The V-Plasty. A New Microsurgical Technique to Anastomose Vessels with Marked Size Discrepancy

Introduction: The purpose of this topic is to present an original, new way to achieve microsurgical vascular anastomoses between two vascular structures with a high diameter discrepancy. The V-Plasty - the name we gave to this technique - can accomplish the continuity of the vascular tube respecting the linear direction of the blood flow and avoiding the turbulences that are zones where blood cells may aggregate in blood clots.

Methodology and Material: Nowadays with the wide spread of the microsurgical techniques, we count at least 30 donor sites offering single or composite free flaps which can be used to reconstruct any body defect. Their nutrient vessels, arteries and particularly veins, often show diameter discrepancies with the recipient vessels. Many techniques have been described and are usually applied depending on the importance of the diameter discrepancy ratio. When the ratio is less than 50%, a simple vessel wall dilatation can adjust temporarily the diameter playing on the wall elasticity. When the ratio is between 50 and 100%, an oblique transection or a double fish mouth incisions can be done on the small vessel to increase its diameter. But these former techniques create systematically an angle on the anastomosis site generating blood flow perturbation. For a discrepancy over 100%, latero-terminal anastomosis is advised.

Results: The microsurgical V-Plasty technique is easy to design. It consists in creating a V-shape flap with a proximal base on the big vessel and a linear incision on the small vessel of the same length of the V flap. This V flap is introduced on the triangular defect created on the small vessel wall.

Conclusions: The advantages of the microsurgical V-Plasty technique are numerous: it respects a linear vessel direction without any angulation on the anastomosis site and it equalizes the vessels diameters creating a soft and progressive change of the small vessel with a gentle slope.

Even if it is impossible to reach the ideal hydrodynamics rules, the microsurgical V-Plasty recreates the ideal conditions of maintaining a laminar blood flow.