"The Accessory Ethmoidal Canal Does Not Necessarily Contain an Arterial Structure".

Introduction: The aim of our study is to describe the prevalence of the accessory ethmoidal artery in endonasal endoscopic cadaver dissections and to identify its intraorbital origin. Material and Methods: From 2018 to 2020, thirty-four nasal dissections were performed in seventeen adult cadaveric heads. We performed a complete ethmoidectomy to identify the ethmoidal canals. Then, we removed the bony canal and the lamina papiracea to verify the injected vessel and to confirm the vascular structure inside the canal. Results: We found the anterior ethmoidal canal (AEC) and the posterior ethmoidal canal (PEC) in 100% of nasal cavities (34/34). We identified 4 accessory ethmoidal canals (AcEC) in the 34 nasal fossae dissected (12%). All AEC contained an arterial vessel. The AcEC contained an arterial vascular structure in 2 cases, a neural structure in other specimen, and in the fourth case no structure could be verified. In 32 of 34 nasal cavities, the PEC contained an artery and only in 2 cases the PEC did not contain any vascular structure. In these specimens, we observed that the AcEC with an arterial vessel inside (6%) was closer to the posterior canal than the anterior canal. Conclusion: According to our findings, we can suggest that the presence of a canal does not necessarily imply the presence of an arterial vessel, and that presence of the accessory ethmoidal artery could be associated with the absence of posterior ethmoidal artery.

The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study.

BACKGROUND: Reconstruction of the anterior thorax is complex because of the presence of aesthetically important areas such as the breast, sternum, and upper abdomen. For this reason, a wide variety of pedicled perforator flaps have been described. The anterior intercostal perforator flap is one of these perforators flaps and is valuable for use in breast reconstruction surgery. METHODS: The location and characteristics of the anterior intercostal perforators were evaluated both anatomically and radiologically. The anatomical study was conducted in a set of 14 hemitrunk cadavers, and the radiologic study was performed retrospectively from a randomly selected set of images obtained from 30 female patients who underwent thoracic computed tomographic angiography for other health problems at the authors' institution during the year 2015. The findings were then compared. RESULTS: A total of 60 perforators in 14 hemitrunks were identified and mapped. Perforators were found in all hemithoraces. The lateral third donor location was the most reliable zone, containing larger and more numerous perforators compared with the other donor regions. According to the radiologic study, a total of 164 perforators in 30 computed tomographic angiographs were identified and mapped. Perforators were found in all thoraxes. CONCLUSIONS: The authors found that the intercostal perforator flap has a consistent vascularization. Computed tomographic angiography is less reliable than dissection in identifying the number of perforators. The authors' findings suggest that intercostal perforator flaps are reliable and consistent flaps for reconstruction of the upper trunk.

[Study of the feasibility of lateral meniscal repair including the popliteal tendon with a knee simulator]. / Estudio de la viabilidad de la reparación meniscal lateral incluyendo el tendón poplíteo con simulador de rodilla.

BACKGROUND: Although the indications for lateral meniscal repair are well established, some aspects are still controversial. The classic recommendation is to avoid going through the popliteal tendon with sutures, even though this is at times difficult to achieve. The purpose of this paper was to assess the feasibility of a meniscal repair that included the popliteal tendon. METHODS: To this end, nine human fresh frozen knees were used, in which a bucket handle lesion of the lateral meniscus was inflicted. The knees were divided into three groups: Group A (control): meniscal repair was performed with 5 vertical sutures, 2 posterior and 3 anterior to the popliteal fossa; Group B: one stitch was added between the lateral meniscus and the popliteal tendon, and Group C: the additional stitch included the meniscus, the popliteal tendon and the articular capsule. In all cases a lateral condyle osteotomy was performed to access the lateral compartment of the knee. Once the osteotomy had been fixed, the knees underwent 1000 gait cycles and a rotational test using an experimental gait simulator. Then a macroscopic assessment of the meniscal repair and the popliteal tendon was performed. RESULTS: No differences were seen in the previous situation in any of the groups. CONCLUSIONS: In this experimental model the repair of the lateral meniscus including the popliteal tendon did not seem to have any repercussions on suture viability.

Distancias anatómicas de la pelvis en relación con las técnicas quirúrgicas a través del foramen obturador / Anatomical distances among pelvic structures related to surgical techniques through the obturator foramen

Objetivo: Describir las distancias entre las principales estructuras óseas, vasculares, neurológicas y viscerales que son relevantes para guiar el paso de las agujas insertoras en las técnicas quirúrgicas a través del foramen obturador. Material y métodos: Se diseccionaron 6 hemipelvis femeninas de cadáver embalsamado, procedentes de donantes de cuerpo voluntarias del Departament de Ciències Morfològiques de la Universitat Autònoma de Barcelona (UAB). En la disección se hizo especial hincapié en la delimitación del agujero obturador y la localización de estructuras osteomusculoaponeuróticas y neurovasculares adyacentes. Resultados: Se midieron distintas distancias. Son especialmente relevantes las distancias en relación con la rama isquiopubiana, la espina ciática y el arco tendinoso del músculo elevador del ano, ya que constituyen las principales referencias para la cirugía. Conclusiones: Un buen conocimiento de la anatomía trae luz al paso a ciegas de los tunelizadores que utilizan el foramen obturador para acceder a la pelvis. Ello debe permitir una cirugía más segura y una mejor comprensión de los riesgos potenciales, cómo evitarlos y cómo tratar las complicaciones perioperatorias

Objective: To describe distances between the major bony, vascular, neurologic and visceral structures of importance when guiding trocar needles through the obturator foramen. Material and methods: Six embalmed female hemipelvises from voluntary donors were dissected at the Department of Anatomy of the Universitat Autònoma de Barcelona (UAB) School of Medicine. Special attention was paid to the obturator foramen and its neighboring bony, aponeurotic and muscular structures, and neurovascular bundles. Results: Several distances were collected. Distances in relation to the ischiopubic ramus, the ischial spine and the arcus tendineus of levator ani seemed to be particularly important, as they are the main landmarks for surgery. Conclusion: A good knowledge of anatomy illuminates the passage of trocar needles inserted through the obturator foramen as a route to enter the pelvic space. This knowledge improves safety, understanding of potential risks and how to avoid them, as well as the management of perioperative complications

Morphological features in human cortical brain microvessels after head injury: a three-dimensional and immunocytochemical study.

We studied the morphology of cortical microvessels in the brains of 10 patients who had died after receiving a traumatic head injury (THI). Scanning electron microscopy (SEM) of vascular corrosion casts, confocal microscopy of histological sections after immunocytochemistry, and detection of apoptosis by terminal dUTP nick end labeling (TUNEL) were used. Microvascular casts showed an angioarchitectonic distribution that was defined as normal according to results obtained in a previous, nontraumatic series of subjects. However, when we compared them with previous works, the cast surface of some of the microvessels showed three types of morphological alterations: longitudinal folds, sunken surfaces with craters, and a significant flattening with reduction of lumen. The vessels that were primarily affected were the arterioles and capillaries of the middle and deep cortical vascular zones. Immunostaining with the monoclonal antibody MAS-336 against endothelial cells also showed the presence of longitudinal folds with a thinning of the vascular lumen, cytoplasmic round bodies, and a thickening of the endothelial cell membrane. The TUNEL technique revealed a positive staining of some endothelial cells. The structural alterations we observed indicate that microvessels undergo endothelial cell damage after THI. We suggest that this kind of lesion and the secondary functional injury to the blood-brain barrier (BBB) could play an important role in the development of the secondary lesions that these patients show in the subacute phase.