Strength of microvascular anastomoses: Comparison between the unilink anastomotic system and sutures
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Abstract The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty‐five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded. All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.Keywords:
Surgical anastomosis
Arteriovenous Anastomosis
Statistical Analysis
Abstract Background and Objectives : The argon laser‐assisted vascular anastomosis may solve the problems of conventional sutured anastomosis, such as vascular stenosis and arrest of growth owing to a foreign‐body reaction to suture material. Study Design/Materials and Methods : Twelve argon laser‐assisted vascular anastomoses, seven conventional anastomoses with interrupted sutures, and five conventional anastomoses with continuous sutures were performed in 12 young mongrel dogs. Results : Five months later, the external diameter at the anastomosis had increased 70.5% in the laser group, 67.0% in the interrupted suture group, and 22.9% in the continuous suture group. Histological examination of the laser‐assisted anastomoses showed almost complete healing, with no granulomatous response around the anastomotic site. In the interrupted suture group, marked scaring and foreign body reactions were observed on the vessel wall at the site of the anastomosis. The continuous suture group showed more remarkable disorientation of the vascular layer and intimal hyperplasia than the interrupted suture group. Conclusion : Vascular anastomosis using the argon laser offers advantages over the conventional procedure in growing vessels.
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Abstract Recent technical development has led to remarkable performances in video‐guided surgical procedures. A video‐endoscopic system (VES) is evaluated as an alternative magnifying solution for microsurgical procedures and compared to table‐top microscopes in terms of technical and surgical aspects. Six surgical residents without microsurgical experience, alternating both systems, performed each 12 aortic end‐to‐end anastomoses on Sprague‐Dawley rats using the triangulation technique. All anastomoses underwent quality review, total and single suture time, suture spacing, vessel bite, vessel overlapping and wall penetration were evaluated and graded. Overall anastomosis quality score was 52.28 (out of a maximum of 140) using the microscope and 42.7 using the VES. Despite significant differences in total anastomosis time, the learning curves are similar for the two systems and no major differences were noted in terms of overall anastomosis quality. Video‐assisted microsurgery can become a useful instrument for microsurgery training. © 2007 Wiley‐Liss, Inc. Microsurgery, 2007.
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Patency rates and histologic findings were evaluated in a pilot study in which continuous and interrupted anastomotic techniques were applied to blood vessels less than 1 mm in external diameter. The results of the continuous suture technique were encouraging and we feel that the advantages gained in time and ease of performance may recommend this technique to those who need to perform large numbers of microvascular anastomoses in animals.
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The fate of arterial interposition grafts in growing rats was investigated. The interrupted- and continuous-suture techniques were compared to see which allowed for better expansion of the anastomosis. We found that a graft enlarges in proportion to the growth of the parent vessel, that in end-to-end anastomosis the interrupted suture technique allowed for better expansion of the anastomosis (but not in the end-to-side model), and that the continuous suture technique was associated with a higher rate of false aneurysm formation.
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Objective Toexplore an ideal way of Microvascular anastomosis.Methods Anastomosis of both femoral arteries were performed in 40 rats.Left side of the arteries were anastomsed with medical adhesive.Right side of the arteries as comparise were anastomsed with suture.Biopsy was performed in two groups of rats at different time intervals postoperatively,and the specimens were examined under microscopy(SEM).Results There were no difference in patency between the two techniques.The average anastomotic time for suture was about 18 minuters,while for the adhesive was 12 minuters.SEM of the anastomotic site revealed major differences between sutured and adhered groups.Conclusion Medicl adhesive microvascular anastomosis technique is safe and reliable.
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Free skin flaps using rabbit ear to replace rabbit scalp have been accomplished using only arteriovenous and venous-venous anastomosis, without arterio-arterial anastomosis. The technique produced excellent graft survival in 30 of 33 rabbits. Without the vascular anastomosis control grafts did poorly. The mechanism of flow reversed revascularization is discussed.
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Abstract Free skin flaps using rabbit ear to replace rabbit scalp have been accomplished using only arteriovenous and venous‐venous anastomosis, without arterio‐arterial anastomosis. The technique produced excellent graft survival in 30 of 33 rabbits. Without the vascular anastomosis control grafts did poorly. The mechanism of flow reversed revascularization is discussed.
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The end-to-side anastomosis is one of the most useful techniques in microsurgery. It creates a recipient opening for the donor, keeps the donor vessel intact, and does not interrupt distal blood flow, compared to the end-to-end anastomosis technique. The end-to-side anastomosis is consequently becoming more acceptable in reconstructive microsurgery. The author describes a manageable microsurgical technique for creating recipient vessel openings in small vessels for end-to-side anastomoses.
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