Cadaveric Dissection Research Articles

Development of associational fiber tracts in fetal human brain: a cadaveric laboratory investigation.

The advent of diffusion tensor imaging (DTI) in addition to cadaveric brain dissection allowed a comprehensive description of an adult human brain. Nonetheless, the knowledge of the development of the internal architecture of the brain is mostly incomplete. Our study aimed to provide a description of the anatomical variations of the major associational bundles, among fetal and early post-natal periods. Seventeen formalin-fixed fetal human brains were enrolled for sulci analysis, and 13 specimens were dissected under the operating microscope, using Klingler's technique. Although fronto-temporal connections could be observed in all stages of development, a distinction between the uncinate fascicle, and the inferior fronto-occipital fascicle was clear starting from the early preterm period (25-35 post-conceptional week). Similarly, we were consistently able to isolate the periatrial white matter that forms the sagittal stratum (SS), with no clear distinction among SS layers. Arcuate fascicle and superior longitudinal fascicle were isolated only at the late stage of development without a reliable description of their entire course. The results of our study demonstrated that, although white matter is mostly unmyelinated among fetal human brains, cadaveric dissection can be performed with consistent results. Furthermore, the stepwise development of the associational fiber tracts strengthens the hypothesis that anatomy and function run in parallel, and higher is the cognitive functions subserved by an anatomical structure, later the development of the fascicle. Further histological-anatomical-DWI investigations are required to appraise and explore this topic.

Anatomical Justification of Extradural Resection of the Anterior Clinoid Process.

Objective The study aimed to provide neuroanatomical justification of the extradural resection of the anterior clinoid process (ACP). Material and Method Using a cross-sectional study design, 47 cranial computed tomography (CT) scans were examined. There were 31 (65.96%) females aged 28 to 79 years. The measured dimensions were ACP length and width, and optic strut (OS) width. Index (i acp ) was measured as the ratio of ACP width to ACP length. The ACP volume and working operating field (WOF) volume were measured using Syngo.via Siemens program. The percentage expansion of WOF after removal of the ACP was estimated on 5 fixed human cadaver heads with the exoscope VITOM 3D. The possibilities of the combined approach were demonstrated in a clinical case. Results The mean ACP lengths were 11.31 ± 2.76 and 11.54 ± 2.86 mm, on the right and left, respectively. The mean ACP widths were 7.70 ± 1.66 and 7.64 ± 1.67 mm, on the right and left, respectively. Average i acp was 0.67 (minimum 0.45; maximum 0.90). The width of the OS varied in the range from 1.37 to 4.75 mm. The average volume of right ACP was 0.71 ± 0.16 cm 3 , right WOF was 3.26 ± 0.74 cm 3 , left ACP was 0.71 ± 0.15 cm 3 , left and WOF was 3.20 ± 0.76 cm 3 . Removal of the right ACP expanded the right WOF by 22.21 ± 3.88%, and left ACP by 22.78 ± 5.50%. There was an approximately 25% increase in the WOF from the cadaveric dissections. Taking into account the variability of the ACP and OS, we proposed our own surgical classification of complicated (i acp ≥ 0.67; medium OS 2.5 mm ≤ 4.0 mm; wide OS ≥ 4.0 mm; ACP with pneumatization) and uncomplicated ACP (i acp 0.45 ≤ 0.67 mm; i acp ≤ 0.45; narrow OS ≤ 2.5 mm; ACP without pneumatization). Using this classification, we developed an algorithm for ACP dissection and removal. This was piloted in a clinical case of microsurgical clipping of a left internal carotid artery-posterior communicating artery aneurysm via the left minipterional approach. Conclusion Extradural removal of ACP expands the WOF by approximately 25%, it helps neurosurgeons to improve proximal vascular control and avoid complications, and expands the range of indications for neurosurgical interventions in the skull base area.

Bridging Anatomy, Histology, and Pathology: A Novel Curriculum Component Incorporating Self-directed Learning for First-Year Medical Students.

During cadaveric dissection or prosection, medical students frequently encounter pathology that can be a springboard to further learning. We designed a novel educational activity linking anatomy, histology, and pathology that incorporated self-directed learning and teamwork, followed by feedback and instruction from pathologists. Post-activity, more than 97% of students rated the activity as useful (Likert scale of 1 to 5), indicating this activity should be continued in the future. Strengths included self-directed learning, content and design, and teamwork, peer, and faculty interactions. Clarity of assignment expectations, range of pathologies, and virtual presentation format remained areas for improvement.

The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports.

Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain. The technical feasibility of nerve capping after GON/LON transection was evaluated in cadaver dissections and intraoperatively. Patient-reported outcomes in the 3- to 4-month period were compiled from clinic visits. At 1-year follow-up, subjective outcomes and Migraine Headache Index scores were tabulated. Two patients underwent nerve capping as a treatment for headaches refractory to medical therapy and surgical decompressions with significant improvement to total resolution of pain without postoperative complications. These improvements on pain frequency, intensity, and duration remained stable at a 1-year time point (Migraine Headache Index score reductions of -180 to -205). Surgeons should be equipped to address the proximal nerve stump to prevent neuroma and neuropathic pain recurrence. Next to known contemporary nerve reconstruction techniques such as targeted muscle reinnervation/regenerative peripheral nerve interface and relocation nerve grafting, nerve capping is another viable method for surgeons to address the proximal nerve stump in settings of GON and LON pain. This option exhibits short operative time, requires only limited dissection, and yields significant clinical improvement in pain symptoms.

The Practice of Teaching and Scientific Research on Cadaveric Material Remains Crucial for Medical Education.

The practice of teaching and scientific research on cadaveric material remains crucial for medical education, especially in surgical disciplines. However, in Italy, this practice has been neglected due to legislative insufficiency and financial constraints. Although innovative methods and tools like simulators and e-learning have been adopted, direct hands-on experience with human cadavers remains irreplaceable for medical and surgical education. The absence of clear legislation governing cadaveric dissection has limited availability for teaching and research, resulting in economic burdens for universities and individuals seeking proper surgical training. To address this issue, Law No. 10/2020 and the recent implementing decree were introduced in Italy, providing detailed legislation on the donation of bodies for educational and research purposes. The law emphasizes the importance of respecting the donor's specific choices and aligns with constitutional principles promoting culture, research, and health protection. However, some critical issues related to consent procedures, duration of body availability, and preservation of anatomical parts remain. Additionally, the law's dissemination among the population needs improvement. Future optimization could include allowing donors to choose the timing of body donation and considering different timeframes for body availability. Furthermore, the implementation of consent procedures could be simplified to increase donations. The law should also address the need for appropriate reception centers and allocate resources for effective dissemination. Despite these challenges, Law No. 10/2020 represents a significant step forward in enhancing medical-surgical training, scientific research, and the overall quality of patient care in Italy.

High-Fidelity Perforator Visualization for Cadaver Dissection in Surgical Training.

In the first half of the third century B.C., Herophilus and Erasistratus performed the first systematic dissection of the human body. For subsequent centuries, these cadaveric dissections were key to the advancement of anatomical knowledge and surgical techniques. To this day, despite various instructional methods, cadaver dissection remained the best way for surgical training. To improve the quality of education and research through cadaveric dissection, our institution has developed a unique method of perforator-preserving cadaver injection, allowing us to achieve high-fidelity perforator visualization for dissection studies, at low cost and high efficacy. Ten full body cadavers were sectioned through the base of neck, bilateral shoulder, and hip joints. The key was to dissect multiple perfusing arteries and draining veins for each section, to increase "capture" of vascular territories. The vessels were carefully flushed, insufflated, and then filled with latex dye. Our injection dye comprised of liquid latex, formalin, and acrylic paint in the ratio of 1:2:1. Different endpoints were used to assess adequacy of injection, such as reconstitution of eyeball volume, skin turgor, visible dye in subcutaneous veins, and seepage of dye through stab incisions in digital pulps. Dissections demonstrated the effectiveness of the dye, outlining even the small osseous perforators of the medial femoral condyle flap and subconjunctival plexuses. Our technique emphasized atraumatic preparation, recreation of luminal space through insufflation, and finally careful injection of latex dye with adequate curing. This has allowed high-fidelity perforator visualization for dissection studies.

Anatomy of the anterior ribs and the composition of the costal margin: A cadaver study.

Traditional rib anatomy and costal margin teaching contends that the costal margin consists of a combined costal cartilage made up of ribs 7 to 10. Variations in 9th and 10th rib anatomy have been observed. We sought to evaluate the variability of interchondral joints and the make-up of the costal margin. Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin. Experienced chest wall surgeons evaluated this anatomy through a standardized dissection and assessment. Dissection videos were performed to allow for further review/assessment. Bilateral chest wall anatomy of 30 cadavers was evaluated (15 male, 15 female). The average age was 78 ± 12 years, and all patients were Caucasian. In all patients, the first rib attached to the manubrium, the second rib attached to the manubriosternal junction, and ribs 3 to 6 attached directly to the sternum. Interchondral joints were present between ribs 4/5-3%, 5/6-68%, 6/7-83%, 7/8-72%. Ribs combining to form a common costal cartilage via cartilaginous unions were observed between 6/7-3%, 7/8-45%, 8/9-30%, and 9/10-20%.The 8th rib attached directly to the sternum without joining the 7th rib in 10% of cadavers. The 8th and 9th ribs had free tips in 45% and 60% of evaluations, respectively. The 10th rib was found to have a hooked tip in 25% of cases and was a floating rib without attachment to the 9th rib 52% of the time. Rib tip mobility was noted in ribs 8, 9, and 10 in 52%, 70%, and 90%, respectively. Interchondral joints are common between ribs 5 and 8. Significant variability exists in the chest wall and costal margin compared with traditional teaching. It is important for chest wall surgeons treating diseases of the costal margin to appreciate this anatomic variability.

940 The Metaverse as a Potential Solution for the Delivery of Global Health Education

Abstract Aim We describe a novel approach to the delivery of global health education (GHE) via the utilisation of the Metaverse. In 2015, the Lancet Commission on Global Surgery identified that the global burden of disease amenable to surgical intervention is substantial and growing. Virtual Reality in Medicine and Surgery (VRiMS) is an academic working group based at Brighton and Sussex Medical School (BSMS) devoted to creating technology-based solutions in surgical and medical training and education. Method 10 East African surgeons were selected to attend a 5-day cadaveric dissection course in-person in Brighton, on fully funded scholarships. A parallel conference was also run in Kampala, Uganda and >1000 delegates attended remotely from 61 different countries. A proof of concept of the metaverse was created using the software Spatial. Delegates from the in-person course in Brighton and Kampala used Oculus and PICO headsets in order to access and interact within the metaverse build. Both a quantitative and qualitative approach was implemented for data collection utilising a survey as well semi-structured interviews. Results Feedback was positive and highlighted the interactivity of the platform, the multiple types of content which could be accessed and the level of immersion it provided. The majority of delegates felt that the metaverse could be beneficial in the delivery of medical and surgical education globally. Conclusions The Metaverse could be a novel approach in tackling issues in global health and global surgery and extensive future work related to its validity as an educational resource could be beneficial to trainees worldwide.

187 Master Students' Perception and Attitude on Methods of Anatomy Teaching and Assessment, Khartoum, Sudan 2014-2020

Abstract Aim Anatomy is the cornerstone of medical education; anatomical knowledge is undoubtedly essential for doctors regardless of their specialty. Teaching and learning anatomy are one of the most important and challenging subjects for both teachers and students. This study aimed at improving the postgraduate teaching and assessment methodologies by eliciting the perception and attitude toward anatomy teaching approaches among anatomy master students. Method A descriptive cross-sectional study was conducted among three consecutive batches of anatomy master students. A structured questionnaire was used as a tool of data collection and data was analysed using IBM statistical package for social sciences version 24 (SPSS 24). Results 44 candidates responded to the questionnaire. Among them, 90.9% chose dissection room sessions as the best tool in attaining the intended learning outcomes. Practical dissection was the best teaching method with regards to interest 81.1%, enjoyment 70.5%, retention of information 65.9% and satisfaction 59.1%. 72.7% of the respondents think that practical dissection test was the best assessment method in fulfilling the intended learning objectives. Multiple choice questions were the most helpful in learning anatomy effectively and was the best tool for assessing knowledge. Conclusions The results have shown a strong positive perception towards the use of cadaveric dissection in teaching and learning anatomy. However, many did not seem to prefer lectures as a tool in anatomy teaching and learning. In addition, practical dissection test and multiple-choice questions were the best assessment methods in attaining the intended learning objectives and learning anatomy effectively respectively.

Evaluation of polyethylene terephthalate glycol (PETG), Simubone™, and photopolymer resin as 3D printed temporal bone models for surgical simulation

ObjectivesAmong types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™. Materials and methodsThis study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection. ResultsThe photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy. ConclusionsPhotopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection.

Sonographic assessment of the tarsal tunnel compared to cadaveric findings: a pictorial study.

To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination. Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle. Sonographic images were correlated with anatomical structures exposed during cadaveric dissection. We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.

Preparation of Soft Embalmed Cadavers by the Modified Thiel Embalming Technique for Surgical Skill Training and Development of a Universal Quantitative Scoring System to Assess the Suitability of Soft Embalmed Cadavers for Such Training Purposes.

Background Cadaver dissection plays an important role in learning anatomy. A surgeon must have a thorough knowledge of anatomy of the operating region to perform safe surgery. Skill laboratories give opportunities to surgeons to practice on cadavers before venturing onto real patients. The most common method of cadaver preservation is through formalin fixation. In the process of fixation, formalin destroys the tissue characteristics and also has issues such as smell, eye irritation, hardening of tissue, and risk of carcinogenesis. The Thiel embalming technique and its modifications were developed to address those issues. Our primary objective was to find the benefits of soft embalmed cadavers over formalin-fixed bodies and, secondly, to find out microbial flora in soft embalmed cadavers. Study design This is a basic study. Methods Four cadavers were prepared for the soft embalming purpose for our workshop for surgeons on spine fixation. Due to unavailability, we replaced 4-chloro-3-methylphenol 1% with phenol 1%. The bodies were preserved in refrigerators at 4°C before being used for the workshop purpose. The delegates and faculties were given a questionnaire to assess their experience of the cadavers in terms of odor, irritation, tissue characteristics, joint mobility, and imaging characteristics. The results were calculated using statistical analysis. Swabs were taken from a few of the cadavers for culture to find the organisms. Results There were 14 questions in the questionnaire, and the data collected were divided into two groups, faculties, and delegates. JASP software was used to analyze the data. The questions addressed various aspects of cadavers such as color, odor, tissue pliability, joint flexibility, imaging characteristics, mucosal irritation, and earlier experience in working with cadavers. Cronbach α was used to find the correlation between the various characteristics analyzed. The authors intend to name the domains being measured: surgical suitability (scores of items 8 to 12), imaging suitability (scores of items 5 and 6), and smell score (scores of items 5 and 6). It can be a guide to constructing and refining a better quantitative scale to measure the "quality of soft-embalmed cadavers for surgical training." Conclusions Skill laboratories give opportunities to young surgeons and trainees to learn and improve their skills before applying them to real patients. This was our first attempt to develop soft embalmed cadavers at our center and our state. We used the parent solution with some variations as per the availability of chemicals at our place and found that the features of the preserved cadavers were good and well-suited to address our purpose. Therefore, with some variations in the parent formulations, centers situated in remote and less developed places can formulate their own solution to develop soft embalmed cadavers and establish cadaver skill laboratories. This will benefit the local surgeons and trainees. The authors tried to develop a few domains through statistical analysis, which can be used to assess and compare the quality of cadavers prepared at various centers.

248 Master Students' Perception and Attitude on Methods of Anatomy Teaching and Assessment, Khartoum, Sudan 2014-2020

Abstract Aim Anatomy is the cornerstone of medical education; anatomical knowledge is undoubtedly essential for doctors regardless of their specialty. Teaching and learning anatomy are one of the most important and challenging subjects for both teachers and students. This study aimed at improving the postgraduate teaching and assessment methodologies by eliciting the perception and attitude toward anatomy teaching approaches among anatomy master students. Methods A descriptive cross-sectional study was conducted among three consecutive batches of anatomy master students. A structured questionnaire was used as a tool of data collection and data was analysed using IBM statistical package for social sciences version 24 (SPSS 24). Results 44 candidates responded to the questionnaire. Among them, 90.9% chose dissection room sessions as the best tool in attaining the intended learning outcomes. Practical dissection was the best teaching method with regards to interest 81.1%, enjoyment 70.5%, retention of information 65.9% and satisfaction 59.1%. 72.7% of the respondents think that practical dissection test was the best assessment method in fulfilling the intended learning objectives. Multiple choice questions were the most helpful in learning anatomy effectively and was the best tool for assessing knowledge. Conclusions The results have shown a strong positive perception towards the use of cadaveric dissection in teaching and learning anatomy. However, many did not seem to prefer lectures as a tool in anatomy teaching and learning. In addition, practical dissection test and multiple-choice questions were the best assessment methods in attaining the intended learning objectives and learning anatomy effectively respectively.

History of anatomy and its involvement with medical science and practice: Historical review

The medical practice starts from Patient’s discomfort in his body structures due to distortion in morphology. This is located and examined by clinician so, medical practice and Anatomical knowledge are hand and gloves with each other. It is evident from history of Anatomy that Anatomy has been discovered by practicing physicians and surgeons. That clearly indicate that they could make the medical practice only after exploring the Anatomy. The source of knowledge of Anatomy were animal or human being as is evident from this review. The medical practice might have been started from evolution of human-being. Earlier some people were exploring the herbal medicine on the results of experiments on themselves for the effect of these medicines to treat their own discomforts. When it shewed the impact, they chose it to treat others for the same discomfort. That time they might not be knowing Anatomy but it was an empirical result. As the location of discomforts was associated with remedy so, this might have involved Anatomy. History of clinical practice and thereby Anatomy is as old as 1600BC. Earliar the people experimented on animals and then on cadavers and executed criminals. Then came different Anatomical Laws governing the use of cadavers. Now, current scenario is that there is lack of cadevers all over the world. To compensate for this, new methods including anatomage table, models and charts have been used to teach anatomy. But these novel methods can only supplement and cannot replace cadaveric dissections. It is very essential to know how Anatomy evolved and took present shape. This encouraged the author to review history of Anatomy and correlate with the simultaneously running clinical practice. The development of Anatomy has been presented along with its advancement with development of science and technology involved with medical education and clinical practice. Thus, Anatomy is not merely an academic subject in medical education rather Anatomy is needed to grasp all the subjects of medical education used to develop clinical skill for clinical practice. This has also been supported by history of Anatomy as all other subjects of medical education evolved from Anatomy. The interwoven interrelations between these subjects with clinical practice are essential as revealed by history of Anatomy to analyse the diagnosis and treatment.

The anterior transmuscular intrapelvic approach for the treatment of acetabular fractures—a new anterior surgical strategy

The anterior ilioinguinal and the posterior Kocher-Langenbeck approach have long been the standard surgical approaches to the acetabulum. The last decade has witnessed the development of so-called intrapelvic approaches for anterior pathologies because they provide better exposure of the quadrilateral plate. Currently, the modified Stoppa approach and the pararectus approach are frequently used by surgeons for the treatment of acetabular fractures. We investigated an even more direct access to the entire anterior column and the quadrilateral plate via the abdominal wall muscles, between the incisions for the ilioinguinal and the pararectus approach.After intensive study of anatomic specimens, a cadaver dissection was performed prior to clinical application. The approach was then used in 20 patients who were assessed retrospectively.Postoperative CT scans showed that, according to the Matta scoring system, the quality of fracture reduction was “anatomical” (≤ 1 mm) in 12 (60%), “imperfect” (2–3 mm) in four (20%), and “poor” (> 3 mm) in four (20%) patients. Numerous minor complications were observed; the majority of these had resolved at the time of discharge.In conclusion, the anterior transmuscular intrapelvic approach (ATI) is a safe and effective alternative to the ilioinguinal and pararectal approaches, and may be regarded as an evolutionary advancement of traditional procedures.

Attitudes of students who study in different departments against body donation

Objective: As technology continues to advance, alternative methods of cadaver education have emerged in anatomy lessons. However, cadaver dissection remains a fundamental component of medical education curricula worldwide. Material and Methods: This research was conducted among students enrolled in health sciences and other disciplines at İzmir Bakırçay University. A total of five hundred and eighty-four students took part in the study. The survey aimed to gather information on students' sociodemographic attributes and their perspectives regarding the potential donation of their and their family members' bodies for use as cadavers after their passing. Resuts: The analysis of the study's data revealed that students in both groups expressed a reluctance to donate their own bodies or those of their family members. Nonetheless, a majority of students emphasized the significance of cadaveric education, indicating that the willingness to donate cadavers could potentially rise with increased exposure to informative advertisements and comprehensive awareness campaigns. Conclusion: Despite the prevalent Islamic faith in Turkish society, survey findings indicate that religious beliefs do not significantly impede body donation. The study reveals that the primary deterrent to body donation in Turkey is the perceived lack of professionalism within the institutions accepting such donations. To enhance body donation rates in the country, a promising strategy involves launching comprehensive body donation campaigns through mass media, effectively showcasing the competence and professionalism of the parties involved in these initiatives.

Rare discovery of sacral "ribs": a cadaveric case report.

Supernumerary ribs are a well-documented congenital anomaly that can occur at any point of the vertebral column, most commonly in the cervical or lumbar region. However, accessory ribs found in the sacrococcygeal region are exceptionally rare and may be difficult to distinguish from other bony manifestations of the pelvic girdle. During cadaveric dissection, a pair of sacral "ribs" were found projecting from the left posterolateral sacral region. The bony projections shared a broad base from the posterior sacrum. The projections followed an anteroinferior trajectory, mimicking the thoracic rib structure. Computed tomography (CT) revealed further bony anomalies, including bilateral ossifications embedded in the sacrotuberous ligament, and a blunt bony protrusion extending toward the ischial spine. Most documented supernumerary ribs in the lumbar and sacrococcygeal regions are asymptomatic and are incidental findings in radiographic studies during the exploration of other medical complaints. Correlated symptoms mentioned in the literature include pelvic pain and decreased hip range of motion, with potential obstetric complications. Owing to their asymptomatic nature, sacral ribs may be underreported. The primary aim of this report is to provide a detailed description of these sacral "ribs" in the unique setting of a cadaveric dissection supplemented with medical imaging to enhance visualization.

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices.

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

New classification system for radical rectal cancer surgery based on membrane anatomy.

Total mesorectal excision along the "holy plane" is the only radical surgery for rectal cancer, regardless of tumor size, localization or even tumor stage. However, according to the concept of membrane anatomy, multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection. To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery. A three-dimensional template of the member anatomy of the pelvis was established, and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation. Then, we suggested a new and simple classification system for rectal cancer surgery. For simplification, the classification was based only on the lateral extent of resection. The fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces (medial, middle and lateral), and blood vessels and nerves are precisely positioned in the fascia or space. Three types of radical surgery for rectal cancer are described, as are a few subtypes that consider nerve preservation. The surgical planes of the proposed radical surgeries (types A, B and C) correspond exactly to the medial, middle, and lateral spaces, respectively. Three types of radical surgery can be precisely defined based on membrane anatomy, including nerve-sparing procedures. Our classification system may offer an optimal tool for tailoring rectal cancer surgery.

Base of the Third Metacarpal as a Palpable and Reliable Landmark for Identifying the Median Nerve’s Thenar Branch

The objective of this study was to investigate whether the base of the third metacarpal can predict the location of the thenar branch (TB) of the median nerve and the accuracy of palpating the base of the third metacarpal. In 15 patients with ulnar nerve lesions around the elbow, we transferred the opponens motor branch to repair the deep terminal division of the ulnar nerve (DTDUN). Before surgery, we located the TB by palpating the base of the third metacarpal volarly. During surgery, we placed three needles at the following places: one at the entrance of the TB into the abductor pollicis brevis, another at the point where the TB contacted the thenar muscles, and third at the DTDUN's trajectory over the third metacarpal. We obtained fluoroscopic images and measured distances between the needles and structures with image software. We also examined the relationship between the TB, DTDUN, and the volar tubercle of the base of the third metacarpal in cadaver hands. Finally, we invited 22 surgeons to palpate the base of the third metacarpal on volunteer hands and verified their accuracy using fluoroscopy. During surgery, after dissection and palpation of the TB, under fluoroscopy, we confirmed that the palpable bone prominence was the base of the third metacarpal. In cadaver dissections, we observed the TB crossing the volar tubercle of the base of the third metacarpal superficially from proximal to distal and from ulnar to radial. The DTDUN was, on average, 14 mm distal to the base of the third metacarpal distal limit. In total, 19 of the 22 surgeons correctly identified the base of the third metacarpal and consequently the trajectory of the TB. The palpable base of the third metacarpal can be used to determine the trajectory of both the TB and DTDUN. Diagnostic II.