Novel microvascular anastomosis between a single vessel and two downstream vessels

Abstract

Microsurgeons rarely encounter a situation that includes multiple downstream arteries requiring reperfusion with only one feeding artery being available. To cope with the difficulty of such a case, a unique microvascular anastomosis is described. This surgical technique is based on the assumption of the presence of a single large outflowing vessel and two small downstream vessels. The axial incisions were made on the cut end of the two small vessels. The ends of the two small vessels were sutured side-to-side and remodeled as one vessel. The partially coalesced small vessels were then anastomosed with the outflowing large vessel in an end-to-end fashion. Case presentation: a crush injury of the foot required reconstruction of the blood flow. The first dorsal metatarsal artery (FDMA) was damaged and occluded by thrombosis. The first and second toes had no blood supply. The original plan was simply to remove the damaged area of the FDMA and replace it with a straight vein graft, as the bifurcation to the two digital arteries appeared to be intact. At the time of microvascular anastomosis, however, the FDMA was found to still be damaged, and it required additional debridement. As a suboptimal method, the vein graft and the two digital arteries were anastomosed by the above-described atypical method. The digits all survived, and the patient subsequently returned to work, with no complications as of 10 months postoperatively. This atypical microvascular anastomosis is not an established method, but it has potential utility in similar situations.

Level of Evidence: Level V, therapeutic study.