Microsurgery and Vessel Caliber Mismatch: A Review of Microsurgery Anastomosis Techniques to Overcome Vessel Diameter Discrepancy.
Introduction: The evolution and progress of microsurgery has brought about numerous advances but some challenges still remain. Among these are discrepancies in the vessel size. A significant size discrepancy still equates to technical difficulty and high rate of flow turbulence possibly resulting in subsequent thrombosis. This article reviews the most common techniques that address this obstacle and highlights the reliability of each technique. Methods: Medline, Embase, Pubmed, Cochrane and google scholar search limited to English language since 1980 till present time. Results: Various techniques were described to address micro-anastomosis size discrepancy with variable reliability. Conclusion: Although many techniques have been described to overcome micro-anastomosis size mismatch, an ideal technique is yet to be perfected. Every technique described has advantages as well as limitations. From our review, it was apparent that the bigger the discrepancy between the vessels, the higher the incidence of complications. That being said, successful anastomoses have been described in vessel mismatch ratios of up to 1:5 in the literature. Moving forward, in our opinion, when describing a vessel size mismatch, it is more informative and helpful to use a ratio rather than a millimeter gauge.
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