The accurate recognition of surgical instruments is essential for the advancement of intraoperative artificial intelligence (AI) systems. In this study, we assessed the YOLOv8 model’s efficacy in identifying robotic and laparoscopic instruments in robot-assisted abdominal surgeries. Specifically, we evaluated its ability to detect, classify, and segment seven different types of surgical instruments. A diverse dataset was compiled from four public and private sources, encompassing over 7,400 frames and 17,175 annotations that represent a variety of surgical contexts and instruments. YOLOv8 was trained and tested on these datasets, achieving a mean average precision of 0.77 for binary detection and 0.72 for multi-instrument classification. Optimal performance was observed when the training set of a specific instrument reached 1300 instances. The model also demonstrated excellent segmentation accuracy, achieving a mean Dice score of 0.91 and a mean intersection over union of 0.86, with Monopolar Curved Scissors yielding the highest accuracy. Notably, YOLOv8 exhibited superior recognition performance for robotic instruments compared to laparoscopic tools, a difference likely attributed to the greater representation of robotic instruments in the training set. Furthermore, the model's rapid inference speed of 1.12 milliseconds per frame highlights its suitability for real-time clinical applications. These findings confirm YOLOv8’s potential for precise and efficient recognition of surgical instruments using a comprehensive multi-source dataset.

Objectif Explorer l’avenir des anciens tuteurs d’anatomie, leur perception de l’impact que le programme de monitorat d’anatomie a eu sur eux, en termes de performance académique, de développement professionnel et personnel, de connaissances anatomiques à long terme, et leurs points de vue sur l’éthique du don du corps. Nous avons aussi comparé leurs résultats académiques à ceux de leurs pairs non-tuteurs en termes de classement à l’examen classant national (ECN/EDN). Méthodes Une enquête volontaire a été envoyée par courriel à tous les tuteurs d’anatomie de 2005 à 2024, via un questionnaire Google Forms comprenant des questions fermées et ouvertes sur quatre thèmes. Les données quantitatives ont été analysées de manière descriptive, tandis que les réponses qualitatives ont fait l’objet d’une analyse thématique. Un test de Wilcoxon a été effectué pour comparer les classements des anciens tuteurs par rapport à leurs pairs. Résultats Quarante-sept tuteurs sur 48 ont répondu. Les tuteurs ont fait état d’un impact positif du programme, notamment d’une amélioration des compétences techniques (100 %), du travail en équipe (97,9 %), de la communication (89,4 %) et des compétences organisationnelles (76,6 %), ainsi que d’une bonne rétention des connaissances anatomiques à long terme (85,7 %). La dissection sur des donneurs de corps a été jugée essentielle pour l’apprentissage de l’anatomie tout en façonnant des valeurs professionnelles et éthiques. Sur les 36 internes/spécialistes, 38,9 % se sont classés dans les 10 % supérieurs à l’ECN/EDN, avec un rang statistiquement plus élevé que leurs pairs (p=0,0011), et 100 % ont obtenu la spécialité souhaitée. Conclusion Ces résultats suggèrent que ce programme a significativement amélioré les performances académiques des tuteurs, leurs compétences techniques, leur développement personnel et professionnel, et qu’il a été utile pour favoriser une perception positive de la dissection sur les donneurs de corps et a renforcé l’importance des connaissances anatomiques dans la pratique clinique.

Robotic sleeve gastrectomy (RSG) is gaining place among surgeons. In our initial RSG practice, we noticed that gastric staple line intraoperative bleeding is more frequent and more important compared to the conventional laparoscopic approach. Any technique that could reduce the likelihood of intraoperative bleeding in RSG would be of tremendous benefit. The present video report is a detailed description of a fully RSG using complete gastric staple line bioabsorbable reinforcement, minimizing intraoperative bleeding. We present the case of a 32-year-old female patient with severe obesity (weight = 132 kg; BMI = 46.8 kg/m2) that underwent fully RSG in our department. RSG technique is thoroughly described, highlighting several important aspects of RSG, including (i) patient positioning to optimize access and ergonomics; (ii) the use of a Nathanson liver retractor, avoiding interference with robotic arms; (iii) trocar placement strategy; (iv) intraoperative selection of stapler reloads; and (v) the use of a bioabsorbable reinforcement (Seamguard®, Gore) for staple line reinforcement and bleeding minimization. Operative time was 180 min, and, blood loss was minimal (< 10 ml). The patient was discharged on postoperative day 1. Postoperative recovery was uneventful, without bleeding, gastric leak, or other complications. Only simple oral analgesics were required postoperatively. At 1-month follow-up visit, the patient had lost 10 kg and reported significant improvement in overall health. Complete gastric staple line bioabsorbable reinforcement seems to decrease intraoperative bleeding when the robotic approach is used for sleeve gastrectomy. Prospective randomized studies are needed to validate this approach as gold standard practice for RSG.

Duodenal injuries are rare, associated with a significant morbidity. Their management is challanging and remains controversial. A retrospective study of all consecutive patients with duodenal trauma managed in 21 French trauma centers from 2004 to 2023. Clinical data, trauma mechanisms, injury severity, treatment modalities and outcomes were collected. Specific attention was given to surgical techniques such as damage control laparotomy, primary repair only and duodenal diversion. Statistical analysis was performed to identify factors associated with duodenal leak, severe morbidity and mortality. One hundred and thirty-five patients (71.7

The surgical management of patients with obesity and body mass index (BMI) ≥ 50 kg/m2 remains challenging, with no clear consensus on the optimal approach. Single-step and two-step metabolic and bariatric surgeries (MBS) are both used, but their comparative efficacy and safety have not been fully elucidated. This research aims to compare the outcomes of single-step and two-step MBS in patients with obesity and BMI ≥ 50 kg/m2. A systematic review and network meta-analysis including 56 studies was conducted following the PRISMA guidelines and the Cochrane protocol searching PubMed, Scopus, Embase, Web of Science, and Cochrane library up to the 28th of February 2025. Primary outcomes included percentage excess weight loss (

PURPOSE:To investigate the current practices in anatomy teaching at French universities in 2023.METHODS:On January 10, 2023, a questionnaire was sent to all members of the official list of the French Medical College of Professors of Anatomy. Each Anatomy centre was asked to complete this online form only once. The questionnaire covered several key themes, including broad questions, dissections practices, "virtual" dissections, teaching methods and teaching staff.RESULTS:The questionnaire was completed by 26/28 anatomy centres. Access to body donor dissection is reported to be mandatory in 15 of the 26 centers (58%), optional in 10 centers (38%), and "tolerated" in one center (4%). Fifteen of 26 centers (58%) reported having a virtual dissection table for teaching anatomy. Concerning the teaching of anatomy via live ultrasound, 10 out of 26 centers (38%) reported providing it. Regarding the teaching methods used for medical students, chalk and board lectures are the most common method, although the intensity of use varies. Most lectures are given with chalk and board in 42% (11/26) of the centers. In about 73% (19/26) of the centers, tablet lectures are used. Regarding anatomy teachers, it was reported that in 24/26 anatomy centres (92%), more than 50% of the courses for medical students are taught by professors holding the chair of anatomy (21/26 professors (81%), 3/26 associate professors (12%)).CONCLUSION:The present study endeavors to contribute to the existing body of knowledge on anatomy education by offering insights into the current practices in French universities.

To provide a detailed examination of the arterial blood supply to the middle third of the nasal skin through cadaveric dissections, identifying the primary arterial sources and their precise locations. Cadaveric dissections were performed on 14 hemifaces from fresh specimens. The main feeding arteries and their branches were carefully dissected under magnification. Morphometric characteristics of the specimens, along with the caliber of the arteries and their branches vascularizing the mid-third nasal skin were recorded, and statistically analyzed. Four main arteries were identified as responsible for the blood supply to the mid-third of the nasal skin: the facial artery, the nasal branch of the infra-orbital artery (nbIOA), the dorsal nasal artery, and the upper branches of the columellar plexus. The lateral nasal artery (LNA) and the nbIOA were the main contributors, each providing significantly larger arterial branches than the other sources (1.8 ± 0.8 branches of 0.67 ± 0.2 mm for the LNA, p-value < 0.001–1 ± 0 branches of 0.55 ± 0.17 mm for the nbIOA, p-value < 0.01). The largest arterial branch consistently penetrated the lateral and inferior angle of the mid-third nasal skin, originated either from the LNA or nbIOA. The LNA and nbIOA endorse crucial roles in the arterial blood supply to the mid-third nasal skin. Despite the variability in vascular anatomy, a consistent pattern of arterial supply with convergence in the depth of the alarfacial groove was observed. Understanding these patterns is vital for improving surgical precision and reducing the risk of complications in both aesthetic and reconstructive surgeries.

BACKGROUND:Over the past 30 years, there has been a major shift in the management of liver trauma. Contained hepatic vascular injuries (CHVI), including pseudoaneurysms and arteriovenous fistulas, are often feared because of the risk of secondary hemorrhage. However, little is known about CHVI. There are no guidelines for their management. Our aim was to validate the risk factors for CHVI, to identify the associated morbidities, and to establish a management protocol. MATERIALS AND METHODS:A retrospective study of 318 liver trauma cases from a level 1 trauma center over the past 15 years, comparing the presence or absence of CHVI. Univariable and multivariable analyses were conducted. The treatment used to manage CHVI was also compared. RESULTS:Liver trauma with the following characteristics, AAST grade ≥III, bilateral injuries, and laceration-type lesions, were associated with a higher risk of CHVI. Grade AAST ≥III and bilateral injuries were confirmed in a multivariable study with odds ratios as high as 4.0 and 3.5, respectively. CHVI was associated with significantly more delayed bleeding and controlled computed tomography. After analyzing the noninterventional management of CHVI less than 2 cm, a management algorithm is proposed. CONCLUSIONS:This retrospective unicentric study and literature review provide additional insight into the patient profile at risk for developing CHVI, its associated morbidity, and its management.

To explore the future of former anatomy tutors, their perception of the impact that the anatomy near-peer teaching (NPT) program have had on them, in terms of academic performance, professional development, personal growth, long-term anatomical knowledge, and views on body donor ethics. Additionally, we compared their academic performance with non-tutor peers in terms of ranking at the National Qualifying Examination (NQE). A voluntary survey was emailed to all anatomy tutors from 2005 to 2024, using an online Google Forms questionnaire including closed and open-ended questions across four themes. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis. A Wilcoxon signed-rank test was performed to compare former tutors’ NQE rankings to their peers. Forty-seven out of 48 tutors responded. Tutors reported a positive program impact, including improvements in technical skills (100

Bochdalek hernias are the most common congenital diaphragmatic hernias, followed by Morgagni hernias. The failure of closure of the pleuroperitoneal membrane results in a posterolateral foramen, which can remain silent until adulthood. They remain a rare pathology with nearly a hundred cases published. Its clinical presentation is variable, making its diagnosis challenging for clinicians. Additionally, its symptoms are not necessarily representative of the content of the hernia. Its management is balanced between the abdominal and the thoracic approaches. However, no guidelines or algorithms are available to help surgeons in the decision-making process. We report here four consecutive cases of symptomatic Bochdalek hernias. Each case has a singular presentation, and we share how they were approached at our institution. In particular, this series shows no reoccurrence in 10+ years of follow-up in two cases and 20+ in one case, underlying the importance of surgical management when Bochdalek hernias are symptomatic.

L'objectif de ce travail était de réaliser un état des lieux des enseignements de l'anatomie au sein des différents laboratoires en France. Un sondage internet a été diffusé via le groupe Renater des enseignants-chercheurs d'anatomie français début janvier 2023. Le questionnaire portait sur les types d'enseignements et formations dispensés au sein des laboratoires ainsi que sur les modalités pédagogiques et les personnels enseignants. Une personne devait répondre par laboratoire. Si l'accès aux dissections sur sujet anatomique est systématique pour les étudiants en médecine dans la majorité des laboratoires, les étudiants au-delà de la première année uniquement peuvent disséquer avec une prédominance en 3e année. La moitié des laboratoires disposent d'une table de dissection virtuelle et s'en servent comme modalité pédagogique. Peu de laboratoires (environ 30 %) proposent des formations académiques de type « écho-anatomie » alors que le reste des laboratoires (> 50 %) se montrent intéressés mais sont actuellement limités par l'accès au matériel ou en personne ressource. La majorité des laboratoires dispensent des cours magistraux à la craie et au tableau. Dans ces laboratoires, ces cours sont réalisés dans des proportions variables mais semblent prépondérant par rapport aux cours à l'aide d'un diaporama ou de la tablette tactile. La tablette tactile est utilisée pour les cours magistraux dans la majorité des laboratoires (> 50 %). Les cours magistraux à destination des étudiants en médecine sont majoritairement et dans la plupart des laboratoires dispensés par des enseignants PU-PH. Cette enquête permet de faire un état des lieux des différentes pratiques d'enseignement ayant cours au sein des différents laboratoires d'anatomie en France en 2023.

BACKGROUND: Low-impact laparoscopy (LIL), combining low-pressure insufflation and microlaparoscopy, is a surgical technique that is still not widely used and that has never been evaluated for the management of acute appendicitis. The aim of this study is to assess the feasibility of an LIL protocol, to compare postoperative pain, average length of stay, and in-hospital use of analgesics by patients who underwent appendectomy according to a conventional laparoscopy or an LIL protocol.STUDY DESIGN: Patients presenting with acute uncomplicated appendicitis who were operated on between January 1, 2021, and July 10, 2022, were included in this double-blind, single-center, prospective study. They were preoperatively randomly assigned to a group undergoing conventional laparoscopy, ie with an insufflation pressure of 12 mmHg and conventional instrumentation, and an LIL group, with an insufflation pressure of 7 mmHg and microlaparoscopic instrumentation.RESULTS: Fifty patients were included in this study, 24 in the LIL group and 26 in the conventional group. There were no statistically significant differences between the 2 patient groups, including weight and surgical history. The postoperative complication rate was comparable between the 2 groups (p = 0.81). Pain was reported as significantly lower according to the visual analog scale 2 hours after surgery among the LIL group (p = 0.019). For patients who underwent surgery according to the LIL protocol, the study confirms a statistically significant difference for theoretical and actual length of stay, ie -0.77 days and -0.59 days, respectively (p < 0.001 and p = 0.03). In-hospital use of analgesics was comparable between both groups.CONCLUSIONS: In uncomplicated acute appendicitis, the LIL protocol could reduce postoperative pain and average length of stay compared to conventional laparoscopic appendectomy.

The aim of the study was to determine the preoperative predictive factors of overall survival, relapse-free survival, and peritoneal carcinomatosis in obstructive colorectal cancer. Data from patients undergoing emergency surgery for obstructive colorectal cancer at our center between 2004 and 2016 were extracted retrospectively from our health records. Several preoperative parameters were used to predict survival and peritoneal carcinomatosis using univariate and multivariate analysis, and ROC curves. A total of 107 patients with obstructive colorectal cancer were included. Five-year relapse-free and overall survival rates were 14% and 28%, respectively, with 15% peritoneal carcinomatosis. Univariate analysis showed that age ≥ 83 years old, preoperative ASA score ≥ 3, initial hemodynamic instability, and CRP > 18.3 mg/L was significantly associated with worse relapse-free and overall survival. In a multivariate analysis, only age > 83 years (HR = 1.75; HR = 2.16, for relapse-free and overall survival status, respectively) and hemodynamic instability (HR = 7.29; HR = 6.55) were confirmed in the multivariate model. Global peritoneal carcinomatosis was significantly associated with synchronous liver metastases in the multivariate model (OR = 4.56), and synchronous peritoneal carcinomatosis only was significantly associated with platelet to lymphocyte ratio (PLR) > 269 and synchronous liver metastases in the multivariate model (OR = 0.003; OR = 7.26). Synchronous liver metastases are prognostic risk factor for global and synchronous peritoneal carcinomatosis whereas PLR > 269 was a significant protective factor for synchronous peritoneal carcinomatosis only for obstructive colorectal cancer. Age > 83 years and initial hemodynamic instability were key preoperative prognostic risk factors for worse relapse-free and overall survival. Prognostic usefulness of blood cell ratios for mortality and peritoneal carcinomatosis warrants further investigation.

Background: Digital neurovascular bundle defects are often encountered during crush or avulsion injuries and require complex reconstruction. Use of an arterialized nerve graft (neurovascular graft) serving both as an interpositional arterial conduit and as a nerve graft could be a reconstructive option in these cases. In this anatomical study, the authors aimed to describe a neurovascular graft of the posterior interosseous nerve and a branch of the anterior interosseous artery for neurovascular bundle reconstruction of the fingers. Methods: Eighteen forearms were injected with red latex in order to collect the anatomical characteristics of the posterior interosseous nerve and the artery running near it. Results: In all cases, the posterior interosseous nerve was followed by a branch of the anterior interosseous artery: the distal dorsal branch of the anterior interosseous nerve. The origin of this artery was proximal to the radiocarpal joint, at an average of 56.5 ± 11.1 mm. The proximal and distal diameters of the branch of the anterior interosseous artery were 1.6 ± 0.2 and 1.1 ± 0.2 mm, respectively. The proximal and distal diameters of the posterior interosseous nerve were 1.2 ± 0.3 mm and 1.1 ± 0.3 mm, respectively. Conclusions: These results show that a potential free neurovascular graft using the posterior interosseous nerve as nerve graft and the anterior interosseous artery as an arterial bypass to reconstruct both the nerve and arterial tree of the finger could be a useful approach. The authors speculate that this graft could be used to reconstruct the neurovascular bundle of amputated or devascularized digits.

PURPOSE:Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric dissection. New technologies are favored by students and could improve learning, complementing traditional teaching.METHODS:All students in second-year medicine at a single medical school were submitted to a novel anatomical course with digital tool exposure. We explored a new combined teaching method: a physical blackboard lesson synchronized with digital dissection, imaging and direct evaluation (BDIE). Synchronized dissection is broadcast live in the classroom and in partner medical schools. Following the course, students completed a short survey about their perception of this new anatomic clinical course.RESULTS:The survey included 183 students whom 178 completed the questionnaire, i.e., a 97% response rate. Ninety-nine percent of students thought this synchronized method useful to improve their understanding of anatomy and 90% stated it helped them retain this learning.CONCLUSION:This BDIE method, in conjunction with teaching guidelines and dissection, is highly appreciated by students who consider it helps them to acquire lasting knowledge.

Background & aims Nutrition education is necessary in the training of healthcare professionals, including medical students. However, recent surveys showed that there is a high variability within Medical Schools in different countries. The aim of this ESPEN position paper is to identify a minimum curriculum knowledge in nutrition that serves to improve the training of the future doctors and how to solve the main barriers of its implementation in university centres. Methods In 2017, the ESPEN Executive Committee launched the Nutrition Education in Medical Schools (NEMS) Project and formed a core working group including members of the ESPEN Nutrition Education Study Group (NESG) and representatives of several European Medical Schools. This group met in Brussels, on 19th July 2018 and decided to prepare a position paper on this topic. Results Five main learning objectives and twenty-one topics on human nutrition, within its three domains (basic, applied and clinical nutrition) were identified to be fulfilled at the end of training in all Medical Schools. The experts showed the following key factors for its implementation: establish a nutrition curriculum committee, use different models of integration of the contents in the curriculum (vertical and horizontal), have a multidisciplinary and experienced faculty, incorporate a variety of teaching models, and evaluate the programme periodically. Conclusions Nutrition Education is necessary and should be mandatory in all Medical Schools. This position paper aims at improving this gap knowledge and gives some clues for a successful implementation of the changes in the medical curriculum at university centres.

BackgroundInternal hernia is a rare but a potentially fatal complication of laparoscopic Roux-En-Y gastric bypass (LRYGB). The aims of this study are to determine the impact of mesenteric defects closure on the incidence of internal hernia after LRYGB and to determine the symptoms, characteristics, and management of internal hernias after LRYGB.MethodsA retrospective study for a total of 2093 LRYGB was carried out from 1998 to December 2013. Four hundred twenty-one patients were operated without closure of the mesenteric defects (group A). From January 2005 to December 2013, 1672 patients were operated with closure of the mesenteric defects at Petersen defect (PD) and at jejunojejunal anastomosis (J-J) defect (group B). The incidence of internal hernias was compared between the two periods.ResultsOut of the 2093 patients who underwent LRYGB, 20 patients (0.95%) developed a symptomatic internal hernia that required primary surgical intervention; 7 patients (1.66%) in group A all at J-J DEFECT versus 13 patients (0.78%) in (group B) 6 at (J-J DEFECT), 5 at PD, and 2 at PD, J-J DEFECT. This incidence was significantly lower in (group B) (p=0.0021). The median interval between LRYGB and reoperation was 53 months in group A and 26 months in group B. A CT scan was performed in 8 patients, 40%, and showed signs of occlusion in all cases.ConclusionsThe closure of mesenteric defects during LRYGB is recommended because it is associated with a significant reduction in the incidence of internal hernia.

BackgroundEndoscopic stent (ES) as a bridge to surgery in obstructed left colon cancer (OLCC) is controversial. Our goal was to compare the operative and oncological results of primary diverting colostomy (PDC) and ES for the curative treatment of OLCC.MethodsBetween 2000 and 2015, patients who underwent PDC or ES in a curative intent for OLCC at member centers of the French Surgical Association were included. Patients with unresectable tumors and/or synchronous metastases were excluded. Comparisons between the two groups were performed after ponderation with propensity score for: demographic and tumor characteristics, operative, and oncological results.ResultsA total of 518 patients were included: PDC (n=327); ES (n=191). The demographic characteristics were similar between the groups. ES failed in 23% of the patients (11% perforation). Cumulative tumor resection rates were 80% and 86% after PDC and ES, respectively (p=0.049). The rates of primary anastomosis were 57% in the PDC group and 40% in the ES group (p<0.0001). The permanent stoma rates were similar between the two groups (29% vs. 28%, p=0.0586). Cumulative overall, surgical, and medical complications were significantly higher in PDC group. The resected tumors were significantly smaller and less frequently perforated and metastatic in the PDC group. The median overall survival was significantly higher after PDC (123.6 vs. 58.5months, p=0.046), whereas the median disease-free survival was similar between the two groups (54.1 vs. 53.6months, p=0.646).ConclusionsAlthough endoscopic stenting is associated with better surgical outcomes than diverting stoma, it may negatively impact histological features and overall survival.

11548 Background: Some previous studies in geriatric oncology have described the GI and their adherence. Today’s challenge is to screen patients needing specific GI and repeated Comprehensive Geriatric Assessments (CGA). We recently analyzed a phenotype of patients requiring more GI (Boulahssass et al, Cancers 2019). The main purpose of the present study is to compare types of GI implemented, according to patient frailty levels, in order to better understand the necessary care plan. Methods: Between April 2012 and May 2018, 3530 consecutive patients with solid tumors were enrolled in this multicentric, prospective cohort. 3140 patients (mean age:82y) were finally included and a CGA was performed at Baseline. Twelve GI were standardized, individualized or based on experience if no guidelines were available. Within 1 month, geriatricians including patients in the cohort received standardized training. Logistic regression was performed to compare types of GI in the 3 groups using the Balducci Score (B1/B2/B3). Results: 8819 GI were implemented for the 3140 patients. On average, fit patients had 1.5 GI (n = 146), vulnerable patients 2.4 GI (n = 1568) and frail patients 3.3 GI (n = 1426). We observed no significant differences between the 3 groups concerning specific pain management (Fit vs B2: p = 0.19; Fit vs B3: p = 0.57) and psychological care (Fit vs B2:p = 0.03; Fit vs B3:p = 0.24). In vulnerable and frail patients, we recorded more significant GI for nutritional care, delirium prevention, comorbidity management, nursing interventions, social worker interventions, treatment modifications for optimization or iatrogenic disorders and physiotherapy, with the highest Odds Ratio for nursing interventions (Fit vs B2 OR:2.9 p = 0.011; Fit vs B3 OR:9 P < 0.001) and physiotherapy (Fit vs B2:OR 4.3 p < 0.001; Fit vs B3:OR:9 p < 0.001). B3 patients had significantly more GI on care pathways modifications (OR:3.1, p = 0.002) and caregiver care (OR:2, p = 0.049). Conclusions: Fit patients also needed GI. We observed differences in types of GI between the groups. However, the aims and levels also seemed to differ and need further studies to analyze their impact.

Background The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction. Methods Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery's characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction. Results We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of >= 0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections. Conclusion The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.