47 research outputs found
What do plastic surgeons expect from anatomy in 2018? Clinical anatomy and applied research in plastic surgery
No full text
Intraoperatives Neuromonitoring autonomer Beckennerven mittels Bioimpedanzmessung
No full textAutonome Beckennerven sind bei viszeralchirurgischen Eingriffen im Bereich des kleinen Beckens wie beispielsweise Rektumresektionen bei Rektumkarzinom einem sehr hohen Risiko der intraoperativen iatrogenen Schädigung ausgesetzt. Die Folgen von Schädigungen der Beckennerven sind postoperativ auftretende Funktionsstörungen der Beckenorgane wie Harninkontinenz, Stuhlinkontinenz und sexuelle Funktionsstörungen, die zu einer Beeinträchtigung der Lebensqualität der Patienten führen können. Das autonome Nervengeflecht des Beckens ist hochkomplex, sehr filigran, innerviert glatte Muskulatur und kann in seiner topografischen Lage interindividuell verschieden sein. Da die Nerven rein visuell nur sehr schwer identifiziert werden können, ist deren Schonung im Verlauf der chirurgischen Präparation ohne technische Hilfsmittel und ohne fundierte Kenntnisse der pelvinen Neuroanatomie nicht möglich. Aufgrund der Unterschiede im Erregungs- und Reizreaktionsverhalten zwischen dem somatischen und dem autonomen Nervensystem können bekannte elektrophysiologische Neuromonitoring-Methoden nicht direkt auf das Monitoring autonomer Nerven übertragen werden, wodurch die Entwicklung neuer Methoden notwendig ist. Im Rahmen dieser Arbeit wurde eine neue Neuromonitoring-Methode zur Lokalisation autonomer Nerven mittels elektrischer Stimulation im OP-Gebiet und Impedanzmessung an glatter Muskulatur konzipiert und erforscht. Die bei der Durchführung einer präklinischen, wie auch einer klinischen Studie erzielten Ergebnisse weisen sowohl die technische als auch die klinische Machbarkeit der Impedanzmessung als Verfahren des intraoperativen Neuromonitorings nach und lassen darauf schließen, dass eine nervenschonende Präparation und eine damit verbundene Verminderung des Risikos für das Auftreten von postoperativen Funktionsstörungen der Beckenorgane möglich ist. Die klinische Machbarkeit wurde bei 28 der 30 Patienten (93,3 %) nachgewiesen. Darüber hinaus gehen erste klinische Daten zur klinischen Sicherheit und zum klinischen Nutzen der Methode aus der Auswertung des funktionellen Outcomes der Patienten der klinischen Studie hervor. Der auf der Basis der gewonnenen Messdaten der klinischen Studie realisierte softwaregestützte Automatic Muscle Impedance and Nerve Analyzer (AMINA) zur Beurteilung der abgeleiteten Impedanzsignale soll eine assistierte Signalinterpretation für eine einfache und schnelle Identifikation funktionaler Nerven während der OP möglich machen. Die Validierung des Verfahrens anhand erster Messdaten ergab eine Sensitivität der Signalbeurteilung von 96,3 % und eine Spezifität von 91,2 %.During pelvic visceral surgery, for example rectal resection for rectal cancer, the risk of iatrogenic injury to autonomic nerves in the pelvic region is very high. The consequences of pelvic nerve damage are postoperative pelvic organ dysfunction such as urinary incontinence, fecal incontinence, and sexual dysfunction, which may lead to a reduction of the patient’s quality of life. The pelvic plexus is a highly complex and very delicate component of the autonomic nervous system and may show interindividual variability with respect to location. Since it is difficult to identify the nerves purely on a visual basis, nerve-sparing surgical dissection is not possible without technical aids and without an in-depth knowledge of pelvic neuroanatomy. Because of the differences in excitation and stimulus response behavior between the somatic and autonomic nervous systems, known electrophysiological neuromonitoring methods cannot be directly applied to the monitoring of autonomic nerves, necessitating the development of new methods. In this work, a new neuromonitoring method for localization of autonomic nerves using electrical stimulation in the surgical area and impedance measurement on smooth muscle was designed and investigated. The results obtained in both a preclinical and a clinical study demonstrate both the technical and clinical feasibility of impedance measurement as a method of intraoperative neuromonitoring and indicate that nerve-sparing dissection and an associated reduction in the risk for the occurrence of postoperative dysfunction of the pelvic organs is possible. Clinical feasibility was proven in 28 out the 30 patients (93.3%). In addition, initial clinical data on the clinical safety and benefit of the method emerge from the evaluation of the functional outcome of patients in the clinical trial. The software-based Automatic Muscle Impedance and Nerve Analyzer (AMINA) for the evaluation of the derived impedance signals was implemented based on the measurement data obtained in the clinical study and is intended to enable assisted signal interpretation for easy and fast identification of functional nerves during surgery. Validation of the method based on initial measurement data showed a signal assessment sensitivity of 96.3% and a specificity of 91.2%
Relationships among Coracobrachialis, Biceps Brachii, and Pectoralis Minor Muscles and Their Correlation with Bifurcated Coracoid Process
No full textThe aim of this study is to demonstrate the relationship between the proximal attachment of the coracobrachialis muscle and the short head of the biceps brachii and the distal attachment of the pectoralis minor. Their correlation with the bifurcated coracoid process (CP) will be also assessed. On the basis of these observations, a new classification of structures attached to the coracoid process is proposed. Classical anatomical dissection was performed on one hundred forty-five upper limbs. Three types of relationship between the coracobrachialis muscle and the short head of the biceps brachii were observed in the cadavers. In type I (occurring in 54%), the coracobrachialis and the short head of the biceps brachii created a common junction attached to a single CP. Type II was divided into two subtypes (a and b). Subtype IIa (frequency 10%) was represented by independent proximal attachments of the short head of the biceps brachii and the coracobrachialis muscles to the CP. In subtype IIb (frequency 5%), the coracobrachialis muscle was two-headed (the first head located under the second) and not connected to the short head of the biceps brachii; all heads were attached to a single CP. Type III (frequency 31%) was characterized by a two-headed coracobrachialis muscle, the first head originating from a bifurcated CP laterally to the short head of the biceps brachii and the second medially to this structure. Different variations connected with the mentioned structures could be problematic for surgeons during operations, so detailed knowledge of them could contribute to more efficient procedures.Depto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu
Peripheral Nerve Anatomy Revisited: Modern Requirements for Neuroimaging and Microsurgery
No full textSexual Dimorphism in the Atlas Vertebra of Normal and Overweight Patients with its Possible Surgical Implications
No full textBackground: We aimed to detect the sexual dimorphism in the width and external anteroposterior length (EAPL) values of the atlas vertebra, and to detect significant correlations between the width and EAPL with height, weight and body mass index (BMI) in normal weight and in overweighted subjects. Methods: The width and EAPL were measured in 63 (32 females, 31 males) normal weight and in 61 (30 females, 31 males) overweighted individuals that underwent a cervical spine computed tomography scan. Data was first compared between all females and males, and secondly was compared between normal and overweight individuals. Spearman's correlation analysis was used to evaluate correlations between width and EAPL with height, weight and BMI. Results: Atlas width and EAPL were significantly higher in normal and overweight males (p<0.001). No correlations were found between height, weight and BMI and the width and EAPL in normal and overweight individuals. The only significant correlation found was between width and EAPL in both normal and overweight individuals (p <0.001). Conclusions: There is sexual dimorphism in atlas width and EAPL, with males presenting significantly higher values but there are no correlations between height, weight and BMI and the width and EAPL in both normal and overweight individuals. In addition, being overweight does not affect the correlation between width and EAPL
The carotid axis revisited
No full textThe aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures.
Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test.
The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height—0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = − 0.19 cm.) than the left one (x = − 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender.
Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system.Depto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu
Popliteal artery: Anatomical study and review of the literature
No full textBackground
The frequency of appearance of anatomical variability in the terminal division of the popliteal artery (PA) is different according to the type of sample used, and ranges from 2% to 21%.
The PA locates 1,01 cm behind to the lateral meniscus, which makes it vulnerable during surgical procedures. Iatrogenic injury of the PA or its terminal branches increases if anatomical variables are present.
Our aim was to describe and review the branching pattern of the PA in a body-donors to science sample to determine the influence of the sample used (body-donors vs imaging test).
Methods
A sample consisting of 260 popliteal regions, corresponding to 130 corpses (66 women, 64 men), have been dissected. Multivariate analysis was carried out.
Results
The terminal division of the PA was classified as follows:
Pattern 1: the PA divided into the anterior tibial (ATA) and the posterior tibial arteries (PTA) at the level or distal to the lower border of the popliteal muscle (PM) (94.7%).
Pattern 2: the PA bifurcated into the ATA and PTA, proximal to the lower border of the PM (3.3%).
Pattern 3: the PA divided at the same level into the ATA, PTA and PEA. (2%).
No significant differences between gender and side of the limb could be find.
Conclusions
We propose a classification that encloses three identifiable groups only. This will allow clinicians to bear in mind these variables easily, at the same time avoiding injuries during surgical procedures such as lateral meniscus repair.Depto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu
Variant plantaris muscle with degenerated accessory head: Gross and histological analysis
No full textThe variant plantaris muscle has itself been reported to have variable presentations. Here, we report an unusual finding of the plantaris muscle and report its gross and histological findings. A duplicated head of the plantaris muscle was identified in the right leg of an adult cadaver age and sex. The more anterior head of the muscle was in the typical location and originated from the superolateral condyle of the femur. However, the more posteriorly located head arose from the iliotibial band at the level of the distal thigh. The two heads united and continued as the typical distal tendon of the plantaris muscle to insert into the calcaneus tendon (Achilles). The normally positioned head of the plantaris muscle was found to be composed of typical skeletal muscle fibres. However, the accessory head of the plantaris muscle was found to be severely degenerated and infiltrated with adipose tissue. We report a duplicated head of the plantaris muscle. Histologically, the accessory head was degenerated and infiltrated with adipose tissue. To our knowledge, this is the first report of such a case. Further cases are now necessary to further elucidate this finding.Depto. de Anatomía y EmbriologíaFac. de MedicinaTRUEpu
