Precision in Preservation: Mastering Cadaver Embalming with the Femoral Artery Approach - a technical note.

Human anatomy is a fundamental aspect of a physician's knowledge. While novel technologies offer innovative ways to teach anatomy, cadavers remain an essential component of anatomical education. The quality of specimens begins with well-preserved cadavers, and the chosen vascular access for injection plays a crucial role. Unfortunately, there is a lack of literature regarding embalming procedures, as discourse on such practices could enhance the quality, safety, and effectiveness of anatomical instruction. In this study, a femoral artery approach is described for embalming, which entails a meticulous process of cutting through the skin, navigating through fascias and adipose tissue by means of blunt dissection, ultimately reaching the artery for embalming injection. Tips and techniques pertaining to this technique are provided, including vital details for convenient accessibility and minimal impairment of tissue. The objective of this study is to facilitate anatomists and technicians in the adoption of the femoral artery approach, and to encourage further exploration of alternative embalming methods, thus contributing to the continuous advancement of anatomical sciences.

Single-injection nerve blocks for total knee arthroplasty: femoral nerve block versus femoral triangle block versus adductor canal block-a randomized controlled double-blinded trial.

INTRODUCTION: Femoral nerve block (FNB) is a well-established analgesic technique for TKA. However, it associates quadriceps weakness. Therefore, femoral triangle block (FTB) and adductor canal block (ACB) were proposed as effective alternative motor-spearing techniques. The primary objective was to compare quadriceps muscle strength preservation between FNB, FTB and ACB in TKA. The secondary objective was to analyze pain control and functional outcomes. METHODS: This is a prospective, double-blinded RCT. From April 2018 to April 2019, patients who undergo a primary TKA were randomized into three experimental groups: FNB-G1/FTB-G2/ACB-G3. Quadriceps strength preservation was measured as the difference in maximum voluntary isometric contraction (MVIC) preoperatively and postoperatively. RESULTS: Seventy-eight patients (G1, n = 22; G2, n = 26; G3, n = 30) met our inclusion/exclusion criteria. Patients with FNB retained significantly lower baseline MVIC at 6 h postoperatively (p = 0.001), but there were no differences at 24 and 48 h. There were no differences between the groups in functional outcomes at any time point. Patients in the FNB-G1 presented significant lower pain scores at 6 h (p = 0.01), 24 h (p = 0.005) and 48 h (p = 0.01). The highest cumulative opioid requirement was reported in ACB-G3. CONCLUSION: For patients undergoing TKA, FTB and ACB preserve quadriceps strength better than FNB at 6 h postoperatively, but there are no differences at 24 and 48 h. Moreover, this early inferiority does not translate to worse functional outcomes at any time point. FNB is associated with better pain control at 6, 24 and 48 h after surgery, while ACB presents the highest cumulative opioid requirement. CLINICAL TRIAL REGISTRATION: This study was registered in clinicaltrials.gov (NCT03518450; https://clinicaltrials.gov/ct2/show/NCT03518450 ; submitted March 17, 2018).

Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial.

(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus.

Femoral nerve inguinal approach versus proximal femoral triangle ap proach for continuous regional analgesia in active rehabilitation after total knee arthroplasty: A prospective, randomised study.

BACKGROUND: A catheter in femoral nerve block (F-Cath) is an effective regional analgesia technique in total knee arthroplasty (TKA) but results in significant quadriceps weakness. The femoral triangle catheter (FTB-Cath) seems to be an interesting alternative. In this study, we aim to demonstrate that the nerve block administration for analgesic purposes via an FTB-Cath results in less quadriceps weakness than via an F-Cath. METHODS: This study included patients scheduled for TKA performed under general anaesthesia. The patients were randomised to receive either an F-Cath or an FTB-Cath. A unique regimen of 0.2% ropivacaine was administrated for 72 h. The primary endpoint was quadriceps strength assessed clinically on postoperative day (POD) 2 by the Manual Muscle Test (MMT) using a motor grading scores (0-5). The secondary endpoints were quadriceps strength measured by a dynamometer, the Timed Up and Go (TUG) test, the 30-m walk test (30MWT) and pain scores. RESULTS: Forty-four patients were analysed (22 in each group). On POD 2, 77.3% of the patients in the FTB-Cath group had MMT scores ≥ 4 and 13.6% in the F-Cath group (p < 0.001). During the first four POD assessments, quadriceps strength evaluated with a dynamometer was less diminished in the FTB-Cath group (p < 0,001). There was no difference between groups regarding pain scores, TUG test results and 30MWT assessment. CONCLUSION: The FTB-Cath provided a better preservation of quadriceps strength than the F-Cath in TKA, with a similar pain relief.

Unilateral Anomalous Profunda Femoris Artery: An Anatomical Variation of Clinical Significance.

The profunda femoris artery (PFA) is the largest branch of the femoral artery (FA) in the femoral triangle and is the chief arterial supply for the adductors, flexors, and extensors of the thigh, as well as the hip joint and the femur. Unilateral anomalous origin and variant course of the PFA were observed during the routine cadaveric dissection for undergraduate teaching. Of note, the FA gave only a few muscular branches, whereas all the other significant arteries of the front of the thigh took their origin from the anomalous profunda femoris artery. Both interventional radiologists and surgeons must be familiar with the anatomical variants of the PFA and FA. The likelihood of many sources supplying the skin and pedicle, particularly in reconstructive surgery, requires surgeons to be cognizant of this subject hence crucial in order to minimize surgical complications.

Incidence of Suture-Method Catheter Dislocation with Femoral Nerve Block and Femoral Triangle Block after Total Knee Arthroplasty.

Catheter dislocation with continuous peripheral nerve blocks represents a major problem in clinical settings. There is a range of factors affecting the incidence of catheter dislocation, including catheter type. This study aimed to assess the incidence of suture-method catheter (SMC) dislocation 24 h after total knee arthroplasty (TKA), with continuous femoral nerve block (CFNB) and continuous femoral triangle block (CFTB), respectively. In the prospective randomized trial, 40 patients qualified for TKA with SMC and were divided into two groups, those who received CFNB (Group 1, n = 20) and those who received CFTB (Group 2, n = 20). After 24 h, the degree of catheter displacement (cm), pain intensity (NRS) and opioid consumption (mg) was assessed. The catheter dislocation rates were found to be 15% in Group 1 versus 5% in Group 2, with the catheter dislocated by 0.83 cm (SD = ±0.87) and 0.43 cm (SD = ±0.67), respectively. There were no differences in NRS score (p = 0.86) or opioid consumption (p = 0.16) between the groups. In each case, a displaced catheter was successfully repositioned by pulling, which clinically resulted in a lower NRS score. The results of the study suggest that CFTB with SMC may be used after TKA with a good effect, as it is associated with low catheter dislocation rates and an adequate analgesic effect.

Primary leiomyosarcoma is a rare cause of femoral triangle mass: A case report.

OBJECTIVES: Primary leiomyosarcoma in the femoral vein is an extremely rare vascular disorder and is often misdiagnosed. In order to improve the knowledge and treatment of this disease, a case of leiomyosarcoma in the femoral vein was reported. METHODS: We report the case of a 58-year-old woman with a leiomyosarcoma of the femoral vein and treated successfully by surgical resection. After surgery, no recurrence had been noted follow-up.Subsequently, we reviewed information derived from 31 previously published cases from 1954 to 2019. RESULTS: A total of 31 patients diagnosed with femoral vein leiomyosarcoma were presented in previous studies; in all of these patients, 14 (45.2%, 14/31) patients were men. Of these, the median age was 51.6 years old (ranging from 3 to 84). CONCLUSIONS: Complete resection with adjuvant chemotherapeutic was the main strategy to treat the disease. Prognosis remains poor if metastasis was present, especially pulmonary metastasis.

Comparison of the ultrasound-guided single-injection femoral triangle block versus adductor canal block for analgesia following total knee arthroplasty: a randomized, double-blind trial.

PURPOSE: The aim of the study is to compare the femoral triangle (FT) and adductor canal (AC) blocks in terms of the analgesic efficacy and ambulatory outcomes in the context of multimodal analgesia following total knee arthroplasty (TKA). METHODS: Patients presenting for TKA were assigned to a preoperative ultrasound-guided single-injection FT or AC block. Combined spinal and epidural anesthesia with bupivacaine was administered for TKA. Perioperatively a multimodal analgesic regimen was applied up to 48 h after surgery. The primary outcome was the average pain score during movement in the first 24 h postoperatively. The secondary outcomes included pain scores at rest and during movement at postoperative predetermined time points, cumulative opioid consumption in oral morphine equivalents, functional mobility measured by the timed "Up and Go" (TUG) test and muscle strength in the lower extremity. RESULTS: Ninety-eight patients completed the study. Patients in the FT group had lower median pain scores during movement in the first 24 h postoperatively than those in the AC group (1.3 [1.0-3.3] vs. 3.0 [1.7-4.3]; median difference: - 1.0, adjusted 95% CI from - 1.7 to - 0.3, P = 0.010). There were significant differences in the pain scores at rest and during movement at 12 and 24 h postoperatively between the two groups (P = 0.008 and 0.005, respectively). Cumulative oral morphine equivalent consumption in the first and second 24 h postoperatively, Functional mobility reflected by the TUG test and muscle strength in the lower extremity showed no significantly statistically differences between the two groups. CONCLUSIONS: The preoperative FT block provided improved analgesic outcomes without compromising functional mobility in the context of multimodal analgesia following TKA compared with the AC block. TRIAL REGISTRATION: https://www.chictr.org.cn . Identifier: ChiCTR-INR-17012716.

[Clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities].

Objective: To investigate the clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities. Methods: From January 2016 to November 2017, 14 patients (9 males and 5 females, aged 19 to 54 years) with skin and soft tissue defects in extremities accompanied with tendon and bone exposure were admitted to our unit. The size of skin and soft tissue defects after debridement ranged from 7 cm×3 cm to 10 cm×7 cm. The defects were repaired with free superficial femoral artery femoral triangle perforator flaps, with size ranging from 13.0 cm×2.0 cm to 20.0 cm×4.5 cm. The medial femoral cutaneous nerve was applied to the flap. The perforator flap was grafted onto the medial femoral cutaneous nerve in 6 patients. The donor sites were sutured directly. The survival of flaps and the follow-up of patients were observed. Results: All flaps of 14 patients survived successfully. The recipient sites and donor sites were healed completely in 13 patients, and 1 patient with partial skin necrosis at the edge of flap was healed after treatment. All patients were followed up for 6 months to 1 year after the operation. The flaps were in good shape, with nearly normal color and soft texture and no cicatrix contracture deformity. The flaps recovered protective sense in 6 patients who had medial femoral cutaneous nerve grafting, and the sensory recovery of the flap was slightly worse in the remaining 8 patients. There was no significant complications on the appearance and walking of the donor thigh in 14 patients, only a linear scar was left on the inner thigh, and no numbness was felt in the donor sites of patients. Conclusions: The free superficial femoral artery femoral triangle perforator flap is an ideal therapy for repairing skin and soft tissue defects in extremities.

Adductor canal versus femoral triangle anatomical locations for continuous catheter analgesia after total knee arthroplasty: a multicentre randomised controlled study.

BACKGROUND: Adductor canal (AC) catheters are being used to provide continuous postoperative analgesia after total knee arthroplasty (TKA) surgery. There are anatomical arguments that most AC catheters are being inserted into the femoral triangle (FT) compartment of the thigh rather than the AC compartment. The clinical relevance of this is unknown with respect to motor weakness, quality of analgesia, and opioid consumption. We hypothesised that AC catheters provide superior functional mobilisation on postoperative Day 1 after TKA as measured using the Timed Up and Go (TUG) test. METHODS: In this multinational, multicentre, double-blinded RCT, catheters were inserted under ultrasound guidance into the anatomical AC and FT compartments. The standardised protocol included spinal anaesthesia without intrathecal morphine, fixed catheter infusion rates, and oral analgesia. RESULTS: Of 151 subjects recruited, 75 were in the AC group and 76 in the FT group. There was no statistically significant difference in TUG on postoperative Day 1 between AC (38 [29-55] s) and FT subjects (44 [32-64] s) (median [inter-quartile range]); P=0.11). There was no difference in TUG Day 2, AC (38 [27-53] s) vs FT (42 [31-59] s); P=0.66. There were no statistically significant differences for secondary endpoints of pain level, effectiveness of pain relief, interference of functional activities and interpersonal relationships by pain, and opioid consumption between groups. CONCLUSIONS: There were no differences in immediate postoperative functional mobility, analgesia, and opioid consumption provided by catheters inserted into the AC vs FT locations for TKA surgery. CLINICAL TRIAL REGISTRATION: ANZCTR12617001421325.

Clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities / 中华烧伤杂志

Objective@#To investigate the clinical effects of free superficial femoral artery femoral triangle perforator flap in the repair of skin and soft tissue defects in extremities.@*Methods@#From January 2016 to November 2017, 14 patients (9 males and 5 females, aged 19 to 54 years) with skin and soft tissue defects in extremities accompanied with tendon and bone exposure were admitted to our unit. The size of skin and soft tissue defects after debridement ranged from 7 cm×3 cm to 10 cm×7 cm. The defects were repaired with free superficial femoral artery femoral triangle perforator flaps, with size ranging from 13.0 cm×2.0 cm to 20.0 cm×4.5 cm. The medial femoral cutaneous nerve was applied to the flap. The perforator flap was grafted onto the medial femoral cutaneous nerve in 6 patients. The donor sites were sutured directly. The survival of flaps and the follow-up of patients were observed.@*Results@#All flaps of 14 patients survived successfully. The recipient sites and donor sites were healed completely in 13 patients, and 1 patient with partial skin necrosis at the edge of flap was healed after treatment. All patients were followed up for 6 months to 1 year after the operation. The flaps were in good shape, with nearly normal color and soft texture and no cicatrix contracture deformity. The flaps recovered protective sense in 6 patients who had medial femoral cutaneous nerve grafting, and the sensory recovery of the flap was slightly worse in the remaining 8 patients. There was no significant complications on the appearance and walking of the donor thigh in 14 patients, only a linear scar was left on the inner thigh, and no numbness was felt in the donor sites of patients.@*Conclusions@#The free superficial femoral artery femoral triangle perforator flap is an ideal therapy for repairing skin and soft tissue defects in extremities.

Efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in patients undergoing knee arthroplasty / 中华麻醉学杂志

Objective@#To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.@*Methods@#Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 53-68 yr, scheduled for elective total knee arthroplasty under general anesthesia, were assigned into 2 groups (n=30 each) using a random number table method: femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A). Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5% ropivacaine 20 ml in group F and group A, respectively.Patient-controlled saphenous nerve block analgesia was used in two groups, and the analgesic pump solution contained 1% ropivacaine 400 mg diluted to 160 ml in 0.9% sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose, a 30-min lockout interval and background infusion at a rate of 5 ml/h, and analgesia lasted until 72 h after operation.When visual analog scale score > 4 and pain was not relived after 30-min pressing by patients, pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4, 8, 24, 48 and 72 h after operation.The patient′s satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication, itching, dizziness, urinary retention, nausea and vomiting) were recorded within 72 h after operation.@*Results@#Compared with group F, the muscle strength of quadriceps femoris was significantly increased at 4, 8 and 24 h after operation, the rate of postoperative rescue analgesia was decreased (P<0.05), and no significant change was found in patient′s satisfaction score or incidence of adverse reactions in group A (P>0.05).@*Conclusion@#Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.

Efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in patients undergoing knee arthroplasty / 中华麻醉学杂志

Objective To compare the efficacy of femoral triangle versus adductor canal approach to saphenous nerve block for postoperative analgesia in the patients undergoing knee arthroplasty.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 53-68yr,scheduled for elective total knee arthroplasty under general anesthesia,were assigned into 2 groups (n=30 each) using a random number table method:femoral triangle approach to saphenous nerve block group (group F) and adductor canal approach to saphenous nerve block group (group A).Femoral triangle and adductor canal approach to saphenous nerve block was performed by injecting 0.5％ ropivacaine 20 ml in group F and group A,respectively.Patient-controlled saphenous nerve block analgesia was used in two groups,and the analgesic pump solution contained 1％ ropivacaine 400 mg diluted to 160 ml in 0.9％ sodium chloride injection.The analgesic pump was set up with a 5 ml bolus dose,a 30-main lockout interval and background infusion at a rate of 5 ml/h,and analgesia lasted until 72 h after operation.When visual analog scale score ＞ 4 and pain was not relived after 30-min pressing by patients,pethidine hydrochloride 100 mg was intramuscularly injected as rescue analgesic.The muscle strength of quadriceps femoris was assessed by manual muscle test at 4,8,24,48 and 72 h after operation.The patient's satisfaction score was assessed and recorded at 72 h after operation.Rescue analgesia and development of adverse reactions (local anesthetic intoxication,itching,dizziness,urinary retention,nausea and vomiting) were recorded within 72 h after operation.Results Compared with group F,the muscle strength of quadriceps femoris was significantly increased at 4,8 and 24 h after operation,the rate of postoperative rescue analgesia was decreased (P＜0.05),and no significant change was found in patient's satisfaction score or incidence of adverse reactions in group A (P＞0.05).Conclusion Adductor canal approach to saphenous nerve block provides better efficacy for postoperative analgesia than femoral triangle approach to saphenous nerve block in the patients undergoing knee arthroplasty.

The analgesic effect of a popliteal plexus blockade after total knee arthroplasty: A feasibility study.

INTRODUCTION: An obturator nerve block (ONB) and a femoral triangle block (FTB) provide effective analgesia after total knee arthroplasty (TKA) without impeding the ambulation, although the ONB produces motor blockade of the hip adductor muscles. The popliteal plexus (PP) in the popliteal fossa is formed by contribution from the tibial nerve and the posterior obturator nerve, innervating intraarticular genicular structures and the posterior capsule of the knee. We hypothesised that a popliteal plexus block (PPB) as a supplement to an FTB would reduce pain after TKA without anaesthetising motor branches from the sciatic nerve in the popliteal fossa. AIM: To assess the analgesic effect of adding a PPB to an FTB in 10 subjects with significant pain after TKA. METHODS: All subjects underwent unilateral TKA with spinal anaesthesia and received an FTB. The cutaneous sensation and the postoperative pain were assessed. The primary outcome was the proportion of subjects with pain above numeric rating scale (NRS) 3 followed by a reduction to NRS 3 or below after conducting a PPB. RESULTS: Ten subjects with a median pain of NRS 5.5 (interquartile range [IQR] 4-8) after unilateral TKA received a PPB. All 10 subjects experienced a reduction in pain to NRS 3 or below (NRS 1.5 [IQR 0-3]) within a mean time of 8.5 (95% CI 6.8-10.2) minutes. Three subjects were completely pain free after the PPB. The ankle muscle strength was not affected. CONCLUSIONS: The PPB provided effective pain relief without affecting the ankle muscle strength in all 10 subjects with significant pain after TKA and an FTB.