Nichter L S, Haines P C, Edgerton M T
Plast Reconstr Surg. 1985 May;75(5):686-91. doi: 10.1097/00006534-198505000-00012.
Inadequate venous outflow is the factor most responsible in digital replantation failure and is a common cause of tissue loss in general. An experimental replantation model utilizing the rabbit ear was used to study the extreme example of venous congestion: absent venous drainage in the replanted part. Results of this study support the use of single arterial inflow along with an efferent AV fistula for outflow in the management of replants with absent venous drainage. Potential indications for the use of an efferent arteriovenous fistula in digital revascularization include the following: (1) the finding of distal veins too small to reanastomose, as is often the case in children and at distal levels in adults; (2) preferential destruction of distal venous structures, as commonly seen in degloving or other dorsal injuries; and (3) in the management of postreplant venous thrombosis.
静脉回流不足是导致断指再植失败的最主要因素，也是组织缺失的常见原因。利用兔耳建立的实验性再植模型，用于研究静脉淤血的极端情况：再植部位静脉引流缺失。本研究结果支持在处理静脉引流缺失的再植手术时，采用单一动脉流入并结合动静脉分流作为流出道的方法。在手指血管重建中使用动静脉分流的潜在适应证包括：（1）发现远端静脉过细无法进行再吻合，这在儿童以及成人的远端部位较为常见；（2）远端静脉结构遭到优先破坏，如在脱套伤或其他背侧损伤中常见的情况；（3）在处理再植后静脉血栓形成时。
