The venous territories of muscles: anatomical study and clinical implications

The venous architecture of the muscles of the body was studied in 425 specimens obtained from four fresh cadavers after total body injection with a radio-opaque lead oxide mixture. In 40 muscles the site and orientation of the valves was identified with the operating microscope. The venous network of each muscle was compared with similar arterial studies. The venous territories in each muscle matched the arterial territories. Where arterial territories were linked with choke arteries the venous territories were linked by veins devoid of valves which allowed bidirectional flow--the "oscillating veins". Elsewhere the valves of adjacent territories were directed away from each other and towards their respective pedicles. These anatomical observations reinforce our angiosome concept. The muscles were classified into Type A, B and C where there were one, two or more territories respectively. When a skin paddle is designed distally on a Type B or C muscle its venous return at first must negotiate the anatomical obstruction of the valves of the distal muscle territory before reaching the safety of the oscillating veins and the venous territory of the drainage pedicle. Finally, afferent veins were noted entering many muscles from the superficial and deep tissues. This highlights the importance of the muscles in aiding venous return by their muscle pump action.