Healing of two microarterial anastomoses with diameter mismatch

被引:10
作者
Rickard, Rory F. [1 ,2 ,3 ]
McPhaden, Allan R. [4 ]
Hudson, Donald A. [3 ]
机构
[1] Royal Ctr Def Med, Acad Dept Mil Surg & Trauma, Birmingham, W Midlands, England
[2] Derriford Hosp, Dept Plast Surg, Plymouth PL6 8DH, Devon, England
[3] Univ Cape Town, Dept Surg, Div Plast Reconstruct & Maxillofacial Surg, ZA-7925 Cape Town, South Africa
[4] Univ Glasgow, Dept Pathol, Glasgow G12 8QQ, Lanark, Scotland
关键词
Microvascular; Anastomosis; Diameter discrepancy; Histology; Intimal hyperplasia; MICROVASCULAR SLEEVE ANASTOMOSIS; INTERNAL MAMMARY PERFORATORS; INTERPOSITION VEIN GRAFTS; SMALL-TO-LARGE; BREAST RECONSTRUCTION; SIZE DISCREPANCY; RECIPIENT VESSELS; UNEQUAL DIAMETER; PREFERRED SITES; FLOW PATTERNS;
D O I
10.1016/j.jss.2014.03.011
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The use of fascial perforating vessels as recipients for microvascular composite tissue autotransplants has led to vessel diameter discrepancy becoming an increasingly common finding. Little evidence, however, is available to direct the choice of anastomotic technique where a discrepancy exists. We have been studying two methods of anastomosing arteries where a small-to-large discrepancy exists-a 45 degrees section of the smaller vessel, and invaginating the smaller vessel inside the larger. As part of this work, this study examines intimal hyperplasia and healing of the two methods. Materials and methods: A previously described paired Wistar rat femoral axis model was used. Anastomoses were performed, one on each side, and specimens were harvested in groups at 24 h, 1 wk, 6 wk, and 8 mo. Inflammation, necrosis, and fibrosis in each layer of the vessel wall and intimal hyperplasia were each scored by an assessor blinded to the group and anastomotic technique. Results: Significant differences in healing were found. The invagination technique induced less inflammation, and caused less endothelial and medial necrosis than the oblique cut end-to-end method. Intimal hyperplasia was most pronounced at 6 wk, but no evidence of a difference in the severity of intimal hyperplasia between the two methods was found. Conclusions: The invaginating anastomosis causes less inflammation and less vessel wall necrosis than the oblique end-to-end method in this model. This finding, alongside results from previous work, suggests that this is the better method to deal with a small-to-large microarterial diameter discrepancy in the range 1:1.5 to 1:2.5. Crown Copyright (C) 2014 Published by Elsevier Inc. All rights reserved.
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页码:239 / U257
页数:14
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