Re‐endothelialization stages at the microvascular anastomosis

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Abstract
After microsurgical suturing, the wound healing process at the rat femoral artery anastomosis was studied with scanning electron microscopy. The reendothelialization was divided into four successive stages, based on the development of a fibrin network and the rate of endothelial regrowth. Within 5 minutes of blood flow re‐establishment the fibrin network formation started to cover the wound surface; it was completed by the 3rd or 4th day. The endothelial recovery started on the 2nd day and continued to the base of the suture by the 6th day. Re‐endothelialization from the wound edge, which was formed between intact and injured endothelium toward the suture‐restrained site, was a two‐fold process: initially, a single endothelial film covered the anastomosis site, then, the singled endothelial sheet proliferated and thickened to complete the endothelialization. A better understanding of the stages involved in microvascular repair is beneficial in evaluating vascular recovery and its relationship to patency rates in microvascular surgery.