Microvascular anastomosis using fish-mouth incision.

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(7):1306-1316.
Published online October 1, 1998.

Microvascular anastomosis using fish-mouth incision.

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Abstract

There are various methods of anastomosing or attaching the two ends of a severed blood vessel together. The most popular method is suturing, but it is tedious and time-consuming, has a tendency to leak between suture sites, and requires special training in microvascular surgery. Other anastomosis methods such as mechanical devices, tissue adhesives, lasers and modified suturing also have problems in achieving easy, reliable and fast anastomosis, and high patency rate. We developed a new eversion method to eliminate some of the current problems by allowing a quicker, simpler, and more reliable method of attachment. Our method consists of fish-mouth incision to the severed ends of vessels parallel to the vascular direction simultaneously accompanied by 2 stitches to the top of the incised vessels to obtain complete eversion and intima-to-intima contact.In this study, four clinical methods of attachments were compared; group 1, conventional interrupted suture, group 2, fish-mouth incision method with fibrin glue, group 3, fish-mouth incision with continuous horizontal mattress suture, group 4, fisy-mouth incision with angulated vascular ligating clips.We compare the patency rate and time required for anastomosis. histological changes(postoperative 1 week, 3 weeks) were also investigated to illustrate the endothelial regeneration, hyaline degeneration, microthrombus, and microaneurysm of anastomosis site. All the groups has similar high patency rate(p> 0.05). But, there was significant difference in anastomosing time among conventional suture method(group 1; average 45 minutes) and other methods(group 2; average 24 minutes, group 4; average 18 minutes). Especially, using fish-mouth incision with ligating clips, we could shorten the anastomosing time extremely. Microscopically, we found the relatively smooth healing surface of the anastomosis site with less hyaline degeneration, microthrombus, and microaneurysm in the groups using fish-mouth incision with fibrin glue and with ligating clip compared to conventional suture group. With fish-mouth incision method, possible advantages include consistent eversion of intima producing a continuous intimal surface within the lumen, tight sealing of the vascular edges, and minimal leakage. Moreover, operative time by using fibrin glue and ligating clip was significantly shorter and the patency rates were similar to the conventional suture method.

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