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The occipital artery (OA) typically originates from the external carotid artery (ECA). Variations of the ECA has been well described in the current literature, while the OA is a relatively stable vessel, and its variations are uncommon. In the current case report, an aberrant OA has been found coexisting with a linguofacial trunk (LFT) on the right hemineck of a 51-year-old male patient. The OA was identified originating from the cervical internal carotid artery (ICA) at the level of the second cervical vertebra (C2). On the ECA, the lingual and facial arteries were emanating in common, as LFT. The left hemineck of the patient was free of variations. The current coexistence of arterial variants has been reported only once previously; therefore, the current case corresponds to the second case in the English literature. The aberrant OA origin from the ICA has been estimated with a pooled prevalence of 0.37%, while the origin at the C2 level and from the anterior surface of the ICA corresponds to a very rare variation. Additionally, the LFT is one of the most common trunk that can be found on the ECA. Interventional radiologists and surgeons must be aware of common and uncommon variation to avoid iatrogenic lesion.
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Variação Anatômica , Artéria Carótida Interna , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Externa/anormalidades , Artéria Carótida Externa/diagnóstico por imagem , Angiografia por Tomografia ComputadorizadaRESUMO
PURPOSE: Ultrasound is becoming an essential tool for hand surgeons, but most of them are trained on the job, without any diploma or dedicated training. The aim of this study was to assess the ability of hand surgeons new to ultrasound to identify hand and wrist anatomical structures. METHODS: A monocentric study was conducted from January 2022 to April 2022. Ten residents and five attending hand surgeons, ultrasound novices, were involved in this study. The participants underwent two tests, wherein they were required to identify 17 anatomical structures using ultrasound, on the same subject. The second test was similar and carried out 2 to 6 weeks later by all participants. The number of structures successfully identified and if it was the case, the detection time per structure, were recorded. The correlations between participants age, years of surgical experience, surgical background (orthopedic or plastic) and the ability to perform immediately during the first test or to progress between the two tests were also assessed. RESULTS: The average number of structures identified during the first test (T1) was 14.1+/-2.1 (82.9%), versus 16.2+/-0.8 (95.3%) structures during the second test (T2) (p = 0.001). The mean detection time per structure was 53.4 +/- 18.9 s during T1 versus 27.7 +/- 7.2 s during T2 (p < 0.0001). A moderate negative correlation between the progression in the number of anatomical structures identified between the two tests and the years of surgical experience (ρ=-0.56; p = 0.029) was found. The other parameters were neither correlated with the ability to perform at the first test nor with the progression between the two tests. CONCLUSION: Hand surgeons new to ultrasound are most of the time able to identify hand and wrist anatomical structures. Comparison of their first and second tests showed significant potential for improvement in anatomical structure identification and detection time of those, especially in surgeons with limited surgical experience.
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Mãos , Ultrassonografia , Punho , Humanos , Mãos/anatomia & histologia , Mãos/diagnóstico por imagem , Punho/diagnóstico por imagem , Punho/anatomia & histologia , Masculino , Feminino , Adulto , Competência Clínica , Cirurgiões , Pessoa de Meia-Idade , Internato e ResidênciaRESUMO
PURPOSE: The current systematic review with meta-analysis aimed to investigate the pooled prevalence of the superior thyroid artery (STA) pattern of origin (distinct or fused-common origin with adjacent arteries in the form of a common trunk). The standard and uncommon variants were also studied, considering the STA's exact surface of origin and the relationship with the upper border of the thyroid cartilage (TC, reference point), considering the laterality effect. Thus, the STA topographical anatomy was considered. METHODS: An evidence-based systematic review with meta-analysis was performed according to the PRISMA 2020 guidelines. A literature search was conducted in four online databases using specific keywords, the pooled prevalence was calculated using statistical analysis in the R programming language, and multiple subgroup analyses were performed. RESULTS: The most common distinct origin of the STA was from the external carotid artery (ECA) (56.94% pooled prevalence, 95%CI: 50.89-62.89), and the rarest one was from the internal carotid artery (ICA) (< 0.01%, 95%CI: 0.00-0.00). Common trunks were also investigated, with the thyrolingual trunk emanating from the ECA estimated at 0.61% (95%CI: 0.21-1.14), representing the most common. Subgroup analysis based on the nationality, type of study, and sample size, as well as a comparison between left and right sides and males and females, were investigated. CONCLUSIONS: The most common STA origin was estimated as the ECA, the medial surface of origin, and above the TC upper border. Adequate knowledge of STA origin is paramount for surgeons, especially during thyroidectomy, not to cause iatrogenic injury to the external branch of the superior laryngeal nerve.
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Variação Anatômica , Glândula Tireoide , Humanos , Glândula Tireoide/irrigação sanguínea , Artéria Carótida Externa/anatomia & histologia , Artéria Carótida Externa/anormalidades , Artéria Carótida Interna/anatomia & histologia , Artéria Carótida Interna/anormalidadesRESUMO
INTRODUCTION: In lateral ankle instability, anatomical ligament reconstructions are generally performed using arthroscopy. The ligament graft is passed through the talar, fibular and calcaneal tunnels, reconstructing the anterior talofibular and calcaneofibular (CFL) bundles. However, the calcaneal insertion of the CFL needs to be performed in an extra-articular fashion, and cannot be carried out under arthroscopy, thus requiring specific anatomical landmarks. For obtaining these landmarks, methods based on radiography or surface anatomy have already been described but can only offer an approximate identification of the actual CFL anatomical insertion point. In contrast, an ultrasound technique allows direct visualization of the insertion point and of the sural nerve that may be injured during surgery. Our study aimed to assess the reliability and accuracy of ultrasound visualization when performing calcaneal insertion of the CFL with specific monitoring of the sural nerve. MATERIALS AND METHODS: Our anatomical study was carried out on 15 ankles available from a body donation program. Ultrasound identification of the sural nerve was obtained first with injection of dye. A needle was positioned at the level of the calcaneal insertion of the CFL. After dissection, in all the ankles, the dye was in contact with the sural nerve and the needle was located in the calcaneal insertion area of the CFL. The mean distance between the sural nerve and the needle was 4.8 mm (range 3-7 mm). DISCUSSION AND CONCLUSION: A pre- or intra-operative ultrasound technique is a simple and reliable means for obtaining anatomical landmarks when drilling the calcaneal tunnel for ligament reconstruction of the lateral plane of the ankle. This tunnel should preferably be drilled obliquely from the heel towards the subtalar joint (1 h-3 h direction on an ultrasound cross section), which preserves a maximum distance from the sural nerve for safety purposes, while allowing an accurate anatomical positioning of the osseous tunnel.
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Calcâneo , Instabilidade Articular , Ligamentos Laterais do Tornozelo , Procedimentos de Cirurgia Plástica , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos Laterais do Tornozelo/anatomia & histologia , Reprodutibilidade dos Testes , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/anatomia & histologia , Calcâneo/diagnóstico por imagem , Calcâneo/cirurgia , Instabilidade Articular/cirurgia , CadáverRESUMO
PURPOSE: To estimate the prevalence of the sphenoidal emissary foramina (SEF), and the effect of possible moderators on it. METHODS: A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated. Outlier and influential analyses were performed. The presence of small-study effect and publication bias were evaluated. Moderator analyses were executed to investigate the effect of the specimens' continent of origin, type of study (dried skull or imaging), probing for the evaluation of SEF patency (conduction and instruments used), side dominance (bilateral or unilateral), morphometric data [SEF diameter, distances SEF-Foramen ovale (FO) and SEF-Foramen spinosum (FS)], and the methodology used for the morphometric measurements (caliper, DICOM Viewer, and image analysis software) on the estimated prevalence. RESULTS: In total, 6,460 subjects from 26 studies were included in the meta-analysis. The overall SEF prevalence was estimated as 38.1%. The heterogeneity was high and statistically significant. No indications of publication bias and small-study effect were identified. The conducted subgroup analyses did not yield statistically significant differences in the SEF prevalence between groups, except of the type of side dominance. Both results of the univariable and multivariable regression analyses showed the association of the unilateral dominance with a decrease in the reported SEF prevalence. CONCLUSION: The identification of more unilateral than bilateral foramina in a given cohort is associated with a decrease in the reported crude SEF prevalence. Laterality-specific estimates should be established for a precisive estimation of the emissary foramina prevalence.
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Forame Oval , Osso Esfenoide , Humanos , Cabeça , Prevalência , Exame FísicoRESUMO
We present a rare case of ossification of the falx cerebri in a 25-year-old man, discovered incidentally on a craniofacial computed tomodensitometry (CT) scanner. This ossification presented a true cortico-medullary differentiation and pushed aside the right frontal lobe. There was no associated clinical manifestation.
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Dura-Máter , Osteogênese , Masculino , Humanos , Adulto , Lobo FrontalRESUMO
PURPOSE: Several reports have suggested that transverse arches between the radial and ulnar sides of dorsal hand skin supply the proximal part of the skin. The main objective of the study was to provide an anatomical and radiological description of a superficial vascular arch in the proximal third of the metacarpals of the long fingers. METHODS: We dissected 11 hands after injection with a mixture of lead and resin. A CT scan was performed before dissection. All vessels supplying the skin were individualized on the back of the hand and measured. RESULTS: A superficial perforating dorsal arch of the hand was present in all cases in this study. It was supplied by a dorsal radial perforating artery arising from the radial artery and by a dorsal ulnar perforating artery arising from the dorsal carpal arch. The distal recurrences of the intermetacarpal spaces communicated with this arch. This arch was the only source of vascularization of thess proximal third of the third space and presented a dominant ulnar side in the majority of cases. It presented numerous anatomical variations. The source vessels had mean diameters of 0.5 mm. There was an excellent radiological-anatomical correlation on CT scan. CONCLUSION: Given the constancy of this arch in the study, perforating flaps not yet described could be considered, having as pivot points the ulnar or radial origin of this arch.
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Mãos , Ossos Metacarpais , Humanos , Mãos/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Pele/irrigação sanguínea , Artéria Ulnar/diagnóstico por imagemRESUMO
PURPOSE: A recent study published in the JMIR Med Educ Journal explored the potential impact of the Generative Pre-Train (ChatGPT), a generative language model, on medical education, research, and practice. In the present study, an interview with ChatGPT was conducted to determine its capabilities and potential for use in anatomy education (AE) and anatomy research (AR). METHODS: The study involved 18 questions asked of ChatGPT after obtaining an online subscription to the 4th edition. The questions were randomly selected and evaluated based on accuracy, relevance, and comprehensiveness. RESULTS: The ChatGPT provided accurate and well-structured anatomical descriptions, including clinical relevance and relationships between structures. The chatbot also offered concise summaries of chapters and helpful advice on anatomical terminology, even with complex terms. However, when it came to anatomical variants and their clinical significance, the chatbot's replies were inadequate unless variants were systematically classified into types. ChatGPT-4 generated multiple-choice quizzes and matching questions of varying difficulty levels, as well as summaries of articles when presented with text. However, the chatbot recognized its limitations in terms of accuracy, as did the authors of the current study. CONCLUSION: ChatGPT-4 can be a valuable interactive educational tool for students in the field of anatomy, encouraging engagement and further questions. However, it cannot replace the critical role of educators and should be used as a complementary tool. Future research should establish guidelines for ChatGPT's optimal use and application in medical education.
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PURPOSE: Exhaustive literature is available on the metacarpophalangeal joints of the long fingers, but the dorsal ligamentous structure overlaying the interosseous muscles and joining the metacarpal heads of the long fingers remains to be fully characterized. Previously, our surgical hand team observed a non-classically reported structure connecting the metacarpal heads of the long fingers, in the dorsal part of the intermetacarpal spaces. Therefore, the aim of this anatomical study was to characterize this ligamentous structure in terms of size, insertions, and anatomical position. METHODS: Twenty-five hands were dissected for a total of 75 long finger intermetacarpal spaces. A ligamentous structure was exposed after cellular tissue excision and dorsal superficial fascia opening. The length and thickness were measured and anatomical position and insertions were studied. Histological analysis was performed on five specimens and ultrasound analysis in one healthy subject. RESULTS: All 25 dissections revealed a dorsal ligamentous structure, hereafter named distal dorsal intermetacarpal ligament, which was inserted in the lateral tubercle of each adjacent long finger metacarpal head. This distal dorsal intermetacarpal ligament surrounded interosseous tendons. It was more proximal compared to oblique and transversal interosseous muscle fibers. Histological analysis confirmed the ligamentous nature of the structure. Ultrasound analysis showed that this structure was well identified under the dorsal aspect of the hand. CONCLUSION: All dissections revealed a tense ligamentous structure between each metacarpal head of the long fingers. This was a constant structure meeting the definition of a ligament. The distal dorsal intermetacarpal ligament seems to stabilize the metacarpal heads at the second and fourth spaces by limiting hyperabduction.
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Mãos , Ossos Metacarpais , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ossos Metacarpais/diagnóstico por imagem , TendõesRESUMO
Human cadaveric donors are essential for research in the anatomical sciences. However, many research papers in the anatomical sciences often omit a statement regarding the ethical use of the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To rectify this issue, 22 editors-in-chief of anatomical journals, representing 17 different countries, developed standardized and simplified language that can be used by authors of studies that use human cadaveric tissues. The goal of these editor recommendations is to standardize the writing approach by which the ethical use of cadaveric donors is acknowledged in anatomical studies that use donor human cadavers. Such sections in anatomical papers will help elevate our discipline and promote standardized language use in others non anatomy journals and also other media outlets that use cadaveric tissues.
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Anatomia , Doadores de Tecidos , Cadáver , HumanosRESUMO
PURPOSE: To describe the management of the discovery of a retropharyngeal carotid artery in the context of a cervical dislocation. DESCRIPTION OF THE CASE: A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast-enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular variation and an anterior C5-C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis. DISCUSSION/CONCLUSION: Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.
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Fratura-Luxação , Fraturas da Coluna Vertebral , Fusão Vertebral , Idoso , Artérias Carótidas , Artéria Carótida Primitiva , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodosRESUMO
PURPOSE: To estimate the prevalence of the left-sided aortic arch (LSAA) variants, and the effect of possible moderators on variants' detection. METHODS: A systematic online literature search was conducted. The pooled prevalence with 95% confidence intervals was estimated for the typical and atypical branching patterns to compare the overall proportions of different variants. Meta-regression analyses were performed to investigate the effect of the subjects' gender and geographical region, and the multidetector computed tomography (MDCT) scanner's technology on the estimated prevalence. RESULTS: In total, 18,075 cases from 23 imaging studies were included and 33 different LSAA variants were detected. The estimated heterogeneity was statistically significant. Based on the estimated prevalence, approximately 77% of the population is expected to have the typical branching anatomy with sequence brachiocephalic trunk-left common carotid artery-left subclavian artery, and 23% variant branching patterns. Approximately 71%, 23%, 2%, and 0.1% of the atypical populations are expected to have two, four, three, and five emerging branches, respectively. The meta-regression analyses showed that the number of detector rows of the MDCT scanner, and the subjects' geographical region are statistically significant moderators of the estimated prevalence. CONCLUSION: The current findings indicate that the prevalence of the LSAA variant branching anatomy is significantly affected by the subjects' geographical region and the MDCT scanner's technological improvement, with the advanced scanners to facilitate the detection of the aortic arch variants. However, due to the heterogeneity among studies, further research is required.
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Aorta Torácica , Artéria Subclávia , Aorta Torácica/anatomia & histologia , Aorta Torácica/diagnóstico por imagem , Tronco Braquiocefálico , Artéria Carótida Primitiva , Humanos , PrevalênciaRESUMO
INTRODUCTION: Morton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound-guided technique for DTML-release in a cadaver model. MATERIALS, METHODS, AND RESULTS: The DTML was visualized in 10 fresh frozen donated body to science-feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound-guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection. CONCLUSIONS: The results of this study indicate that our novel approach of an ultrasound-guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.
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Pontos de Referência Anatômicos , Ligamentos Articulares/cirurgia , Ossos do Metatarso/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ultrassonografia de Intervenção/métodos , Cadáver , Feminino , Humanos , MasculinoRESUMO
Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.
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Anatomia/educação , Cadáver , Publicações Periódicas como Assunto , Obtenção de Tecidos e Órgãos , Pesquisa Biomédica , Dissecação , HumanosRESUMO
INTRODUCTION: Our goal was to study the influence of the author's compliance with the Instructions for Authors for a submitted manuscript to a journal, on the final outcome of the submission. MATERIAL AND METHODS: 1200 consecutive submissions to the journal Surgical and Radiologic Anatomy have been evaluated and divided into four groups: A: Accepted, R: Rejected, I + : Instructions for Authors followed, I - : Instructions for Authors not followed. The quantity of manuscripts in the groups was measured and compared through statistical tests. We tried to determine if a specific category of authors was more likely to incorrectly follow the Instructions for Authors by verifying the lists of authors and the tables of contributions of co-authors. 322 (26.83%) manuscripts were accepted, 248 were I + , 74 were I - ; 878 (73.16%) were rejected, 526 were I + ; 352 were I - . RESULTS: The comparisons of the observed values and percentages showed significant differences between the groups. We could not identify a specific type of author associated with non-compliance with the Instructions for Authors. CONCLUSION: Most of the guidelines that have been published concern the preparation of the scientific contents of the manuscript (How to write), but the submission process (How to submit) has rarely been explained. We suggest including the rules of submitting a manuscript in graduate and post-graduate medical education.
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Guias como Assunto , Editoração/normas , Anatomia/educação , Educação Médica/métodos , Humanos , Radiologia , Especialidades Cirúrgicas/métodosRESUMO
INTRODUCTION: The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability. MATERIAL AND METHODS: One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined. RESULTS: Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished. CONCLUSION: An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM. WHAT IS KNOWN ABOUT THIS SUBJECT "AND" WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.
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Variação Anatômica , Anatomia Regional/classificação , Processo Coracoide/anatomia & histologia , Úmero/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Selective percutaneous tenotomy of the flexor digitorum longus (FDL) is a treatment for claw toes that gives astonishingly good functional results despite tendon sacrifice. However, the involution of the FDL tendon stump after tenotomy is unknown. The aim of our study was to assess the involution of the tendon stump after selective percutaneous tenotomy of the FDL. METHODS: The study included two parts. In the clinical part, an ultrasound analysis of 15 FDL tenotomies in 7 patients was carried out 3 months post-surgery. In the anatomic part, the feet of 10 bodies donated to science were dissected and examined anatomically. RESULTS: The proximal stump of the FDL was located near the base of the proximal phalanx and moved synchronously with the flexor digitorum brevis (FDB).Separating the FDB and FDL revealed a large tissue connection between the plantar surface of the tendinous chiasm of the FDB and the dorsal part of the FDL. These connections had significant resistance ranging from 2 to 9 Newtons depending on the toe. Tenotomy of the FDL followed by proximal traction of it led to retraction of the stump up to the base of the proximal phalanx and transfer of its action to the FDB by tensioning the intertendinous structure. Histologically, these structures were mostly comprised of tendon connective tissue. Their vascular component was small. CONCLUSION: The presence of this intertendinous connection leads, in the case of isolated tenotomy of the FDL, to equivalent transfer of the latter to the FDB.
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Síndrome do Dedo do Pé em Martelo/cirurgia , Músculo Esquelético/anatomia & histologia , Transferência Tendinosa/métodos , Tendões/anatomia & histologia , Tenotomia/métodos , Cadáver , Humanos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/cirurgia , Tendões/diagnóstico por imagem , Tendões/cirurgia , Dedos do Pé/anatomia & histologia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , UltrassonografiaRESUMO
The coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. Both the proximal and distal attachment of the CBM, as well as its relationship with the musculocutaneus nerve demonstrate morphological variability, some of which can lead to many diseases. The present case study presents a new description of a complex origin type (four-headed CBM), as well as the fusion of both the short biceps brachii head, brachialis muscle and medial head of the triceps brachii. In addition, the first and second heads formed a tunnel for the musculocutaneus and median nerves. This case report has clear clinical value due to the split mature of the coracoid process, and is a significant indicator of the development of interest in this overlooked muscle.
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Variação Anatômica , Processo Coracoide/anormalidades , Músculo Esquelético/anormalidades , Cadáver , Processo Coracoide/inervação , Feminino , Humanos , Nervo Mediano/anatomia & histologia , Pessoa de Meia-Idade , Nervo Musculocutâneo/anatomia & histologiaRESUMO
BACKGROUND: The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the "GIAR"- technique: the gastrocnemius-intramuscular aponeurosis release. METHODS AND RESULTS: An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6 years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2 mm (± 1 mm). The mean gain at the ankle joint ROM after the GIAR was 7.9° (± 1.1°). No damages of important anatomical structures could be found. CONCLUSION: Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.
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Aponeurose/cirurgia , Músculo Esquelético/cirurgia , Procedimentos Ortopédicos/métodos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Ultrassonografia de IntervençãoRESUMO
Two "surgeons-anatomists" Rapp in Montpellier and Couinaud in Paris at the same period (1953) given precise anatomy useful for the hepatic surgery and to the tremendous upheavals of radiological investigations. Actually, the fundamental anatomy of liver is classic with 8 segments with autonomous territories having a vascular afferent pedicle and a venous and biliary efferent drainage. These autonomous territories supported the surgical approach of the liver with the possibility of resecting a hepatic territory in a carcinological perspective well saving quite vascularized parenchyma. It will be in the future history about liver morphology to specify the contribution of these two "surgeons-anatomists". Actually it will be possible to look in the "Conservatory of Anatomy" in Montpellier these original livers corrosions.