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OBJECTIVE: This study aims to compare the major anatomical aspects among anterolateral thigh, parascapular and lateral arm flaps. METHODS: Sixty flaps were dissected in 20 human cadavers, comparing their vascular pedicle length, flap thickness and arterial/venous pedicle diameters. RESULTS: The vascular pedicle length (from the origin of the vascular pedicle to its entry into the skin flap) of anterolateral thigh flap (13.43 ± 3.92 cm, lateral circumflex femoral artery) was longer than parascapular (9.07 ± 1.20 cm, circumflex scapular artery) and lateral arm flap (8.90 ± 1.65 cm, posterior collateral radial artery) (P < 0.001). The thickness of lateral arm flap (6.32 ± 2.33 mm) was lesser than parascapular (8.59 ± 2.93 mm) and anterolateral thigh flap (9.30 ± 3.54 mm) (P < 0.001). The arterial/venous pedicle diameters of lateral arm flap (2.37 ± 0.69 mm / 2.61 ± 0.74 mm) were lesser than parascapular (3.46 ± 0.80 mm / 4.07 ± 0.87 mm) and anterolateral thigh flap (3.26 ± 0.74 mm / 3.87 ± 0.70 mm) (P < 0.001). CONCLUSIONS: The vascular pedicle length of anterolateral thigh flap was the longest and that lateral arm flap presented a pedicle with the smallest arterial and venous diameters, in addition to being the thinnest flap.
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Brazo/irrigación sanguínea , Escápula/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Muslo/irrigación sanguínea , Adolescente , Adulto , Anciano , Arterias/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad , Venas/anatomía & histología , Adulto JovenRESUMEN
INTRODUCTION: The pterygopalatine fossa (PPF) is a narrow space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Endonasal approaches using rod lens endoscopes, however, provide better visualization of this area and are associated with less morbidity than external approaches. Our aim was to develop a simple anatomical model using cadaveric specimens injected with intravascular colored silicone to demonstrate the endoscopic anatomy of the PPF. This model could be used for surgical instruction of the transpterygoid approach. METHODS: We dissected six PPF in three cadaveric specimens prepared with intravascular injection of colored material using two different injection techniques. An endoscopic endonasal approach, including a wide nasoantral window and removal of the posterior antrum wall, provided access to the PPF. RESULTS: We produced our best anatomical model injecting colored silicone via the common carotid artery. We found that, using an endoscopic approach, a retrograde dissection of the sphenopalatine artery helped to identify the internal maxillary artery (IMA) and its branches. Neural structures were identified deeper to the vascular elements. Notable anatomical landmarks for the endoscopic surgeon are the vidian nerve and its canal that leads to the petrous portion of the internal carotid artery (ICA), and the foramen rotundum, and V2 that leads to Meckel's cave in the middle cranial fossa. These two nerves, vidian and V2, are separated by a pyramidal shaped bone and its apex marks the ICA. CONCLUSION: Our anatomical model provides the means to learn the endoscopic anatomy of the PPF and may be used for the simulation of surgical techniques. An endoscopic endonasal approach provides adequate exposure to all anatomical structures within the PPF. These structures may be used as landmarks to identify and control deeper neurovascular structures. The significance is that an anatomical model facilitates learning the surgical anatomy and the acquisition of surgical skills. A dissection superficial to the vascular structures preserves the neural elements. These nerves and their bony foramina, such as the vidian nerve and V2, are critical anatomical landmarks to identify and control the ICA at the skull base.
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Endoscopía/educación , Seno Maxilar/anatomía & histología , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Hueso Paladar/anatomía & histología , Hueso Esfenoides/anatomía & histología , Materiales de Enseñanza , Cadáver , Arteria Carótida Interna/anatomía & histología , Colorantes , Disección , Humanos , Nervio Mandibular/anatomía & histología , Arteria Maxilar/anatomía & histología , Nervio Maxilar/anatomía & histología , Seno Maxilar/irrigación sanguínea , Seno Maxilar/inervación , Modelos Anatómicos , Nariz/irrigación sanguínea , Órbita/inervación , Hueso Paladar/irrigación sanguínea , Hueso Paladar/inervación , Hueso Petroso/irrigación sanguínea , Hueso Petroso/inervación , Base del Cráneo/anatomía & histología , Hueso Esfenoides/irrigación sanguínea , Hueso Esfenoides/inervaciónRESUMEN
OBJECTIVE: The brain sulci constitute the main microanatomic delimiting landmarks and surgical corridors of modern microneurosurgery. Because of the frequent difficulty in intraoperatively localizing and visually identifying the brain sulci with assurance, the main purpose of this study was to establish cortical/sulcal key points of primary microneurosurgical importance to provide a sulcal anatomic framework for the placement of craniotomies and to facilitate the main sulci intraoperative identification. METHODS: The study was performed through the evaluation of 32 formalin-fixed cerebral hemispheres of 16 adult cadavers, which had been removed from the skulls after the introduction of plastic catheters through properly positioned burr holes necessary for the evaluation of cranial-cerebral relationships. Three-dimensional anatomic and surgical images are displayed to illustrate the use of sulcal key points. RESULTS: The points studied were the anterior sylvian point, the inferior rolandic point, the intersection of the inferior frontal sulcus with the precentral sulcus, the intersection of the superior frontal sulcus with the precentral sulcus, the superior rolandic point, the intersection of the intraparietal sulcus with the postcentral sulcus, the superior point of the parieto-occipital sulcus, the euryon (the craniometric point that corresponds to the center of the parietal tuberosity), the posterior point of the superior temporal sulcus, and the opisthocranion, which corresponds to the most prominent point of the occipital bossa. These points presented regular neural and cranial-cerebral relationships and can be considered consistent microsurgical cortical key points. CONCLUSION: These sulcal and gyral key points can be particularly useful for initial intraoperative sulci identification and dissection. Together, they compose a framework that can help in the understanding of hemispheric lesion localization, in the placement of supratentorial craniotomies, as landmarks for the transsulcal approaches to periventricular and intraventricular lesions, and in orienting the anatomic removal of gyral sectors that contain infiltrative tumors.
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Corteza Cerebral/anatomía & histología , Corteza Cerebral/cirugía , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To describe the topography of the superior laryngeal nerve (SLN) and to evaluate the influence of gender, ethnicity, side of the neck, and individual height on the topography of the SLN. DESIGN: Anatomical study of human cadavers. SUBJECTS: Fifty fresh human cadavers (19 female subjects and 31 male subjects; age range, 22-89 years; mean age, 61 years) were randomly selected for this study. The subjects were divided into nonwhite (n = 18) and white (n = 32) ethnic groups. The t test and linear regression were used for statistical analysis of data. RESULTS: All SLNs emerged medially to the vagus nerve. The SLNs mostly divided into internal (ibSLN) and external (ebSLN) branches distally from their origin (94%). The mean +/- SE length of the SLN trunk was 16.7 +/- 0.9 mm and was affected by gender (P =.01) but not ethnicity (P =.57), side of the neck (P =.96), or individual height (R2 = 0.01; P =.33). The length of the ibSLN reached 44.9 +/- 1.0 mm and was unaffected by gender (P =.91), ethnicity (P =.24), side (P =.40), or height (R2<0.01; P =.71). The length of the ebSLN measured 62.6 +/- 1.2 mm and was unaffected by gender (P =.69), ethnicity (P =.42), side (P =.26), or height (R2<0.01; P =.85). The mean +/- SE angle between the ibSLN and the tracheoesophageal sulcus was 49 degrees +/- 1 degrees and was unaffected by gender (P =.35), ethnicity (P =.11), side (P =.26), or height (R2<0.01; P =.96). Only 1 subject demonstrated a bilateral anatomical variation of the ibSLN close to its entrance into the thyrohyoid membrane. CONCLUSIONS: The topography of the SLN has a few anatomical variations and is unaffected by gender, ethnicity, side of the neck, and individual height, except that the SLN is longer in males than in females. These findings are important in that they can help in the prevention of SLN injuries during operations such as laryngectomy and neck dissection, as well as in the planning of laryngeal reinnervation and transplantation.
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Nervios Laríngeos/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Etnicidad , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: Characterization of the structural changes occurring in the pulmonary arteries resulting from surgically produced congenital diaphragmatic hernia in rabbits, with particular emphasis on the preventive effects of prenatal tracheal ligation or administration of intra-amniotic dexamethasone or surfactant. METHODS: Twenty rabbit fetuses underwent surgical creation of a left-sided congenital diaphragmatic hernia on the 24th or 25th gestational day. They were divided according to the following procedures: congenital diaphragmatic hernia (n = 5), congenital diaphragmatic hernia plus tracheal ligation (n = 5), congenital diaphragmatic hernia plus intra-amniotic administration of dexamethasone 0.4 mg (n = 5) or surfactant (Curosurf 40 mg, n = 5). On gestational day 30, all the fetuses were delivered by caesarean section and killed. A control group consisted of five nonoperated fetuses. Histomorphometric analysis of medial thickness, cell nuclei density, and elastic fiber density of pulmonary arterial walls was performed. RESULTS: Arteries with an external diameter > 100 microm have a decreased medial thickness, lower cell nuclei density, and greater elastic fiber density when compared with arteries with external diameter < or = 100 microm. Congenital diaphragmatic hernia promoted a significant decrease in medial thickness and an increase in cell nuclei density in artery walls with external diameter > 100 microm. Prenatal treatments with tracheal ligation or intra-amniotic administration of dexamethasone or surfactant prevented these changes. In arteries with external diameter < or = 100 microm, congenital diaphragmatic hernia promoted a significant increase in medial thickness and in cell nuclei density and a decrease in elastic fiber density. The prenatal treatments with tracheal ligation or intra-amniotic administration of dexamethasone or surfactant prevented these changes, although no effect was observed in elastic fiber density in the congenital diaphragmatic hernia plus dexamethasone group. CONCLUSIONS: Congenital diaphragmatic hernia promoted different structural changes for large or small arteries. The prenatal intra-amniotic administration of dexamethasone or surfactant had positive effects on the lung structural changes promoted by congenital diaphragmatic hernia, and these effects were comparable to the changes induced by tracheal ligation.
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Dexametasona/farmacología , Glucocorticoides/farmacología , Hernias Diafragmáticas Congénitas , Arteria Pulmonar/efectos de los fármacos , Surfactantes Pulmonares/farmacología , Tráquea/cirugía , Amnios , Animales , Desarrollo Embrionario y Fetal/efectos de los fármacos , Femenino , Hernia Diafragmática/prevención & control , Hernia Diafragmática/cirugía , Inyecciones , Ligadura/métodos , Embarazo , Arteria Pulmonar/embriología , Arteria Pulmonar/patología , ConejosRESUMEN
BACKGROUND CONTEXT: The ligaments consist of collagen bands intermingled with elastic fibers that support hundreds of pounds of stress per square inch. In the spine the basic functional unit comprises vertebrae, intervertebral disc and ligament tissues. The interspinous ligaments with the function of limiting the spine flexion are exposed to a traumatic and degenerative process that promotes pain or instability. It has been shown that aging induces structural changes to capsular, fascial and ligamentous structures, mainly to the elastic and collagen fibers. However, the relative changes with age in elastic and collagen fibers have not been quantified. PURPOSE: Examine the changes in the arrangement and amount of the elastic and collagen fibers of the human cervical interspinous ligament and attempt to correlate them with age. STUDY DESIGN/SETTING: Histomorphometric analysis of ligament samples harvested during surgery. PATIENT SAMPLE: We studied the dorsal portion of this ligament from 17 patients aged 16 to 69 years. OUTCOME MEASURES: Fraction of collagen and elastic fibers with linear regression analysis correlating fraction versus age. METHODS: The elastic and collagen fibers were identified by selective staining methods, and a blinded investigator using an image analysis system performed the histomorphometry. RESULTS: There is an age-related progressive increase in collagen and mature and elaunin elastic fibers responsible to elasticity. However, these elastic fibers showed structural degenerative changes with aging. Furthermore, there is an age-related decrease of oxytalan elastic fibers responsible to resistance. CONCLUSIONS: The aged interspinous ligament showed loss of elasticity that could alter the flexion limiting of the vertebral column.
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Envejecimiento/patología , Vértebras Cervicales , Colágeno/ultraestructura , Ligamentos/patología , Adolescente , Adulto , Anciano , Elasticidad , Femenino , Humanos , Inestabilidad de la Articulación/patología , Ligamentos/ultraestructura , Masculino , Microscopía Electrónica , Persona de Mediana EdadRESUMEN
Os autores estudaram a eficácia da administraçäo de cimetidina na reduçäo da incidência de hemorragia gastrintestinal em dois grupos de pacientes tetraplégicos após traumatismo raquimedular, na fase aguda, em uso decorticoterapia. Observou-se incidência de 10,6% de hemorragia gastrintestinal no grupo controle e 3,5% no grupo que recebeu cimetidina profilaticamente. Os autores concluem favoravelmente pela eficácia deste método na preservaçäo da hemorragia gastrintestinal, nos pacientes vítimas de traumatismo raquimedular