A Secure Technique for Microvascular Anastomosis in Arteries with Intimal Dissection Intimal Sleeve Fold-Over Technique

作者：Hsieh Tung Ying; Huang Yu Hao; Chang Feng Shu; Chang Chih Hau; Chen Ko Kang; Huang Shu Hung; Lai Chung Sheng; Lin Sin Daw; Chang Kao Ping^*

来源：Annals of Plastic Surgery, 2016, 76(4): 420-423.

DOI：10.1097/SAP.0000000000000384

• intimal sleeve fold-over
• microvascular anastomosis
• intimal dissection
• microsurgery

Background
Intimal dissection can cause an irregular internal surface with intimal flaps and subendothelial collagen exposure. This has been associated with a high risk of thrombosis. Trimming the artery to a healthy level is routinely recommended to avoid intimal dissection. However, this method is limited when there is inadequate vascular length to work with.
Methods
We dealt with an artery exhibiting severe intimal dissection by using a new suture technique: the intimal sleeve fold-over technique. Severe arterial intimal dissections were observed in 9 (6.9%) of 130 arterial microvascular anastomoses in free flap reconstruction for oral cancer patients from January 2013 to December 2013. We used this technique in 6 of the 9 patients.
Results
All 6 patients were discharged as scheduled without perioperative problems and complications during follow-ups. The mean diameters of the recipient and pedicle arteries with intimal dissection were 2.13 and 2.20 mm. The mean time for performing sleeve fold-over procedure of on each artery was 5.1 minutes.
Conclusions
A secure intima-to-intima contact can be achieved using this technique. This technique can provide an alternative method to intimal dissection when the length of the artery is limited.

• 出版日期2016-4