A Comprehensive Investigation of the Effect of Technical Errors in Microsurgical Anastomotic Patency in the Rat Model

Zheng, YuanDian; Paladino, BS Joseph R.; Gasteratos, Konstantinos; Corvi, BS John J.; Park, N/A Katherine H.; Akelina, Yelena; Strauch, Robert J.

doi:10.1097/01.gox.0000799752.53266.14

Plastic and Reconstructive Surgery - Global Open

2021

DOI: 10.1097/01.gox.0000799752.53266.14

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A Comprehensive Investigation of the Effect of Technical Errors in Microsurgical Anastomotic Patency in the Rat Model

YuanDian Zheng¹,

BS Joseph R. Paladino²,

Konstantinos Gasteratos³

et al.

Abstract: PURPOSE:The rat has long been regarded as the standard microsurgery research and training model. Anastomotic patency and thrombosis has since been a central focus in related studies. However, extensive literature indicates that rat microvessels are resilient and can remain patent despite clinically unacceptable technical errors. A design flaw in these studies is that they were oftentimes created by one or two experienced surgeons in a precise and standardized manner with only one technical error committed, whi… Show more

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Rat Microvascular Model is Tolerant to Technical Errors

Paladino,

Zheng,

Gasteratos

et al. 2023

J Reconstr Microsurg

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Background Extensive studies have been conducted using the rat model to understand the potential technical errors that lead to anastomotic failure. However, current literature indicates the rat model has excellent tolerance to diverse errors committed by microsurgeons. The error-investigating rat model is often created by one or two experienced surgeons, and only one isolated technical error is examined. These biases may potentially cause limitations of the results from previous studies. Meanwhile, venous anastomoses have rarely been investigated in previous literature. Therefore, it is important to elucidate this topic with a more comprehensive study design. Methods Nighty-four arterial and 94 venous anastomoses on Sprague–Dawley rat femoral vessels were done by forty-seven microsurgeons who participated in the microsurgery course at Columbia University and the University of Thessaloniki evaluated. Ten total technical errors were examined 1: Disruption of suture line, 2: Back-wall stitch, 3: Oblique stitch, 4: Wide bite, 5: Partial thickness bite, 6: Unequal suture distance, 7: Tear in vessel wall, 8: Excessively tight suture, 9: Suture threads in lumen, and 10: Large edge overlap. The frequency of each error committed and the 30-min postoperative patency was also recorded. The underlying causal relationship between these errors, potential interaction, and the short-term anastomosis patency was analyzed statistically. Results Only the back-wall stitch was found to have a significant causal effect on arterial anastomosis failure (p < 0.001). Back-wall stitch, wide bite, and partial thickness bite significantly impact venous anastomosis patency (p <0 .001). No other statistically significant result was found. Conclusion Overall, the rat model is highly resilient to various technical errors despite these mistakes being often considered clinically unacceptable. Therefore, researchers need to consider the resilience of the rat model when designing and analyzing future studies. In addition, microsurgery instructors should focus on individual stitch quality rather than the final patency.

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Rat Microvascular Model is Tolerant to Technical Errors

Paladino,

Zheng,

Gasteratos

et al. 2023

J Reconstr Microsurg

Self Cite

View full text Add to dashboard Cite

show abstract

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A Comprehensive Investigation of the Effect of Technical Errors in Microsurgical Anastomotic Patency in the Rat Model

Cited by 1 publication

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Rat Microvascular Model is Tolerant to Technical Errors

Rat Microvascular Model is Tolerant to Technical Errors

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