calcinosislike Lesions): Clinicopathologic Study of 43 Cases Emphasizing a Pathogenesis-based Approach to Classification." American Journal of Surgical Pathology 31, no. 1 (January 2007): 15–25. http://dx.doi.org/10.1097/01.pas.0000213321.12542.eb.
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Malas, M. A., A. Salbacak, and O. Sulak. "The growth of the upper and lower extremities of Turkish fetuses during the fetal period." Surgical and Radiologic Anatomy 22, no. 5-6 (March 2001): 249–54. http://dx.doi.org/10.1007/s00276-000-0249-2.
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Ilic, Marko, Aleksandar Lesic, and Marko Bumbasirevic. "Main morphological characteristics of the vascular pedicle of latissimus dorsi muscle and their relevance in operative treatment." Srpski arhiv za celokupno lekarstvo 138, no. 7-8 (2010): 449–55. http://dx.doi.org/10.2298/sarh1008449i.
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Introduction. Considering operative treatment of various pathological conditions and traumatic injuries of extremities latissimus dorsi flap presents the most frequently used flap in reconstructive surgery. Objective. The aim of this paper was to analyze anatomical characteristics of the vascular pedicle of the latissimus dorsi muscle followed by morphometric analyzes of vascular elements. Methods. This paper was carried out in cooperation with the Institute of Anatomy of the School of Medicine, University of Belgrade. The study was based on 40 cadaver dissections followed by anatomical and morphometric analyzes. The first analysis included the determination of thoracodorsal artery (TDA) origin and its lateral and terminal branches, and the second one the observation of artery path. Furthermore the same features were analyzed on the thoracodorsal vein. During morphometric analyzes artery and vein length and diameter were recorded. Results. Our results showed that TDA always contains one lateral branch, while three other lateral branches were inconstant. In most cases TDA terminated in two branches, upper and lower, with average distance of 3.4 cm from the muscle. The mean recorded pedicle length was 9.9 cm. The average inner diameter of TDA was 1.85 mm. In further analyses the average observed thoracodorsal vein length was 10.5 cm with mean diameter of 2.93 mm. The result showed that vein origin was usually represented with two branches. Conclusion. The thoracodorsal artery is a blood vessel of considerable length and diameter which represents a great advantage in reconstructive flap surgery.
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Cho, Woo Cheal, Brian Wagner, Melissa Gulosh, and Zendee Elaba. "Syringoid Eccrine Carcinoma of the Foot: Report of a Rare Cutaneous Adnexal Neoplasm." International Journal of Surgical Pathology 25, no. 7 (May 29, 2017): 659–64. http://dx.doi.org/10.1177/1066896917712453.
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Syringoid eccrine carcinoma is a rare malignant adnexal tumor that typically presents in the head and neck region. Involvement of the extremities is uncommon, with only a few cases reported in the literature. Here, we report our experience with a rare case of syringoid eccrine carcinoma occurring on the plantar surface of the right foot in a 47-year-old African American woman. Histologically, incisional biopsy revealed a tumor consisting of tubulocystic structures lined by basaloid cells with an infiltrative growth pattern, extending from the reticular dermis to the deep biopsy margin. Some of the nests and cords of basaloid cells displayed syringoma-like, tadpole morphology. Immunohistochemical analysis showed diffuse immunoreactivity with monoclonal carcinoembryonic antigen, epithelial membrane antigen, cytokeratin 7, S100 protein, and CD117. These morphologic and immunophenotypic features were most consistent with syringoid eccrine carcinoma. Syringoid eccrine carcinoma has a broad differential diagnosis which must be carefully ruled out by morphology, immunohistochemistry, and thorough metastatic survey with imaging studies. Our case highlights the importance of recognizing this rare entity, which is locally destructive and has a propensity for recurrence. To the best of our knowledge, this is the first reported case of syringoid eccrine carcinoma presenting on the sole of the foot.
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Chow, Louis Tsun Cheung, Michael Ho Ming Chan, and Simon Kwok Chuen Wong. "Functional Ulnar Nerve Paraganglioma: First Documented Occurrence in the Extremity With Hitherto Undescribed Associated Extensive Glomus Cell Hyperplasia and Tumorlet Formation." International Journal of Surgical Pathology 26, no. 1 (July 11, 2017): 64–72. http://dx.doi.org/10.1177/1066896917720750.
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Extra-adrenal paraganglioma has never been described in the extremities. A 34-year-old woman complained of an enlarging mass in the right forearm for 18 months. Imaging showed a circumscribed vascular tumor attached to the ulnar nerve; biopsy revealed features of paraganglioma. The resected tumor consisted of zellballen pattern of chief cells staining positively for chromogranin with surrounding S100-positive sustentacular cells. The chief cells contained many neurosecretory granules and mitochondria, whereas the sustentacular cells contained a large amount of rough endoplasmic reticulum and some microfilaments. There was adjacent extensive glomus cell hyperplasia and tumorlet formation. The intraoperative blood pressure dropped abruptly on tumor removal. The serum normetanephrine level decreased from a preoperative level of 1987 pg/mL (normal < 149 pg/mL) to normal after operation. The patient admitted on questioning to a history of paroxysmal attacks of transient palpitation, hand tremors, and sweating; imaging showed no evidence of tumor in other parts of the body, and there was no family history of similar tumor; she remained well 33 months after the operation. This occurrence of functional ulnar nerve paraganglioma with the hitherto undescribed associated glomus cell hyperplasia and tumorlet formation attests to the probable existence of normal sympathetic paraganglia in the extremity and their intimate functional relationship with glomus bodies.
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Figgie, Mark P., Barbara Kahn, and Evan A. O’Donnell. "Shoulder and Elbow Surgery in Juvenile Idiopathic Arthritis." Open Orthopaedics Journal 14, no. 1 (August 19, 2020): 82–87. http://dx.doi.org/10.2174/1874325002014010082.
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Juvenile idiopathic arthritis (JIA) is a chronic inflammatory arthropathy that manifests itself prior to the age of sixteen years with symptoms lasting six weeks or longer. As JIA frequently effects the upper extremities, activities of daily living become compromised during the stages of development when young adults are striving for independence. Symptomatology includes ankylosing, pain and early growth plate closure. Patients with joint involvement prior to growth plate closure have the most destruction in terms of joint abnormality and surgical complexity.Medical management of JIA has allowed for better non-surgical management, yet, there is a continued need to understand the appropriate surgical intervention and order for the greatest functional gains. Comparative studies have shown that varied results as to whether the shoulder replacement should supersede the elbow replacement or should that be reversed or both joint replacements done simultaneously. Our experience found a more significant functional improvement after total elbow replacement due to the unpredictable nature from the shoulder replacement outcomes and an inability for patients to do simple tasks such as bringing a cup to their mouths or handling a toothbrush. The exception to this occurs if the ipsilateral shoulder joint is severely limited to the point that the stressors placed on the elbow due to compensation will lead to early loosening or failure of the elbow joint replacement.Various methods for performing joint replacement of the shoulder and elbow in the JIA population will be discussed. Soft tissue integrity including the functional status of the rotator cuff will be a consideration for which surgical procedure should be considered. Surgical approaches for the elbow present fewer options for improving pain and function in this patient population. Pre, peri and postoperative management is reviewed as careful attention to irregular bony dimensions and dysmorphic anatomy precludes the use of standard implants.Total shoulder and total elbow arthroplasty should be considered in the JIA population where pain and significant functional compromise are present. The order of procedures is dependent on multiple factors and expected outcomes. Educating patients on postoperative expectations over the lifespan is an important part of surgical management for patients with JIA.
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Gupta, Mayank, Mayur Suryawanshi, Ramani Kumar, and Abraham Peedicayil. "Angioleiomyoma of Uterus: A Clinicopathologic Study of 6 Cases." International Journal of Surgical Pathology 26, no. 1 (September 14, 2017): 18–23. http://dx.doi.org/10.1177/1066896917731516.
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Background and Objectives. Angioleiomyoma is a benign perivascular neoplasm commonly involving subcutaneous tissue of extremities, head, and trunk region. They rarely involve the female genital tract. This study analyses clinicopathological features of 6 cases of uterine angioleiomyoma. Methods. Routine sections of 6 cases were reviewed and immunohistochemical markers namely muscle-specific actin, h-caldesmon, desmin, CD10, WT-1, HMB-45, and melan-A were done. Results. Of the 6 cases, 4 cases had tumor involving the corpus and 2 cases had tumor in the cervix. Grossly, all tumors had a whorled and congested cut surface. Microscopic examination of all the cases revealed circumscribed neoplasms composed of interlacing fascicles of benign perivascular smooth muscle cells with evenly distributed slit-like blood vessels (solid variant) along with vessels exhibiting thick muscular walls with swirling pattern (venous variant). In only 2 cases many dilated vessels were seen (cavernous variant). Immunohistochemically, all cases were positive for muscle-specific actin, h-caldesmon, and desmin. All cases were negative for CD10 and WT-1 ruling out endometrial stromal tumor and were negative for HMB-45 and melan-A ruling out perivascular epithelioid cell tumor (both endometrial stromal tumor and perivascular epithelioid cell tumor have prominent vessels but have different histomorphology). In all cases, surgical excision was curative and there were no intraoperative or postoperative complications. Follow-up of all the cases has been unremarkable. Conclusion. As the World Health Organization has not included angioleiomyoma in the classification of mesenchymal tumors of uterine corpus and cervix, we recommend that it should be included in the classification.
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Rukmana Tri Pratistha, Indra, Nyoman Gede Bimantara, I. Gede Mahardika Putra, Made Bramantya Karna, Anak Agung Gde Yuda Asmara, and Putu Feryawan Meregawa. "Nerves Transfer Procedure in Patients with Left Upper Extremities Weakness Following Gunshot Wounds: A Case Report." Open Access Macedonian Journal of Medical Sciences 9, no. C (September 5, 2021): 140–45. http://dx.doi.org/10.3889/oamjms.2021.6393.
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BACKGROUND: Gunshot wounds (GSWs) to the extremities can result in damage to the neurovascular structure which results in high morbidity and loss of function. According to the Centers for Disease Control report, the incidence of non-fatal GSWs has increased in the past decade. Trauma to the brachial plexus is a type of peripheral nerve trauma that is most difficult to treat due to its complex surgical procedures. Early exploration and reconstruction of peripheral nerve trauma are still being debated to this day. However, most recommend surgical exploration when the suspicion of neurovascular trauma is very high based on clinical findings. Nerve transfer is one of the recommended methods of nerve reconstruction even in pre-ganglionic lesions. We report a case of a patient with weakness of the upper limb after a gunshot wound to his left shoulder. Based on clinical considerations and investigations, nerve transfer procedure is carried out to restore patient’s shoulder function. CASE REPORT: Male, 32 years old, working as a policeman, complained difficulty on moving his shoulder for 3 months. Patients had a history of GSWs to the left shoulder which also results in a left clavicular fracture. First aid, debridement, and fracture management were performed at Bhayangkara Hospital, Palu. Physical examination revealed winging scapula positive on his left shoulder, shoulder abduction 5/1, and hypoesthesia at left C5 level. Electromyographic examination revealed lesions on the left posterior chord and left brachial plexus. Based on clinical findings and supporting examination, we performed nerve transfers procedure from the accessory nerve to suprascapular notch. In the previous study, 63% of cases GSWs associated with nerve dysfunction. About 75% of patients with nerve palsy are associated with nerve lacerations during surgical exploration. However, many surgeons continue to recommend early exploration after GSWs to the upper extremities, especially in patients who will undergo surgical treatment for other indications. Based on this, we suggest the probable cause of brachial plexus lesions in this case resulted from gunshot wound which injures the brachial plexus or as a complication from previous procedures. Surgery that is too early can interfere with the spontaneous reinnervation process, but late surgical procedures can result in failure of reinnervation. In general, optimal time is set between 3 and 6 months after trauma. Nerve transfer is one method of reconstructing peripheral nerve lesions that can be applied to pre-ganglionic or post-ganglionic lesions. CONCLUSION: This procedure has several benefits, namely, the proximity of the donor and the recipient nerve anatomy, shorter operating time and does not require grafts. Brachial plexus trauma due to trauma or non-trauma together has an impact on the patient’s quality of life. However, advances in surgical techniques and further understanding of nerve physiology have led clinicians and patients to better outcomes. The current trend of treatment strategies for brachial plexus trauma is surgical reconstruction with the nerve transfer procedure.
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Khmara, T. V., P. V. Hryhorieva, M. Yu Leka, and A. I. Popovych. "Method of Anterior Femoral Region Preparation for Establishing the Fetal Anatomical Variability of Vasculonervous Formations." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 5, no. 5 (October 24, 2020): 73–81. http://dx.doi.org/10.26693/jmbs05.05.073.
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Determining of projection-syntopic relationships of vasculonervous structures within the femoral ring, femoral triangle, and obturator and adductor canal in human fetuses is particularly important in fetal surgery, and requires the use of an appropriate set of methods of morphological examination. Obtaining data on the topographic and anatomical features of nerves, superficial and deep blood vessels of the anterior femoral region during the fetal period of human ontogenesis is a topical urgent task of fetal anatomy. The purpose of the study was to determine the method of the most rational sequence of actions during the preparation of the vasculonervous structures of the anterior femoral region in human fetuses to obtain standard results suitable for comparison in the age aspect. Material and methods. The study was performed on 80 human fetuses 81.0-375.0 mm parietal-coccygeal length using macromicroscopic preparation. After the selected sequence of preparation of nerves and vessels of the anterior femoral region in human fetuses 4-10 months we used additional methods such as vascular injection, surface staining of dissected vessels and nerves and morphometry to determine the forms of their age and individual anatomical variability. Results and discussion. The chosen sequence of preparation of nerves and vessels of the anterior femoral region in human fetuses allowed determining the forms of their age and individual anatomical variability. In particular, features of intramuscular branching of nerves and arteries in the muscles of the anterior and medial femoral groups, anatomical variability of the femoral artery and its branches, variant anatomy of the great saphenous vein, characterized by variability in shape, topography and bilateral asymmetry of its tributaries and formation of anastomoses were found in human fetuses. The identified connections and complexes of the femur cutaneous nerves, as well as areas of overlap and displacement are compensatory mechanisms in the peripheral nervous system and are observed not only between ontogenetically related nerves, but also nerves of different segmental affiliation. Conclusion. The proposed and tested method of preparation of vasculonervous structures of the anterior femoral region in human fetuses provides a standard for obtaining data on their typical and variant anatomy. The sequence of actions used during the preparation of the vasculonervous formations of the anterior femoral region of the human fetus preserves the natural appearance and relationships between the structures of the object of study. Age-related and individual fetal anatomical variability of vasculonervous formations of the anterior femoral region was discovered during the gradual preparation of the lumbar plexus branches, superficial and deep veins of the lower extremities, superficial and deep inguinal lymph nodes, and femoral artery branches
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Novikova, Valeria P., Maria O. Revnova, and Anastasia P. Listopadova. "Irritable bowel syndrome and food allergy in children." Pediatrician (St. Petersburg) 9, no. 2 (May 15, 2018): 71–77. http://dx.doi.org/10.17816/ped9271-77.
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Dysplasia of the main veins (DMV) is known by the names of authors had described this pathology as the Klippel-Trenone syndrome (KTS). Many authors consider the cause of the syndrome to be the impact of various teratogenic factors. These include drugs, infectious agents, radiation exposure, domestic and occupational hazards. Teratogenic factors can damage embryo vessels, causing local stasis and hemorrhages, which can be cause for the perverse formation of veins and surrounding tissues. The clinical picture of severe and extremely severe degrees embryonic type DMV is quite simple. It include asymmetric hypertrophy of the extremities, “disfiguring” in patients with extremely severe degree, extensive cyanotic vascular spots, often accompanied by papillomatous nevus of the skin. The spots are located on the anterolateral surface of the thigh and lower leg. Embryonic veins, which can be found under the spots – a characteristic pathognomonic sign of the KTS. Disturbances in the shape of the limb and external signs of angiodysplasia (vascular spots, atypical veins) in children with mild to moderate severity degree are less pronounced and can be inconstant. Examination and treatment of children with DMV, depending on the severity of the lesion, it is rational to start from the time of detection to 6 years. Phlebography reveal various variants of violation of the surgical anatomy of the veins of the affected limbs. Medium and light forms of dysplasia of the main veins should be differentiated with similar forms of fetal type, congenital Parkes Weber syndrome and acquired iliofemoral thrombosis (atypical veins above the bosom). Sometimes there are combinations of dysplasia of the main, deep, intermuscular and superficial veins. The following operations, according to the indications, are performed: phlebectomy and perforant veins ligation; embryonic veins removal and main outflow correction; musculoskeletal system surgery, abdominal and retroperitoneal surgery, as well as amputation of affected limb. Treatment including surgical and non-surgical methods should be comprehensive and should be performed in highly specialized, multidisciplinary hospitals.
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Brown, Jeffrey Mark, David Matichak, Kyla Rakoczy, and John Groundland. "Osteosarcoma of the Pelvis: Clinical Presentation and Overall Survival." Sarcoma 2021 (December 6, 2021): 1–10. http://dx.doi.org/10.1155/2021/8027314.
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Introduction. Osteosarcoma is the most common sarcoma of bone. Pelvic osteosarcoma presents a significant therapeutic challenge due to potential late symptom onset, metastatic dissemination at diagnosis, and inherent difficulties of wide surgical resection secondary to the complex and critical anatomy of the pelvis. The rates of survival are well reported for osteosarcoma of the appendicular skeleton, but specific details regarding presentation and survival are less known for osteosarcoma of the pelvis. Methods. The Surveillance, Epidemiology, and End Results (SEER) program was queried for primary osteosarcoma of the bony pelvis from 2004 to 2015. Cases with Collaborative Staging variables (available after 2004) were analyzed by grade, histologic subtype, surgical intervention, tumor size, tumor extension, and presence of metastasis at diagnosis. The 2-, 5-, and 10-year survival rates were assessed with respect to these variables. The SEER database was then queried for age, tumor size, surgical intervention, metastasis at time of presentation, and survivorship data for patients with primary osteosarcoma of the upper extremity, lower extremity, vertebrae, thorax, and face/skull, and rates for all anatomic locations were then compared to patients with primary pelvic osteosarcoma. Results. A total of 292 cases of pelvic osteosarcoma were identified from 2004 to 2015 within the database, representing 9.8% of cases among all surveyed primary sites. The most common histologic subtype was osteoblastic osteosarcoma (69.9%), followed by chondroblastic osteosarcoma (22.3%). The majority of cases were high-grade tumors (94.3%), of size >8 cm (72.0%), and with extension beyond the originating bone (74.0%). For the entire pelvic osteosarcoma group, the 2-, 5-, 10-year survival rates were 45.6%, 26.5%, and 21.4%, respectively, which were the poorest among surveyed anatomic sites. The 5-year overall survival was an abysmal 5.3% for patients with metastatic disease at diagnosis, and 37.0% for non-metastatic pelvic osteosarcoma treated with surgery and chemotherapy. When compared to other locations, pelvic osteosarcoma had higher rates of metastatic disease at presentation (33.5%), larger median tumor size (11.0 cm), and older median age at diagnosis (47.5 years). While over 85% of patients with tumors at the extremities received surgery, only 47.4% of pelvic osteosarcomas in this cohort received surgical resection—likely influenced by larger tumor size, sacral involvement, frequency of metastasis, older age, or delayed referral to a sarcoma center. Conclusion. This study clarifies presenting features and clinical outcomes of pelvic osteosarcomas, which often present with large, high-grade tumors with extracompartmental extension, high likelihood of metastatic disease at diagnosis, and a potential limited ability to be addressed surgically. The survival rates of primary osteosarcoma of the pelvis are poor and are lower than osteosarcomas from other anatomic locations. While acknowledging the influence of metastasis, tumor characteristics, and advanced age on the decision to undergo surgical excision of a pelvic osteosarcoma, the rates of surgical resection are low and highlight the importance of understanding appropriate conditions for oncologic resection of pelvic sarcomas.
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Kononovich, N. A., E. R. Mingazov, E. N. Gorbach, and D. A. Popkov. "Impact of telescopic intramedullary rodding on the growing tibia: an experimental study." Genij Ortopedii 28, no. 6 (December 2022): 817–22. http://dx.doi.org/10.18019/1028-4427-2022-28-6-817-822.
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Introduction Telescopic intramedullary osteosynthesis (TIO) is used in children with osteogenesis imperfecta and other diseases accompanied by frequent fractures and deformities of long bones due to pathological bone tissue featuring reduced strength properties. Purpose In an animal experiment to study the growth characteristics of an intact tibia under conditions of intramedullary reinforcement with a telescopic rod. Material and methods A non‑randomized controlled study was conducted on 4 animals (puppies, littermates) that underwent TIO of the right limb tibia with a telescopic titanium rod (outer diameter of 4.2 mm) at the age of 5 months. X-ray parameters (length of the tibia, angles of inclination of the articular surfaces, telescoping magnitude) were studied before surgery, on the day of rod placement, and after the end of spontaneous growth of the segment (7 months after surgery). The contralateral left tibia served as a control, and its X-ray parameters were studied at the same time-points. Results Transphyseal reinforcement with a telescopic rod caused growth retardation with loss of length in only one case out of four (8 mm or 4.8 % of residual growth). In other cases, no difference in the length of the tibias of the right and left lower extremities was found. Eccentric insertion of the transphyseal rods into the posterior third of the distal epiphysis (due to the natural anatomy of the canine tibial shaft) formed an angular deformity during growth: a significant increase in the distal anterior and lateral tibial angles of the operated limb compared to the intact limb. The amount of divergenceof the parts of the rods was, on average, 11.3 mm. There were no cases of migration of intramedullary rods or loss of fixation of threaded sections in the epiphyses. Conclusion Under experimental conditions, the slowing down of longitudinal bone growth is not a constantly observed effect. Titanium telescopic rods are not prone to blocking during the limb growth or to losing the position of the threaded parts in the epiphyses. The eccentric passage of the rods through the growth zones causes angular deformities in the course of growth of the segment.
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Luo, T. David, Michael De Gregorio, Andrey Zuskov, Mario Khalil, Zhongyu Li, Fiesky A. Nuñez, and Fiesky A. Nuñez. "Distal Metaphyseal Osteotomy Allows for Greater Ulnar Shortening Compared to Diaphyseal Osteotomy for Ulnar Impaction Syndrome: A Biomechanical Study." Journal of Wrist Surgery 09, no. 02 (August 28, 2019): 100–104. http://dx.doi.org/10.1055/s-0039-1695707.
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Abstract Purpose To compare the biomechanical characteristics between diaphyseal and metaphyseal ulnar-shortening osteotomy with respect to (1) maximal shortening achieved at each osteotomy site and (2) force required to achieve shortening at each site. Methods Nine fresh frozen cadaveric upper extremities were affixed through the proximal ulna to a wooden surgical board. A metaphyseal 20-mm bone wedge was resected from the distal ulna and sequential shortening was performed. A load cell was attached to a distal post that was clamped to the surgical board and used to measure the force required for each sequential 5-mm of shortening until maximal shortening was achieved. The resected bone was reinserted, and plate fixation was used to restore normal anatomy. A 20-mm diaphyseal osteotomy was performed, and force measurements were recorded in the same manner with (1) interosseous membrane intact, (2) central band released, and (3) extensive interosseous membrane and muscular attachments released. Results Metaphyseal osteotomy allowed greater maximal shortening than diaphyseal osteotomy with the interosseous membrane intact and with central band release but similar shortening when extensive interosseous membrane and muscle release was performed. Force at maximal shortening was similar between metaphyseal and diaphyseal osteotomy. Sequential soft tissue release at the diaphysis allowed for increased shortening with slightly decreased shortening force with sequential release. Conclusion Metaphyseal ulnar osteotomy allows greater maximal shortening but requires similar force compared with diaphyseal osteotomy. Sequential release of the interosseous membrane permits increased shortening at the diaphysis but requires extensive soft tissue release. Clinical Relevance Both sites of osteotomy can achieve sufficient shortening to decompress the ulnocarpal joint for most cases of ulnar impaction syndrome. The greater shortening from metaphyseal ulnar osteotomy may be reserved for severe cases of shortening, especially after distal radius malunion or in the setting of distal radius growth arrest in the pediatric population. Level of Evidence This is a Level V, basic science study.