[Microsurgical vascular suture].

OBJECTIVE

Anastomosis of two vessels by end-to-end or end-to-side suturing to create an uninterrupted blood flow between the two vessels.

INDICATIONS: Transplantations; replantations; vascular trauma.

CONTRAINDICATIONS: Active infections in the area to be vascularized or surgical site; large differences in caliber between the vessels; hypercoagulability; extensive tissue damage.

SURGICAL TECHNIQUE: First, clamping, cleaning and flushing of the vessel ends; adaptation of the vessel ends using end-to-end or end-to-side anastomosis, using an end-to-side anastomosis if an existing vessel axis should not be interrupted; creation of the anastomosis using a single button suture or continuous suture technique; careful avoidance of puncturing the posterior wall and exact adaptation of the vessel ends without leaks; release of the blood flow and examination of the anastomosis.

POSTOPERATIVE MANAGEMENT: Postoperative avoidance of traction, tension, pressure and shear forces on the anastomosis; regular blood flow checks of the revascularized tissue or flap; sufficient anticoagulation.

RESULTS

An atraumatic and gentle suturing technique is a basic requirement for a successful anastomosis. Special suturing techniques can improve the anastomosis of fragile vessels.