There have been numerous attempts to shorten the anastomosis duration since Jacobson used the term “microvascular surgery” firstly in 1960. These alternative techniques can be classfied in four headlines: 1. Alternative suturing techniques 2. Mechanical equipments 3. Anastomosis techniques with fibrin glue 4. Laser assisted microvascular anastomosis However, none of these alternatives have the combination of facility, low cost, reliabilty, durability and high sucess rates. In this study, we aimed to shorten the anastomosis duration especially in operations which require multiple anastomoses such as multiple digit replantations and reconstruction cases which require transfer of more than one free flap. Experimental anastomoses were performed with fish-mouth technique using fibrin glue. In this technique, firstly two longitudinal incisions were made 180 degrees apart from each other, like a fish mouth, at each vessel end, thus creating a pair of equal-sized, full thickness vessel flaps on both vessels. These incisions were equal in length and were long as the radius of the vessel. Two simple stay sutures were put from the corners of the flap bases and vessels were approximated. Then, whole contact surfaces were sealed with fibrin glue. 64 Wistar Albino rats were used in the study. Both control and experimental groups were consisted of 32 rats. Conventional nine suture end-to-end technique was used in control group anastomoses. Experimental anastomoses were performed in fish mouth technique using fibrin glue. All anastomoses were done under X40 magnification and on carotid arteries. Patency rates, microaneurism formation, histological healing patterns and operation durations were assesed and statistically evaluated with 3rd, 7th, 14th, and 21st day biopsies. The mean anastomosis duration was 13, 11 minutes in the experiment group and 18, 32 minutes in the control group. Patency rates and microaneurism formation were statistically insignificant between groups. Histological evaluation revealed a faster epithelialization, minimal internal damage, and better healing and less foreign body reaction in fish mouth anastomosis group. In conclusion, anastomosis with fish-mouth technique using fibrin glue is shorter, requires fewer sutures, decreases the amount of foreign materials in direct contact with blood stream, creates less foreign body reaction in the vessel wall and everts contact surfaces. With these advantages, our technique is a reliable and successful alternative especially in operations which require multiple anastomosis.

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