A comparison of irrigation solutions for microanastomoses

Area of Science:

• Vascular Surgery
• Biomaterials Science
• Pharmacology

Background:

• Microvascular anastomosis is critical in reconstructive surgery.
• Maintaining vessel patency after microanastomosis is challenging.
• Irrigating solutions can influence surgical outcomes.

Purpose of the Study:

• To evaluate the efficacy of various irrigating solutions containing clot-active and/or vasodilating agents.
• To compare the patency rates of different irrigating solutions in a rat femoral artery crush injury model.
• To determine the optimal composition of irrigating solutions for compromised microanastomoses.

Main Methods:

• A crush injury model of the rat's femoral artery was utilized.
• Routine microanastomosis was performed using seven different irrigation solutions.
• Solutions included lactated Ringer's, heparin, urokinase, phentolamine, tissue plasminogen activator (tPA), and combinations thereof.
• Patency rates were statistically analyzed.

Main Results:

• Heparin, phentolamine, and urokinase individually showed statistically significant improvements in patency rates.
• A combination of tPA, heparin, and phentolamine resulted in a 42.5% patency rate.
• A combination of urokinase, heparin, and phentolamine yielded the highest patency rate at 55%.
• All tested agents and combinations demonstrated statistically significant improvements over the control.

Conclusions:

• The addition of vasoactive agents (e.g., phentolamine) or clot-active agents (e.g., heparin, urokinase, tPA) to microvascular irrigating solutions benefits compromised microanastomoses.
• Specific combinations of these agents can significantly enhance vessel patency.
• These findings suggest improved strategies for intraoperative irrigation during microvascular surgery.