Digital venous anatomy

The veins of the digits and their valves were studied in nine cadaveric hands by sequential angiography, microdissection, routine histology, cross-sectional microradiography, and corrosion casting. The findings revealed a pattern of dorsal venous arches situated over each digit. Connections between those arches were at the level of the metacarpal heads, the point at which most of the palmar venous blood joins the dorsal system by intercapitular veins. A system of valves, which were arranged so as to direct flow from distal to proximal, from palmar to dorsal, and from radial to ulnar in the hand, was present in all veins as far distal as the pulp.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.

Abstract：

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.     

Role of the perforating vein in vascular pedicle of free forearm flap

An innovation in the preparation of the vascular pedicle of the free radial forearm flap is presented. While the radial artery is commonly used as the arterial pedicle of the flap, either the cutaneous venous system or the radial comitant vein (deep venous system) is used as the venous pedicle. The perforating vein communicates between these two venous systems at the cubital fossa, and we confirmed its presence in all but one of more than 180 cases. When the vascular pedicle is dissected proximally to the perforating vein contained in the flap, the venous drainage of both the deep and cutaneous systems can be restored by anastomosis of only one vein: the cutanous or the radial comitant vein. On the other hand, the flap can be raised with the radial vessels (without the cutaneous vein) at the start of surgery, and a large caliber cutaneous vein, such as the median cubital, the cephalic, or the basilic, can be used for anastomosis in cases where the cutaneous veins in the distal forearm are too thin, or where the radial comitant vein is composed of two thin separated veins. We believe that preserving the perforating vein would make the forearm flap more reliable and more convenient in reconstructive surgery. © 1995 Wiley-Liss, Inc.     

Venous anatomy of the thumb.

The venous anatomy of 20 thumbs (10 pairs) was detailed by latex injection. The thumbs were studied on the dorsal, palmar, radial, and ulnar surfaces. Characteristic patterns were found; these included a dominant longitudinal network, palmar veins within the pulp, oblique veins at the interphalangeal joint on the radial side, and a web space vein. A layered vascular pattern with a superficial fine network overlying a deeper system was noted. Cross sections were taken at the metacarpophalangeal joint and at the proximal and distal phalanges. The distribution of the vessels in cross section reveals consistent dorsal veins at all levels, as well as palmar veins distal to the interphalangeal joint in all thumbs. Palmar veins were present over the length of the proximal phalanx in more than 65% of the thumbs.     

The blood supply of digital nerves: a microanatomical study of superficial and deep palmar venous networks.

In this work on vascularization of digital nerves, we have studied the anatomy of the deep network of venae comitantes of digital arteries, and the system of superficial palmar venules. 22 specimens of nerve and artery were dissected as one unit and were infused with Microfil prior to study under the microscope. The deep venous network, a satellite of the digital artery, can be classified into four types. A true network of deep venae comitantes exists in three of these four types, drained by deep veins arising from the transverse anastomotic arches between the palmar digital pedicles. Vascularization of the digital nerve is supplied by numerous anastomotic vessels connecting epineurial vessels, digital artery and the periarterial network (venae comitantes and vasa vasorum). This anatomical configuration lends itself to vascularized nerve grafting; for example, it is possible to use a nerve/artery graft taken as a unit from an amputated finger unsuitable for replantation. Two types of valves in this superficial venous network have been identified and their function is discussed.     

Microsurgical anatomy of the veins of the posterior fossa

The microsurgical anatomy of the veins of the posterior fossa was defined in 25 cadavers. These veins are divided into four groups: superficial, deep, brain-stem, and bridging veins. The superficial veins are divided on the basis of which of the three cortical surfaces they drain: the tentorial surface, which faces the tentorium and is exposed in a supracerebellar approach, is drained by the superior hemispheric and vermian veins; the suboccipital surface, which is below and between the lateral and sigmoid sinuses and is exposed in a wide suboccipital craniectomy, is drained by the inferior hemispheric and inferior vermian veins; and the petrosal surface, which faces forward toward the posterior surface of the petrous bone and is retracted to expose the cerebellopontine angle, is drained by the anterior hemispheric veins. The deep veins course in the three fissures between the cerebellum and the brain stem, and on the three cerebellar peduncles. The major deep veins in the fissures between the cerebellum and brain stem are the veins of the cerebellomesencephalic, cerebellomedullary, and cerebellopontine fissures, and those on the cerebellar peduncles are the veins of the superior, middle, and inferior cerebellar peduncles. The veins of the brain stem are named on the basis of whether they drain the midbrain, pons, or medulla. The veins of the posterior fossa terminate as bridging veins, which collect into three groups: a galenic group which drains into the vein of Galen; a petrosal group which drains into the petrosal sinuses; and a tentorial group which drains into the tentorial sinuses near the torcula.     

指掌侧静脉在断指再植中的应用

目的研究吻合指掌侧静脉重建断指血运的方法。方法应用指掌侧静脉重建断指血运27例，其中行指掌侧静脉端端吻合20指，与指背静脉交叉吻合4指，指掌侧静脉动脉化3指。结果25指顺利成活，1例于术后24h发生静脉危象，另1例于术后8h发生血管危象，经二次手术探查，再植手指顺利成活。结论对于利用背静脉重建血运的断指，可行指掌侧静脉端端吻合、与指背侧静脉交叉吻合和远断端静脉动脉化等方式重建手指血运，以提高再植成功率。     

Detailed anatomy of the internal spermatic vein and the ovarian vein. Human cadaver study and operative spermatic venography: clinical aspects

The exact anatomical course of the spermatic vein and the ovarian vein (gonadal) has not been described in detail previously. To determine the precise anatomy of the gonadal veins an autopsy study of 70 fresh human cadavers (40 men, 10 women, 10 male stillborns and 10 female stillborns) was performed by making a resin cast of both gonadal veins which then was carefully dissected. The study showed absence of valves in the spermatic vein, cross-communications between the right and left spermatic veins, and communication between the spermatic and renal capsular veins, spermatic and ipsilateral ureteral veins, and spermatic ipsilateral colonic veins. For clarification of the presence of valves intraoperative antegrade spermatic venography was done in 6 men with and 5 without varicocele. In both groups valves were not detected. These observations regarding the anatomy of the spermatic vein and the ovarian vein may help to explain related clinical conditions.     

Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?

Objective: The retrograde cerebral perfusion via cannulation of the superior vena cava is a widespread method for optimising protection of the brain during hypothermic circulatory arrest. Methods: In 14 cadavers (8 females, 6 males) of the local department of pathology, an examination was performed to check the competence of the valves of the internal jugular veins. After a complete preparation of the superior vena cava, the innominate vein and both internal jugular veins, ligating all side branches, a retrograde perfusion on 7 cadavers was installed, documenting flow and pressure of each internal jugular vein (IJV) in vitro. Afterwards, the veins were opened and their valves inspected. Results: In all 14 cadavers, anatomically and functionally competent valves on the right proximal IJV were found. Only 1/14 cadaver had no valve in the left proximal IJV. Additional rudimentary and incompetent valves could be identified in 1/14 cadaver on the distal right IJV, and in 2/14 cadavers on the left IJV. Retrograde flow measurement of 7/14 cadavers revealed 0 ml/min in 4/7 cadavers, 6 ml/min in 1/7, 340 ml/min in 1/7 and 2500 ml/min in 1/7 cadaver. Conclusions: As a rule, anatomically and functionally competent valves in the proximal IJV are present. In human beings, they obstruct the direct retrograde inlet to the intracranial venous system, which suggests an unbalanced and unreliable perfusion of the brain. Therefore, retrograde cerebral perfusion by cannulating the superior vena cava may help flushing out embolism and supporting ‘the cold jacket’ of the brain. However, its effect of retrograde backflow cannot be a sign of adequate cerebral perfusion.     

Valvular obstruction of blood flow through saphenous veins

To measure effects of vein valves upon blood flow through venous bypass conduits, 15 human saphenous veins (mean length 40.6 cm, 5.3 valves/vein) were perfused with normal saline at constant pressure (100 mm Hg). Flow through vein was measured before and after valve bisection. Vein valves were bisected using Leather's techniques. After valve bisection, flow in antegrade and retrograde directions was measured in seven veins. These data were analyzed using paired t tests. Antegrade flow through seven veins with intact valves averaged 317.1 cc/min. With valve bisection this increased significantly (P < 0.001) to 474.3 cc/min. Retrograde flow through veins with valves bisected increased significantly (P < 0.0001) to 428.3 cc/min. Eleven veins (mean length 42.2 cm, 5.6 valves/vein) perfused simulated capillary beds with banked blood using pulsatile flow (mean pressure 92 mm Hg). Flow, again, was measured before and after valve bisection. Data were analyzed using the paired t test. Antegrade flow increased from 124.4 cc/min in veins with valves intact to 142.5 cc/min once valves were bisected (P = 0.02). These data demonstrate that saphenous vein valves cause significant obstruction to blood flow under conditions similar to those in the arterial system. Bisection of vein valves significantly increases flow through vein. Improved patency of vein grafts using valve bisection techniques may be explained by increased blood flow alone.     

Microsurgical anatomy of the superficial veins of the cerebrum

The microsurgical anatomy of the superficial cortical veins was examined in 20 cerebral hemispheres. The superficial cortical veins are divided into three groups based on whether they drain the lateral, medial, or inferior surface of the hemisphere. The veins on the three surfaces are further subdivided on the basis of the lobe and cortical area that they drain. The superficial cerebral veins collect into four groups of bridging veins: a superior sagittal group, which drains into the superior sagittal sinus; a sphenoidal group, which drains into the sphenoparietal and cavernous sinuses on the inner surface of the sphenoid bone; a tentorial group, which converges on the sinuses in the tentorium; and a falcine group, which empties into the inferior sagittal or straight sinus or their tributaries. The superior sagittal group drains the superior part of the medial and lateral surfaces of the frontal, parietal, and occipital lobes and the anterior part of the basal surface of the frontal lobe. The sphenoidal group drains the parts of the frontal, temporal, and parietal lobes adjoining the sylvian fissure. The tentorial group drains the lateral surface of the temporal lobe and the basal surface of the temporal and occipital lobes. The falcine group drains an area that includes the cingulate and parahippocampal gyri and approximates the cortical parts of the limbic lobe of the brain. The relationship of these veins to the venous lacunae was also examined.     

Doppler testing as an important conservation measure in the treatment of varicose veins

While it is rational to ligate incompetent proximal saphenous valves, when treating varicose veins, it is hard to justify ligation if they are competent. Accurate diagnosis of competence by clinical tests have proved less than satisfactory. Doppler testing, with a simple blood flow indicator, is suggested as a sound basis on which to make decisions regarding 'selective ligations' of incompetent proximal valves.     

Revascularization of a finger with a thenar mini-free flap

A devascularized index finger with a soft tissue defect on its palmar side was managed by using a small free flap raised at the level of the metacarpophalangeal joint of the thumb. The radial digital artery was included in the flap and used to revascularize the index finger, and a palmar vein was used to drain the flap. This resulted in minimal donor side morbidity.     

去细胞牛颈静脉带瓣管道支架生物学与生物力学特性的初步研究

目的比较去细胞牛颈静脉带瓣管道支架与新鲜牛颈静脉组织的生物学和生物力学特性。方法取新鲜牛颈静脉48条,采用随机数字表法分为对照组和实验组,每组24条。对照组为新鲜牛颈静脉组织和实验组为去细胞牛颈静脉组织,采用脱氧胆酸钠+Triton-X-100方法去除瓣膜及血管壁细胞成分。检测两组瓣膜及血管壁的组织厚度、吸水率、保水率、断裂强度及组织伸长率。结果实验组瓣膜及血管壁中内皮细胞、成纤维细胞去除完全,无细胞核碎片;瓣膜及血管壁胶原纤维和弹力纤维呈波浪状排列、整齐,结构完整;瓣膜、血管壁的基因组脱氧核糖核酸含量分别较对照组下降97.58%和97.25%。实验组瓣膜及血管壁的厚度、吸水率、保水率较对照组均轻度增加,但差别无统计学意义(P>0.05)。两组瓣膜及血管壁的断裂强度及组织伸长率差别无统计学意义(P>0.05)。结论去细胞牛颈静脉带瓣管道支架的生物学和生物力学特性稳定,为种植受者细胞的组织工程右心带瓣管道研制提供了可靠的天然纤维支架材料。     

Palmar plate fixation of AO type C2 fracture of distal radius using a locking compression plate--a biomechanical study in a cadaveric model

The stability of palmar plate fixation using a locking compression T-plate was compared with that of a conventional palmar T-plate and a dorsal T-plate in a cadaveric model of an AO type C2 fracture of distal radius. The wrist axial load transmission through the radius was tested for each fixation. The results show that, under 100N axial load, the palmar locking compression T-plate restores stability comparable to that of the intact radius, and is superior to conventional palmar or dorsal T-plates.     

吻合指掌侧静脉断指再植的研究

目的 为复杂性断指再植血液循环的建立提供新的手术方法。方法 通过新鲜的成人手标本,解剖观测了手指掌侧静脉的分布状态,走向及口径。设计吻合指掌侧静脉断指再植的手术程序及技术方法。