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Objetivo: identificar factores de riesgo ergonómicos en enfermeras. Método: estudio piloto observacional, descriptivo y transversal. La muestra se conformó por 4 enfermeras. Se utilizó la escala de Borg para medir la intensidad de la molestia y el método de Ovako Working Posture Analysing System para clasificar las posturas. Resultados: el total de las participantes presentan molestia en alguna región del cuerpo con intensidad de leve a moderada. Conclusiones: las molestias percibidas por enfermeras podrían estar relacionadas a las posturas que adoptan durante la realización de actividades laborales, ya que está documentado que el dolor en la región posterior del cuello, dolor en la región posterior de los hombros, dolor en la región lumbar y dolor en la región poplítea y pantorrillas, se asocian a lesiones recurrentes en el trabajo de enfermería.

Introduction/aims Cross-sectional area (CSA) reference values using ultrasonography vary widely for lower extremity peripheral nerves. In addition, there is a lack of data on the muscular branches of the tibial nerve and the anatomical variations of the sural nerve. We aimed to evaluate the ultrasonographic reference values for lower extremity peripheral nerves considering different anatomical variations and physical factors. Methods The CSA of the lower extremity nerve was measured at 10 sites. In addition to establishing reference values, differences in the CSA owing to anatomical variations were verified. The relationship between CSA and physical factors, such as age, height, weight, body mass index, and ankle circumference, was also examined. Results A total of 100 healthy Japanese volunteers were recruited. The mean CSA of the sural nerve significantly differed depending on its formation pattern (1.4-1.8 mm2 ). The mean decreases in CSAs from the proximal to distal tibial and fibular nerves within the popliteal region significantly differed based on the fine branching pattern. The maximum value of the mean decreases in CSAs in the tibial and fibular nerves reached 7.2 and 2.5 mm2 , respectively. With respect to physical factors, age and ankle circumferences were associated with CSA at several measurement sites. Discussion Fine branching from the tibial and fibular nerves and sural nerve formation may affect CSA measurements. The establishment of accurate CSA reference values requires consideration of anatomical variations in the peripheral nerves of the lower extremity.

Popliteal cyst is a common condition of popliteal region and usually coexists with intra-articular pathologies. Typically it is an extension of the natural gastrocnemius-semimembranosus bursa caused by one-way joint fluid leakage to the bursa through existing valvular mechanism. If symptomatic, the popliteal cyst should be treated surgically. The most effective treatment involves correction of intra-articular pathologies, elimination of the valvular mechanism, and excision of cystic walls. In this chapter we present an arthroscopic technique of typical popliteal cyst treatment addressing each step of pathophysiological pathway of cyst formation.

Purpose Although the plantaris muscle is vestigial in humans, it is far too important to remain omitted. The aim of this study is to provide a comprehensive review of the existing literature focused on plantaris muscle clinical value, grafting usefulness and its morphological variations. Hopefully this study will be of great use for every medical practitioner due to its clarity and conciseness despite such broaden scope of this article. Material and Methods The article is written based on 100 studies published since 1868 until 2020. During careful selection process 12 papers were dismissed due to their insufficient sample size, wrong methods used or results that were previously discovered. Results Many aspects concerning the plantaris muscle are already well examined, summarized and described. However this study has shown how much we still do not know and which fields require further investigations. Conclusion The anatomical variations of plantaris muscle morphology may cause mid-portion Achilles tendinopathy, tennis leg syndrome or increase the risk of failure while harvesting the tendons.

The treatment of popliteal artery (PA) disease with stenting or stent-grafting procedures has renewed the interest in the definition of its anatomic features at rest and, more compelling and intriguing, during knee movements, as the popliteal region is a very dynamic anatomic segment [1]. The main problem related to endovascular devices applied to PA is represented by the close relationship with the knee joint [2–4]. PA is susceptible to simultaneous forces of flexion, extension, and rotation [5]. Ageing and atherosclerosis cause elongation and loss of elasticity of PA, which may consequently kink upon flexion of the knee [6, 7].

Marjolin’s ulcers are the result of malignant transformation of chronically inflamed skin or damaged skin into squamous cell carcinoma. As the most common etiologies that arise from such a transformation, it is usually a burn scar. Our study focuses on the case of a female patient admitted to our hospital with giant Marjolin's ulcer of around 20x12 cm in the popliteal fossa. Wide excision followed by free flap reconstruction was proposed. The uniqueness of the case consisted in (i) the latency period of over 42 years, (ii) the lack of metastasis and (iii) the functionality issue as a result of the affected area.

We report a case of a symptomatic tensor fasciae suralis (TFS) muscle in an elite jumper, with a very rare tear in its origin. The TFS muscle must be recognized and differentiated from other pathologic entities in the popliteal region. The magnetic resonance imaging (MRI) and ultrasound (US) can reliably identify this variant and its pathology.

Background: In a previous study of 1,081 limbs affected with varicose recurrence (VR) at the saphenofemoral junction (SFJ) and at the sapheno-popliteal junction (SPJ), the anatomical causes were investigated. VR appeared to be due to inadequate diagnosis and surgery; neoangiogenesis appeared to play a minimal role. The so-called cavernoma was secondary to reflux and consisted with a complex collateral circulation (CC). Only 52 of 1,081 (4.8%) studied limbs developed a VR at the SPJ, but the anatomical findings were poorly described. The aims of this study were: 1) to distinguish between VR at the SPJ and the ones caused by different sources of reflux, 2) the reliability of the preoperative DUS examination, and 3) the efficacy and safety of the treatment. Methods: DUS examinations, surgery and sclerotherapy were performed by one single group of physicians. Nineteen of 207 (9.1%) limbs affected with VR at the popliteal region were studied and treated. Most of the previous interventions performed in different vascular units (only one in our center) were high or low interruption +/- stripping of the small saphenous vein (17/19, 89.4%). VRs > 3 mm were treated by surgical high ligation and intraoperative sclerotherapy in 13/19 (68.4%) and short invagination stripping in 1/19 (5.2%); 4/19 (21.0%) with VR 3 mm) at the PR. Sclerotherapy gave satisfactory results in the treatment of the smallest VR (< 3 mm). J Curr Surg. 2017;7(3):27-34 doi: https://doi.org/10.14740/jcs325w

BACKGROUND: 3D printing is becoming more popular across many industries. The first step to safely introducing 3D printed sockets in to prosthetics is to conduct strength testing on these sockets. PURPOSE: This study tests how changing the infill percentage (the percentage of material between the internal and external socket wall) affects the strength of 3D-printed transtibial sockets. METHODS: A Fused Deposition Modelling (FDM) printer was used to print a total of nine transtibial (TT) sockets (three sockets at 30% infill, three sockets at 40% infill, and three sockets at 50%) using polylactic acid (PLA). A strength-testing apparatus measured, in Newtons (N), the maximum load the 3D-printed transtibial sockets could withstand at initial contact of the gait cycle. RESULTS: Based on the specific criteria outlined in this research project, all nine sockets exceeded the 4480N threshold set by ISO Standard 10328. Eight out of nine sockets failed at approximately double the force required with one socket (socket #2) failing at 5360N. Seven out of nine sockets failed at the medial popliteal region and two out of nine sockets failed at lateral mid socket region. Differences in infill percentage from 30%, 40%, 50% did not appear to influence strength of sockets. CONCLUSION: Strength of 3D-printed TT sockets needs rigorous testing to be deemed safe for patient use. More definitive research and a higher number of samples are required to investigate how a larger range of infill percentage can affect strength. Until all the requirements of ISO Standard 10328 are satisfied, the safety of using 3D-printed TT sockets in clinical practice are uncertain. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30843/23262 LAYMAN’S ABSTRACT 3D printing is beginning to be used in prosthetics because it has the potential to be less expensive and more customizable to individual needs and styles. Unfortunately, there are companies using this technology to print prosthetic sockets for people without the proper education and training. Before people can start using this new technology safely, testing needs to be done to determine the strength of these 3D printed prosthetic sockets. Our project investigates how strong a 3D printed prosthetic socket is for an amputee below the knee. This is challenging because the entire weight will be put through the socket and it needs to be strong enough that it will not break. There is an international standard that gives instructions and information on testing the strength of a prosthetic socket. Our project will follow a part of these instructions and see how much weight can be put through a socket before it breaks. Our project printed nine identical prosthetic sockets, but the infill percentage of each socket was different. The infill percentage is the amount of material between the walls of an object. We put each socket in a machine and applied a compressive force until it broke and measured that force. Our tests showed the infill percentage did not change the strength of the sockets. They all passed the force measurement given by the international standard. Because our project only tested a part of the standard, there are many more tests that need to be done before the public can start using 3D-printed prosthetic sockets safely. How to Cite: Campbell L, Lau A, Pousett B, Janzen E, Raschke S.U. How infill percentage affects the ultimate strength of 3D-printed transtibial sockets during initial contact. Canadian Prosthetics & Orthotics Journal, Volume 1, Issue 2, No 2, 2018. https://doi.org/10.33137/cpoj.v1i2.30843

OBJECTIVES It is possible to observe the in-vivo movements of nerves using real-time ultrasound. In this study, we aimed to visualize the movements of the sciatic nerve as a guide to identify the sciatic nerve to distinguish from surrounding tissue. METHODS This trial was a prospective, cross-over comparative study. We included 25 healthy volunteers in this study. The movements of the sciatic nerve were visualized in the transverse view at popliteal and midthigh levels using ultrasonography. Anterior-posterior movements were assessed by measuring skin-to-nerve distance. The distances were measured during maximum ankle dorsiflexion, maximum plantar flexion and neutral position and compared with each other. We also evaluated the quality of dynamic (real-time) rotation/lateral movements of the sciatic nerve by assigning a subjective observer score. RESULTS The movement of sciatic nerve was significant at popliteal region with active and passive ankle dorsiflexion which was 0.32 cm and 0.23 cm respectively (p=0.003). The movement of sciatic nerve was significant at midthigh region with active and passive ankle plantar flexion which was 0.11 cm and 0.01 cm respectively (p

We present a case of Kaposi’s sarcoma-related immune reconstitution inflammatory syndrome in an HIV-infected patient who developed fever, worsening pulmonary infiltrates with respiratory distress, and progression of skin tumors at the popliteal region and thigh that resulted in limitation on movement of the right knee joint at 3.5 months following a significant increase of CD4 count after combination antiretroviral therapy.

Background Popliteal venous aneurysms are an uncommon clinical entity although they have been the subject of a number of published clinical cases. Herein we have conducted an updated review of reports of these aneurysms while also describing our own experience with 4 such cases over the last 10 years. Methods A systematic search was conducted on MEDLINE and Embase concerning popliteal venous aneurysms. We collected all information mentioned associated with their clinical morphology, diagnosis, treatment, and follow-up. The patients included consisted of all those from the literature reports for whom the presence of an aneurysm in the popliteal region was described, plus the 4 cases in our own series. Results The most significant contribution was made by Sessa et al. in 2000, who recommended that this disorder be actively searched for in conventional echo-Doppler studies and, once detected, surgical repair should be undertaken by tangential aneurysmectomy with lateral venorrhaphy to prevent repeat pulmonary embolisms. In conjunction with their series, we reviewed other publications over the last 10 years to determine whether these recommendations have undergone any changes based on the new findings. We found 91 cases in addition to the 117 cases described by Sessa and colleagues as well as the 4 contributed by our group. Most of these cases do not present any specific symptomatology and are discovered by chance via echo Doppler. They are sometimes detected as a palpable mass in the popliteal fossa, with a tendency toward growth, venous thrombosis, and repeat pulmonary embolisms. Phlebography is usually left to preoperative study, and NMR and CAT are rarely used. The objective of surgical treatment is to eliminate the aneurysm while maintaining venous drainage to the limb, with the technique employed most often being tangential aneurysmectomy with lateral venorrhaphy. There are very few postoperative complications and relapses are rare. Conclusions The most recent publications confirm the recommendations made by Sessa et al. more than 10 years ago. Thus, no further changes should be made to the current approach to treatment of venous aneurysms.

Sindrom kompresije poplitealne arterije (PAES, od eng. popliteal artery entrapment syndrome) prilično se rijetko pojavljuje kod opće populacije, no treba ga uvijek uzeti u obzir kod sportaša koji se žale na bolne simptome u području potkoljenica nakon tjelesne aktivnosti. Kompresija poplitealne arterije moguća je u zakoljenom području zbog urođene deformacije ili anatomskih varijacija u građi mišića ili vezivnog tkiva ili može biti funkcionalna. Dostupno je nekoliko mogućnosti liječenja s ciljem da se poplitealna arterija oslobodi od kompresije i očuva poplitealni arterijski tok. Uz prikaz karakteristika sindroma kompresije poplitealne arterije, cilj ovoga rada je pregled i sistematičan prikaz dostupnih objavljenih radova koji prikazuju slučajeve ovoga sindroma kod sportaša. Popliteal artery entrapment syndrome occurs rather rarely in the general population, but it should always be taken into consideration when an athlete complains of pain in the lower leg after physical activity. Popliteal artery can be compressed in the popliteal region due to congenital deformation or anatomical variations of muscles or fibrous tissue or it can be functional. Several treatment possibilities are available with the aim to decompress the popliteal artery and preserve the blood flow. Alongside describing the characteristics of the popliteal artery entrapment syndrome, the aim of this thesis was to review and systematically present the available published case reports describing cases of popliteal artery entrapment syndrome in athletes.

Wegener granulomatosis (WG) is a kind of vasculitis that affects small and medium-sized arteries. Necrotizing granulomatous vasculitis of the upper and lower respiratory tracts and necrotizing glomerulonephritis of the kidneys are present. WG affects mainly Caucasian individuals between 15–75 years old, with a mean age of onset of 41 years. It affects both males and females equally. Kidney involvement is not present in the limited form of WG. Peripheral nerve blocks are good alternatives when general anaesthesia is risky. Popliteal block is blockade of the sciatic nerve at the popliteal region. Popliteal block is a kind of peripheral block for surgeries below the knee level. In this article, we report on the anaesthesia management of a 61-year-old limited-form WG patient for whom general anaesthesia was risky because of lung involvement.

Real-time ultrasonography was performed on both legs of 104 patients with suspected deep-vein thrombosis of the legs. The results were compared with those of phlebography (146 one-extremity phlebograms) independently performed. During the first part of the study (69 individual phlebograms) only the upper leg and popliteal region were assessed: absent compressibility of the vessel lumen was the only criterion of thrombosis. In the second part (77 phlebograms) the lower leg was also investigated: non-compressible, echo-poor vessels were typical of thrombosis. Phlebography demonstrated 21 thromboses of the common femoral vein, 36 of the superficial femoral vein, and 41 of the popliteal vein. The 77 phlebograms in the second part demonstrated 29 thromboses of the deep veins of the lower leg. Sonography had a sensitivity of 100% and a specificity of 99% for the region of the common femoral vein, 95% and 99%, respectively, for the superficial femoral vein, 95% and 99% for the popliteal vein and 89% and 100% for the deep veins of the lower leg. Real-time ultrasonography of the deep-vein system of the leg is thus of great diagnostic value both for the upper and the lower leg and is very useful as the initial physical method of examination if thrombosis is suspected.

In the diagnosis of deep vein thrombosis compression B-mode sonography and colour coded Duplex-sonography both are reported to give excellent results in sensitivity and specificity in comparison to phlebography. Therefore value and cost effectiveness of colour coded Duplex-sonography versus compression B-mode sonography are questionable. In our examinations with colour coded Duplex-scanning done one 116 patients in comparison to phlebography we achieved corresponding results to the values of present publications (sensitivity in the leg was 100%, in the calf 89%; specificity in the leg was 94%, in the calf 91%). In earlier examinations with compression B-mode sonography done on 64 patients we were less successful in gaining these results in comparison to phlebography: sensitivity was 76% and specificity was 88% in the iliaco-, femoro-, popliteal region. We discuss the limitations of the compression test in our experiences and point out the advantages of colour coding under special situations.

The objectives of the current study were to compare intra-socket pressure differences between comfortable and uncomfortable socket conditions, and the usefulness of subject perception of satisfaction, activity limitations, and socket comfort in distinguishing between these two socket conditions. Five unilateral trans-tibial amputees took part in the study. They answered the Socket Comfort Score (SCS) and Trinity Amputation and Prosthetic Experience Scale (TAPES) questionnaires before the interface pressure (in standing and walking) was measured for the uncomfortable socket condition at five regions of the residual limb. Participants were then provided with a comfortable socket and wore it for two weeks. Participants who were satisfied with the socket fit after two weeks repeated the SCS and TAPES questionnaires and interface pressure measurements. The differences between the test results of the two conditions were not statistically significant, except for the interface pressure at the popliteal region during the early stance phase, TAPES socket fit subscale, and the SCS. Due to large variability of the data and the lack of statistical significance, no firm conclusion can be made on the possible relationship between the interface pressure values and the patient-reported outcomes of the two socket conditions. A larger sample size and longer acclimation period are required to locate significant differences.

El objetivo fue determinar en profundidad la localizacion anatomica de las estructuras neurovasculares importantes para el bloqueo del nervio popliteo. Se utilizaron cuarenta muestras de 22 cadaveres coreanos adultos frescos. El angulo medio y la profundidad del sitio de bifurcacion del nervio ciatico (BC) fue 18,7±3,6° y 20,6±7,1 mm, respectivamente. El punto en el que se identifica la ramificacion del nervio para los musculos del compartimento posterior de la pierna se expreso en porcentaje de distancia relativa a la distancia vertical desde el pliegue popliteo a BC. La distancia relativa de los nervios cutaneos sural medial y lateral fue 129,0% y 116,4%, respectivamente; de las cabezas medial y lateral del musculo gastrognemio fue 137,2% y 141,9%, del musculo soleo fue 179,5%, y del compartimento profundo de la pierna fue 167,0%. Nuestros resultados proporcionan informacion anatomica detallada para guiar en forma optima el bloqueo del nervio.

Synovial sarcomas are malignant soft tissue tumors that carry a metastatic potential and portend poor prognoses. We report a very rare synovial sarcoma arising from the tibial nerve and describe its successful treatment including limb preservation. To the best of our knowledge, this is the 40th reported incident of intraneural synovial sarcoma, and only the fourth arising from the tibial nerve. Extensive resection of synovial sarcoma arising in the popliteal region is difficult, particularly when limb preservation is desired. Ours is the first reported patient treated for tibial nerve-derived synovial sarcoma whose limbs were preserved.

Pseudoaneurysm formation is a rare but recognized complication of total knee arthroplasty (TKR), with fewer than 20 cases described in the literature. Multiple management techniques have been described for such pseudoaneurysms. As thrombin injection is an established technique, we report a case of a post-TKR tibioperoneal pseudoaneurysm successfully occluded via percutaneous injection of a dual thrombin-collagen preparation.

La arteria poplitea se encuentra en la fosa del mismo nombre y es un punto de referencia importante en los procedimientos quirurgicos. Las lesiones de este vaso y sus ramas pueden ser peligrosas, bloqueando la circulacion a la extremidad inferior pudiendo llevar a gangrena o incluso a la insuficiencia vascular. El objetivo de este trabajo fue describir la anatomia de la arteria poplitea y el nivel de su primera bifurcacion en tronco tibiofibular y arteria tibial anterior, y ademas el nivel de bifurcacion del tronco en arterias tibial posterior y fibular (segunda bifurcacion), en relacion a la cabeza de la fibula. Para ello se realizo diseccion en 38 miembros inferiores. El intervalo de confianza para la media de la primera bifurcacion fue de 2,82 cm a 3,18 cm de la cabeza de la fibula y la de la segunda bifurcacion fue de 5,72 cm a 6,68 cm. La bifurcacion de la arteria poplitea en la arteria tibial anterior y el tronco tibiofibular mostro un posicionamiento mas constante que la altura de la bifurcion de la arteria tibial posterior y la arteria fibular. Estos datos pueden ayudar en el desarrollo de nuevas vias de acceso a estas arterias, o la optimizacion de la planificacion quirurgica de la region.

The popliteal artery is located deep inside the popliteal fossa, and is an important landmark in surgical procedures. Lesions of this vessel and its branches can be dangerous, blocking circulation to the lower limb and leading to gangrene or even vascular failure. The aim of this work was to describe the biometric characteristics of the bifurcations of the popliteal artery and the tibiofibular trunk in relation to the head of the fibula in 38 lower limbs through dissection. The bifurcation of the both arteries was present in all the cases. The mean confidence interval for the bifurcation of the popliteal artery was from 2.82 cm to 3.18 cm from the head of the fibula, and that of the bifurcation of the tibiofibular trunk was from 5.72 cm to 6.68 cm. The bifurcation of the popliteal artery into the anterior tibial artery and tibiofibular trunk showed a more constant positioning than the level of the birfurcation of the posterior tibial artery and fibular artery. These data can help in the development of new access routes to these arteries, or the optimization of surgical planning in the region in question. La arteria poplítea se encuentra en la fosa del mismo nombre y es un punto de referencia importante en los procedimientos quirúrgicos. Las lesiones de este vaso y sus ramas pueden ser peligrosas, bloqueando la circulación a la extremidad inferior pudiendo llevar a gangrena o incluso a la insuficiencia vascular. El objetivo de este trabajo fue describir la anatomía de la arteria poplítea y el nivel de su primera bifurcación en tronco tibiofibular y arteria tibial anterior, y además el nivel de bifurcación del tronco en arterias tibial posterior y fibular (segunda bifurcación), en relación a la cabeza de la fíbula. Para ello se realizó disección en 38 miembros inferiores. El intervalo de confianza para la media de la primera bifurcación fue de 2,82 cm a 3,18 cm de la cabeza de la fíbula y la de la segunda bifurcación fue de 5,72 cm a 6,68 cm. La bifurcación de la arteria poplítea en la arteria tibial anterior y el tronco tibiofibular mostró un posicionamiento más constante que la altura de la bifurción de la arteria tibial posterior y la arteria fibular. Estos datos pueden ayudar en el desarrollo de nuevas vías de acceso a estas arterias, o la optimización de la planificación quirúrgica de la región.

Light affects the circadian axis in at least two ways. It can cause the acute suppression of pineal melatonin synthesis, and/or a phase-shift of the circadian oscillator. As recent evidence has suggested that extraocular light exposure may cause phase-shifts of the circadian clock, we have investigated whether suppression of melatonin can be induced by the same type of light exposure. In the first study subjects' eyes were exposed to white light (2250 lux for 30 mins) via a fibre optic cable. As expected, suppression of nighttime plasma melatonin levels (61 +/- 6%) was observed. In the second study, light of the same quality but higher intensity (14,000 or 67,500 lux for 180 mins) was delivered in the same manner to the popliteal region behind the subjects' knees, whilst shielding their eyes. No suppression of plasma melatonin levels (4 +/- 7%) was detected in any of the subjects. Thus, extraocular photoreception, if it exists in mammals, does not affect the suprachiasmatic nucleipineal pathway.

A cutaneo-subcutaneous flap based on the lateral superior genicular artery was anatomically investigated and applied in three clinical cases. Consistent anatomy, a long vascular pedicle, fairly easy dissection, primary donor closure, and minimal donor-site morbidity are the most important advantages when a medium-sized flap is needed. The flap may be used as a thin, delicate, free cutaneous-subcutaneous transfer for reconstruction of skin defects. It may also be applied as an axial flap to cover defects of the popliteal region.

The fabella is a sesamoid bone located in the proximal tendon of the gastrocnemius muscle. In rare cases, its presence may lead to a variety of clinical problems, including fabella syndrome and common fibular (CF) nerve palsy. The purpose of this study was to analyze the morphology of the fabella and CF nerve and discuss the influence of any existing fabellae on the size of the CF nerve. The morphology of the fabella and CF nerve in the popliteal region of the lateral head of the gastrocnemius muscle was investigated in 102 knees of 51 Japanese cadavers. The maximum circumference of the thigh, knee, and calf and the frequency, position, and size of the fabella were measured. In addition, the CF nerve width and thickness were measured proximal to the fabellar region and again as the CF nerve passed posterior, lateral, or medial to the region. A fabella was observed in 70 knees (68.6%). The CF nerve adjacent to the fabella was significantly wider and thinner than in the region proximal to the fabella (P < 0.001). In cases in which a bony fabella was present, there was a significant relationship between the thickness of the CF nerve and the circumference of the thigh and knee. The following factors were observed to contribute to the presence of a fabella causing alterations in the size of the CF nerve: a bony fabella, a CF nerve path posterior or lateral to the fabella, and subjects with a thin physique and bony fabella.

We present a case of angiomyomatous hamartoma (AMH) in the popliteal region of a patient with Klippel-Trenaunay syndrome. A 14-year-old boy with a right popliteal mass and recurrent edema of the right leg was admitted to a local hospital where a diagnosis of Klippel-Trenaunay syndrome was made. Three lymph nodes in the right popliteal fossa were removed. Histopathologic examination showed angiomyomatous hamartomas. Postoperatively, the patient was followed for 6 years. He had occasional mild edema of the right leg, but no signs of inflammation or recurrence of the angiomyomas. Our case is the first reported case of angiomyomatous hamartoma in a patient with Klippel-Trenaunay (KT) syndrome.

OBJECTIVE: A review of Harvey Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early work using nerve xenografts to repair peripheral nerve injuries. METHODS: The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. A single case in which Cushing used a xenograft to repair a peripheral nerve defect was selected for further study. RESULTS: In August 1902, a 23-year-old woman presented with tingling and numbness in her left foot and focal tenderness in the popliteal region. Cushing performed an exploratory operation, revealing an encapsulated tumor originating from the internal popliteal nerve. After resecting the segment of involved nerve, Cushing harvested the spinal cord from a rabbit and used it to span the 18-cm defect. At a 5-month postoperative follow-up, according to Cushing's clinical notes, the patient had partially regained some sensation in her leg and foot. Seven months later, the patient presented with a local tumor recurrence, and her leg was amputated. An examination of the amputated specimen demonstrated that the xenograft was still intact without gross evidence of xenograft rejection. CONCLUSION: Despite its questionable functional success, we report a previously unpublished operative case by Harvey Cushing in which a rabbit spinal cord was transplanted into a human to bridge a sciatic nerve gap. This sheds light on the potential for animal tissue as a source for the treatment of neurological disease in humans.

Pressure ulcer is defined as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli and posterior heels. Herein, we present a case of grade III pressure ulcer seen in popliteal region which is an unusual localisation that is rarely seen in the literature. An awareness of this unusual localisation of pressure ulcer is necessary to prevent decrease in quality of life, particularly in the wheelchair-dependent population.

62歳女性の右足底に生じたtumor thickness 1 mmの悪性黒色腫の1例を経験した。術前に行ったlymphoscintigraphyでは右鼠径と膝窩にsentinel nodeが存在すると考えられた。術中blue dyeを用いてsentinel node biopsyを行ったところ,右鼠径と膝窩にそれぞれ1個のsentinel nodeを認めた。これらには組織学的に転移は認められなかった。原発腫瘍が下腿以下にある場合sentinel nodeは膝窩にも存在することもあり,術前にlymphoscintigraphyを行いsentinel nodeの位置を確認する必要があると思われた。

Background: In magnetic resonance imaging (MRI) of the knee joint, when imaging the knee in a flexed position using the chemical-shift-selective (CHESS) method, lingering fat signals in the popliteal region are sometimes seen. Purpose: To investigate whether a pad filled with rice (rice pad) placed in the popliteal space is effective in eliminating the lingering fat signals in MR images of the flexed knee, based on the hypothesis that the use of a rice pad would improve the fat suppression effect. Material and Methods: Subjects were 10 healthy volunteers (five males, five females; age, 20–45 years) from whom images were taken using CHESS. Images were obtained with: 1) the knee extended and nothing placed underneath; 2) the knee bent with a sponge placed underneath; and 3) the knee bent with a rice pad placed underneath. The effectiveness of suppressing fat signals was visually assessed by one radiologist and one radiological technologist. Results: The fat suppression effect in images obtained with the knee extended was good. In contrast, the images made with a sponge under the knee had conspicuous lingering fat signals for nearly all subjects. In the images made with a rice pad under the knee, a uniformly good fat signal suppression effect was seen in all patients, and the assessment score was far higher than that with the sponge pillow ( P Conclusion: Lingering fat signals were suppressed with the use of a rice pad, and fat-suppressed images of the knee joint using CHESS were found to be improved.

Primary cutaneous osteosarcoma is extremely rare. An extraskeletal osteosarcoma of the skin occurring in the popliteal region of a 51-year-old woman is described. There were no associated predisposing conditions.

AKTAN IKIZ, Z. ASLI/0000-0001-8949-1691; Ucerler, Hulya/0000-0002-8261-9442 WOS: 000271963400007 PubMed: 19418007 The aim of this study was to demonstrate some anatomic variations of popliteal artery and its surrounding structures that may be important especially for popliteal artery entrapment (PAE) syndrome. A cadaveric study in 46 lower limbs was performed to improve the understanding of anatomy of the popliteal artery and its relations with surrounding structures. The popliteal artery was lateral to the popliteal vein in four specimens (8.7%) and deep to popliteal vein in three specimens (6.5%). An aberrant accessory head of gastrocnemius was present in three specimens (6.5%). The popliteal artery and vein were tethered at the adductor magnus hiatus very tightly in one specimen (2.2%). An aberrant medial arterial course around normal medial head of gastrocnemius muscle was seen in one specimen (2.2%). Various anomalous anatomic relationships between muscle and arteries in the popliteal fossa results in arterial compression. We believe that a review of the anatomic variations of the popliteal artery and its surrounding structures will be beneficial for the surgical approaches in PAE.

Background: The sural nerve is the nerve most commonly used for peripheral nerve reconstruction. According to requirements for nerve graft length, it is dissected from the retromalleolar up to the popliteal region, where the main root of the sural nerve fibers, the medial sural cutaneous nerve, arises from the tibial nerve. It has been recommended to complete sural nerve harvesting below this area, to avoid damage to the tibial nerve. The aim of this study was to determine whether sural nerve fibers can be isolated from tibial and, more proximal, sciatic nerve fibers to gain more sural nerve graft length. Methods: The sural nerve was dissected in 30 lower limbs. Anatomical characteristics such as the existence of a union forming the sural nerve, identification of the main root of sural nerve fibers, and the site of origin of the branch(es) forming the sural nerve were noted. Careful nerve preparation in the region of the sural nerve and its main root origin was conducted. Results: In 18 specimens (60 percent), the authors found the classic formation of the sural nerve: the union of the medial sural cutaneous nerve and the peroneal communicating branch. The medial sural cutaneous nerve was the main root of sural nerve fibers in 28 of 30 cases (93 percent) and originated from the tibial nerve. Careful nerve preparation and epineurolysis beyond its anatomical origin allowed isolation and gain of sural nerve graft length of a median of 14 cm. Conclusion: In the authors' opinion, this is a feasible method of increasing the quantitative and qualitative outcome of sural nerve harvesting when greater length of sural nerve donor graft is needed for adequate nerve reconstruction.

PubMedID: 9727927 An alternative free flap technique in a patient presenting with an incomplete amputation in the right cubital region, resulting from a gunshot wound, is introduced. The defect area was repaired using a flow-through fasciocutaneous free flap, which, when following a cubical or popliteal region amputation, is a suitable option for revascularisation and salvage of the extremity.

Nodular fascitis is a benign fibroblastic tumour characterized by rapid growth and most of the time requires its differentiation from other tumorous lesions. Here is a case of 45 year old male who presented with a soft tissue swelling in the popliteal region. On FNAC, a differential diagnosis of proliferative myositis and proliferative fasciitis was given. Histopathological examination gave a diagnosis of nodular fascitis. Hence cytology helps to give a definite diagnosis and aid in the surgical management of soft tissue tumors.

The endogenous clock of humans can be influenced by light application to the popliteal region. Previously, it had been assumed that light must fall directly into the eye in order to influence the inner circadian clock. This study, published in 1998, has not been reproduced. We investigated the effects of laser light illumination (785 nm for 5 min) on cerebral near infrared spectroscopy (NIRS) in 33 volunteers. There were significant (p < 0.001) delayed (2 min) alterations in NIRS parameters during popliteal light illumination. This could be further evidence for extraocular phototransduction in humans. [Neurol Res 2001; 23: 807-809]