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.

The significance of anatomy and Doppler ultrasound observation of small saphenous vein on distally pedicled flap

Objective:To explore venous drainage of small saphenous vein and distally pedicled flap.Methods:For studying venous flow of distally pedicled flap,such as sural neurocutaneous vascular flap,anatomic observation and doppler ultrasound inspection of small saphenous vein was performed on 40 specimens,and 60 healthy adults respectively. Results: The Body surface projection of small saphenous vein was basically consistent with the axial ray of the flap 3cm～4cm above the lateral malleolus.,with only the interval of about (0.5±0.3)cm between them. Out of 40 cases,one communicating branch reaching fibular veins (3.0±0.7) cm above the lateral malleolus appeared on 12 cases,with the external diameter of (1.2±0.5) mm.According to the ultrasound,the inner diameter of small saphenous vein 3cm～4cm above the lateral malleolus was (2.3±0.7)mm,and about (3.2±1.0)mm away from the body surface. For 78.3 % healthy adults,small saphenous vein was the main vessel to guide distal venous flow,and helped venous drainage when great saphenous vein flow was blocked. Conclusion: Ligation of small saphenous vein will eliminate superficial vein flow backward to distally pedicled flap,thus improve the venous drainage,Ultrasound localization proves that,the incision and ligation of small saphenous vein 3cm～4cm above the lateral malleolus is simple and avoid the damage for perforating branch and vascular net.