Application of Kunlin's technique in vascular micro‐anastomosis: Experimental and clinical study

Fossati, Enrique; Asurey, Néstor; Irigaray, Alberto

doi:10.1002/micr.1920060111

Cited by 9 publications

(7 citation statements)

References 3 publications

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“…We applied a hemoclip obliquely in the wider venous stump to reduce its orifice to facilitate venous anastomosis in a less discrepant manner. Other techniques have been described, such as V-Y plasty, 21 spatulation, 41 unequal bite technique, 42 fish mouth incisions, 43 sleeve anastomosis 44 and the use of a venous coupler. 45 Although there are many alternative options, we prefer the hemoclip method because it is easy and quick.…”

Section: Discussionmentioning

confidence: 99%

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Ribeiro

Tsao

Hung

et al. 2022

J Reconstr Microsurg

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Background Superficial temporal vessels have been used successfully as recipient vessels for head and neck reconstruction. This study evaluates the impact of several treatment variables on flap failure and take-back rate when using these recipient vessels. Methods We conducted a retrospective study of all microsurgical reconstructions using superficial temporal vessels as recipient vessels in a period of 10 years. Variables collected included previous treatments (radiotherapy, chemotherapy, neck dissection, free flap reconstruction), type of flaps used (soft tissue, osteocutaneous), and vessel size discrepancy between donor and recipient vessels. Results A total of 132 patients were included in the study. The flap success rate was 98.5%. The take-back rate was 10.6%. The most frequent reason for take-back was venous congestion secondary to thrombosis. None of the studied variables was associated with flap failure. Reconstructions using osteocutaneous flaps and vein diameter discrepancy (ratio ≥ 2:1) had significantly higher take-back rates. Conclusion Flaps with a significant size discrepancy between donor and recipient veins (ratio ≥ 2:1) and fibula flaps (compared with soft tissue flaps) were associated with a higher risk of take-back. It is crucial to minimize venous engorgement during flap harvest and anastomosis, and limit vein redundancy during flap in-setting.

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Section: Discussionmentioning

confidence: 99%

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Ribeiro

Tsao

Hung

et al. 2022

J Reconstr Microsurg

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“…52 Despite widespread use of the modified Kunlin's technique in the 1950s, it was not until 1985 that Fossati et al published their experience adapting this technique to the microvascular scale. 53 They demonstrated several advantages, claiming that the triangular shape of the anastomosis made it easier to suture, and it was particularly useful in cases with markedly disparate vessel calibers. 53 We have modified the Kunlin's technique for ETE anastomosis with respect to those originally described by Linton and Menendez.…”

Section: Discussionmentioning

confidence: 99%

“…53 They demonstrated several advantages, claiming that the triangular shape of the anastomosis made it easier to suture, and it was particularly useful in cases with markedly disparate vessel calibers. 53 We have modified the Kunlin's technique for ETE anastomosis with respect to those originally described by Linton and Menendez. 2 An oblique rather than orthogonal vessel transection was first created for each vessel to create larger apertures for better exposure during anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Inbal

Collier

et al. 2019

J reconstr Microsurg

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Background In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side anastomotic technique to address large vessel size mismatches. It was later modified by Dr. Robert Linton for end-to-end (ETE) anastomoses on the “macrovascular” scale. While multiple procedures exist for addressing moderate caliber discrepancies, few safely and reliably compensate for marked diameter differences at the microvascular level. In this study, we present the first large series adapting a modified geometric Kunlin's technique for arterial and venous ETE anastomoses in reconstructive microsurgery. Methods We reviewed 100 consecutive cases of free flap reconstructions from 2006 to 2015 utilizing a modified geometric Kunlin's technique for arterial and venous ETE anastomoses. Patient demographics and flap outcomes were analyzed. Overall flap survival rates and postoperative complications were analyzed and compared with standard values in the microsurgical literature. Results A total of 146 ETE anastomoses from 100 free flaps were analyzed. The average patient age was 51 ± 3.1 years (range: 10–84 years). Free flaps in this study were used for gender confirmation phalloplasties (20%) and reconstructing defects of the head and neck (63%), extremities (16%), and trunk (1%). There was a total of 17 takebacks including 5 for hematoma, 8 for anastomotic thromboses (6 venous), and 4 without any identifiable complication. Of these takebacks, two partial and two complete flap losses occurred. There was an 88% salvage rate for flaps requiring takebacks during the postoperative period. Overall, flap survival rate was 98% including those with complications or takebacks. Conclusion The modified Kunlin's technique is a reliable, facile, and versatile method of performing ETE anastomoses for arterial and venous vessels, especially with vessel diameter mismatches of 3:1 or greater, as well as for challenging orientations. Notably, it provides equivalent flap survival and complication rates as compared with other techniques in the microsurgical literature.

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“…1 Kunlin 3 described a technique of spatulating the smaller vessel in order to reduce vessel size mismatch which has gained widespread use in macrovascular surgery but which has had relatively limited exposure in plastic surgery. 4,5 We have found this is a very useful technique for addressing vessel size mismatch and report our experience with this technique.…”

Section: Dear Sirmentioning

confidence: 97%

Spatulated end-to-end microvascular anastomosis: A useful technique for overcoming vessel size discrepancy

Ridha

Morritt

Wood

2014

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Application of Kunlin's technique in vascular micro‐anastomosis: Experimental and clinical study

Abstract: Vascular microanastomosis of vessels that presents marked discrepancy in size can be performed without difficulty by making a longitudinal incision of the end of the smallest vessel, forming a kind of "spatula," and joined to the vessel of greater diameter.

Cited by 9 publications

References 3 publications

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Venous Size Discrepancy Is a Critical Factor When Using Superficial Temporal Vessels as Recipient Vessels for Free Flaps

Modified Kunlin's Technique for Microsurgical End-to-End Anastomoses: A Series of 100 Flaps

Spatulated end-to-end microvascular anastomosis: A useful technique for overcoming vessel size discrepancy

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