title: The V-Plasty: A Novel Microsurgical Technique for Anastomosis of Vessels with Marked Size Discrepancy.
abstract: BACKGROUND
  The art of reconstructive microsurgery is still progressing after Carrel's original description of "vascular repair" in 1902. Reports of the successful repair of vessels smaller than 1 mm in diameter are currently commonplace. However, the technique of microvascular anastomosis to connect vessels with large diameter discrepancy, greater than 1 mm, has not yet been perfected. This article reports a novel option to anastomose two vessels of different sizes by adapting the diameters of the two stumps and creating a gentle slope that dramatically reduces turbulences in the blood stream.
  
  
  METHODS
  The "V-plasty" consists in designing a v-shaped flap on the wall of the large vessel and a longitudinal incision on the small one. The V-flap is then introduced into the V-defect of the small vessel, creating a smooth transition of the diameters between the two vessels. Mathematical calculation of the dimensions of the V-flap was conducted with different ratios' discrepancies of the two vessels ranging from 1.5 to 4. Clinically, 14 microvascular V-plasty were performed in 8 patients.
  
  
  RESULTS
  The theoretical simulation and our clinical experience of 14 cases allowed us to propose the different dimensions (length and width) of the V-plasty according to the ratio of vessels discrepancies.
  
  
  CONCLUSIONS
  The V-plasty microanastomosis is an alternative method to attach vessels with size discrepancy. It simply equalizes the donor and recipient vessels' diameters. Its main advantage is to maintain a linear axis between the two vessels whatever the discrepancy ratio is.
authors.affiliation: Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bakhach
authors.affiliation: Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Saad
authors.initials: S
authors.lastname: Dibo
authors.affiliation: Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Elias R
authors.initials: ER
authors.lastname: Zgheib
authors.affiliation: Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Nazareth
authors.initials: N
authors.lastname: Papazian
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D008962:Models, Theoretical; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult