Department of Plastic Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
Microsurgery. 2014 Mar;34(3):197-202. doi: 10.1002/micr.22161. Epub 2013 Aug 27.
The use of unipedicled venous flaps has been limited due to their unconventional perfusion patterns and inconsistent survival. Further information regarding the optimal conditions required for unipedicled venous flap coverage is needed to increase flap survival. The purpose of this study was to investigate the effect of the pedicle orientation and length on the viability of unipedicled venous flaps based on a review of our clinical experience. Thirty-one skin and soft tissue hand defects of 29 patients were treated with unipedicled venous flaps. Sixteen defects were treated with proximally pedicled flaps and 15 were treated with distally pedicled flaps. Five of the 16 proximally pedicled flaps and eight of the 15 distally pedicled flaps had pedicle lengths ≥ 5 cm. All proximally pedicled flaps survived, and distally pedicled flaps with pedicle lengths <5 cm (n = 7) also survived. Distally pedicled flaps with pedicle lengths ≥5 cm (n = 8) developed congestion within 1-2 days after surgery, and external bleeding was applied. Four of the eight flaps survived completely, and partial necrosis developed in the other four. The results demonstrate that proximally pedicled venous flaps of the hand can survive regardless of pedicle length. Distally pedicled venous flaps can also survive completely when pedicle length is <5 cm. Distally pedicled venous flaps with pedicle lengths ≥5 cm should be used with caution.
由于其非常规的灌注模式和不一致的存活率，使用单蒂静脉皮瓣受到限制。需要进一步了解单蒂静脉皮瓣覆盖所需的最佳条件，以提高皮瓣存活率。本研究旨在通过回顾我们的临床经验，探讨蒂的方向和长度对单蒂静脉皮瓣存活的影响。29 例患者 31 个手部皮肤和软组织缺损采用单蒂静脉皮瓣治疗。16 个缺损采用近蒂皮瓣治疗，15 个缺损采用远蒂皮瓣治疗。16 个近蒂皮瓣中有 5 个蒂长≥5cm，15 个远蒂皮瓣中有 8 个蒂长≥5cm。所有近蒂皮瓣均存活，蒂长<5cm（n=7）的远蒂皮瓣也存活。蒂长≥5cm（n=8）的远蒂皮瓣术后 1-2 天内出现淤血，应用外部止血。8 个皮瓣中有 4 个完全存活，另外 4 个出现部分坏死。结果表明，手部的近蒂静脉皮瓣无论蒂长均可存活。蒂长<5cm 时，远蒂静脉皮瓣也可完全存活。蒂长≥5cm 的远蒂静脉皮瓣应慎用。
