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J Reconstr Microsurg 2017; 33(02): 097-102
DOI: 10.1055/s-0036-1593746
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Comparison of the Minimal-Touch Technique and the Eversion Technique for Microvascular Anastomosis in a Rat Model

Collin W. Blackburn
1   Department of Orthopedic Surgery, Columbia University, New York, New York
,
Sarah R. Vossoughi
2   Department of Pathology and Cell Biology, Columbia University, New York, New York
,
Bukola Ojo
3   Department of Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio
,
Prakash Gorroochurn
4   Department of Biostatistics, Columbia University, New York, New York
,
Charles C. Marboe
2   Department of Pathology and Cell Biology, Columbia University, New York, New York
,
Yelena Akelina
1   Department of Orthopedic Surgery, Columbia University, New York, New York
,
Robert J. Strauch
1   Department of Orthopedic Surgery, Columbia University, New York, New York
› Author Affiliations
Further Information

Publication History

27 June 2016

08 August 2016

Publication Date:
21 October 2016 (online)

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Abstract

Background During microvascular anastomosis, needle placement is facilitated by inserting the tips of the forceps into the lumen of the vessel, rather than grasping and everting the luminal wall, to minimize trauma to the vessel. This study examines whether the vessel wall can be grasped and everted during microvascular anastomosis without compromising surgical outcomes.

Methods A total of 20 Sprague–Dawley rats weighing between 252 and 483 g were used. Bilateral anastomoses of the animals' femoral arteries (mean size: 0.90 mm) were performed using two different techniques: the classic minimal-touch approach and the eversion technique. The first 10 animals were survived for 48 hours and the second 10 animals were survived for 2 weeks. Patency was assessed immediately after surgery and just before sacrifice. Hematoxylin and eosin stains were performed and each anastomosis scored according to a grading rubric assessing endothelial cell loss, neointimal proliferation, medial necrosis, adventitial inflammation, and inflammation thickness.

Results The patency rates of both techniques were identical (100%). There was no difference in the patency rates of anastomoses evaluated 48 hours after surgery (100%) and 2 weeks after surgery (100%). Histological outcomes between the minimal-touch technique and the eversion method were similar. The thickness of adventitial inflammation at 2 weeks was the only outcome found to be statistically different (p = 0.046) between the two treatments and this difference favored the eversion technique (i.e., less inflammation thickness).

Conclusion The eversion method of performing microvascular anastomosis provides comparable results to the classic minimal-touch approach in rat femoral artery anastomoses.

Keywords

eversion - microvascular anastomosis - back-wall stitch
 

  • References

  • 1 Gardiner MD, Nanchahal J. Strategies to ensure success of microvascular free tissue transfer. J Plast Reconstr Aesthet Surg 2010; 63 (9) e665-e673
    CrossrefPubMedGoogle Scholar
  • 2 Khouri RK. Avoiding free flap failure. Clin Plast Surg 1992; 19 (4) 773-781
    Google Scholar
  • 3 Nahabedian MY, Momen B, Manson PN. Factors associated with anastomotic failure after microvascular reconstruction of the breast. Plast Reconstr Surg 2004; 114 (1) 74-82
    CrossrefPubMedGoogle Scholar
  • 4 Guity A, Young PH, Fischer VW. In search of the “perfect” anastomosis. Microsurgery 1990; 11 (1) 5-11
    CrossrefPubMedGoogle Scholar
  • 5 Gahankari DR, Lalwani NR, Phatak AM. Classification and comparison of five techniques of end-to-end microarterial anastomoses in rats: a new proposed technique. Microsurgery 1995; 16 (12) 793-802
    CrossrefPubMedGoogle Scholar
  • 6 Chen LE, Seaber AV, Urbaniak JR. Comparison of 10-0 polypropylene and 10-0 nylon sutures in rat arterial anastomosis. Microsurgery 1993; 14 (5) 328-333
    CrossrefPubMedGoogle Scholar
  • 7 Alghoul MS, Gordon CR, Yetman R , et al. From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses. Microsurgery 2011; 31 (1) 72-80
    CrossrefPubMedGoogle Scholar
  • 8 Lin TS, Chiang YC. Combined microvascular anastomosis: experimental and clinical experience. Ann Plast Surg 2000; 45 (3) 280-283
    CrossrefPubMedGoogle Scholar
  • 9 Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg 1994; 33 (1) 28-31
    CrossrefPubMedGoogle Scholar
  • 10 Mazer N, Henrique Barbieri C, Pinto Gonçalves R. Effect of different irrigating solutions on the endothelium of small arteries: experimental study in rats. Microsurgery 1986; 7 (1) 9-28
    CrossrefPubMedGoogle Scholar
  • 11 Jackiewicz TA, McGeachie JK, Tennant M. Structural recovery of small arteries following clamp injury: a light and electron microscopic investigation in the rat. Microsurgery 1996; 17 (12) 674-680
    CrossrefPubMedGoogle Scholar
  • 12 Petry JJ, French TS, Wortham KA. The effect of the “patency test” on arterial endothelial surface. Plast Reconstr Surg 1986; 77 (6) 960-964
    CrossrefPubMedGoogle Scholar
  • 13 Esclamado RM, Carroll WR. The pathogenesis of vascular thrombosis and its impact in microvascular surgery. Head Neck 1999; 21 (4) 355-362
    CrossrefPubMedGoogle Scholar
  • 14 Santana AC, Marinotto DB, Dellê H, Cordeiro AC, Noronha IL. Effectiveness of thalidomide and tamoxifen in preventing neointimal hyperplasia in experimental vascular injury in rats. Transplant Proc 2010; 42 (2) 585-588
    CrossrefPubMedGoogle Scholar
  • 15 Nasir S, Aydin MA, Altuntaş S, Ozgüner M. Thrombotic effect of purposeful back-wall stitch for end-to-side microarterial anastomosis in rats. J Reconstr Microsurg 2008; 24 (6) 429-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Nasir S, Aydin MA, Ozgüner M. Thrombotic effect of purposeful back-wall stitch for different suture locations and vessels in rats. Ann Plast Surg 2005; 55 (5) 508-511
    CrossrefPubMedGoogle Scholar
  • 17 Cooley BC. A Laboratory Manual for Microvascular and Microtubal Surgery. 2nd ed. Reading, PA: Surgical Specialties Corporation; 2009
    Google Scholar
  • 18 Schiller W, Rudorf H, Welzel CB , et al. Sutureless anastomoses of rabbit carotid arteries with BioGlue. J Thorac Cardiovasc Surg 2007; 134 (6) 1513-1518
    CrossrefPubMedGoogle Scholar
  • 19 Zilla P, Weissenstein C, Human P, Dower T, von Oppell UO. High glutaraldehyde concentrations mitigate bioprosthetic root calcification in the sheep model. Ann Thorac Surg 2000; 70 (6) 2091-2095
    CrossrefPubMedGoogle Scholar
  • 20 Yazici I, Cavusoglu T, Comert A, Vural AC. Use of triangulation method in end-to-side arterial microvascular anastomosis. J Craniofac Surg 2009; 20 (6) 2225
    CrossrefPubMedGoogle Scholar