Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model

Miyamoto, Shimpei; Sakuraba, Minoru; Asano, Takayuki; Tsuchiya, Sunao; Hamamoto, Yusuke; Onoda, Shigeki; Tomori, Yuji; Yasunaga, Yoshichika; Harii, Kiyonori

doi:10.1016/j.bjps.2009.05.044

Cited by 23 publications

(23 citation statements)

References 23 publications

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“…We found that the patency rates of both the conventional and the suture guide technique were the same (92.7 %) in our study. This is similar to the work of Miyamoto [ 8 ] who found no signifi cant diff erences in the patency rates for conventional, open suture guide technique and intravascular stenting method in the repair of rat superfi cial epigastric artery (external diameter less than 0.5 mm). It does appear that other factors such as the microsurgeon's experience may play a more important role than technique of repair in sub-millimeter vessel anastomosis.…”

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confidence: 89%

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Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis?

Mofikoya

Ugburo

Bankole

2014

Handchir Mikrochir plast Chir

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supporting

confidence: 89%

“…Miyamoto's fi ndings [ 8 ] . We acknowledge that our small sample size, the exclusion of similar caliber veins and short-term evaluation of patency rates are limitations of this study, while the experience of the microsurgeon as well is likely to infl uence the fi ndings.…”

mentioning

confidence: 99%

Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis?

Mofikoya

Ugburo

Bankole

2014

Handchir Mikrochir plast Chir

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“…18 Considerable tissue between the needle site and cut edge obscured visualization of the posterior wall and restricted needle rotation. 2,19,20 To minimize tissue damage and avoid back-wall stitches, all large bite anastomoses had to be performed more slowly than a standard bite anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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

Zheng

Nicolas

Corvi

et al. 2020

J Reconstr Microsurg

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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.

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“…5,6 Another variable to consider is the type of anastomosis and whether this is performed end to end, end to side, or even side to side. [7][8][9][10] The causes of flap failure are diverse but can be broadly separated into inflow problems, outflow problems, and Keywords ► microsurgery ► anastomosis ► free flap ► animal model…”

mentioning

confidence: 99%

Focused Arterial Anastomotic Assessment in a Novel Univariate Design of a Vertical Rectus Abdominis Muscle Flap in a Pig Model

Fischlin

Mbaidjol

Olariu

et al. 2017

J Reconstr Microsurg Open

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Background Microsurgical anastomosis is the basis for free tissue transfer. The goal of this study was to create an animal model that mimics free tissue transfer but would focus on the arterial anastomotic assessment alone, without additional bias of a venous anastomosis. Methods A vertical rectus abdominis musculocutaneous (VRAM) flap based on the left deep superior epigastric artery (DSEA) was raised in six large white pigs. The right DSEA was raised and used as the donor vessel. An arterial end-to-end microsurgical anastomosis was then performed between the right and the left SEA artery. The lateral deep epigastric vein (DIEV) was left intact to drain the flap. Perfusion of the flap was confirmed clinically by laser Doppler and by flowmetry. Results One flap failure was observed in this study that occurred on postoperative day (POD) 5 as a consequence of venous occlusion due to hematoma. There was a significant initial drop in arterial flow across the anastomosis in comparison to preanastomotic flow measurements (p < 0.05); however, this was normalized by the seventh POD (p > 0.05). Flow measurements in the vein significantly increased after the arterial anastomosis was completed and the seventh POD (p < 0.05). Laser Doppler assessment demonstrated adequate tissue perfusion of the skin island flap. Conclusion This modified VRAM flap is a viable procedure to simulate a free flap transfer and assess the arterial anastomosis alone, while maintaining the flap's innate venous drainage. This method can allow the investigation of new arterial anastomosis techniques and devices.

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Optimal technique for microvascular anastomosis of very small vessels: Comparative study of three techniques in a rat superficial inferior epigastric arterial flap model

Cited by 23 publications

References 23 publications

Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis?

Does Open Guide Suture Technique Improve the Patency Rate in Submillimeter Rat Artery Anastomosis?

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

Focused Arterial Anastomotic Assessment in a Novel Univariate Design of a Vertical Rectus Abdominis Muscle Flap in a Pig Model

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