ANASTOMOTIC AND TISSUE PROTECTION IN MICR OVASCULAR SURGERY

Although microvascular surgery has become a safer procedure in recent years, failure still occurs. The main cause of failure is thrombosis o f the anastomosed vessels. Thrombosis involves the vascular wall, plat elets and the coagulation system. Sometimes the transferred tissue die s with the anastomoses open. This is caused by an insufficient perfusi on at the microcirculatory level, e.g. a reduction of capillary inflow by arteriolar vasoconstriction. Tissue damage also occurs after ische mia and reperfusion. Oxygen free radicals and activated leukocytes are responsible for this phenomenon. Thrombosis can be reduced by antipla telet and anticoagulant drugs, substances increasing fibrinolysis and other agents. In the clinical situation, aspirin, heparin and dextrane have proven reliable. The microcirculation can be protected by aspiri n. Reperfusion injury is affected with superoxiddismutase, allopurinol and perfusion sulutions. Future developments in this field will inclu de locally applied antithrombotic agents and substances acting more sp ecifically.