Objective To evaluate the surgical approach of left superior vena cava（LSVC） distal abnormalities in infant and young children. Methods From April 1999 to December 2004, 19 cases of LSVC distal abnormalities were corrected by primary repair. There were 10 males and 9 females. Their age ranged from 2.7 months to 6.5 years and body weight from 3. 1 to 15.0 kg. Diseases complicated with LSVC included complex congenital cardiac disease 9 cases, ostium secundum atrial septal defect 4, partial abnormal pulmonary venous drainage （PAPVD） with atrial septal defect（ASI）） 2, tetralogy of Fallot（TOF） 3, and double outlet of right ventricle （DORV） 1 case. The ways for surgical treatment of distal abnormalities of LSVC were reconstruction of atrial septum, translocation of LSVC and reconstruction of atrial septum, right atrium and LSVC anastomosis, cavopulmonary anastomosis and repair of partially unroofed coronary sinus. Results One patient died and the diagnosis for the patient was LSVC with DORV and pulmonary hypertension （PH）. This patient died from crisis of PH , obstruction of blood flow in the left cavopulmonary anastomosis, severe low cardiac output,low arterial oxygen saturation and abnormal function of kidney. The mean pressure of right atrium was 9 to 18 mmHg. The percutaneous oxygen saturation （SpO2） was 0.98 1.00 for biventricular repair and 0.79-0. 88 for single ventricular repair and palliative repair. The echocardiography showed no obstruction of the blood flow in LSVC and pulmonary veins. The results of follow-up were satisfactory, from 3 months to 2 years. Conclusions Key for success of surgical approach of LSVC distal abnormalities is precise evaluation of different kinds of LSVC and different surgical approaches. Cavopulmonary anastomosis can not be used in the case of LSVC with PH.
Objective To investigate the venous drainage in retrograde island flaps by fluorescence tracing technique and to observe the pathway of venous drainage. Methods The 0.1mL venous blood was collected from the marginal ear vein of every rabbit (n=20), respectively, and erythrocytes were separated by centrifugation and then were labeled with FITC. Positive rate and fluorescence intensity of FITC-labeled RBC were detected by flow cytometry. RBC morphous was observed under the inverted fluorescence microscope. Saphenous retrograde island fasciocutaneous flap and antegrade islandfasciocutaneous flap (4.0 cm × 3.0 cm in size with vascular pedicle length of 3.0 cm) were successfully establ ished in hind l imbs of 20 New Zealand white rabbits．One hind l imb of each rabbit was randomly assigned as the experimental group and the contralateral side was assigned as the control. The same flap was establ ished in the control group without any fluorescence tracer. According to retrograde or antegrade flaps, the experimental group was divided into 2 groups with 10 rabbits in each group. And then, according to different pathways of tracer-giving, each group was divided into 2 subgroups of artery and vein, with 5 rabbits in each subgroup. The labeled erythrocytes (5 μL) were injected into artery or vein and then flaps were cut down 5 seconds later. The flaps were immediately frozen and chipped (5-7 μm). Consecutive three frozen sections were made and two of them were stained with HE and GENMED, respectively, but the third one was squashed without staining. All frozen sections were observed under the microscope. Results Positive rate of FITC-labeled RBC was beyond 99% and fluorescence intensity was more than or equal to 103. FITC-labeled RBC showed steady green fluorescence under the inverted fluorescence microscope. Fluorescence appeared in all experimental groups, but none was found in the control groups. In antegrade island flap group, fluorescence appeared mainly in lumen of vein, wall of vein and inner membrane and outer membrane of artery. In retrograde island flap group, fluorescence distributed principally in inner membrane and outer membrane of artery and wall of vein. Conclusion The fluorescence tracing is appl icable to the research of venous drainage. Venous drainage in the antegrade island flaps is mainly through lumen of vein, wall of vein and inner membrane and outer membrane of artery. While, venous drainage in retrograde island flaps is principally through inner membrane and outer membrane of artery and wall of vein.
Objective To observe the survival rate of reversed-flow free flap after anastomosing one venous reverse flow and to explore the change of intravenous pressure and mechanism of venous reverse flow. Methods Thefree vascularized posterior tibial flap with reversed flow was successfully established in NewZealand white rabbits.Fifteen rabbits were randomly allocated into 3 groups of 30 flaps. In group A,two vena comitans were anastomosed.In groups B and C,only onevenae comitans was anastomosed. In groups A and B,intravenous pressure was measured immediately and 30,60 and 120 minutes after anastomosing the vascular pedicle.Flap survival rate of group B was measured after two weeks. In group C, radiography of one venae comitans was observed.The diameters of posterior tibial vessels was measured on all the rabbits before anastomosing the vascular pedicle. Results The diameters of posterior tibial artery was 8.0±0.3mm and of vena comitans was 11.0±0.5 mm。The intravenous pressure of group B increased rapidly and reached its top value after about 30 minutes (P＜0.05).It then decreased and approached normal level after about 60 minutes (Pgt;0.05).The intravenous pressure was not significantly different between groups A and B in each time interval (Pgt;0.05).Two flapsresulted in avulsion,infection and necrosis.The remaining 8 flaps survived completely.Most of the radiopaque in group C flew back to the proximal tibia one hourlater. Conclusion Venous retrograde return is abundant in reverseflow free flap of anatomosing one vena comitans.The main way of venous reflux in reverseflow free flap can be through “direct incompetent valve route”.
In order to investigate the survival mechanism and the role of venous drainage in arterialized venous skin flap, 60 rabbits’ ears were used for research and clinical application of the flap was performed subsequently in two cases. The rabbits were divided into 4 groups. Experimental group was standard arterialized venous skin flap, control 1 group was venous skin flap, control 2 group was arterialized venous skin flap with only one drainage vein and control 3 group was normal skin flap. The process of survival of the flaps was observed by hemodynamic and histological method. The results showed that there was no significant difference between standard arterialized venous skin flap and normal skin flap (P gt; 0.01). Two cases of arterialized venous skin flap survived completely. The conclusion were as follow: 1. the opening of collateral circulation between the veinlets was the main change of the microcirculation; 2. the blood flow of the graft was changed from unphysiological circulation to physiological circulation as the time elapsed and 3. amelioration of venous drainage was important in inproving the survival rate of arterialized vein graft.
ObjectiveTo investigate the decompression and diverting effects of vascular anastomosis based on the digital arterial arch branch in replantation of free finger-pulp in distal phalanges. MethodsA retrospective analysis was performed on the clinical data of 12 patients (12 fingers) who underwent free finger-pulp replantation with anastomosis of proper palmar digital artery and the palmar digital artery arch branch in the distal end between December 2004 and March 2015. Of 12 cases, 9 were male and 3 were female, aged 15-39 years with an average of 32 years. The causes of injury included cutting injury in 4 cases, crush injury in 7 cases, and avulsion injury in 1 case. The thumb was involved in 2 cases, index finger in 4 cases, ring finger in 3 cases, middle finger in 1 case, and little finger in 2 cases. The free finger pulp ranged from 1.8 cm×1.5 cm to 2.8 cm×2.0 cm. The time from injury to operation ranged from 1.5 to 11.0 hours, with an average of 5.7 hours. No arterial arch or proper palmar digital arteriae anastomosis was excluded. ResultsFree finger-pulp survived in 11 cases after operation; venous crisis occurred in 1 case at 2 days after operation, and was cured after symptomatic treatment. Nine cases were followed up 6-18 months with an average of 10 months. The finger-pulp had good appearance, clear fingerprint, and soft texture. The two-point discrimination was 3.1-6.0 mm, with an average of 4.6 mm at 6 months after operation. The function of finger flexion and extension was normal. And according to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, the results were excellent in 7 cases, and good in 2 cases. ConclusionIn the replantation of amputated pulp with insufficiency of venous blood outflow, the anastomosis of digital arterial arch branch in the distal end can decompress and shunt arterial blood, adjust blood inflow and outflow, and solve the problems of insufficient quantity of the vein and venous reflux disturbance.