The efficacy of absorbable suture for microvascular anastomoses

Although microvascular anastomoses are routinely performed with nonabsorbable sutures, a foreign body reaction can be stimulated that acts as a nidus for inflammation, infection, and possible thrombosis. Absorbable sutures should be able to diminish this reaction. There are sparse data describing the use of absorbable sutures for both arterial and venous anastomoses. This investigation compares standard microvascular anastomotic technique using nonabsorbable 10-0 sutures (nylon) with absorbable 10-0 sutures (polyglactin 910), using a previously reported tubed superficial epigastric flap model in rats. Patency rates and histologic responses are compared at intervals of 3 days and 1, 2, 8 and 12 weeks postoperatively. Arterial and venous patency rates were similar for both materials (overall nonabsorbable, 85.9%; overall absorbable, 84.4%). A somewhat increased inflammatory response was noted in the arterial absorbable group at 1 week and in both the venous and arterial nonabsorbable groups at 8 and 12 weeks postoperatively. The later finding most probably represents the continued presence of the nylon sutures. The incidence of intraluminal thrombosis was greater for nonabsorbable suture, occurring in two arterial and four venous anastomoses, compared with only one absorbable suture venous anastomosis. We conclude that nonabsorbable suture is as efficacious as standard absorbable material in both arterial and venous microanastomoses with the potential benefit of diminished foreign body reaction.