Venous thrombosis is the primary reason for flap loss and classical venous anastomoses are hand-sewn under an operating microscope. Technical errors may result in damage at the anastomosis due to an inadequate eversion of the vessel walls, the introduction of unequal bite distances or endothelial injury at the suture sites, causing increased thrombotic potential. Since the introduction of microvascular free-tissue transfer, surgical technique modifications and new devices have become highly sought after as a means for improving overall outcome. Vessel couplers are one such device, with pins and coupling rings providing an alternative to traditional hand-sewn anastomoses. In this article, we describe a technique that we used to decrease vessel wall handling and minimize trauma, which involves dividing the vessel into three leaflets and then excising the excess vessel wall.
Key words: Free flaps, venous thrombosis, microsurgery
|
