Digital and 3D printing technologies in design of superficial iliac circumflex artery flap for coverage of donor site of anterolateral thigh flap: Report of 8 cases / 中华显微外科杂志

Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.

COVID-19-induced myocarditis in patient with anomalous origin of the left circumflex artery from the right coronary artery: a case report / Miocardite induzida por COVID-19 em paciente com origem anômala da artéria circunflexa esquerda da artéria coronária direita: relato de caso

Abstract The prevalence of coronary artery anomalies has been increasing due to the increasing usage of coronary angiography. There is a paucity of literature concerning management of viral-induced myocarditis in patients with anomalous coronary artery. We present a very unusual case of a 44-year-old man with anomalous origin of the left circumflex artery from the proximal ostium of the right coronary artery who was admitted for COVID-19-induced myocarditis. He presented with signs of heart failure and coronary angiography revealed the left circumflex artery with a separate ostium originating from the proximal right coronary artery. He was treated medically with Bisoprolol, Perindopril Arginine, Rivaroxaban, and Furosemide. His condition improved rapidly and he resumed regular life within 1 month. Coexistence of cardiac disease such as viral-induced myocarditis with an underlying anomalous origin of the coronary artery is challenging to spot and can lead to worse outcomes in case of misdiagnosis and inaccurate management.

Resumo A prevalência de anomalias da artéria coronária vem aumentando devido ao uso crescente da angiografia coronariana. Há uma escassez de literatura sobre o manejo da miocardite induzida por vírus no contexto de artéria coronária anômala. Apresentamos um caso incomum de um homem de 44 anos com origem anômala da artéria circunflexa esquerda do óstio proximal da artéria coronária direita admitido por miocardite induzida por COVID-19. O paciente apresentava sinais de insuficiência cardíaca, e a cineangiocoronariografia revelou artéria circunflexa esquerda de óstio separado originando-se da artéria coronária direita proximal. Ele foi tratado clinicamente com bisoprolol, perindopril arginina, rivaroxabana e furosemida. Sua condição melhorou rapidamente, e o paciente recuperou uma vida normal em 1 mês. A coexistência de doença cardíaca, como miocardite induzida por vírus com uma origem anômala subjacente da artéria coronária, é difícil de detectar e pode levar a resultados piores em caso de diagnóstico incorreto e manejo impreciso.

Excision and clinical application of ALTPF based on lateral branch of the lateral femoral circumflex artery descending branch / 中华显微外科杂志

Objective:To investigate the removal of ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery and its application in wound repair.Methods:From January, 2019 to March, 2021, 32 cases of limb wounds were repaired with ALTPF pedicled with the lateral branch of the descending branch of the lateral femoral circumflex artery, including 25 males and 7 females. The age ranged from 21 to 63 years, with an average of 34 years. Injury mechanism: there were 12 cases of traffic accident injury, 8 cases of machine injury, 6 cases of heavy object crushing injury and 6 cases of chronic infectious wound. The area of soft tissue defect was 8.2 cm × 6.3 cm-18.6 cm × 11.2 cm. There were 25 cases of direct suture and 7 cases of free skin grafting. All patients who needed flap repair underwent CTA and high-frequency CDU before operation to judge the approximate direction of the lateral branch of the descending branch of the lateral femoral circumflex artery and the position of the perforating branch. All patients were followed-up regularly for 3 - 13 months, with an average of 11 months.Results:All patients who underwent free flap surgery had no vascular crisis and the flap survived smoothly. At the last follow-up, the appearance of the flap was beautiful without bloating and there were no complications in the donor area.Conclusion:Compared with the traditional ALTPF, the perforator flap of the lateral branch of the descending branch of the anterolateral femoral artery is relatively simple, which can replace the traditional ALTPF to a certain extent, and is worthy of popularization and application in clinic.

Successful Primary PCI in a Patient with Acute Myocardial Infarction and Cardiogenic Shock with Super-dominant Right Coronary Artery and Absent Left Circumflex Artery

Super-dominant right coronary artery and the absent left circumflex artery is a rare congenital coronary anomaly, with only a few cases reported in the literature. Left anterior descending artery arises directly from the left anterior coronary cusp. Rare coronary anomalies are sometimes encountered during primary percutaneous interventions, which may lead to changes in the course of action. We report a case of a 38-year-old patient admitted with acute anterior wall myocardial infarction and cardiogenic shock. Coronary angiography revealed super-dominant right coronary artery and absent left circumflex artery. There was thrombotic occlusion of the proximal left anterior descending artery. The patient underwent successful primary percutaneous intervention of the left anterior descending artery with a good result, was discharged after 5 days. Our case also shows the importance of taking coronary angiogram of the contralateral artery first, before taking the shoot of the infarct-related artery.

Cadaveric Study On Normal And Variant Anatomy Of Left Coronary Artery

Background: Human heart is supplied by coronary arteries – Right and Left coronary artery. The coronary arteriesarise from the aortic sinuses and the left coronary artery from the left posterior aortic sinus. The left coronaryartery has two branches, the anterior interventricular and circumflex arteries. The anterior interventricularbranch is the continuation of left coronary artery, gives off septal branches, right and left ventricular branches.The left ventricular branches are called diagonal arteries. The left circumflex artery gives off left atrial and leftventricular branches. One of these atrial branches supply the sinoatrial node in 35% of subjects and AV node in10-20% of the subjects.Materials and Methods: The study was carried out in the department of anatomy, Kasturba Medical College,Manipal, India. The study was performed on 50 formalin fixed human hearts of unknown sex and age. The leftcoronary artery and their branches were carefully dissected. The origin, branches & branching pattern of leftcoronary artery was observed, noted and photographed.Results: In present study, 49 samples (98%) showed the origin of left coronary artery from left posterior aorticsinus while 01 sample (02%) had no trunk of left coronary artery. Sino-atrial nodal artery was originating formcircumflex artery in 13 samples (26%) and atrio-ventricular nodal artery from the circumflex artery in 05samples (10%). The trunk of left coronary artery was bifurcating in 37 samples (74%) and trifurcating in 12samples (24%) with one sample (02%) showing absent trunk of left coronary artery. The median artery waspresent in 12 samples (24%) and posterior interventricular artery was originating from circumflex artery in 05samples (10%).Conclusion: Left coronary artery commonly originated from left posterior aortic sinus with very few variations.Sino-atrial nodal artery and atrioventricular nodal artery commonly originates from right coronary artery.Bifurcation of left coronary artery is commoner than trifurcation. The present study is useful in better understandingof the normal and variant anatomy of left coronary artery

Left Main Coronary Artery Ramification - Bifurcation Vs Trifurcation

BACK GROUND OF STUDY:A detailed awareness of branching pattern of left main coronary artery is of immense help for various diagnostic and therapeutic measures on coronary arteries, in this era of increasing coronary artery disease. MATERIALS & METHODS: Fifty human hearts were included in the study group. The LMCA and its branches were studied in detail after removing the epicardium and subepicardial fat. RESULTS: This dissection study on the ramification of LMCA could detect bifurcation , trifurcation and quadrifurcation in 76%, 22% and 2% respectively.

Diagnostic value of electrocardiogram in acute myocardial infarction associated with different circumflex branches / 中国基层医药

Objective@#To investigate the characteristics of body surface electrocardiogram (ECG) of different segments of circumflex artey (LCX) occlusion.@*Methods@#The ECG characteristics of 85 patients with acute myocardial infarction caused by LCX occlusion in the People's Hospital of Rugao, Jiangsu, from February 2015 to February 2018 were analyzed.The results of coronary angiography were taken as the criteria.The efficacy of the body surface ECG for the diagnosis of LXC occlusion of acute myocardial infarction was analyzed by receiver operating characteristic curve (ROC).@*Results@#The ECG of right dominant LCX occlusion was dominated by STⅡ, Ⅲ, AVF elevation (76.47%), and the balance type was dominated by STV1-V3 (68%), and the dominant left dominant type was STⅡ, Ⅲ, AVF elevation (88.89%) and STV7-V9 elevation (66.67%). STV1-V3 moved down, STⅡ, Ⅲ, AVF elevation, STV7-V9 elevated in different coronary points.The differences between the two groups was statistically significant (χ2=4.028, 4.061, all P<0.05). The ECG changes of LCX occluded in the distal and middle segments were dominated by STⅡ, Ⅲ, AVF (100%, 78.95%), and the proximal and blunt branches were dominated by STV1-V3 (88.24%). STV1-V3 moved down, STⅡ, Ⅲ, AVF elevation, STⅠ, aVL elevation and STV7-V9 elevation had statistically significant differences(χ2=6.024, 5.318, 4.971, all P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve of STV1-V3, STⅡ, Ⅲ, AVF elevation were 82.06%, 92.63%, 89.91%, 86.34%, 88.06%, 0.830 (95%CI: 0.853-0.991), respectively, and 86.83%, 95.37%, 92.38%, 88.61%, 90.64%, 0.922 (95%CI: 0.729-0.931), respectively, the efficiency is better than STⅠ, aVL and STV7-V9.@*Conclusion@#The body surface ECG of LCX occlusive acute myocardial infarction is varied with various factors.STV1-V3 shift, STⅡ, Ⅲ, AVF elevation are of high diagnostic value for LCX occlusion of acute myocardial infarction, and the clinical history and other methods should be used for accurate diagnosis.

Design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery / 中华整形外科杂志

Objective@#To explore the flap design and clinical applications of the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery in defect reconstruction.@*Methods@#Between September 2009 and December 2018, 27 patients with soft tissue defects from lower extremities were involved in this study, including 15 males and 12 females, with an average age of 34.6 years old (range, 3 to 73 years old). Before surgery, the type of the flap to be used was designed preliminarily by evaluating the location, size and shape of the lesion or defect. The perforators of the lateral circumflex femoral artery were explored using an ultrasound Doppler probe, marked on skin. The computed tomographic angiography was also used to get more information of the branches of the lateral circumflex femoral artery when possible. The propeller flaps were divided into typeⅠ, Ⅱ, Ⅲ, and Ⅳ according to the perforators that originated from the transverse, descending, oblique, and rectus femoris branches of the lateral circumflex femoral artery, respectively. The type Ⅱ flap was subdivided into type Ⅱa and type Ⅱb flaps that were based on antegrade and reverse flow from the descending branch. The defects were reconstructed using the perforator propeller flap.@*Results@#Twenty-seven patients underwent reconstruction of defects using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery including 3 type Ⅰ flap, 12 type Ⅱa, 2 type Ⅱb, 10 type Ⅲ and 3 type Ⅳ. The size, pedicle length and rotation angle of the flaps were 12 cm×6 cm to 30 cm×15 cm, 4 cm to 15 cm, and 60 to 180 degrees, respectively. Total necrosis occurred in one flap and small-sized distal necrosis in another one. Minor complications occurred in two flaps and the remaining propeller flaps survived completely. All patients were followed up from one to 25 months and mean follow-up time was 9.9 months. Tumor recurrence was noticed in one patient. All patients were satisfied with the final functional and aesthetic outcomes.@*Conclusions@#For appropriate cases, reconstruction of defects from the groin to the knee could be achieved by using the propeller flaps based on perforators from different branches of the lateral circumflex femoral artery, with advantages of easy-to-operate and minor donor-site morbidity.

The oblique branch of lateral circumflex femoral artery: alternative vascular pedicle for pedicled anterolateral thigh flaps / 中华整形外科杂志

Objective@#To explore the feasibility and technical points of soft tissue defect reconstruction using the pedicled anterolateral thigh flap based on perforating vessels from the lateral circumflex femoral artery oblique branch.@*Methods@#Between November 2009 and April 2019, 27 pedicled anterolateral thigh flaps were performed to repair the wound of trunk and lower extremity, based on perforating vessels from the lateral circumflex femoral artery oblique branch. 16 flaps were proximally based and 11 were distally based.@*Results@#The proximally based flap ranged from 15 cm×8 cm to 32 cm×12 cm. The mean length of the pedicle was 8.2 cm. The distally based flap ranged from 9 cm×7 cm to 24 cm×8 cm. The mean length of the pedicle was 18.6 cm. All flaps survived after surgery. Venous congestion occurred in one flap and relieved in five days.@*Conclusions@#With oblique branch as the pedicle, the vascular dissection was easy and donor site morbidity was minimized while harvesting the proximally based anterolateral thigh flaps; long pedicle could be obtained, and the reconstructive sphere was extended when using the distally based anterolateral thigh flaps.

Selection strategy of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair / 中华整形外科杂志

Objective@#To provide clinical guidance for clinical selection, through retrospective analysis for the advantages and disadvantages of superficial iliac circumflex artery and lateral circumflex femoral artery perforator flap in wound repair.@*Methods@#From July 2016 to January 2018, 89 cases were repaired with superficial iliac circumflex artery or lateral femoral circumflex artery perforator flap, including 32 cases of superficial circumflex iliac artery perforator flap, 18 cases of upper limb, 6 cases of face and neck, and 8 cases of lower extremity. There were 52 cases of lateral circumflex femoral artery perforator flap, 21 cases of upper limb, 2 cases of neck, 3 cases of trunk, 26 cases of lower extremity, 5 cases of superficial circumflex iliac artery perforator flap combined with lateral femoral circumflex artery perforator flap, 3 cases of upper limb and 2 cases of lower extremity. The perforators of superficial circumflex iliac artery or (and) lateral circumflex femoral artery were detected by portable Doppler flow detector before operation. According to the wound size, the superficial circumflex artery perforator flap or (and) lateral circumflex femoral artery perforator flap was or (were) designed and resected. End-to-end or end-to-side anastomosis was performed in vascular pedicle. In the combined resection group, the end-to-end or end-to-side anastomosis of the perforator of the lateral circumflex thigh artery was performed, and the pedicled part of the superficial circumflex iliac artery was used for supercharging.@*Results@#All the flaps survived successfully except one combined flap had tip necrosis on the superficial iliac circumflex artery perforator flap part. and healed after 2 weeks of dressing change. Venous crisis occurred on the first day after operation of superficial iliac circumflex artery perforator flap in 1 case.10 cases of lateral femoral circumflex artery perforator flap were slightly bloated and 3 cases returned to hospital for secondary thinning. All the flaps were soft in texture, satisfactory in shape and function, and numbed in the small area of the donor region of the perforator flap of lateral femoral circumflex artery in the early stage. All the patients had no severe complications after follow-up.@*Conclusions@#The perforator flap of superficial iliac circumflex artery and lateral femoral circumflex artery are ideal donor areas for wound repair. The perforator flap of superficial iliac circumflex artery is preferred for small area wound, hand wound and small bone defect. Lateral circumflex femoral perforator flap is suitable for all trunk and limbs with large or complex wounds.

Diagnostic value of electrocardiogram in acute myocardial infarction associated with different circumflex branches / 中国基层医药

Objective To investigate the characteristics of body surface electrocardiogram (ECG) of different segments of circumflex artey (LCX) occlusion.Methods The ECG characteristics of 85 patients with acute myocardial infarction caused by LCX occlusion in the People's Hospital of Rugao,Jiangsu,from February 2015 to February 2018 were analyzed.The results of coronary angiography were taken as the criteria.The efficacy of the body surface ECG for the diagnosis of LXC occlusion of acute myocardial infarction was analyzed by receiver operating characteristic curve (ROC).Results The ECG of right dominant LCX occlusion was dominated by STⅡ,Ⅲ,AVF elevation (76.47％),and the balance type was dominated by STv1-v3 (68％),and the dominant left dominant type was ST Ⅱ,Ⅲ,AVF elevation (88.89％) and STV7-v9 elevation (66.67％).STV1-V3 moved down,ST Ⅱ,Ⅲ,AVF elevation,STV7-V9 elevated in different coronary points.The differences between the two groups was statistically significant (x2 =4.028,4.061,all P ＜ 0.05).The ECG changes of LCX occluded in the distal and middle segments were dominated by STⅡ,Ⅲ,AVF(100％,78.95％),and the proximal and blunt branches were dominated by STvi-v3 (88.24％).STv1-V3 moved down,STⅡ,Ⅲ,AVF elevation,ST I,aVL elevation and STv7-v9 elevation had statistically significant differences (x2 =6.024,5.318,4.971,all P ＜ 0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve of STv1-v3,STⅡ,Ⅲ,AVF elevation were 82.06％,92.63％,89.91％,86.34％,88.06％,0.830 (95％ CI:0.853-0.991),respectively,and 86.83％,95.37％,92.38％,88.61％,90.64％,0.922 (95％ CI:0.729-0.931),respectively,the efficiency is better than STi,aVL and STv7-v9.Conclusion The body surface ECG of LCX occlusive acute myocardial infarction is varied with various factors.STV1 ～V3 shift,STⅡ,Ⅲ,AVF elevation are of high diagnostic value for LCX occlusion of acute myocardial infarction,and the clinical history and other methods should be used for accurate diagnosis.

Superficial circumflex iliac artery perforator flap for reconstruction of buccal and plate soft tissue defects / 中华整形外科杂志

Objective@#To investigate the therapeutic effect of free superficial circumflex iliac artery perforator (SCIP)flap for reconstruction of soft tissue defects secondary to resection of retromolar and lateral buccal squamous cell carcinoma.@*Methods@#From January 2014 to January 2017, eight patients with retromolar and lateral buccal squamous cell carcinoma received radical resection and reconstructed with SCIP flap immediately. CTA and color Doppler sonography were routinely performed before the surgery. According to the size of the defect in the recipient area, the flap vascularized by the perforator vessel was carefully prepared and transferred to the buccal-pharynx-palate composite defect. The recipient area and donor area were sutured tightly after arteriovenous anastomosis under microscope. The survival and functional recovery of the flap were observed after operation.@*Results@#The flap sizes ranged from 5 cm× 6 cm to 7 cm×9 cm.The mean diameter of the superficial circumflex iliac arteries was 0.65 mm. And the mean diameter of the veins was 1.2 mm. The mean arterial pedicle length was 7.0 cm, and the venous pedicle length was 8.0 cm. Eight flaps were all survived. The shape of the buccal-parapharyngeal-palate was good and the mouth opening was normal after operation.@*Conclusions@#Superficial circumflex iliac artery perforator flap was a good choice for repairing the defect of parapharyngeal squamous cell carcinoma in the posterior molar region.

Clinical Implication of the Presence of Notch Wave in ECG for Patients With Left Circumflex Artery-related Acute Myocardial Infarction / 中国循环杂志

Objectives: To evaluate the clinical implication of notch (N) Wave in ECG for patients with left circumflex artery-related acute myocardial infarction. Methods: A total of 416 patients with left circumflex artery-related acute myocardial infarction hospitalized in our hospital from January 2013 to December 2016 were included in this study. According to the electrocardiogram, 156 people were divided into ST segment elevation myocardial infarction group, 108 patients in N wave non-ST segment elevation myocardial infarction group, and 152 patients in non-N wave NSTEMI group. Troponin I and creatine kinase isoenzyme, hospitalization to operation time, vascular lesion site and degree, the intraoperative and postoperative complications were compared among the 3 groups. Results: Troponin I and creatine kinase isoenzyme levels were significantly lower in non-N wave NSTEMI group than in STEMI group and N wave NSTEMI group (P<0.05). The occurrence rate of no-reflow phenomenon was significantly higher in N wave NSTEMI group than in STEMI group and non N wave NSTEMI group (P<0.05). There was no significant difference in incidence of cardiac shock, ventricular fibrillation, ventricular aneurysm and death rate among the 3 groups(P>0.05). Incidence rate of lesion located in the proximal and middle section of left circumflex artery as well as the mean vascular stenosis degree were significantly lower, while incidence rate of lesion located in the distal section of left circumflex artery and obtuse marginal branches was significantly higher in non N wave NSTEMI group than in STEMI group and N wave NSTEMI group(P<0.05). Conclusions: Presence of Notch wave in ECG is associated with higher incidence of lesion located in the proximal and middle section of left circumflex artery, larger infarct size and higher incidence of no-reflow in patients with left circumflex artery-related acute myocardial infarction.

Free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area / 中华整形外科杂志

Objective@#To investigate the feasibility and efficacy of free lobulated lateral circumflex femoral artery perforator flap for foot and ankle defect at non-weight bearing area.@*Methods@#From January 2008 to June 2016, 28 cases with foot and ankle skin and soft tissue defects at non-weight bearing area were treated, including 16 cases with traffic accident, 8 cases with machine injury, and 4 cases with falling injury. There were 10 cases with Achilles tendon exposure, 16 cases with dorsalis pedis tendons exposure and 12 cases with bone exposure. The defect size ranged from 10 cm×8 cm to 16 cm×13 cm. Doppler ultrasound detector was used to select two perforators of lateral femoral circumflex artery. The lobulated perforator flap was designed and harvested as one flap. After clip test was performed to make sure the blood supply of flap, the flap was segmented and repositioned to cover the wound. The width of lobulated flaps was less than 8cm, in order to close the defect at donor sites directly. Postoperative rountine anti-inflammatory, anticoagulant, anticonvulsive treatment and function exercise were adopted. The patients were followed up for 6-28 months.@*Results@#The flap size ranged from 9.0 cm×4.5 cm to 17.0 cm×7.0 cm. Partial necrosis happened at the end of one flap lobe due to pressure, which healed after dressing. All the other 27 flaps survived completely with satisfactory cosmetic and functional result. The wounds at donor sites all healed primarily.@*Conclusions@#Free lobulated lateral circumflex femoral artery perforator flap is one of the ideal flaps with high survival rate and low complication for foot and ankle defect at non-weight bearing area.

Clinical cognition of anterolateral femoral skin flap with high cutantous artery branches / 中华显微外科杂志

Objective To recognize the relationship between high cutantous artery branches and descending branch of lateral femoral circumflex artery artery,and to investigate the blood supply of anterolateral thigh flap in clinical.Methods Retrospective analysis 152 cases of anterolateral thigh flap from November,2003 to December,2016.It contains cutting with descending branchs in 99 cases,cutting with lateral branchs in 43 cases,the union of them in 8 cases and high cutantous artery branches in 2 cases.Results The flaps survival in 147 cases,cutting necrosis in 3 cases and partly necrosis in 2 cases.Descending and lateral branchs were both dominance neurovascular bundle of vastus lateralis muscle,independently or commonly dominate the skin of anterolateral thigh,occurrence rate was 33.5％.Conclusion The descending branch of lateral femoral circumflex artery include lateral branch,all of which are the neurovascular bundles,supply the anterolateral thigh muscle,and divid into some perforator branches crossing the musle to the anterolateral thigh skin subsequently,which constitute "the anatomical functional unit".High cutantous artery branche is the one of all of the branches,its origin lies hight and arise from lateral branch.

Intraoperative perforators of personalized designed KISS flap of the descending branch of the lateral circum-flex femoral artery / 中华显微外科杂志

Objective To summarize the individualized design of perforating branches in the KISS flap of the descending branch of lateral femoral circumflex artery and improve the survival rate of flap. Methods From September, 2012 to June, 2016, the individualized design KISS flap of perforating branches of lateral femoral circum-flex artery was used to repair the soft defect in arms and legs in 20 cases, which contained 12 males and 8 females aged from 23 to 71 years old with an average of 48 years. The wounds in upper limb and wrist were 16 cases, and in instep and lower extremity wounds were 4 cases. The areas of tissue defect were ranged from 8.5 cm ×12.0 cm to 12.0 cm×23.0 cm. The area of flap ranged from 5.0 cm×8.0 cm to 8.0 cm×14.0 cm. Donor sites were sutured directly. Post-operative follow-up was done termly. Results All flaps survived without vascular crisis. The wounds and incisions at donor sites were the primary healing. Seventeen cases were followed-up 6 to 24 months (average, 18 months). The color and texture of the flaps were good, and the appearance was satisfactory. The donor site of the flap only left linear scar. Conclusion Designed KISS flap according to diameter of the perforator artery in the operation can improve the survival rate of the flap. The design of the KISS flap is more flexible and reliable, which is worthy of promotion.

Anatomical considerations of percutaneous transvenous mitral annuloplasty: a novel procedure for treatment of functional mitral regurgitation / 대한해부학회지

Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1–6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.

Study of Origin, Course and Branching Pattern of Left Coronary Artery in Hyderabad Karnataka Region.

Abstracts: Background: Sound knowledge of left coronary artery (LCA) is necessary for performing coronary angiographies and shunt surgeries. Study of origin, course of left coronary artery and its branches helps in judging the area of myocardium supplied by them which in turn helps in judging the size of infarct. Methodology: The present study is done on 76 adult heart specimens obtained from routine dissection conducted for undergraduate students in the Department of Anatomy at Bidar Institute of Medical Sciences, Bidar and also at other nearby medical colleges of Karnataka and Maharashtra. The data obtained is tabulated and analyzed statistically. Results: In our study, in all the cases the Left coronary artery originates from left posterior aortic sinus. Bifurcation of left coronary artery is seen in 81.5%, trifurcation in 14.5% and quadrifurcation in 4% cases. The left anterior descending artery (LAD) terminates by wrapping around apex in 70% cases and the left circumflex artery (LCX) terminates between obtuse border and crux of heart in 52.5% of cases. Conclusion: The present study is done to know origin, distribution, branching and level of termination of left coronary artery in adult human hearts of Hyderabad Karnataka region to provide vital inputs for making a correct diagnosis and planning treatment for procedures like coronary angiography, stenting procedures and surgical myocardial revascularization in extensive myocardial ischemia.

Impact of post‑operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India.

BACKGROUND: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast‑conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx). MATERIALS AND METHODS: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student’s t‑test was used for comparative analysis of the means. RESULTS: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14–3.48). The mean Dmean of LAD for L‑EBC and R‑EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77–1.60). The mean‑Dmax of LCx for patients with L‑EBC (2.9 Gy; range: 1.2–4.35 Gy) was statistically higher than that for R‑EBC (1.3 Gy; range: 0.7–3.2 Gy) (P = 0.045). The mean‑Dmean of LCx for L‑EBC (2.1 Gy; range: 0.6–3.6 Gy) was also significantly higher than that of L‑EBC (0.9 Gy; range: 0.7–2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m‑Dmax and m‑Dmean of LCx). CONCLUSION: This pilot dosimetric study confirms the assumption that patients with left‑sided EBC are at higher risk of developing long‑term cardiac morbidity when treated with PORT due to increased dose to LAD.

The iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease / 中华显微外科杂志

Objective To investigate the clinical effect of the iliac periosteal flap with ascending branch of lateral femoral circumflex artery for the treatment of Legg-Calvé-Perthes disease.Methods Followed-up 18 patients with Legg-Calvé-Perthes disease who had undergone the treatment of iliac periosteal flap with ascending branch of lateral femoral circumflex artery from January,2008 to May,2012 in our hospital.Minimum follow-up time was from 24 to 60 months,and the average time was 38 months.The followed-up period ended in May,2014.Assessed the effect of surgery by X-ray,clinical examination and Harris scoring system.Results Sixteen patients had good healing with iliac periosteal flap according to X-ray show.Their epiphyseal height recovered and the femoral head rounded gradually.Two cases became flat and collapse.The result of excellent and good rate was 88.9％ by Mose method combined with the results of X-ray.The average Harris hip score improved from 72.3 ± 4.9 points preoperatively to 91.3 ± 2.4 points postoperatively.The difference of the result was statistically significant (P ＜ 0.05).Conclusion The transfer of iliac periosteal flap with ascending branch of lateral femoral circumflex artery is an effective treatment for Legg-Calvé-Perthes disease.