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OBJECTIVE: To evaluate the impact of the interatrial sulcus opening regarding of left atrium gain when harvesting heart and lungs for transplantation. METHODS: It was evaluated the left atrium dimension, from the right mediastinal side, after the interatrial sulcus dissection in fifty human cadaver. The interatrial sulcus gain was related with gender, age and ethnic group. RESULTS: The gain observed through right interatrial opening was, in media, 1.31 cm (0.3 cm to 2.5 cm). When that value was related to the variable gender it was observed that in the 27 (54%) cases of the male the earnings was 1.19 cm +/- 0.6 cm and, in the 23 (46%) female, 1.21 cm +/- 0.5 cm (p = 0.895). In relation to age, it was observed that, in the 24 (48%) cases with smaller age than 50 years, the value was 1.08 cm +0.6 cm and, in the 26 (52%) with larger age or same to 50 years, 1.36 cm +/- 0.6 cm (p = 0.088). In relation to ethnic group, it was observed that the value of the earnings in the 31 (62%) cases of whites it was 1.34 cm +/- 0.5 cm and, in the 19 (38%) non white, 1.27 cm +/- 0.4 cm (p = 0.589). CONCLUSION: Heart grafts and lung grafts must be harvested maintaining adequate segments of left atrium near the heart and the pulmonary veins of the lungs that will be transplanted. Although there is no correlation between the observed gain in the interatrial sulcus dissection and the variables gender, age and ethnic group, our results confirm that the interatrial sulcus opening can give access to significant extension of left atrium wall when separating heart and lungs.

Assuntos

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PURPOSE: Despite the advances in microvascular free tissue transfer for intraoral reconstruction, this surgery is not recommended for all patients. In specific cases, the pedicled temporoparietal galeal flap may be an option for reconstructive procedures in the head and neck regions. The objective of this paper is to present the anatomical aspects of a galeal flap based on the superficial temporal vessels and to test its potential for reconstructing diverse sites of the oral cavity and pharynx. METHODS: We performed 40 dissections on 34 fresh adult cadavers. The flap vascular anatomy was studied by injecting latex into the superficial temporal vessels. A standardized square-shape flap measuring 10 x 10 cm(2), pedicled on the superficial temporal vessels, was raised. Oral cavity and oropharynx reconstruction simulations were performed after flap transposition into the mouth by passing it under the zygomatic arch. Hypopharyngeal reconstruction was tested by transposing the flap to the neck under the facial nerve. RESULTS: After latex injection, a rich vascular network over the temporoparietal galea was observed directly from the superficial temporal artery, and a well-vascularized flap based on this vessel was raised. In the reconstruction simulations, the flap was shown to be suitable for the coverage of hypothetical defects in most oral cavity and pharyngeal sites, mainly the retromolar trigone, tonsil area, and buccal mucosa. CONCLUSIONS: A galeal flap based on the superficial temporal vessels presents favorable anatomical characteristics for oral cavity and pharyngeal reconstruction.

Assuntos

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OBJECTIVE: The primary aim of this study was to establish standard sites for bur holes that maintain constant anatomical relationships with the skull base and neural structures and can serve as the basal aspect of supratentorial temporooccipital craniotomies. METHODS: To determine cranial-cerebral relationships, the authors created bur holes in 16 adult cadaveric skulls. Three bur holes were made on each side of the skulls (32 cerebral hemispheres). The authors then introduced plastic catheters through the bur holes to evaluate pertinent cranial and neural landmarks. The first bur hole, located anterior to the auricle of the ear, appeared to have a particular anatomical relationship with the anterior aspect of the petrous portion of the temporal bone and the most anterior aspect of the midbrain. The second bur hole, whose base was located 1 cm above the interface of the parietomastoid and squamous sutures, had a particular relationship with the posterior border of the petrous portion of the temporal bone and with the posterior aspect of the midbrain. The third bur hole, whose base was located 1 cm above the asterion, was mostly supratentorial and particularly related to the preoccipital notch. CONCLUSIONS: The preauricular bur hole and the bur hole whose base was located 1 cm above the interface of the parietomastoid and squamous sutures delimit anteriorly and posteriorly the external projection of the petrous bone and the midbrain. The middle fossa floor is located anterior to the site of the preauricular bur hole, and the superior surface of the tentorium is posterior to the bur hole located above the parietomastoid-squamous suture interface. Together with the bur hole whose base is located above the asterion, these bur holes can be considered standards for temporooccipital craniotomies.

Assuntos

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UNLABELLED: The auditory brainstem implant (ABI) is an option for deaf patients who do not have the whole of their auditory pathways preserved. The surgery, because of its anatomical and functional complexity, requires specific training of the surgeon in an anatomy lab. AIM: To study the surgical anatomy of the surgery for auditory brainstem implant. STUDY DESIGN: Anatomic study. MATERIAL AND METHOD: In this exercise we dissected a fresh cadaver prepared with a dye solution injected into the arteries and intra-cranial veins. The location for the insertion of the electrode for the ABI has been studied through the translabyrinthine access. RESULTS: The surgical technique used for implanting the electrode of the brainstem is similar to that used in the removal of the schwannoma vestibular. The cochlear nucleus complex, composed of the ventral and dorsal cochlear nuclei is the location for placing the electrode. The ventral cochlear nucleus is the principal nucleus for transmission of neural impulses from the VIII par and form the main ascendant route of the cochlear nerve. Neither the ventral nor the dorsal nuclei are visible during surgery and their location depends on the identification of adjacent anatomical structures. CONCLUSION: The region for the implantation of the electrode in the auditory brainstem implant presents anatomical references that allow its easy identification during surgery.

Assuntos

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OBJECTIVE: The objective of this study is to evaluate the benefits of drainage in the Stoppa procedure for inguinal repair. PATIENTS AND METHODS: The use of a suction drain was randomized at the end of the surgical intervention in 26 male patients undergoing inguinal hernia repair, divided into 2 groups: Group A, 12 patients undergoing drainage, and group B, 14 patients not undergoing drainage. On the second postoperative day, all patients underwent abdominal pelvic computed tomography scan examination to detect the presence of abdominal fluid collection. RESULTS: In group A, no patient developed fluid collection in the preperitoneal space, and 1 patient presented with an abscess in the preperitoneal space on the 15th postoperative day. In group B, 12 patients presented with fluid collections in the preperitoneal space on computed tomography scan evaluation. However, only 3 patients presented minor complications. None of the patients developed a major complication. CONCLUSION: The use of suction drainage with the Stoppa procedure does not provide any benefit.

Assuntos

Assuntos