Download THE BLOOD SUPPLY OF THE TALUS

THE
G.
L.
BLOOD
MULFINGER,
Fronz
It has
long
been
fractures
subject
of considerable
in most
not
of
been
study
The
first
their
there
within
were
the
but
mainly
many
talus.
to
entire
the
the
blood
vessels
Sneed
inject
artery
vessels
supply
talus
from
the
legs
particularly
talus
Lexer,
with
Kuliga
rather
numerous
neck
and
body
to study
to come
small
Kleiger
pedis
from
blood
of the
the
the
and
They
talus
in the
of the
tarsal
blood
pointed
canal.
He also
and the tarsal
canal.
The
calcaneus.
It lies obliquely
Similar
said
to
that
opinions
out
the
were
reported
that the
were distributed
sinus
area.
vasculature
of the talus.
He
a branch
of the dorsalis
pedis artery
ofthe
tarsal
substance
the
the taio-navicular
ligament.
(1950)
gave a complete
description
artery
to
been
well described
the bone have
The present
(1904).
vessels.
this
the
Turk
(1948).
Phemister
(1940)
artery
and that its branches
from the posterior
with the artery
sinus
ofthe
sequel
in showing
a radiopaque
and
of the artery
which
arises
terminates
by anastomosing
vessel
a
has
applicable
first full description
the tarsal
canal and
the tarsal
the sulcus
as
talus
but made
no mention
of their origin
or of their pattern
arterial
injection
in five specimens,
concluded
that there
in order
appeared
the
by
(1940)
and
was the dorsalis
of
seven
are
occur
to the
to the talus has been
anastomoses
within
surgical
implications.
the
significant
of
was
but
supply
may
supply
supply.
the
in the
(1925)
junction
bone through
Wildenauer
their
talus
blood
and
techniques
radiologically
nutrient
injected
despite
Englaizd
of the
the
arterial
OF AMERICA
Oxford,
necrosis
The
arterial
to
SPAIN
distribution
modern
intraosseous
attempt
STATES
(‘entre,
avascular
TALUS
UNITED
Orthopaedic
arterial
THE
BARCELONA,
Consequently
the
expressed
by Watson-Jones
major
vessel
to the talus
(1943)
that
because
distribution
no main
No/field
completely
aIld
study
TRUETA,
investigation.
aspects
undertaken
extraosseous
J.
dislocations.
elucidated
was
was
known
and
its
the
OF
PASADENA,
and
certain
SUPPLY
supply
McKeever
stated
which
to the
that its
reached
talus
and
the
tibial
artery,
runs through
of the tarsal
sinus;
he called
anatomical
tarsal
canal is formed
from a postero-medial
distinction
between
by the sulcus
of the
to an antero-lateral
talus and
position
and opens
into the tarsal
sinus.
The canal
contains
the interosseous
talo-calcaneal
ligament
and the artery
of the tarsal
canal.
Further,
Wildenauer
believed
that the most
important
vascular
contributions
came
from
the arteries
of the tarsal
sinus,
tarsal
canal
and medial
periosteal
network.
Coltart
(1952)
listed three areas as the most important
in relation
to the arterial
supply:
the
upper
surface
of the
neck,
was
to any one
Lauro
of these areas could
and Purpura
(1956)
after
arterial
apparently
the
conclusion
injection
distribution
of arteries
tarsi area, a well defined
talo-calcaneal
ligament.
Fourteen
amputated
for study
osseous
of the arterial
pattern
of the
based
of
a
160
photographs,
that
legs were
supply
and
medium,
they
injected
the
surfaces
of the
the
but they
arteries
ofthe
neck.
which
the
areas
smallest
are
Kelly
pattern
supplied
THE
It
by
JOURNAL
and
arteries
Peterson
talus.
The
contributions
body received
vessels
were
areas.
and
of the
equal
neck.
The
The medial
body.
This
supply
bone.
studies
find a definite
pattern
of
the talus from the sinus
branch,
Sullivan,
approximately
of the
that the blood
viability
of the
by radiological
the
talus
articular
vascular
showed
surface
believed
did not
supplying
by Haliburton,
supplied
medial
He
a medial
intraosseous
lateral
aspect
vessels
noted
termed
talus
and
without
endangering
blood
supply
to the
They
of the
to determine
area
observation.
be destroyed
found
a rich
the bone.
artery
head
sinus
clinical
radiopaque
within
the superior
and tile inferior
through
the antero-inferior
and the lateral
alld
posterior
illustrative
tarsal
on
the
OF
in the
(1958)
intra-
from
both
the largest
branches
next in importance,
is difficult,
various
BONE
from
vessels,
AND
JOINT
their
and
SURGERY
no
G. L. MULFINGER
distinction
was
twenty-five
importance
segnlental
to vessels
entering
supplied
the
Coltart
network
but
from
DORSAL
VIEW
SHOWING
THE
AREAS
Further
of the
sinus
within
They
branches
studies
Ridola
the
bone.
the
tarsal
the
the
the
did
not
delineate
and
Hollingshausen
TALUS
BL000
A
the
SUPPLY
MEDIAL
THE
of
SECTIOSS
TURSVI
TARSAL
TO
ONE
TALUS
PERFORATING
-
THE
THIRD
PERONEAL
THE
ARTERVOE
SINuS
TARL
THE
POSTERIOR
CANAL
TUBERCLE
BRATICHES
SUPPLY
IDDLE
lAS
TO
FIG.
to show
the blood
were
injection
of
tllirty-six
There
a 50
bed
callnOt
injection
and
by
cannulation
tile
other
52 B,
VOl..
L
method
cent
the
advantage
be
of
injection
I,
FEBRUARY
done
posterior
by
1970
tile
two
This
time
sections.
they
by cannulation
ofthe
tibial,
tibial,
anterior
methods
range
Harrison
perfusions
were
allows
the
because
pass
into
alone,
are
of nineteen
and
interval
usually
patterns
when
age
of Trueta
arterial
not
arterial
different
in sagittal
in the
that
The
does
distinguished
was
disease
was
death.
in studying
easily
foot
the
arterial
material
THE
METHODS
solution.
after
injected
to the talus
AND
employed
micropaque
hours
that
ofthe
ilalt.
NO.
per
always
The
of known
The
forty-eight
so
is a definite
bone
free
used.
and
capillary
ill
specimens
years
TO
#{149}
THIRD
1
supply
MATERIALS
Necropsy
BLOOD
SUPPLY
LATERAL
ONE
OP THE TALUS
C
Diagram
two
BRANCHES
THE
THIHD
LU
periosteal
ARTERY
ARTERVTR
M
(1950)
Wildenauer
through
ARTEPT
BLOOD
the
found
canal.
LATERAL
B
of
prime
vesselswere
of
supply
injection
attributed
small
work
COVERED
FOLLOWING
they
Depreux
with
of
on
they
between
importance
from
but
tarsi,
agreed
based
(1959);
anastomoses
areas
separate
161
J. TRUETA
and
Many
medial
the
major
Of
THE
BY THE
region
specimens.
stressed
the
veins.
Montis
vessels.
and
injected
(1952)
and
by
in the
lateral
fifty
and
arteries
reported
by these
upper,
examined
alld
between
were
areas
connecting
(1963)
made
specimens
AND
completely
femoral
and
made
artery
common
no
apparent
to seventy-
with
(1953),
done
between
deterioration
venous
arteries
of
the
circulation.
and veins
injected.
in halfthe
specimens
peroneal
arteries
difference
in
in
the
162
WALTER
results.
No
injection
with
feet
and
on
all
to irrigate
frozen
to
were
in thickness
formalin
used
made
were
Fifteen
varied
neutral
was
feet
a saw.
which
was
attempt
the
-4
cut
slices.
BIRTHDAY
the
vessels
degrees
VOLUME
before
Centigrade.
sagittally,
eleven
vessels
were
the
injection
The
whole
coronally,
5 and 25 millimetres.
with
10 per cent
between
decalcification
The
the
MERCER
then
and
four
Fixation
nitric
acid.
studied
by
PEREORATING
of Micropaque.
foot
was
After
then
sectioned
transversely
into
slices
was done with 10 per cent
The Spalteholz
technique
the naked
eye, by dissecting
PERONEAL
DORSAIIS
ARTERY
PEDIS
ARTERY
LATERAL
ANASTOMOT
TARSAL
ARTERY
ARTERY
FROM
DELTOID
BRANCH
.ITAI
.I/.
SHOVwNC
10
QI
TII
THE
E
UVIAS
‘C
ILLL,.
CCLI
DORSALIS
ARTERY
TARSAL
SINUS
BRANCHES
BLOOD
B
URTIRY
01
TARSAL
CANAL
TO
ONE
TALUS
T[
DELTOID
BRANCH
TIlE
BLOOD
C
THIRD
2
to the talus
FIG.
of the
and
various
results
by
presellted
to show
fine-grain
patterns
the blood
radiography.
in the
talus
was
paper
are
based
in this
supply
With
this
obtained
on
the
artery
branches-The
are from
the
tubercle
with
calcaneal
branches
branches.
from the
The
of
centimetre
passes
tendons
tibial
artery
proximal
anteriorly
to enter
the
tarsal
canal
to the
between
the
tarsal
first
origin
the
of the
sheaths
canal.
The
artery
technique,
out
THE
sections.
satisfactory
of thirty-six
made
to the
lies
the
lateral
digitorum
in the
from
form
from
and
flexor
talus
arteries
arises
medial
of the
TO
on
demonstration
specimens,
the
thirty
and
the
specimens.
ARTERIES
small
artery.
usually
coronal
observations
arteries
These
peroneal
SUPPLY
POSTERIOR
ONE . THIRD
Or THE
TALUS
in
in thirty
EXTRAOSSEOUS
Posterior
BLOOD OFSUPPLY
TO THE
HEAD
THE TALUS
)‘.S
PEDIS
Diagram
microscope
SINUS
BRANCHES
SUPPLY
MIDDLE
OF THE
Of THE
TARSAL
A
PIE
EICT
ARTERY
dorsal
TIlE
the
posterior
a network
posterior
tibial
plantar
arteries
longus
and
half
JOURNAL
of
OF
tibial
over
the
artery
(A
flexor
the
BONE
artery
posterior
in Fig.
hallucis
canal,
AND
much
JOINT
about
1).
longus
closer
SURGERY
a
It
G. L. MULFINGER
AND
163
J. TRUETA
to the talus
than
to the calcaneus
(B in Fig.
off in the canal
and the largest
of these enters
I and Fig. 3). Branches
into the body are given
about
the middle
of the body (Fig. 6). A few
small
branches
artery
artery
of the
to the
pass
About
medial
runs
tibial
to as the
branch
the
of
artery
110
all
was
tile
superior
surface
the
medial
malleolar
at
level
tile
ill
which
it.
It
tibial
or
dorsalis
Tile
the
SinuS
the
peroneal
larger
than
the
anastomotic
peroneal
head
body,
There
from
supplied
either
anterior
Peroneal
lateral
2).
area.
artery
in four
of
significant
\O’.
52 B,
dorsalis
pedis
artery
line
or just
vessel
is from
pedis
artery
with
a small
tibial
artery
and
from
sinus
was
The
found
artery
branch
artery
of the
in all specimens.
of the
tarsal
the
anterior
ofthe
dorsalis
tarsal
sinus
pedis
and
the dorsalis
two
pedis
specimens
arteries
in the
anterior
lateral
artery
the
was
anterior
to classify
them.
from
to form
as
tarsal
the
have
peroneal
over
previously
sinus
been
artery
the
the
off
a few
giving
head
of the
tarsal
artery
and
tibial
artery
from
an
perforating
branches
off branches
sinus.
malleolar
to
talus
and
to the
This
is formed
branches.
the perforating
bifurcated
sinus
and
originated
complexity
well
summarised
join
posterior
mentioned,
appeared
and
gives
slightly
starts
after
absent
perforating
peroneal
into
medial
The origin
of the artery
of the tarsal
sinus was
any of the anastomotic
plexus
of arteries
situated
These
a plexus
usually
artery
usually
contribution
the
It is usually
sinus
the
peroneal,
artery,
vessel
was
blood
supply.
NO.
to the
or anterior
at thejoint
dorsalis
body of the talus.
network
of small
In
of the
three
the
the
a particular
branches
branches
arise
varied
originated
with
contributes
as a direct
the
tubercle
branch
to
from
as a direct
branch
of the variations,
by Adachi
calcaneal
area
the
branches
of the
plexus
the perforating
(1928)
talus.
in
of
The
the tarsal
peroneal
specimens.
Variations-In
size
sends
artery
can
found
vessels
branch
anterior
enters
branches
peroneal
artery
becomes
In six specimens
the artery
of the tarsal
pedis artery.
Because
of the great number
artery
The
artery
usual.
was
duplicated.
artery
tarsal
another,
than
sinus
deltoid
it was
pedis
talus
larger
tarsal
anastomotic
The
medial
to the
whether
tarsal
The
then
specimen
tibial
sinus.
vessel
plantar
In
by the
canal.
perforating
here
perforating
pedis
this
medial
ofthe
tarsal
and
is made
(1941).
artery-Small
posterior
tibial
branches
much
of which
or dorsalis
as direct
was
of the
bone.
the
duplicated.
mainly
tarsal
anastomotic
this
vessel
The
dorsalis
paper
from
of the
of the
ill the
tarsal
5II1U5.
from the dorsalis
the
size
the
in two
artery
and lateral
divisions
proximal
to the ankle.
extremely
variable
and was seen to arise from
no attempt
and Huber
the
artery
tarsal
one
Variations-In
artery
with
branch
of the
the
Fig.
ill
talus
tarsal,
off
was
sinus
the
within
specimens,
the
tarsal
and
aspect
is an
lateral
is given
present
originated
vessel
tarsal
canal in which,
with
the artery
of the tarsal
canal.
artery
may also give direct
branches
to the
lateral
anterior
a branch
2 and Fig. 4). This
the deltoid
ligament.
In the
the
but
determine
supplied
of the
it anastomoses
The
lateral
the
anastomoses
talus.
of the
was
The
and
to
artery
(A
of the
with
canal
of
and
canal
canal
present,
talus
malleolar
between
artery
to the
body
of the
artery
tibial
of the
is
artery
loop
anastomoses
artery.
area
The
tarsal
I, C in Fig.
specimen
tarsal
in nine
joint,
lateral
artery.
the
were
difficult
tarsi
one
anastomosis
branches.
ankle
anterior
and
both
neck
pedis
canal
parts
the
of the tarsal
In
anterior
is often
neck
of the
artery
artery
above
from
area
the
tibial
of
the
over
artery
instances
of the
tarsal
of the
talo-calcaneal
of
artery.
artery-The
tibial
tile
in this
posterior
Anterior
artery
(A in Fig.
surface
the artery
tibial
found
In four
the
branch.
between
specimens
greatly.
from
deltoid
posterior
Anastomosis
ill
branches
five specimens
Variations-In
and
periosteal
artery
of the
of the talus
talo-tibial
medial
of
canal.
origin
body
the
the
The
tarsal
the
of the
between
or anterior
calcaneus.
in the
from
surface
supplies
is referred
the
sinus
5 millimetres
forward
artery
into
tarsal
I,
FEBRUARY
specimens
not
constant,
1970
the
perforating
and
frequently
peroneal
it was
artery
very
could
small
not
and
be identified.
The
did not represent
a
164
WALTER
MERCER
BIRTHDAY
VOLUME
INTRAOSSEOUS
ARTERIAL
Head-The
head
plied from
the anterior
artery
half,
and
the
the
supply
the
of
or
direct
branches
from
S
‘‘
;
.
Li’
rA
was
._t\
TARSAL
SINUS
ARTERY
area
section
from
of the
posterior
periosteal
2 and
through
superior
Second
Fig.
r.
the
TARSAL
CANAL
ARTERY
gives
neck
facet
in
and
middle
arteries.
and
importance
surface
Fig.
the
supply
third
are
the
of the
It supplies
variable
amount
the
constant,
were
section
body
the
lateral
and
no
seen.
of the talus
anastomotic
and
talus.
of the
quarter
lateral
branches,
or
6).
This
artery
or
main
branches
five
which
form
(B
The
of the middle
lateral
third
edge
which
third
ofthe
is mostly
artery
in
canal.
four
body
of the
vessel
I,
part
the
body
(A
in Fig.
3
Figs.
almost
except
for
the lateral
trochlear
body
curving
Fig.
supplies
third,
except
enter
arcs
in
usually
into
on
all
a small
aspect
of the
body.
its
medial
I, B and
C in
6).
DORSALIS
A sagittal
of the
relatively
by
tarsal
the
all of the
deltoid
medial
from
anastomosis,
variations
postero-laterally
3
FIG.
A sagittal
sinus,
tarsi
#{149}
supplied
e-._
half
from
(A in Fig. 2 and Fig. 5).
vascular
pattern
in the
Body-The
r
superior
directly
tarsal
sinus
significant
:‘IIz?
the
of the
sup-
inferior
is supplied
artery
is
medial
and
branches
head
talus
branches
from
or the dorsalis
the
lateral
head
tarsal
artery
Variations-The
‘S
the
two sources:
tibial artery
pedis
of
of
PATTERN
of the middle
PEDIS
FIG. 4
third of the tarsal bones.
Anastomoses
between
dorsalis
pedis artery branches
can be seen.
THE
JOURNAL
the deltoid
OF
BONE
branches
AND
JOINT
and
SURGERY
the
6.
Tile
anterior
arteries
from
surface
facet
(C
ill
of
Fig.
the
I, B
L.
the
anastomotic
body
supply
Fig.
ill
MULFINGER
AND
network
its
in
lateral
I 65
J. TRUETA
the
inferior
tarsal
aspect
sinus
which
including
enter
most
of
the
the
lateral
posterior
2).
LATERAL
TARSAL
ARTERY
DORSALIS
FED IS
I
PER P
PERON EAL
TARSAL
ARTEI
I’
.
n’--,
;U.[-
I’
‘.
‘
#{149}
FIG.
A coronal
section
through
the head
of the talus.
DORSALIS
PEDIS
ARTERY
TARSAL
CANAL
ARTERY
ARTERY
FIG.
6-A
coronal
section
the middle third of the talus.
Figure
Tile
iIltO
tile
VOL.
52 B,
arteries
that
middle
NO.
of the
I,
FEBRUARY
6
through
the middle
third of the talus.
Figure
Anastomoses
can be seen between
the dorsalis
artery of the tarsal canal branches.
enter
the
anterior
1970
superior
aspect
of
superior
aspect
of the
the
neck
trochlea
FIG.
7-A
pedis
usually
(B in
send
Fig.
7
sagittal
artery
one
1 and
section
branches
or
through
and the
two
branches
Fig.
3).
166
WALTER
There
are
posterior
several
tubercle
tubercle
branches
1).
VOLUME
BIRTHDAY
from
C in Fig.
(B and
the
posterior
These
supply
periosteal
only
network
a small
area
which
limited
entered
to the
tile
posterior
region.
Variations-In
the
small
MERCER
two
body.
In
branched
specimens
ten
superiorly
vessels
were
these
vessels
and
lateral
just
above
were
malleolar
the
anastomosis
not
results
in the
periosteal
quarter
to
of the
the
rapid
ofthe
from
the
of any
other
medial
tali
one
two.
superior
neck
although,
in seven
three
the medial
larger
arteries
is a continuous
of the
aspect
of
network
between
of the
There
one-half
the
body
at all.
the ankle
around
Injection
filling
In two
of the
body
anastomoses
networks.
network
body.
a third
penetrate
arterial
in very
very large and supplied
the tarsal
sinus
anastomotic
from
approximately
seen
extraosseous
ankle
lateral
supplied
extensive
were
branches
the
and
were
branches
lateral
supplied
calibre
Anastomoses-There
deltoid
the
and
of large
specimens,
the
specimens
posterior
arterial
tubercle
along
the medial
surface
of the body to the superior
aspect
of the neck and then into the tarsal
sinus
(Fig. 4). TIle periosteal
network
ended
on the lateral
side of the body at the anterior
edge
of
the articular
surface
for the lateral
malleolus.
The largest
anastomotic
arteries
in periosteal
network
are
superior
aspect
of
the
neck.
As
previously
artery
of the
tarsal
sinus
in the
with
of
the
between
the
deltoid
In the study of these
the thirty
tali.
The
superior
neck
Four
had
had
and
the
body.
the
tarsal
This
small
One
it known
the
anastomosis
one
specimens
further,
not
section
between
specimen
and
tubercle
and
arteries
canal
on
the
anastomoses
filled,
are
anastomoses
the
after
Eight
were
head
(Fig.
5) and
canal
the
and
must
have
and
artery
of
canal.
because
during
following
anastomoses
four
within
obscured
simultaneously
Also,
the
identified.
artery
of the tarsal
arterial
anastomoses
death.
difficult
in eighteen
entering
of the tarsal
which
open
bone
arteries
branches
the
potential
well
was
artery
and
ofthe
equally
to another
the
posterior
channels
in the
tarsal
canal
(Fig. 7).
vessels
in the
branches
number
not
canal
of the
were seen within
was between
tile
sinus
the
a small
tarsal
artery
the tarsal
and superior
deltoid
the
of the
canal.
of
anastomotic
occur
of the
of
the
of the tarsal
were
all
changes
because
artery
tarsal
inferior
was
in all
what
the
noted,
artery
the artery
canal
and one between
probably
represents
only
anastomoses;
missed
the
between
between
arteries
from
from
anastomosis
of
sections,
definite
anastomoses
most
common
anastomosis
those
anastomosis
branch
some
life
nor
small
were
is
vessels
undoubtedly
this.
DISCUSSION
The
‘hose
results
of
medial
Wildenauer
aspect
tibial
of this
study
on
(1950),
of the
whereas
thirty
specimens.
in this
series
of
This
investigation
has
the
areas
of
supplied
vessels
to
posterior
found
and
that
that
the
largest
posterior
with
with
an incidence
fractures
entering
the
simple
that
vessels
entered
in the
cent
from
the
of
artery
the
lateral
body
were
et
tarsal
et
through
branches
from
the
consistently
and
a!.
to
a!.
the
the
tarsal
canal
small
and
with
the
supplies
as from
of the
Haliburton
agreement
which
vessel
of Haliburton
arteries.
the
in general
branch
of this
antero-inferiorly
branches
showed
medial
fracture
of 28 per
origin
are
deltoid
the
posterior
canal
in twenty
further
delineates
found
neck
body.
the
and
In
posterior
relatively
this
largest
that
the
series
to the
it
neck
insignificant
arteries.
correlation
ofthe
tarsal
the
work
various
traversed
equalled
study
Most
vessels
talus
the
the
talus
the
of
it originated
by
other
of the
origin
described
confirmed
tuhercie
the
anatomical
ofthe
also
the
supply
the
This
necrosis
of
compared
to this bone.
The vessels
part
body
tubercle
was
when
the
talus
the
in
Wildenauer
o’tt
the
vasculature
except
body.
artery,
the
neck
surface
canal
ofthe
should
neck.
of avascular
with
ofthe
of
some
of
the
clinical
talus
the
remain
Mindell,
necrosis
do not cause avascular
body,
the anterior
lateral
intact.
Coltart
Cisek,
Kartalian
of the body with
THE
JOURNAL
(1952)
problems
necrosis
vessels
reported
peculiar
ofthe
and
body.
at
least
no avascular
and Dziob
(1963)
reported
simple
fracture
of the neck.
OF
BONE
AND
JOINT
SURGERY
G.
The incidence
which
is what
Avascular
of necrosis
would
necrosis
unrecognised
of
the
or
arterial
Triple
employed
rupture
artilrOdesis
removal
all
removes
superior
neck
vessels
In spite
to support
of the
the
the
are
loss
view
all
talus
after
simple
talus
with
the
partial
likely
or
fracture-dislocation
most
of
its
fracture
of
arterial
of the
soft-tissue
neck
the
occlusion
body,
attachments.
must
from
imply
soft-tissue
dislocation.
with
the
the
blood
tarsal
damage
vessels
and
loses
the
through
will
dislocation
body
around
interferes
approach
facet
of
from
also
surgical
wide
body
167
J. TRUETA
AND
with
if the
damage
arthrodesis
MULFINGER
sharply
expected
soft-tissue
swelling
and
rises
be
L.
the
which
supply
sinus
artery
enter
to
of the
the
the
the
obliterates
tarsal
inferior
talus.
The
artery
commonly
of the
canal.
tarsal
sinus
A Lambrinudi
surface,
though
the
triple
deltoid
and
This
tends
unaffected.
of major
that
vessels,
arterial
avascular
anastomoses
necrosis
within
of the talus
the
talus
are
talus
was
is unusual.
numerous.
SUMMARY
1.
The
intraosseous
and
extraosseous
circulation
of the
examined
in thirty
necropsy
specimens.
2.
The
the
lower
3.
The
blood
supply
to
the
talus
is quite
diffuse
and
arises
the
from
three
major
arteries
of
leg.
common
patterns
of circulation,
as well
as the
variations,
have
been
documented.
REFERENCES
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ADAHI,
W.
COLTART,
D.
M.
DEPREUX,
Das
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R.,
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der
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Journal
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J., and HARRISON,
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