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目的 探讨分析两种不同灌流方式的动脉化静脉皮瓣的存活稳定性.方法 2012年5月至2013年12月,选取H型、Y型、Ⅰ型、Ⅱ型、Ⅹ型、Ⅴ型及山型血管走行方式,以一条静脉为主干蒂的动脉化多个静脉皮瓣患者共40例,分别行静脉顺瓣膜动脉化的不倒置吻合以及静脉逆瓣膜动脉化的倒置吻合,同时均进行灌注血管和回流血管之间的结扎处理.对皮瓣的存活情况按照临床五度观察指标进行评估;术后1、6、12个月定期随访,观察皮瓣愈合效果及组织修复情况.结果 术后两组皮瓣的成活率分别为97.82％、90.47％,顺瓣膜动脉化静脉皮瓣组术后反应及成活率均优于逆瓣膜动脉化静脉皮瓣组,差异有统计学意义(P＜0.05).存活情况的五度观察统计结果(将轻度与较轻度合并成轻度,较重度与重度合并成重度进行比较):顺瓣膜动脉化静脉皮瓣组,轻度占45.5％、中度占36.4％、重度占15.9％、坏死占2.2％;逆瓣膜动脉化静脉皮瓣组,轻度占20.0％、中度占27.5％、重度占42.5％、坏死占10.0％.5个坏死的皮瓣经过换药治疗后均愈合.结论 顺瓣膜动脉化静脉皮瓣修复手部软组织缺损术后反应及成活率优于逆瓣膜动脉化静脉皮瓣.“,”Objective To explore the survival rates of arterialized venous flaps with two different perfusion types.Methods From May 2012 to December 2013,arterialized venous flaps were used in 40 cases.One venous trunk was used as the major vascular pedicle for arterialization while there were seven different types of vascular configuration:type H,type Y,type Ⅰ,type Ⅱ,type Ⅹ,type Ⅴ and type “mountain peak”.The patients were divided into two groups:in one group the veins were not inverted before anastomosis (pro-valve arterialized venous flap group),while in another group the veins were inverted before anastomosis (anti-valve arterialized venous flap group).Ligation of the feeding vessels and drainage vessels was performed in both groups.Postoperatively the patients were regularly follow-up at 1,6 and 12 months to observe flap healing and tissue repair conditions.Flap survival was assessed according to the five degrees of clinical measurement.Results Survival rates of pro-valve arterialized venous flap group and anti-valve arterialized venous flap group were 97.82％ and 90.47％,respectively.The postoperative survival and tissue recovery of the pro-valve artefialized venous flap group were significantly better than those of the anti-valve arterialized venous flap group (P ＜ 0.05).Based on the five degrees measurement,there were 45.5％ mild,36.4％ moderate,15.9 ％ severe and 2.2％ necrosis in the pro-valve arterialized venous flap group; and 20.0％ mild,27.5％ moderate,42.5％ severe and 10.0％ necrosis in the anti-valve arterialized venous flap group.All fivc flaps with necrosis healed after dressing change.Conclusion Pro-valve arterialized venous flap has better survival and tissue reaction than anti-valve arterialized venous flap in the treatment of soft tissues defects of the hand.