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A new and useful method to prevent spasm of microvascular anastomosis in the postoperative period

The intraoperative usage of topical vasodilators in reconstructive microsurgery is a well known method and widely used in many centers to prevent vessel spasm resulting in anastomotic failure and free flap loss. Vascular spasm is a common condition ( 5–10% of all cases in the literature) and the cause of the spasm could not be clearly explained yet. But the risk of vascular spasm continues in the postoperative period and this is one of the most important reasons of early free flap loss in microsurgery. Therefore, irrigation of microvascular anastomosis site in the postoperative period might be useful to prevent vascular spasm and microsurgical flap loss. To overcome this problem, we use a 22G (Blue) or 24G (Yellow) IV Cannula with injection valve (Biçakçilar Tıbbi Cihazlar A.S ., _ Istanbul, Türkiye). After the completion of microvascular anastomosis, the IV cannula is inserted through either the skin or the incision line so that the tip point of the cannula is placed near to the microvascular anastomosis (Fig. 1). The IV cannula is secured to the skin with a silk suture and a small hole is left over the postoperative dressing to have easy access to the cannula. The anastomosis is irrigated easily with 0.5–1 cc of Lidocaine with 2 hour time intervals for two days. The cannula is taken out at the postoperative second day by cutting the silk suture. This method is used in our institution since 2009 by 50 patients with various types of microvascular tissue transplantations without any complications. The most likely complication caused by the cannula might be infection. In order to prevent this complication, the cannula is taken out at the second postoperative day together with the penrose drains placed under the flap. The utilization of IV cannulas for the postoperative irrigation of the anastomosis site is an easy, cheap, and versatile method to prevent postoperative vascular spasm in microsurgery.