Three end-to-end techniques for microvascular anastomosis of vessels with different size discrepancy
Retrospective study published in Ann Plast Surg (2020)
Abstract
BACKGROUND: Size discrepancy in microvascular anastomosis is a common issue in free flap transfer and replantation surgery. A number of different techniques have been described to overcome the problem, but optimal method continues to be defined. METHODS: Since June 2015 to May 2018, clinical courses of 103 microvascular cases performed by one senior surgeon were reviewed. Three end-to-end techniques including mechanical dilation, single-mattress suture, and wedge resection were applied in 364 anastomoses with caliber ratio between 1:1 and 1:1.5, 1:1.5 and 1:2, and 1:2 and 1: 3, respectively. RESULTS: A total of 112 flaps were incorporated in this study. The incidence of anastomotic failure was 3.0% (11/364), and the overall flap failure rate was 3.6% (4/112). The failure cases included 2 replanted scalps, 1 replanted ear, and 1 superficial temporal artery flap for nasal reconstruction. CONCLUSIONS: Our results depicted operational convenience and reliability of the 3 end-to-end anastomotic techniques in addressing mild-to-large vessel discrepancy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
A series of 364 anastomoses across 112 flaps used mechanical dilation, single-mattress suture, or wedge resection for graded caliber-ratio mismatches, yielding a 3.0% anastomotic failure rate and a 3.6% flap failure rate.
Context
This study reviewed 103 microvascular cases (112 flaps, 364 anastomoses) performed by one senior surgeon, comparing three end-to-end anastomotic techniques (mechanical dilation, single-mattress suture, wedge resection) for vessel size discrepancy in free flap transfer and replantation. Overall anastomotic failure was 3.0% and flap failure 3.6%. The work addresses technical aspects of microvascular surgery in the setting where medicinal leeches are sometimes deployed for postoperative venous congestion, but leeches are not mentioned. No data on hirudotherapy, the secretome, or venous-congestion management are provided. The study is limited to surgical technique outcomes from a single surgeon's experience.
Citation
Reference (Vancouver style)
Zhang Y, Wang T, Liu Y, He J, Dong J, Xu H. Three end-to-end techniques for microvascular anastomosis of vessels with different size discrepancy. Ann Plast Surg. 2020;85(2):141-145. doi:10.1097/SAP.0000000000002158. PMID: 31913895
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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