Arterial supply of the soleus muscle: anatomical study of fifty lower limbs

Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. The arterial blood supply of the soleus muscle was studied in 50 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The distance of the origin of the perforators was measured from fixed bony landmarks. Branches of the popliteal artery trunk, the posterior tibial artery, and the peroneal artery supplied the soleus muscle. The number of branches to the soleus muscle from these main arteries were analyzed. The medial part of the muscle was supplied throughout its length by perforators arising from the posterior tibial artery. This constant feature makes the medial part of the muscle reliable as a proximally or distally based flap. The average distances of the lower perforators arising from the posterior tibial artery were 6.5 cm, 11.6 cm, and 16.8 cm from the medial malleolus. The branches of the peroneal artery were mostly distributed in the upper half of the muscle. These large pedicles allow a composite transfer of the soleus muscle with the fibula. Lower perforators were demonstrated to arise from the peroneal artery in 60% of the limbs but the scarcity of perforators in this region limits the clinical usefulness of an inferiorly based lateral hemisoleus flap. The study demonstrates the distribution of arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. The average numbers of the perforators arising from the vessels and their distribution have been highlighted.     

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 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.

     

Elasticity changes in the large arteries of human limbs in response to cycle ergometry performed with upper and lower limbs

Summary At rest and after cycle ergometry the elastic properties of the large arteries of limbs of healthy men were examined using an original non-invasive quantitative oscillometric method. It has been shown that in response to muscle work performed with the legs there is a decrease of the effective inner radius, and an increase of the characteristic impedance modulus and bulk modulus and of the elastic resistance of the intact and relaxed wall in the large arteries in the upper limbs. All these changes testify to an increase of vascular tension in the upper limbs. In response to work performed with the hands, there is an increase of the effective inner radius of large arteries of the upper limbs, a large increase of the pulsatile blood volume increment of the intact vessels and a decrease of the characteristic impedance modulus, of the bulk modulus and of the elastic resistance of the intact arterial wall. These changes indicate a decrease of the vascular tension of these arteries. In response to work performed either with the legs or with the hands a decrease of the effective inner radius of large arteries and an increase of the elastic resistance of the relaxed arterial wall were observed in the lower limbs, all these changes indicating relatively small changes in tone of these vessels. It is concluded that the wall tension of large arteries supplying blood to the muscles of non-working limbs is increased. Vascular tension changes in the arteries in working limbs are accounted for by the superimposition of centrally originating vasoconstriction with local vasodilatation, which also affects large arteries.     

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.

     

Very weak luminescence of blood plasma in experimental embolism of the main limb arteries

Changes in the level of chemiluminescence of the blood plasma, initiated by hydrogen peroxide and bivalent iron, were studied in 15 dogs with experimental embolism of the bifurcation of the aorta. After occlusion of the artery the level of chemiluminescence initiated by iron fell. Meanwhile, the level of chemiluminescence initiated by hydrogen peroxide rose to reach a maximum 6 h after the beginning of occlusion, followed by a tendency to fall. A statistically significant increase in luminescence initiated by hydrogen peroxide can be used to judge the duration of the disease. After restoration of the blood flow to the limb there was a decrease in chemiluminescence initiated by hydrogen peroxide together with a further decrease in chemiluminescence initiated by iron.Professorial Surgical Clinic, N. I. Pirogov Second Moscow Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR V. S. Savel'ev.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 88, No. 9, pp. 304–306, September, 1979.     

肠系膜上动脉夹闭休克时大鼠肝线粒体损伤及其抗损伤的研究

本文探讨SMAO休克时大鼠肝线粒体损伤以及自由基清除酶(剂)对肝线粒体的保护作用。实验组线粒体RCR于松夹1 hr即明显下降(P<0.05),松夹2 hr下降更甚(P<0.01)。ADP/O值也明显降低(P<0.05)。单用ALLO或伍用SOD CAT,SOD ALLO,SOD CAT ALLO治疗对SMAO休克大鼠肝线粒体氧化磷酸化功能均有显著的保护作用,并且在松夹2 hr后,除单用ALLO组外,其它诸组RCR仍较对照组无显著下降(P>0.05),而且还明显高于实验组(P<0.01),其中以SOD CAT ALLO伍用效果最佳。提示脂质过氧化损伤是SMAO休克时肝脏线粒体损伤的重要原因;而伍用自由基清除酶(剂)是防止其损伤的理想选择。     

The arterial blood supply of the pancreas: a review III. The inferior pancreaticoduodenal artery

Summary This article is the third part of a comprehensive review on the pancreatic arterial blood supply and deals with the inferior pancreaticoducdenal a. The aim of this review is to summarise the anatomical studies, starting from Haller's reports, and to supply as far as possible, with original material, angiographic evidences for the classic anatomical notions. For this purpose, the overall research was carried out by picking out and studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric a.) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. Angiographically, the authors observed the inferior pancreaticoduodenal a., present in most instances, as arising from the superior mesenteric a., from the right accessory hepatic a., or from a common trunk with the first or the first two jejunal aa. Some variations of the course have been shown. The authors underline and discuss the discordant opinions still existing regarding the incidence of the different ways the inferior pancreaticoduodenal a. arises and the surgical importance of the variation of origin of this artery.

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La vascularisation artérielle du pancréas : une mise au point. III. L'artère pancréatico-duodénale inférieure

Résumé Cet article est la troisième partie d'une étude détaillée de la vascularisation artérielle du pancréas et traite de l'a. pancréatico-duodénale inférieure. Le but de ce travail est de résumer les études anatomiques, depuis la publication de Haller, et de fournir autant qu'il est possible, avec un matériel original, les preuves angiographiques des notions anatomiques classiques. Pour cela, la recherche complète a été menée sur le choix et l'ðude de 1015 angiographies sélectives (tronc coeliaque et ses branches, a. mésentérique supérieure) tirées des archives angiographiques des instituts de radiologie de Sienne, Rome (université catholique) et Pérouse. Sur les angiographies les auteurs ont observé l'a. pancréatico-duodénale inférieure, présente dans la plupart des cas, naissant de l'a. mésentérique supérieure, de l'a. hépatique droite accessoire, ou d'un tronc commun avec la première ou les deux premières aa. jéjunales. Quelques variantes ont été montrées dans son trajet. Les auteurs soulignent et discutent les opinions encore divergentes sur la fréquence des différentes origines de l'a. pancréatico-duodénale inférieure et sur leur importance chirurgicale.

     

Preparation of four-color arterial corrosion casts of the laryngeal arteries

Summary The supply areas of the superior and inferior laryngeal arteries were studied in order to plan tissue-sparing laryngeal surgery. Arterial corrosion casts with and without preservation of the laryngeal skeleton were prepared and the supply areas of the superior and inferior laryngeal arteries were distinguished from each other by injecting differently colored methacrylates. The ramifications of the laryngeal arteries could be classified clearly in the macerated specimens which preserved the laryngeal skeleton.

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Etude des artères laryngées par injection corrosion en quatre couleurs

Résumé Les territoires vasculaires des artères laryngées supérieure et inférieure ont été étudiés afin de préciser l'abord chirurgical de ces artères. Des injections corrosions artérielles ont été réalisées avec ou sans conservation du squelette laryngé et les territoires vasculaires des différentes artères ont été différenciés grâce à l'utilisation de quatre couleurs. Les rameaux des artères laryngées ont pu être facilement analysés sur les pièces où le squelette laryngé avait été conservé.

     

Cholecalciferol treatment restores the relaxant responses of spontaneously hypertensive rat arteries to bradykinin

The vasodilation and hyperpolarization induced by bradykinin (BK) in the mesenteric vascular bed and mesenteric arteries from spontaneously hypertensive rats (SHR) and from normotensive Wistar rats (NWR), as well as Wistar Kyoto rats (WKY), was investigated before and after prolonged oral treatment with cholecalciferol (125 mg kg⁻¹ body weight per day) for 3 weeks. The cholecalciferol treatment caused a decrease in the SHR blood pressure, as well as a normalization in the resting potential of the smooth muscle cell membrane of mesenteric arteries and restored their hyperpolarizing response to BK. The concentration–response curves for the vasodilator effect of BK on the mesenteric vascular bed were significantly decreased in SHR and in WKY when compared with NWR. Cholecalciferol treatment improved the maximum responses of the SHR preparation, bringing them to levels similar to those of the NWR preparations, which themselves were unaffected by the treatment. In the presence of apamin, a Ca²⁺-dependent K⁺ channel inhibitor, the maximum responses to BK in preparations from NWR or cholecalciferol-treated SHR decreased to values similar to those observed in untreated SHR. Our results indicate that the low responsivity of the SHR resistance vessels to the relaxant effect of BK is due to impaired Ca²⁺-dependent K⁺ channels and that reversion of this impairment contributes to the blood pressure reduction caused by the cholecalciferol treatment. However, the mechanism of the low responsivity in WKY remains to be investigated.     

Development of neuromuscular junctions on small mesenteric arteries of the rat

This ultrastructural study has investigated the development of the innervation of second order mesenteric arteries from the ileum region of the rat intestine, particularly, the time course of the formation of the plexus of varicose axons around the arteries, and the formation of autonomic neuromuscular junctions. The time points studied were postnatal days-2, -4, -8 and -13. This study has revealed that the formation of neuromuscular junctions with mature structural characteristics occurred at ~2 weeks postnatal. The plexus of varicose axons developed predominantly between day-4 and day-13, which agrees with previous light microscopy studies of catecholamne containing nerves around similar vessels. At day-2 and day-4, the axons lacked varicosities and were mainly contained in large bundles located in the outer region of the adventitia. The medio-adventitial border consisted of a dense layer of extracellular matrix and fibroblasts. By day-8, there were more axons and most were distributed in smaller bundles. Some had grown through the adventitia to lie at the medio-adventitial border and axon varicosities were also observed. Some varicosities had formed rudimentary neuromuscular contacts. By day-13, there were significantly more contacting varicosities compared to day-8. They were structurally more mature, being twice the size with three times the number of synaptic vesicles and consistently contained a mitochondrion. Conversely, the neuromuscular contact areas were similar at both time points. Some organisation of the synaptic vesicles associated with the prejunctional membrane, was evident in varicosities at day-8 but there were no presynaptic membrane specialisations similar to the putative neurotransmitter release sites found at mature skeletal neuromuscular junctions. The aggregation of small vesicles at the prejunctional membrane was more pronounced in neuromuscular junctions at day-13 with some having presynaptic membrane specialisations. Comparison of the structure of developing autonomic neuromuscular junctions with that of skeletal neuromuscular junctions has revealed a number of similarities.     

Rho激酶在阻断休克肠淋巴液回流、提高大鼠血管钙敏感性中的作用

目的: 观察Rho激酶在肠淋巴管结扎或肠淋巴液引流提高失血性休克大鼠血管钙敏感性中的作用。方法: Wistar雄性大鼠随机分为假手术组(sham)、失血性休克组(shock)、休克肠淋巴管结扎组(shock+ligation,行肠淋巴管结扎)、休克肠淋巴液引流组(shock+drainage,行肠淋巴液引流),在休克3 h或sham组的相应时点,制备肠系膜上动脉(SMA)血管环,采用离体血管环张力测定技术,观察SMA血管环对梯度钙离子收缩性的变化;shock+ligation与shock+drainage组SMA血管环分别与Rho激酶激动剂血管紧张素Ⅱ(Ang Ⅱ)、抑制剂fasudil孵育后,观察钙敏感性变化。结果: Shock组SMA血管环的钙敏感性显著低于sham组;shock+ligation组与shock+drainage组SMA血管环钙敏感性显著高于shock组,但低于sham组。Shock+ligation组与shock+drainage组SMA血管环与AngⅡ或fasudil孵育后,AngⅡ不同程度地提高了shock+ligation组与shock+drainage组大鼠SMA血管环对梯度钙离子的收缩性与pD₂;fasudil显著降低了两组大鼠SMA血管环对梯度钙离子的收缩性与最大收缩力E_max,降低了shock+ligation组的pD₂。结论: Rho激酶在阻断休克肠淋巴液回流提高血管钙敏感性中发挥重要作用。     

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.     

The arterial blood supply of the pancreas: a review: IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study

The present article is the fourth part of a comprehensive review of the arterial blood supply of the pancreas and completes the study of the arterial vascularization of the pancreatic head dealing with the anterior inferior and posterior inferior pancreaticoduodenal aa. and with some minor sources of blood supply not involving the classical system of the pancreaticoduodenal arches. The aim of this review is to summarise the anatomical studies, starting from Haller’s reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomical concepts. For this purpose, 1015 selective angiographs (celiac trunk and its branches, superior mesenteric a.) were taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. These demonstrated the anterior inferior pancreaticoduodenal a., present in most instances, as arising from the inferior pancreaticoduodenal a., from a common trunk with the posterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the 1st jejunal a. or from the superior mesenteric a.; on the other hand, the posterior inferior pancreaticoduodenal a. was more variable, originating from the inferior pancreaticoduodenal a., from a common trunk with the anterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the superior mesenteric a., from the dorsal pancreatic a., or from a right accessory hepatic a. coming from the superior mesenteric a. In addition, minor branches to the head of the pancreas arose from the gastroduodenal a., the dorsal pancreatic a., the common hepatic a. and the inferior right phrenic a. Other origins of the inferior pancreaticoduodenal aa. previously reported, but not angiographically detectable with certainty, as well as further minor sources of blood supply to the head of the pancreas, have been listed. The differing opinions regarding the incidence of the various ways the inferior pancreaticoduodenal aa. arise are discussed and an attempt is made to explain the variability of the vascular anatomy of the pancreatic head on embryologic grounds.     

Dual effect of initial [K] on vascular tone in rat mesenteric arteries

A slight increase in extracellular concentration of potassium () can act as a vasodilator in rat mesenteric vascular bed. However, in recent years, several groups have failed to consistently observe relaxation of rat mesenteric arteries in these conditions. The aim of the present study was to provide a mechanistic understanding of this discrepancy. In rat small mesenteric arteries, 37 of 40 arteries mounted for measurement of isometric force and pre-contracted with phenylephrine (PE) did not relax when was raised from 5.9 mM (control ) to 11.2 or 21.2 mM. However, when was briefly lowered to 1.2 mM, increasing to between 5.9 and 41.2 mM evoked relaxation. This relaxation was not reduced by barium or by removal of the endothelium, but was abolished by 0.1 mM ouabain. Raising from concentrations between 0 and 5.9 mM to 13.8 mM elicited a relaxation of PE-induced tone that was inversely proportional to initial . Relaxation was associated with a ouabain-sensitive hyperpolarization of smooth muscle cells. In arteries exposed to dihydroouabain (DHO), raising from 5.9 to 13.8 mM and simultaneously washing out DHO resulted in relaxation of PE-induced force. These results suggest that only when the initial is less than ∼5 mM do small elevations in evoke smooth muscle hyperpolarization and relaxation via activation of Na,K-ATPase, and not inwardly rectifying K⁺ channels. Therefore, small differences in the initial (4.6 vs 5.9 mM) can strongly influence the variations of vascular tone to increases in .     

Subcutaneous and skeletal muscle vascular responses in human limbs to lower body negative pressure

Jacobsen , T. N., Nielsen , H. V., Kassis , E. & Amtorp o S. 1992. Subcutaneous and skeletal muscle vascular responses in human limbs to lower body negative pressure. Acta Physiol Scand 144 , 247–252. Received 8 March 1991, accepted 7 Novcmber 1991. ISSN 0001–6772. Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark Cardiopulmonary baroreceptor unloading in humans comparably increases sympathetic discharge to skeletal muscle in the forearm and calf, but blood flow studies have disclosed differential rather than uniform vasomotor responses in the extremities. The aim of the present study was to address the issue of differential effects of orthostatic stress on forearm and calf vascular adjustment and to extend previous studies by determining changes in vascular responses separately in various vascular beds of the limbs. The local [¹³³Xenon] washout method was used for recording blood flow rates in subcutaneous tissue and skeletal muscle. Simultaneous recordings from the forearm and calf were performed in 11 healthy young males during lower body negative pressure at —10 mmHg. Heart rate, arterial mean and pulse pressures did not change during lower body negative pressure. In the forearm blood flow rates decreased significantly, in subcutaneous tissue by 16 ± 2% (mean ± SEM) and in skeletal muscle by 16 ± l%. In the calf lower body negative pressure induced a significant decrease in blood flow rates of 17 ± 3% in subcutaneous tissue and of 30 ± 2% in skeletal muscle. This vasoconstriction in calf skeletal muscle was consistently disclosed in both legs and was about the same magnitude in each calf when studied with the one leg exposed to lower body negative pressure and the other outside the lower body negative pressure chamber. These findings suggest that during unloading of cardiopulmonary afferents, reflex sympathetic activation as an important autonomic adjustment to orthostatic stress is accompanied by uniform vasoconstriction in subcutaneous and skeletal muscle vascular beds of human limbs.