Objective. The aim of this review was to present the vascular pattern of the STA, as well as anatomical variations, and to accentuate the areas which should be taken into consideration during manipulations along the course of the artery. Background. The STA may be encountered during several aesthetic procedures on the face, and iatrogenic trauma could be an incriminating factor of diverse sequelae. The constant increase in demand for facial aesthetic procedures has rendered it imperative to maximize safety and patient satisfaction. Methods. We conducted a narrative literature review using the electronic databases of PubMed and Google Scholar, retrieving studies concerning the anatomy and variations of the STA. Moreover, we identified registered clinical cases presenting complications which involved the artery. Discussion. The anatomic morphology of the STA is described and classification systems summarized, on the basis of the studies retrieved. In addition, the STA is related to defined landmarks, and specific danger zones are emphasized. Finally, the clinical significance of the artery is reflected in registered cases of adverse events following specific aesthetic surgeries. Conclusion. Thorough knowledge of the anatomical variability of the STA, and awareness of the danger zones involved in aesthetic procedures, combined with intraoperative vigilance could increase safety and minimize the advent of relevant sequelae.

Background: Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re‐laparotomy or re‐laparoscopy as a surgical option in the management of abdominal sepsis due to secondary peritonitis are limited and conflicting. Herein, we report the outcomes of patients undergoing staged peritoneal lavage (SPL) for secondary peritonitis in our department.Methods: This is a single‐center retrospective analysis of the data of patients undergoing SPL for secondary peritonitis. SPL was performed via either re‐laparotomy or re‐laparoscopy. The simplified acute physiology score (SAPS II) was calculated at the time of the initial operation and for each SPL. The end points of interest included: the evolution of sepsis characterized by the SAPS II score, the mortality rate and the rate of definitive abdominal wall closure.Results: The data of 74 patients with a median age of 73 years requiring at least one SPL between 2012 and 2019 were analyzed. The median number of SPL performed was three (range 1–12). A sequential drop of SAPS II score from 41 at the initial procedure to 32 at the third SPL was documented. The overall mortality rate was 16.2%, definitive abdominal closure was achieved in all surviving patients and the median length of stay was 17.5dConclusion: Staged re‐laparotomy or re‐laparoscopy with peritoneal lavage may reduce the severity of peritonitis and reduce the risk of mortality in patients with abdominal sepsis. Maintaining the abdominal wall under constant retraction using a rigid mesh while creating an open abdomen is a crucial step in achieving definite abdominal wall closure. Thus, staged peritoneal lavage may be a good surgical option for selected patients with peritonitis.

As the aesthetic expectations of our society are rising, the patients are increasingly inquiring about ways to reduce the postoperative scars and avoid multiple operations. Herein, we present a case of cholecystectomy combined with lipoabdominoplasty whereby gallstone disease, abdominal wall laxity and skin excess were concurrently addressed, thereby eliminating the need for trocar-incisions on the abdominal skin. We can conclude that lipoabdominoplasty with laparoscopic cholecystectomy is a safe combined procedure that can be performed selectively in patients with cholecystolithiasis and body contour problems leading to improved cosmetic results without the presence of unnecessary scars.

Objective. The subscapular artery vascularizes a substantial region of the thoracic wall, and the significance of its distribution is well depicted in the diversity of reconstructive procedures that rely on its blood supply. The aim of this study is to present an uncommon anatomical variation of the artery and discuss the clinical implications of its presence. Case Report. This case report depicts a rare variant of compression and the kinking of the subscapular artery by the radial nerve on the posterior wall of the axilla that was encountered during dissection of a male cadaver of Greek origin. Conclusion. The use of autologous tissues in the reconstruction of defects and treatment of lymphedema is expanding, so the need to establish safer surgical dissections is also becoming more apparent. The case of entrapment of the subscapular artery by the radial nerve is extremely rare, however, utiliz- ing tissues perfused by this artery for reconstructive purposes could potentially be futile and unsuccessful due to the inadequate blood supply or vessel thrombosis. Hence, the surgeon should adapt the treatment plan according to preoperative findings, as the presence of anatomical variants should always be suspected.

Background: The sternocleidomastoid (SCM) muscle is a prominent feature of the neck related to significant neurovascular structures with major clinical relevance in head and neck surgery. Variations of its anatomy and course have been widely documented; however, anatomical variants of its insertion are considered a rare occurrence. The aim of this study is to present a considerably uncommon anatomical variation of the insertion of the sternocleidomastoid muscle, discuss the clinical implications of its presence and suggest a possible role in the treatment of facial palsy. Case report: We present a rare case of bilateral supernumerary insertions of the sternocleidomastoid muscle that we came across during routine dissection on a male cadaver of a Caucasian donor to the Department of Anatomy. Specifically, the right sternocleidomastoid ascended as a single muscle belly that gave rise to six distinct tendons which inserted into the superior nuchal line of the occiput, while the left sternocleidomastoid muscle formed four distinct tendons prior to insertion. Conclusions: Morphological variations of the sternocleidomastoid muscle are relevant for clinical, surgical and radiological approaches of the neck. To our knowledge, the present case is the second reported insertional variation of the sternocleidomastoid muscle with supernumerary tendons. Its potential role in the treatment of facial palsy as a split muscle flap is also discussed and confirmation in the setting of a clinical scenario is encouraged. Keywords: sternocleidomastoid muscle supernumerary insertions anatomical variation head and neck surgery

Objective. The external jugular vein drains a considerable part of the head and neck and constitutes a vessel implicated in vari- ous procedures in the cervical region. The aim of this study is to present an uncommon anatomical variation of the external jugular vein, and discuss the clinical implications of its presence. Case Report. We present a rare case of an ectopic external jugular vein terminating into the axillary vein, that we came across during routine dissection of a male cadaver of Greek origin. Conclusion. The venous system of the external jugular vein is used during procedures for the treatment of various conditions such as cardiac arrhythmias, hydrocephalus and defects of the head and neck. Hence, encountering the unpredictable course of a variant draining into the axillary vein may complicate these interventions, leading to multiple manipulations and undesirable results. Surgeons should be aware of the alternate anatomy of the venous system of the cervical region, and mindful of the pos- sibility of encountering them.