Cadaveric Dissection Research Articles

Effect of structured cadaver dissection on the durability of anatomical learning in surgery residents

Effect of structured cadaver dissection on the durability of anatomical learning in surgery residents

A detailed review of the spinal accessory nerve and its anatomical variations with cadaveric illustration.

The spinal accessory nerve, considered part of the eleventh cranial nerve, provides motor innervation to sternocleidomastoid and trapezius. A comprehensive literature review and two cadaveric dissections were undertaken. The spinal accessory nerve originates from the spinal accessory nucleus. Its rootlets unite and ascend between the denticulate ligament and dorsal spinal rootlets. Thereafter, it can anastomose with spinal roots, such as the McKenzie branch, and/or cranial roots. The spinal accessory nerve courses intracranially via foramen magnum and exits via jugular foramen, within which it usually lies anteriorly. Extracranially, it usually crosses anterior to the internal jugular vein and lies lateral to internal jugular vein deep to posterior belly of digastric. The spinal accessory nerve innervates sternocleidomastoid, receives numerous contributions in the posterior triangle and terminates within trapezius. Its posterior triangle course approximates a perpendicular bisection of the mastoid-mandibular angle line. The spinal accessory nerve contains sensory nociceptive fibres. Its cranial nerve classification is debated due to occasional non-fusion with the cranial root. Surgeons should familiarize themselves with the variable course of the spinal accessory nerve to minimize risk of injury. Patients with spinal accessory nerve injuries might require specialist pain management.

Online training for hearing implant surgery : Anew approach to otological training.

Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is aneed to broaden education facilities in an on-line format. Therefore, afirst basic on-line training for otosurgery was developed. The system consists of an artificial temporal bone model together with aset of basic surgical instruments and implant dummies. As an essential part of the training kit, ahigh-resolution camera set is included that allows for connection to avideo streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, apre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. Over the three courses held to date, 28participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of aquestionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. The presented program of an otosurgical online training allows for basal education in practical exercises on aremote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.

Prosthetic Limb Attachment via Electromagnetic Attraction Through a Closed Skin Envelope.

Current socket-based methods of prosthetic limb attachment are responsible for many of the dominant problems reported by persons with amputation. In this work, we introduce a new paradigm for attachment via electromagnetic attraction between a bone-anchored ferromagnetic implant and an external electromagnet. Our objective was to develop a design framework for electromagnetic attachment, and to evaluate this framework in the context of transfemoral amputation. We first used inverse dynamics to calculate the forces required to suspend a knee-ankle-foot prosthesis during gait. We then conducted cadaveric dissections to inform implant geometry and design a surgical methodology for covering the implant. We also developed an in silico framework to investigate how electromagnet design affects system performance. Simulations were validated against benchtop testing of a custom-built electromagnet. The physical electromagnet matched simulations, with a root-mean-square percentage error of 4.2% between measured and predicted forces. Using this electromagnet, we estimate that suspension of a prosthesis during gait would require 33 W of average power. After 200 and 1000 steps of simulated walking, the temperature at the skin would increase 2.3 °C and 15.4 °C relative to ambient, respectively. Our design framework produced an implant and electromagnet that could feasibly suspend a knee-ankle-foot prosthesis during short walking bouts. Future work will focus on optimization of this system to reduce heating during longer bouts. This work demonstrates the initial feasibility of an electromagnetic prosthetic attachment paradigm that has the potential to increase comfort and improve residual limb health for persons with amputation.

Surgical Anatomy and Technique of Peri-Insular Hemispherotomy in Pediatric Epilepsy.

Hemispherotomy is a highly complex procedure that demands a steep learning curve. An incomplete brain disconnection often results in failure of seizure control. The purpose of this article was to present a step-by-step guide to the surgical anatomy of this procedure. It is composed of a 7-stage approach, enhancing access to and improving visualization of deep structures. A retrospective analysis of 39 pediatric patients with refractory epilepsy who underwent this technique was conducted. Engel scores were assessed 1 year postsurgery. Cadaveric dissections were performed to illustrate the procedure. Between 2015 and 2022, 39 patients were surgically treated using the peri-insular technique. The technique involved 7 stages: patient positioning, operative approach, opercular resection, transventricular callosotomy, fronto-orbital disconnection, anterior temporal disconnection, and posterior temporal disconnection. Most of the patients (92.30%) were seizure-free (Engel class I) at 1 year postoperative, 5.13% were nearly seizure-free (Engel II), and 2.56% showed significant improvement (Engel III). Complications occurred in 8% of cases, including 1 infection, 2 cases of aseptic meningitis, and 1 non-shunt-requiring acute hydrocephalus. The peri-insular hemispherotomy technique offers excellent seizure control with a low complication rate. Our visual documentation of surgical anatomy, complemented by detailed descriptions of surgical nuances, significantly contributes to a comprehensive understanding of this technique.

Clinical Anatomy of the Ligaments of the Face and Their Fundamental Distinguishing Features

Our study aimed to clarify the anatomical features of the zygomatic, upper masseteric, lower masseteric and mandibular ligaments and their possible contribution to age-related gravitational ptosis. The study was carried out by the method of layered dissection of fresh cadavers. In several observations, the zygomatic ligament is represented by the fibers originating from the zygomaticus major muscle fibers. It is a true ligament with the fibers inserted directly into the skin. The upper and lower masseteric ligaments originate from the parotideomasseteric fascia and weave into the thickness of the SMAS. The mandibular ligament consists of two connective tissue laminae originating from the parotideomasseteric fascia at the lower edge of the mandible and from the inner surface of this fascia, along the anterior edge of the masseter muscle, skirting the facial vein sheath and the facial artery, traveling toward the platysma and the depressor anguli oris muscle, and merging with their fibers. The zygomatic ligament should be considered an osteo-musculocutaneous ligament, emphasizing the role of the associated zygomaticus major muscle in the mechanism of aging. The upper and lower masseteric and mandibular ligaments are false fascio-SMAS ligaments rather than osteo-cutaneous ones, playing the barrier role and fixing the superficial fascia and the platysma muscle.

Modified Function-Preserving Endoscopic Endonasal Extracapsular Resection of a Large Orbital Apex Cavernous Hemangioma.

Various invasive oculoplastic procedures are commonly utilized to control the rectus muscles and widen the surgical corridor through the endoscopic endonasal removal of large orbital apex cavernous hemangiomas (OACHs). They require additional transconjunctival incision, rectus muscle insertional retraction, or muscle deinsertion at the globe that might not be safe and lead to prolonged postoperative extraocular muscle dysfunction. In this article, the authors described a modified 3-handed extracapsular technique for the resection of a large OACH without an additional procedure for rectus muscle control. The aim is to achieve a safe gross total tumor removal while minimizing the procedure-related complications. An intraoperative video is included, along with a stepwise cadaveric dissection relevant to the approach. A 71-year-old female presented with progressive left-sided blurred vision, binocular diplopia, and mild proptosis. Contrast-enhanced brain MRI revealed a large heterogeneous enhanced inferomedial intraconal mass in the left orbital apex, mostly consistent with cavernous hemangioma. Gross total tumor removal was achieved through a modified 3-handed endoscopic endonasal extracapsular approach. The diplopia was resolved, and significant visual improvement was achieved. Computed tomography scan demonstrated complete tumor removal, and histological examination confirmed the diagnosis. Endoscopic endonasal resection of large OACH can be feasibly performed by using a modified 3-handed extracapsular technique through the generous use of Q-tip swab applicators within the natural separation plane around the tumor capsule and a sequential traction-countertraction method. Subsequently, a gross total removal and optimal postoperative functional outcome are attainable through minimal rectus muscle fiber violation and intraconal fat manipulation.

Expressing the Complexities of the Student-Cadaver Relationship Through Visual Artwork.

Many physician assistant (PA) students first encounter death in the earliest days of their training when working with cadavers in the gross anatomy laboratory. Developing a deep knowledge of human anatomy is fundamental to health profession training programs and modern medical practice. Despite decreased laboratory hours and integration of technology and diagnostic imaging into modern anatomy courses, there remains value in the cadaver dissection experience. Medical learners experience diverse and complex feelings toward cadavers; learning to regulate one's personal responses within the anatomy laboratory is a skill that can be extrapolated to clinical practice. Art is one way for students to process their experiences with cadavers, and creating art for cadaver memorial ceremonies is an opportunity for student emotional processing while honoring the lives of their cadaveric teachers. A PA program in New England incorporated student art into a cadaver memorial ceremony, with 4 pieces of artwork and corresponding artist statements from that ceremony included in this piece. The works of art are visually diverse, but there is a shared sentiment in the artist statements of reflection, awe, appreciation, and humanity. Encouraging students to process complex experiences artistically may provide an enduring practice throughout a career in medicine.

Superficial branch of the radial nerve passing through the supinator canal, emerging between the extensor digitorum and abductor pollicis longus muscles and consequently supplying the second finger and radial portion of the third finger: a case report and clinical implications.

Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.

The Crossing Motor Ulnar Nerve Branch at Elbow

BACKGROUND AND OBJECTIVES: Cubital tunnel syndrome is the second most common nerve entrapment, and understanding the anatomy is crucial for the success of the nerve release. During ulnar nerve release for cubital tunnel syndrome, a motor branch is frequently encountered crossing anteriorly over the ulnar nerve from its medial/ulnar side proximally to the lateral/radial side distally. Little has been noted about this crossing branch in the literature. In this anatomic study, we sought to characterize this branch further and discuss its potential significance in cubital tunnel release. METHODS: We performed a cadaveric dissection of 48 elbow specimens as if performing a cubital tunnel release. We assessed for the presence of the crossing motor branch of the ulnar nerve and measured the distance from the medial epicondyle to the branch takeoff and to its target of innervation. RESULTS: Of our 48 specimens, 34 (71%) were noted to have a crossing motor branch at the area of compression by the deep flexor carpi ulnaris muscle fascia (common aponeurosis). On average, the distance from the medial epicondyle to the branch origin from the ulnar nerve was 18.2 mm and to the target muscle innervation was 28.4 mm. CONCLUSION: Identifying this branch is important for performing a cubital tunnel release, and awareness of this anatomy during ulnar nerve decompression procedures may help avoid injury to this motor branch.

Rare case of divided phrenic nerve variation: a cadaveric case report.

The phrenic nerve innervates the respiratory diaphragm, the primary muscle active during ventilation. The canonical path of the phrenic nerve originates from the cervical spine at C3-C5 spinal nerves and travels inferiorly through the neck and thoracic cavity to reach the diaphragm. During a cadaver dissection, a variation of the phrenic nerve was discovered in a 93-year-old male specimen. A traditional origin of the phrenic nerve was noted; however, the nerve branched into medial and lateral components at the level of the superior trunk of the brachial plexus. The branches reconnected at the apex of the aortic arch and continued inferiorly to innervate the ipsilateral diaphragm. This case study describes a rare type of branching of the phrenic nerve and explores its potential impact on clinical procedures.

Neurophysiologic Monitoring of Oculomotor Nerves During Transorbital Surgery: Proof of Concept and Anatomic Demonstration.

Transorbital neuroendoscopic surgery (TONES) is continuously evolving and gaining terrain in approaching different skull base pathologies. The objective of this study was to present our methodology for introducing recording electrodes, which includes a new transconjunctival pathway, to monitor the extraocular muscle function during TONES. A translational observational study was performed from an anatomic demonstration focused on the transconjunctival electrode placement technique to a descriptive analysis in our series of 6 patients operated using TONES in association with intraoperative neurophysiologic monitoring of the oculomotor nerves from 2017 to 2023. The stepwise anatomic demonstration for the electrode placement and correct positioning in the target muscle was realized through cadaveric dissection. The descriptive analysis evaluated viability (obtention of the electromyography in each cranial nerve [CN] monitored), security (complications), and compatibility (interference with TONES). In our series of 6 patients, 16 CNs were correctly monitored: 6 (100%) CNs III, 5 (83.3%) CNs VI, and 5 (83.3%) CNs IV. Spontaneous electromyography was registered correctly, and compound muscle action potential using triggered electromyography was obtained for anatomic confirmation of structures (1 CN III and VI). No complications nor interference with the surgical procedure were detected. The methodology for introducing the recording electrodes was viable, secure, and compatible with TONES.

Transpalpebral mini-orbitozygomatic approach for nonvascular skull base lesions: a single neurosurgeon's experience.

The authors aim to describe the advantages, utility, and disadvantages of the transpalpebral mini-orbitozygomatic (MOZ) approach for tumors of the lateral and superior orbit, orbital apex, anterior clinoid, anterior cranial fossa, middle cranial fossa, and parasellar region. The surgical approach from skin incision to closure is described while highlighting key technical and anatomical considerations, and cadaveric dissection demonstrates the surgical steps and focuses on important anatomy. Intraoperative images were included to supplement the cadaveric dissection. A retrospective review of adults who had undergone the MOZ approach for nonvascular pathology performed by a single neurosurgeon from 2017 to 2023 was included in this institutional review board-approved study. Descriptive statistics was used to summarize the data. Four representative cases were included to demonstrate the utility of the MOZ approach. The study included 65 patients (46 female, 19 male), average age 54.84 years, who had undergone transpalpebral MOZ surgery. Presenting symptoms included visual changes (53.8% of cases), vision loss (23.1%), diplopia (21.8%), and proptosis (13.8%). The optic nerve and optic chiasm were involved in 32.3% and 10.8% of cases, respectively. The most common pathology was meningioma (81.5% of cases), and gross-total resection was achieved in 50% of all cases. Major complications included an infection and a carotid injury. Improvement of preoperative symptoms was reported in 92.2% of cases. Visual acuity improved in 12 patients. The mean follow-up was 8.57 ± 8.45 months. The MOZ approach is safe and durable. The transpalpebral incision provides better cosmesis and functional outcomes than those of standard anterolateral approaches to the skull base. Careful consideration of the limits of the approach is paramount to appropriate application on a case-by-case basis. Further quantitative anatomical studies can help to define and compare the utility of the approach to open cranio-orbital and endoscopic transorbital approaches.

Anterolateral keyhole transorbital routes to the skull base: a comparative anatomical study.

Although keyhole transorbital approaches are gaining traction, their indications have not been adequately studied comparatively. In this study the authors have defined them also as transwing approaches-meaning that they use the different facies of the sphenoid wing for cranial entry-and sought to compare the four major ones: 1) lateral orbitocraniotomy through a lateral canthal incision (LatOrb); 2) modified orbitozygomatic approach through a palpebral incision (ModOzPalp); 3) modified orbitozygomatic approach through an eyebrow incision (ModOzEyB); and 4) supraorbital craniotomy through an eyebrow incision (SupraOrb), coupled with its expanded version (SupraTransOrb). Cadaveric dissections were performed at the neuroanatomy lab. To delineate the skull base exposure, four formalin-fixed heads were used, with two sides dedicated to each approach. The outer limits were assessed via image guidance and were mapped and illustrated accordingly. A fifth head was dissected purely endoscopically, just to facilitate an overview of the transwing concept. Qualitative features were also rigorously examined. The LatOrb proves to be more versatile in the middle cranial fossa (MCF), whereas the anterior cranial fossa (ACF) exposure is limited to a small area above the sphenoid ridge. An anterior clinoidectomy is possible; however, the exposure of the roof of the optic canal is suboptimal. The ModOzPalp adequately exposes both the ACF and MCF. Its lateral trajectory allows the inferior to superior view, yet there is restricted access to the medial anterior skull base (olfactory groove). The ModOzEyB also provides extensive exposure of the ACF and MCF, but has a more superior to inferior trajectory compared to the ModOzPalp, making it more appropriate for pathology reaching the medial anterior skull base or even the contralateral side. The anterior clinoidectomy is performed with improved visualization of the optic canal. The SupraOrb provides mainly anterior cranial base exposure, with minimal middle fossa. An anterior clinoidectomy can be performed, but without any direct observation of the superior orbital fissure. Some MCF access can be accomplished if the lateral sphenoid wing is drilled inferiorly, leading to its highly versatile variant, the SupraTransOrb. All the aforementioned approaches use the sphenoid wing as skull base corridor from a specific orientation point; hence these are designated as transwing approaches. Their peculiarities mandate careful case selection for the effective and safe completion of the surgical goals.

Sushruta: The Father of Indian Surgical History

Summary: Sushruta, an ancient surgeon from 600 BCE in Kashi, India, is a pioneering figure in medical history. His innovations in surgical techniques, predating Hippocrates and Galen, have left an indelible mark in the field. This review article focuses on Sushruta’s contributions to surgery, particularly his foundational work in plastic and reconstructive procedures. We delve into the Sushruta Samhita, the oldest surgical text, covering essential principles, pathology, anatomy, and surgical management. Sushruta’s approach emphasized cleanliness, cadaver dissection, and innovative practices in anesthesia. Our article underscores the enduring impact of Sushruta’s work on modern surgical science.

422 Novel Application of a Mixed-Reality Platform for Learning Neuroanatomy

INTRODUCTION: Neuroanatomy is a difficult and intimidating, but also foundational, subject for many medical specialties, especially Neurosurgery. Yet, few modern tools exist for teaching neuroanatomy. This pilot study sought to evaluate the effectiveness of a novel mixed-reality (MR) neuroanatomy visualization software and headset compared to traditional methods of instruction. METHODS: This was a prospective randomized cross-over study of volunteer participants in a graduate neuroanatomy course. Students were randomly assigned to either traditional (Group-1) or MR (Group-2) modalities for 2 of 4 course units. All students participated in class lectures. Following each lecture, the MR group conducted MR lab modules while the traditional group conducted traditional cadaveric dissections or yarn and paper lab activities. All students then took the traditional Unit-lab exam. The two groups switched modalities between units. For logistical reasons, the MR laboratory sessions were taught in a separate location than traditional modalities with a teaching assistant. Student opinions were collected via survey and exam results were analyzed via Student’s t-test. RESULTS: Thirty-seven students volunteered to participate, with 23 completing the study (Group-1 n = 11 and Group-2 n = 12). Twenty-one students completed the post-course survey. Performance on both lab exams did not differ significantly between traditional and MR groups (p > 0.05). Most participants (95.2%) recommended traditional neuroanatomy teaching methods while 47.6% recommended the MR application. However, 95.2% of participants agreed that using MR with traditional methods would be better than either separately. CONCLUSIONS: Students’ neuroanatomy exam performance did not differ based on laboratory modality, though students preferred the traditional approach. Most students acknowledged the potential usefulness of MR in addition to traditional modalities. Further studies with larger sample sizes and a single location and instructor are needed to more fully elucidate the value of MR in learning neuroanatomy.

Prevalence and Anatomical Variations of Middle Hepatic Artery: A Cadaveric and Radiological Study

Introduction
 Middle Hepatic Artery is a hilar artery that supplies segment IV of the left hemi-liver. Anatomical Variations of this hilar artery has led to its classification into various sub-types based on its origin. Many studies have elucidated the surgical importance of MHA and in-depth knowledge of its variations is essential to minimize the morbidity during liver surgeries. In LDLT and during hepatic resections any injury to MHA and vascular compromise to Segment IV can bring in catastrophic consequences such as reduction in functional volume of left lobe in right allograft, possible graft loss in left allograft and ischemic cholangiopathy at all cases.
 Methods
 This is a cross-sectional study on 25 cadaveric Livers and 25 CECT- Abdomen arterial phase, a total of 50 Liver specimens at our center. The origin and course of MHA was accessed and characterized after meticulous dissection of cadavers and 3D reconstruction of CECT-Abdomen arterial phase. Collected data was entered and analyzed by using IBM SPSS STATISTICS 16.
 Results
 MHA was present in 76% of cases. MHA originated from RHA in 34% of cases; from LHA in 24% of cases; from RHA in presence of replaced LHA in 6%; from LHA in presence of replaced RHA in 8% and from non-left non-right hepatic artery along the axis of CHA in 4% of cases.
 Conclusion
 MHA is a hilar artery that predominately originates from RHA. It is very important for a surgeon to meticulously study the course of MHA in patients prior to liver surgeries using 3D-reconstruction of radiological images to minimize morbidities.

Critical Steps and Common Mistakes during Temporal Bone Dissection: A Survey among Residents and a Step-by-Step Guide Analysis.

Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for the learning and training of the young oto-surgeon in order to perform middle ear surgery, which includes the management of inflammatory pathology, hearing rehabilitation, and also cognitive decline prevention surgery. The primary objective of this study was to identify common mistakes and critical passages during the initial steps of temporal bone dissection, specifically cortical mastoidectomy and posterior tympanotomy. A survey among 100 ENT residents was conducted, gathering insights into the most prevalent errors encountered during their training to uncover the most challenging aspects faced by novice surgeons during these procedures. The most common mistakes included opening the dura of the middle cranial fossa (MCF), injury of the sigmoid sinus (SS), chorda tympani (CT), and facial nerve (FN) injury while performing the posterior tympanotomy. The most important critical steps to prevent mistakes are related to the absence of wide exposure during cortical mastoidectomy and the consequent impossibility of identifying the landmarks of the facial recess before performing posterior tympanotomy. Injury of these structures was more common in younger surgeons and in the ones who performed less than five temporal bone dissection courses. Numerous temporal bone dissections on cadavers are mandatory for ENT residents looking forward to performing middle ear surgery.

[Online training for hearing implant surgery : Anew approach to otological training. German version].

Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is aneed to broaden education facilities in an on-line format. Therefore, afirst basic on-line training for otosurgery was developed. The system consists of an artificial temporal bone model together with aset of basic surgical instruments and implant dummies. As an essential part of the training kit, ahigh-resolution camera set is included that allows for connection to avideo streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, apre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. Over the three courses held to date, 28participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of aquestionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. The presented program of an otosurgical online training allows for basal education in practical exercises on aremote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.

Entrapment of the Subscapular Artery between the Radial Nerve and the Posterior Wall of the Axilla: An Anatomical Variation with Clinical Significance

Objective. The subscapular artery vascularizes a substantial region of the thoracic wall, and the significance of its distribution is well depicted in the diversity of reconstructive procedures that rely on its blood supply. The aim of this study is to present an uncommon anatomical variation of the artery and discuss the clinical implications of its presence.
 Case Report. This case report depicts a rare variant of compression and the kinking of the subscapular artery by the radial nerve on the posterior wall of the axilla that was encountered during dissection of a male cadaver of Greek origin.
 Conclusion. The use of autologous tissues in the reconstruction of defects and treatment of lymphedema is expanding, so the need to establish safer surgical dissections is also becoming more apparent. The case of entrapment of the subscapular artery by the radial nerve is extremely rare, however, utiliz- ing tissues perfused by this artery for reconstructive purposes could potentially be futile and unsuccessful due to the inadequate blood supply or vessel thrombosis. Hence, the surgeon should adapt the treatment plan according to preoperative findings, as the presence of anatomical variants should always be suspected.