A Novel End-to-End Anastomosis Technique in Vessels Smaller than 1 mm Diameter: the Zigana Method

Abstract

Introduction: Traditional end-to-end microvascular anastomoses, the sine qua non of reconstructive microsurgery, has disadvantages, such as narrowing in the anastomosis line, excessive suture use, and risks of rotation and injuring the posterior wall especially for vessels with small diameter. It is aimed to compare the traditional method with a novel end-to-end vascular anastomosis technique suitable for use in very narrow vessels. Methods: Fifteen female Wister Albino rats weighing 235-275 g were used. The experimental (Zigana) technique was applied to the right femoral artery, and the traditional anastomosis technique to the left. Operative time, suture counts, permeability rates and bleeding time were analyzed at clinical evaluation, and endothelialization, inflammation, fibrosis, foreign body reaction, intimal hyperplasia, intimal injury, thrombus and necrosis at histopathological evaluation. Results: Clinical evaluation revealed a longer operative time, lower suture count, and a shorter bleeding time with the Zigana technique, while permeability rates were the same with both methods. Similar thrombus, stenosis, inflammation, fibrosis, and foreign body reaction rates were observed in both groups at histopathological examination. Intimal hyperplasia rates were lower in the Zigana technique group, while no necrosis was encountered in either. Conclusion: The Zigana Technique exhibited better suture use and bleeding time values than the traditional method, although the difference between the two groups was not statistically significant. It is thought that the Zigana technique, which can yield positive results even with vessels less than 1 mm in diameter, is capable of use in microvascular anastomoses in both clinical and experimental studies.