预构扩张皮瓣微循环灌注量的动态变化

目的 研究预构扩张皮瓣微循环灌注量的动态变化。方法 选取成年雄性新西兰白兔36只，随机分为预构扩张组（A组）、扩张器衬垫预构组（B组）及预构组（C组）各12只。股动静脉血管束移位后。A、B组分别在肉膜深面植人50ml扩张器，预构扩张组7d后开始注水。利用激光多普勒血流计定点测量术前、术后即刻、术后3、7、27、52、62d的微循环灌注量。结果 3组术后皮瓣微循环血量均急剧下降，术后第3d呈上升趋势，随扩张的进行。预构扩张组微循环血量上升趋势较其它组显著，至扩张充分后达到相对稳定状态。结论 扩张术能明显增加预构皮瓣的微循环灌注量，提高皮瓣移植的安全性。     

VEGF对大鼠预构皮瓣血管化及皮瓣成活的影响

目的观察血管内皮生长因子（VEGF）对预构皮瓣血管化及皮瓣成活的影响。方法雄性Wistar大鼠32只,在其腹部设计6 cm×6 cm的矩形皮瓣,由肉膜下掀起植入大鼠右侧股血管束,形成预构皮瓣。随机分为实验组和对照组,各16只。实验组在血管蒂部注射VEGF重组蛋白165（VEGF165）0.5 mg/0.5 ml,对照组注射0.5ml生理盐水。分别于术后1、2、3、4周检测血管芽、血管口径、血流速度;行血管染色计算皮瓣筋膜面血管着色面积;用Bielschowsky改良法镀银染色和Loyez-苏木素髓鞘染色,显微镜下观察植入血管与原皮瓣间的血管新生情况和皮瓣的组织学变化;于上述各时间点取动物,分别将预构皮瓣切开,仅留血管束与皮瓣相连,再将皮瓣原位缝合,7 d后观察并计算皮瓣成活面积。结果术后2周实验组新生血管与皮瓣血管交织成网,毛细血管数及植入血管远心端流速均优于对照组,血管染色着色面积明显加大,可观察到新生血管分布皮肤全层;实验组术后1、2周皮瓣成活面积均高于对照组（P均〈0.05）。结论局部应用VEGF对预构皮瓣的血管化有促进作用,有利于预构皮瓣的成活。     

预构扩张皮瓣的研究与应用进展

预构扩张皮瓣是将浅表的动静脉血管束移位植入无直接动脉走行的部位预构轴形皮瓣,同时在该皮瓣下放置皮肤软组织扩张器,逐渐充水扩张,以形成扩张变薄的轴形皮瓣。具有血液循环好,皮瓣薄,皮瓣转移后无臃肿,增加预构皮瓣范围,供区可直接缝合不需植皮等优点。现结合国内外文献,对近年来预构扩张皮瓣的研究与应用进展状况综述如下。     

带蒂血管神经皮瓣移植修复四肢皮肤缺损26例疗效观察

2005年5月～2006年8月，我们采用带蒂血管神经皮瓣移植，修复四肢皮肤缺损26例，疗效满意。现报告如下。     

应用VSD技术和腓肠神经皮瓣逆行转移治疗严重的足踝部损伤

选择50例严重足外伤骨外露患者,对感染皮肤缺损先行清创及封闭负压引流（VSD）治疗1—3个疗程,后期应用腓肠神经营养皮瓣逆行移位修复足部的皮肤缺损骨外露,并且术中对小隐静脉和腓肠神经进行处理。结果发现,经VSD治疗后,患者感染均得到控制,骨外露创面有部分肉芽生长,其余创面肉芽组织生长新鲜,触之易出血,行细菌培养均阴性。行腓肠神经营养血管皮瓣移位后,1例皮瓣远端1／4坏死伤口感染外,其余均无感染发生,皮瓣均成活,恢复大部分感觉。认为封闭负压吸引可以控制感染、免除换药、刺激肉芽组织生长,为腓肠神经皮瓣移植提供良好的条件。腓肠神经皮瓣能为足部皮肤缺损提供很好的覆盖和足部耐磨功能恢复。     

带血管蒂皮瓣修复足踝部软组织缺损18例疗效分析

2003年9月～2007年12月，我院应用带血管蒂的足背、足底内侧皮瓣及带腓肠神经营养血管蒂的逆行岛状皮瓣修复踝周及足底皮肤缺损18例，取得良好的疗效。现报告如下。     

腓肠神经营养血管逆行岛状皮瓣的临床应用观察

小腿远端及足踝部皮肤、软组织缺损时，常造成局部骨骼、肌腱外露，但由于局部软组织少，愈合及修复较困难。目前认为，采用皮瓣修复是最佳选择。1998年以来，我们采用带腓肠神经营养血管的逆行岛状皮瓣修复小腿远端、足踝部及足跟部皮肤、软组织缺损26例，效果良好。现报告如下。     

股前外侧皮瓣在修复小腿大面积软组织合并主干血管缺损中的应用效果观察

目的评估游离股前外侧皮瓣修复小腿大面积软组织合并主干血管缺损的疗效。方法回顾性分析该院2013-08～2017-09收治的15例严重小腿软组织合并主干血管缺损患者的临床资料。所有患者均一期清创、骨折复位固定; 1例不全断肢患者急诊行游离皮瓣移植并桥接血管以恢复血供; 14例患者一期采用负压封闭引流技术(VSD)覆盖创面,二期移植股前外侧皮瓣桥接动、静脉并覆盖创面。皮瓣切取面积15 cm×10 cm～30 cm×12 cm。结果患者全部获得随访;术后2例患者发生静脉栓塞,经及时探查后血管复通; 1例因局部感染创面延迟愈合;末次随访时所有皮瓣及肢体血运良好,供区无严重并发症发生,患肢外观及功能恢复满意。结论应用股前外侧皮瓣在覆盖小腿创面的同时能修复保留肢体的主干血管,可改善肢体外观,增加远端血供。     

游离皮瓣移植修复肢体软组织缺损(附59例报告)

对 5 9例严重肢体软组织缺损伤患者 ,取自体组织皮瓣游离移植修复肢体缺损。根据不同缺损与缺损的范围应用不同的游离皮瓣。皮瓣面积最小 10 cm× 12 cm,最大 2 0 cm× 40 cm。其中背阔肌皮瓣 43例 ,股前外侧皮瓣 7例 ,侧胸皮瓣 6例 ,脐胸皮瓣 3例。结果 :完全成活 5 6例。因受区创面不新鲜感染 ,2例部分坏死 ,1例完全坏死。认为用游离自体皮瓣移植修复严重的肢体软组织缺损 ,可有效修复肢体创面 ,防止因皮肤缺损所致血管、神经和骨骼的进一步损伤或感染 ,提高伤肢修复的疗效和功能     

补阳还五汤加味在游离股前外侧皮瓣修复下肢创面术后应用的疗效及安全性

目的:探讨补阳还五汤在游离股前外侧皮瓣修复下肢创面术后应用的疗效及安全性.方法:选取本院收治的62例下肢皮肤软组织缺损患者为观察对象,随机分为对照组和观察组各31例,所有患者均行游离股前外侧皮瓣手术.对照组术后常规治疗,观察组加用补阳还五汤口服,对比两组下肢感觉神经传导速度(SCV),并对比安全性.结果:术后8周时,两...     

游离指动脉皮支皮瓣移植修复指端皮肤缺损（附8例报告）

目的观察游离指动脉皮支皮瓣移植修复指端缺损的疗效。方法对8例（8指）指端缺损患者按受区需要,在手指近节设计适当大小和形状的指动脉皮支皮瓣,解剖游离皮瓣边缘的浅静脉和指固有神经和指神经背侧支发向皮瓣的分支分别做为皮瓣的回流静脉和感觉神经,解剖游离指动脉发向皮瓣的皮支并在指动脉皮支起始处切断,形成以指动脉皮支为蒂的游离皮瓣。皮瓣移植至指端修复创面,皮瓣上的指动脉皮支与手指远端的指动脉分支或主干吻合,皮瓣神经与指神经残端吻合,皮瓣的静脉与受区浅静脉吻合。结果8例皮瓣全部成活。术后随访3～6个月,皮瓣色泽正常,质软,两点辨别觉3～8mm。结论指动脉皮支皮瓣游离移植修复指端皮肤缺损,皮瓣质地好,指端感觉恢复良好,且不损伤指动脉与指固有神经。     

Experimental surgery in infrarenal aorta and sigmoid ischemia.

AIM: Colon ischemia is a rare but serious complication in surgery of the infrarenal aorta, due to ligation of the inferior mesenteric artery and the ischemia-reperfusion syndrome. In order to investigate the degree of intestinal damage, we employed experimental surgery in pigs, applying the usual protocol for elective repair of the infrarenal aorta (AAA or Y graft). METHODS: Three groups of pigs were operated on. In Group A (n=4, 21-25 kg, mean 22.6) a sham operation was performed. In Group B (n=6, 21-26 kg, mean 24) the infrarenal aorta was cross-clamped along with the internal and external iliac arteries and a longitudinal incision was performed in the aorta, while in Group C (n=5, 20-27 kg, mean 23.8) a Pruitt-Inahara shunt was used to allow flow from the infrarenal aorta towards the iliac arteries and the inferior mesenteric artery during cross-clamping. The duration of cross-clamping was two hours (Group B and C). In all groups we evaluated sigmoid histology after reperfusion under light microscopy. RESULTS: The pathologic examination of the sigmoid revealed increased postischemic injuries in Group B, while the protective effect of the shunt was obvious in Group C. The tissue samples of Group B presented hyperemia, submucosal edema, dilatation of the lymph vessels and severe inflammatory infiltration of the mucosa, muscularis propria and serosa, with cells showing acute and chronic inflammatory responses. In Group C all specimens presented hyperemic vessels and a slight inflammatory reaction of mucosa. In conclusion, Group B, presented the most severe inflammatory changes, involving all layers, while in Group C congestion and slight inflammatory reactions of the mucosa were observed. In Group A, no significant changes in normal histology were observed. CONCLUSION: The importance of these findings is evident, because in the clinical situation patients have variable degrees of arteriopathy, thus even short periods of ischemia might prove disastrous and this could occur in repair of the infarenal aorta as well as in other cases of inevitable risk, such as in surgery of the thoraco-abdominal aorta.     

Most accurate definition of a high femoral artery puncture: Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention

Background : Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. Methods : We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Results : Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3–898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk‐stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Conclusions : Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH. © 2012 Wiley Periodicals, Inc.     

Transcatheter closure of perimembranous ventricular septal defect in a patient with abnormal inferior vena cava return

An 8-year-old boy with a 3.8 mm perimembranous ventricular septal defect (PmVSD) and abnormal inferior vena cava return was attempted cardiac catheterization to occlude the VSD. Through the right jugular vein and right femoral artery approach, an 8 mm Amplatzer VSD occluder was successfully deployed under fluoroscopic and echocardiographic guidance. After a 2 year follow-up, the patient is symptom-free. Our report offers a new perspective to percutaneous treatment of PmVSD with abnormal inferior vena cava return.     

A case of liver cirrhosis with bleeding from stomal varices successfully treated using balloon-occluded retrograde transvenous obliteration

A 66-year-old male patient with liver cirrhosis because of alcohol intake underwent a Hartmann’s procedure for rectal cancer. Four months later, bleeding from the sigmoid stoma occurred and persisted for 2 months. A colonoscopic examination revealed bleeding from stomal varices. Three-dimensional computed tomography (CT) imaging demonstrated the inferior mesenteric vein and left superficial epigastric vein as the feeding and drainage vessels, respectively. Balloon-occluded retrograde transvenous obliteration (B-RTO) through the left epigastric vein was performed using a microballoon catheter inserted from the right femoral vein according to the Seldinger method. A CT examination performed 2 days after the B-RTO procedure revealed that the blood flow had disappeared, with thrombosis formation in both the stomal varices and the feeding vein. No recurrent bleeding from the stoma occurred. B-RTO using a microballoon catheter is useful as a therapeutic procedure for stomal varices to prevent bleeding, since the procedure can be performed with minimal invasion using the Seldinger method.     

胸降主动脉瘤手术提高下半身灌注血压的临床研究

选择 15例胸降主动脉瘤非体外循环下手术病人 ,按阻断期间输血方法将其随机分 3组 ,A组 ( 5例 ) :失血回收并经上肢外周静脉输入 ;B组 ( 5例 ) :用体外循环机泵 ,将出血回收并间断经股动脉插管回输体内 ,输血流量 <50 0ml/min ;C组 ( 5例 ) :途径同组B ,采取“短阵定量快速输入”法 ,即每次输血 2 0 0～ 30 0ml,流量 >150 0ml/min。主动脉阻断时 3组股动脉压均明显下降 ,3组间无统计学差异。经三种不同输血方法处理后 ,阻断 30min时 ,B组桡动脉压显著高于C组 (P <0 0 1) ,而股动脉压明显低于C组 (P <0 0 5) ,但高于A组(P <0 0 5)。C组股动脉压显著高于A组 (P <0 0 1)及B组 (P <0 0 5)。开放主动脉时B组股动脉压显著低于A组 (P <0 0 5) ;与自身桡动脉压比较下降非常显著 (P <0 0 1)。C组能有效地提高阻断期间股动脉压。B组桡动脉压提高显著 ,但股动脉压提高不明显。A组对股动脉压无影响     

Arterial blood flow and microcirculatory changes in the rat groin flap after ischemia provocation by electrical stimulation of the artery.

An island groin flap based on the inferior epigastric vessels was raised in 10 rats in order to monitor simultaneous ischemic changes in arterial blood flow and skin microcirculation induced by electrical stimulation of the feeding artery. A modified laser Doppler perfusion system recorded blood flow in the epigastric artery and in the skin microcirculation of the flap before and for 40 min after the experimentally induced ischemia. Sections of the stimulated segment of the vessel were obtained at the end of the experimental procedure for histological analysis to determine the extent of endothelial changes, if any. Artery blood flow and the flap microcirculation decreased significantly immediately after stimulation, both slowly increasing to prestimulation levels after 30 min. Artery perfusion was quicker than microcirculation to recover to the baseline value, indicating that reperfusion of larger vessels could involve mechanisms fundamentally different from those active in the resolution of ischemia at the capillary level. Histological artery examination revealed no significant endothelial damage at the stimulation site, thus demonstrating that electrical stimulation induces reproducible ischemia without visible endothelial damage. The differential effects on the feeding artery and on capillary perfusion indicate recruitment of several different mechanisms.     

New performed catheter for entry into pulmonary artery in complete transposition of great arteries.

A new performed, semi-rigid, polyethylene catheter, with built-in torque control, has been devised for entry to the pulmonary artery in complete transposition of the great arteries. It has been used 19 times in 17 patients: 18 times the pulmonary artery was entered from the right atrium (via the left atrium and ventricle) in a time between 40 s and 15 min (median 5 min); the patients' ages were 2 days to 6 years (median 8 months) and their weights were 3.1 to 13.3 kg (median 6.9 (kg: in the remaining 1 day-old patient, the procedures was terminated because of atrial flutter. The catheter was introduced into the axillary vein in 3 patients and thesaphenous or femoral vein in the remainder. It is suitable for angiocardiography, and the other heart chambers and vessels were easily entered.Thus the catheter has certain advantages over previously described methods for entry to the pulmonary artery, particularly when there is inferior vena caval thrombosis, or when angiocardiography is necessary. Its use does depend on the presence of an interatrial communication, so a method for entry to the pulmonary artery by retrograde catheterization from the axillary artery using a different catheter is also presented; this was successful in 2 patients with ventriculal sepatal defect.     

New performed catheter for entry into pulmonary artery in complete transposition of great arteries.

A new performed, semi-rigid, polyethylene catheter, with built-in torque control, has been devised for entry to the pulmonary artery in complete transposition of the great arteries. It has been used 19 times in 17 patients: 18 times the pulmonary artery was entered from the right atrium (via the left atrium and ventricle) in a time between 40 s and 15 min (median 5 min); the patients' ages were 2 days to 6 years (median 8 months) and their weights were 3.1 to 13.3 kg (median 6.9 (kg: in the remaining 1 day-old patient, the procedures was terminated because of atrial flutter. The catheter was introduced into the axillary vein in 3 patients and thesaphenous or femoral vein in the remainder. It is suitable for angiocardiography, and the other heart chambers and vessels were easily entered.Thus the catheter has certain advantages over previously described methods for entry to the pulmonary artery, particularly when there is inferior vena caval thrombosis, or when angiocardiography is necessary. Its use does depend on the presence of an interatrial communication, so a method for entry to the pulmonary artery by retrograde catheterization from the axillary artery using a different catheter is also presented; this was successful in 2 patients with ventriculal sepatal defect.     

Intraoperative diagnosis of pancreatic cancer extension using IVUS

BACKGROUND/AIMS: Pancreatic cancer easily invades retroperitoneal tissue, especially the portal vein and extrapancreatic nerve plexus. We evaluated the diagnostic accuracy of intraportal endovascular ultrasonography in portal vein and extrapancreatic nerve plexus invasion. METHODOLOGY: Intraportal endovascular ultrasonography was performed in 78 cases of pancreatic cancer (head 67, body 8, total 3). Intraportal endovascular ultrasonography was performed intraoperatively from the superior mesenteric vein with an 8-French, 20-MHz intravascular ultrasound catheter. Three-dimensional intraportal endovascular ultrasonography was constructed by volume rendering. RESULTS: Intraportal endovascular ultrasonography visualized the portal vein as an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic criterion of portal vein invasion was obliteration of this echogenic band. Intraportal endovascular ultrasonography visualized segment II of the extrapancreatic nerve plexus as the high-echoic area around the inferior pancreaticoduodenal artery. The diagnostic criterion of extrapancreatic nerve plexus invasion was low-echoic infiltration around the inferior pancreaticoduodenal artery. The sensitivity, specificity, and overall accuracy of intraportal endovascular ultrasonography for diagnosis of portal vein invasion was, respectively, 97.4%, 92.5%, and 94.9%. The values for diagnosis of extrapancreatic nerve plexus invasion, respectively, were 94.4%, 97.1%, and 96.2%. Three-dimensional intraportal endovascular ultrasonography depicted the invasion area as a defect of the portal vein wall. CONCLUSIONS: Intraportal endovascular ultrasonography detected subtle portal invasion and provided accurate portal invasion area which was useful for portal vein an reconstruction. Intraportal endovascular ultrasonography could also diagnose the extrapancreatic nerve plexus invasion of segment II.