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Microvascular anastomosis
British Journal of Oral and Maxillofacial Surgery (2002) 40, 510–511 © 2002 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/S0266-4356(02)00237-1, available online at http://www.idealibrary.com on
SHORT COMMUNICATION Microvascular anastomosis V. Ilankovan, ∗ L. C. Hsing, † A. Webb ‡ ∗ Consultant
Oral and Maxillofacial Surgeon; †Research Fellow; ‡Specialist Registrar, Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset, UK
INTRODUCTION The conventional technique for microvascular anastomosis is to place two stay sutures and then complete one wall followed by the other, each knot being completed before progressing to the next.1 We report a simpler and faster technique of microvascular anastomosis.
TECHNIQUE After preparing the vessels in the normal way, microclamps are applied and the vessels approximated. Stay sutures are placed and attached to the cleats of a double clamp. Dilator forceps are used to support the wall and sutures are placed starting from one end of the stay suture. Each suture is cut, leaving an adequate length to form a knot, but the knot is not tied at this time (Fig. 1). The sutures are placed at equal distances, usually 3–4 to a 1 mm diameter vessel (Fig. 2). Once the sutures are in place they are knotted one by one and the ends are trimmed, which gives a clear view of the back wall at all times internally (Fig. 3). The clamp is turned over to expose the back wall and the patency is
Fig. 2 Sutures all in place in one wall.
checked by irrigation with heparinised saline. The same technique is used to complete the anastomosis (Fig. 4). We have used this method for 44 consecutive anastomoses without encountering a failure.
Fig. 3 Sutures in posterior wall.
Fig. 1 Stay sutures and first three sutures in place. 510
Microvascular anastomosis
511
equidistant sutures and this ensures a similar tension force on the knots; and it is easier to make certain that the posterior wall is not included in the anastomosis. We have found it easier to anastomose vessels of dissimilar dimensions by this technique. REFERENCE 1. Riediger D, Ehrenfeld M. Microsurgical Tissue Transplantation. Chicago: Quintessence, 1989: 243.
The Authors
Fig. 4 The posterior wall completed.
DISCUSSION The benefits of this technique, as opposed to the conventional method, are that it reduces the anastomosis time and, therefore, minimises tissue trauma; it is easier to place
V. Ilankovan FDSRCS, FRCS Consultant Oral and Maxillofacial Surgeon L. C. Hsing MD Research Fellow A. Webb FDSRCS, FRCS Specialist Registrar Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset, UK Correspondence and requests for offprints to: Mr V. Ilankovan, Consultant Oral and Maxillofacial Surgeon, Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK. Tel: +44 (0) 1202 442576; Fax: +44 (0) 1202 448410 Accepted 3 September 2002
SHORT COMMUNICATION Microvascular anastomosis V. Ilankovan, ∗ L. C. Hsing, † A. Webb ‡ ∗ Consultant
Oral and Maxillofacial Surgeon; †Research Fellow; ‡Specialist Registrar, Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset, UK
INTRODUCTION The conventional technique for microvascular anastomosis is to place two stay sutures and then complete one wall followed by the other, each knot being completed before progressing to the next.1 We report a simpler and faster technique of microvascular anastomosis.
TECHNIQUE After preparing the vessels in the normal way, microclamps are applied and the vessels approximated. Stay sutures are placed and attached to the cleats of a double clamp. Dilator forceps are used to support the wall and sutures are placed starting from one end of the stay suture. Each suture is cut, leaving an adequate length to form a knot, but the knot is not tied at this time (Fig. 1). The sutures are placed at equal distances, usually 3–4 to a 1 mm diameter vessel (Fig. 2). Once the sutures are in place they are knotted one by one and the ends are trimmed, which gives a clear view of the back wall at all times internally (Fig. 3). The clamp is turned over to expose the back wall and the patency is
Fig. 2 Sutures all in place in one wall.
checked by irrigation with heparinised saline. The same technique is used to complete the anastomosis (Fig. 4). We have used this method for 44 consecutive anastomoses without encountering a failure.
Fig. 3 Sutures in posterior wall.
Fig. 1 Stay sutures and first three sutures in place. 510
Microvascular anastomosis
511
equidistant sutures and this ensures a similar tension force on the knots; and it is easier to make certain that the posterior wall is not included in the anastomosis. We have found it easier to anastomose vessels of dissimilar dimensions by this technique. REFERENCE 1. Riediger D, Ehrenfeld M. Microsurgical Tissue Transplantation. Chicago: Quintessence, 1989: 243.
The Authors
Fig. 4 The posterior wall completed.
DISCUSSION The benefits of this technique, as opposed to the conventional method, are that it reduces the anastomosis time and, therefore, minimises tissue trauma; it is easier to place
V. Ilankovan FDSRCS, FRCS Consultant Oral and Maxillofacial Surgeon L. C. Hsing MD Research Fellow A. Webb FDSRCS, FRCS Specialist Registrar Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset, UK Correspondence and requests for offprints to: Mr V. Ilankovan, Consultant Oral and Maxillofacial Surgeon, Maxillofacial Unit, Poole Hospitals NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK. Tel: +44 (0) 1202 442576; Fax: +44 (0) 1202 448410 Accepted 3 September 2002