A Modified Open Loop Suture: A Reliable Alternative in Microvascular Anastomosis

Background Microvascular patency is essential in free flap tissue transfer, and achieving an anastomosis in a shorter operative time helps reduce the ischemia and ensures adequate tissue perfusion. Although various techniques have been proposed in microsurgery, the simple interrupted suture remains the gold standard for very small vessels. Continuous suturing can reduce anastomosis time; however, in small-caliber vessels it carries the risk of incorporating the posterior wall and producing a pursue-string effect, potentially compromising patency. The open-loop anastomosis technique described by Lee represents a valuable alternative between interrupted and continuous suturing techniques. In this study, we modified the open-loop approach by employing a continuous suture arranged in a spiral configuration, in which the loops are sequentially interrupted and divided after each stitch is tied. Methods This technique was evaluated in the carotid arteries of 30 Sprague-Dawley rats. The simple interrupted suture was performed on one side and the modified open-loop suture on the contralateral side. Results The mean anastomosis time was 29.97 ± 7.78 minutes for the simple interrupted suture technique and 26.27 ± 5.61 minutes for the modified open-loop suture, with a statically significant difference (p=0.039). This technique resulted in a shorter operative time without compromising vascular patency. Conclusion The modified open-loop suture represents a viable and effective alternative to conventional microsurgical anastomosis techniques. It achieves patent anastomoses, while reducing operative time.