Impact of Fibrin Adhesive Application in Microvascular Anastomosis: Comparative Experimental Study

Microvascular anastomosis is a most critical step in free-flap transfers or replantations. Although the conventional suture is still considered the gold standard, it is technically difficult, time consuming, and traumatic to the vessel wall. The aim of this study was to evaluate the effectiveness of fibrin adhesive in overcoming these problems, when applied in microvascular anastomosis.

Sixty-eight Wistar rats were used in the study. The first eight animals were used in a pilot study to determine the minimum amount of suture stitches required per anastomosis when fibrin adhesive was applied. In that definitive study, the authors performed 30 anastomosis using the femoral artery and 30 anastomosis using the carotid artery. In each artery, half the anastomosis were performed using interrupted sutures without fibrin adhesive (control groups), and, in the other half, they were performed using fibrin adhesive and four sutures in the femoral artery, and fibrin adhesive and six sutures in the carotid artery (experimental groups). Both groups were compared by means of statistical analysis of the clinical and histologic parameters.

The application of fibrin adhesive significantly (p < 0.05) reduced the number of sutures and the time taken to perform the anastomosis. Bleeding at the anastomotic site was also significantly (p < 0.05) reduced in both experimental groups. Immediate and late patency rates were not compromised by fibrin glue application. No significant differences were observed in the evaluated histologic parameters (inflammatory process, medial fibrosis, and subintimal hyperplasia), between the two techniques.

The application of fibrin adhesive with adequate concentration of thrombin did not show any harmful effects on the microvascular anastomosis. On the contrary, the anastomosis could be completed in a more rapid and easier fashion, and with fewer sutures. The authors strongly recommended the routine application of fibrin adhesive in microvascular anastomosis, not as a substitute for the sutures, but as a useful auxiliary.