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Research Article| Volume 40, ISSUE 2, P113-141, March 1987

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The vascular territories (angiosomes) of the body: experimental study and clinical applications

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      Abstract

      The blood supply to the skin and underlying tissues was investigated by ink injection studies, dissection, perforator mapping and radiographic analysis of fresh cadavers and isolated limbs. The results were correlated with previous regional studies done in this department.
      The blood supply is shown to be a continuous three-dimensional network of vessels not only in the skin but in all tissue layers. The anatomical territory of a source artery in the skin and deep tissues was found to correspond in most cases, giving rise to the angiosome concept.
      Arteries follow closely the connective tissue framework of the body. The primary supply to the skin is by direct cutaneous arteries which vary in calibre, length and density in different regions. This primary supply is reinforced by numerous small indirect vessels, which are “spent” terminal branches of arteries supplying the deep tissues.
      An average of 374 major perforators was plotted in each subject, revealing that there are still many more potential skin flaps. Our arterial roadmap of the body provides the basis for the logical planning of incisions and flaps. The angiosomes defined the tissues available for composite transfer.

      Reference

        • Acland R.D.
        • Schusterman M.
        • Godina M.
        • Eder E.
        • Taylor G.I.
        • Carlisle I.R.
        The saphenous neurovascular free flap.
        Plastic and Reconstructive Surgery. 1981; 67: 763
        • Badran H.A.
        • El-Helaly M.S.
        • Safe I.
        The lateral intercostal neurovascular free flap.
        Plastic and Reconstructive Surgery. 1984; 73: 17
        • Bakamjian V.Y.
        A two stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap.
        Plastic and Reconstructive Surgery. 1965; 36: 173
        • Blair V.P.
        The delayed transfer of long pedicle flaps in plastic surgery.
        Surgery, Gynecology and Obstetrics. 1921; 33: 261
        • Boyd J.B.
        • Taylor G.I.
        • Corlett R.J.
        The vascular territories of the superior epigastric and the deep inferior epigastric systems.
        Plastic and Reconstructive Surgery. 1984; 73: 1
        • Carriquiry C.
        • Aparecida Costa M.
        • Vasconez L.O.
        An anatomical study of the septocutaneous vessels of the leg.
        Plastic and Reconstructive Surgery. 1985; 76: 354
        • Cormack G.C.
        • Lamberty B.G.H.
        A classification of fascio-cutaneous flaps according to their patterns of vascularisation.
        British Journal of Plastic Surgery. 1984; 37: 80
        • Costa M.A.C.
        • Carriquiry C.
        • Grotting J.C.
        • Herrera R.H.
        • Vasconez L.O.
        • Windle B.H.
        An anatomical study of the venous drainage of the transverse rectus abdominis musculocutaneous flap.
        Plastic and Reconstructive Surgery. 1987; (In Press)
        • Crock H.I.
        The Blood Supply of the Lower Limb Bones.
        E. and S. Livingston Ltd., Edinburgh1967
        • Daniel R.K.
        • Taylor G.I.
        Distant transfer of an island flap by microvascular anastomoses.
        Plastic and Reconstructive Surgery. 1973; 52: III
        • Daniel R.K.
        • Williams H.B.
        The free transfer of skin flaps by microvascular anastomoses.
        Plastic and Reconstructive Surgery. 1973; 52: 16
        • Esser J.F.S.
        Artery Flaps.
        De Vos-van Kleef, Antwerp1929
        • Gillies H.D.
        • Millard D.R.
        The Principles and Art of Plastic Surgery.
        Little Brown, Boston1957
      1. Grant's Atlas of Anatomy (1958). Ed. Anderson, J. E. 7th Edition. Baltimore: The Williams and Wilkins Co.

      2. Gray's Anatomy. (1958). Ed. Johnston, T. B. Davies, I. E. S. and Davies, F. 32nd Edition. London: Longmans.

      3. Gray's Anatomy. (1980). Ed. Williams, P. and Warwick, R. 36th Edition. Edinburgh: Churchill Livingstone.

        • Hunter J.
        A Treatise on the Blood, Inflammation and Gunshot wounds.
        John Richardson, London1794
        • Last R.J.
        • Tompsett D.H.
        Corrosion casts of the blood vessels of stillborn babies.
        Acta Anatomica. 1962; 51: 338
        • Manchot C.
        Die Hautarterien des menschlichen Korpers.
        Vogel, Leipzig1889
        • Manchot C.
        The Cutaneous Arteries of the Human Body.
        Springer-Verlag, New York1983 (Translated by Ristic, J. and Morain, W. D.)
        • McCraw J.B.
        The recent history of myocutaneous flaps.
        Clinics in Plastic Surgery. 1980; 7: 3
        • McDowell F.
        Logs vs. harpsichords, blobby flaps vs. finished results.
        Plastic and Reconstructive Surgery. 1979; 64: 249
        • McGregor I.A.
        • Morgan G.
        Axial and random pattern flaps.
        British Journal of Plastic Surgery. 1973; 26: 202
        • Nakajima H.
        • Fujino T.
        • Adachi S.
        A new concept of vascular supply to the skin and classification of skin flaps according to their vascularisation.
        Annals of Plastic Surgery. 1986; 16: I
        • Palmer J.H.
        • Taylor G.I.
        The vascular territories of the anterior chest wall.
        British Journal of Plastic Surgery. 1986; 39: 287
        • Patten B.M.
        Human Embryology.
        in: 3rd Edition. Blakiston Division, McGraw-Hill Book Company, New York1968
        • Ponte´n B.
        The fasciocutaneous flap: its use in soft tissue defects of the lower leg.
        British Journal of Plastic Surgery. 1981; 34: 215
        • Quain J.
        • Wilson E.
        A Series of Anatomical Plates in Lithography. Volume 2. Taylor and Walton, London1842
        • Rees M.J.W.
        • Taylor G.I.
        A simplified lead oxide cadaver injection technique.
        Plastic and Reconstructive Surgery. 1986; 77: 141
        • Reid C.D.
        • Taylor G.I.
        The vascular territory of the acromiothoracic axis.
        British Journal of Plastic Surgery. 1984; 37: 194
        • Salmon M.
        Arte`res de la Peau.
        Masson et Cie, Paris1936
        • Salmon M.
        Arte`res des Muscles des Membres et du Tronc.
        Masson et Cie, Paris1936
        • Salmon M.
        Arteries of the Skin.
        in: Taylor G.I. Tempest M. Churchill Livingstone, London1987 (In press)
        • Shanahan R.E.
        • Gingrass R.P.
        Medial plantar sensory flap for coverage of heel defects.
        Plastic and Reconstructive Surgery. 1979; 64: 295
        • Shaw D.T.
        • Payne R.L.
        One-staged tubed abdominal flaps.
        Surgery; Gynecology and Obstetrics. 1946; 83: 205
        • Song R.
        • Gao Y.
        • Song Y.
        • Yu Y.
        • Song Y.
        The forearm flap.
        Clinics in Plastic Surgery. 1982; 9: 21
        • Spalteholz W.
        Die Vertheilung der Blutgefasse in der Haut.
        Archive fu¨r Anatomie und Physiologie. 1893; I (Anatomische Abtheilung): 54
        • Tansini I.
        Sopra il mio nuovo processo di amputazione della mamella.
        Gazetta Medica Italiana. 1906; 57: 141
        • Taylor G.I.
        • Daniel R.K.
        The free flap: Composite tissue transfer by vascular anastomosis.
        Australian and New Zealand Journal of Surgery. 1973; 43: I
        • Taylor G.I.
        • Miller G.D.H.
        • Ham F.J.
        The free vascularised bone graft.
        Plastic and Reconstructive Surgery. 1975; 55: 533
        • Taylor G.I.
        • Daniel R.K.
        The anatomy of several free flap donor sites.
        Plastic and Reconstructive Surgery. 1975; 56: 243
        • Taylor G.I.
        • Ham F.J.
        The free vascularised nerve graft.
        Plastic and Reconstructive Surgery. 1976; 57: 413
        • Taylor G.I.
        Nerve grafting with simultaneous microvascular reconstruction.
        Clinics in Orthopaedics. 1978; 133: 56
        • Taylor G.I.
        • Watson N.
        One stage repair of compound leg defects with revascularised flaps of groin skin and iliac bone.
        Plastic and Reconstructive Surgery. 1978; 61: 494
        • Taylor G.I.
        • Townsend P.L.
        Composite free flap and tendon transfer: an anatomical study and a clinical technique.
        British Journal of Plastic Surgery. 1979; 32: 170
        • Taylor G.I.
        • Townsend P.L.
        • Corlett R.J.
        Superiority of the deep circumflex iliac vessels as the supply for free groin flaps: experimental work.
        Plastic and Reconstructive Surgery. 1979; 64: 595
        • Taylor G.I.
        • Townsend P.L.
        • Corlett R.J.
        Superiority of the deep circumflex iliac vessels as the supply for free groin flaps: clinical work.
        Plastic and Reconstructive Surgery. 1979; 64: 745
        • Taylor G.I.
        • Corlett R.J.
        The vascular territories of the body and their relation to tissue transfer.
        in: Plastic Surgery Forum. 4. 1981: 113
        • Taylor G.I.
        The Cutaneous Arteries of the Human Body.
        Springer-Verlag, New York1983 (Translated by Risic, J. and Morain, W. D.)
        • Taylor G.I.
        • Corlett R.J.
        • Boyd J.B.
        The extended deep inferior epigastric flap: a clinical technique.
        Plastic and Reconstructive Surgery. 1983; 72: 751
        • Taylor G.I.
        • Corlett R.J.
        • Boyd J.B.
        The versatile deep inferior epigastric (inferior rectus abdominis) flap.
        British Journal of Plastic Surgery. 1984; 37: 330
        • Timmons M.J.
        Landmarks in the anatomical study of the blood supply of the skin.
        British Journal of Plastic Surgery. 1985; 38: 197
        • Webster J.P.
        Thoraco-epigastric tubed pedicles.
        Surgical Clinics of North America. 1937; 17: 145