Anastomosis Device Research Articles

Sutureless microvascular anastomosis assisted by an expandable shape-memory alloy stent.

Vascular anastomosis is the highlight of cardiovascular, transplant, and reconstructive surgery, which has long been performed by hand using a needle and suture. However, anastomotic thrombosis occurs in approximately 0.5–10% of cases, which can cause serious complications. To improve the surgical outcomes, attempts to develop devices for vascular anastomosis have been made, but they have had limitations in handling, cost, patency rate, and strength at the anastomotic site. Recently, indwelling metal stents have been greatly improved with precise laser metalwork through programming technology. In the present study, we designed a bare metal stent, Microstent, that was constructed by laser machining of a shape-memory alloy, NiTi. An end-to-end microvascular anastomosis was performed in SD rats by placing the Microstent at the anastomotic site and gluing the junction. The operation time for the anastomosis was significantly shortened using Microstent. Thrombus formation, patency rate, and blood vessel strength in the Microstent anastomosis were superior or comparable to hand-sewn anastomosis. The results demonstrated the safety and effectiveness, as well as the operability, of the new method, suggesting its great benefit for surgeons by simplifying the technique for microvascular anastomosis.

Biomechanical characterization of a novel ring connector for sutureless aortic anastomosis.

The surgical treatment for aortic diseases remains a challenge for any cardiac surgeon. The use of sutureless ring connector in aortic anastomosis can simplify the procedure and shorten anastomosis time. Therefore, we developed a novel device for sutureless aortic anastomosis. A series of experiments were carried out for tensile and leakproof-capacity assessments to verify the feasibility of the ring connector by using fresh swine aorta samples. In in vivo test, the ring connector was implanted in 6 swine with follow-up of 6 months. Radiographic and pathological studies of the aorta were performed. In the tensile tests, the strength was 32.7±5.9 Newton (N) in the sutureless anastomosis group, compared with 73.3±12.5 N in the control group by traditional manual suture. In the leakproof-capacity assessment, no sign of either leakage or bursting was evident at 280 mmHg of internal pressure in the aorta samples. In in vivo tests, it took 9.47±0.3 minutes for the sutureless anastomosis, compared with 15.58±1.39 minutes for hand-sewn suturing. Insertion was easy and rapid. Radiographic and pathological studies were performed at first month, third month and sixth month after surgery, each time obtained from the two swine, showed patency of the anastomosis and no signs of stenosis, blood leakage, migration or pseudoaneurysm formation, except one paralyzed swine developed of thrombo-occlusion at the site of the sutureless anastomosis. The result indicates that this novel ring connector offers considerable promise for sutureless aortic anastomosis.

Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery

Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency.

Cervical esophago-gastric anastomosis using linear cutter stapler in esophageal cancer.

Anastomosis in gastrointestinal (GI) surgery is a commonly performed procedure. Irrelevant various methods of intestinal anastomosis were followed - recent advance is the use of a stapler as a device for GI anastomosis. Due to the use of staplers, technical failures are a rarity, anastomosis is more consistent and can be used at difficult locations. : Between 2008 and August 2016, 75 patients with esophagus or gastroesophageal junction carcinoma underwent curative intent resection either via a right posterolateral thoracotomy (TTE) or transhiatal esophagectomy or video-assisted thoracoscopic surgery with linear stapler anastomosis. The average follow-up was approximately 9 months. Anastomotic leakage was observed in three patients. On follow-up, two patients presented with difficulty in swallowing, and on upper GI endoscopy, they were found to have anastomotic site stricture. There was no perioperative mortality. The linear-stapled esophagogastric anastomosis is a safe and effective anastomotic technique, which can decrease the rate of leak, postoperative dysphagia, and anastomotic stricture. As in this technique only two linear staplers are used in comparison to other techniques where three or more staplers are used, it is also cost-effective. The procedure deserves more attention and further application.

Thermal Resistance Anastomosis Device for the Percutaneous Creation of Arteriovenous Fistulae for Hemodialysis

PurposeTo evaluate the safety and efficacy of arteriovenous fistula (AVF) creation with a thermal resistance anastomosis device (TRAD). Materials and MethodsFrom January 2014 to March 2015, 26 patients underwent ultrasound (US)-guided percutaneous creation of proximal radial artery–to–perforating vein AVFs with a TRAD that uses heat and pressure to create a fused anastomosis. Primary endpoints were fistula creation, patent fistula by Doppler US, two-needle dialysis at the prescribed rate, and device-related complications. ResultsTechnical success rate of fistula creation was 88% (23 of 26). Procedure time averaged 18.4 minutes (range, 5–34 min), and 96% of anastomoses (22 of 23) were fused. At 6 weeks, 87% of AVFs (20 of 23) were patent, 61% (14 of 23) had 400-mL/min brachial artery flow, 1 patient was receiving dialysis, 2 fistulae had thrombosed, and 1 patient had died unrelated to the procedure. Eighty percent (16 of 20), 70% (14 of 20), and 60% (12 of 20) of patients were receiving dialysis at 3, 6, and 12 months; 4 patients died, 3 fistulae failed, and one patient was lost to follow-up. Overall, 87% of AVFs (20 of 23) had an additional procedure at a mean of 56 days (range, 0–239 d), including balloon dilation in 43% (n = 10), brachial vein embolization in 26% (n = 6), basilic vein ligation in 17% (n = 4), venous transposition in 30% (n = 7), and valvulotomy in 4% (n = 1). There were no major complications related to the device. ConclusionsPercutaneous AVFs created with a TRAD met the safety endpoints of this study. Midterm follow-up demonstrated intact anastomoses and fistulae suitable for dialysis.

A Safe Technique for Using an Enclose II Anastomosis Assist Device During Off-Pump Coronary Bypass

Several proximal anastomosis devices have been developed to facilitate the creation of a clampless, hand-sewn coronary artery bypass-to-ascending aorta anastomosis. An Enclose IIanastomosis assist device (Novare Surgical Systems, Cupertino, CA) is a device commonly used for this purpose. We demonstrate a new, easy, and safe technique for cutting the aortic wall and making a punch hole over the aorta.

Cerebrovascular Events After No-Touch Off-Pump Coronary Artery Bypass Grafting, Conventional Side-Clamp Off-Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta-Analysis.

BackgroundOff‐pump coronary artery bypass (OPCAB) has been shown to reduce the risk of neurologic complications as compared to coronary artery bypass grafting performed with cardiopulmonary bypass. Side‐clamping of the aorta while constructing proximal anastomoses, however, still carries substantial risk of cerebral embolization. We aimed to perform a comprehensive meta‐analysis of studies assessing 2 clampless techniques: aortic “no‐touch” and proximal anastomosis devices (PAD) for OPCAB.Methods and ResultsPubMed, CINAHL, CENTRAL, and Google Scholar databases were screened for randomized controlled trials and observational studies comparing “no‐touch” and/or PAD with side‐clamp OPCAB and reporting short‐term (≤30 days) outcomes: cerebrovascular accident and all‐cause mortality. A total of 18 studies (3 randomized controlled trials) enrolling 25 163 patients were included. Aortic “no‐touch” was associated with statistically lower risk of cerebrovascular accident as compared to side‐clamp OPCAB: risk ratio 95% CI: 0.41 (0.27–0.61); P<0.01; I2=0%. Event rates were 0.36% and 1.28% for “no‐touch” and side‐clamp OPCAB, respectively. No difference was seen between PAD and side‐clamp OPCAB: 0.71 (0.33–1.55); P=0.39; I2=39%. A trend towards increased 30‐day all‐cause mortality with PAD and no difference with “no‐touch” were observed when compared to side‐clamp OPCAB. In a subset analysis, “no‐touch” consistently reduced the risk of cerebrovascular accident regardless of patients’ baseline risk characteristics. A benefit with PAD was observed in low‐risk patients.ConclusionsAortic “no‐touch” technique was associated with nearly 60% lower risk of postoperative cerebrovascular events as compared to conventional side‐clamp OPCAB with effect consistent across patients at different risk.

Novel Anastomotic Device for Distal Coronary Anastomosis: Preclinical Results From Swine Off-Pump Coronary Artery Bypass Model

We evaluated the safety and feasibility of a new anastomotic device that simplifies coronary distal anastomosis during minimally invasive and robotically assisted coronary artery bypass graft surgery (CABG). Fourteen miniature pigs underwent off-pump CABG using bilateral internal thoracic arteries (ITA), namely, left ITA to left anterior descending artery and right ITA to right coronary artery. The device was used for distal anastomosis in a device group (n= 11), and conventional 7-0 polypropylene suture in a control group (n= 3). Graft flow was measured intraoperatively. One-month, 3-month, and 6-month postoperative angiography evaluations were done. Histopathologic examination of the anastomosis was also done. Baseline and intraoperative characteristics were similar in the two groups. There was no difference of anastomotic time between groups (p= 0.59). Graft flows werealso similar (p= 0.55), with good diastolic pattern in both groups. Angiography demonstrated FitzGibbon A patency in all anastomoses of both groups at each evaluation period. Histopathologic examination showed nonspecific inflammatory changes in the device group. The safety and feasibility of this anastomotic device for distal coronary anastomosis were shown in the swine model.

Evidence-based treatment of patients with rectal cancer.

Rectal cancer is a worldwide disease whose incidence has increased significantly. Evidence-based medicine is a category of medicine that optimizes decision making by using evidence from well-designed and conducted research. Evidence-based medicine can be used to formulate a reasonable treatment plan for newly diagnosed rectal cancer patients. The current review focuses on the application of evidence-based treatment on patients with rectal cancer. The relationship between perioperative blood transfusion and recurrence of rectal cancer after surgery, the selection between minimally invasive laparoscopic surgery and traditional laparotomy, choice of chemotherapy for patients with rectal cancer prior to surgery, selection between stapled and hand-sewn methods for colorectal anastomosis during rectal cancer resection, and selection between temporary ileostomy and colostomy during the surgery were addressed. Laparoscopy is considered to have more advantages but is time-consuming and has high medical costs. In addition, laparoscopic rectal cancer radical resection is preferred to open surgery. In radical resection surgery, use of a stapling device for anastomosis can reduce postoperative anastomotic fistula, although patients should be informed of possible anastomotic stenosis.

Invited Commentary

Invited Commentary

The Use of a Mechanical Stapler in Jejunal Free Flaps in Laryngopharyngectomy Defects.

The Use of a Mechanical Stapler in Jejunal Free Flaps in Laryngopharyngectomy Defects.

Mo1533 Endoscopic Treatment of Large Esophageal Diverticula Using a Magnetic Anastomosis Device: Report of Three Cases

Mo1532 Feasibility and Usefullness of Application of Oxidized Cellulose (Surgicell) to Treat and Prevent Hemorrhage After Large Endosocpic Colorectal Resections Seiichiro Abe*, Ivan Jovanovic, Helmut Neumann, Yutaka Saito, Monkemuller Klaus Endoscopy, National Cancer Center, Tokyo, Japan; Basil I. Hirschowitz Endoscopic Center of Excellence, University of Alabama, Birmingham, AL Background: The most common complication of endoscopic resection (ER) of large colorectal polyps is bleeding, especially in patients who must continue anticoagulation medications for thrombophilic or cardiovascular disorders. Oxidized cellulose (OC) mesh (Surgicell ) is a well-known and widely available surgical hemostatic agent. OC, which has bactericidal activity, exerts its effect as a tissue-apposing device. OC is used to stop bleeding from liver lacerations, gynecological surgery and in neurosurgical interventions. Therefore, it use in endoluminal GI interventions is appealing. Aim: To evaluate the feasibility of endoscopic application of OC and the hemostatic efficacy after endoscopic resection (endoscopic submucosal dissection or piecemeal endoscopic mucosal resection). Materials and Methods: Retrospective, observational, open label, single-center study of patients undergoing endoscopic resection of large rectal and rectosigmoid lesions. After the colorectal epithelial neoplasm removed, OC was applied onto the submucosal surface using one of two methods: a) anoscope or cap-assisted delivery. In both techniques, a hemoclip was advanced through the working channel of the scope and 10 x 10 to 20 x 20 mm large pieces of the OC were grasped with the clip and then delivered and attached to the wound. Results: A total of 12 patients (8 male, 4 female, mean age 64, range 48 to 87) underwent endoscopic resection (ESD, nZ8 or piecemeal EMR, nZ4) of large rectum or rectosigmoid lesions with either primary intent of complete resection or debulking (in the case of large mucin-secreting rectal tumors). All patients were on anticoagulants and/or antiplatelet agents. The mean size of the lesions was 40 mm, range 30 to 120 mm. An endoscopic R0 was achieved in 75%. (50.0%) underwent the Surgicell application. During follow-up period there were no rectal bleeding episodes or adverse events, despite patients continuing on anticoagulant therapy. Conclusions: OC can be successfully applied to large resection sites using the capassisted or anoscope techniques. OC effectively decreases hemorrhage and prevents post-endoscopic resection bleeding. Thus, this feasibility study suggests that OC may be a valuable tool to provide hemostasis and prevent bleeding after ESD. Now prospective and randomized studies are warranted.

P26 The utility of coupler devices for arterial anastomosis in free tissue transfer

Introduction Microvascular free-tissue transfer remains a reliable method for head and neck reconstruction particularly when dealing with extensive oncological resection. The microvascular anastomosis is a technically sensitive and critical determinant of success in free-tissue transfer. In Europe hand-sewn anastomosis is widely used, especially for the arterial anastomosis. Our hypothesis is that anastomotic-coupling devices offer a reliable and efficient alternative to hand-sewn anastomosis. Material and methods We performed a retrospective analysis of 68 patients who underwent a head and neck tumor resection and free-tissue transfer using the coupling system for the venous and arterial anastomosis between 2010 and 2014. Results Within the first three years (2010–2012) there were performed 37 forearm flap transplantations, three flap failures (8.1%) occurred (three venous thrombosis, no arterial thrombosis). Between 2013 and 2014 a total of 31 forearm flap transplantations were performed. Only in one patient an arterial thrombosis occurred (3.2%), thus we saw in total one flap failure. Regarding the total group (68 patients), we saw one arterial thrombosis. That is a ratio of 0.14%. This is a thrombosis rate rather similar to those reported in literature for coupled arterial anastomosis. Conclusion Regarding the decreased flap failure rate in 2013 and 2014 there is a learning curve performing microvascular free tissue transfer. After a certain experience of the surgeon the coupling system is a reliable, efficient and faster method for microvascular arterial anastomosis. Beside our own experiences the metaanalysis of Amandeep et al. shows similar results using the coupling system for arterial anastomosis. This metaanalysis included twenty-five studies with a total of 3207 patients. There were performed 342 arterial coupled anastomosis, 12 arterial thrombosis occurred (3.6%). The thrombosis rates were similar to those performing hand-sewn arterial anastomosis and coupling time was shorter. Therefore we recommend using the coupling system likewise for the arterial microvascular anastomosis.

Morbidity of Open Saphenous Vein Harvesting after Preoperative Ultrasonic Mapping

Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, branching, or varicose saphenous veins. The location of the saphenous vein was marked. Saphenous veins were harvested by the open harvest technique, and the caliber of the veins and the availability of the anastomosis device were recorded. Postoperative morbidity was recorded. Preoperative findings revealed that four (6.5%) of 62 femoral saphenous veins were estimated as “not graftable” because of being a varicose vein or having a small caliber. Seven of 32 lower saphenous veins were estimated as “not graftable”. The mean discrepancy of the caliber was 0.6 mm undersized with preoperative estimation. During harvesting, one of 31 patients had a wrong marking. We were able to use all harvested veins. The morbidity of saphenous harvesting was observed in two (6.5%) of 31 patients. One patient whose marking was wrong had minor skin necrosis. Another patient experienced a hematoma because of the excess effect of warfarin. Preoperative ultrasonic mapping of the saphenous vein reduced useless harvesting, provided information concerning anastomosis device availability, and seemed to reduce morbidity because dissection can be minimal.

1P2-W05 マイクロサージャリーに用いる微小血管吻合器の研究・開発

In this study we focus on the microsurgery that is surgical operation using operative microscope. Only a special trained microsurgeon can perform the microvessel anastomosis operation. As for the microvessel anastomosis operation, a maneuver is mainstream. However, the operation by the maneuver is easy to come to have a long time, and the burden to depend on a patient is big. In addition, bad points such as the fear of a leak and the secession by the roughness of the sewing width exist. Therefore, is this study; for the purpose of shortening of the blood vessel anastomosis time in the operation, the reduction of the burden on patient by it, the reduction of the degree of difficulty of the microvessel anastomosis operation, I develop a thread and the new anastomosis device for the maneuver using the needle.

Experimental rationale for colocolonic anastomosis formation by a compression suturing device

Aim. To experimentally compare the durability and biological integrity of compressional and manually made anastomoses, and to find out morphological features of their regeneration. Methods. Experimental studies were performed on 54 non-pedigree dogs of both gender and on autopsied specimens in prosectorium. Colocolonic anastomoses were formed by compression suturing device, Ziganshin-Gunter device, compression anastomosis device, and manually. Results. Compression anastomoses had higher durability compared to manual sutures (р 0.05). A test for microbial penetration showed only minimal signs of bacterial contamination of colocolonic anastomoses made by compression suturing device. Bacterial contamination of colocolonic anastomoses performed by compression anastomosis device and compression suturing device, was significantly less common compared to anastomoses formed by Ziganshin-Gunter device and manually (р 0.05). Examination of compression anastomoses morphogenesis revealed that healing of colocolonic anastomoses is accompanied by homogenous standard morphologic pattern. No scarring occurs due to absence of inflammation and low amount of connective tissue at the anastomosis region. Study of colocolonic anastomoses formation by compression devices on an autopsied specimens confirmed the opportunity for anastomosis formation on any part of colon. Conclusion. Compression colocolonic anastomosis formed by compression suturing device is characterized by low bacterial permeability, provides good durability and does not cause scarring in the anastomosis region. Revealed advantages of compression colonic suture allow recommending it for clinical use.

The vascular connector, design of a new device for sutureless vascular anastomosis.

BackgroundIn recent years, several methods and new techniques have been studied and proposed for establishment of sutureless vascular anastomoses, streaming use of sutureless vascular surgery in the future.Presentation of the hypothesisThe new vascular connector (NVC) is a hypothetical design of a vascular device, proposed for creation and maintenance of sutureless vascular anastomosis. Implication of NVC would introduce a new device and technique in establishment of sutureless vascular anastomosis in which surgical approach is minimized and so post-operation disorders. It would eliminate need for suture; shorten clampage and operation time, consequently reducing stress for both, the surgeon and the patient. It enables the creation of vascular anastomosis fast, simple, safe, reliable, with satisfactory patency and stability of anastomosis.Testing the hypothesisEfficacy of NVC needs to be evaluated in further studies, in order to be confirmed for clinical use. The effectiveness of NVC should be verified firstly in vitro and in vivo tests; and by animal experiments. The likelihood of its negative influence in thrombogenicity should be well evaluated.Implications of the hypothesisImplication of the new vascular connector (NVC) would be of interest to both patients and the surgeon due to the following main achievements: 1) enables the creation of vascular anastomosis fast and simple, 2) significant shortening of clampage time of blood vessels and operation time-this assumption would be followed by reduced risk of operative and post-operative complications and length of hospital stay or admission to Intensive care unit, 3) safe and reliable, 4) compatible with any blood vessel and standard vascular graft, 5) using the NVC we will reduce in minimum need for replaced blood volume, 6) reduces the cost of treatment. It is anticipated that the NVC would provide shorter operation time and least operative and post-operative complications in creation of sutureless vascular anastomosis.

Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink.

Sutureless anastomosis devices are designed to reduce surgical time and difficulty, which may lead to quicker and less invasive cardiovascular anastomosis. The implant uses a barb-and-seat compression fitting composed of one male and two female components. The implant body is resorbable and capable of eluting heparin. Custom robotic deposition equipment was designed to fabricate the implants from a self-curing silk solution. Curing did not require deleterious processing steps but devices demonstrated high crush resistance, retention strength, and leak resistance. Radial crush resistance is in the range of metal vascular implants. Insertion force and retention strength of the anastomosis was dependent on fit sizing of the male and female components and subsequent vessel wall compression. Anastomotic burst strength was dependent on the amount of vessel wall compression, and capable of maintaining higher than physiological pressures. In initial screening using a porcine implant, the devices remained intact for 28 days (the length of study). Histological sections revealed cellular infiltration within the laminar structure of the male component, as well as at the interface between the male and female components. Initial degradation and absorption of the implant wall were observed. The speed per anastomosis using this new device was much faster than current systems, providing significant clinical improvement.

Analysis of service provision for patients with nail bed injuries

s / International Journal of Surgery 12 (2014) S13eS117 S71 referenced to PACS Radiology reports to determine: FNAs performed by radiologists and/or ultrasound-guidance; diagnostic sufficiency and reasons for inadequacy. Results: 104 FNAs were carried out on 89 patients 74% for melanoma and 21% for squamous cell carcinoma primaries. 38% of FNAs were in the head and neck region, 31% axillary, and 27% in the groin. Surgeons performed 58%, of which 37% were ‘unsatisfactory for diagnosis’, versus 25% of those by radiologists. Anatomical region did not influence rates of unsatisfactory specimens. 36% of unsatisfactory specimens were acellular/hypocellular, whilst 12% were poorly preserved. Conclusions: Radiologist-performed FNA ismore likely to be diagnostic, but delays and costswill be incurred to access this service.We are piloting a local training program to increase the diagnostic yield of surgeon-performed FNA. 1160: ANALYSIS OF SERVICE PROVISION FOR PATIENTS WITH NAIL BED INJURIES Zita Jessop , Matthew Gardiner, Sonya Gardiner, Neil Toft. Royal Free Hospital, London, UK. Introduction: Although viewed as minor procedures, nail bed repairs take up a significant amount of time and resources. Our aim was to assess service delivery from referral to discharge. Methods: This was a retrospective review of patients with nail bed injuries identified by hospital episode statistics. Data was collected on delays in treatment, financial performance, and patient reported outcomes via a telephone questionnaire. Results: Over one month 62 of 310 hand trauma cases underwent nail bed repair. Patients were seen in trauma clinic one day after referral, waited two days (0-4days) for an operation and 6 days for a follow up clinic (012days), attending 2.6 appointments. We had a 32% questionnaire response rate; 11% of appointments were not attended, most common reason being inability to get time off work and main suggestion was reducing waiting time for an operation. Two cases were performed in clinic and 11 were coded wrongly resulting in a lower tariff estimated to cost the department £36,000 per year. Conclusions: The data formed the basis of a business case for introducing an outpatient minor operating theatre which will streamline service provision and increase available theatre time. 1172: FEASIBLE, EFFECTIVE AND EFFICIENT; THE MICROVASCULAR COUPLER DEVICE FOR END-TO-SIDE VENOUS ANASTOMOSIS IN FREE TISSUE TRANSFER FOR HEAD AND NECK RECONSTRUCTION Jane Maraka , Nigel Abreo, Omar Hausien, Nakul Patel, Amer Durrani. Addenbrookes Hospital, Cambridge, UK. Introduction: The use of a microvascular coupling device (MCD) for venous anastomosis in free tissue transfer (RTT) in head and neck reconstruction (HN University of Edinburgh, Edinburgh, UK; National University of Singapore,

The application of microvascular anastomotic device in microvascular anastomosis with diameter discrepancy

Objective To investigate the methods and efficacy of anastomosis between vessels with different diameterby using microvascular anastomotic device.Methods From February 2013 to June 2013,5 patients underwent five free-flap transfered with the use of the microvascular anastomotic device in 12 vessels anastomosis,which included 6 anastomosis with different luminal diameter between donor and recipient vessels.We performed vasoplasity via lateral incision or on the Y-shape branch of small-diameter vessels to enlarge the diameter of anastomotic stoma,then microvascular anastomosis device matched the larger-diameter vessel were used in the anastomosis.Conventional therapy of microvascular anastomosis was performed postoperatively.Results Six anastomoses (4 venous,2 arterial) were performed with the microvascular anastomotic device in anastomotic stoma with different luminal diameter between donor and recipient vessels,with diameter (0.8-1.5)mm in one side and 2.0-3.5 mm in the other side,which had ratio from 1.0 ∶ 1.5-1.0∶ 3.0.The end of small-diameter vessel could be everted over the pins of larger microvascular anastomosis device successfully via vasoplasity.The 2.0-3.5 mm microvascular anastomotic device implant was used in these cases.These anastomoses were successfully completed with microvascular anastomotic device without vessel shedding,blood leak intraoperatively and without vascular crisis postoperatively.The time taken to complete an end-to-end anastomosis with microvascular anastomotic device varied from 3-5 min.The followed-up time ranged from 1-3 months,and flap survival in the 5 patients was 100％.Conclusion It is a simple,fast and effective method to perform microvascular anastomosis using microvascular anastomotic device in anastomotic stoma with different luminal diameter through vasoplasity. Key words: Microvascular anastomotic device; Blood vessels; Vasoplasity; Free flap