Akan Mithat, Cakir Bariş, Aköz Tayfun
Department of Plastic and Reconstructive Surgery, Dr. Lütfi Kirdar Education and Research Hospital, Istanbul, Turkey.
Microsurgery. 2006;26(7):506-14. doi: 10.1002/micr.20278.
For the last 20 years, free tissue transfers have increasingly become the mainstay of plastic surgery. Size discrepancy between the vessels during tissue transfers are frequently encountered in clinical practice, and this may potentially be an important factor in the patency of anastomosis. In our clinic, we first studied a rat model and a fresh sheep cadaver to improve the diameter discrepancy in microvascular anastomosis with "open y" technique. At the end of our research, we progressed to success, and the open y technique was applied to nine patients in our clinic with a diameter discrepancy in microvascular anastomosis. After finding the bifurcation of vessels (artery, vein, or a vein graft) that are prepared for anastomosis, a distal cut of 2-3 mm was made for the anastomosis, which is considered to increase the diameter. Both legs of the resultant "y"-shaped vessel were united after inserting the microscissors from one leg and exiting from the other. Performing an end-to-end anastomosis between the vessels, we obtain an increase in the diameter. By using this method, we eliminated the diameter discrepancy in microvascular anastomosis in nine patients in our clinic. There was not any flap loss. To increase the usage of this technique, when we come across a problem of size discrepancy, it is important to use the open y technique, both to the recipient vessels, donor vessels, and to the vein grafts. Owing to its high prevalence and the ease of application, we are convinced that this is a suitable technique in appropriate cases.
在过去的20年里，游离组织移植越来越成为整形手术的主要手段。组织移植过程中血管之间的尺寸差异在临床实践中经常遇到，这可能是影响吻合口通畅的一个重要因素。在我们诊所，我们首先研究了大鼠模型和新鲜绵羊尸体，以用“开放Y”技术改善微血管吻合中的直径差异。在我们的研究结束时，我们取得了成功，开放Y技术应用于我们诊所9例微血管吻合存在直径差异的患者。在找到准备用于吻合的血管（动脉、静脉或静脉移植物）的分叉处后，对用于吻合的血管进行2 - 3毫米的远端切割，这被认为可以增加直径。从“Y”形血管的一条腿插入显微剪刀并从另一条腿穿出后，将所得“Y”形血管的两条腿合并。在血管之间进行端端吻合，我们使直径增加。通过使用这种方法，我们消除了我们诊所9例患者微血管吻合中的直径差异。没有任何皮瓣丢失。为了增加该技术的应用，当我们遇到尺寸差异问题时，对受区血管、供区血管以及静脉移植物使用开放Y技术都很重要。由于其高发生率和易于应用，我们确信这在适当的病例中是一种合适的技术。
