International Journal of Research in Medical Sciences
Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic s... more Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between t...
The IPAA technique restores anal functionality in patients who have had the large intestine and r... more The IPAA technique restores anal functionality in patients who have had the large intestine and rectum removed; however, 1 of the most important reasons for pouch failure is tension on the anastomosis. The aim of this study was to compare technical procedures for mesenteric lengthening used for IPAA to reduce this tension. After randomization, 4 different techniques for mesenteric lengthening were performed and compared on fresh cadavers. This was a cross-sectional cadaveric study. In the first group (n = 5), stepladder incisions were made on the visceral peritoneum of the mesentery of the small intestine. In the second and third groups, the superior mesenteric pedicle was divided, whereas the ileocolic pedicle (n = 7) or marginal vessels (n = 6) were preserved during proctocolectomy. In the fourth group (n = 7), the superior mesenteric pedicle was cut without preserving any colic vessels. Mesenteric lengthening was analyzed. Angiography was performed to visualize the blood supply o...
Interactive cardiovascular and thoracic surgery, Jan 16, 2018
The purposes of this study were to identify possible compression points along the transit route o... more The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space ...
OBJETIVOS: Durante o tratamento de fraturas fechadas do colo do metacarpo do dedo mínimo (fratura... more OBJETIVOS: Durante o tratamento de fraturas fechadas do colo do metacarpo do dedo mínimo (fraturas do boxeador) usando fixação percutânea com fio K transversal e outros procedimentos, pode ocorrer lesão iatrogênica do ramo digital dorsal do dedo mínimo (RDDDM) do ramo dorsal do nervo ulnar (RDNU). Neste estudo, visamos descrever a relação do RDDDM do RDNU e os pontos de inserção na face lateral do quinto metacarpo durante fixação percutânea com fio K transversal de fraturas subcapitais. MÉTODOS: Foram realizadas dissecações e medições desse ramo depois de colocação de pino transversal percutâneo na parte distal do quinto osso do metacarpo em dez mãos de cadáveres fixadas em formalina. RESULTADOS: Os resultados desse estudo confirmam a grande proximidade da trajetória do pino e desse ramo, e demonstram sua possível lesão iatrogênica durante a fixação do fio K no quinto metacarpo. CONCLUSÕES: Para evitar a penetração desse nervo e limitar as chances de lesão iatrogênica, é importante ...
Intraosseous access is a method for providing vascular access in resuscitation of critically ill ... more Intraosseous access is a method for providing vascular access in resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. There is a lack of detailed description for the landmark for the insertion point in the literature. The aim of this study was to determine the exact location for intraosseous access. Radiographic computed tomography (CT) images of a total of 50 dry tibia bones were obtained. With 5-mm intervals, for all transverse images and by selecting transverse section, measurements were taken from the thickness of the cortex at anterior margin and mid-line medial surface, distance from anterior margin and mid-line medial surface of the tibia to the posterior wall of medullar cavity, distance from anterior margin and mid-line medial surface of the tibia to the posterior surface of the tibia. The thinner part of the cortex of the tibia and the larger width of the medullar cavity is at 0.5 cm below the tibial tuberosity in the midline of the medial surface. The application region for proximal tibia access and landmark and most suitable insertion point for intraosseous infusion should be at level 0.5 cm below the tibial tuberosity in the midline of the medial surface. It was recommended that standard length for intraosseous canule should be 17 mm except for the thickness of skin. Presented study provides certain localization for intraosseous access and standard length for intraosseous canule and this will be more effective in using this technique. This article is protected by copyright. All rights reserved.
Surgical and radiologic anatomy : SRA, Jan 19, 2017
The purpose of this study was to elucidate the anatomy and clinical importance of extraforaminal ... more The purpose of this study was to elucidate the anatomy and clinical importance of extraforaminal ligaments in the cervical region. This study was performed on eight embalmed cadavers. The existence and types of extraforaminal ligaments were identified. The morphology, quantity, origin, insertion, and orientation of the extraforaminal ligaments in the cervical region were observed. Extraforaminal ligaments could be divided into two types: transforaminal ligaments and radiating ligaments. It was observed that during their course, transforaminal ligaments cross the intervertebral foramen ventrally. They usually originate from the anteroinferior margin of the anterior tubercle of the cranial transverse process and insert into the superior margin of the anterior tubercle of the caudal transverse process. The dorsal aspect of the transforaminal ligaments adhere loosely to the spinal nerve sheath. The length, width and thickness of these ligaments increased from the cranial to the caudal d...
Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical ... more Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. Three-fourths of the precentral gyrus and postcentral gyrus were in the superior parietal window. The inferior frontal gyrus extended to the inferior parietal window in 80%. The 3 important parts of this gyrus were located below the superior temporal line in all hemispheres. The orbital and triangular parts were in the inferior frontal window, and the opercular part was in the inferior parietal window. The superior temporal gyrus was usually located in the inferior parietal and temporal windows, whereas the supramarginal gyrus and angular gyrus were usually located in the superior and inferior parietal windows. The farthest anterior point of the Heschl gyrus was usually located in the inferior parietal window. The mean positions of arachnoid granulations were measured as 3.9 +/- 0.39 cm anterior and 7.3 +/- 0.51 cm posterior to the bregma. Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery, 2010
The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. T... more The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. This study aims to demonstrate the complexity of the lateral ankle structures in detail. The study was performed on 11 cadavers (22 ankles) fixed in 10% formaldehyde, and 24 free talus specimens. The detailed course and attachments of each ligament was observed and noted with the ankle in neutral position. Talar measurements were applied to 46 specimens including the dissected cadavers and free talus ones. This study also investigated the relationships between these ligaments and gross morphologic pattern of lateral complex and talus, including the morphological pattern of the peroneal groove and the relationship between the peroneal tendons before and after the peroneal groove. The whole relationship of lateral ankle structures including anatomic and morphologic patterns and talus were evaluated. No morphologic variation was found concerning peroneus brevis and longus muscles. Although t...
The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy... more The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy. Hip arthroscopy was performed on two hip joints of a fresh-frozen male human cadaver. The arthroscopic control of the femoral head and neck and acetabular labrum were evaluated using the da Vinci Surgical System. Docking of the robotic system and manipulation of the instruments were successful. Although most regions reached in standard arthroscopy were also reached with this robotic setting, the 5-mm instrument was limited in movement due to its long articulation section. The 8-mm instrument had shorter articulation section and exhibited a full range of motion inside the joints. The posterior part of the femoral head and the posteroinferior portion of the acetabular labrum could not be observed because of the rigidity of the equipment. Robotic hip arthroscopy appears feasible in a cadaveric model but has some significant limitations. With the development of special instrumentations, ar...
European Journal of Orthopaedic Surgery & Traumatology, 2011
... Burak Akan • Mehmet Armangil • Kerem Basarir • Halil Acar • Sinan Sirri Bilgin • Mehmet Demir... more ... Burak Akan • Mehmet Armangil • Kerem Basarir • Halil Acar • Sinan Sirri Bilgin • Mehmet Demirtas ... McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH (2000) Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary ...
Lower local recurrence rates and better overall survival are associated with complete mesocolic e... more Lower local recurrence rates and better overall survival are associated with complete mesocolic excision with central vascular ligation for treatment of colon cancer. To accomplish this, surgeons need to pay special attention to the surgical anatomical planes and vascular anatomy of the colon. However, surgical education in this area has been neglected. The aim of this study is to define the correct surgical anatomical planes for complete mesocolic excision with central vascular ligation and to demonstrate the correct dissection technique for protecting anatomical structures. Macroscopic and microscopic surgical dissections were performed on 12 cadavers in the anatomy laboratory and on autopsy specimens. The dissections were recorded as video clips. Dissections were performed in accordance with the complete mesocolic excision technique on 10 male and 2 female cadavers. Vascular structures, autonomic nerves, and related fascias were shown. Within each step of the surgical procedure, ...
International Journal of Research in Medical Sciences
Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic s... more Background: The anatomy of the proximal femur comprises important landmarks for many orthopedic surgical procedures. However, this area exhibits morphological differences depending on race, gender and age. Besides being the insertion area of the hip flexor muscles, the lesser trochanter is also used as an angular reference in many orthopedic surgical procedures. The aim of this study is to investigate the morphologic relationship of the lesser trochanter with the femoral neck and greater trochanter.Methods: Around 67 dry femur bones (32 left, 35 right) belonging to humans of unknown gender that belong to the Ankara University Medical Faculty, Department of Anatomy were used in this study. The morphologic relationship of the lesser trochanter (TRMI) with the femoral neck (FN) and greater trochanter (TRMJ) was studied and the results were provided in a table.Results: The measured mean lesser trochanter and greater trochanter tip distance was 67.5±4.9mm (60mm-75mm). The angle between t...
The IPAA technique restores anal functionality in patients who have had the large intestine and r... more The IPAA technique restores anal functionality in patients who have had the large intestine and rectum removed; however, 1 of the most important reasons for pouch failure is tension on the anastomosis. The aim of this study was to compare technical procedures for mesenteric lengthening used for IPAA to reduce this tension. After randomization, 4 different techniques for mesenteric lengthening were performed and compared on fresh cadavers. This was a cross-sectional cadaveric study. In the first group (n = 5), stepladder incisions were made on the visceral peritoneum of the mesentery of the small intestine. In the second and third groups, the superior mesenteric pedicle was divided, whereas the ileocolic pedicle (n = 7) or marginal vessels (n = 6) were preserved during proctocolectomy. In the fourth group (n = 7), the superior mesenteric pedicle was cut without preserving any colic vessels. Mesenteric lengthening was analyzed. Angiography was performed to visualize the blood supply o...
Interactive cardiovascular and thoracic surgery, Jan 16, 2018
The purposes of this study were to identify possible compression points along the transit route o... more The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. The average width and length of the interscalene space in cadavers were 15.28 ± 1.94 mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43 mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space ...
OBJETIVOS: Durante o tratamento de fraturas fechadas do colo do metacarpo do dedo mínimo (fratura... more OBJETIVOS: Durante o tratamento de fraturas fechadas do colo do metacarpo do dedo mínimo (fraturas do boxeador) usando fixação percutânea com fio K transversal e outros procedimentos, pode ocorrer lesão iatrogênica do ramo digital dorsal do dedo mínimo (RDDDM) do ramo dorsal do nervo ulnar (RDNU). Neste estudo, visamos descrever a relação do RDDDM do RDNU e os pontos de inserção na face lateral do quinto metacarpo durante fixação percutânea com fio K transversal de fraturas subcapitais. MÉTODOS: Foram realizadas dissecações e medições desse ramo depois de colocação de pino transversal percutâneo na parte distal do quinto osso do metacarpo em dez mãos de cadáveres fixadas em formalina. RESULTADOS: Os resultados desse estudo confirmam a grande proximidade da trajetória do pino e desse ramo, e demonstram sua possível lesão iatrogênica durante a fixação do fio K no quinto metacarpo. CONCLUSÕES: Para evitar a penetração desse nervo e limitar as chances de lesão iatrogênica, é importante ...
Intraosseous access is a method for providing vascular access in resuscitation of critically ill ... more Intraosseous access is a method for providing vascular access in resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. There is a lack of detailed description for the landmark for the insertion point in the literature. The aim of this study was to determine the exact location for intraosseous access. Radiographic computed tomography (CT) images of a total of 50 dry tibia bones were obtained. With 5-mm intervals, for all transverse images and by selecting transverse section, measurements were taken from the thickness of the cortex at anterior margin and mid-line medial surface, distance from anterior margin and mid-line medial surface of the tibia to the posterior wall of medullar cavity, distance from anterior margin and mid-line medial surface of the tibia to the posterior surface of the tibia. The thinner part of the cortex of the tibia and the larger width of the medullar cavity is at 0.5 cm below the tibial tuberosity in the midline of the medial surface. The application region for proximal tibia access and landmark and most suitable insertion point for intraosseous infusion should be at level 0.5 cm below the tibial tuberosity in the midline of the medial surface. It was recommended that standard length for intraosseous canule should be 17 mm except for the thickness of skin. Presented study provides certain localization for intraosseous access and standard length for intraosseous canule and this will be more effective in using this technique. This article is protected by copyright. All rights reserved.
Surgical and radiologic anatomy : SRA, Jan 19, 2017
The purpose of this study was to elucidate the anatomy and clinical importance of extraforaminal ... more The purpose of this study was to elucidate the anatomy and clinical importance of extraforaminal ligaments in the cervical region. This study was performed on eight embalmed cadavers. The existence and types of extraforaminal ligaments were identified. The morphology, quantity, origin, insertion, and orientation of the extraforaminal ligaments in the cervical region were observed. Extraforaminal ligaments could be divided into two types: transforaminal ligaments and radiating ligaments. It was observed that during their course, transforaminal ligaments cross the intervertebral foramen ventrally. They usually originate from the anteroinferior margin of the anterior tubercle of the cranial transverse process and insert into the superior margin of the anterior tubercle of the caudal transverse process. The dorsal aspect of the transforaminal ligaments adhere loosely to the spinal nerve sheath. The length, width and thickness of these ligaments increased from the cranial to the caudal d...
Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical ... more Knowledge of the cranium projections of the gyral structures is essential to reduce the surgical complications and to perform minimally invasive interventions in daily neurosurgical practice. Thus, in this study the authors aimed to provide detailed information on cranial projections of the eloquent cortical areas. Ten formalin-fixed adult human skulls were obtained. Using sutures and craniometrical points, the crania were divided into 8 windows: superior frontal, inferior frontal, superior parietal, inferior parietal, sphenoidal, temporal, superior occipital, and inferior occipital. The projections of the precentral gyrus, postcentral gyrus, inferior frontal gyrus, superior temporal gyrus, transverse temporal gyri, Heschl gyrus, genu and splenium of the corpus callosum, supramarginal gyrus, angular gyrus, calcarine sulcus, and sylvian fissure to cranial vault were evaluated. Three-fourths of the precentral gyrus and postcentral gyrus were in the superior parietal window. The inferior frontal gyrus extended to the inferior parietal window in 80%. The 3 important parts of this gyrus were located below the superior temporal line in all hemispheres. The orbital and triangular parts were in the inferior frontal window, and the opercular part was in the inferior parietal window. The superior temporal gyrus was usually located in the inferior parietal and temporal windows, whereas the supramarginal gyrus and angular gyrus were usually located in the superior and inferior parietal windows. The farthest anterior point of the Heschl gyrus was usually located in the inferior parietal window. The mean positions of arachnoid granulations were measured as 3.9 +/- 0.39 cm anterior and 7.3 +/- 0.51 cm posterior to the bregma. Given that recognition of the gyral patterns underlying the craniotomies is not always easy, awareness of the coordinates and projections of certain gyri according to the craniometric points may considerably contribute to surgical interventions.
Eklem hastalıkları ve cerrahisi = Joint diseases & related surgery, 2010
The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. T... more The anatomy of the lateral complex of the ankle joint comprises multiple ligaments and muscles. This study aims to demonstrate the complexity of the lateral ankle structures in detail. The study was performed on 11 cadavers (22 ankles) fixed in 10% formaldehyde, and 24 free talus specimens. The detailed course and attachments of each ligament was observed and noted with the ankle in neutral position. Talar measurements were applied to 46 specimens including the dissected cadavers and free talus ones. This study also investigated the relationships between these ligaments and gross morphologic pattern of lateral complex and talus, including the morphological pattern of the peroneal groove and the relationship between the peroneal tendons before and after the peroneal groove. The whole relationship of lateral ankle structures including anatomic and morphologic patterns and talus were evaluated. No morphologic variation was found concerning peroneus brevis and longus muscles. Although t...
The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy... more The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy. Hip arthroscopy was performed on two hip joints of a fresh-frozen male human cadaver. The arthroscopic control of the femoral head and neck and acetabular labrum were evaluated using the da Vinci Surgical System. Docking of the robotic system and manipulation of the instruments were successful. Although most regions reached in standard arthroscopy were also reached with this robotic setting, the 5-mm instrument was limited in movement due to its long articulation section. The 8-mm instrument had shorter articulation section and exhibited a full range of motion inside the joints. The posterior part of the femoral head and the posteroinferior portion of the acetabular labrum could not be observed because of the rigidity of the equipment. Robotic hip arthroscopy appears feasible in a cadaveric model but has some significant limitations. With the development of special instrumentations, ar...
European Journal of Orthopaedic Surgery & Traumatology, 2011
... Burak Akan • Mehmet Armangil • Kerem Basarir • Halil Acar • Sinan Sirri Bilgin • Mehmet Demir... more ... Burak Akan • Mehmet Armangil • Kerem Basarir • Halil Acar • Sinan Sirri Bilgin • Mehmet Demirtas ... McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH (2000) Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary ...
Lower local recurrence rates and better overall survival are associated with complete mesocolic e... more Lower local recurrence rates and better overall survival are associated with complete mesocolic excision with central vascular ligation for treatment of colon cancer. To accomplish this, surgeons need to pay special attention to the surgical anatomical planes and vascular anatomy of the colon. However, surgical education in this area has been neglected. The aim of this study is to define the correct surgical anatomical planes for complete mesocolic excision with central vascular ligation and to demonstrate the correct dissection technique for protecting anatomical structures. Macroscopic and microscopic surgical dissections were performed on 12 cadavers in the anatomy laboratory and on autopsy specimens. The dissections were recorded as video clips. Dissections were performed in accordance with the complete mesocolic excision technique on 10 male and 2 female cadavers. Vascular structures, autonomic nerves, and related fascias were shown. Within each step of the surgical procedure, ...
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