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Peters F, Raith S, Bock A, Kniha K, Möhlhenrich SC, Heitzer M, Hölzle F, Modabber A. Development of a universal cutting guide for raising deep circumflex iliac artery flaps. Int J Comput Assist Radiol Surg 2024; 19:1875-1882. [PMID: 38676830 PMCID: PMC11365821 DOI: 10.1007/s11548-024-03144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The deep circumflex iliac crest flap (DCIA) is used for the reconstruction of the jaw. For fitting of the transplant by computer-aided planning (CAD), a computerized tomography (CT) of the jaw and the pelvis is necessary. Ready-made cutting guides save a pelvic CT and healthcare resources while maintaining the advantages of the CAD planning. METHODS A total of 2000 CTs of the pelvis were divided into groups of 500 by sex and age (≤ 45 and > 45 years). Three-dimensional (3D) pelvis models were aligned and averaged. Cutting guides were designed on the averaged pelvis for each group and an overall averaged pelvis. The cutting guides and 50 randomly selected iliac crests (10 from each group and 10 from the whole collective) were 3D printed. The appropriate cutting guide was mounted to the iliac crest and a cone beam CT was performed. The thickness of the space between the iliac crest and the cutting guide was evaluated. RESULTS Overall the mean thickness of the space was 2.137 mm and the mean volume of the space was 4513 mm3. The measured values were significantly different between the different groups. The overall averaged group had not the greatest volume, maximum thickness and mean thickness of the space. CONCLUSION Ready-made cutting guides for the DCIA flap fit to the iliac crest and make quick and accurate flap raising possible while radiation dose and resources can be saved. The cutting guides fit sufficient to the iliac crest and should keep the advantages of a standard CAD planning.
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Affiliation(s)
- Florian Peters
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Stefan Raith
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Anna Bock
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kristian Kniha
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | - Marius Heitzer
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Schulte R, Loberg C, Ghassemi A. Evaluating the length, diameter, and stenosis of deep circumflex iliac artery and neighboring arteries based on digital subtraction angiography. Microsurgery 2023; 43:373-381. [PMID: 36762598 DOI: 10.1002/micr.31022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 12/31/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The vascularized iliac bone crest flap offers excellent usable bone in terms of volume and quality. Its nourishing vessel, the deep circumflex iliac artery (DCIA), although relatively short, is reliable vessel. Digital subtraction angiography presents still the gold standard for diagnostic purpose. However, computed tomography (CT) and magnetic resonance imaging (MRI) angiography is used for preoperative planning with low morbidity. The purpose of this study is to evaluate the gainable information using digital subtraction angiography (DSA) as compared to other imaging modalities. MATERIALS AND METHODS We evaluated information gainable from standard DSA of 130 consecutive patients (average age was 69.5 years [range 18-90 years]) concerning topography, dimension, and condition of the vessel wall. We looked for differences considering gender and side. RESULTS DCIA could not be followed in the periphery constantly in all cases due to the small, illustrated field. Arteriosclerotic changes showed to be very low in DCIA as compared to the neighboring vessels. Diabetes mellitus and smoking had a significant impact on vessel condition. DCIA branched off into its main two branches early after 40 mm (11%), after 40-60 mm (30%), or late after 60 mm (59%). DCIA showed to be least affected by different risk factors that reported to affect the vessel condition. CONCLUSIONS We present additional detailed topographic anatomy of DCIA and its variation that can be used intraoperative guide to harvest the flap and teaching purpose. Standard DSA delivers valuable preoperative data regarding stenosis in addition to the topographic anatomy of the flap pedicle. However, imaging of the distal parts of the DCIA, nourishing the skin paddle is limited by the detector field used. For a full imaging of both DCIAs from the origin to the perforators, the intraarterial injection of contrast medium, as applied in DSA, could be combined with different imaging modalities like CT-angiography.
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Affiliation(s)
| | - Christina Loberg
- Clinic for Diagnostic and Interventional Radiology, University Hospital, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Alireza Ghassemi
- Oral and Maxillofacial Surgery, Klinikum Detmold, University Hospital OWL, Detmold, Germany.,Medical Faculty University RWTH-Aachen, Aachen, Germany
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Yang ZY, Kang YF, Lv XM, LiuFu JF, Zhang L, Shan XF, Cai ZG. Iliac crest towards alveolar processes or mandibular inferior margin in mandibular reconstruction with a vascularized iliac bone flap: which is better? Clin Oral Investig 2023; 27:751-758. [PMID: 36571588 DOI: 10.1007/s00784-022-04823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The study aims to compare differences among iliac bone flaps with different iliac crest orientations for the repair of mandibular defects with an aim to analyze their advantages, disadvantages, and effects. MATERIAL AND METHODS Clinical data and computed tomography scans of all patients who underwent iliac bone flap repair of the mandible in Peking University School and Hospital of Stomatology from January 2016 to April 2021 were collected. Patients were divided into the iliac crest towards alveolar process (Group A) and the iliac crest towards mandibular inferior margin (Group B). Software was used to measure corresponding indicators. The results obtained for the groups were statistically analyzed. RESULTS The study included 78 patients (25 and 53 in groups A and B, respectively). The symmetry of the LC-type defect was better in group A (p < 0.05). The all-bone width of the alveolar process side in group A was greater than 6 mm; in 15 cases of group B, the width was less than 6 mm (p < 0.05). The intermaxillary distance of two sites were higher in group B (p < 0.05). The bone cortical thickness was significantly thicker in group A (p < 0.05). CONCLUSION One year after the mandibular body defect was reconstructed with a vascularized iliac bone flap, the iliac crest towards alveolar process group showed better bone symmetry, width, intermaxillary distance, and cortical thickness to meet the planting requirements. CLINICAL RELEVANCE The use of an iliac crest towards alveolar process may be a better approach for mandible reconstruction.
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Affiliation(s)
- Zong-Yan Yang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Jian-Feng LiuFu
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Lei Zhang
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Peking University School and Hospital of Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
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Zurcher KS, Staack SO, Spencer EB, Liska A, Alzubaidi SJ, Patel IJ, Naidu SG, Oklu R, Dymek RA, Knuttinen MG. Venous Anatomy and Collateral Pathways of the Pelvis: An Angiographic Review. Radiographics 2022; 42:1532-1545. [PMID: 35867595 DOI: 10.1148/rg.220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pelvic venous system is complex, with the potential for numerous pathways of collateralization. Owing to stenosis or occlusion, both thrombotic and nonthrombotic entities in the pelvis may necessitate alternate routes of venous return. Although the pelvic venous anatomy and collateral pathways may demonstrate structural variability, a number of predictable paths often can be demonstrated on the basis of the given disease and the level of obstruction. Several general categories of collateral pathways have been described. These pathway categories include the deep pathway, which is composed of the lumbar and sacral veins and vertebral venous plexuses; the superficial pathway, which is composed of the circumflex and epigastric vessels; various iliofemoral collateral pathways; the intermediate pathway, which is composed of the gonadal veins and the ovarian and uterine plexuses; and portosystemic pathways. The pelvic venous anatomy has been described in detail in cadaveric and anatomic studies, with the aforementioned collateral pathways depicted on CT and MR images in several imaging studies. A comprehensive review of the native pelvic venous anatomy and collateralized pelvic venous anatomy based on angiographic features has yet to be provided. Knowledge of the diseases involving a number of specific pelvic veins is of clinical importance to interventional and diagnostic radiologists and surgeons. The ability to accurately identify common collateral patterns by using multiple imaging modalities, with accurate anatomic descriptions, may assist in delineating underlying obstructive hemodynamics and diagnosing specific occlusive disease entities. ©RSNA, 2022.
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Affiliation(s)
- Kenneth S Zurcher
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sasha O Staack
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - E Brooke Spencer
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Addison Liska
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sadeer J Alzubaidi
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Indravadan J Patel
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Sailendra G Naidu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Rahmi Oklu
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Ryanne A Dymek
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
| | - Martha-Gracia Knuttinen
- From the Division of Vascular and Interventional Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ (K.S.Z., S.O.S., S.J.A., I.J.P., S.G.N., R.O., M.G.K.); Minimally Invasive Procedure Specialists, Highlands Ranch, Colo (E.B.S., A.L.); and University of Illinois College of Medicine at Chicago, Chicago, IL (R.A.D.)
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Rosli MA, Wan Ismail WF, Wan Sulaiman WA, Mat Zin NA, Abdul Halim S, Mat Johar F, Mat Saad AZ, Halim AS. Calcaneal Reconstruction With Free Deep Circumflex Iliac Artery Osseocutaneous Flap Following Aggressive Benign Bone Tumor Resection. Foot Ankle Int 2021; 42:1570-1578. [PMID: 34286617 DOI: 10.1177/10711007211025280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors. METHODS We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case. RESULTS The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either. CONCLUSION Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mohamad Aizat Rosli
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Faisham Wan Ismail
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Wan Azman Wan Sulaiman
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nor Azman Mat Zin
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Syurahbil Abdul Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Orthopaedic Oncology and Reconstructive Unit (OORU), School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Fatimah Mat Johar
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Arman Zaharil Mat Saad
- Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Plastic & Reconstructive Unit, MSUMC, Management and Science University, University Drive, Off Persiaran Olahraga, Shah Alam, Selangor, Malaysia
| | - Ahmad Sukari Halim
- Hospital Universiti Sains Malaysia, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.,Reconstructive Sciences Unit, School of Medical Sciences, Medical Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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6
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Winocour SJ, Schultz KP, Davis MJ, Abu-Ghname A, Bohl M, Ropper AE, Maricevich M, Reece EM. Vascularized Posterior Iliac Crest Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives. Semin Plast Surg 2021; 35:37-40. [PMID: 33994877 DOI: 10.1055/s-0041-1725986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pseudarthrosis is a feared complication of spinal fusion procedures. Currently, the gold standard in prevention or treatment of pseudarthrosis is placement of nonvascularized iliac crest bone autograft. While rates of fusion are significantly higher in patients with use of nonvascularized bone autografts than with allografts, patients who have previously failed lumbar arthrodesis or those at a high risk for pseudarthrosis may benefit from a more robust, vascularized bone graft with enhanced osteogenicity. In this article, we discuss the use of iliac crest vascularized bone grafts as an adjunct for high-risk patients undergoing lumbosacral spine arthrodesis.
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Affiliation(s)
- Sebastian J Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kelly P Schultz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Michael Bohl
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Marco Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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7
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Sarna K, Amuti T, Butt F, Kamau M, Muriithi A. Variations of the Anatomy and Bony Landmarks of Deep Circumflex Iliac Artery in a Select Kenyan Population. Craniomaxillofac Trauma Reconstr 2021; 13:300-304. [PMID: 33456701 DOI: 10.1177/1943387520958333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The deep circumflex iliac artery (DCIA) is a large caliber artery which branches laterally from the external iliac artery (EIA), directly opposite the origin of the inferior epigastric artery (IEA). Population variations have been reported in its origin, length, and branching patterns. These may alter its relationship to palpable surgical landmarks such as the anterior superior iliac spine (ASIS) and the pubic tubercle (PT) which are used to locate the artery preoperatively, thus predisposing it iatrogenic injury. Despite this, there is paucity of data from the Kenyan setting. Study Design Cross-sectional study design. Objective To determine the variations of the anatomy and bony landmarks of the Deep circumflex iliac artery in a select Kenyan population. Methods A total of 104 DCIA from 52 formalin fixed adult cadavers were dissected to expose the DCIA, following which its vessel of origin and distance from the ASIS and PT, relation to the inguinal ligament (IL), length and branching patterns were noted. The average of the measurements were calculated. All data were collected and analyzed using Microsoft Excel 2007 (Microsoft Corporation, Redmond, WA). Representative photos of the vessel and its variations were taken. Results The DCIA was found to be present and bilaterally symmetrical in all cadavers. In all cases observed, it originated as a lateral branch from the EIA (100%), opposite the IEA and directly behind the IL in 98% of the cases. Its average distance from the ASIS along the IL was 7.28 ± 0.99, while it was 5.91 ± 1.03 from the pubic tubercle to its origin. Its length ranged from 3.7 cm to 9.5 cm, with an average length of 3.86 cm in the right limb and 3.67 cm in the left limb. As regards its branching patterns, in 78% of the cases, it bifurcated into the horizontal and ascending branches, in 6%, it trifurcated and in 4%, it divided into more than 3, exhibiting a fine tree-like branching (arborization). Conclusion The DCIA in our setting exhibited variations from other settings and an increase in awareness of these variations will probably reduce future iatrogenic lesions of the DCIA and its major branches in Kenya.
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Affiliation(s)
- Krishan Sarna
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Thomas Amuti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Fawzia Butt
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Martin Kamau
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Anne Muriithi
- Department of Human Physiology, University of Nairobi, Nairobi, Kenya
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Kostov S, Kornovski Y, Slavchev S, Ivanova Y, Dzhenkov D, Dimitrov N, Yordanov A. Pelvic Lymphadenectomy in Gynecologic Oncology-Significance of Anatomical Variations. Diagnostics (Basel) 2021; 11:diagnostics11010089. [PMID: 33430363 PMCID: PMC7825766 DOI: 10.3390/diagnostics11010089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 01/15/2023] Open
Abstract
Pelvic lymphadenectomy is a common surgical procedure in gynecologic oncology. Pelvic lymph node dissection is performed for all types of gynecological malignancies to evaluate the extent of a disease and facilitate further treatment planning. Most studies examine the lymphatic spread, the prognostic, and therapeutic significance of the lymph nodes. However, there are very few studies describing the possible surgical approaches and the anatomical variations. Moreover, a correlation between anatomical variations and lymphadenectomy in the pelvic region has never been discussed in medical literature. The present article aims to expand the limited knowledge of the anatomical variations in the pelvis. Anatomical variations of the ureters, pelvic vessels, and nerves and their significance to pelvic lymphadenectomy are summarized, explained, and illustrated. Surgeons should be familiar with pelvic anatomy and its variations to safely perform a pelvic lymphadenectomy. Learning the proper lymphadenectomy technique relating to anatomical landmarks and variations may decrease morbidity and mortality. Furthermore, accurate description and analysis of the majority of pelvic anatomical variations may impact not only gynecological surgery, but also spinal surgery, urology, and orthopedics.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Yavor Kornovski
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Stanislav Slavchev
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Yonka Ivanova
- Department of Gynecology, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria; (S.K.); (Y.K.); (S.S.); (Y.I.)
| | - Deyan Dzhenkov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Division of General and Clinical Pathology, Faculty of Medicine, Medical University Varna “Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria;
| | - Nikolay Dimitrov
- Department of Anatomy, Faculty of Medicine, Trakia University, 6000 Stara Zagora, Bulgaria;
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
- Correspondence:
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Bohl MA, Hlubek RJ, Turner JD, Reece EM, Kakarla UK, Chang SW. Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series. Oper Neurosurg (Hagerstown) 2019; 14:639-646. [PMID: 28961732 DOI: 10.1093/ons/opx162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.
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Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward M Reece
- Arizona Center for Hand Surgery-Reconstructive Plastic Surgery, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Vascularized Iliac Bone Graft for Complex Closure During Spinal Deformity Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2345. [PMID: 31942366 PMCID: PMC6952161 DOI: 10.1097/gox.0000000000002345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
Spinal pseudarthrosis is failure of bony union across a segment where arthrodesis has been attempted. A variety of treatment approaches have been proposed to promote bony union, including use of vascularized bone graft. We report a successful application of vascularized pedicled iliac crest bone graft (ICBG) to treat recurrent lumbar and sacral pseudarthrosis. The vascularized ICBG offers the advantages of biocompatibility, mechanical stability, and minimal antigenicity. Vascularized bone transfers to the spine undergo fusion without resorption, even in the presence of compressive and rotatory forces. With its ease of access within the operative field and limited donor site morbidity, vascularized ICBG is an ideal orthobiologic that expedites time to bony union.
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Anatomical Consideration for the Safe Elevation of the Deep Circumflex Iliac Artery in Flap Surgery. Plast Reconstr Surg 2018; 142:193-201. [PMID: 29649061 DOI: 10.1097/prs.0000000000004514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Deep circumflex iliac artery osteocutaneous flap transfer has frequently been applied to large defects in the maxillary and mandible regions, but the use rate has decreased gradually because of the complicated anatomy of the deep circumflex iliac artery. This study investigated the comprehensive anatomy of the deep circumflex iliac artery in relation to flap surgery with the aim of providing navigational guidelines for safe deep circumflex iliac artery harvesting. METHODS Sixty-two sides of the hemi-abdominal wall were dissected in fixed Korean cadavers. Several dimensions of the deep circumflex iliac artery and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified. RESULTS The mean distance between the anterior superior iliac spine and the lateral border of the femoral artery was 57.5 mm. The deep circumflex iliac artery generally originated almost at the same level as the inguinal ligament, and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the anterior superior iliac spine, but no transverse branch pierced the transversus abdominis muscle medial to the anterior superior iliac spine. CONCLUSIONS The incision line for safe deep circumflex iliac artery harvesting was parallel and 2 cm superior to the inguinal ligament and 6 cm from the anterior superior iliac spine. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the deep circumflex iliac artery originating above or below the inguinal ligament will be another useful guide for easily detecting the deep circumflex iliac artery.
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Li G, Jin D, Shao X, Liu Z, Duan J, Akileh R, Cao S, Liu T. Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults. Injury 2018; 49:1587-1593. [PMID: 29929779 DOI: 10.1016/j.injury.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Surgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults. METHODS From March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B). RESULTS All patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001). CONCLUSIONS Cannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.
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Affiliation(s)
- Guanghui Li
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China; Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Dadi Jin
- Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China.
| | - Xianfang Shao
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Zhijun Liu
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Jianhui Duan
- Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China
| | - Raji Akileh
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, 24901, United States
| | - Shousong Cao
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Tuoen Liu
- Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, 24901, United States.
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Ong HS, Yu M, Liu JN, Gil CS, Wan K, Zhang CP, Xu LQ. Modified maxillary reconstruction technique for Brown's class III defects by subdividing a rhomboid shaped iliac crest into 2 subunits. Head Neck 2018; 40:1824-1833. [PMID: 29638021 DOI: 10.1002/hed.25169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/09/2017] [Accepted: 02/14/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Men and women share a common maxillary morphology with heterogeneity in size. This indicated that our technique of reconstruction with a rhomboid-shaped iliac crest bone flap incorporating a 30° vertical wedge osteotomy may be widely used for Brown's class III maxillectomy defect reconstruction among a population with class I skeletal profile. The reconstruction of Brown's class III maxillary defects is extremely challenging. The purpose of this study was to closely study the maxilla geometrically in order to establish a standardized maneuver, which facilitates conversion of the iliac bone flap into a natural maxilla's contours. METHODS We evaluated the geometries of 40 adult maxillas. The perimeter lengths of perinasal and infraorbital subunits were analyzed, in addition to the intersecting angle (δ) of both subunits. Sex variation was evaluated using the Student's t test. RESULTS In the 80 studied unilateral maxillas (40 maxillas from 18 men and 22 women), there were no significant sex differences for δ (P = .1527). In addition, both sexes shared common morphological features, hence, in surgical reconstruction, the δ can be constantly set at 150°. Perimeter of bone segments had a greater intersubject variability (coefficient of variation [CV] of approximately 4.5-11). From both cadaveric dissections and clinical applications, our results have shown that our standard maneuver was reproducible and reliable in reestablishing natural facial contours. CONCLUSION Our standard maneuver can serve as a universal guideline, with individualized perimeter manipulations, to yield an aesthetically natural and functional outcome.
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Affiliation(s)
- Hui Shan Ong
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Miao Yu
- 2nd Dental Center, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jian Nan Liu
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Carlos Salcedo Gil
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Kenneth Wan
- Department of Oral and Maxillofacial Surgery, Royal Perth Hospital and Oral Health Centre Western Australia, University of Western Australia, Perth, Western Australia
| | - Chen Ping Zhang
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Li Qun Xu
- Oral Maxillofacial - Head and Neck Oncology Department, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University, Shanghai, China
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Behrens V, Modabber A, Loberg C, Herrler A, Prescher A, Ghassemi A. Patient-Specific Topographic Anatomy of the Deep Circumflex Iliac Artery Flap: Comparing Standard and Modified Computed Tomographic Angiography. J Oral Maxillofac Surg 2018; 76:1587-1593. [PMID: 29494804 DOI: 10.1016/j.joms.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/20/2018] [Accepted: 01/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Computed tomographic angiography (CTA) is reported to give insight into patient-specific anatomy of the flap pedicle preoperatively. We compared information available from standard CTA (s-CTA) with that gained by modifying the conventional CTA technique (modified CTA [m-CTA]). Dissected cadavers served as the control group. MATERIALS AND METHODS We evaluated 16 s-CTA scans (32 deep circumflex iliac arteries [DCIAs]) and 12 m-CTA scans (17 DCIAs) using 3-dimensional software (Vesalius; ps-medtech, Amsterdam, The Netherlands). We dissected 17 cadavers (n = 34 DCIAs) to serve as the control group. The positions of 4 landmarks (anterior superior iliac spine, origin of DCIA, origin of ascending branch, and crossing of horizontal branch and iliac crest) were defined in a 3-dimensional coordinate system. RESULTS We found significant differences concerning the distances from the origin of the DCIA to the femoral bifurcation (P < .05) and the anterior superior iliac spine to the crossing point of the horizontal branch with the iliac crest (P < .05) between CTA scans and cadaveric studies. The imaging quality of the m-CTA scans was shown to be more consistent than and superior to that of the s-CTA scans. The visible length of the DCIA was longer on m-CTA scans (mean, 134.32 mm) than on s-CTA scans (mean, 73.62 mm). We could evaluate the branching off of perforators and the relation of the pedicle to the surrounding bone and soft tissue in more detail on m-CTA scans. Standard CTA allowed the bilateral evaluation of the pedicle, whereas m-CTA allowed the evaluation of the injected side only. CONCLUSIONS The quality and quantity of information available from CTA could be improved by modifying the s-CTA examination by injection as close as possible to the target vessel. Standard CTA delivered information about both sides, whereas m-CTA may need an additional injection for contralateral-side imaging.
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Affiliation(s)
| | - Ali Modabber
- Consultant, Department of Oral and Maxillofacial Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Christina Loberg
- Consultant, Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen, Aachen, Germany
| | - Andreas Herrler
- Associate Professor, Department of Anatomy and Embryology, FHML Maastricht University, Maastricht, The Netherlands
| | - Andreas Prescher
- Associate Professor, Department of Molecular and Cellular Anatomy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Alireza Ghassemi
- Oral and Maxillofacial Surgery Consultant, Klinikum-Lippe, Detmold, Germany; Teaching Hospital of Georg-August-University Göttingen, Göttingen, Germany; and Medical Faculty, University RWTH Aachen, Aachen, Germany.
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Dumont CE, Keel MJ, Djonov V, Haefeli PC, Schmid T, Olariu R, Cullmann JL, Bastian JD. The Pararectus approach provides secure access to the deep circumflex iliac vessel for harvest of a large sized and vascularized segment of the iliac crest. Injury 2017; 48:2169-2173. [PMID: 28823386 DOI: 10.1016/j.injury.2017.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The feasibility of harvesting a vascularized iliac crest utilizing the Pararectus approach was assessed in cadavers and then this new technique was implemented in a clinical case. METHODS Bilaterally in five cadavers the branches of both external iliac arteries were injected with colored silicone to assess their position to each other and to harvest a bone graft vascularized by the deep circumflex iliac artery (DCIA) through the Pararectus approach. This technique was implemented in a 68-years-old female patient, initially admitted to a level-I-trauma center after sustaining multiple injuries by falling from great height. For definitive treatment of a severely contaminated medially open (Gustilo-Anderson Type 3A) calcaneal luxation fracture (Sanders type IIIBC) in this patient a vascularized iliac crest autograft harvest by the Pararectus approach was used for reconstructive surgery. RESULTS The DCIA and the deep inferior epigastric vessels (DIEV: vascularizing the rectus abdominis muscle and main pedicle of the inferiorly based rectus abdominis myocutaneous flap) are very close on the lateral and medial border of the external iliac artery, respectively. As a consequence, the retrograde dissection of the DIEV towards the DCIA through the Pararectus approach made the dissection of the vascularized iliac crest more amenable, preserving both the lateral femoral cutaneous and the genitofemoral nerves. Four months after the surgery the patient was able to fully weight-bear in orthopedic shoes. Radiographs and CT scans showed correct hind foot alignment and bony integration of the vascularized iliac crest graft into the residual calcaneal body. CONCLUSION The Pararectus approach allowed for secure collection of large vascularized iliac grafts. The presented technique was successful as a salvage procedure in a clinical case with substantial bone loss after an open calcaneal fracture.
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Affiliation(s)
- C E Dumont
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - M J Keel
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - V Djonov
- Institute of Anatomy, University of Bern, Switzerland
| | - P C Haefeli
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - T Schmid
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland
| | - R Olariu
- Department of Plastic and Hand Surgery, University of Bern, Inselspital, Switzerland
| | - J L Cullmann
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Switzerland
| | - J D Bastian
- Department of Orthopaedic and Trauma Surgery, University of Bern, Inselspital, Bern, Switzerland.
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Mattine S, Payne KFB. Variation in the site of the lateral femoral cutaneous nerve during harvest of a deep circumflex iliac artery free flap. Br J Oral Maxillofac Surg 2016; 55:563-564. [PMID: 27923510 DOI: 10.1016/j.bjoms.2016.11.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/18/2016] [Indexed: 11/25/2022]
Affiliation(s)
- S Mattine
- Head and Neck Unit, Worcestershire Royal Hospital, UK
| | - K F B Payne
- Head and Neck Unit, Worcestershire Royal Hospital, UK.
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Ghassemi A, Schreiber L, Prescher A, Modabber A, Nanhekhan L. Regions of ilium and fibula providing clinically usable bone for mandible reconstruction: “A different approach to bone comparison”. Clin Anat 2016; 29:773-8. [DOI: 10.1002/ca.22732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Alireza Ghassemi
- Consultant, Oral and Maxillofacial Surgery, Teaching Hospital Klinikum-Lippe, Detmold, Germany and Medical Faculty University of RWTH Aachen; Aachen Germany
| | | | - Andreas Prescher
- Professor, Institute for Molecular and Cellular Anatomy University of RWTH Aachen; Aachen Germany
| | - Ali Modabber
- Associate Professor, Oral and Maxillofacial Surgery, University Hospital RWTH Aachen; Aachen Germany
| | - Lloyd Nanhekhan
- Consultant, Plastic Surgery University Hospital Leuven; Leuven Belgium
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