Superficial Branch Research Articles

Breast reconstruction using the superficial circumflex iliac artery superficial branch perforator (SCISP) flap.

The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One downside is its risk of postsurgical herniation and bulging due to the opening of the rectus fascia and intramuscular dissection of the rectus abdominis muscle. Additionally this part of the surgery is very time consuming. While the superficial inferior epigastric artery perforator (SIEA) flap has been thoroughly described for total autologous breast reconstruction, the use of the superficial circumflex iliac artery perforator flap in this field is limited. This series introduces the use of an extended superficial circumflex iliac artery (SCIA) perforator flap nourished solely by perforators of the superficial branch of the SCIA- artery for total autologous breast reconstruction.Superficial preparation over the abdominal wall was performed without incising the rectus fascia, dissecting the superficial branch of the SCIA and its accompanying veins and the superficial inferior epigastric vein for additional venous drainage.Four patients underwent successful autologous breast reconstruction with this extended SCIP (superficial circumflex iliac artery perforator)-flap-variation. The term superficial circumflex iliac artery superficial branch perforator (SCISP) flap was introduced to standardize the surgical technique for using only perforators of the superficial branch of the SCIA as free flaps.The SCISP flap is safe and viable for total autologous breast reconstruction, particularly for women with small to medium sized breasts and with superficial dominance of the abdominal vascular system.

A variant deep femoral artery passing anterior to femoral vein: an anatomical observation with implication in femoral vein cannulation.

The common femoral artery (CFA) typically gives rise to its superficial and deep branches, with the deep femoral artery (DFA) being the largest and most substantial of these branches. This case study presents a rare variation of the DFA characterized by an unusual branching pattern and its specific relationship with the femoral vein within the subinguinal region. In nutshell, the DFA and the medial femoral circumflex artery shared a common origin from the medial aspect of the CFA. The DFA assumed an unusual course, initially passing anterior to the femoral vein above the saphenofemoral junction, followed by a spiraling trajectory around the medial aspect of the femoral vein before running posteriorly. The embryological origins and clinical implications of this anatomical variation are thoroughly examined. This unusual vascular relationship in the subinguinal region may potentially result in arterial injury during femoral vein cannulation or formation of arteriovenous fistula after the procedure.

Clinical application of the free superficial palmar branch of radial artery flap for soft-tissue reconstruction of distal digital injury

PurposeThe purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury.Method13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6–12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap.ResultsAll the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases.ConclusionThe SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries.

Innervation of thumb carpometacarpal joint: implications for diagnostic block and denervation procedures

IntroductionOsteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is a common disorder that negatively impacts hand function. Denervation of the thumb CMC joint has emerged as a viable treatment option....

The precision of technical aspects in the minimally invasive Broström–Gould procedure: a cadaveric anatomical study

BackgroundA comprehensive understanding of the anatomy of the anterolateral ankle joint and its interrelationships is essential for advancing the development of minimally invasive Broström–Gould procedure, thereby enhancing surgical efficacy and minimizing postoperative complications.MethodsTen fresh human ankle specimens were dissected to observe the shape and trajectory of the lateral bundle of the inferior extensor retinaculum (IER) and its relationship with the deep fascia. To observe the relationship between the ankle capsule and the anterior talofibular ligament (ATFL). The center of the insertion point of ATFL at the lateral malleolus was used as the reference point. The vertical distance from the reference point to the fibula tip, the horizontal distance from the reference point to the lateral branch of the superficial peroneal nerve, the shortest distance from the reference point to IER, the narrowest width of the IER, the angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula were measured. The tension and elasticity of ATFL was understood. To describe the minimally invasive Broström–Gould procedure according to the anatomical characteristics of the anterolateral ankle joint.ResultsAmong the 10 cases, 8 cases (80%) had double bundles of ATFL, 2 cases (20%) had single bundle of ATFL, and no outer superior oblique bundle was observed in IER. The vertical distance from the reference point to the fibula tip was 1.2 ± 0.3 (range 1.1–1.3) mm. The shortest distance from the reference point to the level of the superficial peroneal branch was 28.2 ± 4.3 (range 24.5–32.4) mm. The shortest distance from the reference point to IER was 12.5 ± 0.6 (range 12.1–12.9) mm, and the width of IER at this point was 7.2 ± 0.3 (range 7.0–7.6) mm. The angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula was about 60° ± 2.8° (range 58.1°–62.1°) mm. The space between the anterolateral deep fascia of the ankle joint and the ankle capsule is very small, and only a few fat granules are separated between them. The ATFL is largely fused to the ankle capsule. The ATFL exhibited high tension and poor elasticity after traction with the probe hook.ConclusionsThe results showed that in the minimally invasive Broström–Gould technique for lateral ankle stabilization, the Broström procedure actually sutured the insertion of the ATFL together with the ankle capsule to the anterior edge of the lateral malleolus. In the Gould procedure, the deep fascia was mostly reinforced with the ankle capsule. The minimum suture span was obtained when the Gould suture needle direction was at an Angle of 60° to the longitudinal axis of the fibula.

Upper-Extremity Nerve Transfers for Sensation: A Systematic Review

Sensory nerve transfers may be performed to restore protective sensation and tactile perception after peripheral nerve injury in the upper extremity. There is a paucity of literature on the available donor-recipient configurations for sensory nerve transfers. This article presents a systematic review of reported sensory nerve transfers in the upper extremity. Original articles published between 1982 and 2022 were searched in MEDLINE and EMBASE. Articles describing a sensory nerve transfer were included if patient sensory outcomes were reported. Outcomes were categorized according to the modified British Medical Research Council scale, with an outcome of S3 or better defined as satisfactory. Of 1,049 articles, 39 met inclusion and quality criteria. Twenty-seven articles were primary research studies reporting on 197 patients who underwent 11 unique nondigital sensory donor nerve transfers and 24 unique digital donor nerve transfer procedures. The most reliable recipient nerve for restoring sensation to the ulnar border of the small finger was proper ulnar digital nerve of the small finger (38 patients, 89% satisfactory sensory outcome). The best available donors for transfer into the proper ulnar digital nerve of the small finger were proper ulnar digital nerve of the long finger (16 patients, 87.5% good sensory outcome) and palmar cutaneous branch of the median nerve (15 patients, 100% good sensory outcome). To restore sensation along the ulnar border of the thumb and radial aspect of the index finger, the best available donor was the superficial branch of the radial nerve, regardless of transfer into common digital nerve 1 (38 patients, success rate 63%) or directly to proper ulnar digital nerve of the thumb or proper radial digital nerve of the index finger (nine patients, success rates 67%). Outcomes after sensory nerve transfers are generally good. Surgeons should transfer into a digital nerve recipient when attempting to reconstruct sensation. Therapeutic IV.

Anatomical analysis of the radial nerve and arcade of Frohse in the cubital fossa using human cadavers.

The radial nerve (RN) is a peripheral nerve that originates from the posterior bundle of the brachial plexus and carries C5-Th1 fibers. In the cubital fossa radial nerve divides into a superficial branch of the radial nerve (SBRN) and a deep branch of the radial nerve (DBRN). Next DBRN enters under the arcade of Frohse (AF) and changes its name to posterior interosseous nerve of antebrachii (PIN). The AF was first described in 1908 by Frohs and Frankel. It is the superior proximal part of the supinator muscle, which can be tendinous or membranous. Eight dissected upper limbs were examined to measure the distances and characteristics of the RN, DBRN, SBRN and AF, utilizing precise electronic caliper. The average distance from the point of branching of the RN into its terminal branches to the AF was 54.64 mm on average. In half of the cases DBRN divided before entering the AF. The average distance from the point of branching of the DBRN to the AF in these cases was 13.88 mm. The width of the AF averaged 8.60 mm. Five tendinous AF and three membranous AF were identified. A thorough understanding of the anatomy of the radial nerve and its branches in the cubital fossa, as well as the AF, is important for the development of anatomy and may also contribute to the reduction of surgical complications during procedures in this area.

Arterial Vascularization of the Forehead in Aesthetic Dermatology Procedures: A Review.

Background: The growing popularity of aesthetic procedures on the face raises the question of their safety. The forehead region is crucial aesthetically, but due to its abundant vascularization, it is also one of the most dangerous areas for dermatologic procedures, especially in the glabella area. The purpose of this article is to review the literature on the arterial vascularization of the forehead to identify potential high-risk zones for aesthetic dermatology procedures. Methods: A database search (PubMed, Web of Science, Scopus, and Embase) was conducted, and the titles and abstracts of all identified studies were screened, followed by full-text evaluation. Results: We identified 714 articles during the database search, and 25 articles were included in the review. The included studies used cadaveric dissection and computed tomography applied to cadavers as well as Doppler ultrasonography on volunteers to evaluate the forehead arteries (supratrochlear (STrA), supraorbital (SOA), central (CA), paracentral artery (PCA), and frontal branch of superficial temporal artery(FBSTA)). A total of 1714 cases involving the forehead arteries were analyzed. The included arteries were observed over a relatively large area, and their locations varied. The CA and PCA in cadaver studies were observed in an area of 0.2 to 10.8 mm and 0.8 to 16.2 mm, respectively, on the entire path from the glabellar point to the frontal prominence point. The distances from the midline in cadaveric studies at various measurement points ranged from 0.6 to 28.0 mm for the superficial branch of the STrA and 13.6 to 40.7 mm for the deep branch of STrA. In case of SOA, the distance from the midline ranged from 23 to 32 mm. Measurements from the midline in Doppler studies ranged from 0 to 23 mm for STrA and from 10 to 50 mm for the SOA. In studies using computed tomography, STrA was observed at a distance of 11 to 21 mm and the SOA at a distance of 21 to 32 mm, both lateral to the midline. Conclusions: Medical professionals should be aware of zones where frontal arteries are more likely to be encountered. The glabella region appears to be one of the most dangerous areas for dermatologic procedures. It is believed that the supratrochlear, supraorbital, and the paracentral arteries may cause ophthalmic complications due to occlusion of the ophthalmic artery, while this risk for the frontal branch of the superficial temporal artery seems to be low but cannot be completely excluded.

A modified supraclavicular artery island flap for reconstruction of oral and maxillofacial defects

ObjectiveTo overcome the limitation of the supraclavicular artery island flap (SCAIF), we describe a modified SCAIF which incorporates a portion of the upper trapezius and the superficial branch of the transverse cervical artery (TCA) for the reconstruction of oral and maxillofacial defects. Study designThe modified SCAIF was used on 20 patients at our hospital between April 2013 to August 2022. All patients underwent resection of the primary lesion site and immediate reconstruction with the modified SCAIF. Demographic data and flap details were recorded. Complications were assessed for at least a 6-month follow-up period. ResultsThis study included 20 patients. The mean flap harvest time was 50 minutes. The mean flap length was 6.0 cm, and the mean flap width was 5.0 cm. All flaps of 20 cases survived with good appearance, and no shoulder morbidity was found during a follow-up period of at least 6 months. ConclusionThe modified SCAIF is a versatile and reliable local flap option for moderate to large reconstruction in this special region after resection of the primary lesions. We found this simple flap design has overcome the limitations of the traditional one with a reliable blood supply and adequate tissue for larger defects.

Neuromuscular Junction Development Differs Between Extraocular and Skeletal Muscles and Between Different Extraocular Muscles.

To determine whether development of neuromuscular junctions (NMJs) differs between extraocular muscles (EOMs) and other skeletal muscles. Mouse EOMs, diaphragm, and tibialis anterior (TA) were collected at postnatal day (P)0, P3, P7, P10, P14, and P21, and 12 weeks. Whole muscles were stained with α-bungarotoxin, anti-neurofilament antibody, and slow or fast myosin heavy chain antibody, and imaged with a confocal microscope. Images were quantified using Imaris software. NMJs in the EOMs show a unique pattern of morphological development compared to diaphragm and TA. At P0, diaphragm and TA NMJs were oval plaques; EOM single NMJs were long, thin rods. NMJs in the three muscle types progress to mature morphology at different rates. At all ages, EOM single NMJs were larger, especially relative to myofiber size. The inferior oblique and inferior rectus muscles show delayed single NMJ development compared to other EOMs. NMJs on multiply-innervated fibers in the EOMs vary widely in size, and there were no consistent differences between muscles or over time. Incoming motor nerves formed complex branching patterns, dividing first into superficial and deep branches, each of which branched extensively over the full width of the muscle. Motor axons that innervate multiply-innervated fibers entered the muscle with the axons that innervate singly-innervated fibers, then extended both proximally and distally. EOM NMJs had more subsynaptic nuclei than skeletal muscle NMJs throughout development. EOMs show a unique pattern of NMJ development and have more subsynaptic nuclei than other muscles, which may contribute to the exquisite control of eye movements.

An anatomical variant of the posterior branch of the great auricular nerve: A case report and a short review of the literature

The great auricular nerve (GAN) is a sensory cutaneous nerve, which provides sensory innervation to the skin overlaying auricle, parotid gland, and mastoid region. The emergency of GAN is located at Erb’s point over the posterior burden of the belly of the sternocleidomastoid muscle (SCM). During its course, it normally bifurcates in a pair of, respectively, posterior and anterior, branches. The latter one then further divides into superficial and deep branches. Some different anatomical patterns of GAN branches were reported in the literature to underline the high variability of the GAN course. The aim of this case report is to underline a particular anatomical variant of a posterior branch of GAN we recently observed. It was characterized by an anomalous bifurcation involving two different groups of fibers, within the same field of innervation, which had an independent course toward the auricular lobe. To promptly face such a somewhat unexpected anomaly, besides the basic recommendation to surgeons of mastering a good knowledge of the high variability of the anatomy of GAN, a careful dissection around the SCM is believed to help the surgeon to recognize other anatomical variants of GAN course with the aim to preserve it.

Ultra high-frequency ultrasound of fascicles in the ulnar and radial nerves.

Ultra high-frequency ultrasound (UHFUS) has been demonstrated to allow easy visualization and quantification of median and digital nerve fascicles; however, there is a lack of normative data for other upper limb nerves. The purpose of this study was to use UHFUS to establish normative reference values and ranges for fascicle count and density within selected upper extremity nerves. Twenty-one healthy volunteers underwent sonographic examination of the ulnar, superficial branch of the radial, and radial nerves on one upper limb using UHFUS with a 48 MHz linear transducer. The number of fascicles in each peripheral nerve and fascicle density were assessed. The mean fascicle number and fascicle density for each of the measured nerves was ulnar nerve at the wrist 11.7 and 2.0, ulnar nerve at the elbow 9.2 and 1.1, superficial branch of the radial nerve 7.3 and 2.5, and radial nerve at the spiral groove 4.2 and 0.8. A single significant association was observed between CSA and fascicle number in the ulnar nerve at the wrist (p = .023, r = 0.66). Neither fascicle number nor density could be predicted by age, sex, height, weight, or body mass index. UHFUS may help to establish a baseline of normative data on upper limb nerves that are not frequently biopsied due to their mixed motor and sensory functions and has the potential for increased understanding of nerve fascicular anatomy to improve diagnostic accuracy of focal nerve lesions, particularly those with selective fascicular involvement.

Anatomical Variations of the Medial Plantar Artery Flap: A Cadaveric Study With Clinical Applications

The medial plantar artery flap (MPAF) presents both unique value as well as significant challenges. As the plantar foot has specific anatomy, the use of the MPAF to recreate this highly specialized area may provide improvements in durability and rates of limb salvage. The purpose of this study is to establish the anatomic course of the branching patterns of the medial plantar artery (MPA) and provide a foundation for MPA flap nomenclature as it is related to design and elevation. Thirty-seven fresh frozen cadaver feet were used for dissection: 20 right and 17 left sided limbs. Anatomic measurements recorded included: branching pattern of the MPA, bifurcation distance of the superficial branch (SB) and deep branch (DB) from the origin of the MPA, distance from the MPA origin to the anterior colliculus of the medial malleolus, and the distance from the SB and the DB to the navicular tuberosity. The MPA was found to bifurcate into SB and DB in 30 (81%) specimens; 6 (16%) specimens had only a SB, whereas 1 (3%) specimen had only a DB, which had not been previously described. The distance from the anterior colliculus to the MPA was 3.0 cm, MPA to the distal bifurcation was 2.9 cm, and navicular tuberosity to the SB and DB was 2.2 cm and 1.3 cm, respectively. Minimizing the complexity of the dissection with the use of more reliable landmarks and a deeper understanding of the anatomy may reduce complications and allow for more reproducible outcomes when utilizing the MPAF.

Improved Neurotization in High Peripheral Nerve Injury: Side to Side H-shaped Nerve Graft at the Most Distal Part of an Injured Extremity in a Rabbit Model.

We aimed to investigate the effects of nerve repair by setting a side-to-side (H-shaped) nerve graft on the most distal part of the damaged nerve to the adjacent intact nerve to accelerate its regeneration in the end organ. This pure experimental study was done on the lower extremities of two groups of rabbits in Animal Laboratory Department, 15 Khordad Hospital Tehran, Iran. In both groups, the sciatic nerve at the proximal part of the extremity below the superficial femoral branch was first cut and then repaired. In the investigation group, side-to-side H-shaped nerve grafts were applied between the sciatic and superficial femoral nerves (i.e., two branches) at the most distal to the cut site of the sciatic nerve below the superficial femoral branch at the lower extremity. The sciatic nerve was conventionally repaired in the control group. None of the rabbits' feet in the control group respond to pain stimulation (were without senses) and had ulcers. They had numb legs and went lame. All had muscular atrophy and lacked nerve growth (regeneration) according to pathology. In the investigation group, 86.7% of the rabbits responded to pain stimulation and only 13.3% of them had ulcers. In addition, in pathology report, 13.3% had suffered muscular atrophy and lacked nerve regeneration. Therefore, nerve regeneration was successful in 86.7% of rabbits who underwent H-shaped nerve grafts. Side-to-side H-shaped nerve graft at the most distal part of an injured nerve may cause successful recovery of high (proximal) nerve injury.

Posttraumatic Scrotal Reconstruction with a Pedicled "Extended" Superficial Circumflex Iliac Artery Perforator Flap: A Case Report.

The superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been used for scrotal reconstruction after Fournier's gangrene, skin cancer, or infections. However, there are few publications with regard to penoscrotal reconstruction after a traumatic injury with this flap. In this article, we propose a new SCIP flap variation, the "extended" or "direct" SCIP flap, to effectively reconstruct a wide scrotal defect after a traumatic injury. The "extended" SCIP flap is designed medial and cranial to the anterosuperior iliac spine (ASIS) using the superficial branch of the SCIA as the main pedicle.

E023 Intimomedial mucoid degeneration. A rare vascular disease mimicking giant cell arteritis presentation

Abstract Background/Aims The accuracy of giant cell arteritis (GCA) diagnosis has greatly improved in recent years with increasing use of fast track clinics and vascular ultrasound. The “halo” sign is recognised as confirmation of a positive test and is considered virtually pathognomonic of GCA in the setting of a correlating clinical presentation. There are caveats to this and “false halos” have been reported associated with arterial thickening seen in other conditions including atherosclerosis and lymphoma. In this case a focal area of arterial wall thickening mimicking a halo on ultrasound was due to a rare vascular condition called intimomedial mucoid degeneration. Methods A 63 year old female presented via the direct assessment unit to the fast track GCA service. She reported an 8 week history of a tender right forehead lump and a 3 week history of associated new headache with marked tenderness at the site of the lump. The headache was severe and had become persistent. Mild shoulder stiffness was present. No jaw claudication. Blurring while wearing glasses noted but no definite visual change. CRP 2mg/L, ESR at usual baseline of 30mm/hr. Other indices normal. On examination: No shoulder restriction. No visual field deficit. Palpable pulsatile area of artery right side of forehead that was exquisitely tender with less marked tenderness of the artery adjacent to this. No symptoms on left side. GCA probability score (GCAPS) 10 indicating intermediate probability of GCA. Results Temporal artery ultrasound performed using GE Logiq e and 10-22mHz probe. Left side imaged entirely normally. Right side symptomatic area imaged as a focal asymmetric thickened area of frontal branch artery measuring 1.5mm maximally in compression. The frontal branch artery imaged normally proximal and distal to this as did the right common superficial and parietal branches. Features were unusual however she was commenced on prednisolone 40mg daily pending further investigations. Eye assessment detected no ischaemic concerns. She returned for reassessment after 4 days. There was some symptomatic improvement however the tender lump persisted. A second opinion on the ultrasound was sought from the interventional radiologist, who felt the focal area may be a lymph node, with thickened artery adjacent. Surgical exploration and temporal artery biopsy was subsequently performed. Conclusion Histology showed there was actually mucoid change with eccentric thickening of the artery with aneurysmal change in keeping with the rare diagnosis of intimomedial mucoid degeneration. This is a very rare condition which causes predisposition to arterial aneurysm formation, and typically presents with acute pain of the artery involved. This lady had developed an aneurysm which was excised at the time of the biopsy, relieving her symptoms. This case is a reminder to pursue additional investigations and tissue diagnosis in the setting of unusual clinical and imaging findings. Disclosure S. Black: None. M. Wray: None. H. Stewart: None. E. Durkan: None. V. Serafimov: None. P. Davey: None. L. Smith: None.

Syndactylized glabrous flaps for multiple finger palmar defects.

Palmar finger or pulp defects require coverage with glabrous tissue to achieve a good match with the lost tissue. The management of multiple finger palmar or pulp defects is challenging because these defects may not always be suitable for local or pedicled flaps. In such situations, syndactylizing free or pedicled flaps can be used. We evaluated the results of free glabrous flaps syndactylizing across multiple finger defects. The two flaps used were the superficial branch of the radial artery (SUPBRA) flap and hypothenar free flap. Seven syndactylized glabrous free flaps were used to cover the defects in 16 fingers. The functional results and complaints were also assessed. Mean flap size was 14.35 cm2. Six flaps survived. Postoperative evaluation data were obtained for the 13 fingers. All the patients returned to their previous work. All patients had a diminished protective sensation of at least 4.31 according to the SWM test. The mean two-point discrimination score of the patients was 9.9 mm (7-14). One finger had a PIP joint flexion contracture of 30°, no donor-site complaints were observed. The advantages of these flaps include single operation site, strong glabrous tissue coverage, low risk of flexion contracture, and adequate tissue size for large defects. Disadvantages include two-stage and complex microsurgical operations, prolonged treatment, and hospital stay.

9-point Injection Technique for Lip Augmentation and Lip Corner Lifting Using Sonographic Imaging of the Labial Artery Pathway.

As lip enhancement with fillers has grown in popularity, practitioners have sought to identify injection methods that achieve aesthetically pleasing results while avoiding adverse events such as arterial injury due to intravascular injection. The primary objective of this study was to establish a safe injection technique for creating appealing, proportionate, and aesthetically pleasing lips while elevating the lip corners with filler. Before injection, the locations of the superior and inferior labial arteries were established by sonography and a 9-point injection technique (9-PIT) was devised to reliably achieve fashionable lips. Particle hyaluronic acid filler was administered to 50 patients by the 9-PIT and these patients were monitored for 3 months. The extent of lip corner elevation and the angle of lip corners were quantified by 3-dimensional analysis, while changes in the length and curvature along the upper peristomal lines were evaluated after 1 week. The superior and inferior labial arteries originated from the deep lateral aspect of the lip and gradually traversed toward the midline in the superficial layer. Superficial arterial branches were identified in the submucosal layer near the midline. All patients expressed satisfaction with the lip shaping and corner elevation, without any adverse effects or vascular complications. The angle of lip corners decreased by 8.80%, and lip corners were lifted by 1.02 mm. The upper lip exhibited a more pronounced S-shape, with the upper lip line being elongated by 6.5%. This accentuated S-shape contributed to the appearance of lifted lip corners. The 9-PIT facilitated safe and aesthetically pleasing lip volumization with corner elevation in a consistent manner, while elucidating vascular pathways. Lip corner elevation was achieved solely using HA filler.

Superficial branch of the radial nerve regularly contains fibers from the lateral antebrachial cutaneous nerve: A role in neuroma treatment

BackgroundMany surgical strategies aim to treat the symptomatic neuroma of the superficial branch of the radial nerve (SBRN). It is still difficult to treat despite many attempts to reveal a reason for surgical treatment failure. The lateral antebrachial cutaneous nerve (LACN) is known to overlap and communicate with SBRN. Our study aims to determine the frequency of spreading of LACN fibers into SBRN branches through a microscopic dissection to predict where and how often LACN fibers may be involved in SBRN neuroma. MethodsEighty-seven cadaveric forearms were thoroughly dissected. The path of LACN fibers through the SBRN branching was ascertained using microscopic dissection. Distances between the interstyloid line and entry of LACN fibers into the SBRN and emerging and bifurcation points of the SBRN were measured. ResultsThe LACN fibers joined the SBRN at a mean distance of 1.7 ± 2.5 cm proximal to the interstyloid line. The SBRN contained fibers from the LACN in 62% of cases. Most commonly, there were LACN fibers within the SBRN’s third branch (59%), but they were also observed within the first branch, the second branch, and their common trunk (21%, 9.2%, and 22%, respectively). The lowest rate of the LACN fibers was found within the SBRN trunk (6.9%). ConclusionThe SBRN contains LACN fibers in almost 2/3 of the cases, therefore, the denervation of both nerves might be required to treat the neuroma. However, the method must be considered based on the particular clinical situation.

Atriovenous Malformation of Pinna (A Rare Case) At a Tertiary Care Hospital, Patna, Bihar

Introduction: Arteriovenous malformations are vascular abnormalities in which the arterial vasculature connects to the venous, leading to potentially disfiguring and life-threatening complications. Venous malformations (70 %) are the most common CVM (congenital vascular malformation), followed by lymphatic malformations (12 %),arterio-venous malformations (8 %), combined malformation syndromes (6 %) and capillary malformations (4 %).The majority of these lesions are sporadic in nature.Case Report: A 15-year-old male came to E.N.T.OPD at PMCH with a history of swelling and skin discoloration of the right pinna (medial as well as lateral side) since last 2 years.Physical examination Vital signs were normal. Nopallor, no localized lymphadenopathy. A pulsatile swelling with areas of skin discoloration at the right pinna with no necrosis .Ear canal and the tympanic membrane- normal.On palpation Well defined welling, circumscribed margins, soft, non-compressible, spongy, non-tender, and pulsatile with a thrill. Bruit on auscultation.Investigations Routine tests were within normal limits. PTA- bilateral mild S.N.H.L.MRI-High flow vascular malformation seen in right retro auricular region with feeding vessels arising from right superficial temporal artery and branches of right maxillary artery.Treatment- Patient underwent sclerotherapy of the lesion. Postoperatively, the patient was evaluated in the E.N.T OPD at one, two and four weeks following sclerotherapy without recurrence of a mass, pulsation or bruit.