多血管神经蒂腹内斜肌瓣修复面瘫的应用解剖

目的：为了探索晚期面瘫动力性修复中多神经支配的供区，提供多血管神经蒂腹内斜肌瓣的应用解剖学基础。方法：在２２侧红色乳胶灌注的成人尸体上，测量观察了腹内斜肌的神经支配及血供情况。结果：腹内斜肌主要接受第１１肋间神经和肋下神经支配的占９０．９％，接受第１０、１１肋间神经和肋下神经支配的占９．１％。第１１肋间神经入肌处至腋后线的平均长度为１２．７ｃｍ，肋下神经入肌处至腋后线的平均长度为１２．９ｃｍ，血供主要来源于第１１肋间动脉、肋下动脉和旋髂深动脉的腹壁肌支，在腹内斜肌和腹横肌筋膜之间有丰富的血管吻合。结论：可利用腹内斜肌多血管神经支配的特点，设计超长吻合多血管神经蒂的腹内斜肌瓣跨面移植治疗晚期面瘫的新术式。     

Applied anatomy of the musculus flexor carpi ulnaris and its clinical application

The blood vessels and nerves supplying 50 specimens of musculi flexor carpi ulnaris (FCU) in 25 Chinese male adult cadavers were investigated. The majority of the muscles were supplied by four to six blood vessels and by two branches of the ulnar nerve. The diameters of the second to fourth arteries were larger than 0.9 mm, which would allow them to be anastomosed to recipient vessels. As the arteries to the muscle were derived directly and/or indirectly from the ulnar artery, they could therefore be used as the arterial pedicles. The nerves were broad enough (1.18–1.05 mm) to act as nerve pedicles. These findings suggest that the FCU might be suitable for use as a free transplantation flap. Since the vessels and nerves to the FCU enter the muscle in its superior half, transposition in the reversed position is also possible. Eight patients have been treated by reversed transplantation of the FCU to restore lost function of the elbow joint. Follow-up studies showed uniformly good results.     

Anatomical Relationship Between the Kidney Collecting System and the Intrarenal Arteries in the Sheep: Contribution for a New Urological Model

Previous studies have demonstrated that the pig collecting system heals after partial nephrectomy without closure. Recently, a study in sheep showed that partial nephrectomy without closure of the collecting system resulted in urinary leakage and urinoma. The aim of this study was to present detailed anatomical findings on the intrarenal anatomy of the sheep. Forty two kidneys were used to produce tridimensional endocasts of the collecting system together with the intrarenal arteries. A renal pelvis which displayed 11–19 (mean of 16) renal recesses was present. There were no calices present. The renal artery was singular in each kidney and gave two primary branches one to the dorsal surface and one to ventral surface. Dorsal and ventral branches of the renal artery were classified based on the relationship between their branching pattern and the collecting system as: type I (cranial and caudal segmental arteries), type II (cranial, middle and caudal segmental arteries) or type III (cranial, cranial middle, caudal middle, and caudal segmental arteries). Type I was the most common branching pattern for the dorsal and ventral branches of the renal artery. The arterial supply of the caudal pole of the sheep kidney supports its use as an experimental model due to the similarity to the human kidney. However, the lack of a retropelvic artery discourages the use of the cranial pole in experiments in which the arteries are an important aspect to be considered. Anat Rec, 299:405–411, 2016. © 2016 Wiley Periodicals, Inc.     

Innervation of the levator scapulae, the serratus anterior, and the rhomboideus in crab-eating macaques and its morphological significance

The origin, course and distribution of the nerves supplying the levator scapulae, the serratus anterior, and the rhomboideus were carefully examined in four body-halves of crab-eating macaques. The levator scapulae arises from all the cervical vertebrae and is continuous with the serratus anterior, which arises from the upper ten ribs. The rhomboideus originates not only from the dorsal midline but also from the occipital bone. 6 segmental nerves from C3 to C8 innervate the 3 muscles: C3, C4, C5, and C6 innervate the levator scapulae; C6, C7, and C8 the serratus anterior; and C3, C4, C5, and C6 the rhomboideus. Each segmental nerve of supply originates as one or 2 branches from the dorsal surface of the corresponding root of the cervico-brachial plexus and runs dorso-caudally to enter the muscles. After supplying them, 6 or 7 branches pierce the levator scapulae and serratus anterior to reach the deep surface of the rhomboideus which they innervate. The upper segmental nerve tends to be distributed to the upper part of the muscle it innervates, while the lower segmental nerve is distributed to the lower part. According to the relationships between nerves and muscles, these 3 muscles may be regarded as the most medial of the dorsal musculature which is connected to the pectoral girdle and limb, as they are in man. It may surmised that the occipital portion of the rhomboideus and the caudal portion of the levator scapulae in crab-eating macapues correspond to the cranial portions of the levator scapulae and serratus anterior, respectively, in man.     

Arterial supply of the upper cranial nerves: A comprehensive review

The arterial supply to the upper cranial nerves is derived from a complex network of branches derived from the anterior and posterior cerebral circulations. We performed a comprehensive literature review of the arterial supply of the upper cranial nerves with an emphasis on clinical considerations. Arteries coursing in close proximity to the cranial nerves regularly give rise to small vessels that supply the nerve. Knowledge of the arteries supplying the cranial nerves is of particular importance during surgical approaches to the skull base. Clin. Anat. 27:1159–1166, 2014. © 2014 Wiley Periodicals, Inc.     

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.     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

以节段性肌肉移植为目的的股薄肌应用解剖

目的对股薄肌的主次血管蒂进行显微解剖,为节段性移植提供参考。方法解剖40例福尔马林保存的股薄肌标本,采用一种比例测量法,解剖及测量动脉蒂以及神经和血管的伴行关系。通过将每1例标本营养血管的位置比例化,总结肌肉动脉及神经分布的规律。结果股薄肌有4条动脉供血,其中股深动脉/旋股内侧动脉肌支和股动脉肌支是恒定出现的两条营养动脉,管径粗大、长度充分,适于游离移植。它们分别在距肌肉近端1/5与距肌肉后缘2/3相交的位置、和距肌肉近端1/2与距肌肉后缘1/2相交的位置进入肌肉,95%的神经和血管伴行。结论股薄肌可以凭借主要营养动脉分支为蒂纵行游离移植,或分别以主次营养动脉为蒂横行游离移植。     

The sartorius muscle: anatomic considerations for reconstructive surgeons

To evaluate the sartorius muscle as an alternative donor site for functional transfer, the neurovascular anatomy of the muscle was studied in 42 human sartorius muscle specimens (22 fresh and 20 preserved). Eleven adult fresh cadavers were injected with a mixture of lead oxide, gelatin and water (200 ml/kg) through the common carotid and femoral arteries. The sartorius muscle with its neurovascular pedicles was dissected, and radiographed. The sartorius muscle was also dissected out in 10 preserved cadavers. The neurovascular anatomy was thus analyzed in 42 sartorius muscles. The results show that each nerve supplying the sartorius muscle is accompanied by one vascular pedicle, forming a neurovascular hilum. Within the muscle, most of the nerves and vessels divide early, and their branches run parallel to each other and to the muscle fibers. Many of the vessels anastomose with each other to form an intricate vascular network. We conclude that it is possible to subdivide the muscle into functional units to harvest a segmental muscle flap with a neurovascular pedicle for transfer.     

Comparative anatomical study of the kidney position in amniotes using the origin of the renal artery as a landmark

The anatomical relationship between the kidney position and its arterial supply was investigated in 21 mammals, 1 bird, and 3 reptiles (n = 1 for each species) and in 43 human cadavers. The following observations were made. (1) Although the right kidney was located caudal to the left kidney in 29 out of 43 human cadavers (67.4%), the origin of the right renal artery from the aorta was located cranial to the origin of the left renal artery in 36 human cadavers (83.7%). Therefore, the relative positions of the kidneys do not correspond with the relative origins of the renal arteries in humans. (2) Among the mammals that were examined, the position of the kidney and the branching level of the renal artery on the right side were usually cranial to those on the left side. (3) In the bird and most reptiles that were examined, kidneys were typically located in the pelvic region and were supplied by segmental arterial branches. These results suggest that the right kidney and its arterial supply are generally located cranial to the left kidney in phylogeny of mammals. While the presence of a human accessory renal artery in 9 out of 86 sides (10.5%) and a cranial origin of the left renal artery relative to the right renal artery in 7 out of 43 cadavers (16.3%), shows some variation in the arterial supply to the kidneys, the origin of the renal arteries can generally be used as phylogenetic landmarks indicating the relative positions of the kidneys. Hence, from an ontological perspective, the human right kidney may be initially situated cranial to the left kidney during the early stages of development. Thereafter, the human right kidney may shift downwards secondary.     

Dog kidney: Anatomical relationships between intrarenal arteries and kidney collecting system

The detailed findings of canine intrarenal anatomy (collecting system and arteries) are presented. Ninety‐five three‐dimensional endocasts of the kidney collecting system together with the intrarenal arteries were prepared using standard injection–corrosion techniques and were studied. A single renal artery was observed in 88.4% of the casts. The renal artery divided into a dorsal and a ventral branch. Using the branching pattern of the ventral and dorsal divisions of the renal artery, the vessels were classified in type I or type II. Type I presented a cranial and a caudal artery, whereas type II presented a mesorenal and a caudal artery. Cranial branches of dorsal and ventral arteries supplied the cranial pole in 90.5% of the specimens. Caudal branches of the dorsal and the ventral divisions of the renal artery irrigated both the caudal pole and the mid‐zone of the kidney in 95.8% and 98.9% of the cases, respectively. In all casts, caudal branches of both dorsal and ventral arteries supplied the caudal pole. Therefore, the caudal branches of the ventral and dorsal divisions of the renal artery are of utmost importance in the kidney arterial supply. Although many results of renal and intrarenal anatomy in dogs may not be completely transposed to humans, the anatomical relationship between arteries and the collecting system in the cranial pole of the dog kidney is similar to those in man. This fact supports the use of the dog as an animal model for urologic procedures at the cranial pole. Anat Rec, 290:1017–1022, 2007. © 2007 Wiley‐Liss, Inc.     

股内侧推进肌瓣的应用解剖

在40侧成人下肢标本上,观察了股内侧肌的形态、血供和神经支配。该肌血供分布呈节段性,来自股动脉,膝降动脉、股深动脉和旋股外侧动脉。肌的静脉回流通过与动脉的伴行静脉注入股静脉。肌的运动神经来自股神经的股内侧肌支。本文讨论了股内侧推进肌瓣的应用解剖学要点。     

Anatomical contribution to the surgical construction of the sartorius muscle flap

The sartorius muscle (SM) is frequently used as a surgical flap. This study intends to describe sartorius nerve and artery distribution in adult men. Fifty-three specimens obtained from fresh cadavers were prepared as described: 32 specimens were injected with a red-colored gelatin solution through the femoral artery so that intra-muscular arteries and nerves were dissected; six specimens were injected with barium sulfate solution through the femoral artery for radiography; seven specimens were injected with a Chinese ink solution, also through the femoral artery, for diaphanization; seven specimens were injected with a solution of vinyl acetate, through the femoral artery, to obtain an arterial cast and one specimen was cut and colored by Masson’s Trichrome. Sartorius branching patterns of the nerve and artery were schematized. The following measurements were taken for each dissected muscle: total length, arterial pedicle length and distance between each arterial pedicle to the proximal muscle extremity. Five to nine arterial pedicles were found in the sample. In their trajectories, these arteries may give rise to many branches to form a dense and elongated net of anastomoses. Intra- and inter-pedicular anastomoses were observed in the inner part of the muscle. The nerve supply originated from one or two branches, which enter the muscle together with the first or second arterial pedicle. The nerve branches were divided into two or three territorial branches, and then into four or five segmental branches, running longitudinally inside the muscle. The muscles showed an average length of 44.81 cm. SM is a segmented structure and it can be divided into as many as five arterial and nervous segments. In the proximal and middle parts, the muscle has better arterial supply. The segments can be filled by adjacent pedicles, due to an elongated net of anastomoses, which allow a longer arc of rotation in the construction of pedicled flaps.     

Studies on the vasa vasorum of the human renal artery.

The transplantation of a donor kidney is currently the treatment of choice for terminal renal insufficiency. However, major postoperative problems may be caused by vascular complications. It was therefore decided to look for possible correlations between these vascular problems and the arterial wall supply. The following methods were used to elucidate the origin and distribution of nutrient vessels: 1. Injection of the abdominal aorta with resin in three fresh cadavers. 2. The precise microscopic location of the branches originating from the renal arteries in eighteen autopsy subjects. 3. Abdominal angiography and selective angiography of the first left lumbar artery and left renal artery in one patient. It was found that the renal artery receives its blood supply from both internal and external nutrient vessels. The external vascular supply of the renal arterial wall originates from the aorta itself, from the inferior suprarenal artery (which sometimes has connections with the first and/or second lumbar artery) or from the diffuse vascular system of the retroperitoneal space. Because of the variety in number, course and origin of these nutritional vessels, an ideal point for the anastomosis of the renal artery cannot be indicated.     

The sartorius muscle: anatomic considerations for reconstructive surgeons

Summary To evaluate the sartorius muscle as an alternative donor site for functional transfer, the neurovascular anatomy of the muscle was studied in 42 human sartorius muscle specimens (22 fresh and 20 preserved). Eleven adult fresh cadavers were injected with a mixture of lead oxide, gelatin and water (200 ml/kg) through the common carotid and femoral arteries. The sartorius muscle with its neurovascular pedicles was dissected, and radiographed. The sartorius muscle was also dissected out in 10 preserved cadavers. The neurovascular anatomy was thus analyzed in 42 sartorius muscles. The results show that each nerve supplying the sartorius muscle is accompanied by one vascular pedicle, forming a neurovascular hilum. Within the muscle, most of the nerves and vessels divide early, and their branches run parallel to each other and to the muscle fibers. Many of the vessels anastomose with each other to form an intricate vascular network. We conclude that it is possible to subdivide the muscle into functional units to harvest a segmental muscle flap with a neurovascular pedicle for transfer.This paper was presented at the 50th Annual Meeting of the Canadian Society of Plastic Surgeons in Halifax, NS, in May of 1996.