Wee J T
Department of Hand Surgery, Singapore General Hospital.
Handchir Mikrochir Plast Chir. 1988 May;20(3):119-23.
In recent years the distally pedicled radial forearm flap has proved to be a versatile technique for resurfacing the hand. The venous drainage of this flap, however, has remained a puzzle. Various explanations have been suggested, including bypass of the valves by collateral veins and by crossover between the venae comitantes. However, venous drainage must be against the direction of the valves in at least one segment of the veins. The question of reversed venous flow and how it may be achieved reliably is addressed in this study. Timmons has postulated three criteria which all must be satisfied for reversal of venous flow. These criteria, namely higher proximal venous pressure, denervation of the valves, and the filling of the venous segments may be achieved satisfactorily if a few precautions are taken and certain technical manoeuvres performed. The criteria were re-examined in the light of known physiological phenomena. In addition, certain pertinent anatomical facts which arose from our cadaveric studies and which may be exploited to advantage are discussed. Our studies have led to greater understanding of reversed venous flow and to greater success with this flap in our clinical practice.
近年来，远端蒂桡动脉前臂皮瓣已被证明是一种用于手部创面修复的多功能技术。然而，该皮瓣的静脉引流问题一直是个谜。人们提出了各种解释，包括侧支静脉绕过瓣膜以及伴行静脉之间的交叉引流。然而，静脉引流在静脉的至少一个节段中必须与瓣膜的方向相反。本研究探讨了静脉逆流的问题以及如何可靠地实现静脉逆流。廷蒙斯提出了三个标准，静脉逆流必须满足所有这些标准。如果采取一些预防措施并进行某些技术操作，这些标准，即较高的近端静脉压、瓣膜去神经支配以及静脉节段充盈，可以令人满意地实现。根据已知的生理现象对这些标准进行了重新审视。此外，还讨论了我们尸体研究中出现的某些相关解剖学事实，这些事实可以加以利用。我们的研究使我们对静脉逆流有了更深入的了解，并在临床实践中使用该皮瓣取得了更大的成功。
