The application of vascular anastomoses is one of the most technically complex manipulations in microvascular surgery. When performing skin flap transplantation or finger replantation, doctors often face the need to create anastomoses between arterial and venous vessels. Anastomoses are necessary to restore effective blood circulation in the tissues of the body, and their application – This is a job that not every surgeon can do. However, even the correct imposition of the vascular anastomosis is not an absolute guarantor of the restoration of blood flow. How to evaluate the patency of microvascular anastomoses – read on estet-portal.com.
Basic methods for assessing the patency of vascular anastomoses
The creation of microvascular anastomoses makes it possible to restore normal blood flow in transplanted tissues. When performing such surgical interventions, only vascular anastomosis makes it possible to connect arteries and veins, restoring normal blood flow in them. It is extremely important to assess the patency of the vessels, since manipulations on them, in particular suturing, often narrow the lumen of the vessels, and create unfavorable conditions for normal blood flow. The patency of microvascular anastomoses can be assessed using several methods, the main and most accessible of which are clinical and visual methods.
Anastomosis:
- clinical methods for assessing the patency of anastomoses;
- visual methods for assessing the patency of anastomoses;
- major errors in vascular anastomoses.
Clinical methods for assessing the patency of anastomoses
Clinical methods for assessing the patency of vascular anastomoses include the study of the state of peripheral circulation in limb segments or transplanted flaps.
Surgeons evaluate three main clinical symptoms:
- skin color: pale skin color indicates a change in blood flow, and cyanotic – about its insufficient outflow;
- capillary response to pinpoint compression of blood vessels: when a vessel is pressed with fingers or instrumental, blood is removed from the skin plexuses in this area, and after the pressure is stopped, a pale spot remains on the skin. The faster the spot disappears, the higher the level of perfusion pressure in the tissues. Too fast disappearance of the spot indicates a violation of the venous outflow, and an imperceptible or inconspicuous spot – about violation of blood flow to the tissues;
- tissue bleeding: this method can be used directly on the operating table or in the early postoperative period. It is strictly forbidden to use an injection needle, as the puncture site quickly thromboses.
Visual methods for assessing the patency of anastomoses
Visual assessment of the patency of microvascular anastomoses is carried out using an operating microscope.
The main criterion for the patency of the arteries is their pulsation distal to the site of the anastomosis. Pulsation can be longitudinal or transverse with a pulsating change in the curvature of the vessels. Longitudinal pulsation is assessed by observing a certain point of the vessel, its increase indicates arterial blockade of the vessel. The patency of the veins is confirmed by a noticeable change in their outer diameter. Excessive expansion of the vein distally and collapse proximal to the site of the anastomosis is a sign of thrombosis of the venous anastomosis.
Main errors in vascular anastomoses
The following main mistakes can be distinguished when applying microvascular sutures:
- Wrong choice of suture.
- Inadequate vascular mobilization and insufficient access to them.
- Excessive capturing of the vessel edges during suture, resulting in a narrowing of the anastomosis.
- Infrequent sutures that lead to poor tightness of the created anastomosis.
- Strong tightening of the knots, resulting in the eruption of the vessel walls.
- To eruption of the sutures and narrowing of the anastomosis line is also caused by a strong tension of the sutured vessels.
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