Taylor G I, Caddy C M, Watterson P A, Crock J G
Department of Plastic Surgery, Royal Melbourne Hospital.
Plast Reconstr Surg. 1990 Aug;86(2):185-213. doi: 10.1097/00006534-199008000-00001.
The venous architecture of the integument and the underlying deep tissues was studied in six total-body human fresh cadavers and a series of isolated regional studies of the limbs and torso. A radiopaque lead oxide mixture was injected, and the integument and deep tissues were dissected and radiographed. The sites of the venous perforators were plotted and traced to their underlying parent veins that accompany the source (segmental) arteries. A series of cross-sectional studies were made in one subject to illustrate the course of the perforators between the integument and the deep tissues. The veins were dissected under magnification to identify the site and orientation of the valves. Results revealed a large number of valveless (oscillating) veins within the integument and deep tissues that link adjacent valved venous territories and allow equilibration of flow and pressure throughout the tissue. Where choke arteries define the arterial territories, they are matched by boundaries of oscillating veins in the venous studies. The venous architecture is a continuous network of arcades that follow the connective-tissue framework of the body. The veins converge from mobile to fixed areas, and they "hitchhike" with nerves. The venous drainage mirrors the arterial supply in the deep tissues and in most areas of the integument in the head, neck, and torso. In the limbs, the stellate pattern of the venous perforators is modified by longitudinal channels in the subdermal network. However, when an island flap is raised, these longitudinal channels are disconnected, and once again the arterial and venous patterns match. Our venous studies add strength to the angiosome concept. Where source arteries supply a composite block of tissue, we have demonstrated radiologically and by microdissection that the branches of these arteries are accompanied by veins that drain in the opposite direction and return to the same locus. Hence each angiosome consists of matching arteriosomes and venosomes. The clinical implications of these results are discussed with particular reference to the design of flaps, the delay phenomenon, venous free flaps, the pathogenesis of flap necrosis, the "muscle pump," varicose veins, and venous ulceration.
在六具全身新鲜人体尸体以及一系列对四肢和躯干的局部单独研究中，对皮肤及深层组织的静脉结构进行了研究。注入不透射线的氧化铅混合物后，对皮肤和深层组织进行解剖并拍摄X光片。绘制静脉穿支的位置，并追踪至其下方与源（节段性）动脉伴行的母静脉。对一名受试者进行了一系列横断面研究，以阐明穿支在皮肤和深层组织之间的走行。在放大条件下解剖静脉，以确定瓣膜的位置和方向。结果显示，在皮肤和深层组织内存在大量无瓣膜（摆动）静脉，它们连接相邻的有瓣膜静脉区域，使整个组织内的血流和压力达到平衡。在动脉区域由阻塞动脉界定的地方，在静脉研究中与之对应的是摆动静脉的边界。静脉结构是一个连续的拱廊网络，遵循身体的结缔组织框架。静脉从活动区域向固定区域汇聚，并与神经“搭伴”。在深层组织以及头、颈和躯干皮肤的大多数区域，静脉引流与动脉供应相对应。在四肢，皮下网络中的纵向通道改变了静脉穿支的星状模式。然而，当掀起岛状皮瓣时，这些纵向通道会断开，动脉和静脉模式再次匹配。我们的静脉研究为血管体概念提供了有力支持。在源动脉供应复合组织块的地方，我们通过放射学和显微解剖证明，这些动脉的分支伴有向相反方向引流并返回同一位置的静脉。因此，每个血管体由相互匹配的动脉体和静脉体组成。本文特别参考皮瓣设计、延迟现象、静脉游离皮瓣、皮瓣坏死的发病机制、“肌肉泵”、静脉曲张和静脉溃疡等方面，讨论了这些结果的临床意义。
