Role of side branches in determining suitable arterial segments for anastomosis in avulsion injuries: experimental...

The role of side branches, when the parent arterial trunk is stretched, with emphasis on preventing the effects of avulsion injury, was investigated in an experimental model. In ten New Zealand rabbits, the femoral arteries were isolated with and without side branches in the left and right legs, respectively, and controlled longitudinal traction was applied. The elongation of the arteries just before avulsion rupture at each side, with and without side branches, was compared, by measuring the initial and final length from the inguinal ligament to the mid-point of the distance between the inguinal ligament and the saphenous bifurcation. Side branches were observed to be tethered in a way that resisted elongation of the trunk artery. Arteries without side branches in the right legs elongated more, as they lacked the fixating and protective support provided by the side branches. Comparison of the two legs, with and without side branches, showed an average of 50 percent more arterial elongation, resulting in severe injury to the arteries without side branches. In the light of these results, the authors suggest performing microsurgical arterial anastomosis after resection past a minimum of two unruptured branch points of the avulsed part, in order to obtain a safer arterial segment for a better patency rate.