Microvascular anastomosis, basic steps. A, Adventitial excision. Traction is applied to adventitia, and it is excised sufficiently to avoid intrusion into vascular lumen. B, Appearance of vessel end after adventitial excision. C, Placement of initial suture. Forceps can be used as counterpressor agents without internal damage. D, Needle is passed through full thickness of vessel wall some distance from cut edge that is slightly greater than thickness of vessel wall. E, Passage of needle through opposite end of vessel is accomplished at similar distance from cut edge. F, Forceps, used as counterpressor agents, assist in passage of needle through opposite end of vessel. G and H, After completion of initial sutures, vessel is stabilized, allowing completion of even anastomosis. SEE TECHNIQUE 63.1.