A New Microvascular Anastomosis Technique Using Muscle Graft

Abstract

A novel microvascular anastomosis technique is described. Forty-five male Sprague-Dawley rats were divided equally into three groups before undergoing femoral artery anastomosis. The first group received standard eight-suture anastomotic repair. Group 2 (muscle group) received three sutures plus autogenous muscle graft wrapped around the anastomosis. In group 3 (fascial surface group), a muscle graft was wrapped around the anastomosis with the fascial side of the graft facing the anastomosis. Significantly less time and suture usage were noted using both fascial surface and muscle groups compared with controls (p < 0.05). No significant difference regarding patency rates or aneurysm formation existed among the three groups (p > 0.05). Additionally, grade 2 anastomotic leakage was less frequent in the study groups compared with the control group (p < 0.05). This new microvascular anastomosis technique took less time and achieved better performance than standard anastomotic repair.

Keywords

microvascular anastomosis - muscle graft - three-suture technique

• References

• 1 Jacobson JH, Suarez EL. Microsurgery in anastomosis of small vessels. Surg Forum 1960; 11: 243-251
• 2 Tetik C, Unal MB, Kocaoglu B, Erol B. Use of continuous horizontal mattress suture techniques in microsurgery: an experimental study in rats. J Hand Surg Am 2005; 30: 587-595
• 3 Acland RD. Microsurgery practice manual. St. Louis: Mosby; 1980
• 4 Suarez EL, Jacobson II JH. Results of small artery endarterectomy-microsurgical technique. Surg Forum 1961; 12: 256-257
• 5 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg 1994; 33: 28-31
• 6 Ong YS, Yap K, Ang ES, Tan KC, Ng RT, Song IC. 2-Octylcynanoacrylate-assisted microvascular anastomosis in a rat model: long-term biomechanical properties and histological changes. Microsurgery 2004; 24: 304-308
• 7 Turan T, Ozçelik D, Kuran I , et al. Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis. Plast Reconstr Surg 2001; 107: 463-470
• 8 Benlier E, Top H, Aygit AC, Usta U, Unal Y. Microvascular anastomosis with minimal suture and Arista: an experimental study. J Reconstr Microsurg 2007; 23: 311-315
• 9 Suominen S, Asko-Seljavaara S. Free flap failures. Microsurgery 1995; 16: 396-399
• 10 Acland RD, Trachtenberg L. The histopathology of small arteries following experimental microvascular anastomosis. Plast Reconstr Surg 1977; 60: 868-875
• 11 Lidman D, Daniel RK. The normal healing process of microvascular anastomoses. Scand J Plast Reconstr Surg 1981; 15: 103-110
• 12 Servant JM, Ikuta Y, Harada Y. A scanning electron microscope study of microvascular anastomoses. Plast Reconstr Surg 1976; 57: 329-24
• 13 Siemionow M. Histopathology of microarterial anastomoses: end-to-end versus end-in-end (sleeve) technique. J Hand Surg Am 1990; 15: 619-625
• 14 Sasaki A, Harii K. Everting method: a new modification to obtain reliable microvascular anastomosis. Surgery 1981; 89: 558-564
• 15 Lauritzen C, Bagge U. A technical and biomechanical comparison between two types of microvascular anastomoses. An experimental study in rats. Scand J Plast Reconstr Surg 1979; 13: 417-421
• 16 Harris GD, Finseth F, Buncke HJ. The microvascular anastomotic autogenous cuff. Br J Plast Surg 1981; 34: 50-52
• 17 Nakayama Y, Soeda S, Kiyosawa T. Vessel anastomosis using a venous cuff and two sutures: an experimental study in rat femoral and epigastric vessels. J Reconstr Microsurg 1988; 4: 335-339
• 18 Hung LK, Au KK, Ho YF. Comparative study of artery cuff and fat wrap in microvascular anastomosis in the rat. Br J Plast Surg 1988; 41: 278-283
• 19 Kirsch WM, Zhu YH, Hardesty RA, Chapolini R. A new method for microvascular anastomosis: report of experimental and clinical research. Am Surg 1992; 58: 722-727
• 20 Zhu YHKW, Cushman R, Becker K, McCabe W, Kornfeld M. Comparison of suture and clip for microvascular anastomoses. Surg Forum 1985; 36: 492-495
• 21 Baguneid MS, Goldner S, Fulford PE, Hamilton G, Walker MG, Seifalian AM. A comparison of para-anastomotic compliance profiles after vascular anastomosis: nonpenetrating clips versus standard sutures. J Vasc Surg 2001; 33: 812-820
• 22 Holt GP, Lewis FJ. A new technique for end-to-end anastomosis of small arteries. Surg Forum 1960; 11: 242-243
• 23 Ostrup LT, Berggren A. The UNILINK instrument system for fast and safe microvascular anastomosis. Ann Plast Surg 1986; 17: 521-525
• 24 Berggren A, Ostrup LT, Lidman D. Mechanical anastomosis of small arteries and veins with the unilink apparatus: a histologic and scanning electron microscopic study. Plast Reconstr Surg 1987; 80: 274-283
• 25 Daniel RK, Lidman D, Olding M, Williams JA, Matlaga BF. An anastomotic device for microvascular surgery: evolution. Ann Plast Surg 1984; 13: 402-411
• 26 Qu W, Muneshige H, Ikuta Y. An absorbable pinned-ring device for microvascular anastomosis of vein grafts: experimental studies. Microsurgery 1999; 19: 128-134
• 27 Karamürsel S, Kayikçioğlu A, Safak T, Keçik A, Sürücü S. A new technique for microvascular anastomosis: external metallic circle. Plast Reconstr Surg 1999; 104: 1059-1065
• 28 Abbe R. The surgery of the hand. NY Med J 1894; 59: 33-40
• 29 Moskovitz MJ, Bass L, Zhang L, Siebert JW. Microvascular anastomoses utilizing new intravascular stents. Ann Plast Surg 1994; 32: 612-618
• 30 Solem JO, Boumzebra D, Al-Buraiki J, Nakeeb S, Rafeh W, Al-Halees Z. Evaluation of a new device for quick sutureless coronary artery anastomosis in surviving sheep. Eur J Cardiothorac Surg 2000; 17: 312-318
• 31 Matras HCF, Kletter G, Dinges HP. Zur klebung kleinster gefabe tierversuch. Dtsch Z Mund Kiefer Gesichtschir 1977; 1: 19-23
• 32 Pearl RM, Wustrack KO, Harbury C, Rubenstein E, Kaplan EN. Microvascular anastomosis using a blood product sealant-adhesive. Surg Gynecol Obstet 1977; 144: 227-231
• 33 Han SK, Kim SW, Kim WK. Microvascular anastomosis with minimal suture and fibrin glue: experimental and clinical study. Microsurgery 1998; 18: 306-311
• 34 Green AR, Milling MA, Green AR. Butylcyanoacrylate adhesives in microvascular surgery: an experimental pilot study. J Reconstr Microsurg 1986; 2: 103-105
• 35 Ang ES, Tan KC, Tan LH, Ng RT, Song IC. 2-octylcyanoacrylate-assisted microvascular anastomosis: comparison with a conventional suture technique in rat femoral arteries. J Reconstr Microsurg 2001; 17: 193-201
• 36 Jain KK, Gorisch W. Repair of small blood vessels with the neodymium-YAG laser: a preliminary report. Surgery 1979; 85: 684-688
• 37 Quigley MR, Bailes JE, Kwaan HC, Cerullo LJ, Brown JT. Aneurysm formation after low power carbon dioxide laser-assisted vascular anastomosis. Neurosurgery 1986; 18: 292-299
• 38 Martinot VL, Mordon SR, Mitchell VA, Pellerin PN, Brunetaud JM. Determination of efficient parameters for argon laser-assisted anastomoses in rats: macroscopic, thermal, and histological evaluation. Lasers Surg Med 1994; 15: 168-175
• 39 Tulleken CA, Verdaasdonk RM, Mansvelt Beck HJ. Nonocclusive excimer laser-assisted end-to-side anastomosis. Ann Thorac Surg 1997; 63: S138-S142
• 40 Leclère FM, Schoofs M, Buys B, Mordon SR. Outcomes after 1.9-microm diode laser-assisted anastomosis in reconstructive microsurgery: results in 27 patients. Plast Reconstr Surg 2010; 125: 1167-1175
• 41 Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R. Non-suture methods of vascular anastomosis. Br J Surg 2003; 90: 261-271
• 42 de Bruijn HP, Marck KW. Coupling the venous anastomosis: safe and simple. Microsurgery 1996; 17: 414-416
• 43 Ahn CY, Shaw WW, Berns S, Markowitz BL. Clinical experience with the 3M microvascular coupling anastomotic device in 100 free-tissue transfers. Plast Reconstr Surg 1994; 93: 1481-1484
• 44 DeLacure MD, Kuriakose MA, Spies AL. Clinical experience in end-to-side venous anastomoses with a microvascular anastomotic coupling device in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1999; 125: 869-872
• 45 Sullivan SK, Dellacroce F, Allen R. Management of significant venous discrepancy with microvascular venous coupler. J Reconstr Microsurg 2003; 19: 377-380
• 46 Spector JA, Draper LB, Levine JP, Ahn CY. Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction. Ann Plast Surg 2006; 56: 365-368
• 47 Dascombe WH, Dumanian G, Hong C , et al. Application of thrombin based fibrin glue and non-thrombin based batroxobin glue on intact human blood vessels: evidence for transmural thrombin activity. Thromb Haemost 1997; 78: 947-951
• 48 Marek CA, Amiss Jr LR, Morgan RF, Spotnitz WD, Drake DB. Acute thrombogenic effects of fibrin sealant on microvascular anastomoses in a rat model. Ann Plast Surg 1998; 41: 415-419