J Reconstr Microsurg 2007; 23(6): 311-315
DOI: 10.1055/s-2007-985213
© Thieme Medical Publishers

Microvascular Anastomosis with Minimal Suture and Arista: An Experimental Study

Erol Benlier1 , Husamettin Top1 , A. Cemal Aygit1 , Ufuk Usta2 , Yasin Unal1
  • 1Department of Plastic, Reconstructive, and Aesthetic Surgery, Trakya University, Medical School, Edirne, Turkey
  • 2Department of Pathology, Trakya University, Medical School, Edirne, Turkey
Further Information

Publication History

Publication Date:
31 October 2007 (online)

ABSTRACT

Background: The conventional technique of microvascular anastomosis may cause trauma to the vessel wall. In addition, the technique is difficult for beginners and is time consuming. The duration of ischemia is an important limiting factor for muscle transfer. In the case of multiple-digit replantations, fatigue developed in the surgeon may also result in suboptimal results. This study was performed to establish an easier and shorter method of microvascular anastomosis using the Arista hemostatic agent. Methods: In this study, 20 carotid arteries obtained from rats were equally divided into two groups. The arteries were then divided and repaired using three simple interrupted stay sutures with Arista powder. Evaluations were performed using the following three methods: (1) clamping time during the vessel anastomosis, (2) patency test (after 1 hour, 24 hours, and 28 days), and (3) light microscopic findings. Results: The clamping time in the conventional suture anastomosis group was 21 ± 4 minutes, whereas that of the minimal suture in the Arista group was 12 ± 2 minutes; the difference between the two groups was statistically significant (P < .001). There was no significant difference between the patency rates of the two groups (P = .474). It was observed that the Arista group showed qualitatively less perivascular foreign-body giant cell reaction than the control group. There was no evidence of vascular mural fibrinoid necrosis, indicating that Arista was nontoxic for the vessel walls. Conclusions: The Arista-assisted microvascular anastomosis is an alternative to the conventional suture-only method because it reduces the anastomosis time significantly and does not cause narrowing of the vessel wall. We believe that this technique has the potential for improving the performance of microvascular anastomosis in clinical practice.

REFERENCES

  • 1 Acland R D. Practice Manual for Microvascular Surgery. St. Louis; Mosby Co 1989: 48-76
  • 2 Ang E S, Tan K C, Tan L H, Ng R T, Song I C. 2-Octylcyanoacrylate-assisted microvascular anastomosis: comparison with a conventional suture technique in rat femoral arteries.  J Reconstr Microsurg. 2001;  17 193-201
  • 3 Han S K, Kim S W, Kim W K. Microvascular anastomosis with minimal suture and fibrin glue: experimental and clinical study.  Microsurgery. 1998;  18 306-311
  • 4 Daniel R K, Olding M. An absorbable anastomotic device for microvascular surgery: experimental studies.  Plast Reconstr Surg. 1984;  74 329-336
  • 5 Leppaniemi A, Wherry D, Pikoulis E et al.. Arterial and venous repair with vascular clips: comparison with suture closure.  J Vasc Surg. 1997;  26 24-28
  • 6 Pikoulis E, Burris D, Rhee P et al.. Rapid arterial anastomosis with titanium clips.  Am J Surg. 1998;  175 494-496
  • 7 Cope C, Lee K, Stern H, Pennington D. Use of the vascular closure staple clip applier for microvascular anastomosis in free-flap surgery.  Plast Reconstr Surg. 2000;  106 107-110
  • 8 De Lorenzi F, van der Hulst R R, Boeckx W D. VCS auto suture stapled microvascular anastomoses in lower leg free flaps.  Plast Reconstr Surg. 2002;  109 2023-2030
  • 9 Nakamura T, Fukui A, Maeda M et al.. Microvascular anastomoses using an Nd-YAG laser.  J Reconstr Microsurg. 2000;  16 577-584
  • 10 Padubidri A N, 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 41-47
  • 11 Isogai N, Cooley B G, Kamiishi H. Clinical outcome of digital replantation using the fibrin glue-assisted microvascular anastomosis technique.  J Hand Surg [Br]. 1996;  21 573-575
  • 12 Alam H B, Uy G B, Miller D et al.. Comparative analysis of hemostatic agents in a swine model of lethal groin injury.  J Trauma. 2003;  54 1077-1082
  • 13 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis.  Ann Plast Surg. 1994;  33 28-31
  • 14 Sagi A, Yu H L, Ferder M, Gordon M J, Strauch B. “No suture” microanastomosis using vicryl rings and fibrin adhesive system: an unsuccessful attempt.  Plast Reconstr Surg. 1987;  79 776-777

Erol BenlierM.D. 

Trakya Üniversitesi Tip Fakültesi, Plastik

Rekonstrüktif ve Estetik Cerrahi AD, Edirne 22030, Turkey