Aneurysms after microvascular anastomoses. Incidence and pathogenesis in experimental animals.

This study has demonstrated that aneurysms occur in about 50 percent of the rat femoral arteries subjected to microvascular anastomosis. These aneurysms are consistent histologically--being characterized by medial necrosis, loss of elastic lamellae, and subintimal hyperplasia. Mechanical trauma is implicated as a factor in their pathogenesis, though further study in necessary to define the exact etiology.     

Bone scintigraphy of experimental composite bone grafts revascularized by microvascular anastomoses.

In these experiments the reliability of bone scintigraphy with 99mTc diphosphonate, to assess anastomotic patency and the viability of revascularized composite fibular grafts, was studied. It was shown that bone scintigraphy is very useful for the diagnosis of anastomotic patency, but only in the first postoperative weeks. Bone scintigraphy gives no information on the viability of bone grafts.     

Use of the united suture in microvascular anastomoses.

A technique for microvascular anastomoses is described. It leaves one suture united until the last, a maneuver which helps to avoid picking up the posterior wall with the anterior wall.     

A scanning electron microscope study of microvascular anastomoses.

The abdominal aortas of 30 rats were sutured under an operating microscope. The results were studied under a scanning electron microscope at 8 different periods after operation, ranging from 3 minutes to one month. The observations are presented.     

Experimental transplantation of small joints by microvascular anastomoses.

Metacarpophalangeal joints in dogs were transplanted with microvascular anastomoses. Some were transplanted as half-joints, others as whole joints, and these dogs were followed for up to 5 1/2 months. When a half-joint was transplanted within the foot, the joint movement became restricted but the vascularized half-joints were well preserved with only slight damage and well-preserved epiphyseal plates--compared to severe damage of the articular cartilage and destruction of the epiphyseal plates in the non-vascularized joint transplants. Vascularized whole joint transplants within the foot were indistinguishable macroscopically and microscopically from normal joints, and they had only a slight restriction of joint movement. They took up tetracycline from the circulation, demonstrating their viability.     

Therapeutic value of intravenous heparin in microvascular surgery: an experimental vascular thrombosis study

In an attempt to decrease a 10 to 15 percent vascular thrombosis rate leading to graft occlusion, low-dose human-grade heparin was studied to determine if carefully monitored intravenous therapy would increase 7-day patency in a known potent thrombosis model. In New Zealand white rabbits, the type of infusate administered intravenously, either saline (30 animals) or heparin (35 animals), was selected at random after completing a 2-mm arterial inversion graft in the femoral artery. A 72-hour infusion was used in all animals; the control group received sterile saline and the experimental group received a heparin infusion at 45 microliters per hour after a 500-unit bolus. All grafts in both groups were patent at the time of groin closure. Patency in the heparin-perfused group was 67 percent (24 of 35) as compared to 19 percent (6 of 30) in the control group (p less than 0.05) 1 week postoperatively. Scanning electron microscopy showed significantly less dense fibrin deposition and a decrease in the number of aggregated platelets in the heparin-perfused grafts. Partial tissue thromboplastin time values in the experimental group ranged between 55 and 75 seconds (control 20 to 25 seconds). We have shown that heparin, an inexpensive and readily available agent, maintains 1-week microarterial patency and results in few complications in a reliable, reproducible, and versatile thrombosis model. The clinical ramifications of using an antiplatelet agent that diminishes fibrin deposition in microsurgery are apparent.     

Thrombosis of microvascular anastomoses in traumatized vessels: fibrin versus platelets

Thrombosis is the end result of two closely interrelated processes: the coagulation cascade and the platelet aggregation process. To determine their relative contribution, we used pharmacologic agents that selectively block each process. The specific effect of each pharmacologic agent on either fibrin deposition or platelet activity was confirmed morphologically by scanning electron microscopy and was substantiated with ADP-induced platelet aggregation and blood clotting time determinations. Forty-two rats had both femoral arteries subjected to a standardized crush-avulsion injury. A total of 84 femoral microvascular anastomoses were subsequently performed. None of the 24 control anastomoses treated with saline remained patent, whereas 6 of 24 of the anastomoses treated with dazmagrel (a selective thromboxane synthetase and platelet aggregation inhibitor), 2.5 mg/kg IV, remained patent and 18 of 24 of those treated with a single dose of heparin, 200 U/kg IV, remained patent. All 12 anastomoses treated with both drugs remained patent but developed a 33 percent hematoma rate. We conclude that in this microvascular model, fibrin mesh deposition is a more significant factor than platelet aggregation in the pathogenesis of occlusional thrombosis within traumatized arteries. Its temporary inhibition with a single dose of heparin yielded a 75 percent improvement in patency rate.