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Grin EA, Wiggan DD, Sangwon KL, Baranoski J, Sharashidze V, Shapiro M, Raz E, Chung C, Nelson PK, Riina HA, Rutledge C, Nossek E. Interrupted Versus Running Sutures for Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01438. [PMID: 39641541 DOI: 10.1227/ons.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 10/13/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is the workhorse for flow augmentation surgery. Although either interrupted or running sutures can be used to complete the anastomosis with high intraoperative patency rates, no previous study in the cranial bypass literature has compared long-term patency and maturity of end-to-side STA-MCA anastomoses. We compared STA-MCA anastomoses performed with running vs interrupted sutures by evaluating bypass flow and anastomotic maturation on follow-up vascular imaging. METHODS Ninety-six STA-MCA anastomoses were performed from 1/2019 to 6/2024. Forty-seven anastomoses (40 patients) with long-term vascular imaging were retrospectively analyzed. All anastomoses were intraoperatively patent on initial revascularization. Patient demographics, clinical course, and imaging were reviewed. All images were reviewed by a neuroradiologist or a cerebrovascular neurosurgeon. RESULTS Twenty-five anastomoses were performed with interrupted sutures and compared with 22 anastomoses performed with running sutures. All patients underwent a preoperative perfusion assessment confirming a significant hypoperfusion state. There were no significant differences between cohorts in demographics, bypass indication, or time to follow-up. Formal digital subtraction angiography was performed for 35 anastomoses (21 interrupted, 14 running). On digital subtraction angiography follow-up, there was no difference in STA caliber between cohorts (P = .204), but there was a difference in anastomotic growth (P = .014), with 5/21 (23.8%) anastomoses stable or enlarged in the interrupted cohort vs 9/14 (64.3%) stable or enlarged in the running cohort. Notably, of the 47 total anastomoses, there was no difference in long-term bypass patency between interrupted and running anastomoses (22/25 (88.0%) vs 22/22 (100.0%), respectively, P = .380). CONCLUSION No significant differences in patency or STA caliber on follow-up imaging were observed between STA-MCA anastomoses performed with interrupted vs running sutures although a difference in anastomotic maturity was observed, with the running suture cohort having a higher proportion of enlarged or stable anastomoses. Further studies are needed for validation.
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Affiliation(s)
- Eric A Grin
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel D Wiggan
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Karl L Sangwon
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Jacob Baranoski
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Vera Sharashidze
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Maksim Shapiro
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Eytan Raz
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Charlotte Chung
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Peter Kim Nelson
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Caleb Rutledge
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York, USA
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Lu LT, Zou XF, Han SQ. Anterior-interrupted and posterior-continuous suture technique improved the success rate of kidney transplantation model in rats. Acta Cir Bras 2024; 39:e396024. [PMID: 39319899 PMCID: PMC11414520 DOI: 10.1590/acb396024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/15/2024] [Indexed: 09/26/2024] Open
Abstract
PURPOSE This study aimed to introduce and evaluate two new microvascular anastomosis techniques compared to the conventional method in a rat renal transplant model. METHODS Using a Fisher-to-Lewis rat kidney transplantation model, the renal artery anastomosis was performed using the interrupted (I) suture technique, Y-shaped continuous (Y) suture technique, and anterior-interrupted and posterior-continuous (I-C) suture technique. The rats were then divided into three groups: I group, Y group, and I-C group. Parameters such as arterial anastomosis time, warm ischemia time, seven-day survival rate of the rats, and vessel histopathology were assessed. RESULTS The mean arterial anastomosis time, blood leakage scores, and warm ischemia time were significantly reduced in groups Y and I-C compared to group I. Moreover, the seven-day survival rate was significantly higher in the I-C group compared to the other two groups. Arterial histopathology demonstrated vessel wall recovery without damage in all three groups, suggesting the safety of both Y and I-C techniques. CONCLUSIONS The anterior-interrupted and posterior-continuous suture method is particularly beneficial for small artery reconstruction in organ transplantation.
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Affiliation(s)
- Lan-Tao Lu
- Fifth Tianjin Central Hospital – Department of General Surgery – Tianjin – China
| | - Xun-Feng Zou
- Nankai University – Department of General Surgery – First Central Hospital – Tianjin – China
| | - Shuang-Qing Han
- Tianjin Medical University – Central Hospital Clinic Institute – Tianji – China
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Jung J, Jeong D. A comparison study of vessel twisting by different microsurgical suture techniques in a chicken wing artery side to side bypass training model. J Cerebrovasc Endovasc Neurosurg 2023; 25:260-266. [PMID: 37188332 PMCID: PMC10555616 DOI: 10.7461/jcen.2023.e2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Microvascular anastomosis, particularly side-to-side (STS) bypass, is a complex surgical procedure. While several suture techniques exist, none of them is superior to the others. We assessed the association between various STS bypass techniques and vessel twisting using chicken wing training models. METHODS Three suture techniques were compared over an anterior wall suture procedure. The unidirectional continuous suture (UCS) group used a downward "right-to-left" continuous suture. The reverse continuous suture (RCS) group used a downward "left-to-right" continuous suture. The interrupted suture (IS) group used the standard interrupted suture. The number of samples in each of the three groups was 30 (n=90). We compared the incidence of vessel twisting and rotation angles across groups. RESULTS Vessel twisting occurred in 96.7%, 56.7%, and 0% of the cases in the UCS, IS, and RCS groups, respectively. The incidence of vessel twisting differed significantly in all 3 groups (p<0.001), with an apparent trend (p=0.002). The mean rotation angles were 201˚±90.6˚, 102˚±107.6˚, and 0˚ in the UCS, IS, and RCS groups, respectively, which were significantly different (p<0.001). On excluding cases without twisting, the rotation angles of twisted vessels in the UCS and IS groups were 207.9˚±83.7˚ and 180˚±77.9˚, respectively, which yielded a significant difference between these groups (p<0.001). CONCLUSIONS We found that the incidence and trend of vessel twisting differed significantly across suture techniques. The RCS technique may aid in preventing vessel twisting in the STS bypass procedure.
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Affiliation(s)
- Junho Jung
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea
| | - Donghwan Jeong
- Department of Neurosurgery, Danwon Hospital, Ansan, Korea
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Sert G, Aksoyler D, Kara M, Bolletta A, Losco L, Cam SB, Korkusuz P, Chen HC. Comparison of total anastomosis time between four different combinations of suturing and knot tying techniques in microsurgical anastomosis. J Plast Surg Hand Surg 2023; 57:240-246. [PMID: 35301916 DOI: 10.1080/2000656x.2022.2052083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Various techniques have been described for performing microsurgical anastomosis with providing high patency rates. Although the total anastomotic time may not be an issue when dealing with a single set of anastomoses, using a faster technique may save significant amount of time in cases of transferring flaps with shorter critical ischemia time or where multiple anastomoses are required. This study compares the total anastomosis time between four different combinations of commonly used suturing and knot tying techniques. METHODS Twenty-four rats were divided into 4 groups. Simple interrupted suture with conventional knot tying technique (SIS-CT) was used in group I, continuous suture technique with conventional knot tying (CST) was used in group II, simple interrupted suture with airborne knot tying technique(SIS-AT) was used in group III, and continuous-interrupted suture with airborne knot tying technique(CIS-AT) was used in group IV for microsurgical anastomosis. Total anastomosis time and patency rates with each technique and samples from anastomotic sites were analyzed. RESULTS The mean time required for microvascular anastomosis of the femoral artery was 1075 s in group I, 799 s in group II, 844 s in group III, and 973 s in group IV. The difference between four groups was statistically significant. The anastomoses in group II and group III were completed in the shortest period of time. Intergroup comparison revealed that the difference between group II and group III was not statistically significant, however, total anastomosis time for completion of the anastomosis was significantly longer for group I, followed by group IV. Thrombosis rates and histological analysis revealed no significant differences among four groups. CONCLUSION CST and SIS-AT techniques can significantly reduce microsurgical anastomosis time and provide high patency rates. Also, the time needed to complete an anastomosis was significantly shorter for CIS-AT when compared to SIS-CT.
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Affiliation(s)
- Gokhan Sert
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Dicle Aksoyler
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey
| | - Alberto Bolletta
- Department of Translational Research and New Technologies in Medicine and Surgery, Plastic Surgery Unit, University of Pisa, Pisa, Italy
| | - Luigi Losco
- Department of Medicine, Surgery and Dentistry - University of Salerno
| | - Sefa Burak Cam
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Petek Korkusuz
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hung-Chi Chen
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
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Shahrestani S, Brown NJ, Loya J, Patel NA, Gendreau JL, Himstead AS, Pierzchajlo N, Singh R, Sahyouni R, Diaz-Aguilar LD, Rennert RC, Levy ML. Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note. Clin Neurol Neurosurg 2022; 222:107422. [PMID: 36084429 DOI: 10.1016/j.clineuro.2022.107422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow surgical corridor. No data exist on the efficacy of these clips for pediatric spinal dural closure. METHODS A single surgeon case series of 152 pediatric patients underwent procedures involving lumbar durotomy with subsequent dural closure using the AnastoClip® nonpenetrating titanium clip closure system. Rates of infection and cerebrospinal fluid leak were measured during the follow-up period. RESULTS A total of 152 pediatric patients (mean age: 6.25 ± 5.85 years, 50.7 % female) underwent intradural surgery with clip closure. The mean follow-up time was 57.0 ± 28.5 months. All patients were initially indicated for procedures involving spinal durotomy, with a majority being isolated tethered cord release (84.2 %). Others required tethered cord release and excision of a lipomyelomeningocele, spinal meningioma or arachnoid cyst (15.8 %). Post operative CSF leak occurred in two (1.32 %) patients at 11 and 18 days. Only one (0.66 %) patient was diagnosed with an infection, which was in a separate patient from those that had CSF leaks. CONCLUSION The remarkably low incidence of post-operative CSF leak and infection with nonpenetrating titanium clips suggests a strong safety and efficacy profile for this form of dural closure in a pediatric cohort. Further research evaluating this technique is required to fully demonstrate its acceptability as a cost-effective alternative to traditional suture-based closure.
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Affiliation(s)
- Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Nolan J Brown
- School of Medicine, University of California, Irvine, Orange, CA, USA.
| | - Joshua Loya
- Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA
| | - Neal A Patel
- School of Medicine, Mercer University, Columbus, GA, USA
| | - Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | | | | | - Rohin Singh
- School of Medicine, University of California, Irvine, Orange, CA, USA
| | - Ronald Sahyouni
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA
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Feler J, Sun F, Bajaj A, Hagan M, Kanekar S, Sullivan PLZ, Fridley JS, Gokaslan ZL. Complication Avoidance in Surgical Management of Vertebral Column Tumors. Curr Oncol 2022; 29:1442-1454. [PMID: 35323321 PMCID: PMC8947448 DOI: 10.3390/curroncol29030121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
The surgical management of spinal tumors has grown increasingly complex as treatment algorithms for both primary bone tumors of the spine and metastatic spinal disease have evolved in response to novel surgical techniques, rising complication rates, and additional data concerning adjunct therapies. In this review, we discuss actionable interventions for improved patient safety in the operative care for spinal tumors. Strategies for complication avoidance in the preoperative, intraoperative, and postoperative settings are discussed for approach-related morbidities, intraoperative hemorrhage, wound healing complications, cerebrospinal fluid (CSF) leak, thromboembolism, and failure of instrumentation and fusion. These strategies center on themes such as pre-operative imaging review and medical optimization, surgical dissection informed by meticulous attention to anatomic boundaries, and fastidious wound closure followed by thorough post-operative care.
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Affiliation(s)
- Joshua Feler
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Felicia Sun
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ankush Bajaj
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Matthew Hagan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Samika Kanekar
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
| | - Patricia Leigh Zadnik Sullivan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Jared S. Fridley
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; (J.F.); (F.S.); (A.B.); (M.H.); (S.K.); (P.L.Z.S.); (J.S.F.)
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI 02903, USA
- Correspondence:
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Modabber A, Winnand P, Goloborodko E, Möhlhenrich SC, Kniha K, Tolba R, Jockenhoevel S, Hermanns-Sachweh B, Hölzle F, Heitzer M. Biodegradation and Immunological Parameters of Polyurethane-based Tissue Adhesive in Arterial Microvascular Anastomoses - a Long-term in Vivo Study. Macromol Biosci 2022; 22:e2100451. [PMID: 35080346 DOI: 10.1002/mabi.202100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/16/2022] [Indexed: 11/07/2022]
Abstract
In microsurgical anastomosis, non-synthetic fibrin-based adhesives have predominantly shown superior properties to synthetic cyanoacrylates, but they have hardly any clinical application. This study aimed to investigate the local and systemic effects of synthetically produced biodegradable adhesive VIVO when used in microsurgical anastomosis. VIVO was used in two different anastomosis procedures in the common carotid artery in a rat model: VIVO in addition to a temporary catheter (VIVO TC) and VIVO with a custom-shaped memory nitinol stent (VIVO SM). Conventionally sutured anastomoses served as controls (C). Tissue response was assessed by in vivo fluorescence imaging and histological examination. The systemic effects of biodegradation were measured using hematologic parameters and serum levels of transaminase activity and lactate dehydrogenase. Finally, the degree of local adhesion of the different anastomotic procedures was evaluated. Fluorescence imaging showed reduced inflammatory blood flow in the VIVO TC group. Histological analysis of the anastomosed vessels also revealed significantly more inflammation in C than in the two adhesive groups. The severity of VIVO adhesions proved acceptable, and no histotoxic effects of VIVO were detected. The data demonstrated that the synthetic tissue adhesive VIVO is a reliable and- compared to sutures-tissue-friendly adhesive for microsurgical anastomoses. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
| | - Evgeny Goloborodko
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
| | - Stephan Christian Möhlhenrich
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle.,Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, Witten, 58455, Germany.,Head & Chairman Univ.-Prof. Dr. med. dent. Golamreza Danesh
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
| | - René Tolba
- Institute of Laboratory Animal Science and Experimental Surgery of RWTH-Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ.-Prof. Dr. med. René H. Tolba
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, 52074, Germany
| | - Benita Hermanns-Sachweh
- Implant Pathology ZBMT, Campus Melaten, Pauwelsstraße 17, Aachen, 52074.,Prof. Dr. med. Benita Hermanns-Sachweh
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.,Head & Chairman Univ. Prof. Dr. med. Dr. med. dent. Frank Hölzle
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Mehta SH, Belykh E, Farhadi DS, Preul MC, Kikuta KI. Needle Parking Interrupted Suturing Technique for Microvascular Anastomosis: A Technical Note. Oper Neurosurg (Hagerstown) 2021; 21:E414-E420. [PMID: 34424326 DOI: 10.1093/ons/opab280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Interrupted and continuous suturing are 2 common techniques for microvascular anastomosis in cerebrovascular surgery. One of the technical complexities of interrupted suturing includes the risk of losing the needle in between interrupted sutures during knot tying, which may result in unnecessary movements and wasted time. OBJECTIVE To report a new needle parking technique for microvascular anastomosis that addresses a needle control problem during interrupted suturing. METHODS The needle parking technique involves puncturing both vessel walls at the site of the next provisional suture and leaving the needle parked in place while the knots at the first suture are being made. The thread is then cut, the needle is pulled through, and the process is repeated. Illustrative cases in which the needle parking technique was used are presented. We also compared time of anastomosis completion between the conventional interrupted, needle parking interrupted, and continuous suturing techniques during an in vitro study on standardized artificial vessels. RESULTS This technique is being used successfully by the senior author for various cerebrovascular bypass surgeries. The in vitro study demonstrated that the needle parking technique can be significantly faster than the conventional interrupted suturing technique and may be as fast as continuous suturing. CONCLUSION Needle parking technique is a modification of conventional interrupted suturing and solves the problem of losing the needle during knot tying. This technique is simple, prevents unnecessary movements, and may result in a faster anastomosis time.
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Affiliation(s)
- Shyle H Mehta
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Evgenii Belykh
- Department of Neurological Surgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Dara S Farhadi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Training model for the intraluminal continuous suturing technique for microvascular anastomosis. Sci Rep 2021; 11:4862. [PMID: 33649423 PMCID: PMC7921418 DOI: 10.1038/s41598-021-84619-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022] Open
Abstract
Microvascular anastomosis is a critical procedure in cerebral bypass surgeries. In some rare cases, the extraluminal interrupted technique is not optimal because the vessels are immobile and cannot be rotated, and anastomosis can be performed effectively through the intraluminal continuous suturing technique. The authors reported the application of the intraluminal continuous suturing technique in microanastomosis training with silicone tube, rat’s common iliac arteries and abdominal aorta. A silicone tube with a diameter of 1.5 mm was used to practice microanastomosis in intraluminal continuous suturing technique. Then the technique was applied in side-to-side, end-to-side anastomoses of common iliac arteries and the end-to-end abdominal aorta anastomoses of rat. The suturing time and patency rates were compared with an alternative intraluminal continuous suturing technique and one-way-up interrupted suturing technique in silicone tube and rat vessel anastomoses. The intraluminal continuous suturing technique could be gained through practicing with silicone tube, and the technique has also been demonstrated effective in side-to-side, end-to-side anastomoses of common iliac arteries of rat and the abdominal aorta end-to-end anastomoses. In all the animal experimental groups with different suturing techniques, there was no difference between the patency rates, all the immediate patency rate was 100%. There was no significant suturing time difference between the two intraluminal continuous suturing techniques, but the two intraluminal continuous suturing techniques were faster than the interrupted technique. The intraluminal continuous suturing technique described in the study could be used as an efficient method for side-to-side, end-to-side and end-to-end anastomosis, especially under the situation the posterior wall of the anastomosis could not be rotated. Proficiency of the technique could be achieved through practicing in laboratory with silicone tube and live animals.
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Sullivan B, Zoppo M, Yao A, Henderson PW. Simple Interrupted Microvascular Anastomosis: Review of Four Sutures Placement Sequences. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2020. [DOI: 10.1055/s-0040-1719152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background Microsurgical anastomosis is a delicate, highly nuanced procedure that can be done in several different ways; the most basic approach to performing microsurgical anastomoses is by using simple interrupted sutures, but even within that approach, there are different sequences by which the sutures can be placed. To date, there is no review of these sequences and the advantages and disadvantages of each.
Methods A PubMed search was performed in October 2019 that sought all published descriptions of simple interrupted microsurgery techniques. Keywords included were “microvascular anastomosis,” “microvascular anastomosis technique,” “simple interrupted,” and “microsurgery.”
Results Four simple interrupted microsurgery techniques were identified: triangulation, 12 o'clock to 6 o'clock, posterior-wall-first, and 3 o'clock to 9 o'clock-side-side. Additionally, there is no uniform nomenclature that describes the techniques for simple interrupted microvascular anastomoses.
Conclusion This study identified four distinct sequences for the placement of simple interrupted sutures for microsurgical anastomosis and the advantages and disadvantages of each, and for the first time described them utilizing standardized nomenclature.
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Affiliation(s)
- Brianne Sullivan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Alice Yao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Peter W. Henderson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Nicoletti GF, Umana GE, Graziano F, Florio A, Scalia G. Repair of a spinal pseudomeningocele in a delayed postsurgical cerebrospinal fluid leak using titanium U-clips: Technical note. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Bot GM, Zhao X, McElenney BK, Tayebi Meybodi A, Belykh E, Lawton MT, Preul MC. Comparative Analysis of Continuous Suturing, Interrupted Suturing, and Cyanoacrylate-Based Lid Techniques for End-to-End Microvascular Anastomosis: Laboratory Investigation. World Neurosurg 2020; 134:465-471. [DOI: 10.1016/j.wneu.2019.11.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/14/2022]
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Matsuo S, Amano T, Nakamizo A. Single loop interrupted suture technique for cerebrovascular anastomosis: Technical note. J Clin Neurosci 2019; 72:434-437. [PMID: 31493997 DOI: 10.1016/j.jocn.2019.08.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022]
Abstract
The ideal suturing technique for cerebrovascular anastomosis remains a point of debate. Although simple interrupted sutures are considered to achieve higher patency, they require longer anastomosis time compared with running sutures. The authors describe a novel techniques named single loop interrupted suture to place interrupted sutures for cerebrovascular anastomosis. The single loop interrupted suture technique consists of repeatedly placing, tying and cutting a single loop between anchor stitches. A single loose loop was placed next to the anchor stitch, tied and cut, and then another loop was placed next to the knot. The loops resulted in efficiently placed interrupted sutures. This technique is employed for a range of end-to-side cerebrovascular anastomosis procedures, and is feasible in placing interrupted suture.
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Affiliation(s)
- Satoshi Matsuo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Toshiyuki Amano
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Marin Laut FM, Gómez Cárdenas EA, Dormido JR, Molina NM, López López JA. Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip. Neurocirugia (Astur) 2019; 30:173-178. [PMID: 30782504 DOI: 10.1016/j.neucir.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/24/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. OBJECTIVE The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). METHODS We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. RESULTS The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. CONCLUSIONS We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.
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Affiliation(s)
| | | | - Jesús Riqué Dormido
- Department of Neurosurgery, University Hospital of Puerta de Mar, Cádiz, Spain
| | | | - Jose A López López
- Department of Neurosurgery, University Hospital of Puerta de Mar, Cádiz, Spain
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Barber SM, Fridley JS, Konakondla S, Nakhla J, Oyelese AA, Telfeian AE, Gokaslan ZL. Cerebrospinal fluid leaks after spine tumor resection: avoidance, recognition and management. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:217. [PMID: 31297382 DOI: 10.21037/atm.2019.01.04] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Post-operative CSF leaks are a known complication of spine surgery in general, and patients undergoing surgical intervention for spinal tumors may be particularly predisposed due to the presence of intradural tumor and a number of other factors. Post-operative CSF leaks increase morbidity, lengthen hospital stays, prolong immobilization and subject patients to a number of associated complications. Intraoperative identification of unintended durotomies and effective primary repair of dural defects is an important first step in the prevention of post-operative CSF leaks, but in patients who develop post-operative pseudomeningoceles, durocutaneous fistulae or other CSF-leak-related sequelae, early recognition and secondary intervention are paramount to preventing further CSF-leak-related complications and achieving the best patient outcomes possible. In this article, the incidence, risk factors and complications of CSF leaks after spine tumor surgery are reviewed, with an emphasis on avoidance of post-operative CSF leaks, early post-operative identification and effective secondary intervention.
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Affiliation(s)
- Sean M Barber
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jared S Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jonathan Nakhla
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
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Ercin BS, Bicer A, Yigitturk G, Cinar C, Cavusoglu T, Uyanikgil Y, Gurler T. Who needs extra time? Amniotic membrane wrapped pauci-suture model for rapid anastomoses . J Plast Surg Hand Surg 2019;53:89-96. [PMID: 30654665 DOI: 10.1080/2000656x.2018.1550419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An ideal anastomosis method will obtain the highest post-anastomotic vessel patency and will repair the vessel anatomically with minimal thrombosis in an easier, faster and cheaper fashion. To achieve these goals an anastomosis model using an amniotic membrane is introduced. The study was performed on the femoral arteries of 22 Wistar Albino rats (11 control group, 11 experimental group). In the experiment group, the microvascular anastomosis was completed with three sutures and a patch of amniotic membrane which was wrapped around the anastomotic site. The conventional anastomosis technique with eight sutures was performed in the control group. The effects of the model on the patency and histological structure of the vessels were evaluated. As a result, normal patency was determined radiologically and macroscopically in all of the anastomoses. No thrombosis or aneurysm was detected in any of the anastomoses. In the angiographic study, vessel patency was detected in both the control and experimental groups. The average time to complete the arterial anastomosis was 18.14 (±2.84) and 10.39 (±2.45) minutes in the control and the experiment groups respectively. In the histological studies, anti-eNOS staining revealed that endothelin levels were significantly higher in the experimental group. This method describes a new anastomosis model in microvascular surgery with promising results that call for additional experimental studies and further clinical implementations. We believe that this experimental technique can be put into clinical practice as an alternative to the conventional microvascular anastomosis technique.
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Affiliation(s)
- Burak Sercan Ercin
- a Department of Plastic, Reconstructive and Aesthetic Surgery , Turkish Ministry of Health, Siirt Urban Hospital , Siirt , Turkey
| | - Ahmet Bicer
- b Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery , Ege University , Izmir , Turkey
| | - Gurkan Yigitturk
- c Faculty of Medicine, Department of Histology and Embryology , Mugla Sitki Kocman University , Mugla , Turkey
| | - Celal Cinar
- d Faculty of Medicine, Department of Radiology, Division of Interventional Radiology , Ege University , Izmir , Turkey
| | - Turker Cavusoglu
- e Faculty of Medicine, Department of Histology and Embryology , Ege University , Izmir , Turkey.,f Cord Blood, Cell And Tissue Research And Application Centre, Ege University , Izmir , Turkey
| | - Yigit Uyanikgil
- e Faculty of Medicine, Department of Histology and Embryology , Ege University , Izmir , Turkey.,f Cord Blood, Cell And Tissue Research And Application Centre, Ege University , Izmir , Turkey
| | - Tahir Gurler
- b Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery , Ege University , Izmir , Turkey
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18
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Barros RSMD, Leal RA, Teixeira RKC, Yamaki VN, Feijó DH, Gouveia EHH, Valente AL, Silva Feitosa-Junior DJ, Carvalho LTFD. Continuous versus interrupted suture technique in microvascular anastomosis in rats. Acta Cir Bras 2017; 32:691-696. [DOI: 10.1590/s0102-865020170090000001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022] Open
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Cutiongco MFA, Kukumberg M, Peneyra JL, Yeo MS, Yao JY, Rufaihah AJ, Le Visage C, Ho JP, Yim EKF. Submillimeter Diameter Poly(Vinyl Alcohol) Vascular Graft Patency in Rabbit Model. Front Bioeng Biotechnol 2016; 4:44. [PMID: 27376059 PMCID: PMC4896917 DOI: 10.3389/fbioe.2016.00044] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/17/2016] [Indexed: 11/13/2022] Open
Abstract
Microvascular surgery is becoming a prevalent surgical practice. Replantation, hand reconstruction, orthopedic, and free tissue transfer procedures all rely on microvascular surgery for the repair of venous and arterial defects at the millimeter and submillimeter levels. Often, a vascular graft is required for the procedure as a means to bridge the gap between native arteries. While autologous vessels are desired for their bioactivity and non-thrombogenicity, the tedious harvest process, lack of availability, and caliber or mechanical mismatch contribute to graft failure. Thus, there is a need for an off-the-shelf artificial vascular graft that has low thrombogenic properties and mechanical properties matching those of submillimeter vessels. Poly(vinyl alcohol) hydrogel (PVA) has excellent prospects as a vascular graft due to its bioinertness, low thrombogenicity, high water content, and tunable mechanical properties. Here, we fabricated PVA grafts with submillimeter diameter and mechanical properties that closely approximated those of the rabbit femoral artery. In vitro platelet adhesion and microparticle release assay verified the low thrombogenicity of PVA. A stringent proof-of-concept in vivo test was performed by implanting PVA grafts in rabbit femoral artery with multilevel arterial occlusion. Laser Doppler measurements indicated the improved perfusion of the distal limb after implantation with PVA grafts. Moreover, ultrasound Doppler and angiography verified that the submillimeter diameter PVA vascular grafts remained patent for 2 weeks without the aid of anticoagulant or antithrombotics. Endothelial cells were observed in the luminal surface of one patent PVA graft. The advantageous non-thrombogenic and tunable mechanical properties of PVA that are retained even in the submillimeter diameter dimensions support the application of this biomaterial for vascular replacement in microvascular surgery.
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Affiliation(s)
- Marie F A Cutiongco
- Mechanobiology Institute, National University of Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Marek Kukumberg
- Mechanobiology Institute, National University of Singapore , Singapore
| | | | - Matthew S Yeo
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Health System, Singapore; Plastic, Reconstructive and Aesthetic Surgery Section, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Jia Y Yao
- Department of Biomedical Engineering, National University of Singapore , Singapore
| | - Abdul Jalil Rufaihah
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Catherine Le Visage
- INSERM, U791, Center for OsteoArticular and Dental Tissue Engineering, Université de Nantes , Nantes , France
| | - Jackie Pei Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiovascular and Thoracic Surgery, National University Health System, Singapore
| | - Evelyn K F Yim
- Mechanobiology Institute, National University of Singapore, Singapore; Department of Biomedical Engineering, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Chemical Engineering, University of Waterloo, Waterloo, ON, Canada
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Gurien LA, Wyrick DL, Smith SD, Maxson RT. A stitch in time saves nine: suture technique does not affect intestinal growth in a young, growing animal model. J Pediatr Surg 2016; 51:819-21. [PMID: 26949143 DOI: 10.1016/j.jpedsurg.2016.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although this issue remains unexamined, pediatric surgeons commonly use simple interrupted suture for bowel anastomosis, as it is thought to improve intestinal growth postoperatively compared to continuous running suture. However, effects on intestinal growth are unclear. We compared intestinal growth using different anastomotic techniques during the postoperative period in young rats. METHODS Young, growing rats underwent small bowel transection and anastomosis using either simple interrupted or continuous running technique. At 7-weeks postoperatively after a four-fold growth, the anastomotic site was resected. Diameters and burst pressures were measured. RESULTS Thirteen rats underwent anastomosis with simple interrupted technique and sixteen with continuous running method. No differences were found in body weight at first (102.46 vs 109.75g) or second operations (413.85 vs 430.63g). Neither the diameters (0.69 vs 0.79cm) nor burst pressures were statistically different, although the calculated circumference was smaller in the simple interrupted group (2.18 vs 2.59cm; p=0.03). No ruptures occurred at the anastomotic line. CONCLUSIONS This pilot study is the first to compare continuous running to simple interrupted intestinal anastomosis in a pediatric model and showed no difference in growth. Adopting continuous running techniques for bowel anastomosis in young children may lead to faster operative time without affecting intestinal growth.
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Affiliation(s)
- Lori A Gurien
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR; Department of Pediatric Surgery, Arkansas Children's Hospital Research Institute, Little Rock, AR.
| | - Deidre L Wyrick
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - Samuel D Smith
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - R Todd Maxson
- Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, AR
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Umezawa H, Ogawa R, Nakamizo M, Yokoshima K, Hyakusoku H. A comparison of microsurgical venous anastomosis techniques. J NIPPON MED SCH 2016; 82:14-20. [PMID: 25797870 DOI: 10.1272/jnms.82.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Successful vascular anastomosis is essential for the survival of transferred free tissue. Arterial anastomosis is typically uncomplicated because the lumen is easily maintained and the vessel walls have elasticity. Venous anastomosis, however, is more time consuming because the vessel walls are thin and extensible. This article describes, reviews, and compares 3 currently used venous anastomosis techniques. METHODS From April 2012 through January 2014, free tissue transfer and supercharging pedicled tissue transfer were performed in 107 and 10 patients, respectively, at our hospital. According to the anastomotic technique used, patients (83 men and 34 women; mean age, 60.6 years) were divided into interrupted suture, continuous suture, and microvascular anastomotic coupling device (MACD) groups. Medical records were reviewed, and postoperative results were analyzed. RESULTS The diameter of anastomosed veins did not differ significantly among the groups. However, among the interrupted suture, continuous suture, and MACD groups, there were significant differences in vascular anastomosis time (51, 43.9, and 29.5 minutes, respectively) and transferred tissue ischemic time (151.9, 139.1, and 117.5 minutes, respectively). Surgical site infection occurred in 9 patients, and flap necrosis occurred in 2 patients. However, complication rates did not differ significantly among the 3 groups. CONCLUSIONS The venous anastomosis technique does not affect the complication rate but does affect anastomosis time and flap ischemia time. On the basis of these results, we believe that the continuous suture and MACD techniques are easier and safer for venous anastomosis than is the traditional interrupted suture technique.
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Affiliation(s)
- Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
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Aitken E, Jeans E, Aitken M, Kingsmore D. A randomized controlled trial of interrupted versus continuous suturing techniques for radiocephalic fistulas. J Vasc Surg 2015; 62:1575-82. [DOI: 10.1016/j.jvs.2015.07.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/23/2015] [Indexed: 10/22/2022]
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Microvascular anastomosis using Ankaferd blood stopper: demonstration of long-term histopathologic effects on vascular tissue. Blood Coagul Fibrinolysis 2015; 25:721-5. [PMID: 24806319 DOI: 10.1097/mbc.0000000000000135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ankaferd blood stopper (ABS) (Ankaferd İlaç Kozmetik A.Ş., Turkey) is a medicinal plant extract, which is used in Turkish traditional medicine as a haemostatic agent. The aim of this study was to investigate the haemostatic effect of ABS in preventing microvascular leakage on an anastomosis site and to look into its long-term impact on vascular tissue. Twenty-one Wistar albino rats were randomly divided into three groups. The animals in the second and third groups were pretreated with acetylsalicylic acid. All of the right femoral arteries were divided and anastomosed in an end-to-end fashion. Following microvascular anastomosis, saline-soaked gauze tampons were applied in the first and second groups. In the third group, ABS-soaked tampons were applied to the anastomosis sites. The mean bleeding time of group 3 was significantly shorter than group 2 and group 1. Three weeks after the operation, there were aneurysms on all of the anastomosis sites in group 3 and none of the anastomoses were patent. Histologic examination demonstrated increased inflammatory cell infiltration, tunica media degeneration and contraction of tunica intima in group 3. This is the first study reporting the long-term effects of ABS on microvascular anastomosis. Contrary to previously reported studies, this agent is not appropriate for use on injured or anastomosed vessels.
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Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J 2015; 15:1099-105. [PMID: 23973097 DOI: 10.1016/j.spinee.2013.06.044] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 04/14/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Incidental durotomy occurs in 1% to 17% of lumbar spine surgery. This is treated with watertight suture repair, often combined with a sealant. PURPOSE To compare the hydrostatic strength of dural repair using various suture sizes, closure techniques, and adhesives. STUDY DESIGN A novel in vitro hydrostatic calf spine model. OUTCOME MEASURES Dural leakage as a function of hydrostatic pressure and leak area. METHODS We compared surgical repair between 5-0 surgilon and 6-0 prolene suture, continuous locked versus interrupted suture, and the effectiveness of three adhesives hydrogel, cyanoacrylate, and fibrin glue. The leakage flow rate was compared among suture groups using analysis of variance (ANOVA). The percent reduction of leak area was determined for the sealants and compared using ANOVA. The study was funded from an intramural departmental grant. RESULTS 6-0 Prolene was found to have significantly decreased leakage flow rate than 5-0 surgilon. We found no significant differences in the flow rate between the interrupted and continuous locked sutures. In most cases, leakage occurred from the needle holes around sutures. There was an 80% reduction in leak area with the hydrogel and cyanoacrylic sealants compared with only a 38% reduction with fibrin glue; however, there was no statistical difference between the leak rates using any of the sealants. CONCLUSION 6-0 Prolene using either interrupted or locked techniques was the best at creating watertight closure of an incidental durotomy. If a watertight seal cannot be obtained, a hydrogel or a fibrin sealant will immediately improve the strength of repair. Newer sutures that have a larger diameter of suture relative to needle should be developed for use in dural repair.
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Affiliation(s)
- Erica E Dafford
- Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, 1685 Highland Ave., 6th floor, Madison, WI 53705-2281, USA
| | - Paul A Anderson
- Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, 1685 Highland Ave., 6th floor, Madison, WI 53705-2281, USA.
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Siemionow MZ, Zor F. Microsurgical Techniques in Reconstructive Surgery. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sacak B, Tosun U, Egemen O, Sakiz D, Ugurlu K. Microvascular anastomosis using fibrin glue and venous cuff in rat carotid artery. J Plast Surg Hand Surg 2014; 49:72-6. [DOI: 10.3109/2000656x.2013.800528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yagi T, Shinoura S, Umeda Y, Sato D, Yoshida R, Yoshida K, Utsumi M, Nobuoka D, Sadamori H, Fujiwara T. Surgical rationalization of living donor liver transplantation by abolition of hepatic artery reconstruction under a fixed microscope. Clin Transplant 2012; 26:877-83. [PMID: 22594796 DOI: 10.1111/j.1399-0012.2012.01651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2012] [Indexed: 02/07/2023]
Abstract
The small diameter of the hepatic artery is one of the complexities of living donor liver transplantation (LDLT). We analyzed whether the direct suture technique using surgical loupes can simplify the operative process for LDLT compared with fixed microscopic reconstruction. We applied the direct technique to rationalize the operative process and abolished routine microsurgery from 2004. Two hundred and nine LDLT with a postoperative period over 34 months were carried out from 1996 to 2008. The patients were divided into two groups: the micro group (children: 20, adults: 72) and the non-micro group (children: 12, adults: 97). Running anastomosis was undertaken in the non-micro group. The anastomotic size of the children was significantly smaller than that of the adults, but larger than 2 mm (2.38±0.4 vs. 2.7±0.47 mm, p=0.0005). By appropriate choice of the proximal artery, direct anastomosis is possible even in children. Early complications occurred in seven cases in the micro group, but none occurred in the non-micro group (p<0.05). Significant reductions were observed in operation time (p<0.0001), blood loss (p<0.05), and hospital stay (p<0.01) in the non-micro group. Non-microscopic anastomosis is useful for the rationalization of LDLT.
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Affiliation(s)
- Takahito Yagi
- Department of Gastroenterological, Transplant Surgery and Surgical Oncology, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan.
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Lange F, Domergue S, Meziane J, Fassio E, Yachouh J. [Techniques of anastomoses issue from vascular surgery and apply to maxillofacial microsurgery]. ANN CHIR PLAST ESTH 2011; 57:254-9. [PMID: 22153893 DOI: 10.1016/j.anplas.2011.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022]
Abstract
Vascular surgeons use an anastomosis technique that has proven its efficiency for a long time. This technique consists in an anastomosis with spatulated ended vessels designed with opposite obliquity. This anastomosis is closed by a continuous suture. Authors expose the results of this technique applied to microvascular surgery in facial reconstruction.
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Affiliation(s)
- F Lange
- Service de chirurgie maxillofaciale et plastique, CHU Lapeyronie, 371 avenue du Doyen-Gaston-Giraud, Montpellier, France.
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Abstract
Researchers have made numerous attempts to shorten anastomosis duration since Jacobson first used the term microvascular surgery in 1960. However, none of these alternatives has its combination of facility, low cost, reliability, durability, and high success rate. This study aimed to shorten the anastomosis duration, especially in operations that require multiple anastomoses, and the authors performed experimental anastomoses with the fish-mouth technique using fibrin glue. This technique first involves 2 longitudinal incisions made 180 degrees apart in the shape of a fish mouth at each vessel end, thus creating a pair of equal-sized, full-thickness flaps on both vessels. These incisions, equal in length, were as long as the radius of the vessel. Two simple stay-sutures placed on the corners of the flap bases and vessels were approximated. Then, the anastomosis site was sealed with fibrin glue. Both control and experimental groups are consisted of 32 rats. This study assessed and statistically evaluated the groups with biopsies on days 3, 7, 14, and 21 and also assessed patency rates, microaneurysm formation, histologic healing patterns, and operation duration. The present study concluded that anastomosis with fish-mouth technique using fibrin glue takes less time, requires fewer sutures, decreases the amount of foreign materials in direct contact with the blood stream, creates less foreign-body reaction in the vessel wall, and everts contact surfaces. With these advantages, this technique provides a reliable and successful alternative, especially in operations requiring multiple anastomoses.
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Alghoul MS, Gordon CR, Yetman R, Buncke GM, Siemionow M, Afifi AM, Moon WK. From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses. Microsurgery 2010; 31:72-80. [PMID: 21207502 DOI: 10.1002/micr.20813] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 05/24/2010] [Indexed: 11/10/2022]
Abstract
Accomplishing successful microvascular anastomoses is undoubtedly one of the most critical steps in performing free tissue transfer. However, the ideal technique has often been a subject of debate. Therefore, our objective was to review the current literature in an attempt to find objective evidence supporting the superiority of one particular technique. A PubMed and OVID on-line search was performed in November 2007 using the following keywords: microvascular anastomoses, microsurgical anastomosis, continuous suture, interrupted suture, mattress suture, and sleeve anastomosis. Our literature review found no difference in short- and/or long-term patency rates between the six main published techniques, which includes continuous suture, interrupted suture, locking continuous, continuous horizontal, horizontal interrupted with eversion, and sleeve anastomoses. These findings were consistent for each technique as long as the microsurgeon maintained standard microsurgical principles and practice, including suture line eversion, minimized tension, and direct intima-to-intima contact. Current literature supports no overall statistical difference in short- and/or long-term patency rates between any of the various techniques. The choice to perform one suture technique over another ultimately depends on the plastic surgeon's preference and microsurgical experience. To date, there are no human randomized, controlled clinical trials comparing the efficacy and clinical outcomes of each of the various suture techniques, and therefore one's comfort and familiarity should dictate his or her microsurgical technique. However, "exposure to many and mastery of one" simply provides the plastic surgery resident, fellow, or staff the technical flexibility needed for less-complicated surgical planning when performing free tissue transfer.
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Affiliation(s)
- Mohammed S Alghoul
- Departement of Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
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‘Through-the-loop’ tie for microsurgical suturing. J Plast Reconstr Aesthet Surg 2010; 63:1087-90. [DOI: 10.1016/j.bjps.2009.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/20/2009] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE Some centres have proposed creating the bidirectional cavopulmonary anastomosis without cardiopulmonary bypass, while others continue to use deep hypothermic circulatory arrest. The purpose of this review is to evaluate the results of using continuous cardiopulmonary bypass with moderate hypothermia, perhaps the most commonly used of the three techniques for this procedure. METHODS Between 1990 and 2005, 114 patients, having a mean age of 1.58 years, with a median age of 8 months, and ranging from 3 months to 16 years, underwent creation of either a unilateral cavopulmonary anastomosis, in 94 cases, or bilateral anastomoses in 20 cases. All had continuous cardiopulmonary bypass with moderate hypothermia at 32 degrees Celsius, with 24 also having aortic cross-clamping with cardioplegia for simultaneous intracardiac procedures. Interrupted absorbable sutures were used to create the anastomosis in 105 patients. RESULTS Perioperative mortality was 5%, with 6 of the patients dying. The mean period of cardiopulmonary bypass for an isolated anastomosis was 91 minutes, with a range from 44 to 160 minutes. In 10 patients (8.8%), it was necessary to place a graft to augment the anastomosis. The average postoperative length of stay was 7.9 days for those undergoing an isolated unilateral anastomosis, and 16.4 days for patients undergoing combined cardiac operations. We have now created the Fontan circulation in 79 of the patients, at an average interval from the bidirectional cavopulmonary anastomosis of 2.1 plus or minus 1.14 years. In 76 patients, we performed postoperative angiograms, and none revealed any stenoses. CONCLUSIONS The bidirectional cavopulmonary anastomosis can be performed successfully with continuous cardiopulmonary bypass and moderate hypothermia with a beating heart, avoiding circulatory arrest. The use of interrupted and absorbable sutures was not associated with any late anastomotic stenosis.
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Radad K, El-Shazly M. Clinical and pathological assessment of different suture techniques for microvascular anastomosis in rat femoral artery. J Vet Sci 2007; 8:269-73. [PMID: 17679774 PMCID: PMC2868134 DOI: 10.4142/jvs.2007.8.3.269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study examined the clinical and pathological features after a microvascular anastomosis of a rat femoral artery using four different suture techniques. Sixty Sprage-Dawely rats were divided randomly into 4 groups. Fifteen bisected arteries (one from each animal) in Group I, II, III and IV were sutured with the simple interrupted suture, continuous suture, sleeve suture and cuff suture, respectively. The anastomosis times in Group I, II, III and IV were 28.67, 14.67, 15.47 and 15.93 min, respectively. Immediate bleeding that stopped without intervention (grade I) was observed in 67%, 73% and 60% of the anastomosed vessels in Groups II, III and IV, respectively, while 60% of the vessels in Group I showed light bleeding that was inhibited by gentile pressure (grade II). All vessels examined appeared to be patent at 5 and 15 min after the anastomosis. On the 7th day postoperatively, the vessels of Group I showed the highest patency rate (93%) compared with Groups II (67%), III (73%) and IV (87%). Moreover, there were more pronounced pathological changes in Group I than in the other groups. These changes included endothelial loss, endothelial proliferation, degeneration and necrosis of the tunica media. Suture materials surrounded by an inflammatory reaction were also observed. In conclusion, the simple interrupted suture is preferable for microvascular anastomosis due to its highest patency rate. The other techniques investigated can be good alternatives because of their short anastomotic time and moderate pathological changes.
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Affiliation(s)
- Khaled Radad
- Department of Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.
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Lee SE, Yang SH, Jang JY, Kim SW. Pancreatic fistula after pancreaticoduodenectomy: a comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: interrupted vs continuous stitches. World J Gastroenterol 2007. [PMID: 17879405 DOI: 10.3748/wjg.13.6296] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e. the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage. METHODS During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon. RESULTS There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients (11%) among the interrupted suture cases and in 10 (6%) among the continuous suture cases (P = 0.102). Major pancreatic leakage developed in three interrupted suture patients (2%) and zero continuous suture patients (P = 0.026). In multivariate analysis, soft pancreatic consistency (odds ratio, 5.5; 95% confidence interval 2.3-13.1) and common bile duct cancer (odds ratio, 3.7; 95% CI 1.6-8.5) were predictive of pancreatic leakage. CONCLUSION Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy.
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Affiliation(s)
- Seung-Eun Lee
- Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
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Lee SE, Yang SH, Jang JY, Kim SW. Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches. World J Gastroenterol 2007; 13:5351-6. [PMID: 17879405 PMCID: PMC4171325 DOI: 10.3748/wjg.v13.i40.5351] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e., the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage.
METHODS: During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon.
RESULTS: There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients (11%) among the interrupted suture cases and in 10 (6%) among the continuous suture cases (P = 0.102). Major pancreatic leakage developed in three interrupted suture patients (2%) and zero continuous suture patients (P = 0.026). In multivariate analysis, soft pancreatic consistency (odds ratio, 5.5; 95% confidence interval 2.3-13.1) and common bile duct cancer (odds ratio, 3.7; 95% CI 1.6-8.5) were predictive of pancreatic leakage.
CONCLUSION: Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy.
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Affiliation(s)
- Seung-Eun Lee
- Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
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Wang J, Ma H, Zhang H, Lu B, Wang J, Wang Z, Li Y, Li J. Continuous locked suture technique for arterial anastomosis in rat small bowel transplantation. Microsurgery 2007; 27:112-7. [PMID: 17285597 DOI: 10.1002/micr.20315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous locked suture technique in arterial anastomosis was used in a rat heterotopic small bowel transplantation model. Blood loss, time consumption and success rate of the technique, as well as long-term blood flow and histological changes of arterial anastomosis and intestinal graft were compared with the traditional simple continuous suture technique. The results showed that the time consumption was similar between the two techniques while the continuous locked suture technique had a higher success rate (P = 0.016) and was more secure than the simple continuous suture technique. Moreover, it provided a higher long-term blood flow. Under light microscopy and electron scanning microscopy, the anastomosis of continuous locked suture technique showed significantly less stenosis than those of simple continuous suture technique. No difference was found between the two techniques considering the graft intestinal histological changes. In conclusion, the continuous locked suture technique was a more superior technique than simple continuous suture technique in arterial end-to-side anastomosis considering long-term hemodynamics.
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Affiliation(s)
- Jian Wang
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Orak I, Güneren E, Yildiz L. A hemodynamic study of the effects of arterial anastomoses with interrupted simple versus horizontal mattress sutures on rat epigastric flap perfusion. Ann Plast Surg 2006; 57:84-8. [PMID: 16799315 DOI: 10.1097/01.sap.0000204035.77692.a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effects of interrupted simple versus horizontal mattress sutures and of the internal diameter of the arterial pedicle at the level of the anastomosis on rat epigastric flap perfusion were investigated. In the first group, a microclip was applied to the femoral artery for 30 minutes. In the second group, the artery was cut, and a classic 7- to 8-suture microarterial end-to-end anastomosis was performed. In the third group, the artery was cut, and a microarterial end-to-end anastomosis with 3 horizontal mattress sutures at 120-degree intervals was performed. Perfusion was measured using a laser Doppler flowmeter (Periflux 2B, Perimed, Sweden) at 3 zones of the flap at 30 and 60 minutes and at 21 days after the procedure. Internal vascular diameters were measured histopathologically. Perfusion was better in the control group than in the experimental groups. However, the internal vascular diameters were greater with the classic method than with the new method, and the perfusion did not differ statistically in the anastomosis groups. In conclusion, even when significant narrowing develops at the anastomosis, flap viability is not affected.
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Affiliation(s)
- Ibrahim Orak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
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Lieber D, Tran V, Belani J, Ames C, Morissey K, Yan Y, Humphrey P, Venkatesh R, Landman J. Comparison of Running and Interrupted Vesicourethral Anastomoses in a Porcine Model. J Endourol 2005; 19:1109-13. [PMID: 16283849 DOI: 10.1089/end.2005.19.1109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare running and interrupted suturing techniques for porcine vesicourethral anastomosis with regard to procedure time, histopathologic effects, and leakage. MATERIALS AND METHODS Twelve domestic pigs were randomized to a running (N = 6) or an interrupted (N = 6) vesicourethral anastomosis with polyglycolic acid sutures. In each case, the bladder was drained for 7 days. A cystogram was performed immediately after completion of each anastomosis and on postoperative days 7 and 30. Animals were sacrificed on postoperative day 30, and the area of the anastomosis was excised en bloc for histopathologic evaluation. RESULTS All procedures were completed laparoscopically. The mean operative time for continuous and interrupted suturing were 27.5 and 36.8 minutes, respectively (P = 0.3324). A significant learning curve was noted for both anastomoses, with operative times decreasing with experience in both groups. There was no difference in anastomotic leakage. Histopathology examination revealed more muscle-layer fibrosis in the interrupted- suture group than in the continuous-suture group, with a mean score of 2.17 and 1.67, respectively (P = 0.0325). CONCLUSIONS Both continuous and interrupted vesicourethral anastomoses are feasible. In this in-vivo porcine comparison, there was no difference with respect to procedure time or anastomotic leakage. However, histopathologic grading demonstrated greater muscle fibrosis in the interrupted-suture group.
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Affiliation(s)
- David Lieber
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA
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Rosenthal E, Carroll W, Dobbs M, Scott Magnuson J, Wax M, Peters G. Simplifying head and neck microvascular reconstruction. Head Neck 2005; 26:930-6. [PMID: 15508120 DOI: 10.1002/hed.20076] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. METHODS This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. RESULTS Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. CONCLUSIONS This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results.
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Affiliation(s)
- Eben Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, 1501 5th Avenue South, Birmingham, AL 35249, USA.
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Hadlock T, Varvares M. Microvascular and microneural surgery new horizons in facial plastic and reconstructive surgery. Facial Plast Surg Clin North Am 2002; 10:167-74. [PMID: 15062319 DOI: 10.1016/s1064-7406(02)00002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tessa Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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