The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery

The clinical role of the lower trapezius musculocutaneous flap varies within the literature. Many describe its use in the reconstruction of the lateral neck and facial regions, but very few refer to its use in the posterior cervical and occipital regions. Different vascular pedicles have also been described and effectively used. A retrospective analysis was conducted, reviewing the authors' experience with 13 patients who suffered complex open wounds to the posterior cervical and occipital regions that were treated with a lower trapezius muscle or musculocutaneous flap. All flaps were based on the deep branch of the transverse cervical artery. This pedicle was used to support a relatively large skin segment over the distal portion of the lower trapezius muscle, a margin that, in the authors' experience, extends at least 1 cm beyond the muscular margin. Postoperatively, patients were evaluated based on complications, residual shoulder function, and aesthetic outcome. In addition to the clinical study, cadaveric dissection of the trapezius muscle was conducted on 22 specimens, and the vascular anatomy was confirmed by direct visualization. The authors' experience indicates that the lower trapezius musculocutaneous flap, when based on the deep branch of the transverse cervical artery, provides a reliable alternative for the reconstruction of complicated wounds in the posterior cervical and occipital regions, with the added capability of providing richly vascularized tissue to compromised wounds as far cephalad as the vertex of the skull.     

Comparative anatomical studies of thyroid and thymic arteries: I. Rat (Rattus norvegicus albinus)

The thyroid and thymic arteries were investigated in 50 male and 50 female rats. In more than 70% of the animals, on both sides the cranial thyroid artery forms a common trunk with the ascending pharyngeal artery. The caudal thyroid artery arises not from the deep cervical but from the pericardiacophrenic artery. It may be replaced, however, by a branch of some other artery, such as the brachiocephalic, subclavian, vertebral, or ascending cervical, suggesting a shift of its origin from the internal thoracic artery to the thyrocervical trunk as in man. All the thoracic lobes of the thymus are supplied directly by a thymic branch of the internal thoracic artery or indirectly by a branch of the pericardiacophrenic artery. More than half of the specimens have a cervical thymic lobe of variable size, which is supplied by a branch of the cranial thyroid, external carotid, and/or occipital arteries. Some of these thymic arteries, except those from the external carotid and occipital arteries, reach the thoracic lobe. The thoracic lobes lacking a cervical lobe may be supplied by the thymic branch arising only from the cranial thyroid artery. Other anomalous arteries supplying the thoracic lobe are derived from the superficial cervical and/or the right common carotid arteries. These results show that the thymic arteries of rats are basically similar to those of man, although they display a clear difference in their frequency and origin.     

Unique occipital articulation with the first vertebra found in pristigasterids, chirocentrids, and clupeids (Teleostei: Clupeiformes: Clupeoidei)

This study recognized a W-shaped occipital articulation associated with the first vertebra in pristigasterids, chirocentrids, and clupeids as a unique character among teleosts, based on an evaluation of 43 species within 40 genera of these three families of the Clupeoidei. This occipital articulation is accompanied by an anterior extension of the neural arch bases, which are autogenous with the first vertebral centrum. In chirocentrids and many of the clupeid species examined, the anterior extension occurs on the second vertebra, and similar occipital articulation is found between the first and second vertebrae. The W-shaped occipital articulation is not found in any other teleosts, including Denticeps (suborder Denticipitoidei), which is thought to be a sister group to the suborder Clupeoidei. The W-shaped occipital articulation is absent in the other family of the Clupeoidei, Engraulidae, based on an evaluation of 11 species in 10 genera. Instead, the convex anterior surface of the first vertebral centrum forms a condyle that articulates with the basioccipital, and the neural arches fuse with the centrum behind this condyle. Therefore, it is unclear whether the anterior extension of the first vertebral neural arch bases, which causes the W-shaped occipital articulation, occurs in engraulids. Based on an evaluation of the osteological development of Konosirus punctatus and Engraulis japonicus, the cartilaginous neural arch bases of the first and second vertebrae extend anteriorly at an early developmental stage in the former, whereas no anterior extension of the first vertebral neural arch bases occurs at any developmental stage in the latter. Therefore, the anterior extension of the neural arch bases, which causes the W-shaped occipital articulation, seems to be a unique character of pristigasterids, chirocentrids, and clupeids among teleosts. Within the recent phylogenetic context, this character may be a synapomorphy of these three families.     

The angular branch of the thoracodorsal artery and its blood supply to the inferior angle of the scapula: an anatomical study

An anatomical study of the thoracodorsal arterial system was performed; it focused on the angular branch. The aim of the study was to document the anatomical variations of this pedicle and to delineate the area of supply to the inferior angle of the scapula with a view to free bone transfer. A total of 81 cadaver dissections were performed; they revealed the constant presence of the thoracodorsal artery and four vascular patterns of origin of the angular branch. Selective India ink perfusion studies performed on 11 sides in six fresh cadavers demonstrated a reliable supply to the inferior angle of the scapula to the extent of 6 cm of the vertebral margin and 3 cm of the lateral margin of the scapula. Histologic analysis of sections of this region of the scapula confirmed the presence of ink within the periosteal, cortical, and medullary vascular channels, implying the viability of this area of bone if transferred based on the angular branch.     

The occipital region in the basal bony fish Erpetoichthys calabaricus (Actinopterygii: Cladistia)

Erpetoichthys calabaricus has unusual cranio‐vertebral anatomy, with an occipital centrum forming a component part of the compound basiexoccipital bone, and a ‘free‐floating’ occipital neural arch that differs from accessory arches found in some teleosts. The occipital neural arch bears autapomorphic lateral projections that articulate with small rod‐like bones resembling the spatial relationship of parapophyses and ribs, a feature normally restricted to vertebral centra. Based on analyses of cleared and stained specimens, computed tomography and histology, it is hypothesized that the lateral projections and associated rod‐shaped bones are structures that share developmental homologies to the unique ‘dorsal ribs’ of Polypteridae.     

New insights into the complex structure and ontogeny of the occipito‐vertebral gap in barbeled dragonfishes (Stomiidae,Teleostei)

In all stomiid genera there is an occipito‐vertebral gap between the skull and the first vertebra bridged only by the flexible notochord. Morphological studies from the early 20th century suggested that some stomiid genera have 1–10 of the anteriormost centra reduced or entire vertebrae missing in this region. Our study reviews this previous hypothesis. Using a new approach, we show that only in Chauliodus, Eustomias and Leptostomias gladiator vertebral centra are actually lost, with their respective neural arches and parapophyses persisting. We present results from a comparative analysis of the number and insertion sites of the anteriormost myosepta in 26 of the 28 stomiid genera. Generally in teleosts the first three myosepta are associated with the occiput, and the fourth is the first vertebral myoseptum. The insertion site of the fourth myoseptum plays an important role in this analysis, because it provides a landmark for the first vertebra. Lack of association of the fourth myoseptum with a vertebra is thus evidence that the first vertebra is reduced or absent. By counting the occipital and vertebral myosepta the number of reduced vertebrae in Chauliodus, Eustomias and Leptostomias gladiator can be inferred. Proper identification of the spino‐occipital nerves provides an additional source of information about vertebral reduction. In all other stomiid genera the extensive occipito‐ vertebral gap is not a consequence of the reduction of vertebrae, but of an elongation of the notochord. The complex structure and ontogeny of the anterior part of the vertebral column of stomiids are discussed comparatively. J. Morphol. 271:1006–1022, 2010. © 2010 Wiley‐Liss, Inc.     

Recurrent posterior circulation infarction caused by anomalous occipital bony process in a young patient

Background

Structural anomaly of the cervical spine or craniocervical junction has been reported as one of the rare causes of ischemic stroke. We report a case of a young patient with recurrent posterior circulation infarction that may have been associated with an anomalous occipital bony process compressing the vertebral artery.

Case presentation

A 23-year-old man experienced recurrent posterior circulation infarction 5 times over a period of 5 years. He had no conventional vascular risk factors. Young age stroke work-up including thorough cardiac, intra- and extracranial vascular evaluation and laboratory tests for the hypercoagulable state or connective tissue disease yielded unremarkable results. An anomalous bony process from the occipital base compressing the left vertebral artery was observed on brain CT. All the recurrent strokes were explainable by the arterial thromboembolism originating from the compressed left vertebral artery. Therefore, the left vertebral artery compressed by the anomalous occipital bony process may have been the culprit behind the recurrent thromboembolic strokes in our patient. Intractable recurrent strokes even under optimal medical treatment led us to make a decision for the intervention. Instead of surgical removal of the anomalous occipital bony process, the left vertebral artery was occluded permanently by endovascular coiling after confirming that this would cause no neurological deficits or flow disturbance in the posterior circulation. There was no recurrence of stroke for 2 years after permanent occlusion of the left vertebral artery.

Conclusion

Arterial thromboembolism originating from the left vertebral artery compressed by the anomalous occipital bony process is a rare but not to be overlooked cause of posterior circulation infarction. When intractable to medical treatment, endovascular occlusion of the vertebral artery without flow disturbance to the posterior circulation may be a useful treatment option when surgical removal is not feasible.

     

Morphofunctional peculiarities of the transverse processes of the axis, considerations on their pathogenetic significance.

The transverse process C2 plays an important role in the stabilization of the vertebral unit C2/C3 and the protection of the vertebral artery and the cervical spinal cord. The anatomical disposition of the transverse processes C2 and especially the lateral processes may be different from one subject to another. Certain anatomical variants of the transverse process can exert a negative effect on the stabilizing and protective function of the same. Our observations suggest that a maldevelopment or a lesion of the transverse process of the axis may induce extra stresses in the vertebral unit C2/C3 with subsequent development of a zygapophyseal arthrosis at this level. Any zygapophyseal arthrosis (uni- or bilaterally) should lead us to think of this possibility too.     

南京2号人类头骨化石的复位和形态

南京2号人类头骨化石仅保留部分的额骨、顶骨、枕骨和颞骨,为一不完整的颅盖骨。其顶骨和枕骨有数条断裂缝,各断块之间有程度不一的错动,致使该颅盖骨显得外形异常。本项研究是对该颅盖骨的错动部分进行复位,结果表明,南京2号头骨有较大的顶骨、较小的上枕鳞相对宽度、可能较大的颅容量。这些形态提示该头骨与直立人有所不同而与早期智人相近。该头骨所具有的角圆枕、颞鳞顶缘形状、枕骨圆枕发育程度、枕骨的枕平面与项平面过渡情况、枕内隆突点与枕外隆突点的距离、头骨骨壁厚度、脑膜中动脉分支情况、头骨枕面观之轮廓线样式等形态细节,还很难作为可靠的依据把南京2号头骨鉴定为直立人。南京2号头骨很大可能是属于智人亚种(Homo sapiens sapiens)中的一员。     

The arterial system of the sperm whale (Physeter macrocephalus)

The angioarchitecture of the sperm whale is basically similar to that of other mammals, but it has specific attributes associated with the aquatic environment of this animal and its tolerance for deep and long diving. Specialized features include an expansive aortic arch, unusually far anterior localization of the arch, symmetrical branching of common carotid and subclavian arteries from the aorta, the absence of direct connection between internal carotid arteries and brain arteries, the absence of a costocervical artery, and the presence of a well-developed occipital artery. The sperm whale has extraordinarily well-developed retia mirabilia, distributed in the cranial cavity, vertebral canal, neck and thoracic cavity, around the optic nerve, and in the walls of the uterus. These retia are more extensively developed in the sperm whale than in any other cetacean previously studied. J. Morphol. 234:37–50, 1997. © 1997 Wiley-Liss, Inc.     

Regionalization of axial skeleton in the lungfish Neoceratodus forsteri (Dipnoi)

Differentiation of the axial skeleton into distinct regions, once thought to be characteristic of the Tetrapoda, also occurs in the actinopterygian Danio rerio. In these taxa, the boundary between the cervical-thoracic regions correlates with Hoxc6 expression and morphological features such as position of the pectoral fin and associated nerves, and the absence of ribs. In the lungfish Neoceratodus, a member of the extant sister taxon to the Tetrapoda, the first vertebral element to chondrify is situated well posterior to the skull, developing from somites 6 and 7 (6/7) and associated with an enlarged cranial rib and nerves innervating the pectoral fin. Two vertebral elements develop later and more anteriorly, associated with somites 4/5 and 5/6. These three elements become incorporated into the occipital region of the skull during Neoceratodus ontogeny, until the cranial rib itself articulates to the rear of the skull. These features of early development indicate a regionalization of the Neoceratodus vertebral column: the cranial rib marks the boundary between the cervical and thoracic regions, the two more anterior vertebrae lacking ribs represent the cervical region, while somites 1-4 (cranial half), lacking any vertebral development, represent the occipital region. However, the cervical region of the vertebral column is effectively lost during ontogeny of Neoceratodus. A recognizable cervical region in the tetrapod vertebral column, as in zebrafish, suggests that cervical vertebrae are not incorporated into the skull but maintained as distinct elements of the column, representing an important shift in relative developmental timing and the influence of heterochrony in this region during the fish-tetrapod transition.     

The timing of spheno‐occipital fusion in hominoids

The degree of spheno‐occipital fusion has been used to assign a relative age to dentally mature hominoid cranial specimens. However, a recent study of captive individuals (Poe: Am J Phys Anthropol 144 (2011) 162–165) concluded that fusion of the spheno‐occipital suture in great ape taxa is of little utility for aging dentally mature individuals. In this contribution, I use dentally mature samples of extant hominoid taxa (Homo sapiens, Pan troglodytes schweinfurthii, Gorilla gorilla gorilla, Pongo pygmaeus pygmaeus and Hylobates lar) to investigate a) the temporal relationship between spheno‐occipital fusion and dental maturity, b) whether there is an association between the degree of spheno‐occipital fusion and relative age, c) whether there are differences in relative timing of spheno‐occipital fusion between taxa, and d) whether there are sex differences in the relative timing of spheno‐occipital fusion. Results suggest that a) a substantial proportion of dentally mature wild‐shot chimpanzee, gorilla and orang‐utans have unfused or partially fused spheno‐occipital synchondoses, b) there is an association between the degree of spheno‐occipital fusion and age, c) there are interspecific differences in the timing of spheno‐occipital fusion, and d) there are significant sex differences in spheno‐occipital fusion in chimpanzees, orang‐utans and gibbons. Thus, contrary to previous work, degree of spheno‐occipital fusion is a potentially useful indicator of relative maturity, especially in great ape taxa. Am J Phys Anthropol 156:135–140, 2015. © 2014 Wiley Periodicals, Inc.     

Anatomy of the lymph vessels and nodes of the head and neck in green marmosets]

In 50 mature green monkeys, the lymphatic system of the skin on the hairy part of the skull (occipital, parietal, frontal) and on the face was studied. The lymphatic vessels of cranial and cervical organs flow into submental, submandibular (anterior, medial, posterior) lymph nodes and into profound cervical (cranial, medial, caudal) lymph nodes. Lymph nodes together with efferent lymphatic vessels form lymph collectors of the neck which follow the blood vessels branching: superficial jugular, profound jugular and paratracheal network.     

The equine neck and its function during movement and locomotion

During both locomotion and body movements at stance, the head and neck of the horse are a major craniocaudal and lateral balancing mechanism employing input from the visual, vestibular and proprioceptive systems. The function of the equine neck has recently become the focus of several research groups; this is probably also feeding on an increase of interest in the equine neck in equestrian sports, with a controversial discussion of specific neck positions such as maximum head and neck flexion. The aim of this review is to offer an overview of new findings on the structures and functions of the equine neck, illustrating their interplay. The movement of the neck is based on intervertebral motion, but it is also an integral part of locomotion; this is illustrated by the different neck conformations in the breeds of horses used for various types of work. The considerable effect of the neck movement and posture onto the whole trunk and even the limbs is transmitted via bony, ligamentous and muscular structures. Also, the fact that the neck position can easily be influenced by the rider and/or by the employment of training aids makes it an important avenue for training of new movements of the neck as well as the whole horse. Additionally, the neck position also affects the cervical spinal cord as well as the roots of the spinal nerves; besides the commonly encountered long-term neurological effects of cervical vertebral disorders, short-term changes of neural and muscular function have also been identified in the maximum flexion of the cranial neck and head position. During locomotion, the neck stores elastic energy within the passive tissues such as ligaments, joint capsules and fasciae. For adequate stabilisation, additional muscle activity is necessary; this is learned and requires constant muscle training as it is essential to prevent excessive wear and tear on the vertebral joints and also repetitive or single trauma to the spinal nerves and the spinal cord. The capability for this stabilisation decreases with age in the majority of horses due to changes in muscle tissue, muscle coordination and consequently muscle strength.     

Development and evolution of the tetrapod skull–neck boundary

The origin and evolution of the vertebrate skull have been topics of intense study for more than two centuries. Whereas early theories of skull origin, such as the influential vertebral theory, have been largely refuted with respect to the anterior (pre‐otic) region of the skull, the posterior (post‐otic) region is known to be derived from the anteriormost paraxial segments, i.e. the somites. Here we review the morphology and development of the occiput in both living and extinct tetrapods, taking into account revised knowledge of skull development by augmenting historical accounts with recent data. When occipital composition is evaluated relative to its position along the neural axis, and specifically to the hypoglossal nerve complex, much of the apparent interspecific variation in the location of the skull–neck boundary stabilizes in a phylogenetically informative way. Based on this criterion, three distinct conditions are identified in (i) frogs, (ii) salamanders and caecilians, and (iii) amniotes. The position of the posteriormost occipital segment relative to the hypoglossal nerve is key to understanding the evolution of the posterior limit of the skull. By using cranial foramina as osteological proxies of the hypoglossal nerve, a survey of fossil taxa reveals the amniote condition to be present at the base of Tetrapoda. This result challenges traditional theories of cranial evolution, which posit translocation of the occiput to a more posterior location in amniotes relative to lissamphibians (frogs, salamanders, caecilians), and instead supports the largely overlooked hypothesis that the reduced occiput in lissamphibians is secondarily derived. Recent advances in our understanding of the genetic basis of axial patterning and its regulation in amniotes support the hypothesis that the lissamphibian occipital form may have arisen as the product of a homeotic shift in segment fate from an amniote‐like condition.     

Sonographic imaging of the bovine fetus

Transrectal sonography documenting the anatomical features of 71 bovine fetuses was performed between Day 30 and 10 mo of gestation. Sector scanners, which have a wider field of view into the depth of the uterus, were used, and it was found that most macroscopic organs were visible with B-scan ultrasound. The first organ detected around the end of the first month of pregnancy was the heart. The orbit, the stomach and the braincase were identified at Day 40. Most bones of the skeleton and the scrotum appeared around Month 3. Characteristic sonographic images of the head, neck, vertebral column, thorax, stomach, liver, kidneys, urinary bladder, limbs, scrotum-respectively teats, as well as the umbilical cord, amnion and allantois are described in this study.     

Sexual selection is not the origin of long necks in giraffes

The evolutionary origin of the long neck of giraffes is enigmatic. One theory (the 'sexual selection' theory) is that their shape evolved because males use their necks and heads to achieve sexual dominance. Support for this theory would be that males invest more in neck and head growth than do females. We have investigated this hypothesis in 17 male and 21 female giraffes with body masses ranging from juvenile to mature animals, by measuring head mass, neck mass, neck and leg length and the neck length to leg length ratio. We found no significant differences in any of these dimensions between males and females of the same mass, although mature males, whose body mass is significantly (50%) greater than that of mature females, do have significantly heavier (but not longer) necks and heavier heads than mature females. We conclude that morphological differences between males and females are minimal, that differences that do exist can be accounted for by the larger final mass of males and that sexual selection is not the origin of a long neck in giraffes.     

The lower trapezius musculocutaneous flap from pedicled to free flap: anatomical basis and clinical applications based on the dorsal scapular artery

The pedicled lower trapezius musculocutaneous flap is a standard flap in head and neck reconstruction. A review of the literature showed that there is no uniform nomenclature for the branches of the subclavian artery and the vessels supplying the trapezius muscle and that the different opinions on the vessels supplying this flap lead to confusion and technical problems when this flap is harvested. This article attempts to clarify the anatomical nomenclature, to describe exactly how the flap is planned and harvested, and to discuss the clinical relevance of this flap as an island or free flap. The authors dissected both sides of the neck in 124 cadavers to examine the variations of the subclavian artery and its branches, the vessel diameter at different levels, the course of the pedicle, the arc of rotation, and the variation of the segmental intercostal branches to the lower part of the trapezius muscle. Clinically, the flap was used in five cases as an island skin and island muscle flap and once as a free flap. The anatomical findings and clinical applications proved that there is a constant and dependable blood supply through the dorsal scapular artery (synonym for the deep branch of the transverse cervical artery in the case of a common trunk with the superficial cervical artery) as the main vessel. Harvesting an island flap or a free flap is technically demanding but possible. Planning the skin island far distally permitted a very long pedicle and wide arc of rotation. The lower part of the trapezius muscle alone could be classified as a type V muscle according to Mathes and Nahai because of its potential use as a turnover flap supplied by segmental intercostal perforators. The lower trapezius flap is a thin and pliable musculocutaneous flap with a very long constant pedicle and minor donor-site morbidity, permitting safe flap elevation and the possibility of free-tissue transfer.     

Evolution of axial patterning in elongate fishes

Within the ray-finned fishes, eel-like (extremely elongate) body forms have evolved multiple times from deeper-bodied forms. Previous studies have shown that elongation of the vertebral column may be associated with an increase in the number of vertebrae, an increase in the length of the vertebral centra, or a combination of both. Because the vertebral column of fishes has at least two anatomically distinct regions (i.e. abdominal and caudal), an increase in the number and relative length of the vertebrae could be region-specific or occur globally across the length of the vertebral column. In the present study, we recorded vertebral counts and measurements of vertebral aspect ratio (vertebral length/width) from museum specimens for 54 species representing seven groups of actinopterygian fishes. We also collected, from published literature, vertebral counts for 813 species from 14 orders of actinopterygian and elasmobranch fishes. We found that the number of vertebrae can increase independently in the abdominal and caudal regions of the vertebral column, but changes in aspect ratio occur similarly in both regions. These findings suggest that abdominal vertebral number, caudal vertebral number, and vertebral aspect ratio are controlled by separate developmental modules. Based on these findings, we suggest some candidate developmental mechanisms that may contribute to vertebral column patterning in fishes. Our study is an example of how comparative anatomical studies of adults can generate testable hypotheses of evolutionary changes in developmental mechanisms.  © 2007 The Linnean Society of London, Biological Journal of the Linnean Society , 2007, 90 , 97–116.     

A new aid to aging immature skeletons: development of the occipital bone

A total of 150 immature and young adult skeletons from the medieval necropolis at Mistihalj, in southern Yugoslavia, were aged by the standard methods: dentition, osseous development, and extent of vertebral union. The development of the occipital bone was examined in 117 cases to determine if it could be used in aging the skeletons. The stages of development were found to be regular enough to permit reasonable prediction of age for other Yugoslavian specimens. Comparisons with a series of 20 German fetuses suggest measurements of the parts of the occipital bone can be used to help determine the approximate age of skeletons in the fetal to few-months post-natal range. Comparisons with the ten Egyptian skulls and data on 19 unpublished Eskimo skeletons suggest that the stages of development can be used with other populations.