Features of Blood Supply to the Bones of the Lower Leg in the Ankle Joint Region

The purpose of the study was to investigate the topography of permeable (nutrition) arteries in the lower third of leg during human ontogenesis. Materials and methods. The research was conducted on 30 specimens of human prefetuses and fetuses aged 3-9 months of prenatal development; 28 bone specimens of adult tibia and fibula and 27 series of computerized tomography scans of lower extremities of adults aged 21-72 were used. We have used a complex of methods for morphological research: anthropometry, morphometry, macromicroscopy, injections of blood vessels of X-ray contrasting mixtures, three-dimensional reconstruction and statistical analysis. Results and discussion. Cartilage osteogenesis occurs in the prefetal period of prenatal human development, in which blood vessels play a crucial morphofunctional role. During endochondral ossification of the tibia, the vessels of the bone cuff grow into the diaphysis of the cartilaginous model of the bone and osteogenic cells go beyond their limits. In the third trimester of prenatal development, blood vessels grow into the epiphyseal part of the cartilaginous model and an epiphyseal centre of ossification forms. Between the epiphysis and diaphysis centers of ossification, a metaphysical growth plate forms that develops intraosseous anastomosis between the diaphyseal and metaphysical blood vessels. In the metaphysis region, there are extra-skeletal anastomoses. Often, the insertion of nutrition arteries into the bone of the tibia is usually the middle third of bones (55%) and distal metaphysis (37%). In 10%, there were nutrition foramina in the upper third of the tibia. Three-dimensional reconstruction also clearly shows a more extensive and developed network of vessels in the bone marrow canal in metaphysical regions. In the middle third of the tibia and fibula, 1-3 nutrient foramina can be traced on most specimens. On the fibular, in addition to the posterior-medial localization of the nutrient arteries, there were variants with a "high" (above the metaphysis) placement of the entrance of the vessel into the bone substance. Conclusion. The most common places where arteries enter the bones of the lower leg are the middle third of the bones (55%) and the distal metaphysis (37%). In 10%, there were nutrient foramina in the upper third of the tibia. The three-dimensional reconstruction also clearly shows a more extensive and developed network of vessels in the bone marrow canal in metaphysical regions. During the postnatal period, we most often encountered the localization of nutritional arteries on the anterior-lateral surface of the tibia (23%), or their combination – the presence of both nutrient arteries on the posterior and medial bone surfaces (18.3%)

Robot-assisted pyeloplasty with buccal mucosa graft for the management of an extended recurrent ureteropelvic junction stricture

A clinical case of robot-assisted pyeloplasty with buccal mucosa graft of an extended recurrent stricture of the left ureteropelvic junction is presented. The patient had previously undergone left-sided laparoscopic antevasal pyeloplasty and retrograde endopyelotomies with ureteral stenting. However, after these interventions, the dilatation of the left pelvicalyceal system persisted, the patient complained of lumbar pain and periodic exacerbations of chronic pyelonephritis. Transperitoneal robotic access isolated the ureteral upper third and the ureteropelvic junction from scar tissue, after dissecting the narrowed ureteral section, its length was about 3.0 cm. In this regard, plastic surgery was performed with a buccal mucosa graft, the ureter was drained with a stent. There were no postoperative complications, and on day 3 the patient was discharged. The stent was removed 4 weeks after. During the control ultrasound examination, the renal pelvicalyceal system was relatively reduced, and the patient did not notice any pain.

Sternocleidomastoid flap for pedicled reconstruction in head & neck surgery- revisiting the anatomy and technique

Background Previous studies on sternocleidomastoid flaps, have defined the importance of preserving sternocleidomastoid (SCM) branch of superior thyroid artery (STA). This theory drew criticism, as this muscle is known to be a type II muscle, i.e., the muscle has one dominant pedicle (branches from the occipital artery at the superior pole) and smaller vascular pedicles entering the belly of muscle (branches from STA and thyrocervical trunk) at the middle and lower pole respectively. It was unlikely for the SCM branch of STA to supply the upper and lower thirds of the muscle. We undertook a cadaveric angiographic study to investigate distribution of STA supply to SCM muscle. Methods It is a cross-sectional descriptive study on 10 cadaveric SCM muscles along with ipsilateral STA which were evaluated with angiography using diatrizoate (urograffin) dye. Radiographic films were interpreted looking at the opacification of the muscle. Results were analyzed using frequency distribution and percentage. Results Out of ten specimens, near complete opacification was observed in eight SCM muscle specimens. While one showed poor uptake in the lower third of the muscle, the other showed poor uptake in the upper third segment of muscle. Conclusion Based on the above findings we suggest to further investigate sternocleidomastoid muscle as a type III flap, as the STA branch also supplies the whole muscle along with previously described pedicle from occipital artery. However, this needs to be further corroborated intra-operatively using scanning laser doppler. This also explains better survival rates of superior thyroid artery based sternomastoid flaps.