The Trapezius Muscle Flap: A Viable Alternative for Posterior Scalp and Neck Reconstruction

BACKGROUND: The trapezius muscle flap is not usually the first reconstructive option for skin and soft tissue defects in the posterior neck and scalp due to surgeons' unfamiliarity with the surgical anatomy and developments in free tissue transfer techniques. The goals of this study were to describe the clinical use of trapezius flaps in posterior neck and scalp reconstruction, and to investigate the vascular anatomy of trapezius flaps in Asians in order to obtain information facilitating the safe design and elevation of flaps in which most of the muscle is preserved. METHODS: A retrospective chart review was performed of 10 patients who underwent trapezius muscle flap for posterior neck and scalp defects. We also performed an anatomical study of 16 flaps harvested from 8 preserved Asian adult cadavers and evaluated the main landmarks relevant for trapezius muscle flap. RESULTS: In the anatomical study, the mean vertical height from the inferior angle of the scapula to the point at which the superficial cervical artery penetrated the trapezius was 4.31±2.14 cm. The mean vertical height of the trapezius muscle flap pivot point was 9.53±2.08 cm from the external occipital protuberance. Among the 10 flaps, partial necrosis on the overlaid skin graft occurred in 1 patient and postoperative seroma occurred in another patient. CONCLUSIONS: Vascular variations in the trapezius muscle flap are uncommon in Asians, but when present, such variations appear to have little impact on harvesting the flap or on its circulation. The trapezius muscle flap is a viable alternative for posterior neck and scalp reconstruction.

Multiple Muscular Variations in the Neck, Upper Extremity, and Lower Extremity Biased toward the Left Side of a Single Cadaver

Although numerous reports have found accessory or supernumerary muscles throughout the human body, multiple appearances of these variations biased toward one side of body are rare. We report a 76-yr-old male cadaver with an accessory head of the biceps brachii and palmaris profundus, and a muscular slip between the biceps femoris and semitendinosus on the left side in addition to a bilateral accessory belly of the digastric muscle. No remarkable nervous, vascular, or visceral variation accompanied these variations. An interruption of normal somitogenesis or myogenesis may be a cause of these variations.

Development of a type II diabetic mellitus animal model using Micropig(R) / 한국실험동물학회지

Diabetes, which has shown an explosive increase in terms of its incidence, is regarded as a serious disease that must be overcome for the sake of human life. Among animal models used for testing of drug efficacy, the mini-pig model has shown a rapid upload due to its many similarities with human, particularly concerning the pharmacokinetics of compounds after subcutaneous administration, the structure and function of the gastrointestinal tract, the morphology of the pancreas, and overall metabolic status. Based on these various advantages, we sought to develop an animal model of type II diabetic mellitus using the Micro-pig, which differs from other miniature pigs. We used six male Micro-pigs for induction of a moderate insulin deficient model with nicotinamide (NIA)/streptozotocin (STZ) treatment and three animals for control. For evaluation of incidence of type II diabetes, we measured blood glucose level, and performed oral glucose tolerance test and immunohistochemistry on pancreatic tissue using insulin antibody. Compared to control animals, all animals treated with NIA/STZ showed high levels of glucose and low levels of insulin. In addition, we observed the partially destroyed beta cell population from tissue of the pancreas in treated animals. Based on these results, we report that the Micro-pig model developed in this study can be used for testing of the efficacy of therapeutic agents for treatment of Type 2 diabetic mellitus.

Anatomy of the Femoral Attachment Site of the Anterior Cruciate Ligament and the Posterolateral Structures Related to the Stability of the Knee Joint / 대한해부학회지

The anterior cruciate ligament (ACL) and the posterolateral structures are functionally important structures that assist with the stability of the knee joint. Sport-related injuries to these structures and reconstructive surgery are becoming more frequent. However, the anatomic characteristics and the relationship between these structures are not well understood. We measured the morphological characteristics of the posterolateral structures of the knee and the ACL, and we identified the anatomic relationship between the center of the femoral attachment area of the ACL and other femoral structures. We dissected 34 cadaveric knees with no signs of previous surgery, knee abnormality, or disease. The lateral collateral ligament (LCL) and the popliteus tendon (PLT) were present in all knees, although the popliteofibular ligament (PFL) was not present in 20.6% of knees. The mean length of the LCL was 51.99 mm and differed significantly between men and women (P<0.05). The mean length of the PLT was 21.59 mm, and the mean length of the PFL was 18.49 mm. In 67.7% of knees, the PLT was attached to the inferior aspect of the femoral attachment of the LCL, and the femoral attachment of the PLT was covered by the bundle of the LCL. The ACL was distinguished into anteromedial (AM) and posterolateral (PL) bundles in all knees. The mean lengths of the AM and PM bundles were 22.14 mm and 15.98 mm, respectively. The measured lengths in each bundle differed significantly between men and women (P<0.05). The mean distance between the center of the femoral attachment area of the ACL and the intercondylar line was 8.36 mm in the AM bundle, 15.98 mm in the PL bundle, and 10.96 mm in the entire ACL. The mean distance between the center of the femoral attachment area of the ACL and the medial border of the lateral condyle was 8.14 mm in the AM bundle, 7.36 mm in the PL bundle, and 8.45 mm in the entire ACL.

Distribution of Purinergic Receptor and Vanilloid Receptor Participating in Micturition and Reciprocal Relationship between Them / 대한해부학회지

Two of the synaptic receptors involved in the regulation of micturition, P2X(3) receptor, which is operated by ATP, and vanilloid receptor 1 (VR1), which is operated by capsaicin, are regarded as newcomers. To investigate the possibility that these receptors act as therapeutic targets for treatment of an overactive bladder, we investigated their distribution and reciprocal relationship. Eight-week-old Sprague Dawley rats were injected with retrograde nerve tracer within the bladder wall, and 15 rats were injected with 0.5% acetic acid inside the bladder. After a week, the animals were killed, and their dorsal root ganglia (DRG) at the levels of L6 and S1 were harvested. Immunohistochemistry or Western blot analysis of P2X(3) and VR1 were performed on the DRG. The DRG neurons with afferent fibers from the bladder had increased expression of VR1 and downregulated P2X(3) receptors. The P2X(3) receptor and VR1 seemed to account for the important parts of the hypersensitivity of the inflammatory bladder. We conclude that the simultaneous modulations of both P2X(3) receptor and VR1 may have a synergic effect on the treatment of overactive bladder and may produce greater response rates.

Variations of the Superficial Brachial Artery in Korean Cadavers

The superficial brachial artery (SBA), a branch of the axillary artery, is one of the most common arterial variations in this area. While it is more vulnerable to accidental arterial injection or injury, it could be useful for the nourishment of a medial arm skin free flap. To analyze the relationship between the SBA of axillary origin and segmental variation of the axillary artery, we dissected 304 arms of Korean cadavers. We found an SBA of axillary origin in 12.2% of cadaveric arms. Unilateral occurrence was detected in 16 cadavers and bilateral in 10. SBAs gave rise to radial and ulnar arteries in the cubital fossa (8.9%), continued in the forearm as the radial artery (2.3%), or ended in the upper arm (1.0%). The SBA ended as ulnar artery was not found in any of the cadavers. The bifurcation of the SBA into the radial and ulnar arteries, presence of an SBA that ends in the upper arm, and the lack of continuation as the ulnar artery are characteristics of SBAs in Korean cadavers.