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. 2021 Oct 7;6(6):1321-1324.
doi: 10.1002/lio2.650. eCollection 2021 Dec.

Solution to vessels mismatch in microsurgery: Vertical arteriotomy technique

Uthman Alamoudi  1   2 , Tamer Ghanem  2
Affiliations

Solution to vessels mismatch in microsurgery: Vertical arteriotomy technique

Uthman Alamoudi et al. Laryngoscope Investig Otolaryngol. .

Abstract

Background: Microvascular anastomosis is the key for successful free flap transplantation. Ideally, the anastomosis should maintain the flow with minimal turbulence, disruption of endothelium, and minimizing the furrow to prevent thrombosis and failure of the flap. One of the main pitfalls of micro-anastomosis is vessels size mismatch.

Method and result: There are many ways to overcome this issue, which includes forced mechanical dilation of the smaller vessel, oblique cuts, fish mouth cuts, interposition grafts, end-to-side anastomosis, coupling device, and others. Here, we report a simple technique with single customizable longitudinal arteriotomy of the smaller vessel to achieve an adequate size match to the larger vessel. It has been used for more than 10 years at our institution that allow us to achieve an end-to-end patent anastomosis.

Conclusion: Vertical arteriotomy is a simple technique that in our experience achieved end-to-end anastomosis high patency rate.

Keywords: arteriotomy; microsurgery; microsurgical anastomosis; vessels mismatch.

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Conflict of interest statement

Nothing to disclose.

Figures

FIGURE 1
FIGURE 1
A, Vessels mismatch. B, Vertical arteriotomy in the small vessel. C, Suturing technique. D, Result of the closure
FIGURE 2
FIGURE 2
View of the vessels under the surgical microscope. A, The facial artery; B, peroneal artery; C, a longitudinal cut been performed to the facial artery, D, increase in the diameter after the cut; and E, improvement of size mismatch
FIGURE 3
FIGURE 3
Suturing technique. A, First stay suture passed through the heel at the apex of the longitudinal incision to the larger vessel. B, Two stay sutures 180° apart. C, Look inside the lumen after running one wall. D, At the end of the anastomosis with arterial flow established
See this image and copyright information in PMC

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