Location Of Branches Research Articles

What Is the Lobular Branch of the Great Auricular Nerve? Anatomical Description and Significance in Rhytidectomy

Current literature suggests that preserving the lobular branch of the great auricular nerve has greater impact on sensory function of the auricle than preservation of the posterior branch during rhytidectomy. However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch. This study describes the branching characteristics of the lobular branch and algorithmic surface markings to assist surgeons in preservation of the great auricular nerve during rhytidectomy flap elevation. The lobular branch was dissected in 50 cadaveric necks. Measurements were taken from the lobular branch to conchal cartilage, tragus, and antitragus. The anterior branch was measured to its superficial musculoaponeurotic system insertion, and the posterior branch was measured to the mastoid process. The McKinney point was marked and the great auricular nerve diameter was recorded. Branching pattern and location of branches within the Ozturk 30-degree angle were documented. Basic statistics were performed. The lobular branch was present in all specimens and distributed to three regions. In 85 percent of specimens, the lobular branch resided directly inferior to the antitragus; in the remaining specimens, it was located directly inferior to the tragus. Preoperative markings consisting of two vertical lines from the tragus and antitragus to the McKinney point can be used to outline the predicted location of the lobular branch. This study delineates the location of the lobular branch of the great auricular nerve. The authors translate these findings into a quick and simple intraoperative marking, which can assist surgeons in avoiding lobular branch injury during rhytidectomy dissection.

Is There a Credit Union Difference? Comparing Canadian Credit Union and Bank Branch Locations

This study of credit union and bank branch locations and neighbourhoods in Canada seeks to discover if there is a distinct credit union niche. The study builds on an earlier paper of credit unions and banks in the US which found that credit unions in Wisconsin, Arizona and New Hampshire were more likely to be located in lower-income areas than bank branches (Mook, Maiorano & Quarter, 2015). In Canada, we find that credit union branches are over-represented in rural areas, and under-represented in large population centres relative to bank branches. Additionally, credit unions are overrepresented in middle income areas and underrepresented in high income areas compared to bank branches both at the national level and in all provinces where differences are statistically significant. Another significant finding is that while both credit unions and banks cater to marginalized communities, the type of marginalized communities they cater to distinguishes them. Making use of the Canadian Marginalization Index, we find credit union branches in Canada to be overrepresented in communities marginalized along the dimensions of Material Deprivation and Dependency, while bank branches are overrepresented in communities marginalized along the dimension of Residential Instability and Ethnic Concentration.

A Decision Support Methodology for Locating Bank Branches: A Case Study in Turkey

This paper presents an integrated decision support methodology for locating bank branches. The methodology is composed of two stages: problem structuring, and modeling. In the first stage, initially, a number of criteria are selected with the help of a detailed literature review and expert opinions. Subsequently, importance weights of these criteria for different types of bank branches are identified based on judgments of experts for pairwise comparison questions. At the modeling stage, considering the characteristics and importance of the criteria, a novel multi-objective mathematical programming model is proposed to find specific locations of bank branches. The proposed methodology is applied in locating branches of a Turkish bank. In order to test the validity of the results and robustness, a sensitivity analysis is conducted and the solutions are found to be robust.

REDESIGNING THE ASSIGNMENT OF INTERNAL AUDITORS BASED ON AUDITOR UTILITY

This study presents a novel model for assignment of internal auditors to branches of businesses. Previous studies have concerned with minimizing the cost but in this model, aim is maximizing auditor’s utility. For this purpose an integer programming model introduced. The objective is maximizing the auditors’ total utility. Each branch has different impact values for auditors, which indicate auditors’ utility level in terms of location, size and type of branches. Also to keep the balance of auditor’s working days and total gained impact values particular constraints are defined for the integer programming model. This implementation has 3 particular steps; first is quantification of the branches’ effects on the auditors. AHP method is used to define branches’ impact values. The second is simulating the durations of auditing process. To minimize the effect of abnormal situations, durations are simulated. Last step is to reach the rotation of auditors, total working days and the total utility of the auditor; the integer programming model is solved by Python-Gurobi Optimizer.

REDESIGNING THE ASSIGNMENT OF INTERNAL AUDITORS BASED ON AUDITOR UTILITY

This study presents a novel model for assignment of internal auditors to branches of businesses. Previous studies have concerned with minimizing the cost but in this model, aim is maximizing auditor’s utility. For this purpose an integer programming model introduced. The objective is maximizing the auditors’ total utility. Each branch has different impact values for auditors, which indicate auditors’ utility level in terms of location, size and type of branches. Also to keep the balance of auditor’s working days and total gained impact values particular constraints are defined for the integer programming model. This implementation has 3 particular steps; first is quantification of the branches’ effects on the auditors. AHP method is used to define branches’ impact values. The second is simulating the durations of auditing process. To minimize the effect of abnormal situations, durations are simulated. Last step is to reach the rotation of auditors, total working days and the total utility of the auditor; the integer programming model is solved by Python-Gurobi Optimizer.

Supinator to ulnar nerve transfer via in situ anterior interosseous nerve bridge to restore intrinsic muscle function in combined proximal median and ulnar nerve injury: a novel cadaveric study

BackgroundIn cases of high ulnar nerve palsy, result of nerve repair in term of intrinsic muscle recovery is unsatisfactory. Distal nerve transfer can diminish the regeneration time and improve the results. But, there was no perfect distal nerve transfer for restoring intrinsic hand function in combined proximal median and ulnar nerve injuries. This cadaveric study aims to evaluate the possibility and feasibility of supinator nerve transfer to motor branch of ulnar nerve (MUN). MethodsTen cadaveric upper limbs dissected to identify the location of the supinator branch, anterior interosseous nerve (AIN), and MUN. The AIN was cut from its origin and transferred to the supinator branches. Also, the AIN was distally cut and transferred to the MUN. After nerve coaptation, surface area, fascicle count, and axon number were determined by histologic methods. ResultsIn all limbs, the proximal and distal stumps of AIN reached the supinator branch and the MUN without tension, respectively. The mean of axon number in the supinator, proximal stump of AIN, distal stump of AIN and MUN branches were 32,426, 45,542, 25,288, and 35,426, respectively. ConclusionsThis study showed that transfer of the supinator branches to the MUN is possible via the in situ AIN bridge. The axon count data showed a favorable match between the supinator branches, AIN, and MUN. Therefore, it is suggested that this technique can be useful for patients with combined high median and ulnar nerve injuries.

Who Pays More in ATM Fees at Large Banks?

This paper explains why large bank customers living in low or moderate income neighborhoods (LMI) pay more in fees for automated teller machine (ATM) use than those in other areas. To determine who pays more in ATM fees, I looked at customer checking account data at several large banks to determine if demographics, account type selected or account usage leads to higher fees. For demographics I use Census tract income, population density, and age. For account type selected, I looked at the distance of the customer (based on their Census tract location) to the location of the closest branch for their institution to see if customers who must travel further to get to their branch pay more in ATM fees. I also used tenure with the bank and the level of account requirements to avoid fees. For account usage I looked at withdrawal activity, deposit activity, average balances and the amount of cash taken out each month. This study looked at data from several major banks consisting of every transaction from a significant sample of the banks’ customers over a 12-month period in 2011. I found customers living in LMI neighborhoods relied more on cash transactions from an ATM than in other areas. I discovered how living far from the closest branch results in greater ATM fees in LMI neighborhoods and how the volume of withdrawal transactions drives up ATM fees paid.

Manipulating polymerization chemistry of Cr/silica catalysts through calcination

More than any other parameter, the calcination process is capable of modifying the performance of the Cr/silica catalyst system (also known as Phillips-type catalysts) to generate activity and to influence the diverse active population in order to produce a wide variety of different polymer characteristics. This includes the polymer molecular weight, the shape and breadth of the MW distribution, the efficiency of comonomer and macromer incorporation, and the location of both short-chain and long-chain branches within the MW distribution. These fundamental polymer characteristics control how the polymer behaves during molding operations and they influence every physical property of the finished HDPE part. For this reason, a considerable number of calcination recipes have been developed over 60 years of commercial use to tailor the polymer characteristics for various HDPE applications. This is done by manipulating the relative amounts of differing active sites on the catalyst. This report attempts to explain the chemistry involved in the calcination process, to show how it can be controlled in various ways to achieve commercial ends, and to extrapolate these trends to predict the future of catalyst activation in the HDPE industry.

SMEs, banks and the spatial differentiation of access to finance

By utilizing the SME Finance Monitor and a unique dataset on the geographical location of all bank branches in 11 UK economic regions, this paper examines the relevance of spatial differentiation on SMEs’ access to bank finance during the period of economic weakness following the 2007 financial crisis. We find evidence suggesting the presence of a regional-specific effect on SMEs’ access to bank finance. Our findings show that greater functional distance between bank headquarters and branches exacerbates the credit constraints faced by local SMEs although the impact of a smaller operational distance between branches and local SMEs is inconclusive, ceteris paribus. Our finding holds over a battery of robustness tests.

Improving ATM coverage area using density based clustering algorithm and voronoi diagrams

Facility location is a problem of paramount importance and optimizing business operations without affecting customer service is very challenging. In the case of banking services, the location of bank branches and ATMs must match the service demands (turn around time for service, reachability etc) of the customers’ and the expected quality of service is determined by the socio-economic background of the customer. Therefore, it is necessary to formulate the optimization problem so as to reflect the customers’ expectations and tolerance for quality of service in a given geographical region. The ability to do so requires clustering people living in the region into several smaller areas called service areas. An ideal clustering algorithm should consider the social behavior of people living in the service area and the uncertainty associated with their social behavior.In this paper, we propose a modification to generalized density based clustering algorithm (GDBSCAN) to deal with fuzziness in the values describing the population demographics and the preferences for ATM location among customers utilizing the ATM services. The modified version of GDBSCAN clustering algorithm, which we call GFDBSCAN, is used to cluster people around key socio-economic parameters. GFDBSCAN can also be used to cluster geographical regions based on the requirement and preferences expressed by the customers for services like business outlets, ATMs, bank branch operations, public utilities, etc. We apply the proposed algorithm to cluster geo-spatial data based on personal traits of people living in the geographical area under study. We measure and compare the performance of GFDBSCAN with other popular clustering algorithms using Silhouette coefficient, Dunn index and Davies–Bouldin index. We plot the clustering results on Google maps for better visualization of results. We found that GFDBSCAN is better able to cope with fuzziness in the values of both spatial and non-spatial attributes. We finally use voronoi diagrams to identify the ideal locations to place ATMs so as to ensure that the customers’ preferences are served and, at the same time, the service area of each ATM is optimized.

Financial Exclusion and Branch Closures After the Great Recession

This paper analyzes the causes and consequences of closures of bank branches in terms of spatial accessibility after a negative shock in the demand for bank services, and whether closures concentrate in less-favored regions. We posit a theoretical framework to analyze markets with partial and total financial exclusion and derive testable empirical implications. Using data of the locations of Spanish bank branches before and after the bank restructuring (2007-2014), we find that the crisis has reduced the spatial accessibility to financial services, it has been heterogeneous across regions and it has been more acute in small municipalities, which might become banking deserts. The results show that the closures of branches respond to two factors. On the one hand, the general decrease in the demand for banking products. On the other hand, the larger reduction of the branch network of cajas compared to banks. Bailed-out cajas were forced to reduce their productive capacity to receive capital injections. As well as this, cajas were acting like microfinance banks in Spain and their transformation into profit-maximizing banks implied the closing of those branches that were providing services in low-income areas.

Abstract: What Is the Lobular Branch of the Great Auricular Nerve? Anatomical Description and Significance in Rhytidectomy

INTRODUCTION: Recent literature describes a distinct third branch of the great auricular nerve (GAN) named the lobular branch. Studies demonstrate preserving the lobular branch of the GAN has greater impact on sensory function at the auricle than preservation of the posterior branch during rhytidectomy.1,2 However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch. This study described the branching characteristics of the lobular branch and algorithmic surface markings to assist surgeons in preservation of this nerve during rhytidectomy flap elevation. MATERIALS AND METHODS: The lobular branch was dissected bilaterally in 50 cadaveric necks. Measurements were taken from the lobular branch to conchal cartilage, tragus, and antitragus. The anterior branch was measured to its SMAS insertion and the posterior branch was measured to the mastoid process. McKinney’s point was marked and the GAN diameter was recorded. Branching pattern and location of branches within the Ozturk 30-degree angle were documented. Basic statistics were performed. A student’s t-statistic was used to compare male and female GAN diameter difference. RESULTS: The anterior, posterior, and lobular branches were present in all specimens. In comparing nerve diameter between males and females a highly significant difference was identified (t=-2.780, p<0.01). The most common origin of the lobular branch was from a trifurcation with the anterior and posterior branches. The lobular branch always terminated in the lobular area, but may send accessory branches to the pre-auricular area or posterior inferior auricle. In 85% of specimens, the lobular branch resided directly inferior to the antitragus and in the remaining specimens it was located directly inferior to the tragus. Pre-operative markings consisting of two vertical lines from the tragus and antitragus to McKinney’s point can be used to outline the predicated location of the lobular branch. CONCLUSION: This study delineated the location of the lobular branch of the GAN. We translate these findings into a quick and simple intraoperative marking, which can assist surgeons in avoiding the lobular branch injury during rhytidectomy dissection. DISCLOSURE/FINANCIAL SUPPORT:None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Hu J, Ye W, Zheng J, Zhu H, Zhang Z. The feasibility and significance of preservation of the lobular branch of the great auricular nerve in parotidectomy. International journal of oral and maxillofacial surgery. Jul 2010;39(7):684–689. 2. Zumeng Y, Zhi G, Gang Z, Jianhua W, Yinghui T. Modified superficial parotidectomy: preserving both the great auricular nerve and the parotid gland fascia. Otolaryngol Head Neck Surg. 2006;135(3):458–462.

Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy.

Electrophysiologic facial nerve monitoring is becoming an established intraoperative aid to assist the surgeon in facial nerve trunk or branch location and dissection. Limited studies have addressed the postoperative outcomes of parotid surgery with and without monitoring. To examine the influence of intraoperative facial nerve monitoring on postoperative facial nerve function and procedure duration in parotid surgery. An 8-year retrospective review of parotidectomies performed at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Münster. The study analyzed 120 patients undergoing parotidectomy without monitoring from January 1, 1988, to December 31, 1991, and 147 patients undergoing parotidectomy with monitoring from January 1, 2003, to December 31, 2006. The patients were further subdivided in partial parotidectomy (PP) (n = 222) and total parotidectomy (TP) (n = 45) groups. An evaluation of operative time was performed to test the hypothesis of shorter duration of surgery with facial nerve monitoring. Final follow-up was completed on December 31, 2008, and data were analyzed from June 1 to December 31, 2013. Comparison of the incidence of facial nerve dysfunction and operative time between the PP and TP subgroups with and without monitoring. A total of 267 patients (127 men [47.6%] and 140 women [52.4%]; mean [SD] age, 51.3 [17.6] years; range, 3-90 years) were included in the analysis. A significant reduction in postoperative facial nerve dysfunction with the use of nerve monitoring could be seen in the PP group (46 of 99 without monitoring [46.5%] vs 18 of 123 with monitoring [14.6%]; P = .001). A similar finding was evident in the TP group when comparing moderate and severe nerve dysfunction (9 of 21 without monitoring [42.9%] vs 2 of 24 with monitoring [8.3%]; P = .01). The mean (SD) operative time in the PP subgroup without nerve monitoring was 115.3 (37.8) minutes; with nerve monitoring, 110.1 (33.6) minutes. The mean (SD) operative time in the TP subgroup without nerve monitoring was 134.5 (50.4) minutes; with nerve monitoring, 158.3 (56.3) minutes. There was no statistical difference between these groups. Facial nerve monitoring in primary parotid surgery for benign and malignant disease does not necessarily reduce the operative time, but the rate of transient postoperative facial nerve dysfunction or the grade of palsy is reduced.

How to Avoid Damaging the Terminal Branches of the Medial Antebrachial Cutaneous Nerve and the Medial Brachial Cutaneous Nerve During Operations Involving the Medial Elbow?

Objective: Medial elbow incision is obligatory for cubital tunnel syndrome surgical treatment. However, the terminal branches of both the medial antebrachial cutaneous nerve (MACN) and the medial brachial cutaneous nerve (MBCN) are likely to be harmed using the current incision technique. The aim of this study was to seek a new incision to avoid damaging the branches of MACN and MBCN during the operation for cubital tunnel syndrome. Methods: Ten fresh frozen cadaver upper extremities and 20 clinical cases (elbows) were analyzed. A conventional incision and a new incision were used in the cadaveric specimens and the clinical cases, respectively. The medial epicondyle was set as the reference landmark to quantify the location of the terminal branches, with the elbow at full extension. The numbers of the terminal branches and their locations were noted for MACN and MBCN, and the locations of the posterior branch of the MACN were recorded in the elbow medial incision. Results: The average numbers of MACN’s posterior terminal branches were 2.6 ± 1.6 and 4.4 ± 2.4 in the cadaveric specimens and clinical cases, respectively. The average number of MBCN’s terminal branches was 2 ± 0.87 in the cadaveric specimens. The MACN’s posterior terminal branches were located at 19 and 45 mm, respectively, measuring from the medial epicondyle. And the posterior branch of MACN was always located in between the medial epicondyle and the basilic vein, and the average distance was 10 ± 6 mm to the medial epicondyle. We could preserve all the MBCN’s terminal branches in the new incision. The MACN’s posterior terminal branches could be perfectly exposed by the use of the antegrade dissection technique, finding the MACN’s posterior branch in advance. Conclusions: The new elbow medial incision technique could reduce the risk of injuring the terminal branches from the MBCN. The medial epicondyle and the basilic vein are reliable anatomical landmarks to identify the posterior branch of the MACN. An antegrade method of dissection can effectively identify and avoid the injury to the terminal branches of the MACN in the elbow medial incision.

Evaluation of an Axial Pattern Flap Based on the Cranial Cutaneous Branch of the Saphenous Artery: A Cadaveric Perfusion Study.

To confirm the anatomic location of the cranial cutaneous branch of the saphenous artery (CCSA), delineate the angiosome of the CCSA, and provide guidelines for clinical use of an axial pattern flap based on the CCSA. Anatomic study. Greyhound cadavers (n=10). Shortly after euthanasia, the CCSA was identified and isolated in each hindlimb. Methylene blue and radiographic perfusion studies were performed. The skin was freed from the thigh for photographic and radiographic images. The dimensions of the skin area suitable for use as an axial pattern flap were related to anatomical landmarks. Mock surgical elevation and transposition of the flap in 2 dogs allowed assessment of flap mobility and ease of donor site closure for clinical use. The CCSA was reliably identified in all dogs branching from the saphenous artery as it became superficial to the sartorius muscle, immediately distal to the caudal cutaneous branch and proximal to the genicular branches. Genicular branches were variably paired or singular. Perfusion studies defined the CCSA angiosome as the area cranial to the saphenous artery and caudal to the cranial border of the thigh, extending proximally from the level of the medial tibial condyle to two-thirds of the distance to the inguinal ring. An axial pattern flap based on the CCSA could be expected to cover skin defects of the cranial aspect of the distal thigh and stifle, the popliteal region caudal to the stifle, and the proximal medial crus.

The clinical types and application of perforator branches of anterosuperior malleolus flap

Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application. Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect of hands in 18 patients, in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases, anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases, anterosuperior malleolus flap-dorsal pedal trilobate flap in 2 cases; Anterosuperior malleolus retrograde island (bone) flap was used in recovering pedal soft tissue in 22 patients, the flap pedicled from stem of anterior tibial artery in 16 cases, dorsal pedal flap-anterosuperior malleolus flap in 2 cases, the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases, the bone flap combined with the distal of tibia in 2 cases. Results In the 18 cases of hands, 17 cases survived, and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair. Twenty cases of anterosuperior malleolus retrograde island (bone) flap survived, and the other 2 cases needed secondary skin-grafting to repair the necrosis edge of flaps because of venous limited. After a follow-up from 3 to 6 months, 30 cases showed the satisfied postoperative outlook, with the good healing of the donor sites. Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap, 20 cases locate in the medial of anterior tibial muscle, 16 cases locate between the anterior tibial muscle and extensor hallucis longus, 4 cases locate between extensor hallucis longus and extensor digitorum longus. Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of operations、preventing cutaneous branches, but also improving the success rate of surgery. Key words: Anterosuperior malleolus flap; Perforator flap; Perforator branches; Clinical type; Microsurgery

SLICER: inferring branched, nonlinear cellular trajectories from single cell RNA-seq data.

Single cell experiments provide an unprecedented opportunity to reconstruct a sequence of changes in a biological process from individual “snapshots” of cells. However, nonlinear gene expression changes, genes unrelated to the process, and the possibility of branching trajectories make this a challenging problem. We develop SLICER (Selective Locally Linear Inference of Cellular Expression Relationships) to address these challenges. SLICER can infer highly nonlinear trajectories, select genes without prior knowledge of the process, and automatically determine the location and number of branches and loops. SLICER recovers the ordering of points along simulated trajectories more accurately than existing methods. We demonstrate the effectiveness of SLICER on previously published data from mouse lung cells and neural stem cells.Electronic supplementary materialThe online version of this article (doi:10.1186/s13059-016-0975-3) contains supplementary material, which is available to authorized users.

Nonrecurrent inferior laryngeal nerves and anatomical findings during thyroid surgery: report of three cases.

A nonrecurrent inferior laryngeal nerve (NRILN) is found more frequently on the right side than on the left, and it is closely associated with an aberrant right subclavian artery. The presence of the aberrant right subclavian artery on preoperative computed tomography (CT) scan suggests NRILN; however, different types of branching locations and pathways exist. Here, we report three NRILN cases with different pathways where the vagus nerve arises more medial than usual and a review of the literature. Case 1: A 30-year-old Japanese female presented with papillary thyroid carcinoma. Preoperative CT scan revealed an aberrant right subclavian artery, and an operation was performed under suspicion of NRILN. During the operation, the vagus nerve was found to arise more medially than usual and two NRILNs originated from it at the level of the cricoid cartilage and at a more caudal position; the two NRILNs were preserved. Case 2: A 33-year-old Japanese female with a thyroid nodule of increased size underwent surgery. Preoperative CT scan revealed an aberrant right subclavian artery, which suggested NRILN. During the operation, the vagus nerve was identified to run more medially than usual and NRILN was found to originate at the level of the cricoid cartilage; NRILN was preserved. Case 3: A 78-year-old Japanese female underwent an operation with a diagnosis of papillary thyroid carcinoma. Preoperative CT scan showed an aberrant right subclavian artery. During the operation, NRILN was found to originate from the vagus nerve at the level of the lower pole of the thyroid gland, and the vagus nerve ran medial to the common carotid artery at the caudal level.

Financial Development and Occupational Choice: Evidence from India

Theory suggests that access to finance facilitates entrepreneurship. However, evidence from randomized surveys of over one million individuals in India show instead that financial access shifts workers away from entrepreneurship into wage employment. Identifying access to finance using bank branch location determined by government policy, we find that individuals living in a district with greater access to finance are on average significantly less likely to be entrepreneurs in micro-enterprises and more likely to be formally employed. This shift is more pronounced for more educated workers. The results also show that individuals are paid higher wages on average in districts with more bank branches, and this effect is driven by those engaged in formal employment. To establish the firm-level channel, we use randomized surveys of over 400,000 service sector firms, and find that firms located in districts with more bank branches have significantly higher bank loans. The results indicate that firms in more financially developed districts are more productive, employ more workers, and pay higher wages on average, with the benefits mostly accruing to larger, formal sector firms. Our results suggests a mechanism by which financial development facilitates economic growth: by moving workers out of less productive, informal entrepreneurial activity into formal jobs in more productive firms.

Assessing the Anatomical Variability of Deep Circumflex Iliac Vessels in Harvesting of Iliac Crest-Free Flap for Mandibular Reconstruction.

In this study, the authors' aims were to measure the length and location of branching of the pedicle from iliac artery, to describe the anatomical variability of iliac crest free flap with deep circumflex iliac (DCI) artery pedicle. Fourteen patients with ameloblastoma, osteosarcoma, and squamous cell carcinoma underwent mandibular resection and iliac crest-free flap reconstruction in one-step surgery. During surgery and before harvesting the deep circumflex iliac artery vascular pedicle, the location, origin, and the branching pattern of the pedicles were studied. Then, the pedicle length was measured and the data was analyzed using χ and independent samples t test. In all patients, the DCI vascular pedicles were separated with a common trunk from the external iliac artery and vein and the DCI arteries were posterior and lateral to the veins. Also after branching from the external iliac artery, all vascular DCI pedicles traveled upward and medially along the Iliacus muscle and the iliac fascia. The mean pedicle length was 21.78 mm for men and 19 mm for women. No statistically significant relationship was observed between the patient's age and the vascular pedicle length or number of branches. There are great variations in the anatomy of this vascular pedicle. According to the finding of this study, the length of the vascular pedicle is 2.78 mm higher in men which might help to increase the feasibility and success rate of this operation. No significant correlation was found between other variables.