ADVANTAGES OF SHARP ADVENTITIAL DISSECTION FOR MICROVASCULAR ANASTOMOSES

Adventitia is usually removed from arteries to simplify microvascular anastomoses. Some surgeons peel the adventitia away bluntly whereas ot hers trim the adventitia sharply with scissors, We used a rat cremaste r flap for intravital microscopy to evaluate these two techniques. Ani mals with unmanipulated vessels, without anastomosis or adventitial re moval, served as controls. Fifty-four rats were studied in three group s of 18 rats. Functional capillary density, red blood cell velocity, d iameter of the flap's feeding artery (Al), microthrombi formation, and neutrophilic activity were studied for 5 hours following anastomosis, and 24 and 72 hours later. Histological changes in blunt and sharply prepared arteries were compared with control vessels. After blunt prep aration, capillary perfusion was reduced to 61% of control values (p < 0.05) and Al diameter was reduced to 77% of control values (p < 0.05) . Capillary perfusion and Al diameter were unchanged in sharply prepar ed arteries. Architectural changes in the vessel wall were more profou nd, and neutrophilic activity was increased in bluntly prepared arteri es. In this study, sharp preparation of small arteries was beneficial compared with blunt preparation.