Ihara Jun, Imanishi Nobuaki, Kishi Kazuo
Department of Plastic and Reconstructive, Surgery, Keio University, Shinjukuku, Tokyo, Japan; Department of Anatomy, Keio University, Shinjukuku, Tokyo, Japan; and Department of Plastic and Reconstructive, Surgery, Keio University, Shinjukuku, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2017 Dec 22;5(12):e1585. doi: 10.1097/GOX.0000000000001585. eCollection 2017 Dec.
Distally based flaps are useful for the treatment of skin defects of the extremities. However, congestion in the peripheral part of the flap due to reverse flow can cause partial flap necrosis. Previously, we reported on the effectiveness of venous anastomoses to rescue peripheral congestion of distally based flaps and applied this idea in a clinical setting. In this report, we present clinical cases of distally based flaps with venous supercharge anastomoses for changing the reverse venous flow into physiological flow, thereby reducing venous congestion.
Four patients with skin defects of the extremities (2 cases with defects of the knee and the upper third of the lower leg, 1 case of the lower third of the lower leg, and 1 case of the distal third of the forearm) were treated with local flaps (2 cases with distally based greater saphenous venoadipofascial sartorius muscle combined flaps, 1 case with a distally based lesser saphenous venoadipofascial flap, and 1 case with a distally based ulnar artery perforator flap). In each reconstruction, 1 or 2 veins in the flaps were anastomosed with superficial veins in the recipient area to change the reverse venous flow into a normal, physiologic flow.
All flaps healed completely without any obvious venous congestion or flap necrosis. The coverage quality provided by these defects was satisfactory.
Adding venous anastomoses may reduce the risk of venous congestion and improve the outcomes of the distally based flaps.
远端蒂皮瓣对于治疗肢体皮肤缺损很有用。然而，由于反流导致皮瓣周边部分充血可引起部分皮瓣坏死。此前，我们报道了静脉吻合术挽救远端蒂皮瓣周边充血的有效性，并将这一理念应用于临床。在本报告中，我们展示了采用静脉增压吻合术的远端蒂皮瓣临床病例，以将反向静脉血流转变为生理性血流，从而减轻静脉充血。
4例肢体皮肤缺损患者（2例为膝部和小腿上1/3处缺损，1例为小腿下1/3处缺损，1例为前臂远端1/3处缺损）接受了局部皮瓣治疗（2例为远端蒂大隐静脉脂肪筋膜缝匠肌联合皮瓣，1例为远端蒂小隐静脉脂肪筋膜皮瓣，1例为远端蒂尺动脉穿支皮瓣）。在每次重建中，将皮瓣中的1条或2条静脉与受区浅静脉进行吻合，以将反向静脉血流转变为正常的生理性血流。
所有皮瓣均完全愈合，无明显静脉充血或皮瓣坏死。这些缺损所提供的覆盖质量令人满意。
增加静脉吻合术可能降低静脉充血风险，并改善远端蒂皮瓣的治疗效果。
