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DOI: 10.1055/s-0038-1669451
A Novel Technique to Perform Microvascular Anastomosis Revisions without Clamps
Funding This study was funded by an Orthopedic Scientific Research Foundation grant to the Microsurgery Training and Research Laboratory at the Columbia University Irving Medical Center.Publikationsverlauf
23. März 2018
25. Juli 2018
Publikationsdatum:
11. September 2018 (online)
Abstract
Background For surgeons learning microsurgery, uneven spacing between sutures while performing microvascular arterial anastomoses is one of the most common technical errors made that can lead to leakage. Based on the previous surgical experience and training of these surgeons, the first option chosen to prevent bleeding is to place a vascular clamp proximal to the anastomosis and an additional suture at the site of the leak. Because this technique may have technical and thrombosis concerns, our study proposes an alternative technique of performing post-anastomotic revisions without the use of clamps.
Methods Our technique involves placing a cotton-tipped applicator under the artery and lifting it to partially occlude flow within the vessel as an additional suture is placed at the leakage site to complete the revision. One-hundred eighty-four microvascular anastomoses were performed on the femoral arteries of 92 Sprague-Dawley rats, and of the 184 anastomoses, 147 had a leak and required a post-anastomotic revision. All revisions were completed using our technique, and no clamps were used during any of the revisions.
Results Of the 147 post-anastomotic revisions completed using our technique, 141 (95.9%) were patent 2 hours post-revision. The mean operating time for the revisions was 5:03 minutes (range, 1:44–6:30 minutes).
Conclusion Our technique of partially occluding an artery with a cotton-tipped applicator while performing a post-anastomotic revision is a safe and effective alternative to using vascular clamps. Our technique may also reduce technical errors and have a low risk of causing thrombosis when completing post-anastomotic revisions.
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References
- 1 Jose RR, Raja WK, Ibrahim AM. , et al. Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink. J Biomed Mater Res B Appl Biomater 2015; 103 (07) 1333-1343
- 2 Stanley JC, Veith F, Wakefield TW. Current Therapy in Vascular and Endovascular Surgery E-Book. Philadelphia, PA: Elsevier Health Sciences; 2014
- 3 Rumack CM, Levine D. Diagnostic Ultrasound E-Book. Philadelphia, PA: Elsevier Health Sciences; 2017
- 4 Wolfe SW, Pederson WC, Hotchkiss RN. , et al. Green's Operative Hand Surgery: The Pediatric Hand. Philadelphia, PA: Elsevier Health Sciences; 2010
- 5 Chang T. Principles, Techniques and Applications in Microsurgery. Singapore: World Scientific; 1986
- 6 Cooley BC. A Laboratory Manual for Microvascular and Microtubal Surgery. 2nd ed. Reading, PA: Surgical Specialties Corporation; 2009
- 7 Naides A, Noland R, Lu JG, Akelina Y, Marboe C, Strauch RJ. Histological changes in the rat femoral artery following the use of the empty-and-refill test. J Reconstr Microsurg 2018; 34 (04) 270-276
- 8 Economopoulos GC, Sfirakis PD, Zarkalis DA, Loukas LL. Pedicled pericardial fat pad: a useful hemostatic supplement. Ann Thorac Surg 1995; 59 (03) 768-770
- 9 Kerschner JE, Futran ND. The effect of topical vasodilating agents on microvascular vessel diameter in the rat model. Laryngoscope 1996; 106 (11) 1429-1433
- 10 Bojrab MJ, Waldron DR, Toombs JP. Current Techniques in Small Animal Surgery. Jackson, WY: Teton NewMedia; 2014
- 11 Stein PD, Sabbah HN. Measured turbulence and its effect on thrombus formation. Circ Res 1974; 35 (04) 608-614