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PubMed1992

[Free myocutaneous flap of the latissimus dorsi in cervicofacial surgery].

Free myocutaneous latissimus dorsi transplants are exceptionally used in cervicofacial surgery. The authors have performed an anatomical study of 23 non-embalmed subjects, using injections of neoprene latex and barium sulfate into the axillary artery and dye injections. Dissections, arteriographs and corrosion show that the lower scapular pedicle is constant, with an average length of 9.5 cm and a caliber that is sufficient for vasuclar microsurgery. Eight patients with large T4 cervicocephalic neoplasms were operated, including two with tongue tumors, one with a tumor of the oropharynx, two oromandibular lesions, two lesions of the maxillary sinus and a neuroblastoma involving the middle level of the facial structures. A free myocutaneous latissimus dorsi transplant was used. The transplant was revascularised by neck vessels using microsurgical techniques. Complete success was obtained in all eight patients. Good functional, cosmetic and morphological results were obtained as a rule. In cervicofacial surgery, the authors have thus chosen and used a free myocutaneous latissimus dorsi transplant in three topographic indications: for the oropharynx, to fill large cavities, especially the maxillary sinus, and to fill the middle level of the facial structures and of the base of the skull.

Adult↗
PubMed1992

[Three-dimensional analysis of arteriography in human posterior circulation (preliminary report)].

In earlier articles it was suggested that there is a relation between vertigo and the posterior circulation. This study was designed to ascertain the course of the branches of the vertebral artery and the basilar artery, as well as the principal blood vessels of the vestibular nucleus by using radiographic three-dimensional observation. We studied 27 human brains (17 males, 10 females) fixed with the arterial embalming method at the Department of Anatomy of Kawasaki Medical School. The results were as follows: 1. Many variations in the course of the anterior inferior cerebellar artery and the posterior inferior cerebellar artery were observed, but the most frequent pattern, observed in 56% of our subjects, was the anterior inferior cerebellar arteries originating from the basilar artery and the posterior inferior cerebellar arteries from the vertebral artery. 2. Measurement of the inside diameter of both vertebral arteries showed the diameter of the left side to be thicker than that of the right side. 3. Perforating branches in the brain stem consisted of the pontine branches from the basilar artery and small branches from the anterior inferior cerebellar artery. Moreover, the transverse section showed a large number of them to originate from the ventral part of the brain stem.

Aged↗
PubMed1992

A comparative study of the thickness of the tunica muscularis in the forestomach and abomasum of grey, white and black Karakul lambs.

Homozygous grey Karakul lambs are born with a lethal genetic factor responsible for death and weaning age. When put on a high roughage diet under field conditions they develop distended, thin-walled rumens and sand impacted abomasa. Homozygous white Karakul lambs have a similar factor but survive for a longer period. Black Karakul lambs are not affected. The present study was undertaken to compare by image analysis the thickness of the tunica muscularis of the forestomach and abomasum of 24-hour old grey, white and black Karakul lambs. One square centimetre samples were taken from equivalent areas in each case of the rumen, reticulum, omasum and abomasum of 38 embalmed Karakul lambs. Haematoxylin and eosin stained histological sections of each sample were studied with a Vids 2 Image Analyzer and the thickness of the circular and longitudinal muscle layers was measured. An analysis of variance indicated a significant difference between the groups in the thickness of the tunica muscularis of the rumen, reticulum and abomasum; the grey group displaying the thinnest and the black group the thickest. The omasa were not affected. The study indicates a reduction in thickness of the tunica muscularis of the homozygous grey and white lambs when compared to normal black lambs.

Abomasum↗
PubMed2003

[Chemical synthesis of biodegradable poly-para-dioxanone and its application for mandibular fracture fixation].

OBJECTIVE: To observe mandibular fracture healing after synthesized bioabsorable poly-para-dioxanone (PDS) ligature fixation. METHODS: Para-dioxanone monomer was prepared by chemical reactions of metallic sodium, ethylene glycol and other raw materials. PDS was synthesized by polymerizing the purified para-dioxanone in the presence of catalyst under the conditions of negative pressure and certain temperature. PDS ligature was obtained by processing the polymer into small granules, drying and melt-extruding through a spinnerette. Eighteen adult male New Zealand rabbits were assigned randomly into two groups. After mandibular fracture models were created, reductions of the artificial fractures were accomplished by means of transosseous PDS ligatures on each of 12 rabbits in experimental group. While the other six rabbits without any internal fixation were set as control. Schedules for killing were arranged to give postoperative samples at two-week interval till 12th week. RESULTS: Radiographical and histological examinations demonstrated that all fractures fixed with PDS ligatures healed without any complication. Periosteal and cartilaginous osteogenesis was observed in newly formed external callus. In contrast, bone fragment migration and the consequent nonunion occurred in the control group. PDS ligature degraded and absorbed without interference with osseous union and healing. The tensile strength reduction of PDS ligature was prior to its absorption in vivo. CONCLUSION: The synthesized PDS is a colorless, flexible, themoplastic and monofilament fiber, which can be sterilized by ethylene oxide embalmment without serious loss of tensile strength. It seems that the application of this macromolecular material in internal fixation is of great worth for further study.

Absorbable Implants↗
PubMedDate not supplied

Imaging of semimembranosus bursitis: MR findings in three patients and anatomical study.

We report on three patients with posteromedial knee pain related to semimembranosus bursitis. The semimembranosus bursa has a typical location and morphology around the central tendon of the semimembranosus muscle. These characteristics are demonstrated in patients and by dissection of the tendon and bursa in an embalmed knee specimen.

Adult↗
PubMed2004

Intrathecal ligaments and nerve root tension: possible sources of lumbar pain during spaceflight.

UNLABELLED: Lumbar intrathecal ligaments have recently been demonstrated to randomly bind dorsal nerve roots to the dura within the lumbar vertebral column. Lengthening of the vertebral column and associated lumbar back pain experienced by astronauts is common in microgravity. This study was designed to investigate the relationship of lumbar intrathecal ligaments in spinal lengthening as a possible mechanism for back pain. METHODS: A two-part study was designed using 36 vertebral columns from embalmed cadavers. There were 12 vertebral columns studied in mid-sagittal section to demonstrate the possible movement of the spinal cord during lengthening of the vertebral column. The remainder were assessed for the amount of tension placed on a dorsal nerve root by the lumbar intrathecal ligament during lengthening of the vertebral column. RESULTS: The spinal cord moves in a cephalic direction approximately 2.8 mm with 4 cm lengthening of the vertebral column. During lengthening, a loss of thoracic and lordotic curvature was noted with an increase in disk height. Tension was significantly increased on the dorsal nerve roots being tethered by the lumbar intrathecal ligaments in comparison to non-tethered nerve roots during lengthening of the vertebral column. CONCLUSION: A significant amount of tension is placed on dorsal nerve roots tethered by intrathecal ligaments within the lumbar spine during spinal lengthening. These ligaments randomly bind dorsal nerve roots in the lumbar spine and may be involved in the back pain experienced by astronauts in microgravity.

Chronic Disease↗
PubMed2004

[Anatomic study of perforator neurovascular bundles of the deep inferior epigastric perforator flap].

OBJECTIVE: To investigate the anatomic characteristics of the perforator neurovascular bundles in the anterior abdominal wall for the anatomical basis of the sensate deep inferior epigastric perforator (DIEP) flap. METHODS: Abdominal wall dissection was performed on 9 embalmed female cadavers (18 sides). RESULTS: Most of the deep inferior epigastric perforators emerged at the anterior sheath of the rectus. There were averaged 17.5 perforators on each side, with the diameter equal to or larger than 0.5 mm in 7.8 perforators. The number of skin perforators was the greatest in the supero-medial area. 56.2 percent of vascular perforators traveled with the sensory branches while 80.9 percent of larger perforators (> or = 0.5 mm in diameter) run with the sensory branches. CONCLUSIONS: The lateral perforator neurovascular bundle was the first choice in the design of the sensate DIEP flap.

Abdominal Wall↗
PubMed1992

A comparative histological study of the number and size of the myenteric ganglia and neurones in the fore-stomach and abomasum of grey, white and black Karakul lambs.

Homozygous grey Karakul lambs are born with a lethal genetic factor responsible for death at weaning age. When put on a high roughage diet under field conditions they develop distended, thin-walled rumens and sand impacted abomasa. Homozygous white Karakul lambs have a similar factor but survive for a longer period. Black Karakul lambs are not affected. The present study was undertaken to compare by image analysis the number and size of the myenteric ganglia, and the number of myenteric neurones in the walls of the fore-stomach and abomasum of 24-h-old grey, white and black Karakul lambs. One square centimetre samples were taken from analogous areas of the rumen, reticulum, omasum and abomasum of 38 embalmed Karakul lambs. Haematoxylin and eosin stained histological sections of each sample were studied with a Vids 2 Image Analyzer. One way analysis of variance indicated a significant difference between the groups regarding the number and size of the myenteric ganglia and in the number of myenteric neurones in the reticulum, rumen and abomasum. The number and size of the ganglia and the number of neurones was greatest in the black lambs and decreased progressively in the white and grey lambs. The omasum was not affected. It is suggested that the paucity of myenteric ganglia and neurones in the regions examined is instrumental in causing the lethal condition described above.

Abomasum↗
PubMed2003

Comparison of two headless screw designs for fixation of capitellum fractures.

In order to determine the effects of two different headless screw designs on fixation of simulated capitellum fractures six matched pairs of embalmed humeri had simulated capitellum fractures created. Fixation with Acutrac compression screws was compared to Herbert screws in a matched pair experimental design. All specimens were cyclically tested with simulated physiologic loading. Both displacement of the capitellum as a function of the number of cycles and failure loads were determined. Fixation by the Acutrac screws was significantly more stable than Herbert screws at 2000 cycles, 0.17 mm wersus 1.57 mm (p < 0.02) The Acutrac fixation also had a higher failure load, 154 N versus 118 N (p < 0.05). The Acutrac screws tested in this biomechanical study provided more stable fixation of simulated capitellum fractures than Herbert screws. This appears to be related to the design of these screws.

Biomechanical Phenomena↗
PubMedDate not supplied

The human first carpometacarpal joint: osteoarthritic degeneration and 3-dimensional modeling.

The purpose of this study was to gain insight into potential mechanical factors contributing to osteoarthritis of the human first carpometacarpal joint (CMC). This was accomplished by creating three-dimensional (3-D) computer models of the articular surfaces of CMC joints of older humans and by determining their locus of cartilage degeneration. The research questions of this study were: 1) What is the articular wear pattern of cartilage degeneration in CMC osteoarthritis?, (2) Are there significant topographic differences in joint area and contour between the joints of males and females?, and 3) Are there measurable bony joint recesses consistently found within the joint? The articular surfaces of 25 embalmed cadaveric joints (from 13 cadavers) were graded for degree of osteoarthritis, and the location of degeneration was mapped using a dissection microscope. The surfaces of 14 mildly degenerated joints were digitized and reconstructed as 3-D computer models using the Microscribe 3D-X Digitizer and the Rhinoceros 2.0 NURBS Modeling Software. This technology provided accurate and reproducible information on joint area and topography. The dorsoradial trapezial region was found to be significantly more degenerated than other quadrants in both males and females. Mean trapezial articular surface area was 197 mm 2 in males and 160 mm(2) in females; the respective mean areas for the metacarpal were 239 mm(2) in males and 184 mm(2) in females. Joints of females were found to be significantly more concave in radioulnar profile than those of males. Three bony joint recesses were consistently found, two in the radial and ulnar aspects of the trapezium and the third in the palmar surface of the metacarpal.

Aged↗
PubMed1992

A biomechanical study of two methods of internal fixation of unstable fractures of the femoral neck. A preliminary study.

A model of an unstable femoral neck fracture was used in this study to compare the axial and torsional displacement obtained when the neck was fixed by a compression hip screw (CHS) and side plate, or three Knowles pins. Six paired, embalmed femora were mounted on a special, custom-made jig that grasped the femoral head and shaft securely. A standardized osteotomy was made with an oscillating saw, bisecting the distance between the lower cartilaginous portion of the femoral head and the intertrochanteric line. A 5-mm thick slice of bone was excised from the posteromedial quadrant of the distal fragment. The right or left femur in each pair was then randomly assigned to internal fixation with either three Knowles pins or a keyed CHS plus a 130 degrees four-hole side plate. After potting of the specimens and application of rosette strain gauges, axial displacements were measured during the application of in-plane and out-of-plane compressive loads. The resistance to torsion was also determined. There were no statistical differences between the two devices for compressive or torsional loading using this model.

Biomechanical Phenomena↗
PubMedDate not supplied

[Contributions of Herodotus to surgery within the historiographic analysis of his Histories].

During the splendor of Athens, Herodotus of Helicarnasus develops his life and work in the V century B.C. that led him to be considered the father of history. The available knowledge of ancient medicine and surgery is based on the descriptions of authors such as Homer, Herodotus, Hippocrates, and Plinius. Herodotus, a contemporary of Hippocrates, in his Histories, defines the limit between the epic narratives of Homer and the beginning of scientific history based on observation, reflection, and analysis. He develops an erudite, objective, and clear narrative of facts that allow him to discover the causes in order to determine their consequences in society. He describes the magic-religious model of the health-disease process, etiology, diagnostic methods, and treatment for diseases in ancient towns. He makes a description of Egyptian medicine, particularly about medical specialization, embalmment, and common diseases. He emphasizes surgical procedures: circumcision, castration, amputations of ears, nose and hands, ocular evisceration and mastectomies (punishments) and describes traumatic wounds, their prognosis and treatment. He also mentions the names and actions of the most famous physicians of the time. Herodotus lived the cultural decadence of Ionia, his native land, at the time of economic and intellectual hegemony of Athens. His work is universal and has the purposes of projection to the future and to seek causes.

General Surgery↗
PubMed2005

[Fabrication and application in vitro of pedicle guide device for pedicle screws insertion].

OBJECTIVE: To evaluate the accuracy of pedicle guide device for the placement of the pedicle screws. METHODS: Pedicle guide device was designed and made for the anatomical trait of pedicle. The 3-D anatomical data of the thoracic pedicles were measured by multi-slice spiral CT in two embalmed human cadaveric thoracic pedicles spine (T1-T10). Depending on transverse section angle (TSA) and sagittal section angle (SSA) of pedicle axis, the degree of horizontal dial and sagittal dial were adjusted in the guide device. The screws were inserted bilaterally in the thoracic pedicles by using the device. After pulling the screws out, the pathways were filled with contrast media. The TSA and SSA of developed pathways were measured. RESULTS: Analysis of the difference between pedicle axis and developed pathway was of no statistical significance (P > 0.05). CONCLUSION: The guide device could be easily operated and guarantee high accuracy of the pathways of screws and the incidence of pedicle penetration could be significantly reduced.

Adult↗
PubMed1979

[A study of the tensile strength of cruciate ligaments with regard to the possibilities of prosthetic replacement (author's transl)].

Recent clinical and experimental results in the prosthetic replacement of the anterior cruciate ligament are minimal and this fact has incited us to search for additional fundamental characteristics of natural and synthetic ligaments. The dissection of over 30 human knees (5 fresh and 27 embalmed specimens), of 50 dog knees and of 20 cat knees showed that the posterior cruciate ligament was longer and of bigger size than the anterior cruciate ligament. In dogs, the anatomo-radiological study showed a lenghtening of 14,4 p. 100 for the anterior cruciate and of 10,5 p. 1u0 for the posterior cruciate ligament in the various goniometric positions. Traction with the Instron apparatus using whole knee with preserved bony attachments revealed an elastic resistance (yield point) of the ligament of about 50 kg, 60 kg and 30 kg (for human, dog and cat respectively) with elastic elongation (at the yield stress) of 25 p. 100, 35 p. 100 and 45 p. 100 (respectively). Trials on the polyethylene prosthetic ligament used at the present time for replacement of cruciate ligaments in humans showed an elastic resistance of only 16 kg with an elasticity of only 1,4 p. 100. The major differences between the physical properties of the artificial and natural ligaments that we have studied in experimental conditions incite our serious doubt as to the value for the practical use of such a prosthesis and provoque strongly the necessity of search for alternative synthetic or other material more suitable for the task in question.

Animals↗
PubMed2005

How pilot-hole size affects bone-screw pullout strength in human cadaveric cancellous bone.

OBJECTIVE: Screw failure of cancellous bone screws is not uncommon. To compare the effect of varying pilot-hole size on pullout strength of cancellous bone screws in human cadaveric bone, we designed and performed a biomechanical study to allow quantitative analysis. METHODS: Three pairs of distal femurs and 4 pairs of proximal tibias from embalmed human cadavers were stabilized in a mould, and the bone cortex was overdrilled. Four sites in a linear transverse plane were randomly assigned, anatomically matched with the paired bone and drilled with either pilot-hole size 3.2 mm or 2.5 mm. The cancellous screw (Synthes noncannulated 4.5-mm shaft, 6.5-mm external diameter) was guided into the pilot hole and pulled on by a test frame (Instron 8874 biaxial servo-hydraulic test frame) with increasing force to the point of failure, and the forces at which failure resulted were compared. RESULTS: A comparison of 25 anatomically paired sites with a 2-tailed paired t test and Wilcoxon matched-pairs signed rank test indicated significantly stronger pullout strength (p = 0.047 and p = 0.047) of the 2.5-mm compared with the 3.2-mm pilot hole. Subanalysis of the 4 studied locations indicated that 3 supported the above findings and 1 supported a reverse trend. CONCLUSIONS: Generally, cancellous screws demonstrated a significantly (p < 0.05) stronger hold using a smaller size pilot hole than the recommended standard diameter. All locations except the inner lateral site supported this finding.

Aged↗
PubMed2006

[The effect of the plantar plate and the collateral ligaments on the flexion of the metatarsophalangeal joints].

OBJECTIVE: To explore the effect of the collateral ligaments and the plantar plate on the flexion of the metatarsophalangeal (MP) joints. METHODS: Twenty-four preserved human No. 2-4 digits were obtained from embalmed cadaver feet, which were divided into 2 groups at random. In group A, the bilateral collateral ligaments were cut first, and then the plantar plate was sectioned. They were cut in opposite sequence in group B. Angle of the flexion of MP joint was observed in the same load after the bilateral collateral ligaments and the plantar plate were sectioned in different sequence. From 1994 to 2000, 11 cases were used with this technic, including plantar section in 2 cases and both plantar section and bilateral collateral ligaments cut in 9 cases. RESULTS: The angle of flexion of the MP joint before operation in group A is 37.30 +/- 5.42 degrees, it increased 11.29 +/- 2.36 degrees and to 48.60 +/- 2.98 degrees when the bilateral collateral ligaments were cut, and there was significant difference. Later the cut of the plantar plate increased another 5.30 +/- 1.59 degrees and to 53.35 +/- 2.76 degrees. Both have an increasing trend for the angle of flexion of the MP joint (P < 0.01). While in group B, the angle of flexion of the MP joint before operation is 34.59 +/- 5.32 degrees, it increased 6.29 +/- 2.98 degrees and to 40.89 +/- 2.36 degrees when the plantar plate were cut, later the cut of the bilateral collateral ligaments increased another 9.71 +/- 1.94 degrees and to 50.60 +/- 2.01 degrees. Both had an increasing trend for the angle of flexion of the MP joint (P < 0.01). The bilateral collateral ligaments had more influence than the plantar plate (P < 0.01). There was the same effect in different sequence (P > 0.05). In 2 cases with plantar section, the flexion angle of MP joint could achieve 15 degrees to 45 degrees in 2 months. The other 9 cases with both plantar section and bilateral collateral ligaments cut, the MP joint flexion achieved 10.3 degrees to 58.4 degrees in 26.3 months. CONCLUSION: The flexion angle of the MP joint can be increased by cutting the bilateral collateral ligaments and the plantar plate.

Adult↗
PubMed2005

Anatomic safe zone of pin insertion point for distal clavicle fixation.

Clavicle fracture is the most common childhood fracture and one of the most common fractures in adults. Only some types of distal clavicular fractures, and dislocation of the acromioclavicular joint, require internal fixation. Many surgeons prefer closed pinning; however, the difficulty inserting many of the various kinds of pins from acromion into the medullary canal, of the distal clavicle, means the likelihood of iatrogenic complications from repeated drilling is heightened. The purpose of the present study was to establish what would be the optimum insertion point and direction for safe intramedullary pinning of the distal clavicle. Embalmed cadaveric shoulders (32) were studied. A bone window was created at the distal one-thirds of the clavicle, approximately 1.5 cm medial from the conoid tuberosity - as wide as could be freely, retrogradely drilled into the medullary canal of the distal clavicle. A 2.0-mm Kirschner wire was inserted until it penetrated the acromion. The point of emergence was recorded as ratio compared with the acromial width and length in coronal and sagittal planes, respectively. K-wire directions were measured as the angle between the K-wire and the reference line from the anterosuperior tubercle of the clavicle to the anterior angle of the acromion. The process was repeated until the acromion fractured 304 drillings were performed on 32 specimens. The length of the sagittal vs.coronal pin insertion point from the anterior vs. lateral borders of the acromion divided by its length vs. width averaged 0.325 +/- 0.04 and 0.397 +/- 0.09, respectively. The angle of the K-wire and the reference was 7.69 +/- 3.04 and 14.59 +/- 4.34 degrees in the coronal and horizontal planes, respectively. At 8 and 10 drillings survival was 0.72 (95%CI: 0.53-0.84) and 0.41 (95%CI: 0.24-0.57), respectively. The optimum pin inserting point for fixation of distal clavicle fracture and acromioclavicular joint dislocation is 32.5% and 39.7% of acromial length and width, respectively. If a 2.0-mm K-wire is used for fixation, drilling should not be repeated drilled more than 8 times to avoid sudden, high risk iatrogenic acromial fracture.

Bone Nails↗
PubMed2005

Pattern of angular change of the anterior cruciate ligament across the range of knee flexion and the related anatomical dimensions.

Improper femoral and/or tibial tunnel placements are major causes of failure in anterior cruciate ligament (ACL) reconstruction. The 52 embalmed cadaveric knees were measured the dimensions of the surgical related structures using vernier caliper and goniometer. The intercondylar notch width was 17.4 +/- 2.3 mm and slope of the roof was 31.3 +/- 3.4 degrees. The average length of ACL was 21.6 +/- 2.5 mm. The relation of tibial attachment was 47.98% of the width of the lateral tibial plateau and 49.8% anteriorly, when it was measured through ACL attachment. Angle of ACL in sagittal plane was decreased during knee flexion. On the contrary, angle of ACL in coronal plane was increased during knee flexion. According to this study), The expected femoral tunnel at 10.00 am to 10.30 am could be performed by arthroscopic transtibial technique using the 48% of tibial width anteriorly for intraartricular tibial-tunnel drill-guide placement and aiming for sagittal and coronal plane of 52.0+/-4.6 / 20.9+/-3.9, 46.2+/-5.1 / 26.8+/-4.6 degrees, and 41.6+/-5.1 / 32.0+/-4.3 degrees while knee flexion degree were as 60, 90, and 120 degrees, respectively.

Aged↗