Rickard Rory F, McPhaden Allan R, Hudson Donald A
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Department of Plastic Surgery, Derriford Hospital, Plymouth, United Kingdom; Division of Plastic, Reconstructive and Maxillofacial Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.
Department of Pathology, University of Glasgow, Glasgow, United Kingdom.
J Surg Res. 2014 Sep;191(1):239-49.e3. doi: 10.1016/j.jss.2014.03.011. Epub 2014 Mar 13.
The use of fascial perforating vessels as recipients for microvascular composite tissue autotransplants has led to vessel diameter discrepancy becoming an increasingly common finding. Little evidence, however, is available to direct the choice of anastomotic technique where a discrepancy exists. We have been studying two methods of anastomosing arteries where a small-to-large discrepancy exists-a 45° section of the smaller vessel, and invaginating the smaller vessel inside the larger. As part of this work, this study examines intimal hyperplasia and healing of the two methods.
A previously described paired Wistar rat femoral axis model was used. Anastomoses were performed, one on each side, and specimens were harvested in groups at 24 h, 1 wk, 6 wk, and 8 mo. Inflammation, necrosis, and fibrosis in each layer of the vessel wall and intimal hyperplasia were each scored by an assessor blinded to the group and anastomotic technique.
Significant differences in healing were found. The invagination technique induced less inflammation, and caused less endothelial and medial necrosis than the oblique cut end-to-end method. Intimal hyperplasia was most pronounced at 6 wk, but no evidence of a difference in the severity of intimal hyperplasia between the two methods was found.
The invaginating anastomosis causes less inflammation and less vessel wall necrosis than the oblique end-to-end method in this model. This finding, alongside results from previous work, suggests that this is the better method to deal with a small-to-large microarterial diameter discrepancy in the range 1:1.5 to 1:2.5.
将筋膜穿支血管用作微血管复合组织自体移植的受区血管，导致血管直径差异成为越来越常见的情况。然而，几乎没有证据可指导在存在差异时吻合技术的选择。我们一直在研究两种在存在小至大直径差异时吻合动脉的方法——较小血管的45°截面法，以及将较小血管内翻入较大血管内的方法。作为这项工作的一部分，本研究检查了这两种方法的内膜增生和愈合情况。
使用先前描述的成对Wistar大鼠股轴模型。在每侧进行吻合，在24小时、1周、6周和8个月时分组采集标本。由对分组和吻合技术不知情的评估者对血管壁各层的炎症、坏死和纤维化以及内膜增生进行评分。
发现愈合存在显著差异。内翻技术引起的炎症较少，与斜切端端吻合法相比，引起的内皮和中层坏死也较少。内膜增生在6周时最为明显，但未发现两种方法在内膜增生严重程度上存在差异的证据。
在该模型中，内翻吻合术比斜切端端吻合法引起的炎症和血管壁坏死更少。这一发现与先前工作的结果表明，这是处理1:1.5至1:2.5范围内小至大微动脉直径差异的更好方法。
