A Case of Fatal Bleeding from Acute Varicose Leg Ulcer: Clinico-pathological Characteristics

AbstractVaricosity of the superficial leg veins is a common human pathology leading to a number of serious complications. Acute severe bleeding is one of the rarest occurrences; however, it could cause death within minutes. This article describes a case of a small (4 mm) acute varicose ulcer in the right medial calf region of a 55-year-old woman that caused fatal exsanguination. The specific clinico-pathological features and possible pathogenesis of this condition are briefly reviewed. The present case along with several others described in the literature suggests that even the small, ‘cosmetic’ leg varicosities are indeed dangerous and require proper and timely management

Variety of transversus thoracis muscle in relation to the internal thoracic artery: an autopsy study of 120 subjects

<p>Abstract</p> <p>Background</p> <p>The transversus thoracis muscle is a thin muscular layer on the inner surface of the anterior thoracic wall that is always in concern during harvesting of the internal thoracic artery. Because the muscle is poorly described in the surgical literature, the aim of the present study is to examine in details its variations.</p> <p>Methods</p> <p>The data was obtained at standard autopsies of 120 Caucasian subjects (Bulgarians) of both sexes (97 males and 23 females), ranging in age from 18 to 91 years (mean age 52.8 ± 17.8 years). The transversus thoracis morphology was thoroughly examined on the inner surface of the chest plates collected after routine incisions.</p> <p>Results</p> <p>An overall examination revealed that in majority of cases the transversus thoracis slips formed a complete muscular layer (left - 75.8%, right - 83.3%) or some of the slips (left - 22.5%, right - 15%) or all of them (left - 1.7%, right - 1.7%) were quite separated. Rarely (left - 3.3%, right - 5.8%), some fibrous slips of the transversus thoracis were noted. In 55.8% of the cases there was left/right muscle symmetry; 44.2% of the muscles were asymmetrical. Most commonly, the highest muscle attachment was to the second (left - 53.3%, right - 37.5%) or third rib (left - 29.2%, right - 46.7%). The sixth rib was the most common lowest attachment (left - 94.2%, right - 89.2%). Most frequently, the muscle was composed of four (left - 31.7%, right - 44.2%) or fifth slips (left - 53.3%, right - 40.8%).</p> <p>Conclusions</p> <p>This study provides detailed basic information on the variety of the transversus thoracic muscle. It also defines the range of the clearly visible, uncovered by the muscle part of the internal thoracic artery and the completeness of the muscular layer over it. The knowledge of these peculiar muscle-arterial relations would definitely be beneficial to cardiac surgeon in performing fast and safe arterial harvesting.</p

Sternalis muscle: an underestimated anterior chest wall anatomical variant

Over the recent years, an increased alertness for thorough knowledge of anatomical variants with clinical significance has been recorded in order to minimize the risks of surgical complications. We report a rare case of bilateral strap-like sternalis muscle of the anterior chest wall in a female cadaver. Its presence may evoke alterations in the electrocardiogram or confuse a routine mammography. The incidental finding of a sternalis muscle in mammography, CT, and MRI studies must be documented in a patient's medical records as it can be used as a pedicle flap or flap microvascular anastomosis during reconstructive surgery of the anterior chest wall, head and neck, and breast. Moreover, its presence may be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumors

A Unique Case of ‘Superficial’ Posterior Tibial Artery – Anatomical and Clinical Considerations

AbstractWe report a unique dissectional case of ‘superficial’ posterior tibial artery, unknown in anatomical and surgical literature. Arising from the popliteal artery, the aberrant posterior tibial artery coursed medially and passed between the tendons of the soleus and the medial head of gastrocnemius muscles. Covered by the crural fascia, the variant artery descended along the medial border of the tibia, parallel to the great saphenous vein. The arterial variation described here, though rare, could present some diagnostic and therapeutic challenges in the field of vascular surgery

Angiosome of the anterior tibial artery - anatomical basis and implications for limb salvage procedures

The angiosome concept of the human body describes a number of three-dimensional vascular territories or body blocks called angiosomes that are supplied by specific artery. In 1998 Taylor and Pan studied extensively the angiosomes of the leg. In the area of vascular surgery, the understanding of angiosomes helps in developing preferential strategies for surgical access, vascular reconstruction and amputations. In non-diseased vascular system the neighboring angiosomes are connected by numerous collateral vessels. However, in atherosclerotic patients a huge collateral depletion develops that may jeopardize this natural `rescue system` between adjacent angiosomes. In the present study we describe patients with end stage lower limb ischemia (Fontaine stage IV) and isolated tissue loss and gangrene of the anterior leg compartment corresponding to the anterior tibial artery angiosome. In common surgical practice the preferred treatment for this condition is still above-knee amputation. Another option, demonstrated here, is to perform an isolated excision of the necrotic anterior compartment and to follow a multi step limb salvage treatment