Thick Subcutaneous Tissue Research Articles

Gluteal muscle and subcutaneous tissue thicknesses in adults: a systematic review and meta-analysis.

Nurses often administer intramuscular injections at the gluteal site. This study aimed to determine gluteal muscle and subcutaneous tissue thicknesses in adults. Systematic review and meta-analysis. The databases Turkish Medline, Ulakbim, National Thesis Center, Cochrane, Web of Science, Science Direct, PubMed, CINAHL Plus with Full text (EBSCO host), OVID and SCOPUS were screened using the keywords 'intramuscular injection', 'subcutaneous tissue thickness', 'muscle tissue thickness' and 'needle length' between April and May 2021. The studies were evaluated with ultrasound. This study was reported according to the PRISMA recommendations. Six studies met the eligibility criteria. The total sample size was 734 (women: 432, men: 302). The V method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 38.071 ± 2.119 and 19.927 ± 2.493 mm, respectively. The geometric method revealed that the ventrogluteal site had a muscle and subcutaneous tissue thickness of 35.989 ± 4.190 and 19.661 ± 3.992 mm, respectively. The geometric method also revealed that the dorsogluteal site had a thickness of 42.560 ± 8.840 mm. According to the V method, females had thicker subcutaneous tissue at the ventrogluteal site than males (Q = 5.37, df = 1, p = 0.0204). Body mass index did not affect the subcutaneous tissue thicknesses at the ventrogluteal site. The results show that gluteal muscle, subcutaneous and total tissue thicknesses vary across injection sites.

Patterns of superficial antecubital veins observed by near-infrared light technique: A community-based study

<b>Background: </b>The area of the cubital fossa contains the main superficial veins, including the basilic, cephalic, median cubital, and median antebrachial veins, and their innominate small tributaries. For this reason, it is the area most preferred by medical practitioners to access the circulatory system for various clinical applications.<br /> <b>Objective:</b> The aim of this study was to address the prevalence of different types of antecubital fossa superficial vein patterns observable among Saudi subjects by applying a tourniquet and using a VeinViewer®.<br /> <b>Materials and methods:</b><b> </b>Over the period from September 2020 to April 2021, a cross-sectional study was carried out in the Eastern Province of Saudi Arabia. The 151 study subjects were randomly chosen from the emergency department of King Fahad University Hospital. A total of 302 venous patterns were obtained; 55 were excluded due to the presence of scar tissues over the antecubital fossa, obesity, or thick subcutaneous tissue. Four classes of cubital venous patterns were established according to other studies, and a VeinViewer® and a tourniquet were used to visualize the venous patterns.<br /> <b>Results: </b>Of the 151 people, 21 were female and 130 were male. Among the included 247 venous patterns, the predominant type was type 2 (52.2%), characterized by a branching off the median cubital vein from the cephalic vein and an upward progression to join the basilic vein.<br /> <b>Conclusion: </b>Type 2 appears to be the dominant pattern, with no significant relation to the origins of the parents, in the Saudi population. Gender does not influence the venous patterns. Further studies are needed outside the restrictions of the COVID-19 pandemic to obtain a larger sample.

Distal vaginal atresia: a report of a rare type found a late-term fetus and its histological comparison with the normal pelvis.

Solitary distal vaginal atresia is generally caused by a transverse septum or an imperforate hymen. We found a novel type of distal vaginal atresia in a late-term fetus (gestational age approximately 28 weeks) in our histology collection. This fetus had a vaginal vestibule that was closed and covered by a thick subcutaneous tissue beneath the perineal skin in the immediately inferior or superficial side of the imperforate hymen. The uterus, uterine tube, anus, and anal canal had normal development. The urethral rhabdosphincters were well-developed and had a normal topographical relationship with the vagina, but the urethrovaginal sphincter was absent. Thus, vaginal descent seemed to occur normally and form the vestibule. However, the external orifice of the urethra consisted of a highly folded duct with hypertrophied squamous epithelium. Notably, the corpus cavernosum and crus of the clitoris had poor development and were embedded in the subcutaneous tissue, distant from the vestibule. Normally, the cloacal membrane shifts from the bottom of the urogenital sinus to the inferior aspect of the thick and elongated genital tubercle after establishment of the urorectal septum. Therefore, we speculate there was a failure in the transposition of the cloacal membrane caused by decreased elongation of the genital tubercle. The histology of this anomaly strongly suggested that the hymen does not represent a part of the cloacal membrane, but is instead a product that appears during the late recanalization of the distal vagina after vaginal descent. The transverse septum was also likely to form during this recanalization.

Bedside insertion of a peripherally inserted central catheter into a patient with BMI of 84.8 kg/m2 using a magnetic tracking and electrocardiogram-based tip confirmation system: a case report

BackgroundPeripherally inserted central catheters (PICCs) are typically placed under fluoroscopy. We used a magnetic tracking and electrocardiogram-based tip confirmation system for insertion of a PICC insertion in a morbidly obese patient at the bedside.Case presentationA 53-year-old female with severe obesity (height, 160 cm; weight, 217 kg; BMI, 84.8 kg/m2) was admitted to the intensive care unit. Both bilateral, inguinal, and cervical regions were covered with an excess of adipose tissue, making it difficult to place a central venous line. Since transferring her to fluoroscopy seemed dangerous, a PICC was inserted using Sherlock 3CG® TCS at the bedside. Magnetic sensor guidance failed due to the thick subcutaneous tissue her precordium, but intracavity electrocardiography could direct the tip to an appropriate position.ConclusionWe experienced bedside insertion of a PICC into a patient with BMI of 84.8 kg/m2 patient using a Sherlock 3CG® TCS. Since the interaction between Sherlock 3CG® TCS and body habitus has not been investigated, further reports are needed.

No influence of obesity on mid-term clinical, functional, and radiological results after computer-navigated total knee arthroplasty using a gap balancing technique

ObjectiveIn obese patients, thick subcutaneous tissue can introduce errors during registration and leg weight can influence gap balancing in navigated TKA. Present study is done to determine if computer navigated TKA using a gap balancing technique can achieve consistent accuracy for limb and component alignment, and similar clinical and functional results in obese patients like in non-obese patients. MethodsWe prospectively compared the radiological, clinical, and functional results of 78 knees in 57 non-obese patients and 79 knees in 58 obese patients who underwent computer-assisted TKA. Non-obese individuals were defined as those having BMI of <30 kg/m2 and obese individuals as BMI ≥30 kg/m2. The degree of knee deformity was calculated by Hip – Knee – Ankle (HKA) angle and clinical and functional assessment was done using the Knee Society Score – clinical knee score and Knee Society Score - function score, respectively. All these were documented before and at 6 months, 2 year, and 5 years after TKA. ResultsThe outlier rate of postoperative limb alignment (HKA angle) was 8.9% in the obese group which was not significantly different (p =1.00) from that of the non-obese group (7.7%). Mean clinical knee scores were not significantly different between the non-obese and obese groups preoperatively (58.8 vs 57.4, p = 0.14) and at 6 months (92.7 vs 91, p = 0.06), 2 years (91.4 vs 90, p = 0.07), and 5 years (92.4 vs 91.3, p = 0.1) post-surgery. Similarly, mean functional scores were not significantly different between the non-obese and obese groups preoperatively (50.9 vs 49.9, p = 0.31) and at 6 months (92.7 vs 90.9, p = 0.06), 2 years (91.3 vs 92, p = 0.44), and 5 years (90.6 vs 91.1, p = 0.51) post-surgery. ConclusionObesity has no influence on mid-term clinical, functional, and radiological results after computer navigated TKA, done by gap balancing technique. Level of evidenceTherapeutic level II.

Immediate Tissue-expander Breast Reconstruction Using a Skin Flap with Thick Subcutaneous Tissue: A Preliminary Study on Selective Patients

Immediate Tissue-expander Breast Reconstruction Using a Skin Flap with Thick Subcutaneous Tissue: A Preliminary Study on Selective Patients

Ultrasound-Guided Multiple Peripheral Nerve Blocks in a Superobese Patient

The number of obese patients has increased dramatically worldwide. Morbid obesity is associated with an increased incidence of medical comorbidities and restricts the application choices in anesthesiology. We report a successfully performed combined ultrasound-guided blockade of the femoral, tibial, and common peroneal nerve in a superobese patient. We present a case report of a 31-year-old, ASA-PS II, super obese man (190 kg, 180 cm, BMI: 58 kg/m2) admitted to the emergency department with a type II segmental tibia shaft fracture and ankle dislocation after a vehicle accident. After two failed spinal anesthesia attempts, we decided to apply a femoral block combined with a sciatic block. Femoral blocks were successfully performed with US guided in-plane technique. Separate blocks of the tibial and common peroneal nerves were planned after the sciatic nerve could not be located due to the thick subcutaneous tissue. We performed a tibial nerve block at 2 cm above the popliteal crease and common peroneal nerve at the level of the fibular head with US guided in-plane technique. The blocks were successful and no block-related complications were noted. Ultrasound guidance allows new approaches for multiple peripheral nerve blocks with low local anesthetic doses in obese patients.

Epicanthal fold correction: Our experience and comparison among three kinds of epicanthoplasties

Epicanthal fold, which is unique to Asian population, forms a web across and covering the medial canthus. It often impairs the beauty of the eyelids and the outcome of double-eyelid blepharoplasty that is popular in Asians. Although many surgical procedures have been reported, most of them were only description of a single technique. Comparison among techniques will help form universally accepted algorithm or consensus in epicanthus treatment. We want to present our experience of three kinds of epicanthoplasties: horizontal incision method, Z-plasty and V-W plasty and a detailed comparison among these surgical techniques. From 2005 to 2011, the authors had performed epicanthoplasties in 252 cases, in which 220 cases simultaneously underwent a double-eyelid surgery. The choice of technique was based on presurgical evaluation of severity of epicanthal fold. Horizontal incision method was used for majority of mild epicanthal fold. Z-plasty mainly applied to moderate cases and V-W plasty was chosen for severe ones. In addition to skin rearrangement in medial canthic region, underlying orbicularis oculi muscle and thick subcutaneous tissue also needed treatment for effective release. The degree of postoperative scarring and epicanthal fold correction were reviewed. All these three methods produced satisfactory long-term results with alleviation of the skinfold and formation of vivid upper eyelid crease. No complete recurrence was observed. Horizontal incision method left an inconspicuous scar and V-W plasty might cause a relatively obvious scar. Persistent hypertrophic scars were observed in 12 patients and gradually faded after injection of diprospan. In conclusion, preoperative evaluation of skinfold severity, making a rational choice and careful implementation of surgical technique available are important in effective correction of epicanthal fold.

Fetal development and variations in the cartilages surrounding the human external acoustic meatus

In contrast to the osseus part that develops from the tympanic ring of the squamous part of the temporal bone after birth, there is little information on fetal development of the cartilages surrounding the human external acoustic meatus. Using routine histology and immunohistochemistry, we examine sections of 22 fetuses (CRL 100-270mm) to study the development of these cartilages. Early external ear cartilages are composed of three groups: (1) a ring-like cartilage at the putative tragus on the anterior side of the meatus, (2) two or three bar-like cartilages along the inferior wall of the meatus, and (3) a plate-like cartilage in a skin fold for the putative helix on the posterior side. In contrast to the first and second pharyngeal arch cartilages, all the external ear cartilages express glial fibrillary acidic protein. Notably, the bar-like cartilages along the meatus are connected with a fascia-like structure to the second pharyngeal arch cartilage. Later, with considerable individual variation, new cartilage bars extend from the inferior cartilages to the superior side of the meatus. Thus, via an intermediate stage showing a chain of triangular elastic cartilages, a chain of bar-like cartilages on the inferior side appears to change into a complex of H-shaped cartilages. Numerous ceruminous glands are seen in the thick subcutaneous tissue overlying the cartilaginous part of the meatus. However, they do not insert into the cartilage. The external ear cartilages develop much earlier than, and independently of, the osseus part.

A selective sac extraction method: another minimally invasive procedure for inguinal hernia repair in children: a technical innovation with satisfactory surgical and cosmetic results

Purpose To achieve satisfactory surgical and cosmetic results with minimal surgical invasiveness without laparoscopic assistance in childhood inguinal hernia repair, a novel technique, the selective sac extraction method (SSEM), was devised. The technical feasibility of this method was retrospectively examined. Methods The method was applied to 162 consecutive hernia repairs in 153 patients, 79 boys and 74 girls, excluding patients with incarcerated or irreducible hernia, sliding hernia of the ovary (hernia with palpable ovary at repair), or hernia associated with an undescended testis. Hernia repair was performed by several young surgeons under the guidance of one teaching surgeon. Results Patients' ages ranged from 1 month to 12 years (median, 3 years), and their body weights ranged from 2.9 to 41 kg (median, 14.4 kg). The SSEM was accomplished in 149 (92%) of 162 repairs, and lengths of incision at the end of the procedure were less than 10 mm in all repairs. The success rate was 72 (88%) of 82 repairs in male patients and 77 (96%) of 80 repairs in female patients. In the remaining 13 (8%) repairs in 13 patients, 10 males and 3 females, the procedure was converted to a conventional open method by extending the incision to 10 mm or longer. The ages of the 13 patients ranged from 1 month to 8 years (median, 3 months), being significantly younger than patients whose repair was accomplished by the SSEM ( P = .006). The reason for conversion in 9 repairs was a huge or thickened sac that could not be extracted from the small incision, of which 6 involved male infants younger than 11 months. Obesity (the body mass index was 22.2 and >97th percentile for the patient's age) and thick subcutaneous tissue characteristic of early infancy were also reasons, both of which hindered the approach to the inguinal canal. Other reasons included malpositioning of the skin incision and difficulty in sac identification. The lengths of incision at the end of the 162 repairs ranged from 4.5 to 13.0 mm (median, 7.0 mm). Those in female patients, 4.5 to 11.5 mm (median, 6.5 mm), were significantly shorter than in male patients, 5.0 to 13.0 mm (median, 7.5 mm) ( P < .001). The median length of the operation was 25 minutes. A follow-up interview revealed that there was no hernia recurrence with a median follow-up time of 20 months (range, 12-29 months). No postoperative complications were reported by the parents. As for the parents' satisfaction with wound cosmesis, 93% of them rated it as good or excellent. Conclusions Inguinal hernia repair with the SSEM through a minimal skin incision is technically feasible, with very satisfactory surgical and cosmetic results. As it has the potential to be a standard method for inguinal hernia repair in children, a prospective study to confirm the safety of the procedure should be carried out.

Vascular Access in Children: The Importance of Microsurgery for Creation of Autologous Arteriovenous Fistulae

Microsurgery gives much better immediate and long term results than classical surgery for the creation of direct arteriovenous fistulae, the best chronic access to blood in children.

A Comparison of a Needle-Free Injection System for Local Anesthesia Versus EMLA® for Intravenous Catheter Insertion in the Pediatric Patient

Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7-19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip (n = 57) or 2.5 g of EMLA (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0-10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA (median = 3) and the J-Tip (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.

The Lateral Arm/Proximal Forearm Flap

The classic lateral arm flap is constrained by limited skin availability, thick subcutaneous tissue, a short vascular pedicle, and inconsistent sensory innervation. We report modifications of the lateral arm flap which increase its skin availability, provide thin sensate skin, and extend the overall reach of the flap. The vascular anatomy of the lateral arm/proximal forearm flap was studied in 10 fresh anatomic specimens. The posterior radial collateral artery communicated with a rich vascular plexus that extended well into the proximal forearm. This plexus is also fed by communicating branches from the radial recurrent artery. Fifteen lateral arm/proximal forearm flaps have been utilized for various upper and lower extremity reconstructions and three penile constructions. All flaps survived, and there was primary healing of all wounds. Three are presented which demonstrate the versatility of the lateral arm/proximal forearm flap.

Cavity Filling Technique in Mastoid Surgery

A method for reducing the size of the operation cavity in modified radical and radical mastoid operations is described. Two stilated flaps are used, a postauricular and a meatal flap. The postauricular flap is skin-lined and includes also thick subcutaneous tissue. The distal part of the meatal flap consists of subcutaneous tissue without any epidermis. In order to avoid the recurrence of cholesteatoma in a filled operation cavity, neither flap is placed over that part of the operation cavity where cholesteatoma has been observed. In many cases the ultimate operation cavity is only a small extension of the medial upper part of the auditory canal. In those cases, too, where the primary operation cavity is very large, the final result is an operation cavity without any recesses posteriorly, laterally and distally. The cavity is lined with real skin, which has no increased tendency towards desquamation. Therefore, periodic inspection and cleaning of the cavity can be utterly reduced. The thick postauricular ...