Anatomy and histophysiology of the periosteum: quantification of the periosteal blood supply to the adjacent bone with 85Sr and gamma spectrometry.

The periosteum or periosteal membrane is a continuous composite fibroelastic covering membrane of the bone to which it is intimately linked. Although the bone cortex is the main beneficiary of the principal anatomical and physiological functions of the periosteal membrane, the behavior of the entire bone remains closely influenced by periosteal activity. These principal functions are related to the cortical blood supply, osteogenesis, and muscle and ligament attachments. Through its elastic and contractile nature, it participates in the maintenance of bone shape, and plays an important role in metabolic ionic exchange and physiologic distribution of electro-chemical potential differences across its membranous structure. It has also been suggested that the periosteum may have its own specific proprioceptive property. This paper presents a study of the anatomy and histophysiology of the periosteum, and discusses in detail its main functions of cortical blood supply and osteogenesis. It also presents the third intermediary report on a current study of the quantification of cortical vascularization of femoral bone via the periosteum, using an isotonic salt solution containing 85 Strontium. The afferent-efferent (arterio-venous) flows of this solution in the thigh vascular system of guinea pigs were measured by gamma spectrometry after a series of selective macro- and micro-injections of radioactive salt into the femoral arterial system was carried out. Each vascular territory was meticulously selected and the injections were made according to size, starting with the larger vessels, with or without ligatures of neighboring vessels, going progressively to smaller and smaller vessels with diameters not exceeding 100 microns. The principal technical difficulty at this stage of experimentation was related to the identifying and acquiring of appropriate microcatheters. The study also includes a series of measurements after blockage of the transmuscular blood flow and the corresponding periosteal vascular system by selective ligation of the thigh muscles. The results clearly show the fundamental predominance of periosteal blood circulation to the bone cortex (70 to 80% of the arterial supply and 90 to 100% of venous return) compared with centromedullary vascularization. A quantitative formula related to the general blood circulation in the bone cortex and marrow, taking into account the two pathways, is presented. Although the application of these results (which concern a long-bone site in an animal) to the alveolar and maxillo-mandibular periosteum requires the conception of an appropriate human experimental model, the extrapolation of the findings seems plausible in the case of the mandible, where the osseous structures and the vascular network are comparable with those found in long bone. However, in the maxilla, where the general blood supply is more intense and anastomotic, the periosteal contribution may legitimately be considered less important than the centro-medullary circulation. Finally, the presentation analyzes the physio-pathology of an experimentally damaged periosteum either directly (by thermodestruction, squashing, and chemodestruction), or indirectly (by muscular pull and tear), leading to the inevitable chain reaction, i.e., "ischemia-necrosis-atrophy and partial regeneration" of the underlying bone and very frequently compromising the survival of an implant that had been placed within it. The report emphasizes the importance of impeccable soft tissue and periosteum management at the time of implant surgery and indicates a number of technical precautions that should be observed in order to avoid periosteal damage.