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Background Salivary transplantation or duct transposition can provide continuous physiological secretion of tear substitutes.This may be an ideal method in treatment of dry eye.But the relative anatomical literatures is few,and some of the conclusions in the literatures are still controversial,which limit its clinical application.Objective This study was to discuss the possibility and the advantage and disadvantage of applying three major salivary glands to treat xerophthalmia.Methods The relationship between the branches of the facial nerve out of the parotid gland and the salivary glands,the salivary glands size,origin of blood supply,out diameter of vessels and adjacent relation were observed in 34 sides pate specimens perfused with red latex under the operating microscope.To find the vessels in recipient site to anastomose,the vessels around fossa orbitalis and forehead were anatomized and observed.The parotid gland duct transfer operation,the submandibular gland free transplantation surgery and sublingual gland free transplantation surgery in the human anatomy specimens were simulated.Results The position of parotid duct was constant.The duct length was(4.20± 1.10) cm,duct diameter was (O.60±0.30) cm.The stensen's duct was likely to be prolonged by the cheek mucous membrane or venous andthe damage of buccal branch,zygomatic branch and temporal branches of facial nerve should be avoided during the operation of transplanting stensen' s duct.When submandibular gland was transplanted,facial vessel was taken as its pedicle,whose outside diameter was (2.70 ± 0.28) mm,and the length of the transplant vascular pedicle was (1.90 ± O.30) cm.Thc anastomosed vessel was superficial temporal vessel in recipient site.When sublingual gland was transplanted,sublingual(88.2％,30 sides) or submental vessel(11.8％,4 sides) was taken as its pedicle,whose outside diameter was(1.92±0.36) mm and (1.96±0.54) mm,and the length of the transplant vascular pedicle was(2.60± 1.10) cm and(3.50±0.40) cm,and the anastomosed vessel was the frontal branch of superficial temporal vessel in recipient site.Three sides of specimens lacked sublingual glands.Conclusions It is feasible that treating severe xerophthalmia by the operation of grafting the major salivary glands or transplanting stensen' s duct on the point of anatomical view.Parotid duct inversion and the submandibular gland transplantation have been applied to clinic.However,sublingual transplantation remains to be further confirmed by the animal experiments.
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<p><b>OBJECTIVE</b>To investigate the anatomical study and clinical applications of sural neuron-myocutaneous flap transposition for repairing the special patients with soft tissue defect in foot and ankle.</p><p><b>METHODS</b>The branches, distributions and anastomoses of the vessels and nerves lie in superficial layer of the posterior crural region were observed on 30 sides of adult cadaver lower limb specimens perfused with red latex. Since February 2004, distally based sural neuron-myocutaneous flap was applied for repairing 7 cases of soft tissue defect in foot and ankle.</p><p><b>RESULTS</b>The nutrient vessels of sural nerve, small saphenous vein and posterior femoral cutaneous nerve anastomosed permanently with the musculocutaneous perforators of medial and lateral head of gastrocnemius. There were 2 - 3 anastomoses found respectively. The musculocutaneous perforators pierced the two heads of gastrocnemius muscle (1.8 +/- 0.5) cm medially and (3.7 +/- 0.9) cm laterally away from the groove of the muscle. The medial anastomoses more closed to the middle groove and their diameters were found larger than the lateral ones. In operation, we routinely observed the compound flap for 15 to 20 minutes and found actively errhysis on the muscle, so the fine blood circulation in the flap was demonstrated. All flap survived after operation and the cases were followed up 2 to 6 months with cured osteomyelitis and satisfied flap outline.</p><p><b>CONCLUSIONS</b>Distally based sural neuro-myocutaneous flap can live. The operative method is simple. The flap offers an excellent donor site for repairing the soft tissue defect in foot and ankle in special cases.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Popliteal Artery , Soft Tissue Injuries , General Surgery , Sural Nerve , General Surgery , Surgical FlapsABSTRACT
Objective To provide applied anatomy basis for upper fibular bone flap pedieled with cir- cumflex fibular neck artery.Methods The origin,course,branches,distribution and anastomosis of cir- cumflex fibular neck artery were observed on 54 sides of adult cadaver lower limb speeimens perfused with red latex.Results The circumflex fibular neck artery derived from popliteal artery (3.3?1.1)cm beneath the tip level of fibular head,with its length of (1.4?1.0) cm and diameter of (1.4?0.5) mm.The ascending periosteal branches of circumflex fibular neck artery anastomosed consistently with the descending periosteal branches of inferior lateral genicular artery.Conclusion The transplanting operative design of upper fibular bone flap pedicled with circumflex fibular neck artery was feasible.
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Currently, the conventional empirical or semi-empirical dose calculation algorithms for radiation treatment planning system have been selected as dose engines. The accuracy of these dose calculation algorithms is limited. The main problem is that they fail to adequately consider the lateral transport of radiation or loss of electronic equilibrium near interface between two heterogeneous mediums. Monte Carlo method provides a kind of precise and general solution to photon and electron dose calculation problem, but the puzzle of the longer CPU time affects its clinical application finally. The Monte Carlo code system (EGSnrc) has been used to investigate the different voxel sizes effect on the accuracy of dose distributions and computing time in the present paper. Based on a patient head and neck CT data case studied, it may be concluded that less than 4mm voxels should be used for Monte Carlo dose calculations to insure the superior accuracy of dose distribution, higher image resolution and shorter CPU time.
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The decrease of accuracy in patients' repeated positioning in radiotherapy due to body's transformation is considered and a positioning error measurement method using dynamic template matching technique is brought forward in this paper. This method is an improvement of the matching method to correct positioning error based on the CT digitally reconstructed radiograph(DRR), which uses the video reconstructed 3D surface model that can reflect the body's transformation as the matching template instead of DRR. This method can not only improve the positioning accuracy but also eliminate the adverse influence brought by body's transformation.
