Objectives: To describe the presence and origin of superficial inferior epigastric artery (SIEA) of Vietnameses in formalined cadavers, and to describe the anatomical surface of SIEA on abdominal wall. Method: A cross-sectional study was carried out in 30 cadavers.
Trang 1RESEARCH ON THE PRESENCE, ORIGIN AND ANATOMICAL SURFACE
OF SUPERFICIAL INFERIOR EPIGASTRIC ARTERY
Cao Ngoc Bich*; Pham Dang Dieu**
Tran Ngoc Anh***; Tran Dang Khoa***
SUMMARY
Objectives: To describe the presence and origin of superficial inferior epigastric artery (SIEA)
of Vietnameses in formalined cadavers, and to describe the anatomical surface of SIEA on abdominal wall Method: A cross-sectional study was carried out in 30 cadavers Results: The presence of SIEA is about 85% and eighty five percents of SIEA which originate from the femoral artery The artery runs outward from middle column to lateral column and we can find the SIEA in the circle with 4 cm diameter at the middle inguinal ligament (90.0%) Conclusion: The presence of SIEA have a high proportion highly and we can find the SIEA in the circle with
4 cm diameter at the middle inguinal ligament
* Keywords: Superficial inferior epigastric artery; Femoral artery; Inguinal ligament
INTRODUCTION
The principal blood supply to the
abdominal wall are superficial epigastric
artery, inferior epigastric artery and superior
epigastric artery These blood supplies
have a correlation in presence and vascular
diameter Since that in using the abdominal
tissue flaps for plastic surgery, the SIEA
flap is first choice However, the inconsistent
anatomy and small dimension of SIEA is
problematic According to many studies by
authors in the world, the presence of SIEA
varies from 10% to 90% In Vietnam, this
research has not been informed yet Therefore
we carried out the research “Research on
the presence, origin and anatomical
surface of SIEA” with two targets: To
describe the presence and origin of SIEA
of Vietnamese in formalized cadavers, and to describe the anatomical surface of SIEA on abdominal wall
SUBJECTS AND METHODS
1 Subjects
- 30 adult Vietnamese cadavers
- Place of implement: the Department
of Anatomy at Pham Ngoc Thach Medical University in Hochiminh City
- Inclusion criteria: Adult Vietnamese over 18 years old and has not any surgery
on the abdominal wall
- Exclusion criteria: Abdominal wall defects by surgery, trauma or inborn and there was any intervention result in structural changes of abdominal wall vasculature
* An Sinh Hospital
** Pham Ngoc Thach Medical University
*** Vietnam Military Medical University
Corresponding author: Tran Ngoc Anh (anhtngoc @ gmail.com)
Date received: 07/01/2018
Date accepted: 28/02/2018
Trang 2Fig 1: Skin incision is on superficial layer of abdominal wall
- Make skin incisions: (1) an incision
along the inguinal ligament from superior
anterior illiac spine to pubic tubercle, (2)
an incision at medial one-third of thigh
from midpoint of inguinal ligament forward
to femoral direction, (3) a transversal
incision over pubic tubercle, (4) a vertical
incision from midpoint of pubis to xiphoid
process via navel, (5) an incision along
the costal coast to extend laterally
- Dissected skin follows above
incisions to find SIEA for description of its
origin and measurement of its
dimensions The presence of SIEA and
the distance from its origin to midpoint of inguinal ligament also were investigated
* Data analysis:
Codified variables, statistical analysis was performed with descriptive statistics
by using SPSS software ver.21.0 (IBM Co.)
RESULTS
The study was performed on
30 abdominal wall areas and 60 thigh areas both two sides of right and left of 30
cadavers including 11 females (36.7%),
19 males (63.3%) at the age from 47 to
93 (average 70)
1 Description of presence of SIEA
Table 1: Presence of SIEA on cadavers
0,337
Presence ratio of SIEA on cadavers were fairly high of 83.3% (right side) and 86.7%
(left side), which showed that the presence of SIEA on the same cadaver may not
different between two sides (p = 0.337)
Trang 3Fig 2: SIEA present in both two sides
The anatomical inconsistence of SIEA was described by Taylor G.I in 1975 According
to that, SIEA was absent or coud not be identified in 35% of dissected cadavers [2, 7] Some other studies presented the absent ratio of SIEA from 13% to 40% This ratio in the our study was compared with the other author’s in the following table:
Table 2: Compare the present ratio of SIEA with the other authors’
Author Sample size Presence
The present ratio in our study was high
at 85% In several cadavers, SIEA was
presented in one side only After study by
Thoma A et al in 2008 [9], the absence of
SIEA was common and was reported by
many authors with ratio at 13 - 40% [10]
As Tachi M et al (2005), SIEA was absent
in 50% Whereby, SIEA flap has
backward by the inconsistent presence,
too small caliber and short trunk of SIEA
[8]
As Nahabedian et al (2008), SIEA flap
could be used only in 30% of female with
average body mass [5]
Previous studies showed that SIEA flap
vascular pedicle was not present in 13 -
42% of surgery A recent study showed only 43% had at least 1 SIEA seen and suitable for elevation a tissue flap on 21%
of patients [4] Chevray P.M (2003) said that the anatomical variation and small size is flaw of SIEA flap Taylor and Daniel reported that SIEA was absent in 35% of cadavers Chevray found the absence of SIEA in 51% of patients Arnez et al also found the absence of SIEA
in 40% and too small caliber in 30% [1] Fukaya et al (2011) found 35% could not see SIEA [3] and SIEA flap was not
be a option for surgeons due to the inconsistence of anatomy and the short and the small of dimension of SIEA
Trang 4Common trunk of external circumflex femoral artery 1 (4.0%) 1 (3.8%)
Origin of SIEA from femoral artery was majority in both two sides, with 84% in right and 84.6% in left The minority originated from common trunk with the superficial circumflex illiac artery, pudendal artery, external femoral artery
Fig 3: SIEA arose from common trunk with pudendal artery
Fig 4: SIEA arose from external femoral artery above the inguinal ligament
Trang 5Fig 5: SIEA arose from common trunk with external circumflex femoral artery
The superficial epigastric artery located right under the inguinal ligament, arising from femoral artery (17%) or from common trunk with superficial circumflex illiac artery (48%) [11] In cases of clearly presented, 36% from a common trunk and 64.8% arose directly from femoral artery [3] Heaster et al supposed that in cases of could not see SIEA at level of femoral artery, it could arise from superficial circumflex illiac artery or
could be replaced by branches of superficial circumflex illiac artery [3]
3 Site of SIEA in 3 columns
To investigate the site of SIEA in 3 columns of abdominal wall for each side
Table 4: Location of SIEA as 3 abdominal wall skin colums on cadavers
Level of the
inguinal ligament
0.012
Level of superior
anterior iliac spine
0.011
Level of the
umbilicus
0.248
On the cadavers, the site of SIEA at the level of inguinal ligament got high ratio at 96.0% in right side and 88.5% in left side, remaining ratio was in exterior column and not any in the interior column
Trang 6Fig 6: Location of SIEA in the left side following 3 columns on cadaver
At the level of inguinal ligament, the site of SIEA in medial column, at the level of anterior superior illiac spine it was still in medial column, but at the level of imbilicus, it was in exterior column
These results were appropriate to the report by Fukaya et al (2011), the ability to see clearly a SIEA in medial column at level of inguinal ligament was 54.4%, at the ASIS was 68.7% in exterior column and at the umbilicus the they came back to medial column up to 60% [3]
4 Relation between SIEA and midpoint of inguinal ligament
Table 6: Relation between origin of SIEA and midpoint of inguinal ligamenton
the cadavers
(n = 25)
Left side
0.040
On the cadavers, SIEA located to exteriorly - and inferiorly was 60% in right side and the next was interiorly-inferiorly area There was only one case of arising directly from external illiac artery and located right over inguinal ligament
Whereby, we classified radius of circle at midpoint of inguinal ligament to determine the probability of presence of SIEA’s origin
Trang 7Table 7: Site of origin of SIEA in the
classified circle at midpoint of inguinal
ligament
Ratio Radius
Right side (n = 25)
Left side (n = 26)
On the cadavers, draw a circle with
radius of 40 mm at the midpoint of
inguinal ligament to find origin of SIEA
The probability of seeking the origin of
SIEA was 88% (right) and 92.3% (left)
The circle of radius 40 mm also accorded
with “Rule of interval 40” on the
abdominal wall
Fig 7: Circle with radius 5 cm to determine
the origin of SIEA was beneath the
inguinal ligament
The result of the study realized that in
the circle with radius 4 cm could find SIEA
at 90%, different from result of Fukaya et
al (2011) SIEA arose from femoral artery
at 2 - 3 cm inferiorly to inguinal ligament [3] and with Fathi M [2] in circle with radius of 1 cm might got the probability to find SIEA was 86.8%
CONCLUSION
Present rate of superficial epigastric artery was rather high up to 85% At the same indvidual, the presence of SIEA might not be simultaneous in both two sides Origin of SIEA from femoral artery was approximate by 85% The other minority arising from common trunk with superficial circumflex illiac artery, pudendal artery, external circumflex femoral artery and external illiac artery The course of SIEA ran gradually from medial column to exterior column The rate of presence of SIEA at this level decreased one - half in right side and nearly one - quarter in left side At the site laterally - inferiorly to the midpoint of inguinal ligament SIEA was present more than 60.0% and in the circle with radius 4
cm and the center was the midloint of inguinal ligament, the probability to find out SIEA was 90% This circle was suitable to the “rule of intervals of 40” in the abdominal wall
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