Giesen Thomas, Forster Natasha, Künzi Walter, Giovanoli Pietro, Calcagni Maurizio
Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
Plastic and Hand Surgery Department, University Hospital of Zurich, Zurich, Switzerland.
J Hand Surg Am. 2014 Mar;39(3):511-23. doi: 10.1016/j.jhsa.2013.12.002.
Although the literature is encouraging with regard to the survival rate of arterialized free venous flaps, previously reported difficulty in healing owing to early venous congestion and subsequent epidermolysis continues to prevent their widespread application. We report 14 arterialized free venous flaps for primary reconstruction of the hand, with inflow in the arterialized vein running against the valves.
Between February 2010 and May 2012, we performed 14 arterialized free venous flaps, each of which included at least 2 veins running in parallel. The arterialized vein was anastomosed in a retrograde manner, with the inflow running against the valves. All flaps were customized with regard to dimension, shape, quality of skin, pedicle length, vessel size, inclusion of additional anatomical structures, and donor site. The flaps were used to cover small, medium, and large defects; 2 flaps were larger than 100 cm(2). Three flaps were injected with indocyanine green on the table after harvesting, to visualize the vascular tree of the flap. These 3 flaps were then monitored with systemic indocyanine green injection and an infrared camera for 3 days postoperatively.
All but 1 flap survived. Venous congestion and epidermolysis were observed in 2 small flaps. The flaps injected with indocyanine green displayed a ramified vascular tree with no arteriovenous flow-through phenomenon.
Arterialized free venous flaps with retrograde arterial flow offer thin and pliable coverage that fits easily around the contours of the hand. They are easy to harvest, with little donor site morbidity. Tendons or nerves can be incorporated for reconstruction of composite defects.
Our series suggests the possibility of routine use of a free venous flap with retrograde arterial flow for reconstruction of the hand.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
尽管文献中关于动脉化游离静脉皮瓣的存活率令人鼓舞，但先前报道的由于早期静脉淤血和随后的表皮松解导致的愈合困难仍阻碍了其广泛应用。我们报告了14例用于手部一期重建的动脉化游离静脉皮瓣，动脉化静脉中的血流方向与瓣膜相反。
2010年2月至2012年5月期间，我们进行了14例动脉化游离静脉皮瓣手术，每例皮瓣至少包含2条并行的静脉。动脉化静脉以逆行方式吻合，血流方向与瓣膜相反。所有皮瓣在尺寸、形状、皮肤质量、蒂长度、血管大小、是否包含额外解剖结构以及供区等方面均进行了定制。这些皮瓣用于覆盖小、中、大不同大小的缺损；2例皮瓣面积大于100 cm²。3例皮瓣在切取后于手术台上注射吲哚菁绿，以观察皮瓣的血管树。然后对这3例皮瓣在术后3天通过全身注射吲哚菁绿并使用红外摄像机进行监测。
除1例皮瓣外，其余皮瓣均存活。2例小皮瓣出现静脉淤血和表皮松解。注射吲哚菁绿的皮瓣显示出分支状血管树，未出现动静脉分流现象。
具有逆行动脉血流的动脉化游离静脉皮瓣提供了薄且柔韧的覆盖，易于贴合手部轮廓。它们易于切取，供区并发症少。可纳入肌腱或神经用于复合缺损的重建。
我们的系列研究表明，逆行动脉血流的游离静脉皮瓣有可能常规用于手部重建。
研究类型/证据水平：治疗性IV级。
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