1/14. The blood supply of the reverse temporalis muscle flap: anatomic study and clinical implications.Although the reverse temporalis muscle flap has been used clinically, the exact vascular connection between the superficial and deep temporal vessels has not been clearly defined. The purpose of this study was to investigate the vascular territory of the reverse temporalis muscle supplied by the superficial temporal vessels. Six cadaver heads were studied using a colored lead oxide injection through the superficial temporal artery. The specimens were examined macroscopically and radiographically. The reverse temporalis muscle flap was then applied to a clinical case presenting with traumatic anterior skull base defect communicating with the nasal cavity. The cadaver specimens demonstrated that the superficial temporal artery formed an average 1.3 /- 0.2 cm in width of dense vascular zone, which was located within 1.8 cm below the superior temporal line. The dense vascular network further perfused the anterior and posterior deep temporal arteries and the muscular branch of the middle temporal artery to supply the temporalis muscle. The mean perfused area of the temporalis muscle was 83 percent, ranging from 79 to 89 percent, in five cadaver heads. One cadaver revealed only 55 percent of perfused area in the absence of the muscular branch of the middle temporal artery. The consistent area without perfusion was located in the distal third of the posterior portion of the reverse temporalis muscle. In clinical cases, the reverse temporalis muscle flap was used successfully to obliterate the anterior skull base defect without evidence of muscle flap necrosis. The exact blood supply to the distal third of the posterior portion of the reverse temporalis muscle flap needs to be investigated further in vivo. Particular attention was paid to the inclusion of the muscular branch of the middle temporal artery in this flap to augment the blood supply to the temporalis muscle.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/14. Reconstruction of the upper portion of the ear by using an ascending helix free flap from the opposite ear.Reconstruction of partial, marginal defects of the ear has been a challenge. The ascending helix free flap based on superficial temporal vessels has been described and used solely to repair nose defects. We used reversed pedicle helical free flap for the repair of a major loss of the upper one-third of the opposite auricle. The method permits the transfer of tissue of the same quality with satisfactory cosmetic result. The equalization of the ears in dimension was accomplished with minimal donor-site deformity.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/14. Medicolegal diagnostic value and clinical significance of traumatic incomplete tears of the basilar artery.Ruptures of arteries of the vertebrobasilary system are relatively frequent in medicolegal practice, and their origin may be both natural and violent. tears that affects the whole thickness of the basilar artery cause subarachnoid hemorrhage (SAH), with an often rapid fatal outcome. 1-3 However, in some situations, arterial tears may be incomplete, involving the intima or both the intima and the media, but with preserved adventitia. 1, 4 Although such incomplete tears are not the source of immediate subarachnoid bleeding, their presence may be important from both a medicolegal and a clinical point of view.The aim of this article is to point out the significance of incomplete tears of basilar artery as a possible diagnostic sign of traumatic origin of SAH as well as a certain mechanism of injury, which involves forcible hyperextension and rotational movements of the head. The authors also describe their method of performing longitudinal section of the basilar artery, both at autopsy and for histologic examination, which is convenient for identifying multiple transversal incomplete tears of this blood vessel. The article is based on the analysis of three cases from the autopsy material of the Institute of forensic medicine in Belgrade.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/14. Prefabricated galeal flap based on superficial temporal and posterior auricular vessels.scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/14. The fate of hydroxyapatite cement used for cranial contouring: histological evaluation of a case.Craniofacial contouring is a commonly performed procedure applied for traumatic and postsurgical cranial vault or facial skeleton irregularities. Hydroxyapatite cement is an alloplastic material composed of tetracalcium phospate and dicalcium phospate anhydrous that transforms into a paste-like substance when these two compounds placed in an aqueous environment. This mixture, which is a nonceramic microporous calcium phosphate combination, is another alternative for refining the craniofacial contour. There are not enough data regarding bone formation within this material after its use in human beings, however. A case requiring secondary craniofacial contouring after a motor vehicle accident is presented. Hydroxyapatite cement was used for reconstruction, and a second look was carried out for further correction during which secondary contouring of the cement was made and a sample of the previously implanted material was histologically evaluated. It was observed in this case that hydroxyapatite cement is incorporated within the surrounding bony structures and permits secondary contouring procedures. New bone and vessel formation was also detected within the implanted material, but this was limited and thus was not convincing for significant osteoconversion as seen in animal studies.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/14. Traumatic neonatal intracranial bleeding and stroke.Ischaemia within the regions supplied by vertebral and posterior cerebral arteries has been described as a complication of birth injury, either by direct trauma or by compression from a herniated temporal uncus. Ischaemia within the territory of the middle cerebral artery has been documented after a stretch injury of the vessel's elastica interna. From a series of seven personal observations on birth trauma and related cerebral stroke, we describe three neonates with the uncal herniation type of occipital stroke and four infants with hypoperfusion of the middle cerebral artery or one of its major branches. In three of the latter a basal convexity subdural haemorrhage probably induced the ischaemia, whereas in the other it was associated with haemorrhagic contusion of the parietal lobe. Experimental work and reports on older children support the idea that vasospasm due to surrounding extravasated blood can be one of the responsible mechanisms. Both forceps delivery and difficult vacuum extraction can be implicated in this supratentorial injury, leading to permanent neurological damage in at least half of the survivors in this series.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/14. Combination of vascularized outer-table calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in a child.CASE PRESENTATION: A vascularized outer-table calvarial bone graft was used for repairing a Posnick type 2 traumatic orbito-frontal bone defect supported by the use of a calcium-based putty (Allomatrix) in a 7-year-old girl. Gaps between the donor and recipient sites were filled with Allomatrix containing demineralized bone matrix particles. Four years later there was a good cosmetic result using an artificial left eye. DISCUSSION: Orbito-frontal defects have been repaired using iso-, allo- or xenografts as well as synthetic materials. Anatomical studies have pointed to the importance of the superficial temporal vessels for the vascular supply of a graft to the calvaria. CONCLUSION: The vascularized outer-table calvarial bone graft based on the superficial temporal vessels is a reliable option for repairing bony defects in the craniofacial skeleton especially in irradiated or scarred areas where there is a paucity of well-vascularized tissues. It also has the potential for bony growth in children.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
8/14. Contralateral total steal associated with direct high-flow shunt between carotid artery and internal jugular vein after digital compression of carotid artery for posttraumatic carotid-cavernous fistula: a study of selective four-vessel angiography findings.A 40-year-old woman was involved in a traffic accident and was admitted to another hospital with a severe head injury with a glasgow coma scale score 1 of 8. Skull radiographic film showed extensive temoralbasal fracture unilaterally. Two months later, she presented with left ophthalmoplegia and exophthalmos and with chemosis 4 months after the accident.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/14. Fetal skull fracture from an automobile accident.This is a case report of a fetal skull fracture that resulted in fetal death caused by a high-velocity automobile accident. As a 25-year old gravida 3, para 2, was pulling out of a driveway onto a highway, her car was struck in the left front end by a car traveling perpendicular to her vehicle. She died almost instantly from shock caused by massive injuries and internal hemorrhage. She had a fractured rib and multiple fractures of the pelvis as well as bilateral hemothorax and ruptured splenic and renal vessels. The fetus had depressed multiple skull fractures. The probable mechanism of fetal injury, as well as the influence of seat restraints on injury to the mother and fetus, are discussed.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/14. Bitemporal compression injury caused by static loading mechanism. Report of two cases.The authors report two cases of bitemporal compression injury caused by a static loading mechanism. These head injuries resulted from gradual bitemporal compression of the head. Plain skull films showed multiple skull fractures, and carotid angiography revealed internal carotid artery obstruction at the base of the skull. Neurological examination disclosed a slight disturbance of consciousness, hemiparesis, multiple cranial nerve injuries, and Horner's syndrome. In comparison with impact head injury, the energy from this type of trauma tends to be transmitted to the foramina and hiati of the middle cranial fossa and results in multiple injuries to the cranial nerves, sympathetic nerves, and blood vessels.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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