Colgajo anterior de muslo en hemipelvectomía externa, reporte de caso / Anterior fl ap on external hemipelvectomy, case report

Introducción. La hemipelvectomía es un procedimiento agresivo para el tratamiento de tumores localmente avanzados. Requiere la conformación de un equipo interdisciplinario. Las opciones de cobertura dependen de la topografía de la lesión, existiendo 3 tipos de colgajo: posterior, anterior, y libre. Material y método. Se presenta el caso clínico de un paciente que presentó una ulcera de Marjolin a nivel de región trocantérica y glútea derecha, en el que se realizó una hemipelvectomía externa extendida, asociada a un colgajo anterior de muslo. Se trató de un colgajo músculo-cutáneo pediculado a los vasos femorales superfi ciales y profundos, compuesto por todos los planos de la logia anterior de muslo. Resultados. En este paciente se alcanzó una adecuada cobertura del defecto, que permitió su pronta rehabilitación. Discusión. Este colgajo es descripto como un colgajo pediculado en los vasos femorales superfi ciales. Creemos que si bien presenta vascularización por estos vasos, su mayor vascularización está dada por la arteria femoral profunda y su rama lateral circunfl eja. Este colgajo permite una adecuada cobertura en lesiones posteriores, con buena calidad de cobertura y menor número de complicaciones que el colgajo posterior. Conclusión. La hemipelevectomía externa es un tratamiento agresivo realizado para lesiones localmente avanzadas, con alta morbimortalidad, y que debe ser realizada por un equipo interdisciplinario. En cuanto a la cobertura, el colgajo anterior presenta buenos resultados dada su buena vascularización.

Background. Hemipelvectomy is an aggressive procedure for the treatment of locally advanced tumors. It requires the formation of an interdisciplinary team. The coverage options depend on the topography of the lesion, being 3 types of fl aps: posterior, anterior, and free. Material and Method. We present a case of a patient presenting an ulcer of Marjolin at the right trochanteric region. In which an extended external hemipelvectomy anterior fl ap is performed. It is a muscle cutaneous fl ap pediculated to the superfi cial and deep femoral vessels, composed of all the planes of the anterior thigh lodge. Results. In our patient we have reached an adequate coverage of the defect, which allowed an early rehabilitation of the patient. Discussion. This fl ap is described as a pedicled fl ap in the superfi cial femoral vessels. We believe that this fl ap is vascularized by these vessels, but its major vascularization is given by the deep femoral artery and its circumfl ex lateral branch. This fl ap allows adequate coverage in posterior lesions, with a good quality of coverage, and a lower number of complications than the posterior fl ap. Comments. External hemipelvectomy is an aggressive treatment performed for locally advanced lesions, with high morbidity and mortality, which must be performed by an interdisciplinary team. Regarding the coverage, we highlight the good results achieved by this fl ap given its good vascularization.

Unusual branches of femoral artery in the femoral triangle: a case report / Ramas inusuales de la arteria femoral en el triángulo femoral: reporte de caso

Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origin of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.

La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Presentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral.

Aneurisma verdadero en arteria ciática persistente: caso clínico / Persistent sciatic artery aneurysm: a case report

We report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaiso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superficial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superficial femoral artery hipoplasia and the PSA becomes the dominant arterial inflow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.

Se reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superficial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superficial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superficial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.

anatomical study of the relation between the descending branch of the inferior gluteal artery and the posterior cutaneous nerve of the thigh

The gluteal thigh flap is a myofascio-cutaneous flap receiving its blood supply from a descending branch of the inferior gluteal artery. The superior and inferior myocutaneous gluteal free flaps have been considered as valuable alternatives to the latissimus dorsi or TRAM flap since 1975. The purpose of this study was to gain a better understanding of the anatomical relationship between the posterior cutaneous nerve of the thigh, and the descending branch of the inferior gluteal artery. Twenty four posterior thigh specimens of adult human cadavers were dissected after latex injection of the internal iliac artery. The inferior gluteal artery and the posterior cutaneous nerve of the thigh were carefully dissected. The relation between the descending branch of inferior gluteal artery and the posterior cutaneous nerve of the thigh was studied and photographed. The external diameter and the length of the descending branch of the inferior gluteal artery were measured. The inferior gluteal artery gave off a descending branch that is accompanied by the posterior cutaneous nerve of the thigh. The descending branch was observing in all cadavers dissected. Its average external diameter was 0.3 +/- 0.07mm and it was arising about 7.15 +/- 0.68cm away from the tip of the greater trochanter of the femur. In 5 lower limbs [20.8%] the descending branch was passing medial to the posterior cutaneous nerve of the thigh. In the remaining cadavers the descending branch of the inferior gluteal artery was passing lateral to the posterior cutaneous nerve of the thigh in 19 out of 24 specimens [79.2% of lower limbs]. It was descending below the gluteal fold with the posterior cutaneous nerve of the thigh in a common connective tissue sheath in 21 out of 24 specimens. In all dissected lower limbs, one or two cutaneous branches of the descending branch of inferior gluteal artery and one or two cutaneous nerves were supplying the infragluteal perforator flap. Loop of nerves was found surrounding the inferior gluteal artery and its descending branch in 3 out of 24 lower limbs [12.5%]. Knowledge of the vascular anatomy extends the clinical applicability of the posterior thigh fasciocutaneous flap to patients who might otherwise be excluded because of prior injury or operative procedure

Microscopic observations on the great saphenous vein at the upper third level of the thigh and at the level of discharge into the femoral vein

For the microscopical study of the great saphenous vein wall, the venous segments from six male necropsiedcadavers: were obtained three young individuals between 16 and 35 years old and three aged individuals between 50 and 83 years old. The tunica media of the great saphenous vein at the upper third level of the thigh belonging to both young and aged individuals is made up of two layers: an internal formed by fascicles of smooth longitudinal muscular fibers and the external layer made up by fascicles of smooth circular muscular fibers. At the level of the discharge in the femoral, the tunica media of the great saphenous vein wall of both, young and aged individuals, is made up of one layer, whose fascicles of smooth muscular fibers are circularly orientated in relation to the vascular axis. The tunica adventitia of the great saphenous vein wall at the upper third level of the young individuals thigh, presents elastic fibers whereas it the aged individuals it is made up of fascicles of smooth longitudinal fibers; at the level of the femoral vein disdarge in both young and aged individuals, the tunica adventitia presents a fiber elastic constitution. The young and aged individuals' parietal venous valve is elastic fiber in nature. The young individuals' ostial valve is also elastic and that of aged individuals is muscular fiber in nature.

La irrigación arterial del muslo de la llama (Lama glama) / Arteries of the thigh of the llama (Lama glama)

Se trabajó con 5 cadáveres conservados en solución de formol al 6 por ciento a 0ºC y perfundidos por vía arterial con yeso al 14 por ciento y gelatina industrial al 17 por ciento por vía venosa. Se realizaron disecciones con instrumental standard. La Lacuna vasorum está relacionada con las dos cabeza del M. sartorius; en la salida del Trigonum femorale, sólo un tenue anillo de Fascia fija la A. femoralis al Femur. Sus dos primeras colaterales son las Aa, circumflexa ilum superficialis y circumflexa femoris lateralis; la primera puede tener un origen atípico desde la A. iliaca externa; la segunda de ellas, emite los R. ascendens y descendens y, éste último da el R. transversus. La A. profunda femoris está ausente, emitiendo separadamente el Troncus pudendoepigastricus y la A. circumflexa femoris medialis; ésta se origina directamente de la A. femoralis con su tercera colateral, emitiendo los R. obturatorius, profundus, ascendens, transversus y acetabularis. La emergencia de la A. saphena del Trigonum femorale se da a la altura de la inserción distal del M. pectineus; la A. caudalis femoris media surge en este nivel, y proximal a éstas, se origna la A. caudalis femoris proximalis. Al A. saphena emite el R. articularis genus. En la salida del Trigonum femorales, emerge la A. caudalis femoris distalis, la cual pasa por un tenue anillo de Fascia que fija la arteria al Femur. La A. genus descendens se origina en el mismo nivel o ligeramente en distal de esta última. Cuando la A. circumflexa ilum superficialis tiene un origen atípico de la A. iliaca externa, parece reemplazar a la A. iliacofemoralis que presentan algunos individuos. Consideramos a esta especie como un interesante modelo didáctico por poseer una distribución arterial completa

Origen de la arteria femoral profunda / Origin of the femoral deep artery

La arteria femoral profunda es el vaso más importante de la región femoral, otorgando irrigación a la mayor parte del muslo. El conocimiento anatómico más detallado de ella es importante, debido a las frecuentes intervenciones quirúrgicas que se realizan, tanto en reconstrucciones vasculares primarias como secundarias. Fueron disecados 50 miembros inferiores, de cadáveres formolizados, adultos, de sexo masculino y diferentes grupos étnicos, en las disciplinas de anatomía descriptiva y topográfica de la Universidad Federal de Sao Paulo, Escola Paulista de Medicina y Universidad de la Frontera, Chile. Se disecó el trifono femoral y sus elementos vasculares, reconociendo las arterias femoral profunda y circunflejas femorales medial y lateral. La distancia media entre el ligamento inguinal y el origen de la arteria femoral profunda, fue de 38,88 mm. En el 40 por ciento de los casos su origen se encontraba entre 36 y 45 mm distal al ligamento inguinal. La arteria femoral se originó en el 44 por ciento de la parte posterolateral de la arteria femoral; en el 34 por ciento de la parte posterior; en el 12 por ciento de la parte posteromedial; en el 8 por ciento de la parte lateral y en el 2 por ciento de la parte medial de la arteria femoral. En el 34 por ciento de los casos, la arteria femoral profunda da origen, separadamente a las arterias circunflejas femorales medial y lateral. En el 32 por ciento la arteria femoral origina sólo a la arteria circunfleja femoral lateral y en el 20 por ciento sólo a la arteria circunfleja femoral medial, existiendo además porcentajes menores para otros orígenes. Las variaciones del origen de la arteria femoral profunda, son importantes para el cirujano vascular, permitiéndole tener un conocimiento morfométrico y anatomo-quirúrgico de la región y enfrentar con mayor seguridad las reconstrucciones vasculares que se realizan en la región

Anatomical observation on draining patterns of saphenous tributaries in Korean adults

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males and 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.

Ischaemic mouse thigh model for evaluation of pathogenicity of non-clostridial anaerobes.

A mouse thigh model has been devised in which the growing culture of non-clostridial anaerobe in the ischaemic tissue produces inflammatory swelling and death. The swelling of the right thigh served as an index of pathogenicity of the test strain in comparison to the negatively reacting left thigh which received injection of the control strain of Bifidobacterium infantis. Actinomyces naeslundii exceptionally caused death in all animals within 24 h. Mortality and thigh swelling were pronounced (greater than 75%) in case of Fusobacterium gonidiaformans and Propionibacterium acnes but less (less than 50%) in Acidaminococcus fermentans. High (less than 75%) rate of thigh swelling was also encountered in case of Bacteroides oralis, Bacteroides corrodens, Fusobacterium necrophorum, Fusobacterium prausnitzii, Fusobacterium plauti, Peptococcus prevotii, Streptococcus intermedius, Eubacterium lentum and Propionibacterium freudenreichii ss. shermanii.