title: A Secure Technique for Microvascular Anastomosis in Arteries with Intimal Dissection: Intimal Sleeve Fold-Over Technique.
abstract: 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.
authors.affiliation: 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.
authors.forename: Tung-Ying
authors.initials: TY
authors.lastname: Hsieh
authors.forename: Yu-Hao
authors.initials: YH
authors.lastname: Huang
authors.forename: Feng-Shu
authors.initials: FS
authors.lastname: Chang
authors.forename: Chih-Hau
authors.initials: CH
authors.lastname: Chang
authors.forename: Ko-Kang
authors.initials: KK
authors.lastname: Chen
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Huang
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
authors.forename: Sin-Daw
authors.initials: SD
authors.lastname: Lin
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chang
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000209:etiology / Q000601:surgery*; D001158:Arteries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013536:Suture Techniques; D017539:Tunica Intima / Q000601:surgery