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目的:探讨小隐静脉与远端蒂皮瓣静脉回流。方法:以腓肠神经营养血管皮瓣为例。(1)解剖观察40侧小隐静脉。(2)用多普勒超声检查60侧人的小隐静脉。结果:解剖观察外踝尖水平上3～4cm小隐静脉体表投影与皮瓣轴线基本一致,两者相差(0.5±0.3)cm。40侧中有12侧各有1支与腓静脉的交通支,距外踝尖(3.0±0.7)cm,外径(1.2±0.5)mm;彩超检查外踝尖水平上3～4cm小隐静脉内径为(2.3±0.7)mm,距体表(3.2±1.0)mm,78.3%正常人的小隐静脉能较显著将远侧的静脉血导入近侧。若足踝部大隐静脉回流障碍,小隐静脉引流将加剧。结论:(1)结扎小隐静脉消除了浅静脉干对远端蒂皮瓣的倒灌,可改善皮瓣静脉回流。(2)经超声定位,在外踝尖水平上3～4cm行0.5～1cm的纵向小切口能准确结扎小隐静脉,操作简单,不会损伤蒂部穿支血管和血管网。
Objective: To study the venous return of small saphenous vein and distal pedicle flap. Methods: Sural neurocutaneous vascular flap was taken as an example. (1) Anatomical observation of 40 small saphenous vein. (2) Doppler ultrasound examination of 60 small human saphenous vein. Results: Anatomical observation showed that the projection of the surface of the small saphenous vein in 3 ~ 4 cm at the level of the lateral malleolus was basically consistent with the axis of the flap, with a difference of (0.5 ± 0.3) cm. 40 sides of the 12 sides have a branch and the peroneal artery traffic branch, from the lateral malleolus tip (3.0 ± 0.7) cm, diameter (1.2 ± 0.5) mm; color Doppler ultrasound level at the tip of the lateral malleolus 3 ~ 4cm small saphenous vein diameter (2.3 ± 0.7) mm. From the surface (3.2 ± 1.0) mm, 78.3% of normal human small saphenous vein can be significantly more distal venous blood into the proximal. If the ankle and saphenous vein reflux disorder, small saphenous vein drainage will be exacerbated. Conclusions: (1) Ligation of the small saphenous vein eliminates the superficial veins of distal superficial pedicel flap intrusion, can improve the flap venous return. (2) Ultrasound positioning, 3 ~ 4cm at the level of the lateral malleolus 0.5 ~ 1cm longitudinal small incision can accurately ligate the saphenous vein, the operation is simple, will not damage the pedicle perforating branch and vascular network.