Anatomy Research Articles

PROBABLE NEW FRAGMENTS AND A TESTIMONIUM FROM GALEN'S COMMENTARY ON PLATO'STIMAEVS

As his writings tend to prioritize the incorporeal over the corporeal, Plato seems an unlikely authority on medicine. He does not appear to have engaged in any systematic investigation of the body through direct examination of animal anatomy, like his pupil Aristotle. Notwithstanding Plato's apparent lack of interest in anatomical research, modern scholars view his dialogues as valuable witnesses for earlier and contemporary theories about the body. Famously, thePhaedrus(270c–e) mentions Hippocrates’ holistic approach to studying the body. Out of all his dialogues, theTimaeusoffers the most extensive comments about the nature of the body and its functions. Many of its physiological ideas, however, seem to derive from earlier medical and philosophical authorities such as Alcmaeon of Croton (fifth century), Empedocles (fifth century) and Philistion of Locri (fourth century) rather than from Plato himself.

Clinicopathological catalogue of male breast diseases

Background: Though relatively uncommon compared to diseases of the female breast, diseases of the male breast do occur, but are poorly studied. These range from benign lesions to malignant disease. The purpose of this study was to enumerate the various disorders of the male breast encountered in our practice, so as to develop a better understanding of the clinicopathological profile of these conditions.Methods: This was a retrospective study conducted in the Department of Surgery, KIMS Hospital, Bangalore, from September 2017 to September 2018. Male patients treated for disorders of the breast were included in the study. The clinical profile of the patients and the disease conditions were studied.Results: 21 patients were included in the study. The most common presentation was due to swelling, pain or lump in the breast. The most commonly encountered condition was gynaecomastia (66.66%). Primary malignancy of the breast was encountered in 2 cases.Conclusions: The male breast is subjected to various disease conditions. Most presentations are due to aesthetic defects. Rarely, primary malignancy can develop in the male breast. The breast is an often-neglected part of the male anatomy, and hence patients often present late with complications.

Mesopancreas (pancreas capsule): review of clinical anatomy

With the development of fine anatomy, the concept of mesopancreas has been proposed, and total mesopancreatic excision continues to be used in clinical practice. This method has become the best surgical method of pancreatic head cancer. But due to deep position of pancreas and mesopancreas, the surrounding adjacent organs and complexs tructure and other factors, experts are concerned about at the presence or absence of the mesopancreas. So the scope of clinical surgical resection structural reservations are also controversial. This article reviewed the development of embryonic development of the pancreas and the research progress in order to provide theoretical support for the study of the fine anatomy of the pancreas and the precise operation of pancreatic diseases. Key words: Pancreas; Mesopancreas; Total mesopancreatic excision; Space anatomy; Membrane surgery

Anatomical study in exposed area and operating space of extended endonasal approach to the ventral region of cranio-cervical junction

Objective To explore the scope, feasibility and indications of extended neuroendoscopic endonasal approach to reveal the region of cranial-cervical junction. Methods Ten (20 sides) intact frozen adult cadaveric heads were used to simulate the extended neuroendoscopic endonasal approach to remove the anterior tubercle of atlas, part of the atlas anterior arch, odontoid and part of the slope. In the cranial-cervical junction area, we observed the exposed range and measured the distance from the nostril to the anterior tubercle of atlas, the height and width of the anterior arch of the atlas, the distance of bilateral medial margin of occipital condyle, the distance of bilateral medial margin of the foramen lacerum, the vertical distance from the occipital condyle to the homolateral foramen lacerum, and the height, anteroposterior diameter and transverse diameter of the odontoid. Results The exposed range of the extended neuroendoscopic endonasal approach was as follows: when the lesion was located at the foramen magnum, the medial margin of the occipital condyle was the boundary of both sides, the root of the odontoid was the lower boundary, and the lower edge of the occipital bone was the upper boundary. When the lesion was located at the region of cranial-cervical junction, the upper edge of the foramen lacerum on both sides was the upper boundary, and the foramen lacerum and the outer edge of the occipital condyle were the boundaries of both sides of the bone window. By measurement, the distance from the nostril to the anterior tubercle of atlas was 8.9-9.7 cm, with an average of 9.3±0.3 cm. The height of the anterior arch of the atlas was 2.3-3.0 cm, with an average of 2.7±0.3 cm; the width was 1.5-2.0 cm, with an average of 1.8±0.2 cm; the distance of bilateral medial margin of occipital condyle was 1.5-2.0 cm, with an average of 1.8±0.2 cm; the distance of bilateral medial margin of the foramen lacerum was 2.1-2.9 cm, with an average of 2.4 ±0.3 cm; the vertical distance from the occipital condyle to the homolateral foramen lacerum was 1.6-2.2 cm, with an average of 1.9±0.3 cm; the height of the odontoid was 0.9-1.3 cm, with an average of 1.1±0.2 cm, its length was 0.8-1.3 cm, with an average of 1.1±0.2 cm; the transverse diameter of the dentate was 0.9-1.2 cm, with an average of 1.0±0.1 cm.The maximum exposed area of cranio-cervical junction was 6.4-9.8 cm2, with an average of 8.6±1.6 cm2. Conclusion The extended neuroendoscopic endonasal approach with removal of the anterior tubercle of atlas and part of the atlas anterior arch could effectively reveal the cranial-cervical junction area which is suitable for the treatment of odontoid deformity, skull base depression and atlantoaxial joint dislocation as well as resection of epidural tumors in the cranial-cervical junction and ventral and ventral midline tumors. Key words: Natural orifice endoscopic surgery; Anatomy; Cranio-cervical junction; Extended endonasal approach

MDCT with three-dimensional fusion images in the preoperative evaluation of pancreaticoduodenectomy

Objective To study the role of MDCT with 3D fusion images in the preoperative evaluation of pancreaticoduodenectomy. Methods 37 patients who underwent pancreaticoduodenectomy from March 2016 to May 2018 in the Affiliated Wuxi No.2 People’s Hospital of Nanjing Medical University were included in this retrospective study. All patients underwent a dual-phase enhanced MDCT before operation. The volume data of enhanced MDCT were transmitted to a dedicated CT post-processing workstation. The 3D images, including the tumor, pancreas, portal vein system, arterial system, pancreatic and biliary tract, were reformatted respectively before the fusion imaging. Two reviewers analyzed the tumor location and its spatial relations with the pancreaticobiliary system, peripancreatic vessels and vascular variations by means of zooming, rotating, splitting and transparent displaying on fusion images. Then, the assessed items were compared to the surgical and pathological findings. Results The 3D fusion images of 37 patients in this study depicted the tumor, pancreas, peripancreatic vessels and pancreatic and biliary tract clearly. Compared with the intraoperative and pathological findings, the accuracy of both tumor detection and localization with the 3D fusion images was 100%. To compare the intraoperative findings, visualization and variation detection of the celiac, splenic, common hepatic, gastroduodenal, hepatic, and superior mesenteric arteries, and the superior mesenteric and portal veins were all 100%. Visualizations of the anterior superior pancreaticoduodenal artery (ASPDA), posterior superior pancreaticoduodenal artery (PSPDA), inferior pancreaticoduodenal artery (IPA) and dorsal pancreatic artery (DPA) were 85.7%, 82.8%, 72.2% and 75.8%, respectively. Conclusion The MDCT 3D fusion imaging technology allowed one stop preoperative assessment of pancrea-ticoduodenectomy, especially in clearly outlining the tumor location and its spatial relations with the surrounding surgical anatomies before surgery. Key words: Pancreaticoduodenectomy; Multi-detector computed tomography; 3-dimensional reconstruction; Evaluation

An anatomic study of superficial temporal artery to anterior cerebral artery bypass using ipsilateral parietal branch of superficial temporal artery as graft

Objective Revascularization of the distal segment of the anterior cerebral artery (ACA) using extracranial donors requires long interposition grafts. A novel bypass procedure which uses the two main branches of the superficial temporal artery (STA) to reach the A3 segment of the anterior cerebral artery with a single skin incision was designed. Methods Ten cadaveric specimens were dissected through a single skin incision to harvest the frontal and parietal branches of the STA from June, 2017 to September, 2017. An anterior interhemispheric approach provided access to the middle internal frontal artery (MIFA). The parietal STA was used as an interposition graft between the frontal STA and MIFA. Lengths and calibers of the distal branches of STA and MIFA were measured at the anastomotic sites. All data was statistical analysis by t-test. Results The average caliber of MIFA was (1.4±0.2) mm, which matched the caliber of both frontal and parietal branches of STA. The mean distance for an end-to-side bypass from STA to MIFA was (144.5±7.4) mm and the average harvested donor-graft complex length was (203.1±27.9) mm. This bypass construct provided around 140% donor graft length. Conclusion Using the parietal branch of the STA as an interposition graft enabled a successful tension-free STA-MIFA bypass. The advantages of this technique over existing approaches include sufficient graft length, caliber match and relative technical ease. Key words: Anterior cerebral artery (ACA); Extracranial-intracranial bypass; Superficial temporal artery; Interhemispheric approach; Cerebral revascularization; Microsurgical anatomy

An experimental investigation of changing cut mark cross-sectional size during butchery: Implications for interpreting tool-assisted carcass processing from cut mark samples

Butchery occurs at the intersection between technology, carcass processing behavior, and animal anatomy, and records traces on fragmentary specimens including cut marks. The causal factors and contexts that generate bone surface modifications have been well-studied in experimental archaeology but the ways in which cut mark size or morphology change with time during butchery in response to tool edge dulling or carcass desiccation is currently unknown. This study examines cut mark cross-sectional width and depth change during a sequence of experimental butchery trials that control for the effects of animal size, bone portion density, tool weight, and flake versus core tool type. Mark size is measured from vinyl molds under low-power magnification (40×) and compared to more precise 3d measurement techniques. Tool type and the order of carcass segment defleshing was systematically varied across the experiment, and a linear mixed effect regression model was used to explore the impact of these fixed factors and consider random variability introduced by potential differences in the four cows butchered by eight tools. Mark width and depth samples were negatively related to the density of the portion where marks occur, tool weight had a weak, but significant influence on mark size, and marks incised at different stages in the sequence of defleshing events were similar in width and depth. With current measurement techniques and the large variability in mark size produced during butchery, it is not impossible to infer the timing of mark creation during a tool's use life or its place in a sequence of butchery events, but methodological advancement may overturn this pessimistic conclusion.

Research progresses of quadratus lumborum block in anatomy and clinical application

Quadratus lumborum block (QLB) is a kind of nerve block that is performed in the posterior abdominal wall. QLB can provide anesthesia and analgesia for surgeries in the abdominal, hip and inguinal regions. QLB has been widely recognized and improved in recent years. This review aims to summarize the research advances in the anatomy of adjacent structures of quadratus lumborum and thoracolumbar fascia(TLF), the clinical application of QLB, the four types of QLB, and the potential complications of QLB. Key words: Quadratus lumborum block; Thoracolumbar fascia

Advances in selection of surgical approach and internal fixation for posterolateral tibial plateau fractures

There haven't been an uniform criterion for the treatment of posterolateral tibial plateau fracture till now. For this type of fractures, surgical approaches are divided into two main parts, non-osteotomy approach and osteotomy approach. The non-osteotomy approach includes posterolateral approach, anterolateral approach, lateral approach, posteromedial approach and posterior approach. Each of them includes advantage and disadvantage. Posterolateral approach is the most effective exposure of posterolateral tibial plateau fracture. Satisfactory reduction and buttress fixation could be achieved under direct view. Posterolateral tibial plateau fracture could also be exposed from the gap between fibular head and posterolateral tibial plateau via anterolateral approach, but the raft plate should be placed backwardly to achieve the best fixation result. With a single lateral incision of the tibial plateau, the anterolateral and posterolateral plateau fragments could be fixed simultaneously through the anterolateral and posterolateral interval of the deep tissue. The anatomy of the posteromedial approach is simpler, however, it's difficult to view all the comminuted fragments of the posterolateral tibial plateau. The injury risk of popliteal blood vessels and nerves is relatively high, therefore it's rarely used right now. The osteotomy approach includes fibular head, lateral femoral epicondyle and tibial Gerdy tuberosity osteotomy. The osteotomy approaches of lateral femoral epicondyle and tibial Gerdy tuberosity are usually used in the cases associated with the anterolateral approach of the knee. The best view of the posterolateral tibial plateau could be obtained via the fibular head osteotomy approach. But the extra damage is too severe to recommend routinely. On the other hand, there are several fixation options when posterolateral tibial plateau fractures are treated. The buttress plate was verified to be the best fixation method and the rim plating provided a novel idea for this fracture pattern. The fibular support is a reliable method for posterolateral compression fracture as well. We will summarize the selection of surgical approaches and internal fixation methods to provide a reference for the clinical doctors. Key words: Tibial plateau; Posterolateral; Surgical approach; Osteotomy; Fracture fixation, internal

Sphenoid bone and its sinus - anatomo-clinical review of the literature including application to FESS.

Authors paid attention to anatomy and clinical implications which are associated with the variations of the sphenoid sinus. We discuss also anatomical structure of the sphenoid bone implementing clinical application of this bone to different invasive and miniinvasive procedures (i.e. FESS).

Anatomical study on the attachment location of forearm interosseous membrane ligament

Objective To elucidate the composition and precise attachment location of the forearm interosseous membrane ligament complex. Methods Thirty-two adult cadaveric forearm specimens were dissected to identify all ligaments of the interosseous membrane, measure the distance between the attachment site and the radius styloid process or the tip of the ulna head, and express the attachment location of the ligament by the percentage of the length to the length of the whole ulna and radius. Results The forearm interosseous membrane consists of five ligament components: central ligament, accessory ligament, distal oblique tract, proximal oblique cord and dorsal accessory oblique cord. The distal and proximal positions of the radius origin of the central ligament were 55% and 66% of the total radius length, respectively, and 30% and 42% of the total ulna length. The central points of the radius and ulna attachment location were 38% of the radius and 24% of the ulna for the accessory ligament, 10% of the radius and 16% of the ulna for the distal oblique tract, 78% of the radius and 82% of the ulna for the proximal oblique cord, and 63% of the radius and 65% of the ulna for the dorsal accessory oblique cord. Conclusion This study elucidates the precise attachment location of all the typical forearm interosseous membrane ligaments. This information is very useful for the biomechanical study of the interosseous membrane ligaments and the appropriate transplantation location of the interosseous membrane reconstruction surgery. Key words: Forearm; Anatomy; Interosseous membrane; Ligaments; Attachment location

Pathomorphological changes of the thymus of pigs at different stages of development of clinically expressed circovirus infection type ІІ

PCV2-infection of pigs plays an important role in the infectious pathology of pigs, having a significant impact on the economy of pig farms in different countries. Pathomorphological changes in the body of pigs with PCV2-infection occur moderately and in stages, as a result of the simultaneous launch of a set of mechanisms to counter the causative agent of the disease, resulting in the formation of a whole spectrum of reactive and pathological processes. The main “target” for PCV-2 is the immune system, and the multiplication of PCV-2 in the cells of the immune system leads to their death and development of immunodeficiency state. Thymus is the central organ of lymphocytopoiesis and imunopoiesis, in it occurs differentiation of all cellular forms of mature T-lymphocytes in the pre-T-lymphocyte stage, which migrate from the bone marrow to the bloodstream. The growth and development of the thymus, as well as the bone organs, is in direct interaction with the growth and development of the spleen, lymph nodes and is reflected in the structure of the interstitial connective tissue and lymphoid parenchyma. Purpose: determination of pathomorphological changes in the thymus of pigs at different stages of the development of clinically expressed PCV2-infection. Methods. The work was carried out in pig farms of Ukraine, with intensive technology of pig rearing, at the department of normal and pathological anatomy of agricultural animals and the Scientific and Research Center for Biosafety and Environmental Control of the Agroindustrial Complex Resources of Dnipro State Agrarian and Economic University. For pathomorphological studies, animals were selected with clinical signs of active PCV2‑infection (in 1 ml of whole blood of which contained more than 107 copies of the PCV-2 virus equivalent gene) and also piglets with positive optical density of specific antibodies (Ig G and Ig M) in serum blood. Pathomorphological changes were characterized by gradual exhaustion of the lymphoid parenchyma with a sharp decrease in the area of the cortical substance of the particles. Against the background of the degradation of the lymphoid parenchyma of the organ, there is a tendency to increase the relative area of the interstitial connective tissue, as well as the absolute size and number of thymic bodies, has been established.

La identificación de la anatomía quirúrgica mediante TIC: comparación entre dos formas de evaluación

Introducción: Tradicionalmente la evaluación de las competencias necesarias para la ejecución de procedimientos quirúrgicos exitosos en residentes de cirugía general se centró en exámenes escritos. Incluso aquellos intentos por medir la capacidad para identificar la anatomía quirúrgica han sido parciales y subjetivos. Incorporar el uso de TIC en las evaluaciones permite, mediante la promoción simultánea de la alfabetización digital, crear una evaluación complementaria que demuestra el verdadero grado de aprendizaje, sin la necesidad de exponer al paciente a riesgos innecesarios. 
 Objetivo: Proponer una evaluación complementaria para medir la capacidad del cirujano en formación para la identificación de las estructuras anatómicas con relevancia quirúrgica incorporando el uso de TIC.
 Método: Se realizó un estudio experimental a 30 residentes, de segundo a cuarto año, de la especialidad de cirugía general sobre anatomía quirúrgica. Se comparó un Grupo A de 15 residentes a los que se les aplicó una evaluación escrita con preguntas de opción múltiple vs un grupo B de 15 residentes a los que se les aplicó una evaluación basada en un software especializado de anatomía (Essential Anatomy®) en tabletas electrónicas. 
 Resultados: La edad media de los residentes fue de 27 años (millennials), 67% del género masculino y 33% del femenino. El Grupo A obtuvo una calificación global significativamente menor (X = 6.0333) en comparación con la obtenida por el Grupo B (X = 8.0467). Ello es probablemente debido a que los residentes están más familiarizados con la anatomía quirúrgica en vivo, propia de las actividades prácticas dentro de quirófano, que con la anatomía quirúrgica de la literatura.
 Conclusiones: Es posible utilizar una evaluación complementaria basada en TIC, fuera del quirófano y segura para el paciente, para medir la capacidad de identificar la anatomía quirúrgica en residentes de cirugía general.

Endoscopy in surgically altered anatomy

Endoscopy in surgically altered anatomy

Painting, Pirouettes and Proving: A Tool‐kit of Methods for Engagement in Anatomy

Anatomy and art are often synonymous with each other, with celebrated artists such as Leonardo Da Vinci producing not just spectacular art works but, also sharing knowledge through his productions. The public curiosity with anatomy and what lies beneath has not dwindled in the centuries since Da Vinci. Anatomists in medical schools may not perform public dissections as in days gone by, but they are still at the forefront of outreach and public engagement and require a diverse repertoire for such activity.This presentation will discuss the use of a range of modalities for engaging the public and students in living and functional anatomy. Discussion will centre around the use of anatomical body painting and drawing, as well as methods for demonstrating functional anatomy through exercise. Finally, edible organs and the use of baking as a method of learning and demonstrating anatomy will be described. The aim is to share practical wisdom, anecdote, evidence and best practice with fellow anatomists.Examples of the use of body painting within the curriculum, as an outreach activity with school groups and as a tool for recruitment days will be provided. Of course, body painting takes time and for a number of reasons, including cultural barriers, it is not always appropriate. Drawing structures on disposable lab gloves or swimming caps provide another useful alternative – not only is it a quicker activity but the participants also create an artefact that they can take home with them. Working with art and textile specialists can provide another string to the bow, resulting in the creation of wearable anatomies that can be utilised for more complex demonstrations and engagement exercises.Lately, anatomical body painting has evolved to use an even more striking medium, that of Ultra‐Violet (UV) paint. UV provides a wet and therefore more visceral look to paintings, coupled with the vibrant fluorescence. It is visually striking and makes an excellent addition to the toolkit of any anatomy educator. UV paintings are spectacular when used on moving models and exhibited in darkness. The glowing paint on the muscles present as if showing muscle tension. Such painting activities can be used for more functional displays such as our well‐publicised UV yoga and fitness demonstrations. The anatomist and the fitness professional working together can tailor powerful lessons which emphasis the relationship between form and function.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A Multi‐Year Quantitative Analysis of Semispinalis Capitis Morphological Variations in the Neck

The semispinalis capitis muscle is located in the posterior neck of humans. This muscle allows us to extend our head and neck. The semispinalis capitis muscle is also known as the biventer cervicis muscle. The majority of anatomy textbooks and atlases depict this muscle as containing two bellies of muscle with a linear intervening white tendinous band that neatly separates the muscle into upper and lower parts. We dissected the posterior neck and upper back of 48 cadavers with a total of 96 individual muscles in order to isolate this muscle and gain better clarification of this muscle's appearance. We found that this muscle does not appear as commonly depicted in most anatomy books. Instead we found that its intervening tendon is not linearly horizontal. Its tendon consists of multiple different parts that are commonly disconnected and lie either superior or inferior to each other in three different categories. The three main classifications include two uniform vertical bands, one vertical with one curved band, and an other group. We found that 56.9 percent falls in the two uniform vertical band classification, 23.2 percent falls in the one vertical one curved band classification, and 19.9 percent falls in the other classification. We recommend that artists change the way in which this muscle is drawn in anatomical textbooks.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

How comparative anatomy provides insight into human anatomy

Human anatomy instructors in the United States have remarkably varied backgrounds for an academic discipline; we work alongside those trained at every scale of biological organization, from molecular genetics to ecology, and these different training regimens provide anatomy departments with a variety of strengths. In this talk, I outline and detail how comparative whole organism anatomy can be useful in teaching human anatomy, primarily in the context of traditional lectures (at both the undergraduate and graduate levels) through three broad categories. First, understanding how relatively anatomically more complex animals like humans develop embryologically is facilitated by appreciating the anatomy of relatively simpler animals like platyhelminth and annelid worms; furthermore, some developmental defects are better understood through the lens of evo‐devo (i.e., normal conditions in other animals are sometimes abnormal conditions in humans, like syndactyly in bats). Second, comparative functional biomechanics yields insight into normal and abnormal musculoskeletal function. The trade‐offs between joint stability or flexibility, or power arm ratios for power or speed, are well‐illustrated by extreme morphology of homologous structures in other animals, such as the incredibly speedy ankles of cheetahs compared to the relatively powerful ankles of humans. Third, much of any scientific professional's development relies upon mastery of Greek‐ and Latin‐derived vocabulary; genus and species names of animals can help anatomy students better remember structural terms. For example, Pterodactylus was a remarkable genus of flying reptiles, and understanding the etymology of the Greek words “pteron” (wing) and “dactyl” (finger) helps students appreciate how the sphenoid bone's pterygoid process and the pterygoid muscles are wing‐shaped, and the clinical conditions syndactyly and polydactyly refer to webbed or conjoined fingers and extra fingers, respectively.Application of human anatomy knowledge by physicians to animals gave rise to the field of comparative anatomy in the 1600s; Edward Tyson, a human physician, recognized chimpanzees were more like humans than monkeys, and porpoises were more like land mammals than fish from detailed comparative gross dissections. These observations of patterns in the anatomy of humans and animals contributed to Darwin and Wallace independently developing the theory of evolution, which underpins the national One Health initiative. Recognizing humanity's shared ancestry with animals ensures a measure of shared descendance in the instruction of human and animal anatomical education.Support or Funding InformationThis work was supported by the American Association of Anatomists and the Arkansas College of Osteopathic Medicine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

UJI EFEKTIFITAS PESTISIDA NABATI DAUN SIRSAK (Annona muricata L.) TERHADAP MORTALITAS HAMA TANAMAN CABAI RAWIT (Capsicum frustescens L.) SERTA KAJIANNYA SEBAGAI SUMBER BELAJAR BIOLOGI

Penelitian ini menggunakan pendekatan mixed method. Pendekatan kuantitatif melalui penelitian terkait pengaruh pestisida berbahan daun sirsak terhadap tingkat kematian hama cabai rawit. Sementara itu, pendekatan kualitatif melalui analisis kesesuaian hasil penelitian dengan pembelajaran biologi. Hasil yang didapatkan adalah dosis paling optimal adalah ekstrak 10% dan 12% daun sirsak. Hasil penelitian dapat menjadi konten untuk menunjang matakuliah Anatomi dan Fisiologi Tumbuhan, dan Entomologi, terutama pada materi yang terkait metabolit sekunder dan pengaruhnya terhadap perilaku serangga Kata Kunci: Daun Sirsak, Hama Cabai Rawit, Sumber Belajar Biologi

Functional anatomy of the semi-membranosus muscle: main thigh pump and derivative route of the Hunter’s canal

Introduction: Our objective is to highlight the role of the semi-membranosus muscle, which is surprisingly not described in the major books of anatomy, as main thigh pump in the venous return [1]. Material and methods: Latex injection of fresh cadavers followed by anatomical dissection and colored segmentation of the whole venous network of 300 lower limbs, 3D reconstructions by CT venography of 1000 CVD patients are at the basis of this study. Results: The venous arcades of the semi-membranosus muscle constitute a main deep collateral route by-passing the narrowed area of the Hunter’s canal. This anatomical study clearly shows that these venous arcades are regularly connected:(Figure 1) Figure 1. Arcades of the semimembranosus muscle (in dark blue). The 2 lower are connected to the popliteal vein (in light blue). The 2 higher to the deep vein of the thigh (in green). Notice the valves (in yellow) • By their 2 lower branches to the popliteal vein • By their 2 higher branches to the deep femoral vein. Consequently, they constitute a derivative route of the femoral axis, explaining their dilatation in case of stenosis of the Hunter’s canal outlet. Similarly, in a physiological situation, the whole amount of blood ejected by the powerful calf pump through the popliteal vein cannot always reach the femoral vein through the Hunter’s canal: the arcades then play the role of a safety valve. Moreover, the veins of the semi-membranosus muscle constitute a main thigh pump: they push up the blood towards the femoral crossroad at the root of the limb. Discussion and conclusion: The veins of the semi-membranosus should be systematically investigated by USD : their dilatation is the witness of venous outlet syndrome of the Hunter’s canal which is a major cause of femoral vein thrombosis. USD investigation should be systematically carried out at that levels to prevent future deep vein obstruction.

Last critical step for transanal total mesorectal excision: anastomosis

Colorectal anastomosis remains a key aspect in mid- and lower-rectal surgery, particularly in patients who are male, obese, status post neoadjuvant chemoradiation, or possess narrow pelvic anatomy. Transanal total mesorectal excision (taTME) and transabdominal total mesorectal excision (TME) both primarily allow position of the tumor to dictate whether circular stapling or hand-sewing is utilized to achieve anastomosis. Given that taTME only requires a single circular stapler to achieve anastomosis, it consequently decreases the risk of jeopardizing blood supply to the anastomotic site. Should transanal hand-sewing be pursued, numerous points in performing the purse-string suture warrant particular attention: (1) Before suturing, separate the distal rectum to be anastomosed from the surrounding tissues, and ensure the full-layer suture of the distal purse-stitched suture. (2) It is recommended that beginners complete the suturing process under direct visualization without removing the transanal platform. (3) Commonly used anastomosis designs include end-to-end, side-to-end, J-pouch, or coloplasty, depending on patient characteristics and surgeon preferences. Our single-institution clinical experience suggests that taTME patients who underwent neoadjuvant chemoradiation or transanal hand-sewn anastomosis should still have a temporary colostomy created. To date, literature has yet to demonstrate the superiority of taTME anastomosis outcomes. This publication aims to point out anastomosis techniques and safety pointers, as well as clinical experiences.