Download PDF
J Reconstr Microsurg 2018; 34(06): 420-427
DOI: 10.1055/s-0038-1626691
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Simplifying Arterial Coupling in Microsurgery—A Preclinical Assessment of an Everter Device to Aid with Arterial Anastomosis

Ian C. Sando
1   Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
,
Jeffrey S. Plott
2   Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
,
Brendan M. McCracken
3   Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
4   Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, Michigan
,
Mohamad H. Tiba
3   Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
4   Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, Michigan
,
Kevin R. Ward
3   Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
4   Michigan Center for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, Michigan
,
Jeffrey H. Kozlow
1   Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
,
Paul S. Cederna
1   Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
,
Adeyiza O. Momoh
1   Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

14 November 2017

23 December 2017

Publication Date:
16 February 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Background A novel arterial everter device was engineered to simplify microvascular coupling of arteries by reliably securing the stiff, muscular wall of arteries over coupler pins. We compare microvascular coupling with the everter device to manual suturing for arterial anastomoses in a live large animal model.

Materials and Methods In this preliminary study, bilateral external femoral arteries of five male swine were exposed and sharply divided. Arteries were anastomosed using either interrupted sutures (n = 5) or the everter device and Synovis Coupler (n = 5). The efficiency in engaging coupler pins, the time taken to perform the anastomosis, and vessel patency immediately post-op and at 1-week postanastomosis were evaluated. Vessel wall injury and luminal stenosis were compared between groups using histomorphometric analyses.

Results On an average, 80% of coupler pins engaged the vessel walls after a single pass of the everter. The average time to perform the anastomosis was significantly less when using the everter/coupler compared with manual suturing (6:35 minutes versus 25:09 minutes, p < 0.001). Immediately post-op, 100% patency was observed in both groups. At 1 week post-op, four of five (80%) of coupled arteries and all five (100%) of hand-sewn arteries were patent. The degree of arterial wall injury, neointimal formation, and luminal stenosis for patent arteries were similar between groups.

Conclusions Successful arterial anastomoses using the everter device with the Synovis Coupler was easier and significantly more efficient when compared with a standard hand-sewn technique. Both techniques had acceptable patency rates and similar effects on the vessel wall and intima.

Keywords

microsurgery - artery - coupler - anastomosis
 

  • References

  • 1 Wade JW, Stephens JA, Bragham RF, Carbo JD. Microsurgery in private practice: is it feasible economically?. Ann Plast Surg 2001; 46 (03) 255-259 , discussion 259–260
    CrossrefPubMedGoogle Scholar
  • 2 Bonawitz SC. Free tissue transfer in the private practice setting: a review of 100 patients. J Reconstr Microsurg 2009; 25 (05) 331-337
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 2009; 124 (05) 1529-1544
    CrossrefPubMedGoogle Scholar
  • 4 Grewal AS, Erovic B, Strumas N, Enepekides DJ, Higgins KM. The utility of the microvascular anastomotic coupler in free tissue transfer. Can J Plast Surg 2012; 20 (02) 98-102
    CrossrefPubMedGoogle Scholar
  • 5 Kulkarni AR, Mehrara BJ, Pusic AL. , et al. Venous thrombosis in handsewn versus coupled venous anastomoses in 857 consecutive breast free flaps. J Reconstr Microsurg 2016; 32 (03) 178-182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010; 125 (03) 792-798
    CrossrefPubMedGoogle Scholar
  • 7 Zhang T, Lubek J, Salama A. , et al. Venous anastomoses using microvascular coupler in free flap head and neck reconstruction. J Oral Maxillofac Surg 2012; 70 (04) 992-996
    CrossrefPubMedGoogle Scholar
  • 8 Shindo ML, Costantino PD, Nalbone VP, Rice DH, Sinha UK. Use of a mechanical microvascular anastomotic device in head and neck free tissue transfer. Arch Otolaryngol Head Neck Surg 1996; 122 (05) 529-532
    CrossrefPubMedGoogle Scholar
  • 9 Chow SP. The histopathology of microvascular anastomosis: a study of the incidence of various tissue changes. Microsurgery 1983; 4 (01) 5-9
    CrossrefPubMedGoogle Scholar
  • 10 Yoshida WB, Naresse LE, Rodriques AC, Fabris VE, Angeleli AY. End-to-end arterial anastomosis with fibrin glue in larger arteries: histology, hydroxyproline concentration and tensile strength study in carotids of rabbits. Acta Cir Bras 2002; 17 (01) 4-11
    PubMedGoogle Scholar
  • 11 Yap LH, Constantinides J, Butler CE. Venous thrombosis in coupled versus sutured microvascular anastomoses. Ann Plast Surg 2006; 57 (06) 666-669
    CrossrefPubMedGoogle Scholar
  • 12 DeLacure MD, Kuriakose MA, Spies AL. Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999; 125 (08) 869-872
    CrossrefPubMedGoogle Scholar
  • 13 Barker EV, Enepekides DJ. The utility of microvascular anastomotic devices in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16 (04) 331-334
    CrossrefPubMedGoogle Scholar
  • 14 Rozen WM, Whitaker IS, Acosta R. Venous coupler for free-flap anastomosis: outcomes of 1,000 cases. Anticancer Res 2010; 30 (04) 1293-1294
    PubMedGoogle Scholar
  • 15 Fitzgerald O'Connor E, Rozen WM, Chowdhry M. , et al. The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes. Gland Surg 2016; 5 (02) 88-92
    PubMedGoogle Scholar
  • 16 Chernichenko N, Ross DA, Shin J, Chow JY, Sasaki CT, Ariyan S. Arterial coupling for microvascular free tissue transfer. Otolayrngol Head Neck Surg 2008; 138 (05) 614-618
    CrossrefPubMedGoogle Scholar
  • 17 Spector JA, Draper LB, Levine JP, Ahn CY. Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction. Ann Plast Surg 2006; 56 (04) 365-368
    CrossrefPubMedGoogle Scholar
  • 18 Spector JA, Draper LB, Levine JP, Ahn CY. A technique for atraumatic microvascular arterial coupling. Plast Reconstr Surg 2007; 119 (06) 1968-1969
    CrossrefPubMedGoogle Scholar
  • 19 Shippert RD. A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. Am J Cosmet Surg 2005; 22 (01) 25-34
    CrossrefPubMedGoogle Scholar