The intravascular stenting (IVaS) method was published by Narushima and Koshima in 2008. This method involves using a monofilament nylon stent to make the anastomosis of small vessels easier. The aim of this study was to explore the IVaS technique to determine its advantages, disadvantages, and usefulness for inexperienced microsurgeons and also for more experienced practitioners during difficult anastomoses. The study was approved by the Catholic University of Louvain Animal Experimentation Ethics Committee. The study was done on 20 Wistar rats; each rat acting as his own control. Group 1 had an anastomosis done with the IVaS technique on the femoral artery. Group 2 had a classic end-to-end anastomosis without a stent. All anastomoses were performed by the same trainee surgeon with 4 months experience in microsurgery. The diameter of the external artery, distance between the double clamp forceps, stent length, number of sutures, stent preparation, and installation time and suture time were all measured. Anastomotic patency was verified using O'Brien's Patency test. The rats were anesthetized 1 week later to reassess the patency of the vessels. While the anastomotic time was shorter in the stent group, the preparation time was longer and so the total time to perform the anastomosis in both groups was the same. All vessels were patent at the completion of the anastomosis. At 1 week, patency rates were identical (83.3%) in both groups. The study shows an improvement in suturing time in the IVaS group. The time saved is equivalent to the time required for preparation and installation of the stent. At 7 days, the Patency test was identical for the two groups (83.3%). IVaS technique is a useful method of vessels anastomosis especially for junior surgeons. The reason why the patency rate was not 100% at 1 week may be because of excessive manipulation of the stent causing thrombosis in the IVaS group and imperfections in suturing technique by a trainee surgeon. Different aspects of the method are open for discussion such as consideration of the stent size and execution of the anastomosis. The IVaS technique helps in the execution of anastomosis in microsurgery and allows for more precise suturing. Care, however, must be taken in its execution and manipulation so as to avoid any lesions of the intima of the vessels.

No abstract

No abstract

No abstract

While elbow dislocation is a common occurrence, the vast majority of them dislocate posteriorly and are due to disruption of the elbow stabilizers, which start on the lateral side and proceed medially, disrupting the anterior and posterior stabilizing structures. We present an unusual case of anterior elbow dislocation, with disruption of the medial stabilizing structures and anterior capsule, without any bony injury. A 44-year-old man presented to the ED after being assaulted. While the exact mechanism of injury was unclear, the patient believes he had been struck with a heavy object on the posterior aspect of his elbow. His dislocation was reduced in the ED, but was highly unstable after reduction. Further imaging revealed disruption of his medial collateral ligaments and common flexor origin. He went on to have an open repair of his medial structures with suture anchors. After six weeks of follow-up he was doing well, with no further episodes of instability and a good functional range of movement. Though rare, anterior elbow dislocations have been reported sporadically in the literature. Surgeons and ED doctors dealing with these injuries should be aware that the maneuvers to relocate the elbow will be different compared to the standard maneuvers used for posterior dislocations. Patients should be examined for stability after reduction, especially on valgus stressing. We would advocate for low threshold for performing an examination under anesthesia (EUA), with open repair of the stabilizing structures if persistently unstable after reduction.