The Angiosomes of the Head and Neck: Anatomic Study and Clinical Applications

Abstract

The angiosome concept was introduced over a decade ago by Taylor and Palmer, whereby the body was considered to be composed anatomically of multiple three-dimensional composite blocks of tissue supplied by particular source arteries. Since then, detailed studies of the forearm and leg have been examined by Taylor and his coworkers. This study focuses on another region--the head and neck. Six fresh head and neck cadaver specimens were examined after infusion with a radio-opaque lead oxide mixture and correlated with over 24 previous body studies. The vascular anatomy of the skin, superficial musculoaponeurotic system (SMAS), muscles, brain, dura, and bone was examined. Each layer was painstakingly removed, photographed, labeled, and mapped to the respective arteries and veins. A radiologic subtraction technique was used to allow successive layers to be compared. This information was then scanned into a computer, analyzed, color coded, and labeled, thereby producing a three-dimensional study of the head and neck region to identify the respective angiosomes. As in previous detailed examinations of the leg and forearm, the angiosomes were found to be connected usually within tissues, such as muscle, skin, specialized organs or glands, rather than between the tissues. The muscles usually had vessels of two or more angiosomes supplying them and fell into three major groups based on the similarity of their arterial supply. In some areas, the midline anastomoses were rich, especially in the integument of the scalp, forehead, and lips. In other regions, the midline vascular connections were poor, especially in the tongue and palate. No fewer than 13 angiosomes of the head and neck, supplied by the branches of the external carotid, internal carotid, and subclavian arteries, have been defined, mapping their three-dimensional territories in the skin, the deep soft tissues, and the bones. Although most angiosomes spanned between skin and bone, three territories, those of the vertebral, lingual, and ascending pharyngeal vessels, were confined to the deep tissues without cutaneous representation. Finally, this study provides additional data for the surgeon to help plan safer incisions and better reconstructive flap procedures. It also gives information that may help explain the etiology and treatment of head and neck arteriovenous vascular malformations.

Arterial anatomy of subdermal plexus of the face.

“…The vascular territories defined by each subdermal plexus anastomose with one another to form the continuous vascular networks. Those con nections between the territories were formed by reduced caliber, choke anstomoses, in the face and the scalp area as described by Houseman, et al 9 True anastomoses (i.e. the connection without change in cal iber) have not been seen between the territories of the facial skin in this study.…”

Progress toward Understanding Vascular Malformations

“…Since then there has been a few descriptions of families with multiple port-wine stains indicatingg a possible autosomal dominant inheritance with a variable expression (66)(67)(68)(69). Of 280 consecutivee capillary malformation patients applying for laser treatment at our unit, 55 patients (19.6%)) had family members with the same anomaly (70).…”

Vascular Injection Technique by RTV 116 Silicone Rubber

“…In 1999, McKinnon and colleagues, performed intraarterial ink injections and subtraction angiography plus latex injection, to define the vascular anatomy of the posterior auricular artery [1]. Houseman and co-workers (2000) preferred to use a lead oxide/gelatine solution, but after adequate perfusion into each vessel, they cooled the cadaver overnight to ensure solidification of the gelatine and lead oxide [2]. Malikov S et al (2005) during the study on thorocodorsal axis injected Rhodorsil before dissecting and the total length of the arterial graft that preserved an external diameter above 2 mm was measured [3].…”