An Anatomical Study On The Venous Architecture Of The Flap And Its Clinical Significance

Objectives:The purposes of the present study are as follows:(1) Anatomical study inclulding observation and measurement on arterial,especially venous system of flap was performed to attempt to illuminate the regular patterns of the distribution of the arteries,veins and their branches in the axial vascular skin flap. (2) Fathoming the origination,distribution,drainage scope and communicating path of deep and superficial veins or accompanied and unaccompanied veins. (3) Elucidating the positions,shape and functions of venous valves in deep and superficial venous stem and its communicating branches,observing their affects on the venous blood circulation. (4) Clarifying the accompanied characters of the veins and arteries of the flap and the reflux routes of vein. (5) Confirming the main channels of venous reflux of flap. (6) Providing anatomical evidence for the selection of vein engrafting in flap free grafting or transplantation. Study the vein reflux and communication of flap whose blood supply is trans-section and clarify the blood circulation of non-physical flap. Through all of the work mentioned above,elucidating the stereo architecture of flap vein and ensuring the mechanism inside,provide anatomical basis for the applying characteristic,selection of engraft vein and the treatment of the circulation crisis.Methods:(1) Using both lower limbs of fresh adult cadavers,cannulas inserted forward from femoral artery and backward from dorsal venous networks of foot to inject 8% gelatin carbonic ink,intra-femoral and local inject formalin to prevent rot. Gutted flap washed by current water,dehydrate using graded ethanol,vitrification by dimethylbenzene and deposited in holly oil. (2) Using both upper and lower limbs of a fresh adult cadaver,inject red gelatin into femoral,forward and backward injecting the blue gelatin withhigh pressure into femoral vein with formalin preventing rot. As for fresh male adult cadaver,inject 8% gelatin carbonic ink,14% ammonia and red gelatin until the ventral skin of the toe turn red from black,washing 6 hours by flowing water. Cutting the scapular flap,anterolateral femoral flap,chest-umbilicus flap and medial superior genicular flap,after washing and rot prevention,inject 8% gelatin ink solution into artery. (3) Left lower limb was used to prepare artery(red) and vein(blue) color cast specimens using perchloroethylene.(4) Deep freezed right lower limb sample,injecting red gelatin into femoral artery,forward and backward injecting blue latex with barium sulfate into femoral vein and great saphenous vein,cuting flap after dealing with formalin and get x-ray photos. (5) Fresh right lower limb sample:making tissue into slice samples,after washing and fixation,injecting 8% gelatin ink into artery by cannulas until the superficial skin turn black equally and injection solution overflow from the vein. Get 4 right anterolateral femoral flaps and 4 left scapular flaps which were dyed obviously after 3 days,dehydrate by graded ethanol,vitrification and paraffin embeded,horizontally and vertically sliced continuously,thickness is 15,20 and lOOjtim respectively,HE dyed,observed under microscope.Results:(1) Direct cutaneous artery or musculo-cutaneous artery,in the procedure of common integument tissue being shallowed up step by step,continuously sending out branches to deep fascia layer,superficial fascia layer,hypodermis layer,hypopapilla layer and papilla layer to form the five-grade cutaneous microcirculation "blood vessel tree" of the skin blood vessel network that can be identified. (2) Common integument tissue venous vessel network can be divided into five layers from superficial layer to deep layer:cutaneous papillary layer,hypopapillary layer,hypodermis layer,subdermal layer and deep fascia layer.The artery branch and arteriole that shallowed up from hypopapillar layer get to papillar layer to form vessel network,circuitous and twisted,reflux and anastomose to become postcapillary micro veins and endothelial venule,then anastomose each other and accompanied with artery to ente...