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Objective: The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large‐scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures. Methods: We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t‐tests for difference statistics, and utilized the least squares method for regression analysis. Results: Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°. Conclusion: Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients. [ABSTRACT FROM AUTHOR]

Information on optimal techniques and outcomes following secondary reduction mammaplasty remains sparse, with only 280 patient cases reported in the literature to date. A total of 7179 medical charts of patients who underwent nononcological breast reduction at the Cleveland Clinic Health System from January 2001 to October 2023 were screened to identify whether the procedure was a secondary reduction. Patient charts were then reviewed to extract demographic, surgical, and outcome data. Patients were also contacted through the electronic medical record to fill out the BREAST-Q V2 questionnaire about postoperative satisfaction. Surgical techniques and satisfaction were compared for patients with complications versus those without. One hundred and twenty-two (1.7%) patients underwent secondary breast reduction. An inferior pedicle was the most used for both primary (n = 59, 48.4%) and secondary (n = 64, 52.5%) surgeries. The primary pedicle was recreated in 62 of the 84 (73.8%) rereductions where a primary pedicle was known. A total of 15 patients (12.3%) completed the BREAST-Q questionnaire. Body mass index was significantly and negatively associated with satisfaction with outcome (R=−0.66, p = 0.01), sexual well-being (R=−0.58, p = 0.04), and physical well-being (R=−0.69, p = 0.006). No patients experienced nipple-areola complex (NAC) necrosis following secondary reduction. However, 21 (17.2%) of patients experienced complications or breast fat necrosis following rereduction. Unmatched secondary pedicles showed a trend toward higher complication rates than matched secondary pedicles (31.3% vs. 12.9%, p = 0.051). When known, the primary pedicle can be safely used for secondary reduction mammaplasty with minimal risk of NAC necrosis or complication. [Display omitted] [ABSTRACT FROM AUTHOR]

Photoreceptors in the mammalian retina convert light signals into electrical and molecular signals through phototransduction and transfer the visual inputs to second-order neurons via specialized ribbon synapses. Two kinds of photoreceptors, rods and cones, possess distinct morphology and function. Currently, we have limited knowledge about rod versus (vs.) cone synapse development and the associated genes. The transcription factor neural retina leucine zipper (NRL) determines the rod vs. cone photoreceptor cell fate and is critical for rod differentiation. Nrl knockout mice fail to form rods, generating all cone or S-cone-like (SCL) photoreceptors in the retina, whereas ectopic expression of Nrl using a cone-rod homeobox (Crx) promoter (CrxpNrl) forms all rods. Here, we examined rod and cone pre-synapse development, including axonal elongation, terminal shaping, and synaptic lamination in the outer plexiform layer (OPL) in the presence or absence of Nrl. We show that NRL loss and knockdown result in delayed OPL maturation and plasticity with aberrant dendrites of bipolar neurons. The integrated analyses of the transcriptome in developing rods and SCLs with NRL CUT&RUN and synaptic gene ontology analyses identified G protein subunit beta (Gnb) 1 and p21 (RAC1) activated kinase 5 (Pak5 or Pak7) transcripts were upregulated in developing rods and down-regulated in developing SCLs. Notably, Gnb1 and Gnb5 are rod dominant, and Gnb3 is enriched in cones. NRL binds to the genes of Gnb1, Gnb3, and Gnb5. NRL also regulates pre-synapse ribbon genes, and their expression is altered in rods and SCLs. Our study of histological and gene analyses provides new insights into the morphogenesis of photoreceptor pre-synapse development and regulation of associated genes in the developing retina. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) in the caudate lobe presents surgical challenges due to the lack of distinct anatomical landmarks. This case report introduces a novel surgical approach combining Takasaki's classification and indocyanine green negative counterstaining for precise anatomical caudate lobectomy. A 78-year-old patient with hepatocellular carcinoma in the caudate lobe underwent surgery following preoperative volumetric assessment. The method involved a glissonian approach for both left and right pedicles, coupled with meticulous dissection of hepatic pedicles of the caudate lobe guided by taping of left and right glissonian pedicles, followed by indocyanine green administration for improved visualization of caudate lobe boundaries. The procedure enabled complete tumor resection with minimal blood loss. At 50 months postsurgery, the patient maintains favorable liver function and performance status. This innovative approach offers a promising solution for precise resection of caudate lobe hepatocellular carcinoma, potentially improving surgical outcomes and long-term prognosis. [ABSTRACT FROM AUTHOR]

Tessier number 10 cleft is one of the rarest facial clefts. Surgical treatment of this type of cleft is challenging due to the complexity of periorbital and temporal soft tissue deformities. A 23-year-old male patient presented with typical facial deformities of Tessier number 10 cleft. The surgical procedure involved using a free anterolateral thigh flap to reconstruct the eye socket, while the superficial temporal artery pedicle scalp flap was used to reconstruct the eyebrow deformity. The patient had no complications and 16 months after surgery, the patient had good aesthetic results. A hair-bearing scalp flap with a pedicle of the frontal branch of the superficial temporal artery combined with an anterolateral thigh-free flap can effectively resolve most soft tissue deformities of Tessier number 10 cleft and reconstruct the orbital socket in a single surgery. At the same time, it augments the soft tissue of the frontotemporal area and provides good aesthetic results. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the feasibility of endoscopic inspection of thoracolumbar and lumbar pedicle tracts in a canine largebreed model and its accuracy for the detection of breached versus nonbreached tracts. ANIMALS: 2 greyhound cadavers. METHODS: CT scans of 2 greyhound cadavers from the sixth thoracic vertebra to the sacrum were obtained. Fifty-six pedicles were randomized to have drill tracts with different modified Zdichavsky grades (nonbreached, partial/full medial breach, or partial/full lateral breach) using 3-D-printed guides. Endoscopy was performed on a single occasion from October 9 to 10, 2023, using a 1.9-mm 0-degree needle arthroscope in a randomized blinded fashion. The grading of drill tracts was performed on postoperative CT. Specificity, sensitivity, positive and negative predictive values, and time to assign endoscopic grade were investigated. RESULTS: Postoperative CT confirmed 43 nonbreached tracts, 7 medial breaches (partial/full), and 5 lateral breaches (partial/full). One tract was excluded because of guide misplacement. Intraosseous endoscopy was successfully performed in the remaining 55 drill tracts. Sensitivity to detect medial and lateral breaches was 71.4% and 60.0%. Negative predictive value was 93.1%. Specificity was 94.2%. Positive predictive value for detection of medial and lateral breaches was 83.3% and 54.5%. Median (range) time to assign an endoscopic grade was 118 (30 to 486) seconds. [ABSTRACT FROM AUTHOR]

The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty. A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared. Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05). Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles. [ABSTRACT FROM AUTHOR]

Objective The C4 is the transition point between the upper and lower cervical vertebrae and plays a pivotal role in the middle of the cervical spine. Currently, there are limited reports on large‐scale sample studies regarding C4 anatomy in children, and a scarcity of experience exists in pediatric cervical spine surgery. The current study addresses the dearth of anatomical measurements of the C4 vertebral arch and lateral mass in a substantial sample of children. This study aims to measure the imaging anatomy of the C4 vertebral arch and lateral mass in children under 14 years of age across various age groups, investigate the growth and development of these structures. Methods We measured 12 indicators, including the size (D1, D2, D3, D4, D5, D6, D7, and D8) and angle (A, C, D, and E) of the C4 vertebral arch and lateral mass, in 513 children who underwent cervical CT examinations at our hospital. We employed the aggregate function for statistical analysis, conducted t‐tests for difference statistics, and utilized the least squares method for regression analysis. Results Overall, as age increased, there was a gradual increase in the size of the vertebral arch and lateral mass. Additionally, the medial inclination angle of the vertebral arch decreased, and the lateral mass flattened gradually. The rate of change decreased gradually with age. The mean value of D1 increased from 2.31 mm to 3.88 mm, of D2 from 16.75 mm to 29.2 mm, of D3 from 2.21 mm to 4.92 mm, and of D4 from 7.34 mm to 11.84 mm. Meanwhile, the mean value of D5 increased from 5.2 mm to 9.71 mm, of D6 from 10.19 mm to 16.16 mm, of D7 from 2.53 mm to 5.67 mm, and of D8 from 6.11 mm to 11.45 mm. Angle A ranged from 49.12° to 54.97°, angle C from 15.28° to 19.83°, angle D from 39.91° to 53.7°, and angle E from 18.63° to 28.08°. Conclusion Prior to cervical spine surgery in children, meticulous CT imaging anatomical measurements is essential. The imaging data serves as a reference for posterior C4 internal fixation, aids in designing posterior cervical screws for pediatric patients, and offer morphological anatomical references for posterior cervical spine surgery and screw design in pediatric patients.

Purpose: To determine if C2 pedicle versus pars screw type predicts change in fusion status, C2 screw loosening, cervical alignment, and patient-reported outcomes measures (PROMs) after C2–T2 posterior cervical decompression and fusion (PDCF). Methods: All adult patients who underwent C2–T2 PCDF for myelopathy or myeloradiculopathy between 2013–2020 were retrospectively identified. Patients were dichotomized by C2 screw type into bilateral C2 pedicle and bilateral C2 pars screw groups. Preoperative and short- and long-term postoperative radiographic outcomes and PROMs were collected. Univariate and multivariate analysis compared patient factors, fusion status, radiographic measures, and PROMs across groups. Results: A total of 159 patients met the inclusion/exclusion criteria (76 bilateral pedicle screws, 83 bilateral pars screws). Patients in the C2 pars relative to C2 pedicle screw group were on average more likely to have bone morphogenic protein (p = 0.001) and four-millimeter diameter rods utilized intraoperatively (p = 0.033). There were no significant differences in total construct and C2-3 fusion rate, C2 screw loosening, or complication and revision rates between C2 screw groups in univariate and regression analysis. Changes in C2 tilt, C2–3 segmental lordosis, C0–2 Cobb angle, proximal junctional kyphosis, atlanto-dens interval, C1 lamina-occiput distance, C2 sagittal vertical axis, C2–7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 screw type. Conclusion: There were no significant differences in fusion status, hardware complications, and radiographic and clinical outcomes based on C2 screw type following C2–T2 PCDF. Accordingly, intraoperative usage criteria can be flexible based on patient vertebral artery positioning and surgeon comfort level. [ABSTRACT FROM AUTHOR]

The vertebral column (spinal column, spine, or backbone) forms the central axis of the body's skeleton. It supports the skull superiorly and participates in the formation of the pelvis inferiorly. The vertebral column comprises the following five regions in cephalocaudal sequence: cervical, thoracic, lumbar, sacral and coccygeal. The vertebral column contains the spinal cord within the vertebral canal, protecting the spinal cord from external trauma. Optimal medical and surgical management of spinal disease is crucially dependent on accurate clinical and radiological diagnosis, which in turn are reliant on a sound understanding of the structural and functional anatomy of the vertebral column. In this article a general description of the articulated vertebral column is followed by a description of the morphology of representative vertebrae from the vertebral regions. [ABSTRACT FROM AUTHOR]

Background Breast reduction has a wide selection of pedicles but often relies on the surgeon's preference and experience. Necrosis of the nipple-areola complex (NAC) is a catastrophic complication of breast reduction surgery. Objectives To solve the above problem objectively, we applied fluorescence imaging technology to the pedicle selection and design of breast reduction surgery for the first time, so that the dominant vessels of the NAC were included in the designed pedicle. Methods We retrospectively enrolled 120 patients with breast reduction (a total of 239 breasts). We compared 60 patients who underwent breast reduction without fluorescence imaging for pedicle selection (Group A) with 60 patients who underwent pedicle selection with fluorescence imaging (Group B). The NAC blood supply was monitored after the operation. Results In this study, 60 Group A cases (119 breasts) and 60 Group B cases (120 breasts) were analyzed. There were no statistically significant differences in patient demographic data or intraoperative resection weights. There were 7 cases of NAC necrosis in Group A (1 case of complete necrosis and 6 cases of partial necrosis), while no NAC necrosis occurred in Group B. There was a significant difference in the rate of NAC necrosis between the 2 groups. Conclusions Preoperative fluorescence imaging can guide the selection and design of breast reduction, significantly reducing postoperative NAC blood supply obstacles and necrosis. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

BACKGROUND: The lower cervical vertebral pedicle is the main stress site of the posterior column of the spine, which is of great significance for the maintenance of the stability of the human center of gravity and the reduction of shock. At present, there are few reports on the characteristics of the internal bone trabeculae, and the characteristics of the joint site of the vertebral pedicle with the articular process and the vertebral body. It is urgent to understand the fine anatomical structure of the vertebral pedicle and the relationship and function of each part. OBJECTIVE: To observe the microanatomical morphology of the vertebral pedicle by Micro-CT scanning of cervical vertebra specimens, and to measure and analyze the microstructure and morphometric parameters of the bone trabecula in the cervical pedicle under normal conditions to evaluate the safety performance of the cervical spine. METHODS: Micro-CT scanning was performed on 31 sets of cervical vertebrae C3-C7. By checking and reconstructing the areas of interest in the bone trabecular within the vertebral pedicle, the morphological characteristics and distribution direction of the bone trabecular within the cervical pedicle were observed, and the bone microstructure parameters were detected, and the differences in the bone microstructure of the C3-C7 vertebral pedicle were analyzed and compared. RESULTS AND CONCLUSION: (1) The Micro-CT images showed that the honeycomb bone trabeculae of the pedicle of the lower cervical spine presented a complex network of microstructures. The trabeculae near the cortical bone were lamellar and relatively compact, extending forward toward the vertebral body and backward toward the articular process lamina. Abatoid bone trabeculae extended into the medullary cavity and transformed into a network structure, and then into rod-shaped bone trabeculae. The rod-shaped bone trabeculae were sparsely distributed in the medullary cavity. (2) Statistical results of morphological parameters of bone trabeculae showed that bone volume fraction values in C4 and C5 were higher than that in C7 (P < 0.05). The bone surface/ bone volume value in C7 was higher than that in C3, C4 and C6 (P < 0.05). The bone surface density of bone trabeculae in C7 was higher than that in C3, C4, C5 and C6 (P < 0.05). Trabecular thickness in C7 was higher than that in C3, C4 and C5 (P < 0.05). Bone surface/bone volume and bone surface density of the left pedicle bone trabecular were greater than those on the right side (P < 0.05). (3) The microstructural changes of C3-C7 were summarized, in which the load capacity and stress of the C7 pedicle were poor, and the risk of injury was high in this area. [ABSTRACT FROM AUTHOR]

Synthetic bone models such as polyurethane (PU) foam are a well-established substitute to cadaveric bone for screw pull-out testing; however, little attention has been given to the effect of PU foam anisotropy on orthopaedic implant testing. Compressive and screw pull-out performance in three PU foam densities; 0.16 g/cm3 (PCF 10), 0.32 g/cm3 (PCF 20) and 0.64 g/cm3 (PCF 40) were performed in each of the X, Y or Z orientations. The maximum compressive force, stiffness in the linear region, maximum stress and modulus were determined for all compression tests. Pedicle screws were inserted and pulled out axially to determine maximum pull-out force, energy to failure and stiffness. One-way ANOVA and post hoc tests were used to compare outcome variables between PU foam densities and orientations, respectively. Compression tests demonstrated the maximum force was significantly different between all orientations for PCF 20 (X, Y and Z) while stiffness and maximum stress were different between X versus Y and X versus Z. Maximum pull-out force was significantly different between all orientations for PCF 10 foam. No significant differences were noted for other foam densities. There is potential for screw pull-out testing results to be significantly affected by orientation in lower density PU foams. It is recommended that a single, known orientation of the PU foam block be used for experimental testing. [ABSTRACT FROM AUTHOR]

Anterior transpedicular screw (ATPS) internal fixation of the lower cervical spine is an alternative for patients who cannot tolerate combined anterior and posterior surgery. The cervical vertebral anatomy varies with many factors, including age, gender, height, weight, and race. Three-dimensional (3D) CT reconstructions were performed on 122 patients. We selected the best level and measured the relevant parameters on both sides of the cervical vertebrae. We identified the entry point and orientation parameters of ATPS fixation for the C3–C7 vertebrae, and analyzed cervical pedicle parameters. Outer pedicle width (OPW), outer pedicle height (OPH), and pedicle axis length (PAL) were not correlated with body weight and age, but were positively correlated with body height (P < 0.05). After multiple linear regression analysis to exclude the effects of body height, no significant differences in OPW, OPH, and PAL were found between male and female subjects at most cervical levels. Pedicle cortical thickness was negatively correlated with age (P < 0.05). The percentage of pedicles with OPW <4.5 mm was: C3, 38.10%; C4, 34.92%; C5, 12.70%; C6, 9.52%; and C7, 0%. The percentage of pedicles with OPWs ≤4.5 mm, ≤4.0 mm, and ≤3.5 mm was higher among subjects with body height <160 cm. This study presents the internal anatomy of the cervical spine and provides accurate preoperative evaluation data for ATPS fixation. OPW, OPH, and PAL are positively correlated with body height, while pedicle cortical thickness is negatively correlated with age. [ABSTRACT FROM AUTHOR]

Background In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty. Objectives The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming. Methods Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected. Results Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P <.001) and with the length-to-width ratio across the nipple (P <.05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established. Conclusions ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare low-grade lytic spondylolisthesis (LS) and degenerative spondylolisthesis (DS) radiologically. In addition, it seeks to identify underlying similarities between LS and DS. Methods: This study included patients with low-grade single-level spondylolisthesis at L4–L5 or L5–S1. They were categorized into LS and DS. Radiological features, including pedicle height, width, transverse, and sagittal angle, as well as anterior vertebral heights (AVH) and posterior vertebral heights (PVH), were measured using T1-weighted magnetic resonance imaging. Results: The study involved 88 patients: 46 in the DS group and 42 in the LS group. In the LS group, the AVH was significantly higher than the posterior height at L4 and L5 (L4 PVH/AVH ratio 0.93 in LS vs. 0.96 in DS; L5 PVH/AVH ratio 0.84 in LS vs. 0.92 in DS), and pedicles were more medially oriented (L4: 19.62° in LS vs. 17.7° in DS; L5: 28.92° in LS vs. 26.47° in DS). In addition, at L5, the pedicle height (10.67 mm in LS vs. 11.48 mm in DS) and width (13.56 mm in LS vs. 14.37 mm in DS) were smaller compared to the DS group. Conclusions: Low-grade LS shows distinct radiological vertebral and pedicle anatomy compared to DS. Short and thin pedicles and wedge-shaped vertebrae in LS resemble DS, indicating its dysplastic origin.

Photoreceptors in the mammalian retina convert light signals into electrical and molecular signals through phototransduction and transfer the visual inputs to second-order neurons via specialized ribbon synapses. Two kinds of photoreceptors, rods and cones, possess distinct morphology and function. Currently, we have limited knowledge about rod versus (vs.) cone synapse development and the associated genes. The transcription factor neural retina leucine zipper (NRL) determines the rod vs. cone photoreceptor cell fate and is critical for rod differentiation. Nrl knockout mice fail to form rods, generating all cone or S-cone-like (SCL) photoreceptors in the retina, whereas ectopic expression of Nrl using a cone-rod homeobox (Crx) promoter (CrxpNrl) forms all rods. Here, we examined rod and cone pre-synapse development, including axonal elongation, terminal shaping, and synaptic lamination in the outer plexiform layer (OPL) in the presence or absence of Nrl. We show that NRL loss and knockdown result in delayed OPL maturation and plasticity with aberrant dendrites of bipolar neurons. The integrated analyses of the transcriptome in developing rods and SCLs with NRL CUT&RUN and synaptic gene ontology analyses identified G protein subunit beta (Gnb) 1 and p21 (RAC1) activated kinase 5 (Pak5 or Pak7) transcripts were upregulated in developing rods and down-regulated in developing SCLs. Notably, Gnb1 and Gnb5 are rod dominant, and Gnb3 is enriched in cones. NRL binds to the genes of Gnb1, Gnb3, and Gnb5. NRL also regulates pre-synapse ribbon genes, and their expression is altered in rods and SCLs. Our study of histological and gene analyses provides new insights into the morphogenesis of photoreceptor pre-synapse development and regulation of associated genes in the developing retina.

Lower extremity revascularization via groin incisions can be complicated by wound dehiscence associated with infection, seroma and femoral vessel exposure. This may require additional surgical debridement and coverage of vascular structures and grafts. The pedicled rectus femoris muscle flap (RFF) has both bulk and a large arc of rotation, making it useful for reconstruction. Its main pedicle is the descending branch of the lateral femoral circumflex artery (DLFCA), a branch of the profunda femoris artery. One could anticipate that ligation of more proximal vasculature could lead to ischemia of the RFF. We present two patients who each underwent vascular surgery involving the common femoral artery and subsequent reconstruction utilizing a pedicled RFF. Both patients then required additional vascular procedures involving the ligation of inflow vessels proximal to the DLFCA. The flaps remained viable, demonstrating the rich collateralization of blood supply that occurs in vascular disease patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to compare low-grade lytic spondylolisthesis (LS) and degenerative spondylolisthesis (DS) radiologically. In addition, it seeks to identify underlying similarities between LS and DS. Methods: This study included patients with low-grade single-level spondylolisthesis at L4–L5 or L5–S1. They were categorized into LS and DS. Radiological features, including pedicle height, width, transverse, and sagittal angle, as well as anterior vertebral heights (AVH) and posterior vertebral heights (PVH), were measured using T1-weighted magnetic resonance imaging. Results: The study involved 88 patients: 46 in the DS group and 42 in the LS group. In the LS group, the AVH was significantly higher than the posterior height at L4 and L5 (L4 PVH/AVH ratio 0.93 in LS vs. 0.96 in DS; L5 PVH/AVH ratio 0.84 in LS vs. 0.92 in DS), and pedicles were more medially oriented (L4: 19.62° in LS vs. 17.7° in DS; L5: 28.92° in LS vs. 26.47° in DS). In addition, at L5, the pedicle height (10.67 mm in LS vs. 11.48 mm in DS) and width (13.56 mm in LS vs. 14.37 mm in DS) were smaller compared to the DS group. Conclusions: Low-grade LS shows distinct radiological vertebral and pedicle anatomy compared to DS. Short and thin pedicles and wedge-shaped vertebrae in LS resemble DS, indicating its dysplastic origin. [ABSTRACT FROM AUTHOR]

This study aimed to compare screw accuracy and incidence of skive between two robotically navigated instrumented techniques in posterior spine fusion surgery: manual anti-skive instrumentation with an anti-skive cannula (ASC) and the use of a navigated, high-speed drill (HSD). Over a 3-year period, consecutive patients are undergoing RNA posterior fusion surgery with either ASC (n = 53) or HSD (n = 63). Both groups met a value of approximately 292 screws in our analysis (296 ASC, 294 HSD), which was determined by a biostatistician at an academic institution. Screw accuracy and skive was analyzed using preoperative CT and intraoperative three-dimensional (3D) fluoroscopy. Among 590 planned robotically inserted pedicle screws (296 ASC, 294 HSD), 245 ASC screws (82.8%) and 283 HSD screws (96.3%) were successfully inserted (p < 0.05). Skive events occurred in 4/283 (1.4%) HSD screws and 15/245 (6.2%) ASC screws (p < 0.05). HSD screws showed better accuracy in the axial and sagittal planes, being closer to planned trajectories in all directions except cranial deviation (p < 0.05). Additionally, HSD had a significantly lower time per screw (1.9 ± 1.0 min) compared to ASC (3.2 ± 2.0 min, p < 0.001). No adverse clinical effects were observed. The HSD technique showed significant improvements in time and screw accuracy compared to ASC. Biplanar fluoroscopy and 3D imaging resulted in significantly lower radiation exposure and time compared to ASC. These significant findings in the HSD group may be attributed to the lower occurrence of malpositioned screws, leading to a decrease in the need for second authentication. This represents a notable iterative improvement of the RNA platform. [ABSTRACT FROM AUTHOR]

Newer third generation percutaneous kyphoplasty (PKs) may minimize risks associated with older generation kyphoplasties such as new adjacent fractures, fracture progression, cement leakage, neurologic sequelae, and kyphosis. Additionally, posterior pedicle spinal fusion (PPSF) may minimize risk of long-term complications following PKs while maximizing the benefits of stable spinal alignment. The patient developed adjacent fracture progression, posterior retropulsion, and kyphosis following third generation kyphoplasty. Vertebral compression fracture progression was corrected and prolonged symptomatic relief was successfully achieved with T11-L4 PPSF and L1-L2 laminectomy. Postoperative follow-ups at 2, 4, 7 weeks, 1 and 2 years showed continued symptomatic improvement in back pain with resolution of thigh and groin pain. This case supports the use of PPSF in third generation PK-related complications to provide long-term symptom relief and improve quality of life in patients with severe osteoporotic compression fractures. [ABSTRACT FROM AUTHOR]

The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws. [ABSTRACT FROM AUTHOR]

Background The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest computed tomography (CT) angiography. Methods We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. Results A total of 700 blood vessels were classified according to the Kyungpook National University Plastic Surgery-Thoracodorsal Artery (KNUPS-TDA) classification: 388 (185 right and 203 left), 126 (64 right and 62 left), 91 (49 right and 42 left), 57 (27 right and 30 left), and 38 (25 right and 13 left) vessels were classified as type I, type II, type III, type IV, and type V, respectively. Among 350 patients, 205 patients showed matching types for left and right vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with type I, type II, type III, type IV, and type V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with type I + type II, type I + type III, type I + type IV, type I + type V, type II + type III, type II + type IV, type II + type V, type III + type IV, type III + type V, and type IV + type V, respectively. Conclusion While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes. [ABSTRACT FROM AUTHOR]

The present study was conducted to collect morphometric data on the lumbar vertebrae pedicles of the adult population from the eastern parts of India and analyse the variations, if any, with other parts of the country and the world. The retrospective cross-sectional study where lumbar pedicle morphometric data was obtained via dried bone, the 3D Lumbar vertebrae images were obtained by scanning the dried lumbar vertebrae, and the 3D lumbar vertebrae model was generated from a 1 mm thin CT scan slice of the Lumbar spine of patients who were advised to have a CT scan of the abdomen for reasons other than related to the vertebral column. Both linear and angular measurements in the lumbar pedicles were made bilaterally. The transverse pedicle width is widest at L3 and the narrowest at L2 vertebra bilaterally. The sagittal pedicle width at L4 vertebrae was observed to be the widest bilaterally, while L3 had the narrowest pedicle. The pedicular and body length along the pedicular axis is longer than the central axis at all the lumbar levels. The linear measurement along the pedicular axis was longest at L5 bilaterally via both modes, with a range of 18.2–47.31 mm for bones and 21.03–49.28 mm for CT scan morphometry. The transverse pedicular angle on analysis was observed to increase as one goes down the spine from L1 to L5, with a steep rise between L4 and L5. In contrast, the sagittal pedicular angle decreased as we went caudally toward the L5 vertebrae. The present study data had significant differences among the values reported in the literature from the different populations for the parameters studied. The data obtained by this study will be highly beneficial for the success of the free-hand technique of pedicle screw insertion. [ABSTRACT FROM AUTHOR]

Objectives: Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of the peroneal vessels. Methods: Multi‐institutional retrospective chart review from 2000 to 2020. Results: Of 2975 harvested fibula free flaps, 26 had a history of pedicle severance during surgical reconstruction. Reasons for intraoperative pedicle severance included transection during muscular dissection 10/26 (39%), accidental severance with the bone saw 12/26 (46%), and other 4/26 (15.6%). The surgeon responsible for pedicle severance included residents 5/26 (19%), fellows 10/26 (39%), attendings 10/26 (39%), and unknown 1/26 (3.9%). The pedicle artery and vein were severed 10/26 (39%), artery 8/26 (31%), and vein 8/26 (31%). Truncated pedicle vessels were used 3/26 (11.7%), intraoperative anastomoses were performed 23/26 (89%). Postoperative revision in the OR within 7 days of surgery was required 6/26 (23%); 4 flaps were salvaged and 2 flaps failed, both arterial thrombosis. Flap failure was attributed to vascular thrombosis. Long‐term flap survival and successful reconstructions were reported 24/26 (92%). Conclusion: Accidental severance of fibula free flap pedicle vessels can be corrected with intraoperative repair, without affecting long‐term flap survival or reconstructive outcomes. Protecting the flap vessels while using the bone saw and during intramuscular dissection prevents accidental severance. [ABSTRACT FROM AUTHOR]

Introduction: The atypical anatomy of the C2 vertebra has led to terminological discrepancies within reports and studies in the literature regarding the location of its pedicle, pars interarticularis, and isthmus. These discrepancies not only limit the power of morphometric analyses, but they also confuse technical reports regarding operations involving C2, and thus confuse our ability to properly communicate this anatomy. Herein, we examine the variations in nomenclature regarding the pedicle, pars interarticularis, and isthmus of C2, and via an anatomical study, propose new terminology. Methods: The articular surface and underlying superior and inferior articular processes and adjacent transverse processes were removed from 15 C2 vertebrae (30 sides). Specifically, the areas regarded as the pedicle, pars interarticularis, and isthmus were evaluated. Morphometrics were performed. Results: Our results indicate that, anatomically, C2 has no "isthmus" and that a pars interarticularis for C2, when present, is very short. Deconstruction of the attached parts allowed for visualization of a bony arch extending from the anterior most aspect of the lamina to the body of C2. The arch is composed almost entirely of trabecular bone and without its attached parts, e.g., transverse process, really has no cortical bone laterally. Conclusions: We propose a more accurate terminology, the pedicle, for pars/pedicle screw placement of C2. Such a term more accurately describes this unique structure of the C2 vertebra and would alleviate terminological confusion in the future literature on this topic. [ABSTRACT FROM AUTHOR]

Attachment of a detached retina does not always restore vision to pre-injury levels, even if the attachment is anatomically successful. The problem is due in part to long-term damage to photoreceptor synapses. Previously, we reported on damage to rod synapses and synaptic protection using a Rho kinase (ROCK) inhibitor (AR13503) after retinal detachment (RD). This report documents the effects of detachment, reattachment, and protection by ROCK inhibition on cone synapses. Conventional confocal and stimulated emission depletion (STED) microscopy were used for morphological assessment and electroretinograms for functional analysis of an adult pig model of RD. RDs were examined 2 and 4 h after injury or two days later when spontaneous reattachment had occurred. Cone pedicles respond differently than rod spherules. They lose their synaptic ribbons, reduce invaginations, and change their shape. ROCK inhibition protects against these structural abnormalities whether the inhibitor is applied immediately or 2 h after the RD. Functional restoration of the photopic b-wave, indicating cone-bipolar neurotransmission, is also improved with ROCK inhibition. Successful protection of both rod and cone synapses with AR13503 suggests this drug will (1) be a useful adjunct to subretinal administration of gene or stem cell therapies and (2) improve recovery of the injured retina when treatment is delayed. [ABSTRACT FROM AUTHOR]

Background: The recommendation of breast lift surgery in the setting of patients requiring breast implant removal is twofold. First, a breast lift is indicated for patients who present with breast mound or nipple-areolar complex ptosis. Second, a breast lift is indicated to accommodate the forecasted redundancy in skin and breast ptosis created by implant explantation. The most popular approaches to mastopexy include the inferior and superior pedicled breast lifts. We present a surgical algorithm with diagrams and cases clarifying mastopexy approaches for patients desiring breast implant removal in patients presenting with breast implant illness syndrome. Methods: An algorithm was developed to explain the process for selecting the ideal pedicle approach for mastopexy and implant removal surgeries. Results: Three cases are presented to illustrate the application of each pedicle under different presentations and goals. Conclusions: Advantages of an inferior pedicle include the capacity for unlimited lifting of the nipple-areola complex and for preservation of maximal breast mound volume. Its disadvantages include the inability to remove the breast capsule simultaneously and contraindicated if the lower breast pole is contracted. The advantages of a superior pedicle include the ability to remove the entire capsule and to eliminate lower breast pole if it is contracted. Its disadvantages include limitations to how high the nipple-areola complex can be lifted and the inability to preserve maximal breast mound volume. With the current trend for the request of implant removal in patients presenting with breast implant illness syndrome, the algorithm presented may assist surgeons with selecting the ideal breast lift and implant removal approach. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

• There is no cortical perforation in C1 transverse foramen, vertebral canal, and medial border of lateral mass along virtual screw based on Axis C in the axial plane. • The design method of Axis C can be an inspiration for artificial intelligence screw trajectory design. • Axis C is an ideal C1 transpedicular screw trajectory which can be used as a navigation route for computer assisted surgery system. Previous studies mainly reported perpendicular and medial inclination insertion methods for C1 transpedicular screw insertion (TSI). Our recent study showed the ideal C1 transpedicular screw trajectory (TST) can be achieved by medial inclination, perpendicular or even lateral inclination insertion, and Axis C can be a reliable trajectory. The purpose of this study is to confirm Axis C is an ideal C1 TST by comparing the cortical perforation differences between actual C1 TSI and virtual C1 transpedicular screw insertion along Axis C (Virtual C1 Axis C TSI). Firstly, the cortical perforations of the transverse foramen and vertebral canal caused by C1 TSIs in twelve randomly selected patients were evaluated based on their postoperative CT data. Secondly, Virtual C1 Axis C TSIs were performed based on same patients' preoperative CT data. Thirdly, the cortical perforation differences between actual and virtual screws were compared. In actual C1 TSI group, there were thirteen locations of cortical perforation in the axial plane, with five sides in transverse foramen and eight sides in vertebral canal, the cortical perforation rate was 54.2%; the degree of perforation was mild in twelve locations and medium in one location. In contrast, there was no cortical perforation in Virtual C1 Axis C TSI group. Axis C is an ideal trajectory for C1 TSI, it can be utilized as a navigation route for computer assisted surgery system. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objective: To (1) define utilization trends for navigated instrumented posterior lumbar fusion (PLF), (2) compare reasons and rates of revision at 30-day, 60-day, 90-day, and 1-year follow-up, and (3) compare 90-day perioperative complications between navigated versus conventional instrumented PLF. Methods: Patients who underwent navigated or conventional instrumented PLF were identified from the Humana insurance database using the PearlDiver Patient Records between 2007-2017. Usage of navigation was characterized. Patient demographics and operative characteristics (number of levels fused, interbody usage) were compared between the 2 treatment groups. Propensity score matching was done and comparisons were made for revision rates at different follow-up periods (categorized by reasons) and other 90-day perioperative complications. Results: This study included 1,648 navigated and 23 429 conventional instrumented PLF. Navigated cases increased over the years studied to approximately 10% in 2017. Statistical analysis after propensity score matching revealed significantly lower rates of hardware-related revision at 90-day follow-up in the navigated cohort (0.49% versus 1.15%, P =.033). At 1-year follow-up, the navigated cohort continued to have significantly lower rates of hardware-related revision (1.70% versus 2.73%, P =.044) as well as all cause revision (2.67% versus 4.00%, P =.032). There were no statistical differences between the 2 cohorts in any of the 90-day perioperative complications studied, such as cellulitis and blood transfusion (P >.05 for all). Conclusions: These findings suggest that navigation is associated with reductions in hardware-related revisions after instrumented PLF. However, these results should be interpreted cautiously in the setting of potential confounding by other unmeasured variables. [ABSTRACT FROM AUTHOR]

Abstract Objective To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. Methods Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. Results Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. Conclusions People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.

Abstract Background Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion. Methods A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3. Results We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85–100% in RS (relative risk 1.01, 95% CI 1.00–1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI −13.59 to 26.49, p = 0.53). Mean hospital stay was MD of −0.36 days (95% CI −1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p

Pedicle screw fixation provides one of the most stable spinal constructs. Their designs together with osseous characteristics have been known to influence the screw-bone interplay during surgical maneuvers and thereafter the fusion process. Various technical modifications to enhance screw performance have been suggested. This study evaluated the pull-out strength and axial stiffness of a novel pedicle screw design with variable thread geometry and pitch. The newly designed triple threaded pedicle screw is tapered, and has unique out-turned flanges to hold the cancellous bone and a finer pitch at its distal and proximal end to engage the cortical bone. Five lumbar and 4 lower thoracic cadaveric vertebrae were divided into hemivertebrae. A standard cancellous pedicle screw and the newly designed pedicle screw were inserted into each hemivertebra. Axial stiffness and peak pull-out force between the screw types were compared; a finite element analysis was also performed to additionally compare the pull out under toggle forces. In cadaveric study, the axial stiffness of the new screw was significantly better than that of the standard screw. However, the peak load between the screws was not statistically different. Finite element analyses suggested lesser stress at bone-implant interface for the new screw along with better axial stiffness under both co-axial and toggle forces. Our novel pedicle screw design with variable thread geometry demonstrates greater axial stiffness compared with the standard screws, and therefore is likely to withstand a greater surgical manipulation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Facet screw fixation is currently accepted as an internal fixation method. It has been extensively studied and applied in the cervical spine and lumbar spine. OBJECTIVE: To quantitatively analyze and compare biomechanical properties of transarticular screw fixation and traditional pedicle screw fixation in adolescents using finite element method to explore the feasibility of the former in thoracic internal fixation. METHODS: The finite element models of total thoracic vertebral pedicle screw fixation (Model A) and transarticular screw fixation (Model B) were established in 14-year-old adolescents. The original data of continuous scan thoracic vertebral tomography images were imported into Mimics 21.0 in DICOM format. T1-T12 were reconstructed and then imported into 3-Matic to establish preliminary geometric models of discs, facet joints, screws and titanium rods, and then processed with denoising, surfacing, smoothing and so on. The models were imported into Hypermesh software to carry on the grid. After attribute assignment, materials were imported into Ansys 19.2 to show the finite element model. Boundary and load condition were set. The motion range and stress of pedicles, intervertebral discs, screws, and titanium rods were observed, and whether the two had the same force and biomechanical stability were analyzed. RESULTS AND CONCLUSION: (1) The range of motion of facet joints in all segments of pedicle screws was greater than that of facet screws in all six working conditions (flexion, extension, left rotation, right rotation, left flexion, right flexion). The maximum motion was located at T1segment in the left flexion state (Model A: 0.691°; Model B: 0.563°). (2) There was no significant difference in the stress value of the pedicle between the two groups in flexion, extension, lateral flexion and left rotation (P > 0.05). In right-rotation state, the segments with significant differences (P < 0.05) were located at T3 and T6-T9, respectively, and the stress values of the model in Model A were higher than those in Model B. (3) There was no significant difference in the stress value of the superior articular process between Model A and B in flexion, extension, and lateral flexion motion (P > 0.05). In left-rotation and right-rotation states, the segments with significant differences (P < 0.05) were located at T10 and T8, respectively, and the stress values of the superior facet in Model B were higher than those in Model A. (4) The average stress value of T1-2 intervertebral disc in Model B was greater than that in Model A only in flexion forward, flexion right and rotation right, but was smaller than that in Model A under other conditions. In the overall stress cloud of titanium screw and rod, the average stress value of Model A was greater than that in Model B. (5) It is concluded that the biomechanical properties of small articular screws are similar to those of traditional pedicle screws, and posterior transarticular screw fixation in the thoracic spine can be used as an alternative fixation method. [ABSTRACT FROM AUTHOR]

Objective: To establish a clinical score for morbidity prediction based on patient-related risk factors after breast reduction surgery. Method: The retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Kafrelsheikh University Hospital, Egypt, and comprised data of female patients with bilateral macromastia who underwent breast reduction, using the inferior pedicle inverted T technique between February 2019 and June 2020. After data retrieval, risk factors and complications were documented and related to the patients’ risk factors Data was analysed using SPSS 20. Results: Of the 30 cases, 20(66.7%) were aged &gE;35 years, 16(53.3%) had body mass index &gE;37kg/m2 and 27(90%) were non-smokers. The mean preoperative haemoglobin level was 12.15±1.115g/dL and the mean weight of tissue resected on both sides was 2074.17±696.12gm. Factors significantly associated with complications included smoking, suprasternal notch to nipple distance &gE;38cm, haemoglobin

Objective: To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. Methods: Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions. Results: Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance. Conclusions: People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this investigation was to evaluate the effectiveness of a pedicled latissimus dorsi musculocutaneous flap (PLDMF) applied to trauma-complicated large soft tissue defects in the upper extremity up to the elbow area. Materials and Methods: Six patients who received a PLDMF at our clinic for a traumatic soft tissue defect around the elbow between 2014 and 2019 were included in this prospective follow-up, retrospective cohort-type analysis. In addition to the extent of the soft tissue defect, the length of postoperative hospitalization, follow-up, complications, and time to return to work, the patient's demographic information was also noted. The Q-DASH questionnaire was used to assess elbow and shoulder joint range of motion (ROM) 9 months after surgery. Results: Six male patients with an average age of 39.8±13.07 years had defects with a mean size of 272 cm2. In a patient who underwent amputation at the elbow level, a flap was used to treat an antecubital deformity after replantation in the same session. Three patients experienced hematoma in the donor location, superficial necrosis distal to the flap, and superficial infection. They were released after 14--29 days. The flaps survived in all patients, and both the Q-DASH questionnaire and shoulder and elbow joint ROM outcomes were satisfactory. Conclusion: In complex soft tissue problems around the elbow joint that may need extensive therapy and would probably result in disability, a PLDMF can be used safely. Intraoperative Doppler ultrasonography helps prevent the most typical consequence, distal necrosis. [ABSTRACT FROM AUTHOR]

The deep inferior epigastric perforator (DIEP) flap has been widely used for autologous breast reconstruction after mastectomy. In the conventional surgical method, a long incision is needed at the anterior fascia of the rectus abdominis muscle to obtain sufficient pedicle length; this may increase the risk of incisional hernia. To shorten the incision, several trials have investigated the use of endoscopic/robotic devices for pedicle harvest; however, making multiple additional incisions for port insertion and operating in the intraperitoneal field were inevitable. Here, we describe the first case, in which a DIEP free flap was successfully made using the da Vinci SP model. Our findings can help surgeons perform operations in smaller fields with a single port in the extraperitoneal space. Moreover, this method is expected to lead to fewer donor-related complications and faster healing.