VASCULAR TERRITORIES

Introduction

Vascular anatomical research

Historical perspective
- In 1889, Manchot4 performed the first examination of the vascular supply
of the human integument.
- Manchot identified the cutaneous perforators, assigned them to their
underlying source vessels, and charted the cutaneous vascular territories
of the body

- Salmon,8,9 a French anatomist and surgeon in the 1930s, Aided by

radiography, he was able to delineate the smaller vessels of the cutaneous
circulation and charted more than 80 territories encompassing the entire
body
- The 1970s witnessed the beginning of the “anatomic revolution.”
McGregor and Morgan19 differentiated between large flaps based on a
known axial blood supply and those based on random vessels
- Surgeons soon rediscovered that blood vessels follow fascial planes and,
starting in the 1980s, there was a much greater awareness of the
fasciocutaneous flap.28 With this development, there has been an
explosion of new terms and new classifications of the cutaneous cir-
culation.
 1. Angiosome
The angiosome (from the Greek angeion, meaning vessel, and somite,
meaning segment or sector of the body derived from soma, body) is
defined as a composite block of tissue supplied by a main source
artery.

In the original studies of the vascular supply of tissues of the body, the
integument was radiographed, and a montage of the entire cutaneous circulation
was constructed in “plan view”, but neither worker illus- trated the course of the
arteries between the deep tissues and the skin. Currently, a detailed three-
dimensional appraisal of the vascular anatomy of tissues.

Other study: all cutaneous perforators of diameter greater than 0.5 mm were
traced to their underlying source arteries. The results were averaged from each
cadaveric study and plotted on a diagram of the body
2. arterial territories

The arterial network of the body forms a continuous

interlocking arcade of vessels throughout each tissue and
throughout the body, linked together as loops of vessels, often
of reduced caliber.

Arteries generally fall into two groups, direct and indirect :

Direct vessel: usually the primary cutaneous vessels, their main

destination being the skin ; larger-diameter vessels

indirect vessels: secondary cutaneous supply; emerge from the

deep fascia as terminal branches of arteries which supply the
muscles and other deep tissues

In the human body, there are approxi- mately 400 perforators,

about 40% of vessels are direct and 60% indirect perforators

2. venous drainage
The cutaneous veins also form a three-dimensional plexus of
interconnecting channels throughout the body. There are valved
segments in which valves direct flow in a particular direction,
and there are avalvular segments where no valves are present.
The avalvular or oscillating veins allow bidirectional flow
between adjacent venous territories, or they whose valves
oriented in opposite direction  providing for the equilibration
of flow and pressure

the veins travel with the direct and indirect cutaneous arteries,
draining ultimately into the venae comitantes of the source
arteries in the deep tissue.

the origin, course, and distribution of the deep veins (vena

comitantes) are a mirror image of the deep source arteries, but
they are larger and more plen- tiful.
muscles can be classified into three types on the basis of their
venous architecture

two types of extramuscular veins: afferent and efferent (contain valves, drain the
muscles to efferent veins) (from the overlying integument).

3. neurovascular territories
In general, the orientation of cutaneous nerves is longitudinal in
the limbs, transverse or oblique in the torso, and radiating from
loci in the head and neck

The nerves follow the connective tissue framework.

The nerves are economical  The nerves take the shortest

extramuscular and intramuscular routes compatible with the
function of each muscle

Neurovascular relations vary with the muscle, the

extramuscular course, and the intramuscular branching of the
nerves and the vessels 


4. neurovascular anatomy
5. angiosome concept
6. comparative anatomy