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Medial Aspect (medial + aspect)
Selected AbstractsA Method of Augmenting the Cheek Area Through SMAS, subSMAS, and Subcutaneous Tissue Recruitment During Facelift SurgeryDERMATOLOGIC SURGERY, Issue 3 2003Dominic A. Brandy MD BACKGROUND As the human face ages, there is a depletion of fat that occurs in the submalar region. Various techniques such as fat transfers, fillers, alloplastic implants, and composite rhytidectomies have been used to augment this area in the past. OBJECTIVE To describe a technique that augments the submalar areas during facelift surgery without the use of fat transfer, fillers, alloplastic implants, or a risky composite technique. METHOD An oval is scribed over the depressed submalar areas preoperatively. During facelift surgery, a fusiform area is scribed over the SMAS. This fusiform is scribed so that the medial end is directed at the center of the submalar depression, and the lateral end is toward the posterior earlobe. A defect is created within the lateral aspect of the fusiform, but not the medial portion. The fusiform is subsequently closed with a 2-0 Ethibond suture using three horizontal mattress sutures and two interrupted sutures. Upon closure of this defect, SMAS, subSMAS, and subcutaneous tissue overlying the SMAS are recruited into the submalar defect by the simple phenomenon of dog-ear formation. Additionally, there is a component of frank elevation of the tissues inferior to the medial aspect of the fusiform and submalar space. RESULTS The aforementioned technique has been performed on 123 patients over 7 years and has resulted in consistently good improvement in the submalar space. The procedure is not difficult to learn, and good results can be achieved with initial cases. The learning curve was not found to be steep, with good results being achieved quickly. CONCLUSION Depression of the submalar space plays a significant role in creating an aged face. In the past, various fillers and/or alloplastic implants have been used to augment this region. A low-risk method is described that mobilizes SMAS, subSMAS, and subcutaneous tissues into the submalar space through the phenomenon of dog-ear formation after fusiform closure. [source] Radiographic and clinical survey of degenerative joint disease in the distal tarsal joints in Icelandic horsesEQUINE VETERINARY JOURNAL, Issue 3 2000S. Björnsdóttir Summary The prevalence of degenerative joint disease (DJD) in the distal tarsal joints and the relation between radiographic and clinical signs compatible with the disease were estimated in a population of Icelandic horses used for riding. The material consisted of 614 horses age 6,12 years (mean age = 7.9 years). Radiographs with 3 projections of each tarsus were made and a clinical examination, including palpation of the medial aspect of the distal tarsus and motion evaluation of the hindlimbs before and after a flexion test of the tarsus, was performed. Radiographic signs of DJD in the distal tarsal joints were found in 30.3% of the horses and the prevalence was strongly correlated with age. Hindlimb lameness before and after flexion test and palpation abnormalities were significantly associated with the radiographic findings. The lameness was usually mild and, in most cases, detectable only after the flexion test. The prevalence of lameness was not significantly correlated with age. Lameness could not be predicted by details of the radiographic findings. [source] Necrotizing fasciitis: delay in diagnosis results in loss of limbINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2006Rajat Varma MD A 58-year-old man presented to the Emergency Room with a 1-day history of severe pain in the left lower extremity preceded by several days of redness and swelling. He denied any history of trauma. He also denied any systemic symptoms including fever and chills. His past medical history was significant for diabetes, hypertension, deep vein thrombosis, and Evans' syndrome, an autoimmune hemolytic anemia and thrombocytopenia, for which he was taking oral prednisone. Physical examination revealed a warm, tender, weeping, edematous, discolored left lower extremity. From the medial aspect of the ankle up to the calf, there was an indurated, dusky, violaceous plaque with focal areas of ulceration (Fig. 1). Figure 1. Grossly edematous lower extremity with well-demarcated, dusky, violaceous plaque with focal ulceration Laboratory data revealed a white blood cell count of 6.7 × 103/mm3[normal range, (4.5,10.8) × 103/mm3], hemoglobin of 11.5 g/dL (13.5,17.5 g/dL), and platelets of 119 × 103/mm3[(140,440) × 103/mm3]. Serum electrolytes were within normal limits. An ultrasound was negative for a deep vein thrombosis. After the initial evaluation, the Emergency Room physician consulted the orthopedic and dermatology services. Orthopedics did not detect compartment syndrome and did not pursue surgical intervention. Dermatology recommended a biopsy and urgent vascular surgery consultation to rule out embolic or thrombotic phenomena. Despite these recommendations, the patient was diagnosed with "cellulitis" and admitted to the medicine ward for intravenous nafcillin. Over the next 36 h, the "cellulitis" had advanced proximally to his inguinal region. His mental status also declined, and he showed signs of septic shock, including hypotension, tachycardia, and tachypnea. Vascular surgery was immediately consulted, and the patient underwent emergency surgical debridement. The diagnosis of necrotizing fasciitis was then made. Tissue pathology revealed full-thickness necrosis through the epidermis with subepidermal splitting. Dermal edema was also present with a diffuse neutrophilic infiltrate (Fig. 2). This infiltrate extended through the fat into the subcutaneous tissue and fascia. Tissue cultures sent at the time of surgery grew Escherichia coli. Initial blood cultures also came back positive for E. coli. Anaerobic cultures remained negative. Figure 2. Necrotic epidermis with subepidermal splitting. Marked dermal edema with mixed infiltrate and prominent neutrophils. Hematoxylin and eosin: original magnification, ×20 After surviving multiple additional debridements, the patient eventually required an above-the-knee amputation due to severe necrosis. [source] Complications following tarsal arthrodesis using bone plate fixation in dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2008S. P. Roch Objectives: To report the complications encountered following tarsal arthrodesis surgery with bone plate fixation and describe the previously unreported complication of plantar necrosis. Methods: Medical records of 40 dogs that had been treated by tarsal arthrodesis with bone plate fixation were reviewed to determine the major and minor complications and the associated risk factors. Results: The major complication rate was 32·5 per cent and the minor complication rate was 42·5 per cent. Pantarsal arthrodeses had a higher major complication rate than partial tarsal arthrodeses. Plantar necrosis was the most common major complication and occurred in 15 per cent of cases. Plantar necrosis occurred more frequently when a bone plate was applied to the medial aspect of the hock, and only occurred in cases where tarsometatarsal joint arthrodesis was performed. Clinical Significance: Plantar necrosis is a catastrophic complication that may be associated with injury to the dorsal pedal artery or perforating metatarsal artery. Application of a bone plate to the medial aspect of the hock should be performed with care during tarsal arthrodesis, particularly where the tarsometatarsal joint is debrided of cartilage. Strict attention to surgical technique and proper postoperative coaptation is critical to reduce the potential for complications with tarsal arthrodesis. [source] Co-existence of ununited anconeal process and fragmented medial coronoid process of the ulna in the dogJOURNAL OF SMALL ANIMAL PRACTICE, Issue 2 2006A. Meyer-Lindenberg Objectives: To determine the incidence of fragmented medial coronoid process of the ulna in dogs with ununited anconeal process. The efficacy of presurgical radiography to diagnose the co-existence of these diseases was also investigated. Methods: One hundred and fifty-five joints from 137 dogs with ununited anconeal process were included in the study. For the radiographic examinations, an extended mediolateral projection and a craniolateral-caudomedial oblique projection of each elbow joint were taken before surgery. Inspection of the medial part of the joint was carried out either by arthrotomy or arthroscopy. Results: Seventy-two per cent of the dogs were German shepherd dogs. In 25 joints (16 per cent) a fragmented medial coronoid process was diagnosed and removed via arthrotomy or arthroscopy. The co-existence of a fragmented medial coronoid process was diagnosed correctly in only 13 cases (52 per cent) by radiography. In five of these cases with advanced osteoarthritis, the fragment was directly visible because of its dislocation. Compared with published information, the occurrence of ununited anconeal process with fragmented medial coronoid process is noted more frequently in the present study. Clinical Significance: It can be summarised that if ununited anconeal process is present, it is not usually possible to clearly identify fragmented medial coronoid process by radiography. Therefore, it is important to be able to inspect the medial aspect of the joint concerned during surgery. [source] What is your diagnosis?JOURNAL OF SMALL ANIMAL PRACTICE, Issue 1 2001Article first published online: 28 JUN 200 A two-year-old, female English springer spaniel was admitted as an emergency soon afier being hit by a car. The dog was unable to stand on the pelvic limbs, which appeared weak. A small skin wound was noted on the medial aspect of the right thigh. There were no apparent neurological deficits. Radiographs were made to rule out pelvic fracture (Fig lA, B). What are the radiological signs? What would you do next to better evaluate this abnormality? [source] CRANIAL TIBIAL ARTERY CATHETER FOR MONITORING PRESSURES AND SAMPLINGJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue S1 2004DT Crowe A technique for placement of a long-term arterial catheter that the author developed was used in 20 canine patients. The catheter was used for pressure monitoring and arterial blood sampling. The technique involved the following steps post-sedation and placement of a local anesthetic: 1Clipping and prepping of the medial aspect of the distal tibia and proximal metatarsal region; 2Incision over the medial tibial malleolus just caudal to the cranial tibial muscle-tendon; 3Blunt dissection of the space just caudal to the cranial tibialis tendon; 4Isolation of the cranial tibial artery and loop placement proximally and distally; 5Placement of a 3 Fr. polyurethane 4,8 cm catheter using a Seldinger wire technique; 6Placement of a suture in the periosteium of the distal tibia and anchoring of the catheter with this suture; 7Closure of the skin incision with sutures or staples; 8Bandage application to hold the catheter in place. The entire surgical procedure was done using sterile technique. The catheter was able to be kept in place and working for up to 9 days (averaged 4 days). This compared favorably retrospectively over dorsalis pedis catheters that lasted only a maximum of 4 days. (average 1.5 days). Because of the size of the catheter (3 Fr.) it provided improved waveforms over that observed with the dorsalis pedis catheter (22 g) and its occlusion rate was very low (2 in 20). The cranial tibial artery catheter was found to be particularly effective because the catheter was able to be inserted several cm up the artery and the catheter was able to be anchored well. No major complications were observed with this technique. Because of its effectiveness it is recommended to be used routinely over femoral artery and dorsal pedis artery catheters. [source] The morphometric analysis of the central retinal arteryOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2005Necdet Kocabiyik Abstract In this study, we aimed to investigate some features of the central retinal artery (CRA), which supplies the internal aspect of the retina. The CRA is the main vessel supplying blood to the retina. The origin, course and penetration point of the optic nerve by the CRA were studied in 30 human orbits. We compared the right sides to the left sides on the basis of gender in order to statistically analyse the relation between them. The CRA arose directly from the ophthalmic artery in 28 specimens. In two specimens, however, it arose in common with the medial posterior ciliary artery. When we observed the penetration point (site) of the CRA into the optic nerve, in 28 of 30 (93.3%) cases, the artery entered the nerve from the lower medial aspect and in two (6.7%) cases from the upper lateral aspect. The CRA penetrated the optic nerve between 6.4 and 15.2 mm behind the eyeball and reached the eyeball through the centre of the optic nerve. Because of the small diameter of the artery, it has a high risk of getting damaged during a surgical approach to the orbit. Therefore the anatomical relationships of this artery must be well known. [source] Structural parameters of the vastus medialis muscle and its relationship to patellofemoral joint deteriorationCLINICAL ANATOMY, Issue 3 2007J. Peeler Abstract Vastus medialis (VM) muscle dysfunction and abnormal limb alignment are commonly observed in patients who experience changes in patellofemoral joint (PFJ) function, leading many clinicians to assume that there is a direct relationship between VM structural parameters, leg alignment, and PFJ dysfunction. This study tested the hypothesis that there is a relationship between structural parameters of the VM muscle, limb alignment, and the location and severity of patellofemoral joint deterioration (PFJD). The dissection study used 32 limbs from 24 intact cadavers. Data were collected on limb alignment, angle of VM muscle fibers below the superior aspect of the patella, length of VM inserting on the medial aspect of the patella, and severity and location of PFJD. Parametric and nonparametric statistical analyses illustrated that PFJD was most commonly located on the middle third of the medial half of the patellar articular surface. The severity of PFJD did not vary with location. There was no significant correlation between any of VM insertion length, VM fiber angle, limb alignment, and PFJD location and severity lpar;r2 < 0.34). The results of this study did not support the hypothesis of a relationship between structural parameters of the VM muscle, limb alignment, and the location and severity of PFJD in this subject group. Future research should examine the relationship between functional parameters of the entire quadriceps muscle group and PFJ dysfunction. Clin. Anat. 20:307,314, 2007. © 2006 Wiley-Liss, Inc. [source] Localized Chronic Fibrosing Vasculitis or Localized Erythema Elevatum Diutinum?JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005L. Clarke Localized chronic fibrosing vasculitis is a rare dermatosis that histologically resembles late-stage erythema elevatum diutinum (EED) but has a different clinical presentation. A 62-year-old male presented with bilateral nodules on his heels that first appeared two years ago and over the past six months had become extremely painful. He denied any recent trauma to the sites, and his medical history was significant only for diabetes mellitus, coronary artery disease, and osteoarthritis. Physical exam demonstrated focally ulcerated violet-red three-centimeter nodules on the medial aspects of both heels. Biopsy revealed dense concentric and lamellar fibrosis with foci of leukocytoclastic debris and a sparse infiltrate of histiocytes, neutrophils, eosinophils, and lymphocytes. No granulomas were present, and histochemical stains and tissue cultures for microorganisms were negative. Imaging studies showed no evidence of underlying osteomyelitis, cellulitis, or abscess formation. Laboratory studies demonstrated a markedly elevated IgA level that was shown to be polyclonal on serum immunofixation studies. All peripheral blood cell counts were normal. Thorough evaluations for systemic vasculitides and connective tissue disorders were negative. A diagnosis of localized chronic fibrosing vasculitis was made. This case illustrates the clinicopathologic overlap between this disorder and EED. [source] The role of the calcar femorale in stress distribution in the proximal femurORTHOPAEDIC SURGERY, Issue 4 2009Qi Zhang MD Objective:, To investigate the role of the calcar femorale in stress distribution in the proximal femur. Methods:, Twenty-five specimens of proximal femurs were fixed to simulate single-limb stance. Strain gauges were applied to record the strain under different loads. Strain values of 27 selected sites in the proximal femur were recorded and analyzed at the level of 100 N, 200 N, 300 N, 400 N, 500 N, 600 N and 700 N, respectively before and after disruption of the calcar femorale. Results:, When a normal load was being borne, strain values measured in the posterior and medial aspects of the proximal femur were greater than those measured in the anterior and lateral aspects, no matter whether the calcar femorale was disrupted or not. However after disruption of the calcar femorale, strain values in the posterior and medial aspects of the proximal femur increased significantly, whereas those of the anterior and lateral aspects decreased significantly. Conclusion:, The calcar femorale redistributes stress in the proximal femur by decreasing the load in the posterior and medial aspects and increasing the load in the anterior and lateral aspects. [source] Visual subdivisions of the dorsal ventricular ridge of the iguana (Iguana iguana) as determined by electrophysiologic mappingTHE JOURNAL OF COMPARATIVE NEUROLOGY, Issue 3 2002Paul R. Manger Abstract The dorsal ventricular ridge (DVR) of reptiles is one of two regions of the reptilian telencephalon that receives input from the dorsal thalamus. Although studies demonstrate that two visual thalamic nuclei, the dorsal lateral geniculate and rotundus, send afferents to the dorsal cortex and DVR, respectively, relatively little is known about physiologic representations. The present study determined the organization of the visual recipient region of the iguana DVR. Microelectrode mapping techniques were used to determine the extent, number of subdivisions, and retinotopy within the visually responsive region of the anterior DVR (ADVR). Visually responsive neurons were restricted to the anterior two thirds of the ADVR. Within this region, two topographically organized subdivisions were determined. Each subdivision contained a full representation of the visual field and could be distinguished from the other by differences in receptive field properties and reversals in receptive field progressions across their mutual border. A third subdivision of the ADVR, in which neurons are responsive to visual stimulation is also described; however, a distinct visuotopic representation could not be determined for this region. This third region forms a shell surrounding the lateral, dorsal, and medial aspects of the topographically organized subdivisions. These results demonstrate that there are multiple physiologic subdivisions in the thalamic recipient zone of the ADVR of the iguana. Comparisons to the ADVR of other reptiles are made, homologies to ectostriatial regions of the bird are proposed, and the findings are discussed in relation to telencephalic organization of other vertebrates. J. Comp. Neurol. 453:226,246, 2002. © 2002 Wiley-Liss, Inc. [source] | |||||||||||||