Expansion of Smaller Vessel Diameter by Fish-Mouth Incision in Microvascular Anastomosis with Marked Size Discrepancy

Harashina, Takao; Irigaray, Alberto

doi:10.1097/00006534-198004000-00019

Cited by 71 publications

(44 citation statements)

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“…[13][14][15][16] The fish mouth incision is useful when a size discrepancy of moderate amount exists; on the other hand, in greater discrepancies, the turbulence between the vessels may lead to thrombosis. 6,[13][14][15][16][17] Neither clinically nor experimentally no difference in patency rates has been found between end-to-end and end-to-side anastomosis. 13,18,19 The end-to-side technique offers several advantages, such as solves discrepancies, 18,19 preserves the blood flow distally, [18][19][20] a good choice for traumatic limb defects, and avoids spasm in the supplying recipient artery.…”

Section: Discussionmentioning

confidence: 98%

“…It is an advantage that there is not a sudden size discrepancy in the anastomosis line, which prevents turbulence and thrombus formation. 6,7 Limited dissection was applied to one patient with a nonhealing wound due to traffic accident in our clinical series, because of the increased amount of the perforators inside the muscle. Open y technique was applied to the perforator artery of the flap, and this increased its diameter, which was 1 mm previously.…”

Section: Discussionmentioning

confidence: 99%

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“Open y” technique in vessel diameter discrepancy

2006

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For the last 20 years, free tissue transfers have increasingly become the mainstay of plastic surgery. Size discrepancy between the vessels during tissue transfers are frequently encountered in clinical practice, and this may potentially be an important factor in the patency of anastomosis. In our clinic, we first studied a rat model and a fresh sheep cadaver to improve the diameter discrepancy in microvascular anastomosis with "open y" technique. At the end of our research, we progressed to success, and the open y technique was applied to nine patients in our clinic with a diameter discrepancy in microvascular anastomosis. After finding the bifurcation of vessels (artery, vein, or a vein graft) that are prepared for anastomosis, a distal cut of 2-3 mm was made for the anastomosis, which is considered to increase the diameter. Both legs of the resultant "y"-shaped vessel were united after inserting the microscissors from one leg and exiting from the other. Performing an end-to-end anastomosis between the vessels, we obtain an increase in the diameter. By using this method, we eliminated the diameter discrepancy in microvascular anastomosis in nine patients in our clinic. There was not any flap loss. To increase the usage of this technique, when we come across a problem of size discrepancy, it is important to use the open y technique, both to the recipient vessels, donor vessels, and to the vein grafts. Owing to its high prevalence and the ease of application, we are convinced that this is a suitable technique in appropriate cases.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“Open y” technique in vessel diameter discrepancy

2006

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“…Technique 1: we use a modification of the Harashina's fishmouth technique (11). Figure 1 shows the double wedge excision fish-mouth technique: two opposite triangle are longitudinally excised from IMAP artery and a gentle dilatation applied to expand the diameter of the vessel allowing for the anastomosis to be performed.…”

Section: Diameter Mismatch Of 1:2mentioning

confidence: 99%

Microsurgical refinements with the use of internal mammary (IM) perforators as recipient vessels in transverse upper gracilis (TUG) autologous breast reconstruction

Saour¹,

Libondi²,

Ramakrishnan³

2017

Gland Surg.

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Background:The transverse upper gracilis (TUG) flap is the senior authors' second choice for autologous breast reconstruction when the DIEP flap is not available. It provides durable, pliable tissue with well hidden scars. The main criticism of this flap is the limited volume, donor site complications, short pedicle and vessel mismatch depending on which recipient vessels are used. We described methods of reducing vessel mismatch, complications of venous coupler and refinements to help give a more superior aesthetic outcome. Methods:We describe several maneuvers to help reduce vessel mismatch with the use of the internal mammary (IM) perforator vessels with a modification of the Harashina fish-mouth technique or the use of a vessel bifurcation to increase vessel diameter. We also describe the optimum method of perforator preparation and potential methods to prevent palpable venous couplers. The author's describe their case series of 14 TUG flaps to reconstruct 13 breasts in 12 patients.Results: Eight unilateral, 2 partial breast reconstruction, 1 bilateral and 1 bilateral TUG flap for a unilateral reconstruction was carried out. All flaps survived with one partial flap necrosis, one donor site seroma and two cases of palpable/tender venous couplers. The mean reconstructed breast was 320 grams. Conclusions:The TUG flap is a reconstructive challenge, but with correct planning a good aesthetic outcome is possible. The IM perforator is our first choice recipient vessel in TUG breast reconstructions.With meticulous preparation and by overcoming vessel mismatch the use of this recipient vessel is a reliable option.

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“…9 Its disadvantages are that (1) an irregular vessel end may increase thrombosis, 9 and (2) an angle may be formed by the two vessel ends 9 (Fig. 1).…”

Section: Oblique Cutmentioning

confidence: 99%

“…There are a number of advantages to the sleeve anastomosis: (1) it can be used in arteries or veins, 9 (2) easy and reliable technique, 11 (3) fewer stitches, saving operating time, 14 (4) fewer sutures and less manipulation, 14 (5) less suture material in the lumen, 11 (6) prevents intimal separation, (7) less platelet accumulation, 15 (8) matching different sizes of vessels, 12 and (9) possibility for use on vein grafts. 12 There are two disadvantages to the sleeve anastomosis: (1) when vessels of the same caliber are anastomosed by the sleeve technique, the blood flow decreases considerably because of a reduction in the internal caliber produced by the double wall at the invagination site, although without harm in the survival of flaps, according to some series; 12,15 and (2) with an unfavorable size discrepancy (large caliber upstream end to small caliber downstream end), this technique is too risky and is not applicable.…”

Section: Sleeve Anastomosismentioning

confidence: 99%