Open Guide Suture Technique for Safe Microvascular Anastomosis

Özkan, Ömer; Özgentaş, H. Ege

doi:10.1097/01.sap.0000171682.53871.72

Cited by 26 publications

(23 citation statements)

References 15 publications

(15 reference statements)

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“…Even though extensive teaching should pave the way to wider use of supermicrosurgery, what matters most at this time is to develop and apply reliable and reproducible methods. In cases where conventional anastomosis techniques are still applicable, a variety of methods have been proposed [9][10][11][12] with the aim of simplifying surgical procedure, but only through techniques facilitating anastomosis procedures is supermicrosurgery likely to finally be democratized.…”

Section: Discussionmentioning

confidence: 99%

“…The first of them requires no specific material but rather consists in a technical modification, and is known as the method of ''open guide suture'' [9]. Stitches are positioned step by step and only subsequently knotted in a precise order, which differs according to involvement of the anterior or the posterior wall of the anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…In this respect, a number of approaches have already been put forward [9][10][11][12], each of them presenting its particular advantages and drawbacks, but supermicrosurgery has yet to be democratized. That is why we are presenting the results of an experimental feasibility study of a new method designed to support supermicrosurgical anastomoses through injection of hyaluronic acid (HA).…”

Section: Original Articlementioning

confidence: 98%

See 2 more Smart Citations

Supermicrosurgery and hyaluronic acid: Experimental feasability study of a new method

Qassemyar

Gianfermi

2015

Annales de Chirurgie Plastique Esthétique

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 98%

See 1 more Smart Citation

Supermicrosurgery and hyaluronic acid: Experimental feasability study of a new method

Qassemyar

Gianfermi

2015

Annales de Chirurgie Plastique Esthétique

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“…Single-layer continuous suture is a common method of blood vessel surgery (13). The advantage of this approach is its simplicity, and is particularly suited for vessel anastomosis in deep tissues.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Zhang

et al. 2014

Oncology Letters

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Surgery for digestive tract disease predominantly consists of reconstruction and anastomosis. Due to the difficult location, anastomosis is extremely challenging and the risk of complication increases accordingly. Traditional manual anastomosis and the application of a stapling device are insufficient. Therefore, the aim of this study was to investigate the feasibility and safety of a novel manual method in a difficult anastomotic location, consisting of a single-layer continuous suture in the posterior wall. In total, 15 beagle dogs were included in the study; eight underwent surgery with the novel manual method for reconstruction and anastomosis of the digestive tract, while seven underwent surgery with the stapler device as a control. The subsequent postoperative complications were observed and, three months later, the anastomotic ports were excised, and the pathological formation and morphological changes were evaluated. No statistically significant differences were identified between the total (50.0 vs. 57.1%; P=0.782) and anastomotic (0.0 vs. 28.6%; P=0.200) complication rates in the manual suture and staple suture groups, respectively. Compared with the control group, the operative expenditure was lower in the manual group (1726.7±33.5 vs. 2135.7±43.1 renminbi; P=0.001), the diameter of the anastomotic port was larger in the manual group (3.04±0.07 vs. 2.24±0.25 cm; P=0.004) and the thickness of the anastomotic port (in cm) was thinner in the manual group (2.94±0.06 vs. 5.07±0.85; P=0.002). Furthermore, the pathological formation of the anastomositic port in the manual group was improved. The results of the current study suggest single-layer continuous suture of the posterior wall in anastomosis of the digestive tract to be a novel method with feasibility and safety, particularly in difficult anastomotic locations.

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“…"Back wall biting" caused by blood vessel collapse is a common cause of failure in the microvascular anastomosis. 5 Here, we report an assisting suspension triangulated continuous suture (ASTCS) technique to prevent back wall biting in end-to-end porto-renal anastomosis for portocaval shunt in rats.…”

mentioning

confidence: 99%

Assisting suspension triangulated continuous suture technique for microvascular anastomosis in rat portocaval shunt

et al. 2014

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Portocaval shunt in rats is widely used for experimental studies of hepatic diseases, 1-3 as well as for microsurgical training. 4 Suture-based anastomosis is technically challenging due to the small diameter, thinness, and deep location of the portal and renal veins in porto-renal anastomosis for portocaval shunt. "Back wall biting" caused by blood vessel collapse is a common cause of failure in the microvascular anastomosis. 5 Here, we report an assisting suspension triangulated continuous suture (ASTCS) technique to prevent back wall biting in end-to-end porto-renal anastomosis for portocaval shunt in rats.Briefly, the major trunk of the portal vein was isolated using an operating microscope under isoflurane anesthesia. The right renal artery was isolated and clamped. The right renal vein was ligated with 0-gauge silk suture adjacent to the infrahepatic caval vein. The right kidney was removed. The blood flow through the portal vein was blocked by ligation at both ends, and the major trunk of the portal vein was dissected. The proximal end of the portal vein was connected with the right renal artery using a stent method, and the distal end of the portal vein was anastomosed with the right renal vein in an end-to-end pattern with 10-0 nylon suture using the ASTCS technique (Fig. 1).The anastomosis was started with 3 whole-layer eversion stitches at 4, 8, and 12 o'clock positions. The suture at the 8 o'clock position was used to perform subsequent continuous eversion stitching. The guide sutures at 8 and 12 o'clock positions were pulled upward; the guide suture at the 4 o'clock position was pulled downward with the gravity of vascular clip. When stitching reached the 12 o'clock position, continuous stitching was carried out before the guide suture at the 8 o'clock position was managed with a vascular clip. Likewise, continuous stitching at the 4 o'clock position was carried out after clipping the guide suture at the 12 o'clock position. We believe that the ASTCS technique is a convenient method to prevent back wall biting in end-to-end portorenal anastomosis for portocaval shunt in rats. Figure 1. Assisting suspension triangulated continuous suture (ASTCS) technique.

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Open Guide Suture Technique for Safe Microvascular Anastomosis

Cited by 26 publications

References 15 publications

Supermicrosurgery and hyaluronic acid: Experimental feasability study of a new method

Supermicrosurgery and hyaluronic acid: Experimental feasability study of a new method

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Assisting suspension triangulated continuous suture technique for microvascular anastomosis in rat portocaval shunt

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