A New Combined “Interrupted-Continuous” Microvascular Anastomotic Technique. Experimental Study and Clinical Application

ABSTRACT

A new combined interrupted-continuous microvascular anastomotic technique is introduced, using four interrupted stay stitches and continuous suturing in between. Its efficacy is compared with the simple interrupted and continuous techniques. Microanastomoses were performed in the femoral artery and vein of rats. The patency, anastomosis time, and blood loss from the suture line of all anastomoses were recorded. Also, the sites of all anastomoses were harvested and histologically examined for lumen stenosis, media regeneration, and endothelial lining. Experimentation findings showed 100% patency rate in all groups. The combined and the continuous techniques were significantly faster and watertight compared with the simple interrupted. The only difference in pathology findings was the development of significant lumen stenosis in vein anastomoses performed with the continuous technique, compared with the other two techniques. The combined technique was clinically used in 16 free flap transfers and ensured 100% patency in all arterial and vein anastomoses, as well as survival of all flaps. In conclusion, the combined technique was found to be fast and easy to perform and ensured the same patency rate as the simple interrupted and continuous techniques. It also diminished the lumen stenosis effect of the continuous technique in vein anastomoses. Therefore, we suggest its use in both experimental studies and clinical cases.

KEYWORDS

Microvascular anastomosis - continuous technique - interrupted technique - combined technique

REFERENCES

• 1 Firsching R, Terhaag P D, Muller M W, Frowein R A. Continuous and interrupted suture technique in microsurgical end-to-end anastomosis.  Microsurgery. 1984;  5 80-84
• 2 Lee B Y, Thoden W R, Brancato R F, Kavner D, Shaw W, Madden J L. Comparison of continuous and interrupted suture techniques in microvascular anastomosis.  Surg Gynecol Obstet. 1982;  155 353-357
• 3 Mao K, Tang M, South J R. A comparison of continuous with interrupted sutures in microvascular anastomosis.  Microsurgery. 1986;  7 158-160
• 4 Hamilton R B, O'Brien BMcC. An experimental study of microvascular patency using a continuous suture technique.  Br J Plast Surg. 1979;  32 153-154
• 5 Little J R, Salerno T A. Continuous suturing for microvascular anastomosis.  J Neurosurg. 1978;  48 1042-1045
• 6 Moscona A R, Owen E R. Continuous anastomotic technique in microsurgery.  Isr J Med Sci. 1978;  14 979-983
• 7 Adani A, Castagnetti C, Lagana A, Perretti M, Carroli A. Proposition for a new continuous suturing technique for microvascular anastomosis: a comparative study.  Br J Plast Surg. 1988;  41 506-508
• 8 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis.  Ann Plast Surg. 1994;  33 28-31
• 9 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
• 10 Samonte B R, Fried M P. Laser assisted microvascular anastomosis using CO₂ and KTP/532 lasers.  Lasers Surg Med. 1991;  11 511-516
• 11 Daniel R K, Olding M. An absorbable anastomotic device for microvascular surgery: experimental studies.  Plast Reconstr Surg. 1984;  74 329-336
• 12 Morris D J, Pribaz J J. The interrupted-continuous microsurgical suture technique.  Microsurgery. 1992;  13 103-105
• 13 Turan T, Özçelik D, Kuran İ et al.. Eversion with four sutures: an easy, fast and reliable technique for microvascular anastomosis.  Plast Reconstr Surg. 2001;  107 463-470
• 14 Thurston J B, Buncke H J, Chater N L, Weinstein P R. A scanning electron microscopy study of micro-arterial damage and repair.  Plast Reconstr Surg. 1976;  57 197-203
• 15 Tetik C, Unal M B, Kocaoglu B, Erol B. Use of a continuous horizontal mattress suture techniques in microsurgery: an experimental study in rats.  J Hand Surg [Am]. 2005;  30 587-595
• 16 Cordeiro P G, Santamaria E. Experience with the continuous suture microvascular anastomosis in 200 consecutive free flaps.  Ann Plast Surg. 1998;  40 1-6