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.
Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity. Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time, number of the incision, postoperative pain, complications, postoperative hospitalized duration and 1-year recurrence rate. Results Endovenous laser treatment group had shorter operation time, fewer incisions, less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (Plt;0.05). The complications and 1-year recurrence rate had no significant differences between two groups (Pgt;0.05). Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars, endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.
Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities. Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases, including arterial occlusive disease (AODs,62 patients) and thromboangiitis obliterans (TAOs,28 patients). By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients, the immediate and the longterm surgical outcomes were summarized. Results During the hospitalization, 88 patients achieved a remarkable surgical effectiveness, with an immediate surgical effectiveness rate of 97.7% (88/90), but 2 patients failed in the operation and had to undergo amputation of the lower limb. Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation, 64 could have a sufficient blood supply to the lower extremities, with a longterm effectiveness rate of 88.9% (64/72); however, 8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb. Conclusion The one-stage arteriovenous shunt performedon the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.
ObjectiveTo explore the feasibility and technical essentials of soft tissue defect reconstruction of the lower extremity using the distally based anteromedial thigh flap (dAMT) pedicled with perforating vessels from rectus femoris branch. MethodsBetween July 2008 and December 2015, 6 patients underwent defect reconstruction of the lower extremity using the dAMT flap pedicled with perforating vessels from rectus femoris branch. There were 4 males and 2 females with an average age of 34 years (range, 4-55 years). The etiologies included liposarcoma in 1 case, malignant fibrous histocytoma in 1 case, post-burn scar contracture around the ankle in 1 case, and post-burn scar contracture around the knee in 3 cases. The disease duration ranged from 3 to 28 months (mean, 13 months). After resection of lesion tissues, the defect size ranged from 13 cm×7 cm to 24 cm×12 cm. The flap size ranged from 15 cm×8 cm to 24 cm×12 cm. The length of the pedicle ranged from 10 to 25 cm (mean, 19.8 cm). The distance from the flap pivot point to the superolateral border of the patella ranged from 8 to 13 cm (mean, 11.3 cm). The donor sites were directly sutured. ResultsAll flaps survived postoperatively without any complications. All wounds at the donor and the recipient sites healed primarily. The patients were followed up from 5 to 36 months (mean, 17.8 months). The color, texture, and thickness of the flaps were similar to those of the surrounding skin. No tumor recurrence was observed. The range of motion of flexion and extension of the joint were greatly improved in the patients with scar contracture. ConclusionIf the rectus femoris branch gives off cutaneous branch to the anteromedial thigh region and arises from the descending branch of the lateral circumflex femoral artery, a dAMT flap could be raised to reconstruct soft tissue defects of the lower extremity.
Objective To evaluate the effectiveness and safety of surgical thrombectomy for acute deep venous thrombosis of lower extremities. Methods Randomized controlled trials of surgery versus conservative treatment were sought from MEDLINE (1966-Jun.2006), EMbase (1974-Jun.2006), The Cochrane Library (Issue 2, 2006), CBM (1989-Jun. 2006) and CMCC (1994-Jun. 2006). Collections of Chinese Congress on Vascular Surgery (1991-Jun.2006) and the journal of Vascular Surgery (2000-Jun. 2006) were handsearched. Two reviewers independently extracted data into a designed extraction form. The guidance in The Cochrane Collaboration’s Handbook was consulted for quality evaluation and data analysis. Results Six potentially eligible studies were identified. Six were included according to the inclusion criteria. The 6-month total patency was significantly higher in the surgical treatment group than in the conservative treatment group with OR 7.26 and 95%CI 2.40 to 21.94, while the 5-year total patency was not different between the two groups with OR 2.59 and 95%CI 0.88 to 7.67. At month 6 and year 5, the incidence of post-thrombosis syndrome (PTS) was significantly higher in the conservative treatment group than in the surgical treatment group with OR 0.11, 95%CI 0.59 to 1.59, OR0.18, 95%CI 0.06 to 0.60 respectively. The incidence of 10-year PTS and the results of valvular function measurements were similar between the two groups. The incidence of pulmonary thrombosis was also comparable between the two groups with OR 1.40 and 95%CI 0.39 to 4.97. Conclusion Surgical thrombectomy may improve the extent of patency and venous valvular sufficiency in the short term, but without increasing the patency rate. There is no enough evidence to assess whether surgical throbectomy improves long-term outcomes. It is safe to preform surgical thrombectomy. The small number of patients randomised and the low quality of the trials decreases the reliability of the current evidence. Therefore, more high quality randomised controlled studies should be done, to determine the long-term outcomes of surgical thrombectomy.
Objective To report the methods and clinical effect of the lateral crural flaps in repairing anterior tibal, dorsal and calcaneal softtissue defects. Methods From August 1999 to December 2004, 18cases of defects were repaired with lateral crural flap, including 15 cases of anterior tibal, dorsal and calcaneal softtissue defects with vascular pedicled island lateral crural flaps and 3 cases of dorsal pedal soft-tissue defects with free vascular lateral crural flaps.〖WTHZ〗Results All flaps survived after operation.Insufficient arterial supply of the flap occurred in 2 cases after operation, the pedicled incision sewing thread was removed and lidocain was injected around vascular pedicle, then the flap ischemia was released. Inadequate venous return and venous hyperemia occurred in 1 case because peroneal vein was injured duringoperation.The flap edge skin was cut and heparin was locally dripped for one week, the flap vascular cycle was resumed. All patients were followed up two months to one year, the flaps were not fat, and the elasticity was good. Conclusion It is safe and reliable to use lateral crural flap to repair anterior tibial, dorsal pedal and calcaneal soft-tissue defects.
ObjectiveTo evaluate the value of clinical application of determination of lower venous pressure in the diagnosis and treatment of deep venous thrombosis (DVT). MethodsThe 90 patients with DVT of unilateral lower limb who were admitted by using color Doppler or deep veins of lower limb angiography in our hospital during the period of 2013 July to 2014 June were selected and as the research object (case group), 37 cases were male, 53 cases were female; the age was 18-84 years old, mean age was 59.48 years old. According to the development of disease, 90 cases were divided into acute 30 cases, subacute 30 cases, and chronic 30 cases; and according to the pathological types were divided into the central type in 30 cases, 30 cases of peripheral type, and 30 cases of mixed type. At the same time the without lower extremity DVT volunteers of 20 cases were selected as normal control group, including male 9 cases, female 11 cases; age was 21-65 years old, average age was 38.7 years old. The static venous pressure (P0), dynamic venous pressure (P00), and decreased pressure ratio (Pd) of double lower limbs of participants in 2 groups were determinated and comparative analyzed. ResultsThe P0 and P00 of patients with different development of disease and pathological types of the case group were higher than those of the normal control group (P < 0.01), and the Pd was lower than that of the normal control group (P < 0.01). In case group, the P0 and P00 of acute phase were higher than those of the normal control group (P < 0.01), the P0 of central type was higher than that of the peripheral type and mixed type (P < 0.01), and the Pd central type was lower than that of mixed type (P < 0.01). The above 3 indexes' differences of double lower limbs in the normal control group had no statistical significance (P > 0.01). In case group, the P0 and P00 of ipsilateral limb in different development of disease and pathological types were higher than those of the healthy limb, and the Pd were lower than that of the healthy limb (P < 0.01). ConclusionsLower extremity venous pressure measurements can be used in clinical detection for early lower limb DVT, and can be used as the objective index of clinical evaluation curative effect for the treatment of DVT. It is a simple and practical clinical detection method.
Objective To explore the therapeutic effect of catheter-directed thrombolysis combined with vena cava filter on deep venous thrombosis (DVT) of lower extremity.Methods The clinical data of 65 patients with DVT of lower extremities from January 2008 to August 2009 were analyzed retrospectively, whose course of diseases were not more than 7 d and clinical type included central type and mixed type. Thirty-two cases were treated with catheter-directed thrombolysis combined with vena cava filter, while administrating treatment of anticoagulation and activating blood circulation to dissipate blood stasis, which were named as study group. Thirty-three cases were treated traditionally with thrombolysis, anticoagulation, and activating blood circulation to dissipate blood stasis, which were named as control group. The course of therapy was continued 10-14 d, then the efficacy in two groups patients was evaluated. Results It was (7.35±1.42) cm that circumference difference before treatment between affected extremties and unaffected extremties in study group, which of 3, 7, and 14 d after treatment was (4.21±1.12) cm， (2.87±0.98) cm, and (1.22±1.02) cm, respectively. Circumference difference between before and after treatment had significant difference in study group (Plt;0.01). It was (6.97±1.27) cm that circumference difference before treatment between affected extremties and unaffected extremties in control group, which of 3, 7, and 14 d after treatment was (5.72±1.31) cm, (4.58±0.88) cm, and (3.18±1.24) cm, respectively. Circumference difference between before treatment and 3, 7, and 14 d after treatment had significant difference in control group (Plt;0.05 or Plt;0.01). Circumference difference before treatment in two groups had no significant difference (Pgt;0.05). Circumference difference after treatment at different time points in two groups was significantly different, respectively (Plt;0.01). Circumference difference after treatment at different time points in study group was significantly less than that in control group, respectively (Plt;0.01). After 14 d, complete recanalization rate （71.88%, 23/32） and cure rate (71.88%, 23/32) of iliofemoral vein in study group were significant higher than that (36.36%, 12/33) in control group (Plt;0.01). No pulmonary embolism occurred. Conclusion In terms of ideal therapy targets of DVT of lower extremity, the catheterdirected thrombolysis combined with vena cava filter is obviously superior to traditional thrombolysis treatment.
This paper interprets 2017 European Society of Cardiology (ESC) peripheral arterial disease diagnosis and treatment guidelines on lower extremity arterial disease, and in order to provide reference for clinical practice.
Objective To explore the clinical experience of endovascular treatment for arteriosclerosis obliterans (ASO) of lower extremities. Methods Endovascular treatment were performed on 22 patients (26 limbs) suffering from ASO which were diagnosed by magnetic resonance angiography (MRA). The clinical efficacy after operation was analyzed. Results Twentytwo lower extremities of 18 patients successfully accepted endovascular treatment with 12 stents planted without major complications. Four cases failed to endovascular treatment and 2 of them converted to bypass surgery. The clinical symptoms of limb ischemia vanished or significantly improved after treatment. The ankle brachial index (ABI) of affected extremities increased from 0.35±0.13 (before operation) to 0.70±0.15 (after operation), Plt;0.01. During the follow-up of 2-18 months, 3 cases suffered re-occlusion of artery of lower extremity, in them one case received drug treatment and 2 cases resolved by percutaneous transluminal angioplasty (PTA) and stenting again. Conclusion Endovascular treatment for ASO of lower extremities has such advantages as minimal invasiveness, reduced complications and repeatability. It may serve as a more promising choice of method to clinical treatment of ASO.