title: Supermicrosurgery and hyaluronic acid: experimental feasability study of a new method.
abstract: BACKGROUND
  As a technique of anastomosis for vessels of less than 0.8mm in diameter, supermicrosurgery has aroused renewed interest on account of its potential clinical applications. The technical difficulty of surgery at such a small scale necessitates exploration of new methods likely to render the anastomoses accessible and reliable. The aim of this article is to present the results of an experimental study on the feasibility of anastomoses (arterial diameter ≤0.5mm), assisted by the injection of hyaluronic acid (HA).
  
  
  METHODS
  Ten end-to-end arterial anastomoses of the inferior epigastric artery (diameter ≤0.5mm) were performed in 5 rats. An injection of HA had previously been carried out in the vessel lumen and the sutures were made with 12-0 nylon. Immediate and 3-day permeability were controlled and anastomosis times were measured.
  
  
  RESULTS
  Average diameter of the arteries was 0.42 mm (range 0.29-0.48 mm). Mean anastomosis duration was 19.5 min (range 15-23 min). The average number of stitches was 6. Immediate patency was 100% with a success rate of 80% at 3 days.
  
  
  CONCLUSIONS
  The properties of HA seem to effectively facilitate anastomoses of arteries with a diameter ≤0.5mm. HA provides comfort and promotes safety in performance of exceedingly small-scale surgery. While the results appear promising, but further studies are needed in order to determine the potential toxicity of this method on tissues.
authors.affiliation: Service de chirurgie plastique et reconstructrice, Gustave-Roussy, cancer campus Grand-Paris, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Laboratoire d'anatomie et d'organogenèse, université de Picardie Jules-Verne, rue des Louvels, 80000 Amiens, France. Electronic address: q.qassemyar@live.fr.
authors.forename: Q
authors.initials: Q
authors.lastname: Qassemyar
authors.affiliation: Laboratoire d'anatomie et d'organogenèse, université de Picardie Jules-Verne, rue des Louvels, 80000 Amiens, France.
authors.forename: M
authors.initials: M
authors.lastname: Gianfermi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D019074:Epigastric Arteries / Q000601:surgery*; D005240:Feasibility Studies; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular; D008866:Microsurgery / Q000379:methods*; D023421:Models, Animal; D017207:Rats, Sprague-Dawley; D055675:Viscosupplements / Q000008:administration & dosage
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Acide hyaluronique; Hyaluronic acid; Microchirurgie; Microsurgery; Supermicrochirurgie; Supermicrosurgery