Bakhach Joseph, Dibo Saad, Zgheib Elias R, Papazian Nazareth
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
J Reconstr Microsurg. 2016 Feb;32(2):128-36. doi: 10.1055/s-0035-1563394. Epub 2015 Sep 30.
The art of reconstructive microsurgery is still progressing after Carrel's original description of "vascular repair" in 1902. Reports of the successful repair of vessels smaller than 1 mm in diameter are currently commonplace. However, the technique of microvascular anastomosis to connect vessels with large diameter discrepancy, greater than 1 mm, has not yet been perfected. This article reports a novel option to anastomose two vessels of different sizes by adapting the diameters of the two stumps and creating a gentle slope that dramatically reduces turbulences in the blood stream.
The "V-plasty" consists in designing a v-shaped flap on the wall of the large vessel and a longitudinal incision on the small one. The V-flap is then introduced into the V-defect of the small vessel, creating a smooth transition of the diameters between the two vessels. Mathematical calculation of the dimensions of the V-flap was conducted with different ratios' discrepancies of the two vessels ranging from 1.5 to 4. Clinically, 14 microvascular V-plasty were performed in 8 patients.
The theoretical simulation and our clinical experience of 14 cases allowed us to propose the different dimensions (length and width) of the V-plasty according to the ratio of vessels discrepancies.
The V-plasty microanastomosis is an alternative method to attach vessels with size discrepancy. It simply equalizes the donor and recipient vessels' diameters. Its main advantage is to maintain a linear axis between the two vessels whatever the discrepancy ratio is.
自1902年卡雷尔首次描述“血管修复”以来，显微重建外科技术仍在不断发展。目前，直径小于1毫米的血管成功修复的报道屡见不鲜。然而，用于连接直径差异大于1毫米的大血管的微血管吻合技术尚未完善。本文报道了一种通过调整两个血管断端的直径并形成平缓坡度来显著减少血流湍流，从而吻合两种不同大小血管的新方法。
“V形整形术”包括在大血管壁上设计一个V形皮瓣，在小血管上做一个纵向切口。然后将V形皮瓣插入小血管的V形缺损处，使两根血管之间的直径实现平滑过渡。对两根血管直径差异比例从1.5到4的不同情况进行了V形皮瓣尺寸的数学计算。临床上，对8例患者进行了14次微血管V形整形术。
理论模拟和我们14例的临床经验使我们能够根据血管差异比例提出V形整形术的不同尺寸（长度和宽度）。
V形整形术微血管吻合术是连接大小不同血管的一种替代方法。它简单地使供体和受体血管的直径相等。其主要优点是无论差异比例如何，都能在两根血管之间保持线性轴。
