The prevalence of anastomotic failure resulting in return to the operating room and flap necrosis after micro. As you master suturetying techniques, you will need less and less suture for each knot. Extravascular optical coherence tomography for evaluation of. In this paper, we pretended to summarize the techniques. Arterial anastomoses for head and neck reconstructions were performed in endtoend fashion to a branch of the external carotid artery or the transverse cervical artery. Continuous suture technique for microvascular endtoside anastomosis. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and. Microvascular anastomosis is a demanding skill requiring technical excellence and a thorough knowledge of anatomy and physiology. Microvascular anastomosis technique ottie van zyl, johan fagan this chapter describes the surgical technique of microvascular anastomosis, and the management of patients undergoing vascu. During microvascular anastomosis, it is important to maintain the microsurgical field irrigated yet dry so as to achieve a good view of the vessels for approximation. For repair of soft tissue defect requiring split or full thickness graft or other pedicle flaps, see 1505015758 001. This article describes the technique of performing an endtoend arterial anastomosis on a 1mm diameter rat femoral artery. At the time of microvascular anastomosis, however, the fdma was found to still be damaged, and it. Microsurgical technique for 1mm vessel end to end anastomosis.
Studies have evaluated the success of this technique in joining small. The deep system cavernous and crural veins is the main drainage system of the corpora cavernosa and a main source of leakage in venogenic impotence. Video endoscopic monitor images have been used to perform microvascular anastomosis in the rat carotid and femoral arteries. Size discrepancy in microvascular anastomosis is a common issue in free flap transfer. Although the lack of threedimensional vision was the main disadvantage, it could be compensated for. Microvascular anastomosis is a challenging technique that requires extensive training, dedication, time, and effort to be mastered. Venous compromise revised with wound exploration and. Since then, technical refinements of suture materials have made possible surgical reconstruction of most arteries from the root of the aorta to microvascular anastomosis or repair of the smallest vessels, e. To minimize animal use and to create a simple but realistic training model, we developed a pulsatile perfused arteries model based on turkey carotid arteries. The microvessels include terminal arterioles, metarterioles, capillaries, and venules. Video endoscopic images may have a potential use for microvascular surgery. Resultsthe mean diameter of rcia and lcia was about 1 mm.
Current procedural terminology free skin flap with. Sp free flap with wound vac and xenograft postop dx. For flap used for reconstruction, see 15730, 15733, 15734, 15756, 15757, 15758. From april 2012 through january 2014, free tissue transfer and supercharging pedicled tissue transfer were performed in 107 and 10 patients. Pdf fibrin glue application in microvascular anastomosis. Recipient vessel analysis for microvascular reconstruction of the head and neck maurice y. Pdf increasing the flow output by yshaped microvascular. T1 sutureless microvascular anastomosis assisted by an expandable shapememory alloy stent. Eicma stands for extraintracranial microvascular anastomosis. Discrepancies in the cut end diameters have been managed by many geometrical methods in order to reduce the risk to thrombosis. Design and simulation of a training simulation of microvascular.
Microanastomosis definition of microanastomosis by medical. The original plan was simply to remove the damaged area of the fdma and replace it with a straight vein graft, as the bifurcation to the two digital arteries appeared to be intact. Increasing the flow output by yshaped microvascular anastomosis. Inokuchi k, kusaba aalternative device for vascular stapling anastomosis. Novel brain model for training of deep microvascular anastomosis. Factors associated with anastomotic failure after microvascular reconstruction of the breast maurice y. Improving microvascular anastomosis efficiency by combining openloop and airborne suture techniques. A comparison of microsurgical venous anastomosis techniques. Microvascular anastomosis of arteries under tension. It is best to reserve a special set of instruments that will not be used for routine surgery. The vessels are illuminated with a laser, and the fluorescence is picked up by a charged couple device video camera. A sidetoside anastomosis is a worthwhile exercise because it can be used to create a wide connection between parallel vessels. Techniques for management of size discrepancies in.
Specialized training is essential for mastering the anastomosis of small vessels. Microvascular surgery is used to reattach severed fingers, hands, arms, and another amputated. Eicma is defined as extraintracranial microvascular anastomosis very rarely. Dec 01, 2016 microvascular anastomosis coupler device anastomose microchirurgicale avec le coupler duration. The principles of vascular repair with sutures were established in the first decade of the 20th century by alexis carrel, who in 1912 was awarded the nobel prize for medicine for his work. The resident has practiced the art of sewing vascular anastomosis using the graft and suture material provided to them. Index terms microvascular anastomosis, visual and haptic interface. All anastomosis are rechecked prior toall anastomosis are rechecked prior to the final skin closurethe final skin closure dr sumer yadav mch plastic and reconstructive surgery.
Fibrin glue application in microvascular anastomosis. Skills lab vascular surgery one east carolina university. The microvascular anastomosis ma technique remains an important aspect of modern neurosurgical practice. In this method, an infant feeding tube size 4, with its tip sandwiched between layers. Preparation of wound bed 420cm2, placement of integra 420cm2 revision of microvascular anastomosis vein placement of wound vacuum 50cm2 anesthesia. The caliber of the inferior superficial epigastric arteries ranged from 1. Microsurgery anastomosis is a technique required for free flap transfers, transplant surgery and other surgical applications. Rbcp practical training model for microvascular anastomosis. Microvascular anastomosis coupler device surgery video.
Review of facilitated approaches to vascular anastomosis surgery. Surgery on very small blood vessels such as those only 3 to 5 millimeters in diameter. Improving microvascular anastomosis efficiency by combining. Keywords used were sutureless microvascular anastomosis, vascular. The tools necessary to perform the microvascular anastomosis are few in number but highly specialized in nature fig. Microsim is a training simulator for microsurgical tasks. Current procedural terminology free fascial flap with. Hand held doppler shows intact anterior and posterior vessels, sole. A simple and effective way of maintaining the microvascular. At the time of microvascular anastomosis, however, the fdma was found to still be damaged, and it required additional debridement.
The system was adequate in resolution and magnification. Table 2 is a summary of the recipient arteries used based on our algorithm. For practice purposes, multipack sutures are available. Novel microvascular anastomosis between a single vessel and. Most microvascular anastomosis techniques should be completed with either 90 or 100 monofilament nylon suture. Microsurgery is expanding the surgical treatment options for cancer, trauma, and aesthetic plastic surgery, and it is therefore imperative that trainees be well prepared for complicated reconstructive interventions. Pdf on jan 1, 2019, vlad ilie and others published sutureless microvascular anastomosis. Cerebrovascular diseases are among the most widespread diseases in the world, which largely determine the structure of morbidity and mortality rates. Infrared motion tracking camera has been use for objective measurement of the instrument movements in experienced and novice surgeons during microanastomosis training. It appears to combine the speed and even tension of a continuous suture line with improved visualization of the arteries. The selection of recipient vessels that are suitable for microvascular anastomosis in the head and neck region is one of.
Chan departments of orthopaedics and pathology, university of hong kong and the orthopaedics, zhong shan medical college, guangzhou, peoples republic of china. Practical training model for microvascular anastomosis techniques, using the appropriate microsurgical instruments and materials figures 3 and 4. Analgorithmforrecipientvesselselectionin microsurgical head. Diameters, duration of microvascular anastomosis dma and patency rates were reported.
The process of pure manual maneuver also has its disadvantages, which. Microvascular anastomosis by the aid of video endoscopic. Analgorithmforrecipientvesselselectionin microsurgical. This will ensure that they are in good shape and reliable when they are needed. Sutureless microvascular anastomosis assisted by an. Microvascular anastomosis training model based on a turkey. One versus two venous anastomoses in microvascular free. Venous anastomosis, however, is more time consuming because the vessel walls are thin and extensible. Microvascular anastomosis training in neurosurgery. Microvascular surgery is done through an operatingroom microscope using specialized instruments and tiny needles with ultrafine sutures. In our future research directions, we will combine this technique with a conventional surgical. It is a composite flap and comprises muscle, overlying fascia and skin. An endtoend microvascular anastomosis was performed in sd rats by. The sudden change of caliber may cause turbulence to the blood flow and predisposes to platelet aggregation.
Nov 04, 20 a 30 year old male, road traffic accident, compound fracture both bone leg with soft tissue loss and circumferential avulsion. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves typically 1 mm in diameter which have allowed transfer of tissue from one part of the body to another and reattachment of severed parts. Oct 15, 2014 the principles of vascular repair with sutures were established in the first decade of the 20th century by alexis carrel, who in 1912 was awarded the nobel prize for medicine for his work. Upon completion of arterial and venous anastomoses. Proximal and distal fixation stitches are placed using doublearm suture at the extremes of the enterotomy. Microvascular anastomosis definition of microvascular. Anastomosis is a common method for gene exchange in fungi, and the anastomosis abilities of r. Learning to perform microvascular anastomosis europe pmc. Gene deune, md, ronald silverman, md, and anthony p. Microvascular anastomosis guidance and evaluation using realtime. Microvascular anastomosis techniques are important for revascularization surgeries on brachiocephalic and carotid arteries and complex cerebral aneurysms and even during resection of brain tumors that obstruct major cerebral arteries. Vascular and microvascular anastomoses are critical components of reconstructive.
The microcirculation is the circulation of the blood in the smallest blood vessels, the microvessels of the microvasculature present within organ tissues. Recipient vessel analysis for microvascular reconstruction of. Where vascular channels unite, they form interconnections called. Principles of vascular anastomosis linkedin slideshare. Size discrepancy in vessels during microvascular anastomosis.
Table 2 microvascular anastomosis training in neurosurgery. Practical training model for microvascular anastomosis. Microvascular anastomosis coupler device anastomose microchirurgicale avec le coupler duration. Pdf on jan 1, 2018, ahmet hamdi sakarya and others published improving microvascular anastomosis efficiency by combining openloop and airborne suture techniques find, read and cite all the. Microsurgery is a general term for surgery requiring an operating microscope. Microvascular anastomotic coupler system was used for 8 out of 9 performed venous anastomoses with a size ranging from 1.
348 1236 1538 903 608 1148 917 1260 443 45 1030 563 851 1504 743 5 261 1217 1102 858 279 1062 857 751 939 187 287 578 774 1170 1007 917 290 1300 107 251 727 668 894