Bone formation by vascularized periosteal and osteoperiosteal grafts. An experimental study in rats.

The osteogenic capacity of vascularized periosteal and osteoperiosteal grafts was investigated in 82 Wistar rats about 8 weeks old. The periosteal flaps, pedicled on the descending genicular artery, were taken by stripping the lower third of the femur. In the right hindleg, the grafts were made with periosteum only, while in the left hindleg, the periosteal flaps were associated with cancellous bone. The animals were divided into two groups of 41. In group I, both the periosteal and osteoperiosteal grafts were placed in contact with cortical bone, and in group II, the grafts were buried in muscle. Subgroups of 8 animals were killed after 1, 2, 4, 8, and 16 weeks postoperatively. The grafted region was evaluated radiographically, macroscopically, and histologically. Membranous ossification was the main source of bone formation. Osteoperiosteal grafts produced a greater amount of new bone than periosteal ones. There was evidence that the contact of the graft with living cortical bone favored bone formation.

Periosteal flaps: anatomical bases of sites of elevation.

An anatomical study made in 25 injected fresh subjects made it possible to map out the periosteal flaps capable of being raised on the limbs. The preferred donor sites are the distal third of the humerus, the iliac fossa and the distal third of the femur. At the last 2 sites composite osteo-periosteal or musculo-osteo-periosteal flaps can be raised. These technical possibilities illustrate the importance of experimental studies which have shown the osteogenic capacity of grafts of vascularized periosteum.

Non-metric cranial variants in Brazilian skulls.

The incidence of 27 non-metric cranial variants is studied in a sample of 124 skulls from Brazil. The unilateral and bilateral frequencies of the variants are determined. The Brazilian population sample was compared with 28 population samples from different parts of the world.

Topographical and morphometrical study of the atrioventricular junctional area of the cardiac conduction system in the Macaca fascicularis Raffles, 1821.

The morphology of the atrioventricular (AV) junctional area is a subject for great controversies. The present work studies this region in 2 hearts of M. fascicularis adult female perfused with Bouin fluid, serial sectioned in frontal plane and stained by van Gieson trichromic method. A three-dimensional wax reconstruction of the AV specialized tissue was performed. The areas of the AV bundle and left bundle branch (LBB) cross-section were calculated by point-counting. The results showed that the junctional AV region in M. fascicularis is approximately similr to the same region in the human heart. The AV node presents compact and transitional portions. The cardiac central fibrous body is well developed and gives off an incomplete septum of connective tissue interposed between the terminal portion of the AV node and the beginning of the AV bundle. The reconstruction showed that the right bundle branch (RBB) is the direct continuation of the AV bundle while the LBB is a broad left side detachment. The average diameters of the AV bundle, LBB and RBB proved to be respectively 867.08 micron and 126.65 micron. The length and the volume of the AV bundle were respectively 406.86 micron and 0.223 mm3.

The posterior interosseous flap.

The posterior interosseous flap is a new fasciocutaneous flap designed on the postero-lateral aspect of the forearm. The anatomical study was carried on seventy dissections of fresh specimens. The flap is supplied by the posterior interosseous artery which delivers several cutaneous branches. The posterior interosseous flap can be used as a proximally based pedicled flap or as a distally based one thanks to the anastomosis at the level of the wrist, with the anterior interosseous artery and with the dorsal arch of the carpus. The flap can be employed as a fascial flap. Eight clinical cases have been performed to cover soft tissues defects of elbow, wrist and hand.

The anatomic basis of the fascio-cutaneous flap of the posterior interosseous artery.

The authors present a study of the surgical anatomy of the posterior interosseous artery (PIA) in 70 cases to establish the anatomic basis of a new forearm fascio-cutaneous flap, the posterior interosseous flap which has been described by one of the authors (AC Masquelet). The PIA was verified in every case. Its course corresponds to a line drawn from the lateral epicondyle of the humerus to the head of the ulna, i.e. to the septum between the extensor carpi ulnaris and extensor digiti minimi proprius muscles. The artery, whose average caliber is 1.7 mm, gives off 7 to 14 cutaneous branches in its course. The point of emergence of the artery in the posterior aspect of the forearm corresponds to the junction between the upper and middle thirds of the line from the epicondyle and the ulnar head. The PIA anastomoses with the anterior interosseous artery and the dorsal carpal network in 98.6% of cases. The artery remains closely related to the deep branch of the radial nerve and is crossed by the branches of this nerve to the extensor carpi ulnaris muscle. The cutaneous distribution of the PIA extends from elbow to wrist, centered on the epicondylarulnar line, with an average breadth of 5 cm. Twelve operations have already been performed using the posterior interosseous flap, 2 with a direct pedicle and 10 with a retrograde pedicle, and all survived completely.

Non-metric traits of the infracranial skeleton.

The authors have studied the right and left incidence of 30 non-metric infracranial variations in 2,103 dry bones of Brazilians and have concluded that the bilateral asymmetry is not significant in all but 2 traits: "The lateral tibial squatting facet" (X2 = 7.93) and "The peroneal tubercle present" (X2 = 20.35).

The number and location of the parietal foramen in human skulls.

The number and location of the parietal foramen were examined in 100 skulls of brazilian whites, negroes and mulattoes. The authors observed its presence or absence, the lateral differences, the bilateral symmetry, the existence of a median or multiple foramina and the perforation of one or both tables. The parietal foramen was more frequent in the right side than in the left, but the difference was statistically not significant.

Presence of a groove in the lateral wall of the human orbit.

The presence of a groove in the lateral wall of the human orbit (Royle, 1973) was found in 45 of 100 orbits examined (45%). In 15 skulls the groove was present bilaterally. The groove probably lodges an anastomosis between the middle meningeal and infraorbital blood vessels. No reference to this groove was found in general anatomical texts.

Contribution of the superficial and deep circumflex iliac arteries to the blood supply of the anterior third of the iliac crest and adjacent skin.

The contribution of the superficial and deep circumflex iliac arteries to the blood supply of the anterior third of the iliac crest and adjacent skin was studied in fresh cadavers using the Indian ink arterial injection method followed by one examination.

Venous drainage of the groin flap.

The superficial circumflex iliac vein and the venae comitantes of the superficial and deep circumflex iliac arteries are studied by dissection of 43 Formalin-fixed cadavers. The local peculiarities of their ends as well as their caliber, course, and symmetry are pointed out. A large venous trunk present in 35 percent of cases that receives the drainage of the venae comitantes of the superficial circumflex iliac artery is described.