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分叶串联游离静脉皮瓣在双手指近中节软组织缺损修复中的应用
APPLICATION OF THE DOUBLE SKIN PADDLE ARTERIALIZED VENOUS FLAPS FOR RECONSTRUCTING SOFT TISSUE DEFECTS OF MIDDLE AND PROXIMAL PARTS OF DOUBLE FIGURES
 [PDF]

杨帅智,陈禄,郑灿镔,杨俊贵,黄昱,崔建德
- , 2016, DOI: 10.7507/1002-1892.20160088
Abstract: 目的探讨采用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损的方法及临床疗效。 方法2011年9月-2014年12月采用仅用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损创面6例。男5例,女1例;年龄19~52岁,平均33.8岁。致伤原因:绞割伤4例,挤压伤2例。患指位于示指5指、中指3指、环指2指、小指2指。所有患者均为手指近中节皮肤软组织缺损,缺损平面不超过远侧指间关节,缺损范围2.5 cm×2.5 cm~5.5 cm×4.0 cm;均有不同程度骨或肌腱外露,伴指骨骨折2例。伤后至手术时间为1.5~7 h,平均3.5 h。切取皮瓣范围8 cm×3 cm~14 cm×5 cm;供区宽度≤3.0 cm者直接缝合,>3.0 cm者取腹部全厚皮片植皮修复。 结果患者手术时间为2.5~5.0 h,平均4.0 h。术后皮瓣全部成活;4例出现张力性水疱,拆除蒂部及局部张力较大处2~3根缝线,1周左右逐渐好转。5例患者皮瓣及供区创面均Ⅰ期愈合;1例其中1指皮瓣边缘部分坏死,二期清创直接缝合后Ⅰ期愈合,另1指皮瓣愈合良好。6例均获随访,随访时间6~18个月,平均13个月。皮瓣质地、弹性良好,外观饱满。末次随访时手功能按中华医学会手外科学会上肢部分功能评定试用标准评定,获优3例、良2例、可1例;皮瓣两点辨别觉为8~10 mm,平均9 mm。 结论利用一套供血系统的分叶串联游离静脉皮瓣修复2个手指近中节软组织缺损,手术简便、疗效确切。
ObjectiveTo investigate the application of the double skin paddle arterialized venous flaps for reconstruction of soft tissue defects in the middle and proximal parts of double fingers. MethodBetween September 2011 and December 2014, 6 cases (12 fingers) of soft tissue defects in the middle and proximal parts of double fingers underwent reconstructive surgery with the double skin paddle arterialized venous flaps. There were 5 males and 1 female with an average age of 33.8 years (range, 19-52 years). The causes included cut injury in 4 cases and crush injury in 2 cases. Five index fingers, 3 middle fingers, 2 ring fingers, and 2 little fingers were involved. All defects located at proximal and middle fingers and defect did not exceed the distal interphalangeal joint. The defect area ranged from 2.5 cm×2.5 cm to 5.5 cm×4.0 cm. All cases had bone or tendon exposure, and 2 cases had phalangeal fracture. The disease duration was 1.5-7 hours (mean, 3.5 hours). The flap size was 8 cm×3 cm-14 cm×5 cm. The donor site was directly sutured (≤ 3.0 cm in width) or was repaired with skin graft (>3.0 cm in width). ResultsThe operation time was 2.5-5.0 hours (mean, 4.0 hours). All flaps survived completely. Tensive blisters occurred in 4 cases and were improved at 1 week after removal of suture around pedicle. Partial distal flap necrosis was noted in 1 case, healing was obtained after secondary debridement; other wounds healed in one stage. The patients were followed up 6-18 months (mean, 13 months). The flap had good texture, elasticity, and appearance. According to the hand function evaluation criteria issued by the Chinese Hand Society, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case at last follow-up. The two-point discrimination of the flap was 8-10 mm (mean, 9 mm). ConclusionsThe double skin paddle arterialized venous flaps have the advantages of simple technique and definite effectiveness for
The new experimental design of arterialized venous flap on the rabbit ear model
Lalkovi? Mikica,Kozarski J.,Panajotovi? Lj.,?ijan G.
Acta Veterinaria , 2010, DOI: 10.2298/avb1006633l
Abstract: The aim of this study was to test a new experimental design of venous system arterialization on the rabbit ear arterialized venous flap (AVF) model. Total number of 10 "Big Chinchila" rabbits were divided in two experimental groups. On both ears of the five rabbits (Group 1) we have performed our original method of venous system arterialization with microsurgical arterialization of the central artery and vein with the preservation of central and peripheral vascular perfusion; at both ears of five rabbits (Group 2) we have performed AVF according to Byan et al., (1995). Vital AVF surface and necrosis percentage were determined in both experimental groups at day 1 and day 14 and results were compared using Student t-test. The results of our experiment indicate that our new experimental design of the AVF on rabbit ear model has better hemodynamic conditions, improves AVF survival and gives significantly bigger vital flap surface at 14 days after venous system arterialization.
Novel Biomarkers of Arterial and Venous Ischemia in Microvascular Flaps  [PDF]
Gerard K. Nguyen, Brian H. Hwang, Yiqiang Zhang, John F. W. Monahan, Gabrielle B. Davis, Yong Suk Lee, Neli P. Ragina, Charles Wang, Zhao Y. Zhou, Young Kwon Hong, Ryan M. Spivak, Alex K. Wong
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071628
Abstract: The field of reconstructive microsurgery is experiencing tremendous growth, as evidenced by recent advances in face and hand transplantation, lower limb salvage after trauma, and breast reconstruction. Common to all of these procedures is the creation of a nutrient vascular supply by microsurgical anastomosis between a single artery and vein. Complications related to occluded arterial inflow and obstructed venous outflow are not uncommon, and can result in irreversible tissue injury, necrosis, and flap loss. At times, these complications are challenging to clinically determine. Since early intervention with return to the operating room to re-establish arterial inflow or venous outflow is key to flap salvage, the accurate diagnosis of early stage complications is essential. To date, there are no biochemical markers or serum assays that can predict these complications. In this study, we utilized a rat model of flap ischemia in order to identify the transcriptional signatures of venous congestion and arterial ischemia. We found that the critical ischemia time for the superficial inferior epigastric fasciocutaneus flap was four hours and therefore performed detailed analyses at this time point. Histolgical analysis confirmed significant differences between arterial and venous ischemia. The transcriptome of ischemic, congested, and control flap tissues was deciphered by performing Affymetrix microarray analysis and verified by qRT-PCR. Principal component analysis revealed that arterial ischemia and venous congestion were characterized by distinct transcriptomes. Arterial ischemia and venous congestion was characterized by 408 and 1536>2-fold differentially expressed genes, respectively. qRT-PCR was used to identify five candidate genes Prol1, Muc1, Fcnb, Il1b, and Vcsa1 to serve as biomarkers for flap failure in both arterial ischemia and venous congestion. Our data suggests that Prol1 and Vcsa1 may be specific indicators of venous congestion and allow clinicians to both diagnose and successfully treat microvascular complications before irreversible tissue damage and flap loss occurs.
Importance of hemodynamic factors in vascular remodeling of muscular elastic type in arterial hypertension  [PDF]
Melnikova L.V.
Saratov Journal of Medical Scientific Research , 2011,
Abstract: The research goal is to investigate the relationship between hemodynamic factors and parameters of remodeling of common carotid arteries. 102 patients with essential hypertension of l-ll stage (49 men, 53 women, average age 47,5±11,2 years, duration of hypertension 7,8±1,5 years) have been examined. The study has revealed the relation between blood flow velocity in the common carotid artery (CCA) and the parameters of vascular remodeling, depending on the degree of hypertension. With the increase in systolic blood pressure dilation of common carotid arteries has been observed, reducing the rate of blood flow and wall thickness of the intima-media complex, accompanied by increased stiffness of the vascular wall. The increase in systolic blood pressure is accompanied by decrease in the rate of blood flow and wall tension on the endothelium, which contributes to thickness of the intima-media complex and increases the rigidity of the vascular wall
Drenaje suplementario del sistema venoso superficial en colgajos pediculados Supplementary drainage of superficial venous system in pedicled flaps  [cached]
A. Fernández García,C. Fernández Pascual,R.A. Moreno Villalba,Ll. Gerrero Navarro
Cirugía Plástica Ibero-Latinoamericana , 2012,
Abstract: Los colgajos pediculados pueden sufrir edema y congestión debido a que su drenaje a trevés del sistema venoso superfical es imposible y el flujo hacia el sistema profundo a nivel del pedículo es precario. Esta situación suele evolucionar hacia la necrosis parcial o la pérdida total del colgajo en pocas horas. La apertura del sistema venoso superficial permite el drenaje adecuado de los tejidos transferidos y evita estas complicaciones. Este artículo analiza el papel de las anastomosis microquirúrgicas en el sistema venoso superficial de los colgajos pediculados. Esta técnica permite comunicar el sistema venoso superfical de los tejidos transferidos con el sistema venoso superficial del territorio que rodea al defecto. Presentamos los resultados obtenidos con esta técnica en colgajos de perforante en hélice, colgajos miocutáneos, colgajos neurocutáneos y colgajos fasciograsos volteados. The pedicled flaps can suffer edema and congestion due to the impossibility of drainage toward the superficial venous system and the precarious flow via the deep system at the level of the pedicle. The evolution of this situation is usually partial necrosis or total loss of the flap in a few hours. The opening of the venous superficial system achieves an appropriate drainage of the transfered tissues and avoids these complications. In this article we analyze the role of the microsurgical anastomosis at the level of the superficial venous system of pedicled flaps. This technique allows to communicate the superficial venous system of the transfered tissues with the superficial venous system of the territory around the defect. We report the results with this method in propeller perforator flaps, miocutaneous flaps, neurocutaneous flaps and adipofascial turn over flaps.
Venous air embolism: Does the site of embolism influence the hemodynamic changes?
Bithal P,Dash H,Vishnoi N,Chaturvedi A
Neurology India , 2003,
Abstract: Three hundred and ninety-seven patients undergoing posterior cranial fossa surgery in the sitting position were prospectively studied to evaluate the incidence of venous air embolism (VAE) and its effects on hemodynamics. End-tidal carbon dioxide (ETC02) tension was monitored to diagnose VAE. A sudden and sustained decrease in ETC02 of more than 5 mmHg, in the absence of sudden hypovolemia, was presumed to be the result of VAE. The site of probable air entrainment (whether muscle, bone or tumor) was noted. Hemodynamic consequences were managed symptomatically. ETC02 monitoring detected VAE in 22% of the patients. The highest incidence of embolism resulted from muscles and tumor (40% in each case). Forty-two per cent of patients developed hypotension during the embolic episode (systolic BP less than 100 mmHg). Ten per cent of patients developed ventricular arrhythmias during the embolic episode. Air aspiration was successful in 4.8%. There were no statistically significant differences in the frequency of VAE among the different groups (P>0.05). Also, the frequency of hypotension and ventricular arrhythmias were not significantly different, irrespective of the source of VAE (P>0.05). The general condition of the patients in the preoperative stage had no influence on the incidence of embolism, hypotension or ventricular arrhythmias.
Management of venous thrombosis in fibular free osseomusculocutaneous flaps used for mandibular reconstruction: clinical techniques and treatment considerations
Florian G Draenert, Martin Gosau, Bilal Al Nawas
Head & Face Medicine , 2010, DOI: 10.1186/1746-160x-6-8
Abstract: Methods consist of immediate revision surgery with clot removal, heparin perfusion by direct injection in the arterial vessel of the pedicle, subsequent high dose low-molecular weight heparin therapy, and leeches. After 6 hours postoperatively, images of early flap recovery show first sings of recovery by fading livid skin color.The application of this technique in a patient with venous thrombosis resulted in the complete recovery of the flap 60 hours postoperatively. Other cases achieved similar success without additional lysis Therapy or revision of the arterial anastomosis.Rescue of fibular flaps is possible even in patients with massive thrombosis if surgical revision is done quickly.Mandibular and maxillary reconstruction with fibular osseomusculocutaneous free flaps represents a common procedure that is often applied in primary and secondary reconstructions of large bony defects in these areas [1,2]. A possible complication of free flap procedures is venous failure of the anastomosis [2], which demands immediate revision surgery involving clot removal and anticoagulation therapy. We avoid the reopening of the arterial anastomosis by injecting the necessary rinsing with heparin in the arterial vessel with a small syringe.We apply standard anti-thrombosis prophylaxis with low molecular weight heparin, for instance, Fragmin P, but do not preoperatively use any further anti-coagulatives, such as ASS or high dose heparin. Signs of venous failure after flap surgery, which becomes visible by livid skin color, represent a peracute indication for revision surgery. Therefore, nursing staff in the intensive care unit control the flap every 2 hours within the first 72 hours after initial surgery. This procedure includes visual control of the flap color, refill control by mild compression, and palpation of the flap consistence. The revision procedure includes opening of the venous anastomosis, clot removal, and flap perfusion with 3 ml heparin solution (5000 I.E./ml). This
Histological characteristics of arterialized medullary vein in spinal dural arteriovenous fistulas related with clinical findings: Report of five cases
Takami Toshihiro,Ohata Kenji,Nishio Akimasa,Hara Mitsuhiro
Neurology India , 2006,
Abstract: The histological features of arterialized medullary vein (MV) in spinal dural arteriovenous fistulas (SDAVF) were studied in five consecutive patients who presented with progressive congestive myelopathy. Retrograde venous filling on preoperative angiography was recognized as being severe in 3 cases and moderate in 2 cases. Direct intradural interruption of the arterialized MV was performed in all patients. The arterialized MV was sampled and examined histologically to determine the percentage of the hyperplasia of venous wall (hypertrophic ratio). Histological examination of arterialized MV showed that hypertrophic alteration of venous wall structure was due to hyperplasia of elastic fibers, ranging from 41 to 82%. Patients with angiographically severe venous hypertension tended to have a higher hypertrophic ratio than patients with moderate venous hypertension. Our observations support the clinical concept that long-standing arterial stress in the spinal venous circulation causes histological alterations of spinal vascular structure associated with the progression of venous hypertension. We suggested that possibly the histological parameter can be used for predicting neurological recovery after occlusion of the fistulas.
Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification
Dezotti, Nei Rodrigues Alves;Joviliano, Edwaldo Edner;Moriya, Takachi;Piccinato, Carlos Eli;
Acta Cirurgica Brasileira , 2011, DOI: 10.1590/S0102-86502011000800021
Abstract: context: previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (apg). purpose: to correlate the venous hemodynamics obtained by apg with the ceap classification after surgical treatment of primary varicose veins. methods: we studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the university hospital, faculty of medicine of ribeir?o preto, university of s?o paulo, during the period from january 2001 to december 2004. the 63 limbs were divided into the three following groups according to ceap classification: group c2 + c3 (38 limbs), group c4 (15 limbs) and group c5 + c6 (10 limbs). the patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative apg. results: there was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. conclusion : surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group c5 + c6).
Detec o de trombose venosa em retalhos livres por medidas de glicemia capilar Detection of venous thrombosis in free flaps by measurement of capillary blood glucose  [cached]
Lincoln Saito Millan,Luiz Carlos Ishida,Esther Mihwa Oh Choi,Enio Cesar Giacchetto Junior
Revista Brasileira de Cirurgia Plástica , 2012,
Abstract: INTRODU O: A monitoriza o do retalho livre após a cirurgia é de vital importancia, especialmente nas primeiras horas de pós-operatório, pois o momento de reabordagem pode ser o definidor entre o salvamento ou a perda do retalho. Até o momento, n o existe trabalho na literatura estudando a decis o de abordagem do retalho baseada em medidas objetivas ou a compara o da glicemia entre retalhos que evoluíram bem com os que sofreram sofrimento vascular. O objetivo deste estudo é avaliar a validade da medida da glicemia capilar do retalho como método de monitoriza o de retalhos microcirúrgicos comparando com a avalia o clínica. MéTODO: Foram estudados prospectivamente 16 pacientes portadores de retalhos livres, realizados de maio de 2012 a julho de 2012. A glicemia capilar foi avaliada por equipe formada por profissionais n o envolvidos com a cirurgia realizada. A avalia o clínica do retalho foi realizada no pós-operatório imediato, na chegada à UTI, a cada 3 horas e sempre que necessário. RESULTADOS: Dos 16 pacientes, 5 (31,3%) apresentaram complica es nas primeiras 24 horas. Todas as complica es observadas foram trombose venosa. Foi observada diferen a estatisticamente significante na glicemia capilar de portadores de retalhos que apresentaram trombose venosa em compara o àqueles que n o tiveram a complica o, nas medidas realizadas 6 horas, 9 horas e 12 horas após a opera o (P < 0,05). CONCLUS ES: A medida da glicemia capilar n o foi superior à avalia o clínica por profissional experiente na detec o de trombose venosa de retalhos livres. BACKGROUND: Monitoring of free flaps after surgery is vitally important, especially in the first few hours because the timing of reoperation can determine flap salvage or loss. To date, no study has examined the decision to reoperate on a flap based on the objective measure of glycemia or a comparison between flaps that showed good outcomes and those that showed vascular damage. The objective of this study was to evaluate the validity of blood glucose measurements within the flap as a method for monitoring free flaps and to compare the efficacy of this method with that of clinical assessments. METHODS: The study was prospective, included 16 patients with free flaps, and was conducted from May 2012 to July 2012. A team of professionals not involved in the surgery evaluated capillary glycemia. Flaps were clinically evaluated during the immediate postoperative period, on ICU admission, at every 3 hours, and as needed. RESULTS: Of the 16 patients, 5 (31.3%) had venous thrombosis in the first 24 hours. Statistically
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