Nobuaki Imanishi

Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications.

The arteries adjacent to the lesser saphenous vein and sural nerve were investigated in 10 fresh cadavers that had been systemically injected with a lead oxide-gelatin mixture. The accompanying arteries were found to lie along the lesser saphenous vein and sural nerve and to nourish the skin through venocutaneous and neurocutaneous perforators. On the basis of the anatomy of these accompanying arteries, the lesser saphenous venoadipofascial (VAF) pedicled fasciocutaneous flap and the lesser saphenous-sural veno-neuro adipofascial (V-NAF) pedicled fasciocutaneous flap have been developed and applied to 23 cases of various reconstructions of the lower extremity with proximal and distal bases. Survival of the flaps has been extremely good, and the flaps have been clinically useful.

Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap.

&NA; The arterial anatomy of the accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities was investigated in 10 fresh cadavers that had been injected with a lead oxide‐gelatin mixture throughout the entire body. It is well known that cutaneous nerves have neurocutaneous perforators, but it was found that cutaneous veins also have their own accompanying arteries as well. The accompanying arteries of the cutaneous veins had branches not only to the vein wall, but also to the skin, i.e., venocutaneous perforators. Based on these findings, the concept of the adipofascial pedicled fasciocutaneous flap using the accompanying arteries of the cutaneous veins, cutaneous nerves, or both was proposed. (Plast. Reconstr. Surg. 102: 779, 1998.)

Facial artery in the upper lip and nose: anatomy and a clinical application.

&NA; Twenty‐five facial arteries were examined radiographically in 19 fresh cadavers that had been injected systemically with a lead oxide‐gelatin mixture. Major branches of the facial artery in the upper lip and nose were investigated, and the anatomical variations were classified into three types on the basis of the anatomy of the lateral nasal artery, which was determined as an artery running toward the alar base. In 22 cases (88 percent), the facial artery bifurcated into the lateral nasal artery and superior labial artery at the angle of the mouth. In two cases (8 percent), the facial artery became an angular artery after branching off into the superior labial artery and the lateral nasal artery sequentially. In one case (4 percent), the facial artery became an angular artery after branching off into the superior labial artery, and the lateral nasal artery then branched off from the superior labial artery. Branches from the lateral nasal and superior labial arteries were observed stereographically. Vascular anastomoses between those branches were created in the upper lip, columella base, and nasal tip, and an intimate vascular network was formed. With a vascular network in the mucosa of the upper lip, a bilobed upper‐lip flap was created for a clinical case with a full‐thickness defect of the ala. (Plast. Reconstr. Surg. 109: 855, 2002.)

The arterial anatomy of the temporal region and the vascular basis of various temporal flaps

The arterial anatomy of the temporal region was examined macroscopically and radiographically in 10 fresh cadavers which had been injected with lead oxide. The blood supply of the temporal region is derived from the superficial temporal, middle temporal, deep temporal, posterior auricular, transverse facial, zygomatico-orbital, zygomaticotemporal, zygomaticofacial, and middle meningeal arteries. The vascular network formed by these arteries can be divided into four arterial networks corresponding to the different layers of the temporal region. With a new understanding of the arterial networks and their anastomoses, the techniques for elevating various flaps in the temporal region are discussed.

Arterial anatomy of the nipple-areola complex

Keio University Department of Plastic and Reconstructive Surgery School of Medicine 35 Shinanomachi, Shinjuku-ku Tokyo 160, Japan The blood supply of the nipple-areola complex was investigated radiographically in five fresh cadavers that had been systemically injected with lead oxide. The blood supply of the breast is derived from the external mammary, internal mammary, intercostal, and thoracoacromial arteries. We found that branches of the external and internal mammary arteries provided the dominant blood supply to the nipple-areola complex. These branches provide small vessels that traverse the subcutaneous tissue to the nipple-areola complex. Branches are given off to the areolar skin. These ascended, arborizing in the upper and middle thirds of the nipple. (Plast. Reconstr. Surg. 96: 843, 1995.)

Venous drainage of the distally based lesser saphenous-sural veno- neuroadipofascial pedicled fasciocutaneous flap: A radiographic perfusion study

The drainage pathway of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap using accompanying arteries of the lesser saphenous vein and sural nerve as nutrient vessels of the flap was radiographically investigated using five fresh cadavers. Small long veins existed along the lesser saphenous vein, and they were considered to be concomitant veins of the accompanying arteries of the lesser saphenous veins. They anastomosed with the lesser saphenous vein in some places and played a role in bypassing valves in the lesser saphenous vein.

Vascular anatomy of the anterolateral thigh flap.

Arterial and venous anatomy and their relation to the anterolateral thigh flap were examined in 10 specimens of six fresh cadavers in which radiopaque materials were injected into both the arterial and venous systems. Territories and positions of individual perforating arteries were measured, and the venous drainage pathway of the flap was analyzed. All specimens were radiographed stereoscopically to observe the three-dimensional structure of the arteries and veins. The territory of each perforating artery was smaller than expected. Most of the venous blood that had perfused the dermis was considered to pool in a polygonal venous network located in the skin layer and to enter the descending branch of the lateral circumflex femoral artery through large descending veins. The venous territories were considered different from the arterial territories. The findings in this study suggest that the design of the anterolateral thigh flap should be based on the venous architecture rather than on the arterial architecture and that the flap survival rate might be improved if thinning is performed appropriately.

Effect of shortening deformity of the clavicle on scapular kinematics: A cadaveric study

Background In some short malunion cases, midshaft clavicular fractures are reported to result in unsatisfactory clinical outcomes. Shortening deformity of the clavicle could change the anatomical alignment of the shoulder girdle and is surmised to affect shoulder kinematics on arm movements. Nevertheless, no report has ever referred to documented changes. Hypothesis Scapular motion will change with clavicular shortening in cadaveric models. Study Design Controlled laboratory study. Methods Twelve cadaveric shoulders were used, and sequential clavicular shortening by 0%, 5%, 10%, 15%, and 20% from the original length was simulated in this study. The scapulothoracic motion during passive arm elevation in 3 planes was monitored using an electromagnetic tracking device. Differences in kinematics of the scapula between the 0% shortening models and the other 4 experimental groups were analyzed. Results During arm elevation, posterior tilting and external rotation of the scapula significantly decreased with ≥10% shortening of the clavicle. Decreased posterior tilting was found with a shorter clavicle and at higher positions of arm elevation in all planes and became obvious during coronal plane elevation. Upward rotation of the scapula did not change with shortening at any elevated arm positions. Conclusion The findings of this study clearly indicated that shortening of the clavicle affects the kinematics in the shoulder girdle. Clinical Relevance The results of this cadaveric study suggest that clavicular shortening of ≥10% affects scapular kinematics and might produce clinical symptoms.

Three-dimensional analysis and classification of arteries in the skin and subcutaneous adipofascial tissue by computer graphics imaging

&NA; To develop new types of surgical flaps that utilize portions of the skin and subcutaneous tissue (e.g., a thin flap or an adipofascial flap), three‐dimensional investigation of the vasculature in the skin and subcutaneous tissue has been anticipated. In the present study, total‐body arterial injection and three‐dimensional imaging of the arteries by computer graphics were performed. The full‐thickness skin and subcutaneous adipofascial tissue samples, which were obtained from fresh human cadavers injected with radioopaque medium, were divided into three distinct layers. Angiograms of each layer were introduced into a personal computer to construct three‐dimensional images. On a computer monitor, each artery was shown color‐coded according to the three portions: the deep adipofascial layer, superficial adipofascial layer, and dermis. Three‐dimensional computerized images of each artery in the skin and subcutaneous tissue revealed the components of each vascular plexus and permitted their classification into six types. The distribution of types in the body correlated with the tissue mobility of each area. Clinically, appreciation of the three‐dimensional structure of the arteries allowed the development of several new kinds of flaps. (Plast. Reconstr. Surg. 102: 748, 1998.)

Is the platysma flap musculocutaneous? Angiographic study of the platysma.

Background: The platysma flap has often been used for reconstructions of the head and neck, but the arterial anatomy of the platysma itself has not been clarified. Methods: The anterolateral neck skin in five sides of four fresh cadavers that had been injected systemically with a lead oxide–gelatin mixture was elevated and divided into three layers: the skin with adipofascial tissue over the platysma, the platysma, and the adipofascial tissue under the platysma. Radiographs were taken of each specimen using the soft x-ray system. Results: The anterolateral neck skin was chiefly supplied by branches of the submental, facial, superior thyroid, transverse cervical, and occipital arteries, and it was found that the vasculature of the arterial branches can be classified into three groups. In all of the groups, the arterial branches penetrated the platysma and did not run long in the platysma layer. The platysma was supplied by only small vessels from the arterial branches. Furthermore, there was little connection between the vascular plexus of the platysma and that of the skin layer with adipofascial tissue above the platysma and the platysma located in the subcutaneous tissue. Conclusions: The platysma flap should be considered fasciocutaneous rather than musculocutaneous. Therefore, the platysma flap should usually be elevated with the deep adipofascial tissue under the platysma. Flap survival is threatened if it is elevated without the adipofascial tissue under the muscle as with a usual musculocutaneous flap.