The Experts below are selected from a list of 321 Experts worldwide ranked by ideXlab platform
David M. Knize - One of the best experts on this subject based on the ideXlab platform.
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A study of the supraorbital nerve
Plastic and reconstructive surgery, 1995Co-Authors: David M. KnizeAbstract:A detailed description of the anatomical relationships of the supraorbital nerve as it courses across the forehead and under the scalp cannot be found in most anatomy textbooks, and illustrations of the nerve beyond the superior orbital rim frequently misrepresent its course. Because the supraorbital nerve is a structure at risk in many plastic surgical techniques, the plastic surgeon would benefit from a clearer understanding of its anatomy and function. The supraorbital nerve was studied anatomically in 12 (24 half-head) fresh cadaver specimens, and its sensory distribution was studied in 30 living subjects using selective nerve blocks. Beyond the orbital rim, the supraorbital nerve has two consistently present divisions : (1) a superficial (medial) division that passes over the frontalis muscle, providing sensory supply to the forehead skin and only to the anterior margin of the scalp in 90 percent of the study subjects ; and (2) a deep (lateral) division that runs cephalad across the lateral forehead between the Galea Aponeurotica and the pericranium as the sensory nerve to the frontoparietal scalp. When a forehead lift is performed, injury to this deep division causes most of the distressful sequelae of scalp numbness and paresthesia. Unlike the superficial division, the course of the deep division in all cadaver specimens and its sensory distribution in all living volunteer subjects was consistent. This study has application for any procedure requiring scalp or forehead incisions, such as the forehead lift and the endoscopic facial techniques. With preoperative planning, scalp incisions may be placed to avoid the superficial supraorbital nerve branches and preserve the deep division of the supraorbital nerve. (Plast. Reconstr. Surg. 96 : 564, 1995.)
Seok Keun Choi - One of the best experts on this subject based on the ideXlab platform.
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Fundamental Basis of Scalp Layering Techniques to Protect Against Wound Infection: A Comparative Study Between Conventional and In-to-Out Dissection of the Superficial Temporal Artery.
World Neurosurgery, 2016Co-Authors: Yeongu Chung, Sung Ho Lee, Seok Keun ChoiAbstract:Background Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is associated with several surgical problems. Despite the vascular patency and hemodynamic changes after the anastomosis, wound problems can be a major surgical complication. Methods In a review of 41 surgical cases of STA-MCA bypass for moyamoya disease or cerebral occlusive vascular disease, we compared the conventional (out-to-in) dissection method for STA (n = 23) with the in-to-out (ITO) dissection method (n = 18) and evaluated the surgical results with respect to wound problems. Results The incidence of skin maceration was significantly higher in the conventional dissection group than the ITO dissection group (34.8% vs. 5.5%; P Conclusions These data suggest that the simple layering technique of the ITO dissection method can protect against contamination from bacteria and reduce postoperative surgical wound problems. Sealing of the Galea Aponeurotica (first protective barrier), including fibrous septa and loose areolar tissues, including the periosteal layer (second protective barrier), is an important factor to decrease the rate of scalp wound infection.
Yeongu Chung - One of the best experts on this subject based on the ideXlab platform.
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Fundamental Basis of Scalp Layering Techniques to Protect Against Wound Infection: A Comparative Study Between Conventional and In-to-Out Dissection of the Superficial Temporal Artery.
World Neurosurgery, 2016Co-Authors: Yeongu Chung, Sung Ho Lee, Seok Keun ChoiAbstract:Background Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is associated with several surgical problems. Despite the vascular patency and hemodynamic changes after the anastomosis, wound problems can be a major surgical complication. Methods In a review of 41 surgical cases of STA-MCA bypass for moyamoya disease or cerebral occlusive vascular disease, we compared the conventional (out-to-in) dissection method for STA (n = 23) with the in-to-out (ITO) dissection method (n = 18) and evaluated the surgical results with respect to wound problems. Results The incidence of skin maceration was significantly higher in the conventional dissection group than the ITO dissection group (34.8% vs. 5.5%; P Conclusions These data suggest that the simple layering technique of the ITO dissection method can protect against contamination from bacteria and reduce postoperative surgical wound problems. Sealing of the Galea Aponeurotica (first protective barrier), including fibrous septa and loose areolar tissues, including the periosteal layer (second protective barrier), is an important factor to decrease the rate of scalp wound infection.
Antonio Bernardo - One of the best experts on this subject based on the ideXlab platform.
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A safe and effective technique for harvesting the occipital artery for posterior fossa bypass surgery: a cadaveric study.
World Neurosurgery, 2014Co-Authors: Hitoshi Fukuda, Alexander I. Evins, Justin C. Burrell, Phillip E. Stieg, Antonio BernardoAbstract:Objective The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is believed to be difficult and time consuming due to its 3-dimensional course through different suboccipital tissue layers. We propose a safe and effective means of dissecting the OA. Methods The course of the OA was explored in 5 cadaveric heads (10 sides). The OA was divided into 3 segments based on the vertical muscle layer it ran through; subcutaneous, transitional, and intramuscular. Three different approaches were attempted, and their respective advantages and disadvantages were assessed. Results The subcutaneous segment of the OA was found to run above the Galea without traversing any vertical layers, and was thus easily dissected down to the superior nuchal line (SNL). The segment between the SNL and the digastric groove, traditionally the suboccipital segment, was divided into transitional and intramuscular segments. After detaching and retracting the suboccipital muscles, the OA was found to run in a single vertical layer of connective tissue. Dissection of the transitional segment was more involved as it ran between the SNL and the superior edge of the splenius capitis muscle, and vertically through the Galea Aponeurotica and the tendon of the sternocleidomastoid muscle. Conclusions This segmentation provided a safe and effective procedure for harvesting the OA, in which dissection of the transitional segment is a critical step. Although the course of the OA is complex, precise anatomical knowledge of the suboccipital muscles and a stepwise dissection make harvesting the OA relatively simple.
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A safe and effective technique for harvesting the occipital artery for posterior fossa bypass surgery: a cadaveric study.
World neurosurgery, 2013Co-Authors: Hitoshi Fukuda, Alexander I. Evins, Justin C. Burrell, Phillip E. Stieg, Antonio BernardoAbstract:The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is believed to be difficult and time consuming due to its 3-dimensional course through different suboccipital tissue layers. We propose a safe and effective means of dissecting the OA. The course of the OA was explored in 5 cadaveric heads (10 sides). The OA was divided into 3 segments based on the vertical muscle layer it ran through; subcutaneous, transitional, and intramuscular. Three different approaches were attempted, and their respective advantages and disadvantages were assessed. The subcutaneous segment of the OA was found to run above the Galea without traversing any vertical layers, and was thus easily dissected down to the superior nuchal line (SNL). The segment between the SNL and the digastric groove, traditionally the suboccipital segment, was divided into transitional and intramuscular segments. After detaching and retracting the suboccipital muscles, the OA was found to run in a single vertical layer of connective tissue. Dissection of the transitional segment was more involved as it ran between the SNL and the superior edge of the splenius capitis muscle, and vertically through the Galea Aponeurotica and the tendon of the sternocleidomastoid muscle. This segmentation provided a safe and effective procedure for harvesting the OA, in which dissection of the transitional segment is a critical step. Although the course of the OA is complex, precise anatomical knowledge of the suboccipital muscles and a stepwise dissection make harvesting the OA relatively simple. Copyright © 2014 Elsevier Inc. All rights reserved.
Gregory L. Borah - One of the best experts on this subject based on the ideXlab platform.
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Pseudoaneurysm of the anterior superficial temporal artery.
Annals of Plastic Surgery, 1996Co-Authors: Ken-ryu Han, Gregory L. BorahAbstract:Pseudoaneurysm of the superficial temporal artery must be considered in the differential diagnosis of masses of the lateral forehead and temporal fossa. While the first reported case of a temporal artery aneurysm was reported by Thomas Bartholin in 1740, there is scant mention of this lesion in the plastic and maxillofacial surgical literature. Pseudoaneurysms can arise in the forehead and scalp as a result of blunt traumatic impingement of the superficial temporal artery against the calvarium. The anterior branch of the artery is most vulnerable, because in the lateral forehead it courses over the frontal osseous ridge in the Galea Aponeurotica formed by the fusion line of the deep and superficial temporalis muscle fascia. This dense fascial investment has a tethering effect in the gap between the temporalis and frontalis muscles and prevents the artery from displacing laterally in response to traumatic forces. A history of recent blunt trauma or surgery to the forehead, combined with a pulsatile bruit, should direct the physician to the diagnosis of pseudoaneurysm of the superficial temporal artery. Treatment is surgical resection of the involved segment without the need for reconstruction. This report includes a review of the literature and presents the first documented case of a bicycle helmet as the cause of a superficial temporal artery pseudoaneurysm.
