The angiosomes of the head and neck: Anatomic study and clinical applications

The angiosome concept was introduced over a decade ago by Taylor and Palmer , whereby the body was considered to be composed anatomically of multiple t hree-dimensional composite blocks of tissue supplied by particular source a rteries. Since then, detailed studies of the forearm and leg have been exam ined 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 bod y 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 s uccessive layers to be compared. This information was then scanned into a c omputer, analyzed, color coded, and labeled, thereby producing a three-dime nsional study of the head and neck region to identify the respective angios omes. As in previous detailed examinations of the leg and forearm, the angiosomes were found to be connected usually within tissues, such as muscle, skin, s pecialized organs or glands, rather than between the tissues. The muscles u sually had vessels of two or more angiosomes supplying them and fell into t hree 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 conne ctions 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 be en defined, mapping their three-dimensional territories in the skin, the de ep soft tissues, and the bones. Although most angiosomes spanned between sk in and bone, three territories, those of the vertebral, lingual, and ascend ing pharyngeal vessels, were confined to the deep tissues without cutaneous representation. Finally, this study provides additional data for the surgeon to help plan s afer incisions and better reconstructive flap procedures. It also gives inf ormation that may help explain the etiology and treatment of head and neck arteriovenous vascular malformations.