逆行皮瓣中浅静脉干血流动力学SPECT研究

目的：明确浅静脉干在逆行皮瓣静脉回流中的作用。方法：用8头实验猪制成16块带大隐静脉的逆行皮瓣,用^99mTc9（锝）标记红细胞。①在4块皮瓣蒂部远端的大隐静脉中滴注标记了^99mTc的红细胞;②将12块皮瓣分成两组,I组皮瓣的大隐静脉保留完整,Ⅱ组皮瓣的大 隐静脉在蒂部结扎切断,将标记了^99mTc的红细胞注射入皮瓣内的大隐静脉中。用SPECT扫描并观察浅静脉干中的血流情况。结果：①标记了^99mTc的红细胞并未顺大隐静脉倒灌入逆行皮瓣内;②I组皮瓣内的同位素计数下降比Ⅱ组快。结论：浅静脉干的存在并不会因静脉血倒灌而增加逆行皮瓣的回流负担,且能促进其静脉回流。     

逆行皮瓣中浅静脉干血流动力学的SPECT研究

目的 :明确浅静脉干在逆行皮瓣静脉回流中的作用。　方法 :用 8头实验猪制成 16块带大隐静脉的逆行皮瓣 ,用 99m Tc(锝 )标记红细胞。 1在 4块皮瓣蒂部远端的大隐静脉中滴注标记了 99m Tc的红细胞 ;2将 12块皮瓣分成两组 , 组皮瓣的大隐静脉保留完整 , 组皮瓣的大隐静脉在蒂部结扎切断 ,将标记了 99m Tc的红细胞注射入皮瓣内的大隐静脉中。用 SPECT扫描并观察浅静脉干中的血流情况。　结果 :1标记了 99m Tc的红细胞并未顺大隐静脉倒灌入逆行皮瓣内 ;2 组皮瓣内的同位素计数下降比 组快。　结论 :浅静脉干的存在并不会因静脉血倒灌而增加逆行皮瓣的回流负担 ,且能促进其静脉回流     

带浅静脉干逆行皮瓣的应用研究

目的：探讨带浅静脉干逆行皮瓣的治疗效果。方法：28例四肢创面用带浅静脉干的逆行皮瓣进行修复,包括4种类型：（1）带大隐静脉的小腿内侧逆行皮瓣；（2）带小隐静脉的小腿后侧逆行皮瓣；（3）带头静脉的前臂逆行皮瓣；（4）带手背静脉的手指逆行皮瓣。结果：21例完全存活，6例基本存活，1例坏死。结论：在逆行皮瓣中带上浅静脉干既可增加动脉血供又可促进静脉回流，有利于逆行皮瓣的存活。     

兔耳逆行皮瓣中浅静脉干的压强测定

目的：明确静脉血是否会顺着浅静脉干倒灌入逆行皮瓣内,从而为探索浅静脉干在逆行皮瓣中的作用提供依据。方法：采用墨汁灌注以明确静脉是否会顺着浅静脉干倒灌入逆行皮瓣内,并用病理切片以明确。浅静脉干内压强的测定,进一步说明是否倒灌的原因。结果：墨汁未顺浅静脉干倒灌入逆行皮瓣内,逆行皮瓣内的静脉压显著高于蒂部的静脉压。结论：静脉血不会顺着浅静脉干倒灌入逆行皮瓣内,不会增加逆行皮瓣的静脉回流负担。但浅静脉干是否能促进逆行皮瓣的静脉回流尚需进一步研究。     

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。     

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。     

吻合浅静脉的逆行皮神经营养血管皮瓣的应用

目的探讨吻合浅静脉的皮神经营养血管逆行皮瓣临床应用的效果。方法1996年6月起对19例肢体远端皮肤缺损采用皮神经营养血管逆行皮瓣移位修复,其中皮肤创伤性缺损10例,慢性溃疡3例,瘢痕挛缩6例。采用腓肠神经营养血管皮瓣9例,隐神经营养血管皮瓣2例,前臂内侧皮神经营养血管皮瓣5例,前臂外侧皮神经营养血管皮瓣3例。术中将皮瓣远端的浅静脉与受区皮下静脉作端端吻合以改善静脉回流。皮瓣范围15cm×24cm～4cm×6cm,血管蒂长6～15cm。结果17例皮瓣完全成活,1例前臂内侧皮神经皮瓣修复手掌创面及1例腓肠神经皮瓣修复足内侧瘢痕创面,术后因吻合的静脉栓塞致皮瓣远端部分坏死。16例获得6～24个月随访,皮瓣质地优良,恢复保护性感觉,外形及功能改善满意。结论吻合浅静脉可以明显改善该类皮瓣的静脉回流,扩大皮瓣成活面积及修复范围。     

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     

浅静脉干及其滋养血管对静脉皮瓣成活的影响

静脉在皮瓣成活中的作用越来越受到人们的重视 ,单纯静脉蒂皮瓣临床应用获得成功 ,但其成活机制仍不甚清楚。既往研究只注重静脉内血流的作用 ,而对静脉干本身的研究较少 ,浅静脉是否存在滋养血管 ?如果有 ,其对静脉皮瓣的成活作用和意义如何 ?为此 ,我们进行了实验研究 ,现报道如下。材料与方法一、标本与仪器正常成人新鲜上肢标本 3具 ,2 0 %泛影葡胺 2 0 ml× 10支 ,义齿基托枝脂 ,自凝牙托水 ,手术显微镜 ,Olympus照相机 ,冲洗相材设备。二、实验方法1.血管造影 :2 0 %泛影葡胺 2 0 ml加入等量生理盐水稀释 ,X线监视下 ,首先用稀释后的…     

颞浅血管预构扩张皮瓣的临床应用

目的:探讨颞浅血管预构扩张皮瓣在修复面、颈部较大皮肤软组织缺损中的应用及其修复效果。方法:通过将颞浅动、静脉植入颈部皮下,皮下置入扩张器,经过3个月的组织扩张,形成以颞浅动、静脉为蒂的颈部预构扩张皮瓣,转移修复同侧面、颈部的皮肤软组织缺损。结果:2001年至2006年,应用此方法修复10例面、颈部瘢痕挛缩患者的面颊部及颏颈部皮肤软组织缺损,均取得了成功。随访6个月,效果满意。结论:采用颞浅动、静脉颈部预构扩张皮瓣修复面、颈部皮肤软组织缺损是一种可行的方法。     

Immediate use of medicinal leeches to salvage venous congested reverse pedicled neurocutaneous flaps

Reverse pedicled neurocutaneous flaps have recently become popular for reconstructing soft tissue defects of the lower extremity. Venous congestion is a relatively common problem in these flaps in diabetic patients and those with electric burns, and this may cause partial or complete loss if capillary perfusion is not re‐established urgently. We describe our experience of 13 neurocutaneous flaps, of which five developed venous congestion and were treated successfully with leeches placed immediately.     

低浓度平阳霉素联合地塞米松硬化治疗唇部浅表静脉畸形

目的:观察低浓度平阳霉素加地塞米松硬化治疗唇部浅表静脉畸形的临床疗效.方法:2007年1月～2011年1月,笔者科室应用低浓度平阳霉素(0.5mg/ml)联合地塞米松(1mg/ml)硬化治疗唇部浅表静脉畸形患者68例,其中男29例,女39例,年龄13～69岁;病变范围最小0.5cm×0.8cm,最大3cm×2.4cm.根据病变情况决定治疗的次数,2次治疗间隔15天.结果:68例患者最少注射2次,最多注射8次,治疗后随访12～32个月,平均随访21个月.患者外观满意,没有复发倾向.根据疗效评价标准,治愈66例,有效2例.结论:低浓度平阳霉素联合地塞米松硬化治疗唇部浅表静脉畸形是一种安全、有效的治疗方法.     

双干型静脉皮瓣在撕脱性断指再植中的应用

目的 报告双干型静脉皮瓣在撕脱性断指再植中的应用和临床效果.方法 2007年3月至2009年6月,采用前臂双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指6例,损伤至入院时间为30 min至8 h,切取皮瓣面积为1.8cm×1.8cm～2.2 cm×5.8cm,供区创面直接缝合.结果 术后6例伤口均Ⅰ期愈合,断指再植全部存活;5例静脉皮瓣无肿胀,顺利存活;1例皮瓣早期肿胀明显,紫红色,并见散在小水泡,经拆除部分缝线、换药等对症处理后顺利存活.术后随访时间为6个月至2年.皮瓣及再植手指血运好,皮瓣质地软,弹性好、耐磨.根据中华医学会手外科学会断指再植功能评定试用标准评定;优4例,良1例,可1例;优良率为82.5%.结论 采用前臂掌侧双干型静脉皮瓣游离移植修复伴有皮肤软组织缺损的撕脱性断指,能最大程度地恢复手指的功能和外形.

Abstract：

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

双干型静脉皮瓣在撕脱性断指再植中的应用

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

Morphological and haemodynamic aspects of cerebral aneurysms

Summary 4 patients with aneurysms of different size and location were examined by cerebral angiography, computed tomography, angiocomputed tomography, magnetic resonance imaging and angiography, in order to demonstrate haemodynamic and morphological aspects of cerebral aneurysms. Turbulent flow within aneurysms could be shown by cerebral angiography and magnetic resonance angiography. In contrast MRI or computed tomography are necessary to visualize additional thrombosed parts. MRI is the method of choice to reflect the formation of thrombus, CT to show possible calcifications.     

双干型静脉皮瓣在撕脱性断指再植中的应用

Objective To report the application and results of venous flap with double vein trunks in replantation of degloved fingers.Methods From March 2007 to June 2009, 6 cases of soft tissue defect in the degloved finger were replanted with venous flap with double vein trunks.The interval between injury and operation was 30 minutes to 8 hours.All fingers were replanted by arterialized free venous flap from the ipsilateral forearm with double vein trunks.The flap was 1.8 cm×1.8 cm to 2.2 cm× 5.8 cm in size.The donor site was directly closed.Results Primary wound healing was observed in all 6 cases postoperatively.All the replanted fingers survived completely.In 5 cases the venous flaps survived uneventfully.In 1 case there was partial superficial necrosis of the flap which healed with conservative management.Postoperative follow-up ranged from 6 to 24 months.The flaps and fingers had good circulation, good texture and color match.According to the criteria for functional assessment of amputated finger issued by the Chinese Hand Surgery Society, the results were graded as excellent in4cases, goodin 1 case, andfairin 1 case.Theoverall excellent rate was 82.5%.Conclusion Replantation of degloved finger with fransfer of venous flap with double vein trunks is capable of repairing pulp soft tissue defect and maximizing the restoration of finger appearance and function.     

The effect of chemical hemodynamic regulation on the survival of arterialized venous flaps

The role of nitric oxide (NO) on the microcirculation of arterialized venous flaps (AVFs) remains controversial. We aimed to investigate the effect of hemodynamic regulation using nitric oxide synthase (NOS) inhibitor and its agonist as a chemical intervention on the survival of AVF. A 10?×?8?cm arterialized venous flap was designed symmetrically on the rabbit abdomen. Thirty-six rabbits were used and randomly divided into three groups: control group, L-arg group and L-NAME group, respectively. The L-arg group and the L-NAME group received intraperitoneal injections of L-arginine (a NOS agonist, 1?g/kg/d) and L-NAME (nitro-L-arginine-methyl ester, a NOS inhibitor, 50?mg/kg/d) respectively, whereas the control group received intraperitoneal injections of the same amount of saline. Flap viability, water content, status of vascular perfusion and gene expression of eNOS and HIF-1α in each group were observed and analyzed. The average value of water content (venous congestion) in the L-arg group was the highest in comparison with the control group and the L-NAME group with a statistically significant difference (all p?相似文献   

结扎伴行静脉对逆行岛状皮瓣存活的影响

目的 以新西兰大白兔隐动静脉逆行岛状皮瓣为实验模型,探讨结扎血管蒂伴行静脉干对逆行岛状皮瓣存活的影响.方法 将10只新西兰大白兔两侧后肢左右随机分为2组,每组10个皮瓣,进行同体对照.建立隐动静脉逆行岛状皮瓣实验模型(面积3 cm×3 cm,血管蒂长4 cm,血管蒂周围保留1 cm宽筋膜).对照组:血管蒂部不做任何处理;实验组:在放大10倍手术显微镜视下于血管蒂的两端分别结扎伴行静脉干,使2根伴行静脉干完全闭塞.术后每天观察皮瓣颜色、肿胀情况.术后1周测皮瓣成活率,并切取血管蒂进行组织学观察.结果 术后两组皮瓣均有较明显的肿胀,实验组皮瓣肿胀更为明显.两组皮瓣平均成活率比较,对照组为(92.7±12.1)%,实验组为(46.8±38.3)%,差异有统计学意义(t=3.61,P＜0.01).两组皮瓣蒂部均可见扩张的微血管,高度肿胀导致坏死的皮瓣,在其蒂部扩张的微血管内可见血栓形成.结论 血管蒂的伴行静脉结扎使皮瓣更易发生静脉危象,导致皮瓣坏死.微血管内血栓形成可能是导致皮瓣静脉回流障碍的又一重要因素.

Abstract：

Objective To evaluate the effect of ligating venae commutantes in the pedicle on the survival of reverse-flow island flaps. Methods Ten New Zealand rabbits were used. Reverse flow island flap based on the saphenous artery and vein was created on both hind limbs,with a total of 20 flaps. The size of the flap was 3 cm×3 cm with a 4 cm long vascular pedicle containing 1 cm strip of connective tissue. These flaps were randomly divided into 2 groups of 10 flaps each. In group Ⅰ,the vascular pedicle (1 saphenous artery and 2 venae commutantes) was raised and its sheath was not disturbed,maintaining communicating and collateral branches intact. In group Ⅱ,the 2 venae commutantes were ligated with 8-0 suture at both ends of the pedicle under 10X microscope and the connective tissue was maintained intact. The color and congestion of flaps were observed daily. Flap survival rate was measured after one week. The vascular pedicle was harvested and observed histologically. Results The flaps began to appear obviously swelling after blood oozing stopped. The extent of swelling was more severe in group Ⅱ than in group Ⅰ. Flap survival rate of group Ⅰ (92.7±12.1)% was significantly higher than that of group Ⅱ (46.8±38.3)% (t=3.61,P<0.01). Histological examination revealed lots of dilated venules in the vascular pedicle. The amount of dilated venules in group Ⅱ was more than that in group Ⅰ. Lots of thrombi could be seen in the dilated venules in the pedicle of completely or partially necrotic flaps. Conclusion Venous crisis takes place more easily in flaps without venae commutantes,resulting in flap necrosis. The venous thrombosis may be the other important influencing factor for necrosis of reverse-flow flaps.