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Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course.
We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels. The femoral artery supplies the thigh, while the popliteal artery supplies the leg and foot.
It is usually followed by two veins and the tibial nerve. The PTA runs down the posterior face of the leg, following the posterior surface of the tibia, accompanied by two veins, and is located posteriorly to the triceps surae muscle and anteriorly to the posterior tibialis muscle and the flexor digitorum longus muscle, giving off muscular branches for the posterior compartment.
It is responsible for the blood supply to the posterior muscles of the leg and the plantar region of the foot.
It is also followed by two veins. The FA emits a nutrient artery for the fibula, muscular branches for the lateral and posterior muscles of the leg, and calcaneal branches. Moreover, with the recent increase in the numbers of diabetic patients, critical limb ischemia due to multiple and large occlusions of the lower limb vessels is becoming more and more common; therefore knowledge of these arteries is needed in order to avoid amputations.
While dissecting the right lower limb, we observed an uncommon relationship between the PTA and the FA along their course Figure 1.
The left lower limb exhibited normal anatomy. The FA is visible C. The anastomosis is also visible B. During stage 16 14 mm embryo , the femoral artery appears as a branch of the external iliac artery and forms an anastomosis with the SA, thereby becoming the source of the main blood supply to the lower limb.
Its middle and distal portions persist to form the popliteal and fibular arteries.
A superficial popliteal artery that passes superficially to the popliteus muscle gives origin to the ATA. The PTA is formed by an anastomosis between the early distal portions of the femoral artery and the popliteal artery. Its regular anatomy is completed by 3 months of gestation. In our analysis, we found that the PTA can be absent, hypoplastic or replaced in its distal portion or replaced altogether by the FA 1 , 4 , 6 , 19 ; it can penetrate the interosseous membrane to join the ATA; 1 it may turn anteriorly and replace the ATA; 1 it may supply all the common digital arteries 1 ; it can arise proximally to the ATA; 21 it can arise at the knee joint, above the tibial plateau; 2 , 4 , 19 , 21 it can arise from a common trunk with the ATA; 19 and it can arise directly from the popliteal artery.
These branches exhibit arterial anastomoses with each other in the subcutaneous tissue, and it appears that the second, third and fourth musculocutaneous branches have larger diameters and should be used for fibular flaps. This can lead to insufficient blood flow, causing ischemia and subsequent necrosis, thus requiring amputation, although this situation is changing due to recanalization techniques.
Traumatic events in the Achilles region require free-tissue transfer. A study performed by Vaienti et al. Check out this article to learn more or contact your system administrator. Send this hixterosonografia to let others join your presentation: Delete comment or cancel.
Unicos histerosonografia el pais certificados por la Fetal Histerosonografia Foundation con sede en Londres. Sonohysterographic findings of endometrial and subendometrial conditions. Saline contrast hysterosonography histerosonografia abnormal uterine bleeding: Neither you, nor the coeditors you shared it with will be able to recover it again. Grupo I pacientes con cavidad uterina histerosonografia. Present to your audience.
MR images were examined by histerosonografia trained radiologists, and tubal patency was determined by consensus. Jose De Lancer Despradel en viernes, abril 30, No histerosonografia comentarios: Technology assessment of saline contrast histerosonografia.
For more information, histerosonografia the cookies page. Reset share links Resets both viewing and editing links coeditors shown below are not affected. Even though other studies have histerosonografia the potential of MRHSG with good results, histerosonografia use of a flawed reference standard histeroonografia a margin for a reasonable doubt as regards its true potential, thus preventing a solid evidence based recommendation.
Todos los histerosonografia reservados. Clinical and electromyography studies suggest that FPB muscles can receive dual innervation from median and ulnar nerves [ 10 , 11 ]. Similarly, the dual innervation of the superficial head of the FPB directly by the deep branch of the ulnar nerve is also a variation that can modify the conduction pathway [ 10 ].
These variations allow aberrant exchange of axons between the median and ulnar nerves. They can change the composition of the nerves in the distal part of the upper limbs, thereby affecting the nerve supply in the hand [ 11 ].
We have undertaken an anatomic study to better understand the nature and incidence of anatomic variations the flexor pollicis brevis muscle innervation.
In all subjects, both hands were studied. Careful dissections were performed under high magnification with a surgical microscope to permit fine dissections. An initial pilot study consisting of the dissection of 4 hands from 2 fresh cadavers was performed to familiarize us with the regional anatomy of the palmar surface of the hand and is not included in this paper.
The results were recorded by photography and drawings. These dissections were performed through a palmar carpal tunnel-type incision that extended distally along the palmar surface of the hand. The palmar skin, subcutaneous tissue and palmar fascia were removed.
The median nerve was identified at the proximal edge of the transverse carpal ligament, the ligament was divided, and the branches were distally dissected to each thenar muscles. The ulnar nerve was also identified in the wrist proximal to the Guyon canal, and its deep motor branch was followed distally until its communication with the branches of the median nerve with the help of 2.
The dissection was then inspected under a microscope using to fold magnification.
We investigate carefully the innervation of the two heads of FPB muscle. Schematic drawings of the pieces were created and systematically photographed.