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.     

手部动静脉伴行关系及临床意义

目的 为手外科提供手部动、静脉伴行关系的规律性。方法 10例新鲜前臂材料,血管分别灌注过氯乙烯乙酸乙酯或乳胶填充剂,制成动、静脉分色腐蚀铸型标本和解剖剥制标本,观察手部动、静脉伴行关系。结果 手部浅、深血管弓,掌心血管,指掌侧总血管呈紧密伴行关系。手掌侧和背侧部浅血管以及手指的掌侧和背侧部血管,无伴行关系或伴行不紧密。结论 手部动静脉血管配布规律是,浅层血管呈网络型分布,动静脉无伴行关系,越接近深部,动静脉伴行关系越紧密。指部血管伴行关系都不紧密或没有伴行关系。     

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.     

指掌侧静脉的应用解剖学研究及临床意义

目的 探讨指掌侧固有深静脉是否存在,指掌侧浅、深静脉在断指再植中的应用价值.方法 将6只新鲜尸体手,用环氧树脂混合溶液作为填充剂,灌注后制成动、静脉分色手血管铸型标本,在手术显微镜下解剖,并测量血管外径.结果 指掌侧固有深静脉分布不恒定,在30条手指血管神经束中发现3条,指掌侧固有深静脉起自手指中节,在血管束内伴随指动脉而行,在指根部注入指掌侧总静脉,在手指近节其外径为(0.21±0.03)mm.指掌侧浅静脉位置恒定,位于指掌侧真皮下层,起始于指端,向近端上行,在远侧指间关节处汇聚成2-4条较粗大的纵向静脉干,逐渐向指掌侧中线的两侧分布,形成两条静脉主干,其在中节的外径为(0.64±0.12)mm,在近节的外径为(0.78±0.10)mm.静脉干继续上行至指蹼处形成指蹼静脉并转向背侧,注入手背侧浅静脉网.指掌侧浅静脉管径较粗,但细于指背静脉,其与指背静脉外径的差异有非常显著意义(p<0.01).结论 指掌侧固有深静脉存在,但在总体中分布不恒定,属于一种退化现象,不能作为断指再植中的常规吻合静脉,指背静脉是断指再植中的主要吻合静脉.指掌侧浅静脉具有吻合价值.在断指再植中吻合指背静脉的同时,吻合指掌侧浅静脉以便使再植指的血液流动通畅,提高断指再植的成活率.     

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。     

小儿手指掌侧浅静脉显微解剖及吻合指掌侧浅静脉的断指再植

手指背侧损伤较重的断指再植，因指背静脉挫伤重不能吻合，未节断指无可供吻合的指背静脉，以往将此类断指列为再植之禁忌。我们对４０指小儿尸体手指指掌侧浅静脉进行了显微解剖，在此基础上，临床４０指不能吻合指背静脉的断指实施了吻合指掌侧浅静脉的再植，成活３６指，失败４指，成活率９１％。由于指掌侧浅静脉口径粗，解剖较恒定，吻合后通畅率高。本研究提供了指掌侧浅静脉的显微解剖学数据和临床应用经验。     

手掌部皮肤浅静脉的显微解剖学研究

目的对手掌部浅静脉进行解剖学研究,为临床应用的吻合浅静脉治疗手掌部皮肤撕脱伤的方法提供依据。方法8只新鲜成人手标本,用乳胶灌注后对手掌部浅静脉干在掌心区、大鱼际区、小鱼际区、腕掌区、掌指关节区的分支进行解剖学观察。结果掌心部存在交叉灌通的浅静脉血管网;大鱼际区、腕掌区存在1.0mm以上可供吻合的浅静脉;小鱼际区相对较少;掌指关节区与背侧静脉相交汇;各区域间浅静脉互有交通。结论对于手掌部皮肤逆行撕脱伤,通过吻合腕掌区及大鱼际区的浅     

指侧方静脉在末节断指再植中的应用

我院从 1996年至今 ,再植末节完全离断伤 173例 185指 ,其中 95例 10 2指采用动静脉 1∶1吻合 ,静脉吻合中应用指侧方静脉 80指 ,取得了满意的效果 ,现介绍如下。1　资料与方法1 1　一般资料本组 95例 10 2指 ,其中男性 6 0例 ,女性 35例 ,最小年龄 10个月 ,最大 6 5岁 ,平均年龄 2 7岁。静脉吻合的方式有 :①远端侧方静脉吻合近端侧方静脉 (侧—侧 ) ;②远端侧方静脉吻合近端掌侧静脉 (侧—掌 ) ;③远端侧方静脉吻合近端背侧静脉 (侧—背 ) ;④远端掌侧静脉吻合近端侧方静脉 (掌—侧 ) ;⑤远端掌侧静脉吻合近端掌侧静脉 (掌—掌 )。其中应…     

手静脉的解剖及其临床应用

解剖了８２只成年人手标本的静脉，并在手术显微镜下观察了１０只手静脉瓣的分布情况。发现手掌侧深静脉较伴行动脉细的多，其管径仅及其伴行动脉管径的１／３—１／４。指背静脉粗大，分布也恒定。断指再植没有适宜的动脉供吻接时可用指背静脉代替。手背静脉有静脉弓和静脉网两主型。手背静脉、掌背静脉和指背静脉均可见静脉瓣，主要分布于静脉汇合口的稍远侧，以利于静脉血回流。介绍二例手外伤患者，将拇指指背静脉同桡动脉吻合，使拇指再植获得成功。     

Successful replantation of circularly severed palm and multiply severed fingers. A case report]

Replantation of a circularly severed palm, partially severed middle finger and completely severed ring and small fingers was done successfully in one patient. Two palmar arteries, 5 digital arteries, 3 dorsal palmar veins, 9 dorsal digital veins were anastomosed. Vein transplantation was carried out to repair the ulnar digital artery defect of the middle finger. Severe swelling after arterial thrombosis was noted on the 7th day and was eliminated by the use of urokinase. All the replanted parts survived with good functional results. Precise anastomosis, prevention and treatment of thrombosis, early exercises were essential to the survival of fingers and functional recovery of hand.     

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。     

断指血液循环重建与血流通畅性相关因素的临床研究

目的 探讨断指再植血液循环重建和血流通畅性相关因素与再植成活率的关系。方法 采用显微血管移植动物实验、手指掌侧浅静脉显微解剖、断指再植血流平衡动力学研究、解痉与抗凝剂对血液流变学影响、断指高凝等方面进行研究。结果 显微血管移植可获得较高通畅率；手指掌侧浅静脉口径粗；断指再植吻合血管多，吻合的血管口径粗，血液循环危象发生率低；解痉与抗凝剂用于高凝状态病例，可获得较好效果。结论 熟练的显微外科技术是获得断指再植较高成活率的关键，良好的血流再通和合理用药是保证再植手指血流通畅的关键。     

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.     

The palmar digital venous anatomy

Fresh human cadaveric hands were injected with a liquid plastic polymer and dissected under the operating microscope. On the palmar aspect of the digits, four different venous patterns could be identified, characterized by their tributaries and branching pattern, and by the presence, position and direction of valves. Arborized veins drain a limited volume of tissue by a number of very slender vessels that come together to form a common trunk. Venous arches are found both superficial and deep, palmar and lateral; they neither branch nor have valves, except at both ends. Deep axial veins accompany the digital arteries as comitant veins. They drain to both the metacarpal comitant veins and the web space veins. Superficial axial veins run principally in the subdermal layer of the finger; they drain either directly to dorsal veins or to the natatory vein on the ligament of the same name.     

Surgical anatomy of the dorsal face of the hand and the wrist

The anatomical knowledge of the dorsal aspect of the hand has been enriched these last years by a more surgically applied approach, especially of that of its integument and blood supply. The vascularization of the superficial nerves, the anastomoses between the dorsal and palmar arterial networks has allowed designing new flaps, ante- and retrograde, usable in the coverage of more and more distal defects. The extensor apparatus shows many anatomic variations, often asymptomatic, except the extensor digitorum brevis manus muscle, which can mimic a mass at the dorsal aspect of the hand.     

Transient bone resorption following finger replantation: a report of 3 cases

Radiographic changes consisting of alterations in mineral content, osteopaenia or destructive neuropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes developed in the first three months postoperatively with complete “restitution ad integrum”.Three patients, 21-49 years old (average 36 years) sustained a clean-cut amputation of four fingers. The first patient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an amputation at the base of the first metacarpal bone and the proximal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arteries and nerves were repaired. In the second case, one palmar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and two digital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaarticular region and metaphyses of the bone. These changes were followed by subperiosteal, intracortical and endosteal bone resorption. No further surgical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks (average 12 weeks) postoperatively, the X-rays showed a complete recovery with new periosteal bone formation.We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel compromise and microinfarction and transient hyperemia secondary to neurovascular damage or to sympathetic progressive recovery.     

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.