Kato N, Ueno H
Department of Dermatology, National Sapporo Hospital, Japan.
J Dermatol. 1995 Sep;22(9):681-5. doi: 10.1111/j.1346-8138.1995.tb03898.x.
Four cases of saphenous vein graft donor site dermatitis are reported from Japan for the first time. The patients were four Japanese men aged from 57 to 69. They noted pruritic eruptions along the lower extremity scar after coronary artery bypass graft surgery using the autogenous saphenous vein. The eruptions appeared mainly on and around the lower end of the venectomy scars from 1.5 to 9 months after graft operations performed at three different hospitals. All four patients showed an objective sensory deficit of the saphenous nerve around the saphenous vein incision scar, although none of them complained of saphenous neuralgia subjectively. Histologically, two patients showed mild epidermal acanthosis, spongiosis, intraepidermal blisters, and perivascular infiltration of lymphocytes and a few eosinophils around dermal blood vessels. The eruption responded well to topical corticosteroids in all cases, although it recurred again in two patients. The entity is characterized by a subacute (belatedly appearing, then slowly disappearing) dermatitis and a mild sensory deficit of the saphenous nerve. Apparently, mild impediment of the saphenous nerve due to an ablational procedure of saphenous venectomy can play a role in causing saphenous vein graft donor site dermatitis.
日本首次报告了4例大隐静脉移植供区皮炎病例。患者为4名日本男性，年龄在57至69岁之间。他们在使用自体大隐静脉进行冠状动脉旁路移植手术后，注意到下肢瘢痕处出现瘙痒性皮疹。皮疹主要出现在三个不同医院进行移植手术后1.5至9个月的静脉切除术瘢痕下端及其周围。所有4例患者在大隐静脉切口瘢痕周围均出现大隐神经客观感觉障碍，尽管他们均无主观的大隐神经痛主诉。组织学上，2例患者表现为轻度表皮棘层增厚、海绵形成、表皮内水疱以及真皮血管周围淋巴细胞和少量嗜酸性粒细胞浸润。所有病例的皮疹对外用糖皮质激素反应良好，尽管有2例患者皮疹复发。该疾病的特点是亚急性（迟发，然后缓慢消退）皮炎和大隐神经轻度感觉障碍。显然，大隐静脉切除术的切除操作导致的大隐神经轻度损伤可能在大隐静脉移植供区皮炎的发生中起作用。
