Large and Uneven Bites in End-to-End Anastomosis of the Rat Femoral Artery

Abstract

Background Successful microvascular anastomosis depends on sutures that adequately oppose both cut vessel edges. Trainees tend to take oversized or uneven bite. To improve early microsurgical skill acquisition using the rat, this study tests the belief that such bites compromise early patency by applying exaggerated bites to end-to-end arterial anastomoses. Methods Twelve Sprague–Dawley rats were randomly assigned to one of the four bite techniques to be applied to both femoral arteries (mean diameter, 0.8 mm). Large (L) and standard (S) bites measured 1.0 and 0.2 mm from the edge, respectively. Eight simple interrupted anastomoses were performed per bite technique, each labeled according to every proximal end bite size, followed by every distal end bite size: LL, LS, SL, and SS. Anastomosis time and blood flow rates were recorded and analyzed statistically. After sacrifice 5 days postoperation, anastomosis sections of each technique were examined histologically. Results All 24 anastomoses (100%) maintained patency for 5 days. There was no statistical difference between all postoperative blood flow measurements at any given time. Anastomosis times using LL, LS, SL, and SS bite techniques were 41.6, 33.2, 34.8, and 25.5 minutes, respectively. Anastomosis time for the traditional bite technique (SS) was significantly shorter than all other bite techniques (p< 0.05). Histological examination of the harvested segments from each group revealed similar pathophysiological features. Conclusion Oversized bites (1 mm), placed symmetrically and asymmetrically across the anastomosis, do not affect early patency in the rat femoral artery. A reduced reliance on conventional guidelines for suture bites appears acceptable during microarterial anastomoses if the goal is vessel patency. However, we believe clinical competence involves the ability to place small, even bites consistently and uniformly. During microsurgical training, the occasional large bite need not be replaced; however, the trainee should be encouraged to take standard bites.

Rat Microvascular Model is Tolerant to Technical Errors

“…Past literature often reported a high patency rate of up to 100% upon applying various technical errors, given the seeming discrepancy between experimental models and clinical practice. 3 4 5 6 7 8 9 10 11…”

“…1,2 In-depth analyses of technical error types, including vessel torsion, large or uneven bites, back wall sutures, and others, have been shown to have varying differential effects on vessel patency in a rat model. [3][4][5][6][7][8][9][10][11] Such clinical errors are considered unacceptable in the clinical world due to the increased risk of vessel thrombosis. [12][13][14][15][16][17] However, the rat model exhibits a high tolerance to select technical errors.…”

Microsurgical education in Greece: past, present, and future

“…All of these innovative grading tools are comprehensive and reliable for assessing the students' progress throughout a microsurgical course [30,31]. However, they focus solely on the technical aspects [32], such as manual dexterity, hand-eye coordination, meticulous suture placement [33,34], speed, operative flow, motion 35, and patency of the anastomosis based on taskspecific checklists [36][37][38][39][40]. On the other hand, nontechnical skills (NTS) are equally important.…”

Superiority of living animal models in microsurgical training: beyond technical expertise

“…All of these innovative grading tools are comprehensive and reliable for assessing the students' progress throughout a microsurgical course [16,17]. However, they focus solely on the technical aspects [18], such as manual dexterity, hand-eye coordination, meticulous suture placement [19,20], speed, operative flow, motion [21], and patency of the anastomosis based on task-specific checklists [22][23][24][25][26].…”