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The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. This established the following points: 1) The arterial supply is abundant, consisting of several pedicles reaching the muscle on its deep aspect. The main neurovascular pedicle arises from the deep vessels of the thigh, via either the a. of the adductors (73%), the medial circumflex a. (19.2%) or as a double supply from both arteries (7.7%); 2) The cutaneous vascularisation over the gracilis m., derived from the solitary main pedicle, is inconstant. In 20 injections, it was satisfactory in 11 cases, poor in 5 and absent in 4; 3) The distal tendon of the gracilis m. is closely related to the posterior branch of the saphenous n. to the leg, which it crosses in an elongated X; 4) A simple method of calculation based on the distance between the upper border of the pubis and the medial femoral epicondyle allows quite precise determination of the point of entry of the main pedicle into the gracilis m. 5) Complete dissection of the main pedicle adds to the available length of the muscle flap.

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The authors report four cases of arterial priapism in the child, a rare condition since only 13 cases are described in the literature. High-flow priapism follows perineal or penile injury with damage to a cavernosal artery and formation of an arteriosinusoidal fistula. The onset may be immediate but more often occurs after a few days. Arterial priapism is painless, as the corpora cavernosa are less tumescent in the anterior third of the penis. The clinical appearance and circumstances of onset suggest the diagnosis. Doppler ultrasound is the complementary investigation of choice, confirming and localising the fistula. Various methods of treatment have been proposed. Injections of alphastimulant seem ineffective in most cases and are not without danger. Surgery, which is potentially damaging, has been used only in the adult. Most authors propose embolising with resorbable material the artery which feeds the fistula. However, priapism may resolve spontaneously in less than three weeks, as occurred in our cases, without recurrence or subsequent erectile dysfunction. We thus consider the condition may initially be managed by observation alone, with recourse to embolisation if priapism does not resolve after a period of time which however remains to be defined.

Summary. Two arterial systems contribute to the blood supply of the penis. The deeper system, responsible for supplying the erectile tissues, arises from the internal pudendal arteries (a. pudendae internae), or sometimes from an accessory internal artery. Four branches, either collateral or terminal, should be considered: the artery to the bulb of the penis, the urethral artery, the deep artery of the penis and the dorsal artery of the penis. Variations are frequently present in the origin, distribution and symmetry of these arteries, but on the whole the blood supply is organised into three planes, inferior or ventral, middle and deep, superior or dorsal. These three planes are complementary: when the blood supply to any one of them is occluded, at whatever level this may be, the blood supply is supplemented by the plane immediately above it. Arteriograms should be interpreted with caution because anatomical variations may at first sight be taken for pathological change.The superficial system, supplying the tissues around the erectile organs, arises from the lateral inferior pudendal arteries. Three types of supply have been described, according to whether the right and left arteries have a symmetrical distribution or whether the arterial network arises in large part or totally from one side. Contribution fi l'6tude de la vaseularisation art&idle du p6nisR6sum& Deux syst~mes art6riels participent fi la vascularisation du p6nis. Le syst6me profond, tenant sous sa d6pendance les organes 6rectiles, a pour origine les art6res honteuses internes (a. pudendae internae), parfois une art6re interne accessoire. Quatre branches, collat~rales ou terminales sont Offprint requests to: S Juskiewenski /t consid6rer: l'art6re du bulbe du p6nis, l'art6re ur6trale, l'art6re profonde du p6nis, l'art6re dorsale. I1 existe de fr6quentes variations dans l'origine, la distribution et la sym&rie de ces art6res mais, dans son ensemble, la vascularisation est organis6e selon trois plans, inf6rieur ou ventral, moyen ou profond, sup6rieur ou dorsal. Ces trois plans sont compl6mentaires: lorsque l'un d'eux s'6puise, fi quelque niveau que ce soit, le relais est pris par le plan imm6diatement sup6rieur.Le syst6me superficiel, vascularisant les enveloppes provient des art6res honteuses externes inf6rieures. Trois types de vascularisation sont d6-crits, selon que tes deux art6res droite et gauche ont une distribution sym6trique ou que le r6seau art6riel provient en majeure partie ou totalement d'un seul c6t6.