Two Suture Fish Mouth End to Side Microvascular Anastomosis With Fibrin-Glue

Abstract: The most decisive step during free tissue transfers and
replantation surgery may be respected as microvascular anastomosis.
The conventional end-to-side anastomosis technique with simple
interrupted sutures is well established and proven to be successful.
On the other hand, conventional technique can be time consuming
and can cause vascular thrombosis, vessel narrowing, and foreignbody
reactions. Search for a more rapid and secure alternative to
conventional technique is carried on. In this study, we defined a new
technique for end-to-side anastomosis with fish-mouth incisions and
application of fibrin glue and compared our results with those we
obtained with conventional end-to-side anastomosis. We evaluated
end-to-side anastomosis of carotid arteries of a total number of
64 Wistar-Albino rats. In control group (n = 32), conventional
anastomoses with 8 to 10 sutures were performed. In experimental
group (n = 32), fish-mouth incisions were applied first on the recipient
artery, followed by performing anastomosis with only 2
corner sutures and applying commercially available fibrin glue. Time
taken to perform the anastomosis was significantly shorter with the
experimental group (P = 0.001), whereas early and late patency and
aneurysm rates were comparable to those achieved with control
group. Histological evaluation did not point out any significant
differences between the groups. We have defined a rapid and safe
alternative technique of end-to-side anastomosis with the use of
fibrin glue. This method may be an alternative especially where
multiple anastomoses are required or where it is difficult to approach
anastomotic line, as it is easily performed, rapid, safe, and not involving
any complex equipments.