Anatomical relationship between arteries and veins in the paraumbilical region.

Veins in the paraumbilical region were investigated in eight fresh cadavers, in which radiopaque materials were injected into both the arterial and the venous systems, to determine their locational relationship to the arteries. Veins in the skin and subcutaneous tissue consisted of venae comitantes and non-venae comitantes. The main trunk of the non-venae comitantes was the superficial inferior epigastric vein, and it formed a polygonal venous network in the skin layer. A large communicating vein, which did not accompany an artery, connected the venous network to a vena comitans of a large paraumbilical arterial perforator. Venous blood that had perfused the dermis of the paraumbilical region had two kinds of pathways to a deep vein: through the superficial inferior epigastric vein to the femoral vein and through the vena comitans to the deep inferior epigastric vein.

Angiographic study of the subdermal plexus: a preliminary report.

The subdermal plexus was pictured angiographically in five fresh cadavers injected systemically with a lead oxide-gelatin mixture. Subdermal plexus was found either in the subdermal plane or in the deep part of the dermis. Diameters of vessels in the subdermal plexus are not uniform and there are differences in vascular continuity, which means that the subdermal plexus does not always have a random pattern. This observation is important when designing a thin flap.

Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications.

The arteries adjacent to the lesser saphenous vein and sural nerve were investigated in 10 fresh cadavers that had been systemically injected with a lead oxide-gelatin mixture. The accompanying arteries were found to lie along the lesser saphenous vein and sural nerve and to nourish the skin through venocutaneous and neurocutaneous perforators. On the basis of the anatomy of these accompanying arteries, the lesser saphenous venoadipofascial (VAF) pedicled fasciocutaneous flap and the lesser saphenous-sural veno-neuro adipofascial (V-NAF) pedicled fasciocutaneous flap have been developed and applied to 23 cases of various reconstructions of the lower extremity with proximal and distal bases. Survival of the flaps has been extremely good, and the flaps have been clinically useful.

Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging.

To develop new types of surgical flaps that utilize portions of the skin and subcutaneous tissue (e.g., a thin flap or an adipofascial flap), three-dimensional investigation of the vasculature in the skin and subcutaneous tissue has been anticipated. In the present study, total-body arterial injection and three-dimensional imaging of the arteries by computer graphics were performed. The full-thickness skin and subcutaneous adipofascial tissue samples, which were obtained from fresh human cadavers injected with radio-opaque medium, were divided into three distinct layers. Angiograms of each layer were introduced into a personal computer to construct three-dimensional images. On a computer monitor, each artery was shown color-coded according to the three portions: the deep adipofascial layer, superficial adipofascial layer, and dermis. Three-dimensional computerized images of each artery in the skin and subcutaneous tissue revealed the components of each vascular plexus and permitted their classification into six types. The distribution of types in the body correlated with the tissue mobility of each area. Clinically, appreciation of the three-dimensional structure of the arteries allowed the development of several new kinds of flaps.

Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap.

The arterial anatomy of the accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities was investigated in 10 fresh cadavers that had been injected with a lead oxide-gelatin mixture throughout the entire body. It is well known that cutaneous nerves have neurocutaneous perforators, but it was found that cutaneous veins also have their own accompanying arteries as well. The accompanying arteries of the cutaneous veins had branches not only to the vein wall, but also to the skin, i.e., venocutaneous perforators. Based on these findings, the concept of the adipofascial pedicled fasciocutaneous flap using the accompanying arteries of the cutaneous veins, cutaneous nerves, or both was proposed.

Three-dimensional reconstruction of cutaneous arteries of the back by computer graphic imaging.

Computer graphics using a personal computer were introduced to demonstrate the three-dimensional architecture of cutaneous arteries of the back in humans: the direct cutaneous artery of the circumflex scapular artery and the perforating cutaneous branches and musculocutaneous perforators of the superficial cervical, posterior intercostal, and thoracodorsal arteries. The entire thickness of the skin and underlying subcutaneous tissue over the deep fascia was obtained from five fresh cadavers injected systemically with lead oxide-gelatin mixture, and the integument was divided into the three layers; the skin, superficial adipofascial layer with the superficial fascia, and the deep adipofascial layer. Computer graphic reconstruction of the cutaneous arteries was performed using data based on angiograms of the three layers. The computer graphic depictions demonstrated in which layer cutaneous arteries branched and how the vessels were running in each layer by displaying each layer in different colors: red, yellow, and blue. Knowledge of the three-dimensional structure and architecture of the cutaneous arteries will aid in the development of flaps that use a portion of the skin and subcutaneous adipofascial tissue.

The arterial anatomy of the temporal region and the vascular basis of various temporal flaps.

The arterial anatomy of the temporal region was examined macroscopically and radiographically in 10 fresh cadavers which had been injected with lead oxide. The blood supply of the temporal region is derived from the superficial temporal, middle temporal, deep temporal, posterior auricular, transverse facial, zygomatico-orbital, zygomaticotemporal, zygomaticofacial, and middle meningeal arteries. The vascular network formed by these arteries can be divided into four arterial networks corresponding to the different layers of the temporal region. With a new understanding of the arterial networks and their anastomoses, the techniques for elevating various flaps in the temporal region are discussed.

[The use of the reverse latissimus dorsi muscle flap in the management of bronchopleural fistula].

The management of a postoperative bronchopleural fistula remains a major challenge for the thoracic surgeon. We present a series of three patients who underwent closure of the fistulas with the distal flap of the divided latissimus dorsi muscle (the reverse latissimus dorsi muscle flap) and a limited thoracoplasty. The primary resections, which were performed through a standard posterolateral thoracotomy, were right lower lobectomy in two patients and right middle and lower bilobectomy in the other. The initial myoplasty produced prompt fistula closure in 2 patients and failed in the other patient because of a large empyema space. The reverse latissimus dorsi muscle flap could be used for the management of bronchopleural fistula in selected patients who underwent lower lobectomy or middle and lower bilobectomy.

An anatomic review of the delay phenomenon: I. Experimental studies.

A number of experiments were conducted to study the anatomic changes in a flap following a surgical delay using the Doppler probe to add precision to the technique. After scanning the integument of a series of anesthetized animals with the probe, each was sacrificed; a total-body arterial injection was performed with a lead oxide mixture, the integument and deep tissues were radiographed separately, and the results were correlated and compared with our previous human studies. The dog was selected from the range of animals examined, and the arterial networks of a number of skin and muscle flaps were studied with and without a surgical delay. The study included the use of a tissue expander. Results revealed that an adjacent cutaneous perforator could be captured with safety on the artery at the base of an undelayed flap; that the survival length of that flap was related to the distance between perforators; that the necrosis line of the flap usually appeared in the zone of choke vessels connecting adjacent territories; that a surgical delay results in a dilatation of existing vessels with maximal effect in the zone of choke arteries; that the most effective delay was obtained by elevating the flap in stages from the base, leaving detachment of the tip until last; that tissue expansion is a form of surgical delay, with particular emphasis on vessel hypertrophy; and that similar changes occur when a muscle is delayed. The clinical applications of this investigation are presented in Part II of this anatomic review of the delay phenomenon.

The angiosomes of the mammals and other vertebrates.

This is a comparative study of the vasculature of the integument and underlying deep tissues of a range of mammals and other vertebrates. The investigation was conducted in the pig, monkey, dog, cat, possum, guinea pig, rat, rabbit, duck, and toad. The results from each are compared not only to each other, but also to previously performed human studies. The arterial network of the fresh animal cadaver was injected with a mixture of lead oxide and gelatin. The vascular anatomy of the skin, deep tissues, and individual muscles was defined by dissection, cutaneous perforator counts, photography, and radiography. A similar pilot study of the venous framework was performed in the pig, dog, and rabbit that included maps of the sites and orientations of the valves. The vasculature of the integument and deep tissues was correlated, and we found that we were able to define angiosomes (composite blocks of tissue supplied by the same source vessel) in each animal. Results revealed a marked dissimilarity of the overlying cutaneous vessels in many cases, yet a striking resemblance of the vascular architecture of the deep tissues. The size and density of the cutaneous perforators bore a close relation to the degree of the skin mobility, being large and sparse where the skin was mobile and smaller and more densely grouped where the integument was tethered or fixed. The cutaneous vasculature of the human resembled that of the monkey closely, was similar to that of the dog, cat, and possum, and was dissimilar to that of the pig, rat, guinea pig, and rabbit. Studies of the amphibian and bird bore many resemblances to those of the mammals. They provided basic concepts regarding modification of the animals' vascular anatomy in response to the functional demands of the species. In each animal, the arteries formed an unbroken network throughout the body. This consisted of anatomic territories linked by anastomotic vessels that were usually of reduced caliber. The pattern of the venous system was almost identical. Valved venous territories were linked by avalvular (oscillating) veins. The common denominator in the vascular system is the capillary bed. Conceptually, the anatomic arrangement of the arteries and veins, reproduced in each species, appears to be a sophisticated mechanism to allow equilibration of flow and pressure arriving at and departing from the capillary bed. The angiosome concept is reinforced by the animal studies. Although this investigation is essentially a detailed pilot study, it embraces many animals commonly used for experimentation and provides a reference atlas of their vasculature.(ABSTRACT TRUNCATED AT 400 WORDS)