Improvement in preventing the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits / 中国比较医学杂志

Objective To investigate the method to prevent the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits .Method 40 rabbits were divided into two groups randomly: the experimental group and the control group .Through an incision on the back , a pocket was made by dissecting between the rabbit panniculus carnosus and deep fasia .The panniculus carnosus at the pocket boundary were sutured with the deep fascia inside the pocket by interrupted 3-0 sutures.A 50 mL kidney-shaped tissue expander was implanted .The expander was inflated with 10 mL saline after the wound was sutured .7 days after implantation , black tattoos were made on the skin around the expander to mark the site of expander .Two months after implantation , the expanders in the experimental group were inflated with 10 mL saline weekly to a total of 140 mL.7 days after implantation the expanders of control group were inflated with 10 mL saline weekly to a total of 140 mL.The incidence of expander displacement , dehiscence of incision , reversal of injection pot and death were recorded .Results There was no expander displacement in the 19 rabbits of experimental group .All the expanders were located within the tattoo area .There was no expander displacement in 11 rabbits of the control group .4 expanders of the control group moved from the back to belly .The difference between them was statistically significant ( P 0.05 ) .Meanwhile there was no significant difference in the incidences of reversal of injection pot , infections and deaths ( P >0.05 for all ) .Conclusions Sutures between the panniculus carnosus and the deep fascia at the pocket boundary asisted by delayed inflating can prevent the displacement of tissue expander implanted between the panniculus carnosus and deep fasia in rabbits , thus to obtain effective expansion .

Axilla; a rare variation: axillary arch muscle.

Axillary arch muscle or the Langer’s muscle is one of the rare muscular variation in the axillary region. It is the additional muscle slip extending from latissimus dorsi in the posterior fold of axilla to the pectoralis major or other neighbouring muscles and bones. In the present article a case of 68 yrs old female cadaver with axillary arch in the left axillary region is reported. It originated from the anterior border of lattissimus dorsi and merged with the short head of biceps and pectoralis major muscles. The arch was compressing the axillary vein as well as the branches of the cords of brachial plexus. The presence of the muscle has important clinical implications, as the position, unilateral presence, axillary vein entrapment, multiple insertions makes the case most complicated. Recognising the presence of axillary arch muscle in such complex form is important in clinical practice as the arch causes the difficulties in staging lymph nodes, axillary surgery, thoracic outlet syndrome, shoulder instability or cosmetic problems. The anatomy, embryological and clinical importance of this muscular variation is discussed in this paper.

Panniculus carnosus, remanentes vestigiales en la región axilar / Panniculus carnosus, vestigial remanents in the axillary region

Las variaciones anatómicas de los elementos musculares de la región axilar son poco frecuentes y, generalmente, se encuentran olvidadas en los textos modernos de anatomía. Sin embargo, cuando existen, presentan un serio escollo para el cirujano, ya que alteran los hitos anatómicos de referencia para el abordaje de los importantes elementos vasculares y neurales de la región. Desde el siglo XIX algunos autores han descrito una variedad de pequeños fascículos musculares originados en el Panniculus carnosus, que se disponen en relación con los elementos neurovasculares de la axila. En esta ocasión presentamos un hallazgo efectuado en un cadáver, de sexo masculino, utilizado con fines docentes en el Departamento de Anatomía de la Escuela de Medicina de la Pontificia Universidad Católica de Chile. En la región axilar derecha, se observa un fascículo muscular que se extiende desde la apófisis coracoides, dispuesto por delante del músculo subescapular y pasando por detrás del paquete neurovascular de la axila. En su trayecto, este fascículo toma íntima relación con el nervio axilar y con la porción distal de la arteria subescapular. El músculo aberrante termina como una expansión aponeurótica, dispuesta ventral al tendón del latísimo del dorso, que se funde con la fascia axilar.

The anatomical variations of the muscular elements of the axillary region are infrequent and, generally, they are forgotten in modern texts of anatomy. Nevertheless, when they exist, they present a serious obstacle for the surgeon, since they alter the anatomical landmarks of reference for the approach to important neural and vascular elements of the region. Since the 19th century some authors have described a variety of small muscular fascicles originated in the "panniculus carnosus", that are arranged in relation to neurovasculares elements of the axila. In this occasion we present a finding performed in a corpse, male sex, dissected in the Department of Anatomy of the School of Medicine of the Pontificia Universidad Católica de Chile. In the right axillary region, a muscular fascicle is observed that extends from the coracoid process, arranged in front of the subscapularis muscle, and passing behind the neurovascular elements of the axila. In its course, this fascicle takes close relation with the axillary nerve and with the distal portion of the subscapular artery. This aberrant fascicle ends as an aponeurotic expansion, arranged ventral to the tendon of the latissimus dorsi muscle, which melts with the axillary fascia.