PubMed · 14924632
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L VAN DER MEIREN, H REYNAERS. 1952. [Diffuse periungual glomus].. https://pubmed.ncbi.nlm.nih.gov/14924632/
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Whether or not multiple venous anastomoses reduce the risk of free-flap failure is a subject of controversy. We report here, for the first time, on the importance of selecting 2 separate venous systems of the flap for dual anastomoses. The efficacy of multiple anastomoses was verified through a retrospective review of 310 cases of the free radial forearm flap transfer. Dual anastomoses of separate venous systems (the superficial and the deep) showed a lower incidence of venous insufficiency than single anastomosis did (0.7% versus 7.5%; P < 0.05). On the other hand, dual anastomoses of a sole venous system showed no significant difference in the incidence of venous insufficiency compared with single anastomosis (11.5% versus 7.5%; P = 0.48). Our results suggest that dual venous anastomoses of separate venous systems is conducive to reduced risk of flap failure and affords protection against venous catastrophe through a self-compensating mechanism that obviates thrombosis of either anastomosis.
We demonstrate here for the first time the formation of vascular anastomoses in the human neocortex. The orbitofrontal cortex (OFC) of the perinatal human brain is structurally immature, so that the maturation of neurons, neuroglia and intracortical capillaries can be conveniently studied by comparison with these elements in motor and striatal cortex of the same brain. In OFC of the perinatal human brain, indication of prominent anastomosis formation in the upper layers (lamina II and III) is observed. Golgi silver impregnation and electron microscopic techniques were employed to demonstrate individual stages of vascular anastomosis development. Along with capillary angiogenesis, vascular anastomosis formation is of major importance for the ontogenesis of neuronal and glial elements of the CNS, particularly with respect to optimal metabolic support of structural elements of the mature brain. In the neocortex of the adult human brain, a characteristic three-dimensional capillary angioarchitecture is observed, contrasting with the two-dimensional arrangement in the immature perinatal cortex. Abnormal OFC angioarchitecture was also found in 14% of histomorphologically investigated brains from persons with endogenous psychoses. For the pathogenesis of functional disorders of the human brain, including endogenous psychoses, knowledge about the processes of structural maturation of neurons and neuroglia, but also of capillary architecture, is essential.
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