Optimal Anastomotic Angle for Prevention of Shear Related Thrombosis in Microsurgical End-To-Side Anastomosis

Document Type

Conference Proceeding

Publication Date

8-2024

Publication Title

Plastic and Reconstructive Surgery - Global Open

Abstract

AIM: In light of the paradigm shift from the reconstructive ladders to the reconstructive elevator in plastic surgery, free tissue transfer is now emerging as a common procedure. End-to-side (ETS) microsurgical anastomosis is a powerful technique in microsurgery. It can overcome vessel’s diameter discrepancy and preserve the distal blood flow. The anastomotic angle is created based on surgeon preference and experience. Optimal angle of the ETS anastomosis has been debated and studied, and is currently limited to animal models only. In this study, we sought to explain the physiology behind shear related thrombosis in microsurgical End-to-Side anastomosis and the effect that the anastomotic angle has on the same. METHOD: Computational model using Finite Element Analysis (FEA) was used to simulate the models with 45 (model45), 90 (model90), and 135 (model135) ETS anastomosis angles. Flow dynamics, including flow velocity and wall shear rate, were studied, and compared. RESULTS: Maximum flow velocity ranged from the highest to the lowest in model135, model90, and model45, respectively. The velocity in model135 showed fluctuation of flow. The maximum wall shear rate and distribution were highest in model45 and lowest in model90. CONCLUSION: ETS anastomosis angle of 90 degrees provided the most favorable flow dynamics to prevent shear related thrombosis and subsequent flap failure in comparison to ETS anastomosis at 45 and 135 degrees. This finding can potentially enhance clinical outcomes with respect to shear related thrombosis in microsurgical End-to-Side anastomosis in microsurgical reconstructive procedures.

Volume

12

Issue

S7

First Page

15

Last Page

16

Comments

Michigan Academy of Plastic Surgeons Biennial Scientific Meeting, August 1-4, 2024, Mackinac Island, MI

DOI

10.1097/01.GOX.0001028272.49199.1

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