The Venous Territories (Venosomes) of the Human Body: Experimental Study and Clinical Implications
The Venous Territories (Venosomes) of the Human Body: Experimental Study and Clinical Implications
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人体静脉区域（毒体）：实验研究和临床意义
DOI：
10.1097/00006534-199008000-00001
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发表时间：
1990
影响因子：
3.6
通讯作者：
John G. Crock
中科院分区：
文献类型：
--
作者：
G. Ian Taylor;Christopher M. Caddy;P. Watterson;John G. Crock
在6具新鲜人体全身标本和一系列四肢和躯干的孤立区域研究中，研究了皮肤及其深层组织的静脉构筑。注射不透射线的氧化铅混合物，解剖外皮和深部组织并进行X线摄影。绘制静脉穿支的位置，并追踪其伴随源（节段性）动脉的下方母静脉。对一个受试者进行了一系列的横断面研究，以说明在被皮和深部组织之间的穿支的路线。在放大镜下解剖静脉，以确定瓣膜的位置和方向。结果显示，大量的无瓣（振荡）静脉的外皮和深层组织，连接相邻的带瓣静脉领土，并允许整个组织的流量和压力的平衡。当阻塞动脉定义动脉区域时，它们与静脉研究中的振荡静脉边界相匹配。静脉结构是一个连续的拱状网络，遵循身体的结缔组织框架。静脉从移动的到固定的区域汇聚，它们与神经“搭便车”。静脉引流反映了深部组织和头部、颈部和躯干中大部分区域的动脉供应。在四肢，静脉穿支的星状模式被皮下网络中的纵向通道所改变。然而，当岛状皮瓣被提起时，这些纵向通道被断开，动脉和静脉模式再次匹配。我们的静脉研究加强了血管小体的概念。在源动脉供应复合组织块的情况下，我们已经通过放射学和显微解剖证明，这些动脉的分支伴随有静脉，这些静脉向相反方向引流并返回相同的部位。因此，每个血管小体由匹配的动脉小体和静脉小体组成。这些结果的临床意义进行了讨论，特别是参考皮瓣的设计，延迟现象，静脉游离皮瓣，皮瓣坏死的发病机制，“肌肉泵”，静脉曲张，静脉溃疡。
The venous architecture of the integument and the underlying deep tissues was studied in six total-body human fresh cadavers and a series of isolated regional studies of the limbs and torso. A radiopaque lead oxide mixture was injected, and the integument and deep tissues were dissected and radiographed. The sites of the venous perforators were plotted and traced to their underlying parent veins that accompany the source (segmental) arteries. A series of cross-sectional studies were made in one subject to illustrate the course of the perforators between the integument and the deep tissues. The veins were dissected under magnification to identify the site and orientation of the valves. Results revealed a large number of valveless (oscillating) veins within the integument and deep tissues that link adjacent valved venous territories and allow equilibration of flow and pressure throughout the tissue. Where choke arteries define the arterial territories, they are matched by boundaries of oscillating veins in the venous studies. The venous architecture is a continuous network of arcades that follow the connective-tissue framework of the body. The veins converge from mobile to fixed areas, and they “hitchhike” with nerves. The venous drainage mirrors the arterial supply in the deep tissues and in most areas of the integument in the head, neck, and torso. In the limbs, the stellate pattern of the venous perforators is modified by longitudinal channels in the subdermal network. However, when an island flap is raised, these longitudinal channels are disconnected, and once again the arterial and venous patterns match. Our venous studies add strength to the angiosome concept. Where source arteries supply a composite block of tissue, we have demonstrated radiologically and by microdissection that the branches of these arteries are accompanied by veins that drain in the opposite direction and return to the same locus. Hence each angiosome consists of matching arteriosomes and venosomes. The clinical implications of these results are discussed with particular reference to the design of flaps, the delay phenomenon, venous free flaps, the pathogenesis of flap necrosis, the “muscle pump,” varicose veins, and venous ulceration.