Evaluation on the changes of luminal width and early patency of Microvascular anastomosis using eversion technique

Original article Evaluation on the changes of luminal width and early patency of Microvascular anastomosis using eversion technique I Nyoman P Riasa Sub Department of Plastic & Reconstructive Surgery, School of Medicine, Indonesia University/ Cipto Mangunkusumo Hospital, Jakarta (Abstract) It is well known, that a small decrease of vessel lumen in microvascular anastomosis has a great effect on the flow of the vessel and consequently may have an effect on its patency. Alexis Carrell stated in his Nobel Lecture the fundamental principle in vascular anastomosis, is union of the vessel extremities is made by eversion of the edges, which are united not by their surface of section, but by their endothelial surfaces. Although many eversion techniques have been proposed, the disadvantages of the technique still exist. In this study, evaluation of an eversion technique was compared to the conventional technique of end to end anastomosis regarding the changes of lumen area and patency rate. The eversion technique required fish mount incision of Harashina and Irigaray at both vessel ends previously prepared by trimming the adventitia, and completed with six interrupted sutures (two sutures in both base of fish mount incisions, two sutures in each everted flap). Eighteen carotid arteries of nine Sprague-Dawley rats were used. Each rats received both threatments, and selection of the artery for the given treatments was changed alternately. One hundred percent early patency rate for both techniques were achieved immediately after anastomosis, 30 minutes, 1 hour and 2 hours post operatively. On histological evaluation, eversion technique produced wider lumen area in 75 % (6/8) anastomosis, in contrast with standard technique that produced luminal narrowing in 67% (6/9) anastomosis. In addition to those advantages, eversion technique needed less number of sutures (6,2) and resulted with less number of sutures exposed to the lumen (2,1). Although bleeding time of the eversion technique was longer (3 minutes), the entire time needed was comparable to the standard technique (28,7 minutes). It was concluded that eversion technique for microvascular anastomosis (1 mm diameter) using fish mounth incision at both vessel ends previously prepared by trimming the adventitia and completed with six interrupted sutures, produced wider lumen area, needed less sutures, with anastomosis time comparable to the standard technique without compromising the patency rate.[ Indones J Plast Surg 2002; 1(1):6-15 ] Keywords : eversion technique, interrupted sutures, lumen size, microvascular anatomosis.