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 provide the anatomic basis for thelag screw placement in the anterior column of the acetabulum. Methods Twenty-two pelvis specimens with 44 acetabula of the native adult cadavers were studied. The anthropometric measurement was performed on 44 acetabula to determine the shape of the transverse section of the anterior column of the acetabulum, the optimal entry point for the lag screw on the outer table of the ilium, the direction of the screw, and the distance from the entry point to the obturator groove. Results The transverse section of the anterior column of the acetabulum was almost triangle-shaped. The path for the lag screw placement was 10.5±0.8 mm in diameter. The optimal entry point on the posterolateral ilium for the screw fixation was found toexist 9.2±2.4 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 38.5±3.8 mm superior to the greater sciatic notch. The distance from the entry point to the obturator groove was 84.1±6.2 mm. The inclination of the lag screw was 54.2±5.5° at the caudal direction in the sagittal plane and 40.7±3.8° in the horizontal plane. The device for the safe screw placement in the anterior column was designed. Conclusion The above datacan facilitate an insertion of one 6.5 mm lag screw into the anterior acetabular column and minimize the risk of articular violation or cortical penetration, which has a narrow margin of safety. The safe length of the lag screw should be 70 mm.The optimal entry point on the posterolateral ilium for the screw fixationis determined to be 10 mm superior to the line between the anterior superior iliac spine and the greater sciatic notch and 40 mm superior to the greater sciatic notch. The inclination of the lag screw should be 55° at the caudal direction in the sagittal plane and 40° in the horizontal plane. It is safe to place thelag screw in the anterior column with the help of the targeting device.
Objective To study the vascular applied anatomy，the anatomic features of fascial，and interfascial space around the pancreas and duodenum，observe marker and safe surgical plane of pancreaticoduodenal region，and provide clinical anatomy basis for surgery of duodenum， pancreatic head，and distal common bile duct．Methods Anatomical observations were performed in 7 formalin fixed cadavers on duodenum，distal common bile duct，and pancreatic peripheral blood supply．Transverse mesocolon，pancreatic capsule and potential interfascial space，surgical plane and anatomic marker for reorganization around pancreas were observed．Results Gastropancreatic fold and hepatopancreatic fold formed by pancreatic capsule were good markers to locate the root of left gastric artery and common hepatic artery．A vessel-free plane between the behind pancreas and the anterior lamella of Gerota fascia could be used to make lymphadenectomy and pancreatic dissection behind pancreas and duodenum．Gerota fascia should be regarded as a safe posterior border to avoid injuring vessels and adrenal gland by mistake．The descending part and horizontal part of duodenum were mainly supplied by the anterior and posterior pancreaticoduodenal arterial arcade．The anterior and posterior pancreaticoduodenal arterial arcade should be protected in duodenum-preserving resection of pancreatic head．Conclusions Full understanding of pancreatic fascial and interfascial space formed in embryonic development is very important．Operation along the interfascial spaces is safe without bleeding and organ injury，which is essential in oncosurgery．
OBJECTIVE: To provide anatomy basis for a free latissimus dorsal muscular flap with the sensate nerve. METHODS: The structure of back and lateral chest area were dissected and the origin, alignment and distribution of the intercostals nerve within the area of latissimus dorsal muscular flap were observed in 40 adult cadaver specimens. RESULTS: The 5th to 10th lateral posterior branches of the thoracic nerve pierced from respective intercostal area near the axial anterior line and run a long distance in deep fascia. They distributed mainly in lateral latissimus skin outside the scapular line and anastomosed with the lower branch near the scapular line. Among these branchs, the 6th to 8th branches had a longer nerve distribution respectively and the pedicle of nerve and artery was parallel and long. CONCLUSION: It is possible to design a sensate latissimus dorsal muscular flap with the 6th to 8th lateral posterior branch of the intercostal nerve.
Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
Objective To study the clinical anatomical basis of the liver hanging maneuver through research of applied anatomy. Methods Retrohepatic portions of the inferior vena cava of 21 cadaver were observed intracavitarily, and the numbers of short hepatic vein (SHV) opening were counted based on different possible pathway of the liver hanging maneuver and different width of retrohepatic tunnel (10 mm, 6 mm). Results The number of SHV was 0 to 3 (median=1) using standard pathway of the liver hanging maneuver in 6 mm retrohepatic tunnel, and the number of SHV was 0 to 2 (median=0) using EM pathway that was on the right border of retrohepatic portion of the inferior vena cava and 1 cm away from the inferior border of liver. There was a significant difference between the EM pathway and standard pathway, P=0.003.Conclusion The results show that setting up a retrohepatic tunnel through the liver hanging maneuver is feasible and safe.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
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 determine the entry point and screw implant technique in posterior pedicle screw fixation by anatomical measurement of adult dry samples of the axis so as to provide a accurate anatomic foundation for clinical application. MethodsA total of 60 dry adult axis specimens were selected for pedicle screws fixation. The entry point was 1-2 mm lateral to the crossing point of two lines: a vertical line through the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, and a horizontal line through the junction between the lateral border of inferior articular process and the posterior branch of transverse process. The pedicle screw was inserted at the entry point. The measurement of the anatomic parameters included the height and width of pedicle, the maximum length of the screw path, the minimum distance from screw path to spinal canal and transverse foramen, and the angle of pedicle screw. The data above were provided to determine the surgical feasibility and screw safety. ResultsThe width of upper, middle, and lower parts of the pedicle was (7.35±0.89), (5.50±1.48), and (3.97±1.01) mm respectively. The pedicle height was (9.94±1.16) mm and maximum length of the screw path was (25.91±1.15) mm. The angle between pedicle screw and coronal plane was (26.95±1.88)° and the angle between pedicle screw and transverse plane was (22.81±1.61)°. The minimum distance from screw path to spinal canal and transverse foramen was (2.72±0.83) mm and (1.98±0.26) mm respectively. ConclusionAccording to the anatomic research, a safe entry point for C2 pedicle screw fixation is determined according to the midpoint of distance from the junction of pedicle medial and lateral border to lateral mass, as well as the junction between the lateral border of inferior articular process and the posterior branch of transverse process, which is confirmed to be effectively and safely performed using the entry point and screw angle of the present study.
Objective To investigate the anatomic foundation of using main branch of posterior femoral nerve to restore the sensation function of distal basedsural island flap. Methods Thirty cases of adult human cadaver legs fixed by 4%formaldehyde were used. Anatomical investigation of the posterior femoral nerves of lower legs was conducted under surgical microscope to observe their distribution, branches and their relationship with small saphenous vein. Nerve brancheswith diameter more than 0.1 mm were dissected and accounted during observation.The length and diameter of the nerves were measured. Results The main branch of posterior femoral nerve ran downwards from popliteal fossa within superficial fascia along with small saphenous vein. 70% of the main branch of the posterior femoral nerves lay medially to small saphenous vein, and 30% laterally. They wereclassified into 3 types according to their distribution in lower legs: typeⅠ (33.3%) innervated the upper 1/4 region of lower leg (region Ⅰ), type Ⅱ (43.3%) had branches in upper 1/2 region (region Ⅰ and Ⅱ), and type Ⅲ (23.3%) distributed over the upper 3/4 region (region Ⅰ, Ⅱ and Ⅲ). In type Ⅱ, the diameter of the main branches of posterior femoral nerves in the middle of popliteal tossa was 10±04 mm and innervated the posterior upper-middle region (which was the ordirary donor region of distal based sural island flaps) of lower legs with 2.0±0.8 branches, whose diameter was 0.3±0.2 mm and length was 3.5±2.7 mm. The distance between the end of these branches and small saphenous vein was 0.8±0.6 mm. In type Ⅲ, their diameter was 1.2±0.3 mm and innervated the posterior upper-middle region of lower legs with 3.7±1.7 branches, whose diameter was 0.4±0.1 mm and length was 3.7±2.6 mm. The distancebetween the end of these branches and small saphenous vein was 0.8±0.4 mm. Conclusion 66.6% of human main branch of posteriorfemoral nerves (type Ⅱ and type Ⅲ) can be used to restore the sensation of distal based sural island flap through anastomosis with sensor nerve stump of footduring operation.