ABSTRACT
A rare case of an anomalous location of the orifice of the coronary artery was found in a 99-year-old male cadaver undergoing routine dissection. The presence of the right coronary artery (RCA), left coronary artery (LCA), and conus artery (conus branch) originating from the right Valsalva sinus are the characteristic findings of this case. Then, the LCA passed through the aorta and the pulmonary artery. The LCA and RCA branches were normal. These findings are useful for future surgical procedures, including cardiac catheterization.
Subject(s)
Cadaver , Sinus of Valsalva , Aged, 80 and over , Humans , Male , Coronary Vessel Anomalies , Coronary Vessels/anatomy & histology , East Asian People , Japan , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imagingABSTRACT
The temporomandibular joint (TMJ) is a complex structure that plays a vital role in the movement of the jaw. Some anatomy and dental textbooks show that, at the medial margin, the TMJ capsule attaches to a suture between the sphenoid ala major and the temporal bone squamosa. In near-term fetuses, the ala major extends posterolaterally to approach the TMJ. In this study, we aimed to investigate the contribution of the sphenoid ala major to the socket of the TMJ in near-term fetuses. We examined histological sections from 22 human fetuses (approximately 15-40 weeks). At midterm, the lateral and superior walls of the TMJ cavity were formed by the temporal bone squamosa, whereas the ala major was distant from the joint. However, at near-term, the ala major formed the medial wall of almost the entire part of the joint cavity. The top of the TMJ was attached to both the squamosa and ala major, with the condylar head consistently separated from the sphenoid by the joint disk. We observed a significant descent of the middle cranial fossa in near-term fetuses, which brought the ala major close to the TMJ. This transient position of the TMJ near the sphenoid is likely due to brain enlargement and posterolateral growth of the ala major. After birth, occlusion causes the anterior growth of the mandibular fossa of the squamosa, which moves the ala major away from the TMJ. Similarly, the lateral growth of the sphenoid toward the squamosa suture may also stop in children.
ABSTRACT
BACKGROUND: There is currently no information on positional changes in the brachial nerve plexus during prenatal growth. The subclavian-axillary artery passing through the medianus nerve ansa is considered a good landmark for evaluating the height of the plexus. MATERIALS AND METHODS: We used histologic sections from 9 embryos and 17 fetuses (approximately 6-15 weeks of gestational age) to identify the height of the ansa by referring to the level of the rib and the glenohumeral joint. RESULTS: The nerve ansa was usually (23 plexuses) observed at the level of the first and/or second ribs. However, it was sometimes observed above the first rib, at a distance equal to or more than an intercostal width (7 plexuses). In the latter group, the ansa was usually located below the glenohumeral joint. Thus, the joint was located higher than the first rib, although the upper extremities were in the anatomic position for all specimens. The left-right difference in the height of the plexus corresponded to or was less than the width of the first intercostal space. Despite the synchronized growth between the thorax and shoulder girdle, the brachial plexus showed a considerable variation in comparative height; the range corresponded to twice of an intercostal width. Whether the nerve plexus is located high or low is determined at an early developmental stage and is maintained during the later growth stages. CONCLUSION: The high-positioned plexus might cause nerve injury at delivery, followed by a glenohumeral joint deformity because of the fragility without fixation in the thorax.
Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Thoracic Wall , Humans , Shoulder , Brachial Plexus/injuries , Upper Extremity , FetusABSTRACT
BACKGROUND: The sphenomandibular ligament (SML) is considered to originate from Meckel's cartilage (MC). However, no study has examined how the os goniale contributes to SML development. METHODS: Semiserial histological sections of heads from 18 near-term fetuses at 27-40 weeks of gestation were examined. OBSERVATIONS: The os goniale and the anterior process of the malleus (AP) provided a long, bar-like membranous bone complex that passed through the petrotympanic and tympanosquamosal fissures. Notably, the AP-goniale complex is sometimes elongated inferiorly to join the SML (n = 4 specimens). Along the complex in the bone fissures, a degenerating MC was often present (n = 12). With (n = 6) or without (n = 3) the MC remnant, the tympanic bone (TYB) protruded inferomedially near the tympanosquamosal fissure, and it sometimes continued to a cartilaginous SML (n = 3). The temporal bone squamosa or petrosa provided a similar bony process approaching the SML. The middle meningeal artery often ran between the sphenoid and petrosa. CONCLUSIONS: Most of the specimens (n = 15) exhibited a sequential change from a cartilaginous SML as a continuation of the MC remnant to the ligament after the disappearance of the cartilage. The degenerating MC appeared to cause transformation from the AP-goniale complex and/or TYB to "another ligament" that replaced the usual SML at the upper part. Near the MC remnant, a similar transformation was also suggested on the squamosa or petrosa. The sphenoid spine appeared to originate often from the sphenoid ala major but sometimes from the TYB.
Subject(s)
Ligaments, Articular , Temporomandibular Joint , Humans , Cartilage , Fetus , Temporal Bone , MandibleABSTRACT
The topographical relationships among the lower cranial nerves, internal carotid artery (ICA), and internal jugular vein (IJV) in the upper parapharyngeal neurovascular bundle remain obscure. Thus, details of the anatomy were examined in human fetus histology. We observed the horizontal histological sections from 20 midterm (9-18 weeks) and 12 near-term (28-40 weeks) fetuses. At the external skull base, the glossopharyngeal nerve crosses the anterior aspect of the IJV to reach the medially located Hyrtl's fissure in the petrous temporal bone. The nerve crossed the anterior aspect of the ICA medially near or below the first cervical nerve root. Below the hypoglossal nerve canal, the accessory nerve crosses the anterior or posterior aspects of the IJV and moves laterally. During the half-spiral course, the hypoglossal nerve was tightly attached to the posterolateral-anterior aspects of the vagus nerve and surrounded by a common nerve sheath. The glossopharyngeal ganglia sometimes extended inferiorly to the level of the hypoglossal nerve canal but were absent along the inferior course. The inferior vagal ganglion rarely extends above the occipital condyle. The superior cervical sympathetic ganglion occasionally extends above the first cervical nerve root. The IJV (or ICA) descends to the lateral (or medial) margins of the parapharyngeal neurovascular bundle. The glossopharyngeal (or accessory) nerve crosses the ICA (or IJV) to exit the bundle at the base of the skull (or below the hypoglossal nerve canal). The glossopharyngeal and vagus inferior ganglia differ at each site.
ABSTRACT
In human fetuses, the left hepatic artery (LHA) issues the marginal artery that runs along the umbilical vein and, sometimes, reaches the umbilicus. The further observation demonstrated that, in 5 of 12 Japanese midterm fetuses (crown-rump length mm: 46, 50, 54, 59, 102), the marginal artery issued not only a thin umbilical branch but also a liver parenchymal branch that took a posterosuperior recurrent course in a peritoneal fold and supplied the anterior surface of the liver left lobe (segment III). However, in 22 Spanish fetuses of which gestational ages corresponded to the Japanese ones, we did not find the parenchymal branch. Therefore, between human populations, there seemed to be a considerable difference in the incidence as to whether or not the marginal artery issues the liver parenchymal branch. The parenchymal branch might be degenerated at the later stages due to friction between the liver free surface and growing diaphragm.
ABSTRACT
Even in mammals with the diaphragm, the lung and liver are likely to attach mutually without separation by any structure in embryos. The aim of this study was to examine whether or not the lung attaches to the liver in embryonic development of birds without diaphragm. First, we ensured the topographical relation between the lung and liver in 12 human embryos at 5 weeks. After the serosal mesothelium was established, the human lung sometimes (3 embryos) attached tightly to the liver without interruption by the developing diaphragm in the pleuroperitoneal fold. Second, we observed the lung-liver interface in chick and quail embryos. At 3-5 days' incubation (stages 20-27), the lung and liver were fused at bilateral narrow areas just above the muscular stomach. Therein, mesenchymal cells, possibly derived from the transverse septum, were intermingled between the lung and liver. The interface tended to be larger in the quail than the chick. At and until 7 days' incubation, the fusion of the lung and liver disappeared and, instead, a membrane connected them bilaterally. The right membrane extended caudally to attach to the mesonephros and caudal vena cava. At 12 days' incubation, bilateral thick folds, containing the abdominal air sac and pleuroperitoneal muscle (striated muscle), separated the dorsally located lung from the liver. Therefore, the lung-liver fusion occurred transiently in birds. Rather than the presence of the muscular diaphragm, whether the lung and liver were fused seemed to depend on a timing and sequence of development of the mesothelial coverings of these viscera.
Subject(s)
Chickens , Quail , Female , Pregnancy , Animals , Humans , Liver , Diaphragm , Lung , MammalsABSTRACT
Bcl-2-associated athanogene 1 (Bag-1) is a multifunctional prosurvival protein that binds to several intracellular targets and promotes cell survival. HSP70 and Raf-1 are important targets of Bag-1; however, the protective function of Bag-1 in nucleus pulposus (NP) cells remains unclear. In this study, we determined the effects of Bag-1 on NP cells under oxidative stress induced by treatment with hydrogen peroxide (H2O2). We found that Bag-1 was bound to HSP70, but Bag-1-Raf1 binding did not occur in NP cells. Bag-1 overexpression in NP cells enhanced cell viability and mitochondrial function and significantly suppressed p38/MAPKs phosphorylation during oxidative stress, although NP cells treated with a Bag-1 C-terminal inhibitor, which is the binding site of HSP70 and Raf-1, decreased cell viability and mitochondrial function during oxidative stress. Furthermore, the phosphorylation of the ERK/MAPKs was significantly increased in Bag-1 C-terminal inhibitor-treated NP cells without H2O2 treatment but did not change with H2O2 exposure. The phosphorylation of Raf-1 was not influenced by Bag-1 overexpression or Bag-1 C-terminal binding site inhibition. Overall, the results suggest that Bag-1 preferentially interacts with HSP70, rather than Raf-1, to protect NP cells against oxidative stress.
ABSTRACT
Recent molecular biology studies have revealed the process of nasal capsule determination. We aimed to create a fate map showing the association between the adult and embryonic components of the nasal wall and nasal capsule derivatives. We examined paraffin-embedded histological sections between 15 mid-term (9-16 weeks) and 12 near-term (27-40 weeks) foetuses. Until 15 weeks, membranous ossification occurred 'along' the capsular cartilage, contributing to the formation of the vomer, maxilla and bony nasal septum as well as the nasal, frontal and lacrimal bones. After 15 weeks, a wide lateral part of the capsule became thin and fragmented, and degenerative cartilage was observed near the lacrimal bone, in the three conchae, and at the inferolateral end of the capsule sandwiched between the maxilla and palatine bone. The disappearing cartilages appeared to be replaced by nearby membranous bones. This type of membranous ossification did not appear to use the capsular cartilage as a 'mould', although the perichondrium may have a role in inducing ossification. Calcified cartilage indicated endochondral ossification in the inferior concha until 15 weeks and, later, at the bases of three conchae and around the future sphenoid sinus (i.e. the concha sphenoidalis). The capsular cartilage extended antero-superiorly over the frontal bone and inserted into the nasal bone. At 40 weeks, the capsular cartilage remained in the cribriform plate and at the inferolateral end along the palatine bone. Consequently, less guidance from the nasal capsule seemed to provide great individual variation in the shape of the wide anterolateral wall of the nasal cavity.
Subject(s)
Nasal Cavity , Osteogenesis , Humans , Adult , Cartilage , Fetus , MaxillaABSTRACT
BACKGROUND: Embryonic pulmonary veins (PVs) are believed to be absorbed into the left atrium (LA) to provide an adult morphology in which "four" veins drain separately into the atrium. MATERIALS AND METHODS: Serial histological sections were obtained from 27 human embryos and fetuses. RESULTS: Between 5 and 6 weeks, the four PVs joined together to form a trunk-like structure (initial spatium pulmonalis) that was larger than the initial LA (two-ostia pattern). The cardiac nerves ran inferiorly along the posterior aspect of the four veins, as well as the spatium. At and until 7 weeks, the cardiac nerves were concentrated to elongate the nerve fold, and the latter separated the left PV trunk from the expanding LA (left spatium). Similarly, the right PV opened to a thick and deep LA recess (right spatium). At 8-12 weeks, depending on the growth of the LA, the opening of the left and right PVs became distant, and the spatium was elongated transversely. The left spatium was enlarged to open widely to the proper left atrium in contrast to the right spatium pushed anteriorly by the right atrium. The three-ostia pattern was transiently observed because of the lost delimitation between the left spatium and proper atrium. The myocardium was thin in the left spatium behind the left atrial nerve fold, whereas the right spatium was tube-like with a thick myocardium. CONCLUSIONS: The four-ostia pattern seemed to be established at birth due to a drastically increased venous return from the lung, resulting in a flat smooth left atrial posterior wall.
Subject(s)
Atrial Fibrillation , Pulmonary Veins , Adult , Infant, Newborn , Humans , Pulmonary Veins/anatomy & histology , Heart Atria/anatomy & histology , Fetus , MyocardiumABSTRACT
The human fetal sacroiliac joint (SIJ) is characterized by unequal development of the paired bones and delayed cavitation. Thus, during the long in utero period, the bony ilium becomes adjacent to the cartilaginous sacrum. This mor-phology may be analogous to that of the temporomandibular joint (TMJ). We examined horizontal histological sections of 24 fetuses at 10-30 weeks and compared the timing and sequences of joint cartilage development, cavitation, and ossification of the ilium. We also examined histological sections of the TMJ and humeroradial joint, because these also contain a disk or disk-like structure. In the ilium, endochondral ossification started in the anterior side of the SIJ, extended posteriorly and reached the joint at 12 weeks GA, and then extended over the joint at 15 weeks GA. Likewise, the joint cartilage appeared at the anterior end of the future SIJ at 12 weeks GA, and extended along the bony ilium posteriorly to cover the entire SIJ at 26 weeks GA. The cavitation started at 15 weeks GA. Therefore, joint cartilage development seemed to follow the ossification of the ilium by extending along the SIJ, and cavitation then occurred. This sequence "ossification, followed by joint cartilage formation, and then cavitation" did not occur in the TMJ or humeroradial joint. The TMJ had a periosteum-like membrane that covered the joint surface, but the humeroradial joint did not. After muscle contraction starts, it is likely that the mechanical stress from the bony ilium induces development of joint cartilage.
ABSTRACT
BACKGROUND AND PURPOSE: The calcaneal tendon sheath has several vascular routes and is a common site of inflammation. In adults, it is associated with the plantaris muscle tendon, but there are individual variations in the architecture and insertion site. We describe changes of the tendon sheath during fetal development. MATERIALS AND METHODS: Histological sections of the unilateral ankles of 20 fetuses were examined, ten at 8-12 weeks gestational age (GA) and twelve at 26-39 weeks GA. RESULTS: At 8-12 weeks GA, the tendon sheath simply consisted of a multilaminar layer that involved the plantaris tendon. At 26-39 weeks, each calcaneal tendon had a multilaminar sheath that could be roughly divided into three layers. The innermost layer was attached to the tendon and sometimes contained the plantaris tendon; the multilaminar intermediate layer contained vessels and often contained the plantaris tendon; and the outermost layer was thick and joined other fascial structures, such as a tibial nerve sheath and subcutaneous plantar fascia. The intermediate layer merged with the outermost layer near the insertion to the calcaneus. CONCLUSION: In spite of significant variations among adults, the fetal plantar tendon was always contained in an innermost or intermediate layer of the calcaneal tendon sheath in near-term fetuses. After birth, mechanical stresses such as walking might lead to fusion or separation of the multilaminar sheath in various manners. When reconstruction occurs postnatally, there may be individual variations in blood supply routes and morphology of the distal end of the plantaris tendon.
Subject(s)
Achilles Tendon , Adult , Humans , Infant , Achilles Tendon/anatomy & histology , Muscle, Skeletal/anatomy & histology , Lower Extremity , Fetus , Gestational AgeABSTRACT
It is unclear whether forearm and crural muscle fibers extend distally across the wrist and ankle joints, respectively. We hypothesized, in late-term fetuses, an over-production of muscle bellies extending over the joint. Muscle fibers in histological sections from unilateral wrists and ankles of 16 late-term fetuses (30-40 weeks) were examined and compared with 15 adult cadavers. Muscle fibers of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) in fetuses, especially muscle bellies to the third and fourth fingers, were found to extend far distally beyond the radiocarpal joint. The extensor digitorum and extensor pollicis longus on the extensor side of the wrist were found to carry distally-extending muscle fibers, but these fibers did not extend beyond the distal end of the radius. In the ankle, most muscle bundles in the flexor hallucis longus (FHL), fibularis brevis (FB) and extensor digitorum longus extended distally beyond the talocrural joint, with most FB muscle fibers reaching the level of the talocalcaneal joint. In adult cadavers, muscle fibers of the FDP and FHL did not reach the levels of the radiocarpal and talocrural joints, respectively, whereas the FB muscle belly always reached the talocalcaneal joint. Similarly, some of the FDS reached the level of the radiocarpal joint. Generally, infants' movements at the wrist and ankle could result in friction injury to over-extended muscle. However, the calcaneal and FDP tendons might protect the FB and FDS tendons, respectively, from friction stress.
ABSTRACT
BACKGROUND: Laennec's capsule is the proper membrane covering the entire surface of the liver parenchyma, including around the Glissonean pedicles and hepatic veins. Laennec's capsule around the hepatic veins has been clinically reported to comprise two layers: the hepatic and cardiac Laennec's capsules. However, where the cardiac Laennec's capsule is derived from and the two capsules' separability are still unclear. This study aimed to investigate the anatomy of the two capsules using cadaveric specimens. METHODS: Histopathological examinations of autopsy specimens from four cadavers were conducted. Each specimen was sliced in the longitudinal section to include the pericardium, right hepatic vein (RHV), and inferior vena cava (IVC). Additionally, long-axis specimens of the RHV were obtained to determine the separability of the capsules and to examine the extent to which the capsules extended along the RHV. Laennec's capsule was estimated using elastic fiber staining. RESULTS: The cardiac Laennec's capsule is derived from the pericardium (parietal and visceral) and diaphragm and runs parallel with the IVC and hepatic veins associated with the hepatic Laennec's capsule. The two capsules were separable micro- and macroscopically. The hepatic Laennec's capsule was observed from the root to the peripheral side and the cardiac Laennec's capsule from the root to the middle side of the hepatic vein. CONCLUSIONS: The existence of the two layers of Laennec's capsule around the hepatic veins was confirmed histologically and they were separable. Identification and decollement of these layers would contribute to establishing safe and feasible anatomic liver resection techniques.
Subject(s)
Hepatic Veins , Liver Neoplasms , Humans , Hepatic Veins/surgery , Capsules , Hepatectomy/methods , Liver/surgery , Liver/anatomy & histology , Liver Neoplasms/surgeryABSTRACT
BACKGROUND: The muscular branches of the tibial nerve within the popliteal fossa innervate the gastrocnemius, soleus, plantaris, and popliteus muscles. Various branching patterns have been described in textbooks; however, the underlying fundamental rules explaining the patterns remain unclear. Understanding the fundamental rule explaining the branching pattern of the innervating nerves is essential for understanding the ontogeny of skeletal muscles. Therefore, this study aimed at establishing a theory to explain the branching pattern of the muscular branches of the tibial nerve within the popliteal fossa. METHODS: The branching patterns of the muscular branches of the tibial nerve within the popliteal fossa were examined macroscopically in 62 lower limbs derived from 31 adult cadavers (22 males and 9 females, aged 49-95 years). RESULTS: The branch to the medial head of the gastrocnemius muscle invariably arose from the posteromedial side of the tibial nerve. The branches to the soleus muscle and lateral head of the gastrocnemius muscle had a common trunk in all the lower limbs and invariably arose from the posterolateral side. The branches to the plantaris and popliteus muscles arose anteriorly from the tibial nerve in this order (plantaris branch first, followed by the popliteus branch). These branches invariably arose more distally than the branch to both the heads of the gastrocnemius and soleus muscles. CONCLUSIONS: Based on these fundamental branching patterns, we suggest a novel branching categorization. The branches could be categorized into a posterior group and an anterior group, which has independent branches to the plantaris and popliteus muscles. This fundamental branching pattern and novel categorization contribute to the understanding of the ontogeny of the skeletal muscles around the flexor compartment of the leg.
Subject(s)
Nerve Tissue , Tibial Nerve , Adult , Male , Female , Humans , Tibial Nerve/anatomy & histology , Leg , Muscle, Skeletal/innervation , CadaverABSTRACT
Neonicotinoid pesticides (NPs) are neurotoxic substances. They are highly effective as insecticides owing to their water solubility, permeability, and long-lasting activity. These molecules are structurally similar to nicotine and act as nicotinic acetylcholine receptor agonists. The administration of NPs to experimental animals reportedly causes neuromuscular and reproductive disorders. Moreover, recently reported problems caused by NPs include damage to land-dwelling creatures (such as mammals and birds), hydrobiology, and ecosystems. This review summarizes the recent reports on NP concentrations detected in river systems in several Japanese regions. These values were lower than the environmental standard values; however, seasonal variations were observed. Furthermore, reports on NP-induced testicular and ovarian toxicity were examined, revealing that the mechanism of injury is mainly driven by oxidative stress. The use of NPs is declining worldwide, except in Japan; therefore, continuous monitoring remains necessary.
Subject(s)
Insecticides , Pesticides , Receptors, Nicotinic , Water Pollutants, Chemical , Animals , Ecosystem , Insecticides/pharmacology , Japan , Mammals , Neonicotinoids/toxicity , Nicotine , Pesticides/analysis , Pesticides/toxicity , Water , Water Pollutants, Chemical/toxicityABSTRACT
At birth, the umbilical cord contains various types of thin vessels that are near and outside the umbilicus and separate from the umbilical arteries and vein. These vessels are regarded as the remnant "vitelline vessels" and are often called "umbilical vessels", although this terminology could lead to confusion with the true umbilical arteries and vein. No study has yet comprehensively examined these vessels using histological sections. Our examination of these vessels in 25 midterm fetuses (gestational age: 10-16 weeks) led to five major findings: (i) all specimens had umbilical branches of the inferior epigastric artery; (ii) 5 specimens had vitelline vein remnants; (iii) 4 specimens had a thin artery originating from the left hepatic artery that ran along the umbilical vein; (iv) 2 specimens had a so-called "para-umbilical vein" that was along the umbilical vein and reached the umbilicus; and (v) all specimens had lymphatic vessels originating from the umbilicus that ran caudally along the umbilical artery. The pelvic vein tributaries were well developed along the intra-abdominal umbilical artery, but did not reach the umbilicus. The lymphatic vessel was distinguished from the veins by an intraluminar cluster of lymphocytes attaching to the endothelium. The arterial branch in the umbilical cord did not accompany veins and lymphatic vessels, in contrast to the mother artery in the rectus abdominis. All these thin vessels seemed to be obliterated when the fibrous umbilical ring grew during late-term. The para-umbilical collateral vein in adults might develop outside the fibrous umbilical ring after birth.
ABSTRACT
BACKGROUND AND PURPOSE: Ankle sprain is often attributed to damage of the anterior and posterior talofibular ligaments (ATFL, PTFL). We compared the morphology of these ligaments in fetuses of different gestational ages (GAs) with the horizontal configuration in adults. MATERIALS AND METHODS: Histological sections of unilateral ankles were examined in 22 fetuses, 10 at GA of 9-12 weeks and 12 at GA of 26-39 weeks. RESULTS: At a GA of 9 to 10 weeks, the ATFL and PTFL consisted of horizontally running straight fibers. The initial ATFL appeared as a thickening of the capsule of the talocrural joint, although the initial PTFL was distant from this joint. Until a GA of 12 weeks, the talus and fibula were separated by an expanding joint cavity. Thus, the initial horizontal ligaments were "pulled" in a distal direction. The distal parts of the ligaments consisted of thin collagenous fibers that had an irregular array, whereas the short proximal parts had thick fibers and a horizontal array. In near-term fetuses, the ligaments contained no horizontal fibers. The ATFL had a wavy course around the thick synovial fold, and was exposed to the joint cavity along the entire course; the distal part was thinner than the proximal part. The PTFL was bulky and consisted of fibers with an irregular array. Therefore, the morphology in a near-term fetus was quite different from that in adults. CONCLUSION: The horizontal and straight composite ankle fibers in adults apparently result from postnatal reconstruction, depending on mechanical demand.
Subject(s)
Ankle Injuries , Lateral Ligament, Ankle , Adult , Ankle Joint/anatomy & histology , Fetal Development , Humans , Lateral Ligament, Ankle/anatomy & histology , LigamentsABSTRACT
Thiel embalmed and fresh-frozen cadavers have been mainly used for hand surgery training. We held a training seminar on skin flap elevation using cadavers embalmed by the saturated salt solution method. This study aimed to evaluate the usefulness of such training and to validate the suitability of saturated salt solution-embalmed cadavers for hand surgery training. Participants were trained in elevation procedures for the oblique triangular, reverse digital artery, reverse radial forearm, and reverse dorsal metacarpal artery flaps. Forty-eight surgeons participated in three seminars (one held in 2017, 2018, and 2019 each). A self-assessment of the participants' confidence levels for their surgical skills was performed before and immediately after the seminar, and the suitability of saturated salt solution-embalmed cadavers was determined in terms of visual perception, tactility, comparison with real-world surgical settings, and usefulness. The confidence level for all skills increased immediately after the seminar. The surgeons reported that the visual perception and tactility of the saturated salt solution-embalmed cadavers were comparable to those of a living body, and the cadavers were rated higher with respect to their usefulness. Hand surgery seminars using cadavers embalmed by the saturated salt solution method are considered useful for training in skin flap techniques.
Subject(s)
Embalming , Hand , Cadaver , Embalming/methods , Hand/surgery , Humans , Sodium ChlorideABSTRACT
BACKGROUND: Lateral femoral cutaneous nerve (LFCN) injury after total hip arthroplasty causes patient dissatisfaction. This cadaveric study aimed to assess the risk for LFCN injury after the direct anterior approach (DAA) and anterolateral supine approach (ALS) with a focus on the anatomical variations of the LFCN. METHODS: Thirty-seven hemipelves from 20 formalin-preserved cadavers (10 males and 10 females) were dissected to identify the LFCN, evaluate variations, and measure the distance from the LFCN to each approach. The LFCN was classified as classical, late, multi trunk, or primary femoral. RESULTS: There were no significant variations in the LFCN between the sexes. The distance from the LFCN to DAA incision (10 [0-17.8] mm) was significantly less than that from the LFCN to ALS incision (27 [0-40] mm); moreover, 64.9% of DAA incisions crossed the LFCN. The classical type LFCN was closest to the DAA incision. The DAA incision most frequently crossed the LFCN at the proximal third, and the frequency of intersection of the LFCN and DAA incisions decreased by 25% by a 10-mm shortening of the DAA proximal incision. In contrast, 27% of ALS incisions crossed the LFCN. Multi trunk type LFCN was closest to the ALS incision. There were no significant differences between each approach and LFCN variations, and the frequency of intersection of the LFCN and ALS incisions decreased by 20% by a 10-mm shortening of the ALS proximal incision. CONCLUSIONS: The intersection rates between the LFCN and the DAA and between the LFCN and the ALS were approximately 65 and 30%, respectively. Approximately 20-25% of these injuries may be avoidable by a 10-mm shortening of the proximal incision.