Bourgery's artery: anatomic basis for a new cutaneous skin flap (21.06.88)

Bourgery's artery, the first branch of the popliteal a., delivers further branches to the vastus lateralis and biceps femoris m., by its terminal cutaneous branch, supplies a large territory of the external surface of the thigh. This area can be mobilized as a skin flap pedicle to cover tissue losses in the knee area.     

The anatomy and variations of the internal thoracic (internal mammary) artery and implications in autologous breast reconstruction: clinical anatomical study and literature review

Background  

The internal thoracic (IT) vessels (otherwise known as the thoracica interna or internal mammary vessels) are widely used as recipient vessels in autologous breast reconstruction. Despite this, normal and pathological variations in IT artery architecture have been described, and these have the potential to complicate dissection and the selection of suitable vessels.     

翻转胸廓内动脉冠状动脉旁路术的实验研究

目的 研究翻转胸廓内动脉用于冠状动脉旁路术的可行性。方法 对１０具成人尸体胸廓内动脉的特性进行观察,并测量左、右各助间点到ＩＴＡ起点、冠状动脉左前降支中点的距离。结果 于近端切断胸廓内动脉可以保证该动脉逆向供血,血供来源于下位肋间动脉、肌隔动脉和腹壁上动脉。左侧第３肋间以下的各肋间中点,到ＩＴＡ起点处的长度明显长于其到冠状动脉左前降支中点的距离;右侧第４肋间以下的各肋间中点,到ＩＴＡ起点处的长距离     

The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery

Summary After traumatic loss of the index finger the second metacarpal bone is often used as a free graft to reconstruct bony defects of the thumb. Since clinical experience has shown numerous advantages of using a blood supplied bone graft, an anatomical study was performed in 104 cadaveric hands to investigate the vascularization supply of this bone. After dye injections into the arterial system the vascular situation of the second metacarpal was studied and a classification was made. Six variations in arterial vascularization were found. The nutrient vessels to the bone originate from the radial artery or from the deep palmar arch and correspond to variable metacarpal arteries. Selective injection studies via the respective pedicles showed sufficient perfusion and complete dye distribution in the bone. Further dissections could demonstrate the feasibility of raising a pedicled bone graft only partially with preservation of the index finger. The second metacarpal as a vascularized graft may be harvested entirely in serious injuries with destruction of the index finger in emergency cases of skeletal thumb reconstruction or partially as an elective procedure. All type have a useful are of rotation and their pedicles allow transpositions within the radial side of the hand, especially for applications in the thumb and carpus. The clinical application of these procedures could be shown in five cases. The results of this study therefore provide the anatomical basis for transposition or free microvascular transplantation of the second metacarpal as a vascularized bone graft for a variety of indications in hand surgery.

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Vascularisation du deuxième métacarpien. Bases anatomiques pour un nouveau greffon vascularisé en chirurgie de la main

Résumé Après une perte de substance osseuse post traumatique du pouce associée à une perte de l'index, un greffon osseux vascularisé est souvent utilisé pour reconstruire le pouce à partir du deuxième métacarpien. Un transfer osseux présente des avantages quand il est vascularisé. Pour cette raison les auteurs ont étudié, sur 104 mains prelevées sur des cadavres, les bases anatomiques et les possibilités d'une transposition du métacarpe II avec un pédicule vasculaire. Après l'injection intraartérielle, la vascularisation du 2eme métacarpien II a été étudiée et une classification a été faite. Les auteurs ont trouvé six variantes différentes. Les artères nourricières proviennent de l'a. radiale ou de l'arcade palmaire profonde et forment les aa. métacarpiennes de situation variable. Des injections sélectives avec bleu de méthylène dans les artères ont prouvé les bonnes conditions de perfusion avec une diffusion du la substance colorante dans l'os entier. La longueur des pédicules vasculaires permet une rotation correcte de ce transfert osseux sur le versant radial de la main dans chaque variante, plus particulièrement dans le cas des applications au pouce et à la racine de main. Les résultats de ces recherches constituent la base anatomique pour une nouvelle méthode reconstructive dans la chirurgie de la main.

     

Anatomic bases of aorto-coronary bypasses: the internal thoracic artery and blood supply of the sternum

The internal thoracic a. is much used in cardiac surgery because of its anatomic position, but its mobilisation may lead to devascularisation of the sternum. The aim of this study was to establish a precise systematisation of the vascularisation of the sternum by means of dissections and radiography after injection of contrast medium in 15 subjects. It is based on the internal thoracic a. and its collaterals, which form multiple anastomoses. This anatomic basis provides an understanding of the problems of the devascularisation (partial and temporary) and the infections that may occur following the use of one or both internal thoracic aa. during coronary bypass operations. However, it should always be regarded as the graft of choice, given the longevity of these bypasses.This study was presented at the Société Anatomique de Paris on Friday 3 of March 1995     

Anatomic basis of a fascio-cutaneous flap supplied by the perforating branch of the peroneal artery

Summary The length, caliber and course of the perforating branch of the peroneal artery are described following examination of both feet of 20 cadavers. This terminal branch of the peroneal artery has a constant, predictable course and may normally be sacrificed without any vascular compromise in the foot. It has great surgical potential at it is strategically situated so that it can act as a vascular pedicle for a large cutaneous flap situated on the lower lateral leg, with an axis of rotation centered at the midtarsal joint. This has been used by the senior author (AC Masquelet) as a pedicle flap and as an island flap for reconstruction of the foot and ankle with satisfying results.

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Bases anatomiques d'un lambeau cutanéo-aponévrotique vascularisé par la branche perforante de l'artère péronière

Résumé La longueur, le calibre et la direction de la branche perforante de l'artère péronière ont été décrites après examen des 2 pieds de 20 cadavres. Cette branche terminale de l'artère péronière a un trajet constant et prévisible. Elle peut être sacrifiée sans risque vasculaire pour le pied. Elle a un grand intérêt chirurgical du fait de sa situation, car elle représente le pédicule vasculaire d'un large lambeau cutané situé sur la face latérale de la partie basse de la jambe avec un axe de rotation centré au milieu de l'articulation du tarse. Ce lambeau a été initialement utilisé par AC Masquelet pour la reconstruction du pied et de la cheville comme lambeau pédiculé et un lambeau en îlot avec des résultats satisfaisants.

     

Comparison of basis functions for 3D PET reconstruction using a Monte Carlo system matrix

In emission tomography, iterative statistical methods are accepted as the reconstruction algorithms that achieve the best image quality. The accuracy of these methods relies partly on the quality of the system response matrix (SRM) that characterizes the scanner. The more physical phenomena included in the SRM, the higher the SRM quality, and therefore higher image quality is obtained from the reconstruction process. High-resolution small animal scanners contain as many as 103-10? small crystal pairs, while the field of view (FOV) is divided into hundreds of thousands of small voxels. These two characteristics have a significant impact on the number of elements to be calculated in the SRM. Monte Carlo (MC) methods have gained popularity as a way of calculating the SRM, due to the increased accuracy achievable, at the cost of introducing some statistical noise and long simulation times. In the work presented here the SRM is calculated using MC methods exploiting the cylindrical symmetries of the scanner, significantly reducing the simulation time necessary to calculate a high statistical quality SRM and the storage space necessary. The use of cylindrical symmetries makes polar voxels a convenient basis function. Alternatively, spherically symmetric basis functions result in improved noise properties compared to cubic and polar basis functions. The quality of reconstructed images using polar voxels, spherically symmetric basis functions on a polar grid, cubic voxels and post-reconstruction filtered polar and cubic voxels is compared from a noise and spatial resolution perspective. This study demonstrates that polar voxels perform as well as cubic voxels, reducing the simulation time necessary to calculate the SRM and the disk space necessary to store it. Results showed that spherically symmetric functions outperform polar and cubic basis functions in terms of noise properties, at the cost of slightly degraded spatial resolution, larger SRM file size and longer reconstruction times. However, we demonstrate that post-reconstruction smoothing, usually applied in emission imaging to reduce the level of noise, can produce a spatial resolution degradation of ~50%, while spherically symmetric basis functions produce a degradation of only ~6%, compared to polar and cubic voxels, at the same noise level. Therefore, the image quality trade-off obtained with blobs is higher than that obtained with cubic or polar voxels.     

Preoperative color-doppler assessment of vascularisation of the rectus abdominis: anatomic basis of breast reconstruction with a transverse rectus abdominis myocutaneous flap A prospective study

The unipedicled TRAM flap is an useful alternative to breast reconstruction after mastectomy in patients who refuse mammary implants. There is however the risk of unpredictable partial skin necrosis even after rigorous surgical procedures. Certain authors have proposed color flow doppler assessment before reconstructive surgery better to identify the vascular network and optimise patient selection. We performed a prospective study in 20 outpatients in order to compare preoperative assessment of the blood supply to the abdominal flap with the operative findings. An Ultramark 9 HDI (Advanced Technology Laboratories) equipped with a high frequency (10 Mhz) linear probe was used to measure blood flow and vessel caliber in the epigastric a. and perforating vessels (localisation, number, peak flow). Despite three limiting factors (anatomic, technical, morphologic) the results obtained in this series could be used to determine the indications for a TRAM flap.     

Territories of the perforating (lenticulostriate) branches of the middle cerebral artery

Summary The territories of the central branches of the middle cerebral artery (MCA) were examined in 21 injected human brains. It was noted that these central arteries supplied: the caudate nucleus (dorsolateral half of the rostral part of its head; the entire caudal part of the head; the body and rostral portion of the tail in some cases), the putamen (dorsolateral part of its rostral portion, the remainder of the putamen, except the most caudal part occasionally), the globus pallidus (the entire lateral segment, except the ventrorostral and, sometimes, the most caudal part), the basal forebrain (lateral parts of the basal nucleus of Meynert and the nucleus of the diagonal band, as well as fiber bundles in this region), the internal capsule (dorsal and ventrocaudal part of the anterior limb, dorsal part of the genu, dorsal and ventrorostral part of the posterior limb), the corona radiata (a narrow strip close to the internal capsule) and the cerebral cortex (the caudal orbitofrontal cortex occasionally). The presented data may have certain neuroradiologic, neurologic and neurosurgical signifiance.

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Territoire des branches perforantes (lenticulo-striées) de l'artère cérébrale moyenne

Résumé Le territoire des artères centrales nées de l'ACM a été étudié sur vingt et un cerveaux humains injectés. Les artères centrales vascularisent : le noyau caudé (la moitié dorso-latérale de la partie rostrale de sa tête ; la totalité de la partie caudale de sa tête ; dans certains cas son corps et la partie rostrale de sa queue), le putamen (la partie dorso-latérale de sa portion rostrale ; parfois le reste du putamen, à l'exception de sa portion la plus caudale), le globus pallidus (la totalité de son segment latéral sauf sa partie ventro-rostrale et parfois sa portion la plus caudale), le cerveau basal (parties latérales du noyau basal et noyau de la bandelette diagonale, de même que les faisceaux des fibres de cette région), la capsule interne (partie dorsale et ventro-caudale du bras antérieur ; partie dorsale du genou; partie dorsale et ventrorostrale du bras postérieur), la couronne rayonnante (étroite bande bordant la capsule interne) et le cortex cérébral (parfois la partie caudale du cortex orbito-frontal). Ces données peuvent avoir une certaine importance en neuro-radiologie, neurologie et neuro-chirurgie.

     

The osteo-muscular dorsal scapular (OMDS) flap. Anatomic basis of a new pedicled flap for mandibular reconstruction

The fibula free flap has become the dominant free flap for all mandible reconstructions, except in case of severe peripheral vascular disease. In these cases we propose to use the pedicled osteo-muscular dorsal scapular flap as an alternative technique. This flap is an original technique, it is pedicled on the dorsal scapular vessels with harvesting of the medial border of the scapula and the lateral part of the rhomboid muscles. We carried out an anatomic study of the scapular region on 33 subjects in order to describe the surgical landmarks of the dorsal scapular pedicle. We determined the feasibility of this technique using a ten fresh cadavers and performed this flap on three patients. In most cases (58%), the dorsal scapular artery passed very close to the superior angle of the scapula and ran lateral to the medial border of the scapula, in 42% of cases the artery divided into a lateral branch which stayed deep to the medial border of the scapula and a medial branch which ran deep to the rhomboid muscles. In all cases an anastomosis between the dorsal scapular artery and the descending branch of the transverse cervical artery was present. In this technique, after harvesting the medial border of the scapula and the lateral part of the rhomboid muscles, the flap has been transposed in the cervical region through a tunnel under the superior part of the trapezius. This technique has been used in three patients after lateral resection of the mandible. The functional results were good, allowing the preservation of the scapular elevation.     

股前外侧部皮瓣的进一步解剖学研究--高位皮动脉与皮瓣血供的分型

目的：研究股前外侧皮瓣高位皮动脉及皮瓣的血供类型。方法：在50例灌注红色乳胶的成人防腐标本上对股前外侧部皮动脉进行解剖观察，记录高位皮动脉的出现率、来源动脉、位置及其走行，分析股前外侧部皮动脉的分布规律。结果：高位皮动脉出现率为58％（29侧，34支），其中发自旋股外侧动脉升支的占10％（5侧）、横支的占44％（22侧）和降支根部的占4％（2侧）。无高位皮动脉出现时，旋股外侧动脉降支发出皮动脉营养皮瓣，降支皮动脉浅出点在髂髌连线附近，可定为正常型（21侧，42％）。出现高位皮动脉时，降支发出的皮动脉位置偏低，管径较细，皮瓣的血供可分为降支皮动脉主要型（18侧，36％）、均匀分布型（6侧，12％）和高位皮动脉支主要型（5侧，10％）。结论：高位皮动脉出现率高，分布具有规律性，可作为股前外侧部皮瓣血管蒂的补充。     

Clinical outcomes of primary anatomic all-inside Anterior Cruciate Ligament reconstruction using the TransLateral technique: A minimum one-year follow-up study

BackgroundAnatomic all-inside Anterior Cruciate Ligament (ACL) reconstruction using the TransLateral technique is relatively new. This technique utilises single tendon autograft and instruments permitting inside-to-out drilling to create retrograde sockets. Few studies have investigated clinical outcomes following this technique. We investigate clinical outcomes in patients who underwent primary anatomic all-inside ACL reconstruction using the TransLateral technique with a minimum one-year follow-up.MethodsInterrogation of our prospectively maintained database identified patients who underwent surgery from June 2013 to December 2017. Patients were followed up clinically and using patient-reported outcome measures (PROMS) including EQ-5D, KOOS, IKDC and Tegner scores from the National Ligament Registry. Paired two-tailed Student t-test was used to assess for clinical significance.ResultsOne hundred forty-one cases with a mean age of 30 years (range 16.0–60.2) and mean follow-up of 17.4 months (12.1–75.2) were included. Grafts included isolated quadrupled semitendinosus (n = 115) and both quadrupled semitendinosus and gracilis (n = 26). One hundred and two patients (72.3%) had complete peri-operative PROMS. Mean increases in EQ-5D VAS and IKDC scores were 18.9 and 29.2 points (p < 0.001). Significant peri-operative improvements were observed for all KOOS domains (p < 0.001). Median Tegner activity score increased by two levels (p < 0.001). Incidence of graft re-rupture was 5.7% (n = 8), all were following significant knee trauma and seven cases were mid-bundle femoral tunnel placements.ConclusionsAll-inside ACL reconstruction using the TransLateral technique demonstrates good clinical and functional outcomes with low complication and failure rate. Mid-bundle femoral tunnel placements have been abandoned in favour of placement deep within the anteromedial bundle footprint.     

Classification of breast tissue using a laboratory system for small-angle x-ray scattering (SAXS)

Structural changes in breast tissue at the nanometre scale have been shown to differentiate between tissue types using synchrotron SAXS techniques. Classification of breast tissues using information acquired from a laboratory SAXS camera source could possibly provide a means of adopting SAXS as a viable diagnostic procedure. Tissue samples were obtained from surgical waste from 66 patients and structural components of the tissues were examined between q = 0.25 and 2.3 nm(-1). Principal component analysis showed that the amplitude of the fifth-order axial Bragg peak, the magnitude of the integrated intensity and the full-width at half-maximum of the fat peak were significantly different between tissue types. A discriminant analysis showed that excellent classification can be achieved; however, only 30% of the tissue samples provided the 16 variables required for classification. This suggests that the presence of disease is represented by a combination of factors, rather than one specific trait. A closer examination of the amorphous scattering intensity showed not only a trend of increased scattering intensity with disease severity, but also a corresponding decrease in the size of the scatterers contributing to this intensity.     

Proximity of the maxillary artery to the mandibular ramus: An anatomic study using three‐dimensional reconstruction of computer tomography

The maxillary artery (MA) is the main source of brisk bleeding during maxillectomy and procedures in the subcondylar portion of the mandible. The purpose of the study was to investigate the relationship between the MA and the mandible in the infratemporal fossa. The CT scans of 100 patients were retrospectively evaluated. The distances from the MA to bony landmarks were assessed in a three‐dimensional model of the CT scan. In the cases where the MA was lateral to the LP [164 of 200 MAs (82%)], the mean shortest distances from the MA to the apex of the coronoid and condyle and the deepest portion of the mandibular notch were 13.6 ± 1.6 mm, 21.3 ± 2.0 mm, and 3.6 ± 1.0 mm, respectively. The contact point between the MA and medial surface of the mandible was measured and found to be 3.6 ± 2.2 mm posterior and 1.7 ± 1.4 mm inferior relative to the deepest portion of the mandibular notch. In the cases where the MA was medial to the LP [36 of 200 MAs (18%)], the mean shortest distances from the MA to the apex of the coronoid and condyle and the deepest portion of the mandibular notch were 19.5 ± 2.5 mm, 20.7 ± 2.4 mm, and 16.3 ± 3.7 mm, respectively. The studied measurements will help guide surgeons to determine the anatomy of the operative field in relation to the MA and minimize risks of injuring the vessel. Clin. Anat. 27:691–697, 2014. © 2013 Wiley Periodicals, Inc.     

Ultrasonographic autopsy (echopsy): a new autopsy technique

Autopsy has been one of the most important techniques for the development of modern medicine, mainly during the nineteenth century and the first half of last century. However, in the last few years, the number of autopsies performed in hospitals has dramatically decreased all over the world. This loss of interest can be attributed both to important advances in other diagnostic and therapeutic techniques and to the fear of malpractice suits. Several groups have tried to overcome this problem, developing different autopsy techniques, one of which is needle autopsy. Most authors using this technique have acknowledged that it is difficult to obtain material from certain organs and lesions, which makes its diagnostic reliability worse than that of conventional autopsy. To overcome this drawback, our team has recently developed a modification of needle autopsy, called ultrasonographic autopsy or echopsy, in which samples are obtained under ultrasonographic control. We report the results of the first 100 cases of echopsy performed in our hospital, comparing this technique with conventional autopsy performed on all the corpses. The concordance rate for the cause of death and the main pathological diagnosis between echopsy and classical autopsy was 83% in our series, which makes echopsy a feasible and reliable alternative to conventional autopsy in cases in which families refuse to give their consent for classical autopsy or in cases of infectious diseases.     

Assessment of necrosis and hypoxia in ductal carcinoma in situ of the breast: basis for a new classification

Modern classifications of ductal in situ carcinoma (DCIS) of the breast suffer from unsatisfactory reproducibility in inter-observer circulation analyses. Ducts in DCIS are markedly enlarged in the range of 360 μm in diameter. Since the diffusion of oxygen from peri-ductal vessels is limited to 100 μm, cells in the center of DCIS are poorly oxygenated and become either necrotic or remain hypoxic but viable. There is evidence that such alternative fate is dictated by the biological characteristics of the neoplastic cells. Therefore, determination of presence or absence of necrosis in ducts up to 360 μm in diameter might represent a simple, reproducible, and biologically sound criterion to classify DCIS. In the present work, following this criterion, we classified 32 cases of intra-ductal lesions as either ”necrotic” or ”hypoxic” and tested the reproducibility of such classification using K statistics. These cases had already been circulated among a group of European pathologists, who classified the lesions using five different classifications. The K statistics value obtained with the presently proposed system was extremely high (0.91). It remains to be established whether the classification ”necrotic/hypoxic” withstands large inter-observer circulation analyses, whether it is predictive of the clinical evolution of DCIS, and whether it might constitute a reproducible basis for selecting appropriate treatments. Received: 20 September 1999 / Accepted: 6 June 2000