Correlation between body mass index and elbow vein grading in patients with metabolic syndrome based on superficial vein evaluation / 中国实用护理杂志

Objective:To analyze the correlation between body mass index (BMI) and the graded expression, subcutaneous depth, and diameter of elbow veins (cephalic vein, median vein, basilic vein) in patients with metabolic syndrome, to provide a method and theoretical basis for precise puncture of peripheral veins in obese patients.Methods:From January to October 2021, a total of 767 patients with metabolic syndrome with gastric volume reduction were selected as the study subjects by retrospective cohort study from the first Affiliated Hospital of Nanjing Medical University. According to the quartile Q1, M and Q3 of BMI level, they were divided into four groups: group A, group B, group C and group D. The subcutaneous depth and diameter of the cephalic vein, median vein and basilic vein were measured by B-ultrasound, and the three veins were evaluated and graded according to the grading criteria of superficial veins.The correlation between BMI and the subcutaneous depth and diameter of the three elbow veins was analyzed, and collected data such as puncture method and puncture times. Results:There was no significant correlation between BMI and subcutaneous depth and vessel diameter of the basilic vein ( r = 0.041 and 0.046, both P>0.05), the level of BMI was positively correlated with the subcutaneous depth and diameter of cephalic vein ( r = 0.275 and 0.117, both P<0.05) and median vein ( r = 0.236 and 0.148, both P<0.05), and a linear regression relationship was found ( OR values were 1.013-1.031, all P<0.05). 187 cases had direct puncture conditions under direct vision, and the success rate of one puncture was 86.63%(162/187).Venipuncture was completed under the guidance of B-mode ultrasound for 25 cases with failure under direct vision and 580 cases without direct puncture conditions under direct vision, the success rate of one puncture was 98.51% (596/605). Conclusions:With the increase of BMI level in patients with metabolic syndrome, the depth and diameter of both cephalic vein and median vein increase, venous exposure is difficult to express. The visual vein puncture guided by B-ultrasound is more accurate and catheterization is more reliable.

Reconstruction of soft tissue defects of extremities with polyfoliate anterolateral thigh perforator flap / 中华显微外科杂志

Objective:To report the clinical effect of using polyfoliate anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects of extremities.Methods:From April 2017 to January 2020, 21 cases of soft tissue defect in extremities were repaired by polyfoliate ALTPF, including 11 cases of traffic accident trauma, 8 of machine crush injury, and 2 of iatrogenic complications. There were 14 cases in calf and ankle, and 7 in hand and wrist. The area of defect was 17.0 cm×12.0 cm-20.0 cm×14.0 cm. Eight cases were complicated with fracture and bone exposure, 13 with tendon and nerve exposure. Thirteen cases had 2 adjacent wounds and 8 had large wound. The polyfoliate ALTPF was designed for wound repair. The patients entered follow-up regularly. The last follow-up included the colour, texture, shape, sensation of the flap and the scar of the donor area.Results:There was no infection in the recipient site of all 21 patients after operation, and all flaps survived. Two cases had venous crisis, with 1 was found in 5 hours after operation. Emergency exploration found that there were thrombosis in anastomosed veins. The flap survived completely after the thrombus removed and the embolized vein was anastomosed again. Another case was found with venous crisis at 1 lobe of flap in 2 hours after operation. Emergency exploration found that the anastomotic site between the superficial vein from the medial edge of the flap to the great saphenous vein and the superficial vein of the recipient area was embolised. The flap survived completely after the thrombus removed and the embolized veins was anastomosed again. The wounds of all donor sites healed in the first stage. All patients were followed-up for 6-30 (mean 12.3) months. All flaps had good colour and texture, with slightly bloated appearance and dull sensation. There was only a linear scar in the donor area, and the appearance evaluation was good.Conclusion:Polyfoliate ALTPF can be used to repair 2 large or adjacent wounds in 1 stage, reduce the damage of donor site. It is an ideal method to repair large or adjacent wounds of limb.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the re鄄lationship between the incidence of vein crisis and superficial vein anastomosis. Methods A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed.The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anasto鄄mosis was compared by Chi-square test. The difference was considered as statistically significant when P＜0.05. The regular postoperative followed-up was performed. Results The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The dif鄄ference was statistically significant ( χ2=4.217, P＜0.05). There was no significant difference in the superior rate be鄄tween the 2 groups after operation(96.8% and 90.0% respectively, χ2=0.596, P＞0.05). The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm. Con鄄clusion DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects / 中华显微外科杂志

Objective@#To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the relationship between the incidence of vein crisis and superficial vein anastomosis.@*Methods@#A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed. The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anastomosis was compared by Chi-square test. The difference was considered as statistically significant when P<0.05. The regular postoperative followed-up was performed.@*Results@#The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The difference was statistically significant (χ2=4.217, P<0.05) . There was no significant difference in the superior rate between the 2 groups after operation (96.8% and 90.0% respectively, χ2=0.596, P>0.05) . The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm.@*Conclusion@#DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis.

Air pressure cuff-assisted thrombolytic therapy in treating deep venous thrombosis of lower extremity:a comparison study of two kinds of air pressure cuff / 介入放射学杂志

Objective To investigate the optimal pressure range produced by two types of air pressure cuff in order to block superficial vein to assist thrombolytic therapy for deep venous thrombosis (DVT) of lower extremity,which can effectively dissolve the thrombus as well as improve the patient's comfort,and to provide useful basis for the implementation of individualized and standard nursing process.Methods A total of 80 patients with lower limb DVT were randomly and equally divided into the modified air pressure cuff group (study group,n=40) and the traditional standard sphygmomanometer cuff group (control group,n=40).Thrombolytic therapy by using continuous intravenous infusion of urokinase via the dorsalis pedis vein with infusion pump was performed in all patients of both groups.The daily dose of urokinase was the same.The pressure value to obstruct lower limb superficial venous blood flow,that was the airbag pressure value when the deep veins of lower limb became visualized on venography,was determined.Leg swelling fade-away rate,mean thrombus clearance rate and patient's comfort degree,etc.were calculated,and the results were compared between the two groups.Results In the study group,the pressure value to block superficial venous blood flow of lower limb was 65-75 mmHg with a mean of (70±5) mmHg;which in the control group was 60-85 mmHg with a mean of (70±10) mmHg.The Leg swelling fade-away rate,the mean thrombus clearance rate determined at different time points,and the patient's comfort degree of the study group were remarkably better than those of the control group (P＜0.05).Conclusion Compared to the use of traditional standard sphygmomanometer cuff,the use of modified air pressure cuff to block the lower limb superficial venous blood flow can obtain better thrombolytic effect,meanwhile,the patients can get high comfort degree in the therapeutic process.

Risk factors of traumatic arterial and venous cerebral infarction in patients with moderate or severe craniocerebral trauma / 中华创伤杂志

Objective To provide theoretic support for preventing traumatic arterial and venous cerebral infarction after craniocerebral trauma by probing into the related risk factors.Methods The clinical data of 154 pateints with moderate or severe craniocerebral trauma treated by decompressive craniectomy were studied retrospectively.Univariate analysis was carried out on 13 related factors including gender,age,Glasgow Coma Score(GCS)on admission,pupil status,morphological changes of ambient cisterns,brain midline,associated injury,blood pressure,traumatic superficial cerebral veins injury,platelet count,plasma D-dimer value,dosage of dehydrating agent and perioperative fluid balance.Then,the logistic multiple regression analysis was made on significant indexes with SPSS 10.0.Results Univariate analysis showed that seven factors including pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline were significantly correlated with traumatic arterial cerebral infarction(P ＜ 0.05)and that three factors including traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury were significantly correlated with traumatic venous cerebral infarction(P ＜ 0.05).Logistic multi-factors regression analysis showed that mydriasis and hypotension might be the independent risk factor of traumatic arterial cerebral infarction and that traumatic superficial cerebral veins injury might be the independent risk factors of traumatic venous cerebral infarction.Conclusion The pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline are the risk factors of traumatic arterial cerebral infarction,with mydriasis and hypotension as independent risk factors.Traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury are the risk factors of raumatic venous cerebral infarction,with traumatic superficial cerebral veins injury as independent risk factor.

Mondor’s Disease

A Mondor’s disease is a rare, benign and self-limiting condition. It is due to thrombophlebitis of the superficial veins of the breast and chest wall. It usually occurs in middle-aged women who present with a palpable cordlike structure, often painful in the acute phase. The aetiology is unknown, and may be related to trauma, surgery, infection or tight clothing. The finding of a superficial vessel seen as a linear opacity on mammography and a tubular structure on ultrasound is typical. An intra-luminal thrombus may be seen on ultrasound, and there may be absent flow on Doppler imaging. Conservative treatment is usually instituted, although surgery may be indicated in certain circumstances.

Microanatomy study and clinical application of superficial palmar digital veins in fingertip replantation / 中华显微外科杂志

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.

The Pattern & Change of Venous Reflux in Primary Varicose Vein

PURPOSE: Venous reflux in primary varicose vein arises from the saphenofemoral junction (SFJ), and the saphenopopliteal junction (SPJ) and it can arise from the non-junctional great saphenous vein (GSV) tributaries and, the non-saphenous veins. Superficial venous surgery (SVS) is associated with a significant improvement in the lower leg venous hemodynamics. We performed a retrospective study to examine the prevalence of the reflux pattern in the primary varicose veins and, to observe any change of non-junctional GSV reflux. METHOD: From May 2004 to July 2005, 481 patients (766 limbs) were diagnosed with venous incompetence by performing a duplex ultrasound examination. A follow-up duplex ultrasound examination was performed for a group of non-junctional GSV reflux patients and for a group of patient having both superficial vein reflux and deep vein reflux. RESULT: The prevalence of SFJ reflux, SPJ reflux, below the knee GSV reflux with competent SFJ and, non saphenous vein reflux was 82%, 13%, 10% and, 4.5% respectively. In the patients with SVS who had deep vein reflux (DVR), DVR was absent in only on two patients (6%). Eight patients (9.1%) of the 88 primary varicose vein patients had asymptomatic left iliac vein obstruction detected by performing an ascending venogram during radiofrequency ablation (RFA). On the duplex findings after SVS, the reflux pattern of left deep venous system was not different from the right deep venous system. CONCLUSION: Varicose veins may occur in any vein, even if junctional reflux is predominant. Careful duplex ultrasound evaluation will delineate the changing pattern of venous reflux with/without SVS. Although superficial venous surgery must fit the patient's map, the results might be variable. Prospective studies are needed to analyze the dynamics of venous reflux after SVS.

Clinical application of the third dorsal metacarpal artery island flap with the dorsal metacarpal superficial vein / 中华创伤骨科杂志

Objective To explore the surgical technique of applying the third retrograde 3rd dorsal metacarpal artery island flap with d orsal metacarpal superficial vein i n order to expand the repairing range of the3rd dorsal metacarpal artery island flap and increase the survival of the flap.Methods After 1999,13cases of the dorsal and pulp soft tissue defect of the 3rd and 4th fingers were designed to be repaired with the third dorsal metacarpal artery island fla p with dorsal metacarpal superficia l vein.The flap pedicle carried the 3rd dorsal cutaneous nerve and superficial metacarpal vein.The flap axis extended proximally 6cm along the original axis.The flap was harvested according to t he axis of the superficial vein.Results All flaps survived completely and2cases seemed survived as vein flaps.Consclusions This surgical technique can be used t o expand the re-pairing range of the 3rd dorsal metac arpal artery island flap,and be suitable to repair the dorsal and pulp soft tissue defcts of the 3rd and 4th finge rs.The one stage operation is simple,practical and effective.

Microsurgical Anatomy of Intracranial Venous System / 대한뇌혈관학회지

OBJECTS: Although plenty of articles about microsurgical anatomy of the cerebral arteries exist in literatures, there is a few articles which studied the microsurgical anatomy of the cerebral venous system. To get the more accurate knowledge about microsurgical anatomy of the cerebral venous system related to the commonly used surgical approach route for cerebovascular lesions, this study is performed. MATERIAL AND METHODS: The author reviewed several articles which described about the anatomy of cerebral venous system, and selected some articles which studied the microsurgical anatomy of cerebral veins related to the area of the surgical approach routes for cerebrovascular lesions. General venous anatomy of lateral surface of cerebral hemisphere and the venous system related to the surgical approach route are described. RESULTS: The superficial cortical veins of lateral surface of cerebral hemisphere are divided into an ascending group, which drain into superior sagittal sinus, and a descending group, which drain into superficial sylvian veins or transverse sinus. Three anastomotic veins, such as the vein of Labbe, Trolard and the superficial sylvian veins, connect between superior sagittal sinus, veins along the sylvian fissure and transverse sinus. The anatomical knowledge of the sylvian and frontal basal veins, venous sinus around the superior sagittal sinus and medial frontal veins, and temporal basal veins are required in pterional, interhemispheric, and subtemporal approach respectively. CONCLUSION: The author concludes that the advancement of anatomical knowledge about cerebral venous system will contribute the improvement of outcome of surgically treated patients with cerebrovascular disease.

MICROANATOMY OF THE MESENCEPHALIC VEINS OF THE CHINESE / 解剖学报

A new method known as continuous arterio-venous perfusion and clearing of thick sections according to Mulligan's procedure Were applied. After the vessels of the mesencephalon were perfused, arteries revealed red colour and the -veins blafck. Under SXP-1 stereo-microscope, the morphology, rate of occurrence, tributaries and drainage of the interpeduncular veins, the posterior communicating vein, the lateral peduncular veins, the circumpeduncular veins, the veins of the pontomesencephalic sulcus, the lateral mesencephalic veins, the veins of the brachium conjunctivum, the precentral cerebellar vein and the quadrigeminal veins of 27 (54 sides) adult mesencephala were observed. The origin, course, drainage and outlet of internal veins such as antero-medial, anterolateral, lateral and posterior veins of 10 adult mesencephala were investigated and compared with 3 venograms of mesencephalon from other specimens. The clinical significance of some of the above vessels were discussed.