The usual diameters of the vessels in microvascular surgery are over 1.0mm, so the patency rate of 90% can be anticipated. However, the anastomosis of smaller vessels is very difficult and the patency rate is very low. We have devised a new technique for the anastomosis of smaller vessels. To obtain experience with the handling of smaller arteries, we performed anastomoses in the superficial epigastric arteries of Lewis rats. This surgical technique can be done without specially designed instruments and suture materials.
The first method is the end to end anastomosis. Longitudinal incisions, the length of the arterial diameter, are made down opposite sides of each end of the superficial epigastric artery. Each of the flared ends are approximated and sutured together by two or three stitches. The second method is the end to sideanastomosis. In the side of the femoral artery an elliptical hole is made, same as the length of the circumference of the superficial epigastric artery. Then the opposite sides of the superficial epigastric artery are longitudinally incised the length of its diameter. The flared ends of the superficial epigastric artery are then inserted into the hole of femoral artery and sutured by four or six stitches. Light microscopic observations were performed serially at 3 days, 2 weeks and 3 weeks after the microvascular anastomosis.
The results were as follows:
1. The mean external diameter of the rat’s femoral arteries was 0.55mm and the
superficial epigastric arteries was 0.25mm.
2. Anastomoses were completed with 10-0 monofilament nylon, the interrupted 2-3
sutures for the end to end anastomosis and 4-6 sutures for the end to side anastomosis.
3. The patency rate was 80% in the end to end anastomosis and 100% in the end to side anastomosis.
4. The average time spent during surgery of the end to end anastomosis was about 35minutes and the end to side anastomosis was abour 45 minutes.
5. On both the end to end and the end to side anastomosis, the diameter of the
anastomotic site of the superficial epigastric artery increased.
6. The intimal regeneration in the end to end anastomosed vessels was completed after 3 weeks and regeneration of the end to side anastomosed vessels was completed after 2 weeks.
7. The medial necrosis was not healed, durings these periods, but it was reduced in its extent within 3 weeks.
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