Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief.

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.

Cutaneous perforators of the arm and anatomical landmarks for defining the flap donor sites.

PURPOSE: There are few studies searching for possible perforator flap donor sites on the arm. This study aimed to identify the locations of cutaneous perforators of the arm according to anatomical landmarks. METHODS: Thirteen Thiel-fixed and latex-filled upper extremities of bodies donated to science were used. The distance between the acromion and medial or lateral epicondyle of the humerus was defined as the Y-axis, and the axis that cut the Y-axis perpendicularly through the epicondyles of the humerus was identified as the X-axis. The Y-axis was then divided into three parts Cutaneous arterial perforators were found using surgical dissection. The locations of the perforators were determined according to the defined lines and regions. RESULTS: On the lateral side, there were 6.00 ± 2.08 perforators per arm, of which 56.4% were septocutaneous and 43.6% muscular. In all extremities, with in the distal 1/3 of the lateral arm, there were 1-4 radial collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.16 ± 0.53 cm. On the medial side, there were 5.05 ± 1.44 perforators per arm, which were all septocutaneous perforators. In 85% of the extremities, within the middle 1/3 of the medial arms, there were 1-2 superior ulnar collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.53 ± 0.61 cm. CONCLUSION: There are always perforators from the radial collateral artery with in the distal third of the lateral arm. Within the middle third of the medial arm, it is usually possible to find a perforator from the superior ulnar collateral artery.

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors.

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.

Location of the infraorbital foramen with reference to soft tissue landmarks.

PURPOSE: The location of the infraorbital foramen and its variations are important during periorbital, dental, plastic, and oromaxillofacial surgeries. The aim of this study is to document the most practical anatomical soft tissue landmarks for defining the location of infraorbital foramen and infraorbital nerve for effective nerve blockade and to decrease its risk of injury during periorbital surgeries. METHODS: Forty sides from 20 adult fixed cadavers were used for this study. The position of the infraorbital nerve was determined in reference to the lateral edge of the ala of the nose, medial and lateral palpebral commissures. All these three soft tissue landmarks were then connected to each other forming a triangular shaped region. RESULTS: In 75 % of the cases the infraorbital foramen was located on the line which is connecting the lateral palpebral commissure to the ala of the nose. The closest distance of infraorbital foramen to the inferior orbital margin and to facial midline was also measured. The infraorbital foramen was located outside the previously defined triangular region in 20 % and inside the triangle in 5 %. The closest mean distance between the infraorbital foramen and the infraorbital margin was measured as 8.8 ± 1.0 mm and the distance between the medial wall of the infraorbital foramen and the facial midline was measured as 30.3 ± 2.7 mm. CONCLUSION: The triangular region and the soft tissue landmarks we offered in this study may facilitate prediction of the locations of the infraorbital foramen thus, the infraorbital nerve.

The subdiaphragmatic part of the phrenic nerve - morphometry and connections to autonomic ganglia.

Few anatomical textbooks offer much information concerning the anatomy and distribution of the phrenic nerve inferior to the diaphragm. The aim of this study was to identify the subdiaphragmatic distribution of the phrenic nerve, the presence of phrenic ganglia, and possible connections to the celiac plexus. One hundred and thirty formalin-fixed adult cadavers were studied. The right phrenic nerve was found inferior to the diaphragm in 98% with 49.1% displaying a right phrenic ganglion. In 22.8% there was an additional smaller ganglion (right accessory phrenic ganglion). The remaining 50.9% had no grossly identifiable right phrenic ganglion. Most (65.5% of specimens) exhibited plexiform communications with the celiac ganglion, aorticorenal ganglion, and suprarenal gland. The left phrenic nerve inferior to the diaphragm was observed in 60% of specimens with 19% containing a left phrenic ganglion. No accessory left phrenic ganglia were observed. The left phrenic ganglion exhibited plexiform communications to several ganglia in 71.4% of specimens. Histologically, the right phrenic and left phrenic ganglia contained large soma concentrated in their peripheries. Both phrenic nerves and ganglia were closely related to the diaphragmatic crura. Surgically, sutures to approximate the crura for repair of hiatal hernias must be placed above the ganglia in order to avoid iatrogenic injuries to the autonomic supply to the diaphragm and abdomen. These findings could also provide a better understanding of the anatomy and distribution of the fibers of that autonomic supply.

Insertional Characteristics of the Peroneus Tertius Tendon: Revisiting the Anatomy of an Underestimated Muscle.

The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the fifth metatarsal bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points.

The effect of the dimensions of the distal femur and proximal tibia joint surfaces on the development of knee osteoarthritis.

The aim of this study was to determine whether the dimensions of the distal femur and proximal tibia joint surfaces affect the etiology of knee osteoarthritis (OA). The study comprised the records of 1,324 patients who had been admitted to hospital with knee pain. Anterioposterior (AP) and lateral radiographs of the knee were taken. Using the Kellgren-Lawrence Scale, the patient group comprised Stages 2, 3, and 4 radiographs and the controls comprised Stages 0 and 1 radiographs. Four lengths were measured for each patient in both groups: femur mediolateral (femur ML), tibia mediolateral (tibia ML), femur anteroposterior (femur AP), and tibia anteroposterior (tibia AP). Osteophytes were not included in the measurements in the patient group. All the measurements were repeated by two researchers at two different times. The groups were compared in terms of these measurements and the correlations between them. The mean femur ML length was significantly greater in the patient group than the control group (P = 0.032) and the mean femur AP length was significantly less (P = 0.037). In addition, the difference between the femur ML and AP lengths was significantly high in the patient group (P < 0.001). The difference between the tibia and femur ML lengths was significantly high in the patient group (P < 0.001) and the difference between the tibia and femur AP lengths was higher in the control group (P = 0.001). A longer femur ML and a shorter femur AP, together with a greater difference between these two lengths and a greater difference between the tibia ML and femur ML lengths, could be a risk factor for developing knee OA. More extensive anatomical and biomechanical studies in the future will enable these results to be corroborated.

Medical students' attitudes towards science and gross anatomy, and the relationship to personality.

Assessment of the personalities of medical students can enable medical educators to formulate strategies for the best development of academic and clinical competencies. Previous research has shown that medical students do not share a common personality profile, there being gender differences. We have also shown that, for French medical students, students with personality traits associated with strong competitiveness are selected for admission to medical school. In this study, we further show that the medical students have different personality profiles compared with other student groups (psychology and business studies). The main purpose of the present investigation was to assess attitudes to science and gross anatomy, and to relate these to the students' personalities. Questionnaires (including Thurstone and Chave analyses) were employed to measure attitudes, and personality was assessed using the Big Five Inventory (BFI). Data for attitudes were obtained for students at medical schools in Cardiff (UK), Paris, Descartes/Sorbonne (France), St George's University (Grenada) and Ankara (Turkey). Data obtained from personality tests were available for analysis from the Parisian cohort of students. Although the medical students were found to have strongly supportive views concerning the importance of science in medicine, their knowledge of the scientific method/philosophy of science was poor. Following analyses of the BFI in the French students, 'openness' and 'conscientiousness' were linked statistically with a positive attitude towards science. For anatomy, again strongly supportive views concerning the subject's importance in medicine were discerned. Analyses of the BFI in the French students did not show links statistically between personality profiles and attitudes towards gross anatomy, except male students with 'negative affectivity' showed less appreciation of the importance of anatomy. This contrasts with our earlier studies that showed that there is a relationship between the BF dimensions of personality traits and anxiety towards the dissection room experience (at the start of the course, 'negative emotionality' was related to an increased level of anxiety). We conclude that medical students agree on the importance to their studies of both science in general and gross anatomy in particular, and that some personality traits relate to their attitudes that could affect clinical competence.

The fibular collateral ligament of the knee: a detailed review.

The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee.

The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears.

BACKGROUND: The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears. MATERIALS AND METHODS: A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured. RESULTS: The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r (2) = 0.208, p = 0.003) and without tear (n = 60) (r (2) = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear. CONCLUSION: The impact of femorotibial incongruence on the medial meniscus tear is important for the understanding of the lesions.

Impact of fibular torsion and rotation on chronic ankle instability.

BACKGROUND: The fibula is known not to involve in transmission of weight but known simply as an ankle stabilizer. However, its main function in stabilizing the ankle remains obscure. Since the fibula has an impact on torsion and rotation of the ankle, its effect on lateral ankle instability should be investigated. MATERIALS AND METHODS: Twenty patients with lateral ankle instability (Group 1) and 19 healthy volunteers (Group 2) were included in the study. The tibiofibular and talofibular relationships were evaluated using MRI images. Fibular torsion and rotation angles were calculated using a new method. Range of motion of the ankle joint was investigated while the knee was at flexion (90°) and extension (0°). The comparisons performed between the 2 groups and independent from the groups were statistically evaluated and, the p value of <0.05 was considered as statistically significant. RESULTS: A significant difference was found between the two groups for age (p<0.05). There were no statistically significant differences between the right and left sides for all measurements in the group 1 and 2 (p>0.05). There was a statistically significant difference between the two groups in dorsal flexion when the knee is at flexion (90°) and extension (0°) position. There was also a statistically significant difference between the two groups in plantar flexion which was measured while the knee was at extension (0°) position. No statistically significant difference was found between both groups in terms of fibular torsion and rotation. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, in patients with posteriorly localized fibula it was demonstrated that the fibular torsion and rotation was increased significantly. CONCLUSION: We did not detect any relationship between fibular torsion and rotation and ankle instability. However, independent from the groups when the patients were divided into 2 groups according to whether the fibula localized posteriorly or not, we realized that in patients with posteriorly localized fibula, fibular torsion and rotation significantly increased. This finding did not explain the cause of instability. However, it may gain significance with new further studies regarding ankle instability.

Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip.

The superior gluteal nerve (SGN) is vulnerable to damage during total hip arthroplasty and various pelvic surgeries. Recently introduced minimally invasive approaches to the hip show promise for less muscle trauma compared to conventional approaches. However, the risk of damaging the SGN has not been well documented for such alternative approaches. Therefore, we aimed to investigate the anatomic course of the SGN and to define anatomical landmarks that may be used by surgeons during minimally invasive approaches to the hip. Twenty-eight gluteal regions from 14 formalin-fixed cadavers were dissected and the course and the distances of the SGN and its branches to the tip of the greater trochanter (GT) were measured. The landmarks for standardizing the course of the SGN included the posterior inferior iliac spine (PIIS), GT, and a line (PIIS-GT) connecting these two points. The exit of the SGN was found to be at the medial one third of the PIIS-GT line and 5.4 cm from the GT. Two branching patterns were noted. The branches of the SGN were distributed lateral to the PIIS-GT line. On the basis of our study, the safe zone for the SGN was smaller than previously reported. Posterior, lateral, or anterolateral minimally invasive approaches to the hip should take into account the point of exit of the SGN and the area of distribution of its branches. A minimally invasive anterolateral approach may particularly compromise branches to the tensor fasciae latae muscle. Localization of the SGN and its branches using the anatomic landmarks defined in this study may decrease surgical morbidity.

Posteromedial Compartment Arthroscopy of the Knee and Resection of Osteophytes: An Anatomic Perspective on Posteromedial Knee Impingement.

Posteromedial knee pain is a common clinical problem. It is often accompanied by degenerative changes or tears in the posterior horn of the medial meniscus and/or pain during deep flexion of the knee. In more advanced cases, it is accompanied by the osteophytic formation of a cam lesion that develops gradually in the posterior of the medial condyle of the femur and, with it (or less frequently without it), an osteophytic lesion at the posterior of the tibia (i.e. pincer lesion) occurs. It is believed that resection of the cam lesion may delay the progression of knee osteoarthritis, similarly to repairing the posterior horn of the medial meniscus. In this technical note, we describe a 2-portal technique for resection of cam lesions by posteromedial knee arthroscopy using anatomic landmarks. Using both portals provides better visualization and a better approach.

The adductor minimus muscle revisited.

The adductor minimus muscle has had scant and conflicting reports regarding its anatomy with some authors ignoring its existence altogether. The present study was conducted to more precisely describe the anatomy of this muscle. Forty human cadavers underwent dissection of the posterior thigh for observation of the adductor minimus muscle. When identified, this muscle was measured and relationships to the muscle documented. Additionally, five fetuses were dissected to observe for the presence of the adductor minimus muscle. The adductor minimus muscle was found in roughly one half of our specimens and was seen in all fetal specimens. When absent, the quadratus femoris muscle was always more prominent and extended more inferiorly toward the territory of the adductor minimus muscle. The average maximal length, width and thickness for the adductor minimus muscle was 14.6 cm, 7 cm, and 2.25 mm, respectively. Such data may be of consequence to clinicians who rehabilitate posterior thigh musculature or surgeons who operate this region.

Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury.

The axillary nerve is invariably reported to be one of the most commonly injured nerves during surgical procedures of the shoulder, and the importance of protecting it cannot be overemphasized. Many researchers have tried to identify safe regions, but the results vary among published studies. The axillary nerve may also be injured during acute trauma to the shoulder or by chronic repeated trauma as has been described in the quadrilateral space syndrome. The nerve injury may occur together with shoulder dislocation and rotator cuff tear, thus comprising the so-called "unhappy triad" of the shoulder joint. Simple attention to potential variations in the origin and course of the axillary nerve and its relationship to the shoulder capsule and having a precise knowledge of "safe zones" during operations can enhance clinical outcomes. The objective of this review, therefore, is to discuss the surgical anatomy of the axillary nerve and further emphasize the clinical importance of the its injury following shoulder trauma.

Correlation between the lengths of the upper limb and cubital tunnel: potential use in patients with proximal ulnar nerve entrapment.

INTRODUCTION: We hypothesized that a correlation may exist between the length of the upper limb and the length of the cubital tunnel, which transmits the ulnar nerve from the arm to the forearm. If true, this association might aid in predicting individuals at greater risk of developing ulnar nerve compression at this site. MATERIALS AND METHODS: A total of 46 cadaveric upper limbs were dissected. The lengths of the upper limb and cubital tunnel were measured and analysis made of any correlation between these two distances. RESULTS: The average length of the cubital tunnel was found to be 2.7 cm (range 1.2-4.7 cm, SD 0.82), and the average length of the upper limb was 62.5 cm (range 51-72 cm, SD 4.33). No significant difference was found with either length of the tunnel between left and right sides or among genders. Neither the ratio of upper limb length to length of the cubital tunnel between genders nor the ratio between left and right sides was found to have a positive correlation. CONCLUSIONS: These data suggest that the cubital tunnel length maintains similar proportion to upper limb length among genders and sides and that a correlation between these two distances does not exist.

A novel approach for anterior sciatic nerve block: cadaveric feasibility study.

BACKGROUND: Sciatic nerve block is a commonly used technique for providing anesthesia and analgesia to the lower extremity. It is classically performed through posterior or lateral approaches. However, an anterior approach should be considered in certain conditions where patient positioning would be complicated. The success rate of the sciatic nerve block with previously defined approaches has been reported to be low, however, the complication rate with such approaches has been found to be high. Therefore, we aimed to conduct an anatomical study defining a new anterior approach to block the sciatic nerve and also to examine if the femoral nerve can be blocked via the same approach. METHODS: Initially, various landmarks and practical measurements were examined on 11 lower extremities. Eight of the lower extremities were used for defining the best approach to the sciatic nerve anteriorly. Once defined, Indian ink was injected into two cadaveric extremities with an anesthetic needle through such an approach. The route of the needle was evaluated via dissection and we observed whether the ink stained the sciatic nerve or injured regional neurovascular structures. The remaining extremity was cut axially to observe the route of the needle after injection. RESULTS: The ideal site of needle insertion was found to be 4-5 cm distal to the inguinal crease and 1-2 cm lateral to the femoral artery. On average, this point corresponded to a point located 8.0 ± 0.7 cm distal to a perpendicular line drawn midway through the straight line connecting the anterior superior iliac spine (ASIS) and the pubic tubercle (PT). The distance of this point to the straight line drawn between the ASIS and PT was approximately equal to half the distance of this line. CONCLUSION: The technique described herein appears anatomically safe with a lower risk of damage to major neurovascular structures. Additionally, the femoral nerve can be blocked simultaneously to obtain a larger area of anesthesia of the lower limb.

The clinical anatomy of the sinutubular junction.

Specific sites of atherosclerotic processes due to hemodynamic changes and resultant stress, including how these normal anatomical structures become problematic in certain individuals, have yet to be acknowledged. One of these areas of the cardiovascular system occurs at the sinutubular junction (SJ), causing altercation in an otherwise normal flow status. The anatomy of the SJ was examined in 100 adult human hearts during the gross anatomy course at St George's University, during the years 2006-2007. All hearts were examined in situ, using a General Electric model 3200S ultrasound machine with a 5 MHz linear probe. The aforementioned cadavers were also examined using a Stryker laparoscopic unit. Serial transverse histological sections were made through the SJ perpendicular to its axis, and stained with eosin-hematoxylin, van Gieson, Masson trichrome, and Orcein methods. In addition, an immunohistochemical analysis was performed for the detection of positive smooth muscle cells stained areas. During gross and endoscopic examination we were able to identify the SJ in all adult heart specimens. Neonatal and fetal hearts did not exhibit any gross evident SJ; however, a SJ was evident histologically. Ultrasonographically we were able to identify the SJ in all adult heart specimens examined, and a sinutubular ridge in 62%. A significant association was present between the thickness of the ridge and the age of the specimens. The SJ was found to exhibit atherosclerotic changes and plaque formation in an age-related manner. In older subjects, the SJ was marked with local calcification and hemorrhages. In contrast, the SJ of neonatal hearts appeared to have intimal thickening with focal fragmentation and absent or duplicate internal elastic lamina. Intuitively speaking, the presence of a sinutubular ridge, an inevitable fate in humans based on the results of this study, provides an irreversible atherosclerotic process as there is no evidence that the promoting ridge regresses. This is an alarming situation in those individuals who will eventually develop cardiovascular risk factors, whether through inevitable genetic manifestations or by means of exogenous environmental causes.

Anatomy of the lateral intermuscular septum of the arm and its relationships to the radial nerve and its proximal branches. Laboratory investigation.

OBJECT: Other than very simple descriptions of the existence of the lateral intermuscular septum (LIS), the literature offers almost nothing about its detailed anatomy, relationships to the radial nerve, and proximal branches. To further elucidate its morphological characteristics, the present cadaveric study was performed. METHODS: The lateral arm was bilaterally dissected from 25 adult fixed cadavers (50 sides). Specifically, a detailed evaluation of the LIS was made, and this structure's attachments and relationships to the radial nerve were analyzed and measured. RESULTS: In addition to the previously described muscles arising from the LIS, the authors identified the extensor carpi radialis brevis muscles as partially arising from this structure. The deep and posterior portion of the deltoid tendon was confluent with the superior aspect of the LIS. The mean thickness of the LIS was 1.0 mm. Distally, the LIS attached strongly to the lateral epicondyle of the humerus and became confluent with the annular ligament encircling the head of the radius. The distal attachment of the LIS was confluent with the capsule of the elbow joint. All radial nerves traveled through a defect (mean diameter 1 cm) in the LIS. With traction on the nerve from proximal and distal to this defect, there was free excursion. In 85% of the specimens, however, the posterior antebrachial cutaneous nerve traveled through a tunnel within the LIS and pierced the septum at a mean of 5 cm proximal to the lateral epicondyle. The lower lateral brachial cutaneous nerve proximally pierced the LIS near its origin, occurring a mean of 3.2 cm distal to the LIS's origin from the humerus. CONCLUSIONS: To the authors' knowledge, the details regarding the LIS and its relationships to the radial nerve have not been reported. Such information may be of use to surgeons who operate in this region, for example, during neural repair or entrapment procedures.