title: Influence of vascular twisting on the supermicroanastomosis of superficial inferior epigastric artery.
abstract: Arterial microanastomoses with small-caliber vessels, such as those with an internal diameter less than 0.2 mm, are susceptible to inadvertent twisting. A total of 20 supermicroanastomoses were performed in the superficial inferior epigastric artery (SIEA)-based flap model of ten 10-week old, 300- to 350-g male Sprague-Dawley rats. Two rats with 4 flaps comprised each experimental group: a negative control, a control with end-to-end SIEA arterial supermicroanastomosis, and 3 experimental groups (EAs), such as EA1, 2, and 3 with 90-, 180-, and 270-degree twisting supermicroanastomosis, respectively. Each SIEA was clamped with a Superfine Vascular Clamp (S&T Co, Neuhausen, Switzerland) and anastomosed with 6 stitches. On postoperative day 10, the skin flap surface texture had no color change, and skin necrosis was not found in any group within a 1.0-mm grid measurement in less than 1% of the whole skin flap surfaces. There were statistically significant differences between the groups in 4 criteria, such as cellular swelling, nuclear pleomorphism, nuclear swelling, and microvessel numbers. The pulsatility index was increased in the EA1 and EA2 on postoperative days 1 and 2, showing decrease in the similar preoperative value on postoperative day 10, but decreased pulsatility index was continuous in the EA3 during the postoperative day 10. The resistance index was significantly different between preoperative and postoperative day 10 especially in the EA2 and EA3. Ultramicroscopic findings in the EA3 group showed an increase in tunica media necrosis, convolution of the internal elastic lamina, and densely packed platelets, fibrins, and erythrocytes.
authors.affiliation: From the Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry Seoul National University, Seoul, Korea.
authors.forename: Mi Hyun
authors.initials: MH
authors.lastname: Seo
authors.forename: Soung Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Hoon
authors.initials: H
authors.lastname: Myoung
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008854:Microscopy, Electron; D051381:Rats; D017207:Rats, Sprague-Dawley; D013524:Surgical Flaps / Q000098:blood supply*; D018608:Ultrasonography, Doppler