Vascular anatomical features of the medial thigh flap in human cadavers of Caucasian origin

Background: Medial fasciocutaneous flaps, which are based on the femoral artery from the thigh region, are used for wide inguinal, scrotal, vaginal, perineal, leg, head and neck defect reconstructions in injured human patients. Within this regard, anatomical knowledge about perforating and cutaneous branches of the femoral artery is important for the surgeons. Materials and methods: In the present study, vascular pedicles of the medial thigh perforator flap based on the femoral artery were investigated according to anatomical and surgical landmarks. Human Caucasian preserved cadavers of 15 adults (13 males, 2 females; age range 55–82 years: 30 sides, bilaterally) that were previously formalin fixed were subjected to our analytical examinations. Micro dissections were performed under 4× loop magnification while representing the perforating branches of the femoral artery after filling by coloured latex injection via the external iliac artery. Results: The size and length parameters of these branches which appeared around the apex of the femoral triangle were evaluated. The mean size of the perforating branch at the point of origin was 0.14 cm and the mean size of the cutaneous branch at the point of origin was 0.09 cm, the mean length of the pedicle was 4.74 cm and the mean length of the cutaneous branch was 3.30 cm, respectively. Location of the perforating and the cutaneous branches were also determined according to the surgical landmarks such as the anterior superior iliac spine, inguinal ligament, pubic tubercle and interepicondylar line. Conclusions: The pedicle of the medial flap should locate up to 25 cm from the anterior superior iliac spine so as to preserve the vascular structures. Exact location of this artery helps the surgeons to perform anastomosis in an easier and safer manner during surgical operations.

HER2 and proliferation of wound-induced breast carcinoma

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The arterial anatomy of the saphenous flap: a cadaveric study

The saphenous flap is a fasciocutaneous flap generally used for knee and upper third of the leg coverage. Due to various descriptions of the saphenous flap, such as venous, sensory, and free flap, the origin and distributing characteristics of the saphenous artery are important for plastic surgeons. The aim of this cadaveric study was to evaluate the anatomical features of the saphenous flap. The pedicles of the saphenous flap were dissected under 4 x loop magnification in thirty-two legs of 16 formalin-fixed adult cadavers. The findings of this anatomic study were as follows: Descending genicular artery originated from the femoral artery in all of the cases. The first musculoarticular branch, which arose from descending genicular, to the vastus medialis muscle existed in all dissections. The second branch was the saphenous artery which seperately originated from the descending genicular artery in all of the cases. At the level of origin the mean diameter of the saphenous artery was found to be 1.61 mm. The muscular branches to the anterior or posterior sides of the sartorious muscle existed in all of the dissections. Two vena comitantes and a saphenous nerve were accompanying the saphenous artery in all cadavers. The mean distance between the origin of the artery and interepicondylar line of tibia was 115 mm. The muscular branches of the saphenous artery to the gracilis muscle were encountered 6.66% of the cases. The cutaneous branches numbered between one and four, and arose 3.5 to 9.5 cm from the site of origin of the saphenous artery. The distal end of the saphenous artery reached approximately 122 mm distally to the knee joint in all cases. Due to variations of the arterial anatomy and limited number of anatomic studies of the saphenous flap, we studied the topography and anatomy of the saphenous artery for increasing reliability of the saphenous flap

Anatomy of the anteromedial thigh flap based on the oblique branch of the descending branch of the lateral circumflex femoral artery

Anteromedial thigh (AMT) flaps based on lateral circumflex femoral artery (LCFA) have characteristics which make them favourable for use in reconstruction of extensive thigh, head, neck and leg defects. AMT flap which is elevated on the artery has the advantages of low donor site morbidity and preservation of main arteries. Due to inconstant anatomy of the pedicle, the flap is mostly not preferable. Hence, we aimed to describe the anatomical features of the unnamed branch of the descending branch of the LCFA harvesting AMT flap. For this purpose, the external iliac artery was displayed bilaterally on 15 adult (13 males and 2 females; age range 55–82 years) preserved cadavers using latex injection. The perforator branch of the descending branch from the LCFA was microdissected under 4× loupe magnification. The perforator branch was located 28.53 (20.20–34.20) cm distal to the anterior superior iliac spine, 22.12 (13.40–28.00) cm distal to the pubic tubercle, and 13.20 (10.80–16.20) cm proximal to the interepicondylar line. At the level of origin point the mean diameter of the perforating branch was 0.17 cm and the mean diameter of its cutaneous branch was 0.14 cm. The mean length of the pedicle was 5.71 (3.70–9.00) cm. We conclude that our findings contribute to the literature in terms of anatomical knowledge for surgical safety.

Suprascapular foramen: a rare variation caused by ossified suprascapular ligaments

Background: The aim of this study was to investigate the incidence of the suprascapular foramen in West Anatolian population. Materials and methods: Eighty-one dried human scapulae of West Anatolian people of unknown ages and gender belonging to the Anatomy Department Laboratory of Dokuz Eylul University Medical School were examined macroscopically. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments were measured with calliper in millimetres and digital calliper, respectively. Results: We observed the suprascapular foramen due to ossification of the suprascapular ligament only in 2 of 81 (2.47%) scapulae. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments (No. 1 and No. 2) were measured as 8.0 mm vs. 4.0 mm, 3.6 mm vs. 2.0 mm and 4.0 mm vs. 1.4 mm, respectively. Conclusions: The suprascapular foramen caused by ossified suprascapular ligament is rarely observed variation in West Anatolian population.

Assessment of the orbit morphometry on West Anatolian dry skulls

The orbit is very frequently damaged by traumas which result in not only bone deficits, but also functional deformities if reconstruction is not appropriate. Anatomical exposure of the bony orbit is of importance for both anatomists and surgeons who perform operation on this area. The current study evaluated the group of morphometrical parameters on 74 adult West Anatolian dry skulls and stereological surface area on the dry skull orbits while describing the clinical importance. Surface areas on the orbital base of the skulls were also evaluated using stereological method, bilaterally. Anthropological assessment of orbital base (in terms of width and height) revealed no significant difference between right and left sides. Both width and height of the optic foramen were significantly higher on the right side compared to left. The distances between the margins (medial, lateral, superior, inferior) of the orbital base and the optic foramen were longer on the right side compared to left, except the distances between the lateral margins. There was no significant difference among the subjects between right and left sides with respect to the orbital base in terms of stereological area calculation. The results are significant because there are no recorded anatomical data on West Anatolian skulls at previous researches. (Folia Morphol 2018; 77, 1: 105–109

Investigation of temporal bone asymmetry in cases with unilateral tinnitus: morphometric and multicentric clinical study

The aim of this multicentric study was to compare the anatomical structures of temporal bone in patients with unilateral tinnitus with their healthy ears. We also aimed at evaluating whether age and gender-related asymmetrical changes occur in temporal bones or not. Fifty two ears of 26 patients who had unilateral tinnitus were included into the retrospective study. The patients who had subjective nonpulsatile tinnitus and who previously had temporal computed tomography according to their file records were accepted to study. Temporal CT scans and audiometric results of patients were examined retrospectively. Middle ear volume, diameter of internal acoustic meats and diameter of jugular bulb were evaluated by both anatomist and radiologist, interobserverly. Internal acoustic meats and jugular bulb were found larger in the ears that had tinnitus than healthy ears; however, there was no statistically significance. The stereological morphometrical study of temporal bone asymmetry in humans correlate with sex is of importance for both otolarygologs and anatomists. These results will contribute to data on middle ear volume, internal acustic meats and jugular bulb sizes

Developmental effects of endocrine-disrupting chemicals in wildlife and humans.

Large numbers and large quantities of endocrine-disrupting chemicals have been released into the environment since World War II. Many of these chemicals can disturb development of the endocrine system and of the organs that respond to endocrine signals in organisms indirectly exposed during prenatal and/or early postnatal life; effects of exposure during development are permanent and irreversible. The risk to the developing organism can also stem from direct exposure of the offspring after birth or hatching. In addition, transgenerational exposure can result from the exposure of the mother to a chemical at any time throughout her life before producing offspring due to persistence of endocrine-disrupting chemicals in body fat, which is mobilized during egg laying or pregnancy and lactation. Mechanisms underlying the disruption of the development of vital systems, such as the endocrine, reproductive, and immune systems, are discussed with reference to wildlife, laboratory animals, and humans

Treatment Response of Cystic Echinococcosis to Benzimidazoles: A Systematic Review

Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1–2 y after initiation of benzimidazole treatment 50%–75% of active C1 cysts were classified as inactive/disappeared compared to 30%–55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%–60% of cysts <6 cm responded to treatment after 1–2 y compared to 25%–50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities