Drake, Richard L.

During the past two decades, anatomy instruction has changed due to curricular reforms in medical schools. Reduction in total hours of anatomy course and cadaver dissection, as well as shifts towards an integrated curricula has raised questions whether changes have had a negative impact on the students’ knowledge of anatomy. Our purpose was to investigate the effect of changes in course hours, curriculum type, and laboratory experience on USMLE Step 1 and Step 2 CK scores. Results of 2009 AAA online survey of anatomy course directors from 54 LCME‐accredited schools were matched with USMLE scores for 6,411 examinees taking Step 1 for the first time in 2009. The USMLE scores included Step 1 total test scores, Step 1 gross anatomy sub‐scores, and Step 2 CK total test scores. Analyses of data indicate that for all three USMLE scores, examinees from schools with stand‐alone gross anatomy courses slightly outperformed examinees from schools with integrated curricula. Conversely, the number of course hours had no effect on how students performed on Step 1 or Step 2 CK. Examinees that were exposed to both dissection and prosection slightly outperformed on Step 2 examinees that had dissection only. While these relationships are statistically significant, they may not be practically meaningful and more research is needed to fully explore different aspects of anatomy curricula and retention of anatomy knowledge.

Background Dynamic and functional abdominal wall reconstruction (FAWR) remains a complex challenge. The ideal flap should have a minimal donor-site morbidity and cover a large surface area with motor and sensory capabilities. The goal was to investigate the feasibility of using a free chimeric flap with anterolateral thigh (ALT) and rectus femoris (RF) components pedicled only on the motor nerve branch. Methods Ten fresh cadavers were dissected with a designed chimeric thigh flap including ALT and RF flaps. Anterolateral thigh was designed and raised with the lateral femoral cutaneous nerve integrated, and the descending branch of the lateral circumflex femoral artery was preserved. Rectus femoris was elevated and the common pedicle was dissected up to the femoral origin. Accompanying motor nerve branches were carefully dissected to their femoral origin. Results Twenty RF flaps were dissected and 9 were harvested as a true chimeric flap with ALT. The mean number of neurovascular bundles associated with RF flap was 2.11 ± 0.47, and the mean primary motor nerve average length was 9.40 ± 2.42 cm. The common vascular bundle in all 9 chimeric flaps was ligated, and the flap was rotated toward the abdomen pedicled only by primary motor nerve of the RF muscle. Nerve length was adequate for reach up to xiphoid area in all 20 flaps. Conclusions This study demonstrates the feasibility of the chimeric ALT/RF muscle free flap pedicled only by the motor nerve branch, with adequate flap rotation. Even with the limitations in a live patient, this flap would be an excellent option for FAWR in the right patient.