© Thieme Medical Publishers
Use of Microsurgical Background as an Anastomotic Frame
21 January 2011 (online)
The Acland clamp with its square frame of steel wire is a useful instrument for applying stay sutures on its cleats. This places the vessel edges under tension during microsurgical suturing and keeps the lumen open, which minimizes catching the back wall and allows more even placement of sutures. However, it is bulky, rigid, and difficult to use in small spaces.
We describe an innovative utilization of the standard microsurgical background to simultaneously serve as a malleable frame to keep the vessels under tension and even out suturing.
On each edge of the background, two 3-mm straight cuts are made ∼5 mm apart, creating symmetrical flaps on the opposing sides of the background. One cut on each side is further extended obliquely by 2 mm. This is essential to grip the stay suture as it is wound around the background flap (Fig. [1A] shows the cuts made in the background).
Figure 1 (A) Placement of cuts on the background. (B) Application of stay sutures to the side flaps on the background.
With the background in place, the vessel ends are either brought together in double clamps or positioned together. The first stay suture is tied with one of its ends left long. This is wound around the created background flap twice and gently pulled to fasten it. The second suture is placed one-half of the circumference away from the first, and the long end is fastened to the other background flap with sufficient tension to open the lumen (Fig. [1B] shows the vessel fastened to the background).
This enables the surgeon to precisely position the remaining sutures and reduce the chances of catching the back wall. Any inadvertent pull on the stay suture is cushioned by the resiliency of the elastic background, thus minimizing trauma load to the sutured segment of the vessel.
We believe this technique is easier and quicker to execute than Tajima’s trapdoor technique.
- 1 Acland R D. Microvascular anastomosis: a device for holding stay sutures and a new vascular clamp. Surgery. 1974; 75 185-187
- 2 Tajima S. Trap-door technique in the background for holding stay sutures in the microvascular anastomosis. Plast Reconstr Surg. 1980; 66 463-465
Ben Ardehali, M.D.
Royal Free Hospital, Plastic Surgery, Pond Street London
Hampstead, London NW3 2QG, UK