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PubMed2007

[Indications and techniques for wrist arthroscopy].

After considering the anatomy of the wrist, the technical requirements for wrist arthroscopy are discussed. This method is used as an additional diagnostic procedure and staging procedure as well as a therapeutic technique. Complications, which are rare, most commonly involve nerve irritation, damage to cutaneous nerves and extensor tendons. Lose bodies can be removed arthroscopically, however, arthroscopically assisted fracture treatment or the removal of ganglions are uncommon. Approaches are lateral and oriented on the extensor tendons or other anatomical landmarks. Arthroscopy is especially useful by carpal instability as it offers many possibilities, not only diagnostically but also therapeutically.

Arthroscopes↗
PubMed2002

[Basic principles and surgical technique of tibio-fibula-plasty in cartilage-bone transplantation].

BACKGROUND: Within the last few years autologous cartilage-bone-grafting is becoming an established standardized procedure in joint surgery. One significant disadvantage of this technique is the harvesting of the bone plugs from the weight-bearing area of the knee joint. PURPOSE: The tibiofibular articulation is located close to the knee joint that is operated on. This articulation is covered with cartilage. The purpose of this study was to evaluate the question, whether this joint is suitable as a donor site for bone-cartilage transplants. MATERIAL AND METHODS: Favourable approaches and committing of anatomical landmarks were investigated on 44 fixed tibiofibular joints. In knee extension, the shortest distance between the joint cleft and common fibular nerve was measured. The cartilage thickness and histology of both the fibular and tibial joint surface were documented. The developed surgical approach was evaluated in patients. RESULTS: Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The average cartilage thickness was 1.9 +/- 0.29 mm (minimum: 1.5 mm; maximum: 2.6 mm). The peroneal nerve showed an average distance to the tibiofibular joint of 24 mm (minimum: 12 mm; maximum: 30 mm). Different surgical procedures are possible and clinical relevant. CLINICAL RELEVANCE: The tibiofibular joint contains cartilage, which may be a reasonable donor site even for the elderly patient. Harvesting the graft from this area may avoid iatrogenic damaging of intraarticular weight bearing cartilage of the knee joint.

Aged↗
PubMed2005

[Skull base tumors].

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.

Cerebellopontine Angle↗
PubMed2007

[MSCT for staging and response evaluation of esophageal cancer].

Squamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.

Esophageal Neoplasms↗
PubMed2002

[Standardized sectional planes of the locomotor apparatus].

Comparable to the standardized ultrasound screening of newborns and infants according to Graf's method, the standardized ultrasound examination of the locomotor apparatus has become an important feature in the evaluation of many acute and chronic diseases. The standardized ultrasound examination technique according to the guidelines of DEGUM and DGOOC helps the experienced and inexperienced user to avoid diagnostic mistakes by reproducibly displaying anatomical landmarks. Specific individual planes can be necessary in certain indications. The main advantage in comparison to other diagnostic means (i.e., computed tomography and magnetic resonance imaging) lies in the possibility of dynamic examination, which allows excellent imaging especially in rotator cuff affections. In cases without pathological findings, two standardized planes have to be documented. Otherwise, the pathological finding has to be documented in two standardized planes. The standardized procedure is a useful means for assuring and improving the quality of sonographic examinations of articular and periarticular structures.

Ankle Joint↗
PubMed2007

[Injection therapy of the spine without imaging].

Nerve root blocks and epidural perineural injections are main part in the conservative treatment of degenerative spine diseases. These injections should be done without imaging because degenerative spine diseases - discogenic oder spinal stenotic - tend to recurrence and danger arises from too many imaging with cumulative ionizing radiation over the years, especially in younger people. After certain training it is possible to perform spinal injections without imaging only considering topographic anatomical landmarks like in any other local anesthesia for surgical reasons. Repetitive periradicular injections desensitize the nerve root by local anesthetics and reduce its inflammatory swelling by steroids. The decompensated symptomatic deformity turns back into an asymptomatic compensated status.

Analgesics↗
PubMed2000

[Computer-assisted implant positioning in knee endoprosthetics. Kinematic analysis for optimization of surgical technique].

Modern approaches in knee endoprosthetics using computer-assisted navigation systems are based on matching procedures which refer to osseous anatomical landmarks. However, surface replacement techniques require a correct position of the implants in relation to the bone, as well as an optimal postoperative interaction of the ligaments and the surface design of the endoprosthesis. Functional aspects are of elementary importance. Insufficient design of the prosthetic surface or incorrect implantation overstresses ligamentous structures and result in functional disturbance, increased wear, and early loosening of the components. The present computer model permits a quantitative analysis of different implant positions. Distal positioning of the femoral component or insufficient resection of the tibial plateau results in a lag of extension. Increased distal resection of the tibial plateau produces marked translatory instabilities in the sagital plane which exceed the absolute height of the resection in millimeters. Monocondylar replacements with preservation of the ACL react kinematically more sensitively than bicondylar endoprostheses sacrificing the ACL. The results of this study are systematically summarized in an algorithm and indicate correction steps in order to avoid functional impairment. The computer model delivers in addition some basic data for optimized navigation procedures in knee surgery and demonstrates the importance of further developments in custom-made endoprosthetics.

Algorithms↗
PubMed1997

Improvement of internal jugular vein cannulation using an ultrasound-guided technique.

OBJECTIVE: To determine whether ultrasound guidance can help operators to improve the results of jugular vein access in the ICU. DESIGN: Prospective, randomized study. SETTING: General Intensive Care Unit of a University Hospital. PATIENTS: Seven-nine patients were assigned to internal jugular vein cannulation using anatomical landmarks alone (control group, n = 42) or with ultrasound guidance (ultrasound group, n = 37). INTERVENTION: All cannulations were performed by junior house staff under the direct supervision of a senior physician. In the ultrasound group, an ultrasonography (7.5 MHz) was used and the transducer was covered by a sterile sheath. The placement and direction of the cannulating needle were determined on the ultrasound image. MEASUREMENTS AND RESULTS: Internal jugular vein cannulation was successful in 37/37 (100%) patients in the ultrasound group and in 32/42 patients (76%) in the control group (p < 0.01). Average access time was longer in the control group (235 +/- 408 s vs 95 +/- 174 s, p = 0.06) and carotid artery puncture occurred in five patients in each group (p = 0.83). Jugular cannulation was successful at the first attempt in 26% in the control group and 43% in the ultrasound group (p = 0.11). Thirty-two patients (86%) in the ultrasound group and 23 patients (55%) in the control group (p < 0.05) were cannulated within 3 min. The cannula could therefore not be inserted within 3 min in 19 patients (45%) in the control group. Failure was explained by thrombosis (n = 1), small caliber of the internal jugular vein (< 5 mm, n = 3), abnormal vascular relations (n = 3). Among the ten primary failures of cannulation, an internal jugular vein catheter was able to be inserted in four cases by an experienced physician on the side initially selected and with ultrasound guidance in two cases. The catheter was inserted into the contralateral internal jugular vein under ultrasound guidance in the remaining four cases. CONCLUSION: Ultrasound guidance improved the success rate of jugular vein cannulation in ICU patients. Our results suggest that ultrasound guidance should be used when the internal jugular vein has not been successfully cannulated within 3 min by the external landmark-guided technique.

Aged↗
PubMed2002

Understanding the contribution of binocular vision to the control of adaptive locomotion.

Abstract. Although the contribution of binocular vision to reach-to-grasp movements has been extensively studied, it has been largely ignored in locomotion. The aim of these studies was to explore the role of binocular vision during the approach phase and step over the obstacle and the contribution of head movements to acquisition of depth information under monocular vision. Binocular and monocular vision was manipulated in different phases using either an eye patch or liquid crystal glasses. Head movement relative to the trunk was restricted in the first experiment by a modified Ferno Universal Head Immobilizer attached to a rigid board strapped to the participant's back. Whole body kinematics were collected by placing infrared diodes on anatomical landmarks and using an Optotrak imaging system. Several measures related to head and limb movement were analyzed. Three major findings emerged from these studies. First, binocular vision is important for the acquisition of accurate information about the surrounding environment: accuracy but not precision of limb elevation over the obstacle was adversely affected when binocular vision was unavailable. Second, motion parallax due to self-motion provides the most critical depth information and it can be used to partially compensate for the loss of binocular vision. Although head movement is not essential to augment depth information, it is important for reorientation of the visual field to obtain the necessary information about the moving limbs when visual field is suddenly limited under monocular vision. Third, step over the obstacle is pre-planned based on visual information acquired during the approach phase: changes in visual condition during the adaptive step do not influence the limb trajectory. Collectively these three studies provide unique insights into the contribution of binocular vision during adaptive locomotion.

Adaptation, Psychological↗
PubMed2006

Characteristics of single and double obstacle avoidance strategies: a comparison between adults and children.

Activities of daily living often require us to negotiate several obstacles in the travel path. To date, there is little work investigating how adults accomplish such tasks, and there is even less known about multiple obstacle avoidance strategies used by children. The current work will expand our knowledge about the role of vision in adults and children when avoiding two obstacles placed in their travel path under altered ambient lighting. Healthy 7-year old children (n=10; aged 7.51+/-0.2 years) and adults (n=10; aged 22.76+/-1.7 years) were instrumented with infrared markers (Optotrak, NDI) placed on anatomical landmarks and asked to walk along a ten meter path under three conditions: unobstructed, single obstacle, or double obstacle. These trials were performed under two lighting conditions: Full (simulating standard office lighting) and Low (simulating a dark hallway lit by nightlights). Data analyses included lead and trail clearance values, step length, step width and step velocity, take-off distance and Horizontal toe Displacement at Apex (HDA) which was defined as the distance between the horizontal position of the toe to the leading edge of the obstacle when the toe reaches its peak height. Adults were able to maintain consistent behaviour regardless of the number of obstacles in the travel path. Children, however, adjusted their foot placement for the second obstacle. This indicates that having multiple obstacles in the travel path is a more challenging task for 7-year old, and suggests that children at this age may not have fully developed anticipatory locomotor strategies. Children had larger clearance values than adults for the lead foot crossing the obstacle under all obstacle and lighting conditions, and consistently used larger HDA values than adults. Together, these findings suggest that children adopt more cautious strategies than adults in complex environments. Additionally, children decreased walking velocity, increased step width and decreased their step length in a Low light environment. These changes are all indicators of a more careful avoidance strategy, which implies that children at this age rely heavily on visual information to guide foot placements in a complex environment.

Adult↗
PubMed2002

Virtual endoscopy combined with intraoperative neuronavigation for planning of endoscopic surgery in patients with occlusive hydrocephalus and intracranial cysts.

We assessed the clinical value of MR ventriculoscopy (virtual endoscopy, VE) combined with image-guided frameless stereotaxy for endoscopic surgery of occlusive hydrocephalus and intracranial cysts. VE was obtained in 20 patients with hydrocephalus and three with intracranial cysts. All surgical operations were endoscopic. The path of the rigid endoscope to the target point was planned using neuronavigation. VE was carried out along the same trajectory retrospectively in 20 cases and prospectively in three. The results were analysed for demonstration of anatomical landmarks and structures at risk. VE was successful in all patients. Possible obstacles to endoscopic access to the lamina terminalis and the basal cisterns and structures at risk, such as the basilar artery, were clearly shown in relation to the direction of the endoscope. However, the floor of the third ventricle and septum pellucidum were not clearly seen and possible abnormalities could therefore not be appreciated. VE can provide realistic simulation of endoscopic third ventriculostomy and cystostomy. The appropriate trepanation point and trajectory of the endoscope can be assessed with regard to the size of the foramen of Monro and the position of vulnerable structures. This simulated trajectory can be adapted to the field of operation by image-guided neuronavigation. This regime may potentially reduce the risk of damage to intracranial structures.

Adolescent↗
PubMed2004

Latest techniques in head and neck CT angiography.

Continuous evolution of multi row CT is increasingly making CT angiography a viable imaging modality for assessment of the supraaortic and intracranial vessels as an anatomically and functionally coherent vascular system. Extended non-invasive examinations with reduced contrast volume have become feasible with the availability of 16 and 64 row MDCT scanners. Prerequisites to obtain high resolution CT angiographies of the head and neck vessels with superior detail include the administration of low contrast volume, high contrast density (400 mg I/ml) contrast media, adequate timing and data acquisition, optimal flow rate (4 ml/s) and saline flushing. Non-invasiveness, delineation of vessel calcification, virtual independence from hemodynamic conditions, and the ability to provide quantification without needing to correct for magnification are all attributes that favour CT angiography over digital subtraction angiography and to some extent even magnetic resonance angiography as an alternative non-invasive technique. CT angiography is established as a modality of choice for the assessment of patients with acute stroke and chronic steno-occlusive disease. CT angiography may indicate the presence of extra- or intracranial acute vessel occlusion and dissection, predisposing atherosclerotic steno-occlusive disease and thus indicate thrombo-embolism or local appositional thrombosis as the principle pathogenic factor. CT angiography is used to assess anatomy, and to depict the presence, location and extent of calcified and non-calcified plaque as a cause of high grade stenosis. Despite relatively limited sensitivity CT angiography is indicated for suspected or confirmed aneurysms that demand further verification of their presence, geometry, or relationship to parent artery branches and osseous anatomic landmarks. Low volume high density contrast media have substantially increased the ability of CT angiography to depict small aneurysms, small branches, and collateral vessels, and to recognize the residual lumen in vessels with high grade stenosis or conditions such as dissection or pseudo-occlusion. Superior detail high resolution CT angiography is thus a viable alternative to DSA, relegating the latter technique to endovascular treatment applications only.

Angiography↗
PubMed2001

Spontaneous intracranial hypotension: the value of brain measurements in diagnosis by MRI.

Caudal brain displacement is inconstantly reported as an MRI feature of spontaneous intracranial hypotension (SIH). We reviewed the clinical data and MRI of eight patients diagnosed as having SIH and investigated the possibility of more precise assessment. On midsagittal images we measured four anatomical landmarks: the position of the cerebellar tonsils, fourth ventricle, and infundibular recess, plus the angle between the bicommissural line and a line tangential to the floor of the fourth ventricle; midsagittal images from 89 normal controls were also measured. On statistical analysis, all measurements differed in the two groups, and the difference was significant for the cerebellar tonsils, fourth ventricle, and infundibular recess. Some overlap between patients and controls was found for each measurement; however, all the patients had two (two patients) or more (six) values outside the range in normal controls range or not above their 1st quartile. Measurement of the position of the third ventricle seemed particularly sensitive. We suggest that examination of midsagittal images can help in diagnosing clinically suspected SIH.

Adult↗
PubMed2002

Gallium-67 scintigraphy in lymphoma: is there a benefit of image fusion with computed tomography?

The usefulness and complementarity of gallium (67Ga) scintigraphy and computed tomography (CT) in the management of patients with lymphoma have been extensively demonstrated. Owing to a lack of anatomical landmarks and physiological distribution of the tracer, precise localisation of abnormalities on 67Ga scintigraphy can be difficult. As fusion imaging techniques between single-photon emission tomography (SPET) and CT have been developed recently, we investigated whether use of CT/67Ga SPET fusion imaging could help in the interpretation of 67Ga scintigraphy. From November 1999 to May 2001, 52 consecutive fusion studies were performed in 38 patients [22 patients with Hodgkin's disease (HD) and 16 patients with non-Hodgkin's lymphoma (NHL)] as part of pre-treatment staging (n=13), treatment evaluation (n=20) or evaluation of suspected recurrence (n=19). 67Ga scintigraphy was carried out 2 and 6 days following the injection of 185-220 MBq 67Ga citrate. On day 2, 67Ga SPET and CT were performed, focussing on the chest and/or the abdomen/pelvis. Data from each imaging method were co-registered using external markers. 67Ga scintigraphy and CT were initially interpreted independently by nuclear medicine physicians and radiologists. CT/67Ga SPET fusion studies were then jointly interpreted and both practitioners indicated when fusion provided additional information in comparison with CT and 67Ga SPET alone. Image fusion was considered to be of benefit in 12/52 (23%) studies which were performed for initial staging (n=4), treatment evaluation (n=4) or evaluation of suspected recurrence (n=4). In these cases, image fusion allowed either confirmation and/or localisation of pathological gallium uptake (n=10) or detection of lesions not visible on CT scan (n=2). Fusion was relevant for discrimination between osseous lesions and lymph node involvement adjacent to bone, especially in the thoracic and lumbar spine and pelvis. In the abdomen and pelvis, fusion helped to differentiate physiological bowel elimination from abnormal uptake, and assisted in precisely locating uptake in neighbouring viscera of the left hypochondrium, including the spleen, left liver lobe, coeliac area, stomach wall and even the splenic flexure. At the thoracic level, fusion also proved useful for demonstrating clearly the relationships of abnormal foci to the pleura, hepatic dome, mediastinum, ribs or thoracic spine. Clinical management was altered by fusion imaging in one patient (chemotherapy was given instead of radiotherapy) and was potentially affected in three other patients (in that, in conjunction with other factors, the results of fusion imaging had an influence on the decision regarding use of irradiation and especially the treatment volume). In conclusion, CT/67Ga SPET fusion imaging allowed precise localisation of gallium uptake and correct attribution to the involved viscera, thereby altering the diagnosis in 20%-25% of studies in comparison with CT and 67Ga SPET analyses alone. CT/67Ga SPET fusion therefore appears valuable in facilitating the interpretation of 67Ga scintigraphy and we recommend its use in patients with lymphoma when CT and 67Ga scintigraphy are planned.

Adolescent↗
PubMed2004

Quantitation of dopamine transporter blockade by methylphenidate: first in vivo investigation using [123I]FP-CIT and a dedicated small animal SPECT.

PURPOSE: The aim of this study was to investigate the feasibility of assessing dopamine transporter binding after treatment with methylphenidate in the rat using a recently developed high-resolution small animal single-photon emission computed tomograph (TierSPECT) and [123I]FP-CIT. METHODS: [123I]FP-CIT was administered intravenously 1 h after intraperitoneal injection of methylphenidate (10 mg/kg) or vehicle. Animals underwent scanning 2 h after radioligand administration. The striatum was identified by superimposition of [123I]FP-CIT scans with bone metabolism and perfusion scans obtained with 99mTc-DPD and 99mTc-tetrofosmin, respectively. As these tracers do not pass the blood-brain barrier, their distribution permits the identification of extracerebral anatomical landmarks such as the orbitae and the harderian glands. The cerebellum was identified by superimposing [123I]FP-CIT scans with images of brain perfusion obtained with 99mTc-HMPAO. RESULTS: Methylphenidate-treated animals and vehicle-treated animals yielded striatal equilibrium ratios (V''3) of 0.24+/-0.26 (mean +/- SD) and 1.09+/-0.42, respectively (t test, two-tailed, p<0.0001). Cortical V''3 values amounted to 0.05+/-0.28 (methylphenidate) and 0.3+/-0.39 (saline, p=0.176). This first in vivo study of rat dopamine transporter binding after pre-treatment with methylphenidate showed a mean reduction of 78% in striatal [123I]FP-CIT accumulation. CONCLUSION: The results can be interpreted in terms of a pharmacological blockade in the rat striatum and show that in vivo quantitation of dopamine transporter binding is feasible with [123I]FP-CIT and the TierSPECT. This may be of future relevance for in vivo investigations on rat models of attention deficit/hyperactivity disorder. Furthermore, our findings suggest that investigations in other animal models, e.g. of Parkinson's and Huntington's disease, may be feasible using SPECT radioligands and small animal imaging systems.

Animals↗
PubMed1998

FDG-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases? The Leuven Lung Cancer Group.

Exact localisation of thoracic lymph nodes (LNs) on fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) can be hampered by the paucity of anatomical landmarks. In non-small cell lung cancer (NSCLC) patients referred for locoregional LN staging, we prospectively examined to what extent localisation of LNs at PET reading could be improved by visual correlation with computed tomography (CT), or by anatometabolic PET+CT fusion images. Fifty-six patients with potentially operable NSCLC underwent CT, PET and surgical staging. Prospective reading was performed for CT, PET without CT, PET+CT visual correlation and PET+CT fusion. Reading was blinded to surgical pathology data and noted on a standard LN map. Surgical staging was available for 493 LN stations. In the evaluation per individual LN station, CT was accurate in 87%, PET in 91% and visual correlation and fusion in 93%. In the identification of the nodal stage, CT was correct in 28/56 patients (50%), PET in 37/56 (66%), visual correlation in 40/56 (71%), and fusion in 41/56 (73%). It is concluded that in the exact localisation of metastatic thoracic LNs, the accuracy of reading of PET is increased if the PET images can be visually correlated with CT images. PET+CT anatometabolic fusion images add only a marginal benefit compared with visual correlation.

Adult↗
PubMedDate not supplied

Restoration of the gluteal fold by a deepithelialized skin flap: preliminary observations.

BACKGROUND: The gluteal fold represents an important aspect of the gluteal region. Destruction of this anatomic landmark as a consequence of trauma or tissue harvest can result in an aesthetically disturbing disfigurement. A technique for reconstruction of the gluteal fold and preliminary results are presented. METHODS: The newly formed gluteal fold is created by fixation of a deepithelialized skin flap to the periosteum of the tuber ischiadicum. RESULTS: The operative procedure is quick and easy to apply. The method is used mainly for patients with a distorted gluteal fold after tissue harvest for breast reconstruction. However, it also can be used after trauma such as that associated with burn injuries. In all patients, reconstruction of the gluteal fold yielded aesthetically pleasing and reliable results with high patient satisfaction. CONCLUSIONS: The authors present a simple and effective technique for reconstruction of the gluteal fold by a deepithelialized skin flap. The technique is applicable for patients who have lost their natural gluteal sulcus, with a resultant altered buttock shape, after trauma or other causes.

Adipose Tissue↗
PubMed2004

Anatomical study concerning the origin and course of the pectoral branch of the thoracoacromial trunk for the pectoralis major flap.

The patterns of the feeding vessels to each muscle determine the extent of their safe transposition and the muscle's value as a pedicled flap in reconstructive surgery. This study aimed to demonstrate the point of origin and the intra- and submuscular course of the pectoral branch of the thoracoacromial trunk (TAT) for pectoralis major (PM) flap surgery. Seventy sides of the PM were dissected based on a clinical reference line that has been used for several decades. The branching point of the TAT from the axillary artery was located lateral to the midclavicular line on the right-sided specimens (100%) and medial to the midclavicular line on the left sides (86%). The branching patterns of the pectoral branch to the PM muscle from the TAT were classified into three types. In type I the pectoral branches originated directly from the TAT (55 cases, 78.6%). In type II (11 cases, 15.7%) and type III (4 cases, 5.7%) the pectoral branch divided from the medial and lateral pedicle of the TAT, respectively. The course of the pectoral branch from the TAT in the PM was categorized into three patterns according to the degree of proximity to the midclavicular line. In 49 cases (70%), the pectoral branch in the PM ran within 1 cm of the midclavicular line. The other cases ran 2 cm (20 cases, 29%) and 3 cm (1 case, 1%) from the midclavicular line, respectively. These results provide topographic data of the pectoral branch based on anatomical landmarks, and will be useful in surgical planning as well as the procedure for PM flap surgery.

Adult↗