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Microvascular anastomosis

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https://www.readbyqxmd.com/read/29452442/simplifying-arterial-coupling-in-microsurgery-a-preclinical-assessment-of-an-everter-device-to-aid-with-arterial-anastomosis
#1
Ian C Sando, Jeffrey S Plott, Brendan M McCracken, Mohamad H Tiba, Kevin R Ward, Jeffrey H Kozlow, Paul S Cederna, Adeyiza O Momoh
BACKGROUND: A novel arterial everter device was engineered to simplify microvascular coupling of arteries by reliably securing the stiff, muscular wall of arteries over coupler pins. We compare microvascular coupling with the everter device to manual suturing for arterial anastomoses in a live large animal model. METHODS: In this preliminary study, bilateral external femoral arteries of five male swine were exposed and sharply divided. Arteries were anastomosed using either interrupted sutures ( n = 5) or the everter device and Synovis Coupler ( n = 5)...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29432617/outcomes-following-coronary-artery-bypass-grafting-with-microsurgery-in-paediatric-patients
#2
Mark S Shafarenko, Joseph Catapano, Shuhua Luo, Ronald M Zuker, Glen Van Arsdell, Gregory H Borschel
OBJECTIVES: Paediatric coronary artery bypass grafting is indicated in cases of clinically significant and symptomatic coronary stenosis, with frequent complications occurring in the perioperative period. To reduce complications and improve outcomes of these procedures, surgical microscopes have been used at our centre with the anastomosis performed by a microvascular surgeon. The purpose of this article is to report our institutional experience in all patients who have undergone paediatric coronary artery bypass grafting procedures with and without microvascular techniques...
February 8, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29328540/case-of-late-onset-relapsing-surgical-site-infection-related-to-a-venous-coupler-placed-during-free-flap-reconstruction-for-major-head-and-neck-cancer
#3
Yin Ren, Daniel G Deschler, Dipti Sajed, Marlene L Durand
BACKGROUND: Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. METHODS: We conducted a case report. RESULTS: A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy...
January 12, 2018: Head & Neck
https://www.readbyqxmd.com/read/29322547/improvement-of-the-salvage-rate-of-flap-after-venous-thrombosis-with-intraparenchymatous-venous-pressure-monitoring
#4
Hajime Matsumine, Mariko Mogami, Osamu Fujiwara, Masahiro Hasegawa, Hiroshi Ito, Hiroyuki Sakurai
PURPOSE: Intraparenchymatous venous pressure (IVP) monitoring in flap can measure venous pressure with catheter placement. Among patients with IVP monitoring, this study reviewed postoperative microvascular complications for investigating the transplanted-tissue salvage-rate. PATIENTS AND METHODS: Two hundred and seventy-one patients (male, 132; female, 139; mean age, 52.3 years; age range, 9-82 years) underwent free flap transfer and postoperative continuous IVP monitoring, which performed as follows; a venous catheter was connected to a transducer, and venous pressure in the flap was recorded for three consecutive days postoperatively...
January 11, 2018: Microsurgery
https://www.readbyqxmd.com/read/29309665/running-to-interrupted-microsuture-technique-for-vascular-bypass
#5
Robert C Rennert, Ben A Strickland, Ryan E Radwanski, Kristine Ravina, Mark Chien, Jonathan J Russin
BACKGROUND: The ideal suturing technique for microvascular anastomosis for neurosurgical bypass procedures remains a point of debate. Simple interrupted sutures are thought to possess higher long-term patency but require more time to place as compared to running sutures. OBJECTIVE: To optimize the efficiency of microvascular anastomosis and limit brain ischemia time. METHODS: The running-to-interrupted microsuture technique, a modification of the previously published spiral anastomosis, is described wherein loosely thrown running sutures are placed between 2 opposed anchor stitches...
December 21, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29299526/chicken-thigh-microvascular-training-model-improves-resident-surgical-skills
#6
Francis X Creighton, Allen L Feng, Neerav Goyal, Kevin Emerick, Daniel Deschler
Objectives: Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high-fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design: Validation study. Methods: Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model...
December 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29284163/geometric-three-dimensional-end-to-side-microvascular-anastomosis-a-simple-and-reproducible-technique
#7
Adrian S H Ooi, Daniel R Butz, Sean M Fisher, Zachary J Collier, Lawrence J Gottlieb
BACKGROUND:  End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. METHODS:  The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a "spatula" fitting this defect...
December 28, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29243415/compact-dual-mode-diffuse-optical-system-for-blood-perfusion-monitoring-in-a-porcine-model-of-microvascular-tissue-flaps
#8
Seung Yup Lee, Julia M Pakela, Michael C Helton, Karthik Vishwanath, Yooree G Chung, Noah J Kolodziejski, Christopher J Stapels, Daniel R McAdams, Daniel E Fernandez, James F Christian, Jameson O'Reilly, Dana Farkas, Brent B Ward, Stephen E Feinberg, Mary-Ann Mycek
In reconstructive surgery, the ability to detect blood flow interruptions to grafted tissue represents a critical step in preventing postsurgical complications. We have developed and pilot tested a compact, fiber-based device that combines two complimentary modalities-diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy-to quantitatively monitor blood perfusion. We present a proof-of-concept study on an in vivo porcine model (n=8). With a controllable arterial blood flow supply, occlusion studies (n=4) were performed on surgically isolated free flaps while the device simultaneously monitored blood flow through the supplying artery as well as flap perfusion from three orientations: the distal side of the flap and two transdermal channels...
December 2017: Journal of Biomedical Optics
https://www.readbyqxmd.com/read/29187756/pilot-study-on-microvascular-anastomosis-performance-and-future-educational-prospects
#9
G Berretti, G Colletti, G Parrinello, A Iavarone, P Vannucchi, A Deganello
The introduction of microvascular free flaps has revolutionised modern reconstructive surgery. Unfortunately, access to training opportunities at standardised training courses is limited and expensive. We designed a pilot study on microvascular anastomoses with the aim of verifying if a short course, easily reproducible, could transmit microvascular skills to participants; if the chosen pre-test was predictive of final performance; and if age could influence the outcome. A total of 30 participants (10 students, 10 residents and 10 surgeons) without any previous microvascular experience were instructed and tested during a single 3 to 5 hour course...
November 30, 2017: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/29127507/influence-of-coupler-size-on-revision-rate-and-timing-of-revision-after-free-flap-tissue-transfer-in-the-head-and-neck
#10
Ulrich Kisser, Christine Adderson-Kisser, Philipp Baumeister, Maximilian Reiter
OBJECTIVE: Microvascular coupler devices have been proven an effective alternative to standard hand-sutured anastomoses in reconstructive surgery. Until now, the influence of the coupler size on the revision rate after free flap tissue transfer in head and neck surgery has not been investigated. Neither has its influence on the timing of venous revisions. MATERIALS AND METHODS: A retrospective mono-center cohort study was performed in order to analyze the influence of coupler size on timing and revision rate of microvascular procedures...
November 10, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29107094/hyperspectral-imaging-for-monitoring-of-perfusion-failure-upon-microvascular-anastomosis-in-the-rat-hind-limb
#11
Eberhard Grambow, Michael Dau, Amadeus Holmer, Vicky Lipp, Bernhard Frerich, Ernst Klar, Brigitte Vollmar, Peer Wolfgang Kämmerer
BACKGROUND/PURPOSE: Objective, reliable and easy monitoring of microvascular tissue perfusion is a goal that was achieved for many years with limited success. Therefore, a new non-invasive hyperspectral camera system (TIVITA™) was tested for this purpose in an in vivo animal model. METHODS: Evaluation of tissue oxygenation during ischemia and upon reperfusion was performed in left hind limb in a rat model (n=20). Ischemia was induced by clamping and dissection of the superficial femoral artery...
October 31, 2017: Microvascular Research
https://www.readbyqxmd.com/read/29069877/is-robot-assisted-surgery-really-scarless-surgery-immediate-reconstruction-with-a-jejunal-free-flap-for-esophageal-rupture-after-robot-assisted-thyroidectomy
#12
Seong Hoon Park, Joo Hyun Kim, Jun Won Lee, Hii Sun Jeong, Dong Jin Lee, Byung Chun Kim, In Suck Suh
Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury...
November 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/29062670/comment-box-modification-to-muscle-sparing-latissimus-dorsi-design-for-microvascular-anastomosis-coverage
#13
Kenneth L Fan, Michael V DeFazio, Francis D Graziano, Jocelyn Lu, David H Song
No abstract text is available yet for this article.
September 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29059111/pedicled-rotational-medial-and-lateral-gastrocnemius-flaps-surgical-technique
#14
REVIEW
Zeke Walton, Milton Armstrong, Sophia Traven, Lee Leddy
Gastrocnemius flaps have been used for decades to reconstruct defects of the proximal tibia and knee. They have proven to be useful in the soft-tissue reconstruction of defects caused by trauma, tumors, and infections about the knee, and the reconstruction of extensor mechanism discontinuity with and without total joint arthroplasty. The flaps have low failure rates and a distinct proximally based blood supply that allows them to be elevated and rotated up to 15 cm above the level of the knee joint. The vascular anatomy is reproducible because rotational flaps do not require microvascular anastomosis...
November 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29037204/thoracodorsal-artery-perforator-flap-as-an-autologous-alternative-to-acellular-dermal-matrix
#15
Tarek Hashem, Ahmed Farahat
BACKGROUND: Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. METHODS: This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015...
October 16, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29030029/improving-free-flap-survival-using-intra-operative-heparin-ritualistic-practice-or-evidence-base-medicine-a-systematic-review
#16
C Couteau, K Rem, D Guillier, V Moris, M Revol, S Cristofari
INTRODUCTION: The failure rate of free flaps is approximately 5%, mostly due to thrombosis of microvascular anastomosis. A number of pharmacological agents have been tested in order to enhance the patency of microvascular anastomosis and so to as extend the survival of free flaps. One of them is heparin, a very commonly used anticoagulant. However, there exists no consensus on its use in microsurgery as concerns time of introduction (pre-, intra- or post-operative), recommended dosage, or duration of utilization...
October 10, 2017: Annales de Chirurgie Plastique et Esthétique
https://www.readbyqxmd.com/read/29019586/continuous-versus-interrupted-suture-technique-in-microvascular-anastomosis-in-rats
#17
Rui Sergio Monteiro de Barros, Rafael Aquino Leal, Renan Kleber Costa Teixeira, Vitor Nagai Yamaki, Daniel Haber Feijó, Eduardo Henrique Herbster Gouveia, André Lopes Valente, Denilson José Silva, Luan Teles Ferreira de Carvalho
PURPOSE: To compare the continuous and interrupted suture technique on femoral artery on rats after vessel repair and 14 days after. METHODS: Twenty rats were operated randomly divided into two group matched according to the suture technique used: interrupted or continuous. We performed a femoral anastomosis on the right femoral artery. We analyzed weight, arterial caliber, anastomosis time and patency after vessel repair and 14 days after. RESULTS: There was no significant difference between groups in the weight (p=0...
September 2017: Acta Cirúrgica Brasileira
https://www.readbyqxmd.com/read/28963799/-airborne-suture-tying-technique-simple-steps-to-make-it-easy
#18
Mouchammed Agko, Pedro Ciudad, Hung-Chi Chen
A multitude of microsurgical suture techniques have been described. Although accurate apposition and eversion of the vessel ends is paramount for the patency of anastomosis, rapidity is usually of secondary importance. However, in situations in which either multiple anastomoses are required or timely revascularization is crucial, speed becomes a determinant factor for eventual success. "Airborne" suture tying is aimed at decreasing operative time by streamlining the microvascular anastomosis. Over the years, several considerations have emerged as key points for achieving mastery of this helpful maneuver...
December 2017: Head & Neck
https://www.readbyqxmd.com/read/28910897/-the-application-of-microvascular-anastomotic-coupler-in-vascular-anastomosis-of-free-tissue-flap-for-reconstruction-of-defect-after-head-and-neck-cancer-resection
#19
Y J Zhang, Z H Wang, C H Li, J Chen
Objective: To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection. Methods: From August 2015 to July 2016, in Department of Head and Neck Surgery, Sichuan Cancer Hosipital, 17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps, including forearm flaps in 11 casess, anterolateral flaps in 4 casess and fibula flaps in 2 casess. Totally 17 MAC were used, including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis...
September 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/28894667/dual-vascular-free-anterolateral-thigh-flap
#20
Toshiaki Numajiri, Daiki Morita, Shoko Tsujiko, Hiroko Nakamura, Yoshihiro Sowa, Akihito Arai, Matsui Masahiro, Hiroshi Nakano, Shigeru Hirano
BACKGROUND: The optimum number of microvascular anastomoses for safe free tissue transfer is controversial. Although the case for 2 venous anastomoses versus 1 anastomosis has been argued, the use of an additional arterial anastomosis has not been examined in detail. METHODS: Twelve patients who underwent 2 arterial anastomoses for a free flap transfer were identified retrospectively from the medical records of patients undergoing reconstruction for head and neck cancer...
August 2017: Plastic and Reconstructive Surgery. Global Open
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