title: The "11 O'clock Heel First" technique for microvascular end-to-side anastomosis.
abstract: BACKGROUND
  The heel of a microvascular end-to-side anastomosis is a common site for technical imperfections. We describe a simple technique to overcome this challenge. The aim of the technique is to insert all the sutures in an inside-to-outside manner at the heel area on the donor side of the anastomosis. This technique has first been tested in a laboratory setting and then was further elaborated in a clinical setting.
  
  
  METHODS
  One hundred and twenty adult albino Wistar rats of both genders were randomized into the following two groups: (A) Control, 48 rats, representing approximately 40% of the total sample, underwent the usual two anchoring stitch technique; (B) Study group, 72 rats, representing approximately 60% of the total sample, underwent the technique described. Patency was confirmed both clinically and by the use of fluorescein angiography. Rat weight, diameter of both the donor and recipient vessels, type of anastomosis (arterio-arterial or arterio-venous) and angiographic findings were used as variables. A P value of less than 0.05 was considered significant.
  
  
  RESULTS
  The proposed technique had increased patency rates as compared to the standard technique, which was statistically significant (P = 0.021). However, there was no difference between the patency rates of arterio-arterial and arterio-venous atastomoses.
  
  
  CONCLUSIONS
  The proposed technique is useful for perfecting the heel area of a microvascular end-to-side anastomosis in both laboratory and clinical settings.
authors.affiliation: Department of Neurosurgery, Kasr Al-Ainy Medical College, Cairo University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hegazy
authors.affiliation: Department of Neurosurgery, Kasr Al-Ainy Medical College, Cairo University, Cairo, Egypt.
authors.forename: Mohammad Fathy
authors.initials: MF
authors.lastname: Adel
authors.affiliation: Department of Interventional Neurology, Ain Shams Medical College, Ain Shams University, Cairo, Egypt.
authors.forename: Foad
authors.initials: F
authors.lastname: Abd-Allah
authors.affiliation: Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo, Egypt.
authors.forename: Hiedar
authors.initials: H
authors.lastname: Al-Shamy
authors.affiliation: Department of Interventional Neurology, Ain Shams Medical College, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elbassiouny
authors.affiliation: Department of Otorhinolaryngiology and Head and Neck Surgery, Kasr Al-Ainy Medical College, Fayoum University, Egypt.
authors.forename: Sameh Mahmoud
authors.initials: SM
authors.lastname: Amin
authors.affiliation: Department of Neurosurgery, Kasr Al-Ainy Medical College, Cairo University, Cairo, Egypt.
authors.forename: A
authors.initials: A
authors.lastname: El Samadoni
authors.affiliation: Department of Neurosurgery, Albert Einstein Medical College, New York, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Sandler
authors.affiliation: Department of Neurosurgery, Albert Einstein Medical College, New York, USA.
authors.forename: Arundhati
authors.initials: A
authors.lastname: Biswas
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D005260:Female; D005528:Foot / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000601:surgery*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D014656:Vascular Surgical Procedures / Q000379:methods*