The arterial blood supply of the human patella

Summary The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o'clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.

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La vascularisation artérielle de la patella humaine : son importance clinique dans la technique opératoire des transplantations vascularisées d'articulation du genou

Résumé La disposition des artères alimentant le réseau patellaire a été examinée sur 14 pièces anatomiques dans le but d'améliorer la technique de la transplantation de l'articulation du genou. Les pièces étaient fixées dans la solution de Jores et désarticulées à la hanche. Les membres inférieurs étaient injectés à la gélatine colorée au bleu de Berlin et les artères étaient disséquées sans grossissement optique. Cinq ou six artères alimentaient le réseau patellaire à 1, 3, 5, 7 et 11 heures et formaient un cercle artériel. Ces artères sont les mêmes artères principales qui vascularisent la partie distale du fémur et la partie proximale du tibia. D'un point de vue anatomique, ces artères fournissent la totalité de la vascularisation artérielle de l'articulation du genou à transplanter, patella incluse. A partir de ces résultats anatomiques, nous avons préparé et transplanté deux articulations de genou humaines comme allogreffes vascularisées incluant la patella, la capsule et le ligament patellaire. Plus de 6 mois après l'intervention, nous avons montré la vascularisation et la réhabitation de ces trois os transplantés, en particulier de la patella grâce à la scintigraphie au technetium 99. Nous avons comparé ces résultats avec les données de l'arthroscopie et l'analyse histologique des biopsies prélevées au niveau de la patella. Les examens postopératoires ont clairement montré la réhabitation des patellas transplantées grâce à cette nouvelle technique opératoire. Les résultats de cette étude montrent qu'il est techniquement faisable de transplanter une articulation du genou entière, qui reste cliniquement viable.

     

The arterial blood supply of the human patella

The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o’clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.     

The arterial blood supply of the human fetal diaphragm

To gain a better understanding of the development of the human diaphragm, a study of the arterial supply was made in 20 fetuses. The Micropaque injection was injected either by an ascending route in the thoracic aorta or by a descending route in the left internal carotid below the ductus arteriosus. Two studies using diaphanization have displayed the diaphragmatic anastomoses. The phrenic and the intercostal a. seemed the most important to explain the diaphragm organogenesis.     

The arterial architecture of the left ventricular wall of human hearts

The normal arterial and microvascular patterns of the left ventricular wall, including the papillary muscles, were studied in 54 human hearts using coronary angiography, arterial and microvascular casts, and histologic sections. According to their shapes and distributions, the arteries in the left ventricular wall may be classified as epicardial, arborized, straight, and papillary. The arborized arteries supply the whole myocardial wall, including some trabeculae carneae, and they anastomose with the straight arteries to form the subendocardial plexus. The papillary arteries have various arrangements: hooked, bifurcated, and tortuous S-shaped. The use of histologic sections and arterial casts revealed no single central core artery and at least two arteries in each papillary muscle. The morphology and blood supply of the anterior and posterior papillary muscles varied somewhat. Scanning microscopy of the arrangement and appearance of arterioles, capillaries, and venules of the left ventricle revealed that large-diameter capillaries, which were sometimes guarded by precapillary sphincters, arose from arterioles. The capillaries were parallel to cardiac muscle fibers and had numerous Y-, H-, and O-shaped anastomotic connections. The small venules were arranged in a fan-shaped fashion in relation to these capillaries.     

The arterial blood supply of the pancreas: a review

Summary The gross anatomy of the pancreatic blood supply has been subjected to numerous studies. The results of such studies, however, have never been summarized in detail, even in the most important textbooks. For this reason, a certain confusion was generated, especially regarding the interpretation of the nomenclature used to identify pancreatic arteries. This review summarizes more than two centuries of studies of the gross anatomy of the pancreatic blood supply, clarifies the arterial nomenclature, and underlines the aspects about which anatomists are not in agreement. Moreover, it supplies, as far as possible, documentary evidence for numerous observations previously reported only verbally. For this purpose, more than 200 references were directly consulted to provide the anatomical background of the topic, and more than 1000 angiograms were studied to support the review with original figures. The present paper, on the superior pancreaticoduodenal and anterior superior pancreaticoduodenal arteries, is the first of a series of articles dealing with the pancreatic blood supply.

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Etude anatomo-radiologique de la vascularisation artérielle du pancréasI. Les artères pancréaticoduodénale supérieure et pancréaticoduodénale antérieure et supérieure

Résumé L'anatomie de la vascularisation du pancréas a fait l'objet de nombreux travaux. Les résultats de ces études n'ont jamais été récapitulés en détail, même dans les livres les plus importants. C'est pourquoi une certaine confusion est née, spécialement en ce qui concerne l'interprétation de la nomenclature utilisée pour indentifer les artères pancréatiques. Ce travail résume plus de deux siècles d'études d'anatomie générale de la vascularisation du pancréas, il clarifie la nomenclature des artères et souligne les points sur lesquels les anatomistes ne sont pas d'accord. En outre il fournit, autant que faire se peut, des documents concernant de nombreuses observations antérieures rapportées uniquement oralement. Dans ce but plus de 200 références ont été consultées directement pour fournir la documentation anatomique de ce sujet et plus de 1000 angiographies ont été étudiées pour illustrer ce travail avec des figures originales. Le présent article sur les artères pancréatico-duodénale supérieure et pancréatico-duodénale antéro-supérieure est le premier d'une série de travaux se rapportant à la vascularisation du pancréas.

     

Craniofacial growth modified by blood supply. 2. Changes in arterial cross sections and arterial blood supply

The cross sectional areas of arteries were calculated from their measured thicknesses. The monthly increase in size of the cross sectional area of the aorta is higher in both the controls and the operated animals between the 6th week and 4th month of life than during the subsequent period. The rate at which the cross sectional area of the aorta increased in operated animals was about twice that observed in the controls. The left common carotid artery increased its cross section in the operated animals most rapidly up to the fourth month. The cross sectional areas of all anastomoses increased five-fold by the 12th month of life. The quantities of blood flowing correlated closely with the angiometric values.     

Reevaluation of the arterial blood supply of the auricle

The anatomical basis for auricular flaps used in multiple aesthetic and reconstructive procedures is currently based on a random distribution of the underlying arterial network. However, recent findings reveal a systematic pattern as opposed to the present concepts. Therefore, we designed this study to assess the arterial vascular pattern of the auricle in order to provide reliable data about the vascular map required for surgical interventions. Sixteen human auricles from eight body donors (five females/three males, 84.33 ± 9.0 years) were investigated using the unique ‘Spalteholz’ method. After arterial injection of silicone, a complete transparency of the tissue was achieved and the auricular arteries and branches were visible. Qualitative and quantitative evaluation of the arterial vascular pattern was performed. The superior and the inferior anterior auricular artery provided the vascular supply to the helical rim, forming an arcade, i.e. helical rim arcade. On the superior third of the helical rim another arcade was confirmed between the superior anterior auricular artery and the posterior auricular artery (PAA), i.e. the helical arcade. The perforators of the PAA were identified lying in a vertical line 1 cm posterior to the tragus, supplying the concha, inferior crus, triangular fossa, antihelix and the earlobe. The results of this study confirmed the constant presence of the helical rim arcade (Zilinsky‐Cotofana), consistent perforating branches of the PAA, and the helical arcade (Erdman), and will help and guide physicians performing auricular surgeries toward fast and simple procedures with optimal patient satisfaction.     

A study of the arterial blood supply to the penis

Summary Two arterial systems contribute to the blood supply of the penis. The deeper system, responsible for supplying the erectile tissues, arises from the internal pudendal arteries (a. pudendae internae), or sometimes from an accessory internal artery. Four branches, either collateral or terminal, should be considered: the artery to the bulb of the penis, the urethral artery, the deep artery of the penis and the dorsal artery of the penis. Variations are frequently present in the origin, distribution and symmetry of these arteries, but on the whole the blood supply is organised into three planes, inferior or ventral, middle and deep, superior or dorsal. These three planes are complementary: when the blood supply to any one of them is occluded, at whatever level this may be, the blood supply is supplemented by the plane immediately above it. Arteriograms should be interpreted with caution because anatomical variations may at first sight be taken for pathological change.The superficial system, supplying the tissues around the erectile organs, arises from the lateral inferior pudendal arteries. Three types of supply have been described, according to whether the right and left arteries have a symmetrical distribution or whether the arterial network arises in large part or totally from one side.

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Contribution à l'étude de la vascularisation artérielle du pénis

Résumé Deux systèmes artériels participent à la vascularisation du pénis. Le système profond, tenant sous sa dépendance les organes érectiles, a pour origine les artères honteuses internes (a. pudendae internae), parfois une artère interne accessoire. Quatre branches, collatérales ou terminales sont à considérer: l'artère du bulbe du pénis, l'artère urètrale, l'artère profonde du pénis, l'artère dorsale. Il existe de fréquentes variations dans l'origine, la distribution et la symétrie de ces artères mais, dans son ensemble, la vascularisation est organisée selon trois plans, inférieur ou ventral, moyen ou profond, supérieur ou dorsal. Ces trois plans sont complémentaires: lorsque l'un d'eux s'épuise, à quelque niveau que ce soit, le relais est pris par le plan immédiatement supérieur.Le système superficiel, vascularisant les enveloppes provient des artères honteuses externes inférieures. Trois types de vascularisation sont décrits, selon que les deux artères droite et gauche ont une distribution symétrique ou que le réseau artériel provient en majeure partie ou totalement d'un seul côté.

     

The arterial supply of the clavicle

Summary This report based on delineation of the arterial system with 3 component plastic material on 10 human cadavers describes the arterial supply to the clavicle. The study was performed in 2 parts. One part, which showed the total arterial supply to the clavicle and one part with selective injections of the relevant arteries, with the intention of finding a central nutrient arterial supply to the clavicle. Three arteries were found to supply the clavicle: the suprascapular a.; the thoracoacromial a.; and the internal thoracic (mammary) a. The main supply was primarily periosteal. No nutrient artery was found.

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La vascularisation artérielle de la clavicule

Résumé Ce travail, basé sur l'injection du système artériel avec 3 composants plastiques sur 10 cadavres humains, décrit la vascularisation artérielle de la clavicule. L'étude a été faite en 2 parties, la première montre la vascularisation artérielle dans son ensemble et la seconde comporte des injections sélectives des artères concernées, dans le but de rechercher un apport artériel central de la clavicule. Trois artères ont été mises en évidence: l'a. suprascapulaire; l'a. thoracoabdominale; l'a. thoracique interne. L'apport artériel principal est périosté. Aucune artère nourricière n'a été trouvée.

     

Development of binucleated myocytes in normal and hypertrophied human hearts

To clarify the development of binucleated cardiac myocytes (BCMs) in human hearts, lengths for BCMs and mononucleated cardiac myocytes (MCMs) were histologically measured and compared in 49 hearts weighing 13-730 g. The mean cell length was significantly longer in BCMs. The growth rate of cell length relative to the heart weight in BCMs and MCMs was almost identical and less than 0.333. The scattering of different lengths of BCMs and MCMs was much greater in adults, suggesting that each myocyte develops at a different rate. Short MCMs of 37.5 microns in hypertrophied hearts suggested that some BCMs might divide into two. In adult hearts, binucleation might arise, because BCMs with internuclear distance under 2.5 microns were found. The mean half of the sum of nuclear lengths of BCMs was shorter than the mean nuclear length of MCMs. They were largely constant in hearts weighing under 500 g but increased in larger hearts.     

The arterial supply of the coracoid process

Objective

The aim of this study was to describe the arterial supply of the coracoid process and to define its possible involvement in complications of Latarjet procedure.

Method

Five shoulder dissections were performed to highlight the extraosseous blood supply of the coracoid process. Postmortem arteriographies of the upper limb were performed. Diaphanization of a scapula enabled to view its intraosseous blood supply.

Results

The vertical part of coracoid process was supplied by supra-scapular artery, and the horizontal part by branches of the axillary artery.

Discussion and conclusion

This anatomical study has shown that the coracoid process had its own blood supply. During the Latarjet procedure, vascular sacrifices are mandatory to allow coracoid process transfer to the scapular neck. Such sacrifices could explain lysis or non-union of the coracoid process after Latarjet procedure. Preservation of axillary artery branches supplying horizontal part of the coracoid process could be a possible solution to prevent non-union and lysis of the bone transfer.     

The arterial supply of the temporalis muscle

Owing to the diverse applications of the temporalis muscle in reconstructive surgery, the study of its arterial supply is becoming an issue of great importance nowadays. The material of the present study consisted of 44 specimens, four obtained from two stillbirths and 40 dissected from 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. Direct branches from the second part of the maxillary artery and the middle temporal artery proved to be constantly furnishing the muscle from its superficial and deep surfaces. The muscular branch of the middle temporal artery supplied the middle and posterior thirds of the superficial surface and the posterior third of the medial surface of the muscle. The superficial temporal artery participated in supplying the muscle from its lateral surface, while the anterior and posterior deep temporal arteries lay deep to the anterior and the middle thirds of the muscle, respectively. The temporal branches of the middle meningeal artery anastomosed with the deep temporal arteries, thereby contributing to the supply of the temporalis muscle. An arterial pedicle arising from the third part of the maxillary artery constituted an additional supply in 9.1% of the specimens, providing an additional arterial pedicle for temporalis-muscle-flap elevation.     

心房动脉的应用解剖

目的:为心房切开术或经心房介入治疗术提供心房动脉的解剖学基础.方法:对27例成人心的心房动脉进行解剖,重点观测营养房间隔及左心耳的动脉的起源并测量其外径、主干长度.结果:右心房动脉有2～4支,平均3.0支,均起于右冠状动脉右侧壁,起始处外径为(1.6±0.4) mm,左心房动脉有2～5支,平均3.0支,92.6%分支起于旋支,7.4%的分支来自右冠状动脉.营养房间隔的动脉行于前房间沟下部,48.1%(13例)由右冠状动脉发出,起始处外径为(1.3±0.4) mm,主干长度为(21.0±9.6) mm,51.9%(14例)由旋支发出,起始处外径为(1.2±0.4) mm,主干长度为(9.0±4.2) mm;左心耳动脉有1～5支,平均2.3支,除1例起于右冠状动脉外,其余均起于旋支,起始处外径(0.7±0.4) mm,主干长度(13.1±6.7) mm.根据其行走特点可分为4型.结论:进行心腔内直视手术时需注意房间隔动脉及左心耳动脉的走行特点,以防伤及,引起血供障碍.