Ghali S, Bowman N, Khan U
Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, London W6 8RF, UK.
Br J Plast Surg. 2005 Dec;58(8):1086-9. doi: 10.1016/j.bjps.2005.04.059. Epub 2005 Aug 10.
The skin of the lower leg is nourished by a number of perforating vessels arising from the named arteries which travel in the longitudinal axis of the limb. The distribution of these perforating arteries has been elucidated using a combination of techniques but which are essentially based on cadaveric studies. Clinically, this knowledge has provided the basis for methods of local tissue transfer in the lower limb. A common finding with the use of local fasciocutaneous flaps is venous congestion. The relationship of the veins to the arteries in perforating vessels of the lower limb has not been investigated. We studied the veins accompanying these arteries by dissecting them in 40 lower limbs (20 cadavers). A total of 40 pedicles were dissected. We concentrated our analysis of the arterial/venous relationship on the most distal vessels on the medial aspect of the lower limbs (the vascular basis for the commonly used distally based fasciocutaneous flap). We found that 25 of these arteries were accompanied by one perforating vein whereas 12 were accompanied by two or more veins. When there was a single vein this was usually larger than the artery in external diameter and lay inferior to the artery 76% of the time. When there were two veins or more, there was an interconnection between the two around the artery in over half of the samples (7/12). Surprisingly, three vessels did not have any accompanying vein. This study sheds some light on the variation in venous drainage important to the initial survival of these flap transfers.
小腿皮肤由一些源自沿肢体纵轴走行的命名动脉的穿支血管滋养。这些穿支动脉的分布已通过多种技术得以阐明，但这些技术本质上基于尸体研究。临床上，这一知识为下肢局部组织转移方法提供了基础。使用局部筋膜皮瓣时常见的一个发现是静脉充血。下肢穿支血管中静脉与动脉的关系尚未得到研究。我们通过解剖40条下肢（20具尸体）来研究伴行于这些动脉的静脉。共解剖了40个蒂。我们将动脉/静脉关系的分析集中在下肢内侧最远端的血管上（常用的远端蒂筋膜皮瓣的血管基础）。我们发现这些动脉中有25条伴有1条穿支静脉，而12条伴有两条或更多静脉。当只有一条静脉时，其外径通常大于动脉，并且76%的情况下位于动脉下方。当有两条或更多静脉时，超过一半的样本（7/12）中两条静脉在动脉周围相互连接。令人惊讶的是，有三条血管没有任何伴行静脉。这项研究揭示了对这些皮瓣转移初期存活至关重要的静脉引流变异情况。
