Interrupted Micro-Mattress Sutures Solve Vessel-Size Discrepancy

ABSTRACT

Although technical refinements have improved microvascular techniques, the problem of vessel-size discrepancy between donor and recipient vessels is still unsolved and can decrease the success rate of free tissue transfer. In fact, if vessels with incongruent diameters are not adequately anastomosed, the risk of free flap failure is increased.

In this paper, the authors present a new type of microvascular anastomosis to overcome the problem of vessel-size discrepancy. Interrupted mattress sutures are placed in end-to-end anastomosis narrowing the wider diameter and compensating for the diameter incongruency. The surgical technique and main clinical applications of the interrupted micro-mattress sutures are described in detail. Indications and advantages are discussed.

KEYWORDS

Micro-mattress sutures - vessel-size discrepancy - anastomosis

REFERENCES

• 1 Pho RW H. General principles of microsurgery. In Pho RWH Microsurgical Technique in Orthopaedics. London; Butterworths & Co. Ltd 1988
• 2 Hidalgo D A, Shaw W W, Romita M C, Godfrey N V. Anastomotic technique and vein grafts. In Shaw WW, Hidalgo DA Microsurgery in Trauma New York; Futura Publishing Company, Inc 1987
• 3 Harashina T, Irigaray A. Expansion of smaller vessel diameter by fish-mouth incision in microvascular anastomosis with marked size discrepancy.  Plast Reconstr Surg. 1980;  6 502-503
• 4 O'Brien B Mc C, Morrison W A. End-to-end anastomosis. In: O'Brien B McC, Morrison WA Reconstructive Microsurgery Edinburgh; Churchill Livingstone 1987: 47-50
• 5 Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers.  Plast Reconstr Surg. 1979;  64 673-682
• 6 Boeckx W. Clinical microsurgery. In: Marquet R, Hess F, Kort W, Boeckx W Micro-surgery. Experimental Techniques in the Rat and Clinical Applications Ghent, Belgium; European Press 1976
• 7 Harris G D, Finseth F, Buncke H J. Posterior-wall-first microvascular anastomotic technique.  Br J Plast Surg. 1981;  34 47-49
• 8 Boeckx W, Vereecken R, Depuydt K. Microsurgery for intra-abdominal testicular retention.  Eur J Obstet Gynecol. 1998;  81 191-196
• 9 Boeckx W, Fossion E, Guelinckx P, Demey R, Dewilde R. Free flaps in head and neck surgery.  Acta Chir Belg. 1982;  82 219-229