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PubMedDate not supplied

Modification of the Zitelli bilobed flap: a comparison of flap dynamics in human cadavers.

OBJECTIVE: To investigate the effects on overall flap dynamics of altering the length of the primary flap in the Zitelli bilobed flap procedure, because the standard Zitelli design can result in distortion of the alar margin after repair of cutaneous nasal alar defects. METHODS: Identical 1.5-cm circular cutaneous defects were made on the nasal alae and cheeks of 6 fresh human cadavers. A rectangle was inked around each cheek defect in a standardized fashion. A standard-design Zitelli bilobed flap was used to close the nasal and cheek defects on 1 side of each specimen (n = 6). The contralateral defect was closed with a modified design in which the primary flap was either 10% longer (n = 3) or 10% shorter (n = 3) than the standard primary flap as measured from the pivot point. Alar margin retraction and cheek defect distortion were measured from standardized photographs obtained before and after the repair. RESULTS: The long-flap design resulted in alar retraction that was 1.33 mm less in the nasal reconstructions (P = .02) and distal defect distortion that was 2.17 mm less in the cheek reconstructions (P = .01) compared with the standard Zitelli bilobed flap. The short-flap design caused more distortion than did the standard design for both types of defect. CONCLUSION: Lengthening the primary flap in the Zitelli bilobed flap design may reduce distal wound distortion and alar retraction in the closure of certain cutaneous defects.

Cadaver↗
PubMed1994

Hydration changes in cadaver eyes prepared for practice and experimental surgery.

OBJECTIVES: To identify reliable and efficient methods of thinning postmortem corneas for surgical experiments and to develop methods of maintaining stable corneal thickness. METHODS: Three methods of corneal thinning were evaluated by group: group A, increased intraocular pressure; group B, exchange of anterior chamber fluid with dextran solution and immersion in dextran solution; and group C, immersion in dextran solution without aqueous replacement. The stability of the thinned central cornea was then evaluated by exposing 30 corneas thinned by methods used in groups B and C to air, Balanced Salt Solution drops (Alcon, Fort Worth, Tex), or dextran solution drops. RESULTS: By 1 hour, the thinning method used in group A resulted in only three of 11 eyes achieving normal central corneal thickness. The method used in group B resulted in normal central thickness in 14 of 14 corneas and in group C, in nine of 15 corneas, at 1 hour. Once thinned by methods used in group B or C, air exposure further thinned the 30 additional corneas by 22% to 26%, Balanced Salt Solution drops thickened the corneas by 16% to 22%, and dextran solution drops stabilized the corneas with only 5% to 13% additional thinning. CONCLUSIONS: Hyperosmolar solutions were more efficient than pressure gradients in thinning the cadaver central cornea. Hydration shifts of the de-epithelialized cornea were dramatic with use of Balanced Salt Solution drops or drying and were minimized with use of hyperosmolar topical solutions.

Aged↗
PubMed1975

Pediatric cadaver kidneys. Their use in renal transplantation.

Of 350 consecutive cadaver kidney transplants, 32 kidneys from donors aged 1 day to 9 years were transplanted. Our results indicate that, with strict adherence to certain guidelines in kidney procurement and transplantion, pediatric kidneys are excellent donor graft material. In contrast to en bloc transplantation of both kidneys from pediatric donors, each donor can provide kidneys for two recipients. In addition, the transplantation of pediatric kidneys as single units is both simple and safe.

Adult↗
PubMed1976

Analysis of 75 discarded cadaver kidneys.

Of 431 cadaver kidneys available for transplantation, 75 were discarded after a period of pulsatile perfusion. Kidneys were discarded because of poor flow, multiple arteries with segmental obstruction, prolonged warm ischemia time, perfusion pump malfunction, and lack of donor cells for cross-matching, among other reasons. Certain selected variables common to transplantated kidneys and kidneys discarded have been analyzed. The most significant finding was that 70% of transplanted kidneys came from donors who had recieved pretreatment with either phenoxybenzamine hydrochloride, methylprednisolone sodium succinate, or phentolaminemesylate. Only 33.3% of kidneys discarded were taken from donors who had received such pretreatment (P less than .01). Attention is focused on the need for careful consideration of the technical aspects of donor nephrectomy as well as the need for donor pretreatment, in order to decrease the number of discarded kidneys.

Cadaver↗
PubMed1979

Race as a risk factor in cadaver kidney transplantation.

Recipients of 93 first-cadaver kidney transplants were studied for the effect of recipient and donor race on graft and patient survival. Both graft and patient survival were lower for black recipients than for whites. The difference was not explained by racial mismatch between donor and recipient. Black recipients had more rejection episodes and more instances of bacterial pneumonia. Pretransplant splenectomy reduced the likelihood of rejection episodes for black recipients and increased their rate of graft survival.

Adult↗
PubMed1980

En bloc excision for cadaver kidneys for transplantation.

A method for the excision of human cadaver kidneys for transplantation is described that features en bloc removal with preservation of all vessels, in situ cooling, and rapid preparation of well-dissected organs for transplantation.

Cadaver↗
PubMed1982

Transplantation of microbially contaminated cadaver kidneys.

Bacterial cultures of graft perfusion fluid were taken on 514 renal perfusions during a ten-year period. A total of 22 positive cultures were found. Two sets of kidneys were discarded because of the bacteriology report. Only two possible wound infections were found that could be attributable to the preoperative contamination even though 19 of 24 patients with "contaminated" kidneys received no antibiotics. No loss of kidneys or life was found. Of the 22 contaminated perfusates, 18 (80%) originated from other institutions although only 144 (28%) of the total kidneys that were perfused came from other institutions. The majority of cultures indicated that the organisms were skin contaminants or organisms of low virulence. Microbial contamination of perfused cadaver kidneys is uncommon (1.2% in local kidneys and 9.3% in shared kidneys). Contaminated kidneys are not a major source of infection in renal transplant recipients. Kidneys that are contaminated with frequently virulent Gram-negative bacteria, such as Escherichia coli, should be discarded. Contamination of kidneys with Gram-positive organisms should not be a contraindication for transplantation, but the patients should probably be given prophylactic antibiotics.

Cadaver↗
PubMed1987

Simultaneous cadaver renal and pancreas transplantation in type I diabetes.

Between February 1985 and April 1986, we performed 11 simultaneous cadaver kidney and segmental pancreatic transplants in patients with type I diabetes. There were nine men and two women ranging in age from 25 to 47 years (mean, 38.5 years). All pancreatic grafts were extraperitoneal, and the pancreatic duct was managed by pancreaticocystostomy utilizing an internal stent. Three patients died from two to six weeks postoperatively of septic complications. Four pancreatic grafts were functioning at 2, 5, 11, and 14 months after operation, and eight patients had had functioning renal allografts from two to 14 months (mean, 6.8 months) with a mean serum creatinine level of 2.4 mg/dL (210 mumol/L). Graft failure occurred in the other four patients from vascular thrombosis (three patients) or hemorrhagic pancreatitis (one patient). Significant morbidity included an infected arterial anastomosis (two patients), pancreatic fistulas (four patients), and bladder leak (four patients). In conclusion, this procedure is an effective option for selective diabetics with end-stage renal disease. Although technical complications were frequent, no adverse effect on renal allograft function was evident. With technical refinements, this procedure should be applicable to most type I diabetics with renal failure.

Adult↗
PubMed1998

Initial stability of femoral neck osteosynthesis with absorbable self-reinforced poly-L-lactide (SR-PLLA) and metallic screws: a comparative study on 21 cadavers.

The initial stability of femoral neck osteosynthesis provided by three self-reinforced poly-L-lactide (SR-PLLA) or three metallic cannulated screws was compared. A standard transverse subcapital osteotomy was created with a hand saw in 19 pairs of human cadaver femora. Two fixation methods were randomly used in each pair. Fixations were exposed to a progressive cyclic loading test to determine the deflection curves, the ultimate load-carrying capacity, and the total amount of load absorbed. One pair served as a pilot and two nonoperated pairs served as controls. The positioning of the three fixation screws, whether one screw proximally and two screws distally or vice versa, provided equal stability. Metallic fixation proved to be more stable than SR-PLLA fixation as the average maximum load-carrying capacity was 3400N for the metallic and 2600N for the SR-PLLA fixation. However, SR-PLLA screws showed sufficient fixation properties for considering clinical trials in Garden I-II femoral neck fractures in well cooperative patients.

Absorption↗
PubMed1997

Morphological and histological analysis of the thoracic duct at the jugulo-subclavian junction in Japanese cadavers.

The macroscopic arrangement of the termination of the thoracic duct (TD) was examined in detail in Japanese cadavers, and the distribution of various types of collagen, tenascin, laminin, and fibronectin in the framework of the wall of the thoracic duct termination was demonstrated. We identified several branching patterns and pathways of the TD (i.e., those terminating 1) at the venous angle (Type A); 2) at the end of the internal jugular vein (Type B); 3) at the the external jugular vein (Type C); or 4) in a complex with various branches (Type D). The TD often divided into two or three trunks before or after passing beneath the left brachiocephalic vein. Compared with the main trunk of the TD, fewer muscle fibers, elastic fibers, specific compounds of the extracellular matrices, and valvular connective tissues were found near the termination of the TD and the valves of the TD and veins. Smooth muscle cells were arranged irregularly in each region of the TD.

Cadaver↗
PubMed1977

Metastatic choriocarcinoma transplanted with cadaver kidney: a case report.

A unique case of a metastasising choriocarcinoma, inadvertently transplanted to a man from a female cadaver kidney is reported. When the kidney was removed six days after transplantation, arterial blood vessel infiltration by chorio-carcinoma cells and high levels of human chorionic gonadotropin (HCG) in the serum of the recipient indicated an haematogenous dissemination of viable neoplastic cells. The immunosuppressive therapy was discontinued after removal of the graft and the HCG levels in the recipient gradually decreased over a periode of eight weeks, indicating a slow immunologic rejection of the tumor cells. The recipient committed suicide seven months after the transplantation had failed. No metastases were found at a legal autopsy. It seems advisable, whenever there is evidence that neoplastic cells might have been transfered by a homograft, to remove the graft and discontinue the immunosuppressive therapy. Neoplastic cells already disseminated can still be eliminated when the immunologic system is intact and not suppressed.

Cadaver↗
PubMed2001

Gross anatomy in the surgical curriculum in Switzerland: improved cadaver preservation, anatomical models, and course development.

The invention of new techniques for surgery and interventional radiology demand improved training for ongoing specialists. The Anatomical Institutes in Switzerland support these requirements by establishing hands-on practical training courses by using new procedures for cadaver embalming and model construction. Improvements allow courses to provide students with more realistic simulations of both established and experimental surgical methods. Through these changes, the value of in-depth gross anatomy is enhanced as a topic of fundamental importance for the postgraduate medical and surgical curriculum. The web site http://www.unifr.ch/sgahe/snga.html contains information on courses using the Thiel embalming solution. Details about training courses in Switzerland using anatomical models are available at http://www.heartlab.org, http://www.vascular-international.org, and http://www.elastrat.com.

Anatomy↗
PubMed2005

A new way to teach an old topic: the cadaver-based anatomy short course for high school students.

An outreach program has been developed at the Department of Biological Sciences, Northern Illinois University (NIU), that offers an intensive short course in human gross anatomy to high school students and their teachers. Prior to the short course, the high school teachers attend a laboratory orientation, view the facilities, and then develop a syllabus suitable for the class needs. When the students arrive, they spend between 1 and 2 days rotating through five different work stations. Using their syllabus, they identify and learn the function of various structures on human cadavers and models. Evaluation and content testing of 143 students demonstrated a significant degree of enthusiasm and retention of the syllabus material at the end of the course. All teachers who participated in the program indicated that they wish to return the following year and new groups have already applied to attend. The results of the program demonstrate ways that universities can generate excitement about science and learning at the high school level.

Academic Medical Centers↗
PubMed1982

Experiences with cadaver renal allograft contamination before transplantation.

Microbial contamination occurred in 23 (13 per cent) of 177 cadaver donor kidneys prior to renal transplantation. In 16 cases there were no complications directly attributable to the organisms recovered from the preservation media. Three patients developed perinephric infections associated with renal artery anastomotic disruption and required emergency transplant nephrectomy. A fourth patient developed renal artery stenosis and a hypogastric artery aneurysm that required correction 6 months later with preservation of renal allograft function. In 3 cases no follow-up information was available. None of the 154 uncontaminated kidneys developed arterial disruption or aneurysm. Candida albicans and Pseudomonas aeruginosa infections were responsible for the nearly disastrous arterial disruptions and possibly the hypogastric arterial aneurysm. These findings demonstrate the importance of bacteriological surveillance of perfusion media to detect nosocomial infection, to guide antibiotic chemotherapy and to direct surgical management of septic complications. In our experience contamination was not necessarily incompatible with long term satisfactory results; however, when complications did occur they were serious. It is likely that the size of the microbial inoculum, the patient's immune competence and the protective effect of antibiotic therapy administered to the donor and recipient affected the eventual outcome.

Adult↗
PubMed2003

High prevalence of tarsal coalitions and tarsal joint variants in a recent cadaver sample and its possible significance.

Tarsal coalitions (TC) are defined as fibrous (beyond normal ligaments), cartilaginous, or osseous unions of at least two tarsal bones. Most of the clinical studies report the prevalence of TC as <1%, but they disregard the asymptomatic coalitions. Because TC have been associated with pathologic conditions, including degenerative arthritic changes, knowledge of their prevalence has clinical importance. The aim of our study was to establish the prevalence of TC and tarsal joint variants. A total of 114 feet from 62 cadavers (average age = 78 years) without obvious foot pathologies were dissected at the Department of Anatomical Sciences, The University of Adelaide. Ten non-osseous TC in eight subjects were identified: two talocalcaneal and eight calcaneonavicular (occurred twice bilaterally). Variant calcaneonavicular and cuboideonavicular joints were found in 8% and 31% of feet, respectively. Other joint variants included a variable number of talocalcaneal joint surfaces and sesamoid bones. No secondary TC (due to trauma, infections, or neoplasm) were found. Our study demonstrated that the overall prevalence of TC is higher (13%) than previously thought; tarsal joint variations (39%) and sesamoid bones (42%) were common as well. The supposed secular increase in the prevalence of TC as well as the high number of anatomical variants could reflect a short-term response to altered life-style or a microevolutionary trend due to relaxed selection.

Aged↗
PubMed2004

Multiple arterial variations in the upper limb of a South Indian female cadaver.

In a routine dissection of a female cadaver, a variation in the course of the radial artery in the cubital fossa and a communication between the brachial artery and radial artery were observed. A rare origin and course of the median artery was also found. These anomalies are discussed in detail and their clinical relevance is highlighted.

Arm↗
PubMed2005

Ramification pattern of the thenar branch of the median nerve entering the thenar fascia and the distribution of the terminal branches in the thenar musculature: Anatomic cadaver study in 144 hands.

Knowledge of the anatomy of the median nerve is important in surgery of the palmar aspect of the hand. The purpose of our study was to investigate the ramification pattern of the thenar branch before entering the thenar fascia and the distribution of the terminal branches in the thenar musculature. The observations were carried out on 144 hands of 74 dissecting room cadavers. According to the number of the thenar branches entering the thenar fascia we classified our specimens into four types. In 121 hands (84%, Group I) the thenar branch piercing the thenar fascia was a single trunk. In 19 hands (13.2%, Group II) two branches; in three (2.1%; Group III), three branches; and in one hand (0.7%; Group IV), four branches were identified entering the thenar fascia. Accessory thenar nerve was found in 8.3% of hands. The further division of each branch to its terminal branches was investigated in detail. Our results show that the more the number of thenar branches entering the thenar fascia, the less the terminal branching. Because more than one branch was seen in 16% of the specimens, meticulous dissection is required for preventing injury of the thenar branches before entering the thenar fascia.

Aged↗
PubMed2007

The poor, the Black, and the marginalized as the source of cadavers in United States anatomical education.

When the practice of hands-on anatomical dissection became popular in United States medical education in the late 18th and early 19th centuries, demand for cadavers exceeded the supply. Slave bodies and thefts by grave robbers met this demand. Members of the public were aware that graves were being robbed and countered with various protective measures. Since the deterrence of grave robbing took time and money, those elements of society who were least economically and socially advantaged were the most vulnerable. Enslaved and free African Americans, immigrants, and the poor were frequently the target of grave robbing. The politically powerful tolerated this behavior except when it affected their own burial sites. Slave owners sold the bodies of their deceased chattel to medical schools for anatomic dissection. Stories of the "night doctors" buying and stealing bodies became part of African American folklore traditions. The physical and documentary evidence demonstrates the disproportionate use of the bodies of the poor, the Black, and the marginalized in furthering the medical education of white elites.

Anatomy↗