BACKGROUND: Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself. METHODS: Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue. RESULTS: Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap). CONCLUSION: Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are "true" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.
- MeSH
- Humans MeSH
- Cadaver MeSH
- Perforator Flap * blood supply MeSH
- Forearm blood supply surgery MeSH
- Thigh blood supply MeSH
- Free Tissue Flaps * blood supply MeSH
- Plastic Surgery Procedures * methods MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND OBJECTIVES: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy. METHODS: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy). RESULTS: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements. CONCLUSION: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.
- MeSH
- Sacrum * surgery anatomy & histology innervation MeSH
- Middle Aged MeSH
- Humans MeSH
- Spinal Nerve Roots * anatomy & histology surgery MeSH
- Cadaver * MeSH
- Aged MeSH
- Splanchnic Nerves anatomy & histology surgery MeSH
- Plastic Surgery Procedures methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Lips are central to facial aesthetics, influencing overall balance and harmony. Ultrasound has become a key tool for assessing lip musculature and neurovascular structures, particularly in aesthetic filler injections. By enhancing precision and safety, ultrasound is valuable in procedures addressing age-related lip changes, yet standardized scanning protocols remain underexplored. AIMS: This review examined lip anatomy, summarized ultrasound applications in aesthetic procedures, introduced a structured scanning protocol, and highlighted its role in guiding filler injections. METHODS: A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted up to August 1, 2024, using keywords related to ultrasound and lip anatomy. Studies involving human subjects or cadavers using ultrasound for lip assessment and injection guidance were included, whereas nonhuman studies, alternative imaging methods, and research unrelated to the lip region were excluded. Six studies met the criteria. RESULTS: Ultrasound improves precision in lip injections by identifying key structures, including the superior and inferior labial arteries and the orbicularis oris muscle, reducing vascular risks. A structured scanning approach enhances procedural safety and efficacy. CONCLUSIONS: Ultrasound is a valuable tool in aesthetic lip procedures, improving accuracy and minimizing complications. Further research is needed to refine protocols and establish ultrasound as a standard practice in lip augmentation.
- MeSH
- Dermal Fillers * administration & dosage adverse effects MeSH
- Esthetics MeSH
- Ultrasonography, Interventional * methods adverse effects MeSH
- Cosmetic Techniques * adverse effects MeSH
- Humans MeSH
- Lip * diagnostic imaging anatomy & histology blood supply MeSH
- Skin Aging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1-4). The mean distance of the most distal branch was 35 mm (range 26-40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16-26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.Level of evidence: V.
- MeSH
- Ulnar Artery * surgery MeSH
- Surgical Flaps * blood supply MeSH
- Muscle, Skeletal * blood supply MeSH
- Humans MeSH
- Cadaver * MeSH
- Median Nerve surgery MeSH
- Forearm * surgery blood supply MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Lateral plating of calcaneal fractures using variable-angle locking plates is still the golden standard for severely comminuted cases. The aim of this study is to explore the possibilities of improving stability of osteosynthesis by changing screw directions. It provides an assessment and comparison of cadaveric biomechanical experiment with retrospective radiologic data analysis. METHODS: In the cadaveric study 8 intact calcaneus-talus specimens were obtained from 4 deceased donors. Fracture type 2b according to Sanders' classification was created in each specimen and fixed with variable-angle locking plate. The specimens were divided in 2 groups differing in orientation of anterior screws and fixed in PMMA base. A push-in test was performed by a two-column testing machine until gross failure. Retrospective cohort study was performed, reviewing data of 74 patients which underwent surgical treatment of calcaneal fractures with the same construct. Evaluation was performed at scheduled CT and X-Ray controls. Direction of inserted screws and implant failure were noted. FINDINGS: The cadaveric study proved that there is no significant difference in mean failure force between two abovementioned screw configurations in Sanders 2b fracture. A significant difference was observed in initial stiffness. The radiologic retrospective study showed that difference in screw position within all fracture types but type 2b is significant. INTERPRETATION: Screw configuration in the anterior part of variable-angle locking plate appears to affect primary stiffness and stability of the construct. Particularly in more comminuted fractures, screw inserted in the direction of sustentaculum improves the stability and lowers risk of implant failure.
- MeSH
- Biomechanical Phenomena MeSH
- Adult MeSH
- Fractures, Bone * surgery diagnostic imaging physiopathology MeSH
- Intra-Articular Fractures * surgery diagnostic imaging physiopathology MeSH
- Bone Plates * MeSH
- Bone Screws * MeSH
- Middle Aged MeSH
- Humans MeSH
- Cadaver MeSH
- Calcaneus * surgery diagnostic imaging injuries MeSH
- Radiography MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Fracture Fixation, Internal * methods instrumentation MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
UNLABELLED: The study aimed to analyze the entomological material collected during 13 autopsies performed on the unidentified cadavers revealed at different stages of decay in the Upper Silesia Region (Poland) over 2016-2022. During the preparation of human tissues for genetic identification, we revealed larvae, puparia, and adult insects in previously undescribed locations: costal cartilage, femur nutrient canals (foramen nutrients), and tooth cavities. The taxonomical assessment was done using morphological examination or DNA barcoding, where necessary. Based on our observations, we conclude that the apical constriction, foramen, and cavities may serve as migration paths inside teeth, and the femur nutrient canals to the bone marrow. The study also revealed that the beetle Necrobia ruficollis (Fabricius, 1775) and the moth family Pyralidae Latreille, 1802 (Phycitinae) moths can form pupal chambers inside the costal cartilage, indicating that these insects can complete their life cycle inside this cache. We believe that the newly reported locations of carrion insects in human remains may be relevant to forensic entomology, as they provide new opportunities to collect insect evidence. KEY POINTS: Costal cartilage may serve as an occasional cache for adults and immatures of carrion insects.Tooth cavities and apical foramen may serve as entryways for necrophilous insect larvae.Insect larvae use nutrient canals as migratory pathways to the bone marrow.
- Publication type
- Journal Article MeSH
Considering the growing role of ultrasound-guided procedures in musculoskeletal medicine, training as regards these interventions is pivotal. While hands-on training on cadavers can be considered optimal, it has several drawbacks, e.g., high cost, poor availability, and technical challenges regarding preservation. Apart from cadavers, different approaches to practicing needle guidance are taught in ultrasound workshops whereby phantoms from meat (e.g., chicken breast), cheese or gelatin are used. Likewise, this article aims to provide a detailed description as to how different gelatin-based phantoms can be prepared. In line with the EURO-MUSCULUS/USPRM (European Musculoskeletal Ultrasound Study Group/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) protocols/background, the authors describe particular basic and advanced phantoms to be used for practicing different technical/manual skills pertaining to common ultrasound-guided procedures. The present manuscript can be considered a practical and ready-to-use "recipe book" for readers who are interested in the wide spectrum of interventional ultrasound.
- MeSH
- Phantoms, Imaging * MeSH
- Ultrasonography, Interventional * MeSH
- Clinical Competence MeSH
- Humans MeSH
- Musculoskeletal Diseases diagnostic imaging rehabilitation MeSH
- Physical and Rehabilitation Medicine * education MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
This study aimed to delineate the macroscopic and microscopic topography of muscles surrounding the anterior aspect of the hip joint and the underlaying joint capsule. Seven fresh-frozen cadavers were bilaterally dissected as per study protocol. Eleven hip joints were evaluated macroscopically, while three hip joints underwent histological analysis. Additionally, twenty hip bones and femurs were examined for the osseous morphology near the anterior portion of the articulating surfaces. Macroscopically, the rectus femoris muscle contributed to the articular capsule exclusively through its reflected head. The iliocapsularis and iliopsoas muscles were in direct contact with the articular capsule. Although the iliocapsularis muscle was adherent to the capsule throughout its whole course, the iliopsoas muscle was connected to the capsule through the iliopectineal bursa. Microscopically, different spatial thickness of the capsule was observed, with the thicker regions corresponding to the capsular ligaments. Osseous landmarks, relevant to the course of the iliopsoas muscle, included the iliopsoas notch and a groove for the psoas major muscle. Furthermore, split of the anterior inferior iliac spine and the "subspine" were constant findings corresponding to the origin of the direct head of the rectus femoris and the iliocapsularis muscles, and attachment of the medial band of the iliofemoral ligament, respectively. On the head of the femur, the Poirier's facet (35.0%), the Allen's fossa (60.0%), and the so-called plaque (50.0%) were observed. Conclusively, we introduce the concept of a four-layered anterior musculocapsular complex of the hip, aiming to aid the orthopaedic surgeon in both hip replacement and preservation procedures.
- Publication type
- Journal Article MeSH
PURPOSE: This study provides an insight on the extent of muscular variability at the suprascapular notch and elaborates on its anatomical interference in suprascapular nerve arthroscopic decompression procedures. METHODS: The suprascapular notch was dissected and its muscular topography was observed in 115 cadaveric specimens. High resolution imaging of the suprascapular notch was captured by a handheld digital microscope (Q-scope). The supraspinatus and subscapularis muscles were traced as they course at the suprascapular notch vicinity. The omohyoid muscle attachment onto the suprascapular ligament was measured. A scoping review and meta-analysis were done to investigate the observed rare muscular variants. RESULTS: In 3.48%, the suprascapular notch anterior surface was fully covered by the subscapularis muscle. The omohyoid muscle inserted onto the suprascapular ligament in 31.25% and extended up to 3/4th of the suprascapular ligament length in 2.61%. Two rare variant muscles were encountered: subclavius posticus muscle and a newly reported "coracoscapularis muscle". CONCLUSIONS: Four categories of muscles with topographical relationship to the suprascapular notch and its arthroscopic feasibility have been classified: (1) constant muscles not intervening with the suprascapular notch space - supraspinatus muscle; (2) constant muscles with variable positions that can intervene with the suprascapular notch space - subscapularis muscle; (3) constant muscles with variable positions that can intervene with the surgical approach - omohyoid muscle; (4) variable muscles intervening with the suprascapular notch space and surgical approach - subclavius posticus and coracoscapularis muscles. This study elucidates the necessity to assess/secure the omohyoid muscle attachment onto the suprascapular ligament in suprascapular nerve decompression ligamentectomy. LEVEL OF EVIDENCE: V Basic Science Research.
- MeSH
- Anatomic Variation * MeSH
- Arthroscopy * methods MeSH
- Decompression, Surgical methods MeSH
- Muscle, Skeletal * innervation anatomy & histology MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula innervation anatomy & histology MeSH
- Cadaver * MeSH
- Shoulder Joint innervation surgery anatomy & histology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: Nerve grafting with the sural nerve is a standard treatment method for radial nerve injury that requires another incision at the lateral ankle distal from the injured upper limb. The aim of this study was to investigate the common trunk (CTCB) of the inferior lateral brachial cutaneous nerve (ILBCN) and posterior antebrachial cutaneous nerve (PACN) as a possible donor inside the lateral intermuscular septum. MATERIALS AND METHODS: The arms and legs of 8 formalin-embalmed cadaver specimens were studied. The radial nerve, common trunk of the ILBCN and PACN, and the sural nerve were identified and measured in length and diameter. For histological examination, nerve samples from 6 fresh cadavers were harvested and processed for further axonal counting. RESULTS: The average length of the CTCB was 114.92 ± 18.9 mm. To match the diameter of the radial nerve at its proximal third, 3 cables of CTCB graft were necessary, which corresponds to a defect length of 3.8 cm. At the level of the distal third, the number of grafts was reduced to 2 with a corresponding defect length of 5.7 cm. The radial nerve contained 15162 ± 318 axons, and the CTCB comprised 3959 ± 176 axons. To match the axon count of the recipient nerve, 4 grafts of CTCB were necessary, which corresponded to a defect length of 2.8 cm. CONCLUSION: CTCB is a consistent and easily dissected cutaneous nerve branch of the radial nerve that can be used for bridging small gaps after neuroma-in-continuity in radial nerve palsy.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Cadaver MeSH
- Nerve Transfer * methods MeSH
- Radial Nerve * surgery anatomy & histology injuries MeSH
- Sural Nerve * transplantation anatomy & histology MeSH
- Aged MeSH
- Plastic Surgery Procedures * methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
