Abstract
Thrombosis of the arterial microanastomosis is the major reason for flap complications. Thrombus formation can occur rapidly at the site of anastomosis, or it may be delayed in developing, inducing secondary ischemia. The damaged endothelial cells and the exposed connective tissue play an important role in the molecular and cell mechanisms of coagulation and thrombosis. For this reason the early morphological changes in the endothelial cell layer after arterial microanastomoses in the rat were investigated. The results showed that the anastomotic site appeared completely sealed, with cut ends protruding into the vessel lumen. Extensive deendothelialized areas with fibrin deposition were visible between surgical microclamps on the inner surface of the artery. For this reason we believe that the damaged endothelium and exposed connective tissue elements are the primary cause of thrombin formation, platelet accumulation, and thrombosis at the anastomotic site. The reconstructive surgeon must employ a very meticulous microvascular technique to minimize damage to the vascular endothelium.
Similar content being viewed by others
References
Acland RD, Anderson G, Siemionov M, McCabe S (1989) Direct in vivo observations of embolic events in the microcirculation distal to a small-vessel anastomosis. Plast Reconstr Surg 84:280
Carroll WR, Esclamado RM (2000) Ischemia/ reperfusion injury in microvascular surgery. Head Neck 22:700
Esclamado RM, Carroll WR (1999) The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck 21:355
Fahmy HW, Moneim MS (1988) The effect of prolonged blood stasis on a microarterial repair. J Reconstr Microsurg 4:139
Hill GE, Whitten CW (1997) The role of the vascular endothelium in inflammatory syndromes, atherogenesis and the propagation of disease. J Cardiovasc Anesth 11:316
Hjortdal VE, Sinclair T, Kerrigan CL, Solymoss S (1994) Arterial ischemia in skin flaps: microcirculatory intravascular thrombosis. Plast Reconstr Surg 93:375
Johnson PC, Dickson CS, Garrett KO, Sheppeck RA, Bentz ML (1993) The effect of microvascular anastomosis configuration on initial platelet deposition. Plast Reconstr Surg 91:522
Kanaujia RR, Hoi KI, Miyamoto Y, Yoshikazu I, Tsuge K (1988) Further technical considerations of the sleeve microanastomosis. Plast Reconstr Surg 81:725
Kroll SS, Reece GP, Miller MJ, Schusterman MA (1992) Comparison of the rectus abdominis free flap with the pectoralis major myocutaneous flap for reconstruction in the head and neck. Am J Surg 164:615
May JW Jr, Chait LA, O'Brien BM, Hurley JV (1978) The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg 61:256
Rosen HM, Slivjak MJ, McBrearty FX (1987) Delayed microcirculatory hyperpermeability following perfusion washout. Plast Reconstr Surg 79:102
Rosenbaum TJ, Sundt TM (1977) Thrombus formation and endothelial alterations in microarterial anastomoses. J Neurosurg 47:430
Urken ML, Vickery C, Weinberg H, Buchbinder D, Biller HF (1989) Geometry of the vascular pedicle in free tissue transfers to the head and neck. Arch Otolaryngol Head Neck Surg 115:954
Author information
Authors and Affiliations
Corresponding author
Additional information
An invited commentary on this paper is available at http://dx.doi.org/10.1007/s00238-003-0469-x
Rights and permissions
About this article
Cite this article
Benazzo, M., Casasco, M., Bertino, G. et al. Early microscopic evidence for endothelial damage in arterial microanastomoses. Eur J Plast Surg 26, 26–28 (2003). https://doi.org/10.1007/s00238-003-0468-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-003-0468-y