[Catheterization of the jugular vein (vena jugularis interna). The advantage of Boulanger's technic]. / Katheterisierung der Drosselvene (Vena jugularis interna) Vorteil der Technik nach Boulanger.

The present study was designed to emphasize the technical accuracy of the percutaneous internal jugular vein approach in operative reanimation (Boulanger Technik). In 18 specimens with hyperextended neck, the cannulation of the internal vein was achieved from a puncture point situated 7.3 cm lateral to the sternoclavicular joint, at level of the top of the thyroid cartilage; then the catheter was pushed slanting downwards an laterally by 50 degrees with respect to the inner border of the sternomastoid muscle toward the union medial third-middle third of the clavicle. The acknowledge of the distance between the puncture point and the right auricle allows to ascertain the proper location of the catheter. The use of the internal jugular vein can be recommended in operative reanimation because its cannulation is harmless and easy to carry out and both its large size and deep situation lower the usual risks of more distal venous catheterizations.

Organization of the extensor complex of the digits.

On the basis of 150 dissections the authors show that, on the back of the hand, the tendinous formations ensuring the extension of the fingers can be arranged in four groups of a least two tendons for each finger, excepting the thumb. In the little finger the group comprises a constant tendon, the extensor proper, and two variables, the common extensor and the expansion of the extensor carpi ulnaris. In the index finger the extensor proper and the common extensor nearly always coexist. In the middle finger the great common extensor, sometimes divided, can be accompanied at depth, by an extensor tendon. Finally, in the ring finger, two or three more or less intricate slips are found forming the common extensor. The presence of anastomoses and the numerous slips originating in the tendon-forming band can reduce functional deficiency following the section or rupture of a tendon. On account of these variations the surgeon should operate with caution in tendon transplantations.

[Factors in the stabilization of the ulnar head]. / Les facteurs de stabilisation de la tête ulnarienne.

The authors studied the stability of the ulnar head by dissections of the radio-ulnar joint and experimental ligamentous removals in 150 specimens. They emphasize the importance of the tendon of the extensor carpi ulnaris and medial collateral ligament tightened by Kuhlmann's sling which firmly apply the ulnar head against the anterior edge of the sigmoid potch of the radius. Transsection of the separate fibro-osseous tunnel of the extensor carpi ulnaris with forward creeping of the tendon out of its groove enlarges the size of the gap between extensor carpi ulnaris and extensor digiti quinti; if in addition both fibro-cartilaginous disk and medial collateral ligament are torn, the ulnar head dislocates dorsally. Such a displacement can be obtained by full supination following forced pronation. The volar dislocation of the ulnar head occurs more rarely; it might be caused by insufficient extensor carpi ulnaris and ruptured fibro-cartilaginous disk and yielded by shallow sigmoid notch and blunt anterior border. So muscular structures avoid dorsal displacement of the ulnar head actively whereas only fibro-osseous structures passively prevent from anterior displacement.

[Descriptive and topographical anatomy of the dorsal artery of the foot]. / Anatomie descriptive et topographique de l'artère dorsale du pied (pédieuse).

The authors studied the course of the A. dorsalis pedis in 67 specimens cleared up with formalin and injected with terpentine and minium. The classical statement was found in 44 cases (2/3): the A. dorsalis pedis following the course of the A. Tibialis arise in front of the upper edge of the retinaculum extensorum, ran through the first intermetatarsal space and anastomosed with the A. plantaris lateralis. In 15 cases, it divided into 2 terminale branches - A. dorsalis medialis and lateralis - at 2-3 cm cm beyond its origin. In 6 cases, the artery was tiny and the arterial supply of the dorsum of the foot was mainly provided by both the lateral malleolar and the fibular arteries. Twice, the A. dorsalis pedis ran down into the second intermetatarsal space. The knowledge of these individual variations is to be pointed out by arteriography before using either M. extensor digitorum brevis or skin of the dorsum of the foot as flaps for covering cutaneous defects at the bindfoot.

[Arterial vascularization of the triceps sural muscle]. / Contribution à l'étude de la vascularisation artérielle du muscle triceps sural.

The triceps surae muscle, the dorsal and medial leg skin constitute a very important reserve of muscular and myocutaneous flaps. The material on which the study was carried out consisted of 20 legs from standard cadavers. The superficialis femoral artery was injected with terebenthene and minimum mixture. The medial head of gastrocnemius is 23.3 em long, 6.9 cm wide, 1.25 mm thick at distal third. Its dominant blood supply is carried by the medialis gastrocnemius artery. It rises from popliteal artery 1.2 cm above the femoral tibial articulation with 1.9 mm diameter. It runs 3 cm down before entering muscle where it provides 2 or 3 mean branches. These branches give musculocutaneous arteries to the skin of the dorsal leg. The same study was performed for the lateral head of gastrocnemius and soleus. We studied also arteries of dorsomedial leg skin. The characteristics of long saphenous and short saphenous arteries were described. These muscles and dorsomedial leg skin can be used as muscular or myocutaneous flap for covering defects between the lower leg and the lower thigh.

Anatomical basis for the use of muscle flaps in the leg.

The aim of this study is to define the anatomical features of each of the anterior crural muscles and to determine their respective usefulness as flaps for surgical repair.

Vascular anatomy of the pisiformis bone.

The authors examined 41 dried pisiform specimens; it was found that the vascular apertures were situated on the lateral aspect, in the proximal half of the ridge occupied by the ulnar artery, on the medial aspect and at the distal tip of the bone. An average number of 6.9 foramina were encountered, their mean diameter attained 40/100 mm. In 34 injected specimens the nutrient vessels of the pisiforme were traced from the ulnar artery and its carpal dorsal and deep volar branches; all the tiny bony twigs anastomosed with one another and contributed to an arterial circle running around the pisiforme. The carpal dorsal artery which provides at least 2 descending branches toward the proximal tip of the bone, can be called the main pedicle; when its superficial branches are ligated, the pedicle is long enough (3 cm) to make the replacement of the lunate by the pisiform attached to the flexor carpi ulnaris quite safe in Kienböck's disease, without any risk of osteonecrosis.

[Contribution to the study of the vascularization of the fascia lata tensor muscle]. / Contribution à l'étude de la vascularisation du muscle tenseur du fascia lata.

The tensor fascia lata is a short flat muscle arising from the anterior superior iliac spine and inserting into the fascia lata at mid thigh. It is supplied by three arterial pedicles of unequal importance, branching from the external iliac, gluteal and deep femoral arteries. The 'dominant' blood supply is carried by the lateral circumflex femoral artery which comes from the deep femoral and enters the muscle, approximately 8.8 cm beneath the anterior superior iliac spine. This vessel varies in size from 2 to 3.5 mm; it is 8 cm long but can be lengthened by ligating the branch for the vastus lateralis. On the deep sheath of the iliotibial tract it gives off three branches which supply each third of the fleshy body. The upper branch runs vertically to the iliac insertion of the muscle but not so far as the iliac crest and provides no cutaneous twig. On the contrary, the mid branch runs transversally through the muscle and sends perforating vessels to the skin overlying the fascia lata 6--7 cm below the anterior superior iliac spine. The descending branch runs parallel to the muscular fibers of the muscle and supplies the skin of the lateral lower thigh down to 8 cm above the knee. So the pedicle supports an area of the skin which is double the length (22 cm) and triple the width (9.5 cm) of the fleshy body. The tensor fascia lata including the two layers of the iliotibial tract but excluding its upper insertion, together with the skin of the lateral aspect of the thigh can be safely used as a myocutaneous flap for covering defects of the trochanteric, ischial and sacral areas.

[Morphologic anatomy of the interjugochiasmatic fenestra]. / Anatomie morphologique de la fenêtre interjugochiasmatique.

The pituitary body can be surgically approached through the triangular cleft limited by the sphenoidal jugum and the anterior side of the optic chiasma. The mean surface was calculated by measurements on 51 specimens; it reached 65 mm2. The ratio height : width of the cleft attained 1,3-1,4 corresponding to an anterior chiasmatic angle of about 66-70 degrees. With regard to the variations of the intermalar distance, the values of the triangular surface could be classified into 3 types:--to a distance of 100 mm corresponds a surface less than 50 mm2 (narrow or first grade);--to a distance of 115 mm corresponds a surface greater than 80 mm2 (wide or third grade);--Between these values, the surface can be reckoned on a grossly parabolic curve, the top of which amounts to 90 mm when the intermalar distance equals 107 mm.

[Comparative morphology of the trabecula septomarginalis in terrestrial mammals]. / Morphologie comparee de la trabecula septo-marginalis chez les mammiferes terrestres

The authors studied macroscopic morphology and histologic structure of the moderator band - trabecula septomarginalis - in 100 earthly mammals. A real trabecula septomarginalis was never found in carnivora (dog and fox) because the "anterior" papillary muscle of the right ventricle is located on the lower part of the septum ventriculorum or at times bridge-shaped above the anteiror interventricular groove and attached on both septum and anterior wall of the right ventricle. On the opposite, in ungulates, a well-known band runs across the right ventricular chamber from the septum close to the musculus papillaris coni arteriosi up to the anterior wall close to the anterior papillary muscle. In fact the attachments lie more or less approximate to the pillars; in suidae, the trabecula usually ends on a vertical trabecula carnea just under Luschka's muscle. Three types of trabecula septomarginalis were encountered as previously described by Bortolami in ox: - Mostly (66%), the trabecula septomarginalis is a short and thick fleshy column. The ratio Length mm Thickness mm amounts to about 4 to 7 and can be regarded as reasonably constant within each variety. Moreover the quotients Length mm Height of septum MM. and Thickness of the trabecula mm Highest thickness of the anterior wall mm (measured just beneath the tricuspid attachment) keep constant in each group; thus it may be concluded that size and shape of the trabecula depend on the volume of the heart and the age of the animal. - Rarely, the trabecula looks like a tendinous cord. Such a fibrous string is nearly constant in suidae, especially in wild boar, but seldom in bovidae and cervidae. In all cases, the trabecula septomarginalis supports the right branch of the atrioventricular bundle and a thin artery which originates from the left coronary artery and branches into the right coronary vessels within the anterior papillary muscle. Some venous capillaries were also observed but only in the muscular trabeculae; they are not constant and mouth into the right ventricular chamber or run towards the septal veins around the atrioventricular node. Therefore whatever is the size, the trabecula septomarginalis must be regarded as the shortest pathway from the septum to the anteiror wall of the right ventricle and is a mere band bearing the "right nodal pedicle".

[Comparative anatomy of the arterial and venous vascularization of the septomarginal trabecula in man and mammals]. / Anatomie comparée de la vascularisation artérielle et veineuse de la trabecule septomarginale chez l'homme et les mammifères

By means of naked-eyed dissections and microscopic examinations of the right ventricle in 71 mammals, the authors explained the contents of the trabecula septomarginalis. Besides the right branch of the atrioventricular bundle, they always observed a long artery running deeply from the left coronary artery to the anterior papillar muscle where it joins some right coronary vessels. A few various venous capillaries may be observed going to the anterior interventricular vein or mouthing into the right ventricular chamber (Thebesian veins).

[Neuroskeletal radiography and relationships of the sensitive branch of the radial nerve]. / Radiographie neurosquélettique et rapports de la branche sensitive du nerf radial

The authors carried out an anatomical, roentgenological and surgical study of the ramus superficialis of the radial nerve in man. This branch springs down 1,2 cm. below the humeroradial space and crosses the posterior rim of brachioradialis 8 cm. above the tip of the radial processus styloideus. Twice the exceptional arteria antebrachialis dorsalis was found; the vessel and the radial nerve looked like a posterior pedicle at the forearm. Among the 3 ending branches, the middle one is the most vulnerable in lateral approach of radius and naviculare.