Distinct intergender difference in the femoral artery ramification patterns found in the Turkish population: angiographic study

Using 600 bilateral femoral angiographies (300 male lower extremities and 300 female lower extremities), we observed configurations of the femoral origins of the medial circumflex femoral artery (MCFA), lateral circumflex femoral artery (LCFA) and the deep femoral artery. The distinct intergender difference was found in the incidence of direct origin of the MCFA from the femoral artery (17.8% and 80.0% in male and female limbs, repsectively). The LCFA also exhibited a marked difference between genders in the incidence of direct origin. The Turkish population seemed to be characterized by an intergender difference in specific somatic arterial morphology.     

Anatomic variations of the musculotendinous junction of the soleus muscle and its clinical implications

The soleus muscle, like the gastrocnemius, is a powerful plantarflexor muscle in the lower limb. The soleus muscle joins the aponeurosis of the gastrocnemius muscle to form the calcaneal (Achilles) tendon. While the basic anatomy of the soleus muscle has been previously described, no study has addressed the anatomical variations of its distal attachment. We found considerable anatomic variation in the distance between this musculotendinous junction and the most proximal point of the proximal edge. This distal measuring point was defined as the most proximal point of the proximal edge of the posterior surface of the calcaneal tuberosity. Eighty human cadaver specimens were preserved according to Thiel's method; we examined one limb from each cadaver, studying 80 lower extremities in total. Following careful dissection of the lower limb, we measured the distance between the distal point of attachment of the soleus muscle fibers (the musculotendinous junction) and the designated measuring point. Our findings were divided into three groups: Group 1 (10 cases, 12.5%), where the distance between the musculotendinous junction and the designated point on the calcaneal tuberosity was between 0 and 1 inches; Group 2 (56 cases, 70%), where the distance was between 1 and 3 inches; and Group 3 (14 cases, 17.5%), where the distance was greater than 3 inches. Detailed knowledge of the anatomic variations of the soleus muscle at its insertion point onto the calcaneal tendon has clinical implications in calcaneal tendon repair following rupture and in the planning of reconstructive surgery using soleus muscle flaps.     

Rare case of femoral artery ramification and origin of the obturator artery

We observed two rare patterns of femoral artery ramification in the bilateral thighs of an 83-year-old male cadaver. In the right thigh, the lateral circumflex femoral and deep circumflex iliac arteries formed a common trunk, while in the left, the medial circumflex femoral, inferior epigastric, and obturator arteries formed a common trunk. In the left pelvis, the obturator artery comprised branches from the inferior epigastric, superior gluteal, and inferior gluteal arteries. We describe this rare case and discuss the genesis and clinical significance of these variations.     

Multiple variations of the deep artery of arm: double deep artery of arm and deep artery of arm with the superior ulnar collateral artery. A case report

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.     

全髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折☆

背景：由于多数伴有下肢短缩的陈旧性股骨颈骨折患者经历过长期牵引或失败的内固定手术,髋部已严重骨质疏松,髋关节周围软组织及关节囊挛缩或股骨头缺血坏死,下肢短缩,临床治疗很困难。 目的：探讨全髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折的临床疗效。 方法：对35例伴有下肢短缩的陈旧性股骨颈骨折患者施行全髋关节置换。置换前股骨髁上骨牵引、双下肢和骨盆正位片X射线测量,置换中股骨颈截骨水平及软组织松解程度,调整假体头颈长度等对下肢短缩进行纠正。 结果与结论：置换后6例置换前短缩3.0~4.0 cm,置换后仍然1例短缩在1.0 cm,其余5例及29例短缩在2 cm以内者置换后双下肢等长。置换后1年Harris评分较置换前明显提高(P < 0.05)。说明全髋关节置换后功能恢复快而稳定,优良率高,近期随访效果良好,是治疗伴有下肢短缩的陈旧性股骨颈骨折有效方法。      

Fibular aplasia, tibial campomelia, and oligosyndactyly in a male newborn infant: a case report and review of the literature

We report on a male newborn with a rarely described congenital limb deficiency syndrome consisting of shortening and anterior bowing of the right lower limb at the distal third of the tibia with associated overlying soft tissue dimpling, oligodactyly of the right foot, and a left-sided oligosyndactyly of the hand. The right hand and left lower limb were clinically normal. Radiographic examination revealed complete absence of the right fibula, absence of the right-sided Vth ray, and anterior bowing and shortening of the right-sided tibia. Femora, humeri, ulnae, and radii were normal. The infant had neither facial dysmorphia nor other associated anomalies. A limb deficiency syndrome comparable to this case has been reported in a female by Hecht and Scott, the only report classified under OMIM 246570 so far. We found two other reports describing three cases comparable to our case and the female reported by Hecht and Scott, and reviewed these cases. The major common findings in all the five cases consist of fibular aplasia, tibial campomelia, and oligosyndactyly. Therefore, we propose to name it fibular aplasia-tibial campomelia-oligosyndactyly (FATCO) syndrome. Additional case reports are needed for further delineation of this rare limb deficiency syndrome.     

Three‐dimensional demonstration of the lymphatic system in the lower extremities with multi‐detector‐row computed tomography: A study in a cadaver model

Sentinel lymph node biopsy (SLNB) has had a great impact on the staging and treatment of cancer. The purpose of this study was to study the lymphatic anatomy of the lower extremities by constructing three‐dimensional images using multi‐detector‐row computed tomography (MDCT). To select appropriate contrast media for MDCT lymphatic imaging in a cadaver, we tested four kinds of contrast media by injecting them into fresh swine kidneys. After the suitable contrast medium was selected, 10 lower extremities from 5 fresh cadavers were studied. After injection of the contrast medium, each lower extremity was scanned with high‐spatial‐resolution MDCT. The zinc oxide mixture was found to be the most appropriate contrast formula for MDCT imaging of cadaver lymphatics in terms of CT value and no extravasation. The high‐resolution MDCT imaging revealed two different superficial lymphatic pathways in the legs. One lymphatic pathway accompanying the great saphenous vein had a constant course and was connected to the superficial inguinal lymph nodes. However, another pathway, along the small saphenous vein, was variable. Some of the deep lymphatic vessels bypassed the inguinal lymph nodes. Using a new protocol, we were able to construct three‐dimensional images of the lower extremity lymphatics in a cadaver model. MDCT imaging provided novel information about two different superficial lymphatic pathways in the lower extremities. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.     

A case of the persistent sciatic artery

During the dissecting practice of students at Gifu University School of Medicine in 1989, a rare developmental anomaly showing the sciatic artery was found in the left lower limb of a cadaver of 88-year-old Japanese female. The left sciatic artery (5 mm in diameter) arose from the internal iliac artery and appeared at the buttock between the piriformis and superior gemellus muscles through foramen infrapiriforme. The femoral artery (6 mm in diameter) of the left lower limb was normal in distribution and belonged to the type III by Adachi's classification (1928). The terminal vessel of the femoral artery was joined to the sciatic artery at the popliteal fossa.     

Deep femoral artery with four variations: a case report

During our routine dissection course for students we found a complex variation of the femoral artery on the left side of a 72-year-old male cadaver. The deep femoral artery was originating from the anterior aspect of the femoral artery; the inferior epigastric and the external pudendal arteries were arising from the deep femoral artery. Besides, the lateral circumflex femoral artery was arising from the lateral aspect of the femoral artery and distal to the origin of the deep femoral artery.     

Trifurcation of brachial artery with variant course of radial artery: Rare observation

Variations in the arterial pattern of the upper limb have been observed frequently, either in the routine dissections or in clinical practice. The aim of the present study was to describe the anatomical, surgical and embryological importance of major arteries of upper limbs of human beings. The present article is the report of low division and trifurcation of brachial artery and abnormal course of radial artery (passing deep to the pronator teres muscle) found in a 45-year-old embalmed male cadaver. Knowledge of the arterial variations in the upper limb is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures.     

Bilateral persistent complete sciatic artery

A case with persistent sciatic artery (PSA) was found in a cadaver of a 65-year-old female during a medical gross anatomy course. The artery was bilateral and complete and provided the major blood supply to both lower extremities. The vessel arose from the internal iliac artery that was extremely large bilaterally. The sciatic artery passed out of the pelvis through the infrapiriform foramen and descended posterior to the sciatic nerve through the gluteal region. The sciatic nerve was considerably flattened out under the artery. Large articular branches arose from the part of the artery at the buttock just below the piriform muscle. The artery descended along the back of the thigh and was crossed obliquely posteriorly by the long head of the biceps femoris muscle. The sciatic artery continued as the popliteal artery located very superficially in the popliteal fossa. A companion vein, i.e., the sciatic vein, accompanied each artery. The right sciatic vein entered the pelvis posteriorly through the infrapiriform foramen, whereas the left perforated the quadriceps muscle from behind and joined the femoral vein anteriorly. There was a gracile superficial femoral artery bilaterally. The deep femoral arteries of both lower limbs were hypoplastic with slender circumflex branches. There were no macroscopic connections between the sciatic and the deep or superficial femoral arteries on either side. This anomaly should be kept in mind in the evaluation of patients with sciatic or buttock pain or palpable "pulsating" buttock mass. Persistent sciatic artery also could be a potential hazard during orthopedic manipulations, hip joint surgery, and renal transplant surgery.     

On unknown bone bridge and foramen of the atlas

The atlas of a 52-year-old male Japanese cadaver, which had been removed and macerated, presented a bilateral unknown bone bridge forming a foramen (Case 1). The bone bridge connected the ponticulus lateralis (PL) and posterior (PP) to form an oval foramen between the superior roots of both ponticuli. The atlas of a 69-year-old male Japanese cadaver was found to have similar variations in situ (Case 2). In this case, the right bone bridge connected the superior root of the incomplete PL and the inferior root of the also incomplete PP to form a long ellipsoid foramen opening medially. The medial opening of the foramen was closed by a ligamentous connective tissue in situ. The condylar emissary vein passed this complete foramen to join the cervical epidural venous plexus. The similar bilateral foramen in case 1 was supposed to pass the same vein as in case 2. The bone bridge between the two ponticuli and the resulting foramen mentioned above have not been described previously, as far as we know. We propose that these structures be called the ponticulus interponticularis atlantis and the foramen atlantoideum interponticulare, respectively.     

Anatomical variants of the lateral femoral circumflex artery: an angiographic study

The descending branch of the lateral femoral circumflex artery (LFCA) has found recent use as a new arterial graft for coronary artery bypass grafting (CABG). Anatomical variants of the LFCA were assessed on femoral arteriograms obtained before CABG in 131 adult patients. The most common pattern, found in 78.6% of extremities, consisted of the LFCA arising from the deep femoral artery, and the arterial graft was selected from this pattern in 92.3% of patients in whom the descending branch of the LFCA was used for CABG.     

Deep femoral artery aneurysm presenting as lower limb swelling: a case report

We report a rare case of lower limb swelling due to compression of the superficial femoral vein by a solitary deep femoral artery aneurysm. The patient was a 58-year-old man presenting with acute swelling of the right lower limb caused by deep venous thrombosis. A multi-detector computed tomographic scan (CT) confirmed the diagnosis of a deep femoral artery aneurysm and revealed no evidence of aneurysms or occlusive lesions in the other arteries. Aneurysmectomy and ligation of the deep femoral artery were successfully performed. Preoperative multi-detector CT scanning is a valuable, non-invasive diagnostic tool to delineate not only the state of the aneurysm, but also that of the distal arterial tree.     

介入治疗股骨头缺血性坏死的应用解剖

目的 介入治疗股骨头缺血性坏死提供解剖学基础.方法 选用经乳胶灌注防腐成人下肢标本20侧及新鲜成人下肢标本2侧,观察股深动脉的起点方位及分支类型,测量股深动脉及各分支长度和外径以及各分支起始部的角度.结果 股深动脉主要从股动脉后方(36.4％)和后外侧方(36.4％)发出,旋股内侧动脉从股深动脉发出(72.7％),从股动脉发出(27.3％).各主要血管的长度为:股深动脉(19.22±10.19) mm,其根部距腹股沟韧带的距离为(38±11.78)mm;旋股内侧动脉(12.56±6.17) mm;旋股外侧动脉(13.93±11.04) mm.各主要血管的外径为:股深动脉(5.20±1.57)mm,旋股内侧动脉(3.64±0.99) mm,其升支(2.66±0.99)mm;旋股外侧动脉(4.48±1.19) mm,其升支(2.12±0.59) mm.旋股内侧动脉升支以与主干成接近90°的夹角;旋股外侧动脉与其升支间约呈115.82°夹角.结论 熟悉股动脉应用解剖,有利于完善这种治疗方法.     

髋部骨折后下肢深静脉血栓形成家兔模型的建立

背景：目前各种方法诱导下肢深静脉血栓的动物模型缺乏统一的标准。 目的：建立髋部骨折后下肢深静脉血栓形成兔模型。 方法：采用专用击打装置,用位于28 cm高度的击打物击打家兔后下肢左侧大腿根部;建立兔髋部骨折模型,另一侧兔后下肢不击打设为对照侧。4周后选取下肢髂静脉行彩色多普勒超声以及凝血功能的检查血栓形成情况。 结果与结论：家兔经打击后经彩色多普勒超声检查存在下肢深静脉血栓,血栓长度(124±37) mm。对照侧无下肢深静脉血栓形成。血栓形成率81.8%,死亡率为9.1%。结果证实,实验成功建立的兔髋部骨折后下肢深静脉血栓形成模型,简单可行。     

Muscle variations and abnormal branching and course of the ulnar nerve in the forearm and hand

During dissection of the right forearm of a 27-year-old female cadaver, variations in the form and insertion of the palmaris longus muscle were observed. The tendon of the palmaris longus muscle, which demonstrated a centrally placed belly, split into two tendons: one inserted into the palmar aponeurosis and the other into the proximal part of the flexor retinaculum. Additionally, we found an accessory muscle extending between the flexor retinaculum and the tendon of the abductor digiti minimi muscle. This accessory muscle was located deep to the ulnar artery but superficial to the superficial and deep branches of the ulnar nerve at the wrist. Finally, an aberrant branch of the ulnar nerve was identified in the forearm; it traveled distally alongside the ulnar artery and in the palm demonstrated communications with common palmar digital nerves from the ulnar and the median nerves. No variations were observed in the contralateral upper limb.     

Multiple Neurovascular Abnormalites of a Single Cadaver-A Case Report

Neurovascular variations are of interest to anatomists, clinicians, anaesthesiologists and especially to the surgeons.During routine dissection of a 65 years old male cadaver in Kolkata Medical College; it was found that there was no standard formation of lateral cord of brachial plexus on right side because anterior division of upper trunk continued as Musculocutaneous nerve and the Median nerve was formed medial to the first part of Axillary artery just below and behind the Clavicle by the fibres of anterior division of middle trunk via lateral root and anterior division of lower trunk via medial root. About 1.5cm distal to its formation Median nerve gave a branch which crossed the second part of the Axillary artery and supplied the Coracobrachialis muscle in addition to Musculocutaneous nerve. A single Pectoral nerve was formed by union of two nerves arising from anterior division of middle and lower trunk respectively. The Musculocutaneous nerve of opposite limb was formed by union of two nerves arising from the lateral cord of brachial plexus. In posterior thoracic wall, a left sided Azygos vein and multiple communicating veins between Azygos and Hemiazygos vein were found. An altered relation between Tibial nerve and Posterior Tibial blood vessel and an abnormal termination of latter were encountered in right lower limb.