前臂腕掌侧H型浅静脉弓的解剖学观察及在复杂断指再植中的应用

Anatomical observation of type H superficial venous arch on volar aspect of the forearm and wrist and its application in complicated replantation of amputated fingers

目的 观察前臂腕掌侧H型浅静脉弓的解剖学特点,并总结其在复杂断指再植中的应用和疗效.方法 选择100例健康成人和12例新鲜尸体观察前臂腕掌侧H型浅静脉弓的特点,并应用浅静脉弓进行移植,修复复杂断指血管缺损32例33指.结果 通过解剖学观察,了解前臂腕掌侧普遍存在H型较为恒定的浅静脉弓,该弓的远心端和近心端的静脉直径与手指固有动脉、指背静脉相近.对26例伴有血管缺损的复杂断指和6例再植术后血管危象病例,共进行浅静脉弓移植32例33指（移植静脉弓33条、修复动脉60条、修复静脉6条）,术后断指全部存活,无动静脉危象发生,随访优良率达90％.结论 腕掌侧H型浅静脉弓具有位置相对恒定、直径适宜、取材方便等优点,相比单条静脉和2条静脉移植不增加额外切口和创伤,移植术后无血管危象发生,适合在复杂断指再植和断指术后危象探查中应用.

Objective To observe the anatomical characteristics of type H superficial venous arch on the volar aspect of the forearm and wrist and summarize its application and surgical results in replantation of complicated finger amputations.Methods The characteristics of type H superficial venous arch on the volar aspect of the forearm and wrist were observed in 100 healthy adult volunteers and 12 fresh cadaver specimens.This superficial venous arch was used as vascular graft for repairing vascular defect in replantation of complicated finger amputations in 33 fingers of 32 cases.Results The existence of type H superficial venous arch on the volar aspect of the forearm and wrist was constant.The diameters of the distal and proximal ends of the veuous arch were similar to the diameters of the digital artery and dorsal digital vein,respectively.This venous arch was harvested to bridge vascular defect in replantation of 26 cases of complicated finger amputations with vascular defects and in salvaging procedures of post-replantation vascular crises in 6 cases.A total of 33 fingers in 32 patients were treated with superficial venous arch transfer （33 venous arches were harvested to repair 60 arteries and 6 veins）.All replanted fingers survived.No arterial or venous crisis occurred.The excellent and good results were achieved in 90% of the cases.Conclusion Type H superficial venous arch on the volar aspect of the forearm and wrist has relatively constant location and suitable diameter,and is easy to harvest.Compared to single vein and two vein grafts,type H superficial venous arch neither requires additional incision for harvesting nor has post-graft vascular crisis.It is suitable as venous grafts in replantation of complicated finger amputations and in exploration and salvage procedures of post-replantation vascular crisis.