Objective To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous venosaphenous neurocutaneous vascular island flaps. Methods The origin, diameter, branches, distribution and anatomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another4 fresh cadaver voluntary legs were radiogeaphed with a soft X-ray system afterthe intravenous injection of Vermilion and cross-sections under profound fascial, otherhand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity,upper extremity, heel or Hucou in handwere repaired with the proximal or distal pedicle flaps or free flaps in 18 patients(12 males and 6 females,aging from 7 to 3 years). The defect was caused by trauma, tumour, ulcer and scar.The locations were Hucou (1 case), upper leg(3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicatedby bone exposure, 3 cases by tendon exposure and 1 case by steel expouse. the defect size were 4 cm×4 cm to 7 cm×13 cm. The flap sizes were 4 cm×6 cm to 8 cm×15 cm, which pedicle length was 8-11 cm with 2.-4.0 cm fascia and 12 cm skin at width. Results Genus descending genicular artery began from 9.33±0.81 cm away from upper the condylus medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21±0.82 cm away from lower the condylus medialis,and anastomosed with the branches of tibialis posterior artery, like “Y” or “T” pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 00-0.10 mm in diameter, distributed around the great saphenousvein within 58 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal flaps,distal pedicle flaps and free flaps survived well. The appearance, sensation and function were satisfactory in 14 patientsafter a follow-up of 6-12 months. Conclusion The great saphenous vein as well as saphenous neurocutaneous has a chain linking system vascular net. A flap with the vascular net can be transplanted by free, by reversed pedicle, or by direct pedicle to repair the wound of upper leg and foot. A superficial vein-superficial neurocutaneous vascular flap with abundance blood supply and without sacrificing a main artery is a favouriate method in repair of soft tissue defects in foot and lower extremity.
ObjectiveTo observe the efficiency of endovenous laser therapy combined with planning sucking operation in the treatment of great saphenous varicose veins.
MethodsTotally 48 patients (60 limbs) were treated from May 2011 to May 2014 in general surgery department of our hospital. The main trunk of great saphenous vein was ablated by endovenous laser treatment; and the varicose veins in calf were resected by planning sucking operation.
ResultsAll 48 patients (60 limbs) were cured without recurrent during 6-36 months followed-up. The operative time of each side was 18-43 min, the average operative time was 22.6 min; with 1-3 skin incisions. Hospital stay was 5-8 d, the average hospitalization time was 6.7 d. After operation, the varicose veins and the felling of swelling were disappeared, the pigmentation was reduced or disappeared. Local skin numbness showed in 6 cases and recovered in 3-7 months after operation. Felling of burns appeared in 2 cases, and was healed after treatment. Ankle swelling presented in 5 cases, and released in 6-13 d with related treatment. Different degree of subcutaneous bruising appeared without any hematoma, and recovered in 2-4 weeks. Two cases were lost during the followed-up.
ConclusionsEndovenous laser therapy combined with planning sucking operation is safe and effective in the treatment of great saphenous varicose. It is worthy of promotion with minimum damage, less pain, fast recovery, no scars, shorter operative time, and shorter hospital stay.
Objective
To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer.
Method
Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24).
Results
The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups.
Conclusion
Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
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.
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 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.
Objective
To compare the short-term effect of no-touch technique and routine method for harvesting great saphenous vein in coronary artery bypass grafting.
Methods
The clinical data of patients receiving the great saphenous vein by no-touch technique (a NT group) or routine method (a routine group) for coronary artery bypass grafting from April 2016 to July 2017 in our hospital were retrospectively analyzed. There were 26 males and 13 females with an average age of 60.1±8.0 years ranging from 40 to 75 years in the routine group, as well as 21 males and 17 females with an average age of 61.3±6.9 years ranging from 38 to 75 years in the NT group. The operation time, postoperative ventilation duration, postoperative myocardial injury index, postoperative complications, postoperative ejection fraction, postoperative hospital stays and other indicators were compared.
Results
There was no statistical difference between the two groups in operation time, postoperative ventilation time, postoperative ejection fraction or postoperative hospital stays. Incisions of postoperative lower extremity in two groups successfully healed. There was no recurrence of acute myocardial infarction or death. All patients recovered and discharged. One patient was treated with thoracotomy in the routine group. One patient in the NT group had bad healing of chest incision, and one patient with acute kidney injury recovered after treatment.
Conclusion
The great saphenous vein by no touch technique has a good early effect in coronary artery bypass grafting without increasing the risk of surgery.
Abstract: Coronary artery bypass grafting (CABG) is one of the conventional treatments of coronary artery disease. Though the artery grafts have its own superiority, autologous great saphenous vein is still commonly used. Ten years after operation, half of the vein grafts will be occluded and half of the remainder will often undergo severe pathological conditions. The poor long term patency of vein grafts has become the bottleneck of the efficiency of CABG. The restenosis of vein grafts resulting from neointima and atherosclerosis has become an urgent problem waiting to be resolved. As the study on the molecular mechanism and pathophysiology of the vein grafts disease develops, many therapeutic schedules have been made, including drug therapy, external stent, expanding solution and gene therapy. By contrast, gene therapy has a broader prospect. This article will have a review on the prevention of restenosis of the vein grafts after CABG.
This study was to observe the result in patients suffering from severe ischemia of legs with arterialization of the great saphenous vein. Eighty nine patients suffering from the disease were treated by bridging the autogenous cephalic vein or Gore-Tex artificial vessel between the great saphenous vein and the femoral or external iliac arteries. The results showed that the blood supply of the affected legs was increased immediately after operation. The ulcers of the toes and the plantar areas were healed gradually and the pain relieved. It was concluded that this method did not interfere with the reflux of the venous blood in the diseased limbs. This method was simple, safe and effective for treating severe ischemia of the lower limbs.
ObjectiveTo investigate short-term outcomes and surgical techniques of endoscopic saphenous vein harvesting (ESVH) for coronary artery bypass grafting (CABG).
MethodsClinical data of 554 patients undergoing CABG with ESVH in General Hospital of Shenyang Military between July 2009 and August 2013 were retrospectively analyzed. There were 372 male and 182 female patients with their age of 38-84(61.3±9.0) years. Clinical outcomes, postoperative lower extremity pain and edema, wound infection and healing were analyzed.
ResultsDuring ESVH, 13 patients with very little subcutaneous fat received transition to skin bridge technology or partially open incision. Average number of harvested vein grafts was 1-4 (2.0±0.6), and the quality of the vein grafts was satisfactory. Postoperative lower extremity pain and edema were significantly reduced, and there was no delayed wound healing or infection. Seven patients died postoperatively, including 2 patients with perioperative myocardial infarction, 2 patients with pneumonia, 1 patient with ventricular fibrillation, 1 patient with massive cerebral infarction, and 1 patient with multiple organ dysfunction syndrome. A total of 452 patients were followed up for 120-1 460 (742.6±188.5) days. There was no late death or reintervention during follow-up.
ConclusionESVH is a safe and efficacious procedure with less postoperative lower extremity pain and edema, satisfactory vein graft quality, better postoperative recovery and cosmetic results, compared with traditional fully or intermittently open wound for saphenous vein harvesting.
