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This experimental study reports the evaluation of a mechanical, non-suture technique for the repair of small blood vessels under the operating microscope. The method uses the Unilink implantable pinned rings on which the vessel ends are everted 90 degrees and impaled on small pins. An instrument approximates the rings and completes the anastomosis. The device was used for the end-to-end anastomosis of 80 vessels in ten beagle dogs. Both arteries (ulnar and saphenous) and veins (cephalic and saphenous) were included in the study. Vessels were assessed for patency and harvested for histologic examination and scanning electron microscopy at 4-, 16-, and 32-week implantation times. Both longitudinal and cross sections were stained using hematoxylin and eosin, Verhoeff-Van Gieson techniques for elastin, and a modified Masson's trichrome for muscle and collagen, and examined under light microscopy. Scanning electron microscopy (SEM) was completed on longitudinally bisected anastomoses. Patency rates, histology, and SEM at all implantation times of the mechanical anastomoses compared favorably with experimental investigations of suturing techniques that have appeared in the literature. This microvascular anastomotic technique provided a rapid, safe, and efficacious method for the end-to-end repair of severed peripheral arteries and veins in the dog model.

Reconstruction of the traumatically amputated thumb can be achieved with good cosmetic and functional results utilizing autogenous bone graft and a neurosensory free wrap-around flap from the great toe. The donor area of the toe is modified to create a wrap-around flap to transfer innervated glabrous skin from the medial and lateral borders of the toe. This modification includes nail and nail matrix while preserving toe length and the important plantar weight-bearing skin of the great toe. A series of three patients who have undergone thumb reconstruction utilizing this method are reported. Postoperative follow-up averages 15 months. Sensory recovery is comparable to that reported in the literature; cosmetic appearance of the thumb and nail growth are good.

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