A retrograde island flap pedicled on the frontal branch of superficial temporal artery with additional vein anastomosis for reconstruction of peri-auricular defects / 中华整形外科杂志

Objective@#To investigate an effective method for solving the venous stasis in reverse peri-auricular flap pedicled on the frontal branch of superficial temporal artery(STA).@*Methods@#From October 2013 to May 2016, 5 patients with peri-orbital defects were reconstructed with a retrograde flap pedicled on the frontal branch of STA that incorporated additional venous anastomosis. The additional venous anastomosis was created between the parietal branch of STV (superficial temporal vein) and the middle temporal vein. The defects at donor sites were directly sutured.@*Results@#The size of flaps ranged from 2 cm×2 cm to 2 cm×8 cm. All flaps survived without venous stasis. Color and texture match of the flap were excellent .In three cases, flaps were thinned in secondary operation. During the follow-up period(6 months to 2 years, average of 12.4 months), flaps survived well on early period. Excellent color and tissue match with peri-orbital tissue were achieved on later stage. The scar at the donor site was inconspicuous.@*Conclusions@#Retrograde island flaps pedicled on the frontal branch of superficial temporal artery with vein anastomosis has the advantages of robust blood supply, good texture, and color match, and acceptable donor mobidity, while avoiding the venous stasis and flap necrosis.

Treatment of Venous Stasis Ulcer with 3M(TM) Coban(TM) 2 Layer Compression System: A Case Report

PURPOSE: Venous stasis ulcer is the most severe form of chronic venous insufficiency and this commonly appears in the lower limb. Pharmacological therapy, reconstruction of the venous system, surgical management, cellular therapy and compression therapy are known as the treatments of venous stasis ulcer, but relapses are common, which make it a typical chronic wound. We report here on a case of recurrent venous stasis ulcer that healed with compression therapy without any other treatment. METHODS: A 35-year-old man with a 13 years history of venous stasis had developed an ulcer on the distal third portion of the lower left limb which was developed 12-year before enrollment in this study. He had been treated with vacuum assist closure, 2 times of cell therapy and 3 times of skin graft for 8 years, but the lesion recurred. From November, 2008 compression therapy was done with the 3M Coban(TM) 2 Layer Compression System(3M, St. Paul, USA). The ulcer at that time was oval shaped and 3x4cm in size. A comfort layer bandage was applied from the proximal phalanx of the great toe to the knee. A compression layer bandage was applied on the previous layer with it being overlapped one half the width of the comfort layer bandage. The dressing was changed every 4 days and the change was recorded with photography. RESULTS: A total of 12 Coban(TM) 2 Layer Compression Systems were used. The size of the ulcer decreased to 2.5x2.5cm in one month, to 2x2cm in 2 months, it was 1x1.8cm in size at 3 months and it completely healed in 4 months. CONCLUSION: The venous stasis ulcer was completely healed using the 3M Coban(TM) 2 Layer Compression System. This method was easy to apply, made the patient comfortable and it provided an excellent compression effect. As in the previous studies, this compression therapy has been proven to play an important role for the treatment and prevention of venous stasis ulcer.

Doença veno-linfática: alterações linfocintilográficas nas úlceras venosas / Venous-lymphatic disease: lymphoscintigraphic abnormalities in venous ulcers

Contexto: O sistema linfático tem papel relevante em qualquer tipo de edema periférico. Atualmente, a linfocintilografia é considerada o principal exame para diagnóstico da doença linfática das extremidades. Embora haja associação entre edema linfático e úlcera de estase venosa crônica, a fisiopatologia dessas alterações permanece indefinida. Objetivo: Verificar as alterações linfocintilográficas qualitativas que ocorrem em pacientes portadores de úlceras de estase dos membros inferiores. Métodos: Quarenta pacientes portadores de úlcera de estase venosa crônica ou cicatriz unilateral foram submetidos a linfocintilografia de ambos os membros inferiores. Foram estudados 25 mulheres e 15 homens, com média de idade de 53,7 anos (28 a 79 anos) e tempo médio de úlcera de 71,5 meses (3 a 240 meses). Foram comparados qualitativamente os parâmetros linfocintilográficos dos membros inferiores, previamente classificados em três grupos de acordo com a classificação clínica, etiológica, anatômica e patológica (CEAP): I, membros sem sinais clínicos de doença venosa ou com telangiectasias e veias reticulares (classes 0 e 1); II, membros inferiores com veias varicosas, edema e/ou alterações de pele e subcutâneo (classes 2, 3 e 4); III, membros inferiores com úlcera e/ou cicatriz (classes 5 e 6). Resultados: Quando foi comparada a presença de alterações linfocintilográficas dos membros com úlcera ou cicatriz (grupo III - classes 5 e 6) com as dos membros sem úlcera (grupos I e II - classes 0, 1, 2, 3 e 4), houve diferença significativa (p < 0,001). Estratificando os membros inferiores de acordo com a classificação CEAP, também foi observada diferença estatisticamente significante (p < 0,001), sendo as alterações linfocintilográficas presentes em 72,5 por cento no grupo III (classes 5 e 6), 30,8 por cento no grupo II (classes 2, 3 e 4) e 7,1 por cento no grupo III (classes 0 e 1). Em relação aos parâmetros analisados na linfocintilografia, ocorreu diferença...

Background: The lymphatic system plays a relevant role in any type of peripheral edema. Lymphoscintigraphy is currently considered the primary test in the diagnosis of lymphatic disease of the lower limbs. Although there is an association between lymphatic edema and chronic venous ulcers, the physiopathology of such changes remains uncertain. Objective: To assess qualitative lymphoscintigraphic findings in patients with chronic venous ulcers of the lower limbs. Methods: Forty patients with unilateral chronic venous ulcer or scar were submitted to bilateral lymphoscintigraphy of the lower limbs. The sample was comprised of 25 women and 15 men, with a mean age of 53.7 years (28 to 79) and mean ulcer duration of 71.5 months (3 to 240 months). Lymphoscintigraphic parameters were qualitatively compared among three groups of lower limbs previously classified according to the clinical, etiologic, anatomic and pathologic classification (CEAP): I, limbs without clinical signs of venous disease or with telangiectasias and/or reticular veins (classes 0 and 1); II, limbs with varicose veins, edema and/or skin and subcutaneous alterations (classes 2, 3 and 4); III, lower limbs with ulcer and/or ulcer scars (classes 5 and 6). Results: There was a significant difference (p < 0.001) in the comparison of lymphoscintigraphic findings of the lower limbs with (group III - classes 5 and 6) and without ulcers/scars (groups I and II - classes 0, 1, 2, 3 and 4). There was also a significant difference (p < 0.001) in the comparison of groups according to the clinical CEAP classification: lymphoscintigraphic abnormalities were present in 72.5 percent in group III (classes 5 and 6), in 30.8 percent in group II (classes 2, 3 and 4), and in 7.1 percent in group I (classes 0 and 1). There was a statistically significant difference between group III and the other groups with regard to radiotracer retention, inguinal adenomegaly and dermal reflux. There was no significance...

A Case of Venous Stasis Ulcer Treated by Subfascial Endoscopic Perforator Ligation and Split Thickness Skin Graft

PURPOSE: The wound of a patient who has chronic venous insufficiency is easy to recur. Also they develop a complication even after the conservative therapy or skin graft. We have to diagnose the venous stasis ulcer correctly and remove the cause to improve the effectiveness of treatment. We operated endoscopic perforating vein ligation and splitt thickness skin graft on a patient with venous stasis ulceration on right leg. METHODS: A 26 year old male patient who had a scalding burn on his right leg in July 2005 checked into our hospital in March 2008. Even though he got three operations-the split thickness skin graft-at different clinics, the wound did not heal. The size of the wound was 12 by 8 cm2 and granulation with edema and fibrosis had been formed. We kept observation on many collateral vessels and perforating vein through venogram and doppler sonography and firmly get to know that the wound came with chronic venous insufficiency. After a debridement and an application of VAC(r) for two weeks, the condition of granulation got better. So we proceeded with the operation using subfascial endoscopic perforating surgery and split thickness skin graft. RESULTS: Through the venogram after the operation, we found out that the collateral vessels had been reduced compared to the previous condition and the widened perforating vein disappeared. During a follow up of 6 months, the patient did not develop recurrent stasis ulcer and postoperative complications. CONCLUSION: Subfascial endoscopic perforator ligation is a relatively simple technique with a low complication rate and recurrence rate. Split thickness skin graft with subfascial endoscopic perforator surgery can be a valuable method for treating severe venous stasis ulcers.

A Case of Elephantiasis Nostras Verrucosa

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV

Cluster-like Headache Secondary to Cerebral Venous Thrombosis

Cluster headache (CH) is considered a primary headache syndrome. However, symptomatic cases that resemble CH have also been reported. A patient with cerebral venous thrombosis presented with ipsilateral frontal pain accompanied by ophthalmoparesis, nasal congestion, and lacrimation. The patient's headache showed a dramatic response to oxygen. He experienced no further cluster-like headaches after treatment with an anticoagulant. This case suggests the possible role of venous stasis of the cavernous sinus in cluster-like headache.