Objective To investigate the clinical feasibility of different types of the saphenous neuro-veno-fascial cutaneous flaps. Methods From June 1996 to October 2002, 18 cases of skin defects in the knee and the lower part of the limb were treated with proximally(4 cases) or distally(11 cases) based pedicles of saphenous neuro-venofascial cutaneous flap or crossleg flap (3 cases)according to the site of defects . The sizes of the flaps ranged from 4 cm×5 cm to 9 cm×20 cm. Results The flaps survived completely in 17 cases, distal 1/5 of the flap necrosed partially in 1 case because of vein drainage disturbance. The colour and texture of flaps were excellent, the appearance and function were satisfactory after a follow up of 6-24 months.Conclusion The saphenous neuro-veno-fascial cutaneous flap is an idea flap in repairing skin defects of the knee, the leg, the ankle and the foot because it is easy to be designed and dissected and it has reliable blood supply and preserved main artery. The relationship between the septal perforating branches of the tibial posteriorartery and survival size of flap need to be investigated further.
Objective To investigatethe anatomic structure of the compound flap of distally-based saphenous nervegreat saphenous vein nutritional vessels so as to provide anatomic basis for the clinical operation. Methods The origin, branches, anastomosis of nutritional vessels of sural nerve-great saphenous vein, and the relationof blood supply of tibia and soleus muscle were observed on 30 low limb specimens of adult cadaver, which were perfused with red gelatin to dissect from the artery. Results The nutritional vessels of sural nerve-great saphenous vein originated from: the saphenous artery 3-5 branches with a diameter of 0.7±0.4 mm；the cutaneous branches of medial inferior genicular artery, diameter of 0.7±0.2 mm；the intermuscular space perforating branches of posterior tibial artery 2-7 branches with a diameter of 1.0±0.2 mm，the internus halfside of the muscular branches nutrient soleus muscle；the perforating osteoseptocutaneous 1-2 branches with a diameter of 1.3±0.3 mm; the perforating branches of superior malleolus with a diameter of 0.6±0.2 mm; the perforating branches of medial anterior malleolus with a diameter of 0.8±0.3 mm. A vascularnetwork of 3 layers, which included periosteum, deep artery, and fascia nerve and superficial vein, was formed by those branches of deep artery, fascia branches, periosteum branches, and nerve-vein nutrition branches. Conclusion The nutritional vessels of saphenous nerve-great saphenous vein has the same origin as muscles, bones, and cutaneous nutritional vessels. It provides anatomic basis for the compound flap of distally-based saphenous nerve nutritional vessels.
ObjectiveTo summarize experience of diagnosis and surgical treatment of popliteal artery entrapment syndrome (PAES).MethodThe clinical data of 10 patients (10 limbs) with PAES underwent surgery in the China-Japan Hospital of Jilin University from January 2012 to July 2018 were retrospectively analyzed.ResultsAmong 10 cases of PAES, 7 cases were firstly diagnosed with the intermittent claudication, 3 cases had presented the acute lower extremity ischemia. The preoperative ultrasound and (or) computed tomography angiography showed that 9 cases were all the popliteal artery occlusion and the digital subtraction angiography (DSA) was performed in 1 patient after the admission for the treatment. Six patients were preoperatively diagnosed with the PAES. Seven cases were treated with the autologous saphenous vein interstitial bypass; 1 case was occluded on day 3 after the popliteal artery thrombectomy, then the reconstruct of femoral popliteal artery was performed after the exploration and diagnosis. One case directly received the catheter thrombolysis and balloon dilatation during the process of DSA examination, the effect was not good, then the muscular bundle resection and popliteal artery artificial patch plasty was performed after confirming the PAES. All the 10 cases were followed up by the color doppler ultrasound after the surgery, 1 patient underwent the saphenous vein graft reconstruction (distal anastomotic anastomosis) was obliterated on month 1 after the surgery, 1 case was occluded on month 3 after the popliteal artery reconstruction, the patency rate of the remaining 8 patients was 100% from 3-month to 1-year of following-up. ConclusionSurgical treatment is an only effective radical treatment of PAES and its patency rate of total occlusive lesions with autogenous saphenous vein graft is higher.
Objective To investigate the origin of small saphenous vein of distally-based of sural nerve nutrient vessels flap and its clinical application. Methods The origins of nutrient vessels of small saphenousvein and communicating branches of superficial-deep vein were observed on specimens of 30 adult cadaveric low limbs by perfusing red gelatin to dissect the artery. Results The nutrient vessels of small saphenous vein originated from the heel lateral artery, the terminal perforator branches of peroneal artery and intermuscular septum perforating branches of peroneal artery. There were 2 to 5 branches ofsuch distally-based perforating branches whose diameters ranged from 0.6 to 1.0 mm. Those perforating branches included fascia branches, cutaneous branches nerve and vein nutrient branches. Those nutrient vessels formed a longitudinalvessel chain of sural nerve shaft, vessel chain of vein side and vessel networkof deep superficial fascia. The small saphenous vein had 1 to 2 communicating branches of superficial-deep vein whose diameter was 1.7±0.5 mm， 3.4±0.9 cm to the level of cusp of lateral malleolus, and converged into the fibular vein. Conclusion Distally-based sural nerve, small saphenous vein, and nutrient vessles of fascia skin have the same region. The communicating branches of superficial-deep vein is 3 to 4 cm to the level of cusp lateral malleolus. These communicating branches could improve the venousdrainage of the flap.
The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short-and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH.
Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
Objective To explore the effect, operational essential, and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity. Methods In the study, 255 patients with 363 lower extremities of varicose vein in our hospital between May 2006 and November 2009 were treated by transilluminated powered phlebectomy. According to revised clinical etiology anatomic and pathophysiological classification system (CEAP), there were 104 limbs in C2, 53 limbs in C3, 155 limbs in C4, 34 limbs in C5, and 17 limbs in C6. The patients were followed up to observe postoperative complications. Results All varicose vein labeled before operation were resected. Surgical time was (100±20) min in unilateral lower extremity and (147±19) min in bilateral lower extremities. Total 221 patients (302 lower extremities) were followed up in 4 to 46 months, median follow up time was 24.5 months. Total 167 cases (247 lower extremities) had accepted the operation more than 1 year, 154 cases (229 lower extremities) in which were followed up. In the 229 lower extremities above, recurrences occurred in 11 extremities, small amounts of residual small varices were observed in 2 extremities, the recurrence rate was 5.68% （13/229）. Twenty-one limbs with ulcer were healing in 3 to 6 weeks after operation. Postoperative complications: there was paresthesias or pain of ankle area in 16 limbs, which was improved in 3 to 6 months after physical therapy; there was ecchymosis of skin of leg in 112 limbs, which disappeared in 3 to 5 weeks after operation; there was light edema in 37 limbs, which disappeared in 1 to 2 weeks after operation; there was local hematoma in 2 limbs, incision light infection in 5 limbs, skin and subcutaneous tissue necrosis above medial malleolus in one limb, and back of knee popliteal skin lesion in 2 limbs, which were all cured by the symptomatic treatment. Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures. Varicose vein extraction using transilluminated powered phlebectomy is safe, efficacious, and cosmetically satisfactory.
ObjectiveThis study is designed to explore the indications, clinical pathway, and benefits of ultrasound-guided local anesthesia in radiofrequency endovenous obliteration (RFO) for great saphenous vein varices (GSV).MethodsA total of 350 patients diagnosed with GSV were divide into observation group (n=175) and control group (n=175). Patients in the observation group underwent local anesthesia RFO, and patients in the control group underwent intravertebral anesthesia. Comparion in the visual analogue scale pain scores (VAS) when anesthesia and after surgery, operative indexes, recovery time, satisfaction, and complications were performed.ResultsCompared with the control group, the VAS score with anesthesia time were lower (P<0.05), while in the surgery were higher (P<0.05), as well as the operative time, the first time for underground activity, normal activity time, incidences of complication of anesthesia and urinary were shorter (P<0.05), and the satisfaction rate was higher (P<0.05). There was no difference in the pain score of 12 h and 24 h after surgery, blood loss, volume of anesthetic swelling fluid, postoperative hospitalization, incidences of urinary tract infection, incisional infection, and deep vein thrombosis (P>0.05).ConclusionsThe RFO is feasible and safe after local anaesthesia. It can decrease the complication of anesthesia, that will promote the patient soon to be restored to health.
Objective To summarize the treatment outcomes of antegrade sequential anastomosis of great saphenous veins in off-pump coronary artery bypass grafting for coronary atherosclerotic heart disease. Methods A total of 116 patients with coronary atherosclerotic heart diseases underwent off-pump coronary artery bypass grafting from January 2013 to June 2015 in our hospital. There were 63 males and 53 females with a mean age of 42–80 (64.26±9.67) years. Left internal mammary artery was anastomosed to left anterior descending artery. The rest of the target vessels received antegrade sequential anastomosis of great saphenous veins with the order of proximal ascending aorta, diagonal branch, circumflex branch, obtuse marginal branch, left ventricular branch and posterior descending artery. Results All patients were performed off-pump coronary artery bypass grafting successfully without death or perioperative myocardial infarction. A total of 436 grafts were adopted with 3.75±0.53 in each patient. Three patients suffered low cardiac output syndrome, and were cured after administration of vasoactive drugs combined with the intra-aortic balloon pump. One patient suffered tardive pericardial tamponade and one acute renal failure, who were cured with disappearance of angina symptoms and increase of activities without discomfort. Conclusion Antegrade sequential anastomosis, as a safe and effective method, can reduce aortic stoma, save the length of grafts, shorten operative time and quickly restorate blood supply of myocardium in off-pump coronary artery bypass grafting.
Objective To compare the condition of the structure and oxidative stress of great saphenous vein grafts between the patients with and without type 2 diabetes mellitus, and to study the mechanisms for providing the theory evidence ofthe protective way for great saphenous vein graft in patients with type 2 diabetes mellitus. Methods The segments of human great saphenous vein graft were collected from 36 patients undergoing coronary artery bypass graft surgery, who were divided into 2 groups, experimental group (17 patients with type 2 diabetes mellitus) and control group (19 patients without type 2 diabetes mell itus). There was no significant difference in age, gender, hypertension, serum creatinine, hyperl ipidemia, smoking, and the number of pathological coronary arteries between 2 groups (P gt; 0.05). Two cm distal great saphenous vein from each patient was obtained. The structure of great saphenous vein was observed by the microscope, and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase enzymatic activity and superoxide anion level were quantified by lucigenin-enhanced chemilumi nescence. Results The NADPH oxidase activity and superoxide anion levels were significantly higher in experimental group [(308.8 ± 33.7) counts/μg and (1 951.71 ± 355.2) counts/(min.mg)] than in control group [(202.7 ± 29.5) counts/μg and (1 230.73 ± 340.5) counts/(min.mg)] (P lt; 0.05). HE staining showed the damage of ultrastructure of great saphenous vein endothel ium in experimental group, including necrosis and exfol iation of endoepithel ial cells, spl itting of the basement membrane, thickened lower layer of the endothelium with vacuoles and deformed vascular smooth muscle cells; however, integrated vessel intima was observed in control group.