Objective To provide the anatomic bases for clinical application of the second dorsal metacarpal artery(SDMA) island flap with double pivot points. Methods The origin,branches and distribution of the recurrent cutaneous branch of the SDMA were observed in 30 adult fresh cadaver specimens, which were illustrated with special dye.Eighteen cases of skin defets of the thumb were repaired with the SDMA island flap. The defect locations were the dorsal part in 11 cases and palmar part in 7 cases, including 3 cases of defect in association with long pollical extensor defect and 2 cases of defect in association with dorsal skin defect of proximal finger. The flap area ranged from 2 cm×3 cmto 3 cm×5 cm. Results The appearance of therecurrent cutaneous branch of the SDMA was observed in all cases(100%), which originated 0.5±0.2 cm distant from the distal intersectiones between the SDMA and the index extensor and disappeared 1.2±0.5 cm distant from the proximal metacarpophalangeal joint. The branches of 1.7±0.7 were seen with a longitudinal fan-like distributionforward proximal part on the deep surface of the dorsal superficial vein. The exradius and the length of the recurrent cutaneous branch of the SDMA were 0.3±0.1 mm and 6.5±0.8 mm, respectively. The transplanted flaps survived in all cases and 16 cases were followed up for 8-14 months. The colour and appearance of the skin were satisfactory. The two-point discriminations were 0.9 mm in 3 cases by bridging digital nerve and 1.1 mm in 9 cases by anastomosing dorsal digital nerve; while the two-point discrimination was 13-15 mm in 4 cases without anastomosing nerve. Conclusion The origin,branches and distribution of the recurrent cutaneous branch of the SDMA is constant, which provide a potentially longer pedicle and increase the possibility to rotate the flap and also avoid the donor skin defect of rotation of the flap.
ObjectiveTo compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. MethodsEighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. ResultsThe correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ2=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ2=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). ConclusionIt has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.
To evaluate the possibil ity of collateral outflow tract of arterial sclerosis obstruction （ASO）and the prospect of cl inical appl ication. Methods The red emulsion was infused into the arteries of the above knee amputation of 10 fresh specimens. Then the pathological changes of the anterior tibial artery, posterior tibial artery and the popl iteal artery, and the contribution of these bole artery branch were observed. From September 2005 to April 2007, 5 patients with ASO were treated, unilateral lower l imb was involved in all cases. There were 3 males and 2 females, aged 68-81 years. The arteriography and Color Doppler ultrasound of lower l imbs showed that the femoral artery and the popl itealartery and the branches had no development. The exploratory operation on the popl iteal artery and the branches was carried out. Results The walls of the anterior tibial artery, posterior tibial artery, and the popl iteal artery were stiff and the lumens were filled with atheromatous plaque. The sural arteries opening to the bole artery was frequent. The collateral circulation at the knee perimeter was raritas rather affluent at the muscle group. All of the operations were successful, the skin temperature increased gradually after operation, and the degrees of blood oxygen saturation increased to 90%-100% at 6 hours from 0 before operation . After a follow-up of 3 to 12 months, the symptom improved obviously, rest pain disappeared, lower l imb ulcer healed. The Color Doppler ultrasound showed that most of the blood flow at the anastomotic stoma ejected into bypass circuit, and the blood flow at the distally posterior tibial artery and anterior tibial artery was l ittle. Conclusion The collateral outflow tract construction is feasible, it is an effective path after cl inical verification to solve the advanced stage ASO
Objective To explore the significance of parathyroid micro vascular anatomy in thyroid lobectomy with capsular technique. Methods The pertinent literatures in recent thirty years were screened with key words “parathyroid micro vascular anatomy， capsular technique， and protection”and reviewed. Results There were many types of number， origin， and length of parathyroid vascular， and specific measurements should be taken in thyroid lobectomy with capsular technique. Conclusion Fully awareness of parathyroid micro vascular anatomy will benefit to ensure preservation of their function during thyroid lobectomy with capsular technique.
Objective To provide the anatomic basis for the posterior urethral repair via the perineal approach. Methods The anatomicconstructions andtheir relationships of the perineal approach from skin to the membranous and prostate apical urethra were observed and some related data were measured in 12 adult male specimens by microanatomy, and the procedures of urethral repair via the perineal approach were carried out in 3 fresh male specimens. Results All the blood vessels and nerves, which supplied the scrotum, the perineum, and bulbourethra, passed lateral-medially. The cavernous nerves coursed posterolaterally from the bottom to the apex of the prostate, pierced the urogenital diaphragm and passed laterally to themembranous urethra in a status of gridding, whose width was (12.11±2.32) mm.Conclusion The structures of the perineum and around the posterior urethra are complicated. The strategy for diminishing the damages to them is that all structures must be dissected strictly in the midline. Confining the dissections strictly to the range of 5 mm from the membranous urethra and resecting the apical prostatic tissues anterolaterally could avoid impairments of the cavernous nerves.
OBJECTIVE: To explore the kidney anatomic structure of banna minipig inbred-lines, and to provide data for kidney xenotransplantation. METHODS: The fresh and infused kidneys of banna minipig (including the vessel and the ureter) were checked by anatomic microscope and vernier caliper in original location and away body. The tissue structure was observed by HE stain. RESULTS: The structure of kidney of banna minipig inbred-lines (including the vessel and the ureter) are similar to that of human being. The fascia propria of kidney is divided into three layers including capsula fibrosa, capsula adipose and fascia renalis. The thickness of cortex renalis is (20.0 +/- 2.4) mm. The average diameter of renal artery is 5.1 mm and is similar to that of human being. All the kidneys of banna minipig inbred-lines have a single branch renal artery. The diameters of left and right ureters are 5.1 mm and 4.7 mm, respectively. CONCLUSION: The kidney of banna minipig inbred-lines is an ideal replacement of human kidney for xenotransplantation.
Objective To study the microsurgical anatomy of the facial nerve (FN ) trunk and provide some important morphometric data about facialhypoglossal nerve anastomosis (FHA). Methods Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalinwith three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side ofthis muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. Results The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57±0.60mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62±2.88 mm. The length of the FN trunk was 15.71±1.97 mm. The distance between the bifurcation and the mastoidale was 18.20±4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91±8.38 mm. The distance between the mastoidale and the SMF was 17.91±2.68 mm. The branches fromthe FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve.Conclusion The third method to expose the FN trunk on its emergence from the SMFis safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.
ObjectiveTo review research progress in the anterolateral ligament (ALL) of knee, and provide a clinical reference for diagnosis and treatment of ALL injury.MethodsThe literature on the diagnosis and treatment of ALL injury was widely reviewed. The incidence, anatomy, biomechanics, injury mechanism, and treatment status of ALL were summarized.ResultsThe ALL contributes to the effect of controlling the internal rotation and anterior translation of the tibia, which affects the axial migration of the knee. ALL injury can be diagnosed according to the signs and MRI examination. Currently, no consensus exists for the surgical indications of ALL injury, but most surgeons tend to perform ALL reconstruction in patients requiring anterior cruciate ligament (ACL) reconstruction or revision surgery with higher pivot-shift tests. At present, various techniques have been used for ALL reconstruction, and there is no optimal technique. In addition, the long-term effectiveness of ALL reconstruction is unclear due to the lack of high-quality studies and long-term postoperative follow-up.ConclusionThe ALL contributes to maintaining knee stability, and the ALL reconstruction technique and its effectiveness still need further research.
Objective To observe and measure the approach next to the erector spinae in the thoracic and lumbar segments of the spine and adjacent anatomical structures by the topographic method, to clarify the positioning method and safe range so as to provide the anatomical basis of the approach for spinal canal decompression. Methods Twelve formaldehyde-treated adult cadaver specimens were selected, including 6 males and 6 females with an average age of 43 years (range, 27-52 years) and with an average height of 166 cm (range, 154-177 cm). The related data of the approach at T1-S1 levels were respectively measured: the distance between the lateral edge of the erector spinae and the spinous process, the length of the approach, the angle between the approach and the horizontal plane, the size of intervertebral foramen, and the vertical distance between the segmental artery and the upper edge of the vertebrae. Results The distance between the lateral edge of the erector spinae and the spinous process ranged from (41.75 ± 3.29) mm to (74.54 ± 7.08) mm. The length of the approach ranged from (66.75 ± 10.81) mm to (97.13 ± 13.35) mm. The angle between the approach and the horizontal plane ranged from (38.38 ± 6.16)° to (53.67 ± 4.40)°. The vertical distance between the segmental artery and the upper edge of the vertebrae ranged from (9.50 ± 0.60) mm to (18.30 ± 1.56) mm. The size of foraminal was also measured. The spinal canal could reach when iliocostalis lateral edge was used as the starting point in the lumbar segments, and longissimus lateral edge as the starting point in the thoracic segments. It was confirmed that there was enough safe space for the spinal decompression without the resection of the articular process. Conclusion The approach next to the erector spinae can reach spinal canal to achieve the purpose of decompression through the intervertebral foramen. The minimally invasive approach is feasible and safe. It has the value of the operative application.
ObjectiveTo explore early clinical effects of Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium minitype plate fixation, to research the data of the best slotting in the CT-based open-door cervical operation and to provide the reference for accurate operation. MethodsA retrospective analysis of the patients who had received Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation from West China Hospital of Sichuan University from February 2013 to November 2013 were performed. The neurological function assessment results (JOA score), cervical curvature indexhave, Pavlov value, spinal canal cross-sectional area and different position, angle and depth of C7 lamina slotting data of all patients before and after the operation were all analyzed and compared. ResultsA total of 58 patients were included. The postoperative JOA score was significantly higher than that of the preoperative (9.4±2.9 vs. 14.7±2.6, t=11.417, P=0.000). The sagittal diameter of vertebral canal (21.3±2.1 mm vs. 9.7±2.1 mm, t=27.737, P=0.000), Pavlov value (0.92±0.13 vs. 0.44±0.12, t=30.621, P=0.000), and spinal canal cross-sectional area (276±37 mm2 vs. 129±25 mm2, t=32.104, P=0.000) at the end of the last follow-up were significantly greater than those of preoperative. When comparing the last follow-up with preoperative, cervical curvature index showed significant difference (11.2±11.5 vs. 9.3±11.7, t=-1.713, P=0.000). Significant differences were found in the comparison of the ideal position and angle of the open door of the C7 lamina and the angle and position of the operation (all P values >0.05); when comparing the position and angle of the ideal position and angle of the C7 lamina hinge with that of the actual operation, no significant differences were found (all P values >0.05); but when comparing the ideal depth with the actual depth of the operation, a significant difference was found (P<0.05). ConclusionCenterpiece micro plate used in posterior cervical expansive open-door laminoplasty forming operation of laminectomy fixed screw loosening and plate breakage, can effectively maintain the lamina in the open state, and prevent it to be closed. The patients have good recovery of nerve function after operation and the clinical efficacy is good.