Assessment of the orbit morphometry on West Anatolian dry skulls.

The orbit is very frequently damaged by traumas which result in not only bone deficits, but also functional deformities if reconstruction is not appropriate. Anatomical exposure of the bony orbit is of importance for both anatomists and surgeons who perform operation on this area. The current study evaluated the group of morphometrical parameters on 74 adult West Anatolian dry skulls and stereological surface area on the dry skull orbits while describing the clinical importance. Surface areas on the orbital base of the skulls were also evaluated using stereological method, bilaterally. Anthropological assessment of orbital base (in terms of width and height) revealed no significant difference between right and left sides. Both width and height of the optic foramen were significantly higher on the right side compared to left. The distances between the margins (medial, lateral, superior, inferior) of the orbital base and the optic foramen were longer on the right side compared to left, except the distances between the lateral margins. There was no significant difference among the subjects between right and left sides with respect to the orbital base in terms of stereological area calculation. The results are significant because there are no recorded anatomical data on West Anatolian skulls at previous researches. (Folia Morphol 2018; 77, 1: 105-109).

Vascular anatomical features of the medial thigh flap in human cadavers of Caucasian origin.

BACKGROUND: Medial fasciocutaneous flaps, which are based on the femoral artery from the thigh region, are used for wide inguinal, scrotal, vaginal, perineal, leg, head and neck defect reconstructions in injured human patients. Within this regard, anatomical knowledge about perforating and cutaneous branches of the femoral artery is important for the surgeons. MATERIALS AND METHODS: In the present study, vascular pedicles of the medial thigh perforator flap based on the femoral artery were investigated according to anatomical and surgical landmarks. Human Caucasian preserved cadavers of 15 adults (13 males, 2 females; age range 55-82 years: 30 sides, bilaterally) that were previously formalin fixed were subjected to our analytical examinations. Micro dissections were performed under 4× loop magnification while representing the perforating branches of the femoral artery after filling by coloured latex injection via the external iliac artery. RESULTS: The size and length parameters of these branches which appeared around the apex of the femoral triangle were evaluated. The mean size of the perforating branch at the point of origin was 0.14 cm and the mean size of the cutaneous branch at the point of origin was 0.09 cm, the mean length of the pedicle was 4.74 cm and the mean length of the cutaneous branch was 3.30 cm, respectively. Location of the perforating and the cutaneous branches were also determined according to the surgical landmarks such as the anterior superior iliac spine, inguinal ligament, pubic tubercle and interepicondylar line. CONCLUSIONS: The pedicle of the medial flap should locate up to 25 cm from the anterior superior iliac spine so as to preserve the vascular structures. Exact location of this artery helps the surgeons to perform anastomosis in an easier and safer manner during surgical operations.

Suprascapular foramen: a rare variation caused by ossified suprascapular ligaments.

BACKGROUND: The aim of this study was to investigate the incidence of the suprascapular foramen in West Anatolian population. MATERIALS AND METHODS: Eighty-one dried human scapulae of West Anatolian people of unknown ages and gender belonging to the Anatomy Department Laboratory of Dokuz Eylul University Medical School were examined macroscopically. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments were measured with calliper in millimetres and digital calliper, respectively. RESULTS: We observed the suprascapular foramen due to ossification of the suprascapular ligament only in 2 of 81 (2.47%) scapulae. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments (No. 1 and No. 2) were measured as 8.0 mm vs. 4.0 mm, 3.6 mm vs. 2.0 mm and 4.0 mm vs. 1.4 mm, respectively. CONCLUSIONS: The suprascapular foramen caused by ossified suprascapular ligament is rarely observed variation in West Anatolian population.

Anatomy of the anteromedial thigh flap based on the oblique branch of the descending branch of the lateral circumflex femoral artery.

Anteromedial thigh (AMT) flaps based on lateral circumflex femoral artery (LCFA) have characteristics which make them favourable for use in reconstruction of extensive thigh, head, neck and leg defects. AMT flap which is elevated on the artery has the advantages of low donor site morbidity and preservation of main arteries. Due to inconstant anatomy of the pedicle, the flap is mostly not preferable. Hence, we aimed to describe the anatomical features of the unnamed branch of the descending branch of the LCFA harvesting AMT flap. For this purpose, the external iliac artery was displayed bilaterally on 15 adult (13 males and 2 females; age range 55-82 years) preserved cadavers using latex injection. The perforator branch of the descending branch from the LCFA was microdissected under 4× loupe magnification. The perforator branch was located 28.53 (20.20-34.20) cm distal to the anterior superior iliac spine, 22.12 (13.40-28.00) cm distal to the pubic tubercle, and 13.20 (10.80-16.20) cm proximal to the interepicondylar line. At the level of origin point the mean diameter of the perforating branch was 0.17 cm and the mean diameter of its cutaneous branch was 0.14 cm. The mean length of the pedicle was 5.71 (3.70-9.00) cm. We conclude that our findings contribute to the literature in terms of anatomical knowledge for surgical safety.

The arterial anatomy of the saphenous flap: a cadaveric study.

The saphenous flap is a fasciocutaneous flap generally used for knee and upper third of the leg coverage. Due to various descriptions of the saphenous flap, such as venous, sensory, and free flap, the origin and distributing characteristics of the saphenous artery are important for plastic surgeons. The aim of this cadaveric study was to evaluate the anatomical features of the saphenous flap. The pedicles of the saphenous flap were dissected under 4 x loop magnification in thirty-two legs of 16 formalin-fixed adult cadavers. The findings of this anatomic study were as follows: Descending genicular artery originated from the femoral artery in all of the cases. The first musculoarticular branch, which arose from descending genicular, to the vastus medialis muscle existed in all dissections. The second branch was the saphenous artery which separately originated from the descending genicular artery in all of the cases. At the level of origin the mean diameter of the saphenous artery was found to be 1.61 mm. The muscular branches to the anterior or posterior sides of the sartorious muscle existed in all of the dissections. Two vena comitantes and a saphenous nerve were accompanying the saphenous artery in all cadavers. The mean distance between the origin of the artery and interepicondylar line of tibia was 115 mm. The muscular branches of the saphenous artery to the gracilis muscle were encountered 6.66% of the cases. The cutaneous branches numbered between one and four, and arose 3.5 to 9.5 cm from the site of origin of the saphenous artery. The distal end of the saphenous artery reached approximately 122 mm distally to the knee joint in all cases. Due to variations of the arterial anatomy and limited number of anatomic studies of the saphenous flap, we studied the topography and anatomy of the saphenous artery for increasing reliability of the saphenous flap.

Medial circumflex femoral artery with different origin and course: a case report and review of the literature.

The femoral artery (FA) and its branches play important roles in the arterial supply of the lower extremity. If the femoral artery is occluded, the circulation of the extremity is maintained by certain anastomoses. Therefore, identification of variations of these arteries is critical from a clinical and surgical point of view. During routine anatomical dissections for student education at the Department of Anatomy of the School of Medicine at Ondokuz Mayls University, a variation of the medial circumflex femoral artery (MCFA) was observed and photographed in a male, formalin-fixed cadaver aged 55 years. In this case, MCFA branched off from the posterolateral aspect of the FA, 32 mm distal to the inguinal ligament. A frequency rate of 17-26% has been reported regarding this variation. However, MCFA emerging from the postero-lateral aspect of the FA and its course, as in this case, is not that frequent. Knowledge of anomalies in the emergence and course of the arteries that join the cruciate anastomosis and are important in the arterial supply of the head and neck of the femur appear to be a critical component that requires caution during surgical interventions towards this region.

Surgical anatomy of the deep lateral orbital wall.

PURPOSE: To determine the exact anatomic location and volume of the thickest section of the greater wing of the sphenoid bone (trigone), which is removed during deep lateral orbital wall decompression. METHODS: Eighteen dried skulls were used to determine the exact anatomic location and computed tomography (CT) images of 20 patients (10 male, 10 female) were used for volumetric calculations. RESULTS: Mean values were 14.5 mm for the orbital rim to inferior orbital fissure distance, 23.3 mm for rim to trigone distance, 13.0 mm for width of the trigone base, 5.8 mm for trigone to orbital apex distance, and 12.3 mm for trigone height. The width of the narrowest section of the trigone was 5.2 mm. The trigone was found to have a lower segment (0.92 cc) neighboring the inferior orbital fissure, and an upper segment (0.32 cc) adjoining the thick substance of frontal bone. The narrowest part between these two segments was located just at the superior border of the lateral rectus muscle. CONCLUSIONS: The authors recommend avoiding the thin rectangular portion located in the inter-fissural area adjacent to the superior orbital fissure. A high intersubject variability underscores the need for individualized preoperative analysis by imaging studies.

Absence of the musculocutaneous nerve together with unusual innervation of the median nerve.

During routine anatomical dissections, absence of the musculocutaneous nerve was determined in a 58-year-old male cadaver. Moreover, the biceps brachii and brachialis muscles were innervated by two separate branches which divided from the median nerve instead of the musculocutaneous nerve. From a branch that divides from the main trunk of the median nerve at nearly the middle of the arm a motor branch again divided that innervated the brachialis muscle and a sensory branch that conveyed the sense of the lateral part of the forearm. Furthermore, it was found that the brachial artery divided into its terminal branches, the radial and ulnar arteries. We believe that this rare variation of the median nerve will shed light upon surgical procedures involving the median nerve.

Anatomy of deltoid flap based on posterior subcutaneous deltoid artery: a cadaveric investigation / Anatomía del colgajo deltoideo basado en la arteria subcutánea deltoidea posterior: una investigación en cadáver

The purpose of the study is to evaluate neurovascular anatomy of the deltoid flap based on the posterior subcutaneous deltoid artery (PSDA). Bilateral axillary artery dissections of the thirty-four shoulders of 17 formalin-fixed cadavers were performed (15 male, 2 female; age range 40 to 82 years) under the 4x loupe magnification. During the dissection of each region, the PSDA was evaluated with respect to the origin, the branches, course and anatomical relations with neighbouring structures. The PSDA was present in all cases. The PSDA was single in 26 (76.5%) cases, double in 2 (5.9%) cases and had early bifurcation in 6 (17.6%) cases. The mean length of the lateral cutaneous brachial nerve was 6.0 mm range from 49.0 mm to 83.9 mm. The mean distance between the piercing point of the PSDA and the acromion was 74.2 mm range from 51.0 mm to 96.3 mm. The pedicle bifurcated before reaching the superficial fascia in 6 cases (17.6%). An anatomic study of the posterior subcutaneous deltoid artery achieves reliable quantitative anatomic data and would be very helpful for utilizing deltoid flap. The quantitative and detailed anatomic information provided from the study may be of guidance to surgeons for safe operating period.

El objetivo del presente estudio fue evaluar la anatomía neurovascular del colgajo deltoideo basado en la arteria subcutánea deltoidea posterior (ASDP). Se realizaron disecciones axilares bilaterales de 34 hombros de 17 cadáveres (15 hombres y 2 mujeres con un rango etareo entre 40-82 años) fijados en formalina con ampliación mediante una lupa 4X. Durante la disección de cada región, la ASDP fue evaluada en relación con su origen, ramas, curso y relaciones anatómicas con estructuras vecinas. La ASDP estuvo presente en todos los casos. Observamos una ASDP en 26 casos (76,5%), dos en 2 casos (5,9%) y la bifurcación temprana en 6 casos (17,6%). La longitud media del nervio cutáneo braquial lateral fue de 6,0 mm (intervalo de 49,0-83,9 mm). La distancia media entre el punto de entrada y el acromion de la ASDP fue 74,2 mm (rango de 51,0-96,3 mm). La bifurcación del pedículo se presentó antes de llegar a la fascia superficial en 6 de los casos (17,6 %). El estudio anatómico de la parte posterior de la arteria deltoidea subcutánea entrega datos anatómicos, cuantitativos, fiables para la utilización del colgajo deltoideo. La información detallada y cuantitativa proporcionada en este estudio puede servir de orientación a los cirujanos para un abordaje y período quirúrgico seguro.