Hands-Free Suction in Microsurgery

During microsurgical anastomoses, economy of movement, efficient assistance and clarity of the microscopic surgical field all contribute to the safety, efficacy, and quality of the procedure. Several novel techniques have been described to produce safe suction during microsurgical operations, including tailored sponge/mat devices[1] [2] and a syringe connected to standard suction tubing.[3] Although useful, these techniques have the drawbacks of using additional equipment necessitating additional preoperative sterilization,[3] of requiring constant and timely input from assistants[3] and may be cumbersome.[1] [2] To address these limitations, a hands-free constant suction technique for use in microsurgery is presented. The technique is described as follows:

Size 10 Redivac drainage tubing (Biomet Ltd., Bridgend, United Kingdom) is attached to standard Yanker suction tubing using a Steri-Strip (3M, Maplewood, MN) wrapped around the connection to seal it ([Fig. 1]). The tip of the tubing is cut short so that only two or three drainage holes remain. The tip of the Redivac suction tubing is placed in the most dependent part of the sump ([Fig. 2]). The tubing is secured to the side wall of the cavity using one or two staples. On top of the suction tip a swab is placed to enable homogenous aspiration of the whole microsurgical field. In this way, continuous low-level suction is provided to optimize views of the vessels without having to charge an assistant with the duty of suction.

Figure 1 The drainage system prior to insertion into the operative field: size 10 Redivac drainage tubing is attached to standard Yanker suction tubing using a Steri-Strip.

Figure 2 Intraoperative image showing the automated microsurgical suction in use, with Redivac tubing stapled to the wound edge, with the tip of the tubing in the most dependent part of the sump.

The efficiency of the system encourages the liberal use of irrigation, which assists in optimizing the clarity of the operating field, as previously highlighted during intraoral surgery.[4] This microsurgical technique reduces the risk of iatrogenic trauma associated with accidental injury from repeated hand held suction and allows the assistant to contribute more to the procedure. The equipment is inexpensive and cost-effective, which is increasingly important in today's cost-conscious climate. The materials are available in all operating rooms without prior preparation and the system is straightforward to set-up. The technique has been used by the authors in over one thousand cases. Although this technique may be used in all microvascular anastomoses, we find it particularly useful in microvascular breast reconstruction via a rib-sparing approach to access the internal mammary vessels, where the anastomosis may be performed in a deep and narrow cavity ([Fig. 2]).[5] The overlying gauze provides a degree of elevation of the anastomotic site and background contrast. We now routinely practice this technique and have benefited from the increased clarity and automatic suction, which allows the surgeons to focus on the microsurgical anastomosis.

• References

• 1 Toksoy S, Karaca M, Karanfil H, Akoz T. Safe suction device for microsurgical operations. Microsurgery 2011; 31 (1) 81-82
• 2 Shermak MA, Wolfort SF, Thomas D, Chang B. A universal micro-suction mat to optimize TRAM breast reconstruction. Plast Reconstr Surg 1998; 102 (6) 2276
• 3 Caulfield RH, Niranjan NS. A novel suction device for microsurgery. J Plast Reconstr Aesthet Surg 2008; 61 (5) 561
• 4 Peled IJ, Wexler MR, Kaplan H. Continuous nasopharyngeal suction. Ann Plast Surg 1981; 6 (3) 244
• 5 Sojitra NM, Fabre G, Vandevoort M. A valuable method for exposure of the recipient internal mammary vessels for microvascular breast reconstruction. Plast Reconstr Surg 2010; 125 (2) 77e-78e