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It was aimed to reveal whether the positions and dimensions of the extrinsic and intrinsic muscle tendons related to the hallux around the first metatarsal bone are affected by the severity of hallux valgus (HV) and whether tendon positional changes and tendon sizes affect each other. In formalin-fixed 46 feet, three HV angle subgroups (normal, mild and moderate/severe ) were defined. Width, thickness and cross sectional area (CSA) of tendons of the extensor hallucis longus (EHL) and brevis (EHB), abductor hallucis (AH) and flexor hallucis longus (FHL) were measured. On the clock model created in coronal plane, positional variations of each tendon were indicated. In the moderate-severe HV group, thickness and CSA of the EHB, width and CSA of the AH were smaller, compared to mild HV. Width and CSA of the FHL were smaller in moderate/severe HV than in the normal. Regardless of HV, the width and CSA of the FHL was greater in cases where the FHL located more lateral, and the width of both FHL and AT were greater in cases where AH located more plantar. The smaller tendon size of two intrinsic (one plantar and one dorsal) and one extrinsic muscle in the moderate/severe HV group indicates that the changes reflected in the tendons are more pronounced in the case of high HV severity, and the changes are not limited to the tendons on just one side of the foot. The possible biomechanical effects of AH, FHL and EHB tendon dimensional weakness may be important when planning surgery for moderate/severe HV cases.

Purpose: Proper nerve blocking is significant for the success of locally anesthetized assisted surgeries. Dis-acknowledging the anatomical variations of targeted nerve anatomy can be problematic for the success of anesthetic fundamentals. Considering the diverse nature of obturator nerve (ON), blockage of ON (ONB) during clinical procedures can be counted within such problematic. Current focus is to revisit the ON anatomy via exemplifying at adult cadavers and fetuses, and then intensively discuss its relevance to ONB from an anatomical perspective. Methods: ON and its branches were exposed at the posterior wall of the abdomen, lateral wall of the lesser pelvis and anterior aspect of the thigh region in 47 fetuses and 10 adult cadavers. Thereafter, several anatomical motifs and morphometric of ON were meticulously assessed and measured. Results: Presence of anterior branches (AB) / posterior branches (PB) divergence in the obturator channel and extra-pelvic territory were detected as 40 and 60% respectively, while intra-pelvic occurrence wasn’t observed among the adult cadavers. In fetuses, regional distribution of ON divergence was scattered as 8.5% intra-pelvic, 33% in the channel and 58.5% distal to the channel. Concerning the muscular branching of ON, three fully traceable branching from AB and single one from PB were evident in all the adult cadavers. Significant morphometric distances were also provided in detail. Conclusion Our discussion regarding the variable motifs of ON anatomy from a nerve-blocking window, covering the results of the current and just few existed anatomical data sets might be helpful for anesthesiologists to improving the success of ONB.

A replaced right hepatic artery (RHA) arising from the superior mesenteric artery and an interlobar parenchymal bridge over the sagittal fissure have been observed on a 64-year-old formalin-fixed male cadaver in the anatomy laboratory. As we had followed a detailed segmental anatomy, we encountered an arterial distribution of segment IV featuring a different pattern from the literature so far. According to our observations, the segment I is supplied by both left (LHA) and middle (MHA) hepatic arteries; the segments II and III are supplied by the LHA while the segment IV is supplied by both the MHA and replaced RHA. The segments V-VIII are supplied only by the replaced RHA. The case emphasizes the importance of arterial variations of liver in terms of the surgical procedures during the liver transplantation, hepatic resections, hepatic tumours, and etc. Our discussion focuses to the arterial supply of the segment IV and possible complications it may cause during/after the liver operations.

Background: In neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This study’s main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery. Materials and methods: Fifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software. Results: No statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = –225.652 + 14.417 × age (weeks), y = –5.571 + 0.595 × age (weeks), y = –4.276 + 0.909 × age (weeks), and y = –4.468 + 0.779 × age (weeks), respectively. Conclusions: Linear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

Objectives: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. Methods: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. Results: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger ( p =0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. Conclusion: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations. Saudi Med J 2016; Vol. 37 (4): 457-460 doi: 10.15537/smj.2016.4.12665 How to cite this article: Koc T, Gilan IY, Aktekin M, Kurtoglu Z, Dagtekin A, Aytac G, et al. Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery. Saudi Med J 2016; 37: 457-460.

A replaced right hepatic artery (rRHA) arising from the superior mesenteric artery and an interlobar parenchymal bridge over the sagittal fissure of liver have been observed on a 64 year old formalin-fixed male cadaver in the anatomy laboratory. As we followed a detailed segmental anatomy, encountered an arterial distribution on the segment IV featuring a different pattern from the literature so far. According to our observations, the segment I is supplied by both left (LHA) and middle (MHA) hepatic arteries; the segments II and III are supplied by the LHA while the segment IV is supplied by both the MHA and rRHA. The segments V-VIII are supplied only by the rRHA. Our case emphasizes the importance of arterial variations of liver once again in terms of the surgical procedures during the liver transplantation, hepatic tumors, and etc. Our discussion particularly focuses to the arterial supply of the segment IV and possible complications it may cause during/after the liver operations.