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Collateral circulation of the femoral and genicular systems in human lower limbs is highly uncommon.
Journal of Anatomy ( IF 1.8 ) Pub Date : 2020-06-11 , DOI: 10.1111/joa.13226 Beeran Jethwa 1 , Ramaswamy Sharma 1 , Jordan Tanner 1 , Omid B Rahimi 1
Journal of Anatomy ( IF 1.8 ) Pub Date : 2020-06-11 , DOI: 10.1111/joa.13226 Beeran Jethwa 1 , Ramaswamy Sharma 1 , Jordan Tanner 1 , Omid B Rahimi 1
Affiliation
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The descending branch of the lateral circumflex artery is a septocutaneous vessel that is vital for free and pedicle thigh flap transfer surgeries when repairing tissue defects. It also forms an anastomosis with the superior lateral genicular artery to create a collateral pathway for circumventing occlusions in the superficial femoral artery (SFA). Many anatomical texts and atlases imply the persistence of this anastomosis. However, previous studies indicate variability in the source of the arteries that form the anastomosis, and have reported cases where an anastomosis does not exist. We hypothesized that variations from the conventional accepted pattern can be predicted by comparisons of arterial diameters, and that unconventional anastomoses may be present to facilitate collateral circulation to the limb. Fifty‐one limbs were dissected and analyzed to establish the source of the descending branch of the lateral circumflex artery, classify the types of anastomoses, and compare the diameters of the descending branch of the lateral circumflex artery, the SFA and the profunda femoris artery to the common femoral artery (CFA). Vessel diameters were normalized to the diameter of the CFA to allow comparison of limbs from both sexes and to minimize the effects of cadaver size on correlating vessel size to the presence or absence of collateral circuits. We report that 62.7% of limbs (32/51) had typical branching patterns; however, only 27.4% of limbs (14/51) had any anastomosis to connect the proximal and distal regions of the thigh. Importantly, the SFA had a wider relative diameter in limbs without anastomoses than in limbs that had normal anastomoses, perhaps precluding the formation of a collateral pathway. Overall, collateral circulation of the lower limb was highly uncommon, in contrast to information inferred from anatomical texts. This study suggests the need for more thorough procedures for determining viable anastomoses prior to thigh flap surgeries to ensure flap survival.
中文翻译：
人类下肢股骨和膝关节系统的侧支循环非常罕见。
回旋外侧动脉的降支是皮肤间隔血管，在修复组织缺损时对于游离和带蒂大腿皮瓣转移手术至关重要。它还与膝上外侧动脉形成吻合，以形成用于绕过股浅动脉 (SFA) 闭塞的侧支通路。许多解剖学文本和地图集暗示了这种吻合的持久性。然而，先前的研究表明形成吻合的动脉来源存在差异，并报告了不存在吻合的病例。我们假设通过比较动脉直径可以预测与传统公认模式的变化，并且可能存在非常规吻合以促进肢体侧支循环。对51条肢体进行解剖分析，确定旋外动脉降支的来源，对吻合的类型进行分类，比较旋外动脉降支、SFA和股深动脉的直径。股总动脉（CFA）。血管直径被归一化为 CFA 的直径，以便比较两性的肢体，并尽量减少尸体大小对血管大小与侧支回路存在或不存在相关性的影响。我们报告说 62.7% 的肢体 (32/51) 具有典型的分支模式；然而，只有 27.4% 的肢体 (14/51) 有任何吻合以连接大腿的近端和远端区域。重要的是，与正常吻合的肢体相比，没有吻合的肢体的 SFA 相对直径更大，也许排除了侧支通路的形成。总体而言，与从解剖文本推断的信息相比，下肢侧支循环非常罕见。这项研究表明需要在大腿皮瓣手术之前进行更彻底的手术来确定可行的吻合，以确保皮瓣存活。
更新日期：2020-06-11
中文翻译：
人类下肢股骨和膝关节系统的侧支循环非常罕见。
回旋外侧动脉的降支是皮肤间隔血管，在修复组织缺损时对于游离和带蒂大腿皮瓣转移手术至关重要。它还与膝上外侧动脉形成吻合，以形成用于绕过股浅动脉 (SFA) 闭塞的侧支通路。许多解剖学文本和地图集暗示了这种吻合的持久性。然而，先前的研究表明形成吻合的动脉来源存在差异，并报告了不存在吻合的病例。我们假设通过比较动脉直径可以预测与传统公认模式的变化，并且可能存在非常规吻合以促进肢体侧支循环。对51条肢体进行解剖分析，确定旋外动脉降支的来源，对吻合的类型进行分类，比较旋外动脉降支、SFA和股深动脉的直径。股总动脉（CFA）。血管直径被归一化为 CFA 的直径，以便比较两性的肢体，并尽量减少尸体大小对血管大小与侧支回路存在或不存在相关性的影响。我们报告说 62.7% 的肢体 (32/51) 具有典型的分支模式；然而，只有 27.4% 的肢体 (14/51) 有任何吻合以连接大腿的近端和远端区域。重要的是，与正常吻合的肢体相比，没有吻合的肢体的 SFA 相对直径更大，也许排除了侧支通路的形成。总体而言，与从解剖文本推断的信息相比，下肢侧支循环非常罕见。这项研究表明需要在大腿皮瓣手术之前进行更彻底的手术来确定可行的吻合，以确保皮瓣存活。
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