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 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 conducting system in normal human hearts

The distributing artery of the conducting system of the heart is occasionally injured in cardiac surgery. The aim of this study was to define the anatomic characteristics of the principal arterial source of the sinu-atrial node and atrioventricular node. Furthermore, the morphology of the tendon of Todaro was clarified. Thirty hearts were studied by gross anatomic methods, and the exact area of the conducting system was supported by histologic observations of four hearts. The sinu-atrial node was supplied by the right coronary artery more frequently (73% of cases) than by the left (3%), and in 23% of cases this node was supplied by both coronary arteries. The atrioventricular node was supplied by the right coronary artery (80% of cases) more than by the left (10%), and in 10% of the cases this node was supplied by both coronary arteries. The atrioventricular bundle branch arose from the right coronary artery in 10% of cases, the left coronary artery in 73%, and both coronary arteries in 17%. Most of the blood to the right bundle (the moderator band) was supplied by the interventricular septal branches of the anterior interventricular branch from the left coronary artery. Finally, all the arteries of the right bundle and left bundle were defined to be derived from left coronary arteries.     

Extraneural arterial blood vessels of human fetal sciatic nerve

Nerves get segmental blood supply either from the neighboring muscular and cutaneous branches or from the regional main arterial trunks. The aim of our research was to detect, in the gluteal and posterior femoral region, the blood vessels which are involved in the blood supply of the human fetal sciatic nerve, as well as to establish their origin. Micro-dissection was performed on 48 fetal lower extremities which were previously fixed in 10% formalin. Micropaque solution (barium sulfate) was injected into their blood vessels. The fetal gestational age was established by measuring the crump-crown length and it ranged from the third to the ninth lunar month. The observed nutritional arteries of the human sciatic nerve originated from the inferior gluteal artery, medial circumflex femoral artery, perforating branches, and popliteal artery. The anastomotic arterial chain of the human sciatic nerve was observed in all cases. In 75% of the cases it was composed of the branches of the inferior gluteal artery, the medial circumflex femoral artery and the first two perforating arteries. The nutrient branch of the third perforating branch was less frequently (in 14.5% of the cases) part of this anastomotic arterial chain.     

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.

     

Blood supply of the human fetal mandible

Gross anatomic and radiologic studies of the blood supply to the human mandible of the full-term fetus and newborn infant were performed on 22 specimens ranging from 320–538 mm crown-heel length and 1,192–4,108 gm in weight. Ten specimens were injected with red-lead and liquid soap to demonstrate the arteries radiographically. Twelve other specimens were injected with Castolite with a sprinkling of red-lead and yellow dye. The best side of each specimen was studied by radiography and dissection. This study demonstrated: (1) a masseteric arterial plexus supplying the coronoid process and the lateral wall of the ramus with contributions from the facial, masseter, transverse facial and external carotid arteries or combinations thereof; (2) a mental arterial plexus anastomosing with the mental, submental and inferior labial arteries; (3) an inferior alveolar artery supplying most of the body of the mandible with a majority of its branches passing in an upward direction; and (4) periosteal vessels supplying the lower border of the mandible and receiving their blood supply from the blood vessels supplying the muscles attaching to these areas and the periosteum. Supplemental to the above findings were anastomoses between the submental, mylohyoid and sublingual arteries along the medial border of the mandible. Also a significant variation not previously recorded was noted in one specimen in which the sublingual artery originated from the facial artery rather than the lingual.     

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.     

Size and location of the fetal diaphragm during the fetal period in human fetuses

Aim The aim of this study was to determine the development and the size and localization of the diaphragm during the fetal period in human fetuses. Materials and methods One hundred and eighty-four diaphragm obtained from human fetuses aged between 9 and 40 weeks of gestation was used in this study. The localization of the diaphragm with respect to abdominal cavity and the level of costodiaphragmatic recess with respect to the ribs were determined. The dimensions (height, width, and depth) of the diaphragm were measured. The diameter and localization of apertures on the diaphragm were determined. Results During the fetal period, the costodiaphragmatic recess was most commonly located at the level of the 9th rib. Means and standard deviations of the all parameters with respect to gestational weeks and months were calculated. No significant differences were observed between sexes for any of the parameters (P > 0.05). All parameters were increasing with age during fetal period. There was significant correlation between gestational age and all parameters (P < 0.001). The localizations of the diaphragmatic apertures did not change throughout the fetal period and aortic hiatus and oesophageal hiatus were most frequently situated to the left of the median plane. Conclusion New data are derived for human fetuses to evaluate diaphragmatic development. Data acquired in this study are believed to contribute to studies of obstetrics, perinatology, forensic medicine and fetal pathology on fetal development of the diaphragm, and diagnosis of its anomalies, pathologies and variations.     

Blood supply of human fetal teeth

Injection studies were made of the blood vessels of developing human teeth, using 114 unfixed aborted fetuses and new-born infants ranging in gestation age from three through nine months. These specimens were injected with India ink-formalin, Micropaque-formalin, Microfil, or vinyl acetate solutions via the umbilical vessels; in cases where an autopsy had been performed, injection was made through the carotid artery. After further fixation by immersion in 10% neutral formalin, the head was bisected in the sagittal plane. One half was dissected and tissue obtained for microscopic study; the other half was radiographed, dissected or dehydrated and cleared. These techniques revealed that the plexus of vessels which surrounds the developing dental organs is derived mainly from the inferior alveolar and palatine arteries, respectively. However, branches from vessels in adjacent tissues also supplied this plexus. The teeth growing most rapidly, and which usually erupt the earliest, receive the largest blood supply. Odontoblasts were supplied by vessels which course through the dental pulp to their deeper surface. The ameloblasts were adjacent to vessels in the capillary plexus on the outer surface of the enamel organ. A venous sinus was located at the base of the dental organ.     

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.     

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.

     

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.     

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.