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J Reconstr Microsurg 2016; 32(07): 556-561
DOI: 10.1055/s-0036-1584218
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Microvascular Anastomosis Technique on End Product Outcome in Simulated Training: A Prospective Blinded Randomized Controlled Trial

Eunsol Kim
1   Microvascular Anastomosis Simulation Hub (MASH), Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
,
Masha Singh
2   Imperial College London, London, United Kingdom
,
Yelena Akelina
3   Microsurgery Research and Training Laboratory, Department of Orthopaedic Surgery, Columbia University, New York City, New York
,
Sandra Shurey
4   Department of Surgical Research, Northwick Park Institute for Biomedical Research, Northwick Park Hospital, London, United Kingdom
,
Simon R. Myers
1   Microvascular Anastomosis Simulation Hub (MASH), Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
,
Ali M. Ghanem
1   Microvascular Anastomosis Simulation Hub (MASH), Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
› Author Affiliations
Further Information

Publication History

02 March 2015

02 April 2016

Publication Date:
15 June 2016 (online)

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Abstract

Background The aim of this article is to evaluate the difference in skills acquisition of two end-to-end microvascular anastomosis techniques—the triangulation and biangulation—in early microsurgery training.

Method In this study, 32 candidates ranging from medical students to higher surgical trainees underwent a 5-day basic microsurgery course. On days 3 and 5 of the course, candidates performed two end-to-end anastomoses on cryopreserved rat aortas. One anastomosis was performed using the biangulation technique and the other using the triangulation technique. Candidates were randomized to the order of technique performed. Structural patency, errors performed, and suture distribution were evaluated randomly by a blinded reviewer using the anastomosis lapse index score and ImageJ (U.S. National Institutes of Health, Bethesda, MD) Software.

Results A total of 128 anastomoses were evaluated during the study period. A total of six anastomoses performed with the biangulation technique, and four anastomoses with the triangulation technique, were physically occluded on day 3 of the course. On day 5, two biangulation technique anastomoses and one triangulation technique produced a nonpatent outcome. There was a statistically significant difference of patency rate between the 2 days of evaluation confirming evidence of skill acquisition but no statistically significant difference between the two techniques in relation to anastomotic patency, errors performed, or suture placement quality.

Conclusion The biangulation and triangulation techniques of microvascular anastomosis produce similar outcomes in relation to vessel structural patency and quality of anastomosis when taught in early stages of microsurgery training. Our results suggest that both techniques are equally suitable in training novices, basic microsurgical skills.

Keywords

microsurgery - educational - technique - biangulation - triangulation
 

  • References

  • 1 Ghanem AM, Hachach-Haram N, Leung CCM, Myers SR. A systematic review of evidence for education and training interventions in microsurgery. Arch Plast Surg 2013; 40 (4) 312-319
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Aggarwal R, Darzi A. Simulation to enhance patient safety: why aren't we there yet?. Chest 2011; 140 (4) 854-858
    CrossrefPubMedSearch in Google Scholar
  • 3 Padubidri AN, Browne E, Kononov A. Fibrin glue-assisted end-to-side anastomosis of rat femoral vessels: comparison with conventional suture method. Ann Plast Surg 1996; 37 (1) 41-47
    CrossrefPubMedSearch in Google Scholar
  • 4 Gelli R, Pini R, Toncelli F, Chiarugi C, Reali UM. Vessel-wall recovery after diode laser-assisted microvascular anastomosis: clinical and histologic analysis on long-term follow-up. J Reconstr Microsurg 1997; 13 (3) 199-205
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Chen YX, Chen LE, Seaber AV, Urbaniak JR. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. J Hand Surg Am 2001; 26 (3) 530-539
    CrossrefPubMedSearch in Google Scholar
  • 6 Turan T, Ozçelik D, Kuran I , et al. Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis. Plast Reconstr Surg 2001; 107 (2) 463-470
    CrossrefPubMedSearch in Google Scholar
  • 7 Simşek T, Eroglu L, Engin MS, Kaplan S, Yildiz L. End-to-end microvascular anastomosis in the rat carotid artery using continuous horizontal mattress sutures. J Reconstr Microsurg 2006; 22 (8) 631-640
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Watanabe H, Ueda K, Ohkouchi M, Kajikawa A, Suzuki Y. Posterior-wall-first continuous suturing combined with conventional interrupted suturing for microvascular anastomosis. J Reconstr Microsurg 2006; 22 (8) 617-623
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Zhang L, Tuchler RE, Shaw WW, Siebert JW. A new technique for microvascular sleeve anastomosis. Microsurgery 1991; 12 (5) 321-325
    CrossrefPubMedSearch in Google Scholar
  • 10 Blair WF, Steyers CM, Brown TD, Gable RH. A microvascular anastomotic device: part I. A hemodynamic evaluation in rabbit femoral arteries and veins. Microsurgery 1989; 10 (1) 21-28
    CrossrefPubMedSearch in Google Scholar
  • 11 Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The rat model in microsurgery education: classical exercises and new horizons. Arch Plast Surg 2014; 41 (3) 201-208
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Gilbert RW, Ragnarsson R, Berggren A, Ostrup L. Strength of microvascular anastomoses: comparison between the unilink anastomotic system and sutures. Microsurgery 1989; 10 (1) 40-46
    CrossrefPubMedSearch in Google Scholar
  • 13 Ostrup LT, Berggren A. The UNILINK instrument system for fast and safe microvascular anastomosis. Ann Plast Surg 1986; 17 (6) 521-525
    CrossrefPubMedSearch in Google Scholar
  • 14 Nishida S, Levi D, Kato T , et al. Ninety-five cases of intestinal transplantation at the University of Miami. J Gastrointest Surg 2002; 6 (2) 233-239
    CrossrefPubMedSearch in Google Scholar
  • 15 Grober ED, Hamstra SJ, Wanzel KR , et al. Validation of novel and objective measures of microsurgical skill: hand-motion analysis and stereoscopic visual acuity. Microsurgery 2003; 23 (4) 317-322
    CrossrefPubMedSearch in Google Scholar
  • 16 Cobbett J. Small vessel anastomosis. A comparison of suture techniques. Br J Plast Surg 1967; 20 (1) 16-20
    CrossrefPubMedSearch in Google Scholar
  • 17 Temple CLF, Ross DC. A new, validated instrument to evaluate competency in microsurgery: the University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument [outcomes article]. Plast Reconstr Surg 2011; 127 (1) 215-222
    CrossrefPubMedSearch in Google Scholar
  • 18 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg 1994; 33 (1) 28-31
    CrossrefPubMedSearch in Google Scholar
  • 19 Kalu PU, Atkins J, Baker D, Green CJ, Butler PEM. How do we assess microsurgical skill?. Microsurgery 2005; 25 (1) 25-29
    CrossrefPubMedSearch in Google Scholar
  • 20 Singh M, Ziolkowski N, Ramachandran S, Myers SR, Ghanem AM. Development of a five-day basic microsurgery simulation training course: a cost analysis. Arch Plast Surg 2014; 41 (3) 213-217
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis lapse index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg 2016; 32 (3) 233-241
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63 (8) 1329-1334
    CrossrefPubMedSearch in Google Scholar
  • 23 Alghoul MS, Gordon CR, Yetman R , et al. From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses. Microsurgery 2011; 31 (1) 72-80
    CrossrefPubMedSearch in Google Scholar
  • 24 Lausada NR, Escudero E, Lamonega R, Dreizzen E, Raimondi JC. Use of cryopreserved rat arteries for microsurgical training. Microsurgery 2005; 25 (6) 500-501
    CrossrefPubMedSearch in Google Scholar