How to Perform a Safe, Quick, and Easy Suture Technique for Microvascular Anastomosis, Where a Single Surgeon Works Alone: The Parachute Technique

An ideal anastomosis technique should be safe, practical, and quick to minimize the ischemia time. In addition, it should be easy to learn and teach and to not cause vessel wall trauma.

The parachute technique was originally described in cardiovascular surgery. Since then, it has been successfully used for other microsurgery fields as well. We aim to present the details, tips, and tricks of the parachute technique according to the perspective of the senior author (H.C.).

After dissection and preparation of the two vessels, clamps are applied. The anastomosis of the back wall is performed in a conventional manner by placing interrupted sutures from the 3 to 9 o'clock quadrants in a clockwise pattern ([Fig. 1A]). Then, the front wall is clearly observed and irrigated. Before completing the anastomosis, the last four to five sutures are passed through each end of the vessel in interrupted parallel sutures, perpendicular to the anastomosis line. Yamamoto et al[1] performed this technique in a continuous fashion. These sutures are not knotted ([Fig. 1B]). The lumen is observed and irrigated with heparinized saline to wash away debris to further reduce the risk of clotting and maintain patency of the lumen. Then, the sutures are knotted and tightened one by one ([Video 1]). The aim of the parachute technique is to maintain lumen patency and prevent back wall bites by continuous inspection of the vessel lumen. It also provides a way to accurately place the sutures through the full thickness of the vessel, providing well-aligned edges while avoiding crumpling of vessel edges. It is of extreme importance to visualize the blind spot and securing lumen patency in end-to-side anastomosis.

Fig. 1 (A) The view of the normal initial sutures in the end-to-side anastomosis before switching to the other side. (B) The view of the parachute technique suture.

Video 1 The parachute technique.

When the parallel sutures are placed on the front side and the lumen is visualized during the process, there is less manipulation to the vessel ends when the suture is tightened. This is due to the fact that the needle is facing the vessel wall in a perpendicular direction and the sutures are knotted in the same manner. It is also very important in cases where the vessel has arteriosclerosis or has been irradiated and is prone to intimal fibrosis, which can lead to intimal dehiscence.

In conclusion, when a surgeon works alone and unassisted, we think that the parachute technique is especially useful for the end-to-side anastomosis, in which the poor visualization of the lumen is the most common cause for failure of anastomosis.

Publication History

Article published online:
24 December 2020

• Reference

• 1 Yamamoto T, Chen WF, Yamamoto N. et al. Technical simplification of the supermicrosurgical side-to-end lymphaticovenular anastomosis using the parachute technique. Microsurgery 2015; 35 (02) 129-134