Microsutures Traction Device for Small Vessel Anastomosis

In last decades microvascular surgery has evolved considerably.[1] Advances in suturing materials, surgical techniques, and optical augmentation have enabled the anastomosis of small vessels (below 0.5 mm in diameter).[2] Clinically that means the possibility of replantation for fingertip amputations, flap harvest from a perforator vessel, and anastomosis to secondary branches (without sacrificing a major pedicle) or treatment of lymphedema by lymphovenular anastomosis.[3]

To facilitate small caliber vessels anastomosis we have designed a microsutures traction device, which is easy to manufacture and use. The device is compound by a common contrast background, with two rods anchored on it. At the top of each rod there is a spring to fix the sutures (Figs. [1] and [2]).

Figure 1 Microsutures traction device.

Figure 2 Rat model. Retroperitoneal vein anastomosis (diameter 0.2 mm) with three microsutures (12/0).

First suture is placed at 0 degree and is left long to be attached at the opposite spring. This maneuver keeps antagonist tension during the second suture, which is fixed in the surgeon side spring. Third suture is placed between the first and the second one. Afterward, we interchange the attachment of the sutures at springs, so the vessel rotates 180 degrees and back wall is exposed. At this moment vessel lumen can be easily seen and back wall suture becomes safer (Fig. [3]).

Figure 3 (A) First suture al 0 degree. (B) The first suture anchored in the spring keeps tension for second suture. (C) Anterior wall suture is finished. (D) Sutures are exchanged and the vessel rotates 180 degrees to expose the back wall.

This instrument helps open the vessel lumen and enables to keep a space for needle passage. The aim is to avoid the damage of the intima and the inclusion of the opposite wall in the suture. It also helps achieve an equal distance between stitches, and in our experience, reduces total suture time.

The manufacture is very simple, based on materials available everywhere, and the total cost is very low. However, more suture material is used. So far we have only used the device in experimental surgery, no commercial interest, but thought it might be helpful in clinical practice.

REFERENCES

• 1 Acland R D. Microvascular anastomosis: a device for holding stay sutures and a new vascular clamp.  Surgery. 1974;  75 (2) 185-187
• 2 Narushima M, Koshima I, Mihara M, Uchida G, Gonda K. Intravascular stenting (IVaS) for safe and precise supermicrosurgery.  Ann Plast Surg. 2008;  60 (1) 41-44
• 3 Yazar M, Basaran K, Guven E, Ugurlu A M, Topalan M. A new approximator used in microvascular anastomosis.  Microsurgery. 2009;  Letter to editor 1-4