The Microvasculature of the Sesamoid Complex: Its Clinical Significance

Foot & Ankle ◽  
1992 ◽  
Vol 13 (6) ◽  
pp. 359-363 ◽  
Author(s):  
Mark Sobel ◽  
Jun Hashimoto ◽  
Steven P. Arnoczky ◽  
Walther H.O. Bohne
Keyword(s):  
Clinical Significance ◽  
Blood Supply ◽  
Surgical Approach ◽  
Vascular Supply ◽  
Joint Capsule ◽  
Tissue Clearing ◽  
Plantar Surface ◽  
Plantar Plate ◽  
Capsular Attachment

The microvascular anatomy of the sesamoid complex was investigated in 15 cadaver specimens using histology and tissue clearing (Spalteholz) techniques. It was found that both sesamoids appeared equally well vascularized and the vascular supply to each sesamoid originated from two major sources (proximal and plantar) and one minor source (distal). Proximally, vessels originating from the first plantar metatarsal artery enter the sesamoid at its attachment to the flexor hallucis brevis. In addition, vessels enter the plantar surface of the sesamoid near the midline and arborize throughout the bone, anastamosing with the proximal vessels. The distal vascular supply to the sesamoids originates from its distal capsular attachment and appears to contribute minimally to the overall vascular scheme. The lateral attachments of the sesamoids to the plantar plate and joint capsule were relatively avascular. In two bipartite specimens examined, the major blood supply originated from the proximal and distal poles of the sesamoid. No vessels were observed entering the plantar surface of these specimens. The results of this study suggest that injury to the proximal or plantar aspects of the sesamoids could disrupt the vascular supply to these bones. These areas should, therefore, be avoided during the surgical approach to the sesamoids.

scholarly journals Angiology of the Plantar Plate

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Fred Finney ◽  
Basma Khoury ◽  
Jaron Scott ◽  
Ken Kozloff ◽  
Todd Irwin ◽  
...  
Keyword(s):  
Blood Supply ◽  
Perfusion Imaging ◽  
Surgical Techniques ◽  
Vascular Supply ◽  
Micro Ct ◽  
Ct Scanner ◽  
Micro Computed Tomography ◽  
Surgical Interventions ◽  
Plantar Plate ◽  
Mtp Joints

Category: Basic Sciences/Biologics, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Hammertoes, crossover toes, and claw toes are common deformities and can be a major source of pain and dysfunction. These deformities result from instability of the metatarsophalangeal (MTP) joint due to incompetence of the plantar plate and/or collateral ligaments. Non-operative management is the first line of treatment. When non-operative treatment is unsuccessful, surgical interventions have been described. Newer surgical techniques focus on performing anatomic repairs of plantar plates. The vasculature of the foot has been well studied, but the vascular supply of the plantar plate has not been described. This study presents a new technique for imaging the microvasculature of the lesser toe plantar plates through micro- computed tomography (micro-CT) in order to better understand tear pathology and the capacity of healing with plantar plate repairs. Methods: The posterior tibial and dorsalis pedis arteries of a fresh frozen human cadaver foot were dissected and cannulated at the ankle for perfusion distally. After administration of an anticoagulant, each artery was perfused with Microfil® Silicone Rubber, a contrast agent. The compound was then allowed to cure, and the foot was fixed in formalin. The foot was sectioned through the metatarsal shafts for imaging, and imaging of the lesser toe MTP joints was performed using a Bruker Skyscan 1176 micro-CT scanner at 18 micron slices. Computerized reconstruction of the images was performed for three dimensional visualization of the vasculature. Results: Post-perfusion imaging of the lesser toe MTP joints using micro-CT allows for visualization of the plantar plate microvasculature. Preliminary imaging suggests that micro-CT is a useful modality for analysis of the blood supply of the plantar plate. Conclusion: Anatomic repair of the plantar plate has become a viable treatment option for MTP joint instability. One important question that remains to be answered is whether plantar plate tears have the capacity to heal. We present a novel technique for imaging of lesser toe plantar plate microvascularity using micro-CT. Preliminary results of post-perfusion imaging of the plantar plate are promising for developing a better understanding of its blood supply. Further definition of the plantar plate vascular supply will help clinicians understand the capacity for healing after repairs and may provide some insight to the biological causes plantar plate tears.

The Blood Supply to the Canine Palmar Metacarpal Sesamoid Bones

1995 ◽  
Vol 08 (02) ◽  
pp. 76-81 ◽  
Author(s):  
M. A. Cake ◽  
R. A. Read
Keyword(s):  
Blood Supply ◽  
Vascular Supply ◽  
Arterial Supply ◽  
Sesamoid Bones ◽  
Vascular Compromise

SummaryEleven canine forelimbs were examined using either gross dissection or a modified Spalteholz technique to investigate the blood supply of the palmar metacarpal sesamoid bones. In addition, the sesamoid bones, from two prepared skeletons, were examined for the presence of vascular foramina. Multiple vascular foramina were observed over the sesamoid surface. The most consistent elements of the arterial supply were proximal vessels supplying the axial and dorsal abaxial sides of the bone. In addition, palmar and distal sources often made contributions to the blood supply. Various minor or occasional sources were noted. This study demonstrates that the palmar metacarpal sesamoid bones of the dog have an abundant but highly variable vascular supply.The blood supply of the canine palmar metacarpal sesamoid bones was examined, using several methods, in order to evaluate the possible involvement of vascular compromise in sesamoid disease. It was found that the sesamoid bones have an abundant blood supply which is presumably resistant to disruption.

scholarly journals Vascular Supply of the Human Spiral Ganglion: Novel Three-Dimensional Analysis Using Synchrotron Phase-Contrast Imaging and Histology

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xueshuang Mei ◽  
Rudolf Glueckert ◽  
Annelies Schrott-Fischer ◽  
Hao Li ◽  
Hanif M. Ladak ◽  
...  
Keyword(s):  
Blood Supply ◽  
Phase Contrast ◽  
Spiral Ganglion ◽  
Three Dimensional ◽  
Vascular Anatomy ◽  
Helical Structure ◽  
Vascular Supply ◽  
Phase Contrast Imaging ◽  
Contrast Imaging ◽  
Temporal Bones

AbstractHuman spiral ganglion (HSG) cell bodies located in the bony cochlea depend on a rich vascular supply to maintain excitability. These neurons are targeted by cochlear implantation (CI) to treat deafness, and their viability is critical to ensure successful clinical outcomes. The blood supply of the HSG is difficult to study due to its helical structure and encasement in hard bone. The objective of this study was to present the first three-dimensional (3D) reconstruction and analysis of the HSG blood supply using synchrotron radiation phase-contrast imaging (SR-PCI) in combination with histological analyses of archival human cochlear sections. Twenty-six human temporal bones underwent SR-PCI. Data were processed using volume-rendering software, and a representative three-dimensional (3D) model was created to allow visualization of the vascular anatomy. Histologic analysis was used to verify the segmentations. Results revealed that the HSG is supplied by radial vascular twigs which are separate from the rest of the inner ear and encased in bone. Unlike with most organs, the arteries and veins in the human cochlea do not follow the same conduits. There is a dual venous outflow and a modiolar arterial supply. This organization may explain why the HSG may endure even in cases of advanced cochlear pathology.

scholarly journals Treatment of juvenile angiofibromas: 18-year experience of a single tertiary centre in Spain

2012 ◽  
Vol 50 (1) ◽  
pp. 95-103
Author(s):  
Fernando Lopez ◽  
Vanessa Suarez ◽  
Maria Costales ◽  
Carlos Suarez ◽  
Jose L. Llorente
Keyword(s):  
Surgical Approach ◽  
Early Stage ◽  
Tumour Size ◽  
Vascular Supply ◽  
Open Approach ◽  
Tertiary Centre ◽  
Preauricular Approach ◽  
Conventional Open Approach ◽  
Open Surgical Approach

Background: The management of juvenile angiofibroma (JA) has changed during the last decades but it still continues to be a challenge. The objective of this study was to review the used treatment and our outcomes. Methods: From 1992 to 2010, 48 cases of JA were treated at our department. Charts were reviewed for standard demographic, tumour size and location, vascular supply and results of embolization, surgical approach, operative results, adjuvant therapies, recurrence and postoperative follow-up. Results: Most tumours were Andrews-Fisch stages III and IV and surgery was used as the main treatment in all cases. We used an open surgical approach in 37 (77%) patients and 11 (23%) were treated endoscopically. The most common open approach used in this series was the subtemporal-preauricular approach. Until 1995, all tumours were operated on by a conventional open approach. Afterwards, early-stage tumours were operated on through an endoscopic approach. Ten patients were treated through surgery followed by radiosurgery. Two (4%) patients had recurrent disease. Conclusions: These tumours should be treated at centres with expertise in skull base surgery to achieve complete surgical resections with low morbidity. Radiosurgery after surgery seems to be a valuable option in the long-term control of some extended JAs.

Posterior Petrosal Transotic Approach for Cerebellopontine Angle Hemangioblastoma: Technical Case Report

2019 ◽  
Vol 17 (6) ◽  
pp. E269-E273
Author(s):  
Michael A Mooney ◽  
Claudio Cavallo ◽  
Evgenii Belykh ◽  
Sirin Gandhi ◽  
Justin Mascitelli ◽  
...  
Keyword(s):  
Blood Supply ◽  
Cerebellopontine Angle ◽  
Radiation Treatment ◽  
Vascular Supply ◽  
Vascular Tumors ◽  
Subtotal Resection ◽  
Anterior Inferior Cerebellar Artery ◽  
Adjuvant Radiation ◽  
Arterial Blood ◽  
Transotic Approach

Abstract BACKGROUND AND IMPORTANCE Although posterior petrosal approaches are utilized less frequently in many practices today, they continue to provide distinct surgical advantages in carefully selected cases. Here, we report a case of a recurrent cerebellopontine angle (CPA) hemangioblastoma that had failed a prior, more conservative, surgical approach. We provide cadaveric dissections of variations of posterior petrosal approaches to illustrate the advantages of the selected approach. CLINICAL PRESENTATION A 70-yr-old female presented with a growing left CPA hemangioblastoma. The lesion had undergone a prior subtotal resection from a retrosigmoid approach and subsequent adjuvant radiation treatment. The patient had worsening left facial strength, progressive balance difficulty, and absent left auditory function. Preoperative angiogram demonstrated arterial blood supply from the left anterior inferior cerebellar artery (AICA) that was deemed unsafe for embolization due to significant arteriovenous shunting. A posterior petrosal transotic approach was performed in order to optimize the working angle to the anterior brainstem and afford the ability to occlude the vascular supply from AICA prior to surgical resection of the lesion. CONCLUSION The posterior petrosal transotic approach offers an improved surgical working angle to the anterior brainstem compared to the translabyrinthine approach. This advantage can be particularly important with vascular tumors that receive blood supply anteriorly, as in this case from AICA, and can improve the safety of the resection.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma

2018 ◽  
Vol 127 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Jeffrey J. Harmon ◽  
Zoe Walters ◽  
Ravi Samy ◽  
Alessandro de Alarcon ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Facial Nerve ◽  
Blood Supply ◽  
Facial Palsy ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Potential Complication ◽  
Nasopharyngeal Angiofibroma

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

scholarly journals The Innervation and Vascular Supply of the Antrum

1934 ◽  
Vol 27 (6) ◽  
pp. 745-751 ◽  
Author(s):  
Cecil Strong
Keyword(s):  
Carotid Artery ◽  
Prussian Blue ◽  
Blood Supply ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Antral Mucosa ◽  
Thermal Tests ◽  
Made In

An attempt has been made to obtain information about the condition of the pulp of teeth, immediately below the bony incision, made in the lateral antral wall in radical antrotomy, and to investigate the conditions obtaining in the vascular supply of that neighbourhood. The investigation has two parts: (1) Experimental; (2) Clinical. Experimental.—( a) Injections of specimens of the superior maxillæ were made with lipiodol, then X-rayed. These showed vascular anastomoses along the antral floor. ( b) Sections of the lateral antral wall and floor were cut and stained to show nerves and blood spaces. ( c) The external carotid artery was injected with Prussian Blue and the maxilla then removed. ( d) Transverse sections of the teeth denervated were cut and their pulps examined. Clinical.—The patients who had been submitted to operation were taken, and their teeth examined by:— ( a) Transillumination. ( b) Percussion. ( c) Thermal tests. ( d) Faradic currents. ( e) Radiography. From these investigations it appears that the teeth are denervated but not devitalized by the trauma to the lateral antral wall above their apices. Their blood-supply is still present, and probably comes through a collateral anastomosis, along the antral floor and partly through the antral mucosa.

Muscle separation approach to scapular neck fractures in eight dogs

2008 ◽  
Vol 21 (05) ◽  
pp. 471-473 ◽  
Author(s):  
C. B. Garvan ◽  
W. T. McCartney
Keyword(s):  
Retrospective Study ◽  
Internal Fixation ◽  
Clinical Significance ◽  
Current Literature ◽  
Surgical Approach ◽  
Operating Time ◽  
Surgical Trauma ◽  
Excellent Outcome ◽  
Scapular Neck Fractures

Summary Objectives: To report on a new surgical approach to scapular neck fractures. Methods: A combined prospective and retrospective study of eight dogs that had sustained a fracture of the scapular neck between 1992 and 2005 was performed. All eight dogs had an internal fixation using a T plate through a muscle separation approach. Retraction of the supraspinatus from the deltoideus and infraspinatus allows an adequate surgical window to enable plating of the scapular neck. Results: Sixty-two percent had an excellent outcome without any lameness or stiffness detected. The remaining cases experienced infrequent bouts of stiffness, or, in one case lameness. Clinical significance: The current literature recommends that the surgical approach to the scapular neck is by osteotomy of the acromion process, which is unnecessary in the authors’ opinion as it increases surgical trauma, operating time and the number of implants required.

scholarly journals Vascular Supply to the Liver: A Report of a Rare Arterial Variant

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Peter B. Johnson ◽  
Shamir O. Cawich ◽  
Sundeep Shah ◽  
Michael T. Gardner ◽  
Patrick Roberts ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Clinical Significance ◽  
Rare Variant ◽  
Vascular Supply ◽  
Common Hepatic Artery ◽  
Arterial Supply ◽  
Variant Pattern ◽  
Classic Pattern ◽  
Coeliac Trunk ◽  
The Common

In the classic description of hepatic arterial supply, the common hepatic artery originates from the coeliac trunk. However, there are numerous variations to this classic pattern. We report a rare variant pattern of hepatic arterial supply and discuss the clinical significance of this variation.

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