手部静脉分布的规律

目的从临床应用解剖学角度，分析手部静脉分布的规律性。方法将６例前臂离断的新鲜上肢，以过氯乙烯乙酸乙酯溶液为填充剂，制成动、静脉分色铸型腐蚀标本。结果手部深静脉与相关动脉有伴行关系，但多数静脉的管径细小。手部浅静脉无伴行动脉，掌侧静脉管径细小，行程分散；背侧静脉管径粗大，行程规律性强。结论手部深静脉除掌深静脉弓和掌心静脉可供外科作吻合外，其它静脉不具备吻合条件。手掌侧浅静脉网无临床吻合价值，手背侧浅静脉是外科吻合的主要血管     

第一掌骨背侧血管蒂岛状皮瓣的应用解剖

目的研究第一掌骨背侧４种血管蒂岛状皮瓣的应用解剖学基础。方法对３２只新鲜尸手标本,分别行血管染料灌注、血管造影、透明标本后,进行显微解剖学观察。结果（１）桡动脉腕背支、拇指桡侧指背动脉、第一掌背动脉的拇指尺侧支、拇指桡掌侧动脉掌指关节周围支、拇主要动脉分出的拇指尺侧指背动脉等５支血管,共同构成第一掌骨背面区域筋膜层的血管网;并与拇指背皮神经呈节段性伴行。（２）供区内有２条同行浅静脉干,存在静脉瓣膜。结论该供区可设计成拇指桡侧指背动脉、拇指桡侧血管筋膜蒂、拇指尺侧指背动脉筋膜蒂和拇指背皮神经伴行血管蒂等４种类型的岛状皮瓣,可顺行或逆行移位修复创面。     

手与前臂皮神经伴行血管逆行岛状皮瓣的临床应用

目的：报道手、前臂皮神经伴行血管逆行岛状皮瓣的临床应用结果。方法：用桡神经拇指背尺侧支及前臂外侧皮神经前支伴行血管为蒂设计逆行岛状皮瓣，蒂部携带浅静脉及皮下组织，修复拇指缺损时皮神经与指神经缝合。结果：手部６例、前臂部２例皮瓣全部成活，伤指恢复良好感觉。结论：这两种皮瓣血供充分，不牺牲主干血管，前者可修复拇指指腹及指端缺损，后者可修复腕、掌背侧中、小面积皮肤缺损。     

前臂掌侧浅静脉网的解剖学特点和临床应用

目的 研究前臂掌侧浅静脉网、手部掌浅弓、指总动脉及指固有动脉的解剖学特点.探讨前臂掌测浅静脉网在断掌、多指离断再植中的临床意义.方法 观察健康成人6具尸体标本的前臂掌侧浅静脉网的形态特点、管径情况;掌浅弓、指总动脉及指固有动脉的位置、形态及管径情况.临床应用前臂掌侧浅静脉网移植修复掌浅弓合并其分支动脉有缺损的严重手部损伤,恢复手指血供4例.结果 解剖中发现前臂掌侧浅静脉网其管径及形态结构能匹配掌浅弓、指总动脉及指固有动脉.临床应用4例,手指血运恢复良好.术后随访11个月,功能良好.结论 前臂掌侧浅静脉网位置表浅,相对丰富,易于切取,供区可满足各平面掌浅弓损伤修复的需要,为严重手掌部动脉毁损伤实施血管移植提供了一个良好的移植血管供区.     

颞浅动脉分支与静脉伴行解剖基础及临床应用

目的 了解颞浅动脉分支走行及静脉伴行规律,为临床皮瓣手术设计提供解剖学依据. 方法 解剖10具成人尸体标本头面部(共19侧)并拍照,利用Digimizer图形分析软件建立以外耳孔为原点的坐标,测量分析颞浅动脉额支及顶支走行和伴行静脉.以此解剖结构为基础,用超声多普勒探查颞浅动脉及分支,低头憋气法或环扎法显示相应静脉,设计轴心线位于动静脉之间的转位皮(筋膜)瓣10侧,修复2008年2月-2009年12月笔者单位收治的面部损伤患者9例.数据行方差齐性检验. 结果 19侧标本中,额支伴行静脉缺如6侧,动静脉间最大间距(2.1±1.2)cm;顶支伴行静脉缺如3侧,动静脉间最大间距(1.4±0.7)cm.额支间血管距离大于顶支,且前者离散程度高于后者(F=0.0404,P=0.0475).皮(筋膜)瓣全部成活,无淤血、坏死. 结论 选用颞浅血管分支为轴心血管时,皮瓣设计应根据静脉伴行情况而定,避免术后因静脉回流障碍致皮瓣坏死.低头憋气法或环扎法可较好显现颞浅静脉及其分支,该法简单实用、安全可靠.     

以手部皮神经伴行血管为蒂的岛状皮瓣的临床应用

目的应用手部皮神经伴行血管蒂岛状皮瓣修复手指指背软组织缺损。方法采用手部桡神经浅支、尺神经手背支伴行血管蒂的岛状皮瓣，即拇指桡、尺侧皮神经伴行血管岛状皮瓣修复拇指；第一掌背皮神经伴行血管岛状皮瓣修复示指；第三、四掌背皮神经伴行血管岛状皮瓣修复中、环指；小指尺背侧皮神经伴行血管岛状皮瓣修复小指。共５种１５块，修复指部皮肤缺损１５例。皮瓣切取的最大面积达５ｃｍ×３ｃｍ。结果１５例皮瓣全部成活，效果满意。结论该类皮瓣血供可靠，创伤小，操作简单。特别适用于一期修复伴有伸肌腱缺损的指背创面     

额部皮瓣内颞浅静脉额支的应用解剖学研究

目的 研究颞浅静脉额支的变异情况及其与颞浅动脉额支的关系,为避免颢浅血管蒂额部皮瓣发生淤血性坏死提供解剖学依据.方法 观察颢浅静脉额支的变异情况,以颧弓上缘为X轴、过骨性外耳门前缘点X轴的垂线为Y轴的二维坐标系定位颞浅静脉额支,测量颞浅动静脉额支之间的距离.结果 颞浅静脉额支缺如率为50%(10/20),多数(9/10)位于颞浅动脉额支的上方,颞浅静脉额支与颞浅动脉额支的平均距离为(17.3±8.4)mm,且越向颅顶方向,动静脉之间的距离越大.结论 颞浅静脉额支解剖变异较大,颞浅血管额支动静脉伴行多不紧密.因此,颞浅血管蒂额部皮瓣蒂部应较宽(3～4 cm)设计成逐渐增宽的扇形,可避免皮瓣发生静脉回流障碍.     

腹壁浅动脉皮瓣的应用解剖研究

目的为腹壁浅动脉皮瓣的临床应用提供解剖学基础。方法取甲醛固定6个月以内的成年尸体标本10具,其中男8具,女2具;死亡年龄35～78岁,平均58岁。尸体标本经颈总动脉或股动脉灌注红色乳胶后,于两侧腹股沟韧带区域解剖观察腹壁浅动、静脉的起源、走行、分支、分布及与周围血管的位置关系,并测量腹壁浅动、静脉管径及蒂长。结果 10具标本中,1具两侧腹壁浅动脉缺如;9具标本18侧在腹股沟水平可见腹壁浅动脉,动脉管径平均为1.48mm,蒂长平均为4.80cm。11侧在起始处与周围血管形成共干模式,其余7侧单独起源于股动脉。腹壁浅动脉走行与分支方式有4种,其中5侧为总干型,3侧为双分支型,7侧为单外侧支型,3侧为单内侧支型。10具标本20侧均可见腹壁浅静脉,管径平均为2.33mm,蒂长平均为5.45cm。仅有腹壁浅静脉伴行8侧,腹壁浅静脉和1对动脉伴行静脉同时出现12侧。结论腹壁浅动脉皮瓣血供相对恒定,切取简便,不损伤腹直肌,可应用于头颈、四肢、乳房等部位的软组织缺损修复。     

带掌背动脉的逆行复合组织皮瓣修复手外伤的临床应用

在手各掌骨间隙背侧，走行有４条掌背动脉，在各掌骨头之间，均发出一条恒定的吻合，与指掌侧总动脉或其分支相连，构成掌骨的掌，背侧动脉的血管网，并有二条小二静脉伴行。以掌背动脉为轴心，设计逆行岛状复全组织皮瓣复手部皮肤、股腱及骨缺损２６例，获得成功，皮瓣切取最大面积为９＊８ｃｍ。该术式方法简单，实用，可一期修复手指骨、肌腱及皮肤缺损，不损伤手部的主要血管和神经。     

介入栓塞治疗左腕掌部动静脉瘘1例

动静脉瘘是动脉和静脉之间存在异常通道,一般包括先天性血管畸形、后天性外伤、血液透析病人的人工动静脉通路形成的动静脉瘘。由于动脉的血液流入伴行的静脉,可造成瘘的局部血管病变和瘘局部、周围循环和全身系统的血流动力改变,主要表现为瘘口附近的杂音和震颤,肢体皮肤温度的升高,也可由于静脉回心血量的增多导致心率增快、心脏增大甚至出现心衰等。2013年11月我院介入栓塞治疗左腕掌部动静脉瘘1例,现报道如下。     

手及前臂皮神经营养血管蒂皮瓣的应用解剖

目的：观察手及前臂皮神经营养血管的情况，为设计以皮神经及其营养血管为蒂的岛状皮瓣提供形态学依据。方法：用红色氯仿油画染料灌注的20侧成人上肢标本，在手术显微镜下解剖并观测手及前臂 5条皮神经营养血管的来源、数目、外径，穿出深筋膜的位置，与皮神经及浅静脉的关系等项目。结果；营养动脉多以降支方式伴行在皮神经深面内侧，前臂皮神经的血管网可达神经两侧各2．5cm范围内的皮肤，5条皮神经的营养动脉外径接近，结论：手及前臂皮神经的营养血管血供可靠，可设计相应部位的岛状皮瓣。     

多层螺旋CT血管成像三维重建对脑膜瘤血供的评价及应用

目的探讨多层螺旋CT血管成像(MSCTA)对脑膜瘤血供的诊断价值。方法对18例脑膜瘤患者进行MSCTA检查,应用MPR、MIP、SSD和VRT等三维重建技术,对脑膜瘤的血供进行观察。结果18例脑膜瘤中有10例颅内动脉参与供血,有8例脑膜瘤将颅内大血管推移、压迫,但跨过肿瘤段没有直接分支到肿瘤,供血动脉在脑膜瘤内呈放射状分布。静脉分布在肿瘤的表面,回流到附近的浅静脉或静脉窦。结论通过多层螺旋CT扫描及三维重建技术的应用,可以显示脑膜瘤的供血动脉、引流静脉,肿瘤与颅内大血管的关系等,为手术治疗提供重要的信息。     

Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm

The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.     

The distal medial perforators of the lower leg and their accompanying veins.

The skin of the lower leg is nourished by a number of perforating vessels arising from the named arteries which travel in the longitudinal axis of the limb. The distribution of these perforating arteries has been elucidated using a combination of techniques but which are essentially based on cadaveric studies. Clinically, this knowledge has provided the basis for methods of local tissue transfer in the lower limb. A common finding with the use of local fasciocutaneous flaps is venous congestion. The relationship of the veins to the arteries in perforating vessels of the lower limb has not been investigated. We studied the veins accompanying these arteries by dissecting them in 40 lower limbs (20 cadavers). A total of 40 pedicles were dissected. We concentrated our analysis of the arterial/venous relationship on the most distal vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used distally based fasciocutaneous flap). We found that 25 of these arteries were accompanied by one perforating vein whereas 12 were accompanied by two or more veins. When there was a single vein this was usually larger than the artery in external diameter and lay inferior to the artery 76% of the time. When there were two veins or more, there was an interconnection between the two around the artery in over half of the samples (7/12). Surprisingly, three vessels did not have any accompanying vein. This study sheds some light on the variation in venous drainage important to the initial survival of these flap transfers.     

Afferent and efferent lymph-collecting vessels of the submandibular nodes with special reference to the lymphatic route passing through the mylohyoid muscle

BACKGROUND: Although metastasis of cancer in the oral region to the submandibular node is well described, there has been no anatomic representation of lymph vessels penetrating the oral floor and draining into the node. MATERIALS AND METHODS: Ninety specimens were obtained from formalin-fixed, donated cadavers. Histologic observations using serial sections followed the macroscopic observations. RESULTS: In 19 of 90 specimens, we found afferent collecting lymph vessels exiting from the mylohyoid surface and draining into the preglandular submandibular node. In 3 of the 19 specimens, collecting vessels passing through the narrow muscle gap with or without arteries, veins, and nerves were identified histologically. The postglandular submandibular node was not evident in the drainage route. CONCLUSIONS: Although it carries a low incidence, because of the direct lymphatic route or pathway between the oral region and preglandular submandibular node, the pathologically positive supraomohyoid node sometimes seems to be found even in elective neck dissection. However, we speculate that sentinel node investigation would reveal the much more critical role of the jugulodigastric node not only as the actual sentinel node but also as the common terminal node along the various drainage routes from the oral region.     

Arterial patterns of the deep and superficial palmar arches

The vascular patterns of the palmar arches and their interconnecting branches present a complex and challenging area of study. Improvements in microsurgical techniques have made a better understanding of vascular patterns and vessel diameters more important. Forty-five fresh limbs from cadavers were amputated at the level of the midhumerus. Ward's red latex or Batson's compound was injected under pressure to visualize the arterial system in the hand. After hardening of the injected material, the skin, subcutaneous tissues, and tendons were removed. The specimens were digested in concentrated potassium or sodium hydroxide leaving the bony elements and a cast of the arterial system. The superficial palmar arch is most easily classified into two categories: complete or incomplete. An arch is considered to be complete if an anastomosis is found between the vessels constituting it. An incomplete arch has an absence of a communication or anastomosis between the vessels constituting the arch. Complete superficial palmar arches were seen in 84.4% of specimens. In the most common type, the superficial arch was formed by anastomosis between the superficial volar branch of the radial artery and the ulnar artery. This was seen in 35.5% of specimens. In 31.1%, the arch was formed entirely of the ulnar artery. Incomplete superficial arches were seen in 15.5% of specimens. In 11.1%, the ulnar artery forms the superficial arch but does not contribute to the blood supply to the thumb and index finger. The deep palmar arch was found to be less variable with 44.4% formed by an anastomosis between the deep volar branch of the radial artery and the inferior deep branch of the ulnar artery. Injection followed by chemical debridement allows direct visualization and measurement of the arches and the smaller arterial branches that are visualized poorly with other techniques. Based on the vessel measured, vessels of the superficial and deep arches are of sufficient size to allow microvascular repair, although repair of the communicating branches, the dorsal carpal rete, and its branches, probably is not feasible because of their small size.     

Replantation of a circumferentially degloved ring finger by venous arterializations

Treatment of ring degloving injuries of the finger is one of the most demanding problems in hand surgery. Replantation has been advocated as the best solution if the vessels belonging to the degloved skin are not irreversibly destroyed. We present a case involving a ring finger with circumferentially avulsed skin. Debridement under microscopy showed that the peeled skin did not retain any arteries, but did have various superficial veins of good caliber. The neurovascular bundles of the finger remained in situ and did not appear to be disrupted. The degloved finger survived uneventfully by venous arterialization, retaining excellent function and appearance.     

Neovascularization in acute venous thrombosis

OBJECTIVE: The aim of this study was to describe the phenomenon of arteriovenous fistula (AVF) formation in venous thrombus. METHODS: Patients referred to the vascular laboratory for evaluation for deep venous thrombosis were included. Duplex ultrasound scanning was used to detect flow within the thrombus. The flow patterns and the resistivity index were obtained in the veins above/proximal and below/distal to the thrombus, in the adjacent arteries, and within the perivenous vessels. Patients with trauma, hemodialysis access, endovenous ablation, known AVF, or inflammatory conditions were excluded. RESULTS: There were 22 patients with AVF flow in thrombosed veins. Deep veins were involved in 15 cases and superficial veins in the remainder. Perivenous vessels feeding the AVF in the thrombus could be clearly identified in 16 patients (19 vein segments). In 21 of 22 patients, multiple flow channels were present throughout the involved thrombosed vein segment. These flow channels were isolated to a single vein segment. They measured <4 cm in length in 19 cases and were more extensive in the remaining three. Reflux within the vein segment was identified in 13 cases. Local symptoms that could be attributed to the arterialization of thrombosed veins occurred in four cases, and none of the patients manifested systemic symptoms. The flow within the thrombus had high end-diastolic velocities with a mean resistivity index of 0.48 (SD, 0.08), which is typical of a fistula flow pattern. The flow in the main arteries was unaffected. CONCLUSION: Neovessels were found with AVF flow in thrombi of superficial and deep veins. They had variable length and multiple flow channels, with inflow from perivenous arteries. The flow in the adjacent main arteries was not affected, and no systemic symptoms were detected. The exact etiology and natural history of this phenomenon are not known, and its clinical significance is unclear.     

Interactions between angiotensin II and phenylephrine on isolated rat renal arteries and veins

It is know that not only decreased blood flow to the kidney but also obstruction of renal outflow may, in some instances, be a cause of hypertension. In this view were compared angiotensin (Ang) II responses and investigated interactions between Ang II and phenylephrine (Phe) on renal vessels. Studies were performed on renal artery and vein rings without endothelium obtained from young (4 months) and old (12 month of age) male Wistar rats. As compared with control contractions (40 microM KC1) there are no differences between renal artery and veins on Phe- or Ang II-induced contractions. Phe -induced contractions after 1 microM Ang II pretreatment were higher on renal veins than arteries. Ang II administered after 1 microM Phe could additional increase Phe-induced contractions only on renal veins. On the other hand, these differences between renal arteries and veins responses were significantly higher on rings obtained from old as compared those from young rats. These age-dependent differences between renal artery and vein reactivity can be a possible cause of input-output renal blood flow unbalance and might become important in some pathological states which associate sympathetic activation with hyperreninemia.     

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.