Anatomical and Radiological Study of the Vascular Distribution and Skin Territory for the Tensor Fasciae Latae Free Flap / 대한해부학회지

The authors studied the pattern of vascularization of the tensor fasciae latae muscle in 110 Korean cadavers using macroscopic dissection and radiographic methods. The location of the points in this study were expressed as XY coordination in reference to the line between ASIS (A) and lateral margin of the patella (B). The deep femoral artery was arised from XY coordination value X: 8.1 cm, Y: 5.5 cm. The length and external diameter of the deep femoral artery were 30.0 mm, and 5.6 mm, respectively. The most common pattern of the lateral circumflex femoral artery was from the deep femoral artery 81.4% (n: 176) and femoral artery 18.6% (n: 42). The lateral circumflex femoral artery was arised from XY coordination value X: 10.3+/-1.3 cm, Y: 4.6+/-0.8 cm and ended XY coordination value X: 10.5+/-2.3 cm, Y: 3.7+/-9.6 cm. Lateral circumflex femoral artery branched into ascending, transverse and descending branch. The length and external diameter of the lateral circumflex femoral artery was 21.2+/-12.9 mm, and 5.1+/-2.3 mm, respectively. The average number of branches, length and external diameter of pedicles to the tensor fasciae latae muscle were 3.9+/-3.5, 30.9+/-12.1 mm and 2.6+/-0.7 mm, respectively. The pedicle of the tensor fasciae latae muscle arised from XYcoordination X: 8.8+/-2.0cm, 1.8+/-0.9 cm and skin territory was 5x13 cm2 at 13 cm on the line AB. The pattern of distribution, arterial supply and territories of the tensor fasciae latae muscle obtained in this study will provide useful anatomical backgrounds for the free flap surgery.

Morphometrics of Arterial Supply for External Pudendal Artery Flap in Koreans / 체질인류학회지

This study was performed to measure the distance of perforating point for superficial and deep external pudendal arteries from pubic tubercle and anterior superior iliac spine, patterns of arterial distribution, and external diameter. Fifty three thighs from 27 Korean cadavers (13 males / 14 females), clinically normal and without deformity, were dissected and standard points were determined as follows: point of pubic tubercle (A) and point of anterior superior iliac spine (B). The obtained results were as follows: 1. The external pudendal artery branched from femoral artery was distributed in the medial thigh. Superficial external pudendal artery is located above the saphenous opening and Deep external pudendal artery is located below the saphenous opening. 2. The saphenous opening were 4.7+/-1.2 cm apart from point A and 10.1+/-1.3 cm from B. 3. The superficial external pudendal artery were 5.2+/-1.2 cm apart from A and 8.9+/-2.1 cm from B. 4. The deep external pudendal artery were 4.7+/-1.1 cm apart from A and 10.8+/-1.3 cm from B. Consequently, the patterns of distribution of superficial and deep external pudendal arteries, obtained in this study, will provide useful anatomical backgrounds for the external pudendal flap surgery in korean.

Pedicle and Skin Territory of the Vastus Lateralis Muscle for the Anterolateral Thigh Free Flap / 체질인류학회지

The pattern of location, perforator artery and skin territory of the descending branch of the lateral circumflex femoral artery are very important to the anterolateral thigh free flap surgery. The author studied the pattern of vascularization of the anterolateral thigh in 110 Korean cadavers using macroscopic dissection and radiographic methods. The location of the points in this study were expressed as XY coordination in reference to the line between ASIS and center of the lateral margin of the patella. The location of pedicle of the vastus lateralis muscle at XY coordination valued X: 20.8+/-6.0 cm, Y: -1.2+/-1.0 cm. The length and external diameter of the pedicle were 91.7+/-54.9 mm, and 2.7+/-0.8 mm respectively. The average number of perforator artery to the vastus lateralis muscle were 3.2+/-1.5. The skin territory of the perforator of the vastus lateralis muscle was 6 x 18 cm2, its location was 20.8 cm on the line AB. The pattern of distribution and territories of the anterolateral thigh obtained in this study will provide useful anatomical backgrounds for the flap surgery of anterior and anterolateral thigh.

Morphometric Characteristics of Arterial Supply of Tensor Fasciae Latae Muscle in Korean / 체질인류학회지

Tensor fasciae latae muscle is a thick muscle with heavy fascial investment and is extensively used for the reconstruction of musculocutaneous tissue loss following major injuries including burn, trauma, and bed sore. Most of known reference values for the measurement of this muscle are from foreign subjects and no measurement in Korean subject were reported. This study demonstrates the characteristics of the arterial supply of the tensor fasciae latae muscle for flap. Total 67 Korean cadavers (41 males and 26 females), clinically normal and without deformity, were dissected. The pattern of distribution of the arteries supplying the muscle was studied, and entering points of each arteries to the muscle were measured as relative coordination from anterior superior iliac spine (A) and center of patella (B). The point of the line AB which meets perpendicular line from entering point of each vessel (P) was definde as C. The length of AP (X) and PC (Y) was measured. 1. Average length of the line AB was 424.7 mm and was longer in male (438.3 mm) than in female (403.1 mm) subjects ( p< 0.01). 2. The XY coordination of origin of the muscle from line AB was-48.8 mm and-21.7 mm and that of insertion of the muscle was 157.9 mm and-20.9 mm. 3. Average length, width, and thickness of the tensor fasciae latae muscle were 167.2 mm, 35.9 mm, 10.5 mm, respectively, and the muscles were longer in male than in female subjects ( p< 0.01). 4. The existence of ascending branch of lateral femoral circumplex artery was 77.5%. The ascending and transverse branches were 16.9%. The ascending and descending branches were 2.8%. The ascending branch of lateral femoral circumflex artery and branch of femoral artery were 1.4%. The ascending branch of lateral femoral circumflex artery and branch of deep femoral artery were 1.4%. 5. Lateral circumflex femoral artery reached the tensor fasciae latae muscle at X: 97.9 mm, Y: 31.3 mm. 6. Point where the muscular branch of lateral circumflex artery to the tensor fasciae latae muscle began, was X: 88.8 m, Y: 17.1 mm. 7. The length and external diameter of pedicle were 30.9 mm, and 2.6 mm respectively. 8. The average number of branches of pedicle to tensor fasciae latae muscle was 7.1. 9. When line AB length was based on 100%, the origin and insertion of the tensor fasciae latae muscle were-11.5% and 37.2% respectively. The branching point from lateral circumflex femoral artery was 23.5%. The last branching point before entering the muscle was 20.9%. The entering point of the branches of pedicles was 16.7%. These data provides the anatomical characteristics of the arterial supply of the tensor fascia latae muscle in Korean in clinical relevance with musculocutaneous flap.

Age-related Alterations of Apoptosis in Ischemic-reperfused Rat Tibialis Anterior and Soleus Muscles / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Such injury takes place in the phase of reperfusion following ischemia induction in part via regulating of apoptosis-related gene inductions. The present study was performed to examine the age-related alertation of expression of apoptosis in rat tibialis anterior and soleus muscles following ischemia-reperfusion. 9 weeks, 30 weeks, and 65 weeks old male Sprague-Dawley rats were divided into 2 groups such as controls and ischemia. For ischemia, left commom iliac artery was occulded for 4 hours using rodent vascular clamps. The tibialis anterior and soleus muscles were removed 0, 3, and 24 hours after onset of reperfusion. Muscle samples were embedded in paraffin and 6 micrometer sections were made. The apoptotic reactions was detected using TUNEL methods. The results obtained were as follows; 1. In control groups, the number of apoptosis was increased with aging, but not significantly. 2. In ischemia groups, the number of apoptosis was increased at 3 hours after ischemia, and decreased at 24 hours after ischemia. 3. In ischemia groups, the number of apoptosis was increased with aging. 4. In ischemia groups, the number of apoptosis in the tibialis anterior muscle was higher than that in soleus muscle. These results suggested that the ischemic injury of the rat skeletal muscle is increased with aging and that tibialis anterior muscle is more susceptabile to ischemic injury than soleus muscle.

Age-related Alterations of Bcl-2 and Bax Immunoreactivities in the Ischemic-reperfused Tibialis Anterior and Soleus Muscles of the Rats / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Reactive oxygen species generated during reperfusion time induce expression of various genes and apoptosis. Among apoptosis-related gene products, Bcl-2 and Bax regulate the apoptotic response by inhibiting and promoting cell death, respectively. The purpose of this study was to observe the age-related alertation of expression profile of Bcl-2 and Bax in rat tibialis anterior muscle and soleus muscle following ischemia-reperfusion. 9 weeks, 30 weeks, and 65 weeks old male Sprague-Dawley rats were divided into control and ischemia groups. Ischemia group was divided into 3 subgroups based on reperfusion time. For ischemia, left commom iliac artery was occulded for 4 hours using rodent vascular clamps. The animals were sacrificed at hours 0, 3 and 24 after onset of reperfusion and tibialis anterior and soleus muscles were removed. Muscle tissues were embedded in paraffin and 6 micrometer sections were made. The expression level of Bcl-2 and Bax were examined using immunohistochemical methods. The results obtained were as follows; 1. In control group, immunoreactivities (IMRs) of Bcl-2 and Bax were weak or moderate in 30 weeks old rats and were trace in 9 and 65 weeks old rat. 2. In control group, IMRs of Bcl-2 and Bax in tibialis anterior muscle were more higher than those in soleus muscle, but not significantly. 3. In ischemia group, IMRs of Bax were increased with aging. 4. In ischemia group, IMR of Bax in tibialis anterior muscle was higher than that in soleus muscle. These results suggested that the increased IMR of Bax may be related to increasing of ischemic injury, and both old skeletal muscle and tibialis anterior muscle are susceptabile to ischemic injury of rat skeletal muscle.

Age-related Alterations of Bcl-2, Bax and Apoptosis in Ischemic-reperfused Rat Tibialis Anterior Muscles / 체질인류학회지

Prolonged ischemic-reperfusion induces cellular damages and apoptosis in rat skeletal muscle. Such injury takes place in the phase of reperfusion following ischemia induction in part via regulating of apoptosis-related gene inductions. Among apoptosis-related gene products, Bcl-2 and Bax regulate the apoptotic response by inhibiting and promoting cell death, respectively. The present study was performed to examine the age-related alertation of expression of Bcl-2 and Bax along with apoptosis in rat tibialis anterior muscles following ischemia-reperfusion. 9 weeks, 30 weeks and more than 65 weeks old male Sprague-Dawley rats were divided into 2 groups such as controls, 4 hour ischemia. 4 hour ischemia group was divided into 3 subgroups based on reperfusion time. For ischemia, left commom iliac artery was occulded for 4 hours. The tibialis anterior muscles were removed 0, 3, and 24 hours after onset of reperfusion. Muscle samples were embeded in paraffin and 6 micrometer sections were made. The expression level of Bcl-2 and Bax were examed using immunohistochemical methods and apoptotic reactions was detected using TUNEL methods. The results obtained were as follows; 1. In control group, Bcl-2 and Bax were weakly immunostained in 9 weeks old rat tibialis anterior muscles. In 30 and 65 weeks old rat tibialis anterior muscles, Bcl-2 immunostaning was minimal. The level of Bax staining was increased in 30 and 65 weeks old rat tibialis anterior muscles, compared with those of 9 weeks old rats. The level of apopto-sis among different age groups were not altered. 2. In the 4 hour ischemia group, the level of Bax staining was correlated with the level of apoptosis in 9 weeks, 30 weeks and 65 weeks old rat tibialis anterior muscles. 3. The level of apoptosis was increased in older groups relative to younger groups in 4 hour ischemia. These results suggested that the level of apoptosis induced by ischemic-reperfusion in tibialis anterior muscle increase with ageing in rat tibialis anterior muscles, and that a increase of Bax expression is related to increased apoptosis.

Anthropometric Study on Neurovascular Supply of the Gracilis Muscle in Korean / 체질인류학회지

Gracilis muscle, the most superficial to the adductor groups of muscles in the thigh, is widely used to make musculo-cutaneous flap because this muscle has several advantages; 1) Removal of the muscle does not elicit any functional deficit, 2) It is easy to make a flap, 3) It is able to make flaps of various sizes in according to the size of the wound. This study demonstrates the characteristics of the arterial supply of the gracilis muscle for flap. Total 102 thighs from 51 Korean cadavers (32 males/ 19 females), clinically normal and without deformity, were dissected and length and width of gracilis muscles were measured. The pattern of distribution of the arteries supplying the muscle were studied, and entering point of each arteries to the muscle were located in according to following point; A: Pubic tubercle, B: Medial condyle of femur and tibia on gracilis muscle. 1. The average width of gracilis muscle were 31.9 +/-8.1 mm. The length of female subjects was significantly shorter than that of male subjects. 2. Arteries supplying the gracilis muscle were obturator artery (11.0%), medial circumflex femoral artery (100%), first muscular branch of femoral artery (100%), second muscular branch of femoral artery (45.2%), third muscular branch of femoral artery (17.8%), and popliteal artery (9.6%). 3. Medial circumflex femoral artery had 1 -10 pedicles and divided into ascending, transverse and descending branches. The existence of ascending branches were 14.8%, the ascending and descending branches were 22.7%, the ascending, transverse and descending branches were 22.7%, the transverse and descending branches were 22.0%, and the only descending branches were 22.0%. 4. The frist muscular branch of femoral artery pierced the gracilis muscle at a distance which represented 61.9 +/-12.8% of the length from A to B. The external diameter were 1.4 +/-0.4 mm. 5. Obturator nerves reached the gracilis muscle at a distance which represented 29.0 +/-7.4% of the length from A to B. The maximum external width and length were 1.0 +/-0.4 mm and 59.7 +/-25.0 mm, respectively. In conclusion, the length and width of the gracilis muscle in Korean were different depending on gender. These data also provides the anatomical characteristics of the arterial supply of the gracilis muscle in Korean in clinical relevance with musculocutaneous flap

Characteristics and Arterial Distribution of Rectus Femoris Muscle in Korean / 체질인류학회지

Free -flap which is transferred to recipients is a thin flat tissue isolated from human body and nutrient vessel of free - flap is ligated with similarly sized vessel. Free -flap reconstruction is widely used, due to high rate of flap survival and functional refinements, although it gives disadvantage of long surgery time and inefficient adaptation. This study demonstrates the characteristics and arterial supply of rectus femoris muscle of thigh. Seventy thighs (35 right, 35 left) of the 35 cadavers (19 males/16 females) which were clinically normal and without deformity were dissected and measured, according to Martin measurements. 1. The average length and width of rectus femoris muscle were 396.7 +/-39.9 mm and 36.5 +/-7.9 mm, respectively. The length of female subjects was significantly different from that of male subjects (P 0.05). 2. In the origin and insertion of rectus femoris muscle, anterior tendon and posterior tendon were not different between female and male subjects. 3. Artery of the rectus femoris muscle arises from deep femoral artery. The length of pedicle from the entering point of the rectus femoris muscle was average 19.0 +/-11.9 mm. The length from the entering point of the rectus femoris muscle to spliting point was 13.7 +/-7.7 mm of P1, 12.6 +/-7.5 mm of P2, and 14.8 +/-11.63 mm of P3 pedicles. 4. The frequency of the blood vessels inserted into the rectus femoris muscle was the first highest at the portion of 32.5 ~35% and the second highest of 35 ~37.5% and 37.5 ~40% ranges, when anterior superior iliac spine from center of the patellar was considered as 100% of portion. 5. According to the method by Kimata et al. (1998) classifying perforators based on the anatomic variations, type 1 and VIII were 83.58% and 5.97% respectively. Type 5, 6 and 7 were not observed. 6. Femoral nerves inserted into the rectus femoris muscle were distributed within 7.5 ~45% portion when anterior superior iliac spine from center of the patella was converted into 100%. The portion of 17.5 ~20% had the highest frequency of nerves. In conclusion, length of the rectus femoris muscle in Korean were different depending on gender, whereas tendon lengths were not. These data demonstrate artery pattern in Korean and provide anatomical potential for rectus femoris muscle to be used as a free -flap muscle.