小血管移植在断指再植中的应用

目的 探讨小血管移植在断指再植中的应用。方法 再植47例52指，移植修复动脉52条、静脉11条，其中包括静脉皮瓣修复静脉及皮肤缺损2块，静脉皮瓣修复动脉及皮肤缺损1块。结果 52指再植成活38指。1例2指再植失败，l例3指中1指再植失败，成活率73．1％。结论 小血管移植对于血管缺损状态下的断指再植系唯一选择。     

绞窄伤断指动脉缺损再植的探讨

目的 探讨动脉缺损断指再植的手术效果。方法 断指近端动脉缺损施行静脉移植或邻指动脉移植，断指远端动脉缺损施行静脉动脉化。结果 15指动脉缺损断指再植，术后13指成活。结论 动脉缺损的断指再植，术中需行血管移植或静脉动脉化，成活的关键是掌握再植指征、显微操作技术和术后血管危象处理。     

指动脉转位与静脉移植修复断指再植中血管缺损

[目的] 评价指动脉转位与静脉移植修复断指再植中血管缺损的临床效果。[方法] 2014年9月～2018年9月对本院153指伴血管缺损的断指进行断指再植术,其中采用指动脉转位技术94指,比较两组围手术期和随访资料。[结果] 采用指动脉转位技术94指中,同指动脉转位16指,邻指局部转位29指、邻指顺行转位24指、邻指逆行转位18指、虎口动脉转位7指;缺损长度平均(4.74±1.82) cm。静脉移植组59指,缺损长度平均(4.52±1.41)cm。指动脉转位组中7指出现动脉危象,其中4指再次探查吻合后成活,2指截除,1指部分坏死,总成活率96.81%。静脉移植组12指发生动脉危象,其中5指再次探查后成活,4指截除,3指部分坏死,总成活率88.14%,两组成活率比较差异有统计学意义(P0.05)。术后12个月,动脉转位组掌指关节、近侧指间关节和远侧指间关节ROM均显著大于静脉移植组,差异均有统计学意义(P0.05)。术后12个月按BMRC评级标准,动脉转位组再植断指的感觉功能显著优于静脉移植组,差异有统计学意义(P0.05)。[结论] 指动脉转位是修复再植动脉缺损的有效方案,不仅能提高再植指成活率,而且有利于术后神经功能和关节功能恢复。     

652指断指再植的临床体会

目的再植指成活是断指再植早期目的,再植指功能恢复是断指再植最终目的。方法末节甲根部以远指体离断采用：（1）吻合一条动脉,一条静脉或两条静脉;（2）吻合一条动脉,另一条动脉作动静脉转流（即远端动脉与近端静脉吻合）;（3）吻合一条或两条动脉,附加拔除甲板或离断指体侧缘小切口放血治疗。单纯血管缺损或伴有血管、皮肤软组织缺损离断指采用移植血管、微型游离皮瓣治疗。结果本组应用显微外科技术再植652指,成活628指,成活率96．3％。术后随诊1-3年,根据断指再植功能评定标准总优良率75．3％。其中离断指伴有血管缺损或皮肤软组织缺损35指,成活35指,成活率100％;甲根部以远指体离断107例。97例成活,成活率90．7％。结论随着显微外科的发展,显微外科技术不断进步．人们生活水平不断提高,对再植指的要求也越来越高,因此对再植手指的适应证应加以放宽。     

复杂断指再植中的静脉移植选择

目的 探讨在复杂断指再植中,切取不同部位静脉用于移植修复血管缺损的方法和体会.方法 应用游离腕掌侧浅静脉、游离前臂掌侧浅静脉、游离桡动脉伴行静脉、游离近节指背静脉、游离掌背静脉、游离足背网状静脉的方法修复复杂断指的血管缺损98指（动脉83条,静脉22条）.结果 应用静脉移植修复复杂性断指98指,成活93指,成活率95%.术后随访6个月～3年,根据中华医学会手外科分会断指再植功能评定试用标准,优良率为87%.结论 根据复杂断指缺损血管的部位和长度,切取不同供区静脉进行血管移植,扩大了手术适应证,提高了复杂断指再植成活率,而且取得了良好的外观和功能.     

断指再植术中动脉缺损的修复

目的 探讨断指再植术中动脉缺损的修复方法。方法 对137个断指分别采用短缩指骨、静脉移植或动脉移植和邻指动脉转位方法修复。结果 本组成活134指，坏死3指。结论 在断指再植术中，针对动脉缺损的不同类型分别选择有效的修复方法，可提高断指再植的成活率。     

挤压旋转撕脱性断指再植方法的选择

目的 报道挤压旋转撕脱性断指再植不同手术方法的临床效果。方法 1993年5月-2002年6月，对挤压旋转撕脱性手指完全离断实施断指再植66例72指，其中应用自体小静脉移植17例23指，采用掌、指固有动脉全段移位10例10指，进行邻指指固有动脉远端血管局部转位39例39指。结果 自体小静脉移植组的断指再植成活9例13指，采用掌、指固有动脉全段移位再植成活9例9指，1例部分成活，而进行邻指指固有动脉远端血管局部转位的39例39指全部成活。所有成活病例术后随访6个月～5年，按对断指再植功能标准评定，三种手术方法优良率分别为68．8％、86．7％、95．6％。结论 挤压旋转撕脱性手指完全离断，应用邻指指固有动脉远端血管局部转位治疗效果良好，是一种实用有效的再植方法。     

断指再植过程中血管缺损的处理

目的 探讨断指再植过程中血管缺损的处理方法。方法 采用血管转位、血管移植修复长段血管缺损;合并有软组织缺损的采用带血管的微型皮瓣修复;末节及脂尖无静脉缝合时,通过增加离断指体间接触面积进行再植。结果 修复136指,成活112指。随访1-2年,关节活动功能：优42指,良50指,差20指;感染恢复程度：优45指,良51指,差16指;血液循环：优64指,良48指;再植指外观：优62指,良34指,差16指。结论 血管缺损的断指修复应根据具体伤情,采用灵活的手术方法、不要轻易放弃对断指的再植。     

复杂性断指（掌）再植术中的情况处理

复杂性断指（掌）再植术中的情况处理于方提，林欣１９８５～１９９２年间处理无法直接吻合血管的复杂断指３０指，断掌３例，根据伤情，分别采用了邻指血管转位，静脉移植，断指动脉－静脉化以及皮瓣桥接断指移位再植等方法，再植成活２８指，效果满意。临床资料本组断指...     

断指再植手术中血管缺损处理的体会

湖南省长沙市湖南武警总队医院外三科邹勃生,李效,王太周,叶倩和袁华来稿：自１９８６年以来,对有血管缺损的断指７２例９６指进行再植,８４指成活。体会：小静脉移植是血管缺损修复的常用手段;动脉交叉桥接,指背动脉使用,邻指动脉转位是动脉修复的后备方法;指掌...     

Small vessel leg angiography for distal vessel bypass grafts

To improve visualization of the small vessels for distal bypass grafting, arteriograms of the lower extremity were obtained in 187 patients by use of active warming of the extremities, selective distal positioning of the catheter for contrast agent injections, and intraarterial administration of tolazoline. With these techniques, satisfactory visualization was obtained for planning of operation, and in only one patient was an intraoperative arteriogram necessary before bypass grafts were placed.     

Choice of vessel

Presented with the alternative of a bowl or bottle in which to void a urine specimen, patients often chose the unexpected, with mistakes far more frequent among women than men. The “positives” did not differ significantly from our general office population, but errors by women with medical orientation were numerous.     

Small vessel vasculitis

The pediatric small vessel vasculitides reviewed in this article are Henoch–Schönlein purpura (HSP) and the anti-neutrophil cytoplasmic antibody-associated vasculitides (AAV). The new classification criteria for HSP and Wegener’s granulomatosis are now validated and will facilitate the conduct of future epidemiological studies and clinical trials. The clinical manifestations of small vessel vasculitis in children are described, and current therapies discussed. There is a lack of good clinical trial data on which to base therapy for HSP. Similarly, data based on randomized controlled trials (RCTs) for pediatric AAV are lacking, although children with AAV are for the first time now included in a RCT of mycophenolate mofetil versus cyclophosphamide. Significant challenges remain in the field of pediatric small vessel vasculitis, including the development of validated disease outcome measures and biomarkers to be used in clinical trials. Lastly, long-term outcome data are lacking in survivors of pediatric small vessel vasculitis.     

Temporary vessel occlusion

In many situations, temporary artery occlusion is an integral component of aneurysm surgery. The use of temporary clip may allow safer and easier aneurysmal dissection and clipping. Several points, concerning the duration and overall risks of temporary occlusion and the method of choice for cerebral function monitoring have to be discussed. MATERIAL AND METHODS: Non exhaustive review of neurosurgical literature. DISCUSSION: Temporary clip application decreases the risk of intraoperative aneurysmal rupture. The analysis of data published in the literature showed that several questions remain open concerning the optimal method of neuroprotection and cerebral function monitoring, as well as the limit of occlusion duration. Other clinical trials are needed to assess the efficacy and safety of this technique.     

Femoral vessel injuries

Early diagnosis, expeditious vascular repair, and aggressive management of complications have resulted in an amputation rate of less than 9%. Repair rather than ligation of an associated femoral vein injury is commonly practiced by experienced trauma surgeons. In most circumstances, a reversed autogenous saphenous vein graft from the contralateral extremity is the conduit of choice; however, if a saphenous vein cannot be used because of size discrepancies, multiple associated trauma, or extensive contamination, polytetrafluoroethylene can be used with good results. If vein ligation is performed, early fasciotomy is indicated for close and meticulous monitoring of the compartmental pressures. Clearly, the most crucial components for a successful outcome are a thorough evaluation, early operation, and a flawless vascular repair.     

Iliac vessel injuries

Trauma to the iliac vasculature continues to pose a significant challenge to management. In several large series, mortality for penetrating injuries is reported as approaching 40%. Uncontrollable hemorrhage originating from an anatomically inaccessible source and multiple associated injuries often contribute to this high mortality rate. This article discusses the current existing management strategies and the controversial role of PTFE in vascular reconstruction within a contaminated field. Concomitant injuries to the enteric viscera and genitourinary system are also addressed. Postoperative management including anticoagulation and the complications of liberal fasciotomy are mentioned. The evolving role of endovascular therapy as an adjunctive modality in the armamentarium of the trauma surgeon is also presented briefly.     

Shank vessel injuries

The management of lower extremity vascular injuries has undergone dramatic changes over the last century. With the optimal management of femoral and popliteal injuries established, controversy still exists with respect to management of vascular injuries below the popliteal fossa, in the shank arterial vessels. These injuries are uncommon, often limb threatening, and usually require complex management decisions. Incidence of shank vessel injuries, imaging studies required for accurate and expedient diagnosis, determinants influencing the decision for repair or amputation, and details of techniques in surgical intervention are discussed.     

Large vessel vasculitis

Takayasu arteritis is a chronic granulomatous disease of the aorta and its major branches that usually affects women during the second and third decades of life, but it has been reported in young children. This review details the clinical, pathological and radiological features, differential diagnoses and management of the condition, focusing chiefly on the disease in children. The recent definition of Takayasu arteritis is discussed. The condition should be considered in patients with unexplained arterial hypertension or unexplained inflammatory syndromes without signs of localization. Since the disease may be life-threatening and progressive, early recognition is necessary to initiate appropriate therapy. Patients with persistent ischaemic symptoms including hypertension might benefit from revascularization procedures.     

Central vessel trauma

During a 24 month period, 30 patients were treated for central vessel trauma (CVT). Injured vessels included all of the major arteries and veins in the chesk, neck and abdomen except the infrarenal aorta. Overall survival was 70 per cent. Experience with specific injuries is reviewed with commentary on surgical access to difficult areas including the thoracic outlet, suprarenal aorta and inferior vena cava. Common factors in the nine deaths are reviewed with the findings that cardiac arrest at any time during pre- or intraoperative management is uniformly lethal; emergency thoracotomy for control of bleeding carries an expectedly high mortality; cross-clamping of the descending thoracic aorta to control hemoperitoneum has a limit of tolerance of about one hour, and prolonged shock, whether compensated or profound is poorly tolerated and is associated with a high mortality.