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    Neurovascular anatomy of pronator quadratus for reanimation of blepharoptosis
    (Springer France, 2022) Igde, Murat; Yilmaz, Mehmet; Gungor, Yigit; Saglam, Murat Enes; Salman, Necati; Tapan, Mehmet; Comert, Ela
    Purpose Pronator quadratus (PQ) is a quadrilateral muscle on a volar distal side of the forearm. The purpose of this study was to establish a novel surgical technique for reanimation of the upper eyelid for severe ptosis using PQ functional free muscle flap. Methods The current study is a cadaveric study, designed to assess a PQ free flap transfer that lies between the frontalis muscle and the upper eyelid. Fourteen PQ from fourteen embalmed cadavers were dissected, and their neurovascular pedicles were isolated. Then they were transferred to the area on the contralateral side between the frontalis muscle and upper eyelid tarsal cartilage. Measurements of the PQ flap, antebrachial region, orbitofrontal region, recipient vessels, and motor nerve were performed using a caliper. The extendibility of neurovascular pedicles was evaluated by measurements of lengths. In addition, the diameter of PQ flap vascular pedicle vessels was compared with recipient vessels. Results The mean width of the proximal border of PQ was 41.92 +/- 2.05 mm and the distal border of the PQ was 42.84 +/- 4.04 mm. The mean PQ artery (type II, Mathes-Nahai flap classification) length was found to be 117.72 +/- 7.77 mm. The mean diameter of the anterior interosseous nerve was 1.89 +/- 0.08 mm. The mean diameter of the uppermost branch of the frontal branch of the facial nerve was 1.18 +/- 0.25 mm. The length and diameter of neurovascular pedicles of muscle flaps were adequate for microvascular anastomoses and neurorrhaphy. Conclusions The results of this anatomical study demonstrate that the PQ free flap transfer has anatomical features that are suitable and compatible with the surgical treatment of blepharoptosis.
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    Pronator quadratus musculo-osseous free flap for wide hard palatal defect reconstruction: An anatomical study
    (Elsevier Sci Ltd, 2023) Igde, Murat; Salman, Necati; Gungor, Yigit; Yilmaz, Mehmet; Comert, Ela; Saglam, Murat Enes; Baykara, Yigit
    Wide hard palate defects include congenital and acquired defects that are six square centimeters or larger in size. Obturator prostheses and autologous soft tissue transfers have been used to reconstruct palatal defects. This study aims to repair wide, hard palatal defects by using a pronator quadratus musculo-osseous free flap to achieve subtotal reconstruction. Seventeen formalin-fixed cadavers were dissected. Free musculo-osseous pronator quadratus flaps were prepared after a 12 cm curvilinear volar skin incision. Standard 30 x 23 mm (690 & PLUSMN; 52.12 mm2) hard palate defects were made by chisels and saws. A subcutaneous tunnel was created between the mandibular edge cross point of the facial vessels and the retromolar trigone through the subcutaneous to the superficial musculoaponeurotic system by dissection. Area measurements of the pedicle and palate defects were performed by the ImageJ program (National Institutes of Health, Bethesda, MD, USA) on drawings over an acetate layer of materials. Mandibular distances of gonion-facial vessel cross point (a), goniongnathion (m), and facial vessels' cross point-retromolar entrance point (h) were measured. Ratios of h/m and a/m were calculated. The mean pronator quadratus area was 2349.39 & PLUSMN; 444.05 mm2, and the arterial pedicle pronator quadratus diameter was 2.32 & PLUSMN; 0.34 mm. The mean pedicle length of the pronator quadratus was 117.13 & PLUSMN; 8.10 mm. Study results showed that musculo-osseous pronator quadratus flaps' bone and muscle parts perfectly fit on the defects in all cadavers. Pronator quadratus musculo-osseous flap is a feasible surgical option for wide, hard palatal defect reconstruction strategies.& COPY; 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
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    Topographical Anatomy of the Superficial Temporal Artery
    (Turkish Neurosurgical Soc, 2023) Guler, Tugba Morali; Comert, Ayhan; Gungor, Yigit; Guner, Yahya Efe; Sayaci, Yagiz Emre; Korkmaz, Ali Can; Comert, Ela
    AIM: To describe in detail the gross anatomy of the superficial temporal artery (STA), its course and branches, its relationships with the branches of the facial nerve, and certain anatomical and surgical landmarks to preserve these structures in daily neurosurgical practice, and to use the STA during revascularization surgery.MATERIAL and METHODS: This cadaveric study was conducted on 16 cadaver heads bilaterally, in which 32 silicon/latex-injected STAs were dissected using a microdissection technique in a neuroanatomy laboratory. The distances between the facial nerve, tragus, STA, superficial temporal vein (STV), and imaginary lines created between important anatomical landmarks were measured. The curvilinear lengths of STA and STV were also measured.RESULTS: The average distances of the most posteriorly located branch of the facial nerve to the frontal region and the tragus at the midpoint of zygoma in the horizontal plane, at the superior border of the zygoma and at the level of the superior border of the parotid gland, were measured as 25.39, 29.84, and 15.56 mm, respectively. The average distance directly measured between the tragus and STA was 39.29 mm, and that between the tragus and STV was 20.26 mm. The average curvilinear lengths of the frontal and parietal branches of STA were 97.63 and 96.45 mm, respectively.CONCLUSION: Understanding the clinical anatomy of the STA and its branches and its relationships with other structures is of critical importance for a successful and noncomplicated surgery. Our findings will be useful not only for surgical approaches such as pterional craniotomy and orbitozygomatic approaches but also for cerebral revascularization.