The anastomosis of vessels < 0.5 mm in diameter is challenging. We developed a supermicrosurgical anastomosis method, the dual intravascular stent flipping technique, which uses a 7-0 nylon intravascular stent and either a double or single microclip. In rats, the double-clip technique was performed on 20 saphenous and 15 superficial inferior epigastric arteries, assessing immediate and 1-week patency, and the single-clip technique on 10 epigastric arteries. Clinically, the dual flipping technique was applied to 21 vessels in 9 cases of digital replantations and flap surgeries. Using the double-clip technique, immediate patency was 90% (saphenous) and 93% (epigastric) , and 81% at 1 week; with the single-clip, immediate patency was 100%. All clinical replantation and flap cases were successful. Advantages of this technique include easy stent insertion, minimal slippage, spontaneous vessel dilation by the flipped stent, and easier posterior-wall suturing (even without reversing clips) . The dual flipping technique enables relatively easy anastomosis when insertion of forceps into the lumen is difficult.
