Use of the Vascular Closure Staple Clip Applier for Microvascular Anastomosis in Free-Flap Surgery

Abstract

We report our initial experience using the vascular closure staple clip applier (a nonpenetrating titanium clip applied in an interrupted, everting fashion) for microvascular anastomosis in free-flap surgery. In total, 153 anastomoses were performed in 87 free flaps (174 potential anastomoses) using the vascular closure stapler between October of 1997 and June of 1999. In 66 flaps, both the arterial and venous anastomosis were performed with the clip applier, whereas in 21 flaps only the venous anastomosis was performed using the clips. A total of 146 anastomoses were performed in an end-to-end fashion, and seven were performed end-to-side. Of the 87 flaps there were 53 TRAM flaps, seven bilateral TRAM, five latissimus dorsi, four gastrocnemius, three rectus abdominis, two radial forearm fibula, and four Rubens fat-pad flaps. Seventy flaps were used for breast reconstruction, seven flaps for lower limb reconstruction, four flaps for head and neck reconstruction, and six flaps for chest wall/trunk reconstruction. There were no postoperative anastomotic complications of bleeding, thrombosis, or need for revision (100 percent patency rate), with a significantly reduced time for completion of anastomoses. The clip applier is a safe, reliable method for performing microvascular anastomoses, allowing reduced operating time and possible cost savings in free-flap surgery.

Sutureless Vascular Anastomoses by N-Butyl-2 Cyanoacrylate Adhesive: An Experimental Animal Study

“…Therefore, surgeons have been searching for a better anastomotic method with easier manipulation, minimal complications and higher patency rate. In order to minimize injury to the vascular intima, most researchers focused on the study of vascular closure staple, a nonpenetrable anastomosis technique [7][8][9] . Even though it was a good idea initially, vascular closure staple has not been accepted by surgeons because of its high cost, complexity, special skills required, long mobilization of the vascular segment between the anastomotic ends and necessity of similar diameters of the two anastomotic vascular ends.…”

Mediastinal micro-vessels clipping during lymph node dissection may contribute to reduce postoperative pleural drainage

“…As non-penetrating titanium clips provide a close apposition of the tissues without creating a suture tract and the use of titanium clips is easier and faster (14,15), it gradually changes to be a routine instrument at surgery. At the beginning of our practice, we clipped some fine vascular vessels to avoid potential bleeding after dissecting.…”

Improved microvessel repair: Laser welding with an anti‐thrombotic solder

“…Therefore, suture-less methods for microvascular anastomoses are being developed. Both adhesive based [7] and mechanical systems [8] have been studied recently. Another method developed as a replacement to suturing microvessels is the use of laser assisted microvascular anastomoses (LAMA) techniques [9,10].…”