"Open y" technique in vessel diameter discrepancy

For the last 20 years, free tissue transfers have increasingly become the mainstay of plastic surgery. Size discrepancy between the vessels during tissue transfers are frequently encountered in clinical practice, and this may potentially be an important factor in the patency of anastomosis. In our clinic, we first studied a rat model and a fresh sheep cadaver to improve the diameter discrepancy in microvascular anastomosis with “open y” technique. At the end of our research, we progressed to success, and the open y technique was applied to nine patients in our clinic with a diameter discrepancy in microvascular anastomosis. After finding the bifurcation of vessels (artery, vein, or a vein graft) that are prepared for anastomosis, a distal cut of 2–3 mm was made for the anastomosis, which is considered to increase the diameter. Both legs of the resultant “y”‐shaped vessel were united after inserting the microscissors from one leg and exiting from the other. Performing an end‐to‐end anastomosis between the vessels, we obtain an increase in the diameter. By using this method, we eliminated the diameter discrepancy in microvascular anastomosis in nine patients in our clinic. There was not any flap loss. To increase the usage of this technique, when we come across a problem of size discrepancy, it is important to use the open y technique, both to the recipient vessels, donor vessels, and to the vein grafts. Owing to its high prevalence and the ease of application, we are convinced that this is a suitable technique in appropriate cases. © 2006 Wiley‐Liss, Inc. Microsurgery, 2006.