Microsurgical Anastomosis Revision

The techniques described in this chapter are specifically relevant for microvascular revisions, addressing common mistakes made during anastomosis procedures involving venous or arterial vessels. One of the most prevalent errors made by surgeons in microvascular procedures is the placement of uneven sutures, which results in gaps that can lead to leakage. Traditionally, surgeons are trained to manage these situations by using clamps to stop bleeding and then adding additional sutures to close the gaps in the anastomosis. However, this approach has potential drawbacks. Applying vascular clamps may fully occlude small blood vessels, making it challenging to identify the precise site of the leak and also increasing the risk of thrombosis. To overcome these concerns and improve the revision process, a new technique was developed. Instead of using clamps, this method involves placing a cellulose hemostatic sponge spear or a cotton-tipped applicator underneath the site of the anastomosis to partially occlude the blood flow within the vessel. This partial occlusion allows the surgeon to add an additional suture precisely at the leakage site without causing thrombosis of the vessel. By implementing this revised approach, surgeons can effectively address gaps in the anastomosis without compromising the microvascular integrity. This technique can lead to improved outcomes in microvascular revision surgeries by reducing the risk of thrombosis and facilitating precise suturing to correct leakage.