Study On Transplanting Multi-Branched Superficial Veins From Dorsum Of Feet To Solve The Problem Of Insufficient Of Superficial Veins On Dorsum Of Hands

ObjectiveTo investigate the clinical application value and possibility of transplantingmulti-branched superficial veins from dorsum of feet to dorsum of hands in the cases ofvein defects.MethodThe normal blood pressures of upper and lower extremities of30volunteers aged25to30were measured, then the blood pressure of every volunteer was kept at three-forth ofhis/her normal blood pressure with mercury sphygmomanometer making the over-filling ofsuperficial veins. Under this condition, the calibers of superficial veins on the dorsum ofhands/feet of volunteers were measured with vernier caliper and color Doppler, and therelative position of veins was observed.From August2010to December2011,5patients with large area defects of soft tissueof hands were treated with transplanting multi-branched superficial veins from dorsum offeet. Of5patients,4were male and1was female.They ranged in age from21to56yearswith a median age of35.3. The smallest area of soft tissue defects was11cm×25cm, and alldefect areas were covered with ALT or ALT combining other transplants. The shape,circulation and restoration of sensation of the flaps were observed and recorded.ResultsThe average systolic pressure of both upper extremities of volunteers was125.887±11.673mmHg, the average diastolic pressure was86.792±7.683mmHg. Theaverage systolic pressure of their lower extremities was132.487±11.673mmHg, theaverage diastolic pressure was94.018±10.114mmHg.The observation of the superficial veins on the dorsum of hands of all volunteers showed that there were two main types of superficial veins’ shape: bow-type(22hands) andnet-type(38hands).14left hands’ and8right hands’ were bow-type,16left hands’ and22right hands’ were net-type. Shape of superficial veins on distal part of dorsum of feet waslike a bow, and the protruding point was at the line connecting the metatarsal heads. Therewere thinner veins which communicated with distal venous arch, SVG and SVS makingthe rete venosum.Both results gained through naked eyes measurement and Doppler measurementshowed that calibers of superficial veins presented gradual enlargement from the distal partto the proximal part on dorsum of hands and feet. Meanwhile, the difference value betweenwidth of cephalic vein and veins on the distal part of dorsum of feet was larger than onethird of the former, and so was the situation between basilica vein and SVS, basilica veinand cephalic vein. Thus it might be unsuitable that superficial veins on the distal part ofdorsum of feet were anastomosed to cephalic vein or basilica vein directly, and it wasunsuitable for SVS to be anastomosed to cephalic vein directly too.All cases were followed up from3to13months (mean,9.6months). All transplantssurvived with primary healing and no infection was found. One flap appeared veincirculation crisis and survived after operative treatment. The grafts had tender texture andgood elasticity with the similar color with the adjacent skin. However, most flaps appearedswollen and needed plastic operation.ConclusionThe treatment by transplanting multi-branched superficial veins had flexibleapplication increasing the survival rate of combined tissues. It applied to the cases of largearea defects of hands which lacked of superficial veins to be anastomosed.