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Magnetic resonance imaging (MRI) has emerged as the imaging method of choice for evaluation of perianal fistulizing disease. As treatment of Crohn disease and associated perianal fistulas has evolved to include a combination of systemic treatments and surgical interventions, perianal MRI provides critical information to guide treatment selection and timing. Radiologists need to be familiar with the normal regional anatomy to accurately describe perianal fistulas and any associated complications which can then be used to classify fistulas based on several available classification systems. Following treatment, MRI can provide information that suggests treatment success or failure. We propose a perianal fistula reporting template that includes the necessary information to convey fistula complexity, guide treatment, and evaluate treatment response. This review article will also discuss the postoperative appearance of many treatments currently used for management of perianal fistulizing disease and some associated complications.

SUMMARY Skeletal traction is a fundamental tool for the orthopaedic surgeon caring for patients with traumatic pelvic and lower-extremity orthopaedic injuries. Skeletal traction has proven to be an effective initial means of stabilization in patients with these injuries. Traction may be used for both temporary and definitive treatment in a variety of orthopaedic injuries. With the appropriate knowledge of regional anatomy, skeletal traction pins can be placed safely and with a low rate of complications. Several methods for placing skeletal traction have been described, and it is critical for orthopaedic surgeons to be proficient not only in their application but also understanding of the appropriate indications for use. Here we present a case example of a patient with a right femur fracture and discuss the technique and indications for placement of proximal tibia skeletal traction.

Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.

In view of debate on the optimal surgical planes for total mesorectal excision, this study was designed to explore the regional anatomy of the perirectal fascia and spaces.Twenty-one cadavers (15 male and 6 female) were embalmed and their vessels visualized by injection with color dye. From the cadavers, 30 hemipelves and 6 three-quarter pelves were harvested. The perirectal fascia and spaces and the pelvic autonomic nerves were dissected and examined.Three tissue layers were dissected from the inside to the periphery: the proper rectal fascia enveloping the mesorectum, the presacral fascia, and the piriformis fascia fused with the sacral periosteum. The mesorectum comprised 2 parts: posterior, with the classical posterolateral fat covered by the proper rectal fascia; and anterior, with the anterior fat covered by the posterior layer of Denonvilliers fascia. Extending anteriorly to the anterior layer of Denonvilliers fascia, the presacral fascia bisected the space between the mesorectum and the piriformis fascia into the retrorectal space and the presacral space. The retrorectal space extended cranially to the left Toldt's space, anterior to the space between the 2 layers of Denonvilliers fascia.From the inside to the periphery, the proper rectal fascia, the presacral fascia, and the muscular fascia are distributed in an annular pattern around the mesorectum. The presacral fascia divides the perirectal space into 2 annular parts: the central retrorectal space and the peripheral presacral space. The retrorectal space is the ideal surgical plane for the total mesorectal excision.

An understanding of the regional anatomy and specific biomechanics of the craniovertebral junction is relevant to the specific diseases that affect the region as well as instrumentation of the occiput, atlas, and axis. This article reviews the bony, ligamentous, and vascular anatomy of the region, in relation to the posterior surgical approach to this anatomically unique segment of the cervical spine. Anatomic variations of the area are also discussed. Basic principles of instrumentation of the region are also reviewed. The kinematics of the region as they pertain to the anatomic discussion are reviewed and discussed.

Owing to its complex anatomy, the neck harbors multiple pathologic processes. A comprehensive knowledge of regional anatomy and recognition of the patterns of disease presentation are vital to arriving at a meaningful differential diagnosis. This review of basic neck anatomy has utilized magnetic resonance imaging in showcasing the well-accepted spatial approach that emphasizes anatomic imaging, surgical landmarks, and imaging principles. To permit early recognition of neck pathology, detailed anatomic correlation is mandatory. Current imaging with high-resolution helical computed tomography, high speed magnetic resonance, and multiplanar reformations permit a detailed analysis of the complex anatomy in this region and is the key to understanding many of its disorders. Through such understanding we can recognize the issues involved in conservative neck surgery, neck nodal texture and functional assessment, brachial plexopathy, and the treated neck, appreciate the relevant surgical anatomy of the spaces in the neck, and relate better with our ENT colleagues.

Lymph node transfer is a novel technique in lymphedema surgery. In this study, we present our experience in harvesting lymph nodes flap based on the right transverse cervical artery. In a period of 7 months, we harvested 11 cervical lymph node flaps based on the right transverse cervical artery (TCA). The reliable anatomy of the TCA and the low complication rate of the donor site make this lymph node flap ideal for transfer in the treatment of lymphedema. Knowledge of the regional anatomy and the anatomic variations of the TCA are mandatory for safe dissection of this flap. We also present the preliminary results of our first 2 cases in which we performed cervical lymph node transfer for secondary lower extremity lymphedema.

Elbow arthroscopy is, to a degree, technically demanding. A complete knowledge of the regional anatomy of the elbow is essential. The technical expertise of the arthroscopist continues to improve, and sophistication of equipment continues to increase. These clear the way for new indications of elbow arthroscopy. It is obvious that with sound judgment in regard to case selection, with caution, and with prone patient positioning, arthroscopy can effectively address many pathologic conditions of the elbow in a minimally invasive fashion.

This textbook is coauthored by two hand surgeons who individually have made relevant and unique contributions to the understanding of hand surgery anatomy during their careers. Their collaboration has produced a convenient stand-alone comprehensive reference resource consisting of a collection of material from multiple texts and journals. The textbook is organized into two main sections. The first, entitled “Systems Anatomy,” consists of four chapters that separate the anatomy into skeletal, muscle, nerve, and vascular systems. The chapter on muscle anatomy includes a wonderful appendix that summarizes the origin, insertion, action, and innervations of all of the muscles of the upper extremity. These four pages will probably be cherished and carried around by every hand fellow for years to come. The chapter on vascular systems includes a brief description of vascularized bone grafts; however, illustrations are omitted and there is no description of the intercompartmental supraretinacular arterial supply, which one would expect to find here. The second section, entitled “Regional Anatomy,” consists of six chapters that divide …

This crisp, compact text covers the complete array of problems of the ankle and foot in recreational and high-performance athletes. The chapters are arranged according to regional anatomy, and each includes a concise description of the pathoanatomical and clinical features of each injury as well as a discussion of the appropriate diagnostic tests. The accompanying illustrations are …

by Steven J. Willing, 632 pp., ill., Philadelphia, WB Saunders, 1995, $135.00. The book is organized into 13 chapters based on disease processes for the central nervous system and by regional anatomy for the head and …

This two-volume single-author work was written by an internationally known expert in the closed management of fractures. In his introduction, Connolly appropriately acknowledges Sarmiento's major contributions to the field as well as Clawson's influence on his career. The book is divided into a large section on “Principles,” followed by a chapter entitled “Pediatric/Epiphyseal Plate Injury” and then by chapters on regional anatomy. The format is attractive, with a two-column design. An outline format is used on one side, and line drawings are presented in the opposite column. …

Injury to the greater auricular, hypoglossal and superior laryngeal nerves during carotid endarterectomy is preventable. A knowledge of regional anatomy and the mechanisms of such injury allows prevention of this complication. Unilateral individual nerve injury is generally well tolerated, but bilateral or combined nerve injuries can pose a serious threat to life. Minor modifications in technique aid greatly in avoiding nerve injury.

The distal ulnar tunnel is a region of the wrist 4-4.5 cm in length in which the ulnar nerve is particularly vulnerable to external compression. The relation of the internal topography of the nerve to the structures comprising the tunnel provides a basis for dividing the tunnel into three zones. Zone 1 is that portion of the tunnel proximal to the bifurcation of the ulnar nerve. Zone 2 encompasses the deep motor branch of the nerve, and Zone 3 surrounds the superficial branch. A review of the literature of ulnar nerve compression lesions confirmed expectations based on the regional anatomy. Zone 1 lesions included all (39) cases of combined motor and sensory deficits, one case of pure motor paralysis, and seven cases of sensory deficits. All Zone 2 lesions (36 cases) resulted in paralysis of the intrinsic muscles. Whether or not the hypothenar muscles were affected was dependent upon the location of the lesions within Zone 2. Zone 3 lesions caused sensory deficits only. Combined motor and sensory loss was most often caused by compression from deep to the nerve, while pure sensory deficits were a result of compression lesions lying superficial to the nerve.

The distal ulnar tunnel is a region of the wrist 4-4.5 cm in length in which the ulnar nerve is particularly vulnerable to external compression. The relation of the internal topography of the nerve to the structures comprising the tunnel provides a basis for dividing the tunnel into three zones. Zone 1 is that portion of the tunnel proximal to the bifurcation of the ulnar nerve. Zone 2 encompasses the deep motor branch of the nerve, and Zone 3 surrounds the superficial branch. A review of the literature of ulnar nerve compression lesions confirmed expectations based on the regional anatomy. Zone 1 lesions included all (39) cases of combined motor and sensory deficits, one case of pure motor paralysis, and seven cases of sensory deficits. All Zone 2 lesions (36 cases) resulted in paralysis of the intrinsic muscles. Whether or not the hypothenar muscles were affected was dependent upon the location of the lesions within Zone 2. Zone 3 lesions caused sensory deficits only. Combined motor and sensory loss was most often caused by compression from deep to the nerve, while pure sensory deficits were a result of compression lesions lying superficial to the nerve.