Alex V Orădan1,2, George C Dindelegan2,3, Ramona C Vinaşi2,4, Maximilian V Muntean5, Maximilian G Dindelegan2,6, Liviu Chiriac7, Victor Volovici8,9. 1. Department of Plastic Surgery, Clinical Rehabilitation Hospital, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 2. Center for Surgical Simulation and Training, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 3. First Surgical Clinic, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 4. Department of Neuroscience, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 5. Department of Plastic Surgery, "Prof. Dr. I. Chiricuta" Institute of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 6. Department of Otorhinolaryngology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. 7. National Magnetic Resonance Center, Faculty of Physics, Babeş-Bolyai University, Cluj Napoca, Romania. 8. Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 9. Center for Medical Decision Making, Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Abstract
Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats' femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
Authors: Christopher R Davis; C Travis Rappleye; Peter A Than; Melanie Rodrigues; Michael W Findlay; Sarah N Bishop; Arnetha J Whitmore; Zeshaan N Maan; Rory B McGoldrick; Adriaan O Grobbelaar; Geoffrey C Gurtner Journal: Plast Reconstr Surg Date: 2016-02 Impact factor: 4.730