We propose a new classification of five main techniques for microarterial anastomoses: Interrupted, autogenous cuff, continuous, sleeve and partial sleeve. The last method was developed by the authors. A study was performed on 48 albino rats and comprised 20 anastomoses of each type (for a total of 100), performed on femoral and carotid arteries of average size 0.83 mm. These were compared with respect to patency, anastomosis time, leak, bleeding time, number of sutures (bites), microangiography, histopathology and scanning electron microscopy. The overall patency was 88%, and that of the partial sleeve technique was 100%, associated with 30% incidence of aneurysms. Clinical, histopathological and scanning electron microscopy findings showed better results for techniques with predominantly extraluminal sutures (sleeve and partial sleeve), which was particularly relevant in our situation, in which a larger sized needle (150 microns) had to be used. An overall aneurysm incidence of 17% was noted.
Although Z-plasty is one of the basic skills in the armamentarium of a plastic surgeon, one is rarely found using a protractor to measure the exact angles. Two types of simple gadgets are described here to fashion Z-plasties with desired (fixed or variable) angles useful in various types of Z-plasties. These gadgets are made from transparent plastic sheets. They can be sterilized by formalin vapor or ethylene oxide gas. Since they are pliable, they can be adapted to the contours on the body. These are found to be particularly useful in cases where asymmetrical Z-plasties are needed.
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