Contributions of the Thiel's Method in teaching and researching anatomy.

INTRODUCTION: Knowledge of the human body is based on teaching and research. Anatomy remains an essential prerequisite for medical personnel to know the human body. The idea of Thiel's technique is to preserve the natural texture, volume, color and shape of the body. The objective of this study was to analyze a literature review of this technique from the perspective of anatomy teaching and biomechanical research. METHOD: We have taken up the process of Thiel's method from the original publication, stating the known applications of this technique in teaching and research. We have integrated into our study the specific advantages of using bodies preserved by this method in intertropical countries with a warm climate: the example of Gabon. DISCUSSION: Biomechanical research and teaching of medical and surgical sciences are regularly performed on human cadavers. Anatomical dissection therefore represents one of the main activities of anatomy laboratories. We have limited our analysis to aspects of anatomy teaching, research, and clinical and surgical practice. CONCLUSION: We have sought to popularize the Thiel body preservation technique. It offers many advantages. Teaching and research on human cadavers preserved by this method is an educational alternative. The simulation centre creates the conditions of a surgical block for the learners. We recommend this technique to anatomists and clinicians. This technique seems to be very interesting for structures with a limited number of bodies.

[Alfred-Louis-Dominique Richet (1816-1891): education, anatomy and surgery]. / Alfred-Louis-Dominique Richet (1816-1891) : pédagogie, anatomie et chirurgie.

Alfred-Louis-Dominique Richet was an anatomist and surgeon born in Dijon, France in 1816. He defended the teaching of clinical anatomy instead of descriptive anatomy, judged inappropriate to learn operative medicine. His name is associated with several anatomical structures that we cite in the present article.

[Étienne Destot (1864-1918): the first radioanatomist in Lyon, France]. / Étienne Destot (1864-1918) : l'anatomie radiographique.

Destot was born in Dijon, France, in 1864. He began his education in Burgundy, then he started his preclinical curriculum in Lyon, France, from 1884. He had to leave Lyon, and spent some times in Algeria to treat a tuberculosis. He came back in Lyon as a resident in 1886. Destot worked as an assistant in the laboratory of anatomy of Leo Testut in 1880. His thesis, in 1892, analyzed mortality in the departments of surgery of the Lyon hospitals. The polemical results he presented compromised his surgical career. He went on as prosector by Leo Testut, and then became electrician-physician in 1895 (electrotherapy and galvanotherapy). Étienne Destot of Lyon, France, developed in 1895 the first radiography room ever at the Hôtel-Dieu of Lyon, France. Wilhelm Röntgen discovered the X-rays in the same year, and Destot felt his discovery could revolutionize the approach of anatomy and traumatology. He studied wrist, ankle and calcaneus fractures, and described a new anatomy: "traumatic anatomy". For example, he focused on the posterior talar surface hollow in posterior tarsus fractures. He proposed the term of "thalamus" for this articular surface; this term is nowadays widely used by the clinicians. He introduced the term of "third malleolus" to describe the posterior part of the distal extremity of the tibia. He was the first author to analyze the normal and pathological movements of the scaphoid bone and the lunatum in wrist extension.

[Can one harvest a long bone stick in the radial forearm flap? Original radioanatomical and NanoSPECT-CT Bioscan microvascular study]. / Peut-on prélever une grande baguette osseuse radiale dans le lambeau antébrachial radial composite ? Étude radio-anatomique et microscannographique originale.

OBJECTIVES: The composite radial forearm flap is a surgical option in the reconstruction of large traumatic or oncologic orofacial defects. Nevertheless, it has been criticized for its poor bone transport faculties that would make this flap insufficient in large osseous mandibular reconstructions, or for oral prosthetic rehabilitation with dental implants. What is more, the morbidity of the donor site has often been pointed. The aim of this radioanatomic study was to revisit the vascularization of the composite radial forearm flap, focusing on the bone stick. METHODS: A radioanatomic study was performed on seven upper limbs taken from fresh cadavers. First, the vessels were washed with a 40°C solution of potassium acetate. Then an intra-arterial injection of a mixture of lead oxide and agar-agar was performed. 3D-CT-scan examinations of the anatomical pieces were performed. In a second step, the flaps were harvested and analyzed with a Microscan examination (NanoSPECT-CT Bioscan(®), voxel 220 microns). Collateral branches of the radial artery to the bone and the skin were counted and classified. RESULTS: One radial diaphyseal artery was present in all the cases. The nutrient foramen took place at the anteromedial aspect of the diaphysis, between 45 and 65 % of the length of the bone. A dense anastomotic periosteal network was highlightened, supplied by one to four musculoperiosteal branches, and one to six fascio-periosteal arteries arising from the radial artery. A total of mean five osseous branches, and 12 cutaneous branches have been observed. CONCLUSIONS: The results of the present preclinical study suggested that a 16-cm bone stick could be harvested with an optimal vascular safety, without consideration for the morbidity at the donor site. The original approach in this study, relating anatomy to the preclinical imaging, allowed a precise visualization of the microvascularization of the soft and hard tissues. It opened a field of innovative research in plastic and reconstructive surgery.

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

[Joseph-Guichard Duverney (1648-1730). Doctor, teacher and researcher in the 17th and 18th centuries]. / Joseph-Guichard Duverney (1648-1730). Médecin, anatomiste et chercheur aux xviie et xviiie siècles.

Duverney was a leader in the field of research and education, because he worked as a physician, as a surgeon and he led many scientific works. To Peltier, he was the first academic professor of surgery. His wonderful career was explained by his heavy interest in knowledge. He became one of the main actors of the scientific revolution of the 17th century, especially concerning the methods of investigation in the medical science. He had so much fear for imperfect purposes, that many scientists of his century called him the Master. The only work he published about the anatomy and physiology of the ear and audition, was a world success, and is still amazing today. During about 50 years, Duverney allowed many advances in the field of osteology, otology, embryology, respiratory and circulatory physiology, but also provided competent pupils as Winslow, Sénac, Petit, Dionis, Valsalva. Duverney is still frequently cited by veterinary and dentists for many descriptions in animal anatomy. He died at the age of 82 years, and worked for the service of science until his death. His legacy consists of many works, some have been used by his pupils to highlight all the benefits he gave to the scientific community.

Cricoid cartilage and esophagus: CT scan study of the dynamic variability of their relative positions.

INTRODUCTION: Cricoid pressure occludes the esophagus (E) by compressing it between the cricoid cartilage (CC) and the body of the sixth cervical vertebra (C6). This technique is used to prevent passive regurgitation during the induction of anesthesia in patients at high risk for regurgitation. Failures of this technique had been described and a possible displacement of the E relative to the CC had been reported, but there is no study about displacement during antero-posterior movements of the head. AIM: The aim of our study was to evaluate the displacement of the CC relative to the cervical E, during flexion and extension movements of the head. MATERIALS AND METHODS: We retrospectively studied X-ray computed tomography (CT) images of 21 patients with suspected cervical trauma. Patients were in the supine position. In the first series of images, the head was positioned at maximal flexion by means of a support placed under the external occipital protuberance. In the second series of images, the head was maintained in extension by means of a support placed under the shoulders. Each position was obtained as far as possible within the limits of pain and restricted movement. In flexion and extension, we used the lowest slice from the cricoid cartilage. The variables measured were: diameters of CC (CD) and E (OD), left and right lateral displacements of E. RESULTS: A total of 13 CT were analyzed. CD and OD as well as OD/OC ratios did not vary significantly in flexion and extension. We noticed 61.5 and 92.3% (respectively in flexion and in extension) of left or right displacement: 23% of patients presented right displacement in both flexion and extension; 38.5% of patients did not present any right displacement in flexion or in extension; 61.5% of patients presented left displacement in both flexion and extension. More generally, almost 92% of patients presented displacement either in flexion or extension, or both. DISCUSSION: In our study, it can be seen that the E is clearly displaced with regard to the CC, that this displacement is favored by extension. Only 2/13 patients have an "over than 3 mm" displacement in extension whereas 5/13 in flexion. So, even if there are more displacements in extension, they are inferior to 3 mm and may not be considered as significant considering the occlusion of E. According to our results, the extension position of the head produces more displacement of the E but should preserve the containment of the cricoid pressure if we consider the thickness of the E wall.

[Isolated mandibular B-cell lymphoma revealed by inferior alveolar nerve anesthesia]. / Lymphome B mandibulaire isolé révélé par une anesthésie du nerf alvéolaire inférieur.

INTRODUCTION: Mandibular lymphomas are rare and most often revealed by painless swelling. The authors report the case of a mandibular lymphoma revealed by an isolated lesion of the inferior alveolar nerve evolving for eight months. CASE REPORT: A 41-year-old male patient was followed for left mandibular pain, with progressive hypoesthesia of the left inferior alveolar nerve. The radiological assessments remained normal during eight months. Then a vestibular tumor developed in front of tooth 34. The biopsy revealed a B-cell lymphoma. No other localization was found. The patient was in complete remission two years after polychemotherapy. DISCUSSION: Our observation is unusual in its clinical presentation. Mandibular lymphomas most often present as a painless swelling, sometimes ulcerated in the mouth. They are very rarely diagnosed after an isolated hypoesthesia of V3. Lymphomas are the second most frequent head and neck lymphomas after epidermoid carcinomas, but the frequency seems to be increasing. In almost all the cases, they present as B-cell tumours of the DLBCL subtype in the WHO classification. Mandibular localizations account for only 0.6% of the cases. They are often misdiagnosed as a dental problem. The complete remission rate after chemotherapy ranges from 60 to 80% at one year. Nevertheless, the prognosis remains bad with a survival rate of only 50% at five years.

[François Chaussier (1746-1828). A vision of the anatomic nomenclature based on education]. / François Chaussier (1746-1828). Une vision de la nomenclature anatomique fondée sur la pédagogie.

François Chaussier (1746-1828) developed an original point of view concerning the anatomic nomenclature teaching and learning. The myology nomenclature proposed by Chaussier was based on a very simple concept: the name of a muscle is composed by its two attachment points. He wanted to make science learning easier for the students; that we can see in his myology nomenclature, his publications and anatomical drawings. His experience is still interesting nowadays.

[Contribution of the posterior auricular artery in the vascularization of the facial nerve in prestylian space: anatomical study and surgical applications]. / Contribution de l'artère auriculaire postérieure à la vascularisation du nerf facial dans l'espace préstylien : étude anatomique et conséquences chirurgicales.

INTRODUCTION: The aim of our study was to establish a systematization of collateral branches originating from posterior auricular artery to facial nerve in prestylian space. MATERIALS AND METHODS: Thirty posterior auricular arteries were studied on 15 fresh cadavers after selective patent blue injection. We observed subsequent colouration of facial nerve. Number and topography of collateral branches were highlighted. RESULTS: Posterior auricular artery supplied facial nerve in 67%. Collateral branches dedicated to facial nerve could be classified into three types: type 1 corresponded to one artery in prestylian space, type 2 to several branches in prestylian space; finally type 3 featured several branches originating from posterior auricular artery in prestylian space on the one hand, in superficial retroauricular area on the other hand. CONCLUSION: Posterior auricular artery is the main blood supply to facial nerve in prestylian space. In most of the cases, branches to facial nerve originate deeply in parotid space. Nevertheless nervous branches may originate from superficial retroauricular segment of posterior auricular artery. Their damage during surgical procedures as bat ear surgery can cause definitive facial nerve palsy.

[Trapezio second metacarpal joint: anatomical study and clinical matters]. / Articulation du trapèze avec le second métacarpien: étude anatomique et intérêts cliniques.

INTRODUCTION: An unusual dislocation of the column of the thumb associated with a fracture of the base of the second metacarpal inspired an anatomical study of the trapeziosecond metacarpal joint. MATERIALS AND METHODS: Forty-five dissections of the palmar aspect of trapeziometacarpal joint aimed at focusing on palmar ligaments and tendons reinforcing the joints. RESULTS: Trapeziosecond metacarpal joint is a constant little diarthrosis reinforced by a palmar ligament stressed between the crest of the trapezium and the base of the second metacarpal. The tendon of flexor radialis carpi muscle is an active link due to strong vinculae to trapezium bone and distal attachment to the bases of both second and third metacarpals. CONCLUSION: The connections between the trapezium and the base of the second metacarpal bone play a role in the treatment of thumb instability and their mechanical importance is illustrated in our original clinical observation.

Arthroscopy-assisted Trillat procedure for anterior shoulder instability: Surgical technique and preliminary clinical results.

The Trillat procedure performed as open surgery to treat anterior shoulder instability has been proven effective in preventing recurrences and restoring range of motion. An arthroscopically assisted variant of the Trillat procedure is described here, together with the preliminary clinical results in 18 patients treated between 2011 and 2014. After a mean follow-up of 24.7±9.8 months, the clinical outcomes were very satisfactory, with a Walch-Duplay score of 81.5±18.0, a Rowe score of 83.6±16.0, and 94% of satisfied or very satisfied patients. Mean operative time was 55±13min. No recurrences were recorded. As an easily performed procedure that provides good clinical outcomes, the arthroscopically assisted Trillat procedure is a simple and reproducible alternative to arthroscopic Latarjet procedure, which is still reserved for highly experienced surgical teams.

Computer aided surgery system for shoulder prosthesis placement.

The aim of this research is to provide a light and easy-handling shoulder model for surgeons in order to ease the preoperative and peroperative work required when replacing the shoulder joint with a prosthesis. The digital mock-up of the shoulder is simplified according to the criteria of the surgeon, allowing easy manipulation of the model for a virtual operation. The model can be parameterized from X-rays or CT images. This paper describes the method used to obtain a virtual mock-up that is useful for preoperative simulation. Furthermore, it is shown that a real-time augmented reality system could be achieved for peroperative application.

Modified iliofemoral approach with osteotomy of the iliac crest, sparing the abdominal muscles, for the treatment of acetabular fracture.

Treatment of acetabular fracture is complex, requiring adapted and often extensive surgical approaches. We describe a modified iliofemoral approach, with the particularity of including iliac crest osteotomy sparing abdominal muscles to allow direct control of reduction while respecting the abdominal muscles, creating a workspace as close to the fracture as possible, without involving the inguinal canal or femoral vascular-neural bundle. In 15 complex fractures, the technique provided 13 excellent or good reductions and 13 excellent or good results according to the Matta criteria. This approach can be combined with others, such as a posterior approach, thus providing an alternative to the ilioinguinal approach in the treatment of complex acetabular fracture.

[Synovial cyst of the hip: a misleading strangulated crural hernia diagnosis]. / Le kyste arthrosynovial de hanche : à ne pas confondre avec une hernie crurale étranglée.

We report a case of crural tumefaction becoming rapidly painful revealing a synovial cyst of the hip. Literature data concerning differential diagnosis, pathogenesis, clinical varieties, diagnosis and treatments of this rare pathology are emphasized.

Ipsilateral omovertebral bones in the levator scapulae muscle and the rhomboid muscle in a Sprengel deformity: case report.

Our interest was stimulated by the uncommon case of a 4-year-old girl who presented a Sprengel deformity associated with two omovertebral bones on the same side. The first omovertebral bone was situated in the levator scapulae muscle and the second omovertebral bone was lying in the rhomboid muscle. The removal of these two bones was combined with a Woodward procedure to obtain a good correction.

[Postero-postero-external instabilities of the knee: experimental study of an extra-articular system to protect reconstructions]. / Instabilités postéro-postéro-externes du genou: étude expérimentale d'un système de protection extra-articulaire des plasties.

INTRODUCTION: Autologous tendon grafts still remain the best material for the reconstruction of the knee ligaments. They provide the most constant and durable results. For the cases of important postero-posterolateral instability, strong and biomechanically correct techniques of reconstruction exist, but most publications state the fact that laxities progressively reappear in the course of the rehabilitation, that is during the crucial period of fragility of the transplants due to remodeling. These grafts must therefore be protected without impinging on the functional therapy and without impeding the progressive introduction of the mechanical strains necessary for the metaplasia of the transplants. The authors present the biomechanical study of a protection system represented by a synthetic ligament placed between the posterior aspect of the fibular head and a point midway between the femoral insertions of the lateral collateral ligament and of the popliteus tendon. MATERIAL AND METHODS: Anatomical, radiological, mathematical studies and measures on cadaver knees were made. The antero-posterior laxity and the laxity in rotation were measured between 20 degrees and 120 degrees of flexion on 4 knees in the autopsy room and on 2 fresh frozen knees. 3 series of measures were made for each knee: firstly on intact articulations, secondly after cutting of each posterior and posterolateral ligamentary component successively, and finally after putting in place of the synthetic ligament, without any other reconstruction. Graphs showing the laxity in relation to flexion were established. RESULTS: The different studies confirm that the ligament does not significantly interfere with joint function, apart from reducing the automatic inwards rotation of the femur at the end of extension. The graphs concerning the intact knees are very similar to these established with the ligament in place. DISCUSSION AND CONCLUSION: Quasi normal function was restored by the protection ligament, after cutting of every posterior and posterolateral ligament, without any other reconstruction. This means that abnormal movements that could injure the autologous grafts were eliminated. Both posterior and posterolateral reconstructions should be therefore protected. We used this protection system for 12 cases since 1986. It definitely improved the results of our postero-posterolateral reconstructions.

[Retrosternal dislocation of the clavicle complicated by subclavian venous thrombosis. Case report and review of the literature]. / Luxation rétro-sternale de la clavicule compliquée d'une thrombose veineuse sous-clavière. A propos d'un cas et reveu de la littérature.

Retrosternal dislocation of the clavicle is a highly uncommon lesion. Diagnosis may be delayed with the risk of discovery after severe complications resulting from the protrusion of the medial part of the clavicle into the anterosuperior mediastinum. Currently, diagnosis is based on computed tomographic findings. We report a case of retrosternal dislocation of the clavicle complicated by subclavian venous thrombosis and review the therapeutic indications proposed in the literature.

[Anterior spinal fusion by thoracoscopy. A non-traumatic technique]. / La spondylodèse antérieure sous thoracoscopie: une technique atraumatique.

PURPOSE OF THE STUDY: Video assisted thoracic surgery (VATS) is a new modality which allows visualization of, and access to the intrathoracic organs without thoracotomy. Recently, this technique has been used for anterior thoracic spine approach to perform surgery which previously required standard postero-lateral thoracotomy. The authors report their initial experience of anterior spinal fusion using thoracoscopy and give a detailed description of their surgical procedure. MATERIAL AND METHODS: This technique, started on June 1993, was performed only in one level 1 in 10 patients who had thoracic spine trauma with fracture or luxation. The procedure was performed in the lateral decubitus position. The patient was prepared in the standard manner for a full thoracotomy. Surgical instruments that are needed for conversion to an open procedure must be in the operative room. Ventilation was stopped to the ipsilateral lung. Lung's collapse of the surgical side was obtained with a double lumen tube. Carbon dioxide (CO2) insufflation was used to further collapse. The first thoracoscopic portal was placed through the sixth or seventh intercostal space in the posterior axillary line, which was the safest place. All subsequent portals were placed under thoracoscopic visualization, in a triangular way as recommended by Landreneau (1992). Only open trocars were used to avoid complication of CO2 insufflation. Once the target level has been defined, a needle was placed into the disc space and roentgenographic confirmation obtained. The parietal pleura was then divided using monopolar electrocautery. Segmental vessels of the operation field lied transversely across the midportion of the vertebral body. They were mobilised and systematically ligated with endoscopic clip to simplify the procedure. Then the intervertebral space was opened and bone and disc were removed, restricted to the anterior and middle third. The graft was placed into the thoracic cavity by using a high density calcium hydroxyapatite ceramic block. Peroperative radiologic control ascertained the good position of the implant. At the end of the procedure a chest tube was placed through the lower trocar site and the lung re-expanded. A post operative CT Scan controlled good position of the graft and complete lung expansion. Contra-indications for VATS are previous surgical procedures or empyema causing extensive pleural adhesions. Procedures not appropriate for VATS approach are some that require anterior instrumentation for stabilisation, burst fracture, or fracture with posterior wall involved. RESULTS: The planned procedure was accomplished in all but one patient who required conversion to an open procedure because of segmental artery bleeding. Mean operative time was 1 h 45 mm, and mean estimated blood loss was 650 cc. There was no complication from CO2 insufflation neither postoperative complication. With an average of 2 years follow up, anterior grafting is as good as an open technique, radiologic evaluation according to Uchida (1990) showed good incorporation of each block without any radiolucent line or displacement. DISCUSSION: According to literature this technique was performed safely in 10 cases, especially without any respiratory complications and chronic pain (impairement of pulmonary function, re-expansion failure, incisional complications, rib fractures, chronic pain and malfunction of the chest wall, limitation of shoulder girdle motion) which are considered to be the main disadvantage of traditional thoracotomy. Many authors previously used VATS for multi level thoracic discectomy for correction of spinal deformities (Mack 1995), spinal reconstructive surgery (Mac Afee 1995) or removal of protrude thoracic disc (Rosenthal 1994). CONCLUSION: This original technique demonstrates that thoracoscopy for anterior thoracic surgery is better for the patients, reducing surgical trauma of the chest wall and to the lung parenchyma (in term of post operative comfort, sh