Parkville, Victoria, Australia From the Taylor Laboratory, Department of Anatomy and Neuroscience, University of Melbourne.
Plast Reconstr Surg. 2014 Jun;133(6):790e-804e. doi: 10.1097/PRS.0000000000000228.
Previous studies of venous anatomy lack the detail of their arterial counterparts because of (1) the technical challenge of retrograde perfusion against competent valves and (2) anterograde venous perfusion failing to adequately delineate the area of interest. We introduced a novel technique: retrograde hydrogen peroxide priming that dilates veins and renders valves incompetent, thereby facilitating complete cadaveric venous perfusion.
The superficial and deep venous systems of 41 hemiabdomens and 20 hemichests of unembalmed human cadavers were primed by retrograde injection with 6% hydrogen peroxide. Specimens were then injected with lead oxide contrast, radiographed, and dissected. In five hemiabdomens, the valves were mapped by dissection. Results were compared with archival venous studies of six total body injections, six abdominal lipectomy specimens, and two intraoperative venograms of delayed transverse rectus abdominis musculocutaneous flaps.
Unprecedented venous filling of the anterior torso was demonstrated. Two types of superficial-to-deep venous connections were defined: large venae communicantes and small venae comitantes. Venae communicantes (>2 mm) formed major connections between large superficial and deep veins, mostly within 5 cm of the umbilicus in the abdomen, the axilla and fifth or sixth intercostal space parasternally. Seventy-four percent of venae communicantes coursed with arteries greater than 1.0 mm. Four major longitudinal valved subcutaneous pathways of the superficial inferior epigastric vein and superficial circumflex iliac vein were defined bilaterally with large avalvular transverse connections in the midline and small-caliber connections laterally that explain venous complications seen sometimes in transverse abdominal flaps.
Retrograde hydrogen peroxide priming of veins in cadavers renders valves incompetent and facilitates detailed venous studies that help refine flap design and explain venous complications.
由于（1）对抗功能正常的瓣膜进行逆行灌注的技术挑战，以及（2）顺行静脉灌注不能充分描绘感兴趣区域，先前的静脉解剖研究缺乏其动脉对应物的细节。我们引入了一种新的技术：逆行过氧化氢预充，它可扩张静脉并使瓣膜失去功能，从而促进完整的尸体静脉灌注。
用 6%过氧化氢逆行注射对 41 个半腹部和 20 个半胸部的浅静脉和深静脉系统进行预充。然后将标本用氧化铅造影剂进行注射、拍摄射线照片并进行解剖。在 5 个半腹部中，通过解剖对瓣膜进行了映射。结果与六次全身注射、六次腹部脂肪切除术标本和两次延迟横向 rectus abdominis musculocutaneous 皮瓣的术中静脉造影的存档静脉研究进行了比较。
前所未有的前躯干静脉充盈得到了证明。定义了两种浅静脉到深静脉的连接方式：大交通静脉和小伴行静脉。交通静脉（>2 毫米）在大浅静脉和深静脉之间形成主要连接，主要位于腹部脐部 5 厘米以内、腋窝和第五或第六肋间胸骨旁。74%的交通静脉与直径大于 1.0 毫米的动脉一起走行。双侧定义了四条主要的浅下腹部静脉和浅旋髂静脉的纵向带瓣皮下通路，中线有大无瓣横连接，外侧有小口径连接，这解释了有时在横向腹部皮瓣中看到的静脉并发症。
尸体静脉的逆行过氧化氢预充可使瓣膜失去功能，并促进详细的静脉研究，有助于完善皮瓣设计并解释静脉并发症。
