The arterial communication between the gastrocnemius muscle heads: a fresh cadaveric study and clinical implications

The purpose of this investigation was to describe the anatomy of the communicating (anastomotic) vessels between the gastrocnemius muscle heads and to record the extent of their supply potential. Ensuing clinical implications are discussed. Fourteen fresh cadaveric gastrocnemius muscles were examined. Detailed dissections of the communicating vessels were facilitated after injections of methylene blue or cadaveric blood solutions through the medial, lateral, or both sural arteries. The extent of the arterial cross-supply between the muscles' heads through these vessels was determined in-eight specimens after methylene blue perfusions through the lateral sural arteries, while one specimen was examined after injection of methylene blue and yellow ink through the lateral and medial sural arteries, respectively. Communicating vessels were detected in all 14 specimens. A mean number of 5.8 vascular bundles and single vessels was found. The bundles consisted of arterioles and, as all indications suggested, of concomitant venules as well. Regarding arterial cross-supply, it was clearly evident that each head could be vascularized solely from the contralateral one, mostly through these bundles. However, even if only a part of the bundles was preserved intact, vasculature was not affected.     

The venous communication between the gastrocnemius muscle heads

This investigation establishes the venous communication between the gastrocnemius muscle heads. Fourteen fresh (with the exception of one) cadaveric specimens were examined. Anastomotic veins were dissected along the raphe after perfusion of each muscle with 0.1 % methylene blue solution. A distally based musculocutaneous perforating vein of the medial head was the site of perfusion in 13 specimens, whereas one specimen received injection through the accompanying vein of the medial sural cutaneous nerve. Additional perfusion of dye from different sites was required in two specimens. Communicating veins were dissected in all 14 muscles. Direct anastomotic veins were detected in eight specimens; whereas in six the accompanying vein of the medial sural cutaneous nerve that had been included proved to be the intermediate pathway of venous communication between the muscle heads. Obstructive valves were encountered in most cases; nevertheless anastomotic veins were always recognized. The role of valves and the clinical implications are discussed.     

The medial sural artery perforator free flap.

The medial sural artery supplies the medial gastrocnemius muscle and sends perforating branches to the skin. The possible use of these musculocutaneous perforators as the source of a perforator-based free flap was investigated in cadavers. Ten legs were dissected, and the topography of significant perforating musculocutaneous vessels on both the medial and the lateral gastrocnemius muscles was recorded. A mean of 2.2 perforators (range, 1 to 4) was noted over the medial gastrocnemius muscle, whereas in only 20 percent of the specimens was a perforator of moderate size noted over the lateral gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease. When two perforators were present (the most frequent case), the perforators were located at a mean of 11.8 cm (range, 8.5 to 15 cm) and 17 cm (range, 15 to 19 cm) from the popliteal crease. A series of six successful clinical cases is reported, including five free flaps and one pedicled flap for ipsilateral lower-leg and foot reconstruction. The dissection is somewhat tedious, but the vascular pedicle can be considerably long and of suitable caliber. Donor-site morbidity was minimal because the muscle was not included in the flap. Although the present series is short, it seems that the medial sural artery perforator flap can be a useful flap for free and pedicled transfer in lower-limb reconstruction.     

Architecture of the human gastrocnemius muscle and some functional consequences

Measurements were performed on the m. gastrocnemius of eight human cadavers in order to describe, in some detail, the architecture of the muscle and its heads. The fibres of the lateral head contain more sarcomeres than those of the medial head. The effect of this difference on the length-force curve of the muscle, calculated with a planimetric muscle model, is diminished by the effect of the difference of fibre angle with respect to the line of pull of the muscle. Within the heads some variation of the number of sarcomeres of the proximal and distal fibres occurs in all muscles. In the lateral head the distal fibres contain fewer sarcomeres than the proximal fibres. In the medial head this is also found in some heads, while others show the reverse. In the lateral head the longer fibres have smaller angles of attachment to the tendon plate and vice versa, while in the medial heads this relationship is only found occasionally. Some variation in the number of sarcomeres is found in the fibres of one bundle. The effects of variations in the number of sarcomeres on the length-force curve are probably insignificant at greater muscle lengths, but may have some importance for the individual with relatively small muscle lengths.     

The medial gastrocnemius muscle flap: a local free flap

A new application of the medial gastrocnemius muscle flap has been described. Lengthening of the sural vascular pedicle was obtained using interposition vein grafts. This allowed coverage of a larger defect than that which could have been obtained with the tethered muscle and without further insult to the already disturbed lower extremity anatomy. The principle of pedicle lengthening can be used to increase the arc of rotation of various other muscle, myocutaneous, skin, or bone flaps and thereby increase their usefulness.     

Experimental study of seita-fitting

The purpose of this study was to verify the difference between carrying a load on the sacrum (LOS) and on the lumbar vertebrae (LOL) in oxygen uptake, muscle activities, heart rate, cadence, and subjective response. Nine males (26.7 +/- 3.1 years old), each carrying a 7.5 kg carrier frame and a 40 kg load, walked on a treadmill at a speed of 50 m/min. EMGs were recorded from the trapezius, rectus abdominis, erector spinae, vastus lateralis, rectus femoris, vastus medialis, biceps femoris long head, tibial anterior, soleus, medial head of gastrocnemius, and the lateral head of gastrocnemius. For each subject the integrated EMG (IEMG) was normalized by dividing the IEMG in the LOL and LOS by the IEMG in a no-load condition (NL) for each investigated muscle. The following was significantly higher in LOL than in LOS: oxygen uptake; IEMG of the tibial anterior, soleus, and medial head of gastrocnemius; cadence; and rated perceived exertion. However, IEMG of the erector spinae was significantly lower in LOL than in LOS. These results suggest that seita-fitting in LOS causes a decrease of leg muscle activities, which causes oxygen uptake to decrease beyond the increase of the erector spinae activity.     

Demonstration of multiple innervation of skeletal muscle fibers in the rat following localized repetitive freezing of the sciatic nerve]

The medial head of the gastrocnemius muscle of the rat was denervated by three successive freezings of the sciatic nerve at the same focal localization. After the third denervation, the compound potentials obtained during a transient period of time indicated that some muscle fibres are innervated by two or several axonal terminals. It can be concluded from the electrophysiological, histological and cytoenzymological results that this multiple innervation is polyneural and located within a single end-plate.     

Gastrocnemius fascicle length changes with two-joint passive movements

Predicting muscle fascicle length changes during passive movements may lead to a better understanding of muscle function. The purpose of this study was to experimentally compare fascicle length changes in the gastrocnemius during two-joint passive movements with a previously derived kinematic model based on anatomical measures from a cadaver. The ratio of passive ankle to knee motion was manipulated to generate medial gastrocnemius fascicle elongation and lateral gastrocnemius fascicle shortening. Ultrasound images from both heads of the gastrocnemius fascicles were acquired at 10 degrees knee flexion increments and compared with this kinematic model. Our results suggest that the two-joint kinematic model from which we originally based our knee and ankle movements did not adequately reflect fascicle length changes during any of the movement conditions in this study. From our data, we propose that for every degree of ankle motion the medial and lateral gastrocnemius changes 0.42 mm and 0.96 mm, respectively, whereas changes of 0.14 mm and 0.22 mm are observed for the medial and lateral gastrocnemius, respectively, during knee movements.     

Elbow extensor muscles of the horse: postural and dynamic implications.

Based on histochemical and immunohistochemical evidence, horse elbow extensor muscles are composed of two morphologically distinct muscle groups. The long and lateral heads of the triceps brachii are large, predominantly type II (presumed fast) muscles. The long and lateral heads of the triceps together account for 96% of the weight of the elbow extensors (long head of triceps is 81%). The long and lateral heads contain three histochemical fiber types: types I, IIa and IIb. Type I muscle fibers account for approximately 18 and 27% of the fibers in the long and lateral heads of the triceps, respectively. In the lateral head, type IIa and IIb fibers account equally for the remaining 70%, while in the long head of the triceps type IIb fibers predominate (50%) over type IIa fibers (32%). In contrast, the much smaller medial head of the triceps (2% of triceps mass) and the anconeus (2% of mass) contain almost exclusively type I muscle fibers. It is hypothesized that the medial head and anconeus, with their slow fibers, contribute to the postural maintenance of the forelimb by preventing flexion at the elbow joint during passive stance. The larger long and lateral heads, with their generally fast fiber populations, are most likely important during dynamic activity.     

Coverage of wounds in the distal lower leg by advancement of an enlarged medial gastrocnemius skin flap

Advancement of a medial gastrocnemius flap is a new technique in treating skin defects of the lower third of the lower leg, including that at the anteromedial aspect of the distal portion of the lower leg. Satisfactory results have been obtained in two clinical cases using this technique. In this modified technique, the size of the flap is enlarged, the origin of the medial head of the gastrocnemius is severed so that the island myocutaneous flap may be advanced 8 to 9 cm distally, and good blood supply to the flap is also maintained. In the authors' opinion, this method is a new approach that is simple, easy, safe, and reliable in treating skin defects of the lower leg.     

The blood supply of the reverse temporalis muscle flap: anatomic study and clinical implications

Although the reverse temporalis muscle flap has been used clinically, the exact vascular connection between the superficial and deep temporal vessels has not been clearly defined. The purpose of this study was to investigate the vascular territory of the reverse temporalis muscle supplied by the superficial temporal vessels. Six cadaver heads were studied using a colored lead oxide injection through the superficial temporal artery. The specimens were examined macroscopically and radiographically. The reverse temporalis muscle flap was then applied to a clinical case presenting with traumatic anterior skull base defect communicating with the nasal cavity. The cadaver specimens demonstrated that the superficial temporal artery formed an average 1.3 +/- 0.2 cm in width of dense vascular zone, which was located within 1.8 cm below the superior temporal line. The dense vascular network further perfused the anterior and posterior deep temporal arteries and the muscular branch of the middle temporal artery to supply the temporalis muscle. The mean perfused area of the temporalis muscle was 83 percent, ranging from 79 to 89 percent, in five cadaver heads. One cadaver revealed only 55 percent of perfused area in the absence of the muscular branch of the middle temporal artery. The consistent area without perfusion was located in the distal third of the posterior portion of the reverse temporalis muscle. In clinical cases, the reverse temporalis muscle flap was used successfully to obliterate the anterior skull base defect without evidence of muscle flap necrosis. The exact blood supply to the distal third of the posterior portion of the reverse temporalis muscle flap needs to be investigated further in vivo. Particular attention was paid to the inclusion of the muscular branch of the middle temporal artery in this flap to augment the blood supply to the temporalis muscle.     

Mechanisms of changes in blood flow distribution between organs in hens during ontogenesis

Anatomical and histological investigations of large arteries feeding head, extremities and chorioallantoic membrane were carried out in 11-, 14-, and 18-day old chicken embryos and in 1- and 40-day old Shaver chickens. The numerical relationships between an arterial diameter and a body mass; a vessel length, its external diameter and a wall thickness, were determined. Our data demonstrate that walls of large arteries in the anterior and the posterior parts of the chicken embryo body are different in quantity, composition, and maturity of their tissue components, determining the lumen size and hemodynamic conditions in the blood bed. The vessel growth velocity have been estimated. Ontogenic widening of gastrocnemius and pectoralis muscle capillary beds and of their supplying trunks, was compared. Calculations using the data on organ portions of cardiac output in chicken embryos show the maintenance of similar liner blood flow velocities in different large arteries suring ontogenesis.     

Anatomical separation and clinical importance of two different parts of the vastus medialis muscle

In 32 corpses, either fresh or fixed, the deviations of the two heads (musculus vastus medialis longus and musculus vastus medialis obliquus) of the vastus medialis muscle from the long axis of the femur were measured. The deviations were between 15 and 18 degrees medially for the m. vastus medialis longus and between 46 and 52 degrees medially for the m. vastus medialis obliquus. Anatomical dissections of the vastus medialis muscle in 115 fixed thigh specimens could always demonstrate a clear separation between a long head of the muscle that inserts at the base (m. vastus medialis longus) and a short head (m. vastus medialis obliquus) that inserts at the medial margin of the patella. The plane of separation could be identified by a femoral nerve's branch in every case. In 17 instances the nerve's localization was superficial, in 57 in an areolar fascial plane, and in the depth between the muscles in 41 instances. The ramification of the femoral nerve's branch that runs along the separation plane showed four types of variation. With these investigations it was possible to distinguish between two individual heads of the vastus medialis muscle not only with regard to its function, but also to its anatomy.     

Blood flow distribution in dog gastrocnemius muscle at rest and during stimulation

The distribution of blood flow within the isolated perfused dog gastrocnemius muscle (weight 100-240 g) was studied by intra-arterial injection of radioactively labeled microspheres (diameter 15 micron) at rest and during supramaximal stimulation to rhythmic isotonic tetanic contractions of varied frequency against varied loads. After the experiment the muscle was cut into 180-250 pieces of approximately 0.75 g each, and the blood flow to each muscle piece was determined from its radioactivity. The inhomogeneity of blood flow was represented as the frequency distribution of the ratios of regional specific blood flow, i.e., blood flow per unit tissue weight of the piece, QR, to the overall specific blood flow of the muscle, Q. The QR/Q values for the individual pieces of a muscle were found to vary widely both at rest and during stimulation. With rising work load the frequency distribution had a tendency to broaden and flatten, indicating increasing perfusion inhomogeneity. On the average of the experiments, there was no significant difference in specific blood flow between the three anatomic components of the gastrocnemius (lateral and medial heads of gastrocnemius and flexor digitorum superficialis) nor between the superficial and deep portions within these anatomic components, only the distal third of the muscle was relatively less perfused compared with the proximal two-thirds. The considerable inhomogeneity of blood flow as revealed by microsphere embolization and by other methods is expected to exert important limiting effects on local O2 supply, particularly during exercise. Its neglect would lead to serious errors in the analysis of O2 supply to muscle tissue.     

Phenotype of distinct primary sensory afferent subpopulations and caspase-3 expression following axotomy

Specific sensory neuronal subpopulations show contrasting responses to peripheral nerve injury, as shown by the axotomy-induced death of many cutaneous sensory neurons whilst muscular sensory afferents survive an identical insult. We used a novel combination of retrograde neuronal tracing with immunohistochemistry and laser microdissection techniques, in order to describe the neurochemistry of medial gastrocnemius (muscular sensory afferents) and sural (cutaneous sensory afferents) branches of the rat sciatic nerve and relate this to the pro-apoptotic caspase-3 gene expression following nerve transection. Our results demonstrated distinctions in medial gastrocnemius and sural neuron populations with the most striking difference in the respective proportions of isolectin B4 (IB4) staining neurons (3.7 V 32.8%). The mean neuronal area of the medial gastrocnemius (MG) neurons was larger than that of the sural (SUR) neurons (1,070.8 V 646.2 μm2) and each phenotypic group was significantly smaller in sural neurons than in MG neurons. At 1 week post-axotomy, MG neurons markedly downregulated caspase-3, whilst SUR neurons upregulated caspase-3 gene expression; this may be attributable to the differing IB4-positive composition of the subpopulations. These findings provide further clarification in the understanding of two distinct neuronal populations used increasingly in nerve injury models.     

Increased resistance in postobstructive pulmonary vasculopathy: structure-function relationships

Postobstructive pulmonary vasculopathy (POPV) was produced by chronic ligation (120 days) of the left main pulmonary artery of seven dogs. To explain the abnormal physiological changes found using arterial and venous occlusion (AVO) in POPV (J. Appl. Physiol. 69: 1022-1032, 1990), the light-microscopic morphology, morphometry (n = 5), and ultrastructure (n = 6) of ligated left lower lobes were compared with contralateral control right lower lobes. First, there was a proliferation of bronchial vessels around pulmonary vessels and airways to explain bronchial blood flow rates of 330 ml/min in left lower lobes. The walls of the bronchial vessels contained smooth muscle with minimal elastic tissue and prominent myoendothelial junctions. Second, focal bronchopulmonary anastomoses were seen in pulmonary arteries approximately equal to 100 microns diam, which is consistent with our conclusion that the major site of communication is at the precapillary level and suggests that the limit between arterial and middle segments defined by AVO may lie in arteries of approximately equal to 100 microns. Third, to explain the increased arterial resistance in POPV, the pulmonary arteries had an increased percent medial muscle thickness, peripheral muscularization, and focal intimal thickening but had no plexiform lesions. The ultrastructure of the arteries revealed new intimal cells and numerous myoendothelial junctions rarely found in controls. Capillaries and veins were only subtly altered. Fourth, the hyperreactivity of arteries to serotonin and of veins to histamine found using AVO was partially explained by the increased medial thickness and decreased diameter but may also be due to increased receptor concentration or related to the myoendothelial junctions. We conclude that most of the hemodynamic alterations in POPV are related to morphological abnormalities and that this model has clinical and experimental relevance in the study of bronchopulmonary vascular interactions.     

Muscle activation patterns of selected lower extremity muscles during stepping and cutting tasks

Lower extremity muscle activations during crossover and side step cut tasks are hypothesized to play an important role in controlling knee motion, and therefore, impact the design of knee injury prevention and rehabilitation programs. However, the contribution of lower extremity muscles to frontal and transverse plane moments during cutting tasks is unclear. The purpose of this study was to compare the muscle activation patterns of selected lower extremity muscles (vastus lateralis, medial/lateral hamstrings and medial/lateral gastrocnemius) of subjects performing a stepping down and side step cut, a stepping down and crossover cut and an equivalent straight ahead task. Ground reaction force was used to determine the cut angle, stance time and compare the lower limb loading during each task. Electromyography data during all tasks were normalized to the average activation during the straight ahead tasks to determine relative changes in muscle activation between the straight ahead and different cut styles (crossover and side step). There were no differences in the pattern of muscle activation of the vastus lateralis, or lateral hamstring muscles when comparing the cutting tasks to the equivalent straight ahead task. However, the crossover cut task resulted in significantly higher muscle activation of the medial hamstrings and lateral gastrocnemius muscles relative to both the side step cut and straight ahead tasks. These results suggest the medial/lateral hamstrings and medial/lateral gastrocnemius play a role in transverse and frontal plane control during cut tasks.     

Pulmonary arterial dilation by inhaled NO: arterial diameter, NO concentration relationship.

The objective of this study was to determine the nitric oxide (NO) concentration and vessel diameter dependence of the pulmonary arterial dilation induced by inhaled NO. Isolated dog lung lobes were situated between a microfocal X-ray source and X-ray detector and perfused with either blood or plasma. Boluses of radiopaque contrast medium were injected into the lobar artery under control conditions, when the pulmonary arteries were constricted by infusion of serotonin and when the serotonin infusion was accompanied by inhalation of from 30 to 960 parts/million NO. Arterial diameter measurements were obtained from X-ray images of vessels having control diameters in the 300- to 3,400-microm range. Serotonin constricted the vessels throughout the size range studied, with an average decrease in diameter of approximately 20%. The fractional reversal of the serotonin-induced constriction by inhaled NO was directly proportional to inhaled NO concentration, inversely proportional to vessel size, and greater with plasma than with blood perfusion in vessels as large as 3 mm in diameter. The latter indicates that intravascular hemoglobin affected the bronchoalveolar-to-arterial luminal NO concentration gradient in fairly large pulmonary arteries. The data provide information regarding pulmonary arterial smooth muscle accessibility to intrapulmonary gas that should be useful as part of the database for modeling the communication between intrapulmonary gas and pulmonary arterial smooth muscle cells in future studies.     

Three-dimensional organisation of the vasculature of the rat spermatic cord and testis

Summary The vascular architecture of the rat testis and spermatic cord was studied by a corrosion cast technique combined with scanning and transmission electron microscopy, and light microscopy. The casts preserve the endothelial impressions of the vessels and enable them to be differentiated into the various vascular components. Frequent arterio-arterial anastomotic arcades and occasional arterio-venous anastomotic channels are seen. A well defined hexagonal pattern of intertubular and peritubular vessels surround the seminiferous tubules. Prominent large endothelial nuclei protrude into the arterial lumina at branching sites, but their functional significance is not known. The outermost vascular layer of the testis consists of large veins, venules, and capillaries, but lacks any arterial branches; it also contains loosely arranged veno-venous anastomotic networks. We have named this vascular layer the sub-albugineal venous plexus. The testicular artery increases in luminal diameter as it approaches the testis. The periarterial capillary plexus, which lies between the pampiniform plexus and the testicular artery, is drained by two types of venules.     

The blood circulation inside the spleen. I. The arterial blood vessels general distribution in the rat spleen

As an attempt to investigate the different pathways followed by the blood into the spleen and to analyse their functional significance, a technique was used mainly based on the intraarterial perfusion of a Prussian blue "solution" added of some chemical mediators and vasoactive substances. Such technique provides results which may be analysed taking into account the effect of the anaesthetic used, that may influence the findings. From the anaesthetic used, the sulfuric ether and the barbital sodium produce vasoconstriction of the white pulp blood vessels, whereas the chlorpromazine-promethazine doesn't have this effect, and so the Prussian blue appears inside these vessels. The vasodilator drugs, such as succinonitrile and papaverine hydrochloride, show a general vasodilator effect on the splenic arterial system. Teh arterial vessels of the white and the red pulp, including those placed at the subcapsular areas, become enlarged; into the white pulp, either the central or the peripheral blood vessel plexus of the lymphatic follicle becomes evident. The latter readily constitutes the perifollicular and the pericolumnar plexus. The blood vessels of this plexus become permeable to the Prussian blue "solution" by the heparin sodium effect, and so the dye particles enter the marginal zone and the splenic sinuses. In addition, from the white pulp arteries arise 2 types of anastomotic arterioles which appear enlarged after succinonitrile treatment: The short anastomotic arterioles that crosses the marginal zone entering the red pulp near the white pulp; the long anastomotic arterioles which enter the red pulp and after a long course end up into or around a collector sinus. The addition of histamine dihydrochloride to the perfusion solutions shows a slight vasodilator effect mainly on the subcapsular penicillar arterioles, including the helicine arterioles. The adrenergic stimulation of the splenic blood vessels induces a generalized arterial constriction, except of the anastomotic arterioles, that becomes open; in such way, the blood pathway follows the course of the anastomotic arterioles and the collector arterioles also become constricted. The adrenergic vasoconstrictor effect is inhibited by the phenoxy-benzamine hydrochloride. The addition of acetylcholine chloride, in the dosage, used, induces a generalized arterial vessel constriction, mainly of the perifollicular plexus. This effect is inhibited by atropine sulfate which, on the other hand, produces evident enlargement of the perifollicular and pericolumnar arterial plexus.