Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

Abstract

Anatomies of the vascular and lymphatic systems have been vital research topics in reconstructive surgery. Harvey was a pioneer who provided the earliest descriptions of the cutaneous vasculature in the 17th century. The concept of vascular territories of the skin was first described by Manchot. The radiographic injection method in cadavers was developed by Salman, who defined more than 80 vascular territories. The arterial system has been thoroughly investigated with the development of regional and free flaps. The concept of axial and random pattern flaps was introduced by McGregor and Morgan. Manchot's vascular territories were refined by Taylor and Palmer as the angiosome concept. Detailed information about the venous circulation is essential for reconstructive surgeries. The concept of intrinsic and extrinsic venocutaneous vascular systems was introduced by Nakajima and led to the development of the venoadipofascial flap. The importance of venous augmentation in flap survival was emphasized by Chang. The lymphatic system was discovered much later than the arterial and venous systems. Aselli was credited for discovering the lacteal vessels in the 17th century; mercury was popularly used as a contrast agent to distinguish lymphatic vessels for the next three centuries. A radiographic method in cadavers was developed by Suami. Lymphatic imaging devices are constantly upgrading, and photoacoustic imaging was recently introduced for three-dimensional visualization of architecture of superficial layers of the lymphatic and venous systems.

Soft Tissue Reconstruction of the Posterior Trunk after Tumor Excision: A Surgical Algorithm

“…The so-called "anatomical" territory of any single perforator can be significantly expanded to adjacent angiosomes via direct and indirect linking vessels [18], which supply the "dynamic" and "potential" territories. Conversely, traditional fasciocutaneous "axial" flaps are based on a major vascular axis, which must be included in the flap, thus limiting the potential donor sites and representing a more invasive approach because they sacrifice a major vascular bundle [19]. Instead, the perforator flaps can be virtually elevated anywhere a sizable perforator is available [20], and can provide surprisingly large flaps in the area neighboring the defect without the sacrifice of important vessels, thus achieving the goal of reconstructing in a "like with like" fashion, which is one of the paradigms of plastic surgery.…”

Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting

“…Knowledge of microvascular anatomy is crucial for conducting safe reconstructive surgery [ 1 , 2 ]. The occurrence of life-threatening fat embolisms is still a matter of great concern [ 3 , 4 ], despite efforts to deepen the knowledge of gluteal microvascular anatomy.…”