A modified technique of end-to-side microvascular anastomosis for the posterior wall

A modified technique of interrupted suturing for the posterior wall in end-to-side microvascular anastomosis is presented. It has advantages, especially for the suturing of the pedicle vein and the internal jugular vein in head and neck reconstructions when the pedicle vessel is so short that it cannot be turned over to expose the posterior wall. The pedicle vein is located vertical to the internal jugular vein, and the first stitch begins at the left end of the vessels for a right-handed person. To facilitate the exposure of the left edge of the vessels, the donor vessel is rotated approximately 90 degrees. The advantage of our technique is clear visualization of each suture by rotating the pedicle vessel. Subsequent to the interrupted suturing of the posterior wall, the anterior wall can be sutured by conventional methods. This modified technique is useful for end-to-side microvascular anastomosis, which the microsurgeon may find useful.     

Experimental laser-assisted end-to-side microvascular anastomosis

The authors present a new technique of end-to-side microvascular anastomosis in a rat carotid artery model, employing a milliwatt CO2 laser. Both carotid arteries were isolated and approximated in an end-to-side fashion by the placement of four 10-0 nylon stay sutures. The milliwatt CO2 laser was used to effect vessel anastomosis between the sutures, using 70-100 mW of power. Animals were killed 8 weeks postoperatively. Angiography of each anastomosis was performed in all animals. All anastomoses were then harvested, and submitted for histological analysis. Anastomotic patency was 100%, both intraoperatively and angiographically. There was no evidence of intravascular thrombus, anastomotic stenosis, or pseudoaneurysm formation. Early in the experiment, some anastomoses showed localized dilatation at the anastomotic site. The histologic changes at the anastomotic site are described. Laser-assisted microvascular anastomosis is a feasible technique, and a potential alternative to conventional suture techniques.     

A new clamp for end-to-side microvascular anastomosis

A new clamp for use in microvascular end-to-side anastomosis is described. The advantages of the clamp are that the end of the donor vessel is placed precisely over the opening of the recipient vessel without tension, good exposure of the posterior wall is provided, and the tension on the stay sutures is easily adjusted.     

Simple and reliable procedure for end-to-side microvascular anastomosis: the diamond technique

In the last few decades, microsurgery has become a reliable technique in reconstructive surgery due to numerous technical and conceptual advances. End-to-side anastomosis is currently preferred by many microsurgeons. Many recent clinical and experimental studies showed no significant difference between the slit and hole techniques for end-to-side anastomosis. We propose a different technique, based on geometrical planning of arteriotomies on both the recipient and pedicle artery. The diamond technique is easy to execute, simple, and reliable, with many advantages, and should be kept in mind in selected patients.     

The precise technique of end-to-side microvascular anastomosis with a suitable experimental model.

In order to perform extracranial to intracranial microrevascularisation a good end-to-side microvascular anastomosis technique is the first essential. The rabbit femoral vessels are similar in size to the human cortical branches of the middle meningeal artery and superficial temporal artery and an easy technique of end-to-side anastomosis of these vessels is described. This pays particular attention to proof of patency until the last stitch is applied. Assessment of patency in all three directions is checked by the directional Doppler or the electromagnetic flow probe.     

小血管端侧吻合新方法

吻合血管的游离组织移植的成功率，主要取决于小血管吻合的通畅率，端端吻合技术是常用的小血管吻合技术，但是，端侧吻合与其相比，由于吻合后发生血管痉挛较低，组织供血量大。2006年以来，我们采用Sen等介绍的菱形端侧小血管吻合技术，取得满意效果，现介绍如下。     

End-to-end versus end-to-side arterial anastomosis patency in microvascular surgery

The patency rates of microsurgical end-to-end and end-to-side anastomosis in the rat carotid artery were studied. Seventy end-to-end and seventy end-to-side arterial anastomoses, using 10-0 nylon interrupted sutures, were performed on 140 Sprague-Dawley rats. Findings indicated 100% patency in end-to-end as well as end-to-side immediately and 1 week post-anastomosis. This investigation suggests that there is no significant advantage between the methods studied based on vessel patency alone. The decision to perform an end-to-end vs. an end-to-side arterial anastomosis should be based upon the clinical circumstances encountered, since no significant difference in patency rates exists. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:125-128 1998     

A one-suture end-to-side microvascular sleeve anastomosis: Preliminary report

A new technique is presented for end- to- side anastomosis of vessels smaller than 0.5 mm in diameter. This technique employs a “sleeve” or “telescoped” method of joining the vessels, which has previously been used in end-to-end anastomoses.     

Re-endothelialization of microvascular carotid end-to-side anastomosis in the rat.

A carotid end-to-side anastomosis was performed on 25 male and female Wistar rats (mean weight 197.8 gm). The animals were sacrificed at time intervals varying from 0 to 21 days after the operation. The anastomosis was exposed, the aorta cannulated, and the animals perfused with a 2.5% buffered glutaraldehyde solution at a constant pressure of 80 mm Hg. The anastomoses were removed for scanning electron microscopic (SEM) and light microscopic studies. The SEM results indicate that after the acute platelet-fibrin reaction in the first 48 hours, the suture line itself becomes re-endothelialized after 4 days. On the stitches, however, a cellular population consisting of leukocytes transforming into flattened cells was seen after 2 days. The morphology of these cells and their role in the regeneration of endothelium is discussed. This study presents evidence supporting a blood-borne genesis of endothelial cells in vivo.     

Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis

To compare the speed and patency rates of the continuous and interrupted suture techniques in microvascular end-to-side anastomosis, 10 anastomoses utilizing each technique were performed using a femoral artery-superficial epigastric vein bypass model in Sprague-Dawley rats. The continuous suture technique was found to be almost twice as fast as the interrupted technique with no functional compromise. Patency for both techniques was 100 percent. These results are similar to those of several recent reports comparing the two techniques in end-to-end anastomosis and suggest that the continuous suture technique may be the most efficient technique for end-to-side anastomosis as well.     

加压吻合环：一项结直肠吻合新技术

目的 评价用一种新型镍钛记忆合金加压吻合环（CAR27）进行结直肠吻合的安全性和有效性.方法 2009年11月12日,采用镍钛记忆合金加压吻合环（CAR27）对1例行直肠高位切除术的乙状结肠癌患者进行结直肠端端吻合.结果 本例手术时间42 min,其中吻合时间11 min,术后第1天肛门即排气,术后第2天开始进食.CAR27吻合环于术后第10天随粪便中排出.患者术后随访1个月,无感染、肠梗阻、吻合口狭窄或瘘等并发症发生.结论 本例研究初步提示,采用镍钛记忆合金加压吻合环进行结直肠吻合安全、可行.     

Open guide suture technique for safe microvascular anastomosis

Despite the evident advances in microsurgery, anastomosis of small vessels or anastomosis of vessels having size discrepancy, remains one of the most precise and technically demanding issues in replantation surgery and free tissue transfer procedure. The patency of the vascular anastomosis is critical and essential for a successful outcome. In this study, a microvascular anastomosing technique called open guide suture technique is introduced. The technique starts with a conventional whole-layer stitch and continues under the control of a guided suture that is inserted but not completed to a knot 180 degrees distant from the initial suture. Recently, we used this technique in 30 free flap transfers and 4 replantation procedures. A total of 103 anastomoses were performed. Only 1 flap, which had both arterial and venous problems, and 1 finger replantation case that had arterial problems required revision. Both the revised cases were salvaged, giving a revision rate of 2.91% for the total number of anastomoses (3 of 103), and a 100% success rate for final flap and replanted part survival. In conclusion, this technique provides a safe anastomosis performed under completely clear visualization at each step with well-arranged knot intervals.     

A simple cuff-suture technique for microvascular anastomosis.

The use of synthetic cuffs to simplify and hasten microvascular anastomoses is offered as an alternative to conventional methods. In this study, a soft, non-irritating, silicone rubber cuff was used to construct end-to-end and end-to-side cuff-sutured anastomoses in rats. This technique was as rapid as other non-sutured anastomoses, required no assistant, and provoked no foreign-body reactions.