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In side to side anastomosis and end to end (one way up) microvascular anastomosis, the back wall of the vessel is sutured first with inverted/buried knots. A common mistake made by surgeons during this step is the formation of a granny knot. In inverted suturing, cut ends of granny knot points inside the vessel lumen and interfere with the suture line. This additional Intraluminal thread may promote foreign body reaction and may act as a nidus for thrombus formation. Hence, this subtle mistake in knot formation may cause immediate and/or delayed anastomosis failure. The purpose of the study was to describe principles of inverted/buried reef knot formation. We describe in detail the methodology to form an inverted reef knot in microsurgery using paracords and a glove model.

In macrosurgery creating a knot with at least three throws is an established practice. The potential disadvantages of this practice in microsurgery include the following: the direction of the cut ends interfere with the suture line, unbalanced nature of knot disturbs the apposition of delicate vessel ends and the excessive knot weight. A reef knot with only 2 throws may thus be a better alternative. We have described our technique of end to end anastomosis with 2-throw reef knots in a rat femoral artery model using one way up method. Judging from the surgical outcome the practice of two throw reef knot seems feasible and appealing.

Aim: Micro-vascular anastomosis is a difficult art. It can be learnt and perfected only by practice using vessels of small animals in the laboratory. The purpose of the study was to practice various anastomotic techniques using rat femoral vessels and study the patency rates., Material and Methods: Sixty-four Sprague-Dawley rats were used in the study. The following procedures were conducted on rat femoral vessels; Femoral artery end-to-end anastomosis- classical method, one way up method, Femoral vein end-to-end anastomosis and end-to-side anastomosis. The animals were subsequently sacrificed at a later date to assess delayed patency., Results: The immediate patency rates for femoral artery end-to-end anastomosis- classical method (n=10), one way up method (n=16), femoral vein end-to-end anastomosis (n=12) and end-to-side anastomosis (n=26) were 100%, 81.3%, 58.3% and 53.8% respectively. The delayed patency rates (Mean follow-up=3.6 months) were 66.7%, 69.2%, 83.3% and 16% respectively. The clamp duration and suturing time significantly decreased and patency rates improved significantly in the latter half of the study., Conclusion: The clamp duration, suturing time and patency rates improved considerably with time. The need of the hour is to establish well-planned training programs in centers with Animal Research facilities. This will promote younger colleagues and trainees to take up and perfect this difficult art. The present work could be used as a baseline study in this direction.