Nikolaos Anastasopoulos

Relapse of deformity after a successful Ponseti treatment remains a problem for the management of clubfoot. An untreated varus heel position and restricted dorsal flexion of the ankle are the main features of recurrences. We analyze the anatomical structures responsible for these recurrences. Materials and methods: During 5 years, 52 children with CTEV (Congenital Talipes Equino Varus) were treated with casts according to the Ponseti method, with a mean number of 7 casts. Closed percutaneous tenotomy was performed in 28 infants. Children were followed monthly and treated with the continuous use of a molded cast. We had 9 children with relapsed clubfeet. During the standing and walking phase, they had a fixed deformity with a varus position of the heel and dorsal flexion of the ankle <10 d. They were surgically treated with the posterolateral approach. Results: In all patients, we found a severe thickening of the paratenon of the Achilles in the medial side, with adhesions with the subcutaneous tissue. The achilles after the previous tenotomy was completely regenerated. The achilles was medially displaced. Conclusions: A severe thickening of the paratenon of the achilles and adhesions with the subcutaneous tissue are anatomical structures in fixed relapsed cases of clubfoot. We treated our patients with an appropriate surgical release.

Lipomas represent the most common benign mesenchymal tumor. They are usually located subcutaneously and rarely become symptomatic. Occasionally pressure symptoms on adjacent neurovascular structures may be exerted, thereby causing functional impairment. Lipomas rarely grow larger than 5 cm, becoming the so-called giant lipomas, posing a real diagnostic and surgical challenge. We report an unusual case of a 43-year-old Caucasian female with an accidental pelvic ultrasound finding of a giant mass, which was also palpable over the right gluteal region. Interestingly the patient was free of any sciatic nerve compression symptoms. Magnetic resonance imaging (MRI) revealed a soft tissue tumor, partially located in between the external rotator muscles of the hip and the gluteus muscle. The tumor forced up and advanced through the great sciatic foramen into the pelvis. The patient underwent an uneventful complete and safe surgical excision of the gluteal mass, via a wide transgluteal approach. Pathology confirmed lipoma diagnosis. Patient is free from recurrence two years post operatively. Physicians involved in the diagnosis and treatment of gluteal masses should always consider in their differential diagnosis the presence of a sciatic hernia.

Background: Detailed knowledge of the popliteal artery division and possible anatomical variants is of paramount importance for vascular surgery. Aim: The aim of the current study was to highlight a rare unilateral case of posterior tibial artery hypoplasia. Materials and methods: A dissection was performed at the posterior surface of the tibia in a 78-year-old Caucasian male cadaver of Greek origin. Results: The findings were consistent with unilateral posterior tibial artery hypoplasia and fibular artery enlargement. The variant fibular artery supplied the posterior surface of the distal leg and foot. Clinical implications of the fibular artery dominance are discussed. Conclusions: Rare anatomical variants of the tibial artery are of clinical significance to maximize safety and minimize intraoperative complications.