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

Hsieh, Tung-Ying MD; Huang, Yu-Hao MD; Chang, Feng-Shu MD; Chang, Chih-Hau MD; Chen, Ko-Kang MD; Huang, Shu-Hung MD; Lai, Chung-Sheng MD, PhD; Lin, Sin-Daw MD; Chang, Kao-Ping MD, PhD

doi: 10.1097/SAP.0000000000000384
Microsurgery
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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.

Supplemental Digital Content is available in the text.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital; and †Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Received June 9, 2014, and accepted for publication, after revision, October 6, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Kao-Ping Chang MD, PhD, Division of Plastic and Reconstructive Surgery, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Rd, Kaohsiung 807, Taiwan. E-mail: kapich@kmu.edu.tw.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsplasticsurgery.com).

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