1/5. Reverse venous outflow of a free fibular osteocutaneous flap: a salvage procedure.The authors report 2 patients with a massive bony defect of the tibia due to chronic osteomyelitis. They reconstructed the defect using a free vascularized fibular osteocutaneous flap. Unfortunately, venous insufficiency was diagnosed 24 hours postoperatively. The previous anastomosed veins were promptly explored. The peroneal veins of the vascularized fibular bone graft were noted to be full of thrombi. After thrombectomy, the vessels became very fragile and broke down easily. It was impossible to achieve normal antegrade venous outflow from the previous vein of the donor graft; however, they found that distal runoff of the peroneal vein achieved a reverse venous outflow from the donor graft. The great saphenous vein was dissected and reanastomosed to achieve adequate venous drainage. This procedure may offer an alternative treatment for a flap with venous insufficiency.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. leg ulcers in a patient with spherocytosis: a clinicopathological report.In a case of spherocytosis combined with ulcus cruris, Doppler sonography and phlebography revealed a chronic venous insufficiency, together with fibrinous precipitates in capillary and venous vessel walls. Some haemolysis and fragmentation of red cells in the biopsy was also observed. It is suggested that the haemodynamic alteration due to chronic venous insufficiency may have played the main role in the development of the ulcers, although the rheological disturbance caused by the spherocytosis may have had an aggravating effect. Circulatory disorders should be excluded, if skin ulcers are to be classified as haematological disorders.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. Decreased venous outflow without venous obstruction--an analysis of three cases.Three patients without prior thrombosis or varicosities presented with decreased venous outflow. They suffered from venous complaints, such as oedema and pain in the leg after prolonged standing. Phlebograms showed no obstruction or hypoplasia. Normal function of calf muscle pump and valves was present at venous pressure determination. The theoretical basis of venous emptying is discussed and a hypothesis is postulated that decreased emptying is due to a change in elastic properties of the venous vessel wall.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. Duplex diagnosis of venous insufficiency in a free flap.Venous monitoring and evaluation present a dilemma in free flap care. Duplex ultrasonography provides information on vessel flow and anatomy. This case demonstrates the use of duplex technology in identifying problems following vascular microsurgery, and it raises discussion of possible future roles for the application of duplex ultrasonography in the management of free flaps.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. Lower-limb salvage in a patient with recalcitrant venous ulcerations.The authors report the salvage of a lower limb with recalcitrant venous stasis ulcers by "sequential" free flaps in a patient with co-existing chronic venous insufficiency and arterial occlusive disease. This presentation is interesting for inclusion of the following: (1) treatment of a recalcitrant venous ulcer by the combination of free-tissue transfer and valvular transplantation; (2) thrombosis of the free flap pedicle at an indeterminate time postoperatively without flap loss or leg ischemia; and (3) performance of a second free flap to the peroneal artery-only, to a one-vessel leg with an excellent clinical outcome at long-term follow-up.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |