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Cadaveric Study (cadaveric + study)
Selected AbstractsEfficacy of mediastinal lymphadenectomy in transhiatal esophagectomy with and without diaphragm opening: a cadaveric studyDISEASES OF THE ESOPHAGUS, Issue 2 2002F. A. M. Herbella SUMMARY., Transhiatal esophagectomy (THE) is believed to induce a lower morbidity and mortality compared with transthoracic esophagectomy, but to be inefficient in performing mediastinal lymphadenectomy. Some surgeons are convinced that lymphadenectomy of the lower mediastinum in THE and transthoracic esophagectomy are equivalent. To test this, the authors performed THE in 20 cadavers (10 with and 10 without diaphragm opening). The number of lymph nodes resected with the esophagus and dissected through the hiatus was counted. After THE, the thorax was opened and the number of residual lymph nodes was evaluated. Complications were also assessed. The results show that lymphadenectomy in THE is incomplete in the lower mediastinum and not possible in the upper mediastinum; comparing THE with and without diaphragm opening, the first permits resection of a superior number of lymph nodes with the esophagus and dissection of a higher number of nodes through the hiatus. It is concluded that THE does not provide an effective mediastinal lymphadenectomy. [source] The perforator angiosome: A new concept in the design of deep inferior epigastric artery perforator flaps for breast reconstructionMICROSURGERY, Issue 1 2010B.Med.Sc., P.G.Dip.Surg.Anat., Ph.D., Warren M. Rozen M.B.B.S. Background: The previously described "perfusion zones" of the abdominal wall vasculature are based on filling of the deep inferior epigastric artery (DIEA) and all its branches simultaneously. With the advent of the DIEA perforator flap, only a single or several perforators are included in supply to the flap. As such, a new model for abdominal wall perfusion has become necessary. The concept of a "perforator angiosome" is thus explored. Methods: A clinical and cadaveric study of 155 abdominal walls was undertaken. This comprised the use of 10 whole, unembalmed cadaveric abdominal walls for angiographic studies, and 145 abdominal wall computed tomographic angiograms (CTAs) in patients undergoing preoperative imaging of the abdominal wall vasculature. The evaluation of the subcutaneous branching pattern and zone of perfusion of individual DIEA perforators was explored, particularly exploring differences between medial and lateral row perforators. Results: Fundamental differences exist between medial row and lateral row perforators, with medial row perforators larger (1.3 mm vs. 1 mm) and more likely to ramify in the subcutaneous fat toward the contralateral hemiabdomen (98% of cases vs. 2% of cases). A model for the perfusion of the abdominal wall based on a single perforator is presented. Conclusion: The "perforator angiosome" is dependent on perforator location, and can mapped individually with the use of preoperative imaging. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Computer-assisted tibia preparation for total ankle arthroplasty: a cadaveric studyTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 4 2007Samuel B. Adams Jr Abstract Background Most surgeons performing total ankle arthroplasty (TAA) suggest that accurate tibial preparation perpendicular to the tibial shaft axis improves outcomes. Recent studies demonstrate that computerized surgical navigation significantly improves the accuracy of tibial preparation in total knee arthroplasty (TKA). Methods We performed the tibial preparation for TAA in seven matched pairs of cadaver lower extremities. One set of matched pairs was prepared using the conventional external tibial alignment guide/cutting block from the Scandanavian Total Ankle Replacement system (STAR, Waldemar Link GmbH & Co., Hamburg, Germany) under fluoroscopic guidance. The second set of matched pairs was prepared using the VectorVision® navigation system (BrainLAB, Munich, Germany), with currently available computed tomography (CT)-based TKA software. Pre-operative CT data were used to assess the tibial mechanical axis. In both groups, accuracy of the tibial plafond preparation relative to the tibial shaft axis in both the coronal and sagittal planes was determined by fluoroscopic, radiographic and CT analysis. Results Mean values of the tibial cut for the set of matched-pair tibiae prepared by the conventional surgical method ranged across the three imaging assessment techniques in the ranges 89.3,89.6° (coronal plane, anteroposterior) and 90.3,90.4° (sagittal plane, lateral). For the computer-navigated set, the values were 89.7,89.9° (coronal) and 89.1,89.4° (sagittal). Comparison between the conventional and computer-navigated tibial measurements were not different at the 95% confidence interval (CI) for CT, fluoroscopy or radiographic assessments. Conclusions Our results demonstrate that accuracy of TAA tibial preparation using computer-navigation equals that of the conventional technique performed by a foot and ankle surgeon experienced in TAA. We anticipate that this investigation will encourage the development of computer-navigation applications specific to TAA, with the potential of improving accuracy over conventional methods. Copyright © 2008 John Wiley & Sons, Ltd. [source] Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric studyANAESTHESIA, Issue 7 2009M. J. Barrington Summary Ultrasound-guided transversus abdominis plane (TAP) block can be performed using a subcostal technique. This technique was simulated using dye injection in cadavers in order to determine segmental nerve involvement and spread of injectate using either single or multiple-injection techniques. Dye most commonly spread to affect T9 and T10 nerves with the single injection technique and T9, T10 and T11 with multiple injections. The median (IQR [range]) spread of dye was 60 (36,63 [32,78]) cm2 using the single-injection technique and 90 (85,96 [72,136]) cm2, in the multiple-injection technique, and this difference was statistically significant (p = 0.003). These results indicate that ultrasound-guided subcostal TAP block will involve nerve roots T9, T10 and T11 and that a multiple-injection technique may block more segmental nerves and increase spread of injectate. [source] Alternative approaches for regional ulnar nerve blockade: A cadaveric studyCLINICAL ANATOMY, Issue 5 2004N. Lizamore Abstract Wrist blockade is a safe and effective alternative to general anesthesia in surgery of hand injuries. With regard to the ulnar nerve, the volar approach is used, where the needle passes through or medial to the flexor carpi ulnaris tendon; however, the ulnar artery is at risk because the needle may accidentally penetrate it, causing profuse bleeding. Alternatively, the wrist may be approached medially, the ulnar approach, and the needle tip placed posterior to the flexor carpi ulnaris tendon. To determine which of these methods may be preferable for avoiding ulnar artery injury, needles were inserted into the wrist area of cadaver hands (n = 57) using the volar and ulnar approaches; detailed dissection of the region around the inserted needles was subsequently carried out. The position of the ulnar nerve relative to the ulnar artery and injury to the artery was documented. Damage to the ulnar artery using the volar approach was 36.8% (21/57 cases) compared to no (0%) injury observed using the ulnar approach. At the level of the wrist crease just proximal to the pisiform bone, the ulnar nerve was medial to the artery in 92.9% (53/57) of cases, medial and posterior in 5.3% (3/57), and anterior to the artery in 1.8% (1/57) of cases. This study suggests that in cases where ulnar artery pulsation is not reliable, the ulnar approach may be preferable for ulnar nerve blockade due to an increased incidence of ulnar artery penetration with the volar approach. Clin. Anat. 17:373,377, 2004. © 2004 Wiley-Liss, Inc. [source] | ||||||||||