Influence of silicone sheets on microvascular anastomosis

The use of silicone products combined with free flap transfer is well established in reconstructive surgery. We determined the risk of thrombosis as a result of direct contact between the silicone sheet and the point of microanastomosis. We performed microvascular surgery in 24 female Chinchilla Bastard rabbits weighing 3500 to 4000 g using two groups: Group 1 (n = 12), microanastomosis directly in contact with silicone sheets; and Group 2 (n = 12), microanastomosis protected by a 2 x 3 x 1-cm muscle cuff before being placed in contact with the silicone. We assessed flow-through of the microanastomosis by selective microangiography and histology at 1 and 3 weeks. All microanastomoses in Group 1 were occluded by postoperative thromboses, whereas all microanastomoses in Group 2 had adequate flow-through. Histologic analysis revealed thromboses in Group 1 formed from collagenous bundles of fiber securely attached to the intraluminal wall of the vessel. Three weeks after the procedure, these thromboses were canalized by varying small vessels. In Group 2, a slight luminal stenosis with evidence of infiltration of inflammatory cells at the microanastomosis line was observed histologically in all cases. Prefabricated flaps using silicone sheets and muscular cuffs placed around the anastomoses appear to reduce the risk of thrombosis and enhance neovascularization.