The arterial blood supply to the testes is used in clinical applications (arterioles supplying the testes are found within the testicular leads in clinical practice, so preserving the testicular leads should not be neglected to maintain the blood supply to the testes). 1. testicular artery ← internal spermatic artery 2. levator ani artery ← inferior abdominal wall artery 3. vas deferens artery ← superior cystic artery a The distribution range of the blood supply of the vas deferens artery: the entire vas deferens, the head, body and tail of the epididymis and part of the testicular parenchyma. b Testicular artery blood supply to the whole testis. c The levator artery is on the surface of the internal fascia of the spermatic cord and supplies little blood to the internal structures. However, some terminal branches may reach the lower pole of the testis to anastomose with the vas deferens loops of the epididymis while supplying the sphincter organ of the testis. During the progression of testicular torsion, ischemic necrosis, the most important structures for the testis are the parenchymal structures of the testis (testicular varicocele and cellular structures such as sertoli/lydig), and in terms of importance testicular artery > vas deferens artery > levator artery (levator artery supplies mainly the visceral sphincter and peripheral structures of the testis and is supplied by lateral branch anastomoses). In the case of testicular torsion, because the structures of the internal fascia of the spermatic cord are twisted, the testicular artery > vas deferens artery > levator artery are affected and ischemic necrosis occurs, and this ischemic necrosis is often most obvious in the center of the testis. The most fatal and essential significance of testicular torsion is that the blood supply of the testicular parenchyma is over, not the rim, and the sheath is over. The pathology of testicular torsion: the testis gradually enters a stage resembling dry gangrene, while early venous obstruction and late release of inflammatory material sheath cavity, peripheral tissues, congestion causing edema, and ischemia continuing edema, together lead to a local inflammatory manifestation in the clinical scrotal area. A common clinical phenomenon seen in cases of testicular torsion is the ischemic necrosis of the testicular epididymis with a corresponding inflammatory response in the surrounding tissues and increased blood supply, which can be seen with ultrasound ECT and is more pronounced during surgery, with congestion and edema in the testicular sphincter layer and in the tissues beyond. Application 1 Therefore, this can explain why the ultrasound indicates that the central blood supply of the testis is reduced, while the scrotum is swollen and there is partial blood flow signal in the periphery of the testis after torsional necrosis of some testes. Application 2 Because the beginning of the vas deferens artery and the testicular raphe artery are below the opening of the internal ring, the chances of testicular atrophy in the iliac fossa above the opening of the internal ring and the laparoscopic execution of the internal spermatic vein (2 cm above the opening of the internal ring, when the internal spermatic vein is ligated even if the internal spermatic artery is injured are also very rare).