Citations

Background: The sural nerve is widely used as a nerve graft for various types of peripheral nerve repair due to its ease of harvest and acceptable donor-site morbidity. Nevertheless, certain clinical scenarios, such as cable grafting or multiple cross-face nerve grafts, require grafts longer than the typical 35 cm. This study aims to investigate the anatomic feasibility and clinical safety of an extended sural nerve harvest above the popliteal crease by interfascicular dissection. Methods: An anatomic study using 5 fresh-frozen cadaver legs was conducted, focusing on identifying the anatomic relationship of the sural nerve above the popliteal crease to its surrounding structures and nerve histopathology. A retrospective review was performed of all patients who underwent an extended sural nerve harvest, and patient outcomes, including nerve graft length and postoperative complications, were reviewed to evaluate the clinical feasibility of the extended harvest technique. Results: Anatomic dissection revealed that interfascicular dissection allowed for an additional 14.3 ± 6 cm of nerve length, achieving a total graft length of 49.1 ± 5 cm. Histologic analysis showed no significant differences in fascicle number or axon count along the nerve. A retrospective review, which included 7 adults and 2 pediatric patients, demonstrated that an extended sural nerve harvest was feasible and safe. The maximum graft length was 55 cm, and no intraoperative complications or functional deficits were reported. Conclusion: The extended sural nerve harvest above the popliteal crease with a step-incision approach was both anatomically feasible and clinically safe, providing additional graft length without increasing donor-site morbidity.

Background: Nerve transfer from the masseteric branch of the trigeminal nerve is a widely performed procedure for facial reanimation. Despite achieving powerful muscle force, clinical and aesthetic results leave room for improvement. Preclinical animal models are invaluable to establishing new therapeutic approaches. This anatomical study aimed to establish a masseteric-to-zygomatic nerve transfer model in rats and pigs. Methods: The masseteric branch of the trigeminal nerve and the zygomatic branch of the facial nerve were dissected in 30 swine and 40 rat hemifaces. Both nerves were mobilized and approximated to achieve an overlap between the nerve ends. Over the course of dissecting both nerves, their anatomy, length, and branching pattern were documented. At the coaptation point, diameters of both nerves were measured, and samples were taken for neuromorphometric analysis. Results: Anatomic details and landmarks were described. Tension-free coaptation was possible in all rat and pig dissections. In rats, the masseteric branch had an average diameter of 0.36 mm (±0.06), and the zygomatic branch average diameter was 0.46 mm (±0.13). In pigs, the masseteric branch measured 0.52 (±0.16) mm and the zygomatic branch, 0.59 (±0.16) mm. No significant differences were found between the diameters and axon counts of both nerves in pigs. In rats, however, their diameters, axon counts, and fascicular areas were significantly different. Conclusion: Our study demonstrated the feasibility of direct masseteric-to-zygomatic nerve transfer in rats and pigs and provided general anatomic knowledge of both nerves.

AbstractInflammatory pseudotumor (IPT), also known as plasma cell granuloma, is a rare lesion of unknown etiology that occurs in many organs, especially in the lung. Here we report five cases of IPT arising in pulmonary artery mimicking chronic thromboembolic disease, not previously documented in the literature. Those cases were identified at our institute among over 2500 pulmonary endarterectomy (PEA) specimens acquired from 2000 to 2017. The cohort included three men and two women with a median age of 41 years (range: 23–54). All patients presented with dyspnea and radiologic findings of pulmonary artery thromboembolism, some concerning for intimal sarcoma. The duration between disease onset and PEA ranged from 6 months to approximately 3 years. Histologically, all cases showed proliferation of spindle cells with marked inflammatory infiltrates composed predominantly of plasma cells, histiocytes, and small lymphocytes. Ancillary studies were performed in each case and ruled out other possibilities, such as sarcoma, lymphoma, plasmacytoma, IgG4‐related disease, and infection. IPT arising in pulmonary artery presenting clinically as acute or chronic thromboembolic disease is very unusual, in which clinical data, radiographic findings, and histopathologic features have to be integrated for reaching the proper diagnosis.