Principles of Microvascular Surgery

A Microsurgical Suture Technique Without the Need for Vascular Clamps

“…Owing to relatively weak in strength, small digital arteries and veins are more likely to be injured by pressure generated by a clamp system. Especially, pressure on the vessels for a prolonged duration may cause the injury, resulting in failure of replantation [2]. Richling et al [8] reported that time of arterial occlusion and pressure exerted by the clamp is correlated with severity of vessel injury.…”

“…Early and late failure of an anastomosis can increase due to anastomisis site tension and vein grafting [2,9]. To negate possibility of bias, we excluded the digits requiring vessel grafting in primary or revision procedures.…”

“…Vascular clamps are often used during microsurgical anastomosis of a vessel. The double clamp system developed by Ikuta is widely used nowadays [1,2]. By holding both ends of the vessel, this device provides good approximation, a tension-free anastomosis, and easy rotation of the vessel from front to back.…”

“…By holding both ends of the vessel, this device provides good approximation, a tension-free anastomosis, and easy rotation of the vessel from front to back. However, pressure exerted by the clamps may damage the small vessel [3], and sometimes, a small vessel is difficult to be mounted in a clamp system [2]. The purpose of this study is to report on a microsurgical suture technique performed without any vascular clamp.…”

Technical Tips to Trim the Stump of a Nonspurting Recipient Artery

“… 1 – 3 Furthermore, adequate proximal flow is absolutely necessary for successful anastomosis. 4 When a blood spurt cannot be observed from the stump of a recipient artery, the artery should be shortened until a good spurt occurs. For such shortening, most microsurgeons cut the arterial stump with straight microscissors in a guillotine fashion ( See Video 1 , Supplemental Digital Content 1 , which demonstrates preparation of an arterial stump in a guillotine fashion, http://links.lww.com/PRSGO/A58 ).…”