Arterial variations of the upper extremities

During the dissection of the right and left upper limbs of a 70-year-old female cadaver, we encountered combined vascular anomalies. On the left side, we observed the presence of a lateral inferior superficial brachial artery, large anterior interosseous artery and an absence of a radial artery, which is quite a rare anomaly. The lateral inferior superficial brachial artery that arose 39 mm distal to the brachial artery descended to the wrist. The anterior interosseous artery originated from the brachial artery at the level of 12 mm distal to the head of the radius and descended on the anterior aspect of the interosseous membrane with the anterior interosseous branch of the median nerve. On the right side, a trifurcation of the brachial artery was observed. It gave off three terminal branches: the radial, ulnar and a muscular artery at the proximal one-third of the humerus. It is obvious that accurate information concerning unusual patterns of the arteries in the upper limbs is relevant clinically, especially in order to avoid accidental injury or intra-arterial injection.     

The long thoracic nerve: Its origin,branches, and relationship to the middle scalene muscle

Anatomical knowledge regarding the long thoracic nerve (LTN) is important during surgical procedures considering that dysfunction of this nerve results in clinical problems. The purpose of this study was to explore the anatomy of the LTN, its origin, configuration, branching pattern, and relationship to the middle scalene muscle (MSM). The course of the LTN was investigated in 12 embalmed cadavers (21 sides). We defined four different types for this nerve according to the origins of its roots. The most common formation of the LTN was the contribution of three branches that originated from the fifth, sixth, and seventh cervical ventral roots. C5 and C6 components or upper portion of the LTN roots lay primarily between the middle and posterior scalene muscles, sometimes passed through the MSM, and less frequently coursed over the MSM. C7 contributions to the LTN were always located anterior to the MSM. Contributions from C8 were also found over the MSM. The median number of branches arising directly from the cervical roots and branches arising from the main trunk of the nerve were 3 and 7, respectively. Along its course, the median number of branches to the serratus anterior was 10. Clin. Anat. 22:476–480, 2009. © 2009 Wiley‐Liss, Inc.     

A Custom-Made Silicon Mold for Pressure Therapy to Ear Keloids

Keloids are raised reddish nodules that develop at the site of an injury. They are characterized histologically by an abundance of fibroblasts, thick collagen bundles, and ground substance. Auricular keloid formation is a known complication of ear piercing. Many types of treatments have been described for auricular keloids. Pressure therapy in combination with surgery, corticosteroid injection, or both is widely used to manage and prevent hypertrophic scarring. Many pressure devices and procedures have been developed. However, all of them are designed for the earlobe region. If a keloid grows in the posterior auricular region, none of the devices described in the literature will be effective. The authors developed a custom-made silicon ear mold that covers whole ear. With this mold, pressure can be applied homogeneously to the lobule and cartilaginous region, which the other devices described in the literature cannot affect. The preparation technique includes making the negative cast mold of the patient’s ear, creating the positive cast mold from the negative cast mold, and forming the negative silicon mold from the positive cast. After all the processes, a silicon sheet has been designed according to the region needing to be pressurized. The designed silicon sheet is applied to the region, followed by placement of the silicon mold. A simple tennis headband can be used to stabilize the silicon cast. If the keloid extends to the posterior auricular region, pressurizing with clips or other devices described previously will be difficult. Application of pressure to the cartilaginous auricle needs custom-made devices. At this point, a pressure sore caused by a device applied to the ear is the most important problem. To prevent the ear from developing a pressure sore, the device should press to whole area homogeneously. For this reason, the device applied for pressure therapy to the ear must be custom made.     

Anomalies musculaires et neuro-vasculaires de la région glutéale : un nerf honteux atypique

Sans résumé(Traduction : J.M. Mauppin)     

Modulating the functions of neutrophils and lipid peroxidation by FK506 in a rat model of thermal injury

Neutrophils diffusely invade lung, liver, kidney, intestine, muscle and burned skin following burn injury. To ameliorate this invasion and minimize its effects, neutrophils can be modulated by giving neutrophil inhibitors and modulators. In this study, FK506 was used to decrease neutrophil infiltration and lipid peroxidation in remote organs (lung, liver, kidney and intestine) in a burned rat model. FK506 is a new major immunosuppressive agent that is known to modulate neutrophils during inflammation. Neutrophil infiltration was assessed indirectly by measuring myeloperoxidase (MPO) activity biochemically in remote organs following 30% full thickness burn injury. Malondialdehyde (MDA), the end product of lipid peroxidation, was measured biochemically in remote organs and plasma to determine if there is a relationship between neutrophil infiltration and lipid peroxidation after burn injury. FK506 was given intramuscularly at the dose of 0.5 and 1.0 mg/kg for three days before burn injury. Thermal trauma to the skin caused a statistically significant increase in MPO activity and MDA content in remote organs. FK506 was effective in reducing lipid peroxidation and neutrophil infiltration especially at 24 h postinjury in lung, liver and kidney. FK506 may have some benefit (prophylactic) in reducing systemic neutrophilic injury and related lipid peroxidation in burns.     

Transcanal anterior approach for cystic lesions of the petrous apex.

OBJECTIVE: To investigate the utility of a newly described approach, the transcanal anterior approach that is a modification of the subcochlear approach for the drainage of cystic lesions of the petrous apex. STUDY DESIGN: Prospective temporal bone study. SETTING: Tertiary referral center. MATERIALS: A total of six cadaveric temporal bone specimens (four males) were included. Right ear in four specimens and left ear in two specimens were used. INTERVENTIONS: The approach commenced with postauricular skin incision. After the transsection of the meatal skin, antero-inferior tympanotomy was performed. Anteroinferior canaloplasty localized the carotid canal. As much as 0.5 cm of the vertical segment of the internal carotid artery was skeletonized. After the identification of the artery, petrous apex cells were reached by drilling the cortical bone between the cochlea and the internal carotid artery. An air cell tract was established. Position and length of the tract in two specimens were demonstrated on the 1 mm-cut computerized tomography scans. MAIN OUTCOME MEASURES: Utility of the approach was investigated based on the established criteria: anteroposterior diameter and height of the fenestra of the tract, length of the tract from the cochlea to the deepest point of the tract (depth of the tract), and the injury risk of the internal carotid artery and the cochlea. RESULTS: The mean anteroposterior diameter, the height, and the length were 4.7 +/- 1.05 mm, 3.2 +/- 0.68 mm, and 14.7 +/- 1.1 mm, respectively. Injury did not occur in the cochlea or internal carotid artery in any of the specimens. CONCLUSION: With the subcochlear approach, there is always potential risk of injury to the cochlea, the internal carotid artery, and the jugular bulb. Although this new approach includes a technically challenging stage (exposing the vertical portion of the internal carotid artery), partly exposing the vertical portion of the artery provides a safer approach, which decreases the injury risk for the round window and the jugular bulb. Additionally, measurements show that it is possible to reach a considerable part of the petrous apex cells.     

An unusual long-term complication of burn injury: malignant fibrous histiocytoma developed in chronic burn scar

Development of malignant tumors in chronic burn wounds is a well-known complication. These tumors are almost always squamous cell carcinomas, although other types of malignancies such as basal cell carcinoma, malignant melanoma and sarcomas can be seen rarely. There are only three previously reported cases of malignant fibrous histiocytoma developed in chronic burn scar in the literature. Two cases with malignant fibrous histiocytoma developed in chronic, badly treated burn wounds are presented. One of the tumors was multifocal and overexpression of the p53 gene was present. Both tumors were excised widely and skin grafted. Regional lymph node dissection was performed in one case. One of the patients died due to tumor recurrence and lymphatic metastases. These cases represent a very uncommon complication of burn injury and indicate the importance of the appropriate primary treatment of the burn wound.