Techniques for management of size discrepancies in microvascular anastomosis

Which are the ideal donor and recipient vessels for a whole ovarian transplantation?

“…Below this ratio end-to-end anastomoses are reliable at 96%. Beyond this ratio, the donor versus recipient vessel discrepancy may be managed by microsurgical methods, such as oblique cut, fish mouth cut, or end-to-side anastomosis (11), to reach an adequate functional patency of the blood vessel connection and to reduce the risk of thrombosis (16). However, these intricate anastomoses have a higher rate of vascular complications.…”

“…Several studies have shown that end-to-end vascular anastomosis is the most reliable technique in revascularizing free tissue transfers and allografts. However, such an anastomosis can only be achieved by suturing vessels of identical or nearly similar calibers (ratio 1:1.5) (16). A sudden change of caliber may cause turbulence in the blood flow and predispose to platelet aggregation on the vascular walls surrounding the suture line with subsequent arterial or vein thrombosis, which unfortunately could lead to the failure of the transplantation.…”

CT Angiography for Surgical Planning in Face Transplantation Candidates

“…Moreover, abrupt caliber changes are also undesirable because these induce turbulence and predispose to platelet aggregation. 31 In related interventions, artery size discrepancy 32 and/or intricate anastomoses 33 have been shown to have higher complication rates. In our experience, 3-fold diameter discrepancies between donor and recipient vessels have been encountered and are accommodated for by end-to-side anastomoses.…”

“…Other options would include sleeve and so-called "fishmouth" anastomoses for the management of size discrepancies in microvascular anastomosis. 31 Practically, an end-to-side anastomosis is often the only A, After catastrophic loss of facial tissues, muscle flaps and skin grafts placed during Ͼ20 surgeries rendered the patient's face featureless. B, Surgical-planning volume-rendered CT angiography depicts residual arteries after previous reconstructions using bilateral free latissimus muscle and serratus muscle flap arteries (dashed arrows), which are anastomosed end-to-end to the bilateral facial artery stumps (arrows).…”

Reproductive organ transplantation: advances and controversies

“…The choice of the technique of reanastomosis is affected by the degree of discrepancy. There is no ideal technique to deal with every size discrepancy, and choices may have to be individualized according to case and body area (100). Options range from dilatation with the use of a jeweller's forceps (99) in case of simple discrepancies <1:1.5 to using the oblique cut, fish-mouth cut, or end-to-side anastomosis when discrepancies exceed 1:1.5 (99).…”