*4.1.3 Continuous interrupted*

The continuous interrupted technique (also known as open-loop technique) is our technique of choice. It combines the safety of simple sutures with the comfort and speed of the continuous ones. It allows to constantly maintain a perfect visualisation of the vascular lumen and at the same time minimises the necessary manoeuvres. In this technique, a continuous suture with a spiral of very wide loops is made,

#### **Figure 3.**

*Triangulation technique, after placing tension between the first two stitches, the longer posterior wall of the anastomosis falls down, precluding transmural stitches.*

**211**

**Figure 4.**

*Basic Principles in Microvascular Anastomosis and Free Tissue Transfer*

then moved towards a lateral. Finally, each one of the loops is sectioned and knit

This technique is of first choice when we cannot properly manipulate both the vessels of the microvascular anastomosis, we cannot manage to rotate it in order to carry out the suture of the posterior wall. When performing the one-way-up technique, we begin suturing the posterior side. The needle is introduced from the deep side of the vessel to the intima of the posterior wall and returns through the intima in the lumen of the posterior wall of the opposite vessel. The knots are the same as in simple stitches. After placing three or four stitches in the posterior wall in an inverted fashion, it is easy to perform the remaining stitches in a conventional way. It is important to place the posterior wall stitches close enough to prevent any leakages, as revising the posterior wall is bothering. Lastly, the anterior face is sutured. This technique is one of our preferences as it minimises the incidence of transfixing

This type of suture is very useful when there is a great discrepancy between vascular lumens, or when the flow through a vascular axis must be preserved.

*Open-loop technique. Continuous suture of the upper face of the vessel, with very loose loops. Afterwards these* 

*loops are divided, and knotted as simple stitches. The posterior wall is depicted sutured first.*

*DOI: http://dx.doi.org/10.5772/intechopen.91917*

separately [24] (**Figure 4**).

sutures [24] (**Figure 5**).

**4.2 End-to-side anastomosis**

*4.1.4 One way up*

*Basic Principles in Microvascular Anastomosis and Free Tissue Transfer DOI: http://dx.doi.org/10.5772/intechopen.91917*

then moved towards a lateral. Finally, each one of the loops is sectioned and knit separately [24] (**Figure 4**).
