Techniques for management of size discrepancies in microvascular anastomosis

Size discrepancy in microvascular anastomosis is a common issue in free fla p transfer. The sudden change of caliber may cause turbulence to the blood flow and predisposes to platelet aggregation, Discrepancies in the cut end diameters have been managed by many geometrical methods in order to reduce the risk to thrombosis. In this paper, we pretended to summarize the techni ques described and published about the management of size discrepancies in microvascular anastomosis, from the simple mechanical expansion with the je weler's forceps to the sophisticated hardware such as devices or laser. Adv antages and disadvantages are analyzed for many geometrical designs of anas tomosis. We may conclude there is not an ideal technique to manage every size discre pancy, rather to question for the best method with the less complications, we should search for the best procedure to fit a specific case. A small cal iber discrepancy may be well managed only with mechanical expansion. In tra umatic or ischemic leg reconstruction, an end to side anastomosis will offe r the continuity of the blood flow to both the vessel and the flap. In head and neck reconstruction, when a great discrepancy may be anticipated and t he upstream donor vessel is smaller than the recipient one, a sleeve anasto mosis can be performed. In the clinical set of a gap between the vessel end s, a graft must be used. Other geometrical designs (fish mouth or oblique c ut), devices, glues or adhesives and laser helped anastomosis should be con sidered according the surgeon experience. (C) Wiley-Liss, Inc.