BackgroundThe medial coracoclavicular ligament (MCCL), is a structure that shows defined morphologic and histologic features. However, little attention has been paid to the MCCL to date. This study was conducted to (1) determine whether the MCCL is a constant structure, (2) analyze its mechanical properties, and (3) determine its possible role in acromioclavicular (AC) stability.MethodsAC joints, lateral coracoclavicular ligaments (LCCLs; conoid and trapezoid), and MCCLs were dissected in 30 fresh frozen upper limbs. In 6 of these specimens, we performed a sequential sectioning following the aforementioned order. A 20-N cephalad force was applied to the lateral clavicle at each step, recording the AC distance and coracoclavicular space and their variation. In 6 other specimens, we evaluated the anteroposterior motion of the clavicle following the MCCL section. Biomechanical testing was performed in 8 specimens, comparing the resistance of the MCCL to the LCCLs.ResultsThe MCCL in all of the specimens featured a sharp-edge bundle stretching from the coracoid process to the clavicle and subclavius sheath. It showed ligament-like mechanical properties although less tensile resistance than the LCCLs. Once the AC and LCCLs were sectioned, transection of the MCCL determined a significant increase in both cephalad and posterior displacement.ConclusionThe MCCL is a constant structure with the mechanical behavior of a ligament. It may act as the last container of the coracoclavicular space both in cephalad and posterior directions, precluding additional displacement in the absence of the LCCLs.

Background: The distal half of the hypothenar eminence (HE) skin vascularization has been extensively investigated. Different flaps have been described based on these arteries. Similarly, the vascularization of the proximal half of HE has also been investigated, although to a lesser extent. The aim of this paper is to determine, in a cadaver sample, the anatomy of the hypothenar cutaneous branches in their proximal half. Methods: In all, 20 adult, red-colored-latex-injected hands were studied. Dissections were performed with a 4X to 10X magnification. Cutaneous branches in the proximal half of the HE were found. Their variants were studied, and they were classified into different types according to their relationships. Results: A cutaneous branch of the deep palmar artery (CBDPA) was identified. It was located in the subcutaneous cellular tissue thickness in the proximal half of the HE. Moreover, it presented 3 anatomical variants, classified according to its relationships with the superficial ulnar nerve branch (SUN). Type 1 variant: the CBDPA and the PDA ran in front of the SUN (60% of cases). Type 2: the CBDPA and the DPA ran behind the SUN (30% of cases). Type 3: the CBDPA ran in front of the SUN while the DPA ran behind it (10% of cases). Conclusion: There is a CBDPA which is the HE proximal half main cutaneous branch. Although it presented several variants, its existence is constant, making it possible to use it as pedicle for proximal hypothenar flaps.

The abductor digiti quinti flap for thumb hypoplasia has been used in its muscular variant as musculocutaneous flap. Several authors have reported myocutaneous branches in the proximal hypothenar region which would vascularize the skin segment covering the hypothenar muscles. Nevertheless, the presence of a cutaneous branch deep palmar artery (CBDPA) vascularizing the proximal hypothenar territory and possibly responsible for the proximal hypothenar cutaneous vascularization was reported. In this paper, a fasciocutaneous hypothenar flap was designed, based on the CBDPA, transposed to the wrist anterior region for the treatment of a post burn contracture which was limiting the wrist extension. Its viability was assessed. The flap had a lozenge-shaped design from the cutaneous fold of the wrist to the fifth metacarpophalangeal joint over the abductor digiti quinti muscle. It was dissected in the fasciocutaneous plane to a width of 20 mm. The adipose tissue zone 10 mm distal to the pisiform was preserved, as well as the ulnar nerve sensory branch crossing the flap longitudinally. The flap was transposed to the anterior fold of the wrist. Neither the flap nor the donor site underwent complications. The patient improved wrist extension without referring any discomfort. Sensitivity was 8 mm 2 months after surgery compared to 6 mm within the preoperative period. In conclusion, it is possible to develop a proximal fasciocutaneous hypothenar flap based on CBDPA involving the proximal and distal hypothenar territory.

ResumenAbordamos el estudio de las bolsas adiposas palpebrales inferiores contemplando la importancia de dos ejes fundamentales como son, en la práctica, la blefaroplastia estética y el aspecto puramente anatómico.Sobre material formolizado de la región orbitaria y según técnica habitual, practicamos disecciones en cada una de las preparaciones anatómicas mediante las cuales fue posible estudiar, en la mitad inferior de la órbita, el comportamiento de la grasa y de las estructuras involucradas con ella permitiendo además incorporar la noción de la arquitectura del espacio retroseptal ántero-inferior y la de sus compartimentos o subdivisiones medial, central y lateral.Esta línea de investigación anatomo-quirúrgica condujo finalmente al preciso establecimiento de la ubicación y de las principales características de cada uno de los paquetes adiposos palpebrales inferiores. Palabras clave Párpado inferior, Grasa orbitaria,Bolsas palpebrales, Blefaroplastía.Nivel de evidencia científica 5 AbstractWe addressed the study of the lower eyelid fats bags contemplating the importance of two fundamental axes as they are, in the practice, cosmetic blepharoplasty and the purely anatomical aspect.Using formolized material orbital region and common technique, according dissections in each of the preparations were made in order to clarify, in the lower half of the orbit, the behavior of fat and structures involved with it, allowing besides incorporating the notion of architecture of the retroseptal space and of their compartments or medial, central and lateral subdivisions.This line of anatomic-surgical research led us finally to stablish precisely both the location and also the main features of each adipose packet of the lower lid.

<p><strong>Objetivo</strong></p><p>El ligamento de Caldani o córacoclavicular medial (LCCM) ha sido estudiado anatómicamente pero no hemos hallado mención alguna sobre su identificación imagenológica. El objetivo del presente trabajo es presentar una técnica original de resonancia magnética que hemos desarrollado para identificarlo, y describir las imágenes correspondientes.</p><p><strong>Materiales y Métodos</strong></p><p> Se incluyeron en el protocolo de investigación a 7 voluntarios sin patología de hombro conocida. Se utilizó un Resonador Magnético PHILLIPS INGENIA de una intensidad de campo magnético de 1.5 Tesla Versión 4.1, diámetro de Gantry (túnel del resonador) de 70 cm, bobina Sense específica para Hombro de 8 canales con imágenes de alta resolución. Se realizaron las secuencias de búsqueda del ligamento en tres planos.</p><p><strong>Resultados</strong></p><p>El LCCM fue identificado en todos los casos, extendiéndose oblicuamente desde la apófisis coracoides a la clavícula coincidiendo con las descripciones de la bibliografía anatómica consultada. Presentó una señal hipointensa en todas las secuencias, indicando el poco espacio entre fibras y correspondiendo a tejido colágeno compacto. Su longitud promedio fue de 41,15mm (entre 34mm y 47mm, desvío standard de 4,40). El espesor promedio fue de 2,11mm (entre 1,3mm y 3,2mm, desvío standard de 0,66).</p><p><strong>Conclusión</strong></p><p>El LCCM puede ser observado en imágenes de resonancia magnética mediante la técnica original que describimos. La posibilidad de localizar y observar el LCCM mediante resonancia magnética abre las puertas al estudio del mismo en futuras investigaciones, no sólo de compresiones neurovasculares sino también en lesiones traumáticas acromioclaviculares, especialmente en las tipo V de la clasificación de Rockwood.</p>