Marko Konschake

Mors auxilium vitae--causes of death of body donors in an Austrian anatomical department.

BACKGROUND Anatomical dissection is, despite several critical annotations, a highly valuable component of under- and postgraduate medical education and research. Our current causes-of-death statistics on our body donors is aimed to find out to which extent they are representative of the Austrian population. METHODS We evaluated the causes of death stated in their death certificates of a total of 3399 people who donated their bodies to our department in the course of the last 25 years (1988-2013). The categorisation is based on the official ICD-10-WHO classification. RESULTS Our data show a prevalence of cardiovascular diseases in about half of the donors (42%) examined; no gender difference could be revealed in cardiovascular diseases. Tumours were responsible for about 20% of deaths, lead by lung cancer; cancers showed a slight male excess. All other deaths were caused by diseases of the respiratory system, the digestive organs, the genitourinary system, the nervous system, alimentary and metabolic disorders, infections and blood diseases, psychiatric disorders, external and other causes in descending order. Compared to the official Austrian and German statistics, there are only minor deviations. CONCLUSION Our data clearly show that body donors, at least in our department, depict a representative sample of Austrian population in terms of their causes of death. Therefore anatomical dissection provides appropriate insight into the morbidity of the increasing major target population of medicine, the elders. Limitations in the acceptance by age, excluding either young or old donors, which appear to exist in other anatomical departments, will limit this representativeness. Being aware of these facts, the anatomical dissection course cannot only provide anatomical learning experiences but can also provide an introduction to the basics of epidemiology. Therefore, a topographical dissection course remains an indispensable method for both undergraduate and postgraduate training as well as for research.

The nonrecurrent laryngeal nerve: A clinical anatomic mapping with regard to intraoperative neuromonitoring.

BACKGROUND We investigated the nonrecurrent inferior laryngeal nerve (nrILN), an important variant in the course of the inferior laryngeal nerve (ILN; 0.5-6.0%). Its importance was demonstrated in a clinical case as well as in cadaver specimens, and the pattern was identified with intraoperative neuromonitoring (IONM). METHODS The ILN and the presence of an nrILN were investigated in 36 formaldehyde-embalmed specimens. Our anatomic findings showed differences in the anatomic course of the ILN and thus produced possible explanations for different IONM signals that would correlate with differences in the anatomic course of the ILN. Preoperative ultrasonographic evaluation of the brachiocephalic trunk and the recurrent laryngeal nerve were used for the exclusion or identification of an nrILN, respectively. RESULTS We found 2 nrILNs (ascending, horizontal; 6%) in the anatomic specimens. These 2 specimens each showed an aberrant right subclavian artery (lusorial artery) and were, therefore, associated with the absence of a brachiocephalic trunk. The intraoperative case displayed a descending nrILN. Signals derived from the vagus nerve were positive if derived proximal to and negative if derived distal to the branching of an nrILN. By ultrasonographic identification of a normal brachiocephalic trunk, an nrILN could be excluded. CONCLUSION Surgeons need a working knowledge about nrILNs to avoid recurrent nerve palsy and should be familiar with all the possible course variations in the ILN when IONM signals are absent with vagal stimulation. Moreover, endocrine surgeons need to be able to interpret correctly negative as well as positive signals. Preoperative ultrasonography should ideally be performed, because the presence of a normal brachiocephalic trunk is a quick method to exclude or identify a nrILN.

Anatomical mapping of the nasal muscles and application to cosmetic surgery

We present an anatomical mapping of the most important muscles influencing the nose, incorporating constant anatomical structures, and their spatial correlations. At our disposal were the midfaces of 18 bodies of both sexes, obtained by informed consent from body donors aged between 60 and 80 years. Macroscopically, we dissected the nasal regions of eight corpses, six midfaces were prepared according to plastination histology, four by creating plastinated slices. On their way from their periosteal origin to the edge of the skin, the muscles of the nose cross the subcutaneous adipose tissue, dividing it into superficial and deep layers. The individual muscle fibers insert into the skin directly at the reticular corium. Sometimes, they reach the border of the epidermis which represents a special arrangement of corial muscle attachments. The course of the anatomical fibers of individual nasal muscles presented macroscopically and microscopically in this study offers surgeons a detailed overview of the anatomically important muscular landmarks of the midface. Clin. Anat. 27:1178–1184, 2014.

New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study

The aim was to develop a new laparoscopic technique for placement of a pudendal lead.

Biomechanical evaluation of cable and suture cerclages for tuberosity reattachment in a 4-part proximal humeral fracture model treated with reverse shoulder arthroplasty

BACKGROUND Sufficient tuberosity fixation in proximal humeral fractures treated with shoulder arthroplasty is essential to gain a good clinical outcome. This biomechanical study evaluated the strength of the reattached tuberosities in reverse total shoulder arthroplasty fixed with cables or with sutures in a cerclage-like technique. Considering the mechanical advantages of flexible titanium alloy cables compared with conventional sutures for cerclage-like fixations, we hypothesized that titanium alloy cables would achieve higher fixation strengths of the tuberosities compared with heavy nonabsorbable sutures. METHODS A 4-part fracture was created on 8-paired proximal human humeri. The tuberosities were reduced anatomically and fixed by 2 heavy nonabsorbable sutures (suture group) or by two 1-mm titanium alloy cables (cable group) in a cerclage-like technique around the neck of the prosthesis. The humeri were placed in a custom-made test setup enabling internal and external rotation. Cyclic loading with a stepwise increasing load magnitude was applied with a material testing machine, starting with 1 Nm and increasing the load by 0.25 Nm after each 100th cycle until failure of the fixation occurred (>15° rotation of the tuberosities). Any motion of the tuberosities was measured with a 3-dimensional ultrasound motion analysis system. RESULTS Overall, the cable group reached 1414 ± 372 cycles, and the suture group reached 1257 ± 230 cycles until the fixations failed (P = .313). The suture group showed a significantly higher rotation of the lesser tuberosity relative to the humerus shaft axis after 200, 400, and 600 cycles compared with the cable group (P = .018-.043). CONCLUSIONS Tuberosities reattached with cable cerclages showed higher fixation strength and therefore less rotation compared with suture cerclages in a 4-part proximal humeral fracture model treated with reverse total shoulder arthroplasty. Whether this higher fixation strength results in higher bony ingrowth rates of the tuberosities and thus leads to a better clinical outcome needs to be investigated in further clinical studies.

What do plastic surgeons expect from anatomy in 2018? Clinical anatomy and applied research in plastic surgery

This special issue of Surgical and Radiological Anatomy addresses translational research in the field of Anatomy and Plastic and Reconstructive Surgery. All the original articles presented deal with clinical anatomy and applied research in plastic surgery. The first half of this issue comprises papers, which provide interesting findings in perforators of the fibular and medial sural artery, morphometric properties of the latissimus dorsi muscle, and also essential anatomical and histological data referring to the deep fascia of the neck. All articles in this special issue show data, which had been collected by applying translational research on human bodies. The knowledge of the human topographic anatomy is considered the vital basis of professional medical activity and clinical practitioners postulate that anatomy is the basis of medical knowledge. Modern translational anatomic research is concerned about plastic surgery research. Clinical anatomy and applied research in plastic surgery, as shown in this special issue, deal with a large field of cartography of flaps (surface anatomy), thickness of flaps and perforators (arterial and venous supplies) for both local and free flaps. But, all of this plastic surgery research requires a strong updating of precise topographical knowledge of precise anatomic areas; this knowledge can only be gained from research on human body donors. Human cadavers are discussed as being the medical student ́s “first patient”, but promoters regard them as “more than a model” due to its individuality, while rejecters argue that the cadaver lacks a major property of a patient, the vitality. But, there are several properties classifying the human cadaver as a distinct educational tool among all others: activity, morbidity, variability and dimension (3-dimensional individual). Compared to a simulated patient, a “virtual human” or an anatomic model and a textbook, the human cadaver is a non-vital, variable, 3-dimensional individual with low hazard and high quality haptic experience. Thus, anatomic dissection provides, next to research, a distinct educational method. Dissection itself, practiced on human bodies, has been valued as an indispensable part of medical underand postgraduate education by many clinical anatomists and surgeons. The demands of modern medicine, not only in plastic surgery, but also in medical imaging, place special emphasis on the importance of topography in education and research. Translational anatomy aims to disseminate the knowledge gained in the basic science of anatomy and to apply it to the diagnosis and treatment of human pathology to improve the patients’ (individual) outcome. Teachers of anatomy and surgery must be able to provide the appropriate medical knowledge and skills. Each teacher should therefore have at least a certain amount of postgraduate medical education on human bodies. Competencies, skills, attitudes and strategies to solve morphological problems and a thorough understanding of the anatomic individuality of humans are mandatory prerequisites of professionalism in medicine. Therefore, in this special issue, we also provide an interesting review article, which deals with special techniques of cadaver perfusions, which is important for postgraduate surgical training. Translational anatomy as a basic science improves surgical outcomes by transporting knowledge from “bench-to-bedside”. The second part of this issue presents important results concerning the rectus abdominis muscle innervation providing a surgical implication in DIEP flap harvesting, a practical rerouting of the internal thoracic pedicle, which might be a solution in maxillofacial reconstruction, but also shows an important anatomical variation of the nasal columella and the nostril sill with importance for reconstructive and esthetic surgery. An overview of the different flaps available * Marko Konschake marko.konschake@i-med.ac.at

Contemporary CBCT diagnostics—discovery of a new artery with possible impact on surgical planning: the anterior superior palatal alveolar artery

PurposeAn ongoing clinical trial regarding intra- and post-surgical morbidity in maxillary apicoectomies showed significant higher morbidity for upper canines and palatal roots of upper 1st premolars. Analysis of available presurgical cone beam computed tomography (CBCT)-scans revealed the existence of an unknown bone-canal branching off from the bone-canal or groove of the anterior superior alveolar artery (asaa). Aim of the study was the determination of the contents of this newly found bone canal in human cadaver heads, its prevalence as possible standard anatomical structure and its automatized detection with a contemporary high-resolution TRIUM-CBCT-device in vivo.Methods35 human cadaver heads were dissected, the prevalence of the bone-canal determined and its contents analyzed by histology. 835 consecutive routine high-resolution TRIUM-CBCT-scans from routine patients were analyzed by an automatized detection- and tracing-algorithm for in vivo-determination of prevalence of this bone canal. Automatized detection and additional manual tracing were statistically evaluated by SSPS 20.0 software.ResultsThe bone-canal was found in 96% of the anatomical specimens, its content identified as artery not described until now and named after the first finder “Arteria Kurrekii”. Automatized tracing of TRIUM-CBCT-scans with additional manual tracing revealed an in vivo prevalence of this newly found artery of 95% (p ≤ 0.05).ConclusionsThe newly found anterior superior palatal alveolar artery (aspaa—“Arteria Kurrekii”) might have the same clinical impact for surgical procedures in the maxilla as the posterior superior alveolar artery (psaa). Its first detection was enabled by high-resolution TRIUM-CBCT devices and prevalence as standard anatomical structure proven in vivo by automatized CBCT-scan analysis.

The supraorbital region revisited: An anatomic exploration of the neuro-vascular bundle with regard to frontal migraine headache

BACKGROUND Recent findings on the pathogenesis of frontal migraine headache support, besides a central vasogenic cause, an alternative peripheral mechanism involving compressed craniofacial nerves. This is further supported by the efficiency of botulinum toxin injections as a new treatment option in frontal migraine headache patients. METHODS The supraorbital regions of 22 alcohol-glycerine-embalmed facial halves of both sexes were dissected. Both the supratrochlear and supraorbital nerves (STN and SON, respectively) were identified, and their relationship with the corrugator supercilii muscle (CSM) was investigated by dissection and ultrasound. The course of both nerves was defined, and the interaction between the supraorbital artery (SOA) and SON was determined. RESULTS We discovered a new possible compression point of the STN passing through the orbital septum and verified previously described compression points of both STN and SON. Osteofibrous channels used by the STN and SON were found constantly. We described the varying topography of the STN and CSM, the SON and CSM, and the SON and SOA. Further, we provide an algorithm for the ultrasound visualization of the supraorbital neurovascular bundle. CONCLUSION Our data support the hypothesis of a peripheral mechanism for frontal migraine headache because of following potential irritation points: first, the CSM is constantly perforated by the SON and frequently by the STN; second, the topographic proximity between SOA and SON and the osteofibrous channels is used by the SON and STN; and third, the STN passes through the orbital septum.