Deep and superficial circumflex iliac arteries and their relationship to the ultrasound-guided femoral nerve block procedure: A cadaver study

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study

BACKGROUND

 Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft.

METHODS

 The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left-right position.

RESULTS

 The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm.

CONCLUSION

 To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left-right position due to anatomical differences.

Vascularized Lymph Node Transfer: A Primer for the Radiologist

Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. Online supplemental material is available for this article. ^©RSNA, 2020.

Anatomical Consideration for the Safe Elevation of the Deep Circumflex Iliac Artery in Flap Surgery

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.

Tendinous Inscriptions of the Rectus Abdominis: A Comprehensive Review

The rectus abdominis muscles are interrupted by tendinous inscriptions, which typically appear as fibrous bands crossing the muscle. The current literature on tendinous inscriptions is scarce; hence, this review will provide a detailed overview of their anatomical description, including their variation, embryology, comparative anatomy, and clinical application. Understanding the anatomy and function of the tendinous inscription assists in providing clinical relevance and in guiding reconstructive surgeons in their surgical planning and design.