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1.
Am Surg ; 86(2): 146-151, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106908

RESUMO

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4-10 cm). D2: 4.9 ± 0.8 cm (3.5-7 cm). D3: 6.8 ± 0.9 cm (5-9 cm). D4: 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Músculos Abdominais/anatomia & histologia , Dissecação/métodos , Artérias Epigástricas/anatomia & histologia , Humanos , Masculino , Estudos Prospectivos , Sínfise Pubiana/anatomia & histologia , Telas Cirúrgicas , Artérias Umbilicais/anatomia & histologia , Ducto Deferente/anatomia & histologia
3.
Br J Anaesth ; 124(3): 308-313, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31973825

RESUMO

BACKGROUND: Incomplete peripheral nerve blocks distal to the popliteal region are commonly considered a sciatic and femoral/saphenous nerve block failure. The existence of a much more distal innervation area of the posterior femoral cutaneous nerve (PFCN) as described has not been assumed yet. We therefore investigated the distal termination of the PFCN in the lower leg. METHODS: In 83 human lower extremities embalmed with Theil's method, the course of the PFCN was investigated from the sub-gluteal fold to the most distal macroscopically dissectible branch. The topographic connection to other landmarks, such as the small saphenous vein or small arteries, was investigated. RESULTS: Popliteal ending of the PFCN was found in 9.7% of cases. The PFCN terminated at the proximal or distal lower leg in 45.7% and 44.6% of cases, respectively. The PFCN had a close connection to the Achilles tendon in 13.2% of cases and was found distally to the medial malleolus in one case. The small saphenous vein was close to the PFCN in 90.3% of cases and can therefore be used as a landmark to identify the nerve. In 40.9% of cases, the PFCN was accompanied by a small descending branch of the inferior gluteal artery. In two cases, an innervation of the fibula or calcaneus periosteum was found. CONCLUSIONS: The PFCN has a much more distal termination in the lower leg than previously demonstrated. To ensure complete anaesthesia of the lower leg and foot, the PFCN must be included in combined peripheral nerve block procedures.


Assuntos
Nervo Femoral/anatomia & histologia , Extremidade Inferior/inervação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Sensação , Pele/inervação , Coxa da Perna/inervação
4.
Khirurgiia (Mosk) ; (1): 94-99, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994507

RESUMO

Nowadays, the issue of splenic flexure mobilization (SFM) in anterior and low anterior rectal resection for rectal cancer is still debatable. This stage is important because dissection results tension-free anastomosis and excision of specimen of enough length with adequate number of harvested lymph nodes. However, literature review confirmed the absence of agreement regarding reduced incidence of colorectal anastomotic leakage and improved long-term oncologic outcomes after SFM. Opinion about selective approach to this procedure is becoming more common. Therefore, randomized trials are necessary to determine a need for routine SFM or indications for selective approach to SFM in anterior rectal resection for rectal cancer.


Assuntos
Colo Transverso/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Colectomia/métodos , Dissecação/métodos , Humanos , Laparoscopia
5.
Eur. j. anat ; 24(1): 37-48, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186063

RESUMO

Paralysis of the facial nerve is a common complication during the surgical removal of parotid gland tumors (parotidectomies). This may be due to the close relationship of the tumor and the facial nerve (along its extracranial course). This study aimed to explore the extracranial course of the facial nerve in terms of branching patterns, bony anatomical landmarks and variations. The sample comprised of 40 facial nerve specimens. The parameters identified and recorded were facial nerve trunk division, branching patterns and variations in terms of connections, course and branching. The parameters were classified and compared according to sex and laterality. Bifurcation of the facial nerve trunk occurred in 90% of cases, whilst trifurcation occurred in only 10%. The cases of trifurcation displayed variations. The frequency of each type of branching pattern was: Type I = 7.5%, Type II = 12.5%, Type III = 25%, Type IV = 15%, Type V = 27.5% and Type VI =12.5%. The six types were further categorized into three subtypes based on the origin of the buccal branch. The distance fromthe facial nerve trunk to bony anatomical landmarks was measured viz. mastoid process, angle of the mandible and external auditory canal. Only the distance to the angle of the mandible displayed significant differences according to sex (p-value < 0.001) and laterality (p- value = 0.002). All three landmarks displayed good-excellent reliability (ICC values ranged from 0.82 to 0.95) with regard to bony anatomical landmarks for the localization of the facial nerve trunk. The present study proposes the use of the three subtypes in conjunction with the classification system. Anatomical knowledge of the extracranial course of the facial nerve and its relation to bony anatomical landmarks are of im-portance to surgeons during procedures such as parotidectomies


No disponible


Assuntos
Humanos , Masculino , Feminino , Nervo Facial/anatomia & histologia , Glândula Parótida/anatomia & histologia , Glândula Parótida/cirurgia , Pontos de Referência Anatômicos/inervação , Cadáver , Processo Mastoide/anatomia & histologia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Dissecação/métodos , Mandíbula/anatomia & histologia
6.
Eur. j. anat ; 24(1): 63-68, ene. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-186066

RESUMO

During a routine female cadaveric dissection, we found an unusual bilateral pelvic branching pattern of the internal and external iliac arteries. The vaginal and middle rectal arteries had a common origin from the right internal pudendal artery. An aberrant obturator artery arises from both external iliac arteries. A right aberrant obturator artery gives a small branch to the back of the pubic bone. The left inferior epigastric artery arises from the common trunk of the external iliac artery with the aberrant obturator artery. Knowledge of arterial variations helps to reduce the internal hemorrhage during abdominal and pelvic surgeries


No disponible


Assuntos
Humanos , Feminino , Artéria Ilíaca/anatomia & histologia , Cadáver , Dissecação/métodos , Variação Anatômica , Artérias/anatomia & histologia , Músculos Psoas/anatomia & histologia , Linfonodos/anatomia & histologia , Nervo Pudendo/anatomia & histologia , Hemorragia
7.
Urology ; 136: 263-265, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31704457

RESUMO

OBJECTIVE: To find a method of safely inserting a suprapubic catheter (SPC) under local anesthetic and under ultrasound guidance in patients who may not be fit for a general anesthetic but also are seen to have bowel overlying the anterior bladder wall which obscures a safe route to the bladder. MATERIALS AND METHODS: We used ultrasonography to visualize the bladder which was initially filled via the indwelling urethral catheter. A 22-gauge needle attached to a syringe filled with 30 mL of fluid (made up of 10 mL of 1% lidocaine plus 20 mL sterile water) was inserted transabdominally under ultrasound guidance into a space between the pubic symphysis and bowel. The fluid was then injected into the space to hydrodissect the bowel away from the bladder. Once the space had been created, an 18-guage needle was passed into the bladder and a SPC was inserted via the Seldinger technique. RESULTS: Successful SPC insertion was confirmed on ultrasound guidance with no associated bowel or other injury. Telephone follow-up with the patient 6 months later revealed that the patient had no complications and no infections. CONCLUSION: Hydrodissection can be considered when inserting SPC under local anesthetic under ultrasound guidance when there is bowel obscuring any safe route to the bladder. This may be particularly useful in patients who may not be fit for a general an aesthetic.


Assuntos
Cateteres de Demora , Ultrassonografia de Intervenção , Cateterismo Urinário/métodos , Idoso , Dissecação/métodos , Humanos , Masculino , Água/administração & dosagem
8.
Braz J Cardiovasc Surg ; 34(6): 667-673, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364343

RESUMO

OBJECTIVE: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). METHODS: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. RESULTS: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. CONCLUSION: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.


Assuntos
Dissecação/métodos , Eletrocoagulação/métodos , Artéria Radial/cirurgia , Coleta de Tecidos e Órgãos/métodos , Procedimentos Cirúrgicos Ultrassônicos/métodos , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Molécula 1 de Adesão Intercelular , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória , Período Pós-Operatório , Artéria Radial/patologia
9.
World Neurosurg ; 135: e562-e566, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863894

RESUMO

BACKGROUND: The need for a better understanding of the subthalamic nucleus (STN)'s vascular anatomy is still evident because revealing its vascular supply may increase insight in the pathogenesis of related disorders, such as STN ischemia. The mechanisms under motor, behavioral, and cognitive changes following deep brain stimulation treatment may also be explained by its pattern of vascularization. The primary goal of this study was to delineate the vascularization of the STN and highlight the predominant perforating arteries supplying its territory. METHODS: Fiber dissections were performed with the modified Klingler technique under 6-40× magnification by preserving all vascular structures. RESULTS: The thalamic and subthalamic regions were dissected from medial to lateral in silicone-injected cadavers. The STN was revealed as a biconvex-shaped structure surrounded by dense inferolateral bundles of myelinated fibers, the zona incerta, bordering the superolateral portion of the red nucleus. The ventral limit of the STN was the substantia nigra, and the internal capsule traversed from its inferior to anterolateral side. The premamillary artery, a large perforator arising from the posterior communicating artery, constantly supplied the STN and was followed proximally along the anterior third ventricular floor toward its origin. The premamillary artery was found to be one of the posterior perforators of the posterior communicating artery in all hemispheres. CONCLUSIONS: The 3-dimensional microsurgical anatomy of the deep-seated STN region is complex, and the additional knowledge on its vascularization should improve our understanding of its surgical anatomy.


Assuntos
Artérias Cerebrais/anatomia & histologia , Núcleo Subtalâmico/irrigação sanguínea , Cadáver , Dissecação/métodos , Humanos , Imagem Tridimensional , Microcirurgia/métodos , Fotografação , Núcleo Subtalâmico/cirurgia
11.
Curr Sports Med Rep ; 18(11): 416-420, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702723

RESUMO

Hamstring muscle injuries (HMI) are common among athletes. HMI can take many months to years to resolve. Often, athletes do not report complete resolution with typical conservative therapy. We present several cases of athletes who presented with chronic hamstring injuries that resolved immediately after being treated with an ultrasound-guided fascial hydrodissection procedure. Following the procedure and graded rehabilitation protocol, athletes reported resolution of pain and tightness in addition to increased performance and a quicker return to play.


Assuntos
Traumatismos em Atletas/cirurgia , Dissecação/métodos , Músculos Isquiotibiais/lesões , Traumatismos da Perna/cirurgia , Lesões dos Tecidos Moles/cirurgia , Adolescente , Adulto , Atletas , Feminino , Humanos , Masculino , Ultrassonografia
12.
Artigo em Inglês | MEDLINE | ID: mdl-31751007

RESUMO

Until now, scissors, clips and electrocautery have been used to harvest the gastroepiploic artery (GEA) for grafting. Because this artery has many branches and large fragile satellite veins tangled around it, conventional methods are not suitable for quick harvesting without bleeding. In order to harvest the GEA easily and efficiently, a skeletonized technique using an ultrasonic scalpel was developed, but the blade of this device was not well designed for fine tissue dissection.  In order to address this problem, we have developed an alternative harvesting technique using a hybrid bipolar/ultrasonic energy device. This hybrid device integrates both electrical bipolar energy and ultrasonic frictional heat energy and is thus more versatile than traditional energy devices.  In addition, it achieves faster dissection speed while offering similar bursting pressure and acceptable thermal spread. Finally, our device has an improved blade design that is suitable for fine tissue dissection.  This video tutorial demonstrates our use of this new hybrid energy device and shows how it enables the surgeon to harvest the GEA quickly, safely, with little bleeding, and with less instrument exchange.


Assuntos
Dissecação , Artéria Gastroepiploica/transplante , Coleta de Tecidos e Órgãos/métodos , Ponte de Artéria Coronária/métodos , Dissecação/instrumentação , Dissecação/métodos , Humanos , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Procedimentos Cirúrgicos Ultrassônicos/métodos
13.
Artigo em Inglês | MEDLINE | ID: mdl-31751008

RESUMO

Malignant pleural mesothelioma is a cancer of the mesothelial cells lining the pleural sac. Surgery for malignant pleural mesothelioma should be part of a multimodality treatment approach and the aim of surgery should be macroscopic complete tumor resection. Lung-sparing operations, such as extended pleurectomy decortication, have gained increasing popularity in the past decade.  This video tutorial illustrates the main steps of extended pleurectomy decortication for the treatment of malignant pleural mesothelioma.


Assuntos
Neoplasias Pulmonares , Pulmão , Mesotelioma , Pleura/cirurgia , Neoplasias Pleurais , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Dissecação/métodos , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/patologia , Mesotelioma/cirurgia , Tratamentos com Preservação do Órgão/métodos , Pleura/patologia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia , Resultado do Tratamento
14.
Eur. j. anat ; 23(6): 435-446, nov. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-185086

RESUMO

Thorough knowledge of the variation of intrahepatic course of the portal vein is essential for pre-operative assessment of various hepatic surgeries like hepatectomy and live donor liver transplant. This study aims to determine the variation in the branching pattern of the portal vein in South Indian population. The branching pattern of the portal vein was studied by 3D reconstruction of 100 contrast-enhanced computed tomography images and in 15 formalin fixed livers using modified luminal casting technique. Radiologically, the normal portal vein anatomy was seen in 89%. The most common variation was trifurcation of portal vein (5%). A rare anomaly was noted in one case where the left portal vein gave a branch to segment VII. Using the modified luminal casting technique all the 15 specimens displayed Type I portal vein anatomy. The most common variation in the intrahepatic branching pattern observed was the right posterior segmental division supplying segment VIII. A rare left portal vein variation, in which it gave branches to segments V and VIII was noted. In this study, variations in the segmental supply of the portal vein were observed, which have not been studied in detail previously in the Indian population. Variations on the left portal vein are infrequent. A prior knowledge of such variations will help the interventional radiologists to reduce misinterpretations and subsequent misdiagnosis and guide the hepatobiliary


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Nervo Facial/anatomia & histologia , Nervo Facial/diagnóstico por imagem , Orelha Média/anatomia & histologia , Dissecação/métodos , Cadáver , Osso Temporal/anatomia & histologia , Deiscência da Ferida Operatória/diagnóstico por imagem , Orelha Média/diagnóstico por imagem , Anatomia/educação , Reabsorção Óssea/patologia
15.
Eur. j. anat ; 23(6): 459-463, nov. 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-185089

RESUMO

Situs inversus viscerum (SIV) is a rare congenital anomaly, which is still an intriguing phenomenon to anatomists and physicians alike. A complete SIV is characterized by a left-right transposition and mirror image of all thoraco-abdominal organs and their vasculature. The present report is based on one case with complete SIV, which was observed during the routine educational dissections of cadavers in the authors' Anatomy Department. A transposition of all truncal organs and their vasculature, and several variations of arteries and veins were present. The right branch of the proper hepatic artery was replaced by an artery that emanated from the superior mesenteric artery. The latter also released the inferior mesenteric artery. Additionally, a left accessory renal artery ran anterior to the inferior caval vein and posterior to the ureter to enter the hilum of the left kidney. There was also a variation in the anterior-posterior arrangement of the hilar structures of the left kidney. Additionally, a globally enlarged heart with coronary artery by-passes, a replaced aortic valve and an aortic arch aneurysm was observed. This case report is unique, as it presents a previously unreported co-incidence of SIV and hepatic, intestinal and renal vascular anomalies. It is important for the surgeon to be aware of such variations while planning an abdominal surgery in patients with SIV


No disponible


Assuntos
Humanos , Masculino , Idoso , Situs Inversus , Ductos Biliares Intra-Hepáticos/anormalidades , Trato Gastrointestinal/anormalidades , Rim/anormalidades , Anomalias dos Vasos Coronários , Ductos Biliares Intra-Hepáticos/anatomia & histologia , Trato Gastrointestinal/anatomia & histologia , Rim/anatomia & histologia , Dissecação/métodos , Artérias Mesentéricas/anormalidades , Artérias Mesentéricas/anatomia & histologia , Cadáver , Vasos Coronários/anatomia & histologia
17.
J Craniofac Surg ; 30(7): e609-e611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503125

RESUMO

Orbital blowout fractures are common. The same goes for its surgical complications when the efficiency of the dissection of entrapped or herniated intraorbital contents into the fracture could not be completely and safely dissected out. The authors describe a modification of the commonly used Howarth periosteal elevator for dissection of intraorbital content displacement or herniation on orbital blowout fracture. The instrument was modified by marking out the instrument from the tip into 10, 20, 25, 30, and 40 mm on both of its concave and convex surfaces to allow safe orbital soft tissue dissection and distance control. From the authors' experience, these simple modifications from its original instrument design allow better intraoperative control and appreciation of any intact important intraorbital anatomical structures such as inferomedial strut and posterior ledge. At the same time of importantly getting complete orbital fracture dissection and visualization, it causes less trauma to surrounding soft tissue with the markings ensuring unnecessary orbital exploration or visualization. Dissection can be kept for optimum maneuverability at the required or intended location based on the preoperative scan or dimension of anatomical orbital implant.


Assuntos
Fraturas Orbitárias/cirurgia , Equipamentos Ortopédicos , Dissecação/instrumentação , Dissecação/métodos , Humanos , Tomografia Computadorizada por Raios X
18.
Bull Hosp Jt Dis (2013) ; 77(3): 159-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487479

RESUMO

PURPOSE: The purpose of the study was to investigate clinical outcomes following a mini-open posterior technique. METHODS: Patients who received mini-open popliteal cyst excisions between April 1999 and April 2010 were identified. Charts were retrospectively reviewed for postoperative complications, cyst recurrence, previous aspiration, re-operation, intraoperative findings, cyst size, comorbidities, and co-surgeries. Visual Analogue Pain Scale and Rauschning's symptomatic knee criteria were collected prospectively to assess functional outcomes. RESULTS: Twenty-two legs in 21 patients were included in the study [males: 12 (57%); females: 9 (43%); age: 48.23 ± 11.74 years; BMI: 26.7 ± 4.54 kg/m2; follow-up: 4.55 ± 3.01 years]. Average cyst size was 4.16 ± 1.64 cm and were all located in the posteromedial aspect of the leg. All 22 cases had associated intra-articular pathology based on MRI, physical examination, and arthroscopy. Complications after cyst excision included: paresthesia in the distribution of the saphenous nerve (3/22, 14%), keloid formation (1/22, 4%), joint effusion requiring aspiration (1/22, 4%), and one recurrence requiring cystectomy 10 years later (4%). All incidences of paresthesia resolved. Mean visual analog pain score decreased by 6 points (p < 0.001) and Rauschning and Lindgren score decreased by two categories, from a 2.6 (category 2-3) preoperatively to 0.6 (category 0-1) postoperatively (p < 0.001). CONCLUSION: Mini-open popliteal cyst excision is a safe and effective technique for refractory popliteal cysts in patients who desire a decrease in pain, an increase range of motion, and improved function in knee flexion and extension. Further studies are needed to evaluate the clinical outcomes of patients over a longer duration as our one patient with a 10-year follow-up required a repeat procedure.


Assuntos
Dissecação , Articulação do Joelho , Procedimentos Cirúrgicos Minimamente Invasivos , Cisto Popliteal , Complicações Pós-Operatórias , Artroscopia/estatística & dados numéricos , Dissecação/efeitos adversos , Dissecação/métodos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cisto Popliteal/diagnóstico , Cisto Popliteal/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
Eur. j. anat ; 23(5): 341-353, sept. 2019. ilus, graf, tab
Artigo em Inglês | IBECS | ID: ibc-183864

RESUMO

Coronary artery disease (CAD) is a major cause of death and disability in developed countries, and incidence of CAD is increasing annually in the underdeveloped world. Today, percutaneous coronary intervention plays a major role both in diagnosis and treatment of CAD. As a result, an understanding of the anatomy of the coronary artery system is vital cardiologists. Yet, studies are lacking that focus on Vietnamese hearts. The objective of this study was to examine the morphometric anatomical variation of the right coronary artery (RCA) in Vietnamese cadavers. The hearts from 125 cadavers were used in the study. In all hearts, the RCA originated from the right aortic sinus, had a right marginal branch, and gave rise to one to three right posterior ventricular (RPV) branches. In 96.8% of hearts, the posterior interventricular branch (PIV) originated from the RCA; in 3.2% from the left circumflex artery (LCX), and the mean diameter was 2.09 mm ± 0.62 mm. The RCA had a mean diameter and length of 4.21 mm ± 0.64 mm and 122.5 mm ± 17.8 mm, respectively, and terminated between the crux and left border (72%) and at the crux (14.4%). The origin of the sinoatrial node artery was 81.6% from the RCA, 16.8% from the LCX, and 1.6% from both the RCA and LCX. There were one to four right atrial branches observed across the hearts studied; a maximum of 32% (one branch) and a minimum of 12.8% (four branches). In 68.8% of hearts the conus artery originated from the RCA. In 8.8%, it arose from the right aortic sinus at the same site as the RCA, but in 22.4% away from this site of origin. The RCA gave rise to one to eight right anterior ventricular (RAV) branches (i.e., because they are at the anterior surface of the right ventricular); with the highest incidence of 3 branches in 37.6% of hearts. The RCA gave rise to one to seven left posterior ventricular branches; the majority of cases, 28.8% gave rise to 4 branches. The rare incidence of myocardial bridging in the right coronary system occurred in 7.2% of hearts, and each case involved the posterior interventricular branch. Anatomical variations of the RCA system can cause difficulties in imaging interpretation and interventional procedures. This study is the first to document these variations of the RCA system in Vietnamese hearts, contributing knowledge that is essential for physicians


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vasos Coronários/anatomia & histologia , Cadáver , Músculos Peitorais/anatomia & histologia , Nó Atrioventricular/anatomia & histologia , Nó Sinoatrial/anatomia & histologia , Dissecação/métodos , Doadores de Tecidos
20.
Cir. plást. ibero-latinoam ; 45(3): 295-306, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184404

RESUMO

Antecedentes y Objetivo. Entre las opciones para cobertura de defectos de piel en mano y especialmente para reconstrucción del pulgar, el colgajo de primera arteria metacarpiana dorsal (PAMD) que utiliza la piel del dorso de la falange proximal del índice es una técnica utilizada desde hace años y que brinda buenos resultados. Nuestro objetivo es actualizar este colgajo mediante una revisión crítica de la literatura al respecto ilustrada con disección en cadáver y su aplicación en varios casos clínicos de nuestra experiencia. Material y método. Revisamos los antecedentes históricos y la anatomía del colgajo y hacemos una descripción detallada de la técnica quirúrgica mediante disección en cadáver, aportando dibujos y fotografías, complementado con la descripción detallada de 4 casos clínicos exitosos. Resultados. Encontramos 21 artículos relevantes sobre el colgajo de PAMD complementados con 2 capítulos de libros de mano. En cuanto a la revisión anatómica en cadáver comprobamos que este colgajo tiene un eje vascular similar al descrito en la literatura y en relación al componente clínico, demostramos que es un colgajo reproducible y seguro. Conclusiones. Teniendo en cuenta las indicaciones precisas y un conocimiento claro de la técnica, el colgajo de PAMD es una alternativa versátil y segura para el tratamiento de defectos cutáneos en mano


Background and Objective. Among coverage options for skin defects on the hand and especially for reconstruction of the thumb, the flap of the first metacarpal dorsal artery that uses the skin of the back of the proximal phalanx of the index, is a well known technique providing good results. Our aim is to carry out an actualization of this flap with a critical review of the literature, illustrated with cadaver dissection, and its application in some clinical cases of our own experience. Methods. We conduct a review of the historical antecedents, the anatomy and a detailed description of the surgical technique by means of dissections in cadaver complemented with drawings and photos and the presentation of 4 successful clinical cases. Results. We found 21 relevant articles complemented with 2 chapters of hand books. Based on these, a detailed documentation of the history, anatomy and surgical technique of the first metacarpal dorsal artery flap was made. On the part of the anatomical revision in corpses it was found that this flap has a vascular axis similar to that described in the literature, and on the part of the clinical application, we demostrate that is a secure and reproducible flap. Conclusions. Taking into account the precise indications and a clear knowledge of the technique, the first metacarpal dorsal artery flap is a versatile and safe alternative for the management of skin defects in the hand


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Metacarpo/cirurgia , Retalhos Cirúrgicos/cirurgia , Artérias/cirurgia , Cadáver , Falanges dos Dedos da Mão/cirurgia , Dissecação/métodos , Tenossinovite/cirurgia
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