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Öğe Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study(Journal Bone Joint Surgery Inc, 2006) Çetik, Özgür; Uslu, Murad; Acar, Halil Ibrahim; Cömert, Ayhan; Tekdemir, Ibrahim; Çift, HakanBackground: Several authors have defined a variety of so-called safe zones for deltoid-splitting incisions. The first aim of the present study was to investigate the distance of the axillary nerve from the acromion and its relation to arm length. The second aim was to identify a safe area for the axillary nerve during surgical dissection of the deltoid muscle. Methods: Twenty-four shoulders of embalmed adult cadavers were included in the study. The distance from the anterior edge of the acromion to the course of the axillary nerve was measured and was recorded as the anterior distance. The same measurement from the posterior edge of the acromion to the course of the axillary nerve was made and was recorded as the posterior distance for each limb. Correlation analysis was performed between the arm length and the anterior distance and the posterior distance for each limb. The ratios between arm length and the anterior and posterior distances were calculated for each case and were recorded as an anterior index and a posterior index. Results: The average arm length was 30.40 cm. The average anterior distance was 6.08 cm, and the average posterior distance was 4.87 cm. There was a significant correlation between arm length and both anterior distance (r = 0.79, p < 0.001) and posterior distance (r = 0.61, p = 0.001). The axillary nerve was not found to lie at a constant distance from the acromion at every point along its course. The average anterior index was 0.20, and the average posterior index was 0.16. Conclusions: The present study describes a safe area above the axillary nerve that is quadrangular in shape, with the length of the lateral edges being dependent on the individual's arm length. Using this safe area should provide a safe exposure for the axillary nerve during shoulder operations.Öğe Surgical anatomy of the transcanal infracochlear approach(Springer, 2022) Cömert, Ela; Cömert, AyhanPurpose The objective of this study is to describe the detailed surgical anatomy of the infracochlear approach to prevent complications and to compare the postauricular transcanal microscopic and endoscopic approaches to reach the petrous apex. Methods Cadaver heads were dissected using a binocular surgical microscope, endoscopes, and an electric drill. The dimensions of the access field that could be reached and manipulated with surgical instruments and straight drill via postauricular transcanal microscopic and endoscopic approaches were evaluated. Results Both postauricular microscopic and transcanal endoscopic approaches were considered to be inapplicable in cases with a tympanic cavity located jugular bulb closer than 3 mm to the cochlea. This relationship was seen in 3 (9%) sides of the cadavers. In 4 specimens (12%), a cochlear aqueduct with an open lumen was detected. Both postauricular microscopic and transcanal endoscopic approaches reached a nearly identic dissection area. Detailed anatomy of the approach and measurements about the topography of the third portion of the facial nerve from the tympanic cavity were presented. Conclusion Both traditional microscopic postauricular and endoscopic transcanal approaches provided comparable access areas to the inferior petrous apex with wide exposure, and radiologic measurements were compatible. A tympanic cavity located jugular bulb in close relation with cochlea was the only instance that restricted the applicability of this technique.Öğe Topographical anatomy of the dorsal branch of the ulnar nerve and artery: a cadaver study(Springer France, 2011) Cavuşoğlu, Tarık; Özden, Hilmi; Cömert, Ayhan; Yazıcı, İlker; Acar, Halil İbrahim; Tellioglu, Ali Teoman; Tekdemir, İbrahimPurpose The surgical anatomy of the dorsal branch of the ulnar nerve and artery on the dorsal aspect of the hand is important in design of neurocutaneous flaps for reconstructive surgery and serves as a donor site for nerve grafts. In this study, the course, location, and diameter of the dorsal branches of the ulnar nerve and artery were studied from anatomical and reconstructive perspectives. Methods Upper limbs of 14 (7 left and 7 right) and 22 formalin-preserved adult cadavers (15 left and 7 right) were dissected in two different centers. Results The diameters of the ulnar nerve, artery, and their dorsal branches were measured at selected reference points. The distances to specific anatomical landmarks were also measured, during their courses from the proximal forearm towards the middle phalanges of the 4th and 5th fingers. Conclusions Our data may facilitate the design of neurocutaneous flaps nourished from the dorsal branches of the ulnar nerve and artery, and may aid in the harvesting of nerve grafts from the dorsal branch of the ulnar nerve, and provide a safe surgical approach to the dorsum of the hand.Öğe Training Model for Microvascular Anastomosis(Lippincott Williams & Wilkins, 2009) Tellioğlu, Ali Teoman; Eker, Esabil; Çimen, Kadir; Cömert, Ayhan; Karaeminoğulları, Gökhan; Tekdemir, İbrahimA cadaver model was used for microvascular training as nonviable biologic model. Twenty-four fixed and 2 fresh adult cadavers were used for microvascular training. The radial artery, ulnar artery, and cephalic vein of the forearm were preferred. Respectively, end-to-end, end-to-side, and end-on-side microanastomosis techniques were performed. A cadaver model has several advantages over other training models. There are numberless vessels to perform different techniques for microvascular anastomoses. Several students can simultaneously work on the same cadaver at the same time. In addition, there is the opportunity of working on vessels of different sizes and diameters. The same conditions on the cadaver can be created before operation, and effective presurgical microvascular practice can be performed. A free-flap dissection can be easily performed to get experience before clinical operations. Furthermore, it may be combined with live animal models.Öğe Use of Dental Mirror in Microsurgical Practice(Lippincott Williams & Wilkins, 2009) Yazıcı, İlker; Çavuşoglu, Tarık; Cömert, Ayhan; Karakaya, Esen İbrahimIn this article, we introduce the use of dental mirror during microsurgery. We have been using no. 4 dental mirror during microvascular anastomoses and nerve coaptations for the last 6 months successfully and found that, as a cheap and easily obtainable instrument, it has facilitated our practice. We are strongly recommending the use of dental mirrors in microsurgical practice and inclusion to every microsurgery instrument set.
