Normal Anatomical Features Research Articles

Biomechanical design optimization and experimental verification of Bezier curve based two-sectional cervical pillow with variable-density cellular structure

The fundamental function of an optimal cervical pillow is to provide sufficient support to maintain normal spinal alignment and minimize biological stress on the contact surface throughout sleep. The recent advancements in cervical pillows have mainly focused on the subjective and objective evaluations of support comfort, as well as the relationship between pillow height and cervical vertebrae posture. However, only a few studies have addressed shape design guidelines and mechanical performances of the pillows themselves. In this study, a two-sectional contour cervical pillow comprising an arc and a Bezier curve is designed to support the head and neck. The design of the arc-shaped neck section incorporates the Cobb’s angle and Borden value from healthy individuals to reflect the consistency of normal cervical anatomical features. The Bezier curve-based head section takes the head length and neck depth into account as significant individual differences. Static analysis and lattice optimization are performed in ANSYS Workbench to develop a variable-density cellular structure, aimed at improving air permeability and reducing the risk of pressure ulcers associated with the cervical pillow. The rapid prototyping technique fused deposition modeling (FDM) and thermoplastic material polylactic acid (PLA) are employed for fabricating different cellular structures. The results demonstrate that the neck section experiences less stress and greater deformation in comparison to the head section, indicating good comfort and support provided by the designed cervical pillow. Additionally, the compressive, bending, and cushion properties of the 3D-printed cervical pillow with variable-density cellular structure are experimentally validated, further confirming its effectiveness.

Histology Atlas of the Developing Mouse Respiratory System From Prenatal Day 9.0 Through Postnatal Day 30.

Respiratory diseases are one of the leading causes of death and disability around the world. Mice are commonly used as models of human respiratory disease. Phenotypic analysis of mice with spontaneous, congenital, inherited, or treatment-related respiratory tract abnormalities requires investigators to discriminate normal anatomic features of the respiratory system from those that have been altered by disease. Many publications describe individual aspects of normal respiratory tract development, primarily focusing on morphogenesis of the trachea and lung. However, a single reference providing detailed low- and high-magnification, high-resolution images of routine hematoxylin and eosin (H&E)-stained sections depicting all major structures of the entire developing murine respiratory system does not exist. The purpose of this atlas is to correct this deficiency by establishing one concise reference of high-resolution color photomicrographs from whole-slide scans of H&E-stained tissue sections. The atlas has detailed descriptions and well-annotated images of the developing mouse upper and lower respiratory tracts emphasizing embryonic days (E) 9.0 to 18.5 and major early postnatal events. The selected images illustrate the main structures and events at key developmental stages and thus should help investigators both confirm the chronological age of mouse embryos and distinguish normal morphology as well as structural (cellular and organ) abnormalities.

Morphological and radiographic studies on the Manus region in the Arabian one-humped camel (Camelus dromedaries).

The study aims to analyse the normal anatomical and radiographical features of the Manus of the southern Aswanian-adapted Arabian one-humped camel, providing crucial data for diagnosing and treating various ailments. Our study was applied to 10 cadaver forelimbs of adult male one-humped camels (4-5 years old) for an explanation of the gross anatomy of the bones of the Manus region from under the carpal bones by using traditional techniques, including the gross anatomical, radiographic and x-ray (at the dorsopalmar and lateral planes) of the preparation of Manus bones. Our results showed that the large fused (third and fourth) metacarpal bones, in which the fusion extended along the entire length of the bone except at the distal end, diverged to form separate articulations with cross-ponding digits. As described in all ruminant species, especially the camel, there were two digits, and each digit consisted of three phalanges and two proximal sesamoid bones. Our radiographic x-ray data revealed that the complete radiopaque septum that completely divided the medullary cavity into two separate parts was clear from the dorsopalmar view, while the lateral view showed the proximal sesamoid bones that were placed over each other and located palmar to the head of the large metacarpal bone. In conclusion, our study reveals the adaptations of the Arabian one-humped camel to Egyptian conditions, aiding in the early diagnosis of lameness and digit problems and enabling veterinarians and camel owners to better address these issues, thereby improving the overall health and well-being of these animals.

Sphenoid sinus in the Holstein cow: A sectional and 3D reconstructive anatomical study.

Cattle disorders affecting the sphenoid sinus are underreported, likely due to difficulties in imaging and lacking topographic knowledge. This study aimed to provide a detailed description of the normal anatomical and morphometric features of the cattle sphenoid sinus. Twelve healthy adult Holstein cow heads were used, and the sinus was examined using CT, anatomical sectioning and 3D modelling. The sinus was bilaterally detected in all animals but exhibited structural asymmetry and significant interindividual differences in morphological characteristics. Three parts of the sinus were defined, namely the rostral, median and alar parts, which conform to the morphological structure of the sphenoid bone. The rostral part was bilateral in shape and located on the orbit wall of the presphenoid bone in all animals. The median part, which pneumatized the body of the sphenoid bone, was observed bilaterally in seven animals, while the alar part, which pneumatized the wing of the sphenoid bone, was formed bilaterally in four animals. The sinus volume and surface area were 11 ± 8 cm3 and 49 ± 30 cm2 , respectively. These findings may aid in the diagnosis of cattle sphenoid sinus disorders and contribute to the knowledge of regional anatomy for radiologists and clinicians.

A Morphologic and Morphometric Study of the Vermian Fossa and Internal Occipital Crest in Adult Indian Human Skulls

Introduction: The inner surface of the squamous part of occipital bone shows a prominent internal occipital crest that descends and bifurcates close to foramen magnum to enclose a small depression called vermian fossa. It has been reported that the internal occipital crest and vermian fossa affect the dural venous sinuses close to it and influence the cerebrospinal fluid flow. Few studies have reported morphology the morphology and morphometric features of vermian fossa. There is a paucity of literature regarding the morphology and morphometry of the internal occipital crest. Hence, the present study evaluated the morphological and morphometric details of the vermian fossa and internal occipital crest. Objectives: To provide morphologic & morphometric data of the vermian fossa and internal occipital crest in the Indian population. Materials and Methods: This was a cross-sectional study, with a sample size of 64, carried out for a period of three months in the Department of Anatomy. The fossa's morphometric dimensions and the vermian fossa's different shapes observed were documented. The internal occipital crest was observed for shape & length. All data was tabulated, analyzed, and summarized using mean and standard deviation. Results: The vermian fossa was present in 56(82.35%) bones. The type 1 variety was observed in 48(70.6%), type 2 variety in 1 (1.1%) bone and type 3 - atypical variety in 10.3%. The mean length and width of the vermian fossa was 8.9 ±4.41 mm and 8.02±3.50 mm, respectively. The internal occipital crest was sharp in 37(54.4%) bones, rounded in 24(35.3%) bones and wide in 6(8.8%) bones and ill-defined in one bone. The mean length of the internal occipital crest from the internal occipital protuberance to the posterior margin of the foramen magnum was 4.16±0.56 cm. Conclusion: An accurate knowledge of morphology and morphometry of vermian fossa and internal occipital crest and their variations is of significance in diagnostic and therapeutic performance of clinicians and radiologists. Variations in normal anatomical features need to be explored. Hence, this is of importance to anatomists and morphologists. KEY WORDS: occipital crest, vermian fossa, morphology, morphometry, cerebellum.

Ultrasonographic anatomy of the palmar region of the carpus of the dog.

The palmar region of the canine carpus may be injured by traumatic, inflammatory, infectious, neoplastic, and degenerative disorders. The normal ultrasonographic anatomic features of the dorsal region of the canine carpus have been published, however information regarding the palmar region is currently lacking. The aims of this prospective, descriptive, anatomic study were (1) to describe the normal ultrasonographic characteristics of the palmar carpal structures in medium to large-breed dogs, and (2) to establish a standardized ultrasonographic protocol for evaluating them. As in the previously published study, the current study consisted of two phases: (1) identification phase, in which the palmar structures of the carpus were identified ultrasonographically in fifty-four cadaveric specimens and an ultrasonographic protocol to examine them was developed; and (2) descriptive phase, in which the ultrasonographic characteristics of the main palmar structures in twenty-five carpi of thirteen living healthy adult dogs were documented. The tendons of the flexor muscles of the carpus and digits, the superficial and deep parts of the retinaculum flexorum, the carpal canal and the median and ulnar neurovascular structures were ultrasonographically identified and described. Findings from the current study can serve as a reference for evaluating dogs with suspected injury involving the palmar carpal region using ultrasonography.

Anatomical Description of Loggerhead Turtle (Caretta caretta) and Green Iguana (Iguana iguana) Skull by Three-Dimensional Computed Tomography Reconstruction and Maximum Intensity Projection Images.

The growing interest in reptiles has posed a challenge to veterinary clinicians due to the lack of a standardized system to perform anatomical studies similar to those used for dogs and cats. In this paper, we have attempted to describe, employing computed tomography and subsequent three-dimensional reconstructions, the normal anatomical features that comprise the skulls of two species of reptiles: the loggerhead turtle (Caretta caretta) and the green iguana (Iguana iguana). Computed tomography (CT) and subsequent image processing allowed the identification of the bony structures that comprise the head of these species. As a result, and based on previous articles, we propose the most significant anatomical differences and similarities between these species.

REVERSE SHOULDER ARTHROPLASTY. HISTORY AND DEVELOPMENT PROSPECTS

In elderly patients with a low bone mineral density primary endoprosthesis shoulder joint is one of the methods of surgical treatment. Goal. Perform a historical review of the development of reverse shoulder arthroplasty (RSA) with analysis of biomechanical features of existing implants, their advantages and disadvantages to identify possible areas for further ways of improvement. Methods. Search for scientific information was performed in electronic databases PubMed, ScienceDirect, Google Scholar with a search depth of 30 years. There were selected 68 sources. Results. Unsatisfactory results after shoulder hemiarthroplasty caused in patients with severe damage to the rotator cuff and multifragmental fractures of the proximal humerus using RSA. Endoprosthesis design C. Neer replaced the implants of P. Grammont design, built on the principles: spherical glenoid component, concave support part on the humerus, the center of rotation at the level or medially of the scapular neck, proximal humerus fractures is displaced medially and distally. Medialization of the center of rotation is anunfavorable factor that leads to loss of tension of the deltoid muscle. To eliminate this disadvantages, lateralized hemispheres have been developed, with the help of which stability is achieved, the formation of a defect of the lower edge of the scapular neck is prevented. Their size affects on the volume of movements: the smallest diameters should be used for prevention of soft tissue strain. Note that the use of RSA with a lateralized center of rotation and varus shoulder component brings biomechanics closer shoulder joint to normal anatomical features. Conclusions. The main directions of RSA improvement: conducting biomechanical research to evaluate structures endoprostheses in order to choose the optimal design; introduction of modern additive technologies that will allow to obtain porous components with increased osteointegrative properties; reduce the weight of the hemisphere; improving friction pairs

The Utility of Smartphone 3D Scanning, Open-Sourced Computer-aided Design, and Desktop 3D Printing in the Surgical Planning of Microtia Reconstruction: a Step by Step Guide and Concept Assessment

IntroductionMicrotia, a congenital anomaly of the auricle with a wide spectrum of presentation with challenging reconstruction. Management depends on its severity with variable reconstructive options. Preoperative planning is crucial to achieve better results and decrease operative time. In this article, we aim to show the utility of an affordable technology with the use of a smartphone, an open-source computer-aided design (CAD) software, and a desktop 3D printer in planning future ear location for unilateral microtia reconstruction in step-by-step fashion. MethodologyFacial 3D scanning was done using a smartphone that has a three-dimensional capture system. The scan was then used in an open-sourced CAD software. A mirror image mask was created by reflecting normal side anatomic features to the abnormal side. The mask constitutes the desired area for reconstruction given the ear anthropometrics. Finally, the model was 3D printed and fitted to the patient in which incision marking and framework location was planned. DiscussionEar reconstruction requires careful assessment and specific technicality in its anthropometric measures. One important aspect in surgical planning resides in future ear location that varies between person to person. This variability makes the reconstructive option more customized based on the patient's needs. The utility of CAD software in the measurement and planning can help predict and optimize postoperative results as possible; however, it has major technical demands and added surgical fees. ConclusionHerein, we demonstrate the efficacy of an easy-to-use system beneficial for preoperative planning that is affordable, time-saving, and cost effective.

Gross anatomy and mineralization of larynx, trachea and syrinx in gray heron (Ardeacinerea)

This study aims to determine the normal anatomical features of the larynx, trachea, and syrinx of the heron birds and to identify the cartilage and mineralized areas with red Alcian blue staining. Three adult heron birds' larynx, trachea, and syrinx were used as materials in the study. Sex of the birds was neglected. With the staining of alizarin red Alcian blue, cartilage tissues were blue, and mineralized areas with calcium accumulation were red. In the macroscopic examination, mons laryngealis was seen on the caudal side of the tongue on the larynx under a stereomicroscope. It was observed that there was a thin and long-looking glottis on mons laryngealis. Larynx cranialis was observed to consist of two cartilago arytenoidea and one cartilago cricoidea in alizarin red staining. Trachea was found to consist of fully mineralized rings, except for the first and incomplete mineralized cartilago trachealis. Trachea rings were found to form a complete ring except for the first cartilago trachealis. Diameters of the rings differed regionally throughout for the trachea. It was determined that the widths of the trachea rings were approximately the same size except the first one. Syrinx was found to be the tracheobronchial type, which is the typical simple type syrinx. The four rings that make up the tracheabrochial syrinx were seen to merge. This is the first study showed the detailed anatomical description of larynx trachea and syrinx belonging to heron birds with alizarin red Alcian blue staining.

Point-of-Care Tomosynthesis Imaging of the Wrist.

Musculoskeletal injury to extremities is a common issue for both stateside and deployed military personnel, as well as the general public. Superposition of anatomy can make diagnosis difficult using standard clinical techniques. There is a need for increased diagnostic accuracy at the point-of-care for military personnel in both training and operational environments, as well as assessment during follow-up treatment to optimize care and expedite return to service. Orthopedic tomosynthesis is rapidly emerging as an alternative to digital radiography (DR), exhibiting an increase in sensitivity for some clinical tasks, including diagnosis and follow-up of fracture and arthritis. Commercially available digital tomosynthesis systems are large complex devices. A compact device for extremity tomosynthesis (TomoE) was previously demonstrated using carbon nanotube X-ray source array technology. The purpose of this study was to prepare and evaluate the prototype device for an Institutional Review Board-approved patient wrist imaging study and provide initial patient imaging results. A benchtop device was constructed using a carbon nanotube X-ray source array and a flat panel digital detector. Twenty-one X-ray projection images of cadaveric specimens and human subjects were acquired at incident angles from -20 to +20 degrees in various clinical orientations, with entrance dose calibrated to commercial digital tomosynthesis wrist scans. The projection images were processed with an iterative reconstruction algorithm in 1 mm slices. Reconstruction slice images were evaluated by a radiologist for feature conspicuity and diagnostic accuracy. The TomoE image quality was found to provide more diagnostic information than DR, with reconstruction slices exhibiting delineation of joint space, visual conspicuity of trabecular bone, bone erosions, fractures, and clear depiction of normal anatomical features. The scan time was 15 seconds and the skin entrance dose was verified to be 0.2 mGy. The TomoE device image quality has been evaluated using cadaveric specimens. Dose was calibrated for a patient imaging study. Initial patient images depict a high level of anatomical detail and an increase in diagnostic value compared to DR.

A Rare Case: Duplication of Lungs on Left Side in Human Cadaveric Study

Knowledge of lung variation is essential to all medical professionals to exactly interpret radiographs, computed tomography scans, to diagnose, plan and modify a surgical procedure. In this case, a very rare variation has been studied, where three lungs were present in a cadaver. There was a duplication of lungs on left side, none of them had a fissure. Whereas, right lung had normal gross anatomical features. Such variation has not been reported till date. It should be taken into consideration while interpreting radiological variations and during surgeries like lobectomy, segmentectomies.

Cardiac CT angiography: normal and pathological anatomical features-a narrative review.

The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.

Effectiveness of blended learning in radiological anatomy for first year undergraduate medical students.

The aim of the study was to assess the effectiveness of blended learning modules for radiological anatomy among first-year medical students by estimating knowledge gain and evaluating student perceptions. A single-group, pre- and post-test study design was utilized. Five radiological anatomy modules consisting of online presentations and self-assessment quizzes were developed for the upper limb, lower limb, head and neck, thorax, and abdomen and pelvis. The content of the modules was uploaded on to a learning management system called TYRO. Each module focused on the normal anatomical features observed on plain and contrast radiographs. Other relevant imaging modalities and clinical contexts were also introduced. During the classroom session, the students were instructed to peruse the modules and answer the self-assessment quiz. The teacher in the classroom acted as a facilitator and was available to the students for any clarifications. A pre- and post-test was administered to the students before and after exposure to the modules, respectively. A paired t test was used to estimate differences in the pre- and post-test scores. Students' perceptions were assessed using a questionnaire. One-hundred students attended both the tests. The mean and standard deviation of pre- and post-test scores were 17 ± 5.5 and 26 ± 7.6, respectively, and this difference was significant. Students' perceptions about the intervention were on the whole positive. A significant improvement in the knowledge of radiological anatomy was noted after exposure to five blended learning modules of radiological anatomy. The modules were well received by the students.

Size Matters! Evaluating the Effect of Model Size on Anatomy Learning

Historically, learning anatomical specimens was limited to studying cadaveric materials, and by extension, specimens which are “life‐sized”. Recent technological advancements in 3D scanning and printing now allow for the production of inexpensive, durable anatomical replicas at virtually any size. This, however, creates a dilemma: what is the most effective model size to learn from? The goal of this project is to discover the appropriate size of an object to learn nominal anatomy and thus provide a critical step in improving anatomic education.We hypothesize that there is a curvilinear relationship between model size and learning, where a model too small or too big would not be the most conducive to learning and an ideal intermediate size can be determined. In this study, undergraduate students (n = 351) without prior anatomical training learned from four bones of varying normal anatomical size and features and were assessed on their ability to identify various landmarks. Thoracic vertebra (VE), hemipelvis (HE), sphenoid (SP), and scapula (SC) was 3D‐printed at four different scalar sizes. The VE and HE models were printed at 50%, 100%, 200%, and 400% scale, while SP and SC models were printed at 50%, 100%, 200%, and 300% scale. Each participant was randomly assigned to a group of two bone models (VE/HE or SP/SC) of a certain size, and randomized across the order in which they learned the models. They were then tested on the respective real bone specimens, followed by a qualitative survey reporting their experience with the 3D‐printed models, a Mental Rotations Test (MRT), and an Operation Span Test (OSPAN). Data collection for the 50% SP/SC group is still ongoing.Multiple regression suggested significant effects of Model Type, Model Size, MRT and OSPAN, (F(9, 596) = 17.96, p = 0.000, R2 = 0.2133). The most significant predictor of test score was MRT, which suggested a 10% increase in MRT score is associated with a ~3% increase in test score. The score variability independently accounted for by MRT and OSPAN was 14.6%, while the variability independently accounted for by model size and type was 7.8%. This means, that while test scores are primarily driven by participants’ mental rotation ability, model size remains an important feature that can be manipulated to improve learning. 3D printing allows for this in a cost‐effective way.Support or Funding InformationThis study was funded by the Education Program in Anatomy at McMaster University. Many thanks to the University of Buffalo for 3D printing the 400% VE and HE models.

Challenges in plain film radiographic diagnosis for the dental team: a review of the maxillary sinus.

The maxillary sinus is the largest of the paranasal sinuses, with its structure and contents commonly visualised on dental radiographs. Dental practitioners are required to evaluate the entire radiograph, and it is likely there is limited exposure to maxillary sinus pathoses and radiological interpretation in the undergraduate curriculum and routine continuing professional development courses. This review covers radiological features of common benign and malignant sinus disease. Identification of normal anatomical features, common variations and pathoses can facilitate holistic patient management and potentially early detection of neoplastic disease.

Morphological changes of the dorsal contour of the corpus callosum during the first two years of life.

In the medicolegal literature, focal concavities or notching of the corpus callosum has been thought to be associated with fetal alcohol spectrum disorders. Recent work suggests corpus callosum notching is a dynamic and normal anatomical feature, although it has not yet been defined in early life or infancy. Our purpose was to characterize the dorsal contour of the corpus callosum during the first 2years of life by defining the prevalence, onset and trajectory of notching on midsagittal T1-weighted images. We reviewed retrospectively 1,157 consecutive patients between birth and 2years of age. Corpus callosum morphology was evaluated and described. A notch was defined as a dorsal concavity of at least 1mm in depth along the dorsal surface of the corpus callosum. Patient age as well as notch depth, location, number and presence of the pericallosal artery in the notch were noted. Two hundred thirty-three notches were identified in 549 patients: 36 anterior, 194 posterior and 3 patients with undulations. A statistically significant (R2=0.53, Beta=0.021, P=0.002) positive correlation between posterior notch prevalence and age in months was noted. A positive correlation between age and depth of the posterior notch was also statistically significant (r=0.32, n=179, P≤0.001). A trend for increased anterior notch prevalence with age was identified with significant correlation between visualized pericallosal artery indentation and anterior notching (r=0.20, n=138, P=0.016). Sub-analysis of the first month of life showed corpus callosum notching was not present. The presence of posterior notching increased significantly with age and was more frequent than that of anterior notching. Corpus callosum notching was absent in the first week of life, building on prior studies suggesting corpus callosum notching is acquired. This study provides baseline data on normative corpus callosum notching trajectories by age group during early life, a helpful correlate when associating corpus callosum morphology with disease.

Comparative Evaluation The Role of Venous and Peritoneal Autograft as Bioscaffold for Repairing Achilles Tendon Defect in Dogs

The study was conducted on eighteen healthy dogs, which were allocated into three equal groups (six dogs each). In the first treatment, the hind limbs were prepared at the calcaneus region where Achilles’ tendon was sharply incised, sutured with Kessler method, and immobilized with gypsona. The second treatment included the using of a peritoneum graft, while the third treatment utilized the venous autograft. Following surgery, all animals were inspected clinically, grossly and histopathologically for two months. Results of the first treatment exhibited adhesion and inflammatory reaction after one and two months of surgery. Histopathological examination revealed the organization of collagen fibers and mild inflammatory reaction after two months of surgery. The second treatment exhibited complete healing and the animal showed normal activities without any impairment on leg function. Grossly, a mild degree of adhesion was determined after two months of surgery. Histopathological examination exhibited complete granulation tissue formation with the slightest degree of fibroblast formation at 60 days. In the third treatment, there was an inflammatory reaction with moderate adhesion at one month of surgery. However, after 60 days post operation, the tendon restored the normal anatomical feature. In conclusion, unlike other treatments, results obtained from the using of peritoneal graft for reconstruction tendon defect was with the most convincing and efficient outcomes. The findings reported here shed a new light on treating of the defective tendon.

An Anatomical Study of the Tibia in the North Indian Population

Introduction The human tibia is a complex anatomical unit and the knowledge of its morphometric values is important in Forensic, Anatomic and Radiological cases in order to identify unknown bodies and stature. Objective It was to analyze the tibia, its morphometry, side difference and to investigate the position of nutrient foramina in tibia. Methods In this study, 60 adult human tibias (30 right and 30 left) were obtained from the Department of Anatomy SMSR SHARDA UNIVERSITY. In the study a total of two parameters i.e. Cross Section Index in the middle and Cnemicus Index of the bones were obtained and evaluated by using two instruments- a Measuring Tape and a Vernier Calipers. All the bones were dry and showed normal anatomical features. Results The mean Cross Section Index in the middle was calculated as 80.42 ± 11.33 on the right side and 78.15± 12.78 on the left side; and the Cnemicus index was 78.40 ± 13.19 on the right side and 70.84 ± 11.38 on the left side Conclusion The two parameters in the North Indian population were compared with other populations. The values were found to be almost comparable however there were subtle differences between different populations. The position of nutrient foramen was also assessed. This knowledge will thus help further researchers and orthopedic surgeons in various procedures like joint replacement therapy, fracture repair, bone grafts and vascularized bone microsurgery as well as in medico‐legal cases.

Preoperative cross-sectional mapping for deep inferior epigastric and profunda artery perforator flaps.

Perforator flap-based breast reconstruction in a post mastectomy patient requires dissection of the artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap. Traditionally, these reconstructions were performed with the transverse rectus abdominis myocutaneous (TRAM) flap, but autologous breast reconstruction using muscle sparing free flaps has become steadily more popular in recent years. Preoperative imaging to locate and evaluate candidate perforators has become an essential step before patients undergo the microsurgical procedure. Preoperative mapping assists with operative planning, reduces operating times, and brings anatomical variations to their attention. Pre-operative imaging also assists in choosing the appropriate donor site for harvesting flaps. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have been widely used for this type of preoperative imaging. Both MRA and CTA have their inherent advantages and disadvantages, and the preferred modality for this purpose varies by institution based on factors such as scanner availability, radiologist and surgeon experience, and comfort in interpreting the images. Concerns over excessive exposure to ionizing radiation and poor iodinated contrast agent enhancement of the intramuscular perforator course has made MRA the first-choice imaging modality in many centers. The purpose of the article is to review technique and protocols for the pre-operative CTA/MRA in patients who are being considered for a deep inferior epigastric artery perforator (DIEP) or profunda artery perforator (PAP) flap and to familiarize the reader with the normal and variant anatomic features of the deep inferior epigastric and PAP vessels along with the anatomic and surgical considerations used in the selection of perforator flap donor site for breast reconstruction post mastectomy.