大隐静脉重建颈动脉在头颈部恶性肿瘤手术治疗中的应用

目的 探讨大隐静脉在颈动脉重建手术中的应用以及对恶性肿瘤侵犯颈动脉的患者行颈动脉重建手术的临床疗效和安全性。方法 回顾性研究。纳入中国医学科学院肿瘤医院头颈外科2017年11月-2019年9月18例行肿瘤切除颈动脉重建的恶性肿瘤患者,其中男10例、女8例,年龄47～72(58.8±6.6)岁;甲状腺乳头状癌11例,头颈部鳞癌7例,其中5名患者在术前接受过放射治疗。完成综合术前检查后,术中完整切除肿物及受侵的部分颈动脉,并以自体大隐静脉重建颈动脉。观察患者术前颈部超声及颈部CT提示肿瘤包绕角度、下肢静脉超声所提示的大隐静脉情况及距汇入股静脉远心端5 cm处内径,手术时间、术中出血量、移植大隐静脉侧别、供体大隐静脉长度、术中颈动脉阻断时间、肿瘤包绕颈动脉角度、受体颈动脉吻合处内径,术后病理组织学检查结果、患者住院时间、重建血管的通畅情况、有无出现神经系统及下肢供区并发症,随访期间有无局部复发及远处转移病例。结果 术前超声探查及颈部CT示,18例患者大隐静脉在距汇入股静脉远心端5 cm处内径(0.53±0.14)cm;颈部CT扫描见肿瘤对颈动脉的包绕角度均超过180°,其中超过270° 15例、全部包绕颈动脉9例。术中大隐静脉取材长度(7.3±1.1)cm,取用左侧大隐静脉9例、右侧大隐静脉9例。颈动脉近心端吻合处均为颈总动脉,内径(0.74±0.06)cm;远心端吻合处位于颈总动脉14例,颈内动脉4例,内径(0.71±0.17)cm。术中颈动脉阻断时间(640±117)s。术中观察颈动脉受侵角度190°～360°(317°±56°),与术前影像学检查一致。18例患者手术时间4～6 h,术中出血200～500 mL,住院时间7～28 d(平均13.13 d)。术后病理提示侵犯颈动脉血管壁组织13例。术后随访时间3～24个月,平均11.06个月。18例中,死亡2例、局部复发1例,余15例无瘤生存;术后颈动脉CT血管成像示重建血管均通畅,未见移植血管破裂、感染、狭窄及假性动脉瘤形成,供区下肢均未见水肿、跛行等血液循环障碍并发症。结论 在头颈部肿瘤患者的颈动脉重建手术中,大隐静脉具有易于取材、移植物感染率低等优势,同时该手术能在低神经系统并发症风险下安全、完整地切除肿瘤,值得推广应用。     

小儿颈外静脉穿刺的解剖学研究

目的 :为临床儿科静脉穿刺抽血提供解剖学依据。方法 :在 30例 (6 0侧 )甲醛固定的小儿尸体上解剖并观测了颈外静脉的深度、外径、长度及毗邻关系 ,并与大隐静脉、肘正中静脉进行了对比。结果 :双侧颈外静脉上段的平均深度为 3.6 1± 0 .46 m m,左侧外径为 3.34± 0 .78m m,右侧外径为 3.86± 0 .6 4mm,左侧长度为 35 .6 7± 3.30 mm,右侧长度为 41.6 2± 4.19mm。结论 :小儿浅静脉穿刺抽血应当首选颈外静脉上段 ,次选大隐静脉 ,肘正中静脉基本上不适用于穿刺。     

改形趾甲皮瓣与第2足趾联合移植再造拇指术的解剖学基础

目的为改形趾甲皮瓣与第2足趾联合移植再造拇指手术提供解剖学基础。方法对10例20侧红色乳胶灌注的成人足标本(其中新鲜足标本5例10侧)进行显微解剖,观测营养趾甲皮瓣、第2足趾骨皮瓣血供。结果趾甲皮瓣的血供为多源性,主要为趾腓侧趾底动脉和趾趾背动脉,二者外径分别为(1.5±0.3)mm、(0.9±0.2)mm;趾甲皮瓣静脉为大隐静脉-第一跖背静脉-趾腓侧趾背静脉;神经为趾腓侧固有神经和腓深神经。剔除第2足趾甲皮瓣的第2足趾骨皮瓣血供为第2足趾胫侧趾底、趾背动脉,外径分别为(0.7±0.1)mm、(0.3±0.1)mm;静脉为大隐静脉-第一跖背静脉-第2足趾胫侧趾背静脉;神经为第2足趾胫侧趾底固有神经。结论趾腓侧趾底动脉、趾趾背动脉及第2足趾胫侧趾底、趾背动脉起始、走行恒定,外径较粗,有较多皮肤穿支和恒定血供范围,可为改形趾甲皮瓣与第2足趾联合移植再造拇指手术提供理想的血供。     

下肢股段主要静脉及其瓣膜的解剖及临床意义

目的通过对103侧成人尸体下肢股段主要静脉及其瓣膜的观测,为临床血管疾病的外科及介入诊疗提供形态学依据。方法在103侧成人尸体下肢股段中观测主要静脉瓣膜的数量及形状、静脉特别点外径、静脉特别点的体表位置。结果大隐静脉股段瓣膜均为双瓣型,隐股点处外径(真径)为(5.18±1.25)mm,隐股点至腹股沟韧带的距离为(3.92±0.71)cm;股浅静脉第一对瓣膜多为双瓣型,瓣膜附着缘静脉外径(压扁径)为(1.06±0.17)cm,其位置较恒定,距股深静脉入口下缘(1.16±0.66)cm,到隐股点距离为(6.16±1.69)cm;股深静脉注入点下缘至隐股点下缘的距离为(5.00±1.57)cm,至腹股沟韧带的距离为(7.84±1.89)cm。结论以上观测结果为临床血管外科手术及介入治疗提供解剖学基础。     

Influence of carotid baroreceptors on different components of the vascular system

1. Reflex changes in wall tension of the lateral saphenous vein of one hind limb, the splenic veins and capsule, and the resistance vessels of the other hind limb caused by changes in baroreceptor activity were measured in vagotomized dogs under thiopentone-chloralose anaesthesia.2. Three different methods were used to alter pressure in one or both carotid sinuses. (1) Both carotid sinuses were vascularly isolated and filled with fully oxygenated Krebs-Ringer bicarbonate solution (pH 7.4) from a reservoir in which the pressure could be altered at will. (2) One sinus was denervated, and the contralateral sinus was perfused with arterial blood at different flow rates. (3) One sinus was denervated, and the innervated sinus was perfused with arterial blood at constant flow, the pressure being altered by changing the outflow resistance.3. The left saphenous vein was perfused at constant flow with autologous blood; changes in perfusion pressure were used as a measure of changes in veno-motor activity. The right common iliac artery was perfused at constant flow to measure changes in resistance vessel activity. Blood flow through the spleen was temporarily arrested, trapping a fixed volume of blood in the organ. Under these conditions, changes in splenic vein pressure were a measure of changes in smooth-muscle tension in the splenic capsule and veins.4. In order to assess the responses to baroreceptor stimulation in terms of alterations in sympathetic nerve traffic to different components of the peripheral vascular system, ;frequency-response curves' were constructed for spleen, saphenous vein, and limb resistance vessels by electrical stimulation of the splenic nerves and lumbar sympathetic chains.5. The saphenous vein showed no consistent response to changes in baroreceptor activity. Reduction in carotid sinus pressure from 180 to 100 mm Hg caused an increase in venous pressure in the isovolumetric spleen and in the iliac artery perfusion pressure. These results were confirmed by electrical stimulation of the carotid sinus nerve. Whereas the peak responses of the limb resistance vessels corresponded to an increase in lumbar sympathetic nerve traffic of 6-10 c/s, the maximal splenic responses were equivalent to an increase in splenic nerve traffic of 1-4 c/s. These results are consistent with selective autonomic nervous control of different components of the peripheral vascular system.     

小隐静脉解剖和多普勒超声活体观察在远端蒂皮瓣的意义

目的:探讨小隐静脉与远端蒂皮瓣静脉回流.方法:以腓肠神经营养血管皮瓣为例.(1)解剖观察40侧小隐静脉.(2)用多普勒超声检查60侧人的小隐静脉.结果:解剖观察外踝尖水平上 3～4 cm小隐静脉体表投影与皮瓣轴线基本一致,两者相差(0.5±0.3)cm.40侧中有12侧各有1支与腓静脉的交通支,距外踝尖(3.0±0.7)锄,外径(1.2±0.5)mm;彩超检杳外踝尖水平上3～4cm小隐静脉内径为(2.3±0.7)mm,距体表(3.2±1.0)mm,78.3%正常人的小隐静脉能较显著将远侧的静脉血导入近侧.若足踝部大隐静脉回流障碍,小隐静脉引流将加剧.结论:(1)结扎小隐静脉消除了浅静脉干对远端蒂皮瓣的倒灌,可改善皮瓣静脉回流.(2)经超声定位,在外踝尖水平上3～4cm行0.5～1 cm的纵向小切口能准确结扎小隐静脉,操作简单,不会损伤蒂部穿支血管和血管网.     

Histologic findings after in vivo placement of small intestine submucosal vascular grafts and saphenous vein grafts in the carotid artery in dogs.

A small caliber vascular graft from porcine small intestine submucosa (SIS) was implanted in a canine carotid artery (n = 24) and compared with an autogenous saphenous vein graft that was implanted in the contralateral carotid artery. In this study, four grafts were evaluated at the following times after surgery: 2, 7, 14, 28, 90, and 180 days. One SIS graft thrombosed at 2 days, two SIS and two saphenous vein grafts were thrombosed at 90 days, and one SIS and one saphenous vein graft were thrombosed at 180 days. At 2 days after implant, the luminal surface of the SIS graft was covered by a thin (30 mu) fibrin meshwork. By 14 days after surgery, endothelial cells on the fibrin meshwork were staining for FVIII-related antigen. Smooth muscle cells were observed in the new intima (fibrin meshwork) by 28 days. At 90 days, both types of graft had arterialized with an intima covered by endothelium, a smooth muscle media, and marked adventitial fibrosis. Similar histology was observed at 180 days. These results indicate that this SIS graft was similar to saphenous vein graft in the dog.     

Comparison of vascular distensibility in the upper and lower extremity

AIM: Because of the great differences in hydrostatic pressure acting along the blood vessels in the erect posture, leg vessels are exposed to greater transmural pressures than arm vessels. The in vivo pressure-distension relationship of arteries, arterioles and veins in the arm were compared with those of the leg. METHODS: Experiments were performed with the subject (n = 11) positioned in a pressure chamber with an arm or lower leg (test limb) extended at heart level through a hole in the chamber door. Intravascular pressure in the arm/lower leg was increased by stepwise increasing chamber pressure to +180 and +210 mmHg, respectively. Diameters of blood vessels and arterial flow were measured using ultrasonographic/Doppler techniques. Changes in forearm and lower leg volumes were assessed using an impedance technique. The subject rated perceived pain in the test limb. RESULTS: The brachial and radial arteries were found to be more distensible than the posterior tibial artery (P < 0.001). Likewise, the distension was more pronounced in the cephalic than in the great saphenous vein (P < 0.001). In the brachial artery, but not in the posterior tibial artery, flow increased markedly at the highest levels of distending pressure (P < 0.001). At the highest intravascular pressures, the rate of change in tissue impedance was greater in the forearm than the lower leg (P < 0.01). At any given level of markedly increased pressure, pain was rated higher in the arm than in the leg (P < 0.001). CONCLUSION: It seems that the wall stiffness of arteries, pre-capillary resistance vessels and veins adapts to meet the long-term demands imposed by the hydrostatic pressure acting locally on the vessel walls.     

经贵要静脉行PICC置管的解剖观察

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法:选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01mm,女性约331.50mm;贵要静脉在前臂中部管径,男性约1.90mm,女性约1.85mm;贵要静脉接肘正中静脉处管径,男性约2.35mm,女性约2.26mm;贵要静脉末端管径,男性约2.90mm,女性约2.60mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。     

贵要静脉的应用解剖

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01 mm,女性约331.50 mm;贵要静脉在前臂中部管径,男性约1.90 mm,女性约1.85 mm;贵要静脉接肘正中静脉处管径,男性约2.35 mm,女性约2.26 mm;贵要静脉末端管径,男性约2.90 mm,女性约2.60 mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。     

The arch of the great saphenous vein: anatomical bases for failures and recurrences after surgical treatment of varices in the pelvic limb. About 54 dissections

The arch of the great saphenous vein presents numerous tributaries. Misappreciation of their anatomical variations might cause recurrence after surgical treatment of varices. We dissected 54 inguino-femoral regions of fresh, black African corpses. Our purpose was to study the anatomical variations in the vein confluents of the arch of the great saphenous vein; its positions in relation to the external pudendal artery; establish palpable anatomical markers for its surgical approach. The conventional type in a ‘vein star’ shape was not the most frequent. Upper or abdominal common vein produced through the merging of superficial veins of the anterior abdominal wall and genital or internal common vein were more frequent. An anterior saphenous vein was found in 23 cases. The external pudendal artery crossed beneath the arch of the great saphenous vein cross in 56% of cases and previously in 44% of cases. On average, the top of the arch of the great saphenous vein was projected out 10.88 cm from the ventral and cranial iliac spine, 3.83 cm from the pubic tubercle and 4.19 cm from the inguinal ligament. In view of our results, variations are real. Knowing and taking them into account are essential to prevent recurrences after surgical treatment of varices of the pelvic limb.     

原位静脉动脉化与静脉动脉间置后静脉的实验形态学研究

目的：探讨原位静脉动脉化与静脉动脉间置后，静脉的组织学和超微结构变化。在１８只犬后肢设计原位大隐静脉动脉化，静脉动脉间置实验模型，对原位大隐静脉动脉化和静脉动脉间置后不同时间（２、４、８、１６ｗ）静脉管壁的变化，进行了实验形态学观察。结果：①原位静脉动脉化后早期内皮细胞损伤较轻微，中、晚期主要表现为管腔内皮细胞损伤较轻微，管腔的扩张和中膜平滑肌的增生，肥厚；②静脉动脉间置早期内皮细胞有广泛脱落，中膜平滑肌细胞肿胀，细胞间积液，中晚期变化主要为内皮不规则增生，肥厚，中膜平滑肌不同程度的增生与纤维化，使血管腔呈现不同程度的狭窄。结论：原位静脉动脉化后静脉呈现结构上的“动脉化”倾向，并且较静脉动脉间置更有利于保持血管的通畅。     

Mechanical properties of cellulose: chitosan blends for potential use as a coronary artery bypass graft

The development of intimal hyperplasia is the major cause of failure of both autologous saphenous vein and synthetic coronary artery bypass grafts. This is partially due to graft-host vessel compliance mismatch. Cellulose and chitosan (CELL:CHIT) are both biocompatible, nontoxic, and naturally occurring biopolymers that have been used extensively for biomedical applications. Elastic properties of membranes made of CELL:CHIT blends with different ratios between each polymer were determined using uniaxial tests and the ratio that yielded the less stiff membrane was chosen to prepare a small diameter hollow tube. The presence of chitosan had a favorable impact on the elasticity of the membranes, where the CELL:CHIT 5:5 ratio showed the lowest Young’s modulus. Small diameter tubular constructs were fabricated using this optimal CELL:CHIT ratio and the compliance was determined on samples with different wall thickness and internal diameter. The compliance of the hollow tube with inner diameter of 4?mm and wall thickness of 1.2?mm was found to be 5.91%/mmHg?×?10^?2, which is higher than those of Dacron, expanded polytetrafluorethylene, and saphenous vein, but very close to that of human coronary artery. Burst strength tests revealed that the tubes can withstand at least 300?mmHg. Finally, the tubes showed satisfactory cell attachment property when myofibroblast cells adhered and proliferated on the lumen of the samples.     

颈动脉分叉部的三维CT血管成像解剖测量

背景：解剖测量是临床医学的基础,可为临床影像学诊断与外科手术提供依据与参考。利用三维CT血管成像技术进行相关解剖测量具有明显的技术优势与很好的应用前景。 目的：应用64排螺旋CT血管成像对颈动脉分叉部的形态结构进行测量,为相关研究提供解剖基础。 方法：查阅2008年6月至2010年6月于厦门大学附属中山医院影像科行头颈部64排螺旋CT血管成像受检者的扫描图像,随机选取颈动脉分叉部无明显病变者92例。其中男45例,女47例;≤40岁者40例,> 40岁者52例。利用其断面图像进行三维成像处理,获得满意的三维图像后,对颈动脉分叉部相关结构进行解剖学测量。 结果与结论：三维图像可清晰显示颈动脉分叉部结构,实现其结构的单独和多结构、多方向观察及测量。测量结果显示受试者颈动脉分叉角为(43.5±12.3)°,颈总动脉远端内径(6.83±0.65) mm,颈内动脉膨大区近端内径(7.25±1.04) mm,颈内动脉膨大区最大内径(8.15±1.35) mm,颈内动脉膨大区远端内径(5.03± 0.55) mm,颈外动脉内径(4.22±0.60) mm。与≤40岁组比较,>40岁组颈动脉分叉角度、颈内动脉膨大区近端内径、颈内动脉膨大区最大内径、颈内动脉膨大区远端内径均明显粗大,颈外动脉内径明显细小(P < 0.05),而颈总动脉内径差异无显著性意义(P > 0.05)。与男性组比较,女性组颈动脉分叉部各测量指标均显著细小(P < 0.05)。左、右侧组测量值比较,除颈动脉分叉角左侧明显大于右侧外,其他测量指标差异均无显著性意义(P > 0.05)。三维CT可客观、准确测量颈动脉分叉部相关解剖值,具有个体化特征,可为相关应用解剖、疾病诊断及介入或手术治疗提供客观依据。     

头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路PICC置管术的影响

目的　探讨头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路上肢外周静脉穿刺中心静脉置管（peripherally inserted central catheters，PICC）操作的影响。 方法　解剖38具（76侧）捐献者遗体，测量和分析上肢外展0 °和90 °时男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角。 结果　头静脉汇入腋静脉或锁骨下静脉的前外侧壁，汇入处管径平均为（7.27±2.94）mm，95%可信区间为6.51~8.03 mm，夹角有锐角、直角和钝角3种类型。上肢外展0 °时，夹角平均为（47.14±27.02）°，95%可信区间为40.97°~63.32°；上肢外展90°时，夹角平均为（63.88±24.26）°，大于上肢外展0°时夹角，95%可信区间为53.96°~65.64°。上肢外展0°时，男、女夹角无明显差异，而上肢外展90°时男性夹角大于女性夹角。上肢外展0°和90°时，左、右侧夹角均无明显差异。 结论　经头静脉入路PICC术时，男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角不影响导管通过，但有少部分人夹角接近或大于90°，尤其男性上肢外展90°可能增加导管通过夹角的难度，操作中需加以注意。     

颈动脉的形态与动脉粥样硬化的解剖学观测

目的研究颈动脉的形态与动脉粥样硬化的情况,为颈总、颈内动脉狭窄的诊治提供形态学基础。方法解剖观测成尸30(男24、女6)侧颈动脉,观测颈动脉的形态及动脉粥样硬化情况。结果①颈总动脉中段外径,左侧(8.75±1.56)mm;右侧(8.31±0.99)mm。②颈内动脉根部外径,左侧(8.15±1.42)mm;右侧(7.51±1.63)mm。③颈外动脉中段外径,左侧(4.87±1.09)mm;右侧(4.39±0.89)mm。④颈动脉粥样硬化发生率占60%(18侧),其中颈内动脉根部四壁明显动脉硬化,内腔直径1.6mm严重狭窄1侧,占总数的3.33%。结论颈动脉粥样硬化发生率最高为颈动脉窦,占颈动脉硬化标本的100%,可致颈内动脉内腔狭窄。     

Evolution of bubbles from gas micronuclei formed on the luminal aspect of ovine large blood vessels

It has been shown that tiny gas nanobubbles form spontaneously on a smooth hydrophobic surface submerged in water. These nanobubbles were shown to be the source of gas micronuclei from which bubbles evolved during decompression of silicon wafers. We suggest that the hydrophobic inner surface of blood vessels may be a site of nanobubble production. Sections from the right and left atria, pulmonary artery and vein, aorta, and superior vena cava of sheep (n = 6) were gently stretched on microscope slides and exposed to 1013 kPa for 18 h. Hydrophobicity was checked in the six blood vessels by advancing contact angle with a drop of saline of 71 ± 19°, with a maximum of about 110 ± 7° (mean ± SD). Tiny bubbles ∼30 μm in diameter rose vertically from the blood vessels and grew on the surface of the saline, where they were photographed. All of the blood vessels produced bubbles over a period of 80 min. The number of bubbles produced from a square cm was: in the aorta, 20.5; left atrium, 27.3; pulmonary artery, 17.9; pulmonary vein, 24.3; right atrium, 29.5; superior vena cava, 36.4. More than half of the bubbles were present for less than 2 min, but some remained on the saline-air interface for as long as 18 min. Nucleation was evident in both the venous (superior vena cava, pulmonary artery, right atrium) and arterial (aorta, pulmonary vein, left atrium) blood vessels. This newly suggested mechanism of nucleation may be the main mechanism underlying bubble formation on decompression.     

Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein

Saphenous donor site neuralgia is a cause of morbidity post‐coronary artery bypass surgery. Saphenous nerve damage during harvesting of the great saphenous vein is thought to be responsible. We dissected 37 cadaveric lower limbs from the knee fold to the dorsal venous arches, to study the spatial relations of the saphenous nerve and great saphenous vein to identify its distribution within the leg. Distribution of the saphenous nerve was categorized into Type A, where the nerve traveled inferiorly and split into an anterior and posterior branch during its course between the knee fold and medial malleolus, Type B, where the nerve traveled anterior to the vein with a small caliber branch traveling posteriorly at the proximal end, Type C where two main branches originated at the knee fold, one anterior to and one posterior to the vein. Overall the vein and nerve crossed in 27 out of the 37 cases (73%), occurring between 5 and 29 cm from the malleolus (60% occurred between 16 and 26 cm). In 32 (86%) of cases, the distal part of the nerve and vein were tightly adhered to each other within a common sheath. The length of adherence ranged from 3 to 26 cm with an average of 14 cm. The saphenous nerve is highly vulnerable during harvesting of the great saphenous vein due to its close relationship and crossing branches. Knowledge of the distribution categories of the nerve can help guide the surgeon to avoid damaging nerve branches during harvesting. Clin. Anat. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Anatomical observation on draining patterns of saphenous tributaries in Korean adults.

This study was done to identify the normal and variants of saphenous tributaries in Korean adults. The pattern of confluence of saphenous tributaries, medial accessory saphenous, lateral accessory saphenous, superficial epigastric, superficial circumflex iliac and superficial external pudendal veins, was carefully examined in 249 lower limbs (right, 129; left, 120) of embalmed Korean cadavers (73 males & 56 females). The medial accessory saphenous vein drained into the great saphenous vein directly (in 82.3%) or by a common trunk (in 17.7%) with the superficial epigastric or superficial external pudendal vein. The lateral accessory saphenous vein entered the great saphenous (in 67.1%) or the femoral vein (in 32.9%) directly or, forming a common trunk with other saphenous tributaries. The superficial epigastric vein joined the great saphenous (in 77.1%) or the femoral vein (in 22.9%) directly or, by a common trunk with other saphenous tributaries. The superficial circumflex iliac vein reached the great saphenous (in 83.1%) or the femoral vein (in 16.9%) directly or, by a common trunk with other saphenous tributaries. The superficial external pudendal vein opened into the great saphenous (in 95.2%) or the femoral vein (in 4.8%) directly or by a common trunk with other saphenous tributaries. In Koreans, the incidence of the normal pattern of saphenous tributaries was 23.7% and in 76.3% any one of variant saphenous tributaries entered the femoral or the great saphenous vein by a common trunk with other saphenous tributaries.     

小腿内侧神经血管复合体岛状皮瓣的应用解剖

目的 :为小腿内侧神经血管复合体岛状皮瓣的设计提供解剖学基础。方法 :在 5 4侧下肢标本上解剖观察了大隐静脉及隐神经营养血管的来源、走行、分支、分布及吻合情况。结果 :小腿内侧浅筋膜层营养血管链由隐动脉、胫后动脉肌间隔皮支及内踝前动脉构成 ,沿大隐静脉及隐神经分布 ,三者密切相关 ,构成一复合体。血管链筋膜皮支分布达外侧 5 .2cm ,内侧 4.0cm。结论 :以小腿内侧神经血管复合体为蒂截取岛状皮瓣可用于膝周、足背及足跟软组织缺损的修复。