Abstract
Background For surgeons learning microsurgery, uneven spacing between sutures while performing
microvascular arterial anastomoses is one of the most common technical errors made
that can lead to leakage. Based on the previous surgical experience and training of
these surgeons, the first option chosen to prevent bleeding is to place a vascular
clamp proximal to the anastomosis and an additional suture at the site of the leak.
Because this technique may have technical and thrombosis concerns, our study proposes
an alternative technique of performing post-anastomotic revisions without the use
of clamps.
Methods Our technique involves placing a cotton-tipped applicator under the artery and lifting
it to partially occlude flow within the vessel as an additional suture is placed at
the leakage site to complete the revision. One-hundred eighty-four microvascular anastomoses
were performed on the femoral arteries of 92 Sprague-Dawley rats, and of the 184 anastomoses,
147 had a leak and required a post-anastomotic revision. All revisions were completed
using our technique, and no clamps were used during any of the revisions.
Results Of the 147 post-anastomotic revisions completed using our technique, 141 (95.9%)
were patent 2 hours post-revision. The mean operating time for the revisions was 5:03
minutes (range, 1:44–6:30 minutes).
Conclusion Our technique of partially occluding an artery with a cotton-tipped applicator while
performing a post-anastomotic revision is a safe and effective alternative to using
vascular clamps. Our technique may also reduce technical errors and have a low risk
of causing thrombosis when completing post-anastomotic revisions.
Keywords
microsurgery - anastomosis - leak - clamp - partial occlusion
