四肢带表浅静脉干的局部皮瓣在创伤修复中的应用

设计４种带表浅静脉干的局部皮瓣用于修复四肢创面１４例，获得了满意的效果，该皮瓣所包含的一条浅静脉干不仅有利于静脉回流，且共血流对皮瓣亦有营养作用。因此，该皮瓣容易成活，长宽比值可大于传统任意型皮瓣，并具有操作简便，不损务主要动脉等优点，文中介绍了皮瓣的设计及手术方法，并对该皮瓣的血液循环特点，适应证及供区选择等进行了讨论。     

四肢带表浅静脉干的局部皮瓣在创伤修复中的应用

设计４种带表浅静脉干的局部皮瓣用于修复四肢创面１４例，获得了满意的效果。该皮瓣所包含的一条浅静脉干，不仅有利于静脉回流，且其血流对皮瓣亦有营养作用。因此，该皮瓣容易成活，长宽比值可大于传统任意型皮瓣，并具有操作简便，不损伤主要动脉等优点。文中介绍了皮瓣的设计及手术方法，并对该皮瓣的血液循环特点、适应证及供区选择等进行了讨论。     

保留大隐静脉的小腿内侧逆行皮瓣在足跟缺损修复中的应用

应用保留大隐静脉的小腿内侧逆行皮瓣修复足跟部缺损，效果满意，该皮瓣的特点是带一根浅静脉干，可以促进皮瓣的静脉回流，同时静脉干内流动的的静脉血可以逆流入小静脉，对皮瓣亦有营养作用，因此该皮瓣血循丰富，长宽比可达３：１，可满足足跟部缺损修复的需要，且设计，操作比较简单，不损伤动脉，一次完成手术。可以认为对足跟部缺损不失为一种较为安全，可靠的方法。文中介绍了皮瓣的设计，手术方法并对其血循特点及其优点，手     

带浅静脉干局部皮瓣的基础与临床

静脉在顺行皮瓣中的作用是不言而喻的 ,但带浅静脉干的逆行皮瓣或逆行岛状皮瓣静脉的作用仍存在争议 ,主要有二点 :一是静脉有瓣膜存在 ,静脉血如何回流 ;二是静脉血倒灌影响皮瓣的存活。目前在这方面的研究较少 ,近几年来 ,第一军医大学珠江医院通过对主要浅静脉干的组织解剖学研究 ;浅静脉干的血流动力学以及临床应用方面的研究证实 :浅静脉干存在自身的滋养血管 ,其与静脉干本身及其周围组织存在广泛的联系 ,对皮瓣的供血及引流具有重要作用 ;静脉血不会倒灌 ,带浅静脉干更有助于静脉血引流 ;临床应用也证实带浅静脉干皮瓣较不带浅静脉干的皮瓣成活率要高。目前该研究比较粗浅 ,还有许多因素值得进一步探讨     

猪带浅静脉干逆行皮瓣的经皮血气分析

目的：研究浅静脉干在逆行皮瓣静脉回流中所起的作用。方法：采用配伍组设计,在猪腹部分别形成3组逆行皮瓣共计24块：I组;随机以一侧腹壁浅静脉为轴形成逆行皮瓣;Ⅱ组：以另一侧腹壁浅静脉为轴形成逆行皮瓣,腹壁浅静脉在蒂部结扎;Ⅲ组：在上述两组皮瓣的随机一侧形成不带任何知名浅静脉干的逆行皮瓣。用经皮血气分析仪测量3组皮瓣 的PO2和PCO2,2周后比较3组皮瓣成活率。结果：I组皮瓣的PO2和PCO2及成活率均显著好于Ⅱ组和Ⅲ组,Ⅲ组皮瓣的PO2和PCO2及成活率均显著好于Ⅱ组。结论：浅静脉干能促进逆行皮瓣的静脉回流。     

皮神经伴行血管皮瓣内浅静脉干不同处理方法的临床研究

目的 探讨皮神经伴行血管皮瓣内浅静脉干不同处理方法对皮瓣的影响。方法 对137例手、足软组织缺损的患者，分别采用带桡神经浅支、尺神经手背支及腓肠神经伴行血管为主的筋膜蒂逆行岛状皮瓣，术中对皮瓣内浅静脉采取静脉干不结扎、结扎组和吻合等三种不同的处理方法。结果 术后浅静脉干不结扎组（27例），皮瓣出现不同程度的水泡、肿胀、青紫色，术后第7天皮瓣远端部分坏死。结扎组（87例）和吻合组（23例），术后皮瓣无静脉危象出现，两组皮瓣全部成活。结论 对皮神经伴行血管皮瓣内浅静脉干吻合是三种术式中最理想的方法，而对浅静脉干结扎是三种中最实用、有效的方法。     

带浅静脉干逆行皮瓣早期微血管密度研究

目的 探讨带浅静脉干逆行局部皮瓣早期微血管密度的变化特点，以评价浅静脉干对皮瓣早期再血管化的影响。方法 应用生物体视学技术测量带静脉干皮瓣微血管体积密度，与不带静脉干皮瓣作对照比较。结果 带静脉干皮瓣早期微血管密度整体水平高于不带静脉干不皮瓣。结论 浅静脉干的存在有利于皮瓣再血管化进程，保留浅静脉干对皮瓣成活有利。     

逆行皮瓣中浅静脉干的形态学与血流动力学观察

目的：通过对浅静脉干的形态学和血流动力学观察，探索浅静脉干促进逆行皮瓣静脉回流的机理，进一步指导带浅静脉千逆行皮瓣的临床应用。方法：用小鼠耳制成带浅静脉干的逆行皮瓣模型共48例，每个皮瓣内只有一条浅静脉干，用微循环观察仪对浅静脉干进行形态学和血流动力学观察。结果：根据形态可将逆行皮瓣中的浅静脉千分为3种类型：“I”形，“Y”形和树枝形，各种类型的浅静脉干都是皮瓣静脉逆向回流的主要通道，如果在蒂部将浅静脉干闭塞，皮瓣的静脉回流基本停滞。结论：浅静脉千的存在有助于逆行皮瓣的静脉逆向回流，并在回流中起类似“枢纽”的重要作用，临床应尽量选用“I”形浅静脉干。     

兔耳岛状皮瓣静脉干滋养系统的活体观察

目的：探讨浅静脉干滋养血管的分布及其在皮瓣成活中的意义。方法：新西兰大白兔32只，每只兔耳形成蒂在近心端的岛状皮瓣2块，按对血管蒂的处理不同分为四组：Ⅰ组单纯静脉干组；Ⅱ组结扎静脉干组；Ⅲ组动静脉干组；Ⅳ组无血管组。在兔耳的背侧开窗，灌注液连续灌注下，OlympusBH-2型微循环仪连续24小时观察滋养血管的来源、分布及管径变化等结果：可见边缘静脉和中央静脉附近有数条较直的细小血管分布，沿静脉干呈网状分布于静脉干壁，并向远端和静脉干以外的区域分布，与中央动脉及其周围血管相沟通。结论：浅静脉干有自身的滋养血管，其对皮瓣的成活具有重要意义。     

浅静脉干在皮瓣成活中的作用实验研究

目的 :探讨浅静脉干在局部皮瓣成活中的作用。　方法 :在猪的大腿及腹部设计蒂在近端的长宽比为 4:1的局部皮瓣 (2 0× 5 cm) ,按静脉干的处理不同分三组 : 组包含浅静脉干及其周围组织 , 组将浅静脉干在皮瓣蒂部栓塞 , 组将浅静脉干及其周围 0 .5 cm内的软组织结扎切断。术后即刻 ,2 4h,48h用激光多普勒血流探测仪检测皮瓣蒂部 ,中部 ,远端的微循环血流情况 ,7天观察各组皮瓣成活情况 ,术后 7天切取 、 组皮瓣 ,自蒂部用 10 %硫酸钡钡餐乳剂行静脉干逆行造影。　结果 : 、 组间蒂部不同时期微循环血流灌注速率 ,峰值均数比较无显著差别 (P>0 .0 5 )。　结论 :局部皮瓣带上浅静脉干不仅可以通过其本身的滋养系统为皮瓣提供部分血供 ,同时其与周围组织的广泛联系亦有助于皮瓣的引流 ,尤其是浅静脉干的引流作用更重要 ,实验中未发现有静脉血倒灌现象存在     

带掌背浅静脉的第三掌背动脉岛状皮瓣

目的探讨带掌背浅静脉的第三掌背动脉逆行岛状皮瓣的手术方法,扩大第三掌背动脉皮瓣的修复范围,提高皮瓣的成活质量。方法通过皮瓣蒂部带第三掌背皮神经及掌背浅静脉,在原轴线近端距轴点6cm左右,以浅静脉为轴线向腕背部延伸,在此轴线上设计切取皮瓣。自1999年以来,修复中指、环指近、中节指背或指腹软组织缺损13例,其中合并远节指腹指背软组织缺损5例。结果皮瓣全部成活,2例类似于静脉皮瓣成活。结论本术式扩大了第三掌背动脉岛状皮瓣的修复范围,使之可修复中、环指的整个指背或指腹软组织缺损。该术式操作方便,效果较好,值得临床推广。     

Ear helix flap for reconstruction of total loss of the upper eyelid.

We present a patient with a recurrent carcinoma of the right upper eyelid who underwent resection of the subtotal upper eyelid resulting in a full-thickness defect. The eyelid was reconstructed with advanced conjunctival lining and an ascending helix chondrocutaneous flap from the right auricle. This flap was nourished with a reverse flow of the frontal branch of the superficial temporal vessels. A superficial temporal vein of the flap was anastomosed to the zygomaticofacial branch of the superficial temporal vein at the lateral canthal region to ensure adequate drainage. The flap survived without any congestion. An ascending helix flap is the best candidate for total loss of the upper eyelid.     

Microvascular reconstruction of nasal ala using a reversed superficial temporal artery auricular flap.

Microsurgical technique allows successful transfer of an auricular flap in a one-stage procedure, using the root of the helix. Although a free composite auricular flap with the superficial temporal artery pedicle provides a good solution to repair nasal defects, its vascular pedicle is so limited that a vein graft from other area of the body is usually needed to reach the recipient site, leaving an unpleasant scar on the donor site. The authors present a reversed superficial temporal artery auricular free flap for alar reconstruction by microsurgical transfer. This technique has been performed on four patients with posttraumatic alar defects. In three patients, the reversed superficial temporal vessels of the flap were anastomosed directly with the recipient facial vessels in the nasolabial fold. In one patient, the reversed superficial temporal artery of the flap was anastomosed with the facial artery as above, its accompanying vein to the proximal stem of the superficial temporal vein by a graft taken from the excess length of the reversed superficial temporal artery pedicle because a suitable vein was not found for microvascular anastomosis in the nasolabial area. In these four patients, the size of the flap was 2.5 x 2.0-4.0 x 2.5 cm, the length of the vascular pedicle is 5-8 cm, average 6.5 cm. The reversed superficial temporal artery auricular flap offers a long vascular pedicle of the auricular free flap for microvascular anastomosis in the reconstruction of the ala of nose, delivers a good solution to the problem of the vascular pedicle shortage of the proximal superficial artery auricular flap. There is no need of vein graft from other parts of the body because the superficial temporal vessels on the temple provide not only the flap pedicle but also a source of vessel grafts. This technique may have even wider applications in other facial cutaneous defect.     

Venous drainage system of the transverse rectus abdominis musculocutaneous flap

The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used for reconstruction of the breast. Partial loss of the flap is still a problem, however, and venous congestion may cause partial necrosis of the flap. There are few studies of the venous anatomy of the TRAM flap that compares with that of the arterial system, so the aim of this study was to investigate the venous anatomy of the TRAM flap and assess its drainage pathway using venography. A mixture of barium and gelatin were injected through the cutaneous veins such as the superficial inferior epigastric vein (SIEV), the superficial circumflex iliac vein (SCIV), or the perforating branch of the deep inferior epigastric vein (DIEV) in 11 hemiTRAM flaps. Venograms of TRAM flaps were taken, and the venous anatomy evaluated. The study showed that it consisted of the dominant superficial venous system, the SIEV and SCIV, and the secondary deep venous system, and the perforating vein of DIEV (DIEV perforator). In addition, we saw the large communicating veins between the SIEV and DIEV perforator near the umbilicus. We think that these communicating veins, which are considered as the DIEV perforators between the superficial and deep venous system, are an important venous drainage pathway after the TRAM flap has been raised.     

Evaluation of Role of Arterialization of Venous Flaps in Abdomen in Rats

Introduction  Reconstruction forms the primary tenet in plastic surgery. Venous flaps are a known option but the survival is limited. Arterialization of venous flap can enhance its survival. While various techniques of arterialization of venous flaps are described, there are very few studies comparing them. Material and methods  The current study was conducted among 34 rats weighing 160 to 200 grams. The rats were divided into four groups. Group I—islanded epigastric flap was raised with superficial caudal epigastric vessels as pedicle. Group II—arterialized flow through venous flap was raised with superficial caudal epigastric vein (SCEV) as afferent and lateral thoracic vein as drainage vein. Side-to-side anastomosis was done between femoral artery and vein, lateral to the origin of superficial caudal epigastric artery. Group III—after raising the flap, as in group II, femoral vein was ligated proximal to superficial caudal epigastric vessels. Group IV—an arterialized flow through venous flap was raised with superficial caudal epigastric vein as afferent and lateral thoracic vein as drainage vein. End-to-side anastomosis was done between femoral artery and superficial caudal epigastric vein. Animals that died before completion of the study were excluded. The color changes of flaps were noted. Flap survival was expressed as a percentage of the total flap surface area. The patency of anastomosis was seen on postoperative day 5. Results  There was no total flap failure. On statical analysis, the flap survival area on day 5 between Group I and Group IV was not significant ( p value 0.431). The survival area in Group I (78.85 ± 10.54%) was comparable to Group IV (65.71 ± 20.70%). Group II and III had poor results as compared with Group I. In four rats, thrombosis of arteriovenous anastomosis was noted with flap survival area of 30 to 33%. Conclusion  It was noted that epigastric venous flaps with end-to-side anastomosis between femoral artery and superficial caudal epigastric vein (group IV) have survival area comparable to islanded flaps.     

前臂皮神经,皮神经营养血管与浅静脉的关系和临床意义？…

目的 为设计皮神经营养血管皮瓣和对该类皮瓣与某些局部移转的静脉的的关系的认识提供学基础。方法 用显微解剖法,标本双色透明法观测前臂内侧皮神经血供、贵要静脉与前臂内侧皮神经及其营养血管的关系和前臂外侧皮神经的血供、头静脉与前外侧皮神经及其营养血管的关系。结果 前臂内、外侧皮神经的血供形式不相同,前者由神经旁血管供养,后者由主要动脉和神经旁血管共同供养。头静脉与前外侧皮神经及其营养血管,贵要静脉与前后     

Venous augmentation of the free TRAM flap.

Venous congestion in a free TRAM or DIEP flap when the main pedicle is still patent (both the artery and the vein) is an occasional dire situation. Here, we describe ways of salvaging the free TRAM or DIEP flap from imminent loss. In the last 4 years, we have had three patients who developed venous congestion after the use of the TRAM or DIEP flap for breast reconstruction. This was detected as late as the third postoperative day in our first patient. On exploration, patent arterial and venous anastomoses were found. Fortunately, the opposite pedicle had been dissected and preserved with the flap. The patent congested vein in this pedicle was anastomosed to the cephalic vein using an interpositional vein graft, relieving the congestion. In the other two patients congestion was detected earlier and relieved using the superficial inferior epigastric vein. It has been our policy to dissect a length of the opposite pedicle and/or preserve a length of the superficial inferior epigastric vein or the superficial circumflex iliac vein. These can then be used to augment venous drainage if inadequacy is noted at the end of the operation or during the postoperative period.     

Comparison of normal and venous flaps. An experimental study]

The abdominal skin of 135 rats was fashioned to be normal on venous flap for investigating the difference in quality of the two. For normal flap, the right superficial epigastric artery was used to serve as the nourishing vessel and the left superficial epigastric vein the draining one. For venous flap, the right superficial epigastric vein was made to be the nourishing vessel and the left superficial epigastric vein the draining one. The flap in group I was fed with blood from the distal end of the femoral vein; the flap in group II was supplied with blood from the distal end of the femoral artery; and the flap in group III was nourished with blood from the femoral artery. It demonstrated that the venous flaps in group I were better in quality than the normal flaps in terms of survival rate, elasticity and size of ulcer. However, the results in group II and group III were quite different. As for clinical use, it would be all right to cover small wound with venous flap; while repairing large defect, particularly in exposed part or area near a joint, normal flap should be of the choice.     

改良(足母)趾腓侧皮瓣修复拇手指指腹缺损

目的介绍改良躅趾腓侧皮瓣修复拇、手指指腹缺损的手术方法。方法对15例拇、手指指腹缺损的患者，采用改良的躅趾腓侧皮瓣移植修复。该皮瓣在传统躅趾腓侧皮瓣设计方法基础上，将皮瓣腓侧缘及近端分别向背侧及趾蹼侧移动，从而避开口径细小又紧贴于皮下的躅趾腓侧浅静脉，直接游离第一跖背浅静脉；皮瓣的动脉和神经游离仍以常规方式进行。结果术后15例皮瓣全部成活，未发生动、静脉危象。12例获得4～11个月随访，3例失访。手功能评定：优10例，良2例。皮瓣两点分辨觉为4～8mm，12例对皮瓣外形满意。供区行走无影响，步态正常。10例对供区外观满意，2例欠满意，其中1例蹲趾腓侧偶有触痛。结论应用改良躅趾腓侧皮瓣可显著降低手术难度，提高成功率。